bipolar combination device that automatically adjusts pressure based on energy mode

专利摘要:
It is a surgical instrument, a system and a method for adjusting a compression force applied by a surgical instrument. The method includes determining the tissue tissue impedance in contact with a surgical instrument end actuator, determining a tissue type based on the tissue impedance, selecting a first energy modality to apply to the surgical instrument, generating a first form of signal wave based on the first energy mode, select a second energy mode to apply to the surgical instrument, generate a second signal waveform based on the second energy mode, emit the first and second signal waveforms to supply power to the end actuator, and adjust a compression force applied by the end actuator by changing a gap size between the fabric and the clamping arm based on a ratio between the first signal waveform and the second signal waveform.
公开号:BR112020013010A2
申请号:R112020013010-9
申请日:2019-02-28
公开日:2020-11-24
发明作者:David C. Yates；Frederick E. Shelton Iv；Jason L. Harris
申请人:Ethicon Llc；
IPC主号:

专利说明:

[0001] [0001] The present application claims the benefit of the priority of the non-provisional patent application serial number 16 / 115.223, entitled "BIPOLAR COMBINATION DEVICE THAT AUTOMATICALLY AD- JUSTS PRESSURE BASED ON ENERGY MODALITY", filed on August 28, 2018, whose revelation is hereby incorporated by reference, in its entirety.
[0002] [0002] This application claims priority under 35 USC $ 119 (e) to provisional patent application No. 62 / 721,995, entitled "CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT AC- CORDING TO TISSUE LOCATION", filed on August 23, 2018, whose disclosure is hereby incorporated by reference, in its entirety.
[0003] [0003] The present application claims priority under 35 US $ 119 (e) to provisional patent application 62 / 721,998, entitled SITUATIONAL AWARENESS OF ELECTROSURGICAL SYSTEMS, filed on August 23, 2018, the disclosure of which is here incorporated by reference, in its entirety.
[0004] [0004] The present application claims priority under 35 U.S.C. $ 119 (e) to provisional patent application No. 62 / 721,999, entitled IN-
[0005] [0005] The present application claims priority under 35 U.S.C. $ 119 (e) to provisional patent application No. 62 / 721,994, entitled BIPO- LAR COMBINATION DEVICE THAT AUTOMATICALLY ADJUSTS
[0006] [0006] The present application claims priority under 35 U.S.C. $ 119 (e) to provisional patent application No. 62 / 721,996, entitled RA-
[0007] [0007] This application claims priority under 35 USC $ 119 (e) to provisional patent application No. 62 / 692,747, entitled SMART ACTIVATION OF AN ENERGY DEVICE BY ANOTHER DEVICE, filed on June 30, 2018, to the application provisional patent for No. 62 / 692,748, entitled SMART ENERGY ARCHITEC-TURE, filed on June 30, 2018 and provisional patent application for No. 62 / 692,768, entitled SMART ENERGY DEVICES, filed on June 30, 2018, the disclosure of each of which is incorporated herein by reference, in its entirety.
[0008] [0008] This application also claims the priority benefit under 35 U.S.C. $ 119 (e) for US provisional patent application No. 62 / 650,898 filed on March 30, 2018, entitled CAPACI-
[0009] [0009] This application claims priority under 35 USC8 $ 119 (e) to provisional patent application US serial number 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, to the provisional patent application US serial number 62 / 611,340, entitled CLOUD-BASED MEDICAL ANALYTICS, filed on December 28, 2017, and provisional patent application US serial number 62 / 611,339, entitled ROBOT ASSISTED SURGICAL PLATFORM, filed on December 28 2017, the disclosure of each of which is incorporated herein by reference, in its entirety. BACKGROUND
[0010] [0010] In a surgical environment, intelligent energy devices may be needed in an environment of intelligent energy architecture. SUMMARY
[0011] [0011] In a general aspect, a method is provided to adjust a compression force applied by a surgical instrument. The surgical instrument comprises an end actuator and a clamping arm, configured to receive energy modalities from a generator configured to supply a plurality of energy modalities to the surgical instrument. The method comprises: determining, through a control circuit, the tissue impedance in contact with an end actuator of the surgical instrument; determine, through the control circuit, the type of tissue based on tissue impedance. select, through the control circuit, a first energy modality from the plurality of energy modes to supply the surgical instrument; generate, by means of the control circuit, a first signal waveform based on the first energy modality; select, by means of the
[0012] [0012] In another aspect, a surgical instrument is provided. The surgical instrument that comprises: a control circuit configured to connect in a communicative way to a generator configured to apply a plurality of energy modalities to an end actuator of the surgical instrument, the control circuit being additionally configured to: determine the tissue impedance in contact with a surgical instrument end actuator; determine a type of tissue based on tissue impedance; selecting a first energy modality from the plurality of energy modalities; generate a first signal waveform based on the first energy modality; selecting a second energy mode from the plurality of energy modes; generate a second signal waveform based on the second energy mode; and adjusting a compression force applied by an end actuator to the tissue by changing a gap between the tissue and an end actuator based on a ratio between the first signal waveform and the second signal waveform. signal.
[0013] [0013] In yet another aspect, a surgical system is provided. The surgical system comprising: a central surgical controller configured to receive a tissue treatment algorithm transmitted from a cloud computing system, with the central surgical controller being connected in a communicative way to the computer computing system. a cloud; a surgical instrument connected in a communicative way to the central surgical controller, and the surgical instrument comprises: an end actuator comprising: a clamping arm; and an ultrasonic blade; a generator configured to supply a plurality of energy modalities to the end actuator; a control circuit connected to the end actuator and generator, the control circuit is configured to treat tissue, and the control circuit is configured to: determine the impedance of tissue in contact with the actuator edge; determine the type of tissue based on tissue impedance; selecting a first energy mode from the plurality of energy modes; generate a first signal waveform based on the first energy modality; selecting a second energy mode from the plurality of energy modes; generate a second signal waveform based on the second energy mode; applying the first and second signal waveforms to the end actuator; and adjust a compression force applied by the end actuator by changing a gap size between the fabric and the waveguide based on a ratio between the first signal waveform and the second waveform of signal. FIGURES
[0014] [0014] The appeals of several aspects are presented with particularity in the attached claims. The various aspects, however, with regard to both the organization and the methods of operation, together with additional objects and advantages of the same, can be better understood in reference to the description presented below, considered together with the attached drawings as follows.
[0015] [0015] Figure 1 is a block diagram of an interactive surgical system implemented by computer, according to at least one aspect of the present disclosure.
[0016] [0016] Figure 2 is a surgical system being used to perform a surgical procedure in an operating room, according to at least one aspect of the present disclosure.
[0017] [0017] Figure 3 is a central controller or surgical "hub" paired with a visualization system, a robotic system, and an intelligent instrument, according to at least one aspect of the present disclosure.
[0018] [0018] Figure 4 is a partial perspective view of a surgical hub enclosure, and of a generator module in combination received slidingly in a surgical hub enclosure, according to at least one aspect of the present revelation.
[0019] [0019] Figure 5 is a perspective view of a generator module in combination with bipolar, ultrasonic and monopolar contacts and a smoke evacuation component, in accordance with at least one aspect of the present disclosure.
[0020] [0020] Figure 6 illustrates a surgical data network comprising a central modular communication controller configured to connect modular devices located in one or more operating rooms of a health care facility, or any environment in a hospital. installation of health services specially equipped for surgical operations, to the cloud, in accordance with at least one aspect of the present disclosure.
[0021] [0021] Figure 7 illustrates an interactive surgical system implemented by computer, according to at least one aspect of the present disclosure.
[0022] [0022] Figure 8 illustrates a central surgical controller that comprises a plurality of modules coupled to the modular control tower, according to at least one aspect of the present disclosure.
[0023] [0023] Figure 9 illustrates an aspect of a universal serial bus (USB) central controller device, in accordance with at least one aspect of the present disclosure.
[0024] [0024] Figure 10 illustrates a logical diagram of a control system for an instrument or surgical tool, according to at least one aspect of the present disclosure.
[0025] [0025] Figure 11 illustrates a control circuit configured to control aspects of the instrument or surgical tool, according to at least one aspect of the present disclosure.
[0026] [0026] Figure 12 illustrates a combinational logic circuit configured to control aspects of the instrument or surgical tool, according to at least one aspect of the present disclosure.
[0027] [0027] Figure 13 illustrates a sequential logic circuit configured to control aspects of the instrument or surgical tool, according to at least one aspect of the present disclosure.
[0028] [0028] Figure 14 illustrates an instrument or surgical tool that comprises a plurality of motors that can be activated to perform various functions, according to at least one aspect of the present disclosure.
[0029] [0029] Figure 15 is a schematic diagram of a robotic surgical instrument configured to operate a surgical tool described therein, in accordance with at least one aspect of the present disclosure.
[0030] [0030] Figure 16 illustrates a block diagram of a surgical instrument programmed to control the distal translation of a displacement member, according to an aspect of the present disclosure.
[0031] [0031] Figure 17 is a schematic diagram of a surgical instrument configured to control various functions, according to at least one aspect of the present disclosure.
[0032] [0032] Figure 18 is a system configured to perform adaptive ultrasonic blade control algorithms in a surgical data network that comprises a central modular communication controller, in accordance with at least one aspect of the present disclosure. .
[0033] [0033] Figure 19 illustrates an example of a generator, according to at least one aspect of the present disclosure.
[0034] [0034] Figure 20 is a surgical system comprising a generator and several surgical instruments usable with it, according to at least one aspect of the present disclosure.
[0035] [0035] Figure 21 is a view of an end actuator, according to at least one aspect of the present disclosure.
[0036] [0036] Figure 22 is a model that illustrates the movement ramification current, according to at least one aspect of the present disclosure.
[0037] [0037] Figure 23 is a structural view of a generator architecture, in accordance with at least one aspect of the present disclosure.
[0038] [0038] Figures 24A to 24C are functional views of a generator architecture, according to at least one aspect of the present disclosure.
[0039] [0039] Figures 25A to 25B are structural and functional aspects of a generator, according to at least one aspect of the present disclosure.
[0040] [0040] Figure 26 is a schematic diagram of an aspect of an ultrasonic drive circuit.
[0041] [0041] Figure 27 is a schematic diagram of a control circuit, according to at least one aspect of the present disclosure.
[0042] [0042] Figure 28 shows a simplified block circuit diagram that illustrates another electrical circuit contained within a modular ultrasonic surgical instrument, in accordance with at least one aspect of the present disclosure.
[0043] [0043] Figure 29 illustrates a generator circuit divided into multiple stages, according to at least one aspect of the present disclosure.
[0044] [0044] Figure 30 illustrates a generator circuit divided into multiple stages in which the first stage circuit is common to the second stage circuit, according to at least one aspect of the present disclosure.
[0045] [0045] Figure 31 is a schematic diagram of an aspect of a drive circuit configured to drive a high frequency current (RF), according to at least one aspect of the present disclosure.
[0046] [0046] Figure 32 illustrates a control circuit that allows a dual generator system to switch between the energy modes of the RF generator and the ultrasonic generator for a surgical instrument.
[0047] [0047] Figure 33 illustrates a diagram of an aspect of a surgical instrument that comprises a feedback system for use with a surgical instrument, in accordance with an aspect of the present disclosure.
[0048] [0048] Figure 34 illustrates an aspect of a fundamental architecture for a direct digital synthesis circuit, such as a digital direct synthesis circuit (DDS) configured to generate a plurality of waveforms for the electrical signal waveform. for use in a surgical instrument, in accordance with at least one aspect of this disclosure.
[0049] [0049] Figure 35 illustrates an aspect of the digital direct synthesis circuit (DDS) configured to generate a plurality of waveforms for the electrical signal waveform for use in a cyclic instrument.
[0050] [0050] Figure 36 illustrates a cycle of a discrete-time digital electrical signal waveform, in accordance with at least one aspect of the present disclosure, of an analog waveform (shown superimposed over a waveform of discrete time digital electrical signal for comparison purposes), in accordance with at least one aspect of the present disclosure.
[0051] [0051] Figure 37 is a diagram of a control system configured to provide progressive closure of a closing member as it advances distally to close the clamping arm to apply a load of closing force at a rate of - desired, according to one aspect of the present disclosure.
[0052] [0052] Figure 38 illustrates a proportional, integral, derivative (PID) controller feedback system, according to one aspect of the present disclosure.
[0053] [0053] Figure 39 is an exploded elevation view of the modular portable ultrasonic surgical instrument that shows the left half of the compartment removed from a grip set that exposes a device identifier communicatively coupled to the set of handles. multi-conductor terminal handle, in accordance with an aspect of the present disclosure.
[0054] [0054] Figure 40 is a detailed view of a trigger and key portion of the ultrasonic surgical instrument shown in Figure 39, according to at least one aspect of the present disclosure.
[0055] [0055] Figure 41 is an enlarged fragmentary perspective view of an end actuator from a distal end with a claw member in an open position, in accordance with at least one aspect of the present disclosure.
[0056] [0056] Figure 42 illustrates an aspect of an end actuator comprising RF data sensors located in the member.
[0057] [0057] Figure 43 is a spectrum of the same ultrasonic device with a variety of different states and conditions of the end actuator where the phase and magnitude of the impedance of an ultrasonic transducer are plotted as a function of frequency, according to at least one aspect of the present revelation.
[0058] [0058] Figure 44 is a graphical representation of a plot of a 3D training S data set, where the magnitude and impedance phase of the ultrasonic transducer are plotted as a function of frequency, according to at least one aspect of the present revelation.
[0059] [0059] Figure 45 is a logic flow diagram representing a control program or a logical configuration to adjust the compression force applied to the tissue, based on one or more selected energy modalities, according to at least one aspect of the present revelation.
[0060] [0060] Figure 46 illustrates a mechanical method of adjusting the compression force applied by an end actuator for different types of treatment, according to at least one aspect of the present disclosure.
[0061] [0061] Figures 47A and 47B illustrate a mechanical method of adjusting the compression force applied by an end actuator for different types of treatment, by rotating an ultrasonic blade, in accordance with at least one aspect of the present review. tion.
[0062] [0062] Figure 48 shows a diagram that illustrates the switching between active electrodes of an end actuator, according to at least one aspect of the present disclosure.
[0063] [0063] Figure 49 is a timeline that represents the recognition
[0064] [0064] The applicant for this application holds the following US patent applications, filed on August 28, 2018, with the disclosure of each of which is incorporated herein by reference in its entirety: and US Patent Application, summary number END8536USNP2 / 180107-2, entitled ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR; and US Patent Application, docket number END8560USNP2 / 180106-2, entitled TEMPERATURE CONTROL OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR; and US Patent Application, docket No. END8561USNP1 / 180144-1, entitled RADIO FREQUENCY ENERGY DEVICE FOR DELIVERING COMBINED ELECTRICAL SIGNALS; and US Patent Application, docket No. END8563USNP1 / 180139-1, entitled CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO TISSUE LOCATION; and US Patent Application, docket number END8563USNP2 / 180139-2, entitled CONTROLLING ACTIVATION OF AN ULTRA-
[0065] [0065] The applicant of the present application holds the following US patent applications, filed on August 23, 2018, with the disclosure of each of which is incorporated herein by reference in its entirety: e US Provisional Patent Application No. 62 / 721,995, entitled CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT AC- CORDING TO TISSUE LOCATION; and US Provisional Patent Application No. 62 / 721,998, entitled SITUATIONAL AWARENESS OF ELECTROSURGICAL SYSTEMS;
[0066] [0066] The applicant for this application holds the following US patent applications, filed on June 30, 2018, with the disclosure of each of which is incorporated herein by reference in its entirety: and Provisional US Patent Application 62 / 692,747, entitled SMART ACTIVATION OF AN ENERGY DEVICE BY ANOTHER DEVICE; and US Provisional Patent Application No. 62 / 692,748, entitled SMART ENERGY ARCHITECTURE; and and US Provisional Patent Application No. 62 / 692,768, entitled SMART ENERGY DEVICES.
[0067] [0067] The applicant for the present application holds the following US patent applications, filed on June 29, 2018, with the disclosure of each of which is incorporated herein by reference in its entirety: e US Patent Application No. serial number 16 / 024.090, entitled
[0068] [0068] The applicant for this application holds the following provisional US patent applications, filed on June 28, 2018, with the disclosure of each of which is incorporated herein by reference in its entirety: and Provisional Patent Application US serial no. 62 / 691,228, entitled A METHOD OF USING REINFORCED FLEX CIRCUITS WITH MULTIPLE SENSORS WITH ELECTROSURGICAL DEVICES; and US Provisional Patent Application Serial No. 62 / 691,227, entitled CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSED CLOSURE PARAMETERS; and US Provisional Patent Application Serial No. 62 / 691,230,
[0069] [0069] The applicant for this application holds the following provisional US patent applications, filed on April 19, 2018, with the disclosure of each of which is incorporated herein by reference in its entirety: and Provisional Patent Application US serial number 62 / 659,900, entitled METHOD OF HUB COMMUNICATION.
[0070] [0070] The applicant for this application holds the following Provisional US Patent Applications, filed on March 30, 2018, with the disclosure of each of which is incorporated herein by reference in its entirety: and Provisional Patent Application US No. 62 / 650,898 deposited on March 30, 2018, entitled CAPACITIVE COUPLED RE-TURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS; and US Provisional Patent Application Serial No. 62 / 650,887, entitled SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPA-
[0071] [0071] The applicant for the present application holds the following US patent applications, filed on March 29, 2018, with the disclosure of each of which is incorporated herein by reference in its entirety: e US Patent Application No. serial 15 / 940,641, entitled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES; and US Patent Application Serial No. 15 / 940,648, entitled
[0072] [0072] The applicant for this application holds the following provisional US patent applications, filed on March 28, 2018, with the disclosure of each of which is incorporated by reference in its entirety for reference: and Provisional Patent Application US serial number 62 / 649,302, entitled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES; and US Provisional Patent Application Serial No. 62 / 649,294, entitled DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD;
[0073] [0073] The applicant for this application holds the following provisional US patent applications, filed on March 8, 2018, with the disclosure of each of which is incorporated herein by reference in its entirety: e Provisional Patent Application US serial number 62 / 640,417, entitled TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR; and and US Provisional Patent Application Serial No. 62 / 640,415, entitled ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR.
[0074] [0074] The applicant for this application holds the following provisional US patent applications, filed on December 28, 2017, with the disclosure of each of which is incorporated herein by reference in its entirety: e Provisional Patent Application US Serial No. 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM; and US Provisional Patent Application Serial No. 62 / 611,340, entitled CLOUD-BASED MEDICAL ANALYTICS; and e US Provisional Patent Application Serial No. 62 / 611,339, entitled ROBOT ASSISTED SURGICAL PLATFORM.
[0075] [0075] Before explaining in detail the various aspects of surgical instruments and generators, it should be noted that the illustrative examples are not limited, in terms of application or use, to the details of construction and arrangement of parts illustrated in the descriptions in the attached description. Illustrative examples can be implemented or incorporated in other aspects, variations and modifications, and can be practiced or executed in several ways. In addition, except where otherwise indicated, the terms and expressions used in the present invention have been chosen for the purpose of describing illustrative examples for the convenience of the reader and not for the purpose of limiting it. In addition, it should be understood that one or more of the aspects, expressions of aspects, and / or examples described below can be combined with any one or more among the other aspects, expressions of aspects and / or examples described a follow.
[0076] [0076] Several aspects are addressed to improved ultrasonic surgical devices, electrosurgical devices and generators for use with them. Aspects of ultrasonic surgical devices can be configured to transect and / or coagulate tissue during surgical procedures, for example. The aspects of electrosurgical devices can be configured to transect, coagulate, scale, weld and / or dry the tissue during surgical procedures, for example.
[0077] [0077] Referring to Figure 1, a computer-implemented interactive surgical system 100 includes one or more surgical systems 102 and a cloud-based system (for example, cloud 104 which may include a remote server 113 coupled to a device storage 105). Each surgical system 102 includes at least one surgical hub 106 in communication with the cloud 104 which can include a remote server 113. In one example, as illustrated in Figure 1, surgical system 102 includes a visualization system 108, a system robotic 110, a smart handheld surgical instrument 112, which are configured to communicate with each other and / or hub 106. In some respects, a surgical system 102 may include a number of M 106 hubs, an N number of visualization systems
[0078] [0078] Figure 3 represents an example of a surgical system 102 being used to perform a surgical procedure on a patient who is lying on an operating table 114 in a surgical operating room 116. A robotic system 110 is used in surgical procedure as a part of the surgical system 102. The robotic system 110 includes a surgeon console 118, a patient car 120 (surgical robot), and a surgical robotic hub 122. The patient car 120 can manipulate at least one removable-coupled surgical tool 117 through a minimally invasive incision in the patient's body while the surgeon views the surgical site through the surgeon's console 118. An image of the surgical site can be obtained by an imaging device doctor 124, which can be manipulated by patient's car 120 to orient imaging device 124. Robotic hub 122 can be used to process images of the surgical site for display subsequent to the surgeon via the surgeon's console 118.
[0079] [0079] Other types of robotic systems can be readily adapted for use with the surgical system 102. Various examples of robotic systems and surgical instruments that are suitable for use with the present disclosure are described in provisional patent application no. 62 / 611,339, entitled ROBOT ASSISTED SURGI-CAL PLATFORM, filed on December 28, 2017, the disclosure of which is hereby incorporated by reference in its entirety.
[0080] [0080] Several examples of cloud-based analysis that are performed by the cloud 104, and are suitable for use with the present disclosure, are described in US provisional patent application serial number 62 / 611,340, entitled CLOUD-BASED MEDICAL ANALYTICS,
[0081] [0081] In several 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, load-coupled device (CCD) sensors and complementary metal oxide semiconductor (CMOS) sensors.
[0082] [0082] The optical components of the imaging device 124 may include one or more light sources and / or one or more lenses. One or more light sources can be directed to illuminate portions of the surgical field. The one or more image sensors can receive reflected or refracted light from the surgical field, including reflected or refracted light from the tissue and / or surgical instruments.
[0083] [0083] One or more light sources can be configured to radiate electromagnetic energy in the visible spectrum, as well as in the invisible spectrum. The visible spectrum, sometimes called the optical spectrum or light spectrum, is that portion of the electromagnetic spectrum that is visible to (that is, can be detected by) the human eye and can be called visible light or simply light. A typical human eye will respond to wavelengths in the air that are from about 380 nm to about 750 nm.
[0084] [0084] The invisible spectrum (that is, the non-luminous spectrum) is that portion of the electromagnetic spectrum located below and above the visible spectrum (that is, wavelengths below about 380 nm and above about 750 nm). The invisible spectrum is not detectable by the human eye. Wavelengths greater than about 750 nm are longer than the visible red spectrum, and they become invisible infrared (IR), microwaves, radio and electromagnetic radiation. Wavelengths shorter than about 380 nm are shorter than the ultraviolet spectrum, and they become invisible ultraviolet, x-ray, and gamma-ray electromagnetic radiation.
[0085] [0085] In several respects, the imaging device 124 is configured for use in a minimally invasive procedure. Examples of imaging devices suitable for use with the present disclosure include, but are not limited to, an arthroscope, angioscope, bronchoscope, choledocoscope, colonoscope, cytoscope, duodenoscope, enteroscope, esophagus-duodenoscope (gastroscope), endoscope, laryngoscope, nasopharyngeal-neproscope, sigmoidoscope, thoracoscope, and ureteroscope.
[0086] [0086] In one aspect, the imaging device employs multiple spectrum monitoring to discriminate topography and underlying structures. A multi-spectral image is one that captures image data within wavelength bands across the electromagnetic spectrum. The wavelengths can be separated by filters or by using instruments that are sensitive to specific wavelengths, including light from frequencies beyond the visible light range, for example, IR and ultraviolet light. Spectral images can allow the extraction of additional information that the human eye cannot capture with its receivers for the colors red, green, and blue. The use of multi-spectral imaging is described in greater detail under the heading "Advanced Imaging Acquisition Module" in US provisional patent application serial number 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28 2017, the disclosure of which is incorporated here as a reference in its entirety. Multi-spectral monitoring can be a useful tool for relocating a surgical field after a surgical task is completed to perform one or more of the tests previously described on the treated tissue.
[0087] [0087] It is axiomatic that strict sterilization of the operating room and surgical equipment is necessary during any surgery. The strict hygiene and sterilization conditions required in an "operating room", that is, an operating or treatment room, justify the highest possible sterilization of all medical devices and equipment. Part of this sterilization process is the need to sterilize anything that comes into contact with the patient or enters the sterile field, including the imaging device 124 and its connectors and components. It will be understood that the sterile field can be considered a specified area, such as inside a tray or on a sterile towel, which is considered free of microorganisms, or the sterile field can be considered an area, immediately around a patient, who was prepared to perform a surgical procedure. The sterile field may include members of the brushing team, who are properly dressed, and all furniture and accessories in the area.
[0088] [0088] In various aspects, the visualization system 108 includes one or more imaging sensors, one or more image processing units, one or more storage arrays and one or more screens that are strategically arranged in relation to the field sterile, as shown in Figure 2. In one aspect, the visualization system 108 includes an interface for HL7, PACS and EMR. Various components of the 108 visualization system are described under the heading "Advanced Imaging Acquisition Module" in US provisional patent application serial number 62 / 611.341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, whose disclosure it is hereby incorporated by reference in its entirety.
[0089] [0089] As shown in Figure 2, a primary screen 119 is positioned in the sterile field to be visible to the operator on the operating table 114. In addition, a viewing tower 111 is positioned outside the sterile field. The display tower 111 includes a first non-sterile screen 107 and a second non-sterile screen 109, which are opposite each other. Visualization system 108, guided by hub 106, is configured to use screens 107, 109, and 119 to coordinate the flow of information to operators inside and outside the sterile field. For example, hub 106 can have the visualization system 108 display a snapshot of a surgical site, as recorded by an imaging device 124, on a non-sterile screen 107 or 109, while maintaining a live broadcast. from the surgical site on the main screen 119. The snapshot on the non-sterile screen 107 or 109 can allow a non-sterile operator to perform a diagnostic step relevant to the surgical procedure, for example.
[0090] [0090] In one aspect, hub 106 is also configured to rotate a diagnostic input or feedback by a non-sterile operator in the viewing tower 111 to the primary screen 119 within the sterile field, where it can be seen by an operator sterile on the operating table. In one example, the entry may be in the form of a modification of the snapshot displayed on the non-sterile screen 107 or 109, which can be routed to the main screen 119 by the hub ("central device") 106.
[0091] [0091] With reference to Figure 2, a surgical instrument 112 is being used in the surgical procedure as part of the surgical system 102. Hub 106 is also configured to coordinate the flow of information to a screen of the surgical instrument 112. For example , in US provisional patent application serial number 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, the disclosure of which is incorporated herein by reference in its entirety. A diagnostic input or feedback inserted by a non-sterile operator in the viewing tower 111 can be routed through hub 106 to the surgical instrument screen
[0092] [0092] Now with reference to Figure 3, a hub 106 is shown in communication with a visualization system 108, a robotic system 110 and a smart handheld surgical instrument 112. Hub 106 includes a screen from hub 135, a module from imaging 138, a generator module 140, a communication module 130, a processor module 132 and a storage matrix 134. In certain aspects, as shown in Figure 3, hub 106 additionally includes a smoke evacuation module 126 and / or a suction / irrigation module 128.
[0093] [0093] During a surgical procedure, the application of energy to the tissue, for sealing and / or cutting, is generally associated with the evacuation of smoke, suction of excess fluid and / or irrigation of the tissue. Fluid, power, and / or data lines from different sources are often intertwined during the surgical procedure. Valuable time can be wasted in addressing this issue during a surgical procedure. To untangle the lines, it may be necessary to disconnect the lines from their respective modules, which may require a restart of the modules. The modular housing of hub 136 offers a unified environment for managing power, data and fluid lines, which reduces the frequency of entanglement between such lines.
[0094] [0094] Aspects of the present disclosure feature a surgical hub for use in a surgical procedure that involves the application of
[0095] [0095] In one aspect, the fluid line is a first fluid line and a 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 comprises a fluid interface.
[0096] [0096] Certain surgical procedures may require the application of more than one type of energy to the tissue. One type of energy may be more beneficial for cutting the fabric, while another type of energy may be more beneficial for sealing the fabric. For example, a bipolar generator can be used to seal the tissue while an ultrasonic generator can be used to cut the sealed tissue. Aspects of the present disclosure present a solution in which a modular hub hub 136 is configured to accommodate different generators and facilitate interactive communication between them. One of the advantages of the central modular housing 136 is that it allows quick removal and / or replacement of several modules.
[0097] [0097] Aspects of the present disclosure feature a modular surgical wrap for use in a surgical procedure that involves applying energy to the tissue. The modular surgical cabinet includes a first energy generator module, configured to generate a first energy for application to the tissue, and a first docking station that comprises a first docking port that includes first data contacts and energy contacts, being that the first power generator module is slidingly movable in an electrical coupling with the power and data contacts and the first power generator module is slidingly movable out of the electric coupling with the first power contacts power and data.
[0098] [0098] In addition to the above, the modular surgical enclosure also includes a second energy generator module configured to generate a second energy, different from the first energy, for application to the tissue, and a second docking station that comprises it has a second coupling port that includes second data and power contacts, the second power generating module being slidably movable in an electrical coupling with the power and data contacts, and the second power generating module being sliding way out of the electric coupling with the second power and data contacts.
[0099] [0099] In addition, the modular surgical cabinet also includes a communication bus between the first coupling port and the second coupling port, configured to facilitate communication between the first power generator module and the second power generator module .
[0100] [0100] With reference to Figures 3 to 7, aspects of the present disclosure are presented for a modular housing of hub 136 that allows the modular integration of a generator module 140, a smoke evacuation module 126, and a suction module / irrigation 128. The central modular enclosure 136 further facilitates interactive communication between modules 140, 126, 128. As shown in Figure 5, generator module 140 can be a generator module with monopolar, bipolar and ultrasonic components integrated, supported in a single cabinet unit 139 slidably insertable in the central modular housing 136. As shown in Figure 5, generator module 140 can be configured to connect to a monopolar device 146, a bipolar device 147 and an ultrasonic device 148. Alternatively, generator module 140 may comprise a series of monopolar, bipolar and / or ultrasonic generator modules that interact through the modular enclosure central 136. The central modular enclosure 136 can be configured to facilitate the insertion of multiple generators and interactive communication between the generators anchored in the central modular enclosure 136 so that the generators would act as a single generator.
[0101] [0101] In one aspect, the central modular enclosure 136 comprises modular power and a rear communication board 149 with external and wireless communication heads to allow removable fixing of modules 140, 126, 128 and interactive communication between the themselves.
[0102] [0102] In one aspect, the central modular housing 136 includes docking stations, or drawers, 151, here also called drawers, which are configured to receive sliding modules 140, 126, 128. Figure 4 illustrates a partial perspective view of a surgical housing of hub 136, and a combined generator module 145 received slidably at a docking station 151 of the housing of surgical hub 136. A docking port 152 with power and data contacts on one side posteri-
[0103] [0103] In several respects, the smoke evacuation module 126 includes a fluid line 154 that transports fluid captured / collected smoke away from a surgical site and to, for example, the smoke evacuation module 126. The vacuum suction that originates from the smoke evacuation module 126 can pull the smoke into an opening of a utility conduit at the surgical site. The utility conduit, coupled to the fluid line, can be in the form of a flexible tube that ends in the smoke evacuation module 126. The utility conduit and the fluid line define a fluid path that extends towards the smoke evacuation module 126 which is received in the hub housing 136.
[0104] [0104] In several respects, the suction / irrigation module 128 is coupled to a surgical tool comprising a fluid suction line and a fluid suction line. In one example, the suction and suction fluid lines are in the form of flexible tubes that extend from the surgical site towards the suction / irrigation module 128. One or more drive systems can be configured to cause irrigation and aspiration of fluids to and from the surgical site.
[0105] [0105] In one aspect, the surgical tool includes a drive shaft that has an end actuator at one end
[0106] [0106] The irrigation tube can be in fluid communication with a fluid source, and the suction tube can be in fluid communication with a vacuum source. The fluid source and / or the vacuum source can be housed in the suction / irrigation module 128. In one example, the fluid source and / or the vacuum source can be housed in the hub housing 136 separately of the suction / irrigation module 128. In such an example, a fluid interface can be configured to connect the suction / irrigation module 128 to the fluid source and / or the vacuum source.
[0107] [0107] In one aspect, modules 140, 126, 128 and / or their corresponding docking stations in the central modular housing 136 may include alignment features that are configured to align the docking ports of the modules in engagement with their counterparts in the docking stations of the central modular housing 136. For example, as shown in Figure 4, the combined generator module 145 includes side brackets 155 that are configured to slide the corresponding brackets 156 of the corresponding docking station sliding 151 of the central modular enclosure 136. The brackets cooperate to guide the coupling port contacts of the combined generator module 145 in an electrical engagement with the contacts of the central modular enclosure 136 coupling port.
[0108] [0108] In some respects, the drawers 151 of the central modular housing 136 are the same, or substantially the same size, and the modules are adjusted in size to be received in the drawers 151. For example, the side brackets 155 and / or 156 can be larger or smaller depending on the size of the module. In other respects, drawers 151 are different in size and are each designed to accommodate a specific module.
[0109] [0109] In addition, the contacts of a specific module can be switched to engage with the contacts of a specific drawer to avoid inserting a module in a drawer with unpaired contacts.
[0110] [0110] As shown in Figure 4, the docking port 150 of a drawer 151 can be coupled to the docking port 150 of another drawer 151 via a communication link 157 to facilitate interactive communication between the modules housed in the modular housing central 136. The coupling ports 150 of the central modular housing 136 can, alternatively or additionally, facilitate interactive wireless communication between the modules housed in the central modular housing 136. Any suitable wireless communication can be used, such as Air Titan Bluetooth.
[0111] [0111] Figure 6 illustrates a surgical data network 201 comprising a central modular communication controller 203 configured to connect modular devices located in one or more operating rooms of a healthcare facility, or any environment in a facility. from health services specially equipped for surgical operations, to a cloud-based system (for example, cloud 204 which may include a remote server
[0112] [0112] Modular devices 1a to 1n located in the operating room can be coupled to modular communication hub 203. Network hub 207 and / or network switch 209 can be coupled to a network router 211 to connect the devices 1a to 1h to cloud 204 or to the local computer system 210. Data associated with devices 1a to 1n can be transferred to cloud-based computers via the router for remote data processing and manipulation. The data associated with devices 1a to 1h can also be transferred to the local computer system 210 for processing and manipulation of the local data. Modular devices 2a to 2m located in the same operating room can also be attached to a network switch 209. Network switch 209 can be attached to network hub 207 and / or to network router 211 to connect devices 2a to 2m to cloud 204. Data associated with devices 2a to 2n can be transferred to cloud 204 via network router 211 for data processing and manipulation. The data associated with devices 2a to 2m can also be transferred to the local computer system 210 for processing and manipulation of local data.
[0113] [0113] It will be understood that the surgical data network 201 can be expanded by interconnecting multiple network hubs 207 and / or multiple network keys 209 with multiple network routers
[0114] [0114] In one aspect, the surgical data network 201 can comprise a combination of network hubs, network switches, and network routers that connect devices 1a to 1n / 2a to 2m to the cloud. Any or all of the 1a to 1n / 2a to 2m devices attached to the network hub or network key can collect data in real time and transfer the data to cloud computers for data processing and manipulation. It will be understood that cloud computing depends on sharing computing resources instead of having local servers or personal devices to handle software applications. The word "cloud" can be used as a metaphor for "the Internet", although the term is not limited as such. Consequently, the term "cloud computing" can be used here to refer to "a type of Internet-based computing", in which different services - such as servers, storage, and applications - are applied to the modular communication hub 203 and / or computer system 210 located in the operating room (for example, a fixed, mobile, temporary, or operating room or operating space) and devices connected to the modular communication hub 203 and / or computer system 210 through from Internet. The cloud infrastructure can be maintained by a cloud service provider. In this context, the cloud service provider may be the entity that coordinates the use and control of devices 1a to 1n / 2a to 2m located in one or more operating rooms. Cloud computing services can perform a large number of calculations based on data collected by smart surgical instruments, robots, and other computerized devices located in the operating room. The hub's hardware allows multiple devices or connections to be connected to a computer that communicates with cloud computing and storage resources.
[0115] [0115] The application of cloud computer data processing techniques to data collected by devices 1a to 1n / 2a to 2m, the surgical data network provides better surgical results, reduced costs, and better patient satisfaction. At least some of the devices 1a to 1n / 2a to 2m can be used to view tissue status to assess leakage or perfusion of sealed tissue after a tissue sealing and cutting procedure. At least some of the devices 1a to 1n / 2a to 2m can be used to identify pathology, such as the effects of disease, with the use of cloud-based computing to examine data including images of body tissue samples for diagnostic purposes. . This includes confirmation of the location and margin of the tissue and phenotypes. At least some of the devices 1a to 1n / 2a to 2m can be used to identify anatomical structures of the body using a variety of sensors integrated with imaging devices and techniques such as overlaying images captured by multiple imaging devices. Data collected by devices 1a to 1n / 2a to 2m, including image data, can be transferred to the cloud 204 or the local computer system 210 or both for data processing and manipulation including data processing and manipulation. Image. The data can be analyzed to improve the results of the surgical procedure by determining whether additional treatment, such as the application of endoscopic intervention, emerging technologies, targeted radiation, targeted intervention, precise robotics at specific sites and conditions of fabric, can be followed. This data analysis can additionally use analytical processing of the results, and with the use of standardized approaches they can provide beneficial standardized feedback both to confirm surgical treatments and the behavior of the surgeon or to suggest modifications to the surgical treatments and the behavior of the surgeon. surgeon.
[0116] [0116] In an implementation, operating room devices 1a to 1n can be connected to the modular communication hub 203 via a wired channel or a wireless channel depending on the configuration of devices 1a to 1h on a network hub. network. The network hub 207 can be implemented, in one aspect, as a device
[0117] [0117] In another implementation, operating room devices 2a to 2m can be connected to a network switch 209 via a wired or wireless channel. The network key 209 works in the data connection layer of the OSI model. Network switch 209 is a multicast device for connecting devices 2a to 2m located in the same operation center to the network. The network key 209 sends data in frames to the network router 211 and works in full duplex mode. Multiple devices 2a to 2m can send data at the same time via network key 209. Network key 209 stores and uses MAC addresses of devices 2a to 2m to transfer data.
[0118] [0118] Network hub 207 and / or network key 209 are coupled to network router 211 for connection to cloud 204. Network router 211 works on the network layer of the OSI model. The route
[0119] [0119] In one example, network hub 207 can be implemented as a USB hub, which allows multiple USB devices to be connected to a host computer. The USB hub can expand a single USB port on multiple levels so that more ports are available to connect the devices to the system's host computer. The 207 network hub can include wired or wireless capabilities to receive information about a wired channel or a wireless channel. In one aspect, a wireless wireless, broadband and short-range wireless USB communication protocol can be used for communication between devices 1a to 1n and devices 2a to 2m located in the operating room.
[0120] [0120] In other examples, operating room devices 1a to 1n / 2a to 2m can communicate with the modular communication hub 203 via standard Bluetooth wireless technology for exchanging data over short distances (with the use of short-wavelength UHF radio waves in the 2.4 to 2.485 GHz ISM band) from fixed and mobile devices and to build personal area networks
[0121] [0121] The modular communication hub 203 can serve as a central connection for one or all operating room devices 1a to 1n / 2a to 2m and handles a data type known as frames. The tables carry the data generated by the devices 1a to 1n / 2a to 2m. When a frame is received by the modular communication hub 203, it is amplified and transmitted to the network router 211, which transfers the data to the cloud computing resources using a series of communication standards or protocols. wireless or wired communication as described in the present invention.
[0122] [0122] The modular communication hub 203 can be used as a standalone device or be connected to compatible network hubs and network switches to form a larger network. The modular communication hub 203 is, in general, easy to install, configure and maintain, making it a good option for network devices 1a to 1n / 2a a
[0123] [0123] Figure 7 illustrates an interactive surgical system, implemented by computer 200. The interactive surgical system implemented by computer 200 is similar in many ways to the interactive surgical system, implemented by computer 100. For example, the interactive, surgical system , implemented by computer 200 includes one or more surgical systems 202, which are similar in many respects to surgical systems 102. Each surgical system 202 includes at least one surgical hub 206 in communication with a cloud 204 which may include a remote server 213 In one aspect, the computer-implemented interactive surgical system 200 comprises a modular control tower 236 connected to multiple operating room devices, for example, smart surgical instruments, robots and other computerized devices located in the operating room. operations. As shown in Figure 8, the modular control tower 236 comprises a central modular communication controller 203 coupled to a computer system 210. As shown in the example in Figure 7, the modular control tower 236 is coupled an imaging module 238 that is attached to an endoscope 239, a generator module 240 that is attached to an energy device 241, a smoke evacuation module 226, a suction / irrigation module 228, a communication module 230, a processor module 232, a storage matrix 234, an intelligent device / instrument 235 optionally coupled to a screen 237, and a non-contact sensor module 242. Operating room devices are coupled with computing resources cloud and data storage via the modular control tower
[0124] [0124] Figure 8 illustrates a central surgical controller 206 that comprises a plurality of modules coupled to the modular control tower 236. The modular control tower 236 comprises a modular communication hub 203, for example, a connection device network functionality, and a computer system 210 to provide local processing, visualization, and imaging, for example. As shown in Figure 8, the modular communication central controller 203 can be connected in a layered configuration to expand the number of modules (for example, devices) that can be connected to the modular communication central controller 203 and transfer data associated with modules to computer system 210, cloud computing resources, or both. As shown in Figure 8, each of the central controllers / network keys in the modular communication central controller 203 includes three downstream ports and one upstream port. The upstream hub / network switch is connected to a processor to provide a communication connection to the cloud computing resources and a local display 217. Communication with the cloud 204 can be done via a wired communication channel or wireless.
