BR112020013123A2 - systems to detect proximity of surgical end actuator to cancerous tissue - Google Patents

Abstract

it is a surgical instrument that includes an end actuator having a first jaw, a second jaw movable with respect to the first jaw to hold tissue therebetween, an anvil, a staple cartridge comprising staples implantable in the tissue, being that the clamps are deformable by the anvil, and a sensor configured to provide a sensor signal according to a physiological parameter of the tissue. the surgical instrument further includes a control circuit coupled to the sensor, the control circuitry being configured to receive the sensor signal and assess the proximity of the sensor to the cancerous tissue based on the sensor signal.

Description

Descriptive Report of the Patent of Invention for "SYSTEMS TO DETECT PROXIMITY OF THE SURGICAL END ACTUATOR TO CANCEROUS TISSUE",

REFERENCE TO RELATED ORDERS

[0001] The present application claims the priority benefit under USC$119(e) for US Provisional Patent Application Serial No. 62/691,227 entitled CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSED CLOSURE PARAMETERS, filed on June 28, 2018 , the disclosure of which is incorporated herein by reference in its entirety.

[0002] This application claims priority benefit under 35 USC 8 119(e) for US Provisional Patent Application Serial No. 62/650,887 entitled SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES, filed March 30, 2018, for US Provisional Patent Application Serial No. 62/650,877, entitled SURGICAL SMOKE EVACUATION SENSING AND CONTROLS, filed on March 30, 2018, for US Provisional Patent Application Serial No. 62/650,882, entitled SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM, filed March 30, 2018, and for US Provisional Patent Application Serial No. 62/650,898 entitled CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS, filed March 30, 2018 , the description of each of which is hereby incorporated by way of reference in its entirety.

[0003] This application also claims priority benefit under 35 USC$119(e) for US Provisional Patent Application Serial No. 62/640,417 entitled TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR filed on March 2018, and for US Provisional Patent Application Serial No. 62/640,415 entitled ESTIMATING STATE OF ULTRASONIC

END EFFECTOR AND CONTROL SYSTEM THEREFOR filed on March 8, 2018, the description of each of which is incorporated herein by reference in its entirety.

[0004] The present application claims priority under 35 USC$119(e) for US Provisional Patent Application Serial No. 62/611,341 entitled INTERACTIVE SURGICAL PLATFORM, filed December 28, 2017, for the Provisional Patent Application US Serial No. 62/611,340, entitled CLOUD-BASED MEDICAL ANALYTICS, filed on December 28, 2017, and for US Provisional Patent Application Serial No. 62/611,339, entitled ROBOT ASSISTED SURGICAL PLATFORM, filed on December 28, 2017, the description of each of which is incorporated herein by way of reference in its entirety.

BACKGROUND

[0005] The present description refers to several surgical systems.

SUMMARY

[0006] The present invention discloses a surgical instrument. The surgical instrument comprises an end actuator and a control circuit. The end actuator comprises a first jaw, a second jaw movable with respect to the first jaw to hold tissue therebetween, an anvil, a staple cartridge comprising staples implantable in the tissue, the staples being deformable by the anvil, and a sensor configured to provide a sensor signal according to a physiological parameter of the tissue. The control circuit is coupled to the sensor, and the control circuit is configured to receive the sensor signal and assess the proximity of the sensor to a cancerous tissue based on the sensor signal.

[0007] The present invention discloses a stapling instrument

surgical ment. The surgical stapling instrument comprises an end actuator and a control circuit. The end actuator comprises a first jaw, a second jaw movable with respect to the first jaw to hold tissue therebetween, an anvil, a staple cartridge comprising staples implantable in the tissue, the staples being deformable by the anvil, and a sensor configured to provide a sensor signal according to a physiological parameter indicative of the sensor's proximity to cancerous tissue. The control circuit is coupled to the sensor, and the control circuit is configured to receive the sensor signal, determine a physiological parameter value based on the sensor signal, and compare the physiological parameter value to a predetermined threshold.

[0008] The present invention discloses a surgical instrument. The surgical instrument comprises an end actuator and a control circuit. The end actuator comprises a first jaw, a second jaw movable with respect to the first jaw to hold tissue therebetween, an anvil, a staple cartridge comprising staples implantable in the tissue, the staples being deformable by the anvil, and a set of sensors configured to deliver sensor signals according to a physiological parameter indicative of the proximity of the sensors to the cancerous tissue. The sensor array comprises a first sensor on a first side of a longitudinal axis extending through the staple cartridge, and a second sensor on a second side of the longitudinal axis. The control circuit is coupled to the sensor array, whereby the control circuit is configured to receive a first sensor signal from the first sensor, receive a second sensor signal from the second sensor, determine determining a first physiological parameter value based on the first sensor signal, determining a second physiological parameter value based on the second sensor signal, and comparing the first value and the second value to a predetermined threshold.

FIGURES

[0009] The characteristics of various aspects are particularly presented in the appended claims. The various aspects, however, as regards both organization and methods of operation, together with objects and additional advantages thereof, may be better understood with reference to the following description, taken in conjunction with the drawings in attachment as follows:

[0010] Figure 1 is a block diagram of an interactive computer-implemented surgical system, in accordance with at least one aspect of the present description.

[0011] Figure 2 illustrates 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.

[0012] Figure 3 illustrates 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.

[0013] Figure 4 is a partial perspective view of a central surgical controller compartment, and a combined generator module slidably received in a central surgical controller compartment, in accordance with at least one aspect of the present disclosure. .

[0014] Figure 5 is a perspective view of a generator module combined with bipolar, ultrasonic and monopolar contacts and a smoke evacuation component, in accordance with at least one aspect of the present description.

[0015] Figure 6 illustrates different power bus connectors for a plurality of side docking ports of a modular side cabinet configured to receive a plurality of modules, in accordance with at least one aspect of the present description.

[0016] Figure 7 illustrates a modular vertical cabinet configured to receive a plurality of modules, in accordance with at least one aspect of the present description.

[0017] Figure 8 illustrates a surgical data network that comprises a central modular communication controller configured to connect modular devices located in one or more operating rooms of a healthcare facility, or in any environment of a facility. of public services specially equipped for surgical operations, to the cloud, in accordance with at least one aspect of the present description.

[0018] Figure 9 illustrates an interactive computer-implemented surgical system, according to at least one aspect of the present description.

[0019] Figure 10 illustrates a central surgical controller comprising a plurality of modules coupled to the modular control tower, in accordance with at least one aspect of the present description.

[0020] Figure 11 illustrates an aspect of a universal serial bus (USB) network central controller device, in accordance with at least one aspect of the present disclosure.

[0021] Figure 12 illustrates a logic diagram of a surgical instrument or tool control system, according to at least one aspect of the present description.

[0022] Figure 13 illustrates a control circuit configured to control aspects of the surgical instrument or tool, in accordance with at least one aspect of the present description.

[0023] Figure 14 illustrates a combinational logic circuit configured to control aspects of the surgical instrument or tool, in accordance with at least one aspect of the present description.

[0024] Figure 15 illustrates a sequential logic circuit configured to control aspects of the surgical instrument or tool, in accordance with at least one aspect of the present description.

[0025] Figure 16 illustrates a surgical instrument or tool comprising a plurality of motors that can be activated to perform various functions, in accordance with at least one aspect of the present description.

[0026] 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 disclosure.

[0027] Figure 18 illustrates a block diagram of a surgical instrument programmed to control distal translation of the displacement limb, in accordance with one aspect of the present disclosure.

[0028] 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.

[0029] Figure 20 is a schematic illustration of a tissue contact circuit showing the closing of the circuit upon tissue contact with a pair of separate contact plates, in accordance with at least one aspect of this description.

[0030] Figure 21 is a perspective view of a surgical instrument having an interchangeable drive shaft assembly operatively coupled thereto, in accordance with at least one aspect of this disclosure.

[0031] Figure 22 is an exploded assembly view of a por-

tion of the surgical instrument of Figure 21, in accordance with at least one aspect of this description.

[0032] Figure 23 is an exploded assembly view of portions of the interchangeable drive shaft assembly, in accordance with at least one aspect of this description.

[0033] Figure 24 is an exploded view of an end actuator of the surgical instrument of Figure 21, in accordance with at least one aspect of this description.

[0034] Figure 25A is a block diagram of a control circuit of the surgical instrument of Figure 21 encompassing two drawing sheets, in accordance with at least one aspect of this description.

[0035] Figure 25B is a block diagram of a control circuit of the surgical instrument of Figure 21 encompassing two drawing sheets, in accordance with at least one aspect of this description.

[0036] Figure 26 is a block diagram of the surgical instrument control circuit of Figure 21 illustrating interfaces between the grip assembly, the power assembly, and the grip assembly and the interchangeable drive shaft assembly. , in accordance with at least one aspect of the present description.

[0037] Figure 27 illustrates a tumor surrounded by healthy tissue, and a clear defined margin in healthy tissue, in accordance with at least one aspect of the present disclosure.

[0038] Figure 28 is a graph illustrating a physiological tissue parameter plotted as a function of distance to a tumor, in accordance with at least one aspect of the present description.

[0039] Figure 29 is a logic flow diagram of a process representing a control program or a logic configuration to assess the proximity of an end actuator of a surgical instrument to cancerous tissue, according to at least an aspect of the present description.

[0040] Figure 30 illustrates a logic flow diagram of a process that represents a control program or a logic configuration to assess the proximity of an end actuator to cancerous tissue, in accordance with at least one aspect of the present description.

[0041] Figure 31 illustrates an end actuator of a surgical instrument, according to at least one aspect of the present description.

[0042] Figure 32 illustrates a control system of a surgical instrument, according to at least one aspect of the present description.

[0043] Figure 33 illustrates a proximity index for correlating a sensor signal to the proximity of an end actuator, in accordance with at least one aspect of the present disclosure.

[0044] Figure 34 illustrates a logic flow diagram of a process that represents a control program or a logic configuration to determine the direction in which the cancerous tissue is situated in relation to an end actuator, according to at least one aspect of the present description.

[0045] Figure 35 illustrates a top view of an end actuator of a surgical instrument, in accordance with at least one aspect of the present description.

[0046] Figure 36 is a graph illustrating sensor signals representing a physiological parameter of tissue plotted as a function of time, in accordance with at least one aspect of the present description.

[0047] Figure 37 illustrates a partial view of an end actuator of a surgical instrument, according to at least one aspect of the present description.

[0048] Figure 38 is a graph illustrating sensor signals representing a physiological parameter of tissue plotted as a function of time, in accordance with at least one aspect of the present description.

[0049] Figure 39 is a logic flow diagram of a process representing a control program or a logic configuration to provide instructions for navigating an end actuator with respect to cancerous tissue, according to at least one aspect of the present description.

[0050] Figure 40 is a logic flow diagram of a process representing a control program or a logic configuration to provide instructions for navigating an end actuator with respect to cancerous tissue, according to at least one aspect of the present description.

[0051] Figure 41 is a graph illustrating sensor signals representing a physiological tissue parameter plotted as a function of time, in accordance with at least one aspect of the present disclosure.

[0052] Figure 42 illustrates a glucose sensor, in accordance with at least one aspect of the present disclosure.

[0053] Figure 43 illustrates an expanded view of the glucose sensor of Figure 42.

[0054] Figure 44 is a graph illustrating a plot of current versus potential, in accordance with at least one aspect of the present description.

[0055] Figure 45 is a graph illustrating a plot of net current versus glucose level, in accordance with at least one aspect of the present description.

[0056] Figure 46 is a timeline representing the situational recognition of a central surgical controller, in accordance with at least one aspect of the present description.

DESCRIPTION

[0057] The applicant of the present application holds the following US patent applications, filed on June 29, 2018, the description of each of which is incorporated herein by reference in its entirety: and US Patent Application No. series, titled

CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS, Proxy Document No. END8542USNP/ 170755; and US Patent Application Serial No., entitled CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSED CLOSURE PARAMETERS, Power of Attorney Document No. END8543USNP/170760; and US Patent Application Serial No., entitled SYSTEMS FOR ADJUSTING END EFFECTOR PARAMETERS BASED ON PERIOPERATIVE INFORMATION, Proxy No. END8543USNP1/170760-1; and US Patent Application Serial No., entitled SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING, Power of Attorney Document No. END8543USNP2/170760-2; and US Patent Application Serial No., entitled SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING, Power of Attorney Document No. END8543USNP3/170760-3; and US Patent Application Serial No.

SURGICAL SYSTEMS FOR DETECTING END EFFECTOR TISSUE DISTRIBUTION IRREGULARITIES, power of attorney document no. END8543USNP4/170760-4; and US Patent Application serial no., entitled SURGICAL INSTRUMENT CARTRIDGE SENSOR ASSEMBLIES, power of attorney document no. END8543USNP6/170760-6; and US Patent Application Serial No., entitled VARIABLE OUTPUT CARTRIDGE SENSOR ASSEMBLY, Proxy Document No. END8543USNP7/170760-7;

and US Patent Application Serial No., entitled SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE, Power of Attorney Document No. END8544USNP/170761; and US Patent Application Serial No., entitled SURGICAL INSTRUMENT HAVING A FLEXIBLE CIRCUIT, Power of Attorney Document No. END8544USNP1/170761-1; and US Patent Application serial no., entitled SURGICAL INSTRUMENT WITH A TISSUE MARKING ASSEMBLY, power of attorney document no. END8544USNP2/170761-2; and US Patent Application Serial No.

