Communication Path of Surgical System

Abstract

A surgical system is disclosed that includes a surgical hub, a surgical instrument, a generator configured to provide energy to an end effector, and a smoke evacuation system configured to remove smoke from a surgical site. The surgical instrument includes an end effector. Control commands are passed directly from the surgical hub to the surgical instrument. The surgical instrument is configured to pass control commands received from the surgical hub to the generator and the smoke evacuation system in a daisy-chain fashion.

Description

Technical Field

[0001] (Cross - reference to Related Applications) This application claims the benefit of U.S. Provisional Patent Application No. 62 / 955,299, filed on December 30, 2019, under 35 U.S.C. § 119, with the title "DEVICES AND SYSTEMS FOR ELECTROSURGERY", the entire disclosure of which is incorporated herein by reference.

Background Art

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

Summary of the Invention

Means for Solving the Problems

[0003] In various embodiments, a surgical system is disclosed that includes a surgical hub, a surgical instrument, a generator configured to supply energy to an end - effector, and a smoke evacuation system configured to remove smoke from a surgical site. The surgical instrument includes an end - effector. Control commands are passed directly from the surgical hub to the surgical instrument. The surgical instrument is configured to pass control commands received from the surgical hub to the generator and the smoke evacuation system in a daisy - chain manner.

[0004] In various embodiments, a surgical system is disclosed that includes a surgical hub, a surgical instrument, a generator configured to supply energy to an end effector, and a smoke evacuation system configured to remove smoke from a surgical site. The surgical instrument includes an end effector. Control commands are passed directly from the surgical hub to the surgical instrument. The surgical instrument is configured to pass control commands received from the surgical hub to the generator and the smoke evacuation system.

[0005] In various embodiments, a surgical system is disclosed that includes a surgical hub, a first surgical instrument, a first generator configured to supply energy to a first end effector, and a second surgical instrument. The first surgical instrument includes a first end effector. Control commands are passed directly from the surgical hub to the first surgical instrument. The first surgical instrument is configured to pass control commands received from the surgical hub to the first generator and the second surgical instrument in a daisy-chain manner.

Brief Description of the Drawings

[0006] The novel features of the various aspects are particularly set forth in the appended "Claims". However, the described forms can be best understood, both as to construction and method of operation, by reference to the following description taken in conjunction with the accompanying drawings.

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DETAILED DESCRIPTION OF THE INVENTION

[0007] The applicant of the present application owns the following US patent applications filed on the same day as the present application, each of which is hereby incorporated by reference in its entirety. · Attorney Docket No. END9234USNP1 / 190717-1M, Invention Title "METHOD FOR AN ELECTROSURGICAL PROCEDURE", · Attorney Docket No. END9234USNP2 / 190717-2, Invention Title "ARTICULATABLE SURGICAL INSTRUMENT", · Attorney Docket No. END9234USNP3 / 190717-3, Invention Title "SURGICAL INSTRUMENT WITH JAW ALIGNMENT FEATURES", · Attorney Docket No. END9234USNP4 / 190717-4, Invention Title "SURGICAL INSTRUMENT WITH ROTATABLE AND ARTICULATABLE SURGICAL END EFFECTOR", · Attorney Docket No. END9234USNP5 / 190717-5, Invention Title "ELECTROSURGICAL INSTRUMENT WITH ASYNCHRONOUS ENERGIZING ELECTRODES", · Attorney Docket No. END9234USNP6 / 190717-6, Invention Title "ELECTROSURGICAL INSTRUMENT WITH ELECTRODES BIASING SUPPORT", · Attorney Docket No. END9234USNP7 / 190717-7, Invention Title "ELECTROSURGICAL INSTRUMENT WITH FLEXIBLE WIRING ASSEMBLIES", · Attorney Docket No. END9234USNP8 / 190717-8, Invention Title "ELECTROSURGICAL INSTRUMENT WITH VARIABLE CONTROL MECHANISMS", · Attorney Docket No. END9234USNP9 / 190717-9, Invention Title "ELECTROSURGICAL SYSTEMS WITH INTEGRATED AND EXTERNAL POWER SOURCES", · Attorney Docket No. END9234USNP10 / 190717-10, Invention Title "ELECTROSURGICAL INSTRUMENTS WITH ELECTRODES HAVING ENERGY FOCUSING FEATURES", · Attorney Docket No. END9234USNP11 / 190717-11, Invention Title "ELECTROSURGICAL INSTRUMENTS WITH ELECTRODES HAVING VARIABLE ENERGY DENSITIES", · Attorney Docket No. END9234USNP12 / 190717-12, Invention Title "ELECTROSURGICAL INSTRUMENT WITH MONOPOLAR AND BIPOLAR ENERGY CAPABILITIES", · Attorney Docket No. END9234USNP13 / 190717-13, Invention Title "ELECTROSURGICAL END EFFECTORS WITH THERMALLY INSULATIVE AND THERMALLY CONDUCTIVE PORTIONS", · Attorney Docket No. END9234USNP14 / 190717-14, Invention Title "ELECTROSURGICAL INSTRUMENT WITH ELECTRODES OPERABLE IN BIPOLAR AND MONOPOLAR MODES", · Attorney Docket No. END9234USNP15 / 190717-15, Invention Title "ELECTROSURGICAL INSTRUMENT FOR DELIVERING BLENDED ENERGY MODALITIES TO TISSUE", · Attorney Docket No. END9234USNP16 / 190717-16, Invention Title "CONTROL PROGRAM ADAPTATION BASED ON DEVICE STATUS AND USER INPUT", and · Attorney Docket No. 9234USNP17 / 190717-17, Invention Title "CONTROL PROGRAM FOR MODULAR COMBINATION ENERGY DEVICE".

[0008] The applicant of this application owns the following U.S. Provisional Patent Applications filed on December 30, 2019, the entire disclosure of each of which is incorporated herein by reference. · U.S. Provisional Patent Application No. 62 / 955,294, Invention Title "USER INTERFACE FOR SURGICAL INSTRUMENT WITH COMBINATION ENERGY MODALITY END-EFFECTOR", · U.S. Provisional Patent Application No. 62 / 955,292, Invention Title "COMBINATION ENERGY MODALITY END-EFFECTOR", and · U.S. Provisional Patent Application No. 62 / 955,306, Invention Title "SURGICAL INSTRUMENT SYSTEMS".

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

[0010] Before describing various aspects of the electrosurgical system in detail, it should be noted that the exemplary embodiments are not limited to the details of the structure and arrangement of the components shown in the accompanying drawings and the specification in terms of application or use. The exemplary embodiments may be implemented or incorporated in other aspects, variations, and modifications, and may be implemented or executed in various ways. Further, unless otherwise specified, the terms and expressions used in this specification are selected for the purpose of explaining the exemplary embodiments for the convenience of the reader and are not intended to limit them. Further, it should be understood that one or more of the aspects, expressions of aspects, and / or embodiments described below can be combined with any one or more of the other aspects, expressions of aspects, and / or embodiments described below.

[0011] The various aspects relate to an electrosurgical system that includes an electrosurgical instrument powered by a generator to effect tissue dissection, cutting, and / or coagulation during a surgical procedure. The electrosurgical instrument can be configured for use in open surgical procedures, but also has applications in other types of surgeries such as laparoscopic procedures, endoscopic procedures, and robot-assisted procedures.

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

[0013] FIG. 1 shows an example of a generator 900 configured to deliver multiple energy modalities to a surgical instrument. The generator 900 provides an RF signal and / or an ultrasonic signal for delivering energy to the surgical instrument. The generator 900 includes at least one generator output configured to deliver multiple energy modalities (e.g., among others, ultrasonic energy, bipolar RF energy or monopolar RF energy, irreversible electroporation and / or reversible electroporation, and / or microwave energy) through a single port, and these signals can be delivered to the end effector individually or simultaneously for treating tissue. The generator 900 includes a processor 902 coupled to a waveform generator 904. The processor 902 and the waveform generator 904 are configured to generate various signal waveforms based on information stored in a memory coupled to the processor 902, which is not shown for clarity of disclosure. The digital information associated with the waveform is provided to a waveform generator 904 including one or more DAC circuits for converting a digital input to an analog output. The analog output is supplied to an amplifier 906 for signal conditioning and amplification. The conditioned and amplified output of the amplifier 906 is coupled to a power transformer 908. The signal is coupled across the power transformer 908 to the secondary side on the patient insulation side. The first signal of the first energy modality is provided to the surgical instrument between terminals labeled ENERGY1 and RETURN. The second signal of the second energy modality is coupled across a capacitor 910 and provided to the surgical instrument between terminals labeled ENERGY2 and RETURN. Three or more energy modalities can be output, and thus the subscript "n" can be used to indicate that up to n ENERGY n terminals can be provided, where it will be understood that this n is a positive integer greater than or equal to 2. Up to "n" return paths RETURN n can also be provided without departing from the scope of the present disclosure.

