radiofrequency variation and ultrasonic power level in cooperation with a variable clamping arm pres

专利摘要:
Surgical instruments and systems and methods for the use of surgical instruments are revealed. A surgical instrument comprises an end actuator comprising an ultrasonic blade and a clamping arm, an electrode, an ultrasonic transducer and a sensor coupled to a control circuit. The electrode receives electrosurgical energy from a generator and applies electrosurgical energy to the end actuator to weld fabric based on the generation of a trigger signal by the generator. The ultrasonic transducer ultrasonically oscillates the ultrasonic blade in response to the trigger signal. The control circuit receives a signal from the sensor indicating a surgical parameter, determines a welding time for a surgical operation based on the sensor signal and varies one or more of the pressure of the clamping arm applied by the clamping arm and a level of electrosurgical energy power to maintain one or more of a predefined heat flow or power applied to the tissue loaded on the end actuator.
公开号:BR112020013163A2
申请号:R112020013163-6
申请日:2018-11-14
公开日:2020-12-01
发明作者:Frederick E. Shelton Iv；David C. Yates
申请人:Ethicon Llc；
IPC主号:

专利说明:

[001] [001] This application claims the benefit of non-provisional US patent application serial number 16 / 182,235, entitled VARIATION OF RADIO FREQUENCY AND ULTRASONIC POWER LEVEL IN COOPE-
[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] The present application also claims priority under 35 of USC $ 119 (e) of US provisional patent application No. 62 / 692,747, entitled SMART ACTIVATION OF AN ENERGY DEVICE BY ANO-THER DEVICE, filed on June 30, 2018 , US provisional patent application No. 62 / 692,748, entitled SMART ENERGY ARCHITECTURE, filed on June 30, 2018, and US provisional patent application No. 62 / 692,768, entitled SMART ENERGY DEVICES, filed on June 30, 2018, the disclosure of each of which is incorporated herein by reference, in its entirety
[004] [004] The present application claims priority under 35 USC $ 119 (e) of US provisional patent application No. 62 / 659,900, entitled METHOD OF HUB COMMUNICATION, filed on April 19, 2018, the disclosure of which is incorporated herein by way of reference, in its entirety.
[005] [005] The present application also claims priority under 35 USC $ 119 (e) of US provisional patent application 62 / 650,898 filed on March 30, 2018, entitled CAPACITIVE COUPLED 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 30, 2018, and provisional US patent application serial number 62 / 650.877, entitled SURGICAL SMOKE EVACUATION SENSING AND CONTROLS, filed on March 30, 2018, the disclosure of which one is hereby 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 number 62 / 640,415, entitled ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR, filed on March 8, 2018, the respective disclosure of which is incorporated herein by reference, in its entirety.
[007] [007] This application also claims priority under 35
[008] [008] The present invention relates to various surgical systems. Surgical procedures are typically performed in theaters or surgical operating rooms in a health care facility, such as a hospital. A sterile field is typically created around the patient. The sterile field may include members of the brushing team, who are properly dressed, and all furniture and accessories in the area. Various surgical devices and systems are used to perform a surgical procedure. FIGURES
[009] [009] The various aspects described here, both with regard to the organization and the methods of operation, together with objects and additional advantages of the same, can be better understood in reference to the description presented below, considered together with the attached drawings as follows.
[0010] [0010] Figure 1 is a block diagram of an interactive surgical system implemented by computer, in accordance with at least one aspect of the present disclosure.
[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 disclosure.
[0012] [0012] Figure 3 is a central surgical controller paired with a visualization system, a robotic system, and an intelligent instrument, in accordance with at least one aspect of the present disclosure.
[0013] [0013] Figure 4 is a partial perspective view of a central surgical controller compartment, and of a combined generator module received slidingly in a central surgical controller compartment drawer, according to at least one aspect of this disclosure.
[0014] [0014] Figure 5 is a perspective view of a generator module combined with bipolar, ultrasonic and monopolar contacts and a smoke evacuation component, in accordance with at least one aspect of the present disclosure.
[0015] [0015] Figure 6 illustrates different power bus connectors for a plurality of side coupling ports of a side modular cabinet configured to receive a plurality of modules, in accordance with at least one aspect of the present disclosure.
[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 disclosure.
[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 health services specially equipped for surgical operations, to the cloud, in accordance with at least one aspect of this disclosure.
[0018] [0018] Figure 9 illustrates an interactive surgical system implemented by computer, according to at least one aspect of the presence
[0019] [0019] Figure 10 illustrates a central surgical controller that comprises a plurality of modules coupled to the modular control tower, according to at least one aspect of the present disclosure.
[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 disclosure.
[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 with at least one aspect of this disclosure.
[0022] [0022] Figure 13 is a functional module architecture of a cloud computing system, according to at least one aspect of this disclosure.
[0023] [0023] Figure 14 illustrates a diagram of a surgical system with situational recognition, according to at least one aspect of the present disclosure.
[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 disclosure.
[0025] [0025] Figure 16 is a schematic diagram of a robotic surgical instrument configured to operate a surgical tool described therein, in accordance with at least one aspect of the present disclosure.
[0026] [0026] Figure 17 illustrates a block diagram of a surgical instrument programmed to control the distal translation of the displacement member, according to at least one aspect of the present disclosure.
[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 disclosure.
[0028] [0028] Figure 19 illustrates an example of a generator, according to at least one aspect of the present disclosure.
[0029] [0029] Figure 20 illustrates a structural view of a generator architecture, according to at least one aspect of the present disclosure.
[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 disclosure.
[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, in accordance with an aspect of the present disclosure.
[0032] [0032] Figures 23A and 23B are graphs that include a graph of clamping force as a function of time and an associated graph that indicates the displacement at the clotting and cutting site along the length of the blade as a function of time, according to at least one aspect of this disclosure.
[0033] [0033] Figures 24A and 24B represent electrode segments of the end actuator and an illustration of the control of the applied clamping force and electrosurgical energy provided by the end actuator, in accordance with at least one aspect of the present disclosure.
[0034] [0034] Figures 25A and 25B are graphs that illustrate the control of energization or supply of electrosurgical electrodes, according to at least one aspect of the present disclosure.
[0035] [0035] Figures 26A to 26E are a series of graphs that illustrate the adjustment of the power level to obtain a predictable sealing time, according to at least one aspect of the present disclosure.
[0036] [0036] Figures 27A to 27F are graphs and flowcharts that illustrate approaches to supply energy according to the power curves, in accordance with at least one aspect of the present disclosure. DESCRIPTION
[0037] [0037] The applicant for this application holds the following US patent applications, filed on November 6, 2018, the disclosure of which is incorporated herein by reference, in its entirety:
[0038] [0038] 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;
[0039] [0039] and US patent application no. 16 / 182.230, entitled SURGI- CAL SYSTEM FOR PRESENTING INFORMATION INTERPRETED FROM EXTERNAL DATA;
[0040] [0040] and US patent application no. 16 / 182.233, entitled MODIFI- CATION OF SURGICAL SYSTEMS CONTROL PROGRAMS BASED ON MACHINE LEARNING;
[0041] [0041] + US patent application no. 16 / 182,239, entitled ADJUSTMENT OF DEVICE CONTROL PROGRAMS BASED ON STRATIFIED ED CONTEXTUAL DATA IN ADDITION TO THE DATA;
[0042] [0042] and US patent application no. 16 / 182.243, entitled SURGI-CAL HUB AND MODULAR DEVICE RESPONSE ADJUSTMENT BA- SED ON SITUATIONAL AWARENESS;
[0043] [0043] and US patent application no. 16 / 182.248, entitled DETEC- TION AND ESCALATION OF SECURITY RESPONSES OF SURGI-CAL INSTRUMENTS TO INCREASING SEVERITY THREATS;
[0044] [0044] * US patent application No. 16 / 182,251, entitled INTE-RACTIVE SURGICAL SYSTEM;
[0045] [0045] and US Patent Application No. 16 / 182,260, entitled AUTO-MATED DATA SCALING, ALIGNMENT, AND ORGANIZING BASED ON PREDEFINED PARAMETERS WITHIN SURGICAL NETWORKS;
[0046] [0046] and US Patent Application No. 16 / 182,267, entitled SENSING THE PATIENT POSITION AND CONTACT UTILIZING THE MONO- POLAR RETURN PAD ELECTRODE TO PROVIDE SITUATIONAL AWARENESS TO A SURGICAL NETWORK;
[0047] [0047] * US patent application No. 16 / 182,249, entitled POWE-RED SURGICAL TOOL WITH PREDEFINED ADJUSTABLE CONTRROL ALGORITHM FOR CONTROLLING END EFFECTOR PARA-METER;
[0048] [0048] and US Patent Application No. 16 / 182,246, entitled ADJUSTMENTS BASED ON AIRBORNE PARTICLE PROPERTIES;
[0049] [0049] and US Patent Application No. 16 / 182,256, entitled ADJUSTMENT OF A SURGICAL DEVICE FUNCTION BASED ON SITUATI-ONAL AWARENESS;
[0050] [0050] * 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;
[0051] [0051] * US patent application No. 16 / 182,255, entitled USAGE AND TECHNIQUE ANALYSIS OF SURGEON / STAFF PERFOR- MANCE AGAINST A BASELINE TO OPTIMIZE DEVICE UTILIZATION AND PERFORMANCE FOR BOTH CURRENT AND FUTURE PROCEDURES;
[0052] [0052] 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;
[0053] [0053] and US patent application No. 16 / 182,278, entitled COMMU- NICATION OF DATA WHERE A SURGICAL NETWORK IS USING CONTEXT OF THE DATA AND REQUIREMENTS OF A RECEIVING SYSTEM / USER TO INFLUENCE INCLUSION OR LINKAGE OF DATA AND METADATA TO ESTABLISH CONTINUITY;
[0054] [0054] and US Patent Application No. 16 / 182,290, entitled SURGI- CAL NETWORK RECOMMENDATIONS FROM REAL TIME ANALYS- IS OF PROCEDURE VARIABLES AGAINST A BASELINE HIGHLIGHTING DIFFERENCES FROM THE OPTIMAL SOLUTION;
[0055] [0055] and US patent application No. 16 / 182,232, entitled CONTRACT OF A SURGICAL SYSTEM THROUGH A SURGICAL BARRIER;
[0056] [0056] * US patent application No. 16 / 182,227, entitled SURGI- CAL NETWORK DETERMINATION OF PRIORITIZATION OF COMMUNICATION, INTERACTION, OR PROCESSING BASED ON SYSTEM OR DEVICE NEEDS;
[0057] [0057] * 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;
[0058] [0058] 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;
[0059] [0059] * US patent application No. 16 / 182,234, entitled STA- PLING DEVICE WITH BOTH COMPULSORY AND DISCRETIONARY LOCKOUTS BASED ON SENSED PARAMETERS;
[0060] [0060] * US patent application No. 16 / 182,240, entitled POWE-RED STAPLING DEVICE CONFIGURED TO ADJUST FORCE, AD- VANCEMENT SPEED, AND OVERALL STROKE OF CUTTING MEMBER BER BASED ON SENSED PARAMETER OF FIRING OR CLAMPING; and
[0061] [0061] and US patent application No. 16 / 182,238, entitled ULTRA- SONIC ENERGY DEVICE WHICH VARIES PRESSURE APPLIED BY CLAMP ARM TO PROVIDE THRESHOLD CONTROL PRESSURE AT A CUT PROGRESSION LOCATION.
[0062] [0062] The applicant for this application holds the following US patent applications filed on September 10, 2018, the disclosure of which is incorporated herein by reference in its entirety:
[0063] [0063] 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 A SENSED SITUATION OR USAGE;
[0064] [0064] and US Provisional Patent Application No. 62 / 729,177, entitled AUTOMATED DATA SCALING, ALIGNMENT, AND ORGANIZING BASED ON PREDEFINED PARAMETERS WITHIN A SURGICAL NETWORK BEFORE TRANSMISSION;
[0065] [0065] 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;
[0066] [0066] 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 CUITING MEMBER OF THE DEVICE BASED ON SENSED PARAME- TER OF FIRING OR CLAMPING;
[0067] [0067] 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;
[0068] [0068] 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;
[0069] [0069] 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;
[0070] [0070] + US Provisional Patent Application No. 62 / 729,195, entitled ULTRASONIC ENERGY DEVICE WHICH VARIES PRESSURE AP-
[0071] [0071] 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.
[0072] [0072] The applicant for this application holds the following US patent applications, filed on August 28, 2018, the disclosure of which is incorporated herein by reference in its entirety:
[0073] [0073] + US patent application No. 16 / 115,214, entitled ESTIMATE- TING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR;
[0074] [0074] * Patent application U, nº 16 / 115,205, entitled TEMPE-RATURE CONTROL OF ULTRASONIC END EFFECTOR AND CONTRROL SYSTEM THEREFOR;
[0075] [0075] and US patent application No. 16 / 115,233, entitled RADIO FREQUENCY ENERGY DEVICE FOR DELIVERING COMBINED ELECTRICAL SIGNALS;
[0076] [0076] and US Patent Application No. 16 / 115,208, entitled CONTRACTING AN ULTRASONIC SURGICAL INSTRUMENT ACCORING TO TISSUE LOCATION;
[0077] [0077] and US Patent Application No. 16 / 115,220, entitled CONTRACTING ACTIVATION OF AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO THE PRESENCE OF TISSUE;
[0078] [0078] and US Patent Application No. 16 / 115,232, entitled DETERMINING TISSUE COMPOSITION VIA AN ULTRASONIC SYSTEM;
[0079] [0079] and US Patent Application No. 16 / 115,239, entitled DETER- MINING THE STATE OF AN ULTRASONIC ELECTROMECHANICAL SYSTEM ACCORDING TO FREQUENCY SHIFT;
[0080] [0080] and US Patent Application No. 16 / 115,247, entitled DETERMINING THE STATE OF AN ULTRASONIC END EFFECTOR;
[0081] [0081] and US patent application No. 16 / 115,211, entitled SITUATI-ONAL AWARENESS OF ELECTROSURGICAL SYSTEMS;
[0082] [0082] and US patent application No. 16 / 115,226, entitled MECHA- NISMS FOR CONTROLLING DIFFERENT ELECTROMECHANICAL SYSTEMS OF AN ELECTROSURGICAL INSTRUMENT;
[0083] [0083] and US Patent Application No. 16 / 115,240, entitled DETECTION OF END EFFECTOR IMMERSION IN LIQUID;
[0084] [0084] and US Patent Application No. 16 / 115,249, entitled INTER-RUPTION OF ENERGY DUE TO INADVERTENT CAPACITIVE COU-PLING;
[0085] [0085] and US Patent Application No. 16 / 115,256, entitled INCREA-SING RADIO FREQUENCY TO CREATE PAD-LESS MONOPOLAR LOOP;
[0086] [0086] and US Patent Application No. 16 / 115,223, entitled BIPOLAR COMBINATION DEVICE THAT AUTOMATICALLY ADJUSTS PRESENT SURE BASED ON ENERGY MODALITY; and
[0087] [0087] and US patent application No. 16 / 115,238, entitled ACTIVATION OF ENERGY DEVICES.
[0088] [0088] The applicant of the present application holds the following US patent applications, filed on August 23, 2018, with the disclosure of each incorporated herein by reference in its entirety:
[0089] [0089] + US provisional patent application No. 62 / 721,995, entitled CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT AC- CORDING TO TISSUE LOCATION;
[0090] [0090] and US Provisional Patent Application No. 62 / 721,998, entitled SITUATIONAL AWARENESS OF ELECTROSURGICAL SYSTEMS;
[0091] [0091] and US Provisional Patent Application No. 62 / 721,999, entitled INTERRUPTION OF ENERGY DUE TO INADVERTENT CAPACITIVE COUPLING;
[0092] [0092] and US Provisional Patent Application No. 62 / 721,994, entitled BIPOLAR COMBINATION DEVICE THAT AUTOMATICALLY AD- JUSTS PRESSURE BASED ON ENERGY MODALITY; and
[0093] [0093] and US Provisional Patent Application No. 62 / 721,996, entitled RADIO FREQUENCY ENERGY DEVICE FOR DELIVERING COMBI- NED ELECTRICAL SIGNALS.
[0094] [0094] The applicant for this application holds the following US patent applications, filed on Friday, June 30, 2018, the disclosure of which is incorporated herein by way of reference in its entirety:
[0095] [0095] and US Provisional Patent Application No. 62 / 692,747, entitled SMART ACTIVATION OF AN ENERGY DEVICE BY ANOTHER DEVICE;
[0096] [0096] and US Provisional Patent Application No. 62 / 692,748, entitled SMART ENERGY ARCHITECTURE; and
[0097] [0097] and US Provisional Patent Application No. 62 / 692,768, entitled SMART ENERGY DEVICES.
[0098] [0098] The applicant for this application holds the following US patent applications, filed on Friday, June 29, 2018, the disclosure of which is incorporated herein by reference in its entirety:
[0099] [0099] and US patent application serial number 16 / 024,090, entitled CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS;
[00100] [00100] and US patent application serial number 16 / 024,057, entitled CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENED CLOSURE PARAMETERS;
[00101] [00101] and US patent application serial number 16 / 024,067, entitled SYSTEMS FOR ADJUSTING END EFFECTOR PARAMETERS BA- SED ON PERIOPERATIVE INFORMATION;
[00102] [00102] and US patent application serial number 16 / 024,075, entitled SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING;
[00103] [00103] and US patent application serial number 16 / 024,083, entitled SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING;
[00104] [00104] and US patent application serial number 16 / 024,094, entitled SURGICAL SYSTEMS FOR DETECTING END EFFECTOR TISSUE DISTRIBUTION IRREGULARITIES;
[00105] [00105] and US patent application serial number 16 / 024,138, entitled SYSTEMS FOR DETECTING PROXIMITY OF SURGICAL END EF- FECTOR TO CANCEROUS TISSUE;
[00106] [00106] and US patent application serial number 16 / 024.150, entitled SURGICAL INSTRUMENT CARTRIDGE SENSOR ASSEMBLIES;
[00107] [00107] and US patent application serial number 16 / 024,160, entitled VARIABLE OUTPUT CARTRIDGE SENSOR ASSEMBLY;
[00108] [00108] and US patent application serial number 16 / 024.124, entitled SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE;
[00109] [00109] and US patent application serial number 16 / 024,132, entitled SURGICAL INSTRUMENT HAVING A FLEXIBLE CIRCUIT;
[00110] [00110] and US patent application serial number 16 / 024,141, entitled SURGICAL INSTRUMENT WITH A TISSUE MARKING ASSEMBLY;
[00111] [00111] and US patent application serial number 16 / 024,162, entitled SURGICAL SYSTEMS WITH PRIORITIZED DATA TRANSMISSION CAPABILITIES;
[00112] [00112] and US patent application serial number 16 / 024,066, entitled SURGICAL EVACUATION SENSING AND MOTOR CONTROL;
[00113] [00113] and US patent application serial number 16 / 024.096, entitled SURGICAL EVACUATION SENSOR ARRANGEMENTS;
[00114] [00114] and US patent application serial number 16 / 024,116, entitled SURGICAL EVACUATION FLOW PATHS;
[00115] [00115] and US patent application serial number 16 / 024,149, entitled SURGICAL EVACUATION SENSING AND GENERATOR CONTROL;
[00116] [00116] and US patent application serial number 16 / 024,180, entitled SURGICAL EVACUATION SENSING AND DISPLAY;
[00117] [00117] and US patent application serial number 16 / 024.245, entitled COMMUNICATION OF SMOKE EVACUATION SYSTEM PARAME- TERS TO HUB OR CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM;
[00118] [00118] and US patent application serial number 16 / 024,258, entitled SMOKE EVACUATION SYSTEM INCLUDING A SEGMENTED CONTRROL CIRCUIT FOR INTERACTIVE SURGICAL PLATFORM;
[00119] [00119] and US patent application serial number 16 / 024,265, entitled SURGICAL EVACUATION SYSTEM WITH A COMMUNICATION
[00120] [00120] and US patent application serial number 16 / 024,273, entitled DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS.
[00121] [00121] The applicant for this application holds the following provisional US patent applications, filed on Thursday, June 28, 2018, the disclosure of which is incorporated herein by reference in its entirety:
[00122] [00122] and US provisional patent application serial number 62 / 691,228, entitled A Method of using reinforced flex circuits with multiple sensors with electrosurgical devices;
[00123] [00123] and US provisional patent application serial number 62 / 691.227, entitled controlling a surgical instrument according to sensed closure parameters;
[00124] [00124] and US Provisional Patent Application Serial No. 62 / 691,230, entitled SURGICAL INSTRUMENT HAVING A FLEXIBLE ELEC- TRODE;
[00125] [00125] and US provisional patent application serial number 62 / 691,219, entitled SURGICAL EVACUATION SENSING AND MOTOR CONTRROL;
[00126] [00126] and US Provisional Patent Application Serial No. 62 / 691,257, entitled COMMUNICATION OF SMOKE EVACUATION SYSTEM PARAMETERS TO HUB OR CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM;
[00127] [00127] and US provisional patent application serial number 62 / 691.262, entitled SURGICAL EVACUATION SYSTEM WITH A COMMUNICATION-
[00128] [00128] and US provisional patent application serial number 62 / 691,251, entitled DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS.
[00129] [00129] The applicant for this application holds the following provisional US patent applications, filed on April 19, 2018, with the disclosure of each of which is incorporated herein by reference, in its entirety:
[00130] [00130] and US provisional patent application serial number 62 / 659,900, entitled METHOD OF HUB COMMUNICATION.
[00131] [00131] The applicant for this application holds the following provisional US patent applications, filed on Thursday, March 30, 2018, with the disclosure of each of which is incorporated by reference in its entirety for reference. :
[00132] [00132] and US Provisional Patent Application No. 62 / 650,898 filed on March 30, 2018, entitled CAPACITIVE COUPLED RE-TURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS;
[00133] [00133] and US Provisional Patent Application Serial No. 62 / 650,887, entitled SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPA-BILITIES;
[00134] [00134] and US Provisional Patent Application Serial No. 62 / 650,882, entitled SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM; and
[00135] [00135] and US Provisional Patent Application Serial No. 62 / 650,877, entitled SURGICAL SMOKE EVACUATION SENSING AND CONTRROLS.
[00136] [00136] The applicant for this application holds the following US patent applications, filed on March 29, 2018, the disclosure of which is incorporated herein by reference in its entirety:
[00137] [00137] and US patent application serial no. 15 / 940,641, entitled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMU- NICATION CAPABILITIES;
[00138] [00138] and US Patent Application Serial No. 15 / 940,648, entitled INTERACTIVE SURGICAL SYSTEMS WITH CONDITION HANDLING OF DEVICES AND DATA CAPABILITIES;
[00139] [00139] and US patent application serial number 15 / 940,656, entitled SURGICAL HUB COORDINATION OF CONTROL AND COMMUNICATION OF OPERATING ROOM DEVICES;
[00140] [00140] and US patent application serial number 15 / 940,666, entitled SPATIAL AWARENESS OF SURGICAL HUBS IN OPERATING RO-WHO;
[00141] [00141] and US patent application serial number 15 / 940,670, entitled COOPERATIVE UTILIZATION OF DATA DERIVED FROM SECON- DARY SOURCES BY INTELLIGENT SURGICAL HUBS;
[00142] [00142] and US patent application serial number 15 / 940,677, entitled SURGICAL HUB CONTROL ARRANGEMENTS;
[00143] [00143] and US Patent Application Serial No. 15 / 940,632, entitled DATA STRIPPING METHOD TO INTERROGATE PATIENT RE-CORDS AND CREATE ANONYMIZED RECORD;
[00144] [00144] and US patent application serial number 15 / 940,640, entitled COMMUNICATION HUB AND STORAGE DEVICE FOR STORING PARAMETERS AND STATUS OF A SURGICAL DEVICE TO BE SHARED WITH CLOUD BASED ANALYTICS SYSTEMS;
[00145] [00145] and US Patent Application Serial No. 15 / 940,645, entitled SELF DESCRIBING DATA PACKETS GENERATED AT AN ISSUING INSTRUMENT;
[00146] [00146] and US patent application serial number 15 / 940,649, entitled DATA PAIRING TO INTERCONNECT A DEVICE MEASURED PA-RAMETER WITH AN OUTCOME;
[00147] [00147] and US Patent Application Serial No. 15 / 940,654, entitled SURGICAL HUB SITUATIONAL AWARENESS;
[00148] [00148] and US patent application serial number 15 / 940,663, entitled SURGICAL SYSTEM DISTRIBUTED PROCESSING;
[00149] [00149] and US patent application serial number 15 / 940,668, entitled AGGREGATION AND REPORTING OF SURGICAL HUB DATA;
[00150] [00150] and US patent application serial number 15 / 940,671, entitled SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER;
[00151] [00151] and US patent application serial number 15 / 940,686, entitled DISPLAY OF ALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LI-NEAR STAPLE LINE;
[00152] [00152] and US patent application serial number 15 / 940,700, entitled STERILE FIELD INTERACTIVE CONTROL DISPLAYS;
[00153] [00153] and US patent application serial number 15 / 940,629, entitled COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS;
[00154] [00154] 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;
[00155] [00155] and US Patent Application Serial No. 15 / 940,722, entitled CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OF MONO-CHROMATIC LIGHT REFRACTIVITY;
[00156] [00156] and US patent application serial number 15 / 940,742, entitled DUAL CMOS ARRAY IMAGING;
[00157] [00157] and US patent application serial number 15 / 940,636, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES;
[00158] [00158] and US patent application serial number 15 / 940,653, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL HUBS;
[00159] [00159] and US patent application serial number 15 / 940,660, entitled CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER;
[00160] [00160] and US patent application serial number 15 / 940,679, entitled CLOUD-BASED MEDICAL ANALYTICS FOR LINKING OF LOCAL USAGE TRENDS WITH THE RESOURCE ACQUISITION BEHA- VIORS OF LARGER DATA SET;
[00161] [00161] and US Patent Application Serial No. 15 / 940,694, entitled CLOUD-BASED MEDICAL ANALYTICS FOR MEDICAL FACILITY SEGMENTED INDIVIDUALIZATION OF INSTRUMENT FUNCTION;
[00162] [00162] and US patent application serial number 15 / 940,634, entitled CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AU- THENTICATION TRENDS AND REACTIVE MEASURES;
[00163] [00163] and US Patent Application Serial No. 15 / 940,706, entitled DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK;
[00164] [00164] and US patent application serial number 15 / 940,675, entitled CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES;
[00165] [00165] and US patent application serial number 15 / 940,627, entitled DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;
[00166] [00166] and US patent application serial no. 15 / 940,637, entitled COMMUNICATION ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;
[00167] [00167] and US patent application serial number 15 / 940,642, entitled CONTROLS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;
[00168] [00168] and US patent application serial number 15 / 940,676, entitled AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;
[00169] [00169] and US patent application serial number 15 / 940,680, entitled CONTROLLERS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;
[00170] [00170] and US Patent Application Serial No. 15 / 940,683, entitled COOPERATIVE SURGICAL ACTIONS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;
[00171] [00171] and US Patent Application Serial No. 15 / 940,690, entitled DISPLAY ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS ,; and
[00172] [00172] and US Patent Application Serial No. 15 / 940,711, entitled SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS.
[00173] [00173] The applicant for this application holds the following provisional US patent applications, filed on Thursday, March 28, 2018, the disclosure of which is incorporated herein by reference in its entirety:
[00174] [00174] and US Provisional Patent Application No. 62 / 649,302, entitled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES;
[00175] [00175] and US Provisional Patent Application Serial No. 62 / 649,294, entitled DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD;
[00176] [00176] and US provisional patent application serial number 62 / 649,300, entitled SURGICAL HUB SITUATIONAL AWARENESS;
[00177] [00177] and US Provisional Patent Application Serial No. 62 / 649,309, entitled SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER;
[00178] [00178] and US Provisional Patent Application No. 62 / 649,310, entitled COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS;
[00179] [00179] and US Provisional Patent Application No. 62 / 649,291, entitled USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT;
[00180] [00180] and US Provisional Patent Application No. 62 / 649,296, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DE- VICES;
[00181] [00181] and US Provisional Patent Application Serial No. 62 / 649,333, entitled CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER;
[00182] [00182] and US Provisional Patent Application Serial No. 62 / 649,327, entitled CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES;
[00183] [00183] and US Provisional Patent Application No. 62 / 649,315, entitled DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK;
[00184] [00184] and US Provisional Patent Application Serial No. 62 / 649,313, entitled CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES;
[00185] [00185] and US Provisional Patent Application No. 62 / 649,320, entitled DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;
[00186] [00186] and US provisional patent application serial number 62 / 649,307, entitled AUTOMATIC. TOOL ADJUSTMENTS FOR ROBOT- ASSISTED SURGICAL PLATFORMS; and
[00187] [00187] and US Provisional Patent Application No. 62 / 649,323, entitled SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS.
[00188] [00188] The applicant for this application holds the following provisional US patent applications, filed on March 8, 2018, the disclosure of which is incorporated herein by reference in its entirety:
[00189] [00189] and US Provisional Patent Application Serial No. 62 / 640,417, entitled TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR; and
[00190] [00190] and US provisional patent application serial number 62 / 640,415, entitled ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR.
[00191] [00191] e The applicant for this application holds the following provisional US patent applications, filed on December 28, 2017, the disclosure of which is incorporated herein by reference in its entirety:
[00192] [00192] and US provisional patent application serial number 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM;
[00193] [00193] and US provisional patent application serial number 62 / 611,340, entitled CLOUD-BASED MEDICAL ANALYTICS; and
[00194] [00194] and US provisional patent application serial number 62 / 611,339, entitled ROBOT ASSISTED SURGICAL PLATFORM.
[00195] [00195] 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
[00196] [00196] Referring to Figure 1, a computer-implemented interactive surgical system 100 includes one or more surgical systems 102 and a cloud-based system (for example, cloud 104 which may include a remote server 113 coupled to a device storage 105). Each surgical system 102 includes at least one central surgical controller 106 in communication with the cloud 104 which can include a remote server 113. In one example, as illustrated in Figure 1, surgical system 102 includes a display system 108, a robotic system 110, a smart handheld 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 a number of central controllers M 106 , an N number of visualization systems 108, an O number of robotic systems 110, and a P number of smart, hand-held surgical instruments 112, where M, N, O, and P are larger integers or equal to one.
[00197] [00197] In several respects, intelligent 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 and 23B, 24A and 24B, 25A and 25B, 26A to 26E, 27A to 27F. Intelligent instruments 112 (for example, devices 1a to 1n) as ultrasonic / combined surgical instruments 7012, as described in Figures 23A and 23B, 24A and 24B, 25A and 25B, 268A to 26E, 27A to 27F are configured to operate in a 201 surgical data network, as described with reference to Figure 8.
[00198] [00198] Figure 2 represents an example of a surgical system 102 being used to perform a surgical procedure on a patient who is lying on an operating table 114 in a surgical operating room 116. A robotic system 110 is used in the surgical procedure as 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.
[00199] [00199] Other types of robotic systems can be readily adapted for use with the surgical system 102. Various examples of robotic systems and surgical instruments that are suitable for use with the present disclosure are described in provisional patent application serial number 62 / 611.339 , entitled ROBOT ASSISTED SURGICAL PLATFORM, filed on December 28, 2017, whose disclosure is hereby incorporated by reference in its entirety.
[00200] [00200] Several examples of cloud-based analysis that are performed by the cloud 104, and are suitable for use with the present disclosure, are described in US provisional patent application serial number 62 / 611.340, entitled CLOUD-BASED MEDICAL ANALYTICS, filed on December 28, 2017, the disclosure of which is incorporated herein by reference, in its entirety.
[00201] [00201] In several aspects, the imaging device 124 includes at least one Image sensor and one or more optical components. Suitable image sensors include, but are not limited to, load-coupled device (CCD) sensors and complementary metal oxide semiconductor (CMOS) sensors.
[00202] [00202] The optical components of the imaging device
[00203] [00203] 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.
[00204] [00204] The invisible spectrum (that is, the non-luminous spectrum) is that portion of the electromagnetic spectrum located below and above the visible spectrum (that is, wavelengths below about 380 nm and above about 750 nm). The invisible spectrum is not detectable by the human eye. Wavelengths greater than about 750 nm are longer than the visible red spectrum, and they become invisible infrared (IR), microwaves, radio and electromagnetic radiation. Wavelengths shorter than about 380 nm are shorter than the ultraviolet spectrum, and they become invisible ultraviolet, x-ray, and gamma-ray electromagnetic radiation.
[00205] [00205] In several aspects, the imaging device 124 is configured for use in a minimally invasive procedure. Examples of imaging devices suitable for use with the present disclosure include, but are not limited to, an arthroscope, angioscope, bronchoscope, choledocoscope, colonoscope, cytoscope, duodenoscope, enteroscope, esophagus-duodenoscope (gastroscope)
[00206] [00206] In one aspect, the imaging device employs multiple spectrum monitoring to discriminate topography and underlying structures. A multispectral image is one that captures image data within wavelength bands across the electromagnetic spectrum. The wavelengths can be separated by filters or by using instruments that are sensitive to specific wavelengths, including light from frequencies beyond the visible light range, for example, IR and ultraviolet light. Spectral images can allow the extraction of additional information that the human eye cannot capture with its receivers for the colors red, green, and blue. The use of multi-spectral imaging is described in more detail under the heading "Advanced Imaging Acquisition Module" in US provisional patent application serial number 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28 2017, whose disclosure is incorporated here as a reference in its entirety. Multispectral monitoring can be a useful tool for relocating a surgical field after a surgical task is completed to perform one or more of the tests previously described on the treated tissue.
[00207] [00207] 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.
[00208] [00208] In several aspects, the visualization system 108 includes one or more imaging sensors, one or more image processing units, one or more storage arrays and one or more screens that are strategically arranged in relation to the field sterile, as shown in Figure 2. In one aspect, the visualization system 108 includes an interface for HL7, PACS and EMR. Various components of the visualization system 108 are described under the heading "Advanced Imaging Acquisition Module" in US provisional patent application serial number 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, whose disclosure it is incorporated here as a reference in its entirety.
[00209] [00209] “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 a snapshot of a surgical site, as recorded by an imaging device.
[00210] [00210] In one aspect, the central controller 106 is also configured to route an entry or diagnostic feedback by a non-sterile operator in the display tower 111 to the primary screen 119 within the sterile field, where it can be seen by a sterile operator on the operating table. In one example, the entry may be in the form of a modification of the snapshot displayed on the non-sterile screen 107 or 109, which can be routed to main screen 119 by central controller 106.
[00211] [00211] 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 number 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 number 62 / 611.341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28,
[00212] [00212] 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. The 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 certain respects, as shown in Figure 3, the central controller 106 additionally includes a smoke evacuation module 126, a suction / irrigation module 128 and / or an OR 133 mapping module.
[00213] [00213] 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 compartment of the central controller 136 offers a unified environment to manage power, data and fluid lines, which reduces the frequency of interleaving between such lines.
[00214] [00214] Aspects of the present disclosure 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 compartment
[00215] [00215] 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 compartment. In one aspect, the central controller compartment comprises a fluid interface.
[00216] [00216] Certain surgical procedures may require the application of more than one type of energy to the tissue. One type of energy may be more beneficial for cutting the fabric, while another type of energy may be more beneficial for sealing the fabric. For example, a bipolar generator can be used to seal the tissue while an ultrasonic generator can be used to cut the sealed tissue. Aspects of the present disclosure present a solution in which a modular compartment of central controller 136 is configured to accommodate different generators and facilitate interactive communication between them. One of the advantages of the modular central controller compartment 136 is that it allows quick removal and / or replacement of several modules.