SURGICAL SYSTEMS WITH PRIORITIZED DATA TRANSMISSION CAPABILITIES, power of attorney document no. END8544USNP3/ 170761-3; and US Patent Application Serial No., entitled SURGICAL EVACUATION SENSING AND MOTOR CONTROL, Power of Attorney Document No. END8545USNP/170762; and US Patent Application Serial No., entitled SURGICAL EVACUATION SENSOR ARRANGEMENTS, Proxy Document No. END8545USNP1/170762-1; and US Patent Application Serial No., entitled SURGICAL EVACUATION FLOW PATHS, Proxy Document No. END8545USNP2/170762-2; and US Patent Application Serial No., entitled SURGICAL EVACUATION SENSING AND GENERATOR CONTROL, Power of Attorney Document No. END8545USNP3/170762-3; and US Patent Application Serial No., entitled SURGICAL EVACUATION SENSING AND DISPLAY, Power of Attorney Document No. END8545USNP4/170762-4; and US Patent Application Serial No. , entitled COMMUNICATION OF SMOKE EVACUATION SYSTEM PARAME-

TERS TO HUB OR CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM, power of attorney document no. END8546USNP/170763; and US Patent Application Serial No., entitled SMOKE EVACUATION SYSTEM INCLUDING A SEGMENTED CONTROL CIRCUIT FOR INTERACTIVE SURGICAL PLATFORM, Proxy Document No. END8546USNP1/170763-1; and US Patent Application Serial No.

SURGICAL EVACUATION SYSTEM WITH A COMMUNICATION

CIRCUIT FOR COMMUNICATION BETWEEN A FILTER AND A SMOKE EVACUATION DEVICE, power of attorney document no. END8547USNP/170764; and and US Patent Application Serial No., entitled DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS, Power of Attorney Document No. END8548USNP/170765.

[0058] The applicant of the present application holds the following provisional US patent applications, filed on June 28, 2018, the description of each of which is incorporated herein by reference in its entirety: and Provisional Patent Application US Serial No. 62/691,228, entitled A METHOD OF USING REINFORCED FLEX CIRCUITS WITH MULTIPLE SENSORS WITH ELECTROSURGICAL DEVICES; and US Provisional Patent Application Serial No. 62/691,227 entitled CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSED CLOSURE PARAMETERS; and US Provisional Patent Application Serial No. 62/691,230 entitled SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE; and US Provisional Patent Application Serial No. 62/691,219 entitled SURGICAL EVACUATION SENSING AND MOTOR CON-

TROL; and US Provisional Patent Application Serial No. 62/691,257 entitled COMMUNICATION OF SMOKE EVACUATION SYSTEM

PARAMETERS TO HUB OR CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM; and US Provisional Patent Application Serial No. 62/691,262 entitled SURGICAL EVACUATION SYSTEM WITH A COMMUNICA-

TION CIRCUIT FOR COMMUNICATION BETWEEN A FILTER AND A SMOKE EVACUATION DEVICE; and and US Provisional Patent Application Serial No. 62/691,251 entitled DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS.

[0059] The applicant of the present application holds the following US patent applications, filed on March 29, 2018, the description of each of which is incorporated herein by reference in its entirety: and US Patent Application No. serial 15/940,641 entitled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES; and US Patent Application Serial No. 15/940,648 entitled

INTERACTIVE SURGICAL SYSTEMS WITH CONDITION HANDLING OF DEVICES AND DATA CAPABILITIES; and US Patent Application Serial No. 15/940,656, entitled SURGICAL HUB COORDINATION OF CONTROL AND COMMUNICATION OF OPERATING ROOM DEVICES; and US Patent Application Serial No. 15/940,666 entitled SPATIAL AWARENESS OF SURGICAL HUBS IN OPERATING ROOMS; and US Patent Application Serial No. 15/940,670 entitled COOPERATIVE UTILIZATION OF DATA DERIVED FROM SECONDARY SOURCES BY INTELLIGENT SURGICAL HUBS;

and US Patent Application Serial No. 15/940,677 entitled SURGICAL HUB CONTROL ARRANGEMENTS; and US Patent Application Serial No. 15/940,632 entitled DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD; and US Patent Application Serial No. 15/940,640 entitled

COMMUNICATION HUB AND STORAGE DEVICE FOR STORING

PARAMETERS AND STATUS OF A SURGICAL DEVICE TO BE SHARED WITH CLOUD BASED ANALYTICS SYSTEMS; and US Patent Application Serial No. 15/940,645 entitled

SELF DESCRIBING DATA PACKETS GENERATED AT AN ISSUING INSTRUMENT; and US Patent Application Serial No. 15/940,649 entitled DATA PAIRING TO INTERCONNECT A DEVICE MEASURED PARAMETER WITH AN OUTCOME; and US Patent Application Serial No. 15/940,654 entitled SURGICAL HUB SITUATIONAL AWARENESS; and US Patent Application Serial No. 15/940,663 entitled SURGICAL SYSTEM DISTRIBUTED PROCESSING; and US Patent Application Serial No. 15/940,668 entitled AGGREGATION AND REPORTING OF SURGICAL HUB DATA; and US Patent Application Serial No. 15/940,671 entitled

SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER; and US Patent Application Serial No. 15/940,686 entitled DISPLAY OF ALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LINEAR STAPLE LINE; and US Patent Application Serial No. 15/940,700 entitled STERILE FIELD INTERACTIVE CONTROL DISPLAYS; and US Patent Application Serial No. 15/940,629 entitled

COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS; and US Patent Application Serial No. 15/940,704 entitled USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT; and US Patent Application Serial No. 15/940,722 entitled

CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OF MONO-CHROMATIC LIGHT REFRACTIVITY; and and US Patent Application Serial No. 15/940,742 entitled DUAL CMOS ARRAY IMAGING.

[0060] The applicant of the present application holds the following US patent applications, filed on March 29, 2018, the description of each of which is incorporated herein by reference in its entirety: and US Patent Application No. serial 15/940,636 entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES; and US Patent Application Serial No. 15/940,653 entitled

ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL HUBS; and US Patent Application Serial No. 15/940,660 entitled CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER; and US Patent Application Serial No. 15/940,679 entitled CLOUD-BASED MEDICAL ANALYTICS FOR LINKING OF LOCAL USAGE TRENDS WITH THE RESOURCE ACQUISITION BEHAV-IORS OF LARGER DATA SET; and US Patent Application Serial No. 15/940,694 entitled CLOUD-BASED MEDICAL ANALYTICS FOR MEDICAL FACILITY SEGMENTED INDIVIDUALIZATION OF INSTRUMENT FUNCTION; and US Patent Application Serial No. 15/940,634 entitled

CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES; and US Patent Application Serial No. 15/940,706 entitled

DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK; and and US Patent Application Serial No. 15/940,675 entitled CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES.

[0061] The applicant of the present application holds the following US patent applications, filed on March 29, 2018, the description of each of which is incorporated herein by reference in its entirety: and US Patent Application No. serial 15/940,627 entitled DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; and US Patent Application Serial No. 15/940,637 entitled COMMUNICATION ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; and US Patent Application Serial No. 15/940,642 entitled CONTROLS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; and US Patent Application Serial No. 15/940,676 entitled AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; and US Patent Application Serial No. 15/940,680 entitled CONTROLLERS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; and US Patent Application Serial No. 15/940,683 entitled COOPERATIVE SURGICAL ACTIONS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; and US Patent Application Serial No. 15/940,690 entitled DISPLAY ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; and and US Patent Application Serial No. 15/940,711 entitled SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS.

[0062] The applicant of the present application holds the following provisional US patent applications, filed on March 28, 2018, the description of each of which is incorporated herein by reference in its entirety: and Provisional Patent Application US 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 entitled 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 Interim Patent Application Serial No. 62/649,307 entitled AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; and and US Provisional Patent Application Serial No. 62/649,323 entitled SENSING. ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS.

[0063] The applicant of the present application holds the following provisional US patent applications, filed on April 19, 2018, the description of each of which is incorporated herein by reference in its entirety: and Provisional Patent Application US Serial No. 62/659,900, entitled METHOD OF HUB COMMUNICATION.

[0064] The applicant of the present application holds the following provisional US patent applications, filed on March 30, 2018, the description of each of which is incorporated herein by reference in its entirety: and Provisional Patent Application US Serial No. 62/650,887, entitled SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES;

and US Provisional Patent Application Serial No. 62/650,877 entitled SURGICAL SMOKE EVACUATION SENSING AND CONTROLS; and US Provisional Patent Application Serial No. 62/650,882 entitled SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM; and and US Provisional Patent Application Serial No. 62/650,898 entitled CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS.

[0065] The applicant of the present application holds the following US Provisional Patent Applications, filed on March 8, 2018, the description of each of which is incorporated herein by reference in its entirety: and Provisional Patent Application US Serial No. 62/640,417, entitled TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR; and and US Provisional Patent Application Serial No. 62/640,415 entitled ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR.

[0066] The applicant of the present application holds the following US Provisional Patent Applications, filed on December 28, 2017, the description of each of which is incorporated herein by reference in its entirety: and Provisional Patent Application US Serial No. 62/611,341, entitled INTERACTIVE SURGICAL PLATFORM; and US Provisional Patent Application Serial No. 62/611,340 entitled CLOUD-BASED MEDICAL ANALYTICS; and and US Provisional Patent Application Serial No. 62/611,339 entitled ROBOT ASSISTED SURGICAL PLATFORM.

[0067] Before explaining in detail the various aspects of the systems,

surgical topics and devices, 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 the parts illustrated in the drawings and the attached description. The illustrative examples may be implemented or incorporated in other aspects, variations and modifications, and may be practiced or performed in a variety of ways. Furthermore, except where otherwise indicated, terms and expressions used in the present invention have been chosen for the purpose of describing the illustrative examples for the convenience of the reader and not for the purpose of limiting the same. In addition, it is to be understood that one or more of the aspects, aspect expressions and/or examples described below may be combined with any one or more of the other aspects, aspect expressions and/or examples described below. Next.

[0068] Aspects of the present description present various surgical instruments used in the treatment of cancer, which employ various sensors and algorithms to assess proximity to cancerous tissue and/or to assist a user in navigating a safe distance in the direction opposite cancer tissue. Surgical instruments can be used alone or as components of an interactive computer-implemented surgical system.

[0069] Referring 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 device storage 105). Each surgical system 102 includes at least one central surgical controller 106 communicating with the cloud 104 which may include a remote server 113. In one example, as illustrated in Figure 1, the surgical system 102 includes a display system 108, a robotic system 110, an in-

handheld device 112, which are configured to communicate with each other and/or with the central controller 106. In some aspects, a surgical system 102 may include a number M of central surgical controllers 106, a number N of visualization systems 108, a number O of robotic systems 110, and a number P of smart handheld surgical instruments 112, where M, NO, and P are integers greater than or equal to one.

[0070] 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. One or more of the surgical instruments of the description can be implemented as robotic tools for use with a robotic system. A robotic system 110 is used in the surgical procedure as part of the surgical system 102. The robotic system 110 includes a surgeon's console 118, a patient cart 120 (surgical robot), and a robotic central surgical controller 122. patient 120 can manipulate at least one detachably attached surgical tool 117 through a minimally invasive incision in the patient's body while the surgeon views the surgical site through the surgeon's console 118. An image of the surgical site can be obtained by a medical imaging device 124, which can be manipulated by the patient cart 120 to orient the imaging device 124. The central robotic controller 122 can be used to process the surgical site images for subsequent display to the surgeon via the surgeon's console 118.

[0071] Other types of robotic systems can be readily adapted for use with the surgical system 102. Several examples of robotic systems and surgical instruments that are suitable for use with the present disclosure are described in the Patent Application

US Provisional Serial No. 62/611,339, titled ROBOT ASSISTED SURGICAL PLATFORM, filed December 28, 2017, the disclosure of which is incorporated herein by reference in its entirety.

[0072] Several examples of cloud-based analytical processes that are performed by cloud 104, and 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 December 28, 2017, the disclosure of which is incorporated herein by reference in its entirety.

[0073] In various aspects, the imaging device 124 includes at least an image sensor and one or more optical components. Suitable image sensors include, but are not limited to, charge-coupled device (CCD) sensors and complementary metal-oxide semiconductor (CMOS) sensors. ").

[0074] 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.

[0075] One or more lighting sources can be configured to radiate electromagnetic energy in the visible spectrum as well as 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 may be called visible light or simply light. A typical human eye will respond to wavelengths in the air that

range from about 380 nm to about 750 nm.

