Electric stapling device configured to adjust force, advance speed, and total travel of a cutting member based on sensed parameters of firing or clamping
阅读说明：本技术 被配置成能够基于击发或夹持的感测参数来调节切割构件的力、推进速度和总行程的电动缝合装置 (Electric stapling device configured to adjust force, advance speed, and total travel of a cutting member based on sensed parameters of firing or clamping ) 是由 F·E·谢尔顿四世 G·J·巴克斯 J·L·哈里斯 C·O·巴克斯特三世 于 2018-11-14 设计创作，主要内容包括：本发明公开了一种外科缝合器械。该外科缝合器械包括：端部执行器,该端部执行器被构造成能够夹持组织；切割构件；马达,该马达联接到该切割构件,该马达被配置成能够使该切割构件在第一位置与第二位置之间运动；以及控制电路,该控制电路联接到该马达。该控制电路被配置成能够：感测与该端部执行器的夹持或该切割构件的击发或该端部执行器的夹持与该切割构件的击发的组合相关联的参数；以及根据该参数控制该马达以调节由该马达施加到该切割构件的扭矩、该马达驱动该切割构件的速度或该马达驱动切割构件的距离,或者调节该扭矩、速度和距离的任何组合。(The invention discloses a surgical suturing apparatus. The surgical stapling instrument comprises: an end effector configured to grasp tissue; a cutting member; a motor coupled to the cutting member, the motor configured to move the cutting member between a first position and a second position; and a control circuit coupled to the motor. The control circuit is configured to be capable of: sensing a parameter associated with the clamping of the end effector or the firing of the cutting member or a combination of the clamping of the end effector and the firing of the cutting member; and controlling the motor to adjust the torque applied to the cutting member by the motor, the speed at which the motor drives the cutting member, or the distance at which the motor drives the cutting member, or any combination of the torque, speed, and distance, according to the parameter.)
1. A surgical stapling instrument comprising:
an end effector configured to clamp tissue;
a cutting member;
a motor coupled to the cutting member, the motor configured to move the cutting member between a first position and a second position; and
a control circuit coupled to the motor, the control circuit configured to:
sensing a parameter associated with clamping of the end effector; and
controlling the motor to adjust a torque applied by the motor to the cutting member.
2. The surgical stapling instrument of claim 1, wherein said cutting member is actuatable independently of said end effector.
3. The surgical stapling instrument of claim 1, wherein said parameter comprises tissue gap, force during closure of said end effector, tissue creep stabilization, or force during firing, or any combination thereof.
4. The surgical stapling instrument of claim 1, wherein the control circuit is configured to control the motor to drive the cutting member in a load control mode or a stroke control mode in accordance with an adjustable control parameter.
5. The surgical stapling instrument of claim 1, wherein said control circuit is configured to control an advancement rate at which said motor drives said cutting member as a function of an initial condition when said motor begins driving said cutting member from said first position.
6. The surgical instrument of claim 1, wherein the control circuit is configured to control the motor to adjust a speed at which the motor drives the cutting member.
7. The surgical instrument of claim 1, wherein the control circuit is configured to control the motor to adjust a distance that the motor drives the cutting member as a function of the parameter.
8. The surgical instrument of claim 1, wherein the control circuit is configured to control the motor to adjust any combination of the torque, the speed, or the distance.
9. A surgical stapling instrument comprising:
an end effector configured to clamp tissue;
a cutting member;
a motor coupled to the cutting member, the motor configured to move the cutting member between a first position and a second position; and
A control circuit coupled to the motor, the control circuit configured to:
sensing a parameter associated with firing of the cutting member; and
controlling the motor to adjust a torque applied by the motor to the cutting member.
10. The surgical stapling instrument of claim 9, wherein said cutting member is actuatable independently of said end effector.
11. The surgical stapling instrument of claim 9, wherein said parameter comprises tissue gap, force during closure of said end effector, tissue creep stabilization, or force during firing, or any combination thereof.
12. The surgical stapling instrument of claim 9, wherein the control circuit is configured to control the motor to drive the cutting member in a load control mode or a stroke control mode in accordance with an adjustable control parameter.
13. The surgical stapling instrument of claim 9, wherein said control circuit is configured to control an advancement rate at which said motor drives said cutting member as a function of an initial condition when said motor begins driving said cutting member from said first position.
14. The surgical instrument of claim 9, wherein the control circuit is configured to control the motor to adjust a speed at which the motor drives the cutting member.
15. The surgical instrument of claim 9, wherein the control circuit is configured to control the motor to adjust a distance that the motor drives the cutting member as a function of the parameter.
16. The surgical instrument of claim 9, wherein the control circuit is configured to control the motor to adjust any combination of the torque, the speed, or the distance.
17. An electrically powered suturing device comprising:
a circular stapling head assembly;
an anvil block;
a trocar coupled to the anvil and coupled to the motor, wherein the motor is configured to advance and retract the trocar; and
a control circuit coupled to the motor, wherein the control circuit is configured to:
determining a position of the trocar in one of a plurality of regions; and
setting an anvil closure rate based on the determined trocar position.
18. The motorized suturing device of claim 17, wherein the plurality of zones comprises:
A first region during attachment of the trocar to the anvil;
a second region during retraction of the trocar and closure of the anvil;
a third region during verification of the trocar attachment to the anvil; and
a fourth region during application of a high closure load.
19. The motorized suturing device of claim 18, wherein the control circuitry is configured to:
setting the closing rate of the anvil to a first speed when the trocar is in the first region to ensure that the trocar is properly attached to the anvil;
setting the closing rate of the anvil to a second speed when the trocar is in the second position during trocar retraction and anvil closure, the second speed being greater than the first speed;
setting the closure rate of the anvil to a third speed, the third speed being less than the second speed to verify that the trocar is attached to the anvil;
setting the rate of closure of the anvil to a fourth speed when the trocar is in a fourth region during application of a high closure load, the fourth speed being less than the third speed.
20. The motorized suturing device of claim 17, wherein the control circuitry is configured to:
determining the rate of closure of the trocar;
determining the rate of closure of the anvil;
comparing the rate of closure of the trocar to the rate of closure of the anvil to determine a difference between the rate of closure of the trocar and the rate of closure of the anvil; and
extending and retracting the trocar to reposition the anvil when the difference is greater than a predetermined value.
21. The powered stapling device of claim 17, wherein said control circuit is configured to verify that said trocar is attached to said anvil and slows the rate of closure of said trocar under a tissue load.
22. The motorized suturing device of claim 17, further comprising:
a knife coupled to the motor;
a sensor located on the anvil, wherein the sensor is configured to detect tissue contact and force applied to the anvil, wherein the sensor is coupled to the anvil, wherein the control circuit is configured to:
Monitoring anvil displacement;
monitoring tissue contact with the anvil;
monitoring a closing force of the anvil;
comparing the closing force to a predetermined threshold; and
setting a first initial knife speed and advancing the knife in a first speed profile suitable for cutting normal tissue toughness when the closing force is less than the predetermined threshold; or
Setting a second initial knife speed and advancing the knife at a second speed profile suitable for cutting strong tissue toughness when the closing force is greater than or equal to the predetermined threshold.
23. The electric stapling device of claim 22, wherein to advance the knife at the second speed profile, the control circuitry is further configured to:
setting the second initial knife speed to a speed less than the first initial knife speed;
monitoring contact of the blade with tissue;
increasing the motor speed to increase the knife speed when tissue contact is detected;
monitoring the completion of the cutting; and
when the completion of cutting is detected, the motor is stopped.
Background
The present disclosure relates to various surgical systems. Surgery is typically performed in a medical facility, such as a surgical operating room or room in a hospital. A sterile field is typically formed around the patient. The sterile field may include members of a team who are properly wearing swabs, as well as all equipment and fixtures in the field. Surgical procedures are performed using a variety of surgical devices and systems.
Disclosure of Invention
In one aspect, the present disclosure provides a surgical stapling instrument comprising: an end effector configured to clamp tissue; a cutting member; a motor coupled to the cutting member, the motor configured to move the cutting member between a first position and a second position; and a control circuit coupled to the motor, the control circuit configured to: sensing a parameter associated with clamping of the end effector; and controlling the motor to adjust a torque applied by the motor to the cutting member.
In another aspect, the present disclosure provides a surgical stapling instrument comprising: an end effector configured to clamp tissue; a cutting member; a motor coupled to the cutting member, the motor configured to move the cutting member between a first position and a second position; and a control circuit coupled to the motor, the control circuit configured to: sensing a parameter associated with firing of the cutting member; and controlling the motor to adjust a torque applied by the motor to the cutting member.
In yet another aspect, the present disclosure provides an electrically powered suturing device comprising: a circular stapling head assembly; an anvil block; a trocar coupled to the anvil and coupled to the motor, wherein the motor is configured to advance and retract the trocar; and a control circuit coupled to the motor, wherein the control circuit is configured to: determining a position of the trocar in one of a plurality of regions; and setting an anvil closure rate based on the determined trocar position.
Drawings
The various aspects (relating to surgical tissues and methods) described herein, together with further objects and advantages thereof, may best be understood by reference to the following description taken in conjunction with the accompanying drawings.
Fig. 1 is a block diagram of a computer-implemented interactive surgical system in accordance with at least one aspect of the present disclosure.
Fig. 2 is a surgical system for performing a surgical procedure in an operating room according to at least one aspect of the present disclosure.
Fig. 3 is a surgical hub paired with a visualization system, a robotic system, and a smart instrument according to at least one aspect of the present disclosure.
Fig. 4 is a partial perspective view of a surgical hub housing and a composite generator module slidably received in a drawer of the surgical hub housing according to at least one aspect of the present disclosure.
Fig. 5 is a perspective view of a combined generator module having bipolar, ultrasonic and monopolar contacts and a smoke evacuation component according to at least one aspect of the present disclosure.
Fig. 6 illustrates a single power bus attachment for a plurality of lateral docking ports of a lateral modular housing configured to accommodate a plurality of modules in accordance with at least one aspect of the present disclosure.
Fig. 7 illustrates a vertical modular housing configured to accommodate a plurality of modules in accordance with at least one aspect of the present disclosure.
Fig. 8 illustrates a surgical data network including a modular communication hub configured to connect modular devices located in one or more operating rooms of a medical facility or any room in a medical facility dedicated to surgical operations to a cloud in accordance with at least one aspect of the present disclosure.
Fig. 9 is a computer-implemented interactive surgical system according to at least one aspect of the present disclosure.
Fig. 10 illustrates a surgical hub including a plurality of modules coupled to a modular control tower according to at least one aspect of the present disclosure.
Fig. 11 illustrates one aspect of a Universal Serial Bus (USB) hub device in accordance with at least one aspect of the present disclosure.
Fig. 12 is a block diagram of a cloud computing system including a plurality of smart surgical instruments coupled to a surgical hub connectable to cloud components of the cloud computing system in accordance with at least one aspect of the present disclosure.
Fig. 13 is a functional module architecture of a cloud computing system according to at least one aspect of the present disclosure.
Fig. 14 illustrates a diagram of a situation-aware surgical system in accordance with at least one aspect of the present disclosure.
Fig. 15 is a timeline depicting situational awareness of a surgical hub, according to at least one aspect of the present disclosure.
Fig. 16 illustrates a logic diagram of a control system of a surgical instrument or tool in accordance with at least one aspect of the present disclosure.
Fig. 17 illustrates a control circuit configured to control various aspects of a surgical instrument or tool in accordance with at least one aspect of the present disclosure.
Fig. 18 illustrates a combinational logic circuit configured to control various aspects of a surgical instrument or tool in accordance with at least one aspect of the present disclosure.
Fig. 19 illustrates sequential logic circuitry configured to control various aspects of a surgical instrument or tool in accordance with at least one aspect of the present disclosure.
Fig. 20 illustrates a surgical instrument or tool including multiple motors that can be activated to perform various functions in accordance with at least one aspect of the present disclosure.
Fig. 21 is a schematic view of a surgical instrument configured to operate a surgical tool described herein, according to at least one aspect of the present disclosure.
Fig. 22 illustrates a block diagram of a surgical instrument configured to control various functions in accordance with at least one aspect of the present disclosure.
Fig. 23 is a schematic view of a surgical instrument configured to control various functions in accordance with at least one aspect of the present disclosure.
Fig. 24 depicts a perspective view of a circular stapling surgical instrument in accordance with at least one aspect of the present disclosure.
Fig. 25 depicts an exploded view of the handle and shaft assembly of the instrument of fig. 24, in accordance with at least one aspect of the present disclosure.
Fig. 26 depicts a cross-sectional view of the handle assembly of the instrument of fig. 24, in accordance with at least one aspect of the present disclosure.
Fig. 27 depicts an enlarged partial cross-sectional view of the motor and battery assembly of fig. 24, in accordance with at least one aspect of the present disclosure.
Fig. 28A depicts a side elevational view of the operating mode selection assembly of the instrument of fig. 24 with the first gear disengaged from the second gear in accordance with at least one aspect of the present disclosure.
Fig. 28B depicts a side elevational view of the operating mode selection assembly of fig. 28A with the first gear engaged with the second gear in accordance with at least one aspect of the present disclosure.
Fig. 29A depicts an enlarged longitudinal cross-sectional view of the stapling head assembly of the instrument of fig. 24 showing the anvil in an open position, in accordance with at least one aspect of the present disclosure.
Fig. 29B depicts an enlarged longitudinal cross-sectional view of the stapling head assembly of fig. 29A showing the anvil in a closed position, in accordance with at least one aspect of the present disclosure.
FIG. 29C depicts an enlarged longitudinal cross-sectional view of the stapling head assembly of FIG. 29A showing the staple driver and blade in a fired position in accordance with at least one aspect of the present disclosure.
FIG. 30 depicts an enlarged partial cross-sectional view of staples formed against an anvil according to at least one aspect of the present disclosure.
Fig. 31 is a graph and associated powered stapling apparatus illustrating anvil closure rate adjustment at certain critical points along the trocar's retraction stroke in accordance with at least one aspect of the present disclosure.
FIG. 32 is a view of a circular stapler according to at least one aspect of the present disclosure.
Fig. 33 is a logic flow diagram of a process depicting a control routine or logic configuration for adjusting the rate of closure of an anvil portion of a powered stapling device at certain critical points along the retraction stroke of a trocar in accordance with at least one aspect of the present disclosure.
Fig. 34 is a graph showing trocar position over time and associated motorized suturing device diagram in accordance with at least one aspect of the present disclosure.
Fig. 35 is a logic flow diagram of a process depicting a control program or logic configuration for detecting multi-directional seating motions on a trocar to drive an anvil into a correct position in accordance with at least one aspect of the present disclosure.
Fig. 36 is a partial schematic view of a circular electric stapling apparatus in accordance with at least one aspect of the present disclosure, illustrating anvil closure on the left side and knife 201616 actuation on the right side.
Fig. 37 is an anvil displacement along a vertical axis according to at least one aspect of the present disclosure ((s))Anvil block) The graphical representation of anvil displacement as a function of clamp closing Force (FTC) along a horizontal axis.
FIG. 38 is a view according to the present disclosureDisplacement of the knife 201616 along a vertical axis of at least one aspect of (a) ((ii))Knife with cutting edge) Is a graphic representation of 201630, the knife displacement being the knife 201616 speed (V) along the left horizontal axisKmm/s) and also as knife 201616 force (F) along the right horizontal axisKlbs).
Fig. 39 is a logic flow diagram of a process depicting a control program or logic configuration for detecting tissue gap and firing force to adjust the stroke and speed of the knife in accordance with at least one aspect of the present disclosure.
