BR112020003983A2 - electrically powered surgical systems for cutting and welding solid organs - Google Patents

Abstract

  The present invention relates to a surgical system comprising a surgical tool including a drive shaft and an end actuator formed at a distal end thereof, with the end actuator having a clamping element and an ultrasonic blade, the movable clamping element in relation to the ultrasonic blade to tighten and treat the tissue arranged between the clamping element and the ultrasonic blade. The system further comprises a closing mechanism configured to move the clamping element towards the ultrasonic blade from an open configuration to a closed configuration at a predetermined clamping speed and a control system. The control system is configured to maintain a first tightening speed greater than a minimum tightening speed until the predetermined tightening force limit is reached, determining a closing parameter that includes an amount of time and the displacement required to reach the limit strength, determine a tissue characteristic based on the closure parameter and release energy to the ultrasonic blade to treat the tissue according to a profiling treatment protocol based on the tissue characteristic.

Description

Invention Patent Descriptive Report for "ELECTRICALLY POWERED SURGICAL SYSTEMS TO CUT AND WELD SOLID ORGANS".

FIELD OF THE INVENTION

[0001] Electrically powered surgical systems and methods for using them are provided for cutting or dissecting tissues.

BACKGROUND OF THE INVENTION

[0002] More and more surgical procedures are being performed using electrically powered surgical devices that are portable or that are coupled to a robotic surgical system. Such devices generally include one or more motors to drive various functions in the device, such as rotation of the drive shaft, articulation and actuation of an end actuator, and one or more generators for applying energy.

[0003] A common concern with electrically powered surgical devices is a relative lack of tactile feedback. Mechanically powered surgical devices may have articulation features (for example, claws, blades, etc.) powered by the user's actuation of actionable objects such as triggers, buttons, etc. These mechanically powered surgical devices can inherently provide a high degree of tactile feedback because the performance of the device is completely dependent on the user's movements and the mechanical connections between the articulated resources and the actuable objects can provide feedback on the force. However, this direct connection between the user's movements and the performance of the surgical device is not present in electrically driven devices, where the articulated resources can move by electrically powered motors in response to the actuation of actuable objects of low feedback, like buttons. Thus, the reliance on tactile feedback to assess the state of surgical functions (eg progress of cutting operations, tightening forces applied to the tissue, etc.) can be significantly impaired in electrically powered surgical devices compared - tion with mechanically powered surgical devices.

[0004] Consequently, there is a need for improved devices and methods that address these issues with electrically powered surgical devices.

SUMMARY OF THE INVENTION

[0005] Surgical systems and methods for using them are provided here.

[0006] In an exemplary embodiment, a surgical system is provided and may include a surgical tool and a control system. The surgical tool may include a drive shaft and an end actuator formed at a distal end thereof. The end actuator can have a clamping element and an ultrasonic blade and can be configured to grasp and treat the tissue arranged between the clamping element and the ultrasonic blade. The control system can be configured to variablely control a clamping force applied to the tissue disposed between the clamping element and the ultrasonic blade according to one or more control modes before transmitting ultrasonic vibrations to the ultrasonic blade for clot and / or cut the tissue. The clamping force can vary between a maximum clamping force (Fmax) and a minimum clamping force (Fmin).

[0007] The control system modalities can have several configurations. In one aspect, the control system can be configured to apply the clamping force to the fabric during a predetermined first clamping time (t.1) in a first control mode. The first control mode can occur before the transmission of ultrasonic vibrations to the ultrasonic blade and may include an increase in

gradual increase in the clamping force from Fmin to Fmax. In another aspect, the control system can be configured to maintain the application of the Fmax to the fabric during a second predetermined tightening time (too) in a second control mode. The second control mode can occur immediately after the first control mode and before the transmission of ultrasonic vibrations to the ultrasonic blade. In another aspect, the control system can be configured to simultaneously apply the clamping force to the tissue and ultrasonic vibrations to the blade for a predetermined treatment time (t :) in a third control mode. The third control mode can occur immediately after the second control mode and can include the application of a treatment clamping force (Ftatamento) between Fmin € Fmax. In another aspect, the control system can be configured to vary a peak amplitude of ultrasonic waves transmitted to the ultrasonic blade between a maximum amplitude (Amáx) and a minimum amplitude (Amin) during the third control mode. In another aspect, an amplitude (A) between Amáx & Amin can be transmitted for a first portion of the predetermined treatment time tu and Amin can be transmitted immediately thereafter for a second portion of the predetermined treatment time ti. In another aspect, the amplitude can be increased from A: to Amáx immediately after tv.

[0008] In another exemplary embodiment, a surgical system is provided and may include a surgical tool and a control system. The surgical tool may include a drive shaft and an end actuator formed at a distal end thereof. The end actuator can have a clamping element and an ultrasonic blade and can be configured to grasp and treat the tissue arranged between the clamping element and the ultrasonic blade. The control system can be configured to control in a variety of ways

A clamping force applied to the tissue disposable between the clamping element and the ultrasonic blade according to one or more control modes during the transmission of ultrasonic vibrations to the ultrasonic blade is used to coagulate and / or cut the tissue. The clamping force can vary between a maximum clamping force (Fmax) and a minimum clamping force (Fmin).

[0009] The control system modalities can have several configurations. In one aspect, the control system can be configured to apply the clamping force to the fabric for a first predetermined clamping time (t'.1) in a first control mode. The first control mode can occur before the transmission of ultrasonic vibrations to the ultrasonic blade and can include a gradual increase in the clamping force of F'min to a clamping force of F'treatment treatment Between F'min € the F'máx. In another mode, the control system can be configured to maintain the application of F'treatment to the tissue during a second predetermined tightening time (t'c2) in a second control mode. The second control mode can occur immediately after the first control mode and before the transmission of ultrasonic vibrations to the ultrasonic blade. In another aspect, the control system can be configured to apply both the clamping force to the tissue and the ultrasonic vibrations to the blade for a predetermined treatment time (t't) immediately after the second control mode. In another aspect, the control system can be configured to apply the Fmax to the tissue for a first portion (t'1) of the predetermined treatment time t: in a third control mode. In another aspect, an amplitude (A's) between a minimum amplitude A'máx and a maximum amplitude A'min is transmitted to the slide during the third control mode. In another aspect, the control system can be configured to apply F'treatment to the fabric in a fourth control mode immediately after the third control mode. In another aspect, an amplitude (A'2) greater than A ', and less than A'máx can be transmitted to the ultrasonic slide during a second predetermined treatment time (t't2) immediately after tm. In another aspect, A'min can be transmitted to the ultrasonic sheet during a third predetermined treatment time (t ': 3) immediately after tw. In another aspect, A'máx can be transmitted to the slide during a fourth predetermined treatment time (t'1) immediately after aunt.

[0010] Methods for treating tissue are also provided. In one embodiment, the method may include operating a motor to cause an end actuator on a surgical instrument, including a clamping element and an ultrasonic blade, to apply a clamping force to the tissue arranged between the clamping element and the ultrasonic sheet. The method can also include transmitting ultrasonic vibrations to the ultrasonic blade to coagulate through a ultrasonic generator or cutting the tissue trapped between the clamping element and the ultrasonic blade. The method may also include varying, by the motor, the clamping force applied to the tissue between the clamping element and the ultrasonic blade before or during the transmission of ultrasonic vibrations to the blade according to one or more control modes, with the clamping force varying between a maximum clamping force (Fmax) and a minimum clamping force (Fmin).

[0011] In another modality, the Fmax can be applied to the fabric for a predetermined tightening time before transmitting the ultrasonic vibrations to the blade.

[0012] In another embodiment, a treatment clamping force (Ftreatment) between Fmax & Fmin can be applied to the tissue for a predetermined treatment time during the transmission of the ultrasonic vibrations to the blade.

[0013] In another modality, a treatment clamping force

(F'treatment) between Fmax & Fmin can be applied to the tissue for a predetermined treatment time before transmission of the ultrasonic vibrations to the slide. The Fmax can be applied to the tissue for a predetermined treatment time during the transmission of the ultrasonic vibrations to the slide. The treatment can be applied to the tissue for a second predetermined treatment time during the transmission of the ultrasonic vibrations to the slide and after the first predetermined treatment time.

[0014] In another exemplary embodiment, a surgical system is provided and may include an end actuator, a drive shaft assembly, an interface assembly and a control system. The end actuator can have an ultrasonic blade and a clamping element, where the ultrasonic blade can be configured to receive ultrasonic vibrations from an ultrasonic transducer and the clamping element can be configured to tighten and treat the tissue arranged between the clamping element and the ultrasonic blade as ultrasonic vibrations are applied to the fabric from the ultrasonic blade. The drive shaft assembly may have a longitudinal geometric axis and the end actuator may be arranged at a distal end thereof. The drive shaft assembly may also include an operable pivot section to deflect the end actuator away from the longitudinal geometric axis by a pivot angle between a minimum pivot angle of about 0 degrees when the end actuator is aligned with the longitudinal axis of the drive shaft assembly to a maximum pivot angle other than zero in any direction when the end actuator is not aligned with the longitudinal axis of the drive shaft assembly. The interface assembly can have one or more drive shafts coupled to the end actuator and the drive shaft set configured to drive the movement of the end actuator and the drive shaft set. The control system can be configured to control an amplitude of the ultrasonic vibrations received by the ultrasonic blade so that the amplitude increases with an increase in the articulation angle of the end actuator.

[0015] The control system modalities can have several configurations. In one aspect, the control system can be configured to measure the rotation of a first drive shaft that is operable to adjust the articulation angle of the end actuator. In another aspect, the control system can be configured to control the amplitude of the ultrasonic vibrations based on the measured rotation of the first drive axis. In another aspect, the control system can be configured to control the amplitude of ultrasonic vibrations during the articulation of the end actuator.

[0016] In another mode, the control system can be configured to control a rate of change in the amplitude of the ultrasonic vibrations in relation to the articulation of the end actuator between the minimum and maximum articulation angles. The rate of change in amplitude can be approximately constant between the minimum and maximum articulation angles. Alternatively, the rate of change in amplitude may vary between the minimum and maximum articulation angles.

[0017] Methods for treating tissue are also provided. In one embodiment, the method may include the actuation of a motor to cause a drive shaft assembly with a longitudinal geometry axis and an end actuator arranged at a distal end of the same that has a clamping element and an ultrasonic blade , deflected at an angle of articulation between an

minimum pivot angle of about 0 degrees when the end actuator is aligned with the longitudinal axis of the drive shaft and a maximum pivot angle other than zero in any direction when the end actuator is not aligned with the axis longitudinal geometry of the drive shaft. The method may also include transmitting, via an ultrasonic generator, ultrasonic vibrations to the ultrasonic sheet to coagulate or cut the tissue trapped between the clamping element and the ultrasonic sheet. The method can additionally include varying, by the ultrasonic generator, an amplitude of the ultrasonic vibrations so that the amplitude increases with an increase in the articulation of the end actuator.

[0018] In another embodiment, the method may include measuring a rotation of a drive shaft coupled to the drive shaft assembly and configured to drive the end actuator hinge between the minimum and maximum hinge angles. The amplitude of the ultrasonic vibrations can vary based on the measured rotation of the drive shaft. The amplitude of the ultrasonic vibrations can vary during the articulation of the end actuator.

[0019] In another modality, the method may include varying a rate of change in the amplitude of ultrasonic vibrations in relation to the articulation of the end actuator between the minimum and maximum articulation angles. The rate of change in amplitude can be approximately constant between the minimum and maximum articulation angles. Alternatively, the rate of change in amplitude may vary between the minimum and maximum articulation angles.

[0020] In another exemplary embodiment, a surgical system is provided and may include a surgical tool, a closing mechanism and a control system. The surgical tool can include a drive shaft and an end actuator formed at a distal end of the same. The end actuator can

of having a clamping element and an ultrasonic blade. The clamping element can be movable in relation to the ultrasonic sheet to trap and treat the tissue arranged between the clamping element and the ultrasonic sheet. The closing mechanism can be configured to selectively move the clamping element towards the ultrasonic blade from an open configuration to a closed configuration at a predetermined clamping speed (vc). The control system can be configured to keep you at a first tightening speed (vc1) greater than a minimum tightening speed (vmin) until a predetermined limit tightening force (Fs) is reached. The control system can also be configured to determine a closing parameter including at least one of the amount of time required to reach Fo and the amount of displacement of the clamping element required to reach Fo. The control system can be further configured to determine a fabric characteristic based on the closure parameter. The control system can also be configured to supply energy to the ultrasonic blade to treat tissue in a profiling treatment according to a profiling treatment protocol based on the determined tissue characteristic.

[0021] In another embodiment, Fo can be a force resulting from the contact of the clamping element with a tissue arranged between the clamping element and the ultrasonic blade.

[0022] In another modality, the profiling treatment can be effective to coagulate a tissue arranged between the clamping arm and the ultrasonic blade.

[0023] In another embodiment, the characteristic of the fabric can be a thickness of a fabric arranged between the clamping element and the ultrasonic sheet.

[0024] In another mode, when the thickness of the fabric is less

even than a predetermined thickness, the control system can be configured to operate in the profiling treatment protocol keeping vc at a third tightening speed (vc3) while a tightening force applied to the fabric disposed between the tightening arm and the ultrasonic sheet is less than a second predetermined treatment force (F2). The control system can also be configured to operate in the profiling treatment protocol by decreasing the vc from vc3 to a fourth tightening speed (vca) during the remainder of the profiling treatment in response to the increased tightening force up to F2 , where you can be configured to keep the clamping force below F2. Each of vc3 and Vca can be approximately constant.

[0025] In another mode, when the thickness of the fabric is greater than a predetermined thickness, the control system can be configured to operate in the profiling treatment protocol by applying a clamping force to the fabric arranged between. the clamping arm and the ultrasonic blade in an approximately constant first treatment force (F :). The control system can also be configured to allow you to decrease to a level approximately equal to vmin and increase the clamping force to a level between F; and one less than a second treatment force (F2) for the rest of the profiling treatment. F1 can be based on the specific characteristic of the fabric.

[0026] In another modality, the system may include an electrode configured to apply radio frequency energy to a tissue arranged between the clamping element and the ultrasonic blade. The control system can be configured to apply at least one of the ultrasonic energy to the ultrasonic blade and radiofrequency energy to the electrode according to a sealing treatment protocol that occurs after the profiling treatment to coagulate and cut a tissue arranged between the clamping element and the ultrasonic blade.

[0027] In another mode, the control system can be configured to perform the seal treatment in response to the detection that a pre-selected trigger condition is satisfied. In one aspect, the trigger condition can be the movement of the clamping element to a predetermined distance from the ultrasonic blade. In another aspect, the trigger condition may be the deviation of vc from a speed setpoint by a predetermined speed limit. In another aspect, the trigger condition may be the application of a clamping force in a predefined amount of a maximum clamping force Fmax.

[0028] Tissue treatment methods are also provided. In one embodiment, the method may include operating a surgical tool motor including a drive shaft and an end actuator. The end actuator can be formed at a distal end of the drive shaft and can have a clamping element and an ultrasonic blade coupled to an ultrasonic transducer. The clamping element can be movable in relation to the ultrasonic blade to a tissue clamping position between an open position and a closed position of the clamping element at a predetermined clamping speed (vc). The method can also include keeping vc at a first tightening speed (vc1) greater than a minimum tightening speed (vm) until a predetermined limit tightening force (Fs) is reached. The method may also include determining a closing parameter including at least one of the amount of time (tc) required to reach Fo and the amount of displacement of the clamping element dc required to reach Fo. The method may also include determining a tissue characteristic based on the closure parameter. The method may also include releasing energy to the ultrasonic sheet to treat tissue in a profiling treatment according to a profiling treatment protocol based on the determined tissue characteristic.

[0029] In another embodiment, Fo can be a force resulting from the contact of the clamping element with a tissue arranged between the clamping element and the ultrasonic blade.

[0030] In another modality, the profiling treatment can be effective to cauterize a tissue arranged between the clamping arm and the ultrasonic blade.

[0031] In another embodiment, the characteristic of the fabric can be a thickness of a fabric arranged between the clamping element and the ultrasonic sheet.

[0032] In another embodiment, the method may include determining the thickness of the tissue to be less than a predetermined thickness. The method can also include keeping vc at a third clamping speed (vc3) while a clamping force applied to the tissue arranged between the clamping arm and the ultrasonic blade is less than a second predetermined treatment force (F2). The method may also include decreasing the vc from vc3 to a fourth tightening speed (vcs) for the remainder of the profiling treatment in response to increasing the tightening force to F2, where u is configured to keep the tightening force below of F2. Each of vc3 and Vca can be approximately constant.

[0033] In another embodiment, the method may include determining the thickness of the tissue to be greater than a predetermined thickness and applying a first F1 treatment force to the tissue positioned between the clamping arm and the ultrasonic blade. The method can also include allowing you to decrease to a level approximately equal to vnin and increasing the first treatment force to a level between F; and a second F2 treatment force for the remainder of the treatment

profiling equipment. A F; it can be based on the specific characteristic of the fabric.

