adjustment of the staple height of at least one row of staples based on the closing force or the thi

专利摘要:
The present invention relates to a surgical stapling instrument. The surgical stapling instrument includes an anvil configured to hold a tissue, a circular stapling head assembly comprising a first row of staples and a second row of staples, a first staple driver configured to drive the first row of staples, a second clamp driver configured to drive the second row of clamps, the first and second clamp drivers being independently actuable. A motor is coupled to the anvil. The motor is configured to move the anvil between a first position and a second position. A control circuit is attached to the motor. The control circuit is configured to define a stroke length of the first and second staple drivers as a first length, detect a malformed staple in the first row of staples, and set the stroke length of the second staple driver as a second length .
公开号:BR112020013204A2
申请号:R112020013204-7
申请日:2018-11-14
公开日:2020-12-01
发明作者:Frederick E. Shelton Iv；Gregory J. Bakos；Jason L. Harris；Chester O. Baxter Iii
申请人:Ethicon Llc；
IPC主号:

专利说明:

[001] [001] The present application claims the benefit of US non-provisional patent application serial number 16 / 182.229, entitled ADJUSTMENT OF
[002] [002] The present application claims priority under 35 USC & 119 (e) for US Provisional Patent Application No. 62 / 729,185, entitled POWERED STAPLING DEVICE THAT IS CAPABLE OF ADJUSTING FORCE, ADVANCEMENT SPEED, AND OVERALL STROKE OF CUTTING MEMBER OF THE DEVICE BASED ON SENSED PA-RAMETER OF FIRING OR CLAMPING, filed on 10 September 2018, the description of which is incorporated herein by way of reference, in its entirety.
[003] [003] The present application claims priority under 35 USC $ 119 (e) for US Provisional Patent Application No. 62 / 659,900, entitled SMART ACTIVATION OF AN ENERGY DEVICE BY ANOTHER DEVI-CE, 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, whose description of each of which is incorporated here for reference, in its entirety.
[004] [004] The present application claims priority under 35 U.S.C.8 119 (e) for US Provisional Patent Application No. 62 / 692,747, instituted
[005] [005] This application also claims priority under 35 US $ 119 (e) of US Provisional Patent Application 62 / 650,898 filed March 30, 2018, entitled CAPACITIVE COU- PLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS, from US Provisional Patent Application Serial No. 62 / 650,887, entitled SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES, filed on March 30, 2018, US Provisional Patent Application Serial No. 62 / 650,882, entitled SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM, filed on March 30, 2018, and US Provisional Patent Application Serial No. 62 / 650,877, entitled SURGICAL SMOKE EVACUATION SENSING AND CONTROLS, filed on March 30, 2018, whose description of which is incorporated herein as title reference, in its entirety.
[006] [006] This application also claims priority under 35 US $ 119 (e) of US Provisional Patent Application serial number 62/640 417, entitled TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR, filed on March 8, 2018 , and US Provisional Patent Application Serial No. 62/640 415, entitled ESTIMATING STATE OF ULTRASONIC END EF- FECTOR AND CONTROL SYSTEM THEREFOR, filed on March 8, 2018, the respective description of which is incorporated herein by reference, in its entirety.
[007] [007] The present application also claims priority under 35 USC $ 119 (e) of US Provisional Patent Application serial number 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, of the Patent Application Provisional
[008] [008] The present description refers to several surgical systems. Surgical procedures are typically performed in theaters or surgical operating rooms in a health care facility, such as a hospital. A sterile field is typically created around the patient. The sterile field may include members of the brushing team, who are properly dressed, and all furniture and accessories in the area. Various surgical devices and systems are used to perform a surgical procedure. SUMMARY OF THE INVENTION
[009] [009] In one aspect, the present description features a surgical stapling instrument that includes an anvil configured to hold a tissue; a circular stapling head assembly comprising a first row of staples and a second row of staples; a first clamp driver configured to drive the first row of clamps; a second clamp driver configured to drive the second row of clamps, wherein the first and second clamp actuators are operable independently; a motor coupled to the anvil, the motor being configured to move the anvil between a first position and a second position; and a control circuit coupled to the motor, the control circuit configured to: adjust a stroke length for the first and second clamp actuators in a first length; detect a malformed clamp the first time
[0010] [0010] In another aspect, the present description presents a surgical stapling instrument that includes an anvil configured to hold a tissue; a circular stapling head assembly comprising a first row of staples and a second row of staples; a first clamp driver configured to drive the first row of clamps; a second clamp driver configured to drive the second row of clamps; a motor coupled to the anvil, the motor being configured to move the anvil between a first position and a second position; and a control circuit coupled to the motor, the control circuit configured to: adjust a clamp height of the first and second rows of clamps to a first height; detecting a malformed clamp in the first row of clamps; and defining a staple height for the second row of staples at a second height.
[0011] [0011] In yet another aspect, the present description presents a surgical stapling instrument that includes an anvil configured to hold a tissue; a circular stapling head assembly comprising a first row of staples and a second row of staples; a first staple driver configured to drive the first row of staples; a second clamp driver configured to drive the second row of clamps; a motor coupled to the anvil, the motor being configured to move the anvil between a first position and a second position; and a control circuit coupled to the motor, the control circuit configured to: define an anvil span of the first row of clamps in a first span; detecting a malformed clamp in the first row of clamps; and define an anvil span of the second row of staples in a second span. FIGURES
[0012] [0012] 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.
[0013] [0013] Figure 1 is a block diagram of an interactive surgical system implemented by computer, according to at least one aspect of the present description.
[0014] [0014] Figure 2 is a surgical system being used to perform a surgical procedure in an operating room, according to at least one aspect of the present description.
[0015] [0015] Figure 3 is a central surgical device or "hub" paired with a visualization system, a robotic system, and an intelligent instrument, according to at least one aspect of the present description.
[0016] [0016] Figure 4 is a partial perspective view of a surgical hub enclosure, and of a generator module in combination received slidingly in a surgical hub enclosure, in accordance with at least one aspect of this description.
[0017] [0017] Figure 5 is a perspective view of a generator module in combination with bipolar, ultrasonic and monopolar contacts and a smoke evacuation component, in accordance with at least one aspect of the present description.
[0018] [0018] Figure 6 illustrates different power bus connectors for a plurality of side coupling ports of a side modular cabinet configured to receive a plurality of modules, in accordance with at least one aspect of the present description.
[0019] [0019] Figure 7 illustrates a vertical modular housing configured to receive a plurality of modules, in accordance with at least one aspect of the present description.
[0020] [0020] Figure 8 illustrates a surgical data network that comprises a modular communication hub configured to connect modular devices located in one or more operating rooms of a healthcare facility, or any environment in a healthcare facility. public specially equipped for surgical operations, to the cloud, in accordance with at least one aspect of this description.
[0021] [0021] Figure 9 illustrates an interactive surgical system implemented by computer, in accordance with at least one aspect of the present description.
[0022] [0022] Figure 10 illustrates a surgical hub that comprises a plurality of modules coupled to the modular control tower, according to at least one aspect of the present description.
[0023] [0023] Figure 11 illustrates an aspect of a universal serial bus (USB) network hub device, in accordance with at least one aspect of the present description.
[0024] [0024] Figure 12 is a block diagram of a cloud computing system that comprises a plurality of intelligent surgical instruments coupled to central surgical controllers that can connect to the cloud component of the cloud computing system, according to with at least one aspect of the present description.
[0025] [0025] Figure 13 is a functional module architecture of a cloud computing system, according to at least one aspect of the present description.
[0026] [0026] Figure 14 illustrates a diagram of a surgical system with situational recognition, according to at least one aspect of the present description.
[0027] [0027] Figure 15 is a timeline that represents the situational recognition of a central surgical controller, according to at least one aspect of the present description.
[0028] [0028] Figure 16 illustrates a logical diagram of a control system for an instrument or surgical tool, according to at least one aspect of the present description.
[0029] [0029] Figure 17 illustrates a control circuit configured to control aspects of the instrument or surgical tool, according to at least one aspect of the present description.
[0030] [0030] Figure 18 illustrates a combinational logic circuit configured to control aspects of the instrument or surgical tool, according to at least one aspect of the present description.
[0031] [0031] Figure 19 illustrates a sequential logic circuit configured to control aspects of the instrument or surgical tool, according to at least one aspect of the present description.
[0032] [0032] Figure 20 illustrates an instrument or surgical tool that comprises a plurality of motors that can be activated to perform various functions, according to at least one aspect of the present description.
[0033] [0033] Figure 21 is a schematic diagram of a surgical instrument configured to operate a surgical tool described therein, in accordance with at least one aspect of the present description.
[0034] [0034] Figure 22 illustrates a block diagram of a surgical instrument configured to control various functions, in accordance with at least one aspect of the present description.
[0035] [0035] Figure 23 is a schematic diagram of a surgical instrument configured to control various functions, according to at least one aspect of the present description.
[0036] [0036] Figure 24 represents a perspective view of an instrument
[0037] [0037] Figure 25 represents an exploded view of the handle and drive shaft assemblies of the instrument of Figure 24, according to at least one aspect of the present description.
[0038] [0038] Figure 26 represents a cross-sectional view of the handle assembly of the instrument of Figure 24, according to at least one aspect of the present description.
[0039] [0039] Figure 27 represents an enlarged partial cross-sectional view of the motor and battery assemblies in Figure 24, according to at least one aspect of the present description.
[0040] [0040] Figure 28A represents a side elevation view of an operational mode selection set of the instrument of Figure 24, with a first gear disengaged from a second gear, in accordance with at least one aspect of the present description. .
[0041] [0041] Figure 28B represents a side elevation view of the operating mode selection set of Figure 28A, with the first gear engaged with the second gear, according to at least one aspect of the present description.
[0042] [0042] Figure 29A represents an enlarged longitudinal cross-sectional view of a stapling head assembly of the instrument of Figure 24 showing an anvil in an open position, in accordance with at least one aspect of the present description.
[0043] [0043] Figure 29B represents an enlarged longitudinal section view of the stapling head assembly of Figure 29A showing the anvil in a closed position, according to at least one aspect of the present description.
[0044] [0044] Figure 29C represents an enlarged longitudinal cross-sectional view of the stapling head assembly of the
[0045] [0045] Figure 30 represents an enlarged partial cross-sectional view of a clamp formed against the anvil, in accordance with at least one aspect of the present description.
[0046] [0046] Figure 31 is a partial sectional view of a motorized circular stapling device comprising a circular stapling head assembly and an anvil, in accordance with at least one aspect of the present description.
[0047] [0047] Figure 32 is a partial top view of the circular stapling head assembly shown in Figure 31 showing a first row of staples (internal staples) and a second row of staples (external staples), according to ão least one aspect of the present description.
[0048] [0048] Figure 33 is a graph of the stroke of the clamp actuators when the actual stroke of the first clamp actuator is less than the upper limit of the stroke length, according to at least one aspect of the present description.
[0049] [0049] Figure 34 is a graph of the stroke of the staple actuators when the actual stroke of the first staple actuator is equal to the upper limit of the stroke length, according to at least one aspect of the present description.
[0050] [0050] Figure 35 is a diagram that illustrates the limit of the length of the course and the algorithm adjustments based on the clamp formation, according to at least one aspect of the present description.
[0051] [0051] Figure 36 is a graphical representation of the viable staple firing range, as indicated by the usable staple height windows, based on the fabric span, closure force (FTC) or stabilization of tissue deformation detected by the device or combinations thereof, in accordance with at least one aspect of the present description.
[0052] [0052] Figure 37 is a logic flow diagram of a process representing a control program or a logical configuration to adjust the course of the outer row of staple heights based on the force, span of fabric, or deformation of fabric during firing of the first row of staples, in accordance with at least one aspect of the present description.
[0053] [0053] Figure 38 illustrates a perspective view of an anvil clip forming pocket of Figure 31 including an electrically conductive circuit element, in accordance with at least one aspect of the present description.
[0054] [0054] Figure 39 illustrates a perspective view of the clamp-forming pocket of Figure 38 after the electrically conductive circuit element has been cut by a clamp leg during proper formation of the clamp leg, according to at least one aspect of the present description.
[0055] [0055] Figure 40A illustrates a cross-sectional view of two adjacent staple forming pockets in a row of staple forming anvil pockets of Figure 39, in accordance with at least one aspect of the present description.
[0056] [0056] Figure 40B illustrates a cross-sectional view of the clamp-forming pockets of Figure 40A being engaged with a properly formed clamp that includes two clamp legs that cut the electrically conductive circuit elements of the clamp-forming pockets, accordingly with at least one aspect of the present description.
[0057] [0057] Figure 40C illustrates a cross-sectional view of the clamp-forming pockets of Figure 40A being engaged with an incorrectly formed clamp that includes clamp legs that have stopped cutting or lost the electrically conductive circuit elements of the forming pockets clamps, according to at least one aspect of the present description.
[0058] [0058] Figure 41 illustrates a partial cross-sectional view of an anvil being pressed against the staples of a staple cartridge, in accordance with at least one aspect of the present description.
[0059] [0059] Figure 42 is a circuit diagram, according to at least one aspect of the present description. DESCRIPTION
[0060] [0060] The applicant of the present application holds the following US patent applications, filed on November 6, 2018, with the description of each incorporated herein by reference, in its entirety:
[0061] [0061] 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;
[0062] [0062] and US Patent Application No. 16 / 182,230, entitled SURGICAL SYSTEM FOR PRESENTING INFORMATION INTERPRETED FROM EXTERNAL DATA;
[0063] [0063] and US Patent Application No. 16 / 182,233, entitled MODIFI- CATION OF SURGICAL SYSTEMS CONTROL PROGRAMS BASED ON MACHINE LEARNING;
[0064] [0064] and US Patent Application No. 16 / 182,239, entitled ADJUSTMENT OF DEVICE CONTROL PROGRAMS BASED ON STRATIFIED ED CONTEXTUAL DATA IN ADDITION TO THE DATA;
[0065] [0065] and US Patent Application No. 16 / 182,243, entitled SURGI-CAL HUB AND MODULAR DEVICE RESPONSE ADJUSTMENT BA- SED ON SITUATIONAL AWARENESS;
[0066] [0066] and US Patent Application No. 16 / 182,248, entitled DETEC- TION AND ESCALATION OF SECURITY RESPONSES OF SURGI-CAL INSTRUMENTS TO INCREASING SEVERITY THREATS;
[0067] [0067] and US Patent Application No. 16 / 182,251, entitled INTERACTIVE SURGICAL SYSTEM;
[0068] [0068] and US Patent Application No. 16 / 182,260, entitled AUTOMATED DATA SCALING, ALIGNMENT, AND ORGANIZING BASED ON PREDEFINED PARAMETERS WITHIN SURGICAL NETWORKS;
[0069] [0069] 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;
[0070] [0070] and US Patent Application No. 16 / 182,249, entitled POWE-RED SURGICAL TOOL WITH PREDEFINED ADJUSTABLE CONTRROL ALGORITHM FOR CONTROLLING END EFFECTOR PARA-METER;
[0071] [0071] and US Patent Application No. 16 / 182,246, entitled ADJUSTMENTS BASED ON AIRBORNE PARTICLE PROPERTIES;
[0072] [0072] and US Patent Application No. 16 / 182,256, entitled ADJUSTMENT OF A SURGICAL DEVICE FUNCTION BASED ON SITUATI-ONAL AWARENESS;
[0073] [0073] and US Patent Application No. 16 / 182,242, entitled REAL-TIME ANALYSIS OF COMPREHENSIVE COST OF ALL INSTRU- MENTATION USED IN SURGERY UTILIZING DATA FLUIDITY TO TRACK INSTRUMENTS THROUGH STOCKING AND IN-HOUSE PROCESSES;
[0074] [0074] and US Patent Application No. 16 / 182,255, entitled USAGE AND TECHNIQUE ANALYSIS OF SURGEON / STAFF PERFOR- MANCE AGAINST A BASELINE TO OPTIMIZE DEVICE UTILIZATI- ON AND PERFORMANCE FOR BOTH CURRENT AND FUTURE PROCEDURES;
[0075] [0075] 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;
[0076] [0076] and US Patent Application No. 16 / 182,278, entitled COMMUNICATION OF DATA WHERE A SURGICAL NETWORK IS USING CONTEXT OF THE DATA AND REQUIREMENTS OF A RE-CEIVING SYSTEM / USER TO INFLUENCE INCLUSION OR LINKAGE OF DATA AND METADATA TO ESTABLISH CONTINUITY;
[0077] [0077] and US Patent Application No. 16 / 182,290, entitled SURGICAL NETWORK RECOMMENDATIONS FROM REAL TIME ANALYSIS OF PROCEDURE VARIABLES AGAINST A BASELINE HIGHLIGHTING DIFFERENCES FROM THE OPTIMAL SOLUTION;
[0078] [0078] and US Patent Application No. 16 / 182,232, entitled CONTROL OF A SURGICAL SYSTEM THROUGH A SURGICAL BARRIER;
[0079] [0079] and US Patent Application No. 16 / 182,227, entitled SURGICAL NETWORK DETERMINATION OF PRIORITIZATION OF COMMUNICATION, INTERACTION, OR PROCESSING BASED ON SYSTEM OR DEVICE NEEDS;
[0080] [0080] and US Patent Application No. 16 / 182,231, entitled WIRE- LESS PAIRING OF A SURGICAL DEVICE WITH ANOTHER DEVICE WITHIN A STERILE SURGICAL FIELD BASED ON THE USAGE AND SITUATIONAL AWARENESS OF DEVICES;
[0081] [0081] and US Patent Application No. 16 / 182,234, entitled STA- PLING DEVICE WITH BOTH COMPULSORY AND DISCRETIONARY LOCKOUTS BASED ON SENSED PARAMETERS;
[0082] [0082] and US Patent Application No. 16 / 182,240, entitled POWE- RED STAPLING DEVICE CONFIGURED TO ADJUST FORCE, AD- VANCEMENT SPEED, AND OVERALL STROKE OF CUTTING MEMBER BER BASED ON SENSED PARAMETER OF FIRING OR CLAMPING;
[0083] [0083] and US Patent Application No. 16 / 182,235, entitled VARIATION OF RADIO FREQUENCY AND ULTRASONIC POWER LEVEL IN CO-
[0084] [0084] 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.
[0085] [0085] The applicant for the present application holds the following US patent applications filed on September 10, 2018, the description of which is incorporated herein by reference, in its entirety:
[0086] [0086] 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;
[0087] [0087] and US Provisional Patent Application No. 62 / 729,177, entitled AUTOMATED DATA SCALING, ALIGNMENT, AND ORGANIZING BA- SED ON PREDEFINED PARAMETERS WITHIN A SURGICAL NETWORK BEFORE TRANSMISSION;
[0088] [0088] 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;
[0089] [0089] and US Provisional Patent Application No. 62 / 729,185, entitled POWERED STAPLING DEVICE THAT IS CAPABLE OF ADJUSTING FORCE, ADVANCEMENT SPEED, AND OVERALL STROKE OF CUT- TING MEMBER OF THE DEVICE BASED ON SENSED PARAMETER OF FIRING OR CLAMPING;
[0090] [0090] 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;
[0091] [0091] 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 SITUATIONAL AWARENESS TO THE HUB;
[0092] [0092] 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;
[0093] [0093] and US Provisional Patent Application No. 62 / 729,195, entitled ULTRASONIC ENERGY DEVICE WHICH VARIES PRESSURE APPLIED BY CLAMP ARM TO PROVIDE THRESHOLD CONTROL PRESSU- RE AT A CUT PROGRESSION LOCATION; and
[0094] [0094] 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.
[0095] [0095] The applicant of the present application holds the following US patent applications, filed on August 28, 2018, the description of which is incorporated herein by reference in its entirety:
[0096] [0096] and US Patent Application No. 16 / 115,214, entitled ESTIMATE- TING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR;
[0097] [0097] and US Patent Application, No. 16 / 115,205, entitled TEMPE- RATURE CONTROL OF ULTRASONIC END EFFECTOR AND CONTRROL SYSTEM THEREFOR;
[0098] [0098] and US Patent Application No. 16 / 115,233, entitled RADIO FREQUENCY ENERGY DEVICE FOR DELIVERING COMBINED ELECTRICAL SIGNALS;
[0099] [0099] and US Patent Application No. 16 / 115,208, entitled CONTROL- LING AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO TISSUE LOCATION;
[00100] [00100] and US Patent Application No. 16 / 115,220, entitled CONTRACTING ACTIVATION OF AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO THE PRESENCE OF TISSUE;
[00101] [00101] and US Patent Application No. 16 / 115,232, entitled DETERMINING TISSUE COMPOSITION VIA AN ULTRASONIC SYSTEM;
[00102] [00102] and US Patent Application No. 16 / 115,239, entitled DETER- MINING THE STATE OF AN ULTRASONIC ELECTROMECHANICAL SYSTEM ACCORDING TO FREQUENCY SHIFT;
[00103] [00103] and US Patent Application No. 16 / 115,247, entitled DETERMINING THE STATE OF AN ULTRASONIC END EFFECTOR;
[00104] [00104] and US Patent Application No. 16 / 115,211, entitled SITUATIO-NAL AWARENESS OF ELECTROSURGICAL SYSTEMS;
[00105] [00105] and US Patent Application No. 16 / 115,226, entitled MECHA- NISMS FOR CONTROLLING DIFFERENT ELECTROMECHANICAL SYSTEMS OF AN ELECTROSURGICAL INSTRUMENT;
[00106] [00106] and US Patent Application No. 16 / 115,240, entitled DETECTION OF END EFFECTOR IMMERSION IN LIQUID;
[00107] [00107] and US Patent Application No. 16 / 115,249, entitled INTER- RUPTION OF ENERGY DUE TO INADVERTENT CAPACITIVE COUPLING;
[00108] [00108] and US Patent Application No. 16 / 115,256, entitled INCREA- SING RADIO FREQUENCY TO CREATE PAD-LESS MONOPOLAR LOOP;
[00109] [00109] and US Patent Application No. 16 / 115,223, entitled BIPO-
[00110] [00110] and US Patent Application No. 16 / 115,238, entitled ACTIVATION OF ENERGY DEVICES.
[00111] [00111] The applicant for the present application holds the following US patent applications, filed on August 23, 2018, the description of which is incorporated herein by reference in its entirety:
[00112] [00112] and US Provisional Patent Application No. 62 / 721,995, entitled CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO TISSUE LOCATION;
[00113] [00113] and US Provisional Patent Application No. 62 / 721,998, entitled SITUATIONAL AWARENESS OF ELECTROSURGICAL SYSTEMS;
[00114] [00114] and US Provisional Patent Application No. 62 / 721,999, entitled INTERRUPTION OF ENERGY DUE TO INADVERTENT CAPACITIVE COUPLING;
[00115] [00115] and US Provisional Patent Application No. 62 / 721,994, entitled BIPOLAR COMBINATION DEVICE THAT AUTOMATICALLY AD- JUSTS PRESSURE BASED ON ENERGY MODALITY; and
[00116] [00116] and US Provisional Patent Application No. 62 / 721,996, entitled RADIO FREQUENCY ENERGY DEVICE FOR DELIVERING COMBINED ELECTRICAL SIGNALS.
[00117] [00117] The applicant of the present application holds the following US patent applications, filed on June 30, 2018, the description of each of which is incorporated herein by way of reference in its entirety:
[00118] [00118] and US Provisional Patent Application No. 62 / 692,747, entitled SMART ACTIVATION OF AN ENERGY DEVICE BY ANOTHER DEVI- CE;
[00119] [00119] and US Provisional Patent Application No. 62 / 692,748, entitled SMART ENERGY ARCHITECTURE; and
[00120] [00120] and US Provisional Patent Application No. 62 / 692,768, entitled SMART ENERGY DEVICES.
[00121] [00121] The applicant of the present application holds the following US patent applications, filed on June 29, 2018, the description of which is incorporated herein by reference in its entirety:
[00122] [00122] and US Patent Application Serial No. 16 / 024,090, entitled CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS;
[00123] [00123] and US Patent Application Serial No. 16 / 024,057, entitled CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSED CLOSURE PARAMETERS;
[00124] [00124] and US Patent Application Serial No. 16 / 024,067, entitled SYSTEMS FOR ADJUSTING END EFFECTOR PARAMETERS BASED ON PERIOPERATIVE INFORMATION;
[00125] [00125] and US Patent Application Serial No. 16 / 024,075, entitled SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING;
[00126] [00126] and US Patent Application Serial No. 16 / 024,083, entitled SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING;
[00127] [00127] and US Patent Application Serial No. 16 / 024,094, entitled SURGICAL SYSTEMS FOR DETECTING END EFFECTOR TISSUE DISTRIBUTION IRREGULARITIES;
[00128] [00128] and US Patent Application Serial No. 16 / 024,138, entitled SYSTEMS FOR DETECTING PROXIMITY OF SURGICAL END EF- FECTOR TO CANCEROUS TISSUE;
[00129] [00129] and US Patent Application Serial No. 16 / 024,150, entitled SURGICAL INSTRUMENT CARTRIDGE SENSOR ASSEMBLIES;
[00130] [00130] and US Patent Application Serial No. 16 / 024,160, entitled VARIABLE OUTPUT CARTRIDGE SENSOR ASSEMBLY;
[00131] [00131] and US Patent Application Serial No. 16 / 024.124, entitled SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE;
[00132] [00132] and US Patent Application Serial No. 16 / 024,132, entitled SURGICAL INSTRUMENT HAVING A FLEXIBLE CIRCUIT;
[00133] [00133] and US Patent Application Serial No. 16 / 024,141, entitled SURGICAL INSTRUMENT WITH A TISSUE MARKING ASSEMBLY;
[00134] [00134] and US Patent Application Serial No. 16 / 024,162, entitled SURGICAL SYSTEMS WITH PRIORITIZED DATA TRANSMISSION CAPABILITIES;
[00135] [00135] and US Patent Application Serial No. 16 / 024,066, entitled SURGICAL EVACUATION SENSING AND MOTOR CONTROL;
[00136] [00136] and US Patent Application Serial No. 16 / 024,096, entitled SURGICAL EVACUATION SENSOR ARRANGEMENTS;
[00137] [00137] and US Patent Application Serial No. 16 / 024,116, entitled SURGICAL EVACUATION FLOW PATHS;
[00138] [00138] and US Patent Application Serial No. 16 / 024,149, entitled SURGICAL EVACUATION SENSING AND GENERATOR CONTROL;
[00139] [00139] and US Patent Application Serial No. 16 / 024,180, entitled SURGICAL EVACUATION SENSING AND DISPLAY;
[00140] [00140] and US Patent Application Serial No. 16 / 024,245, entitled COMMUNICATION OF SMOKE EVACUATION SYSTEM PARAME- TERS TO HUB OR CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM;
[00141] [00141] and US Patent Application Serial No. 16 / 024,258, entitled SMOKE EVACUATION SYSTEM INCLUDING A SEGMENTED CONTRROL CIRCUIT FOR INTERACTIVE SURGICAL PLATFORM;
[00142] [00142] and US Patent Application Serial No. 16 / 024,265, entitled SURGICAL EVACUATION SYSTEM WITH A COMMUNICATION
[00143] [00143] and US Patent Application Serial No. 16 / 024,273, entitled DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS.
[00144] [00144] The applicant for this application holds the following provisional US patent applications, filed on June 28, 2018, with the description of each of which is incorporated herein by reference in its entirety:
[00145] [00145] and US Provisional Patent Application serial number 62 / 691,228, entitled A METHOD OF USING REINFORCED FLEX CIRCUITS WITH MULTIPLE SENSORS WITH ELECTROSURGICAL DEVICES;
[00146] [00146] and Provisional US Patent Application Serial No. 62 / 691,227, entitled CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSED CLOSURE PARAMETERS;
[00147] [00147] and US Provisional Patent Application serial number 62 / 691,230, entitled SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRO- DE;
[00148] [00148] and US Provisional Patent Application serial number 62 / 691,219, entitled SURGICAL EVACUATION SENSING AND MOTOR CONTRROL;
[00149] [00149] and US Provisional Patent Application serial number 62 / 691,257, entitled COMMUNICATION OF SMOKE EVACUATION SYSTEM PARAMETERS TO HUB OR CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM;
[00150] [00150] and US Provisional Patent Application serial number 62 / 691,262, entitled SURGICAL EVACUATION SYSTEM WITH A COMMUNI-
[00151] [00151] and US Provisional Patent Application serial number 62 / 691,251, entitled DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS.
[00152] [00152] The applicant for the present application holds the following provisional US patent applications, filed on April 19, 2018, the description of each of which is incorporated herein by reference, in its entirety:
[00153] [00153] and US Provisional Patent Application serial number 62 / 659,900, entitled METHOD OF HUB COMMUNICATION.
[00154] [00154] The applicant for this application holds the following provisional US patent applications, filed on March 30, 2018, the description of each of which is incorporated herein by reference in its entirety:
[00155] [00155] 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;
[00156] [00156] and US Provisional Patent Application serial number 62 / 650,887, entitled SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES;
