ultrasonic energy device that varies the pressure applied by the clamping arm to provide limit press

专利摘要:
The present invention relates to surgical instruments and systems and methods for the use of surgical instruments. A surgical instrument comprises an end actuator comprising an ultrasonic blade and a clamping arm, an ultrasonic transducer and a control circuit. The ultrasonic transducer ultrasonically oscillates the ultrasonic blade in response to a trigger signal from a generator. The end actuator receives electrosurgical energy to weld fabric. The control circuit determines a measure of resonance frequency indicative of a thermally induced change in resonance frequency and a measure of electrical continuity; calculates a weld focal point based on the determined measurements, controls the closure of the clamping arm to vary the pressure applied by the clamping arm to provide a limit control pressure to the fabric loaded on the end actuator, and maintains a gap between the ultrasonic blade and the clamping arm at a point proximal to the proximal end of the tissue. The pressure is varied based on the corresponding welding focal point.
公开号:BR112020013147A2
申请号:R112020013147-4
申请日:2018-11-14
公开日:2020-12-01
发明作者:Jeffrey D. Messerly；Frederick E. Shelton Iv；David C. Yates；Jason L. Harris；James M. Wilson
申请人:Ethicon Llc；
IPC主号:

专利说明:

[001] [001] The present application claims the benefit of the non-provisional patent application US serial number 16 / 182.238, entitled ULTRASO- NIC ENERGY DEVICE WHICH VARIES PRESSURE APPLIED BY
[002] [002] The present application claims priority under 35 of U.S.C. $ 119 (e) of US Provisional Patent Application No. 62 / 729,195, entitled ULTRASONIC ENERGY DEVICE WHICH VARIES PRESSURE AP-
[003] [003] This application claims priority under 35 USC8 $ 119 (e) to US Provisional Patent Application No. 62 / 692,747, entitled SMART ACTIVATION OF AN ENERGY DEVICE BY ANOTHER DEVICE, filed on June 30, 2018, US Provisional Patent Application 62 / 692,748, entitled SMART ENERGY ARCHITECTURER, filed on June 30, 2018 and US Provisional Patent Application 62 / 692,768, entitled SMART ENERGY DEVICES, filed on June 30, 2018, the description of each of which is incorporated herein by reference, in its entirety.
[004] [004] The present application claims priority under 35 U.S.C.8 $
[005] [005] This application also claims priority under 35 US $ 119 (e) of US Provisional Patent Application 62 / 650,898 filed March 30, 2018, entitled CAPACITIVE COU- PLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS, from US Provisional Patent Application serial number 62 / 650,887, entitled SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES, filed on March 30, 2018, from US Provisional Patent Application serial number 62 / 650,882, entitled SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM, filed on March 2018, and US Provisional Patent Application serial number 62 / 650.877, entitled SURGICAL SMOKE EVACUATION SENING AND CONTROLS, filed on March 30, 2018, the description of which is here incorporated by 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 No. 62 / 640,415, entitled ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR, filed on March 8, 2018, the respective description of which is incorporated herein by way of reference, in its entirety.
[007] [007] The present application also claims priority under 35 U.S.C. $ 119 (e) of US Provisional Patent Application serial number 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, deposited
[008] [008] The present description refers to several 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. FIGURES
[009] [009] The various aspects described here, both with regard to the organization and the methods of operation, together with additional objectives and advantages of these, can be better understood in reference to the description presented below, considered together with the drawings in attached as follows.
[0010] [0010] Figure 1 is a block diagram of an interactive surgical system implemented by computer, according to at least one aspect of the present description.
[0011] [0011] Figure 2 is a surgical system that is used to perform a surgical procedure in an operating room, in accordance with at least one aspect of the present description.
[0012] [0012] Figure 3 is a central surgical controller paired with a visualization system, a robotic system and an instrument.
[0013] [0013] Figure 4 is a partial perspective view of a casing of the central surgical controller and a generator module in combination received slidingly in a casing of the central surgical controller, according to at least one aspect of this description.
[0014] [0014] 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 description.
[0015] [0015] Figure 6 illustrates different power bus connectors for a plurality of side anchoring ports of a side modular cabinet configured to receive a plurality of modules, in accordance with at least one aspect of the present description.
[0016] [0016] Figure 7 illustrates a vertical modular cabinet configured to receive a plurality of modules, according to at least one aspect of the present description.
[0017] [0017] Figure 8 illustrates a surgical data network that comprises a central modular communication controller configured to connect modular devices located in one or more operating rooms of a health care facility, or any environment in a hospital. installation of public services specially equipped for surgical operations, to the cloud, in accordance with at least one aspect of this description.
[0018] [0018] Figure 9 illustrates an interactive surgical system implemented by computer, according to at least one aspect of the present description.
[0019] [0019] Figure 10 illustrates a central surgical controller that comprises a plurality of modules coupled to the control tower.
[0020] [0020] Figure 11 illustrates an aspect of a universal serial bus (USB) network central controller device, in accordance with at least one aspect of the present description.
[0021] [0021] 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 at least one aspect of the present description.
[0022] [0022] Figure 13 is a functional module architecture of a cloud computing system, according to at least one aspect of the present description.
[0023] [0023] Figure 14 illustrates a diagram of a surgical system with situational recognition, according to at least one aspect of the present description.
[0024] [0024] Figure 15 is a timeline that represents the situational recognition of a central surgical controller, according to at least one aspect of the present description.
[0025] [0025] Figure 16 is a schematic diagram of a robotic surgical instrument configured to operate a surgical tool described here, in accordance with at least one aspect of the present description.
[0026] [0026] Figure 17 illustrates a block diagram of a surgical instrument programmed to control the distal translation of a displacement member, according to an aspect of the present description.
[0027] [0027] Figure 18 is a schematic diagram of a surgical instrument configured to control various functions, in accordance with at least one aspect of the present description.
[0028] [0028] Figure 19 illustrates an example of a generator, according to at least one aspect of the present description.
[0029] [0029] Figure 20 is a structural view of a generator architecture, according to at least one aspect of the present description.
[0030] [0030] Figure 21 illustrates a generator circuit divided into multiple stages, with a first stage circuit being common to the second stage circuit, according to at least one aspect of the present description.
[0031] [0031] Figure 22 illustrates a diagram of an aspect of a surgical instrument that comprises a feedback system for use with a surgical instrument, according to an aspect of the present description.
[0032] [0032] Figures 23A to 23B are graphs that include a graph of the clamping force as a function of time and an associated graph of a focal clotting / cutting point, in accordance with at least one aspect of the present description.
[0033] [0033] Figures 24A to 24B are graphs that include a graph of the clamping force as a function of the distance from the distal tip of the end actuator and a graph of the blade displacement as a function of the distance from the distal tip, according to the least one aspect of this description.
[0034] [0034] Figure 25 is a graph of a clamping force distribution as a function of several sections along the length of the end actuator, according to at least one aspect of the present description.
[0035] [0035] Figure 26 is a graph of the blade displacement profile as a function of the distance from the distal end of the end actuator, according to at least one aspect of the present description.
[0036] [0036] Figures 27A to 27C are sectional views of the end actuator that illustrate a closing stroke of the end actuator, in accordance with at least one aspect of the present description.
[0037] [0037] Figures 28A to 28C are graphs of the clamping force applied between the blade and the clamping arm as a function of the distance from the distal end of the end actuator corresponding to the sectional views of Figures 27A to 27C, according to at least one aspect of the present description.
[0038] [0038] Figures 29A to 29C are sectional views of the end actuator that illustrate a proximal starting configuration of the closing stroke, in accordance with at least one aspect of the present description.
[0039] [0039] Figures 30A to 30D are sectional views of the end actuator that illustrate a distal starting configuration of the closing stroke and indicate stresses of the associated parts, in accordance with at least one aspect of the present description.
[0040] [0040] Figures 31A to 31D are graphs of the clamping force applied between the ultrasonic blade and the clamping arm as a function of the distance from the distal tip of the end actuator corresponding to the sectional views of Figures 30A to 30D, according to with at least one aspect of the present description.
[0041] [0041] Figures 32A to 32E are sectional views of the end actuator that illustrate a distal starting configuration of the closing stroke and indicate stresses of associated parts, in accordance with at least one aspect of the present description. DESCRIPTION
[0042] [0042] The applicant for the present application holds the following US patent applications, filed on November 6, 2018, the description of which is incorporated herein by reference, in its entirety:
[0043] [0043] and US Patent Application No. 16 / 182,224, entitled SURGI-CAL NETWORK, INSTRUMENT, AND CLOUD RESPONSES BASED ON VALIDATION OF RECEIVED DATASET AND AUTHENTICATION OF ITS SOURCE AND INTEGRITY;
[0044] [0044] and US Patent Application No. 16 / 182,230, entitled SURGI- CAL SYSTEM FOR PRESENTING INFORMATION INTERPRETED FROM EXTERNAL DATA;
[0045] [0045] and US Patent Application No. 16 / 182,233, entitled MODIFI- CATION OF SURGICAL SYSTEMS CONTROL PROGRAMS BASED ON MACHINE LEARNING;
[0046] [0046] and US Patent Application No. 16 / 182,239, entitled ADJUSTMENT OF DEVICE CONTROL PROGRAMS BASED ON STRATIFIED ED CONTEXTUAL DATA IN ADDITION TO THE DATA;
[0047] [0047] and US Patent Application No. 16 / 182,243, entitled SURGI-CAL HUB AND MODULAR DEVICE RESPONSE ADJUSTMENT BA- SED ON SITUATIONAL AWARENESS;
[0048] [0048] and US Patent Application No. 16 / 182,248, entitled DE- TECTION AND ESCALATION OF SECURITY RESPONSES OF SURGICAL INSTRUMENTS TO INCREASING SEVERITY THREATS;
[0049] [0049] and US Patent Application No. 16 / 182,251, entitled INTERACTIVE SURGICAL SYSTEM;
[0050] [0050] and US Patent Application No. 16 / 182,260, entitled AUTOMATED DATA SCALING, ALIGNMENT, AND ORGANIZING BASED ON PREDEFINED PARAMETERS WITHIN SURGICAL NETWORKS;
[0051] [0051] and US Patent Application No. 16 / 182,267, entitled SEN- SING THE PATIENT POSITION AND CONTACT UTILIZING THE MONO-POLAR RETURN PAD ELECTRODE TO PROVIDE SITUATIONAL AWARENESS TO A SURGICAL NETWORK;
[0052] [0052] and US Patent Application No. 16 / 182,249, entitled POWE-RED SURGICAL TOOL WITH PREDEFINED ADJUSTABLE CON- TROL ALGORITHM FOR CONTROLLING END EFFECTOR PARA-METER;
[0053] [0053] and US Patent Application No. 16 / 182,246, entitled ADJUSTMENTS BASED ON AIRBORNE PARTICLE PROPERTIES;
[0054] [0054] and US Patent Application No. 16 / 182,256, entitled AD-JUSTMENT OF A SURGICAL DEVICE FUNCTION BASED ON SITUATIONAL AWARENESS;
[0055] [0055] and US Patent Application No. 16 / 182,242, entitled REAL-TIME ANALYSIS OF COMPREHENSIVE COST OF ALL INSTRU- MENTATION USED IN SURGERY UTILIZING DATA FLUIDITY TO TRACK INSTRUMENTS THROUGH STOCKING AND IN-HOUSE PROCESSES;
[0056] [0056] and US Patent Application No. 16 / 182,255, entitled USAGE AND TECHNIQUE ANALYSIS OF SURGEON / STAFF PERFORMAN- CE AGAINST A BASELINE TO OPTIMIZE DEVICE UTILIZATION AND PERFORMANCE FOR BOTH CURRENT AND FUTURE PROCEDURES;
[0057] [0057] and US Patent Application No. 16 / 182,269, entitled IMAGE CAPTURING OF THE AREAS OUTSIDE THE ABDOMEN TO IM- PROVE PLACEMENT AND CONTROL OF A SURGICAL DEVICE IN USE;
[0058] [0058] and US Patent Application No. 16 / 182,278, entitled COMMUNICATION OF DATA WHERE A SURGICAL NETWORK IS USING CONTEXT OF THE DATA AND REQUIREMENTS OF A RE-CEIVING SYSTEM / USER TO INFLUENCE INCLUSION OR LINKAGE OF DATA AND METADATA TO ESTABLISH CONTINUITY;
[0059] [0059] and US Patent Application No. 16 / 182,290, entitled SUR- GICAL NETWORK RECOMMENDATIONS FROM REAL TIME ANALYSIS OF PROCEDURE VARIABLES AGAINST A BASELINE HIGHLIGHTING DIFFERENCES FROM THE OPTIMAL SOLUTION;
[0060] [0060] and US Patent Application No. 16 / 182,232, entitled CONTROL OF A SURGICAL SYSTEM THROUGH A SURGICAL BARRIER;
[0061] [0061] and US Patent Application No. 16 / 182,227, entitled SUR- GICAL NETWORK DETERMINATION OF PRIORITIZATION OF COMMUNICATION, INTERACTION, OR PROCESSING BASED ON SYSTEM OR DEVICE NEEDS;
[0062] [0062] and US Patent Application No. 16 / 182,231, entitled WIRE- LESS PAIRING OF A SURGICAL DEVICE WITH ANOTHER DEVICE WITHIN A STERILE SURGICAL FIELD BASED ON THE USAGE AND SITUATIONAL AWARENESS OF DEVICES;
[0063] [0063] and US Patent Application No. 16 / 182,229, entitled ADJUS- TMENT OF STAPLE HEIGHT OF AT LEAST ONE ROW OF STAPLES BASED ON THE SENSED TISSUE THICKNESS OR FORCE IN CLOING;
[0064] [0064] and US Patent Application No. 16 / 182,234, entitled STAPLING DEVICE WITH BOTH COMPULSORY AND DISCRETIONARY LOCKOUTS BASED ON SENSED PARAMETERS;
[0065] [0065] and US Patent Application No. 16 / 182,240, entitled POWE- RED STAPLING DEVICE CONFIGURED TO ADJUST FORCE, AD- VANCEMENT SPEED, AND OVERALL STROKE OF CUTTING
[0066] [0066] and US Patent Application No. 16 / 182,235, entitled VARIA- TION OF RADIO FREQUENCY AND ULTRASONIC POWER LEVEL IN COOPERATION WITH VARYING CLAMP ARM PRESSURE TO ACHIEVE PREDEFINED HEAT FLUX OR POWER APPLIED TO TISSUE.
[0067] [0067] The applicant of the present application holds the following US patent applications filed on September 10, 2018, the description of which is incorporated herein by reference in its entirety:
[0068] [0068] and US Provisional Patent Application No. 62 / 729,183, entitled A CONTROL FOR A SURGICAL NETWORK OR SURGICAL NETWORK CONNECTED DEVICE THAT ADJUSTS ITS FUNCTION BASED ON À SENSED SITUATION OR USAGE;
[0069] [0069] and US Provisional Patent Application No. 62 / 729,177, entitled AUTOMATED DATA SCALING, ALIGNMENT, AND ORGANIZING BA- SED ON PREDEFINED PARAMETERS WITHIN A SURGICAL NETWORK BEFORE TRANSMISSION;
[0070] [0070] and 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;
[0071] [0071] and US Provisional Patent Application No. 62 / 729,185, entitled POWERED STAPLING DEVICE THAT IS CAPABLE OF ADJUSTING FORCE, ADVANCEMENT SPEED, AND OVERALL STROKE OF CUT- TING MEMBER OF THE DEVICE BASED ON SENSED PARAMETER OF FIRING OR CLAMPING;
[0072] [0072] and 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 AD-JUSTMENT;
[0073] [0073] and US Provisional Patent Application No. 62 / 729,182, entitled SENSING THE PATIENT POSITION AND CONTACT UTILIZING THE MONO POLAR RETURN PAD ELECTRODE TO PROVIDE SITUATI-ONAL AWARENESS TO THE HUB;
[0074] [0074] and 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;
[0075] [0075] and US Provisional Patent Application No. 62 / 729,195, entitled ULTRASONIC ENERGY DEVICE WHICH VARIES PRESSURE APPLIED BY CLAMP ARM TO PROVIDE THRESHOLD CONTROL PRESSURE - AT A CUT PROGRESSION LOCATION; and
[0076] [0076] and 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.
[0077] [0077] The applicant for this application holds the following US patent applications, filed on August 28, 2018, the description of which is incorporated herein by reference in its entirety:
[0078] [0078] and US Patent Application No. 16 / 115,214, entitled ESTIMATE- TING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR;
[0079] [0079] and US Patent Application, No. 16 / 115,205, entitled TEMPE-RATURE CONTROL OF ULTRASONIC END EFFECTOR AND CONTRROL SYSTEM THEREFOR;
[0080] [0080] and US Patent Application No. 16 / 115,233, entitled RADIO FREQUENCY ENERGY DEVICE FOR DELIVERING COMBINED ELECTRICAL SIGNALS;
[0081] [0081] and US Patent Application No. 16 / 115,208, entitled CON- TROLLING AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO TISSUE LOCATION;
[0082] [0082] and US Patent Application No. 16 / 115,220, entitled CONTRACTING ACTIVATION OF AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO THE PRESENCE OF TISSUE;
[0083] [0083] and US Patent Application No. 16 / 115,232, entitled DETERMINING TISSUE COMPOSITION VIA AN ULTRASONIC SYSTEM;
[0084] [0084] and US Patent Application No. 16 / 115,239, entitled DE-TERMINING THE STATE OF AN ULTRASONIC ELECTROMECHA- NICAL SYSTEM ACCORDING TO FREQUENCY SHIFT;
[0085] [0085] and US Patent Application No. 16 / 115,247, entitled DETERMINING THE STATE OF AN ULTRASONIC END EFFECTOR;
[0086] [0086] and US Patent Application No. 16 / 115,211, entitled SITUATI-ONAL AWARENESS OF ELECTROSURGICAL SYSTEMS;
[0087] [0087] and US Patent Application No. 16 / 115,226, entitled MECHA- NISMS FOR CONTROLLING DIFFERENT ELECTROMECHANICAL SYSTEMS OF AN ELECTROSURGICAL INSTRUMENT;
[0088] [0088] and US Patent Application No. 16 / 115,240, entitled DETECTION OF END EFFECTOR IMMERSION IN LIQUID;
[0089] [0089] and US Patent Application No. 16 / 115,249, entitled INTER-RUPTION OF ENERGY DUE TO INADVERTENT CAPACITIVE COU-PLING;
[0090] [0090] and US Patent Application No. 16 / 115,256, entitled IN-CREASING RADIO FREQUENCY TO CREATE PAD-LESS MONO-POLAR LOOP;
[0091] [0091] and US Patent Application No. 16 / 115,223, entitled BIPO-
[0092] [0092] and US Patent Application No. 16 / 115,238, entitled ACTIVATION OF ENERGY DEVICES.
[0093] [0093] The applicant of the present application holds the following US patent applications, filed on August 23, 2018, the description of which is incorporated herein by reference in its entirety:
[0094] [0094] and US Provisional Patent Application No. 62 / 721,995, entitled CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT AC- CORDING TO TISSUE LOCATION;
[0095] [0095] and US Provisional Patent Application No. 62 / 721,998, entitled SITUATIONAL AWARENESS OF ELECTROSURGICAL SYSTEMS;
[0096] [0096] and US Provisional Patent Application No. 62 / 721,999, entitled INTERRUPTION OF ENERGY DUE TO INADVERTENT CAPACITIVE COUPLING;
[0097] [0097] and US Provisional Patent Application No. 62 / 721,994, entitled BIPOLAR COMBINATION DEVICE THAT AUTOMATICALLY AD- JUSTS PRESSURE BASED ON ENERGY MODALITY; and
[0098] [0098] and US Provisional Patent Application No. 62 / 721,996, entitled RADIO FREQUENCY ENERGY DEVICE FOR DELIVERING COMBI- NED ELECTRICAL SIGNALS.
[0099] [0099] The applicant of the present application holds the following US patent applications, filed on June 30, 2018, the description of each of which is incorporated herein by reference in its entirety:
[00100] [00100] and US Provisional Patent Application No. 62 / 692,747, entitled SMART ACTIVATION OF AN ENERGY DEVICE BY ANOTHER DEVI-CE;
[00101] [00101] and US Provisional Patent Application No. 62 / 692,748, entitled SMART ENERGY ARCHITECTURE; and
[00102] [00102] and US Provisional Patent Application No. 62 / 692,768, entitled SMART ENERGY DEVICES.
[00103] [00103] The applicant for the present application holds the following US patent applications, filed on June 29, 2018, with the description of each of which is incorporated herein by reference in its entirety:
[00104] [00104] and US Patent Application Serial No. 16 / 024,090, entitled CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE AR- RAY ELEMENTS;
[00105] [00105] and US Patent Application Serial No. 16 / 024,057, entitled CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSED CLOSURE PARAMETERS;
[00106] [00106] and US Patent Application Serial No. 16 / 024,067, entitled SYSTEMS FOR ADJUSTING END EFFECTOR PARAMETERS BA- SED ON PERIOPERATIVE INFORMATION;
[00107] [00107] and US Patent Application Serial No. 16 / 024,075, entitled SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING;
[00108] [00108] and US Patent Application Serial No. 16 / 024,083, entitled SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING;
[00109] [00109] and US Patent Application Serial No. 16 / 024,094, entitled SURGICAL SYSTEMS FOR DETECTING END EFFECTOR TISSUE DISTRIBUTION IRREGULARITIES;
[00110] [00110] and US Patent Application Serial No. 16 / 024,138, entitled SYSTEMS FOR DETECTING PROXIMITY OF SURGICAL END EF- FECTOR TO CANCEROUS TISSUE;
[00111] [00111] and US Patent Application Serial No. 16 / 024,150, entitled SURGICAL INSTRUMENT CARTRIDGE SENSOR ASSEMBLIES;
[00112] [00112] and US Patent Application Serial No. 16 / 024,160, entitled VARIABLE OUTPUT CARTRIDGE SENSOR ASSEMBLY;
[00113] [00113] and US Patent Application Serial No. 16 / 024.124, entitled SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE;
[00114] [00114] and US Patent Application Serial No. 16 / 024,132, entitled SURGICAL INSTRUMENT HAVING A FLEXIBLE CIRCUIT;
[00115] [00115] and US Patent Application Serial No. 16 / 024,141, entitled SURGICAL INSTRUMENT WITH A TISSUE MARKING ASSEMBLY;
[00116] [00116] and US Patent Application Serial No. 16 / 024,162, entitled SURGICAL SYSTEMS WITH PRIORITIZED DATA TRANSMISSION CAPABILITIES;
[00117] [00117] and US Patent Application Serial No. 16 / 024,066, entitled SURGICAL EVACUATION SENSING AND MOTOR CONTROL;
[00118] [00118] and US Patent Application Serial No. 16 / 024,096, entitled SURGICAL EVACUATION SENSOR ARRANGEMENTS;
[00119] [00119] and US Patent Application Serial No. 16 / 024,116, entitled SURGICAL EVACUATION FLOW PATHS;
[00120] [00120] and US Patent Application Serial No. 16 / 024,149, entitled SURGICAL EVACUATION SENSING AND GENERATOR CONTROL;
[00121] [00121] and US Patent Application Serial No. 16 / 024,180, entitled SURGICAL EVACUATION SENSING AND DISPLAY;
[00122] [00122] and US Patent Application Serial No. 16 / 024,245, entitled COMMUNICATION OF SMOKE EVACUATION SYSTEM PARAME- TERS TO HUB OR CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM;
[00123] [00123] and US Patent Application Serial No. 16 / 024,258, entitled SMOKE EVACUATION SYSTEM INCLUDING A SEGMENTED CONTRROL CIRCUIT FOR INTERACTIVE SURGICAL PLATFORM;
[00124] [00124] and US Patent Application Serial No. 16 / 024,265, entitled SURGICAL EVACUATION SYSTEM WITH A COMMUNICATION
[00125] [00125] and US Patent Application Serial No. 16 / 024,273, entitled DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS.
[00126] [00126] The applicant for this application holds the following provisional US patent applications, filed on June 28, 2018, with the description of each of which is incorporated herein by reference in its entirety:
[00127] [00127] and US Provisional Patent Application serial number 62 / 691,228, entitled A METHOD OF USING REINFORCED FLEX CIRCUITS WITH MULTIPLE SENSORS WITH ELECTROSURGICAL DEVICES;
[00128] [00128] and US Provisional Patent Application serial number 62 / 691,227, entitled CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSED CLOSURE PARAMETERS;
[00129] [00129] and US Provisional Patent Application Serial No. 62 / 691,230, entitled SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE;
[00130] [00130] and US Provisional Patent Application serial number 62 / 691,219, entitled SURGICAL EVACUATION SENSING AND MOTOR CONTRROL;
[00131] [00131] and US Provisional Patent Application serial number 62 / 691,257, entitled COMMUNICATION OF SMOKE EVACUATION SYSTEM PARAMETERS TO HUB OR CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM;
[00132] [00132] and US Provisional Patent Application serial number 62 / 691,262, entitled SURGICAL EVACUATION SYSTEM WITH A COMMUNICATION-
[00133] [00133] and US Provisional Patent Application serial number 62 / 691,251, entitled DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS.
[00134] [00134] The applicant for the present application holds the following provisional US patent applications, filed on April 19, 2018, with the description of each of which is incorporated herein by reference, in its entirety:
[00135] [00135] and US Provisional Patent Application serial number 62 / 659,900, entitled METHOD OF HUB COMMUNICATION.
[00136] [00136] The applicant of the present application holds the following provisional US patent applications, filed on March 30, 2018, the description of each of which is incorporated herein by reference in its entirety:
[00137] [00137] and US Provisional Patent Application No. 62 / 650,898 deposited
[00138] [00138] and US Provisional Patent Application serial number 62 / 650,887, entitled SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES;
[00139] [00139] and US Provisional Patent Application serial number 62 / 650,882, entitled SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM; and
[00140] [00140] and US Provisional Patent Application serial number 62 / 650,877, entitled SURGICAL SMOKE EVACUATION SENSING AND CONTRROLS.
[00141] [00141] The applicant of the present application holds the following US patent applications, filed on March 29, 2018, the description of each of which is incorporated herein by reference in its entirety:
[00142] [00142] and US Patent Application Serial No. 15 / 940,641, entitled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNTI- CATION CAPABILITIES;
[00143] [00143] and US Patent Application Serial No. 15 / 940,648, entitled INTERACTIVE SURGICAL SYSTEMS WITH CONDITION HANDLING OF DEVICES AND DATA CAPABILITIES;
[00144] [00144] and US Patent Application Serial No. 15 / 940,656, entitled SURGICAL HUB COORDINATION OF CONTROL AND COMMUNICATION OF OPERATING ROOM DEVICES;
[00145] [00145] and US Patent Application Serial No. 15 / 940,666, entitled SPATIAL AWARENESS OF SURGICAL HUBS IN OPERATING RO-WHO;
[00146] [00146] and US Patent Application Serial No. 15 / 940,670, entitled COOPERATIVE UTILIZATION OF DATA DERIVED FROM SECON- DARY SOURCES BY INTELLIGENT SURGICAL HUBS;
[00147] [00147] and US Patent Application Serial No. 15 / 940,677, entitled SURGICAL HUB CONTROL ARRANGEMENTS;
[00148] [00148] and US Patent Application Serial No. 15 / 940,632, entitled DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD;
[00149] [00149] and US Patent Application Serial No. 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;
[00150] [00150] and US Patent Application Serial No. 15 / 940,645, entitled SELF DESCRIBING DATA PACKETS GENERATED AT AN ISSUING INSTRUMENT;
[00151] [00151] and US Patent Application Serial No. 15 / 940,649, entitled DATA PAIRING TO INTERCONNECT A DEVICE MEASURED PARAMETER WITH AN OUTCOME;
[00152] [00152] and US Patent Application Serial No. 15 / 940,654, entitled SURGICAL HUB SITUATIONAL AWARENESS;
[00153] [00153] and US Patent Application Serial No. 15 / 940,663, entitled SURGICAL SYSTEM DISTRIBUTED PROCESSING;
[00154] [00154] and US Patent Application Serial No. 15 / 940,668, entitled AGGREGATION AND REPORTING OF SURGICAL HUB DATA;
[00155] [00155] and US Patent Application Serial No. 15 / 940,671, entitled SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER;
[00156] [00156] and US Patent Application Serial No. 15 / 940,686, entitled DISPLAY OF ALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LI-NEAR STAPLE LINE;
[00157] [00157] and US Patent Application Serial No. 15 / 940,700, entitled STERILE FIELD INTERACTIVE CONTROL DISPLAYS;
[00158] [00158] and US Patent Application Serial No. 15 / 940,629, entitled COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS;
[00159] [00159] and US Patent Application Serial No. 15 / 940,704, entitled USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT;
[00160] [00160] and US Patent Application Serial No. 15 / 940,722, entitled CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OF MONO-CHROMATIC LIGHT REFRACTIVITY;
[00161] [00161] and US Patent Application Serial No. 15 / 940,742, entitled DUAL CMOS ARRAY IMAGING;
[00162] [00162] and US Patent Application Serial No. 15 / 940,636, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVI-CES;
[00163] [00163] and US Patent Application Serial No. 15 / 940,653, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL HUBS;
[00164] [00164] and US Patent Application Serial No. 15 / 940,660, entitled CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER;
[00165] [00165] and US Patent Application Serial No. 15 / 940,679, entitled CLOUD-BASED MEDICAL ANALYTICS FOR LINKING OF LOCAL USAGE TRENDS WITH THE RESOURCE ACQUISITION BEHA-VIORS OF LARGER DATA SET;
[00166] [00166] and US Patent Application Serial No. 15 / 940,694, entitled CLOUD-BASED MEDICAL ANALYTICS FOR MEDICAL FACILITY SEGMENTED INDIVIDUALIZATION OF INSTRUMENT FUNCTION;
[00167] [00167] and US Patent Application Serial No. 15 / 940,634, entitled CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AU-THENTICATION TRENDS AND REACTIVE MEASURES;
[00168] [00168] and US Patent Application Serial No. 15 / 940,706, entitled DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK;
[00169] [00169] and US Patent Application Serial No. 15 / 940,675, entitled CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES;
[00170] [00170] and US Patent Application Serial No. 15 / 940,627, entitled DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLAT-FORMS;
[00171] [00171] and US Patent Application Serial No. 15 / 940,637, entitled COMMUNICATION ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;
[00172] [00172] and US Patent Application Serial No. 15 / 940,642, entitled CONTROLS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;
[00173] [00173] and US Patent Application Serial No. 15 / 940,676, entitled AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGI-CAL PLATFORMS;
[00174] [00174] and US Patent Application Serial No. 15 / 940,680, entitled CONTROLLERS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;
[00175] [00175] and US Patent Application Serial No. 15 / 940,683, entitled COOPERATIVE SURGICAL ACTIONS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;
[00176] [00176] and US Patent Application Serial No. 15 / 940,690, entitled DISPLAY. ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; and
[00177] [00177] and US Patent Application Serial No. 15 / 940,711, entitled SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS.
[00178] [00178] The applicant for this application holds the following provisional US patent applications, filed on March 28, 2018, the description of each of which is incorporated herein by reference in its entirety:
[00179] [00179] and US Provisional Patent Application serial number 62 / 649,302, entitled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES;
[00180] [00180] and US Provisional Patent Application serial number 62 / 649,294, entitled DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD;
[00181] [00181] and US Provisional Patent Application serial number 62 / 649,300, entitled SURGICAL HUB SITUATIONAL AWARENESS;
[00182] [00182] and US Provisional Patent Application Serial No. 62 / 649,309, entitled SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER;
[00183] [00183] and US Provisional Patent Application serial number 62 / 649,310, entitled COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS;
[00184] [00184] and US Provisional Patent Application serial number 62 / 649,291, entitled USE OF LASER LIGHT AND RED-GREEN-BLUE COLORING TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT;