[0034] In another embodiment, the method may include the release of radiofrequency energy to a tissue arranged between the clamping element and the ultrasonic blade during the profiling treatment. An amplitude of each of the ultrasonic and radiofrequency energies can be approximately constant during the profiling treatment. The method may also include releasing at least one of ultrasonic energy and radiofrequency energy to treat the tissue in a seal treatment that occurs after profiling treatment according to a seal treatment protocol, with the seal treatment configured to coagulate and cut the fabric.

[0035] In another embodiment, the method may include performing the seal treatment in response to the detection that a pre-selected trigger condition is satisfied. In one aspect, the trigger condition can be the movement of the closing mechanism to a predetermined distance from the ultrasonic blade. In another aspect, the trigger condition may be the deviation of vc from a speed setpoint by a predetermined speed limit. In another aspect, the trigger condition can be the application of a clamping force in a predefined amount of a maximum clamping force Fmax-

[0036] In another exemplary embodiment, a surgical system is provided and may include a surgical tool, a closing mechanism, an engine and a control system. The surgical tool can include a drive shaft and an end actuator formed at a distal end of the tool. The end actuator can have a clamping element and an ultrasonic blade operatively coupled to an ultrasonic transducer. The clamping element can be movable in relation to the ultrasonic sheet to clamp the tissue arranged between the clamping element and the ultrasonic sheet, so that a first tissue treatment is carried out by energizing the ultrasonic sheet. The closing mechanism can be configured to selectively move the clamping element from an initial open position to a fabric clamping position. The motor can be operationally coupled to the closing mechanism. The control system can be in communication with the engine and can be configured to dynamically control a predetermined tissue clamping force applied to a tissue disposed between the clamping element and the ultrasonic blade within a desired range between a minimum treatment strength and maximum treatment strength during the first tissue treatment to respond to changes in tissue as a result of the first tissue treatment.

[0037] In another embodiment, the control system can be configured to control a position of the clamping element in response to receiving a commanded position when the clamping force applied to the fabric is less than the minimum treatment force and the clamping element is distant by more than a predetermined minimum quantity from the closed position.

[0038] In another embodiment, the control system can be configured to dynamically control the position of the clamping element to maintain the predetermined tissue clamping force when the clamping force applied to the fabric exceeds the minimum treatment force or the clamping element is spaced less than a predetermined minimum amount from the closed position. The control system can also be configured to control a motor torque within a predetermined range to maintain the tissue's clamping force within the desired range during the first tissue treatment. The control system can also be configured to control an amount of released to the engine to control the engine's torque.

[0039] In another embodiment, the system may include an electrode coupled to the clamping element and operationally coupled to a radio frequency generator. The electrode can be configured to provide a second tissue treatment to the tissue placed between the clamping element and the ultrasonic blade when receiving radio frequency energy from the radio frequency generator.

[0040] In another modality, the control system can be configured to determine a position of the clamping element in relation to the closed position and allow the release of less radio frequency energy than a predetermined energy limit at the time. electrode when the position of the clamping element is spaced more than a predetermined amount from the closed position.

[0041] In another mode, the control system can be configured to determine a position of the clamping element in relation to the closed position and allow the release of more radio frequency energy than a predetermined energy limit at the time. electrode when the position of the clamping element is spaced less than a predetermined amount from the closed position.

[0042] In another embodiment, the control system can be configured to determine a position of the clamping element in relation to the closed position and inhibit the release of more radio frequency energy than a predetermined energy limit at the time. electrode when the clamping element is spaced more than a predetermined minimum distance from the closed position. The control system can also be configured to trigger an alert to position the clamping element at a distance less than the minimum predetermined distance to allow more radio frequency energy to be released than the predetermined energy limit at the element.

trodo.

[0043] Tissue treatment methods are also provided. In one embodiment, the method may include operating a surgical tool motor including a drive shaft and an end actuator. The end actuator can be formed at a distal end of the drive shaft and can include a clamping element and an ultrasonic blade coupled to an ultrasonic transducer. The fastening element can be movable in relation to the ultrasonic blade for a tissue clamping position between an open position and a closed position of the clamping element in response to the motor acting. The method may also include adjusting the position of the clamping element using the motor to a first fabric clamping position where the clamping element applies a clamping force approximately equal to a predetermined minimum clamping force. The method can also include the transmission of ultrasonic energy from the ultrasonic transducer to the ultrasonic blade after the applied clamping force is greater than or equal to the minimum clamping treatment force. The method may also include adjusting the position of the clamping element using the motor to apply a target clamping force between the minimum treatment clamping force and a predetermined maximum clamping force while the ultrasonic energy is transmitted to the ultrasonic sheet.

[0044] In another embodiment, the method may include controlling a position of the clamping element in response to receiving a commanded position when the clamping force applied to the fabric is less than the minimum treatment force and the clamping element position is distanced by more than a predetermined minimum quantity from the closed position.

[0045] In another embodiment, the method may include dynamically controlling the position of the clamping element to maintain the target clamping force when the clamping force exceeds the minimum handling force or the clamping element is spaced by less than one predetermined minimum quantity from the closed position. The method can also include controlling a motor torque within a predetermined range to maintain the tissue clamping force within the desired range during the first tissue treatment. The method may also include controlling an amount of current released to the motor to control the torque of the motor.

[0046] In another embodiment, the method may include releasing radio frequency energy to an electrode attached to the clamping element.

[0047] In another embodiment, the method may include determining a position of the clamping element in relation to the closed position and releasing less radiofrequency energy than a predetermined energy limit on the electrode when the clamping element position is distanced by more than a predetermined amount from the closed position.

[0048] In another embodiment, the method may include determining a position of the clamping element in relation to the closed position and releasing more radiofrequency energy than a predetermined energy limit on the electrode when the clamping element is spaced less than a predetermined amount from the closed position.

[0049] In another embodiment, the method may include determining a position of the clamping element in relation to the closed position and inhibiting the release of more radio frequency energy than a predetermined energy limit on the electrode when the clamping element is further away than a predetermined minimum distance from the closed position. The method may also include triggering an alert to position the clamping element at a distance less than the minimum predetermined distance to allow a release of radio frequency energy greater than the predetermined energy limit at the electrode.

BRIEF DESCRIPTION OF THE DRAWINGS

[0050] The details of the disclosure can be more fully understood from the detailed description below taken in conjunction with the attached drawings, in which:

[0051] Figure 1 is a block diagram illustrating an exemplary mode of a robotic surgical system;

[0052] Figure 2 is a perspective view illustrating an exemplary modality of a controller of the robotic surgical system of Figure 1;

[0053] Figure 3 represents a perspective view illustrating an exemplary modality of a robotic arm carriage of the robotic surgical system of Figure 1;

[0054] Figure 4 is a perspective view illustrating an exemplary modality of a surgical instrument suitable for use with the robotic surgical system of Figure 1;

[0055] Figure 5 is a perspective view showing an underside of a base set of the surgical instrument of Figure 4;

[0056] Figure 6 is a perspective view illustrating exemplary modalities of an end actuator and an articulation section of the drive shaft assembly of the surgical instrument of Figure 4;

[0057] Figure 7 is an exploded view of the end actuator and the hinge section of Figure 6;

[0058] Figure 8 is a side cross-sectional view of the end actuator and the articulation section of Figure 6;

[0059] Figure 9 is a perspective view of the end actuator and the hinge section of Figure 6, omitting an outer sheath and the grip pad features, for clarity purposes;

[0060] Figure 10 is a cross-sectional view of the end actuator and the hinge section of Figure 6, taken along line 10-10 of Figure 8;

[0061] Figure 11 is a cross-sectional view of the end actuator and the articulation section of Figure 6 taken along line 11-11 of Figure 8;

[0062] Figure 12 is a perspective view of a proximal end of the drive shaft assembly of the surgical instrument of Figure 4;

[0063] Figure 13 is an exploded view of the proximal end of the drive shaft assembly of the instrument of Figure 4;

[0064] Figure 14 is a perspective view of the proximal end of the instrument of Figure 4, with the outer covering omitted;

[0065] Figure 15 is a top-down view of the proximal end of the instrument of Figure 4, with the outer covering omitted;

[0066] Figure 16 is an exploded view of the proximal end of the instrument of Figure 4, with the outer covering omitted;

[0067] Figure 17 is a side cross-sectional view of a proximal portion of the proximal end of the instrument in Figure 4, taken along line 17-17 in Figure 15;

[0068] Figure 18 is a side cross-sectional view of a distal portion of the proximal end of the instrument in Figure 4, taken along line 18-18 in Figure 15;

[0069] Figure 19 is a block diagram illustrating an exemplary mode of a control system suitable for use with the robotic surgical system of Figure 1;

[0070] Figure 20A is a schematic illustration of a vessel like an artery;

[0071] Figure 20B is a schematic illustration of the Figure 20A vessel after compression by an end actuator of a surgical instrument;

[0072] Figure 20B is a schematic illustration of the Figure 20B vessel during the application of ultrasonic energy to cut the void;

[0073] Figure 21 is a graph of exemplary modalities of a treatment protocol implemented by the control system of Figure 19 that is suitable for use with the end actuator of Figure 6 to inhibit tissue adhesion to the ultrasonic sheet; (Part A) clamping forces applied to the fabric by the clamping element as a function of time; (Part B) ultrasonic amplitude applied to the ultrasonic blade as a function of time;

[0074] Figure 22 is a graph of another exemplary mode of controlling the end actuator of Figure 6 by the control system of Figure 19 illustrating the clamping forces (Part A) and the amplitude of ultrasonic energy supplied to the ultrasonic blade (Part B) as a function of time;

[0075] Figure 23 is a graph of another exemplary mode of controlling the end actuator of Figure 6 by the control system of Figure 19 illustrating the amplitude of the relative ultrasonic energy that can be applied to a pivoting end actuator in function the articulation angle;

[0076] Figure 24A is a side view of another example of an end actuator that includes a clamping element, an ultrasonic blade and one or more radio frequency (RF) electrodes;

[0077] Figure 24B is another side view of the end actuator of Figure 24A;

[0078] Figure 24C is a sectional view in perspective of the actu

end adapter of Figures 24A-24B;

[0079] Figure 25 is a graph of another exemplary mode of controlling the end actuator of Figures 24A-24C by the control system of Figure 19 illustrating the clamping force applied to a fabric as a function of displacement;

[0080] Figure 25 is a flow chart illustrating an exemplary modality of a method for fine control of the closure of the end actuator of Figures 24A-24C implemented by the control system of Figure 19;

[0081] Figure 26 is a graph of an exemplary modality of motor torque as a function of the displacement of the claw member according to the method of Figure 25;

[0082] Figure 27 is a graph of another exemplary mode of controlling the end actuator of Figures 24A-24C by the control system of Figure 19 illustrating the displacement of the clamping element (part A) and the force of tightness applied to a fabric (part B) as a function of time;

[0083] Figure 28 is a graph of an exemplary modality of the tightening, profiling, cutting and opening operations carried out by the end actuator of Figures 24A-24C under the control of the control system of Figure 19; The amplitudes of ultrasonic energy and radiofrequency delivered to the end actuator as a function of time (Part A); The clamping forces applied to a fabric by the claw member under load control as a function of time (Part B), the speed of the claw member under load control as a function of time (Part C);

[0084] Figure 29 is a graph of an exemplary mode of controlling the end actuator of Figures 24A-24C by the control system of Figure 19; The clamping forces applied to a fabric by the claw member under load control as a function of

po (Part A), the speed of the claw member under load control as a function of time (Part B); and

[0085] Figure 30 is a graph of an alternative mode of controlling the end actuator of Figures 24A-24C by the control system of Figure 19; The clamping forces applied to a fabric by the claw member under position control over time (Part A), the speed of the claw member under position control over time (Part B).

DETAILED DESCRIPTION

[0086] Certain exemplifying modalities will now be described to provide a general understanding of the principles of structure, function, manufacture and use of the devices and methods reviewed here. One or more examples of these modalities are illustrated in the attached drawings. Those skilled in the art will understand that the devices, systems and methods specifically described in the present invention and illustrated in the accompanying drawings are non-limiting exemplary modalities, and that the scope of the present invention is defined solely by the claims. The resources illustrated or described in relation to an exemplary modality can be combined with the resources of other modalities. Such modifications and variations are intended to be included in the scope of the present invention.

[0087] Additionally, in the present disclosure, components with the same names in the modalities have, in general, similar resources and, therefore, in a particular modality, not all the resources of each component with the same names are necessarily described in detail. . In addition, when linear or circular dimensions are used in describing the systems, devices and methods disclosed, these dimensions are not intended to limit the types of format that can be used in conjunction with such systems, available

and methods. One skilled in the art will recognize that an equivalent to such linear and circular dimensions can easily be determined for any geometric shape. The sizes and formats of the systems and devices, and their components, may depend on the anatomy of the individual in which the systems and devices will be used, the size and shape of components with which the systems and devices will be used, and the methods and procedures in which the systems and devices will be used.

[0088] It will be recognized that the terms "proximal" and "distal" are used here with reference to a user, for example a doctor, who holds the handle of an instrument. Other spatial terms such as "front" and "rear" correspond similarly to distal and proximal, respectively. It will also be understood that, for convenience and clarity, spatial terms such as "vertical" and "horizontal" are used in the present invention in relation to drawings. However, surgical instruments are used in many orientations and positions, and such spatial terms are not intended to be limiting and absolute.

[0089] In general, modalities of surgical systems are provided and can include at least one electromechanical tool that has an end actuator and a control system. The end actuator can be designed to cut fabric, for example, a single cutting blade or a pair of cutting blades, or to dry fabric. Depending on the design of the end actuator, the surgical system can include one or more motors that drive the electromechanical tool and / or one or more generators (for example, ultrasound, radio frequency, etc.) can be configured to provide energy to the tissue for treatment.

[0090] The control system modalities can be configured to execute protocols that facilitate tissue treatments

(for example, tightening, cutting, cauterization, etc.) by implementing limits and triggers on the monitored parameters of a coupling fabric of the end actuator. Examples of monitored parameters may include, but are not limited to, the tightening forces applied to the fabric, tightening speed, tightening displacement and energy supplied to the end actuators for tissue treatment. As discussed in greater detail below, these control protocols can compensate for reduced tactile feedback and ensure that tissue treatments are performed properly. Overview of the exemplary robotic surgical system

[0091] Figure 1 illustrates an exemplary modality of a robotic surgical system 10. As shown, system 10 comprises at least one controller 14 and at least one arm car

18. The arm carriage 18 can be mechanically and / or electrically coupled to one or more manipulators or robotic arms 20. Each robotic arm 20 comprises one or more surgical instruments 22 to perform various surgical tasks on a patient 24. The operation of the carriage arm 18, including arms 20 and surgical instruments 22, can be directed by a user 12 (for example, a clinician) from the controller 14.

[0092] Optionally, the modalities of the system 10 can also include a second controller 14 'that is configured for operation by a second user 12'. The second controller 14 'can guide the operation of the carriage of the arm 18 together with the first user 12'. For example, each of the users 12, 12 'can control different arms 20 from the arm 18 carriage or, in some cases, complete control of the arm 18 carriage can be passed between users 12, 12º. In certain embodiments, additional arm cars (not shown) can be used on the patient 24. These additional arm cars can be controlled by one or more of the controllers.

res (14, 14 ').

[0093] The arm cars 18 and the controllers 14, 14 'can be in communication with each other through a communication link 16, which can be any suitable type of wired and / or wireless communication link carrying any suitable type signal (eg electrical, optical, infrared, etc.) according to any suitable communication protocol. Communication link 16 can be a real hard link or it can be a logical link that uses one or more real hard links. When the link is, for example, a logical link, the type of physical link can be a data link, an up link, a down link, a fiber optic link, or a point-to-point link.

[0094] Figure 2 is a perspective view illustrating an exemplary mode of a controller 30 that can serve as a controller 14 of system 10. In this example, controller 30 generally includes a user input set 32 that it has user precision input capabilities (not shown) that can be held by the user and manipulated in space while the user sees the surgical procedure through a screen 34 (for example, a stereoscopic screen). Screen 34 can show views from one or more endoscopes that visualize the surgical site within the patient and / or any other suitable view (s). In addition, a feedback gauge 36 can be viewed through screen 34 and provides the user with a visual indication of the amount of force being applied to a component of the surgical instrument 22 (for example, a cutting member or clamping member, etc.).

[0095] The user input features of user input set 32 can also include manual input devices that move with multiple degrees of freedom to intuitively activate the tools (for example, to close the pressure saws) , apply an electrical potential to an electrode, etc.). As an example,

For example, manual input devices may include actuating handles and / or switch pedals. As shown in Figure 2, controller 30 can include one or more switch pedals 38 that are configured to provide additional control of arms 20 and surgical instruments 22 to the user. Other sensor arrangements can be employed to provide the controller 30 with one or more indications related to the operating conditions of the surgical instrument 22.