[0076] The invisible spectrum (ie the non-luminous spectrum) is that portion of the electromagnetic spectrum lying below and above the visible spectrum (ie wavelengths below about 380 nm and above about 750 nm). The invisible spectrum is not detectable by the human eye. Wavelengths longer than about 750 nm are longer than the visible red spectrum, and make infrared (IR), microwave, radio, and electromagnetic radiation invisible. Wavelengths shorter than about 380 nm are shorter than the ultraviolet spectrum, and become invisible ultraviolet, x-ray and electromagnetic gamma rays.

[0077] In many 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, choledochoscope, colonoscope, cytoscope, duodenoscope, enteroscope, esophagus-duodenoscope (gastroscope), endoscope, laryngoscope, nasopharyngo-neproscope, sigmoidoscope, thoracoscope and ureteroscope.

[0078] In one aspect, the imaging device employs multi-spectrum monitoring to discriminate topography and underlying structures. A multispectral image is one that captures image data within wavelength ranges along the electromagnetic spectrum. The wavelengths can be separated by filters or through the use of instruments that are sensitive to specific wavelengths, including light of frequencies beyond the visible light range, eg IR and ultraviolet light. Spectral images can allow the extraction of additional information that the human eye cannot capture with its receptors for red, green and blue colors. The use of multi-stage imaging

pecral is described in more detail under the title "Advanced Imaging Acquisition Module" in US Provisional Patent Application Serial No. 62/611,341 entitled INTERACTIVE SURGICAL PLATFORM, filed December 28, 2017, the description of which is incorporated herein. 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 previously described tests on treated tissue.

[0079] It is axiomatic that rigorous sterilization of the operating room and surgical equipment is a requirement during any surgery. Strict hygiene and the necessary sterilization conditions in a "operating room", ie an operating or treatment room, demand the highest possible sterilization of all medical devices and equipment. Part of this sterilization process is the need to sterilize everything that comes into contact with the patient or enters the sterile field, including the 124 imaging device and its connectors and components. It will be understood that the sterile field may be considered a specific area, such as inside a tray or on a sterile towel, which is considered to be free of microorganisms, or the sterile field may be considered an area immediately around a patient who has been prepared to perform a surgical procedure. The sterile field may include sterilized staff members, who are appropriately dressed, and all furniture and fixtures in the area.

[0080] 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 with respect to the field. sterile, as illustrated in Figure 2. In one aspect, the 108 visualization system includes an interface for Health Level 7,

image file and communication system, and Electronic Medical Record (EMR). Various components of the visualization system 108 are described under the title "Advanced Imaging Acquisition Module" in US Provisional Patent Application Serial No. 62/611,341 entitled INTERACTIVE SURGICAL PLATFORM, filed December 28, 2017, the description of which is here incorporated by way of reference in its entirety.

[0081] As illustrated in Figure 2, a primary screen 119 is positioned in the sterile field to be visible to the operator at the operating table 114. In addition, a viewing tower 111 is positioned outside the sterile field. Viewing tower 111 includes a first non-sterile screen 107 and a second non-sterile screen 109, which are opposite each other. The display system 108, guided by the central controller 106, is configured to use screens 107, 109, and 119 to coordinate the flow of information for operators in and out of the sterile field. For example, the central controller 106 may cause the visualization system 108 to display a snapshot of a surgical site, as recorded by an imaging device 124, on a non-sterile screen 107 or 109, while maintaining a live stream. of the surgical site on the main mesh 119. The snapshot on the non-sterile mesh 107 or 109 may allow a non-sterile operator to perform a diagnostic step relevant to the surgical procedure, for example.

[0082] In one aspect, the central controller 106 is also configured to route diagnostic input or feedback by a non-sterile operator at the viewing tower 111 to the primary screen 119 within the sterile field, where it can be viewed by a sterile operator on the operating table. In one example, the input may be in the form of a modification of the snapshot displayed on non-sterile screen 107 or 109, which can be routed to main screen 119 by the control.

center side 106.

[0083] Referring 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 surgical instrument screen 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 incorporated herein by reference in its entirety. Diagnostic input or feedback entered by a non-sterile operator into 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 viewed by the surgical instrument operator 112. Exemplary surgical instruments that are suitable for use with the surgical system 102 are described under the heading "Surgical Instrument Hardware" and in US Interim Patent Application Serial No. 62/611,341 entitled INTERACTIVE SURGICAL PLATFORM, filed December 28, 2017 , the disclosure of which is incorporated herein by reference in its entirety, for example.

[0084] Now referring to Figure 3, a central controller 106 is shown in communication with a display system 108, a robotic system 110 and a handheld smart surgical instrument 112. The central controller 106 includes a monitor 135, a imaging module 138, a generator module 140, a communication module 130, a processor module 132, and a storage array 134. In certain aspects, as illustrated in Figure 3, the central controller 106 additionally includes an imaging module 134. smoke evacuation 126 and/or a suction/irrigation module 128.

[0085] During a surgical procedure, the application of energy to tissue, for sealing and/or cutting, is usually associated with evasion.

smoke control, suction of excess fluid and/or tissue irrigation. Lines of fluid, energy and/or data from different sources are often intertwined during the surgical procedure. Valuable time can be lost in dealing with this issue during a surgical procedure. To untangle the lines it may be necessary to disconnect them from their respective modules, which may require a restart of the modules. The 136 central controller's modular enclosure provides a unified environment for managing power, data, and fluid lines, which reduces the frequency of entanglement between such lines.

[0086] Aspects of the present description present a central surgical controller for use in a surgical procedure that involves the application of energy to tissue at a surgical site. The central surgical controller includes a central controller housing and a combined generator module slidably received in a docking station of the central controller housing. The docking station includes data and power contacts. The combined generator module includes two or more of an ultrasonic energy generating component, a bipolar radio frequency (RF) energy generating component and a monopolar RF energy generating component that are housed in a single unit. In one aspect, the combined generator module also includes a smoke evacuation component, at least one power application cable to connect the combined generator module to a surgical instrument, at least one smoke evacuation component configured to evacuate smoke, fluid and/or particulates generated by the application of therapeutic energy to tissue, and a fluid line that extends from the remote surgical site to the smoke evacuation component.

[0087] 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 slidably received in the central controller compartment. In one aspect, the central controller housing comprises a fluid interface.

[0088] 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 tissue, while a different type of energy may be more beneficial for sealing tissue. For example, a bipolar generator can be used to seal the tissue, while an ultrasonic generator can be used to cut the sealed tissue. Aspects of the present description present a solution in which a modular housing of the central controller 136 is configured to accommodate different generators and facilitate interactive communication between them. One of the advantages of the 136 central controller modular enclosure is that it allows for quick removal and/or replacement of multiple modules.

[0089] Aspects of the present description present a modular surgical compartment for use in a surgical procedure that involves application of energy to tissue. The modular surgical compartment includes a first power generating module configured to generate a first power for application to tissue, and a first docking station comprising a first docking port that includes first data contacts and power contacts, being that the first power-generating module is slidingly movable into electrical engagement with the power and data contacts, and the first power-generating module being slidingly movable out of electrical engagement with the first two. the power and data contacts.

[0090] In addition to the above, the modular compartment also includes a second power generating module configured to generate a second power, different from the first power, for application to tissue, and a second docking station comprising a second docking port that includes second power and data contacts, the second power generating module being slidingly movable in electrical engagement with the power and data contacts, and the second power generating module being slidingly movable. sliding out of electrical hook with second power and data contacts.

[0091] In addition, the modular surgical compartment also includes a communication bus between the first docking port and the second docking port, configured to facilitate communication between the first power generator module and the second generator module power.

[0092] With reference to Figures 3 to 7, aspects of the present description are presented for a modular compartment of the central controller 136 that allows the modular integration of a generator module 140, a smoke evacuation module 126, and a module of suction/irrigation 128. The modular housing of the central controller 136 further facilitates interactive communication between modules 140, 126, 128. As illustrated in Figure 5, generator module 140 can be a generator module with single-pole, dual-core components. integrated polar and ultrasonic, supported in a single cabinet unit 139 sliderable into the central controller modular compartment 136. As illustrated in Figure 5, the generator module 140 can be configured to connect to a monopolar device 146, a bipolar device 147 and an ultrasonic device 148. Alternatively, generator module 140 may comprise a series of monopolar, bipolar and/or ultrasonic generator modules. rasonics that interact through the modular housing of the central controller 136. The modular housing of the central controller 136 can be configured to facilitate the insertion of multiple generators and the interactive communication between the generators anchored in the modular housing of the central controller 136 so that the generators would act as a single generator.

[0093] One or more of the monopolar device 146, bipolar device 147 and ultrasonic device 148 may be equipped with sensors and algorithms to assess proximity to cancerous tissue and/or to assist a user in navigating a safe distance in the opposite direction to the cancerous tissue, as described in more detail below.

[0094] In one aspect, the central controller modular housing 136 comprises a modular communication and power backplane 149 with external and wireless communication heads to allow removable attachment of modules 140, 126, 128 and interactive communication between the same.

[0095] In one aspect, the central controller modular housing 136 includes docking stations, or drawers, 151, here also called drawers, which are configured to slideways receive modules 140, 126, 128. Figure 4 illustrates a partial perspective view of a central surgical controller compartment 136, and a combined generator module 145 slidably received in a docking station 151 of the central surgical controller compartment 136. A docking port 152 with the power and data contacts on a rear side of the combined generator module 145 is configured to engage a corresponding docking port 150 with the power and data contacts of a corresponding docking station 151 of the central controller modular compartment 136 as per the combined generator module 145 is slid into position in the corresponding docking station 151 of the central controller's modular compartment 136. In one aspect, the combined generator module 145 includes a bipolar, ultrasonic and monopolar module and a smoke evacuation module integrated into a single cabinet unit 139, as illustrated in Figure 5.

[0096] In various aspects, the smoke evacuation module 126 includes a fluid line 154 that transports smoke and/or captured/collected fluid away from a surgical site and to, for example, the smoke evacuation module. 126. Vacuum suction originating from smoke evacuation module 126 can draw smoke into an opening in a utility conduit at the surgical site. The utility conduit, coupled to the fluid line, may be in the form of a flexible tube that terminates in the smoke evacuation module 126. The utility conduit and the fluid line define a fluid path that runs extends towards the smoke evacuation module 126 which is received in the central controller compartment 136.

[0097] 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 suction. of fluids to and from the surgical site.

[0098] In one aspect, the surgical tool includes a drive shaft that has an end actuator at a distal end thereof and at least one energy treatment associated with the end actuator, a suction tube, and a tube. of irrigation. The suction tube may have an inlet port on an ex-

distal tremolo thereof and the suction tube extends through the drive shaft. Similarly, an irrigation tube may extend through the drive shaft and may have an inlet port near the power application implement. The power delivery 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.

[0099] 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 may be housed in the suction/irrigation module 128. In one example, the fluid source and/or the vacuum source may be housed in the central controller compartment 136 separately from the suction/irrigation module 128. In such an example, a fluid interface may be configured to connect the suction/irrigation module 128 to the fluid source and/or the vacuum source.

[0100] In one aspect, the modules 140, 126, 128 and/or their corresponding docking stations in the central controller modular compartment 136 may include alignment features that are configured to align the docking ports of the modules in engagement with each other. their counterparts in the docking stations of the central controller modular compartment 136. For example, as illustrated in Figure 4, the combined generator module 145 includes side brackets 155 that are configured to slidably engage the corresponding brackets 156 of the docking station. 151 of the central controller modular compartment 136. The brackets cooperate to guide the docking port contacts of the combined generator module 145 into electrical engagement with the docking port contacts of the modular housing of the controller.

central troll 136.

[0101] In some respects, the units 151 of the central controller modular compartment 136 are the same or substantially the same size, and the modules are adjusted in size to be received in the units 151. For example, the side supports 155 and/or 156 can be larger or smaller depending on the module size. In other respects, the 151 drawers are different in size and each is designed to accommodate a specific module.

[0102] In addition, the contacts of a specific module can be keyed to engage with the contacts of a specific unit to avoid inserting a module into a unit with misaligned contacts.

[0103] As illustrated 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 modules housed in the modular compartment of the central controller 136. The docking ports 150 of the modular compartment of the central controller 136 may alternatively or additionally facilitate an interactive wireless communication between the modules housed in the modular compartment of the central controller 136. Any suitable wireless communication can be used, eg Air Titan Bluetooth.

[0104] Figure 6 illustrates individual power bus connectors for a plurality of side docking ports of a modular side cabinet 160 configured to receive a plurality of modules from a central surgical controller 206. The modular side cabinet 160 is configured to receive and laterally interconnect the modules 161. The modules 161 are slidably inserted into the docking stations 162 of the modular side cabinet 160, which includes a back plate for interconnecting the modules.

modules 161. As illustrated in Figure 6, the modules 161 are arranged sideways in the modular side cabinet 160. Alternatively, the modules 161 can be arranged vertically in a modular vertical cabinet.

[0105] Figure 7 illustrates a modular vertical cabinet 164 configured to receive a plurality of modules 165 from the central surgical controller 106. Modules 165 are slidably inserted into docking stations, or drawers, 167 of the vertical modular cabinet 164, which includes a back panel for interconnecting modules 165. Although the drawers 167 of the vertical modular cabinet 164 are arranged vertically, in certain cases, a modular vertical cabinet 164 may include drawers that are arranged laterally. . In addition, the modules 165 can interact with each other through the docking ports of the vertical modular cabinet 164. In the example of Figure 7, a screen 177 is provided to show data relevant to the operation of the modules 165. In addition , the vertical modular cabinet 164 includes a master module 178 that houses a plurality of submodules that are slidably received in the master module 178.