[00157] [00157] and US Provisional Patent Application serial number 62 / 650,882, entitled SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM; and
[00158] [00158] and US Provisional Patent Application serial number 62 / 650,877, entitled SURGICAL SMOKE EVACUATION SENSING AND CONTRROLS.
[00159] [00159] The applicant of the present application holds the following US patent applications, filed on March 29, 2018, the description of each of which is incorporated herein by reference in its entirety:
[00160] [00160] and US Patent Application Serial No. 15 / 940,641, entitled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES;
[00161] [00161] and US Patent Application Serial No. 15 / 940,648, entitled IN- TERACTIVE SURGICAL SYSTEMS WITH CONDITION HANDLING OF DEVICES AND DATA CAPABILITIES;
[00162] [00162] and US Patent Application Serial No. 15 / 940,656, entitled SURGICAL HUB COORDINATION OF CONTROL AND COMMUNICATION OF OPERATING ROOM DEVICES;
[00163] [00163] and US Patent Application Serial No. 15 / 940,666, entitled SPATIAL AWARENESS OF SURGICAL HUBS IN OPERATING RO-WHO;
[00164] [00164] and US Patent Application Serial No. 15 / 940,670, entitled COOPERATIVE UTILIZATION OF DATA DERIVED FROM SECON- DARY SOURCES BY INTELLIGENT SURGICAL HUBS;
[00165] [00165] and US Patent Application Serial No. 15 / 940,677, entitled SURGICAL HUB CONTROL ARRANGEMENTS;
[00166] [00166] and US Patent Application Serial No. 15 / 940,632, entitled DATA STRIPPING METHOD TO INTERROGATE PATIENT RE-CORDS AND CREATE ANONYMIZED RECORD;
[00167] [00167] and US Patent Application Serial No. 15 / 940,640, entitled COMMUNICATION HUB AND STORAGE DEVICE FOR STORING PARAMETERS AND STATUS OF A SURGICAL DEVICE TO BE SHARED WITH CLOUD BASED ANALYTICS SYSTEMS;
[00168] [00168] and US Patent Application Serial No. 15 / 940,645, entitled SELF DESCRIBING DATA PACKETS GENERATED AT AN ISSUING INSTRUMENT;
[00169] [00169] and US Patent Application Serial No. 15 / 940,649, entitled DATA PAIRING TO INTERCONNECT A DEVICE MEASURED PA-RAMETER WITH AN OUTCOME;
[00170] [00170] and US Patent Application Serial No. 15 / 940,654, entitled SURGICAL HUB SITUATIONAL AWARENESS;
[00171] [00171] and US Patent Application Serial No. 15 / 940,663, entitled SURGICAL SYSTEM DISTRIBUTED PROCESSING;
[00172] [00172] and US Patent Application Serial No. 15 / 940,668, entitled AGGREGATION AND REPORTING OF SURGICAL HUB DATA;
[00173] [00173] and US Patent Application Serial No. 15 / 940,671, entitled SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER;
[00174] [00174] and US Patent Application Serial No. 15 / 940,686, entitled DISPLAY OF ALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LI-NEAR STAPLE LINE;
[00175] [00175] and US Patent Application Serial No. 15 / 940,700, entitled STERILE FIELD INTERACTIVE CONTROL DISPLAYS;
[00176] [00176] and US Patent Application Serial No. 15 / 940,629, entitled COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS;
[00177] [00177] 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;
[00178] [00178] and US Patent Application Serial No. 15 / 940,722, entitled CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OF MONO-CHROMATIC LIGHT REFRACTIVITY;
[00179] [00179] and US Patent Application Serial No. 15 / 940,742, entitled DUAL CMOS ARRAY IMAGING;
[00180] [00180] and US Patent Application Serial No. 15 / 940,636, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES;
[00181] [00181] and US Patent Application Serial No. 15 / 940,653, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL HUBS;
[00182] [00182] and US Patent Application Serial No. 15 / 940,660, entitled CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER;
[00183] [00183] and US Patent Application Serial No. 15 / 940,679, entitled CLOUD-BASED MEDICAL ANALYTICS FOR LINKING OF LOCAL USAGE TRENDS WITH THE RESOURCE ACQUISITION BEHA- VIORS OF LARGER DATA SET;
[00184] [00184] and US Patent Application Serial No. 15 / 940,694, entitled CLOUD-BASED MEDICAL ANALYTICS FOR MEDICAL FACILITY SEGMENTED INDIVIDUALIZATION OF INSTRUMENT FUNCTION;
[00185] [00185] and US Patent Application Serial No. 15 / 940,634, entitled CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AU-THENTICATION TRENDS AND REACTIVE MEASURES;
[00186] [00186] and US Patent Application Serial No. 15 / 940,706, entitled DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK;
[00187] [00187] and US Patent Application Serial No. 15 / 940,675, entitled CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES;
[00188] [00188] and US Patent Application Serial No. 15 / 940,627, entitled DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLAT-FORMS;
[00189] [00189] and US Patent Application Serial No. 15 / 940,637, entitled COMMUNICATION ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;
[00190] [00190] and US Patent Application Serial No. 15 / 940,642, entitled CONTROLS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;
[00191] [00191] and US Patent Application Serial No. 15 / 940,676, entitled AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGI-CAL PLATFORMS;
[00192] [00192] and US Patent Application Serial No. 15 / 940,680, entitled CONTROLLERS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;
[00193] [00193] and US Patent Application Serial No. 15 / 940,683, entitled COOPERATIVE SURGICAL ACTIONS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;
[00194] [00194] and US Patent Application Serial No. 15 / 940,690, entitled DISPLAY. ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; and
[00195] [00195] and US Patent Application Serial No. 15 / 940,711, entitled SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS.
[00196] [00196] The applicant for the present application holds the following provisional US patent applications, filed on March 28, 2018, the description of each of which is incorporated herein by reference in its entirety:
[00197] [00197] and US Provisional Patent Application serial number 62 / 649,302, entitled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES;
[00198] [00198] and US Provisional Patent Application serial number 62 / 649,294, entitled DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD;
[00199] [00199] and US Provisional Patent Application serial number 62 / 649,300, entitled SURGICAL HUB SITUATIONAL AWARENESS;
[00200] [00200] and US Provisional Patent Application serial number 62 / 649,309, entitled SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER;
[00201] [00201] and US Provisional Patent Application serial number 62 / 649,310, entitled COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS;
[00202] [00202] and US Provisional Patent Application serial number 62 / 649,291, titled USE OF LASER LIGHT AND RED-GREEN-BLUE COLO- RATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT;
[00203] [00203] and US Provisional Patent Application serial number 62 / 649,296, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGI- LIM DEVICES;
[00204] [00204] and US Provisional Patent Application serial number 62 / 649,333, entitled CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATI- ON AND RECOMMENDATIONS TO A USER;
[00205] [00205] and US Provisional Patent Application serial number 62 / 649,327, entitled CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES;
[00206] [00206] and US Provisional Patent Application serial number 62 / 649,315, entitled DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK;
[00207] [00207] and US Provisional Patent Application serial number 62 / 649,313, entitled CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES;
[00208] [00208] and US Provisional Patent Application serial number 62 / 649,320, entitled DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGI-CAL PLATFORMS;
[00209] [00209] and US Provisional Patent Application serial number 62 / 649,307, entitled AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; and
[00210] [00210] and US Provisional Patent Application serial number 62 / 649,323, entitled SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS.
[00211] [00211] The applicant of the present application holds the following provisional US patent applications, filed on March 8, 2018, the description of which is incorporated herein by reference in its entirety:
[00212] [00212] and US Provisional Patent Application serial number 62 / 640,417, entitled TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR; and
[00213] [00213] and US Provisional Patent Application serial number 62 / 640,415, entitled ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR.
[00214] [00214] The applicant for the present application holds the following provisional US patent applications, filed on December 28, 2017, with the description of each of which is incorporated herein by reference in its entirety:
[00215] [00215] and US Provisional Patent Application serial number 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM;
[00216] [00216] and US Provisional Patent Application serial number 62 / 611,340, entitled CLOUD-BASED MEDICAL ANALYTICS; and
[00217] [00217] and US Provisional Patent Application serial number 62 / 611,339, entitled ROBOT ASSISTED SURGICAL PLATFORM.
[00218] [00218] 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. The illustrative examples can be implemented or incorporated in other aspects, variations and modifications, and can be practiced or executed in several ways. Furthermore, except where otherwise indicated, the terms and expressions used in the present invention were chosen for the purpose of describing illustrative examples for the convenience of the reader and not for the purpose of limiting it. In addition, it should be understood that one or more of the aspects, expressions of aspects, and / or examples described below can be combined with any one or more of the other aspects, expressions of aspects and / or examples described below. Central surgical controllers
[00219] [00219] With reference to Figure 1, an interactive surgical system implemented by computer 100 includes one or more surgical systems 102 and a cloud-based system (for example, cloud 104 which may include a remote server 113 coupled to a device storage 105). Each surgical system 102 includes at least one surgical hub 106 in communication with the cloud 104 which can include a remote server 113. In one example, as illustrated in Figure 1, surgical system 102 includes a visualization system 108, a robotic system 110 , a handheld and intelligent surgical instrument 112, which are configured to communicate with each other and / or hub 106. In some respects, a surgical system 102 may include a number of M 106 hubs, an N number of visualization 108, an O number of robotic systems 110, and a P number of smart, hand-held surgical instruments 112, where M, N, O, and P are whole numbers greater than or equal to one.
[00220] [00220] In several respects, the smart instruments 112 as described in the present invention with reference to Figures 1 to 7 can be implemented as a circular stapling device equipped with motor 201800 (Figures 24 to 30) and 201000 (Figures 31 to 32). Intelligent instruments 112 (for example, devices 1a-1n), such as the circular stapling device equipped with motor 201800 (Figures 24 to 30) and 201000 (Figures 31 to 32) are configured to operate on a network of surgical data 201, as described with reference to Figure 8.
[00221] [00221] 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 procedure 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 surgical robotic hub 122. The patient car 120 can handle at least one removably attached surgical tool 117 through a minimally invasive incision in the patient's body while the surgeon views the surgical site through the surgeon's console 118. An image of the surgical site can be obtained by a medical imaging device 124, which can be manipulated by patient car 120 to guide imaging device 124. Robotic hub 122 can be used to process images of the surgical site for subs display equent for the surgeon through the surgeon's console 118.
[00222] [00222] 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 description are described in provisional patent application no. 62 / 611,339, entitled ROBOT ASSISTED SURGICAL PLATFORM, filed on December 28, 2017, the description of which is hereby incorporated by reference in its entirety for reference.
[00223] [00223] Several examples of cloud-based analysis that are performed by cloud 104, and are suitable for use with the present description, are described in US Provisional Patent Application serial number 62 / 611.340, entitled CLOUD-BASED MEDICAL ANALYTICS, deposited on December 28, 2017, the description of which is incorporated herein by reference, in its entirety.
[00224] [00224] 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.
[00225] [00225] The optical components of the imaging device 124 may include one or more light sources and / or one or more lenses. One or more light sources can be targeted to illuminate portions of the surgical field. The one or more image sensors can receive reflected or refracted light from the surgical field, including reflected or refracted light from the tissue and / or surgical instruments.
[00226] [00226] 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.
[00227] [00227] 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), microwave, radio and electromagnetic radiation. Wavelengths shorter than about 380 nm are shorter than the ultraviolet spectrum, and they become invisible ultraviolet, x-ray, and gamma-ray electromagnetic radiation.
[00228] [00228] 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 description include, but are not limited to, an arthroscope, angioscope, bronchoscope, choledocoscope, colonoscope, cytoscope, duodenoscope, enteroscope, esophagus-duodenoscope (gastroscope), endoscope, laryngoscope, nasopharyngoscope neproscope, sigmoidoscope, thoracoscope, and ureteroscope.
[00229] [00229] 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 No. 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, whose The description 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.
[00230] [00230] It is axiomatic that strict sterilization of the operating room and surgical equipment is necessary during any surgery. The strict hygiene and sterilization conditions required in an "operating room", that is, an operating or treatment room, justify the highest possible sterilization of all medical devices and equipment. Part of this sterilization process is the need to sterilize anything that comes into contact with the patient or enters the sterile field, including imaging device 124 and its connectors and components. It will be understood that the sterile field can be considered a specified area, such as inside a tray or on a sterile towel, which is considered free of microorganisms, or the sterile field can be considered an area, immediately
[00231] [00231] In various aspects, the visualization system 108 includes one or more imaging sensors, one or more image processing units, one or more storage arrays and one or more screens that are strategically arranged 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 No. 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, the description of which is here incorporated as a reference in its entirety.
[00232] [00232] 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 viewing tower 111 includes a first non-sterile screen 107 and a second non-sterile screen 109, which are opposite each other. Visualization system 108, guided by hub 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, hub 106 can have the visualization system 108 display a snapshot of a surgical site, as recorded by an imaging device 124, on a non-sterile screen 107 or 109, while maintaining a live transmission from the site surgical on main screen 119. Snapshot on non-sterile screen 107 or 109 may allow a non-sterile operator to perform a diagnostic step relevant to the surgical procedure, for example.
[00233] [00233] In one aspect, hub 106 is also configured to route an entry or diagnostic feedback by a non-sterile operator in the viewing tower 111 to the primary screen 119 within the sterile field, where it can be seen by an operator sterile on the operating table. In one example, the entry may be in the form of a modification of the snapshot displayed on the non-sterile screen 107 or 109, which can be routed to the main screen 119 by the hub ("central device") 106.
[00234] [00234] With reference to Figure 2, a surgical instrument 112 is being used in the surgical procedure as part of the surgical system 102. Hub 106 is also configured to coordinate the flow of information to a screen of the surgical instrument 112. For example, the flow of coordinated information is further described in US Provisional Patent Application Serial No. 62 / 611.341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, the content of which is incorporated herein by reference, in its entirety. An entry or diagnostic feedback inserted by a non-sterile operator in the viewing tower 111 can be routed through hub 106 to the screen of the surgical instrument 115 in the sterile field, where it can be seen by the operator of the surgical instrument 112. Exemplary surgical instruments that are suitable for use with surgical system 102 are described under the heading "Hardware of Surgical Instruments" in US Provisional Patent Application Serial No. 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, the description of which is here incorporated as a reference, in its entirety, for example.
[00235] [00235] Now with reference to Figure 3, a hub 106 is shown in communication with a visualization system 108, a robotic system 110 and a smart handheld surgical instrument 112. Hub 106 includes a screen from hub 135, a module from imaging 138, a generator module 140, a communication module 130, a processor module 132 and a storage matrix 134. In certain respects, as shown in Figure 3, hub 106 additionally includes a smoke evacuation module 126 and / or a suction / irrigation module 128.
[00236] [00236] During a surgical procedure, the application of energy to the tissue, for sealing and / or cutting, is generally associated with the evacuation of smoke, suction of excess fluid and / or irrigation of the tissue. Fluid, power, and / or data lines from different sources are often intertwined during the surgical procedure. Valuable time can be wasted in addressing this issue during a surgical procedure. To untangle the lines, it may be necessary to disconnect the lines from their respective modules, which may require a restart of the modules. The modular housing of hub 136 offers a unified environment for managing power, data and fluid lines, which reduces the frequency of entanglement between such lines.
[00237] [00237] The aspects of the present description present a surgical hub for use in a surgical procedure that involves the application of energy to the tissue in a surgical site. The surgical hub includes a hub housing and a combination generator module received slidably at a hub housing docking station. The docking station includes data and power contacts. The combined generator module includes two or more of an ultrasonic energy generating component, a bipolar RF energy generating component, and a monopolar RF energy generating component which are housed in a single unit. In one aspect, the combined generator module also includes a smoke evacuation component, at least one power application cable to connect the combined generator module to a surgical instrument, at least one smoke evacuation component configured to evacuate smoke. , fluid, and / or particulates generated by the application of therapeutic energy to the tissue, and a fluid line that extends from the remote surgical site to the smoke evacuation component.
[00238] [00238] In one aspect, the fluid line is a first fluid line and a second fluid line extends from the remote surgical site to a suction and irrigation module received slidingly into the hub housing. In one aspect, the hub housing comprises a fluid interface.
[00239] [00239] Certain surgical procedures may require the application of more than one type of energy to the tissue. One type of energy may be more beneficial for cutting the fabric, while another type of energy may be more beneficial for sealing the fabric. For example, a bipolar generator can be used to seal the tissue while an ultrasonic generator can be used to cut the sealed tissue. Aspects of the present description present a solution in which a modular housing of the central controller 136 is configured to accommodate different generators and facilitate interactive communication between them. One of the advantages of the central modular housing 136 is that it allows quick removal and / or replacement of several modules.
[00240] [00240] - Aspects of the present description present a modular surgical wrap for use in a surgical procedure that involves applying energy to the tissue. The modular surgical housing includes a first energy generator module, configured to generate a first energy for application to the tissue, and a first docking station that comprises a first docking port that includes first data and energy contacts, being that the first power generator module is slidingly movable in an electrical coupling with the power and data contacts and the first power generator module is slidingly movable out of the electric coupling with the first power contacts - frequency and data.
[00241] [00241] In addition to the above, the modular surgical enclosure also includes a second energy generator module configured to generate a second energy, different from the first energy, for application to the tissue, and a second docking station that it comprises a second coupling port that includes second data and power contacts, the second power generator module being slidably movable in an electrical coupling with the power and data contacts, and the second module The power generator is slidably movable out of the electrical coupling with the second power and data contacts.
[00242] [00242] - In addition, the modular surgical cabinet also includes a communication bus between the first coupling port and the second coupling port, configured to facilitate communication between the first power generator module and the second module power generator.
[00243] [00243] With reference to Figures 3 to 7, aspects of the present description are presented for a modular housing of hub 136 that allows the modular integration of a generator module 140, a smoke evacuation module 126, and a suction / irrigation module 128. The central modular housing 136 further facilitates interactive communication between modules 140, 126, 128. As shown in Figure 5, generator module 140 can be a generator module with integrated monopolar, bipolar and ultrasonic components, supported in a single cabinet unit 139 slidably insertable in the central modular housing 136. As shown in Figure 5, generator module 140 can be configured to connect to a monopolar device 146, a bipolar device 147 and a ultrasonic device
[00244] [00244] In one aspect, the central modular housing 136 comprises a modular power and a back communication board 149 with external and wireless communication heads to allow removable fixing of modules 140, 126, 128 and interactive communication between them.
[00245] [00245] In one aspect, the central modular enclosure 136 includes docking stations, or drawers, 151, here also called drawers, which are configured to slide modules 140, 126, 128 in a sliding manner. Figure 4 illustrates a partial perspective view of a central surgical controller housing 136, and a combined generator module 145 slidably received at a docking station 151 of the central surgical controller housing 136. A docking port 152 with power and counter data on a rear side of the combined generator module 145 is configured to engage a corresponding docking port 150 with the power and data contacts of a corresponding docking station 151 of the modular housing of hub 136 as per the combined generator module 145 is slid into position in the corresponding docking station 151 of the modular housing of hub 136. In one aspect, the combined generator module 145 includes a bipolar module, ultrasonic and monopolar and a smoke evacuation module integrated in a single compartment unit 139, as shown in Figure 5.
[00246] [00246] 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 across towards the smoke evacuation module 126 which is received in the hub housing
[00247] [00247] In various aspects, the suction / irrigation module 128 is coupled to a surgical tool comprising a fluid suction line and a fluid suction line. In one example, the suction and suction fluid lines are in the form of flexible tubes that extend from the surgical site towards the suction / irrigation module 128. One or more drive systems can be configured to cause irrigation and aspiration of fluids to and from the surgical site.
[00248] [00248] In one aspect, the surgical tool includes a drive shaft that has an end actuator at a distal end of the same and at least an energy treatment associated with the end actuator, a suction tube, and a 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.
[00249] [00249] 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 hub housing 136 separately from the suction module / irrigation 128. In such an example, a fluid interface can be configured to connect the suction / irrigation module 128 to the fluid source and / or the vacuum source.
[00250] [00250] In one aspect, modules 140, 126, 128 and / or their corresponding docking stations in the central modular housing 136 may include alignment features that are configured to align the docking ports of the modules in engagement with their counterparts in the docking stations of the central modular housing 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 156 of the corresponding docking station sliding 151 of the central modular enclosure 136. The brackets cooperate to guide the coupling port contacts of the combined generator module 145 in an electrical engagement with the contacts of the central modular enclosure 136 coupling port.
[00251] [00251] In some respects, the drawers 151 of the central modular housing 136 are the same, or substantially the same size, and the modules are adjusted in size to be received in the drawers
[00252] [00252] 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.
[00253] [00253] 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 central modular housing 136. The coupling ports 150 of the central modular housing 136 can, alternatively or additionally, facilitate interactive wireless communication between the modules housed in the central modular housing 136. Any suitable wireless communication can be used, such as, for example, Air Titan-Bluetooth.
[00254] [00254] Figure 6 illustrates individual power bus connectors for a plurality of side coupling ports of a side modular compartment 160 configured to receive a plurality of modules from a surgical hub 206. The side modular compartment 160 is configured to receive and later interconnect modules 161. Modules 161 are slidably inserted into docking stations 162 of side modular compartment 160, which includes a back plate for interconnecting modules 161. As shown in Figure 6, modules 161 they are arranged laterally in the side modular cabinet 160. Alternatively, modules 161 can be arranged vertically in a side modular cabinet.
[00255] [00255] Figure 7 illustrates a vertical modular cabinet 164 configured to receive a plurality of modules 165 from surgical hub 106. Modules 165 are slidably inserted into docking stations, or drawers, 167 of vertical modular cabinet 164, which includes a rear panel for interconnecting modules 165. Although the drawers 167 of the vertical modular cabinet 164 are arranged vertically, in certain cases, a vertical modular cabinet 164 may include drawers that are arranged laterally. In addition, modules 165 can interact with each other through the coupling ports of the vertical modular cabinet 164. In the example in Figure 7, a screen 177 is provided to show the data relevant to the operation of the modules
[00256] [00256] In several respects, the imaging module 138 comprises an integrated video processor and a modular light source and is adapted for use with various imaging devices. In one aspect, the imaging device is comprised of a modular compartment that can be mounted with a light source module and a camera module. The compartment can be a disposable compartment. In at least one example, the disposable compartment is removably coupled to a reusable controller, a light source module, and a camera module. The light source module and / or the camera module can be selected selectively depending on the type of surgical procedure. In one respect, the camera module comprises a CCD sensor. In another aspect, the camera module comprises a CMOS sensor. In another aspect, the camera module is configured for imaging the scanned beam. Similarly, the light source module can be configured to provide a white light or a different light, depending on the surgical procedure.
[00257] [00257] 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 description is configured to allow the replacement of a light source module or a "midstream" camera module during a surgical procedure, without the need to remove the imaging device from the surgical field.
[00258] [00258] In one aspect, the imaging device comprises a tubular compartment that includes a plurality of channels. A first channel is configured to receive the Camera module in a sliding way, which can be configured for a snap-fit fit (pressure fit) with the first channel. A second channel is configured to slide the camera module, which can be configured for a snap-fit fit (pressure fit) with the first channel. In another example, the camera module and / or the light source module can be rotated to an end position within their respective channels. A threaded coupling can be used instead of a pressure fitting.
[00259] [00259] 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, the imaging module 138 can be configured to integrate images from different imaging devices.
[00260] [00260] Various image processors and imaging devices suitable for use with the present description are described in US patent No. 7,995,045 entitled COMBINED SBI AND 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 several systems for removing air - image data movement tasks. Such systems can be integrated with imaging module 138. In addition, the publication of US Patent Application No. 2011/0306840, entitled CONTROLLABLE MAGNETIC SOURCE TO FIXTURE INTRACORPORE- AL APPARATUS, published on December 15, 2011, and the publication of US Patent Application No. 2014/0243597, entitled SYSTEM FOR PERFORMING A MINIMALLY INVASIVE SURGICAL PROCE- DURE, published on August 28, 2014, which are each incorporated herein by reference in its entirety.