[00185] [00185] and US Provisional Patent Application serial number 62 / 649,296, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGI-CAL DEVICES;
[00186] [00186] and US Provisional Patent Application serial number 62 / 649,333, entitled CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATI- ON AND RECOMMENDATIONS TO A USER;
[00187] [00187] and US Provisional Patent Application serial number 62 / 649,327, entitled CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES;
[00188] [00188] and US Provisional Patent Application serial number 62 / 649,315, entitled DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK;
[00189] [00189] and US Provisional Patent Application serial number 62 / 649,313, entitled CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES;
[00190] [00190] and US Provisional Patent Application serial number 62 / 649,320,
[00191] [00191] and US Provisional Patent Application serial number 62 / 649,307, entitled AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; and
[00192] [00192] and US Provisional Patent Application serial number 62 / 649,323, entitled SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS.
[00193] [00193] The applicant of the present application holds the following provisional US patent applications, filed on March 8, 2018, with the description of each of which is incorporated herein by reference in its entirety:
[00194] [00194] and US Provisional Patent Application serial number 62 / 640,417, entitled TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR; and
[00195] [00195] and US Provisional Patent Application serial number 62 / 640,415, entitled ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR.
[00196] [00196] The applicant for this application holds the following provisional US patent applications, filed on December 28, 2017, the description of which is incorporated herein by reference in its entirety:
[00197] [00197] and US Provisional Patent Application serial number 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM;
[00198] [00198] and US Provisional Patent Application serial number 62 / 611,340, entitled CLOUD-BASED MEDICAL ANALYTICS; and
[00199] [00199] and US Provisional Patent Application serial number 62 / 611,339, entitled ROBOT ASSISTED SURGICAL PLATFORM.
[00200] [00200] Before explaining in detail the various aspects of surgical instruments and generators, it should be noted that the illustrative examples are not limited, in terms of application or use, to the details of construction and arrangement of parts illustrated in the descriptions in the attached description. Illustrative examples can be implemented or incorporated in other aspects, variations and modifications, and can be practiced or executed in several ways. In addition, except where otherwise indicated, the terms and expressions used in the present invention have been chosen for the purpose of describing illustrative examples for the convenience of the reader and not for the purpose of limiting it. In addition, it should be understood that one or more of the aspects, expressions of aspects, and / or examples described below can be combined with any one or more among the other aspects, expressions of aspects and / or examples described a follow. Central surgical controllers
[00201] [00201] With reference to Figure 1, an interactive surgical system implemented by computer 100 includes one or more surgical systems 102 and a cloud-based system (for example, cloud 104 which may include a remote server 113 coupled to a device. storage volume 105). Each surgical system 102 includes at least one central surgical controller 106 in communication with the number 104 which can include a remote server 113. In one example, as shown in Figure 1, the surgical system 102 includes a visualization 108, a robotic system 110, a handheld and intelligent surgical instrument 112, which are configured to communicate with each other and / or the central controller 106. In some respects, a surgical system 102 may include an M number of central controllers 106, an N number of display systems 108, an O number of robotic systems 110 and a P number of smart hand-held surgical instruments 112, where M, NO and P are integers greater than or equal to one.
[00202] [00202] In several respects, smart instruments 112, as described in the present invention with reference to Figures 1 to 7, can be implemented as ultrasonic surgical instruments and combined energy surgical instruments 7012, as described in Figures 23A a 23B, 24A to 24B, 25 to 26, 27A to 27C, 28A to 28C, 29A to 29C, 30A to 30D, 31A to 31D, 32A to 32E. Intelligent instruments 112 (eg devices 1a to 1n) as ultrasonic / combined surgical instruments 7012, as described in Figures 23A to 23B, 24A to 24B, 25 to 26, 27A to 27C, 28A to 28C, 29A at 29C, 30A at 30D, 31A at 31D, 32A at 32E, are configured to operate on a 201 surgical data network, as described with reference to Figure 8.
[00203] [00203] Figure 2 shows an example of a surgical system 102 that is used to perform a surgical procedure on a patient who is lying on an operating table 114 in a surgical operating room 116. A robotic system 110 is used in the surgical procedure as a part of the surgical system 102. The robotic system 110 includes a surgeon console 118, a patient car 120 (surgical robot) and a robotic central surgical controller 122. The patient car 120 can handle at least one tool removably coupled surgical procedure 117 through a minimally invasive incision in the patient's body while the surgeon views the surgical site through the surgeon's console 118. An image of the surgical site can be obtained by a medical imaging device 124, which can be manipulated by the patient's car 120 to guide the imaging device 124. The robotic central controller 122 can be used to process the images of the cir urgent for subsequent display to the surgeon via the surgeon's console 118.
[00204] [00204] Other types of robotic systems can readily be adapted for use with the surgical system 102. Various examples of robotic systems and surgical instruments that are suitable for use with the present description are described in provisional patent application no. 62 / 611,339, entitled ROBOT ASSISTED SURGICAL PLATFORM, filed on December 28, 2017, the description of which is hereby incorporated by reference in its entirety for reference.
[00205] [00205] Several examples of cloud-based analysis that are performed by cloud 104, and are suitable for use with the present description, are described in US Provisional Patent Application Serial No. 62 / 611.340, entitled CLOUD-BASED MEDICAL ANALYTICS, filed on December 28, 2017, the description of which is incorporated here for reference, in its entirety.
[00206] [00206] In several respects, the imaging device 124 includes at least one image sensor and one or more optical components. Suitable image sensors include, but are not limited to, load-coupled device (CCD) sensors and complementary metal oxide semiconductor (CMOS) sensors.
[00207] [00207] 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 targeted to illuminate portions of the surgical field. The one or more image sensors can receive reflected or refracted light from the surgical field, including reflected or refracted light from the tissue and / or surgical instruments.
[00208] [00208] 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.
[00209] [00209] 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 infrared (IR), microwaves, invisible electromagnetic radio radiation. Wavelengths shorter than about 380 nm are shorter than the ultraviolet spectrum, and they become invisible ultraviolet, x-ray, and gamma-ray electromagnetic radiation.
[00210] [00210] 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 description include, but are not limited to, an arthroscope, angioscope, bronchoscope, choledocoscope, colonoscope, cytoscope, duodenoscope, enteroscope, esophagus-duodenoscope (gastro-scope), endoscope, laryngoscope, nasopharyngoscope, sigmoidoscope, thoracoscope and ureteroscope.
[00211] [00211] 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 by using instruments that are sensitive to specific wavelengths, including light from frequencies beyond the visible light range, for example, IR and ultraviolet light. Spectral images can allow for the extraction of additional information that the human eye cannot capture with its receptors for the colors red, green, and blue. The use of
[00212] [00212] It is axiomatic that strict sterilization of the operating room and surgical equipment is necessary during any surgery. The strict hygiene and sterilization conditions required in an "operating room", that is, an operating or treatment room, justify the highest possible sterilization of all medical devices and equipment. Part of this sterilization process is the need to sterilize anything that comes into contact with the patient or enters the sterile field, including the imaging device 124 and its connectors and components. It will be understood that the sterile field can be considered a specified area, such as inside a tray or on a sterile towel, which is considered free of microorganisms, or the sterile field can be considered an area, immediately around a patient, who was prepared to perform a surgical procedure. The sterile field may include members of the brushing team, who are properly dressed, and all furniture and accessories in the area.
[00213] [00213] In several aspects, the visualization system 108 includes one or more imaging sensors, one or more image processing units, one or more storage matrices and one or more screens that are strategically arranged in relation to to the sterile field, as illustrated in Figure 2. In one aspect
[00214] [00214] 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, central controller 106 can have visualization system 108 display an instant of a surgical site, as recorded by an imaging device 124, on a non-sterile screen 107 or 109, while transmitting to the live from the surgical site on the main screen
[00215] [00215] In one aspect, the central controller 106 is also configured to route an entry or diagnostic feedback by a non-sterile operator in the viewing tower 111 to the primary screen 119 within the sterile field, where it can be seen by 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 the main screen.
[00216] [00216] With reference to Figure 2, a surgical instrument 112 is being used in the surgical procedure as part of the surgical system 102. The central controller 106 is also configured to coordinate the flow of information to a screen of the surgical instrument 112. For For example, the flow of coordinated information is further described in US Provisional Patent Application Serial No. 62 / 611.341, entitled INTERACTIVE SURGICAL PLATFORM, deposited on December 28, 2017, the content of which is incorporated herein as reference, in its entirety. An entry or diagnostic feedback inserted by a non-sterile operator in the viewing tower 111 can be routed by the central controller 106 to the screen of the surgical instrument 115 in the sterile field, where it can be seen by the operator of the surgical instrument 112. Exemplary surgical instruments that are suitable for use with surgical system 102 are described under the heading "Hardware of Surgical Instruments" in US Provisional Patent Application Serial No. 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, whose description is incorporated here for reference, in its entirety, for example.
[00217] [00217] 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 (which may include a monopolar generator 142, a bipolar generator 144 and / or an ultrasonic generator 143), a communication module 130, a processor module 132 and a storage matrix 134 In some respects, as shown in Figure 3, the central controller 106 additionally includes a smoke evacuation module
[00218] [00218] “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 central controller 136 offers a unified environment for managing power, data and fluid lines, which reduces the frequency of entanglement between such lines.
[00219] [00219] The aspects of the present description present a central surgical controller for use in a surgical procedure that involves the application of energy to the tissue at a surgical site. The central surgical controller includes a central controller housing and a combination generator module received slidingly 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 the particles generated by applying therapeutic energy to the tissue and a fluid line that extends from the remote surgical site to the smoke evacuation component.
[00220] [00220] 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.
[00221] [00221] Certain surgical procedures may require the application of more than one type of energy to the tissue. One type of energy may be more beneficial for cutting the fabric, while another type of energy may be more beneficial for sealing the fabric. For example, a bipolar generator can be used to seal the tissue while an ultrasonic generator can be used to cut the sealed tissue. Aspects of the present description present a solution in which a modular housing of the central controller 136 is configured to accommodate different generators and facilitate interactive communication between them. One of the advantages of the modular housing of the central controller 136 is that it allows quick removal and / or replacement of several modules.
[00222] [00222] - Aspects of the present description present a modular surgical wrap for use in a surgical procedure that involves applying energy to the tissue. The modular surgical enclosure 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.
[00223] [00223] In addition to the above, the modular surgical casing 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 anchoring station that comprises it has a second anchor port that includes second power and data contacts, the second power generator module being slidingly movable in an electrical coupling with the power and data contacts, and the second module The power generator is slidably movable out of the electrical coupling with the second power and data contacts.
[00224] [00224] In addition, the modular surgical enclosure also includes a communication bus between the first docking port and the second docking port, configured to facilitate communication between the first power generating module and the second power generating module .
[00225] [00225] “With reference to Figures 3 to 7, aspects of the present description are presented for a modular housing of the central controller 136 that allows the modular integration of a generator module 140, a smoke evacuation module 126 and a suction / irrigation module 128. The modular housing of central controller 136 further facilitates interactive communication between modules 140, 126, 128. As illustrated in Figure 5, generator module 140 can be a generator module with components integrated monopolar, bipolar and ultrasonic units, supported in a single enclosure unit 139 slidably insertable in the central housing of the central controller 136. As shown in Figure 5, generator module 140 can be configured to connect to a monopolar device 146 , a bipolar device 147 and an ultrasonic device 148. Alternatively, generator module 140 may comprise a series of single-phase generator modules
[00226] [00226] In one aspect, the modular housing of the central controller 136 comprises a modular power and a rear communication board 149 with external and wireless communication heads to allow the removable fixing of modules 140, 126, 128 and the - interactive communication between them.
[00227] [00227] In one aspect, the modular housing of the central controller 136 includes docking stations, or drawers, 151, here also called drawers, which are configured to receive modules 140, 126, 128 in a sliding manner. Figure 4 illustrates a partial perspective view of a central surgical controller housing 136 and a combined generator module 145 slidably received at a docking station 151 of the central surgical controller housing 136. An anchoring port 152 with contacts of power and data on a rear side of the combined generator module 145 is configured to engage a corresponding docking port 150 with power and data contacts from a corresponding docking station 151 of the modular housing of the central controller 136 according to the module combined generator 145 is slid into position at the corresponding docking station 151 of the modular housing of central controller 136. In one aspect, the generator module with binado 145 includes a bipolar, ultrasonic and monopolar module and a smoke evacuation module integrated in a single cabinet unit 139, as shown in Figure 5.
[00228] [00228] In several respects, the smoke evacuation module
[00229] [00229] 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 suction of fluids to and from the surgical site.
[00230] [00230] In one aspect, the surgical tool includes a drive shaft that has an end actuator at a distal end of it and at least an energy treatment associated with the end actuator, a suction tube and an irrigation tube - dog. 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 implementation of energy application is configured to supply ultrasonic and / or RF energy to the surgical site and is coupled to the management module.
[00231] [00231] 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 suction / irrigation module 128. In such an example, a fluid interface can be configured to connect the suction / irrigation module 128 to the fluid source and / or the vacuum source.
[00232] [00232] In one aspect, modules 140, 126, 128 and / or their corresponding docking stations in the modular housing of central controller 136 may include alignment features that are configured to align the docking ports of the modules in entry with their counterparts in the docking stations of the modular housing of the central controller 136. For example, as shown in Figure 4, the combined generator module 145 includes side brackets 155 that are configured to slide the brackets together corresponding 156 of the corresponding docking station 151 of the central housing of the central controller 136. The brackets cooperate to guide the contacts of the combined generator module's docking door 145 in an electrical engagement with the contacts of the controller housing of the modular housing of the controller central 136.
[00233] [00233] In some respects, the drawers 151 of the modular housing of the central controller 136 are the same, or substantially the same size, and the modules are sized to be received in the drawers 151. For example, the side brackets 155 and / or 156 can be larger or smaller depending on the size of the module. In other
[00234] [00234] In addition, the contacts of a specific module can be switched to engage with the contacts of a specific drawer to avoid the insertion of a module in a drawer with unpaired contacts.
[00235] [00235] As shown in Figure 4, the anchor door 150 of a drawer 151 can be coupled to the anchor door 150 of another drawer 151 through a communication link 157 to facilitate interactive communication between the modules housed in the modular housing of the central controller 136. The anchoring ports 150 of the modular housing of the central controller 136 can alternatively or additionally facilitate interactive wireless communication between the modules housed in the modular housing of the central controller 136. Any suitable wireless communication can be used, such as Air Titan-Bluetooth.
[00236] [00236] Figure 6 illustrates individual power bus connectors for a plurality of anchoring ports of a lateral modular cabinet 160 configured to receive a plurality of modules from a central surgical controller 206. The lateral modular cabinet 160 is configured to receive and interconnect modules 161 laterally. Modules 161 are slidably inserted into the docking stations 162 of the side modular cabinet 160, which includes a back plate for the interconnection of modules 161. As illustrated in Figure 6, modules 161 are arranged laterally in the side modular cabinet 160. Alternatively, modules 161 can be arranged vertically in a modular side cabinet.
[00237] [00237] Figure 7 illustrates a vertical modular cabinet 164 configured to receive a plurality of modules 165 from the central surgical controller 106. Modules 165 are slidably inserted into docking stations, or drawers, 167 from the vertical modular cabinet 164, which includes a rear panel for interconnecting the 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 docking doors of the vertical modular cabinet 164. In the example in Figure 7, a screen 177 is provided to show data relevant to the operation of modules 165. In addition , the vertical modular cabinet 164 includes a master module 178 that houses a plurality of submodules that are received slidingly in the master module 178.
[00238] [00238] In several aspects, the imaging module 138 comprises an integrated video processor and a modular light source and is adapted for use with various imaging devices. In one aspect, the imaging device is comprised of a modular cabinet that can be mounted with a light source module and a camera module. The case can be a disposable case. In at least one example, the disposable cabinet 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.
[00239] [00239] “During a surgical procedure, removing a surgical device from the surgical field and replacing it with another surgical device that includes a different camera or another light source may be inefficient. Temporarily losing sight of the surgical field can lead to undesirable consequences. The imaging device module of the present description 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 field surgical.
[00240] [00240] In one aspect, the imaging device comprises a tubular cabinet that includes a plurality of channels. A first channel is configured to slide the camera module, which can be configured for a snap fit with the first channel. A second channel is configured to receive the camera module in a sliding way, which can be configured for a snap fit with the first channel. In another example, the camera module and / or the light source module can be rotated to an end position within their respective channels. A threaded coupling can be used instead of a pressure fitting.
[00241] [00241] 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.
[00242] [00242] Various image processors and imaging devices suitable for use with the present description are described in US Patent No. 7,995,045 entitled COMBINED SBI AND CONVENTIO-NAL IMAGE PROCESSOR, granted on August 9, 2011, which is it is incorporated here by way of reference in its entirety. In addition, US Patent No. 7,982,776, entitled SB MOTION ARTIFACT REMOVAL
[00243] [00243] 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 facility. from utilities specially equipped for surgical operations, to a cloud-based system (for example, cloud 204 which can include a remote server 213 coupled to a storage device 205). In one aspect, the modular central communication controller 203 comprises a central network controller 207 and / or a network key 209 in communication with a network router. The modular central communication controller 203 can also be coupled to a local computer system 210 to provide local computer processing and data manipulation. The surgical data network 201 can be configured as a passive, intelligent or switching network. A passive surgical data network serves as a conduit for the data, enabling data to be transmitted from one device (or segment) to another and to cloud computing resources. An intelligent surgical data network includes features to enable traffic to pass through the surgical data network to be monitored and to configure each port on the central network controller 207 or network key 209. An intelligent surgical data network it can be called a central controller or controllable key. A central switching controller reads the destination address of each packet and then forwards the packet to the correct port.
[00244] [00244] 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 key 209 can be coupled to a network router 211 to connect devices 1a to 1h to the cloud 204 or to the local computer system 210. Data associated with devices 1a to 1n can be transferred to cloud-based computers via the router for remote processing and manipulation of the data. The data associated with devices 1a to 1h can also be transferred to the local computer system 210 for processing and manipulation of the local data. Modular devices 2a to 2m located in the same operating room can also be attached to a network switch 209. To network switch 209 can be attached to the central network controller 207 and / or to network router 211 to connect devices 2a 2m to cloud 204. The data associated with devices 2a to 2n can be transferred to cloud 204 via network router 211 for data processing and manipulation. The data associated with devices 2a to 2m can also be transferred to the local computer system 210 for processing and manipulation of the local data.
[00245] [00245] It will be understood that the surgical data network 201 can be expanded by interconnecting multiple central network controllers 207 and / or multiple network keys 209 with multiple routed-
[00246] [00246] In one aspect, the surgical data network 201 may comprise a combination of central network controller (or central network controllers), network key (or network keys) and network router ( or 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 to the network key can collect data in real time and transfer the data to cloud computers for data processing and manipulation. It will be understood that cloud computing depends on sharing computing resources instead of having local servers or personal devices to handle software applications. The word "cloud" can be used as a metaphor for "the Internet", although the term is not limited as such. Consequently, the term "compares
[00247] [00247] “By applying cloud computer data processing techniques to data collected by devices 1a to 1n / 2a to 2m, the surgical data network provides better surgical results, reduced costs and better satisfaction by part of the patient. At least some of the devices 1a to 1n / 2a to 2m can be used to see tissue status to assess leaks or perfusion of sealed tissue after a tissue cutting and cutting procedure. At least some of the devices 1a to 1n / 2a to 2m can be used to identify pathology, such as disease effects, with the use of cloud-based computing to examine data including images of body tissue samples for diagnostic purposes . This includes confirmation of the location and margin of the tissue and phenotypes. At least some of the devices 1a to 1n / 2a to 2m can be used to identify anatomical structures of the body 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 data processing and manipulation including image processing and manipulation. 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, precise 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, it can provide standardized feedback beneficial both to confirm surgical treatments and the surgeon's behavior or to suggest modifications to surgical treatments and the surgeon's behavior.
[00248] [00248] In an implementation, operating room devices 1a to 1n can be connected to the central modular communication controller 203 via a wired or wireless channel depending on the configuration of devices 1a to 1h on a central network controller. The central network controller 207 can be implemented, in one aspect, as a local network transmission device that acts on the physical layer of the OSI model ("open system interconnection"). The central network controller provides connectivity to devices 1a to 1n located in the same area as the operating room. The central network controller 207 collects data in the form of packets and sends them to the router in "halfdu-
[00249] [00249] In another implementation, operating room devices 2a to 2m can be connected to a network switch 209 through a wired or wireless channel. The network key 209 works in the data connection layer of the OSI model. The network switch 209 is a multicast device for connecting devices 2a to 2m located in the same operation center to the network. The network key 209 sends data in frame form to the network router 211 and works in full duplex mode. Multiple devices 2a to 2m can send data at the same time via network key 209. Network key 209 stores and uses MAC addresses of devices 2a to 2m to transfer data.
[00250] [00250] The central network controller 207 and / or the network key 209 are coupled to the network router 211 for a connection with the number 204. The 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 key 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
[00251] [00251] 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.
[00252] [00252] 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 data exchange over short distances (using short wavelength UHF radio waves in the 2.4 to 2485 GHz ISM band) from fixed and mobile devices and building personal area networks (PANs). In other respects, operating room devices 1a to 1n / 2a to 2m can communicate with the central modular communication controller 203 via various wireless and wired communication standards or protocols, including, but not limited to, Wi-Fi (IEEE family
[00253] [00253] 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 type of data 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 the data to the cloud computing resources using a series of communication standards or protocols. - wireless or wired cation, as described in the present invention.
[00254] [00254] 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.
[00255] [00255] Figure 9 illustrates an interactive surgical system implemented by computer 200. The interactive surgical system implemented by computer 200 is similar in many ways to the interactive surgical system implemented by computer 100. For example, the interactive surgical system 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 213. In one aspect, the computer-implemented interactive surgical system 200 comprises a modular control tower 236 connected to multiple operating room devices such as smart surgical instruments, robots and other computerized devices located in the operating room. .
[00256] [00256] Figure 10 illustrates a central surgical controller 206 comprising a plurality of modules coupled to the modular control tower 236. The modular control tower 236 comprises a central modular communication controller 203, for example, a device - network connectivity device, and a computer system 210 to provide local processing, visualization and imaging, for example. As shown in Figure 10, the 203 modular central communication controller can be connected in a layered configuration to expand the number of modules (for example, devices) that can be connected to the 203 modular central communication controller 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 key is connected to a processor to provide a communication connection to the cloud computing resources and a local display 217. Communication with the cloud 204 can be done via a channel of wired or wireless communication.
[00257] [00257] 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 an echo when it bounces off the perimeter of the operating room walls, as described under the title Surgical Hub Spatial Awareness Within an Operating Room "in US Provisional Patent Application serial number 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, deposited on December 28, 2017, which is hereby incorporated by reference in its entirety, in which The sensor module is configured to determine the size of the operating room and to adjust the limits of the Bluetooth pairing distance.A laser-based non-contact sensor module scans the operating room by transmitting pulses of laser light, receiving pulses of laser light that jump from the perimeter walls of the operating room, and comparing the phase of the transmitted pulse to the received pulse to determine the size of the operating room and to adjust r Bluetooth pairing distance limits, for example.