Fig. 40 is a logic flow diagram of a process depicting a control program or logic configuration for advancing the knife 201616 under a strong tissue toughness speed profile with a speed peak as shown in fig. 38, in accordance with at least one aspect of the present disclosure.
Detailed Description
The applicant of the present patent application owns the following U.S. patent applications filed on 6/11/2018, the disclosures of each of which are incorporated herein by reference in their entirety:
U.S. patent application 16/182,224 entitled "SURGICAL NETWORK, INSTRUMENT, AND CLOUDDESPONSES BASED ON VALIDATION OF RECEIVED DATASET AND AUTHENTICATION OF ITSSOURCE AND INTEGRITY";
U.S. patent application 16/182,230 entitled "SURGICAL SYSTEM FOR PRESENTING INFORMATION INTERPRETED FROM EXTERNAL DATA";
U.S. patent application 16/182,233 entitled "MODIFICATION OF SURGICAL SYSTEMS CONTROL PROGRAMS BASED ON MACHINE LEARNING";
U.S. patent application 16/182,239 entitled "apparatus CONTROL program ON structured CONTROL related DATA IN ADDITION TO THE DATA";
U.S. patent application 16/182,243 entitled "SURGICAL HUB AND MODULAR DEVICES PONSE ADJUSTMENT BASED ON SITUATIONAL AWARENESS";
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U.S. patent application 16/182,251, entitled "INTERACTIVE SURGICAL SYSTEM";
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U.S. patent application 16/182,246 entitled "ADJUSTMENTS BASED ON AIRBORNEPARATICLES PROPERTIES";
U.S. patent application 16/182,256 entitled "ADJUSTMENT OF A SURGICAL DEVICEFUNCTION BASED ON SITUATIONAL AWARENESS";
U.S. patent application 16/182,242 entitled "REAL-TIME ANALYSIS OF COMPREHENSIVEOST OF ALL INSTRUMENTATION USE IN SURGERY UTILIZING DATA FLUIDITY TO TRACKINSTRUMENTS THROUGH STOCKING AND IN-HOUSE PROCESSES";
U.S. patent application 16/182,255 entitled "USAGE AND TECHNIQUE ANALYSIS OFSURGION/STAFF PERFOMANCE AGAINST A BASELINE TO OPTIMIZATION DEVICE FOR BOTH CURRENT AND FUTURE PROCEDURES";
U.S. patent application 16/182,269 entitled "IMAGE CAPTURING OF THE AREAS OUTSIDETHE ABDOMEN TO IMPROVE PLACEMENT AND CONTROL OF A SURGICAL DEVICE IN USE";
U.S. patent application 16/182,278 entitled "COMMUNICATION OF DATA WHERE ASURGICAL NETWORKS USE CONTEXT OF THE DATA AND REQUIREMENTS OF A RECEIVINGSYSTEM/USER TO INFONCE INCLUSION OR LINKAGE OF DATA AND METADATA TOESTABILISH CONTINUITY";
U.S. patent application 16/182,290 entitled "SURGICAL NETWORK RECOMMENDITION FROM TIME ANALYSIS OF PROCEDURE VARIABLE AGAINST A BASELINE HIGHLIGHT DIFFERENCES FROM THE OPTIMAL SOLUTION";
U.S. patent application 16/182,232 entitled "CONTROL OF A SURGICAL SYSTEM THROUGHA SURGICAL BARRIER";
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U.S. patent application 16/182,229 entitled "ADJUSTMENT OF STAPLE HEIGHT OF ATLEAST ONE ROW OF STAPLES BASED ON THE SENSED TISSUE THICKNESS OR FOR POWER INCLOSING";
U.S. patent application 16/182,234 entitled "STAPLING DEVICE WITH BOTHCOMPULSOLY AND DISCRETION LOCKOUTS BASED SENSED PARAMETERS";
U.S. patent application 16/182,235 entitled "VARIATION OF RADIO FREQUENCY ANDULTROASONIC POWER LEVEL IN COOPERATION WITH VARYING CLAMP ARM PRESSURE TOACHIEVE PREDEFINED HEAT FLUX OR POWER APPLIED TO TISSUE"; and
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The applicant of the present patent application owns the following U.S. patent applications filed on 2018, 9, 10, the disclosure of each of which is incorporated herein by reference in its entirety:
U.S. provisional patent application 62/729,183, entitled "A CONTROL FOR A SURGICAL NETWORKOR SURGICAL NETWORK CONNECTED DEVICE THAT ADJUTS ITS FUNCTION BASE ASENSED STATIONS OR USAGE";
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U.S. provisional application 62/729,195 entitled "ULTRASONIC ENERGY DEVICE WHICH VARIESPRESSURE APPLIED BY CLAMP ARM TO PROVIDE THRESHOLD CONTROL AT A CUTROOGRESSION LOCATION"; and
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The applicant of the present patent application owns the following U.S. patent applications filed on 28/8/2018, the disclosures of each of which are incorporated herein by reference in their entirety:
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The applicant of the present patent application owns the following U.S. patent applications filed on 23.8.2018, the disclosures of each of which are incorporated herein by reference in their entirety:
U.S. provisional patent application 62/721,995 entitled "control AN ultra minor ignition TO a TISSUE LOCATION";
U.S. provisional patent application 62/721,998 entitled "STATATIONAL AWARENESS OFELECTRROSURGICAL SYSTEMS";
U.S. provisional patent application 62/721,999 entitled "INTERRUPTION OF ENGAGUTIVE DUE TOINADVERTENT CAPACITIVE COUPLING";
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The applicant of the present patent application owns the following U.S. patent applications filed on 30.6.2018, the disclosures of each of which are incorporated herein by reference in their entirety:
U.S. provisional patent application 62/692,747 entitled "SMART ACTIVATION OF AN ENERGYDEVICE BY ANOTHER DEVICE";
U.S. provisional patent application 62/692,748, entitled "SMART ENERGY ARCHITECTURE"; and
us provisional patent application 62/692,768, entitled "SMART ENERGY DEVICES".
The applicant of the present patent application owns the following U.S. patent applications filed on 29.6.2018, the disclosures of each of which are incorporated herein by reference in their entirety:
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U.S. patent application Ser. No. 16/024,245 entitled "COMMUNICATION OF SMOKEEVACUTION SYSTEM PARAMETERS TO HUB OR CLOUD IN SMOKE EVACUTION MODULE FOR RINTERACTIVE SURGICAL PLATFORM";
U.S. patent application Ser. No. 16/024,258 entitled "SMOKE EVACUATION SYSTEMINGLUTING A SEGMENTED CONTROL CIRCUIT FOR INTERACTIVE SURGICAL PLATFORM";
U.S. patent application Ser. No. 16/024,265 entitled "SURGICAL EVACUTION SYSTEM WITHA COMMUNICATION CIRCUIT FOR COMMUNICATION BETWEEN A FILTER AND A SMOKEVACCATION DEVICE"; and
U.S. patent application Ser. No. 16/024,273, entitled "DUAL IN-SERIES LARGE AND SMALLDROPLET FILTERS".
The applicant of the present patent application owns the following U.S. provisional patent applications filed on 2018, 6/28, the disclosure of each of which is incorporated herein by reference in its entirety:
U.S. provisional patent application Ser. No. 62/691,228 entitled "A METHOD OF USENGRINED FLEX CICUITS WITH MULTIPLE SENSOR WITH ELECTRROSURGICAL DEVICES";
U.S. provisional patent application Ser. No. 62/691,227 entitled "control A SURGICALINcorner ACCORDING TO SENSED CLOSURE PARAMETERS";
U.S. provisional patent application Ser. No. 62/691,230 entitled "SURGICAL INSTRUMENT HAVINGA FLEXIBLE ELECTRODE";
U.S. provisional patent application Ser. No. 62/691,219, entitled "SURGICAL EVACUTION SENSING MOTOR CONTROL";
U.S. provisional patent application Ser. No. 62/691,257 entitled "COMMUNICATION OF SMOKEEVACUTION SYSTEM PARAMETERS TO HUB OR CLOUD IN SMOKE EVACUTION MODULE FOR RINTERACTIVE SURGICAL PLATFORM";
U.S. provisional patent application Ser. No. 62/691,262, entitled "SURGICAL EVACUTION SYSTEMWITH A COMMUNICATION CIRCUIT FOR COMMUNICATION BETWEEN A FILTER AND A SMOKEEVACATION DEVICE"; and
U.S. provisional patent application Ser. No. 62/691,251, entitled "DUAL IN-SERIES LARGE ANDSMALL DROPLET FILTERS".
The applicant of the present patent application owns the following U.S. provisional patent applications filed on 2018, 4/19, the disclosures of which are incorporated herein by reference in their entirety:
U.S. provisional patent application serial No. 62/659,900, entitled "METHOD OF hubcmonication".
The applicant of the present application owns the following U.S. provisional patent applications filed on 30/3/2018, the disclosures of each of which are incorporated herein by reference in their entirety:
us provisional patent application 62/650,898, entitled "CAPACITIVITY ECOUPLED RETURN PATH PAD WITH SECARABLE ARRAY ELEMENTS", filed 3, 30.2018;
U.S. provisional patent application Ser. No. 62/650,887 entitled "SURGICAL SYSTEMS WITHOPTIMIZED SENSING CAPABILITIES";
U.S. patent application Ser. No. 62/650,882 entitled "SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM"; and
U.S. patent application Ser. No. 62/650,877, entitled "SURGICAL SMOKE EVACUATIONSENSING AND CONTROLS".
The applicant of the present patent application owns the following U.S. patent applications filed on 29/3/2018, the disclosures of each of which are incorporated herein by reference in their entirety:
U.S. patent application Ser. No. 15/940,641 entitled "INTERACTIVE SURGICAL SYSTEMSWITH ENCRYPTED COMMUNICATION CAPABILITIES";
U.S. patent application Ser. No. 15/940,648, entitled "INTERACTIVE SURGICAL SYSTEMSWITH CONDITION HANDLING OF DEVICES AND DATA CAPABILITIIES";
U.S. patent application Ser. No. 15/940,656 entitled "SURGICAL HUB COORDINATION OFCONTROL AND COMMUNICATION OF OPERATING ROOM DEVICES";
U.S. patent application Ser. No. 15/940,666 entitled "SPATIAL AWARENESS OF SURGICALUHUBS IN OPERATING ROOMS";
U.S. patent application Ser. No. 15/940,670 entitled "Cooling UTILIZATION OF DATAD ERIVED FROM SECONDARY SOURCES BY INTELLIGENT SURGICAL HUBS";
U.S. patent application Ser. No. 15/940,677 entitled "SURGICAL HUB CONTROLARRANGEMENTS";
U.S. patent application Ser. No. 15/940,632 entitled "DATA STRIPPING METHOD INTERROTATE PATIENT RECORD AND CREATE ANONYMIZED RECORD";
U.S. patent application Ser. No. 15/940,640, entitled "COMMUNICATION HUB AND STORAGE EVICE FOR STORING PARAMETERS AND STATUS OF A SURGICAL DEVICE TO BE SHARED WITH CLOUD BASED ANALYTICS SYSTEMS";
U.S. patent application Ser. No. 15/940,645 entitled "SELF DERGROURING DATA PACKETSGENERATED AT AN ISSUING INSTRUMENT";
U.S. patent application Ser. No. 15/940,649 entitled "DATA PAIRING TO INTERCONNECT ADEVICE MEASURED PARAMETER WITH AN OUTCOME";
U.S. patent application Ser. No. 15/940,654 entitled "SURGICAL HUB SITUATIONALAWARENESS";
U.S. patent application Ser. No. 15/940,663 entitled "SURGICAL SYSTEM DISTRIBUTEDPROCESSING";
U.S. patent application Ser. No. 15/940,668 entitled "AGGREGAGATION AND REPORTING OFSURGICAL HUB DATA";
U.S. patent application Ser. No. 15/940,671 entitled "SURGICAL HUB SPATIAL AWARENESSTO DETERMINE DEVICES IN OPERATING THEEATER";
U.S. patent application Ser. No. 15/940,686 entitled "DISPLAY OF ALIGNMENT OF STAPLECARTRIDGE TO PRIOR LINEAR STAPLE LINE";
U.S. patent application Ser. No. 15/940,700 entitled "STERILE FIELD INTERACTIVECONRONTROL DISPLAYS";
U.S. patent application Ser. No. 15/940,629 entitled "COMPUTER IMPLEMENTEDINTERACTIVE SURGICAL SYSTEMS";
U.S. patent application Ser. No. 15/940,704 entitled "USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT";
U.S. patent application Ser. No. 15/940,722 entitled "CHARACTERIZATION OF TISSUEIRREGULARITIES THROUGH THE USE OF MONO-CHROMATIC LIGHT REFRACTIVITY";
U.S. patent application Ser. No. 15/940,742, entitled "DUAL CMOS ARRAY IMAGING";
U.S. patent application Ser. No. 15/940,636 entitled "ADAPTIVE CONTROL program FOR basic DEVICES";
U.S. patent application Ser. No. 15/940,653 entitled "ADAPTIVE CONTROL PROGRAMUPDATES FOR SURGICAL HUBS";
U.S. patent application Ser. No. 15/940,660 entitled "CLOOUD-BASED MEDICAL ANALYTICSFOR CUTOSOMIZATION AND RECOMMENDITION TO A USER";
U.S. patent application Ser. No. 15/940,679 entitled "CLOOUD-BASED MEDICAL ANALYTICSFOR LINKING OF LOCAL USAGE TRENDS WITH THE RESOURCE ACQUISITION BEHAVIORS OFLARGER DATA SET";
U.S. patent application Ser. No. 15/940,694 entitled "CLOOUD-BASED MEDICAL ANALYTICSFOR MEDICAL FACILITY SEGMENTED INDIDUALIZATION OF INSTRUMENTS FUNCTIONS";
U.S. patent application Ser. No. 15/940,634 entitled "CLOOUD-BASED MEDICAL ANALYTICSFOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES";
U.S. patent application Ser. No. 15/940,706 entitled "DATA HANDLING ANDPRIORITIZATION IN A CLOUD ANALYTICS NETWORK";
U.S. patent application Ser. No. 15/940,675 entitled "CLOOUD INTERFACE FOR COUPLEDSURGICAL DEVICES";
U.S. patent application Ser. No. 15/940,627, entitled "DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS";
U.S. patent application Ser. No. 15/940,637 entitled "COMMUNICATION ARRANGEMENTS FOR ROBOOT-ASSISTED SURGICAL PLATFORMS";
U.S. patent application Ser. No. 15/940,642 entitled "CONTROL FOR ROBOT-ASSISTED DSURGICAL PLATFORMS";
U.S. patent application Ser. No. 15/940,676 entitled "AUTOMATIC TOOL ADJUSTMENTS FOR ROBOOT-ASSISTED SURGICAL PLATFORMS";
U.S. patent application Ser. No. 15/940,680 entitled "CONTROL FOR ROBOT-ASSISTED DSURGICAL PLATFORMS";
U.S. patent application Ser. No. 15/940,683 entitled "catalytic minor action Robot-associated minor applications";
U.S. patent application Ser. No. 15/940,690, entitled "DISPLAY ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS"; and
U.S. patent application Ser. No. 15/940,711, entitled "SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS".