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

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

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

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

[0018] FIG. 2 shows one form of a surgical system 1000 that includes a generator 1100 and various surgical instruments 1104, 1106, 1108 that can be used therewith. Surgical instrument 1104 is an ultrasonic surgical instrument, surgical instrument 1106 is an RF electrosurgical instrument, and multifunctional surgical instrument 1108 is a combined ultrasonic / RF electrosurgical instrument. Generator 1100 can be configured to be used with various surgical instruments. According to various forms, generator 1100 can be configured to be used with various different types of surgical devices, including, for example, ultrasonic surgical instrument 1104, RF electrosurgical instrument 1106, and multifunctional surgical instrument 1108 that integrates RF energy and ultrasonic energy delivered simultaneously from generator 1100. In the form of FIG. 2, generator 1100 is shown separately from surgical instruments 1104, 1106, 1108, but in one form, generator 1100 can be integrally formed with any one of surgical instruments 1104, 1106, 1108 to form an integrated surgical system. Generator 1100 includes an input device 1110 located on the front panel of the console of generator 1100. Input device 1110 can include any suitable device that generates a signal suitable for programming the operation of generator 1100. Generator 1100 can be configured for wired or wireless communication.

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

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

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

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

[0023] FIG. 3 shows a schematic view of a surgical instrument or tool 600 comprising a plurality of motor assemblies that can be activated to perform various functions. In the example shown, closing motor assembly 610 is operable to move the end effector between an open configuration and a closed configuration, and articulation motor assembly 620 is operable to articulate the end effector relative to the shaft assembly. In a particular example, the plurality of motor assemblies can be individually activated to cause a firing motion, a closing motion, and / or an articulation motion at the end effector. The firing motion, the closing motion, and / or the articulation motion can be transmitted to the end effector, for example, via the shaft assembly.

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

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

[0026] One or more of the motors of the surgical instrument 600 can include a torque sensor for measuring the output torque with respect to the motor shaft. The force on the end effector can be sensed in any conventional manner, such as by a force sensor outside the jaw or by a torque sensor of the motor that actuates the jaw.

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

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

[0029] In a particular example, the power supply 630 can be used to supply power to, for example, the microcontroller 640. In a particular example, the power supply 630 may comprise a battery (or "battery pack" or "power pack"), such as a lithium-ion battery, for example. In a particular example, the battery pack may be configured to be removably attached to the handle to supply power to the surgical instrument 600. A plurality of battery cells connected in series may be used as the power supply 630. In a particular example, the power supply 630 may be, for example, replaceable and / or rechargeable.

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

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

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

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

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

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

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

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

[0038] Accordingly, the aforementioned size constraints pose many challenges for developing a joint motion system that can achieve the desired range of joint motion and further accommodate the various different drive systems necessary to operate the various features of the surgical end effector. Further, when the surgical end effector is positioned at the desired joint motion position, the joint motion system and the joint motion joint must be able to hold the surgical end effector in that position upon actuation of the end effector and completion of the surgical procedure. The placement of such joint motion joints must also be able to withstand the external forces experienced by the end effector during use.

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

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

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

[0042] The illustrated handheld surgical instrument 27000 has combined electrosurgical functionality, and the surgical instrument 27000 includes an end effector having a first jaw and a second jaw. The first jaw and the second jaw include electrodes disposed thereon. The electrosurgical instrument 27000 includes one or more generators configured to supply power to the electrodes to supply energy to the electrodes. More specifically, energy delivery to patient tissue supported between the first jaw and the second jaw is achieved by supplying energy to electrodes configured to deliver energy in a monopolar mode, a bipolar mode, and / or a combined mode. The combined mode is configured to deliver alternating or fused bipolar energy and monopolar energy. In at least one embodiment, at least one generator includes a battery, a rechargeable battery, a disposable battery, and / or combinations thereof. Various details regarding the operation of the first and second generators are described in more detail in U.S. Patent Application No. 16 / 562,123, filed September 5, 2019, entitled "METHOD FOR CONSTRUCTING AND USING A MODULAR SURGICAL ENERGY SYSTEM WITH MULTIPLE DEVICES", the entire disclosure of which is incorporated herein by reference.

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

[0044] Similarly, the main display monitor 27100 includes a segmented display, however, in various examples, images displayed on the display monitor 27100 can be overlaid on each other. The central portion 27110 of the main display monitor 27100 streams live video and / or still images of the surgical site to the treatment room. The live video and / or images of the surgical site are captured through a properly positioned camera such as an endoscope. The menu selection portion 27130 of the main display monitor 27100 prompts the user to select which mode the main display monitor 27100 is in and / or the information the user desires to view on the main display monitor 27100, and / or otherwise enables such selection by the user. The device status portion 27120 of the main 27100 communicates display monitor information in the same manner as the first portion 27012 of the surgical instrument display 27010. In various examples, the device status portion 27120 is further divided into a plurality of sections. For example, the first portion 27122 is configured to communicate operating parameters reflecting the bipolar mode. Such operating parameters may be specific and / or general. Specific operating parameters can, for example, reflect the power level of the bipolar mode. General operating parameters can, for example, indicate whether the bipolar mode is active or inactive. The second portion 27124 is configured to communicate operating parameters reflecting the monopolar mode. Such operating parameters may be specific and / or general. Specific operating parameters can, for example, reflect the power level of the monopolar mode. General operating parameters can, for example, indicate whether the monopolar mode is active or inactive. The third portion 27126 is configured to communicate operating parameters reflecting the smoke exhaust system. Such operating parameters may be specific and / or general. Specific operating parameters can, for example, reflect the power level of the smoke exhaust system.General operating parameters can indicate, for example, whether the smoke exhaust system is active or inactive.

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

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

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

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

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

[0050] At time t2, the power level of bipolar therapy 27230 increased and monopolar therapy 27240 began to be delivered. At time t3, bipolar therapy 27230 decreased while monopolar therapy 27240 increased. Overall, the combined energy 27250 remained substantially the same from t2 to t3. At time t3, the combined energy 27250 was delivered at a third power level P3, which is higher than the first power level P1 delivered at time t1. As the power increased to P3 during the period from t1 to t3, the rate of the smoke exhaust system duty cycle also increased. At time t3, the third rate S3 of the smoke exhaust duty cycle was utilized. The third rate S3 is greater than the first rate S1. At time t4, the delivery of bipolar therapy 27230 ceased and the only energy delivered to the patient tissue was passed through monopolar therapy 27240. In particular, at time t4, monopolar therapy 27240 delivered energy to the patient tissue at the highest level P4 of monopolar therapy delivered throughout the surgical procedure. Thus, since the energy P4 delivered at time t4 was greater than the energy P3 delivered at time t3, the rate of the smoke exhaust duty cycle also increased. At time t4, the fourth rate S4 of the smoke exhaust duty cycle was utilized. The fourth rate S4 is greater than the rate of the third rate S3 and the first rate S1.

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

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

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

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

[0055] As the power level of the second generator 27330 increases from zero, bipolar energy is delivered to the patient tissue. The impedance of the patient tissue increases in response to the application of bipolar energy 27335. In particular, the impedance of the patient tissue continues to increase over a period of time even after the power level of the second generator 27330 begins to decrease. In other words, the impedance of the tissue sealed by bipolar energy 27335 will ultimately decrease after the power level of the second generator 27330 is reduced when there is no delivery of monopolar energy to cut the patient tissue, although the impedance of the tissue in such an example does not necessarily decrease immediately. At time t1, the power level of the first generator 27340 increases, thereby cutting the tissue through the delivery of monopolar energy to the patient tissue. The impedance of the patient tissue also increases in response to the application of monopolar energy 27345. In particular, the impedance of the patient increases dramatically as the tissue is cut and the power level of the first generator 27340 decreases.

