BR112020012783A2 - situational perception of surgical controller centers - Google Patents

Abstract

The present invention relates to several central surgical controllers. A central surgical controller is configured to connect communicably to a data source and a modular device. The central surgical controller has a processor and memory attached to the processor, or it may have a computer-readable control circuit or media. Instructions are executed that cause the central surgical controller to receive perioperative data from the data source, determine contextual information regarding the surgical procedure, according to the perioperative data, determine control settings for the modular device, according to the contextual information, and control the modular device according to the control settings. Perioperative data includes data detected by the data source during the course of a surgical procedure.

Description

Descriptive Report of the Invention Patent for "SITUATIONAL PERCEPTION OF CENTRAL SURGICAL CONTROLLER".

CROSS REFERENCE TO RELATED ORDERS

[0001] This application claims the priority benefit set forth in Title 35 of USC 119 (e) for provisional patent application Serial No. 62 / 649,300, entitled SURGICAL HUB SITUATIONAL AWARENESS, filed on March 28, 2018, the description of which is hereby incorporated by reference in its entirety.

[0002] The present application claims the priority benefit set forth in Title 35 of USC 119 (e) for provisional US patent application Serial No. 62 / 611.341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, of the application US Provisional Patent Serial No. 62 / 611,340, entitled CLOUD-BASED MEDICAL ANALYTICS, filed on December 28, 2017, from US Provisional Patent Application Serial No. 62 / 611,339, entitled ROBOT ASSISTED SURGICAL PLATFORM, filed on December 28 2017, with the description of each of them in this document incorporated by reference, in its entirety.

BACKGROUND

[0003] The present description refers to several surgical systems. Surgical procedures are typically performed in theaters or surgical operating rooms in a health care facility, such as a hospital. A sterile field is typically created around the patient. The sterile field may include members of the brushing team, who are properly dressed, and all furniture and accessories in the area. Various surgical devices and systems are used to perform a surgical procedure.

SUMMARY

[0004] In one aspect, a surgical centralizing module is provided. The surgical centralizing module is configured to connect communicatively to a data source and to a modular device. The surgical centralizing module comprises a processor and a memory attached to the processor. The memory stores instructions that, when executed by the processor, cause the surgical centralizing module to receive perioperative data from the data source. Perioperative data includes data detected by the data source during the course of a surgical procedure. The instructions executed by the processor also determine contextual information regarding the surgical procedure according to the perioperative data, determine control settings for the modular device according to the contextual information, and control the modular device according to the control settings.

[0005] In another general aspect, a surgical centralizing module is provided, which is configured to connect communicatively to a data source and to a modular device. The surgical centralizing module comprises a control circuit. The control circuit is configured to receive perioperative data from the data source, and perioperative data includes data detected by the data source during the course of a surgical procedure. The control circuit is configured to also determine contextual information regarding the surgical procedure according to perioperative data, to determine control settings for the modular device according to the contextual information, and to control the modular device according to the settings of control.

[0006] In yet another general aspect, a computer-readable non-transitory medium stores computer-readable instructions that, when executed by a surgical central controller configured to be communicably coupled to a data source and a modular device, cause the central surgical controller receives perioperative data from the data source, determine contextual information regarding the surgical procedure according to the perioperative data, determine the control settings for the modular device according to the contextual information and control the modular device according to control settings.

FIGURES

[0007] The appeals of various aspects are presented with particularity in the attached claims. The various aspects, however, with regard to both the organization and the methods of operation, together with additional objects and advantages of the same, can be better understood in reference to the description presented below, considered together with the attached drawings, as follows.

[0008] Figure 1 is a block diagram of an interactive surgical system implemented by computer, according to at least one aspect of the present description.

[0009] Figure 2 is a surgical system being used to perform a surgical procedure in an operating room, in accordance with at least one aspect of the present description.

[0010] Figure 3 is a central surgical controller paired with a visualization system, a robotic system, and an intelligent instrument, according to at least one aspect of the present description.

[0011] Figure 4 is a partial perspective view of a central surgical controller housing, and of a generator module in combination received slidably in a central surgical controller housing, in accordance with at least one aspect of the present description.

[0012] Figure 5 is a perspective view of a generator module in combination with bipolar, ultrasonic and monopolar contacts and a smoke evacuation component, in accordance with at least one aspect of the present description.

[0013] Figure 6 illustrates different power bus connectors for a plurality of side coupling ports of a side modular cabinet configured to receive a plurality of modules, in accordance with at least one aspect of the present description.

[0014] Figure 7 illustrates a vertical modular housing configured to receive a plurality of modules, in accordance with at least one aspect of the present description.

[0015] Figure 8 illustrates a surgical data network comprising a modular communication center configured to connect modular devices located in one or more operating rooms of a health care facility, or any environment in a utility facility especially equipped for surgical operations, to the cloud, in accordance with at least one aspect of the present description.

[0016] Figure 9 illustrates an interactive surgical system implemented by computer, in accordance with at least one aspect of the present description.

[0017] Figure 10 illustrates a central surgical controller that comprises a plurality of modules coupled to the modular control tower, according to at least one aspect of the present description.

[0018] Figure 11 illustrates an aspect of a universal serial bus (USB) central network controller device, in accordance with at least one aspect of the present description.

[0019] Figure 12 illustrates a logical diagram of a control system for an instrument or surgical tool, according to at least one aspect of the present description.

[0020] Figure 13 illustrates a control circuit configured to control aspects of the instrument or surgical tool, according to at least one aspect of the present description.

[0021] Figure 14 illustrates a combinational logic circuit configured to control aspects of the instrument or surgical tool, according to at least one aspect of the present description.

[0022] Figure 15 illustrates a sequential logic circuit configured to control aspects of the instrument or surgical tool, according to at least one aspect of the present description.

[0023] Figure 16 illustrates an instrument or surgical tool that comprises a plurality of motors that can be activated to perform various functions, according to at least one aspect of the present description.

[0024] Figure 17 is a schematic diagram of a robotic surgical instrument configured to operate a surgical tool described therein, in accordance with at least one aspect of the present description.

[0025] Figure 18 illustrates a block diagram of a surgical instrument programmed to control the distal translation of the displacement member, according to an aspect of the present description.

[0026] Figure 19 is a schematic diagram of a surgical instrument configured to control various functions, in accordance with at least one aspect of the present description.

[0027] Figure 20 is a simplified block diagram of a generator configured to provide fine adjustment without inductor, among other benefits, according to at least one aspect of the present description.

[0028] Figure 21 represents an example of a generator, which is a form of the generator of Figure 20, according to at least one aspect of the present description.

[0029] Figure 22 illustrates a diagram of a surgical system with situational perception, according to at least one aspect of the present description.

[0030] Figure 23A illustrates a logical flow chart of a process for controlling a modular device, according to contextual information derived from received data, in accordance with at least one aspect of the present description.

[0031] Figure 23B illustrates a logical flowchart of a process for controlling a second modular device according to contextual information derived from perioperative data received from a first modular device, in accordance with at least one aspect of the present description.

[0032] Figure 23C illustrates a logical flowchart of a process for controlling a second modular device according to contextual information derived from perioperative data received from a first modular device and the second modular device, in accordance with at least one aspect of the present description. .

[0033] Figure 23D illustrates a logical flowchart of a process for controlling a third modular device according to contextual information derived from perioperative data received from a first modular device and a second modular device, in accordance with at least one aspect of the present description.

[0034] Figure 24A illustrates a diagram of a central surgical controller communicatively coupled to a specific set of modular devices and to an Electronic Medical Record ("EMR") database, in accordance with at least an aspect of the present description.

[0035] Figure 24B illustrates a diagram of a smoke evacuator that includes pressure sensors, in accordance with at least one aspect of the present description.

[0036] Figure 25A illustrates a logical flow chart of a process for determining a type of procedure, according to perioperative data from the smoke evacuator, in accordance with at least one aspect of the present description.

[0037] Figure 25B illustrates a logical flowchart of a processor to determine a type of procedure, according to perioperative data from the medical imaging device, the insufflator and the smoke evacuator, in accordance with at least one aspect of the present description.

[0038] Figure 25C illustrates a logical flowchart of a process for determining a type of procedure, according to perioperative data from the medical imaging device, in accordance with at least one aspect of the present description.

[0039] Figure 25D illustrates a logical flow chart of a process for determining a procedure step according to perioperative data from the insufflator, in accordance with at least one aspect of the present description.

[0040] Figure 25E illustrates a logical flow chart of a process to determine a procedural step according to perioperative data of the energy generator, in accordance with at least one aspect of the present description.

[0041] Figure 25F illustrates a logical flow chart of a process to determine a procedural step according to perioperative data of the energy generator, in accordance with at least one aspect of the present description.

[0042] Figure 25G illustrates a logical flow chart of a process for determining a procedure step according to perioperative data from the stapler, in accordance with at least one aspect of the present description.

[0043] Figure 25H illustrates a logical flowchart of a process to determine a patient's state, according to perioperative data from the ventilator, pulse oximeter, blood pressure monitor and / or electrocardiogram monitor, according to the least one aspect of the present description.

[0044] Figure 251 illustrates a logical flowchart of a process to determine a patient's state, according to perioperative data from the pulse oximeter, blood pressure monitor and / or electrocardiogram monitor, according to at least one aspect of this description.

[0045] Figure 25J illustrates a logical flow chart of a process for determining a patient's state according to perioperative data of the ventilator, in accordance with at least one aspect of the present description.

[0046] Figure 26A illustrates a scanner coupled to a central surgical controller to scan a patient's wristband, in accordance with at least one aspect of the present description.

[0047] Figure 26B illustrates a scanner coupled to a central surgical controller to scan a list of surgical items, in accordance with at least one aspect of the present description.

[0048] Figure 27 illustrates a timeline of an illustrative surgical procedure and the interferences that the central surgical controller can make from the data detected at each stage in the surgical procedure, according to at least one aspect of the present description.

[0049] Figure 28A illustrates a flowchart representing the process of importing patient data stored in an EMR database and deriving inferences from it, in accordance with at least one aspect of the present description.

[0050] Figure 28B illustrates a flowchart representing the process of determining control adjustments corresponding to the inferences derived from Figure 28A, in accordance with at least one aspect of the present description.

[0051] Figure 29 illustrates a flow chart of an interactive surgical system implemented by computer, according to at least one aspect of the present description.

[0052] Figure 30 illustrates a logical flowchart of tracking data associated with an operating room event, in accordance with at least one aspect of the present description.

[0053] Figure 31 illustrates a diagram representing how the data tracked by the central surgical controller can be analyzed to provide increasingly detailed metrics, according to at least one aspect of the present description.

[0054] Figure 32 illustrates a bar graph representing the number of patients operated in relation to the days of a week for different operating rooms, according to at least one aspect of the present description.

[0055] Figure 33 illustrates a bar graph representing the total downtime between procedures in relation to the days of a week for a specific operating room, according to at least one aspect of the present description.

[0056] Figure 34 illustrates a bar graph representing total downtime per day of the week represented in Figure

33 differentiated according to each case of individual downtime, according to at least one aspect of the present description.

[0057] Figure 35 illustrates a bar graph representing the average procedure size in relation to the days of a week for a specific operating room, according to at least one aspect of the present description.

[0058] Figure 36 illustrates a bar graph representing the size of the procedure in relation to the type of procedure, according to at least one aspect of the present description.

[0059] Figure 37 illustrates a bar graph representing the average completion time for specific procedure steps for different types of thoracic procedures, according to at least one aspect of the present description.

[0060] Figure 38 illustrates a bar graph representing the procedure time in relation to the types of procedures, according to at least one aspect of the present description.

[0061] Figure 39 illustrates a bar graph representing the operating room downtime in relation to the time of day, according to at least one aspect of the present description.

[0062] Figure 40 illustrates a bar graph representing the operating room downtime in relation to the day of the week, according to at least one aspect of the present description.

[0063] Figure 41 illustrates a pair of pie charts representing the percentage of time that the operating theater is used, according to at least one aspect of the present description.

[0064] Figure 42 illustrates a bar graph representing the surgical items consumed and not used in relation to the type of procedure, according to at least one aspect of the present description.

[0065] Figure 43 illustrates a logical flowchart of a process for storing data from modular devices and the patient information database for comparison, in accordance with at least one aspect of the present description.

[0066] Figure 44 illustrates a diagram of a distributed computing system, according to at least one aspect of the present description.

[0067] Figure 45 illustrates a logical flowchart of a process for diverting distributed computing resources, according to at least one aspect of the present description.

[0068] Figure 46 illustrates a diagram of an imaging system and a surgical instrument that supports a calibration scale, according to at least one aspect of the present description.

DESCRIPTION

[0069] The applicant for this application holds the following provisional US patent applications, filed on March 28, 2018, each of which in this document is incorporated by reference in its entirety for reference: e US Provisional Patent Application Serial No. 62 / 649,302, entitled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES; and US Provisional Patent Application Serial No. 62 / 649,294, entitled DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD; and US Provisional Patent Application Serial No. 62 / 649,300, entitled SURGICAL HUB SITUATIONAL AWARENESS; and US Provisional Patent Application Serial No. 62 / 649,309, entitled SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER;

and US Provisional Patent Application Serial No. 62 / 649,310, entitled COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS; and US Provisional Patent Application Serial No. 62 / 649,291, titled USE OF LASER LIGHT AND RED-GREEN-BLUE

COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT; and US Provisional Patent Application Serial No. 62 / 649,296, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES; and US Provisional Patent Application Serial No. 62 / 649,333, entitled CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER; and US Provisional Patent Application Serial No. 62 / 649,327, entitled CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES; and US Provisional Patent Application Serial No. 62 / 649,315, entitled DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK; and US Provisional Patent Application Serial No. 62 / 649,313, entitled CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES; and US Provisional Patent Application Serial No. 62 / 649,320, entitled DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; and US Provisional Patent Application Serial No. 62 / 649,307, entitled AUTOMATIC. TOOL ADJUSTMENTS FOR ROBOT- ASSISTED SURGICAL PLATFORMS; and e US Provisional Patent Application SERIAL No. 62 / 649,323, TITLE SENSING ARRANGEMENTS FOR ROBOT- ASSISTED SURGICAL PLATFORMS.

[0070] The applicant for this application holds the following US patent applications, filed on March 29, 2018, each of which in this document is incorporated by reference in its entirety for reference: e US Patent Application Serial No., entitled INTERACTIVE —SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES; Attorney document number END8499USNP / 170766; and US Patent Application Serial No., entitled

INTERACTIVE SURGICAL SYSTEMS WITH CONDITION HANDLING OF DEVICES AND DATA CAPABILITIES; Attorney document number END8499USNP1 / 170766-1; and US Patent Application Serial No., entitled

SURGICAL HUB COORDINATION OF CONTROL AND COMMUNICATION OF OPERATING ROOM DEVICES; Attorney document number END8499USNP2 / 170766-2; and US Patent Application Serial No., entitled

SPATIAL AWARENESS OF SURGICAL HUBS IN OPERATING ROOMS; Attorney document number END8499USNP3 / 170766-3; and US Patent Application Serial No., entitled

COOPERATIVE USATION OF DATA DERIVED FROM SECONDARY SOURCES BY INTELLIGENT SURGICAL HUBS; Attorney document number END8499USNP4 / 170766-4; and US Patent Application Serial No., entitled SURGICAL HUB CONTROL ARRANGEMENTS; Attorney's document number END8499USNP5 / 170766-5; and US Patent Application Serial No., entitled

DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD; Attorney document number END8500USNP / 170767;

and US Patent Application Serial No., entitled

COMMUNICATION HUB AND STORAGE DEVICE FOR STORING

PARAMETERS AND STATUS OF A SURGICAL DEVICE TO BE SHARED WITH CLOUD BASED ANALYTICS SYSTEMS; Attorney document number END8500USNP1 / 170767-1; and US Patent Application Serial No., entitled

SELF DESCRIBING DATA PACKETS GENERATED AT AN ISSUING INSTRUMENT; Attorney document number END8500USNP2 / 170767-2; and US Patent Application Serial No., entitled

DATA PAIRING TO INTERCONNECT A DEVICE MEASURED PARAMETER WITH AN OUTCOME; Attorney document number END8500USNP3 / 170767-3; and US Patent Application Serial No., entitled SURGICAL SYSTEM DISTRIBUTED PROCESSING; Attorney document number END8501USNP1 / 170768-1; and US Patent Application Serial No., entitled AGGREGATION AND REPORTING OF SURGICAL HUB DATA; Attorney document number END8501USNP2 / 170768-2; and US Patent Application Serial No., entitled

SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER; Attorney's document number END8502USNP / 170769; and US Patent Application Serial No., entitled

DISPLAY OF ALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LINEAR STAPLE LINE; Attorney document number END8502USNP1 / 170769-1; and US Patent Application Serial No., entitled STERILE FIELD INTERACTIVE CONTROL DISPLAYS; Attorney document number END8502USNP2 / 170769-2;

and US Patent Application Serial No., entitled COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS; Attorney's document number END8503USNP / 170770; and US Patent Application Serial No., entitled USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT; Attorney document number END8504USNP / 170771; and US Patent Application Serial No., entitled

CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OF MONO-CHROMATIC LIGHT REFRACTIVITY; Attorney's document number END8504USNP1 / 170771-1; and US PATENT APPLICATION SERIAL NUMBER; TITLE DUAL CMOS ARRAY IMAGING; Attorney document number END8504USNP2 / 170771-2.

[0071] The applicant for this application holds the following US patent applications, filed on March 29, 2018, each of which in this document is incorporated by reference in its entirety for reference: e US Patent Application Serial No., entitled

ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES; Attorney document number END8506USNP / 170773; and US Patent Application Serial No., entitled

ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL HUBS; Attorney document number END8506USNP1 / 170773-1; and US Patent Application Serial No., entitled CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER; Attorney's document number END8507USNP / 170774; and US Patent Application Serial No., entitled CLOUD-BASED MEDICAL ANALYTICS FOR LINKING OF LOCAL

USAGE TRENDS WITH THE RESOURCE ACQUISITION BEHAVIORS OF LARGER DATA SET; Attorney document number END8507USNP1 / 170774-1; and US Patent Application Serial No., entitled CLOUD-BASED MEDICAL ANALYTICS FOR MEDICAL FACILITY SEGMENTED INDIVIDUALIZATION OF INSTRUMENT FUNCTION; Attorney document number END8507 USNP2 / 170774-2; and US Patent Application Serial No., entitled CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES; Attorney document number END8508USNP / 170775; and US Patent Application Serial No., entitled

DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK; Attorney's document number END8509USNP / 170776; and e US Patent Application Serial No., entitled CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES; Attorney document number END8510USNP / 170777.

[0072] The applicant for this application holds the following US patent applications, filed on March 29, 2018, each of which in this document is incorporated by reference in its entirety for reference: and US Patent Application Serial No., entitled DRIVE ARRANGEMENTS FOR ROBOT- ASSISTED SURGICAL PLATFORMS; Attorney document number END8511USNP / 170778; and US Patent Application Serial No., entitled COMMUNICATION ARRANGEMENTS FOR ROBOT-ASSISTED PLATFORMS; Attorney document number END8511USNP1 / 170778-1;

and US PATENT APPLICATION SERIAL NUMBER; CONTROLS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; Attorney document number END8511USNP2 / 170778-2; and US Patent Application Serial No., entitled AUTOMATIC. TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; Attorney document number END8512USNP / 170779; and US Patent Application Serial No., entitled CONTROLLERS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; Attorney's document number END8512USNP1 / 170779-1; and US Patent Application Serial No., entitled COOPERATIVE SURGICAL ACTIONS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; Attorney document number END8512USNP2 / 170779-2; and US Patent Application Serial No., entitled DISPLAY ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; Attorney document number END8512USNP3 / 170779-3; and e US Patent Application Serial No., entitled SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; Attorney document number END8513USNP / 170780.

[0073] Before explaining in detail the various aspects of surgical instruments and generators, it should be noted that the illustrative examples are not limited, in terms of application or use, to the details of construction and arrangement of parts illustrated in the drawings and description attached. Illustrative examples can be implemented or incorporated into other aspects, variations and modifications, and can be practiced or performed in a variety of ways. Furthermore, except where otherwise indicated, the terms and expressions used in the present invention were chosen for the purpose of describing illustrative examples for the convenience of the reader and not for the purpose of limiting it. In addition, it should be understood that one or more of the aspects, expressions of aspects, and / or examples described below can be combined with any one or more of the other aspects, expressions of aspects and / or examples described below.

[0074] With reference to Figure 1, a computer-implemented interactive surgical system 100 includes one or more surgical systems 102 and a cloud-based system (e.g., cloud 104 which may include a remote server 113 coupled to a storage device 105). Each surgical system 102 includes at least one central surgical controller 106 in communication with the cloud 104 which can include a remote server 113. In one example, as illustrated in Figure 1, surgical system 102 includes a visualization system 108, a robotic system 110, a smart handheld surgical instrument 112, which are configured to communicate with one another and / or the central controller 106. In some respects, a surgical system 102 may include a number of central controllers M 106, an N number of visualization systems 108, an O number of robotic systems 110, and a P number of smart, hand-held surgical instruments 112, where M, N, O, and P are whole numbers greater than or equal to one.

[0075] Figure 3 represents an example of a surgical system 102 being used to perform a surgical procedure on a patient who is lying on an operating table 114 in a surgical operating room 116. A robotic system 110 is used in the surgical procedure as part of the surgical system 102. The robotic system 110 includes a surgeon console 118, a patient carriage 120 (surgical robot), and a robotic central surgical controller 122. The patient carriage 120 can handle at least one attached surgical tool removably 117 through a minimally invasive incision in the patient's body while the surgeon views the surgical site through the surgeon's console 118. An image of the surgical site can be obtained by a medical imaging device 124, which can be manipulated by car 120 to guide imaging device 124. Robotic central surgical controller 122 can be used to process surgical site for subsequent display to the surgeon through the surgeon's console 118.

[0076] Other types of robotic systems can be readily adapted for use with the surgical system 102. Various examples of robotic systems and surgical instruments that are suitable for use with the present description are described in provisional patent application Serial No. 62 / 611.339 , entitled ROBOT ASSISTED SURGICAL PLATFORM, filed on December 28, 2017, the description of which is hereby incorporated by reference in its entirety for reference.

[0077] Several examples of cloud-based analysis that are performed by the cloud 104, and are suitable for use with the present description, are described in US provisional patent application Serial No. 62 / 611.340, entitled “CLOUD-BASED MEDICAL ANALYTICS , filed on December 28, 2017, the description of which is hereby incorporated by reference, in its entirety.

[0078] In several respects, the imaging device 124 includes at least one Image sensor and one or more optical components. Suitable image sensors include, but are not limited to, load-coupled device (CCD) sensors and complementary metal oxide semiconductor (CMOS) sensors.

[0079] The optical components of the imaging device 124 may include one or more light sources and / or one or more lenses. One or more light sources can be directed to illuminate portions of the surgical field. The one or more image sensors can receive reflected or refracted light from the surgical field, including reflected or refracted light from tissue and / or surgical instruments.

[0080] The one or more light sources can be configured to radiate electromagnetic energy in the visible spectrum, as well as in the invisible spectrum. The visible spectrum, sometimes called the optical spectrum or light spectrum, is that portion of the electromagnetic spectrum that is visible to (that is, can be detected by) the human eye and can be called visible light or simply light. A typical human eye will respond to wavelengths in the air that are from about 380 nm to about 750 nm.

[0081] The invisible spectrum (that is, the non-luminous spectrum) is that portion of the electromagnetic spectrum located below and above the visible spectrum (that is, wavelengths below about 380 nm and above about 750 nm). The invisible spectrum is not detectable by the human eye. Wavelengths greater than about 750 nm are longer than the visible red spectrum, and they become invisible infrared (IR), microwaves, radio and electromagnetic radiation. Wavelengths shorter than about 380 nm are shorter than the ultraviolet spectrum, and they become invisible ultraviolet, x-ray, and electromagnetic gamma-ray radiation.

[0082] In several respects, the imaging device 124 is configured for use in a minimally invasive procedure. Examples of imaging devices suitable for use with the present description include, but are not limited to, an arthroscope,

angioscope, bronchoscope, choledocoscope, colonoscope, cytoscope, duodenoscope, enteroscope, esophagus-duodenoscope (gastroscope), endoscope, laryngoscope, nasopharyngoscope, sigmoidoscope, thoracoscope and ureteroscope.

[0083] In one aspect, the imaging device employs multiple spectrum monitoring to discriminate topography and underlying structures. A multi-zespectral image is one that captures image data within wavelength bands across the electromagnetic spectrum. Wavelengths can be separated by filters or using instruments that are sensitive to specific wavelengths, including light from frequencies beyond the visible light range, for example, IR and ultraviolet light. Spectral images can allow the extraction of additional information that the human eye cannot capture with its receivers for the colors red, green and blue. The use of multispectral imaging is described in more detail under the heading "Advanced Imaging Acquisition Module" in US provisional patent application Serial No. 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, the description of which is in the present document incorporated as a reference in its entirety. Multispectral monitoring can be a useful tool for relocating a surgical field after a surgical task is completed to perform one or more of the tests previously described on the treated tissue.

[0084] It is axiomatic that strict sterilization of the operating room and surgical equipment is necessary during any surgery. The strict hygiene and sterilization conditions required in an "operating room", that is, an operating or treatment room, justify the highest possible sterilization of all medical devices and equipment. Part of this sterilization process is the need to sterilize anything that comes into contact with the patient or enters the sterile field, including imaging device 124 and its connectors and components. It will be understood that the sterile field can be considered a specified area, such as inside a tray or on a sterile towel, which is considered free of microorganisms, or the sterile field can be considered an area, immediately around a patient, who was prepared to perform a surgical procedure. The sterile field may include members of the brushing team, who are properly dressed, and all furniture and accessories in the area.

[0085] In various aspects, the visualization system 108 includes one or more imaging sensors, one or more image processing units, one or more storage arrays and one or more screens that are strategically arranged in relation to the sterile field, as illustrated in Figure 2. In one aspect, the display system 108 includes an interface for HL7, PACS and EMR. Various components of the 108 display system are described under the heading "Advanced Imaging Acquisition Module" in US provisional patent application Serial No. 62 / 611.341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, the description of which is in this document incorporated as a reference in its entirety.

[0086] As illustrated in Figure 2, a primary screen 119 is positioned in the sterile field to be visible to the operator on the operating table 114. In addition, a viewing tower 111 is positioned outside the sterile field. The display tower 111 includes a first non-sterile screen 107 and a second non-sterile screen 109, which are opposite each other. Visualization system 108, guided by central controller 106, is configured to use screens 107,

109, and 119 to coordinate the flow of information to operators inside and outside the sterile field. For example, central controller 106 can have visualization system 108 display a snapshot of a surgical site, as recorded by an imaging device 124, on a non-sterile screen 107 or 109, while maintaining a transmission live from the surgical site on the main screen 119. The snapshot on the non-sterile screen 107 or 109 can allow a non-sterile operator to perform a diagnostic step relevant to the surgical procedure, for example.

[0087] In one aspect, central controller 106 is also configured to route a diagnostic input or feedback by a non-sterile operator in the display tower 111 to the primary screen 119 within the sterile field, where it can be seen by a sterile operator on the operating table. In one example, the entry may be in the form of a modification of the snapshot displayed on the non-sterile screen 107 or 109, which can be routed to main screen 119 by central controller 106.

[0088] With reference to Figure 2, a surgical instrument 112 is being used in the surgical procedure as part of the surgical system 102. The central controller 106 is also configured to coordinate the flow of information to a screen of the surgical instrument 112. For example, in US provisional patent application Serial No. 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, the description of which is hereby incorporated by reference in its entirety for reference. An entry or diagnostic feedback inserted by a non-sterile operator in the viewing tower 111 can be routed by the central controller 106 to the surgical instrument screen 115 in the sterile field, where it can be seen by the surgical instrument operator 112. Exemplary surgical instruments that are suitable for use with surgical system 102 are described under the heading "Surgical Instrument Hardware" and in provisional patent application Serial No. 62 / 611.341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, the description of which is in this document incorporated as a reference in its entirety, for example.

[0089] Now with reference to Figure 3, a central controller 106 is shown in communication with a visualization system 108, a robotic system 110 and a smart handheld surgical instrument 112. Central controller 106 includes a central controller screen 135, an imaging module 138, a generator module 140, a communication module 130, a processor module 132 and a storage matrix 134. In certain respects, as illustrated in Figure 3, central controller 106 additionally includes a smoke evacuation module 126 and / or a suction / irrigation module 128.

[0090] During a surgical procedure, the application of energy to the tissue, for sealing and / or cutting, is generally associated with the evacuation of smoke, suction of excess fluid and / or irrigation of the tissue. Fluid, power, and / or data lines from different sources are often intertwined during the surgical procedure. Valuable time can be wasted in addressing this issue during a surgical procedure. To untangle the lines, it may be necessary to disconnect the lines from their respective modules, which may require a restart of the modules. The modular housing of the central controller 136 offers a unified environment for managing power, data and fluid lines, which reduces the frequency of entanglement between such lines.

[0091] Aspects of the present description feature a central surgical controller for use in a surgical procedure that involves applying energy to the tissue at a surgical site. The central surgical controller includes a central controller housing and a combination generator module received slidably at a central controller housing docking station. The docking station includes data and power contacts. The combined generator module includes two or more of an ultrasonic energy generating component, a bipolar RF energy generating component, and a monopolar RF energy generating component which are housed in a single unit. In one aspect, the combined generator module also includes a smoke evacuation component, at least one power application cable to connect the combined generator module to a surgical instrument, at least one smoke evacuation component configured to evacuate smoke, fluid , and / or particulates generated by applying therapeutic energy to the tissue, and a fluid line that extends from the remote surgical site to the smoke evacuation component.

[0092] In one aspect, the fluid line is a first fluid line and a second fluid line extends from the remote surgical site to a suction and irrigation module received slidingly in the central controller housing. In one aspect, the central controller housing comprises a fluid interface.

[0093] Certain surgical procedures may require the application of more than one type of energy to the tissue. One type of energy may be more beneficial for cutting the fabric, while another type of energy may be more beneficial for sealing the fabric. For example, a bipolar generator can be used to seal the tissue while an ultrasonic generator can be used to cut the sealed tissue. Aspects of the present description present a solution in which a modular housing of central controller 136 is configured to accommodate different generators and facilitate interactive communication between them. One of the advantages of the central modular housing 136 is that it allows quick removal and / or replacement of several modules.

[0094] Aspects of the present description present a modular surgical wrap for use in a surgical procedure that involves applying energy to the tissue. The modular surgical compartment includes a first energy generator module, configured to generate a first energy for application to the tissue, and a first docking station that comprises a first docking port that includes first data contacts and energy contacts, the the first power generator module is slidingly movable in an electrical coupling with the data and power contacts and the first energy generator is slidingly movable for the electrical coupling with the first power and data contacts.

[0095] In addition to the above, the modular surgical enclosure also includes a second energy generator module configured to generate a second energy, different from the first energy, for application to the tissue, and a second docking station comprising a second docking port which includes second data and power contacts, the second power generating module being slidably movable in an electrical coupling with the power and data contacts, and the second power generating module being slidingly movable outwards electrical coupling with the second power and data contacts.

[0096] In addition, the modular surgical cabinet also includes a communication bus between the first coupling port and the second coupling port, configured to facilitate communication between the first power generator module and the second power generator module.

[0097] With reference to Figures 3 to 7, aspects of the present description are presented for a modular housing of the central controller 136 that allows the modular integration of a generator module 140, a smoke evacuation module 126, and a suction module / irrigation 128. The central modular housing 136 further facilitates interactive communication between modules 140, 126, 128. As illustrated in Figure 5, generator module 140 can be a generator module with integrated monopoly, bipolar and ultrasonic components, supported in a single cabinet unit 139 slidably insertable into the central modular housing 136. As shown in Figure 5, generator module 140 can be configured to connect to a monopolar device 146, a bipolar device 147 and an ultrasonic device 148. Alternatively, the generator module 140 can comprise a series of monopolar, bipolar and / or ultrasonic generator modules that interact through the cen modular housing tral 136. The central modular enclosure 136 can be configured to facilitate the insertion of multiple generators and interactive communication between the generators anchored in the central modular enclosure 136 so that the generators would act as a single generator.

[0098] In one aspect, the central modular housing 136 comprises a modular power and a back communication board 149 with external and wireless communication heads to allow removable fixing of modules 140, 126, 128 and interactive communication between them.

[0099] In one aspect, the central modular housing 136 includes docking stations, or drawers, 151, in this document also called drawers, which are configured to receive slidingly the modules 140, 126, 128. Figure 4 illustrates a partial perspective view of a central surgical controller housing 136, and a combined generator module 145 slidably received at a docking station 151 of the central surgical controller housing 136. A docking port 152 with power and data contacts in a rear side of the combined generator module 145 is configured to engage a corresponding docking port 150 with the power and data contacts of a corresponding docking station 151 of the central housing modular housing 136 as the combined generator module 145 is slid into position at the corresponding docking station 151 of the modular housing of the central controller 136. In one aspect, the generator module combines do 145 includes a bipolar, ultrasonic and monopolar module and a smoke evacuation module integrated in a single 139 compartment unit, as illustrated in Figure 5.

[0100] In several respects, the smoke evacuation module 126 includes a fluid line 154 that carries captured / collected fluid smoke away from a surgical site and to, for example, the smoke evacuation module 126. Suction a vacuum that originates from the smoke evacuation module 126 can pull the smoke into an opening of a utility conduit at the surgical site. The utility conduit, coupled to the fluid line, can be in the form of a flexible tube that ends in the smoke evacuation module 126. The utility conduit and the fluid line define a fluid path that extends towards the smoke evacuation module 126 which is received in the central controller housing 136.

[0101] In various aspects, the suction / irrigation module 128 is coupled to a surgical tool comprising a fluid suction line and a fluid suction line. In one example, the suction and suction fluid lines are in the form of flexible tubes that extend from the surgical site towards the suction / irrigation module 128. One or more drive systems can be configured to cause irrigation and aspiration of fluids to and from the surgical site.

[0102] In one aspect, the surgical tool includes a drive shaft that has an end actuator at a distal end of the same and at least an energy treatment associated with the end actuator, a suction tube, and a suction tube. irrigation. The suction tube can have an inlet port at a distal end of it and the suction tube extends through the drive shaft. Similarly, an irrigation pipe can extend through the drive shaft and may have an entrance port close to the power application implement. The power application implement is configured to deliver ultrasonic and / or RF energy to the surgical site and is coupled to the generator module 140 by a cable that initially extends through the drive shaft.

[0103] The irrigation tube can be in fluid communication with a fluid source, and the suction tube can be in fluid communication with a vacuum source. The fluid source and / or the vacuum source can be housed in the suction / irrigation module 128. In one example, the fluid source and / or the vacuum source can be housed in the central controller housing 136 separately from the control module. suction / irrigation 128. In such an example, a fluid interface can be configured to connect the suction / irrigation module 128 to the fluid source and / or the vacuum source.

