activation of power devices

专利摘要:
The present invention relates to various systems and methods for controlling the activation of surgical energy instruments. An advanced energy surgical instrument, such as an electrosurgical instrument or an ultrasonic surgical instrument, may include one or more sensor units to detect the condition or position of the end actuator, arm or other components of the surgical instrument. A control circuit can be configured to control the activation of the surgical instrument according to the state or position of the components of the surgical instrument.
公开号:BR112020013051A2
申请号:R112020013051-6
申请日:2019-02-28
公开日:2020-12-01
发明作者:Cory G. Kimball；Mary E. Mootoo；Eric M. Roberson；Ion V. Nicolaescu；Andrew W. CARROLL；David C. Yates；Daniel W. Price；William B. Weisenburgh Ii；Jeffrey L. Aldridge；Monica Louise Zeckel Rivard；Heather N. Doak
申请人:Ethicon Llc；
IPC主号:

专利说明:

[0001] [0001] This application claims the benefit of US Non-Provisional Patent Application serial number 16 / 115,238, entitled ACTIVATION OF ENERGY DEVICES, filed on August 28, 2018, the disclosure of which is hereby incorporated by reference in its entirety. .
[0002] [0002] This application claims priority under US $ 35 US $ 119 (e) to US Provisional Patent Application 62 / 721,995, entitled CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT AC- CORDING TO TISSUE LOCATION, filed on August 23, 2018, whose revelation is hereby incorporated by reference, in its entirety.
[0003] [0003] The present application claims priority under US $ 35 US $ 119 (e) to US Provisional Patent Application 62 / 721,998, entitled SITUATIONAL AWARENESS OF ELECTROSURGICAL SYSTEMS, filed on August 23, 2018, the disclosure of which is incorporated here as a reference, in its entirety.
[0004] [0004] The present application claims priority under 35 U.S.C. $ 119 (e) to US Provisional Patent Application No. 62 / 721,999, entitled
[0005] [0005] The present application claims priority under 35 U.S.C. $ 119 (e) to US Provisional Patent Application No. 62 / 721,994, entitled BI-
[0006] [0006] The present application claims priority under 35 U.S.C. $
[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 US Provisional Patent No. 62 / 692,748, entitled SMART ENERGY ARCHITEC- TURE, filed on June 30, 2018 and US Provisional Patent Application 62 / 692,768, entitled SMART ENERGY DEVICES, filed on 30 December June 2018, the disclosure of each of which is incorporated herein by reference, in its entirety.
[0008] [0008] This application also claims priority benefit under US $ 119 (e) for US Provisional Patent Application serial number 62 / 640,417, entitled TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR, filed on March 8, 2018 , and US Provisional Patent Application Serial No. 62 / 640,415, entitled ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR filed on March 8, 2018, the disclosure of which is incorporated herein by reference in its entirety for reference.
[0009] [0009] 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-
[0010] [0010] The present application claims priority under 35 US $ 119 (e) to US Provisional Patent Application 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 US Provisional Patent Application 62 / 611,339, entitled ROBOT ASSISTED SURGICAL PLATFORM, filed on December 28 2017, whose disclosure of each is incorporated here as a reference in its entirety. BACKGROUND
[0011] [0011] In a surgical environment, intelligent energy devices may be needed in an environment of intelligent energy architecture. SUMMARY
[0012] [0012] In a general aspect, a surgical instrument comprising: an ultrasonic blade, a pivoting arm in relation to the ultrasonic blade between an open position and a closed position, a transducer set coupled to the ultrasonic blade, a configured sensor to detect a position of the arm between the open position and the closed position, and a control circuit coupled to the transducer assembly and the sensor. The transducer set comprises at least
[0013] [0013] In another general aspect, a surgical instrument comprises: an ultrasonic blade, a pivoting arm in relation to the ultrasonic blade between an open position and a closed position, a set of transducer coupled to the ultrasonic blade, a first sensor configured to detect a first force as the arm transitions to the closed position, a second sensor configured to detect a second force as the arm transitions to the open position, and a control circuit coupled to the transducer assembly , the first sensor and the second sensor. The transducer set comprises at least two piezoelectric elements configured to oscillate the ultrasonic blade ultrasonically. The control circuit is configured to activate the transducer assembly according to the first force detected by the first sensor in relation to a first limit and the second force detected by the second sensor in relation to a second limit.
[0014] [0014] In yet another general aspect, a surgical instrument comprises: an ultrasonic blade, a transducer set coupled to the ultrasonic blade, a sensor configured to detect a force against it, and a control circuit coupled to the set of transducer and sensor. The transducer set comprises at least two piezoelectric elements configured to oscillate the ultrasonic blade ultrasonically. The control circuit is configured to activate the transducer assembly according to the force detected by the sensor in relation to a limit force. FIGURES
[0015] [0015] 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 objects and additional advantages of the same, can be better understood by reference to the description presented below, considered together with the drawings attached, as follows.
[0016] [0016] Figure 1 is a block diagram of an interactive surgical system implemented by computer, according to at least one aspect of the present disclosure.
[0017] [0017] Figure 2 is a surgical system used to perform a surgical procedure in an operating room, in accordance with at least one aspect of the present disclosure.
[0018] [0018] Figure 3 is a central surgical controller paired with a visualization system, with a robotic system and with an intelligent instrument, according to at least one aspect of the present disclosure.
[0019] [0019] Figure 4 is a partial perspective view of a central surgical controller housing, and of a combined generator module received slidingly in a central surgical controller housing, according to at least one aspect of the present disclosure.
[0020] [0020] Figure 5 is a perspective view of a generator module combined with bipolar, ultrasonic and monopolar contacts and a smoke evacuation component, according to at least one aspect of the present disclosure.
[0021] [0021] Figure 6 illustrates different power busbars for a plurality of side coupling ports of a lateral modular housing configured to receive a plurality of modules, in accordance with at least one aspect of the present disclosure.
[0022] [0022] Figure 7 illustrates a vertical modular housing configured to receive a plurality of modules, according to at least one aspect of the present disclosure.
[0023] [0023] Figure 8 illustrates a surgical data network comprising a central modular communication controller configured to connect modular devices to the cloud located in one or more operating rooms of a health care facility, or any environment in a installation of health services specially equipped for surgical operations, in accordance with at least one aspect of the present disclosure.
[0024] [0024] Figure 9 illustrates an interactive surgical system implemented by computer, according to at least one aspect of the present disclosure.
[0025] [0025] Figure 10 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.
[0026] [0026] Figure 11 illustrates an aspect of a universal serial bus (USB) central controller device, in accordance with at least one aspect of the present disclosure.
[0027] [0027] Figure 12 illustrates a logical diagram of a control system for an instrument or surgical tool, according to at least one aspect of the present disclosure.
[0028] [0028] Figure 13 illustrates a control circuit configured to control aspects of the instrument or surgical tool, according to at least one aspect of the present disclosure.
[0029] [0029] Figure 14 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.
[0030] [0030] Figure 15 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.
[0031] [0031] Figure 16 illustrates a block diagram of a surgical instrument programmed to control the distal translation of the displacement member, according to one aspect of the present disclosure.
[0032] [0032] 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.
[0033] [0033] Figure 18 is a 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.
[0034] [0034] Figure 19 illustrates an example of a generator, according to at least one aspect of the present disclosure.
[0035] [0035] Figure 20 is a surgical system that comprises a generator and several surgical instruments that can be used with it, according to at least one aspect of the present disclosure.
[0036] [0036] Figure 21 is a view of an end actuator, in accordance with at least one aspect of the present disclosure.
[0037] [0037] Figure 22 is a diagram of the surgical system of Figure 20, according to at least one aspect of the present disclosure.
[0038] [0038] Figure 23 is a model that illustrates the branching current of movement, according to at least one aspect of the present disclosure.
[0039] [0039] Figure 24 is a structural view of a generator architecture, according to at least one aspect of the present disclosure.
[0040] [0040] Figures 25A to 25C are functional views of a generator architecture, in accordance with at least one aspect of the present disclosure.
[0041] [0041] Figures 26A and 26B are structural and functional aspects of a generator, according to at least one aspect of the present disclosure.
[0042] [0042] Figure 27 is a schematic diagram of an aspect of an ultrasonic drive circuit.
[0043] [0043] Figure 28 is a schematic diagram of a control circuit, according to at least one aspect of the present disclosure.
[0044] [0044] Figure 29 shows a simplified block circuit diagram that illustrates another electrical circuit contained within a modular ultrasonic surgical instrument, according to at least one aspect of the present disclosure.
[0045] [0045] Figure 30 illustrates a generator circuit divided into multiple stages, according to at least one aspect of the present disclosure.
[0046] [0046] Figure 31 illustrates a generator circuit divided into multiple stages, the first stage circuit being common to the second stage circuit, according to at least one aspect of the present disclosure.
[0047] [0047] Figure 32 is a schematic diagram of an aspect of a drive circuit configured to drive a high frequency (RF) current, in accordance with at least one aspect of the present disclosure.
[0048] [0048] Figure 33 illustrates a control circuit that allows a double generator system to alternate between the energy modes of the RF generator and the ultrasonic generator for a surgical instrument.
[0049] [0049] Figure 34 illustrates a diagram of an aspect of a surgical instrument that comprises a feedback system for use with a surgical instrument, according to an aspect of the present disclosure.
[0050] [0050] Figure 35 illustrates an aspect of a fundamental architecture for a digital synthesis circuit such as a direct digital 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.
[0051] [0051] Figure 36 illustrates an aspect of the direct digital synthesis (DDS) circuit configured to generate a plurality of waveforms for the electrical signal waveform for use in a surgical instrument, according to at least one aspect of the present revelation.
[0052] [0052] Figure 37 illustrates a cycle of a discrete-time digital electrical signal waveform, according to at least one aspect of the present disclosure, of an analog waveform (shown superimposed on a waveform of discrete time digital electrical signal for comparison purposes), in accordance with at least one aspect of the present disclosure.
[0053] [0053] Figure 38 illustrates an ultrasonic surgical instrument system, according to at least one aspect of the present disclosure.
[0054] [0054] Figures 39A to 39C illustrate a piezoelectric transducer, in accordance with at least one aspect of the present disclosure.
[0055] [0055] Figure 40 illustrates a D31 ultrasonic transducer architecture that includes an ultrasonic waveguide and one or more piezoelectric elements attached to the ultrasonic waveguide, in accordance with at least one aspect of the present disclosure.
[0056] [0056] Figure 41 is a sectional view of an ultrasonic surgical instrument, according to at least one aspect of the present disclosure.
[0057] [0057] Figure 42 is an exploded view of the ultrasonic surgical instrument in Figure 41, according to at least one aspect of the present disclosure.
[0058] [0058] Figure 43 illustrates a block diagram of a surgical system, according to at least one aspect of the present disclosure.
[0059] [0059] Figure 44 illustrates a perspective view of a surgical instrument that includes a sensor unit configured to detect a magnetic reference used by the user, in accordance with at least one aspect of the present disclosure.
[0060] [0060] Figure 45A illustrates a sectional view along line 44—44 of a surgical instrument that includes a sensor unit configured to detect an integral magnetic reference, in accordance with at least one aspect of the present disclosure.
[0061] [0061] Figure 45B illustrates a detailed view of the surgical instrument of Figure 45A, in a first position, according to at least one aspect of the present disclosure.
[0062] [0062] Figure 45C illustrates a detailed view of the surgical instrument of Figure 45A, in a second position, according to at least one aspect of the present disclosure.
[0063] [0063] Figure 46A illustrates a perspective view of a surgical instrument that includes a sensor unit configured to detect contact against it that is orthogonally oriented, in accordance with at least one aspect of the present disclosure.
[0064] [0064] Figure 46B illustrates a perspective view of a surgical instrument that includes a sensor unit configured to detect contact against it that is oriented laterally, in accordance with at least one aspect of the present disclosure.
[0065] [0065] Figure 47 illustrates a circuit diagram of the surgical instrument of Figure 46A or Figure 46B, according to at least one aspect of the present disclosure.
[0066] [0066] Figure 48A illustrates a perspective view of a surgical instrument that includes a sensor unit configured to detect the closure of the surgical instrument, the surgical instrument being in an open position, according to at least an aspect of the present revelation.
[0067] [0067] Figure 48B illustrates a perspective view of a surgical instrument that includes a sensor unit configured to detect
[0068] [0068] Figure 48C illustrates a perspective view of a surgical instrument that includes a sensor unit configured to detect the closure of the surgical instrument, with the surgical instrument in a second closed position, according to with at least one aspect of the present revelation.
[0069] [0069] Figure 49A illustrates a perspective view of a surgical instrument that includes a sensor unit configured to detect the opening of the surgical instrument, according to at least one aspect of the present disclosure.
[0070] [0070] Figure 49B illustrates a sectional view along line 48B — A48B of the surgical instrument of Figure 49A, in accordance with at least one aspect of the present disclosure.
[0071] [0071] Figure 49C is an exploded perspective view of the surgical instrument of Figure 49A, in accordance with at least one aspect of the present disclosure.
[0072] [0072] Figure 49D illustrates a perspective view of the surgical instrument of Figure 49A, in accordance with at least one aspect of the present disclosure.
[0073] [0073] Figure 49E is a detailed view of a portion of Figure 49D, in accordance with at least one aspect of the present disclosure.
[0074] [0074] Figure 49F illustrates a perspective view of the internal face of the arm of the surgical instrument of Figure 49A, according to at least one aspect of the present disclosure.
[0075] [0075] Figure 50 illustrates a perspective view of a surgical instrument that includes a sensor unit comprising a pair of sensors to control the activation of the surgical instrument, in accordance with at least one aspect of the present disclosure.
[0076] [0076] Figure 51 illustrates a perspective view of a surgical instrument that comprises a deactivation key, in accordance with at least one aspect of the present disclosure.
[0077] [0077] Figure 52 illustrates a perspective view of a retractor comprising a sensor, according to at least one aspect of the present disclosure.
[0078] [0078] Figure 53 illustrates a perspective view of a retractor comprising a monitor in use at a surgical site, in accordance with at least one aspect of the present disclosure.
[0079] [0079] Figure 54 is a timeline that shows the situational perception of a central surgical controller, according to at least one aspect of the present disclosure. DESCRIPTION
[0080] [0080] The applicant of the present application holds the following US Patent Applications, filed on August 28, 2018, the disclosure of which is incorporated herein by reference in its entirety: e Patent Application US, summary number END8536USNP2 / 180107-2, entitled ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR; and US Patent Peddo, Precedent No. 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 Peddo, Precedent No. END8563USNP1 / 180139-1, entitled CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO TISSUE LOCATION; and US Patent Peddo, no.
[0081] [0081] The applicant for the present application holds the following US Patent Applications, filed on August 23, 2018, with the disclosure of each incorporated herein by reference in its entirety: and Provisional Patent Application US No. 62 / 721,995, entitled CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT ACCORING TO TISSUE LOCATION; and US Provisional Patent Application No. 62 / 721,998, entitled SITUATIONAL AWARENESS OF ELECTROSURGICAL SYSTEMS; and US Provisional Patent Application No. 62 / 721,999, entitled
[0082] [0082] The applicant for this application holds the following US Patent Applications, filed on June 30, 2018, the disclosure of which is incorporated herein by reference in its entirety for reference: 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 e US Provisional Patent Application No. 62 / 692,768, entitled SMART ENERGY DEVICES.
[0083] [0083] The applicant for the present application holds the following US Patent Applications, filed on June 29, 2018, the disclosure of which is incorporated herein by reference in its entirety: and US Patent Application No. serial number 16 / 024.090, entitled CA-
[0084] [0084] The applicant for the present application holds the following US Provisional Patent Applications, filed on June 28, 2018, the disclosure of which is incorporated herein by reference in its entirety: and US Provisional Patent Application no. series 62 / 691,228, entitled A Method of using reinforced flex circuits with multiple sensors with electrosurgical devices; and US Provisional Patent Application serial number 62 / 691,227, entitled controlling a surgical instrument according to sensed closure para-meters; and US Provisional Patent Application Serial No. 62 / 691,230, entitled SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE; and US Provisional Patent Application Serial No. 62 / 691,219, entitled SURGICAL EVACUATION SENSING AND MOTOR CONTROL; and US Provisional Patent Application serial number 62 / 691,257, entitled COMMUNICATION OF SMOKE EVACUATION SYSTEM PA-
[0085] [0085] The applicant for this application holds the following US Provisional Patent Applications, filed on April 19, 2018, the disclosure of which is incorporated herein by reference in its entirety: and US Provisional Patent Application no. series 62 / 659,900, entitled METHOD OF HUB COMMUNICATION.
[0086] [0086] The applicant for the present application holds the following Provisional US Patent Applications, filed on March 30, 2018, the disclosure of which is incorporated herein by reference in its entirety: and US Provisional Patent Application 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 number 62 / 650,887, entitled SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILI- TIES; and US Provisional Patent Application serial number 62 / 650,882, entitled SMOKE EVACUATION MODULE FOR INTERACTIVE SURGI-CAL PLATFORM; and e US Provisional Patent Application serial number 62 / 650,877, entitled SURGICAL SMOKE EVACUATION SENSING AND CONTROLS.
[0087] [0087] The applicant for the present application holds the following US Patent Applications, filed on March 29, 2018, the disclosure of which is incorporated herein by reference in its entirety: e Patent Application US serial no. 15 / 940,641, entitled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICA- TION CAPABILITIES; and US Patent Application Serial No. 15 / 940,648, entitled
[0088] [0088] The applicant of the present application holds the following Provisional US Patent Applications, filed on March 28, 2018, the disclosure of which is incorporated herein by reference in its entirety:
[0089] [0089] The applicant for this application holds the following Provisional US Patent Applications, filed on March 8, 2018, the disclosure of which is incorporated herein by reference in its entirety: and US Provisional Patent Application no. series 62 / 640.417, entitled TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR; and e US Provisional Patent Application Serial No. 62 / 640,415, entitled ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR.
[0090] [0090] The applicant for this application holds the following Provisional US Patent Applications, filed on December 28, 2017, the disclosure of which is incorporated herein by reference in its entirety: and Provisional Patent Application US serial number 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM; and US Provisional Patent Application serial number 62 / 611,340, entitled CLOUD-BASED MEDICAL ANALYTICS; and e US Provisional Patent Application serial number 62 / 611,339, entitled ROBOT ASSISTED SURGICAL PLATFORM.
[0091] [0091] 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 construction details and arrangement of parts illustrated in the drawings and in the attached description. Illustrative examples can be implemented or incorporated into other aspects, variations and modifications, and can be practiced or executed in a variety of ways. Furthermore, 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 below. lead.
[0092] [0092] Several aspects are addressed to improved ultrasonic surgical devices, electrosurgical devices and generators for use with them. The 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, peel, weld and / or dry the tissue during surgical procedures, for example.
[0093] [0093] 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 central surgical controller 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 robotic system 110, an intelligent hand-held surgical instrument 112, which are configured to communicate with one another and / or with the central controller 106. In some respects, a surgical system 102 may include an M number of central controllers 106, an N number of visualization systems 108, an O number of robotic systems 110, and a P number of intelligent hand-held surgical instruments 112, where M, NO, and P are whole numbers greater than or equal to one.
[0094] [0094] 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 rotary system 110 includes a surgeon console 118, a patient car 120 (surgical robot), and a robotic central surgical controller 122. The patient car 120 can handle at least one surgical tool removably coupled 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 a medical imaging device 124, which can be manipulated by the patient's car 120 to orient the imaging device 124. The robotic central controller 122 can be used to process the images of the surgical site for subsequent display to the surgeon through the surgeon's console 118.
[0095] [0095] 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. serial 62 / 611,339, entitled ROBOT ASSISTED SURGICAL PLAT-FORM, filed on December 28, 2017, the disclosure of which is hereby incorporated by reference in its entirety.
[0096] [0096] Several examples of cloud-based analyzes that are performed by the cloud 104, and are suitable for use with the present disclosure, are described in US Provisional Patent Application Serial No. 62 / 611.340, entitled CLOUD-BASED MEDICAL ANALYTICS, after - adopted on December 28, 2017, the disclosure of which is incorporated herein by reference, in its entirety.
[0097] [0097] In several respects, 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.
[0098] [0098] 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 tissue and / or surgical instruments.
[0099] [0099] The 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 (that is, that 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.
[0100] [0100] 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 to infrared (IR) radiation by microwaves and electromagnetic by radio. Wavelengths less than about 380 nm are shorter than the ultraviolet spectrum, and they become invisible to ultraviolet radiation, x-rays, and electromagnetic radiation from gamma rays.
[0101] [0101] In several respects, 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, nasopharyngoscope, sigmoidoscope, thoracoscope, and ureteroscope.
[0102] [0102] In one aspect, the imaging device employs multiple spectrum monitoring to discriminate topography and underlying structures. A multispectral image captures image data within wavelength bands across the electromagnetic spectrum. The wavelengths can be separated by filters or using instruments that are sensitive to specific wavelengths, including light from frequencies beyond the visible light range, for example, IR and ultraviolet light. Spectral imaging can make it possible to extract additional information that the human eye cannot capture with its receptors for the red, green, and blue colors. The use of multispectral imaging is described in more detail under the heading "Advanced Imaging Acquisition Module" in US Provisional Patent Application Serial No. 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, whose revelation is here incorporated by reference in its entirety. Multispectral 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.
[0103] [0103] 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 that penetrates the sterile field, including imaging device 124 and its fixations 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 properly sterilized team members, who are suitably dressed, as well as all furniture and accessories in the area.
[0104] [0104] In various aspects, the visualization system 108 includes one or more imaging sensors, one or more image processing units, one or more storage matrices 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.
[0105] [0105] 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. The visualization system 108, guided by the central controller 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, the central controller 106 can cause the visualization system 108 to show 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 transmission of the surgical site on the main screen 119. The snapshot on the non-sterile screen 107 or 109 can enable a non-sterile operator to perform a diagnostic step relevant to the surgical procedure, for example.
[0106] [0106] In one aspect, central controller 106 is also configured to route an entry or diagnostic feedback by a non-sterile operator in the viewing tower 111 to primary screen 119 within the sterile field, where it can be seen by a sterile operator 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 main screen 119 by central controller 106.
[0107] [0107] Referring to Figure 2, a 112 surgical instrument is being used in the surgical procedure as part of the surgical system
[0108] [0108] Now with reference to Figure 3, a central controller 106 is shown in communication with a visualization system 108, a robotic system 110 and a smart handheld surgical instrument 112. Central controller 106 includes a central controller screen 135, an imaging module 138, a generator module 140, a communication module 130, a processor module 132 and a storage matrix 134. In certain respects, as shown in Figure 3, central controller 106 additionally includes an evacuation module smoke 126 and / or a suction / irrigation module 128.
[0109] [0109] 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 central housing of the central controller 136 offers a unified environment for managing power, data and fluid lines, which reduces the interlacing frequency between such lines.
[0110] [0110] Aspects of the present disclosure feature a central surgical controller for use in a surgical procedure that involves applying energy to the tissue at a surgical site. The central surgical controller includes a central controller housing and a combined generator module received slidingly in a central controller housing docking station. The docking station includes data and power contacts. The combined generator module includes two or more from among an ultrasonic energy generating component, a bipolar RF energy generating component, and a monopolar RF energy generating component that are housed in a single unit. In one aspect, the combined generator module also includes a smoke evacuation component, at least one power application cable to connect the combined generator module to a surgical instrument, at least one smoke evacuation component configured to evacuate smoke. , fluid, and / or the particles generated by the application of therapeutic energy to the tissue, and a fluid line that extends from the remote surgical site to the smoke evacuation component.
[0111] [0111] 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 received slidingly into the central controller housing. In one aspect, the central controller housing comprises a fluid interface.
[0112] [0112] 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 housing of the central controller 136 is configured to accommodate different generators and facilitate interactive communication between them. One of the advantages of the modular housing of central controller 136 is that it allows the quick removal and / or replacement of several modules.
[0113] [0113] Aspects of the present disclosure feature a modular surgical housing for use in a surgical procedure that involves applying energy to the tissue. The modular surgical housing 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 and energy contacts, the first module being - the power generator module is movable in a sliding way in an electric coupling with the power and data contacts and the first power generator module is movable in a sliding way out of the electric coupling with the first power and data contacts.