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

[0057] As shown in FIG. 13, control algorithm 27400 begins when the user changes the mode 27410 of the surgical instrument. For example, the user may desire to increase the power level of the first generator to cut patient tissue. In another example, the user may desire for the surgical instrument to seal and / or cut patient tissue. In any case, the surgical instrument then communicates the user input to the first generator and the second generator at 27412, 27414 respectively. The surgical instrument further communicates the user input to the surgical hub at 27415. After the surgical hub is notified of the desired increase in monopolar energy at 27420, the surgical hub is configured to command the second generator at 27425 to supply and / or administer an appropriate power level. When receiving the communication from the surgical instrument at 27412, the first generator increases the waveform in preparation for cutting patient tissue at 27440. When receiving the communication from the surgical instrument at 27414 and receiving the command from the surgical hub at 27425, the second generator increases the power level associated with the bipolar modality in preparation for sealing patient tissue after the cutting is performed at 27450. The second generator can then communicate at 27455 to the first generator that it is ready. The first generator can then initiate the cutting of patient tissue at 27442. In other words, the surgical hub prevents the monopolar electrode from being energized until the bipolar electrode is energized to prevent the cutting of tissue that has not been cauterized and / or sealed. The surgical hub is further configured to command the smoke evacuation system at 27426 to increase the motor speed in response to the increase in the power levels of the first and second generators. After the smoke evacuation system increases its motor speed at 27430, the smoke evacuation system is configured to maintain communication lines with the surgical hub, the surgical instrument, and / or the first and second generators throughout the duration of the surgical procedure. For example, the smoke evacuation system is configured to continuously communicate the current motor speed to the surgical hub at 27435.In such examples, the smoke evacuation system transmits its current motor speed to the surgical hub every one or two minutes, although the smoke evacuation system can communicate its current motor speed at any suitable frequency. When the surgical instrument has completed the desired tissue cutting, the user can again provide an input on the instrument handle to reduce the power level of the first generator and / or terminate the control algorithm 27400. In various examples, the control algorithm 27400 is configured to automatically reduce the power level of the first generator after a predetermined period corresponding to the completion of tissue cutting. Using the control algorithm 27400, the surgical hub can adjust the operating parameters of the components of the surgical system, for example, to facilitate an efficient and / or effective surgical procedure.

[0058] Many surgical devices, tools, and / or replaceable components are often used during a particular surgical procedure. In particular, various systems are disclosed herein that serve to rationalize the devices and / or components stocked in the procedure room for use during a particular procedure, minimize operator error, and / or minimize delays during a surgical procedure. The systems described herein enhance the efficiency of surgical procedures, in particular, by using artificial intelligence and machine learning developed during the course of one or more surgical procedures.

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

[0060] The surgical system 27500 further includes a surgical hub 27530. Various surgical hubs are described in U.S. Patent Application No. 16 / 209,395, filed December 4, 2018, entitled "METHOD OF HUB COMMUNICATION", the entire disclosure of which is incorporated herein by reference. The surgical hub 27530 includes a memory 27535 that suitably or otherwise appropriately stores a combination of tool components 27590 used during a particular procedure. In other words, the memory 27535 of the surgical hub 27530 includes a stored information bank that can be used to indicate which tool components 27590 are suitable for use during a selected procedure.

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

[0062] As shown in FIG. 14, four robotic arms 27250 surround or are otherwise attached to the operating table 27510. Three tool components 27590 are connected to three corresponding robotic arms 27250, and one robotic arm is free to receive an additional tool component. A plurality of unique tool components 27560, 27570, 27580 are shown stored on a mobile stand 27550 within the treatment room. As discussed above, the types and / or functions of the tool components 27560, 27570, 27580 can vary. In such an example, the surgical hub 27530 evaluates the available tool components 27560, 27570, 27580 and identifies the appropriate tool components for attachment to the surgical robot. The appropriate tool components are identified based on one or more factors, such as, for example, which tool types and / or functions are still required by the surgical robot and / or which tool components complete a predetermined pairing of tool components associated with the desired surgical procedure. In various examples, the surgical robot comprises a memory that stores a pairing of predetermined tool components, for example, based on a particular surgical procedure and / or a particular patient demographic. In such an example, the surgical robot can identify the appropriate tool components for attachment to the surgical robot based on the identification information of the already attached tool components.

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

[0064] As shown in FIG. 14, each tool component 27560, 27570, 27580 includes a QR code 27565, 27575, 27585 positioned at any suitable location thereon, and each QR code includes a profile of information representing the tool component to which the QR code is associated. The user uses any suitable scanning tool 27540 to scan and / or read the QR codes 27565, 27575, 27585. The scanning tool 27540 then communicates the QR code and / or the information contained within the QR code to the surgical hub 27530. In an example where the QR code itself is communicated to the surgical hub 27530 by the scanning tool 27540, the processor of the surgical hub 27530 is configured to decode the profile of information by the received QR code. The illustrated embodiment includes QR codes, but the tool components can include any suitable memory device such as, for example, barcodes, RFID tags, and / or memory chips.

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

[0066] For example, a user attempts to attach a first tool component 27560 to a robotic arm 27590 available on a surgical robot. Before attaching the first tool component 27560 to the robotic arm 27590, a scan tool 27540 scans a QR code 27565 displayed on the first tool component 27560. The scan tool 27540 communicates the QR code 27565 and / or the information contained within the QR code 27565 to a surgical hub 27530. The surgical hub 27530 compares the information contained within the QR code 27565 to a stored list of acceptable tool components associated with a particular surgical procedure and / or a stored list of acceptable tool components that are compatible with the tool components currently attached to the surgical robot. In this case, the surgical hub 27530 is unable to recognize and / or locate the first tool component 27560 within its memory 27535. Thus, the first tool component 27560 is not recommended and / or not suitable for use with the surgical robot. As discussed above, the surgical hub 27530 is configured to alert a clinician of the incompatibility of the first tool component 27560 with the surgical robot and / or a particular surgical procedure. In various examples, the surgical system 27500 can prevent the first tool component 27560 from being attached thereto, for example, by a mechanical and / or electrical lockout. Such an attachment lockout prevents a clinician from overlooking and / or simply ignoring a warning issued by the surgical system 27500. In other words, the attachment lockout requires a clinician to take a positive step when overriding an error communicated by the surgical system 27500. In such an example, an override can be activated to allow a clinician to override any system lockout and utilize the operating functions of the first tool component 27560. In various examples, the override is not available to prevent a clinician from utilizing the functions of the first tool component 27560 while it is recognized that the first tool component 27560 is incompatible for use with the surgical robot.

[0067] Similarly, the user attempts to attach a second tool component 27570 to the available robot arm 27590 of the surgical robot. Before attaching the second tool component 27570 to the robot arm 27590, the scan tool 27540 scans a QR code 27575 displayed on the second tool component 27570. The scan tool 27540 communicates the QR code 27575 and / or the information contained within the QR code 27575 to the surgical hub 27530. The surgical hub 27530 compares the information contained within the QR code 27575 to a stored list of acceptable tool components associated with a particular surgical procedure and / or a stored list of acceptable tool components that are compatible with the tool components currently attached to the surgical robot. In this case, the surgical hub 27530 is unable to recognize and / or locate the second tool component 27570 within its memory 27535. Thus, the second tool component 27570 is not recommended and / or not appropriate for use with the surgical robot. As discussed above, the surgical hub 27530 is configured to alert the clinician of the incompatibility of the second tool component 27570 with the surgical robot and / or a particular surgical procedure. In various examples, the surgical system 27500 can prevent the second tool component 27570 from being attached thereto. Such an attachment lockout prevents the clinician from overlooking and / or simply ignoring the warning issued by the surgical system 27500. Stated another way, the attachment lockout requires the clinician to take a positive step when overriding an error communicated by the surgical system 27500. In such examples, an override can be activated to allow the clinician to override any system lockout and utilize the operating functions of the second tool component 27570. In various examples, the override is not available to prevent the clinician from utilizing the functions of the second tool component 27570 while it is recognized that the second tool component 27570 is incompatible for use with the surgical robot.

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

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

[0070] FIG. 15 shows a surgical system 27600 comprising one or more cameras configured to assist a clinician in performing an efficient and / or successful surgical procedure. Similar to surgical system 27500, surgical system 27600 comprises an operating table 27610, or any suitable treatment surface. Surgical system 27600 further comprises a surgical hub 27650, and an equipment tower 27660. Various surgical hubs are described in U.S. Patent Application No. 16 / 209,395, filed Dec. 4, 2018, titled "METHOD OF HUB COMMUNICATION", the entire disclosure of which is incorporated herein by reference.