[0106] In various aspects, the imaging module 138 comprises an integrated video processor and a modular light source, and is adapted for use with various imaging devices. In one aspect, the imaging device is comprised of a modular cabinet that can be assembled with a light source module and a camera module. The cabinet can be a disposable cabinet. In at least one example, the disposable case is detachably coupled to a reusable controller, a light source module, and a camera module. The light source module and/or the camera module can be selectively chosen depending on the type of surgical procedure. In one aspect, the camera module

ra comprises a CCD sensor. In another aspect, the camera module comprises a CMOS sensor. In another aspect, the camera module is configured for scanned beam imaging. Similarly, the light source module can be configured to provide either a white light or a different light depending on the surgical procedure.

[0107] 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 can be an inefficient practice. Temporarily losing sight of the surgical field can lead to undesirable consequences. The imaging device module of the present description is configured to allow replacement of a light source module or a midstream camera module during a surgical procedure, without the need to remove the imaging device from the field. surgical.

[0108] In one aspect, the imaging device comprises a tubular housing that includes a plurality of channels. A first channel is configured to slide-receiving the camera module, which can be configured to snap-fit with the first channel. A second channel is configured to slide-receive the camera module, which can be configured for a "snap-fit" 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 in place of the press fit.

[0109] In several examples, multiple imaging devices are placed in different positions in the surgical field to provide multiple views. The imaging module 138 can be configured to switch between imaging devices to provide an optimal view. In various aspects, the imaging module 138 can be configured to integrate the images obtained from the different imaging devices.

[0110] Various image processors and imaging devices suitable for use with the present disclosure are described in US Patent No. 7,995,045 entitled COMBINED SBI AND CONVENTIONAL IMAGE PROCESSOR, issued August 9, 2011 which is incorporated herein as a reference in its entirety. In addition, US Patent No. 7,982,776 entitled SBI MOTION ARTIFACT REMOVAL APPARATUS AND METHOD, issued July 19, 2011, which is incorporated herein by reference in its entirety, describes various systems for removing motion artifacts from data. of image. Such systems can be integrated with the 138 imaging module. Additionally, the publication of US Patent Application No. 2011/0306840, entitled CONTROLLABLE MAGNETIC SOURCE TO FIXTURE INTRACORPOREAL APPARATUS, published on December 15, 2011, and US Patent Application Publication No. 2014/0243597, entitled SYSTEM FOR PERFORMING A MINIMALLY INVASIVE SURGICAL PROCEDURE, published August 28, 2014, is hereby fully incorporated by reference.

[0111] Figure 8 illustrates a surgical data network 201 comprising a central modular communication controller 203 configured to connect modular devices situated in one or more operating rooms of a healthcare facility, or any environment in a facility. from utilities specially equipped for surgical operations, to a cloud-based system (e.g., cloud 204 which may include a remote server 213 coupled to a storage device 205). In one aspect, the modular communication central controller 203 comprises a network central controller 207 and/or a network switch 209 in communication with a network router. The modular communication central controller 203 may 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 data, allowing 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 network central controller 207 or network switch 209. An intelligent surgical data network it can be called a central controller or controllable switch. A central switching controller reads the destination address of each packet and then forwards the packet to the correct port.

[0112] Modular devices 1a to 1n located in the operating room can be coupled to the central modular communication controller 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 1n to cloud 204 or local computer system

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

[0113] It will be understood that the surgical data network 201 may be expanded by interconnecting the multiple network central controllers 207 and/or the multiple network switches 209 with multiple network routers 211. The modular communication central controller 203 may be contained in a modular control tower configured to receive multiple 1a to 1n/2a to 2m devices. The local computer system 210 may also be contained in a modular control tower. The modular communication central controller 203 is connected to a screen 212 to display the images obtained by some of the devices 1a to 1n/2a to 2m, for example, during surgical procedures. In various aspects, devices 1a to 1n/2a to 2m may include, for example, various modules such as an imaging module 138 coupled to an endoscope, a generator module 140 coupled to an energy-based surgical device, a smoke 126, a suction/irrigation module 128, a communication module 130, a processor module 132, a storage array 134, a surgical device coupled to a screen and/or a non-contact sensor module, among other devices. modular devices that can be connected to the central modular communication controller 203 of the surgical data network 201.

[0114] In one aspect, the surgical data network 201 may comprise a combination of central network controllers, network switches, and network routers that connect 1a to 1n/2a to 2m devices to the cloud. Any or all 1a to 1n/2a to 2m devices coupled to the central network controller or network switch can collect data in real time and transfer data to cloud computers for data processing and manipulation. It will be understood that cloud computing depends on sharing computing resources rather than 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 to it. Consequently, the term "cloud computing" may be used here to refer to "a type of Internet-based computing" in which different services — such as servers, storage, and applications — are applied to the modular central communication controller 203 and /or the computer system 210 located in the operating room (e.g., a fixed, mobile, temporary room or space, or field of operation) and devices connected to the central modular communication controller 203 and/or the computer system 210 over the Internet. 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 1a to 1n/2a to 2m devices 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. Central controller hardware allows multiple devices or connections to be connected to a computer that communicates with cloud computing and storage resources.

[0115] Applying cloud computer data processing techniques to the data collected by 1a to 1n/2a to 2m devices, the surgical data network provides better surgical outcomes, reduced costs and better patient satisfaction. at me-

in some of the 1a to 1n/2a to 2m devices can be used to visualize tissue states to assess the occurrence of leaks or perfusion of sealed tissue after a tissue sealing and cutting procedure. At least some of the 1a to 1n/2a to 2m devices can be used to identify pathology, such as disease effects, using cloud-based computing to examine data including images of body tissue samples for diagnostic purposes. . This includes location and confirmation of tissue margin and phenotypes. At least some of the 1a to 1n/2a to 2m devices can be used to identify anatomical structures of the body using a variety of sensors integrated with imaging devices and techniques such as overlaying images captured by multiple imaging devices. Data collected by devices 1a to 1n/2a to 2m, including image data, can be transferred to the cloud 204 or the local computer system 210, or both, for data processing and manipulation including data processing and manipulation. Image. Data can be analyzed to improve surgical procedure outcomes by determining whether additional treatment, such as application of endoscopic intervention, emerging technologies, a targeted radiation, targeted intervention, robotics precise to specific sites and tissue conditions , can be followed. This data analysis can additionally use analytical processing of the results, and using standardized approaches can provide standardized feedback beneficial both to confirm surgical treatments and surgeon behavior or to suggest modifications to surgical treatments and surgeon behavior. surgeon.

[0116] In one implementation, OR devices 1a to 1n can be connected to the modular central communication controller 203 via a wired channel or a wireless channel depending on the configuration of devices 1a to 1h in a central network controller. The central network controller 207 can be implemented, in one aspect, as a local network transmission device that acts on the physical layer of the OSI model ("open system interconnection". The central network controller provides connectivity to devices 1a to 1n situated on the same network as the operating room. The network central controller 207 collects data in the form of packets and sends them to the router in "half-duplex" mode. The network central controller 207 does not store any media access control/internet protocol (MACY/IP) to transfer the device data. 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 has no routing tables or intelligence about where to send information and transmits all network data through each connection and to a remote server 213 (Figure 9) in the cloud 204. The central network controller 207 can detect basic network errors such as collisions, but having all the information transmitted to multiple input ports can be a security risk and cause bottlenecks.

[0117] In another implementation, operating room devices 2a to 2m can be connected to a network switch 209 via a wired or wireless channel. Network key 209 works at the data connection layer of the OSI model. Network switch 209 is a multicast device for connecting devices 2a to 2m located in the same operation center to the network. Network switch 209 sends data in the form of frames to network router 211 and operates in "full-duplex" mode. Multiple devices 2a to 2m can send data at the same time via network key 209. Network key 209 stores and uses MAC addresses of devices 2a to 2m to transfer data.

[0118] Network central controller 207 and/or network switch 209 are coupled to network router 211 for a connection to cloud 204. Network router 211 operates at the network layer of the OSI model. Network router 211 creates a route to transmit data packets received from network central controller 207 and/or network switch 211 to cloud-based computer resources for further processing and manipulation of data collected by any or all of the 1a to 1n/ 2a to 2m devices. Network router 211 can be used to connect two or more different networks located in different locations, such as different operating rooms in the same healthcare facility or different networks located in different operating rooms in different facilities. health services. Network router 211 sends data in the form of packets to cloud 204 and operates in "full-duplex" mode. Multiple devices can send data at the same time. Network router 211 uses IP addresses to transfer data.

[0119] In one example, the network central controller 207 can be implemented as a USB central controller, which allows multiple USB devices to be connected to a host computer. The USB central controller can expand a single USB port to multiple levels so that there are more ports available to connect the devices to the system's host computer. The central network controller 207 may include wired or wireless capabilities to receive information about a wired channel or a wireless channel. In one aspect, a short-range, high-bandwidth wireless USB radio communication protocol can be used for communication between devices 1a to 1n and devices 2a to 2m situated in the operating room.

[0120] In other examples, operating room devices 1a to 1n/2a to 2m can communicate with the central modular communication controller 203 via standard wireless Bluetooth technology for exchanging data over short distances ( using short-wavelength UHF radio waves in the 2.4 to 2.485 GHz ISM band) from fixed and mobile devices and building personal area networks (PANs). In other respects, operating room devices 1a to 1n/2a to 2m can communicate with the 203 modular communication central controller via a number of wireless and wired communication standards or protocols, including but not limited to limited to, Wi-Fi (IEEE 802.11 family), WiMAX (IEEE 802.16 family), IEEE 802.20, long-term evolution (LTE, "long-term evolution"), and Ev-DO, HSPA+, HSDPA+, HSUPAr, EDGE , GSM, GPRS, CDMA, TDMA, DECT, and Ethernet derivatives thereof, as well as any other wireless and wired protocols that are designated as 3G, 4G, 5G, and beyond. The computing module may include a plurality of communication modules. For example, a first communication module can be dedicated to short-range wireless communications like Wi-Fi and Bluetooth, and a second communication module can be dedicated to longer-range wireless communications like GPS, EDGE, GPRS, CDMA , Wi-MAX, LTE, Ev-DO, and others.

[0121] Modular Communications Central Controller 203 can serve as a central connection for one or all of the 1a to 1n/2a to 2m operating room devices and handles a type of data known as frames. Frames carry the data generated by devices 1a to 1n/2a to 2m. When a frame is received by the central modular communication controller 203, it is amplified and transmitted to the network router 211, which transfers the data to the cloud computing resources using a series of standards or protocols. of wireless or wired communication, as described in this description.

[0122] The 203 Modular Communications Core Controller can be used as a standalone device or be connected to compatible core network controllers and network switches to form a larger network. The 203 modular communication central controller is generally easy to install, configure, and maintain, making it a good choice for networking devices 1a to 1n/2a to 2m from the operating room.

[0123] Figure 9 illustrates a computer-implemented interactive surgical system 200. The computer-implemented interactive surgical system 200 is similar in many respects to the computer-implemented interactive surgical system 100. For example, the interactive, computer-implemented surgical system 200 is similar in many respects to the computer-implemented interactive surgical system 100. 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 that may include a remote server 213. In In one aspect, the computer-implemented interactive surgical system 200 comprises a modular control tower 236 connected to multiple operating room devices such as smart surgical instruments, robots, and other computerized devices located in the operating room. of operations. As shown in Figure 10, the modular control tower 236 comprises a modular communication central controller 203 coupled to a computer system 210. As illustrated in the example of Figure 9, the modular control tower 236 is coupled to a 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 module processor 232, a storage array 234, an intelligent device/instrument 235 optionally coupled to a display 237, and a non-contact sensor module 242. Operating room devices are coupled to cloud computing resources and the data storage via modular control tower 236. Robot central controller 222 can also be connected to modular control tower 236 and cloud computing resources. Devices/Instruments 235, display systems 208, among others, can be coupled to modular control tower 236 via wired or wireless communication standards or protocols, as described in the present description. Modular control tower 236 may be coupled to a central controller display 215 (e.g., monitor, display) to display and overlay images received from the imaging module, device/instrument display, and/or other display systems 208 The central controller screen can also display data received from devices connected to the modular control tower together with images and superimposed images.

[0124] 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 central modular communication controller 203, for example, a device - network connectivity facility, and a computer system 210 to provide local processing, display and imaging, for example. As shown in Figure 33, the modular communication central controller 203 can be connected in a layered configuration to expand the number of modules (e.g. devices) that can be connected to the modular communication central controller 203 and transfer to the computer system 210 data associated with the modules, cloud computing resources, or both. As shown in Figure 10, each of the central controllers/network switches in the modular communication central controller 203 includes three downstream ports and one upstream port. The upstream central controller/network switch is connected to a processor to provide a communication link with cloud computing resources and a local display 217. Communication with the cloud 204 may be via a communication channel. wired or wireless.