[00217] [00217] Aspects of the present disclosure present a modular surgical compartment for use in a surgical procedure that involves applying energy to the tissue. The modular surgical compartment includes a first energy generator module, configured to generate a first energy for application to the tissue, and a first docking station that comprises a first docking port that includes first data contacts and energy contacts, being that the first power generator module is slidingly movable in an electric hitch with power and data contacts and the first power generator module is slidingly movable out of the electric hitch with the first - other power and data contacts.
[00218] [00218] In addition to the above, the modular surgical compartment also includes a second energy generator module configured to generate a second energy, different from the first energy, for application to the tissue, and a second docking station comprising a second docking port which includes second data and power contacts, the second power generating module is slidingly movable in an electrical coupling with the power and data contacts, and the second power generating module is slidingly mobile. out of the electrical coupling with the second power and data contacts.
[00219] [00219] In addition, the modular surgical compartment also includes a communication bus between the first coupling port and the second coupling port, configured to facilitate communication between the first power generator module and the second generator module power.
[00220] [00220] With reference to Figures 3 to 7, aspects of this directive
[00221] [00221] In one aspect, the modular central controller compartment 136 comprises modular power and a rear communication panel 149 with external and wireless communication heads to allow removable attachment of modules 140, 126, 128 and interactive communication between them.
[00222] [00222] In one aspect, the modular central controller compartment 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 cyber controller compartment
[00223] [00223] In several respects, the smoke evacuation module 126 includes a fluid line 154 that transports fluid captured / collected smoke away from a surgical site and to, for example, the smoke evacuation module 126. The vacuum suction that originates from the smoke evacuation module 126 can pull the smoke into an opening of a utility conduit at the surgical site. The utility conduit, coupled to the fluid line, can be in the form of a flexible tube that ends in the smoke evacuation module 126. The utility conduit and the fluid line define a fluid path that extends towards the smoke evacuation module 126 which is received in the central controller compartment 136.
[00224] [00224] In several aspects, the suction / irrigation module 128 is coupled to a surgical tool comprising a fluid suction line and a fluid suction line. In one example, the suction and suction fluid lines are in the form of flexible tubes that extend from the surgical site towards the suction / irrigation module 128. One or more drive systems can be configured to cause irrigation and aspiration of fluids to and from the surgical site.
[00225] [00225] 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 a irrigation pipe. The suction tube can have an inlet port at a distal end of it and the suction tube extends through the drive shaft. Similarly, an irrigation pipe can extend through the drive shaft and may have an inlet port close to the power application implement. The energy application implement is configured to supply ultrasonic and / or RF energy to the surgical site and is coupled to the generator module 140 by a cable that initially extends through the drive shaft.
[00226] [00226] 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 vacuum compartment. central controller 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.
[00227] [00227] In one aspect, modules 140, 126, 128 and / or their corresponding docking stations in the central controller modular bay 136 may include alignment features that are configured to align the docking ports of the modules in engagement with their counterparts in the docking stations of the central controller modular compartment 136. For example, as shown in Figure 4, the combined generator module 145 includes side brackets 155 that are configured to slide the corresponding brackets in a sliding way 156 from the corresponding docking station 151 of the modular central controller compartment
[00228] [00228] In some respects, the drawers 151 of the central controller modular compartment 136 are the same, or substantially the same size, and the modules are adjusted in size to be received in the drawers 151. For example, the side supports 155 and / or 156 can be larger or smaller depending on the size of the module. In other respects, drawers 151 are different in size and are each designed to accommodate a specific module.
[00229] [00229] 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.
[00230] [00230] As shown in Figure 4, the coupling port 150 of a drawer 151 can be coupled to the coupling port 150 of another drawer 151 through a communication link 157 to facilitate interactive communication between the modules housed in the modular central controller compartment 136. The coupling ports 150 of the modular central controller compartment 136 can alternatively or additionally facilitate interactive wireless communication between modules housed in the modular central controller compartment 136. Any wireless communication is suitable -
[00231] [00231] Figure 6 illustrates individual power bus connectors for a plurality of side coupling ports of a side modular cabinet 160 configured to receive a plurality of modules from a central surgical controller 206. The side modular cabinet 160 it is configured to receive and interconnect the 161 modules laterally. The modules 161 are slidably inserted into the docking stations 162 of the side modular cabinet 160, which includes a rear panel for interconnecting the 161 modules. 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 side modular cabinet.
[00232] [00232] 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 of vertical modular cabinet 164, which includes a rear panel for interconnection of modules 165. Although drawers 167 of vertical modular cabinet 164 are arranged vertically, in certain cases, a vertical modular cabinet 164 may include drawers that are arranged laterally . In addition, modules 165 can interact with each other through the coupling ports of the vertical modular cabinet 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.
[00233] [00233] In several respects, the imaging module 138 comprises an integrated video processor and a modular light source
[00234] [00234] During a surgical procedure, removing a surgical device from the surgical field and replacing it with another surgical device that includes a different camera or other light source may be inefficient. Temporarily losing sight of the surgical field can lead to undesirable consequences. The imaging device module of the present disclosure is configured to allow the replacement of a light source module or "midstream" camera module during a surgical procedure, without the need to remove the imaging device from the cyclic field. surgical.
[00235] [00235] 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 fit (pressure fit) with the first channel. A second channel is
[00236] [00236] 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.
[00237] [00237] Various image processors and imaging devices suitable for use with the present disclosure are described in US patent No. 7,995,045 entitled COMBINED SBI AND CONVENTIONAL IMAGE PROCESSOR, granted on August 9, 2011 which is incorporated herein as a reference in its entirety. In addition, US patent No. 7,982,776, entitled SBI MOTION ARTIFACT REMOVAL APPARATUS AND METHOD, issued on July 19, 2011, which is incorporated herein by reference in its entirety, describes various systems for removing motion artifacts from the data of image. Such systems can be integrated with the imaging module 138. In addition to these, the publication of US patent application No. 2011/0306840, entitled CONTROLLA-BLE MAGNETIC SOURCE TO FIXTURE INTRACORPOREAL APPA- RATUS, published on December 15, 2011, and the publication of US patent application No. 2014/0243597, entitled SYSTEM FOR PERFORMING A MINIMALLY INVASIVE SURGICAL PROCEDURE, published on August 28, 2014, which are, each of which,
[00238] [00238] 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 health services specially equipped for surgical operations, to a cloud-based system (for example, cloud 204 which may include a remote server 213 coupled to a storage device 205). In one aspect, the modular central communication controller 203 comprises a central network controller 207 and / or a network key 209 in communication with a network router. The modular central communication controller 203 can also be coupled to a local computer system 210 to provide local computer processing and data manipulation. The surgical data network 201 can be configured as a passive, intelligent, or switching network. A passive surgical data network serves as a conduit for the data, allowing the data to be transmitted from one device (or segment) to another and to cloud computing resources. An intelligent surgical data network includes features to allow traffic to pass through the surgical data network to be monitored and to configure each port on the central network controller 207 or network key 209. An intelligent surgical data network it can be called a central controller or a controllable key. A central switching controller reads the destination address of each packet and then forwards the packet to the correct port.
[00239] [00239] Modular devices 1a to 1n located in the operating room can be coupled to the central communication controller modular 203. The central network controller 207 and / or the network switch 209 can be coupled to a network router 211 to connect devices 1a to 1h to the 204 cloud or the local computer system
[00240] [00240] It will be understood that the surgical data network 201 can be expanded by interconnecting multiple central network controllers 207 and / or multiple network switches 209 with multiple network routers 211. The central communication controller 203 can be contained in a modular control roaster configured to receive multiple devices 1a to 1n / 2a to 2m. The local computer system 210 can also be contained in a modular control tower. The central modular communication controller 203 is connected to a screen 212 to display the images obtained by some of the devices 1a to 1n / 2a to 2m, for example, during surgical procedures. In several respects, devices 1a to 1n / 2a to 2m may include, for example, various modules such as an imaging module 138 coupled to an endoscope, a generator module 140 coupled to an energy-based surgical device, an evacuation module smoke 126, a suction / irrigation module 128, a communication module 130, a processor module 132, a storage matrix 134, a surgical device attached to a screen, and / or a non-contact sensor module, among other devices - modular devices that can be connected to the modular communication central controller 203 of the surgical data network 201.
[00241] [00241] In one aspect, the surgical data network 201 may comprise a combination of central network controllers, network switches, and network routers that connect devices 1a to 1n / 2a to 2m to the cloud. Any or all of the devices 1a to 1n / 2a to 2m coupled to the central network controller or network key can collect data in real time and transfer the data to cloud computers for data processing and manipulation. It will be understood that cloud computing depends on sharing computing resources instead of having local servers or personal devices to handle software applications. The word "cloud" can be used as a metaphor for "the Internet", although the term is not limited as such. Consequently, the term "cloud computing" can be used here to refer to "a type of Internet-based computing", in which different services - such as servers, storage, and applications - are applied to the central controller of modular communication 203 and / or computer system 210 located in the operating room (for example, a fixed, mobile, temporary, or operating room or operating space) and devices connected to the central modular communication controller 203 and / or computer system 210 over the Internet. The cloud infrastructure can be maintained by a cloud service provider. In this context, the cloud service provider may be the entity that coordinates the use and control of devices 1a to 1n / 2a to 2m located in one or more operating rooms. Payment services
[00242] [00242] The application of cloud computer data processing techniques in the data collected by devices 1a to 1n / 2a to 2m, the surgical data network provides better surgical results, reduced costs, and better patient satisfaction. At least some of the devices 1a to 1hn / 2a to 2m can be used to view the states of the tissue to assess the occurrence of leaks or perfusion of sealed tissue after a sealing and tissue cutting procedure. At least some of the devices 1a to 1n / 2a to 2m can be used to identify pathology, such as the effects of disease, with the use of cloud-based computing to examine data including images of body tissue samples for diagnostic purposes. . This includes confirmation of the location and margin of the tissue and phenotypes. At least some of the devices 1a to 1h / 2a to 2m can be used to identify anatomical structures of the body using a variety of sensors integrated with imaging devices and techniques such as overlaying images captured by multiple imaging devices. Data collected by devices 1a to 1n / 2a to 2m, including image data, can be transferred to the cloud 204 or the local computer system 210 or both for data processing and manipulation including data processing and manipulation. Image. The data can be analyzed to improve the results of the surgical procedure by determining whether additional treatment, such as the application of endoscopic intervention, emerging technologies, targeted radiation, targeted intervention, precise robotics at specific sites and conditions of fabric, can be followed. This data analysis can additionally use analytical processing of the results, and with the use of standardized approaches they can provide beneficial standardized feedback both to confirm surgical treatments and the behavior of the surgeon or to suggest modifications to the surgical treatments and the behavior of the surgeon. surgeon.
[00243] [00243] In an implementation, the operating room devices 1a to 1n can be connected to the modular central communication controller 203 via a wired channel or a wireless channel depending on the configuration of the devices 1a to 1h in a central network controller. The central network controller 207 can be implemented, in one aspect, as a local network transmission device that acts on the physical layer of the OSI model ("open system interconnection"). The central network controller provides connectivity to devices 1a to 1n located on the same network as the operating room. The central network controller 207 collects data in the form of packets and sends them to the router in "half duplex" mode. The central network controller 207 does not store any media access control / Internet protocol (MACY / IP) to transfer data from the device. Only one of the devices 1a to 1n at a time can send data through the central network controller 207. The central network controller 207 does not have routing tables or intelligence about where to send information and transmits all network data through each connection and a remote server 213 (Figure 9) in the cloud 204. The central network controller 207 can detect basic network errors, such as collisions, but having all (admit that) the information transmitted to multiple input ports can be a risk security and cause strangulation
[00244] [00244] 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 switch 209 works in the data connection layer of the OS | I model. Network switch 209 is a multicast device for connecting devices 2a to 2m located in the same operation center to the network. The network key 209 sends data in frames to the network router 211 and works in full duplex mode. Multiple devices 2a to 2m can send data at the same time via network key 209. Network key 209 stores and uses MAC addresses of devices 2a to 2m to transfer data.
[00245] [00245] 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. The network router 211 creates a route to transmit data packets received from the central network controller 207 and / or the network key 211 to a computer with cloud resources for future processing and manipulation of the data collected by any among or all of the devices 1a to 1n / 2a to 2m. The network router 211 can be used to connect two or more different networks located in different locations, such as different operating rooms in the same healthcare facility or different networks located in different operating rooms. different health service facilities. Network router 211 sends data in packet form to cloud 204 and works in full duplex mode. Multiple devices can send data at the same time. The network router 211 uses IP addresses to transfer data.
[00246] [00246] In one example, the central network controller 207 can be implemented as a central USB controller, which allows multiple USB devices to be connected to a host computer. The central USB controller can expand a single USB port on several levels, so that more ports are available to connect the devices to the system's host computer. The central network controller 207 can include wired or wireless capabilities to receive information about a wired channel or a wireless channel. In one aspect, a wireless wireless, broadband and short-range wireless USB communication protocol can be used for communication between devices 1a to 1n and devices 2a to 2m located in the operating room.
[00247] [00247] In other examples, devices in the operating room 1a to 1n / 2a to 2m can communicate with the central modular communication controller 203 via standard Bluetooth wireless technology for exchanging data over short distances ( with the use of short-wavelength UHF radio waves in the ISM band of 2.4 to 2.485 GHz) from fixed and mobile devices and build personal area networks (PANs). In other respects, operating room devices 1a to 1n / 2a to 2m can communicate with the central modular communication controller 203 via a number of wireless and wired communication standards or protocols, including, but not limited to, limited to, Wi-Fi (IEEE 802.11 family), WiMAX (IEEE 802.16 family), IEEE 802.20, long-term evolution (LTE, "long-term evolution"), and Ev-DO, HSPA +, HSDPA +, HSUPAr +, EDGE , GSM, GPRS, CDMA, TDMA, DECT, and Ethernet derivatives thereof, as well as any other wireless and wired protocols that are designated as 3G, 4G, 5G, and beyond. The computing module can include a plurality of communication modules. For example, a first communication module can be dedicated to short-range wireless communications like Wi-Fi and Bluetooth, and a second communication module can be dedicated to longer-range wireless communications like GPS, EDGE, GPRS, CDMA , Wi-MAX, LTE, Ev-DO, and others.
[00248] [00248] The modular communication central controller 203 can serve as a central connection for one or all operating room devices 1a to 1n / 2a to 2m and handles a data type known as frames. The tables carry the data generated by the devices 1a to 1n / 2a to 2m. When a frame is received by the modular communication central 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 standards or protocols wireless or wired communication, as described in the present invention.
[00249] [00249] 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.
[00250] [00250] Figure 9 illustrates an interactive surgical system, implemented by computer 200. The interactive surgical system implemented by computer 200 is similar in many aspects to the interactive surgical system, implemented by computer 100. For example, the surgical system, interactive , implemented by computer 200 includes one or more surgical systems 202, which are similar in many respects to surgical systems 102. Each surgical system 202 includes at least one central surgical controller 206 communicating 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 devices
[00251] [00251] Figure 10 illustrates a central surgical controller 206 that comprises a plurality of modules coupled to the control tower
[00252] [00252] 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 of the laser or ultrasonic type. An ultrasound-based non-contact sensor module scans the operating room by transmitting an ultrasound explosion and receiving the echo when it bounces outside the perimeter of the operating room walls, as described under the title Surgical Hub Spatial Hardware Within an Operating Room "in US provisional patent application serial number 62 / 611,341, entitled INTERACTIVE SURGICAL PLAT-FORM, filed on December 28, 2017, which is hereby incorporated by reference in its entirety, in the which sense module
[00253] [00253] 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 of a system bus. The system bus can be any one of several types of bus structures, including the memory bus or memory controller, a peripheral bus or external bus, and / or a local bus that uses any variety of architectures available buses including, but not limited to, 9-bit bus, industry standard architecture (ISA), Micro-Charmel Architecture (MSA), extended ISA (EISA), smart drive electronics (IDE), local bus VESA (VLB), Peripheral Component Interconnection (PCI), USB, Accelerated Graphics Port (AGP), PCMCIA bus (International Memory Card Association for Personal Computers, Personal Computer Memory Card International Association), Interface small computer systems (SCSI), or any other proprietary bus.
[00254] [00254] 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 can be a Core Cortex-processor
[00255] [00255] In one aspect, processor 244 may comprise a safety controller comprising two controller-based families, such as TMS570 and RM4x, known under the trade name Hercules ARM Cortex R4, also by Texas Instruments. The safety controller can be configured specifically for IEC 61508 and ISO 26262 safety critical applications, among others, to provide advanced integrated safety features while providing scalable performance, connectivity and memory options.
[00256] [00256] 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.
[00257] [00257] Computer system 210 also includes removable / non-removable, volatile / non-volatile computer storage media, such as, for example, disk storage. Disk storage includes, but is not limited to, devices such as a magnetic disk drive, floppy disk drive, tape drive, Jaz driver, Zip driver, LS-60 driver, flash memory card or memory stick ( pen drive). In addition, the storage disc may include storage media separately or in combination with other storage media including, but not limited to, an optical disc drive such as a compact disc ROM device ( CD-ROM) writeable compact disc drive (CD-R Drive), rewritable compact disc drive (CD-RW drive), or a versatile digital disk ROM drive (DVD-ROM). To facilitate the connection of disk storage devices to the system bus, a removable or non-removable interface can be used.
[00258] [00258] It is to be understood that computer system 210 includes software that acts as an intermediary between users and the basic computer resources described in an appropriate operating environment. Such software includes an operating system. The operating system, which can be stored on disk storage, acts to control and allocate computer system resources. System applications benefit from management capabilities by the operating system through program modules and “program data stored in the system's memory or storage disk. It is to be understood that the various components described in the present invention can be implemented with various operating systems or combinations of operating systems.
[00259] [00259] A user enters commands or information into the computer system 210 through the input device (s) coupled to the 1 / O interface 251. Input devices include, but are not limited to, a pointing device such as a mouse, trackball, stylus, touchpad, keyboard, microphone, joystick, game pad, satellite card, scanner, TV tuner card, digital camera, digital video camera, web camera, and the like. These and other input devices connect to the processor via the system bus via the interface port (s). The interface ports include, for example, a serial port, a parallel port, a game port and a USB. Output devices use some of the same types of ports as input devices. In this way, for example, a USB port can be used to provide input to the computer system and to provide computer system information to an output device. An output adapter is provided to illustrate that there are some output devices such as monitors, screens, speakers, and printers, among other output devices, that need special adapters. Output adapters include, by way of illustration and not limitation, video and sound cards that provide a means of connection between the output device and the system bus. It should be noted that other devices and / or device systems, such as remote computers, provide input and output capabilities.
[00260] [00260] Computer system 210 can operate in a networked environment using logical connections to one or more remote computers, such as cloud computers, or local computers. Remote cloud computers can be a personal computer, server, router, personal network computer, workstation, microprocessor-based device, peer device, or other common network node, and the like, and typically include - in many or all of the elements described in relation to the computer system. For the sake of brevity, only one memory storage device is illustrated with the remote computer. Remote computers are logically connected to the computer system via a network interface and then physically connected via a communication connection. The network interface covers communication networks such as local area networks (LANs) and wide area networks (WANs). LAN technologies include fiber-distributed data interface (FDDI), copper-distributed data interface (CDDI), Ethernet / IEEE 802.3, Token / IEEE 802.5 ring and the like. WAN technologies include, but are not limited to, point-to-point links, circuit switching networks such as digital integrated service networks (ISDN) and variations in them, packet switching networks and digital subscriber lines (DSL).
[00261] [00261] In several respects, the computer system 210 of Figure 10, the imaging module 238 and / or display system 208, and / or the processor module 232 of Figures 9 to 10, may comprise an image processor. image, 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.
[00262] [00262] Communication connections refer to the hardware / software used to connect the network interface to the bus.
[00263] [00263] 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 and 23B, 24A and 24B , 25A and 25B, 26A to 26E, 27A to 27F. Consequently, the ultrasonic / combined surgical instrument 7012, as described in Figures 23A and 23B, 24A and 24B, 25A and 25B, 26A to 26E, 27A to 27F, is configured to interface with the 236 modular control tower and the surgical controller central 206. Once connected to the central surgical controller 206, the ultrasonic / combined surgical instrument 7012, as described in Figures 23A and 23B, 24A and 24B, 25A and 25B, 26A to 26E, 27A to 27F, is configured to interface with cloud 204, server 213, other instruments connected to the central controller, the central controller screen 215, or the visualization system 209, or combinations thereof. In addition, once connected to the central controller 206, the ultrasonic / combined surgical instrument 7012, as described in Figures 23A and 23B, 24A and 24B, 25A and 25B, 26A to 26E, 27A to 27F, can use the processing circuits available on the local computer system of the central controller 210.
[00264] [00264] Figure 11 illustrates a functional block diagram of an aspect of a USB 300 central network controller device, in accordance with at least one aspect of the present disclosure. In the illustrated aspect, the USB 300 network central controller device uses a TUSB2036 integrated circuit central controller available from Texas Instruments. The USB 300 central network controller 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. The upstream USB transceiver port 302 is a differential data root port comprising a "minus" differential data input (DMO) paired with a "plus" differential data input (DPO). The three ports of the downstream USB transceiver 304, 306, 308 are differential data ports, each port including "more" differential data outputs (DP1-DP3) paired with "less" differential data outputs (DM1- DM3).
[00265] [00265] The USB 300 central network controller device is implemented with a digital state machine instead of a micro-controller, and no firmware programming is required. Fully compatible USB transceivers are integrated into the circuit for the upstream USB transceiver port 302 and all downstream USB transceiver ports 304, 306, 308. The downstream USB transceiver ports 304, 306, 308 support both full speed as low speed automatically configuring the scan rate according to the speed of the device attached to the doors. The USB 300 network central controller device can be configured in bus powered or self powered mode and includes 312 central power logic to manage power.
[00266] [00266] The USB 300 network central controller device includes a 310 series 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 with a suspend / resume logic circuit and frame timer 316 and a central controller repeat circuit 318 to control 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 an interface 330 series EEPROM.
[00267] [00267] 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 bus-powered and self-powered modes. The USB 300 central network controller can be configured to support four power management modes: a bus-powered central controller with individual port power management or grouped port power management, and the au central controller - powered, with individual door power management or grouped door power management. In one aspect, using a USB cable, the USB 300 central network controller, the USB transceiver port 302 is plugged into a controller.
[00268] [00268] Additional details regarding the structure and function of the central surgical controller and / or networks of central surgical controllers can be found in provisional US patent application 62 / 659,900, entitled METHOD OF HUB COMMUNICATION, deposited on April 19, 2018, which is incorporated herein by reference, in its entirety.
[00269] [00269] Figure 12 is a block diagram of the interactive surgical system implemented by computer, according to at least one aspect of the present disclosure. 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. health services. The interactive surgical system implemented by a computer comprises a data-based data analysis system. Although the cloud-based data analysis system is described as a surgical system, it is not necessarily limited to this and could in general be a cloud-based medical system. As illustrated in Figure 12, the cloud-based data analysis system comprises a plurality of surgical instruments 7012 (may be the same or similar to instruments 112), a plurality of central surgical controllers 7006 (may be the same or similar to controllers central 106) and a surgical data network 7001 (can be the same or similar to network 201) to couple central surgical controllers 7006 to cloud 7004 (can be the same or similar to cloud 204). Each of the plurality of controls
[00270] [00270] 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 7012 and corresponding central controllers 7006 can indicate specific locations, such as operating rooms in healthcare facilities (for example, hospitals), to provide medical operations. For example, the memory of a central surgical controller 7006 can store location data. As shown in Figure 12, cloud 7004 comprises central servers 7013 (which can be the same or similar to remote server 113 in Figure 1 and / or remote server 213 in Figure 9), application servers for central controllers 7002, data analysis 7034 and an input / output interface ("I / O") 7007. Central servers 7013 of the cloud 7004 collectively manage the cloud computing system, which includes monitoring orders by client 7006 central surgical controllers and managing capacity processing number 7004 to execute orders. Each of the central servers 7013 comprises one or more processors 7008 coupled with suitable memory devices 7010 which may include volatile memory as random access memory (RAM) and non-volatile memory as magnetic storage devices. The 7010 memory devices can comprise machine executable instructions that, when executed, cause the 7008 processors to execute the 7034 data analysis modules for analysis, operations, recommendations and other data based operations services described below. In addition, 7008 processors can run data analysis modules 7034 independently or in conjunction with central controller applications independently run by central controllers 7006. Central servers 7013 also comprise aggregated medical databases 2212, that can reside in memory 2210.
[00271] [00271] Based on connections with several central surgical controllers 7006 through the network 7001, the cloud 7004 can aggregate the specific data data generated by various surgical instruments 7012 and their corresponding central controllers 7006. Such aggregated data can be stored in the aggregated medical databases 7011 of the cloud 7004. In particular, the cloud 7004 can advantageously perform data analysis and operations on the aggregated data to produce information and / or perform individual functions that the individual 7006 central controllers could not achieve on their own. For this purpose, as shown in Figure 12, cloud 7004 and central surgical controllers 7006 are communicatively coupled to transmit and receive information.
[00272] [00272] The configuration of the specific cloud computing system described in this disclosure 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, the instru-
[00273] [00273] 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 disclosure. The cloud-based data analysis system includes a plurality of 7034 data analysis modules that can be run by the 7008 cloud 7004 processors to provide data analysis solutions for problems that arise specifically in the medical field. As shown in Figure 13, the functions of the 7034 cloud-based data analysis modules can be aided through applications for central controllers 7014 hosted by the application servers for central controllers 7002 that can be accessed in surgical controllers central 7006. Cloud computing processors 7008 and central controller applications 7014 can operate together to perform 7034 data analysis modules. Application programming interfaces (APIs) 7016 define the set of protocols and routines that correspond to 7014 central controller applications. In addition, APIs 7016 manage data storage and retrieval in / from the aggregated medical data databases 7011 for the operations of 7014 applications. 7018 caches also store data ( for example, temporarily) and are coupled to the APIs
[00274] [00274] For example, the 7022 data collection and aggregation module could be used to generate self-describing data (for example, metadata), including the identification of notable features or configuration (for example, trends), the management of sets of redundant data and the storage of data in paired data sets that can be grouped by surgery, but not necessarily switched to surgical dates and to actual surgeons. In particular, paired data sets generated from the operations of the 7012 surgical instruments may comprise application of a binary classification, for example, a bleeding or non-bleeding event. More generally, the binary classification can be characterized either as a desirable event (for example, a successful surgical procedure) or as an undesirable event (for example, an improperly used or poorly triggered surgical instrument) 7012). The aggregated self-describing data can correspond to individual data received from various groups or subgroups of central surgical controllers 7006. Consequently, the 7022 data collection and aggregation module can generate aggregated metadata or other organized data based on raw data received from central surgical controllers 7006. For this purpose, 7008 processors can be operationally coupled with applications for central controllers 7014 and aggregated medical databases 7011 to run the 7034 data analysis modules. data collection and aggregation module 7022 can store the aggregated organized data in aggregated medical databases 2212.
[00275] [00275] The resource optimization module 7020 can be configured to analyze this aggregated data to determine an optimal use of resources for a specific health service facility or group of health care facilities. For example, the resource optimization module 7020 can determine an ideal ordering point for surgical stapling instruments 7012 for a group of healthcare facilities based on the corresponding anticipated demand for such instruments 7012. The resource optimization module 7020 resources could also assess resource use or other operational configurations of various health care facilities to determine whether resource use could be improved. Similarly, the 7030 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 recommendation module could recommend to health care facilities (for example, medical providers such as hospitals) that a specific surgical instrument 7012 should be upgraded to an improved version based on an error rate of higher than expected, for example. In addition, the 7030 recommendation module and / or the 7020 resource optimization module could recommend better supply chain parameters such as product repurchase points and provide suggestions for different 7012 surgical instruments, their uses, or steps procedure to improve surgical results. Healthcare facilities can receive such recommendations through corresponding 7006 central surgical controllers. More specific recommendations related to the parameters or configurations of various 7012 surgical instruments can also be provided. Central controllers 7006 and / or surgical instruments 7012 may also have display screens that display data or recommendations provided by the 7004 cloud.
[00276] [00276] The 7028 patient results analysis module can analyze surgical results associated with currently used operating parameters of the 7012 surgical instruments. The 7028 patient results analysis module can also analyze and evaluate other potential operational parameters. In this context, the 7030 recommendations module could recommend the use of these other potential operating parameters based on producing better surgical results, such as better sealing or less bleeding. For example, the 7030 recommendation module could transmit recommendations to a central surgical controller 7006 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 use similar types of instruments, etc., in a way that no health facility