[0096] Controller modalities 30 may also include a control system 39 configured to control the movement and performance of one or more of the instruments 22. For example, control system 39 may include at least one computer system that can include components (for example, one or more processors) that are configured to perform one or more logic functions in relation to a program stored in memory attached to the processor. For example, the processor can be coupled to the user input set 32 and can be configured to receive the detected information, aggregate it and compute the results based at least in part on the detected information. These results can be transmitted to the motors of the instruments 22 to control the instruments 22 during use, as discussed in more detail below.

[0097] Figure 3 is a perspective view illustrating an exemplary modality of a robotic arm carriage 40 that can serve as an arm carriage 18 of the system 10. In this example, the arm carriage 40 can be configured to act a plurality of surgical instruments 50. Although three instruments 50 are shown in the present example, it should be understood that the arm carriage 40 can be operable to support and act on any suitable number of surgical instruments 50. Each of the surgical instruments 50 can be supported by a series of manually articulated connections, generically called assembly joints 44 and a robotic manipulator 46. These structures are illustrated in the present invention with protective coatings that extend over a good part of the robotic connection. These protective covers can be optional, and can be limited in size or eliminated entirely in some versions to minimize the inertia that can be found by the servo mechanisms used to manipulate such devices, to limit the volume of the moving components in order to to avoid collisions, and to limit the total weight of the armrest 40.

[0098] Each robotic manipulator 46 terminates on an instrument platform 70 that can be pivoting, rotating and otherwise movable by the robotic manipulator 46. Each platform includes an instrument dock 72 that is slidable along a pair of tracks 74 to additionally position the instrument 50. Such a slide can be motorized in the present example. Each dock of instrument 72 can also include electrical and mechanical interfaces that can be coupled with an interface set 52 of instrument 50. For example, dock 72 can include four swivel outlets that couple with complementary swivel inputs to the interface set

52. Such rotation-driven features can trigger various functionalities in the instrument 50, as described in various references cited in the present invention and / or described in more detail below. Electrical interfaces can establish communication through physical contact, inductive coupling and / or otherwise; and may be operable to supply electrical power to one or more resources in the instrument 50, to provide commands and / or to communicate data to the instrument 50, and / or to provide commands and / or data communication to the instrument 50. Various forms through which the instrument dock 72 can communicate, mechanically and electrically

specifically, with an interface set 52 of an instrument, it will be evident to those skilled in the art in view of the teachings of the present invention. It should also be understood that the instrument 50 may include one or more cables that couple with a separate power source and / or control unit, to provide power communication and / or commands / data to / from the instrument 50.

[0099] The arm carriage 40 can also include a base 48 that can be movable (for example, by a single assistant to selectively position the arm carriage 40 in relation to a patient). The trolley 40 can generally have adequate dimensions to transport the trolley 40 between the operating rooms. The trolley 40 can be configured to fit through standard operating room doors and standard hospital elevators. In some versions, an automated instrument refill system (not shown) can also be positioned at or near the working envelope 60 of the arm carriage 40 to selectively refill the components (eg, staple cartridges, etc.) of the instru - 50 minutes.

[0100] In addition to the above, it can be understood that one or more aspects of system 10 can be constructed in accordance with the teachings of one or more of U.S. Patent No. 5,792,135; U.S. patent No. 5,817,084; U.S. patent No. 5,878,193; U.S. patent No. 6,231,565; U.S. patent No. 6,783,524; U.S. patent No. 6,364,888; U.S. patent No.

7,524,320; U.S. Patent No. 7,691,098; U.S. patent No. 7,806,891; U.S. Patent No. 7,824,401; and / or US publication No. 2013/0012957. The disclosures of each of the U.S. patents and the aforementioned U.S. patent publication are incorporated by reference in their entirety. Still other suitable features and operability that can be incorporated into the system 10 will be evident to those skilled in the art in view of the teachings of the present invention.

[0101] Although aspects of the disclosure are explained here in the context of a robotic surgical system, it should be understood that the present disclosure is also applicable to powered and non-robotic surgical systems. Il. Ultrasonic surgical instrument with articulation feature

[0102] Ultrasonic surgical instruments are finding increasingly widespread applications in surgical procedures due to the unique performance characteristics of these instruments. Depending on the specific settings of the instrument and the specific operational parameters, ultrasonic surgical instruments can substantially provide simultaneously or almost simultaneously the cut and hemostasis by clotting, desirably minimizing trauma to the patient. Surgical ultrasonic instruments of this nature can be configured for open surgical use, endoscopic or laparoscopic surgical procedures, including procedures controlled by robotics.

[0103] Figures 4 to 18 are schematic diagrams illustrating a modality of an ultrasonic surgical instrument 100 that can be used as at least one instrument 50 in system 10. At least part of the instrument (100) can be constructed and operable from according to the teachings of one or more of US patent no.

5,322,055; U.S. patent No. 5,873,873; U.S. patent No. 5,980,510; US patent No. 6,325,811; U.S. patent No. 6,783,524; U.S. patent No.

8,461,744, U.S. Patent No. 9,023,071, U.S. Patent No. 9,095,367, U.S. Patent No. 9,393,037, U.S. Publication No. 2006/0079874; US publication No. 2007/0191713; US publication No. 2007/0282333; US publication No. 2008/0200940; and / or U.S. patent application No. 61 / 410,603. Each of the aforementioned patents, publications and applications is incorporated by reference in its entirety. As described here and in more detail below, the instrument 100 can be configured to cut tissue, coagulate tissue and seal or weld tissue (e.g., blood vessels) substantially simultaneously. In other words, the instrument 100 operates similarly to a type of cutter stapler, except that the instrument 100 makes it possible to weld fabric by applying ultrasonic vibrational energy instead of providing staple lines to join fabric together. - From.

[0104] Ultrasonic vibrational energy can separate tissue similar to the cut of the tissue by a converter blade positioned at the distal end of the surgical instrument. Vibrating at high frequencies (for example, about 55,500 times per second), the ultrasonic blade can denature proteins in the tissue to form a sticky clot. The pressure exerted on the tissue by the surface of the slide can collapse the blood vessels and allow the clot to form a hemostatic seal. The precision of the cut and coagulation can be controlled by the surgeon's technique and by adjusting one or more of the amplitude of the ultrasonic vibrations, the edge of the blade, the tissue traction and the pressure of the ultrasonic blade.

[0105] As an example, the instrument 100 can have several structural and functional similarities with the HAR-MONIC ACEG ultrasonic scissors, with the HARMONIC WAVEO ultrasonic scissors, with the HARMONIC FOCUSO ultrasonic scissors and / or with the HARMONIC ultrasonic slides SYNERGYO. In addition, instrument 100 may have various structural and functional similarities with the devices taught in any of the other references cited and incorporated for purposes of reference to the present invention.

[0106] As shown in Figure 4, instrument 100 includes an interface assembly 200, a drive shaft assembly 110, a pivot section 130 and an end actuator 150. Interface assembly 200 can be configured to couple with the instrument dock 72 of the robotic arm carriage 40 and can be configured to drive hinge section 130 and end actuator 150 as described in more detail below. As is also described in more detail below, instrument 100 can be configured to articulate end actuator 150 to provide a desired position in relation to the tissue (eg, a large blood vessel, etc.), and then , apply ultrasonic vibrational energy and / or RF energy to the tissue with 150 end actuator to thereby cut, coagulate and seal the tissue.

[0107] Instrument 100 includes an ultrasonic transducer 120, which can be operable to convert electrical energy into ultrasonic vibrations. In some cases, the ultrasonic transducer 120 can receive power directly through the dock 72. In some other cases, the transducer 120 may include a cable 302 that directly couples the ultrasonic transducer 120 with a generator 300. The generator 300 can include a power source and a control module that can be configured to provide a power profile to transducer 120, which is particularly suitable for generating ultrasonic vibrations through transducer 120. Optionally, generator 300 may also be suitable for RF energy generation.

[0108] In some embodiments, generator 300 may include a GEN 300 sold by Ethicon Endo-Surgery, Inc., of Cincinnati, Ohio, USA. In addition or alternatively, the generator 300 can be built in accordance with at least some of the teachings of US patent No. 8,986,302, entitled "Surgical Generator for Ultrasonic and Electrosurgical Devices", published on April 14, 2011, whose review - lation is incorporated by reference in its entirety. Still other suitable forms that the generator 300 can take, as well as the various features and operabilities that the generator 300 can provide, will be apparent to those commonly skilled in the art in view of the teachings in the present invention.

[0109] In some embodiments, at least part of the functionality of the generator 300 can be incorporated directly into the interface set 200. As an example, the interface set 200 may include an integral battery or other integral power source, as well as any circuit required to condition the energy of a battery or other integral power source to drive the ultrasonic transducer 120. A. Acoustic transmission system and end actuator

[0110] As shown in Figures 6 to 8, end actuator 150 can include a clamping arm 152 and an ultrasonic blade 160. Clamping arm 152 includes a clamping pad 154 that is attached to the underside of the clamping pad 152, facing the ultrasonic blade 160. The clamping arm 152 can be hingedly attached to a tongue that projects distally 133 (Figures 7-8) of a first portion of the body provided with ribs 132. The first ribbed portion of the body 132 may form part of the hinge section 130, as described in more detail below. The clamping arm 152 is operable to selectively pivot towards and away from the ultrasonic blade 160 to selectively clamp the fabric between the clamping arm 152 and the ultrasonic blade

160. A pair of arms 156 extends transversely to a clamping arm 152 and is attached to a pin 170 that extends laterally between arms 156. A rod 174 is attached to pin 170. Rod 174 extends distally from a closing tube 176 and is attached to the closing tube 176.

[0111] A drive ring 178 can be attached to the proximal end of the closing tube 176. In particular, and as shown in Figure 13, the proximal end of the closing tube 176 can include a transverse opening 177 that can be configured to align with a transverse opening 179 of the drive ring 178. The openings 177, 179 are configured to receive a pressure screw (not shown) or other feature that can attach the drive ring 178 to the closing tube 176. The drive ring 178 is slidable and coaxially arranged around the outside of the outer sheath 112; while the closing tube 176 is slidable and coaxially arranged inside the outer sheath 112. However, the outer sheath 112 may include a longitudinally extending slot 114 that can be configured to receive the pressure screw and can secure drive ring 178 to closure tube 176. In this way, slot 114 can allow drive ring 178 and closure tube 176 to move together in relation to outer sheath 112. The positioning of the pressure screw in the slot 114 can also provide rotation of the closing tube 176 and the drive ring 178 about the longitudinal geometric axis of the outer sheath 112 when the outer sheath 112 is rotated around its longitudinal geometric axis, as described in more detail below .

[0112] As is also described in more detail below, interface assembly 200 may include features that are operable to drive drive ring 178, closure tube 176 and stem 174 longitudinally with respect to outer sheath 112 and with respect to to the hinge section 130. It can be understood that this translation of the drive ring 178, the closing tube 176, and the stem 174 can provide the articulation of the clamping arm 152 towards the ultrasonic blade 160 when the ring 178, the tube 176 and stem 174 are translated proximally; or away from the ultrasonic blade 160 when ring 178, tube 176 and stem 174 are translated distally. The stem 174 can be sufficiently flexible

flexible to flex with hinge section 130. However, stem 174 may have sufficient tensile and compressive strength to drive clamping arm 152 when stem 174 is moved, regardless of whether hinge section 130 is in a straight or folded configuration.

[0113] As shown in Figures 7-8, a leaf spring 172 is captured between the clamping arm 152 and the clamping pad 154 and is contiguous with the distal face of the tongue 133. The leaf spring 172 can be resiliently forced to drive the clamping arm 152 in the opposite direction of the ultrasonic blade 160 to the open position, as shown in Figures 4, 6 and 8. Therefore, the leaf spring 172 can additionally polarize the tube 176 and the stem 174 distally. Obviously, like other components described in the present invention, leaf spring 172 can be omitted, if desired. In addition, the clamping arm 152 and the clamping pad 154 can be omitted, if desired.

[0114] Ultrasonic blade modalities 160 can be configured to vibrate at ultrasonic frequencies to effectively cut and seal the fabric, particularly when the fabric is being clamped between the grip pad 154 and the ultrasonic blade 160. To the ultrasonic blade 160 it can be positioned at the distal end of an acoustic transmission system.

[0115] This acoustic transmission system includes the ultrasonic transducer 120, a rigid acoustic waveguide 180 and a flexible acoustic waveguide 166. As can best be seen in Figures 5 and 12-17, the ultrasonic transducer 120 includes a set of piezoelectric discs 122 located next to a horn 182 of the rigid acoustic waveguide 180. The piezoelectric discs 122 are positioned coaxially along a proximally extending screw 181, which is a unitary feature of the acoustic waveguide

180 located next to horn 182. A continuous nut is attached to screw 181, thus attaching piezoelectric disks 122 to the rigid acoustic waveguide 180. As noted above, piezoelectric disks 122 are operable to convert electrical energy in ultrasonic vibrations, which are then transmitted along the rigid acoustic waveguide 180 to the ultrasonic blade 160. The rigid acoustic waveguide 180 is illustrated in Figures 13 and 17-18. As shown in Figure 13, the rigid acoustic waveguide 180 includes a transverse opening 186 that complements a transverse opening 118 formed in the outer sheath 112. A pin 184 is arranged in the openings 118, 186 to couple the outer sheath 112 with the rigid acoustic waveguide 180. This coupling provides the rotation of the acoustic waveguide 180 and the rest of the acoustic transmission system around the longitudinal geometric axis of the outer sheath 112 when the outer sheath 112 is rotated about its axis longitudinal geometric pattern, as will be described in more detail below. As an example, aperture 186 may be located in a position corresponding to a node associated with the resonant ultrasonic vibrations communicated through the rigid acoustic waveguide 180.

[0116] The rigid acoustic waveguide 180 ends distally in a coupling 188 which can be seen in Figures 8-11 and 13. Coupling 188 is attached to coupling 168 by a double threaded screw 169. Coupling 168 is located at the proximal end of the flexible acoustic waveguide 166. As shown in Figures 7-11, the flexible acoustic waveguide 166 includes a distal flange 136, a proximal flange 138 and a narrower section 164 located between flanges 138 As an example, flanges 136, 138 are located in positions corresponding to nodes associated with the resonant ultrasonic vibrations communicated through the

of flexible acoustics 166. The narrower section 164 can be configured to allow the flexible acoustic waveguide 166 to flex without significantly affecting the ability of the flexible acoustic waveguide 166 to transmit ultrasonic vibrations. The narrowed section 164 can be configured according to one or more of the teachings of US patent application No. 13 / 538,588 and / or US patent application No. 13 / 657,553, each of which is incorporated herein by way of reference in its totalities. Any of the waveguides 166, 180 can be configured to amplify the magnetic vibrations transmitted through the waveguides 166, 180. In addition, any of the waveguides 166, 180 can include operable features to control the gain of longitudinal vibrations along the waveguide 166, 180 and / or resources to adjust the waveguides 166, 180 to the resonance frequency of the system.

[0117] The distal end of the ultrasonic blade 160 may be located in a position corresponding to an antode associated with resonant ultrasonic vibrations communicated through a flexible waveguide 166 in order to adjust the acoustic set to a preferred resonant frequency f, when the acoustic set is not carried by the fabric. When the ultrasonic transducer 120 is powered, the distal end of the ultrasonic blade 160 can be configured to move longitudinally in the range of, for example, approximately 10 to 500 microns from peak to peak and, in some cases, in the range of about 20 microns to about 200 microns at a predetermined vibrating frequency fo (for example, about 55.5 kHz). When the ultrasonic transducer 120 is activated, these mechanical oscillations are transmitted through the waveguides 180, 166 to reach the ultrasonic blade 160, thus causing the ultrasonic blade 160 to oscillate at the resonant ultrasonic frequency. Therefore, when the tissue is fixed between the ultrasonic blade (160) and the squeeze pad (154), the ultrasonic oscillation of the ultrasonic blade 160 can simultaneously cut the tissue and denature the proteins in the cells of the adjacent tissue, providing thus, a coagulant effect with relatively little thermal propagation. In some versions, an electric current can also be supplied through the ultrasonic blade 160 and the clamping arm 152 to also cauterize the tissue.

[0118] Although some configurations for an acoustic transmission set and ultrasonic transducer 120 have been described, other configurations suitable for an acoustic transmission set and ultrasonic transducer 120 will be evident for a person skilled in the art based on the teachings of the present invention. Similarly, other configurations suitable for end actuator 150 will be apparent to those skilled in the art based on the teachings of the present invention. B. Exemplary drive shaft assembly and pivot section

[0119] The drive shaft assembly 110 can extend distally from the interface assembly 200. Pivot section 130 can be located at the distal end of the drive shaft assembly 110, with end actuator 150 being located distally to the hinge section 130. The drive shaft assembly 110 may include an outer sheath 112 that surrounds the drive features and acoustic transmission features described above that couple interface assembly 200 with the frame section. link 130 and the end actuator 150. The drive shaft assembly 110 can be rotatable around the longitudinal axis defined by the outer sheath 112, in relation to the interface assembly 200. Such rotation can provide the rotation of the actuator of end 150, hinge section 130 and drive shaft assembly 110 unitarily. Of course, rotating resources can simply be omitted, if desired.

