sterile field interactive control screens

专利摘要:
the present invention relates to an interactive control unit. the interactive control unit includes an interactive touch screen, an interface configured to couple the control unit to a central surgical controller, a processor, and memory attached to the processor. memory stores instructions executable by the processor to receive input commands from the interactive touch screen located within a sterile field and transmit the input commands to the central surgical controller to control devices attached to the central surgical controller located outside the field sterile.
公开号:BR112020013075A2
申请号:R112020013075-3
申请日:2018-07-31
公开日:2020-12-01
发明作者:Jeffrey D. Messerly；Frederick E. Shelton Iv；Jerome R. Morgan；Peter K. Shires；Monica L. Rivard；Cory G. Kimball；David C. Yates；Jeffrey L. Aldridge；Daniel W. Price；William B. Weisenburgh Ii；Jason L. Harris
申请人:Ethicon Llc；
IPC主号:

专利说明:

[0001] [0001] The present application claims priority under 35 U.S.C. 119(e) to US Provisional Patent Application No. 62/649,309 entitled
[0002] [0002] The present application claims priority under 35 USC 119(e) to US Provisional Patent Application Serial No. 62/611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed December 28, 2017, to US Provisional Patent Application No. series 62/611,340, entitled CLOUD-BASED MEDICAL ANALYTICS, filed on December 28, 2017, and to the provisional US patent application serial number 62/611,339, entitled ROBOT ASSISTED SURGICAL PLATFORM, filed on December 28, 2017, with the description of each of which is hereby incorporated by reference in their entirety. BACKGROUND
[0003] [0003] The present invention relates to various surgical systems. Surgical procedures are typically performed in operating rooms or operating rooms in a healthcare facility such as a hospital. A sterile field is typically created around the patient. The sterile field may include brushing team members, who are appropriately dressed, and all furniture and fixtures in the area. Various surgical devices and systems are used in performing a surgical procedure. SUMMARY
[0004] [0004] In a general aspect, an interactive control unit is provided. The interactive control unit comprises an interactive touch screen, an interface configured to couple the control unit to a central surgical controller, a processor and a memory attached to the processor. Memory that stores instructions executable by the processor to receive input commands from the interactive touch screen located within a sterile field and transmit the input commands to the central surgical controller to control devices coupled to the central surgical controller located outside the sterile field.
[0005] [0005] In another general aspect, an interactive control unit is provided. The interactive control unit comprises an interactive control unit, an interactive touch screen, an interface configured to couple the control unit to a first central surgical controller, a processor and a memory coupled to the processor. Memory that stores instructions executable by the processor to receive input commands from the interactive touch screen located within a sterile field, transmit the input commands to the central surgical controller to control devices coupled to the central surgical controller located outside the sterile field, receive an inquiry request from a second central surgical controller and configure a portion of the interactive touch screen to show information received from the second central surgical controller after receiving the inquiry request.
[0006] [0006] In another general aspect, an interactive control unit is provided. The interactive control unit comprises an interactive touch screen, an interface configured to couple the control unit to a central surgical controller; and a control circuit for: receiving input commands from the interactive touch screen located within a sterile field and transmitting the input commands to the central surgical controller to control devices coupled to the central surgical controller located outside the sterile field. FIGURES
[0007] [0007] The appeals of various aspects are presented with particularity in the attached claims. The various aspects, however, as regards both organization and methods of operation, together with objects and additional advantages thereof, may be better understood by referring to the description given below, considered in conjunction with the attached drawings. , as follows.
[0008] [0008] Figure 1 is a block diagram of an interactive computer-implemented surgical system, in accordance with at least one aspect of the present invention.
[0009] [0009] Figure 2 is a surgical system being used to perform a surgical procedure in an operating room, in accordance with at least one aspect of the present invention.
[0010] [0010] Figure 3 is a central surgical controller paired with a visualization system, a robotic system, and an intelligent instrument, in accordance with at least one aspect of the present invention.
[0011] [0011] Figure 4 is a partial perspective view of a central surgical controller housing, and a combined generator module slidably received in a central surgical controller housing, in accordance with at least one aspect of the present invention.
[0012] [0012] Figure 5 is a perspective view of a generator module in combination with bipolar, ultrasonic and monopolar contacts and a smoke evacuation component, in accordance with at least one aspect of the present invention.
[0013] [0013] Figure 6 illustrates different power bus connectors for a plurality of side-coupled ports of a modular side cabinet configured to receive a plurality of modules, in accordance with at least one aspect of the present invention.
[0014] [0014] Figure 7 illustrates a modular vertical cabinet configured to receive a plurality of modules, in accordance with at least one aspect of the present invention.
[0015] [0015] Figure 8 illustrates a surgical data network comprising a central modular communication controller configured to connect modular devices situated in one or more operating rooms of a healthcare facility, or any environment in a public service facility. specially equipped for surgical, cloud operations, in accordance with at least one aspect of the present invention.
[0016] [0016] Figure 9 illustrates a computer-implemented interactive surgical system, in accordance with at least one aspect of the present invention.
[0017] [0017] Figure 10 illustrates a central surgical controller comprising a plurality of modules coupled to the modular control tower, in accordance with at least one aspect of the present invention.
[0018] [0018] Figure 11 illustrates an aspect of a universal serial bus (USB) network central controller device, in accordance with at least one aspect of the present invention.
[0019] [0019] Figure 12 illustrates a logic diagram of a surgical instrument or tool control system, according to at least one aspect of the present invention.
[0020] [0020] Figure 13 illustrates a control circuit configured to control aspects of the surgical instrument or tool, in accordance with at least one aspect of the present invention.
[0021] [0021] Figure 14 illustrates a combinational logic circuit configured to control aspects of the surgical instrument or tool, in accordance with at least one aspect of the present invention.
[0022] [0022] Figure 15 illustrates a sequential logic circuit configured to control aspects of the surgical instrument or tool, in accordance with at least one aspect of the present invention.
[0023] [0023] Figure 16 illustrates a surgical instrument or tool comprising a plurality of motors that can be activated to perform various functions, in accordance with at least one aspect of the present invention.
[0024] [0024] Figure 17 is a schematic diagram of a robotic surgical instrument configured to operate a surgical tool described therein, in accordance with at least one aspect of the present invention.
[0025] [0025] Figure 18 illustrates a block diagram of a surgical instrument programmed to control distal translation of the displacement member, in accordance with an aspect of the present invention.
[0026] [0026] Figure 19 is a schematic diagram of a surgical instrument configured to control various functions, in accordance with at least one aspect of the present invention.
[0027] [0027] Figure 20 is a simplified block diagram of a generator configured to provide inductorless tuning, among other benefits, in accordance with at least one aspect of the present invention.
[0028] [0028] Figure 21 illustrates an example of a generator, which is a form of the generator of Figure 20, in accordance with at least one aspect of the present invention.
[0029] [0029] Figure 22 illustrates a diagram of a surgical instrument centered on a linear staple transection line that makes use of the benefit of centering tools and techniques described in connection with Figures 23 to 35, in accordance with at least one aspect of the present invention.
[0030] [0030] Figures 23 to 25 illustrate a process of aligning an anvil trocar of a circular stapler to a staple overlap portion of a linear staple line created by a double stapling technique, in accordance with at least one aspect of the present invention, wherein:
[0031] [0031] Figure 23 illustrates an anvil trocar of a circular stapler that is not aligned with an overlapping staple portion of a linear staple line created by a double stapling technique;
[0032] [0032] Figure 24 illustrates an anvil trocar of a circular stapler that is aligned with the center of the staple overlap portion of the linear staple line created by a double stapling technique; and
[0033] [0033] Figure 25 illustrates a centering tool shown on a central surgical controller screen showing a staple overlap portion of a linear staple line created by a double stapling technique being cut by a circular stapler, where the anvil trocar is not aligned with the staple overlap portion of the double staple row as shown in Figure 23.
[0034] [0034] Figures 26 and 27 illustrate a before image and an after image of a centering tool, in accordance with at least one aspect of the present invention, wherein:
[0035] [0035] Figure 26 illustrates an image of a projected cutting path of an anvil trocar and circular knife prior to alignment with the target alignment ring which circumscribes the linear staple line image over the image of the overlapping portion of staples presented on a central surgical controller screen; and
[0036] [0036] Figure 27 illustrates an image of a projected cutting path of an anvil trocar and circular knife after alignment with the target alignment ring which circumscribes the linear staple line image over the image of the overlapping portion of staples displayed on a central surgical controller screen.
[0037] [0037] Figures 28 to 30 illustrate a process of aligning an anvil trocar of a circular stapler to a center of a linear staple row, in accordance with at least one aspect of the present invention, wherein:
[0038] [0038] Figure 28 illustrates the anvil trocar out of alignment with the center of the linear staple line;
[0039] [0039] Figure 29 illustrates the anvil trocar in alignment with the center of the linear staple line; and
[0040] [0040] Figure 30 illustrates a centering tool shown on a central surgical controller screen of a linear staple row, where the anvil trocar is not aligned with the staple overlap portion of the double staple row as shown in Fig. Figure 28.
[0041] [0041] Figure 31 is an image of a standard reticle field view of a linear staple line transection of a surgical instrument as viewed through a laparoscope shown on the central surgical controller screen, according to at least one aspect of the present invention.
[0042] [0042] Figure 32 is an image of a laser-assisted reticle field of view of the surgical site shown in Figure 31 before the anvil trocar and circular stapler circular knife are aligned to the center of the linear staple line, so according to at least one aspect of the present invention.
[0043] [0043] Figure 33 is an image of a laser-assisted reticle field of view of the surgical site shown in Figure 32 after the anvil trocar and circular stapler circular knife are aligned to the center of the linear staple line, so according to at least one aspect of the present invention.
[0044] [0044] Figure 34 illustrates a non-contact inductive sensor implementation of a non-contact sensor for determining an anvil trocar location relative to the center of a staple line transection, in accordance with at least one aspect of the present invention.
[0045] [0045] Figures 35A and 35B illustrate one aspect of a non-contact capacitive sensor implementation of the non-contact sensor to determine an anvil trocar location relative to the center of a staple line transection, according to at least one aspect of the present invention, wherein:
[0046] [0046] Figure 35A shows the non-contact capacitive sensor without a nearby metal target; and
[0047] [0047] Figure 35B shows the non-contact capacitive sensor close to a metal target.
[0048] [0048] Figure 36 is a logic flow diagram of a process representing a control program or a logic configuration for aligning a surgical instrument, in accordance with at least one aspect of the present invention.
[0049] [0049] Figure 37 illustrates a primary screen of the central surgical controller comprising a local and global screen, in accordance with at least one aspect of the present invention.
[0050] [0050] Figure 38 illustrates a primary screen of the central surgical controller, in accordance with at least one aspect of the present invention.
[0051] [0051] Figure 39 illustrates a grip stabilization sequence for a period of five seconds, in accordance with at least one aspect of the present invention.
[0052] [0052] Figure 40 illustrates a diagram of four separate wide-angle views of a surgical site at four separate times during the procedure, in accordance with at least one aspect of the present invention.
[0053] [0053] Figure 41 is a graph of fabric strain grip stabilization curves for two types of fabric, in accordance with at least one aspect of the present invention.
[0054] [0054] Figure 42 is a time-dependent proportional fill graph of a grip force stabilization curve, in accordance with at least one aspect of the present invention.
[0055] [0055] Figure 43 is a graph of the role of tissue deformation in the grip force stabilization curve, in accordance with at least one aspect of the present invention.
[0056] [0056] Figures 44A and 44B illustrate two graphs for determining when the trapped fabric has reached deformation stability, in accordance with at least one aspect of the present invention, wherein:
[0057] [0057] Figure 44A illustrates a curve representing a tangent vector angle d8 as a function of time; and
[0058] [0058] Figure 44B illustrates a curve representing change in force-to-close (AFTC - force-to-close) as a function of time.
[0059] [0059] Figure 45 illustrates an example of an enlarged video image of an enlarged preoperative video image with data identifying elements shown, in accordance with at least one aspect of the present invention.
[0060] [0060] Figure 46 is a logic flow diagram of a process representing a control program or a logic configuration for displaying images, in accordance with at least one aspect of the present invention.
[0061] [0061] Figure 47 illustrates a communication system comprising an intermediate signal combiner positioned in the communication path between an imaging module and a central surgical controller screen, in accordance with at least one aspect of the present invention.
[0062] [0062] Figure 48 illustrates a standalone interactive headset used by a surgeon to communicate data to the central surgical controller, in accordance with an aspect of the present invention.
[0063] [0063] Figure 49 illustrates a method for controlling the use of a device, in accordance with at least one aspect of the present invention, in accordance with at least one aspect of the present invention.
[0064] [0064] Figure 50 illustrates a surgical system that includes a handle that has a controller and motor, an adapter releasably coupled to the handle, and a charging unit releasably coupled to the adapter, in accordance with at least one aspect of the present invention.
[0065] [0065] Figure 51 illustrates an Automated Endoscopic System for Optimal Positioning (AESOP) camera positioning system, in accordance with at least one aspect of the present invention.
[0066] [0066] Figure 52 illustrates a multifunctional surgical control system and a switching interface for virtual operating room integration, in accordance with at least one aspect of the present invention.
[0067] [0067] Figure 53 illustrates a diagram of a combined beam detector and beam source system used as a device control mechanism in an operating room, in accordance with at least one aspect of the present invention.
[0068] [0068] Figures 54A to E illustrate various types of sterile field data entry and control consoles, in accordance with at least one aspect of the present invention, wherein:
[0069] [0069] Figure 54A illustrates a single zone sterile field control and data entry console;
[0070] [0070] Figure 54B illustrates a multi-zone sterile field control and data entry console;
[0071] [0071] Figure 54C illustrates an anchored sterile field control and data entry console;
[0072] [0072] Figure 54D illustrates a battery operated sterile field control and data entry console; and
[0073] [0073] Figure 54E illustrates a battery operated sterile field control and data entry console.
[0074] [0074] Figures 55A to 55B illustrate a sterile field console in use in a sterile field during a surgical procedure, in accordance with at least one aspect of the present invention, wherein:
[0075] [0075] Figure 55A shows the sterile field console positioned in the sterile field next to two surgeons involved in an operation; and
[0076] [0076] Figure 55B shows one of the surgeons touching the sterile field console touch screen.
[0077] [0077] Figure 56 illustrates a process for accepting query feed streams from another operating room, in accordance with at least one aspect of the present invention.
[0078] [0078] Figure 57 illustrates a standard technique for estimating vessel trajectory and depth and device trajectory, in accordance with at least one aspect of the present invention.
[0079] [0079] Figures 58A to 58D illustrate multiple real-time views of images of a virtual anatomical detail for dissection, in accordance with at least one aspect of the present invention, wherein:
[0080] [0080] Figure 58A is a perspective view of the virtual anatomical detail;
[0081] [0081] Figure 58C is a side view of the virtual anatomical detail;
[0082] [0082] Figure 58B is a perspective view of the virtual anatomical detail; and
[0083] [0083] Figure 58D is a side view of the virtual anatomical detail.
[0084] [0084] Figures 59A and 59B illustrate a touch-sensitive screen that can be used in the sterile field, in accordance with at least one aspect of the present invention, wherein:
[0085] [0085] Figure 59A illustrates an image of a surgical site shown on a touch screen in portrait mode;
[0086] [0086] Figure 59B shows the touch screen rotated in landscape mode and the surgeon uses his index finger to scroll the image in the direction of the arrows;
[0087] [0087] Figure 59C shows the surgeon using his index finger and thumb to open the image by pinching in the direction of the arrows to zoom in;
[0088] [0088] Figure 59D shows the surgeon using his index finger and thumb to close the image by pinching in the direction of the arrows to zoom out; and
[0089] [0089] Figure 59E shows the touch screen rotated in two directions indicated by arrows to allow the surgeon to view the image in different orientations.
[0090] [0090] Figure 60 illustrates a surgical site employing a smart retractor that comprises a direct interface control to a central surgical controller, in accordance with at least one aspect of the present invention.
[0091] [0091] Figure 61 illustrates a surgical site with a smart flexible adhesive fabric attached to a patient's body, in accordance with at least one aspect of the present invention.
[0092] [0092] Figure 62 is a logic flow diagram of a process that represents a control program or a logic configuration to communicate from inside a sterile field to a device located outside the sterile field, according to at least one aspect of the present invention.
[0093] [0093] Figure 63 illustrates a system for performing surgery, in accordance with at least one aspect of the present invention.
[0094] [0094] Figure 64 illustrates a second layer of information overlaying a first layer of information, in accordance with at least one aspect of the present invention.
[0095] [0095] Figure 65 represents a perspective view of a surgeon using a surgical instrument that includes a grip assembly cabinet and a wireless circuit board during a surgical procedure, with the surgeon wearing a set of safety glasses, in according to at least one aspect of the present invention.
[0096] [0096] Figure 66 is a schematic diagram of a feedback control system for controlling a surgical instrument, in accordance with at least one aspect of the present invention.
[0097] [0097] Figure 67 illustrates a feedback controller that includes an on-screen display module and a heads up display (HUD) module, in accordance with at least one aspect of the present invention.
[0098] [0098] Figure 68 is a timeline depicting situational awareness of a central surgical controller, in accordance with at least one aspect of the present invention. DESCRIPTION
[0099] [0099] The applicant of this application holds the following US provisional patent applications, filed on March 28, 2018, each of which is incorporated herein by reference in its entirety: * US Provisional Patent Application No. series 62/649,302, entitled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES;
[0100] [0100] The applicant of the present application holds the following US patent applications, filed on March 29, 2018, each of which is incorporated herein by reference in its entirety: * US patent application serial no., titled INTERACTIVE —SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES; attorney's document no. END8499USNP/170766; * US patent application serial number entitled INTERACTIVE
[0101] [0101] The applicant of the present application holds the following US patent applications, filed on March 29, 2018, each of which is incorporated herein by reference in its entirety: * US patent application serial no., entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES; attorney's document no. END8506USNP/170773; * US patent application serial no. entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL HUBS; attorney's document no. END8506USNP1/170773-1; * US Patent Application Serial No., entitled CLOUD-
[0102] [0102] The applicant of the present application holds the following US patent applications, filed on March 29, 2018, each of which is incorporated herein by reference in its entirety: * US Patent Application Serial No., entitled DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL
[0103] [0103] Before explaining in detail the various aspects of surgical instruments and generators, it should be noted that the illustrative examples are not limited, in terms of application or use, to the details of construction and arrangement of parts illustrated in the drawings and description. attached. The illustrative examples may be implemented or incorporated in other aspects, variations and modifications, and may be practiced or performed in various ways. Furthermore, unless otherwise indicated, the terms and expressions used in the present invention have been chosen for the purpose of describing the illustrative examples for the convenience of the reader and not for the purpose of limiting the same. Further, it will be recognized that one or more of the aspects, aspect expressions and/or examples described below may be combined with any one or more of the other aspects, aspect expressions and/or examples described below.
[0104] [0104] Referring to Figure 1, a computer-implemented interactive surgical system 100 includes one or more surgical systems 102 and a cloud-based system (e.g., cloud 104 which may include a remote server 113 coupled to a storage device 105). Each surgical system 102 includes at least one central surgical controller 106 communicating with the cloud 104 which may include a remote server 113. In one example, as illustrated in Figure 1, the surgical system 102 includes a visualization system 108, a robotic system 110, a handheld surgical instrument and smart 112, which are configured to communicate with each other and/or the central controller 106. In some aspects, a surgical system 102 may include a number M of central controllers 106, a number N of visualization systems 108, a number O of robotic systems 110, and a number P of smart, hand-held surgical instruments 112, where M, N, O, and P are integers greater than or equal to one.
[0105] [0105] 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 the surgical procedure as a part of the surgical system 102. The robotic system 110 includes a surgeon console 118, a patient carriage 120 (surgical robot), and a surgical robotic central controller
[0106] [0106] Other types of robotic systems can be readily adapted for use with the Surgical System 102. Several examples of robotic systems and surgical instruments that are suitable for use with the present invention are described in Provisional Patent Application Serial No. 62/611,339 , entitled ROBOT ASSISTED SURGICAL PLATFORM, filed on December 28, 2017, the description of which is incorporated herein by reference in its entirety.
[0107] [0107] Several examples of cloud-based analysis that are performed by cloud 104, and suitable for use with the present invention, are described in US Provisional Patent Application Serial No. 62/611,340 entitled CLOUD-BASED MEDICAL ANALYTICS, filed on December 28, 2017, the description of which is incorporated herein by reference, in its entirety.
[0108] [0108] In various aspects, the imaging device 124 includes at least an image sensor and one or more optical components. Suitable image sensors include, but are not limited to, Charge-Coupled Device (CCD) sensors and Complementary Metal-Oxide Semiconductor (CMOS) semiconductor sensors.
[0109] [0109] 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 may receive reflected or refracted light from the surgical field, including reflected or refracted light from tissue and/or surgical instruments.
[0110] [0110] The one or more lighting sources can be configured to radiate electromagnetic energy in the visible spectrum as well as the invisible spectrum. The visible spectrum, sometimes called the optical spectrum or light spectrum, is that portion of the electromagnetic spectrum that is visible to (that is, can be detected by) the human eye and may be called visible light or simply light. A typical human eye will respond to wavelengths in air that are from about 380 nm to about 750 nm.
[0111] [0111] The invisible spectrum (ie the non-luminous spectrum) is that portion of the electromagnetic spectrum lying below and above the visible spectrum (ie wavelengths below about 380 nm and above about 750 nm). The invisible spectrum is not detectable by the human eye. Wavelengths longer than about 750 nm are longer than the visible red spectrum, and they become invisible infrared (IR), microwave, radio, and electromagnetic radiation. Wavelengths shorter than about 380 nm are shorter than the ultraviolet spectrum, and they become invisible ultraviolet, x-ray, and gamma-ray electromagnetic radiation.
[0112] [0112] In many respects, the imaging device 124 is configured for use in a minimally invasive procedure. Examples of imaging devices suitable for use with the present invention include, but are not limited to, an arthroscope, angioscope, bronchoscope, choledochoscope, colonoscope, cytoscope, duodenoscope, enteroscope, esophagus-duodenoscope (gastroscope), endoscope, laryngoscope, nasopharyngo- neproscope, sigmoidoscope, thoracoscope, and ureteroscope.
[0113] [0113] In one aspect, the imaging device employs multi-spectrum monitoring to discriminate topography and underlying structures. A multispectral image is one that captures image data within wavelength ranges along the electromagnetic spectrum. The wavelengths can be separated by filters or through the use of instruments that are sensitive to specific wavelengths, including light of frequencies beyond the visible light range, eg IR and ultraviolet light. Spectral imaging can make it possible to extract additional information that the human eye cannot capture with its red, green, and blue color receptors. The use of multispectral imaging is described in greater detail under the title "Advanced Imaging Acquisition Module" in US Provisional Patent Application Serial No. document incorporated by way of 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 described above on treated tissue.
[0114] [0114] 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 a "operating room", that is, an operating or treatment room, justify the highest possible sterilization of all medical devices and equipment. Part of this sterilization process is the need to sterilize anything that comes into contact with the patient or enters the sterile field, including the imaging device 124 and its connectors and components. It will be recognized that the sterile field may be considered a specified area, such as inside a tray or on a sterile towel, which is considered to be free of microorganisms, or the sterile field may be considered an area, immediately around a patient, who was prepared for a surgical procedure. The sterile field may include brushing team members, who are appropriately dressed, and all furniture and fixtures in the area.
[0115] [0115] In various aspects, the visualization system 108 includes one or more imaging sensors, one or more image processing units, one or more storage arrays and one or more screens that are strategically arranged with respect to the sterile field, as illustrated in Figure 2. In one aspect, the display system 108 includes an interface for HL7, PACS and EMR. Various components of the visualization system 108 are described under the title "Advanced Imaging Acquisition Module" in US Provisional Patent Application Serial No. 62/611,341 entitled INTERACTIVE SURGICAL PLATFORM, filed December 28, 2017, the description of which is herein incorporated by way of reference in its entirety.
[0116] [0116] As illustrated in Figure 2, a primary screen 119 is positioned in the sterile field to be visible to the operator at the operating table 114. In addition, a viewing tower 111 is positioned outside the sterile field. Viewing tower 111 includes a first non-sterile screen 107 and a second non-sterile screen 109, which are opposite each other. The display system 108, guided by the central controller 106, is configured to use the screens 107,
[0117] [0117] In one aspect, the central controller 106 is also configured to route diagnostic input or feedback by a non-sterile operator at the viewing tower 111 to the primary screen 119 within the sterile field, where it can be viewed by an operator. sterile on the operating table. In one example, the input may be in the form of a modification of the snapshot shown on non-sterile screen 107 or 109, which may be routed to primary screen 119 by central controller 106.
[0118] [0118] With reference to Figure 2, a surgical instrument 112 is being used in the surgical procedure as part of the surgical system
[0119] [0119] Now referring to Figure 3, a central controller 106 is shown in communication with a display system 108, a robotic system 110 and a handheld smart surgical instrument 112. The 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 array 134. In certain aspects, as illustrated in Figure 3, the central controller 106 additionally includes a smoke evacuation module. 126 and/or a suction/irrigation module 128.
[0120] [0120] During a surgical procedure, the application of energy to the tissue, for sealing and/or cutting, is usually 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 lost 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 136 central controller's modular enclosure provides a unified environment to manage power, data, and fluid lines, which reduces the frequency of interleaving between such lines.
[0121] [0121] Aspects of the present invention feature a central surgical controller for use in a surgical procedure that involves application of energy to tissue at a surgical site. The central surgical controller includes a central controller housing and a combination generator module slidably received in a docking station of the central controller housing. The docking station includes data and power contacts. The combined generator module includes two or more of 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 supply cable for connecting the combined generator module to a surgical instrument, at least one smoke evacuation component configured to evacuate smoke, fluid , and/or the particulates generated by the application of therapeutic energy to tissue, and a fluid line extending from the remote surgical site to the smoke evacuation component.
[0122] [0122] In one aspect, the fluid line is a first fluid line and a second fluid line extends from the remote surgical site to a suction and irrigation module slidably received in the central controller compartment. In one aspect, the central controller housing comprises a fluid interface.
[0123] [0123] 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 tissue, while a different type of energy may be more beneficial for sealing tissue. For example, a bipolar generator can be used to seal tissue while an ultrasonic generator can be used to cut sealed tissue. Aspects of the present invention 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 136 central controller modular bay is that it allows for quick removal and/or replacement of multiple modules.
[0124] [0124] Aspects of the present invention feature a modular surgical compartment for use in a surgical procedure that involves application of energy to tissue. The modular surgical compartment includes a first power generating module configured to generate a first power for application to tissue, and a first docking station comprising a first docking port that includes first data and power contacts, the first module being power generator is slidingly movable into electrical engagement with the power and data contacts and the first power generating module being slidingly movable out of electrical engagement with the first power and data contacts.
[0125] [0125] In addition to the above, the modular surgical compartment also includes a second power generator module configured to generate a second power, different from the first power, for application to tissue, and a second docking station comprising a second docking port. which includes second data and power contacts, the second power generating module being slidingly movable into electrical engagement with the power and data contacts and the second power generating module being slidingly movable out of the electrical coupling with the second power and data contacts.
[0126] [0126] In addition, the modular surgical compartment also includes a communication bus between the first docking port and the second docking port, configured to facilitate communication between the first power generating module and the second power generating module.
[0127] [0127] With reference to Figures 3 to 7, aspects of the present invention 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 module. 128. The modular central controller housing 136 further facilitates interactive communication between modules 140, 126,
[0128] [0128] In one aspect, the central controller modular housing 136 comprises a modular power and communication backplane 149 with external and wireless communication heads to enable removable attachment of modules 140, 126, 128 and interactive communication between the modules. same.
[0129] [0129] In one aspect, the central controller modular housing 136 includes docking stations, or drawers, 151, herein also referred to as drawers, which are configured to slidably receive modules 140, 126, 128. Figure 4 illustrates a partial perspective view of a central surgical controller housing 136, and a combined generator module 145 slidably received in a docking station 151 of the central surgical controller housing 136. A docking port 152 with power and power contacts data on a rear side of the combined generator module 145 is configured to engage a matching docking port 150 with the power and data contacts of a matching docking station 151 of the central controller modular compartment 136 as the combined generator module 145 is slid into the position in the corresponding docking station 151 of the central controller modular compartment
[0130] [0130] In various aspects, the smoke evacuation module 126 includes a fluid line 154 that transports trapped smoke/fluid collected away from a surgical site and to, for example, the smoke evacuation module 126. The vacuum source originating from the smoke evacuation module 126 can draw smoke into an opening of a utility conduit in the surgical site. The utility conduit, coupled to the fluid line, may be in the form of a flexible tube terminating at the smoke evacuation module 126. The utility conduit and fluid line define a fluid path that extends toward the smoke evacuation module 126 which is received in the central controller compartment 136.
[0131] [0131] In various 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 cause irrigation and aspiration of fluids to and from the surgical site.
[0132] [0132] In one aspect, the surgical tool includes a drive shaft that has an end actuator at a distal end thereof and at least one energy treatment associated with the end actuator, a suction tube, and a suction tube. irrigation. The suction tube may have an inlet port at a distal end thereof and the suction tube extends through the drive shaft. Similarly, an irrigation tube may extend through the drive shaft and may have an inlet port near the power application implement. The power delivery implement is configured to deliver ultrasonic and/or RF power to the surgical site and is coupled to generator module 140 by a cable initially extending through the drive shaft.
[0133] [0133] The irrigation tube can be in fluid communication with a source of fluid, and the suction tube can be in fluid communication with a source of vacuum. The fluid source and/or the vacuum source may be housed in the suction/irrigation module 128. In one example, the fluid source and/or the vacuum source may be housed in the central controller compartment 136 separately from the vacuum module. suction/irrigation 128. In such an example, a fluid interface may be configured to connect the suction/irrigation module 128 to the fluid source and/or the vacuum source.
[0134] [0134] In one aspect, the modules 140, 126, 128 and/or their corresponding docking stations in the central controller modular bay 136 may include alignment features that are configured to align the docking ports of the modules in engagement with their counterparts in the docking stations of the central controller modular compartment 136. For example, as illustrated in Figure 4, the combined generator module 145 includes side brackets 155 which are configured to slidably engage the corresponding brackets 156 of the corresponding docking station 151 of the compartment. central controller module 136. The brackets cooperate to guide the coupling port contacts of the combined generator module 145 into electrical engagement with the coupling port contacts of the central controller modular compartment 136.
[0135] [0135] In some respects, the units 151 of the central controller modular compartment 136 are the same or substantially the same size, and the modules are adjusted in size to be received in the units 151. For example, the side brackets 155 and/or or 156 can be larger or smaller depending on the module size. In other respects, the 151 drawers are different in size and are each designed to accommodate a specific module.
[0136] [0136] Additionally, the contacts of a specific module can be keyed to engage with the contacts of a specific unit to avoid inserting a module into a unit with contact mismatch.
[0137] [0137] As illustrated 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 modules housed in the modular compartment of the central controller 136. The docking ports 150 of the modular housing of the central controller 136 may alternatively or additionally facilitate interactive wireless communication between modules housed in the modular housing of the central controller 136. Any suitable wireless communication may be used, such as Air Titan Bluetooth.
[0138] [0138] Figure 6 illustrates individual power bus connectors for a plurality of side docking ports of a modular side cabinet 160 configured to receive a plurality of modules from a central surgical controller 206. The modular side cabinet 160 is configured to receive and laterally interconnect the modules 161. The modules 161 are slidably inserted into the docking stations 162 of the modular side cabinet 160, which includes a backplate for interconnecting the modules 161. As illustrated in Figure 6, the modules 161 are disposed laterally. in the side modular cabinet
[0139] [0139] Figure 7 illustrates a vertical modular cabinet 164 configured to receive a plurality of modules 165 from the central surgical controller 106. The modules 165 are slidably inserted into docking stations, or drawers, 167 of the vertical modular cabinet 164, the which includes a back panel for interconnecting modules 165. Although the drawers 167 of the vertical modular cabinet 164 are arranged vertically, in certain cases, a modular vertical cabinet 164 may include drawers that are arranged laterally. In addition, the modules 165 can interact with each other through the docking ports of the vertical modular cabinet 164. In the example of Figure 7, a screen 177 is provided to show data relevant to the operation of the modules.
[0140] [0140] In various aspects, 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 cabinet that can be assembled with a light source module and a camera module. The cabinet can be a disposable cabinet. In at least one example, the disposable case is detachably coupled to a reusable controller, a light source module, and a camera module. The light source module and/or the camera module can be selectively chosen 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 to image the scanned beam. Similarly, the light source module can be configured to provide either a white light or a different light depending on the surgical procedure.
[0141] [0141] 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 other light source may be inefficient. Temporarily losing sight of the surgical field can lead to undesirable consequences. The imaging device module of the present invention is configured to allow 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.
[0142] [0142] In one aspect, the imaging device comprises a tubular housing that includes a plurality of channels. A first channel is configured to slide in the camera module, which can be configured to snap-fit with the first channel. A second channel is configured to slide-receive the camera module, which can be configured to 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 hitch can be used instead of a snap fit.
[0143] [0143] In several examples, multiple imaging devices are placed in different positions in the surgical field to provide multiple views. The imaging module 138 can be configured to switch between imaging devices to provide an optimal view. In various aspects, the imaging module 138 can be configured to integrate images from different imaging devices.
[0144] [0144] Various image processors and imaging devices suitable for use with the present invention are described in US Patent No. 7,995,045 entitled COMBINED SBI AND CONVENTIONAL IMAGE PROCESSOR, issued August 9, 2011 which is incorporated herein by title 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 motion artifacts. of the image data. Such systems can be integrated with the imaging module 138. In addition to these, the publication of US patent application No. 2011/0306840, entitled
[0145] [0145] Figure 8 illustrates a surgical data network 201 comprising a central modular communication controller 203 configured to connect modular devices situated in one or more operating rooms of a healthcare facility, or any environment in a healthcare facility. utilities specially equipped for surgical operations, to a cloud-based system (e.g., cloud 204 which may include a remote server 213 coupled to a storage device 205). In one aspect, the modular communication central controller 203 comprises a network central controller 207 and/or a network switch 209 in communication with a network router. The modular communication central controller 203 may 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 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 for enabling traffic to pass through the surgical data network to be monitored and for configuring each port on the network central controller 207 or network switch 209. An intelligent surgical data network may be called an intelligent surgical data network. a central controller or controllable switch. A central switching controller reads the destination address of each packet and then forwards the packet to the correct port.
[0146] [0146] Modular devices 1a to 1n located in the operating room can be coupled to the central modular communication controller
[0147] [0147] It will be recognized that the surgical data network 201 may be expanded by interconnecting the multiple network central controllers 207 and/or the multiple network switches 209 with multiple network routers 211. The modular communication central controller 203 may be contained in a modular control tower configured to receive multiple 1a to 1n/2a to 2m devices. The local computer system 210 may 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 various aspects, devices 1a to 1n/2a to 2m may include, for example, various modules such as an imaging module 138 coupled to an endoscope, a generator module 140 coupled to a power-based surgical device, an evacuation module 126, a suction/irrigation module 128, a communication module 130, a processor module 132, a storage array 134, a screen-coupled surgical device, and/or a non-contact sensor module, among others. modular devices that can be connected to the central modular communication controller 203 of the surgical data network 201.
[0148] [0148] In one aspect, the surgical data network 201 may comprise a combination of central network controllers, network switches, and network routers that connect 1a to 1n/2a to 2m devices to the cloud. Any or all of the 1a to 1n/2a to 2m devices coupled to the central network controller or network switch can collect data in real time and transfer the data to cloud computers for data processing and manipulation. It will be recognized that cloud computing relies on sharing computing resources rather than having local servers or personal devices to handle software applications. The word "cloud" can be used as a metaphor for "the Internet", although the term is not limited as such. Consequently, the term "cloud computing" may be used in this document to refer to "a type of Internet-based computing", in which different services — such as servers, storage, and applications — are applied to the central modular communication controller. 203 and/or computer system 210 located in the operating room (e.g., a fixed, mobile, temporary, or field operating room or space) and devices connected to the central modular communication controller 203 and/or the computer system 210 over the Internet. The cloud infrastructure may be maintained by a cloud service provider. In this context, the cloud service provider may be the entity that coordinates the use and control of 1a to 1n/2a to 2m devices located in one or more operating rooms. Cloud computing services can perform a large number of calculations based on data collected by smart surgical instruments,
