stapling device equipped with a motor configured to adjust the force, feed speed, and total travel o

专利摘要:
The present invention relates to a surgical stapling instrument. The surgical stapling instrument includes an end actuator configured to hold a tissue, a cutting member, a motor coupled to the cutting member, the motor configured to move the cutting member between a first position and a second position and a cutting circuit. control coupled to the engine. The control circuit is configured to detect a parameter associated with gripping the end actuator or firing the cutting member, or a combination of fixing the end actuator and firing the cutting member, and control the motor to adjust an applied torque. to the cutting member by the motor, a speed at which the motor drives the cutting member, or a distance at which the motor drives the cutting member, according to the parameter, or any combination of torque, speed and distance.
公开号:BR112020013130A2
申请号:R112020013130-0
申请日:2018-11-14
公开日:2020-12-01
发明作者:Frederick E. Shelton Iv；Gregory J. Bakos；Jason L. Harris；Chester O. Baxter Iii
申请人:Ethicon Llc；
IPC主号:

专利说明:

[001] [001] The present application claims the benefit of non-provisional US patent application serial number 16 / 182,240, entitled POWERED STAPLING DEVICE THAT IS CAPABLE OF ADJUSTING FORCE, ADVANCEMENT SPEED, AND OVERALL STROKE OF CUTTING
[002] [002] The present application claims priority under 35 U.S.C. & 119 (e) for US provisional patent application No. 62 / 729,185, entitled POWERED STAPLING DEVICE THAT IS CAPABLE OF ADJUSTING FORCE, ADVANCEMENT SPEED, AND OVERALL STROKE OF
[003] [003] The present application also claims priority under 35 USC $ 119 (e), for provisional US patent application No. 62 / 659,900, entitled SMART ACTIVATION OF AN ENERGY DEVICE BY ANOTHER DEVICE, filed on June 30, 2018, for US provisional patent application 62 / 692,748, entitled SMART ENERGY ARCHITECTURE, filed on June 30, 2018, and for US provisional patent application 62 / 692,768, entitled SMART ENERGY DEVICES, filed on June 30, 2018 , whose invention of each is in this document incorporated by reference, in its entirety.
[004] [004] The present application claims priority under 35 USC $ 119 (e) for US provisional patent application No. 62 / 692,747, entitled METHOD OF HUB COMMUNICATION, filed on April 19, 2018, whose invention is on the this document incorporated by reference in its entirety.
[005] [005] The present application also claims priority under 35 USC $ 119 (e) of US provisional patent application 62 / 650,898 filed March 30, 2018, entitled CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS, of the application for US Provisional Patent Serial No. 62 / 650,887, entitled SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES, filed on March 30, 2018, from US Provisional Patent Application Serial No. 62 / 650,882, entitled SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM, filed at March 30, 2018, and provisional US patent application serial number 62 / 650,877, entitled SURGICAL SMOKE EVACUATION SENSING AND CONTROLS, filed on March 30, 2018, whose invention is incorporated in this document for reference , in its entirety.
[006] [006] This application also claims priority under 35 US $ 119 (e) of US provisional patent application serial number 62 / 640,417, entitled TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR, filed on March 8, 2018, and US provisional patent application serial number 62 / 640,415, entitled ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR, filed on March 8, 2018, the respective invention of which is incorporated herein by reference, in its entirety for reference .
[007] [007] The present application also claims priority under 35 USC $ 119 (e) of US provisional patent application serial number 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, of the provisional US patent application serial number 62 / 611.340, entitled CLOUD-BASED MEDICAL ANALYTICS, filed on December 28, 2017, and US provisional patent application serial number 62 / 611.339, entitled ROBOT ASSISTED SURGICAL PLATFORM, filed on December 28, 2017, the invention of each of which in this document is incorporated by reference, in its entirety. BACKGROUND OF THE INVENTION
[008] [008] The present invention relates to various surgical systems. Surgical procedures are typically performed in theaters or surgical operating rooms in a health care facility, such as a hospital. A sterile field is typically created around the patient. The sterile field may include members of the brushing team, who are properly dressed, and all furniture and accessories in the area. Various surgical devices and systems are used to perform a surgical procedure. SUMMARY OF THE INVENTION
[009] [009] In one aspect, the present invention provides a surgical stapling instrument that includes an end actuator configured to hold a tissue; a cutting member; a motor coupled to the cutting member, the motor being configured to move the cutting member between the first position and the second position; and a control circuit coupled to the motor, the control circuit being configured to: detect a parameter associated with the fixation of the end actuator; and controlling the engine to adjust the torque applied to the cutting member by the engine.
[0010] [0010] In another aspect, the present invention provides a surgical stapling instrument that includes an end actuator configured to hold a tissue; a cutting member; a motor coupled to the cutting member, the motor being configured to move the cutting member between the first position and the second position; and a control circuit coupled to the motor, the control circuit being configured to: detect a parameter associated with the cutting member trip; and controlling the engine to adjust the torque applied to the cutting member by the engine.
[0011] [0011] In yet another aspect, the present invention provides a motor-equipped stapling device that includes a circular stapling head assembly; an anvil; a trocar attached to the anvil and attached to a motor, the motor being configured to advance and retract the trocar; and a control circuit coupled to the engine, the control circuit being configured to: determine a trocar position in one of a plurality of zones; and defining an anvil closing speed based on the determined trocar position. FIGURES
[0012] [0012] The various aspects in this document described, both with regard to the organization and the methods of operation, together with additional objects and advantages of the same, can be better understood in reference to the description presented below, considered together with the attached drawings as follows.
[0013] [0013] Figure 1 is a block diagram of an interactive surgical system implemented by computer, according to at least one aspect of the present invention.
[0014] [0014] 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.
[0015] [0015] Figure 3 is a central device or 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.
[0016] [0016] Figure 4 is a partial perspective view of a central surgical controller enclosure, and of a generator module in combination received slidably in a central surgical controller enclosure, in accordance with at least one aspect of the present invention.
[0017] [0017] 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.
[0018] [0018] Figure 6 illustrates different power bus connectors for a plurality of side coupling ports of a side modular cabinet configured to receive a plurality of modules, in accordance with at least one aspect of the present invention.
[0019] [0019] Figure 7 illustrates a vertical modular housing configured to receive a plurality of modules, according to at least one aspect of the present invention.
[0020] [0020] Figure 8 illustrates a surgical data network comprising a central modular communication controller configured to connect modular devices located in one or more operating rooms of a healthcare facility, or any environment in a utility facility. specially equipped for surgical operations, to the cloud, in accordance with at least one aspect of the present invention.
[0021] [0021] Figure 9 illustrates an interactive surgical system implemented by computer, in accordance with at least one aspect of the present invention.
[0022] [0022] Figure 10 illustrates a central surgical controller that comprises a plurality of modules coupled to the modular control tower, according to at least one aspect of the present invention.
[0023] [0023] Figure 11 illustrates an aspect of a universal serial bus (USB) central controller device, in accordance with at least one aspect of the present invention.
[0024] [0024] Figure 12 is a block diagram of a cloud computing system that comprises a plurality of intelligent surgical instruments coupled to central surgical controllers that can connect to the cloud component of the cloud computing system, according to the least one aspect of the present invention.
[0025] [0025] Figure 13 is a functional module architecture of a cloud computing system, according to at least one aspect of the present invention.
[0026] [0026] Figure 14 illustrates a diagram of a surgical system with situational recognition, according to at least one aspect of the present invention.
[0027] [0027] Figure 15 is a timeline representing the situational recognition of a central surgical controller, in accordance with at least one aspect of the present invention.
[0028] [0028] Figure 16 illustrates a logical diagram of a control system for an instrument or surgical tool, according to at least one aspect of the present invention.
[0029] [0029] Figure 17 illustrates a control circuit configured to control aspects of the instrument or surgical tool, according to at least one aspect of the present invention.
[0030] [0030] Figure 18 illustrates a combinational logic circuit configured to control aspects of the instrument or surgical tool, according to at least one aspect of the present invention.
[0031] [0031] Figure 19 illustrates a sequential logic circuit configured to control aspects of the instrument or surgical tool, according to at least one aspect of the present invention.
[0032] [0032] Figure 20 illustrates an instrument or surgical tool that comprises a plurality of motors that can be activated to perform various functions, according to at least one aspect of the present invention.
[0033] [0033] Figure 21 is a schematic diagram of a surgical instrument configured to operate a surgical tool described therein, in accordance with at least one aspect of the present invention.
[0034] [0034] Figure 22 illustrates a block diagram of a surgical instrument configured to control various functions, in accordance with at least one aspect of the present invention.
[0035] [0035] Figure 23 is a schematic diagram of a surgical instrument configured to control various functions, in accordance with at least one aspect of the present invention.
[0036] [0036] Figure 24 represents a perspective view of a circular stapling surgical instrument, in accordance with at least one aspect of the present invention.
[0037] [0037] Figure 25 represents an exploded view of the handle and drive shaft assemblies of the instrument of Figure 24, according to at least one aspect of the present invention.
[0038] [0038] Figure 26 represents a cross-sectional view of the handle assembly of the instrument of Figure 24, according to at least one aspect of the present invention.
[0039] [0039] Figure 27 represents an enlarged partial cross-sectional view of the motor and battery assemblies of Figure 24, according to at least one aspect of the present invention.
[0040] [0040] Figure 28A represents a side elevation view of an operating mode selection set of the instrument of Figure 24, with a first gear disengaged from a second gear, in accordance with at least one aspect of the present invention.
[0041] [0041] Figure 28B represents a side elevation view of the operating mode selection set of Figure 28A, with the first gear engaged with the second gear, in accordance with at least one aspect of the present invention.
[0042] [0042] Figure 29A represents an enlarged longitudinal cross-sectional view of a stapling head assembly of the instrument of Figure 24 showing an anvil in an open position, in accordance with at least one aspect of the present invention.
[0043] [0043] Figure 29B represents an enlarged longitudinal section view of the stapling head assembly of Figure 29A showing the anvil in a closed position, in accordance with at least one aspect of the present invention.
[0044] [0044] Figure 29C represents an enlarged longitudinal cross-sectional view of the staple head assembly of Figure 29A showing a staple driver and a blade in a triggered position, in accordance with at least one aspect of the present invention.
[0045] [0045] Figure 30 represents an enlarged partial cross-sectional view of a clamp formed against the anvil, in accordance with at least one aspect of the present invention.
[0046] [0046] Figure 31 is a graph diagram and stapling device equipped with an associated motor illustrating the adjustment of anvil closing speed at some key points along a trocar retraction course, according to at least one aspect of the present invention.
[0047] [0047] Figure 32 is a view of a circular stapler, according to at least one aspect of the present invention.
[0048] [0048] Figure 33 is a logic flow diagram of a process representing a control program or a logical configuration for adjusting a closing speed of the anvil portion of the motor-equipped stapling device at certain key points along the course of retraction of a trocar, in accordance with at least one aspect of the present invention.
[0049] [0049] Figure 34 is a graph diagram and stapling device equipped with an associated motor illustrating the trocar position over time, in accordance with at least one aspect of the present invention.
[0050] [0050] Figure 35 is a logic flow diagram of a process representing a control program or logic configuration to detect multidirectional seating movements in the trocar to trigger the anvil in proper seating, in accordance with at least one aspect of the present invention. .
[0051] [0051] Figure 36 is a partial schematic diagram of a circular stapling device equipped with a motor showing the closure of the anvil on the left side and the performance of the knife 201616 on the right side, according to at least one aspect of the present invention.
[0052] [0052] Figure 37 is a graphical representation of the displacement of the anvil (Ogigorna) along the vertical geometric axis as a function of force to close (FTC - "force to close") a claw along the horizontal geometric axis, according to at least one aspect of the present invention.
[0053] [0053] Figure 38 is a 201630 graphical representation of the 201616 knife displacement (3rac) along the vertical geometric axis as a function of the 201616 knife speed (Vx mm / s) along the left horizontal geometric axis and also as a function of the force of the knife 201616 (Fx Ibs) along the horizontal geometric axis on the right, according to at least one aspect of the present invention.
[0054] [0054] Figure 39 is a logic flow diagram of a process that represents a control program or a logical configuration to detect the tissue gap and the force to fire to adjust the speed and course of the knife, according to the least one aspect of the present invention.
[0055] [0055] Figure 40 is a logic flow diagram of a process representing a control program or logic configuration for advancing knife 201616 under a high tenacity fabric speed profile with a peak speed, as shown in Figure 38, in accordance with at least one aspect of the present invention. DESCRIPTION
[0056] [0056] The applicant for the present application holds the following US patent applications, filed on November 6, 2018, with the invention of each one in this document incorporated by reference, in its entirety:
[0057] [0057] US patent application no. 16 / 182.224, entitled SURGICAL NETWORK, INSTRUMENT, AND CLOUD RESPONSES BASED ON VALIDATION OF RECEIVED DATASET AND AUTHENTICATION OF ITS SOURCE AND INTEGRITY;
[0058] [0058] US patent application no. 16 / 182.230, entitled SURGICAL SYSTEM FOR PRESENTING INFORMATION INTERPRETED FROM EXTERNAL DATA;
[0059] [0059] US patent application No. 16 / 182,233, entitled MODIFICATION OF SURGICAL SYSTEMS CONTROL PROGRAMS BASED ON MACHINE LEARNING;
[0060] [0060] US patent application No. 16 / 182,239, entitled ADJUSTMENT OF DEVICE CONTROL PROGRAMS BASED ON STRATIFIED CONTEXTUAL DATA IN ADDITION TO THE DATA;
[0061] [0061] US patent application no. 16 / 182.243, entitled SURGICAL HUB AND MODULAR DEVICE RESPONSE ADJUSTMENT BASED ON SITUATIONAL AWARENESS;
[0062] [0062] US patent application no. 16 / 182.248, entitled DETECTION AND ESCALATION OF SECURITY RESPONSES OF SURGICAL INSTRUMENTS TO INCREASING SEVERITY THREATS;
[0063] [0063] US patent application No. 16 / 182,251, entitled INTERACTIVE SURGICAL SYSTEM;
[0064] [0064] US patent application No. 16 / 182,260, entitled AUTOMATED DATA SCALING, ALIGNMENT, AND ORGANIZING BASED ON PREDEFINED PARAMETERS WITHIN SURGICAL NETWORKS;
[0065] [0065] US patent application No. 16 / 182,267, entitled SENSING THE PATIENT POSITION AND CONTACT UTILIZING THE MONO- POLAR RETURN PAD ELECTRODE TO PROVIDE SITUATIONAL AWARENESS TO A SURGICAL NETWORK;
[0066] [0066] US patent application No. 16 / 182,249, entitled POWERED SURGICAL TOOL WITH PREDEFINED ADJUSTABLE CONTROL ALGORITHM FOR CONTROLLING END EFFECTOR PARAMETER;
[0067] [0067] US patent application No. 16 / 182,246, entitled ADJUSTMENTS BASED ON AIRBORNE PARTICLE PROPERTIES;
[0068] [0068] US patent application No. 16 / 182,256, entitled ADJUSTMENT OF A SURGICAL DEVICE FUNCTION BASED ON SITUATIONAL AWARENESS;
[0069] [0069] US patent application No. 16 / 182,242, entitled REAL-TIME ANALYSIS OF COMPREHENSIVE cosT OF ALL INSTRUMENTATION USED IN SURGERY UTILIZING DATA FLUIDITY TO TRACK INSTRUMENTS THROUGH STOCKING AND IN-HOUSE PROCESSES;
[0070] [0070] US patent application No. 16 / 182,255, entitled USAGE AND TECHNIQUE ANALYSIS OF SURGEON / STAFF PERFORMANCE AGAINST A BASELINE TO OPTIMIZE DEVICE UTILIZATION AND PERFORMANCE FOR BOTH CURRENT AND FUTURE PROCEDURES;
[0071] [0071] US patent application No. 16 / 182,269, entitled IMAGE CAPTURING OF THE AREAS OUTSIDE THE ABDOMEN TO IMPROVE PLACEMENT AND CONTROL OF A SURGICAL DEVICE IN USE;
[0072] [0072] US patent application No. 16 / 182,278, entitled COMMUNICATION OF DATA WHERE A SURGICAL NETWORK | S USING CONTEXT OF THE DATA AND REQUIREMENTS OF A RECEIVING SYSTEM / USER TO INFLUENCE INCLUSION OR LINKAGE OF DATA AND METADATA TO ESTABLISH CONTINUITY;
[0073] [0073] US patent application No. 16 / 182,290, entitled SURGICAL NETWORK RECOMMENDATIONS FROM REAL TIME ANALYSIS OF PROCEDURE VARIABLES AGAINST A BASELINE HIGHLIGHTING DIFFERENCES FROM THE OPTIMAL SOLUTION;
[0074] [0074] US patent application No. 16 / 182,232, entitled CONTROL OF A SURGICAL SYSTEM THROUGH A SURGICAL BARRIER;
[0075] [0075] US patent application No. 16 / 182,227, entitled SURGICAL NETWORK - DETERMINATION OF PRIORITIZATION OF COMMUNICATION, INTERACTION, OR PROCESSING BASED ON SYSTEM OR DEVICE NEEDS;
[0076] [0076] US patent application No. 16 / 182,231, entitled WIRELESS PAIRING OF A SURGICAL DEVICE WITH ANOTHER DEVICE WITHIN A STERILE SURGICAL FIELD BASED ON THE USAGE AND SITUATIONAL AWARENESS OF DEVICES;
[0077] [0077] US patent application No. 16 / 182,229, entitled ADJUSTMENT OF STAPLE HEIGHT OF AT LEAST ONE ROW OF STAPLES BASED ON THE SENSED TISSUE THICKNESS OR FORCE IN CLOSING;
[0078] [0078] US patent application No. 16 / 182,234, entitled STAPLING DEVICE WITH BOTH COMPULSORY AND DISCRETIONARY LOCKOUTS BASED ON SENSED PARAMETERS;
[0079] [0079] US patent application No. 16 / 182,235, entitled VARIATION OF RADIO FREQUENCY AND ULTRASONIC POWER LEVEL IN COOPERATION WITH VARYING CLAMP ARM PRESSURE TO
[0080] [0080] US patent application No. 16 / 182,238, entitled ULTRASONIC ENERGY DEVICE WHICH VARIES PRESSURE APPLIED BY CLAMP ARM TO PROVIDE THRESHOLD CONTROL PRESSURE AT A CUT PROGRESSION LOCATION.
[0081] [0081] The applicant for the present application holds the following US patent applications filed on September 10, 2018, the invention of each of which is hereby incorporated by reference in its entirety for reference:
[0082] [0082] US provisional patent application No. 62 / 729,183, entitled À CONTROL FOR A SURGICAL NETWORK OR SURGICAL NETWORK CONNECTED DEVICE THAT ADJUSTS ITS FUNCTION BASED ON À SENSED SITUATION OR USAGE;
[0083] [0083] US Provisional Patent Application No. 62 / 729,177, entitled AUTOMATED DATA SCALING, ALIGNMENT, AND ORGANIZING BASED ON PREDEFINED PARAMETERS WITHIN A SURGICAL NETWORK BEFORE TRANSMISSION;
[0084] [0084] US Provisional Patent Application No. 62 / 729,176, entitled INDIRECT COMMAND AND CONTROL OF A FIRST OPERATING ROOM SYSTEM THROUGH THE USE OF A SECOND OPERATING ROOM SYSTEM WITHIN A STERILE FIELD WHERE THE SECOND OPERATING ROOM SYSTEM HAS PRIMARY AND SECONDARY OPERATING MODES;
[0085] [0085] US Provisional Patent Application No. 62 / 729,185, entitled POWERED STAPLING DEVICE THAT IS CAPABLE OF ADJUSTING FORCE, ADVANCEMENT SPEED, AND OVERALL STROKE OF CUTTING MEMBER OF THE DEVICE BASED ON SENSED PARAMETER OF FIRING OR CLAMPING;
[0086] [0086] US Provisional Patent Application No. 62 / 729,184, entitled POWERED SURGICAL TOOL WITH A PREDEFINED ADJUSTABLE CONTROL ALGORITHM FOR CONTROLLING AT LEAST ONE END EFFECTOR PARAMETER AND A MEANS FOR LIMITING THE ADJUSTMENT;
[0087] [0087] US Provisional Patent Application No. 62 / 729,182, entitled SENSING THE PATIENT POSITION AND CONTACT UTILIZING THE MONO POLAR RETURN PAD ELECTRODE TO PROVIDE SITUATIONAL AWARENESS TO THE HUB;
[0088] [0088] US Provisional Patent Application No. 62 / 729,191, entitled SURGICAL NETWORK RECOMMENDATIONS FROM REAL TIME ANALYSIS OF PROCEDURE VARIABLES AGAINST A BASELINE HIGHLIGHTING DIFFERENCES FROM THE OPTIMAL SOLUTION;
[0089] [0089] US Provisional Patent Application No. 62 / 729,195, entitled ULTRASONIC ENERGY DEVICE WHICH VARIES PRESSURE
[0090] [0090] US Provisional Patent Application No. 62 / 729,186, entitled WIRELESS PAIRING OF A SURGICAL DEVICE WITH ANOTHER DEVICE WITHIN A STERILE SURGICAL FIELD BASED ON THE USAGE AND SITUATIONAL AWARENESS OF DEVICES.
[0091] [0091] The applicant for this application holds the following US patent applications filed on August 28, 2018, with the invention of each in this document incorporated by reference in its entirety:
[0092] [0092] US patent application No. 16 / 115,214, entitled ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR;
[0093] [0093] Patent application U, nº 16 / 115,205, entitled TEMPERATURE CONTROL OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR;
[0094] [0094] US patent application No. 16 / 115,233, entitled RADIO FREQUENCY ENERGY DEVICE FOR DELIVERING COMBINED ELECTRICAL SIGNALS;
[0095] [0095] US patent application No. 16 / 115,208, entitled CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO TISSUE LOCATION;
[0096] [0096] US patent application No. 16 / 115,220, entitled CONTROLLING ACTIVATION OF AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO THE PRESENCE OF TISSUE;
[0097] [0097] US patent application No. 16 / 115,232, entitled DETERMINING TISSUE COMPOSITION VIA AN ULTRASONIC SYSTEM;
[0098] [0098] US patent application No. 16 / 115,239, entitled DETERMINING THE STATE OF AN ULTRASONIC ELECTROMECHANICAL SYSTEM ACCORDING TO FREQUENCY SHIFT;
[0099] [0099] US patent application No. 16 / 115,247, entitled DETERMINING THE STATE OF AN ULTRASONIC END EFFECTOR;
[00100] [00100] US patent application No. 16 / 115,211, entitled SITUATIONAL AWARENESS OF ELECTROSURGICAL SYSTEMS;
[00101] [00101] US patent application No. 16 / 115,226, entitled MECHANISMS FOR CONTROLLING DIFFERENT ELECTROMECHANICAL SYSTEMS OF AN ELECTROSURGICAL INSTRUMENT;
[00102] [00102] US patent application No. 16 / 115,240, entitled DETECTION OF END EFFECTOR IMMERSION IN LIQUID;
[00103] [00103] US patent application No. 16 / 115,249, entitled INTERRUPTION OF ENERGY DUE TO INADVERTENT CAPACITIVE COUPLING;
[00104] [00104] US patent application No. 16 / 115,256, entitled INCREASING RADIO FREQUENCY TO CREATE PAD-LESS MONOPOLAR LOOP;
[00105] [00105] US patent application No. 16 / 115,223, entitled BIPOLAR
[00106] [00106] US patent application No. 16 / 115,238, entitled ACTIVATION OF ENERGY DEVICES.
[00107] [00107] The applicant for the present application holds the following US patent applications filed on August 23, 2018, the invention of each of which is incorporated by reference in its entirety for reference in its entirety:
[00108] [00108] US Provisional Patent Application No. 62 / 721,995, entitled CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO TISSUE LOCATION;
[00109] [00109] US Provisional Patent Application No. 62 / 721,998, entitled SITUATIONAL AWARENESS OF ELECTROSURGICAL SYSTEMS;
[00110] [00110] US Provisional Patent Application No. 62 / 721,999, entitled INTERRUPTION OF ENERGY DUE TO INADVERTENT CAPACITIVE COUPLING;
[00111] [00111] US Provisional Patent Application No. 62 / 721,994, entitled BIPOLAR - “COMBINATION DEVICE THAT AUTOMATICALLY ADJUSTS PRESSURE BASED ON ENERGY MODALITY; and
[00112] [00112] US Provisional Patent Application No. 62 / 721,996, entitled RADIO FREQUENCY ENERGY DEVICE FOR DELIVERING COMBINED ELECTRICAL SIGNALS.
[00113] [00113] The applicant of the present application holds the following US patent applications, filed on June 30, 2018, the invention of each of which is incorporated by reference in its entirety for reference in its entirety:
[00114] [00114] US Provisional Patent Application No. 62 / 692,747, entitled SMART ACTIVATION OF AN ENERGY DEVICE BY ANOTHER DEVICE;
[00115] [00115] US provisional patent application No. 62 / 692,748, entitled SMART ENERGY ARCHITECTURE; and
[00116] [00116] Provisional US patent application No. 62 / 692,768, entitled SMART ENERGY DEVICES.
[00117] [00117] The applicant of the present application holds the following US patent applications, filed on June 29, 2018, the invention of each of which in this document is incorporated by reference in its entirety:
[00118] [00118] US patent application serial number 16 / 024,090, entitled CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS;
[00119] [00119] US patent application serial number 16 / 024,057, entitled CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSED CLOSURE PARAMETERS;
[00120] [00120] US patent application serial number 16 / 024,067, entitled SYSTEMS FOR ADJUSTING END EFFECTOR PARAMETERS BASED ON PERIOPERATIVE INFORMATION;
[00121] [00121] US patent application serial number 16 / 024,075, entitled SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING;
[00122] [00122] US patent application serial number 16 / 024,083, entitled SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING;
[00123] [00123] US patent application serial number 16 / 024,094, entitled SURGICAL SYSTEMS FOR DETECTING END EFFECTOR TISSUE DISTRIBUTION IRREGULARITIES;
[00124] [00124] US patent application serial number 16 / 024,138, entitled SYSTEMS FOR DETECTING PROXIMITY OF SURGICAL END EFFECTOR TO CANCEROUS TISSUE;
[00125] [00125] US patent application serial number 16 / 024,150, entitled SURGICAL INSTRUMENT CARTRIDGE SENSOR ASSEMBLIES;
[00126] [00126] US patent application serial number 16 / 024,160, entitled VARIABLE OUTPUT CARTRIDGE SENSOR ASSEMBLY;
[00127] [00127] US patent application serial number 16 / 024.124, entitled SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE;
[00128] [00128] US patent application serial number 16 / 024,132, entitled SURGICAL INSTRUMENT HAVING A FLEXIBLE CIRCUIT;
[00129] [00129] US patent application serial number 16 / 024,141, entitled SURGICAL INSTRUMENT WITH A TISSUE MARKING ASSEMBLY;
[00130] [00130] US patent application serial number 16 / 024,162, entitled SURGICAL SYSTEMS WITH PRIORITIZED DATA TRANSMISSION CAPABILITIES;
[00131] [00131] US patent application serial number 16 / 024,066, entitled SURGICAL EVACUATION SENSING AND MOTOR CONTROL;
[00132] [00132] US patent application serial number 16 / 024,096, entitled SURGICAL EVACUATION SENSOR ARRANGEMENTS;
[00133] [00133] US patent application serial number 16 / 024,116, entitled SURGICAL EVACUATION FLOW PATHS;
[00134] [00134] US patent application serial number 16 / 024,149, entitled SURGICAL EVACUATION SENSING AND GENERATOR CONTROL;
[00135] [00135] US patent application serial number 16 / 024,180, entitled SURGICAL EVACUATION SENSING AND DISPLAY;
[00136] [00136] US patent application serial number 16 / 024,245, entitled COMMUNICATION OF SMOKE EVACUATION SYSTEM PARAMETERS TO HUB OR CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM;
[00137] [00137] US patent application serial number 16 / 024,258, entitled SMOKE EVACUATION SYSTEM INCLUDING A SEGMENTED CONTROL CIRCUIT FOR INTERACTIVE SURGICAL PLATFORM;
[00138] [00138] US patent application serial number 16 / 024,265, entitled SURGICAL EVACUATION SYSTEM WITH A COMMUNICATION
[00139] [00139] US patent application serial number 16 / 024,273, entitled DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS.
[00140] [00140] The applicant for the present application holds the following provisional US patent applications, filed on June 28, 2018, the invention of each of which is hereby incorporated by reference in its entirety for reference:
[00141] [00141] Provisional patent application US serial number 62 / 691,228, entitled A METHOD OF USING REINFORCED FLEX CIRCUITS WITH MULTIPLE SENSORS WITH ELECTROSURGICAL DEVICES;
[00142] [00142] US provisional patent application serial number 62 / 691,227, entitled CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSED CLOSURE PARAMETERS;
[00143] [00143] US provisional patent application serial number 62 / 691.230, entitled - SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE;
[00144] [00144] US provisional patent application serial number 62 / 691,219, entitled SURGICAL EVACUATION SENSING AND MOTOR CONTROL;
[00145] [00145] Provisional patent application US serial number 62 / 691.257, entitled COMMUNICATION OF SMOKE EVACUATION SYSTEM PARAMETERS TO HUB OR CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM;
[00146] [00146] US provisional patent application serial number 62 / 691.262, entitled - SURGICAL - EVACUATION SYSTEM WITH A
[00147] [00147] US provisional patent application serial number 62 / 691,251, entitled DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS.
[00148] [00148] The applicant for the present application holds the following provisional US patent applications, filed on April 19, 2018, the invention of each of which is hereby incorporated by reference in its entirety for reference:
[00149] [00149] US provisional patent application serial number 62 / 659,900, entitled METHOD OF HUB COMMUNICATION.
[00150] [00150] The applicant for the present application holds the following provisional US patent applications, filed on March 30, 2018, the invention of each of which is hereby incorporated by reference in its entirety for reference:
[00151] [00151] US Provisional Patent Application No. 62 / 650,898 filed on March 30, 2018, entitled CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS;
[00152] [00152] US provisional patent application serial number 62 / 650,887, entitled SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES;
[00153] [00153] US provisional patent application serial number 62 / 650,882, entitled SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM; and
[00154] [00154] US provisional patent application serial number 62 / 650.877, entitled SURGICAL SMOKE EVACUATION SENSING AND CONTROLS.
[00155] [00155] The applicant for the present application holds the following US patent applications, filed on March 29, 2018, with the invention of each of which in this document being incorporated by reference in its entirety:
[00156] [00156] US patent application serial number 15 / 940,641, entitled INTERACTIVE - SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES;
[00157] [00157] US patent application serial number 15 / 940,648, entitled INTERACTIVE SURGICAL SYSTEMS WITH CONDITION HANDLING OF DEVICES AND DATA CAPABILITIES;
[00158] [00158] US patent application serial number 15 / 940,656, entitled SURGICAL HUB COORDINATION OF CONTROL AND COMMUNICATION OF OPERATING ROOM DEVICES;
[00159] [00159] US patent application serial number 15 / 940,666, entitled SPATIAL AWARENESS OF SURGICAL HUBS IN OPERATING ROOMS;
[00160] [00160] US patent application serial number 15 / 940,670, entitled COOPERATIVE UTILIZATION OF DATA DERIVED FROM SECONDARY SOURCES BY INTELLIGENT SURGICAL HUBS;
[00161] [00161] US patent application serial number 15 / 940,677, entitled SURGICAL HUB CONTROL ARRANGEMENTS;
[00162] [00162] US patent application serial number 15 / 940,632, entitled DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD;
[00163] [00163] US patent application serial number 15 / 940,640, entitled COMMUNICATION HUB AND STORAGE DEVICE FOR STORING PARAMETERS AND STATUS OF A SURGICAL DEVICE TO BE SHARED WITH CLOUD BASED ANALYTICS SYSTEMS;
[00164] [00164] US patent application serial number 15 / 940,645, entitled SELF DESCRIBING DATA PACKETS GENERATED AT AN ISSUING INSTRUMENT;
[00165] [00165] US patent application serial number 15 / 940,649, entitled DATA PAIRING TO INTERCONNECT A DEVICE MEASURED PARAMETER WITH AN OUTCOME;
[00166] [00166] US patent application serial number 15 / 940,654, entitled SURGICAL HUB SITUATIONAL AWARENESS;
[00167] [00167] US patent application serial number 15 / 940,663, entitled SURGICAL SYSTEM DISTRIBUTED PROCESSING;
[00168] [00168] US patent application serial number 15 / 940,668, entitled AGGREGATION AND REPORTING OF SURGICAL HUB DATA;
[00169] [00169] US patent application serial number 15 / 940,671, entitled SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER;
[00170] [00170] US patent application serial number 15 / 940,686, entitled DISPLAY OF ALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LINEAR STAPLE LINE;
[00171] [00171] US patent application serial number 15 / 940,700, entitled STERILE FIELD INTERACTIVE CONTROL DISPLAYS;
[00172] [00172] US patent application serial number 15 / 940,629, entitled COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS;
[00173] [00173] US patent application serial number 15 / 940,704, entitled USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT;
[00174] [00174] US patent application serial number 15 / 940,722, entitled CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OF MONO-CHROMATIC LIGHT REFRACTIVITY;
[00175] [00175] US patent application serial number 15 / 940,742, entitled DUAL CMOS ARRAY IMAGING;
[00176] [00176] US patent application serial number 15 / 940,636, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES;
[00177] [00177] US patent application serial number 15 / 940,653, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL HUBS;
[00178] [00178] US patent application serial number 15 / 940,660, entitled CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER;
[00179] [00179] US patent application serial number 15 / 940,679, entitled CLOUD-BASED MEDICAL ANALYTICS FOR LINKING OF LOCAL USAGE TRENDS WITH THE RESOURCE ACQUISITION BEHAVIORS OF LARGER DATA SET;
[00180] [00180] US patent application serial number 15 / 940,694, entitled CLOUD-BASED MEDICAL ANALYTICS FOR MEDICAL FACILITY SEGMENTED INDIVIDUALIZATION OF INSTRUMENT FUNCTION;
[00181] [00181] US patent application serial number 15 / 940,634, entitled CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES;
[00182] [00182] US patent application serial number 15 / 940,706, entitled DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK;
[00183] [00183] US patent application serial number 15 / 940,675, entitled CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES;
[00184] [00184] US patent application serial number 15 / 940,627, entitled DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;
[00185] [00185] US patent application serial number 15 / 940,637, entitled COMMUNICATION ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;
[00186] [00186] US patent application serial number 15 / 940,642, entitled CONTROLS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;
[00187] [00187] US patent application serial number 15 / 940,676, entitled AUTOMATIC. TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;
[00188] [00188] US patent application serial number 15 / 940,680, entitled CONTROLLERS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;
[00189] [00189] US patent application serial number 15 / 940,683, entitled COOPERATIVE SURGICAL ACTIONS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;
[00190] [00190] US patent application serial number 15 / 940,690, entitled DISPLAY ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS ,; and
[00191] [00191] US patent application serial number 15 / 940,711, entitled SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS.
[00192] [00192] The applicant for the present application holds the following provisional US patent applications, filed on March 28, 2018, the invention of each of which is hereby incorporated by reference in its entirety for reference:
[00193] [00193] US provisional patent application serial number 62 / 649,302, entitled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES;
[00194] [00194] Provisional patent application US serial number 62 / 649,294, entitled DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD;
[00195] [00195] Provisional patent application US serial number 62 / 649,300, entitled SURGICAL HUB SITUATIONAL AWARENESS;
[00196] [00196] US Provisional Patent Application Serial No. 62 / 649,309, entitled SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER;
[00197] [00197] US provisional patent application serial number 62 / 649,310, entitled COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS;
[00198] [00198] US Provisional Patent Application Serial No. 62 / 649,291, titled USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT;
[00199] [00199] US provisional patent application serial number 62 / 649,296, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES;
[00200] [00200] US provisional patent application serial number 62 / 649,333, entitled CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER;
[00201] [00201] US provisional patent application serial number 62 / 649,327, entitled CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES;
[00202] [00202] US provisional patent application serial number 62 / 649,315, entitled DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK;
[00203] [00203] US provisional patent application serial number 62 / 649,313, entitled CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES;
[00204] [00204] US Provisional Patent Application Serial No. 62 / 649,320, entitled DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;
[00205] [00205] US provisional patent application serial number 62 / 649,307, entitled AUTOMATIC. TOOL ADJUSTMENTS FOR ROBOT- ASSISTED SURGICAL PLATFORMS; and
[00206] [00206] US provisional patent application serial number 62 / 649,323, entitled SENSING. ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS.
[00207] [00207] The applicant for this application holds the following provisional US patent applications, filed on March 8, 2018,
[00208] [00208] US Provisional Patent Application Serial No. 62 / 640,417, entitled TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR; and
[00209] [00209] US provisional patent application serial number 62 / 640,415, entitled ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR.
[00210] [00210] The applicant for the present application holds the following provisional US patent applications, filed on December 28, 2017, the invention of each of which is hereby incorporated by reference in its entirety for reference:
[00211] [00211] Provisional patent application US serial number 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM;
[00212] [00212] US provisional patent application serial number 62 / 611,340, entitled CLOUD-BASED MEDICAL ANALYTICS; and
[00213] [00213] US provisional patent application serial number 62 / 611,339, entitled ROBOT ASSISTED SURGICAL PLATFORM.
[00214] [00214] 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. Illustrative examples can be implemented or incorporated into other aspects, variations and modifications, and can be practiced or performed in a variety of ways. Furthermore, except where otherwise indicated, the terms and expressions used in the present invention were chosen for the purpose of describing illustrative examples for the convenience of the reader and not for the purpose of limiting it. In addition, it should be understood that one or more of the aspects, expressions of aspects,
[00215] [00215] 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 in communication with the cloud 104 which can include a remote server 113. In one example, as illustrated in Figure 1, surgical system 102 includes a visualization system 108, a robotic system 110, a smart handheld surgical instrument 112, which are configured to communicate with one another and / or the central controller 106. In some respects, a surgical system 102 may include a number of central controllers M 106, an N number of visualization systems 108, an O number of robotic systems 110, and a P number of smart, hand-held surgical instruments 112, where M, N, O, and P are whole numbers greater than or equal to one.
[00216] [00216] In several respects, smart instruments 112 as described in the present invention with reference to Figures 1 to 7 can be implemented as a circular stapling device equipped with motor 201800 (Figures 24 to 30), 201502 (Figures 31 to 33) , 201532 (Figures 34 to 35), 201610 (Figures 36 to 40). Intelligent instruments 112 (for example, devices 1a to 1h), such as the circular stapling device equipped with a motor 201800 (Figures 24 to 30), 201502 (Figures 31 to 33), 201532 (Figures 34 to 35), 201610 (Figures 36 to 40) are configured to operate on a 201 surgical data network, as described with reference to Figure 8.
[00217] [00217] Figure 2 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 surgical system 102. Robotic system 110 includes a surgeon console 118, a patient car 120 (surgical robot), and a robotic central surgical controller
[00218] [00218] Other types of robotic systems can be readily adapted for use with the surgical system 102. Various examples of robotic systems and surgical instruments that are suitable for use with the present invention are described in provisional patent application serial number 62 / 611.339 , entitled ROBOT ASSISTED SURGICAL PLATFORM, filed on December 28, 2017, the invention of which is hereby incorporated by reference in its entirety for reference.
[00219] [00219] Several examples of cloud-based analysis that are performed by cloud 104, and are suitable for use with the present invention, are described in US provisional patent application serial number 62 / 611.340, entitled CLOUD-BASED MEDICAL ANALYTICS, filed on December 28, 2017, the invention of which is hereby incorporated by reference in its entirety for reference.
[00220] [00220] In several aspects, the imaging device 124 includes at least one Image sensor and one or more optical components. Suitable image sensors include, but are not limited to, load-coupled device (CCD) sensors and complementary metal oxide semiconductor (CMOS) sensors.
[00221] [00221] The optical components of the imaging device 124 may include one or more light sources and / or one or more lenses. One or more light sources can be directed to illuminate portions of the surgical field. The one or more image sensors can receive reflected or refracted light from the surgical field, including reflected or refracted light from tissue and / or surgical instruments.
[00222] [00222] One or more light sources can be configured to radiate electromagnetic energy in the visible spectrum, as well as in the invisible spectrum. The visible spectrum, sometimes called the optical spectrum or light spectrum, is that portion of the electromagnetic spectrum that is visible to (that is, can be detected by) the human eye and can be called visible light or simply light. A typical human eye will respond to wavelengths in the air that are from about 380 nm to about 750 nm.
[00223] [00223] The invisible spectrum (that is, the non-luminous spectrum) is that portion of the electromagnetic spectrum located below and above the visible spectrum (that is, wavelengths below about 380 nm and above about 750 nm). The invisible spectrum is not detectable by the human eye. Wavelengths greater than about 750 nm are longer than the visible red spectrum, and they become invisible infrared (IR), microwaves, radio and electromagnetic radiation. Wavelengths shorter than about 380 nm are shorter than the ultraviolet spectrum, and they become invisible ultraviolet, x-ray, and electromagnetic gamma-ray radiation.
[00224] [00224] In several respects, the imaging device 124 is configured for use in a minimally invasive procedure. Examples of imaging devices suitable for use with the present invention include, but are not limited to, an arthroscope, angioscope, bronchoscope, choledocoscope, colonoscope, cytoscope, duodenoscope, enteroscope, esophagus-duodenoscope (gastroscope), endoscope, laryngoscope, nasopharyngoscope neproscope, sigmoidoscope, thoracoscope, and ureteroscope.
[00225] [00225] In one aspect, the imaging device employs multiple spectrum monitoring to discriminate topography and underlying structures. A multi-spectral image is one that captures image data within wavelength bands across the electromagnetic spectrum. Wavelengths can be separated by filters or using instruments that are sensitive to specific wavelengths, including light from frequencies beyond the visible light range, for example, IR and ultraviolet light. Spectral images can allow the extraction of additional information that the human eye cannot capture with its receivers for the colors red, green and blue. The use of multispectral imaging is described in greater detail under the heading "Advanced Imaging Acquisition Module" in US provisional patent application serial number 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, whose invention is in the present document incorporated as a reference in its entirety. Multispectral monitoring can be a useful tool for relocating a surgical field after a surgical task is completed to perform one or more of the tests previously described on the treated tissue.
[00226] [00226] It is axiomatic that strict sterilization of the operating room and surgical equipment is necessary during any surgery. The strict hygiene and sterilization conditions required in an "operating room", that is, an operating or treatment room, justify the highest possible sterilization of all medical devices and equipment. Part of this sterilization process is the need to sterilize anything that comes into contact with the patient or enters the sterile field, including imaging device 124 and its connectors and components. It will be understood that the sterile field can be considered a specified area, such as inside a tray or on a sterile towel, which is considered free of microorganisms, or the sterile field can be considered an area, immediately around a patient, who was prepared to perform a surgical procedure. The sterile field may include members of the brushing team, who are properly dressed, and all furniture and accessories in the area.