[0125] [0125] Surgical hub 206 employs a non-contact sensor module 242 to measure the dimensions of the operating room and generate a map of the operating room using non-contact measuring devices such as laser or ultrasonic. A contactless sensor module based on ultrasound scans the operating room by transmitting an ultrasound explosion and receiving echo when it bounces off the perimeter of the operating room walls, as described under the Surgical title Hub Spatial Awareness Within an Operating Room "in US provisional patent application serial number 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, which is hereby incorporated into the reference title in its entirety, in which the sensor module is configured to determine the size of the operating room and adjust the limits of the pairing distance with Bluetooth A laser-based non-contact sensor module scans the operating room by transmitting pulses of laser light, receiving pulses of light that jump from the perimeter walls of the operating room, and comparing the phase of the transmitted pulse to the received pulse to determine the size of the operating room and to adjust the Bluetooth pairing distance limits, for example.
[0126] [0126] Computer system 210 comprises a processor 244 and a network interface 245. Processor 244 is coupled to a communication module 247, storage 248, memory 249, non-volatile memory 250, and an input / output interface 251 through of a system bus. The system bus can be any one of several types of bus structures, including the memory bus or memory controller, a peripheral bus or external bus, and / or a local bus that uses any variety of architectures available bus speeds including, but not limited to, 9-bit bus, industry standard architecture (ISA), Micro-Charmel Architecture (MSA), extended ISA (EISA), smart drive electronics (IDE), local bus VESA (VLB),
[0127] [0127] Processor 244 can be any single-core or multi-core processor, such as those known under the ARM Cortex trade name available from Texas Instruments. In one respect, the processor may be a Core Cortex-M4F LM4F230H5QR ARM processor, available from Texas Instruments, for example, which comprises an integrated 256 KB single-cycle flash memory, or other non-volatile memory, up to 40 MHz , a seek-ahead buffer to optimize performance above 40 MHz, a 32 KB single cycle serial random access memory (SRAM), an internal read-only memory (ROM) loaded with the StellarisWareGO program, read-only memory programmable and electrically erasable (EEPROM) of 2 KB, one or more pulse width modulation (PWM) modules, one or more analogs of quadrature encoder (QEI) inputs, one or more analog to digital converters (ADC) ) 12 bits with 12 channels of analog input, details of which are available for the product data sheet.
[0128] [0128] In one aspect, processor 244 may comprise a safety controller comprising two controller-based families, such as TMS570 and RM4x, known under the tradename Hercules ARM Cortex R4, also by Texas Instruments. The safety controller can be configured specifically for the critical safety applications IEC 61508 and ISO 26262, among others, to provide advanced integrated safety features among
[0129] [0129] System memory includes volatile and non-volatile memory. The basic input / output system (BIOS), containing the basic routines for transferring information between elements within the computer system, such as during startup, is stored in non-volatile memory. For example, non-volatile memory can include ROM, programmable ROM (PROM), electrically programmable ROM (EPROM), EE-PROM or flash memory. Volatile memory includes random access memory (RAM), which acts as an external cache memory. In addition, RAM is available in many forms such as SRAM, dynamic RAM (DRAM), synchronous DRAM (SDRAM), double data rate SDRAM (DDR SDRAM), enhanced SDRAM (ESDRAM), Synchlink DRAM (SLDRAM), and direct RAM Rambus RAM (DRRAM).
[0130] [0130] Computer system 210 also includes removable / non-removable, volatile / non-volatile computer storage media, such as disk storage. Disk storage includes, but is not limited to, devices such as a magnetic disk drive, floppy disk drive, tape drive, Jaz driver, Zip driver, LS-60 driver, flash memory card or memory stick ( pen drive). In addition, the storage disc may include storage media separately or in combination with other storage media including, but not limited to, an optical disc drive such as a compact disc ROM device ( CD-ROM) writeable compact disc drive (CD-R Drive), rewritable compact disc drive (CD-RW drive), or a versatile digital disk ROM drive (DVD-ROM). To facilitate the connection of disk storage devices to the system bus, a removable or non-removable interface can be used.
[0131] [0131] It is to be understood that the computer system 210 includes
[0132] [0132] A user enters commands or information into computer system 210 via the input device (s) coupled to the 1 / O 251. interface. Input devices include, but are not limited to, a pointing device such as a mouse, trackball, stylus, touchpad, keyboard, microphone, joystick, game pad, satellite card, scanner, TV tuner card, digital camera, digital video camera, web camera, and the like. These and other input devices connect to the processor via the system bus via the interface port (s). The interface ports include, for example, a serial port, a parallel port, a game port and a USB. Output devices use some of the same types of ports as input devices. In this way, for example, a USB port can be used to provide input to the computer system and to provide computer system information to an output device. An output adapter is provided to illustrate that there are some output devices such as monitors, screens, speakers, and printers, among other output devices, that need special adapters. Output adapters include, by way of illustration and not limitation, video and sound cards that provide a means of connection between the output device and the system bus. It should be noted that other devices and / or device systems, such as remote computers, provide input and output capabilities.
[0133] [0133] Computer system 210 can operate in a networked environment using logical connections to one or more remote computers, such as cloud computers, or local computers. Remote cloud computers can be a personal computer, server, router, personal network computer, workstation, microprocessor-based device, peer device, or other common network node, and the like, and typically include - in many or all of the elements described in relation to the computer system. For the sake of brevity, only one memory storage device is illustrated with the remote computer. Remote computers are logically connected to the computer system via a network interface and then physically connected via a communication connection. The network interface covers 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 / IEEE 802.5 ring and the like. WAN technologies include, but are not limited to, point-to-point links, circuit switching networks such as digital integrated service networks (ISDN) and variations in them, packet switching networks and digital subscriber lines (DSL ).
[0134] [0134] In several respects, computer system 210 in Figure 8, imaging module 238 and / or display system 208, and / or processor module 232 in Figures 9 to 10, may comprise a image processor, image processing engine, media processor or any digital signal processor
[0135] [0135] The communication connection (s) refers to the hardware / software used to connect the network interface to the bus. Although the communication connection is shown for illustrative clarity within the computer system, it can also be external to computer system 210. The hardware / software required for connection to the network interface includes, for illustrative purposes only, internal and external technologies such as modems, including regular telephone serial modems, cable modems and DSL modems, ISDN adapters and Ethernet cards.
[0136] [0136] Figure 9 illustrates a functional block diagram of an aspect of a USB 300 central network controller device, in accordance with at least one aspect of the present disclosure. In the illustrated aspect, the USB 300 network hub device uses a TUSB2036 integrated circuit hub available from Texas Instruments. The USB network hub 300 is a CMOS device that provides a USB transceiver port 302 and up to three USB transceiver ports downstream 304, 306, 308 in accordance with the USB 2.0 specification. Upstream USB transceiver port 302 is a differential data root port comprising a "minus" differential data input (DMO) paired with a "plus" differential data input (DPO). The three ports of the downstream USB transceiver 304, 306, 308 are differential data ports, with each port including
[0137] [0137] The USB 300 network hub device is implemented with a digital state machine instead of a microcontroller, and no firmware programming is required. Fully compatible USB transceivers are integrated into the circuit 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 as low speed automatically configuring the scan rate according to the speed of the device attached to the doors. The USB 300 network hub device can be configured in bus-powered or self-powered mode and includes 312 central power logic to manage power.
[0138] [0138] The USB 300 network hub device includes a 310 series interface engine (SIE). The SIE 310 is the front end of the USB 300 network hub hardware and handles most of the protocol described in chapter 8 of the USB specification. The SIE 310 typically comprises signaling down to the transaction level. The functions it handles could include: packet recognition, transaction sequencing, SOP, EOP, RESET, and RESUME signal detection / generation, clock / data separation, non-zero data encoding / decoding inverted (NRZI), generation and verification of CRC (token and data), generation and verification / decoding of packet ID (PID), and / or series-parallel / parallel-series conversion. The 310 receives a clock input 314 and is coupled to a logical suspend / resume circuit and frame timer 316 and a hub repeat loop 318 to control communication between the upstream USB transceiver port 302 and the transceiver ports Downstream USB 304, 306, 308 through the logic circuits of ports 320, 322,
[0139] [0139] In several respects, the USB 300 network hub can connect 127 functions configured in up to six logical layers (levels) to a single computer. In addition, the USB 300 network hub can connect all peripherals using a standardized four-wire cable that provides both communication and power distribution. The power settings are bus-powered and self-powered modes. The USB 300 network hub can be configured to support four power management modes: a bus powered hub, with individual port power management or grouped port power management, and the self powered hub, with power management port management or grouped port power management. In one respect, using a USB cable, the USB 300 network hub, the upstream USB transceiver port 302 is plugged into a USB host controller, and the downstream USB transceiver ports 304 , 306, 308 are exposed to connect compatible USB devices, and so on. Surgical instrument hardware
[0140] [0140] Figure 10 illustrates a logical diagram of a 470 control system for a surgical instrument or tool, according to one or more aspects of the present disclosure. The 470 system comprises a control circuit. The control circuit includes a 461 microcontroller comprising a 462 processor and a memory
[0141] [0141] In one aspect, the 461 microcontroller can be any single-core or multi-core processor, such as those known under the ARM Cortex trade name available from Texas Instruments. In one aspect, the main microcontroller 461 can be an LM4F230H5QR ARM Cortex-M4F processor, available from Texas Instruments, for example, which comprises an integrated 256 KB single cycle flash memory, or other non-memory. volatile, up to 40 MHz, a seek-ahead buffer to optimize performance above 40 MHz, a 32 KB single cycle series random access memory (SRAM), an internal read-only memory (ROM) loaded with the StellaRisWareO program, programmable and electronically erasable 2K read-only memory (EEPROM), one or more pulse width modulation (PWM) modules, one or more quadrature encoder (QEI) input analogues , and / or one or more analog to digital converters
[0142] [0142] In one aspect, the 461 microcontroller can comprise a safety controller that comprises two families based on controllers, such as TMS570 and RM4x known under the trade name of Hercules ARM Cortex R4, also available from Texas Instruments. The safety controller can be configured specifically for IEC 61508 and ISO 26262 safety critical applications, among others, to provide advanced integrated safety features while providing scalable performance, connectivity and memory options.
[0143] [0143] The 461 microcontroller can be programmed to perform various functions such as precise control of the speed and position of the scalpel, the articulation systems, the clamping arm, or a combination thereof. In one aspect, the microcontroller 461 includes a processor 462 and a memory 468. The electric motor 482 can be a brushed direct current (DC) motor with a gearbox and mechanical connections with an articulation or scalpel system. In one aspect, a motor drive 492 can be an A3941 available from Allegro Microsystems, Inc. Other motor drives can be readily replaced for use in tracking system 480 which comprises an absolute positioning system. A detailed description of an absolute positioning system is given in US patent application publication 2017/0296213, entitled SYSTEMS AND METHODS FOR CONTROLLING A SURGICAL STA- PLING AND CUTTING INSTRUMENT, published on October 19, 2017, which is incorporated herein as a reference in its entirety.
[0144] [0144] The 461 microcontroller can be programmed to provide precise control of the speed and position of the displacement members and articulation systems. The 461 microcontroller can be configured to compute a response in the 461 microcontroller software. The computed response is compared to a measured response from the real system to obtain an "observed" response, which is used for actual feedback-based decisions. The observed response is a favorable and adjusted value, which balances the uniform and continuous nature of the simulated response with the measured response, which can detect external influences in the system.
[0145] [0145] In one aspect, the 482 motor can be controlled by the 492 motor actuator and can be used by the instrument trigger system or surgical tool. In many ways, the 482 motor can be a brushed direct current (DC) drive motor, with a maximum speed of approximately 25,000 RPM, for example. In other arrangements, the 482 motor may include a brushless motor, a wireless motor, a synchronous motor, a stepper motor or any other suitable type of electric motor. The motor starter 492 can comprise an H bridge drive that comprises field effect transistors (FETs), for example. The 482 motor can be powered by a feed set mounted releasably in the handle assembly or tool compartment to provide control power for the instrument or surgical tool. The power pack may comprise a battery that may include several battery cells connected in series, which can be used as the power source to power the instrument or surgical tool. In certain circumstances, the battery cells in the power pack may be replaceable and / or rechargeable battery cells. In at least one example, the battery cells can be lithium-ion batteries that can be coupled and separable from the power pack.
[0146] [0146] The 492 motor starter can be an A3941, available from Allegro Microsystems, Inc. The 492 A3941 driver is a con-
[0147] [0147] Tracking system 480 comprises a controlled motor drive circuit arrangement comprising a position sensor 472 in accordance with an aspect of the present disclosure. The position sensor 472 for an absolute positioning system provides a unique position signal that corresponds to the location of a displacement member. In one aspect, the displacement member represents a longitudinally movable driving member comprising a rack of driving teeth
[0148] [0148] In other respects, the absolute positioning system can be configured to track the position of a clamping arm in the opening or closing process. In several other respects, the displacement member can be coupled to any position sensor 472 suitable for measuring linear displacement. In this way, the longitudinally movable drive member, or the clamping arm, or combinations thereof, can be coupled to any linear displacement sensor. Linear displacement sensors can include contact or non-contact displacement sensors. Linear displacement sensors can comprise Variable Differential Linear Transformers (LVDT), Variable Reluctance Differential Transducers (DVRT), a potentiometer, a magnetic detection system comprising a moving magnet and a series linearly arranged in Hall Effect Sensors , a magnetic detection system comprising a fixed magnet and a series of furniture, linearly arranged in Hall Effect Sensors, a mobile optical detection system comprising a mobile light source and a series of linearly arranged photodiodes or photodetectors, an optical detection system comprising a fixed light source and a mobile series of linearly arranged photodiodes or photodetectors, or any combination thereof.
[0149] [0149] The 482 electric motor may include a rotary drive shaft, which interfaces operationally with a gear set, which is mounted on a coupling hitch with a set or rack of drive teeth on the drive member. A sensor element can be operationally coupled to a gear assembly so that a single revolution of the position sensor element 472 corresponds to some linear longitudinal translation of the displacement member. An array of gears and sensors can be connected to the linear actuator by means of a rack and pinion arrangement, or by a rotary actuator, by means of a sprocket or other connection. A power supply provides power to the absolute positioning system and an output indicator can display the output from the absolute positioning system. The drive member represents the longitudinally movable drive member comprising a rack of drive teeth formed thereon for engagement with a corresponding drive gear of the gear reducer assembly. The displacement member represents the longitudinally movable firing member for opening and closing a clamping arm.
[0150] [0150] A single revolution of the sensor element associated with the position sensor 472 is equivalent to a linear longitudinal displacement of d1 of the displacement member, where d; represents the longitudinal linear distance by which the displacement member moves from point "a" to point "b" after a single revolution of the sensor element coupled to the displacement member. The sensor arrangement can be connected by means of a gear reduction which results in the position sensor 472 completing one or more revolutions for the complete travel of the displacement member. The 472 position sensor can complete multiple revolutions for the full travel of the displacement member.
[0151] [0151] A series of keys, where n is an integer greater than one, can be used alone or in combination with a gear reduction to provide a single position signal for more than one revolution of the 472 position sensor. the keys are transmitted back to the 461 microcontroller which applies logic to determine a single position signal corresponding to the longitudinal linear displacement of d1 + from + ... dh of the displacement member. The output of the position sensor 472 is supplied to the microcontroller 461. In several embodiments, the position sensor 472 of the sensor array may comprise a magnetic sensor, an analog rotary sensor, such as a potentiometer, or a series of analog Hall effect elements, which emit a unique combination of position of signals or values.
[0152] [0152] The position sensor 472 can comprise any number of magnetic detection elements, such as, for example, magnetic sensors classified according to whether they measure the total magnetic field or the vector components of the magnetic field. The techniques used to produce both types of magnetic sensors cover many aspects of physics and electronics. Technologies
[0153] [0153] In one aspect, the position sensor 472 for the tracking system 480 comprising an absolute positioning system comprises a magnetic rotating absolute positioning system. The 472 position sensor can be implemented as a rotary, magnetic, single-circuit, ASSOSSEQFT position sensor, available from Austria Microsystems, AG. The position sensor 472 interfaces with the 461 microcontroller to provide an absolute positioning system. The 472 position sensor is a low voltage, low power component and includes four effect elements in an area of the 472 position sensor located above a magnet. A high-resolution ADC and an intelligent power management controller are also provided on the integrated circuit. A CORDIC processor (digital computer for coordinate rotation), also known as the digit by digit method and Volder algorithm, is provided to implement a simple and efficient algorithm for calculating hyperbolic and trigonometric functions that require only operations addition, subtraction, bit shift and lookup table. The angle position, alarm bits and magnetic field information are transmitted via a standard serial communication interface, such as a serial peripheral interface (SPI), to the 461 microcontroller. position 472 provides 12 or 14 bits of resolution. The position sensor 472 can be an ASS055 integrated circuit supplied in a small 16-pin QFN package whose measurement corresponds to 4x4x0.85 mm.
[0154] [0154] The tracking system 480 which comprises an absolute positioning system can comprise and / or be programmed to implement a feedback controller, such as a PID, state feedback, and adaptive controller. A power supply converts the signal from the feedback controller to a physical input to the system, in this case the voltage. Other examples include a voltage, current and force PWM. Other sensors can be provided in order to measure the parameters of the physical system in addition to the position measured by the position sensor 472. In some respects, other sensors may include sensor arrangements as described in US patent No. 9,345 .481 entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, granted on May 24, 2016, which is incorporated by reference in its entirety into this document; US patent application serial number 2014/0263552, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, published on September 18, 2014, is incorporated by reference in its entirety into this document; and US patent application serial number 15 / 628,175, entitled TECHNIQUES FOR ADAPTIVE CONTRROL OF MOTOR VELOCITY OF A SURGICAL STAPLING AND CU- TTING INSTRUMENT, submitted on June 20, 2017, is incorporated by reference in its entirety in this document. In a digital signal processing system, an absolute positioning system is coupled with a digital data capture system where the output of the absolute positioning system will have a finite resolution and sampling frequency. The absolute positioning system can comprise a comparison and combination circuit to combine a computed response with a measured response through the use of algorithms, such as a weighted average and a control loop.
[0155] [0155] The absolute positioning system provides an absolute positioning of the displaced member on the activation of the instrument without having to retract or advance the longitudinally movable drive member to the restart position (zero or initial), as may be required by conventional rotary encoders that merely count the number of progressive or regressive steps that the 482 motor has traversed to infer the position of a device actuator, actuation bar, scalpel, and the like.
[0156] [0156] A 474 sensor, such as a strain gauge or a micro strain gauge, is configured to measure one or more parameters of the end actuator, such as the amplitude of the strain exerted on the anvil during a gripping operation, which can be indicative of tissue compression. The measured effort is converted into a digital signal and fed to the 462 processor. Alternatively, or in addition to the 474 sensor, a 476 sensor, such as a load sensor, can measure the closing force applied by the drive system. closing the anvil in a stapler or clamping arm in an electrosurgical or ultrasonic instrument. The 476 sensor, such as a load sensor, can measure the trigger force applied to a closing member coupled to a clamping arm of the instrument or surgical tool or the force applied via a clamping arm to the tissue located in the claws of an electrosurgical or ultrasonic instrument. Alternatively, a current sensor 478 can be used to measure the current drawn by the motor 482.
[0157] [0157] In one form, a 474 strain gauge sensor can be used to measure the force applied to the tissue by the end actuator. A strain gauge can be attached to the end actuator to measure the force applied to the tissue being treated by the end actuator. A system for measuring forces applied to the tissue attached by the end actuator comprises a 474 strain gauge sensor, such as, for example, a microstrain meter, which is configured to measure one or more parameters of the end actuator, for example. In one aspect, the 474 strain gauge sensor can measure the amplitude or magnitude of the mechanical stress exerted on a claw member of an end actuator during a gripping operation, which may be indicative of tissue compression. The measured effort is converted into a digital signal and fed to the 462 processor of a 461 microcontroller. A 476 load sensor can measure the force used to operate the knife element, for example, to cut the captured tissue between the blade. gorna and the staple cartridge. A 476 load sensor can measure the force used to operate the clamping arm element, for example, to capture the fabric between the clamping arm and an ultrasonic blade or to capture the fabric between the clamping arm and a claw of an electrosurgical instrument. A magnetic field sensor can be used to measure the thickness of the captured tissue. The measurement of the magnetic field sensor can also be converted into a digital signal and supplied to the 462 processor.
[0158] [0158] Measurements of tissue compression, tissue thickness and / or force required to close the end actuator on the tissue, as measured by sensors 474, 476 respectively, can be used by microcontroller 461 to characterize the position trigger member and / or the corresponding trigger member speed value. In one case, a 468 memory can store a technique, an equation and / or a query table that can be used by the 461 microcontroller in the evaluation.
[0159] [0159] The 470 control system of the instrument or surgical tool can also comprise wired or wireless communication circuits for communication with the modular communication hub shown in Figures 8 to 11.
[0160] [0160] Figure 11 illustrates a control circuit 500 configured to control aspects of the instrument or surgical tool according to an aspect of the present disclosure. The control circuit 500 can be configured to implement various processes described herein. The control circuit 500 may comprise a microcontroller comprising one or more processors 502 (for example, microprocessor, microcontroller) coupled to at least one memory circuit 504. The memory circuit 504 stores instructions executable on the machine which, when executed by processor 502, cause processor 502 to execute machine instructions to implement several of the processes described here. Processor 502 can be any one of a number of single-core or multi-core processors known in the art. The memory circuit 504 may comprise volatile and non-volatile storage media. The processor 502 can include an instruction processing unit 506 and an arithmetic unit 508. The instruction processing unit can be configured to receive instructions.
[0161] [0161] Figure 12 illustrates a combinational logic circuit 510 configured to control aspects of the instrument or surgical tool according to an aspect of the present disclosure. The combinational logic circuit 510 can be configured to implement the various processes described here. The combinational logic circuit 510 can comprise a finite state machine that comprises a combinational logic 512 configured to receive data associated with the instrument or surgical tool at an input 514, process the data by the combinational logic 512 and provide an output 516.
[0162] [0162] Figure 13 illustrates a sequential logic circuit 520 configured to control aspects of the instrument or surgical tool according to an aspect of the present disclosure. Sequential logic circuit 520 or combinational logic 522 can be configured to implement the process described herein. Sequential logic circuit 520 may comprise a finite state machine. Sequential logic circuit 520 may comprise combinational logic 522, at least one memory circuit 524, a clock 529 and, for example. The at least one memory circuit 524 can store a current state of the finite state machine. In certain cases, the sequential logic circuit 520 may be synchronous or asynchronous. Combinational logic 522 is configured to receive data associated with the surgical instrument or tool from an input 526, process the data using combinational logic 522, and provide an output 528. In other respects, the circuit may comprise a combination of a processor ( for example, processor 502, Figure 11) and a finite state machine to implement various processes of the present invention. In other respects, the finite state machine may comprise a combination of a combinational logic circuit (for example, a combinational logic circuit 510, Figure 12) and the circuit
[0163] [0163] Figure 14 illustrates an instrument or surgical tool that comprises a plurality of motors that can be activated to perform various functions. In certain cases, a first engine may be activated to perform a first function, a second engine may be activated to perform a second function, a third engine may be activated to perform a third function, a fourth engine may be activated to perform a fourth function, and so on. In certain cases, the plurality of motors of the robotic surgical instrument 600 can be individually activated to cause triggering, closing, and / or articulation movements in the end actuator. The triggering, closing and / or articulation movements can be transmitted to the end actuator through a set of drive axes, for example.
[0164] [0164] In certain cases, the instrument or surgical tool system may include a 602 firing motor. The 602 firing motor can be operationally coupled to a 604 firing motor drive assembly, which can be configured to transmitting firing movements generated by motor 602 to the end actuator, particularly to move the closing member of the clamping arm. The closing member can be retracted by reversing the direction of the motor 602, which also causes the clamping arm to open.
[0165] [0165] In certain cases, the instrument or surgical tool may include a closing motor 603. The closing motor 603 can be operationally coupled to a drive assembly of the closing motor 605 that can be configured to transmit closing movements , generated by the motor 603 to the end actuator, particularly to move a closing tube to close the anvil and compress the fabric between the anvil and the staple cartridge. The closing motor 603 can be operationally coupled to a drive assembly of the closing motor 605 that can be configured to transmit closing movements generated by the motor 603 to the end actuator, particularly to move a closing tube to close the closing arm. squeeze and compress the tissue between the clamping arm and an ultrasonic blade or the clamping arm or the claw member of an electrosurgical device. Closing movements can cause the end actuator to transition from an open configuration to an approximate configuration to capture tissue, for example. The end actuator can be moved to an open position by reversing the direction of the 603 motor.
[0166] [0166] In certain cases, the surgical instrument or tool may include one or more articulation motors 606a, 606b, for example. The motors 606a, 606b can be operationally coupled to the drive assemblies of the articulation motor 608a, 608b, which can be configured to transmit articulation movements generated by the motors 606a, 606b to the end actuator. In some cases, articulation movements can cause the end actuator to be articulated in relation to the drive shaft assembly, for example.
[0167] [0167] As described above, the surgical instrument or tool can include a plurality of motors that can be configured to perform various independent functions. In certain cases, the plurality of motors of the instrument or surgical tool can be activated individually or separately to perform one or more functions, while other motors remain inactive. For example, the hinge motors 606a, 606b can be activated to cause the end actuator to be pivoted, while the firing motor 602 remains inactive. Alternatively, the firing motor 602 can be activated to fire the plurality of clamps, and / or advance the cutting edge, while the hinge motor 606 remains inactive. In addition, the closing motor 603 can be activated simultaneously with the firing motor 602 to cause the closing tube or closing member to advance distally as described in more detail later in this document.
[0168] [0168] In certain cases, the surgical instrument or tool may include a common control module 610 that can be used with a plurality of the instrument's instruments or surgical tool. In certain cases, the common control module 610 can accommodate one of the plurality of motors at a time. For example, the common control module 610 can be coupled to and separable from the plurality of motors of the robotic surgical instrument individually. In certain cases, a plurality of instrument or surgical tool motors may share one or more common control modules, such as the common control module 610. In certain cases, a plurality of instrument or surgical tool motors may be individually and selectively engaged with the common control module 610. In certain cases, the common control module 610 can be selectively switched between interfacing with one of a plurality of instrument motors or surgical tool to interface with another among the plurality of motors of the instrument or surgical tool.
[0169] [0169] In at least one example, the common control module 610 can be selectively switched between the operational coupling with the 606a, 606b articulation motors, and the operational coupling with the 602 firing motor or the 603 closing motor. at least one example, as shown in Figure 14, a key 614 can be moved or transitioned between a plurality of positions and / or states. In the first position 616, the switch 614 can electrically couple the common control module 610 to the trip motor 602; in a second position 617, the switch 614 can electrically couple the control module 610 to the closing motor 603; in a third position 618a, the switch 614 can electrically couple the common control module 610 to the first articulation motor 606a; and in a fourth position 618b, the switch 614 can electrically couple the common control module 610 to the second articulation motor 606b, for example. In certain cases, separate common control modules 610 can be electrically coupled to the firing motor 602, closing motor 603, and hinge motors 606a, 606b at the same time. In certain cases, key 614 can be a mechanical key, an electromechanical key, a solid state key, or any suitable switching mechanism.
[0170] [0170] Each of the 602, 603, 606a, 606b motors can comprise a torque sensor to measure the output torque on the motor drive shaft. The force on an end actuator can be detected in any conventional manner, such as by means of force sensors on the outer sides of the jaws or by a motor torque sensor that drives the jaws.
[0171] [0171] In several cases, as illustrated in Figure 14, the common control module 610 may comprise a motor starter 626 that may comprise one or more H-Bridge FETs. The motor drive 626 can modulate the energy transmitted from a power source 628 to a motor coupled to the common control module 610, based on an input from a microcontroller 620 (the "controller"), for example. In certain cases, the microcontroller 620 can be used to determine the current drawn by the motor, for example, while the motor is coupled to the common control module 610, as described above.
[0172] [0172] In certain cases, the microcontroller 620 may include a microprocessor 622 (the "processor") and one or more non-transitory computer-readable media or 624 memory units (the "memory"). In certain cases, memory 624 can store various program instructions that, when executed, can cause processor 622 to perform a plurality of functions and / or calculations described herein. In certain cases, one or more of the memory units 624 can be coupled to the processor 622, for example. In many ways, the 620 microcontroller can communicate via a wired or wireless channel, or combinations thereof.
[0173] [0173] In certain cases, the power supply 628 can be used to supply power to the microcontroller 620, for example. In certain cases, the 628 power source may comprise a battery (or "battery pack" or "power source"), such as a Li ion battery, for example. In certain cases, the battery pack can be configured to be releasably mounted to the handle to supply power to the surgical instrument 600. Several battery cells connected in series can be used as the 628 power supply. In certain cases, the power source 628 can be replaceable and / or rechargeable, for example.
[0174] [0174] In several cases, the 622 processor can control the motor drive 626 to control the position, direction of rotation and / or speed of a motor that is coupled to the common control module 610. In certain cases cases, the processor 622 can signal the motor driver 626 to stop and / or disable a motor that is coupled to the common control module 610. It should be understood that the term "processor", as used here, includes any microprocessor , microcontroller or other suitable basic computing device that incorporates the functions of a central computer processing unit (CPU) in an integrated circuit or, at most, some integrated circuits. The 622 processor is a programmable multipurpose device that accepts digital data as input, processes it according to instructions stored in its memory, and provides results as output. This is an example of sequential digital logic, since it has internal memory. Processors operate on numbers and symbols represented in the binary numeral system.
[0175] [0175] In one example, the 622 processor can be any single-core or multi-core processor, such as those known by the Texas Instruments ARM Cortex trade name. In certain cases, the 620 microcontroller may be an LM 4F230H5QR, available from Texas Instruments, for example. In at least one example, the Texas Instruments LM4F230H5QR is an ARM Cortex-M4F processor core comprising an integrated 256 KB single cycle flash memory, or other non-volatile memory, up to 40 MHz, a search buffer anticipated to optimize performance above 40 MHz, a 32 KB single cycle SRAM, an internal ROM loaded with StellarisWare & software, 2 KB EEPROM, one or more PWM modules, one or more QEI analogs, one or more 12-bit ADCs with 12 analog input channels, among other features that are readily available for the product data sheet. Other microcontrollers can be readily replaced for use with the 4410 module. Consequently, the present disclosure should not be limited in this context.
[0176] [0176] In certain cases, memory 624 may include program instructions for controlling each of the motors of the surgical instrument 600 that are attachable to the common control module 610. For example, memory 624 may include program instructions for controlling the firing motor 602, the closing motor 603 and the hinge motors 606a, 606b. Such program instructions can cause the 622 processor to control the trigger, close, and link functions according to inputs from the instrument or surgical tool control algorithms or programs.
[0177] [0177] In certain cases, one or more mechanisms and / or sensors, such as 630 sensors, can be used to alert the 622 processor about the program instructions that need to be used in a specific configuration. For example, sensors 630 can alert the 622 processor to use the program instructions associated with triggering, closing, and pivoting the end actuator. In certain cases, sensors 630 may comprise position sensors that can be used to detect the position of switch 614, for example. Consequently, processor 622 can use the program instructions associated with firing the closing member coupled to the clamping arm of the end actuator upon detection, through sensors 630, for example, that switch 614 is in the first position 616; the processor 622 can use the program instructions associated with closing the anvil upon detection by sensors 630, for example, that switch 614 is in second position 617; and processor 622 can use the program instructions associated with the articulation of the end actuator upon detection through sensors 630, for example, that switch 614 is in the third or fourth position 618a, 618b.
[0178] [0178] Figure 15 is a schematic diagram of a robotic surgical instrument 700 configured to operate a surgical tool described in this document, in accordance with an aspect of this disclosure. The robotic surgical instrument 700 can be programmed or configured to control the distal / proximal translation of a displacement member, the distal / proximal displacement of a closing tube, the rotation of the drive shaft, and articulation, either with a single type or multiple articulation drive links. In one aspect, the surgical instrument 700 can be programmed or configured to individually control a firing member, a closing member, a driving shaft member, or one or more hinge members, or combinations thereof. Surgical instrument 700 comprises a control circuit 710 configured to control motor-driven firing members, locking members, drive shaft members, or one or more hinge members, or combinations thereof.
[0179] [0179] In one aspect, the robotic surgical instrument 700 comprises a control circuit 710 configured to control a clamping arm 716 and a closing member 714, a portion of an end actuator 702, an ultrasonic blade 718 coupled connected to an ultrasonic transducer 719 excited by an ultrasonic generator 721, a drive shaft 740, and one or more linkage members 742a, 742b through a plurality of motors 704a to 704e. A position sensor 734 can be configured to provide feedback on the position of closing member 714 to control circuit 710. Other sensors 738 can be configured to provide feedback to control circuit 710. A timer / counter 731 provides information about timing and counting to control circuit 710. A power source 712 can be provided to operate motors 704a to 704e and a current sensor 736 provides motor current feedback to the control circuit
[0180] [0180] In one aspect, the control circuit 710 may comprise one or more microcontrollers, microprocessors or other processors suitable for executing instructions that cause the processor or processors to perform one or more tasks. In one aspect, a timer / counter 731 provides an output signal, such as elapsed time or a digital count, to control circuit 710 to correlate the position of closing member 714 as determined by position sensor 734 with the timer output. / counter 731 so that the control circuit 710 can determine the position of the closing member 714 at a specific time (t) in relation to an initial position or the time (t) when the closing member 714 is in a specific position in relation to a starting position. The timer / counter 731 can be configured to measure elapsed time, count external events, or measure external events.
[0181] [0181] In one aspect, control circuit 710 can be programmed to control functions of end actuator 702 based on one or more tissue conditions. The control circuit 710 can be programmed to directly or indirectly detect tissue conditions, such as thickness, as described here. Control circuit 710 can be programmed to select a trigger control program or closing control program based on tissue conditions. A trigger control program can describe the distal movement of the displacement member. Different trigger control programs can be selected to better treat different tissue conditions. For example, when a thicker tissue is present, control circuit 710 can be programmed to translate the displacement member at a lower speed and / or with a lower power. When a thinner tissue is present, control circuit 710 can be programmed to translate the displacement member at a higher speed and / or with greater power. A closing control program can control the closing force applied to the fabric by the clamping arm 716. Other control programs control the rotation of the drive shaft 740 and the hinge members 742a, 742b.
[0182] [0182] In one aspect, the 710 control circuit can generate motor setpoint signals. Motor setpoint signals can be provided for various motor controllers 708a through 708e. Motor controllers 708a through 708e can comprise one or more circuits configured to provide motor drive signals to motors / 704a to 704e in order to drive motors 704a to 704e, as described here. In some instances, motors 704a to 704e may be brushed DC motors. For example, the speed of motors 704a to 704e can be proportional to the respective motor start signals. In some examples, motors 704a to 704e can be brushless DC electric motors, and the respective motor drive signals can comprise a PWM signal provided for one or more stator windings of motors 704a to 704e. In addition, in some examples, motor controllers 708a to 708e can be omitted and control circuit 710 can directly generate motor drive signals.
[0183] [0183] In one aspect, the control circuit 710 can initially operate each of the motors 704a to 704e in an open circuit configuration for a first open circuit portion of a travel member travel. Based on the response of the robotic surgical instrument 700 during the open circuit portion of the stroke, control circuit 710 can select a trigger control program in a closed circuit configuration. The instrument response may include a translation of the distance from the displacement member during the open circuit portion, a time elapsed during the open circuit portion, the energy supplied to one of the motors 704a to 704e during the open circuit portion, a sum of pulse widths of a motor start signal, etc. After the open circuit portion, control circuit 710 can implement the selected trigger control program for a second portion of the travel member travel. For example, during a portion of the closed loop course, control circuit 710 can modulate one of the motors 704a to 704e based on the translation of data describing a position of the closed displacement member to translate the displacement member to a constant speed.
[0184] [0184] In one aspect, motors 704a to 704e can receive power from a 712 power source. Power source 712 can be a DC power source powered by an alternating main power source, a battery, a super capacitor, or any other suitable power source. Motors 704a to 704e can be mechanically coupled to moving individual mechanical elements such as the closing member 714, the clamping arm 716, drive shaft 740, joint 742a, and the joint 742b, through the respective transmissions 706a to 706e. Transmissions 706a through 706e may include one or more gears or other connecting components for coupling motors 704a to 704e to moving mechanical elements. A position sensor 734 can detect a position of the closing member 714. The position sensor 734 can be or can include any type of sensor that is capable of generating position data that indicates a position of the closing member 714 In some examples, the position sensor 734 may include an encoder configured to supply a series of pulses to the control circuit 710 as the closing member 714 translates distally and proximally. Control circuit 710 can track pulses to determine the position of closing member 714. Other suitable position sensors can be used, including, for example, a proximity sensor. Other types of position sensors can provide other signals that indicate the movement of the closing member 714. In addition, in some examples, the position sensor 734 can be omitted. When any of the motors 704a to 704e is a stepper motor, the control circuit 710 can track the position of the closing member 714 by adding the number and direction of the steps that the motor 704 has been instructed to perform. Position sensor 734 can be located on end actuator 702 or any other portion of the instrument. The outputs of each of the engines 704a to 704e include a torque sensor 744a to 744e to detect force and have an encoder to detect the rotation of the drive shaft.
[0185] [0185] In one aspect, control circuit 710 is configured to drive a firing member as the closing member portion 714 of end actuator 702. Control circuit 710 provides a motor setpoint for control of the motor 708a, which provides a drive signal for motor 704a. The output shaft of the motor 704a is coupled to a torque sensor 744a. The torque sensor 744a is coupled to a transmission 706a which is coupled to the closing member 714. The transmission 706a comprises moving mechanical elements such as rotating elements and a firing member to control the movement of the limb distally and proximally. closing mechanism 714 along a longitudinal axis of the end actuator 702. In one aspect, the motor 704a can be coupled to the knife gear assembly, which includes a knife gear reduction assembly that includes a first gear and a second knife drive gear. A torque sensor 744a provides a trigger force feedback signal to control circuit 710. The trigger force signal represents the force required to fire or dislodge the closing member
[0186] [0186] In one aspect, control circuit 710 is configured to drive a closing member like the clamping arm portion 7 of end actuator 702. Control circuit 710 provides a motor setpoint for control of the motor 708b, which provides a drive signal for motor 704b. The output shaft of the 704b motor is coupled to a 744b torque sensor. The torque sensor 744b is coupled to a transmission 706b which is coupled to the clamping arm 716. The transmission 706b comprises moving mechanical elements such as rotating elements and a closing member to control the movement of the clamping arm. tightening 716 from the open and closed positions. In one aspect, the 704b motor is coupled to a closing gear assembly, which includes a closing reduction gear assembly that is supported in gear engaged with the closing sprocket. The torque sensor 744b provides a feedback signal of force force
[0187] [0187] In one aspect, control circuit 710 is configured to rotate a drive shaft member, such as drive shaft 740, to rotate end actuator 702. Control circuit 710 provides an adjustment point motor for a 708c motor control, which provides a drive signal for the 704c motor. The output shaft of the 704c motor is coupled to a 744c torque sensor. The torque sensor 744c is coupled to a transmission 706c which is coupled to the axis 740. The transmission 706c comprises moving mechanical elements, such as rotating elements, to control the rotation of the drive shaft 740 clockwise or anti-clockwise -time up to and over 360º. In one aspect, the 704c motor is coupled to the rotary drive assembly, which includes a pipe gear segment that is formed over (or attached to) the proximal end of the proximal closing tube for engagement operable by a gear assembly rotational that is operationally supported on the tool mounting plate. The torque sensor 744c provides a rotation force feedback signal for control circuit 710. The rotation force feedback signal represents the rotation force applied to the drive shaft 740. The position sensor 734 can be configured to provide the position of the closing member as a feedback signal to control loop 710. Additional sensors 738, such as a drive shaft encoder, can provide the rotational position of drive shaft 740 to the circuit control unit 710.
[0188] [0188] In one aspect, control circuit 710 is configured to link end actuator 702. Control circuit 710 provides a motor setpoint for a 708d motor control, which provides a drive signal for the motor 704d. The output shaft of the 704d motor is coupled to a 744d torque sensor. Torque sensor 744d is coupled to a transmission 706d which is coupled to a pivot member 742a. The 706d transmission comprises moving mechanical elements, such as articulation elements, to control the articulation of the 702 + 65º end actuator. In one aspect, the 704d motor is coupled to a pivot nut, which is rotatably seated on the proximal end portion of the distal column portion and is pivotally driven thereon by a pivot gear assembly. The torque sensor 744d provides a feedback signal from the articulation force to the control circuit 710. The feedback signal from the articulation force represents the articulation force applied to the end actuator 702. The sensors 738, as an articulation encoder, can supply the articulation position of end actuator 702 to control circuit 710.