[0071] Surgical system 27600 further comprises a camera system including one or more cameras 27640 positioned at various locations throughout the treatment room. In the illustrated embodiment, two cameras 27640 are positioned at opposite corners of the treatment room, but the cameras 27640 can be positioned and / or oriented in any suitable location where the cameras 27640 can cooperatively capture the treatment room in an unobstructed manner. An artificial intelligence protocol detects and / or identifies various devices, instruments, and / or personnel, and their corresponding locations and / or orientations within the treatment room.

[0072] Camera 27640 of the camera system is communicating with surgical hub 27650. In other words, the live video of camera 27640 can be transmitted to surgical hub 27650 for processing and analysis. Through the analysis of the video collected by camera 27640, surgical hub 27650 can maintain a real-time inventory of the devices, equipment, and / or personnel in the treatment room, and / or monitor and / or control the interactions between the detected devices, equipment, and / or personnel. Using the images and / or data collected by the camera system, surgical hub 27650 is configured to be notified regarding the identification information of the detected devices, warn the clinician regarding the compatibility regarding the detected devices, and / or control various components of surgical system 27600 based on the presence and / or operation of the detected devices. Surgical hub 27650 is configured to compare any detected devices to determine the compatibility between the devices and / or during a particular surgical procedure, facilitate the cooperation of two devices intended to work together, and / or facilitate the cooperation of two devices that build a sensed and / or controlled operation with each other.

[0073] As shown in FIG. 15, anesthesia cart 27670 and preparation table 27620 are positioned in the treatment room. Preparation table 27620 is configured to support various surgical tools and / or surgical devices so that they can be easily accessed during a surgical procedure. Such surgical tools and / or surgical devices can include, for example, interchangeable staple cartridges of varying sizes, or shaft assemblies with end effectors of varying sizes and / or functions. In the illustrated embodiment, preparation table 27620 supports first device 27630a, second device 27630b, and third device 27630c.

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

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

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

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

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

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

[0080] The end effector 27800 is used to perform various end effector functions during a surgical procedure. At an original time t0, the end effector 27800 is not in contact with patient tissue T t0 Thus, the electrodes of the end effector 27800 are not delivering any energy. At the original time t0, patient tissue T t0is in a relaxed, uncompressed state. The end effector 27800 is shown in the open configuration. In the open configuration, the distance d0 ranges from 0.500 inches to 0.700 inches between the first tissue support surface 27815 and the second tissue support surface 27825. Stated another way, the tissue support surfaces 27815, 27825 are separated by a maximum distance d0 of from 0.500 inches to 0.700 inches from each other when the end effector 27800 is in the open configuration.

[0081] At a first time t1, the jaws 27810, 27820 of the end effector 27800 contact the patient tissue T t1 At least a portion of the patient tissue T t1 is positioned between the jaws 27810, 27820 of the end effector 27800 as the end effector 27800 moves from the open configuration toward the closed configuration. As the jaws 27810, 27820 are moved toward the closed configuration, the tissue T t1 is compressed therebetween. At time t1, the end effector 27800 is configured to deliver bipolar energy to the patient tissue T t1 Upon application of the bipolar energy, the end effector 27800 can, for example, feather through the parenchymal cells. The end effector 27800 is in a partially closed configuration at time T1. The first distance d1 ranges from 0.030 inches to 0.500 inches between the first tissue support surface 27815 and the second tissue support surface 27825 at time t1. Stated another way, the tissue support surfaces 27815, 27825 are separated by a first maximum distance d1 of from 0.030 inches to 0.500 inches when the end effector is delivering bipolar energy to the patient tissue T t1 at time t1. A detailed depiction of the jaws 27810, 27820 of the end effector 27800 delivering bipolar energy to the patient tissue T t1 at the first time t1 is shown in FIG. 17.

[0082] At a second time t2, the jaws 27810, 27820 of the end effector 27800 contact the patient tissue Tt2 Maintains contact with. At least a portion of the patient tissue T t2 is positioned between the jaws 27810, 27820 of the end effector 27800. At time t2, the end effector 27800 is configured to deliver a combination of bipolar energy and monopolar energy to the patient tissue T t2 . By applying the bipolar energy and the monopolar energy, the end effector 27800 can heat the patient tissue T t2 . The end effector 27800 is in a partially closed configuration at time t2, but the end effector 27800 is closer to the fully closed configuration at time t2 than the end effector 27800 at time t1. More specifically, the second distance d2 ranges from 0.010 inches to 0.030 inches between the first tissue support surface 27815 and the second tissue support surface 27825 at time t2. In other words, the tissue support surfaces 27815, 27825 are separated by a second maximum distance d2 of 0.010 inches to 0.030 inches when the end effector is delivering bipolar energy and monopolar energy to the patient tissue T t2 . At the second time t2, a detailed depiction of the jaws 27810, 27820 of the end effector 27800 that deliver bipolar energy and monopolar energy to the patient tissue T t2 is shown in FIG. 18.

[0083] At a third time t3, the jaws 27810, 27820 of the end effector 27800 maintain contact with the patient tissue T t3 . At least a portion of the patient tissue T t3 is positioned between the jaws 27810, 27820 of the end effector 27800. At time t3, the end effector 27800 is configured to continue delivering a combination of bipolar energy and monopolar energy to the patient tissue T t3 . By continuously applying the continuous bipolar energy and the monopolar energy, the end effector 27800 of the patient tissue T t3can be sealed. The end effector 27800 is in a partial closure configuration and / or a full closure configuration at time t3. In other words, the end effector 27800 is in a full closure configuration and / or closer to the full closure configuration at time t3 than the end effector 27800 at time t2. More specifically, the third distance d3 ranges from 0.003 inches to 0.010 inches between the first tissue support surface 27815 and the second tissue support surface 27825 at time t3. In other words, the tissue support surfaces 27815, 27825 are separated by a third maximum distance d3 of 0.003 inches to 0.100 inches when the end effector delivers bipolar energy and monopolar energy to the patient tissue T t3 when delivering bipolar energy and monopolar energy to the patient tissue T. A detailed description of the jaws 27810, 27820 of the end effector 27800 for delivering bipolar energy and monopolar energy to the patient tissue at the third time t3 is shown in FIG. 18.

[0084] At a fourth time t4, the jaws 27810, 27820 of the end effector 27800 maintain contact with the patient tissue T t4 . At least a portion of the patient tissue T t4 is positioned as the end effector 27800 between the jaws 27810, 27820 of the end effector 27800. At time t4, the end effector 27800 is configured to deliver monopolar energy to the patient tissue T t4 . By applying the monopolar energy, the end effector 27800 t4can be severed. The end effector 27800 is in a partially closed configuration and / or a fully closed configuration at time t4. In other words, the end effector 27800 is in a fully closed configuration and / or closer to the fully closed configuration at time t4 than the end effector 27800 at time t2. More specifically, the fourth distance d4 ranges from 0.003 inches to 0.010 inches between the first tissue support surface 27815 and the second tissue support surface 27825 at time t4. In other words, the tissue support surfaces 27815, 27825 are separated by a fourth maximum distance d4 of 0.003 inches to 0.010 inches when the end effector delivers monopolar energy to the patient tissue T t4 at the fourth time t4. At the fourth time t4, the patient tissue T t4 A detailed depiction of the jaws 27810, 27820 of the end effector 27800 that delivers monopolar energy to the patient tissue T is shown in FIG. 19.

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

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

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

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

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

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

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

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

[0093]

Number

[0094]

Count

[0095]

Count

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

[0097]

Count

[0098]

Number

[0099]

Number

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

[0101] [Number] is defined between the first jaw 28110 and the second jaw 28120. At the initial time t0, the patient tissue T C,0 is positioned between the first jaw 28110 and the second jaw 28120. In particular, the patient tissue T C,0 is here in contact with both the first jaw 28110 and the second jaw 28120. In other words, the thickness of the patient tissue T C,0 is the gap

[0102] [Number] and above. As at least one of the first jaw 28110 and the second jaw 28120 continues to move towards each other, the patient tissue compresses, and the gap defined between the first jaw 28110 and the second jaw 28120

[0103]

Number

[0104]

Number

[0105] The motor control program of the combined electrosurgical instrument can utilize the detected tissue stability as an input. The surgical instrument can detect the compression speed and / or measure the creep of the patient tissue compressed between the jaws of the end effector to determine the tissue stability. The control program can adjust the waiting time between end effector functions, define when to make additional determinations of tissue stability, and / or modify to adjust the speed of the jaw clamp based on the determined tissue stability.