[00258] [00258] 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 through a system bus. The system bus can be any of several types of bus structures, including the memory bus or memory controller, a peripheral bus or external bus, and / or a local bus that uses any variety of available bus architectures including , but not limited to, 9-bit bus, industry standard architecture (ISA), Micro-Charm! Architecture (MSA), Extended ISA (EISA), Smart Drive Electronics (IDE), VESA Local Bus (VLB), Peripheral Component Interconnection (PCI), USB, Advanced Graphics Port (AGP), PCMCIA Bus (International association of memory cards for personal computers, "Personal Computer Memory Card International Association"), Systems interface for small computers-
[00259] [00259] Processor 244 can be any single-core or multi-core processor, such as those known under the ARM Cortex trade name available from Texas Instruments. In one respect, the processor may be a Core Cortex-M4F LM4F230H5QR ARM processor, available from Texas Instruments, for example, which comprises an integrated 256 KB single-cycle flash memory, or other non-volatile memory, up to 40 MHz , a seek-ahead buffer to optimize performance above 40 MHz, a 32 KB single cycle serial random access memory (SRAM), an internal read-only memory (ROM) loaded with the StellarisWareO program, read-only memory programmable and electrically erasable (EEPROM) of 2 KB, one or more pulse width modulation (PWM) modules, one or more analogs of quadrature encoder (QEI) inputs, one or more analog to digital converters (ADC) ) 12 bits with 12 channels of analog input, details of which are available for the product data sheet.
[00260] [00260] In one aspect, processor 244 may comprise a safety controller comprising two controller-based families, such as TMS570 and RM4x, known under the tradename Hercules ARM Cortex R4, also by Texas Instruments. The safety controller can be configured specifically for IEC 61508 and ISO 26262 safety critical applications, among others, to provide advanced integrated safety features while providing scalable performance, connectivity and memory options.
[00261] [00261] System memory includes volatile and non-volatile memory. The basic input / output system (BIOS), containing the basic routines for transferring information between elements within the computer system, such as during startup, is stored in non-volatile memory. For example, non-volatile memory can include ROM, programmable ROM (PROM), electrically programmable ROM (EPROM), EEPROM or flash memory. Volatile memory includes random access memory (RAM), which acts as an external cache memory. In addition, RAM is available in many forms such as SRAM, Dynamic RAM (DRAM), Synchronous DRAM (SDRAM), Double Data Rate SDRAM (DDR SDRAM) Enhanced SDRAM (ESDRAM), Synchlihk DRAM (SLDRAM), and Rambus Direct RAM RAM (DRRAM).
[00262] [00262] Computer system 210 also includes removable / non-removable, volatile / non-volatile computer storage media, such as disk storage. Disk storage includes, but is not limited to, devices such as a magnetic disk drive, floppy disk drive, tape drive, Jaz drive, Zip drive, LS-60 drive, flash memory card or memory stick (pen-drive). In addition, disk storage may include storage media separately or in combination with other storage media including, but not limited to, an optical disc drive such as a compact disc ROM (CD-ROM) device recordable (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.
[00263] [00263] It should be considered that computer system 210 includes software that acts as an intermediary between users and the basic computer resources described in an appropriate operating environment. Such software includes an operating system. The operating system, which can be stored in disk storage, acts to control and allocate computer system resources. System applications
[00264] [00264] A user enters commands or information into the computer system 210 through the input device (s) coupled to the 1 / O 251. interface. The input devices include, but are not limited to, a pointing device such as a mouse, trackball, stylus, keyboard, keyboard, microphone, joystick, game pad, satellite card, scanner, TV tuner card, digital camera, digital video camera, video camera web, 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.
[00265] [00265] Computer system 210 can operate in a networked environment using logical connections with 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).
[00266] [00266] In several respects, the computer system 210 of Figure 10, the imaging module 238 and / or the display system 208, and / or the processor module 232 of Figures 9 to 10, can they may comprise an image processor, image processing engine, media processor, or any specialized digital signal processor (DSP) used for processing digital images. The image processor can employ parallel computing with single multi-data instruction (SIMD) or multi-data instruction (MIMD) technologies to increase speed and efficiency. The digital image processing engine can perform a number of tasks. The image processor can be an integrated circuit system with a multi-core processor architecture.
[00267] [00267] 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.
[00268] [00268] In several respects, the devices / instruments 235 described with reference to Figures 9 and 10 can be implemented as ultrasonic surgical instruments and combined energy surgical instruments 7012, as described in Figures 23A to 23B, 24A to 24B, 25 at 26, 27A to 27C, 28A to 28C, 29A to 29C, 30A to 30D, 31A to 31D, 32A to 32E. Consequently, the ultrasonic / combined surgical instrument 7012, as described in Figures 23A to 23B, 24A to 24B, 25 to 26, 27A to 27C, 28A to 28C, 29A to 29C, 30A to 30D, 31A to 31D, 32A to 32E, is configured to interface with the 236 modular control tower and the central surgical controller
[00269] [00269] 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 description. 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- DP3) paired with "less" differential data outputs (DM1- DM3).
[00270] [00270] The USB 300 central network controller device is implemented with a digital state machine instead of a microcontroller, and no firmware programming is required. The fully compatible USB transceivers are integrated into the circuit for the upstream USB transceiver port 302 and all downstream 304, 306, 308 USB transceiver ports. The downstream USB transceiver ports 304, 306, 308 support both full speed and low speed devices by automatically configuring the scan rate according to the speed of the device attached to the doors. The USB 300 network central controller device can be configured in bus-powered or self-powered mode and includes 312 central controller power logic to manage power.
[00271] [00271] The USB 300 network central 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 the communication between the upstream USB transceiver port 302 and the USB transceiver ports downstream 304, 306, 308 through the logic circuits of ports 320, 322, 324. The SIE 310 is coupled to a command decoder 326 through logic interface 328 to control the commands of a Serial EEPROM via a 330 serial EEPROM interface.
[00272] [00272] 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. Power settings are powered modes
[00273] [00273] 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 No. 62 / 659,900, entitled METHOD OF HUB COMMUNICATION, deposited on April 19, 2018, which is incorporated herein by reference, in its entirety. Cloud system hardware and functional modules
[00274] [00274] Figure 12 is a block diagram of the interactive surgical system implemented by computer, according to at least one aspect of the present description. 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 service facilities. Cheers. The interactive surgical system implemented by computer comprises a cloud-based data analysis system. Although the cloud-based data analysis system is described as a surgical system, it is not necessarily
[00275] [00275] In addition, surgical instruments 7012 can comprise transceivers for transmitting data to and from their corresponding central surgical controllers 7006 (which can also comprise transceivers). Combinations of surgical instruments
[00276] [00276] Based on connections with several central surgical controllers 7006 over the network 7001, the cloud 7004 can aggregate the specific data data generated by various surgical instruments
[00277] [00277] The configuration of the specific cloud computing system described in this description is specifically designed 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 7012 surgical instruments and 7006 central surgical controllers can comprise touch-controlled user interfaces, so that physicians can control aspects of interaction between the 7012 surgical instruments and the 7004 cloud. Other user interfaces suitable for control such as audibly controlled users can also be used.
[00278] [00278] Figure 13 is a block diagram that illustrates the functional architecture of the interactive surgical system implemented by a computer, according to at least one aspect of the present description. The cloud-based data analysis system includes a plurality of 7034 data analysis modules that can be run by 7008 cloud processors 7004 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 aided by applications for central controllers 7014 hosted by the application servers for central controllers 7002 that can be accessed on central surgical controllers 7006 The 7008 cloud computing processors and the 7014 central controller applications can operate together to perform the 7034 data analysis modules. 7016 application programming interfaces (APIs) define the set of protocols and routines that correspond to the applications for 7014 central controllers. In addition, APIs 7016 manage the storage and retrieval of data in / from the aggregated medical 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 7014 applications Data analysis modules 7034 in Figure 13 include modules for resource optimization 7020, data collection and aggregation 7022, authorization and security 7024, updating 7026 control programs, analyzing patient results 7028, recommendations 7030 and data classification and prioritization 7032. Other suitable data analysis modules could also be implemented by the 7004 cloud, according to some aspects. In one respect, data analysis modules are used for specific recommendations based on analysis of trends, results, and other data.
[00279] [00279] For example, the data collection and aggregation module 7022 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 sets of redundant data and the storage of data in paired data sets that can be grouped by surgery, but not necessarily linked to surgical dates and to real 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, binary classification can be characterized or as a desirable event (for example, a procedure
[00280] [00280] 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 for various health care facilities to determine whether resource use could be improved. Similarly, the 7030 recommendations module can be configured to analyze aggregated organized data from the 7022 data collection and aggregation module to provide recommendations. For example, the 7030 recommendations module could recommend health care facilities
[00281] [00281] The 7028 patient results analysis module can analyze surgical results associated with operating parameters currently used in 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 about when using a particular cartridge for a corresponding 7012 surgical stapling 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 through multiple health service facilities (advantageously determined with 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 they use similar types of instruments, etc., in a way that no health service facility alone would be able to analyze independently.
[00282] [00282] The 7026 control program update module can be configured to implement various 7012 surgical instrument recommendations when corresponding control programs are updated. For example, the patient results analysis module 7028 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 data performance indicators that were collected and analyzed by the 7022 cloud 7004 data collection and aggregation module. In addition, the 7028 patient results analysis module and the 7030 recommendations module could identify improved methods of using the 7012 instruments with based on aggregated performance data.
[00283] [00283] 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 the even as a username,
[00284] [00284] 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 surgical instruments 7012 may not have functional access to a corresponding central controller 7006 and / or may be prevented from fully functioning when paired with its corresponding central controller 7006. In addition or alternatively, the cloud 7004 can identify instruments 7012 based on incompatibility or other specified criteria. In this way, counterfeit medical devices and inadequate reuse of such devices across the cloud-based data analysis system can be identified and addressed.
[00285] [00285] The surgical instruments 7012 can use wireless transceivers to transmit wireless signals that can represent, for example, credentials for authorization of access to the corresponding central controllers 7006 and the cloud 7004. Wired transceivers can also be used to transmit signals.
[00286] [00286] The cloud-based data analysis system can allow monitoring of multiple health care facilities (eg, medical clinics such as hospitals) to determine improved practices and recommend changes (via the reporting module) 2030 recommendations, for example) appropriately. In this way, processors 7008 from the 7004 cloud can analyze the data associated with a health care 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 an installation of health services that cover a whole 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 region of other facilities or any other comparable facility.
[00287] [00287] 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 the cloud-based data analysis and operations described here. For example, the 7032 data classification and prioritization module can assign a priority to the 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 from the 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 can result in a notification displayed on the corresponding central controllers 7006 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 servers 7013 can be programmed to activate this automatic message in certain significant circumstances, such as when the data is determined to be different from an expected value beyond a predetermined limit, or when it appears that security has been understood, for example, example.
[00288] [00288] In several respects, the surgical instrument (or surgical instruments) 7012 described with reference to Figures 12 and 13 can be implemented as ultrasonic surgical instruments and combined energy surgical instruments 7012, as described in Figures 23A to 23B , 24A to 24B, 25 to 26, 27A to 27C, 28A to 28C, 29A to 29C, 30A to 30D, 31A to 31D, 32A to 32E. Consequently, the ultrasonic surgical instrument and the combined energy surgical instrument 7012, as described in Figures 23A to 23B, MA to
[00289] [00289] Additional details related to the cloud data analysis system can be found in US Provisional Patent Application No. 62 / 659,900, entitled METHOD OF HUB COMMUNICATION, filed on April 19, 2018, which is incorporated herein as a reference, in its entirety. Situational recognition
[00290] [00290] Although a "smart" device, including control algorithms responsive to detected data, may be an improvement over a "stupid" device that operates without taking the detected data, some detected data may 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 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 certain detected parameter may vary according to the type of particular tissue.
[00291] [00291] “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, according to this, the paired modular devices. In other words, the central surgical controller is configured to infer information about the surgical procedure from data received and, then, to control modular devices paired with the central surgical controller based on the inferred context of the surgical procedure. The Fi-
[00292] [00292] “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 stage 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 5104 central surgical controller 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 perception system situational, 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.
[00293] [00293] 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), which has been trained in training data to correlate various entries (for example, data from databases 5122, patient monitoring devices 5124, and / or modular devices 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 perception system situation of the central surgical controller 5104, are associated with a control setting or set of specific control settings for one or more 5102 modular devices. In another example, the situational perception system includes an additional machine learning system , lookup table or other such system, generating or retrieving one or more control settings for one or more 5102 modular devices, when contextual information is provided as input.
[00294] [00294] “A 5104 central surgical controller, which incorporates a system
[00295] [00295] As another example, the type of fabric being operated can 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 the tissue trapped by an end actuator of the stapling and surgical cutting instrument is lung tissue (for a thoracic 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 type of tissue.
[00296] [00296] As yet another example, the type of body cavity that is 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 generally 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 on. In this way, a central surgical controller with 5104 situational awareness can provide a consistent amount of smoke evacuation to both thoracic and abdominal procedures.
[00297] [00297] As yet another example, the type of procedure being performed can affect the ideal energy level for an ultrasonic surgical instrument or radio frequency (RF) electrosurgical instrument 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 awareness 5104 can determine whether the surgical procedure is an arthroscopic procedure. The 5104 central surgical controller can then adjust the RF power level or the ultrasonic amplitude of the generator (ie, 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 equipped with 5104 situational awareness 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 procedural basis. -by-procedure. A central surgical controller with situational perception 5104 can determine which stage 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 for adjust the energy level to an appropriate value for the type of tissue, according to the stage of the surgical procedure.
[00298] [00298] - As yet another example, the 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 au - mentoring the data he receives from modular devices 5102 with contextual information that he has accumulated, referring to the surgical procedure, from other data sources 5126. For example, a central surgical controller with 5104 situational perception can be configured to determine whether hemostasis has occurred (that is, bleeding has 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 in a communicable way 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 may be inconclusive or incomplete on its own.
[00299] [00299] - Another benefit includes proactively and automatically controlling the paired modular devices 5102, according to the specific stage of the surgical procedure being performed to reduce the number of times that 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 situational perception 5104 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 completed.
[00300] [00300] 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) (s) at the surgical site that the surgeon is expected to see. The central surgical controller 5104 could then proactively alter the displayed view (provided, for example, by a Medical Imaging device to the visualization system 108), so that the screen automatically adjusts throughout the procedure surgical.
[00301] [00301] 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 procedure. surgical procedure. The central surgical controller 5104 can be configured to call screens automatically based on data on the stage of the surgical procedure being performed, without waiting for the surgeon to request specific information.
[00302] [00302] - 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 situational perception 5104 could determine whether the operating room is properly or ideally configured for the surgical procedure to be performed. 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 layout of the current operating room 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 manifest or advance 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 another surgical item is missing. In one example, the central surgical controller 5104 can be configured to determine the relative position or distance of modular devices 5102 and patient monitoring devices 5124 via 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 specific surgical procedure. 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.
[00303] [00303] “As another example, the central surgical controller endowed with situational perception 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 surgical procedure. 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 the equipment being used during the course of the surgical procedure with the steps or the equipment expected for the type of surgical procedure that the central surgical controller 5104 determined that it is being executed. In one example, the 5104 central surgical controller 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.
[00304] [00304] In general, the situational perception system for the central surgical controller 5104 improves the results of the surgical procedure by adjusting surgical instruments (and other modular devices 5102) for the specific context of each surgical procedure (such as adjusting to different types of 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
[00305] [00305] With reference now to Figure 15, a time line 5200 is shown representing the situational recognition of a central controller, such as 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, starting with the setup of the operating room and ending with the transfer of the patient to a postoperative recovery room.
[00306] [00306] Situational recognition of a central surgical controller 106, 206 receives data from data sources throughout the course of the surgical procedure, including data generated each time the medical team uses a modular device that is paired with the central surgical controller 106, 206. Central surgical controller 106, 206 can receive this data from paired modular devices and other data sources and continuously derive inferences (that is, contextual information) about the ongoing procedure as new data is received, as what stage of the procedure is being performed at any given time. The situational recognition system of the central surgical controller 106, 206 is, for example, able to record data related to the procedure to generate reports, verify the measures taken by the medical team, provide data or warnings (for example, through a screen display) that may be relevant to the specific step of the procedure, adjust the modular devices based on the context (for example, activate monitors, adjust the field of view (FOV) of the medical imaging device, or change the energy level of an ultrasonic surgical instrument or the RF electrosurgical instrument), and take any other measures described above.
[00307] [00307] In the first step 5202, in this illustrative procedure, members of the hospital team retrieve the patient's electronic medical record (PEP) from the hospital's PEP database. Based on patient selection data in the PEP, the central surgical controller 106, 206 determines that the procedure to be performed is a thoracic procedure.
[00308] [00308] “In the second step 5204, the team members scan the entry of medical supplies for the procedure. The central surgical controller 106, 206 cross-references the scanned supplies with a list of supplies that are used in various types of procedures and confirms that the combination of the 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 input supplies either lack certain supplies that are necessary for a thoracic wedge procedure or, if contrary, that the inlet supplies do not correspond to a thoracic wedge procedure).
[00309] [00309] 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 central surgical controller 106, 206 can then confirm the patient's identity with based on the scanned data.
[00310] [00310] In the fourth step 5208, the medical team connects the auxiliary equipment. The auxiliary equipment in use may vary according to the type of surgical procedure and the techniques to be used
[00311] [00311] 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 devices
[00312] [00312] In the sixth step 5212, the medical team induces anesthesia in the patient. Central surgical controller 106, 206 can infer that the patient is under anesthesia based on data from modular devices and / or patient monitoring devices, including ECG data, blood pressure data, ventilator data, or combinations thereof, for example. After the completion of the sixth step 5212, the preoperative portion of the pulmonary segmentectomy procedure is completed and the operative portion begins.
[00313] [00313] In the seventh step 5214, the lung of the patient being operated on is retracted (while ventilation is switched to the contralateral lung). The central surgical controller 106, 206 can infer from the ventilator data that the patient's lung has been retracted, for example. The central surgical controller 106, 206 can infer that the operative portion of the procedure was initiated since it can compare the detection of the patient's lung retraction to the expected steps of the procedure (which can be accessed or retrieved earlier) and so on. determine that lung retraction is the first operative step in this specific procedure.
[00314] [00314] In the eighth step 5216, the medical imaging device (for example, an endoscope) is inserted and the video of the medical imaging device is started. The 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
[00315] [00315] In the ninth step 5218, the surgical team starts the dissection step of the procedure. Central surgical controller 106, 206 can infer that the surgeon is in the process of dissection to mobilize the patient's lung because he receives data from the RF or ultrasonic generator that indicate that an energy instrument is being triggered. Central surgical controller 106, 206 can cross-check the received data with the steps retrieved from the surgical procedure to determine that an energy instrument is being triggered at that point in the process (that is, after completing the previously discussed steps of the procedure) corresponds to the dissection stage. In certain cases, the energy instrument may be a power tool mounted on a robotic arm in a robotic surgical system.
[00316] [00316] In the tenth step 5220 of the procedure, the surgical team proceeds to the connection step. The central surgical controller 106, 206 can infer that the surgeon is ligating the arteries and veins because he receives data from the stapling and surgical 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 stapling and surgical cutting instrument with the steps recovered in the process. In certain cases, the surgical instrument can be a surgical tool mounted on a robotic arm of a robotic surgical system.
[00317] [00317] 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.
[00318] [00318] In the twelfth step 5224, the node dissection step is then performed. Central surgical controller 106, 206 can infer that the surgical team is dissecting the node and performing a leak test based on data received from the generator that indicates which ultrasonic or RF instrument is being triggered. For this specific procedure, an RF or ultrasonic instrument being used after the parenchyma has been transected corresponds to the node dissection step, which allows the central surgical controller 106, 206 to make this inference. It should be noted that surgeons regularly alternate between surgical stapling / surgical cutting instruments and surgical energy instruments (that is, RF or ultrasonic) depending on the specific step in the procedure because different instruments are better adapted to specific tasks. Therefore, the specific sequence in which the cutting / stapling instruments and surgical energy instruments are used can indicate which stage of the procedure the surgeon is taking. In addition, in certain cases, robotic tools can be used for one or more steps in a surgical procedure and / or hand-held surgical instruments can be used for one or more steps in the surgical procedure. The surgeon can switch between robotic tools and hand-held surgical instruments and / or can use the devices simultaneously, for example. After the completion of the twelfth stage 5224, the incisions are closed and the postoperative portion of the procedure is started.
[00319] [00319] 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.
[00320] [00320] 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 coupled to each other. communicable to the central surgical controller 106, 206.
[00321] [00321] Situational recognition is further described in US Provisional Patent Application serial number 62 / 659,900, entitled METHOD OF HUB COMMUNICATION, filed on April 19, 2018, which is incorporated herein by reference in its entirety. In certain cases, the operation of a robotic surgical system, including the various robotic surgical systems disclosed here, for example, can be controlled by the central controller 106, 206 based on its situational perception and / or feedback from its components and / or based on information from the cloud 104.
[00322] [00322] In one aspect, as described later in this document with reference to Figures 24 to 40, the modular device 5102 is implemented as ultrasonic surgical instruments and combined energy surgical instruments 7012, as described in Figures 23A to 23B , 24A to 24B, 25 to 26, 27A to 27C, 28A to 28C, 29A to 29C, 30A to 30D, 31A to 31D, 32A to 32E. Consequently, the modular device 5102 implemented as an ultrasonic surgical instrument and combined energy surgical instrument 7012, as described in Figures 23A to 23B, 24A to 24B, 26, 27A to 27C, 28A to 28C, 29A at 29C, 30A at 30D, 31A at 31D, 32A at 32E, is configured to operate as a data source 5126 and to interact with database 5122 and patient monitoring devices 5124. The modular device 5102 implemen - used as an ultrasonic surgical instrument and combined energy surgical instrument 7012, as described in Figures 23A to 23B, 24A to 24B, 25 to 26, 27A to 27C, 28A to 28C, 29A to 29C, 30A to 30D, 31A the 31D, 32A to 32E, 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 (for example, data and control) a from the central surgical controller 5104.
[00323] [00323] In one aspect, as described later in this document with reference to Figures 24 to 40, the modular device 5102 is implemented as ultrasonic surgical instruments and combined energy surgical instruments 7012, as described in Figures 23A to 23B , 24A to 24B, 25 to 26, 27A to 27C, 28A to 28C, 29A to 29C, 30A to 30D, 31A to 31D, 32A to 32E. Consequently, the 5102 modular device implemented as an instrument