[00227] [00227] In several aspects, the visualization system 108 includes one or more imaging sensors, one or more image processing units, one or more storage arrays and one or more screens that are strategically arranged in relation to the sterile field, as shown in Figure 2. In one aspect, the display system 108 includes an interface for HL7, PACS and EMR. Various components of the 108 display system are described under the heading "Advanced Imaging Acquisition Module" in US provisional patent application serial number 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, the invention of which is in this document incorporated as a reference in its entirety.
[00228] [00228] As shown in Figure 2, a primary screen 119 is positioned in the sterile field to be visible to the operator on the operating table 114. In addition, a viewing tower 111 is positioned outside the sterile field. The display tower 111 includes a first non-sterile screen 107 and a second non-sterile screen 109, which are opposite each other. The visualization system 108, guided by the central controller 106, is configured to use screens 107, 109, and 119 to coordinate the flow of information to operators inside and outside the sterile field. For example, the central controller 106 can have the visualization system 108 display a snapshot of a surgical site, as recorded by an imaging device 124, on a non-sterile screen 107 or 109, while maintaining a live transmission of the surgical site on main screen 119. Snapshot on non-sterile screen 107 or 109 can allow a non-sterile operator to perform a diagnostic step relevant to the surgical procedure, for example.
[00229] [00229] In one aspect, central controller 106 is also configured to route a diagnostic input or feedback by a non-sterile operator in the display tower 111 to the primary screen 119 within the sterile field, where it can be seen by a sterile operator on the operating table. In one example, the entry may be in the form of a modification of the snapshot displayed on the non-sterile screen 107 or 109, which can be routed to main screen 119 by central controller 106.
[00230] [00230] With reference to Figure 2, a 112 surgical instrument is being used in the surgical procedure as part of the surgical system
[00231] [00231] Now with reference to Figure 3, a central controller 106 is shown in communication with a visualization system 108, a robotic system 110 and a smart handheld surgical instrument 112. Central controller 106 includes a central controller screen 135, an imaging module 138, a generator module 140, a communication module 130, a processor module 132 and a storage matrix 134. In certain respects, as shown in Figure 3, central controller 106 additionally includes a smoke evacuation module 126 and / or a suction / irrigation module 128.
[00232] [00232] During a surgical procedure, the application of energy to the tissue, for sealing and / or cutting, is generally associated with the evacuation of smoke, suction of excess fluid and / or irrigation of the tissue. Fluid, power, and / or data lines from different sources are often intertwined during the surgical procedure. Valuable time can be wasted in addressing this issue during a surgical procedure. To untangle the lines, it may be necessary to disconnect the lines from their respective modules, which may require a restart of the modules. The modular housing of the central controller 136 offers a unified environment for managing power, data and fluid lines, which reduces the frequency of entanglement between such lines.
[00233] [00233] Aspects of the present invention feature a central surgical controller for use in a surgical procedure that involves applying energy to tissue at a surgical site. The central surgical controller includes a central controller housing and a combination generator module received slidably at a central controller housing docking station. 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 which are housed in a single unit. In one aspect, the combined generator module also includes a smoke evacuation component, at least one power application cable to connect the combined generator module to a surgical instrument, at least one smoke evacuation component configured to evacuate smoke, fluid , and / or particulates generated by applying therapeutic energy to the tissue, and a fluid line that extends from the remote surgical site to the smoke evacuation component.
[00234] [00234] In one aspect, the fluid line is a first fluid line and a second fluid line extends from the remote surgical site to a suction and irrigation module received slidingly in the central controller housing. In one aspect, the central controller housing comprises a fluid interface.
[00235] [00235] Certain surgical procedures may require the application of more than one type of energy to the tissue. One type of energy may be more beneficial for cutting the fabric, while another type of energy may be more beneficial for sealing the fabric. For example, a bipolar generator can be used to seal the tissue while an ultrasonic generator can be used to cut the sealed tissue.
[00236] [00236] Aspects of the present invention feature a modular surgical wrap for use in a surgical procedure that involves applying energy to the tissue. The modular surgical housing includes a first energy generator module, configured to generate a first energy for application to the tissue, and a first docking station that comprises a first docking port that includes first data and energy contacts, the first module being The power generator is slidingly movable in an electric coupling with the power and data contacts and the first power generator module is slidingly movable out of the electric coupling with the first power and data contacts.
[00237] [00237] In addition to the above, the modular surgical enclosure also includes a second energy generator module configured to generate a second energy, different from the first energy, for application to the tissue, and a second docking station comprising a second docking port which includes second data and power contacts, the second power generating module being slidably movable in an electrical coupling with the power and data contacts, and the second power generating module being slidingly movable outwards electrical coupling with the second power and data contacts.
[00238] [00238] In addition, the modular surgical cabinet also includes a communication bus between the first coupling port and the second coupling port, configured to facilitate communication between the first power generator module and the second power generator module.
[00239] [00239] 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 module / irrigation 128. The central modular enclosure 136 further facilitates interactive communication between modules 140, 126, 128. As illustrated in Figure 5, generator module 140 can be a generator module with integrated monopolar, bipolar and ultrasonic components, supported on a single cabinet unit 139 slidably insertable into the central modular housing 136. As shown in Figure 5, generator module 140 can be configured to connect to a monopolar device 146, a bipolar device 147 and an ultrasonic device 148. Alternatively, the generator module 140 may comprise a series of monopolar, bipolar and / or ultrasonic generator modules that interact through the modula housing r central 136. The central modular enclosure 136 can be configured to facilitate the insertion of multiple generators and interactive communication between the generators anchored in the central modular enclosure 136 so that the generators would act as a single generator.
[00240] [00240] In one aspect, the central modular housing 136 comprises a modular power and a back communication board 149 with external and wireless communication heads to allow removable fixing of modules 140, 126, 128 and interactive communication between them.
[00241] [00241] In one aspect, the central modular housing 136 includes docking stations, or drawers, 151, in this document also called drawers, which are configured to receive slidingly the 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 at a docking station 151 of the central surgical controller housing 136. A docking port 152 with power and data contacts in a rear side of the combined generator module 145 is configured to engage a corresponding docking port 150 with the power and data contacts of a corresponding docking station 151 of the central housing modular housing 136 as the combined generator module 145 is slid into position at the corresponding docking station 151 of the modular housing of the central controller 136. In one aspect, the generator module combined 145 includes a bipolar, ultrasonic and monopolar module and a smoke evacuation module integrated into a single compartment unit 139, as shown in Figure 5.
[00242] [00242] In several respects, the smoke evacuation module 126 includes a fluid line 154 that carries captured / collected fluid smoke away from a surgical site and to, for example, the smoke evacuation module 126. Suction a vacuum that originates from the smoke evacuation module 126 can pull the smoke into an opening of a utility conduit at the surgical site. The utility conduit, coupled to the fluid line, can be in the form of a flexible tube that ends in the smoke evacuation module 126. The utility conduit and the fluid line define a fluid path that extends towards the smoke evacuation module 126 which is received in the central controller housing 136.
[00243] [00243] In several aspects, the suction / irrigation module 128 is coupled to a surgical tool comprising a fluid suction line and a fluid suction line. In one example, the suction and suction fluid lines are in the form of flexible tubes that extend from the surgical site towards the suction / irrigation module 128. One or more drive systems can be configured to cause irrigation and aspiration of fluids to and from the surgical site.
[00244] [00244] In one aspect, the surgical tool includes a drive shaft that has an end actuator at a distal end of the same and at least an energy treatment associated with the end actuator, a suction tube, and a suction tube. irrigation. The suction tube can have an inlet port at a distal end of it and the suction tube extends through the drive shaft. Similarly, an irrigation pipe can extend through the drive shaft and may have an entrance port close to the power application implement. The power application implement is configured to deliver ultrasonic and / or RF energy to the surgical site and is coupled to the generator module 140 by a cable that initially extends through the drive shaft.
[00245] [00245] The irrigation tube can be in fluid communication with a fluid source, and the suction tube can be in fluid communication with a vacuum source. The fluid source and / or the vacuum source can be housed in the suction / irrigation module 128. In one example, the fluid source and / or the vacuum source can be housed in the central controller housing 136 separately from the control module. suction / irrigation
[00246] [00246] In one aspect, modules 140, 126, 128 and / or their corresponding docking stations in the central modular housing 136 may include alignment features that are configured to align the docking ports of the modules in engagement with their counterparts at the stations coupling of the central modular housing
[00247] [00247] In some respects, the drawers 151 of the central modular housing 136 are the same, or substantially the same size, and the modules are adjusted in size to be received in the drawers
[00248] [00248] In addition, the contacts of a specific module can be switched to engage with the contacts of a specific drawer to prevent the insertion of a module in a drawer with unpaired contacts.
[00249] [00249] “As shown in Figure 4, the coupling port 150 of a drawer 151 can be coupled to the coupling port 150 of another drawer 151 through a communication link 157 to facilitate interactive communication between the modules housed in the housing central modular 136. The coupling ports 150 of the central modular housing 136 can, alternatively or additionally, facilitate interactive wireless communication between modules housed in the central modular housing 136. Any suitable wireless communication can be used, for example, Air Titan-Bluetooth.
[00250] [00250] Figure 6 illustrates individual power bus connectors for a plurality of side coupling ports of a side modular compartment 160 configured to receive a plurality of modules from a central surgical controller 206. Side modular compartment 160 is configured to receive and laterally interconnect modules 161. Modules 161 are slidably inserted into docking stations 162 of side modular compartment 160, which includes a back plate for interconnecting modules 161. As shown in Figure 6, modules 161 are arranged laterally in the side modular cabinet
[00251] [00251] 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 rear panel for interconnecting modules 165. Although the drawers 167 of the vertical modular cabinet 164 are arranged vertically, in certain cases, a vertical modular cabinet 164 may include drawers that are arranged laterally. In addition, modules 165 can interact with each other through the coupling ports of the vertical modular cabinet
[00252] [00252] In several respects, the imaging module 138 comprises an integrated video processor and a modular light source and is adapted for use with various imaging devices. In one aspect, the imaging device is comprised of a modular compartment that can be mounted with a light source module and a camera module. The compartment can be a disposable compartment. In at least one example, the disposable compartment is removably coupled to a reusable controller, a light source module, and a camera module. The light source module and / or the camera module can be selected selectively depending on the type of surgical procedure. In one aspect, the camera module comprises a CCD sensor. In another aspect, the camera module comprises a CMOS sensor. In another aspect, the camera module is configured for imaging the scanned beam. Similarly, the light source module can be configured to provide a white light or a different light, depending on the surgical procedure.
[00253] [00253] 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 the replacement of a light source module or a "midstream" camera module during a surgical procedure, without the need to remove the imaging device from the surgical field.
[00254] [00254] In one aspect, the imaging device comprises a tubular compartment that includes a plurality of channels. A first channel is configured to receive the Camera module in a sliding way, which can be configured for a snap-fit fit (pressure fit) with the first channel. A second channel is configured to slide the camera module, which can be configured for a snap-fit fit (pressure fit) with the first channel. In another example, the camera module and / or the light source module can be rotated to an end position within their respective channels. A threaded coupling can be used instead of a pressure fitting.
[00255] [00255] In several examples, multiple imaging devices are placed in different positions in the surgical field to provide multiple views. Imaging module 138 can be configured to switch between imaging devices to provide an ideal view. In several respects, imaging module 138 can be configured to integrate images from different imaging devices.
[00256] [00256] 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, granted on August 9, 2011 which is hereby incorporated as title reference in its entirety. In addition, US patent No. 7,982,776, entitled SBI MOTION ARTIFACT REMOVAL APPARATUS AND METHOD, issued on July 19, 2011, which is incorporated herein by reference in its entirety for reference, describes various systems for removing motion artifacts image data. Such systems can be integrated with the imaging module
[00257] [00257] Figure 8 illustrates a surgical data network 201 comprising a central modular communication controller 203 configured to connect modular devices located in one or more operating rooms of a healthcare facility, or any environment in a healthcare facility. audiences specially equipped for surgical operations, to a cloud-based system (for example, cloud 204 which may include a remote server 213 coupled to a storage device 205). In one aspect, the modular central communication controller 203 comprises a central network controller 207 and / or a network switch 209 in communication with a network router. The central modular communication controller 203 can also be coupled to a local computer system 210 to provide local computer processing and data manipulation. The surgical data network 201 can be configured as a passive, intelligent, or switching network. A passive surgical data network serves as a conduit for the data, allowing the data to be transmitted from one device (or segment) to another and to cloud computing resources. An intelligent surgical data network includes features to allow traffic to pass through the surgical data network to be monitored and to configure each port on the central network controller 207 or network switch 209. An intelligent surgical data network can be called a 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.
[00258] [00258] Modular devices 1a to 1n located in the operating room can be coupled to the modular central communication controller 203. The central network controller 207 and / or the network switch 209 can be coupled to a network router 211 to connect devices 1a to 1h to the 204 cloud or the local computer system
[00259] [00259] “It will be understood that the surgical data network 201 can be expanded by interconnecting multiple central network controllers 207 and / or multiple network switches 209 with multiple network routers 211. The central communication controller 203 may be contained in a modular control tower configured to receive multiple devices 1a to 1n / 2a to 2m. The local computer system 210 can also be contained in a modular control tower. The modular communication central controller 203 is connected to a screen 212 to show the images obtained by some of the devices 1a to 1n / 2a to 2m, for example, during surgical procedures. In several respects, devices 1a to 1n / 2a to 2m may include, for example, several modules such as an imaging module 138 coupled to an endoscope, a generator module 140 coupled to an energy-based surgical device, an smoke evacuation 126, a suction / irrigation module 128, a communication module 130, a processor module 132, a storage matrix 134, a surgical device attached to a screen and / or a non-contact sensor module, among others modular devices that can be connected to the modular communication center 203 of the surgical data network 201.
[00260] [00260] In one aspect, the surgical data network 201 may comprise a combination of central network controller (s), network switches, and network routers that connect devices 1a to 1n / 2a to 2m to the cloud . Any or all devices 1a to 1n / 2a to 2m 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 understood that cloud computing depends on sharing computing resources instead of having local servers or personal devices to handle software applications. The word "cloud" can be used as a metaphor for "the Internet", although the term is not limited as such. Consequently, the term "cloud computing" can be used 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 controller of modular communication 203 and / or computer system 210 located in the operating room (for example, a fixed, mobile, temporary, or operating room or operating space) and devices connected to the 203 modular communication central controller and / or the computer system 210 through the Internet. The cloud infrastructure can be maintained by a cloud service provider. In this context, the cloud service provider may be the entity that coordinates the use and control of devices 1a to 1n / 2a to 2m located in one or more operating rooms. Cloud computing services can perform a large number of calculations based on data collected by smart surgical instruments, robots, and other computerized devices located in the operating room. The central controller hardware allows multiple devices or connections to be connected to a computer that communicates with cloud computing and storage resources.
[00261] [00261] By applying cloud computer data processing techniques to the data collected by the devices at 1n / 2a to 2m, the surgical data network provides better surgical results, reduced costs, and better patient satisfaction. At least some of the devices 1a to 1n / 2a to 2m can be used to view tissue states to assess leakage or perfusion of sealed tissue after a tissue sealing and cutting procedure. At least some of the devices 1a to 1n / 2a to 2m can be used to identify the pathology, such as the effects of disease, with the use of cloud-based computing to examine data including images of body tissue samples for diagnostic purposes. This includes confirmation of the location and margin of the tissue and phenotypes. At least some of the devices 1a to 1n / 2a to 2m can be used to identify anatomical structures of the body using a variety of sensors integrated with imaging devices and techniques such as the overlay of images captured by multiple imaging devices. Data collected by devices 1a to 1n / 2a to 2m, including image data, can be transferred to the cloud 204 or the local computer system 210 or both for processing and manipulating data including processing and manipulating images. The data can be analyzed to improve the results of the surgical procedure by determining whether additional treatment, such as application of endoscopic intervention, emerging technologies, targeted radiation, targeted intervention, accurate robotics at specific tissue sites and conditions, can be followed. This data analysis can additionally use analytical processing of the results, and with the use of standardized approaches they can provide beneficial standardized feedback both to confirm surgical treatments and the surgeon's behavior or to suggest changes to surgical treatments and the surgeon's behavior.
[00262] [00262] In an implementation, the operating room devices 1a to 1h can be connected to the central controller of modular communication 203 through a wired or wireless channel depending on the configuration of the devices 1a to 1h in a central network controller. The central network controller 207 can be implemented, in one aspect, as a local network transmission device that acts on the physical layer of the OSI model ("open system interconnection"). The central network controller provides connectivity to devices 1a to 1n located on the same network as the operating room. The central network controller 207 collects data in the form of packets and sends it to the router in "half duplex" mode. The central network controller 207 does not store any media / Internet protocol (MAC / IP) access control for transferring data from the device. Only one of the devices 1a to 1n at a time can send data through the central network controller 207. The central network controller 207 has no routing tables or intelligence about where to send information and transmits all network data through each connection and to a remote server 213 (Figure 9) in cloud 204. The central network controller 207 can detect basic network errors, such as collisions, but having all (admit that) the information transmitted to multiple input ports can be a security risk and cause bottlenecks.
[00263] [00263] In another implementation, operating room devices 2a to 2m can be connected to a network switch 209 via a wired or wireless channel. The network switch 209 works on the data connection layer of the OS | I model. The network switch 209 is a multicast device for connecting devices 2a to 2m located in the same operation center to the network. The network switch 209 sends data in frame form to the network router 211 and works in full duplex mode. Multiple devices 2a to 2m can send data at the same time via the network switch
[00264] [00264] The central network controller 207 and / or the network switch 209 are coupled to network router 211 for a connection to the cloud 204. Network router 211 works on the network layer of the OSI model. Network router 211 creates a route to transmit data packets received from central network controller 207 and / or network switch 211 to a computer with cloud resources for future processing and manipulation of data collected by any or all devices 1a to 1n / 2a to 2m. The network router 211 can be used to connect two or more different networks located in different locations, such as different operating rooms in the same health care facility or different networks located in different operating rooms of different service facilities of health. Network router 211 sends data in packet form to cloud 204 and works in full duplex mode. Multiple devices can send data at the same time. The network router 211 uses IP addresses to transfer data.
[00265] [00265] In one example, the central network controller 207 can be implemented as a central USB controller, which allows multiple USB devices to be connected to a host computer. The central USB controller can expand a single USB port on several levels so that more ports are available to connect the devices to the system's host computer. The central network controller 207 can include wired or wireless capabilities to receive information about a wired channel or a wireless channel. In one aspect, a wireless wireless, broadband, short-range wireless USB communication protocol can be used for communication between devices 1a to 1n and devices 2a to 2m located in the operating room.
[00266] [00266] In other examples, operating room devices 1a to 1n / 2a to 2m can communicate with the modular central communication controller 203 via standard Bluetooth wireless technology for exchanging data over short distances (with the use of short-wavelength UHF radio waves in the 2.4 to 2.485 GHz ISM band) from fixed and mobile devices and to build personal area networks (PANs). In other respects, operating room devices 1a to 1n / 2a to 2m can communicate with the central modular communication controller 203 via a number of wireless and wired communication standards or protocols, including, 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 can include a plurality of communication modules. For example, a first communication module can be dedicated to short-range wireless communications like Wi-Fi and Bluetooth, and a second communication module can be dedicated to longer-range wireless communications like GPS, EDGE, GPRS, CDMA , WIMAX, LTE, Ev-DO and others.
[00267] [00267] The modular communication central controller 203 can serve as a central connection for one or all operating room devices 1a to 1n / 2a to 2m and handles a data type known as frames. The tables carry the data generated by the devices 1a to 1n / 2a to 2m. When a frame is received by the modular central communication controller 203, it is amplified and transmitted to the network router 211, which transfers data to cloud computing resources using a series of wireless communication standards or protocols or wired, as described in the present invention.
[00268] [00268] The modular communication central controller 203 can be used as a standalone device or be connected to compatible central network controllers and network switches to form a larger network. The 203 modular communication central controller is, in general, easy to install, configure and maintain, making it a good option for the network of devices 1a to 1n / 2a to 2m from the operating room.
[00269] [00269] Figure 9 illustrates an interactive surgical system, implemented by computer 200. The interactive surgical system implemented by computer 200 is similar in many aspects to the interactive surgical system, implemented by computer 100. For example, the surgical system, interactive, implemented per computer 200 includes one or more surgical systems 202, which are similar in many respects to surgical systems 102. Each surgical system 202 includes at least one central surgical controller 206 in communication with a cloud 204 which may include a remote server
[00270] [00270] 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 controller for modular communication 203, for example, a network connectivity device , and a computer system 210 for providing local processing, visualization, and imaging, for example. As shown in Figure 10, the modular communication central controller 203 can be connected in a layered configuration to expand the number of modules (for example, devices) that can be connected to the modular communication central controller 203 and transfer data associated with modules to computer system 210, cloud computing resources, or both. As shown in Figure 10, each of the central controllers / network switches in the modular central communication controller 203 includes three downstream ports and one upstream port. The upstream central controller / network switch is connected to a processor to provide a communication connection to cloud computing resources and a local display
[00271] [00271] 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 measuring devices such as laser or ultrasonic. An ultrasound-based non-contact sensor module scans the operating room by transmitting an ultrasound explosion and receiving the echo when it bounces off the perimeter of the operating room walls, as described under the heading Surgical Hub Spatial Awareness Within an Operating Room "in US provisional patent application serial number 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, which is hereby incorporated by reference in its entirety, in which the sensor module is configured to determine the size of the operating room and 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 walls. perimeter of the operating room, and comparing the phase of the transmitted pulse to the received pulse to determine the size of the operating room and to adjust the Bluetooth pairing distance limits, for example.
[00272] [00272] Computer system 210 comprises a processor 244 and a network interface 245. Processor 244 is coupled to a communication module 247, storage 248, memory 249, non-volatile memory 250, and input / output interface 251 via a system bus. The system bus can be any of several types of bus structures, including the memory bus or memory controller, a peripheral bus or external bus, and / or a local bus that uses any variety of available bus architectures including, but not limited to, not limited to, 9-bit bus, industry standard architecture (ISA), Micro-Charmel Architecture (MSA), extended ISA (EISA), smart drive electronics (IDE), VESA local bus (VLB), component interconnection peripherals (PCI), USB, advanced graphics port (AGP), PCMCIA bus (International Memory Card Association for Personal Computers, "Personal Computer Memory Card International Association"), Small Computer Systems Interface (SCSI), or any another proprietary bus.
[00273] [00273] Processor 244 can be any single-core or multi-core processor, such as those known under the trade name ARM Cortex available from Texas Instruments. In one aspect, the processor can be a Core Cortex-M4F processor
[00274] [00274] In one aspect, processor 244 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 by Texas Instruments. The safety controller can be configured specifically for IEC 61508 and ISO 26262 safety critical applications, among others, to provide advanced integrated safety features while providing scalable performance, connectivity and memory options.
[00275] [00275] System memory includes volatile and non-volatile memory. The basic input / output system (BIOS), containing the basic routines for transferring information between elements within the computer system, such as during startup, is stored in non-volatile memory. For example, non-volatile memory can include ROM, programmable ROM (PROM), electrically programmable ROM (EPROM), EEPROM or flash memory. Volatile memory includes random access memory (RAM), which acts as an external cache memory. In addition
[00276] [00276] 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 disk ROM (CD-ROM) drive. recordable compact disc (CD-R Drive), rewritable compact disc drive (CD-RW drive), or a versatile digital disk ROM drive (DVD-ROM). To facilitate the connection of disk storage devices to the system bus, a removable or non-removable interface can be used.
[00277] [00277] It is understood that computer system 210 includes software that acts as an intermediary between users and basic computer resources described in an appropriate operating environment. Such software includes an operating system. The operating system, which can be stored on disk storage, acts to control and allocate computer system resources. System applications benefit from the management capabilities of the operating system through program modules and program data stored in system memory or on the storage disk. It is to be understood that the various components described in the present invention can be implemented with various operating systems or combinations of operating systems.
[00278] [00278] A user enters commands or information into computer system 210 via the input device (s) coupled to the I / O interface 251. Input devices include, but are not limited to, a device pointer such as a mouse, trackball, stylus, touchpad, keyboard, microphone, joystick, game pad, satellite card, scanner, TV tuner card, digital camera, digital video camera, web camera, and the like. These and other input devices connect to the processor via the system bus via the interface port (s). The interface ports include, for example, a serial port, a parallel port, a game port and a USB. Output devices use some of the same types of ports as input devices. In this way, for example, a USB port can be used to provide input to the computer system and to provide information from the computer system to an output device. An output adapter is provided to illustrate that there are some output devices such as monitors, screens, speakers, and printers, among other output devices, that need special adapters. Output adapters include, by way of illustration and not limitation, video and sound cards that provide a means of connection between the output device and the system bus. It should be noted that other devices and / or device systems, such as remote computers, provide input and output capabilities.
[00279] [00279] Computer system 210 can operate in a networked environment using logical connections to one or more remote computers, such as cloud computers, or local computers. Remote cloud computers can be a personal computer, server, router, personal network computer, workstation, microprocessor-based device, peer device, or other common network node, and the like, and typically include many or all elements described in relation to the computer system. For the sake of brevity, only one memory storage device is illustrated with the remote computer. Remote computers are logically connected to the computer system via a network interface and then physically connected via a communication connection. The network interface covers communication networks such as local area networks (LANs) and wide area networks (WANs). LAN technologies include fiber distributed data interface (FDDI), copper distributed data interface (CDDI), Ethernet / IEEE 802.3, Token ring / IEEE 802.5 and the like. WAN technologies include, but are not limited to, point-to-point links, circuit switching networks such as digital integrated service networks (ISDN) and variations in them, packet switching networks and digital subscriber lines (DSL).
[00280] [00280] In several respects, the computer system 210 of Figure 10, the imaging module 238 and / or the display system 208, and the processor module 232 of Figures 9 to 10, may comprise an image processor, motor image processing, media processor, or any specialized digital signal processor (DSP) used for processing digital images. The image processor can employ parallel computing with single multi-data instruction (SIMD) or multiple multi-data instruction (MIMD) technologies to increase speed and efficiency. The digital image processing engine can perform a number of tasks. The image processor can be an integrated circuit system with a multi-core processor architecture.
[00281] [00281] Communication connections refer to the hardware / software used to connect the network interface to the bus. Although the communication connection is shown for illustrative clarity within the computer system, it can also be external to computer system 210. The hardware / software required for connection to the network interface includes, for illustrative purposes only, internal and external technologies such as modems, including regular telephone serial modems, cable modems and DSL modems, ISDN adapters, and Ethernet cards.
[00282] [00282] In several respects, the devices / instruments 235 described with reference to Figures 9 to 10 can be implemented as a circular stapling device equipped with a motor 201800 (Figures 24 to 30), 201502 (Figures 31 to 33), 201532 ( Figures 34 to 35), 201610 (Figures 36 to 40). Consequently, the circular stapling device equipped with motor 201800 (Figures 24 to 30), 201502 (Figures 31 to 33), 201532 (Figures 34 to 35), 201610 (Figures 36 to 40) is configured to interface with the tower modular control 236 and the central surgical controller 206. Once connected to the central surgical controller 206 the circular stapling device equipped with motor 201800 (Figures 24 to 30), 201502 (Figures 31 to 33), 201532 (Figures 34 to 35) , 201610 (Figures 36 to 40) is configured to interact with the cloud 204, the server 213, other instruments connected to the surgical controller, the central controller screen 215, or the visualization system 209, or combinations thereof. Additionally, once connected to the central controller 206, the circular stapling device equipped with motor 201800 (Figures 24 to 30), 201502 (Figures 31 to 33), 201532 (Figures 34 to 35), 201610 (Figures 36 to 40) can use the processing circuits available on the local computer system of the central controller 210.
[00283] [00283] Figure 11 illustrates a functional block diagram of an aspect of a USB 300 central network controller device, in accordance with at least one aspect of the present invention. In the illustrated aspect, the USB 300 network central controller device uses a TUSB2036 integrated circuit central controller available from Texas Instruments. The central USB network controller 300 is a CMOS device that provides one USB transceiver port 302 and up to three USB transceiver ports downstream 304, 306, 308 in accordance with the USB 2.0 specification. Upstream USB transceiver port 302 is a differential data root port comprising a "minus" differential data input (DMO) paired with a "plus" differential data input (DPO). The three downstream USB transceiver ports 304, 306, 308 are differential data ports, with each port including "more" differential data outputs (DP1 to DP3) paired with "less" differential data outputs (DM1 to DM3) .
[00284] [00284] 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 into the circuit for the upstream USB transceiver port 302 and all downstream USB transceiver ports 304, 306, 308. The downstream USB transceiver ports 304, 306, 308 support both full speed as low speed automatically configuring the scan rate according to the speed of the device attached to the doors. The USB 300 network central controller device can be configured in bus powered or self powered mode and includes 312 central power logic to manage power.
[00285] [00285] The USB 300 central network controller device includes a 310 serial interface engine (SIE). The SIE 310 is the front end of the USB 300 central network controller hardware and handles most of the protocol described in chapter 8 of the USB specification. SIE 310 typically comprises signaling down to the transaction level. The functions it handles could include: packet recognition, transaction sequencing, SOP, EOP, RESET, and RESUME signal detection / generation, clock / data separation, data encoding / decoding non-inverted zero (NRZI) , generation and verification of CRC (token and data), generation and verification / decoding of packet ID (PID), and / or series-parallel / parallel-series conversion. The 310 receives a clock input 314 and is coupled to a logic suspend / resume and frame timer circuit 316 and a repeater circuit of the central controller 318 to control communication between the upstream USB transceiver port 302 and the ports downstream USB transceiver 304, 306, 308 through the logic circuits of ports 320, 322, 324. The SIE 310 is coupled to a command decoder 326 through the logic interface to control the commands of a serial EEPROM via an interface 330 series EEPROM.
[00286] [00286] In several aspects, the USB 300 central network controller can connect 127 functions configured in up to six logical layers (levels) to a single computer. In addition, the USB 300 central network controller can connect all peripherals using a standardized four-wire cable that provides both communication and power distribution. The power settings are bus-powered and self-powered modes. The USB 300 central network controller can be configured to support four power management modes: a bus-powered central controller with individual port power management or grouped port power management, and the self-powered central controller with power management. individual port power or grouped port power management. In one aspect, using a USB cable, the USB 300 central network controller, the USB upstream transceiver port 302 is plugged into a USB host controller, and the downstream USB transceiver ports 304, 306, 308 are exposed to connect compatible USB devices, and so on.
[00287] [00287] Additional details regarding the structure and function of the central surgical controller and / or networks of central surgical controllers can be found in US provisional patent application 62 / 659,900, entitled METHOD OF HUB COMMUNICATION, filed on April 19 2018, which is incorporated in this document as a reference, in its entirety.
[00288] [00288] Figure 12 is a block diagram of the interactive surgical system implemented by computer, according to at least one aspect of the present invention. In one aspect, the computer-implemented interactive surgical system is configured to monitor and analyze data related to the operation of various surgical systems that include central surgical controllers, surgical instruments, robotic devices, and operating rooms or healthcare facilities. The computer-implemented interactive surgical system comprises a cloud-based data analysis system. Although the cloud-based data analysis system is described as a surgical system, it is not necessarily limited to this and could in general be a cloud-based medical system. As shown in Figure 12, the cloud-based data analysis system comprises a plurality of surgical instruments 7012 (may be the same or similar to instruments 112), a plurality of central surgical controllers 7006 (may be the same or similar to central controllers 106 ), and a surgical data network 7001 (can be the same or similar to network 201) for coupling central surgical controllers 7006 to cloud 7004 (can be the same or similar to cloud 204). Each of the plurality of central surgical controllers 7006 is coupled in a communicable manner to one or more surgical instruments 7012. Central controllers 7006 are also coupled in a communicable manner to the cloud 7004 of the interactive surgical system implemented by computer over the 7001. network. 7004 is a centralized remote source of hardware and software for storing, manipulating, and communicating the data generated based on the operation of various surgical systems. As shown in Figure 12, access to the 7004 cloud is achieved through the 7001 network, which may be the internet or some other suitable computer network. Central surgical controllers 7006 that are coupled to the 7004 cloud can be considered the client side of the cloud computing system (ie, cloud-based data analysis system). Surgical instruments 7012 are paired with central surgical controllers 7006 for control and implementation of various surgical procedures or operations as described in this document.
[00289] [00289] In addition, surgical instruments 7012 may comprise transceivers for transmitting data to and from their corresponding central surgical controllers 7006 (which may also comprise transceivers). Combinations of surgical instruments 7012 and corresponding central controllers 7006 can indicate specific locations, such as operating rooms in healthcare facilities (for example, hospitals), to provide medical operations. For example, the memory of a central surgical controller 7006 can store location data. As shown in Figure 12, cloud 7004 comprises central servers 7013 (which can be the same or similar to remote server 113 in Figure 1 and / or remote server 213 in Figure 9), application servers for central controllers 7002, analysis modules data 7034 and an input / output interface ("I / O") 7007. Central servers 7013 of the cloud 7004 collectively manage the cloud computing system, which includes monitoring orders by client 7006 central surgical controllers and managing processing capacity from the 7004 cloud to execute orders. The central servers 7013 each comprise one or more processors 7008 coupled with suitable memory devices 7010 which may include volatile memory as random access memory (RAM) and non-volatile memory as magnetic storage devices. The 7010 memory devices can comprise machine executable instructions that, when executed, cause the 7008 processors to run the 7034 data analysis modules for analysis, operations, recommendations and other cloud-based data operations described below. In addition, processors 7008 can run data analysis modules 7034 independently or in conjunction with central controller applications independently run by central controllers 7006. Central servers 7013 also comprise aggregated medical databases 2212, which can reside in memory 2210 .