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

[0107] In addition to the sensed parameters associated with the jaw clamp stroke, the surgical system can monitor additional functionality for adjusting and / or improving the operating parameters of the surgical instrument. For example, the surgical system can monitor the orientation of the surgical instrument relative to the user and / or patient, the impedance of tissue positioned between the jaws of the end effector to determine the position and / or composition of the tissue, the level of grounding to the patient, and / or the leakage current. The leakage current can be monitored to determine secondary leakage from other devices and / or to create parasitic generated energy output by capacitive coupling.

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

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

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

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

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

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

[0114] In various examples, a surgical system includes modular components. For example, a surgical system includes a surgical robot having robotic arms configured to receive tools of different capabilities thereon. The control program of the surgical system is modified based on, for example, a modular attachment such as the type of tool connected to the surgical robotic arm. In other examples, a surgical system includes a hand-held surgical instrument configured to receive different and / or interchangeable end effectors thereon. Before performing the intended surgical function, the hand-held surgical instrument is configured to identify the attached end effector and modify the control program based on the determined identification information of the end effector.

[0115] The surgical system is configured to identify attached modular components using adaptable and / or intelligent calling techniques. In various examples, the surgical system uses a combination of electrical calls in combination with mechanical activation calls to determine the capacity and / or capabilities of the attached components. The response to the call can record and / or compare information stored in the memory of the surgical system to establish baseline operating parameters associated with the identified modular attachment. In various examples, the established baseline parameters are stored in the memory of the surgical system to be used when the same or similar modular attachments are identified in the future.

[0116] In various examples, an electrical call signal is transmitted from the handle of the surgical instrument to the attached modular component, and the electrical call signal is sent to attempt to determine the identification information, operating parameters, and / or status of the attached modular component. The attached modular component is configured to transmit a response signal using the identification information. In various examples, the response is not received by the call signal and / or the response signal contains unidentifiable information. In such examples, the surgical instrument can perform a default function to evaluate the capabilities of the attached modular component. The default function is defined by legacy operating parameters. In other words, the default operating parameters used during the performance of the default function are defined at a specific level to avoid damage to the surgical instrument and / or attached modular component, the patient, and / or the user. The surgical instrument is configured to utilize the results of the default function to set an operating program specific to the attached modular component.

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

[0118] Also, the default function can be used to determine the current state and / or status of an attached modular component. For example, the default function can be implemented to determine whether an attached end effector is articulating and / or to what extent the attached end effector is articulating. The surgical instrument is then configured to adjust the control program accordingly. As the end effector articulates over a range of articulation angles, the length of the cutting stroke changes. In other words, the length of the cutting stroke is different when the end effector is in an articulated state compared to when the end effector is in a non-articulated state. The surgical instrument is configured to update the control program to perform a cutting stroke that extends to a length associated with the last detected complete stroke. The surgical instrument is further configured to determine whether the total length of the cutting stroke is achieved and / or completed using the current control program using the length of the last completed cutting stroke when the end effector is not articulating compared to when the end effector is articulating.

[0119] In various examples, the surgical system can perform an intelligent evaluation of the characteristics of the attached components. Such characteristics include, for example, wear of tissue pads, usage of attachments, and / or operating states of attachments. Put another way, the surgical system is configured to evaluate the function and / or state of the attached components. When detecting the characteristics of the attached modular components, the control program used to operate the surgical system is adjusted accordingly.

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

[0121] The surgical instrument has combined electrosurgical functionality and includes an end effector having a first jaw and a second jaw. At least one of the first jaw and the second jaw is configured to move towards each other to transition the end effector between an open configuration and a closed configuration. The first jaw and the second jaw comprise electrodes disposed thereon. The electrosurgical instrument comprises one or more generators configured to supply power to the electrodes to supply energy to the electrodes. The surgical instrument can evaluate the degree of carbonization and / or tissue contamination for one or more of the jaws of the end effector by measuring impedance when the end effector is in a closed configuration with no patient tissue positioned therebetween. A predetermined impedance can be stored in the memory of the surgical instrument, and if the impedance exceeds a predetermined threshold, the jaws contain an undesirable level of carbonization and / or tissue contamination thereon. As will be discussed in more detail herein, a warning can be issued to the user upon detection of an undesirable level of carbonization. In various examples, the operating parameters can be automatically adjusted by a processor of the surgical instrument and / or the surgical hub in response to the detected closed jaw impedance. Such operating parameters include, for example, power level, applied pressure level, and / or advanced tissue cutting parameters.

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

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

[0124] In various examples, a surgical instrument and / or a surgical hub are configured to detect parameters such as elongation, damage, and / or accumulation of tolerances of an integral shaft to compensate for functional parameter operation of an electric actuator. The surgical instrument is configured to warn a user when detected parameters of an attached end effector and / or shaft are near and / or outside of a desired operating range specific to the attached components. In addition to warning the user, in various examples, operation of the surgical instrument is prevented when it is detected that the surgical instrument cannot operate within a pre-defined envelope of adjustment. The surgical instrument and / or the surgical hub include an override, and the user can disable the lockout under certain pre-defined conditions. Such pre-defined conditions include emergencies, and during a surgical procedure where inability to use the surgical instrument would cause harm to the patient, the surgical instrument is considered in use and includes a disposable override to allow one additional use of the surgical instrument at the discretion of the user. In various examples, the override can also be utilized to enable the user to perform a secondary end effector function that is unrelated to the primary end effector function. For example, if the surgical instrument prevents the jaws of the end effector from articulating, the user may activate the override to enable the surgical instrument to articulate the end effector.

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

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

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

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

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

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

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

[0132] As the end effector begins to move toward its closed configuration, the jaws of the end effector begin to clamp the tissue positioned therebetween, and thus the jaw opening 29300 continues to decrease. The tissue begins to be compressed by the jaws, but until fluid begins to be expelled from the compressed tissue, it is desirable that the patient tissue not be sealed by the surgical instrument. The jaw motor force continues to increase during the jaw clamp stroke because the increased resistance is exerted on the end effector jaws by the captured tissue.

[0133] After the initial drainage of extracellular fluid caused a decrease in low-frequency conductance (GE) 29110, the low-frequency conductance (GE) 29110 remained relatively constant during the jaw clamp stroke. High-frequency conductance (GI) 29120 remained relatively constant during the jaw clamp stroke until after the patient tissue was sealed. If the tissue continues to be compressed after sealing is complete, damage to the intracellular tissue occurs and intracellular fluid is drained. At such a point, the high-frequency conductance 29120 decreases, causing a spike in the ratio 29210 of low-frequency conductance to high-frequency conductance. The tissue damage threshold 29220 is pre-determined to modify the operating parameters, to warn the user, and / or to automatically prompt the surgical system when the spike in the ratio 29210 of low-frequency conductance to high-frequency conductance reaches and / or exceeds the tissue damage threshold 29220. At such a point, the surgical system is configured to modify the control program to stop moving the jaw of the end effector towards the closed configuration of the end effector and / or to start moving the jaw of the end effector back towards the open configuration of the end effector. In various examples, the surgical system is configured to modify the control program to reduce the jaw clamp force. Such adaptation of the control program prevents additional tissue damage.

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

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

[0136] The surgical system includes many components. For example, the surgical system includes many handheld surgical instruments, a surgical hub, and a surgical robot. In various examples, each component of the surgical system communicates with other components and can issue commands and / or change control programs based on at least one monitored parameter and / or user input. The surgical system includes means for determining which system is responsible and which system performs the decision-making part of the operation. This designation can be changed based on situation recognition, the occurrence of a predetermined event, and / or the exceeding of a threshold. In various examples, a command protocol is established within the surgical system to indicate the types of commands that each component can issue and / or that the component issuing the command can direct to components within the surgical system.