[0104] In one aspect, modules 140, 126, 128 and / or their corresponding docking stations in the central modular housing 136 may include alignment features that are configured to align the docking ports of the modules in engagement with their counterparts at the stations coupling module of the central modular housing 136. For example, as shown in Figure 4, the combined generator module 145 includes side brackets 155 which are configured to slide the corresponding brackets 156 of the corresponding coupling station 151 of the central modular housing 136 into sliding way. The brackets cooperate to guide the coupling port contacts of the combined generator module 145 in an electrical coupling with the coupling port contacts of the central modular housing 136.

[0105] In some respects, the drawers 151 of the central modular housing 136 are the same, or substantially the same size, and the modules are adjusted in size to be received in the drawers 151. For example, the side brackets 155 and / or 156 can be larger or smaller depending on the size of the module. In other respects, drawers 151 are different in size and are each designed to accommodate a specific module.

[0106] In addition, the contacts of a specific module can be switched to engage with the contacts of a specific drawer to avoid inserting a module in a drawer with unpaired contacts.

[0107] As shown in Figure 4, the docking port 150 of one drawer 151 can be coupled to the docking port 150 of another drawer 151 via a communication link 157 to facilitate interactive communication between the modules housed in the central modular housing 136. The coupling ports 150 of the central modular enclosure 136 can, alternatively or additionally, facilitate interactive wireless communication between the modules housed in the central modular enclosure 136. Any suitable wireless communication can be used, such as Air Titan Bluetooth.

[0108] Figure 6 illustrates individual power bus connectors for a plurality of side coupling ports of a side modular compartment 160 configured to receive a plurality of modules from a central surgical controller 206. Side modular compartment 160 is configured to receive and laterally interconnect modules 161. Modules 161 are slidably inserted into docking stations 162 of side modular compartment 160, which includes a back plate for interconnecting modules 161. As shown in Figure 6, modules 161 are arranged laterally in the side modular cabinet 160. Alternatively, modules 161 can be arranged vertically in a side modular cabinet.

[0109] Figure 7 illustrates a vertical modular cabinet 164 configured to receive a plurality of modules 165 from the central surgical controller 106. The modules 165 are slidably inserted into docking stations, or drawers, 167 of the vertical modular cabinet 164, the which includes a rear panel for interconnecting modules 165. Although the drawers 167 of the vertical modular cabinet 164 are arranged vertically, in certain cases, a vertical modular cabinet 164 may include drawers that are arranged laterally. In addition, modules 165 can interact with each other through the coupling ports of the vertical modular cabinet 164. In the example in Figure 7, a screen 177 is provided to show data relevant to the operation of modules 165. In addition, the vertical modular compartment 164 includes a master module 178 which houses a plurality of submodules that are received slidingly in the master module 178.

[0110] In several respects, the imaging module 138 comprises an integrated video processor and a modular light source and is adapted for use with various imaging devices. In one aspect, the imaging device is comprised of a modular compartment that can be mounted with a light source module and a camera module. The compartment can be a disposable compartment. In at least one example, the disposable compartment is removably coupled to a reusable controller, a light source module, and a camera module. The light source module and / or the camera module can be selected selectively depending on the type of surgical procedure. In one aspect, the camera module comprises a CCD sensor. In another aspect, the camera module comprises a CMOS sensor. In another aspect, the camera module is configured for imaging the scanned beam. Similarly, the light source module can be configured to provide a white light or a different light, depending on the surgical procedure.

[0111] During a surgical procedure, removing a surgical device from the surgical field and replacing it with another surgical device that includes a different camera or other light source may be inefficient. Temporarily losing sight of the surgical field can lead to undesirable consequences. The imaging device module of the present description is configured to allow the replacement of a light source module or a "midstream" camera module during a surgical procedure, without the need to remove the imaging device from the surgical field.

[0112] In one aspect, the imaging device comprises a tubular compartment that includes a plurality of channels. A first channel is configured to receive the Camera module in a sliding way, which can be configured for a snap-fit fit (pressure fit) with the first channel. A second channel is configured to slide the camera module, which can be configured for a snap-fit fit

(snap fit) with the first channel. In another example, the camera module and / or the light source module can be rotated to an end position within their respective channels. A threaded coupling can be used instead of a pressure fitting.

[0113] In several examples, multiple imaging devices are placed in different positions in the surgical field to provide multiple views. Imaging module 138 can be configured to switch between imaging devices to provide an ideal view. In several respects, imaging module 138 can be configured to integrate images from different imaging devices.

[0114] Various image processors and imaging devices suitable for use with the present description are described in US patent No. 7,995,045 entitled COMBINED SBI AND CONVENTIONAL IMAGE PROCESSOR, granted on August 9, 2011 which is hereby incorporated as a title reference in its entirety. In addition, US patent No. 7,982,776, entitled SBIl MOTION ARTIFACT REMOVAL APPARATUS AND METHOD, issued July 19, 2011, which is incorporated herein by reference in its entirety for reference, describes various systems for removing motion artifacts image data. Such systems can be integrated with imaging module 138. In addition to these, the publication of US patent application No. 2011/0306840, entitled CONTROLLABLE MAGNETIC SOURCE TO FIXTURE INTRACORPOREAL APPARATUS, published on December 15, 2011, and the publication of the application for US Patent No. 2014/0243597, entitled SYSTEM FOR PERFORMING A MINIMALLY INVASIVE SURGICAL PROCEDURE, published on August 28, 2014, which are each incorporated herein by reference in their entirety for reference.

[0115] Figure 8 illustrates a surgical data network 201 comprising a modular communication center 203 configured to connect modular devices located in one or more operating rooms of a healthcare facility, or any environment in a utility facility. specially equipped for surgical operations, to a cloud-based system (for example, cloud 204 which may include a remote server 213 coupled to a storage device 205). In one aspect, the modular communication center 203 comprises a central network controller 207 and / or a network switch 209 in communication with a network router. The modular communication center 203 can also be coupled to a local computer system 210 to provide local computer processing and data manipulation. The surgical data network 201 can be configured as a passive, intelligent, or switching network. A passive surgical data network serves as a conduit for the data, allowing the data to be transmitted from one device (or segment) to another and to cloud computing resources. An intelligent surgical data network includes features to allow traffic to pass through the surgical data network to be monitored and to configure each port on the central network controller 207 or network switch 209. An intelligent surgical data network can be called a a central controller or controllable key. A central switching controller reads the destination address of each packet and then forwards the packet to the correct port.

[0116] Modular devices 1a to 1n located in the operating room can be coupled to the modular communication center

203. The central network controller 207 and / or the network switch 209 can be coupled to a network router 211 to connect devices 1a to 1h to the cloud 204 or the local computer system

210. The data associated with devices 1a to 1n can be transferred to cloud-based computers via the router for remote data processing and manipulation. The data associated with devices 1a to 1n can also be transferred to the local computer system 210 for processing and manipulation of the local data. Modular devices 2a to 2m located in the same operating room can also be coupled to a network switch 209. The network switch 209 can be attached to the central network controller 207 and / or to the network router 211 to connect devices 2a 2m to cloud 204. The data associated with devices 2a to 2n can be transferred to cloud 204 via network router 211 for data processing and manipulation. The data associated with devices 2a to 2m can also be transferred to the local computer system 210 for processing and manipulation of the local data.

[0117] It will be understood that the surgical data network 201 can be expanded by interconnecting multiple central network controllers 207 and / or multiple network switches 209 with multiple network routers 211. The modular communication center 203 may be contained in a modular control roaster configured to receive multiple devices 1a to 1n / 2a to 2m. The local computer system 210 can also be contained in a modular control tower. The modular communication center 203 is connected to a screen 212 to display the images obtained by some of the devices 1a to 1n / 2a to 2m, for example, during surgical procedures. In several respects, devices 1a to 1n / 2a to 2m can include, for example, several modules such as an imaging module 138 coupled to an endoscope, a generator module 140 coupled to an energy-based surgical device, an evacuation module smoke 126, a suction / irrigation module 128, a communication module 130, a processor module 132, a storage matrix 134, a surgical device attached to a screen, and / or a non-contact sensor module, among others modular devices that can be connected to the modular communication center 203 of the surgical data network 201.

[0118] In one aspect, the surgical data network 201 may comprise a combination of central network controllers, network switches, and network routers that connect devices 1a to 1n / 2a to 2m to the cloud. Any or all of the devices 1a to 1n / 2a to 2m coupled to the central network controller or network switch can collect data in real time and transfer the data to cloud computers for data processing and manipulation. It will be understood that cloud computing depends on sharing computing resources instead of having local servers or personal devices to handle software applications. The word "cloud" can be used as a metaphor for "the Internet", although the term is not limited as such. Consequently, the term "cloud computing" can be used in this document to refer to "a type of Internet-based computing", in which different services - such as servers, storage, and applications - are applied to the modular communication center 203 and / or computer system 210 located in the operating room (for example, a fixed, mobile, temporary, or operating room or operating space) and devices connected to modular communication center 203 and / or computer system 210 through from Internet. The cloud infrastructure can be maintained by a cloud service provider. In this context, the cloud service provider may be the entity that coordinates the use and control of devices 1a to 1n / 2a to 2m located in one or more operating rooms. Cloud computing services can perform a large number of calculations based on data collected by smart surgical instruments, robots, and other computerized devices located in the operating room. The central controller hardware allows multiple devices or connections to be connected to a computer that communicates with cloud computing and storage resources.

[0119] The application of cloud computer data processing techniques to data collected by devices 1a to 1n / 2a to 2m, the surgical data network provides better surgical results, reduced costs, and better patient satisfaction. At least some of the devices 1a to 1n / 2a to 2m can be used to view tissue status to assess leakage or perfusion of sealed tissue after a tissue sealing and cutting procedure. At least some of the devices 1a to 1n / 2a to 2m can be used to identify the pathology, such as the effects of disease, with the use of cloud-based computing to examine data including images of body tissue samples for diagnostic purposes. This includes confirmation of the location and margin of the tissue and phenotypes. At least some of the devices 1a to 1n / 2a to 2m can be used to identify anatomical structures of the body using a variety of sensors integrated with imaging devices and techniques such as overlaying images captured by multiple imaging devices. The data collected by the devices at 1n / 2a to 2m, including the image data, can be transferred to the cloud 204 or the local computer system 210 or both for data processing and manipulation including image processing and manipulation. The data can be analyzed to improve the results of the surgical procedure by determining whether additional treatment, such as application of endoscopic intervention, emerging technologies, targeted radiation, targeted intervention, accurate robotics at specific tissue sites and conditions, can be followed. This data analysis can additionally use analytical processing of the results, and with the use of standardized approaches they can provide beneficial standardized feedback both to confirm surgical treatments and the surgeon's behavior or to suggest changes to surgical treatments and the surgeon's behavior.

[0120] In an implementation, operating room devices 1a to 1n can be connected to the modular communication center 203 via a wired channel or a wireless channel depending on the configuration of devices 1a to 1h on a central network controller . The central network controller 207 can be implemented, in one aspect, as a LAN transmission device that acts on the physical layer of the open system interconnection model ("OSI" - open system interconnection). The central network controller provides connectivity to devices 1a to 1n located on the same network as the operating room. The central network controller 207 collects data in the form of packets and sends it to the router in "half - duplex" mode. The central network controller 207 does not store any media access control / Internet protocol ("MAC / IP" - media access control / internet protocol) to transfer data from the device. Only one of the devices 1a to 1n at a time can send data through the central network controller 207. The central network controller 207 does not have routing tables or intelligence about where to send information and transmits all network data through each connection and to a remote 213 server (Figure 9) in the cloud

204. The central network controller 207 can detect basic network errors, such as collisions, but having all (admit that) the information transmitted to multiple input ports can be a security risk and cause strangulation.

[0121] In another implementation, operating room devices 2a to 2m can be connected to a network switch 209 via a wired or wireless channel. The network switch 209 works on the data connection layer of the OSI model. The network switch 209 is a multicast device for connecting devices 2a to 2m located in the same operation center to the network. The network switch 209 sends data in frame form to the network router 211 and works in full duplex mode. Multiple devices 2a to 2m can send data at the same time via network switch 209. Network switch 209 stores and uses MAC addresses of devices 2a to 2m to transfer data.

[0122] The central network controller 207 and / or the network switch 209 are coupled to network router 211 for a connection to the cloud 204. Network router 211 works on the network layer of the OSI model. The network router 211 creates a route to transmit data packets received from the central network controller 207 and / or from the network switch 211 to a computer with cloud resources for further processing and manipulation of the data collected by any of all or all of the devices 1a to 1n / 2a to 2m. The network router 211 can be used to connect two or more different networks located in different locations, such as different operating rooms in the same health care facility or different networks located in different operating rooms of different service facilities of health. Network router 211 sends data in packet form to cloud 204 and works in full duplex mode. Multiple devices can send data at the same time. Network router 211 uses | P addresses to transfer data.

[0123] In one example, the central network controller 207 can be implemented as a central USB controller, which allows multiple USB devices to be connected to a host computer. The central USB controller can expand a single USB port on several levels so that more ports are available to connect the devices to the system's host computer. The central network controller 207 can include wired or wireless capabilities to receive information about a wired channel or a wireless channel. In one aspect, a wireless wireless, broadband and short-range wireless USB communication protocol can be used for communication between devices 1a to 1n and devices 2a to 2m located in the operating room.

[0124] In other examples, operating room devices 1a to 1n / 2a to 2m can communicate with the modular communication center 203 via standard Bluetooth wireless technology for exchanging data over short distances (using short-wavelength UHF radio waves in the ISM band of 2.4 to 2.485 GHz) from fixed and mobile devices and to build personal area networks ("PANS" - personal area networks). operation 1a to 1n / 2a to 2m can communicate with the modular communication center 203 via a number of wireless and wired communication standards or protocols, including, but not limited to, Wi-Fi (IEEE 802.11 family) , WiMAX (IEEE 802.16 family), IEEE 802.20, long-term evolution ("LTE" - long-term evolution), and Ev-DO, HSPA +, HSDPA +, HSUPA +, EDGE, GSM, GPRS, CDMA, TDMA, DECT, and derived from them, as well as any other wireless and wired protocols that are designated as 3G, 4G, 5G, and beyond m. The computing module can include a plurality of communication modules. For example, a first communication module can be dedicated to short-range wireless communications like Wi-Fi and Bluetooth, and a second communication module can be dedicated to longer-range wireless communications like GPS, EDGE, GPRS, CDMA , WiMAX, LTE, Ev-DO and others.

[0125] The modular communication center 203 can serve as a central connection for one or all operating room devices 1a to 1n / 2a to 2m and handles a data type known as frames. The tables carry the data generated by the devices 1a to 1n / 2a to 2m. When a frame is received by the modular communication center 203, it is amplified and transmitted to the network router 211, which transfers the data to the cloud computing resources using a series of wireless communication standards or protocols or with wire, as described in the present invention.

[0126] The modular communication center 203 can be used as a standalone device or be connected to compatible central network controllers and network switches to form a larger network. The modular communication center 203 is, in general, easy to install, configure and maintain, making it a good option for the network of devices 1a to 1n / 2a to 2m from the operating room.

[0127] Figure 9 illustrates an interactive surgical system, implemented by computer 200. The interactive surgical system implemented by computer 200 is similar in many respects to the interactive surgical system, implemented by computer 100. For example, the surgical system, interactive, implemented per computer 200 includes one or more surgical systems 202, which are similar in many respects to surgical systems 102. Each surgical system 202 includes at least one central surgical controller 206 in communication with a cloud 204 which can include a remote server 213. In one In this respect, the computer-implemented interactive surgical system 200 comprises a modular control tower 236 connected to multiple operating room devices such as, for example, smart surgical instruments, robots and other computerized devices located in the operating room.

As shown in Figure 10, the modular control tower 236 comprises a modular communication center 203 coupled to a computer system 210. As illustrated in the example in Figure 9, the modular control tower 236 is coupled to an imaging module 238 that is coupled to an endoscope 239, a generator module 240 that is coupled to a power device 241, a smoke evacuation module 226, a suction / irrigation module 228, a communication module 230, a processor module 232, a storage array 234, an intelligent device / instrument 235 optionally coupled to a screen 237, and a non-contact sensor module 242. Operating room devices are coupled with cloud computing resources and data storage through the tower. modular control 236. The robotic central controller 222 can also be connected to the modular control tower 236 and cloud computing resources.

Devices / Instruments 235, display systems 208, among others, can be coupled to the modular control tower 236 by means of wired or wireless communication standards or protocols, as described in the present invention.

The modular control tower 236 can be coupled to a central controller screen 215 (for example, monitor, screen) to display and overlay images received from the imaging module, device / instrument screen and / or other display systems 208. A The central controller screen can also display the data received from the devices connected to the modular control tower together with images and overlapping images.

[0128] Figure 10 illustrates a central surgical controller 206 that comprises a plurality of modules coupled to the modular control tower 236. The modular control tower 236 comprises a modular communication center 203, for example, a network connectivity device, and a computer system 210 for providing local processing, visualization, and imaging, for example. As shown in Figure 10, the modular communication center 203 can be connected in a layered configuration to expand the number of modules (for example, devices) that can be connected to the modular communication center 203 and transfer data associated with the modules to the computer system 210, cloud computing resources, or both. As shown in Figure 10, each of the central controllers / network switches in the modular communication center 203 includes three downstream ports and one upstream port. The central controller / network switch upstream is connected to a processor to provide a communication connection to the cloud computing resources and a local display 217. Communication with the cloud 204 can be done via a wired communication channel or wireless.

[0129] The central surgical controller 206 employs a non-contact sensor module 242 to measure the dimensions of the operating room and generate a map of the operating room using non-contact measuring devices such as laser or ultrasonic. An ultrasound-based non-contact sensor module scans the operating room by transmitting an ultrasound explosion and receiving echo when it bounces off the perimeter of the walls of an operating room, as described under the heading Surgical Hub Spatial Awareness Within an Operating Room "in US provisional patent application Serial No. 62 / 611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, which is hereby incorporated by reference in its entirety for reference, in which the sensor module is configured to determine the size of the operating room and adjust the Bluetooth pairing distance limits. A laser-based non-contact sensor module scans the operating room by transmitting pulses of laser light, receiving pulses of laser light that bounce off the walls of the perimeter of the operating room, and comparing the phase of the transmitted pulse to the received pulse to determine the size of the operating room and to adjust set the Bluetooth pairing distance limits, for example.

[0130] Computer system 210 comprises a processor 244 and a network interface 245. Processor 244 is coupled to a communication module 247, storage 248, memory 249, non-volatile memory 250, and an input / output interface 251 through of a system bus. The system bus can be any of several types of bus structures, including the memory bus or memory controller, a peripheral bus or external bus, and / or a local bus that uses any variety of available bus architectures including, but not limited to, not limited to, 9-bit bus, industry standard architecture (ISA), Micro-Charmel Architecture (MSA), extended ISA (EISA), smart drive electronics (IDE), VESA local bus (VLB), component interconnection peripherals (PCI), USB, accelerated graphics port (AGP), international memory card association bus for personal computers ("PCMCIA" - Personal Computer Memory Card International Association), small computer systems interface (SCSI), or any another proprietary bus.

[0131] Processor 244 can be any single-core or multi-core processor, such as those known under the ARM Cortex trade name available from Texas Instruments. In one respect, the processor may be a Core Cortex-M4F LM4F230H5QR ARM processor, available from Texas Instruments, for example, which comprises an integrated 256 KB single-cycle flash memory, or other non-volatile memory, up to 40 MHz , a prefetch buffer to optimize performance above 40 MHz, a 32 KB single cycle serial random access memory (SRAM), an internal read-only memory (ROM) loaded with the StellarisWare program, read-only memory programmable and electrically erasable (EEPROM) of 2 KB, one or more pulse width modulation (PWM) modules, one or more analog quadrature encoder (QEI) inputs, one or more analog to digital converters (ADC) of 12 bits with 12 analog input channels, details of which are available for the product data sheet.

[0132] In one aspect, processor 244 may comprise a safety controller comprising two controller-based families, such as TMS570 and RM4x, known under the tradename Hercules ARM Cortex R4, also by Texas Instruments. The safety controller can be configured specifically for IEC 61508 and ISO 26262 safety critical applications, among others, to provide advanced integrated safety features while providing scalable performance, connectivity and memory options.

[0133] System memory includes volatile and non-volatile memory. The basic input / output system (BIOS), containing the basic routines for transferring information between elements within the computer system, such as during startup, is stored in non-volatile memory. For example, non-volatile memory can include ROM, programmable ROM (PROM), electrically programmable ROM

(EPROM), EEPROM or flash memory. Volatile memory includes random access memory (RAM), which acts as an external cache memory. In addition, RAM is available in many forms such as SRAM, dynamic RAM (DRAM), synchronous DRAM (SDRAM), double data rate SDRAM (DDR SDRAM), enhanced SDRAM (ESDRAM), Synchlink DRAM (SLDRAM), and direct RAM Rambus RAM (DRRAM).

[0134] Computer system 210 also includes removable / non-removable, volatile / non-volatile computer storage media, such as disk storage Disk storage includes, but is not limited to, devices such as a storage unit magnetic disk, floppy disk drive, tape drive, Jaz drive, Zip drive, LS-60 drive, flash memory card or memory stick (pen-drive). In addition, the storage disc - may include storage media separately or in combination with other storage media including, but not limited to, an optical disc drive such as a compact disc ROM device (CD-ROM) disc drive recordable compact disc (CD-R Drive), rewritable compact disc drive (CD-RW drive), or a versatile digital disk ROM drive (DVD-ROM). To facilitate the connection of disk storage devices to the system bus, a removable or non-removable interface can be used.

[0135] It is to be understood that computer system 210 includes software that acts as an intermediary between users and basic computer resources described in a suitable operating environment. Such software includes an operating system. The operating system, which can be stored on disk storage, acts to control and allocate computer system resources. System applications benefit from the management capabilities of the operating system through program modules and “program data stored in system memory or on the storage disk. It is to be understood that the various components "described in the present invention can be implemented with various operating systems or combinations of operating systems.

[0136] A user enters commands or information into computer system 210 via the input device (s) coupled to the 1I / O 251. interface. Input devices include, but are not limited to, a device pointer such as a mouse, trackball, stylus, touchpad, keyboard, microphone, joystick, game pad, satellite card, scanner, TV tuner card, digital camera, digital video camera, web camera, and the like. These and other input devices connect to the processor via the system bus via the interface port (s). The interface ports include, for example, a serial port, a parallel port, a game port and a USB. Output devices use some of the same types of ports as input devices. In this way, for example, a USB port can be used to provide input to the computer system and to provide information from the computer system to an output device. An output adapter is provided to illustrate that there are some output devices such as monitors, screens, speakers, and printers, among other output devices, that need special adapters. Output adapters include, by way of illustration and not limitation, video and sound cards that provide a means of connection between the output device and the system bus. It should be noted that other devices and / or device systems, such as remote computers, provide input and output capabilities.

[0137] Computer system 210 can operate in a networked environment using logical connections to one or more remote computers, such as cloud computers, or local computers. Remote cloud computers can be a personal computer, server, router, personal network computer, workstation, microprocessor-based device, peer device, or other common network node, and the like, and typically include many or all elements described in relation to the computer system. For the sake of brevity, only one memory storage device is illustrated with the remote computer. Remote computers are logically connected to the computer system via a network interface and then physically connected via a communication connection. The network interface covers communication networks such as local area networks (LANs) and wide area networks (WANs). LAN technologies include fiber distributed data interface (FDDI), copper distributed data interface (CDDI), Ethernet / IEEE 802.3, Token / IEEE 802.5 ring and the like. WAN technologies include, but are not limited to, point-to-point links, circuit switching networks such as digital integrated service networks (ISDN) and variations in them, packet switching networks and digital subscriber lines (DSL).

[0138] In several respects, the computer system 210 of Figure 10, the imaging module 238 and / or display system 208, and / or the processor module 232 of Figures 9 and 10, may comprise an image processor, motor image processing, media processor or any specialized digital signal processor ("DSP" - Digital Signal Processor) used for processing digital images. The image processor can employ parallel computing with single multi-data instruction (SIMD) or multiple multi-data instruction (MIMD) technologies to increase speed and efficiency. The digital image processing engine can perform a number of tasks. The image processor can be an integrated circuit system with a multi-core processor architecture.

[0139] Communication connections refer to the hardware / software used to connect the network interface to the bus. Although the communication connection is shown for illustrative clarity within the computer system, it can also be external to computer system 210. The hardware / software required for connection to the network interface includes, for illustrative purposes only, internal and external technologies such as modems, including regular telephone serial modems, cable modems and DSL modems, ISDN adapters, and Ethernet cards.

[0140] Figure 11 illustrates a functional block diagram of an aspect of a USB 300 central network controller device, in accordance with an aspect of the present description. In the illustrated aspect, the USB 300 central network controller device uses a TUSB2036 integrated circuit central controller available from Texas Instruments. The USB 300 core network controller is a CMOS device that provides one USB transceiver port 302 and up to three USB transceiver ports downstream 304, 306, 308 in accordance with the USB 2.0 specification. Upstream USB transceiver port 302 is a differential data root port comprising a "minus" differential data input (DMO) paired with a "plus" differential data input (DPO). The three ports of the downstream USB transceiver 304, 306, 308 are differential data ports, with each port including "more" differential data outputs (DP1-DP3) paired with "less" differential data outputs (DM1-DM3) .

[0141] The USB 300 central network controller device is implemented with a digital state machine instead of a microcontroller, and no firmware programming is required. Fully compatible USB transceivers are integrated into the circuit for the upstream USB transceiver port 302 and all downstream USB transceiver ports 304, 306, 308. The downstream USB transceiver ports 304, 306, 308 support both full speed as low speed automatically configuring the scan rate according to the speed of the device attached to the doors. The USB 300 central network controller device can be configured in bus powered or self powered mode and includes 312 central power logic to manage power.

[0142] The USB 300 central network controller device includes a 310 series interface engine (SIE). The SIE 310 is the front end of the USB 300 central network controller hardware and handles most of the protocol described in chapter 8 of the USB specification. SIE 310 typically comprises signaling down to the transaction level. The functions it handles could include: packet recognition, transaction sequencing, SOP, EOP, RESET, and RESUME signal detection / generation, clock / data separation, data encoding / decoding non-inverted zero (NRZI) , generation and verification of CRC (token and data), generation and verification / decoding of packet ID (PID), and / or series-parallel / parallel-series conversion. The 310 receives a clock input 314 and is coupled to a suspend / resume logic circuit and frame timer 316 and a repeating circuit 318 of the central controller to control communication between the upstream USB transceiver port 302 and the transceiver ports Downstream USB 304, 306, 308 through the logic circuits of ports 320,

322, 324. The SIE 310 is coupled to a command decoder 326 via the logic interface to control the commands of a serial EEPROM via a serial EEPROM interface

330.

[0143] In several aspects, the USB 300 central network controller can connect 127 functions configured in up to six logical layers (levels) to a single computer. In addition, the USB 300 central network controller can connect all peripherals using a standardized four-wire cable that provides both communication and power distribution. The power settings are bus-powered and self-powered modes. The USB 300 central network controller can be configured to support four power management modes: a bus powered central controller, with individual port power management or grouped port power management, and the self-powered central controller, with power management. individual port power or grouped port power management. In one aspect, using a USB cable, the USB 300 central network controller, the USB transceiver port 302 is plugged into a USB host controller, and the USB transceiver ports downstream 304, 306, 308 are exposed to connect compatible USB devices, and so on. Surgical Instrument Hardware

[0144] Figure 12 illustrates a logic diagram of a module of a 470 control system of an instrument or surgical tool, according to one or more aspects of the present description. The 470 system comprises a control circuit. The control circuit includes a microcontroller 461 comprising a processor 462 and a memory 468. One or more of the sensors 472, 474, 476, for example, provide real-time feedback to processor 462. A motor 482, driven by a driver of motor 492, it is operationally coupled to a longitudinally movable displacement member to drive the beam cutting element with | A tracking system 480 is configured to determine the position of the longitudinally movable displacement member. Position information is provided to processor 462, which can be programmed or configured to determine the position of the longitudinally movable drive member, as well as the position of a firing member, firing bar and a beam cutting element with a profile in |. Additional motors can be provided at the instrument driver interface to control the firing of the beam with an | profile, the displacement of the closing tube, the rotation of the drive shaft and the articulation. A 473 screen displays a variety of instrument operating conditions and can include touchscreen functionality for data entry. The information displayed on screen 473 can be overlaid with images captured using endoscopic imaging modules.

[0145] In one aspect, the 461 microcontroller can be any single-core or multi-core processor, such as those known under the ARM Cortex trade name available from Texas Instruments. In one aspect, the 461 main microcontroller may be an LM4F230H5QOR ARM Cortex-M4F processor, available from Texas Instruments, for example, which comprises an integrated 256 KB single cycle flash memory, or other non-volatile memory, up to 40 MHz, a seek-ahead buffer to optimize performance above 40 MHz, a 32 KB single cycle series random access memory (SRAM), an internal read-only memory (ROM) loaded with the StellarisWareº program, programmable memory and electrically erasable read-only (EEPROM) of 2 KB, one or more pulse width modulation (PWM) modules, one or more analogs of quadrature encoder (QEI) inputs, and / or one or more analog converters for 12-bit digital (ADC) with 12 channels of analog input, details of which are available for the product data sheet.

[0146] In one aspect, the 461 microcontroller may comprise a safety controller that comprises two families based on controllers, such as TMS570 and RM4x known under the trade name Hercules ARM Cortex R4, also available from Texas Instruments. The safety controller can be configured specifically for IEC 61508 and ISO 26262 safety critical applications, among others, to provide advanced integrated safety features while providing scalable performance, connectivity and memory options.

[0147] The 461 microcontroller can be programmed to perform various functions, such as precise control of the speed and position of the joint and knife systems. In one aspect, the microcontroller 461 includes a processor 462 and a memory 468. The electric motor 482 can be a brushed direct current (DC) motor with a gearbox and mechanical connections with an articulation or scalpel system. In one aspect, a motor drive 492 can be an A3941 available from Allegro Microsystems, Inc. Other motor drives can be readily replaced for use in tracking system 480 which comprises an absolute positioning system. A detailed description of an absolute positioning system is provided in US Patent Application Publication No. 2017/0296213, entitled SYSTEMS AND METHODS FOR

CONTROLLING A SURGICAL STAPLING AND CUTTING INSTRUMENT, published on October 19, 2017, which is hereby incorporated by reference in its entirety for reference.

[0148] The 461 microcontroller can be programmed to provide precise control of the speed and position of the displacement members and articulation systems. The 461 microcontroller can be configured to compute a response in the 461 microcontroller software. The computed response is compared to a measured response from the real system to obtain an "observed" response, which is used for actual feedback-based decisions. The observed response is a favorable and adjusted value, which balances the uniform and continuous nature of the simulated response with the measured response, which can detect external influences in the system.

[0149] In one aspect, motor 482 can be controlled by motor driver 492 and can be used by the instrument's trigger system or surgical tool. In many ways, the 482 motor can be a brushed direct current (DC) drive motor, with a maximum speed of approximately 25,000 RPM, for example. In other arrangements, the 482 motor may include a brushless motor, a wireless motor, a synchronous motor, a stepper motor or any other suitable type of electric motor. Motor starter 492 may comprise an H bridge starter comprising field effect transistors (FETs), for example. The 482 motor can be powered by a feed assembly releasably mounted on the handle assembly or tool compartment to provide control power for the instrument or surgical tool. The power pack may comprise a battery that may include several battery cells connected in series, which can be used as the power source to power the instrument or surgical tool. In certain circumstances, the battery cells in the power pack may be replaceable and / or rechargeable. In at least one example, the battery cells can be lithium-ion batteries that can be coupled and separable from the power pack.

[0150] The 492 motor driver can be an A3941, available from Allegro Microsystems, Inc. The 492 A3941 driver is an entire bridge controller for use with external power semiconductor metal oxide (MOSFET) field transistors. , of N channel, specifically designed for inductive loads, such as brushed DC motors. The 492 actuator comprises a single charge pump regulator that provides full door drive (> 10 V) for batteries with voltage up to 7 Ve and allows the A3941 to operate with a reduced door drive, up to 5.5 V. input command can be used to supply the voltage surpassing that supplied by the battery required for the N channel MOSFETs. An internal charge pump for the upper side drive allows operation in direct current (100% duty cycle). The entire bridge can be triggered in fast or slow drop modes using diodes or synchronized rectification. In the slow drop mode, the current can be recirculated by means of FET from the top or from the bottom. The energy FETs are protected from the shoot-through effect through programmable dead-time resistors. Integrated diagnostics provide indication of undervoltage, overtemperature and faults in the power bridge, and can be configured to protect power MOSFETs in most short-circuit conditions. Other motor drives can be readily replaced for use in the tracking system 480 comprising an absolute positioning system.

[0151] The tracking system 480 comprises a controlled motor drive circuit arrangement comprising a position sensor 472 in accordance with an aspect of the present description.

The position sensor 472 for an absolute positioning system provides a unique position signal that corresponds to the location of a displacement member.

In one aspect, the displacement member represents a longitudinally movable drive member * comprising a rack of drive teeth for engagement with a corresponding drive gear of a gear reduction assembly.

In other respects, the displacement member represents the firing member, which can be adapted and configured to include a rack of drive teeth.

In yet another aspect, the displacement member represents a firing bar or the beam with a | profile, each of which can be adapted and configured to include a rack of driving teeth.

Consequently, as used in the present invention, the term displacement member is used generically to refer to any movable member of the surgical instrument or tool, such as the driving member, the firing member, the firing bar, the beam with profile in |, or any element that can be moved.

In one aspect, the longitudinally movable drive member is coupled to the firing member, the firing bar and the beam with an | profile. Consequently, the absolute positioning system can, in effect, track the linear displacement of the beam with | by tracking the linear displacement of the longitudinally movable drive member.

In several other respects, the displacement member can be coupled to any position sensor 472 suitable for measuring linear displacement.

In this way, the longitudinally movable drive member, the firing member, the firing bar or the beam with a | profile, or combinations thereof, can be coupled to any suitable displacement sensor. Linear displacement sensors can include contact or non-contact displacement sensors. Linear displacement sensors can comprise Variable Differential Linear Transformers (LVDT), Variable Reluctance Differential Transducers (DVRT), a potentiometer, a magnetic detection system comprising a moving magnet and a series linearly arranged in Hall Effect Sensors, a magnetic detection comprising a fixed magnet and a series of movable lines, arranged linearly in Hall Effect Sensors, a mobile optical detection system comprising a mobile light source and a series of linearly arranged photodiodes or photodetectors, an optical detection system which comprises a fixed light source and a mobile series of linearly arranged photodiodes or photodetectors, or any combination thereof.

