Image capture of the outer abdominal region for improving the placement and control of a surgical device in use

Abstract

To provide a system and method for controlling a surgical devices by determining states related with surgical staff members and the surgical devices.SOLUTION: A computer system, such as a surgical hub 211801, can be configured to be communicatively coupled to a surgical device 211810 and a camera 211802 configured to view an operating room. The computer system may be programmed to receive images of surgical staff members 211803 and surgical devices within an operating room during a surgical procedure. The computer system may further determine states or characteristics associated with the surgical staff members and the surgical devices, such as whether a surgical staff member is performing a specific gesture 211804, or a posture of the surgical device such as a surgical instrument, during a surgical procedure. Then, accordingly, the computer system can control the paired surgical devices.SELECTED DRAWING: Figure 16

Description

Technical Field

[0001] (Cross - Reference to Related Applications) This application claims the benefit of U.S. Patent Application No. 16 / 182,269, filed on November 6, 2018, entitled "IMAGE CAPTURING OF THE AREAS OUTSIDE THE ABDOMEN TO IMPROVE PLACEMENT AND CONTROL OF A SURGICAL DEVICE IN USE", the entire disclosure of which is incorporated herein by reference.

[0002] This application claims priority under 35 U.S.C. § 119(e) to U.S. Provisional Patent Application No. 62 / 729,191, filed on September 10, 2018, entitled "SURGICAL NETWORK RECOMMENDATIONS FROM REAL TIME ANALYSIS OF PROCEDURE VARIABLES AGAINST A BASELINE HIGHLIGHTING DIFFERENCES FROM THE OPTIMAL SOLUTION", the entire disclosure of which is incorporated herein by reference.

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

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

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

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

[0007] This application further claims priority under 35 U.S.C. § 119(e) to U.S. Provisional Patent Application No. 62 / 611,341, filed Dec. 28, 2017, entitled “INTERACTIVE SURGICAL PLATFORM”; U.S. Provisional Patent Application No. 62 / 611,340, filed Dec. 28, 2017, entitled “CLOUD-BASED MEDICAL ANALYTICS”; and U.S. Provisional Patent Application No. 62 / 611,339, filed Dec. 28, 2017, entitled “ROBOT ASSISTED SURGICAL PLATFORM,” the entire disclosures of each of which are incorporated herein by reference. BACKGROUND OF THE INVENTION

[0008] The present disclosure relates to various surgical systems. Surgical procedures are typically performed in an operating room or room within a medical facility, such as a hospital. A sterile field is typically formed around the patient. The sterile field can include properly attired and scrubbed team members, as well as all equipment and fixtures within that area. Various surgical devices and systems are utilized to perform surgical procedures. SUMMARY OF THE INVENTION SUMMARY OF SOLUTION TO PROBLEM

[0009] In a general aspect, a computer system is configured to be communicatively coupled to a surgical device and a camera configured to view an operating room. The computer system includes a processor and a memory coupled to the processor. The memory stores instructions that, when executed by the processor, cause the computer system to receive an image of an individual within the operating room via the camera, determine whether the individual is making a gesture based on the image, and control the surgical device in accordance with the gesture.

[0010] In another general aspect, a computer system is configured to be communicatively coupled to a surgical device and a camera configured to view an operating room. The computer system includes a processor and a memory coupled to the processor. The memory stores instructions that, when executed by the processor, cause the computer system to receive an image of the surgical device in the operating room via the camera, determine the pose of the surgical device based on the image, and control the surgical device according to the pose of the surgical device.

[0011] In yet another general aspect, a computer system is configured to be communicatively coupled to a surgical device and a camera configured to view an operating room. The computer system includes a processor and a memory coupled to the processor. The memory stores instructions that, when executed by the processor, cause the computer system to receive an image of the surgical device or a person in the operating room via the camera, determine the pose of the surgical device based on the image according to whether the image is an image of the surgical device, determine whether the person is making a gesture based on the image according to whether the image is an image of the person, and control the surgical device according to at least one of the pose of the surgical device or the gesture.

Brief Description of the Drawings

[0012] The novel features of the various aspects are specifically set forth in the appended "Claims". However, the described forms can be best understood with reference to the following description, taken in conjunction with the accompanying drawings, in terms of both structure and method of operation.

[0013] Regarding both the mechanism and the method of operation, the various aspects described herein can be best understood by reference to the following description, in conjunction with the accompanying drawings below, along with their further objectives and advantages.

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DETAILED DESCRIPTION OF THE INVENTION

[0014] The applicant of the present application owns the following U.S. patent applications filed on November 6, 2018, the entire disclosures of each of which are incorporated herein by reference. · U.S. Patent Application No. 16 / 182,224 entitled "SURGICAL NETWORK, INSTRUMENT, AND CLOUD RESPONSES BASED ON VALIDATION OF RECEIVED DATASET AND AUTHENTICATION OF ITS SOURCE AND INTEGRITY", · U.S. Patent Application No. 16 / 182,230 entitled "SURGICAL SYSTEM FOR PRESENTING INFORMATION INTERPRETED FROM EXTERNAL DATA", · U.S. Patent Application No. 16 / 182,233 entitled "MODIFICATION OF SURGICAL SYSTEMS CONTROL PROGRAMS BASED ON MACHINE LEARNING", · U.S. Patent Application No. 16 / 182,239 entitled "ADJUSTMENT OF DEVICE CONTROL PROGRAMS BASED ON STRATIFIED CONTEXTUAL DATA IN ADDITION TO THE DATA", · U.S. Patent Application No. 16 / 182,243 entitled "SURGICAL HUB AND MODULAR DEVICE RESPONSE ADJUSTMENT BASED ON SITUATIONAL AWARENESS", · U.S. Patent Application No. 16 / 182,248 entitled "DETECTION AND ESCALATION OF SECURITY RESPONSES OF SURGICAL INSTRUMENTS TO INCREASING SEVERITY THREATS", · U.S. Patent Application No. 16 / 182,251 entitled "INTERACTIVE SURGICAL SYSTEM", · U.S. Patent Application No. 16 / 182,260 entitled "AUTOMATED DATA SCALING, ALIGNMENT, AND ORGANIZING BASED ON PREDEFINED PARAMETERS WITHIN SURGICAL NETWORKS", · U.S. Patent Application No. 16 / 182,267 entitled "SENSING THE PATIENT POSITION AND CONTACT UTILIZING THE MONO-POLAR RETURN PAD ELECTRODE TO PROVIDE SITUATIONAL AWARENESS TO A SURGICAL NETWORK", · U.S. Patent Application No. 16 / 182,249 entitled "POWERED SURGICAL TOOL WITH PREDEFINED ADJUSTABLE CONTROL ALGORITHM FOR CONTROLLING END EFFECTOR PARAMETER", · U.S. Patent Application No. 16 / 182,246 entitled "ADJUSTMENTS BASED ON AIRBORNE PARTICLE PROPERTIES", · U.S. Patent Application No. 16 / 182,256 entitled "ADJUSTMENT OF A SURGICAL DEVICE FUNCTION BASED ON SITUATIONAL AWARENESS", · U.S. Patent Application No. 16 / 182,242 entitled "REAL-TIME ANALYSIS OF COMPREHENSIVE COST OF ALL INSTRUMENTATION USED IN SURGERY UTILIZING DATA FLUIDITY TO TRACK INSTRUMENTS THROUGH STOCKING AND IN-HOUSE PROCESSES", · U.S. Patent Application No. 16 / 182,255 entitled "USAGE AND TECHNIQUE ANALYSIS OF SURGEON / STAFF PERFORMANCE AGAINST A BASELINE TO OPTIMIZE DEVICE UTILIZATION AND PERFORMANCE FOR BOTH CURRENT AND FUTURE PROCEDURES", · U.S. Patent Application No. 16 / 182,278 entitled "COMMUNICATION OF DATA WHERE A SURGICAL NETWORK IS USING CONTEXT OF THE DATA AND REQUIREMENTS OF A RECEIVING SYSTEM / USER TO INFLUENCE INCLUSION OR LINKAGE OF DATA AND METADATA TO ESTABLISH CONTINUITY", · U.S. Patent Application No. 16 / 182,290 entitled "SURGICAL NETWORK RECOMMENDATIONS FROM REAL TIME ANALYSIS OF PROCEDURE VARIABLES AGAINST A BASELINE HIGHLIGHTING DIFFERENCES FROM THE OPTIMAL SOLUTION", · U.S. Patent Application No. 16 / 182,232 entitled "CONTROL OF A SURGICAL SYSTEM THROUGH A SURGICAL BARRIER", · U.S. Patent Application No. 16 / 182,227 entitled "SURGICAL NETWORK DETERMINATION OF PRIORITIZATION OF COMMUNICATION, INTERACTION, OR PROCESSING BASED ON SYSTEM OR DEVICE NEEDS", · U.S. Patent Application No. 16 / 182,231 entitled "WIRELESS PAIRING OF A SURGICAL DEVICE WITH ANOTHER DEVICE WITHIN A STERILE SURGICAL FIELD BASED ON THE USAGE AND SITUATIONAL AWARENESS OF DEVICES", · U.S. Patent Application No. 16 / 182,229 entitled "ADJUSTMENT OF STAPLE HEIGHT OF AT LEAST ONE ROW OF STAPLES BASED ON THE SENSED TISSUE THICKNESS OR FORCE IN CLOSING", · U.S. Patent Application No. 16 / 182,234 entitled "STAPLING DEVICE WITH BOTH COMPULSORY AND DISCRETIONARY LOCKOUTS BASED ON SENSED PARAMETERS", · U.S. Patent Application No. 16 / 182,240 entitled "POWERED STAPLING DEVICE CONFIGURED TO ADJUST FORCE, ADVANCEMENT SPEED, AND OVERALL STROKE OF CUTTING MEMBER BASED ON SENSED PARAMETER OF FIRING OR CLAMPING", · U.S. Patent Application No. 16 / 182,235 entitled "VARIATION OF RADIO FREQUENCY AND ULTRASONIC POWER LEVEL IN COOPERATION WITH VARYING CLAMP ARM PRESSURE TO ACHIEVE PREDEFINED HEAT FLUX OR POWER APPLIED TO TISSUE", and · U.S. Patent Application No. 16 / 182,238 entitled "ULTRASONIC ENERGY DEVICE WHICH VARIES PRESSURE APPLIED BY CLAMP ARM TO PROVIDE THRESHOLD CONTROL PRESSURE AT A CUT PROGRESSION LOCATION".

[0015] The applicant of the present application owns the following U.S. patent applications filed on September 10, 2018, the entire disclosure of each of which is incorporated herein by reference. · U.S. Provisional Patent Application No. 62 / 729,183 entitled "A CONTROL FOR A SURGICAL NETWORK OR SURGICAL NETWORK CONNECTED DEVICE THAT ADJUSTS ITS FUNCTION BASED ON A SENSED SITUATION OR USAGE", · U.S. Provisional Patent Application No. 62 / 729,177 entitled "AUTOMATED DATA SCALING, ALIGNMENT, AND ORGANIZING BASED ON PREDEFINED PARAMETERS WITHIN A SURGICAL NETWORK BEFORE TRANSMISSION", · U.S. Provisional Patent Application No. 62 / 729,176 entitled "INDIRECT COMMAND AND CONTROL OF A FIRST OPERATING ROOM SYSTEM THROUGH THE USE OF A SECOND OPERATING ROOM SYSTEM WITHIN A STERILE FIELD WHERE THE SECOND OPERATING ROOM SYSTEM HAS PRIMARY AND SECONDARY OPERATING MODES", · U.S. Provisional Patent Application No. 62 / 729,185 entitled "POWERED STAPLING DEVICE THAT IS CAPABLE OF ADJUSTING FORCE, ADVANCEMENT SPEED, AND OVERALL STROKE OF CUTTING MEMBER OF THE DEVICE BASED ON SENSED PARAMETER OF FIRING OR CLAMPING", · U.S. Provisional Patent Application No. 62 / 729,184 entitled "POWERED SURGICAL TOOL WITH A PREDEFINED ADJUSTABLE CONTROL ALGORITHM FOR CONTROLLING AT LEAST ONE END EFFECTOR PARAMETER AND A MEANS FOR LIMITING THE ADJUSTMENT", · U.S. Provisional Patent Application No. 62 / 729,182, entitled "SENSING THE PATIENT POSITION AND CONTACT UTILIZING THE MONO POLAR RETURN PAD ELECTRODE TO PROVIDE SITUATIONAL AWARENESS TO THE HUB", · U.S. Provisional Patent Application No. 62 / 729,191, entitled "SURGICAL NETWORK RECOMMENDATIONS FROM REAL TIME ANALYSIS OF PROCEDURE VARIABLES AGAINST A BASELINE HIGHLIGHTING DIFFERENCES FROM THE OPTIMAL SOLUTION", · U.S. Provisional Patent Application No. 62 / 729,195, entitled "ULTRASONIC ENERGY DEVICE WHICH VARIES PRESSURE APPLIED BY CLAMP ARM TO PROVIDE THRESHOLD CONTROL PRESSURE AT A CUT PROGRESSION LOCATION", and · U.S. Provisional Patent Application No. 62 / 729,186, entitled "WIRELESS PAIRING OF A SURGICAL DEVICE WITH ANOTHER DEVICE WITHIN A STERILE SURGICAL FIELD BASED ON THE USAGE AND SITUATIONAL AWARENESS OF DEVICES".

[0016] The applicant of the present application owns the following U.S. patent applications filed on August 28, 2018, the entire disclosures of each of which are incorporated herein by reference. · U.S. Patent Application No. 16 / 115,214, entitled "ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR", · U.S. Patent Application No. 16 / 115,205 entitled "Temperature Control of Ultrasonic End Effector and Control System Therefor", · U.S. Patent Application No. 16 / 115,233 entitled "Radio Frequency Energy Device for Delivering Combined Electrical Signals", · U.S. Patent Application No. 16 / 115,208 entitled "Controlling an Ultrasonic Surgical Instrument According to Tissue Location", · U.S. Patent Application No. 16 / 115,220 entitled "Controlling Activation of an Ultrasonic Surgical Instrument According to the Presence of Tissue", · U.S. Patent Application No. 16 / 115,232 entitled "Determining Tissue Composition Via an Ultrasonic System", · U.S. Patent Application No. 16 / 115,239 entitled "Determining the State of an Ultrasonic Electromechanical System According to Frequency Shift", · U.S. Patent Application No. 16 / 115,247 entitled "Determining the State of an Ultrasonic End Effector", · U.S. Patent Application No. 16 / 115,211 entitled "Situational Awareness of Electrosurgical Systems", · U.S. Patent Application No. 16 / 115,226 entitled "Mechanisms for Controlling Different Electromechanical Systems of an Electrosurgical Instrument", · U.S. Patent Application No. 16 / 115,240, entitled "DETECTION OF END EFFECTOR IMMERSION IN LIQUID", · U.S. Patent Application No. 16 / 115,249, entitled "INTERRUPTION OF ENERGY DUE TO INADVERTENT CAPACITIVE COUPLING", · U.S. Patent Application No. 16 / 115,256, entitled "INCREASING RADIO FREQUENCY TO CREATE PAD-LESS MONOPOLAR LOOP", · U.S. Patent Application No. 16 / 115,223, entitled "BIPOLAR COMBINATION DEVICE THAT AUTOMATICALLY ADJUSTS PRESSURE BASED ON ENERGY MODALITY", and · U.S. Patent Application No. 16 / 115,238, entitled "ACTIVATION OF ENERGY DEVICES".

[0017] The applicant of the present application owns the following U.S. patent applications filed on August 23, 2018, the entire disclosures of each of which are incorporated herein by reference. · U.S. Provisional Patent Application No. 62 / 721,995, entitled "CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO TISSUE LOCATION", · U.S. Provisional Patent Application No. 62 / 721,998, entitled "SITUATIONAL AWARENESS OF ELECTROSURGICAL SYSTEMS", · U.S. Provisional Patent Application No. 62 / 721,999, entitled "INTERRUPTION OF ENERGY DUE TO INADVERTENT CAPACITIVE COUPLING", · U.S. Provisional Patent Application No. 62 / 721,994 entitled "BIPOLAR COMBINATION DEVICE THAT AUTOMATICALLY ADJUSTS PRESSURE BASED ON ENERGY MODALITY", and · U.S. Provisional Patent Application No. 62 / 721,996 entitled "RADIO FREQUENCY ENERGY DEVICE FOR DELIVERING COMBINED ELECTRICAL SIGNALS".

[0018] The applicant of the present application owns the following U.S. patent applications filed on June 30, 2018, the entire disclosures of each of which are incorporated herein by reference. · U.S. Provisional Patent Application No. 62 / 692,747 entitled "SMART ACTIVATION OF AN ENERGY DEVICE BY ANOTHER DEVICE", · U.S. Provisional Patent Application No. 62 / 692,748 entitled "SMART ENERGY ARCHITECTURE", and · U.S. Provisional Patent Application No. 62 / 692,768 entitled "SMART ENERGY DEVICES".

[0019] The applicant of the present application owns the following U.S. patent applications filed on June 29, 2018, the entire disclosures of each of which are incorporated herein by reference. · U.S. Patent Application No. 16 / 024,090 entitled "CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS", · U.S. Patent Application No. 16 / 024,057 entitled "CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSED CLOSURE PARAMETERS", · U.S. Patent Application No. 16 / 024,067 entitled "SYSTEMS FOR ADJUSTING END EFFECTOR PARAMETERS BASED ON PERIOPERATIVE INFORMATION", · U.S. Patent Application No. 16 / 024,075 entitled "SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING", · U.S. Patent Application No. 16 / 024,083 entitled "SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING", · U.S. Patent Application No. 16 / 024,094 entitled "SURGICAL SYSTEMS FOR DETECTING END EFFECTOR TISSUE DISTRIBUTION IRREGULARITIES", · U.S. Patent Application No. 16 / 024,138 entitled "SYSTEMS FOR DETECTING PROXIMITY OF SURGICAL END EFFECTOR TO CANCEROUS TISSUE", · U.S. Patent Application No. 16 / 024,150 entitled "SURGICAL INSTRUMENT CARTRIDGE SENSOR ASSEMBLIES", · U.S. Patent Application No. 16 / 024,160 entitled "VARIABLE OUTPUT CARTRIDGE SENSOR ASSEMBLY", · U.S. Patent Application No. 16 / 024,124 entitled "SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE", · U.S. Patent Application No. 16 / 024,132 entitled "SURGICAL INSTRUMENT HAVING A FLEXIBLE CIRCUIT", · U.S. Patent Application No. 16 / 024,141 entitled "SURGICAL INSTRUMENT WITH A TISSUE MARKING ASSEMBLY", · U.S. Patent Application No. 16 / 024,162 entitled "SURGICAL SYSTEMS WITH PRIORITIZED DATA TRANSMISSION CAPABILITIES", · U.S. Patent Application No. 16 / 024,066 entitled "SURGICAL EVACUATION SENSING AND MOTOR CONTROL", · U.S. Patent Application No. 16 / 024,096 entitled "SURGICAL EVACUATION SENSOR ARRANGEMENTS", · U.S. Patent Application No. 16 / 024,116 entitled "SURGICAL EVACUATION FLOW PATHS", · U.S. Patent Application No. 16 / 024,149 entitled "SURGICAL EVACUATION SENSING AND GENERATOR CONTROL", · U.S. Patent Application No. 16 / 024,180 entitled "SURGICAL EVACUATION SENSING AND DISPLAY", · U.S. Patent Application No. 16 / 024,245 entitled "COMMUNICATION OF SMOKE EVACUATION SYSTEM PARAMETERS TO HUB OR CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM", · U.S. Patent Application No. 16 / 024,258 entitled "SMOKE EVACUATION SYSTEM INCLUDING A SEGMENTED CONTROL CIRCUIT FOR INTERACTIVE SURGICAL PLATFORM", · U.S. Patent Application No. 16 / 024,265 entitled "SURGICAL EVACUATION SYSTEM WITH A COMMUNICATION CIRCUIT FOR COMMUNICATION BETWEEN A FILTER AND A SMOKE EVACUATION DEVICE, and · U.S. Patent Application No. 16 / 024,273 entitled "DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS".