[0189] [0189] In another aspect, the articulation function of the robotic surgical system 700 may comprise two articulation members, or connections, 742a, 742b. These hinge members 742a, 742b are driven by separate disks at the robot interface (the
[0190] [0190] In one aspect, the one or more motors 704a to 704e may comprise a brushed DC motor with a gearbox and mechanical connections to a firing member, closing member or articulation member. Another example includes electric motors 704a to 704e that operate the moving mechanical elements such as the displacement member, the articulation connections, the closing tube and the drive shaft. An external influence is an excessive and unpredictable influence of things like tissue, surrounding bodies, and friction in the physical system. This external influence can be called drag, which acts in opposition to one of the electric motors 704a to 704e. External influence, such as drag, can cause the functioning of the physical system to deviate from a desired operation of the physical system.
[0191] [0191] In one aspect, the position sensor 734 can be implemented as an absolute positioning system. In one aspect, the 734 position sensor can comprise an absolute rotary magnetic positioning system implemented as a single integrated circuit rotary magnetic position sensor, ASSOSSEQFT, available from Austria Microsystems, AG. The position sensor 734 can interface with the control circuit 710 to provide an absolute positioning system. The position can include multiple Hall effect elements located above a magnet and coupled to a CORDIC processor, also known as the digit by digit method and Volder's algorithm, which is provided to implement a simple and efficient algorithm for calculating hyperbolic functions and trigonometry that require only addition, subtraction, bit shift and lookup table operations.
[0192] [0192] In one aspect, the control circuit 710 can be in communication with one or more sensors 738. The sensors 738 can be positioned on the end actuator 702 and adapted to work with the robotic surgical instrument 700 to measure various derived parameters such as span distance in relation to time, compression of the tissue in relation to time, and deformation of the anvil in relation to time. The 738 sensors can comprise a magnetic sensor, a magnetic field sensor, a strain gauge, a load cell, a pressure sensor, a force sensor, a torque sensor, an inductive sensor as a sensor eddy current, a resistive sensor, a capacitive sensor, an optical sensor and / or any other sensor suitable for measuring one or more parameters of the end actuator 702. The 738 sensors may include one or more sensors. Sensors 738 can be located on the clamping arm 716 to determine the location of tissue using segmented electrodes. The torque sensors 744a to 744e can be configured to detect force such as firing force, closing force, and / or articulation force, among others. Consequently, control circuit 710 can detect (1) the closing load experienced by the distal closing tube and its position, (2) the trigger member on the rack and its position, (3) which portion of the blade ultrasound 718 has tissue in it, and (4) the charge and power
[0193] [0193] In one aspect, the one or more sensors 738 may comprise a strain gauge such as, for example, a micro strain gauge, configured to measure the magnitude of the strain on the anvil 716 during a clamped condition. The voltage meter provides an electrical signal whose amplitude varies with the magnitude of the voltage. The 738 sensors can comprise a pressure sensor configured to detect a pressure generated by the presence of compressed tissue between the clamping arm 716 and the ultrasonic blade 718. The 738 sensors can be configured to detect the impedance of a section of fabric located between the clamping arm 716 and the ultrasonic sheet 718 which is indicative of the thickness and / or completeness of the fabric located between them.
[0194] [0194] In one aspect, the 738 sensors can be implemented as one or more limit switches, electromechanical devices, solid state switches, Hall effect devices, magneto-resistive devices (MR) giant magneto-resistive devices (GMR), magnetometers, among others. In other implementations, the 738 sensors can be implemented as solid state switches that operate under the influence of light, such as optical sensors, infrared sensors, ultraviolet sensors, among others. In addition, the switches can be solid state devices such as transistors (for example, FET, junction FET, MOSFET, bipolar, and the like). In other implementations, the 738 sensors can include driverless electric switches, ultrasonic switches, accelerometers and inertia sensors, among others.
[0195] [0195] In one aspect, sensors 738 can be configured to measure the forces exerted on the clamping arm 716 by the closing drive system. For example, one or more 738 sensors can be at a point of interaction between the
[0196] [0196] In one aspect, a current sensor 736 can be used to measure the current drawn by each of the 704a to 704e motors. The force required to advance any of the moving mechanical elements such as the closing member 714 corresponds to the current drawn by one of the motors 704a to 704e. The force is converted into a digital signal and supplied to the control circuit 710. The control circuit 710 can be configured to simulate the response of the instrument's actual system in the controller software. A displacement member can be actuated to move closing member 714 on end actuator 702 at or near a target speed. The robotic surgical instrument 700 may include a re-information controller, which may be one or any of the re-information controllers, including, but not limited to, a PID controller, state feedback, linear quadratic (LOR) and / or an adaptable controller, for example. The robotic surgical instrument 700 can include a power source to convert the signal from the feedback controller to a physical input such as case voltage, PWM voltage, frequency modulated voltage, current, torque and / or force, for example. Additional details are revealed in US patent application serial number 15 / 636,829, entitled CLOSED LOOP VELOCITY CONTROL TECHNIQUES FOR ROBOTIC SURGICAL INSTRUMENT, filed on June 29, 2017, which is hereby incorporated by reference in its entirety.
[0197] [0197] Figure 16 illustrates a schematic diagram of a surgical instrument 750 configured to control the distal translation of a displacement member according to an aspect of the present disclosure. In one aspect, the surgical instrument 750 is programmed to control the distal translation of the displacement member as the closing member 764. The surgical instrument 750 comprises an end actuator 752 which may comprise a clamping arm 766, a closing member 764 and an ultrasonic blade 768 coupled to an ultrasonic transducer 769 driven by an ultrasonic generator 771.
[0198] [0198] The position, movement, displacement, and / or translation of a linear displacement member, such as closing member 764, can be measured by an absolute positioning system, sensor arrangement, and a position sensor 784. Because the closing member 764 is coupled to a longitudinally movable driving member, the position of the closing member 764 can be determined by measuring the position of the longitudinally mobile driving member using the position sensor.
[0199] [0199] Control circuit 760 can generate a 772 engine setpoint signal. The 772 engine setpoint signal can be supplied to a 758 motor controller. The 758 motor controller can comprise one or more circuits configured to provide a motor 774 drive signal to motor 754 to drive motor 754, as described in the present invention. In some instances, the 754 motor may be a DC motor with a brushed DC electric motor. For example, the speed of motor 754 can be proportional to the drive signal of motor 774. In some instances, motor 754 can be a brushless DC electric motor and the drive signal of motor 774 can comprise a supplied PWM signal for one or more motor stator windings 754. In addition, in some examples, motor controller 758 can be omitted, and control circuit 760 can generate motor drive signal 774 directly.
[0200] [0200] The 754 motor can receive power from a power source
[0201] [0201] The control circuit 760 can be in communication with one or more sensors 788. The sensors 788 can be positioned on the end actuator 752 and adapted to work with the surgical instrument 750 to measure the various derived parameters, such as distance span in relation to time, compression of the tissue in relation to time and tension of the anvil in relation to time. The 788 sensors can comprise a magnetic sensor, a magnetic field sensor, a stress meter, a pressure sensor, a force sensor, an inductive sensor such as a eddy current sensor, a resistive sensor, a capacitive sensor, a sensor optical and / or any other sensor suitable for measuring one or more parameters of the 752 end actuator. The 788 sensors may include one or more sensors.
[0202] [0202] The one or more 788 sensors may comprise a stress meter, such as a microstrain meter, configured to measure the magnitude of the stress on the anvil 766 during a tight condition. The voltage meter provides an electrical signal whose amplitude varies with the magnitude of the voltage. The 788 sensors can comprise a pressure sensor configured to detect a pressure generated by the presence of compressed tissue between the clamping arm 766 and the ultrasonic blade 768. The 788 sensors can be configured to detect the impedance of a section of fabric located between the clamping arm 766 and the ultrasonic sheet 768 which is indicative of the thickness and / or completeness of the fabric located between them.
[0203] [0203] The 788 sensors can be configured to measure the forces exerted on the clamping arm 766 by the closing drive system. For example, one or more sensors 788 may be at an interaction point between the closing tube and the clamp arm 766 to detect the closing forces applied by a closing tube to the clamping arm 766. The forces exerted on the arm clamping 766 can be representative of the tissue compression experienced by the tissue section captured between the clamping arm 766 and the ultrasonic blade 768. One or more sensors 788 can be positioned at various points of interaction throughout the closing drive system to detect force forces
[0204] [0204] A current sensor 786 can be used to measure the current drained by the motor 754. The force required to advance the closing member 764 corresponds to the current drained by the motor 754. The force is converted into a digital signal and supplied control circuit 760.
[0205] [0205] The control circuit 760 can be configured to simulate the response of the real system of the instrument in the controller software. A displacement member can be actuated to move a closing member 764 on end actuator 752 at or near a target speed. The surgical instrument 750 may include a feedback controller, which can be any or any feedback controller, including, but not limited to, a PID controller, status feedback, LOR, and / or an adaptive controller , for example. The surgical instrument 750 can include a power source to convert the signal from the re-information controller to a physical input such as case voltage, PWM voltage, frequency modulated voltage, current, torque and / or force, for example.
[0206] [0206] The actual drive system of the surgical instrument 750 is configured to drive the displacement member, the cutting member or the closing member 764, by a brushed DC motor with gearbox and mechanical connections to an articulation system. tion and / or knife. Another example is the 754 electric motor that operates the displacement member and the articulation drive, for example, from an interchangeable drive shaft assembly. An external influence is an excessive and unpredictable influence on things like tissue, surrounding bodies, and friction in the physical system. This external influence can be called drag, which acts in opposition to the 754 electric motor. External influence, like drag, can cause the functioning of the physical system to deviate from a desired operation of the physical system.
[0207] [0207] Several exemplifying aspects are directed to a surgical instrument 750 that comprises an end actuator 752 with surgical sealing and cutting implements driven by motor. For example, a 754 motor can drive a displacement member distally and proximally along a longitudinal geometric axis of end actuator 752. End actuator 752 may comprise an articulating clamping arm 766 and, when configured to the use, an ultrasonic blade 768 positioned on the opposite side of the clamping arm 766. A clinician can hold the tissue between the clamping arm 766 and the ultrasonic sheet 768, as described in the present invention. When ready to use the 750 instrument, the physician can provide a trigger signal, for example, by pressing a trigger on the 750 instrument. In response to the trigger signal, the 754 motor can drive the displacement member distally along from the longitudinal geometric axis of the end actuator 752 from a proximal start position to an end position distal from the start position. As the displacement member moves distally, the closing member 764 with a cutting member positioned at a distal end, can cut the tissue between the ultrasonic blade 768 and the clamping arm 766.
[0208] [0208] In several examples, the surgical instrument 750 may comprise a control circuit 760 programmed to control the distal translation of the displacement member, such as the closing member 764, for example, based on one or more tissue conditions . The control circuit 760 can be programmed to directly or indirectly detect tissue conditions, such as thickness, as described here. Control circuit 760 can be programmed to select a control program based on tissue conditions. A control program can describe the distal movement of the displacement member. Different control programs can be selected to better treat different tissue conditions. For example, when a thicker tissue is present, the control circuit 760 can be programmed to transfer the displacement member at a lower speed and / or with a lower power. When a thinner tissue is present, the control circuit 760 can be programmed to move the displacement member at a higher speed and / or with greater power.
[0209] [0209] In some examples, control circuit 760 may initially operate motor 754 in an open circuit configuration for a first open circuit portion of a travel member travel. Based on an instrument response 750 during the open circuit portion of the stroke, control circuit 760 can select a trip control program. The response of the instrument may include a travel distance of the displacement member during the open circuit portion, a time elapsed during the open circuit portion, the power supplied to the motor 754 during the open circuit portion, a sum of pulse widths a motor start signal, etc. After the open circuit portion, control circuit 760 can implement the selected trigger control program for a second portion of the travel member travel. For example, during the closed loop portion of the stroke, control circuit 760 can modulate motor 754 based on translation data that describes a position of the displacement member in a closed circuit manner to translate the displacement member into a constant speed. Additional details are revealed in US patent application serial number 15 / 720,852, entitled SYSTEM AND METHODS FOR CONTROLLING A DISPLAY OF A SURGICAL INSTRUMENT, filed on September 29, 2017, which is hereby incorporated by reference in its entirety.
[0210] [0210] Figure 17 is a schematic diagram of a 790 surgical instrument 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 the distal translation of a displacement member such as closing member 764. Surgical instrument 790 comprises an end actuator 792 which may comprise a clamping arm 766, a closing member 764, and an ultrasonic blade 768 that can be interchanged with or work in conjunction with one or more RF 796 electrodes (shown in dashed line). The ultrasonic blade 768 is coupled to an ultrasonic transducer 769 driven by an ultrasonic generator 771.
[0211] [0211] In one aspect, the 788 sensors can be implemented as a limit switch, electromechanical device, solid state switches, Hall effect devices, MRI devices, GMR devices, magnetometers, among others. In other implementations, 638 sensors can be solid state switches that operate under the influence of light, such as optical sensors, infrared sensors, ultraviolet sensors, among others. In addition, the switches can be solid-state devices such as transistors (for example, FET, junction FET, MOSFET, bipolar, and the like). In other
[0212] [0212] In one aspect, the 784 position sensor can be implemented as an absolute positioning system, which comprises a rotating magnetic absolute positioning system implemented as a rotating, magnetic position sensor with circuit single integrated, ASSOSSEQFT, available from Austria Microsystems, AG. The position sensor 784 can interface with the control circuit 760 to provide an absolute positioning system. The position can include multiple Hall effect elements located above a magnet and coupled to a CORDIC processor, also known as the digit by digit method and Volder algorithm, which is provided to implement a simple and efficient algorithm for calculating hyperbolic and trigonometric functions that require only addition, subtraction, bit shift and lookup table operations.
[0213] [0213] In some examples, the position sensor 784 may be omitted. When the motor 754 is a stepper motor, the control circuit 760 can track the position of the closing member 764 by aggregating the number and orientation of the steps that the motor has been instructed to perform. Position sensor 784 can be located on end actuator 792 or any other portion of the instrument.
[0214] [0214] The control circuit 760 can be in communication with one or more sensors 788. The sensors 788 can be positioned on the end actuator 792 and adapted to work with the surgical instrument 790 to measure the various derived parameters, such as distance span in relation to time, compression of the tissue in relation to time and tension of the anvil in relation to time. The 788 sensors can comprise a magnetic sensor, a magnetic field sensor, a stress meter, a pressure sensor, a force sensor, an inductive sensor such as a eddy current sensor, a resistive sensor, a capacitive sensor, a sensor optical and / or any other sensors suitable for measuring one or more parameters of the end actuator 792. The 788 sensors may include one or more sensors.
[0215] [0215] An RF 794 power source is coupled to end actuator 792 and is applied to RF electrode 796 when RF electrode 796 is provided on end actuator 792 in place of ultrasonic blade 768 or to function in together with the 768 ultrasonic sheet. For example, the ultrasonic sheet is produced from electrically conductive metal and can be used as the return path for the RF electrosurgical current. The control circuit 760 controls the supply of RF energy to the RF electrode 796.
[0216] [0216] Additional details are disclosed in US patent application serial number 15 / 636,096, entitled SURGICAL SYSTEM COUPLABLE WITH STAPLE CARTRIDGE AND RADIO FREQUENCY CARTRIDGE, AND METHOD OF USING SAME, filed on June 28, 2017, which is here incorporated as a reference in its entirety. Generator hardware Adaptive ultrasonic blade control algorithms
[0217] [0217] In several respects, intelligent ultrasonic energy devices can comprise adaptive algorithms to control the operation of the ultrasonic blade. In one respect, the adaptive ultrasonic blade control algorithms are configured to identify the type of tissue and adjust the device parameters. In one aspect, the ultrasonic blade control algorithms are configured to parameterize the type of tissue. An algorithm to detect the collagen / tissue ratio to adjust the amplitude of the distal tip of the ultrasonic blade is described in the following section of the present report. Various aspects of intelligent ultrasonic devices are described here with reference to Figures 1 to 106, for example. Consequently, the following description of the adaptive ultrasonic blade control algorithms should be read in conjunction with Figures 1 to 106 and the description associated with them.
[0218] [0218] In certain surgical procedures it would be desirable to use adaptive ultrasonic blade control algorithms. In one aspect, adaptive ultrasonic blade control algorithms can be used to adjust the parameters of the ultrasonic device based on the type of tissue in contact with the ultrasonic blade. In one aspect, the parameters of the ultrasonic device can be adjusted based on the location of the tissue within the claws of the ultrasonic end actuator, for example, the location of the tissue between the clamping arm and the ultrasonic blade. The impedance of the ultrasonic transducer can be used to differentiate the percentage of tissue that is located at the distal or proximal end of the end actuator. The reactions of the ultrasonic device can be based on the type of tissue or the compressibility of the tissue. In another aspect, the parameters of the ultrasonic device can be adjusted based on the type of tissue identified or the parameterization. For example, the amplitude of the mechanical displacement of the distal tip of the ultrasonic blade can be adjusted based on the ratio between collagen and elastin in the tissue detected during the tissue identification procedure. The ratio of collagen to tissue elastin can be detected using a variety of techniques including reflectance and surface emissivity in the infrared (IR) reflectance. The force applied to the fabric by the clamping arm and / or the travel of the clamping arm to produce span and compression. The electrical continuity through a clamp equipped with electrodes can be used to determine the percentage of the claw that is covered with fabric.
[0219] [0219] Figure 18 is an 800 system configured to execute adaptive ultrasonic blade control algorithms in a surgical data network that comprises a central modular communication controller, in accordance with at least one aspect of the present disclosure. In one aspect, the generator module 240 is configured to execute the 802 ultrasonic adaptive blade control algorithms, as described here with reference to Figures 53 to 105. In one aspect, the device / instrument 235 is configured to execute the control algorithms of the adaptive ultrasonic blade 804, as described here with reference to Figures 53 to 105. In another aspect, both the device / instrument 235 and the device / instrument 235 are configured to execute the adaptive ultrasonic blade control algorithms 802, 804 as described in the present invention with reference to Figures 53 to 105.
[0220] [0220] The generator module 240 may comprise an isolated patient stage in communication with a non-isolated stage via a power transformer. A secondary winding of the power transformer is contained in the isolated stage and can comprise a branching configuration (for example, a central branching or non-central branching configuration) to define the drive signal outputs in order to deliver itself - actuation signals for different surgical instruments, such as an ultrasonic surgical device and an RF electrosurgical instrument, and a multifunctional surgical instrument that includes RF and ultrasonic energy modes that can be released alone or simultaneously. In particular, the trigger signal outputs can emit an ultrasonic trigger signal (for example, a 420V medium square root trigger signal (RMS) for a 241 ultrasonic surgical instrument, and the trigger signal outputs). can emit an RF electrosurgical drive signal (for example, a 100V electrosurgical drive signal) to an RF 241 electrosurgical instrument. Aspects of generator module 240 are described here with reference to Figures 21 to 25B.
[0221] [0221] The generator module 240 or the device / instrument 235 or both are coupled to the modular control tower 236 connected to multiple operating room devices, such as intelligent surgical instruments, robots, and other computerized devices located in the operating room, as described with reference to Figures 8 to 11, for example.
[0222] [0222] Figure 19 illustrates an example of a 900 generator, which is a form of a generator configured to couple with an ultrasonic instrument and additionally configured to perform adaptive ultrasonic blade control algorithms in a data network. surgical instruments comprising a central modular communication controller as shown in Figure 18. Generator 900 is configured to supply multiple energy modalities to a surgical instrument. The 900 generator provides ultrasonic and RF signals to power a surgical instrument, independently or simultaneously. Ultrasonic and RF signals can be provided alone or in combination and can be provided simultaneously. As indicated above, at least one generator output can provide multiple types of energy (for example, ultrasonic, bipolar or monopolar RF, irreversible and / or reversible electroporation, and / or microwave energy, among others) through a single port, and these signals can be supplied separately or simultaneously to the end actuator to treat tissue. Generator 900 comprises a processor 902 coupled to a waveform generator 904. Processor 902 and waveform generator 904 are configured to generate various signal waveforms based on information stored in a memory attached to the processor 902, not shown for clarity of disclosure. The digital information associated with a waveform is provided to the waveform generator 904 that includes one or more DAC circuits to convert the digital input to an analog output. The analog output is fed to an amplifier 1106 for signal conditioning and amplification. The conditioned and amplified output of amplifier 906 is coupled to a power transformer 908. The signals are coupled by the power transformer 908 to the secondary side, which is on the patient isolation side. A first signal of a first energy modality is supplied to the surgical instrument between the terminals identified as ENERGY; and RETURN. A second signal from a second energy modality is coupled by a 910 capacitor and is supplied to the surgical instrument between the terminals identified as ENERGY and RETURN. It will be recognized that more than two modes of energy can be issued and, therefore, the subscript "n" can be used to designate that up to n ENERGY terminals can be provided, where n is a larger positive integer that 1. It will also be recognized that up to "n" return paths, RETURN can be provided without departing from the scope of the present disclosure.
[0223] [0223] A first voltage detection circuit 912 is coupled through the terminals identified as ENERGY; and the RETURN path to measure the output voltage between them. A second voltage detection circuit 924 is coupled through the terminals identified as ENERGY, and the RETURN path to measure the output voltage between them. A current detection circuit 914 is arranged in series with the RETURN leg on the secondary side of the power transformer 908 as shown to measure the output current for any energy modality. If different return paths are provided for each energy modality, then a separate current detection circuit would be provided on each return leg. The outputs of the first and second voltage detection circuits 912, 924 are supplied to the respective isolation transformers 916, 922 and the output of the current detection circuit 914 is supplied to another isolation transformer 918. The outputs of the voltage transformers isolation 916, 928, 922 on the primary side of the power transformer 908 (non-isolated side of the patient) are supplied to one or more ADC 926 circuits. The digitized output from the ADC 926 circuit is provided to processor 902 for additional termination and computation. The output voltages and the output current feedback information can be used to adjust the output voltage and the current supplied to the surgical instrument, and to compute the output impedance, among other parameters . Input / output communications between processor 902 and isolated patient circuits are provided via a 920 interface circuit. The sensors can also be in electrical communication with the 902 processor via the 920 interface circuit.
[0224] [0224] In one aspect, impedance can be determined by processor 902 by dividing the output of the first voltage detection circuit 912 coupled through the terminals identified as ENERGIAVRETORNO or the second voltage detection circuit 924 coupled through the terminals identified as ENERGY / RETURN, via the current detection circuit 914 output arranged in series with the RETURN leg on the secondary side of the power transformer 908. The outputs of the first and second voltage detection circuits 912, 924 are provided to separate the transformer isolations 916, 922 and the current detection circuit 914 output is provided for another isolation transformer 916. The digitized voltage and current detection measurements of the ADC 926 circuit are provided to the 902 processor to compute the impedance. As an example, the first type of energy ENERGY: it can be ultrasonic energy and the second mode of energy ENERGY, it can be RF energy. However, in addition to the ultrasonic and bipolar or monopolar RF energy modalities, other energy modalities include irreversible and / or reversible electroporation and / or microwave energy, among others. In addition, although the example shown in Figure 19 shows a single RETURN return path that can be provided for two or more energy modes, in other respects, multiple RETURN return paths can be provided for each energy mode ENERGY . Thus, as described here, the impedance of the ultrasonic transducer can be measured by dividing the output of the first voltage detection circuit 912 by the current detection circuit 914 and the tissue impedance can be measured by dividing the output of the second detection circuit voltage 924 through current detection circuit 914.
[0225] [0225] As shown in Figure 19, generator 900 comprising at least one output port can include a power transformer 908 with a single output and multiple taps to provide power in the form of one or more types of energy such as ultrasonic, bipolar or monopolar RF, irreversible and / or reversible electroporation, and / or microwave energy, among others, for example to the end actuator, depending on the type of tissue treatment being performed. For example, generator 900 can supply energy with higher voltage and lower current to drive an ultrasonic transducer, with lower voltage and higher current to con-
[0226] [0226] Additional details are revealed in US patent application publication No. 2017/0086914 entitled TECHNIQUES FOR OPE-
[0227] [0227] As used throughout this description, the term "wireless" and its derivatives can be used to describe circuits, devices, systems, methods, techniques, communication channels, etc., which can communicate data through the use of electromagnetic radiation modulated through a non-solid medium. The term does not imply that the associated devices do not contain any wires, although in some respects they may not. The communication module can implement any of a number of wireless and wired communication standards or protocols, including, but not limited to, Wi-Fi (IEEE 802.11 family), WiMAX (IEEE 802.16 family), IEEE 802.20 ,
[0228] [0228] As used in the present invention, a processor or processing unit is an electronic circuit that performs operations on some external data source, usually memory or some other data flow. The term is used in the present invention to refer to the central processor (central processing unit) in a computer system or systems (specifically systems on a chip (SoCs)) that combine several specialized "processors".
[0229] [0229] As used here, a system on a chip or system on the chip (SoC or SOC) is an integrated circuit (also known as an "IC" or "chip") that integrates all components of a computer or other electronic systems. It can contain digital, analog, mixed and often radio frequency functions - all on a single substrate. A SoC integrates a microcontroller (or microprocessor) with advanced peripherals such as a graphics processing unit (GPU), i-Fi module, or coprocessor. An SoC may or may not contain internal memory.
[0230] [0230] As used here, a microcontroller or controller is a system that integrates a microprocessor with peripheral circuits and memory. A microcontroller (or MCU for microcontroller unit)
[0231] [0231] As used in the present invention, the term controller or microcontroller may be an independent chip or IC (integrated circuit) device that interfaces with a peripheral device. This can be a connection between two parts of a computer or a controller on an external device that manages the operation of (and connection to) that device.
[0232] [0232] Any of the processors or microcontrollers in the present invention can be any implemented by any single-core or multi-core processor, such as those known under the trade name ARM Cortex by Texas Instruments. In one respect, the processor may be a Core Cortex-M4F LM4F230H5QR ARM processor, available from Texas Instruments, for example, which comprises an integrated 256 KB single cycle flash memory, or other non-volatile memory , up to 40 MHz, a prefetch buffer to optimize performance above 40 MHz, a 32 KB single cycle serial random access memory (SRAM), an internal read-only memory (ROM) loaded with the StellarisWareO program, read-only memory
[0233] [0233] In one aspect, the processor may comprise a safety controller that comprises two controller-based families, such as TMS570 and RM4x, known under the tradename Hercules ARM Cortex R4, also by Texas Instruments. The safety controller can be configured specifically for IEC 61508 and ISO 26262 safety critical applications, among others, to provide advanced integrated safety features while providing scalable performance, connectivity and memory options.
[0234] [0234] The modular devices include the modules (as described in connection with Figures 3 and 9, for example) that are received within a central surgical controller and the devices or surgical instruments that can be connected to the various modules a in order to connect or pair with the corresponding central surgical controller. Modular devices include, for example, smart surgical instruments, medical imaging devices, suction / irrigation devices, smoke evacuators, power generators, fans, insufflators and displays. The modular devices described here can be controlled by control algorithms. The control algorithms can be executed on the modular device itself, on the central surgical controller to which the specific modular device is paired, or on both the modular device and the central surgical controller (for example, through a distributed computing architecture). In some examples,
[0235] [0235] Figure 20 illustrates a form of a surgical system 1000 that comprises a generator 1100 and various surgical instruments 1104, 1106 and 1108 that can be used with it, whereas surgical instrument 1104 is an ultrasonic surgical instrument, the surgical instrument co 1106 is an RF electrosurgical instrument, and the multifunctional surgical instrument 1108 is a combination of ultrasonic / RF electrosurgical instrument. The 1100 generator is configurable for use with a variety of surgical instruments. According to various forms, the 1100 generator can be configurable for use with different surgical instruments of different types, including, for example, the ultrasonic surgical instrument 1104, the RF electrosurgical instruments 1106 and the multifunctional surgical instrument 1108 that integrate ultrasonic and RF energies supplied simultaneously from generator 1100. Although in the form of Figure 20, generator 1100 is shown separately from surgical instruments 1104, 1106, 1108 in one form, generator 1100 can be formed integrally with any of the surgical instruments 1104, 1106 and 1108 to form a unitary surgical system. The 1100 generator comprises an 1110 input device located on a front panel of the generator console.
[0236] [0236] Generator 1100 is configured to drive multiple surgical instruments 1104, 1106, 1108. The first surgical instrument is a 1104 ultrasonic surgical instrument and comprises a 1105 handle (HP), an 1120 ultrasonic transducer, a drive 1126 and an end actuator 1122. The end actuator 1122 comprises an ultrasonic blade 1128 acoustically coupled to the ultrasonic transducer 1120 and a clamping arm 1140. The grip 1105 comprises a trigger 1143 for operating the tightening 1140 and a combination of toggle buttons 1134a, 1134b, 1134c to energize and activate the 1128 ultrasonic blade or other function. Toggle buttons 1134a, 1134b, 1134c can be configured to power the 1120 ultrasonic transducer with the 1100 generator.
[0237] [0237] Generator 1100 is also configured to drive a second surgical instrument 1106. The second surgical instrument 1106 is an RF electrosurgical instrument and comprises a 1107 (HP) handle, an 1127 drive shaft and an actuator. end 1124. The end actuator 1124 comprises electrodes on the clamping arms 1142a and 1142b and return through the electric conductor portion of the drive shaft 1127. The electrodes are coupled to the bipolar power source inside the generator 1100 and energized by the same. The handle 1107 comprises a trigger 1145 to operate the clamping arms 1142a, 1142b and a power button 1135 to actuate a power switch to energize the electrodes on the end actuator 1124.
[0238] [0238] Generator 1100 is also configured to trigger an
[0239] [0239] The 1100 generator is configurable for use with a variety of surgical instruments. According to various forms, the 1100 generator can be configurable for use with different surgical instruments of different types, including, for example, the ultrasonic surgical instrument 1104, the RF surgical instrument 1106 and the multifunctional surgical instrument 1108 which integrates ultrasonic and RF energies supplied simultaneously from generator 1100. Although in the form of Figure 20, generator 1100 is shown separately from surgical instruments 1104, 1106, 1108 in another form, generator 1100 can be formed integrally with any of the surgical instruments 1104, 1106, 1108 to form a unitary surgical system. As discussed above, generator 1100 comprises an input device 1110 located on a front panel of the generator 1100 console. Input device 1110 can comprise any suitable device that generates signals suitable for programming the operation of generator 1100. The 1100 generator may also comprise one or more 1112 output devices. Other aspects of generators for digitally generating electrical signal waveforms and surgical instruments are described in the patent publication US-2017-0086914-A1, which is incorporated herein reference, in its entirety.
[0240] [0240] Figure 21 is an end actuator 1122 of the exemplary ultrasonic device 1104, in accordance with at least one aspect of the present disclosure. The end actuator 1122 may comprise a blade 1128 that can be coupled to the ultrasonic transducer 1120 through a waveguide. When activated by the ultrasonic transducer 1120, the blade 1128 can vibrate and, when placed in contact with tissues, it can cut and / or coagulate them, as described in the present invention. According to several aspects, and as shown in Figure 21, the end actuator 1122 can also comprise a clamping arm 1140 that can be configured for cooperative action with the blade 1128 of the end actuator 1122. With the blade 1128, the clamping arm 1140 can comprise a set of grippers. The clamping arm 1140 can be pivotally connected to a distal end of a drive shaft 1126 of the instrument portion 1104. The clamping arm 1140 can include a block of fabric from the clamping arm 1163, which can be formed of Teflon & or other suitable low-friction material. Block 1163 can be mounted for cooperation with blade 1128, with pivoting movement of the clamping arm 1140 that positions the clamping block 1163 in a relationship substantially parallel to, and in contact with, the blade 1128. For this purpose construction, a tissue portion to be clamped may be caught between the tissue block 1163 and the blade 1128. The tissue block 1163 can be provided with a sawtooth-like configuration including a plurality of gripping teeth 1161 axially spaced and extending proximally to improve the grip of the fabric in cooperation with the blade 1128. The clamping arm 1140 can transition from the open position shown in Figure 21 to a closed position (with the clamping arm 1140 in contact with or near blade 1128) in any suitable manner. For example, handle 1105 may comprise a jaw closure trigger. When operated by a clinician, the clamshell trigger can rotate the clamping arm 1140 in any suitable manner.
[0241] [0241] The 1100 generator can be activated to supply the trigger signal to the 1120 ultrasonic transducer in any suitable way. For example, generator 1100 may comprise a foot switch 1430 (Figure 24) coupled to generator 1100 by means of a 1432 pedal wrench cable. A clinician can activate the 1120 ultrasonic transducer and thus the ultrasonic transducer 1120 and blade 1128, pressing the foot switch 1430. In addition, or instead of the foot switch 1430, some aspects of the ultrasonic device 1104 may use one or more keys positioned on the handle 1105 which, when activated, can cause generator 1100 to activate ultrasonic transducer 1120. In one aspect, for example, the one or more switches may comprise a pair of toggle buttons 1134a, 1134b, 1134c (Figure 20), for example, to stop - terminate an operating mode of the device 1104. When the toggle button 1134a is pressed, for example, the ultrasonic generator 1100 can provide a maximum trigger signal to the transducer 1120, causing it to produce a maximum of ultr power output asonic. Pressing the toggle button 1134b can cause the 1100 ultrasonic generator to provide a user-selectable drive signal to the 1120 ultrasonic transducer, causing it to produce less than the maximum ultrasonic energy output. The device 1104 additionally or alternatively may comprise a second key, for example, to indicate a position.
[0242] [0242] Additionally or alternatively, the one or more keys may comprise a toggle button 1134c which, when pressed, causes generator 1100 to provide a pulse output (Figure 20). The pulses can be provided at any suitable frequency and grouping, for example. In some respects, the power level of the pulses may consist of the power levels associated with the toggle buttons 1134a, 1134b (maximum, less than maximum), for example.
[0243] [0243] It will be recognized that a device 1104 can comprise any combination of toggle buttons 1134a, 1134b, 1134c (Figure 20). For example, device 1104 could be configured to have only two toggle buttons: a toggle button 1134a to produce a maximum of ultrasonic power output and a toggle button 1134c to produce a pulsed output, either at the maximum power level or less than the maximum. Thus, the output setting of the generator 1100 trigger signal could be five continuous signals, or any discrete number of individual pulsed signals (1, 2, 3, 4 or 5). In certain aspects, the specific trigger signal configuration can be controlled based, for example, on the EEPROM settings on the 1100 generator and / or power level selections by the user.
[0244] [0244] In certain respects, a two-position switch can be offered as an alternative to an 1134c toggle button (Figure
[0245] [0245] In some respects, the RF electrosurgical end actuator 1124, 1125 (Figure 20) can also comprise a pair of electrodes. The electrodes can be in communication with the 1100 generator, for example, via a cable. The electrodes can be used, for example, to measure the impedance of a tissue portion present between the clamping arm 1142a, 1146 and the blade 1142b,
[0246] [0246] According to the aspects described, the ultrasonic generator module can produce one or more drive signals with specific voltages, currents and frequencies (for example, 55,500 cycles per second, or Hz). The one or more drive signals can be supplied to the ultrasonic device 1104 and specifically to the transducer 1120, which can operate, for example, as described above. In one aspect, generator 1100 can be configured to produce a trigger signal for a specific voltage, current and / or frequency output signal that can be performed with high resolution, accuracy and repeatability.
[0247] [0247] According to the aspects described, the generator module for electrosurgery / RF can generate one or more drive signals with sufficient output power to perform bipolar electrosurgery using radiofrequency (RF) energy. In bipolar electrosurgery applications, the trigger signal can be supplied, for example, to the electrodes of the electrosurgical device 1106, for example, as described above. Consequently, generator 1100 can be configured for therapeutic purposes by applying sufficient electrical energy to the tissue to treat said tissue (for example, coagulation, cauterization, tissue welding, etc.).
[0248] [0248] The generator 1100 can comprise an input device 2150 (Figure 24B) located, for example, on a front panel of the generator 1100 console. The input device 2150 can comprise any suitable device that generates adequate signals for programming the operation of generator 1100. In operation, the user can program or otherwise control the operation of generator 1100 using the 2150 input device. The 2150 input device can comprise any suitable device that generates signals that can be used by the generator (for example, by one or more processors contained in the generator) to control the operation of the 1100 generator (for example, the operation of the ultrasonic generator module and / or the generator module for electrosurgery / RF). In many respects, the 2150 input device includes one or more of buttons, keys, rotary controls, keyboard, numeric keypad, touchscreen monitor, pointing device and remote connection to a general purpose or dedicated computer. In other respects, the 2150 input device may comprise a suitable user interface, such as one or more user interface screens displayed on a touchscreen monitor, for example. Consequently, using the 2150 input device, the user can adjust or program various generator operational parameters, such as current (1), voltage (V), frequency (f) and / or period (T) of one or more drive generated by the ultrasonic generator module and / or the electrosurgery / RF generator module.
[0249] [0249] The generator 1100 may also comprise an output device 2140 (Figure 24B) located, for example, on a front panel of the generator 1100 console. The output device 2140 includes one or more devices to provide the user with sensory feedback . These devices may comprise, for example, visual feedback devices (for example, a monitor with LCD screen, LED indicators), hearing feedback devices (for example, a speaker, a bell) or feedback devices. - tactile information (for example, haptic actuators).
[0250] [0250] Although certain modules and / or blocks of the 1100 generator can be described by way of example, it should be considered that a greater or lesser number of modules and / or blocks can be used, and yet be in the scope of aspects. In addition, although several aspects can be described in terms of modules and / or blocks to facilitate description, these modules and / or blocks can be implemented by one or more hardware components, for example, processors, processors digital signal systems (DSPs), programmable logic devices (PLDs), application-specific integrated circuits (ASICS), circuits, registers and / or software components, for example, programs, subroutines, logic and / or combinations of hardware and software components.
[0251] [0251] In one aspect, the drive module of the ultrasonic generator and the drive module for electrosurgery / RF 1110 (Figure 20) can comprise one or more integrated applications, implemented as firmware, software, hardware or any combination of the same. The modules can comprise several executable modules, such as software, programs, data, triggers and
[0252] [0252] In one aspect, the modules comprise a hardware component implemented as a processor for executing program instructions for monitoring various measurable characteristics of devices 1104, 1106, 1108 and generating a signal or signal of corresponding output drive for the operation of devices 1104, 1106, 1108. In aspects where generator 1100 is used in conjunction with device 1104, the trigger signal can drive ultrasonic transducer 1120 in ci modes - cutting and / or coagulation surgeons. The electrical characteristics of device 1104 and / or fabric can be measured and used to control the operational aspects of the 1100 generator and / or be provided as feedback to the user. In aspects where generator 1100 is used in conjunction with device 1106, the trigger signal can supply electrical energy (eg RF energy) to end actuator 1124 in the cut, coagulation and / or desiccation modes. The electrical characteristics of the 1106 device and / or the fabric can be measured and used to control the operational aspects of the 1100 generator and / or be provided as feedback to the user. In several aspects, as previously discussed, hardware components can be implemented as PSD, PLD, ASIC, circuits and / or registers. In one aspect, the processor can be configured to store and execute computer software program instructions in order to generate the step function output signals for driving various components of devices 1104, 1106, 1108, such as the 1120 ultrasonic transducer and the 1122, 1124, 1125 end actuators.
[0253] [0253] An electromechanical ultrasonic system includes an ultrasonic transducer, a waveguide, and an ultrasonic blade. The electromechanical ultrasonic system has an initial resonance frequency defined by the physical properties of the ultrasonic transducer, the waveguide, and the ultrasonic blade. The ultrasonic transducer is excited by a voltage signal Va (t) and alternating current /, 7 (t) equal to the resonance frequency of the electromechanical ultrasonic system. When the electromechanical ultrasonic system is in resonance, the phase difference between the voltage Va (t) and current / 1 (t) signals is zero. In other words, in resonance the inductive impedance is equal to the capacitive impedance. As the ultrasonic sheet heats up, the conformity of the ultrasonic sheet (modeled as an equivalent capacitance) causes the resonance frequency of the electromechanical ultrasonic system to shift. In this way, the inductive impedance is no longer equal to the capacitive impedance causing a difference between the drive frequency and the resonance frequency of the electromechanical ultrasonic system. The system is now operating "out of resonance". The difference between the drive frequency and the resonance frequency is manifested as a phase difference between the voltage signals V, (t) and current / 7 (t) applied to the ultrasonic transducer. The generator's electronic circuits can easily monitor the phase difference between the voltage Va (t) and current / 7 (t) signals and can continuously adjust the drive frequency until the phase difference is again equal to zero. At this point, the new drive frequency is equal to the resonance frequency of the new electromechanical ultrasonic system. The change in phase and / or frequency can be used as an indirect measurement of the temperature of the ultrasonic sheet.
[0254] [0254] As shown in Figure 22, the electro-mechanical properties of the ultrasonic transducer can be modeled as an equivalent circuit comprising a first branch that has a static capacitance and a second "in motion" branch that has an inductance, resistance and capacitance connected in series that define the electromechanical properties of a resonator. Known ultrasonic generators may include a tuning inductor to cancel the static capacitance at a resonant frequency so that substantially all of the current from the generator's drive signal flows to the moving branch. Consequently, using a tuning inductor, the current of the generator's trigger signal represents the current of the branch in motion, and the generator is thus able to control its trigger signal to maintain the resonant frequency. - ultrasonic transducer size. The tuning inductor can also transform the phase impedance plot of the ultrasonic transducer to optimize the frequency locking capabilities of the generator. However, the tuning inductor must be combined with the specific static capacitance of an ultrasonic transducer at the operational resonance frequency. In other words, a different ultrasonic transducer having a different static capacitance needs a tuning inductor.