[0125] 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 laser or ultrasonic measurement devices. An ultrasound-based non-contact sensor module scans the operating room by transmitting a burst of ultrasound and receiving the echo as it bounces off the surrounding walls of an operating room, as described under the heading "Surgical Hub Spatial Awareness Within an Operating Room". Room" in US Provisional Patent Application Serial No. 62/611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed December 28, 2017, which is incorporated herein by reference in its entirety, 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 perimeter walls of the operating room, and comparing the phase of the transmitted pulse to the received pulse to determine the size of the operating room and to adjust the Bluetooth pairing distance limits, for example.

[0126] The computer system 210 comprises a processor 244 and a network interface 245. The processor 244 is coupled to a communication module 247, a storage 248, a memory 249, a non-volatile memory 250 and an input/output interface. exit

251 over a system bus. The system bus can be any of several types of bus structures, such as a memory bus or memory controller, a peripheral bus or external bus, and/or a local bus that uses any variety of bus architectures available in the system. - Including, but not limited to, 9-bit bus, Industry Standard Architecture (ISA), Micro-Charmel Architecture (MSA), Extended ISA (EISA), Intelligent Drive Electronic Circuits (IDE), Bus VESA locale (VLB), Peripheral Component Interconnect (PCI), USB, Accelerated Graphics Port (AGP), PCMCIA (Personal Computer Memory Card International Association) bus, Personal Computer Memory Card International Association Small Computer Systems (SCSI), or any other proprietary bus.

[0127] The 244 processor can be any single-core or multi-core processor, such as those known under the tradename ARM Cortex available from Texas Instruments. In one aspect, the processor may be a Core Cortex-M4F LM4F230H5QR ARM processor, available from Texas Instruments, for example, comprising 256 KB single-cycle flash memory, or other non-volatile memory, of up to 40 MHz, a prefetch buffer to optimize performance above 40 MHz, a 32KB single-cycle serial random access memory (SRAM), an internal read-only memory (ROM) loaded with StellarisWareO software, 2 KB programmable and electrically erasable readout (EEPROM), one or more pulse width modulation (PWM) modules, one or more analog quadrature encoder (QEI) inputs, one or more analog-to-digital converters ( ADC) 12-bit with 12 analog input channels, details of which are available for the product data sheet.

[0128] In one aspect, the 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 available from Texas Instruments. The safety controller can be configured specifically for safety critical applications IEC 61508 and ISO 26262, among others, to provide advanced built-in safety features while providing scalable performance, connectivity and memory options.

[0129] System memory includes volatile memory 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 nonvolatile memory. For example, non-volatile memory may include ROM, programmable ROM (PROM), electrically programmable ROM (EPROM), EEPROM, or flash memory. Volatile memory includes random access memory (RAM), which acts as external cache memory. Additionally, 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).

[0130] Computer system 210 also includes removable/non-removable, volatile/non-volatile computer storage media, such as disk storage. Disk storage includes, but is not limited to, devices such as a magnetic disk drive, floppy disk drive, tape drive, Jaz drive, Zip drive, LS-60 drive, flash memory card, or memory stick ( pen drive). In addition, the storage disk can include storage media separately or in combination.

tion with other storage media including, but not limited to, an optical disc drive such as a compact disc ROM (CD-ROM) device, a recordable compact disc drive (CD-R Drive), a disc drive rewritable compact disc (CD-RW drive), or a digital versatile disc ROM (DVD-ROM) drive. To facilitate the connection of disk storage devices to the system bus, a removable or non-removable interface can be used.

[0131] It is to be understood that the computer system 210 includes software that acts as an intermediary between users and the basic computer resources described in a suitable operating environment. Such software includes an operating system. The operating system, which can be stored on disk storage, acts to control and allocate computer system resources. System applications benefit from management capabilities by the operating system through program modules and “program data stored in system memory or on the storage disk. It is to be understood that various components described in the present invention may be implemented with various operating systems or combinations of operating systems.

[0132] A user enters commands or information into the computer system 210 through the input device(s) coupled to the I/O interface 251. Input devices include, but are not limited to, a pointing device such as a mouse, trackball, stylus, touchpad, keyboard, microphone, joystick, game pad, satellite card, scanner, TV tuner card, digital camera, digital video camera, web camera, and the like. These and other input devices connect to the processor via the system bus via the interface port(s). 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, displays, 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 connecting the output device to the system bus. It should be noted that other devices and/or device systems, such as remote computers, provide input and output capabilities.

[0133] 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, networked personal computer, workstation, microprocessor-based appliance, peer device, or other common network node, and the like, and typically include - on many or all of the elements described in relation to the computer system. For the sake of brevity, only one memory storage device is illustrated with the remote computer. Remote computers are logically connected to the computer system through a network interface and then physically connected through a communication link. The network interface covers communication networks such as local area networks (LANs) and wide area networks (WANs). LAN technologies include Fiber Distributed Data Interface (FDDI), Copper Distributed Data Interface (CDDI), Ethernet/IEEE 802.3, Token Ring/IEEE 802.5 and the like. WAN technologies include, but are not limited to, point-to-point links, circuit-switched networks such as integrated services digital networks (ISDN) and variations thereof, packet-switched networks, and digital subscriber lines (DSL). ).

[0134] In various aspects, the computer system 210 of Figure 33, the imaging module 238 and/or the display system 208, and/or the processor module 232 of Figures 9 and 10 may comprise a data processor. image, an image processing engine, a media processor, or any specialized digital signal processor (PSD) used to process digital images. The image processor can employ parallel computing with single instruction multiple data (SIMD) or multiple instruction multiple data (MIMD) technologies to increase speed and efficiency. The digital image processing engine can perform a number of tasks. The image processor can be a system on an integrated circuit with a multi-core processor architecture.

[0135] 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 may also be external to the computer system 210. The hardware/software required for connection to the network interface includes, for illustrative purposes only, technology. internal and external logics such as modems, including regular telephone serial modems, cable modems and DSL modems, ISDN adapters and Ethernet cards.

[0136] Figure 11 illustrates a functional block diagram of an aspect of a USB 300 network central controller device, in accordance with at least one aspect of the present disclosure. In the illustrated aspect, the USB 300 network central controller device uses a TUSB2036 integrated circuit central controller available with the

Texas Instruments. The USB 300 Network Central Controller is a CMOS device that provides one USB upstream transceiver port 302 and up to three USB downstream transceiver ports 304, 306, 308 in compliance with the USB 2.0 specification. Upstream USB transceiver port 302 is a differential data root port comprising a "minus" differential data input (DMO) paired with a "plus" differential data input (DPO). The three downstream USB transceiver ports 304, 306, 308 are differential data ports, with each port including "plus" differential data outputs (DP1-DP3) paired with "minus" differential data outputs. " (DM1-DM3).

[0137] The USB 300 network central 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 in the circuit for USB upstream transceiver port 302 and all USB downstream transceiver ports 304, 306, 308. USB downstream transceiver ports 304, 306, 308 support both full speed and low speed by automatically setting the scan rate according to the speed of the device attached to the ports. The USB 300 network central controller device can be configured in either bus-powered or self-powered mode and includes 312 central controller power logic to manage power.

[0138] The USB 300 Network Central Controller Device includes a 310 Serial Interface Engine (SIE). The SIE 310 is the hardware front end of the USB 300 network central controller and handles most of the protocol described in Chapter 8 of the USB specification. The SIE 310 typically understands signaling down to the transaction level. The functions he handles could include: recognition

packet processing, transaction sequencing, SOP, EOP, RESET, and RESUME signal detection/generation, clock/data separation, non-return-to-inverted (NRZI) data encoding/decoding, CRC (token) generation and verification and data), packet ID (PID) generation and verification/decoding, and/or serial-parallel/parallel-serial conversion. 310 receives a clock input 314 and is coupled to a suspend/resume and frame timer logic circuit 316 and a central controller repeater circuit 318 to control communication between the USB upstream transceiver port 302 and the transceiver ports. USB downstream 304, 306, 308 through the logic circuits of ports 320, 322, 324. The SIE 310 is coupled to a command decoder 326 through the logic interface to control the commands of a serial EEPROM through an interface of EEPROM in series 330.

[0139] In many respects, the USB 300 network central controller can connect 127 functions configured in up to six logical layers (levels) to a single computer. In addition, the USB 300 network central controller can connect all peripherals using a standard four-wire cable that provides both communication and power distribution. Power settings are bus-powered and self-powered modes. The USB 300 network central controller can be configured to support four power management modes: a bus-powered central controller with single port power management or grouped port power management, and the au central controller. - powered, with individual port power management or grouped port power management. In one aspect, with the use of a USB cable, the USB network central controller 300, the USB upstream transceiver port 302 is plugged into a USB host controller, and the USB downstream transceiver ports 304,

306, 308 are exposed for connecting compatible USB devices, and so on. Surgical instrument hardware

[0140] Figure 12 illustrates a logic diagram of a control system 470 of a surgical instrument or tool, in accordance with one or more aspects of the present description. The control circuit includes a microcontroller 461 comprising a processor 462 and a memory 468. One or more of sensors 472, 474, 476, for example, provide real-time feedback to the processor.

462. A motor 482, driven by a motor driver 492, operatively couples a longitudinally movable displacement member to drive the i-profile beam cutting element. A tracking system 480 is configured to determine the position of the longitudinally movable displacement member. Position information is provided to the 462 processor, which can be programmed or configured to determine the position of the longitudinally movable drive member, as well as the position of a firing member, firing bar, and a cutting element. of the beam with profile in i. Additional motors can be provided on the instrument driver interface to control | profile beam firing, closing tube travel, drive shaft rotation and articulation. A 473 screen displays a variety of instrument operating conditions and may include touch screen functionality for data entry. The information displayed on the 473 screen can be overlaid with images captured using endoscopic imaging modules.

[0141] In one aspect, the 461 microcontroller can be any single-core or multi-core processor, such as those known under the tradename ARM Cortex available from Texas Instruments. In one aspect, the main microcontroller 461 may be an LM4F230H5QR ARM Cortex-M4F processor, available from Texas Instruments, for example, which comprises an integrated memory of 256 KB single-cycle flash memory, or other memory not included. volatile, 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 StellarisWareO software, programmable and electrically erasable read-only memory (EEPROM) of 2 KB, one or more pulse width modulation (PWM) modules, one or more analogue quadrature encoder (QEI) inputs ), and/or one or more 12-bit analog-to-digital converters (ADC) with 12 analog input channels, details of which are available in the product data sheet.

[0142] In one aspect, the microcontroller 461 may comprise a safety controller comprising two controller-based families, such as TMS570 and RM4x, known under the trade name Hercules ARM Cortex R4, also available from Texas Instruments. The safety controller can be configured specifically for safety critical applications IEC 61508 and ISO 26262, among others, to provide advanced built-in safety features while providing scalable performance, connectivity and memory options.

[0143] The 461 controller can be programmed to perform various functions, such as precisely controlling 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 may be a brushed direct current (DC) motor with a gearbox and mechanical links with a knuckle or knife system. In one aspect, a 492 motor driver may be an A3941 available from Allegro Microsystems, Inc. Other drivers are available from Allegro Microsystems, Inc.

Motor nators can be readily replaced for use in the 480 tracking system which comprises an absolute positioning system. A detailed description of an absolute positioning system is described in US Patent Application Publication No. 2017/0296213 entitled SYSTEMS AND METHODS FOR CONTROLLING A SURGICAL STAPLING AND CUTTING INSTRUMENT, published October 19, 2017, which is incorporated herein by reference in its entirety.

[0144] The 461 microcontroller can be programmed to provide precise control of the speed and position of travel members and linkage systems. The microcontroller 461 can be configured to compute a response in the software of the microcontroller 461. The computed response is compared to a measured response from the real system to obtain an "observed" response, which is used for actual decisions based on feedback. The observed response is a favorable, adjusted value that balances the uniform and continuous nature of the simulated response with the measured response, which can detect external influences on the system.

[0145] In one aspect, the 482 motor can be controlled by the 492 motor driver and can be used by the triggering system of the instrument or surgical tool. In various forms, the 482 motor can be a brushed direct current (DC) drive motor, with a maximum rotational 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 electric motor. The 492 motor driver may comprise an H-bridge driver comprising field-effect transistors (FETs), for example. The 482 motor can be powered by a power pack releasably mounted on the grip assembly.

dura or tool cabinet to provide control power to the surgical instrument or tool. The power pack may comprise a battery which may include a number of battery cells connected in series which may 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 (Li) batteries that can be attachable and detachable from the power pack.