[00261] [00261] Figure 8 illustrates a surgical data network 201 comprising a modular communication hub 203 configured to connect modular devices located in one or more operating rooms of a healthcare facility, or any environment in a healthcare facility. public 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 communication hub 203 comprises a network hub 207 and / or a network key 209 in communication with a network router. The modular communication hub 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.
[00262] [00262] Modular devices 1a to 1n located in the operating room can be coupled to the central controller of modular communication
[00263] [00263] It will be understood that the surgical data network 201 can be expanded by the interconnection of multiple network hubs 207 and / or multiple network keys 209 with multiple network routers 211. The central communication controller 203 may be contained in a modular control tower configured to receive multiple devices 1a to 1n / 2a to 2m. The local computer system 210 can also
[00264] [00264] In one aspect, the surgical data network 201 may comprise a combination of central network controller (s), network switches, and network routers that connect devices 1a to 1n / 2a 2m to the cloud. Any or all devices 1a to 1n / 2a to 2m coupled to the central network controller or network switch can collect data in real time and transfer the data to cloud computers for data processing and manipulation. It will be understood that cloud computing depends on sharing computing resources instead of having local servers or personal devices to handle software applications. The word "cloud" can be used as a metaphor for "the Internet", although the term is not limited as such. Consequently, the term "cloud computing" can be used here to refer to "a type of Internet-based computing", in which different services - such as servers, storage, and applications - are applied to the modular communication hub 203 and / or computer system 210 located in the operating room (for example, a fixed, mobile,
[00265] [00265] By applying cloud computer data processing techniques to the data collected by devices 1a to 1n / 2a to 2m, the surgical data network provides better surgical results, reduced costs, and better satisfaction by part of the patient. At least some of the devices 1a to 1n / 2a to 2m can be used to see tissue status to assess leaks or perfusion of sealed tissue after a tissue cutting and cutting procedure. At least some of the devices 1a to 1n / 2a to 2m can be used to identify pathology, such as disease effects, with the use of cloud-based computing to examine data including images of body tissue samples for diagnostic purposes . This includes confirmation of the location and margin of the tissue and phenotypes. At least some of the devices 1a to 1n / 2a to 2m can be used to identify anatomical structures of the body using a variety of sensors integrated with imaging devices and techniques such as the overlay of images captured by multiple imaging devices. Data collected by devices 1a to 1n / 2a to 2m, including image data, can be transferred to the cloud 204 or the local computer system 210 or both for data processing and manipulation including image processing and manipulation. The data can be analyzed to improve the results of the surgical procedure by determining whether additional treatment, such as application of endoscopic intervention, emerging technologies, targeted radiation, targeted intervention, precise robotics at specific tissue sites and conditions, can be followed. This data analysis can additionally use analytical processing of the results, and with the use of standardized approaches they can provide standardized feedback that is beneficial both to confirm surgical treatments and the surgeon's behavior or to suggest changes to surgical treatments and the surgeon's behavior.
[00266] [00266] In an implementation, the operating room devices 1a to 1n can be connected to the central modular communication controller 203 via a wired or wireless channel depending on the configuration of the devices 1a to 1n in a central controller of network. The network hub 207 can be implemented, in one aspect, as a local network transmission device that acts on the physical layer of the OSI model ("open system interconnection"). The central network controller provides connectivity to devices 1a to 1n located on the same network as the operating room. The central network controller 207 collects data in the form of packets and sends it to the router in "halfduplex" mode. The network hub 207 does not store any media access control / Internet protocol (MAC / IP) to transfer data from the device. Only one of the devices 1a to 1n at a time can send data through the central network controller 207. The network hub 207 has no routing tables or intelligence about where to send information and transmits all data on the network through each connection and the a remote server 213 (Figure 9) in the cloud 204. Network hub 207 can detect basic network errors, such as collisions, but having all (admit that) information transmitted to multiple input ports can be a security risk and cause strangulations.
[00267] [00267] In another implementation, operating room devices 2a to 2m can be connected to a network switch 209 through a wired or wireless channel. The network key 209 works in the data connection layer of the OSI model. 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.
[00268] [00268] Network hub 207 and / or network key 209 are coupled to network router 211 for connection to cloud 204. Network router 211 works on the network layer of the OSI model. Network router 211 creates a route to transmit data packets received from central network controller 207 and / or network key 211 to a computer with cloud resources for future processing and manipulation of data collected by any or all devices 1a to 1h / 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 of different facilities. health services. Network router 211 sends data in packet form to cloud 204 and works in full duplex mode.
[00269] [00269] In one example, the network hub 207 can be implemented as a USB hub, which allows multiple USB devices to be connected to a host computer. The USB hub can expand a single USB port on multiple levels so that more ports are available to connect the devices to the system's host computer. The 207 network hub can include wired or wireless capabilities to receive information about a wired channel or a wireless channel. In one aspect, a wireless wireless, broadband, short-range wireless USB communication protocol can be used for communication between devices 1a to 1n and devices 2a to 2m located in the operating room.
[00270] [00270] In other examples, operating room devices 1a to 1n / 2a to 2m can communicate with the modular central communication controller 203 via standard Bluetooth wireless technology for exchanging data over short distances ( using short-wavelength UHF radio waves in the 2.4 to 2.485 GHz ISM band from fixed and mobile devices and building personal area networks (PANs). In other respects, operating room devices 1a to 1n / 2a to 2m can communicate with the central modular communication controller 203 via a number of wireless and wired communication standards or protocols, including, 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 +, HSUPA +, EDGE , GSM, GPRS, CDMA, TDMA, DECT, and Ethernet derivatives thereof, as well as any other wireless and wired protocols that are designated as 3G, 4G, 5G, and beyond. The computing module can include a plurality of communication modules. For example, a first communication module can be dedicated to short-range wireless communications such as Wi-Fi and Bluetooth, and a second communication module can be dedicated to longer-range wireless communications such as GPS, EDGE, GPRS , CDMA, WiMAX, LTE, Ev-DO, and others.
[00271] [00271] 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 hub 203, it is amplified and transmitted to network router 211, which transfers data to cloud computing resources using a series of wireless communication standards or protocols or with wire, as described in the present invention.
[00272] [00272] The modular communication hub 203 can be used as a standalone device or be connected to compatible network hubs and network keys to form a larger network. The 203 modular central communication controller is, in general, easy to install, configure and maintain, making it a good option for the network of devices 1st to 1n / 2nd to 2m in the operating room.
[00273] [00273] Figure 9 illustrates an interactive surgical system, implemented by computer 200. The interactive surgical system implemented by computer 200 is similar in many respects to the interactive surgical system, implemented by computer 100. For example, the interactive surgical system, computer implemented 200 includes one or more surgical systems 202, which are similar in many respects to surgical systems 102. Each surgical system 202 includes at least one surgical hub 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 operating room devices, such as intelligent surgical instruments, robots and other computerized devices located in the operating room. . As shown in Figure 10, the modular control tower 236 comprises a modular communication hub 203 coupled to a computer system 210. As illustrated in the example in Figure 9, the modular control tower 236 is coupled to an imaging module 238 that is coupled to an endoscope 239, a generator module 240 that is coupled to a power device 241, a smoke evacuation module 226, a suction / irrigation module 228, a communication module 230, a communication module processor 232, a storage array 234, a smart device / instrument 235 optionally attached to a screen 237, and a non-contact sensor module 242. Operating room devices are coupled with cloud computing and storage resources data through the modular control tower
[00274] [00274] Figure 10 illustrates a surgical hub 206 comprising a plurality of modules coupled to the modular control tower
[00275] [00275] Surgical hub 206 employs a contactless sensor module 242 to measure the dimensions of the operating room and generate a map of the operating room using non-contact measuring devices such as laser or ultrasonic. An ultrasound-based non-contact sensor module scans the operating room by transmitting an ultrasound explosion and receiving the echo when it bounces off the perimeter of the operating room walls, as described under the heading Surgical Hub Spatial Awareness Within an Operating Room "in US Provisional Patent Application serial number 62 / 611,341, entitled IN-TERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, which is hereby incorporated by reference in its entirety, in which the sensor module is configured to determine the size of the operating room and adjust the limits of the pairing distance with Blue tooth A laser-based non-contact sensor module scans the operating room by transmitting pulses of laser light, receiving pulses of bouncing laser light perimeter walls of the operating room, and comparing the phase of the transmitted pulse to the received pulse to determine the size of the operating room and to adjust the Bluetooth pairing distance limits, for example.
[00276] [00276] Computer system 210 comprises a processor 244 and a network interface 245. Processor 244 is coupled to a communication module 247, storage 248, memory 249, non-volatile memory 250, and an input / output interface 251 via a system bus. The system bus can be any of several types of bus structures, including the memory bus or memory controller, a peripheral bus or external bus, and / or a local bus that uses any variety of architectures. available, including, but not limited to, 9-bit bus, industry standard architecture (ISA), Micro-Charmel Architecture (MSA), extended ISA (EISA), smart drive electronics (IDE), VESA local bus ( VLB), Interconnection of peripheral components (PCI), USB, advanced graphics port (AGP), POCMCIA bus (International Association of Memory Cards for Personal Computers, "Personal Computer Memory Card International Association" ), Small Computer Systems Interface (SCSI), or any other proprietary bus.
[00277] [00277] Processor 244 can be any single-core or multi-core processor, such as those known under the trade name ARM Cortex available from Texas Instruments. In one 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 StellarisWare & program, memory only programmable and electrically erasable readout (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 converters for 12 bit digital (ADC) with 12 channels of analog input, details of which are available for the product data sheet.
[00278] [00278] In one aspect, processor 244 may comprise a safety controller comprising two controller-based families, such as TMS570 and RM4x, known under the tradename Hercules ARM Cortex R4, also by Texas Instruments. The safety controller can be configured specifically for IEC 61508 and ISO 26262 safety critical applications, among others, to provide advanced integrated safety features while providing scalable performance, connectivity and memory options.
[00279] [00279] System memory includes volatile and non-volatile memory. The basic input / output system (BIOS), containing the basic routines for transferring information between elements within the computer system, such as during startup, is stored in non-volatile memory. For example, non-volatile memory can include ROM, programmable ROM (PROM), electrically programmable ROM (EPROM), EEPROM or flash memory. Volatile memory includes random access memory (RAM), which acts as an external cache memory. In addition, RAM is available in many forms such as SRAM, Dynamic RAM (DRAM), Synchronous DRAM (SDRAM), Double Data Rate SDRAM (DDR SDRAM), Enhanced SDRAM (ES-DRAM), Synchlink DRAM (SLDRAM), and Direct RAM Rambus RAM (DRRAM).
[00280] [00280] Computer system 210 also includes storage media
[00281] [00281] 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 a suitable operating environment. Such software includes an operating system. The operating system, which can be stored on disk storage, acts to control and allocate computer system resources. System applications benefit from the management capabilities of the operating system through program modules and “program data stored in system memory or on the storage disk. It is to be understood that the various components described in the present invention can be implemented with various operating systems or combinations of operating systems.
[00282] [00282] A user enters commands or information into the computer system 210 via the input device (s) coupled to the 1I / O 251. The input devices include, but are not limited to, a pointing device like a mouse, track-
[00283] [00283] Computer system 210 can operate in a networked environment using logical connections to one or more remote computers, such as cloud computers, or local computers. Remote cloud computers can be a personal computer, server, router, personal network computer, workstation, microprocessor-based device, peer device, or other common network node, and the like, and typically include many or all elements described in relation to the computer system. For the sake of brevity, only one memory storage device is illustrated with the remote computer. Remote computers are logically
[00284] [00284] In various respects, computer system 210 of Figure 10, imaging module 238 and / or display system 208, and / or processor module 232 of Figures 9 to 10, may comprise a processor image processing, image processing engine, media processor, or any specialized digital signal processor (DSP) used for processing digital images. The image processor can employ parallel computing with multi-data instruction (SIMD) or multi-data instruction (MIMD) technologies to increase speed and efficiency. The digital image processing engine can perform a number of tasks. The image processor can be an integrated circuit system with a multi-core processor architecture.
[00285] [00285] Communication connections refer to the hardware / software used to connect the network interface to the bus. Although the communication connection is shown for illustrative clarity within the computer system, it can also be external to computer system 210. The hardware / software required for connection to the network interface includes, for illustrative purposes only, internal and external technologies such as modems, including regular telephone series modems, cable modems and DSL modems, ISDN adapters and Ethernet cards.
[00286] [00286] In several respects, the devices / instruments 235 described with reference to Figures 9 to 10 can be implemented as a circular stapling device equipped with a 201800 (Figures 24 to 30) and 201000 (Figures 31 to 32) motor. Consequently, the circular stapling device equipped with the 201800 (Figures 24 to 30) and 201000 (Figures 31 to 32) motor is configured to interface with the 236 modular control tower and the 206 central surgical controller. Once connected to the central surgical controller 206, the circular stapling device equipped with the 201800 (Figures 24 to 30) and 201000 (Figures 31 to 32) motor is configured to interact with the cloud 204, the server 213, other instruments connected to the surgical controller, the central controller screen 215, or the display system 209, or combinations thereof. In addition, once connected to the central controller 206, the circular stapling device equipped with motor 201800 (Figures 24 to 30) and 201000 (Figures 31 to 32) can use the processing circuits available in the local computer system of the central controller 210.
[00287] [00287] Figure 11 illustrates a functional block diagram of an aspect of a USB 300 network hub device, in accordance with at least one aspect of the present description. In the illustrated aspect, the USB 300 network hub device uses a TUSB2036 integrated circuit hub available from Texas Instruments. The USB network hub 300 is a CMOS device that provides a USB transceiver port 302 and up to three USB transceiver ports downstream 304, 306, 308 in accordance with the USB 2.0 specification. Upstream USB transceiver port 302 is a differential data root port that comprises a "minus" differential data input (DMO)
[00288] [00288] The USB 300 network hub device is implemented with a digital state machine instead of a microcontroller, and no firmware programming is required. Fully compatible USB transceivers are integrated into the circuit for the upstream USB transceiver port 302 and all downstream USB transceiver ports 304, 306, 308. The downstream USB transceiver ports 304, 306, 308 support both full speed as low speed automatically setting the sweep rate according to the speed of the device attached to the doors. The USB 300 network hub device can be configured in bus powered or self powered mode and includes 312 central power logic to manage power.
[00289] [00289] The USB 300 central network controller device includes a 310 serial interface engine (SIE). The SIE 310 is the front end of the USB 300 network hub 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 return (NRZI), generation and verification of CRC (token and data), generation and verification / decoding of packet ID (PID), and / or series-parallel / parallel-series conversion. The 310 receives a clock input 314 and is coupled to a suspend / resume and timing logic circuit.
[00290] [00290] In several aspects, the USB 300 network hub can connect 127 functions configured in up to six logical layers (levels) to a single computer. In addition, the USB 300 network hub 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 network hub can be configured to support four power management modes: a bus powered hub, with individual port power management or grouped port power management, and the self powered hub, with managed individual port power or grouped port power management. In one aspect, using a USB cable, the USB 300 network hub, the upstream USB transceiver port 302 is plugged into a USB host controller, and the downstream USB transceiver ports 304, 306 , 308 are exposed to connect compatible USB devices, and so on.
[00291] [00291] Additional details regarding the structure and function of the central surgical controller and / or networks of central surgical controllers can be found in US Provisional Patent Application No. 62 / 659,900, entitled METHOD OF HUB COMMUNICATION, filed in 19 April 2018, which is hereby incorporated by reference in its entirety. Cloud system hardware and functional modules
[00292] [00292] Figure 12 is a block diagram of the interactive surgical system implemented by computer, according to at least one aspect of the present description.
[00293] [00293] 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 may 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, the number 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 ("I / O") interface 7007. Central servers 7013 of the cloud 7004 collectively administer the cloud computing system, which includes monitoring orders by central surgical controllers clients 7006 and manage the processing capacity of the 7004 cloud to execute orders. The central servers 7013 each comprise one or more processors 7008 coupled with suitable memory devices 7010 which may include volatile memory as random access memory (RAM) and non-volatile memory as magnetic storage devices. 7010 memory devices can comprise machine executable instructions that, when executed
[00294] [00294] 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. The I / O interface 7007 is connected to the plurality of central surgical controllers 7006 via the network 7001. In this way, the I / O interface 7006 can be configured to transfer information between the central surgical controllers 7006 and the bases of aggregated medical data data 7012. Consequently, the I / O interface 7007 can facilitate the read / write operations of the cloud-based data analysis system. Such read / write operations can be performed in response to requests from the central controllers 7006. These requests can be transmitted to the central controllers 7006 through the applications of the central controllers. The 7007 I / O interface can include one or more high-speed data ports, which can include universal serial bus (USB) ports, IEEE 1394 ports, as well as Wi-Fi and I / O interfaces Bluetooth to connect the 7004 cloud to the 7006 central controllers. The 7004 cloud 7004 central controller application servers are configured to host and provide shared capabilities to software applications (for example, central controller applications) run by the controllers. central surgical 7006. For example, application servers for central controllers 7002 can manage requests submitted by applications to central controllers through central controllers 7006, control access to aggregate medical databases 7011 and perform load balancing . The data analysis modules 7034 are described in more detail with reference to Figure 13.
[00295] [00295] The configuration of the specific cloud computing system described in this description is designed specifically to address various issues raised in the context of medical operations and procedures performed using medical devices, such as surgical instruments 7012, 112 In particular, surgical instruments 7012 can be digital surgical devices configured to interact with the 7004 cloud to implement techniques to improve the performance of surgical operations. Various surgical instruments 7012 and / or central surgical controllers 7006 can comprise touch-controlled user interfaces, so that physicians can control aspects of interaction between surgical instruments 7012 and the cloud 7004. Other user interfaces suitable for control such as audibly controlled user interfaces can also be used.
[00296] [00296] Figure 13 is a block diagram that illustrates the functional architecture of the interactive surgical system implemented by computer, according to at least one aspect of the present description. The cloud-based data analysis system includes a plurality of 7034 data analysis modules that can be run by 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 by applications for central controllers 7014 hosted by the application servers for central controllers 7002 that can be accessed on central surgical controllers 7006. The 7008 cloud computing processors and 7014 central controller applications can operate together to perform data analysis modules
[00297] [00297] 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 configurations (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, processors 7008 can be operationally coupled to central controller applications 7014 and aggregated medical data databases 7011 to perform 7034 data analysis modules. data collection and aggregation 7022 can store aggregated organized data in aggregated medical data databases 2212.
[00298] [00298] 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.
[00299] [00299] 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 operational parameters based on the production of 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 to use a particular cartridge for a corresponding 7012 stapling surgical instrument. In this way, the cloud-based data analysis system, while controlling common variables, can be configured to analyze the large collection of raw data and provide centralized recommendations across multiple health service facilities (advantageously determined based on aggregate 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 providers / medical facilities use similar types of instruments, etc., in a way that no health care facility alone would be able to independently analyze.
[00300] [00300] 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.
[00301] [00301] The cloud-based data analysis system can include safety features implemented by the 7004 cloud. These safety features can be managed by the authorization and safety module 7024. Each central surgical controller 7006 can have unique credentials associated with it such as username, password, and other appropriate security credentials. These credentials can be stored in memory 7010 and be associated with a permitted level of cloud access. For example, based on the provision of 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). For this purpose, the aggregated medical data databases 7011 of the cloud 7004 may comprise a database of authorized credentials to verify the accuracy of the supplied credentials. Different credentials can be associated with different permission levels for interacting with the 7004 cloud, such as a predetermined access level to receive data analysis generated by the 7004 cloud.
[00302] [00302] In addition, for security purposes, the cloud could maintain a database of 7006 central controllers, 7012 instruments and other devices that may comprise a "black list" of prohibited devices. In particular, a blacklisted central surgical controller 7006 may not be allowed to interact with the cloud, while blacklisted 7012 surgical instruments may not have functional access to a corresponding 7006 central controller and / or may be prevented from fully functioning - when paired with its corresponding central controller 7006. In addition or alternatively, the cloud 7004 can identify instruments 7012 based on incompatibility or other specified criteria. In this way, counterfeit medical devices and inappropriate reuse of such devices throughout the cloud-based data analysis system can be identified and addressed.
[00303] [00303] Surgical instruments 7012 can use wireless transceivers to transmit wireless signals that can represent, for example, credentials to authorize access to the corresponding central controllers 7006 and the 7004 cloud. Wired transceivers can also be used to transmit signals. Such authorization credentials can be stored in the respective memory devices of surgical instruments 7012. The authorization and security module 7024 can determine whether the authorization credentials are accurate or falsified. The 7024 authorization and security module can also dynamically generate authorization credentials for increased security. Credentials could also be encrypted, such as using hash-based encryption. After transmitting the appropriate authorization, the surgical instruments 7012 can transmit a signal to the corresponding central controllers 7006 and finally to the cloud 7004, to indicate that the instruments 7012 are ready to obtain and transmit medical data. In response, the 7004 cloud can transition to a state enabled to receive medical data for storage in the aggregated medical data databases
[00304] [00304] The cloud-based data analysis system can allow the monitoring of multiple health care facilities (for example, medical posts such as hospitals) to determine improved practices and recommend changes (through the 2030 recommendations module, for example) example) properly. In this way, cloud 7004 processors 7008 can analyze data associated with a healthcare facility to identify the facility and aggregate the data to other data associated with other healthcare facilities in a group. Groups could be defined based on similar operating practices or geographic location, for example. In this way, the 7004 cloud can provide analysis and recommendations regarding a health service facility that covers an entire group. The cloud-based data analysis system could also be used to improve situational recognition. For example, 7008 processors can predictively demonstrate the effects of recommendations on cost and effectiveness for a specific facility (in relation to operations and / or various general medical procedures). The cost and effectiveness associated with that specific facility can also be compared to a corresponding local area of other facilities or any other comparable facility.
[00305] [00305] 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 7004 cloud (corresponding to a level of urgency), such as escalation to an accelerated response, special processing, deletion of aggregated medical databases 7011 or other appropriate responses. In addition, if necessary, the 7004 cloud can transmit a request (for example, a push message) through the application servers to central controllers for additional data from corresponding 7012 surgical instruments. The automatic message may result in a notification displayed on the corresponding central controllers 7006 to request supporting or additional data. This automatic message may be necessary in situations where the cloud detects a significant irregularity or results outside the limits and the cloud cannot determine the cause of the irregularity. Central servers 7013 can be programmed to activate this automatic message in certain significant circumstances, such as when the data is determined to be different from an expected value beyond a predetermined limit, or when it appears that security has been compromised, for example example.