[0152] The 482 electric motor may include a rotary drive shaft, which interfaces operationally with a gear set, which is mounted on a coupling coupling with a set or rack of drive teeth on the drive member. A sensor element can be operationally coupled to a gear assembly so that a single revolution of the position sensor element 472 corresponds to some linear longitudinal translation of the displacement member. An array of gears and sensors can be connected to the linear actuator by means of a rack and pinion arrangement, or by a rotary actuator, by means of a sprocket or other connection. A power supply supplies power to the absolute positioning system and an output indicator can display the output from the absolute positioning system. The drive member represents the longitudinally movable drive member comprising a rack of drive teeth formed thereon for engagement with a corresponding drive gear of the gear reducer assembly. The displacement member represents the longitudinally movable firing member, the firing bar, the beam with | profile, or combinations thereof.

[0153] A single revolution of the sensor element associated with the position sensor 472 is equivalent to a longitudinal linear displacement di of the displacement member, where d1 is the longitudinal linear distance by which the displacement member moves from point "a" to the point "b" after a single revolution of the sensor element coupled to the displacement member. The sensor arrangement can be connected by means of a gear reduction which results in the position sensor 472 completing one or more revolutions for the complete travel of the displacement member. The 472 position sensor can complete multiple revolutions for the full travel of the displacement member.

[0154] A series of keys, where n is an integer greater than one, can be used alone or in combination with a gear reduction to provide a single position signal for more than one revolution of the position sensor 472. The state of the switches is transmitted back to microcontroller 461, which applies logic to determine a single position signal corresponding to the longitudinal linear displacement of d1 + d2 + ... dn of the displacement member. The output of the position sensor 472 is supplied to the microcontroller 461. In several embodiments, the position sensor 472 of the sensor arrangement may comprise a magnetic sensor, an analog rotary sensor, such as a potentiometer, or a series of analog Hall effect elements. , which emit a unique combination of position of signs or values.

[0155] The position sensor 472 can comprise any number of magnetic detection elements, such as, for example, magnetic sensors classified according to whether they measure the total magnetic field or the vector components of the magnetic field. The techniques used to produce both types of magnetic sensors cover many aspects of physics and electronics. Technologies used for magnetic field detection include flow meter, saturated flow, optical pumping, nuclear precession, SQUID, Hall effect! anisotropic magnetoresistance, giant magnetoresistance, magnetic tunnel junctions, giant magnetoimpedance, magnetostrictive / piesoelectric compounds, magnetodiode, magnetic transistor, optical fiber, magneto-optics and magnetic sensors based on microelectromechanical systems, among others.

[0156] In one aspect, the position sensor 472 for tracking system 480 comprising an absolute positioning system comprises a magnetic rotating absolute positioning system. The 472 position sensor can be implemented as a rotary, magnetic, single-circuit, ASSOSSEQFT position sensor, available from Austria Microsystems, AG. The position sensor 472 interfaces with the 461 microcontroller to provide an absolute positioning system. The 472 position sensor is a low voltage, low power component and includes four effect elements in an area of the 472 position sensor located above a magnet. A high-resolution ADC and an intelligent power management controller are also provided on the integrated circuit. A CORDIC (digital computer for coordinate rotation) processor, also known as the digit-for-digit method and Volder algorithm, is provided to implement a simple and efficient algorithm for calculating hyperbolic and trigonometric functions that require only addition, subtraction, displacement operations bits and lookup table. At the angle position, the alarm bits and magnetic field information are transmitted via a standard serial communication interface, such as a serial peripheral interface (SPI), to the 461 microcontroller. The 472 position sensor provides 12 or 14 bits of resolution. The position sensor 472 can be an ASS5055 integrated circuit supplied in a small 16-pin QFN package whose measurement corresponds to 4x4x0.85 mm.

[0157] The tracking system 480 comprising an absolute positioning system can comprise and / or be programmed to implement a feedback controller, such as a PID, state feedback, and adaptive controller. A power supply converts the signal from the feedback controller to a physical input to the system, in this case the voltage. Other examples include a voltage, current and force PWM. Other sensors can be provided in order to measure the parameters of the physical system in addition to the position measured by the position sensor 472. In some respects, the other sensors may include sensor arrangements such as those described in US patent No. 9,345,481 entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, granted on May 24, 2016, which is incorporated by reference in its entirety into this document; US patent application Serial No. 2014/0263552, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, published on September 18, 2014, is incorporated by reference in its entirety into this document; and US patent application Serial No. 15 / 628,175, entitled TECHNIQUES FOR ADAPTIVE CONTROL OF MOTOR

VELOCITY OF A SURGICAL STAPLING AND CUTTING INSTRUMENT, filed on June 20, 2017, incorporated by reference in its entirety in this document. In a digital signal processing system, an absolute positioning system is coupled to a digital data capture system where the output of the absolute positioning system will have a finite resolution and sampling frequency. The absolute positioning system can comprise a comparison and combination circuit to combine a computed response with a measured response through the use of algorithms, such as a weighted average and a theoretical control loop, that trigger the calculated response towards the measured response. The computed response of the physical system considers properties, such as mass, inertia, viscous friction, resistance to inductance, etc., to predict what the states and exits of the physical system will be, knowing the input.

[0158] The absolute positioning system provides an absolute positioning of the displaced member on the activation of the instrument without having to retract or advance the longitudinally movable drive member to the restart position (zero or initial), as may be required by the encoders conventional rotating machines that merely count the number of progressive or regressive steps that the 482 motor has traveled to infer the position of a device actuator, actuation bar, scalpel, and the like.

[0159] A 474 sensor, such as a strain gauge or a micro strain gauge, is configured to measure one or more parameters of the end actuator, such as the amplitude of the strain exerted on the anvil during a gripping operation, which may be indicative of tissue compression. The measured effort is converted into a digital signal and fed to the 462 processor. Alternatively, or in addition to the 474 sensor,

a 476 sensor, such as a load sensor, can measure the closing force applied by the closing drive system to the anvil. The 476 sensor, such as a load sensor, can measure the firing force applied to a beam with a | in a course of firing the instrument or surgical tool. The beam with profile in | it is configured to engage a wedge slide, which is configured to move the clamp drivers upward to force the clamps to deform in contact with an anvil. The beam with profile in | includes a sharp cutting edge that can be used to separate fabric as the beam with a profile | it is advanced distally by the firing bar. Alternatively, a current sensor 478 can be employed to measure the current drained by the 482 motor. The force required to advance the trigger member can correspond to the current drained by the 482 motor, for example. The measured force is converted into a digital signal and supplied to the 462 processor.

[0160] In one form, a 474 strain gauge sensor can be used to measure the force applied to the tissue by the end actuator. A strain gauge can be attached to the end actuator to measure the force applied to the tissue being treated by the end actuator. A system for measuring forces applied to the tissue attached by the end actuator comprises a 474 strain gauge sensor, such as, for example, a microstrain gauge, which is configured to measure one or more parameters of the end actuator, for example. In one aspect, the 474 strain gauge sensor can measure the amplitude or magnitude of the mechanical stress exerted on a claw member of an end actuator during a gripping operation, which can be indicative of tissue compression. The measured effort is converted into a digital signal and fed to the 462 processor of a 461 microcontroller. A 476 load sensor can measure the force used to operate the knife element, for example, to cut the tissue captured between the anvil and the cartridge of staples. A magnetic field sensor can be used to measure the thickness of the captured tissue. The measurement of the magnetic field sensor can also be converted into a digital signal and supplied to the 462 processor.

[0161] The measurements of tissue compression, tissue thickness and / or the force required to close the end actuator on the tissue, as measured by sensors 474, 476 respectively, can be used by microcontroller 461 to characterize the selected position of the trigger member and / or the corresponding trigger member speed value. In one case, a 468 memory can store a technique, an equation and / or a look-up table that can be used by the 461 microcontroller in the evaluation.

[0162] The control system 470 of the instrument or surgical tool can also comprise wired or wireless communication circuits for communication with the modular communication center shown in Figures 8 to 11.

[0163] Figure 13 illustrates a control circuit 500 configured to control aspects of the instrument or surgical tool according to an aspect of the present description. The control circuit 500 can be configured to implement various processes described in this document. The control circuit 500 may comprise a microcontroller comprising one or more processors 502 (for example, microprocessor, microcontroller) coupled to at least one memory circuit 504. The memory circuit 504 stores instructions executable on a machine that, when executed by the processor 502, cause the 502 processor to execute machine instructions to implement several of the processes described in this document. The processor

502 can be any one of a number of single-core or multi-core processors known in the art. The memory circuit 504 may comprise volatile and non-volatile storage media. The processor 502 can include an instruction processing unit 506 and an arithmetic unit 508. The instruction processing unit can be configured to receive instructions from the memory circuit 504 of the present description.

[0164] Figure 14 illustrates a combinational logic circuit 510 configured to control aspects of the instrument or surgical tool according to an aspect of the present description. The combinational logic circuit 510 can be configured to implement various processes described in this document. The combinational logic circuit 510 may comprise a finite state machine comprising a combinational logic 512 configured to receive data associated with the surgical instrument or tool at an input 514, process the data by combinational logic 512 and provide an output 516.

[0165] Figure 15 illustrates a sequential logic circuit 520 configured to control aspects of the surgical instrument or tool according to an aspect of the present description. Sequential logic circuit 520 or combinational logic 522 can be configured to implement the process in this document described. Sequential logic circuit 520 may comprise a finite state machine. Sequential logic circuit 520 may comprise combinational logic 522, at least one memory circuit 524, a clock 529 and, for example. The at least one memory circuit 524 can store a current state of the finite state machine. In certain cases, the sequential logic circuit 520 may be synchronous or asynchronous. Combinational logic 522 is configured to receive data associated with the surgical instrument or tool from an input 526, process the data by combinational logic 522, and provide an output 528. In other respects, the circuit may comprise a combination of a processor (for example , processor 502, Figure 13) and a finite state machine for implementing various processes of the present invention. In other respects, the finite state machine may comprise a combination of a combinational logic circuit (for example, a combinational logic circuit 510, Figure 14) and the sequential logic circuit 520.

[0166] Figure 16 illustrates an instrument or surgical tool that comprises a plurality of motors that can be activated to perform various functions. In certain cases, a first engine can be activated to perform a first function, a second engine can be activated to perform a second function, a third engine can be activated to perform a third function, a fourth engine can be activated to perform a fourth function, and so on. In certain cases, the plurality of motors of the robotic surgical instrument 600 can be individually activated to cause firing, closing, and / or articulation movements in the end actuator. The firing, closing and / or articulation movements can be transmitted to the end actuator through a drive shaft assembly, for example.

[0167] In certain cases, the instrument or surgical tool system may include a 602 firing motor. The 602 firing motor can be operationally coupled to a 604 firing motor drive assembly, which can be configured to transmit movements trigger points, generated by the motor 602 to the end actuator, particularly to move the beam element with | In certain cases, the firing movements generated by the 602 motor can cause the staples to be implanted from the staple cartridge in the fabric captured by the end actuator and / or by the cutting edge of the beam element with profile in | to be advanced in order to cut the captured tissue, for example. The beam element with profile in | can be retracted by reversing the direction of motor 602.

[0168] In certain cases, the surgical instrument or tool may include a closing motor 603. The closing motor 603 can be operationally coupled to a drive assembly of the closing motor 605 that can be configured to transmit closing movements generated by the motor 603 to the end actuator, particularly to move a closing tube to close the anvil and compress the fabric between the anvil and the staple cartridge. Closing movements can cause the end actuator to transition from an open configuration to an approximate configuration to capture tissue, for example. The end actuator can be moved to an open position by reversing the direction of the 603 motor.

[0169] In certain cases, the surgical instrument or tool may include one or more articulation motors 606a, 606b, for example. The motors 606a, 606b can be operationally coupled to the drive assemblies of the articulation motor 608a, 608b, which can be configured to transmit articulation movements generated by the motors 606a, 606b to the end actuator. In certain cases, the articulation movements can cause the end actuator to be articulated in relation to the drive shaft assembly, for example.

[0170] As described above, the surgical instrument or tool can include a plurality of motors that can be configured to perform various independent functions. In certain cases, the plurality of motors of the instrument or surgical tool can be activated individually or separately to perform one or more functions, while other motors remain inactive. For example, the articulation motors 606a, 606b can be activated to cause the end actuator to be articulated, while the firing motor 602 remains inactive. Alternatively, the firing motor 602 can be activated to fire the plurality of clamps, and / or advance the cutting edge, while the hinge motor 606 remains inactive. In addition, the closing motor 603 can be activated simultaneously with the firing motor 602 to make the closing tube and the beam element with profile in | proceed distally, as described in more detail later in this document.

[0171] In certain cases, the instrument or surgical tool may include a common control module 610 that can be used with a plurality of motors of the instrument or surgical tool. In certain cases, the common control module 610 can accommodate one of the plurality of motors at a time. For example, the common control module 610 can be coupled to and separable from the plurality of motors of the robotic surgical instrument individually. In certain cases, a plurality of surgical instrument or tool motors may share one or more common control modules, such as the common control module 610. In certain cases, a plurality of surgical instrument or tool motors may be individually and selectively engaged to the common control module 610. In certain cases, the common control module 610 can be selectively switched between interfacing with one of a plurality of instrument motors or surgical tool to interface with another among the plurality of instrument or tool motors surgical.

[0172] In at least one example, the common control module 610 can be selectively switched between the operating coupling with the 606a, 606B articulation motors, and the operating coupling with the 602 firing motor or the 603 closing motor. at least one example, as illustrated in Figure 16, a key 614 can be moved or transitioned between a plurality of positions and / or states. In the first position 616, the switch 614 can electrically couple the common control module 610 to the trip motor 602; in a second position 617, the switch 614 can electrically couple the control module 610 to the closing motor 603; in a third position 618a, the switch 614 can electrically couple the common control module 610 to the first articulation motor 606a; and in a fourth position 618b, the switch 614 can electrically couple the common control module 610 to the second articulation motor 606b, for example. In certain cases, separate common control modules 610 can be electrically coupled to the firing motor 602, closing motor 603, and hinge motors 606a, 606b at the same time. In certain cases, key 614 can be a mechanical key, an electromechanical key, a solid state key, or any suitable switching mechanism.

[0173] Each of the 602, 603, 606a, 606b motors can comprise a torque sensor to measure the output torque on the motor drive shaft. The force on an end actuator can be detected in any conventional manner, such as by means of force sensors on the outer sides of the jaws or by a motor torque sensor that drives the jaws.

[0174] In several cases, as illustrated in Figure 16, the common control module 610 may comprise a motor starter 626 which may comprise one or more H-Bridge FETs. The motor driver 626 can modulate the energy transmitted from a power source 628 to a motor coupled to the common control module 610, based on an input from a microcontroller 620 (the "controller"), for example. In certain cases, Microcontroller 620 can be used to determine the current drawn by the motor, for example, while the motor is coupled to the common control module 610, as described above.

[0175] In certain examples, the microcontroller 620 may include a microprocessor 622 (the "processor") and one or more non-transitory computer-readable media or 624 memory units (the "memory"). In certain cases, memory 624 can store various program instructions which, when executed, may cause processor 622 to perform a plurality of functions and / or calculations described herein. In certain cases, one or more of the memory units 624 can be coupled to the processor 622, for example.

[0176] In certain cases, the power supply 628 can be used to supply power to the microcontroller 620, for example. In certain cases, the 628 power source may comprise a battery (or "battery pack" or "power source"), such as a Li ion battery, for example. In certain cases, the battery pack can be configured to be releasably mounted to the handle to supply power to the surgical instrument 600. Several battery cells connected in series can be used as the 628 power supply. In certain cases, the power supply 628 power supply can be replaceable and / or rechargeable, for example.

[0177] In several cases, the 622 processor can control the motor drive 626 to control the position, direction of rotation and / or speed of a motor that is coupled to the common control module 610. In certain cases, the processor 622 can signal the motor drive 626 to stop and / or disable a motor that is coupled to the common control module 610. It should be understood that the term "processor", as used herein, includes any microprocessor, microcontroller or other suitable basic computing device that incorporates the functions of a central computer processing unit (CPU) in an integrated circuit or, at most, some integrated circuits. The processor is a programmable multipurpose device that accepts digital data as input, processes it according to instructions stored in its memory, and provides results as output. This is an example of sequential digital logic, as it has internal memory. Processors operate on numbers and symbols represented in the binary numeral system.

[0178] In one example, the 622 processor can be any single-core or multi-core processor, such as those known by the Texas Instruments ARM Cortex trade name. In certain cases, the 620 microcontroller may be an LM 4F230H5QR, available from Texas Instruments, for example. In at least one example, the Texas Instruments LM4F230H5QR is an ARM Cortex-M4F processor core that comprises a 256 KB single cycle flash integrated memory, or other non-volatile memory, up to 40 MHz, an early seek buffer for optimize performance above 40 MHz, a 32 KB single cycle SRAM, an internal ROM loaded with StellarisWareº software, 2 KB EEPROM, one or more PWM modules, one or more QEI analogues, one or more ADCs of 12 bits with 12 channels of analog input, among other features that are readily available for the product data sheet. Other microcontrollers can be readily replaced for use with the 4410 module. Consequently, the present description should not be limited in this context.

[0179] In certain cases, memory 624 may include program instructions for controlling each of the motors of the surgical instrument 600 that are attachable to the common control module 610. For example, memory 624 may include program instructions for controlling the motor trigger 602, closing motor 603 and hinge motors 606a, 606b. Such program instructions can cause the 622 processor to control the trigger, close, and link functions according to inputs from the instrument or surgical tool control algorithms or programs.

[0180] In certain cases, one or more mechanisms and / or sensors, such as 630 sensors, can be used to alert the 622 processor to program instructions that need to be used in a specific configuration. For example, sensors 630 can alert the 622 processor to use the program instructions associated with triggering, closing, and pivoting the end actuator. In certain cases, sensors 630 may comprise position sensors that can be used to detect the position of switch 614, for example. Consequently, the 622 processor can use the program instructions associated with firing the beam with | the end actuator by detecting, through sensors 630, for example, that key 614 is in first position 616; the processor 622 can use the program instructions associated with closing the anvil upon detection through sensors 630, for example, that switch 614 is in second position 617; and processor 622 can use the program instructions associated with the articulation of the end actuator upon detection through sensors 630, for example, that switch 614 is in the third or fourth position 618a, 618b.

[0181] Figure 17 is a schematic diagram of a robotic surgical instrument 700 configured to operate a surgical tool described in this document, in accordance with an aspect of that description. The robotic surgical instrument 700 can be programmed or configured to control the distal / proximal translation of a displacement member, the distal / proximal displacement of a closing tube, the rotation of the drive shaft, and articulation, either with a single type or multiple articulation drive links. In one aspect, the surgical instrument 700 can be programmed or configured to individually control a firing member, a closing member, a driving shaft member and / or one or more hinge members. The surgical instrument 700 comprises a control circuit 710 configured to control motor-driven firing members, closing members, driving shaft members and / or one or more hinge members.

[0182] In one aspect, the robotic surgical instrument 700 comprises a control circuit 710 configured to control an anvil 716 and a beam portion with profile in | 714 (including a sharp cutting edge) of an end actuator 702, a removable clamp cartridge 718, a drive shaft 740 and one or more hinge members 742a, 742b through a plurality of motors 704a to 704e. A 734 position sensor can be configured to provide positional feedback on the beam with profile | 714 to control circuit 710. Other sensors 738 can be configured to provide feedback to control circuit 710. A timer / counter 731 provides timing and counting information to control circuit 710. A power source 712 can be provided to operate the motors 704a to 704e and a current sensor 736 provide motor current feedback to control circuit 710. Motors 704a to 704e can be operated individually by control circuit 710 in an open loop or closed loop feedback control.

[0183] In one aspect, the control circuit 710 may comprise one or more microcontrollers, microprocessors or other processors suitable for executing instructions that cause the processor or processors to perform one or more tasks. In one aspect, a timer / counter 731 provides an output signal, such as elapsed time or a digital count, to control circuit 710 to correlate the position of the beam with | 714, as determined by the position sensor 734, with the timer / counter output 731, so that the control circuit 710 can determine the position of the beam with profile in | 714 at a specific instant (t) in relation to an initial position or instant (t) when the beam with profile in | 714 is in a specific position in relation to an initial position. The timer / counter 731 can be configured to measure elapsed time, count external events, or measure timeless events.

[0184] In one aspect, control circuit 710 can be programmed to control functions of end actuator 702 based on one or more tissue conditions. The control circuit 710 can be programmed to detect, directly or indirectly, the conditions of the fabric, such as thickness, as described in this document. Control circuit 710 can be programmed to select a trigger control program or closing control program based on tissue conditions. A trigger control program can describe the distal movement of the displacement member. Different trigger control programs can be selected to better treat different tissue conditions. For example, when thicker tissue is present, control circuit 710 can be programmed to translate the displacement member at a lower speed and / or with a lower power. When thinner tissue is present, the control circuit 710 can be programmed to translate the displacement member at a higher speed and / or with greater power. A closing control program can control the closing force applied to the tissue by the anvil 716. Other control programs control the rotation of the drive shaft 740 and the hinge members 742a, 742b.

[0185] In one aspect, the 710 control circuit can generate motor setpoint signals. Motor setpoint signals can be supplied to several motor controllers 708a through 708e. Motor controllers 708a to 708e can comprise one or more circuits configured to provide motor drive signals to motors 704a to 704e in order to drive motors 704a to 704e, as described in this document. In some instances, motors 704a to 704e may be brushed DC motors. For example, the speed of motors 704a to 704e can be proportional to the respective motor start signals. In some examples, motors 704a to 704e may be brushless DC electric motors, and the respective motor drive signals may comprise a PWM signal provided for one or more stator windings of motors 704a to 704e. In addition, in some instances, motor controllers 708a through 708e can be omitted and control circuit 710 can directly generate motor drive signals.

[0186] In one aspect, the control circuit 710 can initially operate each of the motors 704a to 704e in an open circuit configuration for a first open circuit portion of a travel member travel. Based on the response of the robotic surgical instrument 700 during the open circuit portion of the stroke, control circuit 710 can select a trigger control program in a closed circuit configuration. The instrument response may include a translation of the distance of the displacement member during the open circuit portion, a time elapsed during the open circuit portion, the energy supplied to one of the motors 704a to 704e during the open circuit portion, a sum pulse widths of a motor start signal, etc. After the open circuit portion, control circuit 710 can implement the selected trigger control program for a second portion of the travel member travel. For example, during a portion of the closed loop course, control circuit 710 can modulate one of the motors 704a to 704e based on the translation of data describing a position of the closed displacement member to translate the displacement member to a constant speed.

[0187] In one aspect, motors 704a to 704e can receive power from a 712 power source. Power source 712 can be a DC power source powered by an alternating main power supply, a battery, a super capacitor, or any other suitable power source. Motors 704a to 704e can be mechanically coupled to individual mobile mechanical elements such as the beam with profile in | 714, the anvil 716, the drive shaft 740, the hinge 742a and the hinge 742b, through the respective transmissions 706a to 706e. Transmissions 706a through 706e may include one or more gears or other connecting components for coupling motors 704a to 704e to moving mechanical elements. A 734 position sensor can detect a beam position with a | 714. The position sensor 734 can be or can include any type of sensor that is capable of generating position data that indicates a beam position profiled in 1 714. In some examples, the position sensor 734 can include a configured encoder to supply a series of pulses to the control circuit 710 as the beam with profile in | 714 transferred distally and proximally. The control circuit 710 can track the pulses to determine the position of the beam with profile in | 714. Other suitable position sensors can be used, including, for example, a proximity sensor. Other types of position sensors can provide other signals that indicate the movement of the beam with profile in | 714. In addition, in some examples, the position sensor 734 may be omitted. When any of the 704a to 704e motors is a stepper motor, the control circuit 710 can track the beam position with | 714 by adding the number and direction of the steps that the 704 engine was instructed to perform. Position sensor 734 can be located on end actuator 702 or any other portion of the instrument. The outputs of each of the engines 704a to 704e include a torque sensor 744a to 744e to detect force and have an encoder to detect the rotation of the drive shaft.

[0188] In one aspect, the control circuit 710 is configured to drive a firing member as the portion of the beam with profile in | 714 of end actuator 702. Control circuit 710 provides a motor setpoint to a motor control 708a, which provides a drive signal to motor 704a. The output shaft of the motor 704a is coupled to a torque sensor 744a. The torque sensor 744a is coupled to a transmission 706a which is coupled to the beam with profile in | 714. The transmission 706a comprises moving mechanical elements, such as rotating elements, and a firing member for distally and proximally controlling the movement of the beam with profile in | 714 along a longitudinal geometric axis of the end actuator 702. In one aspect, the motor 704a can be coupled to the knife gear assembly, which includes a knife gear reduction assembly that includes a first knife drive gear and a second knife drive gear. A torque sensor 744a provides a feedback signal from the firing force to the control circuit 710. The firing force signal represents the force required to fire or move the beam in profile | 714. A 734 position sensor can be configured to provide the beam position with | 714 along the firing stroke or firing member position as a feedback signal to control circuit 710. End actuator 702 may include additional sensors 738 configured to provide feedback signals to control circuit 710. When ready for use, the control circuit 710 can provide a trip signal to the 708a motor control. In response to the trigger signal, motor 704a can drive the trigger member distally along the longitudinal geometry axis of end actuator 702 from an initial proximal position of the stroke to an end distal position of the stroke relative to the initial position of course. As the displacement member moves distally, a beam with a | 714 with a cutting element positioned at a distal end, advances distally to cut the fabric between the staple cartridge 718 and the anvil 716.

[0189] In one aspect, control circuit 710 is configured to drive a closing member, such as anvil portion 716 of end actuator 702. Control circuit 710 provides a motor setpoint to a motor control 708b, which provides a drive signal to motor 704b. The output shaft of the 704b motor is coupled to a 744b torque sensor. The torque sensor 744b is coupled to a transmission 706b which is coupled to the anvil 716. The transmission 706b comprises moving mechanical elements, such as rotating elements, and a closing member, to control the movement of the anvil 716 from the open and closed positions. . In one aspect, the 704b motor is coupled to a closing gear assembly, which includes a closing reduction gear assembly that is supported in gear engaged with the closing sprocket. The torque sensor 744b provides a closing force feedback signal for control circuit 710. The closing force feedback signal represents the closing force applied to the anvil 716. The position sensor 734 can be configured to provide the position of the closing member as a feedback signal to control circuit 710. Additional sensors 738 on end actuator 702 can provide the feedback signal of closing force to control circuit 710. Pivoting anvil 716 is positioned opposite the cartridge of clamps 718. When ready for use, control circuit 710 can provide a closing signal to motor control 708b. In response to the closing signal, motor 704b advances a closing member to secure the fabric between the anvil 716 and the staple cartridge 718.

[0190] In one aspect, control circuit 710 is configured to rotate a drive shaft member, such as drive shaft 740, to rotate end actuator 702. Control circuit 710 provides a motor setpoint to a motor control 708c, which provides a drive signal to the motor 704c. The output shaft of the motor 704c is coupled to a torque sensor 744c. The torque sensor 744c is coupled to a transmission 706c which is coupled to the shaft 740. The transmission 706c comprises moving mechanical elements, such as rotary elements, to control the rotation of the drive shaft 740 clockwise or counterclockwise until and above 360º. In one aspect, the 704c engine is coupled to the rotary drive assembly, which includes a pipe gear segment that is formed over (or attached to) the proximal end of the proximal closing tube for operable engagement by a rotational gear assembly that is supported operationally on the tool mounting plate. The torque sensor 744c provides a rotation force feedback signal for control circuit 710. The rotation force feedback signal represents the rotation force applied to the drive shaft 740. The position sensor 734 can be configured to supply the position of the closing member as a feedback signal to the control circuit 710. Additional sensors 738, such as a drive shaft encoder, can supply the rotational position of the drive shaft 740 to the control circuit 710.

[0191] In one aspect, control circuit 710 is configured to link end actuator 702. Control circuit 710 provides a motor setpoint to a 708d motor control, which provides a drive signal to the motor 704d. The motor output shaft / 704d is coupled to a 744d torque sensor. The torque sensor 744d is coupled to a transmission 706d which is coupled to a pivot member 742a. The 706d transmission comprises moving mechanical elements, such as articulation elements, to control the articulation of the 702 + 65º end actuator. In one aspect, the 704d motor is coupled to a pivot nut, which is rotatably seated on the proximal end portion of the distal column portion and is pivotally driven thereon by a pivot gear assembly. The 744d torque sensor provides a feedback signal from the hinge force to the control circuit

710. The hinge force feedback signal represents the hinge force applied to the end actuator 702. The 738 sensors, like a hinge encoder, can provide the hinge position of the end actuator 702 to the control circuit 710.

[0192] In another aspect, the articulation function of the robotic surgical system 700 may comprise two articulation members, or connections, 742a, 742b. These hinge members 742a, 742b are driven by separate disks at the robot interface (the rack), which are driven by the two motors 708d, 708e. When the separate firing motor 704a is provided, each hinge link 742a, 742b can be antagonistically driven with respect to the other link to provide a resistive holding movement and a load to the head when it is not moving and to provide a movement of articulation when the head is articulated. The hinge members 742a, 742b attach to the head in a fixed radius when the head is rotated. Consequently, the mechanical advantage of the push and pull link changes when the head is rotated. This change in mechanical advantage can be more pronounced with other drive systems for the articulation connection.

[0193] In one aspect, the one or more motors 704a to 704e may comprise a brushed DC motor with a gearbox and mechanical connections to a firing member, closing member or articulation member. Another example includes electric motors 704a to 704e that operate the moving mechanical elements such as the displacement member, the articulation connections, the closing tube and the drive shaft. An external influence is an excessive and unpredictable influence on things like tissue, surrounding bodies, and friction in the physical system. This external influence can be called drag, which acts in opposition to one of the electric motors 704a to 704e. External influence, such as drag, can cause the functioning of the physical system to deviate from a desired operation of the physical system.

[0194] In one aspect, the position sensor 734 can be implemented as an absolute positioning system. In one aspect, the position sensor 734 can comprise an absolute rotary magnetic positioning system implemented as a single integrated circuit rotary magnetic position sensor, ASSOSSEQFT, available from Austria Microsystems, AG. The position sensor 734 can interface with the control circuit 710 to provide an absolute positioning system. The position can include multiple Hall effect elements located above a magnet and coupled to a CORDIC processor, also known as the digit by digit method and Volder algorithm, which is provided to implement a simple and efficient algorithm for calculating hyperbolic and trigonometric functions which only require addition, subtraction, bit shift and lookup table operations.

[0195] In one aspect, control circuit 710 can be in communication with one or more sensors 738. Sensors 738 can be positioned on end actuator 702 and adapted to work with the robotic surgical instrument 700 to measure various derived parameters such as span distance in relation to time, compression of the tissue in relation to time, and deformation of the anvil in relation to time. The 738 sensors can comprise a magnetic sensor, a magnetic field sensor, a strain gauge, a load cell, a pressure sensor, a force sensor, a torque sensor, an inductive sensor such as an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor and / or any other sensor suitable for measuring one or more parameters of end actuator 702. Sensors 738 may include one or more sensors. Sensors 738 may be located on the staple cartridge platform 718 to determine the location of the tissue using segmented electrodes. The torque sensors 744a to 744e can be configured to detect force such as firing force, closing force, and / or articulation force, among others. Consequently, control circuit 710 can detect (1) the closing load experienced by the distal closing tube and its position, (2) the trigger member on the rack and its position, (3) which portion of the staple cartridge 718 has tissue in it, and (4) the load and position on both articulation rods.

[0196] In one aspect, the one or more sensors 738 may comprise a stress meter such as, for example, a microstrain meter, configured to measure the magnitude of the stress on the anvil 716 during a clamped condition. The voltage meter provides an electrical signal whose amplitude varies with the magnitude of the voltage. Sensors 738 can comprise a pressure sensor configured to detect a pressure generated by the presence of compressed tissue between the anvil 716 and the staple cartridge 718. Sensors 738 can be configured to detect the impedance of a section of tissue located between the anvil 716 and the staple cartridge 718 which is indicative of the thickness and / or completeness of the fabric located between them.

[0197] In one aspect, the 738 sensors can be implemented as one or more limit switches, electromechanical devices, solid state switches, Hall effect devices, magneto-resistive devices (MR) giant magneto-resistive devices (GMR), magnetometers, among others. In other implementations, the 738 sensors can be implemented as solid-state switches that operate under the influence of light, such as optical sensors, infrared sensors, ultraviolet sensors,

among others. In addition, the switches can be solid state devices such as transistors (for example, FET, junction FET, MOSFET, bipolar and the like). In other implementations, the 738 sensors can include driverless electric switches, ultrasonic switches, accelerometers, and inertia sensors, among others.

[0198] In one aspect, sensors 738 can be configured to measure the forces exerted on the anvil 716 by the closing drive system. For example, one or more sensors 738 may be at a point of interaction between the closing tube and the anvil 716 to detect the closing forces applied by the closing tube to the anvil 716. The forces exerted on the anvil 716 may be representative of the tissue compression experienced by the tissue section captured between the anvil 716 and the staple cartridge 718. The one or more sensors 738 can be positioned at various points of interaction throughout the closing drive system to detect the closing forces applied to the anvil 716 by the closing drive system. The one or more sensors 738 can be sampled in real time during a gripping operation by the processor of the control circuit 710. The control circuit 710 receives sample measurements in real time to provide and analyze information based on time and evaluate, in real time actual closing forces applied to the clamping arm 716.

[0199] In one aspect, a current sensor 736 can be used to measure the current drawn by each of the 704a to 704e motors. The force required to advance any of the moving mechanical elements, such as the closing member 714, corresponds to the current drained by one of the motors 704a to 704e. The force is converted into a digital signal and supplied to control circuit 710. Control circuit 710 can be configured to simulate the response of the instrument's actual system in the controller software. A displacement member can be actuated to move a beam with a profile | 714 on end actuator 702 at target speed or at a value close to target speed. The robotic surgical instrument 700 may include a feedback controller, which may be one or any of the feedback controllers, including, but not limited to, a PID controller, state feedback, linear quadratic (LOR) and / or an adaptive controller , for example. The robotic surgical instrument 700 can include a power source to convert the signal from the feedback controller to a physical input such as case voltage, PWM voltage, frequency modulated voltage, current, torque and / or force, for example. Additional details are described in US patent application Serial No. 15 / 636,829, entitled CLOSED LOOP VELOCITY CONTROL TECHNIQUES FOR ROBOTIC SURGICAL INSTRUMENT, filed on June 29, 2017, which is hereby incorporated by reference in its entirety for reference.

[0200] Figure 18 illustrates a block diagram of a surgical instrument 750 programmed to control the distal translation of a displacement member, in accordance with an aspect of the present description. In one aspect, the 750 surgical instrument is programmed to control the distal translation of a displacement limb, such as the | 764. The surgical instrument 750 comprises an end actuator 752 which may comprise an anvil 766, a beam with a profile in | 764 (including a sharp cutting edge), and a removable staple cartridge 768.