[0020] The applicant of the present application owns the following U.S. Provisional Patent Applications filed on June 28, 2018, the entire disclosures of each of which are incorporated herein by reference. · U.S. Provisional Patent Application No. 62 / 691,228 entitled "A METHOD OF USING REINFORCED FLEX CIRCUITS WITH MULTIPLE SENSORS WITH ELECTROSURGICAL DEVICES", · U.S. Provisional Patent Application No. 62 / 691,227 entitled "CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSED CLOSURE PARAMETERS", · U.S. Provisional Patent Application No. 62 / 691,230 entitled "SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE", · U.S. Provisional Patent Application No. 62 / 691,219 entitled "SURGICAL EVACUATION SENSING AND MOTOR CONTROL", · U.S. Provisional Patent Application No. 62 / 691,257 entitled "COMMUNICATION OF SMOKE EVACUATION SYSTEM PARAMETERS TO HUB OR CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM", · U.S. Provisional Patent Application No. 62 / 691,262 entitled "SURGICAL EVACUATION SYSTEM WITH A COMMUNICATION CIRCUIT FOR COMMUNICATION BETWEEN A FILTER AND A SMOKE EVACUATION DEVICE", and · U.S. Provisional Patent Application No. 62 / 691,251 entitled "DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS".

[0021] The applicant of the present application owns the following U.S. Provisional Patent Applications filed on April 19, 2018, the entire disclosures of each of which are incorporated herein by reference. · U.S. Provisional Patent Application No. 62 / 659,900 entitled "METHOD OF HUB COMMUNICATION".

[0022] The applicant of the present application owns the following U.S. Provisional Patent Applications filed on March 30, 2018, the entire disclosure of each of which is incorporated herein by reference. · U.S. Provisional Patent Application No. 62 / 650,898 filed on March 30, 2018, entitled "CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS", · U.S. Provisional Patent Application No. 62 / 650,887 filed on March 30, 2018, entitled "SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES", · U.S. Provisional Patent Application No. 62 / 650,882 filed on March 30, 2018, entitled "SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM", and · U.S. Provisional Patent Application No. 62 / 650,877 filed on March 30, 2018, entitled "SURGICAL SMOKE EVACUATION SENSING AND CONTROLS".

[0023] The applicant of the present application owns the following U.S. Patent Applications filed on March 29, 2018, the entire disclosure of each of which is incorporated herein by reference. · U.S. Patent Application No. 15 / 940,641 filed on March 29, 2018, entitled "INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES", · U.S. Patent Application No. 15 / 940,648 filed on March 29, 2018, entitled "INTERACTIVE SURGICAL SYSTEMS WITH CONDITION HANDLING OF DEVICES AND DATA CAPABILITIES", · U.S. Patent Application No. 15 / 940,656 entitled "SURGICAL HUB COORDINATION OF CONTROL AND COMMUNICATION OF OPERATING ROOM DEVICES", · U.S. Patent Application No. 15 / 940,666 entitled "SPATIAL AWARENESS OF SURGICAL HUBS IN OPERATING ROOMS", · U.S. Patent Application No. 15 / 940,670 entitled "COOPERATIVE UTILIZATION OF DATA DERIVED FROM SECONDARY SOURCES BY INTELLIGENT SURGICAL HUBS", · U.S. Patent Application No. 15 / 940,677 entitled "SURGICAL HUB CONTROL ARRANGEMENTS", · U.S. Patent Application No. 15 / 940,632 entitled "DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD", · U.S. Patent Application No. 15 / 940,640 entitled "COMMUNICATION HUB AND STORAGE DEVICE FOR STORING PARAMETERS AND STATUS OF A SURGICAL DEVICE TO BE SHARED WITH CLOUD BASED ANALYTICS SYSTEMS", · U.S. Patent Application No. 15 / 940,645 entitled "SELF DESCRIBING DATA PACKETS GENERATED AT AN ISSUING INSTRUMENT", · U.S. Patent Application No. 15 / 940,649 entitled "DATA PAIRING TO INTERCONNECT A DEVICE MEASURED PARAMETER WITH AN OUTCOME", · U.S. Patent Application No. 15 / 940,654 entitled "SURGICAL HUB SITUATIONAL AWARENESS", · U.S. Patent Application No. 15 / 940,663 entitled "SURGICAL SYSTEM DISTRIBUTED PROCESSING", · U.S. Patent Application No. 15 / 940,668 entitled "AGGREGATION AND REPORTING OF SURGICAL HUB DATA", · U.S. Patent Application No. 15 / 940,671 entitled "SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER", · U.S. Patent Application No. 15 / 940,686 entitled "DISPLAY OF ALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LINEAR STAPLE LINE", · U.S. Patent Application No. 15 / 940,700 entitled "STERILE FIELD INTERACTIVE CONTROL DISPLAYS", · U.S. Patent Application No. 15 / 940,629 entitled "COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS", · U.S. Patent Application No. 15 / 940,704 entitled "USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT", · U.S. Patent Application No. 15 / 940,722 entitled "CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OF MONO-CHROMATIC LIGHT REFRACTIVITY", · U.S. Patent Application No. 15 / 940,742 entitled "DUAL CMOS ARRAY IMAGING", · U.S. Patent Application No. 15 / 940,636 entitled "ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES", · U.S. Patent Application No. 15 / 940,653 entitled "ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL HUBS" · U.S. Patent Application No. 15 / 940,660 entitled "CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER" · U.S. Patent Application No. 15 / 940,679 entitled "CLOUD-BASED MEDICAL ANALYTICS FOR LINKING OF LOCAL USAGE TRENDS WITH THE RESOURCE ACQUISITION BEHAVIORS OF LARGER DATA SET" · U.S. Patent Application No. 15 / 940,694 entitled "CLOUD-BASED MEDICAL ANALYTICS FOR MEDICAL FACILITY SEGMENTED INDIVIDUALIZATION OF INSTRUMENT FUNCTION" · U.S. Patent Application No. 15 / 940,634 entitled "CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES" · U.S. Patent Application No. 15 / 940,706 entitled "DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK" · U.S. Patent Application No. 15 / 940,675 entitled "CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES" · U.S. Patent Application No. 15 / 940,627 entitled "DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS" · U.S. Patent Application No. 15 / 940,637, entitled "COMMUNICATION ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS", · U.S. Patent Application No. 15 / 940,642, entitled "CONTROLS FOR ROBOT-ASSISTED SURGICAL PLATFORMS", · U.S. Patent Application No. 15 / 940,676, entitled "AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS", · U.S. Patent Application No. 15 / 940,680, entitled "CONTROLLERS FOR ROBOT-ASSISTED SURGICAL PLATFORMS", · U.S. Patent Application No. 15 / 940,683, entitled "COOPERATIVE SURGICAL ACTIONS FOR ROBOT-ASSISTED SURGICAL PLATFORMS", · U.S. Patent Application No. 15 / 940,690, entitled "DISPLAY ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS", and · U.S. Patent Application No. 15 / 940,711, entitled "SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS".

[0024] The applicant of the present application owns the following U.S. Provisional Patent Applications filed on March 28, 2018, the entire disclosures of each of which are incorporated herein by reference. · U.S. Provisional Patent Application No. 62 / 649,302, entitled "INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES", · U.S. Provisional Patent Application No. 62 / 649,294, entitled "DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD", · U.S. Provisional Patent Application No. 62 / 649,300 entitled "SURGICAL HUB SITUATIONAL AWARENESS", · U.S. Provisional Patent Application No. 62 / 649,309 entitled "SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER", · U.S. Provisional Patent Application No. 62 / 649,310 entitled "COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS", · U.S. Provisional Patent Application No. 62 / 649,291 entitled "USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT", · U.S. Provisional Patent Application No. 62 / 649,296 entitled "ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES", · U.S. Provisional Patent Application No. 62 / 649,333 entitled "CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER", · U.S. Provisional Patent Application No. 62 / 649,327 entitled "CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES", · U.S. Provisional Patent Application No. 62 / 649,315 entitled "DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK", · U.S. Provisional Patent Application No. 62 / 649,313 entitled "CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES", · U.S. Provisional Patent Application No. 62 / 649,320 entitled "DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS", · U.S. Provisional Patent Application No. 62 / 649,307 entitled "AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS", and · U.S. Provisional Patent Application No. 62 / 649,323 entitled "SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS".

[0025] The applicant of the present application owns the following U.S. provisional patent applications filed on March 8, 2018, the entire disclosure of each of which is incorporated herein by reference. · U.S. Provisional Patent Application No. 62 / 640,417 entitled "TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR", and · U.S. Provisional Patent Application No. 62 / 640,415 entitled "ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR".

[0026] The applicant of the present application owns the following U.S. provisional patent applications filed on December 28, 2017, the entire disclosure of each of which is incorporated herein by reference. · U.S. Provisional Patent Application No. 62 / 611,341 entitled "INTERACTIVE SURGICAL PLATFORM", · U.S. Provisional Patent Application No. 62 / 611,340 entitled "CLOUD-BASED MEDICAL ANALYTICS", and · U.S. Provisional Patent Application No. 62 / 611,339 entitled "ROBOT ASSISTED SURGICAL PLATFORM".

[0027] Before detailing the various aspects of the surgical device and generator, it should be noted that the exemplary embodiments are not limited in their application or use to the details of the structure and arrangement of the components shown in the accompanying drawings and description. The exemplary embodiments may be implemented in or incorporated with other aspects, variations, and modifications, and may be carried out or executed in various ways. Further, unless otherwise specified, the terms and expressions used herein are selected for the purpose of describing the exemplary embodiments for the convenience of the reader and are not intended to be limiting. Further, it should be understood that one or more of the aspects, implementations, and / or embodiments described below can be combined with any one or more of the other aspects, implementations, and / or embodiments described below.

[0028] Surgical hub Referring to FIG. 1, a computer-implemented interactive surgical system 100 includes one or more surgical systems 102 and a cloud-based system (e.g., cloud 104 that may include a remote server 113 coupled to a storage device 105). Each surgical system 102 includes at least one surgical hub 106 that communicates with the cloud 104 that may include a remote server 113. In one embodiment, as shown in FIG. 1, the surgical system 102 includes a visualization system 108, a robotic system 110, and a handheld intelligent surgical instrument 112 that are configured to communicate with each other and / or with the hub 106. In some aspects, the surgical system 102 may include M surgical hubs 106, N visualization systems 108, O robotic systems 110, and P handheld intelligent surgical instruments 112, where M, N, O, and P are integers greater than or equal to 1.

[0029] FIG. 2 shows an example of a surgical system 102 used to perform a surgical procedure on a patient lying on an operating table 114 within an operating room 116. A robotic system 110 is used as part of the surgical system 102 in the surgical procedure. The robotic system 110 includes a surgeon's console 118, a patient-side cart 120 (surgical robot), and a surgical robot hub 122. The patient-side cart 120 can operate at least one removably coupled surgical tool 117 while the surgeon views the surgical site through the surgeon's console 118 during minimally invasive incision of the patient's body. An image of the surgical site can be obtained by a medical imaging device 124, and the medical imaging device 124 can be operated by the patient-side cart 120 to orient the imaging device 124. The robot hub 122 can be used to process an image of the surgical site for subsequent display to the surgeon via the surgeon's console 118.

[0030] Other types of robotic systems can be easily adapted for use with the surgical system 102. Various examples of robotic systems and surgical tools suitable for use with the present disclosure are described in U.S. Patent Provisional Application No. 62 / 611,339, filed Dec. 28, 2017, entitled "ROBOT ASSISTED SURGICAL PLATFORM", the disclosure of which is incorporated herein by reference in its entirety.

[0031] Various examples of cloud-based analysis implemented by the cloud 104 and suitable for use with the present disclosure are described in U.S. Patent Provisional Application No. 62 / 611,340, filed Dec. 28, 2017, entitled "CLOUD-BASED MEDICAL ANALYTICS", the disclosure of which is incorporated herein by reference in its entirety.

[0032] In various aspects, the imaging device 124 includes at least one image sensor and one or more optical components. Suitable image sensors include, but are not limited to, Charge-Coupled Device (CCD) sensors and Complementary Metal-Oxide Semiconductor (CMOS) sensors.

[0033] The optical components of the imaging device 124 may include one or more illumination light sources and / or one or more lenses. One or more illumination light sources may be directed to illuminate a portion of the surgical field. One or more image sensors can receive light reflected or refracted from the surgical field, including light reflected or refracted from tissue and / or surgical instruments.

[0034] One or more illumination light sources can be configured to emit electromagnetic energy within the visible and invisible spectra. The visible spectrum, sometimes referred to as the optical spectrum or emission spectrum, is a portion of the electromagnetic spectrum that is visible to the human eye (i.e., detectable by the human eye) and is sometimes referred to as visible light, or simply light. A typical human eye responds to wavelengths of approximately 380 nm to approximately 750 nm in air.

[0035] The invisible spectrum (i.e., the non-emission spectrum) is a portion of the electromagnetic spectrum that is located below and above the visible spectrum (i.e., wavelengths less than approximately 380 nm and greater than approximately 750 nm). The invisible spectrum is not detectable by the human eye. Wavelengths greater than approximately 750 nm are longer than the red visible spectrum and become invisible infrared (IR), microwaves, and radio electromagnetic radiation. Wavelengths less than approximately 380 nm are shorter than the violet spectrum and become invisible ultraviolet, X-rays, and gamma-ray electromagnetic radiation.

[0036] In various aspects, the imaging device 124 is configured for use in minimally invasive surgery. Examples of imaging devices suitable for use with the present disclosure include, but are not limited to, arthroscopes, angioscopes, bronchoscopes, choledochoscopes, colonoscopes, cytoscopes, duodenoscopes, enteroscopes, esophagogastroduodenoscopes (gastroscopes), endoscopes, laryngoscopes, nasopharyngo-neproscopes, sigmoidoscopes, thoracoscopes, and ureteroscopes.

[0037] In one aspect, the imaging device uses multispectral monitoring to distinguish topography from underlying structures. A multispectral image captures image data within a specific wavelength range across the electromagnetic spectrum. The wavelengths can be separated by filters or by using instruments sensitive to light from specific wavelengths, such as IR and ultraviolet light, beyond the visible light range. Spectral imaging methods can enable the extraction of additional information that the human eye cannot capture with its red, green, and blue receptors. The use of multispectral imaging methods is described in detail in the "Advanced Imaging Acquisition Module" of U.S. Provisional Patent Application No. 62 / 611,341, filed December 28, 2017, entitled "INTERACTIVE SURGICAL PLATFORM," the disclosure of which is hereby incorporated by reference in its entirety. Multispectral monitoring can be a useful tool for repositioning the surgical field to perform one or more of the above tests on the treated tissue after one surgical operation has been completed.

[0038] It is self-evident that strict sterilization of the operating room and surgical instruments is required in any surgical procedure. The strict hygiene and sterilization conditions required in the "surgical theater", i.e., the operating room or treatment room, require the highest level of sterility for all medical devices and instruments. Part of that sterilization process is the need to sterilize anything that comes into contact with the patient or enters the sterile field, including the imaging device 124 and its accessories and components. It will be understood that the sterile field can be considered a specific area, such as within a tray or on a sterile towel, that is considered free of microorganisms, or the sterile field can be considered the area immediately surrounding the patient prepared for the surgical procedure. The sterile field can include scrubbed team members wearing appropriate clothing, as well as all supplies and fixtures within that area.

[0039] In various aspects, the visualization system 108 includes, as shown in FIG. 2, one or more imaging sensors strategically positioned relative to the sterile field, one or more image processing units, one or more storage arrays, and one or more displays. In one aspect, the visualization system 108 includes interfaces for HL7, PACS, and EMR. For the various components of the visualization system 108, the disclosure is described in the "Advanced Imaging Acquisition Module" section of U.S. Patent Provisional Application No. 62 / 611,341, filed Dec. 28, 2017, entitled "INTERACTIVE SURGICAL PLATFORM", the entire disclosure of which is incorporated herein by reference.

[0040] As shown in FIG. 2, the primary display 119 is disposed within the sterile field so as to be visible to the operator of the operating table 114. In addition, the visualization tower 111 is positioned outside the sterile field. The visualization tower 111 includes a first non-sterile display 107 and a second non-sterile display 109 that face away from each other. The visualization system 108 guided by the hub 106 is configured to utilize the displays 107, 109, and 119 to coordinate the flow of information to the operators inside and outside the sterile field. For example, the hub 106 can cause the visualization system 108 to display a snapshot of the surgical site recorded by the imaging device 124 on the non-sterile display 107 or 109 while maintaining a live video of the surgical site on the primary display 119. The snapshot on the non-sterile display 107 or 109 can, for example, enable a non-sterile operator to perform diagnostic steps related to the surgical procedure.

[0041] In one aspect, the hub 106 is also configured to send diagnostic inputs or feedback entered by a non-sterile operator located at the visualization tower 111 within the sterile field to the primary display 119 within the sterile area, where it can be viewed by the sterile operator of the operating table. In one embodiment, the input may be in the form of a modification to a snapshot displayed on the non-sterile display 107 or 109 that can be sent by the hub 106 to the primary display 119.