[00324] [00324] Figure 16 is a schematic diagram of a robotic surgical instrument 700 configured to operate a surgical tool described in this document, in accordance with an aspect of this description. The robotic surgical instrument 700 can be programmed or configured to control the distal / proximal translation of a displacement member, the distal / proximal displacement of a closing tube, the rotation of the drive shaft, and articulation, either with a single type or multiple articulation drive links. In one aspect, the surgical instrument 700 can be programmed or configured to individually control a firing member, a closing member, a driving shaft member, or one or more hinge members, or combinations thereof. Surgical instrument 700 comprises a control circuit 710 configured to control motor-driven firing members, locking members, drive shaft members, or one or more hinge members, or combinations thereof.
[00325] [00325] In one aspect, the robotic surgical instrument 700 comprises a control circuit 710 configured to control a clamping arm 716 and a closing member 714, a portion of an end actuator 702, an ultrasonic blade 718 coupled to an ultrasonic transducer 719 excited by an ultrasonic generator 721, 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 feedback on the position of closing member 714 to control circuit 710. Other sensors 738 can be configured to provide feedback to control circuit 710. A timer / counter 731 provides timing and counting information to control circuit 710. A power source 712 can be provided to operate motors 704a to 704e and a current sensor 736 provides motor current feedback to control circuit 710. Motors 704a a 704e can be operated individually by control circuit 710 in an open circuit or closed loop feedback control.
[00326] [00326] In one aspect, the control circuit 710 may comprise one or more microcontrollers, microprocessors or other processors suitable for executing instructions that cause the processor or processors to perform one or more tasks. In one aspect, a timer / counter 731 provides an output signal, such as elapsed time or a digital count, to control circuit 710 to correlate the position of closing member 714 as determined by position sensor 734 with the output. of timer / counter 731 so that control circuit 710 can determine the position of closing member 714 at a specific time (t) in relation to an initial position or the time (t) when closing member 714 is in a specific position in relation to a starting position. The timer / counter 731 can be configured to measure the elapsed time, count external events or time timeless events.
[00327] [00327] In one aspect, control circuit 710 can be programmed to control functions of end actuator 702 based on one or more tissue conditions. The control circuit 710 can be programmed to directly or indirectly detect tissue conditions, such as thickness, as described here. Control circuit 710 can be programmed to select a trigger control program or closing control program based on the conditions of the fabric. 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 thinner tissue 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 fabric by the clamping arm 716. Other control programs control the rotation of the drive shaft 740 and the hinge members 742a, 742b.
[00328] [00328] In one aspect, the control circuit 710 can generate setpoint signals from the motor. 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 here. In some instances, 704a engines
[00329] [00329] 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 robotic surgical instrument 700 during the open circuit portion of the stroke, control circuit 710 can select a trigger control program in a closed circuit configuration. The instrument's response 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 704a to 704e motors during the circuit portion open, a sum of pulse widths of a motor start signal, etc. After the open loop portion, control circuit 710 can implement the selected trip control program for a second portion of the travel member travel. For example, during a portion of the closed circuit course, control circuit 710 can modulate one of the motors 704a to 704e based on the translation of the data describing a position of the displacement member in closed circuit to translate the displacement member at a constant speed.
[00330] [00330] In one aspect, motors 704a to 704e can receive power from a power source 712. Power source 712 can be a DC power source powered by an alternating main power supply, a battery, a supercapacitor , or any other suitable energy source.
[00331] [00331] In one aspect, control circuit 710 is configured to drive a firing member, such as the closing member portion 714 of end actuator 702. Control circuit 710 provides a motor setpoint for a motor control 708a, which provides a drive signal for motor 704a. The output shaft of the motor 704a is coupled to a torque sensor 744a. The torque sensor 744a is coupled to a transmission 706a which is coupled to the closing member 714. The transmission 706a comprises moving mechanical elements such as rotating elements and a firing member to control the movement of the limb distally and proximally. closure 714 along a longitudinal geometric axis 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 drive gear and a second knife drive gear. A torque sensor 744a provides a trigger force feedback signal to control circuit 710. The trigger force signal represents the force required to fire or move the closing member 714. A position sensor 734 can be configured to provide the position of the closing member 714 along the firing stroke or the position of the firing member 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 closing member 714 moves distally, the clamping arm 716 closes towards the ultrasonic blade
[00332] [00332] In one aspect, control circuit 710 is configured to drive a closing member, such as the clamping arm portion 716 of end actuator 702. Control circuit 710 provides a motor setpoint for control motor 708b, which provides a drive signal for motor 704b. The output shaft of the 704b motor is coupled to a 744b torque sensor. The torque sensor 744b is coupled to a transmission 706b which is coupled to the clamping arm 716. The transmission 706b comprises moving mechanical elements such as rotating elements and a closing member to control the movement of the clamping arm. tightening 716 from the open and closed positions. In one aspect, the 704b motor is coupled to a closing gear assembly, which includes a closing reduction gear assembly that is supported in gear engaged with the closing sprocket. The torque sensor 744b provides a closing force feedback signal to control circuit 710. The closing force feedback signal represents the closing force applied to the clamping arm 716. The position sensor 734 can be configured to provide the position of the closing member as a feedback signal for control circuit 710. Additional sensors 738 on end actuator 702 can provide the feedback signal for closing force to control circuit 710. The arm articulating clamp 716 is positioned opposite the ultrasonic blade 718. When ready for use, control circuit 710 can provide a closing signal to motor control 708b. In response
[00333] [00333] 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 set point motor for a 708c motor control, which provides a drive signal for the 704c motor. The output shaft of the 704c motor is coupled to a 744c torque sensor. The torque sensor 744c is coupled to a transmission 706c which is coupled to the axis 740. The transmission 706c comprises moving mechanical elements, such as rotating elements, to control the rotation of the drive shaft 740 clockwise or anti-clockwise -time up to and over 360º. In one aspect, the 704c motor is coupled to the rotary drive assembly, which includes a pipe gear segment that is formed over (or attached to) the proximal end of the proximal closing tube for engagement operable by a gear assembly rotational that is operationally supported on the tool mounting plate. The torque sensor 744c provides a rotation force feedback signal for control circuit 710. The rotation force feedback signal represents the rotation force applied to the drive shaft 740. The position sensor 734 can be configured to provide the position of the closing member as a feedback signal to control loop 710. Additional sensors 738, such as a drive shaft encoder, can provide the rotational position of drive shaft 740 to the circuit control unit 710.
[00334] [00334] In one aspect, control circuit 710 is configured to link end actuator 702. Control circuit 710 provides a motor setpoint for 708d motor control,
[00335] [00335] In another aspect, the articulation function of the robotic surgical system 700 can 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 actuated with respect to the other link to provide a resistive holding movement and a load to the head when it is not moving and stops. provide a joint movement when the head is pivoted. 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 may be more pronounced
[00336] [00336] 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.
[00337] [00337] In one aspect, the position sensor 734 can be implemented as an absolute positioning system. In one aspect, the 734 position sensor can comprise an absolute rotary magnetic positioning system implemented as a single integrated circuit rotary magnetic position sensor, ASSOSSEQFT, available from Austria Microsystems, AG. The position sensor 734 can interface with the control circuit 710 to provide an absolute positioning system. The position can include multiple Hall effect elements located above a magnet and coupled to a CORDIC processor, also known as the digit by digit method and Volder's algorithm, which is provided to implement a simple and efficient algorithm for calculating hyperbolic and trigonometric functions that require only addition, subtraction, bit shift and table search operations.
[00338] [00338] In one aspect, the control circuit 710 can be in communication with one or more sensors 738. The sensors 738 can be positioned on the end actuator 702 and adapted to work with the robotic surgical instrument 700 to measure various derived parameters such as span distance in relation to time, compression of the tissue in relation to time, and deformation of the anvil in relation to time. The 738 sensors can comprise a magnetic sensor, a magnetic field sensor, a strain gauge, a load cell, a pressure sensor, a force sensor, a torque sensor, an inductive sensor as a sensor eddy current, a resistive sensor, a capacitive sensor, an optical sensor and / or any other sensor suitable for measuring one or more parameters of the end actuator 702. The 738 sensors may include one or more sensors. Sensors 738 can be located on the clamping arm 716 to determine the location of tissue using segmented electrodes. The torque sensors 744a to 744e can be configured to detect force such as firing force, closing force, and / or articulation force, among others. Consequently, control circuit 710 can detect (1) the closing load experienced by the distal closing tube and its position, (2) the trigger member on the rack and its position, (3) which portion of the blade ultrasonic 718 has tissue in it, and (4) the load and position on both articulation rods.
[00339] [00339] In one aspect, the one or more sensors 738 may comprise an effort meter such as, for example, a microstrain meter, configured to measure the magnitude of the effort on the 716 during a stuck condition. The voltage meter provides an electrical signal whose amplitude varies with the magnitude of the voltage. The 738 sensors can comprise a pressure sensor configured to detect a pressure generated by the presence of compressed tissue between the clamping arm 716 and the ultrasonic blade 718. The sensors 738 can be configured to detect the impedance of a section of fabric located between the clamping arm 716 and the ultrasonic blade 718 which is indicative of the thickness and / or completeness of the fabric located between them.
[00340] [00340] 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.
[00341] [00341] In one aspect, sensors 738 can be configured to measure the forces exerted on the clamping arm 716 by the closing drive system. For example, one or more sensors 738 may be at a point of interaction between the closing tube and the clamping arm 716 to detect the closing forces applied by the closing tube to the clamping arm 716. The forces exerted on the clamping arm clamping 716 can be representative of the tissue compression experienced by the tissue section captured between the clamping arm 716 and the ultrasonic blade 718. The one or more sensors 738 can be positioned at various points of interaction throughout the drive system. closing to detect the closing forces applied to the clamping arm 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 clamping arm 716.
[00342] [00342] In one aspect, a current sensor 736 can be used to measure the current drained by each of the 704a to 704e motors. The force required to advance any of the moving mechanical elements such as the closing member 714 corresponds to the current drawn by one of the motors 704a to 704e. The force is converted into a digital signal and supplied to the control circuit 710. The control circuit 710 can be configured to simulate the response of the instrument's actual system in the controller software. A displacement member can be actuated to move closing member 714 on end actuator 702 at or near a target speed. The robotic surgical instrument 700 may include a feedback controller, which can be one or any of the feedback controllers, including, but not limited to, a PID controller, state feedback, linear quadratic (LQR) and / or an adaptable controller, for example. The robotic surgical instrument 700 can include a power source to convert the signal from the feedback controller to a physical input such as case voltage, PWM voltage, frequency modulated voltage, current, torque and / or force, for example. Additional details are disclosed in US Patent Application Serial No. 15 / 636,829, entitled CLOSED LOOP VELOCITY CONTROL TECHNIQUES FOR ROBOTIC SURGICAL INSTRUMENT, filed June 29, 2017, which is hereby incorporated by reference in its entirety.
[00343] [00343] Figure 17 illustrates a schematic diagram of a surgical instrument 750 configured to control the distal translation of the displacement member according to an aspect of the present description.
[00344] [00344] The position, movement, displacement, and / or translation of a linear displacement member, such as closing member 764, can be measured by an absolute positioning system, sensor arrangement, and a position sensor 784. Because the closing member 764 is coupled to a longitudinally movable driving member, the position of the closing member 764 can be determined by measuring the position of the longitudinally mobile driving member using the position sensor.
[00345] [00345] Control circuit 760 can generate a setpoint signal for motor 772. The setpoint signal for motor 772 can be supplied to a motor controller 758. Motor controller 758 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 stator windings of motor 754. In addition, in some examples, motor controller 758 can be omitted, and control circuit 760 can generate motor drive signal 774 directly.
[00346] [00346] The 754 motor can receive power from an energy source
[00347] [00347] The control circuit 760 can be in communication with one or more sensors 788. The sensors 788 can be positioned on the end actuator 752 and adapted to work with the surgical instrument 750 to measure the various derived parameters, such as distance span versus time, tissue compression versus time and anvil effort versus time. The 788 sensors can comprise a magnetic sensor, a magnetic field sensor, a stress meter, a pressure sensor, a force sensor, an inductive sensor such as a eddy current sensor, a resistive sensor, a capacitive sensor, a sensor optical and / or any other sensors suitable for measuring one or more parameters of the 752 end actuator. The 788 sensors may include one or more sensors.
[00348] [00348] The one or more 788 sensors may comprise a stress meter such as a microstrain meter, configured to measure the magnitude of the stress on the clamping arm 766 during a tightening condition. The voltage meter provides an electrical signal whose amplitude varies with the magnitude of the voltage. The 788 sensors can comprise a pressure sensor configured to detect a pressure generated by the presence of compressed tissue between the clamping arm 766 and the ultrasonic blade 768. The 788 sensors can be configured to detect the impedance of a section of fabric located between the clamping arm 766 and the ultrasonic sheet 768 which is indicative of the thickness and / or completeness of the fabric located between them.
[00349] [00349] The 788 sensors can be configured to measure the forces exerted on the clamping arm 766 by the closing drive system. For example, one or more sensors 788 may be at a point of interaction between a closing tube and the clamping arm 766 to detect the closing forces applied by a closing tube to the clamping arm 766. The forces exerted on the clamping arm 766 can be representative of the tissue compression experienced by the section of tissue captured between the clamping arm 766 and the ultrasonic blade 768. The one or more sensors 788 can be positioned at various points of interaction throughout of the closing drive system to detect the closing forces applied to the clamping arm 766 by the closing drive system. The one or more 788 sensors can be sampled in real time during a gripping operation by a control circuit processor
[00350] [00350] A current sensor 786 can be used to measure the current drained by the motor 754. The force required to advance the closing member 764 corresponds to the current drained by the motor 754. The force is converted into a digital signal and supplied control circuit 760.
[00351] [00351] The control circuit 760 can be configured to simulate the response of the real system of the instrument in the controller software. A displacement member can be actuated to move a closing member 764 on end actuator 752 at or near a target speed. The surgical instrument 750 may include a feedback controller, which can be one of any feedback feedback controllers, including, but not limited to, a PID controller, state feedback, LOR, and / or an adaptive controller, for example. example. The surgical instrument 750 can include a power source to convert the signal from the feedback controller to a physical input such as housing voltage, PWM voltage, frequency modulated voltage, current, torque and / or force, for example. example.
[00352] [00352] The actual drive system of the surgical instrument 750 is configured to drive the displacement member, the cutting member or the closing member 764, by a DC motor with brushes with gearbox and mechanical connections to a system joint and / or knife. Another example is the 754 electric motor that operates the displacement member and the articulation drive, for example, from an interchangeable drive shaft assembly. An external influence is an unmeasured and unpredictable influence on things like tissue, surrounding bodies, and friction in the physical system. This external influence can be called drag, which acts in opposition to the 754 electric motor. External influence, like drag, can cause the functioning of the physical system to deviate from a desired operation of the physical system.
[00353] [00353] Several exemplifying aspects are directed to a 750 surgical instrument that comprises a 752 end actuator with motor-operated sealing and cutting implements. For example, a 754 motor can drive a displacement member distally and proximally along a longitudinal axis of the end actuator 752. The end actuator 752 may comprise a pivoting clamping arm 766 and, when configured for use , an ultrasonic blade 768 positioned on the opposite side of the clamping arm 766. A physician can secure the tissue between the clamping arm 766 and the ultrasonic blade 768, as described in the present invention. When ready to use the 750 instrument, the physician can provide a trigger signal, for example, by pressing a trigger on the 750 instrument. In response to the trigger signal, motor 754 can drive the displacement member distally along the axis longitudinal geometric design of end actuator 752 from a proximal start position to a distal end position from the start position. As the displacement member moves distally, the closing member 764 with a cutting element positioned at a distal end, can cut the fabric between the ultrasonic blade 768 and the clamping arm 766.
[00354] [00354] In several examples, the surgical instrument 750 may comprise a control circuit 760 programmed to control the distal translation of the displacement member, such as the closing member 764, for example, based on one or more tissue conditions . The control circuit 760 can be programmed to directly or indirectly detect tissue conditions, such as thickness, as described here. Control circuit 760 can be programmed to select a control program based on tissue conditions. A control program can describe the distal movement of the displacement member. Different control programs can be selected to better treat different tissue conditions. For example, when a thicker tissue is present, the control circuit 760 can be programmed to transfer the displacement member at a lower speed and / or with a lower power. When a thinner fabric is present, the control circuit 760 can be programmed to move the displacement member at a higher speed and / or with greater power.
[00355] [00355] In some examples, the control circuit 760 may initially operate the motor 754 in an open circuit configuration for a first open circuit portion of a travel member path. Based on a response from the 750 instrument during the open circuit portion of the stroke, control circuit 760 can select a trip control program. The response of the instrument may include a travel distance of the displacement member during the open circuit portion, a time elapsed during the open circuit portion, the energy supplied to the motor 754 during the open circuit portion, a sum pulse widths of a motor start signal, etc. After the open circuit portion, control circuit 760 can implement the selected trigger control program for a second portion of the travel member travel. For example, during the closed loop portion of the stroke, control circuit 760 can modulate motor 754 based on translation data that describes a position of the displacement member in a closed circuit manner to translate the displacement member at a constant speed. Additional details are disclosed in US Patent Application Serial No. 15 / 720,852, entitled SYSTEM AND MEODODS FOR CONTROLLING A DISPLAY OF A SURGICAL INSUMENT, filed on September 29, 2017, which is hereby incorporated by reference in its entirety.
[00356] [00356] Figure 18 illustrates a schematic diagram of a surgical instrument 750 configured to control the distal translation of the displacement member according to an aspect of the present description. In one aspect, the surgical instrument 750 is programmed to control the distal translation of the displacement member like the closing member 764. The surgical instrument 750 comprises an end actuator 752 which can comprise a clamping arm 766, a closure 764 and an ultrasonic blade 768 coupled to an ultrasonic transducer 769 driven by an ultrasonic generator 771.
[00357] [00357] The position, movement, displacement, and / or translation of a linear displacement member, such as closing member 764, can be measured by an absolute positioning system, sensor arrangement, and a position sensor 784. Because the closing member 764 is coupled to a longitudinally movable driving member, the position of the closing member 764 can be determined by measuring the position of the longitudinally mobile driving member using the position sensor.
[00358] [00358] Control circuit 760 can generate a 772 motor setpoint signal. The 772 motor setpoint signal can be supplied to a 758 motor controller. The 758 motor controller can comprise one or more circuits configured to provide a motor 774 drive signal to motor 754 to drive motor 754, as described in the present invention. In some instances, the 754 motor may be a DC motor with a brushed DC electric motor. For example, the speed of motor 754 can be proportional to the drive signal of motor 774. In some instances, motor 754 can be a brushless DC electric motor and the motor drive signal 774 can comprise a PWM signal provided for a or more stator windings of motor 754. In addition, in some examples, motor controller 758 can be omitted, and control circuit 760 can generate motor drive signal 774 directly.
[00359] [00359] The 754 motor can receive power from an energy source
[00360] [00360] The control circuit 760 can be in communication with one or more sensors 788. The sensors 788 can be positioned on the end actuator 752 and adapted to work with the surgical instrument 750 to measure the various derived parameters, such as distance span versus time, tissue compression versus time and anvil effort versus time. The 788 sensors can comprise a magnetic sensor, a magnetic field sensor, a stress meter, a pressure sensor, a force sensor, an inductive sensor such as a eddy current sensor, a resistive sensor, a capacitive sensor, a sensor optical and / or any other sensors suitable for measuring one or more parameters of the 752 end actuator. The 788 sensors may include one or more sensors.
[00361] [00361] One or more 788 sensors may comprise a stress meter such as a microstrain meter, configured to measure the magnitude of the stress on the clamping arm
[00362] [00362] The 788 sensors can be configured to measure the forces exerted on the clamping arm 766 by the closing drive system. For example, one or more sensors 788 may be at a point of interaction between a closing tube and the clamping arm 766 to detect the closing forces applied by a closing tube to the clamping arm 766. The forces exerted on the clamping arm 766 can be representative of the tissue compression experienced by the section of tissue captured between the clamping arm 766 and the ultrasonic blade 768. The one or more sensors 788 can be positioned at various points of interaction throughout of the closing drive system to detect the closing forces applied to the clamping arm 766 by the closing drive system. The one or more 788 sensors can be sampled in real time during a gripping operation by a control circuit processor
[00363] [00363] “A current sensor 786 can be used to measure the current drained by the motor 754. The force required to advance the closing member 764 corresponds to the current drained by the mo-
[00364] [00364] The control circuit 760 can be configured to simulate the response of the real system of the instrument in the controller software. A displacement member can be actuated to move a closing member 764 on end actuator 752 at or near a target speed. The surgical instrument 750 may include a feedback controller, which can be one of any feedback feedback controllers, including, but not limited to, a PID controller, state feedback, LOR, and / or an adaptive controller, for example. example. The surgical instrument 750 can include a power source to convert the signal from the feedback controller to a physical input such as housing voltage, PWM voltage, frequency modulated voltage, current, torque and / or force, for example. example.
[00365] [00365] The actual drive system of the surgical instrument 750 is configured to drive the displacement member, the cutting member or the closing member 764, by a DC motor with brushes with gearbox and mechanical connections to a system joint and / or knife. Another example is the 754 electric motor that operates the displacement member and the articulation drive, for example, from an interchangeable drive shaft assembly. An external influence is an unmeasured and unpredictable influence on things like tissue, surrounding bodies, and friction in the physical system. This external influence can be called drag, which acts in opposition to the 754 electric motor. External influence, like drag, can cause the functioning of the physical system to deviate from a desired operation of the physical system.
[00366] [00366] Several exemplifying aspects are directed to a 750 surgical instrument that comprises an end actuator.
[00367] [00367] In several examples, the surgical instrument 750 may comprise a control circuit 760 programmed to control the distal translation of the displacement member, such as the closing member 764, for example, based on one or more tissue conditions . The control circuit 760 can be programmed to directly or indirectly detect tissue conditions, such as thickness, as described here. Control circuit 760 can be programmed to select a control program based on tissue conditions. A control program can describe the distal movement of the displacement member. Different control programs can be selected to better treat different tissue conditions. For example, when a thicker tissue is present, the control circuit 760 can be programmed to transfer the displacement member at a lower speed and / or with a lower power. When a thinner fabric is present, the control circuit 760 can be programmed to move the displacement member at a higher speed and / or with greater power.
[00368] [00368] In some examples, control circuit 760 may initially operate motor 754 in an open circuit configuration for a first open circuit portion of a travel member path. Based on a response from the 750 instrument during the open circuit portion of the stroke, control circuit 760 can select a trip control program. The response of the instrument may include a travel distance of the displacement member during the open circuit portion, a time elapsed during the open circuit portion, the energy supplied to the motor 754 during the open circuit portion, a sum pulse widths of a motor start signal, etc. After the open circuit portion, control circuit 760 can implement the selected trigger control program for a second portion of the travel member travel. For example, during the closed loop portion of the stroke, control circuit 760 can modulate motor 754 based on translation data that describes a position of the displacement member in a closed circuit manner to translate the displacement member at a constant speed. Additional details are disclosed in US Patent Application Serial No. 15 / 720,852, entitled SYSTEM AND MEODODS FOR CONTROLLING A DISPLAY OF A SURGICAL INSUMENT, filed on September 29, 2017, which is hereby incorporated by reference in its entirety.
[00369] [00369] Figure 18 is a schematic diagram of an instrument
[00370] [00370] In one aspect, the 788 sensors can be implemented as a limit switch, electromechanical device, solid state switches, Hall effect devices, MRI devices, GMR devices, magnetometers, among others. In other implementations, 638 sensors can be solid state switches that operate under the influence of light, such as optical sensors, infrared sensors, ultraviolet sensors, among others. In addition, the switches can be solid-state devices such as transistors (for example, FET, junction FET, MOSFET, bipolar, and the like). In other implementations, 788 sensors can include driverless electric switches, ultrasonic switches, accelerometers, inertia sensors and, among others.
[00371] [00371] In one aspect, the position sensor 784 can be implemented as an absolute positioning system, which comprises a rotating magnetic absolute positioning system implemented as a rotating magnetic position sensor, circling single integrated, ASSOSSEQFT, available from Austria Microsystems, AG. The position sensor 784 can interface with the control circuit 760 to provide an absolute positioning system. The position can include multiple Hall effect elements located above a magnet and coupled to a CORDIC processor, also known as the digit by digit method and Volder's algorithm, which is provided to implement a simple and efficient algorithm for calculating hyperbolic functions and trigonometry that require only addition, subtraction, bit shift and table search operations.