[0201] The position, movement, displacement, and / or translation of a member of linear displacement, such as the beam with profile in | 764, can be measured by an absolute positioning system,

sensor arrangement, and a 784 position sensor. Due to the fact that the beam with profile in | 764 be coupled to a longitudinally movable drive member, the position of the beam with profile in | 764 can be determined by measuring the position of the longitudinally movable drive member that employs the position sensor 784. Consequently, in the description below, the position, displacement and / or translation of the beam with profile in | 764 can be obtained by the position sensor 784, as described in the present invention. A control circuit 760 can be programmed to control the translation of the displacement member, such as the beam with | 764. The control circuit 760, in some examples, may comprise one or more microcontrollers, microprocessors or other suitable processors to execute the instructions that cause the processor or processors to control the displacement member, for example, the beam with profile in | 764, as described. In one aspect, a timer / counter 781 provides an output signal, such as elapsed time or a digital count, to the control circuit 760 to correlate the position of the beam with | 764 as determined by the position sensor 784 with the timer / counter output 781, so that the control circuit 760 can determine the position of the beam with profile in | 764 at a specific time (t) in relation to an initial position. The 781 timer / counter can be configured to measure elapsed time, count external events, or measure timeless events.

[0202] Control circuit 760 can generate a 772 motor setpoint signal. The 772 motor setpoint signal can be supplied to a 758 motor controller. The 758 motor controller can comprise one or more circuits configured to provide a motor 774 drive signal to motor 754 to drive motor 754, as described in the present invention. In some examples,

the 754 motor can be a DC motor with a brushed DC electric motor. For example, the speed of motor 754 can be proportional to the drive signal of motor 774. In some instances, motor 754 can be a brushless DC electric motor and the motor drive signal 774 can comprise a PWM signal provided for a or more motor stator windings 754. In addition, in some examples, motor controller 758 may be omitted, and control circuit 760 can generate motor drive signal 774 directly.

[0203] The 754 motor can receive power from a power source

762. The 762 power source can be or include a battery, a super capacitor, or any other suitable power source. The 754 motor can be mechanically coupled to the beam with a profile | 764 by means of a transmission 756. The transmission 756 may include one or more gears or other connecting components for coupling the motor 754 to the beam with profile | 764. A 784 position sensor can detect a beam position with | 764. The position sensor 784 can be or can include any type of sensor that is capable of generating position data that indicate a beam position with profile in | 764. In some examples, the position sensor 784 may include an encoder configured to supply a series of pulses to the control circuit 760 such as the beam with profile | 764 moved distally and proximally. The control circuit 760 can track the pulses to determine the position of the beam with profile in | 764. Other suitable position sensors can be used, including, for example, a proximity sensor. Other types of position sensors can provide other signals that indicate the movement of the beam with profile in | 764. In addition, in some examples, the position sensor 784 may be omitted. When motor 754 is a stepper motor, control circuit 760 can track the position of the beam with a profile | 764 by adding the number and orientation of the steps that the 754 engine was instructed to perform. The position sensor 784 can be located on end actuator 752 or any other portion of the instrument.

[0204] The control circuit 760 can be in communication with one or more sensors 788. The sensors 788 can be positioned on the end actuator 752 and adapted to work with the surgical instrument 750 to measure the various derived parameters, such as span distance in relation to time, compression of the tissue in relation to time and mechanical tension in the anvil in relation to time. The 788 sensors can comprise a magnetic sensor, a magnetic field sensor, a stress meter, a pressure sensor, a force sensor, an inductive sensor such as a eddy current sensor, a resistive sensor, a capacitive sensor, a sensor optical and / or any other sensors suitable for measuring one or more parameters of the 752 end actuator. The 788 sensors may include one or more sensors.

[0205] The one or more sensors 788 may comprise an effort meter, such as a microstrain meter, configured to measure the magnitude of the mechanical stress on the anvil 766 during a grip condition. The voltage meter provides an electrical signal whose amplitude varies with the magnitude of the voltage. The 788 sensors can comprise a pressure sensor configured to detect a pressure generated by the presence of compressed tissue between the anvil 766 and the staple cartridge 768. The 788 sensors can be configured to detect the impedance of a section of tissue located between the anvil 766 and the staple cartridge 768 which is indicative of the thickness and / or completeness of the fabric located between them.

[0206] The 788 sensors can be configured to measure the forces exerted on the anvil 766 by a closing drive system. For example, one or more sensors 788 can be at a point of interaction between a closing tube and anvil 766 to detect the closing forces applied by a closing tube to anvil 766. The forces exerted on anvil 766 can be representative of the tissue compression experienced by the tissue section captured between the anvil 766 and the staple cartridge 768. The one or more sensors 788 can be positioned at various points of interaction throughout the closing drive system to detect the closing forces applied anvil 766 by the closing drive system. The one or more 788 sensors can be sampled in real time during a gripping operation by a processor of the control circuit 760. The control circuit 760 receives sample measurements in real time to provide and analyze information based on time and evaluate, in real time, the closing forces applied to the anvil 766.

[0207] A current sensor 786 can be used to measure the current drained by the 754 motor. The force required to advance the beam with profile in | 764 corresponds to the current drained by the motor

754. The force is converted into a digital signal and supplied to the control circuit 760.

[0208] Control circuit 760 can be configured to simulate the actual system response of the instrument in the controller software. A displacement member can be actuated to move a beam with a profile in | 764 on end actuator 752 at target speed or at a value close to target speed. The 750 surgical instrument may include a feedback controller, which may be one or any of the feedback controllers, including, but not limited to, a PID controller, state feedback, LOR, and / or an adaptive controller,

for example. The surgical instrument 750 can include a power source to convert the signal from the feedback controller to a physical input such as case voltage, PWM voltage, frequency modulated voltage, current, torque and / or force, for example.

[0209] The actual drive system of the surgical instrument 750 is configured to drive the displacement member, the cutting member or the beam with profile in | 764, by a brushed DC motor with gearbox and mechanical connections to an articulation system and / or a knife. Another example is the 754 electric motor that operates the displacement member and the articulation drive, for example, from an interchangeable drive shaft assembly. An external influence is an excessive and unpredictable influence on things like tissue, surrounding bodies, and friction in the physical system. This external influence can be called drag, which acts in opposition to the 754 electric motor. External influence, like drag, can cause the functioning of the physical system to deviate from a desired operation of the physical system.

[0210] Several exemplifying aspects are directed to a 750 surgical instrument that comprises a 752 end actuator with motor-driven surgical stapling and cutting implements. For example, a motor 754 can drive a displacement member distally and proximally along a longitudinal geometry axis of end actuator 752. End actuator 752 may comprise an articulating anvil 766 and, when configured for use, a staples 768 opposite the anvil 766. A doctor can hold the tissue between the anvil 766 and the staple cartridge 768, as described in the present invention. When ready to use the 750 instrument, the physician can provide a trigger signal, for example, by pressing a trigger on the 750 instrument. In response to the trigger signal, motor 754 can drive the displacement member distally along the longitudinal geometric axis of the end actuator 752 from a proximal start position to a distal end position from the start position. As the displacement member moves distally, a beam with a | 764 with a cutting element positioned at a distal end, you can cut the fabric between the staple cartridge 768 and the anvil 766.

[0211] In several examples, the surgical instrument 750 may comprise a control circuit 760 programmed to control the distal translation of the displacement member, such as the beam with profile in | 764, for example, based on one or more tissue conditions. The control circuit 760 can be programmed to detect, directly or indirectly, the conditions of the fabric, such as thickness, as described in this document. Control circuit 760 can be programmed to select a trigger control program based on tissue conditions. A trigger control program can describe the distal movement of the displacement member. Different trigger control programs can be selected to better treat different tissue conditions. For example, when a thicker tissue is present, control circuit 760 can be programmed to translate the displacement member at a lower speed and / or with a lower power. When thinner tissue is present, the control circuit 760 can be programmed to translate the displacement member at a higher speed and / or with greater power.

[0212] In some examples, control circuit 760 may initially operate motor 754 in an open circuit configuration for a first open circuit portion of a travel of the displacement member. Based on a response from the 750 instrument during the open circuit portion of the course, the control circuit

760 can select a trigger control program. The response of the instrument may include a travel distance of the displacement member during the open circuit portion, a time elapsed during the open circuit portion, the power supplied to the motor 754 during the open circuit portion, a sum of pulse widths a motor start signal, etc. After the open circuit portion, control circuit 760 can implement the selected trigger control program for a second portion of the travel member travel. For example, during the closed loop portion of the stroke, control circuit 760 can modulate motor 754 based on translation data that describes a position of the displacement member in a closed circuit manner to translate the displacement member to a constant speed. Additional details are described in US patent application Serial No. 15 / 720,852, entitled SYSTEM AND METHODS FOR CONTROLLING A DISPLAY OF A SURGICAL INSTRUMENT, filed on September 29, 2017, which is hereby incorporated by reference in its entirety for reference. .

[0213] Figure 19 is a schematic diagram of a 790 surgical instrument configured to control various functions, in accordance with an aspect of the present description. In one aspect, the 790 surgical instrument is programmed to control the distal translation of a displacement limb, such as the | 764. The surgical instrument 790 comprises an end actuator 792 which may comprise an anvil 766, a rod with a profile | 764 and a removable staple cartridge 768 that can be interchanged with an RF cartridge 796 (shown in dashed line).

[0214] In one aspect, the 788 sensors can be implemented as a limit switch, electromechanical device, solid state switches, Hall effect devices, MRI devices, GMR devices, magnetometers, among others. In other implementations, 638 sensors can be solid state switches that operate under the influence of light, such as optical sensors, infrared sensors, ultraviolet sensors, among others. In addition, the switches can be solid state devices such as transistors (for example, FET, junction FET, MOSFET, bipolar and the like). In other implementations, 788 sensors can include driverless electric switches, ultrasonic switches, accelerometers, inertia sensors, and more.

[0215] In one aspect, the position sensor 784 can be implemented as an absolute positioning system, which comprises a rotating magnetic absolute positioning system implemented as a single integrated circuit rotary magnetic position sensor, ASSOSSEQFT, available from Austria Microsystems, AG. The position sensor 784 can interface with the control circuit 760 to provide an absolute positioning system. The position can include multiple Hall effect elements located above a magnet and coupled to a CORDIC processor, also known as the digit by digit method and Volder algorithm, which is provided to implement a simple and efficient algorithm for calculating hyperbolic and trigonometric functions which only require addition, subtraction, bit shift and lookup table operations.

[0216] In one aspect, the rod with | 764 can be implemented as a knife member comprising a knife body which operationally supports a tissue cutting blade therein and can additionally include anvil engagement tabs or features and channel engagement or a base. In one aspect, the staple cartridge 768 can be implemented as a standard (mechanical) surgical clamp cartridge. In one respect,

the RF cartridge 796 can be implemented as an RF cartridge. These and other sensor provisions are described in Commonly Owned US Patent Application No. 15 / 628,175, entitled

TECHNIQUES FOR ADAPTIVE CONTROL OF MOTOR VELOCITY OF A SURGICAL STAPLING AND CUTTING INSTRUMENT, filed on June 20, 2017, which is hereby incorporated by reference in its entirety for reference.

[0217] The position, movement, displacement and / or translation of a linear displacement member, such as the beam with profile in | 764, can be measured by an absolute positioning system, sensor arrangement and position sensor represented as the position sensor 784. Due to the fact that the beam with profile in | 764 be coupled to the longitudinally movable drive member, the position of the beam with | 764 can be determined by measuring the position of the longitudinally movable drive member that employs the position sensor 784. Consequently, in the description below, the position, displacement and / or translation of the beam with profile in | 764 can be obtained by the position sensor 784, as described in the present invention. A control circuit 760 can be programmed to control the translation of the displacement member, such as the beam with | 764, as described in this document. The control circuit 760, in some examples, may comprise one or more microcontrollers, microprocessors or other suitable processors to execute the instructions that cause the processor or processors to control the displacement member, for example, the beam with profile in | 764, as described. In one aspect, a timer / counter 781 provides an output signal, such as elapsed time or a digital count, to the control circuit 760 to correlate the position of the beam with | 764 as determined by the position sensor 784 with the timer / counter output 781, so that the control circuit 760 can determine the position of the beam with profile in | 764 at a specific time (t) in relation to an initial position. The 781 timer / counter can be configured to measure elapsed time, count external events, or measure timeless events.

[0218] The control circuit 760 can generate a setpoint signal from the engine 772. The setpoint signal from the engine 772 can be supplied to a 758 motor controller. The 758 motor controller can comprise one or more circuits configured to provide a motor 774 drive signal to motor 754 to drive motor 754, as described in the present invention. In some instances, the 754 motor may be a DC motor with a brushed DC electric motor. For example, the speed of motor 754 can be proportional to the drive signal of motor 774. In some instances, motor 754 can be a brushless DC electric motor and the motor drive signal 774 can comprise a PWM signal provided for a or more motor stator windings 754. In addition, in some examples, motor controller 758 may be omitted, and control circuit 760 can generate motor drive signal 774 directly.

[0219] The 754 motor can receive power from a power source

762. The 762 power source can be or include a battery, a super capacitor, or any other suitable power source. The 754 motor can be mechanically coupled to the beam with a profile | 764 by means of a transmission 756. The transmission 756 may include one or more gears or other connecting components for coupling the motor 754 to the beam with profile | 764. A 784 position sensor can detect a beam position with | 764. The position sensor 784 can be or can include any type of sensor that is capable of generating position data that indicate a beam position with profile in | 764. In some examples, the position sensor 784 may include an encoder configured to supply a series of pulses to the control circuit 760 such as the beam with profile | 764 moved distally and proximally. The control circuit 760 can track the pulses to determine the position of the beam with profile in | 764. Other suitable position sensors can be used, including, for example, a proximity sensor. Other types of position sensors can provide other signals that indicate the movement of the beam with profile in | 764. In addition, in some examples, the position sensor 784 may be omitted. When motor 754 is a stepper motor, control circuit 760 can track the position of the beam with a profile | 764 when adding the number and the orientation of steps that the engine was instructed to perform. Position sensor 784 can be located on end actuator 792 or any other portion of the instrument.

[0220] The control circuit 760 can be in communication with one or more sensors 788. The sensors 788 can be positioned on the end actuator 792 and be adapted to work with the surgical instrument 790 to measure the various derived parameters, such as distance from they go in relation to time, compression of the tissue in relation to time and mechanical tension in the anvil in relation to time. The 788 sensors can comprise a magnetic sensor, a magnetic field sensor, a stress meter, a pressure sensor, a force sensor, an inductive sensor such as a eddy current sensor, a resistive sensor, a capacitive sensor, a sensor optical and / or any other sensors suitable for measuring one or more parameters of the end actuator 792. The 788 sensors may include one or more sensors.

[0221] The one or more sensors 788 may comprise an effort meter, such as a microstrain meter, configured to measure the magnitude of the mechanical stress on the anvil 766 during a grip condition. The voltage meter provides an electrical signal whose amplitude varies with the magnitude of the voltage. The 788 sensors can comprise a pressure sensor configured to detect a pressure generated by the presence of compressed tissue between the anvil 766 and the staple cartridge 768. The 788 sensors can be configured to detect the impedance of a section of tissue located between the anvil 766 and the staple cartridge 768 which is indicative of the thickness and / or completeness of the fabric located between them.

[0222] The 788 sensors can be configured to measure the forces exerted on the anvil 766 by the closing drive system. For example, one or more sensors 788 can be at a point of interaction between a closing tube and anvil 766 to detect the closing forces applied by a closing tube to anvil 766. The forces exerted on anvil 766 can be representative of the tissue compression experienced by the tissue section captured between the anvil 766 and the staple cartridge 768. The one or more sensors 788 can be positioned at various points of interaction throughout the closing drive system to detect the closing forces applied anvil 766 by the closing drive system. The one or more sensors 788 can be sampled in real time during a gripping operation by a processor portion of the control circuit 760. The control circuit 760 receives sample measurements in real time to provide and analyze information based on time and evaluate , in real time, the closing forces applied to the anvil 766.

[0223] A current sensor 786 can be used to measure the current drained by the 754 motor. The force required to advance the beam with profile in | 764 corresponds to the current drained by the motor

754. The force is converted into a digital signal and supplied to the control circuit 760.

[0224] The RF power source 794 is coupled to the end actuator 792 and is applied to the RF 796 cartridge when the RF 796 cartridge is loaded on the end actuator 792 in place of the staple cartridge 768. The control circuit 760 controls the supply of RF energy to the 796 RF cartridge.

[0225] Additional details are described in US patent application Serial No. 15 / 636,096, entitled SURGICAL SYSTEM COUPLABLE

WITH STAPLE CARTRIDGE AND RADIO FREQUENCY CARTRIDGE, AND METHOD OF USING SAME, deposited on June 28, 2017, which is hereby incorporated by reference in its entirety for reference. Generator hardware

[0226] Figure 20 is a simplified block diagram of a generator 800 configured to provide tuning without an inductor, among other benefits. Additional details of generator 800 are described in US patent No. 9,060,775 entitled SURGICAL GENERATOR FOR ULTRASONIC AND ELECTROSURGICAL DEVICES, granted on June 23, 2015, which is hereby incorporated by reference in its entirety. The generator 800 can comprise a patient isolated stage 802 in communication with a non-isolated stage 804 via a power transformer 806. A secondary winding 808 of the power transformer 806 is contained in the isolated stage 802 and can comprise a bypass configuration. (for example, a central or non-central bypass configuration) to define the trigger signal outputs 810a, 810b, 810c, in order to deliver trigger signals to different surgical instruments, such as an ultrasonic surgical device, an electrosurgical RF instrument, and a multifunctional surgical instrument that includes ultrasonic and RF energy modes that can be released alone or simultaneously. In particular, the trigger signal outputs 810a, 810c can provide an ultrasonic trigger signal (for example, a 420 V mean square value (RMS) trigger signal) to an ultrasonic surgical instrument, and the signal signal outputs of drive 810b, 810c can provide an electrosurgical drive signal (for example, a 100 V RMS drive signal) to an RF electrosurgical instrument, with the drive signal output 810b corresponding to the center tap of the 806 power transformer.

[0227] In certain forms, ultrasonic and electrosurgical trigger signals can be supplied simultaneously to different surgical instruments and / or to a single surgical instrument, such as the multifunctional surgical instrument, with the ability to supply both ultrasonic and electrosurgical energy to the tissue. It will be noted that the electrosurgical signal provided by both the electrosurgical instrument - dedicated - and by the “combined electrosurgical / ultrasonic multifunctional instrument can be both a therapeutic and subtherapeutic level signal, where the subtherapeutic signal can be used, for example, to monitor tissue or instrument conditions and provide feedback to the generator. For example, RF and ultrasonic signals can be supplied separately or simultaneously from a generator with a single output port in order to provide the desired output signal to the surgical instrument, as will be discussed in more detail below. Consequently, the generator can combine the RF electrosurgical and ultrasonic energies and supply the combined energies to the multifunctional electrosurgical / ultrasonic instrument. Bipolar electrodes can be placed on one or both claws of the end actuator. A claw can be triggered by ultrasonic energy in addition to RF electrosurgical energy, working simultaneously. Ultrasonic energy can be used to perform tissue dissection while RF electrosurgical energy can be used to cauterize vessels.

[0228] The non-isolated stage 804 may comprise a power amplifier 812 having an output connected to a primary winding 814 of the power transformer 806. In certain forms the power amplifier 812 may comprise a push-pull amplifier. For example, the non-isolated stage 804 may additionally contain a logic device 816 to provide a digital output to a digital-to-analog converter circuit ("DAC" - digital-to-analog converter) 818 which, in turn, provides an analog signal corresponding to a power amplifier 812 input. In certain ways, logic device 816 may comprise a programmable gate array ("PGA"), a field-programmable gate array (FPGA), a programmable logic device ("PLD" - programmable logic device), among other logic circuits, for example. The logic device 816, by controlling the input of the power amplifier 812 through the DAC 818, can therefore control any of several parameters (for example, frequency, waveform, amplitude of the waveform) of drive signals that appear at the trigger signal outputs 810a, 810b and 810c. In certain ways and as discussed below, logic device 816, in conjunction with a processor (for example, a DSP discussed below) can implement various control algorithms based on digital signal processing (DSP) and / or other control algorithms for control parameters of the drive signals provided by generator 800.

[0229] Power can be supplied to a power rail of the power amplifier 812 by a key mode regulator 820, such as a power converter. In certain forms, the key mode regulator 820 may comprise an adjustable regulator, for example. The non-isolated stage 804 may further comprise a first processor 822 which, in one form, may comprise a DSP processor as an ADSP-21469 SHARC DSP analog device, available from Analog Devices, Norwood, MA, USA, for example , although in various forms, any suitable processor can be employed. In certain ways, the DSP processor 822 can control the operation of the key mode regulator 820 responsive to voltage feedback data received from the power amplifier 812 by the DSP processor 822 via an ADC 824 circuit. For example, the DSP 822 processor can receive the waveform envelope of a signal (for example, an RF signal) amplified by the power amplifier via the ADC 824 circuit.

812. The DSP processor 822 can then control the key mode regulator 820 (for example, via a PWM output) so that the rail voltage supplied to the power amplifier 812 tracks the signal waveform envelope amplified. By dynamically modulating the rail voltage of the 812 power amplifier based on the waveform envelope, the efficiency of the 812 power amplifier can be significantly improved over fixed rail voltage amplifier schemes.

[0230] In certain forms, the logic device 816, in conjunction with the DSP processor 822, can implement a digital synthesis circuit as a control scheme with direct digital synthesizer to control the waveform, frequency and / or amplitude of the trigger signals emitted by the generator 800. In one way, for example, the logic device 816 can implement a DDS control algorithm by retrieving waveform samples stored in a lookup table ("LUT" - look -up table) updated dynamically, as a RAM LUT, which can be integrated into an FPGA.

This control algorithm is particularly useful for ultrasonic applications in which an ultrasonic transducer, such as an ultrasonic transducer, can be driven by a clean sinusoidal current at its resonant frequency.

Since other frequencies can excite parasitic resonances, minimizing or reducing the total distortion of the branching current can correspondingly minimize or reduce the undesirable effects of the resonance.

As the waveform of a drive signal output by generator 800 is impacted by various sources of distortion present in the output drive circuit (for example, power transformer 806, power amplifier 812), feedback data of voltage and current based on the trigger signal can be inserted into an algorithm, such as an error control algorithm implemented by the DSP 822 processor, which compensates for the distortion through adequate pre-distortion or modification of the stored waveform samples in the LUT in a dynamic and continuous way (for example, in real time). In one way, the amount or degree of pre-distortion applied to the LUT samples can be based on the error between a current from the computerized motion branch and a desired current waveform, the error being determined on a basis of sample by sample.

In this way, pre-distorted LUT samples, when processed through the drive circuit, can result in a motion branch drive signal that has the desired waveform (for example, sinusoidal) to optimally drive the transducer ultrasonic. In such forms, the LUT waveform samples will therefore not represent the desired waveform of the trigger signal, but the waveform that is needed to ultimately produce the desired waveform of the signal triggering the motion branch, when distortion effects are taken into account.

[0231] The non-isolated stage 804 may additionally comprise a first ADC circuit 826 and a second ADC circuit 828 coupled to the output of the power transformer 806 by means of the respective isolation transformers, 830, 832, to respectively carry out the voltage sampling and of the current of drive signals emitted by the generator 800. In certain ways, the ADC 826, 828 circuits can be configured for sampling at high speeds (for example, 80 mega samples per second ("MSPS" - mega samples per second)) to allow oversampling of the trigger signals. In one way, for example, the sampling speed of the ADC 4826, 828 circuits can allow an oversampling of approximately 200x (depending on the frequency) of the drive signals. In certain ways, the sampling operations of the ADC 826, 828 circuit can be performed by a single ADC circuit receiving voltage and current input signals through a bidirectional multiplexer. The use of high-speed sampling in the forms of generator 800 can allow, among other things, the calculation of the complex current flowing through the branch of motion (which can be used in certain ways to implement DDS-based waveform control described above), digital filtering needs the sampled signals and calculates the actual energy consumption with a high degree of accuracy. The feedback data about voltage and current emitted by the ADC 826, 828 circuits can be received and processed (for example, first-in-first-out temporary storage ("FIFO" - firstin-first-out), multiplexer) by logic device 816 and stored in data memory for subsequent retrieval, for example, by processor 822. As noted above, feedback data about voltage and current can be used as input to an algorithm for pre-distortion or modification of format samples in the LUT, in a dynamic and continuous way. In certain ways, this may require that each stored voltage and current feedback data pair be indexed based on, or otherwise associated with, a sample of the corresponding LUT that was provided by logic device 816 when the data pair of feedback on voltage and current was captured. The synchronization of the LUT samples with the feedback data about voltage and current in this way contributes to the correct timing and stability of the pre-distortion algorithm.

[0232] In certain forms, voltage and current feedback data can be used to control the frequency and / or amplitude (for example, current amplitude) of the drive signals. In one way, for example, feedback data about voltage and current can be used to determine the impedance phase. The frequency of the trigger signal can then be controlled to minimize or reduce the difference between the determined impedance phase and an impedance phase setpoint (eg 0º), thereby minimizing or reducing the effects of harmonic distortion and , correspondingly, accentuating the accuracy of the impedance phase measurement. The determination of phase impedance and a frequency control signal can be implemented in the DSP processor 822, for example, with the frequency control signal being supplied as input to a DDS control algorithm implemented by logic device 816.

[0233] In another form, for example, the current feedback data can be monitored in order to maintain the current amplitude of the drive signal at a current amplitude setpoint. The current amplitude set point can be specified directly or indirectly determined based on the specified set points for voltage and power amplitude. In certain ways, current amplitude control can be implemented by the control algorithm, such as a proportional-integral-derived control (PID) algorithm, on the DSP processor

822. Variables controlled by the control algorithm to properly control the current amplitude of the trigger signal may include, for example, the scaling of the LUT waveform samples stored in logic device 816 and / or the output voltage full-scale circuit DAC 818 (which provides input to the power amplifier 812) via a DAC circuit

834.

[0234] Non-isolated stage 804 may additionally comprise a second processor 836 to provide, among other things, user interface (UI) functionality. In one form, the Ul 836 processor can comprise an Atmel AT91SAM9263 processor with an ARM 926EJ-S core, available from Atmel Corporation, of San Jose, CA, USA, for example. Examples of UI functionality supported by the UI 836 processor may include audible and visual feedback from the user, communication with peripheral devices (for example, via a USB interface), communication with a foot switch, communication with a data entry device ( for example, a touchscreen) and communication with an output device (for example, a speaker). The UIl processor 836 can communicate with the DSP processor 822 and logic device 816 (for example,

through SPI buses). Although the UI 836 processor can primarily support UI functionality, it can also coordinate with the DSP 822 processor to implement risk mitigation in certain ways. For example, the UI 836 processor can be programmed to monitor various aspects of inputs by the user and / or other inputs (for example, touchscreen inputs, foot switch inputs, temperature sensor inputs) and can disable the generator output 800 when an error condition is detected.

[0235] In certain forms, both the DSP 822 processor and the UI 836 processor can, for example, determine and monitor the operational state of generator 800. For the DSP 822 processor, the operational state of generator 800 can determine, for example, which control and / or diagnostic processes are implemented by the DSP 822 processor. For the UI 836 processor, the operational state of the generator 800 can determine, for example, which elements of a UI (user interface) (for example, display screens, sounds) are presented to a user. The respective DSP and UI processors 822, 836 can independently maintain the current operational state of generator 800, as well as recognize and evaluate possible transitions out of the current operational state. The DSP 822 processor can act as the master in this relationship, and can determine when transitions between operational states should occur. The UI 836 processor can be aware of valid transitions between operational states, and can confirm that a particular transition is adequate. For example, when the DSP 822 processor instructs the UIL 836 processor to transition to a specific state, the UI 836 processor can verify that the requested transition is valid. If the UI 836 processor determines that a requested transition between states is invalid, the UI 836 processor can cause generator 800 to enter a fault mode.

[0236] The non-isolated stage 804 may further comprise a controller 838 for monitoring input devices (for example, a capacitive touch sensor used to turn the generator 800 on and off, a capacitive touch screen). In certain ways, controller 838 may comprise at least one processor and / or other controller device in communication with the UI processor 836. In one form, for example, controller 838 may comprise a processor (for example, a Meg168 controller of 8 bits available from Atmel) configured to monitor user inputs via one or more capacitive touch sensors. In one way, the 838 controller can comprise a touchscreen controller (for example, a QT5480 touchscreen controller available from Atmel) to control and manage the capture of touch data from a capacitive touchscreen to the touch.

[0237] In certain ways, when generator 800 is in an "off" state, controller 838 can continue to receive operational power (for example, through a line from a generator 800 power supply, such as the 854 power discussed below). In this way, controller 838 can continue to monitor an input device (for example, a capacitive touch sensor located on a front panel of generator 800) to turn generator 800 on and off. When generator 800 is in the off state, the controller 838 can wake up the power supply (for example, enable one or more DC / DC voltage converters 856 of the power supply 854 to operate), if the activation of the "on / off" input device is detected by a user . Controller 838 can therefore initiate a sequence to transition the generator 800 to an "on" state. On the other hand, controller 838 can initiate a sequence to transition the generator 800 to the off state if activation of the "on / off" input device is detected, when the generator 800 is in the on state. In certain ways, for example, controller 838 may report activation of the "on / off" input device to the UI 836 processor, which in turn implements the process sequence necessary to transition from generator 800 to off state. In such forms, controller 838 may not have any independent capacity to cause the removal of power from generator 800 after its on state has been established.

[0238] In certain ways, controller 838 can cause generator 800 to provide audible feedback or other sensory feedback to alert the user that an on or off sequence has been initiated. This type of alert can be provided at the beginning of an on or off sequence, and before the start of other processes associated with the sequence.

[0239] In certain forms, the isolated stage 802 may comprise an instrument interface circuit 840 to, for example, provide a communication interface between a control circuit of a surgical instrument (for example, a control circuit comprising switches handle) and non-isolated stage components 804, such as logic device 816, DSP processor 822 and / or UI processor 836. Instrument interface circuit 840 can exchange information with non-stage components isolated 804 by means of a communication link that maintains an adequate degree of electrical isolation between the isolated and non-isolated stages 802, 804 such as, for example, an IR-based communication link. Power can be supplied to the instrument interface circuit 840 using, for example, a low-voltage voltage regulator powered by an isolation transformer driven from the non-isolated stage 804.

[0240] In one form, the instrument interface circuit 840 can comprise a logic circuit 842 (for example, a logic circuit, a programmable logic circuit, PGA, FPGA, PLD) in communication with a signal conditioning circuit 844. The signal conditioning circuit 844 can be configured to receive a periodic signal from logic circuit 842 (e.g., a 2 kHz square wave) to generate a bipolar interrogation signal that has an identical frequency. The question mark can be generated, for example, using a bipolar current source powered by a differential amplifier. The question mark can be communicated to a surgical instrument control circuit (for example, using a conductive pair on a cable that connects the generator 800 to the surgical instrument) and monitored to determine a state or configuration of the control circuit . The control circuit can comprise numerous switches, resistors and / or diodes to modify one or more characteristics (for example, amplitude, rectification) of the question mark so that a state or configuration of the control circuit is unambiguously discernible, based on that one or more characteristics. In one form, for example, the signal conditioning circuit 844 may comprise an ADC circuit for generating samples of a voltage signal appearing between inputs of the control circuit, resulting from the passage of the interrogation signal through it. Logic circuit 842 (or a non-isolated stage component 804) can then determine the status or configuration of the control circuit based on the samples of ADC circuits.

[0241] In one form, the instrument interface circuit 840 may comprise a first data circuit interface 846 to enable the exchange of information between logic circuit 842 (or another element of the instrument interface circuit 840) and a first data circuit disposed in a surgical instrument or otherwise associated with it. In certain forms, for example, a first data circuit may be arranged on a cable integrally attached to a handle of the surgical instrument, or on an adapter to interface between a specific type or model of surgical instrument and the 800 generator. The first data circuit can be implemented in any suitable manner and can communicate with the generator in accordance with any suitable protocol, including, for example, as described in this document with respect to the first data circuit. In certain forms, the first data circuit may comprise a non-volatile storage device, such as an EEPROM device. In certain ways, the first data circuit interface 846 can be implemented separately from logic circuit 842 and comprise a suitable circuitry (for example, separate logic devices, a processor) to allow communication between logic circuit 842 and the first data circuit. In other forms, the first data circuit interface 846 can be integral with logic circuit 842.

[0242] In certain forms, the first data circuit can store information pertinent to the specific surgical instrument with which it is associated. This information may include, for example, a model number, a serial number, a number of operations in which the surgical instrument was used, and / or any other types of information. This information can be read by the interface circuit of the instrument 840 (for example, the logic circuit 842), transferred to a component of the non-isolated stage 804 (for example, to the logic device 816, DSP processor 822 and / or processor UI 836) for presentation to a user by means of an output device and / or to control a function or operation of the generator 800. Additionally, any type of information can be communicated to the first data circuit for storage in the same via the first interface data circuit 846 (for example, using logic circuit 842). This information may include, for example, an updated number of operations in which the surgical instrument was used and / or the dates and / or times of its use.

[0243] As discussed earlier, a surgical instrument can be removable from a handle (for example, the multifunctional surgical instrument, it can be removable from the handle) to promote interchangeability and / or disposability of the instrument. In such cases, conventional generators may be limited in their ability to recognize specific instrument configurations being used, as well as to optimize the control and diagnostic processes as needed. The addition of readable data circuits to surgical instruments to address this issue is problematic from a compatibility point of view, however. For example, designing a surgical instrument so that it remains backward compatible with generators that lack the indispensable data reading functionality may be impractical due, for example, to different signaling schemes, design complexity and cost. The instrument forms discussed in this document address these concerns through the use of data circuits that can be implemented in existing surgical instruments, economically and with minimal design changes to preserve the compatibility of surgical instruments with current generator platforms.

[0244] Additionally, the shapes of the generator 800 can allow communication with instrument-based data circuits. For example, generator 800 can be configured to communicate with a second data circuit contained in an instrument (for example, the multifunctional surgical instrument). In some ways, the second data circuit can be implemented in a manner very similar to that of the first data circuit in the present document described. The instrument interface circuit 840 may comprise a second data circuit interface 848 to enable such communication. In one form, the second data circuit interface 848 can comprise a three-state digital interface, although other interfaces can also be used. In certain ways, the second data circuit can generally be any circuit for transmitting and / or receiving data. In one form, for example, the second data circuit can store information related to the specific surgical instrument with which it is associated. This information may include, for example, a model number, a serial number, a number of operations in which the surgical instrument was used, and / or any other types of information.

