Control program adaptation based on equipment status and user input

Abstract

A surgical system is disclosed that includes a surgical instrument, a generator configured to provide power to an end effector, and a processor configured to execute a control program to operate the surgical system. The surgical instrument includes an end effector including a first jaw and a second jaw. At least one of the first jaw and the second jaw is moved relative to one another between an open position and a closed position. Tissue is configured to be positioned between the first jaw and the second jaw. The processor is configured to detect a first parameter of the surgical system, detect at least one user input, and modify the control program in response to the detected first parameter and the at least one user input.

Description

[Technical field]

[0001] (CROSS REFERENCE TO RELATED APPLICATIONS) This application claims the benefit under 35 U.S.C. § 119 of U.S. Provisional Application No. 62 / 955,299, filed December 30, 2019, entitled "DEVICES AND SYSTEMS FOR ELECTROSURGERY," the entire disclosure of which is incorporated herein by reference. [Background technology]

[0002] The present invention relates to surgical instruments designed to treat tissue, including, but not limited to, surgical instruments configured to cut and fasten tissue. The surgical instruments may include electrosurgical instruments powered by a generator to effect dissection, cutting, and / or coagulation of tissue during a surgical procedure. The surgical instruments may include instruments configured to cut and staple tissue using surgical staples and / or fasteners. The surgical instruments may be configured for use in open surgical procedures, but have applications in other types of surgery, such as laparoscopic, endoscopic, and robotic-assisted procedures, and may include an end effector that is articulatable relative to a shaft portion of the instrument to facilitate precise positioning within a patient. Summary of the Invention [Means for solving the problem]

[0003] In various embodiments, a surgical system is disclosed that includes a surgical instrument, a generator configured to provide power to an end effector, and a processor configured to execute a control program to operate the surgical system. The surgical instrument includes an end effector including a first jaw and a second jaw. At least one of the first jaw and the second jaw is moved relative to one another between an open position and a closed position. Tissue is configured to be positioned between the first jaw and the second jaw. The processor is configured to detect a first parameter of the surgical system, detect at least one user input, and modify the control program in response to the detected first parameter and the at least one user input.

[0004] In various embodiments, a surgical system is disclosed that includes a surgical instrument, a generator configured to provide power to the surgical instrument, and a processor configured to execute a control program to operate the surgical system, The processor is configured to detect a status of the surgical instrument, detect at least one user input, and adapt the control program in response to the detected status of the surgical instrument and the at least one user input.

[0005] In various embodiments, a surgical system is disclosed that includes a surgical instrument, a generator configured to provide power to an end effector, and a processor configured to execute a control program to operate the surgical system. The surgical instrument includes an end effector including a first jaw and a second jaw. At least one of the first jaw and the second jaw is moved relative to one another between an open position and a closed position. Tissue is configured to be positioned between the first jaw and the second jaw. The processor is configured to detect a first parameter of the surgical instrument, detect a second parameter of the generator, detect at least one user input, and modify the control program in response to the detected first parameter, the detected second parameter, and the at least one user input. [Brief description of the drawings]

[0006] The novel features of the various aspects are set forth with particularity in the appended claims, however the described aspects, both as to organization and method of operation, can best be understood by reference to the following description taken in conjunction with the accompanying drawings. [Figure 1] 1 illustrates an example of a generator for use with a surgical system, according to at least one embodiment of the present disclosure. [Diagram 2] 1 illustrates one form of a surgical system including a generator and an electrosurgical instrument usable with the generator, according to at least one aspect of the present disclosure. [Diagram 3] 1 shows a schematic diagram of a surgical instrument or tool, according to at least one embodiment of the present disclosure. [Figure 4] FIG. 1 is a perspective view of a surgical system including a surgical instrument and a display monitor, the surgical instrument including a display screen according to at least one embodiment. [Diagram 5] 5 is a schematic diagram of a display screen of the surgical instrument of FIG. 4 and a corresponding view of a display monitor in accordance with at least one embodiment. [Figure 6]5 is a schematic diagram of a display screen of the surgical instrument of FIG. 4 and a corresponding view of a display monitor in accordance with at least one embodiment. [Figure 7] 5 is a schematic diagram of a display screen of the surgical instrument of FIG. 4 and a corresponding view of a display monitor in accordance with at least one embodiment. [Figure 8] 5 is a schematic diagram of a display screen of the surgical instrument of FIG. 4 and a corresponding view of a display monitor in accordance with at least one embodiment. [Figure 9] 5 is a schematic diagram of a display screen of the surgical instrument of FIG. 4 and a corresponding view of a display monitor in accordance with at least one embodiment. [Figure 10] 1 is a graphical depiction of the relationship between the total effective energy delivered by one or more generators of a surgical system and the duty cycle of a motor from a smoke evacuation device, according to at least one embodiment. [Figure 11] FIG. 1 is a schematic diagram of a surgical system including a surgical hub, a combination electrosurgical instrument powered by multiple generators, a smoke evacuation system, and a display according to at least one embodiment. [Figure 12] 1 is a graphical depiction of the relationship between power delivered by one or more generators of a surgical system over time and impedance of treated tissue over time, according to at least one embodiment. [Figure 13] FIG. 1 is a schematic diagram of a communication pathway with a surgical system according to at least one embodiment, the surgical system including a surgical hub, a smoke evacuation device, a surgical instrument, a first generator configured to power a first operation of the surgical instrument, and a second generator configured to power a second operation of the surgical instrument. [Figure 14] FIG. 1 is a schematic diagram of a surgical system comprising a surgical hub and a plurality of robotic arms configured to receive tools thereon, according to at least one embodiment, the surgical system comprising an authentication module configured to approve tools for attachment to and / or use with the surgical system. [Figure 15] FIG. 1 is a schematic diagram of a surgical system positioned in a treatment room, according to at least one embodiment. [Figure 16] 1 is a chart illustrating various operating parameters and / or specifications of a surgical instrument at various stages of a surgical procedure, according to at least one embodiment. [Figure 17] FIG. 17 is an elevational view of the surgical instrument of FIG. 16 shown at a first time delivering bipolar energy to patient tissue. [Figure 18] FIG. 17 is an elevational view of the surgical instrument of FIG. 16 shown at a second time delivering bipolar and monopolar energy to patient tissue. [Figure 19] FIG. 17 is an elevational view of the surgical instrument of FIG. 16 shown at a fourth time delivering monopolar energy to patient tissue. [Figure 20] 17 is a graphical representation of various operating parameters and / or specifications of the surgical instrument of FIG. 16 at various stages of a surgical procedure. [Figure 21] 1 is a graphical representation of measured tissue impedance over the duration of a surgical procedure, according to at least one embodiment. [Figure 22] FIG. 13 is a schematic diagram illustrating a strain calculation according to at least one embodiment, where the applied strain is calculated using a gap defined between the jaws of the end effector when the end effector is in an open configuration. [Diagram 23] FIG. 23 is a schematic diagram illustrating the strain calculation of FIG. 22, where the calculated applied strain overestimates the actual applied strain because the patient tissue is positioned without contact between the jaws of the end effector. [Figure 24] FIG. 1 is a schematic diagram illustrating tissue impedance calculation according to at least one embodiment, where tissue impedance is calculated using a gap defined between the jaws of the end effector when the jaws contact patient tissue positioned therebetween. [Diagram 25] 1 is a graphical representation of the relationship between motor current and jaw gap over time according to at least one embodiment. [Figure 26] FIG. 1 is a schematic diagram of a network formed by a surgical instrument and a cloud-based storage medium, according to at least one embodiment. [Figure 27] 27 is a graphical representation of the relationship between change in jaw gap and jaw motor clamp current determined from the network of FIG. 26. [Figure 28] 27 is a graphical representation of the relationship between generator powers over time determined from the network of FIG. 26. [Figure 29] 1 is a graphical representation of the relationship between actuation cycles of a surgical instrument and measured impedance when the end effectors of the surgical instrument are in a closed configuration with no patient tissue positioned therebetween, in accordance with at least one embodiment. [Diagram 30] 1 is a graphical representation of the relationship between tissue conductance, jaw opening dimension, and jaw motor force during a jaw clamping stroke, according to at least one embodiment. [Diagram 31] 1 is a graphical representation of jaw closing speed based on user input, and based on user input and monitored parameters, in accordance with at least one embodiment. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0007] The applicant of this application has the following U.S. patent applications filed on even date herewith, each of which is incorporated herein by reference in its entirety: Attorney subject matter docket number END9234USNP1 / 190717-1M, invention title "METHOD FOR AN ELECTROSURGICAL PROCEDURE", Attorney subject matter docket number END9234USNP2 / 190717-2, invention title "ARTICULATABLE SURGICAL INSTRUMENT", Attorney subject matter docket number END9234USNP3 / 190717-3, invention title "SURGICAL INSTRUMENT WITH JAW ALIGNMENT FEATURES", -Attorney subject matter docket number END9234USNP4 / 190717-4, invention title "SURGICAL INSTRUMENT WITH ROTATABLE AND ARTICULATABLE SURGICAL END EFFECTOR", Attorney subject matter docket number END9234USNP5 / 190717-5, invention title "ELECTROSURGICAL INSTRUMENT WITH ASYNCHRONOUS ENERGIZING ELECTRODES", Attorney subject matter docket number END9234USNP6 / 190717-6, invention title "ELECTROSURGICAL INSTRUMENT WITH ELECTRODES BIASING SUPPORT", Attorney subject matter docket number END9234USNP7 / 190717-7, invention name "ELECTROSURGICAL INSTRUMENT WITH FLEXIBLE WIRING ASSEMBLIES", -Attorney subject matter docket number END9234USNP8 / 190717-8, invention title "ELECTROSURGICAL INSTRUMENT WITH VARIABLE CONTROL MECHANISMS", -Attorney subject matter docket number END9234USNP9 / 190717-9, invention title "ELECTROSURGICAL SYSTEMS WITH INTEGRATED AND EXTERNAL POWER SOURCES", Attorney subject matter docket number END9234USNP10 / 190717-10, invention title "ELECTROSURGICAL INSTRUMENTS WITH ELECTRODES HAVING ENERGY FOCUSING FEATURES", -Attorney subject matter docket number END9234USNP11 / 190717-11, invention title "ELECTROSURGICAL INSTRUMENTS WITH ELECTRODES HAVING VARIABLE ENERGY DENSITIES", Attorney subject matter docket number END9234USNP12 / 190717-12, invention title "ELECTROSURGICAL INSTRUMENT WITH MONOPOLAR AND BIPOLAR ENERGY CAPABILITIES", Attorney subject matter docket number END9234USNP13 / 190717-13, invention title "ELECTROSURGICAL END EFFECTORS WITH THERMALLY INSULATIVE AND THERMALLY CONDUCTIVE PORTIONS", -Attorney subject matter docket number END9234USNP14 / 190717-14, invention title "ELECTROSURGICAL INSTRUMENT WITH ELECTRODES OPERABLE IN BIPOLAR AND MONOPOLAR MODES", -Attorney subject matter docket number END9234USNP15 / 190717-15, invention name "ELECTROSURGICAL INSTRUMENT FOR DELIVERING BLENDED ENERGY MODALITIES TO TISSUE", Attorney subject matter docket number END9234USNP17 / 190717-17, title of invention "CONTROL PROGRAM FOR MODULAR COMBINATION ENERGY DEVICE", and Attorney subject matter docket number END9234USNP18 / 190717-18, invention title "SURGICAL SYSTEM COMMUNICATION PATHWAYS".

[0008] The applicant of this application owns the following U.S. provisional patent applications, filed December 30, 2019, the disclosures of each of which are incorporated by reference in their entirety herein: · U.S. Provisional Patent Application No. 62 / 955,294, entitled "USER INTERFACE FOR SURGICAL INSTRUMENT WITH COMBINATION ENERGY MODALITY END-EFFECTOR"; U.S. Provisional Patent Application No. 62 / 955,292, entitled "COMBINATION ENERGY MODALITY END-EFFECTOR"; and · U.S. Provisional Patent Application No. 62 / 955,306 entitled "SURGICAL INSTRUMENT SYSTEMS."

[0009] The applicant of the present application owns the following U.S. patent applications, the disclosures of each of which are incorporated herein by reference in their entirety: U.S. Patent Application No. 16 / 209,395, entitled "METHOD OF HUB COMMUNICATION" (currently U.S. Patent Application Publication No. 2019 / 0201136); U.S. Patent Application No. 16 / 209,403, entitled "METHOD OF CLOUD BASED DATA ANALYTICS FOR USE WITH THE HUB" (currently U.S. Patent Application Publication No. 2019 / 0206569); U.S. Patent Application No. 16 / 209,407, entitled "METHOD OF ROBOTIC HUB COMMUNICATION, DETECTION, AND CONTROL" (currently U.S. Patent Application Publication No. 2019 / 0201137); U.S. Patent Application No. 16 / 209,416, entitled "METHOD OF HUB COMMUNICATION, PROCESSING, DISPLAY, AND CLOUD ANALYTICS" (currently U.S. Patent Application Publication No. 2019 / 0206562); U.S. Patent Application No. 16 / 209,423, entitled "METHOD OF COMPRESSING TISSUE WITHIN A STAPLING DEVICE AND SIMULTANEOUSLY DISPLAYING THE LOCATION OF THE TISSUE WITHIN THE JAWS" (currently U.S. Patent Application Publication No. 2019 / 0200981); U.S. Patent Application No. 16 / 209,427, entitled "METHOD OF USING REINFORCED FLEXIBLE CIRCUITS WITH MULTIPLE SENSORS TO OPTIMIZE PERFORMANCE OF RADIO FREQUENCY DEVICES" (now U.S. Patent Application Publication No. 2019 / 0208641); U.S. Patent Application No. 16 / 209,433, entitled "METHOD OF SENSING PARTICULATE FROM SMOKE EVACUATED FROM A PATIENT, ADJUSTING THE PUMP SPEED BASED ON THE SENSED INFORMATION, AND COMMUNICATING THE FUNCTIONAL PARAMETERS OF THE SYSTEM TO THE HUB" (currently U.S. Patent Application Publication No. 2019 / 0201594); U.S. Patent Application No. 16 / 209,447, entitled "METHOD FOR SMOKE EVACUATION FOR SURGICAL HUB" (currently U.S. Patent Application Publication No. 2019 / 0201045); U.S. Patent Application No. 16 / 209,453, entitled "METHOD FOR CONTROLLING SMART ENERGY DEVICES" (now U.S. Patent Application Publication No. 2019 / 0201046); U.S. Patent Application No. 16 / 209,458, entitled "METHOD FOR SMART ENERGY DEVICE INFRASTRUCTURE" (now U.S. Patent Application Publication No. 2019 / 0201047); U.S. Patent Application No. 16 / 209,465, entitled "METHOD FOR ADAPTIVE CONTROL SCHEMES FOR SURGICAL NETWORK CONTROL AND INTERACTION" (now U.S. Patent Application Publication No. 2019 / 0206563); U.S. Patent Application No. 16 / 209,478, entitled "METHOD FOR SITUATIONAL AWARENESS FOR SURGICAL NETWORK OR SURGICAL NETWORK CONNECTED DEVICE CAPABLE OF ADJUSTING FUNCTION BASED ON A SENSED SITUATION OR USAGE" (now U.S. Patent Application Publication No. 2019 / 0104919); U.S. Patent Application No. 16 / 209,490, entitled "METHOD FOR FACILITY DATA COLLECTION AND INTERPRETATION" (now U.S. Patent Application Publication No. 2019 / 0206564); U.S. Patent Application No. 16 / 209,491, entitled "METHOD FOR CIRCULAR STAPLER CONTROL ALGORITHM ADJUSTMENT BASED ON SITUATIONAL AWARENESS" (currently U.S. Patent Application Publication No. 2019 / 0200998); - U.S. Patent Application No. 16 / 562,123, entitled "METHOD FOR CONSTRUCTING AND USING A MODULAR SURGICAL ENERGY SYSTEM WITH MULTIPLE DEVICES"; - U.S. Patent Application No. 16 / 562,135, entitled "METHOD FOR CONTROLLING AN ENERGY MODULE OUTPUT"; U.S. Patent Application No. 16 / 562,144, entitled "METHOD FOR CONTROLLING A MODULAR ENERGY SYSTEM USER INTERFACE"; and U.S. Patent Application No. 16 / 562,125, entitled "METHOD FOR COMMUNICATING BETWEEN MODULES AND DEVICES IN A MODULAR SURGICAL SYSTEM."

[0010] Before describing various aspects of the electrosurgical system 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 specification. The illustrated 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 indicated, the terms and phrases used herein have been selected for the convenience of the reader for the purpose of describing the illustrated embodiments and not for the purpose of limiting them. Furthermore, it should be understood that one or more of the aspects, aspect expressions, and / or examples described below can be combined with any one or more of the other aspects, aspect expressions, and / or examples described below.

[0011] Various aspects are directed to an electrosurgical system including an electrosurgical instrument powered by a generator to effect dissection, cutting, and / or coagulation of tissue during a surgical procedure. The electrosurgical instrument may be configured for use in open surgical procedures, but also has applications in other types of surgery, such as laparoscopic, endoscopic, and robotic-assisted procedures.