[0149] [0149] By applying cloud computer data processing techniques to the data collected by 1a to 1n/2a to 2m devices, the surgical data network provides better surgical outcomes, reduced costs, and better patient satisfaction. At least some of the 1a to 1n/2a to 2m devices can be used to visualize tissue states to assess the occurrence of leaks or perfusion of sealed tissue after a tissue seal and cut procedure. At least some of the 1a to 1n/2a to 2m devices can be used to identify pathology, such as the effects of disease, using cloud-based computing to examine data including images of body tissue samples for diagnostic purposes. This includes confirmation of tissue location and margin and phenotypes. At least some of the 1a to 1n/2a to 2m devices can be used to identify anatomical structures of the body using a variety of sensors integrated with imaging devices and techniques such as overlaying images captured by multiple imaging devices. Data collected by devices 1a to 1n/2a to 2m, including image data, can be transferred to cloud 204 or local computer system 210 or both for data processing and manipulation including image processing and manipulation. Data can be analyzed to improve surgical procedure outcomes by determining whether additional treatment, such as application of endoscopic intervention, emerging technologies, a targeted radiation, targeted intervention, robotics targeted to specific sites and tissue conditions, can be followed. This data analysis can further use analytical processing of the results, and using standardized approaches can provide beneficial feedback to confirm surgical treatments and surgeon behavior or suggest modifications to surgical treatments and surgeon behavior.
[0150] [0150] In one implementation, OR devices 1a to 1n can be connected to the central modular communication controller 203 via a wired channel or a wireless channel depending on the configuration of devices 1a to 1h on a central controller of network. 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 network central controller provides connectivity to devices 1a to 1n located on the same network as the OR. The central network controller 207 collects data in the form of packets and sends them to the router in non-simultaneous transmission (half duplex) mode. The network central controller 207 does not store any media access control/internet protocol (MAC/IP) to transfer the device data. Only one of the devices 1a to 1n at a time can send data through the network central controller 207. The network central controller 207 has no routing tables or intelligence about where to send information and transmits all network data over each connection. and to a remote server 213 (Figure 9) on the cloud 204. The network central controller 207 can detect basic network errors such as collisions, but having all (assuming that) information transmitted to multiple inbound ports can be a risk of failure. safety and cause bottlenecks.
[0151] [0151] In another implementation, OR devices 2a to 2m can be connected to a network switch 209 via a wired or wireless channel. Network key 209 works at the data connection layer of the OSI model. Network switch 209 is a multicast device for connecting 2a to 2m devices located in the same operating room to the network. Network switch 209 sends data in the form of frames to network router 211 and operates 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.
[0152] [0152] Network central controller 207 and/or network switch 209 are coupled to network router 211 for a connection to the cloud
[0153] [0153] In one example, the network central controller 207 can be implemented as a USB central controller, which makes it possible for multiple USB devices to be connected to a host computer. The USB central controller can expand a single USB port to multiple levels so that there are more ports available to connect the devices to the system's host computer. The central network controller 207 may include wired or wireless facilities to receive information about a wired channel or a wireless channel. In one aspect, a wireless USB short-range, broadband, wireless radio communication protocol can be used for communication between devices 1a to 1n and devices 2a to 2m situated in the operating room.
[0154] [0154] In other examples, OR devices 1a to 1n/2a to 2m can communicate with the central modular communication controller 203 via standard wireless Bluetooth technology to exchange data over short distances (with the using short-wavelength UHF radio waves in the ISM band 2.4 to 2.485 GHz) from fixed and mobile devices and building personal area networks (PANs). In other respects, OR devices 1a to 1n/2a to 2m can communicate with the 203 modular communication central controller via a number of wireless and wired communication standards or protocols, including but not limited to a, 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 thereof, as well as any other wireless and wired protocols that are designated as 3G, 4G, 5G, and beyond. The computing module may 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.
[0155] [0155] The modular communication central controller 203 can serve as a central connection for one or all of the 1a to 1n/2a to 2m operating room devices and handles a type of data known as frames. Frames carry the data generated by devices 1a to 1n/2a to 2m. When a frame is received by the central modular communication controller 203, it is amplified and transmitted to the network router 211, which transfers the data to cloud computing resources using a series of wireless communication standards or protocols. or wired, as described in the present invention.
[0156] [0156] The 203 modular communication core controller can be used as a standalone device or be connected to compatible network core controllers and network switches to form a larger network. The 203 modular communication central controller is generally easy to install, configure, and maintain, making it a good choice for the operating room 1a to 1n/2a to 2m device network.
[0157] [0157] Figure 9 illustrates an interactive computer-implemented surgical system 200. The interactive computer-implemented surgical system 200 is similar in many respects to the interactive, computer-implemented surgical system 100. For example, the interactive computer-implemented surgical system 200 200 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 in communication with a cloud 204 that may include a remote server 213. In one aspect, the computer-implemented interactive surgical system 200 comprises a modular control tower 236 connected to multiple operating room devices such as smart surgical instruments, robots, and other computerized devices 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 210. As illustrated in the example of Figure 9, the modular control tower 236 is coupled to an imaging module 238. which is coupled to an endoscope 239, a generator module 240 which is coupled to a power device 241, a smoke evacuation module 226, a suction/irrigation module 228, a communication module 230, a processor module 232, a storage array 234, an intelligent device/instrument 235 optionally coupled to a display 237, and a non-contact sensor module 242. The OR devices are coupled to cloud computing resources and data storage through the tower modular control tower 236. The robot central controller 222 can also be connected to the modular control tower 236 and cloud computing resources. Devices/Instruments 235, visualization systems 208, among others, can be coupled to the modular control tower 236 through wired or wireless communication standards or protocols, as described in the present invention. Modular control tower 236 may be coupled to a central controller display 215 (eg, monitor, display) to display and superimpose images received from the imaging module, device/instrument display, and/or other display systems 208. A The central controller screen can also show the data received from the devices connected to the modular control tower together with images and superimposed images.
[0158] [0158] Figure 10 illustrates a central surgical controller 206 comprising 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 network connectivity device. , 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 (e.g. devices) that can be connected to the modular communication central controller 203 and transfer data associated with the modules. modules to the 210 computer system, cloud computing resources, or both. As shown in Figure 10, each of the central controllers/network switches in the modular communication central controller 203 includes three downstream ports and one upstream port. The upstream central controller/network switch is connected to a processor to provide a communication link with cloud computing resources and a local display 217. Communication with the cloud 204 may be via a wired communication channel. or wireless.
[0159] [0159] 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 burst and receiving the echo as it bounces off the perimeter of an operating room's walls, as described under the heading "Surgical Hub Spatial Awareness Within an Operating Room" in US Provisional Patent Application Serial No. 62/611,341 entitled INTERACTIVE SURGICAL PLATFORM, filed December 28, 2017, which is incorporated herein by reference in its entirety, in which the sensor module is configured to determine the size of the OR and adjust the Bluetooth pairing distance limits. 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. operating room and to adjust Bluetooth pairing distance limits, for example.
[0160] [0160] The computer system 210 comprises a processor
[0161] [0161] The 244 processor can be any single-core or multi-core processor such as those known under the tradename ARM Cortex available from Texas Instruments. In one aspect, the processor may be a Core Cortex-M4F LM4F230H5QR ARM processor, available from Texas Instruments, for example, comprising 256 KB single-cycle flash memory, or other non-volatile memory, up to 40 MHz. , a prefetch buffer to optimize performance above 40 MHz, a 32 KB single-cycle serial random access memory (SRAM), an internal read-only memory (ROM) loaded with the StellarisWareO program, read-only memory programmable and electrically erasable 2 KB EEPROM, one or more pulse width modulation (PWM) modules, one or more analog quadrature encoder (QEI) inputs, one or more analog to digital converters (ADCs) of 12-bit with 12 analog input channels, details of which are available in the product data sheet.
[0162] [0162] In one aspect, the processor 244 may comprise a safety controller comprising two controller-based families, such as TMS570 and RM4x, known under the tradename Hercules ARM Cortex R4, also by Texas Instruments. The safety controller can be configured specifically for safety critical applications IEC 61508 and ISO 26262, among others, to provide advanced built-in safety features while providing scalable performance, connectivity and memory options.
[0163] [0163] System memory includes volatile memory 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 nonvolatile memory. For example, non-volatile memory may include ROM, programmable ROM (PROM), electrically programmable ROM (EPROM), EEPROM, or flash memory. Volatile memory includes random access memory (RAM), which acts as external cache memory. Additionally, 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).
[0164] [0164] 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). 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 device (CD-ROM) compact disc drive recordable (CD-R Drive), rewritable compact disc drive (CD-RW drive), or a digital versatile disc ROM (DVD-ROM) drive. To facilitate the connection of disk storage devices to the system bus, a removable or non-removable interface can be used.
[0165] [0165] It is to be understood that the computer system 210 includes software that acts as an intermediary between the users and the basic computer resources described in a suitable 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 is to be understood that various components described in the present invention may be implemented with various operating systems or combinations of operating systems.
[0166] [0166] A user enters commands or information into the computer system 210 through the input device(s) coupled to the 1/O interface 251. Input devices include, but are not limited to, a device pointer like a mouse, trackball, stylus, touchpad, keyboard, microphone, joystick, game pad, satellite board, scanner,
[0167] [0167] Computer system 210 can operate in a networked environment using logical connections to one or more remote computers, such as cloud computers, or local computers. The remote cloud computer(s) may be a personal computer, server, router, network personal computer, workstation, microprocessor-based device, peer device, or other network node. common, 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. Remote computers are logically connected to the computer system through a network interface and then physically connected through a communication link. 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-switched networks such as Integrated Services Digital Networks (ISDN) and variations thereof, packet-switched networks, and digital transmission lines. subscribers (DSL - Digital Subscriber Lines).
[0168] [0168] In various aspects, the computer system 210 of Figure 10, the imaging module 238 and/or display system 208, and/or the processor module 232 of Figures 9 to 10, may comprise an image processor, image processing engine, media processor, or any specialized digital signal processor (PSD, or digital signal processor) used for processing digital images. The image processor can employ parallel computing with single instruction multiple data (SIMD) or multiple instruction multiple data (MIMD) technologies to increase speed and efficiency. The digital image processing engine can perform a range of tasks. The image processor can be a system on an integrated circuit with a multi-core processor architecture.
[0169] [0169] 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 may also be external to the computer system 210. The hardware/software required for connection to the network interface includes, for illustrative purposes only, internal and external technologies. as modems, including regular telephone serial modems, cable modems, and modems
[0170] [0170] Figure 11 illustrates a functional block diagram of an aspect of a USB 300 network central controller device, in accordance with an aspect of the present invention. In the illustrated aspect, the USB 300 network central controller device employs a TUSB2036 integrated circuit central controller available from Texas Instruments. The USB 300 Network Central Controller is a CMOS device that provides one USB upstream transceiver port 302 and up to three USB downstream transceiver ports 304, 306, 308 in compliance 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 downstream USB transceiver ports 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) .
[0171] [0171] The USB 300 network central controller device is implemented with a digital state machine instead of a microcontroller, and no firmware programming is required. Fully compatible USB transceivers are integrated in the circuit for USB upstream transceiver port 302 and all USB downstream transceiver ports 304, 306, 308. USB downstream transceiver ports 304, 306, 308 support both full speed and low speed by automatically setting 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 either bus-powered or self-powered mode and includes 312 central power logic to manage power.
[0172] [0172] The USB 300 Network Central Controller Device includes a 310 Serial Interface Engine (SIE). The SIE 310 is the hardware front end of the USB 300 network central controller and handles most of the protocol described in Chapter 8 of the USB specification. The SIE 310 typically understands signaling down to the transaction level. The functions it handles could include: packet recognition, transaction sequencing, SOP, EOP, RESET, and RESUME signal detection/generation, clock/data separation, non-return to zero inverted (NRZI) data encoding/decoding. , CRC (token and data) generation and verification, Packet ID (PID) generation and verification/decoding, and/or serial-parallel/parallel-serial conversion. 310 receives a clock input 314 and is coupled to a frame timer circuit 316 and suspend/resume logic and a central controller repeater circuit 318 to control communication between the USB upstream transceiver port 302 and the downstream USB transceiver 304, 306, 308 via logic circuits at ports 320, 322, 324. The SIE 310 is coupled to a command decoder 326 via the logic interface to control serial EEPROM commands via a Serial EEPROM 330.
[0173] [0173] In many respects, the USB 300 network central controller can connect 127 functions configured in up to six logical layers (levels) to a single computer. In addition, the USB 300 network central controller can connect all peripherals using a standard four-wire cable that provides both communication and power distribution. Power settings are bus-powered and self-powered modes. The USB 300 network central controller can be configured to support four power management modes: a bus-powered central controller with single port power management or grouped port power management, and the self-powered central controller with power management. individual port power or grouped port power management. In one aspect, with the use of a USB cable, the USB network core controller 300, the USB upstream transceiver port 302 plugs into a USB host controller, and the USB downstream transceiver ports 304, 306, 308 are exposed for connecting USB compatible devices, and so on.
[0174] [0174] Figure 12 illustrates a logic diagram of a module of a control system 470 of a surgical instrument or tool, in accordance with one or more aspects of the present invention. System 470 comprises a control circuit. The control circuit includes a microcontroller 461 comprising a processor 462 and a memory 468. One or more of sensors 472, 474, 476, for example, provide real-time feedback to processor 462. A motor 482, driven by a driver of motor 492, operatively couples a longitudinally movable displacement member to drive the knife element of the I-profile beam. 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 a trigger member, a trigger bar, and a profiled beam knife element. in |. Additional motors can be provided at the instrument driver interface to control i-beam firing, closing tube travel, drive shaft rotation and articulation. A 473 display shows a variety of instrument operating conditions and may include touch screen functionality for data entry. The information shown on screen 473 can be overlaid with images captured through endoscopic imaging modules.
[0175] [0175] In one aspect, the 461 microcontroller can be any single-core or multi-core processor, such as those known under the tradename ARM Cortex available from Texas Instruments. In one aspect, the main microcontroller 461 may be an LM4F230H5QR ARM Cortex-M4F processor, 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 32KB single-cycle SRAM, an internal ROM loaded with the StellarisWareO program, a 2KB EEPROM, one or more PWM modules, one or more QEI analogues and/or one or more 12-bit ADCs with 12 analogue input channels, details of which are available in the product data sheet.
[0176] [0176] In one aspect, the microcontroller 461 may comprise a safety controller comprising 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 safety critical applications IEC 61508 and ISO 26262, among others, to provide advanced built-in safety features while providing scalable performance, connectivity and memory options.
[0177] [0177] The 461 microcontroller can be programmed to perform various functions, such as precisely controlling the speed and position of the joint and knife systems. In one aspect, microcontroller 461 includes a processor 462 and memory 468. Electric motor 482 may be a brushed direct current (DC) motor with a gearbox and mechanical connections with a knife or linkage system. In one aspect, a 492 motor driver may be an A3941 available from Allegro Microsystems, Inc. Other motor drivers may be readily substituted for use in the 480 tracking system 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
[0178] [0178] The 461 microcontroller can be programmed to provide precise control of the speed and position of travel members and linkage systems. The microcontroller 461 can be configured to compute a response in the software of the microcontroller 461. The computed response is compared to a measured response from the real system to obtain an "observed" response, which is used for actual feedback decisions. The observed response is a favorable, adjusted value that balances the uniform and continuous nature of the simulated response with the measured response, which can detect external influences on the system.
[0179] [0179] In one aspect, the 482 motor can be controlled by the 492 motor driver and can be used by the triggering system of the instrument or surgical tool. In various forms, the 482 motor can be a brushed direct current (DC) drive motor, with a maximum rotational speed of approximately 25,000 RPM, for example. In other arrangements, the 482 motor may include a brushless motor, a wireless motor, a synchronous motor, a stepper motor, or any other suitable type of electric motor. Motor driver 492 may comprise an H-bridge driver comprising field effect transistors (FETs), for example. The 482 motor can be powered by a power pack releasably mounted on the handle assembly or tool cabinet to provide control power to the instrument or surgical tool. The power pack may comprise a battery which may include a number of battery cells connected in series which may be used as the power source to power the instrument or surgical tool. In certain circumstances, the battery cells in the power pack may be replaceable and/or rechargeable. In at least one example, the battery cells may be lithium-ion batteries that may be attachable and separable from the power pack.
[0180] [0180] The 492 motor driver may be an A3941 available from Allegro Microsystems, Inc. The 492 A3941 driver is a full-bridge controller for use with externally powered, semiconductor metal oxide field effect transistors (MOSFET). N-channel motors specifically designed for inductive loads such as brushed DC motors. The 492 driver comprises a single charge pump regulator that provides full gate drive (>10V) for batteries with voltages up to 7V and enables the A3941 to operate with a reduced gate drive, up to 5.5V. input command can be used to supply the voltage in excess of that supplied by the battery required for N-channel MOSFETs. An internal charge pump for the upside drive enables direct current (100% duty cycle) operation. The entire bridge can be driven in fast or slow decay modes using diodes or synchronous rectification. In slow-fall mode, current recirculation can be via FET from either the upside or the downside. Power FETs are protected from the shoot-through effect by programmable dead-time resistors. Built-in diagnostics provide indication of undervoltage, overtemperature and power bridge faults and can be configured to protect power MOSFETs under most short circuit conditions. Other motor drives can be readily replaced for use in the 480 tracking system comprising an absolute positioning system.
[0181] [0181] Tracking system 480 comprises a controlled motor drive circuit arrangement comprising a position sensor 472 in accordance with an aspect of the present invention. 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 corresponding drive gear of a gear reducer assembly. In other aspects, the displacement member represents the trigger member, which may be adapted and configured to include a rack of driving teeth. In yet another aspect, the displacement member represents a trigger bar or profile beam, each of which can be adapted and configured to include a rack of driving teeth. Accordingly, as used in the present invention, the term displacement member is used generically to refer to any movable member of the surgical instrument or surgical tool, such as the drive member, the trigger member, the trigger bar, the beam with profile in | or any element that can be moved. In one aspect, the longitudinally movable drive member is coupled to the firing member, the firing bar and the |-profile beam. Consequently, the absolute positioning system can, in effect, track the linear displacement of the profile beam at | by tracking the linear displacement of the longitudinally movable drive member. In various other aspects, the displacement member may be coupled to any position sensor 472 suitable for measuring linear displacement. In this way, the longitudinally movable driving member, triggering member, triggering bar or profile beam, or combinations thereof, can be coupled to any suitable linear displacement sensor. Linear displacement sensors can include contact or non-contact displacement sensors. Linear displacement sensors may comprise Variable Differential Linear Transformers (LVDT), Variable Reluctance Differential Transducers (DVRT), a potentiometer, a magnetic detection system comprising a moving magnet and a linearly arranged series in Hall Effect Sensors, a magnetic detection comprising a fixed magnet and a series of moving ones, arranged linearly in Hall Effect Sensors, a moving optical detection system comprising a moving light source and a series of linearly arranged photodiodes or photodetectors, an optical detection system which comprises a fixed light source and a moving array of linearly arranged photodiodes or photodetectors, or any combination thereof.
[0182] [0182] The 482 electric motor may include a rotating drive shaft, operationally interfacing with a gear assembly, which is mounted in mating engagement with a set or rack of drive teeth on the drive member. A sensing element may be operatively coupled to a gear assembly so that a single revolution of position sensing element 472 corresponds to some linear longitudinal translation of the displacement member. An arrangement of gears and sensors may be connected to the linear actuator via a rack and pinion arrangement, or a rotary actuator via a sprocket or other connection. A power source 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 which comprises a rack of drive teeth formed therein for engagement with a corresponding drive gear of the gear reducer assembly. The displacement member represents the longitudinally movable firing member, the firing bar, the profiled beam in | or combinations thereof.
[0183] [0183] A single revolution of the sensing element associated with position sensor 472 is equivalent to a linear longitudinal displacement d1 of the displacement member, where d1 is the linear longitudinal distance that the displacement member moves from point "a" to point "b" after a single revolution of the sensing element coupled to the displacement member. The sensor array may be connected via a gear reduction which results in the position sensor 472 completing one or more revolutions for the full stroke of the displacement member. Position sensor 472 can complete multiple revolutions for the full stroke of the displacement member.
[0184] [0184] A series of switches, where n is an integer greater than one, can be employed alone or in combination with a gear reduction to provide a single position signal for more than one revolution of the 472 position sensor. The status of the switches is fed back to the microcontroller 461 which applies logic to determine a unique position signal corresponding to the longitudinal linear displacement d1 + d2 +... dn of the displacement member. The output of position sensor 472 is provided to microcontroller 461. In various embodiments, position sensor 472 of the sensor array may comprise a magnetic sensor, an analog rotary sensor, such as a potentiometer, or a series of analog Hall-effect elements. , which output a unique combination of position values or signals.
[0185] [0185] Position sensor 472 can comprise any number of magnetic sensing elements, such as magnetic sensors classified according to whether they measure the total magnetic field or the vector components of the magnetic field. The techniques used to produce both types of magnetic sensors cover many aspects of physics and electronics. Technologies used for magnetic field detection include flowmeter, saturated flow, optical pumping, nuclear precession, SQUID, Hall effect, anisotropic magnetoresistance, giant magnetoresistance, magnetic tunnel junctions, giant magnetoimpedance, magnetostrictive/piezoelectric compounds, magnetodiode, magnetic transistor, fiber optics, magneto-optics and magnetic sensors based on microelectromechanical systems, among others.
[0186] [0186] In one aspect, the position sensor 472 for the tracking system 480 which comprises an absolute positioning system comprises a magnetic rotary absolute positioning system. The 472 position sensor can be implemented as an ASSOSSEQFT single integrated circuit rotating magnetic position sensor, available from Austria Microsystems, AG. The 472 position sensor interfaces with the 461 microcontroller to provide an absolute positioning system. Position sensor 472 is a low voltage, low power component and includes four effect elements in an area of position sensor 472 situated above a magnet. A high resolution ADC and an intelligent power management controller are also provided on the integrated circuit. A CORDIC (digital computer for rotating coordinates) processor, also known as the digit-by-digit method and Volder algorithm, is provided to implement a simple and efficient algorithm for computing hyperbolic and trigonometric functions that require only addition, subtraction, displacement operations. bit and lookup table. Angle position, alarm bits, and magnetic field information are transmitted through a standard serial communication interface, such as a serial peripheral interface (SPI), to the 461 microcontroller. The 472 position sensor provides 12 or more 14 bit resolution. The 472 position sensor can be an ASS055 integrated circuit supplied in a small 16-pin QFN package whose measurement corresponds to 4x4x0.85 mm.
[0187] [0187] The tracking system 480 comprising an absolute positioning system may comprise and/or be programmed to implement a feedback controller, such as a PID, status feedback, and adaptive controller. A power source converts the feedback controller signal into a physical input to the system, in this case voltage. Other examples include a voltage, current, and power PWM. Other sensors may be provided in order to measure physical system parameters in addition to the position measured by the 472 position sensor. In some respects, the other sensors may include sensor arrangements such as those described in US patent no.
[0188] [0188] The absolute positioning system provides absolute positioning of the displaced member on instrument activation without having to retract or advance the longitudinally movable drive member to the reset position (zero or initial), as may be required by encoders conventional rotary actuators that merely count the number of forward or backward steps the 482 motor has taken to infer the position of an actuator, device, drive bar, knife, and the like.
[0189] [0189] A 474 sensor, such as a strain gauge or a micro-strain gauge, is configured to measure one or more end actuator parameters, such as the magnitude of the strain exerted on the anvil during a gripping operation, which may be indicative of tissue compression. The measured effort is converted into a digital signal and fed to the processor 462. Alternatively, or in addition to the sensor 474, a sensor 476, such as a load sensor, can measure the closing force applied by the closing actuation system. to the anvil The 476 sensor, such as a load sensor, can measure the trigger force applied to a beam with a profile in | on a firing stroke of the surgical instrument or surgical tool. The i-profile beam is configured to engage a wedge slider, which is configured to move the clamp drivers upward to force the clamps to deform in contact with an anvil. The i-profile beam includes a sharp cutting edge that can be used to separate fabric as the i-profile beam is advanced distally through the trigger bar. Alternatively, a current sensor 478 may be employed to measure the current drawn by the motor 482. The force required to advance the firing member may correspond to the current drawn by the motor 482, for example. The measured power is converted into a digital signal and fed to the 462 processor.
[0190] [0190] In one form, a 474 strain gauge sensor can be used to measure the force applied to tissue by the end actuator. A strain gauge can be attached to the end actuator to measure the force applied to the tissue being treated by the end actuator. A system for measuring forces applied to tissue held by the end actuator comprises a strain gauge sensor 474, such as, for example, a micro strain gauge, which is configured to measure one or more parameters of the end actuator, for example. In one aspect, the strain gauge sensor 474 may measure the magnitude or magnitude of strain exerted on a gripper member of an end actuator during a gripping operation, which may be indicative of tissue compression. The measured effort is converted to a digital signal and fed to the processor 462 of a microcontroller 461. A load sensor 476 can measure the force used to operate the knife element, for example, to cut the tissue captured between the anvil and the cartridge. of staples. A magnetic field sensor can be used to measure the thickness of captured tissue. The magnetic field sensor measurement can also be converted to a digital signal and fed to the 462 processor.
[0191] [0191] Measurements of tissue compression, tissue thickness, and/or the force required to close the end actuator on the tissue, as respectively measured by sensors 474, 476, can be used by microcontroller 461 to specify the selected position of the trigger member and/or the corresponding trigger member velocity value. In one case, a memory 468 may store a technique, an equation, and/or a look-up table that may be used by the microcontroller 461 in evaluation.
[0192] [0192] The control system 470 of the instrument or surgical tool may also comprise wired or wireless communication circuits for communication with the central modular communication controller shown in Figures 8 to 11.
[0193] [0193] Figure 13 illustrates a control circuit 500 configured to control aspects of the surgical instrument or tool in accordance with an aspect of the present invention. Control circuit 500 can be configured to implement various processes described herein. Control circuit 500 may comprise a microcontroller comprising one or more processors 502 (e.g., microprocessor, microcontroller) coupled to at least one memory circuit 504. Memory circuit 504 stores machine executable instructions that, when executed by the processor 502, cause the processor 502 to execute machine instructions to implement various of the processes described herein. Processor 502 can be any of a number of single-core or multi-core processors known in the art. The 504 memory circuit may comprise volatile and non-volatile storage media. Processor 502 may include an instruction processing unit 506 and an arithmetic unit 508. The instruction processing unit may be configured to receive instructions from the memory circuit 504 of the present invention.
[0194] [0194] Figure 14 illustrates a combinational logic circuit 510 configured to control aspects of the surgical instrument or tool in accordance with an aspect of the present invention. Combinational logic circuit 510 may be configured to implement various processes described herein. Combinational logic circuit 510 may comprise a finite state machine comprising combinational logic 512 configured to receive data associated with the surgical instrument or tool at an input 514, process the data by combinational logic 512, and provide an output 516.
[0195] [0195] Figure 15 illustrates a sequential logic circuit 520 configured to control aspects of the surgical instrument or tool in accordance with an aspect of the present invention. Sequential logic circuit 520 or combinational logic 522 may be configured to implement the process described herein. The sequential logic circuit 520 may comprise a finite state machine. The sequential logic circuit 520 may comprise combinational logic 522, at least one memory circuit 524, a clock 529 and, for example. The at least one memory circuit 524 can store a current state of the finite state machine. In certain cases, the sequential logic circuit 520 may be synchronous or asynchronous. Combinational logic 522 is configured to receive data associated with the surgical instrument or tool from an input 526, process the data by combinational logic 522, and provide an output 528. In other aspects, the circuit may comprise a combination of a processor (e.g. , processor 502, Figure 13) and a finite state machine for implementing various processes of the present invention. In other aspects, the finite state machine may comprise a combination of a combinational logic circuit (e.g., a combinational logic circuit 510, Figure 14) and sequential logic circuit 520.
[0196] [0196] Figure 16 illustrates a surgical instrument or tool that comprises a plurality of motors that can be activated to perform various functions. In certain cases, a first motor may be activated to perform a first function, a second motor may be activated to perform a second function, a third motor may be activated to perform a third function, a fourth motor may be activated to perform a fourth function, and so on. In certain cases, the plurality of motors of robotic surgical instrument 600 may be individually activated to cause triggering, closing, and/or pivoting movements in the end actuator. The triggering, closing and/or articulation movements can be transmitted to the end actuator through a drive shaft assembly, for example.
[0197] [0197] In certain cases, the instrument or surgical tool system may include a trigger motor 602. The trigger motor 602 may be operatively coupled to a trigger motor drive assembly 604, which may be configured to transmit motion. triggering generated by the motor 602 to the end actuator, particularly for displacing the |-profile beam element. In certain cases, the triggering movements generated by the motor 602 can cause the staples to be positioned from the staple cartridge onto the fabric captured by the end actuator and/or the cutting edge of the profiled beam element | to be advanced in order to cut captured tissue, for example. The profiled beam element | can be retracted by reversing the direction of motor 602.
[0198] [0198] In certain cases, the surgical instrument or tool may include a closing motor 603. The closing motor 603 may be operatively coupled to a closing motor drive assembly 605 which can be configured to transmit closing movements, generated by motor 603 to the end actuator, particularly to move a closing tube to close the anvil and compress tissue between the anvil and staple cartridge. Closing movements can cause the end actuator to transition from an open configuration to an approximate configuration to capture tissue, for example. The end actuator can be transitioned to an open position by reversing the direction of the 603 motor.
[0199] [0199] In certain cases, the surgical instrument or tool may include one or more joint motors 606a, 606b, for example. Motors 606a, 606b may be operatively coupled to linkage motor drive assemblies 608a, 608b, which may be configured to transmit linkage motions generated by motors 606a, 606b to the end actuator. In certain cases, linkage movements can cause the end actuator to link with respect to the drive shaft assembly, for example.
[0200] [0200] As described above, the surgical instrument or tool may include a plurality of motors that may be configured to perform various independent functions. In certain cases, the plurality of motors of the instrument or surgical tool may be activated individually or separately to perform one or more functions, while other motors remain inactive. For example, pivot motors 606a, 606b can be activated to cause the end actuator to pivot while trigger motor 602 remains inactive. Alternatively, firing motor 602 may be activated to fire the plurality of staples, and/or advance the cutting edge, while pivot motor 606 remains inactive. Furthermore, the closing motor 603 can be activated simultaneously with the triggering motor 602 to make the closing tube or beam element with a profile in | advance distally, as described in more detail later in this document.
[0201] [0201] In certain cases, the surgical instrument or tool may include a common control module 610 that can be used with a plurality of motors of the surgical instrument or tool. In certain cases, the common control module 610 can accommodate one of a plurality of motors at a time. For example, the common control module 610 may be attachable to and separable from the plurality of motors of the robotic surgical instrument individually. In certain cases, a plurality of the surgical instrument or tool motors may share one or more common control modules, such as the common control module 610. In certain cases, a plurality of surgical instrument or tool motors may be individually and selectively engaged. to the common control module 610. In certain cases, the common control module 610 may be selectively switched between interfacing with one of a plurality of motors of the instrument or surgical tool to interfacing with another of the plurality of motors of the instrument or surgical tool.
[0202] [0202] In at least one example, the common control module
[0203] [0203] Each of the motors 602, 603, 606a, 606b may comprise a torque sensor for measuring the output torque on the motor drive shaft. The force on an end actuator can be detected in any conventional way, such as through force sensors on the outer sides of the jaws or by a torque sensor on the motor that drives the jaws.
[0204] [0204] In various cases, as illustrated in Figure 16, the common control module 610 may comprise a motor driver 626 which may comprise one or more H-Bridge FETs. Motor driver 626 may modulate power transmitted from a power source 628 to a motor coupled to common control module 610, based on input from a microcontroller 620 (the "controller"), for example. In certain cases, the microcontroller 620 can be used to determine the current drawn by the motor, for example, while the motor is coupled to the common control module 610, as described above.
[0205] [0205] In certain examples, the microcontroller 620 may include a microprocessor 622 (the "processor") and one or more non-transient computer readable media or memory units 624 (the "memory"). In certain cases, memory 624 may store multiple program instructions which, when executed, may cause processor 622 to perform a plurality of functions and/or calculations described herein. In certain cases, one or more of the memory units 624 may be coupled to the processor 622, for example.
[0206] [0206] In certain cases, the power supply 628 can be used to supply power to the microcontroller 620, for example. In certain cases, the power source 628 may comprise a battery (or "battery pack" or "power pack"), such as a Li-ion battery, for example. In certain cases, the battery pack can be configured to be releasably mounted on a handle to provide power to the surgical instrument 600. Multiple battery cells connected in series can be used as the power source 628. In certain cases, the battery pack power source 628 may be replaceable and/or rechargeable, for example.
[0207] [0207] In various cases, processor 622 may control motor driver 626 to control the position, direction of rotation, and/or speed of a motor that is coupled to common control module 610. In certain cases, the processor 622 may signal the motor driver 626 to stop and/or disable a motor that is coupled to the common control module 610. It should be understood that the term "processor", as used herein, includes any microprocessor, microcontroller, or other suitable basic computing device that embodies the functions of a computer central processing unit (CPU) on an integrated circuit, or at most a few integrated circuits. The processor is a multipurpose programmable device that accepts digital data as input, processes it according to instructions stored in its memory, and outputs results. This is an example of sequential digital logic as it has internal memory. Processors operate on numbers and symbols represented in the binary numeral system.
[0208] [0208] In one example, the 622 processor can be any single-core or multi-core processor, such as those known by the Texas Instruments trade name ARM Cortex. In certain cases, the 620 microcontroller may be an LM 4F230H5QR, available from Texas Instruments, for example. In at least one example, the Texas Instruments LM4F230H5QR is an ARM Cortex-M4F processor core comprising 256 KB single-cycle flash memory, or other non-volatile memory, up to 40 MHz, a prefetch buffer for optimize performance above 40 MHz, a 32KB single-cycle SRAM, an internal ROM loaded with StellarisWareO software, a 2KB EEPROM, one or more PWM modules, one or more QEI analogues, one or more ADCs 12-bit with 12 channels of analog input, among other features that are readily available for the product data sheet. Other microcontrollers can be readily replaced for use with the 4410 module. Accordingly, the present invention should not be limited in this context.
[0209] [0209] In certain cases, memory 624 may include program instructions for controlling each of the surgical instrument motors 600 that are attachable to common control module 610. For example, memory 624 may include program instructions for controlling the motor trigger 602, closing motor 603 and hinge motors 606a, 606b. Such program instructions may cause the processor 622 to control triggering, closing, and articulation functions in accordance with inputs from the algorithms or control programs of the surgical instrument or tool.
[0210] [0210] In certain cases, one or more mechanisms and/or sensors, such as sensors 630, may be employed to alert the processor 622 to program instructions that must be used in a specific configuration. For example, sensors 630 can prompt processor 622 to use program instructions associated with triggering, closing, and linking the end actuator. In certain cases, sensors 630 may comprise position sensors that may be employed to detect the position of key 614, for example. Consequently, processor 622 can use the program instructions associated with firing the profiled beam | the end actuator upon detection, through sensors 630, for example, that the key 614 is in the first position 616; processor 622 may use program instructions associated with closing the anvil upon detection through sensors 630, for example, that key 614 is in second position 617; and processor 622 may use the program instructions associated with linkage of the end actuator upon detection through sensors 630, for example, that key 614 is in third or fourth position 618a, 618b.
[0211] [0211] Figure 17 is a schematic diagram of a robotic surgical instrument 700 configured to operate a surgical tool described herein, in accordance with one aspect of that description. The robotic surgical instrument 700 can be programmed or configured to control distal/proximal translation of a displacement limb, distal/proximal displacement of a closure tube, rotation of the drive shaft, and joint, either with a single type or multiple linkage drive links. In one aspect, surgical instrument 700 may be programmed or configured to individually control a trigger member, a closure member, a drive shaft member, and/or one or more pivot members. Surgical instrument 700 comprises a control circuit 710 configured to control motor-driven triggering members, closing members, driving shaft members, and/or one or more pivot members.