[0245] In some ways, the second data circuit stores information about the ultrasonic and / or electrical properties of an associated ultrasonic transducer, end actuator, or ultrasonic drive system. For example, the first data circuit can indicate an initialization frequency slope, as described in this document. Additionally or alternatively, any type of information can be communicated to the second data circuit for storage in it via the second data circuit interface 848 (for example, using logic circuit 842). This information may include, for example, an updated number of operations in which the surgical instrument was used and / or the dates and / or times of its use. In certain ways, the second data circuit can transmit data captured by one or more sensors (for example, an instrument-based temperature sensor). In certain ways, the second data circuit can receive data from generator 800 and provide an indication to a user (for example, a light-emitting indication or other visible indication) based on the received data.

[0246] In certain ways, the second data circuit and the second data circuit interface 848 can be configured so that communication between logic circuit 842 and the second data circuit can be carried out without the need to provide additional conductors for this purpose (for example, dedicated conductors of a cable that connects a handle to the generator 800). In one way, for example, information can be communicated to and from the second data circuit using a wire bus communication scheme, implemented in existing cabling, as one of the used conductors that transmit interrogation signals to from signal conditioning circuit 844 to a control circuit on a handle. In this way, changes or modifications to the design of the surgical device that may otherwise be necessary are minimized or reduced. In addition, due to the fact that different types of communications implemented on a common physical channel can be separated based on frequency, the presence of a second data circuit can be "invisible" to generators that do not have the essential functionality of reading data, which, therefore, allows the backward compatibility of the surgical instrument.

[0247] In certain forms, the isolated stage 802 may comprise at least one blocking capacitor 850-1 connected to the output of the drive signal 810b to prevent the passage of direct current to a patient. A single blocking capacitor may be required to comply with medical regulations and standards, for example. Although failures in single-capacitor designs are relatively uncommon, such failures can still have negative consequences. In one form, a second blocking capacitor 850-2 can be placed in series with the blocking capacitor 850-1, with current leakage from a point between the blocking capacitors 850-1, 850-2 being monitored, for example, by an ADC 852 circuit for sampling a voltage induced by leakage current. Samples can be received, for example, via logic circuit 842. Based on changes in leakage current (as indicated by the voltage samples), generator 800 can determine when at least one of the blocking capacitors 850-1, 850- 2 has failed, thus offering a benefit over single capacitor designs that have a single point of failure.

[0248] In certain embodiments, the non-isolated stage 804 may comprise a power supply 854 to deliver DC power with adequate voltage and current. The power supply may comprise, for example, a 400 W power supply to deliver a system voltage of 48 VDC. The power supply 854 may additionally comprise one or more DC / DC voltage converters 856 to receive the output from the power supply to generate DC outputs at the voltages and currents required by the various components of generator 800. As discussed above in relation to the controller 838, one or more of the 856 DC / DC voltage converters can receive an input from the 838 controller when the activation of the "on / off" input device by a user is detected by the 838 controller, to enable the operation or awakening of the 856 DC / DC voltage converters.

[0249] Figure 21 illustrates an example of generator 900, which is a form of generator 800 (Figure 20). The 900 generator is configured to supply multiple types of energy to a surgical instrument. The 900 generator provides ultrasonic and RF signals to power a surgical instrument, independently or simultaneously. Ultrasonic and RF signals can be provided alone or in combination and can be provided simultaneously. As indicated above, at least one generator output can provide multiple types of energy (for example, ultrasonic, bipolar or monopolar RF, irreversible and / or reversible electroporation, and / or microwave energy, among others) through a single port, and these signals can be supplied separately or simultaneously to the end actuator to treat tissue.

[0250] Generator 900 comprises a processor 902 coupled to a waveform generator 904. Processor 902 and waveform generator 904 are configured to generate various signal waveforms based on information stored in a coupled memory to processor 902, not shown for clarity of description. The digital information associated with a waveform is provided to the waveform generator 904 that includes one or more DAC circuits to convert the digital input to an analog output. The analog output is powered by an amplifier 1106 for signal conditioning and amplification. The conditioned and amplified output of amplifier 906 is coupled to a power transformer 908. The signals are coupled by the power transformer 908 to the secondary side, which is on the patient isolation side. A first signal of a first energy modality is supplied to the surgical instrument between the terminals identified as ENERGIAI1 and RETORNO. A second signal of a second energy modality is coupled by a 910 capacitor and is supplied to the surgical instrument between the terminals identified as ENERGY2 and RETURN. It will be recognized that more than two types of energy can be issued and, therefore, the subscript "n" can be used to designate that up to n ENERGY terminals can be provided, where n is a positive integer greater than 1. It will also be acknowledged that up to "n" return paths, RETURN can be provided without departing from the scope of this description.

[0251] A first 912 voltage detection circuit is coupled through the terminals identified as ENERGY and the RETURN path to measure the output voltage between them. A second voltage detection circuit 924 is connected via the terminals identified as ENERGY? and the RETURN path to measure the output voltage between them. A current detection circuit 914 is arranged in series with the RETURN leg on the secondary side of the power transformer 908, as shown, to measure the output current for any type of energy. If different return paths are provided for each energy modality, then a separate current detection circuit would be provided on each return leg. The outputs of the first and second voltage detection circuits 912, 924 are supplied to the respective isolation transformers 916, 922 and the output of the current detection circuit 914 is supplied to another isolation transformer 918. The outputs of the isolation transformers 916 , 928, 922 on the primary side of the power transformer 908 (non-isolated side of the patient) are supplied to one or more ADC 926 circuits. The digitized output of the ADC 926 circuit is supplied to processor 902 for further computing and processing. The output voltages and the output current feedback information can be used to adjust the output voltage and the current supplied to the surgical instrument, and to compute the output impedance, among other parameters. Input / output communications between the 902 processor and the patient's isolated circuits are provided via a 920 interface circuit. The sensors may also be in electrical communication with the 902 processor via the 920 interface circuit.

[0252] In one aspect, impedance can be determined by processor 902 by dividing the output of the first voltage detection circuit —912 coupled to the terminals identified as ENERGY1 / RETURN or the second voltage detection circuit 924 coupled to the identified terminals as ENERGY2 / RETURN, through the output of the current detection circuit 914 arranged in series with the RETURN leg on the secondary side of the power transformer 908. The outputs of the first and second voltage detection circuits 912, 924 are provided to separate the isolation transformers 916, 922 and the current detection circuit 914 output is provided to another isolation transformer 916. The digitalized voltage and current detection measurements from the ADC 926 circuit are provided to processor 902 to compute the impedance. As an example, the first ENERGIA1 energy modality can be ultrasonic energy and the second ENERGIA2 energy modality can be RF energy. However, in addition to the ultrasonic and bipolar or monopolar RF energy modalities, other energy modalities include irreversible and / or reversible electroporation and / or microwave energy, among others. In addition, while the example shown in Figure 21 shows that a single RETURN return path can be provided for two or more energy modes, in other respects, multiple RETURN return paths can be provided for each ENERGY energy mode. Thus, as in this document described, the impedance of the ultrasonic transducer can be measured by dividing the output of the first voltage detection circuit 912 by the current detection circuit 914 and the fabric impedance can be measured by dividing the output of the second voltage detection circuit 924 by current detection circuit 914.

[0253] As shown in Figure 21, generator 900, which comprises at least one output port, can include a power transformer 908 with a single output and multiple taps to provide power in the form of one or more energy modalities , such as ultrasonic, bipolar or monopolar RF, irreversible and / or reversible electroporation, and / or microwave energy, among others, for example to the end actuator depending on the type of tissue treatment being performed. For example, the 900 generator can supply higher voltage and lower current power to drive an ultrasonic transducer, lower voltage and higher current to drive RF electrodes to seal the tissue or with a coagulation waveform for point clotting using electrosurgical electrodes Monopolar or bipolar RF. The output waveform of generator 900 can be oriented, switched or filtered to provide frequency to the end actuator of the surgical instrument. The connection of an ultrasonic transducer to the output of generator 900 would preferably be located between the output identified as ENERGIAI1 and RETURN, as shown in Figure 21. In one example, a connection of bipolar RF electrodes to the output of generator 900 would be preferably located between the exit identified as ENERGY? and RETURN. In the case of a monopolar output, the preferred connections would be an active electrode (for example, light beam or other probe) for the ENERGIA2 output and a suitable return block connected to the RETURN output.

[0254] Additional details are described in US Patent Application Publication No. 2017/0086914 entitled TECHNIQUES FOR

OPERATING GENERATOR FOR DIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMS AND SURGICAL

INSTRUMENTS, which was published on March 30, 2017, which is incorporated in this document as a reference in its entirety.

[0255] As used throughout this description, the term "wireless" and its derivatives can be used to describe circuits, devices, systems, methods, techniques, communication channels etc., which can communicate data through the use of electromagnetic radiation modulated using a non-solid medium. The term does not imply that the associated devices do not contain any wires, although in some ways they may not. The communication module can implement any of a number of wireless and wired communication standards or protocols, including, but not limited to, Wi-Fi (IEEE 802.11 family), WiMAX (IEEE 802.16 family), IEEE 802.20, evolution long-term evolution (LTE), Ev-DO, HSPA +, HSDPA +, HSUPA +, EDGE, GSM, GPRS, CDMA, TDMA, DECT, Bluetooth, Ethernet derivatives thereof, as well as any other protocols without wired and wired which are designated as 3G, 4G, 5G, and beyond. The computing module can include a plurality of communication modules. For example, a first communication module can be dedicated to short-range wireless communications like Wi-Fi and Bluetooth, and a second communication module can be dedicated to longer-range wireless communications like GPS, EDGE, GPRS, CDMA , WiMAX, LTE, Ev-DO and others.

[0256] As used in the present invention, a processor or processing unit is an electronic circuit that performs operations on some external data source, usually memory or some other data flow. The term is used in the present invention to refer to the central processor (central processing unit) in a computer system or systems (specifically systems on a chip (SoCs)) that combine several specialized "processors".

[0257] As used in this document, a system on a chip or system on the chip (SoC or SOC) is an integrated circuit (also known as an "IC" or "chip") that integrates all components of a computer or other electronic systems. It can contain digital, analog, mixed and often radio frequency functions - all on a single substrate. A SoC integrates a microcontroller (or microprocessor) with advanced peripherals such as a graphics processing unit (GPU), i-Fi module, or coprocessor. An SoC may or may not contain internal memory.

[0258] As used in this document, a microcontroller or controller is a system that integrates a microprocessor with peripheral circuits and memory. A microcontroller (or MCU for microcontroller unit) can be implemented as a small computer on a single integrated circuit. It can be similar to a SoC; a SoC can include a microcontroller as one of its components. A microcontroller can contain one or more core processing units (CPUs) along with memory and programmable input / output peripherals. Program memory in the form of ferroelectric RAM, NOR flash or OTP ROM is also often included on the chip, as well as a small amount of RAM. Microcontrollers can be used for integrated applications, in contrast to microprocessors used in personal computers or other general purpose applications that consist of several separate integrated circuits.

[0259] As used in the present invention, the term controller or microcontroller may be an independent chip or IC (integrated circuit) device that interfaces with a peripheral device. This can be a connection between two parts of a computer or a controller on an external device that manages the operation of (and connection to) that device.

[0260] Any of the processors or microcontrollers in the present invention can be any implemented by any single-core or multi-core processor, such as those known under the trade name ARM Cortex by Texas Instruments. In one respect, the processor may be a Core Cortex-M4F LM4F230H5QR ARM processor, available from Texas Instruments, for example, which comprises an integrated 256 KB single-cycle flash memory, or other non-volatile memory, up to 40 MHz , a prefetch buffer to optimize performance above 40 MHz, a 32 KB single cycle serial random access memory (SRAM), an internal read-only memory (ROM) loaded with the StellarisWare program, read-only memory programmable and electrically erasable (EEPROM) of 2 KB, one or more pulse width modulation (PWM) modules, one or more analog quadrature encoder (QEI) inputs, one or more analog to digital converters (ADC) of 12 bits with 12 analog input channels, details of which are available for the product data sheet.

[0261] In one aspect, the processor may comprise a safety controller that comprises two controller-based families, such as TMS570 and RM4x, known under the tradename Hercules ARM Cortex R4, also by Texas Instruments. The safety controller can be configured specifically for IEC 61508 and ISO 26262 safety critical applications, among others, to provide advanced integrated safety features while providing scalable performance, connectivity and memory options.

[0262] Modular devices include modules (as described in connection with Figures 3 and 9, for example) that are receivable within a central surgical controller and the devices or surgical instruments that can be connected to the various modules in order to connect or pair with the corresponding central surgical controller. Modular devices include, for example, smart surgical instruments, medical imaging devices, suction / irrigation devices, smoke evacuators, power generators, fans, insufflators and displays. The modular devices described in this document can be controlled by control algorithms. The control algorithms can be executed on the modular device itself, on the central surgical controller to which the specific modular device is paired, or on both the modular device and the central surgical controller (for example, surgical (for example, through a distributed computing.) In some examples, the control algorithms of the modular devices control the devices based on the data detected by the modular device itself (ie, by sensors on, over or connected to the modular device). These data can be related to the patient being operated (for example, tissue properties or inflation pressure) or the modular device itself (for example, the rate at which a knife is being advanced, the motor current, or energy levels). control algorithm for a surgical stapling and cutting instrument can control the rate at which the instrument's motor drives its knife until through the fabric according to the resistance encountered by the knife as it progresses. Situational perception of central surgical controller

[0263] Although a "smart" device, including control algorithms - responsive to detected data, can be an improvement over a "stupid" device that operates without taking the detected data, some detected data can be incomplete or inconclusive when considered in isolation, that is, without the context of the type of surgical procedure being performed or the type of tissue that is undergoing the surgery.

Without knowing the context of the procedure (for example, knowing the type of tissue that is undergoing surgery, or the type of procedure that is being performed), the control algorithm may control the modular device incorrectly or suboptimally, provided the detected data without specific context.

For example, the ideal way for a control algorithm to control a surgical instrument in response to a particular detected parameter can vary according to the type of particular tissue being operated on.

This is due to the fact that different types of tissue have different properties (for example, tear resistance) and thus respond differently to actions performed by surgical instruments.

Therefore, it may be desirable for a surgical instrument to perform different actions when the same measurement is detected for a specific parameter.

As a specific example, the optimal way in which to control a stapling and surgical cutting instrument in response to the instrument detecting an unexpectedly high force to close its end actuator, will vary depending on whether the type of tissue is susceptible or resistant to tearing.

For tissues that are susceptible to tearing, such as lung tissue, the instrument's control algorithm would optimally slow the engine in response to an unexpectedly high force to close to prevent tearing of the tissue.

For tissues that are tear resistant, such as stomach tissue, the instrument's control algorithm would optimally accelerate the engine in response to an unexpectedly high force to close to ensure that the end actuator is properly attached to the tissue.

Without knowing whether lung or stomach tissue has been trapped, the control algorithm can make a decision below what is considered ideal.

[0264] One solution uses a central surgical controller including a system configured to derive information about the surgical procedure that is being performed based on data received from various data sources, and then control, accordingly, the paired modular devices. In other words, the central surgical controller is configured to infer information about the surgical procedure from received data and then control modular devices paired with the central surgical controller based on the inferred context of the surgical procedure. Figure 22 illustrates a diagram of a surgical system with 5100 situational awareness, in accordance with at least one aspect of the present description. In some examples, data sources 5126 include, for example, modular devices 5102 (which may include sensors configured to detect parameters associated with the patient and / or the modular device itself), databases 5122 (for example, a base EMR data containing the patient's medical record), and 5124 monitoring devices (for example, a blood pressure monitor (BP) and an electrocardiography monitor (ECG)). The central surgical controller 5104 can be configured to derive contextual information related to the surgical procedure from the data based, for example, on the specific combination (s) of data received or in the specific order in which the data they are received from data sources 5126. The contextual information inferred from the data received may include, for example, the type of surgical procedure being performed, the specific stage of the surgical procedure that the surgeon is performing, the type of tissue being operated on, or the body cavity that is the subject of the procedure. This ability for some aspects of the central surgical controller 5104 to derive or infer information related to the surgical procedure from received data, can be called "situational perception." In one example, the central surgical controller 5104 can incorporate a situational perception system, which is the hardware and / or programming associated with the central surgical controller 5104 that derives contextual information related to the surgical procedure based on the data received.

[0265] The situational perception system of the central surgical controller 5104 can be configured to derive contextual information from data received from data sources 5126 in several ways. In one example, the situational awareness system includes a pattern recognition system, or machine learning system (for example, an artificial neural network), that has been trained in training data to correlate various inputs (for example, data from databases 5122, patient monitoring devices 5124, and / or devices - modular - 5102) to contextual information corresponding to a surgical procedure. In other words, a machine learning system can be trained to accurately derive contextual information regarding a surgical procedure from the inputs provided. In another example, the situational perception system may include a lookup table that stores pre-characterized contextual information regarding a surgical procedure in association with one or more entries (or ranges of entries) corresponding to the contextual information. In response to a query with one or more entries, the lookup table can return the corresponding contextual information to the situational perception system to control the 5102 Modular devices. In an example, the “contextual information received by the controller's situational perception system surgical center 5104, are associated with a control setting or set of specific control settings for one or more modular devices 5102. In another example, the situational awareness system includes an additional machine learning system, research table or other system of this type, generating or retrieving one or more control settings for one or more 5102 modular devices, when contextual information is provided as input.

[0266] A 5104 central surgical controller, which incorporates a situational awareness system, provides several benefits to the 5100 surgical system. One benefit includes improving the interpretation of detected and captured data, which in turn improves processing accuracy and / or the use of data during the course of a surgical procedure. To return to a previous example, a 5104 central surgical controller with situational awareness could determine what type of tissue was being operated on; therefore, when an unexpectedly high force is detected to close the end actuator of the surgical instrument, the central surgical controller with situational perception 5104 could correctly accelerate or decelerate the surgical instrument motor for the tissue type.

[0267] As another example, the type of tissue being operated on may affect the adjustments that are made to the load and compression rate thresholds of a stapling and surgical cutting instrument for a specific span measurement. A central surgical controller with situational perception 5104 could infer whether a surgical procedure being performed is a thoracic or abdominal procedure, allowing the central surgical controller 5104 to determine whether tissue pinched by an end actuator of the surgical cutting and stapling instrument it is lung tissue (for a chest procedure) or stomach tissue (for an abdominal procedure). The central surgical controller 5104 can then properly adjust the loading and compression rate thresholds of the surgical stapling and cutting instrument for the tissue type.

[0268] As yet another example, the type of body cavity being operated during an insufflation procedure, can affect the function of a smoke evacuator. A central surgical controller with situational perception 5104 can determine if the surgical site is under pressure (by determining that the surgical procedure is using insufflation) and determine the type of procedure. As a type of procedure is usually performed in a specific body cavity, the 5104 central surgical controller can then adequately control the speed of the smoke evacuator motor to the body cavity being operated. In this way, a central surgical controller equipped with 5104 situational awareness can provide a consistent amount of smoke evacuation to both thoracic and abdominal procedures.

[0269] As yet another example, the type of procedure being performed can affect the ideal energy level for an ultrasonic surgical instrument or radio frequency electrosurgical instrument (RF) to operate. Arthroscopic procedures, for example, require higher energy levels because the end actuator of the ultrasonic surgical instrument or RF electrosurgical instrument is immersed in fluid. A central surgical controller with situational perception 5104 can determine whether the surgical procedure is an arthroscopic procedure. The central surgical controller 5104 can then adjust the RF power level or the ultrasonic amplitude of the generator (i.e., the "energy level") to compensate for the fluid-filled environment. Related to this, the type of tissue being operated on can affect the ideal energy level at which an ultrasonic surgical instrument or RF electrosurgical instrument operates. A central surgical controller with situational awareness 5104 can determine what type of surgical procedure is being performed and then customize the energy level for the ultrasonic surgical instrument or RF electrosurgical instrument, respectively, according to the tissue profile expected for the surgical procedure. In addition, a central surgical controller equipped with 5104 situational awareness can be configured to adjust the energy level for the ultrasonic surgical instrument or RF electrosurgical instrument throughout the course of a surgical procedure, rather than just on a procedure-by basis. -procedure. A central surgical controller with situational perception 5104 can determine which stage of the surgical procedure is being performed or will be performed subsequently and then update the control algorithms for the generator and / or ultrasonic surgical instrument or RF electrosurgical instrument to adjust the level of energy in an appropriate value for the type of tissue, according to the stage of the surgical procedure.

[0270] As yet another example, data can be extracted from additional data sources 5126 to improve the conclusions that the central surgical controller 5104 extracts from a data source

5126. A central surgical controller with situational perception 5104 can augment the data it receives from modular devices 5102 with contextual information it has accumulated, referring to the surgical procedure, from other data sources 5126. For example, a central surgical controller equipped situational awareness 5104 can be configured to determine whether hemostasis has occurred (ie, bleeding has stopped at a surgical site), according to video or image data received from a medical imaging device. However, in some cases, video or image data may be inconclusive. Therefore, in one example, the 5104 central surgical controller can be additionally configured to compare a physiological measurement (for example, blood pressure detected by a BP monitor communicatively connected to the 5104 central surgical controller) with the visual or image data of hemostasis (for example, from a Medical Imaging device 124 (Figure 2) coupled communicably to the central surgical controller 5104) to make a determination on the integrity of the staple line or tissue union. In other words, the situational perception system of the central surgical controller 5104 can consider the physiological measurement data to provide additional context in the analysis of the visualization data. The additional context can be useful when the visualization data can be inconclusive or incomplete in itself.

[0271] Another benefit includes proactively and automatically controlling paired modular devices 5102, according to the specific stage of the surgical procedure being performed to reduce the number of times medical personnel are required to interact with or control the 5100 surgical system during the course of a surgical procedure. For example, a central surgical controller with 5104 situational awareness can proactively activate the generator to which an RF electrosurgical instrument is connected, if it is determined that a subsequent step in the procedure requires the use of the instrument. Proactively activating the power source allows the instrument to be ready for use as soon as the preceding step of the procedure is complete.

[0272] As another example, a central surgical controller with situational perception 5104 could determine whether the current or subsequent stage of the surgical procedure requires a different view or degree of magnification of the screen, according to the resource (s) in the surgical site that the surgeon is expected to see. The central surgical controller 5104 could then proactively change the displayed view (provided, for example, by a Medical Imaging device to the visualization system 108), so that the screen automatically adjusts throughout the surgical procedure.

[0273] As yet another example, a central surgical controller with situational perception 5104 could determine which stage of the surgical procedure is being performed or will be performed subsequently and whether specific data or comparisons between the data will be required for that stage of the surgical procedure. The central surgical controller 5104 can be configured to call screens automatically based on data about the stage of the surgical procedure being performed, without waiting for the surgeon to request specific information.

[0274] Another benefit includes checking for errors during the configuration of the surgical procedure or during the course of the surgical procedure. For example, a central surgical controller with 5104 situational awareness could determine whether the operating room is properly or ideally configured for the surgical procedure to be performed. The central surgical controller 5104 can be configured to determine the type of surgical procedure being performed, retrieve the corresponding checklists, product location, or configuration needs (for example, from a memory), and then compare the current operating room layout with the standard layout for the type of surgical procedure that the central surgical controller

5104 determines that it is being performed. In one example, the central surgical controller 5104 can be configured to compare the list of items for the procedure (scanned by the scanner 5132 shown in Figure 26B, for example) and / or a list of devices paired with the central surgical controller 5104 with a recommended or anticipated manifestation of items and / or devices for the given surgical procedure. If there are any discontinuities between the lists, the central surgical controller 5104 can be configured to provide an alert indicating that a specific modular device 5102, patient monitoring device 5124 and / or other surgical item is missing. In one example, the central surgical controller 5104 can be configured to determine the position or relative distance of modular devices 5102 and patient monitoring devices 5124 using proximity sensors, for example. The 5104 central surgical controller can compare the relative positions of the devices with a recommended or anticipated layout for the procedure - surgical - specific. If there are any discontinuities between the layouts, the 5104 central surgical controller can be configured to provide an alert indicating that the current layout for the surgical procedure deviates from the recommended layout.

[0275] As another example, the central surgical controller with situational awareness 5104 could determine whether the surgeon (or other medical personnel) was making a mistake or otherwise deviating from the expected course of action during the course of a procedure surgical. For example, the central surgical controller 5104 can be configured to determine the type of surgical procedure being performed, retrieve the corresponding list of steps or order of use of the equipment (for example, from a memory), and then compare the steps being performed or the equipment being used during the course of the surgical procedure with the steps or equipment expected for the type of surgical procedure that the 5104 central surgical controller determined is being performed. In one example, the central surgical controller 5104 can be configured to provide an alert indicating that an unexpected action is being taken or an unexpected device is being used at the specific stage in the surgical procedure.

[0276] In general, the situational perception system for the central surgical controller 5104 improves the results of the surgical procedure by adjusting surgical instruments (and other 5102 modular devices) to the specific context of each surgical procedure (such as adjusting to different types tissue), and when validating actions during a surgical procedure. The situational perception system also improves the surgeon's efficiency in performing surgical procedures by automatically suggesting the next steps, providing data, and adjusting screens and other 5102 modular devices in the operating room, according to the specific context of the procedure.

[0277] Figure 23A illustrates a logical flow chart of a process 5000a for controlling a modular device 5102, according to contextual information derived from received data, in accordance with at least one aspect of the present description. In other words, a central surgical controller with situational awareness 5104 can perform process 5000a to determine appropriate control settings for modular devices 5102 paired with central surgical controller 5104 before, during or after a surgical procedure, as dictated by the context of the surgical procedure. In the following description of process 5000a, reference should also be made to Figure 22. In an example, the process

5000a can be performed by a control circuit of a central surgical controller 5104, as shown in Figure 10 (processor 244). In another example, process 5000a can be performed by a cloud computing system 104, as shown in Figure 1. In yet another example, process 5000a can be performed by a distributed computing system including at least one of the aforementioned cloud computing 104 and / or a control circuit of a central surgical controller 5104 in combination with a control circuit of a modular device, such as the microcontroller 461 of the surgical instrument shown in Figure 12, the microcontroller 620 of the surgical instrument represented in Figure 16, the control circuit 710 of the robotic surgical instrument shown 700 shown in Figure 17, the control circuit 760 of surgical instruments 750, 790 shown in Figures 18 and 19, or the controller 838 of the generator 800 shown in Figure 20. For savings , the following description of the 5000a process will be performed by the control circuit of a control central surgical advisor 5104; however, it should be understood that the description of process 5000a covers all the examples mentioned above.

[0278] The control circuit of the central surgical controller 5104 that executes the 5000a process receives 5004a data from one or more data sources 5126 to which the central surgical controller 5104 is communicably connected. Data sources 5126 include, for example, databases 5122, patient monitoring devices 5124 and modular devices 5102. In one example, databases 5122 can include a patient EMR database associated with the medical facility in which the surgical procedure is being performed. Data received 5004a from data sources 5126 may include perioperative data,

which include preoperative data, intraoperative data and / or postoperative data associated with the given surgical procedure.

The data received 5004a from databases 5122 may include the type of surgical procedure being performed or the patient's medical history (for example, medical conditions that may or may not be the subject of this surgical procedure.

In an example shown in Figure 24A, the control circuit can receive 5004a data from the surgical procedure or from the patient by consulting the patient's EMR database with a unique identifier associated with the patient.

The central surgical controller 5104 can receive the unique identifier, for example, from a 5128 scanner to scan the patient's 5130 wristband that encodes the unique identifier associated with the patient when the patient enters the operating room, as shown in Figure 26A.

In an example, 5124 patient monitoring devices include BP monitors, ECG monitors, and other such devices that are configured to monitor one or more parameters associated with a patient.

As with modular devices 5102, patient monitoring devices 5124 can be paired with central surgical controller 5104 so that central surgical controller 5104 receives 5004a data from it.

In one example, data received 5004a from modular devices 5102 that are paired with (i.e., communicably coupled to) the central surgical controller 5104 includes, for example, activation data (i.e., whether the device is turned on or in use), internal state data for the 5102 modular device (for example, force to fire or force to close a surgical cutting and stapling device, pressure differential for a smoke inflator or evacuator, or energy level for a surgical instrument ultrasound or RF), or patient data (for example, tissue type, tissue thickness, tissue mechanical properties, respiration rate, or airway volume).

[0279] As process 5000a continues, the control circuit of central surgical controller 5104 can derive 5006a contextual information from data received 5004a from data sources 5126. Contextual information may include, for example, the type of procedure being performed, the specific step being performed in the surgical procedure, the patient's condition (for example, if the patient is anesthetized or if the patient is in the operating room), or the type of tissue on which it is being performed the surgery. The control circuit can derive 5006a contextual information, according to the data from an individual data source 5126 or combinations of data sources 5126. Additionally, the control circuit can derive 5006a contextual information according to, for example, the ( s) type (s) of data it receives, the order in which the data is received, or specific measurements or values associated with the data. For example, if the control circuit receives data from an RF generator indicating that the RF generator has been activated, the control circuit could thus infer that the RF electrosurgical instrument is now in use and that the surgeon is or you will perform a stage of the surgical procedure using the specific instrument. As another example, if the control circuit receives data indicating that a laparoscopic imaging device has been activated and an ultrasonic generator is subsequently activated, the control circuit may infer that the surgeon is in a laparoscopic dissection stage of the surgical procedure due to the order in which the events took place. As yet another example, if the control circuit receives data from a ventilator indicating that the patient's breathing is below a certain rate, then the control circuit can determine that the patient is under anesthesia.

[0280] The control circuit can then determine 5008a what control settings are required (if any) for one or more modular devices 5102, according to the contextual information derived from 5006a. After determining the control settings 5008a, the control circuit of the central surgical controller 5104 can then control the modular devices 5010a according to the control settings (if the control circuit determined 5008a that this was necessary). For example, if the control circuit determines that an arthroscopic procedure is being performed and that the next step in the procedure uses an RF or ultrasonic surgical instrument in a liquid environment, the control circuit can determine 5008a that a control adjustment is required. for the generator of the ultrasonic or RF surgical instrument to increase the energy output of the instrument in advance (because such instruments require greater energy in liquid environments to maintain their effectiveness). The control circuit can then consequently control the generator and / or the RF or ultrasonic surgical instrument 5010a, causing the generator to increase its output and / or cause the RF or ultrasonic surgical instrument to increase the drained energy. the generator. The control circuit can control 5010a modular devices 5102 according to the determined control setting 5008a, for example, transmitting the control settings to the specific modular device to update the programming of modular device 5102. In another example, in which ( s) modular device (s) 5102 and central surgical controller 5104 are running a distributed computing architecture, the control circuit can control 5010a the modular device 5102, according to the control settings determined 5008a by the program update distributed.

[0281] Figures 23B to D illustrate representative implementations of process 5000a represented in Figure 23A.

As with the 5000a process shown in Figure 23A, the processes illustrated in Figures 23B to D, in an example, can be performed by a control circuit of the central surgical controller 5104. Figure 23B illustrates a logical flow chart of a 5000b process to control a second modular device according to contextual information derived from perioperative data received from a first modular device, in accordance with at least one aspect of the present description.

In the illustrated example, the control circuit of the central surgical controller 5104 receives 5004b perioperative data from a first modular device.

Perioperative data may include, for example, data regarding the 5102 modular device itself (for example, pressure differential, motor current, internal forces, or motor torque) or data regarding the patient with whom the 5102 modular device is being used. used (for example, tissue properties, respiratory rate, airway volume, or laparoscopic image data). After receiving perioperative data 5004b, the control circuit of the central surgical controller 5104 derives 5006b contextual information from the perioperative data.

Contextual information can include, for example, the type of procedure, the stage of the procedure being performed, or the patient's condition.

The control circuit of the central surgical controller 5104 determines 5008b, then, control settings for a second modular device based on contextual information 5006b and then controls 5010b, the second modular device accordingly.

For example, the central surgical controller 5104 can receive 5004b perioperative data from a ventilator indicating that the patient’s lung has been emptied,

derive 5006b the contextual information from it, so that the subsequent step in the specific procedure uses a Medical Imaging device (for example, an endoscope), determine 5008b that the Medical Imaging device must be activated and configure a specific magnification, and then control 5010b the Medical Imaging device accordingly.

[0282] Figure 23C illustrates a logical flowchart of a 5000c process for controlling a second modular device according to contextual information derived from perioperative data received from a first modular device and the second modular device. In the illustrated example, the control circuit of the central surgical controller 5104 receives 5002c perioperative data from a first modular device and receives 5004c perioperative data from a second modular device. After receiving 5002c, 5004c, perioperative data, the control circuit of the central surgical controller 5104 derives 5006c contextual information from the perioperative data. The control circuit of the central surgical controller 5104 determines 5008c, then, control settings for the second modular device based on the derived contextual information 5006c and then controls 5010c, the second modular device accordingly. For example, the central surgical controller 5104 can receive 5002c perioperative data from an RF electrosurgical instrument indicating that the instrument has been triggered, receive 5004c perioperative data from a surgical stapling instrument indicating that the instrument has been activated, derive 5006c contextual information from addition, so that the subsequent step in the type of specific procedure requires that the surgical stapling instrument be fired with a specific force (because the ideal force for firing may vary according to the type of tissue being operated on), determine 5008c the specific force thresholds that must be applied to the surgical stapling instrument and then check the 5010c surgical stapling instrument accordingly.

[0283] Figure 23D illustrates a logical flow chart of a 5000d process for controlling a third modular device according to contextual information derived from perioperative data received from a first modular device and a second modular device. In the illustrated example, the control circuit of the central surgical controller 5104 receives 5002d perioperative data from a first modular device and receives 5004d perioperative data from a second modular device. After receiving 5002d, 5004d, perioperative data, the control circuit of the central surgical controller 5104 derives 5006d contextual information from the perioperative data. The control circuit of the central surgical controller 5104 determines 5008d, then, control settings for a third modular device based on the contextual information 5006d and then controls 5010d, the second modular device accordingly. For example, the central surgical controller 5104 can receive 5002d, 5004d perioperative data from an insufflator and a medical imaging device indicating that both devices have been activated and paired with the central surgical controller 5104, derive 5006d the contextual information from it so that a Video-Assisted Thoracoscopy ("VATS") procedure is being performed, determine 5008d that the screens connected to the central surgical controller 5104 must be adjusted to display specific views or information associated with the type of procedure, and then control 5010d screens, accordingly.

[0284] Figure 24A illustrates a diagram of a 5100 surgical system that includes a central surgical controller 5104 coupled communicably to a particular set of data sources 5126. A central surgical controller 5104 that includes a situational awareness system can use the data received from data sources 5126 to derive contextual information regarding the surgical procedure with which the central surgical controller 5104, the modular devices 5102 paired with the central surgical controller 5104 and the patient monitoring devices 5124 paired with the central surgical controller 5104 are being used in connection. The inferences (that is, contextual information) that an example of the situational perception system can derive from the particular set of data sources 5126, are represented in dashed boxes extending from the data source (s) 5126 to from which they are derived. Contextual information derived from data sources 5126 may include, for example, which Stage of the surgical procedure is being performed, if and how a particular modular device 5102 is being used, and the condition of the patient.