The applicant of the present application owns the following U.S. provisional patent applications filed on 28/3/2018, the disclosures of each of which are incorporated herein by reference in their entirety:
U.S. provisional patent application serial No. 62/649,302, entitled "INTERACTIVE SURGICALSYSTEMS WITH ENCRYPTED communiation CAPABILITIES";
U.S. provisional patent application Ser. No. 62/649,294 entitled "DATA STRIPPING METHOD OF INTERROTATE PATIENT RECORD AND CREATE ANONYMIZED RECORD";
U.S. patent application Ser. No. 62/649,300 entitled "SURGICAL HUB SITUATIONALAWARENESS";
U.S. provisional patent application Ser. No. 62/649,309 entitled "SURGICAL HUB SPATIALAWARENESS TO DETERMINE DEVICES IN OPERATING THEEATER";
U.S. patent application Ser. No. 62/649,310 entitled "COMPUTER IMPLEMENTEDINTERACTIVE SURGICAL SYSTEMS";
U.S. provisional patent application Ser. No. 62/649,291, entitled "USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT";
U.S. patent application Ser. No. 62/649,296 entitled "ADAPTIVE CONTROL program FOR basic DEVICES";
U.S. provisional patent application Ser. No. 62/649,333 entitled "CLOOUD-BASED MEDICANAL LYTICS FOR CUSTOMIZATION AND RECOMMENDITION TO A USER";
U.S. provisional patent application Ser. No. 62/649,327 entitled "CLOOUD-BASED MEDICANAL POLYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES";
U.S. provisional patent application Ser. No. 62/649,315 entitled "DATA HANDLING ANDPRIORITIZATION IN A CLOUD ANALYTICS NETWORK";
U.S. patent application Ser. No. 62/649,313 entitled "CLOOUD INTERFACE FOR COUPLEDSURGICAL DEVICES";
U.S. patent application Ser. No. 62/649,320, entitled "DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS";
U.S. provisional patent application Ser. No. 62/649,307 entitled "AUTOMATIC TOOL ADJUSTMENTSFOR ROBOT-ASSISTED SURGICAL PLATFORMS"; and
U.S. provisional patent application serial No. 62/649,323, entitled "SENSING ARRANGEMENTS basic-associated basic platformes".
The applicant of the present application owns the following U.S. provisional patent applications filed on 8/3/2018, the disclosures of each of which are incorporated herein by reference in their entirety:
U.S. provisional patent application Ser. No. 62/640,417 entitled "TEMPERATURE CONTROL INDULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR"; and
U.S. provisional patent application serial No. 62/640,415, entitled "ESTIMATING STATE outdoor patent END AND CONTROL SYSTEM valve".
The applicant of the present application owns the following U.S. provisional patent applications filed on 2017, 12, 28, the disclosure of each of which is incorporated herein by reference in its entirety:
U.S. provisional patent application serial No. 62/611,341, entitled "INTERACTIVE SURGICALPLATFORM";
U.S. provisional patent application Ser. No. 62/611,340 entitled "CLOOUD-BASED MEDICALANALYTICS"; and
U.S. patent application Ser. No. 62/611,339, entitled "ROBOT ASSISTED SURGICALLLATFORM".
Before explaining various aspects of the surgical device and generator in detail, it should be noted that the example illustrated application or use is not limited to the details of construction and arrangement of parts illustrated in the accompanying drawings and description. The illustrative examples may be implemented alone or in combination with other aspects, variations and modifications, and may be practiced or carried out in various ways. Furthermore, unless otherwise indicated, the terms and expressions employed herein have been chosen for the purpose of describing the illustrative embodiments for the convenience of the reader and are not for the purpose of limiting the invention. Moreover, it is to be understood that expressions of one or more of the following described aspects, and/or examples may be combined with any one or more of the other below described aspects, and/or examples.
Surgical hub
Referring to fig. 1, a computer-implemented interactive
In aspects, the
Fig. 2 depicts an example of a
Other types of robotic systems may be readily adapted for use with the
Various examples of CLOUD-BASED analyses performed by the
In various aspects, the imaging device 124 includes at least one image sensor and one or more optical components. Suitable image sensors include, but are not limited to, Charge Coupled Device (CCD) sensors and Complementary Metal Oxide Semiconductor (CMOS) sensors.
The optical components of the imaging device 124 may include one or more illumination sources and/or one or more lenses. One or more illumination sources may be directed to illuminate portions of the surgical field. The one or more image sensors may receive light reflected or refracted from the surgical field, including light reflected or refracted from tissue and/or surgical instruments.
The one or more illumination sources may be configured to radiate electromagnetic energy in the visible spectrum as well as the invisible spectrum. The visible spectrum (sometimes referred to as the optical spectrum or the luminescence spectrum) is that portion of the electromagnetic spectrum that is visible to (i.e., detectable by) the human eye, and may be referred to as visible light or simple light. A typical human eye will respond to wavelengths in air from about 380nm to about 750 nm.
The invisible spectrum (i.e., the non-luminescent spectrum) is the portion of the electromagnetic spectrum that lies below and above the visible spectrum (i.e., wavelengths below about 380nm and above about 750 nm). The human eye cannot detect the invisible spectrum. Wavelengths greater than about 750nm are longer than the red visible spectrum and they become invisible Infrared (IR), microwave and radio electromagnetic radiation. Wavelengths less than about 380nm are shorter than the violet spectrum and they become invisible ultraviolet, x-ray and gamma-ray electromagnetic radiation.
In various aspects, the imaging device 124 is configured for use in minimally invasive surgery. Examples of imaging devices suitable for use in the present disclosure include, but are not limited to, arthroscopes, angioscopes, bronchoscopes, cholangioscopes, colonoscopes, cytoscopes, duodenoscopes, enteroscopes, esophago-duodenoscopes (gastroscopes), endoscopes, laryngoscopes, nasopharyngo-nephroscopes, sigmoidoscopes, thoracoscopes, and intrauterine scopes.
In one aspect, the imaging device employs multispectral monitoring to distinguish topography from underlying structures. A multispectral image is an image that captures image data across a particular range of wavelengths of the electromagnetic spectrum. The wavelengths may be separated by filters or by using instruments that are sensitive to specific wavelengths, including light from frequencies outside the visible range, such as IR and ultraviolet. Spectral imaging may allow extraction of additional information that the human eye fails to capture with its red, green, and blue receptors. The use of multispectral Imaging is described in more detail under the heading "Advanced Imaging Acquisition Module" of U.S. provisional patent application serial No. 62/611,341, entitled "INTERACTIVE SURGICAL PLATFORM," filed on 28.12.2017, the disclosure of which is incorporated herein by reference in its entirety. Multispectral monitoring may be a useful tool for repositioning the surgical site after completion of a surgical task to perform one or more of the previously described tests on the treated tissue.
It is self-evident that strict sterilization of the operating room and surgical equipment is required during any surgical procedure. The stringent hygiene and sterilization conditions required in a "surgical room" (i.e., an operating room or treatment room) require the highest possible sterility of all medical devices and equipment. Part of this sterilization process is any substance that needs to be sterilized, including the imaging device 124 and its attachments and components, to contact the patient or penetrate the sterile field. It should be understood that the sterile field may be considered a designated area that is considered free of microorganisms, such as within a tray or within a sterile towel, or the sterile field may be considered an area around a patient that is ready for surgery. The sterile field may include members of a team who are properly wearing swabs, as well as all equipment and fixtures in the field.
In various aspects, the
As shown in fig. 2, a main display 119 is positioned in the sterile field to be visible to the operator at the surgical table 114. Further, the visualization tower 111 is positioned outside the sterile field. Visualization tower 111 includes a first non-sterile display 107 and a second non-sterile display 109 facing away from each other. The
In one aspect, hub 106 is further configured to be able to route diagnostic inputs or feedback entered by non-sterile operators at visualization tower 111 to a main display 119 within the sterile field, where it can be viewed by the sterile operator on the operating floor. In one example, the input may be a modified form of a snapshot displayed on non-sterile display 107 or 109, which may be routed through hub 106 to main display 119.
Referring to fig. 2, a
Referring now to fig. 3, hub 106 is depicted in communication with
During surgery, the energy applied to tissue for sealing and/or cutting is often associated with smoke evacuation, aspiration of excess fluid, and/or irrigation of the tissue. Fluid lines, power lines and/or data lines from different sources are often tangled during surgery. Valuable time may be lost in addressing the problem during surgery. Disconnecting the lines may require disconnecting the lines from their respective modules, which may require resetting the modules. The hub modular housing 136 provides a unified environment for managing power, data, and fluid lines, which reduces the frequency of entanglement between such lines.
Aspects of the present disclosure provide a surgical hub for a surgical procedure involving application of energy to tissue at a surgical site. The surgical hub includes a hub housing and a composite generator module slidably received in a docking station of the hub housing. The docking station includes data contacts and power contacts. The combined generator module includes two or more of an ultrasonic energy generator component, a bipolar RF energy generator component, and a monopolar RF energy generator component seated in a single cell. In one aspect, the combined generator module further includes a smoke evacuation component, at least one energy delivery cable for connecting the combined generator module to a surgical instrument, at least one smoke evacuation component configured to evacuate smoke, fluids, and/or particles generated by application of therapeutic energy to tissue, and a fluid line extending from the remote surgical site to the smoke evacuation component.
In one aspect, the fluid line is a first fluid line and the second fluid line extends from the remote surgical site to a suction and irrigation module slidably received in the hub housing. In one aspect, the hub housing includes a fluid interface.
Certain surgical procedures may require more than one energy type to be applied to tissue. One energy type may be more advantageous for cutting tissue, while a different energy type may be more advantageous for sealing tissue. For example, a bipolar generator may be used to seal tissue, while an ultrasonic generator may be used to cut the sealed tissue. Aspects of the present disclosure provide a solution in which the hub modular housing 136 is configured to accommodate different generators and facilitate interactive communication therebetween. One of the advantages of the hub modular housing 136 is the ability to quickly remove and/or replace various modules.
Aspects of the present disclosure provide a modular surgical housing for use in a surgical procedure involving the application of energy to tissue. The modular surgical housing includes a first energy generator module configured to generate a first energy for application to tissue, and a first docking station including a first docking port including a first data and power contact, wherein the first energy generator module is slidably movable into electrical engagement with the power and data contact, and wherein the first energy generator module is slidably movable out of electrical engagement with the first power and data contact,
As further described above, the modular surgical housing further includes a second energy generator module configured to generate a second energy different from the first energy for application to tissue, and a second docking station including a second docking port including second data and power contacts, wherein the second energy generator module is slidably movable into electrical engagement with the power and data contacts, and wherein the second energy generator is slidably movable out of electrical contact with the second power and data contacts.
In addition, the modular surgical housing further includes a communication bus between the first docking port and the second docking port configured to facilitate communication between the first energy generator module and the second energy generator module.
Referring to fig. 3-7, aspects of the present disclosure are presented as a hub modular housing 136 that allows for modular integration of the generator module 140, smoke evacuation module 126, and suction/irrigation module 128. The hub modular housing 136 also facilitates interactive communication between the modules 140, 126, 128. As shown in fig. 5, the generator module 140 may be a generator module with integrated monopolar, bipolar, and ultrasound components supported in a
In one aspect, the hub modular housing 136 includes a modular power and communications backplane 149 having external and wireless communications connections to enable removable attachment of the modules 140, 126, 128 and interactive communications therebetween.
In one aspect, the hub modular housing 136 includes a docking cradle or drawer 151 (also referred to herein as a drawer) configured to slidably receive the modules 140, 126, 128. Fig. 4 illustrates a partial perspective view of the surgical hub housing 136 and the
In various aspects, the smoke evacuation module 126 includes a
In various aspects, the suction/irrigation module 128 is coupled to a surgical tool that includes an aspiration fluid line and a suction fluid line. In one example, the aspiration fluid line and the suction fluid line are in the form of flexible tubes extending from the surgical site toward the suction/irrigation module 128. The one or more drive systems may be configured to irrigate fluid to and aspirate fluid from the surgical site.
In one aspect, a surgical tool includes a shaft having an end effector at a distal end thereof and at least one energy treatment associated with the end effector, a suction tube, and an irrigation tube. The draft tube may have an inlet at a distal end thereof, and the draft tube extends through the shaft. Similarly, a draft tube may extend through the shaft and may have an inlet adjacent the energy delivery tool. The energy delivery tool is configured to deliver ultrasonic and/or RF energy to the surgical site and is coupled to the generator module 140 by a cable that initially extends through the shaft.
The irrigation tube may be in fluid communication with a fluid source, and the aspiration tube may be in fluid communication with a vacuum source. The fluid source and/or vacuum source may be seated in the suction/irrigation module 128. In one example, the fluid source and/or vacuum source may be seated in the hub housing 136 independently of the suction/irrigation module 128. In such examples, the fluid interface can connect the suction/irrigation module 128 to a fluid source and/or a vacuum source.
In one aspect, the modules 140, 126, 128 on the hub modular housing 136 and/or their corresponding docking stations may include alignment features configured to enable alignment of the docking ports of the modules into engagement with their corresponding ports in the docking stations of the hub modular housing 136. For example, as shown in fig. 4, the combined
In some aspects, the drawers 151 of the hub modular housing 136 are the same or substantially the same size, and the modules are sized to be received in the drawers 151. For example, the
In addition, the contacts of a particular module may be keyed to engage the contacts of a particular drawer to avoid inserting the module into a drawer having unmatched contacts.
As shown in fig. 4, the docking port 150 of one drawer 151 may be coupled to the docking port 150 of another drawer 151 by a communication link 157 to facilitate interactive communication between modules seated in the hub modular housing 136. Alternatively or additionally, the docking port 150 of the hub modular housing 136 can facilitate wireless interactive communication between modules seated in the hub modular housing 136. Any suitable wireless communication may be employed, such as, for example, Air Titan-Bluetooth.
Fig. 6 illustrates a single power bus attachment for multiple lateral docking ports of a lateral
Fig. 7 illustrates a vertical modular housing 164 configured to house a plurality of modules 165 of surgical hub 106. The modules 165 are slidably inserted into docking feet or drawers 167 of a vertical modular housing 164 that includes a floor for interconnecting the modules 165. Although the drawers 167 of the vertical modular housing 164 are arranged vertically, in some cases, the vertical modular housing 164 may include laterally arranged drawers. Further, the modules 165 may interact with each other through docking ports of the vertical modular housing 164. In the example of FIG. 7, a display 177 is provided for displaying data related to the operation of module 165. In addition, the vertical modular housing 164 includes a main module 178 that seats a plurality of sub-modules slidably received in the main module 178.
In various aspects, the imaging module 138 includes an integrated video processor and modular light source, and is adapted for use with a variety of imaging devices. In one aspect, the imaging device is constructed of a modular housing that can be fitted with a light source module and a camera module. The housing may be a disposable housing. In at least one example, the disposable housing is removably coupled to the reusable controller, the light source module, and the camera module. The light source module and/or the camera module may be selectively selected according to the type of the surgical operation. In one aspect, the camera module includes a CCD sensor. In another aspect, the camera module includes a CMOS sensor. In another aspect, the camera module is configured for scanning beam imaging. Also, the light source module may be configured to deliver white light or different light depending on the surgical procedure.
During a surgical procedure, it may be inefficient to remove a surgical device from a surgical site and replace the surgical device with another surgical device that includes a different camera or a different light source. Temporary loss of vision at the surgical site can lead to undesirable consequences. The modular imaging apparatus of the present disclosure is configured to allow for the midstream replacement of either the light source module or the camera module during a surgical procedure without having to remove the imaging apparatus from the surgical site.
In one aspect, an imaging device includes a tubular housing including a plurality of channels. The first channel is configured to slidably receive a camera module, which may be configured to snap-fit engage with the first channel. The second channel is configured to slidably receive a light source module, which may be configured to snap-fit engage with the second channel. In another example, the camera module and/or the light source module may be rotated within their respective channels to a final position. Threaded engagement may be used instead of snap-fit engagement.