[00372] [00372] In some examples, the position sensor 784 can be omitted. When the motor 754 is a stepper motor, the control circuit 760 can track the position of the closing member 764 by aggregating the number and orientation of the steps the motor has been instructed to perform. Position sensor 784 can be located on end actuator 792 or any other portion of the instrument.
[00373] [00373] The control circuit 760 can be in communication with one or more sensors 788. The sensors 788 can be positioned on the end actuator 792 and adapted to work with the surgical instrument 790 to measure the various derived parameters, such as distance span versus time, tissue compression versus time and anvil effort versus time. The 788 sensors can comprise a magnetic sensor, a magnetic field sensor, a stress meter, a pressure sensor, a force sensor, an inductive sensor such as a eddy current sensor, a resistive sensor, a capacitive sensor, a sensor optical and / or any other sensors suitable for measuring one or more parameters of the end actuator 792. The 788 sensors may include one or more sensors.
[00374] [00374] An RF power source 794 is coupled to end actuator 792 and is applied to RF electrode 796 when RF electrode 796 is provided on end actuator 792 in place of ultrasonic blade 768 or to function in conjunction with the ultrasound slide
[00375] [00375] Additional details are disclosed in US Patent Application Serial No. 15 / 636,096, entitled SURGICAL SYSTEM COU-
[00376] [00376] Figure 19 illustrates an example of a generator 900, which is a form of a generator configured to couple with an ultrasonic instrument and additionally configured to execute adaptive ultrasonic blade control algorithms in a surgical data network comprising a central modular communication controller. The 900 generator is configured to supply multiple types of energy to a surgical instrument. The 900 generator provides ultrasonic and RF signals to power a surgical instrument, independently or simultaneously. Ultrasonic and RF signals can be provided alone or in combination and can be provided simultaneously. As indicated above, at least one generator output can provide multiple types of energy (for example, ultrasonic, bipolar or monopolar RF, irreversible and / or reversible electroporation, and / or microwave energy, among others) through a single port, and these signals can be supplied separately or simultaneously to the end actuator to treat tissue. The generator 900 comprises a processor 902 coupled to a waveform generator 904. The processor 902 and the waveform generator 904 are configured to generate various signal waveforms based on information stored in a memory attached to the processor
[00377] [00377] A first voltage detection circuit 912 is coupled through the terminals identified as ENERGY; and RETURN path to measure the output voltage between them. A second voltage detection circuit 924 is coupled through the terminals identified as ENERGY, and RETURN path to measure the output voltage between them. A current detection circuit 914 is arranged in series with the RETURN leg on the secondary side of the power transformer 908 as shown to measure the output current for any type of energy. If different return paths are provided for each energy mode, then a separate current detection circuit would be provided.
[00378] [00378] In one aspect, the impedance can be determined by processor 902 by dividing the output of the first voltage detection circuit 912 coupled through the terminals identified as ENERGY / RETURN or the second voltage detection circuit 924 coupled through the terminals identified as ENERGY / RETURN, by the output of the current detection circuit 914 arranged in series with the RETURN leg on the secondary side of the power transformer 908. The outputs of the first and second voltage detection circuits 912, 924 are provided to separate isolation transformers 916, 922 and output from current detection circuit 914 is provided to another isolation transformer 916. Digitized current and voltage detection measurements from ADC circuit 926 are provided to processor 902 to compute the impedance. As an example, the first type of energy ENERGY: it can be ultrasonic energy and the second mode of energy ENERGY, it can be RF energy. However, in addition to the ultrasonic and bipolar or monopolar RF energy modalities, other energy modalities include irreversible and / or reversible electroporation and / or microwave energy, among others. In addition, although the example shown in Figure 19 shows a single RETURN return path that can be provided for two or more energy modes, in other respects, multiple RETURN return paths, r can be provided for each energy mode ENERGY, r. Thus, as described here, the impedance of the ultrasonic transducer can be measured by dividing the output of the first voltage detection circuit 912 by the current detection circuit 914 and the tissue impedance can be measured by dividing the output of the second voltage detection circuit 924 by current detection circuit 914.
[00379] [00379] “As shown in Figure 19, generator 900 comprising at least one output port can include a power transformer 908 with a single output and multiple taps to provide power in the form of one or more modalities energy, such as ultrasonic, bipolar or monopolar RF, irreversible and / or reversible electroporation, and / or microwave energy, among others, for example to the end actuator depending on the type of tissue treatment being performed. For example, the 900 generator can supply energy with higher voltage and lower current to drive an ultrasonic transducer, with lower voltage and higher current to drive RF electrodes to seal the tissue or with a coag waveform. - lation for point coagulation using monopolar or bipolar RF electrosurgical electrodes. The output waveform of generator 900 can be oriented, switched or filtered to provide the frequency to the actuator.
[00380] [00380] Additional details are revealed in US Patent Application publication 2017/0086914 entitled TECHNIQUES FOR OPERA-
[00381] [00381] As used throughout this description, the term "wireless" and its derivatives can be used to describe circuits, devices, systems, methods, techniques, communication channels etc., which can communicate data through the use of modulated electromagnetic radiation through a non-solid medium. The term does not imply that the associated devices do not contain any wires, although in some respects they may not. The communication module can implement any of a number of wireless and wired communication standards or protocols, including, but not limited to, Wi-Fi (IEEE 802.11 family), WiMAX (IEEE 802.16 family) , IEEE 802.20, long-term evolution (LTE, "long-term evolution"), Ev-DO, HSPA +, HSDPAr +, HSUPA +, EDGE, GSM, GPRS, CDMA, TDMA, DECT, Bluetooth, derived from Ethernet of the same , as well as any other wireless and wired protocols that are designated as 3G, 4G, 5G, and beyond. The computing module can include a plurality of communication modules
[00382] [00382] “As used in the present invention, a processor or processing unit is an electronic circuit that performs operations on some external data source, usually memory or some other data flow. The term is used in the present invention to refer to the central processor (central processing unit) in a system or computer systems (especially systems on a chip (SoCs)) that combine several specialized "processors".
[00383] [00383] As used here, an integrated circuit system or integrated circuit system (SoC or SOC) is an integrated circuit (also known as an "IC" or "chip") that integrates all components of a computer or other electronic systems. It can contain digital, analog, mixed signal and often radio frequency functions - all on a single substrate. A SoC integrates a microcontroller (or microprocessor) with advanced peripherals such as a graphics processing unit (GPU), Wi-Fi module, or coprocessor. A SoC may or may not contain embedded memory.
[00384] [00384] “As used here, a microcontroller or controller is a system that integrates a microprocessor with peripheral circuits and memory. A microcontroller (or MCU for microcontroller unit) can be implemented as a small computer on a single integrated circuit. It can be similar to a SoC; a SoC can include a microcontroller as one of its components. A microcontroller can contain one or more core processing units (CPUs) along with memory and programmable input / output peripherals. Program memory in the form of ferroelectric RAM, NOR flash or OTP ROM is also often included in the integrated circuit, as well as a small amount of RAM. Microcontrollers can be used for integrated applications, in contrast to microprocessors used in personal computers or other general-purpose applications that consist of several discrete integrated circuits.
[00385] [00385] “As used in the present invention, the term controller or microcontroller can be an integrated circuit device or independent IC (integrated circuit) that interfaces with a peripheral device. This can be a connection between two parts of a computer or a controller on an external device that manages the operation of (and connection to) that device.
[00386] [00386] “Any of the processors or microcontrollers in the present invention can be implemented by any single-core or multi-core processor, such as those known under the trade name ARM Cortex by Texas Instruments. In one respect, the processor may be a Cortex-M4F LM4F230H5QR ARM processor core, available from Texas Instruments, for example, which comprises an integrated 256 KB single-cycle flash memory, or other non-volatile memory , up to 40 MHz, a prefetch buffer to optimize performance above 40 MHz, a 32 KB single cycle serial random access memory (SRAM), an internal read-only memory (ROM) loaded with the StellarisWareO program , 2 KB electrically erasable, programmable read-only memory (EEPROM), one or more pulse width modulation (PWM) modules, one or more quadrature encoder (QEI) input analogues, one or plus 12-bit analog-to-digital converters (ADC) with 12 analog input channels, details of which are available in the product data sheet.
[00387] [00387] In one aspect, the processor may comprise a safety controller that comprises two controller-based families, such as TMS570 and RM4x known under the trade name Hercules ARM Cortex R4, also available from Texas Instruments. The safety controller can be configured specifically for IEC 61508 and ISO 26262 safety critical applications, among others, to provide advanced integrated safety features while providing scalable performance, connectivity and memory options.
[00388] [00388] Modular devices include modules (as described in connection with Figures 3 and 9, for example) that are receivable within a central surgical controller and the devices or surgical instruments that can be connected to the various modules in order to connect or pair with the corresponding central surgical controller. Modular devices include, for example, smart surgical instruments, medical imaging devices, suction / irrigation devices, smoke evacuators, power generators, fans, insufflators and monitors. The modular devices described here can be controlled by control algorithms. The control algorithms can be executed on the modular device itself, on the central surgical controller to which the specific modular device is paired, or on both the modular device and the central surgical controller (for example, through a distributed computing architecture) . In some instances, the control algorithms of the modular devices control the devices based on the data detected by the modular device itself (that is, by sensors on, over or connected to the modular device). This data can be related to the patient in surgery (for example, tissue properties or insufflation pressure) or to the modular device itself (for example, the speed at which a knife is being advanced, the motor current, or the levels of energy). For example, a control algorithm for a surgical stapling and cutting instrument can control the rate at which the instrument's motor drives its knife through the fabric according to the resistance encountered by the knife as it progresses.
[00389] [00389] Figure 20 is a simplified block diagram of an aspect of the 1100 generator to provide adjustment without inductor, as described above, among other benefits. Referring to Figure 20, generator 1100 may comprise an isolated stage of patient 1520 in communication with a non-isolated stage 1540 via a power transformer 1560. A secondary winding 1580 of power transformer 1560 is contained in isolated stage 1520 and can understand a bypass configuration (for example, a central bypass or non-central bypass configuration) to define the trigger signal outputs 1600a, 1600b, 1600c in order to output output trigger signals to different surgical devices, such as an ultrasonic surgical device 1104 and an electrosurgical device 1106. In particular, the trigger signal outputs 1600a, 1600b and 1600c can output a trigger signal (for example, a 420V RMS trigger signal) to a ultrasonic surgical device 1104, and the trigger signal outputs 1600a, 1600b and 1600c can emit a trigger signal (for example, a 100V RMS trigger signal) for an electrosurgical device 1106, with output 1600b corresponding to the central tap of the power transformer 1560. The non-isolated stage 1540 may comprise a power amplifier 1620 that has an output connected to a primary winding 1640 of the power transformer 1560. In some respects, the power amplifier 1620 may comprise a push-pull amplifier, for example. The non-isolated stage 1540 may further comprise a programmable logic device 1660 for supplying a digital output to a 1680 digital-to-analog converter (DAC) which, in turn, provides an analog signal corresponding to a power amplifier input. 1620. In certain respects, the 1660 programmable logic device may comprise a field programmable gate array (FPGA), for example. The programmable logic device 1660, by controlling the input of the power amplifier 1620 through the DAC 1680, can therefore control any of a number of parameters (for example, frequency, waveform shape, amplitude of the wave) of trigger signals that appear at the trigger signal outputs 1600a, 1600b and 1600c. In certain respects and as discussed below, the programmable logic device 1660, in conjunction with a processor (for example, the 1740 processor discussed below), can implement various control algorithms based on digital signal processing (DSP) and / or other control algorithms to control parameters of the trigger signals emitted by the generator
[00390] [00390] Power can be supplied to a power rail of the 1620 power amplifier by a key mode regulator
[00391] [00391] In certain aspects, the 1660 programmable logic device, in conjunction with the 1740 processor, can implement a control scheme with direct digital synthesizer ("DDS" - direct digital syntheizer) to control the waveform, frequency and / or the amplitude of the trigger signals emitted by the generator 1100. In one aspect, for example, the programmable logic device 1660 can implement a DDS control algorithm by retrieving waveform samples stored in a lookup table ( "LUT" - look-up table) updated dynamically, like a RAM LUT that can be integrated into an FPGA. This control algorithm is particularly useful for ultrasonic applications in which an ultrasonic transducer, such as the 1120 ultrasonic transducer, can be driven by a clean sinusoidal current at its resonant frequency. As other frequencies can excite parasitic resonances, minimizing or reducing the total distortion of the current of the movement branch can correspondingly minimize or reduce the undesirable effects of the resonance. As the waveform shape of a drive signal output by generator 1100 is impacted by various sources of distortion present in the output drive circuit (for example, power transformer 1560, power amplifier 1620) , gives-
[00392] [00392] The non-isolated stage 1540 may additionally comprise an ADC 1780 and an ADC 1800 coupled to the output of the power transformer 1560 by means of the respective isolation transformers, 1820, 1840, to respectively sample the voltage and current of drive signals emitted by the 1100 generator. In some respects, ADCs 1780 and 1800 can be configured for sampling at high speeds (for example, 80 Msps) to enable over-sampling of the drive signals. In one aspect, for example, the sampling speed of ADCs 1780 and 1800 can enable an oversampling of approximately 200X (depending on the trigger frequency) of the trigger signals. In certain aspects, the sampling operations of ADCs 1780, 1800 can be performed by a single ADC receiving voltage and current input signals through a bidirectional multiplexer. The use of high-speed sampling in aspects of the 1100 generator can make it possible, among other things, to calculate the complex current flowing through the branch of motion (which can be used in certain aspects to implement ba waveform control) - based on DDS described above), precise digital filtering of the sampled signals, and calculation of the actual energy consumption with a high degree of accuracy. The output of the voltage and current feedback data through ADCs 1780 and 1800 can be received and processed (for example, FIFO type buffer, multiplexing) by the 1660 programmable logic device and stored in data memory for subsequent retrieval, for example, by the 1740 processor. As noted above, voltage and current feedback data can be used as an input for an algorithm for pre-distortion or modification of waveform samples in the LUT, in a dynamic and continuous manner. In certain aspects, this may require that each stored voltage and current feedback data pair be indexed based on, or otherwise associated with, a corresponding LUT sample that was issued by the 1660 programmable logic device when the pair data from voltage and current feedback was captured. The synchronization of the LUT samples with the voltage and current feedback data in this way contributes to the correct timing and stability of the pre-distortion algorithm.
[00393] [00393] In certain respects, voltage and current feedback data can be used to control the frequency and / or amplitude (for example, current amplitude) of the drive signals
[00394] [00394] The impedance phase can be determined through Fourier analysis. In one aspect, the phase difference between the voltage triggering signals V, (t) and generator current / 7 (t) can be determined using the fast Fourier transform (FFT) or the discrete Fourier transform ( DFT) as shown below: Eua = ADos (2n fit + 1) Liã = -Az: os (27E. +) Een = GE) +65 fuck (ias) 2 2, lin = SS fo) YOUR fo) Jane SE)
[00395] [00395] The evaluation of the Fourier transform at the sinusoidal frequency produces: Etr = EE) exíiga) and Fi), = q1 Tr ts) ==; (0) esptig, a) after fg L = 9
[00396] [00396] Other approaches include weighted square estimation
[00397] [00397] Where ç is the phase angle, faith the frequency, t is the time, and qo is the phase not = 0.
[00398] [00398] “Another technique to determine the phase difference between the voltage signals Va (t) and current / 7 (t) is the zero-crossing method and produces highly accurate results . For voltage signals V, (t) and current / 7 (t) having the same frequency, each passage through zero from negative to positive of the voltage signal Va (t) triggers the beginning of a pulse, while each passage through zero of negative to positive current signal / 7 (t) triggers the end of the pulse. The result is a pulse train with a pulse width proportional to the phase angle between the voltage signal and the current signal. In one aspect, the pulse train can be passed through an average filter to produce a measurement of the phase difference. In addition, if the passages from zero from positive to negative are also used in a similar way, and the results are averaged, any effects of DC and harmonic components can be reduced. In an implementation, the analog signals of voltage V, a (t) and current / 7 (t) are converted into digital signals that are high if the analog signal is positive and low if the analog signal is negative. High accuracy phase estimates require sharp transitions between high and low. In one aspect, a Schmitt trigger together with an RC stabilization network can be used to convert analog signals to digital signals. In other respects, an edge-triggered RS flip-flop circuit and auxiliary circuits can be used. In yet another aspect, the zero-crossing technique can use an exclusive gate (XOR).
[00399] [00399] - Other techniques for determining the phase difference between voltage and current signals include Lissajous figures and image monitoring; methods such as the three voltmeter method, the "crossed-coil" method, the vector voltmeter and vector impedance methods; and the use of standard phase instruments, phase-locked loops and other techniques as described in Phase Measurement, Peter - O'Shea, 2000 CRC Press LLC, <http: /Mwww.engnetbase. com>, which is incorporated by reference.
[00400] [00400] In another aspect, for example, the current feedback data can be monitored in order to maintain the current amplitude of the drive signal at a current amplitude setpoint. The current amplitude set point can be specified directly or indirectly determined based on the specified set points for voltage amplitude and power. In certain aspects, the control of the current amplitude can be implemented by the control algorithm, such as a proportional-integral-derivative control algorithm (PID), in the 1740 processor. The variables controlled by the control algorithm to properly control - the current amplitude of the drive signal may include, for example, the scaling of the LUT waveform samples stored in the 1660 programmable logic device and / or the full-scale output voltage of the 1680 DAC (which provides the input to the 1620 power amplifier) using an 1860 DAC.
[00401] [00401] The non-isolated stage 1540 may also contain a 1900 processor to provide, among other things, functionality.
[00402] [00402] Figure 21 illustrates a 3500 generator circuit partitioned in multiple stages, in which a first stage circuit 3504 is common for the second stage circuit 3506, according to at least one aspect of the present description. In one aspect, the surgical instruments of the surgical system 1000 described herein may comprise a 3500 generator circuit divided into multiple stages. For example, the surgical instruments of the surgical system 1000 can comprise the generator circuit 3500 divided into at least two circuits: the first stage circuit 3504 and the second stage circuit 3506 of amplification enabling the operation of high frequency energy (RF) only, ultrasonic energy only, and / or a combination of RF energy and ultrasonic energy. A combination 3514 modular drive shaft assembly will be powered by a first common stage circuit 3504 located in the 3512 handle assembly and a second modular stage circuit 3506 integral with the 3514 modular drive shaft assembly. As discussed earlier in this description in connection with the surgical instruments of the surgical system 1000, a battery set 3510 and the drive shaft set 3514 are configured to connect mechanically and electrically to the handle set 3512. The end actuator set it is configured to mechanically and electrically connect to the 3514 drive shaft assembly.
[00403] [00403] “As shown in the example in Figure 21, the 3510 battery pack portion of the surgical instrument comprises a first control circuit 3502, which includes the 3200 control circuit previously described. The handle set 3512, which connects to the battery set 3510, comprises a first common drive stage circuit 3420. As previously discussed, the first drive stage circuit 3420 is configured to drive the ultrasonic current of high frequency (RF), and sensor loads. The output of the first 3420 common drive stage circuit can drive any of the second 3506 stage circuits such as the second 3430 ultrasonic activation stage circuit, the second high frequency current (RF) stage circuit ) 3432, and / or the second 3434 sensor drive stage circuit. The first 3420 common drive stage circuit detects which second stage circuit 3506 is located on the drive shaft assembly.
[00404] [00404] Figure 22 illustrates a diagram of a surgical system 4000, which represents an aspect of surgical system 1000, which comprises a feedback system for use with any of the surgical instruments of surgical system 1000, which can include or implement many of the features described in the present invention. The surgical system 4000 can include a generator 4002 coupled to a surgical instrument that includes a 4006 end actuator, which can be activated when a doctor operates a 4010 trigger. In many ways, the 4006 end actuator can include an ultrasonic blade to apply ultrasonic vibration to perform surgical treatments
[00405] [00405] A control circuit 4008 can receive signals from sensors 4012 and / or 4013. Control circuit 4008 can include any suitable analog or digital circuit components. The control circuit 4008 can also communicate with the generator 4002 and / or the transducer 4004 to modulate the energy supplied to the 4006 end actuator and / or the generator level or the amplitude of the ultrasonic blade of the actuator. end 4006 based on the force applied to the trigger
[00406] [00406] According to various aspects, the 4006 end actuator may include a gripper or gripping mechanism. When trigger 4010 is initially triggered, the clamping mechanism can close, trap the fabric between a clamping arm and the end actuator
[00407] [00407] According to various aspects, the surgical instrument of the surgical system 4000 may also include one or more feedback devices to indicate the amount of energy supplied to the 4006 end actuator. For example, a 4014 speaker can emit a signal indicating the energy of the end actuator. According to several aspects, the 4014 loudspeaker can emit a series of pulse sounds, in which the frequency of the sounds indicates the energy. In addition to, or in place of, the 4014 loudspeaker, the surgical instrument may include a 4016 visual display. The 4016 visual display may indicate the power of the end actuator according to any suitable method. For example, the 4016 visual display may include a series of LEDs, where the power of the end actuator is indicated by the number of LEDs illuminated. The 4014 loudspeaker and / or the 4016 visual display can be activated by the 4008 control circuit. According to several aspects, the surgical instrument may include a ratchet device connected to the 4010 trigger. The ratchet device can generate an audible signal as more force is applied to the 4010 trigger, providing an indirect indication of the energy of the end actuator. The surgical instrument may include other features that can increase safety. For example, control circuit 4008 can be configured to prevent power from being supplied to end actuator 4006 beyond the predetermined limit. In addition, control circuit 4008 can implement a delay between the time when a change in the energy of the end actuator is indicated (for example, by the 4014 speaker or the 4016 screen) and the moment where the change in power to the end actuator is provided. In this way, a physician may be well aware that the level of ultrasonic energy that must be supplied to the 4006 end actuator is about to change.
[00408] [00408] In one aspect, the ultrasonic current or high frequency generators of the surgical system 1000 can be configured to digitally generate the electrical signal waveform of the desired shape, using a predetermined number of phase points stored in one lookup table to scan the waveform. The phase points can be stored in a table defined in a memory, a field programmable port matrix (FPGA) or any suitable non-volatile memory. Advanced power device control algorithms
[00409] [00409] “Various control algorithms for ultrasonic surgical instruments and combined energy surgical instruments (for example, ultrasonic / monopolar surgical instruments, monopolar / bipolar surgical instruments, ultrasonic / bipolar surgical instruments and other such combined energy devices ) are described in the present invention. For the sake of clarity, surgical instruments will be called surgical instrument 7012 in this section of the present description, although the description in this section may also apply to other surgical instruments mentioned above, such as surgical instrument 112, 700.
[00410] [00410] In several aspects, a control algorithm for a 7012 ultrasonic surgical instrument can be configured to apply a variable pressure of the clamping arm over the cycle time or the tissue cutting / coagulation process of an operation surgical procedure to create a constant pressure profile proximal to distal. The constant pressure profile means that each portion of tissue held within the end actuator of the surgical instrument 7012 along the proximal to distal end of the end actuator experiences equal or substantially equal pressure resulting from the force applied by the end actuator clamping arm . This can advantageously result in better coagulation of the surgically cut tissue. The control algorithm can be applied by a control circuit and / or a central surgical controller. The proximal to distal constant pressure profile may involve applying the control algorithm to vary the pressure applied by the clamping arm to provide a limit control pressure at the cutting feed location. The cut advance location can be represented by the advance of a corresponding coagulation / weld focal point determined by the control circuit and / or central surgical controller. In this way, the pressure can be varied based on the focal point. The control limit pressure can be a constant pressure applied to the tissue regardless of the quantity of the end actuator that is active. That is, the applied pressure does not change (or at least does not change significantly) despite any changes in the extent of tissue loading of the end actuator.
[00411] [00411] A portion or piece of tissue can be loaded onto the end actuator for surgical treatment, such as by loading the distal end of the end actuator with the tissue first. In this way, contact can initially be made at a distal point on the end actuator. A distal portion of one or more of the ultrasonic blade and the clamping arm can hold the tissue at that distal point. The initial pressure applied by the clamping arm can be determined or adjusted (for example, from a standard pressure level) by a control circuit and / or central surgical controller based on the size of the tissue portion initially being clamped, which corresponds to a quantity of the blade being used at the beginning (a loading of the initial tissue of the end actuator). After surgical cutting of the tissue, coagulation / surgical sealing can be performed by the surgical instrument 7012, such as by ultrasonic vibration of the ultrasonic blade and / or application of an RF electrical signal waveform output from the generator to RF electrodes. In the coagulation process, the weld advance can be used to adjust the applied clamping pressure. Specifically, the pressure of the clamping arm can be adjusted during advancing the weld as the cut / weld focal point moves along the blade.
[00412] [00412] In order to better hold the tissue at the distal point, one or more of the blade and the clamping arm can be extended or moved to create a preferred initial contact point at the distal end. Subsequently, the remaining portion of the clamping arm can then be largely loaded distally to proximally. Put another way, in this starting configuration distal from the closing stroke, the displacement ultrasonic blade can deflect so that it closes completely against the fabric and the clamping arm at the distal end of the end actuator followed by additional deflection in the proximal direction. The deflections of the blade and clamping arm can be approximately equal or balanced in relation to each other. The configuration of the distal start of the closing stroke is described in more detail below. The pressure of the clamping arm can also be varied from the initial pressure by the control circuit and / or central surgical controller based on the degree to which the end actuator is loaded with tissue and the feed through the weld . In addition, the pressure of the clamping arm can be varied based on the measured fabric impedance (for example, through a pressure, resistive, or other suitable 788 sensor on the end actuator). In addition, depending on which energy modality or modalities of the 7012 surgical instrument is selected, the power level of one or more of the RF and ultrasonic energy supplied to the end actuator can also be varied based on the measured tissue impedance. Electrosurgical energy other than RF and ultrasonic energy could also be used.