[0285] In the example shown in Figure 24A, data sources 5126 include a database 5122, a variety of modular devices 5102 and a variety of patient monitoring devices 5124. Central surgical controller 5104 can be connected to multiple bases data 5122 to retrieve data from there concerning the surgical procedure being performed or will be performed. In an example of the 5100 surgical system, databases 5122 include an EMR database from a hospital ... Data that can be received by the situational perception system of the central surgical controller 5104 from surgical databases 5122 may include, for example, start time (or configuration) or operational information regarding the procedure (for example, a segmentectomy in the upper right portion of the chest cavity). Central surgical controller 5104 can derive contextual information about the surgical procedure from this data alone or from a combination of this data and data from other data sources 5126.

[0286] The 5104 central surgical controller can also be connected to (i.e., paired with) a variety of 5124 patient monitoring devices. In an example of the 5100 surgical system, 5124 patient monitoring devices that can be paired with the central surgical controller 5104 may include a pulse oximeter (SpO22 monitor) 5114, a PA monitor 5116 and an ECG monitor 5120. Perioperative data that can be received by the system with situational perception from the central surgical controller 5104 from 5124 patient monitoring devices may include, for example, the patient's oxygen saturation, blood pressure, heart rate, and other physiological parameters. The contextual information that can be derived by the central surgical controller 5104 from perioperative data transmitted by patient monitoring devices 5124, can include, for example, whether the patient is in the operating room or under anesthesia. Central surgical controller 5104 can derive these inferences from data from patient monitoring devices 5124 alone or in combination with data from other data sources 5126 (for example, ventilator 5118).

[0287] Central surgical controller 5104 can also be connected to (i.e., paired with) a variety of modular devices 5102. In an example of the 5100 surgical system, modular devices 5102 that can be paired with central surgical controller 5104 can include a 5106 smoke evacuator, a 5108 medical imaging device, a 5110 insufflator, a 5112 combined power generator (to power an ultrasonic surgical instrument and / or an RF electrosurgical instrument), and a 5118 ventilator.

[0288] The 5108 medical imaging device includes an optical component and an Image sensor that generates image data. The optical component includes a lens or a light source, for example. The image sensor includes a charge-coupled device ("CCD") or a complementary metal oxide semiconductor ("CMOS" - complementary metal-oxide-semiconductor), for example. In several instances, the 5108 medical imaging device includes an endoscope, a laparoscope, a thoracoscope and other imaging devices. Several additional components of the 5108 medical imaging device are described above. Perioperative data that can be received by the central surgical controller 5104 from medical imaging device 5108 may include, for example, whether medical imaging device 5108 is enabled and a video or image feed stream. Contextual information that can be derived by the 5104 central surgical controller from perioperative data transmitted by the 5108 medical imaging device may include, for example, whether the procedure is a VATS procedure (based on whether the 5108 medical imaging device is activated or paired with the 5104 central surgical controller at the beginning or during the course of the procedure). In addition, image or video data from the 5108 medical imaging device (or data streams representing the video to a 5108 medical imaging device) can be processed by a pattern recognition system or a system machine learning to recognize features (eg organs or tissue types) in the field of view ("FOV" - Field of Vision) of the 5108 medical imaging device, for example. The contextual information that can be derived by the 5104 central surgical controller from recognized features may include, for example, what type of surgical procedure (or its stage) is being performed, which organ is being operated on, or what body cavity is being operated on .

[0289] In an example shown in Figure 24B, the smoke evacuator 5106 includes a first pressure sensor P, configured to detect ambient pressure in the operating room, a second pressure sensor P2 configured to detect internal downstream pressure ( (ie, the pressure downstream of the inlet), and a third pressure sensor P3 configured to detect the internal pressure upstream. In one example, the first pressure sensor P; it may be a separate component of the 5106 smoke evacuator or otherwise be located outside the 5106 smoke evacuator. The perioperative data that can be received by the 5104 central surgical controller from the 5106 smoke evacuator may include, for example, whether the smoke evacuator 5106 is activated, pressure readings for each of the sensors P1, P2, P3, and pressure differentials between pairs of the sensors P1, P2, P3. Perioperative data may also include, for example, the type of tissue on which the operation is being performed (based on the chemical composition of the smoke being evacuated) and the amount of tissue being cut. The contextual information that can be derived by the central surgical controller 5104 from the perioperative data transmitted by the smoke evacuator 5106 can include, for example, whether the procedure being performed is using insufflation. Perioperative data from the 5106 smoke evacuator can indicate whether the procedure is using insufflation according to the pressure differential between P3 and P1. If the pressure detected by P3 is greater than the pressure detected by P1 (i.e., P3 -P1> O), then the body cavity to which the smoke evacuator 5106 is connected is inflated. If the pressure detected by P3 is equal to the pressure detected by P (that is, P3 - P1 = O), then the body cavity is not inflated. When the body cavity is not inflated, the procedure can be an open type of procedure.

[0290] The 5110 insufflator can include, for example, pressure sensors and current sensors configured to detect internal parameters of the 5110 insufflator. Perioperative data that can be received by the central surgical controller 5104 from the insufflator can include, for example, whether the 5110 insufflator is activated and the electric current drained by the 5110 insufflator pump. The central surgical controller 5104 can determine whether the 5110 insufflator is activated by detecting, for example, directly whether the device is on, whether there is a pressure differential between an ambient pressure sensor and a pressure sensor internal to the surgical site, or whether the pressure valves of the 5110 insufflator are pressurized (activated) or not pressurized (deactivated). The contextual information that can be derived by the central surgical controller 5104 from the perioperative data transmitted by the 5110 insufflator may include, for example, the type of procedure being performed (for example, insufflation is used in laparoscopic procedures, but not in procedures arthroscopic) and which body cavity is being operated on (for example, insufflation is used in the abdominal cavity, but not in the chest cavity). In some examples, inferences derived from perioperative data received from different 5102 modular devices can be used to confirm and / or increase the confidence of previous inferences. For example, if central surgical controller 5104 determines that the procedure is using insufflation because inflator 5110 is activated, then central surgical controller 5104 can confirm that inference by detecting whether perioperative data from smoke evacuator 5106 indicates, in the same way, that the body cavity is inflated.

[0291] The 5112 combined energy generator supplies power to one or more ultrasonic surgical instruments or RF electrosurgical instruments connected to it. Perioperative data that can be received by the central surgical controller 5104 from the combined energy generator 5112 may include, for example, the mode for which the combined energy generator 5112 is set (for example, a vessel cauterization mode or a cutting / coagulation mode). The contextual information that can be derived by the central surgical controller 5104 from the perioperative data transmitted by the combined energy generator 5112 may include, for example, the type of surgical procedure (based on the number and types of surgical instruments that are connected to the 5112 power generator) and the procedure step being performed (because the specific surgical instrument being used or the specific order in which the surgical instruments are used, corresponds to different stages of the surgical procedure). Additionally, the inferences derived by the central surgical controller 5104 may depend on inferences and / or perioperative data previously received by the central surgical controller 5104. Once the central surgical controller 5104 has determined the general category or specific type of surgical procedure being performed , the central surgical controller 5104 can determine or retrieve an expected sequence of steps for the surgical procedure and then track the surgeon's progression through the surgical procedure by comparing the detected sequence in which the surgical instruments are used against the expected sequence.

[0292] Perioperative data that can be received by the central surgical controller 5104 from ventilator 5118 may include, for example, the patient's respiratory rate and airway volume. The contextual information that can be derived by the central surgical controller 5104 from perioperative data transmitted by ventilator 5118, can include, for example, whether the patient is anesthetized and whether the patient's lungs are deflated. In some examples, certain contextual information can be inferred by the central surgical controller 5104 based on combinations of perioperative data from multiple data sources 5126. For example, the situational perception system of the central surgical controller 5104 can be configured to infer that the The patient is anesthetized when the respiratory rate detected by ventilator 5118, the blood pressure detected by the PA monitor 5116, and the heart rate detected by the ECG monitor 5120, fall below specific thresholds. For certain contextual information, the central surgical controller 5104 can be configured to derive only a particular inference when perioperative data from a certain number or all relevant data sources 5126, satisfies the conditions for the inference.

[0293] As can be seen from the specific surgical system 5100, the situational perception system of a central surgical controller 5104 can derive various contextual information regarding the surgical procedure being performed from data sources 5126. The surgical controller Central 5104 can use the derived contextual information to control modular devices 5102 and make additional inferences about the surgical procedure in combination with data from other data sources 5126. It should be noted that the inferences represented in Figure 24A and described together with the surgical system represented 5100, are merely exemplary and should not be construed as limiting in any sense. In addition, the central surgical controller 5104 can be configured to derive a variety of other inferences from the same (or different) modular devices 5102 and / or patient monitoring devices 5124. In other examples, a variety of other modular devices 5102 and / or patient monitoring devices 5124 can be paired with the central surgical controller 5104 in the operating room and data received from those additional modular devices 5102 and / or patient monitoring devices 5124 can be used by the central surgical controller 5104 to bypass the same contextual information or different contextual information about the specific surgical procedure being performed.

[0294] Figures 25A through J represent logical flowcharts for processes to derive 5008a, 5008b, 5008c, 5008d contextual information from various modular devices, as discussed above with respect to processes 5000a, 5000b, 5000c, 5000d shown in Figures 23A to D. The contextual information derived in Figures 25A to C is about the type of procedure. The type of procedure may correspond to techniques used during the surgical procedure (for example, a segmentectomy), the category of the surgical procedure (for example, a laparoscopic procedure), the organ, tissue, or other structure being operated on, and other features to identify the specific surgical procedure (for example, the procedure uses insufflation). The contextual information derived in Figures 25D to G is the particular stage of the surgical procedure being performed. The contextual information derived in Figures 25H to J is the patient's condition. It can be seen that the patient's condition may also correspond to the stage of the surgical procedure being performed (for example, determining that the patient's state has changed from non-anesthetized to anesthetized may indicate that the stage of the surgical procedure of placing the patient under anesthesia performed by the medical team). As with process 5000a shown in Figure 23A, the processes illustrated in Figures 25A to J can, in one example, be performed by a control circuit of the central surgical controller 5104. In the following descriptions of the processes illustrated in Figures 25A to J, reference should also be made to Figure 24A.

[0295] Figure 25A illustrates a logical flow chart of a 5111 process to determine a type of procedure, according to the perioperative data from the 5106 smoke evacuator. In this example, the control circuit of the central surgical controller 5104 that performs the 5111 process receives 5113 perioperative data from the 5106 smoke evacuator and then determines 5115 whether the 5106 smoke evacuator is activated based on this. If smoke evacuator 5106 is not activated, then process 5111 continues along the NO branch and the control circuit of the central surgical controller 5104 continues to monitor the receipt of perioperative data from smoke evacuator 5106. If smoke evacuator 5106 is activated, then process 5111 continues along the SIM branch and the control circuit of the central surgical controller 5104 determines 5117 if there is a pressure differential between an upstream internal P3 pressure sensor (Figure 24B) and an external pressure sensor or environment P, (Figure 24B). If there is a pressure differential (that is, the internal pressure upstream of the 5106 smoke evacuator is greater than the ambient pressure of the operating room), then the 5111 process continues along the YES branch and the control circuit determines 5119 that the surgical procedure is a procedure that uses insufflation. If there is no pressure differential, then the 5111 process continues along the NO branch and the control circuit determines 5121 that the surgical procedure is not a procedure that uses insufflation.

[0296] Figure 25B illustrates a logical flow chart of a 5123 process to determine a type of procedure according to perioperative data from smoke evacuator 5106, insufflator 5110 and Medical Imaging device 5108. In this example, the controller control circuit central surgical 5104 that performs the 5123 process, receives 5125, 5127, 5129, perioperative data from the smoke evacuator 5106, insufflator 5110, and Medical Imaging device 5108 and then determines 5131, whether all devices are activated or paired with the central surgical controller 5104. If all of these devices are not activated or paired with the central surgical controller 5104, then process 5123 continues along the NO branch and the control circuit determines 5133 that the surgical procedure is not a VATS procedure. If all of the devices mentioned above are activated or paired with the central surgical controller 5104, then process 5123 continues along the YES branch and the control circuit determines 5135 that the surgical procedure is a VATS procedure. The control circuit can make this determination based on the fact that all of these devices are necessary for a procedure with VATS; therefore, if not all of these devices are being used in the surgical procedure, it cannot be a VATS procedure.

[0297] Figure 25C illustrates a logical flow chart of a 5137 process to determine a type of procedure according to the perioperative data of the Medical Imaging device 5108. In this example, the control circuit of the central surgical controller 5104 that executes the 5137 process , receives 5139 perioperative data from the medical imaging device 5108 and then determines 5141 whether the medical imaging device 5108 is transmitting an image or video. If the medical imaging device 5108 is not transmitting an image or video, then process 5137 continues along the NO branch and the control circuit determines 5143 that the surgical procedure is a VATS procedure. If the medical imaging device 5108 is not transmitting an image or video, then process 5137 continues along the SIM branch and the control circuit determines 5145 that the surgical procedure is a VATS procedure. In one example, the control circuit of the central surgical controller 5104 can execute process 5137 shown in Figure 250C in combination with process 5123 shown in Figure 25B in order to confirm or increase confidence in the contextual information derived by both processes 5123,

5137. If there is a discontinuity between the determinations of processes 5123, 5137 (for example, medical imaging device 5108 is transmitting a feed stream, but not all indispensable devices are paired with the central surgical controller 5104), then the controller Central Surgical 5104 can perform additional processes to reach a final determination that resolves discontinuities between processes 5123, 5137 or displays an alert or feedback to the surgical team regarding the discontinuity.

[0298] Figure 25D illustrates a logical flow chart of a process

5147 to determine a procedure step according to perioperative data from the 5110 insufflator. In this example, the control circuit of the central surgical controller 5104 that performs the 5147 process, receives 5149 perioperative data from the 5110 insufflator and then determines 5151 if there is a pressure between the surgical site and the operating room environment In one example, perioperative data from the 5110 insufflator may include a pressure from the surgical site (eg, intra-abdominal pressure) detected by a first pressure sensor associated with the 5110 insufflator , which can be compared against a pressure detected by a second pressure sensor configured to detect ambient pressure. The first pressure sensor can be configured to detect intra-abdominal pressure between 0-10 mmHg, for example. If there is a pressure differential, then process 5147 continues along the YES branch and the control circuit determines 5153 that a stage of the surgical procedure using insufflation is being performed. If there is no pressure differential, then process 5147 continues along the NO branch and the control circuit determines 5155 that a stage of the surgical procedure using insufflation is not being performed.

[0299] Figure 25E illustrates a logical flow chart of a 5157 process to determine a procedure step according to perioperative data from the 5112 energy generator. In this example, the control circuit of the central surgical controller 5104 that executes the 5157 process, receives 5159 perioperative data from energy generator 5112 and then determines 5161 whether energy generator 5112 is in cauterization mode. In several examples, the 5112 energy generator can include two modes: a sealing mode corresponding to a first energy level and a coagulation / cutting mode corresponding to a second energy level. If the 5112 power generator is not in cauterization mode, then process 5157 proceeds along the NO branch and the control circuit determines 5163 that a dissection step of the surgical procedure is being performed. The control circuit can make this determination 5163 because if the 5112 power generator is not in cauterization mode, then it needs to be in cut / coagulation mode for 5112 power generators that have two modes of operation. The 5112 energy generator's cut / coagulation mode corresponds to a dissection step because it provides an adequate degree of energy to the ultrasonic surgical instrument or electrosurgical instrument to perform tissue dissection. If the 5112 power generator is in cauterization mode, then process 5157 proceeds along the YES branch and the control circuit determines 5165 that a connection step of the surgical procedure is being performed. The cauterization mode of the 5112 energy generator corresponds to a connection step because it provides an adequate degree of energy to the ultrasonic surgical instrument or electrosurgical instrument to connect the vessels.

[0300] Figure 25F illustrates a logical flowchart of a 5167 process to determine a procedural step according to perioperative data from the 5112 energy generator. In various respects, perioperative data received previously and / or contextual information derived previously, can also be considered by processes in the subsequent derivation of contextual information. This allows the situational perception system of the 5104 central surgical controller to derive additional and / or increasingly detailed contextual information about the surgical procedure, as the procedure is performed. In this example, process 5167 determines 5169 that a segmentectomy procedure is being performed.

This contextual information can be derived by this process 5167 or other processes based on other perioperative data received and / or retrieved from a memory.

Subsequently, the control circuit receives 5171 perioperative data from the 5112 energy generator indicating that a surgical instrument is being triggered and then determines 5173 that the 5112 energy generator was used in a preceding step of the procedure to trigger the surgical instrument.

The control circuit can determine 5173 if the 5112 energy generator was used previously in a previous step of the procedure by retrieving a list of the steps that were performed under the present surgical procedure from a memory, for example.

In such examples, when the central surgical controller 5104 determines that a stage of the surgical procedure has been performed or completed by the medical team, the central surgical controller 5104 can update a list of the procedure steps that have been performed, which can then be retrieved by the control circuit of the central surgical controller 5104. In one example, the central surgical controller 5104 can distinguish between sequences of shots from the surgical instrument as corresponding to separate steps of the surgical procedure according to the delay between the sequences of shots, if any action of intervention was performed or if 5102 modular devices were used by the medical team, or other factors that the situational perception system can detect.

If the 5112 energy generator has not been used previously during the course of the segmentectomy procedure, process 5167 proceeds along the NO branch and the control circuit determines 5175 that the tissue dissection step to mobilize the patient's lungs is being performed by the medical team. If the 5112 power generator was used previously during the course of the segmentectomy procedure, process 5167 proceeds along the YES branch and the control circuit determines 5177 that the step of dissecting nodes is being performed by the surgery team. An ultrasonic surgical instrument or RF electrosurgical instrument is used twice during the course of an example of a segmentectomy procedure (for example, Figure 27); therefore, the situational perception system of the central surgical controller 5104 that executes the 5167 process can distinguish between which stage the use of the 5112 energy generator indicates is currently taking place based on whether the 5112 energy generator was used previously. .

[0301] Figure 25G illustrates a logical flow chart of a 5179 process to determine a procedural step according to perioperative data from the stapler. As described above in relation to process 5167 illustrated in Figure 25F, process 5179 uses previously received perioperative data and / or previously derived contextual information in the derivation of subsequent contextual information. In this example, process 5179 determines 5181 that a segmentectomy procedure is being performed. This contextual information can be derived by this 5179 process or other processes based on other perioperative data received and / or retrieved from a memory. Subsequently, the control circuit receives 5183 perioperative data from the surgical stapling instrument (ie, stapler) indicating that the surgical stapling instrument is being triggered and then determines 5185 whether the surgical stapling instrument was used in a previous step of the surgical procedure. As described above, the control circuit can determine 5185 whether the surgical stapling instrument was used previously in a preceding procedure step by retrieving a list of the steps that were performed in the current surgical procedure from a memory, for example. If the surgical stapling instrument has not been used previously, then process 5179 proceeds along the NO branch and the control circuit determines 5187 that the step of connecting arteries and veins is being carried out by the medical team. If the surgical stapling instrument has been used previously - during the course of the segmentectomy procedure, process 5179 proceeds along the YES branch and the control circuit determines 5189 that the parenchyma transection step is being carried out by the medical team. A surgical stapling instrument is used twice during the course of an example of a segmentectomy procedure (for example, Figure 27); therefore, the situational perception system of the central surgical controller 5104 that performs the 5179 process can distinguish between which stage the use of surgical stapling indicates is currently being performed based on whether the surgical stapling instrument was used previously.

[0302] Figure 25H illustrates a logical flow chart of a 5191 process to determine the status of a patient, according to the perioperative data from the 5110 ventilator, 5114 pulse oximeter, 5116 Pa monitor and / or 5120 ECG monitor. For example, the control circuit of the central surgical controller 5104 that performs the 5191 process receives 5193, 5195, 5197, 5199, perioperative data from each of the 5110 ventilators, pulse oximeters 5114, PA monitor 5116, and / or monitor electrocardiogram 5120 and then determines whether one or more values of the physiological parameters detected by each of the devices falls below a threshold for each of the physiological parameters. The threshold for each physiological parameter can correspond to a value that corresponds to a patient under anesthesia. In other words, the control circuit determines 5201 if the patient's respiratory rate, oxygen saturation, blood pressure, and / or heart rate indicate that the patient is under anesthesia according to data detected by the respective - device - modular 5102 and / or patient monitoring devices 5124. In an example, if all perioperative data values are below their respective thresholds, then process 5191 proceeds along the YES branch and the control circuit determines 5203 that the patient is under anesthesia. In another example, the control circuit can determine 5203 that the patient is under anesthesia if a particular number or reason for the monitored physiological parameters indicates that the patient is under anesthesia. Otherwise, process 5191 proceeds along the NO branch, and the control circuit determines 5205 that the patient is not anesthetized.

[0303] Figure 251 illustrates a logical flowchart of a 5207 process for determining the status of a patient, according to the perioperative data from the pulse oximeter 5114, PA monitor 5116 and / or ECG monitor 5120. In this example, the control circuit of central surgical controller 5104 that executes process 5207, receives 5209, 5211, 5213 (or tries to receive) perioperative data from pulse oximeter 5114, PA monitor 5116, and / or ECG monitor 5120, and then determines 5215 if at least one of the devices is paired with the central surgical controller 5104 or the central surgical controller 5104 is otherwise receiving data from there. If the control circuit is receiving data from at least one of these patient monitoring devices 5124, process 5207 proceeds along the SIM branch and the control circuit determines 5217 that the patient is in the operating room. The control circuit can make this determination because the 5214 patient monitoring devices connected to the central surgical controller 5104 need to be in the operating room, and so the patient, likewise, needs to be in the operating room. If the control circuit is not receiving data from at least one of these 5124 patient monitoring devices, process 5207 proceeds along the NO branch and the control circuit determines 5219 that the patient is not in the operating room.

[0304] Figure 25J illustrates a logical flow chart of a 5221 process to determine a patient state, according to the perioperative data of the 5110 ventilator. In this example, the control circuit of the central surgical controller 5104 executing the process 5221, receives 5223 perioperative data from the 5110 ventilator and then determines 5225 whether the patient's airway volume has decreased or is decreasing. In one example, the control circuit determines 5225 if the patient's airway volume falls below a specific threshold value indicative of a collapsed or deflated lung. In another example, the control circuit determines 5225 if the patient's airway volume falls below a baseline or average level by a limit amount. If the volume of the patient's airway has not decreased sufficiently, process 5221 proceeds along the NO branch and the control circuit determines 5227 that the patient's lung is not deflated. If the volume of the patient's airway has decreased sufficiently, process 5221 proceeds along the YES branch and the control circuit determines 5229 that the patient's lung is not deflated.

[0305] In one example, the 5100 surgical system can additionally include several tomographs that can be paired with the central surgical controller 5104 to detect and register objects and individuals entering and leaving the operating room.

Figure 26A illustrates a scanner 5128 paired with a central surgical controller 5104 that is configured to scan a 5130 patient's wristband. In one aspect, the scanner 5128 includes, for example, a barcode reader or an ID reader radio frequency (RFID) that is able to read patient information from the 5130 patient bracelet and then transmit that information to the 5104 central surgical controller. Patient information can include the surgical procedure to be performed or identification information which can be crossed with the hospital's EMR database 5122 by the central surgical controller 5104, for example.

Figure 26B illustrates a 5132 tomograph paired with a central surgical controller 5104 that is configured to scan a list of 5134 products for a surgical procedure.

The central surgical controller 5104 can use data from the CT scanner 5132 regarding the number, type and mix of items to be used in the surgical procedure to identify the type of surgical procedure being performed.

In one example, the 5132 scanner includes a product scanner (for example, a barcode reader or an RFID reader) that is able to read product information (for example, name and quantity) from the product itself product or product packaging, how products are brought into the operating room, and then transmit that information to the central surgical controller 5104. In another example, the 5132 scanner includes a camera (or other display device) and software associated optical character recognition system that is able to read product information from a 5134 product list. The 5104 central surgical controller can be configured to cross-reference the item list indicated by the data received with a lookup table or database of items used for various types of surgical procedures to infer the specific surgical procedure that must be (or was) performed. As shown in Figure 26B, the illustrative product list 5134 includes ring forceps, rib retractors, energized vascular stapler ("PVS" - powered vascular stapler) and a thoracic wound protector. In this example, the central surgical controller 5104 can infer that the surgical procedure is a thoracic procedure from these data, since these products are only used in thoracic procedures. In short, the scanner (s) 5128, 5132 can provide serial numbers, product lists and patient information to the central surgical controller

5104. Based on this data regarding which devices and instruments are being used and the patient's medical information, the central surgical controller 5104 can determine “additional contextual information regarding the surgical procedure.

[0306] In order to contribute to the understanding of process 5000a illustrated in Figure 23A and other concepts discussed above, Figure 27 illustrates a timeline 5200 of an illustrative surgical procedure and the contextual information that a central surgical controller 5104 can derive from data received from data sources 5126 at each stage in the surgical procedure. In the following description of timeline 5200 illustrated in Figure 27, reference should also be made to Figure 22. Timeline 5200 represents the typical steps that would be taken by nurses, surgeons, and other medical personnel during the course of a course. pulmonary segmentectomy procedure, starting with the configuration of the operating room and ending with the transfer of the patient to a recovery room in the postoperative period. The central surgical controller with situational awareness 5104 receives data from data sources 5126 throughout the course of the surgical procedure, including data generated each time medical personnel use a 5102 modular device that is paired with the central surgical controller

5104. The central surgical controller 5104 can receive this data from the paired modular devices 5102 and other data sources 5126 and continually derive inferences (that is, contextual information) about the ongoing procedure as new data is received, such as which step of the procedure is being performed at any given time. The situational perception system of the central surgical controller 5104 is capable, for example, of recording data referring to the procedure to generate reports (for example, see Figures 31 to 42), verifying the steps being followed by the medical team, providing data or requests (for example, via a display screen) that may be relevant to the specific procedure step, adjust modular devices 5102 based on the context (for example, activate monitors, adjust the FOV of the medical imaging device or change the level energy from an ultrasonic surgical instrument or RF electrosurgical instrument), and perform any other such action described above.

[0307] In the first step 5202, in this illustrative procedure, members of the hospital team retrieve the electronic patient record (PEP) from the hospital's PEP database. Based on patient selection data in the EMR, the central surgical controller 5104 determines that the procedure to be performed is a thoracic procedure. In step 5204, team members scan the incoming medical supplies for the procedure. The central surgical controller 5104 cross-references the scanned supplies with a list of supplies that are used in various types of procedures and confirms that the supply mix corresponds to a thoracic procedure (for example, as shown in Figure 26B). In addition, the central surgical controller 5104 is also able to determine that the procedure is not a tissue segment procedure (because supplies are missing, certain supplies that are necessary for a chest tissue segment procedure, or do not correspond to a procedure thoracic segment). Third 5206, medical personnel scan the patient's bracelet (for example, as shown in Figure 26A) through a reader 5128 that is communicably connected to the central surgical controller

5104. The 5104 central surgical controller can then confirm the patient's identity based on the scanned data. In the fourth step 5208, the medical team turns on the auxiliary equipment. The auxiliary equipment being used may vary according to the type of surgical procedure and the techniques to be used by the surgeon, but in this illustrative case they include a smoke evacuator, an insufflator and a medical imaging device. When activated, auxiliary equipment, which is a modular 5102 device, can automatically pair with the central surgical controller 5104 which is located within a specific neighborhood of the 5102 modular devices as part of its initialization process. The central surgical controller 5104 can then derive contextual information about the surgical procedure by detecting the types of modular devices 5102 that are paired with it during this preoperative or initialization phase. In this particular example, the central surgical controller 5104 determines that the surgical procedure is a VATS (video-assisted thoracic surgery) procedure based on this specific combination of paired modular devices

5102. Based on the combination of data from the patient's EMR, the list of medical supplies to be used in the procedure, and the type of modular devices 5102 that connect to the central controller, the central surgical controller 5104 can generally infer , the specific procedure that the medical team will be performing. After the central surgical controller 5104 recognizes which specific procedure is being performed, the central surgical controller 5104 can then retrieve the steps of that procedure from a memory or from the cloud and then cross-reference the data it subsequently receives from the connected data sources 5126 (for example, modular devices 5102 and patient monitoring devices 5124) to infer which stage of the surgical procedure the surgery team is performing. In the fifth step 5210, the team members fix the electrocardiogram (ECG) electrodes and other 5124 patient monitoring devices to the patient. ECG electrodes and other 5124 patient monitoring devices are capable of pairing with the central surgical controller 5104. As the central surgical controller 5104 begins to receive data from patient monitoring devices 5124, the central surgical controller 5104 thus confirms that the patient is in the operating room, as described in process 5207 represented in Figure 251, for example. In the sixth step 5212, medical personnel induce anesthesia in the patient. The central surgical controller 5104 can infer that the patient is under anesthesia based on data from modular devices 5102 and / or patient monitoring devices 5124, including ECG data, blood pressure data, ventilator data or combinations thereof, such as described in process 5191 shown in Figure 25H, for example. After the completion of the sixth step 5212, the preoperative portion of the lung segmentectomy procedure is completed and the operative portion begins.

[0308] In the seventh step 5214, the lung of the patient being operated on is retracted (while ventilation is switched to the contralateral lung). The central surgical controller 5104 can infer from the ventilator data that the patient's lung has been retracted, as described in process 5221 shown in Figure 25J, for example. The central surgical controller 5104 can infer that the operative portion of the procedure has started, since it can compare the detection of the patient's lung by retracting with the expected steps of the procedure (which can be accessed or retrieved previously) and thus determine that the lung retraction is the first operative step in this specific procedure. In the eighth step 5216, the medical imaging device 5108 (for example, an endoscope) is inserted and the video of the medical imaging device is started. The central surgical controller 5104 receives data from the medical imaging device (i.e., video or image data) through its connection to the medical imaging device. Upon receipt of data from the medical imaging device, the central surgical controller 5104 can determine that the portion of the laparoscopic surgical procedure has started. In addition, the central surgical controller 5104 can determine that the specific procedure being performed is a segmentectomy, rather than a lobotomy (note that a segment procedure has already been discarded by the central surgical controller 5104 based on the data received in the second step 5204 of the procedure ). The data from the medical imaging device 124 (Figure 2) can be used to determine contextual information about the type of procedure being performed in several different ways, including by determining the angle at which the medical imaging device is oriented in relation to viewing the anatomy of the patient, monitoring the number or medical imaging devices being used (ie, which are activated and paired with the central surgical controller 5104), and monitoring the types of visualization devices used.

For example, a technique for performing a VATS lobectomy places the camera in the lower anterior corner of the patient's chest cavity above the diaphragm, while a technique for performing a VATS segmentectomy places the camera in an intercostal position preceding the segment fissure.

With the use of standard recognition or machine learning techniques, for example, the situational recognition system can be trained to recognize the positioning of the medical imaging device according to the visualization of the patient's anatomy.

As another example, a technique for performing a VATS lobectomy uses a single medical imaging device, while another technique for performing a VATS segmentectomy uses multiple cameras.

As yet another example, a technique for performing a VATS segmentectomy uses an infrared light source (which can be communicated to the central surgical controller as part of the visualization system) to visualize the segment crack, which is not used in a VATS lobectomy.

By tracking any or all of this data from the medical imaging device 5108, the central surgical controller 5104 can thus determine the specific type of surgical procedure being performed and / or the technique being used for a specific type of surgical procedure.

[0309] In the ninth step 5218, the surgical team starts the dissection step of the procedure.

Central surgical controller 5104 can infer that the surgeon is in the process of dissection to mobilize the patient's lung because he receives data from the RF or ultrasonic generator indicating that an energy instrument is being fired.

The central surgical controller 5104 can cross-check the received data with the steps retrieved from the surgical procedure to determine that an energy instrument fired at that point in the process (that is, after the completion of the previously discussed steps of the procedure) corresponds to the dissection step.

In the tenth stage 5220, the surgical team proceeds to the stage of connection of the procedure.

Central surgical controller 5104 can infer that the surgeon is ligating the arteries and veins because he receives data from the surgical stapling and cutting instrument indicating that the instrument is being fired.

Similar to the previous step, the central surgical controller 5104 can derive this inference by crossing the data received from the stapling and surgical cutting instrument with the steps recovered in the process.

In the eleventh step 5222, the segmentectomy portion of the procedure is performed.

Central surgical controller 5104 can infer that the surgeon is transecting the parenchyma based on data from the surgical stapling and cutting instrument, including data from its cartridge.

The cartridge data can correspond to the size or type of clamp being triggered by the instrument, for example.

As different types of staples are used for different types of fabrics, the cartridge data can thus indicate the type of fabric being stapled and / or transected.

In this case, the type of clamp that is fired is used for the parenchyma (or other similar types of tissue), which allows the central surgical controller 5104 to infer that the segmentectomy portion of the procedure is being performed. In the twelfth step 5224, the node dissection step is then performed. Central surgical controller 5104 can infer that the surgical team is dissecting the node and performing a leak test based on data received from the generator indicating that an ultrasonic or RF instrument is being fired. For this specific procedure, an ultrasonic or RF instrument that is used after the parenchyma has undergone transection, corresponds to the node dissection step, which allows the 5104 central surgical controller to make this inference. It should be noted that surgeons - regularly - alternate between surgical stapling / cutting instruments and surgical energy instruments (ie, RF or ultrasonic) depending on the specific step in the procedure because different instruments are better adapted for specific tasks. Therefore, the specific sequence in which the cutting / stapling instruments and surgical energy instruments are used can indicate which stage of the procedure the surgeon is performing. After the completion of the twelfth stage 5224, the incisions are closed and the post-operative portion of the process begins.

[0310] In the thirteenth stage 5226, the patient's anesthesia is reversed. The central surgical controller 5104 can infer that the patient is emerging from anesthesia based on ventilator data (that is, the patient's respiratory rate begins to increase), for example. Finally, in the fourteenth step 5228 is that medical personnel remove the various patient monitoring devices 5124 from the patient. The central surgical controller 5104 can therefore infer that the patient is being transferred to a recovery room when the central surgical controller loses ECG, blood pressure and other data from patient monitoring devices 5124. As can be seen from the description of this illustrative procedure, the central surgical controller 5104 can determine or infer when each step of a given surgical procedure is taking place according to the data received from the various data sources 5126 that are communicably coupled to the central surgical controller 5104 .

[0311] In addition to using patient data from EMR databases to infer the type of surgical procedure that should be performed, as illustrated in the first step 5202 of timeline 5200 illustrated in Figure 27, patient data can also be used by a central surgical controller with situational perception 5104 to generate the control settings for the paired modular devices 5102. Figure 28A illustrates a flowchart representing the 5240 process of importing patient data stored in a database of EMR 5250 and deriving inferences 5256 from there, in accordance with at least one aspect of the present description. In addition, Figure 28B illustrates a flow chart representing the process 5242 of determining control settings 5264 corresponding to the inferences derived 5256 from Figure 28A, in accordance with at least one aspect of the present description. In the following description of processes 5240, 5242, reference should also be made to Figure 22.

