A system featuring a camera array that can be deployed outside the channel of a tissue-penetrating surgical device.

Abstract

A camera system integrated into the trocar. The camera system allows for a wide view of the internal surgical site and 3D mapping of fiducial markers during a laparoscopic procedure. Once inside the patient, the camera system is configured to deploy from a recessed position in the distal end of the trocar. In various aspects, the internal camera system is configured to keep the trocar port free for surgical instruments and provide surgical personnel with an expanded view of the surgical environment.

Description

Technical Field

[0001] (Cross - reference to Related Applications) This application claims the benefit of U.S. Provisional Patent Application No. 63 / 174,674, entitled "HEADS UP DISPLAY," filed on April 14, 2021, and U.S. Provisional Patent Application No. 63 / 284,326, entitled "INTRAOPERATIVE DISPLAY FOR SURGICAL SYSTEMS," filed on November 30, 2021, under 35 U.S.C. § 119(e). The entire disclosure of each of these applications is incorporated herein by reference in its entirety.

Background Art

[0002] The present disclosure relates to devices, systems, and methods for providing an augmented reality interactive experience during a surgical procedure. During a surgical procedure, it would be desirable to provide an augmented reality interactive experience of the real - world environment in which objects existing in the real world are enhanced by overlaying computer - generated perceptual information across multiple sensory modalities, including, at times, vision, hearing, touch, proprioception, and smell. In the context of the present disclosure, images of the surgical field and surgical instruments and other objects appearing in the surgical field are enhanced by overlaying computer - generated visual, auditory, tactile, proprioceptive, olfactory, or other sensory information onto the real - world images of the surgical field and the instruments or other objects appearing in the surgical field. The images may be streamed in real - time or may be still images. <>

[0003] Real-world surgical instruments include a variety of surgical devices, including energy, staplers, or combinations of energy and staplers. Energy-based medical devices include, but are not limited to, radio frequency (RF) based unipolar and bipolar electrosurgical instruments, ultrasonic surgical instruments, combinations of RF electrosurgical instruments and ultrasonic instruments, and combinations of RF electrosurgical staplers and mechanical staplers. Surgical stapler devices are surgical instruments used to cut and staple tissue in a variety of surgical procedures, including obesity, thoracic, colorectal, obstetric and gynecological, urological, and general surgery. [Overview of the project] [Means for solving the problem]

[0004] In various examples, the Disclosure provides a surgical system comprising: a surgical device, a camera array having an axial passage defining an outer and inner diameter, a proximal end, a distal end configured to penetrate tissue, and individual cameras connected in a ring configuration by elastic connectors; a removable attachment trigger configured to extend the camera array from a first recessed position from the inner diameter of the distal end of the axial passage to a second unfolded position in which the camera array is circumferentially positioned around the outer diameter of the distal end of the axial passage; an augmented reality (AR) device; and a surgical hub communicably connected to the camera array and the AR device, comprising a control circuit connected to memory, the control circuit being configured to receive a plurality of video feeds from the camera array, identify physical markers on the video feeds, and display the physical markers on an AR display.

[0005] In various examples, the present disclosure provides a surgical device comprising: a camera array including individual cameras connected in a ring configuration by elastic connectors, and communicably connectable to a surgical hub; an elongated penetrating member having a proximal end and a distal end further comprising a tissue-penetrating tip; an axial passage through the elongated penetrating member and the tissue-penetrating tip, the inner diameter of which the axial passage is dimensioned to accommodate the camera array in a first recessed position; and a detachable mounting trigger configured to extend the camera array from a first recessed position from the inner diameter of the distal end of the elongated penetrating member to a second deployed position in which the camera array is circumferentially positioned around the outer diameter of the distal end of the elongated penetrating member.

[0006] In various examples, the Disclosure provides a method for displaying a surgical location inside a patient, comprising: a surgical hub receiving a video feed from a camera located inside the patient; the surgical hub identifying physical markers inside the patient; the surgical hub determining a target location based on its relationship to the physical markers; the surgical hub generating virtual elements corresponding to the target locations; and an augmented reality (AR) device connected to the surgical hub displaying the virtual elements overlaid on the video feed on an AR display. [Brief explanation of the drawing]

[0007] The various embodiments described herein with respect to both configuration and operation methods, along with their further purposes and advantages, can be best understood by referring to the following description in conjunction with the accompanying drawings. [Figure 1] This is a block diagram of a computer-implemented interactive surgical system according to one aspect of the present disclosure. [Figure 2] This is a diagram of a surgical system used to perform surgical procedures in an operating room, according to one aspect of the present disclosure. [Figure 3]One aspect of the present disclosure is a visualization system, a robotic system, and a surgical hub paired with an intelligent instrument. [Figure 4] This figure shows a surgical data network, according to one aspect of the present disclosure, which includes a modular communication hub configured to connect modular devices located in one or more operating rooms of a medical facility, or any room within a medical facility equipped with specialized equipment for surgical procedures, to the cloud. [Figure 5] This figure shows a computer-implemented interactive surgical system according to one aspect of the present disclosure. [Figure 6] This figure shows a surgical hub, including a plurality of modules connected to a modular control tower, according to one aspect of the present disclosure. [Figure 7] This figure shows an augmented reality (AR) system, according to one aspect of the present disclosure, which includes an intermediate signal coupler located in the communication path between an imaging module and a surgical hub display. [Figure 8] This figure shows an augmented reality (AR) system, according to one aspect of the present disclosure, which includes an intermediate signal coupler located in the communication path between an imaging module and a surgical hub display. [Figure 9] This figure shows an augmented reality (AR) device worn by a surgeon to communicate data to a surgical hub, according to one aspect of the present disclosure. [Figure 10] This figure shows a system for augmenting surgical instrument information using an augmented reality display, according to one aspect of the present disclosure. [Figure 11] This figure shows a timeline of a situational awareness surgical procedure according to one aspect of the present disclosure. [Figure 12] This figure shows a structural surface comprising a plurality of reference markers according to one aspect of the present disclosure. [Figure 13] This figure shows a process for surface-aligning a patient's external structure with a reference marker, according to one aspect of this disclosure. [Figure 14] This figure shows a process for surface-aligning a patient's internal structure with a reference marker, according to one aspect of this disclosure. [Figure 15] This figure shows a stereotactic frame external surgical fitting device for assisting surgeons in surgical procedures, according to one aspect of the present disclosure. [Figure 16] This figure shows a Starfix platform external surgical integration device for assisting surgeons in surgical procedures, according to one aspect of the present disclosure. [Figure 17] This figure shows a microtable external surgical instrument for assisting surgeons in surgical procedures, according to one aspect of the present disclosure. [Figure 18] This is a flowchart for identifying an object based on a plurality of alignment parameters, according to one aspect of the present disclosure. [Figure 19] This is a flowchart for classifying unknown surgical instruments based on partial information of known and unknown parameters, according to one aspect of the present disclosure. [Figure 20] This figure shows a Trocar equipped with an internal camera system, according to one aspect of the present disclosure. [Figure 21] This figure shows a reusable mounting tool according to one aspect of the present disclosure, which is inserted into the proximal end of a trocar and configured to deploy and retract a camera system around the outer diameter of the trocar. [Figure 22] This figure shows multiple reference markers tagged in a target region in a preoperative computed tomography (CT) scan, according to one aspect of the present disclosure. [Figure 23] This figure shows a laparoscopic surgical procedure, according to one aspect of the present disclosure, that utilizes multiple reference markers to assist the surgeon in locating the surgical site. [Figure 24] This figure shows a physical marker, applied by injection into a patient's vascular system along with an indocyanine dye, according to one aspect of the present disclosure. [Figure 25] This figure further illustrates exemplary tissue, according to one aspect of the present disclosure, that has been injected with a dye and illuminated to show the vascular system. [Figure 26]A diagram showing a system configured to monitor changes in pressure or fluid within a body cavity according to impedance measurements by a probe, according to one aspect of the present disclosure. [Figure 27] A diagram showing an infrared (IR) thermal detection system including an IR camera system configured to direct IR light onto a treatment area of tissue and identify temperature differences within a surgical environment, according to one aspect of the present disclosure. [Figure 28] A diagram showing a surgical procedure employing three end effectors configured to grasp and transect tissue, according to one aspect of the present disclosure. [Figure 29] A diagram showing a third end effector that slides along tissue from a first position to a second position, according to one aspect of the present disclosure. [Figure 30] A diagram showing a third end effector positioned adjacent to a second end effector, according to one aspect of the present disclosure. [Figure 31] A diagram showing a surgical procedure including three static clamps and a dynamic clamp configured to move tissue between the static clamps, according to one aspect of the present disclosure. [Figure 32] A logical flow diagram of a process for displaying an internal surgical site of a patient, according to one aspect of the present disclosure.

[0008] Throughout the several views, corresponding reference numerals indicate corresponding parts. The illustrations described herein are presented as examples of various disclosed embodiments in one form, and such illustrations should in no way be construed as limiting the scope thereof.

Best Mode for Carrying Out the Invention

[0009] The applicant of the present application owns the following co-pending U.S. patent applications, the entire disclosure of each of which is incorporated herein by reference. · U.S. patent application titled "METHOD FOR INTRAOPERATIVE DISPLAY FOR SURGICAL SYSTEMS"; Attorney Docket No. END9352USNP1 / 210120-1M, • U.S. Patent Application entitled "Utilization of surgical data values ​​and situational awareness to control the overlay in surgical field view"; Agent reference number END9352USNP2 / 210120-2 U.S. Patent Application entitled "SELECTIVE AND ADJUSTABLE MIXED REALITY OVERLAY IN SURGICAL FIELD VIEW"; Agent Reference Number END9352USNP3 / 210120-3 • U.S. Patent Application entitled "RISK BASED PRIORITIZATION OF DISPLAY ASPECTS IN SURGICAL FIELD VIEW"; Agent Reference Number END9352USNP4 / 210120-4 • U.S. Patent Application entitled "SYSTEMS AND METHODS FOR CONTROLLING SURGICAL DATA OVERLAY"; Agent Reference Number END9352USNP5 / 210120-5 U.S. Patent Application entitled "SYSTEMS AND METHODS FOR CHANGING DISPLAY OVERLAY OF SURGICAL FIELD VIEW BASED ON TRIGGERING EVENTS"; Agent Reference Number END9352USNP6 / 210120-6 • U.S. Patent Application entitled "CUSTOMIZATION OF OVERLAID DATA AND CONFIGURATION"; Agent Reference Number END9352USNP7 / 210120-7 U.S. Patent Application entitled "INDICATION OF THE COUPLE PAIR OF REMOTE CONTROLS WITH REMOTE DEVICES FUNCTIONS"; Agent Reference Number END9352USNP8 / 210120-8 U.S. Patent Application entitled "Cooperative Overlays of Interacting Instruments Which Resurface in Both Overlays Being Effected"; Agent Reference Number END9352USNP9 / 210120-9 U.S. Patent Application entitled "ANTICIPATION OF INTERACTIVE UTILIZATION OF COMMON DATA OVERLAYS BY DIFFERENT USERS"; Agent Reference Number END9352USNP10 / 210120-10 U.S. Patent Application entitled "MIXING DIRECTLY VISUALIZED WITH RENDERED ELEMENTS TO DISPLAY BLENDED ELEMENTS AND ACTIONS HAPPENING ON-SCREEN AND OFF-SCREEN"; Agent Reference Number END9352USNP11 / 210120-11 U.S. Patent Application entitled "SYSTEM AND METHOD FOR TRACKING A PORTION OF THE USER AS A PROXY FOR NON-MONITORED INSTRUMENT"; Agent Reference Number END9352USNP12 / 210120-12 U.S. Patent Application entitled "UTILIZING CONTEXTUAL PARAMETERS OF ONE OR MORE SURGICAL DEVICES TO PREDICT A FREQUENCY INTERVAL FOR DISPLAYING SURGICAL INFORMATION"; Agent Reference Number END9352USNP13 / 210120-13 • U.S. Patent Application entitled "INTRAOPERATIVE DISPLAY FOR SURGICAL SYSTEMS"; Agent reference number END9352USNP15 / 210120-15 • U.S. Patent Application entitled "ADAPTATION AND ADJUSTABILITY OR OVERLAID INSTRUMENT INFORMATION FOR SURGICAL SYSTEMS"; Agent Reference Number END9352USNP16 / 210120-16, and, U.S. Patent Application entitled "MIXED REALITY FEEDBACK SYSTEMS THAT COOPERATE TO INCREASE EFFICIENT PERCEPTION OF COMPLEX DATA FEEDS"; Agent reference number END9352USNP17 / 210120-17.