[0212] [0212] In one aspect, the robotic surgical instrument 700 comprises a control circuit 710 configured to control an anvil 716 and a profiled beam portion | 714 (including a sharp cutting edge) of an end actuator 702, a removable staple cartridge 718, a drive shaft 740 and one or more pivot members 742a, 742b through a plurality of motors 704a to 704e. A 734 position sensor can be configured to provide position feedback for the profiled beam | 714 to the control circuit 710. Other sensors 738 can be configured to provide feedback to the control circuit
[0213] [0213] In one aspect, the control circuit 710 may comprise one or more microcontrollers, microprocessors or other processors suitable for executing instructions that cause the processor or processors to perform one or more tasks. In one aspect, a timer/counter 731 provides an output signal, such as elapsed time or a digital count, to control circuit 710 to correlate the profiled beam position at | 714, as determined by position sensor 734, with the output of timer/counter 731 so that control circuit 710 can determine the position of the profiled beam at | 714 at a specific time (t) relative to an initial position or the time (t) when the profiled beam at | 714 is in a specific position relative to a home position. The 731 timer/counter can be configured to measure elapsed time, count external events, or measure external events.
[0214] [0214] In one aspect, the control circuit 710 can be programmed to control functions of the end actuator 702 based on one or more tissue conditions. Control circuit 710 can be programmed to directly or indirectly detect tissue conditions, such as thickness, as described herein. The 710 control circuit can be programmed to select a trigger control program or close control program based on tissue conditions. A trigger control program can describe the distal movement of the displacement member. Different trigger control programs can be selected to best handle different tissue conditions. For example, when thicker tissue is present, control circuit 710 can be programmed to translate the displacement member at a slower speed and/or at a lower power. When thinner fabric is present, control circuit 710 can be programmed to translate the displacement member at a higher speed and/or with higher power.
[0215] [0215] In one aspect, the control circuit 710 can generate motor setpoint signals. Motor setpoint signals can be provided to various 708a to 708e motor controllers. Motor controllers 708a to 708e may comprise one or more circuits configured to provide motor drive signals to motors 704a to 704e to drive motors 704a to 704e as described herein. In some examples, motors 704a to 704e may be brushed DC electric motors. For example, the speed of motors 704a to 704e may be proportional to the respective motor drive signals. In some examples, the motors 704a to 704e may be brushless DC electric motors, and the respective motor drive signals may comprise a PWM signal supplied to one or more stator windings of the motors 704a to 704e. Also, in some examples, the motor controllers 708a through 708e may be omitted and the control circuit 710 may directly generate the motor drive signals.
[0216] [0216] In one aspect, the control circuit 710 may initially operate each of the motors 704a to 704e in an open circuit configuration for a first open circuit portion of a travel member stroke. Based on the response of robotic surgical instrument 700 during the open-loop portion of the stroke, control circuit 710 may select a trigger control program in a closed-loop configuration. The instrument response may include a translation of the distance from the displacement member during the open circuit portion, an elapsed time during the open circuit portion, the power supplied to one of the motors 704a to 704e during the open circuit portion, a sum of pulse widths of a motor drive signal, etc. After the open circuit portion, control circuit 710 may implement the selected trigger control program for a second portion of the displacement member stroke. For example, during a portion of the closed-loop stroke, control circuit 710 may modulate one of the motors 704a to 704e based on translating data describing a closed-loop displacement member position to translate the displacement member to a constant speed.
[0217] [0217] In one aspect, the motors 704a through 704e may receive power from a power source 712. The power source 712 may be a DC power source driven by a main AC power source, a battery, a supercapacitor , or any other suitable power source. Motors 704a to 704e can be mechanically coupled to individual movable mechanical elements such as the profile beam | 714, anvil 716, drive shaft 740, articulation 742a and articulation 742b, via respective transmissions 706a to 706e. Transmissions 706a to 706e may include one or more gears or other connecting components to couple the motors 704a to 704e to the moving mechanical elements. A position sensor 734 can detect a profiled beam position at | 714. Position sensor 734 may be or include any type of sensor that is capable of generating position data that indicates a position of the profiled beam at | 714. In some examples, the position sensor 734 may include an encoder configured to supply a series of pulses to the control circuit 710 as the profiled beam | 714 translates distally and proximally. Control circuit 710 can track pulses to determine the position of the profiled beam at | 714. Other suitable position sensors may be used, including, for example, a proximity sensor. Other types of position sensors may provide other signals that indicate the movement of the profiled beam | 714. Also, in some examples, position sensor 734 may be omitted. When any of the motors 704a to 704e is a stepper motor, the control circuit 710 can track the position of the profiled beam in | 714 by aggregating the number and direction of steps that the 704 engine was instructed to perform. Position sensor 734 may be located on end actuator 702 or any other portion of the instrument. The outputs of each of the motors 704a to 704e include a torque sensor 744a to 744e to sense force and have an encoder to sense the rotation of the drive shaft.
[0218] [0218] In one aspect, the control circuit 710 is configured to drive a trigger member as the profiled beam portion at | 714 of end actuator 702. Control circuit 710 provides a motor set point to a motor control 708a which provides a drive signal to motor 704a. The motor output drive shaft 704a is coupled to a torque sensor 744a. Torque sensor 744a is coupled to a transmission 706a which is coupled to the profiled beam at 1714. The transmission 706a comprises movable mechanical elements, such as rotating elements, and a triggering member to distally and proximally control the movement of the profiled beam. | 714 along a longitudinal axis of the end actuator 702. In one aspect, the motor 704a may be coupled to the knife gear assembly, which includes a knife gear reduction assembly that includes a first knife drive gear. and a second knife drive gear. A torque sensor 744a provides a trigger force feedback signal to the control circuit 710. The trigger force signal represents the force required to trigger or displace the profiled beam at | 714. A position sensor 734 can be configured to provide the position of the profiled beam in | 714 along the firing stroke or the position of the firing member as a feedback signal to the control circuit 710. The end actuator 702 may include additional sensors 738 configured to provide feedback signals to the control circuit 710. When ready for use, control circuit 710 can provide a trigger signal to motor control 708a. In response to the trigger signal, motor 704a may drive the trigger member distally along the longitudinal axis of end actuator 702 from a proximal stroke start position to a stroke terminal distal position relative to the stroke start position. course. As the trigger member translates distally, a profile beam in | 714, with a cutting element positioned at a distal end, advances distally to cut tissue located between staple cartridge 718 and anvil 716.
[0219] [0219] In one aspect, the control circuit 710 is configured to drive a closing member, such as the anvil portion 716 of the end actuator 702. The control circuit 710 provides a motor setpoint for a motor control. 708b, which provides a drive signal to the motor 704b. The motor output shaft 704b is coupled to a torque sensor 744b. Torque sensor 744b is coupled to a transmission 706b which is coupled to anvil 716. Transmission 706b comprises movable mechanical elements such as rotating elements and a closing member to control the movement of anvil 716 between the open and closed positions. In one aspect, the motor 704b is coupled to a closing gear assembly, which includes a closing reduction gear assembly that is supported in engagement with the closing sprocket. The torque sensor 744b provides a closing force feedback signal to the control circuit 710. The closing force feedback signal represents the closing force applied to the anvil 716. Position sensor 734 can be configured to provide the position of the closing member as a feedback signal to the control circuit 710. Additional sensors 738 on the end actuator 702 can provide the closing force feedback signal to the control circuit 710. The pivoting anvil 716 is positioned oppositely. to the staple cartridge
[0220] [0220] In one aspect, control circuit 710 is configured to rotate a drive shaft member, such as drive shaft 740, to rotate end actuator 702. Control circuit 710 provides a motor setpoint to a 708c motor control, which provides a start signal to the 704c motor. The output drive shaft of the 704c motor is coupled to a 744c torque sensor. The torque sensor 744c is coupled to a transmission 706c which is coupled to the shaft 740. The transmission 706c comprises moving mechanical elements, such as rotating elements, to control the rotation of the drive shaft 740 clockwise or counterclockwise up to and above 360 degrees. In one aspect, the motor 704c is coupled to the swivel drive assembly, which includes a tube gear segment that is formed over (or attached to) the proximal end of the proximal closure tube for operable engagement by a rotational gear assembly that is operationally supported on the tool mounting plate. The torque sensor 744c provides a rotational force feedback signal to the control circuit 710. The rotational force feedback signal represents the rotational force applied to the drive shaft 740. The position sensor 734 can be configured to provide the position of the closing member as a feedback signal to the control circuit 710. Additional sensors 738, such as a drive shaft encoder, can provide the rotational position of the drive shaft 740 to the control circuit 710.
[0221] [0221] In one aspect, the control circuit 710 is configured to pivot the end actuator 702. The control circuit 710 provides a motor setpoint to a motor control 708d, which provides a drive signal to the motor 704d. The output drive shaft of the 704d motor is coupled to a 744d torque sensor. Torque sensor 744d is coupled to a transmission 706d which is coupled to a pivot member 742a. Transmission 706d comprises movable mechanical elements, such as articulation elements, to control articulation of end actuator 702 +65°. In one aspect, the /04d motor is coupled to a pivot nut, which is pivotally seated on the proximal end portion of the distal column portion and is pivotally driven therein by a pivot gear assembly. The torque sensor 744d provides a linkage force feedback signal to the control circuit 710. The linkage force feedback signal represents the linkage force applied to the end actuator 702. Sensors 738, as a linkage encoder , can provide the pivot position of the end actuator 702 to the control circuit 710.
[0222] [0222] In another aspect, the articulation function of the robotic surgical system 700 may comprise two articulation members, or links, 742a, 742b. These pivot members 742a, 742b are driven by separate disks at the robot interface (the rack), which are driven by the two motors 708d, 708e. When separate trigger motor 704a is provided, each pivot link 742a, 742b can be actuated antagonistically with respect to the other link to provide resistive holding motion and a load to the head when it is not moving and to provide joint when the head is articulated. The pivot members 742a, 742b attach to the head at a fixed radius when the head is rotated. Consequently, the mechanical advantage of the push and pull link changes when the head is rotated. This change in mechanical advantage may be more pronounced with other linkage drive systems.
[0223] [0223] In one aspect, the one or more motors 704a to 704e may comprise a brushed DC motor with a gearbox and mechanical links to a trigger member, closing member, or pivot member. Another example includes electric motors 704a to 704e which operate the moving mechanical elements such as the displacement member, pivot links, closing tube and drive shaft. An outside influence is an unreasonable and unpredictable influence of things like tissue, surrounding bodies, and friction on the physical system. This external influence can be called drag, which acts in opposition to one of the electric motors 704a to 704e. External influence, such as drag, can cause the functioning of the physical system to deviate from a desired operation of the physical system.
[0224] [0224] In one aspect, the 734 position sensor can be implemented as an absolute positioning system. In one aspect, position sensor 734 may comprise an absolute rotary magnetic positioning system implemented as a single integrated circuit rotary magnetic position sensor.
[0225] [0225] In one aspect, control circuit 710 may be in communication with one or more sensors 738. Sensors 738 may be positioned on end actuator 702 and adapted to work with robotic surgical instrument 700 to measure various derived parameters such as span distance versus time, tissue compression versus time, and anvil stress versus time. The 738 sensors may comprise a magnetic sensor, a magnetic field sensor, a strain gauge, a load cell, a pressure sensor, a force sensor, a torque sensor, an inductive sensor such as an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor and/or any other sensor suitable for measuring one or more parameters of the end actuator 702. Sensors 738 may include one or more sensors. Sensors 738 may be located on the staple cartridge platform 718 to determine tissue location using segmented electrodes. Torque sensors 744a to 744e can be configured to detect forces such as trigger force, closing force, and/or linkage force, among others. Accordingly, the control circuit 710 can detect (1) the closing load experienced by the distal closing tube and its position, (2) the firing member in the rack and its position, (3) which portion of the staple cartridge 718 has fabric therein and (4) the load and position on both pivot rods.
[0226] [0226] In one aspect, the one or more sensors 738 may comprise a strain gauge, such as a micro strain gauge, configured to measure the magnitude of strain on anvil 716 during a stuck condition. The effort meter provides an electrical signal whose amplitude varies with the magnitude of the effort. Sensors 738 may comprise a pressure sensor configured to detect a pressure generated by the presence of compressed tissue between anvil 716 and staple cartridge 718. Sensors 738 may be configured to detect the impedance of a section of tissue located between the anvil 716 and staple cartridge 718 which is indicative of the thickness and/or completeness of tissue situated therebetween.
[0227] [0227] In one aspect, 738 sensors can be implemented as one or more limit switches, electromechanical devices, solid state switches, Hall effect devices, magnetoresistive (MR) devices, giant magnetoresistive (GMR) devices, magnetometers, among others. . In other implementations, 738 sensors can be implemented as solid state switches that operate under the influence of light, such as optical sensors, infrared sensors, ultraviolet sensors, among others. In addition, switches can be solid state devices such as transistors (eg, FET, junction FET, MOSFET, bipolar, and the like). In other implementations, 738 sensors may include conductorless electrical switches, ultrasonic switches, accelerometers, and inertia sensors, among others.
[0228] [0228] In one aspect, the 738 sensors can be configured to measure the forces exerted on the anvil 716 by the closing drive system. For example, one or more sensors 738 may be at a point of interaction between the closure tube and the anvil 716 to detect the closure forces applied by the closure tube to the anvil 716. The forces exerted on the anvil 716 may be representative of the tissue compression experienced by the tissue section captured between the anvil 716 and the staple cartridge 718. The one or more sensors 738 may be positioned at various interaction points along the closure drive system to sense closure forces applied to the closure. anvil 716 by the closing drive system. The one or more sensors 738 may be sampled in real time during a gripping operation by the control circuit processor 710. The control circuit 710 receives real-time sample measurements to provide and analyze time-based information and evaluate, in time. actual, the closing forces applied to the anvil 716.
[0229] [0229] In one aspect, a current sensor 736 can be used to measure the current drawn by each of the motors 704a through 704e. The force required to advance any of the moving mechanical elements such as the profiled beam | 714 corresponds to the current drawn by one of the motors 704a to 704e. The power is converted to a digital signal and supplied to the control circuit 710. The control circuit 710 can be configured to simulate the instrument's actual system response in the controller software. An offset member can be actuated to move a profiled beam at | 714 on the 702 end actuator at or near a target speed. The robotic surgical instrument 700 may include a feedback controller, which can be one or any of the feedback controllers, including, but not limited to, a PID controller, state feedback, linear quadratic (LQR) and/or an adaptive controller. , for example. The robotic surgical instrument 700 may include a power source to convert the feedback controller signal into a physical input such as case voltage, PWM voltage, frequency modulated voltage, current, torque, and/or force, for example. Additional details are described in US Patent Application Serial No. 15/636,829 entitled CLOSED LOOP
[0230] [0230] Figure 18 illustrates a block diagram of a surgical instrument 750 programmed to control distal translation of a displacement member in accordance with an aspect of the present invention. In one aspect, the surgical instrument 750 is programmed to control the distal translation of a displacement member, such as the profiled beam | 764. Surgical instrument 750 comprises an end actuator 752 which may comprise an anvil 766, a profiled beam 764 | 764 (including a sharp cutting edge) and a 768 removable staple cartridge.
[0231] [0231] The position, movement, displacement and/or translation of a linear displacement member, such as the profile beam in | 764, can be measured by an absolute positioning system, a sensor array and a 784 position sensor. Like the profile beam in | 764 is coupled to a longitudinally movable drive member, the position of the profiled beam at | 764 can be determined by measuring the position of the longitudinally movable drive member employing the position sensor 784. Accordingly, in the following description, the position, displacement and/or translation of the profiled beam at | 764 can be obtained by position sensor 784 as described in the present invention. A control circuit 760 can be programmed to control the translation of the displacement member, such as the profiled beam | 764. Control circuit 760, in some examples, may comprise one or more microcontrollers, microprocessors, or other processors suitable for executing instructions that cause the processor or processors to control the displacement member, for example the profiled beam | 764, in the manner described. In one aspect, a timer/counter 781 provides an output signal, such as elapsed time or a digital count, to control circuit 760 to correlate the profiled beam position at | 764, as determined by position sensor 784, with the output of timer/counter 781 so that control circuit 760 can determine the position of the profiled beam at | 764 at a specific time (t) relative to a starting position. The 781 timer/counter can be configured to measure elapsed time, count external events, or measure eternal events.
[0232] [0232] Control circuit 760 may generate a motor setpoint signal 772. The motor setpoint signal 772 may be provided to a motor controller 758. Motor controller 758 may comprise one or more circuits configured to provide a drive signal from motor 774 to motor 754 to drive motor 754, as described in the present invention. In some examples, the 754 motor may be a DC motor with a brushed DC electric motor. For example, the speed of motor 754 may be proportional to the drive signal of motor 774. In some examples, motor 754 may be a brushless DC electric motor and the drive signal of motor 774 may comprise a PWM signal supplied to a or more motor stator windings
[0233] [0233] The 754 motor can receive power from a power source
[0234] [0234] Control circuit 760 may be in communication with one or more sensors 788. Sensors 788 may be positioned on end actuator 752 and adapted to work with surgical instrument 750 to measure various derived parameters such as span distance versus time, tissue compression versus time, and anvil stress versus time. The 788 sensors may comprise a magnetic sensor, a magnetic field sensor, a strain gauge, a pressure sensor, a force sensor, an inductive sensor such as an eddy current sensor, a resistive sensor, a capacitive sensor, a sensor optical and/or any other sensor suitable for measuring one or more parameters of end actuator 752. Sensors 788 may include one or more sensors.
[0235] [0235] The one or more sensors 788 may comprise a strain gauge, such as a micro strain gauge, configured to measure the magnitude of strain on anvil 766 during a stuck condition. The effort meter provides an electrical signal whose amplitude varies with the magnitude of the effort. Sensors 788 may comprise a pressure sensor configured to detect a pressure generated by the presence of tissue compressed between the anvil 766 and the staple cartridge 768. Sensors 788 may be configured to detect the impedance of a section of tissue located between the anvil 766 and staple cartridge 768 which is indicative of the thickness and/or completeness of tissue situated therebetween.
[0236] [0236] The 788 sensors can be configured to measure the forces exerted on the 766 anvil by the closing drive system. For example, one or more sensors 788 may be at a point of interaction between a closure tube and anvil 766 to detect closure forces applied by a closure tube to anvil 766. The forces exerted on anvil 766 may be representative. of tissue compression experienced by the section of tissue captured between the anvil 766 and the staple cartridge 768. The one or more sensors 788 may be positioned at various interaction points along the closing drive system to sense the applied closing forces. to the anvil 766 by the closing drive system. The one or more sensors 788 may be sampled in real time during a gripping operation by a processor in the control circuit 760. The control circuit 760 receives real-time sample measurements to provide and analyze time-based information and evaluate, in real-time, the closing forces applied to the anvil 766.
[0237] [0237] A current sensor 786 can be used to measure the current drawn by the motor 754. The force required to advance the profile beam at | 764 corresponds to the current drawn by the motor
[0238] [0238] The 760 control circuit can be configured to simulate the instrument's actual system response in the controller software. An offset member can be actuated to move a profiled beam at | 764 on the 752 end actuator at or near a target speed. Surgical instrument 750 may include a feedback controller, which can be one or any of the feedback controllers, including, but not limited to, a PID controller, status feedback, LOR, and/or an adaptive controller, for example. Surgical instrument 750 may include a power source to convert the feedback controller signal into a physical input such as case voltage, PWM voltage, frequency modulated voltage, current, torque, and/or force, for example.
[0239] [0239] The actual drive system of the 750 surgical instrument is configured to drive the displacement member, cutting member, or profiled beam in | 764, by a brushed DC motor with gearbox and mechanical links to a knife and/or linkage system. Another example is the 754 electric motor which operates the displacement member and linkage driver, for example, from an interchangeable drive shaft assembly. An outside influence is an unreasonable and unpredictable influence of things like tissue, surrounding bodies, and friction on the physical system. This external influence can be called drag, which acts in opposition to the 754 electric motor. External influence, such as drag, can cause the functioning of the physical system to deviate from a desired operation of the physical system.
[0240] [0240] Several exemplifying aspects are directed to a surgical instrument 750 comprising an end actuator 752 with motor-driven surgical stapling and cutting implements. For example, a motor 754 may drive a displacement member distally and proximally along a longitudinal axis of the end actuator 752. The end actuator 752 may comprise a pivoting anvil 766 and, when configured for use, a cartridge of staples 768 positioned on the opposite side of anvil 766. A physician may hold tissue between anvil 766 and staple cartridge 768 as described in the present invention. When ready to use the instrument 750, the clinician may provide a trigger signal, for example, by pressing a trigger of the instrument 750. In response to the trigger signal, the motor 754 may drive the displacement member distally along the longitudinal axis. end actuator 752 from a proximal stroke start position to a stroke start position distal to the stroke start position. As the displacement member translates distally, a profile beam at | 764 with a cutting element positioned at a distal end can cut tissue between staple cartridge 768 and anvil 766.
[0241] [0241] In various examples, the surgical instrument 750 may comprise a control circuit 760 programmed to control the distal translation of the displacement member, such as the profile beam in | 764, for example, based on one or more tissue conditions. Control circuit 760 can be programmed to directly or indirectly detect tissue conditions, such as thickness, as described herein. The 760 control circuit can be programmed to select a trigger control program based on tissue conditions. A trigger control program can describe the distal movement of the displacement member. Different trigger control programs can be selected to best handle different tissue conditions. For example, when thicker tissue is present, the control circuit 760 can be programmed to translate the displacement member at a slower speed and/or at a lower power. When thinner fabric is present, control circuit 760 can be programmed to translate the displacement member at a higher speed and/or with higher power.
[0242] [0242] In some examples, the control circuit 760 may initially operate the motor 754 in an open circuit configuration for a first open circuit portion of a travel member stroke. Based on a response from instrument 750 during the open circuit portion of the stroke, control circuit 760 may select a trigger control program. The instrument response may include a translation distance of the displacement member during the open circuit portion, an elapsed time during the open circuit portion, the power supplied to motor 754 during the open circuit portion, a sum of pulse widths of a motor start signal, etc. After the open circuit portion, control circuit 760 may implement the selected trigger control program for a second portion of the displacement member stroke. For example, during the closed-loop portion of the stroke, control circuit 760 may modulate motor 754 based on translation data describing a position of the displacement member in a closed-loop manner to translate the displacement member in a closed-loop manner. constant speed. Additional details are described in US Patent Application Serial No. 15/720,852 entitled SYSTEM AND METHODS FOR CONTROLLING
[0243] [0243] Figure 19 is a schematic diagram of a surgical instrument 790 configured to control various functions in accordance with an aspect of the present invention. In one aspect, the surgical instrument 790 is programmed to control the distal translation of a displacement member, such as the profiled beam | 764. Surgical instrument 790 comprises an end actuator 792 which may comprise an anvil 766, a profiled beam 764 | 764 and a 768 removable staple cartridge that is interchangeable with a 796 RF cartridge (shown in dashed line).
[0244] [0244] In one aspect, 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, the 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, switches can be solid state devices such as transistors (eg, FET, junction FET, MOSFET, bipolar, and the like). In other implementations, 788 sensors may include conductorless electrical switches, ultrasonic switches, accelerometers, and inertia sensors, among others.
[0245] [0245] In one aspect, the 784 position sensor can be implemented as an absolute positioning system, which comprises an absolute rotary magnetic positioning system implemented as a ASSOSSEQFT single integrated circuit rotary magnetic position sensor, available from Austria Microsystems , AG. The 784 position sensor can interface with the 760 control circuit to provide an absolute positioning system. Position can include multiple Hall effect elements situated above a magnet and coupled to a CORDIC processor, also known as the digit-by-digit method and Volder algorithm, which is provided to implement a simple and efficient algorithm for computing hyperbolic and trigonometric functions. that only require addition, subtraction, bit shift, and lookup table operations.
[0246] [0246] In one aspect, the profiled beam in | 764 may be implemented as a knife member comprising a knife body that operatively supports a tissue cutting blade therein and may additionally include tabs or anvil engagement features and channel engagement features or a base. In one aspect, the staple cartridge 768 may be implemented as a standard surgical (mechanical) fastener cartridge. In one aspect, the 796 RF cartridge can be implemented as an RF cartridge. These and other sensor arrangements are described in commonly owned US patent application No. 15/628,175 entitled TECHNIQUES FOR ADAPTIVE CONTROL OF MOTOR
[0247] [0247] The position, movement, displacement and/or translation of a linear displacement member, such as the profile beam in | 764, can be measured by an absolute positioning system, a sensor array and position sensor represented as the 784 position sensor. As the profile beam in | 764 is coupled to the longitudinally movable drive member, the position of the profiled beam at | 764 can be determined by measuring the position of the longitudinally movable drive member employing the position sensor 784. Accordingly, in the following description, the position, displacement and/or translation of the profiled beam at | 764 can be obtained by position sensor 784 as described in the present invention. A control circuit 760 can be programmed to control the translation of the displacement member, such as the profiled beam | 764, as described in the present invention. Control circuit 760, in some examples, may comprise one or more microcontrollers, microprocessors, or other processors suitable for executing instructions that cause the processor or processors to control the displacement member, for example the profiled beam | 764, in the manner described. In one aspect, a timer/counter 781 provides an output signal, such as elapsed time or a digital count, to control circuit 760 to correlate the profiled beam position at | 764, as determined by position sensor 784, with the output of timer/counter 781 so that control circuit 760 can determine the position of the profiled beam at | 764 at a specific time (t) relative to a starting position. The 781 timer/counter can be configured to measure elapsed time, count external events, or measure eternal events.
[0248] [0248] Control circuit 760 may generate a motor setpoint signal 772. The motor setpoint signal 772 may be provided to a motor controller 758. Motor controller 758 may comprise one or more circuits configured to provide a drive signal from motor 774 to motor 754 to drive motor 754, as described in the present invention. In some examples, the 754 motor may be a DC motor with a brushed DC electric motor. For example, the speed of motor 754 may be proportional to the drive signal of motor 774. In some examples, motor 754 may be a brushless DC electric motor and the drive signal of motor 774 may comprise a PWM signal supplied to a or more motor stator windings
[0249] [0249] The 754 engine can receive power from a power source
[0250] [0250] Control circuit 760 may be in communication with one or more sensors 788. Sensors 788 may be positioned on end actuator 792 and adapted to work with surgical instrument 790 to measure various derived parameters such as span distance versus time, tissue compression versus time, and anvil stress versus time. The 788 sensors may comprise a magnetic sensor, a magnetic field sensor, a strain gauge, a pressure sensor, a force sensor, an inductive sensor such as an eddy current sensor, a resistive sensor, a capacitive sensor, a sensor optical and/or any other sensor suitable for measuring one or more parameters of end actuator 792. Sensors 788 may include one or more sensors.
[0251] [0251] The one or more sensors 788 may comprise a strain gauge, such as a micro strain gauge, configured to measure the magnitude of strain on anvil 766 during a stuck condition. The effort meter provides an electrical signal whose amplitude varies with the magnitude of the effort. Sensors 788 may comprise a pressure sensor configured to detect a pressure generated by the presence of tissue compressed between the anvil 766 and the staple cartridge 768. Sensors 788 may be configured to detect the impedance of a section of tissue located between the anvil 766 and staple cartridge 768 which is indicative of the thickness and/or completeness of tissue situated therebetween.
[0252] [0252] The 788 sensors can be configured to measure the forces exerted on the 766 anvil by the closing drive system. For example, one or more sensors 788 may be at a point of interaction between a closure tube and anvil 766 to detect closure forces applied by a closure tube to anvil 766. The forces exerted on anvil 766 may be representative. of tissue compression experienced by the section of tissue captured between the anvil 766 and the staple cartridge 768. The one or more sensors 788 may be positioned at various interaction points along the closing drive system to sense the applied closing forces. to the anvil 766 by the closing drive system. The one or more sensors 788 may be sampled in real time during a gripping operation by a processor portion of control circuit 760. Control circuit 760 receives real-time sample measurements to provide and analyze time-based information and evaluate , in real time, the closing forces applied to the anvil
[0253] [0253] A current sensor 786 can be used to measure the current drawn by the motor 754. The force required to advance the profile beam at | 764 corresponds to the current drawn by the motor
[0254] [0254] A 794 RF power source is coupled to the 792 end actuator and is applied to the 796 RF cartridge when the 796 RF cartridge is loaded into the 792 end actuator in place of the 768 staple cartridge. The control circuit 760 controls the delivery of RF energy to the 796 RF cartridge.
[0255] [0255] Additional details are described in US Patent Application Serial No. 15/636,096, entitled SURGICAL SYSTEM COUPLABLE
[0256] [0256] Figure 20 is a simplified block diagram of an 800 generator configured to provide inductorless tuning, among other benefits. Additional details of the 800 generator are described in US Patent No. 9,060,775 entitled SURGICAL GENERATOR FOR
[0257] [0257] In certain ways, ultrasonic and electrosurgical trigger signals can be delivered simultaneously to separate surgical instruments and/or to a single surgical instrument, such as the multi-purpose surgical instrument, with the ability to deliver both ultrasonic and electrosurgical energy to tissue. It will be recognized that the electrosurgical signal provided by both the dedicated electrosurgical instrument — and the combined electrosurgical/ultrasonic multifunctional instrument can be either a therapeutic or sub-therapeutic level signal, where the sub-therapeutic signal can be used, for example, to monitor tissue or instrument conditions and provide feedback to the generator. For example, RF and ultrasonic signals can be provided separately or simultaneously from a generator with a single output port in order to provide the desired output signal to the surgical instrument, as will be discussed in more detail below. Consequently, the generator can combine the RF and ultrasonic electrosurgical energies and supply the combined energies to the multifunctional electrosurgical/ultrasonic instrument. Bipolar electrodes can be placed on one or both jaws of the end actuator. A gripper can be powered by ultrasonic energy in addition to electrosurgical RF energy, operating simultaneously. Ultrasonic energy can be used to perform tissue dissection, while RF electrosurgical energy can be used to cauterize vessels.
[0258] [0258] The unisolated stage 804 may comprise a power amplifier 812 which has an output connected to a primary winding 814 of the power transformer 806. In certain forms, the power amplifier 812 may comprise a push-pull amplifier. For example, the non-isolated stage 804 may additionally contain a logic device 816 to provide a digital output to a digital-to-analog converter (DAC) circuit 818, which in turn provides a signal corresponding to an input of power amplifier 812. In certain forms, logic device 816 may comprise a programmable gate array (PGA), an FPGA (field programmable gate array FPGA), a programmable logic device (PLD, for "programmable logic device"), among other logic circuits, for example. The logic device 816, by controlling the input of the power amplifier 812 through the DAC circuit 818, can therefore control any one of several parameters (e.g. frequency, waveform, waveform amplitude) of drive signals. appearing on trigger signal outputs 810a, 810b, and 810c. In certain ways and as discussed below, logic device 816, in conjunction with a processor (e.g., a PSD discussed below), may implement various PSD-based control algorithms and/or other control algorithms to control parameters of the controllers. trigger signals provided by the 800 generator.
[0259] [0259] Power may be supplied to a power amplifier power rail 812 by a switch mode regulator 820, for example a power converter. In certain forms, the switch mode regulator 820 may comprise an adjustable buck (buck) regulator, for example. The non-isolated stage 804 may further comprise a first processor 822 which, in one form, may comprise a PSD processor such as an ADSP-21469 SHARC DSP analog device, available from Analog Devices, Norwood, MA, USA, for example. , although in various forms, any suitable processor can be employed. In certain forms, PSD processor 822 may control the operation of switch mode regulator 820 responsive to voltage feedback data received from power amplifier 812 by PSD processor 822 through an ADC circuit 824. In one form, by For example, PSD processor 822 may receive as input, through ADC circuit 824, the waveform envelope of a signal (e.g., an RF signal) being amplified by power amplifier 812. PSD processor 822 may then control the switch mode regulator 820 (e.g. via an output
[0260] [0260] In certain ways, the logic device 816, in conjunction with the PSD processor 822, can implement a digital synthesis circuit as a direct digital synthesizer control scheme to control the waveform, frequency and/or frequency. amplitude of the trigger signals emitted by generator 800. In one form, for example, logic device 816 may implement a DDS control algorithm by retrieving waveform samples stored in a lookup table (LUT). ") dynamically updated, such as a LUT RAM, which can be built into an FPGA. This control algorithm is particularly useful for ultrasonic applications where an ultrasonic transducer, such as an 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 motion branch current can correspondingly minimize or reduce the undesirable effects of resonance. As the waveform of a drive signal emitted by generator 800 is impacted by various sources of distortion present in the output drive circuit (e.g. power transformer 806, power amplifier 812), voltage feedback data and current based on the trigger signal can be input into an algorithm, such as an error control algorithm implemented by the PSD 822 processor, which compensates for distortion by properly pre-distorting or modifying the waveform samples stored in the LUT dynamically and continuously (for example, in real time). In one way, the amount or degree of predistortion applied to the LUT samples can be based on the error between a computerized motion branch current and a desired current waveform, with the error being determined on an error basis. sample by sample. In this way, pre-distorted LUT samples, when processed through the trigger circuit, can result in a motion branch trigger signal that has the desired waveform (e.g., sinusoidal) to optimally drive the transducer. ultrasonic. In such forms, the LUT waveform samples will therefore not represent the desired waveform of the trigger signal, but rather the waveform that is necessary to ultimately produce the desired waveform of the trigger signal. of the motion branch, when distortion effects are taken into account.
[0261] [0261] The uninsulated stage 804 may additionally comprise a first ADC circuit 826 and a second ADC circuit 828 coupled to the output of the power transformer 806 by means of respective isolation transformers 830 and 832, to sample respectively the voltage and current of trigger signals emitted by generator 800. In certain ways, ADC circuits 826 and 828 can be configured to sample at high speeds (eg, 80 mega samples per second (MSPS)) to allow oversampling of trigger signals. In one form, for example, the sampling rate of the ADC circuits 826 and 828 can allow for approximately 200x oversampling (depending on frequency) of the trigger signals. In certain ways, ADC circuit 826 and 828 sampling operations can be performed by a single circuit.
[0262] [0262] In certain ways, voltage and current feedback data can be used to control the frequency and/or amplitude (eg current amplitude) of drive signals. In one form, for example, voltage and current feedback data can be used to determine the impedance phase. 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 set point (e.g. 0°), thus minimizing or reducing the effects of harmonic distortion and accentuating , correspondingly, the accuracy of the impedance phase measurement. Phase impedance determination and a frequency control signal may be implemented in the PSD processor 822, for example, with the frequency control signal being provided as input to a DDS control algorithm implemented by logic device 816.
[0263] [0263] In another way, for example, the current feedback data can be monitored so as to maintain the current amplitude of the trigger signal at a current amplitude setpoint. The current span setpoint can be specified directly or determined indirectly based on the specified voltage and power span setpoints. In certain ways, current amplitude control can be implemented by the control algorithm, such as a proportional-integral-derivative (PID) control algorithm in the PSD 822 processor. The variables controlled by the control algorithm for to properly control the current amplitude of the trigger signal may include, for example, scaling the LUT waveform samples stored in logic device 816 and/or the full scale output voltage of the DAC 818 circuit (which provides the input to the power amplifier 812) via a DAC circuit 834.
[0264] [0264] The non-isolated stage 804 may additionally comprise a second processor 836 to provide, among other things, user interface (UIl) functionality. In one form, the UI 836 processor may comprise an Atmel AT91SAM9263 processor with an ARM 926EJ-S core, available from Atmel Corporation of San Jose, California, USA, for example. Examples of UIl functionality supported by the UI 836 processor may include audible and visual user feedback, communication with peripheral devices (e.g. through a USB interface), communication with a footswitch, communication with an input device ( for example a touch screen) and communication with an output device (for example a loudspeaker). The UI processor 836 can communicate with the PSD processor 822 and the logic device 816 (for example, via SPI buses). While the UI 836 processor can primarily support UI functionality, it can also coordinate with the PSD 822 processor to implement risk mitigation in certain ways. For example, the UI 836 processor can be programmed to monitor various aspects of user input and/or other inputs (e.g. touchscreen inputs, footswitch inputs, temperature sensor inputs) and can disable the generator drive output 800 when an error condition is detected.
[0265] [0265] In certain ways, both the PSD processor 822 and the UI processor 836 can, for example, determine and monitor the operational state of the generator 800. For the PSD processor 822, the operational state of the generator 800 can determine, for example, which control and/or diagnostic processes are implemented by the PSD processor 822. For the UI processor 836, the operating state of the generator 800 may determine, for example, which elements of a UI (e.g. display screens, sounds) are presented to a user. The respective PSD and UI processors, 822 and 836, can independently maintain the current operational state of the generator 800, as well as recognize and evaluate possible transitions out of the current operational state. The PSD 822 processor can act as the principal in this relationship, and can determine when transitions between operational states should occur. The UI 836 processor can be aware of valid transitions between operational states and can confirm that a given transition is appropriate. For example, when the PSD processor 822 instructs the UI processor 836 to transition to a specific state, the UI processor 836 can verify that the requested transition is valid. If a requested transition between states is determined to be invalid by the UI 836 processor, the UI 836 processor can cause generator 800 to enter a failure mode.
[0266] [0266] The uninsulated platform 804 may further contain a controller 838 for monitoring input devices (eg, a capacitive touch sensor used to turn generator 800 on and off, a capacitive touch screen). In certain forms, controller 838 may comprise at least one processor and/or other controller device in communication with UI processor 836. In one form, for example, controller 838 may comprise a processor (e.g., an 8-inch Meg168 controller). bits available from Atmel) configured to monitor user input provided through one or more capacitive touch sensors. In one form, the 838 controller may comprise a touchscreen controller (e.g., a QT5480 touchscreen controller available from Atmel) to control and manage the capture of touch data from a capacitive touchscreen. to the touch.