[00290] [00290] “Based on connections with several central surgical controllers 7006 through the network 7001, the cloud 7004 can aggregate the specific data data generated by various surgical instruments 7012 and their corresponding central controllers 7006. Such aggregated data can be stored within the aggregated medical databases 7011 of cloud 7004. In particular, cloud 7004 can advantageously perform data analysis and operations on aggregated data to produce information and / or perform individual functions that central controllers 7006 individuals could not achieve on their own. For this purpose, as shown in Figure 12, cloud 7004 and central surgical controllers 7006 are communicatively coupled to transmit and receive information. The I / O interface 7007 is connected to the plurality of central surgical controllers 7006 over the network 7001. In this way, the I / O interface 7006 can be configured to transfer information between the central surgical controllers 7006 and the data databases aggregate doctors 7012. Consequently, the I / O interface 7007 can facilitate read / write operations of the cloud-based data analysis system. Such read / write operations can be performed in response to requests from central controllers
[00291] [00291] The configuration of the specific cloud computing system described in the present invention is designed specifically to address various issues raised in the context of medical operations and procedures performed using medical devices, such as surgical instruments 7012, 112. In particular, surgical instruments 7012 can be digital surgical devices configured to interact with the 7004 cloud to implement techniques to improve the performance of surgical operations. Various surgical instruments 7012 and / or central surgical controllers 7006 can comprise touch-controlled user interfaces, so that doctors can control aspects of interaction between surgical instruments 7012 and the cloud 7004. Other user interfaces suitable for control such as audibly controlled users can also be used.
[00292] [00292] —Figure 13 is a block diagram that illustrates the functional architecture of the interactive surgical system implemented by computer, in accordance with at least one aspect of the present invention. The cloud-based data analysis system includes a plurality of 7034 data analysis modules that can be run by the 7008 cloud 7004 processors to provide data analysis solutions for problems that arise specifically in the medical field. As shown in Figure 13, the functions of the 7034 cloud-based data analysis modules can be supported through applications for central controllers 7014 hosted by the application servers for central controllers 7002 that can be accessed on central surgical controllers 7006. 7008 cloud computing and 7014 central controller applications can operate together to run 7034 data analysis modules. 7016 application programming interfaces (APIs) define the set of protocols and routines that correspond to 7014 central controller applications. In addition, APIs 7016 manage the storage and retrieval of data in / from the aggregated medical data databases 7011 for the operations of 7014 applications. 7018 caches also store data (for example, temporarily) and are coupled to APIs 7016 for more efficient recovery of data used by applications
[00293] [00293] —For example, the 7022 data collection and aggregation module could be used to generate self-describing data (for example, metadata), including the identification of notable features or configuration (for example, trends), the management of data sets redundant data storage in paired data sets that can be grouped by surgery, but not necessarily switched to surgical dates and to actual surgeons. In particular, paired data sets generated from operations of the 7012 surgical instruments may comprise application of a binary classification, for example, a bleeding or non-bleeding event. More generally, the binary classification can be characterized either as a desirable event (for example, a successful surgical procedure) or as an undesirable event (for example, a surgical instrument used improperly or poorly triggered 7012). Aggregated self-describing data can correspond to individual data received from various groups or subgroups of central surgical controllers
[00294] [00294] The resource optimization module 7020 can be configured to analyze this aggregated data to determine an optimal use of resources for a specific health facility or group of healthcare facilities. For example, the 7020 resource optimization module can determine an ideal ordering point for 7012 surgical stapling instruments for a group of healthcare facilities based on the corresponding expected demand for such 7012 instruments. The 7020 resource optimization module it could also assess resource use or other operational configurations of various health care facilities to determine whether resource use could be improved. Similarly, the 7030 recommendation module can be configured to analyze aggregated organized data from the 7022 data collection and aggregation module to provide recommendations. For example, the 7030 recommendation module could recommend to healthcare facilities (for example, medical providers such as hospitals) that a specific 7012 surgical instrument should be upgraded to an improved version based on an error rate of more than expected, for example. In addition, the 7030 recommendation module and / or the 7020 resource optimization module could recommend better supply chain parameters such as product repurchase points and provide suggestions for different 7012 surgical instruments, their uses, or procedural steps to improve surgical results. Healthcare facilities can receive such recommendations through corresponding 7006 central surgical controllers. More specific recommendations related to the parameters or configurations of various 7012 surgical instruments can also be provided. Central controllers 7006 and / or surgical instruments 7012 may also have display screens that display data or recommendations provided by the 7004 cloud.
[00295] [00295] The 7028 patient results analysis module can analyze surgical results associated with currently used operating parameters of the 7012 surgical instruments. The 7028 patient results analysis module can also analyze and evaluate other potential operational parameters. In this context, the 7030 recommendations module could recommend the use of these other potential operating parameters based on producing better surgical results, such as better sealing or less bleeding. For example, the 7030 recommendation module could transmit recommendations to a central surgical controller 7006 on when to use a particular cartridge for a corresponding 7012 stapling surgical instrument. In this way, the cloud-based data analysis system, while controlling common variables, can be configured to analyze the large collection of raw data and provide centralized recommendations across multiple health service facilities (advantageously determined based on aggregated data ). For example, the cloud-based data analysis system could analyze, evaluate and / or aggregate data based on the type of medical practice, type of patient, number of patients, geographical similarity between medical providers, which medical providers / facilities use types similar instruments, etc., in a way that no health service facility alone would be able to independently analyze.
[00296] [00296] The 7026 control program update module can be configured to implement various instrument recommendations - surgical 7012 when corresponding control programs are updated. For example, the 7028 patient outcome analysis module could identify correlations by linking specific control parameters to successful (or unsuccessful) results. Such correlations can be resolved when updated control programs are transmitted to 7012 surgical instruments via the 7026 control program update module. Updates to 7012 instruments that are transmitted via a corresponding central controller 7006 can incorporate aggregated performance data that has been collected and analyzed by the data collection and aggregation module 7022 from the cloud 7004. Additionally, the patient results analysis module 7028 and the recommendations module 7030 could identify improved methods of using the 7012 instruments based on aggregated performance data.
[00297] [00297] The cloud-based data analysis system can include safety features implemented by the 7004 cloud. These safety features can be managed by the authorization and safety module 7024. Each central surgical controller 7006 can have unique credentials associated with it as username, password, and other appropriate security credentials. These credentials can be stored in memory 7010 and be associated with a permitted level of cloud access. For example, based on the provision of exact credentials, a central surgical controller 7006 can be granted access to communicate with the cloud to a predetermined degree (for example, it can only participate in the transmission or receipt of certain defined types of information) . For this purpose, the aggregated medical data databases 7011 of the cloud 7004 may comprise a database of authorized credentials to verify the accuracy of the supplied credentials. Different credentials can be associated with different permission levels for interacting with the 7004 cloud, such as a predetermined access level to receive data analysis generated by the 7004 cloud.
[00298] [00298] In addition, for security purposes, the cloud could maintain a database of 7006 central controllers, 7012 instruments and other devices that may comprise a "black list" of prohibited devices. In particular, a blacklisted central surgical controller 7006 may not be allowed to interact with the cloud, while blacklisted 7012 surgical instruments may not have functional access to a corresponding 7006 central controller and / or may be prevented from functioning fully when paired with its corresponding central controller 7006. In addition or alternatively, cloud 7004 can identify instruments 7012 based on incompatibility or other specified criteria. In this way, counterfeit medical devices and inappropriate reuse of such devices throughout the cloud-based data analysis system can be identified and addressed.
[00299] [00299] Surgical instruments 7012 can use wireless transceivers to transmit wireless signals that can represent, for example, credentials for authorizing access to the corresponding central controllers 7006 and the cloud 7004. Wired transceivers can also be used to transmit signals.
[00300] [00300] The cloud-based data analysis system can allow monitoring of multiple healthcare facilities (eg, medical posts such as hospitals) to determine improved practices and recommend changes (via the 2030 recommendations module, for example) properly. In this way, cloud 7004 processors 7008 can analyze the data associated with a healthcare facility to identify the facility and aggregate the data to other data associated with other healthcare facilities in a group. Groups could be defined based on similar operating practices or geographic location, for example. In this way, the 7004 cloud can provide analysis and recommendations regarding a health service facility that covers an entire group. The cloud-based data analysis system could also be used to improve situational recognition. For example, 7008 processors can predictively demonstrate the effects of recommendations on cost and effectiveness for a specific installation (in relation to operations and / or various general medical procedures). The cost and effectiveness associated with that specific facility can also be compared to a corresponding local area of other facilities or any other comparable facility.
[00301] [00301] —The 7032 data classification and prioritization module can prioritize and classify data based on severity (for example, the severity of a medical event associated with the data, unpredictability, distrust). This classification and prioritization can be used in conjunction with the functions of the other 7034 data analysis modules described above to improve cloud-based data analysis and the operations described in this document. For example, the 7032 data classification and prioritization module can assign a priority to data analysis performed by the 7022 data collection and aggregation module and 7028 patient outcome analysis modules. Different levels of prioritization can result in specific responses to from cloud 7004 (corresponding to a level of urgency) as progression to rapid response, special processing, deletion of the aggregated medical database 7011, or other appropriate responses. In addition, if necessary, the 7004 cloud can transmit a request (for example, a push message) through the application servers to central controllers for additional data from corresponding 7012 surgical instruments. The automatic message may result in a notification displayed on the corresponding 7006 central controllers to request supporting or additional data. This automatic message may be necessary in situations where the cloud detects a significant irregularity or results outside the limits and the cloud cannot determine the cause of the irregularity. Central 7013 servers can be programmed to activate this automatic message in certain significant circumstances, such as when the data is determined to differ from an expected value beyond a predetermined threshold, or when it appears that security has been compromised, for example.
[00302] [00302] In several respects, the surgical instrument (s) 7012 described above with reference to Figures 12 and 13 can be implemented as a circular stapling device equipped with a motor 201800 (Figures 24 to 30), 201502 (Figures 31 to 33), 201532 (Figures 34 to 35), 201610 (Figures 36 to 40). Consequently, the circular stapling device equipped with motor 201800 (Figures 24 to 30), 201502 (Figures 31 to 33), 201532 (Figures 34 to 35), 201610 (Figures 36 to 40) is configured to interface with the controller central surgical 7006 and the 2001 network, which is configured to interface with the 7004 cloud.
[00303] [00303] “Although a" smart "device, including control algorithms responsive to detected data, can be an improvement over a" stupid "device that operates without taking the detected data, some detected data can be incomplete or inconclusive when considered in isolation, that is, without the context of the type of surgical procedure being performed or the type of tissue that is undergoing the surgery. Without knowing the context of the procedure (for example, knowing the type of tissue that is undergoing surgery, or the type of procedure that is being performed), the control algorithm may control the modular device incorrectly or suboptimally, provided the detected data without specific context. For example, the ideal way for a control algorithm to control a surgical instrument in response to a particular detected parameter can vary according to the type of particular tissue being operated on. This is due to the fact that different types of tissue have different properties (for example, tear resistance) and thus respond differently to actions performed by surgical instruments. Therefore, it may be desirable for a surgical instrument to perform different actions when the same measurement is detected for a specific parameter. As a specific example, the optimal way in which to control a stapling and surgical cutting instrument in response to the instrument detecting an unexpectedly high force to close its end actuator, will vary depending on whether the type of tissue is susceptible or resistant to tearing. For tissues that are susceptible to tearing, such as lung tissue, the instrument's control algorithm would optimally slow the engine in response to an unexpectedly high force to close to prevent tearing of the tissue. For tissues that are tear resistant, such as stomach tissue, the instrument's control algorithm would optimally accelerate the engine in response to an unexpectedly high force to close to ensure that the end actuator is properly trapped in the tissue. Without knowing whether lung or stomach tissue has been trapped, the control algorithm can make a decision below what is considered ideal.
[00304] [00304] “A solution uses a central surgical controller including a system configured to derive information about the surgical procedure that is being performed based on data received from various data sources, and then control, accordingly, the paired modular devices . In other words, the central surgical controller is configured to infer information about the surgical procedure from received data and then control modular devices paired with the central surgical controller based on the inferred context of the surgical procedure. Figure 14 illustrates a diagram of a surgical system with 5100 situational recognition, in accordance with at least one aspect of the present invention. In some examples, data sources 5126 include, for example, modular devices 5102 (which may include sensors configured to detect parameters associated with the patient and / or the modular device itself), databases 5122 (for example, a base EMR data containing the patient's medical record), and 5124 monitoring devices (for example, a blood pressure monitor (BP) and an electrocardiography monitor (ECG)).
[00305] [00305] “A 5104 central surgical controller that can be similar to surgical controller 106 in many ways, can be configured to derive contextual information related to the surgical procedure from data based, for example, on the combination (s) ) specific data (s) received or in the specific order in which data is received from data sources 5126. Contextual information inferred from data received may include, for example, the type of surgical procedure being performed, the specific step of the surgical procedure that the surgeon is performing, the type of tissue being operated on, or the body cavity that is the object of the procedure. This ability for some aspects of the central surgical controller 5104 to derive or infer information related to the surgical procedure from received data, can be called "situational perception." In one example, the central surgical controller 5104 can incorporate a situational perception system, which is the hardware and / or programming associated with the central surgical controller 5104 that derives contextual information related to the surgical procedure based on the data received.
[00306] [00306] The situational perception system of the central surgical controller 5104 can be configured to derive contextual information from data received from data sources 5126 in several ways. In one example, the situational perception system includes a pattern recognition system, or machine learning system (for example, an artificial neural network), that has been trained in training data to correlate various inputs (for example, data from databases 5122, patient monitoring devices 5124, and / or devices - modular - 5102) to corresponding contextual information regarding a surgical procedure. In other words, a machine learning system can be trained to accurately derive contextual information regarding a surgical procedure from the inputs provided. In another example, the situational perception system may include a lookup table that stores pre-characterized contextual information regarding a surgical procedure in association with one or more entries (or ranges of entries) corresponding to the contextual information. In response to a query with one or more entries, the lookup table can return the corresponding contextual information to the situational perception system to control the 5102 Modular devices. In an example, the contextual information received by the surgical controller's situational perception system central 5104, are associated with a specific control setting or set of control settings for one or more 5102 modular devices. In another example, the situational awareness system includes an additional machine learning system, research table, or other such system type, generating or retrieving one or more control settings for one or more 5102 modular devices, when contextual information is provided as input.
[00307] [00307] A 5104 central surgical controller, which incorporates a situational perception system, provides several benefits to the 5100 surgical system. One benefit includes improving the interpretation of detected and captured data, which in turn improves processing accuracy and / or the use of data during the course of a surgical procedure. To return to an earlier example, a 5104 central surgical controller with situational awareness could determine what type of tissue was being operated on; therefore, when an unexpectedly high force is detected to close the end actuator of the surgical instrument, the central surgical controller with situational perception 5104 could correctly accelerate or decelerate the surgical instrument motor for the tissue type.
[00308] [00308] As another example, the type of tissue being operated on may affect the adjustments that are made to the load and compression rate thresholds of a stapling and surgical cutting instrument for a specific span measurement. A central surgical controller with situational perception 5104 could infer whether a surgical procedure being performed is a thoracic or abdominal procedure, allowing the central surgical controller 5104 to determine whether tissue pinched by an end actuator of the surgical cutting and stapling instrument it is lung tissue (for a chest procedure) or stomach tissue (for an abdominal procedure). The central surgical controller 5104 can then properly adjust the loading and compression rate thresholds of the surgical stapling and cutting instrument for the tissue type.
[00309] [00309] “As yet another example, the type of body cavity being operated during an insufflation procedure, can affect the function of a smoke evacuator. A central surgical controller with situational perception 5104 can determine if the surgical site is under pressure (by determining that the surgical procedure is using insufflation) and determine the type of procedure. As a type of procedure is usually performed in a specific body cavity, the 5104 central surgical controller can then adequately control the speed of the smoke evacuator motor to the body cavity being operated. In this way, a central surgical controller equipped with 5104 situational awareness can provide a consistent amount of smoke evacuation to both thoracic and abdominal procedures.
[00310] [00310] As yet another example, the type of procedure being performed can affect the ideal energy level for an ultrasonic surgical instrument or radio frequency electrosurgical instrument (RF) to operate. Arthroscopic procedures, for example, require higher energy levels because the end actuator of the ultrasonic surgical instrument or RF electrosurgical instrument is immersed in fluid. A central surgical controller with situational perception 5104 can determine whether the surgical procedure is an arthroscopic procedure. The central surgical controller 5104 can then adjust the RF power level or the ultrasonic amplitude of the generator (i.e., the "energy level") to compensate for the fluid-filled environment. Related to this, the type of tissue being operated on can affect the ideal energy level at which an ultrasonic surgical instrument or RF electrosurgical instrument operates. A central surgical controller with situational awareness 5104 can determine what type of surgical procedure is being performed and then customize the energy level for the ultrasonic surgical instrument or RF electrosurgical instrument, respectively, according to the tissue profile expected for the surgical procedure. In addition, a central surgical controller equipped with 5104 situational awareness can be configured to adjust the energy level for the ultrasonic surgical instrument or RF electrosurgical instrument throughout the course of a surgical procedure, rather than just on a procedure-by basis. -procedure. A central surgical controller with situational awareness! 5104 can determine which step of the surgical procedure is being performed or will be performed subsequently and then update the control algorithms for the generator and / or ultrasonic surgical instrument or RF electrosurgical instrument to adjust the energy level to an appropriate value for the type of tissue, according to the stage of the surgical procedure.
[00311] [00311] As yet another example, data can be extracted from additional data sources 5126 to improve the conclusions that the central surgical controller 5104 extracts from a data source 5126. A central surgical controller with situational perception 5104 can augment the data that it receives from modular devices 5102 with contextual information it has accumulated, referring to the surgical procedure, from other data sources 5126. For example, a central surgical controller with situational perception 5104 can be configured to determine whether hemostasis has occurred (ie , if bleeding stopped at a surgical site), according to video or image data received from a medical imaging device. However, in some cases, video or image data may be inconclusive. Therefore, in one example, the 5104 central surgical controller can be additionally configured to compare a physiological measurement (for example, blood pressure detected by a BP monitor communicatively connected to the 5104 central surgical controller) with the visual or image data of hemostasis (for example, from a Medical Imaging device 124 (Figure 2) coupled communicably to the central surgical controller 5104) to make a determination on the integrity of the staple line or tissue union. In other words, the situational perception system of the central surgical controller 5104 can consider the physiological measurement data to provide additional context in the analysis of the visualization data. The additional context can be useful when the visualization data can be inconclusive or incomplete in itself.
[00312] [00312] Another benefit includes proactively and automatically controlling paired modular devices 5102, according to the specific stage of the surgical procedure being performed to reduce the number of times medical personnel are required to interact with or control the 5100 surgical system during the course of a surgical procedure. For example, a central surgical controller with 5104 situational awareness can proactively activate the generator to which an RF electrosurgical instrument is connected, if it is determined that a subsequent step in the procedure requires the use of the instrument. Proactively activating the power source allows the instrument to be ready for use as soon as the preceding step of the procedure is complete.
[00313] [00313] “As another example, a central surgical controller with situational perception 5104 could determine whether the current or subsequent stage of the surgical procedure requires a different view or degree of magnification of the screen, according to the resource (s) at the surgical site that the surgeon is expected to see. The central surgical controller 5104 could then proactively change the displayed view (provided, for example, by a Medical Imaging device to the visualization system 108), so that the screen automatically adjusts throughout the surgical procedure.
[00314] [00314] As yet another example, a central surgical controller with situational perception 5104 could determine which stage of the surgical procedure is being performed or will be performed subsequently and whether specific data or comparisons between the data will be required for that stage of the surgical procedure. The central surgical controller 5104 can be configured to call screens automatically based on data about the stage of the surgical procedure being performed, without waiting for the surgeon to request specific information.
[00315] [00315] Another benefit includes checking for errors during the configuration of the surgical procedure or during the course of the surgical procedure. For example, a central surgical controller with 5104 situational awareness could determine whether the operating room is properly or ideally configured for the surgical procedure to be performed. The central surgical controller 5104 can be configured to determine the type of surgical procedure being performed, retrieve the corresponding checklists, product location, or configuration needs (for example, from a memory), and then compare the current operating room layout with the standard layout for the type of surgical procedure that the 5104 central surgical controller determines is being performed. In one example, the central surgical controller 5104 can be configured to compare the list of items for the procedure scanned by a suitable scanner, for example, and / or a list of devices paired with the central surgical controller 5104 with a recommended or anticipated manifest of items and / or devices for the given surgical procedure. If there are any discontinuities between the lists, the central surgical controller 5104 can be configured to provide an alert indicating that a specific modular device 5102, patient monitoring device 5124 and / or other surgical item is missing. In one example, the central surgical controller 5104 can be configured to determine the position or relative distance of modular devices 5102 and patient monitoring devices 5124 using proximity sensors, for example. The 5104 central surgical controller can compare the relative positions of the devices with a recommended or anticipated layout for the procedure - surgical - specific. If there are any discontinuities between the layouts, the 5104 central surgical controller can be configured to provide an alert indicating that the current layout for the surgical procedure deviates from the recommended layout.
[00316] [00316] As another example, the central surgical controller with situational awareness 5104 could determine whether the surgeon (or other medical personnel) was making a mistake or otherwise deviating from the expected course of action during the course of a procedure surgical. For example, the central surgical controller 5104 can be configured to determine the type of surgical procedure being performed, retrieve the corresponding list of steps or order of use of the equipment (for example, from a memory), and then compare the steps being performed or equipment being used during the course of the surgical procedure with the steps or equipment expected for the type of surgical procedure that the 5104 central surgical controller determined is being performed. In one example, the central surgical controller 5104 can be configured to provide an alert indicating that an unexpected action is being taken or an unexpected device is being used at the specific stage in the surgical procedure.
[00317] [00317] In general, the situational perception system for the central surgical controller 5104 improves the results of the surgical procedure by adjusting the surgical instruments (and other modular devices 5102) for the specific context of each surgical procedure (such as adjusting to different types tissue), and when validating actions during a surgical procedure. The situational perception system also improves the surgeon's efficiency in performing surgical procedures by automatically suggesting the next steps, providing data, and adjusting screens and other 5102 modular devices in the operating room, according to the specific context of the procedure.
[00318] [00318] In one aspect, as described later in this document with reference to Figures 24 to 40, the modular device 5102 is implemented as a circular stapling device equipped with motor 201800 (Figures 24 to 30), 201502 (Figures 31 to 33 ), 201532 (Figures 34 to 35), 201610 (Figures 36 to 40). Consequently, the modular device 5102 implemented as a circular stapling device equipped with motor 201800 (Figures 24 to 30), 201502 (Figures 31 to 33), 201532 (Figures 34 to 35), 201610 (Figures 36 to 40) is configured to function as a data source 5126 and to interact with the database 5122 and remote monitoring devices 5124. The modular device 5102 implemented as a circular stapling device equipped with a motor 201800 (Figures 24 to 30), 201502 (Figures 31 to 33), 201532 (Figures 34 to 35), 201610 (Figures 36 to 40) is additionally configured to interact with the central surgical controller 5104 to provide information (for example, data and control) to the central surgical controller 5104 and receive information ( eg data and control) of the 5104 central surgical controller.
[00319] [00319] With reference now to Figure 15, a time line 5200 is shown representing the situational recognition of a central controller, such as the central surgical controller 106 or 206 (Figures 1 to 11), for example. Timeline 5200 is an illustrative surgical procedure and the contextual information that the central surgical controller 106, 206 can derive from data received from data sources at each stage in the surgical procedure. Timeline 5200 shows the typical steps that would be taken by nurses, surgeons, and other medical personnel during the course of a pulmonary segmentectomy procedure, beginning with the setup of the operating room and ending with the transfer of the patient to an operating room. postoperative recovery.
[00320] [00320] Situational recognition of a central surgical controller 106, 206 receives data from data sources throughout the course of the surgical procedure, including the data generated each time the medical team uses a modular device that is paired with the operating room 106 , 206. Central surgical controller 106, 206 can receive this data from paired modular devices and other data sources and continuously derive inferences (ie contextual information) about the ongoing procedure as new data is received, such as which step procedure is being performed at any given time. The situational recognition system of the central surgical controller 106, 206 is capable, for example, of recording data relating to the procedure to generate reports, verifying the measures taken by the medical team, providing data or warnings (for example, through a display screen) ) which may be relevant to the specific step of the procedure, adjust the modular devices based on the context (for example, activate monitors, adjust the field of view (FOV) of the medical imaging device, or change the energy level of an instrument ultrasonic surgical or RF electrosurgical instrument), and take any other measures described above.
[00321] [00321] In the first step 5202, in this illustrative procedure, the members of the hospital team retrieve the patient's electronic medical record (PEP) from the hospital's PEP database. Based on patient selection data in the PEP, the central surgical controller 106, 206 determines that the procedure to be performed is a thoracic procedure.
[00322] [00322] In the second step 5204, the team members scan the entry of medical supplies for the procedure. Central surgical controller 106, 206 cross-references the scanned supplies with a list of supplies that are used in various types of procedures and confirms that the combination of supplies corresponds to a thoracic procedure. In addition, the central surgical controller 106, 206 is also able to determine that the procedure is not a wedge procedure (because the inlet supplies either lack certain supplies that are necessary for a thoracic wedge procedure or, otherwise, that the input supplies do not correspond to a thoracic wedge procedure).
[00323] [00323] In the third step 5206, the medical team scans the patient's band with a scanner that is communicably connected to the central surgical controller 106, 206. The surgical controller 106, 206 can then confirm the patient's identity based on the data scanned.
[00324] [00324] In the fourth step 5208, the medical team turns on the auxiliary equipment. The auxiliary equipment in use may vary according to the type of surgical procedure and the techniques to be used by the surgeon, but in this illustrative case they include a smoke evacuator, an insufflator and a medical imaging device. When activated, auxiliary equipment that is modular devices can automatically pair with the central surgical controller 106, 206 which is located within a specific neighborhood of modular devices as part of their initialization process. Surgical controller 106, 206 can then derive contextual information about the surgical procedure by detecting the types of modular devices paired with it during that preoperative or initialization phase. In this particular example, the central surgical controller 106, 206 determines that the surgical procedure is a VATS (video-assisted thoracic surgery) procedure based on this specific combination of paired modular devices. Based on the combination of data from the electronic patient record (PEP), the list of medical supplies to be used in the procedure, and the type of modular devices that connect to the central controller, the central surgical controller 106, 206 can, in general , infer the specific procedure that the surgical team will perform. After the central surgical controller 106, 206 recognizes that a specific procedure is being performed, the central surgical controller 106, 206 can then retrieve the steps of that process from a memory or from the cloud and then cross the data it subsequently receives from the connected data sources (for example, modular devices and patient monitoring devices) to infer which stage of the surgical procedure the surgical team is performing.
[00325] [00325] In the fifth step 5210, the team members fix the electrocardiogram (ECG) electrodes and other patient monitoring devices on the patient. ECG electrodes and other patient monitoring devices are able to pair with central surgical controller 106, 206. As central surgical controller 106, 206 begins to receive data from patient monitoring devices, central surgical controller 106, 206 thus confirming that the patient is in the operating room.
[00326] [00326] In the sixth step 5212, the medical team induces anesthesia in the patient. Central surgical controller 106, 206 can infer that the patient is under anesthesia based on data from modular devices and / or patient monitoring devices, including ECG data, blood pressure data, ventilator data, or combinations of themselves, for example. After the completion of the sixth step 5212, the preoperative portion of the pulmonary segmentectomy procedure is completed and the operative portion begins.
[00327] [00327] At the seventh stage 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. Central surgical controller 106, 206 can infer that the operative portion of the procedure has been initiated since it can compare the detection of the patient's lung retraction to the expected steps of the procedure “(which can be accessed or retrieved earlier) and thus determine that the lung retraction is the first operative step in this specific procedure.
[00328] [00328] At the 8th step 5216, the medical imaging device (for example, an endoscope) is inserted and the video of the medical imaging device is started. Central surgical controller 106, 206 receives data from the medical imaging device (i.e., 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 been initiated. In addition, the central surgical controller 106, 206 can determine that the specific procedure underway is a segmentectomy, rather than a lobectomy (note that a wedge procedure has already been discarded by the central surgical controller 106, 206 based on the data received in the second step 5204 of the procedure). The medical imaging device data 124 (Figure 2) can be used to determine contextual information about the type of procedure underway in several different ways, including determining the angle at which the medical imaging device is oriented in relation to viewing the anatomy of the patient, monitoring the number or medical imaging devices in use (ie, which are activated and paired with the central surgical controller 106, 206), and monitoring the types of visualization 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 anterior intercostal position in relation to the segmental fissure. With the use of 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, a 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 uses an infrared light source (which can be communicably coupled to the central surgical controller as part of the visualization system) to visualize the segmental 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 in progress and / or the technique in use for a specific type of surgical procedure .
[00329] [00329] In the ninth step 5218, the surgical team starts the dissection step of the procedure. Central surgical controller 106, 206 can infer that the surgeon is in the dissection process to mobilize the patient's lung because he receives data from the RF or ultrasonic generator that indicate that an energy instrument is being fired. The central surgical controller 106, 206 can cross-check the received data with the steps retrieved from the surgical procedure to determine that an energy instrument being fired at that point in the process (that is, after the completion of the previously discussed steps of the procedure) corresponds to the step of dissection. In certain cases, the energy instrument may be a power tool mounted on a robotic arm in a robotic surgical system.
[00330] [00330] In the tenth step 5220 of the procedure, the surgical team proceeds to the connection step. 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 fired. Similar to the previous step, the central surgical controller 106, 206 can derive this inference by crossing the data received from the surgical stapling and cutting instrument with the steps recovered in the process. In certain cases, the surgical instrument may be a surgical tool mounted on a robotic arm of a robotic surgical system.
[00331] [00331] In the eleventh step 5222, the portion of the segmentectomy procedure is performed. Central surgical controller 106, 206 can infer that the surgeon is transecting the parenchyma based on the data from the surgical stapling and cutting instrument, including data from its cartridge. The cartridge data can correspond to the size or type of clamp being triggered by the instrument, for example. As different types of staples are used for different types of fabrics, the cartridge data can thus indicate the type of fabric being stapled and / or transected. In this case, the type of clamp that is fired is used for the parenchyma (or other similar types of tissue), which allows the central surgical controller 106, 206 to infer which portion of the segmentectomy procedure is being performed.
[00332] [00332] “In the second step 5224, the node dissection step is then performed. Central surgical controller 106, 206 can infer that the surgical team is dissecting the node and performing a leak test based on the data received from the generator which indicates which ultrasonic or RF instrument is being fired. For this specific procedure, an RF or ultrasonic instrument being used after the parenchyma has been transected corresponds to the node dissection step, which allows the central surgical controller 106, 206 to make this inference. It should be noted that surgeons regularly switch between surgical stapling / surgical cutting instruments and surgical energy instruments (that is, RF or ultrasonic instruments depending on the specific step in the procedure because different instruments are better adapted for specific tasks. Therefore, the specific sequence in which cutting / stapling instruments and surgical energy instruments are used can indicate which step of the procedure the surgeon is performing in. In addition, in certain cases, robotic tools can be used for one or more steps in a surgical procedure and / or hand surgical instruments can be used for one or more steps in the surgical procedure.The surgeon can switch between robotic tools and hand surgical instruments and / or can use the devices simultaneously, for example. second stage 5224, the incisions are closed and the postoperative portion procedure is started.
[00333] [00333] In the thirteenth stage 5226, the patient's anesthesia is reversed. The central surgical controller 106, 206 can infer that the patient is exiting anesthesia based on ventilator data (i.e., the patient's respiratory rate begins to increase), for example.
[00334] [00334] Finally, in the fourteenth step 5228 is that the medical team removes the various patient monitoring devices from the patient. Central surgical controller 106, 206 can thus infer that the patient is being transferred to a recovery room when the central controller loses ECG, blood pressure and other data from patient monitoring devices. As can be seen from the description of this illustrative procedure, the central surgical controller 106, 206 can determine or infer when each step of a given surgical procedure is taking place according to the data received from the various data sources that are communicably coupled to the central surgical controller 106, 206.
[00335] [00335] In several respects, the circular stapling device equipped with motor 201800 (Figures 24 to 30), 201502 (Figures 31 to 33), 201532 (Figures 34 to 35), 201610 (Figures 36 to 40) is configured to work in a situational recognition in a central controller environment, such as the central surgical controller 106 or 206 (Figures 1 to 11), for example, as shown in the timeline
[00336] [00336] Figure 16 illustrates a logic diagram of a module of a 470 control system of a surgical instrument or tool, according to one or more aspects of the present invention. The 470 system comprises a control circuit. The control circuit includes a microcontroller 461 comprising a processor 462 and a memory 468. One or more of the sensors 472, 474, 476, for example, provide real-time feedback to processor 462. A motor 482, driven by a driver motor 492, operationally couples a longitudinally movable displacement member to drive the cutting element, trocar or anvil of a motor-equipped circular stapling device. 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 firing member, firing bar and a cutting element. Additional motors can be provided at the instrument driver interface to control the knife firing, the displacement of the closing tube, the rotation of the drive shaft and the articulation. A 473 screen shows a variety of instrument operating conditions and may include touchscreen functionality for data entry. The information displayed on screen 473 can be overlaid with images captured using endoscopic imaging modules.
[00337] [00337] In one aspect, the 461 microcontroller can be any single-core or multi-core processor, such as those known under the ARM Cortex trade name available from Texas Instruments. In one respect, the main microcontroller 461 can be an LM4F230H5QR ARM Cortex-M4F processor, available from Texas Instruments, for example, which comprises an integrated 256 KB single cycle flash memory, or other non-volatile memory, up to 40 MHz, a seek-ahead buffer to optimize performance above 40 MHz, a 32 KB single cycle series random access memory (SRAM), an internal read-only memory (ROM) loaded with the StellarisWareG program, programmable memory and electrically erasable read-only (EEPROM) of 2 KB, one or more pulse width modulation (PWM) modules, one or more analogs of quadrature encoder (QEI) inputs, and / or one or more analog converters for 12-bit digital (ADC) with 12 channels of analog input, details of which are available for the product data sheet.