[0012] As described in more detail below, electrosurgical instruments generally include a shaft having a distally mounted end effector (e.g., one or more electrodes). The end effector can be positioned relative to tissue such that electrical current is introduced into the tissue. Electrosurgical instruments can be configured for bipolar or monopolar operation. During bipolar operation, electrical current is introduced into tissue by an active electrode of the end effector and returned from the tissue by a return electrode of the end effector, respectively. During monopolar operation, electrical current is introduced into tissue by an active electrode of the end effector and returned via a return electrode (e.g., a ground pad) that is separately located on the patient's body. Heat generated by electrical current flowing through tissue can form a hemostatic seal within and / or between tissues and can thus be particularly useful for sealing blood vessels, for example.

[0013] FIG. 1 illustrates an example of a generator 900 configured to deliver multiple energy modalities to a surgical instrument. The generator 900 provides RF and / or ultrasonic signals for delivering energy to the surgical instrument. The generator 900 includes at least one generator output capable of delivering multiple energy modalities (e.g., ultrasonic energy, bipolar or monopolar RF energy, irreversible and / or reversible electroporation, and / or microwave energy, among others) through a single port, which signals can be delivered individually or simultaneously to an end effector to treat tissue. The generator 900 includes a processor 902 coupled to a waveform generator 904. The processor 902 and the waveform generator 904 are configured to generate various signal waveforms based on information stored in a memory coupled to the processor 902, which is not shown for clarity of disclosure. Digital information associated with the waveforms is provided to the waveform generator 904, which includes one or more DAC circuits to convert the digital input to an analog output. The analog output is provided to an amplifier 906 for signal conditioning and amplification. The conditioned and amplified output of amplifier 906 is coupled to a power transformer 908. The signal is coupled across the power transformer 908 to a secondary on the patient isolated side. A first signal of a first energy modality is provided to the surgical instrument between terminals labeled ENERGY1 and RETURN. A second signal of a second energy modality is coupled across a capacitor 910 and provided to the surgical instrument between terminals labeled ENERGY2 and RETURN. More than two energy modalities may be output, thus the subscript "n" indicates up to n ENERGY modalities. n It will be understood that n is a positive integer equal to or greater than 1. n It will also be understood that various modifications may be provided without departing from the scope of the present disclosure.

[0014] A first voltage sense circuit 912 is coupled across the terminals labeled ENERGY1 and RETURN paths and measures the output voltage therebetween. A second voltage sense circuit 924 is coupled across the terminals labeled ENERGY2 and RETURN paths and measures the output voltage therebetween. A current sense circuit 914 is disposed in series with the RETURN section on the secondary side of the power transformer 908 shown to measure the output current of either energy modality. If different return paths are provided for each energy modality, a separate current sense circuit must be provided in each return section. The outputs of the first voltage sense circuit 912 and the second voltage sense circuit 924 are provided to isolation transformers 928, 922, respectively, and the output of the current sense circuit 914 is provided to another isolation transformer 916. The outputs of the isolation transformers 916, 928, 922 on the primary side (non-patient isolated side) of the power transformer 908 are provided to one or more ADC circuits 926. The digitized output of the ADC circuit 926 is provided to the processor 902 for further processing and calculations. Feedback information of the output voltage and output current can be used to calculate parameters such as output impedance to adjust the output voltage and current provided to the surgical instrument. Input / output communication between the processor 902 and the patient isolation circuit is provided via an interface circuit 920. Sensors may also be in electrical communication with the processor 902 via the interface circuit 920.

[0015] In one aspect, the impedance may be determined by the processor 902 by dividing the output of either the first voltage sense circuit 912 coupled across the terminals labeled ENERGY1 / RETURN or the second voltage sense circuit 924 coupled across the terminals labeled ENERGY2 / RETURN by the output of a current sense circuit 914 disposed in series with the RETURN section of the secondary side of the power transformer 908. The outputs of the first voltage sense circuit 912 and the second voltage sense circuit 924 are provided to separate isolation transformers 928, 922, and the output of the current sense circuit 914 is provided to another isolation transformer 916. Digitized voltage and current sense measurements from the ADC circuit 926 are provided to the processor 902 to calculate the impedance. As an example, the first energy modality ENERGY1 may be RF monopolar energy and the second energy modality ENERGY2 may be RF bipolar energy. Nevertheless, in addition to bipolar and monopolar RF energy modalities, other energy modalities may include, among others, ultrasound energy, irreversible and / or reversible electroporation, and / or microwave energy. Also, while the example shown in FIG. 1 illustrates that a single return path RETURN may be provided to two or more energy modalities, in other embodiments, multiple return paths RETURN n However, each energy modality ENERGY n may be provided to.

[0016] As shown in FIG. 1 , a generator 900 with at least one output port can include a power transformer 908 with a single output and multiple taps to provide power to an end effector in the form of one or more energy modalities, such as ultrasonic energy, bipolar or monopolar RF energy, irreversible and / or reversible electroporation, and / or microwave energy, among others, depending on the type of tissue treatment being performed. For example, the generator 900 can deliver high voltage and low current energy to drive an ultrasonic transducer, low voltage and high current energy to drive an RF electrode to seal tissue, or energy with a coagulation waveform for spot coagulation using either monopolar or bipolar RF electrosurgical electrodes. The output waveform from the generator 900 can be steered, switched, or filtered to provide the frequency to the end effector of the surgical instrument. In one example, the connection of the RF bipolar electrode to the output of the generator 900 would preferably be located between the output labeled ENERGY2 and RETURN. In the case of a monopolar output, the preferred connection would be an active electrode (e.g., a pencil or other probe) to a suitable return pad connected to the ENERGY2 and RETURN outputs.

[0017] Additional details are disclosed in U.S. Patent Application Publication No. 2017 / 0086914, published March 30, 2017, entitled "TECHNIQUES FOR OPERATING GENERATOR FOR DIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMS AND SURGICAL INSTRUMENTS," which is incorporated herein by reference in its entirety.

[0018] 2 illustrates one form of a surgical system 1000 including a generator 1100 and various surgical instruments 1104, 1106, 1108 usable therewith, where the surgical instrument 1104 is an ultrasonic surgical instrument, the surgical instrument 1106 is an RF electrosurgical instrument, and the multi-function surgical instrument 1108 is a combination ultrasonic / RF electrosurgical instrument. The generator 1100 is configurable for use with a variety of surgical instruments. According to various forms, the generator 1100 may be configurable for use with a variety of different types of surgical devices including, for example, the ultrasonic surgical instrument 1104, the RF electrosurgical instrument 1106, and the multi-function surgical instrument 1108 that integrates RF and ultrasonic energy delivered simultaneously from the generator 1100. 2, the generator 1100 is shown separate from the surgical instruments 1104, 1106, 1108, however, in one form the generator 1100 may be integrally formed with any of the surgical instruments 1104, 1106, 1108 to form an integrated surgical system. The generator 1100 includes an input device 1110 located on a front panel of a console for the generator 1100. The input device 1110 may include any suitable device for generating signals suitable for programming the operation of the generator 1100. The generator 1100 may be configured for wired or wireless communication.

[0019] The generator 1100 is configured to drive a number of surgical instruments 1104, 1106, 1108. The first surgical instrument is an ultrasonic surgical instrument 1104 and includes a handpiece 1105 (HP), an ultrasonic transducer 1120, a shaft 1126, and an end effector 1122. The end effector 1122 includes an ultrasonic blade 1128 acoustically coupled to the ultrasonic transducer 1120 and a clamp arm 1140. The handpiece 1105 includes a trigger 1143 for actuating the clamp arm 1140 and a combination of toggle buttons 1137, 1134b, 1134c for energizing and actuating the ultrasonic blade 1128 or other functions. The toggle buttons 1137, 1134b, 1134c can be configured to energize the ultrasonic transducer 1120 using the generator 1100.

[0020] The generator 1100 is also configured to drive a second surgical instrument 1106. The second surgical instrument 1106 is an RF electrosurgical instrument and includes a hand piece 1107 (HP), a shaft 1127, and an end effector 1124. The end effector 1124 includes electrodes in clamp arms 1145, 1142b and return through an electrical conductor portion of the shaft 1127. The electrodes are coupled to and energized by a bipolar energy source in the generator 1100. The hand piece 1107 includes a trigger 1145 for operating the clamp arms 1145, 1142b and an energy button 1135 for actuating an energy switch to energize the electrodes in the end effector 1124. The second surgical instrument 1106 can also be used with a return pad to deliver monopolar energy to tissue.

[0021] The generator 1100 is also configured to drive a multifunction surgical instrument 1108. The multifunction surgical instrument 1108 includes a hand piece 1109 (HP), a shaft 1129, and an end effector 1125. The end effector 1125 includes an ultrasonic blade 1149 and a clamp arm 1146. The ultrasonic blade 1149 is acoustically coupled to the ultrasonic transducer 1120. The hand piece 1109 includes a trigger 1147 for actuating the clamp arm 1146 and a combination of toggle buttons 11310, 1137b, 1137c for energizing and driving the ultrasonic blade 1149 or other functions. The toggle buttons 11310, 1137b, 1137c can be configured to energize the ultrasonic transducer 1120 using the generator 1100, and to energize the ultrasonic blade 1149 using a bipolar energy source also housed within the generator 1100. Monopolar energy can be delivered to tissue in combination with or separate from the bipolar energy.

[0022] The generator 1100 is configurable for use with a variety of surgical instruments. According to various configurations, the generator 1100 may be configurable for use with different types of different surgical instruments including, for example, an ultrasonic surgical instrument 1104, an RF electrosurgical instrument 1106, and a multi-function surgical instrument 1108 that integrates RF and ultrasonic energy delivered simultaneously from the generator 1100. In the configuration of FIG. 2, the generator 1100 is shown separate from the surgical instruments 1104, 1106, 1108, but in another configuration, the generator 1100 may be integrally formed with any one of the surgical instruments 1104, 1106, 1108 to form an integrated surgical system. As discussed above, the generator 1100 includes an input device 1110 located on a front panel of the console of the generator 1100. The input device 1110 may include any suitable device that generates signals suitable for programming the operation of the generator 1100. The generator 1100 may also include one or more output devices 1112. Further aspects of the generator for digitally generating an electrical signal waveform and a surgical instrument are described in U.S. Patent Application Publication No. US-2017-0086914-A1, which is incorporated herein by reference in its entirety.

[0023] 3 shows a schematic diagram of a surgical instrument or tool 600 with multiple motor assemblies that can be activated to perform various functions. In the illustrated example, a closure motor assembly 610 is operable to transition the end effector between an open configuration and a closed configuration, and an articulation motor assembly 620 is operable to articulate the end effector relative to the shaft assembly. In certain examples, the multiple motor assemblies can be individually activated to produce a firing, closing, and / or articulation motion in the end effector. The firing, closing, and / or articulation motion can be transmitted to the end effector via the shaft assembly, for example.

[0024] In certain examples, the closure motor assembly 610 includes a closure motor. The closure motor 603 may be operatively coupled to a closure motor drive assembly 612, which may be configured to transmit a closure motion generated by the motor to the end effector, specifically to displace a closure member and close the end effector to transition to a closed configuration. The closure motion may, for example, transition the end effector from an open configuration to a closed configuration to capture tissue. The end effector may be transitioned to an open position by reversing the direction of the motor.

[0025] In certain examples, articulation motor assembly 620 includes an articulation motor operably coupled to an articulation drive assembly 622, which can be configured to transfer articulation motion generated by the motor to an end effector. In certain examples, the articulation can, for example, cause the end effector to articulate relative to the shaft.

[0026] One or more of the motors of the surgical instrument 600 may be equipped with a torque sensor to measure the output torque on the shaft of the motor. The force on the end effector may be sensed in any conventional manner, such as by a force sensor outside the jaws or by a torque sensor on the motor that actuates the jaws.

[0027] In various examples, the motor assemblies 610, 620 include one or more motor drivers, which may comprise one or more H-bridge FETs. The motor drivers may modulate the power delivered to the motors from the power supply 630 based on inputs, for example, from a microcontroller 640 ("controller") of the control circuit 601. In certain examples, the microcontroller 640 may be used, for example, to determine the current drawn by the motors.

[0028] In certain examples, the microcontroller 640 may include a microprocessor 642 ("processor") and one or more non-transitory computer-readable media or memory units 644 ("memory"). In certain examples, the memory 644 may store various program instructions that, when executed, may cause the processor 642 to perform a number of functions and / or calculations described herein. In certain examples, one or more of the memory units 644 may be coupled to the processor 642, for example. In various aspects, the microcontroller 640 may communicate via a wired channel or a wireless channel, or a combination thereof.

[0029] In certain examples, the power source 630 can be used, for example, to power the microcontroller 640. In certain examples, the power source 630 may comprise a battery (or "battery pack" or "power pack"), such as, for example, a lithium ion battery. In certain examples, the battery pack may be configured to be releasably attached to the handle to power the surgical instrument 600. Multiple battery cells connected in series may be used as the power source 630. In certain examples, the power source 630 may be, for example, replaceable and / or rechargeable.

[0030] In various examples, the processor 642 may control a motor driver to control the position, direction, and / or speed of the motors of the assemblies 610, 620. In certain examples, the processor 642 may signal the motor driver to stop and / or disable the motor. The term "processor" as used herein should be understood to include any suitable microprocessor, microcontroller, or other basic computing device that integrates the functionality of a computer's central processing unit (CPU) on one integrated circuit or up to a few integrated circuits. The processor 642 is a general-purpose programmable device that accepts digital data as input, processes the data according to instructions stored in memory, and provides the results as output. It is an example of sequential digital logic since it has an internal memory. The processor operates on numbers and symbols represented in the binary system.

[0031] In one example, the processor 642 may be any single-core or multi-core processor, such as those known under the trade name ARM Cortex by Texas Instruments. In a particular example, the microcontroller 620 may be, for example, the LM 4F230H5QR available from Texas Instruments. In at least one embodiment, the Texas Instruments LM4F230H5QR is an ARM Cortex-M4F processor core with on-chip memory of 256KB single-cycle flash memory or other non-volatile memory up to 40MHz, a pre-fetch buffer to improve performance above 40MHz, 32KB single-cycle SRAM, internal ROM with StellarisWare® software, 2KB EEPROM, one or more PWM modules, one or more QEI analog, one or more 12-bit ADC with 12 analog input channels, among other features readily available in the product data sheet. Other microcontrollers may be readily substituted for use with the surgical instrument 600. Thus, the present disclosure should not be limited in this context.

[0032] In particular examples, memory 644 can include program instructions for controlling each of the motors of surgical instrument 600. For example, memory 644 can include program instructions for controlling a closure motor and an articulation motor. Such program instructions can cause processor 642 to control the closure and articulation functions according to inputs from an algorithm or control program of surgical instrument 600.

[0033] In certain examples, one or more mechanisms and / or sensors, such as, for example, sensor 645, can be used to alert processor 642 to the program instructions to use in a particular setting. For example, sensor 645 can alert processor 642 to use program instructions associated with closing and articulating the end effector. In certain examples, sensor 645 can include a position sensor that can be used to sense the position of a closure actuator, for example. Thus, processor 642 can activate the motor of closure drive assembly 620 using program instructions associated with closing the end effector when processor 642 receives a signal from sensor 630 indicating activation of the closure actuator.

[0034] In some examples, the motors may be brushless DC electric motors and each motor drive signal may comprise a PWM signal provided to one or more stator windings of the motor, and in some examples, the motor driver may be omitted and the control circuit 601 may generate the motor drive signals directly.

[0035] It is common practice during various laparoscopic surgical procedures to insert a surgical end effector portion of a surgical instrument through a trocar placed in the patient's abdominal wall to access a surgical site located within the patient's abdomen. In its simplest form, a trocar is a pen-shaped instrument with a sharp triangular point at one end that is typically used within a hollow tube known as a cannula or sleeve to create an opening in the body through which the surgical end effector can be introduced. Such an arrangement forms an access port within the body cavity through which the surgical end effector can be inserted. The inner diameter of the trocar's cannula necessarily limits the size of the end effector and drive support shaft of the surgical instrument that can be inserted through the trocar.

[0036] Regardless of the particular type of surgical procedure being performed, once a surgical end effector is inserted into a patient through a trocar cannula, it is often necessary to move the surgical end effector relative to a shaft assembly positioned within the trocar cannula in order to properly position the surgical end effector relative to the tissue or organ to be treated. This movement or positioning of the surgical end effector relative to the portion of the shaft that remains within the trocar cannula is often referred to as "articulation" of the surgical end effector. To facilitate such articulation of the surgical end effector, various articulation joints have been developed to attach the surgical end effector to an associated shaft. In many surgical procedures, as can be expected, it is desirable to use a surgical end effector that has as large a range of articulation as possible.

[0037] Due to size constraints imposed by the size of the trocar cannula, the components of the articulation joint must be sized to be freely insertable through the trocar cannula. These size constraints also limit the size and composition of the various drive members and components that operably interface with the motor and / or with other control systems supported within a housing that may be handheld or may comprise a portion of a larger automated system. In many cases, these drive members must operably pass through the articulation joint to be operably coupled to or operably interfaced with the surgical end effector. For example, one such drive member is commonly used to apply an articulation control motion to the surgical end effector. In use, the articulation drive member can be deactivated to facilitate insertion of the surgical end effector through the trocar and then positioned in a non-articulated position for actuation to articulate the surgical end effector to a desired position when the surgical end effector enters the patient.