[0042] Referring to FIG. 2, surgical instrument 112 is being used as part of surgical system 102 in a surgical procedure. Hub 106 is also configured to regulate the flow of information to the display of surgical instrument 112. For example, the regulation of the information flow is further described in U.S. Provisional Patent Application No. 62 / 611,341, filed Dec. 28, 2017, entitled “INTERACTIVE SURGICAL PLATFORM,” the entire disclosure of which is incorporated herein by reference. Diagnostic inputs or feedback entered by a non-sterile operator at visualization tower 111 may be sent by hub 106 to surgical instrument display 115 within the sterile field, where the diagnostic inputs or feedback may be viewed by the operator of surgical instrument 112. Examples of exemplary surgical instruments suitable for use with surgical system 102 are described, for example, in the “Surgical Instrument Hardware” section of U.S. Provisional Patent Application No. 62 / 611,341, filed Dec. 28, 2017, entitled “INTERACTIVE SURGICAL PLATFORM,” the entire disclosure of which is incorporated herein by reference.

[0043] Referring now to FIG. 3, hub 106 is shown in communication with visualization system 108, robotic system 110, and handheld intelligent surgical instrument 112. Hub 106 includes hub display 135, imaging module 138, generator module 140 (which can include monopolar generator 142, bipolar generator 144, and / or ultrasonic generator 143), communication module 130, processor module 132, and storage array 134. In certain aspects, as shown in FIG. 3, hub 106 further includes smoke evacuation module 126, aspiration / irrigation module 128, and / or OR mapping module 133.

[0044] During a surgical procedure, the application of energy to tissue for sealing and / or cutting generally involves smoke evacuation, aspiration of excess fluid, and / or perfusion of tissue. Fluid, power, and / or data lines from different sources often become entangled during a surgical procedure. Valuable time can be lost in addressing this problem during a surgical procedure. To untangle the lines, it may be necessary to unplug the lines from their corresponding modules, which may require resetting the modules. The modular housing 136 of the hub provides a unified environment for managing power, data, and fluid lines, reducing the frequency of such line entanglements.

[0045] Aspects of the present disclosure present a surgical hub for use in a surgical procedure involving the application of energy to tissue at a surgical site. The surgical hub includes a hub housing and a combined generator module slidably receivable within a docking station of the hub housing. The docking station includes data and power contacts. The combined generator module includes two or more of an ultrasonic energy generator component, a bipolar RF energy generator component, and a monopolar RF energy generator component housed within a single unit. In one aspect, the combined generator module further includes a smoke evacuation component, at least one energy supply cable for connecting the combined generator module to a surgical instrument, at least one smoke evacuation component configured to discharge smoke, fluid, and / or particulates generated by the application of therapeutic energy to tissue, and a fluid line extending from a remote surgical site to the smoke evacuation component.

[0046] In one aspect, the fluid line is a first fluid line, and a second fluid line extends from a remote surgical site to an aspiration and perfusion module slidably received within the hub housing. In one aspect, the hub housing includes a fluid interface.

[0047] Certain surgical procedures may require applying more than one type of energy to tissue. One type of energy may be more beneficial for cutting tissue, while a different type of energy may be more beneficial for sealing tissue. For example, a bipolar generator can be used to seal tissue, while an ultrasonic generator can be used to cut the sealed tissue. Aspects of the present disclosure present a solution in which a modular housing 136 of a hub is configured to accommodate different generators and facilitate two-way communication between them. One advantage of the modular housing 136 of the hub is that it allows for the quick removal and / or replacement of various modules.

[0048] Aspects of the present disclosure present a modular surgical housing for use in surgical procedures involving the application of energy to tissue. The modular surgical housing includes a first energy generator module configured to generate a first energy for application to tissue, and a first docking station having a first docking port that includes first data and power contacts, wherein the first energy generator module is slidably movable to electrically engage with the power and data contacts, and wherein the first energy generator module is also slidably movable to disengage from the electrical engagement with the first power and data contacts.

[0049] In addition to the above, the modular surgical housing further includes a second energy generator module configured to generate a second energy for application to tissue that is different from the first energy, and a second docking station having a second docking port that includes second data and power contacts, wherein the second energy generator module is slidably movable to electrically engage with the power and data contacts, and wherein the second energy generator module is also slidably movable to disengage from the electrical engagement with the second power and data contacts.

[0050] Furthermore, the modular surgical housing further includes a communication bus between a first docking port and a second docking port configured to facilitate communication between a first energy generator module and a second energy generator module.

[0051] Referring to FIGS. 3-7, aspects of the present disclosure are presented with respect to a modular housing 136 of a hub that enables modular integration of a generator module 140, a smoke evacuation module 126, and a suction / irrigation module 128. The modular housing 136 of the hub further facilitates two-way communication between modules 140, 126, 128. As shown in FIG. 5, the generator module 140 may be a generator module comprising integrated monopolar, bipolar, and ultrasonic components supported within a single housing unit 139 slidably insertable into the modular housing 136 of the hub. As shown in FIG. 5, the generator module 140 may be configured to connect to a monopolar device 146, a bipolar device 147, and an ultrasonic device 148. Alternatively, the generator module 140 may comprise a series of monopolar, bipolar, and / or ultrasonic generator modules that interact via the modular housing 136 of the hub. The modular housing 136 of the hub may be configured to facilitate the insertion of multiple generators and two-way communication between the generators docked to the modular housing 136 such that the multiple generators function as a single generator.

[0052] In one aspect, the modular housing 136 of the hub comprises a modular power and communication backplane 149 with external and wireless communication headers to enable removable attachment of modules 140, 126, 128 and two-way communication between them.

[0053] In one aspect, the modular housing 136 of the hub includes a docking station or drawer 151, also referred to herein as a drawer, configured to slidably receive modules 140, 126, 128. FIG. 4 shows a partial perspective view of a surgical hub housing 136 and a combined generator module 145 slidably receivable in the docking station 151 of the surgical hub housing 136. A docking port 152 having power and data contacts on the rear side of the combined generator module 145 is configured to engage a corresponding docking port 150 with the power and data contacts of the corresponding docking station 151 of the modular housing 136 of the hub when the combined generator module 145 is slid into position within the corresponding docking station 151 of the modular housing 136 of the hub. In one aspect, the combined generator module 145 includes a bipolar, ultrasonic, and monopolar module, and a smoke evacuation module integrated with a single housing unit 139, as shown in FIG. 5.

[0054] In various aspects, the smoke evacuation module 126 includes a fluid line 154 that conveys captured / recovered smoke and / or fluid away from the surgical site, for example, to the smoke evacuation module 126. The vacuum suction generated from the smoke evacuation module 126 can draw smoke into the opening of the utility conduit at the surgical site. The utility conduit connected to the fluid line may be in the form of a flexible tube that terminates at the smoke evacuation module 126. The utility conduit and the fluid line define a fluid path that extends towards the smoke evacuation module 126 received within the hub housing 136.

[0055] In various aspects, the aspiration / irrigation module 128 is connected to a surgical tool that includes an aspiration fluid line and a suction fluid line. In one embodiment, the aspiration and suction fluid lines are in the form of flexible tubes that extend from the surgical site towards the aspiration / irrigation module 128. One or more drive systems may be configured to cause the irrigation and aspiration of fluid to and from the surgical site.

[0056] In one aspect, a surgical tool includes a shaft having an end effector at its distal end, at least one energy treatment unit associated with the end effector, a suction tube, and an irrigation tube. The suction tube can have an inlet port at its distal end and extends through the shaft. Similarly, the irrigation tube can extend through the shaft and can have an inlet port proximate to the energy delivery device. The energy delivery device is configured to deliver ultrasonic and / or RF energy to the surgical site and is coupled to the generator module 140 by a cable that first extends through the shaft.

[0057] The irrigation tube can be in fluid communication with a fluid source, and the suction tube can be in fluid communication with a vacuum source. The fluid source and / or the vacuum source can be housed within the aspiration / irrigation module 128. In one embodiment, the fluid source and / or the vacuum source can be housed within the hub housing 136 separately from the aspiration / irrigation module 128. In such an embodiment, the fluid interface can be configured to connect the aspiration / irrigation module 128 to the fluid source and / or the vacuum source.

[0058] In one aspect, the corresponding docking stations on the modular housings 136 of the modules 140, 126, 128 and / or the hub can include an alignment function configured to align the docking ports of the modules and engage these corresponding components within the docking stations of the modular housing 136 of the hub. For example, as shown in FIG. 4, the combined generator module 145 includes side brackets 155 configured to slidably engage corresponding brackets 156 of the corresponding docking station 151 of the modular housing 136 of the hub. The brackets cooperate to guide the docking port contacts of the combined generator module 145 into electrical engagement with the docking port contacts of the modular housing 136 of the hub.

[0059] In some embodiments, the drawers 151 of the modular housing 136 of the hub are the same size or substantially the same size, and the modules are sized to fit within the drawers 151. For example, the side brackets 155 and / or 156 may be larger or smaller depending on the size of the module. In other embodiments, the drawers 151 are different sizes and are each designed to accommodate a particular module.

[0060] Further, to avoid inserting a module into a drawer with incompatible contacts, the contacts of a particular module may be keyed to engage the contacts of a particular drawer.

[0061] As shown in FIG. 4, the docking port 150 of one drawer 151 is connected via a communication link 157 to the docking port 150 of another drawer 151 to facilitate two-way communication between modules housed within the modular housing 136 of the hub. Alternatively or additionally, the docking ports 150 of the modular housing 136 of the hub may facilitate wireless two-way communication between modules housed within the modular housing 136 of the hub. For example, any suitable wireless communication such as Air Titan - Bluetooth may be used.

[0062] FIG. 6 shows the individual power bus attachments of the plurality of lateral docking ports of a lateral modular housing 160 configured to receive a plurality of modules of a surgical hub 206. The lateral modular housing 160 is configured to receive and interconnect modules 161 laterally. The modules 161 are slidably inserted into a docking station 162 of the lateral modular housing 160 that includes a backplane for interconnecting the modules 161. As shown in FIG. 6, the modules 161 are arranged laterally within the lateral modular housing 160. Alternatively, the modules 161 may be arranged vertically within the lateral modular housing.

[0063] FIG. 7 shows a vertical modular housing 164 configured to receive a plurality of modules 165 of a surgical hub 106. The modules 165 are slidably inserted into a docking station or drawer 167 of the vertical modular housing 164 that includes a backplane for interconnecting the modules 165. The drawer 167 of the vertical modular housing 164 is arranged in the vertical direction, but in certain cases, the vertical modular housing 164 may include a laterally arranged drawer. Further, the modules 165 can interact with each other via the docking ports of the vertical modular housing 164. In the embodiment of FIG. 7, a display 177 is provided for displaying data related to the operation of the modules 165. Additionally, the vertical modular housing 164 includes a master module 178 that houses a plurality of sub-modules slidably received within the master module 178.

[0064] In various aspects, the imaging module 138 includes a built-in video processor and a modular light source and is adapted to be used with various imaging devices. In one aspect, the imaging device is composed of a modular housing that can be assembled with a light source module and a camera module. The housing may be a disposable housing. In at least one embodiment, the disposable housing is removably coupled to a reusable controller, a light source module, and a camera module. The light source module and / or the camera module can be selectively selected according to the type of surgical procedure. In one aspect, the camera module includes a CCD sensor. In another aspect, the camera module includes a CMOS sensor. In another aspect, the camera module is configured for imaging a scanned beam. Similarly, the light source module can be configured to deliver white light or different light according to the surgical procedure.

[0065] During a surgical procedure, it can be inefficient to remove a surgical device from the surgical field and replace it with another surgical device that includes a different camera or a different light source. Temporarily losing the view of the surgical field can result in undesirable outcomes. The modular imaging device of the present disclosure is configured to allow for the replacement of a light source module or a camera module midstream during a surgical procedure without the need to remove the imaging device from the surgical field.

[0066] In one aspect, the imaging device comprises a tubular housing that includes a plurality of channels. The first channel is configured to slidably receive a camera module that can be configured to snap-fit engage with the first channel. The second channel is configured to slidably receive a light source module that can be configured to snap-fit engage with the second channel. In another example, the camera module and / or the light source module can be rotated to a final position within their respective channels. A screw engagement may be employed instead of the snap-fit engagement.

[0067] In various examples, a plurality of imaging devices are positioned at various locations within the surgical field to provide a plurality of fields of view. The imaging module 138 can be configured to switch between imaging devices to provide an optimal field of view. In various aspects, the imaging module 138 can be configured to integrate images from different imaging devices.

[0068] Various image processors and imaging devices suitable for use with the present disclosure are described in U.S. Patent No. 7,995,045, issued August 9, 2011, entitled "COMBINED SBI AND CONVENTIONAL IMAGE PROCESSOR", which is hereby incorporated by reference in its entirety. Further, U.S. Patent No. 7,982,776, issued July 19, 2011, entitled "SBI MOTION ARTIFACT REMOVAL APPARATUS AND METHOD", which is hereby incorporated by reference in its entirety, describes various systems for removing motion artifacts from image data. Such systems may be integrated with the imaging module 138. Further, U.S. Patent Application Publication No. 2011 / 0306840, published December 15, 2011, entitled "CONTROLLABLE MAGNETIC SOURCE TO FIXTURE INTRACORPOREAL APPARATUS", and U.S. Patent Application Publication No. 2014 / 0243597, published August 28, 2014, entitled "SYSTEM FOR PERFORMING A MINIMALLY INVASIVE SURGICAL PROCEDURE", are each hereby incorporated by reference in their entirety.

[0069] FIG. 8 shows a surgical data network 201 comprising a modular communication hub 203 configured to connect a modular device disposed in one or more operating rooms of a medical facility or any room within a medical facility equipped with specialized equipment for surgical procedures to a cloud-based system (e.g., cloud 204 that may include a remote server 213 connected to a storage device 205). In one aspect, the modular communication hub 203 comprises a network hub 207 and / or a network switch 209 that communicate with a network router. The modular communication hub 203 can further be coupled to a local computer system 210 to provide local computer processing and data manipulation. The surgical data network 201 may be configured as passive, intelligent, or switched. A passive surgical data network functions as a conduit for data, enabling data to go from one device (or segment) to another and to cloud computing resources. An intelligent surgical data network allows traffic to pass through the surgical data network being monitored and includes additional functionality that configures each port within the network hub 207 or network switch 209. An intelligent surgical data network may be referred to as a manageable hub or switch. A switching hub reads the destination address of each packet and then forwards the packet to the correct port.

[0070] The modular devices 1a to 1n arranged in the operating room may be connected to the modular communication hub 203. The network hub 207 and / or the network switch 209 may be connected to the network router 211 to connect the devices 1a to 1n to the cloud 204 or the local computer system 210. The data associated with the devices 1a to 1n may be transferred via the router to a cloud-based computer for remote data processing and operation. The data associated with the devices 1a to 1n may also be transferred to the local computer system 210 for local data processing and operation. The modular devices 2a to 2m located in the same operating room may also be connected to the network switch 209. The network switch 209 may be connected to the network hub 207 and / or the network router 211 to connect the devices 2a to 2m to the cloud 204. The data associated with the devices 2a to 2n may be transferred via the network router 211 to the cloud 204 for data processing and operation. The data associated with the devices 2a to 2m may also be transferred to the local computer system 210 for local data processing and operation.

[0071] It will be appreciated that the surgical data network 201 can be extended by interconnecting a plurality of network hubs 207 and / or a plurality of network switches 209 with a plurality of network routers 211. The modular communication hub 203 can be housed within a modular control tower configured to receive a plurality of devices 1a - 1n / 2a - 2m. The local computer system 210 may also be housed within the modular control tower. The modular communication hub 203 is connected to a display 212 to display images acquired by some of the devices 1a - 1n / 2a - 2m, for example, during a surgical procedure. In various aspects, the devices 1a - 1n / 2a - 2m can include, among other modular devices connectable to the modular communication hub 203 of the surgical data network 201, for example, an imaging module 138 coupled to an endoscope, a generator module 140 coupled to an energy-based surgical device, a smoke evacuation module 126, a suction / irrigation module 128, a communication module 130, a processor module 132, a storage array 134, a surgical device coupled to a display, and / or a non-contact sensor module, and various other modules.

[0072] In one aspect, the surgical data network 201 may include a combination of network hub(s), network switch(es), and network router(s) that connect devices 1a - 1n / 2a - 2m to the cloud. Any one or all of the devices 1a - 1n / 2a - 2m connected to the network hub or network switch can collect data in real - time and transfer the data to a cloud computer for data processing and operation. It will be understood that cloud computing depends on shared computing resources rather than having a local server or personal device to handle software applications. The term "cloud" can be used as a metaphor for the "Internet", but this term is not so limited. Thus, the term "cloud computing" can be used herein to refer to "a type of Internet - based computing", in which case various services such as servers, storage devices, and applications are delivered to a modular communication hub 203 and / or a computer system 210 located at the surgical site (e.g., a fixed, mobile, temporary, or on - site operating room or space) and to devices connected to the modular communication hub 203 and / or the computer system 210 via the Internet. The cloud infrastructure can be maintained by a cloud service provider. In this context, the cloud service provider can be an entity that coordinates the use and control of devices 1a - 1n / 2a - 2m located in one or more operating rooms. Cloud computing services can perform a number of calculations based on data collected by smart surgical instruments, robots, and other computerized devices located in the operating room. The hub hardware enables multiple devices or connections to connect to a computer that communicates with cloud computing resources and storage devices.

[0073] By applying cloud computer data processing technology to the data collected by devices 1a to 1n / 2a to 2m, the surgical data network provides improvements in surgical outcomes, cost reduction, and patient satisfaction. After tissue sealing and cutting procedures, at least some of devices 1a to 1n / 2a to 2m can be used to observe the state of the tissue to evaluate leakage or perfusion of the sealed tissue. At least some of devices 1a to 1n / 2a to 2m can be used to examine data including images of samples of body tissue for diagnostic purposes using cloud-based computing to identify medical conditions such as the effects of diseases. This includes tissue and phenotype localization and margin confirmation. At least some of devices 1a to 1n / 2a to 2m can be used to identify the anatomical structure of the body using techniques such as various sensors integrated with the imaging device and overlaying images captured by multiple imaging devices. The data collected by devices 1a to 1n / 2a to 2m, including image data, may be transferred to the cloud 204 or the local computer system 210 or both for data processing and operations including image processing and manipulation. The data can be analyzed to improve the results of surgical procedures by determining whether further treatments such as endoscopic interventions, emerging technologies, targeted radiation, targeted interventions, and precision robotics can be performed on tissue-specific sites and conditions. Such data analysis may further employ prognostic analysis processing, and using a standardized approach can provide useful feedback either to confirm surgical treatment and surgeon behavior or to propose modifications to surgical treatment and surgeon behavior.