[00277] [00277] 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 7028 patient outcome analysis module could identify correlations by linking specific control parameters to successful (or unsuccessful) results. Such correlations can be resolved when updated control programs are transmitted to 7012 surgical instruments via the 7026 control program update module. Updates to 7012 instruments that are transmitted via a corresponding central controller 7006 can incorporate de - aggregate performance that was collected and analyzed by the data collection and aggregation module 7022 from the cloud 7004. Additionally, 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.
[00278] [00278] The cloud-based data analysis system can include security features implemented by the 7004 cloud. These security features can be managed by the authorization and security module 7024. Each central surgical controller 7006 may have unique credentials associated with it such as username, password, and other appropriate security credentials. These credentials can be stored in memory 7010 and be associated with an allowed level of cloud access. For example, based on the provision of accurate credentials, a central surgical controller 7006 can be granted access to communicate with the cloud to a predetermined degree (for example, it can only participate in transmitting or receiving certain defined types of information).
[00279] [00279] 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 7006 central controller and / or can be prevented from working fully when paired with their corresponding central controller
[00280] [00280] 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. Such authorization credentials can be stored in the respective memory devices of the surgical instruments 7012. The authorization and security module 7024 can determine whether the authorization credentials are accurate or falsified. The authorization and security module
[00281] [00281] The cloud-based data analysis system can allow monitoring of multiple health care facilities (eg, medical posts 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.
[00282] [00282] The 7032 data classification and prioritization module can prioritize and classify data based on severity (for example, the severity of a medical event associated with the data, unpredictability, distrust). This classification and prioritization can be used in conjunction with the functions of the other 7034 data analysis modules described above to improve cloud-based data analysis and the operations described here. For example, the 7032 data classification and prioritization module can assign a priority to data analysis performed by the 7022 data collection and aggregation module and 7028 patient outcome analysis modules. Different levels of prioritization can result in responses specific to the cloud 7004 (corresponding to a level of urgency), such as escalation to an accelerated response, special processing, deletion of the aggregated medical databases 7011 or other res-
[00283] [00283] 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
[00284] [00284] 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 being operated on. This is due to the fact that different types of tissue have different properties (for example, tear resistance) and thus respond differently to actions performed by surgical instruments. Therefore, it may be desirable for a surgical instrument to perform different actions when the same measurement is detected for a specific parameter. As a specific example, the optimal way in which to control a stapling and surgical cutting instrument in response to the instrument detecting an unexpectedly high force to close its end actuator, will vary depending on whether the type of tissue is susceptible or resistant. - try to tear. For tissues that are susceptible to tearing, such as lung tissue, the instrument's control algorithm would optimally slow down the engine in response to an unexpectedly high force to close to prevent tissue breakage. For tissues that are resistant to tearing, such as stomach tissue, the instrument's control algorithm would optimally accelerate the engine in response to an unexpectedly high force to close to ensure that the end actuator is properly attached to the tissue. Without knowing whether lung or stomach tissue has been trapped, the control algorithm may make a decision below what is considered ideal.
[00285] [00285] “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. Figure 14 illustrates a diagram of a surgical system with 5100 situational recognition, according to at least one aspect of this disclosure. In some examples, data sources 5126 include, for example, modular devices 5102 (which may include sensors configured to detect parameters associated with the patient and / or the modular device itself), databases 5122 (eg example, an EMR database containing the patient's medical record), and 5124 monitoring devices (for example, a blood pressure monitor (BP) and an electrocardiography monitor (ECG)).
[00286] [00286] A central surgical controller 5104 that can be similar to surgical controller 106 in many ways, can be configured to derive contextual information related to the surgical procedure from the data based, for example, on the combination (s) ( specific data (s) received or in the specific order in which data are 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 central surgical controller 5104 to derive or infer information related to the surgical procedure from received data, can be called "situational perception." In one example, the central surgical controller 5104 can incorporate a situational perception system, which is the hardware and / or programming associated with the central surgical controller 5104 that derives contextual information related to the surgical procedure based on the data received.
[00287] [00287] 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 inputs ( for example, data from databases 5122, patient monitoring devices 5124, and / or modular devices 5102) to corresponding contextual information referring to 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 query 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 inputs, the query table can return the corresponding contextual information to the situational perception system to control the modular devices
[00288] [00288] A central surgical controller 5104, which incorporates a situational perception system, provides several benefits to the 5100 surgical system. One benefit includes improving the interpretation of detected and captured data, which in turn improves the accuracy of cessation and / or use of data during the course of a surgical procedure. To return to a previous example, a 5104 central surgical controller with situational awareness could determine what type of tissue was being operated on; therefore, when an unexpectedly high force is detected to close the end actuator of the surgical instrument, the central surgical controller with situational perception 5104 could correctly accelerate or decelerate the surgical instrument motor for the tissue type.
[00289] [00289] “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 tissue clamped by an end actuator of the stapling instrument and surgical cut 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 tissue type.
[00290] [00290] As yet another example, the type of body cavity being operated during an insufflation procedure, can affect the function of a smoke evacuator. A central surgical controller with situational perception 5104 can determine if the surgical site is under pressure (by determining that the surgical procedure is using insufflation) and determine the type of procedure. As a type of procedure is usually performed in a specific body cavity, the 5104 central surgical controller can then adequately control the speed of the smoke evacuator motor to the body cavity being operated 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.
[00291] [00291] 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 perception 5104 can determine whether the surgical procedure is an arthroscopic procedure. The central surgical controller 5104 can then adjust the RF power level or the ultrasonic amplitude of the generator (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 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 situational awareness
[00292] [00292] As yet another example, data can be extracted from additional data sources 5126 to improve the conclusions that the central surgical controller 5104 extracts from a data source
[00293] [00293] 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 com 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 complete.
[00294] [00294] “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 change the displayed view (provided, for example, by a Medical Imaging device to the 108 display system), so that the screen automatically adjusts throughout the surgical procedure.
[00295] [00295] - As yet another example, a central surgical controller with situational perception 5104 could determine which stage of the surgical procedure is being performed or will be performed subsequently and whether specific data or comparisons between the data will be required for that stage of the surgical procedure. The central surgical controller 5104 can be configured to call screens automatically based on data about the stage of the surgical procedure being performed, without waiting for the surgeon to request specific information.
[00296] [00296] Another benefit includes checking for errors during the configuration of the surgical procedure or during the course of the surgical procedure. For example, a central surgical controller with 5104 situational awareness could determine whether the operating room is properly or ideally configured for the surgical procedure to be performed. The central surgical controller 5104 can be configured to determine the type of surgical procedure being performed, retrieve the corresponding checklists, product location, or configuration needs (for example, from a memory), and then compare the 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 5132, 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 other surgical item is missing. In one example, the central surgical controller 5104 can be configured to determine the position or relative distance of modular devices 5102 and patient monitoring devices 5124 using proximity sensors, for example. The 5104 central surgical controller can compare the relative positions of the devices with a recommended or anticipated layout for the 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.
[00297] [00297] As another example, the central surgical controller 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 pro - 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 with the equipment expected for the type of surgical procedure that the 5104 central surgical controller determined is being performed. 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.
[00298] [00298] In general, the situational perception system for the 5104 central surgical controller improves the results of the surgical procedure by adjusting the surgical instruments (and other modular devices 5102) for the specific context of each surgical procedure (such as the different types of tissue), and when validating actions during a surgical procedure. The situational perception system also improves the surgeon's efficiency in carrying out surgical procedures by automatically suggesting the next steps, providing data, and adjusting screens and other 5102 modular devices in the operating room, according to specific context of the procedure.
[00299] [00299] 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 represents typical steps that would be taken by nurses, surgeons, and other medical personnel during the course of a pulmonary segmentectomy procedure, beginning with the setup of the operating room and ending with the transfer of the patient to a recovery room in the postoperative period.
[00300] [00300] The central surgical controller with situational recognition 106, 206 receives data from data sources during the entire course of the surgical procedure, including the data generated each time medical personnel use a modular device that is paired with the surgical controller central 106, 206. Central surgical controller 106, 206 can receive this data from paired modular devices and other data sources and continuously derive inferences (ie, contextual information) about the ongoing procedure as new data is available. received, such as which stage of the procedure is being performed at any given time. The situational recognition system of the central surgical controller 106, 206 is capable of, for example, recording data related to the procedure to generate reports, checking the steps being taken by medical personnel, providing data or warnings (for example, through a 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 ultrasonic surgical instrument or RF electrosurgical instrument), and take any other action described above.
[00301] [00301] In the first step 5202, in this illustrative procedure, the members of the hospital team retrieve the electronic patient 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.
[00302] [00302] In the second step 5204, the team members scan the entry of medical supplies for the procedure. Central surgical controller 106, 206 cross-references the scanned supplies with a list of supplies that are used in various types of procedures and confirms that the supply mix corresponds to a thoracic procedure. In addition, the central surgical controller 106, 206 is also able to determine that the procedure is not a wedge procedure (because the inlet supplies have an absence of certain supplies that are necessary for a thoracic wedge procedure or, otherwise, that inlet supplies do not correspond to a thoracic wedge procedure).
[00303] [00303] In the third step 5206, the medical staff scans the patient's band with a scanner that is connected in a communicative way
[00304] [00304] In the fourth step 5208, the medical staff connects the auxiliary equipment. The auxiliary equipment being used may vary according to the type of surgical procedure and the techniques to be used by the surgeon, but in this illustrative case they include a smoke evacuator, an insufflator and a medical imaging device. When activated, auxiliary equipment that is modular devices can automatically pair with the central surgical controller 106, 206 which is located within a specific vicinity of the modular devices as part of its initialization process. The central surgical controller 106, 206 can then derive contextual information about the surgical procedure by detecting the types of modular devices that correspond with it during this preoperative or initialization phase. In this particular example, the central surgical controller 106, 206 determines that the surgical procedure is a VATS (video-assisted thoracic surgery) procedure based on this specific combination of paired modular devices. Based on the combination of data from the electronic patient record (PEP), the list of medical supplies to be used in the procedure, and the type of modular devices that connect to the central controller, the central surgical controller 106, 206 can, in general , infer the specific procedure that the surgical team will perform. After the central surgical controller 106, 206 recognizes which specific procedure is being performed, the central surgical controller 106, 206 can then retrieve the steps of that process from a memory or from the cloud and then cross over the data that subsequently receives from connected data sources (for example,
[00305] [00305] In the fifth step 5210, the team members fix the electrocardiogram (ECG) electrodes and other patient monitoring devices on the patient. ECG electrodes and other patient monitoring devices are able to pair with the central surgical controller 106, 206. As central surgical controller 106, 206 begins to receive data from the patient's monitoring devices, the central surgical controller 106, 206 thus confirms that the patient is in the operating room.
[00306] [00306] In the sixth step 5212, the medical personnel induced anesthesia in the patient. Central surgical controller 106, 206 can infer that the patient is under anesthesia based on data from modular devices and / or patient monitoring devices, including ECG data, blood pressure data, ventilator data, or combinations of them, for example. After the completion of the sixth step 5212, the preoperative portion of the lung segmentectomy procedure is completed and the operative portion begins.
[00307] [00307] In the seventh step 5214, the lung of the patient who is being operated on is retracted (while ventilation is switched to the contralateral lung). 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 started when it can compare the detection of the patient's lung collapse in the expected stages of the procedure (which can be accessed or retrieved earlier) and thus determine that lung retraction is the first operative step in this specific procedure.
[00308] [00308] In the eighth stage 5216, the medical imaging device
[00309] [00309] In the ninth step 5218 of the procedure, the surgical team starts the dissection step. Central surgical controller 106, 206 can infer that the surgeon is in the process of dissecting to mobilize the patient's lung because he receives data from the RF or ultrasonic generator that indicate that an energy instrument is being triggered. The central surgical controller 106, 206 can cross-check the received data with the steps retrieved from the surgical procedure to determine that an energy instrument is being fired at that point in the process (that is, after completion of the steps previously discussed in the procedure) corresponds to the dissection step. In certain cases, the energy instrument can be a power tool mounted on a robotic arm of a robotic surgical system.
[00310] [00310] In the tenth step 5220 of the procedure, the surgical team proceeds to the connection step. Central surgical controller 106, 206 can infer that the surgeon is ligating the arteries and veins because he receives data from the surgical stapling and cutting instrument
[00311] [00311] In the eleventh step 5222, the segmentectomy portion of the procedure is performed. Central surgical controller 106, 206 can infer that the surgeon is transecting the parenchyma based on data from the surgical stapling and cutting instrument, including data from its cartridge. The cartridge data can correspond to the size or type of clamp being triggered by the instrument, for example. As different types of staples are used for different types of fabrics, the cartridge data can thus indicate the type of fabric being stapled and / or transected. In this case, the type of clamp that is fired is used for the parenchyma (or other similar types of tissue), which allows the central surgical controller 106, 206 to infer which segment of the procedure is being performed.
[00312] [00312] In the twelfth step 5224, the node dissection step is then performed. The central surgical controller 106, 206 can infer that the surgical team is dissecting the node and performing a leak test based on the data received from the generator that indicates which ultrasonic or RF instrument is being fired. For this specific procedure, an RF or ultrasonic instrument being used after the parenchyma has been transected corresponds to the node dissection step, which allows the central surgical controller 106, 206 to make this inference. It should be noted that surgeons regularly switch between stapling instruments.
[00313] [00313] In the thirteenth stage 5226, the patient's anesthesia is reversed. The central surgical controller 106, 206 can infer that the patient is emerging from anesthesia based on ventilator data (that is, the patient's respiratory rate begins to increase), for example.
[00314] [00314] Finally, in the fourteenth step 5228 is that medical personnel remove the various patient monitoring devices from the patient. Central surgical controller 106, 206 can therefore 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 communicated to the cyclic controller
[00315] [00315] Situational recognition is further described in US provisional patent application serial number 62 / 659,900, entitled ME-THOD OF HUB COMMUNICATION, filed on April 19, 2018, which is hereby incorporated by reference in its entirety. in. 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 recognition and / or feedback from its components and / or based on information from the cloud
[00316] [00316] 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 and 23B , 24A and 24B, 25A and 25B, 26A to 26E, 27A to 27F. Consequently, the modular device 5102 implemented as an ultrasonic surgical instrument and combined energy surgical instrument 7012, as described in Figures 23A and 23B, 24A and 24B, 25A and 25B, 26A to 26E, 27A to 27F, are configured to operate as a data source 5126 and to interact with database 5122 and patient monitoring devices 5124. The modular device 5102 implemented as an ultrasonic surgical instrument and combined energy surgical instrument 7012, as described in Figures 23A and 23B, 24A and 24B, 25A and 25B, 26A to 26E, 27A to 27F, are 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) of the 5104 central surgical controller.
[00317] [00317] Figure 16 is a schematic diagram of a robotic surgical instrument 700 configured to operate a surgical tool described in this document, according to an aspect of this disclosure. The robotic surgical instrument 700 can be programmed or configured to control the distal / proximal translation of a displacement member, the distal / proximal displacement of a closing tube, the rotation of the drive shaft, and articulation, either with a single type or multiple articulation drive links. In one aspect, the surgical instrument 700 can be programmed or configured to individually control a firing member, a closing member, a driving shaft member, or one or more hinge members, or combinations thereof. Surgical instrument 700 comprises a control circuit 710 configured to control motor-driven firing members, locking members, drive shaft members, or one or more hinge members, or combinations thereof.
[00318] [00318] In one aspect, the robotic surgical instrument 700 comprises a control circuit 710 configured to control a clamping arm 716 and a closing member 714, a portion of an end actuator 702, an ultrasonic blade 718 coupled connected to an ultrasonic transducer 719 excited by an ultrasonic generator 721, a drive shaft 740, and one or more linkage members 742a, 742b through a plurality of motors 704a to 704e. A position sensor 734 can be configured to provide feedback on the position of closing member 714 to control circuit 710. Other sensors 738 can be configured to provide feedback to control circuit 710. A timer / counter 731 provides information about timing and counting to control circuit 710. A power source 712 can be provided
[00319] [00319] In one aspect, the control circuit 710 may comprise one or more microcontrollers, microprocessors or other processors suitable for executing instructions that cause the processor or processors to perform one or more tasks. In one aspect, a timer / counter 731 provides an output signal, such as elapsed time or a digital count, to control circuit 710 to correlate the position of closing member 714 as determined by position sensor 734 with the timer output. / counter 731 so that the control circuit 710 can determine the position of the closing member 714 at a specific time (t) in relation to an initial position or the time (t) when the closing member 714 is in a specific position in relation to a starting position. The timer / counter 731 can be configured to measure elapsed time, count external events or measure external events.
[00320] [00320] In one aspect, control circuit 710 can be programmed to control functions of end actuator 702 based on one or more tissue conditions. The control circuit 710 can be programmed to directly or indirectly detect tissue conditions, such as thickness, as described here. Control circuit 710 can be programmed to select a trigger control program or closing control program based on tissue conditions. A trigger control program can describe the distal movement of the displacement member. Different trigger control programs can be selected to measure
[00321] [00321] In one aspect, the motor control circuit 710 can generate motor setpoint signals. Motor setpoint signals can be provided for various motor controllers 708a through 708e. Motor controllers 708a to 708e can comprise one or more circuits configured to provide motor start signals for motors 704a to 704e in order to drive motors 704a to 704e, as described here. In some instances, motors 704a to 704e may be brushed DC motors. For example, the speed of motors 704a to 704e can be proportional to the respective motor start signals. In some examples, motors 704a to 704e may be brushless DC electric motors, and the respective motor drive signals may comprise a PWM signal provided for one or more stator windings of motors 704a to 704e. In addition, in some instances, motor controllers 708a through 708e can be omitted and control circuit 710 can directly generate motor drive signals.
[00322] [00322] In one aspect, the control circuit 710 can initially operate each of the motors 704a to 704e in an open circuit configuration for a first open circuit portion of a travel 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 response may include a translation of the distance from the displacement member during the open circuit portion, a time elapsed during the open circuit portion, the energy supplied to one of the motors 704a to 704e during the open circuit portion, a sum of pulse widths of a motor start signal, etc. After the open circuit portion, control circuit 710 can implement the selected trigger control program for a second portion of the travel member travel. For example, during a portion of the closed loop course, control circuit 710 can modulate one of the motors 704a to 704e based on the translation of data describing a position of the closed displacement member to translate the displacement member to a constant speed.
[00323] [00323] In one aspect, motors 704a to 704e can receive power from a 712 power source. Power source 712 can be a DC power source powered by an alternating main power supply, a battery, a super capacitor, or any other suitable power source. Motors 704a to 704e can be mechanically coupled to moving individual mechanical elements such as the closing member 714, the clamping arm 716, drive shaft 740, joint 742a, and the joint 742b, through the respective transmissions 706a to 706e. Transmissions 706a through 706e may include one or more gears or other connecting components for coupling motors 704a to 704e to moving mechanical elements. A position sensor 734 can detect a position of the closing member 714. The position sensor 734 can be or can include any type of sensor that is capable of generating position data that indicates a position of the closing member 714 In some examples, the position sensor 734 may include an encoder configured to supply a series of pulses to the control circuit 710 as the closing member 714 is translated from this and proximally. Control circuit 710 can track pulses to determine the position of closing member 714. Other suitable position sensors can be used, including, for example, a proximity sensor. Other types of position sensors can provide other signals that indicate the movement of the closing member 714. In addition, in some examples, the position sensor 734 can be omitted. When any of the motors 704a to 704e is a stepper motor, the control circuit 710 can track the position of the closing member 714 by adding the number and direction of the steps that the motor 704 has been instructed to perform. Position sensor 734 can be located on end actuator 702 or any other portion of the instrument. The outputs of each of the engines 704a to 704e include a torque sensor 744a to 744e to detect force and have an encoder to detect the rotation of the drive shaft.
[00324] [00324] In one aspect, control circuit 710 is configured to drive a firing member, such as closing member portion 714 of end actuator 702. Control circuit 710 provides a motor setpoint for control motor 708a, which provides a drive signal for motor 704a. The output shaft of the motor 704a is coupled to a torque sensor 744a. The torque sensor 744a is coupled to a transmission 706a which is coupled to the closing member 714. The transmission 706a comprises moving mechanical elements such as rotating elements and a trigger member to control distally and proximally.
[00325] [00325] 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 motor 704b is coupled to a torque sensor 744b. The 744b torque sensor is coupled to a transmission
[00326] [00326] 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 motor 704c is coupled to a torque sensor 744c. The torque sensor 744c is coupled to a transmission 706c which is coupled to the drive shaft 740. The drive 706c comprises moving mechanical elements, such as rotary elements, to control the rotation of the drive shaft 740 in a clockwise direction. or counterclockwise up to and above 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 operable engagement 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 for the control circuit 710. Additional sensors 738, such as a drive shaft encoder, can provide the rotational position of the drive shaft 740 to the control circuit
[00327] [00327] In one aspect, control circuit 710 is configured to pivot end actuator 702. Control circuit 710 provides a motor setpoint for a 708d motor control, which provides a drive signal for the motor 704d. The output shaft of the 704d motor is coupled to a 744d torque sensor. Torque sensor 744d is coupled to a transmission 706d which is coupled to a pivot member 742a. The 706d transmission comprises moving mechanical elements, such as articulation elements, to control the articulation of the 702 + 65º end actuator. In one aspect, the 704d motor is coupled to a pivot nut, which is rotatably seated on the proximal end portion of the distal column portion and is pivotally driven thereon by a pivot gear assembly. The torque sensor 744d provides a feedback signal from the articulation force to the control circuit 710. The feedback signal from the articulation force represents the articulation force applied to the end actuator 702. The sensors 738, as an articulation encoder, can supply the articulation position of end actuator 702 to control circuit 710.
[00328] [00328] In another aspect, the articulation function of the robotic surgical system 700 may comprise two articulation members, or connections, 742a, 742b. These articulation members 742a, 742b are driven by separate disks at the robot interface (the rack), which are driven by the two motors 708d, 708e. When the separate firing motor 704a is provided, each hinge link 742a, 742b can be antagonistically driven with respect to the other link to provide a resistive holding motion and a load to the head when it is not moving and to provide a articulation movement when the head is articulated. The hinge members 742a, 742b attach to the head in a fixed radius when the head is rotated. Consequently, the mechanical advantage of the push and pull connection changes when the head is turned. This change in mechanical advantage can be more pronounced with other drive systems for the articulation connection.
[00329] [00329] In one aspect, the one or more motors 704a to 704e may comprise a brushed DC motor with a gearbox and mechanical connections to a firing member, closing member or articulation member. Another example includes electric motors 704a to 704e that operate the moving mechanical elements such as the displacement member, the articulation connections, the closing tube and the drive shaft. An external influence is an excessive and unpredictable influence of things like tissue, surrounding bodies, and friction in the physical system. This external influence can be called drag, which acts in opposition to one of the electric motors
[00330] [00330] In one aspect, the position sensor 734 can be implemented as an absolute positioning system. In one aspect, the position sensor 734 can comprise an absolute rotary magnetic positioning system implemented as a single integrated circuit rotary magnetic position sensor ASSOSSEQFT, available from Austria Microsystems, AG. The position sensor 734 can interface with the control circuit 710 to provide an absolute positioning system. The position can include multiple Hall effect elements located above a magnet and coupled to a CORDIC processor, also known as the digit by digit method and Volder's algorithm, which is provided to implement a simple and efficient algorithm for calculating hyperbolic functions and trigonometry that require only addition, subtraction, bit shift and lookup table operations.
[00331] [00331] 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.
[00332] [00332] 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 burner during a clamped condition. The voltage meter provides an electrical signal whose amplitude varies with the magnitude of the voltage. The 738 sensors can comprise a pressure sensor configured to detect a pressure generated by the presence of compressed tissue between the clamping arm 716 and the ultrasonic blade 718. The 738 sensors can be configured to detect the impedance of a section of fabric located between the clamping arm 716 and the ultrasonic sheet 718 which is indicative of the thickness and / or completeness of the fabric located between them.
[00333] [00333] 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. Besides that,
[00334] [00334] In one aspect, the 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 an interaction point 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 716 may be representative of the tissue compression experienced by the section of fabric trapped between the clamping arm 716 and the ultrasonic blade 718. The one or more sensors 738 can be positioned at various points of interaction along the closing drive system 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 actual closing forces applied to the clamping arm 716.
[00335] [00335] 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 re-information controller, which may be one or any of the re-information controllers, including, but not limited to, a PID controller, state feedback, linear quadratic (LQOR) 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 number 15 / 636,829, entitled CLOSED LOOP VELOCITY CONTROL TECHNIQUES FOR ROBOTIC SURGICAL INSTRUMENT, filed on June 29, 2017, which is hereby incorporated by reference in its entirety.
[00336] [00336] 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 disclosure. In one aspect, the surgical instrument 750 is programmed to control the distal translation of the displacement member as the closing member 764. The surgical instrument 750 comprises an end actuator 752 that can comprise a clamping arm 766, a closing member 764 and an ultrasonic blade 768 coupled to an ultrasonic transducer 769 driven by an ultrasonic generator 771.
[00337] [00337] The position, movement, displacement, and / or translation of a linear displacement member, such as the 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.
[00338] [00338] 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 DC electric motor chosen
[00339] [00339] Motor 754 can receive power from a power source 762. Power source 762 can be or include a battery, a super capacitor, or any other suitable power source. The motor 754 can be mechanically coupled to the closing member 764 by means of a transmission 756. The transmission 756 may include one or more gears or other connecting components to couple the motor 754 to the closing member 764. A position sensor 784 can detect a position of the closing member
[00340] [00340] The control circuit 760 can be in communication with one or more sensors 788. The sensors 788 can be positioned on the end actuator 752 and adapted to work with the surgical instrument 750 to measure the various derived parameters, such as distance span in relation to time, compression of the tissue in relation to time and tension of the anvil in relation to time. The 788 sensors can comprise a magnetic sensor, a magnetic field sensor, a stress meter, a pressure sensor, a force sensor, an inductive sensor such as a eddy current sensor, a resistive sensor, a capacitive sensor, a sensor optical and / or any other sensors suitable for measuring one or more parameters of the 752 end actuator. The 788 sensors may include one or more sensors.
[00341] [00341] Oum or more 788 sensors may comprise a stress meter such as, for example, a microstrain meter, configured to measure the magnitude of the stress on the clamping arm 766 during a tight condition. The voltage meter provides an electrical signal whose amplitude varies with the magnitude of the voltage. The 788 sensors can comprise a pressure sensor configured to detect a pressure generated by the presence of compressed tissue between the clamping arm 766 and the ultrasonic blade 768. The 788 sensors can be configured to detect the impedance of a sequence. of fabric located between the clamping arm 766 and the ultrasonic blade 768 which is indicative of the thickness and / or completeness of the fabric located between them.
[00342] [00342] The 788 sensors can be configured to measure the forces exerted on the clamping arm 766 by the drive system
[00343] [00343] “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 control circuit 760.
[00344] [00344] The control circuit 760 can be configured to simulate the response of the real system of the instrument in the controller software. A displacement member can be actuated to move a closing member 764 on end actuator 752 at or near a target speed. The surgical instrument 750 may include a feedback controller, which can be any or any feedback controller, including, but not limited to, a PID controller, status feedback, LOR, and / or an adaptive controller , for example. The 750 surgical instrument can include
[00345] [00345] The actual drive system of the surgical instrument 750 is configured to drive the displacement member, the cutting member or the closing member 764, by a brushed DC motor, with gearbox and mechanical connections to a system articulation and / or knife. Another example is the 754 electric motor that operates the displacement member and the articulation drive, for example, from an interchangeable drive shaft assembly. An external influence is an excessive and unpredictable influence on things like tissue, surrounding bodies, and friction in the physical system. This external influence can be called drag, which acts in opposition to the 754 electric motor. External influence, like drag, can cause the functioning of the physical system to deviate from a desired operation of the physical system.
