Display control of layered systems based on capacity and user operation

Abstract

The surgical hub may be configured to receive images from a laparoscopic scope and surgical information from at least one surgical instrument. The surgical hub may be operatively connected to multiple displays, such as a primary display and a secondary display. The surgical hub may generate visualization data for the primary display. The surgical hub may obtain a visualization control mode based on the visualization control parameters and may determine whether to generate a different set of visualization data for the secondary display based on the visualization control mode. If the visualization control mode supports multiple display capabilities, the surgical hub may generate visualization data specifically for the secondary display. If the visualization control mode does not support multiple display capabilities, the surgical hub may transmit the same visualization data for display on the secondary display as the primary display.

Description

[Technical Field]

[0001] (CROSS-REFERENCE TO RELATED APPLICATIONS) This application is related to the following concurrently filed applications, the contents of each of which are incorporated herein by reference: - Attorney Reference Number END9287USNP1, Title of Invention: "METHOD FOR OPERATING TIERED OPERATION MODES IN A SURGICAL SYSTEM" Attorney Docket No. END9287USNP15, Title of Invention: "COOPERATIVE SURGICAL DISPLAYS" Attorney Docket No. END9287USNP16, Title of Invention: "INTERACTIVE INFORMATION OVERLAY ON MULTIPLE SURGICAL DISPLAYS," and Attorney Docket No. END9287US17, Invention Title: "COMMUNICATION CONTROL OPTIONS FOR A SURGEON CONTROLLED SECONDARY DISPLAY AND PRIMARY DISPLAY." [Background technology]

[0002] Surgical systems often incorporate imaging systems that can enable clinicians to view the surgical site and / or one or more portions thereof on one or more displays, such as, for example, monitors. The displays may be local to the surgical site and / or remote. The imaging system may include a scope with a camera that views the surgical site and transmits the view to a display viewable by the clinician. Scopes include, but are not limited to, arthroscopes, angioscopes, bronchoscopes, cholangioscopes, colonoscopes, cystoscopes, esophagogastroduodenoscopes, enteroscopes, esophagogastroduodenoscopes (gastroscopes), endoscopes, laryngoscopes, nasopharyngological-nephroscopes, sigmoidoscopes, thoracoscopes, ureteroscopes, and exoscopes. Imaging systems may be limited by the information they can recognize and / or convey to the clinician. For example, certain hidden structures, physical contours, and / or dimensions in three-dimensional space may not be recognizable during surgery with a particular imaging system. Additionally, certain imaging systems may not be able to communicate and / or convey certain information to the clinician during surgery. Summary of the Invention [Means for solving the problem]

[0003] According to one embodiment of the present invention, a surgical hub is configured to receive images from a laparoscopic scope and surgical information from at least one surgical instrument. The surgical hub may be operatively connected to multiple displays, such as a primary display and a secondary display. The surgical hub may generate visualization data for the primary display. The surgical hub may obtain a visualization control mode based on the visualization control parameters and determine whether to generate a different set of visualization data for the secondary display based on the visualization control mode. If the visualization control mode supports multiple display capabilities, the surgical hub may generate visualization data specifically for the secondary display. If the visualization control mode does not support multiple display capabilities, the surgical hub may transmit visualization data for display on the same secondary display as the primary display. The visualization data may be generated by receiving data from multiple smart surgical devices and combining the received data for display on both the primary and secondary displays.

[0004] For example, the surgical hub can receive an instruction to change the visualization control mode to an updated visualization control mode. The surgical hub can generate and transmit visualization data to the primary display and / or the secondary display according to the updated visualization control mode. For example, based on the updated visualization control mode, the surgical hub can generate and transmit visualization data for display to the primary display and generate and transmit a different set of visualization data for display to the secondary display. In an exemplary visualization control mode supporting touchless control, the surgical hub can generate visualization data based on touchless control parameters such as user movement, the orientation of the user's head relative to the monitor, the user's hand gestures, and / or the user's voice activation. In an exemplary visualization control mode supporting augmented reality, the surgical hub can generate overlay information for overlaying on the primary display via the secondary display.

[0005] In various examples, the visualization control parameters may include one or more of available memory, available data bandwidth, heat generated by the surgical hub, heat generated by the secondary display, power capacity associated with the surgical hub, power capacity associated with the operating room, power capacity associated with the medical facility, power usage, a balance of power consumption for at least one attached system, processor utilization, or memory utilization. The visualization control parameters may include user preferences associated with the surgical display, hardware capabilities associated with the surgical hub, the primary display, and the secondary display, software capabilities associated with the surgical hub, the primary display, and the secondary display, or instructions from a tiered control system.

[0006] For example, visualization control parameters may include instructions from a tiered system that may scale display and interactive display control capabilities, etc. based on available data bandwidth, power capacity and usage, processor and memory utilization, and / or internal or attached systems. The tiered system may determine the maximum display and interactive display control capabilities under which the surgical hub may operate.

[0007] As examples above and below, the surgical hub can control the data displayed by the primary and secondary displays and tailor this data to the specific context of the surgical procedure being performed. The surgical hub's ability to control the display allows the hub to adapt to the type of procedure being performed, the personnel involved in the procedure, the progress of the procedure, and any anomalies or irregularities that arise. This improves the adaptability of the surgical hub, which in turn allows the hub to be used for a wider variety of procedures. Patient safety is also improved by ensuring greater control over when and where data is displayed during the surgical procedure, and the ability to adapt in real time to irregularities or irregularities that arise. The hub's ability to control the display based on specific visualization control parameters also improves the efficiency of the surgical procedure by eliminating the need for surgical team members to manually adjust these displays.

[0008] As shown above and below, particularly in Examples 2 and 12 below, the surgical hub can disable the generation of second visualization data for the secondary display based on the context of the surgical procedure being performed. This can ensure that data is displayed only when it is safe to do so and does not distract surgical personnel from more important tasks. It can also ensure that data is displayed only when resources are available to generate and display the information without compromising the procedure due to, for example, excessive processing load or power consumption. This further improves the adaptability of the surgical hub to different procedures, as well as procedural efficiency and patient safety.

[0009] As examples above and below, particularly examples 3, 4, 13, and / or 14 below, the surgical hub can control the data displayed by the primary and secondary displays to ensure there are sufficient computing, network, or electrical resources available. For example, if the processor is generating excessive heat, drawing excessive power, or running low on available memory, the secondary display can be disabled or the amount of data generated can be scaled back. This can then ensure that the hub remains operational or that the hub prioritizes tasks critical to the patient's health. This further improves the adaptability of the surgical hub to different procedures and scenarios, further improving patient safety.

[0010] As examples above and below, particularly examples 7 and / or 17 below, the surgical hub can control the data displayed by the primary and secondary displays to ensure that the correct data is sent to the correct user, e.g., the correct member of the surgical team. For example, if the secondary display is one used by a surgeon's assistant, the surgical hub can ensure that data intended for the surgeon's assistant is sent to the secondary display. This ensures that the correct user is sent data that they need to see in the most efficient manner, thereby improving the efficiency and safety of the procedure.

[0011] As examples above and below, particularly Examples 8 and / or 18 below, the surgical hub can use contactless control parameters to control the display of visualization data. This may allow a user to control the data displayed on the primary and secondary displays using contactless control, or the hub may control which data is displayed and on which display based on the user's location and / or the display the user is viewing. This further improves the adaptability of the surgical hub as well as improving the efficiency and safety of surgical procedures involving the hub. The use of contactless control also reduces the risk of infection as a result of a surgeon or surgical team member touching unclean surfaces, further improving safety.

[0012] As examples above and below, particularly Examples 9 and / or 19 below, the processor of the surgical hub may adjust the first visualized data or the second visualized data when a particular event occurs. Specifically, when an anomaly or abnormality occurs, the surgical hub can adjust the first visualized data and / or the second visualized data to account for the anomaly or abnormality. For example, the processor can adjust the first visualized data and / or the second visualized data to draw attention to the anomaly or abnormality (e.g., with an alert) or to assist a user, such as a surgeon, in correcting the anomaly or abnormality. Procedural efficiency and patient safety are improved because users are alerted to important events more quickly so that they can take necessary action.

[0013] According to further embodiments of the present invention, the following examples are provided.

[0014] 1. A surgical hub comprising: a communications array configured to be operatively connected to the primary and secondary displays, the laparoscopic scope, and the at least one surgical instrument; a processor, wherein the processor: Obtaining a visualization control mode based on the visualization control parameter; generating first visualization data for a primary display; determining whether to generate second visualization data for the secondary display based on the obtained visualization control mode; and transmitting data for display on at least one of the primary display or the secondary display based on the determination. Surgical Hub.

[0015] The visualization control parameter may be a display control parameter, and the visualization control mode may be a display control mode.

[0016] In Example 1, some exemplary visualization control modes may enable multi-display capabilities, while other exemplary visualization control modes may limit visualization displays to be on the primary display or may display the same content on both the primary and secondary displays. For example, visualization control modes with more supported capabilities may require interlocking hardware and / or software to ensure synchronization or pairing of data in time. Thus, the visualization control mode may affect whether visualization or display data is generated, transmitted to, and displayed on the secondary display, and what form this data takes.

[0017] In Example 1, a visualization control parameter may be associated with the primary display and / or the secondary display. The processor may determine a visualization control mode based on the visualization control parameter. The processor may determine or obtain the visualization control mode based on or by detecting that the visualization control parameter has passed a threshold. Generating the first visualization data may include generating the first visualization data for the primary display based on or in accordance with the visualization control mode, and may further include transmitting the first visualization data for display on the primary display.

[0018] Transmitting data for display on at least one of the primary display or the secondary display based on the determination may include transmitting second visualization data for display on the secondary display based on the determination.

[0019] The first visualization data and / or the second visualization data may include a view of the surgical site, perioperative visualization of the surgical site, instrument settings such as settings for a monopolar, bipolar or ultrasonic instrument, settings for a laparoscopic scope, and / or settings for at least one surgical instrument, a magnified view of the surgical site, a composite image, an overhead view of the surgical site, and information regarding a staple cartridge loaded in at least one surgical instrument.

[0020] 2. The processor: generating second visualization data for a secondary display based on determining that the visualization and control mode supports multiple display capabilities; and disabling generating second visualization data for the secondary display based on a determination that the visualization and control mode does not support multiple display capabilities.

[0021] For example, in Example 1 or Example 2, determining whether to generate second visualization data and transmitting the data for display may include determining whether the visualization and control mode supports multiple display capabilities, and generating the second visualization data for the secondary display if the visualization and control mode supports multiple display capabilities, or disabling generating the second visualization data for the secondary display if the visualization and control mode does not support multiple display capabilities.

[0022] 3. The surgical hub of example 1 or 2, wherein the visualization control parameters include at least one of available memory, available data bandwidth, heat generated by the surgical hub, heat generated by the secondary display, power capacity associated with the surgical hub, power capacity associated with the operating room, power capacity associated with the medical facility, power usage, a balance of power consumption for at least one attached system, processor utilization, or memory utilization.

[0023] 4. The surgical hub of any one of Examples 1-3, wherein the visualization control parameters include at least one of user preferences associated with the surgical display, hardware capabilities associated with the surgical hub, the primary display, and the secondary display, software capabilities associated with the surgical hub, the primary display, and the secondary display, or instructions from a layered control system.

[0024] For example, in any of Examples 1-4, the visualization control parameters include at least one of available computing resources, available network resources, and / or available electrical resources.

[0025] For example, in any of Examples 1 to 4, the visualization control parameter may include an instruction from the hierarchical system or may be an instruction from the hierarchical system.

[0026] The tiered system may scale display capabilities and / or interactive display / visualization control capabilities based on one or more system parameters. For example, the tiered system may scale or modify the first and / or second visualization data based on one or more system parameters. For example, the one or more system parameters may include resources available to and / or connected to the hub, such as electrical resources and / or computing resources. For example, the one or more system parameters may include hardware and software available to and / or connected to the hub.

[0027] The tiered system may scale display capabilities and / or interactive display / visualization control capabilities when it detects that a system parameter has passed a threshold. For example, the tiered system may scale down display capabilities and / or interactive display / visualization control capabilities when it detects that a system parameter (e.g., power capabilities, available data bandwidth associated with an operating room, associated with a surgical hub, and / or associated with a medical facility) falls below a threshold. For example, the tiered system may scale down display capabilities and / or interactive display / visualization control capabilities when it detects that a system parameter (e.g., memory utilization, power usage, and / or other system conditions that may be reason for scaling down visualization control capabilities) exceeds a threshold.

[0028] Scaling or scaling down the visualization control capabilities of the surgical hub may include limiting or disabling display-related communications between the surgical hub and devices (such devices may include a laparoscopic scope and / or at least one surgical instrument), limiting or disabling display-related communications between the surgical hub and an external server, limiting or disabling augmented reality capabilities, and limiting or disabling multiple display capabilities, such as disabling or limiting the data displayed on a secondary display and / or a primary display.

[0029] In Example 3 or 4, determining whether to generate second visualization data for the secondary display based on the obtained visualization control mode may include determining whether to generate the second visualization data based on any of the given example visualization control parameters.

[0030] 5. The processor: receiving an instruction to change the visualization control mode to an updated visualization control mode; The surgical hub of any one of Examples 1-4, further configured to: transmit data for display on at least one of the primary display or the secondary display based on the updated visualization control mode.

[0031] For example, in any of Examples 1-5, the processor may be configured to change the visualization control mode to an updated visualization control mode based on a visualization control parameter. The change in visualization control mode may be based on a change in the visualization control parameter or may be triggered by the visualization control parameter passing a threshold. The visualization control parameter may be the original visualization control parameter or a second visualization control parameter. The processor may be configured to change the visualization control mode to the updated visualization control mode based on either the original visualization control parameter or the second visualization control parameter. The processor may be further configured to generate updated first visualization data based on the updated visualization control mode, and, in a further determination, determine whether to generate updated second visualization data for the secondary display based on the updated visualization control mode, and, based on the further determination, transmit the updated second visualization data for display on the secondary display.

[0032] 6. The processor: receiving data from a plurality of smart surgical devices; 6. The surgical hub of any one of Examples 1-5, further configured to: combine the received data for display on the primary display.

[0033] The plurality of smart surgical devices may include a laparoscopic scope and at least one surgical instrument.

[0034] 7. The surgical hub of any one of Examples 1-6, wherein the processor is further configured to: determine whether to generate second visualization data based on a user role associated with the secondary display based on the visualization control mode.

[0035] For example, in any of Examples 1-7, the visualization control parameter may be a user role associated with the secondary display, and the processor may obtain or determine a visualization control mode based on the user role associated with the secondary display. In other words, different visualization control modes may be used by the processor depending on the type of user associated with the display. The user and user role may include a surgeon, a surgeon's assistant, or a medical professional, who may be located inside or outside the sterile field. The processor may obtain or determine the visualization control mode based on whether a user (such as one of the above users) is interacting with the secondary display. A user role may interact with or be associated with the secondary display by at least one of manipulating the display, turning the user's head so that the user can view the display, voice-activating the display, being the intended user for the display, and / or being the user closest to the display. In Example 7, determining whether to generate second visualization data for the secondary display based on the obtained visualization control mode may include determining whether to generate second visualization data based on a user role associated with the secondary display.

[0036] 8. The surgical hub of any one of Examples 1 to 7, wherein the processor is further configured to: determine, based on the visualization control mode, whether to generate second visualization data based on non-contact control parameters, the non-contact control parameters including at least one of detected user movement, detected head orientation relative to the monitor, detected user hand gestures, or user voice activation.

[0037] For example, in any of Examples 1-8, the visualization control parameters may include non-touch control parameters. The processor may obtain or determine a visualization control mode based on the non-touch control parameters. The non-touch control parameters may include at least one of a detected user movement, a user position relative to the monitor, the primary display, and / or the secondary display, a detected head orientation relative to the monitor, the primary display, and / or the secondary display, a detected user hand gesture, or a user voice activation. In Example 8, determining whether to generate second visualization data for the secondary display based on the obtained visualization control mode may include determining whether to generate the second visualization data based on the non-touch control parameters.

[0038] 9. The processor: determining whether to receive a visualization control instruction indicating a display change on at least one of the primary display or the secondary display based on the visualization control mode; The surgical hub of any one of Examples 1 to 8, further configured to: based on a determination to receive the visualization control instruction, generate first visualization data or second visualization data for display based on the display changes indicated in the visualization control instruction.

[0039] The display change may be a display adjustment.

[0040] For example, in any of Examples 1-9, the visualization control mode may support adjusting the primary and / or secondary display based on the adjusted display event. The processor may detect a surgical context based at least in part on perioperative data. The perioperative data may be received from at least one surgical instrument. The processor may determine, based on the surgical context, whether the surgical context corresponds to the adjusted display event on the primary display and / or the secondary display. Based on the determination, the processor may then adjust the first visualization data and / or the second visualization data. If the surgical context does not correspond to the adjusted display event, the hub may refrain from making additional adjustments to the primary display or the secondary display.

[0041] The coordinated display events may include detection of anomalies associated with the surgical procedure, received surgical data being outside of expected values, system parameters being outside of system parameter ranges, and steps in the surgical procedure being out of sequence.

[0042] Adjustments to the first and / or second visualization data may include zooming in on a target within the image, removing irrelevant information from the primary or secondary display, highlighting a portion of an image (such as a laparoscopic scope image) on the primary or secondary display, projecting a warning, error message, or instruction of a detected abnormality and / or overlaying a warning, error message, or instruction of a detected abnormality, and moving data from the primary display to the secondary display or from the secondary display to the primary display.

[0043] 10. The secondary display is an augmented reality device, and the processor: determining whether to generate overlay information for overlaying on the primary display via the secondary display based on the visualization control mode; The surgical hub of any one of Examples 1 to 9, further configured to: generate overlay information based on a determination that the visualization control mode supports augmented reality; and, upon detecting that a user of the secondary display is looking at the primary display, overlay the overlay information on the primary display via the secondary display.

[0044] For example, in Example 10, the augmented reality device may be safety glasses with an augmented reality display, augmented reality goggles, or a head-mounted display.

[0045] For example, in any one of Examples 1-10, the secondary display is an augmented reality device, and the processor is further configured to determine whether the visualization control mode supports augmented reality, and if the visualization control mode supports augmented reality, generate overlay information for overlaying on the primary display via the augmented reality device, and, upon detecting that a user of the secondary display is looking at the primary display, overlay the overlay information on the primary display via the secondary display.

[0046] 11. A method for a surgical hub operably connected to a primary display and a secondary display, a laparoscopic scope, and at least one surgical instrument, comprising: Obtaining a visualization control mode based on the visualization control parameter; generating first visualization data for a primary display; determining whether to generate second visualization data for the secondary display based on the obtained visualization control mode; and transmitting data for display on at least one of the primary display or the secondary display based on the determination.

[0047] The method of Example 11 may be a method of operating a surgical hub.

[0048] All comments above regarding Example 1 apply mutatis mutandis to Example 11.

[0049] 12. generating second visualization data for a secondary display based on determining that the visualization and control mode supports multiple display capabilities; 12. The method of Example 11, further comprising: disabling generating second visualization data for the secondary display based on a determination that the visualization and control mode does not support multiple display capabilities.

[0050] All comments above regarding Example 2 apply mutatis mutandis to Example 12.

[0051] 13. The method of Example 11 or 12, wherein the visualization control parameters include at least one of available memory, available data bandwidth, heat generated by the surgical hub, heat generated by the secondary display, power capacity associated with the surgical hub, power capacity associated with the operating room, power capacity associated with the medical facility, power usage, a balance of power consumption for at least one attached system, processor utilization, or memory utilization.

[0052] All statements made above regarding Example 3 apply mutatis mutandis to Example 13.

[0053] 14. The method of any one of Examples 11-13, wherein the visualization control parameters include at least one of user preferences associated with the surgical display, hardware capabilities associated with the surgical hub, the primary display, and the secondary display, software capabilities associated with the surgical hub, the primary display, and the secondary display, or instructions from a layered control system.

[0054] All comments above regarding Example 4 apply mutatis mutandis to Example 14.

[0055] 15. receiving an instruction to change the visualization control mode to an updated visualization control mode; 15. The method of any one of Examples 11-14, further comprising: transmitting data for display on at least one of the primary display or the secondary display based on the updated visualization control mode.

[0056] All statements made above regarding Example 5 apply mutatis mutandis to Example 15.

[0057] 16. Receiving data from a plurality of smart surgical devices; 16. The method of any one of Examples 11-15, further comprising: combining the received data for display on the primary display.

[0058] All statements made above regarding Example 6 apply mutatis mutandis to Example 16.

[0059] 17. The method of any one of Examples 11-16, further comprising: determining whether to generate second visualization data based on a user role associated with the secondary display based on the visualization control mode.

[0060] All statements made above regarding Example 7 apply mutatis mutandis to Example 17.

[0061] 18. The method of any one of Examples 11-17, further comprising: determining whether to generate second visualization data based on a visualization control mode and based on non-contact control parameters, the non-contact control parameters including at least one of a detected user movement, a detected head orientation relative to the monitor, a detected user hand gesture, or a user voice activation.

[0062] All comments above regarding Example 8 apply mutatis mutandis to Example 18.

[0063] 19. determining whether to receive a visualization control instruction indicating a display change on at least one of the primary display or the secondary display based on a visualization control mode; The method of any one of Examples 11 to 18, further comprising: based on a determination to receive the visualization control instruction, generating first visualization data or second visualization data for display based on the display changes indicated in the visualization control instruction.

[0064] All statements made above regarding Example 9 apply mutatis mutandis to Example 19.

[0065] 20. Determining whether to generate overlay information for overlaying on the primary display via the secondary display based on the visualization control mode; The method of any one of Examples 11-19, further comprising: generating overlay information based on determining that the visualization control mode supports augmented reality; and overlaying the overlay information on the primary display via the secondary display upon detecting that a user of the secondary display is looking at the primary display.

[0066] All comments above regarding Example 10 apply mutatis mutandis to Example 20. [Brief explanation of the drawings]

[0067] [Figure 1] FIG. 1 is a block diagram of a computer-implemented interactive surgical system. [Figure 2] 1 illustrates an exemplary surgical system being used to perform a surgical procedure in an operating room. [Figure 3] 1 illustrates an exemplary surgical hub paired with a visualization system, a robotic system, and an intelligent instrument, in accordance with at least one aspect of the present disclosure. [Figure 4]1 illustrates a surgical data network having a modular communication hub configured to connect modular devices located in one or more operating rooms in a medical facility, or any room in a medical facility equipped for surgical procedures, to a cloud, in accordance with at least one embodiment of the present disclosure. [Figure 5] 1 illustrates an exemplary computer-implemented interactive surgical system. [Figure 6] 1 illustrates an exemplary surgical system with multiple modules coupled to a modular control tower. [Figure 7] 1 illustrates an exemplary surgical instrument or tool. [Figure 8] 1 illustrates a surgical instrument or tool having a motor that can be activated to perform various functions. [Figure 9] 1 is a diagram of an exemplary situation-aware surgical system. [Figure 10] 1 illustrates an exemplary timeline of an exemplary surgical procedure and inferences that a surgical hub can make from data detected at each step in the surgical procedure. [Figure 11] FIG. 1 is a block diagram of a computer-implemented interactive surgical system. [Figure 12] 1 illustrates the functional architecture of an exemplary computer-implemented interactive surgical system. [Figure 13] 1 illustrates an exemplary computer-implemented interactive surgical system configured to adaptively generate control program updates for modular devices. [Figure 14] 1 illustrates an exemplary surgical system including a handle having a controller and a motor, an adapter releasably coupled to the handle, and a loading unit releasably coupled to the adapter. [Figure 15A] 10 illustrates an exemplary flow for determining an operating mode and operating in the determined mode. [Figure 15B] 10 illustrates an exemplary flow for changing the operating mode. [Figure 16]1 shows the primary display of the surgical hub with a global view and a local view. [Figure 17] 1 shows an example of a primary display for a surgical hub. [Figure 18] 1 depicts a perspective view of a surgeon using a surgical instrument including a handle assembly housing and a wireless circuit board during a surgical procedure, the surgeon wearing a set of safety glasses. [Figure 19] FIG. 1 is a diagram of an exemplary operating room (OR) setup. [Figure 20] FIG. 1 is a block diagram illustrating a gesture recognition system. [Figure 21] 1 illustrates exemplary role-based interactions and controls associated with an augmented reality and device-less control system. [Figure 22] 1 illustrates exemplary procedure-based interaction and control associated with an augmented reality and device-less control system. [Figure 23] 1 is a schematic diagram of an exemplary visualization of an anatomical structure with a Spectral surgical visualization system. FIG. [Figure 24] FIG. 1 is a diagram of a surgical instrument access pathway for a video-assisted thoracoscopic surgery (VATS) procedure, according to at least one embodiment of the present disclosure. [Figure 25] FIG. 1 is a diagram of various coordinate systems associated with a VATS procedure, according to at least one embodiment of the present disclosure. [Figure 26] 10A-10C illustrate exemplary changes in display orientation and user controls in response to changes in surgical instrument orientation. [Figure 27] 1 depicts an exemplary camera view of a surgical procedure. [Figure 28] 1 illustrates an exemplary display of a surgical visualization system in accordance with at least one aspect of the present disclosure. [Figure 29] 1 illustrates an exemplary model of an anatomical structure generated by an exemplary surgical visualization system. [Figure 30]1 illustrates an exemplary display of an exemplary model, in accordance with at least one aspect of the present disclosure. [Figure 31] 1 illustrates an exemplary display of an exemplary model of an anatomical structure generated by an exemplary surgical visualization system. [Figure 32] FIG. 1 is an illustration of an exemplary fusion image generated from a multispectral EMR source. [Figure 33] 1 illustrates exemplary treatment steps and progressions that may be detected by the exemplary situational awareness capabilities of the system. [Figure 34A] 1 shows an example of a series of surgical steps with multi-image analysis at the surgical site. [Figure 34B] 1 shows an example of a series of surgical steps with multi-image analysis at the surgical site. [Figure 34C] 1 shows an example of a series of surgical steps with multi-image analysis at the surgical site. [Figure 35] 10 shows an example of an augmented video image of a pre-operative video image augmented with data identifying the displayed element. [Figure 36] 10 shows an example of an augmented reality overlay on a target area using preoperative tumor data and real-time Doppler monitoring. [Figure 37] 10 illustrates an example flow for a hub operating under a layered visualization control mode. [Figure 38] 10 illustrates an example flow for a hub operating under a layered visualization control mode. [Figure 39] 10 shows a detailed example flow for a hub operating under visualization control mode where the secondary display is an augmented reality (AR) device. [Figure 40] 10 illustrates an example flow for a hub operating under visualization control mode supporting situational awareness capabilities. [Figure 41] 10 illustrates an example flow for a hub operating under visualization control mode supporting situational awareness capabilities. [Figure 42]10 illustrates an example flow for a hub operating under a visualization control mode that supports adjusting the display based on adjusted display events. [Figure 43] 10 illustrates an example flow of a hub operating under visualization control mode supporting AR capabilities. [Figure 44] 10 illustrates an example flow of a hub operating under visualization control mode supporting AR capabilities. [Figure 45] 10 illustrates an example flow of a hub operating under visualization control mode supporting role-based AR capabilities. [Figure 46] 10 illustrates an example flow for a hub operating under visualization control mode with AR capabilities supporting overlays on various displays. DETAILED DESCRIPTION OF THE INVENTION

[0068] The applicant of the present application owns the following concurrently filed US patent applications, the contents of each of which are incorporated herein by reference: U.S. Patent Application No. 16 / 209,416, filed December 4, 2018, entitled "METHOD OF HUB COMMUNICATION, PROCESSING, DISPLAY, AND CLOUD ANALYTICS"; U.S. Patent Application No. 15 / 940,671, entitled "SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER," filed March 29, 2018 (Attorney Docket No. END8502USNP); U.S. Patent Application No. 16 / 182,269, entitled "IMAGE CAPTURING OF THE AREAS OUTSIDE THE ABDOMEN TO IMPROVE PLACEMENT AND CONTROL OF A SURGICAL DEVICE IN USE," filed November 6, 2018 (Attorney Docket No. END9018USNP3); U.S. Patent Application No. 16 / 729,747, entitled "DYNAMIC SURGICAL VISUALIZATION SYSTEMS," filed December 31, 2019 (Attorney Docket No. END9217USNP1); U.S. Patent Application No. 16 / 729,778, entitled "SYSTEM AND METHOD FOR DETERMINING, ADJUSTING, AND MANAGING RESECTION MARGIN ABOUT A SUBJECT TISSUE," filed December 31, 2019 (Attorney Docket No. END9219USNP1); U.S. Patent Application No. 16 / 729,807, entitled "METHOD OF USING IMAGING DEVICES IN SURGERY," filed December 31, 2019 (Attorney Docket No. END9228USNP1); U.S. Patent Application No. 15 / 940,654, entitled "SURGICAL HUB SITUATIONAL AWARENESS," filed March 29, 2018 (Attorney Docket No. END8501USNP); U.S. Patent Application No. 15 / 940,671, entitled "SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER," filed March 29, 2018 (Attorney Docket No. END8502USNP); U.S. Patent Application No. 15 / 940,704 (Attorney Docket No. END8504USNP), entitled "USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT," filed March 29, 2018; U.S. Patent Application No. 16 / 182,290, entitled "SURGICAL NETWORK RECOMMENDATIONS FROM REAL TIME ANALYSIS OF PROCEDURE VARIABLES AGAINST A BASELINE HIGHLIGHTING DIFFERENCES FROM THE OPTIMAL SOLUTION," filed November 6, 2018 (Attorney Docket No. END9018USNP5); U.S. Patent No. 9,011,427, entitled "SURGICAL INSTRUMENT WITH SAFETY GLASSES," issued April 21, 2015; U.S. Patent No. 9,123,155, entitled "APPARATUS AND METHOD FOR USING AUGMENTED REALITY VISION SYSTEM IN SURGICAL PROCEDURES," issued September 1, 2015; U.S. Patent Application No. 16 / 209,478, filed December 4, 2018, entitled "METHOD FOR SITUATIONAL AWARENESS FOR SURGICAL NETWORK OR SURGICAL NETWORK CONNECTED DEVICE CAPABLE OF ADJUSTING FUNCTION BASED ON A SENSED SITUATION OR USAGE" (Attorney Docket No. END9015USNP1); and U.S. Patent Application No. 16 / 182,246, entitled "ADJUSTMENTS BASED ON AIRBORNE PARTICLE PROPERTIES," filed November 6, 2018 (Attorney Docket No. END9016USNP1).