[0146] The 492 motor driver can be an A3941, available from Allegro Microsystems, Inc. The 492 A3941 driver is a full bridge controller for use with semiconductor metal oxide field effect transistors (MOSFET - " Metal-Oxide Semiconductor Field-Effect Transistor") external power, N-channel, specifically designed for inductive loads such as brushed direct current motors. The 492 driver comprises a single charge pump regulator that provides full port actuation (>10V) for battery voltages up to 7V and allows the A3941 to operate with a reduced port actuation, up to 5.5V. An input drive capacitor can be employed to supply the above battery supply voltage required for N-channel MOSFETs. An internal charge pump for the upside drive allows direct current (100% duty cycle) operation. The entire bridge can be driven in fast or slow decay modes using diodes or synchronous rectification. In slow-fall mode, current recirculation can be via FET from either the upside or the downside. Power FETs are protected from the shoot-through effect by programmable dead-time resistors. Built-in diagnostics provide indication of undervoltage, overvoltage,

temperature and power bridge faults and can be configured to protect power MOSFETs under most short circuit conditions. Other motor drives can be readily replaced for use in the 480 tracking system comprising an absolute positioning system.

[0147] Tracking system 480 comprises a controlled motor drive circuit arrangement comprising a position sensor 472 in accordance with at least one aspect of this description. The 472 position sensor 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 in mesh with a corresponding drive gear of a gear reducer assembly. In other aspects, the displacement member represents the trigger member, which may be adapted and configured to include a rack of drive teeth. In yet another aspect, the displacement member represents a trigger bar or i-profile beam, each of which can be adapted and configured to include a rack of drive teeth. Consequently, as used in the present invention, the term displacement member is used generically to refer to any movable member of the surgical tool or instrument, such as the drive member, the trigger member, the trigger bar. , the i-profile beam or any element that can be moved. In one aspect, the longitudinally movable drive member is coupled to the trigger member, the trigger bar and the i-profile beam. Consequently, the absolute positioning system can, in fact, track the linear displacement of the i-profile beam by scratching.

linear displacement training of the longitudinally movable drive member. In various other aspects, the displacement member may be coupled to any suitable position sensor 472 for measuring linear displacement. In this way, the longitudinally movable drive member, trigger member, trigger bar or i-profile beam, 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 sliding potentiometer, a magnetic sensing system comprising a moving magnet and a series of linearly arranged Hall effect sensors. , a magnetic detection system comprising a fixed magnet and a series of linearly arranged Hall effect sensors, an optical detection system comprising a moving light source and a series of linearly arranged photodiodes or photodetectors, a detection system optical system comprising a fixed light source and a series of moving linearly arranged photodiodes or photodetectors, or any combination thereof.

[0148] The 482 electric motor may include a rotating drive shaft, operationally interfaced with a gear assembly, which is mounted in mating engagement with a drive tooth assembly or rack on the drive member. A sensing element may be operatively coupled to a gear assembly so that a single revolution of position sensing element 472 corresponds to some linear longitudinal translation of the displacement member. An arrangement of gears and sensors may be connected to the linear actuator via a rack and pinion arrangement, or a rotary actuator via a sprocket or other connection. A power source supplies power to the absolute positioning system and an output indicator can display the output of the absolute positioning system. The drive member represents the longitudinally movable drive member which comprises a rack of drive teeth formed therein for meshing with a corresponding drive gear of the gear reducer assembly. The displacement member represents the longitudinally movable firing member, firing bar, i-profile beam, or combinations thereof.

[0149] A single revolution of the sensing element associated with the position sensor 472 is equivalent to a linear longitudinal displacement di of the displacement member, where d1 is the linear longitudinal distance by which the displacement member moves from point "a" to point "b" after a single revolution of the sensing element coupled to the displacement member. The array of sensors can be connected via a gear reduction which results in the position sensor 472 completing one or more revolutions for the full stroke of the displacement member. The 472 position sensor can complete multiple revolutions for the full stroke of the displacement member.

[0150] A series of switches, where n is an integer greater than one, can be employed alone or in combination with a gear reduction to provide a single position signal for more than one revolution of the 472 position sensor. of the switches is fed back to the microcontroller 461 which applies logic to determine a unique position signal corresponding to the longitudinal linear displacement d1 + d2 + ... of the displacement member. The output of position sensor 472 is fed to microcontroller 461. Position sensor 472 of the sensor array may comprise a magnetic sensor, an analog rotary sensor such as a potentiometer, or a series of analog Hall effect elements. , which output a unique combination of position signals or values.

[0151] Position sensor 472 can comprise any number of magnetic sensing elements, such as 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 flowmeter, saturated flow, optical pumping, nuclear precession, SQUID, Hall effect, anisotropic magnetoresistance, giant magnetoresistance, magnetic tunnel junctions, giant magnetoimpedance, magnetostrictive/piezoelectric compounds, magnetodiode, magnetic transistor, optical fiber, magneto-optic and magnetic sensors based on microelectromechanical systems, among others.

[0152] In one aspect, the position sensor 472 for the tracking system 480 which comprises an absolute positioning system comprises a magnetic rotary absolute positioning system. The 472 position sensor can be implemented as an ASSOSSEQFT single integrated circuit magnetic rotary position sensor available from Austria Microsystems, AG. Position sensor 472 interfaces with microcontroller 461 to provide an absolute positioning system. The 472 position sensor is a low voltage, low power component and includes four Hall 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 rotating coordinates) processor, also known as the digit-by-digit method and Volder algorithm, is provided to implement a simple and efficient algorithm for computing hyperbolic and trigonometric functions that require only addition operations. , subtraction, bit shift and lookup table. Angle position, alarm bits, and magnetic field information are transmitted through a standard serial communication interface, such as a serial peripheral interface (SPI), to the 461 microcontroller. The 472 position sensor provides 12 or more 14 bit resolution. The 472 position sensor can be an ASS055 integrated circuit supplied in a small 16-pin QFN package whose measurement corresponds to 4x4x0.85 mm.

[0153] The 480 tracking system comprising an absolute positioning system may comprise and/or be programmed to implement a feedback controller, such as a PID, status feedback, and adaptive controller. A power source converts the feedback controller signal into a physical input to the system, in this case voltage. Other examples include a voltage, current, and power PWM. Other sensors may be provided to measure physical system parameters in addition to the position measured by the 472 position sensor. In some respects, the other sensors may include sensor arrangements as described in US Patent No. 9,345,481 entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, granted May 24, 2016, which is hereby fully incorporated by reference; US Patent Application Publication No. 2014/0263552, titled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, published September 18, 2014, which is incorporated herein by reference in its entirety; and US Patent Application Serial No. 15/628,175, entitled TECHNIQUES FOR ADAPTIVE CONTROL OF MOTOR VELOCITY OF A SURGICAL STAPLING AND CU-

TTING INSTRUMENT, filed on June 20, 2017, which is hereby fully incorporated by reference. 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 may comprise a compare and match circuit to match a computed response with a measured response through the use of algorithms, such as a weighted average and a theoretical control loop, that drive the calculated response toward 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 outputs of the physical system will be, given the input.

[0154] 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 driving member to the reset position (zero or initial), as may be required by conventional rotary encoders which merely count the number of forward or backward steps the motor 482 has taken to infer the position of an actuator device, drive bar, knife, or the like.

[0155] A 474 sensor, such as a strain gauge or a micro-strain gauge, is configured to measure one or more end actuator parameters, such as the magnitude 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 processor 462. Alternatively, or in addition to sensor 474, a sensor 476, such as a load sensor, can measure the closing force applied by the actuation system. anvil closure. Sensor 476, such as a load sensor, can measure the trigger force applied to an i-profile beam in a trigger stroke of the tool or surgical system. The i-profile beam is configured to engage a wedge slider, which is configured to move the clamp drivers upward to force the clamps to deform in contact with an anvil. The i-profile beam includes a sharp cutting edge that can be used to separate fabric, as the | is advanced distally by the trigger bar. Alternatively, a current sensor 478 may be employed to measure the current drawn by the motor 482. The force required to advance the firing member may correspond to the current drawn by the motor 482, for example. The measured power is converted into a digital signal and fed to the 462 processor.

[0156] In one embodiment, a 474 strain gauge sensor may be used to measure the force applied to 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 tissue held by the end actuator comprises a strain gauge sensor 474, such as 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 may measure the magnitude or magnitude of strain exerted on a gripper member of an end actuator during a gripping operation, which may be indicative of tissue compression. The measured effort is converted into a digital signal and fed to the processor 462 of a microcontroller 461. A load sensor 476 can measure the force used to operate the element.

cutting tool, for example, to cut tissue captured between the anvil and staple cartridge. A magnetic field sensor can be used to measure the thickness of captured tissue. The magnetic field sensor measurement can also be converted to a digital signal and fed to the 462 processor.

[0157] Measurements of tissue compression, tissue thickness, and/or force required to close the end actuator in tissue, as respectively measured by sensors 474, 476, can be used by microcontroller 461 to characterize the position selected of the triggering member and/or the corresponding value of the speed of the triggering member. In one case, a memory 468 can store a technique, an equation and/or a query table that can be used by the microcontroller 461 in the evaluation.

[0158] The 470 control system of the instrument or surgical tool may also comprise wired or wireless communication circuits for communication with the central modular communication controller shown in Figures 8 to 11.

[0159] Figure 13 illustrates a control circuit 500 configured to control aspects of the surgical instrument or tool, in accordance with at least one aspect of this description. Control circuit 500 can be configured to implement various processes described herein. Control circuit 500 may comprise a microcontroller comprising one or more processors 502 (e.g., microprocessor, microcontroller) coupled to at least one memory circuit 504. Memory circuit 504 stores machine-executable instructions which, when executed by processor 502, cause processor 502 to execute machine instructions to implement various of the processes described herein. Processor 502 can be any of a number of single-core or multi-core processors known in the art. The 504 memory circuit may comprise volatile and non-volatile storage media. Processor 502 may include an instruction processing unit 506 and an arithmetic unit 508. The instruction processing unit may be configured to receive instructions from the memory circuit 504 of this disclosure.

[0160] Figure 14 illustrates a combinational logic circuit 510 configured to control aspects of the surgical instrument or tool, according to at least one aspect of this description. Combinational logic circuit 510 can be configured to implement various processes described herein. Combinational logic circuit 510 may comprise a finite state machine comprising 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 a result 516.

[0161] Figure 15 illustrates a sequential logic circuit 520 configured to control aspects of the surgical instrument or tool, in accordance with at least one aspect of this description. Sequential logic circuit 520 or combinational logic 522 may be configured to implement various processes described herein. The sequential logic circuit 520 may comprise a finite state machine. The sequential logic circuit 520 may comprise combinational logic 522, at least one memory circuit 524 and a clock 529, 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 a result 528. In other aspects, the circuit may comprise a combination of a processor (e.g., processor 502, Figure 13) and a finite state machine to implement various processes of the present invention. In other aspects, the finite state machine may comprise a combination of a combinational logic circuit (e.g., a combinational logic circuit 510, Figure 14) and sequential logic circuit 520.

[0162] Figure 16 illustrates a surgical instrument or tool that comprises a plurality of motors that can be activated to perform various functions. In certain cases, a first motor can be activated to perform a first function, a second motor can be activated to perform a second function, a third motor can be activated to perform a third function, a fourth motor can be activated. 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 triggering, closing and/or articulation movements in the end actuator. Tripping, closing and/or articulation movements can be transmitted to the end actuator via a drive shaft assembly, for example.

[0163] In certain cases, the instrument system or surgical tool may include a trigger motor 602. The trigger motor 602 may be operatively coupled to a trigger motor drive assembly 604, which may be configured to transmit to the end actuator triggering movements generated by the trigger motor 602, in particular, to move the i-profile beam element. In certain cases, the triggering motions generated by the triggering motor 602 can cause the staples to be positioned from the staple cartridge into the tissue captured by the end actuator and/or the cutting edge of the blade element. i-profile beam to be advanced in order to cut captured fabric, for example. The i-profile beam element can be retracted by reversing the direction of the trip motor 602.

[0164] In certain cases, the surgical instrument or tool may include a closing motor 603. The closing motor 603 may be operatively coupled to a closing motor drive assembly 605 which can be configured to transmit to the closing actuator 605. end closing movements generated by the closing motor 603, in particular, to displace a closing tube to close the anvil and compress the tissue between the anvil and the staple cartridge. Closing movements can cause the end actuator to transition from an open setting to an approximate setting to capture tissue, for example. End actuator can be transitioned to an open position by reversing the closing motor direction

603.

[0165] In certain cases, the surgical instrument or tool may include one or more joint motors 606a, 606b, for example. The linkage motors 606a, 606b may be operatively coupled to respective linkage motor drive assemblies 608a, 608b, which may be configured to transmit to the end actuator linkage movements generated by the linkage motors 606a, 606b. In certain cases, linkage movements can cause the end actuator to link with respect to the drive shaft assembly, for example.

[0166] As described above, the surgical instrument or tool may 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 may be activated individually or separately to perform one or more functions, while other motors remain inactive. For example, pivot motors 606a, 606b can be activated to cause the end actuator to pivot while the trigger motor 602 remains inactive. Alternatively, firing motor 602 may be activated to fire the plurality of staples and/or advance the cutting edge, while toggle motor 606 remains inactive. Additionally, the closing motor 603 can be activated simultaneously with the firing motor 602 to cause the closing tube and the i-profile beam member to advance distally, as described in more detail later in this document.