[0255] [0255] Figure 22 illustrates an equivalent 1500 circuit of an ultrasonic transducer, such as the 1120 ultrasonic transducer, according to one aspect. Circuit 1500 comprises a first "motion" branch having, connected in series, inductance Ls, resistance Rs and capacitance Cs that define the electromechanical properties of the resonator, and a second capacitive branch having a static capacitance Co. The drive current / 7 (t) can be received from a generator at a drive voltage Va (t), with the movement current / m (t) flowing through the first branch and the current / 4 (t) -Im (t) flowing through the capacitive branch. Control of the electromechanical properties of the ultrasonic transducer can be achieved by properly controlling / g (t) and Va (t). As explained above, conventional generator architectures can include a Lt tuning inductor (shown in dashed line in Figure 22) to cancel, in a parallel resonance circuit, the static capacitance Co at a resonance frequency, so that substantially all current output from the generator / 9 (t) flows through the branch in motion. In this way, the current control of the movement branch / m (t) is obtained by controlling the generator current output / 74 (t). The tuning inductor L: is specific to the static Co capacitance of an ultrasonic transducer, however, and a different ultrasonic transducer having a different static capacitance requires a different tuning inductor Lt. In addition, as the tuning inductor L: correlates to the nominal value of the static capacitance Co at a single resonance frequency, the accurate control of the branching current of motion / m (t) is guaranteed only at that frequency. As the frequency moves downward with the temperature of the transducer, the exact control of the current of the movement branch is compromised.
[0256] [0256] Several aspects of the 1100 generator may not have a tuning inductor L: to monitor the branching current of movement / m (t). Instead, generator 1100 can use the measured value of static capacitance Co between power applications for a specific ultrasonic surgical device 1104 (along with drive feedback and current voltage feedback data) to determine the values of the branching current of movement / m (t) on a dynamic and continuous basis (for example, in real time). These forms of the 1100 generator are therefore capable of providing virtual tuning to simulate a system that is tuned or resonant with any static Co capacitance value at any frequency, and not just at a single resonance frequency imposed by a static capacitance nominal value Co.
[0257] [0257] Figure 23 is a simplified block diagram of an aspect of generator 1100, to provide tuning without an inductor, as described above, among other benefits. Figures 24A to 24C illustrate an architecture of generator 1100 of Figure 23, according to one aspect. Referring to Figure 23, generator 1100 can comprise an isolated stage of patient 1520 in communication with a non-isolated stage 1540 by means of a power transformer 1560. A secondary winding 1580 of power transformer 1560 is contained in isolated stage 1520 and can comprise a bypass configuration (for example, a central bypass or non-central bypass configuration) for defining the drive signal outputs 1600a, 1600b, 1600c to provide output drive signals to different surgical devices, such as an ultrasonic surgical device 1104 and an electrosurgical device 1106. In particular, the trigger signal outputs 1600a, 1600b and 1600c can provide a trigger signal (for example, a 420V RMS trigger signal) ) to an ultrasonic instrument 1104, and the trigger signal outputs 1600a, 1600b and 1600c can provide a trigger signal (for example, a trigger signal then at 100V RMS) to an electrosurgical device 1106, with output 1600b corresponding to the central bypass of the power transformer 1560. The uninsulated stage 1540 can comprise a power amplifier 1620 that has an output connected to a primary winding 1640 of the power transformer. power 1560. In some respects, the 1620 power amplifier may comprise a push-pull amplifier, for example. The non-isolated stage 1540 can also comprise a programmable logic device 1660 to provide a digital output to a 1680 digital-to-analog converter (DAC) which, in turn, provides an analog signal corresponding to an input of the amplifier. power
[0258] [0258] Power can be supplied to a power rail of the 1620 power amplifier by a key mode regulator
[0259] [0259] In certain aspects and as discussed in further details with respect to Figures 25A to 25B, the programmable logic device 1660, in conjunction with the 1740 processor, can implement a control scheme with direct digital synthesizer ( DDS) to control the waveform, frequency and / or amplitude of the output of drive signals by generator 1100. In one aspect, for example, programmable logic device 1660 can implement a DDS 2680 control algorithm ( Figure 25A) through recovery
[0260] [0260] The non-isolated stage 1540 may additionally comprise an ADC 1780 and an ADC 1800 coupled to the output of the power transformer 1560 by means of the respective isolation transformers, 1820 and 1840, to respectively sample the voltage and the current of trigger signals emitted by generator 1100. In certain aspects, ADCs 1780 and 1800 can be configured for high speed sampling (for example, 80 Msps) to enable over-sampling of the trigger signals. In one aspect, for example, the sampling speed of ADCs 1780 and 1800 can enable an oversampling of approximately 200X (depending on the trigger frequency) of the trigger signals. In certain aspects, the sampling operations of ADCs 1780, 1800 can be performed by a single ADC receiving input voltage and current signals through a bidirectional multiplexer. The use of high-speed sampling in the aspects of the 1100 generator can make it possible, among other things, to calculate the complex current flowing through the branch of movement (which can be used in certain aspects to implement waveform control based on DDS described above), accurate digital filtering of the sampled signals, and calculating the actual energy consumption with a high degree of accuracy. The output of voltage and current feedback data by ADCs 1780 and 1800 can be received and processed (for example, FIFO buffering, multiplexing) by the 1660 programmable logic device and stored in data memory for subsequent retrieval, for example, by 1740 processor. As noted above, feedback data on voltage and current can be used as input to an algorithm for pre-
[0261] [0261] In certain respects, feedback data about voltage and current can be used to control the frequency and / or amplitude (for example, current amplitude) of the drive signals. In one aspect, for example, voltage and current feedback data can be used to determine the impedance phase, for example, the phase difference between voltage and current trigger signals. The frequency of the trigger signal can then be controlled to minimize or reduce the difference between the determined impedance phase and an impedance phase setpoint (eg 0º), thereby minimizing or reducing the effects of harmonic distortion and , correspondingly, accentuating the accuracy of the impedance phase measurement. The determination of phase impedance and a frequency control signal can be implemented in the 1740 processor, for example, with the frequency control signal being supplied as input to a DDS control algorithm implemented by the device programmable logic 1660.
[0262] [0262] The impedance phase can be determined using Fourier analysis. In one aspect, the phase difference between the trigger signals for the generated voltage V, (t) and the generated current Ila (t) can be determined using the fast Fouri-
[0263] [0263] The evaluation of the Fourier transform in the sinusoid frequency produces: A:. Cow) = 2 5 (0) expGig,) arg V (fo) = q. 4; Tae) == (0) exp (iq2) arg 1 (fo) = 4,
[0264] [0264] Other approaches include weighted minimum square estimation, Kalman filtering and space and vector based techniques. Virtually all processing in an FFT or DFT technique can be carried out in the digital domain with the aid of two-channel high-speed ADC, 1780.1800, for example. In one technique, samples of digital signals from voltage and current signals are transformed from Fourier with an FFT or DFT. The angle of phase q at any point in time can be calculated by: pq = 21nft + qo, where q is the phase angle, f is the frequency, t is the time and qo is the phase not = 0.
[0265] [0265] Another technique to determine the phase difference between the voltage Va (t) and current / 7 (t) signals is the zero-crossing method and produces highly accurate results. For voltage signals Va (t) and current / 7 (t) having the same, each pass through zero from negative to positive voltage signal Va (t) above.
[0266] [0266] Other techniques for determining the phase difference between voltage and current signals include Lissajous figures and image monitoring; methods such as the three voltmeter method, the "crossed-coil" method, the vector voltmeter and vector impedance methods; and the use of standard phase instruments, phase-locked loops, and other techniques as described in Phase Measurement, Peter O'Shea, 2000 CRC Press LLC, <http: // www.engnetbase. com>, which is incorporated here as a reference.
[0267] [0267] In another aspect, for example, the current feedback data can be monitored in order to maintain the current amplitude of the drive signal at a current amplitude setpoint. The current amplitude set point can be specified directly or indirectly determined based on the specified set points for voltage and power amplitude. In certain aspects, the control of the current amplitude can be implemented by the control algorithm, such as a proportional-integral-derivative control algorithm (PID), in the 1740 processor. The variables controlled by the control algorithm to properly control - the current amplitude of the drive signal may include, for example, the scaling of the LUT waveform samples stored in the 1660 programmable logic device and / or the full-scale output voltage of the 1680 DAC (which provides input to the 1620 power amplifier) via an 1860 DAC.
[0268] [0268] The non-isolated stage 1540 may also contain a 1900 processor to provide, among other things, the functionality of the user interface (UI). In one aspect, the 1900 processor may comprise an Atmel AT91 SAM9263 processor with an ARM 926EJ-S core, available from Atmel Corporation, of San Jose, California, USA, for example. Examples of UI functionality supported by the 1900 processor may include audible and visual feedback from the user, communication with peripheral devices (for example, via a universal serial bus interface (USB)), communication with the 1430 foot switch, communication with a 2150 data input device (for example, a touch screen) and communication with a 2140 output device (for example, a speaker). The 1900 processor can communicate with the 1740 processor and the programmable logic device (for example, via serial peripheral interface (SPI) buses). Although the 1900 processor can primarily support Ul functionality, it can also coordinate with the processor
[0269] [0269] In certain aspects, both the 1740 processor (Figures 23, 24A) and the 1900 processor (Figures 23, 24B) can determine and monitor the operational status of the 1100 generator. For the 1740 processor, the operational status of the 1100 generator can determine, for example, which control and / or diagnostic processes are implemented by the 1740 processor. For the 1900 processor, the operating status of generator 1100 can determine, for example, which elements of a user interface ( eg monitor screens, sounds) are presented to a user. The 1740 and 1900 processors can independently maintain the current operational status of the 1100 generator, as well as recognize and evaluate possible transitions out of the current operational state. The 1740 processor can act as the master in this relationship, and can determine when transitions between operational states should occur. The 1900 processor can be aware of the valid transitions between operational states, and can confirm whether a particular transition is suitable. For example, when processor 1740 instructs processor 1900 to transition to a specific state, processor 1900 can verify that the requested transition is valid. If a requested transition between states is determined to be invalid by processor 1900, processor 1900 may cause generator 1100 to enter a fault mode.
[0270] [0270] The non-isolated stage 1540 may further comprise a 1960 controller (Figures 23, 24B) for monitoring the 2150 input devices (for example, a capacitive touch sensor used to turn the generator 1100 on and off, a capacitive screen touch sensitive). In certain aspects, the 1960 controller may comprise at least one processor and / or another controller device in communication with the 1900 processor. In one aspect, for example, the 1960 controller may comprise a processor (for example, a Mega168 8 bits available from Atmel) configured to monitor the inputs provided by the user through one or more capacitive touch sensors. In one aspect, the 1960 controller can comprise a touchscreen controller (for example, a QT5480 touchscreen controller available from Atmel) to control and manage touch data capture from a capacitive sensitive screen to the touch.
[0271] [0271] In certain respects, when generator 1100 is in an "off" state, controller 1960 may continue to receive operational power (for example, via a line from a generator 1100 power source, as the source power supply 2110 (Figure 23) discussed below). In this way, the 1960 controller can continue to monitor a 2150 input device (for example, a capacitive touch sensor located on a front panel of generator 1100) to turn generator 1100 on and off. When generator 1100 is in the state "off", the 1960 controller can wake up the power supply (for example, enable the operation of one or more DC / DC voltage converters 2130 (Figure 23) of the power supply 2110), if the activation of the 2150 "on / off" input by a user. Controller 1960 can therefore initiate a sequence to transition generator 1100 to an "on" state. On the other hand, the 1960 controller can initiate a sequence to transition from generator 1100 to the off state if activation of the "free" input device is detected.
[0272] [0272] In certain respects, the 1960 controller can cause the 1100 generator to provide audible feedback or other sensory feedback to alert the user that an on or off sequence has started. This type of alert can be provided at the beginning of an on or off sequence, and before the start of other processes associated with the sequence.
[0273] [0273] In certain respects, isolated stage 1520 may comprise an 1980 instrument interface circuit to, for example, offer a communication interface between a control circuit of a surgical device (for example, a control circuit that includes cable switches) and components of the non-isolated stage 1540, such as the programmable logic device 1660, the processor 1740 and / or the processor 1900. The interface circuit of the 1980 instrument can exchange information with components of the non-isolated stage 1540 through a communication link that maintains an adequate degree of electrical isolation between stages 1520 and 1540 such as, for example, an infrared (IR) "infrared" communication link. Power can be supplied to the 1980 instrument interface circuit using, for example, a low drop voltage regulator powered by an isolation transformer driven from the 1540 non-isolated stage.
[0274] [0274] In one aspect, the 1980 instrument interface circuit may comprise a programmable logic device 2000 (for example, an FPGA) in communication with a 2020 signal conditioning circuit (Figure 23 and Figure 24C). The signal conditioning circuit 2020 can be configured to receive a periodic signal from the programmable logic device 2000 (for example, a 2 kHz square wave) to generate a bipolar interrogation signal that has an identical frequency. The question mark can be generated, for example, using a source of bipolar current fed by a differential amplifier. The question mark can be communicated to a control circuit of the surgical device (for example, using a conductor pair on a cable that connects the 1100 generator to the surgical device) and monitored to determine a state or configuration of the circuit of control. The control circuit can comprise numerous switches, resistors and / or diodes to modify one or more characteristics (for example, amplitude, rectification) of the question mark so that a state or configuration of the control circuit is discernible, so unambiguous, based on this one or more characteristics. In one aspect, for example, the signal conditioning circuit 2020 may comprise an ADC for generating samples of a voltage signal appearing between inputs of the control circuit, resulting from the passage of the interrogation signal through it. The programmable logic device 2000 (or a non-isolated stage component 1540) can then determine the status or configuration of the control circuit based on the ADC samples.
[0275] [0275] In one aspect, the instrument interface circuit 1980 can comprise a first data circuit interface 2040 to enable the exchange of information between the programmable logic device 2000 (or another element of the instrument interface circuit) 1980) and a first data circuit disposed in, or otherwise associated with, a surgical device. In some respects, for example, a first 2060 data circuit may be arranged on a wire integrally attached to a handle of the surgical device, or on an adapter to interface between a specific type or model of surgical device and the 1100 generator. In certain aspects, the first data circuit may comprise a non-volatile storage device, such as an electrically erasable programmable read-only memory device (EEPROM). In certain aspects and again with reference to Figure 23, the first data loop interface 2040 can be implemented separately from the programmable logic device 2000 and comprises a suitable set of circuits (for example, separate logic devices, a program to enable communication between programmable logic device 2000 and the first data circuit. In other respects, the first 2040 data circuit interface can be integral to the programmable logic device 2000.
[0276] [0276] In some respects, the first 2060 data circuit can store information related to the specific surgical device with which it is associated. This information may include, for example, a model number, a serial number, a number of operations in which the surgical device was used, and / or any other types of information. This information can be read by the interface circuit of the 1980 instrument (for example, the programmable logic device 2000), transferred to a non-isolated stage component 1540 (for example, to the programmable logic device 1660, processor 1740 and / or processor 1900) for presentation to a user by means of an output device 2140 and / or to control a function or operation of the 1100 generator. In addition, any type of information can be communicated to the first circuit data loop 2060 for storage in it via the first interface of the data loop 2040 (for example, using the programmable logic device 2000). This information may include, for example, an updated number of operations in which the surgical device was used and / or the dates and / or times of its use.
[0277] [0277] As discussed earlier, a surgical instrument can be removable from a handle (for example, the instrument 1106 can be removable from the handle 1107) to promote interchangeability and / or disposability of the instrument. In these cases, known generators may be limited in their ability to recognize specific instrument configurations being used, as well as to optimize the control and diagnostic processes as needed. The addition of readable data circuits to surgical device instruments to resolve this issue is problematic from a compatibility point of view, however. For example, it may be impractical to design a surgical device so that it remains compatible with previous versions of generators that lack the indispensable data reading functionality due to, for example, different signaling schemes, design complexity and cost. Other aspects of the instruments address these concerns through the use of data circuits that can be implemented in existing surgical instruments, economically and with minimal design changes to preserve the compatibility of surgical devices with current generator platforms.
[0278] [0278] Additionally, aspects of the 1100 generator can enable communication with instrument-based data circuits. For example, generator 1100 can be configured to communicate with a second data circuit (for example, a data circuit) contained in an instrument (for example, instrument 1104, 1106, or 1108) of a surgical device. The instrument interface circuit 1980 can comprise a second data circuit interface 2100 to enable such communication. In one respect,
[0279] [0279] In certain respects, the second data circuit and the second data circuit interface 2100 can be configured so that communication between programmable logic device 2000 and the second data circuit can be achieved without the need for provide additional conductors for this purpose (for example, dedicated conductors from a cable that connects a handle to the 1100 generator). In one aspect, for example, information can be communicated to and from the second data circuit using a wire bus communication scheme, implemented in the existing wiring, as one of the conductors used transmitting signals marks from the signal conditioning circuit 2020 to a control circuit on a cable. In this way, changes or modifications to the design of the surgical device that may otherwise be necessary are minimized or reduced. In addition, due to the fact that different types of communications can be implemented on a common physical channel (with or without frequency band separation), the presence of a second data circuit can be "invisible" to generators that are not. they have the indispensable functionality of reading data, which, therefore, allows the backward compatibility of the surgical device instrument.
[0280] [0280] In certain aspects, the isolated stage 1520 may comprise at least one blocking capacitor 2960-1 (Figure 24C) connected to the output of the drive signal 1600b, to prevent the passage of direct current to a patient. A single blocking capacitor may be required to comply with medical regulations and standards, for example. Although failures in single-capacitor designs are relatively uncommon, such failures can still have negative consequences. In one aspect, a second 2960-2 blocking capacitor can be placed in series with the 2960-1 blocking capacitor, with one point current leakage between the 2960-1 and 2960-2 blocking capacitors being monitored by , for example, an ADC 2980 for sampling a voltage induced by the leakage current. Samples can be received by the programmable logic device 2000, for example. Based on changes in leakage current (as indicated by the voltage samples in the aspect of Figure 23), generator 1100 can determine when at least one of the blocking capacitors 2960-1 and 2960-2 has failed. Consequently, the appearance of Figure 23 can provide a benefit
[0281] [0281] In certain respects, the non-isolated stage 1540 may comprise a power supply 2110 for DC power output with adequate voltage and current. The power supply may comprise, for example, a 400 W power supply to provide a system voltage of 48 VDC. As discussed above, the 2110 power supply can additionally comprise one or more 2130 DC / DC voltage converters to receive the power supply output to generate DC outputs at the voltages and currents required by the various components of the 1100 generator. As discussed above in relation to the 1960 controller, one or more of the 2130 DC / DC voltage converters can receive an input from the 1960 controller when the activation of the 2150 "on / off" input device by a user is detected by the user. 1960 controller, to enable the 2130 DC / DC voltage converters to function or wake up.
[0282] [0282] Figures 25A and 25B illustrate certain functional and structural aspects of an aspect of generator 1100. The feedback indicating current and voltage output of secondary winding 1580 of power transformer 1560 is received by ADCs 1780 and 1800, respectively. As shown, ADCs 1780 and 1800 can be implemented in the form of a 2-channel ADC and can take samples of the feedback signals at high speed (for example, 80 Msps) to enable oversampling (for example, approximately 200x oversampling) of the trigger signals. Current and voltage feedback signals can be properly conditioned in the analog domain (for example, amplified, filtered) before processing by ADCs 1780 and
[0283] [0283] The multi-plexed voltage and current feedback samples can be received by a parallel data capture port (PDAP) implemented inside the processor block 2144
[0284] [0284] Block 2200 of the 1740 processor can implement a pre-distortion algorithm to pre-distort or modify the LUT samples stored in the programmable logic device 1660 in a dynamic and continuous way. As discussed above, the pre-distortion of the LUT samples can compensate for various sources of distortion present in the output drive circuit of the 1100 generator. The pre-distorted LUT samples, when processed through the drive circuit, will therefore result , in a drive signal having the desired waveform (for example, sinusoidal) to activate the ultrasonic transducer optimally.
[0285] [0285] In block 2220 of the pre-distortion algorithm, the current is determined through the moving branch of the ultrasonic transducer. The current of the branch in motion can be determined using the Kirchoff current law based, for example, on the current and voltage feedback information stored at the memory location 2180 (which, when properly sized, can be representative of lg and Vg in the model of Figure 22 discussed above), a value of the static capacitance of the ultrasonic transducer Co (measured or known a priori) and a known value of the drive frequency. A sample of current from the movement branch can be determined for each set of stored current and voltage feedback reports associated with a LUT sample.
[0286] [0286] In block 2240 of the pre-distortion algorithm, each current sample of the branch in motion determined in block 2220 is compared to a sample of a desired current waveform to determine a difference, or amplitude error, of the current. sample, between the compared samples. For this determination, the sample of the desired current waveform can be provided, for example, from a LUT 2260 waveform containing amplitude samples for a cycle of a desired current waveform . The specific sample of the current waveform desired from the LUT 2260 used for the comparison can be determined by the LUT sample address associated with the current branch current sample used in the comparison. As needed, the current input from the moving branch in block 2240 can be synchronized with the entry of its associated LUT sample address in block 2240. The LUT samples stored in the 1660 programmable logic device and the LUTs stored in the 2260 waveform LUT can therefore be equal in number. In some respects, the desired current waveform, represented by the LUT samples stored in the 2260 waveform LUT, can be a fundamental sine wave. Other waveforms may be desirable. For example, it is contemplated that a fundamental sine wave could be used to trigger the main longitudinal movement of an ultrasonic transducer, superimposed on one or more other triggering signals at other frequencies, such as a third order ultrasonic to trigger at least two mechanical resonances in order to obtain beneficial vibrations in transverse or other modes.
[0287] [0287] Each value of the sample amplitude error determined in block 2240 can be transmitted to the LUT of programmable logic device 1660 (shown in block 2280 in Figure 25A) together with an indication of its associated LUT address. Based on the value of the amplitude error sample and its associated address (and, optionally, the values of the amplitude error sample for the same LUT address previously received), the LUT 2280 (or other device control block) 1660 programmable logic) can pre-
[0288] [0288] Current and voltage amplitude measurements, power measurements and impedance measurements can be determined in block 2300 of the 1740 processor, based on the current and voltage feedback samples stored in the memory location. 2180. Before determining these quantities, the feedback samples can be appropriately sized and, in certain aspects, processed through a suitable 2320 filter to remove the noise resulting, for example, from the data capture process and the harmonic components induced. The filtered voltage and current samples can therefore substantially represent the fundamental frequency of the generator drive output signal. In certain respects, the 2320 filter can be a finite impulse response filter (FIR) applied in the frequency domain. These aspects can use the fast Fourier transform (FFT) of the current and voltage output signals of the drive signal. In some respects, the resulting frequency spectrum can be used to provide additional functionality to the generator. In one aspect, for example, the ratio of the second and / or third order harmonic component to the fundamental frequency component can be used as a diagnostic indicator.
[0289] [0289] In block 2340 (Figure 25B), a calculation of mean square value (RMS) can be applied to a sample size of the samples.
[0290] [0290] In block 2360, an average square value (RMS) calculation can be applied to a sample size of the voltage feedback samples representing an integral number of trigger signal cycles, to determine a Vrms measurement representing the output voltage of the trigger signal. In block 2380, the current and voltage feedback samples can be multiplied point by point, and an average calculation is applied to the samples representing an integral number of cycles of the drive signal, to determine a Pr measurement of the output energy generator.
[0291] [0291] In block 2400, the measurement P, that of the apparent output power of the generator can be determined as the product Vrms'lrms-
[0292] [0292] In block 2420, the measurement Zm of the magnitude of the load impedance can be determined as the quotient Vrms / lrms.
[0293] [0293] In certain respects, the quantities ltms, Vrms, Pr, Pa & Zm determined in blocks 2340, 2360, 2380, 2400 and 2420, can be used by generator 1100 to implement any of a number of control and / or processes diagnostics. In certain aspects, any of these quantities can be communicated to a user through, for example, an output device 2140 Integral to the generator 1100, or an output device 2140 connected to the generator 1100 through an appropriate communication interface ( for example, a USB interface). The various diagnostic processes can include, without limitation, cable integrity, instrument integrity, instrument fixation integrity, instrument overload, instrument overload proximity, frequency locking failure, over voltage condition, over current condition, over power condition, voltage sensor failure,
[0294] [0294] Block 2440 of the 1740 processor can implement a phase control algorithm for determining and controlling the impedance phase of an electrical charge (for example, the ultrasonic transducer) conducted by the 1100 generator. As discussed above, when controlling the frequency of the trigger signal to minimize or reduce the difference between the determined impedance phase and an impedance phase adjustment point (eg 0º), the effects of harmonic distortion can be minimized or reduced, and increased accuracy in phase measurement.
[0295] [0295] The phase control algorithm receives the current and voltage feedback samples stored in memory location 2180 as input. Before being used in the phase control algorithm, the feedback feedback samples can be appropriately sized and, in certain aspects, processed through a suitable filter 2460 (which can be identical to the filter 2320) to remove the noise resulting from the data capture process and the induced harmonic components, for example. The filtered voltage and current samples can therefore substantially represent the fundamental frequency of the generator drive output signal.
[0296] [0296] In block 2480 of the phase control algorithm, the current is determined through the moving branch of the ultrasonic transducer. This determination can be identical to that described above with respect to block 2220 of the pre-distortion algorithm. Thus, the output of block 2480 can be, for each set of stored current and voltage feedback information, associated with a LUT sample, a current sample of the branch in motion.
[0297] [0297] In block 2500 of the phase control algorithm, the impedance phase is determined based on the synchronized input of samples from the branching current in motion determined in block 2480 and corresponding to voltage feedback samples. In some respects, the impedance phase is determined as the average between the impedance phase measured at the rising edge of the waveforms and the impedance phase measured at the falling edge of the waveforms.
[0298] [0298] In block 2520 of the phase control algorithm, the impedance phase value determined in block 2220 is compared to the set point of phase 2540 to determine a difference, or error of phase, between the compared values.
[0299] [0299] In block 2560 (Figure 25A) of the phase control algorithm, based on a phase error value determined in block 2520 and the impedance magnitude determined in block 2420, a frequency output is determined to control the frequency of the trigger signal. The value of the frequency output can be continuously adjusted by block 2560 and transferred to a DDS 2680 control block (discussed below) in order to maintain the impedance phase determined in block 2500 at the phase setpoint. (for example, zero phase error). In some respects, the impedance phase can be set to a phase setpoint of 0º. In this way, any harmonic distortion will be centered around the crest of the voltage waveform, accentuating the accuracy of the determination of the phase impedance.
[0300] [0300] Block 2580 of the 1740 processor can implement an algorithm for modulating the current amplitude of the drive signal, in order to control the current, voltage and power of the drive signal, according to adjustment specified by the user, or according to requirements specified by other processes or algorithms implemented by the 1100 generator. The control of these quantities can be carried out, for example, by measuring the LUT samples in the LUT 2280 and / or by adjusting of the full-scale output voltage of the DAC 1680 (which provides input to the 1620 power amplifier) via a DAC 1860. Block 2600 (which can be implemented as a PID controller in certain respects) can receive samples of current feedback (which can be properly sized and filtered) from memory location 2180. Current feedback samples can be compared to the "demand p" value or current "lg determined by the controlled variable (for example, current, voltage or power) to determine whether the trigger signal is supplying the required current. In aspects where the drive signal current is the control variable, the demand for current la can be specified directly by a current setpoint 2620A (ls5). For example, an RMS value of the current feedback data (determined as in block 2340) can be compared to the RMS | s current setpoint, specified by the user to determine the appropriate action for the controller. If, for example, the current feedback data indicates a lower RMS value than the current sp setpoint, LUT dimensioning and / or full-scale output voltage of the DAC 1680 can be adjusted by block 2600, so that the current of the trigger signal is increased. On the other hand, block 2600 can adjust a LUT dimensioning and / or the full-scale output voltage of the DAC 1680 to decrease the trigger signal current when the current feedback data indicates a RMS value greater than the current set point | lsp.
[0301] [0301] In aspects where the drive signal voltage is the control variable, the current demand Id can be specified indirectly, for example, based on the current required to maintain a desired voltage reference value 2620B (Vsp) given the magnitude of load impedance Zm measured in block 2420 (for example, la = Vsp / Zm). Likewise, in aspects where the signal strength of the inverter is the control variable, the current demand can be specified indirectly, for example, based on the current required to maintain a desired power setpoint 2620C (Psp) given the voltage Vms measured in blocks 2360 (for example, la = Psp / Vrms).
[0302] [0302] Block 2680 (Figure 25A) can implement a DDS control algorithm to control the trigger signal by recovering LUT samples stored in LUT 2280. In certain aspects, the DDS control algorithm can be an algorithm numerically-controlled oscillator (NCO) to generate samples of a waveform at a fixed timing rate using a jump-point technique (locations in memory). The NCO algorithm can implement a phase accumulator or frequency to phase converter, which functions as an address indicator for retrieving LUT samples from the LUT 2280. In one aspect, the phase accumulator can be a step size step D, module N, where D is a positive integer representing a frequency control value, and N is the number of LUT samples in LUT 2280. A frequency control value D = 1, for example, it can cause the phase accumulator to point sequentially to each LUT 2280 address, resulting in a waveform output that replicates the waveform stored in LUT 2280. When D> 1, the phase accumulator can skip addresses on the LUT 2280, resulting in a waveform output that has a higher frequency. Therefore,
[0303] [0303] Block 2700 of the 1740 processor can implement a switch mode converter control algorithm to dynamically modulate the 1620 power amplifier rail voltage based on the signal waveform envelope being amplified, thereby improving efficiency of the 1620 power amplifier. In certain respects, the characteristics of the waveform envelope can be determined by monitoring one or more signals contained in the 1620 power amplifier. In one aspect, for example, the characteristics of the waveform envelope. wave can be determined by monitoring the minimum of a drain voltage (for example, a MOSFET drain voltage) that is modulated according to the amplified signal envelope. A minimum voltage signal can be generated, for example, by a voltage minimum detector coupled to the drain voltage. The minimum voltage signal can be sampled by the ADC 1760, with samples of the minimum voltage output being received in block 2720 of the switching mode converter control algorithm. Based on the values of the minimum voltage samples, the 2740 block can control a PWM signal output by a 2760 PWM generator, which in turn controls the rail voltage supplied to the 1620 power amplifier by the mode regulator. 1700 switching. In certain aspects, as long as the values of the minimum voltage samples are less than a target input for the minimum 2780 in block 2720, the voltage on the rail can be modulated according to the waveform envelope , as characterized by the minimum voltage samples. When the minimum voltage samples indicate low levels of envelope power, for example, block 2740 can cause a low voltage on the rail to be supplied to the 1620 power amplifier, with the total rail voltage being supplied only when the minimum voltage samples indicate maximum envelope power levels. When the voltage samples from the minimum fall below the target to the minimum 2780, the 2740 block can keep the rail voltage at an adequate minimum value to ensure the proper operation of the power amplifier.
[0304] [0304] Figure 26 is a schematic diagram of an aspect of a 2900 electrical circuit, suitable for driving an ultrasonic transducer, such as the 1120 ultrasonic transducer, in accordance with at least one aspect of the present disclosure. The 2900 electrical circuit comprises a 2980 analog multiplexer. The 2980 analog multiplexer multiplexes several signals from the SCL-A, SDA-A upstream channels, such as ultrasonic, battery and power control circuits. A 2982 current sensor is connected in series to the return or ground leg of the power supply circuit to measure the current supplied by the power supply. A 2984 field effect transistor (FET) temperature sensor provides the ambient temperature. A 2988 pulse width modulation (PWM) surveillance timer automatically generates a system restart if the main program periodically fails to repair it. It is provided to automatically restart the 2900 electrical circuit when it crashes or freezes due to a software or hardware failure. It will be recognized that the 2900 electrical circuit can be
[0305] [0305] A 2986 drive circuit provides left and right ultrasonic power outputs. A digital signal representing the signal waveform is supplied to the SCL-A, SDA-A inputs of the 2980 analog multiplexer from a control circuit, such as the 3200 control circuit (Figure 27). A 2990 digital to analog converter (DAC) converts the digital input to an analog output to generate a 2992 pulse width modulation circuit coupled to a 2994 oscillator. The 2992 pulse width modulation circuit provides a first signal for a first 2996a gate triggering circuit coupled to a first output stage of transistor 2998a to drive a first ultrasonic energy output (left). The 2992 pulse width modulation circuit also provides a second signal for a second 2996b gate drive circuit coupled to a second output stage of transistor 2998b to drive a second ultrasonic (right) power output. A 2999 voltage sensor is coupled between the left / right ultrasonic output terminals to measure the output voltage.
[0306] [0306] Figure 27 is a schematic diagram of a 3200 control circuit, like the 3212 control circuit, according to at least one aspect of the present disclosure. The 3200 control circuit is located inside a battery pack compartment. The battery pack is the power source for a variety of local 3215 power supplies. The control circuit comprises a 3214 main processor coupled via a 3218 interface master to various circuits downstream via the SCL-A and SDA-A, SCL-B and SDA-B, SCL-C and SDA-C, for example. In one aspect, the 3218 interface master is a general purpose serial interface, like an I2C serial interface. The 3214 main processor is also configured to trigger the 3224 switches via general purpose input / output (GPIO) 3220, a 3226 screen (for example, an LCD screen), and several 3228 indicators via GPIO 3222. One 3216 surveillance processor is provided to control the 3214 main processor. A 3230 switch is supplied in series with a 3211 battery to activate the 3212 control circuit by inserting the battery pack into an instrument handle set surgical.
[0307] [0307] In one aspect, the 3214 main processor is coupled to the 2900 electrical circuit (Figure 26) via output terminals
[0308] [0308] In one aspect, the 3214 main processor may be an LM 4F230H5QR, available from Texas Instruments, for example. In at least one example, the Texas Instruments LM4F230H5QR is an ARM Cortex-M4F processor core comprising an integrated 256 KB single-cycle flash memory, or other non-volatile memory, up to 40 MHz, a transfer buffer to optimize performance above 40 MHz, a 32 KB single cycle serial random access memory (SRAM), internal read-only memory (ROM) loaded with the StellarisWareO program, memory only 2 KB electrically erasable and programmable readout (EEPROM), one or more pulse width modulation (PWM) modules, one or more analog quadrature encoder (QED) inputs, one or more analog to digital converters (ADC) ) 12-bit with 12 analog input channels, among other features that are readily available in the product data sheet. Other processors can be easily replaced and, therefore, the present disclosure should not be limited in this context.
[0309] [0309] Figure 28 shows a simplified circuit block diagram that illustrates another 3300 electrical circuit contained within a 3334 modular ultrasonic surgical instrument, in accordance with at least one aspect of the present disclosure. The 3300 electrical circuit includes a 3302 processor, a 3330 clock, a 3326 memory, a 3304 power supply (for example, a battery), a 3306 switch, such as a semiconductor metal oxide field effect transistor power switch ( MOSFET), a drive circuit 3308 (PLL), a transformer 3310, a signal smoothing circuit 3312 (also called a correspondence circuit and can be, for example, a tank circuit), a detection circuit 3314, a 1120 transducer, and a drive shaft assembly (for example, drive shaft assembly 1126, 1129) comprising an ultrasonic transmission waveguide that ends in an ultrasonic blade (for example, ultrasonic blade 1128, 1149) which can be called, in the present invention, simply a waveguide.
[0310] [0310] A feature of the present disclosure that stops reliance on high voltage input energy (120 VAC) (a feature of general ultrasonic cut-off devices) is the use of low voltage switching throughout the entire process waveform and amplification of the drive signal just directly before the transformer stage. For that reason, in one aspect of the present disclosure, the energy is derived from just one battery, or a group of batteries, small enough to fit inside a handle assembly. State-of-the-art battery technology provides powerful batteries a few centimeters high and wide and a few millimeters deep. By combining the features of the present disclosure to provide a self-contained, self-powered ultrasonic device, a reduction in production cost can be achieved.
[0311] [0311] The output of the 3304 power supply is fed to the 3302 processor and energizes it. The 3302 processor receives and sends signals and, as will be described below, works according to custom logic or according to computer programs that are run by the 3302 processor. As discussed above, the 3300 electrical circuit can also include a memory 3326, preferably, a random access memory (RAM) that stores instructions and data readable by computer.
[0312] [0312] The power supply output 3304 is also directed to switch 3306 having a duty cycle controlled by processor 3302. By controlling the dwell time of switch 3306, processor 3302 is able to determine the total amount of energy that is ultimately supplied to the 1120 transducer. In one aspect, key 3306 is a MOSFET, although other key and switch configurations are also adaptable. The output of switch 3306 is fed to a drive circuit 3308 that contains, for example, a phase-to-phase detection circuit (PLL) and / or a low-pass filter and / or a voltage-controlled oscillator. The key output 3306 is sampled by processor 3302 to determine the voltage and current of the output signal (Vin and li, respectively). These values are used in a feedback architecture to adjust the pulse width modulation of the 3306 switch. For example, the duty cycle of the 3306 switch can vary from about 20% to about 80%, depending on the desired output. and actual value of key 3306.
[0313] [0313] The drive circuit 3308, which receives the signal from the key 3306, includes an oscillatory circuit that transforms the output of the switch 3306 into an electrical signal that has an ultrasonic frequency, for example, 55 kHz (VCO). As explained above, a smoothed version of this ultrasonic waveform is ultimately fed to the 1120 ultrasonic transducer to produce a resonating sine wave along the ultrasonic transmission waveguide.
[0314] [0314] At the output of drive circuit 3308 there is a transformer 3310 that is capable of raising the low voltage signal (s) to a higher voltage. It is observed that the upstream switching, before the 3310 transformer, is carried out at low voltages (for example, battery operated), something that, until now, was not possible for ultrasonic devices for cutting and cauterization. This is at least partially due to the fact that the device advantageously uses low-resistance MOSFET switching devices. Low-resistance MOSFET switches are advantageous, as they produce less switching losses and less heat than a traditional MOSFET device and allow greater current to pass through. Therefore, the switching stage (pre-transformer) can be characterized as low voltage / high current. To ensure the lowest resistance of the amplifier's MOSFET (s), the MOSFET (s) is (are) run, for example, at 10 V. In this case, a 10 VDC power supply separate can be used to power the MOSFET port, which ensures that the MOSFET is fully switched on and that a reasonably low resistance is achieved. In one aspect of the present disclosure, the 3310 transformer raises the battery voltage to 120 V average square value (RMS). Transformers are known in the art and are therefore not explained in detail here.
[0315] [0315] In the described circuit configurations, degradation of the circuit component can negatively affect the circuit performance of the circuit. One factor that directly affects the performance of the component is heat. Known circuits generally monitor switching temperatures (ie, MOS-FET temperatures). However, due to technological advances in MOSFET projects and due to the corresponding reduction in size, MOSFET temperatures are no longer a valid indicator of loads and heat in the circuit. For this reason, according to at least one aspect of the present disclosure, a 3314 detection circuit detects the temperature of the 3310 transformer. This temperature detection is advantageous, as the 3310 transformer is operated at its bad temperature - close to or very close to it when using the device. The additional temperature will cause the core material, for example, the ferret, to rupture and permanent damage may occur. The present disclosure can respond to a maximum temperature of the 3310 transformer, for example, by reducing the drive energy in the 3310 transformer, signaling the user, turning off the power, pulsing the energy or by means of other appropriate responses.
[0316] [0316] In one aspect of the present disclosure, the 3302 processor is communicatively coupled to the end actuator (eg 1122, 1125) which is used to bring the material into physical contact with the ultrasonic blade (eg 1128, 1149). Sensors are provided that measure, on the end actuator, a clamping force value (existing within a known range) and, based on the received clamping force value, processor 3302 varies the moving voltage Vu. Since high force values, combined with a defined rate of movement, can result in high blade temperatures, a 3332 temperature sensor can be communicatively coupled to the 3302 processor, with the 3302 processor being operable to receive and interpret a signal that indicates a current blade temperature from the 3336 temperature sensor and to determine a target blade movement frequency based on the received temperature. In another aspect, we feel
[0317] [0317] According to at least one aspect of the present disclosure, the PLL portion of the drive circuit 3308, which is coupled to the processor 3302, is capable of determining a waveform movement frequency and communicating that frequency to processor 3302. Processor 3302 stores this frequency value in memory 3326 when the device is turned off. By reading clock 3330, processor 3302 is able to determine a time elapsed after the device is turned off and to retrieve the last waveform movement frequency if the elapsed time is less than a predetermined value. The device can then start at the last frequency, which, presumably, is the ideal frequency for the current load.
[0318] [0318] In another aspect, the present disclosure provides a modular, battery-powered surgical hand instrument with multistage generating circuits. A surgical instrument is revealed that includes a battery set, a handle set, and a drive shaft set, the battery set and the drive shaft set being configured to mechanically and electrically connect the handle set. The battery pack includes a control circuit configured to generate a digital waveform. The grip set includes a first stage circuit configured to receive the digital waveform, convert the digital waveform to an analog waveform and amplify the analog waveform. The drive shaft assembly includes a second stage circuit coupled to the first stage circuit to receive, amplify and apply the analog waveform to a load.
[0319] [0319] In one aspect, the present disclosure provides a surgical instrument, comprising: a battery pack, which comprises a control circuit comprising a battery, a memory coupled to the battery, and a processor attached to the memory and to the battery, the processor being configured to generate a digital waveform; a handle set comprising a first stage circuit coupled to the processor, the first stage circuit comprising a digital to analog converter (DAC) and a first amplifier stage circuit, the DAC being configured to receive the digital waveform and convert the digital waveform into an analog waveform, the first stage amplifier circuit being configured to receive and amplify the analog waveform; and a drive shaft assembly comprising a second stage circuit coupled to the first stage amplifier circuit to receive the analog waveform, amplify the analog waveform, and apply the analog waveform to a load; the battery set and the drive shaft set are configured to connect mechanically and electrically to the handle set.
[0320] [0320] The charge can comprise any of an ultrasonic transducer, an electrode or a sensor, or any combination thereof. The first stage circuit can comprise a first ultrasonic drive stage circuit and a first high frequency current drive stage circuit. The control circuit can be configured to drive the first ultrasonic drive stage circuit and the first high frequency current drive stage circuit, independently or simultaneously. The first ultrasonic drive stage circuit can be configured to couple with a second ultrasonic drive stage circuit. The second ultrasonic drive stage circuit can be configured to couple with an ultrasonic transducer. The first high-frequency current drive stage circuit can be configured to couple with a second high-frequency stage circuit. The second high frequency drive stage circuit can be configured to couple with an electrode.