[00338] [00338] In one aspect, the 461 microcontroller may comprise a safety controller that comprises two families based on controllers, such as TMS570 and RM4x known under the trade name Hercules ARM Cortex R4, also available from Texas Instruments. The safety controller can be configured specifically for IEC 61508 and ISO 26262 safety critical applications, among others, to provide advanced integrated safety features while providing scalable performance, connectivity and memory options.
[00339] [00339] The 461 microcontroller can be programmed to perform various functions, such as precise control of the speed and position of the joint and knife systems. In one aspect, the microcontroller 461 includes a processor 462 and a memory 468. The electric motor 482 can be a brushed direct current (DC) motor with a gearbox and mechanical connections with an articulation or scalpel system. In one aspect, a motor drive 492 can be an A3941 available from Allegro Microsystems, Inc. Other motor drives can be readily replaced for use in tracking system 480 which comprises an absolute positioning system. A detailed description of an absolute positioning system is given in US patent application publication 2017/0296213, entitled SYSTEMS AND METHODS FOR
[00340] [00340] The 461 microcontroller can be programmed to provide precise control of the speed and position of the displacement members and articulation systems. The 461 microcontroller can be configured to compute a response in the 461 microcontroller software. The computed response is compared to a measured response from the real system to obtain an "observed" response, which is used for actual feedback-based decisions. The observed response is a favorable and adjusted value, which balances the uniform and continuous nature of the simulated response with the measured response, which can detect external influences in the system.
[00341] [00341] In one aspect, motor 482 can be controlled by motor driver 492 and can be used by the instrument's trigger system or surgical tool. In many ways, the 482 motor can be a brushed direct current (DC) drive motor, with a maximum speed of approximately 25,000 RPM, for example. In other arrangements, the 482 motor may include a brushless motor, a wireless motor, a synchronous motor, a stepper motor or any other suitable type of electric motor. Motor starter 492 may comprise an H bridge starter comprising field effect transistors (FETs), for example. The 482 motor can be powered by a feed assembly releasably mounted on the handle assembly or tool compartment to provide control power for the instrument or surgical tool. The power package may comprise a battery that may include several battery cells connected in series, which can be used as the power source to energize 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 can be lithium-ion batteries that can be coupled and separable from the power package.
[00342] [00342] The 492 motor drive can be an A3941, available from Allegro Microsystems, Inc. The 492 A3941 drive is an entire bridge controller for use with external power semiconductor metal oxide field (MOSFET) transistors. , of N channel, specifically designed for inductive loads, such as brushed DC motors. The 492 actuator comprises a single charge pump regulator that provides full door drive (> 10 V) for batteries with voltage up to 7 V and allows the A3941 to operate with a reduced door drive, up to 5.5 V. A capacitor input control can be used to supply the voltage surpassing that supplied by the battery required for the N channel MOSFETs. An internal charge pump for the upper side drive allows operation in direct current (100% duty cycle). The entire bridge can be triggered in fast or slow drop modes using diodes or synchronized rectification. In the slow drop mode, the current can be recirculated by means of FET from the top or from the bottom. The energy FETs are protected from the shoot-through effect through programmable dead-time resistors. Integrated diagnostics provide indication of undervoltage, overtemperature and faults in the power bridge, and can be configured to protect power MOSFETs in most short-circuit conditions. Other motor drives can be readily replaced for use in the tracking system 480 comprising an absolute positioning system.
[00343] [00343] Tracking system 480 comprises a controlled motor drive circuit arrangement comprising a position sensor 472 in accordance with an aspect of the present invention. The position sensor 472 for an absolute positioning system provides a unique position signal that corresponds to the location of a displacement member. In one aspect, the displacement member represents a longitudinally movable drive member comprising a rack of drive teeth for engagement with a corresponding drive gear of a gear reduction assembly. In other respects, the displacement member represents the firing member, which can be adapted and configured to include a rack of drive teeth. In yet another aspect, the displacement member represents the firing bar or knife, each of which can be adapted and configured to include a rack of drive teeth. Consequently, as used in this document, the term displacement member is used generically to refer to any moving member of the surgical instrument or tool, such as the driving member, the firing member, the firing bar, the knife 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 knife. Consequently, the absolute positioning system can, in effect, track the linear displacement of the knife by tracking the linear displacement of the longitudinally movable drive member. In several other respects, the displacement member can be coupled to any position sensor 472 suitable for measuring linear displacement. In this way, the longitudinally movable drive member, the firing member, the firing bar or the knife, 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 can comprise variable differential linear transformers (LVDT), variable reluctance differential transducers (DVRT), a sliding potentiometer, a magnetic detection system comprising a moving magnet and a series of linearly arranged Hall effect sensors, a system magnetic detection system comprising a fixed magnet and a series of linearly arranged mobile Hall effect sensors, an optical detection system comprising a mobile light source and a series of linearly arranged photodiodes or photodetectors, an optical detection system comprising a fixed light source and a series of linearly arranged mobile photodiodes or photodetectors, or any combination thereof.
[00344] [00344] The 482 electric motor may include a rotary drive shaft, which interfaces operationally with a gear set, which is mounted on a coupling coupling with a set or rack of drive teeth on the drive member. A sensor element can be operationally coupled to a gear assembly so that a single revolution of the position sensor element 472 corresponds to some linear longitudinal translation of the displacement member. An array of gears and sensors can be connected to the linear actuator by means of a rack and pinion arrangement, or by a rotary actuator, by means of a sprocket or other connection. A power supply supplies power to the absolute positioning system and an output indicator can show the output from the absolute positioning system. The drive member represents the longitudinally movable drive member comprising a rack of drive teeth formed thereon for engagement with a corresponding drive gear of the gear reducer assembly. The displacement member represents the longitudinally movable firing member, the firing bar, the knife or combinations thereof.
[00345] [00345] A single revolution of the sensor element associated with the position sensor 472 is equivalent to a longitudinal linear displacement di of the displacement member, where di represents the longitudinal linear distance by which the displacement member moves from point "a" to point "b" after a single revolution of the sensor element coupled to the displacement member. The sensor arrangement can be connected by means of a gear reduction which results in the position sensor 472 completing one or more revolutions for the complete travel of the displacement member. The 472 position sensor can complete multiple revolutions for the full travel of the displacement member.
[00346] [00346] A series of keys, where n is an integer greater than one, can be used alone or in combination with a gear reduction to provide a single position signal for more than one revolution of the position sensor 472. The state of the keys is transmitted back to microcontroller 461 which applies logic to determine a single position signal corresponding to the longitudinal linear displacement d1 + d2 + ... dh of the displacement member. The output of the position sensor 472 is provided to the microcontroller 461. In several embodiments, the position sensor 472 of the sensor arrangement may comprise a magnetic sensor, an analog rotary sensor, such as a potentiometer, or a series of effect elements
[00347] [00347] The position sensor 472 can comprise any number of magnetic detection elements, such as, for example, magnetic sensors classified according to whether they measure the total magnetic field or the vector components of the magnetic field. The techniques used to produce both types of magnetic sensors cover many aspects of physics and electronics. Technologies used for magnetic field detection include flow meter, saturated flow, optical pumping, nuclear precession, SQUID, Halli effect anisotropic magnetoresistance, giant magnetoresistance, magnetic tunnel junctions, giant magneto impedance, magnetostrictive / piesoelectric compounds, magnetodiode, magnetic transistor, optical fiber , magneto-optics and magnetic sensors based on microelectromechanical systems, among others.
[00348] [00348] In one aspect, the position sensor 472 for the tracking system 480 which comprises an absolute positioning system comprises a magnetic rotating absolute positioning system. The 472 position sensor can be implemented as a rotary, magnetic, single-circuit, ASSOSSEQFT position sensor, available from Austria Microsystems, AG. The position sensor 472 interfaces with the 461 microcontroller to provide an absolute positioning system. The 472 position sensor is a low voltage, low power component and includes four effect elements in an area of the 472 position sensor located above a magnet. A high-resolution ADC and an intelligent power management controller are also provided on the integrated circuit. A CORDIC (digital computer for coordinate rotation) processor, also known as the digit-for-digit method and Volder algorithm, is provided to implement a simple and efficient algorithm for calculating hyperbolic and trigonometric functions that require only addition, subtraction, displacement operations bits and lookup table. The angle position, alarm bits and magnetic field information are transmitted via a standard serial communication interface, such as a serial peripheral interface (SPI), to the 461 microcontroller. The 472 position sensor provides 12 or 14 bits of resolution. The position sensor 472 can be an ASS055 integrated circuit supplied in a small 16-pin QFN package whose measurement corresponds to 4x4x0.85 mm.
[00349] [00349] The tracking system 480 comprising an absolute positioning system can understand and / or be programmed to implement a feedback controller, such as a PID, state feedback, and adaptive controller. A power supply converts the signal from the feedback controller to a physical input to the system, in this case the voltage. Other examples include a voltage, current and force PWM. Other sensors can be provided to measure the parameters of the physical system in addition to the position measured by the position sensor 472. In some respects, the other sensors may include sensor arrangements as described in US patent No. 9,345,481 entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, granted on May 24, 2016, which is incorporated by reference in its entirety into this document; publication of US patent application serial number 2014/0263552, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, published on September 18, 2014, is incorporated by reference in its entirety in this document; and US patent application serial number 15 / 628,175, entitled TECHNIQUES FOR
[00350] [00350] The absolute positioning system provides an absolute positioning of the displaced member on the activation of the instrument without having to retract or advance the longitudinally movable driving member to the restart position (zero or initial), as may be required by the encoders conventional rotating machines that merely count the number of progressive or regressive steps that the 482 motor has traveled to infer the position of a device actuator, actuation bar, scalpel, and the like.
[00351] [00351] “A 474 sensor, such as a strain gauge or a micro strain gauge, is configured to measure one or more parameters of the end actuator, such as, for example, the amplitude of the strain exerted on the anvil during a gripping operation, which can be indicative of tissue compression. The measured effort is converted into a digital signal and fed to the 462 processor. Alternatively, or in addition to the 474 sensor, a 476 sensor, such as a load sensor, can measure the closing force applied by the drive system. anvil closure. The 476 sensor, such as a load sensor, can measure the firing force applied to a knife in a firing stroke of the instrument or surgical tool. The knife is configured to engage a wedge slide, which is configured to move the clamp actuators upward to force the clamps to deform in contact with an anvil. The knife includes a sharp cutting edge that can be used to separate the fabric, as the knife is advanced distally by the firing bar. Alternatively, a current sensor 478 can be used to measure the current drained by the 482 motor. The force required to advance the trigger member can correspond to the current drained by the 482 motor, for example. The measured force is converted into a digital signal and supplied to the 462 processor.
[00352] [00352] In one form, a 474 strain gauge sensor can be used to measure the force applied to the tissue by the end actuator. A strain gauge can be attached to the end actuator to measure the force applied to the tissue being treated by the end actuator. A system for measuring forces applied to the tissue attached by the end actuator comprises a 474 strain gauge sensor, such as, for example, a microstrain meter, which is configured to measure one or more parameters of the end actuator, for example. In one aspect, the 474 strain gauge sensor can measure the amplitude or magnitude of the mechanical stress exerted on a claw member of an end actuator during a gripping operation, which can be indicative of tissue compression. The measured effort is converted into a digital signal and fed to the 462 processor of a microcontroller
[00353] [00353] Measurements of tissue compression, tissue thickness and / or force required to close the end actuator on the tissue, as measured by sensors 474, 476, can be used by microcontroller 461 to characterize the selected position of the trigger member and / or the corresponding trigger member speed value. In one case, a 468 memory can store a technique, an equation and / or a look-up table that can be used by the 461 microcontroller in the evaluation.
[00354] [00354] The control system 470 of the instrument or surgical tool can also comprise wired or wireless communication circuits for communication with the central modular communication controller shown in Figures 1 to 14. The control system 470 can be employed by the instrument circular stapling equipment equipped with a 201800 engine (Figures 24 to 30), 201502 (Figures 31 to 32), 201532 (Figures 34 to 35), 201610 (Figures 36 to 40) to control aspects of the circular stapling instruments equipped with a 201800 motor, 201502, 201532 and 201610. Aspects of the 470 control system can be used by the circular stapling instruments equipped with motor 201800, 201502, 201532 and 201610 to detect the position of the anvil, the forces of tissue compression, among others, using 472, 474, 476, tracking system 480, and current sensor 478 to provide feedback to controller 461.
[00355] [00355] Figure 17 illustrates a control circuit 500 configured to control aspects of the instrument or surgical tool according to an aspect of the present invention. The control circuit 500 can be configured to implement various processes described in this document. The control circuit 500 may comprise a microcontroller comprising one or more processors 502 (for example, microprocessor, microcontroller) coupled to at least one memory circuit 504. The memory circuit 504 stores instructions executable on a machine that, when executed by the processor 502, cause the 502 processor to execute machine instructions to implement several of the processes described in this document. The 502 processor can be any one of a number of single-core or multi-core processors known in the art. The memory circuit 504 may comprise volatile and non-volatile storage media. The processor 502 can include an instruction processing unit 506 and an arithmetic unit 508. The instruction processing unit can be configured to receive instructions from the memory circuit 504 of this invention.
[00356] [00356] Figure 18 illustrates a combinational logic circuit 510 configured to control aspects of the instrument or surgical tool according to an aspect of the present invention. The combinational logic circuit 510 can be configured to implement various processes described in this document. The combinational logic circuit 510 can comprise a finite state machine comprising a 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.
[00357] [00357] Figure 19 illustrates a sequential logic circuit 520 configured to control aspects of the instrument or surgical tool according to an aspect of the present invention. Sequential logic circuit 520 or combinational logic 522 can be configured to implement the process in this document described. Sequential logic circuit 520 may comprise a finite state machine. Sequential logic circuit 520 may comprise combinational logic 522, at least one memory circuit 524, a clock 529 and, for example. The at least one memory circuit 524 can store a current state of the finite state machine. In certain cases, the sequential logic circuit 520 may be synchronous or asynchronous. Combinational logic 522 is configured to receive data associated with the surgical instrument or tool from an input 526, process the data by combinational logic 522, and provide an output 528. In other respects, the circuit may comprise a combination of a processor (for example , processor 502, Figure 17) and a finite state machine for implementing various processes of the present invention. In other respects, the finite state machine may comprise a combination of a combinational logic circuit (e.g., a combinational logic circuit 510, Figure 18) and the sequential logic circuit 520.
[00358] [00358] Figure 20 illustrates an instrument or surgical tool 600 that comprises a plurality of motors that can be activated to perform various functions. In certain cases, a first engine can be activated to perform a first function, a second engine can be activated to perform a second function, a third engine can be activated to perform a third function, a fourth engine can be activated to perform a fourth function, and so on. In certain cases, the plurality of motors of the surgical instrument 600 can be individually activated to cause firing, closing and / or articulation movements in the end actuator. The firing, closing and / or articulation movements can be transmitted to the end actuator through a drive shaft assembly, for example. In one aspect, the surgical instrument 600 is representative of a hand-held surgical instrument. In another aspect, the surgical instrument 600 is representative of a robotic surgical instrument. In other respects, the surgical instrument 600 is representative of a combination of a hand-held and robotic surgical instrument. In many respects, the surgical stapler 600 can be representative of a linear stapler or a circular stapler.
[00359] [00359] In certain cases, the instrument or surgical tool system may include a 602 firing motor. The 602 firing motor can be operationally coupled to a 604 firing motor drive assembly, which can be configured to transmit movements trigger points, generated by motor 602, to the end actuator, particularly to move the cutting element. In certain cases, the triggering movements generated by the 602 motor can cause the staples to be positioned from the staple cartridge in the fabric captured by the end actuator and / or the cutting edge of the cutting element to be advanced in order to cut the captured tissue, for example. The cutting element can be retracted by reversing the direction of the motor 602.
[00360] [00360] In certain cases, the surgical instrument or tool may include a closing motor 603. The closing motor 603 can be operationally coupled to a drive assembly of the closing motor 605 that can be configured to transmit closing movements generated by the motor 603 to the end actuator, particularly to move a closing tube to close the anvil and compress the fabric between the anvil and the staple cartridge. 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. In a circular stapler implementation, the 603 motor can be coupled to a trocar portion of a circular stapling portion of an equipped stapling device with engine. The 603 engine can be used to advance and retract the trocar.
[00361] [00361] In certain cases, the surgical instrument or tool may include one or more articulation motors 606a, 606b, for example. The motors 606a, 606b can be operationally coupled to the drive assemblies of the articulation motor 608a, 608b, which can be configured to transmit articulation movements generated by the motors 606a, 606b to the end actuator. In certain cases, the articulation movements can cause the end actuator to be articulated in relation to the drive shaft assembly, for example.
[00362] [00362] “As described above, the surgical instrument or tool can include a plurality of motors that can be configured to perform various independent functions. In certain cases, the plurality of motors of the instrument or surgical tool can be activated individually or separately to perform one or more functions, while other motors remain inactive. For example, the articulation motors 606a, 606b can be activated to cause the end actuator to be articulated, while the firing motor 602 remains inactive. Alternatively, the firing motor 602 can be activated to fire the plurality of clamps, and / or advance the cutting edge, while the hinge motor 606 remains inactive. In addition, the closing motor 603 can be activated simultaneously with the firing motor 602 to cause the closing tube or the cutting element to advance distally, as described in more detail later in this document.
[00363] [00363] In certain cases, the instrument or surgical tool may include a common control module 610 that can be used with a plurality of motors of the instrument or surgical tool. In certain cases, the common control module 610 can accommodate one of the plurality of motors at a time. For example, the common control module 610 can be coupled to, and separable from, the plurality of motors of the surgical instrument individually. In certain cases, a plurality of 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 can be selectively switched between interfacing with one of a plurality of instrument motors or surgical tool to interface with another among the plurality of instrument motors or surgical tool.
[00364] [00364] As an example, the common control module 610 can be selectively switched between the operational coupling with the 606a, 606b articulation motors, and the operational coupling with the 602 firing motor or the 603 closing motor. At least an example, as illustrated in Figure 20, a key 614 can be moved or transitioned between a plurality of positions and / or states. In the first position 616, the switch 614 can electrically couple the common control module 610 to the trip motor 602; in a second position 617, the switch 614 can electrically couple the control module 610 to the closing motor 603; in a third position 618a, the switch 614 can electrically couple the common control module 610 to the first articulation motor 606a; and in a fourth position 618b, the switch 614 can electrically couple the common control module 610 to the second articulation motor 606b, for example. In certain cases, separate common control modules 610 can be electrically coupled to the trip motor 602,
[00365] [00365] Each of the 602, 603, 606a, 606b motors can comprise a torque sensor to measure the output torque on the motor drive shaft. The force on an end actuator can be detected in any conventional manner, such as by means of force sensors on the outer sides of the jaws or by a motor torque sensor that drives the jaws.
[00366] [00366] In several cases, as illustrated in Figure 20, the common control module 610 may comprise a motor starter 626 which may comprise one or more H bridge FETs. The motor starter 626 may modulate the energy transmitted from a power supply 628 to a motor coupled to the common control module 610, based on an input from a microcontroller 620 (the "controller"), for example. In certain cases, the microcontroller 620 can be used to determine the current drawn by the motor, for example, while the motor is coupled to the common control module 610, as described above.
[00367] [00367] In certain examples, the microcontroller 620 may include a microprocessor 622 (the "processor") and one or more non-transitory computer-readable media or 624 memory units (the "memory"). In certain cases, memory 624 can store various program instructions 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 can be coupled to the processor 622, for example.
[00368] [00368] 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 "battery"), such as a Li ion battery, for example. In certain cases, the battery pack can be configured to be releasably mounted to the handle to supply power to the surgical instrument 600. Several battery cells connected in series can be used as the 628 power source. In certain cases, the power source 628 power supply can be replaceable and / or rechargeable, for example.
[00369] [00369] In several cases, the 622 processor can control the motor drive 626 to control the position, direction of rotation and / or speed of a motor that is coupled to the common control module 610. In certain cases, the processor 622 can signal the motor driver 626 to stop and / or disable a motor that is coupled to the common control module 610. It should be understood that the term "processor", as used in this document, includes any microprocessor, microcontroller or other suitable basic computing device that incorporates the functions of a central computer processing unit (CPU) in an integrated circuit or, at most, some integrated circuits. The processor is a programmable multipurpose device that accepts digital data as input, processes it according to instructions stored in its memory, and provides results as output. This is an example of sequential digital logic, as it has internal memory. Processors operate on numbers and symbols represented in the binary numeral system.
[00370] [00370] In one example, the 622 processor can be any single-core or multi-core processor, such as those known by the Texas Instruments ARM Cortex trade name. In certain cases, the 620 microcontroller can be an LM 4F230H5QR,
[00371] [00371] In certain cases, memory 624 may include program instructions for controlling each of the motors of the surgical instrument 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 can cause the 622 processor to control the trigger, close, and link functions according to inputs from the instrument or surgical tool control algorithms or programs.
[00372] [00372] In certain cases, one or more mechanisms and / or sensors, such as 630 sensors, can be used to alert the 622 processor about the program instructions that need to be used in a specific configuration. For example, sensors 630 can alert the 622 processor to use the program instructions associated with triggering, closing, and pivoting the end actuator. In certain cases, sensors 630 may comprise position sensors that can be used to detect the position of switch 614, for example. Consequently, processor 622 can use the program instructions associated with triggering the knife of the end actuator by detecting, through sensors 630, for example, that switch 614 is in first position 616; the processor 622 can use the program instructions associated with closing the anvil upon detection through sensors 630, for example, that switch 614 is in second position 617; and processor 622 can use the program instructions associated with the articulation of the end actuator upon detection through sensors 630, for example, that switch 614 is in the third or fourth position 618a, 618b.
[00373] [00373] The surgical instrument 600 may also comprise wired or wireless communication circuits for communication with the central modular communication controller shown in Figures 1 to
[00374] [00374] Figure 21 is a schematic diagram of a surgical instrument 700 configured to operate a surgical tool in the present document described, in accordance with an aspect of this invention. The surgical instrument 700 can be programmed or configured to control the distal / proximal translation of a displacement member, the distal / proximal displacement of a closing tube, the rotation of the drive shaft, and the articulation, either with one or more links articulation drive. In one aspect, the surgical instrument 700 can be programmed or configured to individually control a firing member, a closing member, a driving shaft member and / or one or more hinge members. The surgical instrument 700 comprises a control circuit 710 configured to control motor-driven firing members, closing members, driving shaft members and / or one or more hinge members. In one aspect, surgical instrument 700 is representative of a hand-held surgical instrument. In another aspect, the surgical instrument 700 is representative of a robotic surgical instrument. In other respects, the surgical instrument 700 is representative of a combination of a hand-held and robotic surgical instrument. In many respects, surgical stapler 700 can be representative of a linear stapler or a circular stapler.
[00375] [00375] In one aspect, surgical instrument 700 comprises a control circuit 710 configured to control an anvil 716 and a cutting portion 714 (or cutting element including a sharp cutting edge) of an end actuator 702, a staple cartridge 718 removable, a drive shaft 740 and one or more hinge members 742a, 742b through a plurality of motors 704a to 704e. A position sensor 734 can be configured to provide knife position feedback 714 to control circuit 710. Other sensors 738 can be configured to provide feedback to control circuit 710. A timer / counter 731 provides timing and counting information to the circuit control 710. A power source 712 can be provided to operate motors 704a to 704e and a current sensor 736 provides motor current feedback to control circuit 710. Motors 704a to 704e can be operated individually by the control circuit 710 in an open loop or closed loop feedback control.
[00376] [00376] 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 circuit 731 provides an output signal, such as elapsed time or a digital count, to control circuit 710 to correlate the position of knife 714, as determined by position sensor 734, with the output of the timer / counter 731 so that control circuit 710 can determine the position of knife 714 at a specific time (t) in relation to an initial position or time (t) when knife 714 is in a specific position in relation to a starting position. The timer / counter 731 can be configured to measure elapsed time, count external events, or measure external events.
[00377] [00377] In one aspect, control circuit 710 can be programmed to control functions of end actuator 702 based on one or more tissue conditions. The control circuit 710 can be programmed to directly or indirectly detect tissue conditions, such as thickness, as described in this document. Control circuit 710 can be programmed to select a trigger control program or closing control program based on tissue conditions. A trigger control program can describe the distal movement of the displacement member. Different trigger control programs can be selected to better treat different tissue conditions. For example, when thicker tissue is present, control circuit 710 can be programmed to translate the displacement member at a lower speed and / or with a lower power. When a thinner fabric is present, the control circuit 710 can be programmed to move the displacement member at a higher speed and / or with greater power. A closing control program can control the closing force applied to the tissue by the anvil 716. Other control programs control the rotation of the drive shaft 740 and the hinge members 742a, 742b.
[00378] [00378] In one aspect, the 710 control circuit can generate motor setpoint signals. Motor setpoint signals can be provided for various motor controllers 708a through 708e. Motor controllers 708a to 708e can comprise one or more circuits configured to provide motor drive signals for motors 704a to 704e in order to drive motors 704a to 704e, as described in this document. In some instances, motors 704a to 704e may be brushed DC motors. For example, the speed of motors 704a to 704e can be proportional to the respective motor start signals. In some examples, motors 704a to 704e may be brushless DC electric motors, and the respective motor drive signals may comprise a PWM signal provided for one or more stator windings of motors 704a to 704e. In addition, in some instances, motor controllers 708a through 708e can be omitted and control circuit 710 can directly generate motor drive signals.
[00379] [00379] In one aspect, the control circuit 710 can initially operate each of the motors 704a to 704e in an open circuit configuration for a first open circuit portion of the travel of the displacement member. Based on the response of the surgical instrument 700 during the open circuit portion of the stroke, control circuit 710 can select a trigger control program in a closed circuit configuration. The response of the instrument may include a translation of the distance of the displacement member during the open circuit portion, a time elapsed during the open circuit portion, the energy supplied to one of the motors 704a to 704e during the open circuit portion, a sum pulse widths of a motor start signal, etc.
[00380] [00380] In one aspect, motors 704a to 704e can receive power from a 712 power source. Power source 712 can be a DC power source powered by an alternating main power supply, a battery, a super capacitor, or any other suitable power source. Motors 704a to 704e can be mechanically coupled to individual moving mechanical elements such as knife 714, anvil 716, drive shaft 740, hinge 742a and hinge 742b, through the respective transmissions 706a to 706e. Transmissions 706a through 706e may include one or more gears or other connecting components for coupling motors 704a to 704e to moving mechanical elements. A 734 position sensor can detect a knife position
[00381] [00381] In one aspect, control circuit 710 is configured to drive a firing member like knife portion 714 of end actuator 702. Control circuit 710 provides a motor setpoint for motor control 708a, which provides a drive signal for the 704a motor. The output shaft of the motor 704a is coupled to a torque sensor 744a. The torque sensor 744a is coupled to a transmission 706a which is coupled to knife 714. The transmission 706a comprises moving mechanical elements, such as rotating elements, and a firing member for distally and proximally controlling the movement of knife 714 along an axis longitudinal geometric design of end actuator 702. In one aspect, motor 704a can be coupled to the knife gear assembly, which includes a knife gear reduction assembly that includes a first knife drive gear and a second drive gear knife. A torque sensor 744a provides a trigger force feedback signal to control circuit 710. The trigger force signal represents the force required to fire or move knife 714. A position sensor 734 can be configured to provide the knife position 714 along the firing stroke or firing member position as a feedback signal to control circuit 710. End actuator 702 may include additional sensors 738 configured to provide feedback signals to control circuit 710 When ready for use, control circuit 710 can provide a trip signal to the 708a motor control. In response to the trigger signal, motor 704a can drive the trigger member distally along the longitudinal geometry axis of end actuator 702 from an initial proximal position of the stroke to an end distal position of the stroke relative to the initial position of course. As the displacement member moves distally, a knife 714 with a cutting element positioned at a distal end, advances distally to cut the fabric located between the staple cartridge 718 and the anvil 716.
[00382] [00382] In one aspect, control circuit 710 is configured to drive a closing member, such as anvil portion 716 of end actuator 702. Control circuit 710 provides a motor setpoint for 708b motor control , which provides a drive signal for the 704b engine. The output shaft of the motor 704b is coupled to a torque sensor 744b. The torque sensor 744b is coupled to a transmission 706b which is coupled to the anvil 716. The transmission 706b comprises moving mechanical elements, such as rotating elements and a closing member, to control the movement of the anvil 716 between the open and closed positions. In one aspect, the 704b motor is coupled to a closing gear assembly, which includes a closing reduction gear assembly that is supported in gear engaged with the closing sprocket. The 744b torque sensor provides a closing force feedback signal to the control circuit
[00383] [00383] 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 set point for a motor control 708c, which provides a drive signal for motor 704c. The output shaft of the motor 704c is coupled to a torque sensor 744c. 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 rotary elements, to control the rotation of the drive shaft 740 clockwise or counterclockwise until and above 360º. In one aspect, the 704c engine is coupled to the rotary drive assembly, which includes a pipe gear segment that is formed over (or attached to) the proximal end of the proximal closing tube for operable engagement by a rotational gear assembly that is supported operationally on the tool mounting plate. The torque sensor 744c provides a rotation force feedback signal for control circuit 710. The rotation force feedback signal represents the rotation force applied to the drive shaft 740. The position sensor 734 can be configured to provide the position of the closing member as a feedback signal to 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.
[00384] [00384] In a circular stapler implementation, the transmission element 706c is coupled to the trocar to advance or retract the trocar. In one aspect, the drive shaft 740 is part of a closing system comprising a 201904 trocar and a 201906 trocar actuator, as discussed in more detail with reference to Figures 29A to 29 later in this document. Consequently, control circuit 710 controls the control circuit of motor 708c to control motor 704c to advance or retract the trocar. A torque sensor 744c is provided to measure the torque applied by the drive shaft of the 704c motor to the transmission components 706c employed in advancing and retracting the trocar. The position sensor 734 can include a variety of sensors to track the position of the trocar, anvil 716 or knife 714, or any combination thereof. Other sensors 738 can be used to measure a variety of parameters including the position or speed of the trocar, anvil 716 or knife 714, or any combination thereof. The torque sensor 744c, the position sensor 734 and the sensors 738 are coupled to the control circuit 710 as inputs for various processes to control the operation of the surgical instrument 700 in a desired manner.
[00385] [00385] “In one aspect, control circuit 710 is configured to articulate end actuator 702. Control circuit 710 provides a motor setpoint for a 708d motor control, which provides a drive signal for the motor 704d. The output shaft of the 704d motor is coupled to a 744d torque sensor. The torque sensor 744d is coupled to a transmission 706d which is coupled to a pivot member 742a. The 706d transmission comprises moving mechanical elements, such as articulation elements, to control the articulation of the 702 + 65º end actuator. In one aspect, the 704d motor is coupled to a pivot nut, which is rotatably seated on the proximal end portion of the distal column portion and is pivotally driven thereon by a pivot gear assembly. The torque sensor 744d provides a hinge force feedback signal to control circuit 710. The hinge force feedback signal represents the hinge force applied to the end actuator 702. The 738 sensors, as a hinge encoder , can provide the pivoting position of end actuator 702 for control circuit 710.
[00386] [00386] In another aspect, the articulation function of the robotic surgical system 700 may comprise two articulation members, or connections, 742a, 742b. These hinge members 742a, 742b are driven by separate disks at the robot interface (the rack), which are driven by the two motors 708d, 708e. When the separate firing motor 704a is provided, each hinge link 742a, 742b can be antagonistically driven with respect to the other link to provide a resistive holding movement and a load to the head when it is not moving and to provide a movement of articulation when the head is articulated. The hinge members 742a, 742b attach to the head in 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 can be more pronounced with other drive systems for the articulation connection.
[00387] [00387] In one aspect, the one or more motors 704a to 704e may comprise a brushed DC motor with a gearbox and mechanical connections to a firing member, closing member or articulation member. Another example includes electric motors 704a to 704e that operate the moving mechanical elements such as the displacement member, the articulation connections, the closing tube and the drive shaft. An external influence is an excessive and unpredictable influence on things like tissue, surrounding bodies, and friction in the physical system. This external influence can be called drag, which acts in opposition to one of the electric motors 704a to 704e. External influence, such as drag, can cause the functioning of the physical system to deviate from a desired operation of the physical system.
[00388] [00388] In one aspect, the position sensor 734 can be implemented as an absolute positioning system. In one aspect, the position sensor 734 can comprise an absolute rotary magnetic positioning system implemented as a single integrated circuit rotary magnetic position sensor, ASSOSSEQFT, available from Austria Microsystems, AG. The position sensor 734 can interface with the control circuit 710 to provide an absolute positioning system. The position can include multiple Hall effect elements located above a magnet and coupled to a CORDIC processor, also known as the digit by digit method and Volder's algorithm, which is provided to implement a simple and efficient algorithm for calculating hyperbolic and trigonometric functions which only require addition, subtraction, bit shift and table search operations.
[00389] [00389] In one aspect, the control circuit 710 can be in communication with one or more sensors 738. The sensors 738 can be positioned on the end actuator 702 and adapted to work with the surgical instrument 700 to measure the various derived parameters such as the span distance as a function of time, the compression of the tissue as a function of time and the deformation of the anvil as a function of time. The 738 sensors can comprise a magnetic sensor, a magnetic field sensor, a strain gauge, a load cell, a pressure sensor, a force sensor, a torque sensor, an inductive sensor 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 end actuator 702. Sensors 738 may include one or more sensors. Sensors 738 may be located on the staple cartridge platform 718 to determine the location of the tissue using segmented electrodes. The torque sensors 744a to 744e can be configured to detect force such as firing force, closing force, and / or articulation force, among others. Consequently, the control circuit 710 can detect (1) the closing load experienced by the distal closing tube and its position, (2) the trigger member on the rack and its position, (3) which portion of the cartridge blade 718 has tissue in it and (4) the load and position on both articulation rods.
[00390] [00390] In one aspect, the one or more sensors 738 may comprise a stress meter such as, for example, a microstrain meter, configured to measure the magnitude of the stress on the anvil 716 during a clamped condition. The voltage meter provides an electrical signal whose amplitude varies with the magnitude of the voltage. Sensors 738 can comprise a pressure sensor configured to detect a pressure generated by the presence of compressed tissue between the anvil 716 and the staple cartridge 718. Sensors 738 can be configured to detect the impedance of a section of tissue located between the anvil 716 and the staple cartridge 718 which is indicative of the thickness and / or completeness of the fabric located between them.
[00391] [00391] In one aspect, the 738 sensors can be implemented as one or more limit switches, electromechanical devices, solid state switches, Hall effect devices, magneto-resistive devices (MR) giant magneto-resistive devices (GMR), magnetometers , among others. In other implementations, the 738 sensors can be implemented as solid state switches that operate under the influence of light, such as optical sensors, infrared sensors, ultraviolet sensors, among others. In addition, the switches can be solid state devices such as transistors (for example, FET, junction FET, MOSFET, bipolar and the like). In other implementations, the 738 sensors can include driverless electric switches, ultrasonic switches, accelerometers and inertia sensors, among others.
[00392] [00392] In one aspect, sensors 738 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 closing tube and the anvil 716 to detect the closing forces applied by the closing 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 can be positioned at various points of interaction throughout the closing drive system to detect the closing forces applied to the anvil 716 by the closing drive system. The one or more sensors 738 can be sampled in real time during a gripping operation by the processor of the control circuit 710. The control circuit 710 receives sample measurements in real time to provide and analyze information based on time and evaluate, in real time the closing forces applied to the anvil 716.