[0038] The aforementioned size constraints therefore create many challenges for developing an articulation system that can achieve the desired range of articulation and also accommodate the variety of different drive systems required to operate the various features of the surgical end effector. Furthermore, once the surgical end effector is positioned in a desired articulation position, the articulation system and articulation joints must be capable of retaining the surgical end effector in that position upon actuation of the end effector and completion of the surgical procedure. Such articulation joint arrangements must also be capable of withstanding the external forces experienced by the end effector during use.

[0039] Various modes of one or more surgical devices are often used throughout a particular surgical procedure. A communication path extending between the surgical devices and a centralized surgical hub can, for example, facilitate the efficiency and increase the success rate of the surgical procedure. In various examples, each surgical device in the surgical system includes a display that communicates the presence and / or operational status of other surgical devices in the surgical system. The surgical hub can use information received via the communication paths to evaluate the suitability of the surgical devices for use with each other, evaluate the suitability of the surgical devices for use during a particular surgical procedure, and / or optimize the operating parameters of the surgical devices. As described in more detail herein, the operating parameters of the one or more surgical devices can be optimized based on, for example, patient demographics, the particular surgical procedure, and / or detected environmental conditions such as tissue thickness.

[0040] A split display system is illustrated in Figures 4-9. The split display communicates various generator and / or surgical device parameters between the display 27010 of the handheld surgical instrument 27000 and the primary monitor display 27100. Figure 4 illustrates an example of a display 27010 of a handheld surgical instrument 27000. In various examples, the display 27010 includes a touch-sensitive graphic user interface that can receive user input. The display 27010 includes various settings and / or modes that allow a user to customize the information and / or images shown on the display 27010 at any given time.

[0041] The surgical instrument 27000 is in communication with the primary display monitor 27100. The primary display monitor 27100 includes a larger screen than the display 27010 of the surgical instrument 27000. In various examples, the primary display monitor 27100 displays the same information and / or images as the display 27010 of the surgical instrument 27000. In other examples, the primary display monitor 27100 displays different information and / or images than the display 27010 of the surgical instrument 27000. In various examples, the primary display monitor 27100 includes a touch-sensitive graphic user interface that can receive user input. Similar to the display 27010 of the surgical instrument 27000, the primary display monitor 27100 includes various settings and / or modes that allow a user to customize the information and / or images shown on the primary display monitor 27100 at any given time. As described in more detail herein, the selected mode on the primary display monitor 27100 can change the mode of the display 27010 on the surgical instrument 27000, and vice versa. Stated another way, the primary display monitor 27100 and the surgical instrument display 27010 work together to most effectively communicate selected operating parameters to the user.

[0042] The illustrated handheld surgical instrument 27000 includes a combination electrosurgical function, the surgical instrument 27000 includes an end effector including a first jaw and a second jaw. The first jaw and the second jaw include electrodes disposed thereon. The electrosurgical instrument 27000 includes one or more generators configured to provide power to the electrodes to provide energy to the electrodes. More specifically, energy delivery to patient tissue supported between the first and second jaws is accomplished by providing energy to electrodes configured to deliver energy in a monopolar mode, a bipolar mode, and / or a combination mode. The combination mode is configured to deliver alternating or blended bipolar and monopolar energy. In at least one embodiment, the at least one generator includes a battery, a rechargeable battery, a disposable battery, and / or a combination thereof. Various details regarding the operation of the first and second generators are described in more detail in U.S. patent application Ser. No. 16 / 562,123, filed Sep. 5, 2019, entitled "METHOD FOR CONSTRUCTING AND USING A MODULAR SURGICAL ENERGY SYSTEM WITH MULTIPLE DEVICES," which is incorporated by reference in its entirety.

[0043] The display 27010 of the surgical instrument 27000 and the primary display monitor 27100 comprise a split display for communicating a number of operating parameters to the user. The split display is configured to be selectively segmentable. In other words, the user can select which operating parameters to display and / or where selected operating parameters are displayed. Such customization minimizes distraction by eliminating unnecessary and / or unnecessary information, while allowing the user to efficiently observe necessary and / or desired information to control the surgical instrument 27000 and / or perform a surgical procedure. The display 27010 of the surgical instrument 27000 comprises a first portion 27012, where the power level of a particular mode is displayed. The display 27010 of the surgical instrument 27000 further comprises a second portion 27014, where the current mode of the surgical instrument 27000 and / or the type of energy being delivered by the surgical instrument 27000 are identified or otherwise communicated.

[0044] Similarly, the primary display monitor 27100 comprises a segmented display, however, in various examples, images displayed on the display monitor 27100 may be overlaid on one another. A central portion 27110 of the primary display monitor 27100 streams live and / or still images of the surgical site to the procedure room. The live and / or images of the surgical site are captured through an appropriately positioned camera, such as an endoscope. A menu selection portion 27130 of the primary display monitor 27100 prompts and / or otherwise enables a user to select which mode the primary display monitor 27100 is in and / or the information the user wishes to view on the primary display monitor 27100. An equipment status portion 27120 of the primary 27100 communicates display monitor information similar to the first portion 27012 of the surgical instrument display 27010. In various examples, the equipment status portion 27120 is further divided into multiple sections. For example, the first portion 27122 is configured to communicate operating parameters reflecting a bipolar mode. Such operating parameters may be specific and / or general. The specific operating parameters may reflect, for example, a power level of the bipolar mode. The general operating parameters may indicate, for example, whether the bipolar mode is active or inactive. The second portion 27124 is configured to communicate operating parameters reflecting a monopolar mode. Such operating parameters may be specific and / or general. The specific operating parameters may reflect, for example, a power level of the monopolar mode. The general operating parameters may indicate, for example, whether the monopolar mode is active or inactive. The third portion 27126 is configured to communicate operating parameters reflecting a smoke evacuation system. Such operating parameters may be specific and / or general. The specific operating parameters may reflect, for example, a power level of the smoke evacuation system.The general operating parameters may indicate, for example, whether the smoke evacuation system is active or inactive.

[0045] 5-9, the display 27010 of the surgical instrument 27000 is shown alongside a corresponding display on the primary display monitor 27100. As described in more detail herein, when a user changes the power level on the handheld surgical instrument 27000, such power level changes are reflected on the primary display monitor 27100. For example, as shown in FIG. 5, a generator operating in a bipolar mode is currently operating at a power level of 80 watts, as shown in the device status portion 27120 of the primary display monitor 27100 and the first and second portions 27012 and 27014 of the surgical instrument display 27010. More specifically, the first portion 27012 of the surgical instrument display 27010 represents the output of the generator, while the second portion 27014 of the surgical instrument display 27010 represents the mode and / or type of energy. Similarly, the device status portion 27120 of the primary display monitor 27100 indicates that the generator is operating in a bipolar energy mode at a power level of 80 watts and that the generator is operating in a monopolar energy mode at a power level of 0 watts. Upon receiving a command to increase the power output of the generator to operate in the bipolar mode to 100 watts, the surgical instrument display 27010 and the primary display monitor 27100 change accordingly, as shown in FIG. 6. More specifically, the first portion 27012 of the surgical instrument display 27010 represents a power level of 100 watts and the device status portion 27120 of the primary display monitor 27100 indicates that the generator is currently operating in the bipolar mode at a power level of 100 watts. The primary display monitor 27100 continues to indicate that the monopolar energy mode is operating at a power level of 0 watts, however, the primary display monitor 27100 also indicates at 27126 that the smoke detection system has been activated to 20% due to the detection of smoke within the surgical site and / or increased power levels of the surgical instrument.

[0046] 7-9 show the display 27010 and corresponding primary display monitor 27100 of the surgical instrument 27000 when a combination of both bipolar and monopolar energy is being delivered to the patient tissue. FIG. 7 shows a first portion 27012′ of the surgical instrument display 27010 in a total power mode. As shown on the primary display monitor 27100, the bipolar energy mode 27122 is operating at a power level of 60 watts and the monopolar energy mode 27124 is operating at a power level of 60 watts. However, a combined and / or total power level of 120 watts is represented on the first portion 27012′ of the surgical instrument display 27010. The primary display monitor 27100 also shows that the smoke detection system has been activated at 27126 to 50% due to detection of smoke within the surgical site and / or increased power levels of the surgical instrument. As shown in FIG. 8, the user may wish to view the individual power levels of the bipolar and monopolar modes on a first portion 27012″ of the surgical instrument display 27010, and the total power level on an equipment status portion 27122′ of the primary display monitor 27100. In other words, the information shown on the display of FIG. 8 is reversed from the display shown in FIG. 7. The primary display monitor 27100 further indicates that at 27126 the smoke detection system has been activated to 73% due to detection of smoke within the surgical site and / or a change in the power levels of the bipolar and / or monopolar modes. The pair of displays shown in FIG. 9 is in many respects similar to the pair of displays shown in FIG. 8, except that the user has elected to remove the indication of the operation level of the smoke detection system from the primary display monitor 27100.

[0047] As discussed in more detail herein, the surgical instrument display 27010 and / or the primary display monitor 27100 can include a touch-sensitive graphic user interface. In various examples, the surgical instrument display 27010 is used to control what is displayed on the surgical instrument display 27010 and what is displayed on the primary display monitor 27100. In other examples, the primary display monitor 27100 is used to control what is displayed on the surgical instrument display 27010 and what is displayed on the primary display monitor 27100. In various examples, each display is configured to control what is displayed on its own display. In various examples, each display in the surgical system is configured to cooperatively control what is displayed on other displays in the surgical system.

[0048] In various examples, the surgical system includes an electrosurgical device and a smoke evacuation system. As discussed in more detail herein, the electrosurgical device is configured to deliver energy to patient tissue supported between the jaws of the end effector by supplying energy to the electrodes. The electrodes are configured to deliver energy in a monopolar mode, a bipolar mode, and / or a combination mode having alternating or blended bipolar and monopolar energy. In various examples, the first generator is configured to control a bipolar energy modality and the second generator is configured to control a monopolar energy modality. The third generator is configured to control the smoke evacuation system. Various details regarding the operation of the first and second generators are described in more detail in U.S. Patent Application Serial No. 16 / 562,123, filed September 5, 2019, entitled "METHOD FOR CONSTRUCTING AND USING A MODULAR SURGICAL ENERGY SYSTEM WITH MULTIPLE DEVICES," which is incorporated herein by reference in its entirety.

[0049] FIG. 10 is a graphical representation 27200 illustrating the proportional relationship between the duty cycle of the smoke evacuation system and the total effective energy delivered to the patient tissue. Time 27210 is represented along the x-axis, and power (W) 27220a and the smoke evacuation system duty cycle (%) 27220b are represented along the y-axis. The total effective energy is represented in three phases: (1) bipolar therapy 27230, (2) monopolar therapy 27240, and (3) combined energy 27250. The percentage of the smoke evacuation duty cycle is represented in two phases: (1) in response to combined energy 27260, and (2) in response to only bipolar therapy 27270. For example, at time t0, no power is delivered to the patient tissue and the smoke evacuation system is inactive. At time t1, the bipolar therapy 27230 is delivered at a first power level P1. At time t1, bipolar therapy 27230 is the only energy delivered to the patient tissue. As power increases to P1 during the time period t0-t1, the smoke evacuation system is activated. At time t1, a first fraction S1 of the smoke evacuation duty cycle is utilized.

[0050] At time t2, the power level of the bipolar therapy 27230 is increased and the monopolar therapy 27240 begins to be delivered. At time t3, the bipolar therapy 27230 is decreased while the monopolar therapy 27240 is increased. Overall, the combined energy 27250 remains substantially the same from t2 to t3. At time t3, the combined energy 27250 is delivered at a third power level P3, which is higher than the first power level P1 delivered at time t1. As the power increases to P3 during the period t1 to t3, the percentage of the smoke evacuation system duty cycle also increases. At time t3, a third percentage S3 of the smoke evacuation duty cycle is utilized. The third percentage S3 is greater than the first percentage S1. At time t4, the delivery of the bipolar therapy 27230 stops and the only energy delivered to the patient tissue is through the monopolar therapy 27240. In particular, at time t4, the monopolar therapy 27240 delivers energy to the patient tissue at the highest level P4 of monopolar therapy delivered during the entire surgical procedure. Thus, the energy P4 delivered at time t4 is greater than the energy P3 delivered at time t3, and therefore the percentage of the smoke evacuation duty cycle has also increased. At time t4, a fourth percentage S4 of the smoke evacuation duty cycle is utilized. The fourth percentage S4 is greater than the third percentage S3 and the first percentage S1.

[0051] The graphical representation of FIG. 10 illustrates bipolar energy 27230 being delivered at varying levels throughout different points in a surgical procedure. Such points can correspond to a tissue sealing cycle where the surgical hub commands the smoke evacuation system to increase or decrease its operating level in response to the current bipolar power level. After the tissue sealing cycle is completed, monopolar energy can be applied for a defined period of time to cut the patient tissue. Once the patient tissue is cut, the surgical hub can command the smoke evacuation system to increase its operating level based on the increase in energy being applied to cut the tissue, thus, for example, an increase in applied energy typically corresponds to an increase in smoke from burning tissue. During a particular surgical procedure, the surgical hub knows predefined points in time to change the energy delivery and power level. The predefined points can vary, for example, based on the type of particular surgical procedure to be performed. The predefined points can vary, for example, based on the demographics of the patient identified to the surgical hub. Any detected changes in the type of energy being applied and / or the level of energy being applied can trigger responses of different components of the surgical system.

[0052] Similar to the surgical system described with respect to FIG. 10, the surgical system 27700 shown in FIG. 11 includes an electrosurgical instrument 27710 in communication with a surgical hub. The electrosurgical instrument 27710 is configured to deliver energy to patient tissue supported between the jaws of an end effector by electrodes configured to deliver energy in a monopolar mode, a bipolar mode, and / or a combination mode. When in a combination mode, the electrosurgical instrument 27710 is configured to apply alternating or blended bipolar and monopolar energy to the patient tissue. The surgical system 27700 further includes a first generator 27720 configured to control a monopolar energy modality and a second generator 27730 configured to control a bipolar energy modality. The display screen 27750 is positioned at a location within the procedure room within the field of view of the user. In various examples, the electrosurgical instrument 27710 includes a display positioned thereon. As the second generator 27730 delivers bipolar energy to the patient tissue, the instrument display and / or display screen 27750 in the procedure room indicates the level of power being applied. In various examples, the level of smoke evacuation by the smoke evacuation system is indicated on the display(s), the level of smoke evacuation being based on the level of power and / or type of energy being applied. As discussed in more detail herein, when the first generator 27720 delivers monopolar energy to the patient tissue and / or the second generator 27730 delivers a reduced amount of bipolar energy to the patient tissue, the display(s) is configured to update the displayed or otherwise communicated operating parameters. As the level of power during the surgical procedure changes, such changes are communicated to the surgical hub. In response, the surgical hub is configured to automatically, or without an external prompt, modify the level of smoke evacuation to compensate for the change in the level and / or type of energy being applied to the patient tissue.

[0053] At least one of the instrument displays and display screens 27750 includes a touch-sensitive graphic user interface configured to receive user input. A user can select which information to display, where the selected information is displayed on a particular display, and / or which display in the surgical system displays the desired information. In various examples, the surgical system 27700 further includes one or more cameras positioned in the procedure room. The one or more cameras are configured to monitor the movement of a user and / or an apparatus of the surgical system. The one or more cameras can communicate any detected movement to the surgical hub, which recognizes that the detected movement corresponds to a predetermined command. For example, the camera can detect when a user rocks an arm. A memory in the surgical hub correlates the rocking of the arm with a user request to erase the display of all operating parameters, so that only a live video and / or image of the surgical site remains on the display. Exemplary commands that may be associated with particular user and / or instrument movements include adjusting the position of the display(s), adjusting the view of the display(s), adjusting the information presented on the display(s), adjusting the location of the displayed information on a particular display, adjusting the size of the displayed information, controlling the power level of a generator, and / or controlling the operating parameters of various surgical instruments of the surgical system.

[0054] As discussed with respect to the surgical system 27700, the electrosurgical instrument 27710 comprises a combination electrical modality. The monopolar modality of the electrosurgical instrument is operated by a first generator 27720, while the bipolar modality is operated by a second generator 27730. Monopolar energy is delivered to the patient tissue to make an incision or otherwise cut the treated tissue. Prior to cutting the patient tissue, bipolar energy is delivered to the tissue to seal and / or cauterize the target tissue. A graphical representation 27300 of the power levels (watts) 27320a of the first and second generators versus time (t) 27310 is shown in FIG. 12. The power levels are represented in two phases: (1) of the first generator 27340 and (2) of the second generator 27330. The graphical representation 27300 further illustrates the relationship of tissue impedance (Ω) 27320b versus time (t) 27310. The tissue impedance is represented in two phases: (1) in response to delivered monopolar energy 27345, and (2) in response to delivered bipolar energy 27335.