[0321] [0321] The first stage circuit can comprise a first sensor drive stage circuit. The first sensor drive stage circuit can be configured to a second drive stage circuit. The second sensor drive stage circuit can be configured to couple with a sensor.
[0322] [0322] In another aspect, the present disclosure provides a surgical instrument, comprising: a battery pack, comprising a control circuit comprising a battery, a memory attached to the battery, and a processor attached to the memory and battery, and the processor is configured to generate a digital waveform; a handle set comprising a first common stage circuit coupled to the processor, the first common stage circuit comprising a digital to analog converter (DAC) and a first common stage amplifier circuit, the DAC being is configured to receive the digital waveform and convert the digital waveform into a
[0323] [0323] The charge can comprise any of an ultrasonic transducer, an electrode or a sensor, or any combination thereof. The first common stage circuit can be configured to drive ultrasonic, high frequency, or sensor circuits. The first common drive stage circuit can be configured to couple with a second ultrasonic drive stage circuit, a second high frequency drive stage circuit, or a second sensor drive stage circuit. The second ultrasonic drive stage circuit can be configured to couple with an ultrasonic transducer, the second high frequency drive stage circuit is configured to couple with an electrode, and the second sensor drive stage circuit is configured to attach to a sensor.
[0324] [0324] In another aspect, the present disclosure provides a surgical instrument, which comprises: a control circuit comprising a memory coupled to a processor, the processor being configured to generate a waveform digital; a handle set comprising a first common stage circuit coupled to the processor, the first common stage circuit configured to receive the digital waveform, convert the digital waveform into an analog waveform, and amplify the analog waveform; and a drive shaft assembly comprising a second stage circuit coupled to the first common stage circuit to receive and amplify the analog waveform; The drive shaft assembly is configured to connect mechanically and electrically to the handle assembly.
[0325] [0325] The first common stage circuit can be configured to drive ultrasonic, high frequency circuits or sensors. The first common drive stage circuit can be configured to couple with a second ultrasonic drive stage circuit, a second high frequency drive stage circuit, or a second sensor drive stage circuit. The second ultrasonic drive stage circuit can be configured to couple with an ultrasonic transducer, the second high frequency drive stage circuit is configured to couple with an electrode, and the second sensor drive stage circuit is configured to attach to a sensor.
[0326] [0326] Figure 29 illustrates a generator circuit 3400 divided into a first stage circuit 3404 and a second stage circuit 3406, in accordance with at least one aspect of the present disclosure. In one aspect, the surgical instruments of the surgical system 1000 described herein can comprise a 3400 generator circuit divided into multiple stages. For example, surgical instruments in the surgical system 1000 can comprise the generator circuit 3400 divided into at least two circuits: the first stage circuit 3404 and the second stage circuit 3406 of amplification allowing the operation of energy from RF only, ultrasonic energy only, and / or a combination of RF energy and ultrasonic energy. A combination 3414 modular drive shaft assembly is fed by the first common stage circuit 3404 located in a 3412 handle assembly and the second modular stage circuit 3406 integral with the modular drive shaft assembly
[0327] [0327] Turning now to Figure 29, the 3400 generator circuit is divided into multiple stages located in multiple modular assemblies of a surgical instrument, like the surgical instruments of the surgical system 1000 described here. In one aspect, a 3402 stage control circuit may be located in the 3410 battery pack of the surgical instrument. The 3402 stage control circuit is a 3200 control circuit as described with reference to Figure 27. The 3200 control circuit comprises a 3214 processor, which includes 3217 internal memory (Figure 29) (for example, volatile and non-volatile memory). volatile), and is electrically coupled to a battery
[0328] [0328] The first 3404 stage circuits (for example, the first 3420 ultrasonic drive stage circuit, the first RF drive stage circuit 3422, and the first sensor drive stage circuit 3424) are located on a 3412 handle set of the surgical instrument. The 3200 control circuit supplies the ultrasonic drive signal to the first 3420 ultrasonic drive stage circuit via the SCL-A, SDA-A outputs of the 3200 control circuit. The first 3420 ultrasonic drive stage circuit is described in detail with reference to Figure 26. The 3200 control circuit provides the RF drive signal for the first RF drive stage circuit 3422 through the SCL-B, SDA-B outputs of the control circuit 3200. The first RF 3422 drive stage circuit is described in detail with reference to Figure 31. The 3200 control circuit supplies the sensor trigger signal to the first 3424 sensor drive stage circuit through the SCL-C outputs, Control circuit SDA-C 3200. In general, each of the first 3404 stage circuits includes a digital to analog converter (DAC) and a first stage amplifier section to drive the second circuits stage 3406. The outputs of the first stage 3404 circuits are provided for the inputs of the second stage 3406 circuits.
[0329] [0329] The 3200 control circuit is configured to detect which modules are plugged into the 3200 control circuit. For example, the 3200 control circuit is configured to detect whether the first
[0330] [0330] In one aspect, the second 3406 stage circuit (for example, the second 3430 ultrasonic drive stage circuit, the second RF drive stage circuit 3432, and the second sensor drive stage circuit 3434) are located on the 3414 drive shaft assembly of the surgical instrument. The first 3420 ultrasonic drive stage circuit provides a signal to the second 3430 ultrasonic drive stage circuit via US-left / US-direct outputs. The second 3430 ultrasonic drive stage circuit is described in detail in connection with Figures 30 and 31. In addition to a transformer (Figures 30 and 31), the second 3430 ultrasonic drive stage circuit can also include a filter , amplifier, and signal conditioning circuits. The first high-frequency current (RF) stage circuit 3422 provides a signal for the second 3432 RF drive stage circuit via the left-RF / right-RF outputs. In addition to a transformer and blocking capacitors, the second acoustic stage circuit
[0331] [0331] In one aspect, the third stage 3408 circuits (for example, the 1120 ultrasonic transducer, the RF electrodes 3074a, 3074b, and the 3440 sensors) can be located in various 3416 sets of surgical instruments. In one aspect, the second 3430 ultrasonic drive stage circuit provides a trigger signal to the 1120 ultrasonic transducer piezoelectric battery. In one aspect, the 1120 ultrasonic transducer is located in the ultrasonic transducer assembly of the surgical instrument. In other respects, however, the 1120 ultrasonic transducer can be located in the handle assembly 3412, the drive shaft assembly 3414 or the end actuator. In one aspect, the second RF drive stage circuit 3432 provides a drive signal to RF electrodes 3074a, 3074b, which are generally located in the end actuator portion of the surgical instrument. In one aspect, the second 3434 sensor drive stage circuit provides a trigger signal to several 3440 sensors located on the surgical instrument.
[0332] [0332] Figure 30 illustrates a generator circuit 3500 divided into multiple stages in which a first stage circuit 3504 is common for the second stage circuit 3506, according to at least one aspect of the present disclosure. In one respect, the instruments
[0333] [0333] As shown in the example in Figure 30, the 3510 battery pack portion of the surgical instrument comprises a first 3502 control circuit, which includes the 3200 control circuit described above. The handle set 3512, which connects to the battery set 3510, comprises a first common drive stage circuit 3420. As previously discussed, the first drive stage circuit 3420 is configured to drive the current high frequency (RF) ultrasound, and sensor loads. The output of the first 3420 common drive stage circuit can drive any of the second 3506 stage circuits such as the second 3430 ultrasonic drive stage circuit, the second high frequency (RF) 3432 drive stage circuit , and / or the second 3434 sensor drive stage circuit. The first 3420 common drive stage circuit detects which second stage circuit 3506 is located on the 3514 drive shaft assembly when the 3514 drive shaft assembly is connected to the 3512 handle assembly. After the 3514 drive shaft assembly is connected to the 3512 handle assembly, the first common drive stage circuit 3420 determines which of the second 3506 stage circuits (for example, the second ultrasonic drive stage circuit 3430, the second RF drive stage circuit 3432, and / or the second drive stage circuit sensor 3434) is located on the drive shaft assembly 3514. Information is provided to the control circuit 3200 located on the handle assembly 3512 to provide a suitable digital waveform 4300 (Figure 36) to the second stage circuit 3506 to trigger the appropriate load, for example, ultrasonic, RF or sensor. It will be understood that identification circuits can be included in several 3516 assemblies on the third stage 3508 circuit such as ultrasonic transducer 1120, electrodes 3074a, 3074b, or 3440 sensors. Thus, when a third stage circuit 3508 is connected to a second stage circuit 3506, the second stage circuit 3506 recognizes the type of load that is required based on the identification information.
[0334] [0334] Figure 31 is a schematic diagram of an aspect of a 3600 electrical circuit configured to trigger a high frequency (RF) current, according to at least one aspect of the present disclosure. The 3600 electrical circuit comprises a 3680 analog multiplexer. The 3680 analog multiplexer multiplexes several signals from the SCL-A, SDA-A upstream channels such as RF, battery and power control circuits. A 3682 current sensor is connected in series to the return or ground leg of the power supply circuit to measure the current supplied by the power source. A field effect transistor (FET) 3684 temperature sensor provides room temperature. A 3688 pulse width modulation (PWM) surveillance timer automatically generates a system reset if the main program periodically fails to repair it. It is provided to automatically reset the 3600 electrical circuit when it freezes or freezes due to a software or hardware failure. It will be recognized that the 3600 electrical circuit can be configured to drive RF electrodes or to drive the 1120 ultrasonic transducer as described with reference to Figure 26, for example. Consequently, with reference now again to Figure 31, the electrical circuit 3600 can be used to drive both ultrasonic and RF electrodes interchangeably.
[0335] [0335] A 3686 drive circuit provides left and right RF power outputs. A digital signal representing the signal waveform is supplied to the SCL-A, SDA-A inputs of the 3680 analog multiplexer from a control circuit, such as the 3200 control circuit (Figure 27). A 3690 digital to analog converter (DAC) converts the digital input to an analog output to generate a 3692 pulse width modulation circuit coupled to a 3694 oscillator. The 3692 pulse width modulation circuit provides a first signal for a first gate triggering circuit 3696a coupled to a first output stage of transistor 3698a to drive a first RF + energy output (left). The pulse width modulation circuit 3692 also provides a second signal for a second door drive circuit 3696b coupled to a second output stage of transistor 3698b to drive a second RF-
[0336] [0336] Figure 32 illustrates the 3900 control circuit that allows a dual generator system to switch between the power modes of the RF 3902 generator circuit and the 3920 ultrasonic generator circuit for a surgical instrument of the 1000 surgical system. aspect, a current threshold in an RF signal is detected. When the tissue impedance is low, the high frequency current through the tissue is high when the RF energy is used as the source for treating the tissue. According to one aspect, a visual indicator 3912 or light located on the surgical instrument of the surgical system 1000 can be configured to be in a connected state during this period of high current. When the current drops below a threshold, the visual indicator 3912 goes into an off state. Consequently, a 3914 phototransistor can be configured to detect the transition from a switched state to a switched off state and disable RF energy, as shown in the 3900 control circuit shown in Figure 32. Therefore, when the button power is released and a 3926 power switch is opened, the 3900 control circuit is reset and both the RF and ultrasonic generator 3902, 3920 circuits are kept off.
[0337] [0337] With reference to Figure 39, in one aspect, a method of managing an RF generating circuit 3902 and an ultrasonic generating circuit 3920 is provided. The RF generating circuit 3902 and / or the ultrasonic generating circuit 3920 they can be located in the handle set 1109, in the ultrasonic transducer / RF generator set 1120, in the battery set, in the drive shaft set 1129 and / or in the nozzle, of the multi-functional electrosurgical instrument 1108, for example . The 3900 control circuit is maintained in a reset state if the 3926 power switch is off (for example, open). This way, when the power switch 3926 is open, the control circuit 3900 is reset and both the RF generating and ultrasonic circuits 3902, 3920 are switched off. When the 3926 power switch is pressed and the 3926 power switch is engaged (for example, closed), the RF energy is distributed to the tissue and the visual indicator 3912 operated by a 3904 current detection surge transformer will be lit while fabric impedance is low. The visual indicator light 3912 provides a logic signal to keep the 3920 ultrasonic generator circuit in the off state. Since the tissue impedance increases beyond a threshold and the high frequency current through the tissue decreases below a threshold, the visual indicator 3912 turns off and the light goes into an off state. A logic signal generated by this transition turns relay 3908 off, whereby the RF generator circuit 3902 is switched off and the ultrasonic generator circuit 3920 is switched on, to complete the coagulation and cutting cycle.
[0338] [0338] Still with reference to Figure 39, in one aspect, the configuration of the double generator circuit employs the RF generator circuit 3902 on-board, which is powered by battery 3901, for a modality, and a second 3920 on-board ultrasonic generator circuit, which may be included in the 1109 handle set, in the
[0339] [0339] Any type of system can have separate controls for modes that are not communicating with each other. The surgeon activates RF and ultrasonic energy separately and at his discretion. Another approach would be to provide fully integrated communication schemes that share buttons, tissue states, instrument operating parameters (such as a clamping system, forces, etc.) and algorithms to manage tissue handling. Various combinations of this integration can be implemented to provide the right level of functioning and performance.
[0340] [0340] As discussed above, in one aspect, the 3900 control circuit includes an RF generator circuit 3902 powered by battery 3901 which comprises a battery as a power source. As shown, the RF 3902 generating circuit is coupled to two electrically conductive surfaces here called electrodes 3906a, 3906b (ie active electrode 3906a and return electrode 3906b) and is configured to drive electrodes 3906a, 3906b with power RF (for example, high frequency current). A first winding 3910a of the elevation transformer 3904 is connected in series with a pole of the bipolar RF generator circuit 3902 and the return electrode 3906b. In one aspect, the first winding 3910a and the return electrode 3906b are connected to the negative pole of the 3902 bipolar RF generator circuit. The other pole of the 3902 bipolar RF generator circuit is connected to the active electrode 3906a through a contact of switch 3909 of relay 3908, or any suitable electromagnetic switching device comprising an armature that is moved by a 3936 electromagnet to operate the 3909 switch contact. The 3909 switch contact is closed when the 3936 electromagnet is energized and the switch contact 3909 is opened when the 3936 electromagnet is de-energized. When the switch contact is closed, the RF current flows through the conductive tissue (not shown) located between the electrodes 3906a, 3906b. It will be recognized that, in one aspect, the active electrode 3906a is connected to the positive pole of the 3902 bipolar RF generator circuit.
[0341] [0341] A 3905 visual indicator circuit comprises the 3904 elevation transformer, a R2 series resistor and a 3912 visual indicator. The 3912 visual indicator can be adapted for use with the 1108 surgical instrument and other electrochemical systems and tools. - surgical, such as those described here. The first winding 3910a of the lift transformer 3904 is connected in series to the return electrode 3906b and the second winding 3910b of the lift transformer 3904 is connected in series to the resistor R2 and the visual indicator 3912 comprising a neon lamp of the type NE-2, for example.
[0342] [0342] In operation, when key contact 3909 of relay 3908 is opened, active electrode 3906a is disconnected from the positive pole of the bipolar RF generator circuit 3902 and no current flows through the fabric, return electrode 3906b and of the first roll
[0343] [0343] A first current flows through the first winding 3910a as a function of the fabric impedance between the active and return electrodes 3906a, 3906b providing a first voltage through the first winding 3910a of the lift transformer
[0344] [0344] Referring now to the 3926 power switch portion of the 3900 control circuit, when the 3926 power switch is in the open position, a high logic is applied to the input of a first inverter 3928 and a logic low is applied to one of the two inputs of the AND 3932 gate. Thus, the output of the AND gate 3932 is low and a 3934 transistor is switched off to prevent current from flowing through the 3936 electromagnet winding. With the 3936 electromagnet on in a de-energized state, the 3909 switch contact 3908 remains open and prevents current from flowing through the electrodes
[0345] [0345] When the user presses the 3926 power switch on the instrument cable to apply energy to the tissue between the 3906a, 3906b electrodes, the 3926 power switch closes and applies low logic to the input of the first 3928 inverter, which applies a high logic to the other input of the AND 3932 gate, causing the output of the AND 3932 gate to switch to the high logic and turn on the 3934 transistor. In the on state, the 3934 transistor conducts and reduces the current through the 3936 electromagnet winding to energize electromagnet 3936 and close switch contact 3909 of relay 3908. As discussed above, when switch contact 3909 is closed, current can flow through electrodes 3906a, 3906b and the first winding 3910a of the lift transformer 3904 when the tissue is located between electrodes 3906a, 3906b.
[0346] [0346] As discussed above, the magnitude of the current flowing through electrodes 3906a, 3906b depends on the impedance of tissue located between electrodes 3906a, 3906b. Initially, the impedance of the fabric is low and the magnitude of the current is high through the fabric and the first winding 3910a. Consequently, the voltage applied to the second winding 3910b is high enough to turn on the visual indicator 3912. The light emitted by the visual indicator 3912 turns on the photo transistor 3914, which reduces the input of a 3916 inverter and causes the output of the 3916 inverter increases. An input in the high logic state applied to the CLK of the 3918 flip-flop has no effect on Q or the Q outputs of the 3918 flip-flop and the output Q remains in the low logic state and the output Q remains in the high logic state. Consequently, while the visual indicator 3912 remains energized, the ultrasonic generating circuit 3920 is switched off and the ultrasonic transducer 3922 and an ultrasonic blade 3924 of the multifunctional electrosurgical instrument are not activated.
[0347] [0347] As the tissue between the 3906a, 3906b electrodes dries up due to the heat generated by the current flowing through the tissue, the tissue impedance increases and the current through it decreases. When the current through the first winding 3910a decreases, the voltage across the second winding 3910b also decreases and when the voltage falls below a minimum threshold required to operate the visual indicator 3912, the visual indicator 3912 and the phototransistor 3914 turn off. When phototransistor 3914 turns off, a high logic is applied to the input of the 3916 inverter and a low logic is applied to the CLK input of the 3918 flip-flop to record the time of a high logic for output Q and a low logic for output Q. The high logic at the Q output links the 3920 ultrasonic generator circuit to activate the 3922 ultrasonic transducer and the 3924 ultrasonic blade to start cutting the tissue located between the 3906a, 3906a electrodes. Simultaneously or almost simultaneously with the 3920 ultrasound generating circuit, the Q-output of the 3918 flip-flop switches to the low logic state and causes the output of the AND gate 3932 to go to the low logic state and turn off transistor 3934, thus de-energizing the electromagnet 3936 and opening the switch contact 3909 of relay 3908 to cut the current flow through electrodes 3906a, 3906b.
[0348] [0348] As long as the switch contact 3909 of relay 3908 is open, no current flows through electrodes 3906a, 3906b, the fabric and the first winding 3910a of the lift transformer
[0349] [0349] The Q status and Q outputs of the 3918 flip-flop remain the same as long as the user presses the 3926 power switch on the instrument cable to keep the 3926 power switch closed. In this way, the 3924 ultrasonic blade remains activated and continues to cut the tissue between the claws of the end actuator, while no current flows through the 3906a, 3906b electrodes from the 3902 bipolar RF generator circuit. the user releases the 3926 power switch on the instrument cable, the 3926 power switch opens and the output of the first 3928 inverter goes to the low logic state and the output of the second 3930 inverter goes to the high logic state to reset the flip -flop 3918 causing output Q to go to low logic state and turn off the ultrasonic generator circuit
[0350] [0350] Figure 33 illustrates a diagram of a surgical system 4000, which represents an aspect of the surgical system 1000, which comprises a feedback system for use with any of the Surgical Instruments of the surgical system 1000, which can include or implement many of the features described in the present invention. The 4000 surgical system can include a generator 4002 coupled to a surgical instrument that includes a 4006 end actuator, which can be activated when a doctor operates a 4010 trigger. In many ways, the 4006 end actuator can include an ultrasonic blade to apply ultrasonic vibration to perform surgical coagulation / cutting treatments on living tissue. In other respects, the 4006 end actuator may include electrically conductive elements coupled to a high frequency electrosurgical power source to perform surgical coagulation or cauterization treatments on living tissue and a mechanical knife with a sharp edge or blade ultrasonic to perform cutting treatments on living tissue. When the 4010 trigger is actuated, a 4012 force sensor can generate a signal that indicates the amount of force that is applied to the 4010 trigger. In addition to, or instead of, a 4012 force sensor, the surgical instrument may include a 4013 position sensor, which can generate a signal indicating the position of the 4010 trigger (for example, how far the trigger has been pressed or otherwise acted). In one aspect, the 4013 position sensor can be a sensor positioned with the outer tubular sheath or a reciprocating tubular actuation member located inside the outer tubular sheath of the surgical instrument. In one aspect, the sensor can be a Hall effect sensor or any suitable transducer that varies its output voltage in response to a magnetic field. The Hall effect sensor can be used for proximity switching, positioning, speed detection and current detection applications. In one aspect, the Hall effect sensor works like an analog transducer, directly returning a voltage. With a known magnetic field, its distance from the Hall plate can be determined.
[0351] [0351] A control circuit 4008 can receive signals from sensors 4012 and / or 4013. Control circuit 4008 can include any suitable analog or digital circuit components. The control circuit 4008 can also communicate with the generator 4002 and / or the transducer 4004 to modulate the energy supplied to the end actuator 4006 and / or the generator level or the amplitude of the ultrasonic blade of the end actuator 4006 based the force applied to trigger 4010 and / or the position of trigger 4010 and / or the position of the outer tubular sheath described above in relation to a reciprocating tubular actuating member located within the outer tubular sheath (for example, as measured by a combination Hall effect sensor and magnet). For example, the more force is applied to the 4010 trigger, the more energy and / or greater ultrasonic blade amplitude can be supplied to the 4006 end actuator. According to several aspects, the 4012 force sensor can be replaced by a key multiple positions.
[0352] [0352] According to various aspects, the 4006 end actuator may include a gripper or gripping mechanism. When the 4010 trigger is initially triggered, the locking mechanism can close, trap the fabric between a clamping arm and the 4006 end actuator. As the force applied to the trigger increases (for example, as detected by the 4012 force sensor ), the control circuit 4008 can increase the energy supplied to the end actuator 4006 by the transducer 4004 and / or the generator level or the amplitude of the ultrasonic blade generated in the end actuator 4006. In one aspect, the position trigger, as detected by the 4013 position sensor or the claw or claw arm position, as detected by the 4013 position sensor (for example, with a Hall effect sensor), can be used by the 4008 control circuit to define the energy and / or amplitude of the 4006 end actuator. For example, as the trigger is further moved towards a fully actuated position, the claw or clamping arm moves further in different directions. the ultrasonic blade (or 4006 end actuator), the energy and / or amplitude of the 4006 end actuator can be increased.
[0353] [0353] According to various aspects, the surgical instrument of the surgical system 4000 may also include one or more feedback devices to indicate the amount of energy supplied to the 4006 end actuator. For example, a 4014 speaker can emit a signal indicating the energy of the end actuator. According to several aspects, the 4014 loudspeaker can emit a series of pulse sounds, where the frequency of the sounds indicates the energy. In addition to, or instead of, the 4014 loudspeaker, the surgical instrument may include a 4016 visual screen. The 4016 visual screen may indicate the end actuator according to any suitable method. For example, the 4016 visual display may include a series of LEDs, where the power of the end actuator is indicated by the number of LEDs illuminated. The 4014 loudspeaker and / or the 4016 visual display can be activated by the control circuit 4008. According to several aspects, the surgical instrument may include a ratchet device connected to the 4010 trigger. The ratchet device can generate an audible signal the more force is applied to the 4010 trigger, providing an indirect energy indication from the end actuator. The surgical instrument can include other features that can increase safety. For example, control circuit 4008 can be configured to prevent power from being supplied to end actuator 4006 beyond the predetermined threshold. In addition, control circuit 4008 can implement a delay between the time when a change in the energy of the end actuator is indicated (for example, by the speaker 4014 or visual display 4016) and the time when the change in energy of the end actuator is provided. In this way, a physician may be well aware that the level of ultrasonic energy that must be supplied to the 4006 end actuator is about to change.
[0354] [0354] In one aspect, the ultrasonic current or high frequency current generators of the surgical system 1000 can be configured to generate the electrical signal waveform digitally as desired, using a predetermined number of phase points stored in a lookup table, scan the waveform. The phase points can be stored in a table defined in a memory, a field programmable port arrangement (FPGA) or any suitable non-volatile memory. Figure 34 illustrates an aspect of a fundamental architecture for a digital synthesis circuit, such as a direct digital synthesis circuit (DDS) 4100, configured to generate a plurality of waveforms for the electrical signal waveform. . The generator's software and digital controls can command the FPGA to scan the addresses in lookup table 4104, which in turn provides variable digital input values for a 4108 DAC circuit that powers a power amplifier. The addresses can be checked according to a frequency of interest. The use of such a 4104 look-up table makes it possible to generate several types of waveforms that can be fed into the tissue or a transducer, an RF electrode, multiple transducers simultaneously, multiple RF electrodes or a combination of ultrasonic instruments and RF. In addition, multiple 4104 look-up tables representing multiple waveforms can be created, stored and applied to tissue from a generator.
[0355] [0355] The signal waveform can be configured to control at least one of an output current, an output voltage or an output power of an ultrasonic transducer and / or RF electrode, or multiples thereof ( for example, two or more ultrasonic transducers and / or two or more RF electrodes). Additionally, where a surgical instrument comprises ultrasonic components, the waveform can be configured to trigger at least two modes of vibration for an ultrasonic transducer of at least one surgical instrument. In this way, the generator can be configured to supply a waveform to at least one surgical instrument, where the waveform signal corresponds to at least one waveform of a plurality of waveforms on the table. . In addition, the waveform signal supplied to the two surgical instruments can comprise two or more waveforms. The table can comprise information associated with a plurality of waveforms and the table can be stored inside the generator. In one aspect or example, the table can be a direct digital summary table, which can be stored in a generator FPGA. The table can be addressed in any way that is convenient for categorizing waveforms. According to one aspect, the table, which can be a digital direct synthesis table, is addressed according to a frequency of the waveform signal. Additionally, the information associated with the plurality of waveforms can be stored as digital information in the table.
[0356] [0356] The analog electrical signal waveform can be configured to control at least one of an output current, an output voltage or an output power of an ultrasonic transducer and / or RF electrode, or multiples thereof (for example, two or more ultrasonic transducers and / or two or more RF electrodes). Additionally, where the surgical instrument comprises ultrasonic components, the analog electrical signal waveform can be configured to trigger at least two vibration modes for an ultrasonic transducer of at least one surgical instrument. In this way, the generator circuit can be configured to provide an analog electrical signal waveform to at least one surgical instrument, and the analog electrical signal waveform corresponds to at least one waveform of a plurality of waveforms stored in query table 4104. Additionally,
[0357] [0357] With the widespread use of digital techniques in instrumentation and communications systems, a digitally controlled method of generating multiple frequencies from a reference frequency source has evolved and is referred to as direct digital synthesis. The basic architecture is shown in Figure 34. In this simplified block diagram, a DDS circuit is coupled to a processor, controller or logic device in the generator circuit and to a memory circuit located in the generator circuit of the surgical system 1000. The circuit DDS 4100 comprises an address counter 4102, a look-up table 4104, a register 4106, a DAC circuit 4108 and a filter
[0358] [0358] As the DDS 4100 circuit is a sampled data system, problems involved in sampling need to be considered: quantization noise, distortion, filtering, etc. For example, the higher order harmonics of the output frequencies of the DAC 4108 circuit bend in the Nyquist bandwidth, making them non-filterable, whereas the higher order harmonics of the synthesizer output based on phase lock circuit or phase capture loop (PLL) can be filtered. Lookup table 4104 contains signal data for an integral number of cycles. The final output frequency fou can be changed by changing the frequency of the reference clock fc or reprogramming the PROM.
[0359] [0359] The DDS 4100 circuit can comprise multiple lookup tables 4104, where lookup table 4104 stores a waveform represented by a predetermined number of samples, with the samples defining a predetermined shape of the waveform . In this way, multiple waveforms with a
[0360] [0360] Therefore, the alternation between waveforms can be based on tissue impedance and other factors, for example. In other respects, query tables 4104 can store electrical signal waveforms formatted to maximize the power delivered to the tissue per cycle (i.e., trapezoidal or square wave). In other respects, the 4104 look-up tables can store synchronized waveforms so that they maximize energy supply by the multifunctional surgical instrument of the surgical system 1000 when it provides RF and ultrasonic trigger signals. In yet other aspects, the 4104 look-up tables can store electrical signal waveforms to simultaneously trigger ultrasonic and RF therapeutic and / or subtherapeutic energy while maintaining ultrasonic frequency blocking. Custom waveforms specific to different instruments and their tissue effects can be stored in the generator's non-volatile memory or in the non-volatile memory (for example,
[0361] [0361] A more flexible and efficient implementation of the DDS 4100 circuit employs a digital circuit called the Numerically Controlled Oscillator (NCO, from Numerically Controlled Oscillator). A block diagram of a more flexible and efficient digital synthesis circuit, such as a DDS 4200 circuit, is shown in Figure 35. In this simplified block diagram, a DDS 4200 circuit is coupled to a processor, controller or logic device. generator and a memory circuit located on the generator or any of the surgical instruments of the surgical system 1000. The DDS 4200 circuit comprises a charge register 4202, a parallel delta register 4204, a summing circuit 4216, a phase register 4208, a query table 4210 (phase to amplitude converter), a DAC circuit 4212 and a filter 4214. The summing circuit 4216 and phase register 4208 form part of a phase accumulator
[0362] [0362] The DDS 4200 circuit includes a sample clock that generates the clock frequency fe, the phase accumulator 4206 and the query table 4210 (for example, phase to amplitude converter). The content of the 4206 phase accumulator is updated once per clock cycle fe. When the phase accumulator 4206 is updated, the digital number, M, stored in the delta phase register 4204 is added to the number in the phase register 4208 by a 4216 adder circuit. Assuming that the number in the parallel delta phase register 4204 is 0O ... 01 and that the initial content of the 4206 phase accumulator is 00 ... 00. The 4206 phase accumulator is updated by 00 ... 01 per clock cycle. If the phase accumulator 4206 is 32 bits wide, 232 clock cycles (more than 4 billion) are required before the phase accumulator 4206 returns to 00 ... 00, and the cycle is repeated.
[0363] [0363] A truncated output 4218 of the phase accumulator 4206 is supplied to a lookup table of the phase converter for amplifier 4210 and the output of the lookup table 4210 is coupled to a DAC circuit 4212. The truncated output 4218 of the accumulator Phase 4206 serves as the address for a sine (or cosine) lookup table. An address in the lookup table corresponds to a phase point on the sine wave from 0º to 360º. Lookup table 4210 contains the digital amplitude information corresponding to a complete cycle of a sine wave. The query table 4210, therefore, maps the phase information of the phase accumulator 4206 into a digital amplitude word, which in turn drives the DAC circuit 4212. At the output of the DAC circuit is a first analog signal 4220 and it is filtered by a filter 4214. The output of filter 4214 is a second analog signal 4222, which is supplied to a power amplifier coupled to the generating circuit.
[0364] [0364] In one aspect, the electrical signal waveform can be digitized at 1024 (210) phase points, although the waveform that can be digitized is any suitable number of 2n phase points ranging from 256 (28) to 281.474.976.710.656 (248), where n is a positive integer, as shown in TABLE 1. The waveform of the electrical signal can be expressed as An (8n), where a normalized amplitude Ar at a point n is represented by a phase angle
[0365] [0365] Table 1 specifies the electrical signal waveform digitized at a number of phase points.
[0366] [0366] The generator circuit algorithms and digital controls can scan the addresses in query table 4210, which in turn provides variable digital input values for the 4212 DAC circuit that feeds the 4214 filter and the energy amplifier . The addresses can be checked according to a frequency of interest. The use of the look-up table allows the generation of several types of formats that can be converted into an analog output signal by the DAC 4212 circuit filtered by the 4214 filter, amplified by the power amplifier coupled to the output of the generator circuit and fed to the fabric in the form of RF energy or fed to an ultrasonic transducer and applied to the tissue in the form of ultrasonic vibrations that provide energy to the tissue in the form of heat. The amplifier output can be applied to an RF electrode, multiple output electrodes simultaneously, an ultrasonic transducer, multiple ultrasonic transducers simultaneously or a combination of RF and ultrasonic transducers, for example. In addition, multiple waveform tables can be created, stored and applied to the fabric from a generator circuit.
[0367] [0367] With reference again to Figure 34, for n = 32 and M = 1, the phase accumulator 4206 travels through each of the 232 possible outputs before overflowing and resetting. The corresponding output wave frequency is equal to the input clock frequency divided by
[0368] [0368] For a 4206 phase accumulator configured to accumulate n-bits (n generally ranges from 24 to 32 in most DDS systems, but as previously discussed, n cannot be selected from a wide range of options), there are 2 possible phase points. The digital word in the delta phase register M represents the amount of phase accumulation that is incremented per clock cycle. If f. is the clock frequency, so the frequency of the output sine wave is equal to:
[0369] [0369] The above equation is known as "tuning equation" DDS. It is observed that the frequency resolution of the system is equal to
[0370] [0370] The electrical signal waveform can be characterized by current, voltage or power at a given frequency. In addition, when any of the surgical instruments in the 1000 surgical system comprises ultrasonic components, the electrical signal waveform can be configured to activate at least two modes of vibration of an ultrasonic transducer of at least one surgical instrument. In this way, the generator circuit can be configured to provide an electrical signal waveform to at least one surgical instrument, and the electrical signal waveform is characterized by a predetermined waveform stored in query table 4210 (or query table 4104 - Figure 34). In addition, the electrical signal waveform can be a combination of two or more waveforms. Lookup table 4210 can comprise information associated with a plurality of waveforms. In one aspect or example, query table 4210 can be generated by the DDS 4200 circuit and can be referred to as a direct digital summary table. Direct digital synthesis (DDS) operates by first storing a large repetitive waveform in the integrated memory. A cycle of a waveform (sinusoidal, triangular, square, arbitrary) can be represented by a predetermined number of phase points, as shown in TABLE 1 and stored in memory. Once the waveform is stored
[0371] [0371] In one aspect, the generator circuit can be configured to provide electrical signal waveforms to at least two surgical instruments simultaneously. The generator circuit can also be configured to provide the electrical signal waveform, which can be characterized by two or more waveforms, through an output channel of the generator circuit for the two surgical instruments simultaneously. For example, in one aspect, the waveform of the electrical signal comprises a first electrical signal to drive an ultrasonic transducer (eg, ultrasonic trigger signal), a second RF trigger signal and / or a combination - tion of the same. In addition, an electrical signal waveform may comprise a plurality of ultrasonic trigger signals, a plurality of RF trigger signals and / or a combination of a plurality of ultrasonic and RF trigger signals .
[0372] [0372] Additionally, a method for operating the generator according to the present disclosure comprises generating an electrical signal waveform and supplying the generated electrical signal waveform to any of the surgical instruments of the 1000 surgical system,
[0373] [0373] The generator circuit, as described here, can allow the generation of several types of digital direct synthesis tables. Examples of waveforms for RF / electrosurgical signals suitable for treating a variety of tissues generated by the generator circuit include RF signals with a high crest factor (which can be used for surface coagulation in RF mode), signals Low crest factor RF (which can be used for deeper tissue penetration) and waveforms that promote efficient retouching coagulation. The generating circuit can also generate multiple waveforms using a direct digital synthesis query table 4210 and, in real time, it can switch between particular waveforms based on the desired tissue effect. Alternation can be based on tissue impedance and / or other factors.
[0374] [0374] In addition to traditional sine / cosine waveforms, the generating circuit can be configured to generate waveform (s) that maximize (m) the power in the tissue per cycle (for example, trapezoidal or square wave). The generator circuit can provide waveforms that are synchronized to maximize the power delivered to the load by simultaneously triggering RF and ultrasonic signals and maintaining the ultrasonic frequency lock, as long as the generator circuit includes a circuit topology that allows the simultaneous activation of RF and ultrasonic signals. In addition, customized instrument-specific waveforms and their effects on
[0375] [0375] The DDS 4200 circuit can comprise multiple lookup tables 4104, where lookup table 4210 stores a waveform represented by a predetermined number of phase points (also called samples), the phase points being define a predetermined shape of the waveform. In this way, multiple waveforms, with a single shape, can be stored in multiple 4210 look-up tables to provide different tissue treatments based on instrument settings or tissue feedback. Examples of waveforms include high crest factor RF electrical signal waveforms for surface tissue coagulation, low crest factor RF electrical signal waveform for deeper tissue penetration and forms electrical signal waves that promote efficient retouch coagulation. In one aspect, the DDS 4200 circuit can create multiple 4210 waveform lookup tables and during a tissue treatment procedure (for example, simultaneously or in virtual real time based on user or sensor input). between different waveforms stored in different query tables 4210 based on the effect on the desired tissue and / or tissue feedback.
[0376] [0376] Therefore, alternation between waveforms can be based on tissue impedance and other factors, for example. In other respects, the 4210 lookup tables can store electrical signal waveforms formatted to maximize the power distributed in the tissue per cycle (i.e., trapezoidal or square wave). In other respects, the 4210 look-up tables can store synchronized waveforms so that they maximize energy supply by any of the surgical instruments in the surgical system 1000 when it provides RF and ultrasonic trigger signals. In still other aspects, the 4210 look-up tables can store waveforms of electrical signal to simultaneously activate therapeutic and / or subtherapeutic energy, ultrasonic and RF, while maintaining the blocking of the ultrasonic frequency. In general, the output waveform can be in the form of a sine wave, cosine wave, pulse wave, square wave and the like. However, the custom and more complex waveforms specific to different instruments and their tissue effects can be stored in the non-volatile memory of the generating circuit or in the non-volatile memory (eg, EEPROM) of the surgical instrument and fetched when connecting the surgical instrument. in the generator circuit. An example of a custom waveform is an exponentially damped sine wave as used in many high crest factor "coagulation" waveforms, as shown in Figure 36.
[0377] [0377] Figure 36 illustrates a cycle of a waveform of the discrete-time digital electrical signal 4300, according to at least one aspect of the present disclosure, of an analog waveform 4304 (shown superimposed over the waveform of the 4300 isolated time digital electrical signal for comparison purposes). The horizontal geometric axis represents Time (t) and the vertical geometric axis represents the digital phase points. The waveform of the 4300 digital electrical signal is a version of the digital time isolated from the desired analog waveform 4304, for example. The waveform of the digital electrical signal 4300 is generated by storing an amplitude phase point 4302 that represents the amplitude per Tek clock cycle during a cycle or period To. The digital electrical signal waveform
[0378] [0378] Figure 37 is a diagram of a 12950 control system configured to provide progressive closure of a closing member (eg, closing tube) when the displacement member advances distally and engages a clamping arm. (for example, anvil) to decrease the load of the closing force on the closing member at a desired speed and to decrease the load of the shooting force on the shooting member according to an aspect of the present disclosure. In one aspect, the 12950 control system can be implemented as a nested PID feedback controller. A PID controller is a feedback loop mechanism for the control circuit (controller) to continuously calculate an error value as the difference between a desired setpoint and a measured process variable and apply a correction based on proportional terms , integrals and derivatives (sometimes indicated P, |, and D respectively). The nested PID controller 12950 feedback control system includes a primary controller 12952, on a primary (external) feedback circuit 12954 and a secondary controller 12955 on a secondary (internal) feedback circuit 12956. Primary controller 12952 can be a PID controller 12972, as shown in Figure 38, and secondary controller 12955 can also be a PID controller 12972 as shown in Figure 38. Primary controller 12952 controls a primary process 12958 and secondary controller 12955 controls a secondary process 12960. The 12966 output of the primary processor 12958 is subtracted from a primary setpoint P 1 by a first adder 12962. The first adder 12962 produces a single output sum signal that is applied to the primary controller 12952 The output from the primary controller 12952 is the secondary setpoint SP2. Output 12968 of secondary processor 12960 is subtracted from a primary setpoint SP2 by a first adder 12964.
[0379] [0379] In the context of controlling the displacement of a closing tube, the 12950 control system can be configured so that the primary setpoint SP, is a desired closing force value and the primary controller 12952 is configured to receive the closing force from a torque sensor coupled to the output of a closing motor and determine a speed.
[0380] [0380] Figure 38 illustrates a PID 12970 feedback control system, according to one aspect of this disclosure. Primary controller 12952 or secondary controller 12955, or both, can be implemented as a PID 12972 controller. In one aspect, PID 12972 controller can comprise a proportional element 12974 (P), an integral element 12976 (|), and a derivative element 12978 (D). The outputs of elements P, | and D 12974, 12976, 12978 are added by an adder 12986, which provides the control variable u (t) to process 12980. The output of process 12980 is the process variable y (t). A 12984 adder calculates the difference between a desired setpoint r (t) and a measured process variable y (t). The PID 12972 controller continuously calculates an error value e (t) (for example, the difference between the closing force threshold and the measured closing force) as the difference between a desired setpoint r (t) ( for example, the closing force threshold) and the measured process variable y (t) (for example, the speed and direction of the closing tube) and applies a correction based on the proportional, integral and derivative terms calculated by proportional element 12974 (P), integral element 12976 (| I), and derivative element 12978 (D), respectively. The PID 12972 controller tries to minimize the error e (t) over time by adjusting the control variable u (t) (for example, the speed and direction of the closing tube).
[0381] [0381] According to the PID algorithm, the element "P" 12974 represents the present error values. For example, if the error is large and positive, the control output will also be large and positive. According to the present disclosure, the error term e (t) is the difference between the desired closing force and measured closing force of the closing tube. The "I" element 12976 represents the values passed from the error. For example, if the current output is not strong enough, the integral of the error will accumulate over time, and the controller will respond by applying a stronger action. The "D" element 12978 represents possible future trends of the error, based on its actual rate of change. For example, continuing example P above, when the large positive control output succeeds in bringing the error closer to zero, it also puts the process in a major negative error mode in the near future. In this case, the derivative becomes negative and module D reduces the force of the action to avoid this excess.
[0382] [0382] It will be understood that other variables and set points can be monitored and controlled according to the feedback control systems 12950, 12970. For example, the adaptive closing member speed control algorithm described here can mediate the least two of the following parameters: the location of the trigger member, the load of the trigger member, the displacement of the cutting element, the speed of the cutting element, the travel location of the closing tube, the load of the closing tube, among others.
[0383] [0383] Ultrasonic surgical devices, such as ultrasonic scalpels, are finding applications more and more widespread in surgical procedures, due to their exclusive performance characteristics. Depending on specific device configurations and operational parameters, ultrasonic surgical devices can offer, in a substantially simultaneous manner, tissue transection and coagulation homeostasis, desirably minimizing the patient's trauma. An ultrasonic surgical device may comprise a handle containing an ultrasonic transducer, and an instrument coupled to the ultrasonic transducer having a distally mounted end actuator (for example, a blade tip) to cut and seal the tissue. In some cases, the instrument may be permanently attached to the handpiece. In other cases, the instrument may be separable from the handle, as in the case of a disposable instrument or an interchangeable instrument. The end actuator transmits ultrasonic energy to the tissues placed in contact with it, to perform the cutting and cauterization action. Ultrasonic surgical devices