[0267] [0267] In certain ways, when generator 800 is in a "off" state, controller 838 may continue to receive operating power (e.g., through a line from a power supply to generator 800, such as the power supply 854 discussed below). In this way, controller 838 can continue to monitor an input device (e.g., a capacitive touch sensor located on a front panel of generator 800) to turn generator 800 on and off. When generator 800 is in the off state, the 838 controller can wake up the power supply (e.g. enable one or more 856 DC/DC voltage converters from the 854 power supply) if activation of the input device "on/off" is detected by a user . Controller 838 may therefore initiate a sequence to transition generator 800 to an "on" state. On the other hand, controller 838 may initiate a sequence to transition generator 800 to the off state if activation of the "on/off" input device is detected when generator 800 is in the on state. In certain ways, for example, controller 838 may report input device activation "on/off" to UI processor 836 which, in turn, implements the process sequence necessary to transition generator 800 to the off state. In such forms, the controller 838 may not have any independent capability to cause the generator 800 to be de-powered after its on state has been established.
[0268] [0268] In certain ways, the controller 838 may cause the generator 800 to provide audible feedback or other sensory feedback to alert the user that an on or off sequence has been initiated. 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.
[0269] [0269] In certain forms, isolated stage 802 may comprise an instrument interface circuit 840 to, for example, provide a communication interface between a control circuit of a surgical instrument (e.g., a control circuit comprising switches handle) and non-isolated stage components 804, such as logic device 816, PSD processor 822, and/or UI processor 836. Instrument interface circuit 840 can exchange information with non-isolated stage components. isolated 804 via a communication link that maintains an adequate degree of electrical isolation between the isolated and non-isolated stages 802 and 804, such as an IR-based communication link. Power can be supplied to the instrument interface circuit 840 using, for example, a low-drop voltage regulator powered by an isolation transformer driven from the non-isolated stage 804.
[0270] [0270] In one form, instrument interface circuit 840 may comprise logic circuit 842 (e.g. logic circuit, programmable logic circuit, PGA, FPGA, PLD) in communication with a signal conditioning circuit 844. signal conditioning 844 may be configured to receive a periodic signal from logic circuit 842 (e.g., a 2 kHz square wave) to generate a bipolar interrogation signal of an identical frequency. The interrogation signal can be generated, for example, using a bipolar current source powered by a differential amplifier. The interrogation signal can be communicated to a surgical instrument control circuit (for example, using a lead pair in a cable connecting the generator 800 to the surgical instrument) and monitored to determine a state or configuration of the control circuit. control. The control circuit may comprise a number of switches, resistors and/or diodes to modify one or more characteristics (e.g. amplitude, rectification) of the interrogation signal so that a state or configuration of the control circuit is unambiguously discernible, based on that one or more characteristics. In one form, for example, the signal conditioning circuit 844 may comprise an ADC circuit for generating samples of a voltage signal appearing between inputs of the control circuit, resulting from the passage of an interrogation signal therethrough. Logic circuit 842 (or a component of unisolated stage 804) can then determine the state or configuration of the control circuit based on the ADC circuit samples.
[0271] [0271] In one form, the instrument interface circuit 840 may comprise a first data circuit interface 846 to enable the exchange of information between the logic circuit 842 (or another element of the instrument interface circuit 840) and a first data circuit disposed on or otherwise associated with a surgical instrument. In certain forms, for example, a first data circuit may be disposed on a wire integrally attached to a surgical instrument handle or an adapter to interface a specific type or model of surgical instrument and the generator 800. The first data circuit may be deployed in any suitable manner and may communicate with the generator in accordance with any suitable protocol, including, for example, as described herein with respect to the first data circuit. In certain forms, the first data circuit may comprise a non-volatile storage device, such as an EEPROM device. In certain forms, the first data circuit interface 846 may be implemented separately from the logic circuit 842 and comprise suitable circuitry (e.g. discrete logic devices, a processor) to enable communication between the logic circuit 842 and the first circuit. of data. In other forms, the first data circuit interface 846 may be integral to the logic circuit 842.
[0272] [0272] In certain forms, the first 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. This information can be read by instrument interface circuit 840 (e.g., logic circuit 842), transferred to a component of non-isolated stage 804 (e.g., to logic device 816, PSD processor 822, and/or UI 836) for presentation to a user via an output device and/or for controlling a function or operation of generator 800. Additionally, any type of information may be communicated to the first data circuit for storage therein via the first interface of data circuit 846 (for example, using logic circuit 842). This information may include, for example, an up-to-date number of operations in which the surgical instrument was used and/or the dates and/or times of its use.
[0273] [0273] As discussed above, a surgical instrument may be removable from a handle (e.g., the multipurpose surgical instrument may be removable from the handle) to promote interchangeability and/or disposability of the instrument. In such cases, conventional generators may be limited in their ability to recognize specific instrument settings being used, as well as to optimize control and diagnostic processes as needed. Adding readable data circuits to surgical instruments to address this issue is problematic from a compatibility point of view, however. For example, designing a surgical instrument so that it remains backward compatible with generators lacking the indispensable data readout functionality can be impractical due, for example, to different signaling schemes, design complexity and cost. The instrument shapes discussed in this document address these concerns by using data circuits that can be implemented in existing surgical instruments, economically and with minimal design changes to preserve the compatibility of surgical instruments with current generator platforms.
[0274] [0274] Additionally, generator 800 shapes can enable communication with instrument-based data circuits. For example, generator 800 can be configured to communicate with a second data circuit contained in an instrument (eg, the multifunctional surgical instrument). In some ways, the second data circuit may be implemented similarly to that of the first data circuit described herein. Instrument interface circuit 840 may comprise a second data circuit interface 848 to enable such communication. In one form, the second data circuit interface 848 may comprise a three-state digital interface, although other interfaces may also be used. In certain forms, the second data circuit may generally be any circuit for transmitting and/or receiving data. In one form, for example, the second data circuit may 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.
[0275] [0275] In some forms, the second data circuit may store information about the electrical and/or ultrasonic properties of an associated ultrasonic transducer, end actuator, or ultrasonic drive system. For example, the first data circuit may indicate an initialization frequency slope, as described herein.
[0276] [0276] In certain forms, the second data circuit and the second data circuit interface 848 can be configured so that communication between the logic circuit 842 and the second data circuit can be effected without the need to provide additional conductors for this purpose (for example, dedicated conductors of a cable connecting a handle to the 800 generator). In one form, for example, information may be communicated to and from the second data circuit using a one-wire bus communication scheme, implemented in existing wiring, as one of the conductors used to transmit interrogation signals to from the 844 signal conditioning circuit to a control circuit in a handle. In this way, changes or modifications to the design of the surgical device that might otherwise be necessary are minimized or reduced. Furthermore, due to the fact that different types of communications implemented on a common physical channel can be separated on the basis of frequency, the presence of a second data circuit can be "invisible" to generators that do not have the indispensable readout functionality. data, which, therefore, makes possible the retrocompatibility of the surgical instrument.
[0277] [0277] In certain forms, isolated stage 802 may comprise at least one blocking capacitor 850-1 connected to trigger signal output 810b to prevent direct current from flowing to a patient. A single blocking capacitor may be required to comply with medical regulations and standards, for example. While failures in single-capacitor designs are relatively uncommon, this type of failure can still have negative consequences. In one form, a second blocking capacitor 850-2 can be supplied in series with the blocking capacitor 850-1, with one-point current leakage between blocking capacitors 850-1 and 850-2 being monitored, for example , by an ADC circuit 852 for sampling a voltage induced by leakage current. Samples can be received by logic circuit 842, for example. Based on changes in leakage current (as indicated by voltage samples), the 800 generator can determine when at least one of the blocking capacitors 850-1, 850-2 has failed, thus providing a benefit over single capacitor designs with a single point of failure.
[0278] [0278] In certain embodiments, the unisolated stage 804 may comprise a power supply 854 to provide DC power with adequate voltage and current. The power supply may comprise, for example, a 400 W power supply to provide a system voltage of 48 VDC. Power supply 854 may further comprise one or more DC/DC voltage converters 856 for receiving output from the power supply to generate DC outputs at the voltages and currents required by the various components of generator 800. As discussed above in connection with the controller 838, one or more of the 856 DC/DC voltage converters may receive an input from the 838 controller when a user's "on/off" input device activation is detected by the 838 controller to enable the converters to run or wake up. DC/DC voltage rating 856.
[0279] [0279] Figure 21 illustrates an example of a generator 900, which is a form of generator 800 (Figure 20). Generator 900 is configured to supply multiple modalities of energy to a surgical instrument. The Generator 900 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 supply multiple modalities of energy (e.g., 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.
[0280] [0280] Generator 900 comprises a processor 902 coupled to a waveform generator 904. Processor 902 and waveform generator 904 are configured to generate various signal waveforms based on information stored in an attached memory. to processor 902, not shown for clarity of description. The digital information associated with a waveform is provided to waveform generator 904 which includes one or more DAC circuits for converting the digital input to an analog output. The analog output is fed to an amplifier 1106 for signal conditioning and amplification. The conditioned and amplified output of amplifier 906 is coupled to a power transformer 908. Signals are coupled by power transformer 908 to the secondary side, which is on the patient isolation side. A first signal of a first power mode is provided to the surgical instrument between the terminals labeled POWER1 and RETURN. A second signal of a second power mode is coupled by a capacitor 910 and is supplied to the surgical instrument between the terminals labeled POWER and RETURN. It will be recognized that more than two modes of energy can be emitted and therefore the subscript "n" can be used to denote that up to n ENERGYAn terminals can be provided, where n is a positive integer greater than 1. It will be recognized also that up to "n" return paths, RETURNon can be provided without departing from the scope of the present invention.
[0281] [0281] A second voltage detection circuit 912 is coupled across the terminals identified as POWER and the RETURN path to measure the output voltage between them. A second voltage sensing circuit 924 is coupled across the terminals labeled POWER and the RETURN path to measure the output voltage between them. A current sensing circuit 914 is arranged in series with the RETURN leg of the secondary side of power transformer 908 as shown to measure the output current for any power mode. If different return paths are provided for each power mode, then a separate current sensing circuit would be provided on each return leg. The outputs of the first and second voltage sensing circuits 912, 924 are supplied to respective isolation transformers 916, 922 and the output of the current sensing circuit 914 is supplied to another isolation transformer 918. The outputs of the isolation transformers 916, 928, 922 on the primary side of power transformer 908 (non-isolated patient side) are provided to one or more ADC circuits 926. The digitized output of ADC circuit 926 is provided to processor 902 for further processing and computation. The output voltages and output current feedback information can be used to adjust the output voltage and current supplied to the surgical instrument, and to compute the output impedance, among other parameters. Input/output communications between the 902 processor and isolated patient circuits are provided through an interface circuit
[0282] [0282] In one aspect, the impedance can be determined by the processor 902 by dividing the output of the first voltage sensing circuit 912 coupled across the terminals identified as POWER1/RETURN or the second voltage sensing circuit 924 coupled across the terminals identified as POWER2/RETURN through the output of the current sensing circuit 914 arranged in series with the RETURN leg of the secondary side of the power transformer
[0283] [0283] As shown in Figure 21, the generator 900 comprising at least one output port may include a power transformer 908 with a single output and multiple taps to provide power in the form of one or more energy modalities, such as ultrasonic. , bipolar or monopolar RF, irreversible and/or reversible electroporation, and/or microwave energy, among others, for example, to the end actuator depending on the type of tissue treatment being performed. For example, Generator 900 can supply power with higher voltage and lower current to drive an ultrasonic transducer, with lower voltage and higher current to drive RF electrodes to seal tissue, or with a coagulation waveform for spot coagulation using electrosurgical electrodes. Monopolar or Bipolar RF. The output waveform of the generator 900 can be oriented, switched, or filtered to provide 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 ENERGY1I1 and the RETURN, as shown in Figure 21. In an example, a connection of bipolar RF electrodes to the output of generator 900 would preferably be located between the output identified as ENERGY2 and the RETURN. In the case of a monopolar output, the preferred connections would be an active electrode (eg light beam or other probe) to the ENERGY2 output and a suitable return block connected to the RETURN output.
[0284] [0284] Additional details are described in US patent application publication No. 2017/0086914 titled TECHNIQUES FOR OPERATING
[0285] [0285] As used throughout this description, the term "wireless" and its derivatives may 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 (IEXE 802.11 family), WiMAX (IEZE 802.16 family), IEEE 802.20, 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 protocols without wired and wired which are designated as 3G, 4G, 5G, and beyond. The computing module may 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.
[0286] [0286] 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 stream. The term is used in the present invention to refer to the central processor (central processing unit) in a computer system or systems (specifically systems on a chip (SoCs)) that combine several specialized "processors".
[0287] [0287] As used herein, a system on a chip or system on chip (SoC or SOC) is an integrated circuit (also known as an "IC" or "chip") that integrates all the components of a computer or other electronic systems. It can contain digital, analog, mixed and often radio frequency functions — all on a single substrate. A SoC integrates a microcontroller (or microprocessor) with advanced peripherals such as a graphics processing unit (GPU), Wi-Fi module, or coprocessor. A SoC may or may not contain internal memory.
[0288] [0288] As used herein, 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 on a single integrated circuit. It can be similar to a SoC; a SoC may include a microcontroller as one of its components. A microcontroller may contain one or more core processing units (CPUs) along with memory and programmable input/output peripherals. Program memory in the form of ferroelectric RAM, NOR flash, or OTP ROM is also often included on the chip, 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 distinct integrated circuits.
[0289] [0289] As used in the present invention, the term controller or microcontroller may be an independent chip or IC (integrated circuit) device that interfaces with a peripheral device. This could be a link between two parts of a computer or a controller on an external device that manages the operation of (and connection to) that device.
[0290] [0290] Any of the processors or microcontroller in the present invention may be any implemented by any single-core or multi-core processor, such as those known under the trade name ARM Cortex by Texas Instruments. In one aspect, the processor may be a Core Cortex-M4F LM4F230H5QR ARM processor, available from Texas Instruments, for example, comprising 256 KB single-cycle flash memory, or other non-volatile memory, up to 40 MHz. , a prefetch buffer to optimize performance above 40 MHz, a 32 KB single-cycle serial random access memory (SRAM), an internal read-only memory (ROM) loaded with the StellarisWareO program, read-only memory programmable and electrically erasable 2 KB EEPROM, one or more pulse width modulation (PWM) modules, one or more analog quadrature encoder (QEI) inputs, one or more analog to digital converters (ADCs) of 12-bit with 12 analog input channels, details of which are available in the product data sheet.
[0291] [0291] In one aspect, the processor may comprise a safety controller comprising two controller-based families, such as TMS570 and RM4x, known under the tradename Hercules ARM Cortex R4, also by Texas Instruments. The safety controller can be configured specifically for safety critical applications IEC 61508 and ISO 26262, among others, to provide advanced built-in safety features while providing scalable performance, connectivity and memory options.
[0292] [0292] Modular devices include modules (as described in connection with Figures 3 and 9, for example) that are receivable within a central surgical controller and surgical devices or instruments that can be connected to the various modules 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 screens. The modular devices described herein may be controlled by control algorithms. Control algorithms can run on the modular device itself, on the central surgical controller to which the specific modular device is paired, or both on the modular device and on the central surgical controller (e.g. via a distributed computing architecture). In some examples, the modular devices' control algorithms control the devices based on data detected by the modular device itself (ie, by sensors in, on, or connected to the modular device). This data may be related to the patient being operated on (e.g. tissue properties or inflation pressure) or the modular device itself (e.g. the rate at which a knife is being advanced, motor current, or energy). For example, a control algorithm for a surgical stapling and cutting instrument might control the rate at which the instrument's motor drives its knife through tissue according to the resistance encountered by the knife as it advances. User feedback methods
[0293] [0293] The present invention provides user feedback techniques. In one aspect, the present invention provides an image display via a medical imaging device (e.g. laparoscope, endoscope, thoracoscope and the like). A medical imaging device comprises an optical component and an image sensor. The optical component may comprise a lens and a light source, for example. The image sensor can be implemented as a charge-coupled device (CCD) or complementary oxide semiconductor (CMOS). The image sensor provides image data to electronic components in the central surgical controller. Data representing images can be transmitted via wired or wireless communication to show instrument status, feedback data, imaging data, and highlight tissue irregularities and underlying structures. In another aspect, the present invention provides wired or wireless communication techniques for communicating user feedback from a device (e.g., instrument, robot, or tool) to the central surgical controller. In another aspect, the present invention provides usage and identification enabling and recording. Finally, in another aspect, the central surgical controller can have a direct interface control between the device and the central surgical controller. Data monitor display through laparoscope
[0294] [0294] In various aspects, the present invention provides monitor display of data through the laparoscope. The data monitor display through the data laparoscope may comprise showing a current instrument alignment with respect to adjacent preceding operations, cooperation between local instrument displays and paired laparoscope display, and displaying the instrument-specific data required for use. efficiency of a portion of the end actuator of a surgical instrument. Each of these techniques is described later in this document.
[0295] [0295] In one aspect, the present invention provides alignment guidance display elements that provide the user with information about the location of a previous trigger or actuation and enable them to align the next use of the instrument to the proper position without the need to to view the instrument directly. In another aspect, the first device and the second device are separate; the first device is in the sterile field and the second is used from outside the sterile field.
[0296] [0296] During a colorectal transection using a double-stapling technique, it is difficult to align the location of an anvil trocar of a circular stapler with the center of a row of overlapping staples. During the procedure, the circular stapler anvil trocar is inserted into the rectum below the staple line and a laparoscope is inserted into the peritoneal cavity above the staple line. As the staple line seals the colon, there is no line of sight to align the anvil trocar with the use of the laparoscope to optically align the anvil trocar insertion location with respect to the center of the staple line overlap.
[0297] [0297] One solution provides a non-contact sensor situated over the anvil trocar of the circular stapler and a target situated at the distal end of the laparoscope. Another solution provides a non-contact sensor located at the distal end of the laparoscope and a target located over the anvil trocar of the circular stapler.
[0298] [0298] A central surgical controller computer processor receives signals from the non-contact sensor and displays a centering tool on a screen indicating the alignment of the circular stapler anvil trocar and the overlap portion at the center of the staple row. The display shows a first image of the target staple line with a radius around the staple line overlap portion and a second image of the projected anvil trocar location. The anvil trocar and the overlap portion at the center of the staple row are aligned when the first and second images overlap.
[0299] [0299] In one aspect, the present invention provides a central surgical controller for aligning a surgical instrument. The central surgical controller comprises a processor and a memory coupled to the processor. The memory stores instructions executable by the processor to receive image data from an image sensor, generate a first image based on the image data, first image on a monitor coupled to the processor, receive a signal from a non-contact sensor, generate a second image based on the position of the surgical device and show the second image on the monitor. The data in the first image represents a center of a staple line fence. The first image represents a target corresponding to the center of the staple line. The signal is indicative of a position of a surgical device relative to the center of the staple line. The second image represents the position of the surgical device along a projected trajectory of the surgical device towards the center of the staple line.
[0300] [0300] In one aspect, the center of the staple line will be a double staple overlap portion zone. In another aspect, the image sensor receives an image from a laparoscope. In another aspect, the surgical device is a circular stapler comprising an anvil trocar and the non-contact sensor is configured to detect the location of the anvil trocar with respect to the center of the staple line seal. In another aspect, the non-contact sensor is an inductive sensor. In another aspect, the non-contact sensor is a capacitive sensor.
[0301] [0301] In various aspects, the present invention provides a control circuit for aligning the surgical instrument as described above. In various aspects, the present invention provides non-transient computer-readable media that stores computer-readable instructions that, when executed, cause a machine to align the surgical instrument as described above.
[0302] [0302] This technique provides better alignment of a surgical instrument such as a circular stapler around the overlapping portion of the staple row to produce a better seal and cut after the circular stapler is fired.
[0303] [0303] In one aspect, the present invention provides a system for displaying current instrument alignment with respect to preceding adjacent operations. Instrument alignment information can be displayed on a monitor or any electronic device suitable for visual presentation of data whether located locally on the instrument or remotely from the instrument via the central modular communication controller. The system can show the current alignment of a circular staple cartridge relative to an overlapping row of staples, show the current alignment of a circular staple cartridge relative to a preceding linear staple row, and/or show the existing staple row of the linear transection and an alignment circle that indicates a properly centered circular staple cartridge. Each of these techniques is described later in this document.
[0304] [0304] In one aspect, the present invention provides alignment guidance display elements that provide the user with information about the location of a trigger or a preceding actuation of a surgical instrument (e.g. a surgical stapler) and enable the user to align the next use of instrument
[0305] [0305] Figure 22 illustrates a diagram 6000 of a surgical instrument 6002 centered on a row of staples 6003 that makes use of the benefit of centering tools and techniques described in connection with Figures 23 to 33, in accordance with an aspect of the present invention. As used in the following description of Figures 23 to 33, a row of staples may include multiple rows of misaligned staples typically includes two or three rows of misaligned staples, without limitation. The staple line may be a double staple line 6004 formed using a double stapling technique as described in connection with Figures 23 to 27 or it may be a linear staple line 6052 formed using a transection technique. linear as described in connection with Figures 28 to 33. The centering tools and techniques described herein can be used to align the 6002 instrument located in one part of the anatomy with the 6003 staple line or with another instrument located in a another part of the anatomy without the benefit of a line of sight. Centering tools and techniques include showing the current alignment of the 6002 instrument adjacent to previous operations. The centering tool is useful, for example, during laparoscopy-assisted rectal surgery that employs a double stapling technique, also called the superimposed stapling technique. In the illustrated example, during a laparoscopy-assisted rectal surgical procedure, a circular stapler 6002 is positioned in the rectum 6006 of a patient in the pelvic cavity 6008 and a laparoscope is positioned in the peritoneal cavity.
[0306] [0306] During laparoscopy-assisted rectal surgery, the colon is tranced and sealed by the staple line 6003 with an "I" length. The double stapling technique uses the 6002 circular stapler to create an end-to-end anastomosis and is currently used widely in laparoscopic-assisted rectal surgery. For successful formation of an anastomosis using a circular stapler 6002, the anvil trocar 6010 of the circular stapler 6002 must be aligned with the central "1/2" of the staple line transection 6003 before drilling through the "1/2" 2" of the staple line 6003 and/or fully gripping the tissue before firing the circular stapler 6002 to cut the staple overlap portion 6012 and form the anastomosis. Misalignment of the 6010 anvil trocar to the center of the transection of the 6003 staple line can result in a high rate of anastomotic failure. This technique can be applied to ultrasonic instruments, electrosurgical instruments, combination ultrasonic/electrosurgical instruments, and/or combination surgical stapler/electrosurgical instruments. Various techniques are now described for aligning the anvil trocar 6010 of the circular stapler 6002 to the center "I/2" of the row of staples 6003.
[0307] [0307] In one aspect, as described in Figures 23 to 25 and with reference also to Figures 1 to 11 to show interaction with an interactive surgical system environment 100 that includes a central surgical controller 106, 206, the present invention provides a apparatus and a method for detecting the overlapping portion of the double staple line 6004 in a laparoscopy-assisted rectal surgery colorectal transection using a double staple technique. The overlapping portion of the dual staple line 6004 is detected and the current location of the anvil trocar 6010 of the circular stapler 6002 is shown on a display of the central surgical controller 215 coupled to the central surgical controller 206. The central surgical controller 215 display shows the alignment of a circular stapler cartridge 6002 with respect to the overlapping portion of the double staple line 6004, which is situated at the center of the double staple line 6004. The central surgical controller screen 215 shows a circular image centered around the line region. 6004 overlapping staple line to ensure that the overlapping portion of the double staple row 6004 is contained within the circular stapler knife 6002 and therefore removed after circular firing. Using the mesh, the surgeon aligns the 6010 Anvil Trocar with the center of the 6004 Dual Staple Row before drilling through the center of the 6004 Dual Staple Row and/or fully clamping the tissue before firing the 6002 Circular Stapler to cut the staple overlap portion 6012 and form the anastomosis.
[0308] [0308] Figures 23 to 25 illustrate a process of aligning an anvil trocar 6010 of a circular stapler 6022 to a staple overlap portion 6012 of a double staple line 6004 created by a double stapling technique, in accordance with an aspect of the present invention. Staple overlap portion 6012 is centered on double staple row 6004 formed by a double stapling technique. The circular stapler 6002 is inserted into the colon 6020 below the dual staple line 6004 and a laparoscope 6014 is inserted through the abdomen above the dual staple line 6004. A laparoscope 6014 and a non-contact sensor 6022 are used to determine a location of the anvil trocar 6010 relative to the staple overlap portion 6012 of the dual staple line 6004. The laparoscope 6014 includes an image sensor for generating an image of the dual staple line 6004. The image sensor image is transmitted to the controller surgical center 206 via the imaging module 238. Sensor 6022 generates a signal 6024 that detects the metal clips using either inductive or capacitive metal sensing technology. The signal 6024 varies based on the position of the anvil trocar 6010 relative to the staple overlap portion 6004. A centering tool 6030 displays an image 6038 of the double staple line 6004 and a target alignment ring 6032 that circumscribes the image 6038 of the double staple line 6004 centered around an image 6040 of the staple overlap portion 6012 on the screen of the central surgical controller 215. The centering tool 6030 also presents a projected cutting path 6034 of a circular stapler anvil knife
[0309] [0309] Figure 23 illustrates an anvil trocar 6010 of a circular stapler 6002 that is not aligned with an overlapping staple portion 6012 of a double staple line 6004 created by a double stapling technique. The double staple line 6004 has a length of "II" and the overlapping staple portion 6012 is situated midway along the double staple line 6004 at "1/2". As shown in Figure 23, the circular stapler 6002 is inserted into a section of colon 6020 and is positioned just below the transection of the double staple line 6004. A laparoscope 6014 is positioned above the transection of the double staple line 6004 and feeds with a image of dual staple row 6004 and staple overlap portion 6012 in field of view 6016 of laparoscope 6014 the central surgical controller display
[0310] [0310] As shown in Figure 23, the projected trajectory 6018 of the anvil trocar 6010 is shown along a dashed line to a position marked by an X. As shown in Figure 23, the projected trajectory 6018 of the anvil trocar 6010 is not is aligned with the staple overlap portion 6012. Piercing the anvil trocar 6010 through the double staple row 6004 at a point outside the staple overlap portion 6012 could lead to anastomotic failure. Using the Centering Tool 6030 of the 6010 Anvil Trocar depicted in Figure 25, the surgeon can align the 6010 Anvil Trocar with the Clamp Overlay portion 6012 using the images shown by the Centering Tool.
[0311] [0311] As shown in Figure 24, the anvil trocar 6010 is aligned with the staple overlap portion 6012 at the center of the double staple row 6004 created by a double stapling technique. The surgeon may now pierce the anvil trocar 6010 through the staple overlap portion 6012 of the dual staple line 6004 and/or fully grip the tissue before firing the circular stapler 6002 to trim the staple overlap portion 6012 and form an anastomosis.
[0312] [0312] Figure 25 illustrates a centering tool 6030 shown on a screen of the central surgical controller 215, with the centering tool providing a screen of a staple overlap portion 6012 of a double staple row 6004 created by a technique stapling, wherein the anvil trocar 6010 is not aligned with the staple overlap portion 6012 of the dual staple row 6004 as shown in Figure
[0313] [0313] As shown in Figure 25, the anvil trocar 6010 is not aligned with the desired perforation through the location designated by image 6040 of the staple overlap portion
[0314] [0314] As discussed above, the sensor 6022 is configured to detect the position of the anvil trocar 6010 in relation to the clamp overlap portion 6012. Accordingly, the location of the cross 6036 (X) displayed on the central controller screen 215 is determined. by the surgical stapler sensor 6022. In another aspect, the sensor 6022 may be located on the laparoscope 6014, where the sensor 6022 is configured to detect the tip of the anvil trocar 6010. In other aspects, the sensor 6022 may be located on the circular stapler 6022 or laparoscope 6014, or both, to determine the location of the anvil trocar 6010 in relation to the staple overlap portion 6012 and provide the information to the display of the central surgical controller 215 via the central surgical controller 206.
[0315] [0315] Figures 26 and 27 illustrate a before image 6042 and an after image 6043 of a centering tool 6030, in accordance with an aspect of the present invention. Figure 26 illustrates an image of a cutting path 6034 projected from an anvil trocar 6010 and a circular knife prior to alignment with the target alignment ring 6032 which circumscribes image 6038 of the double staple line 6004 over image 6040 of the portion overlay clip 6040 displayed on a screen of the central surgical controller 215. Figure 27 illustrates an image of a projected cutting path 6034 of an anvil trocar 6010 and a circular knife after alignment with the target alignment ring 6032 that circumscribes the image 6038 of the double staple row 6004 over the image 6040 of the staple overlap portion 6040 displayed on a screen of the central surgical controller 215. The current location of the anvil trocar 6010 is marked by the cross 6036 (X) which as shown in Figure 26, is positioned below and to the left of the image center 6040 of the staple overlap portion 6040. As shown in Figure 27, as the surgeon moves anvil trocar 6010 along projected path 6046, projected cutting path 6034 aligns with target alignment ring
[0316] [0316] In another aspect, the 6022 sensor can be configured to detect the beginning and end of a linear staple line in a colorectal transection and to provide the current location position of the 6010 Anvil Trocar of the 6002 Circular Stapler. In another aspect, the present invention provides a central surgical controller screen 215 for displaying the circular stapler 6002 centered on the linear staple line, which would create uniform folds, and for providing the current position of the anvil trocar 6010 to enable the surgeon to center or Align the 6010 Anvil Trocar as desired before drilling and/or fully clamping the tissue prior to firing the 6002 Circular Stapler.
[0317] [0317] In another aspect, as described in Figures 28 to 30 and with reference also to Figures 1 to 11 to show the interaction with an interactive surgical system environment 100 that includes a central surgical controller 106, 206, in a colorectal transection of laparoscopy-assisted rectal surgery using a linear stapling technique, the beginning and end of the 6052 linear staple row are detected and the current location of the 6010 anvil trocar of the 6002 circular stapler is shown on a surgical controller screen central 215 coupled to central surgical controller 206. The central surgical controller 215 display shows a circular image centered over the double staple row 6004 which would create uniform folds and the current position of the anvil trocar 6002 is shown to enable the surgeon to center or align the 6010 Anvil Trocar prior to drilling through the 6052 Linear Staple Line and/or fully clamping the tissue prior to Separate the circular stapler 6002 to cut the center 6050 of the linear staple line 6052 to form an anastomosis.
[0318] [0318] Figures 28 to 30 illustrate a process of aligning an anvil trocar 6010 of a circular stapler 6022 to a center 6050 of a linear staple line 6052 created by a linear stapling technique, in accordance with an aspect of the present invention. invention. Figures 28 and 29 illustrate a laparoscope 6014 and a sensor 6022 located on the circular stapler 6022 to determine the location of the anvil trocar 6010 with respect to the center 6050 of the linear staple line 6052. The anvil trocar 6010 and sensor 6022 are inserted into the 6020 colon below the 6052 linear staple line and the 6014 laparoscope is inserted through the abdomen above the 6052 linear staple line.
[0319] [0319] Figure 28 illustrates the anvil trocar 6010 out of alignment with the center 6050 of the linear staple row 6052 and Figure 29 illustrates the anvil trocar 6010 in alignment with the center 6050 of the linear staple row 6052. The sensor 6022 is used to detect the center 6050 of the linear staple row 6052 to align the anvil trocar 6010 with the center of the staple row 6052. In one aspect, the center 6050 of the linear staple row 6052 can be located by moving the circular stapler 6002 until one end of the linear staple line 6052 is detected. One end can be detected when there are no more staples in the path of the 6022 sensor. Once one end is reached, the circular stapler 6002 is moved along the linear staple line 6053 until the opposite end is detected and the length " I" of linear staple line 6052 is determined by measurement or by counting individual staples by sensor 6022. Once the length of linear staple line 6052 is determined, the center 6050 of linear staple line 6052 can be determined by division of the length by two "1/2".
[0320] [0320] Figure 30 illustrates a centering tool 6054 shown on a screen of the central surgical controller 215, with the centering tool providing a screen of a linear staple line 6052, where the anvil trocar 6010 is not aligned with the staple overlap portion 6012 of the dual staple line 6004 as shown in Figure 28. The central surgical controller display 215 shows a standard reticle field of view 6056 of the laparoscopic field of view 6016 of the linear staple line 6052 and a 6020. The central surgical controller screen 215 also features a target ring 6062 that circumscribes the center of the linear staple line image and a projected cutting path 6064 of the anvil trocar and circular knife. The cross 6066 (X) represents the location of the anvil trocar 6010 in relation to the center 6050 of the linear clamp row
[0321] [0321] As shown in Figure 30, the Anvil Trocar 6010 is not aligned with the desired bore through the location designated by the offset between the Target Ring 6062 and the Projected Cut Path 6064. To align the Anvil Trocar 6010 with the center 6050 of the linear staple line 6052, the surgeon manipulates the circular stapler 6002 until the projected cutting path 6064 overlaps the target alignment ring 6062 and the cross 6066 (XK) is centered on the image 6040 of the staple overlap portion
[0322] [0322] In one aspect, the present invention provides an apparatus and method for displaying an image of a 6052 linear staple line using a linear transection technique and an alignment ring or target center positioned as if the trocar 6010 of the circular stapler 6022 is properly centered along the linear staple line 6052. The apparatus shows a grayish alignment ring superimposed on the current position of the anvil trocar 6010 relative to the center 6050 of the linear staple line 6052. The image may include indication marks to aid the alignment process by indicating which direction to move the 6010 anvil trocar. The alignment ring may be bolded, change color, or highlighted when it is situated at a predetermined distance from centered.
[0323] [0323] Now with reference to Figures 28 to 31, Figure 31 is an image 6080 of a standard reticle field view 6080 of a linear staple line transection 6052 of a surgical instrument as seen through a laparoscope 6014 shown in central surgical controller screen 215, in accordance with an aspect of the present invention. In a standard 6080 crosshair view, it is difficult to see the 6052 linear staple line in the standard crosshair field of view
[0324] [0324] Now with reference to Figures 28 to 32, Figure 32 is a 6082 image of a laser-assisted reticle 6072 field of view of the surgical site shown in Figure 31 before the anvil trocar 6010 and circular stapler knife circular 6002 are aligned with the center 6050 of the linear staple line 6052, in accordance with an aspect of the present invention. The 6072 laser-assisted reticle field of view provides a 6066 alignment or cross marking (X), currently positioned below and to the left of the center of the 6052 linear staple line, showing the projected trajectory of the 6010 anvil trocar to aid in positioning of the anvil trocar
[0325] [0325] Now with reference to Figures 28 to 33, Figure 33 is an image 6084 of a laser aided reticle field of view 6072 of the surgical site shown in Figure 32 after the anvil trocar 6010 and the circular stapler knife circular 6002 are aligned with the center 6050 of the linear staple line 6052, in accordance with an aspect of the present invention. The 6072 laser-assisted reticle field of view provides a 6066 alignment or cross marking (X), currently positioned below and to the left of the center of the 6052 linear staple line, showing the projected trajectory of the 6010 anvil trocar to aid in positioning of the anvil trocar
[0326] [0326] Figure 33 is a view of the laser-assisted surgical site shown in Figure 32 after the anvil trocar 6010 and circular knife are aligned to the center of the staple line 6052. In this view, within the field of view 6072 of the laser-assisted reticle, alignment marker cross 6066 (X) is positioned over the center of the staple line 6052 and the center of the highlighted target to indicate alignment of the trocar to the center of the staple line. Outside the 6072 field of view of the laser-aided reticle, the status warning box indicates that the trocar is "ALIGNED" and the suggestion is "Proceed with Trocar Insertion".
[0327] [0327] Figure 34 illustrates a non-contact inductive sensor 6090 implementation of the non-contact sensor 6022 to determine a location of anvil trocar 6010 relative to the center of a staple line transection (the 6012 staple overlap portion of the line double staple line 6004 shown in Figures 23 and 24 or the center 6050 of the linear staple row 6052 shown in Figures 28 and 29, for example), in accordance with one aspect of the present invention. The non-contact inductive sensor 6090 includes an oscillator 6092 that drives an inductive coil 6094 to generate an electromagnetic field 6096. As a metal target 6098, such as a metal clamp, is introduced into the electromagnetic field 6096, eddy currents 6100 induced in the target 6098 if oppose the electromagnetic field 6096 and the reluctance shifts and the voltage amplitude of oscillator 6102 drops. An amplifier 6104 amplifies the voltage amplitude of the oscillator 6102 as it changes.
[0328] [0328] Now with reference to Figures 1 to 11, to show interaction with an interactive surgical system environment 100, including a central surgical controller 106, 206, and also to Figures 22 to 33, the inductive sensor 6090 is an electronic sensor without contact. It can be used to position and detect metal objects such as the metal staples in the 6003, 6004, 6052 staple lines described above. The 6090 a inductive sensor detection range is dependent on the type of metal being detected. As the 6090 inductive sensor is a non-contact sensor, it can detect metallic objects through a stapled fabric barrier. The 6090 inductive sensor can be located either on the 6002 circular stapler to detect staples in the 6003, 6004, 6052 staple rows, detect the location of the distal end of the 6014 laparoscope, or it can be located on the 6014 laparoscope to detect the location of the anvil trocar 6010. A control circuit or processor located in the circular stapler 6002, laparoscope 6014, or coupled to the central surgical controller 206 receives signals from the inductive sensors 6090 and may be employed to display the centering tool on the central surgical controller 215 screen to determine the location of anvil trocar 6010 with respect to the staple overlap portion 6012 of a double staple row 6004 or the center 6050 of a linear staple row 6052.
[0329] [0329] In one aspect, the distal end of the 6014 laparoscope can be detected by the 6090 inductive sensor located on the 6002 circular stapler. The 6090 inductive sensor can detect a 6098 metal target positioned at the distal end of the 6014 laparoscope. 6014 is aligned with the center 6050 of the linear clamp line 6052 or the clamp overlap portion 6012 of the double clamp line 6004, a signal from the inductive sensor 6090 is transmitted to circuitry that converts the signals from the inductive sensor 6090 to present a image of the relative alignment of the laparoscope 6014 with the anvil trocar 6010 of the circular stapler 6002.