[00346] [00346] Several exemplifying aspects are directed to a surgical instrument 750 that comprises an end actuator 752 with surgical sealing and cutting implements driven by motor. For example, a 754 motor can drive a displacement member distally and proximally along a longitudinal geometric axis of end actuator 752. End actuator 752 may comprise an articulating clamping arm 766 and, when configured to the use, an ultrasonic blade 768 positioned on the opposite side of the clamping arm 766. A clinician can hold the tissue between the clamping arm 766 and the ultrasonic sheet 768, as described in the present invention. When ready to use the 750 instrument, the physician can provide a trigger signal, for example, by pressing a trigger on the 750 instrument. In response to the trigger signal
[00347] [00347] In several examples, the surgical instrument 750 may comprise a control circuit 760 programmed to control the distal translation of the displacement member, such as the closing member 764, for example, based on one or more tissue conditions . The control circuit 760 can be programmed to directly or indirectly detect tissue conditions, such as thickness, as described here. Control circuit 760 can be programmed to select a control program based on tissue conditions. A control program can describe the distal movement of the displacement member. Different control programs can be selected to better treat different tissue conditions. For example, when a thicker tissue is present, the control circuit 760 can be programmed to transfer the displacement member at a lower speed and / or with a lower power. When a thinner tissue is present, the control circuit 760 can be programmed to move the displacement member at a higher speed and / or with greater power.
[00348] [00348] 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 of the displacement member. Based on an instrument response 750 during the open circuit portion of the stroke, control circuit 760 can select a trip control program. The instrument response may include a travel distance of the displacement member during the open circuit portion, a time elapsed during the open circuit portion, the power supplied to the motor 754 during the circuit portion open, a sum of 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 into a constant speed. Additional details are disclosed in US Patent Application Serial No. 15 / 720,852, entitled SYSTEM AND METHODS FOR CONTROL- LING A DISPLAY OF A SURGICAL INSTRUMENT, filed on September 29, 2017, which is hereby incorporated by reference in its entirety.
[00349] [00349] 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 disclosure. In one aspect, the surgical instrument 750 is programmed to control the distal translation of the displacement member as the closing member 764. The surgical instrument 750 comprises an end actuator 752 that can comprise a clamping arm 766, a closing member 764 and an ultrasonic blade 768 coupled to an ultrasonic transducer 769 driven by an ultrasonic generator 771.
[00350] [00350] The position, movement, displacement, and / or translation of a linear displacement member, such as the closing member
[00351] [00351] 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 drive signal of motor 774 can comprise a supplied PWM signal for one or more motor stator windings 754. In addition, in some examples, motor controller 758 can be omitted, and control circuit 760 can generate motor drive signal 774 directly.
[00352] [00352] Motor 754 can receive power from a power source 762. Power source 762 can be or include a battery, a super capacitor, or any other suitable power source. The motor 754 can be mechanically coupled to the closing member 764 by means of a transmission 756. The transmission 756 may include one or more gears or other connecting components to couple the motor 754 to the closing member 764. A position sensor 784 can detect a position of the closing member
[00353] [00353] The control circuit 760 can be in communication with one or more sensors 788. The sensors 788 can be positioned on the end actuator 752 and adapted to work with the surgical instrument 750 to measure the various derived parameters, such as distance span in relation to time, compression of the tissue in relation to time and tension of the anvil in relation to time. The 788 sensors can comprise a magnetic sensor, a magnetic field sensor, a stress meter, a pressure sensor, a force sensor, an inductive sensor such as a eddy current sensor, a resistive sensor, a capacitive sensor, a sensor optical and / or any other sensors suitable for measuring one or more parameters of the 752 end actuator. The 788 sensors may include one or more sensors.
[00354] [00354] Oum or more 788 sensors may comprise a stress meter such as, for example, a microstrain meter, configured to measure the magnitude of the stress on the clamping arm 766 during a tight condition. The voltage meter provides an electrical signal whose amplitude varies with the magnitude of the voltage. The 788 sensors can comprise a pressure sensor configured to detect a pressure generated by the presence of compressed tissue between the clamping arm 766 and the ultrasonic blade 768. The 788 sensors can be configured to detect the impedance of a sequence. of fabric located between the clamping arm 766 and the ultrasonic blade 768 which is indicative of the thickness and / or completeness of the fabric located between them.
[00355] [00355] 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 can be at a point of interaction between the 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 arm clamping 766 can be representative of the tissue compression experienced by the tissue section captured between the clamping arm 766 and the ultrasonic blade 768. The one or more sensors 788 can be positioned at various points of interaction throughout the closing drive system to detect the closing forces applied 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 processor from the 760 control circuit. The 760 control circuit receives sample measurements in real time to provide and analyze information based on in real time and evaluate, in real time, the closing forces applied to the clamping arm 766.
[00356] [00356] 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.
[00357] [00357] The control circuit 760 can be configured to simulate the response of the real system of the instrument in the controller software. A displacement member can be actuated to move a closing member 764 on end actuator 752 at or near a target speed. The surgical instrument 750 may include a feedback controller, which can be any or any feedback controller, including, but not limited to, a PID controller, status feedback, LOR, and / or an adaptive controller , for example. The surgical instrument 750 can include a power source to convert the signal from the re-information controller to a physical input such as case voltage, PWM voltage, frequency modulated voltage, current, torque and / or force, for example.
[00358] [00358] The actual drive system of the surgical instrument 750 is configured to drive the displacement member, the cutting member or the closing member 764, by a brushed DC motor, with gearbox and mechanical connections to a system articulation and / or knife. Another example is the 754 electric motor that operates the displacement member and the articulation drive, for example, from an interchangeable drive shaft assembly. An external influence is an excessive and unpredictable influence on things like tissue, surrounding bodies, and friction in the physical system. This external influence can be called drag, which acts in opposition to the 754 electric motor. External influence, like drag, can cause the functioning of the physical system to deviate from a desired operation of the physical system.
[00359] [00359] Several exemplifying aspects are directed to a surgical instrument 750 that comprises an end actuator 752 with surgical sealing and cutting implements driven by motor. For example, a 754 motor can drive a displacement member distally and proximally along a longitudinal geometric axis of end actuator 752. End actuator 752 may comprise an articulating clamping arm 766 and, when configured to the use, an ultrasonic blade 768 positioned on the opposite side of the clamping arm 766. A clinician can hold the tissue between the clamping arm 766 and the ultrasonic sheet 768, as described in the present invention. When ready to use the instrument
[00360] [00360] In several examples, the surgical instrument 750 may comprise a control circuit 760 programmed to control the distal translation of the displacement member, such as the closing member 764, for example, based on one or more tissue conditions . The control circuit 760 can be programmed to directly or indirectly detect tissue conditions, such as thickness, as described here. Control circuit 760 can be programmed to select a control program based on tissue conditions. A control program can describe the distal movement of the displacement member. Different control programs can be selected to better treat different tissue conditions. For example, when a thicker tissue is present, the control circuit 760 can be programmed to transfer the displacement member at a lower speed and / or with a lower power. When a thinner tissue is present, the control circuit 760 can be programmed to move the displacement member at a higher speed and / or with greater power.
[00361] [00361] In some examples, control circuit 760 may initially operate motor 754 in an open circuit configuration by a first open circuit portion of a travel member travel. Based on an instrument response 750 during the open circuit portion of the stroke, control circuit 760 can select a trip control program. The instrument response may include a travel distance of the displacement member during the open circuit portion, a time elapsed during the open circuit portion, the power supplied to the motor 754 during the circuit portion open, a sum of 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 into a constant speed. Additional details are disclosed in US Patent Application Serial No. 15 / 720,852, entitled SYSTEM AND METHODS FOR CONTROL- LING A DISPLAY OF A SURGICAL INSTRUMENT, filed on September 29, 2017, which is hereby incorporated by reference in its entirety.
[00362] [00362] Figure 18 is a schematic diagram of a 790 surgical instrument configured to control various functions in accordance with an aspect of the present disclosure. In one aspect, surgical instrument 790 is programmed to control the distal translation of a displacement member such as closing member 764. Surgical instrument 790 comprises an end actuator 792 which may comprise a clamping arm 766, a limb close-up 764, and an ultrasonic blade 768 that can be interchanged with or work in conjunction with one or more RF 796 electrodes (shown in dashed line). The ultrasonic blade 768 is coupled to an ultrasonic transducer 769 driven by an ultrasonic generator 771.
[00363] [00363] 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.
[00364] [00364] In one aspect, the position sensor 784 can be implemented as an absolute positioning system, which comprises an absolute rotary magnetic positioning system implemented as an integrated circuit rotary magnetic position sensor single ASSOSSEQFT, available from Austria Microsystems, AG. The position sensor 784 can interface with the control circuit 760 to provide an absolute positioning system. The position can include multiple Hall effect elements located above a magnet and coupled to a CORDIC processor, also known as the digit by digit method and Volder algorithm, which is provided to implement a simple and efficient algorithm for calculating hyperbolic and trigonometric functions that require only addition, subtraction, bit shift and lookup table operations.
[00365] [00365] In some examples, the position sensor 784 can be omitted. When the 754 motor is a stepper motor, the control circuit
[00366] [00366] The control circuit 760 can be in communication with one or more sensors 788. The sensors 788 can be positioned on the end actuator 792 and adapted to work with the surgical instrument 790 to measure the various derived parameters, such as distance span in relation to time, compression of the tissue in relation to time and tension of the anvil in relation to time. The 788 sensors can comprise a magnetic sensor, a magnetic field sensor, a stress meter, a pressure sensor, a force sensor, an inductive sensor such as a eddy current sensor, a resistive sensor, a capacitive sensor, a sensor optical and / or any other sensors suitable for measuring one or more parameters of the end actuator 792. The 788 sensors may include one or more sensors.
[00367] [00367] “An RF 794 power source is coupled to the 792 end actuator and is applied to the RF 796 electrode when the RF 796 electrode is provided on the 792 end actuator in place of the 768 ultrasonic blade or to function in conjunction with the 768 ultrasonic sheet. For example, the ultrasonic sheet is made of electrically conductive metal and can be used as the return path for the RF electrosurgical current. The control circuit 760 controls the supply of RF energy to the RF electrode 796.
[00368] [00368] Additional details are disclosed in US patent application serial number 15 / 636,096, entitled SURGICAL SYSTEM COUPLA- BLE WITH STAPLE CARTRIDGE AND RADIO FREQUENCY CARTRIDGE, AND METHOD OF USING SAME, filed on 28 June 2017 , which is hereby incorporated as a reference in its entirety.
[00369] [00369] 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 perform adaptive ultrasonic blade control algorithms in a data network. surgical instruments comprising a modular central communication controller. The 900 generator is configured to supply multiple energy modes to a surgical instrument. The 900 generator provides ultrasonic and RF signals to power a surgical instrument, independently or simultaneously. The ultrasonic and RF signals can be supplied alone or in combination and can be supplied 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 900 generator comprises a 902 processor coupled to a 904 waveform generator. The 902 processor and the 904 waveform generator are configured to generate various signal waveforms based on armed information. stored in a memory attached to the 902 processor, not shown for clarity of disclosure. Digital information associated with a waveform is provided to the waveform generator 904 that includes one or more DAC circuits to convert the digital input to an analog output. The analog output is powered by an amplifier 1106 for signal conditioning and amplification. The conditioned and amplified output of the amplifier 906 is coupled to a power transformer 908. The signals are coupled by the power transformer 908 to the secondary side, which is on the isolation side.
[00370] [00370] A second 912 voltage detection circuit is coupled through the terminals identified as ENERGY: and the RETURN path to measure the output voltage between them. A second voltage detection circuit 924 is coupled through the terminals identified as ENERGY, and the RETURN path to measure the output voltage between them. A current detection circuit 914 is arranged in series with the RETURN leg on the secondary side of the power transformer 908 as shown to measure the output current for any energy modality. If different return paths are provided for each energy modality, then a separate current detection circuit would be provided on each return leg. The outputs of the first and second voltage detection circuits 912, 924 are supplied to the respective isolation transformers 916, 922 and the output of the current detection circuit 914 is supplied to another isolation transformer 918. The outputs of the voltage transformers isolation 916, 928, 922 on the primary side of the power transformer 908 (non-isolated patient side) are supplied to one or more ADC 926 circuits.
[00371] [00371] In one aspect, the impedance can be determined by processor 902 by dividing the output of the first voltage detection circuit 912 coupled over the terminals identified as ENERGIAV / RETORNO or the second voltage detection circuit 924 connected over the terminals identified as ENERGY / RETURN, through 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 for separating the insulating transformers 916, 922 and the output of the current sensing circuit 914 is provided for another isolating transformer 916. The digitalized voltage and current detection measurements of the ADC circuit 926 are provided to processor 902 to compute the impedance. As an example, the first modality of energy ENERGY; it may be ultrasonic energy and the second mode of energy ENERGY, it may 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 work
[00372] [00372] “As shown in Figure 19, generator 900 comprising at least one output port may include a power transformer 908 with a single output and multiple taps to provide power in the form of one or more energy modes - technology, such as ultrasonic, of 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 conduct RF electrodes to seal the tissue or with a coagulation waveform for point coagulation using monopolar or bipolar RF electrosurgical electrodes. The output waveform of generator 900 can be oriented, switched or filtered to provide frequency to the end actuator of the surgical instrument. The connection of an ultrasonic transducer to the output of generator 900 would be preferably located between the output identified as ENERGY: and RETURN, as shown in Figure 18. In one example, a connection of bipolar RF electrodes at the output of generator 900 it would preferably be located between the output identified as ENERGY, and the RETURN. In the case of monopolar output, the preferred connections
[00373] [00373] Additional details are disclosed in US patent application publication 2017/0086914 entitled TECHNIQUES FOR OPERATING GENERATOR FOR DIGITALLY GENERATING ELEC- TRICAL SIGNAL WAVEFORMS AND SURGICAL INSTRUMENTS, which was published on March 30, 2017, which is here incorporated as a reference in its entirety.
[00374] [00374] “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 use of electromagnetic radiation modulated through a non-solid medium. The term does not imply that the associated devices do not contain any wires, although in some respects they may not. The communication module can implement any of a number of wireless and wired communication standards or protocols, including, but not limited to, Wi-Fi (IEEE 802.11 family), WiMAX (IEEE 802.16 family), IEEE 802.20 , long-term evolution (LTE, "long-term evolution"), Ev-DO, HSPAr, HSDPA +, HSUPA +, EDGE, GSM, GPRS, CDMA, TDMA, DECT, Bluetooth, Ethernet derivatives thereof, as well as any other wireless and wired protocols that are designated as 3G, 4G, 5G, and beyond. The computing module can include a plurality of communication modules. For example, a first communication module can be dedicated to short-range wireless communications like Wi-Fi and Bluetooth, and a second communication module can be dedicated to longer-range wireless communications like GPS, EDGE, GPRS , CDMA, WiMAX, LTE, Ev-DO, and others.
[00375] [00375] As used in the present invention a processor or unit
[00376] [00376] As used here, a system on a chip or system on the chip (SoC or SOC) is an integrated circuit (also known as an "IC" or "chip") that integrates all components of a computer or others electronic systems. It can contain digital, analog, mixed and often radio frequency functions - all on a single substrate. A SoC integrates a microcontroller (or microprocessor) with advanced peripherals such as a graphics processing unit (GPU), i-Fi module, or coprocessor. An SoC may or may not contain internal memory.
[00377] [00377] 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 on the chip, as well as a small amount of RAM. Microcontrollers can be used for integrated applications, in contrast to microprocessors used in personal computers or other general-purpose applications consisting of several integrated circuits.
[00378] [00378] “As used in the present invention, the term controller or microcontroller can be an independent chip or IC (integrated circuit) device that interfaces with a peripheral device. This can be a connection between two parts of a computer or a controller on an external device that manages the operation of (and connection to) that device.
[00379] [00379] “Any of the processors or microcontrollers in the present invention can be any implemented by any single-core or multi-core processor, such as those known under the trade name ARM Cortex by Texas Instruments. In one respect, the processor may be a Core Cortex-M4F LM4F230H5QR ARM processor, available from Texas Instruments, for example, which comprises an integrated 256 KB single-cycle flash memory, or other non-volatile memory, up to 40 MHz , a 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.
[00380] [00380] In one aspect, the processor may comprise a safety controller comprising two controller-based families, such as TMS570 and RM4x, known under the tradename Hercules ARM Cortex R4, also by Texas Instruments. The safety controller can be configured specifically for IEC 61508 and ISO 26262 safety critical applications, among others, to provide advanced integrated safety features while providing scalable performance, connectivity and memory options.
[00381] [00381] Modular devices include modules (as described in connection with Figures 3 and 9, for example) that are receivable within a central surgical controller and surgical devices or instruments that can be connected to the various modules in order to connect or pair with the corresponding central surgical controller. Modular devices include, for example, smart surgical instruments, medical imaging devices, suction / irrigation devices, smoke evacuators, power generators, fans, insufflators and displays. The modular devices described here can be controlled by control algorithms. The control algorithms can be executed on the modular device itself, on the central surgical controller to which the specific modular device is paired, or on both the modular device and the central surgical controller (for example, surgical (eg , through a distributed computing architecture. In some examples, the control algorithms of the modular devices control the devices based on the data detected by the modular device itself (that is, by sensors in, on or connected to the device These data can be related to the patient being operated on (for example, tissue properties or insufflation pressure) or to the modular device itself (for example, the rate at which a knife is being advanced, the current motor level, or energy levels). For example, a control algorithm for a stapling and surgical cutting instrument can control the rate at ionize your knife through the fabric according to the resistance encountered by the knife as you go.
[00382] [00382] 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 by means of a power transformer 1560. A secondary winding 1580 of power transformer 1560 is contained in isolated stage 1520 and can comprise a bypass configuration (for example, a central bypass or non-central bypass configuration) to define the trigger signal outputs 1600a, 1600b, 1600c, to provide trigger signals for different surgical devices, such as an ultrasonic surgical device 1104 and an electrosurgical device 1106. In particular, the trigger signal outputs 1600a, 1600b and 1600c can provide a trigger signal (for example, a 420V RMS trigger signal) to an 1104 ultrasonic instrument , and the trigger signal outputs 1600a, 1600b and 1600c can provide a trigger signal (for example, a 100V R trigger signal MS) to an electrosurgical device 1106, with the output 1600b corresponding to the central derivation of the power transformer 1560. The non-isolated stage 1540 can comprise a power amplifier 1620 that has an output connected to a primary winding 1640 of the power transformer 1560. In some respects, the 1620 power amplifier may comprise a push-pull amplifier, for example. The non-isolated stage 1540 may further comprise a programmable logic device 1660 to provide a digital output to a 1680 digital-to-analog converter (DAC) which, in turn, provides an analog signal corresponding to an input of the 1620 power amplifier. In certain respects, the 1660 programmable logic device may comprise a field programmable port matrix (FPGA), for example. The programmable logic device 1660, by controlling the input of the power amplifier 1620 through the DAC 1680, can therefore control any of a number of parameters (for example, frequency, waveform, amplitude of the waveform) of drive signals appearing at the drive signal outputs 1600a, 1600b and 1600c. In certain aspects and as discussed below, the programmable logic device 1660, in conjunction with a processor (for example, the 1740 processor discussed below), can implement a number of control algorithms based on digital signal processing (PSD) and / or other control algorithms for control parameters of the drive signals provided by the 1100 generator.
[00383] [00383] Power can be supplied to a power rail of the 1620 power amplifier by a key mode regulator
[00384] [00384] In certain aspects, the programmable logic device 1660, 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 drive signals emitted by the 1100 generator. In one aspect, for example, the programmable logic device 1660 can implement a DDS control algorithm by retrieving waveform samples stored in a dynamically updated look-up table ("LUT"), 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 resonance frequency. Since other frequencies can excite parasitic resonances, minimizing or reducing the total distortion of the branching current can correspondingly minimize or reduce the undesirable effects of the resonance. As the shape of the waveform of a drive signal provided by the 1100 generator is impacted by various sources of distortion present in the output drive circuit (for example, the 1560 power transformer, the 1620 power amplifier ), feedback data on trends
[00385] [00385] The non-isolated stage 1540 can additionally comprise an ADC 1780 and an ADC 1800 coupled to the output of the power transformer 1560 by means of the respective isolation transformers, 1820 and 1840, to sample the voltage and current respectively of trigger signals emitted by the 1100 generator. In certain aspects, ADCs 1780 and 1800 can be configured for sampling at high speeds (for example, 80 Msps) to enable over-sampling of the trigger signals. In one aspect, for example, the sampling speed of ADCs 1780 and 1800 may allow for an oversampling of approximately 200X (de-
[00386] [00386] In certain aspects, voltage and current feedback data can be used to control the frequency and / or amplitude (for example, current amplitude) of the trigger signals. In one aspect, for example, voltage and current feedback data can be used to determine the impedance phase, for example, the phase difference between voltage and current trigger signals. The frequency of the trigger signal can then be controlled to minimize or reduce the difference between the determined impedance phase and an impedance phase setpoint (eg 0º), thereby minimizing or reducing the effects of harmonic distortion and , correspondingly, accentuating the accuracy of the impedance phase measurement. The determination of phase impedance and a frequency control signal can be implemented in the 1740 processor, for example, with the frequency control signal being provided as input to a DDS control algorithm implemented by the programmable logic device.
[00387] [00387] The impedance phase can be determined through Fourier analysis. In one aspect, the phase difference between the triggering signals of the generated voltage V, (t) and the generated current Ila (t) can be determined using the fast Fourier transform (FFT) or the transform Fourier discrete (DFT) as explained below: Ei = After (2n fot +) Luwà = -Ascos (2nf '+ qu) Wen = A GG E) 46 fucks (ias) - 2h lain = SS mf) E SU fo) dao anfnoo)
[00388] [00388] The evaluation of the Fourier transform in the sinusoid frequency produces: Veins = ES00) in GesD was VIRA a,
[00389] [00389] “Other approaches include weighted minimum square estimation, Kalman filtering and space and vector based techniques. Virtually all processing in an FFT or DFT technique can be performed in the digital domain with the aid of two-channel high-speed ADC, 1780, 1800, for example. In one technique, samples of digital signals from voltage and current signals are transformed from Fourier with an FFT or DFT. The angle of faq q at any point in time can be calculated by: e = 21ft o,
[00390] [00390] Where is the phase angle, faith is the frequency, t is time, and qo is the phase not = 0.
[00391] [00391] Another technique to determine the phase difference between voltage signals V, a (t) and current / 7 (t) is the zero crossing method and produces highly accurate. For voltage signals V, a (t) and current / 9 (t) having the same, each pass through zero from negative to positive of the voltage signal Va (t) triggers the beginning of a pulse, while each passing through zero from negative to positive of the 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 V6 (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. The
[00392] [00392] Other techniques for determining the phase difference between voltage and current signals include Lissajous figures and image monitoring; methods such as the three voltmeter method, the "crossed-coil" method, the vector voltmeter and vector impedance methods; and the use of standard phase instruments, phase-locked loops and other techniques as described in Phase Measurement, Peter O'Shea, 2000 CRC Press LLC, <http: //www.engnetbase. com>, which is incorporated here for reference.
[00393] [00393] In another aspect, for example, the current feedback data can be monitored in order to maintain the current amplitude of the drive signal at a current amplitude setpoint. The current amplitude set point can be specified directly or indirectly determined based on the specified set points for voltage and power amplitude. In certain aspects, the control of the current amplitude can be implemented by the control algorithm, such as a proportional-integral-derivative control algorithm (PID), in the 1740 processor. The variables controlled by the control algorithm to properly control - the current amplitude of the drive signal may include, for example, the scaling of the LUT waveform samples stored in the 1660 programmable logic device and / or the full-scale output voltage of the 1680 DAC circuit (which provides the
[00394] [00394] The non-isolated stage 1540 may also contain a 1900 processor to provide, among other things, the functionality of the user interface (UI). In one aspect, the 1900 processor may comprise an Atmel AT91 SAM9263 processor with an ARM 926EJ-S core, available from Atmel Corporation, of San Jose, California, USA, for example. Examples of UI functionality supported by the 1900 processor may include audible and visual feedback from the user, communication with peripheral devices (for example, via a universal serial bus interface (USB)), communication with the 1430 foot switch, communication with a 2150 data input device (for example, a touch screen) and communication with a 2140 output device (for example, a speaker). The 1900 processor can communicate with the 1740 processor and the programmable logic device (for example, via serial peripheral interface (SPI) buses). Although the 1900 UI processor can primarily support UI functionality, it can also coordinate with the PSD 1740 processor to implement risk mitigation in certain ways. For example, the 1900 processor can be programmed to monitor various aspects of inputs by the user and / or other inputs (for example, 2150 touchscreen inputs, 1430 pedal switch inputs, temperature sensor inputs 2160) and can disable the output of generator 1100 when an error condition is detected.
[00395] [00395] 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 disclosure. In one respect, the
[00396] [00396] “As shown in the example in Figure 21, the 3510 battery pack portion of the surgical instrument comprises a first 3502 control circuit, which includes the 3200 control circuit previously described. The handle set 3512, which connects to the battery set 3510, comprises a first common drive stage circuit 3420. As previously discussed, the first drive stage circuit 3420 is configured to drive the current high frequency (RF) ultrasound, and sensor loads. The output of the first 3420 common drive stage circuit can drive any of the second 3506 stage circuits such as the second 3430 ultrasonic drive stage circuit, the second high frequency (RF) 3432 drive stage circuit , and / or the second 3434 sensor drive stage circuit. The first 3420 common drive stage circuit detects which second stage circuit 3506 is located on the 3514 drive shaft assembly when the 3514 drive shaft assembly is connected to the 3512 handle assembly. After the 3514 drive shaft assembly is connected to the 3512 handle assembly, the first common drive stage circuit 3420 determines which of the second 3506 stage circuits (for example, the second ultrasonic drive stage circuit 3430, the second RF drive stage circuit 3432, and / or the second drive stage circuit sensor 3434) is located on the drive shaft assembly 3514. Information is provided to the control circuit 3200 located on the handle assembly 3512 to provide a digital waveform suitable for the second stage circuit 3506 to drive the appropriate load , for example, ultrasonic, RF or sensor. It will be understood that identification circuits can be included in several 3516 assemblies on the third stage 3508 circuit such as ultrasonic transducer 1120, electrodes 3074a, 3074b, or sensors 3440. Thus, when a third stage circuit 3508 is connected to a second stage circuit 3506, the second stage circuit 3506 recognizes the type of load that is required based on the identification information.
[00397] [00397] 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 4000 surgical system may include a generator 4002 accommodated
[00398] [00398] A control circuit 4008 can receive signals from sensors 4012 and / or 4013. Control circuit 4008 can include any suitable analog or digital circuit components. The control circuit 4008 can also communicate with the generator 4002 and / or the transducer 4004 to modulate the energy supplied to the end actuator 4006 and / or the generator level or the amplitude of the ultrasonic blade of the end actuator 4006 based the force applied to trigger 4010 and / or the position of trigger 4010 and / or the position of the outer tubular sheath described above in relation to a reciprocating tubular actuating member located within the outer tubular sheath (for example, as measured by a combination Hall effect sensor and magnet). For example, the more force is applied to the 4010 trigger, the more energy and / or greater ultrasonic blade amplitude can be supplied to the 4006 end actuator. According to several aspects, the 4012 force sensor can be replaced by a key multiple positions.
[00399] [00399] According to several aspects, the 4006 end actuator may include a gripper or gripping mechanism. When the 4010 trigger is initially triggered, the gripping mechanism can close, trap the fabric between a clamping arm and the 4006 end actuator. As the force applied to the trigger increases (for example, as detected by the 4012 force sensor ), the control circuit 4008 can increase the energy supplied to the end actuator 4006 by the transducer 4004 and / or the generator level or the amplitude of the ultrasonic blade generated in the end actuator 4006. In one aspect, the position of the trigger, as detected by the position sensor 4013 or the position of the claw or clamping arm, as detected by the position sensor 4013 (for example, with a Hall effect sensor), can be used by the control circuit 4008 to set the energy and / or amplitude of the 4006 end actuator. For example, as the trigger is further moved towards a fully actuated position, the claw or claw arm moves additionally in towards the ultrasonic blade (or 4006 end actuator), the energy and / or amplitude of the 4006 end actuator can be increased.
[00400] [00400] “According to several aspects, the surgical instrument of the surgical system 4000 can also include one or more feedback devices to indicate the amount of energy supplied to the 4006 end actuator. For example, a 4014 speaker can emit a signal indicating the energy of the end actuator. According to several aspects, the 4014 loudspeaker can emit a series of pulse sounds, where the frequency of the sounds indicates the energy. In addition to, or instead of, the 4014 loudspeaker, the surgical instrument may include a 4016 visual screen. The 4016 visual screen can 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 control circuit 4008. According to several aspects, the surgical instrument may include a ratchet device connected to the 4010 trigger. The ratchet device can generate a audible sound the more force is applied to the 4010 trigger, providing an indirect indication of energy from the end actuator. The surgical instrument can include other features that can increase safety. For example, control circuit 4008 can be configured to prevent power from being supplied to end actuator 4006 beyond the predetermined threshold. In addition, the 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 screen 4016) and the time when the change in the power from the end actuator is supplied. 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.
[00401] [00401] In one aspect, the generator 1000 is configured to digitally generate the electrical signal waveform in such a way that the desired, using a predetermined number of phase points stored in a lookup table, digitize the wave shape. Phase points can be stored in a table defined in a memory, a field programmable port arrangement (FPGA) or any suitable non-volatile memory. Advanced power device control algorithms
[00402] [00402] 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 disclosure, although the disclosure in this section may also apply to other surgical instruments mentioned above, such as surgical instrument 112, 700.
[00403] [00403] In several aspects, a control algorithm for a 7012 surgical instrument can be configured to obtain a constant heat flow along the length of the ultrasonic blade of the 7012 surgical instrument. The control algorithm can be applied by a circuit control and / or a central surgical controller. The control circuit can execute a program / algorithm executable by a local computer of the surgical instrument 7012 or receive an appropriate algorithm (for example, impedance rate algorithm) from the central surgical controller and / or the system cloud computing. Alternatively, the central surgical controller can execute the algorithm remotely for the surgical instrument 7012. The constant heat flow can advantageously improve the quality of coagulation, cutting or sealing the tissue. The surgical instrument 7012 could be an ultrasonic and bipolar or combined energy surgical instrument. The control algorithm may involve the determination or adjustment of the clamping force in proportion to the progression of the surgical coagulation of the tissue grasped by the surgical instrument 7012. In addition, the control algorithm could involve variable changes, such as the pressure of the tightening applied to a tissue portion that was loaded onto the end actuator, to produce constant heat flow along the length of the blade.