[0312] As shown in Figure 28A, the central surgical controller 5104 retrieves patient information (for example, EMR) stored in a 5250 database to which the central surgical controller 5104 is communicably connected. The undeleted portion of the patient data is removed 5252 from the central surgical controller 5104, leaving the patient data anonymous 5254 related to the patient's condition and / or surgical procedure to be performed. Undeleted patient data is removed 5252 in order to maintain certain patient anonymity for data processing (including if the data is moved to the cloud for processing and / or the data tracked for reporting). The stripped patient data 5254 can include any medical conditions the patient is suffering from (including previous treatments or procedures), medication the patient is taking, and other medically relevant details.

The control circuit of the central surgical controller 5104 can then derive various inferences 5256 from the stripped patient data 5254, which, in turn, can be used by the central surgical controller 5104 to derive various control settings for the paired modular devices 5102. Derived inferences 5256 can be based on individual pieces of data or combinations of pieces of data.

Additionally, the derived inferences 5256 can, in some cases, be redundant with each other, since some data can lead to the same inference.

By integrating each patient data 5254 into the situational awareness system, the central surgical controller 5104 is thus able to generate pre-procedure adjustments to optimally control each of the 5102 modular devices based on the unique circumstances associated with each individual patient.

In the illustrated example, rectified patient data 5254 includes that (i) the patient is suffering from emphysema, (ii) has high blood pressure, (ii) is suffering from small cell lung cancer, (iv) is taking warfarin (or another anticoagulant), and / or (v) received radiation pretreatment.

In the illustrated example, inferences 5256 derived from patient data 5254, include (i) lung tissue will be more fragile than normal lung tissue, (ii) hemostasis problems are more likely, (iii) the patient is suffering from a relatively aggressive cancer, (iv) the lung tissue will be more rigid and more prone to fracture, respectively.

[0313] After the control circuit of the central surgical controller 5104 receives or identifies the implications 5256 that are derived from anonymized patient data, the control circuit of the central surgical controller 5104 is configured to perform a process 5242 to control the modular devices 5102 in a manner consistent with the derived implications 5256. In the example shown in Figure 28B, the control circuit of the central surgical controller 5104 interprets how the derived implications 5256 impact modular devices 5102 and then communicates corresponding control settings to each of the modular devices 5102. In the example shown in Figure 28B, control settings include (i) adjusting the compression rate limit parameter of the stapling and cutting instrument, (iii) adjusting the viewing limit value of the central surgical controller 5104 to quantify hemorrhage through the visualization system 108 (Figure 2) (this adjustment can be applied to the visualization system 108 itself, or as an internal parameter of the central surgical controller 5104), (iii) adjust the power and control algorithms of the combination generator module 140 (Figure 3) for the types of lung tissue and types of venous tissue, (iv) adjust the margin ranges of the medical imaging device 124 (Figure 2) to take into account the type of aggressive cancer, (v) notify the stapling and surgical instrument of the parameter adjustment of necessary margin (the margin parameter corresponds to the distance or amount of tissue around the cancer that will be excised), and (vi) notify the stapling and surgical cutting instrument that the tissue is potentially fragile, which makes the stapling and surgical cutting instrument control is adjusted accordingly.

In addition, data on implications 5256 derived from anonymized patient data 5254 are considered by the situational perception system to infer contextual information 5260 regarding the surgical procedure being performed. In the example shown in Figure 28B, the situational perception system further infers that the procedure is a 5262 chest lung resection, for example, segmentectomy.

[0314] Determining where inefficiencies or inefficiencies may be in a medical facility practice can be challenging because the efficiency of medical personnel in completing a surgical procedure, correlating positive patient outcomes with specific medical teams or specific techniques in performing a type surgical procedure, and other performance measures, are not easily quantified using the old systems. As a solution, central surgical controllers can be employed to track and store data regarding the surgical procedures with which central surgical controllers are being used and to generate reports or recommendations related to the tracked data. Tracked data can include, for example, the extent of time spent during a specific procedure, the extent of time spent on a specific step in a specific procedure, the extent of downtime between procedures, the device (s) ) modular (s) (for example, surgical instruments) used (s) during the course of a procedure, and the number and type of surgical items consumed during a procedure (or stage of the same). In addition, the tracked data may include, for example, the operating room in which the central surgical controller is located, the medical personnel associated with the specific event (for example, the surgeon or surgical team performing the surgical procedure), the day and the time at which the specific event (s) occurred, and patient results. This data can be used to create performance metrics, which can be used to detect and then ultimately resolve inefficiencies or inefficiencies within a medical facility. In one example, the central surgical controller includes a situational awareness system, as described above, which is configured to infer or determine information regarding a specific event (for example, when a specific step in a surgical procedure is being performed and / or how long it took to complete the step) based on data received from data sources connected to the central surgical controller (for example, paired modular devices). The central surgical controller can then store this tracked data to provide reports or recommendations to users.

Central surgical controller data aggregation and reporting

[0315] Figure 29 illustrates a block diagram of an interactive surgical system implemented by a 5700 computer, in accordance with at least one aspect of the present description. The 5700 system includes several 5706 central surgical controllers that, as described above, are able to detect and track data related to surgical procedures with which the 5706 central surgical controllers (and modular devices paired with the 5706 central surgical controllers) are used together . In one example, the 5706 central surgical controllers are connected to form local networks so that the data being tracked by the 5706 central surgical controllers is aggregated together over the network. The networks of central surgical controllers 5706 can be associated with a medical facility, for example. Data aggregated from the 5706 central surgical controller network can be analyzed to provide data trend reports or recommendations. For example, central surgical controllers 5706 from a first medical facility 5704a are communicably connected to a first local database 5708a and central surgical controllers 5706 from a second medical facility 5704b are communicably connected to a second database site 5708b. The network of central surgical controllers 5706 associated with the first medical installation 5704a can be distinguished from the network of central surgical controllers 5706 associated with the second medical installation 5704b, so that the aggregated data of each network of central surgical controllers 5706 corresponds to each medical installation 5704a , 5704b, individually. A 5706 central surgical controller or other computer terminal connected in a communicable way to the 5708a, 5708b database, can be configured to provide reports or recommendations based on the aggregated data associated with the respective 5704a, 5704b medical facility. In this example, the data tracked by the 5706 central surgical controllers can be used to report, for example, if a specific incidence of a surgical procedure has deviated from the average network time to complete the specific type of procedure.

[0316] In another example, each 5706 central surgical controller is configured to upload tracked data to the 5702 cloud, which then processes and aggregates the tracked data across multiple 5706 central surgical controllers, 5706 central surgical controller networks, and / or 5704a, 5704b medical facilities that are connected to the 5702 cloud. Each 5706 central surgical controller can then be used to provide reports or recommendations based on aggregated data. In this example, the data tracked by the 5706 central surgical controllers can be used to report, for example, whether a specific incidence of a surgical procedure has deviated from the overall mean time to complete the specific type of procedure.

[0317] In another example, each 5706 central surgical controller can be additionally configured to access the 5702 cloud to locally compare tracked data with aggregated global data from all 5706 central surgical controllers that are communicably connected to the 5702 cloud. Each surgical controller central 5706 can be configured to provide reports or recommendations based on the comparison between local data tracked against local (ie, in-network) or global standards. In this example, the data tracked by the 5706 central surgical controllers can be used to report, for example, whether a specific incidence of a surgical procedure has deviated from the average network time or the global average time to complete the specific type of procedure.

[0318] In one example, each 5706 central surgical controller or other local computer system for the 5706 central surgical controller is configured to aggregate locally tracked data by the 5706 central surgical controllers, store the tracked data, and generate reports and / or recommendations, according to the data tracked in response to the queries. In cases where the 5706 central surgical controller is connected to a network of medical facilities (which may include additional 5706 central surgical controllers), the 5706 central surgical controller can be configured to compare the tracked data with the data from the medical facility. The total data of the medical facility can include EMR data and aggregated data from the local 5706 central surgical controller network. In another example, the 5702 cloud is configured to aggregate the data tracked by the 5706 central surgical controllers, to store the tracked data , and generate reports and / or recommendations, based on the data tracked in response to queries.

[0319] Each 5706 central surgical controller can provide surgical reports regarding trends in the data and / or provide recommendations on improving the efficacy or effectiveness of the surgical procedures being performed. In several examples, data trends and recommendations can be based on data tracked by the 5706 central surgical controller itself, data tracked through a local medical facility network containing multiple 5706 central surgical controllers, or data tracked through multiple central surgical controllers 5706 communicably connected to a 5702 cloud. The recommendations provided by the 5706 central surgical controller can describe, for example, specific surgical instruments or product mixes to use for specific surgical procedures based on the correlations between surgical instruments / product mixes and patient results and the efficiency of the procedure. Reports provided by central surgical controller 5706 can describe, for example, whether a specific surgical procedure has been performed efficiently against local or global standards, whether a specific type of surgical procedure being performed at the medical facility is being performed efficiently against standards overall, and the average time required to complete a specific surgical procedure or stage of a surgical procedure for a given surgical team.

[0320] In one example, each 5706 central surgical controller is configured to determine when events in the operating room occur (for example, through a situational awareness system) and then track the amount of time spent on each event . An event in the operating room is an event that a 5706 central surgical controller can detect or infer. An event in the operating room may include, for example, a particular surgical procedure, a step or portion of a surgical procedure, or downtime between surgical procedures. Events in the operating room can be categorized according to one type of event, such as the type of surgical procedure being performed, so that data from individual procedures can be aggregated to form searchable data sets. Figure 31 illustrates an example of a 5400 diagram representing the data tracked by the 5706 central surgical controllers being analyzed to provide increasingly detailed metrics related to surgical procedures or the use of the 5706 central surgical controller (as further illustrated in Figures 32 to 36 ) for an illustrative data set. In one example, the 5706 central surgical controller is configured to determine whether a surgical procedure is being performed and then track both the time spent between procedures (ie, downtime) and the time spent on the procedures themselves . The 5706 central surgical controller can be additionally configured to determine and track the time spent on each of the individual steps performed by medical personnel (eg, surgeons, nurses, assistants), either between or during surgical procedures. The surgical central surgical controller can determine when surgical procedures or different stages of surgical procedures are being performed using a situational perception system, described in more detail above.

[0321] Figure 30 illustrates a logical flow chart of a 5300 process for tracking data associated with an operating room event. In the following description, description of process 5300, reference should also be made to Figure 29. In one example, process 5300 can be performed by a control circuit of a central surgical controller 206, as shown in Figure 10 (processor 244 ). In yet another example, process 5300 can be performed by a distributed computing system that includes a control circuit of a central surgical controller 206 in combination with a control circuit of a modular device, such as the 461 microcontroller of the surgical instrument represented in Figure 12, the microcontroller 620 of the surgical instrument shown in Figure 16, the control circuit 710 of the robotic surgical instrument 700 shown in Figure 17, the control circuit 760 of the surgical instruments 750, 790 represented in Figures 18 and 19, or the controller 838 of generator 800 shown in Figure 20. For economy, the following description of process 5300 will be made as being executed by the control circuit of a central surgical controller 5706; however, it should be understood that the description of process 5300 covers all the examples mentioned above.

[0322] The control circuit of the central surgical controller 5706 that executes the 5300 process receives 5302 perioperative data from modular devices and other data sources (for example, databases and patient monitoring devices) that are coupled in a communicable way to the central surgical controller 5706. The control circuit determines 5304, so whether an event occurred through, for example, a situational perception system that derives contextual information from the received 5302 data. The event can be associated with an operating room in which the 5706 central surgical controller is being used. The event may include, for example, a surgical procedure, a stage or portion of a surgical procedure, or downtime between surgical procedures or stages of a surgical procedure. In addition, the control circuit tracks data associated with the specific event,

such as the length of the event, the surgical instruments and / or other medical products used during the course of the event, and the medical personnel associated with the event. The central surgical controller 5706 can additionally determine this information regarding the event through, for example, the situational perception system.

[0323] For example, the control circuit of a 5706 central surgical controller with situational awareness can determine that anesthesia is being induced in a patient through data received from one or more 5102 modular devices (Figure 22) and / or patient monitoring 5124 (Figure 22). The control circuit can then determine that the operational portion of the surgical procedure has started by detecting that an ultrasonic surgical instrument or RF electrosurgical instrument has been activated. The control circuit can then determine the length of time for the anesthesia induction step, according to the difference in time between the start of that specific step and the start of the first step in the operational portion of the surgical procedure. Likewise, the control circuit can determine how long the specific operating step took in the surgical procedure, according to when the control circuit detects the start of the subsequent step in the procedure. In addition, the control circuit can determine how long the total operating portion of the surgical procedure took, according to when the control circuit detects the end of the operating step in the procedure. The control circuit can also determine which surgical instruments (and other 5102 modular devices) are being used during each step in the surgical procedure by tracking the activation and / or use of the instruments during each step. The control circuit can also detect the completion of the surgical procedure, for example, detecting when patient monitoring devices 5124 have been removed from the patient (as in step fourteen 5228 in Figure 27). The control circuit can then track downtime between procedures according to when the control circuit infers that the subsequent surgical procedure started.

[0324] The control circuit that executes the 5300 process adds 5306 then the data associated with the event, according to the type of event. In one example, the aggregated data 5306 can be stored in a memory 249 (Figure 10) of the central surgical controller 5706. In another example, the control circuit is configured to load the data associated with the event to the 5702 cloud, when the information 5306 are aggregated according to the type of event for all data loaded by each of the 5706 central surgical controllers connected to the 5702 cloud. In yet another example, the control circuit is configured to load the data associated with the event to a database. data associated with a local network of central surgical controllers 5706, where data is aggregated 5306 according to the type of event for all data loaded through the local network of central surgical controllers 5706.

[0325] In one example, the control circuit is additionally configured to compare the data associated with the type of event with baseline data associated with the type of event. Baseline data can correspond, for example, to average values associated with the specific event type for a specific hospital, network of hospitals, or by the entity in the cloud

5702. Baseline data can be stored in the central surgical controller 5706 or retrieved by the central surgical controller 5706 as the perioperative data received there

5302.

[0326] Aggregating 5306 data for each of the events, according to the type of event, allows individual incidents of the type of event to be compared later with the history or aggregated data to determine when deviations from the norm for a kind of event. The control circuit determines 5308 additionally if it has received an inquiry. If the control circuit has not received a query, then process 5300 continues along the NO branch and returns to continue receiving 5302 data from the data sources. If the control circuit receives a query for a specific event type, the 5300 process continues along the YES branch and the control circuit then retrieves the aggregated data for the specific event type and displays 5310 the appropriate aggregated data corresponding to the query In several examples, the control circuit can retrieve the appropriate aggregated data from the memory of the central surgical controller 5706, from the cloud 5702, or a local database 5708a, 5708b.

[0327] In one example, the central surgical controller 5706 is configured to determine an extension of time for a specific procedure through the aforementioned situation perception system according to data received from one or more modular devices used in the performance of the central surgical procedure (and other data sources). Each time a surgical procedure is completed, the central surgical controller 5706 loads or stores the length of time necessary to complete the specific type of surgical procedure, which is then added to the data of one instance or another of the type of procedure. In some respects, the central surgical controller 5706, cloud 5702, and / or the local database 5708a, 5708b, can then determine an average or expected extension for the specific type of procedure from the aggregated data. When the 5706 central surgical controller receives an inquiry regarding the specific type of procedure then, the 5706 central surgical controller can then provide surgical feedback related to the average (or expected) extension or compare an individual incidence of the type of procedure with the average extension of the procedure. procedure to determine whether the specific incidence deviates from it.

[0328] In some respects, the central surgical controller 5706 can be configured surgical to automatically compare each incidence of an event type with average or expected standards for the type of event and then provide feedback (for example, display a report) when a specific incidence of the type of event deviates from the norm. For example, the 5706 central surgical controller can be configured to provide feedback whenever a surgical procedure (or a surgical procedure step) deviates from the expected length of time to complete the surgical procedure (or the surgical procedure step) by more than a defined amount.

[0329] Referring again to Figure 31, the central surgical controller 5706 could be configured to track, store and display data regarding the number of patients operated (or completed procedures) per day per operating room (bar graph 5402 represented additionally in Figure 32), for example. The 5706 surgical central surgical controller can be configured to further analyze the number of operated patients (or completed procedures) per day in the operating room and can be further analyzed according to the downtime between procedures on a given day (graph of bars 5404 represented additionally in FIG. 33) or the average duration of the procedure on a given day (bar graph 5408 represented additionally in Figure 35). The 5706 central surgical controller can be further configured to provide a detailed breakdown of downtime between procedures, according to, for example, the number and duration of downtime periods and the subcategories of actions or steps during each period of time (bar graph 5406 further represented in Figure 34). The central surgical controller 5706 can be additionally configured to provide a detailed breakdown of the average duration of the procedure on a given day, according to each individual procedure and the subcategory of actions or steps during each procedure (bar graph 5410 additionally shown in Figure 36 ). The various graphs shown in Figures 31 to 36 can represent the data tracked by the central surgical controller 5706 and can additionally be automatically generated or displayed by the central surgical controller 5706 in response to queries submitted by users.

[0330] Figure 32 illustrates an example 5402 bar graph representing the number of 5420 patients operated in relation to the days of the week 5422 for different operating rooms 5424, 5426. The central surgical controller 5/06 can be configured to provide (for example, example, by means of a screen) the number of patients 5420 operated or in procedures that are completed together with each central surgical controller 5706, which can be tracked through a situational perception system or accessing the EMR database of the hospital, for example. In one example, the central surgical controller 5706 can be additionally configured to compare this data from different central surgical controllers 5706 within the medical facility that are communicably connected, which allows each individual central surgical controller to display the aggregated facility data on a central controller-by-central controller or operating room-by-operating room basis. In one example, the 5706 central surgical controller can be configured to compare one or more tracked metrics with a threshold value (which can be unique for each tracked metric). When at least one of the tracked metrics exceeds the limit value (ie, rise above or fall below the limit value, as appropriate for the specific tracked metric), then the 5706 central surgical controller provides a visual, audible or tactile alert to notify the user of this. For example, the 5706 central surgical controller can be configured to indicate when the number of patients or procedures deviates from an expected, average or limit value. For example, Figure 32 shows the number of patients on Tuesday 5428 and Thursday 5430 for a first operating room 5424 being highlighted for being below expectations. On the other hand, no day is assigned to a second operating room 5426 for this specific week, which means, in this context, that the number of patients for each day falls within expectations.

[0331] Figure 33 illustrates a 5404 bar graph showing the total downtime between procedures 5432 in relation to the days of a week 5434 for a specific operating room. The 5706 central surgical controller can be configured to track the length of inactivity between surgical procedures using a situational awareness system, for example. The situational awareness system can detect or infer when each instance of specific downtime is occurring and then track the length of time for each instance of downtime. The 5706 central surgical controller can thus determine the total 5432 downtime for each day of the week

5434 when adding downtime instances for each specific day. In one example, the 5706 central surgical controller can be configured to provide an alert when the total extent of downtime on a given day (or other unit of time) deviates from a limit value, average or expected. For example, Figure 33 shows total downtime 5432 on Tuesday 5436 and Friday 5438 being highlighted for deviating from an expected length of time.

[0332] Figure 34 illustrates a bar graph 5406 representing total downtime 5432 per day of week 5434, as shown in Figure 33, differentiated according to each instance of individual downtime. The number of downtime instances and downtime for each downtime instance can be represented within each day's total downtime. For example, on Tuesday in the first operating room (SO1), there were four instances of downtime between procedures and the magnitude of the first instance of downtime indicates that it was longer than the other three instances. In one example, the 5706 central surgical controller is configured to additionally indicate the specific actions or steps performed during the selected downtime instance. For example, in Figure 34, the second instance of Thursday 5440 downtime was selected, which then causes a 5442 call to be displayed, indicating that that particular downtime instance consisted of performing the initial configuration of the operating room, administering anesthesia and preparing the patient. As with the downtime instances themselves, the size or relative extent of the actions or steps within the 5442 call may correspond to the length of time for each specific action or step. Detailed views for downtime instances can be displayed when a user selects the specific instance, for example.

[0333] Figure 35 illustrates a 5408 bar graph representing the average duration of procedure 5444 over the days of a week 5446 for a specific operating room. The 5706 central surgical controller can be configured to track the average duration of the procedure using a situational perception system, for example. The situational perception system can detect or infer when each specific step in a surgical procedure is taking place (see Figure 27, for example) and then track the length of time for each step. The central surgical controller 5706 can thus determine the total downtime 5432 for each day of the week 5434 by summing the durations of the downtime instances for the specific day. In one example, the 5706 central surgical controller can be configured to indicate when the average procedure duration deviates from an expected value. For example, Figure 35 represents the average procedure duration of Thursday 5448 for the first operating room (SO1), being highlighted by deviating from an expected length of time.

[0334] Figure 36 shows a 5410 bar graph representing the 5450 procedure durations in relation to the 5452 procedure types. The 5450 procedure durations shown can represent the average procedure durations for specific types of procedures or the procedure durations for each individual procedure performed on a given day in a given operating room. The procedure durations 5450 for different types of procedures 5452 can then be compared. In addition, the average durations for the steps in a 5452 procedure type or the duration for each specific step in a specific procedure, can be displayed when a procedure is selected.

In addition, procedure types 5452 can be marked with various identifiers to analyze and compare different data sets.

For example, in Figure 36, the first procedure 5454 corresponds to a colorectal procedure (specifically, a previous lower resection) where there was a preoperative identification of abdominal adhesions.

The second procedure 5456 corresponds to a thoracic procedure (specifically, a segmentectomy). It should be noted again that the procedures shown in Figure 36 can represent the time durations for individual procedures or the average time durations for all procedures for the given procedure types.

Each of the procedures can also be differentiated according to the length of time for each step in the procedure.

For example, Figure 36 represents the second procedure 5456 (a thoracic segmentectomy) including an icon or graphical representation 5458 of the length of time to dissect vessels, ligate (the vessels), nodal dissection, and steps to close the surgical procedure.

As with the procedure durations themselves, the relative size or extent of the steps within the 5442 graphical representation may correspond to the time period for each particular step in the surgical procedure.

Detailed views for the steps of the surgical procedures can be displayed when a user selects the specific procedure, for example.

In one example, the central surgical controller 5706 can be configured to identify when an extension of time to complete a given step in the procedure deviates from an expected extension of time.

For example, Figure 36 represents the nodal dissection step as being highlighted to deviate from an expected period of time.

[0335] In one example, a 5706 central surgical controller analysis package can be configured to provide the user with correlations of results and usage data for surgical procedures (or downtime between procedures). For example, the 5706 central surgical controller can be configured to display methods or suggestions for improving the efficiency or effectiveness of a surgical procedure. As another example, the 5706 central surgical controller can be configured to display methods to improve cost allocation. Figures 37 to 42 represent examples of various meters that can be tracked by the central surgical controller 5706, which can then be used to provide suggestions to medical facility personnel for the use of inventory or results technique. For example, a 5706 surgical central surgical controller could provide a surgeon with a suggestion related to a specific technique result before or at the beginning of a surgical procedure based on the metric tracked by the 5706 central surgical controller.

[0336] Figure 37 illustrates a 5460 bar graph representing the average completion time 5462 for specific procedure steps 5464 for different types of chest procedures. The 5706 central surgical controller can be configured to track and store historical data for different types of procedures and calculate the average time to complete the procedure (or an individual step in it). For example, Figure 37 represents the average completion time 5462 for thoracic segmentectomy 5466, tissue segment 5468, and lobotomy 5470 procedures. For each type of procedure, the central surgical controller 5706 can track the average time to complete each step of the procedure. themselves. In this particular example, the dissection, vessel transection and node dissection steps are indicated for each type of procedure. In addition to tracking and providing the average time for the procedure type steps, the 5706 central surgical controller can additionally track other metrics or historical data, such as the rate of complications for each type of procedure (ie the rate of procedures that has at least one complication, as defined by the central surgical controller 5706 or the surgeon). Additional tracked metrics for each type of procedure, such as the complication rate, can also be represented for comparison between different types of procedures.

[0337] Figure 38 shows a 5472 bar graph representing the 5474 procedure time in relation to 5476 procedure types. The 5706 central surgical controller can be configured to track and store historical or metric data for different types of 5476 procedures or classes, which can cover multiple subtypes of procedures. For example, Figure 38 represents procedure time 5474 for surgical procedures classified as a thoracic procedure 5478, bariatric 5480, or colorectal 5482. In several examples, the central surgical controller 5/06 can issue procedure time 5474 for the classifications of procedure expressed in terms of the total period of time or the average time spent with the 5476 data types given. The analytical package of the 5706 central surgical controller can provide, for example, this data to surgeons, hospital staff, or medical staff to track the efficiency of the researched procedures. For example, Figure 38 represents bariatric procedures 5480 as taking a lower average time (that is, being more efficient with respect to time) than thoracic procedures 5478 or colorectal 5482.

[0338] Figure 39 shows a 5484 bar graph representing the operating room 5486 downtime in relation to the time of day 5488. Similarly, Figure 40 shows a 5494 bar graph representing the downtime of operating room 5496 in relation to the day of the week

5498. Operating room downtime 5486, 5496 can be expressed, for example, in an extension of a unit of time or relative use (ie, percentage of time that the operating room is in use). Operating room downtime data includes an individual operating room or an aggregation of multiple operating rooms in a medical facility. As discussed above, a 5706 central surgical controller can be configured to track the possibility of a surgical procedure being performed in the operating room associated with the 5706 central surgical controller (including the length of time that a surgical procedure is or is not being performed) using a situational perception system, for example. As shown in Figures 39 and 40, the 5706 central surgical controller can provide an output (for example, bar graphs 5484, 5494 or other graphical representations of the data) representing the tracked data for when the operating room is being used (ie when the surgical procedure is being performed) and / or when there is a period of inactivity between the procedures. Such data can be used to identify inefficiency or inefficiency in performing surgical procedures, in cleaning or preparing operating rooms for surgery, scheduling, and other measures associated with using the operating room. For example, Figure 39 represents a comparative increase in operating room downtime 5486 in a first instance 5490 from 11:00 AM to 12:00 PM, and a second instance 5492 from 3:00 to 4:00 PM. As another example, Figure 40 represents a comparative increase in operating room 5496 downtime on Mondays

5500 and on Fridays 5502. In several examples, the central surgical controller 5706 can provide operating room downtime data for a specific instance (ie, a specific hour, day, week) or average room downtime data of operation for a category of instances (that is, aggregated data for a day, hour, week, etc.). Hospital staff or medical staff could thus use this data to identify cases in which an inefficiency may have occurred or to identify trends on specific days and / or hours when there may be inefficiencies. From this data, hospital staff or medical staff can then investigate to identify the specific reasons for these increased downtime, and take corrective action to address the identified reason.

[0339] In several examples, the 5706 central surgical controller can be configured to display data in response to queries in a variety of different formats (for example, bar charts, pie charts, infographics). Figure 41 illustrates a pair of pie charts representing the percentage of time the operating room is used. The operating room usage percentage may include an individual operating room or an aggregation of multiple operating rooms (for example, the operating rooms in a medical facility or each operating room for all medical facilities that have central surgical controllers 5706 connected to the 5702 cloud). As discussed above, a 5/06 central surgical controller can be configured to determine when a surgical procedure is being performed or not (that is, whether the operating room associated with the 5706 central surgical controller is being used) using a situational awareness system , for example. In addition to expressing the use of the operating room in terms of an average or absolute amount for different periods of time (as shown in Figures 39 - 40), the central surgical controller 5706 can additionally express the use of the operating room in terms of percentage or relative quantity compared to a maximum possible use. As described above, operating room usage can be analyzed for specific time periods, including general usage (that is, the percentage of time in total usage history) for the specific operating room (or groups of operating rooms) ) or use over a specific period of time. As shown in Figure 41, a first pie chart 5504 represents the general use of operating room 5508 (85%) and a second pie chart 5506 represents the use of the operating room in the previous week 5510 (75%). Hospital staff, as well as medical staff, could use this data to identify that there may have been some inefficiency in the previous week that caused the specific operating room (or group of operating rooms) to be used less efficiently compared with the historical average, so that further investigations can be carried out to identify the specific reasons for this reduced use.

[0340] In some examples, the 5706 central surgical controller is configured to detect and track the number of surgical items that are used during the course of a surgical procedure. This data can then be aggregated and displayed (automatically or in response to a query), according to, for example, a specific period of time (for example, per day or per week) or for a specific type of surgical procedure (for example thoracic procedures or abdominal procedures). Figure 42 illustrates a bar graph 5512 representing surgical items consumed and not used 5514 in relation to the type of procedure 5516. The central surgical controller 5706 can be configured to determine or infer which surgical items are being consumed during the course of each surgical procedure. through a situational perception system.

The situational awareness system can determine or receive the list of surgical items to be used in a procedure (for example, see Figure 26B), determine or infer when each procedure (and its steps) starts and ends, and determine when a surgical item is being used, according to the stage of the procedure being performed.

The inventory of surgical items that are consumed or not used during the course of a surgical procedure, can be represented in terms of the total number of surgical items or the average number of surgical items per type of procedure 5516, for example.

The surgical items consumed may include non-reusable items that are used during the course of a surgical procedure.

Unused surgical items may include additional items that are not used during the procedure (s) or disposal items.

The type of procedure can correspond to broad classifications of procedures or a specific type of procedure or technique to perform a type of procedure.

For example, in Figure 42 the types of procedure 5516 being compared are thoracic, colorectal and bariatric procedures.

For each of these 5516 procedure types, the average number of consumed and unused items 5514 is provided.

In one aspect, the central surgical controller 5706 can be configured to further analyze the surgical items consumed and / or unused 5514 by the specific item type.

In one example, the central surgical controller 5706 can provide a detailed breakdown of surgical items 5514 that make up each item category for each type of surgical procedure 5516 and graphically represent the different categories of surgical items 5514. For example, in

Figure 42, the unused surgical items are represented in dashed lines and the consumed surgical items are represented in solid lines. In one example, the 5706 central surgical controller is configured to additionally indicate the specific item within a category for a specific type of procedure

5516. For example, in Figure 34, the category of items consumed for the type of chest procedure was selected, which then displays a call 5520 listing the specific surgical items in the category: staple cartridges, sponges, saline , fibrin sealants, surgical sutures and stapler reinforcement material. In addition, call 5520 can be configured to provide the quantities of items listed in the category, which can be the average or absolute quantity of items (whether consumed or not used) for the specific type of procedure.

[0341] In one example, the central surgical controller 5706 can be configured to aggregate tracked data in a format with elimination (that is, with the removal of any patient identification information). Such bulk data can be used for academic or business analysis purposes. In addition, the central surgical controller 5706 can be configured to upload deleted or anonymous data to a local database of the medical facility in which the central surgical controller 5706 is located, an external database system or the 5702 cloud, where anonymized data can be accessed by user / client applications on demand. Anonymized data can be used to compare results and efficiencies within a hospital or across geographic regions, for example.

[0342] Process 5300 depicted in Figure 30 improves scheduling efficiency by allowing 5706 central surgical controllers to automatically store and provide details on correlations between the time periods required for various procedures, according to specific days, specific types of procedure , hospital staff members and others. This 5300 process also reduces surgical item expense by allowing 5706 surgical controllers to provide alerts when the amount of surgical items being consumed, on a per-procedure basis, or as a category, is deviating from expected quantities. Such alerts can be provided automatically or in response to receiving an appointment.

[0343] Figure 43 illustrates a logical flow chart of a 5350 process for storing data from modular devices and a database of patient information for comparison. In the following description, description of process 5350, reference should also be made to Figure 29. In one example, process 5350 can be performed by a control circuit of a central surgical controller 206, as shown in Figure 10 (processor 244 ). In yet another example, process 5350 can be performed by a distributed computing system that includes a control circuit of a central surgical controller 206 in combination with a control circuit of a modular device, such as the 461 microcontroller of the surgical instrument represented in Figure 12, the microcontroller 620 of the surgical instrument shown in Figure 16, the control circuit 710 of the robotic surgical instrument 700 shown in Figure 17, the control circuit 760 of the surgical instruments 750, 790 represented in Figures 18 and 19, or the controller 838 of generator 800 shown in Figure 20. For economy, the following description of process 5350 will be made as being executed by the control circuit of a central surgical controller 5706; however, it should be understood that the 5350 process description covers all of the examples mentioned above.

[0344] The control circuit that runs the 5350 process receives data from data sources, such as the modular device (s) and the patient information database (s) (for example, EMR databases) that are communicably coupled to the 5706 central surgical controller. Data from modular devices may include, for example, usage data (for example, data regarding the frequency of use of the modular device, with which procedures the modular device has been used, and who used the modular devices) and performance data (for example, data regarding the internal state of the modular device and the tissue being operated). Data from patient information databases may include, for example, patient data (for example, data regarding the patient's age, sex and medical history) and patient outcome data (for example, data relating to patients). results of the surgical procedure) In some examples, the control circuit can continuously receive 5352 data from data sources before, during or after a surgical procedure.

[0345] As 5352 data is received, the control circuit aggregates 5354 data into data type comparison groups. In other words, the control circuit causes a first type of data to be stored in association with a second type of data. However, more than two different types of data can be aggregated 5354 together in a comparison group. For example, the control circuit can store a specific type of performance data for a specific type of modular device (for example, the force required to fire into a cutting and stapling surgical instrument or the characterization of the energy spent by a surgical instrument RF or ultrasonic) in association with patient data such as gender, age

(or age group), a condition (for example, emphysema) associated with the patient. In one example, when data is aggregated 5354 into comparison groups, the data is made anonymous so that all patient identification information is removed from the data. This allows 5354 aggregated data in comparison groups to be used for studies, without compromising confidential patient information. The various types of data can be aggregated 5354 and stored in association with each other in query tables, matrices and other formats. In one example, the data received 5352 is automatically aggregated 5354 into comparison groups. Automatically aggregating 5354 and storing the data, allows the 5706 central surgical controller to quickly return query results and the data groups to be exported for analysis, according to specifically desired data types.

[0346] When the control circuit receives 5356 a query for a comparison between two or more of the types of data tracked, the 5350 process proceeds along the SIM branch. The control circuit then retrieves the particular combination of the types of data stored in association with each other and then displays 5358 a comparison (for example, a graph or other graphical representation of the data) between the individual's data types. If the control circuit does not receive a 5356 query, the 5350 process continues along the NO branch and the control circuit continues to receive 5352 data from the data sources.

[0347] In one example, the control circuit can be configured to automatically quantify a correlation between the types of data received 5352. In such aspects, the control circuit can calculate a correlation coefficient (for example, Pearson's coefficient) between pairs of data types. In one aspect, the control circuit can be configured to automatically display a report that provides suggestions or other feedback if the quantified correlation exceeds a specific threshold value. In one aspect, the control circuit of the 5706 central surgical controller can be configured to display a report on quantified correlations that exceed a specific limit value when receiving a query or request from a user.