[0120] The hinge section 130 is operable to selectively position the end actuator 150 at various lateral deflection angles in relation to the longitudinal geometric axis defined by the outer sheath 112. The hinge section 130 can assume a variable variety of forms. As an example, hinge section 130 can be configured in accordance with one or more of the teachings of U.S. Patent Publication No. 2012/0078247, the entirety of which is hereby incorporated by reference. Alternatively or additionally, hinge section 130 can be configured in accordance with one or more of the teachings of US patent application No. 13 / 538,588 and / or US patent application No. 13 / 657,553, each of which is incorporated herein as a reference in its entirety. Various other suitable forms that can be assumed by hinge section 130 will become apparent to those skilled in the art in view of the teachings of the present invention. It should also be understood that some versions of the instrument 100 may omit the articulation section 130.

[0121] As shown in Figures 6 to 11, the hinge section 130 may include the first portion of the ribbed body 132 and a second portion of the ribbed body 134, with a pair of pivot bands 140, 142 extending through the channels defined at the interfaces between the ribbed body portions 132, 134. The ribbed body portions 132, 134 are substantially positioned longitudinally between the flanges 136, 138 of the flexible acoustic waveguide 166 The distal ends of the hinge strips 140, 142 can be unitary to the distal flange 136. The hinge strips 140, 142 also pass through the proximal flange 138, yet the hinge strips

140, 142 can be slidable in relation to the proximal flange 138.

[0122] The proximal end of the articulation strip 140 can be fixed to a first drive ring 250; while the proximal end of the pivot band 142 can be attached to a second drive ring 251. As shown in Figures 13 and 17, the first drive ring 250 includes an annular flange 252 and an anchor feature that projects 254 inward; while the second drive ring 251 also includes an annular flange 253 and an inwardly protruding anchor feature 255. The proximal end of the pivot band 140 can be securely retained within the anchor feature 254 while the proximal end of the articulation strip 142 can be fixedly retained within the anchor feature 255. The drive rings 250, 251 can be slidably arranged around the proximal end of the outer sheath 112. The outer sheath 112 may include a pair of longitudinally extending strands 116, 117 that are configured to receive anchor features 254, 255. Slots 116, 117 can allow drive rings 250, 251 to move in relation to the outer sheath 112. The positioning of the anchor features 254, 255 in the slots 116, 117 can also provide for the rotation of the rings 250, 251 and the articulation bands 140, 142 about the longitudinal geometric axis of the hem the outer 112 when the outer sheath 112 is rotated about its longitudinal geometric axis, as described in more detail below.

[0123] As described in more detail below, the interface assembly 200 is operable to selectively pull one of the articulation strips 140, 142 proximally, by pulling proximally the drive ring 250; While simultaneously allowing the other of the articulation strips 140, 142 and the drive ring 251 to travel distally. It should be understood that, as one of the articulation strips 140, 142 is pulled proximally, this will cause the articulation section 130 to bend, thereby deflecting the end actuator laterally 150 in the direction opposite to the longitudinal geometric axis of the assembly drive shaft 110 at a pivot angle. In particular, the end actuator 150 will be pivoted towards one of the pivot bands 140 and 142 which is being pulled proximally. During such articulation, the other of the articulation strips 140, 142 will be pulled distally by the flange

136. The ribbed body portions 132, 134 and the narrower section 164 can all be flexible enough to accommodate the end actuator joint 150 described above. C. Exemplary robotic arm interface set

[0124] Interface set 200 is illustrated in more detail in Figures 5 and 14-18. As shown, interface assembly 200 comprises a base 202 and a housing 204. For clarity, housing 204 is shown only in Figure 4 and is omitted from Figures 5 and 14-18. Housing 204 may include a housing that contains drive components. In certain embodiments, housing 204 may also include an electronic circuit board, an integrated circuit and / or other features that can be configured to identify instrument 100.

[0125] Base 202 is configured to engage dock 72 of robotic arm carriage 40. Although not shown, it should be understood that base 202 may also include one or more electrical contacts and / or other operable features to establish electrical communication with the complementary features of the dock 72. A drive shaft support structure 206 extends upward from the base 202 and can provide support for the drive shaft assembly 110 while still allowing the drive shaft assembly 110 rotate. As an example only, the drive shaft support structure 206 can include a cushion, bearings and / or other features that facilitate the rotation of the drive shaft assembly 110 in relation to the support structure 206.

[0126] As shown in Figure 5, base 202 additionally includes three drive disks 220, 240, 260 that are rotatable with respect to base 202. Each of disks 220, 240, 260 includes a respective pair of unit pins 222, 242, 262 that are coupled with the complementary recesses not shown in the drive elements of dock 72. In certain embodiments, a pin 222, 242, 262 of each pair may be closer to the corresponding axis of rotation of the corresponding disk 220 , 240, 260 to ensure the adequate angular orientation of the discs 220, 240, 260 in relation to the corresponding drive element of the dock 72.

[0127] As shown in Figures 14-16, a drive shaft 224, 244, 264 extends upwardly from each of the disks 220, 240, 260. As described in greater detail below, the discs 220, 240, 260 can be independently operable to provide independent rotation of the drive shaft 110, flexion of the hinge section 130 and translation of the closing tube 176 through independent rotation of the drive axes 224, 244, 264. Base 202 may also include an idle disk 280, which does not rotate or drive any components. A pair of fixed pivot pins 282, 284 can extend upwardly from disk 280.

[0128] As shown in Figures 14-16, a first helical gear 226 can be fixedly attached to the drive shaft 224, so that the rotation of the corresponding disk 220 provides the rotation of the first helical gear 226 The first helical gear 226 engages a second helical gear 230, which is fixedly attached to the sleeve 232. The sleeve 232 is uni-

fixed to the outer sheath 112. In this way, the rotation of the first helical gear 226 provides the rotation of the drive shaft assembly 110. The rotation of the first helical gear 226 around a first geometry axis is converted into the route - tion of the second helical gear 230 around a second geometry axis, which can be orthogonal to the first geometry axis. A clockwise rotation (CW) of the second helical gear 230 (seen from the top down) can result in the CW rotation of the drive shaft assembly 110 (seen from the distal end of the drive shaft assembly 110) towards proximal end of drive shaft assembly 110, depending on the thread orientation of helical gears 226, 230. An anti-clockwise rotation (CCW) of the second helical gear 132 (seen from top to bottom) can result in the CCW rotation of the drive shaft assembly 110 (seen from the distal end of the drive shaft assembly 110) towards the proximal end of the drive shaft assembly 110, again depending on the thread orientation of the helical gears 226, 230 It should be understood, therefore, that the drive shaft assembly 110 can be actuated by rotating the drive shaft 224. Other suitable ways in which the drive shaft assembly 110 can be g will be evident to those skilled in the art in view of the teachings of the present invention.

[0129] As shown in Figures 14-16, a pair of cylindrical cams 246, 248 is fixedly attached to the drive shaft 244, so that the rotation of the corresponding disc 240 provides the rotation of the cams 246, 248. The Cams 246, 248 can be individually mounted eccentrically to the drive shaft 244, so that the longitudinal geometric axes of the cams 246, 248 are offset, even though parallel, to the longitudinal geometric axis of the drive shaft 244. In addition , the cams 246, 248 can be deflected in an opposite way, so that the cams 246, 248 project laterally in relation to the driving axis 244 in opposite directions. Cams 246, 248 can be positioned to direct the articulated arms 286, 288. The articulation arm 286 can be pivotally coupled with the pivot pin 282; while the articulated arm 288 can be pivotally coupled with the pivot pin 284. The first drive ring 250 can pass through an opening 287 formed through the first drive arm 286; while the second drive ring 251 can pass through an opening 289 formed through the second drive arm 288. Flanges 252, 253 can individually have an outside diameter that can be larger than the inside diameter of the opening corresponding 287, 289. Flanges 252, 253 can thus restrict the distal movement of rings 250, 251 in relation to the respective drive arms 286, 288.

[0130] As the drive shaft 244 is rotated, one of the chambers 246, 248 will push proximally over the corresponding arm 286, 288, depending on the placement of these components and the angular position of the cams 246, 248 at the time of rotation. In some cases, cam 246 can drive arm 288 proximally, so that arm 288 rotates CCW (seen from top to bottom) around pin 284. Arm 288 will rest on flange 253 during such pivoting, thus pulling ring 251 and pivot band 142 proximally. This proximal movement of the pivot band 142 will cause the pivot section 130 to flex, with the end actuator 150 deflected in the direction of the band 142. This flexion of the pivot section 130 will pull the pivot band 140 apart, which in turn will push ring 250 and its flange 252 apart. The distal movement of the flange 252 will drive the arm 286 distally, so that the arm 286 rotates in CW (seen from the top down) around the pin 282. The cam 248 can be oriented to allow this distal rotation of the arm 286. As the drive shaft 244 continues to rotate, or if the drive shaft 244 rotates in the opposite direction, the push and pull action above will eventually be reversed. In other words, cam 248 can drive arm 286 proximally while cam 246 can allow arm 288 to rotate distally while flexing hinge section 130 to provide deflection of end actuator 150 towards band 140. it is understood, therefore, that the hinge section 130 can be actuated by rotating the drive shaft 244. Other suitable ways in which the hinge section 130 can be actuated will be evident to those skilled in the art in view of the teachings of the present invention.

[0131] As shown in Figures 14-16, a cylindrical cam 266 can be fixedly attached to the drive shaft 264, so that the rotation of the corresponding disc 260 can provide rotation of the cam 266. The cam 266 can be eccentrically mounted 264 to the drive shaft 264, so that the longitudinal geometry axis of the cam 266 can also be moved parallel to the longitudinal geometric axis of the drive shaft 264. The cam 266 can be arranged in an oblong opening 272 formed through a rack 270, which can be moved in relation to the base 202. The rack 270 includes a fork 274 that extends laterally. The fork 274 can be arranged in an annular recess 278 of the drive ring 178, which can be attached to the closing tube 176 as noted above. The configuration of the cam 266 and the configuration of the opening 272 can provide a relationship so that the rack 270 translates longitudinally in response to the rotation of the drive shaft 264 and the cam 266. This translation of the rack 270 can provide the translation the closing tube 176 due to the engagement between the fork 274 and the driving ring 178; and the engagement between the drive ring 178 and the closing tube 176. The clamping arm 152 can be selectively driven in the opposite direction or towards the ultrasonic blade 160 by rotating the driving shaft 264. Other suitable ways in which the clamping arm 152 can be actuated will be apparent to members skilled in the art in view of the teachings of the present invention. D. Example operation

[0132] In use, the arm carriage 40 can be used to insert the end actuator 150 into a patient through a trocar. The pivot section 130 can be substantially straight, and the clamping arm 152 can be pivoted towards the ultrasonic blade 160, when the end actuator 150 and part of the drive shaft assembly 110 are inserted through the trocar. The drive shaft 224 can be rotated using drive resources on the dock 72 which are coupled with the corresponding disk 220 to position the end actuator 150 in a desired angular orientation with respect to the fabric. The drive shaft 244 can then be rotated through the drive resources on the dock 72 which are coupled with the corresponding disc 240, to pivot or flex the pivot section 130 of the drive shaft assembly 110 to position the end actuator. 150 in a desired position and orientation in relation to an anatomical structure within the patient. The drive shaft 264 can then be rotated through the drive resources on the dock 72, which are coupled with the corresponding disk 260 to articulate the clamping arm 152 in the opposite direction of the ultrasonic blade 160, thereby effectively opening the end actuator 150.

[0133] The tissue of the anatomical structure can then be captured between the clamping pad 154 and the ultrasonic blade 160 by rotating the drive shaft 264 to advance the closing tube 176 distally, by activating the drive resources at dock 72 which are coupled with the corresponding disc 260. In some cases, this may involve squeezing two layers of tissue to form part of a natural lumen defining an anatomical structure (for example, a blood vessel, portion of the gastrointestinal tract, for example - tion of the reproductive system, etc.) in a patient. However, it should be understood that the modalities of the instrument 100 can be used in various types of tissues and anatomical locations. With the tissue captured between the squeeze pad 154 and the ultrasonic blade 160, the ultrasonic transducer 120 can be activated to transmit ultrasonic vibrations to the ultrasonic blade 160. This can simultaneously cut the tissue and denature proteins in tissue cells adjacent areas, thus providing a coagulant effect with relatively small thermal spread.

[0134] The operation above the drive shaft assembly 110, pivot section 130 and end actuator 150 can be repeated as many times as desired at various locations within the patient. When the operator wishes to remove the end actuator 150 from the patient, the drive shaft 244 can be rotated through the drive resources on dock 72 which are coupled with the corresponding disc 240 to straighten the pivot section 130. The drive shaft 264 can be rotated using the drive resources on dock 72, which are coupled with the corresponding disk 260 to articulate the clamping arm 152 towards the ultrasonic blade 160, thereby effectively closing the end actuator 150. The carriage arm 40 can then be used to remove end actuator 150 from the patient and trocar. Other suitable ways in which the instrument 100 can be operable and operated will be evident to those skilled in the art, considering the teachings of the present invention. Il. Treatment protocols for cutting, coagulating and sealing tissue A. Control system

[0135] Control system 39 can be configured to implement one or more treatment protocols to cut, coagulate and seal the tissue. As discussed in detail below, control system 39 can be implemented using one or more computer systems, which can also be called in the present invention of digital data processing systems and programmable systems.

[0136] One or more aspects or features of the control system 39 can be designed in digital electronic circuits, integrated circuits, specially designed integrated circuits (ASICs), field programmable port matrix (FPGAs), computer, firmware, software and / or combinations thereof. These various aspects or features may include implementation in one or more computer programs that are executable and / or interpretable in a programmable system that includes at least one programmable processor that can be special or general purpose, coupled to receive data and instructions from and transmitting data and instructions to, a storage system, at least one input device and at least one output device. The programmable system or the computer system can include clients and servers. A client and a server are usually remote with each other and typically interact through a communication network. The client and server relationship arises because of computer programs running on the respective computers and having a client-server relationship between them.

[0137] Computer programs, which can also be called programs, software, software applications, applications, components, or code, include machine instructions for a programmable processor, and can be implemented in a language high-level procedure, an object-oriented programming language, a functional programming language, a logical programming language and / or a joint / machine language. As used in the present invention, the term "machine-readable media" refers to any computer program product, equipment and / or device, such as magnetic disks, optical disks, memory and Programmable Logic Devices (PLDs), used to provide instructions and / or machine data to a programmable processor, including machine-readable media that receives machine instructions as a machine-readable signal. The term "machine-readable signal" refers to any signal used to provide instructions and / or machine data to a programmable processor. Machine-readable media can store these machine instructions on a non-temporary basis, as would, for example, non-temporary solid-state memory or a magnetic hard disk or any equivalent storage media. Machine-readable media can alternatively or additionally store these machine instructions in a temporary manner, such as, for example, a processor cache or other random access memory associated with one or more physical processor cores.

[0138] To allow interaction with the user, one or more aspects or features of the subject described in the present invention can be implemented on a computer having a display device, such as a cathode ray tube (CRT) or a liquid crystal display (LCD) or light-emitting diode (LED) monitor to display information to the user and a keyboard and pointing device, such as a mouse, a ftrackball, etc., for example through which the user can enter data on the computer. Other types of devices can also be used to allow interaction with a user. For example, the feedback provided to the user can be any form of sensory feedback, such as, for example, visual feedback, auditory feedback, or tactile feedback; and user input can be received in any form, including, but not limited to, acoustic, speech, or tactile input. Other possible data entry devices include, but are not limited to, touch screens or other touch sensitive devices, such as resistive or capacitive single-point or multi-point trackpads, recognition hardware and software voice, optical scanners, optical pointers, digital image capture devices and associated interpretation software, and the like.

[0139] An exemplary embodiment of control system 39 is illustrated in Figure 19 as the 1900 computer system. As shown, the 1900 computer system can include one or more 1902 processors that can control the operation of the computer system. 1900. "Processors" are also referred to as "controllers" in the present invention. The 1902 processor (s) may include any type of microprocessor or central processing unit (CPU), including general purpose or special purpose programmable microprocessors and / or any one of a variety. single or multiple proprietary or commercially available processor systems. The 1900 computer system may also include one or more 1904 memories that can provide temporary storage for codes to be executed by the 1902 processor (s) or for data acquired from one or more users,

storage devices and / or databases. 1904 memory may include read-only memory (ROM), flash memory, one or more varieties of random access memory (RAM) (for example, static RAM (SRAM), dynamic RAM (DRAM) or synchronous DRAM (SDRAM)) , and / or a combination of memory technologies.