[00404] [00404] In particular, the power of the electrosurgical energy supplied by the 7012 surgical instrument generator, as well as the applied clamping arm pressure can be adjusted or determined to achieve a predefined heat flow. Additionally or alternatively, these can be adjusted to obtain a predefined amount of power to be applied to the tissue. For example, the control algorithm may comprise the variation in the RF and ultrasonic power level provided by the generator together with the variation in the pressure of the clamping arm to obtain a predefined heat flow or power applied to the tissue. The heat flow could be constant or almost constant over the weld time of the tissue in relation to a surgical treatment cycle. The variation implemented by the control algorithm can be based on at least one parameter, which may include, for example, tissue impedance, natural blade frequency, temperature or some other parameter (for example, tissue operational parameter ). Additionally or alternatively, the variation in clamping pressure and power level can be based on a limit controlled by heat flow. This limit controlled by heat flow can be dynamic, so that the limit adjusts along the length of the blade based on the progression of the surgical cut and coagulation. This progression can be assessed by the corresponding focal point, which can be indicative of whether a fibrin clot for coagulation is well formed or not, for example. Consequently, a constant heat flow along the length of the blade could be generated, with the applied clamping force being proportional or corresponding to the coagulation.
[00405] [00405] The control algorithm can also be configured to obtain constant heat flow by adjusting the power over a series of sequential impedance setpoints based on the time required to obtain a setpoint in order to to mimic the increase in impedance. In other words, since the generator of the surgical instrument 7012 progressively delivers power according to the predetermined power curves (which define a relationship between the power delivered to the tissue and the tissue impedance), the control circuit can be configured to determine if the impedance of the tissue reaches a certain amount in a given time. When a certain quality is reached, the generator can be idle for a period of time and / or change to a different power curve. If the given quality is not achieved, the generator can change to a different type of power curve at that time or after the control circuit determines that the given quality will not or is unlikely to be achieved. Additionally or alternatively, the control circuit could select the power curves based on the prediction that the application of the selected power curve could cause the tissue impedance to reach a specific impedance level at a specific time in the cycle. surgical treatment.
[00406] [00406] The target points of tissue impedance or adjustment may be dependent on the next target point and / or the time required
[00407] [00407] In the execution of the control algorithm, the control circuit and / or central surgical controller can cause the end actuator of the surgical instrument 7012 to close progressively during the application of a constant clamping force or pressure or almost constant to the tissue attached along the length of the ultrasonic sheet. That is, the control circuit and / or central surgical controller can adjust the closure of the end actuator to explain the changes in the clamping force applied to the tissue that result from the progression of the surgical cutting and / or coagulation treatment. For example, as the grabbed tissue is coagulated and cut in the proximal portion of the end actuator, the corresponding proximal sections of the tissue may experience greater clamping pressure applied due to the advance of the surgical cut / coagulation. Des-
[00408] [00408] “Due to the fact that the curved clamping arm could result in the different clamping pressure applied to the fabric, the control algorithm can be performed to compensate for this clamping arm deflection. In this way, as the end actuator gradually reaches its full closing stroke, the control circuit and / or central surgical controller can execute the control algorithm to compensate for this deflection in order to provide pressure on the tissue of constant or almost constant clamping along the length of the blade (alternatively called the second claw of the end actuator). Consequently, the end actuator can apply relatively greater clamping force to the distal portions of the end actuator when the tissue is being treated in a proximal to distal direction. In addition, deflection of the clamping arm can cause variation in the heat flow along the length of the end actuator. To resolve this, the control algorithm can selectively involve energizing surgical treatment electrodes (for example, the RF electrodes on the end actuator) to compensate or explain this variation. Specifically
[00409] [00409] The control circuit and / or central surgical controller can be configured to execute the control algorithm to control the energization of the segmented surgical treatment electrodes. For example, the electrodes can comprise two pairs of RF electrodes on each end actuator clamp. The control circuit can control the energization in conjunction with the progressive closing of the clamping arm / first gripper to obtain a constant current density along the end actuator. Each of the two pairs of RF electrodes can be called a set of proximal and distal electrodes, respectively, and can be energized as a set. The control circuit can control the generator to energize the set of proximal and distal electrodes sequentially, so that an equal current density is generated or created in both the proximal and distal portions. In one aspect, the control circuit and / or central surgical controller can energize the set of proximal electrodes while causing the end actuator to compress the tissue in a first claw pressure, which results in a density preset current. When the measured tissue impedance (for example, measured using a pressure sensor, resistive or other suitable sensor on the end actuator) reaches or exceeds a predetermined limit, the control circuit and / or central surgical controller can energize the distal set of electrodes and de-energize or stop the application of power to the set of proximal electrodes. Simultaneously or substantially simultaneously, the clamping force applied by the clamping arm / first claw can be increased to recreate the current density preset in the distal area where the distal electrode assembly is located. In this way, the two sets of proximal and distal electrodes can be energized or sequentially powered. In addition, this sequential energization can occur in conjunction with the application of variable clamping force. Additionally or alternatively, as the proximal electrode set provides electrosurgical energy to treat the tissue, the distal electrode set can simultaneously receive generator power at a lower power level for preheating. That is, the distal portion of the end actuator can be preheated while the proximal portion is used to treat the tissue. Similarly, the proximal portion of the end actuator can also be preheated.
[00410] [00410] The surgical instrument 7012 may have a tissue sealing mode (eg blood vessel) in which the change in specific tissue impedance over time or the rate of increase and the predictable clotting time interval are targeted. During the operation of the 7012 energy-based surgical instrument, tissue impedance can be selectively increased to "deprive" the clotting cycle. Putting it differently, through the application of electrosurgical energy according to the target points of tissue impedance and residence time, the progression of the clotting cycle can be dynamically interrupted or "deprived", as needed, to obtaining the desired impedance change rate and clotting time interval. In this way, the generator can adjust power through increment or cycle through different power or load curves based on impedance adjustment target points with associated power levels and dwell times between switching levels or power curves to obtain a total clotting time interval. The total clotting time may include changes in the impedance increase rates, as discussed in more detail below. In one aspect, an impedance increase rate, such as 50 Ohms (O) per second, can be achieved by adjusting the dwell time on each target to a target time interval of 2 seconds (for example, if the application of the current power level or curve, otherwise, increase the impedance to 100 O) or by increasing the number of targets and spacing them in increments specified as 50 O increments, so that each level or curve of power is applied until the next 50 O target is reached.
[00411] [00411] In addition, selective obtaining of increased rates of tissue impedance can be performed to achieve a predictable exposure time as measured by a surgical coagulation cycle. For example, the generator can apply power to the tissue according to a first power curve (for example, specifying the maximum power of 200 watts) to reach the 100 O target with a dwell time interval of four seconds. After reaching 100 Q and remaining for 4 seconds, the generator can obtain the application of a series of power levels or curves. Each power level or curve can be determined and applied until it reaches a next target impedance point with an associated power level and dwell time, in which the target impedance points progressively increase by 100 Q (ie , each point is 100 The greater than the last). By controlling the generator in this way, at each target impedance point in question, the applied power level or curve can be changed according to the next target impedance point. The next impedance point can have an associated power level and dwell time before the next impedance point is determined, which can be based on the total tissue impedance level and the time required to obtain the target point of impedance. impedance in question. By adjusting the impedance rise rates according to these dynamically determined target impedance points, a predictable sealing time could be obtained, such as a cycle time of 7 seconds in the example currently described.
[00412] [00412] The surgical instrument 7012 can be configured to provide a composite electrosurgical energy that comprises ultrasonic and RF energy to separate the treated tissue from a relatively hard or rigid substructure, such as the patient's bone. To determine when this specific combination of electrosurgical energy should be applied, the 788 sensors can determine and monitor the waveguide's natural or resonant frequency (and the blade on which the waveguide ends). The natural wave guide frequency can be equivalent to the setting of the drive frequency produced by the generator. In particular, the 788 sensors can detect when the natural frequency experiences a wave or phase shift to determine when the end actuator can impact a rigid substructure (eg bone, relatively harder layer of soft tissue, etc. .). When that impact or contact is determined, the generator can be controlled to delay both the ultrasonic blade amplitude and the RF power level. That is, the generator can reduce the current of the transducer used to vibrate the ultrasonic blade and the power transmitted to the RF electrodes. Consequently, the surgical instrument 7012 can properly separate tissue from a harder substructure with the use of ultrasonic energy to complement the heat generated by the application of RF energy when the control circuit and / or central surgical controller detects bone or differences in soft tissues based on the frequency of ultrasonic resonance. The control algorithm could also be configured to detect and delay the application of electrosurgical energy by detecting contact with non-woven objects, such as when clips, underlying clips are found or when the surgical instrument 7012 comes into contact with another instrument.
[00413] [00413] “As stated above, surgical instrument 7012 could be a combined surgical instrument, such as a combined monopolar / bipolar electrosurgical instrument, in which the type of electrosurgical energy could be ultrasonic, RF or some other type of suitable energy . In the monopolar modality, the patient being treated acts as the return path or electrical ground (for example, through the return block on the patient's skin) while in the bipolar modality, the ultrasonic blade acts as the second pole for transmission of electrosurgical energy. The bipolar modality can generally be preferred for more controlled localized electrosurgical energy applications. In this context, the control circuit and / or central surgical controller can execute the control algorithm to change the frequency of monopolar electrosurgical energy, so that it is non-therapeutic (outside the treatment range) to monitor aspects of the modality or system bipolar. Thus, in aspects in which the surgical instrument 7012 functions as a bipolar tool, such as surgical scissors, the performance of the control algorithm can provide improved nerve detection. Specifically, the bipolar and monopolar energy modalities could be applied simultaneously or almost simultaneously to the monopolar energy supplied to the end actuator at a non-therapeutic frequency as feedback for the application of bipolar energy. For example, the generator can provide a trigger signal for nerve stimulation, such as a biphasic signal at 100 to 1,000 hertz (Hz) to stimulate the patient's nerves in which the monopolar energy circuit provides monopolar energy at a non-therapeutic frequency , while the bipolar energy circuit provides bipolar energy in the range of 200 kilohertz (kHz) to 3 me- ghertz (MHz). In this way, the non-therapeutic monopolar component can be used as feedback to the control circuit and / or central surgical controller to determine the proximity of the end actuator to the patient's nerves. With the use of the determined nerve proximity, the surgical instrument can minimize inadvertent nerve cutting by bipolar scissors. Alternatively, the bipolar energy supplied could be fed back into monopolar energy.
[00414] [00414] In addition, the surgical instrument 7012 can regulate the application of bipolar electrosurgical energy based on the change in impedance resulting from the application of monopolar electrosurgical energy. Specifically, the control circuit and / or central surgical controller can execute the control algorithm to monitor the relative change in monopolar energy impedance, so that the bipolar energy control settings are controlled. The 788 sensors, the control circuit and / or the central surgical controller can detect or determine the impedance based on a signal transmitted through the monopolar power circuit. For example, impedance could be determined by dividing the voltage detection circuit output by the monopolar current detection circuit. The bipolar control settings could be settings that define how bipolar energy is supplied to the end actuator. Thus, the execution of the control algorithm can result in the control of bipolar power using monopolar impedance monitored as regulation of the bipolar power level based on changes in the determined monopolar impedance. For example, given an applied clamping arm pressure of 14 to 17 pounds of peak load, the generator can switch from zero power mode to full power mode as 200 Watt (W) and use the monopolar to measure the increase relative impedance (for example, to a specific limit, such as 80 OQ) to control when to switch to a time-based control setting. That is, in the transition from O to 200 W, the change determined from 80 OQ can be used to trigger a change in the time-based bipolar power control setting that specifies the application of a constant amount of power, such as 100 W, during a predetermined period of time. Alternatively, the determined change of 80 O could cause a proportional decrease in energy of the step, such as a decrease in total power that is proportional to the increase in monopolar impedance.
[00415] [00415] The surgical instrument 7012 could also be a combined surgical instrument such as a combined monopolar / ultrasonic electrosurgical instrument in which monopolar energy is used to detect or monitor surgical treatment using the ultrasonic modality. In particular, the operating frequency of monopolar energy can be changed to monitor aspects of the ultrasonic energy model. For example, monopolar energy could initially be emitted at a therapeutic frequency level and changed to a lower non-therapeutic frequency and power level to obtain tissue impedance measurements, which can be used to monitor the ultrasonic energy supply. Although absolute impedance values may not be useful, changes in tissue impedance values can be compared with expected changes in tissue impedance resulting from electrosurgical treatment to detect the tissue treatment effects of the ultrasonic energy provided. In other words, as the tissue is being treated by ultrasonic energy, there may be an expected change in the tissue's impedance. The control circuit and / or central surgical controller can be configured to determine whether the tissue effects caused by the ultrasonic treatment are consistent with the expected change using the change in monopolar energy frequency, such as by switching to a level of non-therapeutic frequency.
[00416] [00416] The change in the operating frequency of monopolar energy mode to monitor the ultrasonic energy mode can also be obtained by switching the drive frequency to a very high level, such as greater than 10 MHz to allow tissue monitoring. Thus, the change in monopolar frequency could be used to monitor the therapeutic effect on the tissue resulting from the other energy modality, such as the ultrasonic energy model, as discussed above. Some situations can result in undesirable parasitic impedances. However, the higher triggering frequencies of the monopolar energy modality can negatively or beneficially minimize the parasitic or parasitic capacitance resulting from the use of a monopolar retort block (for example, reusable patient return electrode MEGADYNET ! Y MEGA SOFT'Y), However, relatively higher therapeutic monopolar frequencies can also operate effectively even with monopolar power set at lower levels to detect tissue impedances. As stated above, alternatively, the generator can trigger the monopolar output at lower frequencies and subtherapeutic currents to detect ultrasonic treatment and the associated effects on the treated tissue. Lower frequencies may not result in many parasitic effects due to undulations, cable length and other such reasons, but the detection or monitoring of the ultrasonic energy modality may be limited by the use of the monopolar return block.
[00417] [00417] Although at least some portion of the algorithm (or something-
[00418] [00418] Figures 23A and 23B are graphs 203500, 203520 that include a 203500 graph of clamping force as a function of time and an associated graph 203520 that indicates the displacement at the clotting and cutting site along the length of the blade as a function of time, in accordance with at least one aspect of this disclosure. As shown in Figures 23A and 23B, increasing the clamping force as it increases to the clotting / cutting site (eg, clotting / cutting focal point) in the ultrasonic blade shifts can result in better tissue coupling ultrasound slide. The focal point can move proximally to distally or distally to proximally depending on the direction of surgical treatment, for example. In addition, the focal point can represent the progress of a fibrin clot to coagulation, for example. The clamping arm of the surgical instrument 7012 could be moved, tilted or also curved to accentuate or amplify the pressure experienced by the tissue, which results from the application of clamping force. The focal point as well as a sealing time or total welding of the surgical operation could be determined by the control circuit 710 based on a sensor signal (for example, from the sensor 788) indicative of a surgical parameter, such as tissue impedance, natural frequency, temperature or some suitable tissue parameter. Control circuit 710 could increase the pressure of the clamping arm based on the sensor signal. The change in the clamping force as a function of the clotting / surgical cutting site could be controlled by the control circuit 710 together with a variation in the electrosurgical power level provided by the generator in order to achieve a predefined heat flow or power applied - attached to the fabric.
[00419] [00419] The heat flow could be implemented by the control circuit 710 as a limit of control of the heat flow that can remain the same or change over the duration of the surgical operation performed by the surgical instrument 7012, as based on the progression coagulation / surgical cut. For example, control circuit 710 could adjust the heat flow control limit based on the given coagulation focal point, focal point progression and / or cut progression. The predefined heat flow can beneficially improve the quality of surgical treatment, such as the tissue seal that is formed. In Figure 23A, the geometric axis x 203508 represents time over the course of a surgical cycle while the geometric axis y 203510 represents the applied clamping force. Des-
[00420] [00420] The dashed line 203502 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 amount or amount of clamping force may be a function of the tissue clotting process process, which could be traced based on the location of the coagulation / cut focal point on the end actuator as it extends from the time to uncle time. As illustrated by the dashed line 203502, the applied clamping force increases as the clotting / cutting action of tissue is detected. The dashed line 203502 reaches the maximum force at a point close to time ts, where the force remains at its maximum level until the time uncle. The dashed and dotted line 203504 represents the impedance of the tissue measured in relation to the surgical cycle. As can be seen in the graph 203500, the impedance of the measured tissue decreases from its initial level at time to the lowest point around time t3, demonstrating the drop in impedance that results from the start of surgical treatment (a so-called "bathtub" portion of the impedance curve). After time t3, the tissue impedance line 203504 increases as the tissue being treated begins to dry. This desiccation results in an increase in tissue impedance. Figure 23A shows how this increase in the fabric impedance line 203504 corresponds to an increase in the applied clamping force line 203502. The increase in applied force can assist in cutting the fabric and welding the denatured fabric to size. that the surgical cycle is completed.
[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 or second claw 203524 (similar to or equal to the ultrasonic blade 718, 768 or others ultrasonic sheets described above) over 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 progress of the focal point of tissue cutting / coagulation throughout the surgical cycle can be represented by the black dots 203522A, 203522B to 203522N, whose advance corresponds to the advance of time through the surgical cycle between the points in time to uncle time. That is, each of the black dots 203522A, 203522B to 203522N corresponds to a point in time in the surgical cycle and also represents the formation of tissue sealing and / or progress in tissue treatment. For example, black dots could represent a coagulation focus or focal point determined by control circuit 710 based on a signal from sensor 788. The sensor signal can be indicative of a surgical parameter such as tissue impedance, a frequency natural
[00422] [00422] In addition, control circuit 710 can be configured to control the closing system of the end actuator while compensating for the deflection of the clamping arm, which can result from the curved shape of the end actuator. For example, the control circuit 710 could mechanically adjust the force applied by the clamping arm to compensate for any disproportionate force exerted based on the curvature of the clamping arm, so that a constant or almost constant tissue pressure be provided along the length of the end actuator. In addition, the control circuit 710 can selectively energize different segments (for example, proximal and distal) of RF electrodes such as RF electrodes 796 to compensate or adjust the variation in heat flow caused by deflection of the clamping arm, as described in more detail below. Control circuit 710 can be configured to determine the cut / weld focal point based on one or more of the resonance frequency and electrical continuity feedback measures. A constant heat flow over the length of the 203524 ultrasonic blade can also be achieved. For example, as the tissue is cut and coagulated in the proximal sections of the end actuator, the level of electrosurgical energy delivered is relatively higher in these proximal sections. Consequently, the control circuit 710 can execute the control algorithm to increase the clamping force in the distal sections, which results in a higher current density in the distal sections that can compensate for the relatively lower power level in the distal sections. In this way, the heat flow and pressure experienced by the fabric along the 203524 ultrasonic sheet can be constant and / or consistent with the heat flow control limit. The control circuit 710 can receive, from a sensor 788, a sensor signal indicative of a surgical parameter. The surgical parameter can be tissue impedance, a natural frequency of the ultrasonic blade, temperature or a tissue parameter. The welding time of the surgical operation can be determined by the control circuit 710 based on the sensor signal. The 710 control circuit can vary one or more of a clamping arm pressure applied by the clamping arm and a power level of electrosurgical energy to maintain one or more of a predefined heat or power flow applied to the tissue loaded in the end actuator.
[00423] [00423] Figures 24A and 24B represent electrode segments of the end actuator and an illustration of the control of the applied clamping force and electrosurgical energy provided by the end actuator, in accordance with at least one aspect of the present disclosure. Figure 24A shows the end actuator 203540 in an open configuration. The end actuator 203540 can be the same or similar to the appropriate end actuator described above, such as the end actuator 702, 752, 792, 4006, or some other suitable end actuator. As shown in Figure 24A, end actuator 203540 comprises two claws including the first claw (for example, the clamping arm) 203542 and the second claw / ultrasonic blade 203544 (same or similar to the ultrasonic blade 203524 ). The clamping arm 203542 can be the same or similar to any suitable clamping arm described above, such as the clamping arm 716, 766, or some other suitable clamping arm. Each of the first and second jaws 203542, 203544 comprises electrosurgical electrodes 203546A to 203546D, 203548A to 203548D, respectively. Electrosurgical electrodes 203546A to 203546D, 203548A to 203548D can be the same or similar to RF electrodes such as RF electrodes 796 or any other suitable electrodes described above. Electrosurgical electrodes 203546A to 203546D, 203548A to 203548D can each be segmented into proximal and distal portions or segments. For example, electrodes 203546A and 203546B, 203548A and 203548B can form a pair or segment of proximal electrodes in the first and second jaws 203542, 203544, respectively. Similarly, electrodes 203546C and 203546D, 203546C and 203546D can form a pair or segment of distal electrodes in the first and second jaws 203542, 203544, respectively. In this way, electrodes 203546A and 203546B, 203548A and 203548B can be longitudinally segmented. The longitudinally segmented electrodes can generate a constant current density.
[00424] [00424] The control circuit 710 can be configured to execute a control algorithm to control the application of power to the segmented electrodes 203546A and 203546B, 203548A and 203548B by the generator 4002 together with the progressive closing control of the clamping arm 203542 to obtain a constant or almost constant current density along the end actuator
[00425] [00425] A fabric impedance signal (or signals indicating current and voltage) can be provided by sensor 788 (for example, pressure sensor, resistive or other suitable sensor) and transmitted to control circuit 10 as feedback. When control circuit 710 determines that the tissue impedance has reached a predetermined or dynamically determined limit, control circuit 710 can control end actuator 203560 and generator 4002 to change one or more of the clamping force and the power level (for example, achieving a constant heat flow and / or heat flow control limit). In particular, the 3560 end actuator can be controlled to apply an increased clamping pressure that is greater than the first clamping pressure. Simultaneously or for the same period of time, control circuit 710 controls generator 4002 to shut down the pair of proximal electrodes and instead supplies power to one of the pair of distal electrodes individually or to both pairs together. In other words, generator 4002 supplies one or more of the distant electrode segments 203546C and 203546D, 203546C and 203546D. In this way, the same current density in the trapped tissue can be obtained for the distal electrodes or a portion of the 203560 end actuator as the proximal electrodes or a portion of the 203560 end actuator. The current density could be predetermined or dynamically determined, as appropriate. As shown in Figures 24A and 24B, the increase in the clamping load pressure on the fabric 203570 corresponds to an increase in the angle between the clamping arm / first claw 203562 and the ultrasonic blade / second claw 203564 to decrease 8, to 82. Also as shown in Figures 24A and 24B, the first and second claws 203562, 203564 pivot around pivot point 203568 to implement the closing stroke of the end actuator.
[00426] [00426] Figures 25A and 25B are graphs 203580, 203600 that illustrate the control of energization or supply of electrosurgical electrodes 203546A to 203546D, 203548A 203548D, in accordance with at least one aspect of the present disclosure. As discussed above, control circuit 710 can be configured to execute the control algorithm to control end actuator 203560 and generator 4002 to produce or generate a constant current density. During the treatment of the proximal portion of the 203560 end actuator, the control circuit 710 can control the end actuator to compress the 203570 tissue in the proximal portion until a first tightening pressure. Simultaneously or in the same period of time, generator 4002 can supply power only to the pairs of proximal electrodes 203546A and 203546B, 203548A and 203548B to treat the proximal section surgically. One or both of the electrodes on the first and second claws 203562, 203564 could be energized so that one or both of the first pair of proximal electrodes 203546A and 203546B and the second pair of proximal electrodes 203548A and 203548B could be energized . After the
[00427] [00427] Figure 25A illustrates the power supply to the proximal electrodes (called the "a" electrode pair) and then distal electrodes (called the "b" electrode pair) sequentially as the pressure of tightening experienced by fabric 203570 is increased correspondingly. The geometric axis x 203582 of the graph 203580 indicates the time, as in units of seconds, that can cover the duration of a surgical cycle. The y axes 203584, 203585 respectively indicate the power level, as expressed as a percentage of the maximum power (100%) and clamping pressure experienced by the 203570 fabric (for example, measured in pounds). Graph 203580 represents the sequence of proximal electrodes pairs "a" 203546A and 203546B, 203548A and 203548B being activated and treating the tissue during a first period of time indicated on the geometric axis x 203582 followed by pairs of electrodes dis- such "b" 203546C and 203546D, 203548C and 203548D being activated and treating the fabric for a second period of time indicated on the geometric axis x. The rectangular function of graph 203580 illustrates this sequential energization. Generator 4002 feeds electrode pairs "a" 203546A and 203546B, 203548A and 203548B according to power level line 203586, disables "a", then supplies electrode pairs "b" 203546C and 203546D, 203548C and 203548D according to the power level line 203588, and finally disables "b". Simultaneously or at the same time, control circuit 710 can control end actuator 203560 to apply clamping pressure at level P; at the same time that the "a" electrode pairs are activated and apply clamping pressure at the P2 level while the "b" electrode pairs are activated. This application of clamping pressure is represented by the clamping pressure line
[00428] [00428] Figure 25B illustrates the preheating of distal electrode pairs "b" 203546C and 203546D, 203548C and 203548D. Consequently, while the proximal portion of end actuator 203560 is being treated, control circuit 710 can also control generator 4002 to preheat the distal portion. In other words, during the time it takes to activate the electrode pairs "a" 203546A and 203546B, 203548A and 203548B, generator 4002 can supply power to the distal electrode pairs "b" 203546C and 203546D, 203548C and 203548D in a lower power level to facilitate surgical treatment in the proximal portion after the completion of surgical treatment in the proximal portion. The 203600 graph represents this. The geometric axis x 203602 of the 203600 graph indicates time, as in units of seconds, that can span the duration of a surgical cycle. The y axes 203604, 203605 respectively indicate the power level, as expressed as a percentage of the maximum power (100%), and the tightening pressure experienced by the 203570 fabric (for example, measured in pounds). The power level line 203606 of graph 203600 shows the sequential activation of the electrode pairs "a" in a similar way to the power level line
[00429] [00429] Figures 26A to 26E are a series of graphs 203620, 203640, 203660, 203680, 203700 that illustrate the adjustment of the power level to obtain a predictable sealing time, in accordance with at least one aspect of the present disclosure. The geometric axis x 203622, 203642, 203662, 203682, 203702 indicates the impedance of the fabric that can be measured in units of Ohms (O). The geometry axis y 203624, 203644, 203664, 203684, 203704 indicates the power level applied by generator 4002. Graphs 203620, 203640, 203660, 203680, 203700 demonstrate how a series of sequential impedance points can be adjusted to mimic an increase in impedance that corresponds to a specific tissue clotting time. By reaching a target impedance increase rate and predictable clotting time interval for the surgical instrument (for example, in vessel sealing mode), a safer or otherwise better tissue seal can be achieved . Each impedance point in the sequential series can be defined based on the
[00430] [00430] The power level associated with each impedance point can be determined based on a power level that obtains a subsequent impedance point that tracks a different impedance versus time curve compared to the impedance curve in standard bathtub shape. The different impedance curve can be less aggressive (although it can also be more) than the bathtub curve, for example. In this way, as each impedance point in the series is reached and each associated power level is determined according to the impedance curve versus time, a desired increase in impedance can be imitated. This increase in impedance can correspond to the drying of the 203570 fabric, except that the increase can be adjusted in relation to the standard tub-shaped curve, so that an improved fabric seal can be achieved. In addition or alternatively, by dynamically determining the impedance set points and associated power levels, the 710 control circuit can implement surgical treatment according to a predictable clotting time interval. The associated power level is determined for each impedance setpoint can be one or more power values. In particular, the associated power level can be determined according to a load or power curve. The power curve can be a predetermined power curve stored in the memory of the surgical instrument 7012, a power curve dynamically determined according to a mathematical model or equation (for example, a change in the variables used in the equation to determine the power or a completely different equation), or some other suitable means, for example.
[00431] [00431] - Consequently, the impedance point can be dynamically determined or directed to obtain an increase in selective impedance. As discussed above, by controlling the rate of increase in tissue impedance 203570 in this way, tissue coagulation can be more predictable and improved. In addition, there may be a dwell time between the adjacent impedance setpoints in the series. This dwell time between impedance points can "deprive" the clotting cycle. That is, during the dwell time, the generator 4002 may not supply any power to the end actuator 203560 so that the impedance of the 203570 fabric does not change significantly during the dwell time. The 203620 graph can show a load curve or natural power (for example, curve that represents the power level as a function of tissue impedance) as indicated by the plotted applied power line 203626 The applied power line 203620 also shows the lenght of stay. The natural power curve can be the desired impedance versus time curve that includes a desired increase in impedance that is obtained dynamically as the impedance points in the series are adjusted. In particular, graph 203640 depicts the first impedance setpoint in the series of sequential impedance points.
[00432] [00432] The first set point occurs at 100 O, so that the generator 4002 provides the associated power level, rising to a maximum power like 200 Watts (w) to obtain 100 OQ. The associated power level (or levels) could be determined based on: applying a power curve stored in the memory of the surgical instrument 7012, corresponding central surgical controller and / or cloud; apply a specific segment or portion of a power curve; or determine a suitable level as by reference to the desired natural power curve. As can be seen in graph 203640, the first corresponding power curve is applied as represented by the applied power line 203646 to incrementally imitate the natural power curve. The applied power line 203646 also shows the dwell time. In this way, the desired rate of increase and the natural power curve can be used as a guide in conjunction with the elapsed time to determine the next impedance point and the associated power level. The remainder of the first power curve or power level (or levels) is usually represented by the dotted line