[0330] [0330] Figures 35A and 35B illustrate an aspect of a non-contact capacitive sensor 6110 implementation of the non-contact sensor 6022 to determine an anvil trocar location 6010 relative to the center of a staple line transection (the overlap portion of staples 6012 of the double staple line 6004 shown in Figures 23 and 24 or the center 6050 of the linear staple line 6052 shown in Figures 28 and 29, for example), in accordance with one aspect of the present invention. Figure 35A shows the non-contact capacitive sensor 6110 without a metal target nearby, and Figure 35B shows the non-contact capacitive sensor 6110 next to a metal target 6112. The non-contact capacitive sensor 6110 includes capacitor plates 6114, 6116 housed in a detection head and establishes the 6118 field lines when powered by an oscillator waveform to define a detection zone. Figure 35A shows field lines 6118 when no target is present proximal to capacitor plates 6114, 6116. Figure 35B shows a ferrous or non-ferrous metal target 6120 in the detection zone. As the 6120 metal target enters the detection zone, the capacitance increases, causing the natural frequency to shift towards the oscillation frequency, causing amplitude gain. As the 6110 capacitive sensor is a non-contact sensor, it can detect metallic objects through a stapled fabric barrier. The capacitive sensor 6110 can be located either on the circular stapler 6002 to detect the staple lines 6004, 6052 or the location of the distal end of the laparoscope 6014, or the capacitive sensor 6110 can be located on the laparoscope 6014 to detect the location of the anvil trocar
[0331] [0331] Figure 36 is a logic flow diagram 6130 of a process representing a control program or logic configuration for aligning a surgical instrument, in accordance with an aspect of the present invention. Referring to Figures 1 to 11, to show interaction with an interactive surgical system environment 100 including a central surgical controller 106, 206, and also to Figures 22 to 35, the central surgical controller 206 comprises a processor 244 and an attached memory 249. to processor 244. Memory 249 stores instructions executable by processor 244 to receive 6132 image data from a laparoscope image sensor, generate 6134 a first image based on the image data, display 6136 the first image on a surgical controller screen hub 215 coupled to processor 244, receiving 6138 a signal from a non-contact sensor 6022, the signal being indicative of a position of a surgical device, generating a second image based on the signal indicative of the position of the surgical device, e.g., the trocar of anvil 6010 and show 6140 trocar the second image on the central surgical controller screen
[0332] [0332] In one aspect, the center 6044 of the dual staple line seal 6004 defines a staple overlap portion
[0333] [0333] In one aspect, the present invention provides an instrument that includes a local display, a central controller with an operating room (OR), or operating room display, separate from the instrument display. When the instrument is connected to the central surgical controller, the secondary screen on the device reconfigures to show different information than when it is independent of the central surgical controller connection. In another aspect, some of the information on the instrument's secondary screen is then displayed on the central surgical controller's primary screen. In another aspect, image fusion enabling the superposition of a device's state, integration reference points being used to interlock multiple images and at least one orientation feature is provided on the instrument screen and/or central surgical controller. Techniques for superimposing or enlarging images and/or text from multiple image/text sources to present composite images on a single screen are described later in this document in connection with Figures 45 to 53 and Figures 63 to 67.
[0334] [0334] In another aspect, the present invention provides cooperation between local instrument displays and a paired laparoscope display. In one aspect, the behavior of an instrument's local display changes when it detects the pluggable presence of a global display coupled to the central surgical controller. In another aspect, the present invention provides superior 360° composite visual field of view of a surgical site to avoid collateral structures. Each of these techniques is described later in this document.
[0335] [0335] During a surgical procedure, the surgical site is shown on a remote "primary" central surgical controller screen. During a surgical procedure, surgical devices track and record surgical variables and data (e.g. surgical parameters) that are stored in the instrument (see Figures 12 to 19 for instrument architectures comprising processors, memory, control circuitry, storage, etc.) . Surgical parameters include force-to-fire (FTF), force-to-close (FTC), firing progress, tissue span, power level, impedance, tissue compression stability (strain), and the like. With the use of conventional techniques during the procedure, the surgeon needs to watch two separate screens. Providing image/text overlay is thus advantageous because, during the procedure, the surgeon can watch a single screen that presents the overlapping image/text information.
[0336] [0336] A solution detects when the surgical device (e.g. instrument) is connected to the central surgical controller and then displays a composite image on the primary screen that includes a field of view of the surgical site received from a first instrument (e.g. medical imaging such as laparoscope, endoscope, thoracoscope and the like), augmented by variables and surgical data received from a second instrument (e.g. a surgical stapler) to provide pertinent images and data on the primary screen.
[0337] [0337] During a surgical procedure, the surgical site is shown as a narrow field of view of a medical imaging device on the primary screen of the central surgical controller. Items outside the current field of view and collateral structures cannot be seen without moving the medical imaging device.
[0338] [0338] One solution provides a narrow field of view of the surgical site in a first screen window augmented by a wide field of view of the surgical site in a separate window of the screen. This provides a composite aerial field of view mapped using two or more imaging matrices to provide a magnified image of multiple perspective views of the surgical site.
[0339] [0339] In one aspect, the present invention provides a central surgical controller comprising a processor and a memory coupled to the processor. The memory stores processor-executable instructions for detecting a connection from a surgical device to the central surgical controller, transmitting a control signal to the detected surgical device to transmit surgical parameter data associated with the detected device to the central surgical controller, receiving the parameter data surgical devices, receiving image data from an image sensor and displaying, on a screen coupled to the central surgical controller, an image received from the image sensor together with the surgical parameter data received from the surgical device.
[0340] [0340] In another aspect, the present invention provides a central surgical controller comprising a processor and a memory coupled to the processor. The memory stores instructions executable by the processor to receive first image data from a first image sensor, receive second image data from a second image sensor and display, on a screen coupled to the central surgical controller, a first image corresponding to the first field. of view and a second image corresponding to the second field of view. The first image data represents a first field of view and the second image data represents a second field of view.
[0341] [0341] In one aspect, the first field of view is a narrow-angle field of view and the second field of view is a wide-angle field of view. In another aspect, the memory stores instructions executable by the processor to augment the first image with the second image on the screen. In another aspect, the memory stores instructions executable by the processor to merge the first image and the second image into a third image and display a merged image on the screen. In another aspect, the fused image data comprises status information associated with a surgical device, an image data integration reference point for interlocking a plurality of images, and at least one orientation parameter. In another aspect, the first image sensor is the same image sensor and wherein the first image data is captured as a first time and the second image data is captured in a second time.
[0342] [0342] In another aspect, the memory stores instructions executable by the processor to receive third image data from a third image sensor, with the third image data representing a third field of view, generating composite image data comprising the second and third image data, display the first image in a first screen window, with the first image corresponding to the first image data, and display a third image in a second screen window, with the third image corresponding to the data of the first image. composite image data.
[0343] [0343] In another aspect, the memory stores instructions executable by the processor to receive third image data from a third image sensor, with the third image data representing a third field of view, merging the second and third data. image to generate merged image data, display the first image in a first screen window, with the first image corresponding to the first image data, and display a third image in a second screen window, with the third image corresponding to the merged image data.
[0344] [0344] In various aspects, the present invention provides a control circuit to perform the functions described above. In various aspects, the present invention provides non-transient computer-readable media that stores computer-readable instructions that, when executed, cause a machine to perform the functions described above.
[0345] [0345] Show augmented endoscope images with surgical device images on a primary screen of the central surgical controller, enables the surgeon to focus on a screen to obtain a field of view of the surgical site augmented with surgical device data associated with the surgical procedure such as force to fire, force to close, firing progression, tissue span, power level, impedance, tissue compression stability (deformation) and the like.
[0346] [0346] Showing a narrow field of view image in a first window of a screen and a composite image of several other perspectives as wider fields of view allows the surgeon to see a magnified image of the surgical site simultaneously with wider fields of view of the surgical site without moving the viewing device.
[0347] [0347] In one aspect, the present invention provides both global and local display of a device, for example a surgical instrument, coupled to the central surgical controller. The device shows all of its menus and relevant displays on a local screen until it detects a connection to the central surgical controller at which point a subset of the information is only shown on the monitor via the central surgical controller and that information is mirrored on the device's screen. device or are no longer accessible on the device's detonated screen. This technique allows freeing the device screen to show different information or to show information from larger sources on the central surgical controller screen.
[0348] [0348] In one aspect, the present invention provides an instrument with a local display, a central surgical controller with an operating room display (eg operating room or OR) that is separate from the instrument display. When the instrument is connected to the central surgical controller, the instrument's local screen becomes a secondary screen and the instrument reconfigures itself to show different information than when it is running independently of the central surgical controller connection. In another aspect, some of the information on the secondary screen is then displayed on the primary screen in the operating room via the central surgical controller.
[0349] [0349] Figure 37 illustrates a primary screen 6200 of the central surgical controller 206 comprising a global screen 6202 and a local instrument screen 6204, in accordance with an aspect of the present invention.
[0350] [0350] The 6200 Central Surgical Controller screen provides perioperative visualization of the 6208 surgical site. Advanced imaging visually identifies and highlights 6222 critical structures such as the 6220 ureter (or nerves, etc.) and also tracks 6210 instrument proximity views and is shown on the left side of the 6200 screen. In the illustrated example, the 6210 instrument proximity displays show instrument-specific settings. For example, the upper instrument proximity display 6212 shows settings for a monopolar instrument, the middle instrument proximity display 6214 shows settings for a bipolar instrument, and the lower instrument proximity display 6212 shows settings for an ultrasonic instrument.
[0351] [0351] In another aspect, independent secondary displays or dedicated local displays can be linked to the central surgical controller 206 to provide either an interaction portal via a touchscreen display and/or a secondary display that can display any number of data streams traced from the central surgical controller 206 to provide a clear non-confusing state. The secondary display can show force to fire (FTF), tissue span, power level, impedance, tissue compression stability (deformation), etc., while the primary display can only show the key variables to maintain flow. of organized food. The interactive screen can be used to move the screen from specific information to the primary screen to a desired location, size, color, etc. In the illustrated example, the secondary screen shows the 6210 instrument proximity displays on the left side of the 6200 screen and the 6204 local instrument screen on the lower right side of the 6200 screen. The 6204 local instrument screen displayed on the 6200 central surgical controller screen shows an icon of the 6218 end actuator, such as the icon of a 6224 staple cartridge currently in use, the 6226 size of the 6224 staple cartridge (for example 60 mm), and an icon of the current position of the end actuator knife 6228.
[0352] [0352] In another aspect, the screen 237 located on the instrument 235 shows the wireless or wired attachment of the instrument 235 to the central surgical controller 206 and the communication/recording of the instrument to the central surgical controller 206. A configuration can be provided in the 235 instrument to enable the user to select screen mirroring or screen extension for both monitoring devices. Instrument controls can be used to interact with the central surgical controller screen for information that is provided on the instrument. As previously discussed, instrument 235 may comprise wireless communication circuitry for wirelessly communicating with central surgical controller 206.
[0353] [0353] In another aspect, a first instrument coupled to the central surgical controller 206 may pair with a display of a second instrument coupled to the central surgical controller 206 enabling both instruments to show some hybrid combination of information from the two devices of both becoming mirrors parts of the primary screen. In yet another aspect, the primary screen 6200 of the central surgical controller 206 provides a 360° composite top view of the surgical site 6208 to avoid collateral structures. For example, a secondary display of the end actuator surgical stapler may be provided on the primary display 6200 of the central surgical controller 206 or another display to provide better perspective around areas within a current field of view 6206. These aspects are described later in this document together with Figures 38 to 40.
[0354] [0354] Figures 38 to 40 illustrate a composite aerial view of a portion of the 6234 end actuator of a surgical stapler mapped using two or more imaging arrays or a time array to provide multiple perspective views of the actuator. end 6234 to enable imaging of a composite aerial field of view. The techniques described herein may be applied to ultrasonic instruments, electrosurgical instruments, combination ultrasonic/electrosurgical instruments — and/or “combination surgical stapler/electrosurgical instruments. Various techniques for overlaying or enlarging images and/or text from multiple image/text sources to present composite images on a single screen are described later in this document in connection with Figures 45 to 53 and Figures 63 to 67.
[0355] [0355] Figure 38 illustrates a primary display 6200 of the central surgical controller 206, in accordance with an aspect of the present invention. A primary window 6230 is located in the center of the screen and shows a small-angle or exploded view of a surgical field of view 6232. The primary window 6230 located in the center of the screen shows a small-angle or magnified view of an end actuator 6234 of the surgical stapler holding a vessel 6236. The primary window 6230 displays mesh images to produce a composite image that allows visualization of structures adjacent to the surgical field of view 6232. A second window 6240 is shown in the lower left corner of the primary display 6200. A second window 6240 shows a mesh image in a wide-angle view in default focus of the image shown in primary window 6230 in a bird's-eye view. The aerial view provided in the second window 6240 enables the viewer to easily see items that are outside the narrow field surgical field of view 6232 without moving the laparoscope, or other imaging device 239 coupled to the imaging module 238 of the central surgical controller 206. A third window 6242 is shown in the lower right corner of the primary screen 6200 which shows an icon 6244 representative of the 6234 end actuator staple cartridge (e.g. a staple cartridge in this case) and additional information such as "4 Row" indicating the number of rows of staples 6246 and "35 mm" indicating the distance 6248 traveled by the knife along the length of the staple cartridge. Below the third window 6242, there is shown an icon 6258 of a current state structure of a grip stabilization sequence 6250 (Figure 39) that indicates grip stabilization.
[0356] [0356] Figure 39 illustrates a 6250 grip stabilization sequence for a period of five seconds, in accordance with an aspect of the present invention. The grip stabilization sequence 6250 is shown over a period of five seconds with flashing displays 6252, 6254, 6256, 6258, 6260 spaced at one second intervals 6268 in addition to providing real time 6266 (e.g. 09:35: 10), which can be pseudo-real time to preserve patient anonymity. Flashing displays 6252, 6254, 6256, 6258, 6260 show the elapsed time of filling in the circle until the grip stabilization period is complete. At this point, the last 6260 screen is shown in solid color. Stabilizing the grip after the 6234 end actuator grips the 6236 vessel enables a better seal to be formed.
[0357] [0357] Figure 40 illustrates a diagram 6270 of four separate wide-angle views 6272, 6274, 6276, 6278 of a surgical site at four separate times during the procedure, in accordance with an aspect of the present invention. The image sequence shows the creation of an aerial composite image in wide and narrow focus over time. A first image 6272 is a wide-angle view of the end actuator 6234 holding the vessel 6236 taken at a previous time to (eg 09:35:09). A second image 6274 is another wide-angle view of the end actuator 6234 gripping the vessel 6236 taken at present time t, (eg 09:35:13). A third image 6276 is a composite image of an overhead view of the end actuator 6234 holding vessel 6236 taken at present time t1. The third image 6276 is shown in the second window 6240 of the primary display 6200 of the central surgical controller 206 as shown in Figure 38. A fourth image 6278 is a small-angle view of the end actuator 6234 trapping the vessel 6236 at the present time t, (e.g. example 09:35:13). The fourth image 6278 is the small angle view of the surgical site shown in the primary window 6230 of the primary screen 6200 of the central surgical controller 206 as shown in Figure 38.
[0358] [0358] In one aspect, the present invention provides a central surgical controller screen of instrument-specific data required for efficient use of a surgical instrument, such as a surgical stapler. The techniques described herein may be applied to ultrasonic instruments, electrosurgical instruments, combination ultrasonic/electrosurgical instruments, and/or combination surgical stapler/electrosurgical instruments. In one aspect, a grip time indicator based on tissue properties is shown on the screen. In another aspect, a 360° composite top view is shown on screen to avoid collateral structures as shown and described in connection with Figures 37 to 40 and is incorporated herein by reference and for brevity and clarity of description , the description of Figures 37 to 40 will not be repeated in this document.
[0359] [0359] In one aspect, the present invention provides a tissue deformation display to provide the user with tissue stability/tissue compression data and to guide the user in making a proper choice of when to conduct the next instrument action. In one aspect, an algorithm calculates a constant advance of a progressive time-based feedback system related to the viscoelastic tissue response. These and other aspects are described later in this document.
[0360] [0360] Figure 41 is a graph 6280 of fabric strain grip stabilization curves 6282, 6284 for two types of fabric, in accordance with an aspect of the present invention. The grip stabilization curves 6284, 6284 are plotted as force to close (FTC) as a function of time, where FTC (N) is shown along the vertical axis and Time, t, (s) is shown along the vertical axis. along the horizontal geometric axis. The FTC is the amount of force exerted to close the gripping arm over the tissue. The first grip stabilization curve 6282 represents stomach tissue and the second grip stabilization curve 6284 represents lung tissue. In one aspect, the FTC along the vertical axis is scaled from 0 to 180 N and the horizontal axis is scaled from 0 to 5 s. As shown, the FTC as a different profile over a five second hold stabilization period (eg, as shown in Figure 39).
[0361] [0361] With reference to the first 6282 grip stabilization curve, as stomach tissue is gripped by the 6234 end actuator, the force to close (FTC) applied by the 6234 end actuator increases from ON to a peak force to close of —180 N after -1 s. Although the 6234 end actuator remains trapped in the stomach tissue, the force to close decays and stabilizes at -150 N over time due to tissue deformation.
[0362] [0362] Similarly, with reference to the second grip stabilization curve 6284, as lung tissue is gripped by the 6234 end actuator, the closing force applied by the 6234 end actuator increases from ON to a peak closing force of — 90 N after less than —-1 s. Although the 6234 end actuator remains trapped in lung tissue, the force to close decays and stabilizes at -60 N over time due to tissue deformation.
[0363] [0363] The grip stabilization of the 6234 end actuator is monitored as described above in connection with Figures 38 to 40 and is shown every second corresponding to sampling times t1, to, ta, ta, ts from the force to close to provide user feedback related to the state of the trapped tissue. Figure 41 shows an example of tissue stabilization monitoring for lung tissue by sampling the force to close each second for a period of 5 seconds. At each sample time ti, ta, ta, ta, ts, The instrument 235 or the central surgical controller 206 calculates a tangent vector 6288, 6292, 6294, 6298, 6302 corresponding to the second grip stabilization curve 6284. The tangent vector 6288, 6292, 6294, 6298, 6302 is monitored until its slope drops below a threshold to indicate that the fabric deformation is complete and the fabric is ready to be sealed and cut. As shown in Figure 41, the lung tissue is ready to be sealed and cut after the hold stabilization period of —5 s, where a solid gray circle is shown at sampling time 6300. As shown, the tangent vector 6302 is less than a predetermined threshold.
[0364] [0364] The equation of a tangent vector 6288, 6292, 6294, 6298, 6302 for the grip stabilization curve 6284 can be calculated using differential calculus techniques, for example. In one aspect, at a given point on the grip stabilization curve 6284, the gradient of curve 6284 is equal to the gradient of the tangent of curve 6284. The derivative (or gradient function) describes the gradient of curve 6284 at any point on the curve 6284. Similarly, it also describes the gradient of a tangent to the curve 6284 at any point on the curve
[0365] [0365] Figure 42 is a graph 6310 of a time-dependent proportional filling of a grip force stabilization curve, in accordance with an aspect of the present invention. The 6310 graph includes 6312, 6314, 6316 grip stabilization curves for standard thick stomach tissue, thin stomach tissue, and standard lung tissue. The vertical axis represents FTC (N) in scale from 0 to 240 N and the horizontal axis represents Time, t, (s) in scale from 0 to 15 s. As shown, the standard thickness 6316 stomach tissue curve is the standard force drop stability curve. All three FTC profiles of grip stabilization curves 6312, 6314, 6316 reach a maximum force just after the tissue grip and then the FTC decreases over time until it finally stabilizes due to the viscoelastic tissue response. As shown, the 6312 standard lung tissue grip stabilization curve stabilizes after a period of —-5 s, the 6314 thin stomach tissue grip stabilization curve stabilizes after a period of -10 s and the tissue grip stabilization curve Thick stomach 6316 stabilizes after a period of -15s.
[0366] [0366] Figure 43 is a graph 6320 of the role of tissue deformation in the grip force stabilization curve 6322, in accordance with an aspect of the present invention. The vertical axis represents force to close FTC (N) and the horizontal axis represents Time, t, (s) in seconds. The tangent vector angles of, de2 ... ddr are measured at each force-to-close sampling time (to, t1, to, ta, ta, etc.). The tangent vector angle dd, is used to determine when the fabric has reached the threshold for strain termination, which indicates that the fabric has reached strain stability.
[0367] [0367] Figures 44A and 44B illustrate two graphs 6330, 6340 for determining when the clamped fabric has reached deformation stability, in accordance with an aspect of the present invention. Graph 6330 in Figure 44A illustrates a curve 6332 representing a tangent vector angle dc as a function of time. The tangent vector angle of is calculated as discussed in Figure 43. The horizontal line 6334 is the limit for tissue deformation termination. The tissue deformation is considered stable at the intersection 6336 of the curve 6332 of the tangent vector angle de with the threshold for tissue deformation termination 6334. Graph 6340 in Figure 44B illustrates an AFTC curve 6342 representing AFTC as a function of time. . AFTC curve 6342 illustrates limit 6344 for 100% complete tissue strain stability meter. The tissue deformation is considered stable at the intersection 6346 of the AFTC curve 6342 with the limit 6344. Communication Techniques
[0368] [0368] Referring also to Figures 1 to 11, to show interaction with an interactive surgical system environment 100, including a central surgical controller 106, 206, and in particular, Figures 9 and 10, in various aspects, the present invention provides communication techniques for exchanging information between an instrument 235, or other modules, and the central surgical controller 206. In one aspect, communication techniques include image fusion to place analysis and instrument state on a laparoscope image, as an overlay. data on the screen, in and around the perimeter of an image presented on a screen of the central surgical controller 215, 217. In another aspect, the communication techniques include combining an intermediate wireless short-range signal, for example Bluetooth, with the image and, in another aspect, the communication techniques include applying security and identification of requested pairing. In yet another aspect, the communication techniques include a standalone interactive headset worn by a surgeon that links to the central controller with visual and audio information that avoids the need for overlaps but allows for personalization of information displayed around the periphery of vision. Each of these communication techniques is discussed later in this document. On-screen data overlay in and around the perimeter of the image shown
[0369] [0369] In one aspect, the present invention provides image fusion enabling the overlay of the state of a device, the integration reference points being used to interlock multiple images and at least one orientation feature. In another aspect, the present invention provides a technique for overlaying data on the screen within and around the perimeter of the displayed image. Radiographic integration can be employed for pre-procedure overlay and live internal detection. The merging of images from one source can be superimposed on another. Image fusion can be employed to place analysis and instrument status on a medical imaging device image (eg laparoscope, endoscope, thoracoscope, etc.). Image merging makes it possible to overlay the state of a device or instrument, integration reference points to interlock multiple images, and at least one orientation feature.
[0370] [0370] Figure 45 illustrates an example of an enlarged video image 6350 comprising an enlarged preoperative video image 6352 with data 6354, 6356, 6358 identifying elements shown. An augmented reality vision system can be employed in surgical procedures to implement a method for augmenting data on a preoperative image 6352. The method includes generating a preoperative image 6352 of an anatomical section of a patient and generating an image video footage of a surgical site on the patient. The enlarged video image 6350 includes an image of at least a portion of a surgical tool 6354 operated by a user 6456. The method further includes processing the preoperative image 6352 to generate data about the patient's anatomical section. The data includes an ID 6358 for the anatomical section and a peripheral margin of at least a portion of the anatomical section. The peripheral margin is configured to guide a surgeon to a cut location relative to the anatomical section, incorporating the data and a user identity 6356 in the preoperative image 6350 to show a 6350 enlarged video image to the user over the anatomical section of the patient. The method further includes detecting a load condition on the surgical tool 6354, generating a feedback signal based on the detected loading condition, and updating, in real time, the data and an identity location of the user operating the embedded surgical tool 6354. in the enlarged video image 6350 in response to a change in a location of the surgical tool 6354 in the enlarged video image 6350. Additional examples are described in US Patent No. 9,123,155 entitled
[0371] [0371] In another aspect, radiographic integration techniques can be employed to superimpose the preoperative 6352 image with data obtained through preprocedural techniques or live internal detection. Radiographic integration can include landmark and marker identification using surgical landmarks, radiographic markers placed inside or outside the patient, identification of clips, radiopaque staples, or other tissue-fixed items. Digital radiography techniques can be employed to generate digital images for overlaying a preoperative 6352 image. Digital radiography is a form of x-ray imaging that employs a digital image capture device with digital x-ray sensors instead of of traditional photographic film. Digital radiography techniques provide pre-visualization and immediate image availability for overlaying the preoperative 6352 image. In addition, special image processing techniques can be applied to digital X-ray images to improve overall image display quality. .
[0372] [0372] Digital radiography techniques employ image detectors that include flat panel detectors (FPDs), which are classified into two main categories indirect FPDs and direct FPDs. Indirect FPDs include amorphous silicon (a-Si) combined with a scintillator in the outer layer of the detector, which is produced from cesium iodide (Csl) or gadolinium oxysulfide.
[0373] [0373] Figure 46 is a 6360 logic flow diagram of a process representing a control program or a logic setup for displaying images, in accordance with an aspect of the present invention. Referring also to Figures 1 to 11, to show interaction with an interactive surgical system environment 100, including a central surgical controller 106, 206, the present invention provides, in one aspect, a central surgical controller 206, comprising a processor 244 and a memory 249 coupled to the processor 244. The memory 249 stores instructions executable by the processor 244 to receive 6362 first image data from a first image sensor, receive 6364 second image data from a second image sensor, and display 6366, in a screen 217 coupled to the central surgical controller 206, a first image corresponding to the first field of view and a second image corresponding to the second field of view. The first image data represents a first field of view and the second image data represents a second field of view.
[0374] [0374] In one aspect, the first field of view is a narrow-angle field of view and the second field of view is a wide-angle field of view. In another aspect, memory 249 stores instructions executable by processor 244 to augment the first image with the second image on the screen. In another aspect, memory 249 stores instructions executable by processor 244 to merge the first image and second image into a third image and display a merged image on screen 217. In another aspect, the merged image data comprises state information associated with a surgical device 235, an image data integration reference point to interlock a plurality of images and at least one orientation parameter. In another aspect, the first image sensor is the same image sensor and wherein the first image data is captured as a first time and the second image data is captured in a second time.
[0375] [0375] In another aspect, memory 249 stores instructions executable by processor 244 to receive third image data from a third image sensor, with the third image data representing a third field of view, generating composite image data that comprise second and third image data, display the first image in a first screen window, the first image corresponding to the first image data, and display a third image in a second screen window 215, the third image corresponds to the composite image data.
[0376] [0376] In another aspect, the memory 249 stores instructions executable by the processor 244 to receive third image data from a third image sensor, with the third image data representing a third field of view, merging the second and second image data. of the third image to generate data from the merged image, display the first image in a first screen window 217, the first image corresponding to the data of the first image, and display a third image in a second screen window 217, the third image corresponds to the merged image data. Wireless short-range intermediate signal combiner (e.g. Bluetooth)
[0377] [0377] A wireless short-range intermediate signal combiner, eg Bluetooth, may comprise a wireless alert display adapter placed in the communication path from the monitor to a laparoscope console enabling the central surgical controller! overlay data on the screen. Security and identification of the requested pairing can enhance communication techniques.
[0378] [0378] Figure 47 illustrates a communication system 6370 comprising an intermediate signal combiner 6372 positioned in the communication path between an imaging module 238 and a central surgical controller screen 217, in accordance with at least one aspect of the present invention. . Signal combiner 6372 receives image data from an imaging module 238 in the form of wired or wireless short-range signals. The signal combiner 6372 also receives image and audio data from a headset 6374 and combines the image data from the imaging module 238 with the audio and image and audio data from the headset 6374. The central surgical controller 206 receives the combined data from combiner 6372 and superimposes the provided data to screen 217, where the superimposed data is shown. Signal combiner 6372 can communicate with central surgical controller 206 via wired or wireless signals. The headset 6374 receives image data from an imaging device 6376 coupled to the headset 6374 and receives audio data from an audio device 6378 coupled to the headset 6374. The imaging device 6376 may be a video camera digital and the 6378 audio device can be a microphone. In one aspect, the 6372 signal combiner may be a wireless short range intermediate signal combiner, for example Bluetooth. Signal combiner 6374 may comprise a wireless alerts display adapter to mate with headset 6374 placed in the communication path from display 217 to a console that enables central surgical controller 206 to overlay data onto display 217. Security and Identification requested pairing can enhance communication techniques. The imaging module 238 may be coupled to a variety of imaging devices such as an endoscope 239, laparoscope, etc., for example.
[0379] [0379] Figure 48 illustrates a standalone interactive headset 6380 used by a surgeon 6382 to communicate data to the central surgical controller, in accordance with an aspect of the present invention. Peripheral information from the 6380 standalone interactive headset does not include active video. Instead, peripheral information only includes device settings, or signals that don't have the same demands for refresh rates. Interaction can augment the 6382 surgeon's information based on linkage with preoperative computed tomography (CT) or other data linked to the central surgical controller 206. The 6380 standalone interactive headset can identify structure - ask if the instrument is playing a nerve, vessel or adhesion, for example. The standalone interactive headset 6380 may include preoperative scan data, an optical view, tissue interrogation properties captured throughout the procedure, and/or processing in the central surgical controller 206 used to provide a response. The surgeon 6382 can dictate notes to the stand-alone interactive headset 6380 to be saved with patient data in central controller storage 248 for later use in the chart or follow-up.
[0380] [0380] In one aspect, the standalone interactive headset 6380 used by the surgeon's 6382 connects to the central surgical controller 206 with visual and audio information to avoid the need for overlaps and allows for personalization of information shown around the periphery of the eyesight. The 6380 standalone interactive headset provides signals from devices (eg instruments), answers queries about device settings or video-linked positional information to identify quadrant or position. The 6380 Standalone Interactive Headset has audio feedback and audio control from the 6380 Headset. The 6380 Standalone Interactive Headset is also capable of interacting with all other systems in the operating room (eg operating room) and have feedback and interaction available whenever the 6382 surgeon is viewing. Registration of use and identification
[0381] [0381] In one aspect, the present invention provides a screen of authenticity of refills, modular components or charging units. Figure 49 illustrates a method 6390 for controlling the use of a device 6392. A device 6392 is connected to a power source 6394. Device 6392 includes a memory device 6396 that includes storage devices 6398 and communication devices 6400. 6398 includes data 6402 which may be either locked data 6404 or unlocked data 6406. Additionally, storage 6398 includes an error detection code 6408 as a cyclic redundancy check (CRC) value and a sterilization indicator 6410. power supply 6394 includes a reader 6412, a display 6414, a processor 6416, and a data port 6418 that couples the power supply 6394 to a network 6420. The network 6420 is coupled to a central server 6422, which is coupled to a central database 6424. Network 6420 is also coupled to a reprocessing facility 6426. Reprocessing facility 6426 includes a reprocessing data reader/printer 64 28 and a sterilization device 6430.
[0382] [0382] The method comprises connecting the device to a 6394 power source. Data is read from a 6396 memory device embedded in the 6392 device. Data including one or more of a unique identifier (UID), a usage value, an activation value, a reprocessing value, or a sterilization indicator. The usage value is incremented when the 6392 device is connected to the 6394 power source. The activation value is increased when the 6392 device is activated, allowing power to flow from the 6394 power source to a power-consuming component of the device 6392. Device usage 6392 can be avoided if: the UID is on a list of prohibited UIDs, the usage value is not less than a usage limiting value, the reprocessing value is equal to a reprocessing limiting value , the activation value is equal to an activation limitation value and/or the sterilization indicator does not indicate that the device has been sterilized since its previous use. Additional examples are described in US Patent Application Publication No. 2015/0317899 entitled SYSTEM AND METHOD FOR USING RFID TAGS TO DETERMINE STERILIZATION OF DEVICES, which was published November 5, 2015, which is incorporated herein by reference at its entirety.
[0383] [0383] Figure 50 provides a surgical system 6500 in accordance with the present invention and includes a surgical instrument 6502 that is in communication with a console 6522 or a handheld device 6526 via a local area network 6518 or a cloud network 6520 via a wired or wireless connection. In many respects, the 6522 console and the 6526 handheld can be any suitable computing device. Surgical instrument 6502 comprises a handle 6504, an adapter 6508 and a charging unit 6514. The adapter 6508 releasably couples with the handle 6504 and the charging unit 6514 releasably couples with the adapter 6508 so that the adapter 6508 transmits a force from a drive shaft to the loading unit 6514. The adapter 6508 or the loading unit 6514 may include a force gauge (not explicitly shown) disposed therein to measure a force exerted on the loading unit 6514. The 6514 charging unit includes an end actuator 6530 with a first jaw 6532 and a second jaw 6534. The charging unit 6514 can be a multi-shot loading unit (MFLU) or loaded in-situ that enables a clinician to fire a plurality of fasteners multiple times without requiring the loading unit 6514 to be removed from a surgical site for reloading r the 6514 charging unit.
[0384] [0384] The first and second jaws 6532, 6534 are configured to clamp the fabric therebetween, shoot fasteners through the clamped fabric and separate the clamped fabric. The first jaw 6532 can be configured to fire at least one fastener a plurality of times or can be configured to include a replaceable multi-shot fastener cartridge including a plurality of fasteners (e.g. staples, clips, etc.) that can be fired. more than once before being replaced. The second jaw 6534 may include an anvil that deforms or otherwise grips the fasteners around the tissue as the fasteners are ejected from the multi-shot fastener cartridge.
[0385] [0385] The 6504 grip includes a motor that is coupled to the drive shaft to affect the rotation of the drive shaft. The 6504 grip includes a control interface to selectively activate the motor. The control interface may include buttons, switches, levers, sliders, touch screen and any other suitable input mechanisms or user interfaces, which can be engaged by a clinician to activate the motor.
[0386] [0386] The 6504 Handle Control Interface is in communication with a 6528 Controller of the 6504 Handle to selectively activate the motor to affect the rotation of the drive shafts. The 6528 controller is arranged on the 6504 handle and is configured to receive control interface input and adapter data from the 6508 adapter or load unit data from the 6514 load unit. The 6528 controller parses control interface input and data. received from the 6508 adapter and/or the 6514 charging unit to selectively activate the motor. The 6504 grip may also include a display that is visible to a clinician while using the 6504 grip. The display is configured to show portions of data from the charging unit or adapter before, during, or after the 6502 instrument is triggered.
[0387] [0387] The adapter 6508 includes an adapter identification device 6510 disposed therein and the charging unit 6514 includes a charging unit identification device 6516 disposed therein. The adapter identification device 6510 is in communication with the 6528 controller and the load unit identification device 6516 is in communication with the 6528 controller. It will be recognized that the load unit identification device 6516 may be in communication with the adapter identification device 6510, which relays or passes communication from the load unit identification device 6516 to the 6528 controller.
[0388] [0388] Adapter 6508 may also include a plurality of sensors 6512 (one shown) disposed around it to detect various conditions of adapter 6508 or the environment (e.g., if adapter 6508 is connected to a charging unit, if the 6508 adapter is attached to a handle, if the drive shafts are rotating, the torque of the drive shafts, the effort of the drive drive shafts, the temperature at the 6508 adapter, multiple shots of the 6508 adapter, a peak force of the 6508 adapter during firing, a total amount of force applied to the 6508 adapter, a peak 6508 adapter retraction force, multiple 6508 adapter pauses during firing, etc.). The plurality of sensors 6512 provide input to adapter identification device 6510 in the form of data signals. Data signals among the plurality of sensors 6512 may be stored, or be used to update stored adapter data, in adapter identification device 6510. The data signals among the plurality of sensors 6512 may be analog or digital. The plurality of sensors 6512 may include a force gauge for measuring a force exerted on the charging unit 6514 during firing.
[0389] [0389] The 6504 Handle and 6508 Adapter are configured to interconnect the 6510 Adapter Identification Device and 6516 Load Unit Identification Device with the 6528 Controller via an electrical interface. The electrical interface may be a direct electrical interface (ie, include electrical contacts that mesh with each other to transmit power and signals between them). Additionally or alternatively, the electrical interface may be a non-contact electrical interface to transmit power and signals between them wirelessly (eg inductive transfer). It is also contemplated that the adapter identification device 6510 and the controller 6528 may be in wireless communication with each other via a wireless connection separate from the electrical interface.
[0390] [0390] Handle 6504 includes a transmitter 6506 that is configured to transmit instrument data from the 6528 controller to other components of the 6500 system (eg LAN 6518, Cloud 6520, Console 6522, or Handheld 6526). The 6506 transmitter may also receive data (e.g., cartridge data, load unit data, or adapter data) from the other components of the 6500 system. For example, the 6528 controller may transmit instrument data including an adapter serial number. (e.g. adapter 6508) attached to handle 6504, a serial number of a loading unit (e.g. loading unit 6514) attached to the adapter and a serial number of a multi-shot fastener cartridge (e.g. multi-shot fasteners), loaded in the loading unit, to the 6528 console. After that, the 6522 console can transmit data (e.g. cartridge data,