[0069] The surgical hub may have cooperative interaction with one of many means for displaying images from a laparoscopic scope and information from one of many other smart devices. The hub may have the ability to interact with these multiple displays using algorithms or control programs that allow for the combined display and control of data distributed across the displays in communication with the hub.

[0070] 1 , a computer-implemented interactive surgical system 100 may include one or more surgical systems 102 and a cloud-based system (e.g., a cloud 104 that may include a remote server 113 coupled to a storage device 105). Each surgical system 102 may include at least one surgical hub 106 in communication with the cloud 104, which may include the remote server 113. In one example, as shown in FIG. 1 , a surgical system 102 includes a visualization system 108, a robotic system 110, and a handheld intelligent surgical instrument 112, which are configured to communicate with each other and / or with the hub 106. In some embodiments, a surgical system 102 may include M hubs 106, N visualization systems 108, O robotic systems 110, and P handheld intelligent surgical instruments 112, where M, N, O, and P may be integers greater than or equal to 1.

[0071] In various embodiments, the visualization system 108 may include one or more imaging sensors strategically positioned relative to the sterile field, one or more image processing units, one or more storage arrays, and one or more displays, as shown in FIG. 2. In one embodiment, the visualization system 108 may include interfaces for HL7, PACS, and EMR. The various components of the visualization system 108 are described in the U.S. patent application Ser. No. 2019-0200844(A1), entitled "METHOD OF HUB COMMUNICATION, PROCESSING, STORAGE AND DISPLAY," filed Dec. 4, 2018 (U.S. patent application Ser. No. 16 / 209,385), the disclosure of which is incorporated herein by reference in its entirety.

[0072] As shown in FIG. 2 , primary display 119 is positioned in the sterile field for viewing by the operator of operating table 114. In addition, visualization tower 111 is positioned outside the sterile field. Visualization tower 111 may include a first non-sterile display 107 and a second non-sterile display 109 facing opposite each other. Visualization system 108, guided by hub 106, is configured to utilize displays 107, 109, and 119 to coordinate information flow to operators inside and outside the sterile field. For example, hub 106 can cause visualization system 108 to display snapshots of the surgical site captured by imager 124 on non-sterile displays 107 or 109 while maintaining a live video of the surgical site on primary display 119. The snapshots on non-sterile displays 107 or 109 can, for example, enable a non-sterile operator to perform diagnostic steps related to the surgical procedure.

[0073] In one aspect, the hub 106 is also configured to send diagnostic input or feedback entered by the non-sterile operator at the visualization tower 111 to the primary display 119 in the sterile field for viewing by the sterile operator at the operating table. In one example, the input can be in the form of modifications to a snapshot displayed on the non-sterile display 107 or 109 that can be sent by the hub 106 to the primary display 119.

[0074] 2 , a surgical instrument 112 is used as part of the surgical system 102 in a surgical procedure. The hub 106 is also configured to coordinate information flow to the display of the surgical instrument 112. For example, U.S. Patent Application Publication No. 2019-0200844(A1), entitled “METHOD OF HUB COMMUNICATION, PROCESSING, STORAGE AND DISPLAY,” filed December 4, 2018 (U.S. Patent Application No. 16 / 209,385), the disclosure of which is incorporated herein by reference in its entirety. Diagnostic input or feedback entered by a non-sterile operator at the visualization tower 111 can be sent by the hub 106 to a surgical instrument display 115 in the sterile field, where it can be viewed by the operator of the surgical instrument 112. Exemplary surgical instruments suitable for use with the surgical system 102 are described, for example, in U.S. Patent Application Publication No. 2019-0200844(A1), entitled "METHOD OF HUB COMMUNICATION, PROCESSING, STORAGE AND DISPLAY," filed December 4, 2018 (U.S. Patent Application No. 16 / 209,385), the entire disclosure of which is incorporated herein by reference.

[0075] FIG. 2 depicts an example of a surgical system 102 being used to perform a surgical procedure on a patient lying on an operating table 114 in a surgical operating room 116. A robotic system 110 may be used as part of the surgical system 102 in the surgical procedure. The robotic system 110 may include a surgeon's console 118, a patient side cart 120 (surgical robot), and a surgical robot hub 122. The patient side cart 120 can manipulate at least one detachably coupled surgical tool 117 through a minimally invasive incision in the patient's body while the surgeon views the surgical site through the surgeon's console 118. Images of the surgical site are acquired by a medical imaging device 124, which can be manipulated by the patient side cart 120 to orient the imaging device 124. The robotic hub 122 can be used to process and then display the images of the surgical site to the surgeon through the surgeon's console 118.

[0076] Other types of robotic systems can be readily adapted for use with surgical system 102. Various examples of robotic systems and surgical tools suitable for use with the present disclosure are described in U.S. Patent Application Publication No. 2018-0201137(A1), entitled "METHOD OF ROBOTIC HUB COMMUNICATION, DETECTION, AND CONTROL," filed December 4, 2019 (U.S. Patent Application No. 16 / 209,407), the entire disclosure of which is incorporated herein by reference.

[0077] Various examples of cloud-based analytics methods implemented by the cloud 104 and suitable for use with the present disclosure are described in U.S. Patent Application Publication No. 2019-0206569(A1), entitled "METHOD OF CLOUD BASED DATA ANALYTICS FOR USE WITH THE HUB," filed December 4, 2018 (U.S. Patent Application No. 16 / 209,403), the entire disclosure of which is incorporated herein by reference.

[0078] In various embodiments, the image capture device 124 includes at least one image sensor and one or more optical components. Suitable image sensors may include, but are not limited to, charge-coupled device (CCD) sensors and complementary metal-oxide semiconductor (CMOS) sensors.

[0079] The optical components of the imaging device 124 may include one or more illumination sources and / or one or more lenses. The one or more illumination sources may be directed to illuminate a portion of the surgical field. The one or more image sensors may receive light reflected or refracted from the surgical field, including light reflected or refracted from tissue and / or surgical instruments.

[0080] The one or more illumination sources may be configured to emit electromagnetic energy in the visible spectrum as well as the invisible spectrum. The visible spectrum, sometimes referred to as the optical spectrum or luminous spectrum, is the portion of the electromagnetic spectrum that is visible to (i.e., detectable by) the human eye and is sometimes referred to as visible light or simply light. The typical human eye responds to wavelengths in air between about 380 nm and about 750 nm.

[0081] The invisible spectrum (e.g., non-radiative spectrum) is the portion of the electromagnetic spectrum located below and above the visible spectrum (i.e., wavelengths less than about 380 nm and greater than about 750 nm). The invisible spectrum is not detectable by the human eye. Wavelengths greater than about 750 nm are longer than the red visible spectrum, which constitutes invisible infrared (IR), microwave, and radio electromagnetic radiation. Wavelengths less than about 380 nm are shorter than the violet spectrum, which constitutes invisible ultraviolet, X-ray, and gamma-ray electromagnetic radiation.

[0082] In various aspects, the imaging device 124 is configured for use in minimally invasive procedures. Examples of imaging devices suitable for use with the present disclosure include, but are not limited to, arthroscopes, angioscopes, bronchoscopes, cholangioscopes, colonoscopes, cystoscopes, duodenoscopes, enteroscopes, esophagogastroduodenoscopes (gastroscopes), endoscopes, laryngoscopes, nasopharyngological-nephroscopes, sigmoidoscopes, thoracoscopes, and ureteroscopes.

[0083] The imaging device may employ multispectral monitoring to distinguish between topology and underlying structures. Multispectral imaging captures image data within specific wavelength ranges across the electromagnetic spectrum. Wavelengths can be separated by filters or by using instruments sensitive to specific wavelengths, including frequencies beyond the visible light range, e.g., IR and UV light. Spectral imaging can extract additional information that cannot be captured by the red, green, and blue receptors of the human eye. The use of multispectral imaging is described in the section entitled "Advanced Imaging Acquisition Module." U.S. Patent Application Publication No. 2019-0200844(A1), entitled "METHOD OF HUB COMMUNICATION, PROCESSING, STORAGE AND DISPLAY," filed December 4, 2018 (U.S. Patent Application No. 16 / 209,385), the entire disclosure of which is incorporated herein by reference. Multispectral monitoring can be a useful tool for repositioning the surgical field after the surgical task is complete to perform one or more of the above-mentioned tests on the treated tissue. It is self-evident that strict sterilization of the operating room and surgical equipment is necessary in any surgical procedure. The strict hygiene and sterilization conditions required in the "surgical field," i.e., the operating room or procedure room, require the highest possible sterility of all medical devices and equipment. Part of the above sterilization process includes the need to sterilize everything that comes into contact with the patient or enters the sterile field, including the imaging device 124 and its accessories and components. It is understood that the sterile field can be considered a specific area deemed free of microorganisms, such as in a tray or on a sterile towel, or the sterile field can be considered the area immediately surrounding the patient prepared for the surgical procedure. The sterile field can include cleaned team members wearing appropriate clothing, as well as all equipment and fixtures within the area.

[0084] Referring now to FIG. 3 , a hub 106 is depicted that communicates with a visualization system 108, a robotic system 110, and a handheld intelligent surgical instrument 112. The hub 106 includes a hub display 135, an imaging module 138, a generator module 140, a communications module 130, a processor module 132, a storage array 134, and an operating room mapping module 133. In certain embodiments, as shown in FIG. 3 , the hub 106 further includes a smoke evacuation module 126 and / or a suction / irrigation module 128. During a surgical procedure, the application of energy to tissue for sealing and / or cutting is commonly associated with smoke evacuation, the aspiration of excess fluid, and / or irrigation of tissue. Fluid, power, and / or data lines from different sources often become tangled during a surgical procedure. Addressing this issue can result in valuable time being lost during a surgical procedure. Untangling the lines may require unplugging them from their corresponding modules, which may require resetting the modules. The hub's modular enclosure 136 provides a unified environment for managing power, data, and fluid lines, reducing the frequency of tangling between such lines. An embodiment of the present disclosure presents a surgical hub for use in a surgical procedure involving the application of energy to tissue at a surgical site. The surgical hub includes a hub enclosure and a combination generator module slidably receivable within the hub enclosure's docking station. The docking station includes data and power contacts. The combination generator module includes two or more of an ultrasonic energy generator component, a bipolar RF energy generator component, and a monopolar RF energy generator component housed within a single unit. In one embodiment, the combination generator module also includes a smoke evacuation component, at least one energy delivery cable for connecting the combination generator module to a surgical instrument, at least one smoke evacuation component configured to evacuate smoke, fluid, and / or particulates generated by the application of therapeutic energy to tissue, and a fluid line extending from a remote surgical site to the smoke evacuation component.In one embodiment, the fluid line is a first fluid line, and a second fluid line extends from a remote surgical site to an aspiration and irrigation module slidably received within the hub enclosure. In one embodiment, the hub enclosure includes a fluid interface. Certain surgical procedures may require the application of two or more energy types to tissue. One energy type may be more beneficial for cutting tissue, while another, different energy type may be more beneficial for sealing tissue. For example, a bipolar generator may be used to seal tissue, while an ultrasonic generator may be used to cut the sealed tissue. An embodiment of the present disclosure provides a solution in which the hub's modular enclosure 136 is configured to house and facilitate interactive communication between various generators. One advantage of the hub's modular enclosure 136 is that it allows for rapid removal and / or replacement of various modules. An embodiment of the present disclosure provides a modular surgical enclosure for use in surgical procedures involving the application of energy to tissue. The modular surgical enclosure includes a first energy generator module configured to generate a first energy for application to tissue and a first docking station with a first docking port including first data and power contacts, wherein the first energy generator module is slidably movable into electrical engagement with the power and data contacts and the first energy generator module is slidably movable out of electrical engagement with the first power and data contacts. In addition to the above, the modular surgical enclosure also includes a second energy generator module configured to generate a second energy for application to tissue, different from the first energy, and a second docking station with a second docking port including second data and second power contacts, wherein the second energy generator module is slidably movable into electrical engagement with the power and data contacts and the second energy generator module is slidably movable out of electrical engagement with the second power and second data contacts.In addition, the modular surgical enclosure also includes a communication bus between the first and second docking ports configured to facilitate communication between the first and second energy generator modules. Referring to FIG. 3 , an aspect of the present disclosure is presented regarding a hub modular enclosure 136 that enables modular integration of a generator module 140, a smoke evacuation module 126, and a suction / irrigation module 128. The hub modular enclosure 136 further facilitates interactive communication between the modules 140, 126, and 128. The generator module 140 may be a generator module with integrated monopolar, bipolar, and ultrasonic components supported within a single housing unit slidably insertable into the hub modular enclosure 136. The generator module 140 may be configured to connect to a monopolar device 142, a bipolar device 144, and an ultrasonic device 146. Alternatively, the generator module 140 may comprise a series of monopolar, bipolar, and / or ultrasonic generator modules that interact via the hub modular enclosure 136. The hub modular enclosure 136 may be configured to facilitate insertion of multiple generators and interactive communication between the generators docked to the hub modular enclosure 136 such that the multiple generators function as a single generator.

[0085] FIG. 4 illustrates a surgical data network 201 comprising a modular communications hub 203 configured to connect modular devices located in one or more operating rooms of a medical facility, or any room within a medical facility equipped for surgical procedures, to a cloud-based system (e.g., a cloud 204, which may include a remote server 213 coupled to a storage device 205). In one aspect, the modular communications hub 203 comprises a network hub 207 and / or a network switch 209 in communication with a network router. The modular communications hub 203 can also be coupled to a local computer system 210 to provide local computer processing and data manipulation. The surgical data network 201 may be configured as passive, intelligent, or switched. A passive surgical data network acts as a conduit for data, allowing data to travel from one device (or segment) to another device (or segment) and to cloud computing resources. An intelligent surgical data network includes additional features that allow traffic to pass through the monitored surgical data network and configure each port within the network hub 207 or network switch 209. An intelligent surgical data network may be referred to as a manageable hub or switch. A switching hub reads the destination address of each packet and then forwards the packet to the correct port.

[0086] Modular devices 1a-1n located in an operating room may be coupled to modular communication hub 203. Network hub 207 and / or network switch 209 may be coupled to network router 211 to connect devices 1a-1n to cloud 204 or local computer system 210. Data associated with devices 1a-1n may be transferred to a cloud-based computer via the router for remote data processing and manipulation. Data associated with devices 1a-1n may also be transferred to local computer system 210 for local data processing and manipulation. Modular devices 2a-2m located in the same operating room may also be coupled to network switch 209. Network switch 209 may be coupled to network hub 207 and / or network router 211 to connect devices 2a-2m to cloud 204. Data associated with devices 2a-2n may be transferred to cloud 204 via network router 211 for data processing and manipulation. Data associated with devices 2a-2m may also be transferred to local computer system 210 for local data processing and manipulation.

[0087] It will be appreciated that surgical data network 201 may be expanded by interconnecting multiple network hubs 207 and / or multiple network switches 209 with multiple network routers 211. Modular communications hub 203 may be housed within a modular control tower configured to receive multiple devices 1a-1n / 2a-2m. A local computer system 210 may also be housed in the modular control tower. Modular communications hub 203 is connected to a display 212 to display images acquired by some of devices 1a-1n / 2a-2m, for example, during a surgical procedure. In various embodiments, devices 1a-1n / 2a-2m may include various modules such as, for example, an imaging module 138 coupled to an endoscope, a generator module 140 coupled to an energy-based surgical device, a smoke evacuation module 126, a suction / irrigation module 128, a communications module 130, a processor module 132, a storage array 134, a surgical device coupled to a display, and / or a non-contact sensor module, among other modular devices that may be connected to a modular communications hub 203 of a surgical data network 201.

[0088] In one aspect, the surgical data network 201 may include a combination of a network hub, a network switch, and a network router that connects the devices 1a-1n / 2a-2m to the cloud. Any one or all of the devices 1a-1n / 2a-2m coupled to the network hub or network switch can collect data in real time and transfer the data to a cloud computer for data processing and manipulation. It will be understood that cloud computing relies on sharing computing resources rather than having local servers or personal devices to handle software applications. While the term "cloud" may be used as a metaphor for the "Internet," the term is not so limited. Accordingly, the term "cloud computing" may be used herein to refer to "a type of Internet-based computing" in which various services, such as servers, storage, and applications, are delivered via the Internet to a modular communications hub 203 and / or computer system 210 located in an operating room (e.g., a fixed, mobile, temporary, or on-site operating room or space) and to devices connected to the modular communications hub 203 and / or computer system 210. The cloud infrastructure may be maintained by a cloud service provider. In this context, a cloud service provider may be an entity that coordinates the use and control of devices 1a-1n / 2a-2m located in one or more operating rooms. Cloud computing services can perform numerous calculations based on data collected by smart surgical instruments, robots, and other computerized devices located in the operating room. Hub hardware allows multiple devices or connections to connect to a computer that communicates with cloud computing resources and storage.

[0089] By applying cloud computer data processing technology to data collected by the devices 1a-1n / 2a-2m, a surgical data network can provide improved surgical outcomes, reduced costs, and improved patient satisfaction. After tissue sealing and cutting procedures, at least some of the devices 1a-1n / 2a-2m can be used to observe tissue status and evaluate leakage or perfusion of the sealed tissue. Using cloud-based computing, at least some of the devices 1a-1n / 2a-2m can be used to diagnostically examine data, including images of body tissue samples, to identify pathologies, such as the effects of disease. Such data can include tissue localization and margin confirmation, as well as phenotyping. At least some of the devices 1a-1n / 2a-2m can be used to identify anatomical structures of the body using various sensors integrated with the imaging devices and techniques such as overlaying images captured by multiple imaging devices. Data collected by the devices 1a-1n / 2a-2m, including image data, can be transferred to the cloud 204 or a local computer system 210, or both, for data processing and manipulation, including image processing and manipulation. The data may be analyzed to improve the outcome of the surgical procedure by determining whether further treatments can be performed, such as endoscopic interventions, emerging technologies, targeted radiation, targeted interventions, and the application of precision robotics to tissue-specific sites and conditions. Such data analysis may further employ prognostic analysis processes, and the use of standardized techniques can provide useful feedback to either confirm or suggest modifications to surgical treatment and surgeon performance.

[0090] The operating room devices 1a-1n may be connected to the modular communications hub 203 via wired or wireless channels, depending on the configuration of the devices 1a-1n relative to the network hub. The network hub 207, in one aspect, may be implemented as a local network broadcasting device operating on the physical layer of the Open System Interconnection (OSI) model. The network hub can provide connectivity to devices 1a-1n located within the same operating room network. The network hub 207 can collect data in the form of packets and transmit them to a router in half-duplex mode. The network hub 207 does not store any media access control / Internet Protocol (MAC / IP) information for transferring device data. Only one of the devices 1a-1n can transmit data through the network hub 207 at a time. The network hub 207 may not have a routing table or intelligence regarding where to send the information; it broadcasts all network data across each connection and to a remote server 213 (FIG. 4) on the cloud 204. Although network hub 207 can detect basic network errors such as collisions, broadcasting all information to multiple ports can pose a security risk and cause bottlenecks.

[0091] The operating room devices 2a-2m may be connected to the network switch 209 via wired or wireless channels. The network switch 209 functions within the data link layer of the OSI model. The network switch 209 may be a multicast device for connecting the devices 2a-2m located in the same operating room to the network. The network switch 209 transmits data in the form of frames to the network router 211 and can function in full duplex mode. Multiple devices 2a-2m can transmit data simultaneously through the network switch 209. The network switch 209 stores and uses the MAC addresses of the devices 2a-2m to forward data.

[0092] The network hub 207 and / or the network switch 209 may be coupled to a network router 211 to connect to the cloud 204. The network router 211 functions within the network layer of the OSI model. The network router 211 creates a path for transmitting data packets received from the network hub 207 and / or the network switch 211 to cloud-based computer resources for further processing and manipulation of data collected by any one or all of the devices 1a-1n / 2a-2m. The network router 211 may be used to connect two or more different networks located in different locations, such as different operating rooms in the same medical facility or different operating rooms in different medical facilities. The network router 211 transmits data in the form of packets to the cloud 204 and can function in full-duplex mode. Multiple devices can transmit data simultaneously. The network router 211 uses IP addresses to forward data.

[0093] In one example, the network hub 207 may be implemented as a USB hub that allows multiple USB devices to be connected to a host computer. The USB hub can expand a single USB port into several tiers so that more ports are available for connecting devices to the host system computer. The network hub 207 may include wired or wireless capabilities for receiving information via wired or wireless channels. In one aspect, a wireless USB short-range, high-bandwidth wireless communication protocol may be used for communication between the devices 1a-1n and 2a-2m located in the operating room.

[0094] In an example, operating room devices 1a-1n / 2a-2m can communicate with modular communication hub 203 via Bluetooth wireless technology standard to exchange data over short distances from fixed and mobile devices (using short wavelength UHF radio waves in the ISM band of 2.4-2.485 GHz) and to create a personal area network (PAN). The operating room devices 1a-1n / 2a-2m can communicate with the modular communications hub 203 via numerous wireless or wired communications standards or protocols, including, but not limited to, Wi-Fi (IEEE 802.11 family), WiMAX (IEEE 802.16 family), IEEE 802.20, new radio (NR), long-term evolution (LTE), and any other wireless and wired protocols designated as EV-DO, HSPA+, HSDPA+, HSUPA+, EDGE, GSM, GPRS, CDMA, TDMA, DECT, and their Ethernet derivatives, as well as 3G, 4G, 5G, and beyond. The computing module may include multiple communications modules. For example, a first communications module may be dedicated to shorter-range wireless communications, such as Wi-Fi and Bluetooth, and a second communications module may be dedicated to longer-range wireless communications, such as GPS, EDGE, GPRS, CDMA, WiMAX, LTE, and EV-DO.

[0095] The modular communications hub 203 can act as a central connection for one or all of the operating room devices 1a-1n / 2a-2m and can handle data types known as frames. The frames can carry data generated by the devices 1a-1n / 2a-2m. Once the frames are received by the modular communications hub 203, they are amplified and transmitted to the network router 211, which forwards this data to cloud computing resources using a number of wireless or wired communications standards or protocols, as described herein.

[0096] The modular communications hub 203 may be used as a stand-alone device or may be connected to compatible network hubs and network switches to form a larger network. Because the modular communications hub 203 is generally easy to install, configure, and maintain, the modular communications hub 203 may be a good choice for networking the operating room devices 1a-1n / 2a-2m.

[0097] FIG. 5 illustrates a computer-implemented interactive surgical system 200. The computer-implemented interactive surgical system 200 is similar in many respects to the computer-implemented interactive surgical system 100. For example, the computer-implemented interactive surgical system 200 includes one or more surgical systems 202 that are similar in many respects to the surgical system 102. Each surgical system 202 includes at least one surgical hub 206 that communicates with a cloud 204, which may include a remote server 213. In one aspect, the computer-implemented interactive surgical system 200 includes a modular control tower 236 connected to multiple operating room devices, such as, for example, intelligent surgical instruments, robots, and other computerized devices located in the operating room. As shown in FIG. 6, the modular control tower 236 includes a modular communication hub 203 coupled to a computer system 210.

[0098] As shown in the example of FIG. 5 , modular control tower 236 may be coupled to an imaging module 238 that may be coupled to an endoscope 239, a generator module 240 that may be coupled to an energy device 241, a smoke evacuator module 226, a suction / irrigation module 228, a communications module 230, a processor module 232, a storage array 234, a smart device / instrument 235 optionally coupled to a display 237, and a non-contact sensor module 242. Operating room equipment may be coupled to cloud computing resources and data storage via modular control tower 236. Robotic hub 222 may also be connected to modular control tower 236 and cloud computing resources. Devices / instruments 235, visualization system 208, among others, may be coupled to modular control tower 236 via wired or wireless communication standards or protocols as described herein. Modular control tower 236 may be coupled to a hub display 215 (e.g., monitor, screen) for displaying and overlaying images received from the imaging module, device / instrument display, and / or other visualization system 208. The hub display may also display data received from devices connected to the modular control tower along with the images and overlaid images.

[0099] FIG. 6 illustrates a surgical hub 206 comprising multiple modules coupled to a modular control tower 236. The modular control tower 236 may comprise a modular communications hub 203, e.g., a network-connected device, and a computer system 210, e.g., for local processing, visualization, and imaging. As shown in FIG. 6, the modular communications hubs 203 may be connected in a hierarchical configuration to expand the number of modules (e.g., devices) that may be connected to the modular communications hub 203 and may transfer data associated with the modules to the computer system 210, cloud computing resources, or both. As shown in FIG. 6, each of the network hubs / switches in the modular communications hub 203 may include three downstream ports and one upstream port. The upstream network hub / switch may be connected to a processor to provide communications connectivity to cloud computing resources and a local display 217. Communication to the cloud 204 may occur via either a wired or wireless communications channel.

[0100] The surgical hub 206 can use the non-contact sensor module 242 to measure the dimensions of the surgical field and generate a map of the operating room using either an ultrasonic or laser-based non-contact measurement device. The ultrasonic-based non-contact sensor module can scan the operating room by transmitting bursts of ultrasound and receiving echoes as they bounce off the surrounding walls of the operating room. This is described in U.S. Patent Application Publication No. 2019-0200844(A1), entitled "METHOD OF HUB COMMUNICATION, PROCESSING, STORAGE AND DISPLAY," filed December 4, 2018 (U.S. Patent Application No. 16 / 209,385), under the heading "Surgical Hub Spatial Awareness Within an Operating Room," the entire disclosure of which is incorporated herein by reference, in which the sensor module is configured to determine the size of the operating room and adjust Bluetooth pairing distance limits. A laser-based non-contact sensor module can, for example, scan an operating room by transmitting laser light pulses, receive laser light pulses that reflect off the exterior walls of the operating room, and compare the phase of the transmitted pulses with the received pulses to determine the size of the operating room and adjust Bluetooth pairing distance limits.

[0101] The computer system 210 may include a processor 244 and a network interface 245. The processor 244 may be coupled to a communication module 247, storage 248, memory 249, non-volatile memory 250, and an input / output interface 251 via a system bus. The system bus may be any of several types of bus structures including a memory bus or memory controller, a peripheral bus or external bus, and / or a local bus using any of a variety of available bus architectures, including, but not limited to, a 9-bit bus, an Industrial Standard Architecture (ISA), a MicroChannel Architecture (MSA), an Extended ISA (EISA), an Intelligent Drive Electronics (IDE), a VESA Local Bus (VLB), a Peripheral Component Interconnect (PCI), a USB, an Advanced Graphics Port (AGP), a Personal Computer Memory Card International Association bus (PCMCIA), a Small Computer Systems Interface (SCSI), or any other proprietary bus.