[0055] As the power level of the second generator 27330 increases from 0, bipolar energy is delivered to the patient tissue. The impedance of the patient tissue increases in response to the application of the bipolar energy 27335. In particular, the impedance of the patient tissue continues to increase for a period of time even after the power level of the second generator 27330 begins to decrease. In other words, the impedance of the tissue sealed by the bipolar energy 27335 eventually decreases after the power level of the second generator 27330 is reduced in the absence of delivery of monopolar energy to cut the patient tissue, but the impedance of the tissue in such an instance does not necessarily decrease immediately. At time t1, the power level of the first generator 27340 increases, thereby cutting the tissue through the delivery of monopolar energy to the patient tissue. The impedance of the patient tissue also increases in response to the application of the monopolar energy 27345. In particular, the impedance of the patient increases exponentially as the tissue is cut and the power level of the first generator 27340 decreases.

[0056] FIG. 13 illustrates an algorithm 27400 for controlling various components of a surgical system. The surgical system includes a surgical instrument configured to perform an intended surgical function. In various examples, the surgical instrument is handheld and includes a handle. A user is configured to operate various modes of the surgical instrument via input elements on the handle. As described in more detail herein, the surgical instrument includes a first generator configured to power a monopolar modality and a second generator configured to power a bipolar modality. The surgical system further includes a smoke evacuation system configured to remove smoke and / or other unwanted particulates from the surgical site. The surgical instrument and / or the smoke evacuation system are in signal communication with a surgical hub, which is configured to adjust the appropriate response(s) of the components of the surgical system in response to user inputs to the surgical instrument, the smoke evacuation system, and / or another component in the surgical system.

[0057] As shown in FIG. 13, the control algorithm 27400 begins when a user changes the mode 27410 of the surgical instrument. For example, the user may want to increase the power level of the first generator to cut the patient tissue. In another example, the user may want the surgical instrument to seal and / or cut the patient tissue. In either case, the surgical instrument then communicates the user input at 27412, 27414 to the first and second generators, respectively. The surgical instrument further communicates the user input at 27415 to the surgical hub. After the surgical hub is notified of the desired increase in monopolar energy at 27420, the surgical hub is configured to command the second generator to supply and / or administer the appropriate power level at 27425. Upon receiving communication from the surgical instrument at 27412, the first generator increases the waveform in preparation for cutting the patient tissue at 27440. Upon receiving a communication from the surgical instrument at 27414 and a command from the surgical hub at 27425, the second generator increases the power level associated with the bipolar modality at 27450 in preparation for sealing the patient tissue after the cut has been made. The second generator can then communicate its readiness to the first generator at 27455. The first generator can then begin cutting the patient tissue at 27442. Stated another way, the surgical hub prevents the monopolar electrodes from being energized until the bipolar electrodes have been energized to prevent cauterization and / or cutting of unsealed tissue. The surgical hub is further configured to command the smoke evacuation system to increase motor speed at 27426 in response to the increase in power levels of the first and second generators. After the smoke evacuation system increases its motor speed at 27430, the smoke evacuation system is configured to maintain a line of communication with the surgical hub, the surgical instruments, and / or the first and second generators throughout the duration of the surgical procedure. For example, the smoke evacuation system is configured to continuously communicate the current motor speed to the surgical hub at 27435.In such examples, the smoke evacuation system transmits its current motor speed to the surgical hub every minute or every two minutes, although the smoke evacuation system may communicate its current motor speed at any suitable frequency. Once the surgical instrument has completed the desired tissue cut, the user may again provide an input on the instrument handle to reduce the power level of the primary generator and / or terminate the control algorithm 27400. In various examples, the control algorithm 27400 is configured to automatically reduce the power level of the primary generator after a predetermined period of time corresponding to the completion of the tissue cut. Utilizing the control algorithm 27400, the surgical hub may adjust operating parameters of components of the surgical system to facilitate, for example, an efficient and / or effective surgical procedure.

[0058] Many surgical devices, tools, and / or replaceable components are often used during a particular surgical procedure. Disclosed herein are various systems that, among other things, serve to streamline the devices and / or components stocked in a procedure room for use during a particular procedure, minimize operator error, and / or minimize delays during a surgical procedure. The systems described herein use, among other things, artificial intelligence and machine learning developed over the course of one or more surgical procedures to increase the efficiency of the surgical procedure.

[0059] Various components of an exemplary surgical system 27500 are shown in FIG. 14. During a particular surgical procedure, a patient rests on an operating table, or any suitable treatment surface 27510. In various examples, the particular procedure is performed at least in part using a surgical robot. The surgical robot comprises one or more robotic arms 27520. Each robotic arm 27520 is configured to receive a tool component 27590. The tool components 27590 are configured to cooperate with one another to perform and / or assist a clinician in performing a particular surgical procedure. The tool components may comprise, for example, surgical stapling and / or tissue cutting tool components, tissue grasping tool components, and / or electrosurgical tool components. The tool components may include other features such as, for example, size, manufacturer, date of manufacture, number of previous uses, and / or expiration date.

[0060] The surgical system 27500 further comprises a surgical hub 27530. Various surgical hubs are described in U.S. Patent Application No. 16 / 209,395, filed December 4, 2018, entitled "METHOD OF HUB COMMUNICATION," which is incorporated herein by reference in its entirety. The surgical hub 27530 comprises a memory 27535 that stores various suitable or otherwise appropriate combinations of tool components 27590 to be used during a particular procedure. Stated another way, the memory 27535 of the surgical hub 27530 comprises a stored bank of information that can be used to indicate which tool components 27590 are suitable for utilization during a selected procedure.

[0061] Prior to performing a desired surgical procedure, the clinician may notify or otherwise communicate details regarding the desired surgical procedure and / or the patient to the surgical hub 27530. Such details may include, for example, an identity of the surgical procedure, an identity of the clinician performing the surgical procedure, and / or a biometric profile of the patient. The surgical hub 27530 is then configured to utilize one or more of the communicated details to evaluate and / or determine which tool components 27950 are necessary and / or appropriate to perform the desired surgical procedure. In various examples, the surgical hub 27530 is configured to evaluate which mode of each tool component 27950 is appropriate to perform the desired surgical procedure on a particular patient.

[0062] As shown in FIG. 14 , four robotic arms 27250 surround or are otherwise attached to the surgical table 27510. Three tool components 27590 are connected to three corresponding robotic arms 27250, with one robotic arm free to receive an additional tool component. A number of unique tool components 27560, 27570, 27580 are shown stored on a mobile stand 27550 within the procedure room. As discussed above, the type and / or functionality of the tool components 27560, 27570, 27580 may vary. In such an example, the surgical hub 27530 evaluates the available tool components 27560, 27570, 27580 and identifies the appropriate tool component for attachment to the surgical robot. The appropriate tool components are identified based on one or more factors, such as, for example, what tool types and / or functions are still needed by the surgical robot and / or what tool configurations complete a pre-defined pairing of tool components associated with a desired surgical procedure. In various examples, the surgical robot includes a memory that stores the pre-defined tool component pairings based, for example, on a particular surgical procedure and / or on the demographics of a particular patient. In such examples, the surgical robot can identify appropriate tool components for attachment to the surgical robot based on the identities of already attached tool components.

[0063] In other examples, the tool components 27560, 27570, 27580 have the same type and / or function, but the tool components 27560, 27570, 27580 include at least one other feature, such as, for example, size, manufacturer, expiration date, and / or number of previous uses. The surgical hub 27530 evaluates the profile of each available tool component 27560, 27570, 27580 and identifies an appropriate tool component based on its characteristics being compatible with the profiles of the other selected and / or installed tool components 27590.

[0064] 14, each tool component 27560, 27570, 27580 includes a QR code 27565, 27575, 27585 positioned in any suitable location thereon, each QR code including a profile of information representative of the tool component to which the QR code is linked. A user scans and / or reads the QR code 27565, 27575, 27585 using any suitable scanning tool 27540. The scanning tool 27540 then communicates the QR code and / or the information contained within the QR code to the surgical hub 27530. In instances where the QR code itself is communicated by the scanning tool 27540 to the surgical hub 27530, a processor of the surgical hub 27530 is configured to decode the profile of information contained by the received QR code. Although the illustrated embodiment includes a QR code, the tool components may include any suitable memory device, such as, for example, a bar code, an RFID tag, and / or a memory chip.

[0065] The surgical hub 27530 is configured to alert the user when a tool component is not acceptable and / or undesirable for use during a surgical procedure. Such alerts can be communicated via various forms of feedback including, for example, tactile feedback, auditory feedback, and / or visual feedback. In at least one example, the feedback includes audio feedback, and the surgical system 27500 can include a speaker that emits a sound, such as a beep, when an error is detected. In a particular example, the feedback includes visual feedback, and the tool components can each include a light emitting diode (LED), for example, that flashes when an error is detected. In a particular example, the visual feedback can be communicated to the user by an alert presented on a display monitor within the field of view of the clinician. In various examples, the feedback includes tactile feedback, and the components of the surgical system 27500 can include an electric motor with an eccentric element that vibrates when an error is detected. The alerts can be specific or general. For example, the warning may specifically state that a QR code on a tool component cannot be detected, or the warning may specifically state that the QR code contains information indicative of a non-compliant and / or malfunctioning tool component.

[0066] For example, a user attempts to attach a first tool component 27560 to an available robotic arm 27590 of a surgical robot. Prior to attaching the first tool component 27560 to the robotic arm 27590, the scan tool 27540 scans a QR code 27565 displayed on the first tool component 27560. The scan tool 27540 communicates the QR code 27565 and / or the information contained within the QR code 27565 to the surgical hub 27530. The surgical hub 27530 compares the information contained within the QR code 27565 to a stored list of acceptable tool components associated with the particular surgical procedure and / or a stored list of acceptable tool components compatible with the tool components currently attached to the surgical robot. In this case, the surgical hub 27530 is unable to recognize and / or locate the first tool component 27560 in its memory 27535. Thus, the first tool component 27560 is not recommended and / or suitable for use with the surgical robot. As discussed above, the surgical hub 27530 is configured to alert the clinician of the incompatibility of the first tool component 27560 with the surgical robot and / or the particular surgical procedure. In various examples, the surgical system 27500 can prevent the first tool component 27560 from being attached to it, for example, by a mechanical and / or electrical lockout. Such an attachment lockout prevents the clinician from overlooking and / or simply ignoring the warning issued by the surgical system 27500. Stated differently, the attachment lockout requires the clinician to take a proactive step in overriding an error communicated by the surgical system 27500. In such examples, an override can be activated to allow the clinician to override any system lockout and utilize the operating functionality of the first tool component 27560. In various examples, no override is available to prevent a clinician from utilizing the functionality of the first tool component 27560 while the first tool component 27560 is recognized as being incompatible for use with a surgical robot.

[0067] Similarly, a user attempts to attach a second tool component 27570 to an available robotic arm 27590 of the surgical robot. Prior to attaching the second tool component 27570 to the robotic arm 27590, the scan tool 27540 scans the QR code 27575 displayed on the second tool component 27570. The scan tool 27540 communicates the QR code 27575 and / or the information contained within the QR code 27575 to the surgical hub 27530. The surgical hub 27530 compares the information contained within the QR code 27575 to a stored list of acceptable tool components associated with the particular surgical procedure and / or a stored list of acceptable tool components compatible with the tool components currently attached to the surgical robot. In this case, the surgical hub 27530 is unable to recognize and / or locate the second tool component 27570 in its memory 27535. Thus, the second tool component 27570 is not recommended and / or suitable for use with the surgical robot. As discussed above, the surgical hub 27530 is configured to alert the clinician of the incompatibility of the second tool component 27570 with the surgical robot and / or the particular surgical procedure. In various examples, the surgical system 27500 can prevent the second tool component 27570 from being attached to it. Such an attachment lockout prevents the clinician from overlooking and / or simply ignoring warnings issued by the surgical system 27500. Stated differently, the attachment lockout requires the clinician to take a proactive step in overriding an error communicated by the surgical system 27500. In such examples, an override can be activated to allow the clinician to override any system lockout and utilize the operating functionality of the second tool component 27570. In various examples, no override is available to prevent a clinician from utilizing the functionality of the second tool component 27570 while the second tool component 27570 is recognized as being incompatible for use with the surgical robot.

[0068] A user attempts to attach a third tool component 27580 to an available robotic arm 27590 of the surgical robot. Prior to attaching the third tool component 27580 to the robotic arm 27590, the scan tool 27540 scans the QR code 27585 displayed on the third tool component 27580. The scan tool 27540 communicates the QR code 27585 and / or the information contained within the QR code 27585 to the surgical hub 27530. The surgical hub 27530 compares the information contained within the QR code 27585 to a stored list of acceptable tool components associated with the particular surgical procedure and / or a stored list of acceptable tool components compatible with the tool components currently attached to the surgical robot. In this case, the surgical hub 27530 successfully recognizes and / or locates the third tool component 27580 in its memory 27535. The third tool component 27580 is then determined to be suitable for use with the surgical robot and / or with other attached tool components during a particular surgical procedure. In various examples, the surgical hub 27530 is configured to alert a clinician to the compatibility of the third tool component 27580 with the surgical robot. In other examples, the surgical system 27500 does not simply prevent attachment of the third tool component 27580 to an available robotic arm 27590.

[0069] In various examples, the memory 27535 of the surgical hub 27530 is configured to store a QR code associated with each tool component used during a particular surgical procedure. The surgical hub 27530 can then analyze the collected information to form observations and / or conclusions regarding factors such as, for example, the efficiency and / or effectiveness of a particular tool component and / or multiple tool components during a surgical procedure. These observations and / or conclusions can then be used by the surgical hub 27530 in selecting and / or recommending which tool components to utilize during future surgical procedures.

[0070] 15 illustrates a surgical system 27600 including one or more cameras configured to assist a clinician in performing an efficient and / or successful surgical procedure. Similar to surgical system 27500, surgical system 27600 includes a surgical table 27610, or any suitable treatment surface. Surgical system 27600 further includes a surgical hub 27650, and an instrument tower 27660. Various surgical hubs are described in U.S. Patent Application Serial No. 16 / 209,395, filed December 4, 2018, entitled "METHOD OF HUB COMMUNICATION," which is incorporated by reference herein in its entirety.

[0071] The surgical system 27600 further comprises a camera system including one or more cameras 27640 positioned at various locations throughout the procedure room. In the illustrated embodiment, two cameras 27640 are positioned at opposite corners of the procedure room, however, the cameras 27640 may be positioned and / or oriented in any suitable location that allows the cameras 27640 to cooperatively capture the procedure room in an unobstructed manner. The artificial intelligence protocol detects and / or identifies various devices, equipment, and / or personnel and their corresponding locations and / or orientations within the procedure room.

[0072] The camera 27640 of the camera system is in communication with the surgical hub 27650. Stated another way, live footage from the camera 27640 can be transmitted to the surgical hub 27650 for processing and analysis. Through analysis of the footage collected by the camera 27640, the surgical hub 27650 can maintain a real-time inventory of devices, equipment, and / or personnel within the procedure room and / or monitor and / or control interactions between detected devices, equipment, and / or personnel. Using the images and / or data collected by the camera system, the surgical hub 27650 is configured to be notified regarding the identity of the detected devices, alert a clinician regarding suitability regarding the detected devices, and / or control various components of the surgical system 27600 based on the presence and / or operation of the detected devices. The surgical hub 27650 is configured to compare any detected devices to determine compatibility between devices and / or during a particular surgical procedure, to facilitate cooperation of two devices that are intended to work together, and / or to facilitate cooperation of two devices that sense and / or establish controlled operations against each other.

[0073] 15, an anesthesia cart 27670 and a preparation table 27620 are positioned within a procedure room. The preparation table 27620 is configured to support a variety of surgical tools and / or surgical devices such that they are easily accessible for use during a surgical procedure. Such surgical tools and / or surgical devices may include, for example, interchangeable staple cartridges of varying sizes, or shaft assemblies with end effectors of varying sizes and / or capabilities. In the illustrated embodiment, the preparation table 27620 supports a first device 27630a, a second device 27630b, and a third device 27630c.

[0074] The camera 27640 is configured to detect identifying information regarding devices, equipment, and / or personnel located within the procedure room. For example, the camera 27640 can capture a serial number printed on a visible portion of each device 27630a, 27630b, 27630c, such as, for example, on the device's packaging. In various examples, the packaging includes a QR code printed thereon, the QR code including information regarding the device contained therein. The QR code is captured by the camera 27640 and communicated to the surgical hub 27650 for analysis and identification of the staple cartridge.

[0075] Such an identification system may be useful, for example, during a surgical procedure in which a surgical stapling instrument comprises an end effector, and a 60 mm staple cartridge is configured to seat within the end effector. A camera 27640 in the procedure room is configured to capture the presence of the surgical stapling instrument, for example, in the form of live video and / or still images. The camera 27640 then communicates the captured image(s) to the surgical hub 27650. The surgical hub 27650 is configured to identify the surgical stapling instrument based on the image(s) received from the camera 27640. In instances in which the surgical hub 27650 is aware of the surgical procedure to be performed, the surgical hub 27650 can alert a clinician as to whether the identified surgical stapling instrument is appropriate. For example, by knowing that a 45 mm staple cartridge is associated with a particular surgical procedure, the surgical hub 27650 can alert the clinician that the detected surgical stapling instrument is inappropriate because the end effector of the detected surgical stapling instrument is configured to accept a 60 mm staple cartridge.