[00306] [00306] In several respects, the surgical instrument (s) 7012 described above with reference to Figures 12 and 13 can be implemented as a circular stapling device equipped with engine 201800 (Figures 24 to 30) and 201000 (Figures 31 to 32). Consequently, the circular stapling device equipped with motor 201800 (Figures 24 to 30) and 201000 (Figures 31 to 32) is configured to interface with the central surgical controller 7006 and the network 2001, which is configured to interface with the 7004 cloud. Consequently, the processing power provided by the central servers 7013 and the data analysis module 7034 are configured to process information (for example, data and control) from the circular stapling device equipped with the 201800 engine. (Figures 24 to 30) and 201000 (Figures 31 to 32). 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 hereby incorporated by reference, in its entirety. Situational recognition
[00307] [00307] “Although a" smart "device, including control algorithms responsive to detected data, can be an improvement over a" stupid "device that operates without taking the detected data, some detected data can be incomplete or inconclusive when considered in isolation, that is, without the context of the type of surgical procedure being performed or the type of tissue that is undergoing the surgery. Without knowing the context of the procedure (for example, knowing the type of tissue that is undergoing surgery, or the type of procedure that is being performed), the control algorithm may control the modular device incorrectly or suboptimally, detected data without specific context is provided. For example, the ideal way for a control algorithm to control a surgical instrument in response to a particular parameter detected 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 tear resistant. For tissues that are susceptible to tearing, such as lung tissue, the instrument's control algorithm would optimally slow the engine in response to an unexpectedly high force to close to prevent 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 unusually high force to close to ensure that the end actuator stays properly stuck in the fabric. Without knowing whether the lung or stomach tissue was trapped, the control algorithm can make a decision below what is considered ideal.
[00308] [00308] “A solution uses a central surgical controller including a system configured to derive information about the surgical procedure that is being performed based on data received from various data sources, and then control, accordingly, the devices paired modules. In other words, the central surgical controller is configured to infer information about the procedure.
[00309] [00309] 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 step specific to the surgical procedure that the surgeon is performing, the type of tissue being operated on, or the body cavity that is the object of the procedure. This ability for some aspects of the 5104 central surgical controller to derive or infer information related to the surgical procedure from received data, can be called "situational perception." In one example, the 5104 central surgical controller 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.
[00310] [00310] 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.
[00311] [00311] A 5104 central surgical controller, which incorporates a situational perception system, provides several benefits to the 5100 surgical system. One benefit includes improving the interpretation of detected and captured data, which in turn improves the accuracy of processing and / or using the 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 type of tissue.
[00312] [00312] 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.
[00313] [00313] As yet another example, the type of body cavity being operated during an insufflation procedure, may affect the function of a smoke evacuator. A central surgical controller with situational perception 5104 can determine if the surgical site is under pressure (by determining that the surgical procedure is using insufflation) and determine the type of procedure. As a type of procedure is generally performed in a specific body cavity, the 5104 central surgical controller can then adequately control the speed of the smoke evacuator motor to the body cavity being operated on. In this way, a central surgical controller with 5104 situational awareness can provide a consistent amount of smoke evacuation to both thoracic and abdominal procedures.
[00314] [00314] 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 (i.e., the "energy level") to compensate for the fluid-filled environment. Related to this, the type of tissue being operated on can affect the ideal energy level at which an ultrasonic surgical instrument or RF electrosurgical instrument operates. A central surgical controller with situational awareness 5104 can determine what type of surgical procedure is being performed and then customize the energy level for the ultrasonic surgical instrument or RF electrosurgical instrument, respectively, according to the profile of tissue expected for the surgical procedure. In addition, a central surgical controller equipped with 5104 situational awareness can be configured to adjust the energy level for the ultrasonic surgical instrument or RF electrosurgical instrument throughout the course of a surgical procedure, rather than just on a procedural basis. -by-procedure. A central surgical controller with situational perception 5104 can determine which stage of the surgical procedure is being performed or will be performed subsequently and then update the control algorithms for the generator and / or ultrasonic surgical instrument or RF electrosurgical instrument for adjust the energy level to an appropriate value for the type of tissue, according to the stage of the surgical procedure.
[00315] [00315] As yet another example, data can be extracted from additional data sources 5126 to improve the conclusions that the central surgical controller 5104 draws from a 5126 data source. A central surgical controller with situational perception 5104 can augment the data that he receives from modular devices 5102 with contextual information that he has accumulated, referring to the surgical procedure, from other data sources 5126. For example, a central surgical controller with situational perception 5104 can be configured to determine if hemosystems occurred tasia (that is, if bleeding has stopped at a surgical site), according to video or image data received from a medical imaging device. However, in some cases, video or image data may be inconclusive. Therefore, in one example, the central surgical controller 5104 can be additionally configured to compare a physiological measurement (for example, blood pressure detected by a PA monitor communicatively connected to the central surgical controller 5104) with visual data or hemostasis imaging (for example, from a Medical Imaging Device 124 (Figure 2) coupled communicably to the central surgical controller 5104) to make a determination on the integrity of the staple line or tissue union. In other words, the situational perception system of the central surgical controller 5104 can consider the physiological measurement data to provide additional context in the analysis of the visualization data. The additional context can be useful when the visualization data can be inconclusive or incomplete on its own.
[00316] [00316] 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 5104 situational awareness can proactively activate the generator to which an RF electrosurgical instrument is connected, if it is determined that a subsequent step in the procedure requires the use of the instrument. Proactively activating the power source allows the instrument to be ready for use as soon as the preceding step of the procedure is complete.
[00317] [00317] As another example, a central surgical controller with situational perception 5104 could determine whether the current or subsequent stage of the surgical procedure requires a different view or degree of magnification of the screen, according to the resource (s) (s) at the surgical site that the surgeon is expected to see. The central surgical controller 5104 could then proactively alter the displayed view (provided, for example, by a Medical Imaging device to the visualization system 108), so that the screen automatically adjusts throughout the procedure surgical.
[00318] [00318] Still as 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
[00319] [00319] Another benefit includes checking for errors during the configuration of the surgical procedure or during the course of the surgical procedure. For example, a central surgical controller with situational perception 5104 could determine whether the operating room is properly or ideally configured for the surgical procedure to be performed. Central surgical controller 5104 can be configured to determine the type of surgical procedure being performed, retrieve the corresponding checklists, product location, or configuration needs (for example, from a memory), and then compare the layout of the current operating room with the standard layout for the type of surgical procedure that the 5104 central surgical controller determines is being performed. In one example, the 5104 central surgical controller can be configured to compare the item list for the procedure scanned by a suitable scanner, for example, and / or a list of devices paired with the 5104 central surgical controller with a recommended manifest or advance of items and / or devices for the given surgical procedure. If there are any discontinuities between the lists, the central surgical controller 5104 can be configured to provide an alert indicating that a specific modular device 5102, patient monitoring device 5124 and / or another surgical item is missing. In one example, the central surgical controller 5104 can be configured to determine the relative position or distance of modular devices 5102 and patient monitoring devices 5124 across
[00320] [00320] As another example, the central surgical controller with situational awareness 5104 could determine whether the surgeon (or other medical personnel) was making a mistake or otherwise deviating from the expected course of action during the course of a 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.
[00321] [00321] In general, the situational perception system for the central surgical controller 5104 improves the results of the surgical procedure by adjusting the surgical instruments (and other modular devices 5102) for the specific context of each surgical procedure (such as the different types of tissue), and when validating actions during a surgical procedure. The situational perception system
[00322] [00322] In one aspect, as described later in this document with reference to Figures 24 to 40, the modular device 5102 is implemented as a circular stapling device equipped with motor 201800 (Figures 24 to 30) and 201000 (Figures 31 to 32). Consequently, the modular device 5102 implemented as a circular stapling device equipped with a 201800 (Figures 24 to 30) and 201000 (Figures 31 to 32) motor is configured to function as a 5126 data source and to interact with the 5122 database. and remote monitoring devices 5124. The modular device 5102 implemented as a circular stapling device equipped with motor 201800 (Figures 24 to 30) and 201000 (Figures 31 to 32) is additionally configured to interact with the central surgical controller 5104 to provide information (for example, data and control) to the 5104 central surgical controller and receive information (for example, data and control) from the 5104 central surgical controller.
[00323] [00323] Now with reference to Figure 15, a time line 5200 is shown representing the situational recognition of a central controller, such as the central surgical controller 106 or 206 (Figures 1 to 11), for example. Timeline 5200 is an illustrative surgical procedure and the contextual information that the central surgical controller 106, 206 can derive from data received from data sources at each stage in the surgical procedure. Timeline 5200 shows the typical steps that would be taken by nurses, surgeons, and other medical personnel during the course of a pulmonary segmentectomy procedure, starting with the setup of the operating room and ending with the transfer of the patient to a postoperative recovery room.
[00324] [00324] Situational recognition of a central surgical controller 106, 206 receives data from data sources throughout the course of the surgical procedure, including the data generated each time the medical team uses a modular device that is paired with the center surgical 106, 206. The central surgical controller 106, 206 can receive this data from the modular modular devices and other data sources and continually derive inferences (that is, contextual information) about the ongoing procedure according to the new data they are received, as what stage of the procedure is being performed at any given time. The situational recognition system of the central surgical controller 106, 206 is, for example, able to record data related to the procedure to generate reports, verify the measures taken by the medical team, provide data or warnings (for example, through a screen display) that may be relevant to the specific step of the procedure, adjust the modular devices based on the context (for example, activate monitors, adjust the field of view (FOV) of the medical imaging device, or change the level of energy from an ultrasonic surgical instrument or the RF electrosurgical instrument), and take any other action described above.
[00325] [00325] In the first step 5202, in this illustrative procedure, the members of the hospital team retrieve the patient's electronic medical record (PEP) from the hospital's PEP database. Based on patient selection data in the PEP, the central surgical controller 106, 206 determines that the procedure to be performed is a thoracic procedure.
[00326] [00326] In the second step 5204, the team members scan the entry of medical supplies for the procedure. The central surgical controller 106, 206 cross-references the scanned supplies with a list of supplies that are used in various types of procedures and confirms that the combination of the supplies corresponds to a thoracic procedure. In addition, the central surgical controller 106, 206 is also able to determine that the procedure is not a wedge procedure (because the input supplies either lack certain supplies that are necessary for a thoracic wedge procedure or, if contrary, that the inlet supplies do not correspond to a thoracic wedge procedure).
[00327] [00327] In the third step 5206, the medical team scans the patient's band with a scanner that is communicably connected to the central surgical controller 106, 206. The surgical controller 106, 206 can then confirm the patient's identity based on in the scanned data.
[00328] [00328] In the fourth step 5208, the medical team turns on the auxiliary equipment. The auxiliary equipment in use may vary according to the type of surgical procedure and the techniques to be used by the surgeon, but in this illustrative case they include a smoke evacuator, an insufflator and a medical imaging device. When activated, auxiliary equipment that is modular devices can automatically pair with the central surgical controller 106, 206 which is located within a specific neighborhood of modular devices as part of their initialization process. Surgical controller 106, 206 can then derive contextual information about the surgical procedure by detecting the types of modular devices paired with it during that preoperative or initialization phase. In this particular example, the central surgical controller 106, 206 determines that the surgical procedure is a VATS procedure (video-assisted thoracic surgery) based on this specific combination of paired modular devices. Based on the combination of data from the patient's electronic medical record (PEP), the list of medical supplies to be used in the procedure, and the type of modular devices that connect to the central controller, the central surgical controller 106, 206 it can, in general, infer the specific procedure that the surgical team will perform. After the central surgical controller 106, 206 recognizes that a specific procedure is being performed, the central surgical controller 106, 206 can then retrieve the steps of that process from a memory or from the cloud and then cross over the data that subsequently receives from connected data sources (for example, modular devices and patient monitoring devices) to infer which stage of the surgical procedure the surgical team is performing.
[00329] [00329] 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 patient monitoring devices, the surgical controller central 106, 206 thus confirms that the patient is in the operating room.
[00330] [00330] In the sixth step 5212, the medical team induces anesthesia in the patient. Central surgical controller 106, 206 can infer that the patient is under anesthesia based on data from modular devices and / or patient monitoring devices, including ECG data, blood pressure data, ventilator data, or combinations thereof, for example. After the completion of the sixth step 5212, the preoperative portion of the pulmonary segmentectomy procedure
[00331] [00331] In the seventh step 5214, the lung of the patient being operated on is retracted (while ventilation is switched to the contralateral lung). The central surgical controller 106, 206 can infer from the ventilator data that the patient's lung has been retracted, for example. Central surgical controller 106, 206 can infer that the operative portion of the procedure has been initiated since it can compare the detection of the patient's lung retraction to the expected steps of the procedure (which can be accessed or retrieved earlier) and thus determine that lung retraction is the first operative step in this specific procedure.
[00332] [00332] In the eighth step 5216, the medical imaging device (for example, an endoscope) is inserted and the video of the medical imaging device is started. The central surgical controller 106, 206 receives the data from the medical imaging device (that is, the video or image data) through its connection to the medical imaging device. Upon receipt of data from the medical imaging device, the central surgical controller 106, 206 can determine that the portion of the laparoscopic surgical procedure has been initiated. In addition, the central surgical controller 106, 206 can determine that the specific procedure in progress is a segmentectomy, rather than a lobectomy (note that a wedge procedure has already been discarded by the central surgical controller 106, 206 based on the data received in the second step 5204 of the procedure). Data from the medical imaging device 124 (Figure 2) can be used to determine contextual information about the type of procedure underway in several different ways, including determining the angle at which the medical imaging device is oriented in relation to visualization of the patient's anatomy, monitoring the number or
[00333] [00333] In the ninth step 5218, the surgical team starts the dissection step of the procedure. Central surgical controller 106, 206 can infer that the surgeon is in the process of dissection to mobilize the patient's lung because he receives data from the RF or ultrasonic generator that indicate that an energy instrument is being triggered. Central surgical controller 106, 206 can cross-check the received data with the steps retrieved from the surgical procedure to determine that an energy instrument is being triggered at that point in the process (that is, after completing the previously discussed steps of the procedure) corresponds to the dissection stage. In certain cases, the energy instrument may be a power tool mounted on a robotic arm in a robotic surgical system.
[00334] [00334] 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 connecting arteries and candles because he receives data from the surgical stapling and cutting instrument indicating that the instrument is being fired. Similar to the previous step, the central surgical controller 106, 206 can derive this inference by crossing the data received from the surgical stapling and cutting instrument with the steps recovered in the process. In certain cases, the surgical instrument may be a surgical tool mounted on a robotic arm of a robotic surgical system.
[00335] [00335] In the eleventh step 5222, the portion of the segmentectomy procedure is performed. Central surgical controller 106, 206 can infer that the surgeon is transecting the parenchyma based on data from the surgical stapling and cutting instrument, including data from its cartridge. The cartridge data can correspond to the size or type of clamp being released by the instrument, for example. As different types of staples are used for different types of fabrics, the cartridge data can thus indicate the type of fabric being stapled and / or transected. In this case, the type of clamp that is fired is used for the parenchyma (or other similar types of tissue), which allows the central surgical controller 106, 206 to infer which portion of the segmentectomy procedure is being performed.
[00336] [00336] In the twelfth step 5224, the node dissection step is then performed. Central surgical controller 106, 206 can infer that the surgical team is dissecting the node and performing a leak test based on the data received from the generator which indicates which ultrasonic or RF instrument is being fired. For this specific procedure, an RF or ultrasonic instrument being used after the parenchyma has been transected corresponds to the node dissection step, which allows the central surgical controller 106, 206 to make this inference. It should be noted that surgeons regularly switch between surgical stapling / surgical cutting instruments and surgical energy instruments (ie, RF or ultrasonic) depending on the specific step in the procedure because different instruments are better adapted for specific tasks . Therefore, the specific sequence in which cutting / stapling instruments and surgical energy instruments are used can indicate which stage of the procedure the surgeon is taking. In addition, in certain cases, robotic tools can be used for one or more steps in a surgical procedure and / or hand-held surgical instruments can be used for one or more steps in the surgical procedure. The surgeon can switch between robotic tools and hand-held surgical instruments and / or can use the devices simultaneously, for example. After the completion of the twelfth step 5224, the incisions are closed and the postoperative portion of the procedure is started.
[00337] [00337] In the thirteenth stage 5226, the patient's anesthesia is reversed. The central surgical controller 106, 206 can infer that the patient is exiting anesthesia based on ventilator data (i.e., the patient's respiratory rate begins to increase), for example.
[00338] [00338] Finally, in the fourteenth step 5228 is that the medical team removes the various patient monitoring devices from the patient. Central surgical controller 106, 206 can thus infer that the patient is being transferred to a recovery room when the central controller loses ECG, blood pressure and other data from patient monitoring devices. As can be seen from the description of this illustrative procedure, the central surgical controller 106, 206 can determine or infer when each step of a given surgical procedure is taking place according to the data received from the various data sources that are coupled to each other. communicable to the central surgical controller 106, 206.
[00339] [00339] In several respects, the circular stapling device equipped with motor 201800 (Figures 24 to 30) and 201000 (Figures 31 to 32) is configured to operate in a situational recognition in a surgical controller environment, such as the central surgical controller - tral 106 or 206 (Figures 1 to 11), for example, as shown in timeline 5200. Situational recognition is further described in US Provisional Patent Application Serial No. 62 / 659,900, entitled METHOD OF HUB COMMUNICATION, filed at April 19, 2018, which is hereby incorporated by reference in its entirety. In certain cases, the operation of a robotic surgical system, including the various robotic surgical systems disclosed here, for example, can be controlled by the central controller 106, 206 based on its situational recognition and / or feedback from its components and / or based on information from the cloud
[00340] [00340] Figure 16 illustrates a logic diagram of a module of a 470 control system of a surgical instrument or tool, according to one or more aspects of the present description. The 470 system comprises a control circuit. The control circuit includes a microcontroller 461 comprising a processor 462 and memory 468. One or more of the sensors 472, 474, 476, for example, provide real-time feedback to the processor 462. A 482 engine, driven by a 492 motor drive, it operationally couples a longitudinally movable displacement member to drive the cutting element, trocar or anvil of a motor-equipped circular stapling device. A tracking system 480 is configured to determine the position of the longitudinally movable displacement member. Position information is provided to processor 462, which can be programmed or configured to determine the position of the longitudinally movable drive member, as well as the position of a firing member, firing bar and a cutting element . Additional motors can be provided at the instrument driver interface to control the knife firing, the displacement of the closing tube, the rotation of the drive shaft and the articulation. A 473 screen shows a variety of instrument operating conditions and can include touchscreen functionality for data entry. The information displayed on screen 473 can be overlaid with images captured using endoscopic imaging modules.
[00341] [00341] In one aspect, the 461 microcontroller can be any single-core or multi-core processor, such as those known under the ARM Cortex trade name available from Texas Instruments. In one aspect, the 461 main microcontroller may be an LM4F230H5QR ARM Cortex-M4F processor, available from Texas Instruments, for example, which comprises a 256 KB single-cycle flash memory, or-
[00342] [00342] In one aspect, the 461 microcontroller may comprise a safety controller that comprises two families based on controllers, such as TMS570 and RM4x known under the trade name of Hercules ARM Cortex R4, also available from Texas Instruments. The safety controller can be configured specifically for IEC 61508 and ISO 26262 safety critical applications, among others, to provide advanced integrated safety features while providing scalable performance, connectivity and memory options.
[00343] [00343] The 461 microcontroller can be programmed to perform various functions, such as precise control of the speed and position of the joint and knife systems. In one aspect, the microcontroller 461 includes a processor 462 and a memory 468. The electric motor 482 can be a brushed direct current (DC) motor with a gearbox and mechanical connections with an articulation or scalpel system. In one aspect, a 492 motor drive can be an A3941 available from Allegro Microsystems, Inc. Other motor drives can be readily replaced for use in the 480 tracking system which comprises an absolute positioning system. A detailed description of an absolute positioning system is provided in US Patent Application publication 2017/0296213, entitled SYSTEMS AND METHODS FOR CONTROLLING A SURGICAL STAPLING AND CUTTING INSTRUMENT, published on October 19, 2017, which is incorporated herein as a reference in its entirety.
[00344] [00344] The 461 microcontroller can be programmed to provide precise control of the speed and position of the displacement members and articulation systems. The 461 microcontroller can be configured to compute a response in the 461 microcontroller software. The computed response is compared to a measured response from the real system to obtain an "observed" response, which is used for actual feedback-based decisions. The observed response is a favorable and adjusted value, which balances the uniform and continuous nature of the simulated response with the measured response, which can detect external influences in the system.
[00345] [00345] In one aspect, the 482 motor can be controlled by the 492 motor driver and can be used by the instrument trigger system or surgical tool. In many ways, the 482 motor can be a brushed direct current (DC) drive motor, with a maximum speed of approximately 25,000 RPM, for example. In other arrangements, the 482 motor may include a brushless motor, a wireless motor, a synchronous motor, a stepper motor or any other suitable type of electric motor. Motor starter 492 may comprise an H bridge starter comprising field effect transistors (FETs), for example. The 482 motor can be powered by a feed set releasably mounted on the handle set or tool compartment to provide control power for the instrument or surgical tool. The power package may comprise a battery that may include several battery cells connected in series, which can be used as the power source to energize the instrument or surgical tool. In certain circumstances, the battery cells in the power pack may be replaceable and / or rechargeable. In at least one example, the battery cells can be lithium-ion batteries that can be coupled and separable from the power package.
[00346] [00346] Motor drive 492 can be an A3941, available from Allegro Microsystems, Inc. The drive 492 A3941 is an entire bridge controller for use with semiconductor metal oxide field effect transistors (MOSFET ) of external power, N channel, specifically designed for inductive loads, such as brushed DC motors. The 492 actuator comprises a single charge pump regulator that provides full door drive (> 10 V) for batteries with voltage up to 7 V and allows the A3941 to operate with a reduced door drive, up to 5 , 5 V. An input command capacitor can be used to supply the voltage surpassing that supplied by the battery needed for N-channel MOSFETs. An internal charge pump for the drive on the upper side allows direct current operation. - bare (100% duty cycle). The entire bridge can be triggered in fast or slow drop modes using diodes or synchronized rectification. In the slow drop mode, the current can be recirculated by means of FET from the top or from the bottom. Energy FETs are protected from the shoot-through effect by means of resistors with programmable dead time. Integrated diagnostics provide indication of undervoltage, overtemperature and faults in the power bridge, and can be configured to protect power MOSFETs in most short-circuit conditions. Other motor starters can be readily replaced for use in the 480 tracking system comprising an absolute positioning system.