[0074] In one implementation mode, the operating room devices 1a to 1n may be connected to the modular communication hub 203 via a wired channel or a wireless channel according to the configuration of the devices 1a to 1n with respect to the network hub. The network hub 207 may be implemented as a local network broadcast device that functions on the physical layer of the Open System Interconnection (OSI) model in one aspect. The network hub provides connectivity to the devices 1a to 1n located within the same operating room network. The network hub 207 collects data in packet form and transmits them to the router in half-duplex mode. The network hub 207 does not store any media access control / Internet Protocol (MAC / IP) for transferring device data. Only one of the devices 1a to 1n can transmit data at a time via the network hub 207. The network hub 207 has no routing table or intelligence regarding the destination of information and broadcasts all network data across each connection and to the remote server 213 (Figure 9) on the cloud 204. The network hub 207 can detect basic network errors such as collisions, but broadcasting all information to multiple ports can pose a security risk and cause bottlenecks.

[0075] In another implementation form, the operating room devices 2a to 2m may be connected to the network switch 209 via a wired channel or a wireless channel. The network switch 209 functions within the data link layer of the OSI model. The network switch 209 is a multicast device for connecting the devices 2a to 2m located in the same operating room to the network. The network switch 209 transmits data in the form of frames to the network router 211 and functions in full-duplex mode. Multiple devices 2a to 2m can transmit data simultaneously via the network switch 209. The network switch 209 stores and uses the MAC addresses of the devices 2a to 2m for data transfer.

[0076] The network hub 207 and / or the network switch 209 are connected to the network router 211 for connecting to the cloud 204. The network router 211 functions within the network layer of the OSI model. The network router 211 creates a path for transmitting the data packets received from the network hub 207 and / or the network switch 211 to cloud-based computer resources for further processing and manipulation of the data collected by any one or all of the devices 1a to 1n / 2a to 2m. The network router 211 may be used, for example, to connect two or more different networks located at different positions, such as different operating rooms in the same medical facility or different networks in different operating rooms of different medical facilities. The network router 211 transmits data in the form of packets to the cloud 204 and functions in full-duplex mode. Multiple devices can transmit data simultaneously. The network router 211 uses IP addresses for data transfer.

[0077] In one embodiment, the network hub 207 may be implemented as a USB hub that enables a plurality of USB devices to be connected to a host computer. The USB hub can expand a single USB port into several levels so that there are more ports available for connecting devices to the host system computer. The network hub 207 can include wired or wireless capabilities for receiving information via a wired channel or a wireless channel. In one aspect, a wireless USB short-range high-bandwidth wireless communication protocol may be used for communication between the devices 1a - 1n and the devices 2a - 2m located in the operating room.

[0078] In other embodiments, the operating room devices 1a - 1n / 2a - 2m can communicate with the modular communication hub 203 via the Bluetooth wireless technology standard to exchange data over a short distance (using short-wavelength UHF radio waves in the 2.4 - 2.485 GHz ISM band) between fixed and mobile devices and to construct a personal area network (PAN). In other aspects, the operating room devices 1a - 1n / 2a - 2m can communicate with the modular communication hub 203 via a number of wireless or wired communication standards or protocols including, but not limited to, Wi-Fi (IEEE802.11 family), WiMAX (IEEE802.16 family), IEEE802.20, long-term evolution (LTE), and Ev-DO, HSPA+, HSDPA+, HSUPA+, EDGE, GSM, GPRS, CDMA, TDMA, DECT, and Ethernet derivatives thereof, as well as 3G, 4G, 5G, and any other wireless and wired protocols designated as such in the future. The computing module may include a plurality of communication modules. For example, the first communication module may be dedicated to short-range wireless communication such as Wi-Fi and Bluetooth, and the second communication module may be dedicated to long-range wireless communication such as GPS, EDGE, GPRS, CDMA, WiMAX, LTE, Ev-DO.

[0079] The modular communication hub 203 can function as a central connection for one or all of the operating room devices 1a~1n / 2a~2m and handles a data type known as a frame. The frame carries data generated by the devices 1a~1n / 2a~2m. When the frame is received by the modular communication hub 203, the frame is amplified and transmitted to the network router 211, which transfers this data to cloud computing resources by using a number of wireless or wired communication standards or protocols described herein.

[0080] The modular communication hub 203 may be used as a stand-alone device or may be connected to compatible network hubs and network switches to form a larger network. Since the modular communication hub 203 is generally easy to install, configure, and maintain, the modular communication hub 203 is a good option for network connecting the operating room devices 1a~1n / 2a~2m.

[0081] Figure 9 shows a computer-implemented interactive surgical system 200. The computer-implemented interactive surgical system 200 is similar to the computer-implemented interactive surgical system 100 in many respects. For example, the computer-implemented interactive surgical system 200 includes one or more surgical systems 202 that are similar to the surgical system 102 in many respects. Each surgical system 202 includes at least one surgical hub 206 that communicates with a cloud 204 that may include a remote server 213. In one aspect, the computer-implemented interactive surgical system 200 includes a modular control tower 236 connected to a plurality of operating room devices such as, for example, intelligent surgical instruments, robots, and other computerized devices located within the operating room. As shown in Figure 10, the modular control tower 236 includes a modular communication hub 203 coupled to a computer system 210. As illustrated in the embodiment of Figure 9, the modular control tower 236 is coupled to an imaging module 238 coupled to an endoscope 239, a generator module 240 coupled to an energy device 241, a smoke evacuator module 226, a suction / irrigation module 228, a communication module 230, a processor module 232, a storage array 234, an optional smart device / instrument 235 coupled to a display 237, and a non-contact sensor module 242. The operating room devices are coupled to cloud computing resources and data storage devices via the modular control tower 236. A robot hub 222 may also be connected to the modular control tower 236 and cloud computing resources. Among other things, the device / instrument 235, visualization system 208 may be coupled to the modular control tower 236 via the wired or wireless communication standards or protocols described herein. The modular control tower 236 may be coupled to a hub display 215 (e.g., a monitor, screen) for displaying and overlaying images received from the imaging module, device / instrument display, and / or other visualization system 208. The hub display may also display data received from devices connected to the modular control tower along with the images and overlaid images.

[0082] FIG. 10 shows a surgical hub 206 comprising a plurality of modules coupled to a modular control tower 236. The modular control tower 236 comprises a modular communication hub 203, such as a network connection device, and a computer system 210 for providing, for example, local processing, visualization, and imaging. As shown in FIG. 10, the modular communication hub 203 is connected in a hierarchical configuration to expand the number of modules (e.g., devices) that can be connected to the modular communication hub 203 and transfer data associated with the modules to the computer system 210, cloud computing resources, or both. As shown in FIG. 10, each of the network hubs / switches within the modular communication hub 203 includes three downstream ports and one upstream port. The upstream network hub / switch is connected to a processor to provide a communication connection to cloud computing resources and a local display 217. Communication to the cloud 204 can be performed via either a wired or wireless communication channel.

[0083] The surgical hub 206 uses a non-contact sensor module 242 to measure the dimensions of the operating room and generate a map of the surgical site using either an ultrasonic or laser-based non-contact measurement device. As described in the section "Surgical Hub Spatial Awareness Within an Operating Room" of U.S. Patent Provisional Application No. 62 / 611,341, filed December 28, 2017, entitled "INTERACTIVE SURGICAL PLATFORM," which is hereby incorporated by reference in its entirety, the ultrasonic-based non-contact sensor module scans the operating room by transmitting ultrasonic bursts and receiving the echoes when the ultrasonic bursts are reflected off the outer walls of the operating room, where the sensor module is configured to determine the size of the operating room and adjust the Bluetooth pairing distance limit. The laser-based non-contact sensor module scans the operating room, for example, by transmitting laser light pulses, receiving the laser light pulses reflected off the outer walls of the operating room, and comparing the phase of the transmitted pulses with the received pulses to determine the size of the operating room and adjust the Bluetooth pairing distance limit.

[0084] The computer system 210 includes a processor 244 and a network interface 245. The processor 244 is connected via a system bus to a communication module 247, a storage device 248, a memory 249, a non-volatile memory 250, and an input / output interface 251. The system bus can use any of various bus architectures including a memory bus or memory controller, a peripheral bus or external bus, and / or a local bus, such as a 9-bit bus, an Industry Standard Architecture (ISA), a Micro-Channel Architecture (MSA), an Extended ISA (EISA), an Intelligent Drive Electronics (IDE), a VESA Local Bus (VLB), a Peripheral Component Interconnect (PCI), a USB, an Advanced Graphics Port (AGP), a Personal Computer Memory Card International Association bus (PCMCIA), a Small Computer Systems Interface (SCSI), or any other proprietary bus, but is not limited to these.

[0085] The processor 244 may be any single-core or multi-core processor, such as those known by the trade name of ARM Cortex made by Texas Instruments. In one aspect, the processor, for example, has on-chip memory of a 256KB single-cycle flash memory or other non-volatile memory with a maximum of 40MHz, the details of which are available in the product datasheet, a prefetch buffer for improving performance beyond 40MHz, 32KB of single-cycle serial random access memory (SRAM), an internal read-only memory (ROM) with StellarisWare (registered trademark) software, 2KB of electrically erasable programmable read-only memory (EEPROM), and / or one or more pulse width modulation (PWM) modules, one or more quadrature encoder input (QEI) analogs, and one or more 12-bit analog-to-digital converters (ADCs) with 12 analog input channels, and may be the LM4F230H5QR ARM Cortex-M4F processor core available from Texas Instruments.

[0086] In one aspect, the processor 244 may include a safety controller that includes two controller families such as TMS570 and RM4x, also known by the trade name of Hercules ARM Cortex R4 made by Texas Instruments. The safety controller may be configured specifically for safety-critical applications of IEC61508 and ISO26262, among others, to provide advanced integrated safety features while offering scalable performance, connectivity, and memory options.

[0087] Examples of system memory include volatile memory and non-volatile memory. The basic input / output system (BIOS), which contains basic routines for transferring information between elements within a computer system during startup and the like, is stored in non-volatile memory. For example, non-volatile memory can include ROM, programmable ROM (PROM), electrically programmable ROM (EPROM), EEPROM, or flash memory. Examples of volatile memory include random-access memory (RAM) that functions as an external cache memory. Further, RAM can be used in many forms such as SRAM, dynamic RAM (DRAM), synchronous DRAM (SDRAM), double data rate SDRAM (DDR SDRAM), enhanced SDRAM (ESDRAM), Synchlink DRAM (SLDRAM), and direct Rambus RAM (DRRAM).

[0088] Computer system 210 also includes removable / non-removable volatile / non-volatile computer storage media, such as disk storage devices. Disk storage devices include, but are not limited to, devices such as magnetic disk drives, floppy disk drives, tape drives, Jaz drives, Zip drives, LS-60 drives, flash memory cards, or memory sticks. Additionally, the disk storage device can include the storage media, either independently or in combination with other storage media such as, but not limited to, optical disk drives such as compact disc ROM devices (CD-ROM), compact disc recordable drives (CD-R Drive), compact disc rewritable drives (CD-RW Drive), or digital versatile disc ROM drives (DVD-ROM). A removable or non-removable interface may be used to facilitate connection of the disk storage device to the system bus.

[0089] It should be understood that computer system 210 includes software that functions as an intermediary between a user and basic computer resources in a suitable operating environment. Such software includes an operating system. The operating system, which can be stored on the disk storage device, functions to control and allocate the resources of the computer system. System applications utilize the resource management by the operating system via program modules and program data stored either in system memory or on the disk storage device. It should be understood that the various components described herein can be implemented with various operating systems or combinations of operating systems.

[0090] The user inputs commands or information into the computer system 210 via an input device (s) connected to the I / O interface 251. Examples of input devices include, but are not limited to, pointing devices such as a mouse, trackball, stylus, touchpad, keyboard, microphone, joystick, gamepad, satellite dish, scanner, TV tuner card, digital camera, digital video camera, web camera, etc. These and other input devices are connected to the processor through the system bus via an interface port (s). Examples of the interface port (s) include, for example, serial port, parallel port, game port, and USB. The output device (s) use some of the same types of ports as the input device (s). Thus, for example, a USB port may be used to provide input to the computer system and output information from the computer system to the output device. The output adapter is provided to indicate the existence of some output devices, such as monitors, displays, speakers, and printers, among others, that require a special adapter. Examples of output adapters include, but are not limited to, video and sound cards that provide connection means between the output device and the system bus. Note that other devices and / or systems of devices, such as remote computer (s), provide both input and output functions.

[0091] The computer system 210 can operate in a networked environment using logical connections to one or more remote or local computers, such as a cloud computer(s). The remote cloud computer(s) can be, for example, a personal computer, a server, a router, a network PC, a workstation, a microprocessor-based device, a peer device, or other common network nodes, and typically includes many or all of the elements described with respect to the computer system. For simplicity, only the memory storage device is shown with the remote computer(s). The remote computer(s) is logically connected to the computer system via a network interface and subsequently physically connected via a communication connection. The network interface includes communication networks such as local area networks (LANs) and wide area networks (WANs). Examples of LAN technologies include Fiber Distributed Data Interface (FDDI), Copper Distributed Data Interface (CDDI), Ethernet / IEEE802.3, Token Ring / IEEE802.5, etc. Examples of WAN technologies include circuit-switched networks such as point-to-point links, Integrated Services Digital Network (ISDN) and its variants, packet-switched networks, and Digital Subscriber Line (DSL), but are not limited thereto.

[0092] In various aspects, the computer system 210 of FIG. 10, the imaging module 238 of FIGS. 9-10, and / or the visualization system 208, and / or the processor module 232 may include an image processor, an image processing engine, a media processor, or any dedicated digital signal processor (DSP) used for the processing of digital images. The image processor can enhance speed and efficiency using parallel computing that employs single instruction multiple data (SIMD), or multiple instruction multiple data (MIMD) techniques. The digital image processing engine can perform various tasks. The image processor may be a system on a chip with a multi-core processor architecture.

[0093] Communication connection(s) refers to the hardware / software used to connect a network interface to a bus. For the sake of clarity of illustration, the communication connection is shown inside the computer system, but the communication connection may be external to the computer system 210. For illustrative purposes only, the hardware / software required for connection to a network interface includes modems such as ordinary telephone grade modems, cable modems, and DSL modems, ISDN adapters, and internal and external technologies such as Ethernet cards.

[0094] FIG. 11 shows a functional block diagram of one aspect of a USB network hub 300 device according to at least one aspect of the present disclosure. In the illustrated aspect, the USB network hub device 300 employs a TUSB2036 integrated circuit hub manufactured by Texas Instruments. The USB network hub 300 is a CMOS device that provides an upstream USB transceiver port 302 and up to three downstream USB transceiver ports 304, 306, 308 that comply with the USB 2.0 standard. The upstream USB transceiver port 302 is a differential routed data port that includes a differential data plus (DP0) input paired with a differential data minus (DM0) input. The three downstream USB transceiver ports 304, 306, 308 are differential data ports where each port includes a differential data plus (DP1 - DP3) output paired with a differential data minus (DM1 - DM3) output.

[0095] The USB network hub 300 device is implemented with a digital state machine instead of a microcontroller and does not require firmware programming. A fully compliant USB transceiver is integrated into the circuitry of the upstream USB transceiver port 302 and all downstream USB transceiver ports 304, 306, 308. The downstream USB transceiver ports 304, 306, 308 support both high - speed and low - speed devices by automatically setting the throughput rate according to the speed of the device attached to the port. The USB network hub 300 device may be configured in either bus - power mode or self - power mode and includes hub power logic 312 for power management.

[0096] The USB network hub 300 device includes a serial interface engine 310 (SIE). The SIE 310 is the front end of the USB network hub 300 hardware and handles most of the protocols described in Chapter 8 of the USB specification. The SIE 310 typically understands signaling up to the transaction level. Functions it handles can include packet recognition, transaction rearrangement, detection / generation of SOP, EOP, RESET, and RESUME signals, clock / data separation, non-return-to-zero invert (NRZI) data encoding / decoding and bit stuffing, CRC generation and checking (for tokens and data), generation of packet ID (PID), and checking / decoding, and / or serial / parallel or parallel / serial conversion. The 310 receives a clock input 314 and is connected to a suspend / resume logic, a frame timer 316 circuit, and a hub repeater circuit 318 to control communication between the upstream USB transceiver port 302 and the downstream USB transceiver ports 304, 306, 308 via port logic circuits 320, 322, 324. The SIE 310 is connected to a command decoder 326 via an interface logic 328 to control commands from a serial EEPROM via a serial EEPROM interface 330.

[0097] In various aspects, the USB network hub 300 can connect up to 127 functions configured within up to six logical layers to a single computer. Further, the USB network hub 300 can be connected to all peripheral devices using four standardized wire cables that provide both communication and power distribution. The power configurations are bus power mode and self-power mode. The USB network hub 300 may be configured to support four modes of power management of a bus-powered hub with either individual port power management or linked port power management, and a self-powered hub with either individual port power management or linked port power management. In one aspect, using a USB cable and the USB network hub 300, the upstream USB transceiver port 302 is plugged into a USB host controller, and the downstream USB transceiver ports 304, 306, 308 are exposed for connecting USB-compatible devices, and so on.

[0098] Further details regarding the structure and function of the surgical hub and / or surgical hub network can be found in U.S. Provisional Patent Application No. 62 / 659,900, filed on April 19, 2018, entitled "METHOD OF HUB COMMUNICATION", which is hereby incorporated by reference in its entirety.

[0099] Cloud System Hardware and Functional Modules FIG. 12 is a block diagram of a computer-implemented interactive surgical system according to at least one aspect of the present disclosure. In one aspect, this computer-implemented interactive surgical system is configured to monitor and analyze data regarding the operation of various surgical systems including a surgical hub, surgical instruments, a robotic device, and an operating room or medical facility. The computer-implemented interactive surgical system includes a cloud-based analysis system. The cloud-based analysis system is described as a surgical system, but is not necessarily limited thereto and may be a cloud-based medical system. As shown in FIG. 12, the cloud-based analysis system includes a plurality of surgical instruments 7012 (which may be the same as or similar to instrument 112), a plurality of surgical hubs 7006 (which may be the same as or similar to hub 106), and a surgical data network 7001 (which may be the same as or similar to network 201) for connecting the surgical hub 7006 to a cloud 7004 (which may be the same as or similar to cloud 204). Each of the plurality of surgical hubs 7006 is communicatively coupled to one or more surgical instruments 7012. The hub 7006 is also communicatively coupled to the cloud 7004 of the computer-implemented interactive surgical system via the network 7001. The cloud 7004 is a remote centralized source of hardware and software for storing, manipulating, and communicating data generated based on the operation of various surgical systems. As shown in FIG. 12, access to the cloud 7004 is achieved via a network 7001 which may be the Internet or some other suitable computer network. The surgical hub 7006 connected to the cloud 7004 can be regarded as the client side of the cloud computing system (i.e., the cloud-based analysis system). The surgical instrument 7012 is paired with the surgical hub 7006 for controlling and performing various surgical procedures or operations described herein.