[0076] The surgical hub 27650 includes a memory 27655 that stores technical requirements and / or specifications associated with various devices therein. For example, the memory 27655 of the surgical hub 27650 recognizes that the above-described surgical stapling instrument is configured to receive a 60 mm staple cartridge. In various examples, the memory 27655 can also recognize a particular brand of 60 mm staple cartridge that is compatible with the surgical stapling instrument. In various examples, the camera 27640 can capture the presence of the replaceable staple cartridge, for example, in the form of live footage and / or still images. The camera 27640 then communicates the captured image(s) to the surgical hub 27650. The surgical hub 27650 is configured to identify characteristics of the replaceable staple cartridge based on the image(s) received from the camera 27640. Such characteristics can include, for example, size, brand, and / or manufacturing lot. As discussed in more detail herein, the warning may be specific or general. In an example where the camera 27640 captures the presence of a package containing a replaceable 45 mm staple cartridge, the surgical hub 27650 is configured to warn the clinician that an incompatible staple cartridge is incorrectly stocked in the room. Such a warning can prevent, for example, a malfunction of a surgical instrument, injury to a patient, and / or loss of valuable time during a surgical procedure.

[0077] As discussed above, the camera system is configured to facilitate the surgical hub 27650 in adjusting devices detected within the procedure room. In various examples, a combined energy device and a smoke evacuation system are detected by the camera system. The combined energy device is configured to apply bipolar and monopolar energy to patient tissue. Upon the camera system and / or the surgical hub 27650 detecting activation of the combined energy device, the presence of the combined energy device in a position near the patient, and / or the presence of smoke within the procedure room, the surgical hub 27650 is configured to instruct the generator to activate the smoke evacuation system, for example.

[0078] The surgical instrument may utilize measurable or otherwise detectable characteristics of the end effector to identify a particular stage of a surgical procedure and / or to control various operating parameters of the surgical instrument. Such characteristics may include, for example, the distance between the jaws of the end effector. The memory of the surgical instrument and / or surgical hub includes stored information that associates a particular jaw gap distance with a particular stage of a surgical procedure. For example, when a distance between the jaws of 0.030 inches to 0.500 inches is measured, the surgical instrument and / or surgical hub may identify that the end effector is to deliver bipolar energy to the patient tissue. In another example, when a distance between the jaws of 0.030 inches to 0.500 inches is measured, the surgical instrument and / or surgical hub may activate the generator, thereby beginning the delivery of bipolar energy to the patient tissue. Stated another way, the detection of characteristics of the surgical instrument and / or contacted patient tissue may be used by the surgical instrument and / or surgical hub to identify and / or adapt the operation of the surgical instrument.

[0079] FIG. 16 includes a chart illustrating various operating parameters and / or specifications of the surgical instrument corresponding to various stages of a surgical procedure. Similar to the surgical instruments described in more detail herein, the surgical instrument 27000 shown in FIGS. 17-19 includes a combination electrosurgical function, the surgical instrument includes an end effector including a first jaw 27810 and a second jaw 27820. At least one of the first jaw 27810 and the second jaw 27820 is movable relative to one another, and the end effector is configurable between an open configuration and a closed configuration. The first jaw 27810 includes a first tissue supporting and / or tissue contacting surface 27815, and the second jaw 27820 includes a second tissue supporting and / or tissue contacting surface 27825. The first jaw 27810 and the second jaw 27810 include electrodes disposed thereon. The electrosurgical instrument 27000 comprises one or more generators configured to provide power to the electrodes to provide energy to the electrodes. More specifically, energy delivery to patient tissue supported between the first and second jaws is accomplished by electrodes configured to deliver energy in monopolar, bipolar, and / or combined modes. Alternating or blended bipolar and monopolar energy is configured to be delivered in combined modes. In at least one embodiment, the at least one generator comprises a battery, a rechargeable battery, a disposable battery, and / or a combination thereof.

[0080] The end effector 27800 is used to perform various end effector functions during a surgical procedure. At an original time t0, the end effector 27800 is inserted into patient tissue T t0 At the original time t0, the patient tissue T t0is in a relaxed, uncompressed state. The end effector 27800 is shown in an open configuration. In the open configuration, a distance d0 ranges between anywhere from 0.500 inches to 0.700 inches between the first tissue support surface 27815 and the second tissue support surface 27825. Stated another way, the tissue support surfaces 27815, 27825 are separated from one another by a maximum distance d0 of 0.500 inches to 0.700 inches when the end effector 27800 is in the open configuration.

[0081] At a first time t1, the jaws 27810, 27820 of the end effector 27800 are inserted into the patient tissue T t1 Patient tissue T t1 At least a portion of the tissue T is positioned between the jaws 27810, 27820 of the end effector 27800 as the end effector 27800 moves from the open configuration toward the closed configuration. t1 At time t1, the end effector 27800 applies bipolar energy to the patient tissue T t1 The application of bipolar energy can cause the end effector 27800 to, for example, feather through parenchymal tissue. The end effector 27800 is in a partially closed configuration at time T1. The first distance d1 spans anywhere between 0.030 inches and 0.500 inches between the first tissue support surface 27815 and the second tissue support surface 27825 at time t1. Stated another way, the tissue support surfaces 27815, 27825 are configured to deliver tissue to the patient tissue T at time t1. t1 At a first time t1, the patient tissue T is separated by a first maximum distance d1 of 0.030 inches to 0.500 inches while delivering bipolar energy to the t1 A detailed depiction of the jaws 27810, 27820 of an end effector 27800 for delivering bipolar energy to is shown in FIG.

[0082] At a second time t2, the jaws 27810, 27820 of the end effector 27800 engage with the patient tissue Tt2 Maintain contact with patient organizations t2 At least a portion of the bipolar energy is positioned between the jaws 27810, 27820 of the end effector 27800. At time t2, the end effector 27800 delivers a combination of bipolar and monopolar energy to the patient tissue T t2 Application of bipolar and monopolar energy causes the end effector 27800 to deliver to the patient tissue T t2 The end effector 27800 is in a partially closed configuration at time t2, however the end effector 27800 is closer to a fully closed configuration at time t2 than the end effector 27800 is at time t1. More specifically, the second distance d2 ranges between anywhere from 0.010 inches to 0.030 inches between the first tissue support surface 27815 and the second tissue support surface 27825 at time t2. Stated another way, the tissue support surfaces 27815, 27825 are spaced apart from each other by a distance that the end effector 27800 is in when in contact with the patient tissue T at time t2. t2 At a second time t2, the patient tissue T is separated by a second maximum distance d2 of 0.010 inches to 0.030 inches while delivering bipolar and monopolar energy to the t2 A detailed depiction of the jaws 27810, 27820 of an end effector 27800 for delivering bipolar and monopolar energy to is shown in FIG.

[0083] At a third time t3, the jaws 27810, 27820 of the end effector 27800 contact the patient tissue T t3 Maintain contact with patient organizations t3 At least a portion of the bipolar energy is positioned between the jaws 27810, 27820 of the end effector 27800. At time t3, the end effector 27800 delivers a combination of bipolar and monopolar energy to the patient tissue T t3 The continued application of bipolar and monopolar energy causes the end effector 27800 to continue delivering energy to the patient tissue T. t3The end effector 27800 may be in a partially closed configuration and / or a fully closed configuration at time t3. Stated another way, the end effector 27800 may be in a fully closed configuration and / or may be closer to the fully closed configuration at time t3 than the end effector 27800 at time t2. More specifically, the third distance d3 may range anywhere between 0.003 inches and 0.010 inches between the first tissue support surface 27815 and the second tissue support surface 27825 at time t3. Stated another way, the tissue support surfaces 27815, 27825 may be positioned such that the end effector is in a partially closed configuration and / or closer to the fully closed configuration at time t3 than the end effector 27800 is at time t2. t3 18. The jaws 27810, 27820 of the end effector 27800 delivering bipolar and monopolar energy to the patient tissue at a third time t3 are separated by a third maximum distance d3 of 0.003 inches to 0.100 inches. A detailed depiction of the jaws 27810, 27820 of the end effector 27800 delivering bipolar and monopolar energy to the patient tissue at a third time t3 is shown in FIG.

[0084] At a fourth time t4, the jaws 27810, 27820 of the end effector 27800 engage with the patient tissue T t4 Maintain contact with patient organizations t4 At least a portion of the end effector 27800 is positioned between the jaws 27810, 27820 of the end effector 27800. At time t4, the end effector 27800 delivers monopolar energy to the patient tissue T t4 Upon application of monopolar energy, the end effector 27800 is configured to deliver the t4The end effector 27800 is in a partially closed configuration and / or a fully closed configuration at time t4. Stated another way, the end effector 27800 is in a fully closed configuration and / or is closer to the fully closed configuration at time t4 than the end effector 27800 is at time t2. More specifically, the fourth distance d4 ranges between anywhere from 0.003 inches to 0.010 inches between the first tissue support surface 27815 and the second tissue support surface 27825 at time t4. Stated another way, the tissue support surfaces 27815, 27825 are positioned such that the end effector is in a partially closed configuration and / or closer to the fully closed configuration at time t4 than the end effector 27800 is at time t2. t4 At a fourth time t4, the patient tissue T t4 A detailed depiction of the jaws 27810, 27820 of an end effector 27800 for delivering monopolar energy to is shown in FIG.

[0085] Graph 27900 shown in Figure 20 illustrates relationships between various operating parameters and / or specifications of the surgical instruments of Figures 16-19 over time. The surgical instrument and / or surgical hub may utilize the illustrated relationships to verify proper functioning of the surgical instrument during a surgical procedure and / or to operate and / or adjust various functions of the surgical instrument in response to one or more measured parameters. The graphs show (1) the change 27930 in the generator power (W) 27920a controlling the bipolar modality of the surgical instrument over time 27910, (2) the change 27935 in the generator power (W) 27920a controlling the monopolar modality of the surgical instrument over time 27910, (3) the change 27940 in the distance between the jaws of the end effector 27920b over time 27910, (4) the change 27950 in the jaw motor force (F) 27920c over time 27910, and (5) the change 27960 in the jaw motor speed (V) 27920d over time 27910.

[0086] At time t0, the electrodes of the end effector are not delivering energy to the patient tissue and the end effector is not yet in contact with the patient tissue. The distance 27920b between the jaws of the end effector is maximum at time t0 due to the end effector being in an open configuration. From time t0 to time t1, the jaw clamping force 27950 is minimum as the end effector encounters little or no resistance from the patient tissue as it moves from the open configuration towards the closed configuration. The jaws of the end effector continue to close around the patient tissue from time t1 to time t2, during which time the end effector begins to deliver bipolar energy 27930. The distance between the jaws of the end effector is smaller at time t1 than at time t0. From time t1 to time t2, the jaw motor speed 27960 begins to decelerate as the end effector jaw clamping force 27950 begins to increase.

[0087] As described with respect to FIGS. 16-29, a combination of monopolar energy 27935 and bipolar energy 27930 is delivered to the patient tissue from time t2 to time t3. The jaws of the end effector continue to close around the patient tissue during this period. The distance between the jaws of the end effector is smaller at time t2 than at time t1. The particular distance between the jaws of the end effector at time t2 indicates to the surgical instrument and / or surgical hub that the tissue heating stage of the surgical procedure has been reached and that a combination of monopolar and bipolar energy should and / or has been delivered to the patient tissue. From time t2 to time t3, the jaw motor speed continues to decrease and is lower than the jaw motor speed at t1. The force required to clamp the jaws increases sharply between times t2 and t3, thereby confirming to the surgical instrument and / or surgical hub that a combination of monopolar and bipolar energy is being delivered to the patient tissue.

[0088] Monopolar and bipolar energy continue to be delivered to the patient tissue, and the patient tissue is sealed from time t3 to time t4. As the end effector reaches its fully closed configuration at time t3, the jaw clamping force also reaches a maximum, but the jaw clamping force remains steady between times t3 and t4. The power level of the generator delivering the monopolar energy increases between times t3 and t4, while the power level of the generator delivering the bipolar energy decreases between times t3 and t4. Finally, between times t4 and t5, the monopolar energy is the only energy being delivered to cut the patient tissue. While the patient tissue is being cut, the jaw clamping force of the end effector may fluctuate. In the example 27952 where the jaw clamping force decreases from its steady state level maintained between times t3 and t4, efficient and / or effective tissue cutting is realized by the surgical instrument and / or surgical hub. In instances 27954 where the force clamping the jaws is increased from its steady state level maintained between times t3 and t4, inefficient and / or ineffective tissue cutting is recognized by the surgical instrument and / or surgical hub, and in such instances, an error can be communicated to the user.

[0089] In various examples, the clamping action of the jaws of the end effector can be adjusted based on the detected characteristics of the contacted patient tissue. In various examples, the detected characteristics include tissue thickness and / or tissue type. For example, actions such as the range of gap distance between the jaws during the jaw closing stroke, the load threshold, the speed of jaw closure, the current limit applied during the jaw closing stroke, and / or the wait time between the jaw closing stroke and the delivery of energy can be adjusted based on the detected thickness of the patient tissue. In various examples, the detected characteristics of the contacted patient tissue can be used to adjust tissue welding parameters. More specifically, the detected characteristics can be used to adjust, for example, a multi-frequency sweep of impedance sensing, the balance and / or sequence of energy modalities, energy delivery levels, impedance cut-off levels, and / or wait times between energy level adjustments.

[0090] As discussed in more detail above, the surgical instrument and / or surgical hub can utilize the measured tissue characteristics to control and / or adjust the operating parameters of the surgical instrument. For example, tissue impedance can be detected when patient tissue is positioned between the jaws of the end effector. Detection of tissue impedance alerts the surgical instrument and / or surgical hub that the jaws of the end effector are in contact with and / or near patient tissue. Referring now to FIG. 21 , a graph 28000 shows tissue impedance 28020 calculated over time 28010. When the jaws of the end effector are not in contact with patient tissue, tissue impedance 28030a is infinite. When the jaws of the end effector are clamped around patient tissue positioned therebetween, the patient tissue is in contact with both jaws. In such an example, tissue impedance 28030b is measurable. The ability to measure tissue impedance indicates to the surgical instrument and / or surgical hub that patient tissue is properly positioned between the jaws of the end effector. The surgical instrument and / or surgical hub can then begin to operate, such as, for example, applying bipolar and / or monopolar energy to the patient tissue.

[0091] In various examples, the surgical instrument and / or surgical hub can utilize the magnitude of the detected tissue impedance to determine the stage of the surgical procedure. For example, as shown in FIG. 21, tissue impedance 28030b is measured at a first level upon initial contact between the jaws of the end effector and the patient tissue. The surgical instrument can then begin to deliver bipolar energy to the patient tissue. As the detected tissue impedance 28030b increases to and / or exceeds a first predetermined level, the surgical instrument begins to deliver a combination of bipolar and monopolar energy to the patient tissue to warm the patient tissue and / or form a seal. As the detected tissue impedance 28030b continues to increase, the tissue impedance 28030b reaches and / or exceeds a second predetermined level, at which point the surgical instrument stops delivering bipolar energy to cut the patient tissue while continuing to deliver monopolar energy. Eventually, the tissue impedance reaches an infinite level as the patient tissue is no longer positioned between the jaws of the end effector upon completion of the cut, In such an instance, the surgical instrument and / or surgical hub can stop delivering monopolar energy.

[0092] In various examples, strain can be a metric used to adjust operating parameters of a surgical instrument, such as, for example, a clamping mechanism. However, contact between the jaws of the end effector and the patient tissue is desirable for accurate estimation of compressive strain. As discussed in more detail with reference to FIG. 21, the surgical instrument and / or surgical hub can determine that contact exists between the jaws of the end effector and the patient tissue by detected tissue impedance. FIG. 22 shows an end effector 28100 with a first jaw 28110 and a second jaw 28120, the end effector in an open configuration. Gap

[0093]

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[0096] Figure 23 shows the end effector 28100 of Figure 22 in an open configuration.

[0097]

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[0100] As mentioned above, calculating the compressive strain by utilizing the gap defined between the first and second jaws of the end effector when the end effector is in an open configuration results in an accurate calculation only when the patient tissue is in contact with both jaws of the end effector at an initial time t0. Therefore, it is not desirable to use the standard gap defined between the first and second jaws of the end effector when the end effector is in an open configuration. Instead, the gap defined between the first and second jaws of the end effector when the patient tissue initially contacts both jaws should be used when calculating the compressive strain. The end effector is shown in an open configuration 28150 in FIG. 24. Notably, the patient tissue is not in contact with both jaws 28110, 28120 of the end effector. Therefore, the dimensions and / or specifications of the end effector in this configuration 28150 should not be used when calculating the compressive strain. As at least one of the first jaw 28110 and the second jaw 28120 continues to move toward one another, a gap

[0101]

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[0105] The motor control program of the combination electrosurgical instrument can utilize the detected tissue stability as an input. The surgical instrument can detect the compression speed and / or measure the creep of patient tissue compressed between the jaws of the end effector to determine tissue stability. The control program can be modified to adjust wait times between end effector functions, define when additional tissue stability determinations should be made, and / or adjust the speed of the jaw clamps based on the determined tissue stability.