[0384] [0384] Ultrasonic energy cuts and coagulates tissues using temperatures lower than those used in electrosurgical procedures and can be transmitted to the end actuator by an ultrasonic generator in communication with the handle. Vibrating at high frequencies (for example, 55,500 cycles per second), the ultrasonic blade denatures the protein present in the tissues to form a sticky clot. The pressure exerted on the tissues by the surface of the slide flattens the blood vessels and allows the clot to form a hemostatic seal. A surgeon can control the cutting and clotting speed through the force applied to the tissues by the end actuator, the time during which the force is applied and the selected excursion level for the end actuator.
[0385] [0385] The ultrasonic transducer can be modeled as an equivalent circuit comprising a first branch that has a static capacitance and a second branch "in motion" that has a series connected inductance, resistance and capacitance that define the electromechanical properties of a resonator. Known ultrasonic generators may include a tuning inductor to cancel static capacitance at a resonant frequency so that substantially all of the generator's trigger signal current flows to the moving branch. Consequently, using a tuning inductor, the current of the generator's trigger signal represents the current of the branch in motion, and the generator is thus able to control its trigger signal to maintain the resonant frequency. - ultrasonic transducer size. The tuning inductor can also transform the phase impedance plot of the ultrasonic transducer to optimize the frequency locking capabilities of the generator. However, the tuning inductor must be combined with the specific static capacitance of an ultrasonic transducer at the operational resonance frequency. In other words, a different ultrasonic transducer having a different static capacitance needs a tuning inductor.
[0386] [0386] Additionally, in some ultrasonic generator architectures, the generator trigger signal has asymmetric harmonic distortion that complicates the magnitude and phase measurements of the impedance. For example, the accuracy of impedance phase measurements can be reduced due to harmonic distortion in current and voltage signals.
[0387] [0387] In addition, electromagnetic interference in noisy environments decreases the generator's ability to maintain locking in the resonance frequency of the ultrasonic transducer, increasing the likelihood of invalid inputs from the control algorithm.
[0388] [0388] Electrosurgical devices for applying electrical energy to tissues in order to treat and / or destroy said tissues are also finding increasingly widespread applications in surgical procedures. An electrosurgical device may comprise a handle and an instrument that has a distally mounted end actuator (for example, one or more electrodes). The end actuator can be positioned against the tissue, so that electric current is introduced into the tissue. Electrosurgical devices can be configured for bipolar or monopolar operation. During bipolar operation, the current is introduced into the tissue and returned from it through the active and return electrodes, respectively, of the end actuator. During monopolar operation, a current is introduced into the tissue by an active electrode of the end actuator and returned via a return electrode (for example, a grounding plate) separately located on the patient's body. The heat generated by the current flowing through the tissue can form hematic seals within the tissue and / or between tissues and, therefore, can be particularly useful for cauterizing blood vessels, for example. The end actuator of an electrosurgical device can also comprise a cutting member that is able to move in relation to the tissue and the electrodes, to transect the tissue.
[0389] [0389] The electrical energy applied by an electrosurgical device can be transmitted to the instrument by a generator in communication with the handle. The electrical energy may be in the form of radio frequency (RF) energy. RF energy is a form of electrical energy that can be in the frequency range of 300 kHz to 1 MHz, as described in EN60601-2-2: 2009 + A11: 2011, Definition
[0390] [0390] During this operation, an electrosurgical device can transmit RF energy at low frequency through the tissue, which causes friction, or ionic agitation, that is, resistive heating, which, therefore, increases the temperature of the tissue. Due to the fact that a precise boundary can be created between the affected tissue and the surrounding tissue, surgeons can operate with a high level of precision and control, without sacrificing adjacent non-target tissue. Low RF energy operating temperatures can be useful for removing, shrinking or sculpting soft tissues while simultaneously cauterizing blood vessels. RF energy can work particularly well in connective tissue, which mainly comprises collagen and shrinks when it comes in contact with heat.
[0391] [0391] Due to their unique trigger signal, detection and feedback information, ultrasonic and electrosurgical devices generally require different generators. In addition, in cases where the instrument is disposable or interchangeable with a handle, ultrasonic and electrosurgical generators are limited in their ability to recognize the configuration of the specific instrument being used and to optimize control and diagnostic processes in conformity. In addition, the capacitive coupling between the non-isolated and isolated patient circuits of the generator, especially in cases where higher voltages and frequencies are used, can result in a patient being exposed to unacceptable levels of escape.
[0392] [0392] In addition, due to their unique trigger signal, detection and feedback information, ultrasonic and electrosurgical devices generally require different user interfaces for different generators. In such conventional ultrasonic and electrosurgical devices, a user interface is configured for use with an ultrasonic instrument whereas a different user interface can be configured for use with an instrument.
[0393] [0393] Additional user interfaces to provide feedback, whether to the user or another machine, are covered in the subsequent disclosure to provide feedback that indicates a mode of operation or status of an ultrasonic and / or electrosurgical instrument. Providing feedback to the user and / or the machine to operate an ultrasonic and / or electrosurgical instrument in combination will require providing sensory feedback to a user and electrical / mechanical / electromechanical feedback to a machine. Feedback devices that incorporate visual feedback information (for example, an LCD display screen, LED indicators), audio feedback information (for example, a speaker, a bell) or tactile feedback devices (for example, haptic actuators) for use in combined ultrasonic and / or electrosurgical instruments are contemplated in the subsequent disclosure.
[0394] [0394] Other electrical surgical instruments include, without limitation, irreversible and / or reversible electroporation, and / or microwave technologies, among others. Consequently, the techniques shown here are applicable to ultrasonic, bipolar or monopolar RF (electrosurgical), irreversible and / or reversible electroporation and / or microwave-based surgical instruments, among others.
[0395] [0395] Several aspects are addressed to improved ultrasonic surgical devices, electrosurgical devices and generators for use with them. Aspects of ultrasonic surgical devices can be configured to transect and / or coagulate tissue during surgical procedures, for example. The aspects of electrosurgical devices can be configured to transect, coagulate, scale, weld and / or dry the tissue during surgical procedures, for example.
[0396] [0396] Generator aspects use analog sampling for high-speed digital (eg, approximately 200 x excess sampling, depending on frequency) of the current and voltage of the generator trigger signal, along with processes - digital signal, to provide numerous advantages and benefits over known generator architectures. In one aspect, for example, based on current and voltage feedback information, a value of the static capacitance of the ultrasonic transducer, and a value of the frequency of the drive signal, the generator can determine the current of the movement of an ultrasonic transducer. This provides the benefit of a virtually tuned system, and simulates the presence of a system that is tuned or resonated with any static capacitance value (for example, Co in Figure 22) at any frequency. Consequently, the control of the branching current of the movement can be carried out by canceling the effects of static capacitance without the need for a tuning inductor. In addition, the elimination of the tuning inductor cannot degrade the frequency locking capabilities of the generator, since the frequency locking can be performed through the proper processing of the current and voltage feedback information.
[0397] [0397] High speed analog to digital sampling of the current and voltage of the generator trigger signal, together with digital signal processing, can also enable accurate digital filtering of samples. For example, aspects of the generator may use a low pass digital filter (for example, a finite impulse response filter (FIR)) that rolls out between a fundamental trigger signal frequency and a second order harmonic to reduce the asymmetric harmonic distortion and noise induced by EMI in the current and voltage feedback samples. The filtered current and voltage feedback samples substantially represent the frequency of the fundamental trigger signal, thus allowing a more accurate measurement of the impedance phase in relation to the frequency of the fundamental trigger signal and an improvement in the generator's ability to maintain the resonance frequency lock. The accuracy of the impedance phase measurement can be further optimized by calculating the average of the measurements of the falling edge and the falling edge, and by adjusting the phase impedance measured at 0º.
[0398] [0398] Various aspects of the generator can also use analog sampling for digital high-speed current and voltage from the generator trigger signal, along with digital signal processing, to determine actual energy consumption and other quantities with a high degree of accuracy. This can allow the generator to implement a number of useful algorithms, such as, for example, controlling the amount of power applied to the tissue as the tissue impedance changes and controlling the application of power to maintain a constant rate of increase in tissue impedance. . Some of these algorithms are used to determine the phase difference between the current and voltage signals of the generator drive signal. In resonance, the phase difference between the current and voltage signals is zero. The phase changes as the ultrasonic system resonates. Various algorithms can be used to detect the phase difference and adjust the trigger frequency until the ultrasonic system returns to resonance, that is, the phase difference between the current and voltage signals reaches zero. The phase information can also be used to infer the conditions of the ultrasonic sheet. As discussed in particular below, the phase changes as a function of the temperature of the ultrasonic sheet. Therefore, the phase information can be used to control the temperature of the ultrasonic sheet. This can be done, for example, by reducing the power supplied to the ultrasonic sheet when the ultrasonic sheet is very hot and by increasing the power applied to the ultrasonic sheet when the ultrasonic sheet is very cold.
[0399] [0399] Various aspects of the generator can have a wide range of frequencies and increased output power required to drive ultrasonic surgical devices and electrosurgical devices. The lower the voltage, the greater the current demand of electrosurgical devices can be met by a dedicated branch in a broadband power transformer, thus eliminating the need for a separate power amplifier and output transformer. In addition, the generator's detection and feedback circuits can support a wide dynamic range that meets the needs of ultrasonic and electro-surgical applications with minimal distortion.
[0400] [0400] Several aspects can provide a simple and economical way for the generator to read and optionally write to a data circuit (for example, a single wire bus device, such as a single wire EEPROM protocol, known under the name commercial "1-Wire") arranged in an instrument fixed to the handpiece using the existing multi-conductor generator / handle cables. In this way, the generator is able to retrieve and process instrument-specific data from an instrument attached to the grip. This can allow the generator to provide better control and improved diagnostics and error detection. In addition, the generator's ability to record data on the instrument enables new functionality in terms of, for example, tracking instrument usage and capturing operational data. In addition, the use of the frequency band allows compatibility with previous versions of instruments containing a bus device with existing generators.
[0401] [0401] Revealed aspects of the generator provide active cancellation of the leakage current caused by the unintentional capacitive coupling between non-isolated and isolated circuits, from the patient, from the generator. In addition to reducing risks to the patient, reducing the leakage current can also decrease electromagnetic emissions.
[0402] [0402] These and other benefits of aspects of the present disclosure will be evident from the description presented below.
[0403] [0403] It will be recognized that the terms "proximal" and "distal" are used here with reference to the doctor's act of tightening a handle. Thus, an end actuator is distal in relation to the most proximal grip. It will be further recognized that, for the sake of convenience and clarity, spatial terms such as "top" and "bottom" can also be used in the present invention in relation to the physician holding the handle. However, surgical devices are used in many orientations and positions, and such terms are not intended to be limiting and absolute.
[0404] [0404] Figure 39 is an exploded elevation view of the 6480 modular portable ultrasonic surgical instrument showing the left half of the compartment removed from a 6482 handle set and exposing a device identifier communicatively coupled to the multi-conductor handle terminal set according to one aspect of the present disclosure.
[0405] [0405] In one aspect, the communication portion includes a 6493 processor and a 6497 memory that can be separated or a single component. The 6493 processor, in combination with the memory, is capable of providing intelligent energy management for the modular portable ultrasonic surgical instrument 6480. This aspect is particularly advantageous due to the fact that an ultrasonic device, such as the ultrasonic surgical instrument 6480 modular portable instrument, has a power requirement (frequency, current and voltage) that can be unique to the 6480 modular portable ultrasonic surgical instrument. In fact, the 6480 modular portable ultrasonic surgical instrument may have a specific energy requirement or limitation for a 6494 external tube size or type and a second different energy requirement for a second type of waveguide that has a different size, shape and / or configuration.
[0406] [0406] A 6486 smart battery pack, in accordance with at least one aspect of the present disclosure, therefore, enables a battery pack to be used between various surgical instruments. Due to the fact that the 6486 smart battery pack is able to identify which device it is attached to and is consequently able to change its output, operators of several different surgical instruments using the 6486 smart battery pack no longer need to worrying about which power source they are trying to install inside the electronic device being used. This is particularly advantageous in an operating environment where a battery pack needs to be replaced or exchanged with another surgical instrument in the middle of a complex surgical procedure.
[0407] [0407] In another aspect of the present disclosure, the 6486 smart battery pack stores, in a 6497 memory, a record each time a specific device is used. This record can be useful for evaluating the end of life or allowable life of a device. For example, after a device is used 20 times, the batteries in the 6486 smart battery pack connected to the device will refuse to supply power to the device - since the device is defined as a "no more" surgical instrument. trustworthy". Reliability is determined based on several factors. One factor may be wear and tear, which can be estimated in several ways, including the number of times the device has been used or activated. After a number of uses, the device parts can become worn and the tolerances between the parts can be exceeded. For example, the 6486 smart battery pack can detect the number of times the button is pressed by the 6482 battery pack and can determine when a maximum number of times the button is pressed has been reached or exceeded. The 6486 smart battery pack can also monitor an impedance of the button mechanism that can change, for example, if the handle is contaminated, for example, with saline.
[0408] [0408] This wear can lead to an unacceptable failure during a procedure. In some ways, the smart battery pack
[0409] [0409] When accounting for the uses of the 6484 ultrasonic transducer / generator set to intelligently end the service life of the 6484 ultrasonic transducer / generator set, the surgical instrument makes a precise distinction between completing an actual use of the kit - 6484 ultrasonic transducer / generator in a surgical procedure and a momentary lapse in the performance of the 6484 ultrasonic transducer / generator set due to, for example, a battery change or a temporary delay in the surgical procedure. Therefore, as an alternative to simply counting the number of activations of the 6484 ultrasonic transducer / generator set, a real-time clock (RTC) circuit can be implemented to monitor the amount of time that the ultrasonic transducer / generator set 6484 is in fact turned off. From the measured length of time, it can be determined, through appropriate logic, whether the shutdown was significant enough to be considered the end of a real use or whether the shutdown was too short in terms of time to be considered the end of a use. Thus, in some applications, this method can be a more accurate determination of the useful life of the 6484 ultrasonic transducer / generator set than a simple "activation-based" algorithm, which can, for example, report that ten "activations" they occur in a surgical procedure and, therefore, ten activations should indicate that the counter is incremented by one. In general, this type and internal time counting system will prevent the incorrect use of the device that is designed to enact a simple "activation-based" algorithm and will prevent the incorrect recording of a complete use in cases where there has been just a simple mismatch of the 6484 ultrasonic transducer / generator set or the 6486 smart battery pack that was required for legitimate reasons.
[0410] [0410] Although the 6484 ultrasonic transducer / generator sets of the 6480 surgical instrument are reusable, in one aspect a finite number of uses can be defined since the 6480 surgical instrument is subject to strict conditions during cleaning and sterilization. More specifically, the battery is configured to be sterilized. Regardless of the material used for external surfaces, there is a limited expected service life for the actual materials used. This useful life is determined by several characteristics that could include, for example, the number of times the battery was actually sterilized, the time since the battery was manufactured and the number of times the battery was recharged, to name a few. In addition, the life of the battery cells themselves is limited. The software of the present disclosure incorporates algorithms of the invention that verify the number of uses of the 6484 ultrasonic transducer / generator set and the 6486 smart battery set and disable the device when that number of uses has been reached or exceeded. The analysis of the outside of the battery in each of the possible sterilization methods can be performed. Based on the most rigorous sterilization procedure, the maximum number of sterilizations allowed can be set and this number can be stored in a memory of the 6486 smart battery pack. It is assumed that a charger is non-sterile and that the 6486 smart battery must be used after being charged, so the charge count can be set to be equal to the number of sterilizations found for that specific battery.
[0411] [0411] In one aspect, the hardware in the battery can be disabled to minimize or eliminate security concerns due to the continuous depletion of the battery cells after the battery has been disabled by the software. There may be a situation where the battery's internal hardware is unable to disable the battery under certain low voltage conditions. In this situation, in one respect, the charger can be used to "kill" the battery. Due to the fact that the battery microcontroller is turned off while the battery is in its charger, non-volatile electrically readable programmable and erasable memory (EEPROM) based on the System Management Bus (SMB) can be used to exchange of information between the battery microcontroller and the charger. In this way, a serial EEPROM can be used to store information that can be recorded and read even when the battery micro-controller is turned off, which is very beneficial when trying to exchange information with the charger or other peripheral devices. This example EEPROM can be configured to contain enough memory records to store at least (a) a usage count limit at which the battery must be disabled (Battery Usage Count), (b) the number of procedures to which the battery has been subjected (Battery Procedure Count) and / or (c) a number of charges to which the battery has been subjected (Load Count), among others. Some of the information stored in the EEPROM, such as the Usage Count Register and the Load Count Register, are stored in protected EEPROM write sections to prevent users from changing the information. In one respect, usage and counters are stored with corresponding bit-inverted secondary records to detect data corruption.
[0412] [0412] Any residual voltage on the SMBus lines (system management bus) could damage the microcontroller and corrupt the SMBus signal. Therefore, to ensure that a battery controller's SMBus lines do not contain a voltage while the microcontroller is switched off, relays are provided between the external SMBus lines and the battery's microplate controller.
[0413] [0413] When charging the 6486 smart battery pack, an "end of charge" condition of the batteries inside the 6486 smart battery pack is determined when, for example, the current flowing into the battery drops below a tapered threshold using a constant current / constant voltage charging scheme. To accurately detect this "end of charge" condition, the battery microcontroller and lowering plates are de-energized and turned off during battery charging to reduce any current drain that may be caused by the plates and that may interfere with detection decreasing current. In addition, the microcontroller and the lowering plates are de-energized during charging to prevent any corruption resulting from the SMBus signal.
[0414] [0414] Regarding the charger, in one aspect, the 6486 smart battery pack is prevented from being inserted into the charger in a different way from the correct insertion position. Consequently, the exterior of the 6486 smart battery pack is provided with charger fixing features. A container for securely attaching the 6486 smart battery pack to the charger is configured with a tapered contour geometry to prevent accidental insertion of the 6486 smart battery pack in any way other than the correct one (intended). It is further contemplated that the presence of the 6486 smart battery pack can be detectable by the charger itself. For example, the charger can be configured to detect the presence of the SMBus transmission from the battery protection circuit, as well as the resistors that are located on the protection plate. In this case, the charger would be able to control a voltage that is exposed on the charger pins until the 6486 smart battery pack is closed.
[0415] [0415] In some respects, the 6486 smart battery pack can communicate with the user through auditory and / or visual feedback. For example, the 6486 smart battery pack can cause LEDs to emit light in a predefined way. In this case, although the microcontroller in the 6484 ultrasonic transducer / generator set controls the LEDs, the microcontroller receives instructions to be performed directly from the 6486 smart battery pack.
[0416] [0416] In yet another aspect of the present disclosure, the microcontroller in the 6484 ultrasonic transducer / generator set, when not in use for a predetermined period, enters suspended mode. Advantageously, when in the suspended mode, the microcontroller clock speed is reduced, significantly cutting the current drain. Some current continues to be consumed because the processor continues to send a signal, waiting to detect an input. Advantageously, when the microcontroller is in this suspended energy saving mode, the microcontroller and the battery controller can directly control the LEDs. For example, a decoder circuit could be built on the 6484 ultrasonic transducer / generator set and connected to the communication lines so that the LEDs can be independently controlled by the 6493 processor while the transducer / set microcontroller / ultrasonic generator 6484 is "OFF" or in a "suspended mode". This is an energy saving feature that eliminates the need to start the micro
[0417] [0417] Another aspect slows down one or more of the microcontrollers to conserve energy when not in use. For example, the clock frequencies of both microcontrollers can be reduced to save energy. To maintain a synchronized operation, the microcontrollers coordinate the change of their respective clock frequencies so that they occur at approximately the same time, both the reduction and the subsequent increase in frequency when full speed operation is required. For example, when entering idle mode, clock frequencies are decreased and when leaving idle mode, frequencies are increased.
[0418] [0418] In an additional aspect, the 6486 smart battery pack is able to determine the amount of useful energy remaining inside its cells and is programmed to only operate the surgical instrument to which it is connected if it determines that there is enough battery remaining to predictably operate the device throughout the intended procedure. For example, the 6486 smart battery pack is able to remain in a non-operational state if there is not enough energy inside the cells to operate the surgical instrument for 20 seconds. According to one aspect, the 6486 smart battery pack determines the amount of energy remaining inside the cells at the end of its most recent previous function, for example, a surgical cut. In this respect, therefore, the 6486 smart battery pack would not allow a subsequent function to be performed if, for example, during that procedure, the pack determines that the cells do not have enough energy. Alternatively, if the contract
[0419] [0419] The following explains an advantage of maximizing the use of the device with the 6486 smart battery pack of the present disclosure. In this example, a set of different devices has different ultrasonic transmission waveguides. By definition, waveguides could have a respective maximum allowable energy limit, and exceeding said energy limit overloads the waveguide and, ultimately, causes it to fracture. A waveguide in the waveguide set will, of course, have the lowest energy tolerance. Since prior art batteries do not have smart battery power management, the output of prior art batteries needs to be limited by a value of the lowest allowable maximum energy input for the lowest / most wave guide. narrow / more fragile in the set to be used with the device / battery. This would be true even if larger and thicker waveguides could later be attached to that grip and, by definition, allow greater force to be applied. This limitation is also true for the maximum battery power. For example, if a battery is designed to be used on multiple devices, its maximum output energy will be limited to the lowest maximum energy rating of any of the devices on which it is to be used. With this configuration, one or more devices or device configurations would not be able to maximize battery usage, since the battery does not know the specific limits of the specific device.
[0420] [0420] In one aspect, the 6486 smart battery pack can be employed to intelligently circumvent the above mentioned limitations of the ultrasonic device. The 6486 smart battery pack can produce an output for a specific device or device configuration, and the same 6486 smart battery pack can later produce a different output for a second device or device configuration. This universal system of intelligent surgical battery lends itself well to modern operating rooms where space and time are limited. By having a smart battery that powers several different devices, nursing staff can easily manage the storage, retrieval and inventory of these batteries. Advantageously, in one aspect, the intelligent battery system, according to the present disclosure, can employ a type of charging station, thereby increasing the ease and efficiency of use and decreasing the costs of charging equipment. operating rooms.
[0421] [0421] In addition, other surgical instruments, for example, an electric stapler, may have a different energy requirement than the modular portable ultrasonic surgical instrument 6480. According to various aspects of the present disclosure, a 6486 smart battery pack can be used with any of a number of surgical instruments and can be produced to adapt its own energy output to the specific device in which it is installed. In one aspect, this energy adaptation is achieved by controlling the duty cycle of a switched-mode power supply, for example, a lowering (buck), lowering-lifting (buck-boost), lifting (boost) configuration ), or other configuration, integrated or otherwise coupled to the 6486 smart battery pack and controlled by it. In other respects, the 6486 smart battery pack can dynamically change its power output while operating the device. For example, in vessel sealing devices, energy management allows for improved tissue sealing. In these devices, high constant current values are required. The total power output needs to be adjusted dynamically because, as the fabric is sealed, its impedance changes. Aspects of the present disclosure provide the 6486 smart battery pack with a maximum variable current limit. The current limit may vary from one application (or device) to another, based on the requirements of the application or device.
[0422] [0422] Figure 40 is a detailed view of a 6483 trigger portion and a key for the 6480 ultrasonic surgical instrument shown in Figure 39, in accordance with an aspect of the present disclosure. The 6483 trigger is operationally coupled to the 6495 claw member of the 6492 end actuator. The 6496 ultrasonic blade is powered by the 6484 ultrasonic transducer / generator set by activating the 6485 activation switch. Now continuing with Figure 39, and also looking for Figure 40, trigger 6483 and activation key 6485 are shown as components of the 6482 handle set. The 6483 trigger activates the 6492 end actuator, which has a cooperative association with the 6496 ultrasonic blade of the drive shaft assembly. of the 6490 wheel guide to allow various types of contact between the 6495 claw member of the end actuator and the 6496 ultrasonic blade with tissue and / or other substances. The 6495 jaw member of the 6492 end actuator is, in general, an articulated jaw that acts to hold or hold the tissue arranged between the jaw and the 6496 ultrasonic blade. In one aspect, audible feedback is provided on the trigger that makes a "click" when the trigger is fully depressed. The noise can be generated by a thin metal part that the trigger touches during closing. This feature adds an audible component to the user's feedback that informs the user that the jaw is fully compressed against the waveguide and that sufficient clamping pressure is being applied to achieve vessel rotation. In another aspect, force sensors, such as strain gauges or pressure sensors, can be coupled to the 6483 trigger to measure the force applied to the 6483 trigger by the user. In another aspect, force sensors, such as strain gauges or pressure sensors, can be coupled to the 6485 key button so that the displacement intensity corresponds to the force applied by the user to the 6485 key button.
[0423] [0423] The 6485 activation key, when pressed, places the modular portable ultrasonic surgical instrument 6480 in an ultrasonic operating mode, which causes ultrasonic movement in the drive shaft assembly of the 6490 waveguide. pressing the activation key 6485 causes the electrical contacts inside the key to close, thus completing a circuit between the 6486 smart battery pack and the 6484 ultrasonic transducer / generator set, so that the energy electrical voltage is applied to the ultrasonic transducer, as previously described. In another aspect, pressing the 6485 activation key closes the electrical contacts for the 6486 smart battery pack. Of course, the electrical closing contacts in a circuit are here merely an example of a general description of the operation of the switch. There are many alternative aspects that may include opening contacts or a processor-controlled power supply that receives information from the switch and directs a corresponding circuit reaction based on the information.
[0424] [0424] Figure 41 is an enlarged fragmentary perspective view of a 6492 end actuator, in accordance with at least one aspect of the present disclosure, from a distal end with a 6495 claw member in an open position. Referring to Figure 41, a partial perspective view of the distal end 6498 of the 6490 waveguide drive shaft assembly is shown. The 6490 waveguide drive shaft assembly includes an outer tube 6494 that surrounds a portion of the waveguide. The 6496 ultrasonic blade portion of the 6499 waveguide protrudes from the distal end 6498 of the 6494 outer tube. It is the 6496 ultrasonic blade portion that comes into contact with the tissue during a medical procedure and transfers its ultrasonic energy to the fabric. The waveguide drive shaft assembly 6490 also includes a claw member 6495 that is attached to the outer tube 6494 and an inner tube (not visible in this view). The 6495 claw member, with the inner and outer tubes and the 6496 waveguide 6496 ultrasonic sheet portion, can be called a 6492 end actuator. As will be explained below, the 6494 outer tube and tube internal not shown slide longitudinally in relation to each other. As the relative movement between the outer tube 6494 and the inner tube not shown occurs, the claw member 6495 hinges over a pivot point, thus causing the claw member 6495 to open and close. When closed, the claw member 6495 provides a clamping force on the tissue between the claw member 6495 and the ultrasonic blade 6496, ensuring positive and efficient contact between the blade and the fabric.
[0425] [0425] Again with reference to Figure 42, end actuator 8400 comprises RF data sensors 8406, 8408a, 8408b located on claw member 8402. The 8400 end actuator comprises a claw member 8402 and a ultrasonic blade 8404. Claw member 8402 is shown holding tissue 8410 located between claw member 8402 and the ultrasonic blade
[0426] [0426] The 8400 end actuator is an exemplary end actuator for a surgical instrument. Sensors 8406, 8408a, 8408b are electrically connected to a control circuit such as the 7400 control circuit (Figure 63) via interface circuits. Sensors 8406, 8408a, 8408b are powered by battery and the signals generated by sensors 8406, 8408a, 8408b are supplied to the analog and / or digital processing circuits of the control circuit.
[0427] [0427] In one aspect, the first sensor 8406 is a force sensor for measuring a normal force F3 applied to tissue 8410 by claw member 8402. The second and third sensors 8408a, 8408b include one or more elements for applying energy from RF to tissue 8410, measure tissue impedance, down force F1, transverse forces F2, and temperature, among other parameters. Electrodes 8409a, 8409b are electrically coupled to a power source and apply RF energy to the 8410 tissue. In one aspect, the first 8406 sensor and the second and third 8408a, 8408b sensors are effort meters for measuring force or force by area unit. It will be recognized that the downward force measurements F1, the lateral forces F2 and the normal force F3 can be easily converted into pressure by determining the surface area on which the force sensors 8406, 8408a, 8408b are acting. In addition, as described in particular here, the flexible circuit 8412 can
[0428] [0428] Intelligent ultrasonic blade spectroscopy algorithm techniques can be used to estimate the claw state (destruction of the clamping arm block, clamps, broken blade, bone in the claw, tissue in the claw, cutting of return with closed claw, etc.) based on the Zo (8) impedance Ig (t) of an ultrasonic transducer, configured to drive the blade of an ultrasonic transducer, according to at least one aspect of the present disclosure. The impedance Z, 'W, magnitude | Z |, and phase q are plotted as a function of frequency f.
[0429] [0429] Dynamic Mechanical Analysis (DMA), also known as dynamic mechanical spectroscopy or simply mechanical spectroscopy, is a technique used to study and characterize materials. A sinusoidal stress is applied to the material, and the stress on the material is measured, allowing the determination of the complex module of the material. Spectroscopy as applied to ultrasonic devices includes excitation of the tip of the ultrasonic blade with a frequency scan (composite signals or traditional frequency scans) and measurement of the resulting complex impedance at each frequency. Complex impedance measurements from the ultrasonic transducer over a frequency range are used in a classifier or model to infer the characteristics of the ultrasonic end actuator. In one aspect, the present disclosure provides a technique for determining the state of an ultrasonic end actuator (clamping arm, claw) to trigger automation on the ultrasonic device (such as disabling power to protect the device, running adaptive algorithms , retrieve information, identify tissue, etc.).
[0430] [0430] Figure 43 is a 132030 spectrum of an ultrasonic device with a variety of different states and conditions of the end actuator when impedance Z7 (Ww, magnitude | Z |, and phase q are plotted as a function the frequency f, according to at least one aspect of the present disclosure.The spectra 132030 are plotted in a three-dimensional space where the frequency (Hz) is plotted along the x axis, the phase (Rad) is plotted along the y-axis, and the magnitude (Ohms) is plotted along the z-axis.
[0431] [0431] Spectral analysis of different claw bites and device states produces different characteristic patterns of complex impedance (fingerprints) over a frequency range for different conditions and states. Each state or condition has a different characteristic pattern in 3D space, when plotted. These characteristic patterns can be used to estimate the condition and state of the end actuator. Figure 43 shows the spectra for air 132032, clamping arm block 132034, suede 132036, clamp 132038 and broken blade 132040. Suede 132036 can be used to characterize different types of fabric.
[0432] [0432] The 132030 spectra can be evaluated by applying a low power electrical signal through the ultrasonic transducer to produce non-therapeutic excitation of the ultrasonic blade. The low-power electrical signal can be applied in the form of a scan or a composite Fourier series to measure the impedance Za (y = xo through the ultrasonic transducer in a frequency range in series (scan) or in parallel ( composite signal) using an FFT.
[0433] [0433] Figure 44 is a graphical representation of a 132042 plot of a 3D training data set (S), where the impedance of the ultrasonic transducer Z, (t), magnitude | Z |, and phase £ are plotted as a function of frequency f, according to at least one aspect of the present disclosure. Plot 132042 of the 3D training data set (S) is plotted in three-dimensional space where the phase (Rad) is plotted along the x axis, the frequency (Hz) is plotted along the y axis, the magnitude (Ohms) is plotted along the z axis, and a parametric Fourier series is fitted to the 3D training data set (S). The methodology for classifying the data is based on the 3D training data set (SO is used to generate the 132042 plot).
[0434] [0434] The parametric Fourier series that fits the 3D training data set (S) is given by: LX a, cosnmt b, sinnmt Ppsa + t> (1 * tOT) n = 1
[0435] [0435] For a new point Z, the perpendicular distance from Pp to 7 is found by: D = | l5 — z | When: at the Er So: D = D,
[0436] [0436] A distribution probability of D can be used to estimate the probability of a data point zZ belonging to group S.
[0437] [0437] Aspects of the present disclosure are presented for a surgical instrument with situation recognition. The surgical instrument can be any suitable surgical instrument described in the present disclosure. For the sake of clarity, the surgical instrument 112 is mentioned. In particular, the surgical instrument 112 can be a bipolar combination surgical instrument 112 that can automatically adjust a compression force applied by the end actuator of the surgical instrument 112 based on a selected energy mode. In one aspect, the bipolar combination surgical instrument 112 can be configured to supply energy according to a bipolar radio frequency (RF) and an ultrasonic energy mode. More specifically, automatic adjustment can be done based on a ratio between two different selected energy modes. This automatic adjustment of the compression force is an example of a situation recognition characteristic of the surgical instrument 112 that can improve the efficiency and quality of a surgical procedure performed with the surgical instrument 112. The clamping pressure applied by the end actuator may be indicative of the compression force applied to the tissue being treated. As discussed above, selectable energy modalities include radio frequency (electrosurgical), ultrasonic, bipolar or monopolar, irreversible or reversible electroporation, and microwave energy mode implemented by a generator of the 112 surgical instrument. aspect, the two selected energy modalities are bipolar RF energy and ultrasonic energy. Additionally or alternatively, to adjust the compression force applied to the fabric based on the selected energy mode, the compression force can also be adjusted
[0438] [0438] In general, the adjustment of the compression force can be actively performed during the performance of a surgical procedure. This active adjustment may mean that the physician operating the surgical instrument 112 does not need to manually adjust the clamping arm, the waveguide or ultrasonic blade or the end actuator to modify the compression force applied to the tissue being treated in the claws of the end actuator. As described in more detail below, a control circuit or generator of surgical instrument 112 with situation recognition can automatically adjust the compression force of the tissue by executing an algorithm. The algorithm is executable to determine an adequate compression force considering the specific proportion or mixture of the selected energy modalities. For example, the relative proportion of time spent applying each energy mode can be considered in determining the appropriate tissue compression forces to be applied during the course of the surgical procedure performed. The relative amplitudes of each energy modality could be considered as well. Also, each type of energy modality can correspond to a certain pressure or pressure range, which could also change depending on other parameters, such as the power and timing of the applied energy mode. This energy-pressure relationship can also be understood as the energy supplied and the pressure existing together in a spectrum. That is, the more compression pressure is applied, the more effective the application of energy to treat the tissue will be. Consequently, less energy may be required when more compression pressure is applied. Energy is applied according to the selected energy mode.
[0439] [0439] The selected energy modes can be applied simultaneously to the tissue. Alternatively, the generator can alternate between providing a trigger output signal according to a first energy mode, such as bipolar RF, and providing the trigger output signal according to a second energy mode, such as ultrasonic . In other words, the RF application can follow ultrasonic and vice versa. The switching extension can be used in the algorithm to determine an automatic adjustment appropriate to the compression force of the tissue. For example, when the generator changes the ultrasonic energy supply to bipolar RF energy, the compression force applied to the tissue can be increased. When multiple energy modes are applied simultaneously, the relative proportion of the energy modes can be used to determine the compression force setting. For example, the control circuit can be the ratio of ultrasonic trigger signals to RF trigger signals provided by the generator. As further described below, electrical or mechanical methods of adjusting tissue compression may be used and such methods may or may not involve control by the processor, control circuit or generator, as appropriate. In some respects, the tissue compression adjustment algorithm can be stored in a memory and can be updated by updating the algorithm program transmitted from the corresponding central surgical controller (eg, central surgical controller 106, 206) to the surgical instrument 112. In contrast, the central controller can receive this update from the algorithm program of a cloud computing system (for example, cloud 104, 204). The central controller can also store the update locally on a central controller memory device. In addition or alternatively, the control circuit or generator of the surgical instrument 112 can modify the algorithm as appropriate, such as by a physician who changes the parameters of the algorithm through a user interface of the surgical instrument 112.
[0440] [0440] Mechanical methods of adjusting the tissue compression force include adjusting the waveguide or the ultrasonic blade and adjusting the clamping arm attachment mechanism (for example, connecting components of the 706a to 706e transmissions) of the instrument. - surgical 112. The ultrasonic blade can be, for example, an oval displacement ultrasonic blade when the end actuator clamping arm and the displacement ultrasonic blade are able to rotate relative to each other to define a distance of fabric gap between the jaws of the end actuator. By adjusting the gap of the fabric, various forces of compressing the fabric are possible. In this way, the ultrasonic blade is adjustable to generate a smaller tissue gap (and thus a relatively greater compression force) when the RF energy mode is selected and to generate a larger tissue gap ( and, thus, a relatively smaller compression force) when the ultrasonic energy mode is selected. The clamping elements of the end actuator can also be adjusted to a desired fabric span size, regardless of the waveguide. For example, in one aspect, a clamping arm connection mechanism is provided to change the travel of the clamping arm actuating stem according to the selected energy mode. The actuating rod of the clamping arm (for example, articulation actuator, such as via the motor output drive shaft 704a, 704b coupled to mobile mechanical transmission elements 706a, 706b) is coupled to a connecting pivot, which in turn instead, it is operationally coupled to a mechanical selector of a 112 surgical instrument.
[0441] [0441] The mechanical selector can be a mechanically actuated key, such as a momentary hand switch, mechanical coupling switch, capacitive touch switch, membrane switch or other suitable mechanical switch. The mechanical key can be controlled by the control circuit or generator to change the link pivot or link mechanism attached to the clamping arm of the end actuator, so that the clamping arm exerts a different compressive force, depending according to the selected energy mode. As such, in a position of the mechanical key, the clamping arm can be linked so that when the actuating rod is actuated, relatively high compressive forces are applied. In a second position of the mechanical key, the clamping arm can be linked so that when the actuating rod is actuated, relatively low compressive forces are applied. In one aspect, the first position corresponds to the ultrasonic energy modality, while the second position corresponds to the bi-polar RF energy modality.
[0442] [0442] Electrical methods of adjusting the fabric compression force are also possible. For example, the compression force can be adjusted automatically by the surgical instrument 112 with situation recognition using an electroactive polymer (WBS). The EAP can be, for example, an electrical EAP (for example, ferroelectric polymer), ionic EAP (for example, ionomeric polymeric metal composite), non-ionic EAP, conductive polymer or other suitable EAP. The EAP can be arranged in parallel with an RF energy circuit of the surgical instrument 112, in which the RF energy circuit is configured to implement the RF energy supply. Consequently, the selection of an RF energy modality would cause the current to flow through the RF energy circuit as RF energy is supplied, which would also cause the WBS to expand. With the expansion of the WBS, the size of the fabric gap decreases and results in the application of a greater compression force.
[0443] [0443] Additionally or alternatively, multiple sets of electrodes (for example, electrodes 796, 3074a, 3074b) can be supplied and activated according to a specific sequence. This type of surgical treatment can be called hybrid activation. In hybrid activation, multiple different electrodes are provided on the end actuator to perform different surgical functions. For example, a first set of electrodes can be used to view the surgical stage and a second set of electrodes can be used for the surgical cut stage. For this purpose, a wrench, filter or other suitable wiring is provided to route the drive signal provided by the generator to one or more suitable electrodes on the end actuator. For example, the situation-aware surgical instrument 112 can determine that an end actuator electrode is configured for sealing instead of cutting. Consequently, a relatively low voltage and high current RF trigger signal can be triggered through the generator output port for pre-defined sealing electrodes for sealing. Similarly, an RF drive signal of greater power than that used for sealing can be triggered for different predefined cutting electrodes. The surgical instrument 112 can determine when the change from the sealing electrodes to the cutting electrodes should occur based on a measured impedance value. When the impedance threshold is reached, the surgical instrument 112 can determine that a sufficiently secure seal has been created and that the cutting stage of the surgical procedure can begin. In general, the trigger signal from the generator's output port is routed properly to the corresponding electrode. In this way, the trigger signals can be sent to the appropriate treatment electrodes based on the appropriate stage of the surgical operation being performed. In addition, the tissue compression force can be adjusted to an appropriate level depending on the power, time or proportion of the signal or trigger signals that are applied to the tissue.
[0444] [0444] In some respects, the automatic clamping pressure adjustment can be based on an algorithm implemented by a control circuit of the surgical instrument 112. As described above, the control circuit is configured to define and change several control parameters of the surgical instrument 112, including clamping pressure, power released to treat the tissue, and the amplitude and frequency of the waveform / trigger signal emitted by the generator. Each type of energy can generally correspond to a compression force. For example, RF energy (bipolar or monopolar) generally requires a greater extent of tissue pressure compared to the ultrasonic energy modality. The high tissue compression forces used for the low operating temperature, RF energy can be advantageous for the treatment of soft connective tissue. Bipolar RF energy may require even higher tissue compression forces as opposed to those used in monopolar RF energy applications. In one aspect, the compression force adjustment algorithm can be adjusted based on a proportion of two or more different energy modes. That is, two energy modalities can be applied during a surgical procedure and the proportion of time spent in each modality can be used in an algorithm to calculate the appropriate tissue compression forces to be applied during the procedure. surgical. Energy, according to the multiple modalities