[0010] The applicant of this application owns the following U.S. patent applications, the entirety of which is incorporated herein by reference: U.S. Patent Application No. 16 / 209,423 (currently U.S. Patent Publication No. 2019 / 0200981-A1) entitled "METHOD OF COMPRESSING TISSUE WITHIN A STAPLING DEVICE AND SIMULTANEOUSLY DISPLAYING THE LOCATION OF THE TISSUE WITHIN THE JAWS", • U.S. Patent Application No. 16 / 209,453, entitled "METHOD FOR CONTROLLING SMART ENERGY DEVICES" (currently published as U.S. Patent Application Publication No. 2019 / 0201046-A1).

[0011] Before describing in detail the various embodiments of surgical devices and generators, it should be noted that the illustrative embodiments are not limited in their application or use to the details of the structure and arrangement of the components illustrated in the accompanying drawings and descriptions. The illustrative embodiments may be implemented or incorporated into other embodiments, variations, and modifications, and may be carried out or performed in various ways. Furthermore, unless otherwise specified, the terms and expressions used herein have been selected for the purpose of describing the illustrative embodiments for the convenience of the reader and are not intended to limit them. Furthermore, it should be understood that one or more embodiments, expressions of embodiments, and / or embodiments described below may be combined with any one or more other embodiments, expressions of embodiments, and / or embodiments described below.

[0012] Various embodiments apply to on-screen displays for surgical systems for various energy and surgical stapler-based medical devices. Energy-based medical devices include, but are not limited to, radio frequency (RF)-based unipolar and bipolar electrosurgical instruments, ultrasonic surgical instruments, combinations of RF electrosurgical instruments and ultrasonic instruments, and combinations of RF electrosurgical staplers and mechanical staplers. Surgical stapler devices include surgical staplers combined with electrosurgical devices and / or ultrasonic devices. Embodiments of ultrasonic surgical devices may be configured, for example, to transversely incise and / or coagulate tissue during surgical procedures. Embodiments of electrosurgical devices may be configured, for example, to transversely incise, coagulate, seal, weld and / or dry tissue during surgical procedures. Embodiments of surgical stapler devices may be configured to transversely incise and staple tissue during surgical procedures, and in some embodiments, surgical stapler devices may be configured to deliver RF energy to tissue during surgical procedures. Electrosurgical devices are configured to deliver therapeutic and / or non-therapeutic RF energy to tissue. Elements of surgical staplers, electrosurgical devices, and ultrasound devices can be used in combination within a single surgical instrument.

[0013] In various embodiments, the Disclosure provides the OR team with on-screen displays of real-time information during surgical procedures. According to various embodiments of the Disclosure, many novel and unique on-screen displays are provided for displaying various visual information feedback to the OR team on screen. According to the Disclosure, the visual information may include one or more of various visual media, with or without sound. Generally, the visual information includes still photographs, moving photographs, video or audio recordings, graphic art, visual aids, models, displays, visual representation services, and support processes. The visual information may be communicated on any number of display options, such as, for example, a primary OR screen, the energy or surgical stapler device itself, a tablet, augmented reality glasses, etc.

[0014] In various embodiments, this disclosure provides a list of many potential options for communicating visual information to an OR team in real time without overwhelming the OR team with too much visual information. For example, in various embodiments, this disclosure provides on-screen displays of visual information that enable a surgeon, or other members of the OR team, to selectively activate on-screen displays, such as icons surrounding screen options, to manage the rich visual information. One or a combination of factors may be used to determine the active display, and these may include, among other things, the energy-based (e.g., electrosurgery, ultrasound) or machine-based (e.g., stapler) surgical device in use, the estimated risk associated with a given display, the surgeon's level of experience, and the surgeon's choice. In other embodiments, the visual information may include rich data overlaid or superimposed on the surgical field to manage the visual information. In various embodiments described below, this includes superimposed images that require video analysis and tracking to properly overlay the data. Visual information data thus communicated can provide additional useful visual information to the OR team in a more concise and understandable way, in contrast to static icons.

[0015] In various embodiments, the Disclosure provides techniques for selectively activating on-screen displays, such as icons surrounding a screen, to manage visual information during a surgical procedure. In other embodiments, the Disclosure provides techniques for determining an active display using one or a combination of factors. In various embodiments, the techniques provided by the Disclosure may include, among other things, selecting an energy-based or machine-based surgical device to be used as the active display, estimating the risks associated with a given display, and utilizing the experience level of the surgeon or OR team making the selection.

[0016] In other embodiments, the techniques described herein may include overlaying or superimposing rich data onto the surgical field for the purpose of managing visual information. Several display arrangements described herein involve overlaying various visual representations of surgical data onto a live stream of the surgical field. As used herein, the term overlay includes translucent overlays, partial overlays, and / or moving overlays. Graphical overlays may take the form of transparent graphics, translucent graphics, or opaque graphics, or combinations of transparent, translucent, and opaque elements or effects. Furthermore, overlays may be positioned on, or at least partially on or near, objects in the surgical field, such as end effectors and / or important surgical structures. A particular display arrangement may include changes in one or more display elements of the overlay, including changes in color, size, shape, display time, display location, display frequency, highlighting, or combinations thereof, based on changes in display priority values. Graphical overlays are rendered on an active display monitor to quickly and efficiently communicate critical information to the OR team.

[0017] In other embodiments, the technology provided by the Disclosure may include superimposing images that require video analysis and tracking in order to appropriately overlay visual information data. In other embodiments, the technology provided by the Disclosure may include communicating rich visual information, as opposed to simple static icons, to provide additional visual information to the OR team in a more concise and easily understandable manner. In other embodiments, the visual overlay may be used in combination with auditory and / or somatosensory overlays, e.g., thermal, chemical, and mechanical devices, and combinations thereof.

[0018] The following description generally pertains to devices, systems, and methods for providing augmented reality (AR) interactive experiences during surgical procedures. In this context, images of the surgical field and surgical instruments and other objects appearing in the surgical field are enhanced by overlaying computer-generated visual, auditory, tactile, somatosensory, olfactory, or other sensory information onto the real-world images of the surgical field, instruments, and / or other objects appearing in the surgical field. The images may be streamed in real time or they may be still images. Augmented reality is a technique for rendering and displaying virtual or "augmented" virtual objects, data, or visual effects that are overlaid on a real environment. The real environment may include the surgical field. Virtual objects overlaid on a real environment may be represented at fixed or set positions relative to one or more aspects of the real environment. In non-limiting examples, if a real-world object moves out of the field of view of the real environment, the virtual object fixed to the real-world object also moves out of the field of view of augmented reality.

[0019] Some of the display arrangements described herein involve overlaying various visual representations of surgical data onto a live stream of the surgical field. As used herein, the term overlay includes translucent overlays, partial overlays, and / or moving overlays. Furthermore, overlays may be placed on, or at least partially on or near, objects in the surgical field, such as end effectors and / or important surgical structures. A particular display arrangement may include changes in one or more display elements of the overlay, including changes in color, size, shape, display time, display location, display frequency, highlighting, or combinations thereof, based on a change in display priority value.

[0020] As described herein, AR is an extended version of the real physical world achieved through the use of digital visual elements, sounds, or other sensory stimuli delivered via technology. Virtual reality (VR) is a computer-generated environment with scenes and objects that appear real, making the user feel immersed in them. This environment is perceived through a device known as a virtual reality headset or helmet. While both mixed reality (MR) and AR are considered immersive technologies, they are not the same. MR is an extension of mixed reality that allows real and virtual elements to interact within an environment. AR often adds digital elements to a live view by using a camera, while an MR experience combines elements of both AR and VR, where real-world and digital objects interact.

[0021] In an AR environment, one or more computer-generated virtual objects may be displayed alongside one or more real-world (i.e., so-called "real-world") elements. For example, real-time images or videos of the surrounding environment may be displayed on a computer screen display along with one or more overlay virtual objects. Such virtual objects can provide supplementary information about the environment or, in general, enhance the user's perception and engagement with the environment. Conversely, real-time images or videos of the surrounding environment can, in addition or alternatively, enhance the user's engagement with the virtual objects displayed on the display.

[0022] Apparatus, systems, and methods in the context of this disclosure enhance images received from one or more imaging devices during surgical procedures. Imaging devices may include various scopes used during non-invasive and minimally invasive surgical procedures, AR devices, and / or cameras that provide images during incisional surgical procedures. Images may be streamed in real time or still images. Apparatus, systems, and methods provide an augmented reality interactive experience by enhancing images of a real-world surgical environment by overlaying representations of virtual objects or data and / or real objects onto the real-world surgical environment. The augmented reality experience may be viewed on a display and / or AR device that allows the user to view virtual objects overlaid on the real-world surgical environment. The display may be located in the operating room or located away from the operating room. The AR device is worn on the head of a surgeon or other operating room personnel and typically includes two stereoscopic display lenses or screens, one for each eye of the user. Natural light can pass through the two transparent or translucent display lenses so that aspects of the real environment are visible, while projecting light to make virtual objects visible to the user of the AR device.

[0023] Two or more displays and AR devices may be used in conjunction with a first display or AR device that controls one or more additional displays or AR devices in a system having defined roles. For example, when activating a display or AR device, the user may select a role (e.g., a surgeon, surgical assistant, nurse, etc. during a surgical procedure), and the display or AR device may display information related to that role. For example, a surgical assistant may have the display show virtual representations of instruments that the surgeon needs to use for the next step of the surgical procedure. The surgeon's focus on the current step may differ from the information displayed by the surgical assistant.

[0024] While many known on-screen displays and alerts exist, this disclosure provides many novel and unique augmented reality interactive experiences during surgical procedures. Such augmented reality interactive experiences include visual, auditory, tactile, somatosensory, olfactory, or other sensory feedback information to the surgical team inside or outside the operating room. Virtual feedback information overlaid on the real-world surgical environment may be provided to the operating room (OR) team, including, but not limited to, personnel within the OR, such as the surgical surgeon, surgical assistants, scrub wearers, anesthesiologists, and circulating nurses. The virtual feedback information can be communicated on any number of display options, such as primary OR screen displays, AR devices, energy or surgical staplers, tablets, augmented reality glasses, and other devices.

[0025] Figure 1 shows a computer-implemented interactive surgical system 1 comprising one or more surgical systems 2 and a cloud-based system 4. The cloud-based system 4 may include a remote server 13 connected to remote storage 5. Each surgical system 2 comprises at least one surgical hub 6 that communicates with the cloud 4. For example, a surgical system 2 may comprise a visualization system 8, a robotic system 10, and a handheld intelligent surgical instrument 12, each configured to communicate with each other and / or with the hub 6. In some embodiments, a surgical system 2 may comprise M hubs 6, N visualization systems 8, O robotic systems 10, and P handheld intelligent surgical instruments 12, where M, N, O, and P are integers of 1 or more. The computer-implemented interactive surgical system 1 may be configured to provide an augmented reality interactive experience during surgical procedures, as described herein.

[0026] Figure 2 shows an example of a surgical system 2 for performing a surgical procedure on a patient lying on an operating table 14 in a surgical operating room 16. A robotic system 10 is used as part of the surgical system 2 in the surgical procedure. The robotic system 10 includes a surgeon's console 18, a patient-side cart 20 (surgical robot), and a surgical robot hub 22. The patient-side cart 20 allows the surgeon to operate at least one detachably connected surgical tool 17 through a minimally invasive incision in the patient's body while viewing the surgical site through the surgeon's console 18 or an augmented reality (AR) device 66 worn by the surgeon. Images of the surgical site during the minimally invasive procedure (e.g., still or live images streamed in real time) can be acquired by a medical imaging device 24. The patient-side cart 20 can operate the imaging device 24 to orient it. Images of the incision surgical procedure can be acquired by a medical imaging device 96. The robot hub 22 processes images of the surgical site for subsequent display on the surgeon's console 18, or on an AR device 66 worn by the surgeon or another person in the surgical room 16.