[0114] [0114] In addition to the above, the modular surgical housing 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 comprising a second door coupling that includes second data and power contacts, the second power generator module is slidingly movable in an electrical coupling with the power and data contacts, and the second power generator module is movable sliding out of the electrical coupling with the second power and data contacts.
[0115] [0115] In addition, the modular surgical housing 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 generator module power.
[0116] [0116] With reference to Figures 3 to 7, aspects of the present disclosure are presented for a modular housing of the central controller 136 that allows the modular integration of a generator module 140, a smoke evacuation module 126, and a suction / irrigation 128. The modular housing of central controller 136 further facilitates interactive communication between modules 140, 126,
[0117] [0117] In one aspect, the modular housing of the central controller 136 comprises a modular rear panel for power and communication
[0118] [0118] In one aspect, the modular housing of central controller 136 includes docking stations, or drawers, 151, here also called drawers, which are configured to receive modules 140, 126, 128 in a sliding manner. Figure 4 illustrates a partial perspective view of a central surgical controller housing 136, and a combined generator module 145 received slidably at a docking station 151 of the central surgical controller housing 136. A docking port 152 with power and data contacts on a rear side of the combined generator module 145 is configured to engage a corresponding docking port 150 with power and data contacts from a corresponding docking station 151 of the central controller 136 modular housing as combined generator module 145 is slid into position in the corresponding docking station 151 of the central controller 136 modular housing. Combined generator module 145 includes a bipolar, ultrasonic and monopolar module and a smoke evacuation module integrated into a single accommodation unit 139, as shown in Figure 5.
[0119] [0119] In several respects, the smoke evacuation module 126 includes a fluid line 154 that carries captured / collected smoke fluid 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 aspirate 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 central controller housing
[0120] [0120] In several aspects, 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 perform irrigation and aspiration of fluids to and from the surgical site.
[0121] [0121] In one aspect, the surgical tool includes a drive shaft that has an end actuator at a distal end of it and at least an energy treatment associated with the end actuator, with a suction tube, and with an irrigation pipe. The suction tube can have an inlet port at a distal end of it and the suction tube extends through the drive shaft. Similarly, an irrigation pipe can extend through the drive shaft and may have an entrance port close to the power application implement. The power application implement is configured to supply ultrasonic and / or RF energy to the surgical site and is coupled to the generator module 140 by a cable that initially extends through the drive shaft.
[0122] [0122] 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 central controller housing 136 separately from the control module. suction / irrigation 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.
[0123] [0123] 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 at the docking stations of the central modular housing 136. For example, as shown in Figure 4, the combined generator module 145 includes side supports 155 which are configured to slide the corresponding supports 156 of the corresponding docking station 151 in a sliding way of the central controller modular housing
[0124] [0124] In some respects, the drawers 151 of the central controller 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 supports 155 and / or 156 can be larger or smaller depending on the size of the module. In other respects, drawers 151 have different sizes and are each designed to accommodate a specific module.
[0125] [0125] 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.
[0126] [0126] As shown in Figure 4, the docking port 150 of one 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 room. central modular configuration 136. The coupling ports 150 of the central housing of the central controller 136 can, alternatively or additionally, facilitate interactive wireless communication between the modules housed in the central housing of the central controller 136. Any communication without suitable wire can be used, such as Air Titan-Bluetooth.
[0127] [0127] Figure 6 illustrates individual power busbars for a plurality of side coupling ports of a side modular housing 160 configured to receive a plurality of modules from a central surgical controller 206. The side modular housing 160 it is configured to receive and later interconnect modules 161. The modules 161 are slidably inserted into the docking stations 162 of the side modular housing 160, which includes a rear panel for interconnecting the modules 161. As shown in Figure 6, modules 161 are arranged laterally in the side modular housing 160. Alternatively, modules 161 can be arranged vertically in a modular side housing.
[0128] [0128] Figure 7 illustrates a vertical modular housing 164 configured to receive a plurality of modules 165 from the central surgical controller 106. Modules 165 are slidably inserted into docking stations, or drawers, 167 of the modular housing vertical 164, which includes a rear panel for interconnecting modules 165. Although the drawers 167 of the vertical modular housing 164 are arranged vertically, in certain cases, a vertical modular housing 164 may include drawers that are arranged side by side . In addition, modules 165 can interact with each other through the coupling ports of the vertical modular housing
[0129] [0129] In several respects, the imaging module 138 comprises an integrated video processor and a modular light source and is adapted for use with various imaging devices. In one aspect, the imaging device is comprised of a modular housing that can be mounted with a light source module and a camera module. The housing can be a disposable housing. In at least one example, the disposable housing is removably coupled to a reusable controller, a light source module, and a camera module. The light source module and / or the camera module can be selected selectively depending on the type of surgical procedure. In one aspect, the camera module comprises a CCD sensor. In another aspect, the camera module comprises a CMOS sensor. In another aspect, the camera module is configured for scanned beam imaging. Similarly, the light source module can be configured to provide a white light or a different light, depending on the surgical procedure.
[0130] [0130] During a surgical procedure, removing a surgical device from the surgical field and replacing it with another surgical device that includes a different camera or another different light source may be inefficient. Temporary loss of sight of the surgical field can lead to undesirable consequences. The imaging device module of the present disclosure is configured to allow the replacement of a light source module or a "midstream" camera module during a surgical procedure, without the need to remove the imaging device from the surgical field.
[0131] [0131] In one aspect, the imaging device comprises a tubular housing that includes a plurality of channels. A first channel is configured to receive the camera module in a sliding way, which can be configured for a press fit with the first channel. A second channel is configured to slide the camera module, which can be configured for a snap fit with the first channel. In another example, the camera module and / or the light source module can be rotated to an end position within their respective channels. A threaded coupling can be used instead of a pressure fitting.
[0132] [0132] In several examples, multiple imaging devices are placed in different positions in the surgical field to provide multiple views. Imaging module 138 can be configured to switch between imaging devices to provide an ideal view. In several respects, imaging module 138 can be configured to integrate images from different imaging devices.
[0133] [0133] Various image processors and imaging devices suitable for use with the present disclosure are described in US Patent No. 7,995,045 entitled COMBINED SBI AND CONVENTIO-NAL IMAGE PROCESSOR, granted on August 9, 2011 which is incorporated herein as a reference in its entirety. In addition, US Patent No. 7,982,776, entitled SBI MOTION ARTIFACT REMOVAL APPARATUS AND METHOD, issued July 19, 2011, which is incorporated herein by reference in its entirety, describes various systems for removing data movement artifacts of image. Such systems can be integrated with the imaging module 138. In addition, US Patent Application Publication No. 2011/0306840, entitled CONTROLLABLE MAGNETIC SOURCE TO FIXTURE INTRACORPO-
[0134] [0134] Figure 8 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 health care facility specially equipped for surgical operations, to a cloud-based system (for example, cloud 204 which may include a remote server 213 coupled to a storage device 205). In one aspect, the modular central communication controller 203 comprises a central network controller 207 and / or a network key 209 in communication with a network router. The modular central communication controller 203 can also be coupled to a local computer system 210 to provide local computer processing and data manipulation. The surgical data network 201 can be configured as a passive, intelligent, or switching network. A passive surgical data network serves as a conduit for the data, enabling data to be transmitted from one device (or segment) to another and to cloud computing resources. An intelligent surgical data network includes features to enable traffic to pass through the surgical data network to be monitored and to configure each port on the central network controller 207 or the network key 209. An intelligent surgical data network can be called central controller or controllable key. A central switching controller reads the destination address of each packet and then forwards the packet to the correct port.
[0135] [0135] Modular devices 1a to 1h located in the operating room can be coupled to the central controller for modular communication
[0136] [0136] It will be understood that the surgical data network 201 can be expanded by interconnecting multiple central network controllers 207 and / or multiple network keys 209 with multiple network routers 211. The central communication controller 203 may be contained in a modular control tower configured to receive multiple devices 1a to 1n / 2a to 2m. The local computer system 210 can also be contained in a modular control tower. The modular communication central controller 203 is connected to a screen 212 to show the images obtained by some of the devices 1a to 1n / 2a to 2m, for example, during surgical procedures. In several
[0137] [0137] In one aspect, the surgical data network 201 may comprise a combination of central network controller (s), network switches, and network routers that connect devices 1a to 1n / 2a 2m to the cloud. Any or all devices 1a to 1n / 2a to 2m coupled to the central network controller 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 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 released to the central communication controller modular 203 and / or computer system 210 located in the operating room (for example, a fixed, mobile, temporary, or surgical field room or space) and devices connected to the modular 203 central communication controller and / or to computer system 210 over the Internet.
[0138] [0138] By applying 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. patient. At least some of the devices 1a to 1n / 2a to 2m can be used to view the states of the tissue to assess the occurrence of leaks or perfusion of sealed tissue after a sealing and tissue cutting procedure. At least some of the devices 1a to 1n / 2a to 2m can be used to identify pathology, such as disease effects, 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 with the use of a variety of sensors integrated with imaging devices and techniques such as overlaying images captured by multiple imaging devices. imaging. 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. images. The data can be analyzed to improve the results of the surgical procedure by determining the need for additional treatment, such as application of endoscopic intervention, emerging technologies, targeted radiation, targeted intervention and precise robotics to specific tissue sites and conditions. . This data analysis can additionally use analytical processing of the results, and with the use of standardized approaches they can provide beneficial feedback both to confirm surgical treatments and the surgeon's behavior and to suggest changes to the surgical treatments and the surgeon's behavior.
[0139] [0139] In an implementation, operating room devices 1a to 1h can be connected to the central modular communication controller 203 via a wired or wireless channel depending on the configuration of devices 1a to 1n on a central network controller. The central network controller 207 can be implemented, in one aspect, as a local network transmission device that acts on the physical layer of the OSI model ("open system interconnection"). The central network controller provides connectivity to devices 1a to 1n located on the same network as the operating room. The central network controller 207 collects data in the form of packets and sends them to the router in "halfduplex" mode. The central network controller 207 does not store any media access control / Internet protocol (MAC / IP) to transfer data from the device. Only one of the devices 1a to 1n at a time can send data via the central network controller 207. The central network controller 207 has no routing tables or intelligence on where to send information and transmits all data on the network via each connection and to a remote server 213 (Figure 9) via cloud 204. The central network controller 207 can detect basic network errors, such as collisions, but have all (admit that) the information transmitted to multiple ports. entry can pose a security risk and cause bottlenecks.
[0140] [0140] In another implementation, the operating room devices 2a to 2m can be connected to a network switch 209 through a wired or wireless channel. The network key 209 works in the data connection layer of the OSI model. The network key 209 is a multicast device for connecting devices 2a to 2m in the same operating room to the network. The network key 209 sends data in frame form 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.
[0141] [0141] The central network controller 207 and / or the network key 209 are coupled to the network router 211 for a connection to the cloud
[0142] [0142] In one example, the central network controller 207 can be implemented as a central USB controller, which allows multiple USB devices to be connected to a host computer. The central USB controller can expand a single USB port on several levels so that more ports are available to connect the devices to the system's host computer. The central network controller 207 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 radio communication protocol can be used for communication between devices 1a to 1h and devices 2a to 2m located in the operating room.
[0143] [0143] In other examples, operating room devices 1a to 1n / 2a to 2m can communicate with the modular central communication controller 203 via standard Bluetooth wireless technology for exchanging data over short distances ( using short-wavelength UHF radio waves in the 2.4 to 2.485 GHz ISM band from fixed and mobile devices and building personal area networks (PANs). In other respects, operating room devices 1a to 1n / 2a to 2m can communicate with the central modular communication controller 203 via a number of wireless and wired communication standards or protocols, including including, but not limited to, Wi-Fi (IEEE 802.11 family), WiMAX (IEEE 802.16 family), IEEE 802.20, long-term evolution (LTE, "long-term evolution"), and Ev-DO, HSPA +, HSDPA + , HSUPA +, EDGE, GSM, GPRS, CDMA, TDMA, DECT, and Ethernet derivatives of the same, as well as any other wireless and wired protocols that are designated as 3G, 4G, 5G, and beyond. The computing module can include a plurality of communication modules. For example, a first communication module can be dedicated to short-range wireless communications like Wi-Fi and Bluetooth, and a second communication module can be dedicated to longer-range wireless communications like GPS, EDGE, GPRS, CDMA , WiMAX, LTE, Ev-DO, and others.
[0144] [0144] The modular communication central controller 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 central communication controller 203, it is amplified and transmitted to the network router 211, which transfers data to cloud computing resources using a series of wireless communication standards or protocols or wired, as described in the present invention.
[0145] [0145] The 203 modular communication central controller can be used as a standalone device or be connected to compatible central network controllers and network switches to form a larger network. The 203 modular communication central controller is, in general, easy to install, configure and maintain, making it a good option for the network of devices 1a to 1n / 2a to 2m from the operating room.
[0146] [0146] Figure 9 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 surgical system, in - computer implemented 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 central surgical controller 206 communicating with a cloud 204 that can 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 such as smart surgical instruments, robots and other devices computerized systems located in the operating room. As shown in Figure 10, the modular control tower 236 comprises a central modular communication controller 203 coupled to a computer system
[0147] [0147] Figure 10 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 central modular communication controller 203, for example, a connectivity device network, and a computer system 210 to provide local processing, visualization, and imaging, for example. As shown in Figure 10, 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 10, each of the central controllers / network switches in the modular central communication controller 203 includes three downstream ports and an upstream port. The central controller / network switch upstream is connected to a processor to provide a communication connection with the cloud computing resources and a local display 217. Communication with the cloud 204 can be done via a communication channel wired or wireless.
[0148] [0148] The central surgical controller 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 laser or ultrasonic measurement devices. An ultrasound-based non-contact sensor module scans the operating room by transmitting an ultrasound explosion and receiving an echo when it bounces off the perimeter of the operating room walls, as described under the heading "Surgical 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 by reference in its entirety, in which the Sensor module is configured to determine the size of the operating room and to adjust the limits of the Bluetooth pairing distance. A laser-based non-contact sensor module scans the operating room by transmitting pulses of laser light, receiving pulses of laser light that bounce off 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.
[0149] [0149] 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 a system bus. The system bus can be any 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 bus architectures. available including, but not limited to, 9-bit bus, industry standard architecture (ISA), Micro-Charm Architecture (MSA), extended ISA (EISA), smart drive electronics (IDE), local bus VESA (VLB), Interconnection of peripheral components (PCI), USB, advanced graphics port (AGP), PCMCIA bus (International Association of Memory Cards for Personal Computers, "Personal Computer Memory Card International Association" ), Small Computer Systems Interface (SCSI), or any other proprietary bus.
[0150] [0150] 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 Cortex-M4F LM4F230H5QR ARM processor core, available from Texas Instruments, for example, comprising 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 , 2 KB electrically erasable, programmable read-only memory (EEPROM), one or more pulse width modulation (PWM) modules, one or more quadrature encoder (QEI) analog inputs, one or more converters 12-bit analog-to-digital (ADC) with 12 analog input channels, details of which are available on the product data sheet.
[0151] [0151] 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 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.
[0152] [0152] 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), EEPROM 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).
[0153] [0153] 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 drive, Zip drive, LS-60 drive, flash memory card or memory stick (pen drive). drive). In addition, disk storage 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 (CD-ROM) device recordable (CD-R Drive), rewritable compact disc drive (CD-RW drive), or a versatile digital 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.
[0154] [0154] It must be understood that computer system 210 includes software that acts as an intermediary between users and the basic computer resources described in an appropriate operating environment. Such software includes an operating system. The operating system, which can be stored on disk storage, acts to control and allocate computer system resources. System applications benefit from resource management by the operating system through program modules and program data stored in system memory or disk storage. It should be understood that the various components described in the present invention can be implemented with various operating systems or combinations of operating systems.
[0155] [0155] A user enters commands or information into computer system 210 through the input device (s) coupled to interface 1 / O 251. Input devices include, but are not limited to, a pointing device such as a mouse, trackball, pen, 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. The output device (s) use some of the same types of ports as the input device (s). In this way, for example, a USB port can be used to provide input to the computer system and to provide information from the computer system 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.
[0156] [0156] Computer system 210 can operate in a networked environment using logical connections to one or more remote computers, such as the cloud computer (s), or local computers. The remote cloud computer (s) 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 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 (s). The remote computer (s) 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 ring / IEEE 802.5 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 ).
[0157] [0157] In various respects, the computer system 210 of Figure 10, the imaging module 238 and / or the display system 208, and / or the processor module 232 of Figures 9 to 10, may comprise a processor image processing, image processing engine, media processor, or any specialized digital signal processor (DSP) used for processing digital images. The image processor can employ parallel computing with multi-data instruction (SIMD) or multi-data instruction (MIMD) technologies to increase speed and efficiency. The digital image processing engine can perform a number of tasks. The image processor can be an integrated circuit system with a multi-core processor architecture.
[0158] [0158] Communication connections refer 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 technologies and external as modems, including regular telephone service modems, cable modems and DSL modems, ISDN adapters and Ethernet cards.
[0159] [0159] Figure 11 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 central controller device uses a TUSB2036 integrated circuit central controller available from Texas Instruments. The central USB network controller 300 is a CMOS device that provides one 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 "plus" differential data outputs (DP1-DP3) paired with "minus" differential data outputs (DM1-DM3) .
[0160] [0160] The USB 300 central network controller device is implemented with a digital state machine instead of a micro controller, and no firmware programming is required. Fully malleable USB transceivers are integrated into the circuit for the upstream USB transceiver port 302 and all downstream 304, 306, 308 USB transceiver ports. The downstream USB transceiver ports 304, 306, 308 support both full speed and low speed devices by automatically configuring the scan rate according to the speed of the device attached to the ports. The USB 300 network central controller device can be configured in bus powered mode or auto power mode.
[0161] [0161] The USB 300 central network controller device includes a 310 serial interface (SIE) engine. The SIE 310 is the front end of the USB 300 central network controller hardware and processes most of the protocol described in chapter 8 of the USB specification. SIE 310 typically comprises signaling down to the transaction level. The functions it handles could include: packet recognition, transaction sequencing, SOP signal detection / generation, EOP, RESET, and RESUME, clock / data separation, data encoding / decoding non-inverted zero (NRZI), generation and verification of CRC (token and data), generation and verification / decoding of packet ID (PID), and / or serial-parallel / parallel-serial conversion. The 310 receives a clock input 314 and is coupled to a logic suspend / resume and frame timer circuit 316 and a repeater circuit of the central controller 318 to control communication between the upstream USB transceiver port 302 and the ports downstream USB transceiver 304, 306, 308 via the logic circuits of ports 320, 322, 324. The SIE 310 is coupled to a 326 command decoder via the logic interface to control the commands of a serial EEPROM via a 330 serial EEPROM interface.
[0162] [0162] In several aspects, the USB 300 central network controller can connect 127 functions configured in up to six logical layers (levels) to a single computer. In addition, the USB 300 central network controller 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 central network controller can be configured to support four power management modes: a bus powered central controller, with individual port power management or grouped port power management, and the self-powered central controller , with individual port power management or grouped port power management. In one aspect, using a USB cable, the USB 300 central network controller, the USB transceiver port 302 is plugged into a USB host controller, and the USB transceiver ports downstream 304, 306, 308 are exposed to connect USB compatible devices, and so on.
[0163] [0163] Figure 12 illustrates a logic 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 microcontroller 461 comprising a processor 462 and a memory 468. One or more of the sensors 472, 474, 476, for example, provide real-time feedback to the processor 462. A motor 482, driven by an aci - engine stop 492, operationally couples a longitudinally movable displacement member to actuate a closing member of the clamping arm. A tracking system 480 is configured to determine the position of the longitudinally movable displacement member. Position information is provided to processor 462, which can be programmed or configured to determine the position of the longitudinally movable drive member as well as the position of the closing member. Additional motors can be provided at the tool driver interface to control the pipe closing path, the rotation of the drive shaft, the joint, or the closing of the clamping arm, or a combination thereof. A 473 screen shows a variety of instrument operating conditions and can include touchscreen functionality for data entry. The information shown on screen 473 can be overlaid with images captured using endoscopic imaging modules.
[0164] [0164] 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 461 main microcontroller may be an LM4F230H5QR ARM Cortex-M4F processor, available from Texas Instruments, for example, which comprises a 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, 2 KB electronically programmable and erasable 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 12-bit analog-to-digital converters (ADC) with 12 analog input channels, details of which are available on the product data sheet.
[0165] [0165] In one aspect, the 461 microcontroller may comprise a safety controller comprising two controller-based families, 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.
[0166] [0166] The 461 microcontroller can be programmed to perform various functions, such as precise control of the speed and position of the knife, 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 direct current (DC) motor with brushes with a gearbox and mechanical connections with an articulation system or Knife. In one respect, a motor drive 492 can be an A3941 available from Allegro Microsystems, Inc. Other motor drives can be readily replaced for use in the tracking system 480 which comprises an absolute positioning system. A detailed description of an absolute positioning system is given in US Patent Application Publication No. 2017/0296213, entitled SYSTEMS AND METHODS FOR CONTROLLING A SURGICAL STAPLING AND CUTTING INSTRUMENT, published on October 19, 2017, which is incorporated herein by reference in its entirety.
[0167] [0167] 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.
[0168] [0168] In one aspect, the 482 motor can be controlled by the 492 motor driver and can be used by the instrument trigger system or surgical tool. In many ways, the 482 motor can be a brushless DC drive motor with a maximum rotational speed of approximately 25,000 RPM.
[0169] [0169] The 492 motor starter can be an A3941, available from Allegro Microsystems, Inc. The 492 A3941 drive is a full bridge controller for use with semiconductor metal oxide field effect transistors (MOSFETs). external power N channel, specifically designed for inductive loads, such as DC motors with brushes. The 492 actuator comprises a unique charge pump regulator that provides complete door drive (> 10 V) for batteries with voltage up to 7 V and allows the A3941 to operate with a reduced door drive, up to 5.5 V. An input command capacitor can be used to supply the above battery supply voltage required for N channel MOSFETs. An internal charge pump for high-side drive allows operation in direct current (100% duty cycle). The complete bridge can be operated at the
[0170] [0170] 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 drive member comprising a rack of drive teeth for engagement with a drive gear corresponding to a gear reduction assembly. In other respects, the displacement member represents the firing member, which could be adapted and configured to include a rack of driving teeth. In yet another aspect, the displacement member represents a longitudinal displacement member for opening and closing a clamping arm, which can be adapted and configured to include a drive tooth rack. In other respects, the displacement member represents a closing member of the clamping arm configured to close and open a clamping arm of a stapler, ultrasonic, or electrosurgical device, or combinations thereof. Consequently, as used in the present invention, the term displacement member is used generically to refer to any movable member of the surgical instrument or tool such as the drive member, the clamping arm, or any element that can be displaced. Consequently, the absolute positioning system can, in effect, track the displacement of the clamping arm by tracking the linear displacement of the movable drive member longitudinally.
[0171] [0171] 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 many other respects, the displacement member can be coupled to any suitable 472 position sensor 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 sliding potentiometer, a magnetic detection system comprising a moving magnet and a series of effect sensors Hall linearly arranged, a magnetic detection system comprising a fixed magnet and a series of linear Hall effect sensors, linearly arranged, an optical detection system comprising a mobile light source and a series of photodiodes or photodetectors linearly arranged, an optical detection system comprising a fixed light source and a series of linearly arranged mobile photodiodes or photodetectors, or any combination thereof.
[0172] [0172] 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 driving 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 gear wheel or other connection. A power supply supplies power to the absolute positioning system and an output indicator can show the output of 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.
[0173] [0173] A single revolution of the sensor element associated with the position sensor 472 is equivalent to a longitudinal linear displacement d1 of the displacement member, where d: represents the longitudinal linear distance by which the displacement member moves from the 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 full travel of the travel member. The 472 position sensor can complete multiple revolutions for the full travel of the displacement member.
[0174] [0174] A series of switches, where n is an integer greater than one, can be used alone or in combination with a gear reduction to provide a unique position signal for more than one revolution of the 472 position sensor. of the switches is transmitted back to microcontroller 461 which applies logic to determine a unique position signal corresponding to the longitudinal linear displacement d 1 + 2 + ... dh of the displacement member. The output of the position sensor 472 is supplied to the microcontroller 461. The position sensor 472 of the sensor arrangement 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 signals or position values.