[0140] The various elements of the computer system 600 can be coupled to a 1912 bus system. The illustrated 1912 bus system is an abstraction representing any one or more separate physical buses, communication lines / interfaces, and / or multi-drop or point-to-point connections, connected by suitable bridges, adapters and / or controllers. Computer system 600 may also include one or more 1906 network interface (s), one or more 1908 input / output (IO) interface (s) which may include one or more interface components and one or more device 1910 storage device (s).

[0141] The 1906 network interface (s) can allow the 1900 computer system to communicate with remote devices, for example, motors coupled to the drive disks of the drive system 220, 240, 260 and / or generator 300. Such communication can occur along dedicated transmission lines, through a network and the like. For example, a network can be any combination of remote connection interfaces, Ethernet adapters and / or other local area network (LAN) adapters. The IO 1908 interface (s) may include one or more interface components to connect the computer system 300 to other electronic equipment, such as sensors located on the motor (s). For a non-limiting example, the 1908 input and output interface (s) may include high-speed data ports, such as universal serial bus (USB) ports, 1394, WiFi ports , Bluetooth, etc. Add-

the 1900 computer system may be accessible to a human user, and thus the 1908 input / output interface (s) may include screens, speakers, keyboards, pointing devices and / or various other video, audio or alphanumeric interfaces. The storage device (s) 1910 may include any conventional means for storing data in a non-volatile and / or non-temporary manner. The 1910 storage device (s) can thus store data and / or instructions in a persistent state, that is, the value (s) is / are maintained despite the interruption power to the 1900 computer system. The 1910 storage device (s) may include one or more hard disk drives, thumb drives, USB drives, optical drives, various media cards, floppy disks, disks compact, and / or any combination thereof and can be directly connected to the 1900 computer system or remotely connected to them, for example, via a network. In an exemplary embodiment, the 1910 storage device (s) may include a readable medium on a tangible or non-temporary computer configured to store data, for example, a hard disk drive, a thumb drive, a USB drive, an optical drive, a media card, a floppy disk, a compact disc, etc.

[0142] The elements illustrated in Figure 19 can be some or all of the elements of a single physical machine. In addition, not all of the illustrated elements need to be located on or on the same physical machine. Exemplary computer systems include conventional desktop computers, workstations, minicomputers, laptop computers, tablet computers, personal digital assistants (PDAs), mobile phones, and the like.

[0143] The 1900 computer system may include a web browser to retrieve web pages or other markup language streams, display those pages and / or streams (visually, sonically, or otherwise), execute scripts , controls and other codes on these pages / streams, accepting user input for those pages / streams (for example, for filling in data entry fields), issuing HyperText Transfer requests Protocol (HTTP) [Hypertext Transfer Protocol] with respect to these pages / streams or otherwise (for example, for sending the filled data entry fields to an information server), and so on . Web pages or other markup languages may be in HyperText Markup Language (HTML) or in other conventional forms, including the built-in Extensible Markup Language (XML) [Extensible Markup Language], scripts, controls, and so on. The 1900 computer system may also include a web server to generate and / or release web pages to the customer's computer systems.

[0144] In an exemplary embodiment, the computer system 1900 can be supplied as a single unit, for example, as a single server, as a single tower, contained within a single housing, etc. The single unit can be modular, so that various aspects of it can be exchanged inside and outside as needed, for example, to upgrade, replace, maintain, etc., without interrupting the functionality of any one. other aspects of the system. The single unit can also be scalable with the ability to be added, since additional modules and / or additional functionality of existing modules are desired and / or improved.

[0145] A computer system can also include any of a variety of other software and / or hardware components, including, by way of non-limiting example, operating systems and database management systems. Although an exemplary computer system is illustrated and described in the present invention, it will be recognized that it is for general and convenience purposes. In other embodiments, the computer system may differ in terms of architecture and operation from that shown and described here.

B. Tissue treatments using ultrasonic surgical instruments

[0146] As noted above, tissue cutting, coagulation and veinage using ultrasonic surgical instruments can be performed by a combination of pressure from an ultrasonic blade and ultrasonic vibrations from the ultrasonic blade . This process is schematically illustrated in Figures 20A-20C. Figure 20A shows a 2000 blood vessel in cross section before contact with an ultrasonic surgical instrument. As shown, blood vessel 2000 can include an outer or adventite layer 2002, an intermediate or middle layer 2004 and an inner or inner layer 2006. When sufficient clamping or compression force Fc is applied to blood vessel 2000, the layer intermediate 2004 may break, leaving only the outer layer 2002 and inner layer 2006 intact. Subsequently, while maintaining the clamping force F., the ultrasonic energy can be applied to an ultrasonic blade of the ultrasonic surgical instrument, as shown further in Figure 20C. The vibration of the ultrasonic blade can transfer mechanical energy to the blood vessel 2000, breaking hydrogen bonds and producing frictional heat. This frictional heat can denature proteins inside blood vessel 2000, forming a clot 2010 that can seal blood vessel 2000. After sealing blood vessel 2000, vibration

the ultrasonic blade and can also be used to cut blood vessel 2000. a. Tissue treatment protocols that inhibit tissue adhesion

[0147] In general, as discussed above, the end actuator 150 can be configured to tighten, cut and clot the tissue. For example, end actuator 150 can be configured to receive tissue between the clamping arm 152 and the ultrasonic blade 160, where the distance that separates the clamping arm 152 from the ultrasonic blade 160 in an open position can be scaled to receive the fabric of predetermined thickness. The movement of the clamping arm 152 towards the ultrasonic blade 160 can apply a clamping force to the tissue arranged between the clamping arm 152 and the ultrasonic blade 160, while the transmission of ultrasonic energy to the ultrasonic blade 160 (for example, mechanical vibrations at ultrasonic frequencies) can clot and cut the tissue.

[0148] A problem encountered when using ultrasonic surgical instruments to cut the tissue is the tissue's adhesion to the ultrasonic sheet. When adhesion occurs, removal of the ultrasound sheet can cause tissue rupture and additional bleeding. Consequently, control system modalities 39 can be configured to provide treatment protocols that reduce or eliminate the likelihood of tissue adherence to ultrasound sheets. As discussed in more detail below, the clamping force can vary between predetermined levels before or during the transmission of ultrasonic energy to the ultrasonic sheet 160 to inhibit tissue adhesion to the ultrasonic sheet 160.

[0149] Figure 21 illustrates an exemplary modality of a tissue treatment protocol to secure, coagulate and cut tissue with an ultrasonic surgical instrument (for example, surgical instrument 100) that can inhibit tissue adhesion to the instrument cy-

ultrasonic surgical 100. Part A of Figure 21 shows clamping forces applied to the fabric by clamping arm 152 as a function of time. Part B of Figure 21 shows the corresponding amplitudes of the ultrasonic vibrations supplied to the ultrasonic blade 160 as a function of time. As discussed below, the control system 39 can implement the treatment protocol, so that a clamping force applied to the tissue can vary before the transmission of the ultrasonic vibrations to the ultrasonic blade 160 in three control modes.

[0150] In a first control mode, a gradual increase in the clamping force is applied to the tissue arranged between the clamping arm 152 and the ultrasonic blade 160 before transmitting ultrasonic energy to the ultrasonic blade 160. The clamping force is increased from a minimum tightening force Fmin to a maximum tightening force Fmax during a first tightening time t .; predetermined, while the clamping arm is under displacement control. In one mode, the minimum clamping force Fmin can be about zero, the maximum clamping force Fmax can be selected from the range of about 22.2411 N (5 lbs) to about 31.1376 N (7 lbs), and the first tightening time te: can be selected from the range of about 1 s to about 4 s.

[0151] A second control mode can occur immediately after the first control mode and it occurs before the transmission of ultrasonic vibrations to the ultrasonic blade 160. As shown, the second control mode includes maintaining the maximum clamping force Fmax during a second predetermined clamping time tc while the clamping arm is under displacement control. The second tightening time t.2 can be selected from the range of about 0.75 s to about 2 s (for example, about 1 s). The relatively high maximum clamping force Fmax can ensure that the middle layer of fabric (for example, 2004) separates, as shown in Figure 20B.

[0152] A third control mode can occur immediately after the second control mode and it can occur during the transmission of ultrasonic vibrations to the ultrasonic blade 160. As shown, the third control mode includes reducing the clamping force until a treatment clamping force Ftreatment that is between the minimum clamping force Fmin and the maximum clamping force Fmax (for example, about half the maximum clamping force Fmax). The third control mode also includes maintaining the treatment clamping force Ftreatment for a predetermined treatment time tr. In one embodiment, the treatment clamping force Ftreatment can be selected from the range of about 13.3447 N (3 lbs) to about 24.4652 N (5.5 lbs) and the treatment time t: it can be about 18 s. The reduction in the clamping force from the maximum clamping force Fmax to the treatment clamping force Ftatamenn '€ Maintaining the treatment clamping force in the load control over the duration of the treatment time t: can ensure that the clamping force is sufficient to ensure good contact between the ultrasonic sheet 160 and the tissue without applying a relatively high clamping force that may tend to cause the tissue to adhere to the ultrasonic sheet 160.

[0153] During the ti treatment time, a peak amplitude of ultrasonic vibrations transmitted to the ultrasonic blade 160 can vary between a minimum ultrasonic amplitude Amin and a maximum ultrasonic amplitude Amáx. As shown, an ultrasonic amplitude A ,, between the minimum ultrasonic amplitude Amin and the maximum ultrasonic amplitude Amáx can be transmitted to the ultrasonic blade 160 immediately after the second clamping time t.2 to a first portion tt: do treatment time t .. The minimum Amiwin ultrasonic range can be transmitted to the ultrasonic blade

160 immediately after the first portion th of treatment time tt for a second portion ti of treatment time t. In one embodiment, the minimum ultrasonic amplitude Amin can be about 50% of AMAX, AND the ultrasonic amplitude A: can be selected from the range of about 80% to about 100% AMAX. In one embodiment, Amáx can be about 77 µm. In one embodiment, tt can be about 1 s and ti can be about 16 s.

[0154] The first and second portions t: and uncle of the treatment time t: can extend over most of the treatment time t .. The intermediate ultrasonic amplitude A: and the first portion tu of the treatment time t: can be configured to quickly heat the tissue to a temperature sufficient to form the clot 2010 and start the ultrasonic cut of the clot 2010. The minimum ultrasonic amplitude Amin and the second portion ti of the treatment time to th can be configured to ensure that the 2010 clot length is sufficient and continues to cut the tissue.

[0155] The maximum amplitude Amáx can be transmitted to the ultrasonic strip 160 immediately after the second portion ti of the treatment time t: for a third portion t: 3 of the treatment time tr. The maximum ultrasonic amplitude Am E is the third portion tg of treatment time t: can be configured to ensure that the fabric is completely cut. In one embodiment, tis can be about 1 s.

[0156] Figure 22 illustrates another exemplary modality of a treatment protocol to inhibit tissue adhesion to an ultrasonic surgical instrument. Part A of Figure 22 shows clamping forces applied to the fabric by clamping arm 152 as a function of time. Part B of Figure 22 shows the corresponding amplitudes of the ultrasonic vibrations supplied to the ultrasonic blade 160 as a function of time. As discussed below, the control system

39 can implement the treatment protocol, so that a clamping force applied to the tissue varies during the transmission of the ultrasonic vibrations to the ultrasonic blade 160 in four control modes.

[0157] In a first control mode, a gradual increase in the clamping force is applied to the tissue arranged between the clamping arm 152 and the ultrasonic blade 160 before transmitting ultrasonic energy to the ultrasonic blade 160. The clamping force can increase from a minimum clamping force Fmin to a maximum clamping force Fmax during the first clamping time t .; predetermined, while the clamping arm is under displacement control. The treatment clamping force F'treatment can be a clamping force that is between the minimum clamping force F'min and a maximum clamping force F'máx. In one embodiment, the minimum clamping force F'min can be about 11.1206 N (2.5 lbs), the treatment clamping force F'treatment can be selected from the range of about 13.3447 N kg (3 Ibs) at about 15.5688 N (3.5 lbs), and the maximum clamping force F'máx can be around 24.4652 N (5.5 lbs).

[0158] A second control mode can occur immediately after the first control mode and it can occur before the transmission of ultrasonic vibrations to the ultrasonic blade 160. As shown, the second control mode includes maintaining the clamping force of treatment F'treatment for a second predetermined tightening time t'c2 while the clamping arm is under displacement control. The treatment clamping force F'treatment can be configured to separate the middle layer of tissue (for example, 2004), as shown in Figure 20B.

[0159] A third control mode can occur immediately after the second control mode and it can occur during a portion of the treatment time t ': during which ultrasonic vibrations

sonics are transmitted to the ultrasonic blade 160. As shown, the third control mode includes increasing the clamping force of the treatment clamping force F'treatment to the maximum clamping force Fmax E Maintaining the maximum clamping force F'máx for a first predetermined portion t'x 'of treatment time t't under load control. In one embodiment, the treatment time t'y can be about 0.5 s).

[0160] At the same time, an amplitude of the ultrasonic vibration A ', between a minimum ultrasonic vibration amplitude A'min and a maximum ultrasonic vibration amplitude A'máx can be transmitted to the ultrasonic blade 160. Increased clamping force from the treatment clamping force Ftreatment to the maximum clamping force Fmax € maintaining the maximum clamping force Fmax in the control load over the first portion of the treatment time t'm can ensure that the clamping force tightening separates the middle layer 2004. The relatively moderate ultrasonic vibration range can be selected to provide tissue coagulation and at the same time reduce the likelihood of the tissue adhering while the tightening force is high.

[0161] A fourth control mode can occur immediately after the third control mode and it can also occur during a portion of the treatment time t ': during which ultrasonic vibrations are transmitted to the ultrasonic blade 160. As shown , the third control mode includes decreasing the clamping force from the maximum clamping force F'máx to the treatment clamping force F'treatment € maintaining the treatment clamping force F'treatment during a second portion t 'º, a third portion t'8g and a fourth portion t't of treatment time t' under load control. In one embodiment, the t 'can be about 0.75 s., T can be about 16 s and the t'u can be about 1 second.

[0162] Simultaneously, the amplitude of the ultrasonic vibrations transmitted to the ultrasonic blade 160 can vary. As an example, an amplitude of ultrasonic vibration A '> greater than the amplitude of ultrasonic vibration A's can be transmitted to the ultrasonic blade 160 during the second portion t'12 of treatment time t'. Subsequently, an amplitude of the ultrasonic vibration A '; can be transmitted to the ultrasonic plate 160 during the third portion t''3 of the treatment time t ',, followed by the maximum ultrasonic vibration amplitude A'máx during the fourth portion t'u of the treatment time t '. In one modality, the minimum ultrasonic amplitude A'min can be about 50% of A'máx, the ultrasonic amplitude A's can be about 80% of A'máx, € the ultrasonic amplitude A '> can be selected from the range of about 85% of A'máx to about 90% of A'máx. In one embodiment, the maximum ultrasonic amplitude A'máx can be around 77 µm.

[0163] The increase in amplitude of A 'ultrasonic vibration; for A '> it can be configured to ensure that the tissue coagulation extends a sufficient distance within the tissue to cover the region to be separated. The amplitude of the A'min minimum ultrasonic vibration can be large enough to cut the tissue. In this way, the decrease in the amplitude of ultrasonic vibration from A 'to A'min can be configured to ensure that tissue adhesion does not occur while the ultrasonic blade 160 cuts through the tissue. The increase in the amplitude of ultrasonic vibration from A'min to A'maáx can be configured to ensure that the tissue is cut by the end of the treatment time t ':. B. Fabric treatment protocols to inhibit tightening pad damage

[0164] As noted above, in robotic surgery, a user 12, 12 'may have less direct tactile feedback compared to traditional manually powered surgical instruments. This lack of tactile feedback can result in uncertainty if the tissue transection has been completed. In this way, a user 12, 12 'can take time to rotate the surgical instrument, while it is clamped and ultrasonic vibrations are transmitted to the ultrasonic blade 160, to visualize and verify the seal formed by the surgical instrument 100. However, in circumstances where tissue transection is complete and clamping arm 152 is fully closed, clamping pad 154 may come into contact with vibrating ultrasonic blade 160. If left in contact with clamping pad 154 for an extended period , the ultrasonic blade 160 can cut and / or burn the clamping pad 154. Depending on the severity of the damage, it may be necessary to replace the clamping pad 154, incurring time and costs. Consequently, the control system 39 modes can be configured to inhibit damage to the grip pad 154 during the use of the ultrasonic surgical instrument 100.