[0102] Processor 244 may be any single-core or multi-core processor, such as those known under the trade name ARM Cortex manufactured by Texas Instruments. In one aspect, the processor may be, for example, an LM4F230H5QR ARM Cortex-M4F processor core available from Texas Instruments. The processor core includes 256KB of on-chip memory of single-cycle flash memory or other non-volatile memory at up to 40MHz, a prefetch buffer to improve performance above 40MHz, 32KB of single-cycle serial random access memory (SRAM), internal read-only memory (ROM) with StellarisWare® software, 2KB of electrically erasable programmable read-only memory (EEPROM), and / or one or more pulse width modulation (PWM) modules, one or more quadrature encoder input (QEI) analog, one or more 12-bit analog-to-digital converters (ADCs) with 12 analog input channels, more details of which are available in the product datasheet.

[0103] In one aspect, the processor 244 may include a safety controller, including two controller-based families such as the TMS570 and RM4x, also known under the trade name Hercules ARM Cortex R4, manufactured by Texas Instruments. The safety controller may be specifically configured for IEC 61508 and ISO 26262 safety limit applications, among others, to provide advanced integrated safety mechanisms while offering scalable performance, connectivity, and memory options.

[0104] System memory may include both volatile and nonvolatile memory. The basic input / output system (BIOS), containing the basic routines for transferring information between elements within a computer system, such as during start-up, is stored in nonvolatile memory. For example, nonvolatile memory may include ROM, programmable ROM (PROM), electrically programmable ROM (EPROM), EEPROM, or flash memory. Volatile memory includes random-access memory (RAM), which acts as external cache memory. RAM is available in many forms, including static RAM (SRAM), dynamic RAM (DRAM), synchronous DRAM (SDRAM), double data rate SDRAM (DDR SDRAM), enhanced SDRAM (ESDRAM), Synchlink DRAM (SLDRAM), and direct Rambus RAM (DRRAM).

[0105] The computer system 210 may also include removable / non-removable, volatile / non-volatile computer storage media, such as disk storage. Disk storage may include, but is not limited to, devices such as magnetic disk drives, floppy disk drives, tape drives, Jaz drives, Zip drives, LS-60 drives, flash memory cards, or memory sticks. In addition, disk storage may include the above storage media, either independently or in combination with other storage media. Other storage media include, but are not limited to, optical disk drives such as compact disc ROM devices (CD-ROMs), compact disc recordable drives (CD-R drives), compact disc rewritable drives (CD-RW drives), or digital versatile disc ROM drives (DVD-ROMs). Removable or non-removable interfaces may be used to facilitate connection of disk storage devices to the system bus.

[0106] It should be understood that computer system 210 may include software that acts as an intermediary between users and the basic computer resources described in a suitable operating environment. Such software may include an operating system. The operating system, which may be stored on disk storage, may function to control and allocate resources of the computer system. System applications may take advantage of resource management by the operating system through program modules and program data stored either in system memory or on disk storage. It should be understood that the various components described herein may be implemented with various operating systems or combinations of operating systems.

[0107] A user may input commands or information into the computer system 210 through input devices coupled to the I / O interface 251. Input devices may include, but are not limited to, pointing devices such as a mouse, trackball, stylus, or touchpad; keyboards; microphones; joysticks; gamepads; satellite dishes; scanners; TV tuner cards; digital cameras; digital video cameras; webcams; and the like. These and other input devices connect to the processor through the system bus via interface ports. Interface ports include, for example, serial ports, parallel ports, game ports, and USB. Output devices use some of the same types of ports as input devices. Thus, for example, a USB port may be used to provide input to the computer system and to output information from the computer system to an output device. Output adapters may be provided to illustrate the existence of some output devices, such as monitors, displays, speakers, and printers, among other output devices that require special adapters. Output adapters may include, by way of example and not limitation, video and sound cards that provide a means of connection between an output device and the system bus. It should be noted that other devices and / or systems of devices, such as remote computers, may provide both input and output capabilities.

[0108] The computer system 210 can operate in a networked environment using logical connections to one or more remote or local computers, such as a cloud computer. The remote cloud computer can be a personal computer, a server, a router, a network PC, a workstation, a microprocessor-based device, a peer device, or other common network node, but typically includes many or all of the elements described with respect to a computer system. For simplicity, only memory storage devices are shown along with the remote computer. The remote computer may be logically connected to the computer system through a network interface, which may then be physically connected through a communications connection. The network interface can encompass communications networks such as local area networks (LANs) and wide area networks (WANs). LAN technologies may include Fiber Distributed Data Interface (FDDI), Copper Distributed Data Interface (CDDI), Ethernet / IEEE 802.3, Token Ring / IEEE 802.5, and the like. WAN technologies may include, but are not limited to, point-to-point links, circuit-switched networks such as Integrated Services Digital Networks (ISDN) and its variants, packet-switched networks, and Digital Subscriber Lines (DSL).

[0109] In various embodiments, the computer system 210 of FIG. 6 , the imaging module 238 of FIG. 5 and FIG. 6 , and / or the visualization system 208, and / or the processor module 232 may include an image processor, an image processing engine, a media processor, or any specialized digital signal processor (DSP) used to process digital images. The image processor may employ parallel computing using single instruction, multiple data (SIMD) or multiple instruction, multiple data (MIMD) techniques to increase speed and efficiency. The digital image processing engine may perform a variety of tasks. The image processor may be a system on a chip with a multi-core processor architecture.

[0110] The communications connection may refer to the hardware / software used to connect the network interface to the bus. While the communications connection is shown internal to the computer system for clarity of illustration, the communications connection may also be external to computer system 210. By way of example only, the hardware / software required to connect to the network interface may include internal and external technologies such as regular telephone-grade modems, modems including cable modems and DSL modems, ISDN adapters, and Ethernet cards.

[0111] FIG. 7 shows a logic diagram of a surgical instrument or tool control system 470 according to one or more embodiments of the present disclosure. The system 470 can include control circuitry. The control circuitry can include a microcontroller 461 with a processor 462 and a memory 468. For example, one or more of sensors 472, 474, 476 provide real-time feedback to the processor 462. A motor 482, driven by a motor driver 492, operably couples a longitudinally movable displacement member to drive the I-beam knife element. A tracking system 480 can be configured to determine the position of the longitudinally movable displacement member. The position information can be provided to the processor 462, which can be programmed or configured to determine the position of the longitudinally movable drive member, as well as the positions of the firing member, firing bar, and I-beam knife element. Additional motors can be provided to the tool driver interface to control I-beam firing, closure tube movement, shaft rotation, and articulation. The display 473 can display various operating conditions of the instrument and may include touch screen functionality for data entry. Information displayed on the display 473 can be overlaid with images acquired via the endoscopic imaging module.

[0112] In one embodiment, microcontroller 461 may be any single-core or multi-core processor, such as those known under the trade name ARM Cortex manufactured by Texas Instruments. In one embodiment, main microcontroller 461 may be, for example, an LM4F230H5QR ARM Cortex-M4F processor core available from Texas Instruments, including on-chip memory of 256 KB of single-cycle flash memory or other non-volatile memory up to 40 MHz, a prefetch buffer to improve performance above 40 MHz, 32 KB of single-cycle SRAM, internal ROM with StellarisWare® software, 2 KB of EEPROM, one or more PWM modules, one or more QEI analog, and / or one or more 12-bit ADCs with 12 analog input channels, details of which are available in the product datasheet.

[0113] In one embodiment, the microcontroller 461 may include a safety controller, including two controller-based families such as the TMS570 and RM4x, also known under the trade name Hercules ARM Cortex R4, manufactured by Texas Instruments. The safety controller may be specifically configured for IEC 61508 and ISO 26262 safety limit applications, among others, to provide advanced integrated safety mechanisms while offering scalable performance, connectivity, and memory options.

[0114] The microcontroller 461 may be programmed to perform various functions, such as precise control over the speed and position of the knife and articulation system. In one embodiment, the microcontroller 461 may include a processor 462 and memory 468. The electric motor 482 may be a brushed direct current (DC) motor with a gearbox and mechanical linkage to the articulation or knife system. In one embodiment, the motor driver 492 may be an A3941 available from Allegro Microsystems, Inc. Other motor drivers may be easily substituted for use in the tracking system 480 with an absolute positioning system. A detailed description of absolute positioning systems is provided in U.S. Patent Application Publication No. 2017 / 0296213, published October 19, 2017, entitled "SYSTEMS AND METHODS FOR CONTROLLING A SURGICAL STAPLING AND CUTTING INSTRUMENT," which is incorporated herein by reference in its entirety.

[0115] The microcontroller 461 may be programmed to provide precise control over the velocity and position of the displacement members and articulation system. The microcontroller 461 may be configured to calculate a response within the microcontroller 461 software. The calculated response may be compared to the measured response of the actual system to obtain an "observed" response, which is used to determine actual feedback. The observed response may be a suitably adjusted value that balances the smooth, continuous nature of the simulated response with the measured response, which can detect external influences on the system.

[0116] In some examples, the motor 482 may be controlled by a motor driver 492 and may be used by the surgical instrument or tool firing system. In various forms, the motor 482 may be a brushed DC drive motor having a maximum rotational speed of, for example, about 25,000 RPM. In some examples, the motor 482 may include a brushless motor, a cordless motor, a synchronous motor, a stepper motor, or any other suitable electric motor. The motor driver 492 may include, for example, an H-bridge driver including field-effect transistors (FETs). The motor 482 may be powered by a power supply assembly releasably attached to the handle assembly or tool housing to provide control power to the surgical instrument or tool. The power supply assembly may include a battery, which may include multiple battery cells connected in series, that may be used as a power source to power the surgical instrument or tool. Under certain circumstances, the battery cells of the power supply assembly may be replaceable and / or rechargeable. In at least one example, the battery cells may be a lithium-ion battery, which may be connectable to and separable from the power supply assembly.

[0117] The motor driver 492 may be the A3941 available from Allegro Microsystems, Inc. The A3941 492 may be a full-bridge controller for use with external N-channel power metal-oxide semiconductor field-effect transistors (MOSFETs), specifically designed for inductive loads such as brushed DC motors. The driver 492 may include an intrinsic charge pump regulator, which can provide full (>10V) gate drive for battery voltages up to 7V, allowing the A3941 to operate with reduced gate drive down to 5.5V. A bootstrap capacitor may be used to provide the required battery supply voltage above the N-channel MOSFET. An internal charge pump for the high-side drive allows DC (100% duty cycle) operation. The full-bridge may be driven in fast or slow decay mode using diode or synchronous rectification. In slow decay mode, current recirculation is possible through either the high-side or low-side FET. The power FETs may be protected from shoot-through by a resistor-adjustable dead time. Integrated diagnostics indicate undervoltage, overtemperature, and power bridge faults and can be configured to protect the power MOSFETs under most short circuit conditions. Other motor drivers can be easily substituted for use in tracking system 480 with an absolute positioning system.

[0118] The tracking system 480 can include a controlled motor drive circuit arrangement including a position sensor 472 according to one aspect of the present disclosure. The position sensor 472 for an absolute positioning system can provide a unique position signal corresponding to the position of the displacement member. In some examples, the displacement member can represent a longitudinally movable drive member including a rack of drive teeth for meshing engagement with a corresponding drive gear of a gear reducer assembly. In some examples, the displacement member can represent a firing member that can be adapted and configured to include a rack of drive teeth. In some examples, the displacement member can represent a firing bar or an I-beam, each of which can be adapted and configured to include a rack of drive teeth. Thus, as used herein, the term displacement member can be used generally to refer to any movable member of a surgical instrument or tool, such as a drive member, firing member, firing bar, I-beam, or any element that can be displaced. In one aspect, a longitudinally movable drive member can be coupled to a firing member, firing bar, and I-beam. Thus, the absolute positioning system can actually track the linear displacement of an I-beam by tracking the linear displacement of the longitudinally movable drive member. In various aspects, the displacement member may be coupled to any suitable position sensor 472 for measuring linear displacement. Thus, the longitudinally movable drive member, firing member, firing bar, or I-beam, or combinations thereof, may be coupled to any suitable linear displacement sensor. The linear displacement sensor may include a contact displacement sensor or a non-contact displacement sensor.The linear displacement sensor may include a linear variable differential transformer (LVDT), a differential variable reluctance transducer (DVRT), a slide potentiometer, a magnetic sensing system comprising a movable magnet and a series of linearly arranged Hall effect sensors, a magnetic sensing system comprising a fixed magnet and a series of movable linearly arranged Hall effect sensors, an optical detection system comprising a movable light source and a series of linearly arranged photodiodes or photodetectors, an optical detection system comprising a fixed light source and a series of movable linearly arranged photodiodes or photodetectors, or any combination thereof.

[0119] The electric motor 482 may include a rotatable shaft operably interfaced with a gear assembly mounted in meshing engagement with a set of drive teeth or rack on the displacement member. The sensor element may be operably coupled to the gear assembly such that one rotation of the position sensor 472 element corresponds to several linear longitudinal translations of the displacement member. The gearing and sensor arrangement may be connected to a linear actuator by a rack and pinion arrangement or to a rotary actuator by a spur gear or other connection. A power source may provide power to the absolute positioning system, and an output indicator may display the output of the absolute positioning system. The displacement member may represent a longitudinally movable drive member having a rack of drive teeth formed thereon for meshing engagement with a corresponding drive gear of a gear reducer assembly. The displacement member may represent a longitudinally movable firing member, a firing bar, an I-beam, or a combination thereof.

[0120] One revolution of the sensor element associated with position sensor 472 may correspond to a longitudinal linear displacement d1 of the displacement member, where d1 is the longitudinal linear distance traveled by the displacement member from point "a" to point "b" after one revolution of the sensor element coupled to the displacement member. The sensor mechanism may be coupled via a gear reduction that results in the position sensor 472 completing one or more revolutions relative to the full stroke of the displacement member. The position sensor 472 may complete multiple revolutions relative to the full stroke of the displacement member.

[0121] A series of switches (where n is an integer greater than 1) may be used alone or in combination with gear reduction to provide a unique position signal for two or more revolutions of the position sensor 472. The state of the switches may be fed back to the microcontroller 461, which applies logic to determine a unique position signal corresponding to the longitudinal linear displacement d1+d2+...dn of the displacement member. The output of the position sensor 472 is provided to the microcontroller 461. The position sensor 472 of the sensor mechanism may comprise a magnetic sensor, an analog rotation sensor such as a potentiometer, or an array of analog Hall effect elements that output a unique combination of position signals or values.

[0122] The position sensor 472 may comprise any number of magnetic sensing elements, such as, for example, magnetic sensors classified according to whether they measure the total magnetic field or a vector component of the magnetic field. The technologies used to produce both types of magnetic sensors can involve many aspects of physics and electronics. Technologies used to sense magnetic fields may include, among others, search coils, fluxgates, optical pumping, nuclear precession, SQUIDs, Hall effect, anisotropic magnetoresistance, giant magnetoresistance, magnetic tunnel junctions, giant magnetoimpedance, magnetostrictive / piezoelectric composites, magnetodiodes, magnetotransistors, optical fiber, magneto-optical, and microelectromechanical systems-based magnetic sensors.

[0123] In one embodiment, the position sensor 472 of the tracking system 480 with an absolute positioning system can comprise a magnetic rotation absolute positioning system. The position sensor 472 may be implemented as an AS5055EQFT single-chip magnetic rotation position sensor available from Austria Microsystems, AG. The position sensor 472 interfaces with the microcontroller 461 to provide the absolute positioning system. The position sensor 472 may be a low-voltage, low-power component and may include four Hall-effect elements in the area of ​​the position sensor 472 located above the magnet. A high-resolution ADC and a smart power management controller may also be provided on-chip. A coordinate rotation digital computer (CORDIC) processor, also known as the digit-by-digit method and the Boulder algorithm, may be provided to implement simple and efficient algorithms for calculating hyperbolic and trigonometric functions, requiring only addition, subtraction, bit shifting, and table lookup operations. The angular position, alarm bits, and magnetic field information may be transmitted to the microcontroller 461 via a standard serial communications interface, such as a serial peripheral interface (SPI) interface. The position sensor 472 can provide 12-bit or 14-bit resolution and can be an AS5055 chip provided in a small QFN 16-pin 4x4x0.85mm package.

[0124] A tracking system 480 comprising an absolute positioning system may comprise and / or be programmed to implement a feedback controller, such as a PID, state feedback, and adaptive controller. A power supply converts a signal from the feedback controller into a physical input to the system, in this case a voltage. Other examples include PWM of voltage, current, and force. In addition to the position measured by position sensor 472, other sensors may be provided to measure physical parameters of the physical system. In some embodiments, other sensors may include sensor arrangements such as those described in U.S. Pat. No. 9,345,481, issued May 24, 2016, entitled "STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM," which is incorporated herein by reference in its entirety; U.S. Patent Application Publication No. 2014 / 0263552, published September 18, 2014, entitled "STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM," which is incorporated herein by reference in its entirety; and U.S. Patent Application No. 15 / 628,175, filed June 20, 2017, entitled "TECHNIQUES FOR ADAPTIVE CONTROL OF MOTOR VELOCITY OF A SURGICAL STAPLING AND CUTTING INSTRUMENT," which is incorporated herein by reference in its entirety. In a digital signal processing system, the absolute positioning system is coupled to a digital data acquisition system, where the output of the absolute positioning system has a finite resolution and sampling frequency. The absolute positioning system may include comparison and combination circuitry to combine the calculated response with the measured response using algorithms such as weighted averages and theoretical control loops that drive the calculated response towards the measured response. The calculated response of the physical system may take into account characteristics such as mass, inertia, viscous friction, induced drag, etc., in order to predict what the state and output of the physical system will be given knowledge of the input.

[0125] The absolute positioning system can provide the absolute position of the displacement member upon power-up of the instrument without retracting or advancing the displacement member to a reset (zero or home) position, as may be required with conventional rotary encoders that simply count the number of forward or backward steps taken by the motor 482 to estimate the position of the device actuator, drive bar, knife, etc.

[0126] A sensor 474, such as a strain gauge or micro-strain gauge, can be configured to measure one or more parameters of the end effector, such as the amplitude of strain exerted on the anvil during clamping, which can be indicative of the closure force applied to the anvil. The measured strain can be converted to a digital signal and provided to the processor 462. Instead of or in addition to the sensor 474, a sensor 476, such as a load sensor, can measure the closure force applied to the anvil by the closure drive system. For example, the sensor 476, such as a load sensor, can measure the firing force applied to the I-beam during the firing stroke of the surgical instrument or tool. The I-beam is configured to engage a wedge-shaped sled, which is configured to cam the staple driver upward and drive the staples into deforming contact with the anvil. The I-beam can also include a sharp cutting edge that can be used to cut tissue as the I-beam is advanced distally by the firing bar. Alternatively, a current sensor 478 can be used to measure the current drawn by the motor 482. The force required to advance the firing member may correspond, for example, to the current drawn by motor 482. The measured force may be converted to a digital signal and provided to processor 462.

[0127] In one form, a strain gauge sensor 474 can be used to measure the force applied to tissue by the end effector. A strain gauge can be coupled to the end effector to measure the force applied by the end effector to the tissue being treated. A system for measuring the force applied to tissue grasped by the end effector can include a strain gauge sensor 474, such as a micro-strain gauge configured to measure one or more parameters of the end effector. In one aspect, the strain gauge sensor 474 can measure the amplitude or magnitude of strain exerted on the jaw members of the end effector during a clamping operation, which can be indicative of tissue compression. The measured strain can be converted to a digital signal and provided to the processor 462 of the microcontroller 461. The load sensor 476 can measure the force used to operate the knife element, for example, to cut tissue captured between the anvil and the staple cartridge. A magnetic field sensor can be used to measure the thickness of the captured tissue. The magnetic field sensor measurements can also be converted to a digital signal and provided to the processor 462.

[0128] Measurements of tissue compression, tissue thickness, and / or force required to close the end effector on the tissue, measured by sensors 474, 476, respectively, can be used by microcontroller 461 to characterize a selected position of the firing member and / or a corresponding value of firing member velocity. In one example, memory 468 can store techniques, equations, and / or look-up tables that can be used by microcontroller 461 during evaluation.

[0129] The surgical instrument or tool control system 470 may also include wired or wireless communication circuitry for communicating with the modular communications hub 203 as shown in FIGS.

[0130] 8 illustrates a surgical instrument or tool with multiple motors that can be activated to perform various functions. In certain examples, a first motor can be activated to perform a first function, a second motor can be activated to perform a second function, a third motor can be activated to perform a third function, a fourth motor can be activated to perform a fourth function, and so on. In certain examples, the motors of the robotic surgical instrument 600 can be individually activated to produce firing, closing, and / or articulation motions in the end effector. The firing, closing, and / or articulation motions can be transmitted to the end effector via, for example, a shaft assembly.

[0131] In certain examples, the surgical instrument system or tool may include a firing motor 602. The firing motor 602 may be operably coupled to a firing motor drive assembly 604, which may be configured to transfer the firing motion generated by the motor 602 to the end effector, particularly to displace an I-beam element. In certain examples, the firing motion generated by the motor 602 may, for example, deploy staples from a staple cartridge into tissue captured by the end effector and / or advance a cutting blade of the I-beam element to cut the captured tissue. The I-beam element may be retracted by reversing the direction of the motor 602.

[0132] In certain examples, the surgical instrument or tool may include a closure motor 603. The closure motor 603 may be operatively coupled to a closure motor drive assembly 605, which may be configured to transmit the closure motion generated by the motor 603 to the end effector, specifically to displace a closure tube to close the anvil and compress tissue between the anvil and the staple cartridge. The closure motion may transition the end effector from an open configuration to an approximation configuration, for example, to capture tissue. The end effector may be transitioned to the open position by reversing the direction of the motor 603.

[0133] In certain examples, a surgical instrument or tool may include, for example, one or more articulation motors 606 a, 606 b. The motors 606 a, 606 b may be operatively coupled to corresponding articulation motor drive assemblies 608 a, 608 b, which may be configured to transfer articulation motion generated by the motors 606 a, 606 b to an end effector. In certain examples, the articulation motion may, for example, cause the end effector to articulate relative to the shaft.

[0134] As described herein, a surgical instrument or tool may include multiple motors that can be configured to perform various independent functions. In certain examples, multiple motors of a surgical instrument or tool can be activated individually or separately to perform one or more functions while other motors remain stopped. For example, articulation motors 606 a, 606 b can be activated to articulate the end effector while firing motor 602 remains stopped. Alternatively, firing motor 602 can be activated to fire multiple staples and / or advance a cutting blade while articulation motor 606 remains stopped. Additionally, closure motor 603 can be activated simultaneously with firing motor 602 to distally advance a closure tube and I-beam element, as described in more detail herein below.

[0135] In certain examples, a surgical instrument or tool may include a common control module 610 that can be used with multiple motors of the surgical instrument or tool. In certain examples, the common control module 610 can accommodate one of the multiple motors at a time. For example, the common control module 610 may be individually connectable and detachable to multiple motors of a robotic surgical instrument. In certain examples, the multiple motors of a surgical instrument or tool may share one or more common control modules, such as the common control module 610. In certain examples, the multiple motors of a surgical instrument or tool can be individually and selectively engaged with the common control module 610. In certain examples, the common control module 610 can selectively switch from interfacing with one of the multiple motors of the surgical instrument or tool to interfacing with another of the multiple motors of the surgical instrument or tool.

[0136] In at least one example, common control module 610 can be selectively switched between operative engagement with articulation motors 606 a, 606 b and operative engagement with either firing motor 602 or closure motor 603. In at least one example, as shown in FIG. 8 , switch 614 can be moved or transitioned between multiple positions and / or states. For example, in a first position 616, switch 614 can electrically couple common control module 610 to firing motor 602, in a second position 617, switch 614 can electrically couple common control module 610 to closure motor 603, in a third position 618 a, for example, switch 614 can electrically couple common control module 610 to first articulation motor 606 a, and in a fourth position 618 b, switch 614 can electrically couple common control module 610 to second articulation motor 606 b. In certain examples, a separate common control module 610 may be electrically coupled to the firing motor 602, the closing motor 603, and the articulation motors 606 a, 606 b at the same time. In certain examples, the switch 614 may be a mechanical switch, an electromechanical switch, a solid-state switch, or any suitable switching mechanism.

[0137] Each of the motors 602, 603, 606a, 606b may be equipped with a torque sensor to measure the output torque on the shaft of the motor. The force on the end effector may be sensed in any conventional manner, such as by a force sensor outside the jaws or by a torque sensor on the motor that actuates the jaws.

[0138] 8, common control module 610 may include a motor driver 626, which may include one or more H-bridge FETs. Motor driver 626 may modulate power transferred from a power supply 628 to a motor coupled to common control module 610, for example, based on input from a microcontroller 620 ("controller"). In certain examples, microcontroller 620 may be used to determine, for example, the current drawn by a motor while the motor is coupled to common control module 610, as described herein.

[0139] In particular examples, microcontroller 620 may include a microprocessor 622 ("processor") and one or more non-transitory computer-readable media or memory units 624 ("memory"). In particular examples, memory 624 may store various program instructions that, when executed, cause processor 622 to perform multiple functions and / or calculations described herein. In particular examples, one or more of memory units 624 may be coupled to processor 622, for example.

[0140] In certain examples, power supply 628 may be used to, for example, power microcontroller 620. In certain examples, power supply 628 may include a battery (or "battery pack" or "power pack"), such as, for example, a lithium-ion battery. In certain examples, the battery pack may be configured to be releasably attached to the handle to power surgical instrument 600. Multiple battery cells connected in series may be used as power supply 628. In certain examples, power supply 628 may be, for example, replaceable and / or rechargeable.

[0141] In various examples, the processor 622 can control the motor drivers 626 to control the position, direction of rotation, and / or speed of the motors coupled to the common control module 610. In certain examples, the processor 622 can signal the motor drivers 626 to stop and / or disable the motors coupled to the common control module 610. The term "processor," as used herein, should be understood to include any suitable microprocessor, microcontroller, or other basic computing device that integrates the functionality of a computer's central processing unit (CPU) on one integrated circuit or up to a few integrated circuits. A processor can be a general-purpose programmable device that accepts digital data as input, processes the data according to instructions stored in memory, and provides a result as output. Because it has internal memory, it can be an example of sequential digital logic. A processor can operate on numbers and symbols represented in the binary system.

[0142] Processor 622 may be any single-core or multi-core processor, such as those known under the trade name ARM Cortex manufactured by Texas Instruments. In a particular example, microcontroller 620 may be, for example, the LM 4F230H5QR available from Texas Instruments. In at least one embodiment, the Texas Instruments LM4F230H5QR is an ARM Cortex-M4F processor core that includes, among other features readily available in the product datasheet, 256 KB of on-chip memory of single-cycle flash memory or other non-volatile memory up to 40 MHz, a prefetch buffer to improve performance above 40 MHz, 32 KB of single-cycle SRAM, internal ROM loaded with StellarisWare® software, 2 KB of EEPROM, one or more PWM modules, one or more QEI analog, and one or more 12-bit ADCs with 12 analog input channels. Other microcontrollers may be readily substituted for use with module 4410. Accordingly, the present disclosure should not be limited in this context.

[0143] The memory 624 may include program instructions for controlling each of the motors of the surgical instrument 600 that are connectable to the common control module 610. For example, the memory 624 may include program instructions for controlling the firing motor 602, the closing motor 603, and the articulation motors 606 a, 606 b. Such program instructions may cause the processor 622 to control the firing, closing, and articulation functions according to inputs from an algorithm or control program of the surgical instrument or tool.

[0144] For example, one or more mechanisms and / or sensors, such as sensor 630, can be used to alert processor 622 to program instructions to use in a particular setting. For example, sensor 630 can alert processor 622 to use program instructions associated with firing, closing, and articulating the end effector. In certain examples, sensor 630 can include a position sensor that can be used to sense the position of switch 614, for example. Thus, processor 622 can use program instructions associated with firing an I-beam of the end effector when it detects, for example, via sensor 630, that switch 614 is in first position 616; processor 622 can use program instructions associated with closing an anvil when it detects, for example, that switch 614 is in second position 617 via sensor 630; and processor 622 can use program instructions associated with articulating the end effector when it detects, for example, via sensor 630, that switch 614 is in third position 618a or fourth position 618b.