[0175] [0175] The position sensor 472 can comprise any number of magnetic detection elements, such as, for example, magnetic sensors classified according to their measurement of 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 used for magnetic field detection include flow meter, saturated flow, optical pumping, nuclear precession, SQUID, Hall effect, anisotropic magnetoresistance, giant magnetoresistance, magnetic tunnel junctions, giant magnetoimpedance, magnetostrictive / piezoelectric compounds, magnetodiode , magnetic transistors, fiber optics, magneto-optics and magnetic sensors based on microelectromechanical systems, among others.
[0176] [0176] In one aspect, the position sensor 472 for tracking system 480 which comprises 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 and low power component and includes four Hall 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's algorithm, is provided to implement a simple and efficient algorithm for calculating hyperbolic and trigonometric functions that require only addition, subtraction operations , bit shift and table search. 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. The 472 position sensor provides 12 or 14 bits of resolution. The position sensor 472 can be an ASS5055 integrated circuit supplied in a small 16-pin QFN package whose measurement corresponds to 4x4x0.85 mm.
[0177] [0177] The tracking system 480 that 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 source converts the signal from the feedback controller to a physical input for the system, in this case the voltage. Other examples include a voltage, current and force PWM. Other sensor (s) can be provided to measure the parameters of the physical system in addition to the position measured by the position sensor 472. In some respects, the other sensor (s) may include sensor 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 in this document; Publication of US Patent Application Serial No. 2014/0263552, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, published on September 18, 2014, is incorporated by reference in its entirety in this document; and US Patent Application Serial No. 15 / 628,175, entitled TECHNIQUES
[0178] [0178] The absolute positioning system provides an absolute positioning of the displaced limb by activating the instrument without having to retract or advance the longitudinally movable drive member to the reset 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 traveled to infer the position of a device actuator, actuation bar, knife, or similar.
[0179] [0179] 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 the compression forces applied to the anvil. The measured effort is converted to a digital signal and supplied to the processor
[0180] [0180] 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 the forces applied to the tissue attached by the end actuator comprises a 474 strain gauge sensor, such as a microstrain gauge, which is configured to measure one or more parameters of the end actuator , for example. In one aspect, the strain gauge sensor 474 can measure the amplitude or magnitude of the strain exerted on a claw member of an end actuator during a gripping operation, which can be indicative of tissue compression. The measured effort is converted into a digital signal and supplied to the 462 processor of a 461 microcontroller. A load sensor 476 can measure the force used to operate the knife element, for example, to cut the captured tissue between the anvil and staple cartridge. A 476 load sensor can measure the force used to operate the clamping arm element, for example, to capture the tissue between the clamping arm and an ultrasonic blade or to capture the tissue 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.
[0181] [0181] Measurements of tissue compression, tissue thickness and / or force required to close the end actuator on the tissue, as measured by sensors 474, 476, can be used by the 461 microcontroller to characterize the selected position of the trigger member and / or the corresponding value of the speed of the trigger member. In one case, a 468 memory can store a technique, an equation and / or a look-up table that can be used by the 461 microcontroller in the evaluation.
[0182] [0182] The control system 470 of the instrument or surgical tool can also comprise wired or wireless communication circuits for communication with the central modular communication controller shown in Figures 8 to 11.
[0183] [0183] Figure 13 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
[0184] [0184] Figure 14 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 several processes described here. The combinational logic circuit 510 can comprise a finite state machine comprising 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.
[0185] [0185] Figure 15 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 here. The logic circuit follows
[0186] [0186] Figure 16 illustrates a schematic diagram of a surgical instrument 750 configured to control the distal translation of the 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 like the closing member 764. The surgical instrument 750 comprises an end actuator 752 which may comprise a clamping arm 766, a closure 764 and an ultrasonic blade 768 coupled to an ultrasonic transducer 769 driven by an ultrasonic generator 771.
[0187] [0187] The position, movement, displacement, and / or translation of a linear displacement member, such as closure 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 drive member,
[0188] [0188] 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 brushed DC motor. For example, the speed of motor 754 may be proportional to the drive signal of motor 774. In some instances, motor 754 may be a brushless DC electric motor and the drive signal of motor 774 may comprise a signal PWM provided for one or more motor stator windings 754. In addition, in some instances, motor controller 758 may be omitted, and control circuit 760 can generate motor drive signal 774 directly.
[0189] [0189] The 754 motor can receive power from a power source
[0190] [0190] 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 versus time, tissue compression versus time and anvil effort versus 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 end actuator parameters
[0191] [0191] 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 clamping arm 766 during a tightening condition. The effort meter provides an electrical signal whose amplitude varies with the magnitude of the effort. 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 tissue located between the clamping arm 766 and the ultrasonic blade 768 which is indicative of the thickness and / or completeness of the tissue located between them.
[0192] [0192] 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 a point of interaction between a closing tube and the clamping arm 766 to detect the closing forces applied by a closing tube to the clamping arm 766. The forces exerted on the clamping arm 766 can be representative of the tissue compression experienced by the section of tissue captured between the clamping arm 766 and the ultrasonic blade 768. The one or more sensors 788 can be positioned at various points of interaction throughout the drive system Closing mechanism to detect the closing forces applied to the clamping arm 766 by the closing drive system. The one or more 788 sensors can be sampled in real time during a pressing operation by a processor of the control circuit 760. The control circuit 760 receives sample measurements in real time to provide and analyze information based on in real time and evaluate, in real time, the closing forces applied to the clamping arm 766.
[0193] [0193] 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
[0194] [0194] Control circuit 760 can be configured to simulate the actual system response 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 one of any feedback feedback controllers, including, but not limited to, a PID controller, state feedback, LOR, and / or an adaptive controller, for example. The surgical instrument 750 can include a power source to convert the signal from the feedback controller to a physical input such as housing voltage, PWM voltage, frequency-modulated voltage, current, torque and / or force, for example.
[0195] [0195] The actual drive system of the surgical instrument 750 is configured to drive the displacement member, cutting member or closing member 764, by a brushed DC motor with gearbox and mechanical connections to an articulation system 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 unmeasured 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.
[0196] [0196] 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 can comprise a pivoting clamping arm 766 and, when configured to the use, an ultrasonic blade 768 positioned opposite the clamping arm 766. A physician can hold the tissue between the clamping arm 766 and the ultrasonic blade 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 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 element positioned at a distal end, can cut the fabric between the ultrasonic blade 768 and the clamping arm 766.
[0197] [0197] 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 more fabric 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, control circuit 760 can be programmed to move the displacement member at a lower speed and / or with a lower power. When a thinner fabric is present, the control circuit 760 can be programmed to move the displacement member at a higher speed and / or with greater power.
[0198] [0198] 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 of the travel member. 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 disclosed in US Patent Application Serial No. 15 / 720,852, entitled SYSTEM AND METHODS FOR CONTROLLING A DISPLAY OF A SURGICAL INSTRUMENT, filed on 29 September 2017, which is hereby incorporated by reference in its entirety .
[0199] [0199] 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.
[0200] [0200] 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 implementations, the 788 sensors can include driverless electric switches, ultrasonic switches, accelerometers, inertia sensors, among others.
[0201] [0201] In one aspect, the position sensor 784 can be implemented as an absolute positioning system, which includes a rotating magnetic absolute positioning system implemented as a rotating magnetic position sensor, circling 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 may 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 and trigonometric functions that require only addition, subtraction, bit shift and table search operations.
[0202] [0202] In some examples, the position sensor 784 can be omitted. When the motor 754 is a stepper motor, the control circuit 760 can track the position of the closing member 764 by adding the number and orientation of the steps that the motor was instructed to perform. Position sensor 784 can be located on end actuator 792 or any other portion of the instrument.
[0203] [0203] 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 versus time, tissue compression versus time and anvil effort versus 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 end actuator parameters
[0204] [0204] An RF power source 794 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 conjunction with the ultrasonic blade
[0205] [0205] Additional details are disclosed in US Patent Application Serial No. 15 / 636,096, entitled SURGICAL SYSTEM COUPLABLE WITH STAPLE CARTRIDGE AND RADIO FREQUENCY CARTRIDGE, AND METHOD OF USING SAME, filed on 28 June 2017, which is incorporated herein by reference in its entirety. Generator hardware Adaptive ultrasonic blade control algorithms
[0206] [0206] In many 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 respect, ultrasonic blade control algorithms are configured to parameterize the type of tissue. An algorithm to detect the collagen / elastin ratio of the tissue to adjust the amplitude of the distal tip of the ultrasonic sheet is described in the following section of the present disclosure. Various aspects of intelligent ultrasonic energy devices are described here in connection with Figures 1 to 37, for example. Consequently, the following description of the adaptive ultrasonic blade control algorithms should be read in conjunction with Figures 1 to 37 and the description associated with them.
[0207] [0207] 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 what percentage of the tissue 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 on the parameterization. For example, the amplitude of the mechanical displacement of the distal tip of the ultrasonic sheet can be adjusted based on the ratio between collagen and elastin in the tissue detected during the tissue identification procedure. The ratio of tissue collagen to elastin can be detected using a variety of techniques including reflectance and infrared (IR) surface emissivity. The force applied to the fabric by the clamping arm and / or the travel of the clamping arm can be used to produce span and compression. Electrical continuity through a clamp equipped with electrodes can be used to determine what percentage of the clamp is covered with tissue.
[0208] [0208] Figure 18 is an 800 system configured to perform adaptive ultrasonic blade control algorithms in a surgical data network comprising a central modular communication controller, in accordance with at least one aspect of the present disclosure. dog. In one aspect, generator module 240 is configured to execute 802 adaptive ultrasonic blade control algorithm (s), as described in US Provisional Patent Application No. 62 / 692,747, entitled SMART ACTIVATION OF AN ENERGY DEVICE BY ANO-THER DEVICE, deposited on June 30, 2018, which is hereby incorporated by reference in the present invention in its entirety. In one aspect, device / instrument 235 is configured to execute the previously mentioned adaptive ultrasonic blade control algorithm (s) 804, as described in US Provisional Patent Application No. 62 / 692,747. In another aspect, both device / instrument 235 and device / instrument 235 are configured to execute the previously mentioned adaptable 802, 804 ultrasonic blade control algorithms, as described in US Provisional Patent Application 62 / 692,747.
[0209] [0209] 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 bypass configuration (for example, a central bypass or non-central bypass configuration) for defining the trigger signal outputs in order to deliver trigger signals to different surgical instruments, such as an ultrasonic surgical device and an electro-surgical RF instrument, and a multifunctional surgical instrument that includes ultrasonic and RF energy modes that can be released alone or simultaneously. In particular, the trigger signal outputs can emit an ultrasonic trigger signal (for example, a 420 V RMS trigger signal ("root-mean-square") for an ultrasonic surgical instrument 241, and the trigger signal outputs can emit an RF electrosurgical trigger signal (for example, a 100 V RMS trigger signal) to an RF electrosurgical instrument 241. Aspects of generator module 240 are described here with reference to Figures 19 to 26B.
[0210] [0210] Generator module 240 or device / instrument 235 or both are coupled to modular control tower 236 connected to multiple operating room devices, such as smart surgical instruments, robots, and other computerized devices located in the operating room, as described with reference to Figures 8 to 11, for example.
[0211] [0211] 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. The generator 900 comprises a processor 902 coupled to a waveform generator 904. The processor 902 and the waveform generator 904 are configured to generate various signal waveforms based on information stored in a memory attached to the process. 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 into an analog output. The analog output is powered by an amplifier 1106 for signal conditioning and amplification. The conditioned and amplified output of the 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 of a second energy modality is coupled through 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 types 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 positive integer greater than 1. It will also be recognized that up to "n" RETURN return paths can be provided without departing from the scope of this disclosure.
[0212] [0212] A first 912 voltage detection circuit is coupled through the terminals identified as ENERGY; and RETURN path to measure the output voltage between them. A second voltage detection circuit 924 is coupled through the terminals identified as ENERGY, and 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 further processing computing. 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. The input / output communications between the 902 processor and the patient's isolated circuits are provided through a 920 interface circuit. The sensors can also be in electrical communication with the 902 processor via the circuit 920 interface.
[0213] [0213] 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 ENERGY / RETURN or the second voltage detection circuit
[0214] [0214] 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 modes 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, the 900 generator can supply higher voltage and lower current power to drive an ultrasonic transducer, lower voltage and higher current to drive RF electrodes to seal the tissue or with a coagulation waveform for point coagulation using electrosurgical electrodes monopolar or bipolar RF. The output waveform of generator 900 can be oriented, switched or filtered to supply the frequency to the end actuator of the surgical instrument. The connection of an ultrasonic transducer to the output of generator 900 would preferably be located between the output identified as ENERGY: and RETURN, as shown in Figure 19. In one example, a connection of bipolar RF electrodes to the output of the 900 generator, would it preferably be located between the output identified as ENERGY and RETURN. In the case of monopolar output, the preferred connections would be an active electrode (for example, pen or other probe) at the ENERGY outlet, and a suitable return block connected to the RETURN outlet.
[0215] [0215] Additional details are revealed in US Patent Application Publication 2017/0086914 entitled TECHNIQUES FOR OPERATING
[0216] [0216] 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, long-term evolution (LTE, "long-term evolution"), Ev-DO, HSPA +, HSDPA +, HSUPA +, EDGE, GSM, GPRS, CDMA, TDMA, DECT, Bluetooth, Ethernet derivatives thereof, as well as any other wireless and wired protocols that are designated as 3G, 4G, 5G, and beyond. The computing module can include a plurality of communication modules. For example, a first communication module can be dedicated to short-range wireless communications like Wi-Fi and Bluetooth, and a second communication module can be dedicated to longer-range wireless communications like GPS, EDGE, GPRS , CDMA, WiMAX, LTE, Ev-DO, and others.
[0217] [0217] 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 (especially systems on a chip (SoCs)) that combine several specialized "processors".
[0218] [0218] As used here, an integrated circuit system or integrated circuit system (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 signal functions and, often, radio frequency functions - all on a single substrate. A SoC integrates a microcontroller (or microprocessor) with advanced peripherals such as graphics processing unit (GPU), module
[0219] [0219] 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) can be implemented as a small computer in a single integrated circuit. It can be similar to a SoC; a SoC can include a microcontroller as one of its components. A microcontroller can contain one or more core processing units (CPUs) together with memory and programmable input / output peripherals. The memory of the program in the form of ferroelectric RAM, NOR flash or OTP ROM is also often included in the integrated circuit, as well as a small amount of RAM. Microcontrollers can be used for integrated applications, in contrast to microprocessors used in personal computers or other general purpose applications that consist of several discrete integrated circuits.
[0220] [0220] As used in the present invention, the term controller or microcontroller can be an integrated circuit device or independent IC (integrated circuit) 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 with) that device.
[0221] [0221] Any of the processors or microcontrollers in the present invention can be implemented by any single-core or multi-core processor, such as those known under the trade name ARM Cortex by Texas Instruments. In one aspect, the processor may be a Cortex-M4F LM4F230H5QR ARM processor core, 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 program StellarisWareO, 2 KB electronically erasable programmable read-only memory (EEPROM), one or more pulse width modulation (PWM) modules, one or more quadrature encoder (QEI) analogues, one or plus 12-bit analog-to-digital converters (ADC) with 12 channels of analog input, details of which are available in the product data sheet.
[0222] [0222] In one aspect, the processor may comprise a safety controller that comprises two controller-based families, such as TMS570 and RM4x known under the trade name 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.
[0223] [0223] Modular devices include modules (as described in connection with Figures 3 and 9, for example) that are receivable 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 monitors. 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 the device.
[0224] [0224] Figure 20 illustrates a form of a surgical system 1000 comprising a generator 1100 and several surgical instruments 1104, 1106, 1108 that can be used with it, with surgical instrument 1104 being an ultrasonic surgical instrument, the 1106 surgical instrument is an RF electrosurgical instrument, and the 1108 multifunctional surgical instrument is a combination of an ultrasonic / electrosurgical RF 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 instruments 1104, the RF electrosurgical instruments 1106 and the multifunctional surgical instruments 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 instruct
[0225] [0225] 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 (HP) handle, 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 clamping arm 1140 and an 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 energize the 1120 ultrasonic transducer with the 1100 generator.
[0226] [0226] 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 end actuator
[0227] [0227] Generator 1100 is also configured to drive a multifunctional surgical instrument 1108. The multifunctional surgical instrument 1108 comprises a handle 1109 (HP), a drive shaft 1129 and an end actuator 1125. The end actuator 1125 comprises an ultrasonic blade 1149 and a clamping arm 1146. The ultrasonic blade 1149 is acoustically coupled to the ultrasonic transducer 1120. The grip 1109 comprises a trigger 1147 to operate the clamping arm 1146 and a combination of toggle buttons 1137a, 1137b, 1137c to energize and activate the 1149 ultrasonic blade or other function. Toggle buttons 1137a, 1137b, 1137c can be configured to power the 1120 ultrasonic transducer with the 1100 generator and to power the 1149 ultrasonic blade with a bipolar power source also contained within the 1100 generator.
[0228] [0228] 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 instrument 1106 and the multifunctional surgical instrument 1108 that 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
[0229] [0229] 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 can 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
[0230] [0230] 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 22) coupled to generator 1100 by means of a foot switch cable 1432. A physician can activate ultrasonic transducer 1120 and thereby ultrasonic transducer 1120 and the blade 1128 by 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 make the generator 1100 to activate the ultrasonic transducer
[0231] [0231] In addition or alternatively, one or more switches may comprise a toggle button 1134c which, when pressed, causes generator 1100 to provide a pulsed output (Figure 20). The pulses can be provided at any suitable frequency and grouping, for example. In some respects, the pulse power level may consist of the power levels associated with the toggle buttons 1134a, 1134b (maximum, less than maximum), for example.
[0232] [0232] 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 maximum ultrasonic energy output and a toggle button 1134c to produce a pulsed output, either at the power level maximum or less than the maximum. Thus, the output setting of the generator 1100 trigger signal could be five continuous signals, or any 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 generator 1100 and / or on power level selections by the user.
[0233] [0233] In certain respects, a two-position switch can be provided as an alternative to a toggle button 1134c (Figure 20). For example, a device 1104 may include a toggle button 1134a to produce a continuous output at maximum power level and a two-position toggle button 1134b. In a first predetermined position, the toggle button 1134b can produce a continuous output at a power level less than the maximum, and in a second holding position, the toggle button 1134b can produce a pulsed output (for example, at a maximum or less than maximum power level, depending on the EE-PROM configuration).
[0234] [0234] In some respects, the RF electrosurgical end actuator 1124, 1125 (Figure 20) may 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 portion of tissue present between the clamping arm 1142a, 1146 and the blade 1142b,
[0235] [0235] In several respects, the 1100 generator can comprise several separate functional elements, such as modules and / or blocks, as shown in Figure 22, a diagram of the surgical system 1000 in Figure 20. Different modules or functional elements can be configured to drive different types of surgical devices 1104, 1106, 1108. For example, an ultrasonic generator module can drive an ultrasonic device, such as the ultrasonic device
[0236] [0236] 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.
[0237] [0237] 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.).
[0238] [0238] The generator 1100 can comprise an input device 2150 (Figure 25B) located, for example, on a front panel of the generator 1100 console. The input device 2150 can comprise any suitable device that generates signals suitable for programming. - 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, manual rotary switches, 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 shown on a monitor with a touch screen, for example. Consequently, by means of the 2150 input device, the user can adjust or program several operational parameters of the generator, such as current (I), voltage (V), frequency (f) and / or period (T) of a or more trigger signals generated by the ultrasonic generator module and / or by the generator module for electrosurgery / RF.
[0239] [0239] The generator 1100 may also comprise an output device 2140 (Figure 25B) 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 a sensory feedback. These devices may comprise, for example, visual feedback devices (for example, a monitor with
[0240] [0240] 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 still be within the scope of the aspects . Additionally, although several aspects can be described in terms of modules and / or blocks to facilitate the description, these modules and / or blocks can be implemented by one or more hardware components, for example, processors, digital signal processors ( 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.
[0241] [0241] In one aspect, the ultrasonic generator drive module and the electrosurgery / RF 1110 drive module (Figure 20) can comprise one or more integrated applications, implemented as firmware, software, hardware or any combination thereof . The modules can comprise several executable modules, such as software, programs, data, triggers and application programming interfaces (API, of "application program interfaces"), among others. The firmware can be stored in non-volatile memory (NVM, of "non-volatile memory"), as in a read-only memory (ROM) with bit mask, or flash memory. In many implementations, storing firmware in ROM can preserve flash memory. NVM can comprise other types of memory including, for example, programmable ROM (PROM, "programmable ROM"), erasable programmable ROM (EPROM, "erasable programmable ROM"), electrically erasable programmable ROM (EEPROM, de " electrically erasable program ROM), or battery-backed random access memory (RAM, random access memory) as dynamic RAM (DRAM, dynamic RAM), dual data rate DRAM (DDRAM, "Double-Data-Rate DRAM"), and / or synchronous DRAM (SDRAM, "synchronous DRAM").
[0242] [0242] 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 corresponding output signal or signals for the operation of devices 1104, 1106, 1108. In aspects where the generator 1100 is used in conjunction with device 1104, the trigger signal can trigger the ultrasonic transducer 1120 in surgical cutting and / or coagulation modes. The electrical characteristics of the 1104 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 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 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 provided as feedback to the user. In several aspects, as previously discussed, hardware components can be implemented as PSD, PLD, ASIC, circuits and / or recorders. 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 ultrasonic transducer 1120 and end actuators 1122, 1124, 1125.
[0243] [0243] 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 / 7 (t) signals is zero. In other words, in resonance the inductive impedance is equal to the capacitive impedance. As the ultrasonic blade heats up, the compliance of the ultrasonic blade (modeled as an equivalent capacitance) causes a shift in the resonance frequency of the electromechanical ultrasonic system. Thus, the inductive impedance is no longer equal to the capacitive impedance causing a disparity between the activation frequency and the resonance frequency of the electromechanical ultrasonic system. The system is now operating "out of resonance". The disparity between the drive frequency and the resonance frequency is manifested as a phase difference between the voltage signals Va (t) and current / a (t) applied to the ultrasonic transducer. The generator's electronic circuits can easily monitor the phase difference between the voltage (Valt) and current / 4 (t) signals and can continuously adjust the drive frequency until the phase difference is again 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.
[0244] [0244] As shown in Figure 23, the electromechanical properties of the ultrasonic transducer can be modeled as an equivalent circuit that comprises a first branch that has a static capacity and a second "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 bypass static capacitance at a resonant frequency so that substantially all of the generator's trigger signal current flows into the motion branch. Consequently, using a tuning inductor, the current of the generator's trigger signal represents the current of the motion branch, and the generator is thus able to control its trigger signal to maintain the resonant frequency. of the ultrasonic transducer. 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 that has a different static capacitance needs a tuning inductor.
[0245] [0245] Figure 23 illustrates a 1500 equivalent 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 resonator's electromechanical properties, and a second capacitive branch having a static capacitance Co. The drive current / 4 (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 / 3 (t) -Im (t) flowing through the capacitive branch. The control of electromechanical properties
[0246] [0246] Several aspects of the 1100 generator may not have a Lt tuning inductor to monitor the branching current / m (t). Instead, the 1100 generator can use the measured value of the static capacitance Co between power applications for a specific ultrasonic surgical device 1104 (together with drive feedback and current voltage feedback data) to determine the movement branch current values / n (t) on a dynamic and continuous basis (for example, in real time). These aspects of generator 1100 are therefore able to provide virtual tuning to simulate a system that is tuned or resonant with any value of Co static capacity at any frequency, and not just on a single resonance frequency imposed by a static capacitance nominal value Co.