In various examples, multiple imaging devices are placed at different locations in a surgical field to provide multiple views. The imaging module 138 may be configured to be able to switch between imaging devices to provide an optimal view. In various aspects, the imaging module 138 may be configured to integrate images from different imaging devices.
Various IMAGE PROCESSORs AND imaging devices suitable for use in the present disclosure are described in U.S. patent No. 7,995,045 entitled "COMBINED SBI AND associated IMAGE PROCESSOR" published on 9.8.2011, which is incorporated by reference herein in its entirety. Further, U.S. patent 7,982,776 entitled "MOTION ARTIFACT removal METHOD AND METHOD," published 7/19/2011, which is incorporated herein by reference in its entirety, describes various systems for removing MOTION ARTIFACTs from image data. Such a system may be integrated with the imaging module 138. Further, U.S. patent application publication No. 2011/0306840 entitled "control MAGNETIC SOURCE TO fine text inner porous SOURCE", published on 15.2011 and U.S. patent application publication No. 2014/0243597 entitled "system gas mixture A MINIMALLY INVASIVE basic process", published on 28.2014, each of which is incorporated herein by reference in its entirety.
Fig. 8 illustrates a surgical data network 201 including a modular communication hub 203 configured to enable connection of modular devices located in one or more operating rooms of a medical facility or any room in a medical facility specially equipped for surgical operations to a cloud-based system (e.g., a
Modular devices 1a-1n located in an operating room may be coupled to a modular communication hub 203. Network hub 207 and/or network switch 209 may be coupled to network router 211 to connect devices 1a-1n to cloud 204 or local computer system 210. Data associated with the devices 1a-1n may be transmitted via the router to the cloud-based computer for remote data processing and manipulation. Data associated with the devices 1a-1n may also be transmitted to the local computer system 210 for local data processing and manipulation. Modular devices 2a-2m located in the same operating room may also be coupled to network switch 209. Network switch 209 may be coupled to network hub 207 and/or network router 211 to connect devices 2a-2m to cloud 204. Data associated with the devices 2a-2n may be transmitted via the network router 211 to the
It should be understood that surgical data network 201 may be expanded by interconnecting multiple hubs 207 and/or multiple network switches 209 with multiple network routers 211. The modular communication hub 203 may be contained in a modular control tower configured to receive a plurality of devices 1a-1n/2a-2 m. Local computer system 210 may also be contained in a modular control tower. The modular communication hub 203 is connected to a display 212 to display images obtained by some of the devices 1a-1n/2a-2m, for example, during surgery. In various aspects, the devices 1a-1n/2a-2m may include, for example, various modules such as non-contact sensor modules in an imaging module 138 coupled to an endoscope, a generator module 140 coupled to an energy-based surgical device, a smoke evacuation module 126, a suction/irrigation module 128, a communication module 130, a processor module 132, a memory array 134, a surgical device connected to a display, and/or other modular devices that may be connected to a modular communication hub 203 of a surgical data network 201.
In one aspect, the surgical data network 201 may include a combination of one or more network hubs, one or more network switches, and one or more network routers that connect the devices 1a-1n/2a-2m to the cloud. Any or all of the devices 1a-1n/2a-2m coupled to the hub or network switch may collect data in real time and transmit the data into the cloud computer for data processing and manipulation. It should be appreciated that cloud computing relies on shared computing resources rather than using local servers or personal devices to process software applications. The term "cloud" may be used as a metaphor for "internet," although the term is not so limited. Accordingly, the term "cloud computing" may be used herein to refer to a "type of internet-based computing" in which different services (such as servers, memory, and applications) are delivered to modular communication hub 203 and/or computer system 210 located in a surgical room (e.g., a fixed, mobile, temporary, or live operating room or space) and devices connected to modular communication hub 203 and/or computer system 210 over the internet. The cloud infrastructure may be maintained by a cloud service provider. In this case, the cloud service provider may be an entity that coordinates the use and control of the devices 1a-1n/2a-2m located in one or more operating rooms. Cloud computing services can perform a large amount of computing based on data collected by smart surgical instruments, robots, and other computerized devices located in the operating room. The hub hardware enables multiple devices or connections to connect to a computer in communication with the cloud computing resources and memory.
Applying cloud computer data processing techniques to the data collected by the devices 1a-1n/2a-2m, the surgical data network provides improved surgical outcomes, reduced costs, and improved patient satisfaction. At least some of the devices 1a-1n/2a-2m may be employed to observe tissue conditions to assess leakage or perfusion of sealed tissue following tissue sealing and cutting procedures. At least some of the devices 1a-1n/2a-2m may be employed to identify pathologies, such as the effects of disease, using cloud-based computing to examine data including images of body tissue samples for diagnostic purposes. This includes localization and edge confirmation of tissues and phenotypes. At least some of the devices 1a-1n/2a-2m may be employed to identify anatomical structures of the body using a variety of sensors integrated with the imaging devices and techniques, such as overlaying images captured by multiple imaging devices. The data (including image data) collected by the devices 1a-1n/2a-2m may be transmitted to the
In one implementation, the operating room devices 1a-1n may be connected to the modular communication hub 203 through a wired channel or a wireless channel, depending on the configuration of the devices 1a-1n to the network hub. In one aspect, hub 207 may be implemented as a local network broadcaster operating at the physical layer of the Open Systems Interconnection (OSI) model. The hub provides connectivity to devices 1a-1n located in the same operating room network. The hub 207 collects the data in the form of packets and sends it to the routers in half-duplex mode. Hub 207 does not store any media access control/internet protocol (MAC/IP) used to transmit device data. Only one of the devices 1a-1n may transmit data through the hub 207 at a time. The hub 207 does not have routing tables or intelligence as to where to send information and broadcast all network data on each connection and to the remote server 213 (fig. 9) through the
In another implementation, the operating room devices 2a-2m may be connected to the network switch 209 via a wired channel or a wireless channel. Network switch 209 operates in the data link layer of the OSI model. The network switch 209 is a multicast device for connecting devices 2a-2m located in the same operating room to the network. Network switch 209 sends data in frames to network router 211 and operates in full duplex mode. Multiple devices 2a-2m may transmit data simultaneously through the network switch 209. The network switch 209 stores and uses the MAC addresses of the devices 2a-2m to transmit data.
Network hub 207 and/or network switch 209 are coupled to network router 211 to connect to cloud 204. Network router 211 operates in the network layer of the OSI model. Network router 211 creates a route for transmitting data packets received from network hub 207 and/or network switch 211 to the cloud-based computer resources for further processing and manipulation of data collected by any or all of devices 1a-1n/2a-2 m. Network router 211 may be employed to connect two or more different networks located at different locations, such as, for example, different operating rooms of the same medical facility or different networks located in different operating rooms of different medical facilities. Network router 211 sends data in packets to cloud 204 and operates in full duplex mode. Multiple devices may transmit data simultaneously. The network router 211 transmits data using the IP address.
In one example, hub 207 may be implemented as a USB hub, which allows multiple USB devices to be connected to a host. A USB hub may extend a single USB port to multiple tiers so that more ports are available for connecting devices to a host system computer. Hub 207 may include wired or wireless capabilities for receiving information over a wired channel or a wireless channel. In one aspect, a wireless USB short-range, high bandwidth wireless radio communication protocol may be used for communication between devices 1a-1n and devices 2a-2m located in an operating room.
In other examples, the operating room devices 1a-1n/2a-2m may communicate with the modular communication hub 203 via the Bluetooth wireless technology standard for exchanging data from stationary and mobile devices over short distances (using short wavelength UHF radio waves of 2.4 to 2.485GHz in the ISM band) and building Personal Area Networks (PANs). In other aspects, the operating room devices 1a-1n/2a-2m may communicate with the modular communication hub 203 via a variety of wireless or wired communication standards or protocols, including but not limited to Wi-Fi (IEEE 802.11 series), WiMAX (IEEE 802.16 series), IEEE 802.20, Long Term Evolution (LTE) and Ev-DO, HSPA +, HSDPA +, HSUPA +, EDGE, GSM, GPRS, CDMA, TDMA, DECT, and ethernet derivatives thereof, as well as any other wireless and wired protocols designated 3G, 4G, 5G, and above. The computing module may include a plurality of communication modules. For example, a first communication module may be dedicated for shorter range wireless communications such as Wi-Fi and bluetooth, and a second communication module may be dedicated for longer range wireless communications such as GPS, EDGE, GPRS, CDMA, WiMAX, LTE, Ev-DO, and the like.
The modular communication hub 203 may serve as a central connection for one or all of the operating room devices 1a-1n/2a-2m and handle a data type called a frame. The frames carry data generated by the devices 1a-1n/2a-2 m. When the modular communication hub 203 receives the frame, it is amplified and transmitted to the network router 211, which transmits the data to the cloud computing resources using a plurality of wireless or wired communication standards or protocols as described herein.
Modular communication hub 203 may be used as a stand-alone device or connected to a compatible network hub and network switch to form a larger network. The modular communication hub 203 is generally easy to install, configure and maintain, making it a good option to network the operating room devices 1a-1n/2a-2 m.
Fig. 9 illustrates a computer-implemented interactive
Fig. 10 shows the
The
Computer system 210 includes a processor 244 and a network interface 245. The processor 244 is coupled via a system bus to the communication module 247, storage 248, memory 249, non-volatile memory 250, and input/output interface 251. The system bus can be any of several types of bus structure(s) including the memory bus or memory controller, a peripheral bus or external bus, and/or a local bus using any variety of available bus architectures including, but not limited to, 9-bit bus, Industrial Standard Architecture (ISA), micro Charmel architecture (MSA), extended ISA (eisa), Intelligent Drive Electronics (IDE), VESA Local Bus (VLB), Peripheral Component Interconnect (PCI), USB, Advanced Graphics Port (AGP), personal computer memory card international association bus (PCMCIA), Small Computer System Interface (SCSI), or any other peripheral bus.
Processor 244 may be any single-core or multi-core processor, such as those provided by texas instruments under the trade name ARM Cortex. In one aspect, the processor may be a processor core available from, for example, Texas Instruments LM4F230H5QR ARM Cortex-M4F, which includes 256KB of on-chip memory of single cycle flash or other non-volatile memory (up to 40MHz), a prefetch buffer for improved performance above 40MHz, 32KB of single cycle Sequence Random Access Memory (SRAM), loaded with a load of memory, etc
In one aspect, the processor 244 may comprise a safety controller comprising two series controller-based controllers (such as TMS570 and RM4x), also known under the trade name Hercules ARM Cortex R4, also manufactured by Texas Instruments. The safety controller may be configured specifically for IEC 61508 and ISO 26262 safety critical applications, etc., to provide advanced integrated safety features while delivering scalable performance, connectivity, and memory options.
The system memory includes volatile memory and non-volatile memory. The basic input/output system (BIOS), containing the basic routines to transfer information between elements within the computer system, such as during start-up, is stored in nonvolatile memory. For example, nonvolatile memory can include ROM, Programmable ROM (PROM), Electrically Programmable ROM (EPROM), EEPROM, or flash memory. Volatile memory includes Random Access Memory (RAM), which acts as external cache memory. Further, RAM may be available in a variety of forms, such as SRAM, Dynamic RAM (DRAM), Synchronous DRAM (SDRAM), Double Data Rate SDRAM (DDRSDRAM), Enhanced SDRAM (ESDRAM), Synchronous Link DRAM (SLDRAM), and Direct Rambus RAM (DRRAM).
The computer system 210 also includes removable/non-removable, volatile/nonvolatile computer storage media such as, for example, disk storage. Disk storage includes, but is not limited to, devices such as a magnetic disk drive, floppy disk drive, tape drive, Jaz drive, Zip drive, LS-60 drive, flash memory card, or memory stick. In addition, disk storage can include storage media separately or in combination with other storage media including, but not limited to, an optical disk drive such as a compact disk ROM device (CD-ROM), compact disk recordable drive (CD-R drive), compact disk rewritable drive (CD-RW drive) or a digital versatile disk ROM drive (DVD-ROM). To facilitate connection of the disk storage devices to the system bus, a removable or non-removable interface may be used.
It is to be appreciated that the computer system 210 includes software that acts as an intermediary between users and the basic computer resources described in suitable operating environments. Such software includes an operating system. An operating system, which may be stored on disk storage, is used to control and allocate resources of the computer system. System applications utilize the operating system to manage resources through program modules and program data stored in system memory or on disk storage. It is to be appreciated that the various components described herein can be implemented with various operating systems or combinations of operating systems.
A user enters commands or information into the computer system 210 through one or more input devices coupled to the I/O interface 251. Input devices include, but are not limited to, a pointing device such as a mouse, trackball, stylus, touch pad, keyboard, microphone, joystick, game pad, satellite dish, scanner, TV tuner card, digital camera, digital video camera, web camera, and the like. These and other input devices are connected to the processor through the system bus via one or more interface ports. The one or more interface ports include, for example, a serial port, a parallel port, a game port, and a USB. One or more output devices use the same type of port as one or more input devices. Thus, for example, a USB port may be used to provide input to a computer system and to output information from the computer system to an output device. Output adapters are provided to illustrate that there are some output devices (such as monitors, displays, speakers, and printers) that require special adapters among other output devices.
The computer system 210 may operate in a networked environment using logical connections to one or more remote computers, such as one or more cloud computers, or local computers. The one or more remote cloud computers can be personal computers, servers, routers, network PCs, workstations, microprocessor-based appliances, peer devices or other common network nodes, etc., and typically include many or all of the elements described relative to the computer system. For purposes of clarity, only a memory storage device having one or more remote computers is illustrated. One or more remote computers are logically connected to the computer system through a network interface and then physically connected via a communications connection. Network interfaces encompass communication networks such as Local Area Networks (LANs) and Wide Area Networks (WANs). LAN technologies include Fiber Distributed Data Interface (FDDI), Copper Distributed Data Interface (CDDI), Ethernet/IEEE 802.3, token Ring/IEEE 802.5, and the like. WAN technologies include, but are not limited to, point-to-point links, circuit switching networks like Integrated Services Digital Networks (ISDN) and variations thereon, packet switching networks, and Digital Subscriber Lines (DSL).
In various aspects, the computer system 210,
One or more communication connections refer to the hardware/software employed to connect the network interface to the bus. While a communication connection is shown for exemplary clarification inside the computer system, it may also be located outside of computer system 210. The hardware/software necessary for connection to the network interface includes, for exemplary purposes only, internal and external technologies such as, modems including regular telephone grade modems, cable modems and DSL modems, ISDN adapters, and Ethernet cards.
In aspects, the device/
Fig. 11 illustrates a functional block diagram of one aspect of a USB hub 300 device in accordance with at least one aspect of the present disclosure. In the illustrated aspect, the USB hub device 300 employs a TUSB2036 integrated circuit hub from texas instruments. The USB hub 300 is a CMOS device that provides an upstream USB transceiver port 302 and up to three downstream USB transceiver ports 304, 306, 308 according to the USB 2.0 specification. The upstream USB transceiver port 302 is a differential root data port that includes a differential data negative (DP0) input paired with a differential data positive (DM0) input. The three downstream USB transceiver ports 304, 306, 308 are differential data ports, where each port includes a differential data positive (DP1-DP3) output paired with a differential data negative (DM1-DM3) output.
The USB hub 300 device is implemented with a digital state machine rather than a microcontroller and does not require firmware programming. Fully compatible USB transceivers are integrated into the circuitry for the upstream USB transceiver port 302 and all downstream USB transceiver ports 304, 306, 308. The downstream USB transceiver ports 304, 306, 308 support both full-speed devices and low-speed devices by automatically setting the slew rate according to the speed of the device attached to the port. The USB hub 300 device may be configured in a bus-powered mode or a self-powered mode and includes hub power logic 312 for managing power.