[0391] [0391] Figure 51 illustrates a verbal AESOP camera positioning system. Additional examples are described in US Patent No.
[0392] [0392] The 6552 surgical device may be a robotic arm that can hold and move a surgical instrument. The 6552 arm may be a device such as the one sold from Computer Motion, Inc. of Goleta, California, USA under the AESOP trademark, which is an acronym for Automated Endoscopic System for Optimal Positioning or Automated Endoscopic System for Optimal Positioning. The arm
[0393] [0393] The 6554 surgical device may be an electrocautery device. Electrocautery devices typically have a bipolar tip that carries a current that heats and denatures tissue. The device is typically coupled with an on/off switch to actuate the device and heat the tissue. The electrocautery device can also receive control signals to vary its power output. The 6550 system allows the surgeon to control the operation of the electrocautery device through the 6560 input device.
[0394] [0394] The 6556 surgical device may be a laser. The 6556 laser can be operated using an on/off switch. Additionally, the power of the 6556 laser can be controlled by control signals. The 6550 system allows the surgeon to control the operation of the 6556 laser through the 6560 input device.
[0395] [0395] The 6558 device may be an operating table. The 6558 operator's table can contain motors and mechanisms that adjust the table's position. The present invention makes it possible for the surgeon to control the position of table 6558 through input device 6560. Although four surgical devices 6552, 6554, 6556 and 6558 are described, it should be understood that other functions in the operating room can be controlled through the input device. input 6560. By way of example, system 6560 may enable the surgeon to control operating room lighting and temperature through input device 6560.
[0396] [0396] Input device 6560 may be a footswitch having a plurality of buttons 6562, 6564, 6565, 6566 and 6568 which may be pressed by the surgeon. Each button is typically associated with a specific control command for a surgical device. For example, when the 6560 input device is controlling the 6552 robotic arm, pressing the 6562 button can move the arm in one direction and pressing the 6566 button can move the arm in the opposite direction. Likewise, when the 6554 electrocautery device or the 6556 laser is coupled to the 6560 input device, pressing the 6568 button can energize the devices and so on. Although a footswitch is shown and described, it should be understood that the 6560 input device may be a hand controller, a speech interface that accepts voice commands from the surgeon, a cantilever footswitch, or other input devices that may be well known in the art. surgical device control technique. Using the speech interface, the surgeon is able to position a camera or endoscope connected to the 6552 robotic arm using verbal commands. The imaging device, such as a camera or endoscope, can be attached to the 6552 robotic arm positioning system which can be controlled through the 6550 system using verbal commands.
[0397] [0397] The 6550 system has a 6570 switching interface that couples the 6560 input device to the 6552, 6554, 6556, and 6558 surgical devices. The 6570 interface has a 6572 input channel that is connected to the 6560 input device by a bus. 6574. The 6570 interface also has a plurality of output channels 6576, 6578, 6580, and 6582 that are coupled to the surgical devices by buses 6584, 6586, 6588, 6590, 6624, 6626, 6628 and which may have adapters or controllers arranged in electrical communication with and between them. Such adapters and controllers will be discussed in more detail later in this document.
[0398] [0398] As each 6552, 6554, 6556, 6558 device may need specifically configured control signals for proper operation, 6620, 6622 adapters or a 6618 controller can be placed as an intermediate(s) and in electrical communication with a specific output channel and a specific surgical device. In the case of the 6552 Robotic Arm System, no adapter is required and as such the 6552 Robotic Arm System can be in direct connection to a specific output channel. The 6570 interface couples input channel 6572 to one of output channels 6576, 6578, 6580, and 6582.
[0399] [0399] The 6570 interface has a select channel 6592 that can switch the input channel 6572 to a different output channel 6576, 6578, 6580 or 6582 so that the input device 6560 can control any of the surgical devices. The 6570 interface can be a multiplexer circuit built as an integrated circuit and placed in an ASIC. Alternatively, the 6570 interface may be a plurality of solenoid actuated relays coupled to the select channel by a logic circuit. The 6570 interface switches to a specific output channel in response to an input signal or switching signal applied to the 6592 select channel.
[0400] [0400] As shown in Figure 51, there may be multiple inputs for select channel 6592. Such inputs originate from footswitch 6560, speech interface 6600, and CPU 6662. Interface 6570 may have a multiplexing unit so that only one switching signal can be received on select channel 6592 at any one time, thus ensuring no substantial hardware conflict. The prioritization of input devices can be configured so that the pedal has the highest priority followed by the voice interface and the CPU. This serves as an example of how the prioritization scheme can be employed to guarantee the system with maximum efficiency. As such, other prioritization schemes can be employed. The 6592 select channel can sequentially connect the input channel to one of the output channels each time a switching signal is supplied to the 6592 select channel. Alternatively, the 6592 select channel can be addressable so that the 6570 interface the input channel to a specific output channel when an address is given to select channel 6592. This addressing is known in the electrical switch art.
[0401] [0401] Select channel 6592 can be connected via line 6594 to a dedicated button 6596 on footswitch 6560. The surgeon can switch surgical devices by pressing button 6596. Alternatively, channel select 6592 can be coupled via line 6598 to an interface 6600 speech technology that enables the surgeon to switch surgical devices with voice commands.
[0402] [0402] The 6550 system may have a 6602 central processing unit (CPU) that receives input signals from the 6560 input device via the 6570 interface and a 6585 bus. The 6602 CPU receives the input signals and can ensure that no inappropriate command is being entered into the controller. If this occurs, the 6602 CPU can respond accordingly, sending a different switching signal to the 6592 select channel or alerting the surgeon via a video monitor or speaker.
[0403] [0403] The 6602 CPU can also provide output commands to the 6592 select channel on the 6608 bus and receive input commands from the 6600 speech interface on the same 6608 bidirectional bus. The 6602 CPU can be coupled to a 6610 monitor and/or a 6612 speaker over the 6614 and 6616 buses, respectively. The 6610 monitor can provide a visual indication of which surgical device is coupled to the 6560 input device. The monitor can also provide a menu of commands that can be selected by the surgeon via the 6600 speech interface or the 6596 button. Alternatively, the surgeon could switch to a surgical device by selecting a command through a graphical user interface. The 6610 monitor can also provide information regarding inappropriate control signals sent to a specific surgical device 6552, 6554, 6556, 6558 and recognized by the 6602 CPU. Each device 6552, 6554, 6556, 6558 has a specific suitable operating range, which is well known to those skilled in the art. As such, the 6602 CPU can be programmed to recognize when the requested operation of the 6560 input device is inappropriate and will then alert the surgeon either visually through the 6610 monitor or audibly through the 6612 speaker. The 6612 speaker can also provide an audio indication of which surgical device is coupled to the input device
[0404] [0404] The 6550 system may include a 6618 controller that receives input signals from the 6560 input device and provides corresponding output signals to control the 6558 operator table. Likewise, the system may have 6620, 6622 adapters that provide an interface between the 6560 input device and specific surgical instruments connected to the system.
[0405] [0405] In operation, the 6570 interface initially couples the 6560 input device to one of the surgical devices. The surgeon can control a different surgical device by generating an input command that is supplied to the select channel 6592. The input command switches the 6570 interface so that the 6560 input device is coupled to a different output channel and corresponding adapter or surgical device. What is then provided is a 6570 interface that enables a surgeon to select, operate, and control a plurality of different surgical devices through a common input device.
[0406] [0406] Figure 52 illustrates a 6650 multifunctional surgical control system and a switch interface for virtual operating room integration. A virtual control system for controlling surgical equipment in an operating room while a surgeon performs a surgical procedure on a patient comprising: a virtual control device that includes an image of a control device situated on a surface and a sensor for interrogating the contact interaction of an object with the image on the surface, the virtual control device providing an interaction signal indicative of the object's contact interaction with the image; and a system controller connected to receive the interaction signal from the virtual control device and provide a control signal to the surgical equipment in response to the interaction signal to control the surgical equipment in response to the object's contact interaction with the image. Additional examples are described in US Patent No. 7,317,955 entitled VIRTUAL OPERATING ROOM INTEGRATION, issued January 8, 2008, which is incorporated herein by reference in its entirety.
[0407] [0407] As shown in Figure 52, the 6674 communication links are established between the 6676 system controller and the various components and functions of the 6650 virtual control system. The 6674 communication links are preferably optical paths, but Communication links may also be formed by radio frequency reception and transmission paths, wired electrical connections or combinations of optical, radio frequency and wired connection paths as may be appropriate for the type of components and functions achieved by those components. Arrows at the ends of 6674 links represent the direction of primary information flow.
[0408] [0408] The 6674 communication links with the 6652 Surgical Equipment, a 6556 Virtual Control Panel, a 6654 Virtual Foot Switch, and 6660 Patient Monitoring Equipment are bidirectional, meaning that information flows in both directions through the 6674 links that connect these components and functions. For example, the 6676 system controller provides signals that are used to create a control panel image from the 6656 virtual control panel and a pedal switch image from the virtual pedal switch.
[0409] [0409] The 6674 communication links between the 6676 system controller and the 6670 system display, the 6668 alerts display, the 6666 display, a 6658 label printer, and 6664 output devices are all unidirectional, which means that the information flows from the 6676 system controller to the components and functions. Similarly, the 6674 communication links between the 6676 system controller and a 6672 scanner and the 6662 input devices are unidirectional as well, but information flows from the 6662, 6672 components to the 6676 system controller. In certain circumstances, certain Control and status information can flow between the 6676 system controller and components
[0410] [0410] Each 6674 communication link preferably has a unique identity so that the 6676 system controller can communicate individually with each of the 6650 virtual control system components. The unique identity of each communication link is preferred when some or all of the 6674 communication links are over the same medium, as would be the case for optical and radio frequency communication. The unique identity of each 6674 communication link ensures that the 6676 system controller has the ability to exert individual control over each of the components and functions very quickly and almost simultaneously. The unique identity of each 6674 communication link can be achieved by using different frequencies for each 6674 communication link or by using unique identification and address codes associated with the communication transferred on each 6674 communication link.
[0411] [0411] In one aspect, the present invention provides and illustrates a surgical communication and control headset that interfaces with the central surgical controller 206 described in connection with Figures 1 to 11. Additional examples are described in the patent application publication US No. 2009/0046146 entitled SURGICAL COMMUNICATION AND CONTROL SYSTEM, which was published February 19, 2009, which is hereby incorporated by reference in its entirety. Figure 53 illustrates a 6680 diagram of a combined beam detector and beam source system used as a device control mechanism in an operating room. The 6680 system is configured and wired to enable device control with the overlay generated on the primary procedure screen. The footswitch shows a method to enable the user to click on command icons that would appear on the screen while the beam source is used to aim at the specific desired command icon to be clicked. The control system graphical user interface (GUI) and a device control processor communicate and parameters are changed using the system. The 6680 system includes a 6684 display coupled to a 6682 beam detection sensor and a 6686 head mounted source. The 6682 beam detection sensor is in communication with a control system GUI overlay processor and a source processor 6688. The surgeon operates a 6692 foot switch, or other adjunct switch, which provides a signal to a 6694 device control interface unit.
[0412] [0412] The 6680 system will provide a means for a sterile clinician to easily and quickly control procedural devices in a hands-free and centralized manner. The ability to maximize the efficiency of the operation and minimize the time a patient is under anesthesia is important for the best patient outcomes. It is common for surgeons, cardiologists or radiologists to verbally request that adjustments be made to certain medical devices and electronic equipment used in the procedure outside the sterile field. It is typical that he or she will need to rely on another team member to make the adjustments he or she needs to settings on devices such as cameras, bovies, surgical beds, shavers or waxers, insufflators, injectors, to name a few. In many circumstances, having to command a team member to make a change to a setting can delay a procedure because the non-sterile team member is busy with another task. The sterile physician cannot adjust non-sterile equipment without compromising sterility, so he or she often has to wait for the non-sterile team member to make the requested adjustment to a particular device before resuming the procedure.
[0413] [0413] The 6680 system enables a user to use a beam source and a beam detector to regenerate a pointer overlay coupled with a GUI and a concomitant switching method (i.e. a foot switch, etc.) to enable doctor to click commands on the primary screen. In one aspect, a GUI could appear on the procedural video screen when activated, such as when the user tilts their head twice to wake it up or steps on a foot switch supplied with the system. Or it is possible that a head tilt to the right will wake the system and a head tilt to the left will simply activate the beam source. When the overlay (called a Device Control GUI Overlay) appears on the screen, it shows button icons representing various surgical devices and the user can use the beam source, in this case a laser beam, to aim at the button. Once the laser is over the correct button icon, a foot switch or other simultaneous switch method can be activated, effectively acting like a mouse click on a computer. For example a user can "wake up" the system by making the device control GUI overlay appear which lists on-screen button icons, each identified as a corresponding procedural medical device. The user can point the laser at the correct case or device and click a footswitch (or some other concomitant control — such as voice control, button on the waistband, etc.) to make a selection, much like clicking a mouse on a computer. The sterilized physician can then select "insufflator, for example". The subsequent screen shows clickable arrow icons for various settings for the device that need to be adjusted (pressure, rate, etc.). In one iteration, the user can then point the laser at the up arrow and click the footswitch repeatedly until the desired setting is reached.
[0414] [0414] In one aspect, 6680 system components may be attached to existing robotic endoscope mounts to "guide" a rigid surgical endoscopic camera by sending motion commands to the endoscope's robotic holding arm (supplied separately, i.e. AESOP along with to Computer Motion). The endoscope is normally held by an attending nurse or resident physician. There are robotic and mechanical scope mounts currently available on the market and some have even been featured with voice control. However, voice control systems have often proven impractical, slow and inaccurate. This aspect would employ a number of hardware and software components to enable the overlay to appear as a cross on the primary procedural video screen. The user could point the beam source anywhere in the quadrant and click a simultaneous switch, such as a foot pedal, to send movement commands to the existing robotic arm which, when coupled to the secondary trigger (i.e., a foot switch, waistband, etc.), would send a command to adjust the arm in minute increments in the direction of the beam source. It could be steered by holding the secondary trigger down until the desired camera position and angle is reached and then released. This same concept could be used for surgical bed adjustments having the overlap similar to the controls of a surgical bed. The surgical bed is commonly adjusted during surgery to allow better access to the anatomy. By using the beam source combination, in this case a laser, a beam detecting sensor such as a camera, a beam source processor and control system GUI overlay processing unit, and a control interface unit device, virtually any medical device could be controlled through this system. Control codes would be programmed into the device control interface unit and most devices can be connected using an RS-232 interface, which is a standard for serially connecting binary data signals between a DTE data terminal or Data Terminal Equipment) and a DCE (Data Circuit-terminating Equipment). The present invention, while described with reference to application in the field of medicine, may be expanded/modified for use in other fields. Another use of the present invention could be in assisting those who are without the use of their hands due to injury or disability or for professions where hands are occupied and hands-free interface is desired. Central surgical controller with direct interface control with secondary surgeon display units designed to be in the sterile field and accessible for surgeon input and display
[0415] [0415] In one aspect, the central surgical controller 206 provides a secondary user interface that enables display and control of functions of the central surgical controller 206 from within the sterile field. The secondary screen could be used to change display locations, what information is shown on which, and pass control of specific devices or functions.
[0416] [0416] During a surgical procedure, the surgeon may not have a user interface device accessible for interactive input by the surgeon and display in the sterile field. Therefore, the surgeon cannot interface between the user interface device and the central surgical controller in the sterile field and cannot control other surgical devices through the central surgical controller from within the sterile field.
[0417] [0417] One solution provides a display unit designed to be used in the sterile field and accessible for input and display by the surgeon to enable the surgeon to have interactive input control from the sterile field to control other surgical devices coupled to the central surgical controller. The display unit is sterile and situated in the sterile field to enable surgeons to interface with the display unit and the central surgical controller to directly interface and configure instruments as needed without leaving the sterile field. The display unit is a master device and can be used for display, control, tool control changes, enabling feed streams from other central surgical controllers without the surgeon leaving the sterile field.
[0418] [0418] In one aspect, the present invention provides a control unit comprising an interactive touch screen, an interface configured to couple the interactive touch screen to a central surgical controller, a processor and a memory coupled to the processor. The memory stores instructions executable by the processor to receive input commands from the interactive touch screen located within a sterile field and transmits the input commands to a central surgical controller to control devices coupled to the central surgical controller located outside the sterile field.
[0419] [0419] In another aspect, the present invention provides a control unit comprising an interactive touch screen, an interface configured to couple the interactive touch screen to a central surgical controller and a control circuit configured to receive commands touchscreen input located within a sterile field and transmit input commands to a central surgical controller to control devices coupled to the central surgical controller located outside the sterile field.
[0420] [0420] In another aspect, the present invention provides a non-transient computer-readable media that stores computer-readable instructions that, when executed, cause a machine to receive input commands from an interactive touch-sensitive screen situated within a sterile field. and transmitting input commands to a central surgical controller through an interface configured to couple the interactive touch screen to the central surgical controller to control devices coupled to the central surgical controller located outside the sterile field.
[0421] [0421] Providing a display unit designed to be used in the sterile field and accessible for input and display by the surgeon provides the surgeon with interactive input control from the sterile field to controlling other surgical devices coupled to the central surgical controller.
[0422] [0422] This sterile field display unit is sterile and allows surgeons to interface it with the central surgical controller. This gives the surgeon control of instruments coupled to the central surgical controller and allows the surgeon to directly interface and configure the instruments as needed without leaving the sterile field. The display unit is a master device and can be used for display, control, tool control changes, enabling feed streams from other central surgical controllers without the surgeon leaving the sterile field.
[0423] [0423] In various aspects, the present invention provides a secondary user interface to enable display and control of central surgical controller functions from within a sterile field. This control could be a display device such as an iPad, for example a portable touchscreen interactive device configured to be introduced into the operating room in a sterile manner. It could be paired like any other device or it could be location sensitive. The display device would be allowed to function in this manner whenever the display device is placed over a specific location on the patient's draped abdomen during a surgical procedure. In other aspects, the present invention provides a smart retractor and a smart adhesive label. These and other aspects are described later in this document.
[0424] [0424] In one aspect, the present invention provides a secondary user interface to enable display and control of central surgical controller functions from within the sterile field. In another aspect, the secondary display could be used to change display locations, determine what information and where the information is shown, and pass control to specific devices or specific functions.
[0425] [0425] There are four types of secondary surgeon screens in two categories. One type of secondary surgeon display units are designed to be used in the sterile field and accessible for input and display by the surgeon on the sterile field interactive control screens. The sterile field interactive control screens can be shared or common sterile field entry control screens.
[0426] [0426] A sterile field screen can be mounted on the operating table, on a stand or merely placed on the patient's abdomen or chest. The sterile field screen is sterile and allows surgeons to interface with the sterile field screen and the central surgical controller. This gives the surgeon control of the system and allows him to directly interface and configure the sterile field display as needed. The sterile field display can be configured as a master device and can be used for display, control, tool control changes, enabling feed streams from other central surgical controllers, etc.
[0427] [0427] In one aspect, the sterile field display can be employed to reconfigure the wireless activation devices in the operating room (OR) and their paired power device if one surgeon hands the device over to another.
[0428] [0428] Figure 54A illustrates a 6700 single zone sterile field control and data entry console, in accordance with an aspect of the present invention. The 6700 Single Zone Console is configured for use in a single zone in a sterile field. Once deployed in a sterile field, the 6700 Single Zone Console can receive touchscreen input from a user in the sterile field. The 6701 touchscreen allows the user to interact directly with what is shown, rather than using a mouse, touchpad or other similar devices (other than a stylus pen or surgical tool). The 6700 single zone console includes wireless communication circuitry to communicate wirelessly with the 206 central surgical controller.
[0429] [0429] Figure 54B illustrates a multi-zone sterile field control and data entry console 6702, in accordance with an aspect of the present invention. The multi-zone console 6702 comprises a first touch screen 6704 for receiving input from a first zone of a sterile field and a second touch screen 6706 for receiving input from a second zone of a sterile field. The 6702 multi-zone console is configured to receive input from multiple users in a sterile field. The 6702 multi-zone console includes wireless communication circuitry to communicate wirelessly with the central surgical controller 206. Accordingly, the 6702 multi-zone sterile field control and data entry console comprises an interactive multi-zone touchscreen display. entry and exit zones.
[0430] [0430] Figure 54C illustrates a docked sterile field control and data entry console 6708, in accordance with an aspect of the present invention. The 6708 docked console includes a 6710 cable to connect the 6708 docked console to the central surgical controller 206 via a wired connection. The 6710 cable makes it possible for the 6708 docked console to communicate over a wired link in addition to a wireless link. The 6710 cable also allows the 6708 docked console to connect to a power source to power the 6708 console and/or recharge the batteries in the 6708 console.
[0431] [0431] Figure 54D illustrates a 6712 battery operated sterile field control and data input console, in accordance with an aspect of the present invention. The 6712 Sterile Field Console is battery operated and includes wireless communication circuitry to communicate wirelessly with the 206 Central Surgical Controller. In particular, in one aspect, the 6712 Sterile Field Console is configured to communicate with any of the modules coupled to the central surgical controller 206 as the generator module 240. Through the sterile field console 6712, the surgeon can adjust the power output level of a generator using a 6713 touch screen interface. An example is described below in connection with Figure 54E.
[0432] [0432] Figure 54E illustrates a 6714 battery operated sterile field control and data input console, in accordance with an aspect of the present invention. The 6714 sterile field console includes a user interface shown on a generator's touch screen. The surgeon can then control the generator output by touching the up/down arrow icons 6718A, 6718B that increase/decrease the power output of the generator module 240. Additional icons 6719 provide access to the generator module 6174 settings, volume 6178 using the +/- icons, among other features directly from the 6/14 sterile field console. The 6714 Sterile Field Console can be employed to adjust settings or reconfigure other wireless activation devices or modules coupled to the 206 central controller in the operating room and its paired power device when the surgeon hands the 6714 Sterile Field Console one by one. other.
[0433] [0433] Figures 55A to 55B illustrate a sterile field console 6700 in use in a sterile field during a surgical procedure, in accordance with an aspect of the present invention. Figure 55A shows the 6714 sterile field console positioned in the sterile field next to two surgeons involved in an operation. In Figure 55B, one of the surgeons is shown touching the touch screen 6701 of the sterile field console with a surgical tool 6722 to adjust the output of a modular device coupled to the central surgical controller 206, reconfigure the modular device, or a power paired with the modular device coupled to the central surgical controller 206.
[0434] [0434] In another aspect, the sterile field screen may be employed to accept query feed streams from another operating room (OR), such as another operating room or central surgical controller 206, where it would then go configure a portion of the OR screens or all of them to mirror the other ORs so the surgeon can see what is needed to help. Figure 56 illustrates a process 6750 for accepting query feed streams from another operating room, in accordance with an aspect of the present invention. The 6700, 6702, 6708, 6712, 6714 sterile field control and data input consoles shown in Figures 54A through 54E, 55A, and 55B can be used as a scalable secondary screen capable of interaction that allows the surgeon to overlay other feed streams or images from laser-scanned Doppler arrays or other imaging sources. The 6700, 6702, 6708, 6712, 6714 sterile field control and data entry consoles can be used to call up a pre-op scan or image for review. Laser Doppler techniques are described in US Provisional Patent Application No. 62/611,341, filed December 28, 2017, and titled
[0435] [0435] It is recognized that the depth of tissue penetration of light depends on the wavelength of light used. In this way, the wavelength of the laser light source can be chosen to detect particle movement (such as blood cells) in a specific range of tissue depth. A laser Doppler employs means to detect moving particles, such as blood cells, based on a variety of tissue depths based on the wavelength of laser light. A laser source can be aimed at a surface of a surgical site. A blood vessel (such as a vein or artery) may be disposed in the tissue at some depth to the tissue surface. Red laser light (which has a wavelength in the range of about 635 nm to about 660 nm) can penetrate tissue to a depth of about 1 mm. Green laser light (which has a wavelength in the range of about 520 nm to about 532 nm) can penetrate tissue to a depth of about 2 to 3 mm. Blue laser light (which has a wavelength in the range of about 405 nm to about 445 nm) can penetrate tissue to a depth of about 4 mm or greater. A blood vessel may be situated at a depth of about 2 to 3 mm below the tissue surface. Red laser light will not penetrate to this depth and therefore will not detect blood cells flowing into this vessel. However, both green and blue laser light can penetrate this depth. Therefore, green and blue laser light scattered from blood cells will result in a Doppler shift observed in both green and blue.
[0436] [0436] In some respects, a tissue can be probed by red, green and blue laser illumination in a sequential manner and the effect of this illumination can be detected by a CMOS imaging sensor over time. It can be recognized that sequential tissue illumination by laser illumination at different wavelengths can allow Doppler analysis at varying tissue depths over time. Although red, green and blue laser sources can be used to illuminate the surgical site, it can be recognized that wavelengths other than visible light (such as in the infrared or ultraviolet regions) can be used to illuminate the surgical site for analysis of Doppler. Imaging sensor information can be provided to the 6700, 6702, 6708, 6712, 6714 sterile field control and data input consoles.
[0437] [0437] The 6700, 6702, 6708, 6712, 6714 sterile field control and data entry consoles provide access to data recorded in the past. In an operating room designated as OR1, the 6700, 6702, 6708, 6712, 6714 sterile field control and data entry consoles can be configured as "consultants" and clear all data when the consultation is complete. In another operating room designated as OR3 (operating room 3), the sterile field control and data entry consoles 6700, 6702, 6708, 6712, 6714 can be configured as a "query" and are configured to log all the data received from the sterile field control and data input consoles 6700, 6702, 6708, 6712, 6714 of OR1 OR1 (Operating Room 1). These settings are summarized in Table 1 below.
[0438] [0438] In an implementation of process 6750, OR1 OR1 receives a 6752 consultation request from OR3. Data is transferred to OR1's 6700 sterile field control and data entry console, for example. The data is temporarily stored 6754. The data is turned in time and OR1's view 6756 of the temporary data starts on the OR1 6700 sterile field control and data entry console 6701 touch screen. When the preview is complete, the data is cleared 6758 and the control returns 6760 to OR1. The data is then cleared 6762 from OR1's 6700 sterile field control and data entry console memory.
[0439] [0439] In yet another aspect, the sterile field screen can be employed as a scalable secondary screen capable of interaction that enables the surgeon to overlay other feed streams or images such as laser scanning Doppler arrays. In yet another aspect, the sterile field screen can be employed to call up a preoperative scan or image for review. Once the vessel trajectory and device depth and trajectory are estimated, the surgeon employs a scalable secondary screen capable of sterile field interaction allowing the surgeon to overlay other feed streams or images.
[0440] [0440] Figure 57 is a 6770 diagram illustrating a technique for estimating depth, vessel trajectory and device trajectory. Prior to dissecting a vessel 6772, 6774 situated below the surface of tissue 6775 using a standard approach, the surgeon estimates the trajectory and depth of vessel 6772, 6774 and a trajectory 6776 of a surgical device 6778 will occur to reach vessel 6772 , 6774. It is often difficult to estimate the trajectory and depth 6776 of a vessel 6772, 6774 lying below the surface of tissue 6775 because the surgeon cannot accurately visualize the location of the trajectory and depth 6776 of the vessel 6772, 6774.
[0441] [0441] Figures 58A to 58D illustrate multiple real-time views of images of a virtual anatomical detail for dissection including perspective views (Figures 58A, 58C) and side views (Figures 58B, 58D). Images are displayed on a sterile field screen of a tablet computer or sterile field input and control console employed as a scalable secondary screen capable of interaction allowing the surgeon to superimpose other feed streams or images, according to an aspect of the present invention. The virtual anatomy images allow the surgeon to more accurately predict the trajectory and depth of a vessel 6772, 6774 located below the surface of tissue 6775, as shown in Figure 57, and the best trajectory 6776 of the surgical device 6778.
[0442] [0442] Figure 58A is a perspective view of a 6780 virtual anatomy shown on a tablet computer or sterile field input and control console. Figure 58B is a side view of the virtual anatomy 6780 shown in Figure 58A, in accordance with one aspect of the present invention. Referring to Figures 58A and 58B, in one aspect, the surgeon uses a 6778 smart surgical device and a tablet computer to visualize the 6780 virtual anatomy in real time and in multiple views. The three-dimensional perspective view includes a portion of tissue 6775 in which vessels 6772, 6774 are located below the surface. The tissue portion is overlaid with a 6786 grid to enable the surgeon to scale and measure the trajectory and depth of vessels 6772, 6774 at target locations 6782, 6784, each marked by an X. The 6786 grid also assists the surgeon in determine the best trajectory 6776 for surgical device 6778. As illustrated, vessels 6772, 6774 have an unusual vessel trajectory.
[0443] [0443] Figure 58C illustrates a perspective view of the virtual anatomy 6780 for dissection, in accordance with an aspect of the present invention. Figure 58D is a side view of virtual anatomy 6780 for dissection, in accordance with one aspect of the present invention. Referring to Figures 58C and 58D, using the tablet computer, the surgeon can zoom and view 360º to obtain an optimal view of the 6780 virtual anatomy for dissection. The surgeon then determines the best path or trajectory 6776 to insert the surgical device 6778 (eg a dissector in this example). The surgeon can view the anatomy in a three-dimensional perspective view or in any of six views. See, for example, the side view of the virtual anatomy in Figure 58D and the insertion of the surgical device 6778 (eg the dissector).
[0444] [0444] In another aspect, a sterile field control and data entry console can enable live conversation between different departments, such as with the oncology or pathology department, to discuss margins or other associated details. the imaging. The sterile field control and data entry console can enable the pathology department to tell the surgeon about margin relationships in a sample and show them to the surgeon in real time using the sterile field console.
[0445] [0445] In another aspect, a sterile field control and data input console can be used to change the focus and field of view of your own image or control this from any of the other monitors coupled to the central surgical controller.
[0446] [0446] In another aspect, a data entry console and sterile field control can be used to display the status of any of the equipment or modules coupled to the central surgical controller 206. The knowledge of which device coupled to the central surgical controller 206 is being used can be obtained through information such as that the device is not in the instrument block or the sensors on the device. Based on this information, the sterile field control and data input console can change the display, settings, switch power to drive one device rather than another, one cable from capital to instrument block and multiple cables from the same. Device diagnostics can gain knowledge that the device is inactive or not being used. Device diagnostics can be based on information such as that the device is not in the instrument block or be based on sensors in the device.
[0447] [0447] In another aspect, a sterile field control and data entry console can be used as a learning tool. The console may show checklists, procedure steps, and/or sequence of steps. A timer/clock can be displayed to measure time to complete steps and/or procedures. The console can show room sound pressure level as an indicator for activity, stress, etc.
[0448] [0448] Figures 59A and 59B illustrate a 6890 touch screen that can be used in the sterile field, in accordance with an aspect of the present invention. Using the 6890 touchscreen, a surgeon can manipulate 6892 images displayed on the 6890 touchscreen using a variety of gestures such as drag and drop, scroll, zoom, rotate, tap, double tap , quick tap, drag, swipe, pinch open, pinch close, tap and hold, two-finger scroll, and more.
[0449] [0449] Figure 59A illustrates a 6892 image of a surgical site shown on a 6890 touchscreen in portrait mode. Figure 59B shows the touchscreen 6890 rotated 6894 to landscape mode and the surgeon uses his index finger 6896 to scroll the image 6892 in the direction of the arrows. Figure 59C shows the surgeon using his index finger 6896 and thumb 6898 to open the image 6892 by pinching in the direction of the arrows 6899 to zoom in. Figure 59D shows the surgeon using his index finger 6896 and thumb 6898 to close the image 6892 by pinching in the direction of arrows 6897 to zoom out. Figure 59E shows touchscreen 6890 rotated in two directions indicated by arrows 6894, 6896 to allow the surgeon to view image 6892 in different orientations.
[0450] [0450] Outside the sterile field, control and static screens are used as they are different from the control and static screens used within the sterile field. Control and static screens situated outside the sterile field provide interactive and static screens for operating room (OR) and device control. Control and static screens located outside the sterile field may include secondary static screens and secondary touch screens for input and output.
[0451] [0451] Secondary static non-sterile screens 107, 109, 119 (Figure 2) for use outside the sterile field include monitors placed on the wall of the operating room, on a rolling stand, or on capital equipment. A static screen is presented with a feed stream from the control device to which it is attached and merely shows what is presented to it.
[0452] [0452] Secondary touch-sensitive input screens situated outside the sterile field may be part of the visualization system 108 (Figure 2), part of the central surgical controller 108 (Figure 2) or may be fixed-placement touch-sensitive monitors on the walls or on rolling supports. One difference between secondary touch input screens and static displays is that a user can interact with a secondary touch input screen by changing what is shown on that specific monitor or others. For capital equipment applications, it could be the interface to control the configuration of connected capital equipment. Secondary touch-sensitive input screens and static screens outside the sterile field can be used to preload surgeon preferences (instrumentation modes and settings, lighting, preferred procedure and sequence and steps, music, etc.)
[0453] [0453] Surgeon secondary screens may include personal input screens with a personal input device that functions similarly to the common sterile field input display device, but is controlled by a specific surgeon. Personal secondary displays can be implemented in many form factors such as a clock, small display block, interface glasses, etc. A personal secondary display may include control capabilities of a common display device and, since it is situated on or controlled by a specific surgeon, the personal secondary display would be keyed to him/her specifically and would indicate this to others and to themselves. . Generally speaking, a personal secondary screen would normally not be useful for switching paired devices because they are not accessible to more than one surgeon. However, a personal secondary screen could be used to grant permission to release a device.
[0454] [0454] A personal secondary screen can be used to provide dedicated data to one of several surgical staff members who want to monitor something that others would typically not want to monitor. In addition, a personal secondary screen can be used as the command module. Additionally, a personal secondary screen can be held by the Chief Surgeon in the operating room and would give the surgeon control to ignore any of anyone else's other inputs. A personal secondary display can be coupled to a wireless short range microphone and headset, for example Bluetooth, enabling the surgeon to have separate conversations or calls or the personal secondary display can be used to broadcast to everyone else in the operating room or in another department.
[0455] [0455] Figure 60 illustrates a surgical site 6900 employing a smart surgical retractor 6902 that comprises a direct interface control to a central surgical controller 206 (Figures 1 to 11), in accordance with an aspect of the present invention. The 6902 Smart Surgical Retractor helps the surgeon and professionals in the operating room keep an incision or wound open during surgical procedures. The 6902 Smart Surgical Retractor assists with the retention of underlying organs or tissues, allowing clinicians/nurses better visibility and access to the exposed area. Referring also to Figures 1 to 11, the smart surgical retractor 6902 may comprise an input screen 6904 operated by the smart surgical retractor 6902. The smart surgical retractor 6902 may comprise a wireless communication device for communicating with a device connected to a generator module 240 coupled to the central surgical controller 206. Using the input screen 6904 of the 6902 intelligent surgical retractor, the surgeon can adjust the power level or mode of the generator module 240 to cut and/or coagulate tissue. If auto-on/off is used to supply power when closing an end actuator over tissue, the auto-on/off state can be indicated by a light, display, or other device located in the 6902 smart retractor cabinet. being used can be changed and displayed.
[0456] [0456] In one aspect, the 6902 smart surgical retractor can detect or know which device/instrument 235 the surgeon is using, either through the 206 central surgical controller or RFID or other device placed on the 235 device/instrument or the 6902 smart surgical retractor , and provide a suitable screen. Alarm and alerts can be activated when conditions require. Other features include showing ultrasonic slide temperature, nerve monitoring, 6906 light source or fluorescence. The light source 6906 can be employed to illuminate the surgical field of view 6908 and to load photocells 6918 on single-use adhesive fabric adhered to the smart retractor 6902 (see Figure 61, for example). In another aspect, the 6902 intelligent surgical retractor can include augmented reality projected onto the patient's anatomy (eg, as a vein viewer).
[0457] [0457] Figure 61 illustrates a surgical site 6910 with a flexible smart adhesive fabric 6912 attached to the body/skin 6914 of a patient, in accordance with an aspect of the present invention. As shown, the 6912 Smart Flexible Adhesive Fabric is applied to a patient's body/skin 6914 between the area exposed by the 6916 Surgical Retractors. In one aspect, the 6912 Smart Flexible Adhesive Fabric can be powered by light, an on-board battery, or a grounding block. The 6912 Flexible Adhesive Display can communicate over short range wirelessly (eg Bluetooth) with a device, can provide readings, lock power or change power. The 6912 Smart Flexible Adhesive Fabric also comprises photocells 6918 to power the 6912 Smart Flexible Adhesive Fabric using ambient light energy. Flexible adhesive screen 6912 includes a screen of a control panel user interface 6920 to enable the surgeon to control devices 235 or other modules coupled to the surgical central controller 206 (Figures 1 to 11).