[0027] The optical components of the imaging device 24, 96, or AR device 66 may include one or more illumination sources and / or one or more lenses. One or more illumination sources may be directed to illuminate a portion of the surgical field. One or more image sensors may receive light reflected or refracted from tissues and instruments in the surgical field.

[0028] In various embodiments, the imaging device 24 is configured for use in minimally invasive surgical procedures. Examples of imaging devices suitable for use with this disclosure include, but are not limited to, arthroscopes, angioscopes, bronchoscopes, cholangioscopies, colonoscopes, cystoscopes, duodenoscopes, intestinaloscopes, esophagogastroduodenoscopes (gastroscopy), endoscopes, laryngoscopes, nasopharyngolaryngoscopes, sigmoidoscopy, thoracoscopy, and ureteroscopes. In various embodiments, the imaging device 96 is configured for use in incisional (invasive) surgical procedures.

[0029] In various embodiments, the visualization system 8 comprises one or more imaging sensors strategically positioned relative to the sterile field, one or more image processing devices, one or more storage arrays, and one or more displays. In one embodiment, the visualization system 8 includes interfaces for HL7, PACS, and EMR. In one embodiment, the imaging device 24 may employ multispectral monitoring to distinguish between topography and underlying structures. Multispectral imaging captures image data within a specific wavelength range in the electromagnetic spectrum. Wavelengths are separated by filters or by instruments sensitive to specific wavelengths, including frequencies beyond the visible light range, e.g., IR and ultraviolet light. Spectral imaging can extract information invisible to the human eye. Multispectral monitoring allows the surgical field to be repositioned after the surgical task for performing tests on the treated tissue is completed.

[0030] Figure 2 shows a primary display 19 positioned in the sterile field for the operator on the operating table 14 to see. The visualization tower 11 includes a first non-sterile display 7 and a second non-sterile display 9 positioned outside the sterile field and facing opposite directions from each other. The visualization system 8, guided by the hub 6, is configured to utilize displays 7, 9, and 19 to coordinate the flow of information to operators inside and outside the sterile field. For example, the hub 6 can cause the visualization system 8 to display AR images of the surgical site recorded by imaging devices 24 and 96 through the non-sterile displays 7, 9, or AR device 66, while maintaining live video of the surgical site on the primary display 19 or AR device 66. The non-sterile displays 7 and 9 can, for example, enable non-sterile operators to perform diagnostic steps related to the surgical procedure.

[0031] Figure 3 shows a hub 6 that communicates with a visualization system 8, a robotic system 10, and handheld intelligent surgical instruments 12. The hub 6 includes a hub display 35, an imaging module 38, a generator module 40, a communication module 30, a processor module 32, a storage array 34, and an operating room mapping module 33. The hub 6 further includes a smoke extraction module 26 and / or a suction / irrigation module 28. In various embodiments, the imaging module 38 includes an AR device 66, and the processor module 32 includes an integrated video processor and an augmented reality modeler (e.g., as shown in Figure 10). Modular light sources can be adapted for use with various imaging devices. In various examples, multiple imaging devices can be positioned at different locations in the surgical field to provide multiple views (e.g., non-invasive, minimally invasive, invasive, or incisional surgical procedures). The imaging module 38 can be configured to switch between imaging devices to provide the optimal view. In various embodiments, the imaging module 38 can be configured to integrate images from different imaging devices and provide an augmented reality interactive experience during surgical procedures as described herein.

[0032] Figure 4 shows a surgical data network 51 including a modular communication hub 53 configured to connect modular devices located in one or more operating rooms / surgery sites of a medical facility to a cloud-based system. The cloud 54 may include a remote server 63 (Figure 5) connected to a storage device 55. The modular communication hub 53 includes a network hub 57 and / or a network switch 59 that communicate with a network router 61. The modular communication hub 53 is connected to a local computer system 60 for data processing. The operating room modular devices 1a-1n may be connected to the modular communication hub 53. The network hub 57 and / or the network switch 59 are connected to the network router 61 so that devices 1a-1n can connect to the cloud 54 or the local computer system 60. Data associated with devices 1a-1n may be transferred to a cloud-based computer via the router for remote data processing and manipulation. The operating room devices 1a-1n may be connected to the modular communication hub 53 via a wired channel or a wireless channel. The surgical data network environment 51 may be employed, as described herein, to provide an augmented reality interactive experience during a surgical procedure, in particular to provide augmented images of the surgical field to one or more remote displays 58.

[0033] Figure 5 shows a computer-implemented interactive surgical system 50. The computer-implemented interactive surgical system 50 is similar in many respects to the computer-implemented interactive surgical system 1. The computer-implemented interactive surgical system 50 includes one or more surgical systems 52 that are similar in many respects to surgical system 2. Each surgical system 52 includes at least one surgical hub 56 that communicates with a cloud 54 which may include a remote server 63. In one embodiment, the computer-implemented interactive surgical system 50 includes a modular control tower 23 connected to a plurality of surgical site devices, such as intelligent surgical instruments, robots, and other computerized devices located in the operating room. As shown in Figure 6, the modular control tower 23 includes a modular communication hub 53 connected to a computer system 60.

[0034] Returning to Figure 5, the modular control tower 23 is connected to an imaging module 38 connected to an endoscope 98, a generator module 27 connected to an energy device 99, a fume exhaust module 76, a suction / irrigation module 78, a communication module 13, a processor module 15, a storage array 16, and optionally smart devices / instruments 21 and sensor modules 29 connected to a display 39. Surgical site devices are connected to cloud computing resources such as a server 63, data storage 55, and a display 58 via the modular control tower 23. The robot hub 72 may also be connected to the modular control tower 23, as well as the server 63, data storage 55, and display 58. In particular, the devices / instruments 21 and the visualization system 58 may be connected to the modular control tower 23 via wired or wireless communication standards or protocols as described herein. The modular control tower 23 may be connected to a hub display 65 (e.g., a monitor, screen) to display received augmented images, including overlaid virtual objects on the real surgical world, received from the imaging module 38, device / instrument display 39, and / or other visualization systems 58. The hub display 65 may also display data received from devices connected to the modular control tower 23, along with the images and overlay images.

[0035] Figure 6 shows a surgical hub 56 including multiple modules connected to a modular control tower 23. The modular control tower 23 includes a modular communication hub 53, such as a network connectivity device, and a computer system 60 for local processing, visualization, and imaging of augmented surgical information. The modular communication hub 53 is connected in a hierarchical configuration to expand the number of modules (e.g., devices) that may be connected to the modular communication hub 53, and data associated with the modules may be transferred to the computer system 60, cloud computing resources, or both. Each of the network hubs / switches 57 / 59 within the modular communication hub 53 may include three downstream ports and one upstream port. The upstream network hubs / switches 57, 59 are connected to the processor 31 to provide communication connectivity to cloud computing resources and local displays 67. Communication to the cloud 54 can be done via either a wired communication channel or a wireless communication channel.

[0036] The computer system 60 includes a processor 31 and a network interface 37. The processor 31 is connected via a system bus to a communication module 41, storage 45, memory 46, non-volatile memory 47, and an input / output interface 48. 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 various available bus architectures.

[0037] The processor 31 may include an augmented reality modeler (e.g., as shown in Figure 10) and may be implemented as a single-core or multi-core processor, such as one known by the trademark name ARM Cortex by Texas Instruments. In one embodiment, the processor may be, for example, the LM4F230H5QR ARM Cortex-M4F processor core available from Texas Instruments. This processor core includes on-chip memory of 256KB single-cycle flash memory or other non-volatile memory with a maximum frequency of 40MHz, a prefetch buffer for improving performance beyond 40MHz, 32KB single-cycle serial random access memory (SRAM), internal read-only memory (ROM) with StellarisWare® software, 2KB electrically erasable programmable read-only memory (EEPROM), and / or one or more pulse-width modulation (PWM) modules, one or more quadrature encoder input (QEI) analogs, and one or more 12-bit analog-to-digital converters (ADCs) with 12 analog input channels. Further details are available in the product datasheet.

[0038] System memory includes volatile and non-volatile memory. The Basic Input / Output System (BIOS), which contains basic routines for transferring information between elements within the computer system during startup, is stored in non-volatile memory. For example, non-volatile memory may include ROM, programmable ROM (PROM), electrically programmable ROM (EPROM), EEPROM, or flash memory. Volatile memory may include random access memory (RAM), which functions as external cache memory. Furthermore, RAM is available in many forms, such as SRAM, dynamic RAM (DRAM), synchronous DRAM (SDRAM), double data rate SDRAM (DDR SDRAM), enhanced SDRAM (ESDRAM), sync-link DRAM (SLDRAM), and direct rhombus RAM (DRRAM).

[0039] The computer system 60 also includes removable / non-removable volatile / non-volatile computer storage media, such as disk storage. Examples of disk storage devices include, but are not limited to, magnetic disk drives, floppy disk drives, tape drives, Jaz drives, Zip drives, LS-60 drives, flash memory cards, or memory sticks. In addition, the disk storage device may include the above-mentioned storage media independently or in combination with other storage media. Examples of other storage media include, but are not limited to, optical disk drives such as compact disk ROM devices (CD-ROMs), compact disk recordable drives (CD-R drives), compact disk rewritable drives (CD-RW drives), or digital multi-purpose disk ROM drives (DVD-ROMs). Removable or non-removable interfaces may be used to facilitate connection of the disk storage device to the system bus.

[0040] In various embodiments, the computer system 60 in Figure 6, the imaging module 38 in Figures 4 to 6, and / or the visualization system 58, and / or the processor module 15 may include an image processor, an image processing engine, an image processing unit (GPU), a media processor, or any dedicated digital signal processor (DSP) used for processing digital images. The image processor can increase speed and efficiency using parallel computing with single-instruction multiple data (SIMD) or multiple-instruction multiple data (MIMD) techniques. The digital image processing engine can perform a variety of tasks. The image processor may be a system on a chip with a multi-core processor architecture.

[0041] Figure 7 shows an augmented reality system 263 that includes an intermediate signal coupler 64 located in the communication path between the imaging module 38 and the surgical hub display 67. The signal coupler 64 combines audio and / or image data received from the imaging module 38 and / or the AR device 66. The surgical hub 56 receives the combined data from the coupler 64, overlays the provided data onto the display 67, and displays the overlaid data. The imaging device 68 may be a digital video camera, and the audio device 69 may be a microphone. The signal coupler 64 may include a wireless head-up display adapter for coupling to the AR device 66 located in the communication path of the display 67 to a console that enables the surgical hub 56 to overlay data onto the display 67.

[0042] Figure 8 shows an augmented reality (AR) system including an intermediate signal coupler positioned in the communication path between the imaging module and the surgical hub display. Figure 8 shows an AR device 66 worn by the surgeon 73 to communicate data to the surgical hub 56. Peripheral information of the AR device 66 does not include active images. Rather, peripheral information includes only signals that do not have the same requirements for device settings or refresh rate. The interaction may extend the surgeon 73's information based on links with preoperative computed tomography (CT) or other data linked within the surgical hub 56. The AR device 66 can identify structures and, for example, ask whether an instrument is touching a nerve, blood vessel, or adhesion. The AR device 66 may include processing in the surgical hub 56 used to provide preoperative scan data, optical views, tissue examination characteristics acquired throughout the procedure, and / or answers. The surgeon 73 may write notes on the AR device 66 so that they are stored in the hub storage 45 along with patient data for later use in reporting or follow-up.

[0043] The AR device 66, worn by the surgeon 73, links to the surgical hub 56 using auditory and visual information to avoid the need for overlays, and allows customization of information displayed around the periphery of the field of view. The AR device 66 provides signals from devices (e.g., instruments) and answers queries regarding location information linked with video to identify device settings or quadrants or locations. The AR device 66 has voice control and voice feedback from the AR device 66. The AR device 66 can interact with other systems in the operating room and can have available feedback and interaction wherever the surgeon 73 looks. For example, the AR device 66 may receive voice or gesture start commands and queries from the surgeon, and the AR device 66 may provide feedback in the form of one or more modalities, including voice, visual, or haptic touch.