[00347] [00347] The tracking system 480 comprises a controlled motor drive circuit arrangement comprising a position sensor 472 in accordance with an aspect of the present description.
[00348] [00348] The 482 electric motor may include a rotary drive shaft, which interfaces operationally with a gear set, which is mounted on a coupling coupling with a set or rack of drive teeth on the drive member. A sensor element can be operationally coupled to a gear assembly so that a single revolution of the position sensor element 472 corresponds to some longitudinal | linear translation of the displacement member. An array of gears and sensors can be connected to the linear actuator by means of a rack and pinion arrangement, or by a rotary actuator, by means of a sprocket or other connection. A power supply supplies power to the absolute positioning system and an output indicator can show the output from the absolute positioning system. The drive member represents the longitudinally movable drive member which comprises a rack of drive teeth formed thereon for engagement with a corresponding drive gear of the gear reducer assembly
[00349] [00349] A single revolution of the sensor element associated with position sensor 472 is equivalent to a longitudinal linear displacement d1 of the displacement member, where d1 represents the longitudinal linear distance by which the displacement member moves from the point " a "to point" b "after a single revolution of the sensor element coupled to the displacement member. The sensor arrangement can be connected by means of a gear reduction which results in the position sensor 472 completing one or more revolutions for the complete travel of the displacement member. The position sensor 472 can complete multiple revolutions for the full travel of the displacement member.
[00350] [00350] A series of keys, where n is an integer greater than one, can be used alone or in combination with a gear reduction to provide a single position signal for more than one revolution of the position sensor 472. The state of the switches is transmitted back to the 461 microcontroller which applies logic to determine a single position signal corresponding to the longitudinal linear displacement d1 + d2 + ... dh of the displacement member. The output of the position sensor 472 is supplied to the microcontroller 461. In various embodiments, the position sensor 472 of the sensor arrangement may comprise a magnetic sensor, an analog rotary sensor, such as a potentiometer, or a series of effect elements. Analog halls, which emit a unique combination of position of signals or values.
[00351] [00351] The position sensor 472 can comprise any number of magnetic detection elements, such as, for example, magnetic sensors classified according to whether they measure the total magnetic field or the vector components of the magnetic field. Techniques
[00352] [00352] In one aspect, the position sensor 472 for tracking system 480 which comprises an absolute positioning system comprises a magnetic rotating absolute positioning system. The 472 position sensor can be implemented as a rotary, magnetic, single-circuit, ASSOSSEQFT position sensor, available from Austria Microsystems, AG. The position sensor 472 interfaces with the 461 microcontroller to provide an absolute positioning system. The 472 position sensor is a low voltage, low power component and includes four effect elements in an area of the 472 position sensor located above a magnet. A high-resolution ADC and an intelligent power management controller are also provided on the integrated circuit. A CORDIC processor (digital computer for coordinate rotation), also known as the digit-by-digit method and Volder's algorithm, is provided to implement a simple and efficient algorithm for calculating hyperbolic and trigonometric functions that require only addition operations. , subtraction, bit offset and lookup table. The angle position, alarm bits and magnetic field information are transmitted via a standard serial communication interface, such as a serial peripheral interface (SPI), to the 461 microcontroller. position 472 provides 12 or 14 bits of resolution
[00353] [00353] The tracking system 480 which comprises an absolute positioning system can comprise and / or be programmed to implement a feedback controller, such as a PID, state feedback, and adaptive controller. A power supply converts the signal from the feedback controller to a physical input to the system, in this case the voltage. Other examples include a voltage, current and force PWM. Other sensors can be provided in order to measure the parameters of the physical system in addition to the position measured by the position sensor 472. In some respects, the other sensors may include sensor arrangements as described in US patent No. 9.345.481 entitled STAPLE CARTRIDGE TISSUE THI-CKNESS SENSOR SYSTEM, granted on May 24, 2016, which is incorporated by reference in its entirety in this document; publication of US Patent Application Serial No. 2014/0263552, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, published on September 18, 2014, is incorporated by reference in its entirety in this document; and US Patent Application Serial No. 15 / 628,175, entitled TECHNIQUES FOR ADAPTIVE
[00354] [00354] The absolute positioning system provides an absolute positioning of the displaced member on the activation of the instrument without having to retract or advance the longitudinally movable drive member to the restart position (zero or initial), as may be required by conventional rotary encoders that merely count the number of progressive or regressive steps that the 482 motor has traversed to infer the position of a device actuator, actuation bar, scalpel, and the like.
[00355] [00355] A 474 sensor, such as, for example, a strain gauge or a micro strain gauge, is configured to measure one or more parameters of the end actuator, such as, for example, the magnitude of the stress exerted on the anvil during a gripping operation, which can be indicative of tissue compression. The measured effort is converted into a digital signal and supplied to the 462 processor. Alternatively, or in addition to the 474 sensor, a 476 sensor, such as a load sensor, can measure the closing force applied by the anvil closing drive system. The 476 sensor, such as a load sensor, can measure the firing force applied to a knife in a firing stroke of the instrument or surgical tool. The knife is configured to engage a wedge slide, which is configured to move the clamp actuators upward to force the clamps to deform in contact with an anvil. The knife includes a sharp cutting edge that can be used to separate the fabric, as the knife is advanced distally by the firing bar. Alternatively, a current sensor 478 can be used to measure the current drained by the 482 motor. The force required to advance the trigger member can correspond to the current drained by the 482 motor, for example. The measured force is converted into a digital signal and supplied to the 462 processor.
[00356] [00356] In one form, a 474 strain gauge sensor can be used to measure the force applied to the tissue by the end actuator. A strain gauge can be attached to the end actuator to measure the force applied to the tissue being treated by the end actuator. A system for measuring forces applied to the tissue attached by the end actuator comprises a 474 strain gauge sensor, such as, for example, a microstrain meter, which is configured to measure one or more parameters of the end actuator, for example. In one aspect, the 474 strain gauge sensor can measure the amplitude or magnitude of the mechanical stress exerted on a clamp member of an end actuator during a gripping operation, which can be indicative of tissue compression. The measured effort is converted into a digital signal and fed to the 462 processor of a 461 microcontroller. A 476 load sensor can measure the force used to operate the knife element, for example, to cut the captured tissue between the anvil and staple cartridge. A magnetic field sensor can be used to measure the thickness of the captured tissue. The measurement of the magnetic field sensor can also be converted into a digital signal and supplied to the 462 processor.
[00357] [00357] Measurements of tissue compression, tissue thickness and / or force required to close the end actuator in the fabric, as measured by sensors 474, 476, can be used by microcontroller 461 to characterize the selected position
[00358] [00358] The control system 470 of the instrument or surgical tool can also comprise wired or wireless communication circuits for communication with the central modular communication controller shown in Figures 1 to 14. The control system 470 can be used by the circular stapling instrument equipped with the 201800 motor (Figures 24 to 30), (Figures 31 to 32) to control aspects of the circular stapling instruments equipped with the 201800, 201000 motor. Aspects of the 470 control system can be employed by the instruments circular stapling devices equipped with a 201800, 201000 motor to detect the position of the anvil, the forces of tissue compression, among others, employing 472, 474, 476, the tracking system 480 and the current sensor 478 to provide re- information to controller 461.
[00359] [00359] Figure 17 illustrates a control circuit 500 configured to control aspects of the instrument or surgical tool according to an aspect of the present description. The control circuit 500 can be configured to implement various processes described herein. The control circuit 500 may comprise a microcontroller comprising one or more processors 502 (for example, microprocessor, microcontroller) coupled to at least one memory circuit 504. The memory circuit 504 stores instructions executable on the machine which, when executed by processor 502, cause processor 502 to execute machine instructions to implement several of the processes described here. Processor 502 can be any one of a number of single-core or multi-core processors known in the art. The memory circuit 504 may comprise volatile and non-volatile storage media. The processor 502 can include an instruction processing unit 506 and an arithmetic unit 508. The instruction processing unit can be configured to receive instructions from the memory circuit 504 of this description.
[00360] [00360] Figure 18 illustrates a combinational logic circuit 510 configured to control aspects of the instrument or surgical tool according to an aspect of the present description. The combinational logic circuit 510 can be configured to implement the various processes described here. The combinational logic circuit 510 may comprise a finite state machine comprising a combinational logic 512 configured to receive data associated with the instrument or surgical tool at an input 514, process the data by the combinational logic 512 and provide an output 516.
[00361] [00361] Figure 19 illustrates a sequential logic circuit 520 configured to control aspects of the surgical instrument or tool according to an aspect of the present description. Sequential logic circuit 520 or combinational logic 522 can be configured to implement the process described here. Sequential logic circuit 520 may comprise a finite state machine. Sequential logic circuit 520 may comprise combinational logic 522, at least one memory circuit 524, a clock 529 and, for example. The at least one memory circuit 524 can store a current state of the finite state machine. In certain cases, the sequential logic circuit 520 can be synchronous or asynchronous. Combinational logic 522 is configured to receive data associated with the surgical instrument or tool from an input 526, process the data using combinational logic 522, and provide an output 528. In other respects, the circuit may comprise a combination of a processor ( for example, processor 502, Figure 17) and a finite state machine to implement various processes of the present invention. In other respects, the finite state machine may comprise a combination of a combinational logic circuit (for example, a combinational logic circuit 510, Figure 18) and the sequential logic circuit 520.
[00362] [00362] Figure 20 illustrates an instrument or surgical tool 600 that comprises a plurality of motors that can be activated to perform various functions. In certain cases, a first engine can be activated to perform a first function, a second engine can be activated to perform a second function, a third engine can be activated to perform a third function, a fourth engine can be activated to perform a fourth function, and so on. In certain cases, the plurality of motors of the surgical instrument 600 can be individually activated to cause firing, closing and / or articulation movements in the end actuator. The firing, closing and / or articulation movements can be transmitted to the end actuator through a drive shaft assembly, for example. In one aspect, the surgical instrument 600 is representative of a hand-held surgical instrument. In another aspect, the surgical instrument 600 is representative of a robotic surgical instrument. In other respects, the surgical instrument 600 is representative of a combination of a hand-held and robotic surgical instrument. In many respects, the surgical stapler 600 can be representative of a linear stapler or a circular stapler.
[00363] [00363] In certain cases, the instrument or surgical tool system may include a 602 firing motor. The 602 firing motor can be operationally coupled to a 604 firing motor drive assembly, which can be configured to transmitting firing movements, generated by the motor 602, to the end actuator, particularly to move the cutting element. In certain cases, the triggering movements generated by the 602 motor can cause the staples to be positioned from the staple cartridge in the fabric captured by the end actuator and / or the cutting edge of the cutting element to be advanced in order to cut the captured tissue, for example. The cutting element can be retracted by reversing the direction of the 602 motor.
[00364] [00364] In certain cases, the surgical instrument or tool may include a closing motor 603. The closing motor 603 can be operationally coupled to a drive assembly of the closing motor 605 that can be configured to transmit closing movements , generated by the 603 motor to the end actuator, particularly to move a closing tube to close the anvil and compress the fabric between the anvil and the staple cartridge. Closing movements can cause the end actuator to transition from an open configuration to an approximate configuration to capture the tissue, for example. The end actuator can be moved to an open position by reversing the direction of the 603 motor. In a circular stapler implementation, the 603 motor can be coupled to a trocar portion of a circular stapling portion of a stapling device equipped with motor. The 603 engine can be used to advance and retract the trocar.
[00365] [00365] In certain cases, the surgical instrument or tool may include one or more articulation motors 606a, 606b, for example. The motors 606a, 606b can be operationally coupled to the drive sets of the articulation motor 608a, 608b, which can be configured to transmit joint movements generated by the motors 606a, 606b to the end actuator. In certain cases, articulation movements can cause the end actuator to be articulated in relation to the drive shaft assembly, for example.
[00366] [00366] As described above, the instrument or surgical tool can include a plurality of motors that can be configured to perform various independent functions. In certain cases, the plurality of motors of the instrument or surgical tool can be activated individually or separately to perform one or more functions, while other motors remain inactive. For example, the hinge motors 606a, 606b can be activated to cause the end actuator to be pivoted, while the firing motor 602 remains inactive. Alternatively, the firing motor 602 can be activated to fire the plurality of clamps, and / or advance the cutting edge, while the hinge motor 606 remains inactive. In addition, the closing motor 603 can be activated simultaneously with the firing motor 602 to cause the closing tube or the cutting element to advance distally, as described in more detail later in this document.
[00367] [00367] In certain cases, the surgical instrument or tool may include a common control module 610 that can be used with a plurality of the instrument's instruments or surgical tool. In certain cases, the common control module 610 can accommodate one of the plurality of motors at a time. For example, the common control module 610 can be coupled to, and separable from, the plurality of motors of the surgical instrument individually. In certain cases, a plurality of instrument or surgical tool motors may share one or more common control modules, such as the common control module 610. In certain cases, a plurality of instrument or surgical tool motors may be individually and selectively coupled to the common control module 610. In certain cases, the common control module 610 can be selectively switched between interfacing with one of a plurality of instrument motors or surgical tool to interface with another among the plurality of instrument motors or surgical tool.
[00368] [00368] In at least one example, the common control module 610 can be selectively switched between the operating coupling with the hinge motors 606a, 606B, and the operating coupling with the firing motor 602 or the closing motor 603 In at least one example, as shown in Figure 20, a key 614 can be moved or transitioned between a plurality of positions and / or states. In the first position 616, the switch 614 can electrically couple the common control module 610 to the trip motor 602; in a second position 617, the switch 614 can electrically couple the control module 610 to the closing motor 603; in a third position 618a, the switch 614 can electrically couple the common control module 610 to the first articulation motor 606a; and in a fourth position 618b, the switch 614 can electrically couple the common control module 610 to the second articulation motor 606b, for example. In certain cases, separate common control modules 610 can be electrically coupled to the firing motor 602, closing motor 603, and hinge motors 606a, 606b at the same time. In certain cases, key 614 can be a mechanical key, an electromechanical key, a solid state key, or any suitable switching mechanism.
[00369] [00369] Each of the 602, 603, 606a, 606b motors can comprise a torque sensor to measure the output torque on the motor drive shaft. The force on an end actuator can be detected in any conventional manner, such as by means of force sensors on the outer sides of the jaws or by a motor torque sensor that drives the jaws.
[00370] [00370] In several cases, as shown in Figure 20, the common control module 610 may comprise a motor starter 626 that may comprise one or more H bridge FETs. The motor starter 626 may modulate energy transmitted from a power supply 628 to a motor coupled to the common control module 610, based on an input from a microcontroller 620 (the "controller"), for example. In certain cases, the microcontroller 620 can be used to determine the current drained by the motor, for example, while the motor is coupled to the common control module 610, as described above.
[00371] [00371] In certain examples, the microcontroller 620 may include a microprocessor 622 (the "processor") and one or more non-transitory computer-readable media or 624 memory units (the "memory"). In certain cases, memory 624 can store various program instructions which, when executed, can cause the processor 622 to perform a plurality of functions and / or calculations described here. In certain cases, one or more of the memory units 624 can be coupled to the processor 622, for example.
[00372] [00372] In certain cases, the power supply 628 can be used to supply power to the microcontroller 620, for example. In certain cases, the power source 628 may comprise a battery (or "battery pack" or "battery"), such as a Li ion battery, for example. In certain cases, the battery pack can be configured to be releasably mounted to the handle to supply power to the surgical instrument 600. Several battery cells connected in series can be used as the power source
[00373] [00373] In several cases, the 622 processor can control the drive
[00374] [00374] In one example, the 622 processor can be any single-core or multi-core processor, such as those known by the Texas Instruments ARM Cortex trade name. In certain cases, the 620 microcontroller may be an LM 4F230H5QR, available from Texas Instruments, for example. In at least one example, the Texas Instruments LM4F230H5QR is an ARM Cortex-M4F processor core comprising an integrated 256 KB single cycle flash memory, or other non-volatile memory, up to 40 MHz, a search buffer anticipated to optimize performance above 40 MHz, a 32 KB single cycle SRAM, an internal ROM loaded with StellarisWare & software, 2 KB EEPROM, one or more PWM modules, one or more QEI analogs, one or more 12-bit ADCs with 12 analog input channels, among other features that are readily available for the product data sheet. Other microcontrollers can be readily replaced for use with the
[00375] [00375] In certain cases, memory 624 may include program instructions for controlling each of the motors of the surgical instrument 600 that are attachable to common control module 610. For example, memory 624 may include program instructions for controlling the firing motor 602, the closing motor 603 and the hinge motors 606a, 606b. Such program instructions can cause the 622 processor to control the trigger, close, and link functions according to inputs from the instrument or surgical tool control algorithms or programs.
[00376] [00376] In certain cases, one or more mechanisms and / or sensors, such as 630 sensors, can be used to alert the 622 processor about the program instructions that need to be used in a specific configuration. For example, sensors 630 can alert the 622 processor to use the program instructions associated with triggering, closing, and pivoting the end actuator. In certain cases, sensors 630 may comprise position sensors that can be used to detect the position of switch 614, for example. Consequently, the processor 622 can use the program instructions associated with triggering the knife of the end actuator by detecting, through sensors 630, for example, that switch 614 is in the first position 616; the processor 622 can use the program instructions associated with closing the anvil upon detection through sensors 630, for example, that switch 614 is in second position 617; and processor 622 can use the program instructions associated with the articulation of the end actuator upon detection through sensors 630, for example, that switch 614 is in the third or fourth position 618a, 618b.
[00377] [00377] The surgical instrument 600 can also comprise wired or wireless communication circuits for communication with the central controller of modular communication shown in Figures 1 to 14. The surgical instrument 600 can be the circular stapling instrument equipped with engine 201800 (Figures 24 to 30), 201000 (Figures 31 to 32).
[00378] [00378] Figure 21 is a schematic diagram of a surgical instrument 700 configured to operate a surgical tool described herein, in accordance with an aspect of that description. The surgical instrument 700 can be programmed or configured to control the distal / proximal translation of a displacement limb, the distal / proximal displacement of a closing tube, the rotation of the drive shaft, and the articulation, either with one or several 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 and / or one or more hinge members. Surgical instrument 700 comprises a control circuit 710 configured to control motor-driven firing members, closing members, driving shaft members and / or one or more hinge members. In one aspect, surgical instrument 700 is representative of a hand-held surgical instrument. In another aspect, the surgical instrument 700 is representative of a robotic surgical instrument. In other respects, the surgical instrument 700 is representative of a combination of a hand-held and robotic surgical instrument. In many respects, surgical stapler 700 can be representative of a linear stapler or a circular stapler.
[00379] [00379] In one aspect, surgical instrument 700 comprises a control circuit 710 configured to control an anvil 716 and a cutting portion 714 (or cutting element including a cutting edge)
[00380] [00380] In one aspect, the control circuit 710 may comprise one or more microcontrollers, microprocessors or other processors suitable for executing instructions that cause the processor or processors to perform one or more tasks. In one aspect, a timer / counter circuit 731 provides an output signal, such as elapsed time or a digital count, to control circuit 710 to correlate the position of knife 714, as determined by the position sensor 734, with timer / counter output 731 so that control circuit 710 can determine the position of knife 714 at a specific time (t) in relation to an initial position or time (t) when knife 714 is in a specific position in relation to an initial position. The timer / counter 731 can be configured to measure elapsed time, count external events, or measure eternal events.
[00381] [00381] 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 better treat different tissue conditions. For example, when a thicker tissue is present, control circuit 710 can be programmed to translate the displacement member at a lower speed and / or with a lower power. When thinner tissue is present, control circuit 710 can be programmed to move the displacement member at a higher speed and / or with greater power. A closure control program can control the closing force applied to the fabric by the whisker 716. Other control programs control the rotation of the drive shaft 740 and the hinge members 742a, 742b.
[00382] [00382] In one aspect, the 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 drive 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 instances, 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 motorized stator windings.
[00383] [00383] In one aspect, the control circuit 710 can initially operate each of the motors 704a to 704e in an open circuit configuration for a first open circuit portion of the travel member travel. Based on the response of 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 engines 704a to 704e during the open circuit portion, a sum of pulse widths from a motor start signal, etc. After the open circuit portion, control circuit 710 can implement the selected trip control program for a second portion of the travel member travel. For example, during a portion of the closed 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.
[00384] [00384] In one aspect, motors 704a to 704e can receive power from a power source 712. Power source 712 can be a DC power source powered by an alternating main power supply, a battery, a supercapacitor , or any other suitable energy source. Motors 704a to 704e can be mechanically coupled to individual mobile mechanical elements such as knife 714, anvil 716, drive shaft 740,
[00385] [00385] In one aspect, control circuit 710 is configured to drive a firing member like knife portion 714 of end actuator 702. Control circuit 710 provides a motor set point for controlling the motor 708a, which provides a drive signal for motor 704a. The output shaft of the engine 704a is coupled to a torque sensor 744a. The torque sensor 744a is coupled to a transmission 706a which is coupled to knife 714. The transmission 706a comprises moving mechanical elements, such as rotating elements, and a firing member to control the movement of the knife 714 distally and proximally. along a longitudinal geometric axis of end actuator 702. In one aspect, motor 704a can be coupled to the knife gear assembly, which includes a knife gear reduction assembly that includes a first drive gear and a second knife drive gear. A torque sensor 744a provides a trigger force feedback signal to control circuit 710. The trigger force signal represents the force required to fire or move knife 714. A position sensor 734 can be configured to provide knife position 714 along the firing stroke or firing member position as a feedback signal to control circuit 710. End actuator 702 may include additional sensors 738 configured to provide feedback signals control circuit 710. When ready for use, control circuit 710 can provide a trip signal to the 708a motor control. In response to the trip signal, the motor 704a can drive the trip member distally along the longitudinal geometric axis of the 702 end actuator from an initial proximal position of the stroke to a distal end position of the stroke in relation to the initial stroke position. As the displacement member travels distally, a knife 714 with a cutting element positioned at a distal end, advances distally to cut the fabric between the staple cartridge 718 and the anvil 716.
[00386] [00386] In one aspect, control circuit 710 is configured to drive a closing member, such as anvil portion 716 of end actuator 702. Control circuit 710 provides a motor setpoint for 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 torque sensor 744b is coupled to a transmission 706b which is coupled to the anvil 716. The transmission 706b comprises moving mechanical elements, such as rotating elements and a closing member, to control the movement of the anvil 716 between the open and closed positions. . In one aspect, the 704b motor is coupled to a closing gear assembly, which includes a closing reduction gear assembly that is supported in gear engaged with the closing sprocket. The 744b torque sensor provides a closing force feedback signal to the control circuit
[00387] [00387] 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 engine set point for engine control 708c, which provides a drive signal for engine 704c. The output shaft of the motor 704c is coupled to a torque sensor 744c. The torque sensor 744c is coupled to a transmission 706c which is coupled to the shaft 740. The transmission 706c comprises moving mechanical elements, such as rotary elements, to control the rotation of the drive shaft 740 clockwise or counterclockwise until and above 360º. In one aspect, the 704c motor is coupled to the rotary drive assembly, which includes a pipe gear segment that is formed over (or attached to) the proximal end of the proximal closing tube for engagement operable by a gear assembly rotational that is operationally supported on the tool mounting plate. The torque sensor 744c provides a rotation force feedback signal for control circuit 710. The rotation force feedback signal represents the rotation force applied to the drive shaft 740. The position sensor 734 can be configured to provide the position of the closing member as a feedback signal to control circuit 710. Additional sensors 738, such as a drive shaft encoder, can provide the rotational position of the drive shaft 740 to control circuit 710.