[00393] [00393] In one aspect, a current sensor 736 can be used to measure the current drawn by each of the 704a to 704e motors. The force required to advance any of the moving mechanical elements such as knife 714, corresponds to the current drained by one of the 704a to 704e motors. The force is converted into a digital signal and supplied to control circuit 710. Control circuit 710 can be configured to simulate the response of the instrument's actual system in the controller software. A displacement member can be actuated to move a knife 714 on end actuator 702 at or near a target speed. The 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 controller (LQR) and / or a adaptive controller, for example. The surgical instrument 700 can include a power source to convert the feedback signal from the feedback controller to a physical input such as housing voltage, pulse width modulation 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 VELOCITY CONTROL TECHNIQUES FOR ROBOTIC SURGICAL INSTRUMENT, filed on June 29, 2017, which is hereby incorporated by reference in its entirety for reference.
[00394] [00394] The surgical instrument 700 may also comprise wired or wireless communication circuits for communication with the central modular communication controller shown in Figures 1 to
[00395] [00395] Figure 22 illustrates a block diagram of a surgical instrument 750 configured to control various functions 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 knife 764, or another suitable cutting element. The surgical instrument 750 comprises an end actuator 752 which may comprise an anvil 766, a knife 764 (including a sharp cutting edge) and a removable staple cartridge 768.
[00396] [00396] The position, movement, displacement and / or translation of a linear displacement member, such as knife 764, can be measured by an absolute positioning system, sensor arrangement and a 784 position sensor. knife 764 is coupled to a longitudinally mobile driving member, the position of knife 764 can be determined by measuring the position of the longitudinally mobile driving member that employs the position sensor 784. Consequently, in the following description, the position, the The displacement and / or translation of the knife 764 can be obtained by the position sensor 784, as described in this document. A control circuit 760 can be programmed to control the translation of the displacement member, such as knife 764. The control circuit 760, in some examples, may comprise one or more microcontrollers, microprocessors or other processors suitable for executing the instructions they make with the processor or processors controlling the displacement member, for example, knife 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 position of knife 764 as determined by position sensor 784 with the timer / counter output. 781 so that the control circuit 760 can determine the position of knife 764 at a specific time (t) in relation to an initial position. The 781 timer / counter can be configured to measure elapsed time, count external events, or measure timeless events.
[00397] [00397] Control circuit 760 can generate a setpoint signal for motor 772. The setpoint signal for motor 772 can be supplied to a 758 motor controller. The 758 motor controller can comprise one or more circuits configured to provide a motor 774 drive signal to motor 754 to drive motor 754, as described in the present invention. In some instances, the 754 motor may be a DC motor with a brushed DC electric motor. For example, the speed of motor 754 can be proportional to the drive signal of motor 774. In some instances, motor 754 can be a brushless DC electric motor and the motor drive signal 774 can comprise a PWM signal provided for a or more motor stator windings 754. In addition, in some examples, motor controller 758 may be omitted, and control circuit 760 can generate motor drive signal 774 directly.
[00398] [00398] The 754 motor can receive power from an energy source
[00399] [00399] In a circular stapler implementation, the transmission element 756 can be coupled to the trocar to advance or retract the trocar, knife 764 to advance or retract knife 764, or anvil 766 to advance or retract anvil 766. These functions can be implemented with a single engine using the appropriate clutch mechanism or can be implemented using separate engines as shown with reference to Figures 21, for example. In one aspect, the 756 transmission is part of a locking system comprising a 201904 trocar and a 201906 trocar actuator as discussed in more detail with reference to Figures 29A to 29C later in this document. Consequently, control circuit 760 controls the control circuit of motor 758 to control motor 754 to advance or retract the trocar. Similarly, motor 754 can be configured to advance or retract knife 764 and to advance or retract anvil 766. A torque sensor can be provided to measure the torque applied by the drive shaft of motor 754 to 756 employed transmission components advancing and retracting the trocar, knife 764 or anvil 766, or combinations thereof. The position sensor 784 can include a variety of sensors to track the position of the trocar, knife 764 or anvil 766, or any combination thereof. Other 788 sensors can be used to measure a variety of parameters including the position or speed of the trocar, knife 764 or anvil 766, or any combination thereof. The torque sensor, the position sensor 784 and the sensors 788 are coupled to the control circuit 760 as inputs for various processes to control the operation of the surgical instrument 750 in a desired manner.
[00400] [00400] The control circuit 760 can be in communication with one or more sensors 788. The sensors 788 can be positioned on the end actuator 752 and adapted to work with the surgical instrument 750 to measure the various derived parameters, such as span distance versus time, tissue compression versus time and anvil effort versus time. The 788 sensors can comprise a magnetic sensor, a magnetic field sensor, a stress meter, a pressure sensor, a force sensor, an inductive sensor such as a eddy current sensor, a resistive sensor, a capacitive sensor, a sensor optical and / or any other sensors suitable for measuring one or more parameters of the 752 end actuator. The 788 sensors may include one or more sensors. In one aspect, the 788 sensors can be configured to determine the position of a trocar from a circular stapler.
[00401] [00401] The one or more sensors 788 may comprise a stress meter, such as a microstrain meter, configured to measure the magnitude of the stress on the anvil 766 during a clamping condition. The voltage meter provides an electrical signal whose amplitude varies with the magnitude of the voltage. The 788 sensors can comprise a pressure sensor configured to detect a pressure generated by the presence of compressed tissue between the anvil 766 and the staple cartridge 768. The 788 sensors can be configured to detect the impedance of a section of tissue located between the anvil 766 and the staple cartridge 768 which is indicative of the thickness and / or completeness of the fabric located between them.
[00402] [00402] The 788 sensors can be configured to measure the forces exerted on the anvil 766 by a closing drive system. For example, one or more sensors 788 may be at a point of interaction between the closing tube and the anvil 766 to detect the closing forces applied by a closing tube to the anvil 766. The forces exerted on the anvil 766 may be representative. of the tissue compression experienced by the tissue section captured between the anvil 766 and the staple cartridge 768. The one or more sensors 788 can be positioned at various points of interaction throughout the closing drive system to detect the closing forces applied anvil 766 by the closing drive system. The one or more 788 sensors can be sampled in real time during a gripping operation by a processor from the 760 control circuit. The 760 control circuit receives sample measurements in real time to provide and analyze time-based information and evaluate, in real time, the closing forces applied to the anvil 766.
[00403] [00403] “A current sensor 786 can be used to measure the current drained by the motor 754. The force required to advance the knife 764 corresponds to the current drained by the motor 754. The force is converted into a digital signal and supplied to the control 760.
[00404] [00404] —The control loop 760 can be configured to simulate the actual system response of the instrument in the controller software. A displacement member can be actuated to move a knife
[00405] [00405] The actual drive system of the surgical instrument 750 is configured to drive the displacement member, cutting member or knife 764, by a brushed DC motor with gearbox and mechanical connections to an articulation system and / or sharp. Another example is the 754 electric motor that operates the displacement member and the articulation drive, for example, from an interchangeable drive shaft assembly. An external influence is an unmeasured and unpredictable influence on things like tissue, surrounding bodies, and friction in the physical system. This external influence can be called drag, which acts in opposition to the 754 electric motor. External influence, like drag, can cause the functioning of the physical system to deviate from a desired operation of the physical system.
[00406] [00406] Several exemplifying aspects are directed to a 750 surgical instrument that comprises a 752 end actuator with motor-driven surgical stapling and cutting implements. For example, a motor 754 can drive a displacement member distally and proximally along a longitudinal geometric axis of end actuator 752. End actuator 752 may comprise a pivot anvil 766 and, when configured for use, a staples 768 positioned on the opposite side of anvil 766. A doctor can hold the tissue between the anvil 766 and the staple cartridge 768, as described in the present invention. When ready to use the 750 instrument, the physician can provide a trigger signal, for example, by pressing a trigger on the 750 instrument. In response to the trigger signal, motor 754 can drive the displacement member distally along the longitudinal geometric axis of the end actuator 752 from a proximal start position to an end position distal from the start position. As the displacement member moves distally, a knife 764 with a cutting element positioned at a distal end, can cut the fabric between the staple cartridge 768 and the anvil 766.
[00407] [00407] In several examples, the surgical instrument 750 may comprise a control circuit 760 programmed to control the distal translation of the displacement member, such as knife 764, for example, based on one or more tissue conditions. The control circuit 760 can be programmed to directly or indirectly detect tissue conditions, such as thickness, as described in this document. Control circuit 760 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 better treat different tissue conditions. For example, when thicker tissue is present, control circuit 760 can be programmed to translate the displacement member at a lower speed and / or with a lower power. When a thinner fabric is present, the control circuit 760 can be programmed to move the displacement member at a higher speed and / or with greater power.
[00408] [00408] In some examples, the control circuit 760 can,
[00409] [00409] The surgical instrument 750 may also comprise wired or wireless communication circuits for communication with the central modular communication controller shown in Figures 1 to
[00410] [00410] Figure 23 is a schematic diagram of a 790 surgical instrument 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 knife 764. The surgical instrument 790 comprises an end actuator 792 that can comprise an anvil 766, a knife 764 and an ink cartridge. removable staples 768 that can be interchanged with an RF 796 cartridge (shown in dashed line).
[00411] [00411] With reference to Figures 21 to 23, in several aspects, sensors 738, 788 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, sensors 738, 788 can be solid state switches that operate under the influence of light, such as optical sensors, infrared sensors, ultraviolet sensors, among others. In addition, the switches can be solid state devices such as transistors (for example, FET, junction FET, MOSFET, bipolar and the like). In other implementations, sensors 738, 788 can include driverless electric switches, ultrasonic switches, accelerometers and inertia sensors, among others.
[00412] [00412] In one aspect, the position sensor 734, 784 can be implemented as an absolute positioning system, which comprises a rotating magnetic absolute positioning system implemented as a single integrated circuit rotary magnetic position sensor, ASSOSSEQFT, available with Austria Microsystems, AG, Austria. The position sensor 734, 784 can interface with the control circuit 760 to provide an absolute positioning system. The position can include multiple Hall effect elements located above a magnet and coupled to a CORDIC processor, also known as the digit by digit method and Volder's algorithm, which is provided to implement a simple and efficient algorithm for calculating hyperbolic and trigonometric functions which only require addition, subtraction, bit shift and table search operations.
[00413] [00413] In one aspect, knife 714, 764 can be implemented as a cutting member comprising a cutting body that operationally supports a fabric cutting blade therein and may additionally include anvil hitches or hinge features and hitch features channel or a base. In one aspect, staple cartridge 718, 768 can be implemented as a standard (mechanical) surgical clamp cartridge, which can be a linear staple cartridge or a circular staple cartridge. In one aspect, the RF cartridge 796 (Figure 23) can be implemented as an RF cartridge. These and other sensor provisions are described in Commonly Owned US Patent Application Serial No. 15 / 628,175, entitled TECHNIQUES FOR ADAPTIVE CONTROL OF MOTOR
[00414] [00414] The position, movement, displacement and / or translation of a linear displacement member, such as knife 714, 764, or anvil 716, 766, can be measured by an absolute positioning system, an arrangement of sensor and a position sensor represented as the position sensor 734, 784. Since knife 714, 764 is coupled to a longitudinally movable drive member, the position of the trocar, knife 714, 764 or anvil 716, 766 can be determined by measuring the position of the movable drive member longitudinally using the position sensor 734, 784. Consequently, in the following description, the position, displacement and / or translation of the trocar, knife 764 or anvil 716, 766 can be achieved by the position sensor 734, 784, as described in this document. A control circuit 710, 760 can be programmed to control the translation of the displacement member, such as the trocar, knife 764, or anvil 716, 766, as described in this document. The control circuit 710, 760, in some examples, may comprise one or more microcontrollers, microprocessors or other suitable processors to execute the instructions that cause the processor or processors to control the displacement member, for example, the trocar, the knife 764, or anvil 716, 766 in the manner described. In one aspect, a timer / counter 731, 781 provides an output signal, such as elapsed time or a digital count, to control circuit 710, 760 to correlate the trocar position, knife 714, 764 or anvil 716, 766 as determined by the position sensor 734, 784 with the timer / counter output 731, 781 so that the control circuit 710, 760 can determine the position of the trocar 714, 764 or the anvil 716, 766 at a specific time ( t) in relation to an initial position. Timer / counter 731, 781 can be configured to measure elapsed time, count external events, or measure eternal events.
[00415] [00415] —The control circuit 710, 760 can generate a 772 engine setpoint signal. The 772 engine setpoint signal (for each engine when multiple engines are used) can be supplied to a 708a engine controller -e, 758. Motor controller 708a-e, 758 may comprise one or more circuits configured to provide a motor 774 drive signal to motor 704a-e, 754 to drive motor 704a-e, 754, as described in this document. In some instances, the 704a-e, 754 motor may be a brushed DC electric motor. For example, the speed of motor 704a-e, 754 can be proportional to the drive signal of motor 774. In some instances, motor 704a-e, 754 may be a brushless DC electric motor and motor drive signal 774 may comprise a pulse width modulation signal provided for one or more motor stator windings 704a-e, 754. In addition, in some instances, motor controller 708a-e, 758 may be omitted, and the control circuit control 710, 760 can generate the motor start signal 774 directly.
[00416] [00416] The 704a-e motor, a battery, a supercapacitor or any other suitable energy source. The motor 704a-e, 754 can be mechanically coupled to the trocar, knife 764 or anvil 716, 766 via a transmission 706a-e, 756. The transmission 706a-e, 756 may include one or more gears or other components of connection for coupling the motor 704a-e, 754 to the trocar, knife 764 or anvil 716, 766. A position sensor 734, 784 can detect a position of the trocar, knife 714, 764 or anvil 716, 766. O position sensor 734, 784 can be or include any type of sensor that is capable of generating position data that indicates a position of trocar 764 or anvil 716, 766. In some examples, position sensor 734, 784 may include a encoder configured to supply a series of pulses to the control circuit 710, 760 according to the trocar, knife 764 or anvil 716, 766 translated distally and proximally. Control circuit 710, 760 can track pulses to determine the position of the trocar, knife 714, 764, or anvil 716, 766. Other suitable position sensors can be used, including, for example, a proximity sensor. Other types of position sensors can provide other signals that indicate the movement of the trocar, knife 764, or anvil 716, 766. In addition, in some examples, the position sensor 734, 784 may be omitted. When motor 704a-e, 754 is a stepper motor, control circuit 710, 760 can track the position of the trocar, knife 714, 764 or anvil 716,
[00417] [00417] The control circuit 710, 760 can be in communication with one or more sensors 738, 788. The sensors 738, 788 can be positioned on the end actuator 702, 752, 792 and adapted to work with the surgical instrument 700, 750, 790 to measure the various derived parameters, such as span distance as a function of time, tissue compression as a function of time and anvil effort as a function of time. The sensors 738, 788 can comprise a magnetic sensor, a magnetic field sensor, a stress meter, a pressure sensor, a force sensor, an inductive sensor such as a eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor and / or any other sensors suitable for measuring one or more parameters of the end actuator 702, 752, 792. Sensors 738, 788 may include one or more sensors.
[00418] [00418] The one or more sensors 738, 788 may comprise a stress meter, such as a microstrain meter, configured to measure the magnitude of the stress on the anvil 716, 766 during a clamped condition. The voltage meter provides an electrical signal whose amplitude varies with the magnitude of the voltage. The sensors 738, 788 can comprise a pressure sensor configured to detect a pressure generated by the presence of compressed tissue between the anvil 716, 766 and the staple cartridge 718, 768. The sensors 738, 788 can be configured to detect the impedance of a section of fabric located between the anvil 716, 766 and the staple cartridge 718, 768 which is indicative of the thickness and / or completeness of the fabric located between them.
[00419] [00419] The sensors 738,788 can be configured to measure the forces exerted on the anvil 716, 766 by the closing drive system. For example, one or more sensors 738, 788 may be at an interaction point between the closing tube and the anvil 716, 766 to detect the closing forces applied by a closing tube to the anvil 716, 766. The forces exerted on the anvil 716, 766 can be representative of the tissue compression experienced by the section of tissue captured between the anvil 716, 766 and the staple cartridge 738, 768. The one or more sensors 738, 788 can be positioned at various points of interaction with the along the closing drive system to detect the closing forces applied to the anvil 716, 766 by the closing drive system. The one or more sensors 738, 788 can be sampled in real time during a gripping operation by a processor portion of the control circuit 710, 760. The control circuit 760 receives sample measurements in real time to provide and analyze information based on in real time and evaluate, in real time, the closing forces applied to the anvil 716, 766.
[00420] [00420] A current sensor 736, 786 can be used to measure the current drained by the motor 704a-e, 754. The force required to advance the trocar, knife 714, 764, or anvil 716, 766 corresponds to the current drained by the motor 704a-e, 754. The force is converted into a digital signal and supplied to the control circuit 710,
[00421] [00421] - Referring to Figure 23, an RF 794 power source is coupled to the end actuator 792 and is applied to the RF 796 cartridge when the RF 796 cartridge is loaded on the end actuator 792 in place of the staple cartridge 768. Control circuit 760 controls the supply of RF energy to the 796 RF cartridge.
[00422] [00422] The surgical instrument 790 may also comprise wired or wireless communication circuits for communication with the central modular communication controller shown in Figures 1 to
[00423] [00423] Additional details are described in US patent application serial number 15 / 636,096, entitled SURGICAL SYSTEM COUPLABLE WITH STAPLE CARTRIDGE AND RADIO FREQUENCY CARTRIDGE, AND METHOD OF USING SAME, filed on June 28, 2017, which is contained in this document incorporated as a reference in its entirety.
[00424] [00424] In some cases, it may be desirable to provide control equipped with a circular stapling instrument motor. The examples below include only an illustrative version of a circular stapling instrument where a single motor can be used to control both the gripping and cutting / stapling of the fabric by means of a single rotary drive. Figure 24 shows an example of a circular stapling instrument equipped with a 201800 engine. The 201800 instrument in this example comprises a 201802 stapling head assembly, a 201804 anvil, a 201806 drive shaft assembly, a 201808 handle assembly and a rotary knob 201812. The 201802 stapling head set selectively attaches to the anvil
[00425] [00425] The 201802 stapling head assembly is operable to hold the fabric, cut the fabric and staple the fabric all in response to a single rotary input communicated through the drive shaft assembly 201806. Consequently, the translated actuation inputs linearly through the drive shaft assembly 201806 are not required for the 201802 staple head assembly, although the 201802 staple head assembly may comprise a translational clutch feature. Just as an example, at least part of the 201802 stapling head assembly can be configured according to at least some of the teachings of US patent application No. 13 / 716,318, entitled "Motor Driven Rotary Input Circular Stapler with Modular End Effector" filed on December 17, 2012, and published as US patent publication No. 2014/0166728, filed on June 19, 2014, the invention of which is hereby incorporated by reference. Other suitable configurations for the 201802 stapling head set will be evident to those skilled in the art, in view of the teachings in this document presented.
[00426] [00426] The 201806 drive shaft assembly couples the 201808 handle set with the 201802 staple head assembly. The 201806 drive shaft assembly comprises a single actuating feature, the 201814 rotary drive actuator shown in Figure 25. The actuator actuator 201814 has the purpose of activating the stapling head assembly 201802 to hold the fabric, cut the fabric and staple the fabric.
[00427] [00427] A 201808 handle set is shown in Figures 25 to 27. The 201808 handle set comprises a 201816 handle housing, a 201818 motor housing, a 201820 motor, a 201822 battery, a 201812 rotary knob and a firing 201826. The 201818 engine housing is positioned inside the 201816 handle housing. The 201816 handle housing comprises ribs (201827, 201828, 201830, 201832) that extend into the 201816 handle housing to support the 201818 engine housing. , as shown in Figure 26. The 201822 battery is positioned proximal to the 201820 engine within the 201818 engine housing. The 201822 battery can be removed from the 201818 engine compartment to be replaced, discarded or recharged. As best seen in Figure 27, the 201822 battery comprises 201834, 201836 electrical contacts that extend distally from the 201822 battery. The 201820 motor comprises 201838, 201840 electrical contacts that extend proximally from the 201820 motor. The electrical contact of the 201836 battery and the electrical contact of the 201840 engine are coupled via a conductive metal strap 201842. A 201844 screw couples the 201842 band to the 201818 engine housing to secure the 201842 band position in relation to the 201818 engine housing. the 201842 band is configured to constantly couple the 201836 battery electrical contact and the 201840 motor electrical contact.
[00428] [00428] “As shown in Figure 27, an electrical contact from the 201846 battery is coupled to a conductive metal strap 201848. The metal strap 201848 is attached to the 201818 motor housing by means of a conductive screw 201854. The electrical contact of the The 201838 engine is coupled to a conductive metal strap 201852. The 201852 metal strap is attached to the 201818 engine housing by means of a 201850 conductive screw. The 201818 engine housing is formed of an electrically insulating material (for example, plastic) and comprises 201856, 201858 ring contacts wrapped around the 201818 motor housing. The 201850, 201854 screws are each coupled with a respective 201856, 201858 ring contact to electrically couple the 201834 battery electrical contact and the motor electrical contact 201838 to ring contacts 201856, 201858, respectively.
[00429] [00429] Another conductive metal strap 201860 is attached to the 201816 handle housing. Each end of the 201860 metal strap forms a respective spring contact 201862, 201864. To the 201818 engine housing, move proximally and / or distally in relation to the case of the 201816 handle for selectively coupling and / or uncoupling the spring contacts 201862, 201864 with the ring contacts 201856, 201858. In particular, when the 201818 engine housing is in a distal position, the 201862 spring contact engages the 201856 ring contact and the 201864 spring contact engages the 201858 ring contact to couple the 201822 battery to the 201820 engine and supply power to the 201820 engine. It should be understood that since the 201862, 201864 spring contacts are part of the same conductive metal strap 201860, and since the contacts 201836, 201840 are already coupled through a band 201866, the engagement between the spring contacts 201862, 201864 and the ring contacts 201856, 201858 completes a ci rcuit between the 201822 battery and the 201820 motor. This positioning is used to provide the motorized actuation of the 201802 stapling head assembly. When the 201818 motor housing is in a proximal position, the spring contacts 201862, 201864 are decoupled from the contacts ring 201856, 201858, so that the 201822 battery is decoupled from the 201820 engine and the 201820 engine does not receive power. This positioning is used to provide the manual actuation of the 201802 stapling head assembly. The annular shape of the 201856, 201858 ring contacts enables proper contact between the 201862, 201864 spring contacts and the 201856, 201858 ring contacts regardless of the angular position of the 201818 engine housing inside the 201816 handle housing. In some versions, the 201860 band may include a break that is coupled with an external key, so that a user can activate the external key to complete the coupling between the 201822 battery and the 201820 engine after the 201818 engine housing is in the distal position.
[00430] [00430] A proximal end of the 201818 motor housing is fixedly attached to the 201812 knob, as shown in Figure 25. In one aspect, the 201812 knob can be coupled to a motor to rotate the 201812 knob. The knob rotary handle 201812 protrudes proximally from the 201816 grip handle and comprises 201868 grooves distally from the 201812 rotary knob. The 201816 handle handle comprises - teeth - corresponding 2018/0 to selectively engage the 201868 grooves. 201812 is pulled and / or pushed to move the 201818 engine housing inside the 201816 handlebar. When the 201812 knob is in a proximal position, the 201868 grooves are disengaged from the 201816 handlebar so that the 201812 knob and the 201818 engine housing are free to rotate in relation to the 201816 handle housing. This positioning is used for provide the manual actuation of the 201802 stapling head assembly. When the 201812 rotary knob is in a distal position, the 201868 grooves engage the corresponding 201870 teeth in the 201816 handle housing to lock the 201812 rotary knob and the 201818 engine housing by turning in relation to the 201816 grip handle. The grooves 201868 and the teeth
[00431] [00431] “An operating mode selection set is positioned distal to the 201818 engine housing inside the 201816 grip housing. As shown in Figures 28A to 28B, the operating mode selection set comprises a first gear 201874 and a second gear 201878, with the first gear 201874 being arranged coaxially and slidably around the second gear 201878. The first gear 201874 comprises square teeth aligned around an internal opening of the first gear 201874. The square teeth define a matrix of circumferentially recesses spaced. The second gear 201878 comprises a drive shaft 201880, grooves 201876 and annular flanges 201882, as shown in Figures 28A to 28B. The 201880 drive shaft has an opening shown distally. The opening presented distally is hexagonal to receive the proximal end 201896 of the actuator actuator 201814, which is also hexagonal (Figure 25). The 201880 drive shaft also has an opening presented proximally (not shown) that is semicircular to complement and receive the 201886 drive shaft that extends distally from the 201820 engine. Other suitable shapes and configurations of 201896, 201886 drive shafts can be used to couple the second gear 201878 to the drive shafts 201896, 201886.
[00432] [00432] “As shown in Figure 28A, the slots 201876 of the second gear 201878 are positioned at a proximal end of the drive shaft 201880 and extend distally. The slots 201876 correspond to the teeth of the first gear 201874, so that the slots 201876 are configured to fit within the defined recesses between the teeth. A pair of annular flanges 201882 is positioned at a distal end of the drive shaft 201880 and extends outwardly to engage an annular rib 201884 which extends into the 201816 handle housing, thereby securing the longitudinal position of the second gear 201878 inside. of the 201816 grip handle. Although the 201884 ring rib fixes the longitudinal position of the second 201878 gear inside the 2001816 handle case, the 201884 ring rib nevertheless allows the second 201878 gear to rotate in relation to the grip handle.
[00433] [00433] The first gear 201874 is positioned around the second gear 201878, as shown in Figures 28A and 28B. The first gear 201874 is fixedly coupled to a distal end of the 201818 engine housing so that the first gear 201874 translates and rotates unitarily with the 201818 engine housing. When the 201818 engine housing is in a proximal position, as shown in Figures 28B, the 201820 engine and the first 201874 gear are also in a proximal position. In this position, the 201886 drive shaft of the 201820 engine is disengaged from the second gear 201878 and the teeth of the first gear 201874 engage the grooves of the second gear 201878. Thus, when the rotary knob 201812 rotates, the 201818 engine housing and the first 201874 gear also rotate. This positioning thus provides the manual actuation of the 201802 stapling head assembly. With the teeth of the first gear 2018784 engaged with the grooves 201876, the rotary knob 201812 thus rotates the second gear 201878 in relation to the 201818 engine housing. the 201818 engine is in a distal position, as shown in Figure 28A, the 201820 engine and the first gear of the 291874 engine are also in a distal position. The 201820 engine is attached to the second gear 201878 by means of the drive shafts 201886, 201880. The first gear 201874 slides over the 201880 drive shaft of the second 201878 gear to disengage the slots 201876. Thus, the rotation of the 201886 drive shaft of the 201820 motor thus rotates the second gear 201878. This positioning thus provides the motorized actuation of the 201802 stapling head assembly. In other words, when the 201812 button and the 201818 motor housing are in a distal position, as shown in Figure 28A, the 201820 engine spins the second gear 201878. When the 201812 button and the 201818 engine housing are in a proximal position, as shown in Figure 28B, the 201812 button rotates the second gear 201878.
[00434] [00434] “Again with reference to Figures 25 to 26, a distal end of the second gear 201878 is coupled to the actuator actuator 201814, so that the rotation of the second gear 201878 turns the actuator actuator 201814. Consequently, when the second gear 201878 is rotated, the actuator actuator 201814 is rotated to adjust the gap span d between the 201804 anvil and the stapling head assembly
[00435] [00435] “When the 201826 firing ring is in a distal position, the 201890 protrusions of the coupling member are positioned inside the 201894 slit of the grip handle
[00436] [00436] As shown in Figure 26, a 201898 wrench is positioned in the 201816 handle housing to align with the 201890 coupling member. When the engine equipped operating mode is selected, the 201898 wrench is configured to electrically couple the 201820 engine and the 201822 battery when the 201898 switch is pressed, and the 201898 switch is configured to electrically decouple the 201820 engine and the 201822 battery when the 201898 switch is not pressed. The 201890 coupling member is configured to engage and press the 201898 key when the 201890 coupling member is rotated.
[00437] [00437] With reference now to Figures 29A to 29C, in the present example, the 201800 instrument comprises a closing system and a triggering system. The closure system comprises a 201904 trocar, a 201906 trocar actuator and a 201812 rotary knob (Figure 24). As previously discussed, the rotary knob 201812 can be coupled to a motor to rotate the rotary knob 201812 clockwise or counterclockwise. The 201804 anvil can be attached to a distal end of the 201904 trocar. The 201812 rotary knob is operable to longitudinally translate the 201904 trocar in relation to the 201802 stapling head assembly, thus translating the 201804 anvil when the 201804 anvil is attached to the 201904 trocar , to hold the fabric between the 201804 anvil and the 201804 stapling head assembly. The firing system comprises a trigger, a trigger actuation assembly, a 201908 actuator actuator and a staple actuator
[00438] [00438] As shown in Figures 29A to 29C, the 201804 anvil is selectively attachable to the 201800 instrument to provide a surface against which the 201902 staples can be curved to staple the material contained between the 201802 stapling head assembly and the anvil 201804. The anvil 201804 of the present example is selectively attachable to a trocar or pointed rod 201904 that extends distally from the 201802 stapling head assembly. With reference to Figures 29A to 29C, the anvil 201804 is selectively attachable via coupling from a 201918 proximal drive shaft of the 201904 anvil to a distal tip of the 201904 trocar. The 201804 anvil comprises a generically circular 201920 anvil head and a 201918 proximal drive shaft that extends proximally from the 201920 anvil head. shown, the proximal drive shaft 201918 comprises a tubular member 201922 having resiliently forced n the retaining clips 201924 to selectively couple the anvil 201804 when trocar 201904, although this is purely optional, and it should be understood that other retention features for attaching the 201804 anvil to trocar 201904 can be used as well. For example, C-clips, claws, thread, pins, stickers, etc. can be used to couple the 201804 anvil to the 201904 trocar. In addition, although the 201804 anvil is described as selectively attachable to the 201904 trocar, in some versions the proximal drive shaft
[00439] [00439] The 201920 anvil head of the present example comprises a plurality of 201936 staple forming pockets formed on a 201940 proximal face of the 201920 anvil head. Consequently, when the 201804 anvil is in the closed position and the 201902 staples are directed outward from the 201802 staple head assembly to the 201936 staple forming pockets, as shown in Figure 29C, the 201938 staples 201902 legs are folded to form the complete staples.
[00440] [00440] With the 201804 anvil as a separate component, it should be understood that the 201804 anvil can initially be inserted and attached to a portion of the 201916 fabric before being attached to the 201802 stapling head assembly. For example, the 201804 anvil can be inserted and attached to a first tubular portion of fabric 201916 while the instrument 201800 is inserted and attached to a second tubular portion of fabric 201916. For example, the first tubular portion of fabric 201916 can be sutured to, or around, a portion of the 201804 anvil, and the second tubular portion of 201916 fabric can be sutured to, or around, the trocar
[00441] [00441] “As shown in Figure 29A, the 201804 anvil is then attached to the 201904 trocar. The 201904 trocar in the present example is shown in a more distal actuated position. Such an extended position for the 201904 trocar can provide a larger area to which the 201916 fabric can be attached prior to fixing the 201804 anvil. In addition, the 20190400 trocar extended position can also provide easier fixing of the 201804 anvil to the 201904 trocar. The 201904 trocar also includes a tapered distal tip. Such a tip may be able to pierce through the fabric and / or assist in the insertion of the 201804 anvil into the 201904 trocar, although the tapered distal tip is merely optional. For example, in other versions, the 201904 trocar may have a blunt tip. In addition, or alternatively, the 201904 trocar may include a magnetic portion (not shown) that can attract the 201804 anvil towards the trocar
[00442] [00442] “When the 201804 anvil is coupled to the 201904 trocar, the distance between a proximal face of the 201804 anvil and a distal face of the 201802 stapling head set defines a span distance d. The 201904 trocar in the present example is translatable longitudinally in relation to the 201802 stapling head assembly via an adjustment button 201812 (Figure 24) located at a proximal end of the 201808 actuator handle assembly (Figure 24), as described in more details below. Consequently, when the anvil 201804 is coupled to the trocar 201904, the rotation of the adjustment knob 201812 increases or reduces the distance of the gap d, the anvil 201804 acting in relation to the stapling head assembly 201802. For example, as shown sequentially in the Figures 29A to 29B, the anvil 201804 is shown acting proximally to the handle set of the actuator 201808 from an open initial position to a closed position, thus reducing the gap distance between the two 201916 fabric portions to be joined . Once the span distance d is brought to a predetermined range, the 201802 stapling head assembly can be triggered, as shown in Figure 29C, to staple and cut the 201916 fabric between the 201804 anvil and the stapling head assembly 201802. The 201802 stapling head set is intended to staple and separate the 201916 fabric, by a trigger on the 201808 actuator handle set, as will be described in more detail below.
[00443] [00443] Still referring to Figures 29A to 29C, a user sutures a portion of the 201916 fabric around the 201944 tubular member so that the 201920 anvil head is located within a portion of the 201916 fabric to be stapled. When the 201916 fabric is attached to the 201804 anvil, the 201924 retaining clips and a portion of the 201922 tubular member protrude out of the 201916 fabric so that the user can attach the 201804 anvil to the 201904 trocar. With 201916 fabric attached to the 201904 trocar and / or to another portion of the 201802 stapling head assembly, the user attaches the 201804 anvil to the 201904 trocar and activates the 201804 anvil proximally towards the 201802 stapling head assembly to reduce the gap distance d. When the 201800 instrument is within the operating range, the user then staples together the ends of the 201916 fabric, thereby forming a tubular portion of the substantially contiguous 201916 fabric.
[00444] [00444] The 201802 stapling head assembly of the present example is coupled to a distal end of the 201806 drive shaft assembly and comprises a tubular housing
[00445] [00445] The circular stapling instruments equipped with motor 201800, 201502, 201532 and 201610 in this document described with reference to Figures 24 to 30 can be controlled using any of the control circuits described in connection with Figures 16 to 23. For example, the control system 470 described with reference to Figure 16. Additionally, the motorized circular stapling instrument 201800, 201502, 201532 and 201610 can be employed in a cloud environment and central controller as described in connection with the Figures 1 to 15. Circular stapler control algorithms
[00446] [00446] In several respects, the present invention provides a motor-equipped stapling device that is configured with circular stapler control algorithms to adjust the force, feed rate, and total stroke of the device's cutting member based on steel least one detected trigger or hold parameter. In another aspect, the cutting member of the device is operable independently of both firing and closing. In yet another aspect, the detected parameter can be a gap of final tissue, the force during closing, the stabilization of tissue deformation, or the force during firing. In still other aspects, the knife drive is capable of being carried out with load control or with stroke control with adjustable limits in the control parameter. Both the maximum applicable force and the total range of the total stroke can be adjusted. The controlled parameter can have secondary limits on the uncontrolled function. In yet another aspect, the advance speed of the cutting member is adjustable at a predefined speed based on the conditions of the device at the beginning of the cut. Adjusting the cutting parameters
[00447] [00447] In one aspect, a stapling device equipped with a motor is configured to adjust the force, the advance speed and the total travel of the cutting member of the device based on at least one detected trigger or grip parameter. In one aspect, the cutting member of the device is operable independently of both firing and closing. In yet another aspect, the detected parameter comprises a final tissue gap, the force during closing, the stabilization of tissue deformation, or the force during firing. In one aspect, the knife drive is configured to be carried out with load control or with stroke control with adjustable limits in the control parameter. For example, both the maximum applicable force and the total general stroke range can be adjusted. The controlled parameter can have secondary limits on the uncontrolled function. In one aspect, the advance speed of the cutting member is adjustable at a predefined rate based on the conditions of the device at the beginning of the cut. Adjustment of direction or closing rate based on detected fixation
[00448] [00448] In several aspects, the direction or closing speed of a circular stapler, or a combination thereof, can be adjusted based on the detected fixation, in relation to the fully fixed state, of the anvil. In one aspect, the present invention provides a digitally enabled circular stapler algorithm for determining the variation of the anvil closing speed at key trocar locations to ensure proper anvil seating in the trocar. Figure 31 is a 201500 diagram of a stapling device equipped with a 201502 motor and a 201504 chart that illustrates the adjustment of the closing speed of a portion of anvil 201514 of the stapling device equipped with a 201502 motor at certain key points along the retraction course of a 2015 trocar, according to at least one aspect of the present invention. The stapling device equipped with a 201502 motor is similar to the motorized circular stapling instrument 201800 in the present document described with reference to Figures 24 to 30, it can be controlled using any of the control circuits described in connection with Figures 16 to 23, and can be employed in a central controller and cloud environment as described in connection with Figures 1 to 15. The anvil 201514 includes an anvil head 201515 and an anvil 201517. The trocar 201510 can be advanced and retracted in direction indicated by the arrow 201516. In one aspect, the closing speed of the anvil 210514 can be adjusted at certain key points along the retraction stroke of the 201510 trocar to improve the final seating of the 201514 anvil in the 201510 trocar if the 201510 trocar is marginally fixed, but not completely fixed to the 2015 anvil.
[00449] [00449] The stapling device equipped with a 201502 motor, shown on the left side of Figure 31, includes a 201506 circular stapling head assembly with a 201508 seating collar that receives the 201510 trocar through it. The 201510 trocar engages the 201514 anvil using a 201512 locking feature. The 210510 trocar is movable, for example, advanced and retracted, in the directions indicated by the 201516 arrow. A cutting element, such as a 201519 knife, cuts the fabric when the circular stapling head assembly 201506 is driven in the direction of the anvil 201514. In one aspect, the closing speed of the anvil 201514 can be adjusted at certain key points along the retraction stroke of the anvil 201510 to, for example, improve the final seating of the 201514 anvil on the 201510 trocar if the 210510 trocar is marginally attached, but not completely attached to the 201514 anvil. Consequently, the closing speed of the 201514 anvil can be varied in key locations to ensure proper seating. The position or displacement of the trocar 210510 as it is advanced or retracted using a trocar actuator coupled to a motor, as previously described with reference to Figures 24 to 30, can be detected by a plurality of proximity sensors arranged along the displacement path of trocar 210510. In some respects, the position or displacement of trocar 210510 can be tracked using the tracking system 480 (Figure 16) or position sensors 734, 784 (Figures 21, 23).