[0165] As an example, the control system 39 can monitor the tightening force exerted on the fabric (for example, by detecting that the torque applied to the motors coupled to the drive discs of the drive system 220, 240 , 260). When tissue cutting and sealing is complete, control system 39 can generate an auditory and / or visual indication (for example, an audible tone) to be provided to signal to a user 12, 12 'that the transection is complete and to relax the pressure on the ultrasonic sheet. As an example, controller 30 may include one or more audio and / or video components in communication with control system 39 and configured to provide auditory and / or visual indication (for example, screen 34).

[0166] Under the condition that the ultrasonic blade 160 is left in contact with the grip pad 154 for more than a predetermined time after the auditory and / or visual indication is provided, the control system 39 can be configured to additionally adjust at least one of the clamping force and amplitude of the ultrasonic vibrations transmitted to the ultrasonic blade 160. As an example, when the predetermined time is exceeded, the control system 39 can transmit a command to the clamping arm 152 to decrease the clamping force. This can allow a user to continue transmitting ultrasonic vibrations to the ultrasonic blade 160 with a slight clamping force, improving the tactile feel and / or the response intensity of the user experience without damaging the clamping pad 154. ç. Tissue treatment protocols to apply tension to complete the transection

[0167] This can be beneficial when using ultrasonic surgical instruments, such as surgical instrument 22 to apply tension to complete tissue transection. This tension can accelerate the completion of tissue transection, limit the heat build-up in the ultrasonic surgical instrument 100 and inhibit damage to the squeeze pad (eg, burn of the pad) due to the relatively fast completion of the transection of tissue. fabric. However, it can be difficult to apply a slight tension with the use of robotic surgical instruments, since they can remain perfectly stable. Consequently, the control system 39 modes can be configured to apply sufficient tension to the tissue near the tissue transection end.

[0168] As an example, control system 39 is configured to monitor the clamping force applied to the fabric by end actuator 150 when operating under displacement control. As the tissue nears completion of the transection, the applied force increases as the clamping pad 154 begins to come in contact with the ultrasonic blade 160. Upon detection of the clamping force reaching a predetermined clamping limit, the control system 39 causes the ultrasonic surgical instrument 100 to apply tension by subtle movements away from the tissue (for example, up and back). Alternatively or in addition, the control system 39 can reduce the clamping pressure to prevent the cushion from burning and the accumulation of heat, as discussed above. Either or both of these operations can be performed immediately upon detecting that the clamping force has reached the predetermined clamping limit or after a predetermined delay time. In addition, one or both of these operations can be configurable by the user 12, 12 'using the control system 39 and can be activated, switched off or modified (for example, the predetermined tightening limit, the predetermined delay, etc.). d. Tissue treatment protocols to maintain constant ultrasonic range

[0169] As discussed above, the modalities of the ultrasonic surgical instrument 100 can be configured to allow the articulation of the end actuator 150, such as flexion, using the articulation section 130. For example, an articulation angle of the end 150 in relation to a longitudinal geometric axis of the ultrasonic surgical instrument 100 can be controlled by rotating the drive shaft 244. However, as the pivot angle increases, the ultrasonic vibrations transmitted to the ultrasonic blade 160 can be mitigated. Consequently, the control system 39 modes are configured to compensate for this attenuation.

[0170] In one aspect, the control system 39 is configured to measure the articulation angle of the end actuator 150. For example, the control system 39 can measure by rotating the drive shaft 244 to measure the angle end actuator pivot 150. In another aspect, control system 39 can receive input from a user 12, 12 'using controller 30 to command end actuator pivot 150. In response, the system control unit 39 can be configured to change the scale of the controlled ultrasonic vibration amplitude based on the measured pivot angle of the end actuator 150 to compensate for the ultrasonic attenuation. The control system 39 can perform this scale change during the articulation of the end actuator 150.

[0171] An example of a scaling relationship between the amplitude of the ultrasonic vibration and the articulation angle of the end actuator 150 is illustrated in the graph in Figure 23. As shown, the amplitude of the ultrasonic vibration generally increases with the articulation of the end actuator increases from a minimum articulation angle (for example, about 0 ° C) to a maximum articulation angle (for example, about 45 ° C), reflecting a greater degree of ultrasonic attenuation at angles of large articulation compared to small articulation angles. In certain embodiments, a rate of change in ultrasonic amplitude may increase with the angle of articulation. As an example, the amplitude of the ultrasonic vibration can be from about 100% to about 0 ° and the amplitude of the ultrasonic vibration can be about 141% at an articulation angle of about 45 °. In alternative modalities, the rate of variation of the ultrasonic amplitude can be approximately constant (dashed line). That is, the ultrasonic amplitude can be directly proportional to the ultrasonic amplitude.

[0172] It must be understood that the relationship between the amplitude of

ultrasonic arm and the articulation angle of the end actuator 150 can take other forms, depending on the configuration of the ultrasonic surgical instrument 100. The shape of this relationship can be determined empirically, theoretically or combinations of the same. C. Combination of ultrasonic and radio frequency surgical instruments

[0173] In additional modalities, the surgical instrument 100 can be configured to provide tissue coagulation through the application of radio frequency energy (RF) only or in combination with ultrasonic vibrations. RF energy is a form of electrical energy that can be in the frequency range of about 200 kilohertz (kHz) to about 1 megahertz (MHz). As discussed in more detail below, instrument 100 can transmit RF energy at low frequency through the tissue, which can cause ionic agitation, or friction, that is, resistive heating, which therefore increases the temperature of the instrument. fabric. Due to the fact that a precise boundary is created between the affected tissue and the surrounding tissue, a user 12, 12 'can operate with a high level of accuracy and control, without sacrificing adjacent non-target tissue. The low operating temperatures of the RF energy can be useful for removing, shrinking or sculpting soft tissues while simultaneously cauterizing blood vessels. RF energy can work particularly well in connective tissue, which mainly comprises collagen that can shrink when it comes in contact with heat.

[0174] To facilitate the release of RF energy to the tissue, generator 300 includes a power source and a control module that is configured to supply RF energy to one or more electrodes mounted on the end actuator 150 Examples of generators configured to drive the ultrasonic transducer 120 and RF electrodes are discussed in more detail in US patent publication 2017/0202609, entitled "Modular Battery Powered Hand-Held Surgical Instrument With Curved End Effectors Having Asymmetric Engagement Between Jaw and Blade "whose entirety is hereby incorporated by reference.

[0175] Figure 24A illustrates a side view of an exemplary embodiment of a 2400 end actuator configured to apply ultrasonic vibrations and RF energy to the tissue. The end actuator 2400 comprises a jaw member 2402 and a drive shaft 2404. Jaw member 2402 can rotate around pivot point 2406 and define a rotation angle. In certain respects, pivot point 2406 may be similar to the pair of arms 156 and pin 170 discussed above.

[0176] Figure 24B illustrates another side view of the end actuator 2400 shown in Figure 24A with a partial cut-out view to expose the underlying structure of the claw member 2402 and an ultrasonic blade 2410. The ultrasonic blade 2410 can be the same to the ultrasonic blade 160 discussed above. An electrode 2412 is fixedly mounted to claw member 2402. Electrode 2412 can be electrically coupled to an RF drive circuit contained within a portion of generator 300 configured to apply RF energy to electrode 2412 (for example, example, the RF 702 drive circuit).

[0177] Electrode 2412 is configured to apply RF energy to the tissue located between claw member 2402 and ultrasonic blade 2410. Figure 24C is a partial sectional view of end actuator 2400 exposing ultrasonic blade 2410 and a modality of electrode 2412 which includes the right and left electrodes 2412a and 2412b, respectively. Claw member 2402 and ultrasonic blade 2410 are wider at a proximal end and more

drills at a distal end. In addition, claw member 2402 and ultrasonic blade 2410 can define more curvature at a distal end in relation to the proximal end. An electrically insulating and soft pad 2414 can be arranged between the first and second electrodes 2412a, 2412b. In one aspect, the electrically insulating pad 2414 can be located adjacent to a high density polymeric pad 2416 to prevent the ultrasonic sheet 2410 from shorting electrodes 2412a, 2412b. In one aspect, pads 2414, 2416 can be formed from polytetrafluoroethylene (PTFE) polymers and copolymers. The heat generated by the current flowing through the tissue can form hemostatic veins within the tissue and / or between tissues and, therefore, can be particularly useful, for example, for sealing blood vessels.

[0178] In one embodiment, the 2400 end actuator can be configured for bipolar or monopolar operation. During bipolar operation, the current can be introduced into the tissue by electrode 2412 and returned from the tissue by the ultrasonic blade 2410. During monopolar operation, the current can be introduced into the tissue by electrode 2412 and returned via an electrode. return (for example, a grounding pad) separately located on the patient's body.

[0179] RF energy can be in a frequency range described in EN 60601-2-2: 2009 + A11: 2011, Definition

201.3.218 - "HIGH FREQUENCY" whose total description is incorporated by reference. For example, the frequency in mono-polar RF applications can typically be restricted to less than about 5 MHz. However, in bipolar RF applications, the frequency can take on any desired value. Frequencies above 200 kHz can typically be used for monopolar applications to avoid

unwanted nerve and muscle tone, which would result from the use of a low frequency current. Lower frequencies can be used for bipolar applications if a risk analysis shows that the possibility of neuromuscular stimulus has been mitigated to an acceptable level. Typically, frequencies above 5 MHz can be avoided in order to minimize problems associated with high frequency dispersion currents. However, higher frequencies can be used in the case of bipolar applications. In certain embodiments, 10 mA can be a lower limit for thermal effects on tissue. A further discussion of the modalities of generator 300 and end actuator 2400 can be found in US patent publication 2017/0202609, entitled "Modular Battery Powered Hand-Held Surgical Instrument With Curved End Effectors Having Asymmetric Engagement Between Jaw and Blade "the entirety of which is incorporated by reference. The. Treatment protocols using the motor torque to maintain the treatment force and the selective application of RF energy to the tissue

[0180] When using electrically powered surgical instruments to apply RF energy to the tissue, it may be desirable to inhibit the release of RF energy to the tissue before the clamping force applied to the tissue reaches a predetermined range. When the clamping force is within this range and the RF energy is subsequently applied to the fabric, the outer layer 2002 and the inner layer 2006 can be adequately sealed even when the thickness of the fabric changes dynamically (for example, it decreases).

[0181] In non-energized surgical instruments, a large corrugated spring can be used to compensate for variations in tissue thickness to apply the clamping force within the predetermined range. However, in energized surgical instruments, where the actuation of the end actuator is driven by motors,

the spring can be very difficult to control. Consequently, the modalities of the present disclosure can provide energized surgical instruments in which the wave spring is omitted. The control system 39 can be configured to implement treatment protocols that achieve the tightening forces within a predetermined range by selectively controlling the closing of an end actuator under any displacement or load control. In this way, a user can employ energized surgical instruments for relatively delicate jobs, such as propagation of dissection and tissue manipulation.

[0182] Figure 25 is a flow chart illustrating an exemplary modality of a 2500 method including operations 2502-2514 for fine closing control of an end actuator to achieve a clamping force within a predetermined range using engines, instead of, for example, a wave spring. The modalities of method 2500 are discussed in detail below in the context of the robotic surgical system 10 employing an ultrasonic surgical instrument 100 using the end actuator 2400. However, as noted above, the modalities described can also also be used with energetic surgical instruments. - portable devices. The additional modalities of the 2500 method can omit one or more of the operations illustrated in Figure 25 or add additional operations and the operations can be performed in an order different from that illustrated and described without limits.

[0183] With 2502 running, user 12, 12 'can employ controller 30 to command claw member 2402 to adopt the home position. In general, claw member 2402 is configured to move between an open position and a closed position. In the open position, the degree of closure of the claw member 2402 can be approximately 0%, while in the closed position, the degree of closure of the claw member 2402 can be approximately 100%. To facilitate reference in the present invention, the open position will be considered as the starting position. However, it should be understood that the open position can be any predefined location between and including the open position and the closed position.

[0184] With 2504 running, user 12, 12 'can employ controller 30 to command claw member 2402 to adopt a certain degree of closure.

[0185] In general, the movement of the claw member 2402 in the control position uses a received position command as a target setpoint regardless of the force applied to the tissue as a result of such movement. Moving the Gripper in this way can be advantageous when the fabric is relatively thin because a low degree of closure can result in the application of a clamping force less than a predetermined minimum clamping force Fmin (for example, a clamping force less than desired for the release of RF energy to the tissue). However, moving the gripper in this way is not advantageous if the fabric is relatively thick because even a low degree of closure can result in the application of a greater clamping force that exceeds a predetermined maximum force Fmax (for example, a clamping force greater than desired for the release of RF energy to the tissue). Therefore, Fmin and Fmax represent a desired range of clamping force applied to the tissue to release RF energy to the tissue.

[0186] In operations 2506 and 2510, control system 39 determines whether the command received is executed in position control. As shown, in operation 2506, control system 39 determines whether the degree of closure is less than a closing limit (for example, about 90%). If so, method 2500 proceeds to operation 2510. In operation 2510, control system 39 determines whether a torque of a motor that controls the travel of jaw member 2402 is greater than a limit torque Tmin. In this context, torque can be used to approach a measured clamping force. As an example, an amount of torque applied by a motor that controls the displacement of the claw member 2402 (for example, a motor operable to rotate the drive shaft 264) can be correlated with the clamping force applied to the fabric by claw member 2402. In this way, Tmin can be correlated with Fmin. This torque check can ensure that even if the degree of closure is relatively low, the tightness does not exceed the Fmax. This circumstance can arise if the fabric is relatively thick and claw member 2402 can come in contact with the fabric with relatively little closure. If the motor torque measured by the control system is less than the limit torque Tmin, representing the application of a relatively low clamping force to the fabric, the 2500 method can proceed to operation 2512, where closing claw member 2402 is controlled by position control.

[0187] Alternatively, if the degree of claw closure is greater than the limit torque or if the motor torque is greater than the limit torque Tmin, method 2500 can proceed to operation 2514. In operation 2514, the control of the claw member 2402 is carried out in the load control to achieve a clamping force at a pre-selected level from the range between about Fmin € Fmax. In load control, the control system 39 employs the torque measurements of the motor to control the clamping force at levels previously selected from the range between about Fmin and Fmax, corresponding to Tmin E Tmax. For example, the current drained by the motor operable to rotate the drive shaft 264 can be used to measure its motor torque.

[0188] An exemplary graph of motor torque as a function of claw member 2402 is illustrated in Figure 26. As shown for a given fabric, when the motor torque is less than O Tmin, The member displacement claw is relatively low (for example, less than 1). As a result, a degree of claw closure can be below the closing limit and the limit torque Tmin € the claw member can be below the travel control. In this regime, the motor torque can generally increase with the increase in the displacement of the claw member, representing the movement of the claw member 2402 towards the closed position and the increase in the clamping force. As discussed in more detail below, the release of RF energy to the tissue is inhibited, since the clamping force is less than desired.

[0189] However, when the motor torque increases up to Tmin, the control of the displacement of the claw member 2402 can be performed by the control system 39 below to control the load. In this regime, the control system 39 can ignore the displacement of any set points received from the user 12, 12 'and, instead, the closing of the claw member 2402 can be controlled based on the torque set points (for example, a torque between the minimum and maximum torques Tmin AND Tmax) to result in the application of a clamping force between Fmin € to Fmax.

[0190] It may also be desirable to limit the application of RF energy to the tissue under circumstances where the end actuator 2400 does not completely compress the tissue disposed between the clamping arm 152 and the ultrasonic blade 160. If relatively high RF energy levels are used in critical tissue, such as in vessels, without substantially complete compression, this can result in death. In non-energized surgical instruments, this functionality

can be obtained using a closing key that confirms that the surgical instrument is completely closed.

[0191] To provide this functionality in electrically operated surgical instruments without a key, the control system 39 uses the degree of claw closure to determine whether a user 12, 12 'can deliver relatively high levels of RF energy to the tissue or not. In one aspect, when the claw closure is under displacement control, the control system 39 can inhibit the release of RF energy to the tissue. In another aspect, when the jaw closure is under load control and the jaw closure is less than completely closed, the control system can allow the release of RF energy at less than a predetermined RF energy limit. If a user 12, 12 'requests RF energy release greater than the predetermined limit RF energy, the control system 39 can cause a notification (eg auditory and / or visual) to be provided by controller 30. In an additional aspect, when the jaw closure is under load control and the jaw closure is complete, the control system can allow the release of RF energy greater than the predetermined RF energy limit. B. Treatment protocols for varying the clamping force based on energy released to the tissue

[0192] In additional modalities, the control system 39 can be configured to vary the compression forces applied to the tissue clamped by an end actuator based on the energy being released into the tissue (for example, ultrasonic vibrations) RF energy and combinations thereof). This flexibility can allow the combination of energized surgical instruments to perform the "profiling" techniques used to section large tissues and simultaneously ensure that such tissues are safe.

blood vessels are properly coagulated and sealed before transection.