[0044] Figure 9 shows a surgeon 73 and a patient 74 wearing AR devices 66, and may include a camera 96 ​​in the operating room 75. The AR device 66 worn by the surgeon 73 may be used to present virtual objects overlaid on a real-time image of the surgical field to the surgeon 73 through an augmented reality display 89 or through a hub-connected display 67. The real-time image may include parts of surgical instruments 77. The virtual objects may not be visible to others in the operating room 75 (e.g., surgical assistants or nurses), but they may also wear AR devices 66. Even if another person is viewing the operating room 75 using an AR device 66, that person may not be able to see the virtual objects, or may be able to see the virtual objects in augmented reality shared with the surgeon 73, or may be able to see modified versions of the virtual objects (e.g., according to customization specific to the surgeon 73), or may see different virtual objects.

[0045] Virtual objects and / or data may be configured to appear on a portion of the surgical instrument 77 or within the surgical field captured by the imaging module 38, the imaging device 68 during minimally invasive surgical procedures, and / or the camera 96 ​​during incisional surgical procedures. In the illustrated example, the imaging module 38 is a laparoscopic camera that provides live images of the surgical area during minimally invasive surgical procedures. The AR system may present virtual objects fixed to real objects regardless of the viewpoint of one or more viewers of the AR system (e.g., the surgeon 73). For example, virtual objects may be visible to viewers of the AR system inside the operating room 75, but not visible to viewers of the AR system outside the operating room 75. Virtual objects may be displayed to viewers outside the operating room 75 when a viewer enters the operating room 75. Augmented images may be displayed on the surgical hub display 67 or the augmented reality display 89.

[0046] The AR device 66 may include one or more screens or lenses, such as a single screen or two screens (e.g., one for each user's eye). The screens may allow light to pass through them so that aspects of the real environment are visible while virtual objects are being displayed. Virtual objects may become visible to the surgeon 73 by projecting light. Virtual objects may appear to have some degree of transparency or may be opaque (i.e., blocking aspects of the real environment).

[0047] An AR system may be visible to one or more viewers and may include differences between views available to one or more viewers, while maintaining some common aspects between views. For example, a heads-up display may change between two views, but virtual objects and / or data may be fixed to real objects or areas in both views. Aspects such as the color, lighting, or other changes of an object may occur between views without changing the fixed position of at least one virtual object.

[0048] Users can view virtual objects and / or data presented within the AR system as opaque or with a certain level of transparency. For example, a user can interact with a virtual object by moving it from a first position to a second position. For instance, a user may move an object with their own hand. This may be done virtually in the AR system by determining that the hand has moved to a position adjacent to or adjacent to the object (using one or more cameras, which may be mounted on the AR device 66, such as AR device camera 79 or a separate camera 96, and which may be static or controlled to move) and moving the object accordingly. The virtual form may include a virtual representation of a real-world object, or it may include visual effects such as lighting effects. The AR system may include rules to govern the behavior of the virtual object, such as exposing the virtual object to gravity or friction, or it may include other predefined rules that negate real-world physical constraints (e.g., floating objects, perpetual motion, etc.). The AR device 66 may include a camera 79 (which should not be confused with a separate camera 96). The AR device camera 79 or camera 96 ​​may include an infrared camera, an infrared filter, a visible light filter, multiple cameras, a depth camera, etc. The AR device 66 may project virtual items onto a representation of the real environment that the user can see.

[0049] The AR device 66 may be used, for example, in an operating room 75 during a surgical procedure performed on a patient 74 by a surgeon 73. The AR device 66 may project or display virtual objects, such as virtual objects during the surgical procedure, to extend the surgeon's vision. The surgeon 73 may view the virtual objects using the AR device 66, a remote controller for the AR device 66, or interact with the virtual objects by using his hands to “interact” with the virtual objects or gestures recognized by the camera 79 of the AR device 66, for example. The virtual objects can extend surgical tools, such as surgical instruments 77. For example, the virtual object may appear to be connected to the surgical instrument 77 (to the surgeon 73 viewing the virtual object through the AR device 66), or to remain at a fixed distance from the surgical instrument 77. In another example, the virtual object may be used to guide the surgical instrument 77 and may appear to be fixed to the patient 74. In certain examples, the virtual object may react to the movement of other virtual or real-world objects in the surgical field. For example, a virtual object may be modified when a surgeon is manipulating a surgical instrument in close proximity to the virtual object.

[0050] The augmented reality display system imaging device 38 captures real images of the surgical area during the surgical procedure. The augmented reality displays 89 and 67 present an overlay of the operating modes of the surgical instrument 77 onto the real images of the surgical area. The surgical instrument 77 includes a communication circuit 231 for communicating operating mode and functional data from the surgical instrument 77 to the AR device 66 via a communication circuit 233 on the AR device 66. The surgical instrument 77 and the AR device 66 are shown in RF wireless communication between circuits 231 and 233, as indicated by arrows B and C, but other communication technologies (e.g., wired, ultrasonic, infrared, etc.) may be employed. The overlay relates to the operating modes of the surgical instrument 77 that are actively visualized. The overlay combines the modes of tissue interaction in the surgical area with functional data from the surgical instrument 77. The processor portion of the AR device 66 is configured to receive operating mode and functional data from the surgical instrument 77, determine overlays related to the operation of the surgical instrument 77, and combine the tissue characteristics within the surgical area with the functional data from the surgical instrument 77. The augmented images display alerts regarding device performance considerations, non-conformity use, and incomplete capture. Non-conformity use includes out-of-range tissue conditions and tissue improperly balanced within the jaws of the end effector. Additional augmented images provide indications of incidental events, including indications of tissue tension and foreign body detection. Other augmented images display device status overlays and instrument indications.

[0051] Figure 10 shows a system 83 for augmenting images of the surgical field with information using an AR display 89, according to at least one aspect of the present disclosure. The system 83 may be used to perform the techniques described below, for example, by using a processor 85. The system 83 includes one aspect of an AR device 66 that can communicate with a database 93. The AR device 66 includes a processor 85, memory 87, an AR display 89, and a camera 79. The AR device 66 may also include a sensor 90, a speaker 91, and / or a haptic controller 92. The database 93 may include image storage 94 or preoperative planning storage 95.

[0052] The processor 85 of the AR device 66 includes an augmented reality modeler 86. The augmented reality modeler 86 may be used by the processor 85 to create an augmented reality environment. For example, the augmented reality modeler 86 may receive images of instruments in the surgical field from a camera 79 or sensor 90, etc., and create an augmented reality environment that fits within the displayed image of the surgical field. In another example, physical objects and / or data may be overlaid on the surgical field and / or surgical instrument images, and the augmented reality modeler 86 may use the physical objects and data to present an augmented reality display of virtual objects and / or data within the augmented reality environment. For example, the augmented reality modeler 86 may use or detect instruments at the patient's surgical site and present virtual objects and / or data on the surgical instruments, and / or images of the surgical site in the surgical field captured by the camera 79. The AR display 89 may display the AR environment overlaid on the real environment. The display 89 can use the AR device 66, which is located in a fixed position, etc., within the AR environment, to show virtual objects and / or data.

[0053] The AR device 66 may include sensors 90 such as infrared sensors. The camera 79 or sensor 90 may be used to detect movements such as gestures by a surgeon or other user, which may be interpreted by the processor 85 as attempted or intended interactions by the user with a virtual target. The processor 85 can identify objects in the real environment by processing information received using the camera 79, for example. In other embodiments, sensor 90 may be a tactile sensor, audible sensor, chemical sensor, or thermal sensor to generate corresponding signals that can be combined with various data feeds to create an augmented environment. Sensor 90 may include binaural audio sensors (spatial sound), inertial measurement (accelerometer, gyroscope, magnetometer) sensors, environmental sensors, depth camera sensors, hand and eye-tracking sensors, and voice command recognition capabilities.

[0054] The AR display 89 may, for example, during a surgical procedure, allow the surgical field to be viewed through the AR display 89, while presenting virtual features within the surgical field that correspond to physical features hidden by the patient's anatomical features. The virtual features may have a virtual position or orientation that corresponds to a first physical position or orientation of the physical features. In one example, the virtual position or orientation of the virtual features may include an offset from the first physical position or orientation of the physical features. The offset may include a predetermined distance from the augmented reality display, a relative distance from the augmented reality display to the anatomical features, and so on.

[0055] In one example, the AR device 66 may be an individual AR device. In one embodiment, the AR device 66 may be a HoloLens 2 AR device manufactured by Microsoft in Redmond, Washington. This AR device 66 includes a visor with lenses and binaural audio features (spatial sound), inertial measurements (accelerometer, gyroscope, magnetometer), environmental sensors, a depth camera, a video camera, hand and eye tracking, and voice command recognition capabilities. It provides a high-resolution, improved field of view by using mirrors to orient waveguides in front of the wearer's eyes. The image can be magnified by changing the angle of the mirrors. It also provides eye tracking to recognize the user and adjust the lens width for a particular user.

[0056] In another example, AR device 66 could be the Snapchat Spectacles 3 AR device. This AR device offers the ability to capture paired images, recreate 3D depth mapping, add virtual effects, and play 3D videos. The AR device includes two HD cameras for capturing 3D photos and videos at 60fps, while four built-in microphones record immersive high-fidelity audio. Images from both cameras are combined to construct a geometric map of the real world around the user, providing a new sense of depth perception. Photos and videos can be wirelessly synchronized to an external display device.

[0057] In yet another example, AR device 66 could be Google's Glass 2 AR device. This AR device provides inertial measurement (accelerometer, gyroscope, magnetometer) information overlaid on the lens (outside the field of view) to supplement the information.

[0058] In another example, AR device 66 could be Amazon's Echo Frames AR device. This AR device does not have a camera / display. The microphone and speaker are linked to Alexa. This AR device has fewer features than a head-up display.

[0059] In yet another example, AR device 66 could be the Focals AR device by North (Google). This AR device provides a notification pusher / smartwatch analog, inertial measurement, screen overlays for information (weather, calendar, messages), and voice control (Alexa) integration. This AR device also provides basic head-up display functionality.

[0060] In another example, AR device 66 could be an Nreal AR device. This AR device includes spatial sound, two ambient cameras, a photographic camera, an IMU (accelerometer, gyroscope), an ambient light sensor, and proximity sensor functions. Nebula projects application information onto the lens.

[0061] In various other examples, the AR device 66 may be any one of the following commercially available AR devices, namely Magic Leap 1, Epson Moverio, Vuzix Blade AR, ZenFone AR, Microsoft AR glasses prototype, or EyeTap, which create light collinear with the ambient light directly onto the retina. A beam splitter makes the same visible light available to a computer, for example, to process and overlay information. The AR visualization system may include a HUD, contact lenses, glasses, virtual reality (VR) headset, virtual retinal display, intraoperative display, and / or smart contact lenses (bionic lenses).

[0062] The multi-user interface for the AR device 66 includes a virtual retinal display such as a raster display that draws directly onto the retina rather than on a screen in front of the eyes, a smart TV, a smartphone, and / or a spatial display such as the Sony Spatial Display System.

[0063] Other AR technologies may include, for example, AR capture devices and software applications, AR creation devices and software applications, and AR cloud devices and software applications. AR capture devices and software applications include, for example, the Apple Polycam app and Ubiquity 6 (Mirrorworld using the Display.land app), which allow users to scan and acquire 3D images of the real world (to create 3D models). AR creation devices and software applications include, for example, Adobe Aero, Vuforia, ARToolKit, Google ARCore, Apple ARKit, MAXST, Aurasma, Zappar, and Blippar. AR cloud devices and software applications include, for example, Facebook, Google (world geometry, object recognition, predictive data), Amazon AR Cloud (commerce), Microsoft Azure, Samsung Project Whare, Niantic, and Magic Leap.

[0064] Situational awareness is the ability of several embodiments of a surgical system to determine or infer information related to a surgical procedure from data received from a database and / or instruments. This information may include the type of procedure being performed, the type of tissue being operated on, or the body cavity being treated. Based on contextual information relating to a surgical procedure, the surgical system can be improved, for example, by controlling modular devices connected to it (e.g., robotic arms and / or robotic surgical tools) and providing contextualized information or suggestions to the surgeon during the course of the surgical procedure.