[0247] [0247] Figure 24 is a simplified block diagram of an aspect of generator 1100, to provide tuning without an inductor, as described above, among other benefits. Figures 25A to 25C illustrate an architecture of the generator 1100 of Figure 24, according to one aspect. Referring to Figure 24, generator 1100 may comprise an isolated stage of patient 1520 in communication with a non-isolated stage 1540 via a power transformer 1560. A secondary winding 1580 of power transformer 1560 is contained in the isolated stage 1520 and can comprise a bypass configuration (for example, a central bypass or non-central bypass configuration) to define the trigger signal outputs 1600a, 1600b, 1600c so as to output output trigger 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 emit a trigger signal (for example, a trigger signal at 420 V RMS) for an ultrasonic surgical device 1104, and the trigger signal outputs 1600a, 1600b and 1600c can output a trigger signal (for example , a 100 V RMS trigger signal) for 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 1560. In some respects, the power amplifier 1620 may comprise a push-pull amplifier, for example. The non-isolated stage 1540 can also comprise a programmable logic device 1660 to supply a digital output to a 1680 digital-to-analog converter (DAC) which, in turn, provides an analog signal corresponding to a power amplifier input. 1620. In certain respects, the 1660 programmable logic device may comprise a field programmable port matrix (FPGA), for example. The programmable logic device 1660, by controlling the input of the power amplifier 1620 through the DAC 1680, can therefore control any of a number of parameters (for example, frequency, waveform shape, amplitude of the wave) of drive signals that appear at the drive signal outputs 1600a, 1600b and 1600c. In certain aspects and as discussed below, the 1660 programmable logic device, in conjunction with a processor (for example, the 1740 processor discussed below), can implement various control algorithms based on digital signal processing (DSP) and / or other control algorithms to control parameters of the drive signals emitted by the 1100 generator.
[0248] [0248] Power can be supplied to a power rail of the 1620 power amplifier by a key mode regulator
[0249] [0249] In certain aspects and as discussed in further detail in connection with Figures 26A and 26B, 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 shape, frequency and / or amplitude of the drive signals emitted by the 1100 generator. In one aspect, for example, the programmable logic device 1660 can implement a DDS 2680 control algorithm (Figure 26A ) by retrieving waveform samples stored in a query table (LUT) dynamically updated, such as a RAM LUT that can be integrated into an FPGA. This control algorithm is particularly useful for ultrasonic applications in which an ultrasonic transducer, such as the 1120 ultrasonic transducer, can be driven by a clean sinusoidal current at its resonant frequency. As other frequencies can excite parasitic resonances, minimizing or reducing the total distortion of the current of the movement branch can correspondingly minimize or reduce the undesirable effects of the resonance. As the waveform shape of a drive signal output by the 1100 generator is impacted by various sources of distortion present in the output drive circuit (for example, the 1560 power transformer, the 1620 power amplifier) , voltage and current feedback data based on the trigger signal can be inserted into an algorithm, such as an error control algorithm implemented by the 1740 processor, which compensates for the distortion through adequate pre-distortion or modification of the waveform samples stored in the LUT dynamically and continuously (for example, in real time). In one aspect, the amount or degree of pre-distortion applied to LUT samples can be based on the error between a current from the computerized motion branch and a desired current waveform shape, the error being determined on a sample-by-sample basis. In this way, pre-distorted LUT samples, when processed through the drive circuit, can result in a trigger signal from the motion branch that has the desired waveform shape (for example, sinusoidal) for ideally drive the ultrasonic transducer. In such aspects, the LUT waveform samples will therefore not represent the desired waveform format of the drive signal, but rather the waveform format that is necessary to ultimately produce the desired waveform shape of the motion branch trigger signal, when distortion effects are taken into account.
[0250] [0250] 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, 1840, to respectively sample the voltage and current of trigger signals emitted by the 1100 generator. In certain aspects, ADCs 1780 and 1800 can be configured for sampling at high speeds (for example, 80 Msps) to enable over-display 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 the 1780, 1800 ADCs can be performed by a single ADC receiving voltage and current input 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 motion branch (which can be used in certain aspects to implement the control of waveform format based on DDS described above), accurate digital filtering of the sampled signals, and calculation of actual energy consumption with a high degree of accuracy. The output of voltage and current feedback data through ADCs 1780 and 1800 can be received and processed (for example, FIFO buffering, multiplexing) by programmable logic device 1660 and stored in data memory for subsequent retrieval. example, by the 1740 processor. As noted above, voltage and current feedback data can be used as an input for an algorithm for pre-distortion or modification of waveform samples in the LUT, dynamically and continuously . In some respects, this may require that each stored voltage and current feedback data pair be indexed based on, or otherwise associated with, a corresponding LUT sample that was issued by the 1660 programmable logic device when the pair of feedback data on voltage and current was captured. The synchronization of the LUT samples with the voltage and current feedback data in this way contributes to the correct timing and stability of the pre-distortion algorithm.
[0251] [0251] In certain respects, voltage and current feedback data 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 the 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 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 programmable logic device 1660.
[0252] [0252] The impedance phase can be determined using Fourier analysis. In one aspect, the phase difference between the V, (t) and generator current / 7 (t) trigger signals can be determined using the fast Fourier transform (FFT) or the transformer discrete Fourier (DFT) as shown below: WA (t) = A cos (2rfot + q.) 14 (t) = Azcos (2nfot + q.) 140 = TES = fo) +56 + fo) expAizas 22) 1 = For - fa) + 6GF + fo)) expG2nf 2)
[0253] [0253] The evaluation of the Fourier transform at the frequency of the sinusoid produces: 1) = 26 (0explioai) - argv (fi) = 9, 146) = 26Oexplio :) - arg (fo) = o:
[0254] [0254] Other approaches include weighted estimation of minimum squares, Kalman filtering and space and vector based techniques. Virtually all processing in an FFT or DFT technique can be performed in the digital domain with the aid of two-channel high-speed ADC, 1780.1800, for example. In one technique, the digital signal samples of the voltage and current signals are transformed by the Fourier technique with an FFT or a DFT. The phase angle q at any point in time can be calculated by: q = 2n7nft + qo, where q is the phase angle, f is the frequency, t is the time, and q. is the phase not = 0.
[0255] [0255] Another technique for determining the phase difference between voltage V, (t) and current / 4 (t) signals is the zero-crossing method and produces highly accurate results. For voltage signals V, (t) and current / 74 (t) having the same frequency, each passing through zero from negative to positive of the voltage signal V, (t) triggers the start of a pulse, while each passing through zero from negative to positive of the current signal / 14 (t) triggers the end of the pulse. The result is a pulse train with a pulse width proportional to the phase angle between the voltage signal and the current signal. In one aspect, the pulse train can be passed through an average filter to produce a measurement of the phase difference. In addition, if the zero passages from positive to negative are also used in a similar way, and the results are averaged, any effects of DC and harmonic components can be reduced. In an implementation, the analog signals of voltage V, (t) and current / 4 (t) are converted into digital signals that are high if the analog signal is positive and low if the analog signal is negative. High accuracy phase estimates require sharp transitions between high and low. In one aspect, a Schmitt trigger together with an RC stabilization network can be used to convert analog signals to digital signals. In other respects, an edge-triggered RS flip-flop circuit and auxiliary circuits can be used. In yet another aspect, the zeroing technique can use an exclusive gate (XOR).
[0256] [0256] 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 "cross-sed-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: /Wwww.engne - tbase.com>, which is incorporated by reference.
[0257] [0257] 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 determined indirectly 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 adequately control the current amplitude of the trigger 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 amplifier 1620 power) using an 1860 DAC.
[0258] [0258] 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 (USB) interface, communication with a 1430 foot switch) , communication with a 2150 input device (for example, a touchscreen) 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 a peripheral serial interface bus (SPI)). Although the 1900 processor can primarily support UI functionality, it can also coordinate with the 1740 processor to implement risk mitigation in certain respects. For example, the 1900 processor can be programmed to monitor various aspects of the inputs by the user and / or other inputs (for example, 2150 touchscreen inputs, 1430 foot switch inputs, temperature sensor inputs 2160) and can disable the output of generator 1100 when an error condition is detected.
[0259] [0259] In certain respects, both the 1740 processor (Figure 24, 25A) and the 1900 processor (Figure 24, 25B) can determine and monitor the operational status of the 1100 generator. For the 1740 processor, the operational state of the 1100 generator can determine, for example, which control and / or diagnostic processes are implemented by the processor
[0260] [0260] The non-isolated stage 1540 may further comprise a 1960 controller (Figures 24, 25B) for monitoring the 2150 input devices (for example, a capacitive touch sensor used to turn generator 1100 on and off, a capacitive screen touch sensitive). In certain respects, the 1960 controller can comprise at least one processor and / or another controller device in communication with the 1900 processor. In one aspect, for example, the 1960 controller can comprise a processor (for example, an 8-bit Mega168 controller available from Atmel) configured to monitor user inputs via one or more capacitive touch sensors. In one respect, 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 touchscreen.
[0261] [0261] 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 24) discussed below). In this way, controller 1960 can continue to monitor an input device 2150 (for example, a touch-sensitive sensor located on a front panel of generator 1100) to turn generator 1100 on and off. When generator 1100 is in the off state, the 1960 controller can wake up the power supply (for example, enable the operation of one or more DC / DC voltage converters 2130 (Figure 24) of the power supply 2110), if the activation of the input device is detected " on / off "2150 by a user. Controller 1960 can therefore initiate a sequence to transition generator 1100 to an "on" state. On the other hand, controller 1960 can initiate a sequence to transition the generator 1100 to the off state if activation of the input device "on / off" 2150 is detected, when the generator 1100 is in the on state . In certain respects, for example, the 1960 controller can report the activation of the 2150 "on / off" input device to the 1900 processor, which in turn implements the process sequence necessary to transition from generator 1100 to off state. In these aspects, the 1960 controller may not have any independent capacity to cause the removal of power from generator 1100, after its on state has been established.
[0262] [0262] In certain respects, the 1960 controller can cause generator 1100 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.
[0263] [0263] In certain respects, the isolated stage 1520 may comprise an 1980 instrument interface circuit to, for example, provide a communication interface between a control circuit of a surgical device (for example, a control comprising grip keys) and non-insulated stage 1540 components, such as programmable logic device 1660, processor 1740 and / or processor 1900. The instrument interface circuit
[0264] [0264] In one aspect, the 1980 instrument interface circuit may comprise a programmable logic device 2000 (for example, an FPGA) in communication with a signal conditioning circuit 2020 (Figure 24 and Figure 25C). 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 bipolar current source powered by a differential amplifier. The interrogation signal can be transmitted 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 may 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, unequivocally, 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 that appears 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.
[0265] [0265] In one aspect, the 1980 instrument interface circuit may comprise a first 2040 data circuit interface to enable the exchange of information between the programmable logic device 2000 (or another element of the 1980 instrument interface circuit) and a first data circuit disposed in, or otherwise associated with, a surgical device. In certain aspects, for example, a first 2060 data circuit may be arranged on a cable 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 some respects, the first data circuit may comprise a non-volatile storage device, such as an electrically erasable programmable read-only memory device (EEPROM). In certain respects and again with reference to Figure 24, the first 2040 data circuit interface can be implemented separately from the programmable logic device 2000 and comprises a suitable circuitry (for example, discrete logic devices, a processor) to enable communication between the programmable logic device 2000 and the first data circuit. In other respects, the first data loop interface 2040 can be integral with the programmable logic device 2000.
[0266] [0266] In certain 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 instrument interface circuit 1980 (for example, by the programmable logic device 2000), transferred to a component of the non-isolated stage 1540 (for example, to the programmable logic device 1660, processor 1740 and / or processor 1900 ) for presentation to a user via an output device 2140 and / or to control a function or operation of the 1100 generator. In addition, any type of information can be transmitted to the first data circuit 2060 for storage on the same through the first interface of the 2040 data circuit (for example, using the programmable logic device 2000). This information can comprise, for example, an updated number of operations in which the surgical device was used and / or dates and / or times of its use.
[0267] [0267] As discussed earlier, a surgical instrument can be removable from a handle (for example, instrument 1106 can be removable from handle 1107) to promote interchangeability and / or disposability of the instrument. In such 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. However, the addition of readable data circuits to surgical device instruments to resolve this issue is problematic from a compatibility point of view. For example, it may be impractical to design a surgical device so that it remains compatible with previous versions of generators lacking the indispensable data reading functionality due, for example, to 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 platforms. generator.
[0268] [0268] 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 aspect, the second data circuit interface 2100 may comprise a three-wire digital interface, although other interfaces may also be used. In some respects, the second data circuit can generally be any circuit for transmitting and / or receiving data. In one aspect, for example, the second data circuit can store information related to the specific surgical instrument 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 instrument was used, and / or any other types of information. Additionally or alternatively, any type of information can be communicated to the second data circuit for storage in it via the second data circuit interface 2100 (for example, using the programmable logic device 2000). This information may include, for example, an updated number of operations in which the surgical instrument was used and / or the dates and / or times of its use. In certain respects, the second data circuit can transmit data captured by one or more sensors (for example, an instrument-based temperature sensor). In certain respects, the second data circuit can receive data from the 1100 generator and provide an indication to a user (for example, an LED indication or other visible indication) based on the received data.
[0269] [0269] In certain respects, the second data circuit and the second data circuit interface 2100 can be configured so that the communication between the programmable logic device 2000 and the second data circuit can be carried out without the need for provide additional conductors for this purpose (for example, dedicated cable conductors connecting 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 to transmit signals. question marks from the signal conditioning circuit 2020 to a control circuit on a handle. 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 do not have indispensable data reading functionality, which, therefore, allows the backward compatibility of the surgical device instrument.
[0270] [0270] In certain respects, the isolated stage 1520 may comprise at least one blocking capacitor 2960-1 (Figure 25C) connected to the output of the trigger signal 1600b, to prevent the passage of direct current to a patient. A single blocking capacitor may be required to meet 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 supplied in series with the 2960-1 blocking capacitor, with one point current leakage between the 2960-1 and 2960-2 blocking capacitors being moved. monitored, for example, by an ADC 2980 for sampling a voltage induced by 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 24), generator 1100 can determine when at least one of the blocking capacitors 2960-1 and 2960-2 has failed. Consequently, the appearance of Figure 24 can provide a benefit over single capacitor designs, having a single point of failure.
[0271] [0271] 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 supply a system voltage of 48 VDC. As discussed above, the power supply 2110 can additionally comprise one or more DC / DC voltage converters 2130 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 allow 2130 DC / DC voltage converters to function or wake up.
[0272] [0272] Figures 26A and 26B 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, 1800 can be implemented in the form of a 2-channel ADC and can take samples of the feedback signals at high speed (eg 80 Msps) to enable oversampling (eg approximately 200x oversampling) of the trigger signals. The warning signs
[0273] [0273] The multi-plexed current and voltage feedback samples can be received by a parallel data capture port (PDAP) implemented inside the processor block 2144
[0274] [0274] 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 the various sources of distortion present in the 1100 generator output drive circuit. The pre-distorted LUT samples, when processed through the drive circuit, will result, therefore, in a drive signal having the desired waveform shape (for example, sinusoidal) to optimally drive the ultrasonic transducer.
[0275] [0275] In block 2220 of the pre-distortion algorithm, the current is determined through the movement branch of the ultrasonic transducer. The branching current of motion can be determined using the Kirchoff current law based, for example, on the current and voltage feedback information stored in the 2180 memory location (which, when properly scaled, can be be representative of ly and Vg in the model in Figure 23 discussed above), a value of the static capacitance of the Co ultrasonic transducer (measured or known a priori) and a known value of the drive frequency. A sample of current from the motion branch can be determined for each set of stored current and voltage feedback samples associated with a LUT sample.
[0276] [0276] In block 2240 of the pre-distortion algorithm, each sample of branching current determined in block 2220 is compared to a sample of a desired current waveform format to determine a difference, or amplitude error, of the sample, between the compared samples. For this determination, the sample with the desired current waveform format can be provided, for example, from a LUT 2260 of waveform formats containing amplitude samples for a cycle of a waveform shape. current wave desired. The specific sample of the LUT 2260 current waveform format used for the comparison can be determined by the LUT sample address associated with the current sample of the motion branch used in the comparison. Consequently, the entry of the branching current in block 2240 can be synchronized with the entry of its associated LUT sample address in block 2240. LUT samples stored in the 1660 programmable logic device and LUT samples stored in stored in the LUT 2260 of waveform formats can therefore be the same in terms of number. In certain respects, the desired current waveform shape, represented by the LUT samples stored in the LUT 2260 of waveform shapes, can be a fundamental sine wave. Other shapes of the waveform 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 trigger signals at other frequencies, such as a third order harmonic to drive at least two mechanical resonances in order to obtain beneficial vibrations in transverse mode or in other modes.
[0277] [0277] 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 26A) together with an indication of its associated LUT address. Based on the amplitude error value and its associated address (and, optionally, the error values in the sample amplitude for the same LUT address previously received), the LUT 2280 (or other logic device control block) programmable 1660) can pre-distort or modify the value of the LUT sample stored at the LUT address, so that the error in the sample amplitude is reduced or minimized. It should be understood that this pre-distortion or modification of each LUT sample in an iterative way across the LUT address range will cause the waveform shape of the generator output current to match or conform to the desired current waveform format, represented by the LUT 2260 samples of waveform formats.
[0278] [0278] 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 memory location 2180. Prior to the determination of these quantities, the feedback samples can be properly scaled and, in certain aspects, processed through a suitable 2320 filter to remove the noise resulting, for example, from the data capture process and the har components. - induced mononics. The filtered voltage and current samples can therefore substantially represent the fundamental frequency of the generator drive output signal. In certain respects, filter 2320 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 signals of the output 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.
[0279] [0279] In block 2340 (Figure 26B), an average square root calculation (RMS) can be applied to a sample size of the current feedback samples representing an integral number of cycles of the drive signal, to generate a lrms measurement representing the output current of the drive signal.
[0280] [0280] In block 2360, an average square root (RMS) value calculation can be applied to a sample size of the voltage feedback samples representing an integral number of drive signal cycles to determine a Vrms measurement representing the output voltage of the drive signal.
[0281] [0281] In block 2380, the current and voltage feedback information can be multiplied point by point, and an average calculation is applied to the samples representing an integral number of trigger signal cycles, to determine a P measurement; the actual output power of the generator.
[0282] [0282] In block 2400, the measurement P of the apparent output power of the generator can be determined as the product Vrms'lrms-
[0283] [0283] In block 2420, the measurement Zm of the magnitude of the load impedance can be determined as the quotient Vrms / lrms.
[0284] [0284] In certain respects, the quantities lrms, Vrms, Pr, Pa and Zm determined in blocks 2340, 2360, 2380, 2400 and 2420, can be used by generator 1100 to implement any of several processing processes. control and / or diagnostics. In certain respects, 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 a suitable communication interface (for example, example, a USB interface). The various diagnostic processes may include, but are not limited to, grip integrity, instrument integrity, instrument attachment integrity, instrument overload, proximity to instrument overload, frequency locking failure, over voltage condition, condition over current, over power condition, voltage sensor failure, current sensor failure, audio indication failure, visual indication failure, short circuit condition, power supply failure, or failure on the blocking capacitor, for example.
[0285] [0285] 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) driven by the 1100 generator. As discussed above, by controlling the frequency of the trigger signal to minimize or reduce the difference between the determined impedance phase and an impedance phase setpoint (for example, 0º), the effects of harmonic distortion can be minimized or reduced , increasing the accuracy in the phase measurement.
[0286] [0286] The phase control algorithm receives the current and voltage feedback information stored in the memory location 2180 as input. Before being used in the phase control algorithm, the feedback feedback samples can be appropriately scheduled and, in certain aspects, processed through an appropriate 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.
[0287] [0287] In block 2480 of the phase control algorithm, the current is determined through the movement branch of the ultrasonic transducer. This determination can be identical to that described above in connection with block 2220 of the pre-distortion algorithm. In this way, the output of block 2480 can be, for each set of stored current and voltage feedback samples associated with a LUT sample, a current sample of the movement branch.
[0288] [0288] In block 2500 of the phase control algorithm, the impedance phase is determined based on the synchronized input of samples from the current of the motion branch determined in block 2480 and the corresponding 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.
[0289] [0289] In block 2520 of the phase control algorithm, the value of the impedance phase determined in block 2220 is compared to the setpoint of phase 2540 to determine a difference, or phase error, between the compared values.
[0290] [0290] In block 2560 (Figure 26A) 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 frequency output value 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 of 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 phase impedance determination.
[0291] [0291] Block 2580 of the 1740 processor can implement an
[0292] [0292] 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 setpoint 2620B (Vsp ) given the magnitude of the load impedance Zm measured in block 2420 (for example, la = Vsp / Zm). Likewise, in aspects where the power of the trigger signal is the control variable, the current demand range can be specified indirectly, for example, based on the current needed to maintain a setpoint of desired power 2620C (Psp) given the voltage Vms measured in blocks 2360 (for example, la = Psp Vrms).
[0293] [0293] Block 2680 (Figure 26A) can implement a DDS control algorithm to control the trigger signal by retrieving 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 point-jumping technique (memory location). The NCO algorithm can implement a phase accumulator, or frequency converter for phase, which acts as an address pointer for retrieving LUT samples from the LUT 2280. In one aspect, the phase accumulator can be an accumulator phase with step size 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, 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 LUT 2280, resulting in a waveform output that has a higher frequency. Consequently, the waveform frequency generated by the DDS control algorithm can therefore be controlled by varying the frequency control value accordingly. In certain respects, the frequency control value can be determined based on the output of the phase control algorithm implemented in block 2440. The output of block 2680 can provide the input of DAC 1680 which, in turn, provides a analog signal corresponding to a 1620 power amplifier input.
[0294] [0294] Block 2700 of processor 1740 can implement a converter control algorithm in key mode to dynamically modulate the rail voltage of the 1620 power amplifier 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 can be determined by monitoring the minimum of a drain voltage (for example, a MOSFET drain voltage) which is modulated according to the amplified signal envelope. A minimum voltage signal can be generated, for example, by a minimum voltage detector coupled to the drain voltage. The minimum voltage signal can be sampled by the ADC 1760, with voltage samples from the minimum output being received in block 2720 of the converter control algorithm in key mode. 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 regulator in mode switch 1700. 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 rail voltage can be modulated according to the waveform envelope, as characterized by the minimum voltage samples. When the voltage samples of the low signal indicate low levels of encoder power, for example, block 2740 can cause a low rail voltage to be supplied to the power amplifier 1620, with the total voltage of the rail being provided only when voltage samples from the minimum indicate maximum envelope power levels. When voltage samples from the minimum drop below the target to the minimum 2780, the 2740 block can keep the rail voltage at an adequate minimum to ensure the proper operation of the 1620 power amplifier.
[0295] [0295] Figure 27 is a schematic diagram of an aspect of a 2900 electrical circuit, suitable for driving an ultrasonic transducer, such as the 1120 ultrasonic transducer, according to 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, as an ultrasonic, battery and power control circuit. 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 room temperature. A 2988 pulse width modulation (PWM) monitoring timer automatically generates a system reset if the main program periodically fails to repair it. It is provided to automatically restart the 2900 electrical circuit when it freezes or freezes due to a software or hardware failure. It will be recognized that the 2900 electrical circuit can be configured as an RF trigger circuit to drive the ultrasonic transducer or to drive the RF electrodes like the 3600 electrical circuit shown in Figure 32, for example. Consequently, with reference now again to Figure 27, the 2900 electrical circuit can be used to interchangeably drive the ultrasonic transducers and the RF electrodes. If activated simultaneously, filter circuits can be provided in the first corresponding stage circuits 3404 (Figure 30) to select both the ultrasonic waveform and the RF waveform. These filtering techniques are described in US Patent Publication No. US-2017-0086910-A1, of common ownership, entitled TECHNIQUES FOR CIRCUIT TOPOLOGIES FOR COMBINED GENERATOR, which is hereby incorporated by reference in its entirety.
[0296] [0296] A 2986 drive circuit provides left and right ultrasonic energy 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 28). A 2990 digital to analog converter (DAC) converts the digital input into an analog output to trigger 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 drive 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 2998b transistor output stage to drive a second (right) ultrasonic energy output. A 2999 voltage sensor is coupled between the left / right ultrasonic output terminals to measure the output voltage. Drive circuit 2986, the first and second drive circuits 2996a, 2996b, and the first and second output stages of transistor 2998a, 2998b define a first stage amplifier circuit. In operation, the 3200 control circuit (Figure 28) generates a 4300 digital waveform (Figure 37) that employs circuits such as the 4100, 4200 direct digital synthesis (DDS) circuits (Figures 35 and 36). The 2990 DAC receives the 4300 digital waveform and converts it to an analog waveform, which is received and amplified by the first stage amplifier circuit.