[0100] In addition, the surgical instrument 7012 may include a transceiver (which may also include a transmitter and a receiver) for data transmission to and from a corresponding surgical hub 7006. The combination of the surgical instrument 7012 and the corresponding hub 7006 may indicate a specific location, such as an operating room within a medical facility (e.g., a hospital) for providing a medical operation. For example, the memory of the surgical hub 7006 may store location data. As shown in FIG. 12, the cloud 7004 includes a central server 7013 (which may be the same as or similar to the remote server 113 of FIG. 1 and / or the remote server 213 of FIG. 9), a hub application server 7002, a data analysis module 7034, and an input / output (I / O) interface 7007. The central server 7013 of the cloud 7004 collectively manages a cloud computing system, which includes monitoring requests by the client module 7006 and managing the processing power of the cloud 7004 for executing requests. Each of the central servers 7013 includes one or more processors 7008 coupled to a suitable memory device 7010, which can include volatile memory such as random access memory (RAM) and non-volatile memory such as a magnetic storage device. The memory device 7010 may include machine-executable instructions that, when executed, cause the processor 7008 to execute the data analysis module 7034 for cloud-based data analysis, operations, proposals, and other operations described below. Further, the processor 7008 can execute the data analysis module 7034 independently of or in conjunction with a hub application independently executed by the hub 7006. The central server 7013 also includes an aggregated medical data database 2212 that can reside within the memory 2210.

[0101] Based on the connection to various surgical hubs 7006 via network 7001, cloud 7004 can aggregate data from specific data generated by various surgical instruments 7012 and their corresponding hubs 7006. Such aggregated data may be stored in database 7011 of the aggregated medical data of cloud 7004. Specifically, cloud 7004 may advantageously perform data analysis and operations on the aggregated data to provide functions that individual hubs 7006 cannot achieve on their own. For this purpose, as shown in FIG. 12, cloud 7004 and surgical hub 7006 are communicatively coupled to transmit and receive information. I / O interface 7007 is connected to a plurality of surgical hubs 7006 via network 7001. In this way, I / O interface 7007 can be configured to transfer information between surgical hub 7006 and the aggregated medical data database 7011. Therefore, I / O interface 7007 can facilitate the read / write operations of the cloud-based analysis system. Such read / write operations may be performed in response to requests from hub 7006. These requests may be sent to hub 7006 via the hub application. I / O interface 7007 may include one or more high-speed data ports, which may include universal serial bus (USB) ports, IEEE 1394 ports, and Wi-Fi and Bluetooth I / O interfaces for connecting cloud 7004 to hub 7006. The hub application server 7002 of cloud 7004 is configured to host and provide shared functions for software applications (e.g., hub applications) executed by surgical hub 7006. For example, hub application server 7002 may manage requests created by the hub application, control access to the aggregated medical data database 7011, and perform load balancing. The data analysis module 7034 will be described in more detail with reference to FIG. 13.

[0102] The configuration of the specific cloud computing system described in this disclosure is designed to address various problems that arise in the context of medical operations and procedures performed using medical devices such as surgical instruments 7012, 112, etc. In particular, the surgical instrument 7012 may be a digital surgical device configured to interact with the cloud 7004 to implement techniques for improving the outcome of surgical procedures. The various surgical instruments 7012 and / or surgical hubs 7006 may include a touch-controlled user interface so that a clinician may control the manner of interaction between the surgical instrument 7012 and the cloud 7004. Other suitable user interfaces for control, such as an auditorily controlled user interface, may also be used.

[0103] FIG. 13 is a block diagram showing the functional architecture of a computer-implemented interactive surgical system according to at least one aspect of the present disclosure. The cloud-based analysis system includes a plurality of data analysis modules 7034 that can be executed by a processor 7008 of a cloud 7004 to provide data analysis solutions for problems specifically occurring in the medical field. As shown in FIG. 13, the functionality of the cloud-based data analysis module 7034 may be assisted via a hub application 7014 hosted by a hub application server 7002 accessible on a surgical hub 7006. The cloud processor 7008 and the hub application 7014 may operate in cooperation to execute the data analysis module 7034. An application program interface (API) 7016 defines a set of protocols and routines corresponding to the hub application 7014. Additionally, the API 7016 manages the storage and retrieval of data into and from a database 7011 of aggregated medical data for the operation of the application 7014. A cache 7018 also stores data (e.g., temporarily) and is coupled to the API 7016 for more efficient retrieval of data used by the application 7014. The data analysis module 7034 of FIG. 13 includes modules for resource optimization 7020, data collection and aggregation 7022, authorization and security 7024, control program update 7026, patient outcome analysis 7028, recommendation 7030, and data classification and prioritization 7032. Other suitable data analysis modules may also be implemented by the cloud 7004 in some aspects. In one aspect, the data analysis module is used for specific recommendations based on the analysis of trends, outcomes, and other data.

[0104] For example, the data collection and aggregation module 7022 may be used to generate self-describing data (e.g., metadata) that includes the identification of significant features or configurations (e.g., trends), the management of redundant data sets, and the storage of data into paired data sets that can be grouped by surgery but do not necessarily match the actual surgery date and surgeon. In particular, the paired data sets generated from the operation of the surgical instrument 7012 may include applying a binary classification, such as a bleeding or non-bleeding event. More generally, the binary classification may be characterized as either a desirable event (e.g., a successful surgical procedure) or an undesirable event (e.g., a misfire or misused surgical instrument 7012). The aggregated self-describing data may correspond to individual data received from various groups or subgroups of the surgical hub 7006. Thus, the data collection and aggregation module 7022 can generate aggregated metadata or other organized data based on the raw data received from the surgical hub 7006. For this purpose, the processor 7008 can be operably coupled to the hub application 7014 and the aggregated medical data database 7011 to execute the data analysis module 7034. The data collection and aggregation module 7022 may store the aggregated organized data in the aggregated medical data database 2212.

[0105] The resource optimization module 7020 can be configured to analyze this aggregated data to determine the optimal use of resources for a particular medical facility or group of medical facilities. For example, the resource optimization module 7020 may determine the optimal order points for surgical staplers 7012 for a group of medical facilities based on the corresponding predicted demands for such instruments 7012. The resource optimization module 7020 may also evaluate the resource usage or other operational configurations of various medical facilities to determine whether resource usage can be improved. Similarly, the proposal module 7030 can be configured to analyze the organized data aggregated from the data collection and aggregation module 7022 to provide proposals. For example, the proposal module 7030 may propose to a medical facility (e.g., a medical service provider such as a hospital) that a particular surgical instrument 7012 should be upgraded to an improved version, for example, based on it having a higher error rate than expected. Additionally, the proposal module 7030 and / or the resource optimization module 7020 may propose better supply chain parameters such as product reorder points and provide proposals such as for different surgical instruments 7012, their use, or the procedural steps to improve surgical outcomes. A medical facility can receive such proposals via the corresponding surgical hub 7006. More specific proposals regarding the parameters or configurations of various surgical instruments 7012 can also be provided. The hub 7006 and / or the surgical instrument 7012 may each have a display screen for displaying data or proposals provided by the cloud 7004.

[0106] The patient outcome analysis module 7028 can analyze surgical results associated with the currently used operating parameters of the surgical instrument 7012. The patient outcome analysis module 7028 may also analyze and evaluate other potential operating parameters. In this connection, the proposal module 7030 may be able to propose using these other potential operating parameters based on resulting in better surgical outcomes such as better sealing or less bleeding. For example, the recommendation module 7030 can send a recommendation to the surgical hub 7006 regarding when to use a particular cartridge for the corresponding stapling surgical instrument 7012. Thus, a cloud-based analysis system may be configured to analyze large-scale collection of raw data while controlling common variables and provide centralized proposals across multiple healthcare facilities (advantageously, determined based on aggregated data). For example, the cloud-based analysis system may be able to analyze, evaluate, and / or aggregate the type of medical procedure, type of patient, number of patients, and geographical similarity among healthcare providers / facilities that use similar types of instruments, etc., where the healthcare providers / facilities use similar types of instruments.

[0107] The control program update module 7026 may be configured to implement proposals for various surgical instruments 7012 when the corresponding control program is updated. For example, the patient outcome analysis module 7028 may be able to identify a correlation that links a particular control parameter to a successful (or failed) result. Such a correlation may be addressed when the updated control program is sent to the surgical instrument 7012 via the control program update module 7026. Updates to the instrument 7012 sent via the corresponding hub 7006 may incorporate aggregated performance data collected and analyzed by the data collection and aggregation module 7022 of the cloud 7004. Additionally, the patient outcome analysis module 7028 and the proposal module 7030 may be able to identify improved ways of using the instrument 7012 based on the aggregated performance data.

[0108] The cloud-based analysis system may include security features implemented by the cloud 7004. These security features may be managed by the authorization and security module 7024. Each surgical hub 7006 can have associated unique credential information such as a username, password, and other suitable security credential information. This credential information can be stored in the memory 7010 and may be associated with an authorized cloud access level. For example, based on providing accurate credential information, the surgical hub 7006 may be granted access to communicate with the cloud up to a certain range (e.g., may transmit or receive certain defined types of information). For this purpose, the aggregated medical data database 7011 of the cloud 7004 may include a database of credential information to verify the accuracy of the provided credential information. Different credential information may be associated with various levels of permission for interaction with the cloud 7004, such as a predetermined access level for receiving data analysis generated by the cloud 7004.

[0109] Furthermore, for security purposes, the cloud may maintain a database of hubs 7006, instruments 7012, and other devices that may include a "blacklist" of prohibited devices. Specifically, a surgical hub 7006 listed on the blacklist may not be permitted to interact with the cloud, while a surgical instrument 7012 listed on the blacklist may not be able to functionally access the corresponding hub 7006 and / or may have its functionality restricted even when paired with the corresponding hub 7006. Additionally or alternatively, the cloud 7004 may flag an instrument 7012 based on incompatibility or other specified criteria. In this way, counterfeit medical devices and the improper reuse of such devices throughout the cloud-based analysis system can be identified and addressed.

[0110] The surgical instrument 7012 may transmit a wireless signal, using a wireless transceiver, that represents, for example, authorization information for access to a corresponding hub 7006 and cloud 7004. A wired transceiver may also be used to transmit the signal. Such authorization information can be stored in the respective memory device of the surgical instrument 7012. The authorization and security module 7024 can determine whether the authorization information is accurate or forged. The authorization and security module 7024 may also dynamically generate authorization information for enhanced security. The qualification information may also be encrypted, such as by using hash-based encryption. When appropriate authorization is transmitted, the surgical instrument 7012 may transmit a signal to the corresponding hub 7006 and ultimately to the cloud 7004 indicating that the instrument 7012 is ready to acquire and transmit medical data. In response, the cloud 7004 may transition to a state where it is capable of receiving medical data for storage in the aggregated medical data database 7011. This data transmission readiness may also be indicated, for example, by an optical indicator on the instrument 7012. The cloud 7004 may also transmit a signal to the surgical instrument 7012 to update their associated control programs. The cloud 7004 can transmit a signal directed to a specific class of surgical instruments 7012 (e.g., electrosurgical instruments) such that software updates to the control programs are transmitted only to appropriate surgical instruments 7012. Further, the cloud 7004 may be used to implement a system-wide solution to address local or global issues based on selective data transmission and authorization information. For example, if a group of surgical instruments 7012 are identified as having a common manufacturing defect, the cloud 7004 may change the authorization information corresponding to this group to implement an operational lockout for this group.

[0111] A cloud-based analytics system may be able to monitor multiple healthcare facilities (e.g., a healthcare facility such as a hospital) to determine improved practices and proposed changes (e.g., via the proposal module 2030). Thus, the processor 7008 of the cloud 7004 can analyze data associated with individual healthcare facilities to identify the facilities and aggregate that data with other data associated with other healthcare facilities. The groups may be defined, for example, based on similar practices or geographical location. In this way, the cloud 7004 may provide a wide range of analysis and proposals for groups of healthcare facilities. The cloud-based analytics system may also be used for enhanced situational awareness. For example, the processor 7008 may predictively model the effect of proposals regarding the cost and effectiveness for a particular facility (with respect to overall operations and / or various medical procedures). The cost and effectiveness associated with that particular facility may also be compared to the corresponding local area of other facilities or any other equivalent facility.

[0112] The data classification and prioritization module 7032 may prioritize and classify data based on significance (e.g., the severity, unexpectedness, suspiciousness of a medical event associated with the data). This classification and prioritization may be used in conjunction with the functions of the other data analysis modules 7034 described herein to improve the cloud-based analysis and operations described herein. For example, the data classification and prioritization module 7032 can assign priorities to the data analysis performed by the data collection and aggregation module 7022 and the patient outcome analysis module 7028. Different priority levels can result in specific responses from the cloud 7004 (corresponding to the level of urgency), such as escalation for rapid response, special processing, exclusion from the aggregated medical data database 7011, or other suitable responses. Further, if necessary, the cloud 7004 can send requests (e.g., push messages) via the hub application server for additional data from the corresponding surgical instrument 7012. The push message can result in a notification being displayed on the corresponding hub 7006 to request support or additional data. This push message may be required in situations where the cloud detects significant irregularities or outliers and the cloud is unable to determine the cause of the irregularities. The central server 7013 may be programmed to trigger this push message in certain critical situations, such as when the data is determined to deviate from the predicted value by more than a predetermined threshold or when security is suspected.

[0113] Further details regarding the cloud analysis system can be found in U.S. Patent Provisional Application No. 62 / 659,900, filed on April 19, 2018, entitled "METHOD OF HUB COMMUNICATION," which is hereby incorporated by reference in its entirety.

[0114] Situation awareness An "intelligent" device that includes a control algorithm that responds to sensed data may be an improvement over a "dumb" device that operates without considering the sensed data, but some sensed data may be incomplete or inconclusive when considered alone, i.e., without the context of the type of surgical procedure being performed or the type of tissue being operated on. Without knowing the procedure context (e.g., knowing the type of tissue being operated on or the type of procedure being performed), the control algorithm may inaccurately or sub-optimally control the modular device when given sensed data that does not include a specific context. For example, the optimal way to control a surgical instrument in response to a particular sensed parameter may vary according to the specific type of tissue being operated on. This is due to the fact that different tissue types have different properties (e.g., resistance to tearing), which causes them to respond differently to actions taken by the surgical instrument. Thus, even when the same measurement is sensed for a particular parameter, it may be desirable for the surgical instrument to take different actions. As one specific example, the optimal way to control a surgical stapling and cutting instrument in response to sensing an unexpectedly high force to close its end effector may vary depending on whether the tissue type is susceptible to tearing or is resistant to it. In the case of tissue that is susceptible to tearing, such as lung tissue, the control algorithm for the instrument optimally ramps down the motor in response to the unexpectedly high force to close in order to avoid tearing the tissue. In the case of tissue that is resistant to tearing, such as stomach tissue, the control algorithm for the instrument optimally ramps up the motor in response to the unexpectedly high force to close in order to ensure that the end effector is properly clamped to the tissue. Without knowing whether lung tissue or stomach tissue is being clamped, the control algorithm may make sub-optimal decisions.

[0115] One solution utilizes a surgical hub that is configured to derive information regarding a surgical procedure based on data received from various data sources and then appropriately control a paired modular device. In other words, the surgical hub is configured to infer information regarding the surgical procedure from the received data and then control a modular device paired with the surgical hub based on the inferred context of the surgical procedure. FIG. 14 shows a diagram of a situation awareness surgical system 5100 according to at least one aspect of the present disclosure. In some examples, the data source 5126 can include, for example, a modular device 5102 (which can include sensors configured to detect parameters associated with the patient and / or the modular device itself), a database 5122 (e.g., an EMR database including patient records), and a patient monitoring device 5124 (e.g., a blood pressure (BP) monitor and an electrocardiogram (EKG) monitor).

[0116] The surgical hub 5104 (which may be similar in many respects to hub 106) can be configured to derive context information regarding the surgical procedure from the data, for example, based on a particular combination of the received data or the particular order in which data is received from the data source 5126. The context information inferred from the received data can include, for example, the type of surgical procedure being performed, a particular step of the surgical procedure that the surgeon is performing, the type of tissue being operated on, or the body cavity that is the subject of the procedure. This ability of the surgical hub 5104, according to some aspects, to derive or infer information related to the surgical procedure from the received data can be referred to as "situation awareness." In one example, the surgical hub 5104 can incorporate a situation awareness system that is hardware and / or programming associated with the surgical hub 5104 that derives context information related to the surgical procedure from the received data.

[0117] The situation recognition system of the surgical hub 5104 can be configured to derive context information from data received from various different data sources 5126. In one example, the situation recognition system correlates various inputs (e.g., data from the database 5122, the patient monitoring device 5124, and / or the modular device 5102) with corresponding context information regarding the surgical procedure, and includes a pattern recognition system or a machine learning system (e.g., an artificial neural network) trained with training data. In other words, the machine learning system can be trained to accurately derive context information regarding the surgical procedure from the provided inputs. In another exemplary example, the situation recognition system can include a lookup table that stores context information pre-characterized regarding the surgical procedure in correspondence with one or more inputs (or ranges of inputs) corresponding to the context information. In response to a query with one or more inputs, the lookup table can return the corresponding context information of the situation recognition system to control the modular device 5102. In one example, the context information received by the situation recognition system of the surgical hub 5104 is associated with a specific control adjustment or a set of control adjustments of one or more modular devices 5102. In another example, the situation recognition system includes a further machine learning system, a lookup table, or other such systems that generate or obtain one or more control adjustments of one or more modular devices 5102 when context information is provided as an input.

[0118] The surgical hub 5104 incorporating the situation awareness system provides many benefits to the surgical system 5100. One benefit includes improving the interpretation of sensed and collected data, which improves the processing accuracy and / or use of data during a surgical procedure. To return to a previous example, the situation awareness surgical hub 5104 can determine which type of tissue is being operated on, and thus, if an unexpectedly high force is detected to close the end effector of a surgical instrument, the situation awareness surgical hub 5104 can correctly ramp up or ramp down the motor of the surgical instrument according to the type of tissue.

[0119] As another example, the type of tissue being operated on can affect the adjustments made to the compression speed and load threshold of a surgical stapling and cutting instrument for specific tissue gap measurements. The situation awareness surgical hub 5104 can estimate whether the surgical procedure being performed is a thoracic procedure or an abdominal procedure, whereby the situation awareness surgical hub 5104 can determine whether the tissue clamped by the end effector of the surgical stapling and cutting instrument is a lung (in the case of thoracic surgery) or a stomach (in the case of abdominal surgery). The surgical hub 5104 can then appropriately adjust the compression speed and load threshold of the surgical stapling and cutting instrument according to the type of tissue.

[0120] As yet another example, the type of body cavity being operated on during an insufflation procedure can affect the function of the smoke evacuator. The situation awareness surgical hub 5104 can determine whether the surgical site is under pressure (by determining that the surgical procedure utilizes insufflation) and can determine the type of procedure. Since the type of procedure is generally performed within a specific body cavity, the surgical hub 5104 can appropriately control the motor speed of the smoke evacuator according to the body cavity being operated on. Thus, the situation awareness surgical hub 5104 can provide a certain amount of smoke evacuation for both thoracic and abdominal surgeries.