[00388] [00388] In a circular stapler implementation, the transmission element 706c is coupled to the trocar to advance or retract the trocar. In one aspect, the drive shaft 740 is part of a closing system comprising a 201904 trocar and a 201906 trocar actuator, as discussed in more detail with reference to Figures 29A to 29 later in this document. Consequently, control circuit 710 controls the control circuit of motor 708c to control motor 704c to advance or retract the trocar. A torque sensor 744c is provided to measure the torque applied by the drive shaft of the 704c motor to the transmission components 706c used in advancing and retracting the trocar. The position sensor 734 can include a variety of sensors to track the position of the trocar, anvil 716 or knife 714, or any combination thereof. Other 738 sensors can be used to measure a variety of parameters including the position or speed of the trocar, anvil 716 or knife 714, or any combination thereof. The torque sensor 744c, the position sensor 734 and the sensors 738 are coupled to the control circuit 710 as inputs for various processes to control the operation of the surgical instrument 700 in a desired manner.
[00389] [00389] In one aspect, control circuit 710 is configured to articulate end actuator 702. Control circuit 710 provides a motor setpoint for a 708d motor control, which provides a trigger signal for the 704d engine. The output shaft of the 704d motor is coupled to a 744d torque sensor. The torque sensor 744d is coupled to a transmission 706d which is coupled to a link 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 over the proximal end portion of the distal column portion and is pivotally driven by a pivot gear assembly. The 744d torque sensor provides a hinge force feedback signal to control circuit 710. The hinge force feedback signal represents the hinge force applied to the end actuator 702. The 738 sensors, as a co - articulation difficult, it can supply the articulation position of the end actuator 702 to the control circuit 710.
[00390] [00390] In another aspect, the articulation function of the robotic surgical system 700 can 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
[00391] [00391] 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 704a to 704e. External influence, such as drag, can cause the functioning of the physical system to deviate from a desired operation of the physical system.
[00392] [00392] 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 may include multiple Hall effect elements located above a magnet and coupled to a CORDIC processor, also known as the digit by digit method and Volder algorithm, which is provided to implement a simple and efficient algorithm for calculating hyperbolic and trigonometric functions that require only addition, subtraction, bit shift and table search operations.
[00393] [00393] In one aspect, the control circuit 710 can be in communication with one or more sensors 738. The sensors 738 can be positioned on the end actuator 702 and adapted to work with the surgical instrument 700 to measure the various parameters derivatives such as span distance as a function of time, tissue compression as a function of time and deformation of the stool as a function of time. The 738 sensors can comprise a magnetic sensor, a magnetic field sensor, a strain gauge, a load cell, a pressure sensor, a force sensor, a torque sensor, an inductive sensor such as an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor and / or any other sensor suitable for measuring one or more parameters of end actuator 702. Sensors 738 may include one or more sensors. Sensors 738 may be located on the staple cartridge platform 718 to determine the location of the tissue using segmented electrodes. The torque sensors 744a to 744e can be configured to detect force such as firing force, closing force, and / or articulation force, among others. Consequently, control circuit 710 can detect (1) the closing load experienced by the distal closing tube and its position, (2) the trigger member on the rack and its position, (3) which portion of the cartridge blade 718 has tissue in it and (4) the load and position on both articulation rods.
[00394] [00394] In one aspect, the one or more sensors 738 may comprise a strain gauge such as, for example, a micro-strain gauge, configured to measure the magnitude of the strain on the beaker 716 during a clamped condition. The voltage meter provides an electrical signal whose amplitude varies with the magnitude of the voltage. Sensors 738 may comprise a pressure sensor configured to detect pressure generated by the presence of compressed tissue between anvil 716 and staple cartridge 718. Sensors 738 can be configured to detect the impedance of a section of fabric located between the anvil 716 and the staple cartridge 718 which is indicative of the thickness and / or completeness of the fabric located between them.
[00395] [00395] In one aspect, the 738 sensors can be implemented as one or more limit switches, electromechanical devices, solid state switches, Hall effect devices, magneto-resistive devices (MR) giant magneto-resistive devices (GMR), magnetometers, among others. In other implementations, the 738 sensors can be implemented as solid state switches that operate under the influence of light, such as optical sensors, infrared sensors, ultraviolet sensors, among others. In addition, the switches can be solid state devices such as transistors (for example, FET, junction FET, MOSFET, bipolar, and the like). In other implementations, the 738 sensors can include driverless electric switches, ultrasonic switches, accelerometers and inertia sensors, among others.
[00396] [00396] In one aspect, sensors 738 can be configured to measure the forces exerted on the anvil 716 by the closing drive system. For example, one or more sensors 738 may be at a point of interaction between the closing tube and the anvil 716 to detect the closing forces applied by the closing tube to the anvil 716. The forces exerted on the anvil 716 may be representative of the tissue compression experienced by the section of tissue captured between the anvil 716 and the staple cartridge 718. The one or more sensors 738 can be positioned at various points of interaction throughout the closing drive system to detect the closing forces applied to the anvil 716 by the closing drive system. The one or more sensors 738 can be sampled in real time during a gripping operation by the processor of the control circuit 710. The control circuit 710 receives sample measurements in real time to provide and analyze information based on time and evaluate, in real time, the closing forces applied to the anvil 716.
[00397] [00397] 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 knife 714, corresponds to the current drained by one of the 704a to 704e motors. The force is converted into a digital signal and fed 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 a knife 714 on end actuator 702 at or near a target speed. The surgical instrument 700 may include a feedback controller, which can be any or any feedback controller, including, but not limited to, a PID controller, state feedback, a linear quadratic controller (LOR) and / or an adaptable controller, for example. Surgical instrument 700 may include a power source for converting the feedback signal from the feedback controller to a physical input such as frame voltage, pulse width modulation voltage, frequency modulated voltage, current, torque and / or force, for example. Additional details are disclosed in US Patent Application Serial No. 15 / 636,829, entitled CLOSED LOOP VELOCITY CONTROL TECHNIQUES FOR ROBOTIC SURGICAL INSTRUMENT, filed June 29, 2017, which is hereby incorporated by reference in its entirety .
[00398] [00398] The surgical instrument 700 may also comprise wired or wireless communication circuits for communication with the central modular communication controller shown in Figures 1 to 14. The surgical instrument 700 may be the circular stapling instrument equipped with a motor 201800 (Figures 24 to 30), 201000 (Figures 31 to 32).
[00399] [00399] Figure 22 illustrates a block diagram of a surgical instrument 750 configured to control various functions according to an aspect of the present description. In one aspect, the surgical instrument 750 is programmed to control the distal translation of a displacement member, such as knife 764, or another suitable cutting element. The surgical instrument 750 comprises an end actuator 752 which may comprise a burner 766, a knife 764 (including a sharp cutting edge) and a removable staple cartridge 768.
[00400] [00400] The position, movement, displacement and / or translation of a linear displacement member, such as knife 764, can be measured by an absolute positioning system, sensor arrangement and a 784 position sensor. knife 764 is coupled to a longitudinally mobile driving member, the position of knife 764 can be determined by measuring the position of the longitudinally mobile driving member that employs position sensor 784. Consequently, in the following description, the position - tion, offset and / or translation of knife 764 can be obtained by position sensor 784, as described here. A control circuit 760 can be programmed to control the translation of the displacement member, such as knife 764. Control circuit 760, in some examples, may comprise one or more microcontrollers, microprocessors or other suitable processors to run the instructions that cause the processor or processors to control the travel member, for example, knife 764, in the manner described In one aspect, a timer / counter 781 provides an output signal, such as elapsed time or a digital counting, to the control circuit 760 to correlate the position of the knife 764 as determined by the position sensor 784 with the timer / counter output 781 so that the control circuit 760 can determine the position of the knife 764 in an instant specific (t) in relation to a starting position. Timer / counter 781 can be configured to measure elapsed time, count external events, or measure eternal events.
[00401] [00401] Control circuit 760 can generate a 772 motor setpoint signal. The 772 motor setpoint signal can be supplied to a 758 motor controller. The 758 motor controller can comprise one or more circuits configured to provide a motor 774 drive signal to motor 754 to drive motor 754, as described in the present invention. In some instances, the 754 motor may be a DC motor with a brushed DC electric motor. For example, motor speed 754 may be proportional to the motor 774 drive signal. In some instances, motor 754 may be a brushless DC electric motor and motor 774 drive signal may comprise a supplied PWM signal. - for one or more stator windings of motor 754. In addition, in some examples, motor controller 758 can be omitted, and control circuit 760 can generate motor drive signal 774 directly.
[00402] [00402] 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. Engine 754 can be mechanically coupled to knife 764 via a 756 transmission. Transmission 756 can include one or more gears or other connecting components to couple motor 754 to knife 764. In one aspect, the transmission is coupled to a trocar actuator using a circular stapler to advance or retract the trocar. A position sensor 784 can detect a position of knife 764, trocar or anvil 766, or a combination thereof. The position sensor 784 can be or include any type of sensor that is capable of generating position data that indicates a position of the knife 764. In some examples, the position sensor 784 may include an encoder configured to provide a series of pulses to the control circuit 760 according to knife 764 transferred distally and proximally. Control circuit 760 can track pulses to determine the position of knife 764. 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 knife 764. In addition, in some examples, the position sensor 784 can be omitted. When motor 754 is a stepper motor, control circuit 760 can track the position of knife 764 by aggregating the number and direction of steps that motor 754 has been instructed to perform. The position sensor 784 can be located on end actuator 752 or any other portion of the instrument.
[00403] [00403] In a circular stapler implementation, the transmission element 756 can be coupled to the trocar to advance or retract the trocar, to knife 764 to advance or retract knife 764,
[00404] [00404] 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 parameters derived, such as span versus time, tissue compression versus time and anvil effort versus time. The 788 sensors can comprise a magnetic sensor, a magnetic field sensor, a stress meter, a pressure sensor, a force sensor, an inductive sensor such as a eddy current sensor, a resistive sensor, a capacitive sensor, a sensor optical and / or any other sensors suitable for measuring one or more parameters of the 752 end actuator. The 788 sensors may include one or more sensors. In one aspect, the 788 sensors can be configured to determine the position of a trocar from a circular stapler.
[00405] [00405] The one or more 788 sensors may comprise a stress meter, such as a microstrain meter, configured to measure the magnitude of the stress on the anvil 766 during a clamping condition. The voltage meter provides an electrical signal whose amplitude varies with the magnitude of the voltage. The 788 sensors can comprise a pressure sensor configured to detect a pressure generated by the presence of compressed tissue between the anvil 766 and the staple cartridge 768. The 788 sensors can be configured to detect the impedance of a section of tissue located between the anvil 766 and the staple cartridge 768 which is indicative of the thickness and / or completeness of the fabric located between them.
[00406] [00406] The 788 sensors can be configured to measure the forces exerted on the anvil 766 by a closing drive system. For example, one or more sensors 788 may be at a point of interaction between the closing tube and the anvil 766 to detect the closing forces applied by a closing tube on the anvil 766. The forces exerted on the anvil 766 can be representative of the tissue compression experienced by the tissue section captured between the anvil 766 and the staple cartridge 768. The one or more sensors 788 can be positioned at various points of interaction
[00407] [00407] A current sensor 786 can be used to measure the current drained by the motor 754. The force required to advance the knife 764 corresponds to the current drained by the motor 754. The force is converted into a digital signal and supplied to the control circuit 760.
[00408] [00408] 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 knife 764 on end actuator 752 at or near a target speed. The surgical instrument 750 may include a feedback controller, which can be one of any feedback feedback controllers, including, but not limited to, a PID controller, state feedback, LOR, and / or a controller. adaptive controller, for example. The surgical instrument 750 can include a power source to convert the signal from the feedback controller to a physical input such as housing voltage, PWM voltage, frequency-modulated voltage, current, torque and / or force, for example.
[00409] [00409] The actual drive system of the surgical instrument 750 is configured to drive the displacement member, cutting member or knife 764, by a brushed DC motor with gearbox and mechanical connections to an articulation system and / or sharp. Another example is the 754 electric motor that operates the travel member.
[00410] [00410] Several exemplifying aspects are directed to a 750 surgical instrument that comprises a 752 end actuator with motor-driven surgical stapling and cutting implements. For example, a 754 motor can drive a displacement member distally and proximally along a longitudinal geometric axis of end actuator 752. End actuator 752 can comprise a pivoting anvil 766 and, when configured for use , a staple cartridge 768 positioned on the opposite side of the anvil 766. A doctor can hold the tissue between the anvil 766 and the staple cartridge 768, as described in the present invention. When ready to use the 750 instrument, the physician can provide a trigger signal, for example, by pressing a trigger on the 750 instrument. In response to the trigger signal, the 754 motor can drive the displacement member distally along from the longitudinal geometric axis of the end actuator 752 from a proximal start position to a distal end position from the start position. As the displacement member moves distally, a knife 764 with a cutting element positioned at a distal end, can cut the fabric between the staple cartridge 768 and the anvil 766.
[00411] [00411] In several examples, the surgical instrument 750 can comprise a control circuit 760 programmed to control the trans-
[00412] [00412] 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 travel member. Based on an instrument response 750 during the open circuit portion of the stroke, control circuit 760 can select a trip control program. The response of the instrument may include a travel distance of the displacement member during the open circuit portion, a time elapsed during the open circuit portion, the power supplied to the motor 754 during the open circuit portion, a sum of pulse widths a motor start signal, etc. After the open circuit portion, control circuit 760 can implement the selected trigger control program for a second portion of the travel member travel. For example, during the closed loop portion of the stroke, control circuit 760 can modulate motor 754 based on translation data that describes a position of the displacement member in a closed circuit manner to translate the displacement member into a constant speed. Additional details are disclosed in US Patent Application Serial No. 15 / 720,852, entitled SYSTEM AND METHODS FOR CONTROL- LING A DISPLAY OF A SURGICAL INSTRUMENT, filed on September 29, 2017, which is hereby incorporated by reference in its entirety.
[00413] [00413] The surgical instrument 750 can also comprise wired or wireless communication circuits for communication with the central controller of modular communication shown in Figures 1 to 14. The surgical instrument 750 can be the circular stapling instrument equipped with a motor 201800 (Figures 24 to 30), 201000 (Figures 31 to 32).
[00414] [00414] Figure 23 is a schematic diagram of a 790 surgical instrument configured to control various functions according to an aspect of the present description. In one aspect, surgical instrument 790 is programmed to control the distal translation of a displacement member, such as knife 764. Surgical instrument 790 comprises an end actuator 792 that can comprise an anvil 766, a knife 764 and a removable staple cartridge 768 that can be interchanged with an RF cartridge 796 (shown in dashed line).
[00415] [00415] With reference to Figures 21 to 23, in several aspects, sensors 738, 788 can be implemented as a limit switch, electromechanical device, solid state switches, Hall effect devices, MRI devices, GMR devices, magnetometers, among others. In other implementations, sensors 738, 788 can be solid state switches that operate under the influence of light, such as optical sensors, infrared sensors, ultraviolet sensors, among others. In addition, the switches can be solid state devices such as transistors (for example, FET, junction FET, MOSFET, bipolar, and the like). In other implementations, sensors 738, 788 can include driverless electric switches, ultrasonic keys, accelerometers and inertia sensors, among others.
[00416] [00416] In one aspect, the position sensor 734, 784 can be implemented as an absolute positioning system, which comprises a rotating magnetic absolute positioning system implemented as a rotating magnetic position sensor, circling single integrated, ASSOSSEQFT, available from Austria Microsystems, AG, Austria. The position sensor 734, 784 can interface with the control circuit 760 to provide an absolute positioning system. The position can include multiple Hall effect elements located above a magnet and coupled to a CORDIC processor, also known as the digit by digit method and Volder's algorithm, which is provided to implement a simple and efficient algorithm for calculating hyperbolic functions and trigonometry that require only addition, subtraction, bit shift and table search operations.
[00417] [00417] In one aspect, knife 714, 764 can be implemented as a cutting member comprising a cutting body that operationally supports a fabric cutting blade in it and may additionally include flaps or anvil engaging features and channel hitch resources or a base. In one aspect, the staple cartridge 718, 768 can be implemented as a standard (mechanical) surgical clamp cartridge, which can be a linear clamp cartridge or a circular clamp cartridge. In one aspect, the RF cartridge 796 (Figure 23) can be implemented as an RF cartridge. These and other sensor provisions are described in Commonly Owned US Patent Application Serial No. 15 / 628,175,
[00418] [00418] The position, movement, displacement and / or translation of a linear displacement member, such as knife 714, 764, or anvil 716, 766, can be measured by an absolute positioning system, a sensor arrangement and a position sensor represented as position sensor 734, 784. As knife 714, 764 is coupled to a longitudinally movable drive member, the position of the trocar, knife 714, 764 or anvil 716 , 766 can be determined by measuring the position of the movable drive member longitudinally using the position sensor 734, 784. Consequently, in the following description, the position, displacement and / or translation of the trocar, knife 764 or anvil 716 , 766 can be reached by the position sensor 734, 784, as described here. A control circuit 710, 760 can be programmed to control the translation of the displacement member, such as the trocar, knife 764, or anvil 716, 766, as described here. The control circuit 710, 760, in some examples, may comprise one or more microcontrollers, microprocessors or other suitable processors to execute the instructions that cause the processor or processors to control the displacement member, for example, the trocar, knife 764, or anvil 716, 766 in the manner described. In one aspect, a timer / counter 731, 781 provides an output signal, such as elapsed time or a digital count, to the control circuit 710, 760 to correlate the position of the changer, knife 714, 764 or the anvil 716, 766 as determined by the position sensor 734, 784 with the timer / counter output 731, 781 so that the control circuit 710, 760 can determine
[00419] [00419] Control circuit 710, 760 can generate a 772 motor setpoint signal. The 772 motor setpoint signal (for each motor when multiple motors are used) can be supplied to a 708a motor controller -e, 758. Motor controller 708a-e, 758 may comprise one or more circuits configured to provide a motor 774 drive signal to motor 704a-e, 754 to drive motor 704a-e, 754, as described here. In some instances, the 704a-e, 754 motor may be a brushed DC electric motor. For example, the speed of motor 704a-e, 754 can be proportional to the drive signal of motor 774. In some instances, motor 704a-e, 754 can be a brushless DC electric motor and the motor drive signal motor 774 may comprise a pulse width modulation signal provided for one or more stator windings of motor 704a-e,
[00420] [00420] The 704a-e motor, a battery, a supercapacitor or any other suitable energy source. The motor 704a-e, 754 can be mechanically coupled to the trocar, knife 764 or anvil 716, 766 via a 706a-e, 756 transmission. The 706a-e, 756 transmission can include one or more gears or other connection components to couple the motor 704a-e, 754 to the trocar, knife 764 or anvil 716, 766. A position sensor 734, 784 can detect a position of the trocar, knife 714, 764 or anvil 716 , 766. The position sensor 734, 784 can be or include any type of sensor that is capable of generating position data that indicate a position of the trocar 764 or the anvil
[00421] [00421] The control circuit 710, 760 can be in communication with one or more sensors 738, 788. The sensors 738, 788 can be positioned on the end actuator 702, 752, 792 and adapted to work with the surgical instrument 700, 750, 790 to measure the various derived parameters, such as span distance as a function of time, compression of the tissue as a function of time and the length of the tube as a function of time. The sensors 738, 788 can comprise a magnetic sensor, a magnetic field sensor, a stress meter, a pressure sensor, a force sensor, an inductive sensor such as a eddy current sensor, a resistive sensor, a sensor capacitive, an optical sensor and / or any other sensors suitable for measuring one or more parameters of the end actuator 702, 752, 792. Sensors 738, 788 may include one or more sensors.
[00422] [00422] One or more sensors 738, 788 may comprise a stress meter, such as a microstrain meter, configured to measure the magnitude of the stress on the anvil 716, 766 during a clamped condition. The voltage meter provides an electrical signal whose amplitude varies with the magnitude of the voltage. The sensors 738, 788 can comprise a pressure sensor configured to detect a pressure generated by the presence of compressed tissue between the whisker 716, 766 and the staple cartridge 718, 768. The sensors 738, 788 can be configured to detecting the impedance of a section of tissue located between the anvil 716, 766 and the staple cartridge 718, 768 which is indicative of the thickness and / or completeness of the tissue located between them.
[00423] [00423] The sensors 738, 788 can be configured to measure the forces exerted on the anvil 716, 766 by the closing drive system. For example, one or more sensors 738, 788 may be at a point of interaction between the closing tube and the anvil 716, 766 to detect the closing forces applied by a closing tube on the anvil 716, 766. The forces exerted on the anvil 716, 766 may be representative of the tissue compression experienced by the section of tissue captured between the anvil 716, 766 and the staple cartridge 738, 768. The one or more sensors 738, 788 can be positioned in several interaction points along the closing drive system to detect the closing forces applied to the anvil 716, 766 by the closing drive system. The one or more sensors 738, 788 can be sampled in real time during a gripping operation by a processor portion of the control circuit 710, 760. The control circuit 760 receives sample measurements in real time to provide and analyze information based on - in real time and evaluate, in real time, the closing forces applied to the anvil 716, 766.
[00424] [00424] “A current sensor 736, 786 can be used to measure the current drained by the motor 704a-e, 754. The force required to advance the trocar, knife 714, 764, or anvil 716, 766 corresponds to the current drained by the motor 704a-e, 754. The force is converted into a digital signal and supplied to the control circuit 710,
[00425] [00425] With reference to Figure 23, an RF power source 794 is coupled to the end actuator 792 and is applied to the RF cartridge 796 when the RF 796 cartridge is loaded on the end actuator 792 in place of the cartridge of clamps 768. Control circuit 760 controls the supply of RF energy to the RF cartridge 796.
[00426] [00426] The surgical instrument 790 can also comprise wired or wireless communication circuits for communication with the central modular communication controller shown in Figures 1 to 14. The surgical instrument 790 can be the circular stapling instrument equipped with a motor 201800 (Figures 24 to 30), 201000 (Figures 31 to 32).
[00427] [00427] Additional details are disclosed in US Patent Application Serial No. 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. Motorized circular stapling surgical instrument
[00428] [00428] In some cases, it may be desirable to provide motorized control of a circular stapling instrument. The examples below include only an illustrative version of a circular stapling instrument where a single motor can be used to control both the gripping and cutting / stapling of the machine.
[00429] [00429] The 201802 stapling head assembly is operable to hold the fabric, cut the fabric and staple the fabric all in response to a single rotary input communicated through the drive shaft assembly 201806. Consequently, the translated actuation inputs linearly through the 201806 drive shaft assembly are not required for the 201802 stapling head assembly, although the 201802 stapling head assembly may comprise a translucent clutch feature
[00430] [00430] The drive shaft assembly 201806 couples the handle assembly 201808 with the clamp head assembly 201802. The drive shaft assembly 201806 comprises a single actuation feature, the rotary drive actuator 201814 shown in Figure 25. The actuator actuator 201814 is intended to drive the 201802 stapling head assembly to secure the fabric, cut the fabric and staple the fabric. Consequently, linear drive via the drive shaft assembly 201806 is not necessary, although the rotary drive actuator 201814 can travel longitudinally to switch between a fabric hold mode and a cut / staple mode. fabric. For example, the actuator actuator 201814 can shift from a first longitudinal position, where the rotation of the actuator actuator 201814 provides the hold of the fabric in the 201802 stapling head assembly, to a second longitudinal position, where the rotation of the actuator 210814 driver provides cutting and stapling of the fabric in the stapling head assembly
[00431] [00431] A 201808 handle set is shown in Figures 25 to 27. The 201808 handle set comprises a 201816 handle cabinet, a 201818 engine housing, a 201820 engine, a 201822 battery, a 201812 rotary knob and a firing ring 201826. The 201818 engine housing is positioned inside the 201816 handlebar. The 201816 handlebar comprises ribs (201827, 201828, 201830, 201832) that extend into the handlebar. 201816 to support the 201818 engine housing, as shown in Figure 26. The 201822 battery it is positioned proximal to the 201820 engine inside the 201818 engine housing. The 201822 battery can be removed from the 201818 engine compartment to be replaced, discarded, or recharged. As can be seen better in Figure 27, the 201822 battery comprises electrical contacts 201834, 201836 that extend distally from the 201822 battery. The 201820 motor comprises electrical contacts 201838, 201840 that extend proximally from the 201820 motor The 201836 battery electrical contact and the 201840 electrical motor contact are coupled via a conductive metal strap 201842. A 201844 screw connects the 201842 band to the 201818 engine housing to fix the 201842 band position in relation to the housing of the 201818 engine.