[0297] [0297] Figure 28 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 housing. 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 master interface to several circuits downstream via the SCL-A outputs 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 IPC 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 a surgical instrument handle set.
[0298] [0298] In one aspect, the 3214 main processor is coupled to the 2900 electrical circuit (Figure 27) through SCL-A / SDA-A output terminals. The main processor 3214 comprises a memory for storing tables of trigger signals or digitized waveforms that are transmitted to the 2900 electrical circuit to drive the 1120 ultrasonic transducer, for example. In other respects, the main processor 3214 can generate a digital waveform and transmit it to the 2900 electrical circuit, or it can store the digital waveform for later transmission to the 2900 electrical circuit. The main 3214 processor can also provide RF drive via SCL-B / SDA-B output terminals and various sensors (eg Hall effect sensors, magneto-rheological fluid (MRF) sensors, etc.) via SCL output terminals -C / SDA-C. In one aspect, the 3214 main processor is configured to detect the presence of an ultrasonic trigger circuit and / or RF drive circuit to enable the appropriate software and user interface functionality.
[0299] [0299] 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 prefetch buffer to optimize performance above 40 MHz, a 32 KB single cycle serial random access memory (SRAM), internal read-only memory (ROM) loaded with StellarisWareO software, programmable and electrically erasable read-only memory ( 2 KB EEPROM, one or more pulse width modulation (PWM) modules, one or more quadrature encoder (QED) input analogs, one or more 12-bit 12-bit analog-to-digital converters (ADC) analog input, 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.
[0300] [0300] Figure 29 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 field-effect transistor power switch. semiconductor metal oxide (MOSFET), a 3308 drive circuit (PLL), a 3310 transformer, a 3312 signal smoothing circuit (also called a correspondence circuit and can be, for example, a tan circuit ), a 3314 detection circuit, 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.
[0301] [0301] 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 this 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 inches high and a few millimeters deep. By combining the features of the present disclosure to provide a self-contained, one-piece ultrasonic device, a reduction in production cost can be achieved.
[0302] [0302] The output of the 3304 power supply is fed to the 3302 processor and energizes it. The 3302 processor receives and emits 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 may also include a memory 3326, preferably, a random access memory (RAM) that stores computer-readable instructions and data.
[0303] [0303] The power supply output 3304 is also directed to switch 3306 having a duty cycle controlled by the processor
[0304] [0304] The drive circuit 3308, which receives the signal from switch 3306, includes an oscillatory circuit that transforms the output of switch 3306 into an electrical signal having 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 resonant sine wave along the ultrasonic transmission waveguide.
[0305] [0305] 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 cutting and cauterization devices. This occurs, 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 the passage of a higher current. 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) operated, for example, at 10 V. In this case, a 10 VDC power supply A separate can be used to power the MOSFET port, which ensures that the MOSFET is fully connected 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 RMS. Transformers are known in the art and are therefore not explained in detail here.
[0306] [0306] 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, MOSFET 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 circuit loads and heat. 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 maximum temperature or very close to it while using the device. The additional temperature will cause the core material, for example, ferrite, to rupture and permanent damage can occur. The present disclosure can respond to a maximum temperature of transformer 3310, for example, by reducing the drive energy in transformer 3310, signaling the user, turning off the power, pulsating the power or by means of other appropriate responses.
[0307] [0307] In one aspect of the present disclosure, the 3302 processor is communicatively coupled to the end actuator (for example, 1122, 1125) which is used to bring the material into physical contact with the ultrasonic blade (for example, 1128, 1149). The sensors are supplied and 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 movement voltage Vm. 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 intended to re- receive and interpret a signal that indicates a current blade temperature from the 3336 temperature sensor and to determine a target frequency of blade movement based on the received temperature. In another aspect, force sensors, such as effort meters or pressure sensors, can be coupled to the trigger (for example, 1143, 1147) to measure the force applied to the trigger by the user. In another aspect, force sensors, such as strain gauges or pressure sensors, can be coupled to a switch button so that the displacement intensity corresponds to the force applied by the user to the switch button.
[0308] [0308] 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 able to determine a frequency of movement of the waveguide and communicate that frequency to the processor
[0309] [0309] In another aspect, the present disclosure provides a modular, battery-powered handheld surgical instrument with multistage generating circuits. A surgical instrument is revealed that includes a battery set, a handle set and a drive shaft set, and the battery set and the drive shaft set are configured to mechanically and electrically connect to the set of grip. 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.
[0310] [0310] In one 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, being that the processor is configured to generate a digital waveform; a handle assembly comprising a first stage circuit coupled to the processor, the first stage circuit comprising a digital to analog converter (DAC) and a first stage amplifier circuit, the DAC being configured for receiving the digital waveform and converting 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 pack and the drive shaft set being configured to connect mechanically and electrically to the grip set.
[0311] [0311] 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 drive stage circuit can be configured to couple with a second high frequency drive stage circuit. The second high frequency drive stage circuit can be configured to couple with an electrode.
[0312] [0312] The first stage circuit can comprise a first sensor drive stage circuit. The first sensor drive stage circuit can be configured to a second sensor drive stage circuit. The second sensor drive stage circuit can be configured to couple with a sensor.
[0313] [0313] In another aspect, the present disclosure provides a surgical instrument, comprising: a battery pack, comprising a control circuit comprising a battery, a memory coupled to the battery, and a processor coupled to memory and battery, the processor being 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, with the DAC being configured to receive the digital waveform and convert the digital waveform into an analog waveform, the first common 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 common stage amplifier circuit to receive the analog waveform, amplify the analog waveform, and apply the analog waveform to a load; the battery pack and the drive shaft set being configured to connect mechanically and electrically to the grip set.
[0314] [0314] The cargo can comprise any one of a transporter
[0315] [0315] In another aspect, the present disclosure provides a surgical instrument, which comprises: a control circuit that comprises a memory coupled to a processor, the processor being configured to generate a waveform digital; a handle assembly 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 shape analog wave; 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.
[0316] [0316] The first common stage circuit can be configured to drive ultrasonic, high frequency current, 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 be coupled to an ultrasonic transducer, the second high frequency drive stage circuit is configured to be coupled to an electrode, and the second stage circuit sensor drive is configured to attach to a sensor.
[0317] [0317] Figure 30 illustrates a generator circuit 3400 divided into a first stage circuit 3404 and a second stage circuit 3406, according to 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, the surgical instruments of 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 that allows the operation of RF energy only. nas, ultrasonic energy only, and / or a combination of RF energy and ultrasonic energy. A combined 3414 modular drive shaft assembly can be powered by the first 3404 common stage circuit located in a 3412 handle assembly and the second 3406 modular stage circuit integral with the 3414 modular drive shaft assembly. previously discussed in this description in connection with surgical instruments of surgical system 1000, a battery set 3410 and the drive shaft set 3414 are configured to mechanically and electrically connect to the handle set 3412. The end actuator set is configured - mechanically and electrically connected to the 3414 drive shaft assembly.
[0318] [0318] Now going back to Figure 30, the 3400 generator circuit is divided into multiple stages located in multiple modular sets of a surgical instrument, like the surgical instruments of the surgical system 1000 described here. In one aspect, a 3402 control stage 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 in connection with Figure
[0319] [0319] 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 provides the ultrasonic drive signal for the first 3420 ultrasonic drive stage circuit through the SCL-A, SDA-A outputs of the 3200 control circuit. The first 3420 ultrasonic drive stage circuit is described in detail in connection with Figure 27. The 3200 control circuit provides the RF trigger signal for the first RF drive stage circuit 3422 through the SCL-B, SDA-B outputs of the circuit control module 3200. The first RF drive stage circuit 3422 is described in detail in connection with Figure 32. The 3200 control circuit supplies the sensor trigger signal to the first 3424 sensor drive stage circuit via of the SCL-C, SDA-C outputs of the 3200 control circuit. 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 3406 stage circuits. The outputs of the first stage circuits 3404 are provided for the inputs of the second stage circuits
[0320] [0320] 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 3420 ultrasonic drive stage circuit, the first circuit RF trigger stage 3422, or the first sensor trigger stage circuit 3424 located in the handle assembly 3412 is connected to the battery assembly 3410. Likewise, each of the first 3404 stage circuits can detect which second stage circuits 3406 are connected to it and what information is provided back to control circuit 3200 to determine the type of signal waveform to be generated. Similarly, each of the second stage circuits 3406 can detect which third stage circuits
[0321] [0321] In one aspect, the second stage circuits 3406 (for example, the second stage of the ultrasonic drive stage 3430, the second stage of the RF drive stage 3432, and the second stage of the sensor drive stage 3434) they are located on the drive shaft set 3414 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 can include, for example, a transformer, filter, amplifier and / or signal conditioning circuits. The first high-frequency current (RF) stage circuit 3422 provides a signal to the second 3432 RF drive stage circuit via the left-RF / right-RF outputs. In addition to a transformer and blocking capacitors, the second RF trigger stage circuit 3432 can also include filter, amplifier, and signal conditioning circuits. The first sensor drive stage circuit 3424 provides a signal to the second sensor drive stage circuit 3434 via sensor-1 / sensor-2 outputs. The second 3434 sensor drive stage circuit can include filter, amplifier, and signal conditioning circuits depending on the type of sensor. The outputs of the second stage circuits 3406 are provided for the inputs of the third stage circuits
[0322] [0322] 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 assemblies
[0323] [0323] Figure 31 illustrates a generator circuit 3500 divided into multiple stages in which a first stage circuit 3504 is common to the second stage circuit 3506, according to at least one aspect of the present disclosure. In one aspect, the surgical instruments of the surgical system 1000 described herein can comprise a 3500 generator circuit divided into multiple stages. For example, the surgical instruments of the surgical system 1000 can comprise the generating circuit 3500 divided into at least two circuits: the first stage circuit 3504 and the second stage circuit 3506 of amplification allowing the operation of energy of high frequency (RF) only, ultrasonic energy only, and / or a combination of RF energy and ultrasonic energy. A combination 3514 modular drive shaft assembly will be powered by a first common stage circuit 3504 located in the 3512 handle assembly and a second modular stage 3506 circuit integral with the 3514 modular drive shaft assembly As previously discussed in this description in connection with the surgical instruments of the surgical system 1000, a battery set 3510 and the drive shaft set 3514 are configured to mechanically and electrically connect to the handle set 3512. The set end actuator is configured to mechanically and electrically connect to the 3514 drive shaft assembly.
[0324] [0324] As shown in the example in Figure 31, the 3510 battery pack portion of the surgical instrument comprises a first 3502 control circuit, which includes the 3200 control circuit previously described. 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 3514 drive shaft assembly. Information is provided to the control circuit
[0325] [0325] Figure 32 is a schematic diagram of an aspect of an electrical circuit 3600 configured to drive a high frequency current (RF), in accordance with 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 current sensor 3682 is coupled in series to the return or ground leg of the power supply circuit to measure the current supplied by the power supply. 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 in connection with Figure 27, for example. Consequently, with reference now
[0326] [0326] A 3686 drive circuit provides left and right RF energy 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 28). 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 an oscillator
[0327] [0327] Referring now to Figure 33, a 3900 control circuit is shown for operating an RF generator circuit powered by the 3901 battery for use with a 3902 surgical instrument, in accordance with at least one aspect of the present disclosure. The surgical instrument is configured to use both ultrasonic vibration and high frequency current to perform surgical coagulation / cutting treatments in living tissue, and uses high frequency current to perform a surgical coagulation treatment in living tissue.
[0328] [0328] Figure 33 illustrates the 3900 control circuit that allows a dual generator system to switch between the energy modes of the RF generator circuit 3902 and the ultrasonic generator circuit 3920 for a surgical instrument of the surgical system 1000. In one aspect, a current limit on an RF signal is detected. When the impedance of the tissue is low, the high frequency current through the tissue is high when the RF energy is used as the treatment source for 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 33. Therefore, when the power button is released and a power switch 3926 is opened, the control circuit 3900 is reset and both the RF circuits and the ultrasonic generator 3902, 3920 are kept off.
[0329] [0329] 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 can be located in the 1109 handle set, the 1120 ultrasonic transducer / generator set, the battery set,
[0330] [0330] 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 one mode, and a second generator circuit on-board 3920 ultrasound scanner, which may be included in the 1109 handle set, the battery set, the 1129 drive shaft assembly, the nozzle and / or the ultrasonic transducer / RF generator set 1120 of the multi-functional electrosurgical instrument 1108, for example. The 3920 ultrasonic generator circuit is also battery operated 3901. In several respects, the RF 3902 generator circuit and the 3920 ultrasonic generator circuit can be a component of the 1109 integrated or separable handle assembly. According to several aspects, the integration of the dual RF / ultrasonic generating circuits 3902, 3920 with the handle assembly 1109 can eliminate the need for complicated wiring. The RF / ultrasonic generator circuits 3902, 3920 can be configured to provide the full capabilities of an existing generator, while using the capabilities of a wireless generator system simultaneously.
[0331] [0331] 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 claw closure, forces, etc.) and algorithms to manage tissue treatment. Various combinations of this integration can be implemented to provide the right level of functioning and performance.
[0332] [0332] 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 generator circuit 3902 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 RF energy (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 via a contact. 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 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 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.
[0333] [0333] A 3905 visual indicator circuit comprises the elevation transformer 3904, a resistor in series R2 and the visual indicator 3912. The visual indicator 3912 can be adapted for use with the surgical instrument 1108 and other electrosurgical systems and tools, such as those described here. The first winding 3910a of the elevating transformer 3904 is connected in series to the return electrode 3906b and the second winding 3910b of the elevating transformer 3904 is connected in series to the resistor R2 and the visual indicator 3912 comprising a neon lamp of type NE -2, for example.
[0334] [0334] In operation, when key contact 3909 of relay 3908 is opened, the active electrode 3906a is disconnected from the positive pole of the 3902 bipolar RF generator circuit and no current flows through the fabric, the return electrode 3906b and the first winding 3910a of lift transformer 3904. Consequently, visual indicator 3912 is not energized and does not emit light. When switch contact 3909 of relay 3908 is closed, active electrode 3906a is connected to the positive pole of the 3902 bipolar RF generator circuit, allowing current to flow through the fabric, return electrode 3906b and the first winding 3910a of elevation transformer 3904 to work on the fabric, for example, cutting and cauterizing the fabric.
[0335] [0335] A first current flows through the first winding 3910a as a function of the impedance of the fabric located between the active and return electrodes 3906a, 3906b providing a first voltage through the first winding 3910a of the elevating transformer 3904. A second high voltage is induced through the second winding 3910b of the elevation transformer 3904. The secondary voltage appears through resistor R2 and energizes the visual indicator 3912, causing the neon lamp to light up when the current through the fabric is greater than one predetermined limit. It will be recognized that the circuit and component values are illustrative and not limited to them. When the 3909 switch contact of relay 3908 is closed, the current flows through the fabric and the visual indicator 3912 is switched on.
[0336] [0336] 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 3928 inverter and a low logic is applied to one of the two inputs of the AND 3932 gate. Thus, the output of the AND 3932 gate is low and a 3934 transistor is switched off to prevent current from flowing through the 3936 electromagnet winding. With the 3936 electromagnet in the de-energized state, the switch contact 3909 of relay 3908 remains open and prevents current from flowing through electrodes 3906a, 3906b. The low logic output of the first 3928 inverter is also applied to a second 3930 inverter, causing the output to increase and resetting a 3918 flip-flop (for example, a D-type flip-flop). At that moment, output Q goes down to turn off the 3920 ultrasound generator circuit and output Q increases and is applied to the other input of the AND 3932 gate.
[0337] [0337] When the user presses the power switch 3926 on the handle of the instrument to apply energy to the tissue between electrodes 3906a, 3906b, the power switch 3926 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 increase and turn on the 3934 transistor. In the | 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 lift transformer 3904 when the fabric it is located between electrodes 3906a, 3906b.
[0338] [0338] As discussed above, the magnitude of the current flowing through electrodes 3906a, 3906b depends on the impedance of the 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 phototransistor 3914, which reduces the input of a 3916 inverter and causes the output of the drive 3916 increase. A high input applied to the CL18 of the 3918 flip-flop has no effect on the Q or Q outputs of the 3918 flip-flop and the Q output remains low and the Q output remains high. 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.
[0339] [0339] As the tissue between electrodes 3906a, 3906b dries up due to the heat generated by the current flowing through the tissue, the tissue's impedance increases and the current through it decreases. When the current through the first winding 3910a decreases, a voltage across the second winding 3910b also decreases and when a voltage falls below the minimum threshold required to operate visual indicator 3912, visual indicator 3912 and phototransistor 3914 turn off. When the 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 register a high logic to output Q and a low logic to output Q. The logic high at output Q turns on the ultrasonic generating circuit 3920 to activate the ultrasonic transducer 3922 and the ultrasonic blade 3924 to start cutting the tissue located between the electrodes 3906a, 3906a. Simultaneously or almost simultaneously with the connection of the 3920 ultrasound generator circuit, the Q output of the 3918 flip-flop goes down and causes the output of the AND gate 3932 to lower and turn off the transistor 3934, thus de-energizing the 3936 electromagnet and opening key contact 3909 of relay 3908 to cut the current flow through electrodes 3906a, 3906b.
[0340] [0340] As long as key contact 3909 of relay 3908 is open, no current flows through electrodes 3906a, 3906b, fabric and first winding 3910a of the lift transformer
[0341] [0341] The status of the Q and Q outputs of the 3918 flip-flop remains the same as long as the user presses the 3926 power switch on the instrument handle to keep the 3926 power switch closed. In this way, the 3924 ultrasonic blade remains activated and continues to cut the tissue between the jaws of the end actuator, while no current flows through the 3906a, 3906b electrodes from the 3902 bipolar RF generator circuit. When the user releases the power 3926 on the instrument handle, the power switch 3926 opens and the output of the first inverter 3928 goes down and the output of the second inverter 3930 increases to reset the flip-flop
[0342] [0342] Figure 34 illustrates a diagram of a surgical system 4000, which represents an aspect of surgical system 1000, which comprises a feedback system for use with any of the surgical instruments in surgical system 1000, which can include or implement many of the features described in the present invention. The surgical system 4000 can include a generator 4002 coupled to a surgical instrument that includes a 4006 end actuator, which can be activated when a physician operates a 4010 trigger. In many respects, the 4006 end actuator can include a 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 current energy source to perform surgical coagulation or cauterization treatments on living tissue and a mechanical knife with a sharp edge or an ultrasonic blade for 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 position sensor 4013 can be a sensor positioned with the outer tubular sheath or a reciprocating tubular actuating 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.
[0343] [0343] 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 level of the generator or the amplitude of the ultrasonic blade of the actuator. end 4006 based on 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 of Hall effect sensor and magnet). For example, the more force is applied to the 4010 trigger, the more power 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 with a multi-wrench positions.
[0344] [0344] According to various aspects, the 4006 end actuator may include a gripper or gripping mechanism. When trigger 4010 is initially triggered, the clamping mechanism can close, trap the fabric between a clamping arm and the end actuator
[0345] [0345] 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 output - take a signal indicating the energy of the end actuator. According to several aspects, the 4014 loudspeaker can emit a series of pulse sounds, in which the frequency of the sounds indicates the energy. In addition to, or in place of, the 4014 loudspeaker, the surgical instrument may include a 4016 visual screen. The 4016 visual screen can indicate the end actuator according to any suitable method. For example, the 4016 visual display may include a series of LEDs, in which the energy of the end actuator is indicated by the number of LEDs illuminated. The loudspeaker 4014 and / or the visual display 4016 can be activated by the control circuit 4008. According to several aspects, the surgical instrument can include a ratchet device connected to the 4010 trigger. The ratchet device can generate a audible signal as more force is applied to the 4010 trigger, providing an indirect indication of the energy of the end actuator. The surgical instrument may 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 limit. 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 4014 speaker or the 4016 screen) 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.
[0346] [0346] In one aspect, the ultrasonic current or high frequency current generators of the surgical system 1000 can be configured to digitally generate the electrical signal waveform of the desired shape, using a predetermined number of phase points stored in a table of query to scan the waveform. The phase points can be stored in a table defined in a memory, a field programmable port matrix (FPGA) or any suitable non-volatile memory. Figure 35 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 query table 4104, which in turn provides variable digital input values for a 4108 DAC circuit that powers an energy amplifier. The addresses can be scanned 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 to the tissue or to a transducer, to an RF electrode, to multiple transducers simultaneously, or to a combination of ultrasonic and RF instruments . In addition, multiple 4104 look-up tables representing multiple waveforms can be created, stored and applied to tissue from a generator.
[0347] [0347] The waveform signal 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 an RF electrode, or multiple of them ( for example, two or more ultrasonic transducers and / or two or more RF electrodes). In addition, when a surgical instrument comprises ultrasonic components, the waveform signal 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 can be configured to provide a waveform signal to at least one surgical instrument, where the waveform signal corresponds to at least one waveform of a plurality of waveforms in a 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 synthesis 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 direct digital 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.
[0348] [0348] 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 an RF electrode, or multiples thereof (for example, two or more ultrasonic transducers and / or two or more RF electrodes). In addition, when a surgical instrument comprises ultrasonic components, the waveform of the analog electrical signal 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 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. In addition, the analog electrical signal waveform provided to at least two surgical instruments can comprise two or more waveforms. Lookup table 4104 can comprise information associated with a plurality of waveforms and lookup table 4104 can be stored inside the generating circuit or surgical instrument. In one aspect or example, query table 4104 can be a direct digital summary table, which can be stored in an FPGA of the generator circuit or surgical instrument. Consultation table 4104 can be addressed in any way that is convenient for categorizing waveforms. According to one aspect, query table 4104, which can be a direct digital synthesis table, is addressed according to a frequency of the desired analog electrical signal waveform. In addition, the information associated with the plurality of waveforms can be stored as digital information in query table 4104.
[0349] [0349] 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 35. 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 DDS 4100 circuit comprises an address counter 4102, a look-up table 4104, a register 4106, a DAC circuit 4108 and a filter 4112. A stable clock f. is received by address counter 4102 and register 4106 triggers a programmable read-only memory (PROM) that stores one or more integer cycles of a sine wave (or other arbitrary waveform) in a 4104 lookup table. As the address counter 4102 travels through the memory locations, the values stored in the query table 4104 are recorded in register 4106, which is coupled to the DAC circuit 4108. The corresponding digital amplitude of the signal at the table memory location query 4104 drives DAC circuit 4108, which in turn generates an analog output signal 4110. The spectral purity of the 4110 analog output signal is mainly determined by DAC circuit 4108. Phase noise is basically that of the reference clock f .. The first analog output signal 4110 of the DAC circuit 4108 is filtered by the filter 4112 and a second analog output signal 4114 produced by the filter 4112 is supplied to an amplifier having u an output coupled to the output of the generator circuit. The second analog output signal has a fout frequency.
[0350] [0350] 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 fold in the Nyquist bandwidth, making them non-filterable, whereas the higher order harmonics of the synthesizer output based on phase-locked loop (PLL), can be filtered. Lookup table 4104 contains signal data for an integral number of cycles. The final output frequency fout can be changed by changing the frequency of the reference clock f. or reprogramming the PROM.
[0351] [0351] The DDS 4100 circuit may comprise multiple lookup tables 4104, where lookup table 4104 stores a waveform represented by a predetermined number of samples, the samples defining a predetermined shape of the waveform. In this way, multiple waveforms, having a unique shape, can be stored in multiple 4104 lookup tables to provide different tissue treatments based on instrument configurations or tissue feedback. Examples of waveforms include RF electrical signal waveforms with high crest factor for coagulation of surface tissue, RF electrical signal waveform with low crest factor for deeper tissue penetration and signal waveforms that promote efficient retouching coagulation. In one respect, the DDS 4100 circuit can create multiple 4104 waveform lookup tables and during a tissue treatment procedure (for example, simultaneously or in virtual real time based on user or sensor inputs) to switch between different waveforms stored in separate 4104 look-up tables based on the effect of the desired tissue and / or tissue feedback.