[0121] As yet another example, the type of procedure being performed can affect the energy level optimal for operation of an ultrasonic surgical instrument or a radio frequency (RF) electrosurgical instrument. An arthroscopic procedure, for example, may require a higher energy level because the end effector of an ultrasonic surgical instrument or an RF electrosurgical instrument is immersed in a fluid. The Situational Awareness Surgical Hub 5104 can determine whether the surgical procedure is an arthroscopic procedure. The Surgical Hub 5104 can then adjust the RF power level or ultrasonic amplitude (i.e., "energy level") of the generator to compensate for the fluid-filled environment. In related fashion, the type of tissue being operated on can affect the energy level optimal for operation of an ultrasonic surgical instrument or an RF electrosurgical instrument. The Situational Awareness Surgical Hub 5104 can determine which type of surgical procedure is being performed according to the expected tissue profile of the surgical procedure and then can customize the energy levels of the ultrasonic surgical instrument or the RF electrosurgical instrument, respectively. Further, the Situational Awareness Surgical Hub 5104 can be configured to adjust the energy levels of the ultrasonic surgical instrument or the RF electrosurgical instrument not only on a procedure basis but also over the course of the surgical procedure. The Situational Awareness Surgical Hub 5104 can determine which step of the surgical procedure is being performed or will be performed next and then update the control algorithms of the generator and / or the ultrasonic surgical instrument or the RF electrosurgical instrument to set the energy level to a value appropriate for the tissue type expected according to the steps of the surgical procedure.

[0122] As yet another example, data can be retrieved from an additional data source 5126 in order to improve the conclusions drawn by the surgical hub 5104 from one data source 5126. The situation awareness surgical hub 5104 can enhance the data received from the modular device 5102 with context information constructed regarding surgical procedures from other data sources 5126. For example, the situation awareness surgical operating hub 5104 can be configured to determine whether hemostasis has occurred (i.e., whether bleeding at the surgical site has stopped) according to video or image data received from a medical imaging device. However, in some cases, the video or image data may not be conclusive. Thus, in one illustration, the surgical hub 5104 can further be configured to compare a physiological measurement (e.g., blood pressure sensed by a BP monitor communicatively coupled to the surgical hub 5104) with visual or image data of hemostasis (e.g., from a medical imaging device 124 (FIG. 2) communicatively coupled to the surgical hub 5104) to make a determination about the integrity of a staple line or tissue weld. In other words, the situation awareness system of the surgical hub 5104 can provide additional context when analyzing visualization data in consideration of physiological measurement data. The additional context can be useful when the visualization data may not be conclusive or complete on its own.

[0123] As another benefit, it includes actively and automatically controlling the paired modular devices 5102 according to specific steps of the surgical procedure being performed in order to reduce the number of times medical personnel need to interact with or control the surgical system 5100 during the course of a surgical procedure. For example, the situation awareness surgical hub 5104 can actively activate the generator to which an RF electrosurgical instrument is connected if it determines that subsequent steps of the procedure require the use of the instrument. By actively activating the energy source, the instrument can be made ready for use as soon as the preceding steps of the procedure are completed.

[0124] As another example, the situation-aware surgical hub 5104 can determine, according to the feature(s) in the surgical site where the surgeon is expected to look, whether the current or subsequent steps of a surgical procedure require different fields of view or degrees of magnification on the display. The surgical hub 5104 can then actively change the displayed field of view (e.g., supplied by a medical imaging device for the visualization system 108) accordingly, causing the display to automatically adjust over the course of the surgical procedure.

[0125] As yet another example, the situation-aware surgical hub 5104 can determine which step of a surgical procedure is being performed or will be performed subsequently, and whether a particular data or comparison between data is required for that step of the surgical procedure. The surgical hub 5104 can be configured to automatically call up a data screen based on the step of the surgical procedure being performed, without waiting for the surgeon to request specific information.

[0126] Another benefit includes checking for errors during the setup of a surgical procedure or during the surgical procedure itself. For example, the situational awareness surgical hub 5104 can determine whether the operating room is appropriately or optimally set up for the surgical procedure being performed. The surgical hub 5104 can determine the type of surgical procedure being performed and obtain the corresponding checklist, product locations, or setup needs (e.g., from memory), and then be configured to compare the current operating room layout to a standard layout for the type of surgical procedure that the surgical hub 5104 has determined is being performed. In one example, the surgical hub 5104 can be configured to compare a list of items for the procedure scanned, for example, by a suitable scanner, and / or a list of devices paired with the surgical hub 5104 to a manifest of recommended or expected items and / or devices for a given surgical procedure. If there are any discontinuities between the lists, the surgical hub 5104 can be configured to provide a warning indicating that a particular modular device 5102, patient monitoring device 5124, and / or other surgical item is missing. In one example, the surgical hub 5104 can be configured to determine, for example, by proximity sensors, the relative distance or position of the modular device 5102 and the patient monitoring device 5124. The surgical hub 5104 can compare the relative position of the devices to a recommended or anticipated layout for a particular surgical procedure. If there is a discontinuity between the layouts, the surgical hub 5104 can be configured to provide a warning indicating that the current layout of the surgical procedure deviates from the recommended layout.

[0127] As another example, the situation awareness surgical hub 5104 can determine whether a surgeon (or other healthcare provider) is making a mistake or otherwise deviating from the expected sequence of actions during a surgical procedure. For example, the surgical hub 5104 can determine the type of surgical procedure being performed, retrieve a corresponding list of steps or order of device use (e.g., from memory), and then compare the steps being taken or devices being used during the surgical procedure to the expected steps or devices for the type of surgical procedure that the surgical hub 5104 has determined is being performed. In one illustration, the surgical hub 5104 can be configured to provide a warning indicating that an unexpected action is being taken or an unexpected device is being utilized at a particular step in the surgical process.

[0128] Overall, the situation awareness system for the surgical hub 5104 improves the outcome of a surgical procedure by adjusting (e.g., adapting to different tissue types) the surgical instruments (and other modular devices 5102) for the specific context of each surgical procedure and verifying actions during the surgical procedure. The situation awareness system also improves the efficiency of the surgeon during the performance of a surgical procedure by automatically suggesting the next step, providing data, and adjusting displays and other modular devices 5102 within the surgical field according to the specific context of the procedure.

[0129] Referring now to FIG. 15, for example, a schedule 5200 showing the situation awareness of a hub such as surgical hub 106 or 206 (FIGS. 1 - 11) is shown. The schedule 5200 is exemplary surgical procedures and context information that can be derived from data received by the surgical hubs 106, 206 from data sources at each step of the surgical procedure. The schedule 5200 shows the typical steps that would be taken by nurses, surgeons, and other healthcare personnel during a lobectomy procedure that begins with setting up the operating room and ends with transferring the patient to the post - operative recovery room.

[0130] The situation awareness surgical hubs 106, 206 receive data from a data source that includes data generated each time a healthcare provider utilizes a modular device paired with the surgical hubs 106, 206 over the course of a surgical procedure. The surgical hubs 106, 206 receive this data from the paired modular devices and other data sources and can continuously derive an estimate regarding the ongoing procedure (i.e., context information), such as which step of the procedure is being performed at any given time, when new data is received. The situation awareness system of the surgical hubs 106, 206 can, for example, record data regarding the procedure to generate a report, verify the steps being taken by the healthcare provider, provide data or prompts that may be associated with a particular procedure step (e.g., via a display screen), adjust the modular device based on the context (e.g., activate a monitor, adjust the field of view (FOV) of a medical imaging device, or change the energy level of an ultrasonic surgical instrument or an RF electrosurgical instrument), and perform any other such operations as described above.

[0131] As a first step 5202 in this exemplary procedure, a hospital staff member reads the patient's EMR from the hospital's EMR database. Based on the selected patient data in the EMR, the surgical hubs 106, 206 determine that the procedure to be performed is a chest procedure.

[0132] In a second step 5204, the staff member scans the incoming medical supplies for the procedure. The surgical hubs 106, 206 cross-reference the scanned supplies with a list of supplies utilized in various types of procedures and confirm that the mix of supplies corresponds to a chest procedure. Additionally, the surgical hubs 106, 206 can also determine that the procedure is not a wedge procedure (either because the incoming supplies do not include the specific supplies required for a chest wall wedge procedure or for some other reason that the supplies do not correspond to a chest wall wedge procedure).

[0133] In the third step 5206, the healthcare provider scans the patient's band via a scanner communicatively connected to the surgical hubs 106, 206. Subsequently, the surgical hubs 106, 206 can confirm the patient's identification information based on the scanned data.

[0134] In the fourth step 5208, the medical staff turns on the auxiliary devices. The auxiliary devices to be used can vary according to the type of surgical procedure and the techniques used by the surgeon. In this exemplary case, these include a smoke evacuator, an inhaler, and a medical imaging device. Once activated, the modular auxiliary devices can automatically pair with the surgical hubs 106, 206 located within a specific vicinity of the modular devices as part of their initialization process. Subsequently, the surgical hubs 106, 206 can derive context information regarding the surgical procedure by detecting the type of modular devices paired with them during this preoperative or initialization stage. In this particular embodiment, the surgical hubs 106, 206 determine that the surgical procedure is a VATS surgery based on this specific combination of paired modular devices. Based on the combination of data from the patient's EMR, the list of medical supplies used in the surgery, and the type of modular devices connected to the hubs, the surgical hubs 106, 206 can generally estimate the specific procedure being performed by the surgical team. Once the surgical hubs 106, 206 know what specific procedure is being performed, they can then read the steps of that procedure from memory or from the cloud and then cross-reference the data subsequently received from the connected data sources (such as modular devices and patient monitoring devices) to estimate which step of the surgical procedure the surgical team is executing.

[0135] In the fifth step 5210, the staff attaches EKG electrodes and other patient monitoring devices to the patient. The EKG electrodes and other patient monitoring devices can pair with the surgical hubs 106, 206. When the surgical hubs 106, 206 start receiving data from the patient monitoring devices, the surgical hubs 106, 206 confirm that the patient is in the operating room.

[0136] In the sixth step 5212, the healthcare provider induces anesthesia in the patient. The surgical hubs 106, 206 can estimate that the patient is under anesthesia based on data from a modular device and / or a patient monitoring device, including, for example, EKG data, blood pressure data, ventilator data, or a combination thereof. When the sixth step 5212 is completed, the preoperative portion of the pneumonectomy is completed and the surgical portion begins.

[0137] In the seventh step 5214, the lung of the patient being operated on is deflated (while ventilation is switched to the contralateral lung). The surgical hubs 106, 206 can estimate, for example, from ventilator data that the patient's lung has been deflated. Since the surgical hubs 106, 206 can compare the detection that the patient's lung has been deflated with the expected steps of the procedure (which can be accessed or read in advance), it can be estimated that the surgical portion of the procedure has begun, and thereby it can be determined that deflating the lung is the first surgical step in this particular procedure.

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

[0139] In the ninth step 5218, the surgical team begins the incision step of the procedure. The surgical hubs 106, 206 can be presumed to be in the process of the surgeon incising and separating the patient's lung, as they receive data from an RF or ultrasonic generator indicating that an energy instrument is being fired. The surgical hubs 106, 206 can determine that the energy instrument being fired at this point in the process (i.e., after the previously considered steps of the procedure have been completed) corresponds to the incision step by cross-referencing the received data with the read steps of the surgical procedure. In a particular example, the energy instrument can be an energy tool attached to a robotic arm of a robotic surgical system.

[0140] In the tenth step 5220, the surgical team proceeds to the ligation step of the procedure. The surgical hubs 106, 206 can be presumed to be in the process of the surgeon ligating arteries and veins, as they receive data from a surgical stapling and cutting instrument indicating that an instrument is being fired. Similar to the previous step, the surgical hubs 106, 206 can derive this presumption by cross-referencing the receipt of data from the surgical stapling and cutting instrument with the steps within the read process. In a particular example, the surgical instrument can be a surgical tool attached to a robotic arm of a robotic surgical system.

[0141] In the 11th step 5222, an excision of the treatment area is performed. The surgical hubs 106, 206 can be estimated by the surgeon to be transecting substantial tissue based on data from the surgical stapling and cutting instrument including data from its cartridge. The cartridge data can correspond, for example, to the size or type of staples fired by the instrument. Since different types of staples are used for different types of tissue, the cartridge data can indicate the type of tissue being stapled and / or transected. In this case, the type of staple fired is used for substantial tissue (or other similar tissue types), whereby the surgical hubs 106, 206 can be estimated to be performing an excision of the treatment area.

[0142] Subsequently, in the 12th step 5224, a nodulectomy step is performed. The surgical hubs 106, 206 can be estimated by the surgical team to be incising a nodule and performing a leak test based on data received from a generator indicating that an RF or ultrasonic instrument is being fired. In this particular treatment, the RF or ultrasonic instrument used after the substantial tissue has been transected corresponds to the nodulectomy step, which enables the surgical hubs 106, 206 to make this estimation. Since different instruments are better suited for specific tasks, it should be noted that the surgeon may periodically switch between the surgical stapling / cutting instrument and the surgical energy (i.e., RF or ultrasonic) instrument depending on the specific step during the treatment. Thus, the specific sequence in which the stapling / cutting instrument and the surgical energy instrument are used can indicate which step of the treatment the surgeon is performing. Further, in certain examples, robotic tools can be used for one or more steps during the surgical treatment and / or handheld surgical instruments can be used for one or more steps during the surgical treatment. The surgeon(s) can, for example, alternate between the robotic tool and the handheld surgical instrument in sequence and / or, for example, use the devices simultaneously. When the 12th step 5224 is completed, the incision is closed and the postoperative portion of the treatment begins.

[0143] In the 13th step 5226, the patient's anesthesia is reversed. The surgical hubs 106, 206 can be estimated to be waking up from anesthesia, for example, based on ventilator data (i.e., the patient's respiratory rate begins to increase).

[0144] Finally, the 14th step 5228 is for the healthcare provider to remove various patient monitoring devices from the patient. Thus, the surgical hubs 106, 206 can be estimated that the patient is being transferred to the recovery room when the hub loses EKG, BP, and other data from the patient monitoring device. As can be seen from the description of this exemplary procedure, based on the data received from various data sources communicatively coupled to the surgical hubs 106, 206, the surgical hubs 106, 206 can determine or estimate when each step of a given surgical procedure is occurring.

[0145] The situation awareness is further described in U.S. Patent Provisional Application No. 62 / 659,900, filed on April 19, 2018, entitled "METHOD OF HUB COMMUNICATION", which is hereby incorporated by reference in its entirety. In a particular example, the operation of a robotic surgical system, including various robotic surgical systems disclosed herein, for example, can be controlled by the hubs 106, 206 based on its situation awareness and / or feedback from its components and / or based on information from the cloud 104.

[0146] Visual Evaluation of the OR for Metadata and Control of Surgical Devices In various aspects, computer systems such as surgical hubs 106, 206 described in connection with FIGS. 1-11 can be programmed to track surgical devices or surgical staff within the OR via a camera assembly. Images of surgical devices and / or surgical staff within the OR can provide a wide variety of data, including the pose (i.e., position and orientation) of the surgical device, the placement of the surgical device (e.g., through which trocar the surgical instrument is currently inserted), which surgical staff member is operating the surgical device, gestures or activities being performed by the surgical staff, the position of the surgical staff, and the like. In one aspect, data generated from a visual assessment of the surgical staff and / or surgical instrument can be stored as metadata associated with or linked to pre- and post-operative data received from the surgical device. Such metadata can provide additional context regarding the pre- and post-operative data generated by the surgical device, and this additional context can be utilized, for example, by a situation awareness system implemented by the surgical hub or by a cloud computing system as described in the "Situation Awareness" section or in the "Cloud System Hardware and Functional Modules" section, to perform an analysis to identify data trends or correlations. In another aspect, data generated from a visual assessment of the surgical staff and / or surgical instrument can be utilized to control surgical devices within the OR.

[0147] In one aspect, the computer system can utilize OR videos / images that are external to the surgical site (e.g., the abdomen of a patient undergoing laparoscopic surgery). In this aspect, the camera assembly that captures images for analysis by the computer system described herein can exclude captured images from a laparoscope, thoracoscope, or any other such endoscope and / or video camera utilized to visualize inside the patient's body. Rather, the camera assembly can include cameras positioned throughout the OR to visualize how the surgical devices are being utilized and how the surgical staff are interacting with each other and with the surgical devices in order to provide a broader context regarding the actions taking place within the OR. In another aspect, the externally captured videos / images can be utilized in conjunction with videos / images from the endoscope for analysis and / or to improve the control of the surgical devices in use.

[0148] FIG. 16 is a diagram of an exemplary OR setup according to at least one aspect of the present disclosure. In various embodiments, the surgical hub 211801 can be communicatively connected to one or more cameras 211802, surgical instruments 211810, a display 211806, overheard lights 211808, and other surgical devices within the OR 211800 via a communication protocol (e.g., Bluetooth), as described above in the section “Surgical Hub”. The camera 211802 can be oriented to capture images and / or videos of the surgical staff 211803 and / or the surgical instruments 211810 (or other surgical devices) within the OR 211800 during a surgical procedure. The captured images can include still images or moving images (i.e., videos). Images of the surgical staff 211803 and / or the surgical instruments 211810 can be captured at various angles and magnifications, and by using various filters, etc. In one embodiment, the camera 211802 is disposed within the OR 211800 so as to collectively visualize each surgical staff member performing the procedure. Thus, the surgical hub 211801 can receive the captured images and / or video data from the camera 211802 for visually analyzing the surgical staff 211803 and / or the surgical instruments 211810 during a surgical procedure. The images and / or video data can be processed using various machine vision, image processing, object recognition, and optical tracking techniques to track the characteristics, properties, actions, and movements of the surgical staff 211803 and / or the surgical instruments 211810.

[0149] FIG. 17A is a logical flow diagram of a process 211600 for controlling a surgical device according to at least one aspect of the present disclosure. The process 211600 can be executed by a processor or control circuit of a computer system, such as the processor 244 of the surgical hub 206 shown in FIG. 10. Accordingly, the process 211600 can be embodied as a set of computer-executable instructions stored in the memory 249, which, when executed by the processor 244, cause a computer system (e.g., the surgical hub 211801) to perform the described steps.