[0065] Figure 11 shows a timeline of a situation-aware surgical procedure. Figure 11 shows an exemplary surgical procedure timeline 5200 and contextual information that the surgical hub 5104 can derive from data received from data source 5126 at each stage of the surgical procedure. Timeline 5200 shows the typical steps that nurses, surgeons, and other healthcare professionals might take during a lung segmentectomy procedure, which begins with setting up the operating room and ends with transferring the patient to the postoperative recovery room. Throughout the surgical procedure, the situation-aware surgical hub 5104 receives data from data source 5126, including data generated each time healthcare professionals use the modular device 5102 paired with the surgical hub 5104. By receiving this data from the paired modular device 5102 and other data sources 5126, the surgical hub 5104 can continuously derive estimations (i.e., contextual information) about the ongoing procedure as new data is received, such as which stage of the procedure is being performed at any given time. The situation awareness system of the surgical hub 5104 can, for example, record data relating to a procedure to generate a report, verify the steps being taken by a healthcare professional, provide data or prompts that may be relevant to a particular procedure step (e.g., via a display screen), adjust the modular device 5102 based on 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 an RF electrosurgical instrument), and perform any other such actions as described above.

[0066] In the first step 5202, hospital staff retrieve the patient's EMR from the hospital's EMR database. Based on the patient data selected in the EMR, the surgical hub 5104 determines that the procedure to be performed is a thoracic surgery.

[0067] In the second 5204, staff scan incoming medical supplies for a procedure. The surgical hub 5104 cross-references the scanned supplies with a list of supplies used in various types of procedures to confirm that the mixture of supplies corresponds to a thoracic procedure. Furthermore, the surgical hub 5104 can also determine that the procedure is not a wedge resection (because the incoming supplies either do not contain specific supplies required for a thoracic wedge resection or are otherwise not corresponding to a thoracic wedge resection).

[0068] In the third 5206, a healthcare worker scans the patient band via a scanner 5128 that is communicably connected to a surgical hub 5104. The surgical hub 5104 can then verify the patient's identity based on the scanned data.

[0069] In the fourth part of 5208, a medical professional turns on the assistive device. The assistive devices used may vary depending on the type of surgical procedure and the techniques used by the surgeon, but in this exemplary case, they include a fume exhauster, an air insulator, and a medical imaging device. Once activated, the assistive device, which is a modular device 5102, can automatically pair with a surgical hub 5104 located within a specific vicinity of the modular device 5102 as part of its initialization process. The surgical hub 5104 can then derive contextual information about the surgical procedure by detecting the type of modular device 5102 paired with it during this pre-operative or initialization phase. In this particular embodiment, the surgical hub 5104 determines that the surgical procedure is a VATS surgery based on this particular combination of paired modular devices 5102. Based on the combination of data from the patient's EMR, a list of medical supplies used in the procedure, and the type of modular device 5102 connected to the hub, the surgical hub 5104 can roughly estimate the specific procedure performed by the surgical team. Once the surgical hub 5104 knows what particular procedure is being performed, it can then read the steps of that procedure from memory or the cloud, and then cross-reference the data subsequently received from connected data sources 5126 (e.g., modular device 5102 and patient monitoring device 5124) to estimate which steps of the surgical procedure the surgical team is performing.

[0070] In step 5210, the staff attaches the EKG electrode and other patient monitoring devices 5124 to the patient. The EKG electrode and other patient monitoring devices 5124 can be paired with the surgical hub 5104. Once the surgical hub 5104 begins receiving data from the patient monitoring devices 5124, the surgical hub 5104 confirms that the patient is in the operating room.

[0071] In step 6, 5212, medical personnel induce anesthesia in the patient. The surgical hub 5104 can infer that the patient is under anesthesia based on data from modular devices 5102 and / or patient monitoring devices 5124, including, for example, EKG data, blood pressure data, ventilator data or a combination thereof. Once step 6, 5212 is completed, the preoperative portion of the lung segmentectomy is complete and the surgical portion commences.

[0072] In section 7 of 5214, the lung of the patient being operated on collapses (while ventilation is switched to the contralateral lung). The surgical hub 5104 can infer from the ventilator data that the patient's lung has collapsed. The surgical hub 5104 can compare the detection of the patient's lung collapse with the expected steps of the procedure (which can be accessed or read in advance), so it can infer that the surgical portion of the procedure has begun and determine that causing the lung to collapse is the first surgical step in this particular procedure.

[0073] In step 8, 5216, a medical imaging device 5108 (e.g., a scope) is inserted, and video footage from the medical imaging device is initiated. The surgical hub 5104 receives medical imaging device data (i.e., still image data or real-time live-streaming video) through its connection to the medical imaging device. Upon receiving the medical imaging device data, the surgical hub 5104 can determine that the laparoscopic portion of the surgical procedure has commenced. Furthermore, the surgical hub 5104 can determine that the particular procedure being performed is a segmentectomy, as opposed to a lobectomy (note that wedge resection has not already been taken into consideration by the surgical hub 5104 based on the data received in step 2, 5204 of the procedure). Using data from the medical imaging device 124 (Figure 2), contextual information regarding the type of procedure being performed can be determined in various ways, for example, by determining the angle of the medical imaging device directed towards the visualization of the patient's anatomical structure, by monitoring the number of medical imaging devices being used (i.e., activated and paired with the surgical hub 5104), and by monitoring the type of visualization device being used.

[0074] For example, one technique for performing VATS lobectomy positions the camera above the diaphragm in the anteroinferior corner of the patient's thoracic cavity, while another technique for performing VATS segmentectomy positions the camera in an anterior intercostal position relative to the segmental fissure. The situational awareness system can be trained, for example, using pattern recognition or machine learning techniques, to recognize the position of the medical imaging device according to the visualization of the patient's anatomical structure. As another example, one technique for performing VATS lobectomy utilizes a single medical imaging device, while another technique for performing VATS segmentectomy utilizes multiple cameras. As yet another example, one technique for performing VATS segmentectomy utilizes an infrared light source (which can be communicably connected to a surgical hub as part of the visualization system) to visualize the segmental fissure, which is not used in VATS lobectomy. By tracking any or all of this data from the medical imaging device 5108, the surgical hub 5104 can determine the specific type of surgical procedure being performed and / or the technique being used for that specific type of surgical procedure.

[0075] In step 9, 5218, the surgical team initiates the incision step of the procedure. The surgical hub 5104 receives data from the RF or ultrasound generator indicating that an energy instrument is being emitted, and can therefore infer that the surgeon is in the process of incising and separating the patient's lung. The surgical hub 5104 can cross-reference the received data with the read-out steps of the surgical procedure to determine that the energy instrument being emitted at this point in the process (i.e., after the completion of the steps of the procedure described above) corresponds to the incision step.

[0076] In the tenth step 5220, the surgical team proceeds to the ligation step of the procedure. The surgical hub 5104 receives data from the surgical stapling and cutting instruments indicating that instruments are being fired, so it can infer that the surgeon is ligating arteries and veins. Similar to the previous step, the surgical hub 5104 can derive this inference by cross-referencing the data received from the surgical stapling and cutting instruments with the steps in the read process.

[0077] In the eleventh step 5222, the segmental resection portion of the procedure is performed. The surgical hub 5104 estimates that the surgeon has transversely incised parenchymal tissue, based on data from surgical instruments, including data from a staple cartridge. Cartridge data may correspond, for example, to the size or type of staples fired by the instrument. Cartridge data may indicate the type of tissue being stapled and / or transversely incised, for different types of staples used for different types of tissue. The type of staples fired is used for parenchymal tissue or other similar tissue types, and the surgical hub 5104 can estimate that a segmental resection procedure has been performed.

[0078] Next, in the twelfth step 5224, the nodule incision step is performed. Based on the data received from the generator indicating that an RF or ultrasonic instrument is being emitted, the surgical hub 5104 can infer that the surgical team is incising the nodule and performing a leak test. In this particular procedure, the RF or ultrasonic instrument used after the parenchymal tissue has been transversely incised corresponds to the nodule incision step, thereby enabling the surgical hub 5104 to make this inference. Note that the surgeon will periodically switch between surgical stapling / cutting instruments and surgical energy (i.e., RF or ultrasonic) instruments depending on the specific step in the procedure, as different instruments are better suited to specific tasks. Thus, the specific sequence in which 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 postoperative portion of the procedure begins.

[0079] In the 13th step 5226, the patient is de-anesthetized. The surgical hub 5104 can estimate that the patient is waking up from anesthesia, for example, based on ventilator data (i.e., the patient's respiratory rate begins to increase).

[0080] Finally, in the 14th step 5228, the healthcare worker removes the various patient monitoring devices 5124 from the patient. Thus, the surgical hub 5104 can infer that the patient has been transferred to the recovery room when the hub loses EKG, BP, and other data from the patient monitoring devices 5124. Based on the data received from various data sources 5126 that are communicably connected to the surgical hub 5104, the surgical hub 5104 can determine or infer when each step of a given surgical procedure is occurring.

[0081] As shown in the first step 5202 of the timeline 5200 shown in Figure 11, in addition to estimating the type of surgical procedure to be performed using patient data from the EMR database(s), the patient data can also be utilized by the situation-aware surgical hub 5104 to generate control adjustments for the paired modular device 5102.

[0082] This disclosure describes a method and system for tracking an organization, identifying marked areas of interest, and generating virtual elements that represent those areas in an augmented reality environment.

[0083] Alignment of physical spatial parameters In various forms, patients may be virtually or physically tagged with reference markers to assist the surgeon during surgery. Surgical procedures may require patients to undergo a preoperative reference marking process.

[0084] Figure 12 shows an example of a structural surface 18000 containing multiple reference markers. Multiple points 18010a-d are identified and tagged on the structural surface 18000. A computing system, such as a remote server 63 (Figure 5) or a surgical hub 56 (Figure 6), evaluates the structural surface and assigns reference markers 18010a-d based on a Target Recognition Error (TRE) model 18008. The TRE model uses a sample dataset to estimate the placement of the reference markers 18010a-d. 18002 shows the initial drawing of the structural surface 18000. 18004 shows the TRE model representation of the structural surface 18000. Transformation 18006 shows the resulting placement of the reference markers 18010a-d on the structural surface 18000.

[0085] Figure 13 illustrates the process 18020 for surface-aligning the patient's external structures with reference markers. A computing system, such as a remote server 63 (Figure 5) or a surgical hub 56 (Figure 6) system, generates an initial surface mapping based on a digital representation of the surface (18022). The system recognizes multiple anatomical landmarks 18028 using facial recognition features such as the eyes and nasal bridge (18024) and maps the surface and the distances between points. Based on the determined distances between the anatomical landmarks 18028, the system generates reference markers 18030 (18026).

[0086] Figure 14 shows a process 18040 for surface-aligning the patient's internal structures 18044 with reference markers 18042. The internal structures are displayed on an output display 18046, allowing the technician to tag areas of the internal structures 18044 with a stylus 18048. The reference markers 18042 may correspond to the route or location of a surgical procedure.

[0087] Figures 15-17 show external surgical alignment devices that assist surgeons in surgical procedures. Figure 15 shows the stereotactic frame 18060, Figure 16 shows the starfix platform 18080, and Figure 17 shows the microtable 18100. The surgical hub 56 (Figure 6) can register and catalog the dimensions of the external surgical aids and assign reference markers to multiple points on the surgical aids. The surgical hub 56 can then align the reference markers of the external surgical alignment devices with the patient's surface markers.

[0088] In various embodiments, the surgical hub 56 (Figure 6) is configured to track the location and position of surgical instruments 12 (Figures 1, 2) and 21 (Figures 5, 6) within the operating room 16 (Figure 2). The surgical instruments 12 and 21 may be equipped with multiple reference markers strategically placed on their external housings to communicate specific parameters of the instruments. These reference markers may be used by a passive tracking system in combination with an infrared (IR) light source. In addition, the surgical instruments 12 and 21 may be equipped with sensors indicating when they are in use and when they are inside a patient's body. In one embodiment, the trocar may be equipped with one or more internal patient sensors indicating when a device has been inserted into a body cavity. Once the trocar determines that a surgical instrument 12 or 21 is inside a patient's body cavity, it may automatically or manually detect and track the location of another surgical instrument 12 or 21. The trocar may be equipped with an internal camera system that identifies reference markers on other surgical instruments 12, 21. The internal camera system may receive commands to locate the end effector and tag the end effector with a marker associated with the tip of the trocar. The tag is used to monitor the tip of the end effector throughout the surgical procedure and provides alignment points that can be associated with virtual elements rendered on the AR display 89 of the AR device 66 (Figure 10). In situations where the tip of the end effector may be outside the field of view of the internal camera system, the virtual elements may, based on the tag, continuously display the tracked position of the end effector tip.