[00432] [00432] As shown in Figure 27, an electrical contact from the 201846 battery is coupled to a conductive metal strap 201848. The metal strap 201848 is attached to the 201818 motor housing by means of a conductive screw 201854. The electrical contact of the motor 201838 is coupled to a conductive metal strap 201852. The metal strap 201852 is attached to the 201818 engine housing by means of a 201850 conductive screw. The 201818 engine housing is formed of an electrically insulating material (for example, plastic) and comprises 201856, 201858 ring contacts wrapped around the 201818 engine housing. The 201850, 201854 screws are each coupled with a respective 201856, 201858 ring contact to electrically couple the 201834 battery electrical contact and the contact electric motor 201838 to ring contacts 201856, 201858, respectively.
[00433] [00433] “Another conductive metal strap 201860 is attached to the handle holder 201816. Each end of the metal strap 201860 forms a respective spring contact 201862, 201864. The 201818 engine housing is moved proximally and / or distally from the 201816 handle housing to selectively couple and / or uncouple the 201862, 201864 spring contacts with the 201856, 201858 ring contacts. In particular, when the 201818 engine housing is in a distal position, the 201862 spring contact engages the 201856 ring contact and the 201864 spring contact engages the 201858 ring contact to couple the 201822 battery to the 201820 engine and supply power to the 201820 engine. It should be understood that, since the 201862 spring contacts, 201864 are part of the same conductive metal strap 201860, and since the contacts 201836, 201840 are already coupled through a band 201866, the engagement between the spring contacts 201862, 201864 and the ring contacts 201856, 201858 com- complete a circuit between the 201822 battery and the 201820 engine. This positioning is used to provide the motorized actuation of the 201802 stapling head assembly. When the 201818 engine housing is in a proximal position, the 201862, 201864 spring contacts are decoupled from the 201856, 201858 ring contacts, so that the 201822 battery is decoupled from the 201820 engine and the 201820 engine does not receive power. This positioning is used to provide manual actuation of the stapling head assembly
[00434] [00434] A proximal end of the 201818 motor housing is fixedly attached to the rotary knob 201812, as shown in Figure 25. In one aspect, the rotary knob 201812 can be coupled to a motor to rotate the rotary knob 201812. The 201812 rotary knob protrudes proximally from the 201816 hilt cabinet and comprises grooves 201868 that extend distally from the 201812 knob. The 201816 hilt cabinet comprises corresponding 201870 teeth to selectively engage the 201868 grooves. The 201812 rotary knob is pulled and / or pushed to move the 201818 engine housing inside the 201816 handle housing. When the rotary knob
[00435] [00435] An operating mode selection set is positioned distal to the 201818 engine housing inside the 201816 handle housing. As shown in Figures 28A to 28B, the operating mode selection set comprises a first gear 201874 and a second gear 201878, with the first gear 201874 being arranged coaxially and sliding around the second gear 201878. The first gear 201874 comprises square teeth aligned around an internal opening of the first gear 201874. The square teeth define an array of circumferentially spaced recesses. The second gear 201878 comprises a drive shaft 201880, grooves 201876 and annular flanges 201882, as shown in Figures 28A to 28B. The 201880 drive shaft has an opening shown distally. The opening presented distally is hexagonal to receive the proximal end 201896 of the actuator actuator 201814, which is also hexagonal (Figure 25). The 201880 drive shaft also has an opening presented proximally (not shown) that is semicircular to complement and receive the 201886 drive shaft that extends distally from the 201820 engine. Other suitable shapes and configurations of 201896, 201886 drive shafts can be used to couple the second gear 201878 to the drive shafts 201896, 201886.
[00436] [00436] As shown in Figure 28A, the grooves 201876 of the second gear 201878 are positioned at a proximal end of the drive shaft 201880 and extend distally. The slots 201876 correspond to the teeth of the first gear 201874, so that the slots 201876 are configured to fit within the defined recesses between the teeth. A pair of annular flanges 201882 is positioned at a distal end of the drive shaft 201880 and extends outwardly to engage an annular rib 201884 that extends into the 201816 handle housing, thus securing the longitudinal position of the second insert. grating 201878 inside the handle housing 201816. Although the annular rib 201884 fix the longitudinal position of the second gear 201878 inside the handle housing 2001816, the annular rib 201884, however, allows the second gear
[00437] [00437] The first gear 201874 is positioned around the second gear 201878, as shown in Figures 28A and 28B. The first gear 201874 is fixedly coupled to a distal end of the 201818 engine housing so that the first gear 201874 translates and rotates unitarily with the 201818 engine housing. When the 201818 engine housing is in a proximal position, as shown in Figures 28B, the 201820 engine and the first 201874 gear are also in a proximal position. In this position, the 201886 drive shaft of the 201820 engine is disengaged from the second gear 201878 and the teeth of the first gear 201874 engage the grooves of the second gear
[00438] [00438] “Again with reference to Figures 25 to 26, a distal end of the second gear 201878 is coupled to the actuator actuator 201814, so that the rotation of the second gear 201878 turns the actuator actuator 201814. Consequently, when the second gear 201878 is rotated, the actuator actuator 201814 is rotated to adjust the gap distance d between the mustache 201804 and the stapling head assembly 201802. The handle holder 201816 additionally comprises a ring 201826 and the 201890 coupling member. The 201890 coupling member is fastened around the 201814 recessed actuator for the 201814 actuator, as shown in Figure 25. Consequently, the 201890 coupling member travels with the actuator. actuator adapter 201814, but the actuator actuator 201814 is free to rotate within the 201890 coupling member. The 201890 coupling member comprises protrusions extending outward from the coupling member 201890 that connect to the 201826 firing ring. The protrusions of the 201890 coupling member extend through the 201894 slot of the 201816 cabinet assembly, as shown in Figure 25. The 201894 slot extends circumferentially around part of the 201816 handle set. The 201826 firing ring is wrapped around the 201816 handle cabinet and is rotatable and translatable depending on the time of the 201816 handle cabinet to trigger handling.
[00439] [00439] “When the 201826 firing ring is in this position, the 201890 protrusions of the coupling member are positioned inside the 201894 slot of the 201816 handle housing. When the 201890 coupling member is positioned inside the fen - from 201894, coupling member 201890 couples actuator actuator 201814 with features in the 201802 stapling head assembly operable to adjust the gap distance d between the 201804 anvil and the 201802 stapling head assembly. For example, if the 201890 coupling element is rotated clockwise inside the 201894 slot, the gap distance d is reduced to close the 201804 anvil in relation to the 201802 stapling head assembly. If the 201890 coupling member is rotated anti- within the slit 201894, the gap distance d is increased to open the 201804 anvil in relation to the stapling head assembly
[00440] [00440] As shown in Figure 26, a 201898 wrench is positioned in the 201816 handle housing to align with the 201890 coupling member. When the engine equipped operating mode is selected, the 201898 wrench is configured to electrically couple the 201820 engine and the 201822 battery when the 201898 switch is pressed, and the 201898 switch is configured to electrically decouple the 201820 engine and the 201822 battery when the 201898 switch is not pressed. The 201890 coupling member is configured to engage and press the 201898 key when the 201890 coupling member is rotated.
[00441] [00441] Referring now to Figures 29A to 29C, in the present example, the 201800 instrument comprises a locking system and a triggering system. The closure system comprises a 201904 trocar, a 201906 trocar actuator and a 201812 rotary knob (Figure 24). As previously discussed, the rotary knob 201812 can be coupled to a motor to rotate the rotary knob 201812 clockwise or counterclockwise. The 201804 anvil can be attached to a distal end of the trocar
[00442] [00442] “As shown in Figures 29A to 29C, the 201804 anvil is selectively attachable to the 201800 instrument to provide a surface against which the 201902 clamps can be curved to staple the material contained between the head assembly staple 201802 and the anvil 201804. The anvil 201804 of the present example is selectively attachable to a trocar or pointed stem 201904 that extends distally in relation to the staple head assembly 201802. With reference to Figures 29A a 29C, the anvil 201804 is selectively attachable by coupling a 201918 proximal drive shaft of the 201904 anvil to a distal tip of the 201904 trocar. The 201804 anvil comprises a generally circular 201920 anvil head and a 201918 proximal drive shaft that extends proximally from the 201920 anvil head. In the example shown, the proximal drive shaft 201918 comprises a tubular member 201922 having forced resiliently retaining clips 201924 to selectively couple the 201804 bib with the 201904 trocar, although this is merely optional,
[00443] [00443] The 201920 anvil head of the present example comprises a plurality of 201936 staple forming pockets formed on a 201940 proximal face of the 201920 anvil head. Consequently, when the 201804 anvil is in the closed position and the 201902 staples are directed out of the 201802 stapling head assembly into the 201936 staple forming pockets, as shown in Figure 29C, the 201938 staples of the 201902 staples are folded to form the complete staples.
[00444] [00444] Eat anvil 201804 as a separate component, it should be understood that the anvil 201804 can initially be inserted and attached to a portion of the 201916 fabric before being attached to the 201802 stapling head set. for example, the 201804 anvil can be inserted and attached to a first tubular portion of fabric 201916 while the instrument 201800 is inserted and attached to a second tubular portion of fabric 201916. For example, the first tubular portion of fabric 201916 a portion of the 201804 anvil can be sutured to, and the second 201916 tubular tissue portion can be sutured to, or around the 201904 trocar.
[00445] [00445] - As shown in Figure 29A, the 201804 anvil is then attached to the 201904 trocar. The 201904 trocar in the present example is shown in a more distal actuated position. Such an extended position for the 201904 trocar can provide a larger area to which the 201916 fabric can be attached prior to fixing the 201804 anvil. In addition, the 20190400 extended trocar position can also provide easier fixing of the 201804 anvil to the trocar 201904. The 201904 trocar also includes a tapered distal tip. Such a tip may be able to pierce through the fabric and / or assist in inserting the 201804 cuff into the 201904 trocar, although the tapered distal tip is merely optional. For example, in other versions, the 201904 trocar may have a blunt tip. In addition, or alternatively, the 201904 trocar may include a magnetic portion (not shown) that can attract the 201804 anvil towards the 201904 trocar. Of course, additionally, the settings and arrangements for the 201804 anvil and the 201904 trocar will become evident for those skilled in the art in view of the teachings of the present invention.
[00446] [00446] “When the 201804 anvil is coupled to the 201904 trocar, the distance between a proximal face of the 201804 anvil and a distal face of the 201802 stapling head set defines a span distance d. The 201904 trocar in the present example is translatable longitudinally in relation to the 201802 stapling head assembly via an adjustment button 201812 (Figure 24) located at a proximal end of the 201808 actuator handle assembly (Figure 24), as will be described in more detail below. Consequently, when the 201804 anvil is attached to the trocar
[00447] [00447] - Still referring to Figures 29A to 29C, a user sutures a portion of the 201916 fabric around the 201944 tubular member so that the 201920 anvil head is located within a portion of the 201916 fabric to be stapled. When the 201916 fabric is attached to the 201804 anvil, the 201924 retaining clips and a portion of the 201922 tubular member protrude out of the 201916 fabric so that the user can attach the 201804 anvil to the 201904 trocar. With 201916 fabric attached to the 201904 trocar and / or to another portion of the 201802 stapling head assembly, the user attaches the 201804 anvil to the 201904 trocar and activates the 201804 anvil proximally towards the 201802 stapling head assembly to reduce the gap span . When the 201800 instrument is within the operating range, the user then staples together the ends of the 201916 fabric, thus forming a tubular portion of the substantially contiguous 201916 fabric.
[00448] [00448] The 201802 stapling head assembly of the present example is coupled to a distal end of the 201806 drive shaft assembly and comprises a 201926 tubular housing that houses a 201910 sliding clamp driver and a plurality of 201902 clamps contained within pockets of clamps 201928. The drive shaft assembly 201806 of the present example comprises an external tubular member 201942 and a drive actuator
[00449] [00449] The circular stapling instruments equipped with motor 201800, 201000 described here with reference to Figures 24 to 31 can be controlled using any of the control circuits described in connection with Figures 16 to 23. For example , the control system 470 described with reference to Figure 16. Additionally, the circular stapling instrument equipped with the 201800 engine can be used in a cloud environment and central controller as described in connection with Figures 1 to 15. Circular stapler control algorithms
[00450] [00450] In several respects, the present description provides a motor-equipped stapling device that is configured with the circular stapler control algorithms to adjust the actionable staple rows independently, based on the force to close (FTC) a staple in the fabric or gap between the claw and the stapler. Consequently, the course of an external row of staple heights can be adjusted based on the force, the fabric gap, or the deformation of the fabric during the firing of the first staple file, for example. Adjusting the staple height of at least one row of staples based on the thickness or strength of the fabric detected at the closure focuses on adjusting a selection window based on the thickness / load of the fabric at the closure. In other respects, the user-adjustable range of the selectable staple heights can be varied based on the tissue loading detected during the anvil retraction operation. As the fabric compression is increased or the fabric gap is decreased, the nominal staple height for the center of the window can be adjusted. In other respects, the adjustment of the acceptable staple interval range is displayed as the compression is increased or the fabric gap is decreased. In other respects, once the tissue compression is completed then the tissue stabilization can further adjust the acceptable range based on the rate of tissue deformation and the expected time. Adjusting the clamp formation parameters
[00451] [00451] In several respects, the staple forming parameters of an energized circular stapler can be adjusted based on a detected tissue property. In one aspect, a control algorithm can be configured to adjust the staple height of at least one row of staples based on the thickness of the fabric detected or force on closing or firing on an old staple row. In one aspect, the user-adjustable range of selectable staple heights is varied based on the tissue loading detected during the anvil retraction operation. As the fabric compression is increased or the fabric gap is decreased, the nominal staple height for the center of the window is adjusted. In one aspect, the adjustment of the acceptable staple interval range is displayed as the compression is increased or the fabric gap is decreased. In one aspect, once the tissue compression is completed and the tissue is stabilized, the control algorithm can be additionally configured to adjust the acceptable parameter ranges based on the tissue deformation rate and the waiting time.
[00452] [00452] Figure 31 is a partial sectional view of a device
[00453] [00453] Figure 32 is a partial top view of the 201002 circular stapling head assembly shown in Figure 31 showing a first row of staples 201010 (internal staples) and a second row of staples 201014 (external staples) , in accordance with at least one aspect of the present description. The internal row of staples 201010 and the second row of staples 201014 are independently operable by the first and the second staple actuator 201012, 201016.
[00454] [00454] - Now with reference to Figures 31 and 32, since the fabric 201006, 201008 is stuck between the anvil 201004 and the circular stapling head assembly 201002, a first gap 3 1; is defined for the internal row of staples 201010 and a second span 5 2 is defined for the external row of staples 201014. As the
[00455] [00455] The rows of independently actionable staples 201010, 201014 can be formed based on the FTC attached by the anvil 201004 to the fabric 201006, 201008 or to the fabric gap 1, 52 between the anvil 201004, the claw and the head assembly circular stapling 201002. Consequently, the stroke of the heights of the external staple row 201014 can be adjusted based on the FTC grip, the fabric gap 31, 52, or the deformation of the fabric during the firing of the first staple row 201010 , for example. The adjustment of the staple height of at least one row of staples based on the thickness or the detected FTC affects the adjustment of a selection window based on the thickness / load of the fabric 201006, 201008 at closing. In other respects, the user-adjustable range of selectable staple heights can be varied based on the loading of the tissue detected during an anvil retraction operation 201004. As tissue compression (eg, FTC) is increased or the fabric gap 31, 52 is decreased the nominal clamp height to the center of the window can be adjusted as described in the present invention with reference to Figure 37. In other respects, the acceptable clamp window range adjustment is displayed as the compression is increased or the tissue gap is decreased. In other respects, once the tissue compression is completed then the tissue stabilization can additionally adjust the acceptable range based on the tissue deformation rate and the expected time. Adjusting rows of staples based on FTC / Fabric span
[00456] [00456] Figures 33 and 34 illustrate a pair of graphs 201020, 201030 and Figure 35 illustrates an associated diagram 201040 that illustrates the adjustment of the trigger rate or height of a second row of clamps according to the formation of a first row of staples, in accordance with at least one aspect of the present description. As shown in Figures 34 to 35 and with reference also to Figures 31 and 32, a control algorithm for a circular stapler equipped with a 201000 motor detects the number and location of malformed staples in the first row or in the inter-row. that of staples 201010 and then adjust the height of the anvil, the length of the stroke or the stroke rate, or a combination of them according to the second row or outer row subsequently triggered 201014 to accommodate malformed areas staples.
[00457] [00457] Figure 33 is a 201020 graph of the stroke of the 201012 clamp actuators, 201016 when the actual stroke of the first 201012 clamp actuator is less than the upper limit of the stroke length, according to at least one aspect of the present description. . With reference also to Figures 31 and 32, the internal row of clamps 201010 is triggered at a first firing rate 201022 over a first stroke length by the first clamp driver
[00458] [00458] Figure 34 is a 201030 graph of the stroke of the 201012 clamp actuators, 201016 when the actual stroke of the first 201012 clamp actuator is equal to the upper limit of the stroke length, according to at least one aspect of the present description. With reference also to Figures 31 and 32, the internal row of staples 201010 is triggered at a second rate of fire 201031 over a second stroke length by the first staple driver
[00459] [00459] “With reference to Figure 35, and Figures 31 to 34, other conditions tested by the algorithm include those when the course is set to the lower limit as shown in row 201044 or when the course is set to an average limit as shown in row 201046. When the stroke is adjusted to the lower limit as shown in row 201044, no adjustment is made by the algorithm when none of the malformed clamps are detected in the inner row of clamps 201010. However, if a malformed clamp is detected in the first row of staples 201010, the algorithm increases the lower limit to increase the gap between the anvil 201004 and the circular stapling head set 201002. When the stroke is adjusted to the middle limit as shown in row 201046, no adjustment is made by the algorithm when none of the malformed staples are detected in the inner row of staples 201010. However, if a malformed staple is detected in the first row of staples 201010, the algorithm increases the average limit to increase the gap between the anvil 201004 and the circular stapling head set 201002. Staple firing range adjustment based on fabric parameters
[00460] [00460] Figure 36 is a graphical representation of the viable staple trigger range, as indicated by the usable staple height windows 201076, 201078, 201080, 201082, based on the fabric span, the closing force (FTC - "closure force") or in the stabilization of tissue deformation detected by the device or combinations thereof, according to at least one aspect of this description. In one aspect, a stapler control algorithm can be configured to adjust the trigger range of
[00461] [00461] In one aspect, the control algorithm of the 201000 motor equipped circular stapling device adjusts the height 1, 2 of the 201004 anvil to prevent deformation below the lowest setting. Figure 36 is a 201070 graph that illustrates the viable staple height windows 201076, 201078, 201080, 201082 according to the FTC and the anvil closure span 201004 3 (or anvil height 201004 as previously described) for the different fabric thicknesses, according to at least one aspect of this description. As shown in Figure 36, the viable staple height windows 201076, 201078, 201080, 201082 for different types of fabric vary according to the anvil closure span and / or FTC.
[00462] [00462] The 201070 graph represents the FTC (lbs), shown along the vertical geometric axis, as a function of the anvil closing gap 201004 31, d2, shown along the horizontal geometric axis, for the thin tissue shown by a first curve 201072 and for the thick tissue shown by a second curve
[00463] [00463] Referring to Figures 31 to 36, Figure 37 is a logic flow diagram of a 201050 process representing a control program or a logical configuration to adjust the course of the external row of clamp heights 201014 with based on strength, fabric span, or fabric deformation during the firing of the first row of staples 201010, according to at least one aspect of this description. This 201050 process can be implemented with any of the control circuits described with reference to Figures 16 to 23. This 201050 process can be implemented in a cloud computing environment or central controller described with reference to Figures 1 to 15, for example.
[00464] [00464] In particular, the 201050 process represented in Figure 37 will now be described with reference to the control circuit 760 in Figure 22. The control circuit 760 defines 201502 the first and the second staple driver 201012, 201016 or the height anvil 201004 1, õ2 for the internal and external rows of staples 201010,
[00465] [00465] Malformed staples can be detected using a variety of techniques. Among these are the detection techniques
[00466] [00466] In certain cases, an electrical circuit can be positioned in the path of a properly formed clamp. In such cases, an interruption in the electrical continuity of an electrical circuit can be interpreted as an indication that a clamp has been formed properly, while persistence in the electrical continuity of the electrical circuit can be interpreted as an indication that the clamp was improperly formed. In other cases, an electrical circuit may be positioned on a likely path of an improperly formed clamp. In other cases, an interruption in the electrical continuity of an electrical circuit can be interpreted as an indication that a clamp has been formed improperly, while persistence in the electrical continuity of the electrical circuit can be interpreted as an indication that the clamp has been formed. - do properly.
[00467] [00467] With reference to Figure 38 and Figures 40A to C, a staple forming pocket 201090, like the staple forming pockets 201011, 201015 of the anvil 201004 shown in Figure 31, can be coupled to an electrical circuit that includes one or more electrically conductive circuit elements 201092 that cause an interruption in the electrical circuit when cut by a clamp leg 201122 from a clamp 201120, such as clamp 201010, 201014 shown in Figure 31, when clamp leg 210122 is formed . An electrically conductive circuit element 201092 of an electrical circuit can be positioned in the path of a properly formed clamp leg
[00468] [00468] To avoid false readings that may occur if a portion of the electrical circuit other than the electrically conductive circuit element 201092 is cut, the different electrical circuit portions of the electrically conductive circuit element 201092 can be shielded with a tough outer layer of protection. Alternatively, portions of the electrical circuit, different from the electrically conductive circuit element 201092, can be layered and / or executed below the fabric contact surface 210094 of the anvil like the anvil 201004 shown in Figure
[00469] [00469] The number of electrically conductive circuit elements 201092 can vary depending on the number of clamp legs 201122 that are tracked. In at least one case, every 201090 staple-forming pocket can include an electrically conductive circuit element 201092. Alternatively, electrical circuits can be strategically positioned against staples with a relatively high probability of malformation. Since inadequate staple formation is more likely to occur in internal rows
[00470] [00470] All 201090 pockets in an internal or external row of the 201090 staple forming pockets may include the electrically conductive circuit elements 201092. Consequently, an anvil may include an electrical circuit for each of the 201090 staple pockets in an internal or external row of anvil staple forming pockets 201090. Alternatively, to reduce the size of the anvil, the electrically conductive circuit elements 201092 can be concentrated in another pocket 201090 in internal or external rows. In at least one example, only the proximal clamp legs 201122 of clamps 201120 in an internal row of clamps 201120 can be traced for malformation by electrical circuits. Alternatively, only the distal clamp legs 210122 of clamps 201120 in an internal row of clamps 201120 can be traced for malformation by electrical circuits.
[00471] [00471] The position of an electrically conductive circuit element 201092 of an electrical circuit in relation to a contact surface with the 201094 fabric of an anvil can determine whether a change in the state of the electrical circuit can be interpreted as an indication of proper or inappropriate formation of a 201122 clamp leg. An electrically conductive circuit element 201092 can be arranged adjacent to a clamp forming pocket
[00472] [00472] - As illustrated in Figure 38 and Figures 40A to C, a staple forming pocket 201090 comprises a concave surface 201096 that crosses the contact surface with the fabric 201094 at the outer edges 201098. The electrically conductive circuit element 201092 can be positioned on the concave surface 201096 in the path of a properly formed 201120 clamp. The 201100 side panels together with the 201096 concave surface define a 201102 forming band for a staple leg
[00473] [00473] As shown in Figure 38 and Figures 40A to C, the electrically conductive circuit element 201092 can be positioned through the formation track 201102. Once successful contact with the first contact portion 201104 increases the probability of proper formation of a clamp leg 201122, placing the electrically conductive circuit element 201092 on formation track 201102 in a position beyond the first contact portion 201104 improves the accuracy of force detection
[00474] [00474] In at least one example, the electrically conductive circuit element 201092 is placed on the formation track 201102 between the first contact portion 201104 and the deep portion 201106. In at least one example, the electrically conductive circuit element 201092 is placed on the formation track 201102 between the deep portion 201106 and the end portion 201108. In at least one example, the electrically conductive circuit element 201092 is placed on the formation track 201102 within the deep portion 201106. In at least one example, the electrically conductive circuit element 201092 is placed on the formation track 201102 in the center, or substantially in the center, of the deep portion 201106. In at least one example, the electrically conductive circuit element 201092 is placed on the 201102 forming track in the deeper section of the 201102 forming rail. In at least one example, the electrically conductive circuit element 201092 is positioned on the concave surface 201096 closer to the first contact portion 201104 than the portion endpoint 201108. In at least one example, the electrically conductive circuit element 201092 is positioned on the concave surface 201096 closest to the ex portion 201108 tremor than the first 201104 contact portion.