[0137] The command protocol can determine when control handoff is guaranteed using pre-defined thresholds. For example, a surgical system includes a generator and a hand-held surgical instrument containing various control units therein. At the start of a surgical procedure, the generator is first controlled to adjust power based on the detected impedance. The generator uses the detected impedance and / or the current power level to command the pressure control unit within the handle of the surgical instrument to follow specific pressure needs. At some point during the surgical procedure, a lower impedance threshold is exceeded, indicating that the generator algorithm has detected an electrical short. The generator passes control to the pressure control unit within the handle by instructing the pressure control unit to determine whether the tissue is still positioned between the jaws of the end effector. The pressure control unit can then determine appropriate tissue compression and communicate which power level and / or energy modality is most appropriate for the detected tissue.

[0138] The control protocol can be determined based on a consensus achieved by multiple components within the surgical system. For example, three components within the surgical system detect a first value for a monitored parameter, while two components within the surgical system detect a second value for the same monitored parameter, and the first value is different from the second value. The group of three components has more components than the group of two components, and thus the first value of the monitored parameter is controlled. Each component within the surgical system can be assigned a position located within a hierarchy. The hierarchy can be established based on the reliability of a particular component and / or the ability of a particular component. A first component detects a first value for a monitored parameter, a second component detects a second value for the same monitored parameter, and the first value is different from the second value. The second component is "higher" within the hierarchy of the surgical system than the first component, and thus the second value of the monitored parameter detected by the second component control is controlled.

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

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

[0141] Example 2 - The surgical system according to Example 1, wherein the control program is configured to control the power level of the generator.

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

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

[0144] Example 5 - The surgical system according to Example 1, 2, 3, or 4, wherein the first parameter includes an instrument operation parameter.

[0145] Example 6 - The surgical system according to any one of Examples 1, 2, 3, 4, or 5, wherein the first parameter includes the generator operation parameter.

[0146] Example 7 - The surgical system according to any one of Examples 1, 2, 3, 4, 5, or 6, wherein the first parameter includes the status of the end effector.

[0147] Example 8 - The surgical system according to any one of Examples 1, 2, 3, 4, 5, 6, or 7, wherein the first parameter indicates whether the end effector is in an open configuration or a closed configuration.

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

[0149] Example 10 - The surgical system according to any one of Examples 1, 2, 3, 4, 5, 6, 7, 8, or 9, wherein the surgical instrument is operationally controlled and the generator is a slave control system by default.

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

[0151] Example 12 - The surgical system according to any one of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or 11, wherein the first parameter includes a combination of two metrics.

[0152] Example 13 - The surgical system according to any one of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or 12, further comprising a trigger configured to receive user input, and a processor configured to interpret a plurality of user inputs received by the trigger, each user input including a different purpose based on the situational use.

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

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

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

[0156] Example 17 - The surgical system according to Example 14, 15, or 16, further comprising an input member configured to receive user input, wherein the processor is configured to interpret a plurality of user inputs received by the input member, and each received user input includes a different purpose based on the situational use of the surgical system.

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

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

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

[0160] Example Set 2 Surgical instrument comprising: Example 1 - a housing, a shaft assembly, a processor, and a memory. The shaft assembly is removably connected to the housing. The shaft assembly includes an end effector. The memory is configured to store program instructions that, when executed from the memory, cause the processor to send an electrical call signal to the attached shaft assembly, receive a response signal from the attached shaft assembly, implement a default function when the response signal is not received by the attached shaft assembly, determine the identification characteristics of the attached shaft assembly as a result of implementing the default function, and modify the control program based on the identification characteristics of the attached shaft assembly.

[0161] Example 2 - The surgical instrument according to Example 1, wherein the identification characteristics include the remaining capacity of the attached shaft assembly.

[0162] Example 3 - The surgical instrument according to Example 1 or 2, wherein the identification characteristics include the performance level of the attached shaft assembly.

[0163] Example 4 - The surgical instrument according to Example 1, 2, or 3, wherein the identification characteristics are different for attached shaft assemblies of different capabilities.

[0164] Example 5 - The surgical instrument according to Example 1, 2, 3, or 4, wherein the memory includes a look-up table containing operating parameters corresponding to specific shaft assemblies, the processor uses the received response signal to identify the attached shaft assembly in the look-up table, and the control program is modified using the stored operating parameters corresponding to the identified shaft assembly.

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

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

[0167] Example 8 - The surgical instrument according to Example 7, wherein the variable call communication includes an electrical call signal and a physical actuation of the surgical instrument.

[0168] Example 9 - The surgical instrument according to Example 7 or 8, wherein the physical actuation of the surgical instrument is monitored to determine the functional capabilities of the attached shaft assembly.

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

[0170] Example 11 - The surgical instrument according to Example 7, 8, 9, or 10, wherein the determined capabilities are related to the performance level of the shaft assembly.

[0171] Example 12 - The surgical instrument according to Example 7, 8, 9, 10, or 11, wherein the determined capabilities vary based on the attached shaft assembly.

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

[0173] Example 14 - A surgical instrument comprising a housing, a shaft assembly, a processor, and a memory. The shaft assembly is connected to the housing in a compatible manner. The shaft assembly includes an end effector. The memory is configured to store program instructions that, when executed from the memory, cause the processor to send a call signal to the shaft assembly connected to the housing, receive a response signal from the shaft assembly connected to the housing, implement a default end effector function when the response signal is not recognized, determine the identification characteristics of the shaft assembly connected to the housing as a result of implementing the default end effector function, and modify a control program based on the identification characteristics of the shaft assembly connected to the housing.

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

[0175] Example 16 - The surgical instrument according to Example 14 or 15, wherein the identification characteristics include the remaining capacity of the shaft assembly connected to the housing.

[0176] Example 17 - The surgical instrument according to Example 14, 15, or 16, wherein the identification characteristics include the performance level of the shaft assembly connected to the housing.

[0177] Example 18 - The surgical instrument according to Example 14, 15, 16, or 17, wherein the determined characteristics may vary based on the shaft assembly connected to the housing in a compatible manner.

[0178] Example 19 - The memory includes a look-up table containing operating parameters corresponding to a specific shaft assembly, the processor uses the received response signal to identify the shaft assembly connected to the housing within the look-up table, and the control program is modified using the stored operating parameters corresponding to the identified shaft assembly, the surgical instrument according to Example 14, 15, 16, 17, or 18.

[0179] Example 20 - The memory further includes program instructions, and when the program instructions are executed, the processor stores the modified control program in the memory, the surgical instrument according to Example 14, 15, 16, 17, 18, or 19.

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

[0181] Example 2 - The surgical system according to Example 1, wherein the surgical instrument is configured to modify the control command using the parameters detected by the surgical instrument.

[0182] Example 3 - The surgical system according to Example 2, wherein the surgical instrument is configured to pass the modified control command to the generator.

[0183] Example 4 - The surgical system according to Example 2 or 3, wherein the operating parameters of the generator are controlled by the modified control command.

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

[0185] Example 6 - The surgical system according to Example 2, 3, 4, or 5, wherein the surgical instrument is configured to pass a modified control command to the surgical hub, and the surgical hub is configured to pass the modified control command to the generator.

[0186] Example 7 - The surgical system according to Example 1, wherein the surgical instrument is configured to detect a first parameter of the surgical instrument and communicate the detected first parameter to the generator, and the generator is configured to modify a control command using the first parameter.

[0187] Example 8 - The surgical system according to Example 1, wherein the surgical instrument is configured to detect a first parameter of the surgical instrument and communicate the detected first parameter to the generator, and the generator is configured to detect a second parameter and modify a control command using the first parameter and the second parameter.

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

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

[0190] Example 11 - The surgical system according to Example 9, wherein the surgical instrument further includes an instrument display configured to display a second operating parameter of the surgical instrument, and the first operating parameter is different from the second operating parameter.

[0191] Example 12 - The surgical system according to Example 9, 10, or 11, wherein the display screen is further configured to display the operating parameters of the generator.

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

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

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

[0195] Example 16 - The surgical system according to Example 15, wherein the first surgical instrument is configured to modify control commands using first parameters detected by the first surgical instrument.

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

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

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

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

[0200] Although several forms have been shown and described, it is not the intention of the applicant to limit or restrict the appended claims in such detail. Many modifications, variations, changes, substitutions, combinations, and equivalents of these forms can be implemented and would 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 implemented by that element. Also, although materials are disclosed with respect to specific components, other materials can 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 within the scope of the disclosed forms. The appended claims are intended to cover all such modifications, variations, changes, substitutions, modifications, and equivalents.