[0150] Accordingly, the processor 244 that executes process 211600 captures (211602) an image of the OR 211800 (which can include a still image or a video) via the assembly of the camera 211802 located within that OR. Any captured image that includes the surgical staff 211803 and / or surgical devices can be analyzed by process 211600 to confirm information regarding the surgical staff 211803 and / or surgical devices for controlling the surgical devices. Targets to be tracked or monitored (i.e., the surgical staff 211803 and surgical devices) can be recognized from the images captured by the assembly of the camera 211802 using various image or object recognition techniques, including techniques based on appearance and features. For example, the captured images can be processed using an edge detection algorithm (e.g., the Canny edge detection algorithm) to generate the contours of various objects within each image. Then, an algorithm can compare a template of the target object with the image containing the contour-generated objects to determine whether any of the target objects are located within the image. As another example, an algorithm can extract features from the captured images. The extracted features can then be supplied to a machine learning model (e.g., an artificial neural network or a support vector machine) trained via supervised or unsupervised learning techniques to correlate the feature vectors to the targets. Features can include edges (e.g., extracted via the Canny edge detection algorithm), curvature, corners (e.g., extracted via the Harris & Stephens corner detection algorithm), etc.

[0151] Accordingly, the processor 244 determines the characteristics or states of the surgical staff and / or surgical devices captured by the image (211604). Such characteristics or conditions can include physical properties, operations, interactions with other objects or individuals, and the like. More specifically, the characteristics or states of the surgical staff member 211803 can include whether the surgical staff member 211803 is making a gesture 211804 (as shown in FIG. 16), whether the surgical staff member 211803 is holding a given surgical instrument 211810, whether the position of the surgical staff member 211803 is identified, the number of surgical staff members 211803 within the OR, whether the surgical staff member 211803 is interacting with a surgical device (and which surgical device), whether the surgical staff member 211803 is passing a surgical instrument 211810 or another surgical device to another surgical staff member 211803, physical characteristics associated with the surgical staff member 211803 (e.g., posture, arm position, wrist angle), and the like. The characteristics or states of the surgical devices can include their postures, whether they are being actively used (e.g., whether the generator is actively supplying energy to the connected surgical instrument 211810), whether the surgical instrument 211810 is being inserted through a trocar (and the position or identity of that trocar), and the like.

[0152] Accordingly, the processor 244 controls (211606) the surgical device paired with the surgical hub 211801 in a manner that depends on a particular determined trait or state. For example, if the processor 244 determines (211604) that a surgical staff member 211803 is performing a "change instrument mode" gesture, the processor 244 may send a signal to a particular surgical instrument 211810 (or its associated generator) connected to the surgical hub 211801 or otherwise control (211606) that surgical instrument to change the operating mode of the surgical instrument 211810 (e.g., change an electrosurgical instrument from a sealing mode to a cutting mode). This enables the surgical staff to control the surgical instrument 211810 without directly interacting with the surgical instrument 211810 itself. As another example, if the processor 244 determines (211604) that a surgical instrument 211810 is being passed (or is being prepared to be passed) from one surgical staff member 211803 (e.g., a nurse) to another surgical staff member 211803 (e.g., a surgeon), the processor 244 may send a signal to an energy generator or otherwise control (211606) the energy generator to activate and initiate the supply of energy to the connected surgical instrument 211810. This enables the surgical hub 211801 to pre-activate the surgical instrument 211810 so that the surgical instrument is ready for use without the surgeon having to perform an active action. As yet another example, if the processor 244 determines (211604) that a surgical instrument 211810 is in a particular orientation when the surgical instrument is being fired (or about to be fired), the processor 244 may send a signal to the surgical instrument 211810 or otherwise control (211606) that surgical instrument to modify the operating parameters of the surgical instrument 211810 (e.g., the force to fire or the maximum allowable joint movement angle) accordingly. This enables the surgical hub 211801 to control the function of the surgical instrument 211810 to account for differences in the placement and orientation of the surgical instrument 211810.

[0153] In another aspect, the surgical hub 211801 can include, in addition to or instead of, the gesture recognition system 211500 described below, an audio recognition system. In this aspect, the surgical hub 211801 can be programmed to identify various voice commands, respond to them, and control the functions of any connected surgical device accordingly.

[0154] In another aspect, FIG. 17B is a logical flow diagram of a process 211620 for generating surgical metadata according to at least one aspect of the present disclosure. As described above in connection with FIG. 17A, the process 211620 can be executed by the processor 244. Accordingly, the processor 244 executing the process 211620 can capture (211622) image / video data and determine (211624) the characteristics of the surgical staff member 211803 and / or the surgical instrument 211810, as described above in connection with FIG. 17A. However, in this aspect, the processor 244 stores (211626) the characteristics or states as metadata associated with or linked to the pre- and post-operative data generated by the surgical device during the surgical procedure. As described above, the characteristics or states stored (211626) as metadata can include various physical characteristics of the surgical staff member 211803 and the surgical instrument 211810 within the OR 211800, their actions, and their interactions with each other.

[0155] In one embodiment of processes 211600, 211620 described in connection with FIGS. 17A and 17B, the surgical hub 211801 can be configured to recognize and respond to gestures made by an individual within the OR 211800. For example, FIG. 18 is a block diagram of a gesture recognition system 211500 according to at least one aspect of the present disclosure. In the following description of FIG. 18, reference is also made to FIGS. 10 and 16. The gesture recognition system 211500 includes a gesture recognition module 211504 that can be executed by a processor or control circuit of a computer system, such as the processor 244 of the surgical hub 206 shown in FIG. 10. Thus, the gesture recognition module 211504 can be embodied as a set of computer-executable instructions stored in the memory 249, and when this set of instructions is executed by the processor 244, it causes the computer system (e.g., the surgical hub 211801) to perform the described steps.

[0156] The gesture recognition system 211500 receives image or video data from image recognition hardware (e.g., camera 211802), recognizes various gestures 211804 that can be performed by surgical staff 211803 (i.e., determines whether a gesture is being made in processes 211600, 211620 described in relation to FIGS. 17A and 17B (211604, 211624)), and for a particular detected gesture 211804, can be programmed to perform a corresponding action or respond in another way (i.e., control a surgical device in processes 211600, 211620 described in relation to FIGS. 17A and 17B (211606), or save data as metadata (211626)). In one aspect, the gesture recognition module 211504 can include a feature extraction module 211506 and a gesture classification module 211508. The feature extraction module 211506 is programmed to extract measurable and discriminative characteristics or traits (i.e., features) from the image / video data. Features can include edges (e.g., extracted via the Canny edge detection algorithm), curvature, corners (e.g., extracted via the Harris & Stephens corner detection algorithm), etc. The gesture classification module 211508 determines whether the extracted features match a gesture from a set of gestures. In one aspect, the gesture classification module 211508 can include a machine learning model (e.g., an artificial neural network or a support vector machine) trained via supervised or unsupervised learning techniques to correlate the feature vector of the extracted features to one or more output gestures. In another aspect, the gesture classification module 211508 can include an algorithm based on Hu invariant moments or a k-curvature algorithm to classify gestures. In yet another aspect, the gesture classification module 211508 can include a template matching algorithm programmed to match the characterized image / video data (or a portion thereof) to a template corresponding to a predetermined gesture.Other aspects can include various combinations of the foregoing techniques and other techniques for classifying gestures.

[0157] When a gesture is recognized via the gesture recognition module 211504, the gesture recognition system 211500 can perform an operation 211510 or response corresponding to the recognized gesture. In one aspect, the operation 211510 performed by the computer system includes controlling a surgical device within the OR 211800, as described above in connection with FIG. 17A. For example, a surgical hub 211801 executing the gesture recognition module 211504 can recognize a "brightness control" gesture and then, in response, dim or brighten an overhard light 211808 paired with the surgical hub 211801. As another example, a surgical hub 211801 executing the gesture recognition module 211504 can recognize a "generator on" gesture and then activate an energy generator paired with the surgical hub 211801, thereby powering an ultrasonic surgical instrument or an electrosurgical instrument connected to the generator. Gestures can also be used to change information displayed on the display 211806 (e.g., scroll a menu related to the surgical instrument 211810 or switch the displayed video feed), change the mode, function, or operating parameters of the surgical instrument 211810 (e.g., change an electrosurgical instrument from a sealing mode to a transverse incision mode), start or stop video recording on a scope, change the output level of an energy generator, and the like. Gestures can be beneficial in that they allow a surgical device outside a sterile barrier to be controlled without creating a risk of contamination from inside the sterile barrier, and allow an individual not directly operating a surgical device or not in close proximity to a surgical device within the OR to control the functions of the surgical device.

[0158] In another aspect, the operation 211510 performed by the computer system, as described above in connection with FIG. 17B, includes storing the gestures made by the surgical staff as metadata associated with or linked to the pre- and post-operative data generated by the surgical device during the surgical procedure. Such metadata can be useful in determining whether the surgical staff is manually controlling the surgical device or controlling the surgical device via gestures, and the gestures can be correlated with the performance of the surgical staff, procedure time, and other such metrics. In various other aspects, the computer system can perform both controlling one or more surgical devices and storing gesture data as metadata.

[0159] In another aspect, the gesture recognition system 211500 utilizes a magnetic sensing system for receiving non-contact input from a user, in addition to or instead of the camera 211802, to visually identify gestures. In this aspect, the gesture recognition system 211500 can include, for example, a magnetic sensing array that can be positioned within the OR 211800. The magnetic sensing array can be configured to monitor the position of magnetic elements that can be controlled by the surgical staff 211803. In one aspect, the magnetic elements can be incorporated into a surgical glove or another such article of clothing. In another aspect, the magnetic elements can be located within an object or token that can be manipulated by the surgical staff 211803. Thus, the magnetic sensing array can be configured to detect the position of the magnetic sensing elements over time and identify any gestures made by the individual controlling the magnetic elements. Similar to the case of the gesture recognition system 211500, the user can scroll through a menu or an item selected from the menu displayed on the display 211806 within the OR 211800, or perform other gestures to control the functions of various surgical devices within the OR 211800. Thus, the position, movement, and / or orientation of the magnetic elements can be utilized as a tracking marker for controlling the display 211806 or other surgical devices connected by the surgical hub 211801, regardless of whether the magnetic elements are located inside or outside the sterile field.

[0160] In a predictive embodiment of processes 211600, 211620 described in connection with FIGS. 17A and 17B, a computer system (e.g., surgical hub 211801) can be configured to determine the orientation of surgical instrument 211654 and control the surgical instrument 211654 accordingly (211606), or save the wrist angle as metadata for analysis (211626), as shown in FIG. 19. In this particular embodiment, the angle of an individual's wrist 211650 is defined as the angle α between the longitudinal axis 211656 of the surgical instrument 211654 held by the surgeon and the longitudinal axis 211652 of the individual's hand (i.e., the proximal-to-distal axis). In other embodiments, the wrist angle can be defined, for example, as the angle between the individual's hand and forearm. The surgical hub 211801 can determine the wrist angle α by visually identifying the surgical instrument 211654 being operated by the surgeon and the surgeon's hand, for example, using the object recognition techniques described above.

[0161] In one aspect of process 211620 described in FIG. 17B, the wrist angle α is stored as metadata (211626) and can be utilized to perform an analysis against recommended surgical techniques. For example, scatter plot 211700 of FIG. 20 represents one such predictive analysis of the relationship between wrist angle α and the result of a surgical procedure. In scatter plot 211700, the vertical axis 211702 represents the wrist angle α, and the horizontal axis 211704 represents the treatment result. The portions of the horizontal axis 211704 on the right and left sides of the vertical axis 211702 can correspond to positive and negative treatment results, respectively, for example. Various different treatment results, such as whether a particular treatment step or firing of the surgical instrument 211654 resulted in excessive bleeding, the incidence rate of reoperations for the surgical procedure, etc., can be compared with the surgeon's wrist angle α. Further, the treatment result can be quantified in various different manners depending on the particular type of treatment result being compared with the surgeon's wrist angle α. For example, if the treatment result is bleeding that occurred after a particular firing of the surgical instrument 211654, the horizontal axis 211704 can represent the degree or amount of blood along the incision line from the firing of the surgical instrument 211654. Further, the wrist angle α of each plotted point within scatter plot 211700 can represent the wrist angle α at a particular instant of the surgical procedure, the average wrist angle α during a particular step of the surgical procedure, the overall average wrist angle during the surgical procedure, etc. Further, whether the wrist angle α corresponds to the average wrist angle α or the wrist angle α at a particular instant can correspond to the type of treatment result against which the wrist angle α is being compared. For example, if the treatment result represented by the horizontal axis 211704 is the amount of bleeding from the firing of the surgical instrument 211654, the vertical axis 211702 can represent the wrist angle α at the instant the surgical instrument 211654 was fired. As another example, if the treatment result represented by the horizontal axis 211704 is the incidence rate of reoperations for a particular type of treatment, the vertical axis 211702 can represent the average wrist angle α during the surgical procedure.

[0162] Furthermore, this data can then be used to establish thresholds or baselines, and as described in Attorney Docket No. END9018USNP2 / 180517-2, entitled "USAGE AND TECHNIQUE ANALYSIS OF SURGEON / STAFF PERFORMANCE AGAINST A BASELINE TO OPTIMIZE DEVICE UTILIZATION AND PERFORMANCE FOR BOTH CURRENT AND FUTURE PROCEDURES", filed concurrently herewith, this threshold or baseline can be used to present recommendations to the surgical staff 211803 during or after a surgical procedure. For example, as shown in FIG. 20, the computer system can calculate a first threshold 211708a and a second threshold 211708b that define a range of wrist angles α that most highly correlates with a positive treatment outcome. Thus, the first and second thresholds 211708a, 211708b can define a first or preferred operating range. When using the surgical instrument 211654, if the surgeon's wrist angle α is within this range, the computer system may, for example, not perform any action. Furthermore, the computer system can calculate a third threshold 211706a and a fourth threshold 211706b that define a range of wrist angles α that at least moderately correlates with a positive treatment outcome. Thus, the third and fourth thresholds 211706a, 211706b can define a second or cautionary operating range in relation to the first and second thresholds 211708a, 211708b, and this cautionary range is defined as the area between corresponding pairs of the first and second thresholds 211708a, 211708b and the third and fourth thresholds 211706a, 211706b. When using the surgical instrument 211654, if the surgeon's wrist angle α is within the cautionary range, the computer system may, for example, present a first recommendation for the surgeon to adjust their technique. The range outside the third and fourth thresholds 211706a, 211706b can define a third or dangerous operating range that highly correlates with a negative treatment outcome.When using the surgical instrument 211654, if the surgeon's wrist angle α is within this dangerous range, the computer system may present, for example, a second recommendation for the surgeon to adjust their technique or deactivate the surgical instrument 211654.

[0163] In one aspect of the process 211600 described in FIG. 17A, the surgical instrument 211810 can be controlled (211606) according to the determined wrist angle α. For example, the surgical hub 211801 can adjust the control program parameters of the surgical instrument 211810, such as the force to be emitted, the force to be closed, or the maximum allowable joint movement angle, to compensate for the orientation of the surgical instrument 211810. Such compensation can ensure that the end effector of the surgical instrument 211810 applies the same force as would be applied if the surgical instrument 211810 were more appropriately oriented.

[0164] In one aspect, the computer system can be programmed to create an orientation index that defines the pose of the surgical instrument 211810 with respect to a predetermined or normalized reference frame. This enables seamless comparison of data captured within ORs of different dimensions. The orientation index can be defined, for example, when the surgical hub 206 scans its surroundings using the non-contact sensor module 242, as described in the section on "surgical hub". Thus, the computer system can detect the pose of the surgical instrument 211810 and store it as a function of a predetermined reference frame.

[0165] In other embodiments, the computer system can track the position and orientation of trocars utilized in a particular surgical procedure type, and this data can then be stored as metadata and / or used to control display 211806 or other surgical devices to present recommendations to the surgical staff. Analyzing the trocar positions can determine which range of positions (or combinations of positions in the case of a surgical procedure utilizing multiple trocars) most highly correlates with positive procedure outcomes. Thus, the computer system can then present recommendations regarding trocar placement in future surgical procedures.

[0166] In other embodiments, the computer system can track the position of the handle relative to surrounding objects (such as the operating table or other equipment), and this data can then be stored as metadata and / or used to control display 211806 or other surgical devices to present recommendations to the surgical staff. For example, the computer system can avoid problems in previous procedures by presenting recommendations regarding trocar placement where a particular placement caused interference by various objects with the surgical instrument 211810 inserted through those trocars, resulting in a more difficult procedure (which may correlate with a worse surgical outcome or longer procedure time).

[0167] In other embodiments, the computer system can identify surgical instruments 211810 and other surgical devices within the setup located on the preoperative back table to provide additional context to the surgical procedure data and / or the estimations made by the situation awareness system as described in the "Situation Awareness" section. Identifying which surgical devices are (or are not) within the preoperative setup can affect the subsequent estimations made by the situation awareness system.

[0168] In other embodiments, the computer system can identify scrub nurses and / or instrument nurses from the surgical staff 211803 and track their locations and activities to help notify what may be the next step in the surgical procedure. The instrument nurse retrieves the surgical instruments 211810 that are expected to be needed next and then, if necessary, passes the surgical instruments 211810 to the surgeon, so the activities of the instrument nurse can be of informational value. Further, some surgical instruments 211810 or other devices need to be prepared before they are used (for example, depending on the tissue condition, staples can be placed on the surgical stapler). Thus, when the instrument nurse is holding the surgical instruments 211810, which surgical instruments 211810 are being held by the instrument nurse and what preparations are being made by the instrument nurse can assist in estimating which step of the surgical procedure is being performed or will be performed. Still further, new equipment passed from the scrub nurse to the instrument nurse generally affects how the procedure progresses, notifies which procedure steps are being performed, and can indicate the likelihood of complications. For example, if additional adjunctive hemostatic agents are passed to the instrument nurse, this can indicate that the surgical procedure is not progressing well because there is more bleeding than initially expected. Still further, the scrub nurse brings substances into the OR, adjusts the settings of surgical devices outside the sterile field, etc. Thus, these activities are monitored and can further be used to notify which step of the surgical procedure is being performed.

Example

[0169] The various aspects of the subject matter described in this specification are illustrated in the following numbered examples. Example 1. A computer system configured to be communicably coupled to a surgical device and a camera configured to view an operating room. The computer system includes a processor and a memory coupled to the processor. The memory stores instructions that, when executed by the processor, cause the computer system to receive an image of a person in the operating room via the camera, determine whether the person is making a gesture based on the image, and control the surgical device according to the gesture.

[0170] Example 2. The computer system according to Example 1, wherein the surgical device includes a display, and the instructions stored in the memory, when executed by the processor, cause the computer system to control the information displayed on the display according to a gesture.

[0171] Example 3. The computer system according to Example 2, wherein the information displayed on the display corresponds to a surgical instrument controlled by a person.

[0172] Example 4. The computer system according to Example 1, wherein the surgical device includes a surgical instrument, and the instructions stored in the memory, when executed by the processor, cause the computer system to change the operation of the surgical instrument according to a gesture.

[0173] Example 5. The computer system according to Example 4, wherein the surgical instrument is selected from the group consisting of an electrosurgical instrument, an ultrasonic surgical instrument, and a surgical stapling instrument.