[0458] [0458] Figure 62 is a 6920 logic flow diagram of a process representing a control program or logic configuration to communicate from within a sterile field to a device outside the sterile field, according to an aspect of the present invention. In one aspect, a control unit comprises an interactive touch screen, an interface configured to couple the interactive touch screen to a central surgical controller, a processor and memory coupled to the processor. The memory stores instructions executable by the processor to receive 6922 input commands from the interactive touch screen located within a sterile field and transmits 6924 input commands to a central surgical controller to control devices coupled to the central surgical controller located outside the sterile field .
[0459] [0459] Figure 63 illustrates a system for performing surgery. The system comprises a control box that includes an internal circuitry; a surgical instrument including a distal element and techniques for detecting a position or condition of said distal element; techniques associated with said surgical instrument for transmitting said detected position or condition to said internal circuitry of said control box; and for transmitting said detected position or condition of said internal circuitry of said control box to a video monitor for display thereon, said detected position or condition being displayed on said video monitor as an icon or symbol , which further comprises a voltage source for generating a voltage contained entirely within said surgical instrument. Additional examples are described in US Patent No. 5,503,320 entitled SURGICAL APPARATUS WITH INDICATOR, issued April 2, 1996, which is incorporated herein by reference in its entirety.
[0460] [0460] Figure 63 schematically shows a system through which data is transmitted to a video monitor for displaying such data relating to the position and/or condition of one or more surgical instruments. As shown in Figure 63, a laparoscopic surgical procedure is performed, whereby a plurality of trocar gloves 6930 are inserted through a body wall 6931 to provide access to a body cavity 6932. A laparoscope 6933 is inserted through one of the gloves. of trocar 6930 to provide illumination (light wire 6934 is shown leading into a light source, not shown) to the surgical site and to image the same. A 6935 camera adapter is attached to the proximal end of the 6933 laparoscope and the 6936 imaging cable extends therefrom to a 6937 control box discussed in more detail below. Image cable entries for image receive port 416 on control box 6937.
[0461] [0461] Additional surgical instruments 6939, 6940 are inserted through additional trocar sleeves 6900 that extend through the body wall 6931. In Figure 63, instrument 6939 schematically illustrates an endoscopic stapling device, for example an Endo GIA instrument* produced by the assignee of the present application, and instrument 6940 schematically illustrates a hand-held instrument, for example an Endo Grasp* device manufactured also by the present assignee. Additional and/or alternative instruments may also be used in accordance with the present invention; the instruments illustrated are merely exemplary surgical instruments that can be used in accordance with the present invention.
[0462] [0462] Instruments 6939, 6940 include adapters 6941, 6942 associated with their respective grip portions. Adapters communicate electronically with conductive mechanisms (not pictured) These mechanisms, which include electrically conductive contact members electrically connected by wires, cables and the like, are associated with the distal elements of the respective instruments, for example the anvil 6943 and cartridge 6944 of the Endo GIA* instrument, the 6945 jaws,
[0463] [0463] Control box 6937 includes a plurality of connectors 6949 which are adapted to receive cables 6947, 6948 and the like. The 6937 control box additionally includes a 6950 output adapter which is adapted to cooperate with a 6951 cable to transmit the laparoscopic image obtained by the 6933 laparoscope together with data relating to the 6939, 6940 surgical instruments to the 6952 video monitor. of circuitry in the 6937 control box is provided to convert the presence of an open circuit, for example, for the electronics in the 6947 cable and the associated mechanism to the distal elements of the 6939 instrument, into an icon or symbol for display on the video monitor 6952. Similarly, the circuitry in the control box 6937 is adapted to provide a second icon or symbol for the video display 6952 when a completed circuit exists for the cable 6947 and the associated mechanism.
[0464] [0464] Illustrative icons/symbols 6953, 6954 are shown on the 6952 video monitor. Icon 6953 shows a surgical clip and can be used to communicate to the surgeon that the 6944 cartridge and 6943 anvil of the 6939 instrument are properly positioned to form tissue staples 6955. Icon 6953 could assume another form when cartridge 6944 and anvil 6943 are not properly positioned to form staples, thus breaking the circuit. Icon 6954 shows a hand instrument with separate jaws, thus communicating to the surgeon that jaws 6945, 6946 of instrument 6940 are open. Icon 6954 could assume another form when jaws 6945, 6946 are closed, thus completing the circuit.
[0465] [0465] Figure 64 illustrates a second layer of information that overlaps a first layer of information. The second layer of information includes a symbolic representation of the knife that overlays the detected position of the knife in the DLU represented in the first layer of information. Additional examples are described in US Patent Application Publication No. 2015/0054753 entitled SURGICAL APPARATUS WITH INDICATOR, which is incorporated herein by reference.
[0466] [0466] Referring to Figure 64, the second layer of information 6963 can overlay at least a portion of the first layer of information 6962 on the screen 6960. In addition, the touch screen 6961 can enable a user to manipulate the second layer. information layer 6963 in relation to the video feedback on the first underlying information layer 6962 on screen 6960. For example, a user may operate touch screen 6961 to select, manipulate, reformat, resize and/or otherwise modify the information shown in the second layer of information
[0467] [0467] The instrument feedback menu 6969 may include a plurality of categories of feedback and may relate to feedback data measured and/or detected by the surgical instrument 6964 during a surgical procedure. As described in the present invention, the surgical instrument 6964 can detect and/or measure the position 6970 of a movable jaw between an open orientation and a closed orientation, the thickness 6973 of the trapped tissue, the gripping force 6976 in the trapped tissue, the joint 6974 of the DLU 6965, and/or the position 6971, the velocity 6972, and/or the force 6975 of the trigger element, for example. Furthermore, the feedback controller in signal communication with the surgical instrument 6964 can provide the detected feedback to the screen 6960, which can display the feedback on the second layer of information 6963. As described herein, the selection, placement, and/or the form of the feedback data shown in the second layer of information 6963 can be modified based on user input on the touch screen 6961, for example.
[0468] [0468] When the DLU 6965 knife is blocked from view by the 6966 end actuator jaws and/or T-fabric, for example, the operator can track and/or approximate the knife position on the 6964 DLU based on the value of change of the feedback data and/or the offset position of the feedback data with respect to the DLU 6965 represented in the first underlying information layer 6962.
[0469] [0469] In various respects, display menu 6977 of control panel 6967 may refer to a plurality of categories, such as 6978 unit systems and/or 6979 data modes, for example. In certain respects, a user can select the 6978 system of units category to switch between systems of units, such as between metric and US customary units, for example. Additionally, a user can select data mode category 6979 to switch between types of numerical representations of feedback data and/or types of graphical representations of feedback data, for example. Numerical representations of the feedback data can be shown as numeric values and/or percentages, for example. In addition, graphical representations of the feedback data can be shown as a function of time and/or distance, for example. As described herein, a user may select the instrument controller menu 6980 from the control panel 6967 to enter directives for the surgical instrument 6964, which may be implemented via the instrument controller and/or microcontroller, for example. A user can minimize or collapse control panel 6967 by selecting the minimize/maximize icon 6968, and a user can maximize or bring back control panel 6967 by selecting the minimize/maximize icon 6968 again.
[0470] [0470] Figure 65 represents a perspective view of a surgeon using a surgical instrument that includes a grip assembly cabinet and a wireless circuit board during a surgical procedure, with the surgeon wearing a set of safety glasses. The wireless circuit board transmits a signal to a set of safety glasses worn by a surgeon who uses the surgical instrument during a procedure. The signal is received through a wireless port on the safety glasses. One or more lighting devices on a front lens of the safety eyewear change color, dimming, or brightness in response to the received signal to provide information to the surgeon about the state of the surgical instrument. Illumination devices are disposable at peripheral edges of the front lens so as not to distract the surgeon's direct line of sight. Additional examples are described in US Patent No.
[0471] [0471] Figure 65 shows a version of the 6991 safety eyewear that can be worn by a 6992 surgeon during a surgical procedure while using a medical device. During use, a wireless communication board housed in a 6993 surgical instrument can communicate with a 6994 wireless port on the 6991 safety eyewear. The 6993 example surgical instrument is a battery operated device, although the 6993 instrument can be powered. by cable or otherwise. The 6993 instrument includes an end actuator. In particular, the 6995 wireless communication board transmits one or more wireless signals indicated by the arrows (B, C) to the 6994 wireless port of the 6991 safety glasses. The 6991 safety glasses receive the signal, analyze the received signal, and show indicated state information received by the signal on the 6996 lens to a user, such as the 6992 surgeon, wearing 6991 safety eyewear. Additionally or alternatively, the 6995 wireless communication board transmits a wireless signal to the 6997 surgical monitor so that the surgical monitor 6997 can display indicated status information received for the surgeon 6992 as described above.
[0472] [0472] A version of the 6991 safety eyewear may include lighting fixture on the peripheral edges of the 6991 safety eyewear. A lighting device provides peripheral vision sensory feedback from the 6993 instrument, with which the 6991 safety eyewear communicates with a wearer wearing safety eyewear 6991. The lighting device may be, for example, a light emitting diode ("LED"), a series of LEDs or any other suitable lighting device known to those skilled in the art and apparent in view of the the teachings of the present invention.
[0473] [0473] LEDs may be situated on the edges or sides of a front lens of the 6991 safety eyewear so as not to distract from the wearer's center of vision while still positioned within the wearer's field of vision so that the wearer does not need to look outside the surgical site to see the lighting device. The lights shown may pulse and/or change color to communicate to the wearer of the 6991 safety eyewear various aspects of information retrieved from the 6993 instrument, such as system status information or tissue detection information (i.e., if the end actuator separated and sufficiently sealed the fabric). Feedback from the housed 6995 wireless communication board can cause a lighting device to activate, flash, or change color to indicate information about the use of the 6993 instrument to a user. For example, a device may incorporate a feedback mechanism based on one or more detected tissue parameters. In this case, a change in the output(s) of the device based on this feedback synchronized with a change in tone can send a signal through the wireless communication card 6995 to the safety glasses 6991 to trigger the activation of the lighting device. . Such means of activating the described lighting device should not be considered limiting, since other means of indicating instrument status information 6993 to the user through safety glasses 6991 are contemplated. Additionally, the 6991 safety eyewear can be single-use or reusable eyewear. Button cell power supplies such as button cell batteries can be used to power wireless receivers and LEDs of safety eyewear versions 6991, which can also include a housed wireless card and tri-color LEDs. Such button cell power supplies can provide a low-cost means of providing sensory feedback of information about the 6993 instrument when in use to the 6992 surgeon wearing the 6991 safety eyewear.
[0474] [0474] Figure 66 is a schematic diagram of a feedback control system for controlling a surgical instrument. The surgical instrument includes a housing and an elongate drive shaft that extends distally from the housing and defines a first longitudinal axis. The surgical instrument also includes a triggering rod disposed on the elongate drive shaft and a drive mechanism disposed at least partially within the cabinet. The drive mechanism mechanically cooperates with the trigger rod to move the trigger rod. A motion sensor detects a change in the electric field (eg capacitance, impedance or admittance) between the trigger rod and the elongated drive shaft. The measuring unit determines a parameter of the trigger rod movement, such as the position, speed and direction of the trigger rod, based on the detected change in the electric field. A controller uses the measured parameter of trigger rod movement to control the trigger mechanism. Additional examples are described in US Patent No.
[0475] [0475] Referring to Figure 66, aspects of the present invention may include a feedback control system 6150. System 6150 includes a feedback controller 6152. Surgical instrument 6154 is connected to feedback controller 6152 via a port data, which can be wired (e.g. FireWireG, USB, Serial R$232, Serial RS485, USART, Ethernet, etc.) or wireless (e.g. BluetoothO, ANT3GO, KNXO, Z-Wave X100, Wireless USBO, Wi -Fi, I/(DAO, nanoNETGO, TinyOSG, ZigBeeGO, 802.11 IEEE and other radio, infrared, UHF, VHF and similar communications.) The 6152 feedback controller is configured to store the data transmitted to it by the 6154 surgical instrument, as well as processing and analyzing the data. The feedback controller 6152 is also connected to other devices, such as a video display 6154, a video processor 6156, and a computing device 6158 (for example, a personal computer, a PDA, a smartphone, a storage device, etc.). Video processor 6156 is used to process output data generated by feedback controller 6152 for output to video screen 6154. Computing device 6158 is used for further processing of the feedback data. In one aspect, the results of sensor feedback analysis performed by a microcontroller can be stored internally for later retrieval by the 6158 computing device.
[0476] [0476] Figure 67 illustrates a 6152 feedback controller including an on-screen display (OSD) module and an on-screen display module (HUD). The modules process the output of a microcontroller for display on multiple screens. More specifically, the OSD module overlays text and/or graphical information from the 6152 feedback controller onto other video images received from the surgical site via cameras disposed therein. The modified video signal having superimposed text is transmitted to the video screen which enables the user to view useful feedback information from the surgical instrument 6154 and/or feedback controller 6152 while still observing the surgical site. Feedback controller 6152 includes a data port 6160 coupled to a microcontroller that enables feedback controller 6152 to be connected to computing device 6158 (Figure 66). Data port 6160 may provide wired and/or wireless communication with computing device 6158 by providing an interface between computing device 6158 and feedback controller 6152 for retrieving stored feedback data, setting operating parameters of the 6152 feedback controller and firmware update and/or other software for the 6152 controller feedback.
[0477] [0477] Feedback controller 6152 includes a cabinet 6162 and a plurality of input and output ports, such as a video input 6164, a video output 6166, and a screen output HUD 6168. The feedback controller 6152 also includes a screen to show status information related to the 6152 feedback controller. Additional examples are described in US Patent No. 8,960,520 entitled METHOD AND APPARATUS FOR
[0478] [0478] Situational recognition is the ability of some aspects of a surgical system to determine or infer information related to a surgical procedure from data received from databases and/or instruments. Information may include the type of procedure being performed, the type of tissue being operated on, or the body cavity that is the object of the procedure. With the contextual information related to the surgical procedure, the surgical system can, for example, improve the way in which it controls the modular devices (e.g. a robotic arm and/or a robotic surgical tool) that are connected to it and provide information or contextualized suggestions to the surgeon during the course of the surgical procedure.
[0479] [0479] Now referring to Fig. 68, a timeline 5200 representing situational awareness of a core controller, such as core surgical controller 106 or 206, for example, is represented. Timeline 5200 is an illustrative surgical procedure and contextual information that the central surgical controller 106, 206 can derive from data received from data sources at each step in the surgical procedure. Timeline 5200 represents the typical steps that would be taken by nurses, surgeons, and other medical personnel during the course of a pulmonary segmentectomy procedure, starting with the operating room setup and ending with the patient's transfer to an operating room. postoperative recovery.
[0480] [0480] The situational awareness central surgical controller 106, 206 receives data from the data sources throughout the course of the surgical procedure, including data generated each time medical personnel use a modular device that is paired with the central surgical controller 106 , 206. The central surgical controller 106,
[0481] [0481] In the first step 5202, in this illustrative procedure, hospital staff members retrieve the electronic patient record (PEP) from the hospital's PEP database. Based on the PEP patient selection data, the central surgical controller 106, 206 determines that the procedure to be performed is a thoracic procedure.
[0482] [0482] In the second step 5204, team members scan the entry of medical supplies for the procedure. The 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 mix of supplies corresponds to a thoracic procedure. Additionally, the central surgical controller 106, 206 is also able to determine that the procedure is not a wedge procedure (because the inlet supplies have an absence of certain supplies that are required for a thoracic wedge procedure or otherwise that inlet supplies do not correspond to a chest wedge procedure).
[0483] [0483] In the third step 5206, medical personnel scan the patient's band with a scanner that is communicably connected to the central surgical controller 106, 206. The central surgical controller 106, 206 can then confirm the patient's identity based on the scanned data.
[0484] [0484] In the fourth step 5208, the medical team turns on the auxiliary equipment. The auxiliary equipment being used may vary depending on the type of surgical procedure and the techniques being used by the surgeon, but in this illustrative case they include a smoke evacuator, an insufflator and a medical imaging device. When activated, auxiliary equipment that are modular devices can automatically pair with the central surgical controller 106, 206 that is situated within a specific neighborhood of the modular devices as part of their startup process. The central surgical controller 106, 206 can then derive contextual information about the surgical procedure by detecting the types of modular devices that correspond with it during this preoperative or start-up 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 electronic patient record (PEP) data, 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 can generally , infer the specific procedure that the surgical team will perform. After the central surgical controller 106, 206 recognizes which 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-reference the data it subsequently receives from the connected data sources (e.g. modular devices and patient monitoring devices) to infer which step of the surgical procedure the surgical team is performing.
[0485] [0485] In the fifth step 5210, team members attach electrocardiogram (ECG) electrodes and other patient monitoring devices to the patient. ECG electrodes and other patient monitoring devices are capable of pairing with the central surgical controller 106, 206. As the central surgical controller 106, 206 begins to receive data from the patient monitoring devices, the central surgical controller 106, 206 this confirms that the patient is in the operating room.
[0486] [0486] In the sixth step 5212, medical personnel induce anesthesia on the patient. The 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 of themselves, for example. Upon completion of the sixth step 5212, the preoperative portion of the lung segmentectomy procedure is completed and the operative portion begins.
[0487] [0487] 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 has started when it can compare the detection of the patient's lung collapse to the expected steps of the procedure (which can be accessed or retrieved earlier) and thus determine that the lung is the first operative step in this specific procedure.
[0488] [0488] In the eighth step 5216, the medical imaging device (eg, a display device) is inserted and video from the medical imaging device is started. The central surgical controller 106, 206 receives data from the medical imaging device (i.e., the 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 commenced. Additionally, the central surgical controller 106, 206 may determine that the specific procedure being performed is a segmentectomy rather than a lobectomy (note that a wedge procedure has already been ruled out by the central surgical controller 106, 206 based on data received in the second procedure step 5204). Data from the medical imaging device 124 (Figure 2) can be used to determine contextual information about the type of procedure being performed in a number of different ways, including by determining the angle at which the medical imaging device is oriented in with respect to viewing the patient's anatomy, monitoring the number or medical imaging devices being used (i.e., which are activated and paired with the central surgical controller 106, 206), and monitoring the types of viewing devices used. For example, a technique for performing a VATS lobectomy places the camera in the lower anterior corner of the patient's chest cavity above the diaphragm, while a technique for performing a VATS segmentectomy places the camera in an intercostal position anterior to the segmental fissure. Using standard recognition or machine learning techniques, for example, the situational recognition system can be trained to recognize the positioning of the medical imaging device according to the visualization of the patient's anatomy. As another example, one technique for performing a VATS lobectomy uses a single medical imaging device, while another technique for performing a VATS segmentectomy uses multiple cameras. As yet another example, a technique for performing a VATS segmentectomy utilizes an infrared light source (which can be communicably coupled to the central surgical controller as part of the visualization system) to visualize the segment fissure, which is not used in a VATS lobectomy. By tracking any or all of these data from the medical imaging device, the central surgical controller 106, 206 can thus determine the specific type of surgical procedure being performed and/or the technique being used for a specific type of procedure. surgical.
[0489] [0489] In the ninth step 5218 of the procedure, the surgical team starts the dissection step. The central surgical controller 106, 206 can infer that the surgeon is in the process of dissecting to mobilize the patient's lung because he receives data from the RF or ultrasonic generator that indicates that an energy instrument is being fired. The central surgical controller 106, 206 can cross-reference the received data with the retrieved steps of the surgical procedure to determine that an energy instrument being fired at that point in the process (i.e., after completion of the previously discussed steps of the procedure) corresponds to the dissection. In certain cases, the power instrument may be a power tool mounted on a robotic arm of a robotic surgical system.
[0490] [0490] In the tenth step 5220 of the procedure, the surgical team proceeds to the ligation step. The central surgical controller 106, 206 can infer that the surgeon is ligating the arteries and veins because he receives data from the surgical stapling and cutting instrument indicating that the instrument is being triggered. Similar to the preceding step, the central surgical controller 106, 206 can derive this inference by cross-referencing the receiving data from the surgical stapling and cutting instrument with the steps retrieved in the process. In certain cases, the surgical instrument may be a surgical tool mounted on a robotic arm of a robotic surgical system.
[0491] [0491] In the eleventh step 5222, the segmentectomy portion of the procedure is performed. The 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. Cartridge data may correspond to the size or type of staple being fired 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 tranced. In this case, the type of staple that is fired is used for the parenchyma (or other similar types of tissue), which enables the central surgical controller 106, 206 to infer which segmentectomy portion of the procedure is being performed.
[0492] [0492] In the twelfth step 5224, the node dissection step is then performed. The central surgical controller 106, 206 can infer that the surgical team is dissecting the node and performing a leak test based on data received from the generator that indicates which ultrasonic or RF instrument is being triggered. For this particular procedure, an RF or ultrasonic instrument being used after the parenchyma has undergone transection corresponds to the node dissection step, which enables the central surgical controller 106, 206 to make this inference. It should be noted that surgeons regularly switch between surgical stapling/cutting instruments and surgical energy instruments (ie, RF or ultrasonic) depending on the specific step in the procedure because different instruments are better suited for specific tasks. Therefore, the specific sequence in which cutting/stapling instruments and surgical energy instruments are used can indicate which step of the procedure the surgeon is performing. Also, 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 a surgical procedure. The surgeon can switch between robotic tools and hand-held surgical instruments and/or can use the devices simultaneously, for example. Upon completion of the twelfth step 5224, the incisions are closed and the post-operative portion of the process begins.
[0493] [0493] In the thirteenth step 5226, the patient's anesthesia is reversed. The central surgical controller 106, 206 can infer that the patient is emerging from anesthesia based on ventilator data (i.e., the patient's respiratory rate begins to increase), for example.
[0494] [0494] Finally, in the fourteenth step 5228 is that the medical personnel removes the various patient monitoring devices from the patient. The 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 data received from the various data sources that are communicably coupled to the controller. central surgery 106, 206.
[0495] [0495] Situational recognition is further described in US Provisional Patent Application Serial No. 62/611,341 entitled INTERACTIVE SURGICAL PLATFORM, filed December 28, 2017, which is incorporated herein by reference in its entirety. In certain cases, the operation of a robotic surgical system, including the various robotic surgical systems described herein, for example, may be controlled by the central controller 106, 206 based on its situational recognition and/or feedback from components thereof and /or based on information from cloud 102.
[0496] [0496] Various aspects of the subject described in this document are defined in the following numbered examples.
[0497] [0497] Example 1. An interactive control unit comprising: an interactive touch screen; an interface configured to couple the control unit to a central surgical controller; a processor; and a memory coupled to the processor, the memory storing instructions executable by the processor to: receive input commands from the interactive touch-sensitive screen situated within a sterile field; and transmitting input commands to the central surgical controller to control devices coupled to the central surgical controller located outside the sterile field.
[0498] [0498] Example 2. The interactive control unit of Example 1, the processor being configured to receive an array of images from a scanning device and display the image on the interactive touch screen.
[0499] [0499] Example 3. The interactive control unit of any of Examples 1 and 2, the processor being configured to display on the interactive touch screen an image of a virtual anatomy based on the matrix of received images.
[0500] [0500] Example 4. The interactive control unit of any one of Examples 1 to 3, where the processor is configured to receive an array of images from a laser-scanning Doppler device.
[0501] [0501] Example 5. The interactive control unit of any one of Examples 1 to 4, the processor being configured to reconfigure wireless devices attached to the central surgical controller from control inputs received via the interactive touch screen .
[0502] [0502] Example 6. The interactive control unit of any one of Examples 1 to 5, the interactive touch screen comprising multiple input and output zones.
[0503] [0503] Example 7. An interactive control unit comprising: an interactive touch screen; an interface configured to couple the control unit to a first central surgical controller; a processor; and a memory coupled to the processor, the memory storing instructions executable by the processor to: receive input commands from the interactive touch-sensitive screen situated within a sterile field; transmitting input commands to the first central surgical controller to control devices coupled to the first central surgical controller located outside the sterile field; receive an appointment request from a second central surgical controller; and configuring a portion of the interactive touch screen to show information received from the second central surgical controller after receiving the consultation request.
[0504] [0504] Example 8. The interactive control unit of Example 7, where the processor is configured to temporarily store data associated with the interactive touch screen.
[0505] [0505] Example 9. The interactive control unit of any of Examples 7 and 8, where the processor is configured to back up the data in time.
[0506] [0506] Example 10. The interactive control unit of any one of Examples 7 to 9, where the processor is configured to see information received from the second central surgical controller.
[0507] [0507] Example 11. The interactive control unit of any one of Examples 7 to 10, the processor being configured to erase information received from the second central surgical controller.
[0508] [0508] Example 12. The interactive control unit of any one of Examples 7 to 11, the processor being configured to return control to the surgical interactive touch screen on the first central surgical controller.
[0509] [0509] Example 13. An interactive control unit comprising: an interactive touch screen; an interface configured to couple the control unit to a central surgical controller; and a control circuit for: receiving input commands from the interactive touch screen situated within a sterile field; and transmitting input commands to the central surgical controller to control devices coupled to the central surgical controller located outside the sterile field.
[0510] [0510] Example 14. The interactive control unit of Example 13, the control circuitry being configured to receive an array of images from a scanning device and display the image on the interactive touch screen.
[0511] [0511] Example 15. The interactive control unit of any of Examples 13 and 14, the control circuitry being configured to display on the interactive touch screen an image of a virtual anatomy based on the matrix of received images.
[0512] [0512] Example 16. The interactive control unit of any one of Examples 13 to 15, the control circuitry being configured to receive an array of images from a laser-scanned Doppler device.
[0513] [0513] Example 17. The interactive control unit of any one of Examples 13 to 16, the control circuitry being configured to reconfigure wireless devices coupled to the central surgical controller from control inputs received via the interactive touchscreen to the touch.
[0514] [0514] Example 18. The interactive control unit of any one of Examples 13 to 17, where the interactive touch screen comprises multiple input and output zones. Example 1. .
[0515] [0515] While various forms have been illustrated and described, it is not the applicant's intention to restrict or limit the scope of the claims appended 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 invention. Furthermore, the structure of each element associated with the form may alternatively be described as a means of providing the function performed by the element. In addition, where materials for certain components are described, other materials may be used. It is to be understood, therefore, that the foregoing description and the appended claims are intended to cover all such modifications, combinations, and variations within the scope of the disclosed embodiments. The appended claims are intended to cover all such modifications, — variations, alterations, — substitutions, modifications and equivalents.
[0516] [0516] The preceding 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 may be individually implemented and/or collectively, through a wide range of hardware, software, firmware, or virtually any combination thereof. Those skilled in the art will recognize, however, that some aspects of the aspects described herein, in whole or in part, may be equivalently implemented on integrated circuits, such as one or more computer programs running on one or more computers (e.g. , as one or more programs running on one or more computer systems), as one or more programs running on one or more processors (for example, as one or more programs running on one or more microprocessors), as firmware, or virtually as any combination thereof, and that designing the circuitry and/or writing the code for the software and firmware would be within the scope of practice of one skilled in the art, in light of this description. Furthermore, those skilled in the art will understand that the mechanisms of the subject matter herein described may be distributed as one or more program products in a variety of ways and that a form illustrative of the subject matter herein described is applicable irrespective of the specific type of signal transmission medium used to effectively carry out distribution.
[0517] [0517] The instructions used to program the logic to perform various aspects described may be stored in a memory in the system, such as dynamic random access memory (DRAM), cache, flash memory, or other storage. In addition, instructions can be distributed over a network or through other computer-readable media. Thus, machine-readable media may include any mechanism for storing or transmitting information in a form readable by a machine (e.g., a computer), but is not limited to, floppy disks, optical disks, read-only memory compact disks ( 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 cards or optical, flash memory, or a tangible, machine-readable storage media used to transmit information over the Internet over electrical, optical, acoustic, or other forms of propagated signals (e.g., carrier waves, infrared signals, digital, etc.). Accordingly, non-transient computer-readable media includes any type of machine-readable media suitable for storing or transmitting instructions or electronic information in a form readable by a machine (eg, a computer).
[0518] [0518] As used in any aspect of the present invention, the term "control circuit" may refer to, for example, a set of wired circuits, programmable circuits (e.g., a computer processor comprising one or more cores instruction processing units, processing unit, processor, — microcontroller, — microcontroller unit, controller, digital signal processor (PSD), programmable logic device (PLD), programmable logic array (PLA), or programmable gate array in field (FPGA)), state machine circuits, firmware that stores instructions executed by the programmable circuit,
[0519] [0519] As used in any aspect of the present invention, the term "logic" may refer to an application, software, firmware and/or circuit — configured — to perform any of the aforementioned operations. The software may be embedded as a software package, code, instructions, sets of instructions and/or data recorded on computer-readable non-transient storage media. Firmware can be embedded as code, instructions or sets of instructions and/or data that are hard-coded (eg, non-volatile) in memory devices.
[0520] [0520] As used in any aspect of the present invention, the terms "component", "system", "module" and the like may refer to a computer-related entity, whether hardware, a combination of hardware and software, software or software running.
[0521] [0521] As in the present document used in one aspect of the present invention, an "algorithm" refers to the self-consistent sequence of steps leading to the desired result, where a "step" refers to the manipulation of physical quantities and/or logical states. which can, although not necessarily need to, take the form of electrical or magnetic signals that can be stored, transferred, combined, compared and otherwise manipulated. It is common usage to call these signs bits, values, elements, symbols, characters, terms, numbers, or the like. These terms and similar terms may be associated with appropriate physical quantities and are merely convenient identifications applied to those quantities and/or states.
[0522] [0522] A network may include a packet switched network. Communication devices may be able to communicate with each other using a selected packet-switched network communications protocol. An exemplary communications protocol may include an Ethernet communications protocol which may be capable of enabling communication using a transmission control protocol/Internet protocol (TCP/IP). The Ethernet protocol may conform 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 may be able to communicate with each other using an X.25 communications protocol. The X.25 communications protocol can conform or be compatible with a standard promulgated by the “International Telecommunication —Union-Telecommunication Standardization Sector (ITU-T). Alternatively or additionally, the communication devices may be able to communicate with each other using a frame-relay communications protocol. The frame-relay communications protocol may conform or be compliant with a standard promulgated by the Consultative Committee for International Telegraph and Telephone (CCITT) and/or the American National Standards Institute (ANSI - American National Standards Institute). Alternatively or additionally, the transceivers may be able to communicate with each other using an ATM ("asynchronous transfer mode") communication protocol. The ATM communication protocol may conform or be compatible with an ATM standard published by the ATM forum titled "ATM-MPLS Network Interworking 2.0" published in August 2001, and/or later versions of that standard. Of course, different and/or post-developed connection-oriented network communication protocols are also contemplated in the present invention.
[0523] [0523] Unless expressly stated to the contrary, as is evident from the preceding description, it is understood that throughout the preceding description, discussions which use terms such as "processing", or "computation", or "calculation", or " determination", or "display", or the like, refers to the action and processes of a computer, or similar electronic computing device, which manipulates and transforms data represented in the form of physical (electronic) quantities in records and memories of the computer system on other data similarly represented in the form of physical quantities in the computer's memories or records, or on other similar information storage, transmission or display devices.
[0524] [0524] One or more components may be referred to in the present invention as "configured to", "configurable to", "operable/operable to", "adapted/adaptable to", "capable of", "conformable/conformed to", etc. Those skilled in the art will recognize that "configured for" can generally encompass active-state components and/or idle-state components and/or standby-state components, unless the context dictates otherwise.
[0525] [0525] The terms "proximal" and "distal" are used in the present invention with reference to a physician who manipulates the handle portion of the surgical instrument. The term "proximal" refers to the portion closest to the physician, and the term "distal" refers to the portion located away from the physician. It will also be understood that, for the sake of convenience and clarity, spatial terms such as "vertical", "horizontal", "upwards" and "downwards" may be used in the present invention in connection with the drawings. However, surgical instruments can be used in many orientations and positions, and these terms are not intended to be limiting and/or absolute.
[0526] [0526] Persons skilled in the art will recognize that, in general, terms used herein, and particularly in the appended claims (e.g. bodies of appended claims) are generally intended as "open" terms (e.g., the term "including" shall be interpreted as "including, but not limited to", the term "having" shall be interpreted as "having at least", the term "includes" shall be interpreted as "includes, but not limits to", etc.). It will further be understood by those skilled in the art that when a specific number of an introduced claim mention is intended, such intent will be expressly mentioned in the claim and, in the absence of such mention, no intent 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 mentions. However, the use of such phrases should not be interpreted as implying that the introduction of a mention of the claim by the indefinite articles "a, an" or "an, an" limits any specific claim containing the mention of the introduced claim 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" (e.g., "one, ones" and /or "one, one" should typically be interpreted to mean "at least one" or "one or more"); the same goes for the use of definite articles used to introduce claim mentions.
[0527] [0527] Furthermore, even if a specific number of an introduced claim mention is explicitly mentioned, those skilled in the art will recognize that such mention needs to typically be interpreted to mean at least the mentioned number (e.g., the mere mention of "two mentions", with no other modifiers, typically means at least two mentions, or two or more mentions). Furthermore, in cases where a convention analogous to "at least one of A, B, and C, etc." is used, this construction is generally intended to have the sense in which the convention would be understood by (e.g., " a system that has at least one of A, B, and C" would include, but not be limited to, systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and /or A, B and C together, etc.). In cases where a convention analogous to "at least one of A, B, or C, etc." is used, this construction is generally intended to have the sense in which the convention would be understood by (e.g., "a system that has at least one of A, B, and C" would include, but not be limited to, systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and/or A , B and C together, etc.). It will further be understood by those skilled in the art that typically a disjunctive word and/or phrase having two or more alternative terms, whether in the description, claims or drawings, is to be understood as contemplating the possibility of including one of the terms, any of the terms or both terms, unless the context dictates otherwise. For example, the phrase "A or B" will typically be understood to include the possibilities of "A" or "B" or "AeB".
[0528] [0528] With respect to the appended claims, those skilled in the art will understand that the operations mentioned therein can generally be performed in any order. Furthermore, although various operational flow diagrams are presented in one or more sequences, it should be understood that the various operations may be executed in orders other than those illustrated, or may be executed simultaneously. Examples of such alternative orderings may include orderings — overlapping, interleaved, interrupted, reordered, incremental, preparatory, supplementary, concurrent, reverse, or other variant orderings, unless the context dictates otherwise. Furthermore, terms such as "responsive to", "related to" or other adjectival participles are not generally intended to exclude these variants, unless the context dictates otherwise.
[0529] [0529] It is worth noting that any reference to "one (1) aspect", "an aspect", "an exemplification" or "one (1) exemplification", and the like means that a particular feature, 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 one exemplification", "in one (1) exemplification", in various places throughout this descriptive report does not necessarily refer to to the same aspect. Furthermore, specific features, structures or features can be combined in any suitable way in one or more aspects.
[0530] [0530] Any patent application, patent, non-patent publication or other descriptive material mentioned in this specification and/or mentioned in any application data sheet is hereby incorporated by reference, to the extent that the Embedded materials are not inconsistent with this. Accordingly, and to the extent necessary, the description as explicitly presented herein supersedes any conflicting material incorporated into the present invention by reference. Any material, or portion thereof, which is hereby incorporated by reference, but which conflicts with the definitions, statements, or other descriptive materials contained herein, will be incorporated herein only to the extent that that there is no conflict between the incorporated material and the existing description material.
[0531] [0531] In summary, numerous benefits have been described that result from employing the concepts described in this document. The foregoing description of one or more embodiments has been presented for purposes of illustration and description. This description is not intended to be exhaustive or to limit the invention to the precise form described.
Modifications or variations are possible in light of the above teachings.
One or more embodiments have been chosen and described for the purpose of illustrating the principles and practical application to thereby enable one skilled in the art to use the various embodiments and with various modifications, as is convenient for the specific use contemplated.
The attached claims are intended to define the global scope.