The USB hub 300 device includes a serial interface engine 310 (SIE). SIE 310 is the front end of the USB hub 300 hardware and handles most of the protocols described in section 8 of the USB specification. The SIE 310 typically includes signaling up to the transaction level. The processing functions thereof may include: packet identification, transaction ordering, SOP, EOP, RESET and RESUME signal detection/generation, clock/data separation, no return to zero inversion (NRZI) data encoding/decoding and digit stuffing, CRC generation and checking (token and data), packet id (pid) generation and checking/decoding, and/or serial-parallel/parallel-serial conversion. 310 receives a clock input 314 and is coupled to pause/resume logic and frame timer 316 circuitry and hub repeater circuitry 318 to control communications between the upstream USB transceiver port 302 and the downstream USB transceiver ports 304, 306, 308 through port logic circuits 320, 322, 324. The SIE 310 is coupled to a command decoder 326 via interface logic to control commands from the serial EEPROM via a serial EEPROM interface 330.
In various aspects, the USB hub 300 may connect 127 functions configured in up to six logical layers (tiers) to a single computer. Further, the USB hub 300 may be connected to all external devices using a standardized four-wire cable that provides both communication and power distribution. The power configuration is a bus powered mode and a self-powered mode. The USB hub 300 may be configured to support four power management modes: bus-powered hubs with individual port power management or package port power management, and self-powered hubs with individual port power management or package port power management. In one aspect, the USB hub 300, upstream USB transceiver port 302, are plugged into the USB host controller using a USB cable, and downstream USB transceiver ports 304, 306, 308 are exposed for connection of USB compatible devices, or the like.
Additional details regarding the structure and function OF the surgical HUB and/or surgical HUB network can be found in U.S. provisional patent application No. 62/659,900 entitled "METHOD OF HUB COMMUNICATION" filed on 19.4.2018, which is incorporated herein by reference in its entirety.
Cloud system hardware and functional module
Fig. 12 is a block diagram of a computer-implemented interactive surgical system in accordance with at least one aspect of the present disclosure. In one aspect, a computer-implemented interactive surgical system is configured to monitor and analyze data related to the operation of various surgical systems, including surgical hubs, surgical instruments, robotic devices, and operating rooms or medical facilities. A computer-implemented interactive surgical system includes a cloud-based analysis system. While the cloud-based analysis system is described as a surgical system, it is not necessarily so limited, and it may generally be a cloud-based medical system. As shown in fig. 12, the cloud-based analysis system includes a plurality of surgical instruments 7012 (which may be the same as or similar to instrument 112), a plurality of surgical hubs 7006 (which may be the same as or similar to hub 106), and a surgical data network 7001 (which may be the same as or similar to network 201) to couple the
Further, the
Based on the connections with the various
The particular cloud computing system configurations described in this disclosure are specifically designed to address various issues arising in the context of medical procedures and procedures performed using medical devices (such as the
Fig. 13 is a block diagram illustrating a functional architecture of a computer-implemented interactive surgical system in accordance with at least one aspect of the present disclosure. The cloud-based analysis system includes a plurality of
For example, the data collection and
The patient
The control
The cloud-based analysis system may include security features implemented by the
Further, for security purposes, the cloud may maintain a database of
The
The cloud-based analysis system may allow monitoring of multiple medical facilities (e.g., medical facilities such as hospitals) to determine improved practices and recommend changes accordingly (e.g., via recommendation module 2030). Thus, the
Data classification and
In various aspects, the
Situation awareness
While a "smart" device that includes a control algorithm responsive to sensed data may be an improvement over a "dumb" device that operates without regard to sensed data, some sensed data may be incomplete or uncertain when considered in isolation, i.e., in the context of no type of surgical procedure being performed or type of tissue being operated upon. Without knowing the surgical context (e.g., knowing the type of tissue being operated on or the type of procedure being performed), the control algorithm may control the modular device incorrectly or sub-optimally given the particular no-context sensing data. For example, the optimal manner in which a control algorithm for controlling a surgical instrument in response to a particular sensed parameter may vary depending on the particular tissue type being operated on. This is due to the fact that: different tissue types have different characteristics (e.g., tear resistance) and thus respond differently to actions taken by a surgical instrument. Thus, it may be desirable for a surgical instrument to take different actions even when the same measurement for a particular parameter is sensed. As one particular example, the optimal manner in which a surgical stapling and severing instrument is controlled in response to the instrument sensing an unexpectedly high force for closing its end effector will vary depending on whether the tissue type is prone to tearing or tear-resistant. For tissue that is prone to tearing (such as lung tissue), the instrument's control algorithm will optimally ramp down the motor speed in response to an unexpectedly high force for closure, thereby avoiding tearing tissue. For tissue that is resistant to tearing (such as stomach tissue), the instrument's control algorithm will optimally ramp the motor speed up in response to an unexpectedly high force for closure, thereby ensuring that the end effector is properly clamped on the tissue. The control algorithm may make a suboptimal decision without knowing whether lung tissue or stomach tissue has been clamped.
One solution utilizes a surgical hub that includes a system configured to derive information about the surgical procedure being performed based on data received from various data sources, and then control the paired modular devices accordingly. In other words, the surgical hub is configured to infer information about the surgical procedure from the received data and then control the modular devices paired with the surgical hub based on the inferred context of the surgical procedure. Fig. 14 illustrates a diagram of a situation-aware surgical system 5100 in accordance with at least one aspect of the present disclosure. In some examples, the data source 5126 includes, for example, a modular device 5102 (which may include sensors configured to be able to detect parameters associated with the patient and/or the modular device itself), a database 5122 (e.g., an EMR database containing patient records), and a patient monitoring device 5124 (e.g., a Blood Pressure (BP) monitor and an Electrocardiogram (EKG) monitor).
The surgical hub 5104 (which may be similar in many respects to the hub 106) may be configured to be capable of deriving background information related to the surgical procedure from the data, e.g., based on a particular combination of received data or a particular order in which the data is received from the data source 5126. The context information inferred from the received data may include, for example, the type of surgical procedure being performed, the particular step of the surgical procedure being performed by the surgeon, the type of tissue being operated on, or the body cavity that is the subject of the procedure. This ability of some aspects of the surgical hub 5104 to derive or infer information related to the surgical procedure from the received data may be referred to as "situational awareness. In one example, the surgical hub 5104 may incorporate a situational awareness system, which is hardware and/or programming associated with the surgical hub 5104 that derives contextual information related to the surgical procedure from the received data.
The situational awareness system of the surgical hub 5104 may be configured to derive contextual information from data received from the data source 5126 in a number of different ways. In one example, the situational awareness system includes a pattern recognition system or machine learning system (e.g., an artificial neural network) that has been trained on training data to associate various inputs (e.g., data from the database 5122, the patient monitoring device 5124, and/or the modular device 5102) with corresponding contextual information about the surgical procedure. In other words, the machine learning system may be trained to accurately derive contextual information about the surgical procedure from the provided inputs. In another example, the situational awareness system may include a look-up table that stores pre-characterized contextual information about the surgical procedure in association with one or more inputs (or input ranges) corresponding to the contextual information. In response to a query with one or more inputs, the lookup table may return corresponding context information that the situational awareness system uses to control the modular device 5102. In one example, the contextual information received by the situational awareness system of the surgical hub 5104 is associated with a particular control adjustment or set of control adjustments for one or more modular devices 5102. In another example, the situational awareness system includes another machine learning system, look-up table, or other such system that generates or retrieves one or more control adjustments for one or more of the modular devices 5102 when providing contextual information as input.
The surgical hub 5104 incorporating the situational awareness system provides a number of benefits to the surgical system 5100. One benefit includes improved interpretation of sensed and collected data, which in turn will improve processing accuracy and/or use of the data during the surgical procedure. Returning to the previous example, the situational awareness surgical hub 5104 may determine the type of tissue being operated on; thus, when an unexpectedly high force is detected for closing the end effector of the surgical instrument, the situation aware surgical hub 5104 can properly ramp up or ramp down the motor speed for the tissue-type surgical instrument.
As another example, the type of tissue being operated on may affect the adjustment of the compressibility and loading thresholds of the surgical stapling and severing instrument for a particular tissue gap measurement. The situational aware surgical hub 5104 can infer whether the surgical procedure being performed is a chest procedure or an abdominal procedure, allowing the surgical hub 5104 to determine whether the tissue held by the end effector of the surgical stapling and severing instrument is lung tissue (for chest procedures) or stomach tissue (for abdominal procedures). The surgical hub 5104 can then adjust the compression rate and load thresholds of the surgical stapling and severing instrument as appropriate for the type of tissue.
As yet another example, the type of body cavity that is manipulated during an insufflation procedure may affect the function of the smoke extractor. The situational awareness surgical hub 5104 may determine whether the surgical site is under pressure (by determining that the surgical procedure is utilizing insufflation) and determine the type of procedure. Since one type of procedure is typically performed within a particular body cavity, the surgical hub 5104 can then appropriately control the motor speed of the smoke extractor for the body cavity in which it is operating. Thus, the situational awareness surgical hub 5104 may provide consistent smoke output for both chest and abdominal surgery.
As yet another example, the type of procedure being performed may affect the optimal energy level at which an ultrasonic surgical instrument or a Radio Frequency (RF) electrosurgical instrument operates. For example, arthroscopic surgery requires higher energy levels because the end effector of an ultrasonic surgical instrument or RF electrosurgical instrument is immersed in fluid. The situation aware surgical hub 5104 can determine whether the surgical procedure is an arthroscopic procedure. The surgical hub 5104 may then adjust the RF power level or ultrasound amplitude (i.e., the "energy level") of the generator to compensate for the fluid-filled environment. Relatedly, the type of tissue being operated on may affect the optimal energy level at which the ultrasonic surgical instrument or RF electrosurgical instrument operates. The situational awareness surgical hub 5104 can determine the type of surgical procedure being performed and then customize the energy level of the ultrasonic surgical instrument or RF electrosurgical instrument, respectively, according to the expected tissue profile of the surgical procedure. Further, the situation-aware surgical hub 5104 may be configured to be able to adjust the energy level of the ultrasonic surgical instrument or RF electrosurgical instrument throughout the surgical procedure, rather than only on a procedure-by-procedure basis. The situation aware surgical hub 5104 can determine the steps of the surgical procedure being performed or to be performed subsequently and then update the control algorithm for the generator and/or ultrasonic surgical instrument or RF electrosurgical instrument to set the energy level at a value appropriate for the desired tissue type according to the surgical procedure.
As yet another example, data may be extracted from additional data sources 5126 to improve the conclusion that the surgical hub 5104 extracts from one data source 5126. The situation aware surgical hub 5104 can augment the data it receives from the modular device 5102 with contextual information about the surgical procedure that has been built from other data sources 5126. For example, the situational awareness surgical hub 5104 may be configured to determine whether hemostasis has occurred (i.e., whether bleeding at the surgical site has stopped) based on video or image data received from the medical imaging device. However, in some cases, the video or image data may be uncertain. Thus, in one example, the surgical hub 5104 may also be configured to compare physiological measurements (e.g., blood pressure sensed by a BP monitor communicatively connected to the surgical hub 5104) with hemostatic visual or image data (e.g., from the medical imaging device 124 (fig. 2) communicatively coupled to the surgical hub 5104) to determine the integrity of the suture or tissue weld. In other words, the situational awareness system of the surgical hub 5104 may take into account the physiological measurement data to provide additional context when analyzing the visualization data. Additional context may be useful when the visualization data itself may be ambiguous or incomplete.
Another benefit includes actively and automatically controlling the paired modular devices 5102 according to the particular step of the surgical procedure being performed to reduce the number of times medical personnel need to interact with or control the surgical system 5100 during the surgical procedure. For example, if the situation-aware surgical hub 5104 determines that a subsequent step of the procedure requires the use of an RF electrosurgical instrument, it may actively activate a generator connected to the instrument. Actively activating the energy source allows the instrument to be ready for use as soon as the previous step of the procedure is completed.
As another example, the situation aware surgical hub 5104 may determine whether a different view or degree of magnification on the display is required for the current or subsequent step of the surgical procedure based on the feature(s) that the surgeon expects to need to view at the surgical site. The surgical hub 5104 may then actively change the displayed view accordingly (e.g., provided by the medical imaging device for the visualization system 108), such that the display is automatically adjusted throughout the surgical procedure.
As yet another example, the situation aware surgical hub 5104 can determine which step of the surgical procedure is being performed or is to be performed subsequently and whether a comparison between particular data or data is required for that step of the surgical procedure. The surgical hub 5104 may be configured to automatically invoke a data screen based on the steps of the surgical procedure being performed without waiting for the surgeon to request this particular information.
Another benefit includes checking for errors during setup of the surgical procedure or during the course of the surgical procedure. For example, the situational awareness surgical hub 5104 may determine whether the operating room is properly or optimally set for the surgical procedure to be performed. The surgical hub 5104 may be configured to determine the type of surgical procedure being performed, retrieve (e.g., from memory) a corresponding manifest, product location, or setup requirements, and then compare the current operating room layout to the standard layout determined by the surgical hub 5104 for the type of surgical procedure being performed. In one example, the surgical hub 5104 may be configured to compare a list of items for a procedure (e.g., scanned by a suitable scanner) and/or a list of devices paired with the surgical hub 5104 to a recommended or expected list of items and/or devices for a given surgical procedure. The surgical hub 5104 may be configured to provide an alert indicating the absence of a particular modular device 5102, patient monitoring device 5124, and/or other surgical item if any discontinuity exists between the lists. In one example, the surgical hub 5104 may be configured to be able to determine the relative distance or location of the modular device 5102 and the patient monitoring device 5124, e.g., via proximity sensors. The surgical hub 5104 can compare the relative position of the devices to a recommended or expected layout for a particular surgical procedure. The surgical hub 5104 may be configured to provide an alert indicating that the current layout for the surgical procedure deviates from the recommended layout if there are any discontinuities between layouts.
As another example, the situational awareness surgical hub 5104 can determine whether the surgeon (or other medical personnel) is making mistakes or otherwise deviating from the expected course of action during the surgical procedure. For example, the surgical hub 5104 may be configured to determine the type of surgical procedure being performed, retrieve (e.g., from memory) a corresponding list of steps or order of device usage, and then compare the steps being performed or the devices being used during the surgical procedure to the expected steps or devices determined by the surgical hub 5104 for the type of surgical procedure being performed. In one example, the surgical hub 5104 may be configured to provide an alert indicating that an unexpected action is being performed or an unexpected device is being used at a particular step in the surgical procedure.
In general, the situational awareness system for the surgical hub 5104 improves surgical results by adjusting the surgical instruments (and other modular devices 5102) for the particular context of each surgical procedure, such as for different tissue types, and verifying actions during the surgical procedure. The situational awareness system also improves the surgeon's efficiency in performing the surgical procedure by automatically suggesting next steps, providing data, and adjusting the display and other modular devices 5102 in the operating room, depending on the particular context of the procedure.
In one aspect, as described below with reference to fig. 24-40, the modular device 5102 is implemented as a circular electric stapling device 201800 (fig. 24-30), 201502 (fig. 31-33), 201532 (fig. 34-35), 201610 (fig. 36-40). Thus, the modular device 5102, implemented as circular powered suturing devices 201800 (fig. 24-30), 201502 (fig. 31-33), 201532 (fig. 34-35), 201610 (fig. 36-40), is configured to be operable as a data source 5126 and to interact with a database 5122 and a patient monitoring device 5124. The modular device 5102, implemented as circular powered suturing devices 201800 (fig. 24-30), 201502 (fig. 31-33), 201532 (fig. 34-35), 201610 (fig. 36-40), is further configured to be capable of interacting with a surgical hub 5104 to provide information (e.g., data and control) to the surgical hub 5104 and receive information (e.g., data and control) from the surgical hub 5104.