[00413] [00413] As discussed above, tissue loading can be initiated at the tip or distal end of the end actuator, so that the first contact between the ultrasonic blade and the clamping arm is at the tip. The central surgical controller and / or control circuit
[00414] [00414] This directed application of force by the clamping arm can be obtained based on the manual or motorized closing control, the first closing of the tip of the end actuator and the feedback provided to the control circuit and / or central surgical controller . The feedback could include thermally induced changes in the resonance frequency and electrical continuity (or discontinuity). The feedback could be received by the control circuit through a circuit comprising the ultrasonic blade and an ultrasonic blade clamping arm / interface (for example, tissue clamping block). Changes or shifts in the resonance frequency of the transducer can be used as feedback to determine the extent of tissue loading. In this way, feedback can be used to adjust the applied clamping pressure. In addition, the control circuit can control the motor of the surgical instrument to implement the closing stroke so that the end actuator closes at a point that is distal to the most proximal point of the trapped tissue. In this way, a gap can be maintained between the clamping arm and the ultrasonic blade at a point that is proximal to the most proximal point of the attached tissue.
[00415] [00415] Sensors 788 (called sensors 788 in this portion of the present description, although they may also refer to sensors 738 or other sensors described above) of surgical instrument 7012 can provide closing signals from the end actuator as input to the circuit of control. Using this input, the control circuit can determine the current closing position of the end actuator. When the control circuit determines that the end actuator is merely closed on the tip portions (for example, distal tip or proximal tip) or some other sub-portion of the length of the end actuator (for example, the distal half the end actuator), the control circuit can reduce the displacement of the ultrasonic blade. For this purpose, the power supplied to the ultrasonic transducer can be reduced. This reduction in displacement can beneficially prevent or reduce the excessive wear of the tissue block of the clamping arm at the distal end. This excessive wear is, in general, caused by high distal forces or pressure at the distal tip (corresponding to the distal departure configuration of the closing stroke) and large distal displacement corresponding to the displacement profiles associated with the ultrasonic sheets.
[00416] [00416] In general, when the tissue does not fully occupy the space between the jaws of the end actuator, reducing the surface area of the clamping arm that is compressed against the blade reduces the superfluous transmission of electrosurgical energy (for example, including ul energy - sonic and RF) to the clamping arm and / or tissue block. In other words, the adjustment in the pressure of the clamping arm allows relatively more electrosurgical energy to be directed to the tissue instead of being undesirably transmitted to other parts of the end actuator. Since the pressure applied by the clamping arm is controlled with the fabric loading base, a constant pressure can be applied to the fabric regardless of how much the end actuator is in an active state. The pressure can be additionally adjusted based on the advancement of the coagulation / cut surgical treatment by the surgical instrument 7012.
[00417] [00417] In addition, the feedback loop comprising the ultrasonic blade and the clamping block can also comprise a 788 sensor for detecting the impedance of the tissue located between the clamping arm and the ultrasonic sheet. In this case, the ultrasonic blade and the associated waveguide that ends at the blade could serve as part of the return path for the feedback circuit. The detected impedance can indicate a state of the clotting / cutting cycle. In other words, for example, comparing the impedance of the tissue to a limit can be indicative of an advance of the tissue weld, such as an advance of the coagulation / weld focal point. This focal point may be indicative of whether a fibrin clot for coagulation is well formed or not, for example. In this way, the impedance of the tissue detected can enable the control circuit and / or central surgical controller to adjust the power supplied to the ultrasonic transducer and the force applied by the clamping arm.
[00418] [00418] “Although at least some portion of the control algorithm (or algorithms) disclosed herein can be performed by central surgical controllers (alone or in conjunction with associated control circuits of surgical instruments), the functions of the algorithm (or algorithms ) of control are described as performed by control circuits for the sake of clarity. Also for clarity, the control circuit of the surgical instrument 7012 in this portion of the present description is identified as a control circuit labeled 710, although control circuit 710 can be the same or similar to control circuits 760, 3200 , 3502, 4008. Control circuit 710 can be a part of generator 4002 itself (called generator 4002 for clarity although generator 4002 can be the same or similar to generator 140, 145, 240, 721, 771, 900, 1100) or another part of the surgical instrument 7012 that is remote from the generator
[00419] [00419] Figures 23A to 23B are graphs 203000, 203020 that include a graph of clamping force as a function of time and an associated graph of a cut / coagulation focal point, according to at least one aspect of this description. In Figure 23A, the geometric axis y 203010 denotes strength while the geometric axis x 203008 denotes time. The dashed line 203002 represents the force applied by the clamping arm over time and tracks the application of force by the clamping arm, from the minimum force in time to the maximum force in time. The clamping force can be measured in suitable units such as pounds (lb). The time spanning the initial time to the uncle time can define a surgical cycle of the surgical instrument
[00420] [00420] In particular, the control circuit 710 can execute the control algorithm to provide a constant proximal to distal pressure profile. Providing such a control limit pressure, the tissue formation formed during the clotting stage can advantageously be more uniform and safer. Consequently, the continuous line 203006, which indicates a measured pressure applied to the tissue in the end actuator, remains the same or approximately constant throughout the surgical cycle. The tissue pressure line 203006 can correspond to the pressure applied to the front edge of the end actuator, where surgical coagulation and cutting occur. The clamping force can be a function of the progress of the tissue coagulation process. This relationship can be used to provide constant tissue pressure. Thus, although the tissue can be cut and coagulated in the proximal sections of the end actuator, the increase in the clamping force in the distal section results in a better coupling of the tissue to the distal sections of the ultrasonic blade. Thus, each section of tissue (which covers the proximal to distal sections of the end actuator) could experience equal or approximately similar pressure. As the fabric weld progresses, the control circuit can control the clamping arm for progressive closure, which is shown by the graph
[00421] [00421] Figure 23B shows that the focal point of the surgical cutting and coagulation operation in the tissue moves along the length of the ultrasonic blade 203026 (similar to or equal to the ultrasonic blade 718, 768 or other ultrasonic plates described above) along the course of the surgical cycle. As shown in Figure 23B, the focal point moves in a proximal to distal direction over time, but the focal point can also move in a distal to proximal direction. The first possibility corresponds to a proximal starting configuration of the closing stroke, while the last corresponds to a distal starting configuration of the closing stroke. As discussed above, the 710 control circuit can be configured to determine the cut / weld focal point based on one or more of the resonance frequency and electrical continuity feedback measures. The 203020 graphic also depicts the clamping arm 203022 (similar to the same clamping arm 716, 766 or other clamping arms described above). The clamping arm 203022 can comprise a clamping block for fabric 203024, which can be formed of TEFLONO or some other suitable low friction material. The 203024 block can be mounted for cooperation with the 203026 blade, with a pivoting movement of the 203022 clamping arm that positions the 203024 clamping block in a substantially parallel relationship and in contact with the blade
[00422] [00422] Figures 24A to 24B are graphs 203040, 203060 that include a 203040 graph of clamping force as a function of the distance from the distal end of the end actuator and a 203060 blade displacement graph as a function of the distance a from the distal tip, in accordance with at least one aspect of the present description. Figure 24A illustrates how the clamping pressure between the ultrasonic blade 203026 and the clamping arm 203022 varies as a function of the distance from the distal tip to the tissue. Specifically, graph 203040 includes a plurality of clamping pressure curves 203042A to 203042D showing how control circuit 710 can adjust the clamping pressure applied depending on the position of the fabric. For this purpose, the control circuit 710 can determine the closing position of one or more between the 203026 ultrasonic blade and a 203022 clamping arm. The geometric axis x 203044, 203064 denotes the distance from the distal end of the actuator end, while the geometric axis y 203046, 203066 denotes the applied clamping force. In the proximal start configuration of the closing stroke of Figure 24A, the applied clamping pressure moves in a distal direction during the closing movement, so that the closing stroke
[00423] [00423] Figure 24B illustrates the corresponding displacement profile of the 203026 ultrasonic blade as a function of the distance from the tip of the end actuator. In graph 203060, the geometric axis x 203064 again denotes the distance from the distal tip, while the geometric axis y 203066 denotes the magnitude of the displacement of the ultrasonic sheet 203026. Similarly, the zero point of the geometric axis x corresponds to a 203062 antinox, while the maximum point corresponds to a 203068 node of the 203026 ultrasonic blade. The 203062 antinox can be defined as a local absolute maximum in which the displacement or vibration of the ultrasonic blade 203026 is maximum. The 203068 node can be defined as a local absolute minimum in which the displacement or vibration of the 203026 ultrasonic blade is minimal. In general, the distance between the adjacent nodes and antinodes can be one-quarter wavelength of the activation frequency or resonance of the ultrasonic blade 203026. As illustrated by graph 203060, in antinode 203062, the occurrence of the maximum positive extension of ultrasonic vibration of the 203026 ultrasonic blade overlaps the maximum distance in the opposite direction to the distal tip. This can also occur in the next antinox corresponding to the maximum negative extent of ultrasonic vibration, although this is not shown in Figure 24B. At the point (node 203068) of minimum distance in the direction opposite to the distal tip, ultrasonic vibration is minimal, in order to completely hold or hold the tissue between the ultrasonic blade 203026 and the clamping arm 203022. This change in ultrasonic displacement as a function of the tip distance it is represented by the displacement line 203070.
[00424] [00424] In contrast to the proximal starting configuration of the closing stroke, the present description may include a configuration of the distal starting of the closing stroke in which closing the distal end of the end actuator first helps, finally, in the advantageous obtaining of heat mitigation. Heat mitigation can occur by configuring control circuit 710 to control the clamping pressure according to the extent of fabric loading on the end actuator. Specifically, pressure can only be provided at intersection points where the ultrasonic blade 203026 and the clamping arm 203022 hold the fabric between them. By avoiding or reducing pressure in portions of the end actuator in which no tissue resides, peak temperatures and residual heat after applying energy from generator 4002 are reduced. In this way, relatively more energy is transmitted to the fabric instead of the tissue block of the electrically conductive clamping arm 203024. The clamping block 203024 can be formed from a molded poly-tetrafluoroethylene, loaded with carbon or some other suitable material and additionally, it can be attached to the lower side of the clamping arm 203022, as described in US publication 2017/0164997, entitled METHOD OF TREATING TISSUE USING END EFFECTOR WITH ULTRASONIC AND ELEC- TROSURGICAL FEATURES, published on June 15, 2017, a which is hereby incorporated by reference in its entirety.
[00425] [00425] In addition, the 203024 fabric clamping block can be electrically conductive based on the use of conductive charging materials (eg carbon, carbon nanotubes, metallic particles, etc.). The electric current can flow through the surgical instrument 7012 from the ultrasonic blade 203026 to the tissue block
[00426] [00426] The control circuit 710 can control the motor of the surgical instrument 7012 to adjust the closing of the clamping arm 203022 and / or the movement of the ultrasonic blade 203026 for heat mitigation and energy efficiency. For this purpose, only a part of the total length of the end actuator could be used to secure and treat the fabric. For example, only the distal end of the end actuator could initially close on a tissue portion followed by more progressive loading of the tissue in the proximal direction. In this distal start configuration of the closing stroke, the force applied by the clamping arm is increased until it reaches the limit of the full closing stroke, while the clamping arm 203022 and / or the ultrasonic blade 203026 gradually deforms until it completely compresses against the tissue while maintaining a small gap between them in non-tissue portions of the end actuator. When the complete closing stroke of the end actuator is reached, the 203024 tissue clamping block can come in contact with the entire length of the tissue treatment portion of the 203026 ultrasonic blade. In this way, the control circuit can be configured secured to close the end actuator at a distal end of the end actuator before closing the non-distal end portions of the end actuator. The pressure profile of the tissue treatment portion and the 203026 ultrasonic blade end actuator is described in more detail below.
[00427] [00427] A displaced, tilted or otherwise curved ultrasonic blade 203026 can facilitate the first closing of the distal tip of the clamping arm 203022. More details on the first closing of the distal end of the end actuator (distal start configuration of the closing course) and the 203026 displacement ultrasonic blade can be found in US Patent No. 8,444,663, entitled ULTRASONIC SURGICAL SHEARS AND TISSUE PAD FOR THE SAME, granted on May 21, 2013; US Patent No. 10,004,527, entitled ULTRASONIC SURGICAL INSTRUMENT WITH STAGED CLAMPING, granted June 26, 2018; US publication 2018/0153574, entitled HEADPIECE AND BLADE CONFIGURATIONS FOR ULTRASONIC SURGICAL INSTRUMENT, published on June 7, 2018; US publication No. 2018/0153574, entitled HEADPIECE AND BLADE CONFIGURATIONS FOR ULTRASONIC SURGICAL INSTRUMENT, issued June 7, 2018; and US publication No.
[00428] [00428] The control circuit 710 can use feedback to control the end actuator for heat mitigation as described above. For example, control circuit 710 can monitor the resonance frequency of the 203026 ultrasonic blade. In particular, generators 4002 may include a tuning inductor to tune out the static capacitance at a resonance frequency so that substantially all the current output of the generator flows to the movement branch. The current of the movement branch together with the drive voltage defines the impedance and the magnitude of the phase. Consequently, the current output of generator 4002 represents the branch current of the movement, thus enabling generator 4002 to maintain its drive output at the resonance frequency of the ultrasonic transducer. Control circuit 710 can monitor trigger signals from generator 4002 that are corrected
[00429] [00429] Control circuit 710 is configured to evaluate this dynamic thermal response through changes in frequency or frequency slope (for example, first derivative of frequency or change in frequency over time), as based on the comparison with a frequency limit parameter value. In addition or alternatively, the 710 control circuit can compare the change in the resonance frequency with an initial frequency value determined at the beginning of the activation of the electrosurgical energy, which can be recorded in the memory of the surgical instrument 7012. Based on the signals electrical generated by generator 4002, control circuit 710 can determine and compare a frequency slope or frequency changes against the corresponding limits. Specifically, the control circuit 710 can determine: (i) when the frequency slope is above the associated threshold parameter value and (ii) when the change in frequency is above a frequency floor. Above a frequency floor it means, for example, that the drop in frequency does not exceed a predetermined limit drop in relation to the determined initial frequency value. Based on one or more of these determinations, the control circuit 710 (for example, through the engine) can control the ultrasonic blade 203026 and / or the clamping arm 203022 to reduce the closing force / stroke when conditions
[00430] [00430] “In this way, the control circuit 710 causes the applied clamping force or pressure to“ recoil ”, to beneficially minimize the application of thermal energy to the clamping block 203024 in locations that are proximal to the proximal extension of the trapped tissue . More details regarding the resonant frequency monitoring can be found in US Patent No. 8,512,365, entitled SURGICAL INSTRUMENTS, granted on August 20, 2013; and in US Patent No.
[00431] [00431] As another example of feedback, the control circuit 710 could monitor the electrical impedance of the surgical instrument 7012. In many respects, the surgical instrument 7012 can conduct electrical current between the ultrasonic blade 203026 and the block for 203024 clamping arm fabric for electrosurgical energy application. By monitoring this electrical current (or lack thereof), tissue impedance or transducer impedance based on a sensor of the end actuator 788 and / or the generator 4002 trigger signal, the control circuit 710 can determine the amount of tissue loading on the end actuator. In particular, the control circuit 710 can be programmed to detect and maintain an impedance of the circuit comprising the blade 203026 and the tissue block of the clamping arm 203024 above a predetermined limit. This maintained impedance can correspond or correspond approximately to a short electrical circuit. In this way, the electrical short circuit means the electrical discontinuity between the ultrasonic blade 203026 and the tissue block of the clamping arm 203024. Therefore, minimal thermal energy is supplied to the portion of the tissue block of the clamping arm 203024 located proximally to the proximal extension of the trapped tissue. To achieve this desired lack of electrical continuity, control circuit 710 can perform a reduction or reduction in the force or closing stroke as described above. In this way, the control circuit 710 can determine an electrical continuity measurement to calculate a weld / fabric seal focal point.
[00432] [00432] On the other hand, when the end actuator is not completely closed, the feedback received by the control circuit 710 can be used to reduce the output of generator 4002. At the output of generator 4002 it may be ultrasonic and / or ultrasonic electrosurgical energy Bipolar RF, depending on the energy mode setting of the surgical instrument 7012. By reducing the ultrasonic displacement of the ultrasonic blade 203026 and / or RF power conducted through the RF electrode 796, the control circuit 710 can avoid or reduce occurrences of relatively high power densities at the distal end of the end actuator. This is especially true given that the ultrasonic vibration of the 203026 ultrasonic blade is generally relatively high at the distal tip. In any case, avoiding these high power densities can advantageously interrupt or reduce excessive wear or deterioration of the 203024 clamp arm tissue block. The acoustic impedance of the 203026 ultrasonic blade could also be used to assess the claw closure state. Additionally or alternatively, a surgical instrument closing key 7012 such as a grip handle can indicate when the clamping arm 203022 and / or the ultrasonic blade 203026 is closed, as described, for example, in US patent No. 9,724,118, entitled
[00433] [00433] Figure 25 is a 203080 graph of a clamping force distribution as a function of several sections along the length of the end actuator, in accordance with at least one aspect of the present description. The geometric axis x 203082 denotes a section along the length of the end actuator, including section numbers 1 to 5. The geometric axis y 203084 denotes pressure gradients measured in suitable units in the range 1 to 4. Units they could be in pounds (Ibs), for example. Section 1 represents the most distal portion, while section 4 represents the closest portion of the end actuator. The measured force can be determined by the control circuit 710 based on sensor 788, as a pressure sensor. The pressure output signal from the pressure sensor 788 used to generate the 203080 graph has been averaged or summed to smooth the 203086 clamping pressure line. In other words, peaks and valleys in the 203086 pressure line that may result - gularities in block 203024 (for example, teeth in clamping block 203024) or sensor 788 are smoothed in graphic 203080. As illustrated by graphic 203080, the force distribution in the proximal half of the end actuator is relatively higher than the distribution of force in the distal half of the end actuator. In other words, the pressure profile ratio of the end actuator is below the value 1.
[00434] [00434] The pressure profile ratio can be defined as the sum of the pressure applied to the distal portion divided by the sum of the pressure applied to the proximal portion of the end actuator. Therefore, pressure profile ratios> 1 indicate that the end actuator is loaded at the distal tip, while pressure profile ratios <1 indicate proximally loaded state. A loaded end actuator on the distal tip may have more cumulative pressure on the distal half, while a proximally loaded end actuator has more cumulative pressure on the proximal half. As shown by graph 203080, the end actuator measured by a pressure sensor 788 is proximally loaded. The proximally charged state can be assessed from a position in which no tissue is contained in the end actuator. Such an example can be seen in Figure 32A. The relatively higher force applied to the proximal portion of the end actuator may result from the greater degree of curvature or displacement between the ultrasonic blade 203026 and the clamping arm 203022 in the distal portion in relation to the proximal portion. Proximal loading of the end actuator may be desirable because the 203026 ultrasonic blade can generally vibrate ultrasonically to a greater extent towards the distal portions. That is, the displacement of the 203026 ultrasonic blade may be greater in the distal portion than in the proximal portion of the end actuator. The relatively high clamping pressure applied to the proximal portion can advantageously ensure a more uniform application of electrosurgical energy to the tissue, thus achieving a safer surgical color / coagulation treatment.
[00435] [00435] Figure 26 is a 203100 graph of the blade displacement profile as a function of the distance from the distal end of the end actuator, according to at least one aspect of the present description. The geometric axis x 203102 denotes the distance from the distal end of the end actuator, which is shown in units of millimeters (mm) in the graph 203100. The geometric axis y 203104 denotes the normalized speed (on a scale in the range of O to 1) of the 203026 ultrasonic blade. When normalized, the speed profile as shown in 203100 is contiguous or overlaps with the 203026 ultrasonic blade travel profile. In addition, the triggered resonance frequency 203108 of the 203026 ultrasonic blade defines the effective wavelength of the displacement or speed profile. As shown in Figure 26, the resonance frequency triggered 203108 is 55.5 kilohertz (kHz), although other suitable resonance frequency values are also possible. The triggered resonance frequency 203108 is a factor of the material, geometry and thermal condition of the surgical instrument 7012. In
[00436] [00436] Put another way, the tissue treatment portion spans 15 mm from the distal end of the end actuator, as measured in the proximal direction. The speed and / or displacement profile as depicted in graph 203100 demonstrates that the speed and / or displacement of the 203026 ultrasonic blade is maximum at the distal tip and decreases to the minimum value as the distance from the distal tip increases to maximum. Consequently, providing a preferential distribution of the clamping force towards the proximal portion of the end actuator as shown in Figure 25 may allow for a more uniform power deposition along the length of the end actuator. The deposition of power is a function of the coefficient of friction, the speed and the force or pressure applied. Thus, as discussed above, correlating the relatively high distal velocity with a relatively low distal pressure and correlating the relatively low proximal velocity with a relatively high proximal pressure can result in a more uniform cut of the tissue, as determined in relation to time . When the end actuator is completely closed so that it has reached the full closing stroke, the resulting pressure or force profile is higher in half or a quarter proximal to the end actuator, then the Graph 203080 shows how the pressure or force profile ratio is <1. In addition, the deflections of the ultrasonic blade 203026 and the clamping arm 203022 can be equivalent or correlated along the closing stroke of the end actuator.
[00437] [00437] Figures 27A to 27C are a sectional view of end actuator 203120 that illustrate a closing stroke of the end actuator, in accordance with at least one aspect of the present description. The advance of the closing stroke, as shown in Figures 27A to 27C, demonstrates a closing stroke of the proximal starting configuration. In Figure 27A, end actuator 203120 (which may be the same or similar to the end actuators described above, including end actuator 702, 752, 792, 4006) is in a more open position than in Figures 27B to 27C. The clamping arm 203122 includes the tissue block of the clamping arm 203124, which can be the same or similar to the 203024 block. In Figure 27A, the clamping arm 203122 is spaced from the ultrasonic blade 203126, so that the block for clamping arm fabric 203124 initially start contacting or touching the blade at the most proximal portion of the clamping arm fabric 203124. clamping arm 203122 is angled or angled upwards relative to a horizontal geometric axis defined by end actuator 203120. Consequently, the gap between the clamping arm 203122 and the ultrasonic blade 203126 increases in the distal direction opposite the pivot point 203128. The clamping arm 203122 and the ultrasonic blade 203126 can pivot around the pivot point 203128.
[00438] [00438] “Although Figure 27A does not show the tissue attached by the end actuator 203120, in operation, the tissue may be located on the end actuator 203120, so that the end actuator 203120 compresses against the tissue in the most proximal extension of block 203124 for tissue treatment in Figure 27A. In Figure 27B, the clamping arm 203122 is further advanced along the closing stroke of the end actuator 203120. Thus, most or all of the proximal portion of the end actuator
[00439] [00439] Figures 28A to 28C are graphs 203140, 203160, 203180 of the clamping force applied between the blade and the clamping arm as a function of the distance from the distal end of the end actuator 203120 corresponding to the cross-sectional views of the Figures 27A to 27C, in accordance with at least one aspect of the present description. The applied pressure or clamping force shown in graphs 203140, 203160, 203180 can be measured by pressure sensor 788. In graphs 203140, 203160, 203180, the geometric axis x 203144, 203164, 203184 denotes the distance from the distal end of the actuator end 203120. The y axis 203146, 203166, 203186 denotes the pressure or force of the clamping arm applied between the clamping arm 203122 and the ultrasonic blade 203126. The applied clamping force line 203142, 203162, 203184 illustrates the clamping pressure as a function of the distance from the distal end of the end actuator 203120. As described above, the clamping pressure applied first begins at the most proximal extension of the 203124 clamping arm tissue block, adjacent to pivot point 203128. This is shown by Figure 28A. In Figure 28B, the clamping pressure started to spread distally. Consequently, the applied clamping force line 203162 starts at a more left-hand point than the applied clamping force line 203142. In addition, the clamping pressure in the most proximal extension of the block to the fabric of the tightening 20312 is greater in Figure 28B than in Figure 28A. That is, the amplitude in the rightmost portion of the applied clamping force line 203162 is greater than the corresponding amplitude of the applied clamping force line 203142.
[00440] [00440] In Figure 28C, the applied clamping force line 203182 starts at a point even further to the left than the applied clamping force line 203162. In fact, the clamping pressure is applied to all points that cover the geometric axis x 203184. The clamping pressure in the most proximal extension of the 20312 clamping arm tissue block is greater in Figure 28C than in Figure 28B and Figure 28A. Graph 203180 in Figure 28C illustrates the pressure applied to a stroke or full closing position of the end actuator
[00441] [00441] An example of such rules executed by the control circuit 710 includes a rule in which, if the user activates the large vessel or advanced hemostasis mode of the surgical instrument 7012, the control circuit 710 checks whether the actuator end 203120 has reached the full closing stroke. This verification can take place through a closing of the handle or full closing key of the surgical instrument 7012, for example. When the closing switch is not in the closed position, it indicates that the end actuator 203120 is not completely closed. Consequently, the surgical instrument 7012 can generate an alert, such as an audible sound or a visual, audible, tactile, haptic, vibrating or any other suitable alert. In some respects, the surgical instrument 7012 may have mechanical components to control the application of relatively high clamping force for displacement of the vascular structure (eg, approaching the adventitia) and relatively low clamping force for application power. Further details regarding such rules and manipulation of vessel structures for cutting and sealing fabrics can be found in US Patent No. 8,779,648, entitled