[00475] [00475] As shown in Figure 38 and Figures 40A to C, an electrically conductive circuit element 201092 can be arranged on the concave surface 201096 and can extend between the side walls 201110. As shown in Figure 39, the electrically conductive circuit element 201092 is separated by a staple leg 201122 during proper formation of the staple leg 201122. An electrical circuit can enter a staple forming pocket 201090 extending over a side wall 201110,
[00476] [00476] Figure 40A is a cross-sectional view of two adjacent staple forming pockets 201090 that are configured to receive staple legs 201122 that extend from a base 201126 of a staple 201120. Referring also to Figures 38 39, each of the two staple forming pockets 201090 includes an electrically conductive circuit element 201092 disposed in a deep portion 201106 thereof. As shown in Figure 40B, a properly formed clamp 201120 will cut or break electrically conductive circuit elements
[00477] [00477] With reference to Figures 38 to 40C, notably, the 201130 points of the clamp legs 201122 of the malformed clamp 201124 lost the initial contact portions 201104 and instead engaged the contact surface with the fabric 201094 out of the pockets staple trainers 201090, which caused the malformation. Consequently, in certain cases, placing electrically conductive circuit elements 201092 on the 201094 fabric contact surface in areas around the staple forming pockets 201090 can be useful in detecting staple malformation. Such electrically conductive circuit elements 201092 are not separated when staples, such as staple 201124, are malformed by engaging the contact surface with the 201094 fabric around the staple forming pockets 201090. In such cases, rupture of electrically conductive circuit elements 201092 indicates inadequate clamp formation.
[00478] [00478] In several cases, the electrically conductive circuit elements 201092 are positioned between the forming pockets of neighboring staples 201090. In at least one example, an electrically conductive circuit element 201092 is placed on a surface of connection 201112 extending between two outer edges 201098 of the adjacent staple forming pockets 201090. In one example, an electrically conductive circuit element 201092 may extend around a staple forming pocket 201090.
[00479] [00479] Other probable trajectories of improperly formed staple legs 201122 cut the outer edges of an anvil. Consequently, the malformation of the clamp can be detected by placing one or more electrically conductive circuit elements on the outer edges of an anvil. Interruptions in the electrical continuity of electrical circuits that include such electrically conductive circuit elements indicate that the clamps near such outer edges have been improperly formed while the persistence in the electrical continuity of the electrical circuits indicates that the clamps nearby such outer edges were properly formed, or at least did not engage the outer edges during formation.
[00480] [00480] “With reference to Figure 41 and Figures 38 to 40C, in an alternative aspect, a portion of the 201142 anvil of a circular stapling device equipped with a 201140 motor includes electrically conductive circuit elements 201144 wound on an outer edge of the 201142 anvil. For example, as shown in Figure 41, an electrically conductive circuit element 201144 is wrapped around a beveled outer edge of the 201142 anvil to reduce trauma to the treated tissue. At least a portion of the outer edge is pressed to make room for the electrically conductive circuit element 201144, so that the electrically conductive circuit element 201144 is level with the contact surface with the 201094 fabric of the anvil 201142, as shown in Figure 41.
[00481] [00481] The use of electrically conductive circuit elements to detect the malformation of the clamp need not be limited to the bobbins of the motor-equipped circular stapling device
[00482] [00482] Like the electrically conductive circuit elements 201144, the electrically conductive circuit elements 201146 are employed to assess the proper formation of the clamps 201120. As illustrated in Figure 41, an electrically conductive circuit element 201146 can be arranged on an extender of pocket
[00483] [00483] Figure 42 illustrates a schematic diagram of a 201160 logic circuit. A 201162 multiplexer can be used to provide an input to the 201160 logic circuit by selecting one of the "hn" number of 201164 input beams. As illustrated in Figure 42, "n" is equal to 10. Also referring to Figures 38 to 41, each entry beam 201164 includes twelve branches, for example, which include electrically conductive circuit elements 201092 arranged in pockets forming 201090 clamps, as shown in Figures 38 to 40C. A 201166 demultiplexer is configured to receive the 201160 logic circuit output. The 201166 demultiplexer is connected to a number "n" of optional indicators 201168 which is equal to the number of 201164 input beams.
[00484] [00484] “A 201170 control circuit is electrically connected to the control lines of the 201162 multiplexer and demultiplexer
[00485] [00485] The 201170 control circuit detects or identifies the number and location of malformed staples 201128 (Figure 40C) in the internal staple file 201010 or external row of staples 201014 or a combination thereof (Figures 31 to 32). Information identifying the number and location of malformed staples 201128 (Figure 40C) of a staple row initially deployed, for example, the internal staple row 201010, is provided to control circuit 760 (Figure 22), for example, to adjust the height of the mustache 201004 (Figure 31) or staple trigger stroke of a subsequently deployed staple row, for example, adjust the staple trigger stroke 201016 of the external staple row 201014. This technique can be employed to accommodate areas with defective or malformed staples in the staple row initially deployed.
[00486] [00486] Various aspects of the subject described in this document are defined in the following numbered examples:
[00487] [00487] Example 1. A surgical stapling instrument comprising: an anvil configured to hold a tissue; a circular stapling head assembly comprising a first row of staples and a second row of staples; a first clamp driver configured to drive the first row of clamps; a second clamp driver configured to drive the second row of clamps, in which the first and the second clamp drivers are operable independently; a motor coupled to the anvil, the motor being configured to move the anvil between a first position and a second position; and a control circuit coupled to the motor, the control circuit being configured to: adjust a stroke length for the first and second clamp actuators in a first length; detecting a malformed clamp in the first row of clamps; and defining the stroke length of the second clamp driver as a second length.
[00488] [00488] “Example 2.0 The surgical stapling instrument, according to Example 1, and the control circuit is additionally configured to detect a parameter associated with anvil pressure.
[00489] [00489] “Example 3. The surgical stapling instrument, according to Example 2, the parameter comprising a tissue gap, the force during the closure of the anvil, the stabilization of tissue deformation, or the force during shooting, or any combination thereof.
[00490] [00490] “Example 4. The surgical stapling instrument, according to any of Examples 1 to 3, and the control circuit is additionally configured to actuate the first staple driver to drive the first row of staples.
[00491] [00491] “Example 5. The surgical stapling instrument, according to any of Examples 1 to 4, the first and the second staple actuator being independently operable.
[00492] [00492] Example 6. A surgical stapling instrument comprising: an anvil configured to hold a tissue; a circular stapling head assembly comprising a first row of staples and a second row of staples; a first staple driver configured to drive the first row of staples; a second clamp driver configured to activate
[00493] [00493] “Example 7.The surgical stapling instrument, according to Example 6, and the control circuit is additionally configured to detect a parameter associated with anvil pressure.
[00494] [00494] “Example 8. The surgical stapling instrument, according to Example 7, the parameter comprising a tissue gap, the force during the closure of the anvil, the stabilization of tissue deformation, or the force during shooting, or any combination thereof.
[00495] [00495] “Example 9. The surgical stapling instrument, according to any of Examples 6 to 8, with the control circuit being additionally configured to actuate the first staple driver to drive the first row of staples.
[00496] [00496] “Example 10. The surgical stapling instrument, according to any of Examples 6 to 9, the first and the second staple actuator being independently operable.
[00497] [00497] Example 11. The surgical stapling instrument, according to any of Examples 6 to 10, the control circuit being configured to adjust the staple height of the second row of staples based on a tissue thickness detected when firing the first row of staples.
[00498] [00498] “Example 12.The surgical stapling instrument, according to any of Examples 6 to 11, the control circuit being configured to adjust the staple height of the second row of staples based on a detected anvil force for closing when firing the first row of staples.
[00499] [00499] “Example 13. The surgical stapling instrument, according to any of Examples 6 to 12, and the control circuit is additionally configured to adjust the staple height within a range of selectable staple heights that it is varied based on the tissue loading detected during anvil retraction.
[00500] [00500] Example 14. The surgical stapling instrument, according to any of Examples 6 to 13, the control circuit being configured to adjust a nominal staple height as the tissue compression is increased or as the tissue gap is decreased.
[00501] [00501] Example 15. The surgical stapling instrument, according to Example 14, the control circuit being configured to display the nominal staple height within a range.
[00502] [00502] Example 16. The surgical stapling instrument, according to Example 15, the control circuit being configured to adjust the range of an acceptable staple height range as the compression is increased or the tissue gap is reduced.
[00503] [00503] “Example 17. A surgical stapling instrument comprising: an anvil configured to hold a tissue; a circular stapling head assembly comprising a first row of staples and a second row of staples; a first clamp driver configured to drive the first row of clamps; a second clamp driver configured to drive the second row of clamps; a motor coupled to the anvil, the motor being configured to move the anvil between a first position and a second position; and a control circuit coupled to the motor, the control circuit being configured to: define an anvil span of the first row of clamps in a first span; detecting a malformed clamp in the first row of clamps; and define an anvil span of the second row of staples in a second span.
[00504] [00504] Example 18. The surgical stapling instrument, according to Example 17, and the control circuit is additionally configured to detect a parameter associated with the grip of the anvil.
[00505] [00505] Example 19. The surgical stapling instrument, according to any of Examples 17 to 18, the parameter comprising a tissue gap, the force during the closure of the anvil, the stabilization of tissue deformation, or the force during shooting, or any combination thereof.
[00506] [00506] “Example 20. The surgical stapling instrument, according to any of Examples 17 to 19, and the control circuit is additionally configured to actuate the first staple driver to drive the first row of staples.
[00507] [00507] Although several forms have been illustrated and described, it is not the applicant's intention to restrict or limit the scope of the claims attached to such detail. Numerous modifications, variations, alterations, substitutions, combinations and equivalents of these forms can be implemented and will occur to those skilled in the art without departing from the scope of the present description. 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, when materials are revealed for certain components, other materials can be used. It should be understood, therefore, that the preceding description and the appended claims are intended to include all of these modifications, combinations and variations that fall within the scope of the modalities presented. The appended claims are intended to cover all such modifications, variations, alterations, substitutions, modifications and equivalents.
[00508] [00508] The previous detailed description presented various forms of devices and / or processes through the use of block diagrams, flowcharts and / or examples. Although these block diagrams, flowcharts and / or examples contain one or more functions and / or operations, it will be understood by those skilled in the art that each function and / or operation within these block diagrams, flowcharts and / or examples can be implemented , individually and / or collectively, through a wide range of hardware, software, firmware or almost any combination thereof. Those skilled in the art will recognize, however, that some aspects of the forms disclosed here, in whole or in part, can be implemented in an equivalent manner in integrated circuits, such as one or more computer programs running on one or more computers (for example , such 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 like any combination thereof, and that the design of the set of circuits and / or the inscription of the code for the software and firmware would be within the scope of practice of those skilled in the art, in light of this description. 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.
[00509] [00509] The instructions used to program the logic to execute various revealed aspects can be stored in a memory in the system, such as dynamic random access memory (DRAM), cache, flash memory or other storage. In addition, instructions can be distributed over a network or via other computer-readable media. In this way, a machine-readable media can include any mechanism to store or transmit information in a machine-readable form (for example, a computer), but is not limited to, floppy disks, optical discs, compact memory disc read-only (CD-ROMs), and magneto-optical discs, read-only memory (ROM), random access memory (RAM), erasable programmable read-only memory (EPROM), electrically erasable programmable read-only memory (EEPROM), magnetic or optical cards, flash memory, or machine-readable tangible storage media used to transmit information over the Internet via an electrical, optical, acoustic cable or other forms of propagated signals (for example , carrier waves, infrared signals, digital signals, etc.). Consequently, computer-readable non-transitory media includes any type of machine-readable media suitable for storing or transmitting electronic instructions or information in a machine-readable form (for example, a computer).
[00510] [00510] As used in any aspect of the present invention, the term "control circuit" can refer to, for example, a set of wired circuits, programmable circuits (for example, a computer processor that includes one or more individual instruction processing cores, processing unit, processing
[00511] [00511] As used in any aspect of the present invention, the term "logic" can refer to an application, software, firmware and / or circuit configured to perform any of the aforementioned operations. The software can be incorporated as a software package, code, instructions, instruction sets and / or data recorded on non-transient, computer-readable storage media. The firmware can be incorporated as code, instructions or instruction sets and / or hard coded (for example, non-volatile) data in memory devices.
[00512] [00512] 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.
[00513] [00513] “As used here in any aspect, an" algorithm "refers to the self-consistent sequence of steps that lead to the desired result, where a" step "refers to the manipulation of physical quantities and / or logical states that can, although not they need to take the form of electrical or magnetic signals that can be stored, transferred, combined, compared and manipulated in any other way. It is 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.
[00514] [00514] 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 can include an Ethernet communications protocol that can enable communication with the use of a transmission control protocol / Internet protocol (TCP / IP). The Ethernet protocol may comply with or be compatible with the Ethernet standard published by the Institute of Electrical and Electronics Engineers (IEEE) entitled "IEEE 802.3 Standard", published in December 2008 and / or later versions of this standard. Alternatively or in addition, the 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 may comply with or be compatible with an ATM standard published by the ATM forum entitled "ATM-MPLS Network Interworking 2.0" published in August 2001, and / or later versions of that standard. Obviously, different and / or post-developed connection-oriented network communication protocols are also contemplated in the present invention.
[00515] [00515] Unless otherwise stated, as is evident from the preceding description, it is understood that, throughout the preceding description, discussions that use terms such as "processing", or "computation", or "calculation ", or" determination ", or" display ", or similar, refer to the action and processes of a computer, or device
[00516] [00516] One or more components can be called in the present invention "configured for", "configurable for", "operable / operational for", "adapted / adaptable for", "capable of", "con- formable / conformed to ", etc. Those skilled in the art will recognize that "configured for" may, in general, include components in an active state and / or components in an inactive state and / or components in a standby state, except when the context determines otherwise .
[00517] [00517] The terms "proximal" and "distal" are used in the present invention with reference to a physician who handles the head portion of the surgical instrument. The term "proximal" refers to the portion closest to the doctor, and the term "distal" refers to the portion located opposite the doctor. It will also be understood that, for the sake of convenience and clarity, spatial terms such as "vertical", "horizontal", "up" and "down" can be used in the present invention with respect to drawings. However, surgical instruments can be used in many orientations and positions, and these terms are not intended to be limiting and / or absolute.
[00518] [00518] Persons skilled in the art will recognize that, in general, the terms used here, and especially in the appended claims (for example, bodies of the appended claims) are generally intended as "open" terms (for example, the term "including" should be interpreted as "including, but not limited to", the term "having" should be interpreted as "having at least" the term
[00519] [00519] 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 (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, in general this construction is intended to have the meaning in which the convention would be understood (for example, "a system that has at least one of A, B and C "would include, but not be limited to, systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and / or A, B and C together, etc.). It will be further understood by those skilled in the art that typically a disjunctive word and / or phrase presenting two or more alternative terms, whether in the description, in the claims or in the drawings, should be understood as contemplating the possibility of including one of the terms, any of the terms or both terms, except when 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 "A and B",
[00520] [00520] With respect to the appended claims, those skilled in the art will understand that the operations mentioned in the same can, in general, be performed in any order. In addition, although several operational flow diagrams are presented in one or more sequences, it must be understood that the various operations can be performed in other orders than those shown, or can be performed simultaneously. Examples of these alternative orderings may include overlapping, interleaved, interrupted, reordered, incremental, preparatory, supplementary, simultaneous, inverse or other variant orders, except when the context determines otherwise. In addition, terms such as "responsive to", "related to" or other adjectival participles are not intended in general to exclude these variants, unless the context otherwise requires.
[00521] [00521] It is worth noting that any reference to "one (1) aspect", "one aspect", "an exemplification" or "one (1) exemplification", and the like means that a given resource, structure or characteristic described in connection with the aspect is included in at least one aspect. Thus, the use of expressions such as "in one (1) aspect", "in one aspect", "in an example", "in one (1) example", in several places throughout this specification it does not necessarily refer to the same aspect. In addition, specific features, structures or characteristics can be combined in any appropriate way in one or more aspects.
[00522] [00522] - Any patent application, patent, non-patent publication or other description material mentioned in this descriptive report and / or mentioned in any order data sheet is incorporated here for reference, until the point at which the materials incorporated are not inconsistent with this. Accordingly, and to the extent necessary, the description as explicitly presented herein replaces any conflicting material incorporated by reference to the present invention. Any material, or portion thereof, considered to be incorporated by reference here, but which conflicts with the definitions, statements, or other description materials existing herein, will be incorporated here only to the extent that it does not there is a conflict between the embedded material and the existing description material.
[00523] [00523] In summary, numerous benefits have been described that result from the use of the concepts described in this document. The previously mentioned description of one or more modalities has been presented for purposes of illustration and description. This description is not intended to be exhaustive or to limit the invention to the precise form disclosed. Modifications or variations are possible in light of the above teachings. One or more modalities were chosen and described in order to illustrate the principles and practical application.
thus, to 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 stapling instrument characterized by comprising: an anvil configured to hold a tissue; a circular stapling head assembly comprising a first row of staples and a second row of staples; a first clamp driver configured to drive the first row of clamps; a second clamp driver configured to drive the second row of clamps, in which the first and second clamp drivers are operable independently; a motor coupled to the anvil, the motor being configured to move the anvil between a first position and a second position; and a control circuit coupled to the motor, the control circuit being configured to: define a stroke length of the first and second clip drivers as a first length; detecting a malformed clamp in the first row of clamps; and defining the stroke length of the second clip driver as a second length.
[2]
2. Surgical stapling instrument, according to claim 1, characterized in that the control circuit is additionally configured to detect a parameter associated with the grip of the anvil.
[3]
3. Surgical stapling instrument, according to claim 2, characterized in that the parameter comprises a tissue gap, the force during the closure of the anvil, the stabilization
deformation of the tissue, or the force during firing, or any combination of them.
[4]
4. Surgical stapling instrument, according to claim 1, characterized in that the control circuit is additionally configured to actuate the first staple driver to drive the first row of staples.
[5]
5. Surgical stapling instrument, according to claim 1, characterized in that the first and the second staple actuators are operable independently.
[6]
6. Surgical stapling instrument characterized by comprising: an anvil configured to hold a tissue; a circular stapling head assembly comprising a first row of staples and a second row of staples; a first clamp driver configured to drive the first row of clamps; a second clamp driver configured to drive the second row of clamps; a motor coupled to the anvil, the motor being configured to move the anvil between a first position and a second position; and a control circuit coupled to the motor, the control circuit being configured to: define a staple height of the first and second rows of staples as a first height; detecting a malformed clamp in the first row of clamps; and defining a staple height of the second row of staples as a second height.
[7]
7. Surgical stapling instrument, according to claim 6, characterized in that the control circuit is additionally configured to detect a parameter associated with the grip of the anvil.
[8]
8. Surgical stapling instrument, according to claim 7, characterized in that the parameter comprises a tissue gap, the force during closing of the anvil, the stabilization of tissue deformation, or the force during firing, or whatever - want a combination of them.
[9]
9. Surgical stapling instrument, according to claim 6, characterized in that the control circuit is additionally configured to actuate the first staple driver to drive the first row of staples.
[10]
10. Surgical stapling instrument, according to claim 6, characterized in that the first and the second staple drivers are independently operable.
[11]
11. Surgical stapling instrument according to claim 6, characterized in that the control circuit is configured to adjust the staple height of the second row of staples based on a thickness of tissue detected during the firing of the first row of staples. Bobby pins.
[12]
12. Surgical stapling instrument, according to claim 6, characterized in that the control circuit is configured to adjust the staple height of the second row of staples based on an anvil force detected for closing during the firing of the first row of staples.
[13]
13. Surgical stapling instrument, according to claim 6, characterized in that the control circuit is additionally configured to adjust the staple height within a range of selectable staple heights which is varied based on the loading of staples. tissue detected during anvil retraction.
[14]
14. Surgical stapling instrument, according to claim 6, characterized in that the control circuit is configured to adjust a nominal staple height as the tissue compression is increased or as the tissue gap is decreased.
[15]
15. Surgical stapling instrument, according to claim 14, characterized in that the control circuit is configured to display the nominal staple height within a range.
[16]
16. Surgical stapling instrument, according to claim 15, characterized in that the control circuit is configured to adjust the interval range of an acceptable staple height as the compression is increased or the tissue gap is decreased.
[17]
17. Surgical stapling instrument characterized by comprising: an anvil configured to hold a tissue; a circular stapling head assembly comprising a first row of staples and a second row of staples; a first clamp driver configured to drive the first row of clamps; a second clamp driver configured to drive the second row of clamps; a motor coupled to the anvil, the motor being configured to move the anvil between a first position and a second position; and a control circuit coupled to the motor, the control circuit being configured for:
define an anvil span of the first row of staples as a first span; detecting a malformed clamp in the first row of clamps; and define an anvil span of the second row of staples as a second span.
[18]
18. Surgical stapling instrument, according to claim 17, characterized in that the control circuit is additionally configured to detect a parameter associated with gripping the anvil.
[19]
19. Surgical stapling instrument, according to claim 18, characterized in that the parameter comprises a tissue gap, the force during closing of the anvil, the stabilization of tissue deformation, or the force during firing, or whatever - want a combination of them.
[20]
20. Surgical stapling instrument, according to claim 17, characterized in that the control circuit is additionally configured to actuate the first staple driver to activate the first row of staples.
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FER + 2 o Z q NEN. :. | : O o - Ss LL se ãa
ES zo mm =
HE df. 2 ê
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GS 2>
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É Pa 135 MODULE OF -106 138 SYSTEM [to GENERATOR MODULE DISPLAY at 108 ad seem
It's 143 [|
SYSTEM MODULE 126 EVACUATION OF SMOKE ROBOTIC 10
128 MODULE | SUCTION / IRRIGATION
MODULE OF
F INSTRUMENT 130 JE INTELLIGENT U2 MODULE 132 | 136 MATRIX PROCESSOR 134 STORAGE
MODULE OF
MAPPING OF 133 OPERATION ROOM

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同族专利:

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公开号 | 公开日

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US20190200996A1|2019-07-04|

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EP3505088B1|2021-08-11|

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US11096693B2|2021-08-24|

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WO2019133137A1|2019-07-04|

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EP3505088A1|2019-07-03|

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CN111683609A|2020-09-18|

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JP2021509050A|2021-03-18|

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

优先权:

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申请号 | 申请日 | 专利标题

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

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US16/182,229|2018-11-06|

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US16/182,229|US11096693B2|2017-12-28|2018-11-06|Adjustment of staple height of at least one row of staples based on the sensed tissue thickness or force in closing|

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PCT/US2018/060973|WO2019133137A1|2017-12-28|2018-11-14|Adjustment of staple height of at least one row of staples based on the sensed tissue thickness or force in closing|

---