Referring now to fig. 15, a timeline 5200 depicting situational awareness of a hub, such as the surgical hub 106 or 206 (fig. 1-11), for example, is shown. The time axis 5200 is illustrative of the surgical procedure and background information that the
The situation aware
As a first step 5202 in this exemplary procedure, the hospital staff retrieves the patient's EMR from the hospital's EMR database. Based on the selected patient data in the EMR, the
In a second step 5204, the staff scans the incoming medical supplies for the procedure. The
In a third step 5206, medical personnel scan the patient belt via a scanner communicatively connected to the
Fourth, the medical staff opens the ancillary equipment 5208. The ancillary equipment utilized may vary depending on the type of surgery and the technique to be used by the surgeon, but in this exemplary case they include smoke ejectors, insufflators, and medical imaging devices. When activated, the auxiliary device as a modular device may be automatically paired with a
In a fifth step 5210, the practitioner attaches EKG electrodes and other patient monitoring devices to the patient. EKG electrodes and other patient monitoring devices can be paired with the
Sixth step 5212, the medical personnel induce anesthesia in the patient. The
In a seventh step 5214, the patient's lungs being operated on are collapsed (while ventilation is switched to the contralateral lungs). For example, the
In an eighth step 5216, a medical imaging device (e.g., an endoscope) is inserted and video from the medical imaging device is initiated. The
Ninth step 5218, the surgical team begins the dissection step of the procedure. The
In a tenth step 5220, the surgical team continues with the surgical ligation step. The
Eleventh step 5222, a segmental resection portion of the procedure is performed. The
A twelfth step 5224 node dissection step is then performed. The
A thirteenth step 5226, reverse anesthetizing the patient. For example, the
Finally, a fourteenth step 5228 is for the medical personnel to remove various patient monitoring devices from the patient. Thus, when the hub loses EKG, BP, and other data from the patient monitoring device, the
In aspects, the circular electric stapling devices 201800 (fig. 24-30), 201502 (fig. 31-33), 201532 (fig. 34-35), 201610 (fig. 36-40) are configured to be operable in situational awareness in a hub environment, such as a surgical hub 106 or 206 (fig. 1-11), e.g., as depicted by a time axis 5200. Situational awareness is further described in U.S. provisional patent application serial No. 62/659,900 entitled "METHOD OF HUB COMMUNICATION", filed on 19.4.2018, which is incorporated herein by reference in its entirety. In certain instances, operation of the robotic surgical system (including the various robotic surgical systems disclosed herein) may be controlled by the
Surgical instrument hardware
Fig. 16 illustrates a logic diagram for a control system 470 for a surgical instrument or tool according to one or more aspects of the present disclosure. The system 470 includes control circuitry. The control circuit includes a microcontroller 461 that includes a processor 462 and a memory 468. For example, one or more of the sensors 472, 474, 476 provide real-time feedback to the processor 462. A motor 482 driven by a motor driver 492 is operably coupled to the longitudinally movable displacement member to drive a knife element, trocar or anvil of the electric circular stapling apparatus. The tracking system 480 is configured to be able to determine the position of the longitudinally movable displacement member. The position information is provided to a processor 462 that may be programmed or configured to determine the position of the longitudinally movable drive member as well as the position of the firing member, firing bar, and knife element. Additional motors may be provided at the tool driver interface to control knife firing, closure tube travel, shaft rotation, and articulation. The display 473 displays a variety of operating conditions of the instrument and may include touch screen functionality for data entry. The information displayed on the display 473 may be overlaid with the image acquired via the endoscopic imaging module.
In one aspect, microprocessor 461 may be any single-core or multi-core processor, such as those known under the trade name ARM Cortex produced by Texas Instruments. In one aspect, microcontroller 461 may be an LM4F230H5QR ARM Cortex-M4F processor core available from Texas Instruments, Inc. (Texas Instruments), for example, that includes 256KB of on-chip memory of single-cycle flash or other non-volatile memory (up to 40MHz), a prefetch buffer for improved performance above 40MHz, 32KB of single-cycle SRAM, loaded with a load of memory above 40MHzInternal ROM of software, 2KB electrical EEPROM, one or more PWM modules, one or more QEI analog, one or more 12-bit ADCs with 12 analog input channels, the details of which can be seen in the product data sheet.
In one aspect, microcontroller 461 may comprise a safety controller comprising two controller-based families such as TMS570 and RM4x, also known under the trade name Hercules ARM Cortex R4, also manufactured by Texas Instruments. The safety controller may be configured specifically for IEC 61508 and ISO 26262 safety critical applications, etc., to provide advanced integrated safety features while delivering scalable performance, connectivity, and memory options.
The controller 461 may be programmed to perform various functions such as precise control of the speed and position of the knife and articulation system. In one aspect, microcontroller 461 includes processor 462 and memory 468. The electric motor 482 may be a brushed Direct Current (DC) motor having a gear box and a mechanical link to an articulation or knife system. In one aspect, the motor driver 492 may be a3941 available from Allegro Microsystems, Inc. Other motor drives can be readily substituted for use in tracking system 480, including an absolute positioning system. Detailed description of the absolute positioning system is described in U.S. patent application publication 2017/0296213 entitled "SYSTEMS AND METHODS FOR CONTROLLING positioning system STAPLING AND CUTTING actuation" published on 19/10/2017, which is incorporated herein by reference in its entirety.
The microcontroller 461 may be programmed to provide precise control of the speed and position of the displacement member and the articulation system. The microcontroller 461 may be configured to be able to calculate a response in the software of the microcontroller 461. The calculated response is compared to the measured response of the actual system to obtain an "observed" response, which is used for the actual feedback decision. The observed response is a favorable tuning value that balances the smooth continuous nature of the simulated response with the measured response, which can detect external effects on the system.
In one aspect, the motor 482 can be controlled by a motor driver 492 and can be employed by a firing system of a surgical instrument or tool. In various forms, the motor 482 may be a brushed DC drive motor having a maximum rotational speed of about 25,000 RPM. In other arrangements, the motor 482 may include a brushless motor, a cordless motor, a synchronous motor, a stepper motor, or any other suitable electric motor. The motor driver 492 may comprise, for example, an H-bridge driver including a Field Effect Transistor (FET). The motor 482 may be powered by a power assembly releasably mounted to the handle assembly or tool housing for supplying control power to the surgical instrument or tool. The power assembly may include a battery that may include a plurality of battery cells connected in series that may be used as a power source to provide power to a surgical instrument or tool. In some cases, the battery cells of the power assembly may be replaceable and/or rechargeable. In at least one example, the battery cell may be a lithium ion battery, which may be coupled to and separated from the power assembly.
The driver 492 may be a3941 available from Allegro Microsystems, Inc. A 3941492 is a full-bridge controller for use with an external N-channel power Metal Oxide Semiconductor Field Effect Transistor (MOSFET) specifically designed for inductive loads, such as brushed DC motors. Driver 492 includes a unique charge pump regulator that provides full (>10V) gate drive for battery voltages as low as 7V and allows a3941 to operate with reduced gate drive as low as 5.5V. A bootstrap capacitor may be employed to provide the aforementioned battery supply voltage required for the N-channel MOSFET. The internal charge pump of the high-side drive allows for direct current (100% duty cycle) operation. The full bridge may be driven in fast decay mode or slow decay mode using diodes or synchronous rectification. In slow decay mode, current recirculation can pass through either the high-side or low-side FETs. The power FET is protected from breakdown by a resistor adjustable dead time. The integral diagnostics provide an indication of undervoltage, overheating, and power bridge faults, and may be configured to protect the power MOSFETs under most short circuit conditions. Other motor drives can be readily substituted for use in tracking system 480, including an absolute positioning system.
The tracking system 480 includes a controlled motor drive circuit arrangement including a position sensor 472 according to one aspect of the present disclosure. The position sensor 472 for the absolute positioning system provides a unique position signal corresponding to the position of the displacement member. In one aspect, the displacement member represents a longitudinally movable drive member including a rack of drive teeth for meshing engagement with a corresponding drive gear of the gear reducer assembly. In other aspects, the displacement member represents a firing member that may be adapted and configured to include a rack of drive teeth. In yet another aspect, the displacement member represents a firing bar or a knife, each of which may be adapted and configured to include a rack of drive teeth. Thus, as used herein, the term displacement member is used generically to refer to any movable member of a surgical instrument or tool, such as a drive member, a firing bar, a knife of an electrically powered circular stapling device, a trocar, or an anvil, or any element that may be displaced. In one aspect, a longitudinally movable drive member is coupled to the firing member, the firing bar, and the knife. Thus, the absolute positioning system may actually track the linear displacement of the knife by tracking the linear displacement of the longitudinally movable drive member. In various other aspects, the displacement member may be coupled to any position sensor 472 suitable for measuring linear displacement. Thus, the longitudinally movable drive member, firing bar, or knife, or a combination thereof, may be coupled to any suitable linear displacement sensor. The linear displacement sensor may comprise a contact displacement sensor or a non-contact displacement sensor. The linear displacement sensor may comprise a Linear Variable Differential Transformer (LVDT), a Differential Variable Reluctance Transducer (DVRT), a sliding potentiometer, a magnetic sensing system comprising a movable magnet and a series of linearly arranged hall effect sensors, a magnetic sensing system comprising a fixed magnet and a series of movable linearly arranged hall effect sensors, an optical sensing system comprising a movable light source and a series of linearly arranged photodiodes or photodetectors, an optical sensing system comprising a fixed light source and a series of movable linearly arranged photodiodes or photodetectors, or any combination thereof.
The electric motor 482 may include a rotatable shaft that operably interfaces with a gear assembly mounted on the displacement member in meshing engagement with the set or rack of drive teeth. The sensor element may be operably coupled to the gear assembly such that a single rotation of the position sensor 472 element corresponds to some linear longitudinal translation of the displacement member. The arrangement of the transmission and sensor may be connected to the linear actuator via a rack and pinion arrangement, or to the rotary actuator via a spur gear or other connection. The power source powers the absolute positioning system and the output indicator may display an output of the absolute positioning system. The displacement member represents a longitudinally movable drive member including a rack of drive teeth formed thereon for meshing engagement with a corresponding drive gear of the gear reducer assembly. The displacement member represents a longitudinally movable firing member, firing bar, knife, or combination thereof.
A single rotation of the sensor element associated with position sensor 472 is equivalent to a longitudinal linear displacement d1 of the displacement member, where d1 is the longitudinal linear distance that the displacement member moves from point "a" to point "b" after a single rotation of the sensor element coupled to the displacement member. The sensor arrangement may be connected via a gear reduction that causes the position sensor 472 to complete only one or more rotations for the full stroke of the displacement member. The position sensor 472 may complete multiple rotations for a full stroke of the displacement member.
A series of switches (where n is an integer greater than one) may be employed alone or in conjunction with the gear reduction to provide unique position signals for more than one rotation of the position sensor 472. The state of the switch is fed back to the microcontroller 461, which applies logic to determine a unique position signal corresponding to the longitudinal linear displacement d1+ d2+ … dn of the displacement member. The output of the position sensor 472 is provided to a microcontroller 461. The position sensor 472 of the sensor arrangement may include a magnetic sensor, an analog rotation sensor (e.g., a potentiometer), an array of analog hall effect elements that output a unique combination of position signals or values.
Position sensor 472 may include any number of magnetic sensing elements, such as, for example, magnetic sensors that are classified according to whether they measure the total or vector component of the magnetic field. The techniques for producing the two types of magnetic sensors described above encompass a number of aspects of physics and electronics. Technologies for magnetic field sensing include search coils, flux gates, optical pumps, nuclear spins, superconducting quantum interferometers (SQUIDs), hall effects, anisotropic magnetoresistance, giant magnetoresistance, magnetic tunnel junctions, giant magnetoimpedances, magnetostrictive/piezoelectric composites, magnetodiodes, magnetotransistors, optical fibers, magneto-optical, and magnetic sensors based on micro-electromechanical systems, among others.
In one aspect, the position sensor 472 for the tracking system 480 including an absolute positioning system comprises a magnetic rotary absolute positioning system. The position sensor 472 may be implemented AS an AS5055EQFT monolithic magnetic rotary position sensor, available from Austria microelectronics, AG, australia. The position sensor 472 interfaces with the microcontroller 461 to provide an absolute positioning system. The position sensor 472 is a low voltage and low power component and includes four hall effect elements located in the area of the position sensor 472 above the magnet. A high resolution ADC and an intelligent power management controller are also provided on the chip. Coordinate rotation digital computer (CORDIC) processors (also known as bitwise and Volder algorithms) are provided to perform simple and efficient algorithms to compute hyperbolic and trigonometric functions, which require only addition, subtraction, digital displacement and table lookup operations. The angular position, alarm bits and magnetic field information are transmitted to the microcontroller 461 via a standard serial communication interface, such as a Serial Peripheral Interface (SPI) interface. The position sensor 472 provides 12 or 14 bit resolution. The position sensor 472 may be an AS5055 chip provided in a small QFN 16 pin 4 × 4 × 0.85mm package.
The tracking system 480, including an absolute positioning system, may include and/or may be programmed to implement feedback controllers such as PID, state feedback, and adaptive controllers. The power source converts the signal from the feedback controller into a physical input to the system: in this case a voltage. Other examples include PWM of voltage, current and force. In addition to the location measured by the location sensor 472, one or more other sensors may be provided to measure physical parameters of the physical system. In some aspects, one or more other SENSORs may include a SENSOR arrangement, such as those described in U.S. patent 9,345,481 entitled "STAPLE CARTRIDGE TISSUE thicknes SENSOR SYSTEM," issued 5/24/2016, which is incorporated herein by reference in its entirety; U.S. patent application publication 2014/0263552 entitled "STAPLE CARTRIDGETISSUE THICKNESS SENSOR SYSTEM" published 9/18/2014, which is incorporated herein by reference in its entirety; and U.S. patent application Ser. No. 15/628,175 entitled "TECHNIQUES FOR ADAPTIVE CONTROL OF A SURGICAL STAPLING AND CUTTING INSTRUMENT," filed 2017, on 20.6.7, which is hereby incorporated by reference in its entirety. In a digital signal processing system, an absolute positioning system is coupled to a digital data acquisition system, wherein the output of the absolute positioning system will have a limited resolution and sampling frequency. The absolute positioning system may include comparison and combination circuitry to combine the calculated response with the measured response using an algorithm (such as a weighted average and a theoretical control loop) that drives the calculated response toward the measured response. The calculated response of the physical system takes into account characteristics such as mass, inertia, viscous friction, inductive resistance to predict the state and output of the physical system by knowing the inputs.
Thus, the absolute positioning system provides an absolute position of the displacement member upon power-up of the instrument, and does not retract or advance the displacement member to a reset (clear or home) position as may be required by conventional rotary encoders, which simply count the number of forward or backward steps taken by the motor 482 to infer the position of the device actuator, drive rod, knife, etc.