[0089] Prior to the surgical procedure, all surgical instruments 12 (Figures 1, 2), 21 (Figures 5, 6) are classified according to several parameters, including mass, size, length, shape, associated surgical procedure, and hand position for the surgical procedure. Figure 18 shows a flowchart for identifying objects based on several alignment parameters. In various embodiments, the surgical hub receives the physical characteristics of objects from one or more object detection cameras in the operating room. The cameras provide raw imaging data of the objects (18122). The surgical hub performs image processing to remove the rear of the image or frame and perform edge detection (18124). After the surgical hub performs image processing, it compares the detected objects to an object catalog (18126). The surgical hub reviews the characteristics of each object (18128) and determines the object that best matches the identified parameters of the image (18130).

[0090] Figure 19 shows a flowchart 18140 for classifying unknown surgical instruments based on partial information of known and unknown parameters. The object recognition system can be implemented by a remote server 63 (Figure 5) or a surgical hub 56 (Figure 6). The object recognition system may not be able to definitively identify an object, but it can narrow down the object to several candidates. The system takes partial object information as input (18142) and evaluates the object using known parameters. If the system determines the physical properties of the object, it can perform a geometric uncertainty analysis (18144). If the system determines the geometric properties of the object, it can perform a physical uncertainty analysis 18146 (18146). However, if the system does not have enough information, it may require manual identification and classify the object as unknown (18148).

[0091] In various aspects, the surgical hub receives spatial and physical parameters associated with the operating room or external environment. Physical parameters may be registered for a specific room or environment. In various aspects, the external environment may be classified according to specific characteristics such as sterile or non-sterile environment, pre-operative, OR, or post-operative room, and specific equipment in the room (e.g., MRI, CT scanner).

[0092] The Trocar, equipped with an externally mounted camera system, keeps the port free from the instrument and increases the field of view. This disclosure further describes a camera system incorporated into a trocar. The camera system enables a wide field of view of the internal surgical site and 3D mapping of reference markers during laparoscopic procedures. Once inside the patient, the camera system is configured to deploy from a recessed position at the distal end of the trocar. In various embodiments, the internal camera system is configured to keep the trocar port free from surgical instruments and to provide surgical personnel with an enlarged view of the surgical environment.

[0093] Figure 20 shows a trocar 18160 equipped with an internal camera system 18166. The internal camera system 18166 comprises multiple cameras 18166a-n connected together by an elastic member 18168. The elastic connection 18168 allows the camera system 18166 to be folded together and fitted through a passage defined in the center of the trocar. In various embodiments, the camera system 18166 emits light in the non-visible spectrum, allowing the cameras 18166a-n to detect various types of reference markers (e.g., IR reference markers). When the internal camera system 18166 is deployed at 18160a, the camera system 18166 is attached to the outer diameter 18170 of the distal end 18162 of the trocar 18160. When the trocar is inserted into and removed from a patient's body cavity, the internal camera system 18166 is in the retracted position 18160b. In the retracted position 18160b, the camera system 18166 is fitted into the inner diameter 18172 of the distal end 18162 of the trocar 18160.

[0094] Referring to Figures 20 and 21, Figure 21 shows a reusable mounting tool 18176 that is inserted into the proximal end 18164 of the trocar 18160 and configured to deploy and retract the camera system 18166 around the outer diameter 18170 of the trocar 18160. The camera system 18166 is communicably connected to a surgical hub 56 (Figure 6) via a wired or wireless connection. In a wireless configuration, each camera 18166a-n may have its own power source (e.g., a rechargeable battery), and the camera system 18166 may have a single external power source connected to each camera 18166a-n via an elastically deformable wired connection. In a wired configuration, the wired connection may be inserted outside the trocar 18160 while the trocar 18160 is inserted, keeping the inner diameter of the trocar 18160 free from surgical instruments. The camera system 18160 can be attached to the outer diameter of the trocar 18160 by compression and friction of an elastic connection, by a magnet in the case of a metal trocar, or by a separate connection on the outer diameter of the trocar 18160.

[0095] Figure 21 also shows a side view 18178a of the mounting plunger 18174a in the fully depressed position. The conical distal end 18158 of the trocar 18160 releases the camera system 18166. The plunger 18174b is pulled proximal, which causes the conical distal end 18158 to push the camera system along the outer diameter 18170 of the trocar 18160. As the plunger 18174c continues to retract proximal, the camera system 18166 is attached to the outer diameter 18170 of the trocar 18160. The reusable mounting tool 18176 is removed so that the laparoscopic surgical procedure can be initiated.

[0096] Reference marker-based preoperative computed tomography (CT) scans with real-time 3D model updates to improve partial treatment tracking. This disclosure further describes a system configured to generate a 3D model for a surgeon to navigate through the internal tissue structure of a patient. The system identifies and marks the target tissue or structure in a preoperative CT scan. The system generates an initial 3D model based on the CT scan used by the surgeon to assist in navigating the internal structure. The 3D model may be continuously updated in real time based on additional data points received during surgery. In one embodiment, the system may determine proximity to surgical instruments and update the model to reflect tissue movement or changes in tissue position.

[0097] In various embodiments, the system generates a 3D rendering of internal tissue structures with virtual elements and displays the 3D model on an augmented reality display. The system may generate a live feed of the surgical environment or provide virtual elements superimposed on a live feed of the real world of the surgical site. In various embodiments, the 3D model indicates areas of interest and areas to be avoided. In addition, markers may indicate tissues that need to be sealed or are difficult to locate, such as pulmonary veins and arteries.

[0098] Figure 22 shows multiple reference markers 18180 tagged in the target region in a preoperative CT scan. The reference markers may be positioned to generate a centroid at a key structure 18182. The centroid value is determined based on the relative distance between each of the reference markers in the set.

[0099] Figure 23 illustrates a laparoscopic surgical procedure that utilizes multiple reference markers to assist the surgeon in locating the surgical site. Preoperative determination of critical structures 18184 is generally an approximation of the structural location, but may not be precise. In various embodiments, an internal camera may be used with the reference markers to provide real-time updated location of critical structures 18186 using an updated model or updated reference markers. In various embodiments, the reference markers are placed on a surgical instrument 18190 to help provide updated location 18186 based on the relationships between other points. The surgical instrument may further include an integrated mapping sensor 18188.

[0100] Tracking tissue movement and position using physical markers in laparoscopic surgery This disclosure further describes various methods and systems for marking and tracking the movement of an organization using physical markers. The tracking system comprises a camera system configured to detect and track physical markers. In various embodiments, the physical marker includes magnetic ink, visible ink in the visible light spectrum, invisible ink in the invisible light spectrum, or other detectable ink by the camera system.

[0101] Figure 24 shows a physical marker applied by indocyanine dye 18202 injecting into the patient's vascular system. The dye 18202 is illuminated by a light source 18204, which enables camera 18206 to capture and record the vascular structure of tissue 18210. In one embodiment, the light source 18204 may be a fluorescent light source. The camera system 18206 may visualize the dye 18202 using various optical frequencies or lasers. The camera system 18206 is further configured to identify various overlay paths of the ink and display a 3D rendering on output display 18208. In various embodiments, the vascular system can be used like a fingerprint to uniquely identify a structure and track the structure as it moves. In addition, preoperative CT imaging may be used to help the system generate a 3D map of the structure. The dye may also be used to track organs and to alert surgical staff if they are attempting to grasp highly vascularized tissue. Figure 25 further shows exemplary tissue that has been injected with dye and illuminated to show the vascular system.

[0102] In various embodiments, the light source 18204 may emit light of wavelengths outside the visible spectrum, such as IR. In addition, the dye 18202 may include magnetic ink used as a marker to distinguish between target areas inside and outside the field of view of the camera 18206. In one embodiment, the dye 18202 may be a splatter sprayed onto the surgical area in the non-visible spectrum so that the body can readily absorb the dye 18202. The splatter generates a unique pattern that allows the camera 18206 to easily track the location and movement of tissue 18210.

[0103] Intraoperative tracking of non-fixed physical markers for measuring anatomical or surgical events. This disclosure further describes a system configured to track tissue or anatomical structures without physically fixed anatomical markers. Physical markers are typically used to track tissue or anatomical structures, but there are situations that prevent the use of this method, such as recently sealed tissue. The system tracks tissue using non-fixed markers having temperature and impedance.

[0104] Figure 26 shows a system 18300 configured to monitor changes in pressure or fluid within a body cavity according to impedance measurements by probe 18302. Probe 18302 is connected to a surgical instrument 18304 and measures impedance values ​​based on the pressure generated by fluid and / or gas within the body cavity 18306. A surgical hub 56 (Figure 6) may be connected to the surgical instrument 18304 and configured to determine whether there is a change in pressure within the body cavity 18306. A change in pressure indicates the presence of a leak within the body cavity 18306. Probe 18302 is configured to maintain a fixed gap to measure the change in pressure at a potential leak site 18308.

[0105] In addition, the surgical hub 56 (Figure 6) may notify surgical personnel of detected leaks by generating alerts through AR content. In one embodiment, a virtual element may be rendered on the AR display 89 of an AR device 66 (Figure 10) fixed to the location of the detected event. The virtual element may be identified by contrasting colors that are solid, flashing, or semi-transparent. The virtual element may be accompanied by a text alert that identifies the type of event and / or the severity of the event.

[0106] Figure 27 shows an infrared (IR) thermal detection system 18310 comprising an IR camera system 18312 configured to direct IR light 18314 onto a treatment area of ​​tissue 18316 and to identify temperature differences within a surgical environment 18304. In one embodiment, the IR camera system 18312 may be configured to identify the location of a leak in a pressurized cavity due to a change in the temperature of the air surrounding the leak. The body cavity is pressurized with air that is colder or warmer than the fluid in the abdominal cavity. The IR camera system 18312 observes the leak by looking at the gas that is warmer or colder than the cavity. In response to leak detection, the surgical hub 56 may notify the surgical staff.

[0107] In one embodiment, the IR camera system 18312 may determine that a region of tissue has been recently sealed. The sealed tissue may be at a different temperature, allowing the IR camera system 18312 to distinguish the sealed tissue as a sensitive treatment area. The surgical hub 56 (Figure 6) may render a virtual element superimposed on the treated area to indicate to the surgeon that the sealed tissue is a recently treated and sensitive area.

[0108] Sealed tissue is identified based on a predetermined tissue temperature threshold at the time the tissue was sealed. Although the tissue temperature may cool slowly, the IR camera system 18312 can mark the area with a non-fixed marker that is maintained even after the tissue temperature has dropped below the initial threshold temperature.

[0109] A motion tracking system configured to control and adjust surgical instruments to prevent excessive tension on tissues. This disclosure further describes a tissue tracking system for preventing excessive tension from being applied to tissue. The system is configured to track markers applied to the tissue at specific locations indicating motion, force, and tension. A surgical hub 56 (Figure 6) can continuously monitor tissue tension and motion parameters. The surgical hub 56 can determine when tissue tension at a specific location has reached a predetermined threshold and provide notification to one or more AR devices 66 (Figure 10).

[0110] Figure 28 shows a surgical procedure 18350 employing three end effectors 18352, 18354, and 18356 configured to grasp and transversely incise tissue 18360. The tissue 18360 is initially grasped at two points by the first end effector 18352 and the second end effector 18356. An AR device 66 (Figure 10) may indicate the initial positions where the end effectors 18352 and 18356 should be positioned. The initial distance 18358 between the first end effector 18352 and the second end effector 18356 is determined based on the force applied to the tissue 18360. The second end effector 18356 is configured to transversely incise the tissue 18360 and requires a third end effector 18354 to compensate for the increase in tissue tension.

[0111] Figure 29 shows a third end effector 18354 sliding along the tissue from a first position 18354a to a second position 18354b. The surgical staff monitors the position of the third end effector 18354 to ensure it is properly positioned to compensate for the increase in tension. In various embodiments, the AR device 66 (Figure 10) may highlight the tissue when the tissue 18360 exceeds a predetermined tension threshold. The surgeon may reposition the third end effector 18354 so that the tissue 18360 is no longer highlighted and the tissue tension has returned to within the predetermined threshold. In various embodiments, the surgeon may receive feedback via a handle or joystick to indicate when repositioning is necessary and when the new position is satisfactory.