[0445] [0445] Figure 45 is a 135000 logical flow diagram that represents a control program or a logical configuration to adjust the compression force applied to the tissue, based on one or more selected energy modalities, according to the less an aspect of the present revelation. The compression force is adjustable for a surgical procedure performed with a surgical instrument 112. A control circuit or surgical instrument processor 112 (Figures 10 to 17) or central controller 106 (for example, processor 244 Figure 8) determines a type of tissue 135002 (which includes any tissue described in the present invention, but is referred to as tissue 8410 for the sake of clarity) being treated by the surgical instrument 112. Tissue types include, for example, tissue connective tissue (for example, blood vessels), muscle tissue and bronchial tissue. Tissue types can be detected or determined in several ways, such as through the use of spectral analysis of tissue portions. As discussed above, the spectral analysis of different claw bites and device states produces different characteristic patterns of complex impedance (fingerprint) over a frequency range for different conditions and states. Spectroscopy can be applied to surgical instrument 112 by exciting the tip of the ultrasonic blade of surgical instrument 112 with a frequency scan, for example. The characteristic patterns of complex impedance over a frequency range can be used in a model or classifier to infer tissue types.
[0446] [0446] In addition to inferring the type of fabric, fabric characteristics such as fabric thickness and hardness can be determined, for example. The determination or inference of the type of fabric and the characteristics of the fabric can be performed by the control circuit, including control circuit 500, 710, 760, 3200, 3300, 3402, 3502, 3686,
[0447] [0447] Based on the determination of the type and characteristic of the tissue, the surgical instrument with situation recognition 112 can infer 135002 a type of surgical procedure or tissue treatment. Alternatively, an appropriate surgical procedure can be determined manually or inserted by the clinician using the
[0448] [0448] A tissue treatment algorithm is determined
[0449] [0449] In contrast, RF energy may be more suitable for cauterization of larger tissue. For this purpose, as discussed above, the 1100 generator can supply energy with higher voltage and lower current to drive an ultrasonic transducer, with lower voltage and higher current to drive RF electrodes to seal the 8410 fabric or with a shape coagulation waveform for point coagulation using monopolar or bipolar RF electrosurgical electrodes. In one aspect, the treatment tissue algorithm can specify the times during a surgical procedure in which a specific energy modality is applied (for example, RF versus ultrasonic). For example, the algorithm can define that a mixture of RF and ultrasonic energy is provided during the sealing stage of the surgical procedure and only ultrasonic energy is provided during the cutting stage. For this purpose, the 1100 ultrasonic generator can apply RF electrosurgical and ultrasonic energy simultaneously from its output port to provide the desired output trigger signal. The RF and ultrasonic mix can be applied simultaneously or substantially simultaneously as a mixing energy modality or the 1100 generator can be configured to switch between the energy application according to the RF energy modalities and ultrasonic (for example, switching between the energy modalities of the RF generator circuit 3902 and the ultrasonic generator circuit 3920). The tissue treatment algorithm can also specify the power at which the energy modes are applied. For example, as discussed above, waveform generator 904 and processor 902 of generator 1100 are configured to generate signal waveforms of various amplitudes (the power parameter can be adjusted by controlling the input of the 1620 power amplifier to define a specific waveform amplitude). The tissue treatment algorithm can also define how the amplitude, frequency and shape of the waveforms emitted by the 1100 generator change during the course of the surgical procedure being performed.
[0450] [0450] The 1100 generator applies 135010 energy to the 8410 tissue according to the desired tissue treatment algorithm. It may be possible to change the tissue treatment algorithm during execution
[0451] [0451] In one aspect, the compression force corresponding to an energy modality is relatively higher. That is, a range of compressive strength to which RF energy is applied may be greater than the range of compressive strength to which ultrasonic energy is applied.
[0452] [0452] When ultrasonic energy and RF energy are applied simultaneously or substantially simultaneously, the overall ratio between ultrasonic energy and RF energy can be used to determine the appropriate compression force.
[0453] [0453] Figure 46 illustrates a mechanical method of adjusting the compression force applied by a 135100 end actuator for different types of treatment, according to one aspect of the present disclosure. The end actuator 135100 of the surgical instrument 112 is the same or similar to other end actuators described above, such as the end actuator 702, 752, 792, 1122, 8400. Consequently, the end actuator 135100 can comprise two members of claw. In many respects, the claw members are a 135102 clamping arm and a waveguide or blade
[0454] [0454] In other words, the 135104 ultrasonic blade has a zero degree orientation corresponding to a horizontal orientation and a ninety degree orientation corresponding to a vertical orientation. With the 135102 clamping arm held in a constant or substantially constant position (shown in Figure 46), the 135104 ultrasonic blade is able to rotate to define a clamping pressure spectrum. An opposite configuration is also possible so that the 135104 ultrasonic blade is the constant claw member instead of the 135102 clamping arm. In one aspect, as the 135104 ultrasonic blade rotates from zero degrees to ninety degrees, the compressive strength of the tissue increases from low strength to high strength. The fabric span resulting from the zero degree orientation can be called the low claw 135106 while the fabric span resulting from the ninety degree orientation can be called the high claw 135108. Various orientations of the 135104 ultrasonic blade correspond to the same pressure level of compression. For example, zero degree and one hundred and eighty degrees both correspond to the low claw 135106. Figure 46 represents the low claw 135106, the high claw 135108 and a third orientation 135110. The third orientation 135110 shown in Figure 46 is slightly larger than ninety degrees, like a hundred and twenty degrees orientation. Consequently, this third orientation 135110 defines a fabric span size that is slightly smaller than the fabric span corresponding to the 135108 high jaw.
[0455] [0455] In horizontal orientation (low claw) 135106, the 135104 ultrasonic blade can be configured for sealing tissue (for example, coagulation or cauterization). In the vertical orientation (high claw) 135108, the 135104 ultrasonic blade can be configured for cutting or dissecting tissue. As discussed above, the RF energy modality can generally correspond to greater tissue compression strength. Consequently, in one aspect, the 135106 horizontal orientation corresponds to the ultrasonic energy modality while the 135108 vertical orientation corresponds to the RF energy modality. Other intermediate positions, including the third orientation 135110, can be used as appropriate during the surgical procedure. For example, a relatively high power RF waveform and an intermediate orientation, such as 60 degrees, can be used when surgical treatment begins. In addition, the orientation of the 135104 ultrasonic blade can be changed throughout a surgical procedure performed according to the selected tissue treatment algorithm 135008, for example. In another aspect, the 135104 ultrasonic blade can be oval in shape and offset from the 135102 clamping arm.
[0456] [0456] Other mechanical methods of adjusting the compression force are disclosed. For example, the clamping arm 135102 or the ultrasonic blade 135104 can be movable so that the 135100 end actuator is configurable between a closed configuration, an open configuration and intermediate positions between them to define various tightening pressures . In one aspect, a mechanical switch, such as a momentary hand-held switch, mechanical safety switch, capacitive touch sensitive switch, diaphragm switch or other suitable mechanical switch of the 112 surgical instrument, can make the transition between two positions. The 3900 control circuit can control the operation of the mechanical key. The first and second positions can correspond to a first and a second level of compression force, which in turn can correspond to a first and a second energy modalities, respectively. Thus, for example, in the first position, the mechanical key can cause an adjustment of the stroke or longitudinal movement of an actuating stem. The actuator stem can refer to a suitable endpoint actuator mechanism 135100, such as transmission link components 706a to 706e for coupling motors 704a to 704e.
[0457] [0457] In particular, the actuating rod may comprise connection elements similar or equal to transmissions 706a to 706e used to transmit mechanical energy from motors 704a and 704b to actuate or close the closing member 714 and the clamping arm 716, respectively. The actuating stroke of the actuating stem can be adjusted by the 3900 control circuit to achieve the different compression forces of the 1351000 end actuator. With the adjustment caused by the first position of the mechanical key, the actuation of the actuating stem can result in an orientation of the 135102 clamping arm corresponding to a relatively large span of fabric. On the other hand, in the second position, the mechanical key can cause a different adjustment so that the actuation of the actuating rod can result in an orientation of the clamping arm 135102 that corresponds to a relatively small gap of fabric. The first position can correspond to the application of energy according to the ultrasonic modality while the second position can correspond to the application of energy according to the RF modality. In one aspect, by displacing the first and second positions, the mechanical key dislocates the pivoting connection or coupling between the actuating rod and the clamping arm 135102. In this way, the 3900 control circuit can control the key mechanics to implement adjustments in the stroke of the actuator, which in turn results in several 135102 clamping arm configurations (between and including open and closed configurations) that correspond to different tissue compression forces. Other suitable mechanical means for adjusting the actuator stroke or clamping arm configuration are also possible.
[0458] [0458] Figures 47A to 47B illustrate a mechanical method of adjusting the compression force applied by a 135200 end actuator for different types of treatment, by rotating an 135204 ultrasonic blade, according to the aspects of the present disclosure. The end actuator 135200 and the ultrasonic blade 135204 are the same or similar to the end actuator 135100 and the ultrasonic blade 135104, respectively. The 135204 ultrasonic blade is capable of rotating between a vertical and horizontal configuration, as shown in Figures 47A and 47B. In one aspect, end actuator 135200 comprises a claw member 135202 (e.g. clamping arm 135102, 716), flexible circuit 135206 and ultrasonic blade 135204. In addition or alternatively, the claw member 135202 may be able to rotate too. Figure 47A illustrates the tissue 135208 located between the jaw member 135202 and the ultrasonic sheet 135204. In the horizontal orientation shown, the ultrasonic sheet 135204 is at or substantially in a zero degree orientation. Consequently, the relatively low compression force is applied to the 135208 tissue. In one aspect, the 135204 ultrasonic sheet is configured for sealing the tissue (for example, cauterization) in horizontal orientation. The ultrasonic blade 135204 also comprises lateral shoulder sections 135210a, 135210b to improve tissue dissection and uniform sections 135212a, 135212b to improve tissue sealing. As discussed above, the 3900 control circuit can control the rotation of the 135202 claw member or the 135204 ultrasonic blade.
[0459] [0459] Figure 47B shows the vertical orientation in which the 135204 ultrasonic blade is or substantially in a ninety degree orientation. In another aspect, the 135204 ultrasonic sheet is configured for tissue dissection in the vertical orientation. The 135206 flexible circuit can include electrodes so that when an RF energy mode is selected, the electrodes are configured to deliver high frequency RF current to the 135208 tissue. The electrodes can be the same or similar to the electrodes described in the present development, such as electrodes 796, 3074a, 3074b, 3906a,
[0460] [0460] Electrical methods of adjusting the compression force between the types of treatment are also presented. For example, a suitable WBS can be used as an electrostatic actuator to change the gap size of the fabric. EAPs are tension-activated elastomers that can be electronic EAPs, such as electrostrictive elastomers and electro-active dielectric polymers (DEAPs) or ionic EAPs, such as ionic polymer metal composites (IPMCs). EAPs have an electromechanical thickness or other stress that is induced by electrostatic forces. In other words, when a tension is applied to an EAP, the EAP flexes, contracts or expands. An EAP actuator can be used on the surgical instrument 112 to change the size of the tissue gap to change the compression forces applied based on the application of a stress potential to the EAP. The EAP actuator can be controlled by the 3900 control circuit. For example, the EAP can be configured to expand, which causes more pressure to be applied to the 135204 blade or 796 electrodes positioned on the 135200 end actuator. For this purpose, the EAP can be positioned on the 135200 end actuator between the power source (eg, generator) and the RF 796 electrodes. For example, the EAP can be part of the flexible circuit
[0461] [0461] Additionally or alternatively, when the WBS expands, this causes a force to be applied to the 135200 blade so that the size of the tissue gap decreases. On the other hand, the EAP can be positioned and configured so that the electrostatic EAP action causes the EAP to contract, which reduces the compression force applied to the tissue. The change in the size of the WBS can be proportional to the voltage used to actuate the WBS and the adjustment of the resulting compression force. In one aspect, the EAP can also be positioned on the drive shaft of the surgical instrument 112, for example, so that the electrostatic actuation causes the EAP to exert additional force on the clamping arm 135102 or end actuator 135200. similarly, the EAP can be configured to remove or reduce the force applied by the 135102 clamping arm. In this way, the EAP actuator can be used to change the configuration of the end actuator, which extends between the con-
[0462] [0462] In general, the end actuator 135200 of the surgical instrument 112 can comprise an ultrasonic blade 135200 and a clamping arm 135102, which can function as the first and second claws of the end actuator 135200. The end actuator - mity 135200 is configured to hold the fabric between the claws, shoot fasteners through the stuck fabric 135208, cut the stuck fabric 135208 and hold the 135208 fabric for energy application, according to the selected energy mode. In addition, the force applied to the fabric 135208 by the end actuator 135200 can be measured by the strain gauge sensor 474, such as by measuring the amplitude or magnitude of the effort exerted on a claw member of the end actuator 135200 during an operation of tightening. As discussed above, energy can be supplied according to multiple energy modalities, such as RF and ultrasonic energy, together to achieve the functions of surgical sealing, cutting and coagulation. Although the power of generator 1100 can be applied simultaneously, such as by simultaneously releasing or outputting waveforms from generator 1100 to RF electrodes 796 and ultrasonic transducer 1120, together, such energy application can also alternate between different energy modes.
[0463] [0463] Figure 48 shows a 135300 diagram illustrating the switching between the active electrodes of an end actuator
[0464] [0464] In one aspect, electrodes "A" 135302 are configured for the sealing stage and electrodes "B" 135304 are configured for the cutting stage. These settings can be used by the surgical instrument 112 to determine whether and which compression force adjustment is required when an energy modality is selected.
[0465] [0465] As discussed above, impedance can be measured by dividing the output of the voltage detection circuit and the current detection circuit or with the use of spectral analysis, for example. When coagulation is complete, the switch can transition to a second position to route a different waveform from generator 1100, where the amplitude of the different waveform is high in relation to the waveform used for coagulation. The different waveform can be applied for surgical cutting instead of coagulation. Consequently, the switch can route this different waveform to electrodes "B" 135304. As can be seen in the power graph 135314 in Figure 48, the amplitude of the waveform is greater than the amplitude of the waveform of coagulation. Although the power levels shown in the 135314 power graph are constant, dynamic power levels can also be used. As discussed above, the increase in power from electrodes "A" 135302 to electrodes "B" 135304 can trigger an adjustment of tissue compression, which can be determined based on the proportion between a selected energy modality and another. In another aspect, the surgical cut obtained through the 135304 "B" electrodes is a knife-free cut. Although the energy modality selected for the treatment of the tissue illustrated in Figure 49 can be RF, other energy modalities can be used for such treatment and in the course of a surgical operation performed. Situational recognition
[0466] [0466] Referring now to Figure 49, a 5200 timeline is shown representing the status recognition of a central controller, such as central surgical controller 106 or 206, for example. Timeline 5200 is an illustrative surgical procedure and the contextual information that surgical hub 106, 206 can derive from data received from data sources at each stage in the surgical procedure. Timeline 5200 represents the typical steps that would be taken by nurses, surgeons, and other medical personnel during the course of a pulmonary segmentectomy procedure, starting with the setup of the operating room and ending with the transfer of the patient to a post-op recovery room.
[0467] [0467] The central surgical controller with situational recognition 106, 206 receives data from data sources throughout the course of the surgical procedure, including the data generated each time medical personnel use a modular device that is paired with the central surgical controller 106, 206. Central surgical controller 106, 206 can receive this data from paired modular devices and other data sources and continuously derive inferences (ie contextual information) about the ongoing procedure as new data is received, such as which stage of the procedure is being performed at any given time. The situational recognition system of surgical hub 106, 206 is, for example, able to record data referring to the procedure to generate reports, verify the steps being taken by medical personnel, provide data or warnings (for example, through a display screen) that may be relevant to the specific step of the procedure, adjust the modular devices based on the context (for example, activate monitors, adjust the field of view (FOV) of the medical imaging device, or change the energy level of an ultrasonic surgical instrument or RF electrosurgical instrument), and take any other action described above.
[0468] [0468] In the first step 5202, in this illustrative procedure, members of the hospital team retrieve the patient's electronic medical record (PEP) from the hospital's PEP database. Based on patient selection data in the PEP, surgical hub 106, 206 determines that the procedure to be performed is a thoracic procedure.
[0469] [0469] In the second step 5204, the team members scan the incoming medical supplies for the procedure. Surgical hub 106, 206 cross-references the scanned supplies with a list of supplies that are used in various types of procedures and confirms that the supply mix corresponds to a thoracic procedure. In addition, surgical hub 106, 206 is also able to determine that the procedure is not a wedge procedure (because inlet supplies have an absence of certain supplies that are required for a cuff procedure.
[0470] [0470] In the third step 5206, medical personnel scan the patient's band with a scanner that is communicably connected to surgical hub 106, 206. Surgical hub 106, 206 can then confirm the patient's identity based on the scanned data.
[0471] [0471] In the fourth step 5208, the medical staff connects the auxiliary equipment. The auxiliary equipment being used may vary according to the type of surgical procedure and the techniques to be used by the surgeon, but in this illustrative case they include a smoke evacuator, an insufflator and a medical imaging device. When activated, auxiliary equipment that is a modular device can automatically pair with the surgical hub 106, 206, which is located within a specific neighborhood of the modular devices as part of its initialization process. The surgical hub 106, 206 can then derive contextual information about the surgical procedure by detecting the types of modular devices that correspond with it during this preoperative or initialization phase. In this particular example, surgical hub 106, 206 determines that the surgical procedure is a VATS (video-assisted thoracic surgery) procedure based on this specific combination of modular paired devices. Based on the combination of data from the patient's electronic medical record (PEP), the list of medical supplies to be used in the procedure, and the type of modular devices that connect to the hub, the surgical hub 106, 206 it can, in general, infer the specific procedure that the surgical team will perform. After surgical hub 106, 206 recognizes which specific procedure is being performed, surgical hub 106, 206 can then retrieve the steps of that process from memory or from the cloud and then cross-reference the data it subsequently receives from connected data (for example, modular devices and patient monitoring devices) to infer which stage of the surgical procedure the surgical team is performing.
[0472] [0472] In the fifth step 5210, the team members fix the electrocardiogram (ECG) electrodes and other patient monitoring devices on the patient. ECG electrodes and other patient monitoring devices are able to pair with surgical hub 106, 206. As surgical hub 106, 206 begins to receive data from patient monitoring devices, the surgical hub 106, 206 thus confirms that the patient is in the operating room.
[0473] [0473] In the sixth step 5212, medical personnel induced anesthesia in the patient. Surgical hub 106, 206 can infer that the patient is under anesthesia based on data from modular devices and / or patient monitoring devices, including ECG data, blood pressure data, ventilator data, or combinations of them, for example. After the completion of the sixth step 5212, the preoperative portion of the lung segmentectomy procedure is completed and the operative portion begins.
[0474] [0474] In the seventh step 5214, the lung of the patient who is being operated on is retracted (while ventilation is switched to the contralateral lung). Surgical hub 106, 206 can infer from the ventilator data that the patient's lung has been retracted, for example. Surgical hub 106, 206 can infer that the operative portion of the procedure started when it can compare the detection of the patient's lung collapse in the expected steps of the procedure (which can be accessed or retrieved earlier) and thus determine that the retraction of the lung is the first operative step in this specific procedure.
[0475] [0475] In the eighth step 5216, the medical imaging device (for example, a visualization device) is inserted and the video from the medical imaging device is started.
[0476] [0476] In the ninth step 5218 of the procedure, the surgical team starts the dissection step. Surgical hub 106, 206 can infer that the surgeon is in the process of dissection to mobilize the patient's lung because he receives data from the RF or ultrasonic generator that indicate that an energy instrument is being fired. Surgical hub 106, 206 can cross-check the received data with the steps retrieved from the surgical procedure to determine that an energy instrument being triggered at that point in the process (that is, after completing the previously discussed steps of the procedure) matches to the dissection step. In certain cases, the energy instrument may be a power tool mounted on a robotic arm in a robotic surgical system.
[0477] [0477] In the tenth step 5220 of the procedure, the surgical team continues to the connection step. Surgical hub 106, 206 can infer that the surgeon is linking arteries and veins because he receives data from the surgical stapling and cutting instrument indicating that the instrument is being fired. Similar to the previous step, surgical hub 106, 206 can derive this inference by crossing the reception data from the stapling and surgical cutting instrument with the steps recovered in the process. In certain cases, the surgical instrument can be a surgical tool mounted on a robotic arm of a robotic surgical system.
[0478] [0478] In the eleventh step 5222, the segmentectomy portion of the procedure is performed. Surgical hub 106, 206 can infer that the surgeon is transecting the parenchyma based on data from the surgical stapling and cutting instrument, including data from its cartridge. The cartridge data can correspond to the size or type of clamp being triggered by the instrument, for example. As different types of staples are used for different types of fabrics, the cartridge data can thus indicate the type of fabric being stapled and / or transected. In this case, the type of clamp that is fired is used for the parenchyma (or other similar types of tissue), which allows the surgical hub 106, 206 to infer which segmentectomy portion of the procedure is being used. fulfilled.
[0479] [0479] In the twelfth step 5224, the node dissection step is then performed. Surgical hub 106, 206 can infer that the surgical team is dissecting the node and performing a leak test based on data received from the generator that indicates which ultrasonic or RF instrument is being fired. For this specific procedure, an RF or ultrasonic instrument being used after the parenchyma has been transected corresponds to the node dissection step, which allows the surgical hub 106, 206 to make this inference. It should be noted that surgeons regularly switch between surgical stapling / cutting instruments and surgical energy instruments (that is, RF or ultrasonic) depending on the specific step in the procedure because different instruments are better adapted for specific tasks. Therefore, the specific sequence in which the cutting / stapling instruments and surgical energy instruments are used can indicate which stage of the procedure the surgeon is performing. In addition, in certain cases, robotic tools can be used for one or more steps in a surgical procedure and / or hand-held surgical instruments can be used for one or more steps in the surgical procedure. The surgeon can switch between robotic tools and hand-held surgical instruments and / or can use the devices simultaneously, for example. After the completion of the twelfth stage 5224, the incisions are closed and the post-operative portion of the process begins.
[0480] [0480] In the thirteenth stage 5226, the patient's anesthesia is reversed. Surgical hub 106, 206 can infer that the patient is emerging from anesthesia based on ventilator data (i.e., the patient's respiratory rate begins to increase), for example.
[0481] [0481] Finally, in the fourteenth step 5228 is that medical personnel remove the various patient monitoring devices from the patient. Surgical hub 106, 206 can thus infer that the patient is being transferred to a recovery room when the hub loses ECG, blood pressure and other data from patient monitoring devices. As can be seen from the description of this illustrative procedure, surgical hub 106, 206 can determine or infer when each step of a given surgical procedure is taking place according to the data received from the various data sources that are communicable. attached to surgical hub 106, 206.
[0482] [0482] Situational awareness is further described in US provisional patent application serial number 62 / 611.341, entitled INTE-RACTIVE SURGICAL PLATFORM, filed on December 28, 2017, which is hereby incorporated by reference in its entirety. in. In certain cases, the operation of a robotic surgical system, including
[0483] [0483] Although several forms have been illustrated and described, it is not the applicant's intention to restrict or limit the scope of the claims attached to such detail. Numerous modifications, variations, alterations, substitutions, combinations and equivalents of these forms can be implemented and will occur to those skilled in the art without departing from the scope of the present disclosure. In addition, the structure of each element associated with the shape can alternatively be described as a means to provide the function performed by the element. In addition, where materials are revealed for certain components, other materials can be used. It should be understood, therefore, that the preceding description and the appended claims are intended to cover all these modifications, combinations and variations that fall within the scope of the modalities presented. The appended claims are intended to cover all such modifications, variations, alterations, substitutions, modifications and equivalents.
[0484] [0484] The previous detailed description presented various forms of devices and / or processes through the use of block diagrams, flowcharts and / or examples. Although these block diagrams, flowcharts and / or examples contain one or more functions and / or operations, it will be understood by those skilled in the art that each function and / or operation within these block diagrams, flowcharts and / or examples can be implemented , individually and / or collectively, through a wide range of hardware, software, firmware or almost any combination thereof. Those skilled in the art will recognize, however, that some aspects of the aspects disclosed here,
[0485] [0485] The instructions used to program the logic to execute various revealed aspects can be stored in a memory in the system, such as dynamic random access memory (DRAM), cache, flash memory or other storage. In addition, instructions can be distributed over a network or through other computer-readable media. In this way, a machine-readable medium can include any mechanism to store or transmit information in a machine-readable form (for example, a computer), but is not limited to floppy disks, optical disks, compact memory disc read-only (CD-ROMs), and optical-dynamos discs, read-only memory (ROM), random access memory (RAM), erasable programmable read-only memory (EPROM), electrically erasable programmable read-only memory ( EEPROM), magnetic or optical cards, flash memory, or a machine-readable tangible storage medium used to transmit information over the Internet via an electrical, optical, acoustic cable or other forms of propagation signals (for example, waves carriers, infrared signal, digital signals, etc.). Consequently, non-transitory, computer-readable media includes any type of machine-readable media suitable for storing or transmitting instructions or electronic information in a machine-readable form (for example, a computer).
[0486] [0486] As used in any aspect of the present invention, the term "control circuit" can refer to, for example, a set of wired circuits, programmable circuits (for example, a computer processor comprising one or more individual instruction processing cores, processing unit, processor, microcontroller, microcontroller unit, controller, digital signal processor (DSP), programmable logic device (PLD), programmable logic matrix (PLA), or arrangement field programmable ports (FPGA)), state machine circuits, firmware that stores instructions executed by the programmable circuit, and any combination thereof. The control circuit can, collectively or individually, be incorporated as an electrical circuit that is part of a larger system, for example, an integrated circuit (IC), an application-specific integrated circuit (ASIC), an on-chip system (SoC), desktop computers, laptop computers, tablet computers, servers, smart headsets, etc. Consequently, as used in the present invention, "control circuit" includes, but is not limited to, electrical circuits that have at least one discrete electrical circuit, electrical circuits that have at least one integrated circuit, electrical circuits that have at least one integrated circuit for a specific application, electrical circuits that form a general-purpose computing device configured by a computer program (for example, a general-purpose computer configured by a computer program that at least partially runs processes and / or devices described here, or a microprocessor configured by a computer program that at least partially performs the processes and / or devices described here), electrical circuits that form a memory device (for example, memory forms of random access), and / or electrical circuits that form a communications device (for example, a modem, communication key cation, or optical-electrical equipment). Those skilled in the art will recognize that the subject described here can be implemented in an analog or digital way, or in some combination of these.
[0487] [0487] As used in any aspect of the present invention, the term "logic" can refer to an application, software, firmware and / or circuit configured to perform any of the aforementioned operations. The software can be incorporated as a software package, code, instructions, instruction sets and / or data recorded on the computer-readable non-transitory storage media. The firmware can be incorporated as code, instructions or instruction sets and / or data that are hard-coded (for example, non-volatile) in memory devices.
[0488] [0488] As used in any aspect of the present invention, the terms "component", "system", "module" and the like may refer to a computer-related entity, be it hardware, a combination of hardware and software, software or software running.
[0489] [0489] As used here in one aspect of the present invention, an "algorithm" refers to the self-consistent sequence of steps leading to the desired result, where a "step" refers to the manipulation of physical quantities and / or logical states that they may, although not necessarily need, take the form of electrical or magnetic signals that can be stored, transferred, combined, compared and manipulated in any other way. It is common use to call these signs bits, values, elements, symbols, characters, terms, numbers or the like. These terms and similar terms may be associated with the appropriate physical quantities and are merely convenient identifications applied to these quantities and / or states.
[0490] [0490] A network may include a packet-switched network. Communication devices may be able to communicate with each other using a selected packet switched network communications protocol. An exemplary communications protocol may include an Ethernet communications protocol that may be able to allow communication using a transmission control protocol / Internet protocol (TCP / IP). The Ethernet protocol can conform to or be compatible with the Ethernet standard published by the Institute of Electrical and Electronics Engineers (IEEE) entitled "IEEE 802.3 Standard", published in December 2008 and / or later versions of this standard. Alternatively or in addition, communication devices may be able to communicate with each other using an X.25 communications protocol. The X.25 communications protocol can conform or be compatible with a standard promulgated by the International Telecommunication Union-Telecommunication Standardization Sector (ITU-T). Alternatively or in addition, communication devices may be able to communicate with each other using a frame-relay communications protocol. The frame-relay communications protocol can conform to or be compatible with a standard promulgated by the Consultative Committee for International Telegraph and Telephone (CCITT) and / or the American National
[0491] [0491] Unless otherwise stated, as is evident from the preceding revelation, it is understood that, throughout the preceding revelation, discussions that use terms such as "processing", or "computation", or "calculation ", or" determination ", or" display ", or similar, refers to the action and processes of a computer, or similar electronic computing device, that manipulates and transforms the represented data in the form of physical quantities (electronic) in computer records and memories in other data represented in a similar way in the form of physical quantities in memories or computer records, or in other similar information storage, transmission or display devices .
[0492] [0492] One or more components in the present invention may be called "configured for", "configurable for", "operable / operational for", "adapted / adaptable for", "capable of", "conforming to / conformed to ", etc. Those skilled in the art will recognize that "configured for" can, in general, encompass components in an active state and / or components in an inactive state and / or components in a standby state, except when the context determines otherwise.
[0493] [0493] The terms "proximal" and "distal" are used in the present invention with reference to a physician who handles the handle portion of the surgical instrument. The term "proximal" refers to the portion closest to the doctor, and the term "distal" refers to the portion located in the opposite direction to the doctor. It will also be understood that, for the sake of convenience and clarity, spatial terms such as "vertical", "horizontal", "up" and "down" can be used in the present invention with respect to drawings. However, surgical instruments can be used in many orientations and positions, and these terms are not intended to be limiting and / or absolute.
[0494] [0494] Persons skilled in the art will recognize that, in general, the terms used here, and especially in the appended claims (eg, bodies of the attached claims) are generally intended as "open" terms (eg, the term "including" should be interpreted as "including, but not limited to", the term "having" should be interpreted as "having, at least", the term "includes" should be interpreted as "includes, but is not limited to ", etc.). It will also be understood by those skilled in the art that, when a specific number of a claim statement entered is intended, that intention will be expressly mentioned in the claim and, in the absence of such mention, no intention will be present. For example, as an aid to understanding, the following appended claims may contain the use of the introductory phrases "at least one" and "one or more" to introduce claim statements. However, the use of such phrases should not be interpreted as implying that the introduction of a claim statement by the indefinite articles "one, ones" or "one, ones" limits any specific claim containing the claim mention. claims that contain only such a mention are introduced, even when the same claim includes the introductory phrases "one or more" or "at least one" and indefinite articles, such as "one, ones" or "one, ones" (for example, example, "one, ones" and / or "one, ones" should typically be interpreted as meaning "at least one" or "one or more"); the same goes for the use of defined articles used to introduce claims.
[0495] [0495] Furthermore, even if a specific number of an introduced claim statement is explicitly mentioned, those skilled in the art will recognize that that statement must typically be interpreted as meaning at least the number mentioned (for example, the mere mention of "two mentions", without other modifiers, typically means at least two mentions, or two or more mentions). In addition, in cases where a convention analogous to "at least one of A, B and C, etc." is used, in general this construction is intended to have the meaning in which the convention would be understood by (for example, For example, "a system that has at least one of A, B and C" would include, but not be limited to, systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and / or A, B and C together, etc.). In cases where a convention analogous to "at least one of A, B or C, etc." is used, this construct is generally intended to have the meaning in which the convention would be understood by (for example, "a system that has at least one of A, B and C" would include, but not be limited to, systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and / or A, B and C together, etc.). It will be further understood by those skilled in the art that typically a disjunctive word and / or phrase presenting two or more alternative terms, whether in the description, in the claims or in the drawings, should be understood as contemplating the possibility of including one of the terms , either term, or both terms, except where the context dictates to indicate something different. For example, the phrase "A or B" will typically be understood to include
[0496] [0496] With respect to the attached claims, those skilled in the art will understand that the operations mentioned in them can, in general, be performed in any order. In addition, although several operational flow diagrams are presented in one or more sequences, it must be understood that the various operations can be performed in other orders than those shown, or can be performed simultaneously. Examples of such alternative orderings may include overlapping, interleaved, interrupted, reordered, incremental, preparatory, supplementary, simultaneous, inverse or other variant orders, unless the context determines otherwise. Furthermore, terms such as "responsive to", "related to" or other adjectival principles are not generally intended to exclude these variants, except when the context determines otherwise.
[0497] [0497] It is worth noting that any reference to "one (1) aspect", "one aspect", "an exemplification" or "one (1) exemplification" ", and the like means that a particular feature, structure or characteristic described in connection with the aspect it is included in at least one aspect. Thus, the use of expressions such as "in one (1) aspect", "in one aspect", "in an exemplification", "in one (1) exemplification", in several places throughout this specification it does not necessarily refer to the same aspect. In addition, specific resources, structures or characteristics can be combined in any appropriate way in one or more aspects.
[0498] [0498] Any patent application, patent, non-patent publication or other description material mentioned in this specification and / or mentioned in any order data sheet is hereby incorporated by reference, to the extent that the Embedded materials are not inconsistent with this. In this way, and to the extent necessary, the disclosure as explicitly presented herein replaces any conflicting material incorporated by reference in this invention. Any material, or portion thereof, which is incorporated herein by reference, but which conflicts with the definitions, statements, or other disclosure materials contained herein, will be incorporated here only to the extent that there is no conflict. between the embedded material and the existing developer material.
[0499] [0499] In short, numerous benefits have been described that result from the use of the concepts described in this document. The previously mentioned description of one or more modalities has been presented for purposes of illustration and description. This description is not intended to be exhaustive or to limit the invention to the precise form disclosed. Modifications or variations are possible in light of the above teachings. One or more modalities were chosen and described in order to illustrate the principles and practical application to, thus, allow those skilled in the art to use the various modalities and with various modifications, as they are convenient to the specific use contemplated. It is intended that the claims presented in the annex define the global scope.
[0500] [0500] Several aspects of the subject described here under the heading "Adjustment of the compression force applied to the fabric based on the proportion of energy modalities" are presented in the following examples:
[0501] [0501] Example 1. A method of adjusting a compressive force applied by a surgical instrument, in which the surgical instrument comprises an end actuator and a clamping arm configured to receive power modalities from a configured generator to provide a plurality of energy modalities to the surgical instrument. The method involves determining, by means of a control circuit, the impedance of tissue in contact with a current
[0502] [0502] Example 2. The method of example 1, the first energy modality being a radiofrequency (RF) energy modality and the second energy modality is an ultrasonic energy modality.
[0503] [0503] Example 3. The method of Example 1 or 2, with the determination of tissue impedance comprising: applying, by the generator, a non-therapeutic electrical signal to the end actuator over a frequency range; and determine, through the control circuit, a characteristic impedance pattern based on spectral analysis of the non-therapeutic electrical signal.
[0504] [0504] Example 4. The method of any of Examples 1 to 3, the proportion being determined by the control circuit based on a time in which each of the first and second signal waveforms is applied during a cycle of surgical treatment or amplitude of each one of the first and the second signal waveforms or a combination of them.
[0505] [0505] Example 5. The method of any of Examples 1 to 4, with the adjustment of the compression force comprising actuating a mechanical key coupled to the clamping arm, with a first position of the mechanical key corresponding to a first actuation of the clamping arm resulting in a high compression force, and a second position of the mechanical key corresponds to a second actuation of the clamping arm resulting in low compression force.
[0506] [0506] Example 6. The method of any of Examples 1 to 5, the adjustment of the compression force comprising the expansion of an electroactive polymer coupled to the clamping arm, and the expansion of the electroactive polymer based on the application of the first and from the second signal waveforms to the end actuator.
[0507] [0507] Example 7. A surgical instrument comprises a control circuit. The control circuit is configured to interconnect with a generator configured to supply a plurality of energy modalities to a surgical instrument end actuator, and the control circuit is additionally configured to: determine the impedance tissue in contact with a surgical instrument end actuator; determine a type of tissue based on tissue impedance; selecting a first energy modality from the plurality of energy modalities; generate a first signal waveform based on the first energy modality; selecting a second energy mode from the plurality of energy modes; generate a second signal waveform based on the second energy mode; and adjust a compression force applied by an end actuator
[0508] [0508] Example 8. The surgical instrument of Example 7, which further comprises an end actuator coupled to the control circuit, the end actuator comprising a clamping arm and an ultrasonic blade.
[0509] [0509] Example 9. The surgical instrument, according to Example 7 or 8, which additionally comprises a generator coupled to the control circuit.
[0510] [0510] Example 10. The surgical instrument of any of Examples 7 to 10, the control circuit determining the proportion based on a time in which each of the first and second signal waveforms is applied during a surgical treatment cycle or amplitude of each of the first and second signal waveforms or a combination of them.
[0511] [0511] Example 11. The surgical instrument of any of Examples 7 to 10, with the control circuit adjusting the compression force based on the performance of a mechanical key coupled to the clamping arm, with a first position of the key mechanical corresponds to a first actuation of the clamping arm resulting in a high compression force, and a second position of the mechanical key corresponds to a second actuation of the clamping arm resulting in low compression force.
[0512] [0512] Example 12. The surgical instrument of any of Examples 7 to 11, the control circuit adjusting the compression force based on the expansion of an electroactive polymer coupled to the clamping arm, and in which the polymer electroactive expands based on the application of the first and second signal waveforms to the end actuator.
[0513] [0513] Example 13. A surgical system comprises a central surgical controller configured to receive a tissue treatment algorithm transmitted from a cloud computing system, the central surgical controller being connected in a communicative way with the cloud computing system; a surgical instrument connected in a communicative way to the central surgical controller, the surgical instrument comprising: an end actuator comprising: a clamping arm; and an ultrasonic blade; a generator configured to supply a plurality of energy modalities to the end actuator; a control circuit connected in a communicating way to the end actuator and generator, the control circuit is configured to treat fabric, and the control circuit is configured to: determine the tissue impedance in contact with the actuator edge; determine the type of tissue based on tissue impedance; selecting a first energy modality from the plurality of energy modalities; generate a first signal waveform based on the first energy modality; selecting a second energy mode from the plurality of energy modes; generate a second signal waveform based on the second energy mode; applying the first and second signal waveforms to the end actuator; and adjust a compression force applied by the end actuator by changing a gap size between the fabric and the waveguide based on a ratio between the first signal waveform and the second waveform of signal.
[0514] [0514] Example 14. The surgical instrument of Example 13, the first energy modality being a radio frequency (RF) energy modality and the second energy modality is an ultrasonic energy modality.
[0515] [0515] Example 15. The surgical instrument of Example 13 or 14,
[0516] [0516] Example 16. The surgical instrument of any of Examples 13 to 15, the control circuit determining the proportion based on a time in which each of the first and second signal waveforms is applied during a surgical treatment cycle or an amplitude of each of the first and second signal waveforms or a combination of them.
[0517] [0517] Example 17. The surgical instrument of any of Examples 13 to 16, and to adjust the compression force, the control circuit is configured to actuate a mechanical key coupled to the clamping arm, with a first position of the mechanical key corresponds to a first actuation of the clamping arm resulting in high compression force, and a second position of the mechanical key corresponds to a second actuation of the clamping arm resulting in low compression force.
[0518] [0518] Example 18. The surgical instrument of any of Examples 13 to 17, in order to adjust the compression force, the control circuit is configured to expand an elecroat polymer attached to the clamping arm, and to expand the electroactive polymer based on the first and second signal waveforms applied to the end actuator.
[0519] [0519] Example 19. The surgical instrument of any of Examples 14 to 18, with the RF energy modality corresponding to a first compression force range and the ultrasonic energy modality to a second compression force range. compression, and the first compression force range is greater than the second compression force range.
[0520] [0520] Example 20. The surgical instrument of any of Examples 13 to 19, the surgical instrument comprising a passive electrode and an active electrode.