[0145] 9 shows a diagram of a context-aware surgical system 5100 in accordance with at least one aspect of the present disclosure. In some examples, the data sources 5126 may include, for example, the modular device 5102 (which may include sensors configured to detect parameters associated with the patient and / or the modular device itself), a database 5122 (e.g., an EMR database containing patient records), and patient monitoring devices 5124 (e.g., blood pressure (BP) monitors and electrocardiography (EKG) monitors). The surgical hub 5104 may be configured to derive contextual information about the surgical procedure from the data based, for example, on a particular combination of the received data or a particular order in which the data is received from the data sources 5126. The contextual information inferred from the received data may include, for example, the type of surgical procedure being performed, the particular step of the surgical procedure the surgeon is performing, the type of tissue being operated on, or the body cavity that is the target of the procedure. This ability of some aspects of the surgical hub 5104 to derive or infer information about the surgical procedure from the received data may be referred to as “situational awareness.” In one example, the surgical hub 5104 may incorporate a situational awareness system, which is hardware and / or programming associated with the surgical hub 5104 that derives contextual information related to the surgical procedure from received data.

[0146] The situational awareness system of the surgical hub 5104 can be configured to derive contextual information from data received from the data sources 5126 in a variety of different ways. In one example, the situational awareness system can include a pattern recognition system or a machine learning system (e.g., an artificial neural network) trained with training data to correlate various inputs (e.g., data from the database 5122, the patient monitor 5124, and / or the modular device 5102) with corresponding contextual information about the surgical procedure. In other words, the machine learning system can be trained to accurately derive contextual information about the surgical procedure from provided inputs. In an example, the situational awareness system can include a lookup table that stores pre-characterized contextual information about the surgical procedure in association with one or more inputs (or ranges of inputs) corresponding to the contextual information. In response to querying with one or more inputs, the lookup table can return corresponding contextual information for the situational awareness system to control the modular device 5102. In examples, the contextual information received by the situational awareness system of the surgical hub 5104 can be associated with a particular control adjustment or set of control adjustments of one or more modular devices 5102. Alternatively, the situational awareness system can include additional machine learning systems, lookup tables, or other such systems that, when provided with the contextual information as input, generate or retrieve one or more control adjustments of one or more modular devices 5102.

[0147] A surgical hub 5104 incorporating a situational awareness system can provide many benefits to the surgical system 5100. One benefit can include improved interpretation of sensed and collected data, which improves processing accuracy and / or use of the data during the course of a surgical procedure. Returning to the previous example, the situational aware surgical hub 5104 can determine what type of tissue is being operated on, and thus, if an unexpectedly high force to close the end effector of the surgical instrument is detected, the situational aware surgical hub 5104 can properly accelerate or decelerate the motor of the surgical instrument to match the tissue type.

[0148] The type of tissue being operated on can affect the adjustments made to the compression speed and load threshold of the surgical stapling and severing instrument for a particular tissue gap measurement. The context-aware surgical hub 5104 can infer whether the surgical procedure being performed is thoracic or abdominal surgery, which allows the surgical hub 5104 to determine whether the tissue being clamped by the end effector of the surgical stapling and severing instrument is pulmonary (in the case of thoracic surgery) or stomach (in the case of abdominal surgery). The surgical hub 5104 can then adjust the compression speed and load threshold of the surgical stapling and severing instrument appropriately for the tissue type.

[0149] The type of body cavity being operated on during an insufflation procedure can affect the function of the smoke evacuator. The situation-aware surgical hub 5104 can determine if the surgical site is under pressure (by determining that the surgical procedure is utilizing insufflation) and determine the procedure type. Generally, certain procedure types can be performed within specific body cavities, so the surgical hub 5104 can control the motor speed of the smoke evacuator appropriately for the body cavity being operated on. Thus, the situation-aware surgical hub 5104 can provide a consistent amount of smoke evacuation for both thoracic and abdominal procedures.

[0150] The type of procedure being performed can affect the optimal energy level at which an ultrasonic surgical instrument or radio frequency (RF) electrosurgical instrument operates. For example, an arthroscopic procedure may require a higher energy level because the end effector of the ultrasonic surgical instrument or RF electrosurgical instrument is immersed in fluid. The context-aware surgical hub 5104 can determine whether the surgical procedure is an arthroscopic procedure. The surgical hub 5104 can then adjust the RF power level or ultrasonic amplitude (i.e., "energy level") of the generator to compensate for the fluid-filled environment. Relatedly, the type of tissue being operated on can affect the optimal energy level at which an ultrasonic surgical instrument or RF electrosurgical instrument operates. The context-aware surgical hub 5104 can determine what type of surgical procedure is being performed and then customize the energy level of the ultrasonic surgical instrument or RF electrosurgical instrument, respectively, according to the tissue geometry envisioned for the surgical procedure. Additionally, the situation-aware surgical hub 5104 can be configured to adjust the energy level of the ultrasonic surgical instrument or RF electrosurgical instrument throughout the course of a surgical procedure, rather than simply on a procedure-by-procedure basis. The situation-aware surgical hub 5104 can determine which step of the surgical procedure is occurring or will continue to occur, and then update the generator and / or the control algorithms of the ultrasonic surgical instrument or RF electrosurgical instrument to set the energy level to a value appropriate for the expected tissue type according to the step of the surgical procedure.

[0151] In examples, the surgical hub 5104 may derive data from additional data sources 5126 to improve conclusions drawn from one data source 5126. The context-aware surgical hub 5104 may augment the data received from the modular device 5102 with contextual information constructed about the surgical procedure from other data sources 5126. For example, the context-aware surgical hub 5104 may be configured to determine whether hemostasis has occurred (i.e., whether bleeding at the surgical site has stopped) according to video or image data received from a medical imaging device. However, in some cases, the video or image data may be inconclusive. Thus, in one example, the surgical hub 5104 may be further configured to compare a physiological measurement (e.g., blood pressure sensed by a BP monitor communicatively connected to the surgical hub 5104) with visual or image data of hemostasis (e.g., from a medical imaging device 124 (FIG. 2) communicatively coupled to the surgical hub 5104) to make a determination regarding the integrity of a staple line or tissue weld. In other words, the situational awareness system of the surgical hub 5104 can take physiological measurement data into account to provide additional context when analyzing the visualization data, which can be useful when the visualization data may not be conclusive or incomplete on its own.

[0152] For example, the situation-aware surgical hub 5104 may proactively activate a generator to which an RF electrosurgical instrument is connected if it is determined that a subsequent step in a procedure will require the use of the instrument. Actively activating the energy source may allow the instrument to be ready for use as soon as a previous step in the procedure is completed.

[0153] The situation-aware surgical hub 5104 can determine whether the current or subsequent steps in the surgical procedure require different views or magnifications on the display according to the characteristics of the surgical site that the surgeon is expected to need to see. The surgical hub 5104 can then proactively change the displayed views (e.g., provided by medical imaging devices for the visualization system 108) appropriately, so that the display automatically adjusts throughout the surgical procedure.

[0154] The context-aware surgical hub 5104 can determine which step in the surgical procedure is occurring or will occur next, and whether specific data or data comparisons are required for that step in the surgical procedure. The surgical hub 5104 can be configured to automatically call up data screens based on the step in the surgical procedure that is occurring, without waiting for the surgeon to ask for specific information.

[0155] Errors can be checked during the setup of a surgical procedure or during the course of a surgical procedure. For example, the situation-aware surgical hub 5104 can determine whether the operating room is properly or optimally set up for the surgical procedure to be performed. The surgical hub 5104 can be configured to determine the type of surgical procedure being performed, retrieve (e.g., from memory) the corresponding checklist, product locations, or setup requirements, and then compare the current operating room layout to a standard layout for the type of surgical procedure the surgical hub 5104 has determined is being performed. In some examples, the surgical hub 5104 can be configured to compare the list of items for the procedure and / or the list of devices paired with the surgical hub 5104 with a recommended or expected manifest of items and / or devices for a given surgical procedure. If a discontinuity exists between the lists, the surgical hub 5104 can be configured to provide an alert indicating that a particular modular device 5102, patient monitoring device 5124, and / or other surgical item is missing. In some examples, the surgical hub 5104 can be configured to determine the relative distance or relative position of the modular device 5102 and the patient monitoring device 5124, for example, by proximity sensors. The surgical hub 5104 can compare the relative positions of the devices to a recommended or predicted layout for a particular surgical procedure. If a discrepancy exists between the layouts, the surgical hub 5104 can be configured to provide an alert indicating that the current layout of the surgical procedure deviates from the recommended layout.

[0156] The situation-aware surgical hub 5104 can determine whether a surgeon (or other medical personnel) is making an error or deviating from the expected sequence of actions during the course of a surgical procedure. For example, the surgical hub 5104 can be configured to determine the type of surgical procedure being performed, retrieve (e.g., from memory) a corresponding list of steps or sequences of equipment use, and then compare the steps being performed or the equipment being used during the course of the surgical procedure with the expected steps or equipment for the type of surgical procedure that the surgical hub 5104 has determined is being performed. In some examples, the surgical hub 5104 can be configured to provide an alert indicating that an unexpected action is being performed or an unexpected device is being utilized at a particular step in the surgical procedure.

[0157] The surgical instruments (and other modular devices 5102) may be tailored for the specific context of each surgical procedure (such as for different tissue types) and may validate actions during the surgical procedure. Subsequent steps, data, and display adjustments may be provided to the surgical instruments (and other modular devices 5102) within the surgical site according to the specific context of the procedure.

[0158] 10 shows a timeline 5200 illustrating an exemplary surgical procedure and the context information the surgical hub 5104 can derive from data received from the data sources 5126 at each step of the surgical procedure. The following description of the timeline 5200 shown in FIG. 9 also refers to FIG. 9. The timeline 5200 may depict the general steps that nurses, surgeons, and other medical personnel would take during the course of a lung segmentectomy surgery, beginning with the setup of the operating room and ending with the transfer of the patient to a post-operative recovery room. The context-aware surgical hub 5104 can receive data from the data sources 5126 throughout the course of the surgical procedure, including data generated each time a medical personnel utilizes a modular device 5102 paired with the surgical hub 5104. The surgical hub 5104 receives this data from the paired modular devices 5102 and other data sources 5126 and can continually derive inferences (i.e., contextual information) regarding the ongoing procedure as new data is received, such as which step of the procedure is occurring at any given time. The situational awareness system of the surgical hub 5104 can, for example, record data regarding the procedure to generate reports, verify steps being taken by medical personnel, provide data or prompts (e.g., via a display screen) that may be relevant to particular procedure steps, adjust the modular device 5102 based on the context (e.g., activate a monitor, adjust the FOV of a medical imaging device, or change the energy level of an ultrasonic surgical instrument or RF electrosurgical instrument), and any other such action described herein.

[0159] As a first step 5202 in this exemplary procedure, hospital personnel can retrieve the patient's EMR from the hospital's EMR database. Based on selected patient data in the EMR, the surgical hub 5104 determines that the procedure to be performed is thoracic surgery. In a second step 5204, the personnel can scan incoming medical supplies for the procedure. The surgical hub 5104 cross-references the scanned supplies with a list of supplies that may be utilized in various types of procedures and verifies that the combination of supplies matches the thoracic procedure. Furthermore, the surgical hub 5104 may also be able to determine that the procedure is not a wedge resection (either because the incoming supplies do not include specific supplies required for a thoracic wedge resection or are otherwise not compatible with a thoracic wedge resection). In a third step 5206, medical personnel can scan the patient band via a scanner 5128 communicatively connected to the surgical hub 5104. The surgical hub 5104 can then verify the patient's identity based on the scanned data. In a fourth step 5208, medical personnel turn on the auxiliary devices. The auxiliary equipment utilized may vary according to the type of surgical procedure and the technology used by the surgeon, but in this exemplary case includes a smoke evacuator, an insufflator, and a medical imaging device. Once activated, the auxiliary device, which is a modular device 5102, may automatically pair with the surgical hub 5104, which may be located within a particular proximity of the modular device 5102, as part of its initialization process. The surgical hub 5104 may then derive contextual information regarding the surgical procedure by detecting the type of modular device 5102 that is paired with it during this pre-operative or initialization phase. In this particular example, the surgical hub 5104 may determine that the surgical procedure is a VATS procedure based on this particular combination of paired modular devices 5102. Based on a combination of data from the patient's EMR, a list of medical supplies used in the procedure, and the types of modular devices 5102 connecting to the hub, the surgical hub 5104 may roughly deduce the particular procedure the surgical team will be performing.Once the surgical hub 5104 knows what particular procedure is being performed, it can then retrieve the steps of that procedure from memory or from the cloud and then cross-reference data subsequently received from connected data sources 5126 (e.g., modular devices 5102 and patient monitors 5124) to deduce which steps of the surgical procedure the surgical team is performing. In a fifth step 5210, personnel attach EKG electrodes and other patient monitors 5124 to the patient. The EKG electrodes and other patient monitors 5124 may pair with the surgical hub 5104. Once the surgical hub 5104 begins receiving data from the patient monitors 5124, the surgical hub 5104 can confirm that the patient is in the operating room, for example, as described in process 5207. In a sixth step 5212, medical personnel may induce anesthesia in the patient. The surgical hub 5104 can infer that the patient is under anesthesia based on data from the modular device 5102 and / or the patient monitor 5124, including, for example, EKG data, blood pressure data, ventilator data, or a combination thereof. Upon completion of the sixth step 5212, the pre-operative portion of the lung segmentectomy surgery is complete and the operative portion begins.

[0160] In a seventh step 5214, the lung of the patient being operated on may be collapsed (while ventilation is switched to the contralateral lung). The surgical hub 5104 may, for example, infer from ventilator data that the patient's lung has been collapsed. The surgical hub 5104 may compare the detection of the patient's collapsed lung with the expected steps of the procedure (which may be accessed or retrieved in advance) and therefore infer that the surgical portion of the procedure has begun, thereby determining that collapsing the lung may be the first surgical step in this particular procedure. In an eighth step 5216, a medical imaging device 5108 (e.g., a scope) may be inserted and video footage from the medical imaging device may be initiated. The surgical hub 5104 may receive medical imaging device data (i.e., video or image data) through a connection to the medical imaging device. Upon receiving the medical imaging device data, the surgical hub 5104 may determine that the laparoscopic portion of the surgical procedure has begun. Additionally, the surgical hub 5104 may determine that the particular procedure being performed is a segmentectomy as opposed to a lobectomy (note that based on the data received in the second step 5204 of the procedure, a wedge resection has not already been taken into account by the surgical hub 5104). Data from the medical imaging device 124 (FIG. 2) may be utilized to determine contextual information regarding the type of procedure being performed in a variety of ways, such as by determining the angle of the medical imaging device pointed relative to visualization of the patient's anatomy, by monitoring the number or medical imaging devices being utilized (i.e., activated and paired with the surgical hub 5104), and by monitoring the type of visualization device being utilized. For example, one technique for performing a VATS lobectomy may position the camera above the diaphragm in the anterior-inferior corner of the patient's chest cavity, while one technique for performing a VATS segmentectomy may position the camera in an intercostal position anterior to the segmental fissure. The situational awareness system can be trained to recognize the location of the medical imaging device according to a visualization of the patient's anatomy, for example, using pattern recognition or machine learning techniques.An exemplary technique for performing a VATS lobectomy may utilize a single medical imaging device. An exemplary technique for performing a VATS segmentectomy utilizes multiple cameras. An exemplary technique for performing a VATS segmentectomy utilizes an infrared light source (which may be communicatively coupled to the surgical hub as part of a visualization system) to visualize the segmental fissure, which is not utilized in a VATS lobectomy. By tracking any or all of this data from the medical imaging device 5108, the surgical hub 5104 can determine the particular type of surgical procedure being performed and / or the technique being used for the particular type of surgical procedure.

[0161] In a ninth step 5218, the surgical team may begin the incision step of the procedure. Because the surgical hub 5104 receives data from the RF or ultrasonic generator indicating that an energy instrument is being fired, it may infer that the surgeon is in the process of incising and separating the patient's lungs. The surgical hub 5104 may cross-reference the received data with the retrieved steps of the surgical procedure to determine that the energy instrument being fired at this point in the process (i.e., after the steps of the procedure described above have been completed) corresponds to the incision step. In a tenth step 5220, the surgical team may proceed to the ligation step of the procedure. Because the surgical hub 5104 may receive data from the surgical stapling and severing instrument indicating that the instrument is being fired, it may infer that the surgeon is ligating arteries and veins. As with the previous step, the surgical hub 5104 may derive this inference by cross-referencing the receipt of data from the surgical stapling and severing instrument with the steps in the retrieved process. In an eleventh step 5222, the segmentectomy portion of the procedure may be performed. Based on data from the surgical stapling and severing instrument (including data from its cartridge), the surgical hub 5104 can infer that the surgeon is transecting parenchyma. The cartridge data can correspond, for example, to the size or type of staples being fired by the instrument. Because different types of staples are applied to different types of tissue, the cartridge data can indicate the type of tissue being stapled and / or transected. In this case, the type of staples being fired is applied to parenchyma (or other similar tissue type), allowing the surgical hub 5104 to infer that the segmentectomy portion of the procedure is being performed. Subsequently, in a twelfth step 5224, a node dissection step is performed. Based on data received from the generator indicating that an RF or ultrasonic instrument is being fired, the surgical hub 5104 can infer that the surgical team is dissecting nodes and performing a leak test. In this particular procedure, the RF or ultrasonic instrument utilized after the parenchyma has been transected corresponds to the node dissection step, allowing the surgical hub 5104 to make this inference.It should be noted that surgeons will routinely alternate between surgical stapling / cutting instruments and surgical energy (e.g., RF or ultrasonic) instruments depending on the particular step in the procedure, as different instruments are better suited for specific tasks. Thus, the particular sequence in which the stapling / cutting instruments and surgical energy instruments are used can indicate which step of the procedure the surgeon is performing. Once the twelfth step 5224 is completed, the incision is closed and the post-operative portion of the procedure can begin.

[0162] In a thirteenth step 5226, the patient may be deanesthetized. The surgical hub 5104 may estimate that the patient is emerging from anesthesia, for example, based on ventilator data (i.e., the patient's breathing rate begins to increase). Finally, a fourteenth step 5228 may be for medical personnel to remove the various patient monitors 5124 from the patient. Thus, the surgical hub 5104 may estimate that the patient is being transferred to a recovery room when the hub loses EKG, BP, and other data from the patient monitors 5124. As can be seen from the description of this exemplary procedure, the surgical hub 5104 can determine or estimate when each step of a given surgical procedure is occurring according to data received from various data sources 5126 communicatively coupled to the surgical hub 5104.

[0163] As shown in the first step 5202 of the timeline 5200 depicted in FIG. 10 , in addition to utilizing patient data from the EMR database to estimate the type of surgical procedure to be performed, the patient data can also be utilized by the situation-aware surgical hub 5104 to generate control adjustments for the paired modular devices 5102.

[0164] FIG. 11 is a block diagram of a computer-implemented interactive surgical system according to at least one embodiment of the present disclosure. In one embodiment, the computer-implemented interactive surgical system may be configured to monitor and analyze data related to the operation of various surgical systems, including surgical hubs, surgical instruments, robotic devices, and surgical sites or medical facilities. The computer-implemented interactive surgical system may include a cloud-based analysis system. While the cloud-based analysis system may be described as a surgical system, it is not necessarily limited to such and may also be a cloud-based medical system. As shown in FIG. 11 , the cloud-based analysis system may include a plurality of surgical instruments 7012 (which may be the same as or similar to instrument 112), a plurality of surgical hubs 7006 (which may be the same as or similar to hub 106), and a surgical data network 7001 (which may be the same as or similar to network 201) for coupling the surgical hubs 7006 to cloud 7004 (which may be the same as or similar to cloud 204). Each of the plurality of surgical hubs 7006 may be communicatively coupled to one or more surgical instruments 7012. The hub 7006 may also be communicatively coupled to a cloud 7004 of computer-implemented interactive surgical systems via a network 7001. The cloud 7004 may be a remote, centralized source of hardware and software for storing, manipulating, and communicating data generated based on the operation of various surgical systems. As shown in FIG. 11 , access to the cloud 7004 may be achieved via the network 7001, which may be the Internet or other suitable computer network. The surgical hub 7006, which may be coupled to the cloud 7004, may be considered the client side of a cloud computing system (i.e., a cloud-based analysis system). A surgical instrument 7012 may be paired with the surgical hub 7006 for control and performance of the various surgical procedures or operations described herein.

[0165] Additionally, the surgical instrument 7012 may include a transceiver for data transmission to and from a corresponding surgical hub 7006 (which may also include a transceiver). The combination of the surgical instrument 7012 and the corresponding hub 7006 can indicate a specific location, such as a surgical site within a medical facility (e.g., a hospital) for providing a medical procedure. For example, the memory of the surgical hub 7006 can store the location data. As shown in FIG. 11 , the cloud 7004 includes a central server 7013 (which may be the same as or similar to the remote server 7013), a hub application server 7002, a data analysis module 7034, and an input / output ("I / O") interface 7006. The central server 7013 of the cloud 7004 collectively manages the cloud computing system, which includes monitoring requests by the client modules 7006 and managing the processing power of the cloud 7004 to execute those requests. Each of the central servers 7013 may include one or more processors 7008 coupled to a suitable memory device 7010, which may include volatile memory such as random access memory (RAM) and non-volatile memory such as a magnetic storage device. The memory device 7010 may include machine-executable instructions that, when executed, cause the processor 7008 to execute a data analysis module 7034 for cloud-based data analysis, actions, recommendations, and other operations described below. Further, the processor 7008 may execute the data analysis module 7034 independently or in conjunction with a hub application executed independently by the hub 7006. The central server 7013 may also include a database 2212 of aggregated medical data, which may reside in the memory 2210.

[0166] Based on its connection to the various surgical hubs 7006 via the network 7001, the cloud 7004 can aggregate data from the various surgical instruments 7012 and the particular data generated by their corresponding hubs 7006. Such aggregated data may be stored in an aggregated medical database 7012 of the cloud 7004. Specifically, the cloud 7004 can advantageously perform data analysis and operations on the aggregated data to provide insights and / or perform functions that individual hubs 7006 cannot accomplish on their own. To this end, as shown in FIG. 11 , the cloud 7004 and the surgical hubs 7006 are communicatively coupled to send and receive information. An I / O interface 7006 is connected to the multiple surgical hubs 7006 via the network 7001. In this manner, the I / O interface 7006 can be configured to transfer information between the surgical hubs 7006 and the aggregated medical data database 7011. Accordingly, the I / O interface 7006 can facilitate read / write operations of the cloud-based analysis system. Such read / write operations may be performed in response to requests from the hub 7006. These requests may be sent to the hub 7006 via a hub application. The I / O interface 7006 may include one or more high-speed data ports, which may include a universal serial bus (USB) port, an IEEE 1394 port, and Wi-Fi and Bluetooth I / O interfaces for connecting the cloud 7004 to the hub 7006. The hub application server 7002 of the cloud 7004 may be configured to host and provide sharing capabilities to software applications (e.g., hub applications) executed by the surgical hub 7006. For example, the hub application server 7002 may manage requests by the hub application through the hub 7006, control access to the database 7011 of aggregated medical data, and perform load balancing. The data analysis module 7034 is described in more detail with reference to FIG. 12 .

[0167] The particular cloud computing system configurations described in this disclosure may be specifically designed to address various problems that arise in the context of medical surgeries and procedures performed using medical devices, such as surgical instruments 7012, 112. Specifically, the surgical instruments 7012 may be digital surgical devices configured to interact with the cloud 7004 to implement techniques for improving surgical outcomes. The various surgical instruments 7012 and / or the surgical hub 7006 may include touch-controlled user interfaces to allow a clinician to control aspects of the interaction between the surgical instruments 7012 and the cloud 7004. Other suitable user interfaces for control, such as an auditory-controlled user interface, may also be used.

[0168] FIG. 12 is a block diagram illustrating a functional architecture of a computer-implemented interactive surgical system according to at least one aspect of the present disclosure. The cloud-based analysis system may include multiple data analysis modules 7034 that may be executed by a processor 7008 of a cloud 7004 to provide data analysis solutions to problems that arise specifically in the medical field. As shown in FIG. 12 , the functionality of the cloud-based data analysis modules 7034 may be supported via a hub application 7014 hosted by a hub application server 7002 that may be accessed on a surgical hub 7006. The cloud processor 7008 and the hub application 7014 may work in conjunction to execute the data analysis modules 7034. An application program interface (API) 7016 may define a set of protocols and routines corresponding to the hub application 7014. Additionally, the API 7016 may manage the storage and retrieval of data from a centralized medical database 7012 for operation of the applications 7014. A cache 7018 may also be coupled to the API 7016 to store data (e.g., temporarily) and for more efficient retrieval of data used by the applications 7014. 12 may include modules for resource optimization 7020, data collection and aggregation 7022, authorization and security 7024, control program updates 7026, patient outcome analysis 7028, recommendations 7030, and data classification and prioritization 7032. Other suitable data analysis modules may also be implemented by the cloud 7004, according to some aspects. In one aspect, the data analysis module may be used to make specific recommendations based on an analysis of trends, outcomes, and other data.

[0169] For example, the data collection and aggregation module 7022 may be used to generate self-describing data (e.g., metadata), including identifying notable features or configurations (e.g., trends), managing redundant data sets, and storing data into paired data sets that may be grouped by procedure but not necessarily linked to the actual date of surgery and surgeon. Specifically, the paired data sets generated from the operation of the surgical instrument 7012 may include applying a binary classification, such as a bleeding or non-bleeding event. More generally, the binary classification may be characterized as either a desired event (e.g., a successful surgical procedure) or an undesired event (e.g., a misfired or misused surgical instrument 7012). The aggregated self-describing data may correspond to individual data received from various groups or subgroups of the surgical hub 7006. Thus, the data collection and aggregation module 7022 may generate aggregated metadata or other organized data based on the raw data received from the surgical hub 7006. To this end, the processor 7008 may be operatively coupled to the hub application 7014 and the database of aggregated medical data 7011 for executing the data analysis module 7034. The data collection and aggregation module 7022 may store the aggregated, organized data in the database of aggregated medical data 2212.

[0170] The resource optimization module 7020 can be configured to analyze this aggregated data to determine optimal use of resources for a particular medical facility or group of medical facilities. For example, the resource optimization module 7020 can determine an optimal order point for surgical stapling instruments 7012 for a group of medical facilities based on corresponding projected demand for surgical stapling instruments 7012. The resource optimization module 7020 can also evaluate resource usage or other operating configurations of various medical facilities to determine whether resource usage can be improved. Similarly, the recommendation module 7030 can be configured to analyze the aggregated organizational data from the data collection and aggregation module 7022 and provide recommendations. For example, the recommendation module 7030 can recommend to a medical facility (e.g., a health care provider such as a hospital) that a particular surgical instrument 7012 should be upgraded to an improved version based, for example, on a higher than expected error rate. Additionally, the recommendation module 7030 and / or resource optimization module 7020 can recommend better supply chain parameters, such as product reorder points, and provide suggestions for different surgical instruments 7012, their use, or procedural steps to improve surgical outcomes. The medical facility can receive such recommendations via the corresponding surgical hub 7006. More specific recommendations regarding the parameters or configurations of various surgical instruments 7012 can also be provided. The hub 7006 and / or surgical instruments 7012 can each have a display screen that displays the data or recommendations provided by the cloud 7004.

[0171] The patient outcome analysis module 7028 may analyze surgical outcomes associated with the currently used operating parameters of the surgical instrument 7012. The patient outcome analysis module 7028 may also analyze and evaluate other potential operating parameters. In this regard, the recommendation module 7030 may use these other potential operating parameters to make recommendations based on resulting in better surgical outcomes, such as a better seal or less bleeding. For example, the suggestion module 7030 may be able to send suggestions to the surgical 7006 regarding when to use a particular cartridge with a corresponding stapling surgical instrument 7012. Thus, the cloud-based analysis system may be configured to analyze large-scale collected raw data and provide centralized recommendations (advantageously determined based on aggregated data) across multiple medical facilities while controlling for common variables. For example, the cloud-based analysis system may analyze, evaluate, and / or aggregate data based on type of medical procedure, type of patient, number of patients, geographic similarities between medical providers using similar types of instruments, etc., in ways that no single medical facility could analyze independently. The control program update module 7026 can be configured to implement recommendations for various surgical instruments 7012 when the corresponding control programs are updated. For example, the patient outcome analysis module 7028 can identify correlations linking particular control parameters to successful (or unsuccessful) outcomes. Such correlations can be addressed when an updated control program is sent to the surgical instrument 7012 via the control program update module 7026. Updates to the instrument 7012, which can be sent via the corresponding hub 7006, may incorporate aggregated performance data collected and analyzed by the data collection and aggregation module 7022 of the cloud 7004. Additionally, the patient outcome analysis module 7028 and recommendation module 7030 can identify improved ways to use the instrument 7012 based on the aggregated performance data.