[0112] Figure 30 shows a third end effector 18354 positioned adjacent to the second end effector 18356. When the tissue 18360 is transversely incised by the second end effector, the tissue tension falls within a predetermined threshold based on the initial distance 18358 (Figure 28).

[0113] Figure 31 shows a surgical procedure 18370 using three stationary clamps 18372, 18274, and 18378 and a dynamic clamp 18376 configured to transfer tissue between the stationary clamps 18372, 18274, and 18378. The first clamp 18372 is a stationary clamp configured to hold the end of the tissue 18386 and prevent tension or pulling beyond the area of ​​interest 18382. The second clamp 18374 and the third clamp 18378 are positioned at a predetermined distance so that the tissue maintains a predetermined tension. The second clamp 18374 and the third clamp 18378 are stationary but can be opened and closed to pull new tissue 18386 over a stationary distance 18380. The fourth clamp 18376 is a dynamic clamp configured to pull the tissue 18386 between the second clamp 18374 and the third clamp 18378, thereby reducing the tension between the first clamp 18372 and the second clamp 18374. The fourth clamp 18376 repositions the tissue 18386 to reduce the excess tension in 18384, as indicated by graphical highlighting. An AR device 66 (Figure 10) may provide similar highlighting to indicate excess tissue tension.

[0114] Figure 32 shows a logical flowchart of method 18400 for displaying surgical locations inside a patient. According to method 18400, a surgical hub 56 (Figure 6) receives video feeds from one or more cameras located inside the patient (18402). The surgical hub 56 identifies one or more physical markers inside the patient (18404). The surgical hub 56 determines a target location based on its relationship to the one or more physical markers (18406). The surgical hub 56 generates a virtual element corresponding to the target location (18408). An AR device 66 (Figure 10) connected to the surgical hub 56 (Figure 6) displays the virtual element overlaid on the video feed on an augmented reality (AR) display 79 (Figure 10) (18410).

[0115] In one aspect of Method 18400, the video feed is a wide-angle view stitched together from at least two video feeds. In another aspect, according to Method 18400, one or more physical markers are visible under illumination from a light source outside the visible spectrum. In yet another aspect of Method 18400, one or more physical markers are reference markers assigned in a preoperative computed tomography (CT) scan. In yet another aspect of Method 18400, the target location is continuously updated in real time on an augmented reality (AR) device 66 (Figure 10).

[0116] Various additional aspects of the subject matter described herein are illustrated in the following numbered examples.

[0117] Example 1: A surgical system comprising: a surgical device, a camera array having an axial passage defining an outer and inner diameter, a proximal end, a distal end configured to penetrate tissue, and individual cameras connected in a ring configuration by elastic connectors; a removable attachment trigger configured to extend the camera array from a first recessed position from the inner diameter of the distal end of the axial passage to a second unfolded position where the camera array is circumferentially positioned around the outer diameter of the distal end of the axial passage; an augmented reality (AR) device; and a surgical hub communicably connected to the camera array and the AR device, the surgical hub comprising a control circuit connected to memory, wherein the control circuit is configured to receive multiple video feeds from the camera array, identify physical markers on the video feeds, and display the physical markers on an AR display.

[0118] Example 2: The surgical system according to Example 1, wherein the video feed is a wide-angle view stitched together from each of the individual cameras.

[0119] Example 3: The surgical system according to either Example 1 or 2, wherein the physical marker is visible under illumination from a light source outside the visible spectrum.

[0120] Example 4: The surgical system according to any one of Examples 1 to 3, wherein the physical marker is a dye.

[0121] Example 5: A surgical system according to any one of Examples 1 to 4, wherein the physical marker is a reference marker assigned in a preoperative computed tomography (CT) scan.

[0122] Example 6: A surgical system according to any one of Examples 1 to 5, wherein a physical marker is configured to indicate the target location for a surgical procedure.

[0123] Example 7: The surgical system according to Example 6, wherein the target location is continuously updated in real time on an AR device.

[0124] Example 8: The surgical system described in Example 7, wherein the target location is updated based on the relationship between the surgical instrument and the physical marker.

[0125] Example 9: A surgical device comprising: a camera array including individual cameras connected in a ring configuration by elastic connectors, and communicably connectable to a surgical hub; an elongated penetrating member having a proximal end and a distal end further comprising a tissue-penetrating tip; an axial passage passing through the elongated penetrating member and the tissue-penetrating tip, the inner diameter of which is dimensioned to accommodate the camera array in a first recessed position; and a detachable mounting trigger configured to extend the camera array from a first recessed position from the inner diameter of the distal end of the elongated penetrating member to a second deployed position in which the camera array is circumferentially positioned around the outer diameter of the distal end of the elongated penetrating member.

[0126] Example 10: The surgical device according to Example 9, wherein the camera array is connectable to a surgical hub via a wireless communication protocol.

[0127] Example 11: The surgical device according to Example 10, wherein the camera array is powered by a rechargeable battery.

[0128] Example 12: A surgical device according to any one of Examples 9 to 11, wherein the camera array is connectable to a surgical hub via a wired communication protocol.

[0129] Example 13: The surgical device according to Example 12, wherein the camera array is powered by a wired external power supply having a wire extending along the outer diameter of an elongated through member.

[0130] Example 14: A surgical device according to any one of Examples 9 to 13, wherein the camera array is attached to the outer diameter of the distal end of an elongated through member in a compression and friction configuration.

[0131] Example 15: A surgical device according to any one of Examples 9 to 14, wherein the camera array does not occupy the space of the inner diameter of the axial passage in the second deployment position.

[0132] Example 16: A method for displaying a surgical location inside a patient, comprising: a surgical hub receiving a video feed from a camera located inside the patient; a surgical hub identifying physical markers inside the patient; a surgical hub determining a target location based on its relationship to the physical markers; a surgical hub generating virtual elements corresponding to the target locations; and an augmented reality (AR) device connected to the surgical hub displaying the virtual elements overlaid on the video feed on an AR display.

[0133] Example 17: The method according to Example 16, wherein the video feed is a wide-angle view stitched together from at least two video feeds.

[0134] Example 18: The method according to either Example 16 or 17, wherein the physical marker is visible only under illumination from a light source outside the visible spectrum.

[0135] Example 19: The method according to any one of Examples 16-18, wherein the physical marker is a reference marker assigned in a preoperative computed tomography (CT) scan.

[0136] Example 20: The method according to any one of Examples 16-19, wherein the target location is continuously updated in real time on an augmented reality (AR) device.

[0137] While several forms have been shown and described, it is not the applicant's intention to limit or restrict the attached claims to such details. Many modifications, variations, alterations, substitutions, combinations, and equivalents of these forms can be implemented and will be conceived by those skilled in the art without departing from the scope of this disclosure. Furthermore, the structure of each element related to the described form can be alternatively described as a means for providing the function performed by that element. Also, while materials are disclosed with respect to specific components, other materials may be used. Therefore, it should be understood that the above description and the attached claims are intended to cover all such modifications, combinations, and variations as being included within the scope of the disclosed forms. The attached claims are intended to cover all such modifications, variations, alterations, substitutions, alterations, and equivalents.

[0138] The detailed descriptions above have described various forms of apparatus and / or processes using block diagrams, flowcharts and / or embodiments. To the extent that such block diagrams, flowcharts and / or embodiments include one or more functions and / or operations, it will be understood by those skilled in the art that each function and / or operation included in such block diagrams, flowcharts and / or embodiments can be implemented individually and / or collectively by various hardware, software, firmware, or virtually any combination thereof. Those skilled in the art will understand that some or all of the forms disclosed herein can be equivalently implemented on integrated circuits as one or more computer programs running on one or more computers (e.g., as one or more programs running on one or more computer systems), as one or more programs running on one or more processors (e.g., as one or more programs running on one or more microprocessors), as firmware, or substantially any combination thereof, and that designing circuits and / or writing software and / or firmware code falls within the scope of the skills of those skilled in the art in light of this disclosure. Furthermore, as will be understood by those skilled in the art, the mechanisms of the subject matter described herein can be distributed in various forms as one or more program products, and the specific forms of the subject matter described herein are applicable regardless of the particular type of signal carrier medium used to actually carry out the distribution.

[0139] Instructions used to program logic to implement various disclosed embodiments may be stored in system memory such as dynamic random access memory (DRAM), cache, flash memory, or other storage. Furthermore, instructions may be distributed over a network or by other computer-readable media. Thus, machine-readable media may include any mechanism for storing or transmitting information in a form readable by a machine (e.g., a computer), but are not limited to floppy diskettes, optical disks, compact disks, read-only memory (CD-ROMs), and magneto-optical disks, read-only memory (ROMs), random access memory (RAMs), erasable programmable read-only memory (EPROMs), electrically erasable programmable read-only memory (EEPROMs), magnetic or optical cards, flash memory, or tangible machine-readable storage used for transmitting information over the Internet via electrical, optical, acoustic, or other forms of propagated signals (e.g., carrier waves, infrared signals, digital signals, etc.). Thus, non-temporary computer-readable media may include any type of tangible machine-readable media suitable for storing or transmitting electronic instructions or information in a form readable by a machine (e.g., a computer).

[0140] When used in any aspect of this specification, the term “control circuit” can mean, for example, hardwired circuits, programmable circuits (e.g., computer processors, processing units, processors, microcontrollers, microcontroller units, controllers, digital signal processors (DSPs), programmable logic devices (PLDs), programmable logic arrays (PLAs), or field-programmable gate arrays (FPGAs) including one or more individual instruction processing cores), state-machine circuits, firmware that stores instructions executed by programmable circuits, and any combination thereof. Control circuits can be embodied collectively or individually as circuits that form part of a larger system, such as an integrated circuit (IC), an application-specific integrated circuit (ASIC), a system-on-a-chip (SoC), a desktop computer, a laptop computer, a tablet computer, a server, or a smartphone. Accordingly, as used herein, “control circuit” includes, but is not limited to, an electrical circuit having at least one separate electrical circuit, an electrical circuit having at least one integrated circuit, an electrical circuit having at least one application-specific integrated circuit, an electrical circuit forming a general-purpose computing device configured by a computer program (e.g., a general-purpose computer configured by a computer program that performs at least partially the processes and / or devices described herein, or a microprocessor configured by a computer program that performs at least partially the processes and / or devices described herein), an electrical circuit forming a memory device (e.g., in the form of random access memory), and / or an electrical circuit forming a communication device (e.g., a modem, a communication switch, or an optical-electric installation). Those skilled in the art will recognize that the subject matter described herein may be implemented in analog form, digital form, or some combination thereof.

[0141] When used in any aspect of this specification, the term “logic” may mean an application, software, firmware, and / or circuit configured to perform any of the operations described above. Software may be embodied as software packages, code, instructions, instruction sets, and / or data recorded on a non-temporary computer-readable storage medium. Firmware may be embodied as code, instructions, or instruction sets, and / or hardcoded (e.g., non-volatile) data in a memory device.

[0142] When used in any aspect of this specification, the terms “component,” “system,” “module,” etc., may refer to a control circuit, a computer-related entity, hardware, a combination of hardware and software, software, or running software.

[0143] Where used in any aspect of this specification, “algorithm” means a self-consistent sequence of steps leading to a desired result, and “step” means the manipulation of physical quantities and / or logical states that can take the form of electrical or magnetic signals, which are not necessarily required to be stored, transferred, combined, compared, and otherwise manipulated. These signals are commonly referred to as bits, values, elements, symbols, characters, terms, numbers, etc. These and similar terms may be associated with appropriate physical quantities, or simply are convenient labels applied to these quantities and / or states.

[0144] A packet-switched network is one example of a network. Communication devices can communicate with each other using a selected packet-switched network communication protocol. One exemplary communication protocol is the Ethernet communication protocol, which can enable communication using the Transmission Control Protocol / Internet Protocol (TCP / IP). The Ethernet protocol may conform to or be compatible with the "IEEE 802.3 Standard" published in December 2008 by the Institute of Electrical and Electronics Engineers (IEEE), and / or later versions of the Ethernet standard. Alternatively or additionally, communication devices can communicate with each other using the X.25 communication protocol. The X.25 communication protocol may conform to or be compatible with standards published by the International Telecommunication Union - Telecommunication Standardization Sector (ITU-T). Alternatively or additionally, communication devices can communicate with each other using the Frame Relay communication protocol. The Frame Relay communication protocol conforms to or may be compatible with standards published by the Consultative Committee for International Telegraph and Telephone (CCITT) and / or the American National Standards Institute (ANSI). Alternatively or additionally, transceivers may communicate with each other using the Asynchronous Transfer Mode (ATM) communication protocol. The ATM communication protocol conforms to or may be compatible with the ATM standard and / or later versions of this standard, published by the ATM Forum in August 2001 under the title "ATM-MPLS Network Interworking 2.0". Naturally, different and / or later developed connection-oriented network communication protocols are equally construed herein.