[0106] As shown in FIG. 25, the end effector 28250 includes a first jaw 28254 and a second jaw 28256, at least one of which is configured to move toward one another and a patient tissue T is configured to be positioned therebetween. FIG. 25 provides a schematic illustration of various positions of the first jaw 28254 and the second jaw 28256 relative to the patient tissue T during a jaw clamping stroke. A gap 28220a defined between the jaws of the end effector and a motor current 28220b required to clamp the jaws of the end effector vary over time 28210 due, at least in part, to a tissue stability measurement. The initial tilt S0 corresponds to the change in the jaw gap 28230 between when the jaws are fully open and when initial contact is made between the jaws and the patient tissue T. The resulting motor current 28240 remains low while there is no tissue contact until the jaws of the end effector contact the patient tissue T. The surgical system is configured to monitor the current 28220b over time 28210 to identify when the slope of the current becomes flat, i.e., when the tissue stabilizes. When the slope of the current becomes flat, the surgical system is configured to take the difference between the peak current at the time the end effector makes initial contact with the tissue and the point where the current becomes flat. In other words, the jaws can continue to clamp the tissue positioned between them until the wait time has expired, which is defined by the time it takes for the tissue compression to stabilize. The motor current creep drives the next stage of motor current and speed to the desired jaw gap or level of tissue compression. The creep measurement is repeated to drive the next stage of motor current and speed until the final jaw cap or level of tissue compression is achieved.

[0107] In addition to sensed parameters associated with the jaw clamp stroke, the surgical system can monitor additional functions to adjust and / or refine the operating parameters of the surgical instrument. For example, the surgical system can monitor the orientation of the surgical instrument relative to the user and / or patient, the impedance of tissue positioned between the jaws of the end effector to determine tissue location and / or tissue composition, the level of ground to the patient, and / or leakage current. Leakage current can be monitored to determine secondary leakage from other devices and / or to create parasitically generated energy output by capacitive coupling.

[0108] In various examples, the surgical instrument is configured to use local unsupervised machine learning to modify the instrument and / or generator settings and / or control program. In such examples, the surgical instrument may update and / or adjust local functional behavior based on a summary and / or aggregation of data from various surgical procedures performed with the same surgical instrument. Such functional behavior may be adjusted based on prior use and / or specific user and / or hospital preferences. In such examples, the surgical instrument's control program recognizes the same user and automatically modifies the default program with the identified user preferences. The surgical instrument may be updated by receiving regional and / or global updates and / or improvements to the digitally enabled control program and / or displayed information through interaction with a non-local server.

[0109] In various examples, the surgical instrument is configured to use a global set of instrument operating parameters and / or surgical procedure outcomes to modify instrument and / or generator settings and / or control programs. The global surgical system is configured to collect data regarding relevant and / or contributing instrument parameters, such as outcomes, complications, co-morbidities, surgical instrument costs, instrument utilization, procedure time, procedure data, and / or patient data. The global surgical system is further configured to collect data regarding generator operating data, such as impedance curves, power levels, energy modalities, event annotations, and / or adverse events. The global surgical system is further configured to collect data regarding intelligent device operating parameters, such as clamp time, tissue pressure, wait time, number of uses, time the patient is on the operating table, battery levels, motor current, and / or actuation stroke. The global surgical system is configured to adapt default control programs and / or update existing control programs based on the detected operating parameters. In this manner, each surgical instrument in the global surgical system can perform the most effective and / or efficient surgical procedure possible.

[0110] FIG. 26 illustrates a network 28300 of surgical instruments 28310 in communication with a cloud-based storage medium 28320. The cloud-based storage medium 28320 is configured to receive data regarding operating parameters from the surgical instruments 28310 collected over many surgical procedures. The data is used by the cloud-based storage medium 28320 to optimize the control program to achieve efficient and / or desirable results. The cloud-based storage medium 28320 is further configured to analyze all of the collected data in random batches 28340. The results of the analysis from the random batches 28340 can be further used in redefining the control program. For example, data collected in batch A may represent a significantly different wear profile. It may then be concluded from this data that, for example, may suggest that an instrument that adjusts power rather than clamp current will deteriorate faster. The cloud-based storage medium 28320 is configured to communicate this finding and / or conclusion to the surgical instruments. The surgical instrument can then maximize the instrument's life by adjusting the clamp current instead of the power, and / or the surgical system can alert the clinician to this finding.

[0111] FIG. 26 illustrates a network 28300 of surgical instruments 28310 in communication with a cloud-based storage medium 28320. The cloud-based storage medium 28320 is configured to receive data regarding operating parameters from the surgical instruments 28310 collected over many surgical procedures. The data is used by the cloud-based storage medium 28320 to optimize the control program to achieve efficient and / or desirable results. The cloud-based storage medium 28320 is further configured to analyze all of the collected data in random batches 28340. The results of the analysis from the random batches 28340 can be further used in redefining the control program. For example, data collected in batch A may represent a significantly different wear profile. It may then be concluded from this data that, for example, may suggest that an instrument that adjusts power rather than clamp current will deteriorate faster. The cloud-based storage medium 28320 is configured to communicate this finding and / or conclusion to the surgical instruments. The surgical instrument can then maximize the instrument's life by adjusting the clamp current instead of the power, and / or the surgical system can alert the clinician to this finding.

[0112] The information collected from the network 28300 of surgical instruments 28310 by the cloud-based storage medium 28320 is presented in graphical form in FIGS. 27 and 28. More specifically, the relationship between the gap 28430 defined between the jaws of the end effector and the initial tissue contact point changes over time during the surgical procedure as shown in FIG. 27 as a function of jaw motor clamping current 28440. The number of times a particular end effector reaches a fully clamped condition during a jaw clamping stroke affects the amount of force required to clamp tissue of the same thickness. For example, the jaws of the end effector can clamp to a greater extent with less current for an instrument 28430a that has been fully clamped 1-10 times than an instrument 28430b that has been fully clamped 10-15 times. Additionally, the jaws of the end effector can clamp to a greater extent with less current for an instrument 28430b that has been fully clamped 10-15 times than an instrument 28430c that has been fully clamped 16-20 times. Eventually, as the surgical instrument continues to be used, more power, and therefore current, is required to clamp the same thickness of tissue into the same fully clamped gap. Using collected information from the surgical instrument 28310 and the cloud-based storage medium 28320, the control program can be modified to perform a more efficient and / or time-efficient jaw clamping stroke.

[0113] The current required to clamp the same thickness of tissue by achieving the same fully clamped gap between the jaws of the end effector is used to set the motor current threshold of the generator. As shown in FIG. 28, the motor current threshold is lower for end effectors that have reached the fully clamped state less than 10 times because less current is required to achieve the fully clamped state. Thus, the control program sets a lower threshold generator power for the new end effector than the threshold generator power for the old end effector. If the same generator power is used in the old end effector than that used in the new end effector, the tissue may not be clamped and / or compressed sufficiently between the jaws of the end effector. If the same generator power is used in the new end effector than that used in the old end effector, the tissue and / or the instrument may be damaged because the tissue may be overly compressed by the jaws of the end effector.

[0114] In various examples, the surgical system comprises a modular component. For example, the surgical system comprises a surgical robot comprising a robotic arm configured to receive tools of different capabilities thereon. The control program of the surgical system is modified based on the modular attachment, e.g., the type of tool connected to the surgical robotic arm. In other examples, the surgical system comprises a handheld surgical instrument configured to receive different and / or interchangeable end effectors thereon. Prior to performing an intended surgical function, the handheld surgical instrument is configured to identify the attached end effector and modify the control program based on the determined identity of the end effector.

[0115] The surgical system is configured to identify the attached modular component using adaptive and / or intelligent interrogation techniques. In various examples, the surgical system uses a combination of electrical interrogations in combination with mechanical actuation interrogations to determine the capacity and / or capabilities of the attached component. The response to the interrogation can be recorded and / or compared to information stored in the memory of the surgical system to establish baseline operating parameters associated with the identified modular attachment. In various examples, the established baseline parameters are stored in the memory of the surgical system to be used when the same or similar modular attachment is identified in the future.

[0116] In various examples, an electrical interrogation signal is transmitted from the handle of the surgical instrument to the attached modular component, the electrical interrogation signal being sent in an attempt to determine the identity, operating parameters, and / or status of the attached modular component. The attached modular component is configured to transmit a response signal with the identification information. In various examples, no response is received to the interrogation signal, and / or the response signal includes non-identifiable information. In such examples, the surgical instrument may perform a default function to evaluate the capabilities of the attached modular component. The default function is defined by legacy operating parameters. In other words, the default operating parameters used during the performance of the default function are defined to a particular level to avoid damage to the surgical instrument and / or the attached modular component, the patient, and / or the user. The surgical instrument is configured to utilize the results of the default function to set an operating program specific to the attached modular component.

[0117] For example, the surgical instrument may perform a tissue-cutting stroke, with the cutting member traversing through the attached end effector from a proximal position to a distal position. In instances where the surgical instrument is unable to identify the attached end effector, the surgical instrument is configured to perform the tissue-cutting stroke using default operating parameters. By utilizing the position of the cutting member within the end effector at the end of the tissue-cutting stroke, the surgical instrument may determine a length of the tissue-cutting stroke associated with and / or appropriate for completion with the attached end effector. The surgical instrument is configured to record the distal-most position of the cutting member in order to set additional operating parameters associated with the attached end effector. Such additional operating parameters may include, for example, the speed of the cutting element and / or the length of the end effector during the tissue-cutting stroke.

[0118] A default function may also be used to determine the current state and / or status of the attached modular component. For example, a default function may be implemented to determine whether the attached end effector is articulated and / or to what extent the attached end effector is articulated. The surgical instrument is then configured to adjust the control program accordingly. As the end effector articulates through a range of articulation angles, the length of the cutting stroke changes. Stated differently, the length of the cutting stroke is different when the end effector is articulated compared to when the end effector is unarticulated. The surgical instrument is configured to update the control program to perform a cutting stroke that spans the length associated with the last detected complete stroke. The surgical instrument is further configured to use the length of the last completed cutting stroke to determine whether the full length of the cutting stroke is achieved and / or completed using the current control program when the end effector is unarticulated compared to when the end effector is articulated.

[0119] In various examples, the surgical system may perform an intelligent evaluation of characteristics of the attached components. Such characteristics may include, for example, tissue pad wear, attachment usage, and / or attachment operational status. Stated another way, the surgical system is configured to evaluate the functionality and / or status of the attached components. Upon detecting the characteristics of the attached modular components, the control program used to operate the surgical system is adjusted accordingly.

[0120] The surgical instrument comprises one or more tissue pads positioned on the jaws of the end effector. It is commonly known that tissue pads tend to deteriorate and wear over time, for example, due to frictional engagement with the blade when no tissue is present between them. The surgical instrument is configured to determine the degree of wear of the tissue pads, for example, by analyzing the thickness and / or stiffness of the remaining tissue pad. Utilizing the determined status of the tissue pad(s), the surgical instrument adjusts the control program accordingly. For example, the control program can modify the applied pressure and / or power level of the surgical instrument based on the determined status of the tissue pad(s). In various examples, the power level of the surgical instrument can be automatically reduced by the processor of the surgical instrument in response to a detected thickness of the tissue pad(s) being less than a threshold thickness.

[0121] The surgical instrument includes a combination electrosurgical function, the surgical instrument includes an end effector including a first jaw and a second jaw. At least one of the first jaw and the second jaw are configured to move toward one another to transition the end effector between an open configuration and a closed configuration. The first jaw and the second jaw include electrodes disposed thereon. The electrosurgical instrument includes one or more generators configured to provide power to the electrodes to provide energy to the electrodes. The surgical instrument can assess the degree of charring and / or tissue contamination on one or more of the jaws of the end effector by measuring impedance when the end effector is in a closed configuration with no patient tissue positioned therebetween. The predetermined impedance can be stored in a memory of the surgical instrument, and if the impedance exceeds a predetermined threshold, the jaw includes an undesirable level of charring and / or tissue contamination thereon. As discussed in more detail herein, upon detecting an undesirable level of charring, a warning can be issued to a user. In various examples, operating parameters can be automatically adjusted by a processor in the surgical instrument and / or surgical hub in response to the detected closing jaw impedance, including, for example, power levels, applied pressure levels, and / or advanced tissue cutting parameters.

[0122] As shown in FIG. 29 , the graphical representation 28500 illustrates a relationship 28530 between the measured impedance 28250 and multiple activation cycles 28510. The baseline impedance is measured and recorded in memory prior to any energy activation (activation n=0). As discussed above, the impedance is measured when the end effector of the surgical instrument is in a closed configuration with no patient tissue positioned therebetween. The surgical instrument and / or surgical hub prompts the user to transition the end effector to the closed configuration to measure the closed jaw impedance. Such prompts can be delivered at predefined activation intervals, for example, n=5, 10, 15, etc. As char and / or tissue contamination accumulates on the jaws of the end effector, the impedance increases. At and / or beyond a first predetermined level 28540, the surgical instrument and / or surgical hub is configured to alert the user of such char accumulation and advise the user to clean the end effector. At and / or beyond the second predetermined level 28550, the surgical instrument and / or surgical hub can prevent the user from using various operational functions of the surgical instrument until the end effector is cleaned. The operational lockout can be released upon cleaning of the end effector, assuming the measured impedance has decreased to an acceptable level.

[0123] As discussed above, the surgical hub and / or the surgical instrument are configured to alert the user when a predetermined impedance is met and / or exceeded. Such alerts can be communicated via various forms of feedback including, for example, haptic feedback, auditory feedback, and / or visual feedback. In at least one example, the feedback includes audio feedback, where the surgical instrument can include a speaker that emits a sound, such as a beep, when an error is detected. In a particular example, the feedback includes visual feedback, where the surgical instrument can include a light emitting diode (LED), for example, that flashes when an error is detected. In a particular example, the visual feedback can be communicated to the user by an alert presented on a display monitor within the user's field of view. In various examples, the feedback includes haptic feedback, where the surgical instrument can include an electric motor with an eccentric element that vibrates when an error is detected. The alerts can be specific or general. For example, the alert can specifically state that the closing jaw impedance has exceeded a predetermined level, or the alert can specifically state the measured impedance.

[0124] In various examples, the surgical instrument and / or surgical hub are configured to detect parameters such as integral shaft stretch, damage, and / or tolerance build-up to compensate for functional parameter operation of the powered actuator. The surgical instrument is configured to alert a user when the detected parameters of the attached end effector and / or shaft are near and / or outside of a desired operating range specific to the attached component. In addition to alerting the user, in various examples, operation of the surgical instrument is prevented when it is detected that the surgical instrument cannot operate within a predefined envelope of adjustment. The surgical instrument and / or surgical hub include overrides that allow the user to override the lockout under certain predefined conditions. Such predefined conditions include emergency situations, during a surgical procedure where not being able to use the surgical instrument would cause harm to the patient, the surgical instrument is currently in use, and a disposable override to allow one additional use of the surgical instrument at the discretion of the user. In various examples, the overrides are also available to allow the user to perform secondary end effector functions that are unrelated to the primary end effector function. For example, if a surgical instrument prevents the jaws of the end effector from articulating, a user may activate an override to allow the surgical instrument to articulate the end effector.

[0125] The surgical system can adapt a control program configured to operate the surgical instrument in response to the detected instrument actuation parameters, energy generator parameters, and / or user input. The determined status of the surgical instrument is used in combination with the user input to adapt the control program. The determined status of the surgical instrument can include, for example, whether the end effector is in its open configuration, whether the end effector is in its closed configuration, and / or whether tissue impedance is detectable. The determined status of the surgical instrument can include two or more detected characteristics. For example, the determined status of the surgical instrument can be evaluated using a combination of two or more measures, a sequence of sequenced actions, and / or an interpretation of a well-known user input based on its situational use. The control program is configured to adjust various functions of the surgical instrument, such as, for example, power levels, incremental step-up or step-down, and / or various motor control parameters.

[0126] The surgical system includes a surgical instrument including a combination electrosurgical function, the surgical instrument including an end effector including a first jaw and a second jaw having electrodes disposed thereon. The electrosurgical instrument includes one or more generators configured to provide power to the electrodes to provide energy to the electrodes. More specifically, energy delivery to patient tissue supported between the first and second jaws is accomplished by electrodes configured to deliver energy in a monopolar mode, a bipolar mode, and / or a combination mode having alternating or blended bipolar and monopolar energy. As described in more detail herein, the surgical system can adapt a level of energy power activation of the one or more generators based on various monitored parameters of the surgical instrument.

[0127] The surgical system is configured to adapt energy power activation based on monitored parameters of the instrument. In various examples, the surgical system can monitor the sequence in which various surgical instrument functions are activated. The surgical system can then automatically adjust various operating parameters based on the activation of the surgical instrument functions. For example, the surgical system can monitor activation of rotation and / or articulation controls and prevent the ability of the surgical instrument to deliver energy to patient tissue while such secondary non-clamping controls are in use.

[0128] In various examples, the surgical system may adapt the power level of the instrument to compensate for detected operating parameters such as, for example, insufficient battery and / or motor drive power levels. Detection of insufficient battery and / or motor drive power levels may indicate to the surgical system, for example, that the clamping strength of the end effector is affected and / or impaired, thereby resulting in undesirable control over patient tissue positioned therebetween.