[0167] In certain cases, the instrument or surgical tool may include a common control module 610 that can be employed with a plurality of motors of the instrument or surgical tool. In certain cases, the common control module 610 can accommodate one of a plurality of motors at a time. For example, the common control module 610 may be attachable to and separable from the plurality of robotic surgical instrument motors individually. In certain cases, a plurality of instrument or surgical tool motors may share one or more common control modules, such as the common control module 610. In certain cases, a plurality of instrument or surgical tool motors may be individual and selectively engaged with the common control module 610. In certain cases, the common control module 610 may be selectively switched between interfacing with one of a plurality of motors of the instrument or surgical tool and interfacing with another of a plurality of surgical tools. instrument or surgical tool motors.

[0168] In at least one example, the common control module 610 can be selectively switched between operational engagement with linkage motors 606a, 606B, and operational engagement with tripping motor 602 or closing motor 603. In In at least one example, as illustrated in Figure 16, a switch 614 may be moved or transitioned between a plurality of positions and/or states. In first position 616, switch 614 can electrically couple common control module 610 to trigger 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, key 614 can electrically couple common control module 610 to first linkage motor 606a; and in a fourth position 618b, the switch 614 can electrically couple the common control module 610 to the second linkage motor 606b, for example. In certain cases, separate common control modules 610 may be electrically coupled to the trip motor 602, the closing motor 603, and the linkage motors 606a, 606b at the same time. In certain cases, the 614 switch can be a mechanical switch, an electromechanical switch, a solid state switch, or any suitable switching mechanism.

[0169] Each of the motors 602, 603, 606a, 606b may comprise a torque sensor for measuring the output torque on the motor drive shaft. The force on an end actuator can be sensed in any conventional way, such as through force sensors on the outside of the jaws or by a torque sensor on the motor that drives the jaws.

[0170] In various cases, as illustrated in Figure 16, the common control module 610 may comprise a motor driver 626 which may comprise one or more H-bridge FETs. The motor driver 626 may modulate the power transmitted from a power source 628 to a motor coupled to the common control module 610, based on input from a microcontroller 620 (the "controller"), for example. In certain cases, the microcontroller

7T1/164 dor 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.

[0171] In certain examples, the microcontroller 620 may include a microprocessor 622 (the "processor") and one or more non-transient computer readable media or memory units 624 (the "memory"). In certain cases, memory 624 may store multiple 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 memories 624 may be coupled to the processor 622, for example.

[0172] In certain cases, the power supply 628 can be used to supply power to the microcontroller 620, for example. In certain cases, the power source 628 may comprise a battery (or "battery pack" or "power source"), such as a Li-battery, for example. In certain cases, the battery pack can be configured to be releasably mounted on a handle to supply power to the surgical instrument 600. Multiple battery cells connected in series can be used as the power source 628. In certain cases , the power source 628 may be replaceable and/or rechargeable, for example.

[0173] In various cases, processor 622 may control motor driver 626 to control the position, direction of rotation, and/or speed of a motor that is coupled to common control module 610. In certain cases In these cases, the processor 622 may signal the motor driver 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 embodies the functions of a computer central processing unit (CPU) in an integrated circuit or, at most, a few integrated circuits. The processor is a multi-function programmable 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 numbering system.

[0174] In one example, the 622 processor can be any single-core or multi-core processor, such as those known by the tradename ARM Cortex available from Texas Instruments. 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 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 32KB single-cycle SRAM, an internal ROM loaded with StellarisWareO software, 2KB EEPROM, one or more PWM modules, one or more QEI, one or more 12-bit ADCs with 12 analog input channels, among other features that are readily available for the product data sheet. Other microcontrollers can be readily replaced for use with the 4410 module. Consequently, the present description should not be limited in that context.

[0175] In certain cases, memory 624 may include program instructions for controlling each of the surgical instrument motors 600 that are attachable to common control module 610. For example, memory 624 may include program instructions for controlling the trigger motor 602, the closing motor 603 and the hinge motors 606a, 606b. Such program instructions may cause processor 622 to control triggering, closing, and articulation functions in accordance with inputs provided by algorithms or control programs of the surgical instrument or tool.

[0176] In certain cases, one or more mechanisms and/or sensors, such as sensors 630, may be employed to alert the processor 622 to program instructions that must be used in a specific configuration. For example, sensors 630 can prompt processor 622 to use program instructions associated with triggering, closing, and linking the end actuator. In certain cases, sensors 630 may comprise position sensors that may be employed to detect the position of key 614, for example. Accordingly, processor 622 can use the program instructions associated with triggering the i-profile beam of the end actuator upon detection, through sensors 630, for example, that switch 614 is in first position 616; processor 622 may use program instructions associated with closing the anvil upon detection, via sensors 630, for example, that key 614 is in second position 617; and processor 622 may use program instructions associated with linkage of the end actuator upon detection, through sensors 630, for example, that key 614 is in the third or fourth position 618a, 618b.

[0177] Figure 17 is a schematic diagram of a robotic surgical instrument 700 configured to operate a surgical tool described in the present invention, in accordance with at least one aspect of this description. The 700 robotic surgical instrument can be programmed or configured to control distal/proximal translation of a displacement limb, distal/proximal displacement of a

7T4/164 tube closure, drive shaft rotation, and linkage with either a single type or multiple linkage drive links. In one aspect, the surgical instrument 700 may be programmed or configured to individually control a trigger member, a closure member, a drive shaft member, and/or one or more hinge members. Surgical instrument 700 comprises a control circuit 710 configured to control motor-driven triggering members, closing members, drive shaft members, and/or one or more pivot members.

[0178] In one aspect, the robotic surgical instrument 700 comprises a control circuit 710 configured to control an anvil 716 and an i-profile beam portion 714 (including a sharp cutting edge) of an end actuator 702, a removable staple cartridge 718, a drive shaft 740 and one or more pivot members 742a, 742b through a plurality of motors 704a to 704e. A position sensor 734 can be configured to provide the control circuit 710 with position feedback from the i-profile beam 714. Other sensors 738 can be configured to provide feedback to the control circuit 710. A timer/ counter 731 provides timing and counting information to control circuit 710. A power source 712 may be provided to operate motors 704a through 704e and a current sensor 736 provides motor current feedback to control circuit 710. Motors 704a through 704e can be operated individually by the 710 control circuit in either an open-loop or closed-loop feedback control.

[0179] 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 i-profile beam 714, as determined by position sensor 734, with the output of the timer/counter 731 so that the control circuit 710 can determine the position of the i-profiled beam 714 at a specific time (t) relative to a start position or the time (t) when the profiled beam at i 714 is at a specific position relative to a home position. The 731 timer/counter can be configured to measure elapsed time, count external events, or measure external events.

[0180] In one aspect, the control circuit 710 can be programmed to control functions of the end actuator 702 based on one or more tissue conditions. The 710 control circuit can be programmed to directly or indirectly sense tissue conditions, such as thickness, as described here. The 710 control circuit can be programmed to select a trigger control program or close 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 handle different tissue conditions. For example, when thicker tissue is present, the control circuit 710 can be programmed to translate the displacement member at a slower speed and/or at a lower power. When thinner fabric is present, the control circuit 710 can be programmed to translate the displacement member at a higher speed and/or with greater power. A closure control program can control the closure force applied to tissue by the anvil

716. Other control programs control the rotation of the drive shaft 740 and pivot members 742a, 742b.

[0181] In one aspect, the 710 motor control circuit can generate motor setpoint signals. Engine setpoint signals can be provided for various 708a to 708e engine controls. Engine controls 708a through 708e may comprise one or more circuits configured to provide engine start signals to engines 704a through 704e to drive engines 704a through 704e as described herein. In some examples, motors 704a to 704e may be brushed DC electric motors. For example, the speed of motors 704a to 704e can be proportional to their motor drive signals. In some examples, the motors 704a to 704e may be brushless DC electric motors, and the respective motor drive signals may comprise a PWM signal supplied to one or more stator windings of the motors 704a to 704e. Also, in some examples, motor controls 708a through 708e may be omitted and control circuit 710 may directly generate motor drive signals.

[0182] In one aspect, the control circuit 710 may initially operate each of the motors 704a through 704e in an open circuit configuration for a first open circuit portion of the travel member's stroke. Based on the response of the robotic surgical instrument 700 during the open loop portion of the stroke, the control loop 710 can select a trigger control program in a closed loop configuration. The instrument response may include a translation of the distance from the displacement member during the open circuit portion, an elapsed time during the open circuit portion, the power supplied to one of the motors 704a to 704e during the open circuit portion, a sum of pulse widths of a motor drive signal, etc. After

7TT/164 open circuit portion, control circuit 710 may implement the selected trigger control program for a second portion of the travel member's stroke. For example, during a portion of the closed-loop stroke, control circuit 710 may modulate one of the motors 704a to 704e based on translating data describing a closed-loop displacement member position to translate the displacement member to a constant speed.

[0183] In one aspect, the motors 704a through 704e may receive power from a power source 712. The power source 712 may be a DC power source driven by an AC mains power supply, a battery, a supercapacitor , or any other suitable source of energy. The motors 704a to 704e can be mechanically coupled to individual movable mechanical elements such as the i-profile beam 714, the anvil 716, the drive shaft 740, the articulation 742a and the articulation 742b, via the respective transmissions 706a to 706e. Transmissions 706a to 706e may include one or more gears or other connecting components to couple the motors 704a to 704e to the moving mechanical elements. A position sensor 734 can detect a position of the profiled beam 714. The position sensor 734 can be or can include any type of sensor that is capable of generating position data that indicates a position of the profiled beam at i 714. In some examples, the position sensor 734 may include an encoder configured to provide a series of pulses to the control circuit 710 as the i-profile beam 714 translates distally and proximally. Control circuit 710 can track the pulses to determine the position of the i-profile beam 714. Other suitable position sensors can be used, including, for example, a proximity sensor. Other types of position sensors may provide other

other signals indicating movement of the i-profile beam 714. Also, in some examples, position sensor 734 may be omitted. When any of the motors 704a to 704e is a stepper motor, the control circuit 710 can track the position of the i-profile beam 714 by aggregating the number and direction of steps that the motor 704 has been instructed to take. run. Position sensor 734 may be disposed on end actuator 702 or any other portion of the instrument. The outputs of each of the 704a to 704e motors include a torque sensor 744a to 744e to detect force and have an encoder to detect the rotation of the drive shaft.

[0184] In one aspect, control circuit 710 is configured to drive a trigger member as the i-profile beam portion 714 of end actuator 702. Control circuit 710 provides a motor set point for a motor control 708a, which provides a start signal to motor 704a. The motor output drive shaft 704a is coupled to a torque sensor 744a. The torque sensor 744a is coupled to a transmission 706a which is coupled to the i-profile beam 714. The transmission 706a comprises movable mechanical elements, such as rotating elements, and a triggering member to control distal and proximal movement of the beam. with i-profile 714 along a longitudinal axis of end actuator 702. In one aspect, the motor 704a may 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 trigger force feedback signal to the control circuit 710. The trigger force signal represents the force required to trigger or displace the i-profile beam 714. A position sensor 734 can be configured to provide the position of the i-profile beam 714 along the firing stroke or the position of the firing member as a feedback signal to the control circuit

710. End actuator 702 may include additional sensors 738 configured to provide feedback signals to control circuit 710. When ready for use, control circuit 710 may provide a trigger signal to motor control 708a. In response to the trigger signal, the motor 704a may drive the trigger member distally along the longitudinal axis of the end actuator 702 from an initial proximal position of the stroke to a terminal distal position of the stroke with respect to to the initial course position. As the trigger member translates distally, an i-profile beam 714 with a cutting element positioned at a distal end advances distally to cut tissue located between the staple cartridge 718 and the anvil 716.

[0185] In one aspect, the control circuit 710 is configured to drive a closing member, such as the anvil portion 716 of the end actuator 702. The control circuit 710 provides a motor set point for a motor control. 708b, which provides a drive signal to the 704b motor. The motor output shaft 704b is coupled to a torque sensor 744b. Torque sensor 744b is coupled to a transmission 706b which is coupled to anvil 716. Transmission 706b comprises movable mechanical elements such as rotating elements and a closing member to control the movement of anvil 716 between 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 mesh with the closing sprocket. The 744b torque sensor provides a closing force feedback signal to the 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 the control circuit.

710. Additional sensors 738 on the end actuator 702 can provide the closing force feedback signal to the control circuit 710. A pivoting anvil 716 is positioned opposite the staple cartridge 718. When ready for use, the clamp circuit 710 control can provide a close signal to the 708b motor control. In response to the closing signal, motor 704b advances a closing member to hold tissue between anvil 716 and staple cartridge 718.

[0186] In one aspect, control circuit 710 is configured to rotate a drive shaft member, such as drive shaft 740, to rotate end actuator 702. Control circuit 710 provides a set point from the motor to a 708c motor control, which provides a start signal to the 704c motor. The output shaft of the 704c motor is coupled to a 744c torque sensor. The torque sensor 744c is coupled to a transmission 706c which is coupled to the shaft 740. The transmission 706c comprises moving mechanical elements, such as rotating elements, to control the rotation of the drive shaft 740 clockwise or counterclockwise. -time up to and above 360º. In one aspect, the 704c motor is coupled to a swivel drive assembly, which includes a tube gear segment that is formed over (or attached to) the proximal end of the proximal closure tube for operable engagement by a gear set. rotational that is operationally supported on the tool mounting plate. The 744c torque sensor provides a rotational force feedback signal to the 710 control circuit. The rotational force feedback signal represents

The rotational force applied to the drive shaft 740 is shown. Position sensor 734 can be configured to provide the position of the closing member as a feedback signal to the control circuit 710. Additional sensors 738, such as an encoder drive shaft, can provide the rotational position of the drive shaft 740 to the control circuit 710.