[0145] Unless otherwise explicitly stated, as is evident from the foregoing disclosures, any use of terms such as “processing,” “computing,” “calculating,” “determining,” and “displaying” throughout the foregoing disclosures should be understood to refer to the actions and processes of a computer system or similar electronic computing device that manipulate and convert data represented as physical (electronic) quantities in the registers and memory of a computer system into other data similarly represented as physical quantities in the memory or registers of a computer system or other such information storage, transmission, or display device.

[0146] One or more components may be referred to herein as “configured to,” “configurable to,” “operable / operative to,” “adapted / adaptable,” “able to,” “conformable / conformed to,” and so on. Those skilled in the art will understand that “configured to” generally encompasses active components and / or inactive components and / or standby components, unless the context should interpret it otherwise.

[0147] The terms “proximal” and “distal” are used herein in reference to the clinician operating the handle portion of a surgical instrument. “Proximal” refers to the part closest to the clinician, and “distal” refers to the part further away from the clinician. For convenience and clarity, spatial terms such as “vertical,” “horizontal,” “up,” and “down” may be used herein in reference to the drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be restrictive and / or absolute.

[0148] Those skilled in the art will generally understand that the terms used herein, and especially in the appended claims (e.g., the text of the appended claims), are generally intended to be "open" terms (for example, the term "including" should be interpreted as "including but not limited to," the term "having" should be interpreted as "having at least," and the term "includes" should be interpreted as "includes but is not limited to"). Furthermore, those skilled in the art will understand that if a particular number is intended in an introduced claim recitation, such intent is clearly stated in the claim, and if such statement is not present, such intent does not exist. For example, to aid understanding, subsequent appended claims may include the introductory phrases "at least one" and "one or more" to introduce the claim recitation. However, the use of such phrases should not be interpreted as suggesting that any particular claim containing such introduced claim description is limited to claims containing only one such description, even if the same claim contains an introductory phrase such as "one or more" or "at least one" and the indefinite article "a" or "an" (for example, "a" and / or "an" should generally be interpreted as meaning "at least one" or "one or more"). The same applies when introducing a claim description using a definite article.

[0149] In addition, even if a specific number is explicitly stated in the introduced claim, it will be recognized by those skilled in the art that such a statement should typically be interpreted as meaning at least the number stated (for example, if there is a statement that is simply “two descriptions” without any other modifiers, it generally means at least two descriptions, or two or more descriptions). Furthermore, when a notation similar to “at least one of A, B, and C, etc.” is used, such a notation is generally intended to be understood in a way that those skilled in the art will understand (for example, “a system having at least one of A, B, and C” is not limited to systems having only A, only B, only C, both A and B, both A and C, both B and C and / or all of A, B and C, etc.). When expressions similar to "at least one of A, B, or C" are used, such expressions are generally intended to be understood in a way that a person skilled in the art would understand (for example, "a system having at least one of A, B, or C" includes, but is not limited to, systems having only A, only B, only C, both A and B, both A and C, both B and C, and / or all of A, B, and C). Furthermore, a person skilled in the art will understand that, typically, any disjunctive word and / or phrase representing two or more selective terms should be understood, whether in the specification, claims, or drawings, as intended to include the possibility of including one of those terms, any of those terms, or both of those terms, unless the context requires a different interpretation. For example, the phrase "A or B" will typically be understood to include the possibility of "A" or "B" or "A and B".

[0150] With respect to the attached claims, those skilled in the art will understand that the operations cited herein may generally be performed in any order. Furthermore, while various operations are shown in sequence(s), it should be understood that the operations may be performed in any order other than those shown, or simultaneously. Examples of such alternative orderings may include repetition, alternation, interruption, reordering, augmentation, preliminary, additional, simultaneous, reverse, or other different orderings, unless the context should imply otherwise. Moreover, terms such as “responsive to,” “related to,” or other past tense adjectives are generally not intended to exclude such variations, unless the context should imply otherwise.

[0151] It is worth noting that any reference to “one aspect,” “aspect,” “example,” or “example” means that the specific feature, structure, or characteristic described in relation to that aspect is included in at least one aspect. Therefore, the phrases “in one aspect,” “in aspect,” “example,” and “example” found in various places throughout this specification do not necessarily all refer to the same aspect. Furthermore, specific features, structures, or characteristics can be combined in any preferred manner in one or more aspects.

[0152] Any patent application, patent, non-patent publication, or other disclosure material referenced herein and / or listed in any application data sheet is incorporated herein by reference to the extent that the incorporated material does not conflict with this Specified. Disclosures expressly stated herein, both in themselves and to the extent required, shall supersede any conflicting statements incorporated herein by reference. Any material, or any part thereof, that is referred to as being incorporated herein by reference but conflicts with current definitions, views, or other disclosures contained herein shall be incorporated only to the extent that there is no conflict between the incorporated material and the current disclosures.

[0153] In summary, the numerous benefits that can be obtained as a result of using the concepts described herein have been described. The above descriptions of one or more forms are presented for illustrative and explanatory purposes only. They are not intended to be comprehensive or to be limited to the exact forms disclosed. Modifications or variations are possible in light of the above teachings. One or more forms have been selected and described to illustrate the principle and practical applications, thereby enabling a person skilled in the art to utilize the various forms, along with various modifications, for specific conceivable uses. The claims presented herein are intended to define the overall scope.

[0154] [Implementation Method] (1) A surgical system, A surgical device, An axial passage defining the outer diameter and inner diameter, The proximal end and A distal end configured to penetrate tissue, A camera array comprising individual cameras connected in a ring configuration by elastic connectors, A surgical device comprising a removable attachment trigger, wherein the camera array is configured to extend from a first recessed position from the inner diameter of the distal end of the axial passage to a second deployed position where the camera array is circumferentially positioned around the outer diameter of the distal end of the axial passage. Augmented reality (AR) devices and A surgical hub, which is communicably connected to the camera array and the AR device, comprises a control circuit connected to a memory, wherein the control circuit is Multiple video feeds are received from the aforementioned camera array, Identify the physical marker on the video feed, A surgical system configured to display the physical marker on the AR display. (2) The surgical system according to Embodiment 1, wherein the video feed is a wide-angle view stitched together from each of the individual cameras. (3) The surgical system according to Embodiment 1, wherein the physical marker is visible under illumination of a light source outside the visible spectrum. (4) The surgical system according to Embodiment 1, wherein the physical marker is a dye. (5) The surgical system according to Embodiment 1, wherein the physical marker is a reference marker assigned in a preoperative computed tomography (CT) scan.

[0155] (6) The surgical system according to Embodiment 1, wherein the physical marker is configured to indicate a target site for a surgical procedure. (7) The surgical system according to Embodiment 6, wherein the target location is continuously updated in real time on the AR device. (8) The surgical system according to Embodiment 7, wherein the target location is updated based on the relationship between the surgical instrument and the physical marker. (9) Surgical devices, A camera array comprising individual cameras connected in a ring configuration by elastic connectors, and which is communicably connectable to a surgical hub, An elongated penetrating member having a proximal end and a distal end further comprising a tissue-penetrating tip, The axial passage passing through the elongated through member and the tissue penetration tip, wherein the inner diameter of the axial passage is sized to accommodate the camera array in a first recessed position, A surgical device comprising a detachable attachment trigger, wherein the camera array is configured to extend from a first recessed position from the inner diameter of the distal end of the elongated through member to a second deployed position in which the camera array is circumferentially positioned around the outer diameter of the distal end of the elongated through member. (10) The surgical device according to embodiment 9, wherein the camera array is communicably connected to the surgical hub via a wireless communication protocol.

[0156] (11) The surgical device according to embodiment 10, wherein the camera array is powered by a rechargeable battery. (12) The surgical device according to Embodiment 9, wherein the camera array is communicably connected to the surgical hub via a wired communication protocol. (13) The surgical device according to embodiment 12, wherein the camera array is powered by a wired external power supply comprising a wire extending along the outer diameter of the elongated through member. (14) The surgical device according to Embodiment 9, wherein the camera array is attached to the outer diameter of the distal end of the elongated through member in a compression and friction configuration. (15) The surgical device according to Embodiment 9, wherein the camera array does not occupy the space of the inner diameter of the axial passage in the second deployed position.

[0157] (16) A method for indicating the location of surgery inside a patient, The surgical hub receives video feeds from cameras located inside the patient, The surgical hub is used to identify physical markers inside the patient, The surgical hub determines the target location based on its relationship with the physical marker, The surgical hub generates a virtual element corresponding to the target location, A method comprising displaying the virtual elements overlaid on the video feed on an AR display using an augmented reality (AR) device connected to the surgical hub. (17) The method according to embodiment 16, wherein the video feed is a wide-angle view stitched together from at least two video feeds. (18) The method according to embodiment 16, wherein the physical marker is visible under illumination of a light source outside the visible spectrum. (19) The method according to embodiment 16, wherein the physical marker is a reference marker assigned in a preoperative computed tomography (CT) scan. (20) The method according to embodiment 16, wherein the target location is continuously updated in real time on an augmented reality (AR) device.

Claims

1. A surgical system, A surgical device, An axial passage defining the outer diameter and inner diameter, The proximal end and A distal end configured to penetrate tissue, A camera array comprising individual cameras connected in a ring configuration by elastic connectors, A surgical device comprising a removable attachment trigger, wherein the camera array is configured to extend from a first recessed position from the inner diameter of the distal end of the axial passage to a second deployed position where the camera array is circumferentially positioned around the outer diameter of the distal end of the axial passage; Augmented reality (AR) devices and A surgical hub, which is communicably connected to the camera array and the AR device, comprises a control circuit connected to a memory, wherein the control circuit is Multiple video feeds are received from the aforementioned camera array, Identify the physical marker on the video feed, A surgical system configured to display the physical marker on the AR display of the AR device.

2. The surgical system according to claim 1, wherein the video feed is a wide-angle view stitched together from each of the individual cameras.

3. The surgical system according to claim 1, wherein the physical marker is visible under illumination of a light source.

4. The surgical system according to claim 1, wherein the physical marker is a dye.

5. The surgical system according to claim 1, wherein the physical marker is a reference marker assigned in a preoperative computed tomography (CT) scan.

6. The surgical system according to claim 1, wherein the physical marker is configured to indicate a target location for a surgical procedure.

7. The surgical system according to claim 6, wherein the target location is continuously updated in real time on the AR device.

8. The surgical system according to claim 7, wherein the target location is updated based on the relationship between the surgical instrument and the physical marker.

9. A surgical device, A camera array comprising individual cameras connected in a ring configuration by elastic connectors, and which is communicably connectable to a surgical hub, An elongated penetrating member having a proximal end and a distal end further comprising a tissue-penetrating tip, The axial passage passing through the elongated through member and the tissue penetration tip, wherein the inner diameter of the axial passage is sized to accommodate the camera array in a first recessed position, A surgical device comprising a detachable attachment trigger, wherein the camera array is configured to extend from a first recessed position from the inner diameter of the distal end of the elongated through member to a second deployed position in which the camera array is circumferentially positioned around the outer diameter of the distal end of the elongated through member.

10. The surgical device according to claim 9, wherein the camera array is connectable to the surgical hub via a wireless communication protocol.

11. The surgical device according to claim 10, wherein the camera array is powered by a rechargeable battery.

12. The surgical device according to claim 9, wherein the camera array is communicably connected to the surgical hub via a wired communication protocol.

13. The surgical device according to claim 12, wherein the camera array is powered by a wired external power supply comprising a wire extending along the outer diameter of the elongated through member.

14. The surgical device according to claim 9, wherein the camera array is attached to the outer diameter of the distal end of the elongated through member.

15. The surgical device according to claim 9, wherein the camera array does not occupy the space of the inner diameter of the axial passage in the second deployed position.

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