[0172] The cloud-based analysis system may include security features implemented by the cloud 7004. These security features may be managed by the authorization and security module 7024. Each surgical hub 7006 may have associated unique credentials, such as a username, password, and other suitable security credentials. These credentials may be stored in memory 7010 and associated with an authorized cloud access level. For example, based on providing accurate credentials, the surgical hub 7006 may be granted access to communicate with the cloud to a predetermined extent (e.g., send or receive certain defined types of information). To this end, the cloud 7004's aggregated medical data database 7011 may include a database of certified credentials to verify the accuracy of the provided credentials. Different credentials may be associated with various levels of permission for interaction with the cloud 7004, such as a predetermined access level for receiving data analyses generated by the cloud 7004. Furthermore, for security purposes, the cloud may maintain a database of hubs 7006, instruments 7012, and other devices, which may include a "blacklist" of prohibited devices. Specifically, surgical hubs 7006 listed on the blacklist may not be permitted to interact with the cloud, while surgical instruments 7012 listed on the blacklist may not have functional access to the corresponding hub 7006 and / or may be prevented from fully functioning when paired with the corresponding hub 7006. Additionally or alternatively, the cloud 7004 may flag instruments 7012 based on incompatibility or other specified criteria. In this manner, counterfeit medical devices and the inappropriate reuse of such devices across the cloud-based analysis system may be identified and addressed.

[0173] The surgical instrument 7012 may use a wireless transceiver to transmit a wireless signal that may represent, for example, authorization credentials for access to the corresponding hub 7006 and the cloud 7004. A wired transceiver may also be used to transmit the signal. Such authorization credentials may be stored in a respective memory device of the surgical instrument 7012. The authorization and security module 7024 may determine whether the authorization credentials are accurate or forged. The authorization and security module 7024 may also dynamically generate authorization credentials for enhanced security. The credentials may also be encrypted, such as by using hash-based encryption. Upon transmitting the appropriate authorization, the surgical instrument 7012 may transmit a signal to the corresponding hub 7006 and ultimately the cloud 7004 indicating that the instrument 7012 is ready to acquire and transmit medical data. In response, the cloud 7004 may transition to a state capable of receiving medical data for storage in the aggregated medical data database 7011. This readiness to transmit data may be indicated, for example, by a light indicator on the instrument 7012. The cloud 7004 may also send signals to the surgical instruments 7012 to update their associated control programs. The cloud 7004 may send signals directed to a particular class of surgical instruments 7012 (e.g., electrosurgical instruments) so that software updates to control programs are sent only to the appropriate surgical instruments 7012. Additionally, the cloud 7004 may be used to implement system-wide solutions to address local or global issues based on selective data transmission and authorization credentials. For example, if a group of surgical instruments 7012 are identified as having a common manufacturing defect, the cloud 7004 may change the authorization credentials corresponding to this group to implement an operational lockout for this group.

[0174] The cloud-based analytics system may enable monitoring of multiple healthcare facilities (e.g., healthcare facilities such as hospitals) to determine improved practices and recommend changes accordingly (e.g., via the suggestions module 2030). Thus, the processor 7008 of the cloud 7004 may analyze data associated with an individual healthcare facility to identify the facility and aggregate that data with other data associated with other healthcare facilities. Groups may be defined, for example, based on similar operational behavior or geographic location. In this manner, the cloud 7004 may provide broader analysis and recommendations for groups of healthcare facilities. The cloud-based analytics system may also be used for enhanced situational awareness. For example, the processor 7008 may predictively model the effect of recommendations on cost and effectiveness for a particular facility (compared to overall operations and / or various healthcare procedures). The costs and effectiveness associated with that particular facility may also be compared to the corresponding local area of ​​other facilities or any other comparable facilities.

[0175] The data classification and prioritization module 7032 may prioritize and classify data based on criticality (e.g., the severity, surprise, or suspiciousness of the medical event associated with the data). This classification and prioritization may be used in conjunction with other data analysis module 7034 functionality described herein to improve the cloud-based analyses and operations described herein. For example, the data classification and prioritization module 7032 may assign priorities to data analyses performed by the data collection and aggregation module 7022 and the patient outcome analysis module 7028. Different priority levels may result in specific responses from the cloud 7004 (corresponding to the level of urgency), such as elevation for rapid response, special handling, exclusion from the aggregated medical data database 7011, or other suitable responses. Additionally, if necessary, the cloud 7004 may send a request (e.g., a push message) via the hub application server for additional data from the corresponding surgical instrument 7012. The push message may result in a notification being displayed on the corresponding hub 7006 to request support or additional data. This push message may be needed in situations where the cloud detects a significant irregularity or outlier and is unable to determine the cause of the irregularity. The central server 7013 can be programmed to trigger this push message in certain critical situations, such as when data is determined to differ from expected values ​​by more than a predetermined threshold, or when security is suspected.

[0176] Further exemplary details regarding the various described functions are provided in the following description, each of which may utilize a cloud architecture, as illustrated in Figures 11 and 12 as an example of a hardware and software implementation.

[0177] 13 shows a block diagram of a computer-implemented adaptive surgical system 9060 configured to adaptively generate control program updates for modular devices 9050, in accordance with at least one embodiment of the present disclosure. In some examples, the surgical system may include a surgical hub 9000, a plurality of modular devices 9050 communicatively coupled to the surgical hub 9000, and an analysis system 9100 communicatively coupled to the surgical hub 9000. While a single surgical hub 9000 is depicted, it should be noted that the surgical system 9060 may include any number of surgical hubs 9000, which may be connected to form a network of surgical hubs 9000 communicatively coupled to the analysis system 9010. In some examples, the surgical hub 9000 may include a processor 9010 coupled to a memory 9020 for executing stored instructions and a data relay interface 9030 through which data is transmitted to the analysis system 9100. In some examples, the surgical hub 9000 may further include a user interface 9090 having an input device 9092 (e.g., a capacitive touchscreen or keyboard) for receiving input from a user and an output device 9094 (e.g., a display screen) for providing output to the user. The output may include data from a query entered by the user, suggestions for products or product mixes to use in a given procedure, and / or instructions for actions to be taken before, during, or after a surgical procedure. The surgical hub 9000 may further include an interface 9040 for communicatively coupling a modular device 9050 to the surgical hub 9000. In one aspect, the interface 9040 may include a transceiver communicatively connectable to the modular device 9050 via a wireless communication protocol. The modular device 9050 may include, for example, a surgical stapling and severing instrument, an electrosurgical instrument, an ultrasonic instrument, an insufflator, a ventilator, and a display screen. In some instances, the surgical hub 9000 can be further communicatively coupled to one or more patient monitoring devices 9052, such as an EKG monitor or a BP monitor.In some examples, the surgical hub 9000 may be further communicatively coupled to one or more databases 9054 or external computer systems, such as an EMR database of the medical facility in which the surgical hub 9000 is located.

[0178] When a modular device 9050 is connected to the surgical hub 9000, the surgical hub 9000 can sense or receive perioperative data from the modular device 9050 and then associate the received perioperative data with surgical procedure outcome data. The perioperative data can indicate how the modular device 9050 was controlled during the course of a surgical procedure. The procedure outcome data includes data associated with the results from the surgical procedure (or steps thereof), which can include whether the surgical procedure (or steps thereof) had a positive or negative outcome. For example, the outcome data can include whether the patient suffered a post-operative complication from a particular procedure or whether there was a leak (e.g., bleeding or air leak) at the staple line or incision line. The surgical hub 9000 can obtain the surgical procedure outcome by receiving data from an external source (e.g., from the EMR database 9054), by directly detecting the outcome (e.g., via one of the connected modular devices 9050), or by inferring the occurrence of the outcome through a situational awareness system. For example, data regarding post-operative complications can be retrieved from the EMR database 9054, and data regarding staple line or incision line leakage can be directly detected or inferred by the situational awareness system. Surgical procedure outcome data can be inferred by the situational awareness system from data received from a variety of data sources, including the modular device 9050 itself, the patient monitoring device 9052, and the database 9054 to which the surgical hub 9000 is connected.

[0179] The surgical hub 9000 can transmit associated modular device 9050 data and outcome data to the analysis system 9100 for processing on the analysis system 9100. By transmitting both perioperative data indicating how the modular device 9050 is controlled and procedure outcome data, the analysis system 9100 can correlate different ways of controlling the modular device 9050 with surgical outcomes for specific procedure types. In some examples, the analysis system 9100 may include a network of analysis servers 9070 configured to receive data from the surgical hub 9000. Each of the analysis servers 9070 may include a memory and a processor coupled to the memory that executes instructions stored therein to analyze the received data. In some examples, the analysis servers 9070 may be connected in a distributed computing architecture and / or utilize a cloud computing architecture. Based on this paired data, the analysis system 9100 can then learn optimal or preferred operating parameters for various types of modular devices 9050, generate adjustments to the control programs of the modular devices 9050 in the field, and then transmit (or "push") updates to the control programs of the modular devices 9050.

[0180] Further details regarding the computer-implemented interactive surgical system 9060, including the surgical hub 9000 and various modular devices 9050 connectable thereto, are described in connection with Figures 5-6.

[0181] 14 provides a surgical system 6500 according to the present disclosure and may include a surgical instrument 6502 that can communicate with a console 6522 or a portable device 6526 through a local area network 6518 or a cloud network 6520 via a wired or wireless connection. In various aspects, the console 6522 and the portable device 6526 may be any suitable computing device. The surgical instrument 6502 may include a handle 6504, an adapter 6508, and a loading unit 6514. The adapter 6508 releasably couples to the handle 6504, and the loading unit 6514 releasably couples to the adapter 6508 such that the adapter 6508 transfers force from the drive shaft to the loading unit 6514. The adapter 6508 or the loading unit 6514 may include a force gauge (not explicitly shown) disposed therein to measure force exerted on the loading unit 6514. The loading unit 6514 can include an end effector 6530 including a first jaw 6532 and a second jaw 6534. The loading unit 6514 can be an in-situ loading or multi-firing loading unit (MFLU) that allows a clinician to fire multiple fasteners multiple times without the loading unit 6514 having to be removed from the surgical site to reload the loading unit 6514.

[0182] The first jaw 6532 and the second jaw 6534 can be configured to clamp tissue therebetween, fire fasteners through the clamped tissue, and cut the clamped tissue. The first jaw 6532 can be configured to fire at least one fastener multiple times or can be configured to include a replaceable multi-fire fastener cartridge containing multiple fasteners (e.g., staples, clips, etc.) that can be fired two or more times before being replaced. The second jaw 6534 can include an anvil that deforms or otherwise secures fasteners around tissue as they are ejected from the multi-fire fastener cartridge.

[0183] The handle 6504 can include a motor coupled to the drive shaft to affect rotation of the drive shaft. The handle 6504 can include a control interface for selectively activating the motor. The control interface can include buttons, switches, levers, sliders, a touch screen, and any other suitable input mechanism or user interface that can be engaged by a clinician to activate the motor.

[0184] The control interface of the handle 6504 can communicate with a controller 6528 of the handle 6504 to selectively activate the motor to affect rotation of the drive shaft. The controller 6528 may be disposed within the handle 6504 and configured to receive input from the control interface and adapter data from the adapter 6508 or loading unit data from the loading unit 6514. The controller 6528 may analyze the input from the control interface and the data received from the adapter 6508 and / or the loading unit 6514 to selectively activate the motor. The handle 6504 may also include a display viewable by a clinician while using the handle 6504. The display may be configured to display portions of the adapter or loading unit data before, during, or after firing of the instrument 6502.

[0185] The adapter 6508 may include an adapter identification device 6510 disposed therein, and the loading unit 6514 includes a loading unit identification device 6516 disposed therein. The adapter identification device 6510 may be in communication with a controller 6528, and the loading unit identification device 6516 may be in communication with the controller 6528. It will be appreciated that the loading unit identification device 6516 may be in communication with the adapter identification device 6510, which relays or passes communications from the loading unit identification device 6516 to the controller 6528.

[0186] The adapter 6508 may also include multiple sensors 6512 (one shown) disposed about its periphery to detect various conditions of the adapter 6508 or the environment (e.g., when the adapter 6508 is connected to the loading unit, when the adapter 6508 is connected to the handle, if the drive shaft is rotating, the torque of the drive shaft, the strain on the drive shaft, the temperature within the adapter 6508, the number of times the adapter 6508 has been fired, the peak force of the adapter 6508 during firing, the total amount of force applied to the adapter 6508, the peak retract force of the adapter 6508, the number of times the adapter 6508 has been dwelled during firing, etc.). The multiple sensors 6512 can provide input to the adapter identification device 6510 in the form of data signals. The data signals of the multiple sensors 6512 may be stored in the adapter identification device 6510 or may be used to update the adapter data stored in the adapter identification device 6510. The data signals of the multiple sensors 6512 may be analog or digital. The plurality of sensors 6512 may include a force gauge for measuring the force exerted on the loading unit 6514 during firing.

[0187] The handle 6504 and adapter 6508 can be configured to interconnect the adapter identification device 6510 and the loading unit identification device 6516 with the controller 6528 via an electrical interface. The electrical interface may be a direct electrical interface (i.e., including electrical contacts that engage with each other to transmit energy and signals to each other). Additionally or alternatively, the electrical interface may be a contactless electrical interface that wirelessly transmits energy and signals to each other (e.g., inductively). It is also contemplated that the adapter identification device 6510 and the controller 6528 may communicate wirelessly with each other via a wireless connection that is separate from the electrical interface.

[0188] The handle 6504 may include a transmitter 6506 configured to transmit instrument data from the controller 6528 to other components of the system 6500 (e.g., the LAN 6518, the cloud 6520, the console 6522, or the portable device 6526). The transmitter 6506 may also receive data (e.g., cartridge data, loading unit data, or adapter data) from other components of the system 6500. For example, the controller 6528 may transmit instrument data to the console 6528 including the serial number of an attached adapter (e.g., adapter 6508) attached to the handle 6504, the serial number of a loading unit (e.g., loading unit 6514) attached to the adapter, and the serial number of a multi-fire fastener cartridge (e.g., multi-fire fastener cartridge) loaded in the loading unit. The console 6522 may then transmit data (e.g., cartridge data, loading unit data, or adapter data) associated with the attached cartridge, loading unit, and adapter, respectively, back to the controller 6528. The controller 6528 can display a message on the local instrument display or send a message via transmitter 6506 to the console 6522 or portable device 6526 to display the message on the display 6524 or portable device screen, respectively.

[0189] 15A shows an exemplary flow for determining an operating mode and operating in the determined mode. The computer-implemented interactive surgical system and / or components and / or subsystems of the computer-implemented interactive surgical system may be configured to be updated. Such updates may include the inclusion of features and benefits that were not available to the user prior to the update. These updates may be established by any method of hardware, firmware, and software update suitable for introducing features to the user. For example, interchangeable / replaceable (e.g., hot-swappable) hardware components, flashable firmware devices, and updatable software systems may be used to update the computer-implemented interactive surgical system and / or components and / or subsystems of the computer-implemented interactive surgical system.

[0190] An update may be contingent on any suitable criterion or set of criteria. For example, an update may be contingent on one or more hardware capabilities of the system, such as processing power, bandwidth, resolution, etc. For example, an update may be contingent on one or more software aspects, such as the purchase of certain software code. For example, an update may be contingent on a purchased service tier. A service tier may represent a feature and / or set of features that a user is entitled to use in connection with the computer-implemented interactive surgical system. A service tier may be determined by a license code, an e-commerce server authentication interaction, a hardware key, a username / password combination, a biometric authentication interaction, a public / private key exchange interaction, etc.

[0191] At 10704, system / device parameters may be identified. A system / device parameter may be any element or set of elements upon which an update is contingent. For example, the computer-implemented interactive surgical system may detect a particular bandwidth of communication between a modular device and a surgical hub. For example, the computer-implemented interactive surgical system may detect an indication to purchase a particular service tier.

[0192] At 10708, an operational mode may be determined based on the identified system / device parameters. This determination may be made by a process that maps system / device parameters to operational modes. The process may be a manual and / or automatic process. The process may be the result of local and / or remote computation. For example, a client / server interaction may be used to determine the operational mode based on the identified system / device parameters. For example, local software and / or locally embedded firmware may be used to determine the operational mode based on the identified system / device parameters. For example, a hardware key, such as a secure microprocessor, may be used to determine the operational mode based on the identified system / device parameters.

[0193] At 10710, operation can proceed according to the determined operating mode. For example, the system or device can proceed to operate in a default operating mode. For example, the system or device can proceed to operate in an alternate operating mode. The operating mode can be dictated by control hardware, firmware, and / or software already present in the system or device. The operating mode can be dictated by newly installed / updated control hardware, firmware, and / or software.

[0194] 15B shows an example functional block diagram for changing the operational mode. The upgradeable element 10714 may include an initialization component 10716. The initialization component 10716 may include any hardware, firmware, and / or software suitable for determining the operational mode. For example, the initialization component 10716 may be part of a system or device startup procedure. The initialization component 10716 may be involved in interactions to determine the operational mode of the upgradeable element 10714. For example, the initialization component 10716 may interact with, for example, a user 10730, an external resource 10732, and / or a local resource 10718. For example, the initialization component 10716 may receive a license key from the user 10730 to determine the operational mode. The initialization component 10716 may use the serial number of the upgradeable element 10714 to query an external resource 10732, such as a server, to determine the operational mode. For example, the initialization component 10716 may query local resources 10718, such as a local query to determine the amount of available bandwidth and / or a local query of a hardware key, to determine the operating mode.

[0195] The upgradeable element 10714 may include one or more operational components 10720, 10722, 10726, 10728 and an operational pointer 10724. The initialization component 10716 may direct the operational pointer 10724 to direct operation of the upgradeable element 10741 to the operational components 10720, 10722, 10726, 10728 corresponding to the determined operational mode. The initialization component 10716 may direct the operational pointer 10724 to direct operation of the upgradeable element to the default operational component 10720. For example, the default operational component 10720 may be selected in the condition that no other alternative operational mode has been determined. For example, the default operational component 10720 may be selected in the condition of an initialization component failure and / or an interaction failure. The initialization component 10716 may direct the operation pointer 10724 to direct the operation of the upgradeable component 10714 to the resident operation component 10722. For example, certain characteristics may be resident in the upgradeable component 10714 but require activation to operate. The initialization component 10716 may direct the operation pointer 10724 to install new operation components 10728 and / or to newly installed operation components 10726 to direct the operation of the upgradeable component 10714. For example, new software and / or firmware may be downloaded. The new software and / or firmware may include code that enables the characteristics represented by the selected operation mode. For example, new hardware components may be installed to enable the selected operation mode.

[0196] The surgical hub may have cooperative interaction with one of many means for displaying images from a surgical scope, such as a laparoscopic scope, and information from one of many other smart devices. The hub may be configured to interact with multiple displays to allow for combined viewing and control of data distributed across multiple displays.

[0197] The display of information can be controlled by different visualization control modes. For example, the content on one or more displays can be user controlled and / or automated. The visualization control modes can be operated at different levels based on the control scheme present in the operating room.

[0198] The display of information from the surgical devices and hub can be operated at multiple levels of complexity and control. These multiple levels can be associated with multiple levels of hardware capacity, software capabilities, and / or firmware capabilities. For example, a visualization control mode with more supported capabilities may require interlocking hardware and / or software to ensure synchronization or pairing of data in time. These levels can be controlled or limited through different visualization control modes. For example, the current visualization control mode can be determined based on the hub's ability to operate the surgical devices at an appropriate refresh rate, processing requirements, memory requirements, user input, and / or the purchased level of a software subscription to operate the surgical system.

[0199] The hub can adjust, e.g., upgrade or downgrade, the visualization control mode based on internal parameters of the surgical hub. The internal control parameters can be determined based on changes in the internal control parameters. The changes can be triggered by processing power, available processing power or memory, heat generated by the system, its power consumption, the balance of power consumption relative to other attached systems, user input, and / or the system's subscription level.

[0200] 37 shows an example flow for a surgical hub operating under a stepped visualization control mode. The hub may include a communications array that may be connected to a primary display, a secondary display, a laparoscopic scope, and at least one surgical instrument. As shown, at 17501, the hub may obtain one or more visualization control parameters associated with the primary and secondary displays.

[0201] 37 , at 17502, the hub can determine a visualization control mode based on visualization control parameters. The visualization control parameters can include at least one of available memory, available data bandwidth, heat generated by the surgical hub, heat generated by a secondary display, power capacity associated with the surgical hub, power capacity associated with the operating room, power capacity associated with the medical facility, power usage, a balance of power consumption for at least one attached system, processor utilization, or memory utilization.

[0202] At 17503, the hub may generate visualization data for the primary and secondary displays according to the visualization control mode.

[0203] For example, visualization control parameters may include instructions from the tiered system. The tiered system may scale display capabilities, interactive display control capabilities, etc. based on available data bandwidth, power capacity and usage, processor and memory utilization, and / or internal or attached systems. The tiered system may determine the maximum display and interactive display control capabilities under which the surgical hub may operate. For example, upon detecting that power capabilities associated with an operating room, surgical hub, and / or medical facility fall below a threshold, the tiered system may scale down the visualization control capabilities of the surgical hub. For example, upon detecting that available data bandwidth falls below a threshold, memory utilization exceeds a certain threshold, power usage exceeds a certain threshold, and / or other system conditions that may be reason for scaling down visualization control capabilities, the tiered system may limit or disable display-related communications between the surgical hub and devices and / or between the surgical hub and external servers. Multiple display capabilities may be disabled. Augmented reality capabilities may be disabled. The tiered system may be a module within the surgical hub or a system external to the surgical hub.

[0204] In an exemplary visualization control mode, multiple displays may be used to display different aspects or types of information relevant to the primary inspector of the display, some or all of which may be controlled by another system with which the hub may communicate.

[0205] In an exemplary visualization control mode, one or a portion of one display may be controlled via another display. Content shown on one or a portion of a display may be associated with another display. For example, in a picture-in-picture display, the content source of the mini-picture may be controlled in an exemplary visualization control mode. This feature is further described in U.S. Patent Application No. 15 / 940,742, entitled "DUAL COMS ARRAY IMAGING," filed March 29, 2018, which is incorporated herein by reference in its entirety.

[0206] In an exemplary visualization control mode, individual users may have different display systems that function in coordination with a main shared display. Different overlay information may be generated for different user roles so that users may be provided with personally directed information or personalized overlay data. For example, users may be provided with personalized data for interaction, as described in U.S. Patent Application No. 15 / 940,671, filed March 29, 2018, entitled "DUAL SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATION THEATER," which is incorporated herein by reference in its entirety.

[0207] In an exemplary visualization control mode, the hub can restrict visualizations to be on the primary display. For example, when operating under a first visualization control mode, the hub can control the primary display. The hub can determine which information and video displays should share a portion of the total actual area of ​​the display.

[0208] FIG. 16 illustrates an exemplary primary display 6200 associated with a surgical hub 206, comprising a global display window 6202 and a local instrument display window 6204, according to one aspect of the present disclosure. With continued reference to FIGS. 1-11 illustrating interactions with the interactive surgical system 100 environment, including the surgical hubs 106, 206, and FIGS. 12-14 for instruments connected to the surgical hub, the local instrument display 6204 behavior may be displayed when the instrument 235 senses the connectable presence of the global display window 6202 via the surgical hub 206. The global display window 6202 may, for example, in the center of the surgical hub display 215, also referred to herein as a monitor, show a view 6206 of the surgical site 6208, as seen through a medical imaging device, such as a laparoscope / endoscope 219 coupled to an imaging module 238. A portion of the end effector 6218 of the connected instrument 235 may be shown within the view 6206 of the surgical site 6208 in the global display window 6202. The image shown on the display 237 located on the instrument 235 connected to the surgical hub 206 is shown or mirrored on the local instrument display window 6204 located in the lower right corner of the monitor 6200, for example, as shown in FIG. 16.

[0209] In operation, associated instruments and information and menus may be displayed on the display 237 located on the instrument 235 until the instrument 235 senses connection of the instrument 235 to the surgical hub 206, at which point all or a subset of the information presented on the instrument display 237 may be displayed on the local instrument display window 6204 portion of the surgical hub display 6200 (e.g., only on the local instrument display window 6204 portion) through the surgical hub 206. The information displayed on the local instrument display window 6204 may be mirrored on the display 237 located on the instrument 235 or may no longer be accessible on the instrument display 237 exploded screen. This technique frees the instrument 235 to show different information or larger font information on the surgical hub display 6200.

[0210] The primary display 6200 may provide perioperative visualization of the surgical site 6208. Advanced imaging may identify and visually highlight 6222 important structures, such as the ureter 6220 (or nerves, etc.), and track instrument proximity indicators 6210 may be shown on the left side of the display 6200. In the illustrated example, the instrument proximity indicators 6210 may indicate instrument-specific settings. For example, the upper instrument proximity indicator 6212 may indicate a monopolar instrument setting, the middle instrument proximity indicator 6214 may indicate a bipolar instrument setting, and the lower instrument proximity indicator 6212 may indicate an ultrasound instrument setting.

[0211] 17 shows an exemplary primary display having a synthetic overhead view of the end effector 6234 portion of a surgical stapler mapped using two or more imaging arrays or one array and time to provide multiple perspectives of the end effector 6234 to enable synthetic imaging of an overhead view. The techniques described herein can be applied to ultrasonic instruments, electrosurgical instruments, combination ultrasonic / electrosurgical instruments, and / or combination surgical stapler / electrosurgical instruments. Several techniques can be implemented to overlay or augment images and / or text from multiple image / text sources to present a composite image on a display (e.g., a single display).

[0212] As shown in FIG. 17 , the primary display 6200 of the surgical hub 206 can display a primary window 6230. The primary window 6230 may be located at the center of the screen and may show a magnified or exploded narrow-angle view of the surgical field of view 6232. The primary window 6230 located at the center of the screen shows a magnified or exploded narrow-angle view of the end effector 6234 of a surgical stapler gripping a blood vessel 6236. The primary window 6230 can display a composite image to produce a composite image that allows visualization of structures adjacent to the surgical field of view 6232. A second window 6240 may be shown in the lower left corner of the primary display 6200. The second window 6240 displays a composite image of a standard focus, wide-angle view of the image shown in the primary window 6230 in an overhead view. The overhead view provided in the second window 6240 can allow the examiner to easily see items outside of the narrow surgical field of view 6232 without moving the laparoscope or other imaging device 239 coupled to the imaging module 238 of the surgical hub 206. The third window 6242 can be displayed in the lower right corner of the primary display 6200 and shows an icon 6244 representing the staple cartridge (e.g., staple cartridge in this example) in the end effector 6234 and additional information such as "4 rows" indicating the number of staple rows 6246 and "35 mm" indicating the distance 6248 the knife has traveled along the length of the staple cartridge. Below the third window 6242 is displayed an icon 6258 of a frame of the current state of the clamp stabilization sequence 6250 indicating clamp stabilization.

[0213] In an exemplary visualization control mode, the display may be controlled by the user, for example, via motion tracking (e.g., head orientation relative to the monitor, hand gestures, voice activation, and other means within the sterile field. User gestures may be determined based on a wearable device worn by the user, such as a smartwatch and / or camera within the OR. The user's head movements may be determined based on AR goggles and / or a camera within the OR.

[0214] 19 is a diagram of an exemplary OR setup that may enable display control via motion tracking, gesture tracking, and / or voice activation. In various embodiments, the surgical hub 211801 can be communicatively connected via a communication protocol (e.g., Bluetooth) to one or more cameras 211802, surgical instruments 211810, displays 211806, overheard lights 211808, and other surgical devices within the OR 211800. The cameras 211802 can be oriented to capture images and / or video of the surgical staff members 211803 and / or surgical instruments 211810 (or other surgical devices) within the OR 211800 during the course of a surgical procedure. The captured images can include still images or moving images (e.g., video). Images of the surgical staff members 211803 and / or surgical instruments 211810 can be captured at various angles and magnifications, utilizing various filters, etc. For example, cameras 211802 may be positioned within the OR 211800 to provide collective visibility of each surgical staff member performing a procedure. Thus, the surgical hub 211801 can receive captured image and / or video data from the cameras 211802 for visual analysis of the surgical staff members 211803 and / or surgical instruments 211810 during a surgical procedure. The image and / or video data can be processed utilizing various machine vision, image processing, object recognition, and optical tracking techniques to track the attributes, characteristics, actions, and movements of the surgical staff members 211803 and / or surgical instruments 211810.