[0174] Example 6. The computer system according to any one of Examples 1 to 5, wherein the instructions stored in the memory, when executed by the processor, cause the computer system to extract features from the image received from the camera and determine whether the person is making a gesture according to whether the extracted features correspond to a gesture.

[0175] Example 7. A computer system configured to be communicably coupled to a surgical device and a camera configured to view an operating room. The computer system includes a processor and a memory coupled to the processor. The memory stores instructions that, when executed by the processor, cause the computer system to receive an image of the surgical device in the operating room via the camera, determine the pose of the surgical device based on the image, and control the surgical device according to the pose of the surgical device.

[0176] Example 8. The computer system according to Example 7, wherein the instructions stored in the memory, when executed by the processor, cause the computer system to change the operation of the surgical device according to the pose.

[0177] Example 9. The computer system according to Example 8, wherein the surgical device includes an end effector and the operation includes the orientation of the end effector.

[0178] Example 10. The computer system according to Example 8, wherein the surgical device includes an end effector configured to staple tissue or deliver energy to tissue according to a control algorithm, and the operation includes the control algorithm.

[0179] Example 11. The computer system according to Example 7, wherein the instructions stored in the memory, when executed by the processor, cause the computer system to cause the surgical device to display information corresponding to the pose.

[0180] Example 12. The computer system according to Example 11, wherein the displayed information corresponds to a surgical context.

[0181] Example 13. When instructions stored in a memory are executed by a processor, the computer system is caused to receive pre- and post-operative data from one or more surgical devices, where the one or more surgical devices include surgical devices, and to determine a surgical context based at least in part on the pre- and post-operative data from the one or more surgical devices. The computer system according to Example 12.

[0182] Example 14. When instructions stored in a memory are executed by a processor, the computer system is caused to determine the orientation of a surgical device according to a static reference frame associated with an operating room. The computer system according to any one of Examples 7 to 13.

[0183] Example 15. A computer system configured to be communicably coupled to a surgical device and a camera configured to view an operating room. The computer system includes a processor and a memory coupled to the processor. The memory stores instructions that, when executed by the processor, cause the computer system to receive an image of a surgical device or an individual in the operating room via the camera, determine the orientation of the surgical device based on the image according to whether the image is an image of the surgical device, determine whether the individual is making a gesture based on the image according to whether the image is an image of the individual, and control the surgical device according to at least one of the orientation of the surgical device or the gesture.

[0184] Example 16. The surgical device includes a display. When instructions stored in a memory are executed by a processor, the computer system is caused to control the information displayed on the display according to a gesture. The computer system according to Example 15.

[0185] Example 17. The surgical device includes a surgical instrument. When instructions stored in a memory are executed by a processor, the computer system is caused to change the operation of the surgical instrument according to a gesture. The computer system according to Example 15.

[0186] Example 18. The computer system according to any one of Examples 15 to 17, wherein when instructions stored in a memory are executed by a processor, the computer system causes the operation of the surgical device to be changed according to the posture.

[0187] Example 19. The computer system according to any one of Examples 15 to 17, wherein when instructions stored in a memory are executed by a processor, the computer system causes the surgical device to display information corresponding to the posture.

[0188] Example 20. The computer system according to any one of Examples 15 to 19, wherein when instructions stored in a memory are executed by a processor, the computer system causes the posture of the surgical device to be determined according to a static reference frame related to the operating room.

[0189] Although several forms have been illustrated and described, it is not the intention of the applicant to limit or restrict the scope of the appended "claims" to such a detailed description. Numerous modifications, variations, changes, substitutions, combinations, and equivalents of these forms can be implemented and will be envisioned by those skilled in the art without departing from the scope of the present disclosure. Further, the structure of each element related to the forms described can alternatively be 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. Therefore, it should be understood that the above description and the appended "claims" are intended to cover all such modifications, combinations, and variations as being included within the scope of the disclosed forms. The appended "claims" are intended to cover all such modifications, variations, changes, substitutions, modifications, and equivalents.

[0190] The foregoing detailed description has described various forms of apparatus and / or processes via block diagrams, flowcharts, and / or examples. As long as such block diagrams, flowcharts, and / or examples include one or two or more functions and / or operations, it should be understood by those skilled in the art that each function and / or operation included in such block diagrams, flowcharts, and / or examples can be implemented individually and / or collectively by a variety of hardware, software, firmware, or virtually any combination thereof. It will be understood by those skilled in the art that all or part of some of the forms disclosed herein can be equivalently implemented on an integrated circuit as one or more computer programs running on one or more computers (e.g., as one or more programs running on one or two or more computer systems), as one or more programs running on one or more processors (e.g., as one or more programs running on one or two or more microprocessors), as firmware, or in virtually any combination thereof, and that designing the circuitry and / or writing the code for the software and / or firmware is within the skill of those skilled in the art in view of the present disclosure. Further, the mechanisms of the subject matter described herein can be distributed in a variety of forms as one or more program products, and it will be understood by those skilled in the art that the illustrative forms of the subject matter described herein apply regardless of the particular type of signal carrier medium used to actually effect the distribution.

[0191] Instructions used to program logic to execute various disclosed aspects may be stored in system memory such as dynamic random access memory (DRAM), cache, flash memory, or other storage devices. Additionally, the instructions may be distributed via a network or by other computer-readable media. Thus, a machine-readable medium can include any mechanism for storing or transmitting information in a form readable by a machine (e.g., a computer), but is not limited to floppy disks, optical disks, compact disks, read only memory (CD-ROM), and magneto-optical disks, read only memory (ROM), random access memory (RAM), erasable programmable read only memory (EPROM), electrically erasable programmable read only memory (EEPROM), magnetic or optical cards, flash memory, or tangible machine-readable storage devices used to transmit information via the Internet via electrical, optical, acoustic, or other forms of propagated signals (e.g., carrier waves, infrared signals, digital signals, etc.). Thus, a non-transitory computer-readable medium can include 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).

[0192] When used in any aspect of this specification, the term "control circuit" can refer to, for example, a hardwired circuit, a programmable circuit (e.g., a computer processor, 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) that includes one or more individual instruction processing cores), a state machine circuit, firmware that stores instructions executed by a programmable circuit, and any combination thereof. The control circuit can be embodied, collectively or individually, as a circuit that forms 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 circuit" includes, but is not limited to, an electrical circuit having at least one individual electrical circuit, an electrical circuit having at least one integrated circuit, an electrical circuit having at least one application-specific integrated circuit, an electrical circuit forming a general-purpose computing device configured by a computer program (e.g., a general-purpose computer configured by a computer program that at least partially executes the processes and / or devices described herein, or a microprocessor configured by a computer program that at least partially executes the processes and / or devices described herein), an electrical circuit forming a memory device (e.g., in the form of a random access memory), and / or an electrical circuit forming a communication device (e.g., a modem, a communication switch, or an opto-electronic device). One of ordinary skill in the art will recognize that the subject matter described herein may be implemented in analog or digital form or some combination thereof.

[0193] As used in any aspect of this specification, the term "logic" can refer to an application, software, firmware, and / or circuitry configured to perform any of the foregoing operations. The software may be embodied as a software package, code, instructions, instruction sets, and / or data recorded on a non-transitory computer-readable storage medium. The firmware may be embodied as code, instructions, or instruction sets within a memory device, and / or hard-coded (e.g., non-volatile) data.

[0194] As used in any aspect of this specification, terms such as "component", "system", "module", etc. can refer to a hardware, a combination of hardware and software, software, or a computer-related entity that is either software in execution.

[0195] As used in any aspect of this specification, an "algorithm" refers to a self-collision-free sequence of steps leading to a desired result, and a "step" refers to an operation of a physical quantity and / or logical state that is not necessarily required but can be in the form of an electrical or magnetic signal 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, etc. These and similar terms can be associated with appropriate physical quantities and are merely convenient labels applied to these quantities and / or states.

[0196] Examples of the network may include a packet-switching network. The communication devices can communicate with each other using a selected packet-switching network communication protocol. One exemplary communication protocol is the Ethernet communication protocol that enables communication using the Transmission Control Protocol / Internet Protocol (TCP / IP). The Ethernet protocol may comply with or be compatible with the Ethernet standard titled "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 can communicate with each other using the X.25 communication protocol. The X.25 communication protocol may comply with or be compatible with the standards published by the International Telecommunication Union-Telecommunication Standardization Sector (ITU-T). Alternatively or additionally, the communication devices can communicate with each other using the frame relay communication protocol. The frame relay communication protocol may comply with or be compatible with the standards published 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 able to communicate with each other using the Asynchronous Transfer Mode (ATM) communication protocol. The ATM communication protocol may comply with or be compatible with the ATM standard titled "ATM-MPLS Network Interworking 2.0" published in August 2001 by the ATM Forum and / or later versions of this standard.Of course, different and / or later-developed connection-type network communication protocols are equally contemplated herein.

[0197] Unless otherwise expressly defined, as will be apparent from the foregoing disclosure, throughout the foregoing disclosure, the use of terms such as "processing," "calculating," "computing," "determining," "displaying," etc., refers to the operation and processing of a computer system or similar electronic computing device that operates on and transforms data represented as a physical (electronic) quantity within the registers and memories of the computer system into other data similarly represented as a physical quantity within the memory or registers of the computer system or within such information storage, transmission, or display device.

[0198] One or more components may be referred to herein as "configured to," "configurable to," "operable / operative to," "adapted / adaptable," "able to," "conformable / conformed to," etc. Those skilled in the art will understand that "configured to" generally may include components in an active state and / or components in a non-active state and / or components in a standby state, unless the context dictates otherwise.

[0199] The terms "proximal" and "distal" are used herein with reference to a clinician manipulating the 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 farther from the clinician. For convenience and clarity, it will be further understood that spatial terms such as "vertical", "horizontal", "above", and "below" may be used herein with respect to the drawings. However, the surgical instrument is one that is used in many orientations and positions, and these terms are not intended to be limiting and / or absolute.

[0200] Those skilled in the art will generally understand that the terms used herein, and particularly those used in the appended "Claims" (e.g., the body of the appended "Claims"), are generally intended to be "open" terms (e.g., the term "including" should be construed as "including but not limited to", the term "having" should be construed as "having at least", the term "includes" should be construed as "includes but is not limited to", etc.). Further, where a specific number is intended in an introduced claim recitation, such intention will be clearly stated in the claim, and those skilled in the art will understand that where there is no such statement, there is no such intention. For example, for the sake of illustration, the following appended "Claims" may include introductory phrases such as "at least one" and "one or more" to introduce claim recitations. However, the use of such phrases should not be construed as suggesting that any particular claim that introduces a claim recitation with an indefinite article such as "a" or "an", even if the claim contains introductory phrases such as "one or more" or "at least one" and the indefinite article "a" or "an" within the same claim, is limited to a "Claim" that includes only one such recited matter (e.g., "a" and / or "an" should generally be construed as meaning "at least one" or "one or more"). The same applies when introducing a claim recitation with a definite article.

[0201] Furthermore, even if a specific number is specified in the introduced claim description, it will be recognized by those skilled in the art that such a description should typically be interpreted to mean at least the recited number (for example, in the case of a mere description of "two descriptions" without any other modifiers, generally, it means at least two descriptions, or two or more descriptions). Further, when a notation similar to "at least one of A, B, and C, etc." is used, generally, such a syntax is intended in the sense that those skilled in the art will understand the notation (for example, "a system having at least one of A, B, and C" includes, but is not limited to, a system 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, generally, such a syntax is intended in the sense that those skilled in the art will understand the notation (for example, "a system having at least one of A, B, or C" includes, but is not limited to, a system 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.). Further, typically, any disjunctive word and / or phrase representing two or more alternative terms should be understood by those skilled in the art to be intended to include one of those terms, any of those terms, or both, whether in the specification, in the "claims," or in the drawings, unless the context requires otherwise. For example, the phrase "A or B" will typically be understood to include the possibilities of "A" or "B" or "A and B."

[0202] Regarding the appended "Claims", those skilled in the art will understand that the recited operations in this specification can generally be performed in any order. Also, although flowcharts of various operations are shown in a sequence (s), it should be understood that the various operations may be performed in an order other than the one(s) illustrated, or may be performed simultaneously. Examples of such alternative orderings may include, unless the context dictates otherwise, repetition, interleaving, interruption, reordering, incremental, preparatory, additional, simultaneous, reverse, or other different orderings. Further, terms such as "responsive to", "associated with", or other past tense adjectives are not generally intended to exclude such variations, unless the context dictates otherwise.

[0203] It is particularly worth noting that any reference to "one aspect", "aspect", "exemplification", "an exemplification", etc. means that the particular function, structure, or characteristic described in relation to that aspect is included in at least one aspect. Thus, the phrases "in one aspect", "in an aspect", "in an exemplification", and "in an exemplification" that appear in various places throughout this specification do not necessarily all refer to the same aspect. Further, a particular feature, structure, or characteristic can be combined in any suitable manner in one or more aspects.

[0204] Any patent application, patent, non-patent publication, or other disclosure material referred to in this specification 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. In itself, and to the extent necessary, the disclosure content clearly described in this specification shall prevail over any conflicting description incorporated herein by reference. Any content, or portions thereof, that are inconsistent with the current definitions, views, or other disclosure content described in this specification shall be incorporated herein by reference only to the extent that no conflict arises between the reference content and the current disclosure content.

[0205] In summary, many benefits resulting from using the concepts described herein have been described. The above description in one or more forms is presented for purposes of illustration and explanation. It is not intended to be exhaustive or to limit to the precise forms disclosed. Modifications or variations are possible in light of the above teachings. One or more forms are selected and described to illustrate the principles and practical applications, thereby enabling one of ordinary skill in the art to utilize the various forms in suitable modifications for the particular uses contemplated, along with the various modifications. The "claims" presented with this specification are intended to define the overall scope.

[0206] [Embodiment] (1) A computer system configured to be communicably coupled to a surgical device and a camera configured to view an operating room, the computer system comprising: a processor; a memory coupled to the processor, the memory storing instructions that, when executed by the processor, cause the computer system to: receive an image of an individual in the operating room via the camera; determine whether the individual is making a gesture based on the image; control the surgical device according to the gesture; a memory. (2) The computer system according to embodiment 1, wherein the surgical device includes a display, and the instructions stored in the memory, when executed by the processor, cause the computer system to control the information displayed on the display according to the gesture. (3) The computer system according to embodiment 2, wherein the information displayed on the display corresponds to a surgical instrument controlled by the individual. (4) The surgical device includes a surgical instrument. The computer system according to Embodiment 1, wherein when the instruction stored in the memory is executed by the processor, the computer system changes the operation of the surgical instrument according to the gesture. (5) The computer system according to Embodiment 4, wherein the surgical instrument is selected from the group consisting of an electrosurgical instrument, an ultrasonic surgical instrument, and a surgical stapling instrument.

[0207] (6) When the instruction stored in the memory is executed by the processor, the computer system extracts features from the image received from the camera, and determines whether the individual is performing the gesture according to whether the extracted features correspond to the gesture. The computer system according to Embodiment 1. (7) A computer system configured to be communicably coupled to a surgical device and a camera configured to view an operating room, the computer system comprising: a processor; a memory coupled to the processor, the memory storing instructions that, when executed by the processor, cause the computer system to receive an image of the surgical device in the operating room via the camera, determine the posture of the surgical device based on the image, and control the surgical device according to the posture of the surgical device. A computer system comprising a memory. (8) The computer system according to Embodiment 7, wherein when the instruction stored in the memory is executed by the processor, the computer system changes the operation of the surgical device according to the posture. (9) The surgical device includes an end effector, and the operation includes the orientation of the end effector. The computer system according to Embodiment 8. (10) The surgical device includes an end effector configured to staple tissue or deliver energy to tissue according to a control algorithm. The operation is the computer system according to Embodiment 8, including the control algorithm.

[0208] (11) The computer system according to Embodiment 7, wherein when the instructions stored in the memory are executed by the processor, the computer system is caused to display information corresponding to the posture of the surgical device. (12) The computer system according to Embodiment 11, wherein the displayed information corresponds to a surgical context. (13) When the instructions stored in the memory are executed by the processor, the computer system receives pre- and post-operative data from one or more surgical devices, wherein the one or more surgical devices include the surgical device, and determines the surgical context based at least in part on the pre- and post-operative data from the one or more surgical devices. The computer system according to Embodiment 12. (14) The computer system according to Embodiment 7, wherein when the instructions stored in the memory are executed by the processor, the computer system is caused to determine the posture of the surgical device according to a static reference frame related to the operating room. (15) A computer system configured to be communicably coupled to a surgical device and a camera configured to view the operating room, the computer system includes a processor, a memory coupled to the processor, the memory storing instructions that, when executed by the processor, cause the computer system to receive an image of a surgical device or an individual in the operating room via the camera. Determine the posture of the surgical device based on the image according to whether the image is an image of the surgical device. Determine whether the individual is making a gesture based on the image according to whether the image is an image of the individual. A computer system including a memory that controls the surgical device according to at least one of the posture of the surgical device or the gesture.

[0209] (16) The surgical device includes a display. The computer system according to embodiment 15, wherein when the instructions stored in the memory are executed by the processor, the computer system controls the information displayed on the display according to the gesture. (17) The surgical device includes a surgical instrument. The computer system according to embodiment 15, wherein when the instructions stored in the memory are executed by the processor, the computer system changes the operation of the surgical instrument according to the gesture. (18) The computer system according to embodiment 15, wherein when the instructions stored in the memory are executed by the processor, the computer system changes the operation of the surgical device according to the posture. (19) The computer system according to embodiment 15, wherein when the instructions stored in the memory are executed by the processor, the computer system causes the surgical device to display information corresponding to the posture. (20) The computer system according to embodiment 15, wherein when the instructions stored in the memory are executed by the processor, the computer system determines the posture of the surgical device according to a static reference frame related to the operating room.

Claims

1. A computer system configured to be communicably coupled to a surgical instrument and a camera configured to view an operating room, the computer system comprising: a processor; a memory coupled to the processor, the memory storing instructions which, when executed by the processor, cause the computer system to: receive, via the camera, images of operating room staff, surgeons, and surgical instruments within the operating room; determine whether a given surgical instrument has been passed from the operating room staff to the surgeon based on the images; activate the supply of energy to the given surgical instrument in accordance with a determination that the given surgical instrument has been passed to the surgeon, a memory, a computer system.

2. The computer system according to claim 1, wherein the surgical instrument is selected from the group consisting of an electrosurgical instrument, an ultrasonic surgical instrument, and a surgical stapling instrument.

3. When the instructions stored in the memory are executed by the processor, the computer system causes the computer system to: extract features from the images received from the camera; determine whether the given surgical instrument has been passed from the operating room staff to the surgeon according to whether the extracted features correspond to the given surgical instrument, the computer system according to claim 1.

Images