[00450] [00450] On the right side of Figure 31, graph 201504 illustrates the closing speed of the 201514 anvil as a function of the 201510 trocar position at certain key points, identified as "Trocar 5" along the vertical geometric axis and "Vrechnamento MM / S "along the horizontal geometric axis, according to at least one aspect of the present invention. A closing speed profile curve 201505 of the 201514 anvil is plotted as a function of the 201510 trocar position. The closing speed of the 201514 anvil can be slow in a first zone 201518 to ensure proper attachment of the 210510 trocar to the 201514 anvil , faster in a second zone 201520 during closing, slower again in the third zone 201522 to check the fixation, and then even slower in a fourth zone 201524 during the application of a high closing load.
[00451] [00451] Adjusting the closing speed of the 201514 anvil at some key points along the 201510 trocar retraction stroke improves the final seating of the 201514 anvil in the 201510 trocar if marginally fixed but not fully fixed. In the 201510 trocar position the 201514 anvil is in a fully open position 201521 and in the 201510 trocar position of the 201514 anvil is in a completely closed position 201523. Between the 201521 completely open position of the 201510 trocar and the completely closed position 34 the closing speed of the 201514 anvil is adjusted based on the 201510 trocar position. For example, in the first zone 201518, as the 201510 trocar moves from the fully open 201521 position to the first 201510 trocar position 1, the speed closing time of the 201514 anvil is slow (between 0 to 2 mm / s) to ensure proper fixing of the 201514 anvil to the 201510 trocar. In the second zone 201520, when the 201510 trocar moves from õ: to 2, the 201514 anvil is closed at a constant fast closing speed (3 mm / s). When the 201510 trocar moves from position 52 to 3, in the third zone 201522, the closing speed of the 201514 anvil is reduced to verify complete attachment of the 201514 anvil to the trocar
[00452] [00452] Figure 32 is a sectional view of the stapling device equipped with the 201502 motor shown in Figure 31 in a closed configuration, for example, the 201506 circular stapling head assembly advanced towards the 201514 anvil. As shown in Figure 32 , the 201506 circular stapling head assembly and the 201510 trocar are shown in an advanced configuration to hold the fabric in the 210511 fabric gap defined between the 201514 anvil and the 201506 circular stapling head assembly. As described in this document, the trocar 201510 can be advanced or retracted using a motor coupled to, for example, a trocar actuator, as previously described with reference to Figures 24 to 30. A 201519 knife is used to cut the tissue captured between the 201514 anvil and the 201510 trocar The 201519 knife is coupled to a motor, which is configured to advance and retract the 201519 knife. A control circuit is employed to contain roll the engine and to control the forward / reverse speed of the 201510 trocar or the 201519 knife or a combination thereof.
[00453] [00453] Figure 33 is a logic flow diagram of a 201700 process that represents a control program or a logical configuration for adjusting a closing speed of the 201514 anvil portion of the 201502 motor-equipped stapling device at certain key points along the 201510 trocar retraction course, in accordance with at least one aspect of the present invention. This 201700 process can be implemented with any of the control circuits described with reference to Figures 16 to 23. This 201700 process can be implemented in a cloud computing environment or central controller described with reference to Figures 1 to 15, for example.
[00454] [00454] In particular, the 201700 process represented in Figure 33 will now be described with reference to the control circuit 760 in Figure
[00455] [00455] In one aspect, the present invention provides an adaptive algorithm to the digitally enabled circular stapler to determine multidirectional seating movements in the trocar to guide the anvil to proper seating. Figure 34 is a 201530 diagram of a stapling device equipped with a 201532 engine and a 201534 graph illustrating the detection of closing speeds for the 201540 trocar and the 201544 anvil, in accordance with at least one aspect of the present invention. The stapling device equipped with a 201532 motor is similar to the motorized circular stapling instrument 201800 in the present document described with reference to Figures 24 to 30, it can be controlled using any of the control circuits described in connection with Figures 16 to 23, and can be used in a central controller and cloud environment as described in connection with Figures 1 to
[00456] [00456] The stapling device equipped with the 201532 engine, shown on the left side of Figure 34, includes a 201536 circular stapling head assembly with a 201538 seating collar that receives the 201540 trocar through it. The 201540 trocar engages the 201544 anvil using a 201542 locking feature. The 210540 trocar is movable, for example, advanced and retracted, in the directions indicated by the 201546 arrow. A cutting element, such as a 201548 knife, cuts the fabric when the circular stapling head assembly 201536 is driven in the direction of the 201544 anvil.
[00457] [00457] In one aspect, the closing speeds of the 201540 trocar and the 201544 anvil can be detected and any discrepancy between the closing speeds of the two components could generate an automatic extension of the 201540 trocar and then the retraction of the 201540 trocar to fully seat the 201544 anvil on the 201540 trocar. In one aspect, any discrepancy between the closing speeds of the 201540 trocar and the 201544 anvil can be provided to a processor or control circuit to operate a motor coupled to the 201540 trocar to generate an automatic trocar extension 201540 and then retract again to fully seat the 201544 anvil in the trocar
[00458] [00458] “Consequently, the system can be configured for multidirectional settlement movements in the 201540 trocar to activate the 201544 anvil in the proper settlement. For example, if the 201547 anvil stem is detected by releasing the 201540 trocar, the clamping device equipped with the 201530 intelligent motor can be configured to retract or even reverse and advance towards the opening until the 201544 anvil seat instability resolved. If the 201544 anvil is pulled completely out, the clamping device equipped with the smart 201532 motor could still be configured to open completely, telling the user to try to reconnect the 201547 anvil stem to the 201540 trocar.
[00459] [00459] On the right side of Figure 34, the graph 201534 illustrates the 201510 trocar position as a function of time in some key points, identified as "Trocar 5" along the vertical geometric axis and "t" along the geometric axis horizontal, in accordance with at least one aspect of the present invention. A 201549 position profile curve for the 201540 trocar is plotted as a function of time (t). With reference to the 201540 position profile curve of the 201549 trocar, the 201540 trocar moves from a fully open position 201541 to a fully closed position 201543 during a first period 201556 at a rapid closing speed. During a second period 201558, the 201540 trocar moves to the 201547 verification zone, where the 201542 anvil locking feature engages the 201538 seating collar, at a slow speed to verify that the 201542 anvil locking feature has properly engaged the seating collar 201538. In the illustrated example, a separate initiation of the 201544 anvil is detected in time 201552. Upon detecting that the 201544 anvil is detached, the 201540 trocar is advanced towards an open position and returns over a third period 201560 The 201540 trocar then moves slowly over a fourth period 201562 until it is confirmed or verified that the 201544 anvil is attached to the 201540 trocar in time 201554. Then the 201540 trocar moves towards the closed position 201543 very slowly during a fifth period 201564 under high tissue load before knife 201548 if advanced to cut the tissue captured between the 201544 anvil and the conjunct the circular stapling head 201536.
[00460] [00460] Figure 35 is a logic flow diagram of a 201720 process representing a control program or a logical configuration to detect multidirectional settlement movements in the 201540 trocar to trigger the 201544 anvil in proper settlement, according to at least one aspect of the present invention. This 201720 process can be implemented with any of the control circuits in this document described with reference to Figures 16 to 23. This 201720 process can be implemented in a cloud computing environment or central controller described with reference to Figures 1 to 15, for example.
[00461] [00461] In particular, the 201720 process represented in Figure 35 will now be described with reference to the control circuit 760 in Figure
[00462] [00462] In several respects, the knife speed of a circular stapler and the end points can be adjusted based on the detected toughness or thickness of the fabric between the anvil and the cartridge. Consequently, the circular stapler control algorithm can be configured to detect the tissue gap and the force to fire to adjust the knife stroke and speed. In one aspect, the present invention provides an adaptive circular stapler algorithm digitally enabled to detect the fabric gap and firing force to adjust the knife stroke and knife speed, in accordance with at least one aspect of the present invention.
[00463] [00463] In general, Figures 36 to 38 represent a circular stapling device equipped with a 201610 engine and a series of graphs that represent the force to close (FTC) a claw in relation to the position of the anvil 201612 (Ogigorna) and the speed of the knife 201616 (V «) and the strength of the knife 201616 (Fx) in relation to the position of the knife 201616 (araca), according to at least one aspect of the present invention. Using data detected at different points along the length of the 201621 stem, a control algorithm can generate a map of the fabric span or reaction force vector of the 201612 anvil, monitoring a high or low side when compressed in the tissue. When firing, the system measures forces acting on a compression element 201620 comprising a force sensor and adjusts to act uniformly along the force vector of the rod to provide uniform and complete cutting.
[00464] [00464] In particular, Figure 36 is a partial schematic diagram of a circular stapling device equipped with a 201610 engine showing the closure of the 201612 anvil on the left side and the performance of the 201616 knife on the right side, according to at least one aspect of the present invention. The 201610 motor-equipped circular stapling device comprises a 201612 anvil which is movable from a completely open position õa2 to a completely closed position dao. An intermediate position of the represents the point at which the 201612 anvil comes into contact with the tissue located between the 201612 anvil and the 201614 circular stapler. One or more position sensors located along the length of the 201621 anvil rod monitored the position of the anvil 201612. In one aspect, the position sensor may be located within the 201618 seat collar. The compression element 201620 may comprise a force sensor, such as an extensometer, for example, to monitor the force applied to the tissue and detect the stitch initial contact of the 201612 anvil with the tissue, shown as the intermediate position therefrom. The position sensor and the force sensor interface with any of the control circuits in this document described with reference to Figures 16 to 23, for example, which implement the circular stapler control algorithm. The circular stapling device equipped with the 201610 engine also comprises a movable cutting element, such as a 201616 knife, which is movable from a completely retracted position to a fully extended position da2 to obtain a complete fabric cut. The intermediate position of, of knife 201616 represents the point at which knife 201616 comes into contact with the compression element 201620 which comprises an extensometer or other contact or proximity sensor.
[00465] [00465] “The stapling device equipped with a 201610 motor includes motors, sensors and control circuits as described in this document in connection with Figures 16 to 30. The motors are controlled by the control circuits to move the 201612 anvil and the knife 201616. One or more position sensors located in the stapling device equipped with the 201610 engine provide the position of the 201612 anvil and the 201616 knife to the control circuit. Additional sensors such as force sensors 201620 also provide fabric and force contact acting on the 201612 anvil and the 201616 knife for the control circuit. The control circuit uses the position of the anvil 201612, the position of the knife 201616, the contact of the initial tissue, or the actuation of the force of the anvil 201612 or the knife 201616 to implement the circular stapler control algorithm described later in this document in connection with Figure 39.
[00466] [00466] Figure 37 is a 201600 graphical representation of anvil displacement 201612 (Anvil) along the vertical geometric axis as a function of force to close (FTC - "force to close") a claw along the horizontal geometric axis, from according to at least one aspect of the present invention. The vertical line represents a limit of FTC 201606 that indicates the toughness of the fabric. The left side of the FTC 201606 threshold represents the fabric with normal toughness and the right side of the FTC 201606 threshold represents the fabric with high toughness. As the 201612 anvil is retracted from the fully open position dan at the intermediate position of, in which the 201612 anvil initially comes into contact with the tissue, the FTC is substantially low (-O0). As the 201612 anvil continues to close beyond this point towards the circular stapler 201614 to the completely retracted position õ less the thickness of compressed tissue, the FTC is not linear. Each type of fabric, from normal to high toughness, will produce a different FTC curve. For example, the first FTC curve 201604, shown in dashed line, ranges from —O to -100 lbs, where the maximum FTC is below the FTC 201606 limit. The second FTC curve 201602, shown in continuous line, covers from —O at -200 Ibs, where the maximum FTC exceeds the FTC 201606 limit. As previously discussed, the FTC is measured by force sensors located on the compression element 201620 and coupled to the control circuit.
[00467] [00467] Figure 38 is a 201630 graphic representation of the 201616 knife displacement (raca) along the vertical geometric axis as a function of the 201616 knife speed (Vx mm / s) along the left horizontal geometric axis and also as a function of the force of the knife 201616 (Fx Ibs) along the horizontal geometric axis on the right, according to at least one aspect of the present invention. On the left is a 201632 graphical representation of the 201616 knife displacement (hole) along the vertical geometric axis as a function of the 201616 knife speed (Vx mm / s) along the horizontal geometric axis. On the right is a 201634 graphical representation of the 201616 knife displacement (3rac) along the vertical geometric axis as a function of the 201616 knife force (Fx Ibs) along the horizontal geometric axis. The dashed line curves 201638, 20142 in each of the graphic representations 201632, 201634 represent the normal tenacity fabric while the solid line curves 201636, 201640 represent the high tenacity fabric.
[00468] [00468] Moving on to the 201632 graphical representation on the left, for normal toughness fabric, as shown by the knife speed profile on normal toughness fabric 201638, the initial knife speed 201616 for normal toughness fabric starts at a first speed , for example, a little more than 4 mm / s, in the starting position of the oxo knife. The 201616 knife continues at this speed until it reaches the dx knife position: where the 201616 knife comes into contact with the fabric and the 201616 knife slows down as it cuts through the fabric until the 201616 knife reaches the 2x2 position indicating a complete cut and the control circuit for the engine and therefore for the knife 201616. Moving on to the graphical representation 201634 on the right, for the normal toughness fabric, as shown by the knife strength curve on normal toughness fabric 201642, the action of the force on the 201616 knife is 0 lbs in the initial xo knife position and varies non-linearly until the 201616 knife reaches the 2x2 knife position until the cut is complete.
[00469] [00469] “Moving on to the graphical representation 201632 on the left, for the high tenacity fabric, as shown by the knife speed profile on high tenacity fabric 201636, the initial speed of the 201616 knife for high tenacity fabric starts at a second speed , for example, just over 3 mm / s, which is lower compared to the first speed, in the initial xo knife position, which is less than the initial speed for normal toughness fabric. The 201616 knife continues at this speed until reaching the ôx1 knife position where the 201616 knife comes into contact with the fabric. At this point the speed of the 201616 knife starts to decrease non-linearly as it cuts through the fabric for a short knife travel
[00470] [00470] Figure 39 is a logic flow diagram of a 201720 process that represents a control program or a logical configuration to detect the fabric gap and the firing force for adjusting the knife speed and stroke, according to with at least one aspect of the present invention. This 201750 process can be implemented with any of the control circuits described with reference to Figures 16 to 23. This 201750 process can be implemented in a cloud computing environment or central controller described with reference to Figures 1 to 15, for example.
[00471] [00471] In particular, the 201750 process represented in Figure 39 will now be described with reference to the control circuit 760 of Figure 22 and the circular stapling device equipped with motor 201610 shown in Figures 36 to 38. The control circuit 760 monitors 201752 the displacement of the 201612 anvil based on the position feedback received from the position sensor 784. As previously discussed, in one aspect, the position sensor 784 can be embedded in the 201612 anvil stem of the 201612. As the 201612 anvil is displaced, the control circuit 760 monitors 201754 the contact of the 201612 anvil with the fabric positioned between the 201612 anvil and the 201614 circular stapler. In one aspect, the fabric contact can be provided by a force sensor embedded in the compression element 201620. O Force sensor is represented as the sensor elements 788 of the surgical instrument 790 shown in Figure 22. Force sensor 788 is used to monitor 20175 6 the force to close (FTC) a claw, which is the closing force of the anvil 201612 on the fabric positioned between the anvil 201612 and the circular stapler 201614. The control circuit 760 compares 201758 the FTC to a predetermined limit. When the FTC is below the predetermined limit, the control circuit 760 sets the motor speed 754 to advance 201760 to knife 201616 using a normal toughness fabric speed profile 201638 as shown in Figure 38. When the FTC is above the predetermined limit, the control circuit 760 sets the motor speed 754 to advance 201762 to knife 201616 using a high tenacity fabric speed profile 201636 with a peak speed 201644 as shown in Figure 38.
[00472] [00472] Figure 40 is a logical flow diagram of a 201762 process that represents a control program or a logical configuration to advance 201762 the knife 201616 under a high tenacity fabric speed profile 201636 with a peak speed 201644, as shown in Figure 38, in accordance with at least one aspect of the present invention. This 201762 process can be implemented with any of the control circuits described with reference to Figures 16 to 23. This 201750 process can be implemented in a cloud computing environment or central controller described with reference to Figures 1 to 15, for example.
[00473] [00473] In particular, the 201762 process represented in Figure 40 will now be described with reference to the control circuit 760 in Figure 22 and the circular stapling device equipped with motor 201610 shown in Figures 36 to 38. When high tenacity fabric is detected , the control circuit 760 sets 201770 to the initial knife speed 201616 with a lower knife speed compared to the knife speed used to cut the normal toughness fabric. In one respect, a lower knife speed under conditions of high tenacity fabric promotes a better cut. The control circuit 760 monitors 201772 when knife 201616 comes into contact with the fabric. As previously discussed, the contact of the fabric can be provided by a force sensor embedded in the compression element 201620. As shown in Figure 38, when knife 201616 comes into contact with the fabric, knife 201616 naturally slows down. Consequently, once the control circuit 760 detects that the knife 201616 has come into contact with the fabric, the contact of the fabric is detected, the control circuit 760 increases 201774 the speed of the motor 754 to increase the speed of the knife 201616 by cutting through of the fabric. The control circuit 760 monitors 201776 the completion of the cut and maintains 201778 the speed of the 740 engine until the completion of the cut is detected and then for 201780 the 740 engine.
[00474] [00474] Various aspects of the subject described in this document are defined in the following numbered examples:
[00475] [00475] Example 1. A surgical stapling instrument comprising: an end actuator configured to hold a tissue; a cutting member; a motor coupled to the cutting member, the motor being configured to move the cutting member between the first position and the second position; and a control circuit coupled to the motor, the control circuit being configured to: detect a parameter associated with the fixation of the end actuator; and controlling the engine to adjust the torque applied to the cutting member by the engine.
[00476] [00476] Example 2. The surgical stapling instrument, according to Example 1, the cutting member being operable independently of the end actuator.
[00477] [00477] Example 3. The surgical stapling instrument, according to any of Examples 1 and 2, the parameter comprising a tissue gap, a force during the closing of the end actuator, a stabilization of tissue deformation, or a force during shooting, or any combination thereof.
[00478] [00478] Example 4.0 The surgical stapling instrument, according to any of Examples 1 to 3, the control circuit being configured to control the motor to drive the cutting member in a load control mode or in a stroke control mode, according to an adjustable control parameter.
[00479] [00479] Example 5. The surgical stapling instrument, according to any of Examples 1 to 4, and the control circuit is configured to control a feed speed at which the motor drives the cutting member according to conditions as the engine starts to drive the cutting member from the first position.
[00480] [00480] “Example 86.The surgical instrument, according to any of Examples 1 to 5, the control circuit being configured to control the motor to adjust a speed at which the motor drives the cutting member.
[00481] [00481] Example 7.The surgical instrument, according to any of Examples 1 to 6, the control circuit being configured to control the motor to adjust a distance at which the motor drives the cutting member according to the parameter.
[00482] [00482] “Example 8.The surgical instrument, according to any of Examples 1 to 7, the control circuit being configured to control the motor to adjust any combination between torque, speed or distance.
[00483] [00483] Example 9. A surgical stapling instrument comprising: an end actuator configured to hold a tissue; a cutting member; a motor coupled to the cutting member, the motor being configured to move the cutting member between the first position and the second position; and a control circuit coupled to the motor, the control circuit being configured to: detect a parameter associated with the cutting member trip; and controlling the engine to adjust the torque applied to the cutting member by the engine.
[00484] [00484] “Example 10. The surgical stapling instrument, according to Example 9, the cutting member being operable independently of the end actuator.
[00485] [00485] “Example 11. The surgical stapling instrument, according to any of Examples 9 and 10, the parameter comprising a tissue gap, a force during the closing of the end actuator, a stabilization of tissue deformation , or a force during shooting, or any combination thereof.
[00486] [00486] Example 12. The surgical stapling instrument, according to any of Examples 9 to 11, the control circuit being configured to control the motor to drive the cutting member in a load control mode or in a stroke control mode, according to an adjustable control parameter.
[00487] [00487] Example 13. The surgical stapling instrument, according to any of Examples 9 to 12, the control circuit being configured to control a feed speed at which the motor drives the cutting member according to conditions as the engine starts to drive the cutting member from the first position.
[00488] [00488] Example 14. The surgical instrument, according to any of Examples 9 to 13, the control circuit being configured to control the motor to adjust a speed at which the motor drives the cutting member.
[00489] [00489] Example 15. The surgical instrument, according to any of Examples 9 to 14, the control circuit being configured to control the motor to adjust a distance at which the motor drives the cutting member according to the parameter.
[00490] [00490] Example 16. The surgical instrument, according to any of Examples 9 to 15, the control circuit being configured to control the motor to adjust any combination between torque, speed or distance.
[00491] [00491] Example 17. Stapling device equipped with a motor characterized by comprising: a circular stapling head assembly; an anvil; a trocar attached to the anvil and attached to a motor, the motor being configured to advance and retract the trocar; and a control circuit coupled to the engine, the control circuit being configured to: determine a trocar position in one of a plurality of zones; and defining an anvil closing speed based on the determined trocar position.
[00492] [00492] “Example 18. The stapling device equipped with a motor according to Example 17, the plurality of zones comprising: a first zone during fixing the trocar to the anvil; a second zone during the retraction of the trocar and the closing of the anvil; a third zone during the verification of the attachment of the trocar to the anvil; and a fourth zone during the application of a high closing load.
[00493] [00493] “Example 19. The stapling device equipped with a motor according to any of Examples 17 and 18, the control circuit being configured to: adjust the closing speed of the anvil to a first speed when the trocar is in the first zone to ensure proper attachment of the trocar to the anvil; adjust the closing speed of the anvil to a second speed, which is greater than the first speed, when the trocar is in the second position during retraction of the trocar and the closing of the anvil; adjust the closing speed of the anvil to a third speed, which is less than the second speed, to check the attachment of the trocar to the anvil; adjust the closing speed of the anvil to a fourth speed, which is less than the third speed, when the trocar is in the fourth zone during the application of a high closing load.
[00494] [00494] “Example 20. The stapling device equipped with a motor, according to any of Examples 17 to 19, and the control circuit is configured to: determine the closing speed of the trocar; determine the closing speed of the anvil; compare the speed of closing the trocar with the speed of closing the anvil to determine a difference between the speed of closing the trocar and the speed of closing the anvil; and with a difference greater than a predetermined value, extend and retract the trocar to return the anvil.
[00495] [00495] “Example 21. The stapling device equipped with a motor, according to any of Examples 17 to 20, the control circuit being configured to verify the attachment of the trocar to the anvil and decrease the closing speed of the trocar under the load of tissue.
[00496] [00496] Example 22. The stapling device equipped with a motor, according to any of Examples 17 to 21, which further comprises: a knife coupled to the motor; a sensor located on the anvil, the sensor being configured to detect the contact of the tissue and the force applied to the anvil, the sensor being coupled to the anvil, and the control circuit is configured to: monitor the displacement of the anvil; monitor the contact of the fabric with the anvil; monitor a force to close the anvil; compare the strength to close to a predetermined limit; and defining a first initial speed of the knife and advancing the knife in a first speed profile suitable for cutting tissue of normal toughness when the force to close is less than the predetermined limit; or set a second initial speed of the knife and advance the knife in a second speed profile suitable for cutting the high toughness fabric when the force to close is less than the predetermined limit.
[00497] [00497] “Example 23. The stapling device equipped with a motor, according to any of Examples 17 to 22, and to advance the knife in the second speed profile, the control circuit is additionally configured to: define the second initial knife speed to a speed that is less than the first initial knife speed; monitor the knife's contact with the fabric; increase the motor speed to increase the knife speed when contact with the fabric is detected; monitor the completeness of the cut; and block the engine when the completion of the cut is detected.
[00498] [00498] Although several forms have been illustrated and described, it is not the applicant's intention to restrict or limit the scope of the attached claims 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. In addition, the structure of each element associated with the shape can alternatively be described as a means of providing the function performed by the element. In addition, when materials for certain components are described, other materials can be used. It should be understood, therefore, that the preceding description and the appended claims are intended to include all of these modifications, combinations and variations that fall within the scope of the modalities presented. The attached claims are intended to cover all such modifications, variations, alterations, substitutions, modifications and equivalents.
[00499] [00499] The previous detailed description presented various forms of devices and / or processes through the use of block diagrams, flowcharts and / or examples. Although these block diagrams, flowcharts and / or examples contain one or more functions and / or operations, it will be understood by those skilled in the art that each function and / or operation within these block diagrams, flowcharts and / or examples can be implemented, individually and / or collectively, through a wide range of hardware, software, firmware or virtually any combination thereof. Those skilled in the art will recognize, however, that some aspects of the forms in this document described, in whole or in part, can be implemented in an equivalent manner in integrated circuits, such as one or more computer programs running on one or more computers (for example , as one or more programs running on one or more computer systems), as one or more programs running on one or more processors (for example, as one or more programs running on one or more microprocessors), as firmware, or virtually as any combination thereof, and that the design of the circuitry and / or the registration of the code for the software and firmware would be within the scope of practice of the person skilled in the art, in light of this invention. In addition, those skilled in the art will understand that the mechanisms of the subject in this document described can be distributed as one or more program products in a variety of ways and that an illustrative form of the subject in this document described is applicable regardless of the specific type of program. means of signal transmission used to effectively carry out the distribution.
[00500] [00500] The instructions used to program the logic to execute various aspects described can be stored in a memory in the system, such as dynamic random access memory (DRAM), cache, flash memory or other storage. In addition, instructions can be distributed over a network or through other computer-readable media. Thus, machine-readable media can include any mechanism for storing or transmitting information in a machine-readable form (for example, a computer), but is not limited to, floppy disks, optical discs, read-only memory compact disc ( 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 machine-readable tangible storage medium used to transmit information over the Internet via an electrical, optical, acoustic cable or other forms of propagated signals (for example, carrier waves, infrared signals, digital signals , etc.). Consequently, computer-readable non-transitory media includes any type of machine-readable media suitable for storing or transmitting instructions or electronic information in a machine-readable form (for example, a computer).
[00501] [00501] “As used in any aspect of the present invention, the term" control circuit "can refer to, for example, a set of wired circuits, programmable circuits (for example, a computer processor that includes one or more individual instruction processing cores, processing unit, processor, - microcontroller, microcontroller unit, controller, digital signal processor (DSP), programmable logic device (PLD), programmable logic matrix (PLA), or programmable port arrangement in field (FPGA)), state machine circuits, firmware that stores instructions executed by the programmable circuit, and any combination thereof. The control circuit can, collectively or individually, be incorporated as an electrical circuit that is part of a larger system, for example, an integrated circuit (IC), an application-specific integrated circuit (ASIC), an on-chip system (SoC ) desktop computers, laptop computers, tablet computers, servers, smart phones, etc. Consequently, as used in the present invention, "control circuit" includes, but is not limited to, a set of electrical circuits that have at least one discrete electrical circuit, a set of electrical circuits that have at least one integrated circuit, electrical circuits that have at least one integrated circuit for a specific application, electrical circuits that form a general purpose computing device configured by a computer program (for example, a general purpose computer configured by a computer program that at least partially performs the processes and / or devices described in this document, or a microprocessor configured by a computer program that at least partially performs the processes and / or devices described in this document), electrical circuits that form a memory device (for example, forms of access memory random), and / or set of electrical circuits that form a device communications device (for example, a modem, communication key, or optical-electrical equipment). Those skilled in the art will recognize that the subject in this document described can be implemented in an analog or digital way, or in some combination of these.
[00502] [00502] “As used in any aspect of the present invention, the term" logical "can refer to an application, software, firmware and / or circuit - configured to perform any of the aforementioned operations. The software may be incorporated as a software package, code, instructions, instruction sets and / or data recorded on non-transitory, computer-readable storage media. The firmware can be embedded as code, instructions or instruction sets and / or hard coded (for example, non-volatile) data in memory devices.
[00503] [00503] "As used in any aspect of the present invention, the terms" component "," system "," module "and the like may refer to a computer-related entity, be it hardware, a combination of hardware and software, software or running software.
[00504] [00504] “As in the present document used in any aspect, an" algorithm "refers to the self-consistent sequence of steps that lead to the desired result, where a" step "refers to the manipulation of physical quantities and / or logical states that can, although they do not necessarily need to take the form of electrical or magnetic signals that can be stored, transferred, combined, compared and manipulated in any other way. It is common use to call these signs bits, values, elements, symbols, characters, terms, numbers or the like. These terms and similar terms may be associated with the appropriate physical quantities and are merely convenient identifications applied to these quantities and / or states.
[00505] [00505] “A network can include a packet-switched network. Communication devices may be able to communicate with each other using a selected packet switched network communications protocol. An exemplifying communications protocol can include an Ethernet communications protocol that can enable communication using a transmission control protocol / Internet protocol (TCP / IP). The Ethernet protocol may comply with or be compatible with the Ethernet standard published by the Institute of Electrical and Electronics Engineers (IEEE) entitled "IEEE 802.3 Standard", published in December 2008 and / or later versions of this standard. Alternatively or in addition, communication devices may be able to communicate with each other using an X.25 communications protocol. The X.25 communications protocol can conform or be compatible with a standard promulgated by the International Telecommunication Union-Telecommunication Standardization Sector (ITU-T). Alternatively or in addition, communication devices may be able to communicate with each other using a frame-relay communications protocol. The frame-relay communications protocol may conform or be compatible with a standard promulgated by the Consultative Committee. for International Telegraph and Telephone (CCITT) and / or the American National Standards Institute (ANSI). Alternatively or additionally, transceivers may be able to communicate with each other using an ATM communication protocol ("asynchronous transfer mode"). The ATM communication protocol may comply with or be compatible with an ATM standard published by the ATM forum entitled "ATM-MPLS Network Interworking 2.0" published in August 2001, and / or later versions of that standard. Obviously, different and / or post-developed connection-oriented network communication protocols are also contemplated in the present invention.
[00506] [00506] Unless otherwise stated, as is evident from the preceding invention, it is understood that, throughout the preceding invention, discussions using terms such as "processing", or "computation", or "calculation", or " determination ", or" display ", or similar, refer to the action and processes of a computer, or similar electronic computing device, that manipulates and transforms the data represented in the form of physical (electronic) quantities in records and memories of the computer in other data represented in a similar way in the form of physical quantities in the memories or records of the computer, or in other similar devices for storing, transmitting or displaying information.
[00507] [00507] “One or more components in the present invention may be called" configured for "," configurable for "," operable / operational for "," adapted / adaptable for "," capable of "," conformable / conformed for ", etc. . Those skilled in the art will recognize that "configured for" may, in general, cover components in an active state and / or components in an inactive state and / or components in a standby state, except when the context dictates otherwise.
[00508] [00508] The terms "proximal" and "distal" are used in the present invention with reference to a physician who handles the handle portion of the surgical instrument. The term "proximal" refers to the portion closest to the doctor, and the term "distal" refers to the portion located opposite the doctor. It will also be understood that, for the sake of convenience and clarity, spatial terms such as "vertical", "horizontal", "up" and "down" can be used in the present invention with respect to 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.
[00509] [00509] Persons skilled in the art will recognize that, in general, the terms used in this document, and especially in the appended claims (for example, bodies of the appended claims) are generally intended as "open" terms (for example, the term "including" should be interpreted as "including, but not limited to", the term "having" should be interpreted as "having, at least", the term "includes" should be interpreted as "includes, but not limits to ", etc.). It will also be understood by those skilled in the art that, when a specific number of a claim statement entered is intended, that intention will be expressly mentioned in the claim and, in the absence of such mention, no intention will be present. For example, as an aid to understanding, the following appended claims may contain the use of the introductory phrases "at least one" and "one or more" to introduce claim statements. However, the use of such phrases should not be interpreted as implying that the introduction of a claim statement by the indefinite articles "one, ones" or "one, ones" limits any specific claim containing the mention of the claim entered to claims that contain only such a mention, even when the same claim includes the introductory phrases "one or more" or "at least one" and indefinite articles, such as "one, ones" or
[00510] [00510] Furthermore, even if a specific number of an introduced claim statement is explicitly mentioned, those skilled in the art will recognize that that statement must typically be interpreted as meaning at least the number mentioned (for example, the mere mention of "two mentions ", without other modifiers, typically means at least two mentions, or two or more mentions). In addition, in cases where a convention analogous to "at least one of A, B and C, etc." is used, in general this construction is intended to have the meaning in which the convention would be understood (for example, "one 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, Be C together, etc.). In cases where a convention analogous to "at least one of A, B or C, etc." is used, in general this construction is intended to have the meaning in which the convention would be understood (for example, "a system that has at least one of A, B and C "would include, but not be limited to, systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and / or A, B and C together, etc.). It will be further understood by those skilled in the art that typically a disjunctive word and / or phrase presenting two or more alternative terms, whether in the description, in the claims or in the drawings, should be understood as contemplating the possibility of including one of the terms, any of the terms or both terms, except where the context dictates something different. For example, the phrase "A or B" will typically be understood to include the possibilities of "A" or "B" or "A and B".
[00511] [00511] With respect to the attached claims, those skilled in the art will understand that the operations mentioned in them can, in general, be performed in any order. In addition, although several operational flow diagrams are presented in one or more sequences, it must be understood that the various operations can be performed in other orders than those shown, or can be performed simultaneously. Examples of such alternative orderings may include overlapping, merged, interrupted, reordered, incremental, preparatory, supplementary, simultaneous, inverse or other variant orders, unless the context otherwise requires. In addition, terms such as "responsive to", "related to" or other adjectival participles are not intended in general to exclude these variants, unless the context otherwise requires.
[00512] [00512] It is worth noting that any reference to "one (1) aspect", "one aspect", "an exemplification" or "one (1) exemplification", and the like means that a particular feature, structure or feature described in connection with the aspect is included in at least one aspect. Thus, the use of expressions such as "in one (1) aspect", "in one aspect", "in an exemplification", "in one (1) exemplification", in several places throughout this specification does not necessarily refer the same aspect. In addition, specific features, structures or characteristics can be combined in any appropriate way in one or more aspects.
[00513] [00513] “Any patent application, patent, non-patent publication or other description material mentioned in this specification and / or mentioned in any order data sheet is in this document incorporated by reference, to the extent that the embedded materials are not inconsistent with this. Accordingly, and to the extent necessary, the invention as explicitly presented herein replaces any conflicting material incorporated by reference into the present invention. Any material, or portion thereof, taken as in this document incorporated by reference, but which conflicts with the definitions, statements, or other materials of invention present in this document presented will be in this document incorporated only until the point in that there is no conflict between the incorporated material and the existing invention material.
[00514] [00514] In summary, numerous benefits have been described that result from the use of the concepts described in this document. The previously mentioned description of one or more modalities has been presented for purposes of illustration and description. This description is not intended to be exhaustive or to limit the invention to the precise form described. Modifications or variations are possible in light of the above teachings. One or more modalities were chosen and described in order to illustrate the principles and practical application to, thus, allow those skilled in the art to use the various modalities and with various modifications, as they are convenient to the specific use contemplated. It is intended that the claims presented in the annex define the global scope.