[00433] [00433] In addition, control circuit 710 can determine that the corresponding power level is less than 200 W, as according to a second power curve that gradually reduces the power level below 200 W. This second curve power or power level (or levels) may be different from the first power curve or power level (or levels) Similar to the first impedance setpoint, generator 4002 can provide power to mimic or follow a rate of increase in desired impedance and / or according to the natural power curve. That is, generator 4002 can deliver power so that the second impedance setpoint is anticipated to be achieved in a desired amount of time. Graph 203660 includes a line of applied power 203666, which shows the application of this second power associated with generator 4002 to reach 200 OQ and the dwell time. The remainder of the second power curve or power level (or levels) is generally represented by the dotted line 203668. After the impedance reaches 200 OQ, the control circuit 710 can determine the amount of dwell time that is appropriate. For example, control circuit 710 can determine that the generator
[00434] [00434] After staying for | second, generator 4002 can supply power according to the corresponding third power curve or power level (or levels) until reaching the next 300 O impedance set point. This is illustrated by graph 203680. In graph 203680 , the applied power line 203686 represents the energy supply according to the third power curve or power level (or levels) and the residence time determined. Similar to that described above, control circuit 710 can implement a predetermined or contemporary dwell time after reaching about 300 O. In addition, control circuit 710 can determine that the next point of im- The threshold to be adjusted is 400 OQ based on the various factors described above. In addition, the control circuit 710 can change / determine that the corresponding power level is a fourth power curve or power level (or levels). The 4002 generator can supply power according to this fourth power curve or power level (or levels), as represented by the applied power line 203706, until it reaches the next impedance setpoint. The remainder of the second power curve or power level (or levels) is usually represented by the dotted line
[00435] [00435] In this way, the control circuit 710 can execute an impedance rate algorithm, which could be programmed in the memory of the surgical instrument 7012 or received by a central surgical controller or cloud computing system. In particular, the control circuit 710 can receive a first impedance point of the tissue (for example, given the first adjustment impedance point), determine a first power level of the electro-surgical energy that corresponds to the first tissue impedance, control the generator to deliver electrosurgical energy at the first power level, determine a second impedance point of the tissue, adjust the first power level to a second electrosurgical power level based on a time interval to reach the second tissue impedance point; control the generator to supply electrosurgical energy at the second power level. More tissue impedance points in the series of impedance points could be determined or targeted to achieve an increase in selective impedance. For example, control circuit 710 can determine a third tissue impedance point and determine the second tissue impedance point based on the third tissue impedance point and a corresponding time interval to reach the target. first tissue impedance point. Control circuit 710 can determine the third impedance point and the associated power level after controlling generator 4002 to supply electrosurgical energy to reach the second impedance point.
[00436] [00436] Dwell time can also be implemented. For example, the control circuit 710 can remain for a time
[00437] [00437] Figures 27A to 27F are graphs and flowcharts 203720, 203740, 203760, 203780, 203800, 203820, which illustrate approaches to supply energy according to the power curves, in accordance with at least one aspect of the present disclosure. More details regarding such approaches can be found in US patent no.
[00438] [00438] Figure 27A shows an aspect of a 203720 graph showing exemplary power curves 203726, 203728,
[00439] [00439] The aggressiveness of two power curves can be compared according to any suitable method. For example, a first power curve can be considered more aggressive than a second power curve in relation to a given range of potential tissue impediments if the first power curve has a higher delivered power that corresponds to at least half the range of possible fabric impedances. In addition, for example, a first power curve can be considered more aggressive than a second power curve in relation to a given range of possible tissue impedances if the area under the first curve along the range is greater than the area under the second curve along the track. Equally, when the power curves are expressed discretely, a first power curve can be considered more aggressive than a second power curve in relation to a given set of possible tissue impedances if the the power values for the first power curve in relation to the set of possible tissue impedances is greater than the sum of the power values for the second power curve in relation to the set of possible tissue impedances.
[00440] [00440] Some aspects of the surgical instrument 7012 include a material with positive temperature coefficient (PTC) positioned between one or more of the electrodes of the claws 203562,
[00441] [00441] It will be understood that during the coagulation or welding process, the impedance of the fabric, in general, can increase. In some respects, tissue impedance may show a sudden increase in impedance indicating successful clotting. The increase may be due to physiological changes in the tissue, to a material with PTC reaching its trigger limit, etc. The amount of energy that may be required to cause the sudden increase in impedance may be related to the thermal mass of the 203570 fabric actuated. The thermal mass of any given tissue portion, in turn, can be related to the type and amount of tissue 203570 in said portion. The material with PTC could be used to determine a welding time for a surgical operation performed by the surgical instrument 7012. In addition, the monitoring of the material with PTC or other 788 sensors on the 203560 end actuator can be performed by the control circuit 710 to determine a coagulation focal point / focal point and the progression of surgical treatment (for example, cutting). Based on these determinations, the control circuit 710 can set a heat flow control limit along the length of the 203564 ultrasonic blade.
[00442] [00442] Several aspects can use this sudden increase in the impedance of the tissue to select an adequate power curve for a given tissue portion. For example, the 4012 generator can select and apply successively more aggressive power curves until the tissue impedance reaches an impedance limit that indicates that the sudden increase has occurred. For example, reaching the impedance limit may indicate that coagulation is progressing properly with the currently applied power curve. The impedance limit can be a tissue impedance value, a rate of change in tissue impedance and / or a combination of impedance and rate of change. For example, the impedance limit can be reached when a certain impedance value and / or rate of change is observed. According to several aspects, different power curves can have different impedance limits, as described in the present invention.
[00443] [00443] Figure 27B shows an aspect of a 203740 process flow for applying one or more power curves to a tissue portion of the 203570 tissue. Any suitable number of power curves can be used. The power curves can be successively applied in order of aggressiveness until one of the power curves leads the fabric to the impedance limit. In step 203742, generator 4002 can apply a first power curve. According to several aspects, the first power curve can be selected to provide power at a relatively low rate. For example, the first power curve can be selected to prevent the tissue from cauterizing with the smallest and most vulnerable tissue portions expected.
[00444] [00444] The first power curve can be applied to the 203570 fabric in any suitable way. For example, generator 4002 can generate a drive signal that implements the first power curve. The power curve can be implemented by modulating the power of the drive signal. The power of the trigger signal can be modulated in any suitable way. For example, the voltage and / or current of the signal can be modulated.
[00445] [00445] “During the application of the first power curve, generator 4002 can monitor the total energy supplied to the 203570 fabric. The impedance of the 203570 fabric can be compared to the impedance limit in one or more energy limits. There can be any suitable number of energy limits, which can be selected according to any suitable methodology. For example, energy limits can be selected to correspond to known points where different types of tissue reach the impedance limit. In step 203744, generator 4002 can determine whether the total energy supplied to the 203570 fabric has met or exceeded a first energy limit. If the total energy has not yet reached the first energy limit, generator 4002 can continue to apply the first power curve in 203742.
[00446] [00446] If the total energy has reached the first energy limit, generator 4002 can determine whether the impedance limit has been reached (step 203746). As described above, the impedance limit can be a predetermined rate of change in impedance (for example, increase) from a predetermined impedance, or a combination of the two. If the impedance limit is reached, generator 4002 can continue to apply the first power curve in the step
[00447] [00447] In the event that the impedance limit is not reached in step 203746, generator 4002 can increment up to the next most aggressive power curve in step 203748 and apply the power curve as the current power curve in 203742 In some respects, the increase to the next more aggressive power curve may include applying a multiplier to a less aggressive power curve, such as the previously implemented power curve. When the next power limit is reached in step 203744, generator 4002 can again determine whether the impedance limit is reached in step 203746. If it is not reached, generator 4002 can again increase until the next power curve. more aggressive in step 203748 and provide this power curve in step 203742.
[00448] [00448] Process flow 203740 may continue until interrupted. For example, process flow 3740 can be interrupted when the impedance limit is reached in step 203746. After reaching the impedance limit, generator 4002 can apply the then current power curve until coagulation or welding is completed. - gives. In addition, for example, the 203740 process flow can be interrupted after all available power curves have been exhausted. Any suitable number of power curves can be used. If the more aggressive power curve fails to drive the tissue to the impedance limit, generator 4002 can continue to apply the more aggressive power curve until the process is otherwise interrupted (for example, by a doctor or when reaching a final energy limit).
[00449] [00449] According to several aspects, the 203740 process flow can continue until an interruption limit occurs. The interruption limit can indicate that coagulation and / or welding is complete. For example, the interruption limit can be based on one or more of the tissue impedance, tissue temperature, tissue capacitance, tissue inductance, elapsed time, etc. After the interruption, the surgical instrument 7012 and / or central surgical controller 5104 can generate an audible tone indicating the interruption. This can be a single interruption limit or, in several aspects, different power curves can have different interruption limits. According to several aspects, different power curves can use different impedance limits. For example, process flow 20 3740 can transition from a first to a second power curve if the first power curve fails to drive the tissue to a first tissue impedance limit and can, subsequently, move from the second to a third power curve if the second power curve fails to drive the tissue to a second impedance limit. In some ways, instead of proceeding between the power curves in order, the generator 4002 can skip one or more power curves. For example, if the tissue impedance at the end of a power curve exceeds a jump limit, then generator 4002, instead of proceeding to the next power curve, can jump to a power curve. more aggressive resistance (for example, a power curve that provides more energy for a given tissue impedance).
[00450] [00450] In some aspects that use a pulsed trigger signal, the generator 4002 can apply one or more load curves composed to the trigger signal and, finally, to the fabric. Compound load curves, like other power curves described in the present invention, can define a power level to be supplied to the fabric according to a measured fabric property or properties. Compound load curves can additionally define pulse characteristics, such as pulse width, in terms of the measured properties of the tissue (eg impedance, current applied
[00451] [00451] Figure 27C is a 203760 graph showing the power and impedance characteristics of an aspect of a drive signal that can be provided by generator 4002 during a first mode. In Figure 27C, the impedance is indicated on the geometric axis x 203762 and the power is indicated on the geometric axis y 203764. During the first mode, generator 4002 can be configured to provide a first power limit 203766 to the fabric while the impedance of the tissue is below a 203768 limit impedance for the method. If the fabric impedance exceeds the limit impedance 203768 for the first mode, generator 4002 can limit the power delivered to a second power limit 203770. In several respects, the second power limit 3770 may be less than the maximum power wherein the generator 4002 is configured to apply to the fabric. In this way, the first mode can prepare the 203570 fabric for greater application of power in later modes. The application period for the first mode can be any suitable value including, for example, a second. It will be understood that the trigger signal can be pulsed during the application of the first mode. For example, the first mode can be applied as a single pulse for the duration of the application period for the first mode, or in multiple shorter pulses. In aspects that use multiple pulses in the first mode, each pulse can conform to the limits determined by impedance for the power of the trigger signal, as described.
[00452] [00452] Figure 27D is a 203780 graph showing the power and impedance characteristics of an aspect of a drive signal that can be provided by generator 4002 during a second mode. In Figure 27D, the impedance is indicated on the geometric axis.
[00453] [00453] Figure 27E is a 203800 graph showing an example of a typical load curve for a generator configured to supply power to an electrosurgical system of the present disclosure. In particular, Figure 27E provides additional details for various electrical readings of the surgical instrument system that is subjected to the sealing procedure during surgery. The left vertical geometric axis represents power (W) and voltage (V), the right vertical geometric axis represents current (A), and the horizontal geometric axis represents load impedance (Ohms). Voltage curve 203802, current curve 203804 and power curve 203806 are shown as load impedance functions. As shown, the amount of power and tension applied to the fabric typically reaches an insurmountable limit, even at ever increasing load impedances. In another way, the amount of energy applied to the tissue in a surgical site has a noticeable effect only up to certain levels of load impedances, and after a certain impedance limit, such as 175 O, the application of more power or extended power typically has little or no benefit. The 203800 graph provides additional details on why exceeding the transition impedance limit, as shown in the 203800 graph, generally represents the cutoff point to which the power should continue to be applied.
[00454] [00454] Figure 27F is a 203820 graph that shows an example of a power profile of a tapered load curve concept, with the additional power characteristics superimposed. In Figure 27F, curve 203822, as shown by the thick line, represents a measure of tension as a function of the load impedance in the tissue. The 203824 curve, as shown by the midline, represents a measure of the calculated power applied to the tissue as a function of the load impedance. The calculated power can be a measure of the power that is determined by the power system of the surgical instrument 7012, while the 203826 curve, as shown by the dashed line, represents the actual or actual power applied to the tissue. As shown, both curves show a power bottleneck that is gradually reduced. This can be caused by the power that is performed per duty cycle at different rates over time, that is, through pulse width modulation. The 203828 curve, as shown by the thin line, represents a measure of current. The current scale is shown on the right, while the power and voltage scale is shown on the left. Examples
[00455] [00455] Various aspects of the subject described in this document are defined in the following numbered examples:
[00456] [00456] Example 1-A surgical instrument comprising an end actuator, an electrode, an ultrasonic transducer, a sensor coupled to 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 electrode is configured to receive electrosurgical energy from a generator and to apply the electrosurgical energy received to the end actuator to weld tissue based on the generator that generates a trigger signal. The ultrasonic transducer is acoustically coupled to the ultrasonic blade. The ultrasonic transducer is configured to ultrasonic oscillate the ultrasonic blade in response to the trigger signal. The sensor is configured to send a signal indicating a surgical parameter to the control circuit. The control circuit is configured to: receive the sensor signal; determine a welding time for a surgical operation performed by the surgical instrument based on the sensor signal; and vary one or more of a clamping arm pressure applied by the clamping arm and an electrosurgical energy power level to maintain one or more of a predefined heat flow or power applied to the tissue loaded on the ex actuator. - tremor.
[00457] [00457] Example 2 - The surgical instrument of Example 1, with the surgical parameter being one or more among tissue impedance,
[00458] [00458] “Example 3 -The surgical instrument of Examples 1 or 2, the control circuit being additionally configured to vary one or more of the pressure of the clamping arm applied by the clamping arm and the power level of the electrosurgical energy based on a heat flow control limit.
[00459] [00459] “Example 4 - The surgical instrument of Example 3, the control circuit being additionally configured to adjust the limit of control of the heat flow along a length of the ultrasonic blade based on one or more of a point of coagulation focus and a progression of a surgical cut.
[00460] [00460] Example 5 - The surgical instrument of Examples 1, 2, 3 or 4, the electrode comprising a plurality of electrodes positioned longitudinally to generate a constant current density.
[00461] [00461] Example 6 - The surgical instrument of Example 5, the control circuit being additionally configured to energize the plurality of electrodes sequentially to generate a first current density in a proximal portion of the plurality of electrodes and a second density current in a distal portion of the plurality of electrodes, and the first and second current densities are equal.
[00462] [00462] Example 7 - The surgical instrument of Example 5, which additionally comprises the generator configured to supply electrosurgical energy to the end actuator, the control circuit being additionally configured to control the generator to energize the plurality of electrodes by providing a first power level to a first portion of the plurality of electrodes and a second power level to a second portion of the plurality of electrodes and the first power level being less than the second power level.
[00463] [00463] Example 8 -The surgical instrument of Examples 1, 2, 3, 4, 5, 6 or 7, the clamping arm being a displaced clamping arm and a control circuit is additionally configured to increase the increase the pressure of the clamping arm based on the sensor signal.
[00464] [00464] Example 9 -A surgical system comprising a central surgical controller configured to receive an impedance rate algorithm transmitted from a cloud computing system and a surgical instrument communicatively coupled to the central surgical controller . The central surgical controller is communicatively coupled to the cloud computing system. The surgical instrument comprises an end actuator, an electrode, an ultrasonic transducer and a control circuit. 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 electrode is configured to receive electrosurgical energy from a generator and apply the electrosurgical energy received to the end actuator to weld tissue based on the generator that generates a trigger signal. The ultrasonic transducer is acoustically coupled to the ultrasonic blade. The ultrasonic transducer is configured to sonically oscillate the ultrasonic blade in response to the trigger signal. The control circuit is coupled to the end actuator. The control circuit is configured to perform the impedance rate algorithm to: receive a first impedance point from the tissue; determine a first power level of electrosurgical energy that corresponds to the first impedance point of the tissue; control the generator to supply electrosurgical energy at the first power level; determining a second tissue impedance point; adjust-
[00465] [00465] Example 10 -The surgical system of Example 9, the control circuit being configured to execute the impedance rate algorithm to further determine a third tissue impedance point; and determining the second tissue impedance point based on the third tissue impedance point and a corresponding time interval to reach the first tissue impedance point.
[00466] [00466] Example 11- The surgical system of Example 10, the control circuit being configured to execute the impedance rate algorithm to further determine the third impedance point of the tissue and a third power level of the electrosurgical energy corresponding to the third tissue impedance point by controlling the generator to provide electrosurgical energy at the second power level to reach the second tissue impedance point.
[00467] [00467] Example 12 - The surgical system of Example 11, the control circuit being configured to execute the impedance rate algorithm to further adjust the third tissue impedance point based on a total tissue impedance level and in the time interval to reach the second fabric impedance point.
[00468] [00468] Example 13- The surgical system of Example 10, the control circuit being configured to execute the impedance rate algorithm to determine additionally a residence time and to control the generator to supply the electrosurgical energy.
[00469] [00469] Example 14 - The surgical system of Examples 9, 10, 11, 12 or 13, the electrode comprising a plurality of electrode segments positioned longitudinally to generate a constant current density.
[00470] [00470] Example 15- The surgical system of Example 14, the control circuit being configured to execute the impedance rate algorithm to further energize the plurality of electrode segments based on a progressive arm closure course tightening.
[00471] [00471] Example 16 - A method of using a surgical instrument to supply electrosurgical energy in accordance with a rate of increase in the target impedance, the surgical instrument comprising an end actuator, a generator, a configured electrode - designed to supply electrosurgical energy to the end actuator, an ultrasonic transducer acoustically attached to the ultrasonic blade, and a control circuit attached to the end actuator. The generator is configured to supply electrosurgical energy to the end actuator based on the generation of a trigger signal. The ultrasonic transducer is configured to sonically oscillate the ultrasonic blade in response to the trigger signal. 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 method comprises: controlling, through the control circuit, the generator to apply power according to a tissue impedance algorithm that comprises the steps of: applying, through the generator, a first power level to reach a first fabric impedance point; end, by means of the generator, the application of the first power level during a first period of residence; determine, by means of the control circuit, a second impedance point of the tissue; apply, by means of the generator, a second power level to reach a second point of tissue impedance; terminate, by means of the generator, the application of the second power level for a second dwell time; determine, by means of the control circuit, a third point of tissue impedance; and apply, through the generator, a third power level to reach the third impedance point of the tissue to obtain the desired rate of increase in impedance.
[00472] [00472] Example 17 - The method of Example 16, which further comprises: interrupting, by means of the generator, the application of the third power level during a third residence time; determine, by means of the control circuit, a fourth impedance point of the tissue; and apply, through the generator, a fourth level of power to reach a fourth point of tissue impedance.
[00473] [00473] Example 18-The method of Example 17, with the third and fourth impedance points of the fabric being determined based on one or more of the first and second impedance points of the fabric and a time to obtain each of the first and second impedance points of the tissue.
[00474] [00474] Example 19-The method of Examples 16, 17 or 18, with a time to obtain the first, second and third impedance points of the tissue corresponding to a predetermined coagulation time interval.
[00475] [00475] Example 20 - The method of Examples 16, 17, 18 or 19, the electrode comprising a plurality of electrode segments positioned longitudinally to generate a constant current density.
[00476] [00476] 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 disclosure. In addition, the structure of each element associated with the shape can alternatively be described as a means to provide the function performed by the element. In addition, where materials are disclosed for certain components, other materials can be used. It should be understood, therefore, that the preceding description and the appended claims are intended to cover all these modifications, combinations and variations that fall within the scope of the modalities presented. The attached claims are intended to cover all such modifications, variations, alterations, substitutions, modifications and equivalents.
[00477] [00477] 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 almost any combination thereof. Those skilled in the art will recognize, however, that some aspects of the aspects 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 a or more computers (for example, as one or more programs running on one or more computer systems), as one or more programs running on one or more processors (for example, as one or more programs running on one or more microprocessors ), as firmware, or virtually any combination thereof, and that designing the circuitry and / or writing the code for the software and firmware would be within the scope of practice for those skilled in the art, in the light of this disclosure. In addition, those skilled in the art will understand that the mechanisms of the subject described herein can be distributed as one or more program products in a variety of ways and that an illustrative form of the subject described here is applicable regardless of the specific type of media. signal transmission used to effectively carry out the distribution.
[00478] [00478] The instructions used to program the logic to execute various disclosed aspects can be stored in a memory in the system, such as dynamic random access memory (DRAM), cache, flash memory or other storage. In addition, instructions can be distributed over a network or through other computer-readable media. In this way, a machine-readable medium can include any mechanism to store or transmit information in a machine-readable form (for example, a computer), but is not limited to floppy disks, optical disks, compact memory disc read-only (CD-ROMs), and optical-dynamos discs, read-only memory (ROM), random access memory (RAM), erasable programmable read-only memory (EPROM), electrically erasable programmable read-only memory ( EEPROM), magnetic or optical cards, flash memory, or a machine-readable tangible storage medium used to transmit information over the Internet via an electrical, optical, acoustic cable or other forms of propagation signals (for example,
[00479] [00479] “As used in any aspect of the present invention, the term" control circuit "can refer to, for example, a set of wired circuits, programmable circuits (for example, a computer processor that includes a 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 executed by the programmable circuit, and any combination thereof. The control circuit can, collectively or individually, be incorporated as an electrical circuit that is part of a larger system, for example, an integrated circuit (IC), an application-specific integrated circuit (ASIC), an on-chip system (SoC), desktop computers, laptop computers, tablet computers, servers, smart headsets, etc. Consequently, as used in the present invention, "control circuit" includes, but is not limited to, electrical circuits that have at least one discrete electrical circuit, electrical circuits that have at least one integrated circuit, electrical circuits that have at least one integrated circuit for a specific application, electrical circuits that form a general-purpose computing device configured by a computer program (for example, a general-purpose computer configured by a computer program that at least partially runs processes and / or devices described herein, or a micropro-
[00480] [00480] As used in any aspect of the present invention, the term "logic" can refer to an application, software, firmware and / or circuit configured to perform any of the aforementioned operations. The software can be incorporated as a software package, code, instructions, instruction sets and / or data recorded on the computer-readable non-transitory storage media. The firmware can be incorporated as code, instructions or instruction sets and / or data that are hard-coded (for example, non-volatile) in memory devices.
[00481] [00481] “As used in any aspect of the present invention, the terms" component "," system "," module "and the like may refer to a computer-related entity, be it hardware, a combination of hardware and software, software or running software.
[00482] [00482] “As used here in one aspect of the present invention, 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 which can, although not necessarily need, take the form of electrical or magnetic signals that can be stored, transferred, combined, compared and manipulated in any other way. It is common use to call these signs bits, values, elements, symbols, characters, terms, numbers or the like. These terms and similar terms may be associated with the appropriate physical quantities and are merely convenient identifications applied to these quantities and / or states.
[00483] [00483] “A network can include a packet-switched network. Communication devices may be able to communicate with each other using a selected packet switched network communications protocol. An exemplary communications protocol may include an Ethernet communications protocol that may be able to allow communication using a transmission control protocol / Internet protocol (TCP / IP). The Ethernet protocol can conform to or be compatible with the Ethernet standard published by the Institute of Electrical and Electronics Engineers (IEEE) entitled "IEEE 802.3 Standard", published in December 2008 and / or later versions of this standard. Alternatively or in addition, communication devices may be able to communicate with each other using an X.25 communications protocol. The X.25 communications protocol can conform or be compatible with a standard promulgated by the International Telecommunication Union-Telecommunication Standardization Sector (ITU-T). Alternatively or in addition, communication devices may be able to communicate with each other using a frame-relay communications protocol. The frame-relay communications protocol can conform to or be compatible with a standard promulgated by the Consultative Committee for International Telegraph and Telephone (CCITT) and / or the American National 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 conform or be compatible with an ATM standard published by the ATM forum entitled "YATM-MPLS Network Interworking 2.0" published in August 2001, and / or later versions of this standard. Obviously, different and / or post-developed connection-oriented network communication protocols are also contemplated in the present invention.
[00484] [00484] Unless stated otherwise, as is evident from the previous disclosure, it is understood that, throughout the previous disclosure, 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 (electronic) quantities ) in the records and memories of the computer system in other data represented in a similar way in the form of physical quantities in the memories or records of the computer, or in other similar information storage, transmission or display devices.
[00485] [00485] “One or more components in the present invention may be called" configured for "," configurable for "," operable / operational for "," adapted / adaptable for "," capable of "," as movable / conformed to ", etc. Those skilled in the art will recognize that "configured for" can, in general, encompass components in an active state and / or components in an inactive state and / or components in a standby state, except when the context dictates otherwise.
[00486] [00486] The terms "proximal" and "distal" are used in the present invention with reference to a physician who handles the handle portion of a surgical instrument. The term "proximal" refers to the portion closest to the doctor, and the term "distal" refers to the portion located opposite the doctor. It will also be understood that, for the sake of convenience and clarity, spatial terms such as "vertical", "horizontal", "up" and "down" can be used in the present invention with respect to the drawings. However, surgical instruments can be used in many orientations and positions, and these terms are not intended to be limiting and / or absolute.
[00487] [00487] Persons skilled in the art will recognize that, in general, the terms used here, and especially in the appended claims (eg, bodies of the attached claims) are generally intended as "open" terms (eg, the term "including" should be interpreted as "including, but not limited to", the term "having" should be interpreted as "having, at least", the term "includes" should be interpreted as "includes, but is not limited to ", etc.). It will also be understood by those skilled in the art that, when a specific number of a claim statement entered is intended, that intention will be expressly mentioned in the claim and, in the absence of such mention, no intention will be present. For example, as an aid to understanding, the following appended claims may contain the use of the introductory phrases "at least one" and "one or more" to introduce claim statements. However, the use of such phrases should not be interpreted as implying that the introduction of a claim statement by the indefinite articles "one, ones" or "one, ones" limits any specific claim containing the claim mention. claims that contain only such a mention are introduced, even when the same claim includes the introductory phrases "one or more" or "at least one" and indefinite articles, such as "one, ones" or "one, ones" (for example, example, "one, ones" and / or "one, ones" should typically be interpreted as meaning "at least one" or "one or more"); the same goes for the use of defined articles used to introduce claims.
[00488] [00488] Furthermore, even if a specific number of an introduced claim statement is explicitly mentioned, those skilled in the art will recognize that that statement needs to be typically interpreted as meaning at least the number mentioned (for example, the mere mention of "two mentions", without other modifiers, typically means at least two mentions, or two or more mentions). In addition, in cases where a convention analogous to "at least one of A, B and C, etc." is used, in general this construction is intended to have the meaning in which the convention would be understood by (for example, For example, "a system that has at least one of A, B and C" would include, but not be limited to, systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and / or A, B and C together, etc.). In cases where a convention analogous to "at least one of A, B or C, etc." is used, this construct is generally intended to have the meaning in which the convention would be understood by (for example, "a system that has at least one of A, B and C" would include, but not be limited to, systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and / or A, B and C together, etc.). It will be further understood by those skilled in the art that typically a disjunctive word and / or phrase presenting two or more alternative terms, whether in the description, in the claims or in the drawings, should be understood as contemplating the possibility of including one of the terms , either term, or both terms, except where the context dictates to indicate something different. For example, the phrase "A or B" will typically be understood to include the possibilities of "A" or "B" or "AeB".
[00489] [00489] “With respect to the attached claims, those skilled in the art will understand that the operations mentioned in the same
[00490] [00490] 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 exemplification", "in one (1) exemplification", in several places throughout this specification it does not necessarily refer to the same aspect. In addition, specific resources, structures or characteristics can be combined in any appropriate way in one or more aspects.
[00491] [00491] “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 disclosure as explicitly presented herein replaces any conflicting material incorporated by reference to the present invention. Any material, or portion thereof
[00492] [00492] In short, numerous benefits have been described that result from the use of the concepts described in this document. The previously mentioned description of one or more modalities has been presented for purposes of illustration and description. This description is not intended to be exhaustive or to limit the invention to the precise form disclosed. Modifications or variations are possible in the light of the above teachings. One or more modalities were chosen and described in order to illustrate the principles and practical application to, thus, allow those skilled in the art to use the various modalities and with various modifications, as they are convenient to the specific use contemplated. It is intended that the claims presented in the annex define the global scope.