[0352] [0352] Consequently, switching 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 distributed in the tissue per cycle (ie, trapezoidal or square wave). In other respects, the 4104 look-up tables can store synchronized waveforms in such a way that they maximize the power supply by the surgical system's multifunctional surgical instrument while providing RF and ultrasonic trigger signals. In still other aspects, the 4104 look-up tables can store electrical signal waveforms to trigger ultrasonic and RF therapeutic and / or subtherapeutic energy simultaneously, while maintaining ultrasonic frequency blocking. Custom waveforms specific to different instruments and their effects on tissue can be stored in the non-volatile memory of the generator or in the non-volatile memory (for example, EEPROM) of the surgical system 1000 and fetched when connecting the multifunctional surgical instrument to the generator circuit. An example of an exponentially damped sinusoid, as used in many high crest factor "coagulation" waveforms, is shown in Figure 37.
[0353] [0353] 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 36. In this simplified block diagram, a DDS 4200 circuit is coupled to a processor, controller or device generator logic 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 phase register 4204, an adding circuit 4216, a 4208 phase recorder, a 4210 look-up table (phase-amplitude converter), a DAC circuit 4212 and a filter 4214. The summing circuit 4216 and the phase recorder 4208 form part of a phase accumulator 4206. A clock frequency fc. it is applied to the phase register 4208 and a DAC circuit 4212. The load register 4202 receives a tuning word that specifies the output frequency as a fraction of the reference frequency signal signal fe. The output of the load register 4202 is supplied to the parallel delta phase register 4204 with a tuning word M.
[0354] [0354] The DDS 4200 circuit includes a sample clock that generates the clock frequency fc, 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 the adding circuit 4216. Assuming that the number in the parallel delta phase register 4204 is 00. ..01 and that the initial content of the phase accumulator 4206 is 00 ... 00. The 4206 phase accumulator is updated by 00 ... 01 per clock cycle. If the 4206 phase accumulator is 32 bits wide, 232 clock cycles (more than 4 billion) are required before the 4206 phase accumulator returns to 00 ... 00, and the cycle is repeated.
[0355] [0355] A truncated output 4218 of the phase accumulator 4206 is supplied to a lookup table of the phase converter for amplitude 4210 and the output of the lookup table 4210 is coupled to a DAC circuit
[0356] [0356] 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 Ar (8rn), where a normalized amplitude Ar at a point n is represented by an an - phase angle 9r is called the phase point at point n. The number of discrete phase points does not determine the tuning resolution of the DDS 4200 circuit (as well as the DDS 4100 circuit shown in Figure 35).
[0357] [0357] Table 1 specifies the digital signal waveform digitized at a number of phase points. [ING fam AAA NC RS
[0358] [0358] The generator circuit algorithms and the digital control circuits can scan the addresses in the query table 4210, which, in turn, provides variable digital input values for the DAC circuit 4212 that supplies the filter 4214 and the amplifier. power. The addresses can be scanned according to a frequency of interest. The use of the look-up table makes it possible to generate 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 tissue in the form of RF energy or fed to an ultrasonic transducer and applied to the tissue in the form of ultrasonic vibrations that supply energy to the tissue in the form of heat. The amplifier output can be applied to an RF electrode, multiple RF 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.
[0359] [0359] Referring again to Figure 35, for n = 32 and M = 1, the phase accumulator 4206 passes through each of the possible outputs 232 before it overflows and resets. The corresponding output wave frequency is equal to the input clock frequency divided by 232. If M = 2, then phase register 1708 "rotates" twice as fast, and the output frequency is doubled. This can be generalized as follows.
[0360] [0360] For a phase accumulator 4206 configured to accumulate n-bits (n, in general, is in the range of 24 to 32 in most DDS systems, but as previously discussed, n cannot be selected from among wide range of options), there are 2 "possible points
[0361] [0361] The above equation is known as the "tuning equation" DDS. It is observed that the frequency resolution of the system is equal to - For n = 32, the resolution is greater than one part in four billion. In one aspect of the DDS 4200 circuit, not all of the bits outside the phase accumulator 4206 pass into query table 4210 but are truncated, leaving only the first 13 to 15 most significant bits (MSBs), for example. This reduces the size of the 4210 lookup table and does not affect the frequency resolution. Phase truncation only adds a small but acceptable amount of phase noise to the final output.
[0362] [0362] The electrical signal waveform can be characterized by a current, voltage or power at a predetermined frequency. Additionally, when any of the surgical instruments in the 1000 surgical system comprises ultrasonic components, the electrical signal waveform can be configured to trigger at least two modes of vibration of an ultrasonic transducer than at least one surgical instrument. Consequently, the generator circuit can be configured to provide an electrical signal waveform to at least one surgical instrument, the electrical signal waveform being characterized by a predetermined waveform stored in query table 4210 (or table consultation 4104 - Figure 35). 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 called a direct digital summary table. Direct digital synthesis (DDS) operates first by 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 the memory. After the waveform is stored in memory, it can be generated at very precise frequencies. The direct digital synthesis table can be stored in a non-volatile memory of the generator circuit and / or can be implemented with an FPGA circuit in the generator circuit. Lookup table 4210 can be addressed by any suitable technique that is convenient for categorizing waveforms. According to one aspect, the lookup table 4210 is addressed according to a frequency of the electrical signal waveform. In addition, information associated with the plurality of waveforms can be stored as digital information in a memory or as part of query table 4210.
[0363] [0363] In one aspect, the generator circuit can be configured to supply waveforms of electrical signal 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 electrical signal waveform comprises a first electrical signal to drive an ultrasonic transducer (for example, ultrasonic trigger signal), a second RF trigger signal and / or a combination thereof . 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 .
[0364] [0364] Additionally, a method for operating the generator circuit in accordance with the present disclosure comprises generating an electrical signal waveform and supplying the generated electrical signal waveform to any of the surgical instruments of the surgical system 1000, being that generating the electrical signal waveform comprises receiving information associated with the electrical signal waveform from a memory. The generated electrical signal waveform comprises at least one waveform. In addition, supplying the generated electrical signal waveform to at least one surgical instrument comprises providing the electrical signal waveform to at least two surgical instruments simultaneously.
[0365] [0365] The generator circuit, as described here, can enable the generation of several types of direct digital 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), RF signals with a low factor crest (which can be used for deeper tissue penetration) and waveforms that promote efficient retouching coagulation. The generator circuit can also generate multiple waveforms using a direct digital synthesis query table 4210 and, in real time, can switch between specific waveforms based on the desired tissue effect. Alternation can be based on tissue impedance and / or other factors.
[0366] [0366] In addition to traditional sine / cosine waveforms, the generator 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 waveform (s) that are synchronized to maximize the power delivered to the load while simultaneously triggering RF and ultrasonic signals and to maintain ultrasonic frequency blocking, as long as the generating circuit includes a circuit topology that allows the simultaneous activation of RF and ultrasonic signals. In addition, custom instrument-specific waveforms and their effects on tissue can be stored in a non-volatile memory (NVM) or in an instrument EEPROM and can be sought when connecting any of the surgical instruments in the 1000 surgical system to the generator circuit.
[0367] [0367] The DDS 4200 circuit can comprise multiple lookup tables 4104, with lookup table 4210 storing a waveform represented by a predetermined number of phase points (also called samples), the phase points defining a predetermined shape of the waveform. In this way, multiple waveforms, having a unique shape, can be stored in multiple 4210 look-up tables to provide different tissue treatments based on instrument configurations or tissue feedback. Examples of waveforms include RF electrical signal waveforms with high crest factor for coagulation of surface tissue, RF electrical signal waveform with low crest factor for deeper tissue penetration and waveforms electrical signals that promote efficient retouching 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 inputs) toggle between different waveforms stored in different query tables 4210 based on the effect on the desired tissue and / or on tissue feedback.
[0368] [0368] Consequently, switching between waveforms can be based on tissue impedance and other factors, for example. In other respects, the 4210 look-up tables can store electrical signal waveforms formatted to maximize the power distributed in the tissue per cycle (ie, trapezoidal or square wave). In other respects, the 4210 look-up tables can store synchronized waveforms so that they maximize the power supply for any of the surgical instruments in the surgical system 1000 by emitting RF and ultrasonic trigger signals. In yet other respects, the 4210 lookup tables can store electrical signal waveforms to simultaneously trigger therapeutic and / or subtherapeutic ultrasonic and RF energy, while maintaining ultrasonic frequency blocking. In general, the output waveform can be in the form of a sine wave, cosine wave, pulse wave, square wave and the like. However, custom and more complex waveforms specific to different instruments and their effects on tissue 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 can be found by connecting the surgical instrument to the generator circuit. An example of a custom waveform is an exponentially damped sine wave as used in many high crest "coagulation" waveforms, as shown in Figure 37.
[0369] [0369] Figure 37 illustrates a cycle of a 4300 discrete time digital electrical signal waveform, according to at least one aspect of the present disclosure, of an analog waveform 4304 (shown superimposed over the 4300 discrete time digital electrical signal wave for comparison purposes). The horizontal geometric axis represents Time (t) and the vertical geometric axis represents digital phase points. The 4300 digital electrical signal waveform is a discrete digital time version of the desired analog waveform 4304, for example. The 4300 digital electrical signal waveform is generated by storing an amplitude phase point 4302 that represents the amplitude per Tek clock cycle over a cycle or period To. The 4300 digital electrical signal waveform is generated over a T period by any suitable digital processing circuit. Amplitude phase points are digital words stored in a memory circuit. In the example illustrated in Figures 35 and 36, the digital word is a six-bit word that is capable of storing the amplitude phase points with a resolution of 26 or 64 bits. It will be understood that the examples shown in Figures 35 and 36 are for illustrative purposes and that in current implementations, the resolution can be much higher. The digital amplitude phase points 4302 during a Tv cycle are stored in memory as a sequence of words in sequence in a query table 4104, 4210, as described in connection with Figures 35 and 36, for example. In order to generate the analog version of the analog waveform 4304, the amplitude phase points 4302 are read sequentially from the 0 to To memory per Tax clock cycle and are converted by a DAC circuit 4108, 4212, also described in connection with Figures 35 and 36. Additional cycles can be generated by repeatedly reading amplitude phase points 4302 of the digital electrical signal waveform 4300 from O to To for as many cycles or periods as desired. The smooth analog version of analog waveform 4304 is achieved by filtering the output of the DAC 4108, 4212 circuit through a 4112, 4214 filter (Figures 35 and 36). The filtered analog output signal 4114, 4222 (Figures 35 and 36) is applied to the input of a power amplifier.
[0370] [0370] Figure 38 illustrates an aspect of an ultrasonic system
[0371] [0371] It will be recognized that the terms "proximal" and "distal" are used in this document with reference to a grip on the handle set 137060 by a physician. In this way, the 137050 ultrasonic blade is distal from the more proximal handle set 137060. It will be further recognized that, for the sake of convenience and clarity, spatial terms such as "top" and "bottom" are also used in this document in regarding the pressure of the handle set 137060 by the doctor. However, surgical instruments are used in many orientations and positions, and such terms are not intended to be limiting and absolute.
[0372] [0372] The distal end of the posterior bell 137020 is connected to the proximal end of the transduction portion 137018, and the proximal end of the anterior bell 137022 is connected to the distal end of the transduction portion 137018. The anterior bell 137022 and the posterior bell 137020 has a length determined by several variables, including a thickness of the transduction portion 137018,
[0373] [0373] Again with reference to Figure 38, the rear bell 137020 may include a threaded member that extends from it that can be configured to be threadably engaged with a threaded opening in the anterior bell 137022. In several respects piezoelectric elements, such as piezoelectric elements 137032, for example, can be compressed between the rear bell 137020 and the front bell 137022 when the rear bell 137020 and the front bell 137022 are assembled together. The 137032 piezoelectric elements can be manufactured from any suitable material, such as lead zirconate titanate, lead methaniobate, lead titanate and / or any suitable piezoelectric crystal material, for example.
[0374] [0374] In several aspects, as discussed in more detail below, the 137014 transducer can additionally comprise electrodes, such as positive electrodes 137034 and negative electrodes 137036, for example, which can be configured to create a voltage potential through one or more piezoelectric elements 137032. Each of the positive electrodes 137034, negative electrodes 137036 and pizoelectric elements 137032 can comprise a hole extending through the center that can be configured to receive the threaded member of the rear bell 137020. In various aspects, the positive and negative electrodes 137034 and 137036 are electrically coupled to wires 137038 and 137040, respectively, wires 137038 and 137040 can be enclosed within a cable 137042 and be electrically connected to the ultrasonic signal generator 137012 of the ultras system - sonic 137010.
[0375] [0375] In several respects, the 137014 ultrasonic transducer of the 137024 acoustic set converts the electrical signal from the 137012 ultrasonic signal generator into mechanical energy which results in mainly longitudinal vibratory movement of the 137014 ultrasonic transducer and the 137050 ultrasonic blade at ultrasonic frequencies . A 137012 ultrasonic surgical generator may include, for example, the 1100 generator (Figure 18) or the 137012 generator (Figure 38). When the 137024 acoustic set is energized, a stationary wave of vibrating motion is generated through the 137024 acoustic set. A suitable vibratory frequency range can be from about 20 Hz to 120 kHz and a suitable vibratory frequency range can be from about 30 to 70 kHz and an exemplary operating vibration frequency can be approximately 55.5 kHz.
[0376] [0376] The amplitude of the vibratory movement at any point along the 137024 acoustic set may depend on the location along the 137024 acoustic set in which the vibratory movement is measured. A pass through zero or minimum value in the stationary wave of vibratory movement is generally called a knot (that is, when the movement is normally minimal), and a maximum or peak of absolute value in the stationary wave is, in general , called antinó (that is, when the movement is normally maximum). The distance between an antino and its nearest node is a quarter of a wavelength (N4).
[0377] [0377] As defined above, wires 137038, 137040 transmit an electrical signal from the ultrasonic signal generator 137012 to positive electrodes 137034 and negative electrodes 137036. Piezoelectric elements 137032 are energized by the electrical signal supplied from of the 137012 ultrasonic signal generator in response to a 137044 foot switch, for example, to produce a stationary acoustic wave in the 137024 acoustic set. The electrical signal causes disturbances in the 137032 piezoelectric elements in the form of repeated small displacements, which result in great compressive forces within the material. Small repeated displacements cause the 137032 piezoelectric elements to expand and contract continuously along the geometric axis of the voltage gradient, producing longitudinal waves of ultrasonic energy.
[0378] [0378] In several respects, the ultrasonic energy produced by the 137014 transducer can be transmitted through the 137024 acoustic set to the 137050 ultrasonic blade via a 137046 ultrasonic transmission waveguide. For the 137024 acoustic set to distribute energy to the ultrasonic blade 137050, the components of the 137024 acoustic set are acoustically coupled to the 137050 ultrasonic blade. For example, the distal end of the 137014 ultrasonic transducer can be acoustically coupled on the surface 137030 to the proximal end of the 137046 ultrasonic transmission waveguide, for example a threaded connection, such as a 137048 pin.
[0379] [0379] The components of the acoustic set 137024 can be acoustically tuned so that the length of any set is an integer of half the wavelengths (nN / 2), with the wavelength À being the length of wave of a preselected or operational longitudinal vibration trigger frequency of the acoustic set 137024, and where n is any positive integer. It is also contemplated that the 137024 acoustic set can incorporate any suitable arrangement of acoustic elements.
[0380] [0380] The 137050 ultrasonic blade may have a length substantially equal to an integer multiple of half of the system's wavelengths (n1 / 2). A distal end
[0381] [0381] As defined above, the 137050 ultrasonic blade can be coupled to the 137046 ultrasonic transmission waveguide. In several respects, the 137050 ultrasonic blade and the 137046 ultrasonic transmission guide, as shown, are formed as a construction of single unit from a material suitable for the transmission of ultrasonic energy, such as, for example, Ti6AIl4V (a titanium alloy including aluminum and vanadium), aluminum, stainless steel and / or any other suitable material. Alternatively, the 137050 ultrasonic blade can be separable (and have a different composition) from the ultrasonic transmission waveguide, and be coupled, for example, by a pin, solder, glue, quick connection or other suitable known methods. The 137046 ultrasonic transmission waveguide can have a length substantially equal to an integer length of half the lengths of the system (nN / 2), for example. The 137046 ultrasonic transmission waveguide can preferably be manufactured from a solid core drive shaft made of material that efficiently propagates ultrasonic energy, such as titanium alloy (ie. TISAIAV) or an aluminum alloy, for example.
[0382] [0382] In the aspect illustrated in Figure 38, the ultrasonic transmission waveguide 137046 comprises a plurality of stabilizing silicone rings or compatible supports 137056 positioned at, or at least close to, a plurality of nodes. The 137056 silicon rings can dampen unwanted vibration and isolate ultrasonic energy from a 137058 sheath that at least partially surrounds the 137046 waveguide, thereby ensuring the flow of ultrasonic energy in a longitudinal direction up to the distal end 137052 of the ultrasonic blade 137050, with maximum efficiency.
[0383] [0383] As shown in Figure 38, sheath 137058 can be attached to the distal end of the handle assembly 137060. Sheath 137058 generally includes a nasal adapter or cone 137062 and an elongated tubular member 137064. The limb tubular 137064 is attached to and / or extends from the 137062 adapter and has an opening that extends longitudinally through it. In several respects, the 137058 sheath can be threaded or snapped into the distal end of the 137016 housing. In at least one aspect, the 137046 ultrasonic transmission waveguide extends through the 137064 tubular member opening and the silicone 137056 can come into contact with the side walls of the opening and isolate the 137046 ultrasonic transmission waveguide inside. In several respects, the adapter 137062 of the sheath 137058 is preferably constructed from UltemO, for example, and the tubular member 137064 is manufactured from stainless steel, for example. In at least one aspect, the 137046 ultrasonic transmission waveguide may have polymeric material, for example, around it, in order to isolate it from external contact.
[0384] [0384] As described above, a voltage, or power supply, can be operationally coupled to one or more of the piezoelectric elements of a transducer, and a voltage potential applied to each of the piezoelectric elements can cause that piezoelectric elements expand and contract, or vibrate, in a longitudinal direction. As also described above, the voltage potential can be cyclical and, in several aspects, the voltage potential can be cyclized at a frequency that is equal to or almost equal to the resonance frequency of the component system comprising the 137014 transducer, the waveguide 137046 and the end actuator 137050, for example. In several respects, however, certain piezoelectric elements within the transducer may contribute more to the standing wave of longitudinal vibrations than other piezoelectric elements within the transducer. More particularly, a longitudinal deformation profile can develop within a transducer, and the deformation profile can control, or limit, the longitudinal displacements that some of the piezoelectric elements can contribute to the standing wave of vibrations. , especially when the system is vibrated at or near its resonant frequency.
[0385] [0385] The 137032 piezoelectric elements are configured in a "Langevin cell", in which the 137032 piezoelectric elements and their activation electrodes 137034 and 137036 (together, the 137014 transducer) are interleaved. The mechanical vibrations of the activated piezoelectric elements 137032 propagate along the longitudinal geometric axis of the 137014 transducer, and are coupled through the acoustic assembly 137024 to the end of the 137046 waveguide. the D33 mode of the element, especially for piezoelectric ceramic elements comprising, for example, lead zirconate titanate, lead methaniobate or lead titanate. The D33 mode of a piezoelectric ceramic element is illustrated in Figures 39A to 39C.
[0386] [0386] Figure 39A shows a 137200 piezoelectric element manufactured from a piezoelectric ceramic material. A piezoelectric ceramic material is a polycrystalline material that comprises a plurality of individual microcrystalline domains. Each microcrystalline domain has a geometric axis of polarization along which the domain can expand or contract in response to an imposed electric field. However, in a native ceramic, the geometric axes of polarization of the microcrystalline domains are randomly arranged, so that there is no liquid piezoelectric effect in bulk ceramics. A net reorientation of the polarization geometry axes can be induced by subjecting the ceramic to a temperature above the material's Curie temperature and placing the material in a strong electric field. When the sample temperature drops below the Curie temperature, most of the individual polarization geometry axes will be reoriented and fixed in a volume polarization direction. Figure 39A illustrates such a piezoelectric element 137200 after being polarized along the inductive electric field geometric axis P. While the non-polarized piezoelectric element 137200 has no liquid piezoelectric axis, the polarized element 137200 can be described because it has a geometric axis of polarization, d3, parallel to the direction of the inductive field geometric axis P. For completeness, a geometric axis orthogonal to the geometric axis d3 can be called a geometric axis d1. The dimensions of the piezoelectric element 137200 are identified as length (L), width (W) and thickness (T).
[0387] [0387] Figures 39B and 39C illustrate the mechanical deformations of a 137200 piezoelectric element that can be induced by subjecting the 137200 piezoelectric element to an electric field of E acting along the geometric axis d3 (or P). Figure 39B illustrates the effect of an electric field E that has the same direction as the polarization field P along the geometric axis d3 on a 137205 piezoelectric element. As illustrated in Figure 39B, the 137205 piezoelectric element can deform by expansion along the geometric axis d3 while it is compressed along the geometric axis d1. Figure 39C illustrates the effect of an electric field E that has an opposite direction to the polarization field P along the geometry axis d3 on a piezoelectric element 137210. As shown in Figure 39C, the piezoelectric element 137210 can deform compression sea along the geometric axis d3 while it is expanded along the geometric axis d1. The vibrating coupling along the d3 geometry axis during the application of an electric field along the d3 geometry axis can be called D33 coupling or activation using a piezoelectric element D33 mode. The 137014 transducer shown in Figure 1 can use the D33 mode of the 137032 piezoelectric elements to transmit mechanical vibrations along the waveguide 46 to the end actuator
[0388] [0388] As illustrated by Figures 39A to 39C, during operation in D31 mode, the cross expansion of the piezoelectric elements 137200, 137205, 137210 can be mathematically modeled by the following equation: AL AW Vas L W T
[0389] [0389] In the equation, L, W and T refer to the dimensions of length, width and thickness of a piezoelectric element, respectively. Va31 denotes the voltage applied to a piezoelectric element that operates in D31 mode. The amount of transverse expansion resulting from the D31 coupling described above is represented by AL (that is,
[0390] [0390] In several respects, as described below, an ultrasonic surgical instrument may comprise a transducer configured to produce longitudinal vibrations, and a surgical instrument that has a transducer base plate (for example, a mounting portion of transducer) operationally coupled to the transducer, an end actuator and a waveguide between them. In certain aspects, as also described below, the transducer can produce vibrations that can be transmitted to the end actuator, and the vibrations can drive the base plate of the transducer, the waveguide, the end actuator and / or the other various components of the ultrasonic surgical instrument at, or close to, a resonant frequency. In resonance, a longitudinal strain model or longitudinal stress model, can develop within the transducer, waveguide and / or end actuator, for example. In many respects, such a longitudinal strain model, or longitudinal stress model, can cause the longitudinal strain, or longitudinal stress, to vary along the length of the transducer base plate, the waveguide, and / or the end actuator, in a sinusoidal form, or at least substantially sinusoidal. In at least one aspect, for example, the longitudinal strain model may have maximum peaks and zero points, with the strain values varying non-linearly between such peaks and zero points.
[0391] [0391] Figure 40 illustrates an ultrasonic surgical instrument
[0392] [0392] In conventional D33 ultrasonic transducer architectures, as shown in Figure 38, the screwed piezoelectric elements
[0393] [0393] In conventional D33 ultrasonic transducer architectures
[0394] [0394] Figures 41 to 42 illustrate various views of a 137400 ultrasonic surgical instrument. In several respects, the 137400 surgical instrument can be generally incorporated as a pair of ultrasonic instruments, as shown. In aspects where the 137400 ultrasonic surgical instrument is incorporated as a pair of ultrasonic scissors, the 137400 surgical instrument may include a first arm 137412a pivotally connected to a second arm 137412b at a pivot point 137413 (for example, by a guarantor). The first arm 137412a includes a clamping arm 137416 positioned at its distal end that includes a cooperation surface (for example, a block), which is configured to cooperate with a 137415 ultrasonic blade that extends distally from the second arm 137412b. The clamping arm 137416 and the ultrasonic blade 137415 can collectively define an end actuator
[0395] [0395] The cutting length of the surgical instrument 137400 corresponds to the lengths of the ultrasonic blade 137415 and the cooperation surface of the clamping arm 137416. The fabric that is retained between the ultrasonic blade 137415 and the cooperation surface of the clamping arm 137416 for a sufficient period of time is cut by the 137415 ultrasonic blade, as described above. The ultrasonic blade 137415 and the corresponding portion of the clamping arm 137416 can have a variety of shapes. In several respects, the ultrasonic blade 137415 and / or the clamping arm 137416 can be substantially linear in shape or have a curvature. In some aspects, the portion of the clamping arm 137416 configured to place the fabric in contact with the ultrasonic sheet 137415 can correspond to the shape of the ultrasonic sheet 137415 so that the clamping arm 137416 is aligned with it.