[0201] The above detailed description has described various forms of apparatuses and / or processes using block diagrams, flow diagrams, and / or examples. As long as such block diagrams, flow diagrams, 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, flow diagrams, 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 recognized by those skilled in the art that all or part of some aspects of the forms disclosed herein can be implemented equivalently on an integrated circuit as one or two or more computer programs running on one or two or more computers (e.g., as one or two or more programs running on one or two or more computer systems), as one or two or more programs running on one or two or more processors (e.g., as one or two or more programs running on one or two or more microprocessors), as firmware, or as 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. Additionally, it should be understood by those skilled in the art that the mechanisms of the subject matter described herein can be distributed in various forms as one or two or more program products, and the specific forms of the subject matter described herein apply regardless of the particular type of signal-carrying medium used to actually carry out the distribution.

[0202] The instructions used to program logic to implement various disclosed aspects may be stored in system memory such as dynamic random access memory (DRAM), cache, flash memory, or other storage. Further, 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 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).

[0203] 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, processing unit, processor, microcontroller, microcontroller unit, controller, digital signal processor (DSP), programmable logic device (PLD), programmable logic array (PLA), or 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 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" refers 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 optical-electrical facility), but is not limited thereto.Those skilled in the art will recognize that the subject matter described herein can be implemented in analog or digital form, or in some combination of these.

[0204] 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 can be embodied as a software package, code, instructions, instruction sets, and / or data recorded on a non-transitory computer-readable storage medium. The firmware can be embodied as code, instructions, or instruction sets within a memory device, and / or hard-coded (e.g., non-volatile) data.

[0205] As used in any aspect of this specification, terms such as "component", "system", "module", etc. can refer to a computer-related entity that is either hardware, a combination of hardware and software, software, or software in execution.

[0206] As used in any aspect of 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 can, although not necessarily, take 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.

[0207] Examples of the network may include a packet-switching network. 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" issued by the Institute of Electrical and Electronics Engineers (IEEE) in December 2008 and / or later versions of this standard. Alternatively or additionally, 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, 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 by the ATM Forum in August 2001 and / or later versions of this standard.Of course, different and / or later-developed connection-type network communication protocols are equally contemplated herein.

[0208] Unless otherwise expressly defined, as will be apparent from the foregoing disclosure, throughout the foregoing disclosure, discussions using terms such as "processing," "computing," "calculating," "determining," "displaying," etc., refer to actions and processes of a computer system or similar electronic computing device that manipulate and transform data represented as physical (electronic) quantities within the registers and memories of the computer system into other data similarly represented as physical quantities within the memories or registers of the computer system or other such information storage, transmission, or display.

[0209] 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. One of ordinary skill in the art will recognize 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.

[0210] 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. It will be further understood that, for convenience and clarity, spatial terms such as "vertical", "horizontal", "above", and "below" may be used herein with respect to the drawings. However, the surgical instrument is used in many orientations and positions, and these terms are not intended to be limiting and / or absolute.

[0211] Those skilled in the art will 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 particular number is intended in an introduced claim recitation, such intent will be clearly recited in the claim, and those skilled in the art will understand that where there is no such recitation, there is no such intent. For example, by way 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 includes such an introduced claim recitation, even where the claim includes both an introductory phrase such as "one or more" or "at least one" and an indefinite article such as "a" or "an" within the same claim, is limited to a claim that includes only one such recited item (e.g., "a" and / or "an" should generally be construed as meaning "at least one" or "one or more"). The same holds true when introducing a claim recitation using a definite article.

[0212] In addition, even when a specific number is specified in the introduced claim description, those skilled in the art will recognize that such description should typically be construed to mean at least the recited number (for example, when there is a mere recitation of "two recitations" without other modifiers, generally it means at least two recitations, or two or more recitations). Further, when an expression similar to "at least one of A, B, and C" is used, generally such syntax is intended in the sense that those skilled in the art will understand the expression (for example, "a system having at least one of A, B, and C" includes, without limitation, 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). When an expression similar to "at least one of A, B, or C" is used, generally such syntax is intended in the sense that those skilled in the art will understand the expression (for example, "a system having at least one of A, B, or C" includes, without limitation, 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). Further, typically, any disjunctive word and / or phrase representing two or more alternative terms should be understood to be intended to include one of those terms, any of those terms, or both of those terms, 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".

[0213] Regarding the appended claims, those skilled in the art will understand that the recited operations herein can generally be performed in any order. Also, although flow diagrams of various operations are shown in a sequence (singular or plural), it should be understood that the various operations can be performed in an order other than the one shown, or simultaneously. Examples of such alternative orderings can include, unless the context dictates otherwise, overlapping, interleaving, interrupting, reordering, incremental, preparatory, additional, simultaneous, reverse, or other different orderings. Further, terms such as "responsive to", "associated with", or other past tense adjectives are generally not intended to exclude such variations, unless the context dictates otherwise.

[0214] It is worth noting that any reference to "one aspect", "aspect", "exemplification", "an exemplification", etc. means that the particular mechanism, 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.

[0215] In this specification, unless otherwise indicated, the term "about" or "approximately" as used in this disclosure means an acceptable error with respect to a particular value determined by those skilled in the art, which depends in part on the method by which the value is measured or determined. In certain embodiments, the term "about" or "approximately" means one, two, three, or four standard deviations. In certain embodiments, the term "about" or "approximately" means within 50%, 20%, 15%, 10%, 9%, 8%, 7%, 6%, 5%, 4%, 3%, 2%, 1%, 0.5%, or 0.05% of a given value or range.

[0216] Unless otherwise indicated herein, all numerical parameters should be understood in every case as being preceded and modified by the word "about," such numerical parameters having the inherent variability characteristics of the measurement method on which the parameter's numerical value is based. At the very least, one should not attempt to limit the application of the doctrine of equivalents to the scope of the claims, and each numerical parameter described herein should be construed, at least, in light of the reported significant digits and by applying ordinary rounding techniques.

[0217] Any numerical range recited herein includes all sub-ranges subsumed within the recited range. For example, the range "1 to 10" includes all sub-ranges between, and including, the recited minimum value of 1 and the recited maximum value of 10, i.e., all sub-ranges having a minimum value of 1 or more and a maximum value of 10 or less. Also, all ranges recited herein include the endpoints of the recited range. For example, the range "1 to 10" includes the endpoints 1 and 10. Any maximum numerical limit described herein is intended to include all lesser numerical limits subsumed therein, and any minimum numerical limit described herein is intended to include all greater numerical limits subsumed therein. Accordingly, the applicant has the right to amend the specification, including the claims, to include any expressly recited sub-range subsumed within an expressly recited range. All such ranges are inherently described in the specification.

[0218] Any patent application, patent, non-patent publication, or other disclosure material referenced 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 herein shall prevail over any conflicting descriptions incorporated herein by reference. Although it is referred to as being incorporated herein by reference, any content, or portions thereof, that conflict with the current definitions, opinions, or other disclosure content described in this specification shall be incorporated only to the extent that no conflict arises between the incorporated content and the current disclosure content.

[0219] In summary, many benefits resulting from using the concepts described in this specification have been described. The above description in one or two or more forms is presented for purposes of illustration and explanation. It is not intended to be comprehensive or to limit to the exact forms disclosed. Modifications or variations are possible in view of the above teachings. One or two or more forms are selected and described to illustrate the principles and practical applications thereof, thereby enabling those skilled in the art to utilize the various forms, along with various modifications, as suitable for the particular applications contemplated. The claims presented with this specification are intended to define the overall scope.

[0220] 〔Embodiments〕 (1) A surgical system, comprising: a surgical hub; a surgical instrument including an end effector, wherein a control command is directly passed from the surgical hub to the surgical instrument, the surgical instrument; a generator configured to supply energy to the end effector; a smoke evacuation system configured to remove smoke from a surgical site, wherein the surgical instrument is configured to pass the control command received from the surgical hub to the generator and the smoke evacuation system in a daisy chain manner, the smoke evacuation system; and comprising a surgical system. (2) The surgical system according to Embodiment 1, wherein the surgical instrument is configured to modify the control command using the parameters detected by the surgical instrument. (3) The surgical system according to Embodiment 2, wherein the surgical instrument is configured to pass the modified control command to the generator. (4) The surgical system according to Embodiment 3, wherein the operating parameters of the generator are controlled by the modified control command. (5) The surgical system according to Embodiment 3, wherein the generator is configured to change the modified control command using the second parameters detected by the generator.