权利要求:
Claims (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 electrode configured to receive electrosurgical energy from a generator and apply the electrosurgical energy received to the end actuator to weld the tissue based on the generator that generates a trigger signal; an ultrasonic transducer acoustically coupled to the ultrasonic blade, the ultrasonic transducer being configured to sonically oscillate the ultrasonic blade in response to the trigger signal; a sensor coupled to a control circuit, the sensor being configured to send a signal indicating a surgical parameter to the control circuit; and a control circuit coupled to the end actuator, the control circuit being configured to: receive the sensor signal; determine a welding time for a surgical operation performed by the surgical instrument based on the sensor signal; and vary one or more of a clamping arm pressure applied by the clamping arm and an electrosurgical energy power level to maintain one or more of a predefined heat flow or power applied to the tissue loaded on the ex actuator. - tremor.
[2]
2. Surgical instrument, according to claim 1, characterized in that the surgical parameter is one or more of the impedance of the tissue, a natural frequency of the ultrasonic blade, temperature and a tissue parameter.
[3]
3. Surgical instrument according to claim 1, characterized in that the control circuit is additionally configured to vary one or more of the pressure of the clamping arm applied by the clamping arm and the power level of the electrosurgical energy based on a limit of heat flow control.
[4]
4. Surgical instrument, according to claim 3, characterized in that the control circuit is additionally configured to adjust the limit of control of the heat flow along a length of the ultrasonic blade based on one or more of a point of coagulation focus and a progression of a surgical cut.
[5]
5. Surgical instrument according to claim 1, characterized in that the electrode comprises a plurality of electrodes positioned longitudinally to generate a constant current density.
[6]
6. Surgical instrument, according to claim 5, characterized in that the control circuit is additionally configured to energize the plurality of electrodes sequentially to generate a first current density in a proximal portion of the electrode plurality and a second density of current in a distal portion of the plurality of electrodes, and the first and second current densities are equal.
[7]
7. Surgical instrument, according to claim 5, characterized by additionally comprising the generator configured to supply electrosurgical energy to the end actuator, the control circuit being additionally configured to control the generator to energize the plurality of electrodes to the supply -
a first power level to a first portion of the plurality of electrodes and a second power level to a second portion of the plurality of electrodes and the first power level being less than the second power level .
[8]
8. Surgical instrument according to claim 1, characterized in that the clamping arm is a displaced clamping arm and a control circuit is additionally configured to increase the pressure of the clamping arm based on the sensor signal.
[9]
9. Surgical system characterized by comprising: a central surgical controller configured to receive an impedance rate algorithm transmitted from a cloud computing system, the central surgical controller being communicatively coupled to the numerical computing system comes; and a surgical instrument communicatively coupled to the central surgical controller, the surgical instrument 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 electrode configured to receive electrosurgical energy from a generator and apply the electrosurgical energy received to the end actuator to weld tissue based on the generator that generates a trigger signal; an ultrasonic transducer acoustically coupled to the ultrasonic blade, the ultrasonic transducer being configured to oscillate the ultrasonic blade in response to the actuation signal;
a control circuit coupled to the end actuator, the control circuit being configured to perform the impedance rate algorithm to: receive a first tissue impedance point; determine a first power level of electrosurgical energy that corresponds to the first impedance point of the tissue; control the generator to supply electrosurgical energy at the first power level; determining a second tissue impedance point; adjust the first power level to a second power level of electrosurgical energy based on a time interval to reach the second point of tissue impedance; control the generator to provide electrosurgical energy at the second power level.
[10]
10. Surgical system, according to claim 9, characterized in that the control circuit is configured to execute the impedance algorithm to additionally: determine a third tissue impedance point; and determining the second tissue impedance point based on the third tissue impedance point and a corresponding time interval to reach the first tissue impedance point.
[11]
11. Surgical system according to claim 10, characterized in that the control circuit is configured to execute the impedance rate algorithm to further determine the third impedance point of the tissue and a third power level of the electrosurgical energy corresponding to the third impedance point of the tissue by controlling the generator to provide electrosurgical energy at the second power level to reach the second impedance point of the tissue.
[12]
12. Surgical system, according to claim 11, characterized in that the control circuit is configured to execute the impedance rate algorithm to further adjust the third impedance point of the tissue based on an impedance level of total tissue and in the time interval to reach the second tissue impedance point.
[13]
13. Surgical system, according to claim 10, characterized in that the control circuit is configured to execute the impedance rate algorithm to additionally determine a residence time and control the generator to supply electrosurgical energy at the first power level for the residence time before adjusting the first power level to the second power level of electrosurgical energy and determining the third impedance point of the tissue.
[14]
14. Surgical system according to claim 9, characterized in that the electrode comprises a plurality of electrode segments positioned longitudinally to generate a constant current density.
[15]
15. Surgical system, according to claim 14, characterized in that the control circuit is configured to execute the impedance rate algorithm to additionally energize the plurality of electrode segments based on a progressive closing arm stroke. tightening.
[16]
16. Method of using a surgical instrument to supply electrosurgical energy according to a rate of increase in the target impedance, characterized in that the surgical instrument comprises: 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; generator configured to supply electrosurgical energy
to the end actuator based on the generation of a trigger signal; an electrode configured to supply electrosurgical energy to the end actuator; an ultrasonic transducer tightly coupled to the ultrasonic blade, the ultrasonic transducer being configured to ultrasonic oscillate the ultrasonic blade in response to a trigger signal generated by the generator; and a control circuit coupled to the end actuator and the method comprises: controlling, through the control circuit, the generator to apply power according to a fabric impedance algorithm that comprises the steps of: applying, through from the generator, a first power level to reach a first point of tissue impedance; end, by means of the generator, the application of the first power level during a first period of residence; determine, by means of the control circuit, a second impedance point of the tissue; apply, by means of the generator, a second power level to reach a second point of tissue impedance; end, by means of the generator, the application of the second level of power for a second period of residence; determine, by means of the control circuit, a third point of tissue impedance; apply, by means of the generator, a third power level to reach the third impedance point of the tissue to reach the target impedance increase rate.
[17]
17. Method according to claim 16, characterized by further comprising: terminating, by means of the generator, the application of the third power level during a third residence time;
determine, by means of the control circuit, a fourth point of tissue impedance; apply, through the generator, a fourth level of power to reach a fourth point of tissue impedance.
[18]
18. Method according to claim 17, characterized in that the third and fourth impedance points of the tissue are determined based on one or more of the first and second impedance points of the tissue and a time to reach each of the first and second impedance points.
[19]
19. Method according to claim 16, characterized by a time to reach the first, second and third points of tissue impedance corresponding to a predetermined clotting time interval.
[20]
20. Method according to claim 16, characterized in that the electrode comprises a plurality of electrode segments positioned longitudinally to generate a constant current density.