[0215] Figure 20 is a block diagram of a gesture recognition system 211500 that may be used to control the display in an exemplary visualization control mode. The gesture recognition system 211500 includes a gesture recognition module 211504 that may be executed by a processor or control circuitry of a computer system, such as the processor 244 of the surgical hub 206 shown in Figure 10. Thus, the gesture recognition module 211504 may be embodied as a set of computer-executable instructions stored in memory 249 that, when executed by the processor 244, cause the computer system (e.g., the surgical hub 211801) to perform the described operations.

[0216] The gesture recognition system 211500 can receive image or video data from image recognition hardware / software (e.g., camera 211802), recognize various gestures 211804 that may be performed by surgical staff members 211803 (e.g., determine if a gesture is being performed (211604, 211624) in processes 211600, 211620), and take a corresponding action or otherwise respond to a particular detected gesture 211804 (e.g., control a surgical device (211606) or store the data as metadata (211626) in processes 211600, 211620). In one aspect, the gesture recognition module 211504 can include a feature extraction module 211506 and a gesture classification module 211508. The feature extraction module 211506 can extract measurable and distinctive characteristics or features (e.g., features) from the image / video data. Features can include edges (e.g., extracted via a Canny edge detection algorithm), curvature, corners (e.g., extracted via a Harris & Stephens corner detection algorithm), etc. The gesture classification module 211508 can determine whether the extracted features match a gesture from the gesture set. In one aspect, the gesture classification module 211508 can include a machine learning model (e.g., an artificial neural network or a support vector machine) trained via supervised or unsupervised learning techniques to correlate feature vectors of the extracted features to one or more output gestures. In another aspect, the gesture classification module 211508 can include a Hu invariant moment-based algorithm or a k-curvature algorithm to classify gestures. In yet another aspect, the gesture classification module 211508 may include a template matching algorithm programmed to match the characterized image / video data (or portions thereof) to templates corresponding to predetermined gestures. Other aspects may include various combinations of the foregoing techniques and other techniques for classifying gestures.

[0217] Upon recognizing a gesture via the gesture recognition module 211504, the gesture recognition system 211500 can take an action 211510 or response corresponding to the identified gesture. For example, an action 211510 taken by the computer system includes controlling a surgical display in the OR.

[0218] Actions 211510 performed by the computer system may include storing gestures made by surgical staff as metadata associated with or linked to perioperative data generated by surgical devices during the course of a surgical procedure. Such metadata may be useful in determining whether surgical staff are controlling surgical devices manually or via gestures, and gestures can be correlated with surgical staff performance, procedure time, and other such metrics. In various other aspects, the computer system can both control one or more surgical devices and store the gesture data as metadata.

[0219] The gesture recognition system 211500 may utilize a magnetic sensing system for receiving contactless input from a user to visually identify gestures in addition to, or instead of, the camera 211802. In this aspect, the gesture recognition system 211500 may include, for example, a magnetic sensing array that may be positioned within the OR.

[0220] Gesture recognition is further described in U.S. Patent Application No. 16 / 182,269, filed November 6, 2018, entitled "IMAGE CAPTURING OF THE AREAS OUTSIDE THE ABDOMEN TO IMPROVE PLACEMENT AND CONTROL OF A SURGICAL DEVICE IN USE" (Attorney Docket No. END9018USNP3), which is incorporated herein by reference in its entirety.

[0221] 38 shows a detailed example flow of hub operation under layered visualization control modes. The hub may obtain the visualization control mode at 17510. At 17511, the hub may generate and send data to the primary display as described herein. At 17512, the hub may determine whether to generate visualization data for the secondary display based on the visualization control mode.

[0222] Some exemplary visualization control modes may support multi-display capabilities, while other exemplary visualization control modes may limit visualization displays to be on the primary display or may display the same content on both the primary and secondary displays. If the visualization control mode supports multi-display capabilities, the hub may generate visualization data for the secondary displays and transmit the generated visualization data to each secondary display at 17513. If the visualization control mode does not support multi-display capabilities, the hub may disable generation and transmission of visualization data for the secondary displays and continue to transmit data to the primary display at 17514.

[0223] 40 shows an example flow for a hub operating under a visualization control mode supporting multi-display capabilities. At 17601, the hub can obtain display control parameters associated with a surgical procedure. The display control parameters may include at least one of a user's orientation relative to at least one display, a progress of the surgical procedure, a surgical context, and / or detection of an anomaly associated with the surgical procedure. For example, the display control parameters may be a voice command, a user input via an interactive display, a content type, an intended examiner of the displayed information, and / or content of the displayed information.

[0224] The hub can determine different content for different displays based on the display control parameters at 17602. The hub can generate and send display content to each display at 17603.

[0225] For example, a display control parameter may be a user's orientation relative to a display. The surgical hub may determine the display content and / or display format on one or more displays based on the orientation of the primary surgeon head (or user for whom the information is useful) relative to the displays in the OR. The surgical hub may determine the display content and / or display format on one or more displays based on user input, including user input either inside or outside the OR. For example, the surgical hub may determine a display location, such as identifying a display, or identify a display window within a display, based on the intended viewer of the information and the viewer's relative location relative to one or more displays (e.g., each display) in the OR. For example, the surgical hub may select the display closest to the intended viewer of the information. The surgical hub may decide to remove certain display content based on the intended viewer of the information and the viewer's relative location relative to various displays in the OR.

[0226] In various aspects, controls for the surgical hub, surgical instruments, and other devices may be adjusted based on the screen operating on the sterile field display. Controls for surgical devices may also be adjusted based on the displayed information. Controls that normally control the panning of a visualization device (e.g., a scope) or adjusting the focus of the visualization device may be configured to adjust magnification, for example, when a hyperspectral imaging overlay is active. Hyperspectral imaging is further described in U.S. Patent Application No. 15 / 940,722, filed March 29, 2018, entitled "CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OF MONO-CHROMATIC LIGHT REFRACTIVITY," which is incorporated herein by reference in its entirety.

[0227] For example, the surgeon may have control to change, focus, or otherwise control the data on the display, which may allow the medical professional to more seamlessly see where they are in relation to other imaging or pre-operative imaging mechanisms.

[0228] Controls on the handles of surgical instruments within the field of view of the sterile field display can be adjusted by selection on the sterile field display. Additionally, adjustments can be based on situational awareness in various instances. For example, the system can determine that a particular surgical device is being utilized and that the system allows the functions of that surgical device to be controlled from a second device, such as a display screen within the sterile field.

[0229] In an exemplary visualization control mode that supports collaborative display capabilities, multiple displays may be used to display different aspects or types of information relevant to the primary inspector of the display, some or all of which may be controlled by separate systems that the main hub only communicates with rather than controls.

[0230] The multiple displays may include, but are not limited to, a primary display on the hub, a visualization tower which may include at least one monitor, displays around the room, and / or small device displays.

[0231] In an exemplary visualization control mode that supports collaborative display capabilities, the surgical hub may allow a medical professional to control a display outside the sterile field via a display inside the sterile field. During a surgical procedure, the surgeon may not have a user interface device accessible for interactive input by the surgeon and a display within the sterile field. Thus, the surgeon may not interface with the user interface device and the surgical hub from within the sterile field and may not be able to control other surgical devices through the surgical hub from within the sterile field.

[0232] For example, a local display, such as a secondary display, may serve as a user interface for viewing and controlling surgical hub functions from within the sterile field. The secondary display can be used to change the display location, what information is displayed where, and to pass control of specific functions or devices. The local display may include a display unit used within the sterile field, which may allow the surgeon to have interactive input control from the sterile field to control other surgical devices and / or displays coupled to the surgical hub. The display unit may be sterile and may be located within the sterile field to allow the surgeon to interface with the display unit and surgical hub to directly interface with and configure instruments, as needed, without leaving the sterile field. The display unit may be a master device and may be used for viewing, control, and exchange of tool control, allowing feeds from other surgical hubs without the surgeon leaving the sterile field.

[0233] The display unit may be or may include an interactive touchscreen display, an interface configured to couple the interactive touchscreen display to a surgical hub, a processor, and memory coupled to the processor, wherein the memory can store instructions executable by the processor to receive input commands from the interactive touchscreen display located inside the sterile field and send the input commands to the surgical hub to control devices coupled to the surgical hub located outside the sterile field.

[0234] Displays outside the sterile field may be or include non-sterile displays 107 or 109 as shown in FIG. 2. For example, displays inside the surgical sterile field may be or include secondary displays, such as a local display or a display on a surgical instrument. Medical personnel may control the secondary displays. The primary and secondary displays may have multiple levels of communication with the primary hub system. Examples of primary and secondary displays can be found in more detail in U.S. Patent Application No. 15 / 940,671, entitled "SURGICAL HUB SPATIAL AWARENESS TO DETERMINES DEVICES IN OPERATING THEATER," filed March 29, 2018 (Attorney Docket No. END8502USNP), which is incorporated herein by reference in its entirety.

[0235] An example of controlling a display outside the sterile field via a display inside the sterile field is described in co-filed patent application entitled "COMMUNICATION CONTROL OPTIONS FOR A SURGEON CONTROLLED SECONDARY DISPLAY AND PRIMARY DISPLAY" with attorney docket number END9287US17, which is incorporated herein by reference in its entirety.

[0236] The secondary display may include a touchscreen display capable of displaying and providing status on any number of surgical hub 206 tracking data feeds and / or a separate secondary display and / or dedicated local display that may be linked to the surgical hub 206 to provide an interaction portal via the secondary screen. The secondary display may display force to fire (FTF), tissue gap, power level, impedance, tissue compressive stability (creep), etc., while the primary display may display variables important to keeping the feed clutter-free. The interactive display may be used to move the display of specific information to a desired position, size, color, etc. on the primary display. In the illustrated example, the secondary display may display an instrument proximity display 6210 on the left side of the display 6200. A local instrument display 6204 is located on the lower right side of the display 6200. The local instrument display 6204 presented on the surgical hub display 6200 may display an icon of the end effector 6218, such as an icon of the staple cartridge 6224 currently in use, the size 6226 of the staple cartridge 6224 (e.g., 60 mm), and an icon of the current position of the knife 6228 of the end effector.

[0237] The secondary display may be a display 237 as shown in Figures 5 and 6. Referring to Figure 6, the display 237 located on the instrument 235 may display the wireless or wired attachment of the instrument 235 to the surgical hub 206, as well as the instrument's communications and / or recordings on the surgical hub 206. Settings may be provided on the instrument 235 to allow the user to select between mirroring or extending the display on both monitoring devices. Instrument controls may be used to interact with the surgical hub display of information being provided on the instrument. The instrument 235 may include wireless communication circuitry for wireless communication with the surgical hub 206, as described herein.

[0238] A first instrument coupled to the surgical hub 206 can be paired with the screen of a second instrument coupled to the surgical hub 206, allowing both instruments to display some hybrid combination of information from both devices that mirrors portions of the primary display. The primary display 6200 of the surgical hub 206 can provide a 360° synthetic top view of the surgical site 6208 to avoid collateral structures. For example, a secondary display of an end effector surgical stapler may be provided within the primary display 6200 of the surgical hub 206, or on a separate display, to provide better perspective around the area within the current field of view 6206.

[0239] This secondary display can also be used as a control to adjust what and how information is displayed on the primary display outside the sterile field, which would allow for better highlighting of other surgical personnel information that needs to be tracked, recognized, or supported.

[0240] These secondary displays may be on the instrument, positioned above the patient adjacent to the surgical access port, or worn by the user. These displays can modify multispectral imaging and control its overlay on the normal scope feed, overlay pre-operative imaging based on established position characteristics, adjust the axillary data displayed around the display, or its order or size, and even allow the user to move one image or data set from one location to another on another display.

[0241] The primary and secondary displays may be controlled via a gesture recognition system as described herein.

[0242] For example, the visualization control parameter may be the progress of the surgical procedure. The surgical hub may determine the display content for the primary and secondary displays based on the progress of the surgical procedure.

[0243] The visualization controls may be adjusted according to the step of the surgical procedure being performed. Contextual awareness may inform the surgical hub of the current and / or next step of the surgical procedure. For example, based on previous surgical acts and / or the sequence of use of surgical devices and / or generators, the surgical hub may determine which particular step of a particular surgical procedure is being performed, such as whether the procedure is currently in a node dissection step, a vessel transection step, etc. The surgical hub and / or generator may determine the procedure-specific step or context.

[0244] For example, surgical context data may include the type of surgical procedure being performed, the particular step in the surgical procedure the surgeon is performing, the type of tissue being operated on, or the body cavity being treated. This ability of some aspects of the surgical hub to derive or infer information about the surgical procedure from received data may be referred to as "situational awareness." In one example, the surgical hub may incorporate a situational awareness system, as described herein with reference to FIGS. 9 and 10. A situationally aware surgical hub may derive contextual information about the surgical procedure from various received surgical data. Such surgical data may include perioperative data from modular devices 5102 and other data sources (e.g., databases 5122 and patient monitoring devices 5124) communicatively coupled to the surgical hub 5706.

[0245] As described herein, the hub can learn and predict procedure-specific steps or contexts by analyzing a particular clinician's most common usage at each stage of a surgical procedure and / or after a certain number or type of surgical instrument exchange. After monitoring the same clinician's behavior over a predetermined number of procedures involving the same steps, the hub can automatically change the content displayed on the display based on the clinician's interaction with and / or controls indicated by the clinician on the monitored past displays. In various examples, the hub can provide notifications to the clinician when the display is adjusted. For example, the hub and / or display can provide an audio notification (e.g., a beep or verbal description), a visual cue (e.g., a flashing light and / or words on the screen), and / or a tactile alert (e.g., vibration and / or movement of the surgical device or part of the surgical device, such as the actuator button itself). In other examples, the surgical hub can recommend display adjustments. Recommendations from the surgical hub are further described herein.

[0246] 41 shows an example flow for a hub operating under a visualization control mode that supports situational awareness capabilities. The hub can obtain 17610 a visualization control mode associated with a surgical procedure. The hub can receive 17611 perioperative data from at least one surgical instrument. The hub can determine 17612 a surgical progress based at least in part on the visualization control mode and the perioperative data.

[0247] The progress of a surgical procedure may be determined using the context-aware surgical system 5100 as shown in FIGS. 9 and 10 . For example, the context-aware hub 5104 may determine which step of a surgical procedure is being performed or will be performed afterward. The context-aware hub 5104 may determine whether an event has occurred based on the received data. An event may include, for example, a surgical procedure, a step or portion of a surgical procedure, or a surgical procedure or downtime between steps of a surgical procedure. Additionally, the surgical hub 5104 may track data associated with a particular event, such as the duration of the event, the surgical instruments and / or other medical products utilized during the course of the event, and the medical personnel associated with the event. The surgical hub 5104 may determine the event data, for example, via a context-aware process as described herein. The situational awareness process is described in U.S. patent application Ser. No. 15 / 940,654 (Attorney Docket No. END8501USNP), filed on March 29, 2018, entitled "SURGICAL HUB SITUATIONAL AWARENESS," U.S. patent application Ser. No. 16 / 209,478 (Attorney Docket No. END9015USNP1), filed on December 4, 2018, entitled "METHOD FOR SITUATIONAL AWARENESS FOR SURGICAL NETWORK OR SURGICAL NETWORK CONNECTED DEVICE CAPABLE OF ADJUSTING FUNCTION BASED ON A SENSED SITUATION OR USAGE," and U.S. patent application Ser. No. 16 / 209,478 (Attorney Docket No. END9015USNP1), filed on November 6, 2018, entitled "ADJUSTMENTS BASED ON AIRBORNE PARTICLE SYSTEMS." This is described in more detail in U.S. patent application Ser. No. 16 / 182,246 (Attorney Docket No. END9016USNP1), entitled "METHOD OF USE IN A HYDROXYPROPERTIES," the disclosures of each of which are incorporated herein by reference in their entireties.

[0248] 41 , based on the determined surgical progress and display type, the hub may then determine display content at 17613. At 17614, the hub can instruct the display to display the determined display content.

[0249] For example, the hub can associate different display content with different exemplary procedural steps shown in FIG. 22. As shown, exemplary surgical steps may include isolating a lung, managing major vessels, and removing a lobe. The surgical hub may instruct the displays to show information specifically related to the current step in the surgical procedure based on situational awareness and automated control. The surgical hub can determine the type of surgical data for display based on the determined surgical progress. The surgical hub may select a display from among the displays in the OR to display the surgical database on the determined surgical progress.

[0250] For example, a baseline visualization of the anatomical structures and / or surgical site may be obtained before the start of a surgical procedure, such as before manipulation and dissection of tissue at the surgical site. The baseline visualization image of the anatomical geometry may include visualization of the surfaces of the anatomical structures and their boundaries. Such a baseline visualization image may be used to maintain the overall orientation of the surgical site and anatomical structures even as local regions within the anatomical structures are gradually disrupted, altered, or otherwise manipulated during the surgical procedure.

[0251] For example, the surgical hub may update the baseline visualization image upon identifying a particular type of surgical procedure, step of the surgical procedure, tissue type, and / or one or more particular tissue features. In one example, an updated baseline visualization image may be useful after a transection or after the application of one or more rows of staples. In certain examples, a distorted subregion within the original anatomy may separately create a new baseline visualization image, or may update an existing baseline visualization image for the distorted subregion to appropriately inform the image overlay. For example, a critical region of a patient's anatomy may be updated after the removal of or growth within a tumor.

[0252] For example, the surgical hub may use spectral imaging techniques to generate display content to visualize different tissue types and / or anatomical structures, as shown in FIG. 23. In FIG. 23, a spectral emitter 2320 (e.g., spectral light source 150) may be utilized by an imaging system to visualize a surgical site 2325. EMR emitted by the spectral emitter 2320 and reflected from tissues and / or structures at the surgical site 2325 may be received by an image sensor to visualize the tissues and / or structures, which may be either visible (e.g., located on the surface of the surgical site 2325) or occluded (e.g., underlying other tissues and / or structures at the surgical site 2325). In this example, the imaging system may visualize a tumor 2332, an artery 2334, and various anomalies 2338 (i.e., tissues that cannot be identified against known or expected spectral signatures) based on spectral signatures characterized by different absorption characteristics (e.g., absorption coefficients) of constituent materials for each of the various tissue / structure types. The visualized tissues and structures can be displayed on a display screen associated with or coupled to the imaging system, such as an imaging system display, a primary display, a non-sterile display, a hub display, or a device / instrument display.

[0253] The visualization of the displayed surgical site can be adjusted or updated according to the surgical hub, identified tissue, and / or structure type. For example, a margin 2330a associated with a visualized tumor 2332 can be displayed on the display. The margin 2330a can indicate the area or amount of tissue to be resected to ensure complete removal of the tumor 2332. The control system can be configured to control or update the dimensions of the margin 2330a based on the tissue and / or structures identified by the imaging system. In the illustrated example, multiple abnormalities 2338 can be identified within the FOV. Accordingly, the control system can adjust the displayed margin 2330a to a first updated margin 2330b having sufficient dimensions to encompass the abnormalities 2338. Additionally, an artery 2334 can be identified that partially overlaps the initially displayed margin 2330a (shown by the highlighted region 2336 of the artery 2334). The surgical hub can adjust the displayed margin 2330 a to match a second updated margin 2330 c that is large enough to encompass the relevant portion of the artery 2334 .

[0254] For example, upon determining that the next surgical step is to resect a portion of tissue, the surgical hub may display on the display an estimated change in deformation for the proposed resection. The proposed resection line may be added to the digital model, and the digital model may be updated to show the anatomical structure with the virtual resection. Referring again to FIG. 13B , in one example, the clinician may intend to remove a wedge-shaped portion of tissue at the surgical site 2325 to remove tumor 2332 along with tissue abnormality 2338. In such a case, the model may be updated to show the organ from which the wedge-shaped portion was removed. The updated model may depict the tissue deformation as well as calculated stresses and / or strains within the tissue based on known tissue mechanical properties and the deformations induced by the surgery. For example, the tissue may be shaded or otherwise layered with stress and / or strain data to inform the clinician as to how a particular resection may affect the strain on the tissue. In some embodiments, stress / strain data may be overlaid on the image as a set of vector lines indicating the stress / strain direction and line type or color to show the stress / strain values. Based on the calculated stress and strain, the clinician may modify the proposed ablation and consider alternative strategies to reduce and / or better distribute the stress and strain within the tissue. For example, the angle of the ablation may be modified. In certain instances, the clinician may reorient the staple line with a preferred strain direction.

[0255] For example, upon determining that a surgical procedure is a video-assisted thoracoscopic surgery (VATS) procedure, the surgical hub can instruct one or more displays to show the exemplary content shown in FIGS. 24 and 25. A VATS procedure is a surgical procedure in which one or more surgical instruments and one or more thoracoscopes (i.e., cameras) are inserted into a patient's chest cavity through a slit positioned between the patient's ribs. The cameras are utilized to provide the surgeon with a view of the interior of the patient's chest cavity, allowing the surgeon to properly position / move the surgical instruments and manipulate tissue / structures within the chest cavity. Because the surgeon controls the surgical instruments based on what is displayed by the imaging system via the camera, and because the surgical instruments may not be aligned with the camera's point of view, the spatial relationship between the surgical instruments and the POV displayed by the imaging system may potentially be misoriented, especially in the case of imaging systems that allow the user to pan, manipulate, and reorient the displayed visualization.

[0256] 24 and 25 show exemplary display content associated with a VATS procedure. In this particular VATS procedure, a surgeon may seek to remove a tumor 6506 located within the apical segment of the upper lobe of a lung 6508. As shown, the surgeon places a port 6502 between a second rib 6501 and a third rib 6503 to provide an access pathway 6504 for a surgical instrument 6510 (e.g., a surgical stapler) insertable through the port 6502 to access the tumor 6506 and / or surrounding areas within the thoracic cavity. Once the access location for the surgical instrument 6510 has been selected, the surgeon can place one or more cameras 6520a, 6520b through other ports 6502 positioned to allow the cameras 6520a, 6520b to visualize the interior of the patent thoracic cavity near the surgical site. Visualizing the surgical site in this manner allows the surgeon to position and orient the end effector 6514 of the surgical instrument 6510 to manipulate tissue as needed (e.g., resect a portion of the lung 6508 surrounding the tumor 6506). In the particular illustrated example, two cameras 6520a, 6520b are utilized, although a different number of cameras may be utilized and / or one or more of the cameras 6520a, 6520b may be oriented in different manners depending on the particular type of surgical procedure being performed and / or the area within the patient's 6500 that needs to be visualized.

[0257] For example, when operating under an exemplary visualization control mode, the surgical hub can adjust a secondary display, such as a local display attached to a surgical instrument, based on a local coordinate system. The local coordinate system may be a surgical visualization coordinate system. Upon determining that the surgical procedure is a VATS procedure, the surgical hub can transmit the locally displayed coordinate system to the surgical instrument or other medical device to enable the instrument / device controls to be adapted to control movement relative to the local visualization coordinate system. At least one measurement derived from the imaging system can be utilized to define the local coordinate system. User controls displayed on the local display may be reoriented relative to the local coordinate system rather than the standard global coordinate system or another coordinate system.

[0258] As shown in FIG. 25 and described below in Table 1, a variety of different coordinate systems can be defined with respect to different POVs of the patient, device, or device components. Additionally, when operating under a visualization control mode that allows the user to manipulate the displayed visualization, a "virtual" POV can be defined that corresponds to the virtual or predicted visualizations displayed to the surgeon, and coordinate systems can also be defined according to these POVs. The generation and control of such visualizations is further described herein.

[0259] [Table 1]

[0260] The coordinate systems may be defined based on sensor measurements and / or measurements by an imaging system. For example, a coordinate system for the surgical instrument handle assembly 6512, shaft 6513, or end effector 6514 may be defined according to measurements by an accelerometer or another such sensor associated with the respective component. As another example, any of the aforementioned coordinate systems may be defined based on measurements of the relative distance and / or position of objects with respect to one another, or may be a global coordinate system determined by imaging the objects via an imaging system.

[0261] In the example shown in FIG. 26 , the surgical instrument 6510 utilizes the provided transformation function to determine that the controls 6518 and display screen 6516 should be adjusted based on the updated coordinates. In various examples, situational awareness can notify when the controls 6518 and / or display screen 6516 are updated, as described further herein. The display screen 6516 can display the GUI 6517 adjusted from a first orientation shown on the left side of FIG. 26 to a second orientation shown on the right side of FIG. 26 , thereby ensuring that the GUI 6517 is properly oriented for the surgeon to control the surgical instrument 6510. In one aspect, the GUI 6517 can further include a GUI element 6524 (e.g., an icon) that indicates the POV or coordinate system being utilized by the surgical instrument 6510. In this example, GUI element 6524 shifts to indicate that the POV displayed by visualization system 2108 has changed from the device coordinate system (“DVC”) to the local coordinate system (“Local”) associated with the image / video displayed by visualization system 2108.

[0262] As an example, the surgical instrument control 6518 adjusted according to the updated coordinates may include an articulation control. The articulation control may include, for example, a first control 6519a configured to articulate the surgical instrument 6510 in a first direction and a second control 6519b configured to articulate the surgical instrument 6510 in a second direction. The articulation controls 6519a, 6519b may be embodied, for example, as rockers, toggles, or separate actuators and / or buttons. In this example, the surgical instrument 6510 causes the first articulation control 6519a and the second articulation control 6519b to swap functions in response to a change in the orientation of the surgical instrument 6510. In other words, actuating the first articulation control 6519a will instead articulate the surgical instrument 6510 in a second direction, and actuating the second articulation control 6519b will articulate the surgical instrument 6510 in a first direction. Thus, the functionality of the articulation controls 6519a, 6519b can be set according to the orientation of the surgical instrument 6510 or a component thereof (e.g., the end effector 6514) displayed to the user.

[0263] Additionally or alternatively, in certain examples, the GUI 6517 on the display screen 6516 may be adjusted. For example, the GUI 6517 may be flipped when the handle assembly 6512 is flipped. In certain examples, the GUI 6517 may include a touch screen such that the surgeon can switch between coordinate systems by interacting with the GUI 6517. For example, the surgeon can switch between the device POV, the local POV, and / or one or more other POVs by interacting with the GUI 6517.

[0264] When operating under an exemplary visualization control mode, the surgical hub can fuse images from different sources to expand the visualization field of view, for example, if the surgical hub determines that the current surgical procedure may benefit from an expanded visualization field of view. For example, if the surgical hub determines that the current surgical procedure is to cut a blood vessel, it may generate and transmit a fused image from the different sources.

[0265] A 3D representation of an object within the visualization field of view of the imaging system may be created, and the 3D shape may be characterized to allow a user to modify the displayed visualization relative to an established coordinate system to better visualize the surgical site. The 3D representation may be generated from images generated from real-time or non-real-time sources (e.g., CT scans or MRIs). In one aspect, structured light or structured EMR may be projected to create structured 3D shapes that can be tracked in real time. These 3D shapes may be generated such that the POV displayed by the display is translated or rotated away from the local coordinate system of the scan source to improve the user's perspective through the display.

[0266] 27 shows an exemplary FOV 6570 of a camera during a VATS procedure. The target of this particular exemplary procedure is a tumor 6506 located within the apical segment of the upper lobe 6580 of a lung 6508. Many biological structures are discernible within this FOV 6570, including the chest wall 6509, veins 6574, arteries 6576, bronchi 6578, fissures 6582 delineating the upper lobe 6580, pulmonary arteries 6584, and pulmonary veins 6586. Non-biological objects are also visible within the FOV 6570, including the end effector 6514 and shaft 6513 of a surgical instrument 6510 controlled by the surgeon. In the exemplary imaging system, such a view, combined with any corresponding views from any additional cameras 6520 being utilized, would be the only view available to the surgeon performing the video-assisted procedure. While these cameras are intended to be positioned to provide the surgeon with an appropriate visualization field of view for performing a surgical procedure, the visualization field of view provided by the camera 6520 may ultimately not provide an ideal FOV 6570 for performing each step or task in the surgical procedure, or there may be unanticipated obstructions at the surgical site that obstruct the surgeon's view. Furthermore, repositioning or reorienting the camera 6520 during surgery may sometimes be impractical or undesirable due to the surgical constraints of the procedure.