[0348] In one example, a 5706 central surgical controller can compile information about procedures in which the 5706 central surgical controller was used to perform, communicate with other 5706 central surgical controllers within its network (for example, a local network of a medical facility or several 5706 central surgical controllers connected by the 5702 cloud), and compare results between the type of surgical procedure or operating room, doctor or departments. Each 5706 central surgical controller can calculate and analyze usage, efficiency, and comparative results (for all 5706 central surgical controllers in a hospital network, a region, etc.). For example, the 5706 central surgical controller can display comparative and efficiency data, including operating room downtime, operating room cleaning and recycling time, step-by-step timing for procedures (including highlighting which procedure steps take the most time, for example), average times for surgeons to complete procedures (including analysis of completion times on a procedure-by-procedure basis), history completion times (for example, to complete procedure classes, specific procedures, or steps within a procedure), and / or operating room usage efficiency (that is, the time efficiency of a procedure for a procedure - subsequent). The data that is accessed and shared across networks by the 5706 central surgical controllers can include anonymized data aggregated into comparison groups, as discussed above.

[0349] For example, the 5706 central surgical controller can be used to perform performance studies by type of instrument or type of cartridge for various procedures. As another example, the 5706 central surgical controller can be used to conduct studies on the performance of each surgeon. As yet another example, the 5706 central surgical controller can be used to conduct studies on the effectiveness of different surgical procedures according to patient characteristics or sick conditions.

[0350] In another example, a 5706 central surgical controller can provide suggestions on streamlining processes based on tracked data. For example, the 5706 central surgical controller can suggest different product ranges, according to the duration of certain procedures or steps within a procedure (for example, suggest a specific item that is more suitable for long procedure steps), suggest ranges of products with better cost / benefit ratio based on the use of items, and / or suggest kits or pre-grouping of certain items to decrease the adjustment time. In another example, a 5706 central surgical controller can compare operating room usage in different surgical groups to better balance high-volume surgical groups with surgical groups that have more flexible bandwidth. In yet another aspect, the central surgical controller 5706 can be placed in a prediction mode that would allow the central surgical controller 5/06 to monitor the preparation and scheduling of the coming procedure, and then notify the administration or department about bottlenecks or allow them to plan the scale of staff. The forecasting mode can be based, for example, on anticipated future stages of the current surgical procedure that is being performed using the 5706 central surgical controller, which can be determined by a situational perception system.

[0351] In another example, a 5706 central surgical controller can be used as a training tool to allow users to compare their procedure times with other types of specific individuals or individuals within their departments (for example, a resident can compare your time with a specific specialist or the average time for a specialist within the hospital) or the department's average time. For example, users can identify which stages of a surgical procedure they are spending an enormous amount of time on, and thus, which stages of the surgical procedure they need to improve on.

[0352] In one example, all stored data processing is performed locally on each 5706 central surgical controller. In another example, each 5706 central surgical controller is part of a distributed computing network, where each individual 5706 central surgical controller compiles and analyze your stored data and then communicate the data to the requesting central surgical controller 5706. A distributed computing network could allow for fast parallel processing. In another example, each 5706 central surgical controller is communicably connected to a 5702 cloud, which can be configured to receive data from each 5706 central surgical controller and then perform the necessary processing (data aggregation, calculations, and so on) in the data.

[0353] The 5350 process depicted in Figure 43 improves the ability to determine when procedures are being performed inefficiently by allowing 5706 central surgical controllers to provide alerts when specific procedures, whether on a per procedure or category basis, are up. deviating from the expected times to complete the procedures. Such alerts can be provided automatically or in response to receiving an appointment. This 5350 process also improves the ability to conduct studies on which surgical instruments and surgical procedure techniques provide the best patient results by automatically tracking and indexing such data in easily retrievable and reportable formats.

[0354] Some systems described in this document download the data processing that controls modular devices (eg, surgical instruments) from the modular devices themselves to an external computing system (eg, a central surgical controller) and / or a cloud. However, in some examples, some modular devices can sample data (for example, from the sensors of surgical instruments) at a rate faster than the rate at which data can be transmitted and processed by a central surgical controller. As a solution, the central surgical controller and surgical instruments (or other modular devices) can use a distributed computing system where at least a portion of the data processing is performed locally on the surgical instrument. This can prevent data or communication strangulation between the instrument and the central surgical controller by allowing the surgical instrument processor to handle at least part of the data processing when the data sampling rate is exceeding the rate at which the data can be transmitted to the central surgical controller. In some examples, the distributed computing system may cease the distribution of processing between the central surgical controller and the surgical instrument and, instead, have the processing performed only in an integrated manner with the surgical instrument. Processing can be performed exclusively by the surgical instrument in situations where, for example, the central surgical controller needs to allocate its processing capabilities to other tasks or the surgical instrument is sampling data at a very high rate and has the capabilities to perform by itself all data processing.

[0355] Similarly, data processing to control modular devices, such as surgical instruments, can be difficult for an individual central surgical controller to perform. If the processing of the central surgical controller of the control algorithms for the modular devices cannot keep pace with the use of the modular devices, then the modular devices will not perform adequately because their control algorithms will not be updated as necessary, or the updates of the control algorithms will lag behind the actual use of the instrument. As a solution, central surgical controllers can be configured to use a distributed computing system where at least a portion of the processing is performed through multiple separate central surgical controllers. This can prevent data or communication strangulation between modular devices and the central surgical controller by allowing each central surgical controller to use the network processing power of multiple central surgical controllers, which can increase the rate at which data is processed and thus the rate at which the control algorithm settings can be transmitted by the central surgical controller to the paired modular devices. In addition to distributing the computing associated with controlling the various modular devices connected to the central surgical controllers, a distributed computing system can also dynamically shift computing resources between multiple central surgical controllers in order to analyze the tracked data in response to queries made by users and perform other of those functions. The distributed computing system for central surgical controllers can be further configured to dynamically move data processing resources between central surgical controllers when any specific central surgical controller becomes overloaded.

[0356] Modular devices that are communicably connectable to the central surgical controller can include sensors, memories, and processors that are coupled to the memories and configured to receive and analyze data detected by the sensors. The central surgical controller can additionally include a processor coupled to a memory that is configured to receive (through the connection between the modular device and the central surgical controller) and analyze the data detected by the sensors of the modular device. In one example, the data detected by the modular device is processed externally to the modular device (for example, externally to a surgical instrument handle assembly) by a computer that is communicably coupled to the modular device. For example, advanced power algorithms to control the operation of a surgical instrument can be processed by an external computer system, rather than a controller built into the surgical instrument (such as an instrument using a processor

Advanced RISC Machine (ARM)). The external computer system that processes the data detected by the modular devices may include the central surgical controller with which the modular devices are paired and / or a cloud computing system. In an example, data sampled at a specific speed (for example, 20 Ms / second) and a specific resolution (for example, 12-bit resolution) by a surgical instrument are decimated and then transmitted via a link to the central surgical controller with the which the surgical instrument is paired. Based on this received data, the control circuit of the central surgical controller then determines the appropriate control settings for the surgical instrument, such as controlling the power for an ultrasonic surgical instrument or RF electrosurgical instrument, defining motor termination points for a motor-driven surgical instrument, and so on. The control settings are then transmitted to the surgical instrument for application.

Distributed processing

[0357] Figure 44 illustrates a diagram of a 5600 distributed computing system. The 5600 distributed computing system includes a set of nodes 5602a, 5602b, 5602c that are communicably coupled by a distributed multiparty communication protocol so that they run a computer program shared or distributed by passing messages between them. Although three nodes 5602a, 5602b, 5602c are shown, the distributed computing system 5600 can include any number of nodes 5602a, 5602b, 5602c that are communicably connected to each other. Each of the nodes at 5602a, 5602b, 5602c comprises a respective memory 5606a, 5606b, 5606c, and processor 5604a, 5604b, 5604c coupled thereto. Processors 5604a, 5604b, 5604c execute the distributed multiparty communication protocol, which is stored at least partially in memories 5606a, 5606b, 5606c. Each node 5602a, 5602b, 5602c can represent either a modular device or a central surgical controller. Therefore, the diagram represented represents aspects in which various combinations of central surgical controllers and / or modular devices are connected in a communicable manner. In several examples, the 5600 distributed computing system can be configured to distribute the computing associated with controlling the modular device (s) (eg, advanced power algorithms) over the device (s) modular (s) and / or the central surgical controller (s) to which the modular device (s) is (are) connected ). In other words, the 5600 distributed computing system incorporates a distributed control system to control the modular device (s) and / or the central surgical controller (s).

[0358] In some examples, the modular device (s) and the central surgical controller (s) use data compression for their communication protocols. Wireless data transmission over sensor networks can consume a significant amount of energy and / or processing resources compared to computing data on the device itself. In this way, data compression can be used to reduce the size of the data at the cost of extra processing time on the device. In one example, the 5600 distributed computing system uses time correlation to detect data, transform data from one dimension to two dimensions, and data separation (for example, upper 8-bit and lower 8-bit data). In another example, the 5600 distributed computing system uses a collection tree protocol to collect data from different nodes 5602a, 5602b, 5602c that have sensors (for example, modular devices) for a root node. In yet another aspect, the 5600 distributed computing system uses first-order prediction encoding to compress data collected by nodes 5602a, 5602b, 5602c that have sensors (for example, modular devices), which can minimize the amount of redundant information and significantly reduce the amount of data transmission between nodes 5602a, 5602b, 5602c of the network. In yet another example, the 5600 distributed computing system is configured to transmit only the characteristics of the electroencephalogram (EEG). In yet another example, the 5600 distributed computing system can be configured to transmit only complex data resources that are pertinent to the detection of a surgical instrument, which can significantly save energy in wireless transmission. Several other examples may use combinations of data compression techniques and / or additional data compression techniques mentioned above.

[0359] Figure 45 illustrates a logical flow chart of a 5650 process for displacing distributed computing resources. In the following description of 5650, reference should also be made to Figure 44. In one example, the 5650 process can be performed by a distributed computing system that includes a control circuit of a central surgical controller 206, as shown in Figure (processor 244), in combination with a control circuit of a second central surgical controller 206 and / or a control circuit of a modular device, such as microcontroller 461 of the surgical instrument shown in Figure 12, microcontroller 620 of the surgical instrument represented in Figure 16, the control circuit 710 of the robotic surgical instrument 700 represented in

Figure 17, the control circuit 760 of the surgical instruments 750, 790 shown in Figures 18 and 19, or the controller 838 of the generator 800 shown in Figure 20. For the sake of economy, the following description of process 5650 will be made as being executed control circuits of one or more nodes; however, it should be understood that the 5650 process description covers all of the examples mentioned above.

[0360] The control circuits of each node execute 5652 a control program distributed in sync. Since the distributed control program is running on the network of nodes, at least one of the control circuits monitors a command that instructs the distributed computing system to move from a first node, where the distributed computing program is run on the network from us, to a second mode, in which the control program is executed by a single node. In one example, the command can be transmitted by a central surgical controller in response to the need for central surgical controller resources for an alternative computing task. In another example, the command can be transmitted by a modular device in response to the rate at which data is sampled by exceeding the rate of the modular device at which the sampled data can be communicated to other nodes on the network. If a control circuit determines that a suitable command has been received 5654, process 5650 continues along the SIM branch and the distributed computing system 5600 moves to a single node running 5656 the program. For example, the 5600 distributed computing system shifts the distributed computing program from execution by both a modular device and a central surgical controller, to execution by the modular device only. As another example, the distributed computing system 5600 shifts the distributed computing program from execution by both a first central surgical controller and a second central surgical controller, to be executed only by the first central surgical controller. If no control circuit determines that a suitable command has been received 5654, the process continues along the NO branch and the control circuits of the node network continue to run 5652 the computer program distributed over the node network.

[0361] In case the program has been moved to be executed 5656 by a single node, the control circuit of the specific node that executes only the specific distributed program and / or a control circuit of another node within the network (which was previously executing the distributed program) monitors a command that instructs the node to redistribute the processing of the program by the distributed computing system. In other words, the node monitors a command to restart the distributed computing system. In one example, the command to redistribute the processing over the network can be generated when the sample rate of the sensor is less than the data communication rate between the modular device and the central surgical controller. If a control circuit receives 5658 a suitable command to redistribute the processing, then process 5650 proceeds along the SIM branch and the program is once again executed on the node network 5652. If a control circuit has not received a suitable command 5658, then the node continues to execute the program 5656 singularly.

[0362] Process 5650 depicted in Figure 45 eliminates data or communication bottlenecks when controlling modular devices using a distributed computing architecture that can move computing resources between modular devices and central surgical controllers or between controllers central surgical procedures as needed. This 5650 process also improves the data processing speed of the modular devices by allowing the processing of the control settings of the modular devices to be performed at least in part by the modular devices themselves. This 5650 process also improves the data processing speed of central surgical controllers by allowing central surgical controllers to move computing resources between themselves, as needed.

[0363] It may be difficult during video-assisted surgical procedures, such as laparoscopic procedures, to accurately measure the sizes or dimensions of features being viewed through a medical imaging device due to the distortion effects caused by the device lens. Being able to accurately measure sizes and dimensions during video-assisted procedures could help a situational awareness system for a central surgical controller by allowing the central surgical controller to accurately identify organs and other structures during video-assisted surgical procedures. As a solution, a central surgical controller could be configured to automatically calculate sizes or dimensions of structures (or distances between structures) during a surgical procedure by comparing the structures with markings affixed to devices that are intended to be within the FOV of the device. Medical imaging during a surgical procedure. The markings can represent a known scale, and can then be used to make measurements by comparing the measured length not known with the known scale.

[0364] In one example, the central surgical controller is configured to receive image or video data from a medical imaging device paired with the central surgical controller. When a surgical instrument with a calibration scale is within the FOV of the medical imaging device, the central surgical controller is able to measure organs and other structures that are similarly within the FOV of the medical imaging device by comparing the structures with the calibration scale. The calibration scale can be positioned, for example, at the distal end of a surgical instrument.

[0365] Figure 46 illustrates a diagram of a 5800 imaging system and a 5806 surgical instrument with a 5808 calibration scale. The 5800 imaging system includes a 5804 medical imaging device that is paired with a 5802 central surgical controller. 5802 central surgical controller can include a pattern recognition system or a machine learning system configured to recognize resources in the FOV from image or video data received from the 5804 medical imaging device. In one example, a 5806 surgical instrument (for example, a surgical cutting and stapling instrument) that is intended to enter the FOV of the medical imaging device 5804 during a surgical procedure, includes a 5808 calibration scale attached to it. The 5808 calibration scale can be positioned on the external surface of the 5806 surgical instrument, for example. In aspects where the 5806 surgical instrument is a cutting and stapling surgical instrument, the 5808 calibration scale can be positioned along the outer surface of the anvil. The 5808 calibration scale may include a series of separate graphic markings at fixed and / or known intervals. The distance between the end or end markings on the 5808 calibration scale can likewise be an adjusted distance L (for example, 35 mm). In one example, the end markings (for example, the most proximal and the most distal mark) on the 5808 calibration scale are distinguished from the intermediate markings in size, shape, color or otherwise. This allows the image recognition system of the 5802 central surgical controller to identify the end markings separately from the intermediate markings. The distance (s) between the markings can be stored in a memory or otherwise retrieved by the 5802 central surgical controller. The 5802 central surgical controller can therefore measure lengths or sizes of structures in relation to the calibration scale provided

5808. In Figure 46, for example, central surgical controller 5802 can calculate that artery 5810a has a diameter or width of D1 (for example, 17.0 mm), vein 5810b has a diameter or width of D2 (for example , 17.5 mm), and the distance between the vessels is D3 (for example, 20 mm) by comparing the views of these distances D1, D2, D3 with the known length L of the 5808 calibration scale positioned on the 5806 surgical instrument within the FOV of medical imaging device 5804. Central surgical controller 5802 can recognize the presence of vessels 5810a, 5810b by means of an image recognition system. In some examples, the 5802 central surgical controller can be configured to automatically measure and display the size or dimension of resources detected within the FOV of the “medical 5804 imaging device. In some examples, the 5802 central surgical controller can be configured to calculate the distance between the various points selected by a user on an interactive screen that is paired with the 5802 central surgical controller.

[0366] The 5800 imaging system configured to detect and measure sizes according to a 5808 calibration scale affixed to 5806 surgical instruments, provides the ability to accurately measure sizes and distances during video-assisted procedures. This can make it easier for surgeons to perform precisely video-assisted procedures by compensating for optical distortion effects inherent in such procedures.

[0367] Various aspects of the subject described in this document are defined in the following numbered examples:

[0368] Example 1. A central surgical controller configured to connect in a communicable way to a data source and to a modular device, the central surgical controller comprising: and a memory coupled to the processor, and the memory stores instructions that , when executed by the processor, make the central surgical controller: receive perioperative data from the data source, with perioperative data comprising data detected by the data source during the course of a surgical procedure; determine contextual information regarding the surgical procedure, according to the perioperative data; determine control settings for the modular device, according to contextual information; and control the modular device according to the control settings.

[0369] Example 2. The central surgical controller of any of Example 1, the Data source comprising a first modular device and the modular device comprising a second modular device.

[0370] Example 3. The central surgical controller according to any of Examples 1-2, the data source comprising a patient monitoring device.

[0371] Example 4. The central surgical controller according to any of Examples 1-3, the contextual information comprising a type of procedure of the surgical procedure.

[0372] Example 5. The central surgical controller according to any of Examples 1-4, the contextual information comprising a procedural step of the surgical procedure.

[0373] Example 6. The surgical central surgical controller according to any of Examples 1-5, the perioperative data comprising a parameter associated with the modular device.

[0374] Example 7. The central surgical controller according to any of Examples 1-6, the perioperative data comprising a parameter associated with a patient.

[0375] Example 8. A central surgical controller configured to connect in a communicable manner to a data source and a modular device, the central surgical controller comprising a control circuit configured to receive perioperative data from the data source, the data being perioperative comprise data detected by the data source during the course of a surgical procedure; determine contextual information regarding the surgical procedure, according to the perioperative data; determine control settings for the modular device, according to contextual information; and control the modular device according to the control settings.

[0376] Example 9. The central surgical controller of any of Example 8, the data source comprising a first modular device and the modular device comprising a second modular device.

[0377] Example 10. The central surgical controller according to any of Examples 8-9, the data source comprising a patient monitoring device.

[0378] Example 11. The central surgical controller according to any of Examples 8-10, the contextual information comprising a type of procedure of the surgical procedure.

[0379] Example 12. The central surgical controller according to any of Examples 8-11, with contextual information - comprising a procedural step of the surgical procedure.

[0380] Example 13. The surgical central surgical controller according to any of Examples 8-12, the perioperative data comprising a parameter associated with the modular device.

[0381] Example 14. The central surgical controller according to any of Examples 8-13, the perioperative data comprising a parameter associated with a patient.

[0382] Example 15. Non-transitory, computer-readable media that stores computer-readable instructions within themselves that, when executed by a central surgical controller configured to communicate in a communicable way with a data source and a modular device, causes the central surgical controller receives perioperative data from the data source, and the perioperative data comprises data detected by the data source during the course of a surgical procedure; determine contextual information regarding the surgical procedure, according to the perioperative data; determine control settings for the modular device, according to contextual information; and control the modular device according to the control settings.

[0383] Example 16. The central surgical controller of any of Example 15, the data source comprising a first modular device and the modular device comprising a second modular device.

[0384] Example 17. The central surgical controller according to any of Examples 15-16, the data source comprising a patient monitoring device.

[0385] Example 18. The central surgical controller according to any of Examples 15-17, the contextual information comprising a type of procedure of the surgical procedure.

[0386] Example 19. The central surgical controller according to any of Examples 15-18, where contextual information = comprises a procedural step of the surgical procedure.

[0387] Example 20. The surgical central surgical controller according to any of Examples 15-19, the perioperative data comprising a parameter associated with the modular device.

[0388] Example 21. The central surgical controller according to any of Examples 15-20, the perioperative data comprising a parameter associated with a patient.

[0389] Although several forms have been illustrated and described, it is not the applicant's intention to restrict or limit the scope of the claims attached to such detail. Numerous modifications, variations, alterations, substitutions, combinations and equivalents of these forms can be implemented and will occur to those skilled in the art without departing from the scope of the present description. In addition, the structure of each element associated with the shape can alternatively be described as a means of providing the function performed by the element. In addition, where materials for certain components are described, other materials can be used. It should be understood, therefore, that the preceding description and the appended claims are intended to cover all such modifications,

combinations and variations within the scope of the modalities presented. The attached claims are intended to cover all such modifications, variations, alterations, substitutions, modifications and equivalents.

[0390] The previous detailed description presented various forms of devices and / or processes through the use of block diagrams, flowcharts and / or examples. Although these block diagrams, flowcharts and / or examples contain one or more functions and / or operations, it will be understood by those skilled in the art that each function and / or operation within these block diagrams, flowcharts and / or examples can be implemented, individually and / or collectively, through a wide range of hardware, software, firmware or virtually any combination thereof. Those skilled in the art will recognize, however, that some aspects of the aspects in this document described, in whole or in part, can be implemented in an equivalent manner in integrated circuits, such as one or more computer programs running on one or more computers (for example , as one or more programs running on one or more computer systems), as one or more programs running on one or more processors (for example, as one or more programs running on one or more microprocessors), as firmware, or virtually as any combination thereof, and that designing the circuitry and / or writing the code for the software and firmware would be within the scope of practice of the person skilled in the art, in the light of this description. In addition, those skilled in the art will understand that the mechanisms of the subject in this document described can be distributed as one or more program products in a variety of ways and that an illustrative form of the subject in this document described is applicable regardless of the specific type of program. means of signal transmission used to effectively carry out the distribution.

[0391] The instructions used to program the logic to execute various aspects described can be stored in a memory in the system, such as dynamic random access memory (DRAM), cache, flash memory or other storage. In addition, instructions can be distributed over a network or through other computer-readable media. Thus, machine-readable media can include any mechanism to store or transmit information in a machine-readable form (for example, a computer), but is not limited to, floppy disks, optical discs, read-only compact disc ( CD-ROMs), and optical discs- dynamo discs, read-only memory (ROM), random access memory (RAM), erasable programmable read-only memory (EPROM), electrically erasable programmable read-only memory (EEPROM), cards magnetic or optical, flash memory, or machine-readable tangible storage media used to transmit information over the Internet via an electrical, optical, acoustic cable or other forms of propagation signals (for example, carrier waves, infrared signal, digital signals, etc.). Consequently, computer-readable non-transitory media includes any type of machine-readable media suitable for storing or transmitting instructions or electronic information in a machine-readable form (for example, a computer).

[0392] As used in any aspect of the present invention, the term "control circuit" can refer to, for example, a set of wired circuits, programmable circuits (for example, a computer processor comprising one or more cores individual instruction processing units, processing unit, - processor, - microcontroller, microcontroller unit, controller, digital signal processor (DSP), programmable logic device (PLD), programmable logic matrix

(PLA), or field programmable port arrangement (FPGA)), state machine circuits, firmware that stores instructions executed by the programmable circuit, and any combination thereof. The control circuit can, collectively or individually, be incorporated as an electrical circuit that is part of a larger system, for example, an integrated circuit (IC), an application-specific integrated circuit (ASIC), an on-chip system (SoC ), desktop computers, laptop computers, tablet computers, servers, smart headsets, etc. Consequently, as used in the present invention, "control circuit" includes, but is not limited to, electrical circuits that have at least one discrete electrical circuit, electrical circuits that have at least one integrated circuit, electrical circuits that have at least one circuit integrated for specific application, electrical circuits that form a general purpose computing device configured by a computer program (for example, a general purpose computer configured by a computer program that at least partially executes processes and / or devices in this document described, or a microprocessor configured by a computer program that at least partially performs the processes and / or devices described in this document), electrical circuits that form a memory device (for example, forms of random access memory), and / or electrical circuits that form a communications device (for example, a modem, communication key, or optical-electrical equipment). Those skilled in the art will recognize that the subject in this document described can be implemented in an analog or digital way, or in some combination of these.

[0393] As used in any aspect of the present invention, the term "logical" can refer to an application, software, firmware and / or circuit - configured - to perform any of the operations mentioned above. The software may be incorporated as a software package, code, instructions, instruction sets and / or data recorded on the computer-readable non-transitory storage media. The firmware can be embedded as code, instructions or instruction sets and / or data that are hard-coded (for example, non-volatile) in memory devices.

[0394] As used in any aspect of the present invention, the terms "component", "system", "module" and the like may refer to a computer-related entity, be it hardware, a combination of hardware and software, software or software running.

[0395] As in the present document used in one aspect of the present invention, an "algorithm" refers to the self-consistent sequence of steps that lead to the desired result, where a "step" refers to the manipulation of physical quantities and / or logical states that they may, although not necessarily need, take the form of electrical or magnetic signals that can be stored, transferred, combined, compared and manipulated in any other way. It is common use to call these signs bits, values, elements, symbols, characters, terms, numbers or the like. These terms and similar terms may be associated with the appropriate physical quantities and are merely convenient identifications applied to these quantities and / or states.

[0396] A network may include a packet-switched network. Communication devices may be able to communicate with each other using a selected packet switched network communications protocol. An exemplary communications protocol may include an Ethernet communications protocol that may be able to allow communication using a transmission control protocol / Internet protocol (TCP / IP). The Ethernet protocol can conform to or be compatible with the Ethernet standard published by the Institute of Electrical and Electronics Engineers (IEEE) entitled "IEEE 802.3 Standard", published in December 2008 and / or later versions of this standard. Alternatively or in addition, communication devices may be able to communicate with each other using an X.25 communications protocol. The X.25 communications protocol can conform or be compatible with a standard promulgated by the International Telecommunication Union-Telecommunication Standardization Sector (ITU-T). Alternatively or in addition, communication devices may be able to communicate with each other using a frame-relay communications protocol. The frame-relay communications protocol can conform to or be compatible with a standard promulgated by the Consultative Committee for International Telegraph and Telephone (CCITT) and / or the American National Standards Institute (ANSI). Alternatively or additionally, transceivers may be able to communicate with each other using an asynchronous transfer mode ("ATM") communication protocol. The ATM communication protocol can conform or be compatible with an ATM standard published by the ATM forum entitled "ATM-MPLS Network Interworking

2.0 "published in August 2001, and / or later versions of this standard. Obviously, different connection-oriented and / or post-developed network communication protocols are also contemplated in the present invention.

[0397] Unless otherwise stated, as is evident from the preceding description, it is understood that, throughout the preceding description, discussions using terms such as "processing", or

"computation", or "calculation", or "determination", or "display", or the like, refers to the action and processes of a computer, or similar electronic computing device, that manipulates and transforms the data represented in the form physical (electronic) quantities in the computer's records and memories in other similarly represented data in the form of physical quantities in the computer's memories or records, or in other similar information storage, transmission or display devices.

[0398] One or more components in the present invention may be called "configured for", "configurable for", "operable / operational for", "adapted / adaptable for", "capable of", "conformable / conformed for", etc. Those skilled in the art will recognize that "configured for" may, in general, cover components in an active state and / or components in an inactive state and / or components in a standby state, except when the context determines otherwise.

[0399] The terms "proximal" and "distal" are used in the present invention with reference to a physician who handles the handle portion of the surgical instrument. The term "proximal" refers to the portion closest to the doctor, and the term "distal" refers to the portion located opposite the doctor. It will also be understood that, for the sake of convenience and clarity, spatial terms such as "vertical", "horizontal", "up" and "down" can be used in the present invention with respect to the drawings. However, surgical instruments can be used in many orientations and positions, and these terms are not intended to be limiting and / or absolute.

[0400] Persons skilled in the art will recognize that, in general, the terms used in this document, and especially in the appended claims (for example, bodies of the appended claims) are generally intended as "open" terms (for example, the term "including" should be interpreted as "including, but not limited to", the term "having" should be interpreted as "having, at least", the term "includes" should be interpreted as "includes, but not limits to ", etc.). It will also be understood by those skilled in the art that, when a specific number of a claim statement entered is intended, that intention will be expressly mentioned in the claim and, in the absence of such mention, no intention will be present. For example, as an aid to understanding, the following appended claims may contain the use of the introductory phrases "at least one" and "one or more" to introduce claim statements. However, the use of such phrases should not be interpreted as implying that the introduction of a claim statement by the indefinite articles "one, ones" or "one, ones" limits any specific claim containing the mention of the claim entered to claims that contain only such a mention, even when the same claim includes the introductory phrases "one or more" or "at least one" and indefinite articles, such as "one, ones" or "one, ones" (for example, "one, ones" and / or "one, ones" should typically be interpreted as meaning "at least one" or "one or more"); the same goes for the use of defined articles used to introduce claims.

[0401] Furthermore, even if a specific number of an introduced claim statement is explicitly mentioned, Those skilled in the art will recognize that that statement must typically be interpreted as meaning at least the number mentioned (for example, the mere mention of "two mentions ", without other modifiers, typically means at least two mentions, or two or more mentions). In addition, in cases where a convention analogous to "at least one of A, B and C, etc." is used, in general this construction is intended to have the meaning in which the convention would be understood by (for example, "a system that has at least one of A, B and C "would include, but not be limited to, systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and / or A, B and C together, etc.). In cases where a convention analogous to "at least one of A, B or C, etc." is used, in general this construction is intended to have the meaning in which the convention would be understood by (for example, "a system that have at least one of A, B and C "would include, but not be limited to, systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and / or A , B and C together, etc.). It will be further understood by those skilled in the art that typically a disjunctive word and / or phrase presenting two or more alternative terms, whether in the description, in the claims or in the drawings, should be understood as contemplating the possibility of including one of the terms, any of the terms or both terms, except where the context dictates something different. For example, the phrase "A or B" will typically be understood to include the possibilities of "A" or "B" or "A and B".

[0402] With respect to the appended claims, those skilled in the art will understand that the operations mentioned in them can, in general, be performed in any order. In addition, although several operational flow diagrams are presented in one or more sequences, it must be understood that the various operations can be performed in other orders than those shown, or can be performed simultaneously. Examples of such alternative orderings may include ordering - overlapping, merging, interrupted, reordered, incremental, preparatory, supplementary, simultaneous, inverse or other variant orders, unless the context otherwise determines. Furthermore, terms such as

"responsive to", "related to" or other adjectival participles are not generally intended to exclude these variants, unless the context otherwise requires.

[0403] It is worth noting that any reference to "one (1) aspect", "one aspect", "an exemplification" or "one (1) exemplification", and the like means that a particular feature, structure or feature described in connection with the aspect is included in at least one aspect. Thus, the use of expressions such as "in one (1) aspect", "in one aspect", "in an exemplification", "in one (1) exemplification", in several places throughout this specification does not necessarily refer the same aspect. In addition, specific features, structures or characteristics can be combined in any appropriate way in one or more aspects.

[0404] Any patent application, patent, non-patent publication or other description material mentioned in this specification and / or mentioned in any order data sheet is in this document incorporated by reference, to the extent that the Embedded materials are not inconsistent with this. Accordingly, and as necessary, the description as explicitly presented herein replaces any conflicting material incorporated into the present invention by reference. Any material, or portion thereof, taken as in this document incorporated by reference, but which conflicts with the definitions, statements, or other description materials present in this document presented will be in this incorporated document only until the point in that there is no conflict between the embedded material and the existing description material.

[0405] In summary, numerous benefits have been described that result from the use of the concepts described in this document.

The previously mentioned description of one or more modalities has been presented for purposes of illustration and description.

This description is not intended to be exhaustive or to limit the invention to the precise form described.

Modifications or variations are possible in light of the above teachings.

One or more modalities were chosen and described in order to illustrate the principles and practical application to, thus, allow those skilled in the art to use the various modalities and with various modifications, as are convenient for the specific use contemplated.

It is intended that the claims presented in the annex define the global scope.

Claims (21)

1. Central surgical controller configured to connect communicatively to a data source and to a modular device, characterized in that the central surgical controller comprises: a processor; and a memory attached to the processor, and the memory stores instructions that, when executed by the processor, make the central surgical controller: receive perioperative data from the data source, and the perioperative data comprise data detected by the data source during the course of a surgical procedure; determine - contextual - information regarding the surgical procedure, according to the perioperative data; determine control settings for the modular device, according to contextual information; and control the modular device according to the control settings. Central surgical controller according to claim 1, characterized in that the data source comprises a first modular device and the modular device comprises a second modular device. Central surgical controller according to claim 1, characterized in that the data source comprises a patient monitoring device. Central surgical controller according to claim 1, characterized in that the contextual information comprises a type of procedure of the surgical procedure. 5. Centrall surgical controller, according to claim 1, characterized in that the contextual information comprises a procedure step of the surgical procedure. Central surgical controller according to claim 1, characterized in that the perioperative data comprise a parameter associated with the modular device. Central surgical controller according to claim 1, characterized in that the perioperative data comprise a parameter associated with a patient. 8. Central surgical controller configured to connect in a communicative way to a data source and to a modular device, “characterized by the central surgical controller comprising: a control circuit configured to: receive perioperative data from the data source, perioperative data comprises data detected by the data source during the course of a surgical procedure; determine - information - contextual - regarding - the surgical procedure, according to the perioperative data; determine control settings for the modular device, according to contextual information; and control the modular device according to the control settings. Central surgical controller according to claim 8, characterized in that the data source comprises a first modular device and the modular device comprises a second modular device. Central surgical controller according to claim 8, characterized in that the data source comprises a patient monitoring device. 11. Central surgical controller, according to claim 8, characterized in that the contextual information comprises a type of surgical procedure procedure. 12. Central surgical controller, according to claim 8, characterized in that the contextual information comprises a procedural step of the surgical procedure. 13. Central surgical controller, according to claim 8, characterized in that the perioperative data comprise a parameter associated with the modular device. 14. Central surgical controller, according to claim 8, characterized in that the perioperative data comprise a parameter associated with a patient. 15. Non-transient, computer-readable media, characterized by storing computer-readable instructions within itself that, when executed by a central surgical controller configured to connect in a communicable way to a data source and a modular device, make the controller central surgical: receive perioperative data from the data source, with perioperative data comprising data detected by the data source during the course of a surgical procedure; determine - information - contextual - regarding - the surgical procedure, according to the perioperative data; determine control settings for the modular device, according to contextual information; and control the modular device according to the control settings. 16. Computer readable non-transitory media according to claim 15, characterized in that the data source comprises a first modular device and the modular device comprises a second modular device. 17. Computer readable non-transitory media according to claim 15, characterized in that the data source comprises a patient monitoring device. 18. Non-transient, computer-readable media, according to claim 15, characterized in that the contextual information comprises a type of surgical procedure procedure. 19. Non-transient, computer-readable media, according to claim 15, characterized in that the contextual information comprises a stage of the surgical procedure. 20. Computer readable non-transitory media according to claim 15, characterized in that the perioperative data comprise a parameter associated with the modular device. 21. Non-transient, computer-readable media according to claim 15, characterized in that the perioperative data comprise a parameter associated with a patient.