The sensor 474 (such as, for example, a strain gauge or a micro-strain gauge) is configured to measure one or more parameters of the end effector, such as, for example, the magnitude of the strain exerted on the anvil during a clamping operation, which may be indicative of the closing force applied to the anvil. The measured strain is converted to a digital signal and provided to the processor 462. Alternatively or in addition to the sensor 474, a sensor 476 (such as a load sensor) may measure the closing force applied to the anvil by the closure drive system. A sensor 476, such as, for example, a load sensor, may measure the firing force applied to the knife during the firing stroke of the surgical instrument or tool. The knife is configured to engage a wedge sled configured to cam the staple drivers upward to push the staples out into deforming contact with the anvil. The knife also includes a sharp cutting edge that can be used to sever tissue as the knife is advanced distally through the firing bar. Alternatively, a current sensor 478 may be employed to measure the current drawn by the motor 482. The force required to advance the firing member may correspond to, for example, the current consumed by the motor 482. The measured force is converted to a digital signal and provided to the processor 462.
In one form, the strain gauge sensor 474 may be used to measure the force applied to tissue by the end effector. A strain gauge may be coupled to the end effector to measure the force on the tissue being treated by the end effector. The system for measuring force applied to tissue grasped by the end effector includes a strain gauge sensor 474, such as, for example, a micro-strain gauge, configured to be capable of measuring one or more parameters of, for example, the end effector. In one aspect, strain gauge sensor 474 can measure the magnitude or magnitude of strain applied to the jaw members of the end effector during a clamping operation, which can indicate tissue compression. The measured strain is converted to a digital signal and provided to the processor 462 of the microcontroller 461. Load sensor 476 may measure a force used to operate the knife member, for example, to cut tissue captured between the anvil and the staple cartridge. A magnetic field sensor may be employed to measure the thickness of the trapped tissue. The measurements of the magnetic field sensors may also be converted to digital signals and provided to the processor 462.
The microcontroller 461 can use measurements of tissue compression, tissue thickness, and/or force required to close the end effector, as measured by the sensors 474, 476, respectively, to characterize selected positions of the firing member and/or corresponding values of the velocity of the firing member. In one case, the memory 468 can store techniques, formulas, and/or look-up tables that can be employed by the microcontroller 461 in the evaluation.
The control system 470 of the surgical instrument or tool may also include wired or wireless communication circuitry to communicate with the modular communication hub, as shown in fig. 1-14. Motorized circular stapling instruments 201800 (fig. 24-30), 201502 (fig. 31-32), 201532 (fig. 34-35), 201610 (fig. 36-40) can employ a control system 470 to control aspects of the motorized
Fig. 17 illustrates a
Fig. 18 illustrates a combinational logic circuit 510 configured to control aspects of a surgical instrument or tool according to an aspect of the present disclosure. The combinational logic circuit 510 may be configured to enable the various processes described herein. Combinatorial logic circuitry 510 may include a finite state machine including combinatorial logic 512 configured to receive data associated with a surgical instrument or tool at input 514, process the data through combinatorial logic 512, and provide output 516.
Fig. 19 illustrates a sequential logic circuit 520 configured to control various aspects of a surgical instrument or tool, according to one aspect of the present disclosure. Sequential logic circuit 520 or combinational logic 522 may be configured to enable the various processes described herein. Sequential logic circuit 520 may comprise a finite state machine. Sequential logic circuitry 520 may include, for example, combinatorial logic 522, at least one memory circuit 524, and a clock 529. The at least one memory circuit 524 may store the current state of the finite state machine. In some cases, the sequential logic circuit 520 may be synchronous or asynchronous. The combinational logic 522 is configured to receive data associated with a surgical instrument or tool from the inputs 526, process the data through the combinational logic 522, and provide the outputs 528. In other aspects, a circuit may comprise a combination of a processor (e.g., processor 502, fig. 17) and a finite state machine to implement various processes herein. In other aspects, the finite state machine may comprise a combination of combinational logic circuitry (e.g., combinational logic circuitry 510, fig. 18) and sequential logic circuitry 520.
Fig. 20 illustrates a
In certain instances, a surgical instrument system or tool may include a firing
In some cases, the surgical instrument or tool may include a
In some cases, the surgical instrument or tool may include, for example, one or
As described above, a surgical instrument or tool may include multiple motors that may be configured to perform various independent functions. In some cases, multiple motors of a surgical instrument or tool may be activated individually or independently to perform one or more functions while other motors remain inactive. For example, the
In some instances, a surgical instrument or tool may include a
In at least one example, the
Each of the
In various instances, as shown in fig. 20, the
In some cases,
In some cases,
In various instances, the
In one case, the
In certain instances, the
In some cases, one or more mechanisms and/or sensors, such as
The
Fig. 21 is a schematic view of a
In one aspect, the
In one aspect,
In one aspect, the
In one aspect, the
In some examples, the
In one aspect, the
In one aspect, the
In one aspect, the
In one aspect, the
In a circular stapler embodiment, a
In one aspect, the
In another aspect, the articulation function of the robotic
In one aspect, one or more of the
In one aspect,
In one aspect, the
In one aspect, the one or
In one aspect, the
In one aspect, the
In one aspect, the
The
Fig. 22 illustrates a block diagram of a surgical instrument 750 configured to control various functions in accordance with an aspect of the present disclosure. In one aspect, the surgical instrument 750 is programmed to control distal translation of a displacement member, such as a knife 764 or other suitable cutting element. The surgical instrument 750 includes an end effector 752, which may include an anvil 766, a knife 764 (including a sharp cutting edge), and a removable staple cartridge 768.
The position, motion, displacement, and/or translation of a linear displacement member, such as the knife 764, may be measured by an absolute positioning system, a sensor arrangement, and a position sensor 784. Since the knife 764 is coupled to the longitudinally movable drive member, the position of the knife 764 may be determined by measuring the position of the longitudinally movable drive member with the position sensor 784. Thus, in the following description, the position, displacement, and/or translation of the blade 764 may be achieved by the position sensor 784 as described herein. The control circuit 760 may be programmed to control the translation of a displacement member, such as the knife 764. In some examples, the control circuitry 760 may include one or more microcontrollers, microprocessors, or other suitable processors for executing instructions that cause the one or more processors to control the displacement member (e.g., blade 764) in the manner described. In one aspect, the timer/counter 781 provides an output signal, such as a time elapsed or a digital count, to the control circuit 760 to correlate the position of the knife 764, as determined by the position sensor 784, with the output of the timer/counter 781 so that the control circuit 760 can determine the position of the knife 764 at a particular time (t) relative to the starting position. The timer/counter 781 may be configured to be able to measure elapsed time, count or time external events.
The control circuit 760 may generate a motor set point signal 772. The motor set point signal 772 may be provided to the motor controller 758. The motor controller 758 may include one or more circuits configured to provide a motor drive signal 774 to the motor 754 to drive the motor 754, as described herein. In some examples, the motor 754 may be a brushed DC electric motor. For example, the speed of motor 754 may be proportional to motor drive signal 774. In some examples, the motor 754 may be a brushless DC electric motor, and the motor drive signals 774 may include PWM signals provided to one or more stator windings of the motor 754. Also, in some examples, the motor controller 758 may be omitted and the control circuitry 760 may generate the motor drive signal 774 directly.
The motor 754 may receive power from an energy source 762. The energy source 762 may be or include a battery, a supercapacitor, or any other suitable energy source. The motor 754 may be mechanically coupled to the knife 764 via a transmission 756. The transmission 756 may include one or more gears or other linkage components to couple the motor 754 to the knife 764. In one aspect, a transmission is coupled to a trocar actuator of the circular stapler to advance or retract the trocar. The position sensor 784 may sense the position of a knife 764, trocar, or anvil 766, or a combination thereof. The position sensor 784 may be or include any type of sensor capable of generating position data indicative of the position of the blade 764. In some examples, the position sensor 784 may include an encoder configured to provide a series of pulses to the control circuit 760 as the blade 764 is translated distally and proximally. The control circuitry 760 may track the pulses to determine the position of the blade 764. Other suitable position sensors may be used, including, for example, proximity sensors. Other types of position sensors may provide other signals indicative of the motion of the blade 764. Also, in some examples, position sensor 784 may be omitted. Where the motor 754 is a stepper motor, the control circuit 760 may track the position of the blade 764 by summing the number and direction of steps that the motor 754 has been instructed to perform. The position sensor 784 may be located in the end effector 752 or at any other portion of the instrument.
In circular stapler embodiments, the transmission 756 element can be coupled to a trocar to advance or retract the trocar, can be coupled to a knife 764 to advance or retract the knife 764, or can be coupled to an anvil 766 to advance or retract the anvil 766. These functions may be accomplished by a single motor using a suitable clutch mechanism, or may be accomplished using separate motors such as those shown with reference to FIG. 21. In one aspect, transmission 756 is part of a closure system that includes
The control circuitry 760 may be in communication with one or more sensors 788. The sensors 788 may be positioned on the end effector 752 and adapted to operate with the surgical instrument 750 to measure various derivative parameters such as gap distance and time, tissue compression and time, and anvil strain and time. The sensors 788 may include, for example, magnetic sensors, magnetic field sensors, strain gauges, pressure sensors, force sensors, inductive sensors (such as eddy current sensors), resistive sensors, capacitive sensors, optical sensors, and/or any other suitable sensors for measuring one or more parameters of the end effector 752. The sensor 788 may include one or more sensors. In one aspect, sensor 788 can be configured to determine the position of the trocar of a circular stapler.
The one or more sensors 788 may include a strain gauge, such as a micro-strain gauge, configured to measure a magnitude of strain in the anvil 766 during a clamping condition. The strain gauge provides an electrical signal whose magnitude varies with the magnitude of the strain. The sensor 788 may comprise a pressure sensor configured to detect a pressure generated by the presence of compressed tissue between the anvil 766 and the staple cartridge 768. The sensor 788 may be configured to detect an impedance of a section of tissue located between the anvil 766 and the staple cartridge 768, which impedance is indicative of the thickness and/or integrity of the tissue located therebetween.
The sensor 788 may be configured to measure the force exerted by the closure drive system on the anvil 766. For example, one or more sensors 788 may be located at an interaction point between the closure tube and the anvil 766 to detect the closing force applied by the closure tube to the anvil 766. The force exerted on the anvil 766 may be indicative of tissue compression experienced by a section of tissue captured between the anvil 766 and the staple cartridge 768. One or more sensors 788 may be positioned at various interaction points along the closure drive system to detect the closure force applied by the closure drive system to the anvil 766. The one or more sensors 788 may be sampled in real time by the processor of the control circuitry 760 during the clamping operation. The control circuit 760 receives real-time sample measurements to provide and analyze time-based information and evaluates the closing force applied to the anvil 766 in real-time.
A current sensor 786 may be used to measure the current drawn by the motor 754. The force required to propel the knife 764 corresponds to the current consumed by the motor 754. The force is converted to a digital signal and provided to the control circuit 760.
The control circuit 760 may be configured to simulate the response of the actual system of the instrument in the software of the controller. The displacement member may be actuated to move the blade 764 in the end effector 752 at or near a target speed. The surgical instrument 750 may include a feedback controller, which may be one of any feedback controllers including, but not limited to, for example, a PID, status feedback, LQR, and/or adaptive controller. The surgical instrument 750 may include a power source to, for example, convert signals from the feedback controller into physical inputs such as housing voltage, PWM voltage, frequency modulated voltage, current, torque, and/or force.
The actual drive system of the surgical instrument 750 is configured to drive the displacement member, cutting member or blade 764 through a brushed dc motor having a gearbox and mechanical linkage to the articulation and/or blade system. Another example is an electric motor 754 that operates a displacement member and articulation driver, such as an interchangeable shaft assembly. External influences are unmeasured, unpredictable effects of things such as tissue, surrounding body and friction on the physical system. Such external influences may be referred to as drag forces acting opposite the electric motor 754. External influences such as drag forces may cause the operation of the physical system to deviate from the desired operation of the physical system.
Various exemplary aspects relate to a surgical instrument 750 that includes an end effector 752 with a motorized surgical stapling and cutting tool. For example, the motor 754 can drive the displacement member distally and proximally along a longitudinal axis of the end effector 752. The end effector 752 may include a pivotable anvil 766 and, when configured for use, a staple cartridge 768 is positioned opposite the anvil 766. The clinician may hold tissue between the anvil 766 and the staple cartridge 768, as described herein. When the instrument 750 is ready for use, the clinician may provide a firing signal, for example, by depressing a trigger of the instrument 750. In response to the firing signal, the motor 754 may drive the displacement member distally along the longitudinal axis of the end effector 752 from a proximal stroke start position to an end of stroke position distal to the stroke start position. As the displacement member is translated distally, the knife 764, with the cutting element positioned at the distal end, may cut tissue between the staple cartridge 768 and the anvil 766.
In various examples, the surgical instrument 750 can include a control circuit 760 that is programmed to control distal translation of a displacement member (such as a knife 764) based on one or more tissue conditions. Control circuit 760 may be programmed to sense a tissue condition, such as thickness, directly or indirectly, as described herein. The control circuit 760 may be programmed to select a firing control program based on tissue conditions. The firing control routine may describe distal movement of the displacement member. Different firing control programs may be selected to better address different tissue conditions. For example, when thicker tissue is present, the control circuit 760 may be programmed to translate the displacement member at a lower speed and/or at a lower power. When thinner tissue is present, the control circuit 760 may be programmed to translate the displacement member at a higher speed and/or at a higher power.
In some examples, the control circuit 760 may initially operate the motor 754 in an open loop configuration for a first open loop portion of the stroke of the displacement member. Based on the response of the instrument 750 during the open loop portion of the stroke, the control circuit 760 may select a firing control routine. The response of the instrument may include the translation distance of the displacement member during the open loop portion, the time elapsed during the open loop portion, the energy provided to the motor 754 during the open loop portion, the sum of the pulse widths of the motor drive signals, and the like. After the open loop portion, the control circuit 760 may implement the selected firing control routine for a second portion of the displacement member travel. For example, during the closed-loop portion of the stroke, the control circuit 760 may modulate the motor 754 based on translation data that describes the position of the displacement member in a closed-loop manner to translate the displacement member at a constant speed. Additional details are disclosed in U.S. patent application serial No. 15/720,852 entitled "SYSTEM AND METHODS FOR CONTROLLING a DISPLAY OF a SURGICAL INSTRUMENT," filed 2017, 9, 29, which is incorporated by reference herein in its entirety.
The surgical instrument 750 may include wired or wireless communication circuitry to communicate with a modular communication hub, as shown in fig. 1-14. The surgical instrument 750 may be a motorized circular stapling instrument 201800 (fig. 24-30), 201502 (fig. 31-32), 201532 (fig. 34-35), 201610 (fig. 36-40).
Fig. 23 is a schematic view of a surgical instrument 790 configured to control various functions in accordance with an aspect of the present disclosure. In one aspect, the surgical instrument 790 is programmed to control distal translation of a displacement member, such as a knife 764. The surgical instrument 790 includes an end effector 792 that may include an anvil 766, a knife 764, and a removable staple cartridge 768 that may be interchanged with an RF cartridge 796 (shown in phantom).
Referring to fig. 21-23, in various aspects, the
In one aspect, the
In one aspect, the
The position, motion, displacement, and/or translation of a linear displacement member, such as a trocar,
The
The
The one or
The
The
Referring to FIG. 23, when an RF cartridge 796 is loaded in the end effector 792 in place of the staple cartridge 768, an RF energy source 794 is coupled to the end effector 792 and applied to the RF cartridge 796. The control circuitry 760 controls the delivery of RF energy to the RF bin 796.
The surgical instrument 790 may include wired or wireless communication circuitry to communicate with a modular communication hub, as shown in fig. 1-14. The surgical instrument 790 may be a motorized circular stapling instrument 201800 (fig. 24-30), 201502 (fig. 31-32), 201532 (fig. 34-35), 201610 (fig. 36-40).