权利要求:
Claims (23)
[1]
1. Surgical stapling instrument characterized by comprising: an end actuator configured to hold a tissue; a cutting member; a motor coupled to the cutting member, the motor being configured to move the cutting member between the first position and the second position; and a control circuit coupled to the motor, the control circuit being configured to: detect a parameter associated with the grip of the end actuator; and controlling the engine to adjust the torque applied to the cutting member by the engine.
[2]
2. Surgical stapling instrument, according to claim 1, characterized in that the cutting member is operable independently of the end actuator.
[3]
3. Surgical stapling instrument, according to claim 1, characterized in that the parameter comprises a tissue gap, the force during closing of the end actuator, the stabilization of the tissue deformation, or the force during firing, or any combination of them.
[4]
4. Surgical stapling instrument, according to claim 1, characterized in that the control circuit is configured to control the motor to drive the cutting member in a load control mode or in a stroke control mode, according to with an adjustable control parameter.
[5]
5. Surgical stapling instrument, according to claim 1, characterized in that the control circuit is configured to control an advance speed at which the motor drives the cutting member according to initial conditions as the motor starts to drive the member cutting edge from the first position.
[6]
6. Surgical instrument, according to claim 1, characterized in that the control circuit is configured to control the motor to adjust a speed at which the motor drives the cutting member.
[7]
7. Surgical instrument, according to claim 1, characterized in that the control circuit is configured to control the motor to adjust a distance at which the motor drives the cutting member according to the parameter.
[8]
8. Surgical instrument, according to claim 1, characterized in that the control circuit is configured to control the motor to adjust any combination between torque, speed or distance.
[9]
9. Surgical stapling instrument characterized by comprising: an end actuator configured to hold a tissue; a cutting member; a motor coupled to the cutting member, the motor being configured to move the cutting member between the first position and the second position; and a control circuit coupled to the motor, the control circuit being configured to: detect a parameter associated with the triggering of the cutting member; and controlling the engine to adjust the torque applied to the cutting member by the engine.
[10]
10. Surgical stapling instrument, according to claim 9, characterized in that the cutting member is operable independently of the end actuator.
[11]
11. Surgical stapling instrument, according to claim 9, characterized in that the parameter comprises a tissue gap, the force during closing of the end actuator, the stabilization of the tissue deformation, or the force during firing, or any combination of them.
[12]
12. Surgical stapling instrument, according to claim 9, characterized in that the control circuit is configured to control the motor to drive the cutting member in a load control mode or in a stroke control mode, according to with an adjustable control parameter.
[13]
13. Surgical stapling instrument, according to claim 9, characterized in that the control circuit is configured to control an advance speed at which the motor drives the cutting member according to initial conditions as the motor starts to drive the member cutting edge from the first position.
[14]
14. Surgical instrument according to claim 9, characterized in that the control circuit is configured to control the motor to adjust a speed at which the motor drives the cutting member.
[15]
15. Surgical instrument, according to claim 9, characterized in that the control circuit is configured to control the motor to adjust a distance at which the motor drives the cutting member according to the parameter.
[16]
16. Surgical instrument, according to claim 9, characterized in that the control circuit is configured to control the motor to adjust any combination between torque, speed or distance.
[17]
17. Stapling device equipped with a motor characterized by comprising: a circular stapling head assembly; an anvil; a trocar attached to the anvil and attached to a motor, the motor being configured to advance and retract the trocar; and a control circuit coupled to the engine, the control circuit being configured to: determine a trocar position in one of a plurality of zones; and configuring an anvil closing speed based on the determined trocar position.
[18]
Stapling device equipped with a motor according to claim 17, characterized in that the plurality of zones comprise: a first zone during the attachment of the trocar to the anvil; a second zone during the retraction of the trocar and the closing of the anvil; a third zone during the verification of the attachment of the trocar to the anvil; and a fourth zone during the application of a high closing load.
[19]
19. Stapling device equipped with motor, according to claim 18, characterized in that the control circuit is configured to: adjust the closing speed of the anvil to a first speed when the trocar is in the first zone to ensure proper fixation of the anvil trocar; adjust the closing speed of the anvil to a second speed, which is greater than the first speed, when the trocar is in the second position during retraction of the trocar and the closing of the anvil; adjust the closing speed of the anvil to a third speed, which is less than the second speed, to check the attachment of the trocar to the anvil; adjust the closing speed of the anvil to a fourth speed, which is less than the third speed, when the trocar is in the fourth zone during the application of a high closing load.
[20]
20. Stapling device equipped with motor, according to claim 17, characterized in that the control circuit is configured to: determine the closing speed of the trocar; determine the closing speed of the anvil; compare the speed of closing the trocar with the speed of closing the anvil to determine a difference between the speed of closing the trocar and the speed of closing the anvil; and with a difference greater than a predetermined value, extend and retract the trocar to return the anvil.
[21]
21. Stapling device equipped with a motor, according to claim 17, characterized in that the control circuit is configured to check the attachment of the trocar to the anvil and to decrease the speed of closing the trocar under the fabric load.
[22]
22. Stapling device equipped with a motor according to claim 17, characterized in that it further comprises: a knife coupled to the motor; a sensor located on the anvil, the sensor being configured to detect the contact of the tissue and the force applied to the anvil, the sensor being coupled to the anvil, and the control circuit is configured to: monitor the displacement of the anvil; monitor the contact of the fabric with the anvil; monitor a force to close the anvil; compare the strength to close to a predetermined limit; and configuring a first initial knife speed and advancing the knife in a first speed profile suitable for cutting normal toughness fabric when the force to close is less than the predetermined limit; or set a second initial knife speed and advance the knife in a second speed profile suitable for cutting high toughness fabric when the force to close is less than the predetermined limit.
[23]
23. Stapling device equipped with motor, according to claim 22, characterized in that, to advance the knife in the second speed profile, the control circuit is additionally configured to: adjust the second knife speed starts at a speed that is less than the first initial knife speed; monitor the knife's contact with the fabric; increase the motor speed to increase the knife speed when contact with the fabric is detected; monitor the completeness of the cut; and stop the engine when the completeness of the cut is detected.
o O o = of healthy M 23
EE 2 = Nr s: 2 ”xo
Í ro - Rs as O | this 58 T BL O) DO 1 ES E z o o s s = = a to minutes 53 + º> o o a [88 and 0] s e:. d oO QN - <= Le se
ES 32 In
EE sz s s o oO - & s8 o 8 ae O | << o | EO - se sa go no "
LES T E iZO is o] Ís s oO o oO as = ss Ex 3>
AT Co & LL (RL: E | À À E
EA LS À —— Vo X [Mm QN) 'SS ER x = RI SON | Wo ar SoÍ EN SB “E | = A
UNR MONITOR 135 MODULE -106
IMAGE 158 | - SYSTEM OF
GENERATOR MODULE VIEW 140 | 108 in T 144 143
SYSTEM
ROBOTIC EVACUATION MODULE 126 OF SMOKE 110
128 SUCCIONRIGATION MODULE | |
H
H
H
MODULE OF
INSTRUMENT 1 So INTERSENT N2 MODULE 132 | 136 MATRIX PROCESSOR 134 STORAGE
MODULE OF
MAPPING OPERATING ROOM 133