[0396] [0396] Various additional details about the ultrasonic transducer and ultrasonic scissors sets can be found in US Patent Application No. 15 / 679,940, entitled ULTRASONIC TRANSDUCER TECHNIQUES FOR ULTRASONIC SURGICAL INSTRUMENT, deposited on August 17, 2017, which it is hereby incorporated by reference in its entirety. Advanced power device activation options
[0397] [0397] Figure 43 illustrates a block diagram of a 137500 surgical system, according to at least one aspect of the present disclosure. The 137500 surgical system can include, for example, the 1000 surgical system shown in Figure 20 and / or the 137010 ultrasonic surgical instrument system shown in Figure 38. The 137500 surgical system can include a 137400 surgical instrument, such as the ultrasonic surgical instrument 1104 (Figure 18) or the ultrasonic surgical instrument 137300 (Figure 29), which is electrically connectable to a 137504 electrosurgical generator, such as generator 1100 (Figure 18) or generator 137012 (Figure 38), capable of produce ultrasonic energy, monopolar or bipolar (RF) radiofrequency energy, other types of energy and / or combinations of these to activate the 137400 surgical instrument.
[0398] [0398] In the aspect shown in Figure 43, the surgical instrument 137400 includes a transducer set 137510 that comprises at least two piezoelectric elements. The 137510 transducer assembly is optionally coupled to the 137512 ultrasonic blade so that the 137510 transducer assembly can ultrasonic oscillate oscillator 137512 when the 137510 transducer assembly is activated, as described in connection with the Figures 38 to 40. The 137510 transducer assembly is, in turn, electrically coupled to the 137504 generator to receive energy from it. Consequently, when energized by the 137504 generator, the 137510 transducer assembly is configured to ultrasonically oscillate the 137512 ultrasonic blade to cut and / or coagulate the tissue captured by the surgical instrument.
[0399] [0399] In another aspect, the surgical instrument 137400 includes one or more electrodes 796 (Figure 17) or other conductive elements located in the end actuator 792 (Figure 17). Electrodes 796 are, in turn, electrically coupled to generator 137504 to receive energy from it. When powered by the 137504 generator,
[0400] [0400] The 137400 surgical instrument additionally includes a 137506 control circuit that is communicably coupled to a 137508 sensor and can be communicated to the 137504 generator. The 137506 control circuit can include, for example, a processor coupled to the primary and / or secondary computer memory to execute instructions stored in memory, a microcontroller, an application specific integrated circuit (ASIC), a field programmable port array (FPGA), and other such devices. The 137508 sensor is configured to detect a property of the environment and / or the 137400 surgical instrument and provide an output corresponding to the presence or magnitude of the captured property. The control circuit 137506 in turn is configured to selectively control the activation of the 137510 transducer set and / or the 796 electrodes as the captured property is above, below or at a limit value. In other words, control circuit 137506 is configured to control the activation of transducer set 137510 and / or electrodes 796 according to the sensor output in relation to a limit. In one aspect, the limit can be stored in a memory of the 137400 surgical instrument and retrieved by the 137506 control circuit to compare the 137508 sensor output signal against it.
[0401] [0401] In several other examples, the 137506 control circuit and / or the 137508 sensor can be external to the surgical instrument
[0402] [0402] Figures 44 to 45C illustrate various views of a 137400 surgical instrument including a 137508 sensor unit configured to detect a 137404 magnetic reference, in accordance with at least one aspect of the present disclosure. In the following description of Figures 44 to 45C, reference should also be made to Figure 43. In one aspect, the 137508 sensor unit includes a 137402 sensor that is configured to detect the position or status (for example, example (open or closed) of the 137400 surgical instrument by detecting the position or corresponding location of a magnetic reference 137404. Sensor 137402 may include, for example, a Hall effect sensor that is configured to detect the location of the magnetic reference 137404 in relation to it. Consequently, the magnetic reference 137404 is configured so that its position corresponds to the position and / or the status of the 137400 surgical instrument. The Hall effect sensor can include, for example, a Hall element configured to detect the relative distance between magnetic reference 137404 and sensor 137402 or a set of multiple Hall elements configured to detect the multidimensional position or orientation of magnetic reference 137404 in relation to sensor 137402 (for example, a TLV493D-A1B6 3D magnetic sensor from Infineon Technologies) . In addition, the Hall effect sensor may include linear Hall effect sensors (ie Hall effect sensors in which the output varies linearly with the magnetic flux density) or Limiting Hall effect sensors (ie Hall effect sensors in the which the output drops sharply as the magnetic flux density decreases).
[0403] [0403] In the aspect shown in Figure 44, the magnetic reference 137404 includes a wearable magnet 137406. Consequently, sensor 137402 is configured to detect the relative position of the wearable magnet 137406 as used, for example, in the hand of a surgeon. In several respects, the relative position of the wearable magnet 137406 in relation to the 137402 sensor can include, for example, the relative distance between the wearable magnet 137406 and the sensor 137402 and / or the relative orientation of the wearable magnet 137406 in relation to to the sensor
[0404] [0404] In another example, the positions of the wearable magnet 137406 and the sensor 137402 can be reversed from the aspect described above. In other words, the magnet can be positioned on or on the 137400 surgical instrument and the sensor 137402 can be positioned on or used by the surgeon (for example, incorporated into a ring or a surgical glove, as described above). Otherwise, this example acts in a similar way to the example that is described above.
[0405] [0405] In the aspect shown in Figures 45A to C, the magnetic reference 137404 includes an integral magnet 137408 positioned inside or on a mobile component of the surgical instrument 137400, such as the arm 137412 thereof. Consequently, sensor 137402 is configured to detect the relative position of integral magnet 137408 within arm 137412 of the surgical instrument.
[0406] [0406] In another example, the positions of integral magnet 137408 and sensor 137402 can be reversed from the aspect described above. In other words, the integral magnet 137408 can be positioned on or in the housing 137414 of the surgical instrument 137400 and the sensor 137402 can be positioned on or in the corresponding mobile component (for example, the arm 137412) of the surgical instrument 137400 being tracked. Otherwise, this example acts in a similar way to the example that is described above.
[0407] [0407] The 137402 sensor is configured to produce an output that corresponds to the position of the magnetic reference 137404 in relation to it (for example, the distance between the magnetic reference 137404 and the 137402 sensor and / or the orientation of the magnetic reference 137404 in relation to to the 137402 sensor). Thus, as the magnetic reference 137404 and / or the sensor 137402 move in relation to each other as the 137400 surgical instrument is closed, opened or otherwise manipulated by a surgeon, the 137400 sensor is able to detect the relative position of magnetic reference 137404 according to the detected magnetic field of magnetic reference 137404. The 137402 sensor can then produce an output corresponding to the detected magnetic field of magnetic reference 137404. In an aspect where the 137402 sensor includes an effect sensor Hall, the sensor output can be a voltage, the magnitude of the output voltage corresponding to the magnetic field strength from the magnetic reference 137404 detected by the 137402 sensor.
[0408] [0408] In one aspect, the 137506 control circuit is configured to receive the output from the 137402 sensor and then compare the 137402 sensor output to a threshold. The 137506 control circuit can additionally activate or deactivate the 137400 surgical instrument according to the comparison between the 137402 sensor output and the limit. The limit can, for example, be predetermined or adjusted by a user of the 137400 surgical instrument. The output of the 137402 sensor can correspond to the position of the 137400 surgical instrument arm (directly, as shown in Figures 45A to C, or indirectly, as in the aspect illustrated in Figure 44), which in turn controls the position of the clamping arm 137416 (Figure 41) in relation to the ultrasonic blade
[0409] [0409] In one example, control circuit 137506 can determine whether magnetic reference 137404 is positioned at a lower or equal limit distance from sensor 137402. In this example, if control circuit 137506 determines that the output of the sensor exceeds the limit, then control circuit 137506 can activate surgical instrument 137400. In another example, control circuit 137506 can determine whether magnetic reference 137404 is positioned at a greater or equal limit distance from the sensor 137402. In this example, if the 137506 control circuit determines that the 137402 sensor voltage output is less than or equal to the limit, then the 137506 control circuit can activate the 137400 surgical instrument. The 137506 control circuit can activate the surgical instrument 137400 transmitting a signal to generator 137504 which causes generator 137504 to energize the 137510 transducer assembly and / or the RF 796 electrodes to cut and / or coagulate the te captured by the 137400 surgical instrument. In short, in some respects the 137506 control circuit can be configured to determine whether the 137400 surgical instrument is sufficiently closed and, if so, then activate the 137400 surgical instrument.
[0410] [0410] In other respects, the 137506 control circuit can be configured to take other measures if it determines that the 137400 surgical instrument is sufficiently closed to provide an instruction to the user or transmit data to a central surgical controller 106, as described in connection with Figures 1 to 11. In still other aspects, the 137506 control circuit can be configured to determine whether the 137400 surgical instrument is sufficiently open or in some specific position (or range of positions) between the open and closed positions. If the 137400 surgical instrument is in the defined position (s) or within it, the 137506 control circuit can therefore activate the 137400 surgical instrument, disable the 137400 surgical instrument, or have a variety of other actions.
[0411] [0411] In some aspects, the 137506 control circuit can be configured to detect touch, friction and other types of movements based on the amplitude, frequency and / or the direction of movement of the magnetic reference 137404 detected through the 137402 sensor. Such movements - tos can be detected because changes in the strength of the magnetic field over time detected by sensor 137402 can be characterized (empirically or otherwise) and defined for different types of movements. For example, a touch movement can be detectable according to the frequency in the magnetic field change detected by the 137402 sensor in a direction substantially perpendicular to the longitudinal geometric axis of the 137400 surgical instrument. As another example, a movement of friction can be detectable according to the frequency in the magnetic field change detected by the 137402 sensor in a direction substantially parallel to the longitudinal geometry axis of the 137400 surgical instrument. In some respects, the 137506 control circuit can be configured to change the state , the mode and / or properties of the 137400 surgical instrument according to the movements detected. For example, the 137506 control circuit can be configured to activate the 137400 surgical instrument by detecting a 137402 touch movement through the sensor.
[0412] [0412] Figures 46A to B illustrate perspective views of a 137400 surgical instrument including a sensor set 137508 configured to detect contact against it and Figure 47 illustrates a corresponding circuit diagram, according to least one aspect of the present disclosure. In the following description of Figures 46A to 47, reference should also be made to Figure 43. In one aspect, the 137508 sensor unit may include a 137420 touch sensor that is configured to detect force, contact and / or pressure against the same. The 137420 touch sensor can comprise, for example, a 137421 force sensitive resistor (FSR). In an example shown in Figure 46A, the 137420 touch sensor is oriented transversely to the longitudinal geometric axis of the 137400 surgical instrument. In this example , the touch sensor 137420 defines a surface that extends orthogonally from housing 137414 in relation to the longitudinal axis of the surgical instrument 137400. In another example shown in Figure 46B, the touch sensor 137420 extends along ( s) side surface (s) of the housing 137414. In this example, the touch sensor 137420 can be integral or positioned in or on the housing 137414 of the surgical instrument 137400. In any of these For example, the 137420 touch sensor can be used by a surgeon, for example, to activate the 137510 transducer set for the 137400 surgical instrument or otherwise provide input for surgical instrument 137400 (for example, to control one or more functions of surgical instrument 137400).
[0413] [0413] In one aspect, where the 137420 touch sensor includes an FSR 137421, as shown in Figure 47, the 137400 surgical instrument can include a circuit to control the activation of the 137426 electrosurgical generator electrically connectable to the surgical instrument 137400. In this example, the FSR 137421 is electrically coupled to an analog-to-digital converter (ADC) 137422 and to a control circuit 137424 (for example, a microcontroller or an ASIC). As a force F is applied to the FSR 137421, the voltage output of the FSR 137721 varies accordingly. The ADC 137422 then converts the analog signal from the FSR 137421 to a digital signal, which is then supplied to the 137424 control circuit. In one example, the 137424 control circuit can then compare the signal received (which is indicative of the output voltage of the FSR 137421, which in turn is indicative of the F force or pressure experienced by the FSR 137421) to a limit to determine whether it is necessary to activate the electrosurgical generator
[0414] [0414] Figures 48A to C illustrate perspective views of a 137400 surgical instrument including a 137429 sensor unit configured to detect the closure of the 137400 surgical instrument, in accordance with at least one aspect of the present disclosure. In the following description of Figures 48A to 48C, reference should also be made to Figure 43. In one aspect, the closure sensor unit 137429 may include a closure sensor 137430 configured to detect when arm 137412 of the surgical instrument 137400 is in a closed position and, in some respects, if additional force is being applied to the arm 137412 after the surgical instrument 137400 is in the closed position. In one example, the 137430 closure sensor comprises a two-stage tactile switch that is configured to detect, in a first stage, when the arm of the surgical instrument is in a closed position and, in addition, it is configured to detect, in a second stage, when additional force or pressure is being applied after the 137412 arm of the 137400 surgical instrument is in the closed position. Such a 137430 closing sensor can be used, for example, to allow the 137400 surgical instrument to be closed without necessarily automatically activating the 137510 transducer assembly and / or the 796 RF electrodes.
[0415] [0415] In one aspect shown in Figures 48A to C, closing sensor 137430 is positioned in housing 137414 so that arm 137412 engages closing sensor 137430 when arm 137412 is rotated in a first direction R: to a position closed, as shown in Figure 48B, from an open position, as shown in Figure 48A. When arm 137412 is in the closed position, arm 137412 can descend to the bottom of housing 137414 (wrap) and / or the closing sensor 137430. When surgical instrument 137400 is open (or otherwise not closed) or when the arm 137412 of the surgical instrument 137400 is closed, but no additional force is being applied to it, the closure sensor 137430 may be in the first position or in the first state, as shown in Figure 48B. When arm 137412 of surgical instrument 137400 is closed and an additional force F; is applied to arm 137412, the 137430 closure sensor can be in the second position or the second state, as shown in Figure 48C. In some respects, when arm 137412 is in the initial closed position, arm 137412 can be at a first angle 81 of housing 137414, and when an F1 force is applied to arm 137412 in the initial closed position, force F1 can cause the closing sensor 137430 is pressed so that the arm 137412 is at a second angle 82 of the housing 137414.
[0416] [0416] In one aspect, the output of the 137430 closing sensor may vary according to the position and / or the state the 137430 closing sensor is in. In other words, when the 137430 closure sensor is in the first state, it can provide a first output to the control circuit 137506 of the 137400 surgical instrument, and the 137430 closure sensor when it is in the second state, it can provide a second output for control circuit 137506 of surgical instrument 137400. In this way, the 137430 closure sensor can be configured to detect whether (i) surgical instrument 137400 is closed and (ii) when surgical instrument - logic 137400 is closed, if additional force is being applied. In one aspect, the 137510 transducer assembly and / or the RF electrodes 796 can be activated and / or supply power only when the 137430 closing sensor is in the second state / position. This aspect would make it possible for surgeons to activate surgical instrument 137400 solely by manipulating arm 137412, but without losing the ability to hold and manipulate tissue without activating the 137510 transducer set and / or 796 RF electrodes.
[0417] [0417] In one aspect, the 137506 control circuit is configured to receive the output from the 137430 close sensor and then compare the 137430 close sensor output to a threshold to determine whether the 137430 close sensor is on. second position / state. The limit can be, for example, predetermined or adjusted by a user of the surgical instrument 137400. In the examples described above where the closure sensor 137430 detects whether the arm 137412 of the surgical instrument 137400 is being closed and, in addition, if a force additional is being applied to the 137412 arm when the 137412 arm is closed, the output of the 137430 closing sensor varies accordingly. In addition to these examples, the limit may correspond to a limit force being applied to the arm 137412 (and thus the closing sensor 137430) after the arm 137412 is closed. For example, if control circuit 137506 determines that the output of closing sensor 137430 exceeds the limit, then control circuit 137506 can activate transducer assembly 137510 and / or RF electrodes 796 by sending a signal for the 137504 generator which causes the 137504 generator to start supplying power to the transducer assembly. In short, in some respects, the 137506 control circuit can determine whether a sufficient amount of force is being applied to the closed arm 137412 of the surgical instrument 137400 and, if so, then activate the 137510 transducer assembly and / or the electro - of RF 796.
[0418] [0418] Figures 49A to F illustrate various views of a 137400 surgical instrument including a 137439 sensor unit configured to detect the opening of the 137400 surgical instrument, in accordance with at least one aspect of the present disclosure. In the following description of Figures 49A to F, reference should also be made to Figure 43. In one aspect, the opening sensor unit 137439 includes an opening sensor 137440 which is configured to detect when the arm 137412 of the surgical instrument 137400 it is rotated in a second direction R2 to an open position. In one example, the aperture sensor
[0419] [0419] In several respects, the 137440 aperture sensor can be positioned at pivot point 137413 or adjacent to it of the 137400 surgical instrument. In one aspect shown in Figures 49A to F, the 137440 aperture sensor is positioned within a 137443 recess on a first lateral portion of the housing
[0420] [0420] In one aspect, control circuit 137506 is configured to receive output from aperture sensor 137440 and then compare the output of aperture sensor 137440 to a limit, where the limit corresponds to the sensor opening 137440 in the second position / state. The limit can, for example, be predetermined or adjusted by a user of the 137400 surgical instrument. In the examples described above where the 137440 aperture sensor detects whether the 137412 arm of the 137400 surgical instrument is open at a specific angle, the outlet of the aperture sensor 137440 thus varies accordingly. In addition to these examples, the limit may correspond to a limit angle at which the arm 137412 of the surgical instrument 137400 is positioned. In one respect, if the 137506 control circuit determines that the 137440 aperture sensor output exceeds the limit, then the 137506 control circuit can activate the 137510 transducer assembly and / or the 796 RF electrodes by sending a signal to the 137504 generator that causes the 137504 generator to start supplying power to the 137510 transducer assembly and / or the RF 796 electrodes. In short,
[0421] [0421] In certain respects, the sensor units for activating a 137400 surgical instrument described above in connection with Figures 44 to 49F can be implemented in various combinations with each other. For example, Figure 50 illustrates an example of a surgical instrument 137400 in which the sensor unit 137508 includes both the closure sensor unit 137429 described in connection with Figures 48A to C and the opening sensor unit 137439 described in connection with Figures 49A to F. The various aspects of the 137508 sensor units described herein can be combined with each other in a 137400 surgical instrument to provide supplementary and / or alternative methods for activating and / or providing the en - returned to the 137400 surgical instrument. It should be noted that the example shown in Figure 50 is intended to be illustrative only and other examples of 137400 surgical instruments may include any other combination of the aforementioned 137508 sensor units.
[0422] [0422] Figure 51 illustrates a perspective view of a surgical instrument comprising a 137450 deactivation control, in accordance with at least one aspect of the present disclosure. In several respects, the 137400 surgical instrument may include a 137450 deactivation control to control whether one or more of the various sensors on the 137400 surgical instrument, such as several sets of 137508 sensors described above in relation to Figures 44 to 49F, are active. The 137450 deactivation control can include, for example, a switch or physical key arranged in the 137414 housing of the 137400 surgical instrument or a touchscreen. The deactivation control 137450 can be connected in a communicable way to the control circuit 137506 of the surgical instrument 137400 and, depending on the input from the deactivation control 137450, the control circuit 137506 can, for example, deactivate the 137508 sensor unit controlled by the 137450 disable control or otherwise ignore the output of or take no action in response to the 137508 sensor assembly output controlled by the 137450 disable control.
[0423] [0423] Referring to Figures 41 to 51, the 137400 surgical instrument may also include an indicator, such as an LED, a monitor and other such output devices. The indicator can be coupled to the control circuit 137506 and thus controlled. In some respects, the 137506 control circuit can be configured to activate the indicator in response to an input received from the 137508 sensor unit. For example, the 137506 control circuit can be configured to activate the indicator when the control circuit 137506 determine that the 137400 surgical instrument is in a closed position (for example, as detected by means of a 137508 sensor unit). Smart retractor
[0424] [0424] Figure 52 illustrates a perspective view of a 137600 retractor comprising a 137602 sensor, in accordance with at least one aspect of the present disclosure. In several respects, a 137600 retractor for fixing a 137650 surgical site opening can include a 137602 sensor that is removable or integrally attached to it. In one aspect, the 137602 sensor is removably fixable to the 137600 tractor by means of a magnet. The 137602 sensor can be configured to detect when the 137600 retractor is touched, pushed, moved, or otherwise manipulated by a user (for example, a surgeon). In one example, the 137602 sensor may include a vibration sensor (for example, a digital triaxial vibration sensor ADIS16223) that is configured to detect vibration or movement by the 137600 retractor to which the 137602 sensor is fixed. In one aspect, the 137602 sensor can be reusable, that is, the 137602 sensor can maintain its effectiveness in sterilization processes (as the 137602 sensor is attached to a 137600 retractor, which is in the surgical field, it would be sterilized after use in a surgical procedure if it needed to be reused). The 137602 sensor can be configured to detect different types of movements or actions (for example, touch) by a user according to the amplitude, frequency and / or direction of movement or vibration detected by the 137600 tractor.
[0425] [0425] The 137602 sensor can be configured to transmit a signal indicating the detected vibration or movement of the 137600 retractor. In one aspect, the 137602 sensor can be coupled in a communicable way to a 137606 surgical instrument (for example, a surgical instrument or a electrosurgical instrument) and / or another device (for example, a generator) through, for example, a 137604 wired connection. Based on the gesture or movement detected by the 137602 sensor, the 137602 sensor can change the state of the (s) 137606 surgical instrument (s) and / or other device (s) that are communicably coupled to the 137602 sensor. The status of the 137606 surgical instrument (s) and / or other device (s) may correspond, for example, to a mode in which the instrument (s) 137606 and / or the device (s) are in a property of the instrument (s) 137606 (s) and / or device (s). For example, when the 137602 sensor detects that the 137600 retractor is being touched, the 137602 sensor can transmit a signal to a 137606 surgical instrument that is communicably coupled to it that causes the 137606 surgical instrument to go from an inactive state to an active state (or vice versa). As another example, when sensor 137602 detects that the 137600 retractor is being touched, sensor 137602 can transmit a signal to a surgical generator that is coupled in a communicable way to it that causes the generator to pass idle to an active mode (or vice versa). In some respects, the 137602 retractor sensor can be configured to transmit data and / or signals to a central surgical controller 106, as described in connection with Figures 1 to 11, which in turn can then take various measures, such as controlling the (a) 137606 surgical instrument (s) and / or other device (s), as described above.
[0426] [0426] Figure 53 illustrates a perspective view of a 137902 retractor comprising a monitor in use at a 137900 surgical site, in accordance with at least one aspect of the present disclosure. A 137902 surgical retractor assists the surgeon and operating room professionals in keeping an incision or wound open during surgical procedures. The 137902 surgical retractor helps to hold the underlying organs or tissues, allowing doctors / nurses to have better visibility and access to the exposed area. A 137902 retractor can include a 137904 monitor or other control device that is configured to display alerts and / or information associated with the surgical procedure being performed, provide a means to control the instruments or devices in use during the course of the surgical procedure or the environment in which the surgical procedure is being performed (for example, the operating room), and perform other such functions. In the aspect shown, the control device is integral to the 137902 retractor. In another aspect, the control device may include, for example, a portable electronic device that includes a touchscreen (for example, a tablet computer) ) which is removably attachable to the 137902 retractor. In yet another aspect, the control device includes a flexible adhesive screen that is attachable to the patient's body / skin or on another surface.