权利要求:
Claims (20)
[1]
1. Method of adjusting a compressive force applied by a surgical instrument, the surgical instrument comprising an end actuator and a clamping arm configured to receive energy modalities from a generator configured to provide a plurality of energy modalities to the surgical instrument, characterized by understanding: determining, by means of a control circuit, the impedance of tissue tissue in contact with an end actuator of the surgical instrument; determine, by means of the control circuit, a type of fabric based on tissue impedance.
select, by means of the control circuit, a first energy modality from the plurality of energy modalities to supply the surgical instrument; generate, by means of the control circuit, a first signal waveform based on the first energy modality; select, by means of the control circuit, a second energy modality from the plurality of energy modalities to supply the surgical instrument; generate, by means of the control circuit, a second signal waveform based on the second energy modality; supply, through the generator, the first and the second signal waveforms to supply energy to the end actuator; and adjust, by means of the control circuit, a compressive force applied by the end actuator by changing a gap size between the fabric and the clamping arm based on a proportion between the first waveform of signal and the second signal waveform.
[2]
2. Method according to claim 1, characterized in that the first energy modality is a radio frequency (RF) energy modality, and the second energy modality is an ultrasonic energy modality.
[3]
Method according to claim 1, characterized in that the determination of tissue impedance comprises: applying, through the generator, a non-therapeutic electrical signal to the end actuator over a frequency range; and determine, through the control circuit, a characteristic impedance pattern based on spectral analysis of the non-therapeutic electrical signal.
[4]
4. Method according to claim 1, characterized in that the proportion is determined by the control circuit based on a time in which each of the first and second signal waveforms is applied during a surgical treatment cycle or amplitude of each of the first and second signal waveforms or a combination of them.
[5]
5. Method, according to claim 1, characterized in that the adjustment of the compression force comprises actuating a mechanical key coupled to the clamping arm, with a first position of the mechanical key corresponding to a first actuation of the clamping arm resulting high compression force, and a second position of the mechanical key corresponds to a second actuation of the clamping arm resulting in low compression force.
[6]
6. Method according to claim 1, characterized in that the adjustment of the compression force comprises the expansion of an electroactive polymer coupled to the clamping arm, and the expansion of the electroactive polymer based on the application of the first and second waveforms signal to the end actuator.
[7]
7. Surgical instrument characterized by comprising: a control circuit configured to connect in a communicating manner to a generator configured to supply a plurality of energy modalities to an end actuator of the surgical instrument, the control circuit is additionally configured to: determine tissue tissue impedance in contact with a surgical instrument end actuator; determine a tissue type based on tissue impedance; select a first energy modality from the plurality of energy modalities; generate a first signal waveform based on the first energy modality; selecting a second energy modality from the plurality of energy modalities; generate a second signal waveform based on the second energy mode; and adjust a compression force applied by an end actuator to the tissue by changing a gap between the tissue and an end actuator based on a ratio between the first signal waveform and the second signal wave.
[8]
8. Surgical instrument, according to claim 7, characterized in that it additionally comprises an end actuator coupled to the control circuit, the end actuator comprising a clamping arm and an ultrasonic blade.
[9]
9. Surgical instrument according to claim 8, characterized in that it additionally comprises a generator coupled to the control circuit.
[10]
10. Surgical instrument, according to claim 7,
characterized by the control circuit determining the proportion based on a time in which each of the first and second signal waveforms is applied during a surgical treatment cycle or amplitude of each of the first and second waveforms signal waveforms or a combination of them.
[11]
11. Surgical instrument, according to claim 7, characterized in that the control circuit adjusts the compression force based on the action of a mechanical key coupled to the clamping arm, with a first position of the mechanical key corresponding to a first actuation of the clamping arm resulting in high compression force, and a second position of the mechanical key corresponds to a second actuation of the clamping arm resulting in low compression force.
[12]
12. Surgical instrument, according to claim 7, characterized in that the control circuit adjusts the compression force based on the expansion of an electroactive polymer coupled to the clamping arm, and the electroactive polymer expands based on the application of first and second signal waveforms to the end actuator.
[13]
13. Surgical system characterized by comprising: a central surgical controller configured to receive a tissue treatment algorithm transmitted from a cloud computing system, with the central surgical controller being connected in a communicative way to the system cloud computing; and a surgical instrument connected in a communicative manner to the central surgical controller, the surgical instrument comprising: an end actuator comprising: a clamping arm; and an ultrasonic blade; a generator configured to supply a plurality of energy modalities to the end actuator; a control circuit connected to the end actuator and the generator, the control circuit is configured to treat tissue, and the control circuit is configured to: determine the tissue impedance in contact with the end actuator; determine the type of tissue based on tissue impedance; select a first energy modality from the plurality of energy modalities; generate a first signal waveform based on the first energy modality; selecting a second energy modality from the plurality of energy modalities; generate a second signal waveform based on the second energy mode; applying the first and second signal waveforms to the end actuator; and adjusting a compression force applied by the end actuator by changing a gap size between the fabric and the waveguide based on a ratio between the first signal waveform and the second signal waveform.
[14]
14. Surgical system, according to claim 13, characterized in that the first energy modality is a radiofrequency (RF) energy modality and the second energy modality is an ultrasonic energy modality.
[15]
15. Surgical system according to claim 13,
characterized by the fact that to determine tissue impedance, the control circuit is configured to: apply a non-therapeutic electrical signal to the end actuator over a range of frequencies; and determine a characteristic impedance pattern based on spectral analysis of the non-therapeutic electrical signal.
[16]
16. Surgical system according to claim 13, characterized in that the control circuit determines the proportion based on a time in which each of the first and second signal waveforms is applied during a cyclic treatment cycle. or an amplitude of each of the first and second signal waveforms or a combination of them.
[17]
17. Surgical system, according to claim 13, characterized by the fact that to adjust the compression force, the control circuit is configured to actuate a mechanical key coupled to the clamping arm, with a first position of the key mechanical corresponds to a first actuation of the clamping arm resulting in high compression force, and a second position of the mechanical key corresponds to a second actuation of the clamping arm resulting in low compression force.
[18]
18. Surgical system, according to claim 13, characterized by the fact that to adjust the compression force, the control circuit is configured to expand an electro-polymer polymer coupled to the clamping arm, and to expand the electroactive polymer with based on the first and second signal waveforms applied to the end actuator.
[19]
19. Surgical system, according to claim 14, characterized in that the RF energy modality corresponds to a first compression force range, and the ultrasonic energy modality, to a second compression force range, and being that the first compression force range is greater than the second compression force range.
[20]
20. Surgical system, according to claim 13, characterized in that the surgical instrument comprises a passive electrode and an active electrode.

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同族专利:

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公开号 | 公开日

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WO2019134009A1|2019-07-04|

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法律状态:
2021-12-07| B350| Update of information on the portal [chapter 15.35 patent gazette]|

优先权:

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申请号 | 申请日 | 专利标题

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US201762611341P| true| 2017-12-28|2017-12-28|

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US201762611339P| true| 2017-12-28|2017-12-28|

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US62/611,339|2017-12-28|

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US62/611,340|2017-12-28|

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US62/611,341|2017-12-28|

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US201862650882P| true| 2018-03-30|2018-03-30|

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