[00442] [00442] Figures 29A to 29C are a sectional view of the 203200 end actuator that illustrate a proximal starting configuration of the closing stroke, in accordance with at least one aspect of the present description. As shown in Figure 29A, the end actuator 203200 starts in an open position in which the clamping arm 203202 and the ultrasonic blade 203206 define a relatively large gap between them. The clamping arm 203202 includes a tissue block of the clamping arm 203204, which can be the same or similar to the block 203024, 203124. In Figure 29B, the clamping arm 203202 has rotated inwardly relative to the pivot point 203208, so that the proximal portion of the tissue block of the clamping arm 203204 contacts the tissue (not shown) located in the 203204 block. In other words, the end actuator 203200 closes first proximally, in order to apply pressure of total tightening to only the proximal portion of the attached tissue, while the tightening force develops or expands progressively in the distal direction. As the 203000 end actuator reaches the full closing stroke shown in Figure 29C, more tightening pressure is applied distally gradually. In Figure 29C, the full close pressure profile or force distribution is achieved in the full close position of the end actuator 203000. As discussed above, relatively more tightening pressure can be applied to the proximal portion of the actuator portion end of the 203026 ultrasonic blade to justify the relatively low proximal speed of the 203026 ultrasonic blade, for example.
[00443] [00443] Figures 30A to 30D are seen in cross section of the actuator of
[00444] [00444] In Figure 30D, the end actuator 203220 has reached the full closing stroke, while advantageously maintaining the proximal span 203230. As the end actuator 203220 progressively approaches a full closed position, one or more of the clamping arm 203224 and the ultrasonic blade 203226 progressively perceives greater stresses on the parts due to the increased flexing force that is exerted. Accordingly, the stresses of the parts gradually increase in correspondence with the transition from Figures 30A, 30C, 30C to 30D. Consequently, the greatest occurrence of contours 203228 occurs in Figure 30D. As shown in Figures 30A to 30D and moving in a proximal direction, incrementally more of the tissue block of the clamping arm 203224 becomes active as more of the end actuator 203220 closes. The closing sequence shown culminates in Figure 30D in which the entire available surface area of block 203224 is used to compress against trapped tissue and ultrasonic blade 203226, while the portion of end actuator 203220 that is proximal to the proximal extension of block 203224 and the trapped tissue defines proximal span 203230. Although block 203224 can end at the most distal extent of proximal span 203230, block 203224 can also extend to proximal span 203230. Even when block 203224 extends in this way, the clamping arm 203222 is lowered to help define the proximal span 203230. In the proximal span 203230, less electrosurgical energy is released, which can advantageously reduce the temperatures and heat residing in the blade. sonication 203226 after activation of the energy release by the generator
[00445] [00445] In addition, the applied clamping pressure, as well as the displacement and speed of the 203226 ultrasonic blade, can be controlled depending on the advance of the closing stroke. For example, when the end actuator 203220 is closed only at the distal tip or approximately only at the distal portion (for example, in Figures 30A to 30B), the displacement and / or speed of the 203226 ultrasonic blade can be reduced to prevent damage. - ration or excessive wear of block 203224. In this way, ultrasonic oscillation can be reduced when end actuator 203220 is not completely closed. As described above, the displacement can be relatively high in the distal tip portion, thus reducing the blade displacement may be desirable for the 203220 end actuator closure distal start configuration. Additionally, the control circuit 710 can be configured to control the closing of one or more of the clamping arm 203222 and the ultrasonic blade 203226 to vary the applied pressure to provide a control limit pressure based on the cutting feed location (eg, corresponding welding focal point). For example, as the end actuator 203220 advances, in Figures 30A to 30D, a coagulation or surgical cutting focal point can travel along the length of the 203226 ultrasonic blade, which can be used to adjust the applied clamping pressure . The change can be proximal or distal, depending on the selected configuration of the closing stroke, for example. When the focal point is in the central portion of the distal half of the 203220 end actuator, for example, relatively more pressure can be applied to that central portion, while relatively less pressure can be applied to locations distal to the central portion.
[00446] [00446] In addition to or alternatively to adjusting the forces of the clamping arm based on the cut / clotting focal point, the control circuit 710 can generally apply a relatively lower distal pressure and higher proximal force to address the displacement profile or velocity of the ultrasonic sheet 203226. As discussed above, the displacement or velocity of the ultrasonic sheet 203226 is relatively higher in distal portions, so the applied forces may be lower in these portions compared to proximal portions. The 203226 ultrasonic blade can be made of a suitable material, such as a metal or a titanium alloy. More specifically, the titanium alloy could be a grade 5 alpha / beta titanium alloy like Ti-6GAI-4V or it could be some other suitable metal. The clamping arm 203224 can also be made of a suitable material such as stainless steel and, more particularly, precipitation-hardened stainless steel 17-4. In addition, the 203224 clamp arm tissue block can be electrically conductive based on conductive charging materials (eg carbon, carbon nanotubes, metallic particles), so that the surgical instrument 7012 can conduct electric current from the 203226 ultrasonic blade to the 203224 block through insulated electrical conduits after the 203220 end actuator is completely closed. In this way, electrosurgical energy, such as therapeutic or subtherapeutic RF, can be applied to the trapped tissue.
[00447] [00447] Figures 31A to 31D are graphs 203240, 203260, 203280, 203300 of the clamping force applied between the ultrasonic blade 203226 and the clamping arm 203224 as a function of the distance from the distal end of the end actuator 203220 corresponding to the sectional views of Figures 30A to 30D, in accordance with at least one aspect of the present description. The graphics 203240, 203260, 203280, 203300 contain the legends 203250, 203270, 203290, 203310, respectively, which have different stitch patterns that denote the associated degree of strength due to compression between the 203226 ultrasonic blade and the arm for tightening 203224, for example. The 203308 pressure contours are plotted along the corresponding blade models 203252, 203272, 203292, 203312, which are a generic representation of the 203226 ultrasonic blade length. The 203308 pressure contours can be indicative of the quantity and location of component stresses applied in relation to the distance from the distal end of the 203220 end actuator. The dotted line 203254, 203274, 203294, 203314 denotes the proximal end of the tissue effector portion (for example, the proximal end of block 203224 ) of end actuator 203220. As can be seen in Figures 31A to 31D, pressure contours 203308 start at the distal end of end actuator 203220 and transition proximally toward dotted line 203254, 203274, 203294, 203314 In graphics 203240, 203260, 203280, 203300, the geometric axis x 203244, 203264, 203284, 203304 denotes the distance from the distal end of the 20322 end actuator 0.
[00448] [00448] The y axis 203246, 203266, 203286, 203306 denotes the applied clamping force resulting from contact between the 203226 ultrasonic blade and the clamping arm 203224. The applied force is represented by the applied force line 203242 , 203262, 203282, 203302. In Figure 14A, the applied clamping force occurs only at the distal tip, which corresponds to the first closing of the distal tip of the distal start configuration of the closing stroke. The application of the clamping force moves proximally gradually, as illustrated by the change in the applied force line 203242, 203262, 203282, 203302 from Figures 31A to 31D. In addition, the amplitude of the clamping force applied
[00449] [00449] Figures 32A to 32E are a sectional view of the end actuator 203340 which illustrate a distal starting configuration of the closing stroke and indicate stresses of the associated parts, in accordance with at least one aspect of the present description. As can be seen in Figures 32A to 32E, the ultrasonic blade 203346 is curved and deformable so that the curvature of the ultrasonic blade 203346 is leveled or lowered in the complete closing stroke, as shown in Figures 32D to 32E. Consequently, the geometric axis of the 203346 ultrasonic sheet is shifted. The ultrasonic blade 203346 and the clamping arm 203342 rotate around the pivot point 203348. The clamping arm 203342 includes the tissue block of the clamping arm 203344. Figures 32A to 32E illustrate the advance of the first closing of the distal tip in 203350 fabric for applying electrosurgical energy through block 203344. In Figure 32B, the distal tip of the curved ultrasonic blade 203346 comes into contact with the distal tip of the clamping arm 203342 based on the articulation of one or more of the ultrasonic blade 203346 and the clamping arm 203342, towards each other. The ultrasonic blade 203346 and the clamping arm 203342 can be moved towards each other by an approximately equal distance during the duration of the closing stroke. The 203340 end actuator can compress against the most proximal extension of the 203350 fabric at that point. Control circuit 710 can be configured to determine an initial tightening pressure to be applied based on the size of the fabric 203350 initially loaded on the end actuator 203340.
[00450] [00450] - As can be seen in Figures 32B to 32C, the deflection of the curved ultrasonic blade 203346 continues and develops proximally. At the same time, more of the 203350 fabric is attached. The deflection can comprise the lowering of the curved ultrasonic blade 203346, incrementally reducing the instantaneous curvature of the curved ultrasonic blade 203346. In Figure 32D, the curved ultrasonic blade 203346 is fully lowered so that the end actuator 203340 is completely closed (that is, it has reached the complete closing stroke). A portion of the trapped tissue 203350 is completely compressed against the ultrasonic blade 203346 and the clamping arm 203342 in the fully closed position so that electrosurgical energy can be released through the 203344 block for cutting and coagulation. The distal to proximal amplitude of the tissue trapped in the end actuator
[00451] [00451] Also shown on the ultrasonic blade 203346 are the blade models 203352, 203372, 203392, 203412, which illustrate the advance of the clamping force along the length of the 203340 end actuator. The first dotted line 203356 represents the tip distal, while the second dotted line 203358 represents the proximal end of the end actuator 203340. The second dotted line 203358 can also represent the most proximal extension of the fabric 203350 or where the fabric 203350 is interrupted. In the 203352 blade model, no force is applied to the 203346 ultrasonic blade. In the 203372 blade model, the distal tip of the 203346 ultrasonic blade comes into contact with the corresponding portion of the clamping arm 203342, so that some force is applied to the distal portion of the ultrasonic sheet 203346. Areas of greater applied force can be denoted by a darker shading of the pressure contours 203376, 203396, 203416. Consequently, the relative force
[00452] [00452] Various aspects of the subject described in this document are defined in the following numbered examples:
[00453] [00453] “Example 1- A surgical instrument comprises an end actuator, an ultrasonic transducer, a control circuit and the control circuit coupled to the end actuator. The end actuator comprises: an ultrasonic blade configured to oscillate ultrasonically against the tissue; and a clamping arm configured to pivot in relation to the ultrasonic blade. The ultrasonic transducer is acoustically coupled to the ultrasonic blade. The ultrasonic transducer is configured to ultrasonic oscillate the ultrasonic blade in response to a trigger signal from a generator. The end actuator is configured to receive electrosurgical energy from the generator to treat tissue based on the trigger signal. The control circuit is configured to: determine one or more of a measure of resonance frequency indicative of a thermally induced change in resonance frequency and a measure of electrical continuity; calculate a weld focal point based on one or more of the resonance frequency measure and the electrical continuity measure; control the closing of the clamping arm to vary the pressure applied by the clamping arm to provide a control limit pressure to the tissue loaded on the end actuator, the pressure being varied based on a focal point corresponding solder; and maintaining a gap between the ultrasonic blade and the clamping arm at a point proximal to a proximal end of the tissue.
[00454] [00454] Example 2 - The surgical instrument, according to Example 1, in which the control circuit is additionally configured to determine an initial pressure applied by the clamping arm based on a size of the tissue initially loaded in the actuator extremity pain.
[00455] [00455] Example 3 - The surgical instrument, according to Examples 1 or 2, in which the control circuit is additionally configured to vary the pressure applied by the clamping arm based on a displacement at the welding focal point to the along the ultrasonic plate.
[00456] [00456] Example 4 - The surgical instrument, according to Example 3, in which the control circuit is additionally configured to vary the pressure applied by the clamping arm based on an extension of the tissue loaded on the end actuator.
[00457] [00457] Example 5 - The surgical instrument, according to Examples 1, 2, 3 or 4, in which the control circuit is additionally configured to control the closing of the clamping arm by rotating the clamping arm to create an initial contact point of the ultrasonic blade and clamping arm at a distal end of the end actuator.
[00458] [00458] “Example 6 - The surgical instrument, according to the
[00459] [00459] “Example 7 - The surgical instrument, according to Examples 1, 2, 3, 4, 5 or 6, which additionally comprises a radiofrequency (RF) electrode configured to supply RF energy to the tissue, being that the control circuit is additionally configured to adjust one or more of a power level of RF energy and a power level of electrosurgical energy based on tissue impedance.
[00460] [00460] Example 8 - A method of using a surgical instrument to provide a control limit pressure, the surgical instrument comprising: an end actuator comprising: an ultrasonic blade configured to oscillate ultrasonically against the fabric; and a clamping arm configured to pivot in relation to the ultrasonic blade; an ultrasonic transducer acoustically coupled to the ultrasonic blade, the ultrasonic transducer being configured to oscillate the ultrasonic blade in response to the trigger signal; and a control circuit coupled to the end actuator, the end actuator being configured to receive electrosurgical energy from a generator to weld the tissue based on a generated trigger signal, and the method comprises: determining, through the control circuit, one or more of a resonance frequency measure indicating a thermally induced change in the resonance frequency and an electrical continuity measure; calculate, through the control circuit, a welding focal point based on one or more of the resonance frequency measurement and the electrical continuity measurement; control, by means of the control circuit, the closing of the clamping arm to vary the pressure applied by the clamping arm to supply the control limit pressure to the tissue loaded on the end actuator, the pressure being varied based on at a corresponding welding spot; and maintaining, through the control circuit, a gap between the ultrasonic blade and the clamping arm at a point proximal to a proximal end of the tissue.
[00461] [00461] Example 9- The method, according to Example 8, which further comprises determining, by means of the control circuit, an initial pressure applied by the clamping arm based on a size of the fabric initially loaded on the actuator. far end.
[00462] [00462] Example 10-The method, according to Examples 8 or 9, which further comprises varying, by means of the control circuit, the pressure applied by the clamping arm based on a displacement of the weld focal point along the ultrasonic blade.
[00463] [00463] Example 11- The method, according to Example 10, which further comprises varying, by means of the control circuit, the pressure applied by the clamping arm based on an extension of the fabric loaded on the end actuator.
[00464] [00464] Example 12- The method, according to Examples 8, 9, or 11, which additionally comprises controlling, by means of the control circuit, the closing of the clamping arm by means of the rotation of the clamping arm. clamping to create an initial contact point of the ultrasonic blade and clamping arm at a distal end of the end actuator.
[00465] [00465] Example 13- The method, according to Examples 8, 9, 10, 11 or 12, which further comprises loading the fabric inside the end actuator from the distal end to a proximal end of the actuator far end.
[00466] [00466] Example 14- The method, according to Examples 8, 9,
[00467] [00467] Example 15 - A surgical system comprising a central surgical controller configured to receive a clamping pressure algorithm transmitted from a cloud computing system, the central surgical controller being coupled in a communicative way to the system cloud computing; and a surgical instrument communicatively coupled to the central surgical controller, the surgical instrument comprising: an end actuator comprising: an ultrasonic displacement blade configured to oscillate ultrasonically against the tissue; and a displacement clamping arm configured to pivot in relation to the ultrasonic blade; and an ultrasonic transducer acoustically coupled to the ultrasonic blade, and the ultrasonic transducer is configured to ultrasonic oscillate the ultrasonic blade in response to a trigger signal from a generator, the end actuator being configured for receiving electrosurgical energy from the generator to weld fabric based on the trigger signal; and a control circuit configured to execute the clamping pressure algorithm to: determine one or more of a resonance frequency measure indicative of a thermically induced change in resonance frequency and an electrical continuity measure; calculate an extension of the tissue loaded on the end actuator based on one or more of the resonance frequency measure and the electrical continuity measure; and varying the pressure applied by the clamping arm according to a closing pressure profile, which comprises a first pressure on a proximal half of the end actuator that is greater than a second pressure on a distal half of the end actuator, and maintaining a gap between the ultrasonic blade and the clamping arm at a point proximal to a proximal end of the tissue loaded on the end actuator when the end actuator is completely closed.
[00468] [00468] “Example 16-0The surgical system, according to Example 15, in which the control circuit is additionally configured to close the end actuator at a distal end of the end actuator before closing the non-distal end portions of the end actuator.
[00469] [00469] Example 17 - The surgical system, according to Examples 15 or 16, which additionally comprises: interrupting, by means of the generator, the application of the third power level for a third time of residence; determine, by means of the control circuit, a fourth point of tissue impedance; and apply, through the generator, a fourth level of power to reach a fourth point of tissue impedance.
[00470] [00470] Example 18-0The surgical system, according to Example 17, in which the first and second deflections are shaped according to the closing pressure profile to provide the first pressure.
[00471] [00471] Example 19 - The surgical system, according to Examples 15, 16, 17 or 18, in which the control circuit is additionally configured to determine a closing position of the clamping arm.
[00472] [00472] Example 20 - The surgical system, according to Example 19, in which the control circuit is additionally configured to reduce ultrasonic oscillation of the ultrasonic blade when the end actuator is not fully closed.
[00473] [00473] Although several forms have been illustrated and described, it is not the applicant's intention to restrict or limit the scope of the claims attached to such detail. Numerous modifications, variations, alterations, substitutions, combinations and equivalents of these forms can be implemented and will occur to those skilled in the art without departing from the scope of this description. In addition, the structure of each element associated with the shape can alternatively be described as a means of providing the function performed by the element. In addition, when materials are revealed for certain components, other materials can be used. It should be understood, therefore, that the preceding description and the appended claims are intended to include all 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.
[00474] [00474] The previous detailed description presented various forms of the 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 disclosed here, in whole or in part, can be implemented in an equivalent way in integrated circuits, such as one or more computer programs executed in one or more computers (for example, as one or more programs running
[00475] [00475] The instructions used to program the logic to execute various revealed aspects can be stored in a memory in the system, such as dynamic random access memory (DRAM), memory, flash memory or other storage. In addition, instructions can be distributed over a network or other computer-readable media. In this way, machine-readable media can include any mechanism to store or transmit information in a machine-readable form (for example, a computer), but is not limited to, floppy disks, optical discs, compact memory disc read-only (CD-ROMs), and magneto-optical discs, read-only memory (ROM), random access memory (RAM), erasable programmable read-only memory (EPROM), erasable programmable read-only memory - mind (EEPROM), magnetic or optical cards, flash memory, or machine-readable tangible storage media used to transmit information over the Internet via an electrical, optical, acoustic cable or other forms of propagated signals (for example, waves carriers, infrared signals, digital signals, etc.). Therefore,
[00476] [00476] 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 which 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 field programmable port arrangement (FPGA)), state machine circuits, firmware that stores instructions performed 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 circuit integrated circuits, 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 program computer program that at least partially runs the processes and / or devices described here, or a microprocessor configured by a computer program that at least partially runs the processes and / or devices described here), electrical circuits that form a memory (for example, forms of random access memory), and / or set of electrical circuits that form a communications device (for example, a modem, communication key, or optical-electrical equipment). Those skilled in the art will recognize that the subject described here can be implemented in an analog or digital way, or in some combination of these.
[00477] [00477] As used in any aspect of the present invention, the term "logic" can refer to an application, software, firmware and / or circuit configured to perform any of the aforementioned operations. The software can be incorporated as a software package, code, instructions, instruction sets and / or data recorded on non-transient, computer-readable storage media. The firmware can be incorporated as code, instructions or instruction sets and / or hard coded (for example, non-volatile) data in memory devices.
[00478] [00478] As used in any aspect of the present invention, the terms "component", "system", "module" and the like may refer to a computer-related entity, be it hardware, a combination of hardware and software, software or software running.
[00479] [00479] “As used here 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 not they 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 a common use to call these signs bits, values, elements, symbols, characters, terms, numbers or the like. These terms and similar terms may
[00480] [00480] A network may include a packet-switched network. Communication devices may be able to communicate with each other using a selected packet switched network communications protocol. An exemplary communications protocol 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 "EEE 802.3 Standard", published in December 2008 and / or later versions of this standard. Alternatively or additionally, communication devices may be able to communicate with one another using an X.25 communications protocol. The X.25 communications protocol can conform or be compatible with a standard promulgated by the International Telecommunication Union-Telecommunication Standardization Sector (ITU-T). Alternatively or in addition, communication devices may be able to communicate with each other using a frame-relay communications protocol. The frame-relay communications protocol can conform to or be compatible with a standard promulgated by the Consultative Committee for International Technology 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 can comply with or be compatible with an ATM standard published
[00481] [00481] Unless otherwise stated, as is evident from the preceding description, it is understood that, throughout the preceding description, discussions that use terms such as "processing", or "computation", or "calculation ", or" determination ", or" display ", or similar, refers to the action and processes of a computer, or similar electronic computing device, that manipulates and transforms the represented data in the form of physical quantities (electronic) in computer records and memories in other data represented in a similar way in the form of physical quantities in memories or computer records, or in other similar information storage, transmission or display devices .
[00482] [00482] One or more components in the present invention may be called "configured for", "configurable for", "operable / operational for", "adapted / adaptable for", "capable of", "con- formable / conformed to ", etc. Those skilled in the art will recognize that "configured for" may, in general, include components in an active state and / or components in an inactive state and / or components in a standby state, except when the context determines otherwise .
[00483] [00483] The terms "proximal" and "distal" are used in the present invention with reference to a physician who handles the head 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 drawings. However, surgical instruments can be used in many orientations and positions, and these terms are not intended to be limiting and / or absolute.
[00484] [00484] Persons skilled in the art will recognize that, in general, the terms used here, and especially in the appended claims (for example, bodies in the appended claims) are generally intended as "open" terms (for example, the term "including" should be interpreted as "including, but not limited to", the term "having" should be interpreted as "having, at least", the term "includes" should be interpreted as "includes, but not limits to ", etc.). It will also be understood by those skilled in the art that, when a specific number of an introduced claim statement is intended, that intention will be expressly mentioned in the claim and, in the absence of such statement, no intention will be present. For example, as an aid to understanding, the following appended claims may contain the use of the introductory phrases "at least one" and "one or more" to introduce claim statements. However, the use of such phrases should not be interpreted as implying that the introduction of a claim statement by the indefinite articles "one, ones" or "one, ones" limits any specific claim containing the mention of the claim entered to claims that contain only such a mention, even when the same claim includes the introductory phrases "one or more" or "at least one" and indefinite articles, such as "one, ones" or "one, ones" (for example, "one , ones "and / or" one, ones "should typically be interpreted as meaning" at least one "or" one or more "); the same goes for the use of defined articles used to introduce claims.
[00485] [00485] Furthermore, even if a specific number of a message
[00486] [00486] In relation to the appended claims, those skilled in the art will understand that the operations mentioned in the same 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 different orders other than
[00487] [00487] 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 given resource, structure or characteristic described in connection with the aspect is included in at least one aspect. Thus, the use of expressions such as "in one (1) aspect", "in one aspect", "in an example", "in one (1) example", in several places throughout this specification it does not necessarily refer to the same aspect. In addition, specific features, structures or characteristics can be combined in any appropriate way in one or more aspects.
[00488] [00488] “Any patent application, patent, non-patent publication or other description material mentioned in this specification and / or mentioned in any order data sheet is hereby incorporated by reference, to the extent that the embedded materials are not inconsistent with this. Thus, and as necessary, the description as explicitly presented here replaces any conflicting material incorporated into the present invention as a reference. Any material, or portion thereof, which is incorporated herein by reference, but which conflicts with the definitions, statements, or other description materials contained herein, will be incorporated here only to the extent that there is no conflict. between the embedded material and the
[00489] [00489] In summary, numerous benefits have been described that result from the use of the concepts described in this document. The aforementioned description of one or more modalities has been presented for purposes of illustration and description. This description is not intended to be exhaustive or to limit the invention to the precise form disclosed. Modifications or variations are possible in light of the above teachings. One or more modalities were chosen and described in order to illustrate the principles and practical application to, thus, allow the person skilled in the art to use the various modalities and with several modifications, as they are convenient to the specific use contemplated. The claims presented in the annex are intended to define the global scope.