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同族专利:

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公开号 | 公开日

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WO2019133140A1|2019-07-04|

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EP3505089A2|2019-07-03|

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JP2021509055A|2021-03-18|

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CN111670014A|2020-09-15|

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US20190201034A1|2019-07-04|

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EP3505089A3|2019-09-04|

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WO2019133140A9|2019-09-19|

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

优先权:

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申请号 | 申请日 | 专利标题

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

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

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

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

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

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

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US201862640417P| true| 2018-03-08|2018-03-08|

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US201862640415P| true| 2018-03-08|2018-03-08|

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US62/640,415|2018-03-08|

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US62/640,417|2018-03-08|

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

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US201862650887P| true| 2018-03-30|2018-03-30|

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US201862650898P| true| 2018-03-30|2018-03-30|

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US201862650877P| true| 2018-03-30|2018-03-30|

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US62/650,887|2018-03-30|

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US62/650,877|2018-03-30|

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US62/650,898|2018-03-30|

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US62/650,882|2018-03-30|

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US201862659900P| true| 2018-04-19|2018-04-19|

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US62/659,900|2018-04-19|

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US201862692747P| true| 2018-06-30|2018-06-30|

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US201862692748P| true| 2018-06-30|2018-06-30|

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US201862692768P| true| 2018-06-30|2018-06-30|

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US62/692,747|2018-06-30|

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US62/692,748|2018-06-30|

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US62/692,768|2018-06-30|

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US201862729185P| true| 2018-09-10|2018-09-10|

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US62/729,185|2018-09-10|

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US16/182,240|2018-11-06|

---

US16/182,240|US20190201034A1|2017-12-28|2018-11-06|Powered stapling device configured to adjust force, advancement speed, and overall stroke of cutting member based on sensed parameter of firing or clamping|

---

PCT/US2018/060977|WO2019133140A1|2017-12-28|2018-11-14|Powered stapling device configured to adjust force, advancement speed, and overall stroke of cutting member based on sensed parameter of firing or clamping|

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