[0193] In one embodiment, the control system 39 is configured to determine the thickness of the tissue to be transected. As discussed in detail below, a determination of the relative thickness of the fabric (for example, relatively thin fabric or relatively thick fabric) can be used to select whether the compression forces are subsequently applied to the fabric under displacement control. (for example, speed) or under load control during profiling treatment.

[0194] Figure 27 is a graph of the closing displacement of claw member 2402 (part A) and the corresponding clamping force F. (Part B) as a function of the time applied to the tissue placed between the claw member 2402 and the ultrasonic blade 160. With the tissue positioned in this way, claw member 2402 can move towards the closed position under position control at a first tightening speed vc: greater than a minimum tightening speed vmin . For example, the first tightening speed vc can be about 0.762 mm / s (0.03 in / s) and the minimum tightening speed vmin can be selected from the range of about 0.127 mm / s (0.005 in / s) ) at about 0.254 mm / s (0.01 in / s). In certain modalities, the first tightening speed vc: can be constant, as illustrated by the constant slope of the displacement-time graph shown in Part A (top) of Figure 27.

[0195] As claw member 2402 comes into contact with the fabric, the compression force Fc applied to the fabric increases. When the compression force Fc. exceeds a limit of the clamping force Fo, a closing time tc is recorded. Assuming that the tightening speed vc: is constant, the corresponding closing displacement õc can also be determined. Comparing the closing time

to you. with a timeout to or the closing offset dc with a timeout of, a relative measure of the fabric thickness can be obtained. As an example, if the closing time is less than the time limit to or the closing displacement dc is less than the limit displacement of (curve X), it is determined that the tissue is thick due to claw member 2402 if move a relatively short distance to contact the fabric. On the other hand, if the closing time t. is greater than the time | limit or the closing displacement 5. is greater than the limit displacement of (curve Y), the fabric is determined to be thin due to the claw member 2402 moving a distance relatively large to come into contact with the fabric. In certain embodiments, the limit displacement of the can be about 1.651 mm / s (0.065 in), the thickness of d: can be about 1.524 mm / s (0.06 in) and the thickness õc2 can be of about 2.032 mm / s (0.08 in).

[0196] Figure 28 is a graph illustrating the exemplifying modalities of the clamping speed vc of claw member 2402, the clamping force Fc applied to the tissue, and the relative amplitudes of various energies applied to the 2400 end actuator (for example , ultrasonic vibrations and RF energy) as a function of time for thick tissue. As shown, the fabric can be subjected to a series of fabric treatments including tightening, profiling and sealing. As discussed in detail below, the tightening treatment is configured to hold the fabric with the 2400 end actuator, the profiling treatment is configured to coagulate the fabric and the sealing treatment is configured to additionally coagulate the fabric and cut the fabric.

[0197] In the modality of Figure 28, it is assumed that the fabric is thick and that the tightening and profiling treatments are carried out under load control. When tightening under load control, the clamping force Fc can start at approximately zero and can rapidly increase until a first treatment force F1, after claw member 2402 comes into contact with the tissue. The first treatment force F1: can be selected between a minimum clamping force Fmin and a second treatment force F2. In certain embodiments, the second treatment force can be a local maximum for the clamping force Fc during the clamping and profiling treatments. As an example, the first treatment force F, can be selected from the range between about 1.1121 N (0.25 l | bs) to about 2.2241 N (0.5 lIbs) (for example, about 2.2241 N (0.5 lbs), and the second treatment force F2> can be selected from the range of about 4.4482 N (1 lb) to about 6.6723 N (1, 5 | b), and the maximum clamping force Fmax can be about 11.1206 N (2.5 bs).

[0198] The release of energy to the 2400 end actuator during tightening treatment is also illustrated in Figure 28. In certain embodiments, the release of RF energy to electrode 2412 is omitted during tightening treatment, while vibrations ultrasonic waves are transmitted to the 2410 ultrasonic blade. As shown, ultrasonic vibrations can have a first amplitude A, selected from a minimum ultrasonic amplitude Amin and a maximum ultrasonic amplitude Amáx. As an example, Amin can be about 25% of Amáx, A: can be selected from the range of about 60% of Amáx to about 80% of Amáx.

[0199] During the tightening treatment, the tightening speed vc can increase from zero to a second tightening speed vc2. For example, the second tightening speed vc2 can be a maximum location in the tightening speed during the tightening and profiling treatments, and can be about 0.635 mm / s (0.025 in / s). In certain modes, the second tightening speed vc2 can be the same as the first tightening speed ve. Claw member 2402 can move at the second tightening speed vc2 for the entire duration of the tightening treatment (for example, until the tightening force Fc increases until the first treatment force F1 and profiling treatment begins.

[0200] A first exemplary modality of profiling treatment is also illustrated in Figure 28. In general, profiling treatment can be configured to coagulate the tissue arranged between the claw member 2402 and the ultrasonic blade 160. As shown in Figure 28 , when the profiling treatment is carried out under load control, the clamping force Fc. is maintained around a first F1 treatment force. In certain modalities, the first treatment force F; is approximately constant over the duration of the profiling treatment. Similarly, the amplitude of ultrasonic vibrations is maintained at about A; and the RF energy released to the ultrasonic blade 160 is maintained at an approximately constant level.

[0201] It can also be seen that the tightening speed vc can in general decrease with time during profiling treatment. This reduction in vc may result from changes in the mechanical properties of the tissue due to friction coagulation of the tissue (for example, mechanical vibrations from the 2410 ultrasonic blade) and RF energy released to the tissue from the 2412 electrode. mechanical properties of the tissue can change over time during profiling treatment. Consequently, as time passes under load control, a tightening speed vc may be sufficient to maintain the first treatment force F1. As long as the vc is greater than a minimum tightening speed Vmin, Control System 39 can maintain the first treatment force F during the profiling treatment. If the tightening speed v. stay below the minimum tightening speed vmin, Control system 39 can perform profiling under load control according to a second example modality, as discussed in more detail below.

[0202] The sealing treatment can be done immediately after the profiling treatment and it can be controlled by the control system 39 under load control. In general, the sealing operation can be configured to coagulate and cut the tissue clamped by the 2400 end actuator. The sealing operation begins in response to the detection of a drive condition being satisfied. In one embodiment, the drive condition can be the movement of the claw member 2402 to a predetermined degree of closure (for example, the claw member 2402 moves to a predetermined distance from the ultrasonic blade 2410). The degree of closure of the claw member 2402 can be monitored by the control system 39 as discussed above. In another embodiment, the drive condition can be a deviation from a speed setpoint by a limit value or a clamping force Fc that rises to a predetermined percentage of a maximum clamping force Fmax, as discussed with more details below in the context of a third example of a profiling treatment under displacement control (speed).

[0203] In the sealing operation, the claw member 2402 is moved to the closed position and the clamping force increases from F; up to the maximum clamping force Fmax. The tightening speed vc can increase sharply to a level higher than the first tightening speed vc1, while the tightening force rises to Fmax E afterwards it decreases to about zero. That is, the claw member 2402 does not move in closing once the closed position is reached and the maximum clamping force Fmax is applied to the fabric. As discussed above, the complete closure of the claw member 2402 can ensure that the middle layer 2004 of the blood vessels are separated. The maximum clamping force Fmax can be an overall maximum force in all tissue treatment operations and it can be selected from the range of about 11.1206 N (2.5 Ibs) to about 16.0136 N (3 , 6 lbs).

[0204] At the same time, the amplitude of the ultrasonic vibrations transmitted to the ultrasonic blade 2410 and the RF energy transmitted to the 2412 electrodes can vary to facilitate coagulation and tissue cutting. As shown in Part A of Figure 28, the amplitude of ultrasonic vibrations increases rapidly up to the maximum amplitude Amáx to provide frictional heating to coagulate the tissue. Subsequently, the amplitude of the ultrasonic vibrations decreases to a second amplitude Az greater than the minimum amplitude, but less than the first amplitude A. As an example, A2 can be about 50% of the Max. This decrease in the amplitude of the ultrasonic vibration can be synchronized with an increase in the amplitude of the RF energy up to a maximum value. This increase in RF energy can be configured to promote tissue clotting. Thereafter, the amplitude of ultrasonic vibration may increase up to the maximum amplitude Amáx a second time to promote the cutting of the tissue, while the amplitude of the RF energy decreases to zero.

[0205] After the sealing operation, the claw member 2402 can open to release the tissue. As shown in Part B of Figure 28, the clamping force Fc decreases from maximum clamping Fmax to about zero. Concomitantly, as shown in Part C of Figure 28, the speed of the jaw member 2402 adopts a negative value, representing the jaw opening.

[0206] A second exemplary modality of profiling treatment under load control is illustrated in Figure 29. In the first modality discussed above (solid lines), the tightening speed vc remains above the minimum tightening speed vmin. In this second profiling modality, the tightening speed vc decreases to a level approximately equal to vmin. Under this circumstance, instead of maintaining the clamping force Fc in the first treatment force F; throughout the profiling treatment, when the tightening speed vc. is below vmin, the clamping force is increased to maintain the clamping speed vc at least equal to vmin, as shown in the dashed lines of Parts A and B of the Figure

29. After determining that the drive condition is satisfied, the second mode of profiling treatment ends and the sealing treatment begins, as discussed above.

[0207] A third example of the profiling treatment under position control is illustrated in Figure 30. As discussed above, position control can be used when it is determined that the fabric is thin. In the first modality under load (solid lines), the tightening speed vc. is dropped while the first treatment force F; is maintained. On the other hand, this third profiling treatment modality initially maintains the clamping speed vc at a third clamping speed vc3, while the clamping force F. is allowed to change from the first treatment force F1. The third tightening speed vc.3 can be approximately constant. In certain embodiments, the third tightening speed vc3 can be equal to the first tightening speed vei.

[0208] The tightening speed vc can be kept constant or changed depending on the tightening force F. resulting from vc3 during profiling treatment. If the clamping force Fc remains less than the second clamping force F2, the control system 39 maintains the third clamping force vc3 throughout the profiling treatment. However, if the clamping force Fc. rise to the level of the second clamping force F2 (for example, at time t2), the speed

clamping speed is reduced from the third clamping speed Vc3 to a fourth clamping speed vc1 which is greater than the minimum clamping speed vmin. The fourth clamping speed vcs can be reached in time t3 sufficient to maintain the clamping force Fc at a lower level than the second treatment force F2 (for example, between the first treatment force F, and the second force of treatment F> 2) until the end of the profiling treatment at time ta. After determining that the drive condition is met, the second mode of profiling treatment can end and the sealing treatment can start. In one embodiment, the length of time between time t2 and time t3 can be in the range of about 0.5 s to about 1.5 s. In another mode, the length of time between time t3 and time ta can range from about 1 s to about 4 s.

[0209] As discussed above, the drive condition can be a deviation from a speed setpoint by a limit amount. This activation condition can be satisfied by deviating the tightening speed vc, the third tightening speed vc3 or the fourth tightening speed vc by a predetermined tightening speed Ave.

[0210] In another mode, the activation condition can be the clamping force F. rising to a predetermined percentage of the maximum clamping force Fmax. Ill. General considerations

[0211] It should be understood that any of the versions of the instruments described here may include several other features in addition to or instead of those described above. Only by way of example, any of the instruments described here may also include one or more of the various resources revealed in any of the various references that are incorporated herein by way of reference.

[0212] Although the examples of the present invention are described mainly in the context of electrosurgical instruments, it should be understood that the various teachings of the present invention can easily be applied to a variety of other types of devices. As an example only, the various teachings of the present invention can be readily applied to other types of electrosurgical instruments, tissue claws, tissue removal bag positioning instruments, surgical staplers, surgical clip applicators, ultrasonic surgical instruments , etc.

[0213] In versions in which the teachings of the present invention are applied to an electrosurgical instrument, it should be understood that the teachings of the present invention can be readily applied to an ENSEALO fabric sealing device from Ethicon Endo Surgery, Inc., of Cincinnati, Ohio, USA. In addition or alternatively, it should be understood that the teachings of the present invention can be combined with the teachings of one or more of the following: US patent No. 6,500,176, entitled "Electro-surgical Systems and Techniques for Sealing Tissue", granted on December 31, 2002, the disclosure of which is hereby incorporated by reference; US Patent No. 7,112,201, entitled "Electrosurgical Instrument and Method of Use", issued on September 26, 2006, the disclosure of which is hereby incorporated by reference; US Patent No. 7,125,409, entitled "Electrosurgical Working End for Controlled Energy Delivery", issued on October 24, 2006, the disclosure of which is incorporated herein by reference; US Patent No. 7,169,146, entitled "Electrosurgical Probe and Method of Use", issued on January 30, 2007, the disclosure of which is incorporated herein by reference; US Patent No. 7,186,253, entitled "Electrosurgical Jaw Structure for Controlled Energy Delivery",

on March 6, 2007, the disclosure of which is hereby incorporated by reference; US patent 7,189,233, entitled "Electrosurgical Instrument", issued on March 13, 2007, the disclosure of which is incorporated herein by reference; in US patent no.

7,220,951, entitled "Surgical Sealing Surfaces and Methods of Use", granted on May 22, 2007, the disclosure of which is incorporated herein by reference; US Patent No. 7,309,849, entitled "Polymer Compositions Exhibiting a PTC Property and Methods of Manufacturing", issued December 18, 2007, the disclosure of which is hereby incorporated by reference; US Patent No. 7,311,709, entitled "Electrosurgical Instrument and Method of Use", issued December 25, 2007, the disclosure of which is hereby incorporated by reference; US patent 7,354,440, entitled "Electrosurgical Instrument and Method of Use", issued on April 8, 2008, the disclosure of which is hereby incorporated by reference; US patent 7,381,209, entitled "Electrosurgical Instrument", issued on June 3, 2008, the disclosure of which is incorporated herein by reference; US publication No. 2011/0087218, entitled "Surgical Instrument Comprising First and Second Drive Systems Actuatable by a Common Trigger Mechanism," published on April 14, 2011, the disclosure of which is hereby incorporated by reference; US publication No. 2012/0116379, entitled "Motor Driven Electrosurgical Device with Mechanical and Electrical Feedback," published on May 10, 2012, the disclosure of which is hereby incorporated by reference. US publication No. 2012/0078243, entitled "Control Features for Articulating Surgical Device", published on March 29, 2012, the disclosure of which is hereby incorporated by reference; US publication 2012/0078247, entitled "Control Features for Articulating Surgical Device", published on March 29, 2012, the disclosure of which is hereby incorporated by reference; US publication No. 2013/0030428,

entitled "Surgical Instrument with Multi-Phase Trigger Bias", published on January 31, 2013, the disclosure of which is incorporated herein by reference; and / or US publication 2013/0023868, entitled "Surgical Instrument with Contained Dual Helix Actuator Assembly", published on January 31, 2013, the description of which is incorporated by reference. Other suitable forms in which the teachings of the present invention can be applied to an ultrasonic surgical instrument will be evident to those skilled in the art in view of the teachings of the present invention.

[0214] In versions in which the teachings of the present invention are applied to a surgical stapling instrument, it should be understood that the teachings of the present invention can be combined with the teachings of one or more of the following, the descriptions of which are here incorporated by reference: US patent 7,380,696; U.S. patent No. 7,404,508; U.S. patent No.

7,455,208; U.S. patent No. 7,506,790; U.S. patent No. 7,549,564; U.S. Patent No. 7,559,450; U.S. Patent No. 7,654,431; U.S. patent No.

7,780,054; U.S. patent No. 7,784,662; and / or U.S. Patent No.

7,798,386. Other suitable forms in which the teachings of the present invention can be applied to a surgical stapling instrument will be apparent to those skilled in the art in view of the teachings of the present invention.

[0215] It should also be understood that the teachings of the present invention can be readily applied to any of the instruments described in any of the other references cited in the present invention, so that the teachings of the present invention can be readily combined with the teachings of any of the references cited in the present invention in various ways. Other types of instruments to which the teachings of the present invention can be incorporated will be evident to those skilled in the art.

[0216] It should be understood that any patent, publication or other disclosure material which, in whole or in part, is said to be incorporated herein by reference, is incorporated herein only to the extent that the incorporated material does not enter in conflict with the definitions, statements, or other disclosure materials presented in this disclosure. Thus, and as necessary, the disclosure as explicitly presented herein replaces any conflicting material incorporated into the present invention as a reference. Any material, or portion thereof, which is incorporated herein by reference, but which conflicts with the definitions, statements, or other disclosure materials contained herein, will be incorporated here only to the extent that there is no conflict between the embedded material and existing disclosure material.

[0217] The versions described above can be designed to be discarded after a single use or can be designed to be used multiple times. The versions can, in either or both cases, be reconditioned for reuse after at least one use. Reconditioning can include any combination of steps to disassemble the device, followed by cleaning or replacing specific parts and subsequent reassembly. In particular, some versions of the device can be disassembled and any number of parts or parts of the device can be selectively replaced or removed in any combination. With the cleaning and / or replacement of specific parts, some versions of the device can be reassembled for subsequent use, either in a reconditioning facility or by a user immediately before a surgical procedure. Those skilled in the art will understand that reconditioning a device can use a variety of techniques to disassemble, clean / replace and reassemble. The use of these techniques, as well as the resulting reconditioned device, are all within the scope of this application.