[0267] The surgical system may be configured to extend the visualization field of view provided by the camera by combining multiple images of the surgical site, including pre-operative and intra-operative images, to generate a 3D representation of the surgical site or tissues and / or structures located at the surgical site. During the surgical procedure, the user may then manipulate the 3D representation displayed by the imaging system 142 to visualize the surgical site from an orientation outside the FOV 6570 of the camera utilized in the procedure. Such a reoriented view may be referred to as a “virtual POV,” as described above. The surgical system thus supplements the FOV 6570 provided by the camera, enabling the surgeon to dynamically adjust the displayed visualization of the surgical site during the surgical procedure to find an ideal viewing POV for performing one or more surgical tasks.

[0268] Locally displayed coordinate systems are further described in U.S. Patent Application No. 16 / 729,747, entitled "DYNAMIC SURGICAL VISUALIZATION SYSTEMS," filed December 31, 2019 (Attorney Docket No. END9217USNP1), the entire contents of which are incorporated herein by reference.

[0269] FIG. 42 shows an example flow of operation of a hub under a visualization control mode that supports adjusting a display based on an adjusted display event. At 17620, the hub can receive data from at least one surgical instrument. At 17621, the hub can detect a surgical context based at least in part on the perioperative data. The hub can determine at 17622, ​​based on the surgical context, whether the surgical context corresponds to an adjusted display event. If the surgical context includes an adjusted display event, the hub may adjust display content for one or more displays based on the adjusted display event, as described at 17623. The adjusted display event may include a stressful procedure step, a critical procedure step, and / or a predetermined procedure step.

[0270] For example, if the surgical hub determines that the current surgical procedure is a stressful procedure, a critical procedure, or a predetermined procedure, the surgical hub may adjust the display format and / or display content on the display to a focus mode.

[0271] FIG. 33 illustrates exemplary procedural steps and progressions that may be detected by the system's exemplary situational awareness capabilities. Certain steps may be considered critical to the success of the surgery or may be associated with high stress levels. For example, ligating the IMA branch, accessing the plane between the omentum and colon, managing a severe hemophilia patient, and releasing the splenic flexure from the omentum and spleen and colon as shown under the segment "Separate the Colon" may be considered stressful procedural steps using a surgical hub. As shown in FIG. 33, steps such as transecting the distal sigmoid colon below the rectosigmoid junction under the segment "Resect the Sigmoid Colon" and firing the circular stapler under the segment "Pre-form the Anastomosis" may be considered stressful procedural steps that may be reason for a change in display content and / or display format.

[0272] For example, the display content may be adjusted by zooming in on a target within the image, removing irrelevant information from the first display content, and / or enhancing a portion of the laparoscopic image.

[0273] The adjusted display event may include the detection of an anomaly associated with a surgical procedure, received surgical data being outside of an expected range of values, or a system parameter being outside of a desired system parameter range. The display content may be adjusted by projecting a warning, error message, or instruction of the detected anomaly onto the hub display (e.g., the main monitor). The display content may be adjusted by overlaying a warning, error message, or instruction of the detected anomaly onto the display.

[0274] The adjusted display event may include detecting that steps for use are out of sequence. For example, procedural steps for use of a surgical instrument may be displayed on a device screen, such as a display attached to the surgical instrument. Based on a surgical context based at least in part on the received perioperative data, the situational awareness hub may detect that steps for use of the surgical instrument are out of sequence. Upon detection, display content on the primary display (e.g., main screen) may be adjusted to show step instructions for use of the out-of-sequence surgical instrument. If early action is identified, the surgical hub may instruct the primary display to show recommended step instructions. For example, upon sensing that the firing trigger is pulled before the clamp time, the surgical hub may adjust display content on the primary display to show instructions instructing the user to wait or count down before firing.

[0275] In an example, display content may be adjusted by moving particular data to another display. The interactive display may receive user instructions, for example from a medical professional such as a surgeon, indicating a selection of where data is to be displayed. The selection may be indicated for a particular surgical procedure, a stressful procedure, a critical procedure, and / or in the event that an abnormality associated with the surgical procedure is detected. Content may be transmitted to the selected display location for display.

[0276] Referring back to FIG. 42, if the surgical context does not include an adjusted display event, the hub may refrain from making additional adjustments to the display at 17624.

[0277] In an example, a hub in communication with the AR device and at least one smart surgical device can provide an interactive overlay of the surgical display that superimposes information on another surgical display. The surgical display may connect to the AR device in the operating room. The AR device may overlay or superimpose additional data sets or data streams received from the hub onto a display, such as a surgical display or a display on a smart device. This interactive overlay may allow a user of the AR device to layer data on a screen when the user is looking at the screen. The surgical hub may adjust the layer data based on the display the user is looking at. For example, the hub can adjust the layer data when the user looks from one display to another. The AR device can adjust the display data on a monitor or device screen. For example, display control instructions can be received from the AR device. In response, the surgical hub can adjust content for display on the monitor or device screen based on the received display control instructions.

[0278] The AR device may, for example, provide an auditory overlay in addition to hearing OR sounds, rather than instead of them. The AR system may communicate specific information only to targeted individuals in the OR who can utilize that information.

[0279] AR content can be enabled or disabled based on the location of the AR device. For example, the surgical hub can detect that the AR device is outside the boundaries of a surgical room. In response, the surgical hub can disable sending AR content to the AR device.

[0280] 39 shows an example flow for hub operation under visualization control mode where the secondary display is an augmented reality (AR) device. At 17520, the hub can obtain the visualization control mode. At 17521, the hub can identify the secondary display that is an AR device.

[0281] 39 , the hub may determine whether to generate overlay information associated with the primary display for overlaying via the secondary display based on the visualization control mode at 17522. If the visualization control mode supports AR capabilities, the hub may disable generation of information associated with the primary display for overlaying via the secondary display at 17524.

[0282] The secondary display may be or include an AR device. The AR device may include a head-mounted display (HMD). The HMD may include a processor, a non-transitory computer-readable memory storage medium, and executable instructions contained in the storage medium that are executable by the processor to perform the methods or portions of the methods disclosed herein. The HMD may include a graphics processor for rendering 2D or 3D video and / or imaging for display.

[0283] FIG. 18 depicts a perspective view of a surgeon using a surgical instrument including a handle assembly housing and a wireless circuit board during a surgical procedure, with the surgeon wearing a set of safety glasses. The safety glasses may be or include an AR device that can function as a secondary display. The wireless circuit board transmits signals to safety glasses worn by the surgeon using the surgical instrument during the procedure. The signals are received by a wireless port on the safety glasses. One or more lighting devices on the front lenses of the safety glasses can change color, go dark, or glow in response to the received signals to provide the surgeon with information regarding the status of the surgical instrument. The lighting devices can be positioned on the periphery of the front lens so as not to obstruct the surgeon's direct line of sight. Further examples are described in U.S. Patent No. 9,011,427, entitled "SURGICAL INSTRUMENT WITH SAFETY GLASSES," filed April 21, 2015, which is incorporated herein by reference in its entirety.

[0284] FIG. 18 shows one variation of safety glasses 6991 that a surgeon 6992 may wear while using a medical device during a surgical procedure. In use, a wireless communication board housed within the surgical instrument 6993 may communicate with a wireless port 6994 on the safety glasses 6991. While the exemplary surgical instrument 6993 is a battery-powered device, the instrument 6993 may also be powered by a cable or other method. The instrument 6993 includes an end effector. In particular, the wireless communication board 6995 transmits one or more wireless signals, indicated by arrows (B, C), to the wireless port 6994 of the safety glasses 6991. The safety glasses 6991 receive the signals, analyze the received signals, and display the indicated status information on the lenses 6996 to a user, such as the surgeon 6992, wearing the safety glasses 6991. Additionally or alternatively, the wireless communication board 6995 transmits a wireless signal to the surgical monitor 6997 as described above, thereby enabling the surgical monitor 6997 to display the received and indicated status information to the surgeon 6992.

[0285] One variation of the safety glasses 6991 may include a lighting device on the periphery of the safety glasses 6991. The lighting device provides peripheral visual sensory feedback of the device 6993 that the safety glasses 6991 communicate to a user wearing the safety glasses 6991. The lighting device may be, for example, a light-emitting diode ("LED"), a series of LEDs, or any other suitable lighting device known to those skilled in the art and apparent to those skilled in the art in view of the teachings herein.

[0286] As shown in FIG. 39, if the visualization control mode supports AR capabilities, in 17523 the hub may overlay overlay information onto the primary display via the secondary display when it detects that a user of the secondary display is looking at the primary display.

[0287] In one example, the primary display can display a live stream of the surgical site in the surgical operating room from a medical imaging device, and the secondary display can be AR glasses. As an example, a surgeon performing laparoscopic surgery wearing AR glasses can see an image of a tumor overlay on the screen. When the hub detects that the surgeon is looking down at the patient (e.g., via gesture recognition described herein, via HMD-based motion tracking, or via image recognition based on images captured by the AR glasses), the hub can instruct the AR glasses to overlay the laparoscopic image with AR content, along with the orientation of the device within the patient. This can allow the surgeon to see the overlay with the orientation of the device within the patient. Because the tumor is in three-dimensional space, with the help of the AR glasses, the surgeon can only see the outer draping of the tissue, but the surgeon can better orient the surgical instruments.

[0288] A surgical hub in communication with a particular AR device can generate and transmit different overlays based on the targeted display within the OR. Users can observe different overlays when viewing different displays without interfering with each other. The hub can tailor the information contained in the overlays based on different displays within the OR, the particular situation, information received from the surgical device, particular user requirements, and / or the particular surgical procedure.

[0289] In an exemplary visualization control mode supporting targeted AR content, individual users may have different display devices that can function in concert with the shared display. Different display devices may be provided with different AR content to overlay on the shared display, allowing users to view personally directed information or overlaid data that only they can see and / or interact with. An exemplary interactive surgical system is described in detail in U.S. Patent Application No. 15 / 940,671, entitled "SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER," filed March 29, 2018 (Attorney Docket No. END8502USNP), which is incorporated herein by reference in its entirety.

[0290] The augmentation of the user's perception can be, for example, vision via AR glasses or a local display. For example, Figures 28 and 34A-34C provide exemplary visual augmentation of the user's perception. Further examples of visual augmentation are described in U.S. Patent Application No. 15 / 940,704, filed March 29, 2018, entitled "USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT" (Attorney Docket No. END8504USNP), which is incorporated herein by reference in its entirety.

[0291] The user's sensory enhancement may be audible, for example. The audible overlay may be provided via an earphone set with pass-through noise capability and / or via a bone conduction speaker system.

[0292] The surgical hub may adjust visual, audible, and / or other types of user perception enhancements based on its situational awareness capabilities as described herein. AR content may be adjusted, for example, based on detected surgical progress. AR content may be adjusted based on actions, voice commands, hand gestures, and / or in a predetermined manner that the user is performing. AR devices may be commanded to operate by the user in pre-customizable manners.

[0293] The AR content may include pre-operative imaging, intra-operative imaging, instrument data, or treatment instructions. Intra-operative imaging can be obtained via indocyanine green (ICG) fluorescence imaging. The AR content may include real-time surgical data received from another connected system. The AR content may include steps for use, device settings, device instructions for use, device status, operating parameters, detected irregularities, or some combination of data derived from instrument operation.

[0294] 43 shows an example flow of hub operation under visualization control mode with AR capabilities. The hub can obtain AR control parameters for controlling multiple AR devices at 17701. The AR control parameters for controlling multiple AR devices can include a user role, a user orientation relative to the display, a progress of the surgical procedure, a surgical context, real-time user input, and / or pre-configured user preferences.

[0295] The hub may then determine different AR content to overlay over the different AR devices based on the AR control parameters at 17702. Based on the determined AR content for the different AR devices, the hub may transmit the respective AR content to the respective AR devices at 17703.

[0296] The AR content may include steps for use associated with the surgical instrument, device settings, device status, device instructions for use, at least one operating parameter, or an indication of a detected abnormality.

[0297] The AR control parameter may be a user's orientation relative to the display, and different AR content to overlay via different AR devices may be determined based on the user's orientation relative to the display. FIG. 46 shows an example flow of hub operation under a visualization control mode with AR capabilities that enables overlays on various displays. The hub may obtain AR control parameters at 17730. The hub may determine overlay data to overlay on the display via the AR device based on the AR control parameters at 17731. The hub may detect a user of the AR device looking at the display at 17732. The hub may overlay the overlay data on content displayed on the display via the AR device at 17733. For example, upon determining that a user is looking at the display, the hub may generate and overlay AR content associated with the display (e.g., AR content associated with content displayed on the display). Upon determining that the user is not looking at the display, the hub may remove the AR content associated with the display from the AR device.

[0298] In an example, the AR control parameter may be a user role associated with the AR device, and different AR content for overlaying through different AR devices may be generated based on the user role associated with each AR device.

[0299] 45 shows an example flow of hub operation under visualization control mode with role-based AR capabilities. The hub may identify a first user role associated with a first AR device at 17721. The hub may determine a first overlay data set for the first AR content based on the first user role at 17722. The hub may then identify a second user role associated with the first AR device at 17723. The hub may determine a second overlay data set for the second AR content based on the second user role at 17724.

[0300] For example, the surgical hub may identify a user role associated with the AR device and a display type associated with the display. The surgical hub may determine AR content to overlay on content displayed on the display via the AR device based on the display type and the user role. The display type may be an instrument display located on a smart surgical instrument, a shared display in an operating room, or a personal display. The AR content may be adjusted based on the display type of the display on which the AR content may be overlaid. For example, when the display is a display with a larger screen, the AR content may be upsized to fit the image on the shared display. When the display is a surgical device display, the AR content may be downsized to accommodate a smaller screen. For example, if the display is a surgical device display, surgical information that may not fit on the surgical device display can be added to the AR content to make such information available to the user.

[0301] 21 illustrates an augmented reality system that can be controlled by multiple users. As shown, the system may include various OR displays 17100, including an instrument 17100(a), a primary display 17100(b), other displays 17100(c), a surgical hub 17104, and a smart device 17100(d). The hub 17104 and AR devices worn by users 17120(A), 17120(B), and 17120(C) can overlay a predefined set of overlay data layers 17110(a)-17110(e) onto the various OR displays 17100(a)-17100(e). Each of the medical professional users 17120(A), (B), and (C) may wear an augmented reality device, such as safety glasses with an AR display, AR goggles, or an HMD, as described herein. The surgical hub and / or AR device can control access to specific displays and overlay data layers.

[0302] The AR content displayed on the AR device may be generated based on the user's role, situational awareness-related data, and / or visualization control mode (e.g., subscription tier). As shown, user 17120(A)'s AR device may receive overlays 17110(a)-17110(e), and user 17120(B)'s AR device may receive only overlays 17110(b)-17110(e), based on user 17120(A)'s user role, operating context, and / or system hierarchical level. As shown in FIG. 21 , the subsets of overlay data layers received by user 17120(A)'s AR device and user 17120(B)'s AR device may be the same, but some of the overlay data layers received at the devices may be different. An exemplary interactive set of overlay data layers 17130 may include pre-operative imaging, intra-operative imaging, instrument data, procedure information, and / or data generated based on the above. As an example, users 17120(A), 17120(B), and 17120(C) may have access to different sets of overlays based on their different roles and different steps in the situation.

[0303] FIG. 44 shows an example of an exemplary flow of hub operation under visualization control with AR capabilities. At 17711, the hub may acquire AR control parameters as described herein. At 17712, the hub may acquire a data stream from a surgical instrument for display on a display. The data stream may be, or may include, a video image of a surgical site within a patient. At 17713, the hub may determine first AR content to overlay on the data stream displayed on the display via a first AR device based on the AR control parameters. The first AR content may include steps for use of the surgical instrument, device settings, device status, device instructions for use, at least one operating parameter, or an indication of a detected abnormality. At 17714, the hub may determine second AR content to overlay on the data stream displayed on the display via a second AR device based on the AR control parameters. At 17715, the hub may transmit AR content to each AR device based on the determined AR content for each AR device for display.

[0304] In an exemplary visualization control mode supporting augmented reality content, the surgical hub can overlay surgical information on an anatomical model on the display. For example, based on a determination that a user associated with the AR device is a surgeon, the surgical hub may transmit AR content to the AR device including visualizations of a tumor, tumor margins, and possible emphysema. For example, based on a determination that a user associated with the AR device is a surgeon's assistant, the surgical hub may transmit AR content including surgical steps requiring assistance, device settings, and / or device status.

[0305] FIG. 28 shows an exemplary display 5020 viewable from an AR device. The display 5020 includes screen content displayed on a screen overlaid with AR content. The display 5020 can depict an information index 5022 and a model of an anatomical structure 5024 generated by the surgical visualization system's control system. The anatomical structure 5024 can include unaffected tissue 5026 that is neither diseased nor occupied by critical structures. The model of the anatomical structure 5024 can depict detected and / or determined characteristics, such as a target tissue 5028, a predetermined margin 5030, a resection margin 5032, a first feature 5034 of the anatomical structure 5024, and an adjusted resection margin 5036. The surgical visualization system's control system 133 can designate each of these detected characteristics of the anatomical structure 5024 with a particular color, and the display 5020 can depict each of the detected characteristics with that particular designated color, as represented by the cross-hatching in FIG. 28 . The information index 5022 may correlate each particular color with information associated with its designated detected feature. For example, the information index 5022 of FIG. 28 correlates each particular color with a text description of the corresponding characteristic of the anatomical structure 5024. In other embodiments, the information index 5022 correlates each particular color with additional information related to the corresponding feature.

[0306] As depicted in FIG. 28 , the surgical visualization system can detect target tissue 5028 within an anatomical structure 5024. An information index 5022 in display 5020 can indicate that the detected target tissue 5028 is a tumor. Instructions stored in memory of the surgical visualization system's control system can instruct the control circuitry to apply a predetermined margin 5030 around the target tissue 5028 based on detected qualities of the tumor, including tumor size, geometry, and / or type. Accordingly, the control system 133 can assign a particular color to the resection margin 5030, and the information index 5022 can correlate the particular color with additional information associated with the resection margin 5030. The surgical visualization system's control circuitry can determine a resection margin 5032 around the target tissue 5028 taking into account the detected target tissue 5028 and the predetermined margin 5030. In display 5020 of FIG. 28 , the resection margin 5032 is depicted with a line segment around the anatomical structure 5024 that corresponds to the capabilities of the intended surgical instrument. For example, the surgical instrument may be a surgical stapler configured to staple tissue before cutting it in a linear stroke, however, the representation 5020 may alternatively depict the resection margin 5032 if other surgical instruments are implemented.

[0307] Display 5020 of FIG. 28 depicts a feature 5034 of an anatomical structure 5024 detected by the surgical visualization system. Information index 5022 of display 5020 of FIG. 28 may indicate that the detected feature 5034 of the anatomical structure 5024 is emphysematous damaged tissue 5026. AR content may include an initially determined resection margin 5032 of FIG. 28 , which may intersect the feature 5034 of the anatomical structure 5024. Control circuitry of the surgical visualization system may determine an adjusted resection margin 5036 to encompass the feature 5036, the target tissue 5028, and the predetermined margin 5030. The AR content may include the adjusted resection margin 5036 via a dashed line. Such AR content may allow the operating clinician to select either the initially determined resection margin 5032 or the adjusted resection margin 5036. In other embodiments, the display 5020 limits the operating clinician to an adjusted resection margin 5036 based on instructions stored in the memory of the control system.

[0308] For example, AR content may be generated for surgical planning and / or critical structure detection, etc. Referring now to FIG. 29 , a three-dimensional model 5068 of an anatomical structure 5069 is depicted generated by a surgical visualization system. The surgical visualization system may include an imaging device 5070 having a distance sensor system 5071 having an emitter 5072 configured to emit electromagnetic radiation 5074 onto the anatomical structure 5069 and a receiver 5076 configured to detect the reflected electromagnetic radiation 5074. The imaging device 5070 of FIG. 29 can utilize the spectral light, structured light, and laser Doppler techniques described above to identify critical structures, such as a tumor 5078, and generate a fully integrated model 5068 and detailed characterization of the anatomical structure 5069. For example, the three-dimensional model 5068 in Figure 25 may depict the anatomical structure 5069 as the upper lobe of the right lung and may specifically depict various features of the anatomical structure 5069, such as an artery 5080, a vein 5082, a bronchus 5084, an upper lobe bronchus 5086, a right pulmonary artery 5090, and / or a main bronchus 5092. While the anatomical structure 5069 in Figure 29 is a lung, the surgical visualization system may model various anatomical structures depending on the intended implementation. Thus, the surgical visualization system may use spectral light, structured light, and / or laser Doppler to characterize any anatomical structure and display the detected features in detail in the three-dimensional model.

[0309] The AR content may include proximity alerts when the distal tip of the surgical instrument moves within a certain range of the critical structure 5078. For example, real-time three-dimensional spatial tracking of the distal tip of the surgical instrument may be performed. The distance sensor system 5071 of the imaging device 5070 may be positioned on the distal tip of the surgical instrument. Thus, the emitter 5072 can emit electromagnetic radiation 5074 onto the surface of the anatomical structure 5069, and the receiver 5076 can detect the electromagnetic radiation 5074 reflected from the surface of the anatomical structure 5069. The surgical visualization system can determine the position of the emitter 5072 relative to the surface of the anatomical structure 5069 based on the time-of-flight of the electromagnetic radiation 5074, or the time between emission from the emitter 5072 and its detection by the receiver 5076. The surgical visualization system uses a distance sensor system 5071 and time-of-flight technology to determine the position of the surgical instrument relative to the anatomical structure 5069, although other suitable components and / or techniques may be used to achieve the same effect, including the position of the surgical instrument within a three-dimensional model 5068 of the anatomical structure 5069.

[0310] In an example, the AR control parameter may be the progress of a surgical procedure, and different AR content for overlaying via different AR devices may be determined based on the progress of the surgical procedure. For example, based on the surgical progress approaching an amputation, AR content provided to an AR device associated with a surgeon may include a suggested amputation path. AR content provided to another AR device may include a notification that the surgery is reaching a critical stage.

[0311] 30 , a display of the three-dimensional model 5068 of FIG. 29 is depicted, in accordance with at least one embodiment of the present disclosure. The AR content may include a resection margin overlay configured to depict a user-selected cutting path 5096 and a system-proposed cutting path 5104. For example, the resection margin overlay may further depict detected features, such as an artery 5080, a vein 5082, and a bronchi 5084, detected target tissue, such as a tumor 5094, and / or a predetermined margin 5095 based on instructions stored in memory 134 ( FIG. 2 ). The operating clinician may review the AR content superimposed or overlaid on the surgical display to determine the user-selected cutting path 5096 for removing the tumor 5094 and the predetermined margin 5095. For example, the operating clinician may determine the user-selected cutting path 5096 that can optimize the remaining volume of an anatomical structure 5069, such as lung volume. Thus, the operating clinician can provide a user-selected cutting path 5096 to the surgical visualization system via the user interface.

[0312] The surgical visualization system can receive the user-selected cut path 5096 via the user interface and evaluate the user-selected cut path 5096 against the locations of any detected features of the anatomical structure 5069. For example, as depicted in FIG. 30 , the surgical visualization system can identify that the user-selected cut path 5096 interferes with an artery 5080, a vein 5082, and a bronchus 5084 of the anatomical structure 5069. Accordingly, the combined view 5093 (e.g., a surgical display overlaid with AR content) can depict the predicted interference and issue a notification to the operating clinician. The notification can be visual, audible, tactile, and / or any combination thereof. The display may further highlight features or portions of the anatomical structure 5069 that are affected by the user-selected cut path 5096 and / or portions of the anatomical structure 5069 that may be rendered non-viable by the user-selected cut path 5096. For example, the AR content may highlight a cut portion 5098 of an artery 5080 to represent the blood supply 5100 that will be affected by the user-selected cut path 5096. The AR content may highlight a portion 5102 of the anatomical structure 5069 that may be rendered non-viable due to a lack of blood or air by the user-selected cut path 5096.

[0313] Additionally and / or alternatively, the AR content may include a system-suggested cutting path 5104 that optimizes the remaining volume of the anatomical structure 5069, removes the target tissue 5094 and predetermined margin 5095, and minimizes detrimental effects on the detected features of the anatomical structure 5069. For example, the system-suggested cutting path 5104 may maintain a small remaining volume of the anatomical structure 5069, but may not interfere with the artery 5080, vein 5082, and bronchi 5084, and still remove the tumor 5094 and predetermined margin 5095 from the upper lobe of the lung. In some aspects, the surgical visualization system may allow the operating clinician to select either the user-selected cutting path 5096 or the system-suggested cutting path 5104. In other aspects, the surgical visualization system may allow the operating clinician to reject the system-suggested cutting path 5104 and input a second user-selected cutting path based on the information depicted on the display.

[0314] 31 , AR content is depicted in combination with a display view 5106 of a three-dimensional model 5108 of an anatomical structure 5110 generated by a surgical visualization system 5107, in accordance with at least one aspect of the present disclosure. The surgical visualization system 5107 may include a surgical instrument 5109 having a distance sensor system, a structured light system, a spectral light system, or any combination thereof. A operative clinician can examine the display 5106 to determine a user-selected cutting path 5112 for removing target tissue from the anatomical structure 5110. The surgical visualization system 5107 of FIG. 31 can receive the user-selected cutting path 5112 via a user interface and evaluate the user-selected cutting path 5112 against the location of any detected features of the anatomical structure 5110. For example, the surgical visualization system 5107 of FIG. 31 has identified that the user-selected cutting path 5112 may interfere with a withered portion 5114 of the anatomical structure 5110. The withered portion 5114 of the anatomical structure 5110 can adversely affect the resection of the target tissue and may result in post-operative complications, including a less-than-optimal residual volume of the anatomical structure 5110. Thus, the AR content can include indications of anticipated problems and notifications to the clinician during the procedure. Notifications can be visual, audible, tactile, and / or any combination thereof.

[0315] Additionally and / or alternatively, the AR content shown in FIG. 31 can depict a system-suggested cutting path 5116, which can be overlaid on the display. The system-suggested path can optimize the remaining volume of the anatomical structure 5110, remove target tissue and a predetermined margin, and / or minimize adverse effects caused by detected features of the anatomical structure 5110. For example, cutting deflated tissue 5114 can complicate the surgical procedure and introduce unnecessary risk. The system-suggested cutting path 5116 of FIG. 31 minimizes risk by teaching the operating clinician fully inflated tissue of the anatomical structure 5110. In some aspects, the surgical visualization system 5107 may allow the operating clinician to select either the user-selected cutting path 5112 or the system-suggested cutting path 5116. In other aspects, the surgical visualization system 5107 may allow the operating clinician to reject the system-suggested cutting path 5116 and enter a second user-selected cutting path based on the information depicted on the display 5106.

[0316] The surgical instruments described herein can be configured with a distance sensor system or other means that allows the surgical visualization system to detect the position of the surgical instrument relative to the anatomical structure. The surgical visualization systems described herein can also issue a notification via the AR device to inform the operating clinician if the detected position of the surgical instrument does not match the selected cutting path. The surgical visualization system can issue a visual, audible, and / or tactile notification to the operating clinician via the AR device indicating that the surgical instrument should be repositioned before beginning the surgical procedure. In some aspects, the surgical visualization system can prevent the operating clinician via the AR device from performing the surgical procedure until the surgical instrument is properly positioned according to the selected cutting path depicted on the display.

[0317] The display of automatically adjustable tumor margins based on visually identified key structures, anomalies, and instrument-detected tissue attributes is further described in U.S. patent application Ser. No. 16 / 729,778, entitled "SYSTEM AND METHOD FOR DETERMINING, ADJUSTING, AND MANAGING RESECTION MARGIN ABOUT A SUBJECT TISSUE," filed December 31, 2019 (Attorney Docket No. END9219USNP1), which is incorporated herein by reference in its entirety.

[0318] In an example, the AR content may include a visualization of an obstructed portion of a surgical site. The visualization of the obstructed portion of a surgical site may be overlaid on a live stream of the surgical site in a surgical operating room from a medical imaging device. The visualization of the obstructed portion of a surgical site may be generated using a multispectral EMR source.