[0129] The surgical system can record the operating parameters of the surgical instrument during a period of use associated with a particular intended function. The surgical system can then use the recorded operating parameters to adapt, for example, the energy power level and / or the mode of the surgical instrument when the surgical system identifies that a particular intended function is being performed. Stated differently, the surgical system can automatically adjust the energy power level and / or the mode of the surgical instrument with the preferred operating parameters stored when a desired function of the surgical instrument is identified, and / or the surgical instrument can adjust the energy power level and / or the mode of the surgical instrument in an attempt to support and complement the desired function. For example, the surgical system can complement a detected lateral load on the shaft with application of monopolar power, since the detected lateral load on the shaft is often due to an abrasive dissection at the end effector in its closed configuration. The surgical system may determine, through previous procedures and / or through information stored in memory, to apply monopolar power because monopolar power results in improved dissection. In various examples, the surgical system is configured to apply monopolar power in proportion to the detected increase in lateral load.

[0130] The surgical system can adapt a control program configured to operate the surgical instrument in response to the detected end effector parameters. As shown in FIG. 30, the surgical instrument can utilize the measured tissue conductance to automatically modify the gap clamp control program. The tissue conductance is measured at two frequencies, e.g., 50 kHz and 5 MHz. The low frequency conductance (GE) is driven by extracellular fluid, while the high frequency conductance (GI) is driven by intracellular fluid. The intracellular fluid level changes, for example, when cells are damaged. The end effector is configurable in an open configuration and a closed configuration. Thus, when the end effector is moved from its open configuration toward its closed configuration, the jaws of the end effector compress the tissue positioned therebetween. During tissue compression, the change in conductance between the two frequencies can be detected and / or recorded. The surgical system is configured to adapt a control program to control end effector clamp compression based on a ratio of low frequency conductance (GE) to high frequency conductance (GI). The surgical system adapts the control program until a discrete predetermined point and / or an inflection point is approached, whereby the predetermined point and / or the inflection point indicates that cell damage may be near.

[0131] More specifically, FIG. 30 is a graphical representation 29000 of the relationship between measured tissue conductance 29100, the ratio of low frequency conductance to high frequency conductance 29200, the dimensions of the jaw opening 29300, and the jaw motor force 29400 over the duration 29010 of the jaw clamp stroke. At the beginning of the jaw clamp stroke, the measured tissue conductance is at a minimum as the jaws of the end effector first contact the patient tissue, and the jaw opening 29300 is at its maximum value when the end effector is in its open configuration. The jaw motor force is low at the beginning of the jaw clamp stroke due, at least in part, to the low resistance offered to the jaws from the tissue positioned between the jaws. Before compression, but after contact between the patient tissue and the jaws of the end effector, the low frequency conductance 29110 increases indicating the presence of extracellular fluid within the captured tissue. Similarly, before compression, but after contact between the patient tissue and the jaws of the end effector, high-energy conductance 29120 increases indicating the presence of intracellular fluid.

[0132] As the end effector begins to move toward its closed configuration, the jaws of the end effector begin to clamp the tissue positioned between them, thus the jaw opening 29300 continues to decrease. The tissue begins to be compressed by the jaws, but it is not until fluid begins to exit the compressed tissue that the patient tissue is sealed off by the surgical instrument. The jaw motor force continues to increase during the jaw clamping stroke as increased resistance is exerted against the end effector jaws by the captured tissue.

[0133] After the initial expulsion of extracellular fluid causes a decrease in the low frequency conductance (GE) 29110, the low frequency conductance (GE) 29110 remains relatively constant during the jaw clamp stroke. The high frequency conductance (GI) 29120 remains relatively constant during the jaw clamp stroke until after the patient tissue is sealed. If the tissue continues to be compressed after the seal is completed, intracellular tissue damage occurs and intracellular fluid is expelled. At such time, the high frequency conductance 29120 decreases, causing a spike in the ratio 29210 of low frequency conductance to high frequency conductance. The tissue damage threshold 29220 is predetermined to alert the user and / or automatically prompt the surgical system to modify operating parameters when the spike in the ratio 29210 of low frequency conductance to high frequency conductance reaches and / or exceeds the tissue damage threshold 29220. At such a point, the surgical system is configured to modify the control program to stop moving the jaws of the end effector toward the closed configuration of the end effector and / or to begin moving the jaws of the end effector back toward the open configuration of the end effector. In various examples, the surgical system is configured to modify the control program to reduce the jaw clamping force. Such adaptation of the control program prevents additional tissue damage.

[0134] The surgical system is configured to modify the control program based on the collaborative dual input. More specifically, the surgical system can vary the motor actuation speed based on the user input and the predefined settings. For example, the more force the user applies to the handle control, the faster the motor is actuated to trigger the system. In various examples, the handle control can be used to communicate different commands to the surgical system depending on the situational use. More specifically, the surgical system can monitor and / or record specific user inputs. The specific user inputs can be analyzed for their length, duration, and / or any suitable characteristic that can be used to distinguish the inputs. For example, the handle of the surgical instrument can include a trigger, the trigger configured to control shaft rotation. In various examples, faster actuation of the trigger corresponds to an increase in the speed at which the shaft rotates, while the maximum force (current) threshold of the motor remains constant. In other examples, faster actuation of the trigger corresponds to an increase in the force applied while the rotation speed threshold remains the same. Such control can be further differentiated by having the shaft rotational speed increase based on the duration that the user actuates the trigger, while the force is based on the speed at which the trigger is actuated.

[0135] In various examples, the motor actuation control is based on a combination of predefined settings and detection of tool operating parameters and / or user control parameters. FIG. 31 is a graphical representation 29500 of a relationship between an actual jaw closing velocity 29520 and a trigger velocity indicated by a user input 29510. The jaw closing velocity 29520 resulting from only the corresponding user input 29510 is represented by a first line 29530. As the user input trigger velocity 29510 increases, the jaw closing velocity 29520 also increases. Such a relationship 29530 is determined without considering any additional parameters. The jaw closing velocity 29520 resulting from the corresponding user input 29510 and a determination of thick tissue positioned between the jaws of the end effector is represented by a second line 29540. As the user input trigger velocity 29510 increases, the jaw closing velocity 29520 also increases, but the jaw closing velocity 29520 is less than if only the user input trigger velocity was considered. Additional considerations of tissue thickness may, for example, slow down jaw closure speed to prevent damage to the patient tissue and / or surgical instrument.

[0136] The surgical system includes many components. For example, the surgical system includes many handheld surgical instruments, a surgical hub, and a surgical robot. In various examples, each component of the surgical system is in communication with the other components and can issue commands and / or change control programs based on at least one monitored parameter and / or user input. The surgical system includes a means for determining which system is in charge and which system will make part of the operational decision. This designation can change based on situational awareness, the occurrence of a predetermined event, and / or the exceeding of a threshold. In various examples, a command protocol can be established within the surgical system to indicate the types of commands each component can issue and / or to components within the surgical system the issuing components can direct commands to.

[0137] The command protocol can use predefined thresholds to determine when a control handoff is warranted. For example, a surgical system includes a generator and a handheld surgical instrument including various controls therein. At the beginning of a surgical procedure, the generator is first controlled to adjust power based on the detected impedance. The generator uses the detected impedance and / or current power level to command a pressure control in the handle of the surgical instrument to follow specific pressure needs. At some point during the surgical procedure, a lower impedance threshold is exceeded indicating that the generator algorithm has detected an electrical short. The generator passes control to the pressure control in the handle by instructing the pressure control to determine if tissue is still positioned between the jaws of the end effector. The pressure control can then determine the appropriate tissue compression and communicate which power level and / or energy modality is most appropriate for the detected tissue.

[0138] The control protocol may be determined based on a consensus reached by multiple components in the surgical system. For example, three components in the surgical system detect a first value for the monitored parameter, while two components in the surgical system detect a second value for the same monitored parameter, where the first and second values ​​are different. A group of three components includes more components than a group of two components, and thus the first value of the monitored parameter is controlled. Each component in the surgical system may be assigned a position located in a hierarchy. The hierarchy may be established based on the reliability of a particular component and / or the capabilities of a particular component. A first component detects a first value for the monitored parameter, and a second component detects a second value for the same monitored parameter, where the first value is different from the second value. The second component is "higher" than the first component in the hierarchy of the surgical system, and thus the second value of the monitored parameter detected by the second component controls is controlled.

[0139] Various aspects of the subject matter described herein are illustrated in the following examples.

[0140] Example Set 1 Example 1 - A surgical system comprising a surgical instrument, a generator configured to provide power to an end effector, and a processor configured to execute a control program to operate the surgical system. The surgical instrument includes an end effector including a first jaw and a second jaw. At least one of the first jaw and the second jaw is moved relative to one another between an open position and a closed position. Tissue is configured to be positioned between the first jaw and the second jaw. The processor is configured to detect a first parameter of the surgical system, detect at least one user input, and modify the control program in response to the detected first parameter and the at least one user input.

[0141] Example 2 - A surgical system as described in Example 1, wherein the control program is configured to control the power level of the generator.

[0142] Example 3 - A surgical system as described in Example 1 or 2, wherein the control program is configured to control a motor, and the motor is configured to move the end effector between an open configuration and a closed configuration.

[0143] Example 4 - A surgical system as described in Example 3, wherein the control program is configured to control the motor via a motor control parameter, and the control program is configured to adjust the motor control parameter in response to the detected first parameter and the detected user input.

[0144] Example 5 - A surgical system as described in Examples 1, 2, 3, or 4, wherein the first parameter includes an instrument operation parameter.

[0145] Example 6 - A surgical system as described in Examples 1, 2, 3, 4, or 5, wherein the first parameter includes a generator operating parameter.

[0146] Example 7 - A surgical system as described in Examples 1, 2, 3, 4, 5, or 6, wherein the first parameter includes a status of the end effector.

[0147] Example 8 - A surgical system as described in Examples 1, 2, 3, 4, 5, 6, or 7, wherein the first parameter indicates whether the end effector is in an open configuration or a closed configuration.

[0148] Example 9 - The surgical system of Examples 1, 2, 3, 4, 5, 6, or 7, wherein the first parameter indicates whether tissue is positioned between the first jaw and the second jaw.

[0149] Example 10 - A surgical system as described in Examples 1, 2, 3, 4, 5, 6, 7, 8, or 9, wherein the surgical instrument is operationally controlled and the generator is the slave control system by default.

[0150] Example 11 - A surgical system as described in Examples 1, 2, 3, 4, 5, 6, 7, 8, or 9, wherein the control program is configured to operationally control the generator and the surgical instrument as a slave control system in response to the detected first parameter and the detected user input.

[0151] Example 12 - A surgical system as described in Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or 11, wherein the first parameter includes a combination of two scales.

[0152] Example 13 - A surgical system as described in Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or 12, wherein the surgical system further comprises a trigger configured to receive a user input, and the processor is configured to interpret multiple user inputs received by the trigger, each user input including a different purpose based on a situational use.

[0153] Example 14 - A surgical system comprising a surgical instrument, a generator configured to provide power to the surgical instrument, and a processor configured to execute a control program to operate the surgical system, the processor configured to detect a status of the surgical instrument, detect at least one user input, and adapt the control program in response to the detected status of the surgical instrument and the at least one user input.

[0154] Example 15 - A surgical system as described in Example 14, wherein the surgical instrument includes an end effector, the end effector being configurable in an open configuration and a closed configuration, and the status of the surgical instrument corresponds to whether the end effector is in the open configuration or the closed configuration.

[0155] Example 16 - A surgical system as described in Example 14 or 15, wherein the surgical instrument includes an end effector, the end effector being configurable in an open configuration and a closed configuration, and the status of the surgical instrument corresponds to whether patient tissue is positioned between the first jaw and the second jaw.

[0156] Example 17 - A surgical system as described in Examples 14, 15, or 16, wherein the surgical system further comprises an input member configured to receive user input, and the processor is configured to interpret multiple user inputs received by the input member, each received user input including a different purpose based on a situational use of the surgical system.

[0157] Example 18 - A surgical system comprising a surgical instrument, a generator configured to provide power to an end effector, and a processor configured to execute a control program to operate the surgical system. The surgical instrument includes an end effector including a first jaw and a second jaw. At least one of the first jaw and the second jaw is moved relative to one another between an open position and a closed position. Tissue is configured to be positioned between the first jaw and the second jaw. The processor is configured to detect a first parameter of the surgical instrument, detect a second parameter of the generator, detect at least one user input, and modify the control program in response to the detected first parameter, the detected second parameter, and the at least one user input.

[0158] Example 19 - A surgical system as described in Example 18, wherein a first parameter of the surgical instrument corresponds to whether the end effector is in an open configuration or a closed configuration and whether patient tissue is positioned between the first jaw and the second jaw.

[0159] Example 20 - A surgical system as described in Example 18 or 19, wherein the surgical instrument further comprises an input member configured to receive user input, and the processor is configured to interpret a plurality of user inputs received by the input member, each received user input including a different purpose based on a situational use of the surgical instrument within the surgical system.

[0160] Example Set 2 Example 1 - A surgical instrument comprising a housing, a shaft assembly, a processor, and a memory. The shaft assembly is interchangeably connected to the housing. The shaft assembly includes an end effector. The memory is configured to store program instructions that, when executed from the memory, cause the processor to: transmit an electrical interrogation signal to an attached shaft assembly; receive a response signal from the attached shaft assembly; perform a default function when the response signal is not received by the attached shaft assembly; determine an identifying characteristic of the attached shaft assembly as a result of the performance of the default function; and modify the control program based on the identifying characteristic of the attached shaft assembly.

[0161] Example 2 - The surgical instrument of example 1, wherein the distinguishing characteristic comprises a remaining volume of an attached shaft assembly.

[0162] Example 3 - The surgical instrument of example 1 or 2, wherein the distinguishing characteristic comprises a performance level of an attached shaft assembly.

[0163] Example 4 - A surgical instrument as described in Examples 1, 2, or 3, wherein the distinguishing characteristic differs with the attached shaft assembly of different capacity.

[0164] Example 5 - A surgical instrument as described in Examples 1, 2, 3, or 4, wherein the memory includes a look-up table containing operating parameters corresponding to a particular shaft assembly, and the processor utilizes the received response signal to identify the installed shaft assembly in the look-up table, and the control program is modified using the stored operating parameters corresponding to the identified shaft assembly.

[0165] Example 6 - A surgical instrument as described in Examples 1, 2, 3, 4, or 5, wherein the memory further includes program instructions that, when executed, cause the processor to store a modified control program in the memory.

[0166] Example 7 - A surgical instrument comprising a housing, a shaft assembly, a processor, and a memory. The shaft assembly is interchangeably connected to the housing. The shaft assembly includes an end effector. The memory is configured to store program instructions that, when executed from the memory, cause the processor to: send a variable interrogation communication to an attached shaft assembly; determine a capability of the attached shaft assembly based on a response to the variable interrogation communication; and modify the control program based on the determined capability of the attached shaft assembly.

[0167] Example 8 - A surgical instrument as described in Example 7, wherein the variable interrogation communication includes an electrical interrogation signal and physical actuation of the surgical instrument.

[0168] Example 9 - A surgical instrument as described in Examples 7 or 8, wherein the physical actuation of the surgical instrument is monitored to determine the functional capability of the attached shaft assembly.

[0169] Example 10 - The surgical instrument of example 7, 8, or 9, wherein the determined capacity is related to the remaining volume of the shaft assembly.

[0170] Example 11 - The surgical instrument of Examples 7, 8, 9, or 10, wherein the determined capacity is related to a performance level of the shaft assembly.

[0171] Example 12 - The surgical instrument of Examples 7, 8, 9, 10, or 11, wherein the determined capacity differs based on the connected shaft assembly.

[0172] Example 13 - A surgical instrument as described in Examples 7, 8, 9, 10, 11, or 12, wherein the memory further includes program instructions which, when executed, cause the processor to store the modified control program and the determined shaft assembly capabilities in the memory.

[0173] Example 14 - A surgical instrument comprising a housing, a shaft assembly, a processor, and a memory. The shaft assembly is operably coupled to the housing. The shaft assembly includes an end effector. The memory is configured to store program instructions that, when executed from the memory, cause the processor to: send an interrogation signal to a shaft assembly coupled to the housing; receive a response signal from the shaft assembly coupled to the housing; perform a default end effector function when the response signal is not recognized; determine an identification characteristic of the shaft assembly coupled to the housing as a result of performing the default end effector function; and modify the control program based on the identification characteristic of the shaft assembly coupled to the housing.

[0174] Example 15 - The surgical instrument of example 14, wherein the response signal is not recognized by the processor because the response signal is not received by the processor.

[0175] Example 16 - The surgical instrument of example 14 or 15, wherein the identification characteristic comprises a remaining volume of the shaft assembly coupled to the housing.

[0176] Example 17 - The surgical instrument of Examples 14, 15, or 16, wherein the distinguishing characteristic comprises a performance level of a shaft assembly coupled to the housing.

[0177] Example 18 - The surgical instrument of Examples 14, 15, 16, or 17, wherein the determined characteristics may differ based on shaft assemblies interchangeably coupled to the housing.