[0218] Just as an example, the versions described here can be sterilized before and / or after a procedure. In a sterilization technique, the device is placed in a closed and sealed container, such as a plastic or TYVEK bag. The container and device can then be placed in a radiation field, such as gamma radiation, X-rays or high-energy electrons, which can penetrate the container. Radiation can kill bacteria on the device and the container. The sterile device can then be stored in a sterile container for later use. The device can also be sterilized using any other known technique, including, but not limited to, beta or gamma radiation, ethylene oxide or water vapor.

[0219] Having shown and described various modalities of the present invention, other adaptations of the methods and systems described herein can be made by means of suitable modifications by a person skilled in the art without departing from the scope of the present invention. Several of these possible modifications have been mentioned, and others will become evident to those skilled in the art. For example, the examples, modalities, geometries, materials, dimensions, proportions, steps and the like discussed above are illustrative and are not mandatory. Consequently, the scope of the present invention must be considered in agreement in terms of the following claims, and it must be understood that it is not limited to the details of structure and operation shown and described in the specification and drawings.

Claims (65)

1. Surgical system characterized by comprising: a surgical tool including a drive shaft and an end actuator formed at a distal end thereof, with the end actuator having a clamping element and an ultrasonic blade, the clamping element being movable in relation to the ultrasonic blade to tighten and treat the tissue placed between the clamping element and the ultrasonic blade; a closing mechanism configured to selectively move the clamping element towards the ultrasonic blade from an open configuration to a configuration closed at a predetermined clamping speed (vc); and a control system configured to: keep vc at a first tightening speed (vc1) greater than a minimum tightening speed (vmin) until a predetermined limit tightening force (Fo) is reached; determining a closing parameter including at least one of the amount of time required to reach Fo and an amount of displacement of the clamping element necessary to reach Fo; determine a tissue characteristic based on the closure parameter; and release energy to the ultrasonic sheet to treat tissue in a profiling treatment according to a profiling treatment protocol based on the determined tissue characteristic. 2. System according to claim 1, characterized in that Fo is a force resulting from the contact of the clamping element with a fabric arranged between the clamping element and the ultrasonic blade. 3. System according to claim 1, characterized in that the profiling treatment is effective for coagulating a tissue arranged between the clamping arm and the ultrasonic blade. 4. System according to claim 1, characterized in that the tissue characteristic is a thickness of a tissue arranged between the clamping element and the ultrasonic sheet. 5. System, according to claim 4, characterized in that the thickness of the fabric is less than a predetermined thickness and the control system is configured to operate in the profiling treatment protocol: maintaining vc at a third tightening speed (vc3 ) while a clamping force applied to the tissue arranged between the clamping arm and the ultrasonic blade is less than a second predetermined treatment force (F2); and decrease the vc from you to a fourth tightening speed (Vac) during the remainder of the profiling treatment in response to the increase in the tightening force up to F2, where vc is configured to keep the tightening force below F>. 6. System according to claim 5, characterized in that each of vc3 and Vcs is approximately constant. 7. System according to claim 4, characterized in that the thickness of the fabric is greater than a predetermined thickness and the control system is configured to operate in the profiling treatment protocol by applying a clamping force to the arranged fabric between the clamping arm and the ultrasonic blade in a first approximately constant treatment force (F1). 8. System according to claim 7, characterized in that the control system is configured to: allow you to decrease to a level approximately equal to Vmin; and increasing the clamping force to a level between F; and less than a second treatment force (F2) for the rest of the profiling treatment. 9. System according to claim 7, characterized by the F: being based on the determined tissue characteristic. 10. System according to claim 1, characterized in that it additionally comprises an electrode configured to release radiofrequency energy to a tissue disposed between the clamping element and the ultrasonic blade. 11. System, according to claim 10, characterized by the control system being configured to release at least one of the ultrasonic energy to the ultrasonic blade and radiofrequency energy to the electrode according to a sealing treatment protocol that occurs after the profiling treatment to coagulate and cut a tissue arranged between the clamping element and the ultrasonic blade. 12. System according to claim 11, characterized in that the control system is additionally configured to perform the seal treatment in response to the detection that a pre-selected drive condition is satisfied. 13. System according to claim 12, characterized by the drive condition being the movement of the clamping element up to a predetermined distance from the ultrasonic blade. 14. The system according to claim 12, characterized by the drive condition being the deviation of vc from a speed setpoint by a predetermined speed limit. 15. System according to claim 12, characterized by the actuation condition being the application of a clamping force in a predefined amount of a maximum clamping force Fmax- 16. Method for treating tissue, characterized by the fact that it comprises: driving an engine of a surgical tool including a drive shaft and an end actuator, the end actuator being formed on a distal end of the drive shaft and having a clamping element and an ultrasonic blade coupled to an ultrasonic transducer, the clamping element being movable relative to the ultrasonic blade to a tissue clamping position between an open position and a closed clamping position at a predetermined clamping speed (you); keep vc at a first tightening speed (vc1) greater than a minimum tightening speed (vmin) until a predetermined limit tightening force (Fo) is reached; determining a closing parameter including at least one of the amount of time (t.) required to reach F, and the amount of displacement of the clamping element c required to reach Fo; determine a tissue characteristic based on the closure parameter; and release energy to the ultrasonic sheet to treat tissue in a profiling treatment according to a profiling treatment protocol based on the determined tissue characteristic. 17. Method according to claim 16, characterized in that Fo is a force resulting from the contact of the clamping element with a tissue arranged between the clamping element and the ultrasonic blade. 18. Method according to claim 16, characterized in that the profiling treatment is effective to cauterize a tissue arranged between the clamping arm and the ultrasonic blade. 19. Method according to claim 16, characterized in that the fabric is a thickness of a fabric arranged between the clamping element and the ultrasonic sheet. 20. Method according to claim 19, characterized in that it further comprises: determining the thickness of the fabric to be less than a predetermined thickness; keep vc at a third clamping speed (vc3) while a clamping force applied to the tissue placed between the clamping arm and the ultrasonic blade is less than a second predetermined treatment force (F2); and decrease the vc from you to a fourth tightening speed (Vac) during the remainder of the profiling treatment in response to the increase in the tightening force up to F2, where vc is configured to keep the tightening force below F>. 21. Method, according to claim 20, characterized by each of vc3 E Vc being approximately constant. 22. The method of claim 19, further comprising: determining the thickness of the fabric to be greater than a predetermined thickness; and applying a first treatment force F; to the tissue arranged between the clamping arm and the ultrasonic blade. 23. The method of claim 22, further comprising: allowing you to decrease to a level approximately equal to Vmin; and increasing the first treatment force to a level between F1: and a second treatment force F2 for the remainder of the profiling treatment. 24. Method according to claim 22, characterized by F; be based on the tissue characteristic determined. 25. The method of claim 16, further comprising: releasing radio frequency energy to a tissue arranged between the clamping element and the ultrasonic blade during the profiling treatment. 26. Method according to claim 26, characterized in that the amplitude of each of the ultrasonic and radio frequency energies is approximately constant during the profiling treatment. 27. Method according to claim 25, characterized in that it comprises releasing at least one of the ultrasonic energy and radiofrequency energy to treat the tissue in a sealing treatment that occurs after the profiling treatment according to a protocol sealing treatment, the sealing treatment being configured to coagulate and cut the tissue. 28. Method according to claim 27, characterized in that it further comprises performing the seal treatment in response to the detection that a pre-selected drive condition is satisfied. 29. Method according to claim 28, characterized by the drive condition being the movement of the closing mechanism up to a predetermined distance from the ultrasonic blade. 30. Method according to claim 28, characterized in that the driving condition is the deviation of vc from a speed setpoint by a predetermined speed limit. 31. Method according to claim 28, characterized in that the driving condition is the application of a clamping force in a predefined amount of a maximum clamping force Fmax. 32. Surgical system characterized by comprising: a surgical tool including a drive shaft and an end actuator formed at a distal end thereof, with the end actuator having a clamping element and an ultrasonic blade operationally coupled to an ultrasonic transducer, the clamping element being movable in relation to the ultrasonic sheet to clamp the tissue arranged between the clamping element and the ultrasonic sheet, so that a first tissue treatment is carried out by energizing the ultrasonic sheet; a closing mechanism configured to selectively move the clamping element from an initial open position to a fabric clamping position; a motor operationally coupled to the closing mechanism; and a control system in communication with the engine and configured to dynamically control a predetermined tissue clamping force applied to a fabric disposed between the clamping element and the ultrasonic blade within a desired range between a minimum treatment force and maximum treatment force during the first tissue treatment to respond to changes in tissue as a result of the first tissue treatment. 33. System according to claim 32, characterized in that the control system is configured to control a position of the clamping element in response to receiving a controlled position when the clamping force applied to the fabric is less that the minimum treatment force and the clamping element are spaced apart by more than a predetermined minimum amount from the closed position. 34. System according to claim 32, characterized in that the control system is configured to dynamically control specifically the position of the clamping element to maintain the predetermined tissue clamping force when the clamping force applied to the fabric exceeds the minimum treatment force or the clamping element is spaced by less than a minimum predetermined amount from the closed position. 35. System according to claim 34, characterized in that the control system is configured to control a motor torque within a predetermined range to maintain the tissue clamping force within the desired range during the first treatment tissue growth. 36. System according to claim 35, characterized in that the control system is configured to control an amount of current released to the motor to control the motor torque. 37. System according to claim 32, characterized in that the system additionally comprises an electrode coupled to the clamping element and operatively coupled to a radio frequency generator, the electrode being configured to provide a second tissue treatment to the disposed tissue between the clamping element and the ultrasonic blade when receiving radio frequency energy from the radio frequency generator. 38. System according to claim 37, characterized in that the control system is configured to: determine a position of the clamping element in relation to the closed position; and allowing the release of radio frequency energy less than a predetermined energy limit to the electrode when the position of the clamping element is distanced by more than a predetermined amount from the closed position. 39. System according to claim 37, characterized used by the control system to be configured to: determine a position of the clamping element in relation to the closed position; and allow the release of radiofrequency energy greater than a predetermined energy limit to the electrode when the position of the clamping element is distanced by less than a predetermined amount from the closed position. 40. System according to claim 37, characterized in that the control system is configured to: determine a position of the clamping element in relation to the closed position; inhibit the release of radio frequency energy greater than a predetermined energy limit to the electrode when the clamping element is spaced more than a minimum predetermined distance from the closed position. 41. System according to claim 40, characterized in that the control system is configured to trigger an alert to position the clamping element at a distance less than the minimum predetermined distance to allow the release of radio frequency energy greater than that predetermined limit energy to the electrode. 42. Method for treating tissue, characterized by the fact that it comprises: driving an engine of a surgical tool including a drive shaft and an end actuator, the end actuator being formed at a distal end of the drive shaft and having a clamping element and an ultrasonic blade coupled to an ultrasonic transducer, the clamping element being movable in relation to the ultrasonic blade to a tissue clamping position between an open position and a closed position of the clamping element in response to the motor actuation; adjusting the position of the clamping element using the motor to a first fabric clamping position where the clamping element applies a clamping force approximately equal to a predetermined minimum clamping treatment force; transmitting ultrasonic energy from the ultrasonic transducer to the ultrasonic blade after the applied clamping force is greater than or equal to the minimum clamping treatment force; and adjust the position of the clamping element using the motor to apply a target clamping force between the minimum treatment clamping force and a predetermined maximum clamping force while the ultrasonic energy is transmitted to the ultrasonic blade. 43. The method of claim 42, comprising controlling a position of the clamping element in response to receiving a commanded position when the clamping force applied to the fabric is less than the minimum treatment force and the position of the clamping element is spaced by more than a predetermined minimum amount from the closed position. 44. The method of claim 42, further comprising dynamically controlling the position of the clamping element to maintain the target clamping force when the clamping force exceeds the minimum handling force or clamping element it is distanced by less than a predetermined minimum quantity from the closed position. 45. Method according to claim 44, characterized in that it further comprises controlling a motor torque within a predetermined range to maintain the tissue clamping force within the desired range during the first treatment of the fabric. 46. Method according to claim 45, characterized because it additionally comprises controlling the amount of current released to the engine to control the engine torque. 47. The method of claim 42, further comprising releasing radio frequency energy to an electrode coupled to the clamping element. 48. The method of claim 47, further comprising: determining a position of the clamping element in relation to the closed position; and releasing radio frequency energy less than a predetermined energy limit to the electrode when the position of the clamping element is spaced by more than a predetermined amount from the closed position. 49. The method of claim 47, further comprising: determining a position of the clamping element in relation to the closed position; and releasing radio frequency energy greater than a predetermined energy limit to the electrode when the position of the clamping element is spaced by less than a predetermined amount from the closed position. 50. The method of claim 47, further comprising: determining a position of the clamping element in relation to the closed position; and inhibiting the release of radio frequency energy greater than a predetermined energy limit to the electrode when the clamping element is spaced more than a minimum predetermined distance from the closed position. 51. Method according to claim 50, characterized because it additionally comprises triggering an alert to position the clamping element at a distance less than the minimum predetermined distance to allow the release of radiofrequency energy greater than the predetermined energy limit for the electrode. 52. Surgical system characterized by comprising: an end actuator having an ultrasonic blade and a clamping element, the ultrasonic blade being configured to receive ultrasonic vibrations from an ultrasonic transducer and the clamping element configured to tighten and treat the tissue arrangement between the clamping element and the ultrasonic sheet as ultrasonic vibrations are applied to the tissue from the ultrasonic sheet; a drive shaft assembly that has a longitudinal geometric axis and the end actuator disposed at a distal end thereof, where the drive shaft assembly includes an operable pivot section to deflect the actuator from far end on the longitudinal axis by a pivot angle between a minimum pivot angle of about 0 degrees when the end actuator is aligned with the longitudinal geometric axis of the drive shaft assembly to a pivot angle maximum non-zero in any direction when the end actuator is not aligned with the longitudinal geometry axis of the drive shaft assembly; an interface set with one or more drive shafts coupled to the end actuator and the drive shaft set configured to drive the movement of the end actuator and the drive shaft set; and a control system configured to control an amplitude of the ultrasonic vibrations received by the ultrasonic blade so that the amplitude increases with an increase in the articulation angle of the end actuator. 53. System according to claim 52, characterized in that the control system is configured to measure the rotation of a first drive shaft that is operable to adjust the articulation angle of the end actuator. 54. System according to claim 53, characterized in that the control system is configured to control the amplitude of ultrasonic vibrations based on the measured rotation of the first drive axis. 55. System according to claim 54, characterized in that the control system is configured to control the amplitude of ultrasonic vibrations during the articulation of the end actuator. 56. System according to claim 52, characterized in that the control system is configured to control a rate of change in the amplitude of the ultrasonic vibrations in relation to the articulation of the end actuator between the minimum and maximum articulation angles. 57. System according to claim 56, characterized in that the rate of change in amplitude is approximately constant between the minimum and maximum articulation angles. 58. System according to claim 56, characterized in that the rate of change in amplitude varies between the minimum and maximum articulation angles. 59. Method for treating fabric, characterized by the fact that it comprises: operating a motor to make a set of drive axes with a longitudinal geometric axis and an end actuator arranged at a distal end of the same which has a clamping element and an ultrasonic blade, deflected in an anguish of articulation between a minimum articulation angle of about 0 degrees when the end actuator is aligned with the longitudinal geometry axis of the drive axis and a maximum articulation angle other than zero in any direction when the actuator of end is not aligned with the longitudinal geometric axis of the drive axis; transmit, by an ultrasonic generator, ultrasonic vibrations to the ultrasonic blade to coagulate or cut the trapped tissue between the clamping element and the ultrasonic blade; and vary, by the ultrasonic generator, an amplitude of the ultrasonic vibrations so that the amplitude increases with an increase in the articulation of the end actuator. 60. The method of claim 59, further comprising measuring a rotation of a drive shaft coupled to the drive shaft assembly and configured to drive the end actuator hinge between the minimum hinge angles and maximum. 61. The method of claim 60, further comprising varying the amplitude of the ultrasonic vibrations based on the measured rotation of the drive shaft. 62. The method of claim 61, further comprising varying the amplitude of the ultrasonic vibrations during articulation of the end actuator. 63. Method according to claim 59, characterized in that it further comprises varying a rate of change in the amplitude of the ultrasonic vibrations in relation to the articulation of the end actuator between the minimum and maximum articulation angles. 64. Method according to claim 63, characterized in that the rate of change in amplitude is approximately constant between the minimum and maximum articulation angles. 65. Method according to claim 63, characterized in that the rate of change in amplitude varies between the minimum and maximum articulation angles.