[0319] FIG. 32 illustrates an exemplary fused image generated from a multispectral EMR source. The fused image can be generated using image data from at least three different EMR wavelength ranges to generate a resulting image. Multiple images can be used to collectively visualize the surgical site in corresponding EMR wavelength ranges. For example, a first image can be captured using the visible light portion of the EMR spectrum and include a first unobstructed portion, with the remainder of the image being obstructed; a second image can be captured using the MWIR portion of the EMR spectrum and include a second unobstructed portion; and a third image 3042c can be captured using the LWIR portion of the EMR spectrum and include a third unobstructed portion. For example, a fourth image can be captured using the visible light portion of the EMR spectrum and thus correspond to the first image, but can include additional image processing to identify portions obstructed by fluid (water). Accordingly, the corresponding portion of the first image can be filtered at a corresponding wavelength or wavelength range (e.g., the blue-green portion of the visible light spectrum) to remove obstructions.

[0320] A combined or fused image 3070 may be generated from the initial images. The fused image 3070 may include a first portion 3072 corresponding to an unobstructed portion of a first image generated from the visible light portion of the EMR spectrum, a second portion 3074 corresponding to an unobstructed portion of a second image generated from the MWIR portion of the EMR spectrum, a third portion 3076 corresponding to an unobstructed portion of a third image generated from the LWIR portion of the EMR spectrum, and a fourth portion 3078 corresponding to an obscured portion of an image generated from the visible light portion of the EMR spectrum but post-processed to remove the blue-green portion of the visible light spectrum. Each of the image portions 3072, 3074, 3076, 3078 may be fused together to generate the fused image 3070, which provides an unobstructed visualization of the tumor 3038 and any other associated structures 3040.

[0321] The use of fused images is described in detail in U.S. Patent Application No. 16 / 729,807, entitled "METHOD OF USING IMAGING DEVICES IN SURGERY," filed December 31, 2019 (Attorney Docket No. END9228USNP1), which is incorporated herein by reference in its entirety.

[0322] 34A-34C illustrate an example series of surgical steps for the removal of a bowel / colon tumor that could benefit from AR content generated using multi-image analysis at the surgical site. FIG. 34A depicts a portion of a surgical site including an intestine 2932 and a branching vasculature 2934 that supplies blood and nutrients to the intestine 2932. The intestine 2932 may have a tumor 2936 surrounded by a tumor margin 2937. A first optical sensor module of the visualization system may have a wide field of view 2930 and may provide imaging data of the wide field of view 2930 to a display system. A second optical sensor module of the visualization system may have a narrow or standard field of view 2940 and may provide imaging data of the narrow field of view 2940 to a display system. In some embodiments, the wide field and narrow field images may be displayed by the same display device. In other embodiments, the wide field and narrow field images may be displayed by separate display devices.

[0323] During surgery, it may be important to remove not only the tumor 2936 but also its surrounding margin 2937 to ensure complete removal of the tumor. The wide-angle field of view 2930 may be used to image both the vasculature 2934 and the portion of the intestine 2932 surrounding the tumor 2936 and margin 2637. As described above, the vasculature supplying the tumor 2936 and margin 2637 should be removed, but the vasculature supplying the surrounding intestinal tissue must be preserved to provide oxygen and nutrients to the surrounding tissue. Migration of the vasculature supplying the surrounding colon tissue removes oxygen and nutrients from the tissue, resulting in necrosis. In some examples, laser Doppler imaging of the tissue visualized within the wide-angle field of view 2630 can be analyzed to provide speckle contrast analysis 2933 indicative of blood flow within the intestinal tissue.

[0324] The AR content may include an indication of blood flow within the tissue. For example, the AR content may include an indication of which portion of the vascular tree may supply blood to a tumor. FIG. 34B illustrates a step during a surgical procedure. The surgeon may be uncertain about which portion of the vascular tree supplies blood to the tumor 2936. The surgeon may test a blood vessel 2944 to determine whether it supplies the tumor 2936 or healthy tissue. The surgeon may clamp the blood vessel 2944 using a clamping device 2812 and determine by speckle contrast analysis the portion of the intestinal tissue 2943 that is no longer perfused. The narrow field of view 2940 displayed on the imaging device may assist the surgeon in the magnification and detail needed to visualize the single blood vessel 2944 being tested. Once the suspected blood vessel 2944 is clamped, a portion of the intestinal tissue 2943 is determined to lack perfusion based on Doppler imaging speckle contrast analysis. Suspect vessel 2944 does not supply blood to tumor 2935 or tumor margin 2937 and is therefore recognized as a spare vessel during the surgical procedure.

[0325] 34C depicts the next stage of the surgical procedure. In this stage, a supply vessel 2984 has been identified that supplies blood to the tumor margin 2937. When this supply vessel 2984 is severed, blood will no longer be supplied to a portion of the intestine 2987, which may include at least a portion of the tumor 2936 margin 2937. In some embodiments, the lack of perfusion to the portion of the intestine 2987 may be determined by speckle contrast analysis based on Doppler analysis of blood flow into the intestine. The non-perfused portion of the intestine 2987 may then be isolated by a seal 2985 applied to the intestine. In this way, only the vessels that perfuse the tissue indicated for surgical removal are identified and sealed, thereby sparing healthy tissue from unintended surgical consequences.

[0326] The AR content may be generated based on imaging analysis of the surgical site. The surgical site may be inspected for the effectiveness of surgical manipulation of tissue. Non-limiting examples of such inspections may include inspection of surgical staples or welds used to seal tissue at the surgical site. Cone beam coherence tomography, using one or more illumination sources, may be used for such methods. The AR content may include landmarks indicated within images of the surgical site. In some examples, the landmarks may be determined by image analysis techniques. In some examples, the landmarks may be indicated by manual intervention of the image by the surgeon. In some aspects, non-smart-ready visualization methods may be imported for use with the hub image fusion technology.

[0327] Instruments not integrated into the hub system may be identified and tracked during use within the surgical site. In this aspect, the hub's computing and / or storage components (including, for example, a cloud system) may include a database of images of EES and competitive surgical instruments that can be identified from one or more images acquired by any image acquisition system or visual analysis of such alternative instruments. Such imaging analysis of the device may further enable identification when an instrument is replaced with a different instrument to perform the same or similar job. Identifying an instrument replacement during a surgical procedure may provide relevant information when an instrument does not perform the device's job or malfunctions.

[0328] In an example, the AR content may include anatomical identification information that may be generated based on preoperative images. The AR content may be overlaid on a video image of the surgical site within the patient. The anatomical identification information may be overlaid on a live stream of the surgical site within the surgical operating room from a medical imaging device.

[0329] FIG. 35 shows an example of an augmented video image 6350 including a pre-operative video image 6352 augmented with data 6354, 6356, 6358 identifying the displayed elements. AR data can be overlaid or superimposed on the pre-operative image 6352 via an AR device. A pre-operative image 6352 of an anatomical cross-section of the patient can be generated. An augmented video image of a surgical site within the patient may be generated. The augmented video image 6350 can include an image of at least a portion of a surgical tool 6354 manipulated by a user 6356. The pre-operative image 6352 can be processed to generate data about the patient's anatomical cross-section. The AR content can include a label 6358 of the anatomical cross-section and a peripheral margin of at least a portion of the anatomical cross-section. The peripheral margin can be configured to guide the surgeon to a cutting position relative to the anatomical cross-section, embed data and identification of the user 6356 within the pre-operative image 6350, and display the augmented video image 6350 of the patient's anatomical cross-section to the user. A load condition on the surgical tool 6354 can be sensed, and a feedback signal can be generated based on the sensed load condition. The AR content, including the identity and position of the user manipulating the surgical tool 6354, can be updated in real time in response to changes in the position of the surgical tool 6354 within the augmented video image 6350. Further examples are disclosed in U.S. Patent No. 9,123,155, entitled "APPARATUS AND METHOD FOR USING AUGMENTED REALITY VISION SYSTEM IN SURGICAL PROCEDURES," issued September 1, 2015, which is incorporated herein by reference in its entirety.

[0330] Radiography integration techniques can be used to overlay the preoperative images 6352 with data obtained by live internal sensing or pre-procedure techniques. Radiography integration can include marker and landmark identification using surgical landmarks, radiographic markers placed inside and outside the patient, and identification of radiopaque staples, clips, or other tissue fixation items. Digital radiography techniques can be used to generate digital images for overlay with the preoperative images 6352. Digital radiography is a form of x-ray imaging that uses a digital image capture device with a digital x-ray sensor instead of traditional photographic film. Digital radiography techniques can provide instant image preview and usability for overlay with the preoperative images 6352. Additionally, special image processing techniques can be applied to digital x-ray images to improve the overall display quality of the image.

[0331] Digital radiology technology can use image detectors, including flat panel detectors (FPDs), which are divided into two major categories: indirect and direct FPDs. Indirect FPDs include amorphous silicon (a-Si) combined with a scintillator in the outer layer of the detector, made from cesium iodide (CSI) or gadolinium oxysulfide (Gd2O2S), which converts X-rays into light. The light can pass through an a-Si photodiode layer, where it is converted into a digital output signal. The digital signal is then read out by a thin-film transistor (TFT) or fiber-coupled charge-coupled device (COD). Direct FPDs include amorphous selenium (a-Se) FPDs, which directly convert X-ray photons into electrical charges. The outer layer of the flat panel in this design is typically a high-voltage bias electrode. X-ray photons generate electron-hole pairs in a-Se, and the passage of these electrons and holes depends on the potential of the bias voltage charge. When holes are replaced by electrons, the resulting charge pattern in the selenium layer is read out by TFT arrays, active matrix arrays, electrometer probes, or microplasma line addressing. Other direct digital detectors are based on CMOS and CCD technology. Phosphor detectors may also be used to record the X-ray energy during exposure, scanned by a laser diode to excite the stored energy, which is released and read out by a CCD digital image capture array.

[0332] In an example, the AR control parameters may be real-time user input, and different AR content for overlaying through different AR devices may be determined based on the user input. For example, a user interface may be presented for a user to select one or more AR contents for display on the AR device. The hub may generate and transmit the AR content according to the user selection.

[0333] FIG. 36 shows an example of a customizable AR content overlay. As shown, AR content options 17410 may be presented, for example, on an interactive display screen. AR content options 17410 may include available overlay layers, which may include pre-operative tumor MRI, other relevant pre-operative data, ICG data, real-time Doppler monitoring, treatment steps, device status, and other overlays customizable by the user. The overlay layers may be provided by the hub. In this example, pre-operative tumor data and real-time Doppler monitoring have been selected, and such data is included in the AR content overlaid on the surgical image. Through the AR device, the user can view a vision 17420 showing two selected overlays: the pre-operative tumor MRI and the real-time Doppler monitoring. As shown, the AR content may include markings of the tumor 14733 and tumor margin 17432. With the help of the overlays, the user can clamp jaws 17436 onto a blood vessel to verify whether the vessel is within or outside the tumor margin. The AR content may show blood flow through the vessel. For example, whether a blood vessel is associated with low or high blood flow may be indicated via color coding in the AR content. To illustrate, the AR content may include changing low blood flow vessels 17434 to blue blood vessels and changing high blood flow vessels 17438 to red.

[0334] A hub communicating with an augmented reality device can provide a simulation or confirmation of an intended action. The AR content can include an indication of a predicted outcome if the user performs the intended action. As an example, when a user clamps or has jaws over an intended area to staple, cut, or seal, the AR content can show the user a change in fluid flow. This can provide the user with guidance to move in one direction or another. For example, a surgical hub can receive instructions of an intended action relative to a target area. The instructions can include an image captured through a surgical scope showing a surgical instrument positioned on or proximate to the target area. The instructions may also include an image captured through an AR device showing a surgical instrument positioned on or proximate to the target area. For example, AR content can be generated based on microwave ablation confirmation, which can show a predicted output based on time and temperature. The surgical hub can receive visual input from a camera in the OR and sensor input from a surgical device in the OR. The surgical hub can combine and compile the received inputs and generate confirmation and / or feedback of the expected results for inclusion in the AR content. The hub can combine the various data streams into a coherent output, which can be overlaid or shown on a display, including a primary display and / or a secondary display, an AR display, and / or a non-AR display. The surgical hub can obtain predicted outcomes associated with performing the intended action on the target area and include the predicted outcomes in the AR content. The predicted outcomes can be determined based on visual data received from the surgical scope and surgical data received from the surgical instruments. The predicted outcomes can be determined by the surgical hub or with the assistance of a remote server. For example, the surgical hub can obtain visual data from the surgical scope and sensor input data from at least one surgical instrument and transmit the visual data and sensor input data to a remote server.The prediction results may be received from a remote server and included in AR content for display on the AR device.

[0335] FIG. 44 shows an example of an exemplary flow of hub operation under visualization control with AR capabilities. AR content for overlaying on the display can vary depending on the AR device. At 17711, the hub can acquire AR control parameters as described herein. The AR control parameters can include at least one of a user role, a user orientation relative to the first display, a surgical procedure progress, a surgical context, real-time use input, or pre-configured user preferences. At 17712, the hub can acquire a data stream from a surgical instrument for display on the display. The data stream can be or include a video image of a surgical site within a patient. At 17713, the hub can determine AR content for overlaying on the data stream displayed on the display via the first AR device based on the AR control parameters. An AR device for use by a surgeon may display different AR content than AR content displayed via an AR device for use by the surgeon's assistant. An AR device with one pre-configured user preference can display different AR content than AR content displayed via an AR device with a different pre-configured user preference. The AR content may include steps for use associated with the surgical instrument, device settings, device status, device instructions for use, operating parameters, and / or an indication of a detected abnormality. At 17714, the hub can determine AR content to overlay on the data stream displayed on the display via the second AR device based on the AR control parameters. At 17715, the hub can transmit AR content to each AR device based on the determined AR content for each AR device for display.

[0336] The following list of embodiments forms part of the description. 1. A surgical hub comprising: a communications array operatively connected to the primary and secondary displays, the laparoscopic scope, and the at least one surgical instrument; a processor, wherein the processor: Obtaining a visualization control mode based on the visualization control parameter; generating first visualization data for a primary display; determining whether to generate second visualization data for the secondary display based on the obtained visualization control mode; and transmitting data for display on at least one of the primary display or the secondary display based on the determination. Surgical Hub. 2. The processor: generating second visualization data for a secondary display based on a determination that the visualization and control mode indicates support for multiple display capabilities; 10. The surgical hub of claim 1, further configured to: disable generating second visualization data for the secondary display based on a determination that the visualization and control mode does not support multiple display capabilities. 3. The surgical hub of embodiment 1, wherein the visualization control parameters include at least one of available memory, available data bandwidth, heat generated by the surgical hub, heat generated by the secondary display, power capacity associated with the surgical hub, power capacity associated with the operating room, power capacity associated with the medical facility, power usage, balance of power consumption for at least one attached system, processor utilization, or memory utilization. 4. The surgical hub of embodiment 1, wherein the visualization control parameters include at least one of a subscription level associated with the surgical display, a user preference associated with the surgical display, hardware capabilities associated with the surgical hub, the primary display, and the secondary display, software capabilities associated with the surgical hub, the primary display, and the secondary display, or instructions from a hierarchical control system. 5. The processor: receiving an instruction to change the visualization control mode to an updated visualization control mode; 10. The surgical hub of embodiment 1, further configured to: transmit data for display on at least one of the primary display or the secondary display based on the updated visualization control mode. 6. The processor: receiving data from a plurality of smart surgical devices; 10. The surgical hub of embodiment 1, further configured to: combine the received data for display on the primary display. 7. The processor: The surgical hub of embodiment 1, further configured to determine whether to generate second visualization data based on a user role associated with the secondary display based on the visualization control mode. 8. The processor: The surgical hub of embodiment 1, further configured to determine whether to generate second visualization data based on non-contact control parameters based on the visualization control mode, the non-contact control parameters including at least one of detected user movement, detected head orientation relative to the monitor, detected user hand gestures, or user voice activation. 9. The processor: determining whether to receive a visualization control instruction indicating a display change on at least one of the primary display or the secondary display based on the visualization control mode; The surgical hub of embodiment 1, further configured to: based on a decision to receive a visualization control instruction, generate first visualization data or second visualization data for display based on a display change indicated in the visualization control instruction. 10. The secondary display is an augmented reality device, and the processor: determining whether to generate overlay information for overlaying on the primary display via the secondary display based on the visualization control mode; The surgical hub of embodiment 1, further configured to generate overlay information based on a determination that the visualization control mode supports augmented reality, and to overlay the overlay information on the primary display via the secondary display when detecting that a user of the secondary display is looking at the primary display. 11. A method for a surgical hub operably connected to a primary display and a secondary display, a laparoscopic scope, and at least one surgical instrument, comprising: Obtaining a visualization control mode based on the visualization control parameter; generating first visualization data for a primary display; determining whether to generate second visualization data for the secondary display based on the obtained visualization control mode; and transmitting data for display on at least one of the primary display or the secondary display based on the determination. 12. generating second visualization data for a secondary display based on determining that the visualization and control mode indicates support for multiple display capabilities; 12. The method of embodiment 11, further comprising: disabling generating second visualization data for the secondary display based on a determination that the visualization and control mode does not support multiple display capabilities. 13. The method of embodiment 11, wherein the visualization control parameters include at least one of available memory, available data bandwidth, heat generated by the surgical hub, heat generated by the secondary display, power capacity associated with the surgical hub, power capacity associated with the operating room, power capacity associated with the medical facility, power usage, a balance of power consumption for at least one attached system, processor utilization, or memory utilization. 14. The method of embodiment 11, wherein the visualization control parameters include at least one of a subscription level associated with the surgical display, a user preference associated with the surgical display, hardware capabilities associated with the surgical hub, the primary display, and the secondary display, software capabilities associated with the surgical hub, the primary display, and the secondary display, or instructions from a hierarchical control system. 15. Receiving an instruction to change the visualization control mode to the updated visualization control mode; 12. The method of embodiment 11, further comprising: transmitting data for display on at least one of the primary display or the secondary display based on the updated visualization control mode. 16. Receiving data from a plurality of smart surgical devices; 12. The method of Example 11, further comprising: combining the received data for display on the primary display. 17. The method of embodiment 11, further comprising: determining whether to generate second visualization data based on a user role associated with the secondary display based on the visualization control mode. 18. The method of embodiment 11, further comprising: determining whether to generate second visualization data based on a visualization control mode and based on non-contact control parameters, the non-contact control parameters including at least one of a detected user movement, a detected head orientation relative to the monitor, a detected user hand gesture, or a user voice activation. 19. determining whether to receive a visualization control instruction indicating a display change on at least one of the primary display or the secondary display based on a visualization control mode; The method of embodiment 11, further comprising: based on a decision to receive a visualization control instruction, generating first visualization data or second visualization data for display based on a display change indicated in the visualization control instruction. 20. Determining whether to generate overlay information for overlaying on the primary display via the secondary display based on the visualization control mode; The method of embodiment 11, further comprising: generating overlay information based on a determination that the visualization control mode supports augmented reality; and overlaying the overlay information on the primary display via the secondary display when detecting that a user of the secondary display is looking at the primary display.

[0337] [Embodiment] (1) A surgical hub, a communications array configured to be operatively connected to the primary and secondary displays, the laparoscopic scope, and the at least one surgical instrument; a processor, the processor Obtaining a visualization control mode based on the visualization control parameter; generating first visualization data for the primary display; determining whether to generate second visualization data for the secondary display based on the obtained visualization control mode; and and transmitting data for display on at least one of the primary display or the secondary display based on the determination. Surgical Hub. (2) The processor: generating the second visualization data for the secondary display based on a determination that the visualization and control mode supports multiple display capabilities; and 2. A surgical hub as described in embodiment 1, further configured to: disable generating the second visualization data for the secondary display based on a determination that the visualization and control mode does not support multiple display capabilities. (3) A surgical hub as described in embodiment 1 or 2, wherein the visualization control parameters include at least one of available memory, available data bandwidth, heat generated by the surgical hub, heat generated by the secondary display, power capacity associated with the surgical hub, power capacity associated with the operating room, power capacity associated with the medical facility, power usage, balance of power consumption for at least one attached system, processor utilization, or memory utilization. (4) A surgical hub described in any of embodiments 1 to 3, wherein the visualization control parameters include at least one of user preferences associated with a surgical display, hardware capabilities associated with the surgical hub, the primary display, and the secondary display, software capabilities associated with the surgical hub, the primary display, and the secondary display, or instructions from a hierarchical control system. (5) The processor: receiving an instruction to change the visualization control mode to an updated visualization control mode; A surgical hub as described in any of claims 1 to 4, further configured to: transmit data for display on at least one of the primary display or the secondary display based on the updated visualization control mode.

[0338] (6) The processor: receiving data from a plurality of smart surgical devices; A surgical hub as described in any of claims 1 to 5, further configured to combine the received data for display on the primary display. (7) The processor: A surgical hub as described in any of embodiments 1 to 6, further configured to determine whether to generate the second visualization data based on the visualization control mode and based on a user role associated with the secondary display. (8) The processor: A surgical hub as described in any of embodiments 1 to 7, further configured to determine whether to generate the second visualization data based on non-contact control parameters based on the visualization control mode, wherein the non-contact control parameters include at least one of detected user movement, detected head orientation relative to a monitor, detected user hand gestures, or user voice activation. (9) The processor: determining whether to receive a visualization control instruction indicating a display change on at least one of the primary display or the secondary display based on the visualization control mode; A surgical hub as described in any of embodiments 1 to 8, further configured to: based on a decision to receive the visualization control instruction, generate the first visualization data or the second visualization data for display based on the display changes indicated in the visualization control instruction. (10) The secondary display is an augmented reality device, and the processor: determining whether to generate overlay information for overlaying on the primary display via the secondary display based on the visualization control mode; A surgical hub as described in any of embodiments 1 to 9, further configured to generate the overlay information based on a determination that the visualization control mode supports augmented reality, and to overlay the overlay information on the primary display via the secondary display when detecting that a user of the secondary display is looking at the primary display.

[0339] (11) A method for a surgical hub operably connected to a primary display and a secondary display, a laparoscopic scope, and at least one surgical instrument, comprising: Obtaining a visualization control mode based on the visualization control parameter; generating first visualization data for the primary display; determining whether to generate second visualization data for the secondary display based on the obtained visualization control mode; and and transmitting data for display on at least one of the primary display or the secondary display based on the determination. (12) generating the second visualization data for the secondary display based on a determination that the visualization and control mode supports multiple display capabilities; and Disabling generating the second visualization data for the secondary display based on a determination that the visualization and control mode does not support multiple display capabilities; and 12. The method of embodiment 11, further comprising: (13) The method of embodiment 11 or 12, wherein the visualization control parameters include at least one of available memory, available data bandwidth, heat generated by the surgical hub, heat generated by the secondary display, power capacity associated with the surgical hub, power capacity associated with the operating room, power capacity associated with the medical facility, power usage, balance of power consumption for at least one attached system, processor utilization, or memory utilization. (14) A method according to any of...

Claims

1. 1. A surgical hub comprising: a communications array configured to be operatively connected to the primary and secondary displays, the laparoscopic scope, and the at least one surgical instrument; a processor, wherein the processor: receiving an image from the laparoscope; obtaining a visualization control mode based on visualization control parameters, the visualization control parameters including at least one of available computing resources, available network resources, available electrical resources, and heat generated by the surgical hub; generating first visualization data for the primary display, the first visualization data including the image received from the laparoscopic scope; determining whether to generate second visualization data for the secondary display based on the obtained visualization control mode, the second visualization data being different from the first visualization data; and transmitting data for display on at least one of the primary display or the secondary display based on the determination; determining whether to generate the second visualization data includes determining whether the visualization control mode supports multiple display capabilities; determining whether to generate the second visualization data is further configured to either generate the second visualization data for the secondary display if the visualization control mode supports multiple display capabilities, or disable generating the second visualization data for the secondary display if the visualization control mode does not support multiple display capabilities. Surgical Hub.

2. A surgical hub as described in claim 1, wherein the visualization control parameters include at least one of available memory, available data bandwidth, heat generated by the secondary display, power capacity associated with the surgical hub, power capacity associated with an operating room, power capacity associated with a medical facility, power usage, a balance of power consumption for at least one attached system, processor utilization, or memory utilization.

3. A surgical hub as described in claim 1 or 2, wherein the visualization control parameters include at least one of user preferences associated with a surgical display, hardware capabilities associated with the surgical hub, the primary display, and the secondary display, software capabilities associated with the surgical hub, the primary display, and the secondary display, or instructions from a hierarchical control system.

4. the processor: receiving an instruction to change the visualization control mode to an updated visualization control mode; 4. The surgical hub of claim 1, further configured to: transmit data for display on at least one of the primary display or the secondary display based on the updated visualization control mode.

5. the processor: receiving data from a plurality of smart surgical devices; The surgical hub of any one of claims 1 to 4, further configured to: combine the received data for display on the primary display.

6. the processor:

6. The surgical hub of claim 1, further configured to determine whether to generate the second visualization data based on the visualization control mode and based on a user role associated with the secondary display.

7. the processor:

7. The surgical hub of claim 1, further configured to: determine whether to generate the second visualization data based on non-touch control parameters based on the visualization control mode, the non-touch control parameters including at least one of a detected user movement, a detected head orientation relative to a monitor, a detected user hand gesture, or a user voice activation.

8. the processor: determining whether to receive a visualization control instruction indicating a display change on at least one of the primary display or the secondary display based on the visualization control mode; 8. The surgical hub of claim 1, further configured to: based on a determination to receive the visualization control instruction, generate the first visualization data or the second visualization data for display based on the display changes indicated in the visualization control instruction.

9. the secondary display is an augmented reality device, and the processor: determining whether to generate overlay information for overlaying on the primary display via the secondary display based on the visualization control mode; 9. The surgical hub of claim 1, further configured to generate the overlay information based on a determination that the visualization control mode supports augmented reality, and to overlay the overlay information on the primary display via the secondary display upon detecting that a user of the secondary display is viewing the primary display.

10. 1. A method for a surgical hub operably connected to a primary display and a secondary display, a laparoscopic scope, and at least one surgical instrument, comprising: receiving an image from the laparoscope; obtaining a visualization control mode based on visualization control parameters, the visualization control parameters including at least one of available computing resources, available network resources, available electrical resources, and heat generated by the surgical hub; generating first visualization data for the primary display, the first visualization data including the image received from the laparoscopic scope; determining whether to generate second visualization data for the secondary display based on the obtained visualization control mode, the second visualization data being different from the first visualization data; and transmitting data for display on at least one of the primary display or the secondary display based on the determination; determining whether to generate the second visualization data includes determining whether the visualization control mode supports multiple display capabilities; The method, wherein determining whether to generate the second visualization data further includes either generating the second visualization data for the secondary display if the visualization control mode supports multiple display capabilities, or disabling generating the second visualization data for the secondary display if the visualization control mode does not support multiple display capabilities.

11. The method of claim 10, wherein the visualization control parameters include at least one of available memory, available data bandwidth, heat generated by the secondary display, power capacity associated with the surgical hub, power capacity associated with the operating room, power capacity associated with the medical facility, power usage, balance of power consumption for at least one attached system, processor utilization, or memory utilization.

12. The method of claim 10 or 11, wherein the visualization control parameters include at least one of user preferences associated with a surgical display, hardware capabilities associated with the surgical hub, the primary display, and the secondary display, software capabilities associated with the surgical hub, the primary display, and the secondary display, or instructions from a hierarchical control system.

13. receiving an instruction to change the visualization control mode to an updated visualization control mode; transmitting data for display on at least one of the primary display or the secondary display based on the updated visualization control mode; The method of any one of claims 10 to 12, further comprising:

14. receiving data from a plurality of smart surgical devices; combining the received data for display on the primary display; The method of any one of claims 10 to 13, further comprising:

15. determining whether to generate the second visualization data based on a user role associated with the secondary display based on the visualization control mode; The method of any one of claims 10 to 14, further comprising:

16. 16. The method of claim 10, further comprising: determining whether to generate the second visualization data based on non-touch control parameters based on the visualization control mode, wherein the non-touch control parameters include at least one of a detected user movement, a detected head orientation relative to a monitor, a detected user hand gesture, or a user voice activation.

17. determining whether to receive a visualization control instruction indicating a display change on at least one of the primary display or the secondary display based on the visualization control mode; generating the first visualization data or the second visualization data for display based on the display change indicated in the visualization control instruction based on a decision to receive the visualization control instruction; The method of any one of claims 10 to 16, further comprising:

18. determining whether to generate overlay information for overlaying on the primary display via the secondary display based on the visualization control mode; generating the overlay information based on a determination that the visualization control mode supports augmented reality, and overlaying the overlay information on the primary display via the secondary display upon detecting that a user of the secondary display is looking at the primary display; The method of any one of claims 10 to 17, further comprising:

Images