[0178] Example 19 - A surgical instrument as described in Examples 14, 15, 16, 17, or 18, wherein the memory includes a look-up table containing operating parameters corresponding to a particular shaft assembly, and the processor uses the received response signal to identify a shaft assembly coupled to the housing in the look-up table, and the control program is modified using the stored operating parameters corresponding to the identified shaft assembly.

[0179] Example 20 - A surgical instrument as described in Examples 14, 15, 16, 17, 18, or 19, wherein the memory further includes program instructions which, when executed, cause the processor to store a modified control program in the memory.

[0180] Example Set 3 Example 1 - A surgical system includes a surgical hub, a surgical instrument, a generator configured to provide energy to an end effector, and a smoke evacuation system configured to remove smoke from a surgical site. The surgical instrument includes an end effector. Control commands are passed directly from the surgical hub to the surgical instrument. The surgical instrument is configured to pass control commands received from the surgical hub to the generator and the smoke evacuation system in a daisy chain manner.

[0181] Example 2 - A surgical system as described in Example 1, wherein the surgical instrument is configured to modify the control commands using parameters detected by the surgical instrument.

[0182] Example 3 - A surgical system as described in Example 2, wherein the surgical instrument is configured to pass modified control commands to the generator.

[0183] Example 4 - A surgical system as described in Example 2 or 3, wherein the operating parameters of the generator are controlled by modified control commands.

[0184] Example 5 - A surgical system described in Example 2, 3, or 4, wherein the generator is configured to modify the modified control command using a second parameter detected by the generator.

[0185] Example 6 - A surgical system described in Examples 2, 3, 4, or 5, wherein the surgical instrument is configured to pass modified control commands to the surgical hub, and the surgical hub is configured to pass modified control commands to the generator.

[0186] Example 7 - A surgical system as described in Example 1, wherein the surgical instrument detects a first parameter of the surgical instrument, the surgical instrument is configured to communicate the detected first parameter to the generator, and the generator is configured to modify the control command using the first parameter.

[0187] Example 8 - A surgical system as described in Example 1, wherein the surgical instrument detects a first parameter of the surgical instrument, the surgical instrument is configured to communicate the detected first parameter to the generator, the generator detects a second parameter, and the generator is configured to modify the control command using the first parameter and the second parameter.

[0188] Example 9 - A surgical system as described in Example 1, 2, 3, 4, 5, 6, 7, or 8, further comprising a display screen configured to display a live image of the surgical site and a first operating parameter of the surgical instrument.

[0189] Example 10 - A surgical system as described in Example 9, wherein the surgical instrument further includes an instrument display configured to display a second operating parameter of the surgical instrument, and the first operating parameter is the same as the second operating parameter.

[0190] Example 11 - A surgical system as described in Example 9, wherein the surgical instrument further includes an instrument display configured to display a second operating parameter of the surgical instrument, the first operating parameter being different from the second operating parameter.

[0191] Example 12 - A surgical system as described in Examples 9, 10, or 11, wherein the display screen is further configured to display operating parameters of the generator.

[0192] Example 13 - A surgical system comprising a surgical hub, a surgical instrument, a generator configured to provide energy to an end effector, and a smoke evacuation system configured to remove smoke from a surgical site. The surgical instrument includes an end effector. Control commands are passed directly from the surgical hub to the surgical instrument. The surgical instrument is configured to pass control commands received from the surgical hub to the generator and the smoke evacuation system.

[0193] Example 14 - A surgical system as described in Example 13, wherein the surgical instrument is configured to pass control commands received from the surgical hub to the generator and smoke evacuation system in a daisy chain manner.

[0194] Example 15 - A surgical system comprising a surgical hub, a first surgical instrument, a first generator configured to provide energy to a first end effector, and a second surgical instrument. The first surgical instrument includes a first end effector. Control commands are passed directly from the surgical hub to the first surgical instrument. The first surgical instrument is configured to pass control commands received from the surgical hub to the first generator and the second surgical instrument in a daisy chain manner.

[0195] Example 16 - A surgical system as described in Example 15, wherein the first surgical instrument is configured to modify the control command using a first parameter detected by the first surgical instrument.

[0196] Example 17 - The surgical system of Example 16, wherein the first surgical instrument is configured to pass modified control commands to the second surgical instrument.

[0197] Example 18 - A surgical system as described in Example 17, wherein the second surgical instrument is configured to modify the modified control command using a second parameter detected by the second surgical instrument, and the second surgical instrument is configured to pass the modified control command to the first surgical instrument.

[0198] Example 19 - A surgical system as described in Example 15, wherein the first surgical instrument is configured to detect a first parameter, the second surgical instrument is configured to detect a second parameter, the second surgical instrument is configured to communicate the detected second parameter to the first surgical instrument, and the first surgical instrument is configured to modify the control command using the first parameter detected by the first surgical instrument and the second parameter detected by the second surgical instrument.

[0199] Example 20 - A surgical system described in Examples 15, 16, 17, 18, or 19, wherein the second surgical instrument includes a smoke evacuation system configured to remove smoke from the surgical site.

[0200] While several embodiments have been shown 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 that 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.

[0201] The above detailed description has set forth various aspects of the apparatus and / or processes via the use of block diagrams, flow diagrams and / or examples. To the extent that such block diagrams, flow diagrams and / or examples include one or more functions and / or operations, it will be understood by those skilled in the art that each function and / or operation included in such block diagrams, flow diagrams and / or examples can be individually and / or collectively implemented by various hardware, software, firmware, or virtually any combination thereof. Those skilled in the art will recognize that some aspects of the embodiments disclosed herein may be equivalently implemented in whole or in part on an integrated circuit as one or more computer programs running on one or more computers (e.g., one or more programs running on one or more computer systems), as one or more programs running on one or more processors (e.g., one or more programs running on one or more microprocessors), as firmware, or as substantially 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 this disclosure. In addition, those skilled in the art will recognize that the subject mechanisms described herein may be distributed as one or more program products in a variety of forms, and that the specific forms of the subject matter described herein apply regardless of the particular type of signal-bearing medium used to actually effect the distribution.

[0202] The instructions used to program the logic to implement the various disclosed aspects may be stored in a system memory, such as dynamic random access memory (DRAM), cache, flash memory, or other storage. Additionally, the instructions may be distributed over a network or by other computer-readable media. Thus, machine-readable media 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 memory (CD-ROM), as well as magneto-optical disks, read-only memory (ROM), random access memory (RAM), erasable programmable read-only memory (EPROM), electrically erasable programmable read-only memory (EEPROM), magnetic or optical cards, flash memory, or tangible machine-readable storage used for transmitting information over the Internet via electrical, optical, acoustic, or other forms of propagated signals (e.g., carrier waves, infrared signals, digital signals, etc.). Thus, 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 (e.g., a computer).

[0203] The term "control circuitry" as used in any aspect of the present specification may 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 may be embodied, collectively or individually, 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-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 performs the processes and / or devices described herein, or a microprocessor configured by a computer program that at least partially performs 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 optical-electrical equipment).Those skilled in the art will recognize that the subject matter described herein can be implemented in an analog or digital form, or some combination thereof.

[0204] As used in any aspect of the present specification, 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.

[0205] 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.

[0206] 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 manipulations of physical quantities and / or logical states, which may, but need not, take 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 can be associated with the appropriate physical quantities and are merely convenient labels applied to these quantities and / or states.

[0207] 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 the 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.

[0208] 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 actions and processing of a computer system or similar electronic computing device that manipulates and transforms data represented as physical (electronic) quantities in the computer system's registers and memory into other data similarly represented as physical quantities in the computer system's memory or registers or other such information storage, transmission, or display.

[0209] 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 recognize that "configured to" may generally encompass active and / or inactive and / or standby components, unless the context requires otherwise.

[0210] 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.

[0211] Those skilled 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 skilled 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 below 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.

[0212] In addition, 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 two or more 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 that typically presents two or more alternative terms, whether in the specification, claims, or drawings, should be understood to contemplate the possibility of including one of those terms, either of those terms, or both of those terms, 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."

[0213] 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 or sequences, it should be understood that the various operations may be performed in orders other than those shown, 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.

[0214] 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 appearances of the phrases "in one embodiment," "in an embodiment," "in an example," and "in one example" in various places throughout this specification do not necessarily all refer to the same embodiment. Furthermore, particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments.

[0215] As used herein, unless otherwise indicated, the term "about" or "approximately" as used in this disclosure refers to an acceptable error for a particular value as determined by one of ordinary skill in the art, which depends in part on how the value is measured or determined. In certain embodiments, the term "about" or "approximately" refers to 1, 2, 3, or 4 standard deviations. In certain embodiments, the term "about" or "approximately" refers to within 50%, 20%, 15%, 10%, 9%, 8%, 7%, 6%, 5%, 4%, 3%, 2%, 1%, 0.5%, or 0.05% of a given value or range.

[0216] In this specification, unless otherwise indicated, all numerical parameters should be understood in all instances to be preceded and modified by the term "about," given the inherent variability of the underlying measurement method used to determine the numerical value of the parameter. At the very least, there should be no attempt to limit the application of the doctrine of equivalents to the scope of the claims, and each numerical parameter set forth herein should at least be construed in light of the number of reported significant digits and by applying ordinary rounding techniques.

[0217] Any numerical range described herein includes all subranges subsumed within the described range. For example, the range "1 to 10" includes all subranges between (and including) the recited minimum of 1 and the recited maximum of 10, i.e., all subranges having a minimum of 1 or more and a maximum of 10 or less. Also, all ranges recited herein include the recited range endpoints. For example, the range "1 to 10" includes the endpoints 1 and 10. Every maximum numerical limit described herein is intended to include all lower numerical limits subsumed therein, and every minimum numerical limit described herein is intended to include all higher numerical limits subsumed therein. Accordingly, applicants reserve the right to amend this specification, including the claims, to include every expressly recited subrange that is subsumed within the expressly recited range. All such ranges are inherently described herein.

[0218] 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 material, or portions thereof, that is referred to as being incorporated herein by reference but that conflicts with current definitions, opinions, or other disclosure material set forth herein shall be incorporated only to the extent that no conflict arises between the incorporated material and the current disclosure material.

[0219] In summary, many benefits have been described that result from using the concepts described herein. The above 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 to illustrate the principles and practical applications, thereby enabling those skilled in the art to utilize the various embodiments, with various modifications, as appropriate for the particular use contemplated. It is intended that the claims presented herewith define the overall scope.

[0220] [Embodiment] (1) A surgical system, comprising: 1. A surgical instrument comprising: An end effector, The first Joe, a second jaw, wherein at least one of the first jaw and the second jaw is configured to be moved relative to one another between an open position and a closed position such that tissue is positioned between the first jaw and the second jaw; a surgical instrument including an end effector, a generator configured to provide power to the end effector; a processor configured to execute a control program to operate the surgical system, the processor comprising: Detecting a first parameter of the surgical system; Detecting at least one user input; modifying the control program in response to the detected first parameter and the at least one user input; A processor configured to: A surgical system comprising: (2) A surgical system as described in embodiment 1, wherein the control program is configured to control the power level of the generator. (3) A surgical system as described in embodiment 1, wherein the control program is configured to control a motor, and the motor is configured to move the end effector between the open configuration and the closed configuration. (4) A surgical system as described in embodiment 3, wherein the control program is configured to control the motor via a motor control parameter, and the control program is configured to adjust the motor control parameter in response to the detected first parameter and the detected user input. (5) A surgical system as described in embodiment 1, wherein the first parameter includes an instrument operation parameter.

[0221] (6) A surgical system as described in embodiment 1, wherein the first parameter includes a generator operating parameter. (7) A surgical system as described in embodiment 1, wherein the first parameter includes a status of the end effector. (8) A surgical system as described in embodiment 7, wherein the first parameter indicates whether the end effector is in the open configuration or the closed configuration. (9) The surgical system of embodiment 7, wherein the first parameter indicates whether the tissue is positioned between the first jaw and the second jaw. (10) A surgical system as described in embodiment 1, wherein the surgical instrument is operationally controlled and the generator is a slave control system by default.

[0222] (11) The surgical system of embodiment 10, wherein the control program is configured to operationally control the generator and to configure the surgical instrument as a slave control system in response to the detected first parameter and the detected user input. (12) A surgical system as described in embodiment 1, wherein the first parameter includes a combination of two scales. (13) The surgical system of embodiment 1, further comprising a trigger configured to receive the user input, and the processor configured to interpret a plurality of user inputs received by the trigger, each user input including a different purpose based on a situational use. (14) A surgical system comprising: Surgical instruments; a generator configured to provide power to the surgical instrument; a processor configured to execute a control program to operate the surgical system, the processor comprising: Detecting a status of the surgical instrument; Detecting at least one user input; adapting the control program in response to the detected status of the surgical instrument and the at least one user input; A processor configured to: A surgical system comprising: (15) The surgical system of embodiment 14, wherein the surgical instrument includes an end effector, the end effector being configurable in an open configuration and a closed configuration, and the status of the surgical instrument corresponds to whether the end effector is in the open configuration or the closed configuration.

[0223] (16) The surgical system of embodiment 14, wherein the surgical instrument includes an end effector, the end effector being configurable in an open configuration and a closed configuration, and the status of the surgical instrument corresponds to whether patient tissue is positioned between the first jaw and the second jaw. (17) The surgical system of embodiment 14, further comprising an input member configured to receive the user input, and wherein the processor is configured to interpret a plurality of user inputs received by the input member, each received user input including a different purpose based on a situational use of the surgical system. (18) A surgical system comprising: 1. A surgical instrument comprising: An end effector, The first Joe, a second jaw, wherein at least one of the first jaw and the second jaw is configured to be moved relative to one another between an open position and a closed position such that tissue is positioned between the first jaw and the second jaw; a surgical instrument including an end effector, a generator configured to provide power to the end effector; a processor configured to execute a control program to operate the surgical system, the processor comprising: Sensing a first parameter of the surgical instrument; Detecting a second parameter of the generator; and Detecting at least one user input; modifying the control program in response to the detected first parameter, the detected second parameter, and the at least one user input; A processor configured to: A surgical system comprising: (19) The surgical system of embodiment 18, wherein the first parameter of the surgical instrument corresponds to whether the end effector is in the open configuration or the closed configuration and whether patient tissue is positioned between the first jaw and the second jaw. (20) The surgical system of embodiment 18, wherein the surgical instrument further comprises an input member configured to receive the user input, and the processor is configured to interpret a plurality of user inputs received by the input member, each received user input including a different purpose based on a contextual use of the surgical instrument within the surgical system.

Claims

1. 1. A surgical system comprising:

1. A surgical instrument comprising: An end effector, The first Joe, a second jaw, wherein at least one of the first jaw and the second jaw is configured to be moved relative to one another between an open position and a closed position such that tissue is positioned between the first jaw and the second jaw; a surgical instrument including an end effector, an actuator configured to receive at least one user input, the actuator configured to move at a speed responsive to the at least one user input; a generator configured to provide power to the end effector; a processor configured to execute a control program to operate the surgical system, the processor comprising: Detecting a first parameter of the surgical system; detecting the velocity of the actuator in response to the at least one user input; modifying the control program to control a jaw closing speed in response to the first parameter and the speed of the actuator in response to the at least one user input; A processor configured to: A surgical system comprising:

2. The surgical system of claim 1 , wherein the control program is configured to control a power level of the generator.

3. The surgical system of claim 1 , wherein the control program is configured to control a motor, the motor configured to move the end effector between the open and closed positions.

4. 4. The surgical system of claim 3, wherein the control program is configured to control the motor via a motor control parameter, the control program configured to adjust the motor control parameter in response to the detected first parameter and the at least one user input.

5. The surgical system of claim 1 , wherein the first parameter comprises an instrument actuation parameter.

6. The surgical system of claim 1 , wherein the first parameter comprises a generator operating parameter.

7. The surgical system of claim 1 , wherein the first parameter comprises a status of the end effector.

8. The surgical system of claim 7 , wherein the first parameter indicates whether the end effector is in the open position or the closed position.

9. The surgical system of claim 7 , wherein the first parameter indicates whether the tissue is positioned between the first jaw and the second jaw.

10. The surgical system of claim 1 , wherein the surgical instrument is motion controlled and the generator is a slave control system by default.

11. 11. The surgical system of claim 10, wherein the control program is configured to operationally control the generator and the surgical instrument to the slave control system in response to the detected first parameter and the at least one user input.

12. The surgical system of claim 1 , wherein the first parameter comprises a combination of two measures.

13. 2. The surgical system of claim 1, wherein the actuator further comprises a trigger configured to receive the user input, and the processor is configured to interpret a plurality of the user inputs received by the trigger, each of the user inputs comprising a different purpose based on a situational use.

14. The surgical system of claim 1, wherein the surgical instrument has combined electrosurgical functionality.

15. The surgical system of claim 1, wherein the first parameter includes a thickness of the tissue positioned between the first jaw and the second jaw.

16. The surgical system of claim 14, wherein the combined electrosurgical function includes energy delivery to the tissue positioned between the first jaw and the second jaw, the energy delivery being accomplished by supplying energy to electrodes configured to deliver energy in a monopolar mode, a bipolar mode, and / or a combined monopolar and bipolar mode.

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