Additional details are disclosed in U.S. patent application serial No. 15/636,096 entitled "minor SYSTEM stable WITHSTAPLE CARTRIDGE AND RADIO FREQUENCY CARTRIDGE, AND METHOD OF USING SAME," filed on 28.6.2017, which is incorporated by reference herein in its entirety.
Motorized circular stapling surgical instrument
In some instances, it may be desirable to provide motorized control of the circular stapling instrument. The following examples include only illustrative versions of circular stapling instruments in which a single motor may be used to control the clamping of tissue and the cutting/stapling via a single rotary drive. Fig. 24 illustrates an example motorized
The stapling
The
The
As shown in fig. 27, battery
Another electrically
The proximal end of the
The operating mode selection assembly is positioned within the
As shown in fig. 28A, the spline 201876 of the
The
Referring back to fig. 25-26, the distal end of the
When the
As shown in fig. 26, the switch 201898 is positioned in the
Referring now to fig. 29A-29C, in the present example, the
As shown in fig. 29A-29C, an
The
With the
As shown in fig. 29A, the
When the
Still referring to fig. 29A-29C, the user staples a portion of
The stapling
Any of the control circuits described in connection with fig. 16-23 may be used to control the motorized
Circular stapler control algorithm
In various aspects, the present disclosure provides a powered stapling device configured with a circular stapler control algorithm to adjust the force, advance speed, and total travel of a cutting member of the device based on at least one sensed parameter of firing or clamping. In another aspect, the cutting member of the device is actuatable independently of both firing and closing. In another aspect, the sensed parameter may be final tissue gap, force during closure, tissue creep stability, or force during firing. In other aspects, however, the knife actuation device can be operated with load control or stroke control with adjustable limits on the control parameters. The maximum force and the total travel range can be adjusted. The controlled parameters may have secondary limitations on the uncontrolled function. In another aspect, the rate of advancement of the cutting member can be adjusted to a predetermined rate based on the state of the device at the beginning of the cut.
Adjustment of cutting parameters
In one aspect, a powered stapling device is configured to adjust the force, advancement speed, and total travel of a cutting member of the device based on at least one sensed parameter of firing or clamping. In one aspect, the cutting member of the device is actuatable independently of both firing and closing. In another aspect, the sensed parameter includes a final tissue gap, a force during closure, tissue creep stability, or a force during firing. In one aspect, the knife actuation device is configured to be operable with load control or stroke control with adjustable limits on control parameters. For example, both the maximum force and the overall total travel range may be adjusted. The controlled parameters may have secondary limitations on the uncontrolled function. In one aspect, the rate of advancement of the cutting member can be adjusted to a predetermined rate based on the state of the device at the beginning of the cut.
Adjustment of closure rate or direction based on sensed attachment
In various aspects, the rate or direction of closure of the circular stapler, or a combination thereof, may be adjusted based on the sensed attachment relative to the fully attached state of the anvil. In one aspect, the present disclosure provides a digitized circular stapler algorithm for determining changes in the rate of closure of the anvil at critical locations of the trocar to ensure proper seating of the anvil on the trocar. Fig. 31 is a
The
On the right side of fig. 31, a
The adjustment of the
Fig. 32 is a cross-sectional view of the
Fig. 33 is a logic flow diagram of a process 201700 depicting a control program or logic configuration for adjusting the rate of closure of an
In particular, the process 201700 depicted in fig. 33 will now be described with reference to the control circuit 760 of fig. 22. The control circuit 760 determines 201702 the position of the
In one aspect, the present disclosure provides a digitized circular stapler-adaptive algorithm for determining multi-directional seating motions on a trocar to drive an anvil to a correct position. Fig. 34 is a graph 201530 and a graph 201534 of a powered stapling device 201532 illustrating detection of a rate of closure of a trocar 201540 and an anvil 201544 according to at least one aspect of the present disclosure. The powered stapling apparatus 201532, similar to the motorized
The powered suturing device 201532 shown on the left side of fig. 34 includes a circular suturing head assembly 201536 having a seating ring 201538 that receives a trocar 201540 therethrough. Trocar 201540 engages anvil 201544 via locking feature 201542. The trocar 210540 can be moved, e.g., advanced and retracted, in the direction indicated by arrow 201546. As the circular stapling head assembly 201536 is driven toward the anvil 201544, a cutting element, such as a knife 201548 severs tissue.
In one aspect, the rate of closure of the trocar 201540 and anvil 201544 can be detected, and any difference between the rates of closure of these two components can produce automatic extension of the trocar 201540 and then retraction of the trocar 201540 so that the anvil 201544 is fully seated on the trocar 201540. In one aspect, any difference between the closing rates of the trocar 201540 and the anvil 201544 can be provided to a control circuit or processor to operate a motor coupled to the trocar 201540 to produce automatic extension and then re-retraction of the trocar 201540 so that the anvil 201544 is fully seated on the trocar 201540. If it is detected that the anvil handle 201547 is pulled loose from the trocar 201540, the smart electric stapling device 201532 can cease to retract or even reverse and advance toward the open position until the instability problem of the seated anvil 201544 is resolved. If the anvil 201544 is fully pulled down, it may even be fully opened, indicating to the user an attempt to reattach the anvil handle 201547 to the trocar 201540. As shown in fig. 34, the control algorithm can be configured to extend the trocar 201540 back toward the open position 201541 to reposition the anvil 201544 upon sensing separation of the anvil 201544, then re-verify attachment of the anvil 201544, and proceed as usual upon confirming attachment of the anvil 201544.
Thus, the system can be configured to enable multi-directional seating movement on the trocar 201540 to drive the anvil 201544 into the correct position. For example, if it is detected that the anvil handle 201547 is pulled loose from the trocar 201540, the smart electric stapling device 201530 can be configured to stop retracting or even reverse and advance toward an open position until the instability problem of the seated anvil 201544 is resolved. If the anvil 201544 is fully pulled down, the smart power stapling device 201532 may even be configured to be fully opened, indicating to the user an attempt to reattach the anvil handle 201547 to the trocar 201540.
On the right side of fig. 34, a graph 201534 shows the position of the
Fig. 35 is a logic flow diagram of a process 201720 depicting a control program or logic configuration for detecting multi-directional seating movement on a trocar 201540 to drive an anvil 201544 into a correct position in accordance with at least one aspect of the present disclosure. This process 201720 may be implemented using any of the control circuits described herein with reference to fig. 16-23. This process 201720 may be implemented in a hub or cloud computing environment, such as described with reference to fig. 1-15.
In particular, the process 201720 depicted in fig. 35 will now be described with reference to the control circuit 760 of fig. 22. The control circuit 760 determines 201722 the rate of closure of the trocar 201540 based on the information received from the position sensor 784. After this, the control circuit 760 determines 201724 a rate of closure of the anvil 201544 based on information received from the position sensor 784. Alternatively, the rate of closure of trocar 201540 or anvil 201544 may be determined based on information received from sensor 788 or timer/counter 781 circuits or a combination thereof. The control circuit 760 compares 207126 the rate of closure of the trocar 201540 and anvil 201544. When there is no difference between the closing rates of the trocar 201540 and the anvil 201544, the process 201720 continues along the no (N) branch and loops until there is a difference between the closing rates of the trocar 201540 and the anvil 201544. When there is a difference between the closing rates of trocar 201540 and anvil 201544, process 201720 continues along the yes (Y) branch and control circuit 760 extends and retracts trocar 201540 and 207128 to reset anvil 201544. Subsequently, the process 201720 verifies attachment of the 201130 trocar 201540 and anvil 201544. If attachment is verified, process 201720 continues along the yes (Y) branch and control circuit 760 slows 207132 the rate of closing of trocar 201540 under the influence of the tissue load. If attachment is not verified, the process 201720 continues along the no (N) branch and loops until the trocar 201540 is verified as attached to the anvil 201544. Once the anvil 201544 is fully closed on the trocar 201540 to capture tissue therebetween, the control circuit 760 actuates the knife 201548 to sever the tissue.
Tissue parameter based adjustment of knife speed/end point
In various aspects, the knife speed and end point of a circular stapler can be adjusted based on the sensed toughness or thickness of the tissue between the anvil and the cartridge. Thus, the circular stapler control algorithm can be configured to detect tissue gaps and firing forces to adjust the stroke and speed of the knife. In one aspect, the present disclosure provides a digitized circular stapler adaptation algorithm for detecting tissue gap and firing force to adjust knife travel and knife speed, according to at least one aspect of the present disclosure.
Generally speaking, fig. 36-38 represent a circular electric stapling apparatus 201610 and a series of graphs depicting the position of the clamp relative to the anvil 201612 (a: (b))Anvil block) And the position relative to the knife 201616 (FTC) ((FTC))Knife with cutting edge) Knife 201616 speed (V)K) And knife 201616 force (F)K). Using the sensed data at different points along the length of the handle 201621, a control algorithm can generate a map of the tissue gap or reaction force vector of the anvil 201612, monitoring the high or low side when compressed on tissue. When fired, the system measures the force acting on the compression element 201620, which includes the force sensor, and adjusts to act uniformly along the force vector of the handle, providing a uniform and complete cut.
Specifically, fig. 36 is a fragmentary schematic view of a circular electric stapling device 201610, showing anvil 201612 closed on the left and knife 201616 actuation on the right, in accordance with at least one aspect of the present disclosure. Circular electric stapling apparatus 201610 includes an anvil 201612 that can be moved from a fully open positionA2Move to a fully closed positionA0. Intermediate positionA1The point at which the anvil 201612 contacts tissue positioned between the anvil 201612 and the circular stapler 201614 is indicated. One or more position sensors positioned along the length of the anvil handle 201621 monitor the position of the anvil 201612. In one aspect, a position sensor may be located within the seat ring 201618. The compression member 201620 may include a force sensor, such as a strain gauge, for example, for monitoring the force applied to the tissue and detecting an initial contact point, e.g., an intermediate position, of the anvil 201612 with the tissueA1As shown. The position sensor and force sensor interface with any of the control circuits, such as described herein with reference to fig. 16-23, which implement a circular stapler control algorithm. The circular electric suturing device 201610 also includes a movable cutting element, such as a knife 201616, that can be moved from a fully retracted position A0To a fully extended positionA2To achieve complete tissue cutting. Intermediate position of knife 201616A1Indicates the point at which the knife 201616 makes contact with a compression element 201620, which includes a strain gauge or other contact or proximity sensor.
The electric stitching device 201610 includes a motor, a sensor, and a control circuit as described herein in connection with fig. 16-30. The motors are controlled by the control circuit to move the anvil 201612 and knife 201616. One or more position sensors located on the electric stapling apparatus 201610 provide the control circuit with the position of the anvil 201612 and knife 201616. Additional sensors such as the force sensor 201620 also provide tissue contact and force to the control circuitry that acts on the anvil 201612 and the knife 201616. The control circuitry uses the position of the anvil 201612, the position of the knife 201616, initial tissue contact, or force of either the anvil 201612 or the knife 201616 to implement the circular stapler control algorithm described below in connection with fig. 39.
FIG. 37 is a schematic representation of at least one aspect in accordance with the present disclosureDisplacement of the anvil 201612 along a vertical axis: (b) ((b))Anvil block) The diagram of (a) represents 201600, the anvil displacement as a function of the clamp closing Force (FTC) along the horizontal axis. The vertical line represents FTC threshold 201606 indicating tissue toughness. The left side of FTC threshold 201606 represents tissue with normal toughness, while the right side of FTC threshold 201606 represents tissue with toughness. When the anvil 201612 is moved from the fully open position A2Retracted to an intermediate position where the anvil 201612 initially contacts tissueA1When this is true, the FTC is substantially low (0). As the anvil 201612 continues to close past this point toward the circular stapler 201614 to a fully retracted positionA0The FTC is nonlinear when subtracted from the compressed tissue thickness. Each tissue type from normal toughness to toughness will yield a different FTC curve. For example, the first FTC curve 201604, shown in dashed lines, ranges from 0 to 100lbs, with the maximum FTC being below the FTC threshold 201606. For example, the second FTC curve 201602, shown in solid lines, ranges from-0 to-200 lbs, where the maximum FTC exceeds the FTC threshold 201606. As previously discussed, the FTC is measured by a force sensor located in the compression element 201620 and coupled to the control circuitry.
FIG. 38 is a knife 201616 displacement along a vertical axis (according to at least one aspect of the disclosure)Knife with cutting edge) Is a graphic representation of 201630, the knife displacement being the knife 201616 speed (V) along the left horizontal axisKmm/s) and also as knife 201616 force (F) along the right horizontal axisKlbs). Left side is the knife 201616 displacement along the vertical axis (Knife with cutting edge) Is a graphic representation of 201632, the knife displacement being the knife 201616 speed (V) along a horizontal axis Kmm/s). To the right is the knife 201616 displacement along the vertical axis (Knife with cutting edge) Is a graphic representation of 201634, the knife displacement being a knife 201616 force (F) along a horizontal axisKlbs). The curves in dashed lines 201638, 20142 in each of the graphical representations 201632, 201634 represent normal tough tissue, while the curves in solid lines 201636, 201640 represent tough tissue.
Turning to the left, the graphical representation 201632, for normal tissue toughness, e.g., normal tissue knife speedCurve 201638 shows, for normal tissue toughness, the initial knife positionK0Here, the initial speed of the knife 201616 begins at a first speed, e.g., just over 4 mm/s. The knife 201616 continues at this speed until a knife position is reached where the knife 201616 contacts tissueK1And slows the speed of the knife 201616 as it cuts through the tissue until the knife 201616 reaches a knife position indicating a complete cutK2The control circuit then stops the motor, thereby stopping the knife 201616. Turning to the right side, the graphical representation 201634 shows, for normal tissue toughness, a normal tissue blade force curve 201642, in an initial blade positionK0The force acting on the knife 201616 is 0lbs and varies non-linearly until the knife 201616 reaches the knife position K2Until the cut is complete.
Turning to the left graphical representation 201632, for strong tissue toughness, as illustrated by the strong tissue knife speed curve 201636, the initial speed of the knife 201616 is at a second, lower speed (e.g., just over 3mm/s) relative to the first speed at the initial knife position for strong tissue toughnessK0Initially, the second speed is lower than the initial speed for normal tissue toughness. The knife 201616 continues at this speed until a knife position is reached where the knife 201616 contacts tissueK1. At this point, as the knife 201616 cuts through a short displacement of the tissue advancing knife 201616, its speed begins to decrease non-linearly. The control circuitry detects that the knife 201616 contacts tissue and correspondingly increases the speed of the motor to increase the speed of the knife 201616, e.g., increases the speed of the knife 201616 to the initial speed until the knife 201616 reaches a position indicating a full cutK2The control circuit then stops the motor, thereby stopping the knife 201616. This is shown as a velocity peak 201644 to improve cutting of tough tissue. Turning to the right side, the graphical representation 201634 shows, for strong tissue toughness, a strong tissue blade force curve 201640, in an initial blade positionK0The force acting on the knife 201616 is 0lbs and varies non-linearly until the knife 201616 reaches the knife position K2And the cut was complete. A comparison of the normal tissue knife force curve 201640 and the strong tissue knife force curve 201642 indicates that at lower speeds and shortly after tissue contact with the knife 201616 a velocity peak 201644 is addedNext, the knife 201616 experiences less force when cutting tough tissue than when cutting normal tough tissue.
Fig. 39 is a logic flow diagram of a process 201720 depicting a control program or logic configuration for detecting tissue gap and firing force to adjust the stroke and speed of the knife in accordance with at least one aspect of the present disclosure. This
In particular, the
Fig. 40 is a logic flow diagram of a
In particular, the
Various aspects of the subject matter described herein are set forth in the following numbered examples:
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