权利要求:
Claims (20)
[1]
1. Surgical instrument, characterized by comprising: an end actuator comprising: an ultrasonic blade configured to oscillate ultrasonically against the tissue; and a clamping arm configured to pivot in relation to the ultrasonic blade; an ultrasonic transducer acoustically coupled to the ultrasonic blade, the ultrasonic transducer configured to ultrasonic oscillate the ultrasonic blade in response to a trigger signal from a generator, where the end actuator is configured to receive energy electrosurgery of the generator to treat tissue based on the trigger signal; and a control circuit coupled to the end actuator, the control circuit being configured to: determine one or more of a measure of resonance frequency indicative of a thermally induced change in resonance frequency and a measure of electrical continuity; calculate a welding focal point based on one or more of the resonance frequency measurement and the electrical continuity measurement; controlling the closing of the clamping arm to vary a pressure applied by the clamping arm to provide a limit control pressure to the fabric loaded on the end actuator, where the pressure is varied based on a corresponding welding focal point; and maintaining a gap between the ultrasonic blade and the clamping arm at a point proximal to a proximal end of the tissue.
[2]
2. Surgical instrument, according to claim 1, characterized in that the control circuit is still configured to determine
terminate an initial pressure applied by the clamping arm based on a fabric size initially loaded on the end actuator.
[3]
3. Surgical instrument, according to claim 1, characterized in that the control circuit is further configured to vary the pressure applied by the clamping arm based on a displacement at the welding focal point along the ultrasonic blade.
[4]
4. Surgical instrument, according to claim 3, characterized in that the control circuit is further configured to vary the pressure applied by the clamping arm based on an extension of the tissue loaded on the end actuator.
[5]
5. Surgical instrument, according to claim 1, characterized in that the control circuit is further configured to control the closing of the clamping arm by means of the pivot of the clamping arm to create an initial contact point of the ultrasonic blade and of the clamping arm at a distal end of the end actuator.
[6]
6. Surgical instrument, according to claim 1, characterized by also comprising the generator configured to supply electrosurgical energy to the end actuator to treat tissue based on the generation of the trigger signal.
[7]
7. Surgical instrument, according to claim 1, characterized by also comprising a radiofrequency (RF) electrode configured to supply RF energy to the tissue, in which the control circuit is further configured to adjust one or more among one power level of RF energy and a power level of electrosurgical energy based on tissue impedance.
[8]
8. Method of using a surgical instrument to provide a control limit pressure, characterized in that the surgical instrument comprises: an end actuator comprising: an ultrasonic blade configured to oscillate ultrasonically against the tissue; and a clamping arm configured to pivot in relation to the ultrasonic blade; an ultrasonic transducer acoustically coupled to the ultrasonic blade, and the ultrasonic transducer is configured to oscillate the ultrasonic blade in response to the trigger signal; and a control circuit coupled to the end actuator, in which the end actuator is configured to receive electrosurgical energy from a generator to weld fabric based on a generated trigger signal and in which the method comprises: determine, through the control circuit, one or more of a measure of resonance frequency indicative of a thermally induced change in resonance frequency and a measure of electrical continuity; calculate, through the control circuit, a welding focal point based on one or more of the resonance frequency measurement and the electrical continuity measurement; control, by means of the control circuit, the closing of the clamping arm to vary a pressure applied by the clamping arm to provide the control limit pressure to the tissue loaded on the end actuator, where the pressure is varied based on at a corresponding welding spot; and maintain, through the control circuit, a gap between the ultrasonic blade and the clamping arm at a point proximal to a proximal end of the tissue.
[9]
Method according to claim 8, characterized in that it further comprises determining, by means of the control circuit, an initial pressure applied by the clamping arm based on a size of the fabric initially loaded on the end actuator.
[10]
10. Method, according to claim 8, characterized in that it also comprises varying, through the control circuit, the pressure applied by the clamping arm based on a displacement of the weld focal point along the ultrasonic blade.
[11]
11. Method according to claim 10, characterized in that it also comprises varying, through the control circuit, the pressure applied by the clamping arm based on an extension of the fabric loaded on the end actuator.
[12]
12. Method, according to claim 8, characterized in that it also comprises controlling, through the control circuit, the closing of the clamping arm by means of the pivoting of the clamping arm to create an initial contact point of the ultrasonic blade and the clamping arm at a distal end of the end actuator.
[13]
Method according to claim 8, characterized in that it further comprises loading the fabric inside the end actuator from the distal end to an end proximal to the end actuator.
[14]
14. Method, according to claim 8, characterized in that it also comprises adjusting, through the control circuit, one or more of a power level of the RF energy and a power level of the electrosurgical energy based on the impedance tissue, in which the surgical instrument also comprises a radio frequency (RF) electrode configured to supply RF energy to the tissue.
[15]
15. Surgical system, characterized by comprising: a central surgical controller configured to receive a clamping pressure algorithm transmitted from a cloud computing system, in which the central surgical controller is communicatively coupled to the naked computing system - comes; and a surgical instrument connected in a communicative way to the central surgical controller, in which the surgical instrument comprises:
an end actuator comprising:
a displaced ultrasonic blade configured to oscillate ultrasonically against the tissue; and a displaced clamping arm configured to pivot in relation to the ultrasonic blade;
and an ultrasonic transducer acoustically coupled to the ultrasonic blade, the ultrasonic transducer configured to ultrasonic oscillate the ultrasonic blade in response to a trigger signal from a generator, where the end actuator is configured to receive electrosurgical energy from the generator to weld fabric based on the trigger signal; and a control circuit configured to execute the clamping pressure algorithm for:
determining one or more of a resonance frequency measure indicative of a thermally induced change in resonance frequency and a measure of electrical continuity;
calculate an extension of the tissue loaded on the end actuator based on one or more of the resonance frequency measure and the electrical continuity measure; and varying the pressure applied by the clamping arm according to a closing pressure profile comprising a first pressure on a proximal half of the end actuator which is greater than a second pressure on a distal half of the end actuator, and maintain a gap between the ultrasonic blade and the clamping arm at a point proximal to a proximal end of the tissue loaded on the end actuator when the end actuator is completely closed.
[16]
16. Surgical system according to claim 15, characterized in that the control circuit is further configured to close the end actuator at a distal end of the end actuator before closing the non-distal end portions of the end actuator .
[17]
17. Surgical system according to claim 15, characterized by a first deflection of the displaced ultrasonic blade corresponding to a second deflection of the displaced clamping arm.
[18]
18. Surgical system according to claim 17, characterized in that the first and second deflections are formed according to the closing pressure profile to provide the first pressure.
[19]
19. Surgical system according to claim 15, characterized in that the control circuit is further configured to determine a closing position of the clamping arm.
[20]
20. Surgical system, according to claim 19, characterized in that the control circuit is further configured to reduce ultrasonic oscillation of the ultrasonic blade when the end actuator is not fully closed.
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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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US62/611,340|2017-12-28|

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US62/611,341|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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US201862650877P| true| 2018-03-30|2018-03-30|

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

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

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US62/650,887|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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US201862692748P| true| 2018-06-30|2018-06-30|

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

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

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US62/692,768|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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US201862729195P| true| 2018-09-10|2018-09-10|

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US62/729,195|2018-09-10|

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US16/182,238|US20190201080A1|2017-12-28|2018-11-06|Ultrasonic energy device which varies pressure applied by clamp arm to provide threshold control pressure at a cut progression location|

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US16/182,238|2018-11-06|

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PCT/US2018/060981|WO2019133142A1|2017-12-28|2018-11-14|Ultrasonic energy device which varies pressure applied by clamp arm to provide threshold control pressure at a cut progression location|

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