权利要求:
Claims (18)
[1]
1. Interactive control unit, characterized by comprising: an interactive touch screen; an interface configured to couple the control unit to a central surgical controller; a processor; and a memory coupled to the processor, the memory storing instructions executable by the processor to: receive input commands from the interactive touch screen situated within a sterile field; and transmitting input commands to the central surgical controller to control devices coupled to the central surgical controller located outside the sterile field.
[2]
2. Interactive control unit, according to claim 1, characterized in that the processor is configured to receive an array of images from a scanning device and display the image on the interactive touch screen.
[3]
3. Interactive control unit, according to claim 2, characterized in that the processor is configured to display on the interactive touch screen an image of a virtual anatomy based on the matrix of received images.
[4]
4. Interactive control unit, according to claim 2, characterized in that the processor is configured to receive an image matrix from a laser scanning Doppler device.
[5]
5. Interactive control unit, according to claim 1, characterized in that the processor is configured to reconfigure the wireless devices coupled to the central surgical controller from the control inputs received through the interactive touch screen.
[6]
6. Interactive control unit, according to claim 1, characterized in that the interactive touch screen comprises multiple input and output zones.
[7]
7. Interactive control unit, characterized by comprising: an interactive touch screen; an interface configured to couple the control unit to a first central surgical controller; a processor; and a memory coupled to the processor, the memory storing instructions executable by the processor to: receive input commands from the interactive touch screen situated within a sterile field; transmitting input commands to the first central surgical controller to control devices coupled to the first central surgical controller located outside the sterile field; receive an appointment request from a second central surgical controller; and configuring a portion of the interactive touch screen to show information received from the second central surgical controller after receiving the consultation request.
[8]
8. Interactive control unit, according to claim 7, characterized in that the processor is configured to temporarily store data associated with the interactive touch screen.
[9]
9. Interactive control unit, according to claim 8, characterized in that the processor is configured to back up the data in time.
[10]
10. Interactive control unit, according to claim 9, characterized in that the processor is configured to view information received from the second central surgical controller.
[11]
11. Interactive control unit, according to claim 10, characterized in that the processor is configured to erase information received from the second central surgical controller.
[12]
An interactive control unit according to claim 11, characterized in that the processor is configured to return control to the interactive surgical touch screen on the first central surgical controller.
[13]
13. Interactive control unit, characterized by comprising: an interactive touch screen; an interface configured to couple the control unit to a central surgical controller; and a control circuit; receive input commands from the interactive touch screen situated within a sterile field; and transmitting input commands to the central surgical controller to control devices coupled to the central surgical controller located outside the sterile field.
[14]
14. An interactive control unit according to claim 13, characterized in that the control circuit is configured to receive an array of images from a scanning device and display the image on the interactive touch screen.
[15]
15. Interactive control unit, according to claim 14, characterized in that the control circuit is configured to display on the interactive touch screen an image of a virtual anatomy based on the matrix of received images.
[16]
16. Interactive control unit, according to claim 14, characterized in that the control circuit is configured to receive an image matrix from a laser scanning Doppler device.
[17]
17. Interactive control unit, according to claim 13, characterized in that the control circuit is configured to reconfigure the wireless devices coupled to the central surgical controller from the control inputs received through the interactive touch screen.
[18]
18. An interactive control unit according to claim 13, characterized in that the interactive touch screen comprises multiple input and output zones.

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

优先权:

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申请号 | 申请日 | 专利标题

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

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

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US201762611340P| true| 2017-12-28|2017-12-28|

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

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

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

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US201862649309P| true| 2018-03-28|2018-03-28|

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US62/649,309|2018-03-28|

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US15/940,700|2018-03-29|

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US15/940,700|US20190205001A1|2017-12-28|2018-03-29|Sterile field interactive control displays|

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PCT/US2018/044455|WO2019133071A1|2017-12-28|2018-07-31|Sterile field interactive control displays|

---