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BR112020013234A2|2020-12-01|state estimation of the ultrasonic end actuator and control system for the same

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BR112020019771A2|2021-01-05|METHOD FOR SMOKE EVACUATION FOR CENTRAL SURGICAL CONTROLLER

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BR112020013057A2|2020-12-01|detection of immersion of the end actuator in a liquid

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BR112020012906A2|2020-12-08|CONTROL OF ACTIVATION OF AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO THE PRESENCE OF TISSUE

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BR112020013070A2|2020-12-01|determine the state of an ultrasonic electromechanical system according to the frequency shift

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BR112020012933A2|2020-12-01|control of an ultrasonic surgical instrument according to the location of the tissue

---

BR112020012938A2|2020-12-01|determination of tissue composition by means of an ultrasonic system

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BR112020013114A2|2020-12-01|smoke evacuation system that includes a segmented control circuit for interactive surgical platform

同族专利:

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公开号 | 公开日

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EP3505096A1|2019-07-03|

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EP3967249A1|2022-03-16|

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US20190201044A1|2019-07-04|

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JP2021509336A|2021-03-25|

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WO2019133141A1|2019-07-04|

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CN111698957A|2020-09-22|

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EP3505096B1|2021-07-14|

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法律状态:
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优先权:

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申请号 | 申请日 | 专利标题

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

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

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

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

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US201862729195P| true| 2018-09-10|2018-09-10|

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