[0221] (6) The surgical system according to Embodiment 2, wherein the surgical instrument is configured to pass the modified control command to the surgical hub, and the surgical hub is configured to pass the modified control command to the generator. (7) The surgical system according to Embodiment 1, wherein the surgical instrument detects a first parameter of the surgical instrument, the surgical instrument is configured to communicate the detected first parameter to the generator, and the generator is configured to modify the control command using the first parameter. (8) The surgical system according to Embodiment 1, wherein the surgical instrument detects a first parameter of the surgical instrument, the surgical instrument is configured to communicate the detected first parameter to the generator, the generator detects a second parameter, and the generator is configured to modify the control command using the first parameter and the second parameter. (9) The surgical system according to Embodiment 1, further comprising a display screen configured to display a live video of the surgical site and a first operating parameter of the surgical instrument. (10) The surgical system according to embodiment 9, wherein the surgical instrument further includes an instrument display configured to display a second operating parameter of the surgical instrument, and the first operating parameter is the same as the second operating parameter.

[0222] (11) The surgical system according to embodiment 9, wherein the surgical instrument further includes an instrument display configured to display a second operating parameter of the surgical instrument, and the first operating parameter is different from the second operating parameter. (12) The surgical system according to embodiment 9, wherein the display screen is further configured to display an operating parameter of the generator. (13) A surgical system, a surgical hub, a surgical instrument including an end effector, wherein a control command is directly passed from the surgical hub to the surgical instrument, a generator configured to supply energy to the end effector, a smoke evacuation system configured to remove smoke from a surgical site, wherein the surgical instrument is configured to pass the control command received from the surgical hub to the generator and the smoke evacuation system. A surgical system comprising. (14) The surgical system according to embodiment 13, wherein the surgical instrument is configured to pass the control command received from the surgical hub to the generator and the smoke evacuation system in a daisy chain manner. (15) A surgical system, a surgical hub, a first surgical instrument including a first end effector, wherein a control command is directly passed from the surgical hub to the first surgical instrument, a first generator configured to supply energy to the first end effector, A second surgical instrument, wherein the first surgical instrument is configured to pass the control command received from the surgical hub to the first generator and the second surgical instrument in a daisy chain manner, the second surgical instrument; A surgical system comprising.

[0223] (16) The surgical system according to embodiment 15, wherein the first surgical instrument is configured to modify the control command using a first parameter detected by the first surgical instrument. (17) The surgical system according to embodiment 16, wherein the first surgical instrument is configured to pass the modified control command to the second surgical instrument. (18) The second surgical instrument is configured to change the modified control command using a second parameter detected by the second surgical instrument, and the second surgical instrument is configured to pass the changed control command to the first surgical instrument. The surgical system according to embodiment 17. (19) The first surgical instrument is configured to detect a first parameter, the second surgical instrument is configured to detect a second parameter, and the second surgical instrument is configured to communicate the detected second parameter to the first surgical instrument. The surgical system according to embodiment 15, wherein the first surgical instrument is configured to modify the control command using the first parameter detected by the first surgical instrument and the second parameter detected by the second surgical instrument. (20) The surgical system according to embodiment 15, wherein the second surgical instrument includes a smoke evacuation system configured to remove smoke from the surgical site.

Claims

1. A surgical system comprising: a surgical hub; a surgical instrument including an end effector, wherein control commands are passed directly from the surgical hub to the surgical instrument; a generator configured to supply energy to the end effector; a smoke evacuation system configured to remove smoke from the surgical site, wherein the surgical instrument is configured to pass the control commands received from the surgical hub to the generator and the smoke evacuation system; and the control commands include adjusting a current from the generator for clamping by the end effector.

2. The surgical system according to claim 1, wherein the current is adjusted based on the number of uses of the surgical instrument.

3. The surgical system according to claim 1 or 2, wherein the control commands do not include adjusting power from the generator.

4. The surgical instrument includes an RF electrosurgical instrument, and the end effector of the RF electrosurgical instrument includes (i) a pair of clamp arms having electrodes therein, or (ii) an ultrasonic blade and a clamp arm having electrodes therein.

5. The end effector of the RF electrosurgical instrument is the pair of clamp arms having electrodes therein, and the end effector of the RF electrosurgical instrument is configured to deliver RF energy in a plurality of modes including a combined mode having alternating or fused bipolar RF energy and monopolar RF energy.

6. The surgical system according to claim 4 or 5, wherein the surgical hub includes a hub processor, the surgical instrument includes an instrument processor, and the generator includes a generator processor.

7. The surgical system according to claim 4 or 5, wherein the surgical instrument is configured to pass the control commands received from the surgical hub to the generator and the smoke evacuation system in a daisy chain manner.

8. The surgical system according to claim 7, wherein the surgical instrument is configured to modify the control commands using parameters detected by the surgical instrument.

9. The surgical system according to claim 8, wherein the surgical instrument is configured to pass the modified control command to the generator.

10. The surgical system according to claim 9, wherein the operating parameters of the generator are controlled by the modified control command.

11. The surgical system according to claim 9, wherein the generator is configured to change the modified control command using a second parameter detected by the generator.

12. The surgical system according to claim 8, wherein the surgical instrument is configured to pass the modified control command to the surgical hub, and the surgical hub is configured to pass the modified control command to the generator.

13. The surgical system according to claim 4 or 5, wherein the surgical instrument detects a first parameter of the surgical instrument, the surgical instrument is configured to communicate the detected first parameter to the generator, and the generator is configured to modify the control command using the first parameter.

14. The surgical system according to claim 4 or 5, wherein the surgical instrument detects a first parameter of the surgical instrument, the surgical instrument is configured to communicate the detected first parameter to the generator, the generator detects a second parameter, and the generator is configured to modify the control command using the first parameter and the second parameter.

15. A surgical system, comprising: a surgical hub; a surgical instrument including an end effector, wherein a control command is directly passed from the surgical hub to the surgical instrument; a generator configured to supply energy to the end effector; a smoke evacuation system configured to remove smoke from the surgical site, wherein the surgical instrument is configured to pass the control command received from the surgical hub to the generator and the smoke evacuation system in a daisy chain manner; a display screen configured to display a live image of the surgical site and a first operating parameter of the surgical instrument.

16. The surgical system according to claim 15, wherein the surgical instrument further includes an instrument display configured to display a second operating parameter of the surgical instrument, and the first operating parameter is the same as the second operating parameter.

17. The surgical system according to claim 15, wherein the surgical instrument further includes an instrument display configured to display a second operating parameter of the surgical instrument, and the first operating parameter is different from the second operating parameter.

18. The surgical system according to claim 15, wherein the display screen is further configured to display an operating parameter of the generator.

19. A surgical system, a surgical hub, a first surgical instrument including a first end effector, wherein a control command is directly passed from the surgical hub to the first surgical instrument, a first generator configured to supply energy to the first end effector, a second surgical instrument, wherein the first surgical instrument is configured to pass the control command received from the surgical hub to the first generator and the second surgical instrument in a daisy chain manner, comprising: The control command includes adjusting a current for clamping by the first end effector from the first generator, in the surgical system.

20. The surgical system according to claim 19, wherein the current is adjusted based on the number of uses of the first surgical instrument.

21. The surgical system according to claim 19 or 20, wherein the first surgical instrument is configured to modify the control command using a first parameter detected by the first surgical instrument.

22. The surgical system according to claim 21, wherein the first surgical instrument is configured to pass the modified control command to the second surgical instrument.

23. The surgical system according to claim 22, wherein the second surgical instrument is configured to change the modified control command using a second parameter detected by the second surgical instrument, and the second surgical instrument is configured to pass the changed control command to the first surgical instrument.

24. The first surgical instrument is configured to detect a first parameter, the second surgical instrument is configured to detect a second parameter, the second surgical instrument is configured to communicate the detected second parameter to the first surgical instrument, and the first surgical instrument is configured to modify the control command using the first parameter detected by the first surgical instrument and the second parameter detected by the second surgical instrument. The surgical system according to claim 19 or 20.

25. The surgical system according to claim 19 or 20, wherein the second surgical instrument includes a smoke exhaust system configured to remove smoke from the surgical site.

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