[0427] [0427] In one aspect, the control device includes an input device (for example, a keyboard, a capacitive touchscreen or a combination thereof) to receive input from a user; an output device (for example, a screen) to provide alerts, information, or other output to a user; a source of energy (for example, a coin-shaped cell, a battery, a photovoltaic cell or a combination thereof); and a network interface controller for a communication protocol (for example, Wi-Fi, Bluetooth) to communicably connect the control device to surgical instruments, devices within the operating room (for example, a central surgical controller 106 as described in Figures 1 to 11) and / or other equipment (surgical or not). The control device can be configured to provide a graphical user interface (GUI) to display information to the user (for example, to a surgeon) and to receive input or commands from the user. In one aspect, the control device additionally includes a 137906 light source (for example, an LED array) that is configured to illuminate the 137908 surgical field of view that the 137902 retractor holds.
[0428] [0428] In one aspect, the control device is removably fixable to the 137902 surgical retractor. In another aspect, the control device is an integral part of the 137902 retractor, defining a "smart" 137902 surgical retractor. The 137902 smart surgical retractor can comprise an input screen operated by the 137902 smart surgical retractor. The 137902 smart surgical retractor can comprise a wireless communication device for communicating with a device connected to a surgical generator module coupled to the central surgical controller. Using the 137902 smart surgical retractor entry screen, the surgeon can adjust the power level or mode of the generator module to cut and / or coagulate tissue. If used in automatic on / off mode for power supply
[0429] [0429] In several respects, the control device can be configured to control various functions of the surgical instruments that are communicably connected to the control device, such as the energy parameters (for example, by an electrosurgical instrument and / or an ultrasonic instrument) or modes of operation (for example, "cut" and "coagulation" modes for an electrosurgical, or automatic instrument) of surgical instruments. In several aspects, the control device can be configured to show information regarding the current surgical procedure and / or information related to the equipment in use during the surgical procedure, such as the temperature of an ultrasonic blade (pressure actuator). extremity), alerts or alarms that are generated during the course of the surgical procedure, or the location of the nerves within the surgical field. Alerts or alarms can be generated, for example, by surgical instruments and / or by a central surgical controller 106 to which surgical instruments (or other modular surgical devices) are communicably connected. In many ways, the control device can be configured to control functions of the environment in which the surgical procedure is being performed (for example, an operating room), such as the intensity and / or position of the field lights within a room. operating room.
[0430] [0430] In several respects, the control device can be configured to detect which surgical instruments or other equipment is close to the control device and then cause any surgical instruments or other equipment that are connected to the control device to pass through. operational controls for the control device. In one aspect, the 137902 smart surgical retractor can detect or recognize which device / instrument the surgeon is using, either through the central surgical controller 106 or RFID or another device placed on the device / instrument or on the 137902 smart surgical retractor, and provide an adequate display. Alarms and alerts can be activated when conditions demand. Other features include the display of the ultrasonic blade temperature, nerve monitoring, light source or fluorescence. The 137906 light source can be used to illuminate the 137908 surgical field of view and to load photocells on the single-use adhesive screen glued to the 137902 smart retractor. In another aspect, the 137902 smart surgical retractor can include a projected augmented reality about the patient's anatomy (for example, a vein observer).
[0431] [0431] In other respects, the control device may comprise an intelligent flexible adhesive screen that can be attached to a patient's body / skin. The flexible flexible adhesive screen can be applied, for example, to a patient's body / skin between the area exposed by surgical tractors. In one aspect, the smart flexible adhesive screen can be powered by light, an integrated battery, or a grounding block. The flexible adhesive screen can communicate over a short-range wireless network (for example, Bluetooth) to a device, can provide readings, lock or change the power. The flexible flexible adhesive screen also includes photocells to energize the flexible flexible adhesive screen with the use of ambient light energy. The flexible flexible adhesive screen includes a 137904 screen from a user interface control panel to allow the surgeon to control devices or other modules attached to the central surgical controller.
[0432] [0432] Additional details regarding several smart retractors can be found in US Patent Application No.
[0433] [0433] Referring now to Figure 54, a 5200 timeline is shown representing the situational 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 the central surgical controller 106, 206 can derive from data received from data sources at each stage in the surgical procedure. Timeline 5200 shows 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.
[0434] [0434] Situational recognition of a central surgical controller 106, 206 receives data from data sources throughout the course of the surgical procedure, including data generated each time the medical team uses a modular device that is paired with the center surgical 106, 206. The 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 according to the new data are received, such as what stage of the procedure is being performed at any given time. The situational recognition system of the central surgical controller 106, 206 is, for example, able to record data related to the procedure to generate reports, verify the measures taken by the medical team, 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 measures described above.
[0435] [0435] 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 the patient selection data in the PEP, the central surgical controller 106, 206 determines that the procedure to be performed is a thoracic procedure.
[0436] [0436] In the second step 5204, the team members scan the incoming medical supplies for the procedure. Central surgical controller 106, 206 cross-references the scanned supplies with a list of supplies that are used in various types of procedures and confirms that the combination of supplies corresponds to a thoracic procedure. In addition, the central surgical controller 106, 206 is also able to determine that the procedure is not a wedge procedure (because the incoming supplies either lack certain supplies that are necessary for a thoracic or wedge procedure). , otherwise, that the incoming supplies do not correspond to a thoracic wedge procedure).
[0437] [0437] In the third step 5206, the medical team scans the patient's band with a scanner that is communicably connected to the central surgical controller 106, 206. The surgical controller 106, 206 can then confirm the patient's identity based on those of the - scanned.
[0438] [0438] In the fourth step 5208, the medical team turns on the auxiliary equipment. The auxiliary equipment in use 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 devices that are modular devices can automatically pair with the central surgical controller 106, 206 which is located within a specific perimeter of the modular devices as part of their initialization process. Surgical controller 106, 206 can then derive contextual information about the surgical procedure by detecting the types of modular devices paired with it during that preoperative or initialization phase. In this particular example, the central surgical controller 106, 206 determines that the surgical procedure is a VATS (video-assisted thoracic surgery) procedure based on this specific combination of paired modular devices. Based on the combination of data from the electronic patient record (PEP), the list of medical supplies to be used in the procedure, and the type of modular devices that connect to the central controller, the central surgical controller 106, 206 it can, in general, infer the specific procedure that the surgical team will perform. After the central surgical controller 106, 206 recognizes that a specific procedure is being performed, the central surgical controller 106, 206 can then retrieve the steps of that process from a memory or from the cloud and then cross over the data that subsequently - it receives from connected data sources (for example, modular devices and patient monitoring devices) to infer which stage of the surgical procedure the surgical team is performing.
[0439] [0439] 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 match the con-
[0440] [0440] In the sixth step 5212, the medical team induces anesthesia in the patient. Central surgical controller 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 thereof, for example. After the completion of the sixth step 5212, the preoperative portion of the pulmonary segmentectomy procedure is completed and the operative portion begins.
[0441] [0441] In the seventh step 5214, the lung of the patient being operated on is retracted (while ventilation is switched to the contralateral lung). The central surgical controller 106, 206 can infer from the ventilator data that the patient's lung has been retracted, for example. The central surgical controller 106, 206 can infer that the operative portion of the procedure was initiated since it can compare the detection of the patient's lung retraction to the expected steps of the procedure (which can be accessed or retrieved earlier) and thus determine that lung retraction is the first operative step in this specific procedure.
[0442] [0442] In the eighth step 5216, the medical imaging device (for example, an endoscope) is inserted and the video of the medical imaging device is started. Central surgical controller 106, 206 receives data from the medical imaging device (ie, video or image data) through its connection to the medical imaging device. Upon receipt of data from the medical imaging device, the central surgical controller 106, 206 can determine that the portion of the laparoscopic surgical procedure has started.
[0443] [0443] In the ninth step 5218, the surgical team starts the dissection step of the procedure. Central surgical controller 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 triggered. The central surgical controller 106, 206 can cross-check the received data with the steps retrieved from the surgical procedure to determine that an energy instrument is being fired at that point in the process (that is, after completion of the steps previously discussed in the procedure) corresponds to the dissection step. In certain cases, the energy instrument can be a power tool mounted on a robotic arm of a robotic surgical system.
[0444] [0444] In the tenth stage 5220 of the procedure, the surgical team proceeds to the connection stage. Central surgical controller 106, 206 can infer that the surgeon is connecting arteries and candles because he receives data from the surgical stapling and cutting instrument indicating that the instrument is being fired. Similar to the previous step, the central surgical controller 106, 206 can derive this inference by crossing the data received from the surgical stapling and cutting instrument with the steps recovered in the process. In certain cases, the surgical instrument may be a surgical tool mounted on a robotic arm of a robotic surgical system.
[0445] [0445] In the eleventh step 5222, the portion of the segmentectomy procedure is performed. Central surgical controller 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 central surgical controller 106, 206 to infer which portion of the segmentectomy procedure is being performed.
[0446] [0446] In the twelfth step 5224, the node dissection step is then performed. Central surgical controller 106, 206 can infer that the surgical team is dissecting the node and performing a leak test based on the data received from the generator which 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 central surgical controller 106, 206 to make this inference. It should be noted that surgeons regularly alternate between surgical stapling / surgical cutting instruments and surgical energy instruments (ie, 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 cutting / stapling instruments and surgical energy instruments are used can indicate which stage of the procedure the surgeon is taking. 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 procedure.
[0447] [0447] In the thirteenth stage 5226, the patient's anesthesia is reversed. The central surgical controller 106, 206 can infer that the patient is exiting anesthesia based on ventilator data (i.e., the patient's respiratory rate begins to increase), for example.
[0448] [0448] Finally, in the fourteenth step 5228, the medical team removes the various patient monitoring devices from the patient. Central surgical controller 106, 206 can thus infer that the patient is being transferred to a recovery room when the central controller loses ECG, blood pressure and other data from patient monitoring devices. As can be seen from the description of this illustrative procedure, the central surgical controller 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 which are communicably coupled to the central surgical controller 106, 206.
[0449] [0449] Situational recognition is further described in US Provisional Patent Application serial number 62 / 659,900, entitled ME-THOD OF HUB COMMUNICATION, filed on April 19, 2018, which is hereby incorporated by reference in its entirety. In certain cases, the operation of a robotic surgical system, including the various robotic surgical systems disclosed here, for example, can be controlled by the central controller 106, 206 based on its situational perception and / or retroinformation of its components and / or based on information from the cloud 102.
[0450] [0450] 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 of providing the function performed by the element. In addition, when 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 include all of these modifications, combinations and variations that fall within the scope of the modalities presented. The attached claims are intended to cover all such modifications, variations, alterations, substitutions, modifications and equivalents.
[0451] [0451] 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 practically any combination of these. Those skilled in the art will recognize, however, that some aspects of the forms disclosed here, in whole or in part, can be implemented in an equivalent manner in integrated circuits, such as one or more computer programs running on one or more computers ( for example, as one or more programs running on one or more computer systems), as one or more programs running on one or more processors (for example, as one or more programs running on one or more microprocessors), as firmware, or virtually as any combination thereof, and that the design of the circuitry and / or the code entry for the software and firmware would be within the scope of practice of the technician, in the light of this disclosure. In addition, those skilled in the art will understand that the mechanisms of the subject described here can be distributed as one or more program products in a variety of ways and that an illustrative form of the subject described here is applicable regardless of the type of program. specific means of signal transmission used to effectively carry out the distribution.
[0452] [0452] 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 via other computer-readable media. In this way, a machine-readable media 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 discs, compact memory disc read-only (CD-ROMs), and magneto-optical 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 propagated signals ( for example, carrier waves, infrared signals, digital signals, etc.). Consequently, the media does not
[0453] [0453] As used in any aspect of the present invention, the term "control circuit" can refer to, for example, a wired circuit set, programmable circuit set (for example, a computer processor comprising one or plus individual instruction processing cores, a processing unit, a processor, a microcontroller, a microcontroller unit, a controller, a digital signal processor (DSP), a programmable logic device (PLD), a programmable logic matrix (PLA), or a field programmable port matrix (FPGA)), state machine circuits, a firmware that stores instructions executed by the programmable circuit, and any combination of them. 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 system -chip (SoC), desktop computers, laptop computers, tablet computers, servers, smart phones, etc. Consequently, as used in the present invention, "control circuit" includes, but is not limited to, a set of electrical circuits that have at least one discrete electrical circuit, a set of 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 the processes and / or devices described here
[0454] [0454] As used in any aspect of the present invention, the term "logic" can refer to an application, software, firmware and / or circuitry configured to perform any of the aforementioned operations. The software may be incorporated as a software package, code, instructions, instruction sets and / or data recorded on non-transitory, computer-readable storage media. The firmware can be embedded as code, instructions or instruction sets and / or hard coded (for example, non-volatile) data in memory devices.
[0455] [0455] 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 running software.
[0456] [0456] As used here in any respect, an "algorithm" refers to the self-consistent sequence of steps that lead to the desired result, where a "step" refers to the manipulation of physical quantities and / or logical states that can, although not necessarily necessary, take the form of electrical or magnetic signals that can be stored, transferred, combined, compared and manipulated in any other way. It is in 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 those quantities and / or states.
[0457] [0457] A network can include a packet-switched network. Communication devices can communicate with each other using a selected packet-switched network communications protocol. An exemplary communications protocol can include an Ethernet communications protocol that can enable communication using a transmission control protocol / Internet protocol (TCP / IP). The Ethernet protocol may comply with 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 additionally, communication devices can communicate with each other using an X.25 communications protocol. The X.25 communications protocol may comply with or be compatible with a standard promulgated by the International Telecommunication Union-Tele-communication Standardization Sector (ITU-T). Alternatively or additionally, communication devices can communicate with each other using a "frame relay" communications protocol. The frame-relay communications protocol may comply with or be compatible with a standard promulgated by the Consultative Committee for International Telegraph and Telephone (CCITT) and / or the American National Stan- dards Institute (ANSI). Alternatively or additionally, transceivers can communicate with each other using an ATM communication protocol ("asynchronous transfer mode"). The ATM communication protocol may comply with or be compatible with an ATM standard published by the ATM forum entitled "ATM-MPLS Network Interworking 2.0" published in August 2001, and / or later versions of that standard. Obviously, different and / or post-developed network communication protocols are also contemplated in the present invention.
[0458] [0458] Unless otherwise stated, as is evident from the preceding disclosure, it is understood that, throughout the preceding disclosure, discussions using terms such as "processing", "computation", "calculation", "determination", "display", or similar, refer to the action and processes of a computer system, or similar electronic computing device, that manipulate and transform the data represented in the form of physical (electronic) quantities in the records and in the computer's memories in other data represented in a similar way in the form of physical quantities in the computer's memories or records, or in other similar information storage, transmission or display devices.
[0459] [0459] One or more components in the present invention may be called "configured for", "configurable for", "operable / operational for", "adapted / adaptable for", "capable of", "as movable / 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 dictates otherwise.
[0460] [0460] 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.
[0461] [0461] Persons skilled in the art will recognize that, in general, the terms used here, and especially in the appended claims (for example, bodies in the appended claims) are generally intended as "open" terms (for example, the term "including" should be interpreted as "including, but not limited to", the term "having" should be interpreted as "having, at least", the term "includes" should be interpreted as "includes, but not limits to ", etc.). It will also be understood by those skilled in the art that, when a specific number of an introduced claim statement 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 mention of the claim entered to claims that contain only such a mention, 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, "one, ones" and / or "one, ones" should typically be interpreted as meaning "not one" or "one or more"); the same goes for the use of defined articles used to introduce claims.
[0462] [0462] 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,
[0463] [0463] 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 these alternative sorts may include overlapping, merged, interrupted, reordered, incremental,
[0464] [0464] 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 resource, structure or characteristic described in connection with the aspect 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 necessarily refers to the same aspect. In addition, specific resources, structures or characteristics can be combined in any appropriate way in one or more aspects.
[0465] [0465] Any Patent Application, Patent, Non-Patent Publication or other disclosure material mentioned in this specification and / or mentioned in any application data sheet is hereby incorporated by reference, to the extent that that the embedded materials are not incompatible with them. Accordingly, and to the extent necessary, the disclosure as explicitly presented herein replaces any conflicting material incorporated by reference to the present invention. Any material, or portion thereof, taken as incorporated by reference, but which conflicts with the definitions, statements, or other disclosure materials presented herein will be incorporated here only to the extent that it does not there is a conflict between the embedded material and the existing disclosure material.
[0466] [0466] In summary, numerous benefits have been described that result from the use of the concepts described in this document. Soy beverage-
[0467] [0467] Various aspects of the subject described in this document are defined in the following numbered examples:
[0468] [0468] Example 1. A surgical instrument comprising: an ultrasonic blade, a pivoting arm in relation to the ultrasonic blade between an open position and a closed position, a transducer set coupled to the ultrasonic blade, a sensor configured to detect a position of the arm between the open position and the closed position, and a control circuit coupled to the transducer assembly and the sensor. The transducer set comprises at least two piezoelectric elements configured to oscillate the ultrasonic blade ultrasonically. The control circuit is configured to activate the transducer assembly according to a position of the arm detected by the sensor in relation to a limit position.
[0469] [0469] Example 2. The surgical instrument of Example 1, the first sensor comprising a Hall effect sensor.
[0470] [0470] Example 3. The surgical instrument of Example 2, the arm comprising a magnet detectable by the Hall effect sensor.
[0471] [0471] Example 4. The surgical instrument of Example 2, with the Hall effect sensor being configured to detect a magnet placed on a user.
[0472] [0472] Example 5. The surgical instrument according to any of Examples 1 to 4, the limit position corresponding to the open position.
[0473] [0473] Example 6. The surgical instrument according to any of Examples 1 to 5, the limit position corresponding to the closed position.
[0474] [0474] Example 7. A surgical instrument comprising: an ultrasonic blade, a pivoting arm in relation to the ultrasonic blade between an open position and a closed position, a transducer set coupled to the ultrasonic blade, a first sensor configured for detect a first force as the arm transitions to the closed position, a second sensor configured to detect a second force as the arm transitions to the open position, and a control circuit coupled to the transducer assembly at the first sensor and the second sensor. The transducer set comprises at least two piezoelectric elements configured to oscillate the ultrasonic blade ultrasonically. The control circuit is configured to activate the transducer set according to the first force detected by the first sensor in relation to a first limit and the second force detected by the second sensor in relation to a second limit.
[0475] [0475] Example 8. The surgical instrument of Example 7, the first sensor comprising a humidity sensor.
[0476] [0476] Example 9. The surgical instrument of Example 8, the tactile switch comprising a two-stage tactile switch.
[0477] [0477] Example 10. The surgical instrument of Example 9, the first limit being a second stage of the two-stage tactile switch.
[0478] [0478] Example 11. The surgical instrument of any of Examples 7 to 10, the first sensor being arranged in a housing of the surgical instrument so that the arm rests against it as the arm makes the transition to the position closed.
[0479] [0479] Example 12. The surgical instrument according to any of Examples 7 to 11, the second sensor comprising a tactile switch.
[0480] [0480] Example 13. The surgical instrument of Example 12, the tactile switch comprising a one-stage tactile switch.
[0481] [0481] Example 14. The surgical instrument according to any of Examples 7 to 13, the second limit being a non-zero force.
[0482] [0482] Example 15. The surgical instrument according to any of Examples 7 to 14, the second sensor being arranged adjacent at a point of rotation between the arm and the ultrasonic blade so that the arm rests against the second sensor as the arm transitions to the open position.
[0483] [0483] Example 16. A surgical instrument comprising: an ultrasonic blade, a transducer set coupled to the ultrasonic blade, a sensor configured to detect a force against it, and a control circuit coupled to the transducer set and the sensor. The transducer set comprises at least two piezoelectric elements configured to oscillate the ultrasonic blade ultrasonically. The control circuit is configured to activate the transducer assembly according to the force detected by the sensor in relation to a limit force.
[0484] [0484] Example 17. The surgical instrument of Example 16, the sensor comprising a resistor sensitive to force.
[0485] [0485] Example 18. The surgical instrument of Example 16 or 17, the control circuit being configured to activate the transducer assembly when the force detected by the sensor exceeds the limit force.
[0486] [0486] Example 19. The surgical instrument according to any of Examples 16 to 18, the sensor being disposed on an external surface of the surgical instrument.
[0487] [0487] Example 20. The surgical instrument according to any of Examples 16 to 19, with a sensor output varying according to a degree of force against it and the control circuit is configured to activate the transducer assembly according to the sensor output in relation to a limit representative of the limit force.

权利要求:
Claims (20)
[1]
1. Surgical instrument characterized by comprising: an ultrasonic blade; a pivoting arm in relation to the ultrasonic blade between an open position and a closed position; a transducer set coupled to the ultrasonic blade, the transducer set comprising at least two piezoelectric elements configured to oscillate the ultrasonic blade; a sensor configured to detect an arm position between the open position and the closed position; and a control circuit coupled to the transducer assembly and the sensor, the control circuit being configured to activate the transducer assembly according to a position of the arm detected by the sensor in relation to a limit position.
[2]
2. Surgical instrument according to claim 1, characterized in that the first sensor comprises a Hall effect sensor.
[3]
3. Surgical instrument, according to claim 2, characterized in that the arm comprises a magnet detectable by the Hall effect sensor.
[4]
4. Surgical instrument, according to claim 2, characterized in that the Hall effect sensor is configured to detect a magnet placed on a user.
[5]
5. Surgical instrument, according to claim 1, characterized in that the limit position corresponds to the open position.
[6]
6. Surgical instrument according to claim 1, characterized in that the limit position corresponds to the closed position.
[7]
7. Surgical instrument characterized by comprising: an ultrasonic blade;
a pivoting arm in relation to the ultrasonic blade between an open position and a closed position; a transducer set coupled to the ultrasonic blade, the transducer set comprising at least two piezoelectric elements configured to oscillate the ultrasonic blade; a first sensor configured to detect a first force as the arm transitions to the closed position; a second sensor configured to detect a second force as the arm transitions to the open position; and a control circuit coupled to the transducer assembly, the first sensor and the second sensor, the control circuit being configured to activate the transducer assembly according to the first force detected by the first sensor in relation to a first limit and the second force detected by the second sensor in relation to a second limit.
[8]
Surgical instrument according to claim 7, characterized in that said first sensor comprises a tactile switch.
[9]
9. Surgical instrument according to claim 8, characterized in that the tactile switch comprises a two-stage tactile switch.
[10]
10. Surgical instrument according to claim 9, characterized in that the first limit corresponds to a second stage of the two-stage tactile switch.
[11]
11. Surgical instrument according to claim 7, characterized in that the first sensor is arranged in a housing of the surgical instrument so that the arm rests against it as the arm transitions to the closed position.
[12]
12. Surgical instrument according to claim 7, characterized in that the second sensor comprises a tactile switch.
[13]
Surgical instrument according to claim 12, characterized in that the tactile wrench comprises a one-stage tactile wrench.
[14]
14. Surgical instrument according to claim 7, characterized in that the second limit corresponds to a force other than zero.
[15]
15. Surgical instrument according to claim 7, characterized in that the second sensor is disposed adjacent to a point of rotation between the arm and the ultrasonic blade so that the arm rests against the second sensor as the arm makes the transition position to the open position.
[16]
16. Surgical instrument characterized by comprising: an ultrasonic blade; a transducer set coupled to the ultrasonic blade, the transducer set comprising at least two piezoelectric elements configured to oscillate the ultrasonic blade; a sensor configured to detect a force against it; and a control circuit coupled to the transducer assembly and the sensor, the control circuit being configured to activate the transducer assembly according to the force detected by the sensor in relation to a limit force.
[17]
17. Surgical instrument according to claim 16, characterized in that the sensor comprises a resistor sensitive to force.
[18]
18. Surgical instrument, according to claim 16, characterized in that the control circuit is configured to activate the transducer assembly when the force detected by the sensor exceeds the limit force.
[19]
19. Surgical instrument, according to claim 16, characterized in that the sensor is disposed on an external surface of the surgical instrument.
[20]
20. Surgical instrument according to claim 16, characterized in that: a sensor output varies according to a degree of force against it; and the control circuit is configured to activate the transducer assembly according to the sensor output in relation to a limit representative of the limit force.

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同族专利:

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公开号 | 公开日

---

EP3505098B1|2020-07-29|

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WO2019134007A1|2019-07-04|

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US20190201041A1|2019-07-04|

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