[0187] In one aspect, the control circuit 710 is configured to pivot the end actuator 702. The control circuit 710 provides a motor setpoint to a motor control 708d, which provides a drive signal to the motor. 704d. The output shaft of the 704d motor is coupled to a 744d torque sensor. Torque sensor 744d is coupled to a transmission 706d which is coupled to a pivot member 742a. The 706d transmission comprises movable mechanical elements, such as linkage elements, to control the linkage of the 702+65° end actuator. In one aspect, the motor 704d is coupled to a pivot nut, which is pivotally seated on the proximal end portion of the distal column portion and pivotally driven therein by a pivot gear assembly. The 744d torque sensor provides a linkage force feedback signal to the 710 control circuit. The linkage force feedback signal represents the linkage force applied to the 702 end actuator. a linkage encoder can provide the linkage position of the end actuator 702 to the control circuit 710.

[0188] In another aspect, the articulation function of the robotic surgical system 700 may comprise two articulation members, or links, 742a, 742b. These pivot 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 mo-

separate triggering torque 704a is provided, each of the pivot links 742a, 742b can be actuated antagonistically with respect to the other link to provide resistive holding motion and a load to the head when it is not moving and to provide see a joint movement when the head is articulated. The pivot members 742a, 742b attach to the head at a fixed radius when the head is rotated. Consequently, the mechanical advantage of the push and pull connection changes when the head is rotated. This change in mechanical advantage may be more pronounced with other linkage drive systems.

[0189] 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 trigger member, closing member or pivot member. Another example includes electric motors 704a to 704e which operate the moving mechanical elements such as the displacement member, pivot links, closing tube and drive shaft. An external influence is an inordinate and unpredictable influence of things like tissue, surrounding bodies, and friction on 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.

[0190] In one aspect, the 734 position sensor can be implemented as an absolute positioning system. In one aspect, the 734 position sensor may comprise an absolute rotating magnetic positioning system implemented as a single integrated circuit rotating magnetic position sensor, ASSOSSEQFT, available from Austria Microsystems, AG. The 734 position sensor can interface with the 710 control circuit for

to provide an absolute positioning system. Position can include multiple Hall effect elements arranged 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 computing hyperbolic functions. and trigonometric ones that require only addition, subtraction, bit shift, and lookup table operations.

[0191] In one aspect, the control circuit 710 may be in communication with one or more sensors 738. The sensors 738 may be positioned on the end actuator 702 and adapted to work with the robotic surgical instrument 700 to measure the various derived parameters as span distance as a function of time, tissue compression as a function of time, and anvil deformation as a function of time. 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 a sensor. 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 the end actuator 702. Sensors 738 may include one or more sensors. Sensors 738 can be arranged on the staple cartridge platform 718 to determine tissue location using segmented electrodes. Torque sensors 744a through 744e can be configured to detect forces such as trigger force, closing force, and/or linkage force, among others. Accordingly, the control circuit 710 can detect (1) the closing load experienced by the distal closing tube and its position, (2) the firing member in the rack and its position, (3) which portion of the staple cartridge 718 has fabric therein, and (4) the load and position on both pivot rods.

[0192] In one aspect, the one or more sensors 738 may comprise a strain gauge, such as a micro strain gauge, configured to measure the magnitude of strain on the anvil 716 during a pinched condition. The voltage meter provides an electrical signal whose amplitude varies with the magnitude of the voltage. Sensors 738 may comprise a pressure sensor configured to detect a pressure generated by the presence of compressed tissue between anvil 716 and staple cartridge 718. Sensors 738 may 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 tissue situated therebetween.

[0193] In one aspect, 738 sensors can be implemented as one or more limit switches, electromechanical devices, solid state switches, Hall effect devices, magneto-resistive (MR) devices, giant magneto-resistive devices. (GMR), magnetometers, among others. In other implementations, 738 sensors can be implemented as solid-state switches that operate under the influence of light, such as optical sensors, infrared sensors, and ultraviolet light sensors, among others. In addition, switches can be solid-state devices such as transistors (eg, FET, junction FET, MOSFET, bipolar, and the like). In other implementations, 738 sensors may include driverless electrical switches, ultrasonic switches, accelerometers, and inertia sensors, among others.

[0194] In one aspect, the 738 sensors 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 clamp tube and the anvil 716 to detect clamping forces applied to the clamp.

gorna 716 by the closing tube. The forces exerted on the anvil 716 may be representative of the tissue compression experienced by the section of tissue captured between the anvil 716 and the staple cartridge 718. The one or more sensors 738 may be positioned at multiple locations. interaction points along the closing drive system to detect the closing forces applied to the 716 anvil by the closing drive system. The one or more sensors 738 can be sampled in real time during a gripping operation by the control circuit processor 710. The control circuit 710 receives real-time sample measurements to provide and analyze time- and evaluate, in real time, the closing forces applied to the anvil

716.

[0195] In one aspect, a current sensor 736 can be used to measure the current drawn by each of the motors 704a to 704e. The force required to advance any of the moving mechanical elements such as the i-profile beam 714 corresponds to the current drawn by one of the motors 704a to 704e. The power is converted to a digital signal and supplied to the control circuit 710. The control circuit 710 can be configured to simulate the instrument's actual system response in the controller software. A displacement member can be actuated to move an i-profile beam 714 on end actuator 702 at or near a target speed. The 700 robotic 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, status feedback, linear quadratic ( LOR) and/or an adaptive controller, for example. The 700 robotic surgical instrument can include a power source to convert the feedback controller signal into a physical input such as case voltage,

PWM, voltage modulated by frequency, current, torque and/or force, for example. Additional details are disclosed in US Patent Application Serial No. 15/636,829 entitled CLOSED LOOP VELOCITY CONTROL TECHNIQUES FOR ROBOTIC SURGICAL INSTRUMENT, filed June 29, 2017, which is incorporated herein by reference in its entirety.

[0196] Figure 18 illustrates a block diagram of a surgical instrument 750 programmed to control distal translation of the displacement limb, in accordance with at least one aspect of this description. In one aspect, the surgical instrument 750 is programmed to control the distal translation of a displacement member, such as the i-profile beam 764. The surgical instrument 750 comprises an end actuator 752 which may comprise an anvil 766. , a 764 i-profile beam (including a sharp cutting edge), and a 768 removable staple cartridge.

[0197] The position, movement, displacement and/or translation of a linear displacement member, such as the i-profile beam 764, can be measured by an absolute positioning system, sensor array and 784 position sensor Due to the fact that the i-profile beam 764 is coupled to a longitudinally movable drive member, the position of the i-profile beam 764 can be determined by measuring the position of the longitudinally movable driving member that employs the position sensor 784. Accordingly, in the following description, the position, displacement and/or translation of the i-profile beam 764 can be obtained by the position sensor 784 as described in the present description. A control circuit 760 may be programmed to control the translation of the displacement member, such as the i-profile beam 764. The control circuit 760, in some examples, may comprise one or more microcontrollers, microprocessors, or others. processors suitable for executing the instructions that cause the processor or processors to control the displacement member, for example the i-profile beam 764, in the manner described. In one aspect, a timer/counter 781 provides an output signal, such as elapsed time or a digital count, to control circuit 760 to correlate the position of the i-profile beam 764 as determined by position sensor 784 with output. - timer/counter 781 output so that control circuit 760 can determine the position of the i-profile beam 764 at a specific time (t) relative to a start position. The 781 timer/counter can be configured to measure elapsed time, count external events, or measure external events.

[0198] Control circuit 760 may generate a motor setpoint signal 772. The motor setpoint signal 772 may be supplied to a motor control 758. Motor control 758 may comprise one or more circuits configured to provide a drive signal from motor 774 to motor 754 to drive motor 754, as described in the present description. In some examples, the 754 motor may be a DC motor with a brushed DC electric motor. For example, the speed of the 754 motor may be proportional to the 774 motor drive signal. In some examples, the 754 motor may be a brushless DC electric motor and the 774 motor drive signal may comprise a PWM signal supplied for one or more stator windings of motor 754. Also, in some examples, motor control 758 may be omitted, and control circuit 760 may generate motor drive signal 774 directly.

[0199] Engine 754 can receive power from a power source

762. Power source 762 may be or include a battery, supercapacitor, or any other suitable power source. The engine

754 may be mechanically coupled to the i-profile beam 764 via a transmission 756. The transmission 756 may include one or more gears or other connecting components to couple the motor 754 to the i-profile beam 764. A position sensor 784 can detect a position of the i-profile beam 764. The position sensor 784 may be or may include any type of sensor that is capable of generating position data that indicates a position of the i-profile beam 764. In some examples , the position sensor 784 may include an encoder configured to provide a series of pulses to the control circuit 760 as the i-profile beam 764 translates distally and proximally. Control circuit 760 can track the pulses to determine the position of the i-profile beam 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 i-profile beam 764. Also, in some examples, the position sensor 784 can be omitted. When the 754 motor is a stepper motor, the 760 control circuit can track the position of the i-profiled beam 764 by aggregating the number and orientation of steps the 754 motor has been instructed to perform. . Position sensor 784 can be arranged on end actuator 752 or any other portion of the instrument.

[0200] The 760 control circuit can be in communication with one or more 788 sensors. The 788 sensors can be positioned on the 752 end actuator and adapted to work with the 750 surgical instrument to measure the various derived parameters such as distance span as a function of time, tissue compression as a function of time and anvil stress as a function of time. 788 sensors may comprise a magnetic sensor, a magnetic field sensor, a strain gauge, a pressure sensor, a force sensor, an inductive sensor such as an eddy current sensor, a resistive sensor, a sensor capacitive, an optical sensor, and/or any other sensors suitable for measuring one or more parameters of the end actuator 752. Sensors 788 may include one or more sensors.

[0201] The one or more sensors 788 may comprise a strain gauge, such as a micro strain gauge, configured to measure the magnitude of strain on anvil 766 during a pinched condition. The effort meter provides an electrical signal whose amplitude varies with the magnitude of the effort. Sensors 788 may comprise a pressure sensor configured to detect pressure generated by the presence of compressed tissue between anvil 766 and staple cartridge 768. Sensors 788 may be configured to detect the impedance of a section of tissue lying between the anvil 766 and the staple cartridge 768 which is indicative of the thickness and/or completeness of the tissue situated therebetween.

[0202] The 788 sensors can be configured to measure the forces exerted on the 766 anvil by a closing drive system. For example, one or more sensors 788 may be at a point of interaction between a closure tube and anvil 766 to detect closure forces applied to anvil 766 by a closure tube. The forces exerted on the anvil 766 may be representative of the tissue compression experienced by the section of tissue captured between the anvil 766 and the staple cartridge 768. The one or more sensors 788 may be positioned at various interaction points along the clamping system. close drive to detect the closing forces applied to the anvil 766 by the close drive system. The one or more 788 sensors can be sampled in real-time during a gripping operation by a processor in the 760 control circuit. The 760 control circuit receives real-time sample measurements to provide and analyze time-based information. and evaluate, in real time, the closing forces applied to the 766 anvil.

[0203] A current sensor 786 can be used to measure the current drawn by the 754 motor. The force required to advance the i-profile beam 764 corresponds to the current drawn by the motor

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

[0204] The 760 control circuit can be configured to simulate the instrument's actual system response in the controller software. A displacement member can be actuated to move an i-profile beam 764 on end actuator 752 at or near a target speed. Surgical instrument 750 may include a feedback controller, which can be one or any of the feedback controllers, including, but not limited to, a PID controller, status feedback, LOR, and/or an adaptive controller, e.g. example. The 750 surgical instrument may include a power source to convert the feedback controller signal into a physical input such as case voltage, PWM voltage, frequency modulated voltage, current, torque, and/or force, for example. plo.

[0205] The actual drive system of the surgical instrument 750 is configured to drive the displacement member, cutting member or i-profile beam 764, by a DC motor with brushes with gearbox and mechanical links to a system joint and/or knife. Another example is the 754 electric motor which operates the displacement member and linkage driver, for example, from an interchangeable drive shaft assembly. An outside influence is an unreasonable and unpredictable influence of things like tissue, surrounding bodies, and friction on the physical system. Such in-

External fluency can be called drag, which acts in opposition to the 754 electric motor. External influence, such as drag, can cause the physical system's functioning to deviate from a desired physical system operation.

[0206] Several exemplifying aspects are directed to a surgical instrument 750 that comprises an end actuator 752 with motor-driven surgical cutting and stapling implements. For example, a motor 754 may drive a displacement member distally and proximally along a longitudinal axis of the end actuator 752. The end actuator 752 may comprise a pivoting anvil 766 and, when configured for use, a staple cartridge 768 positioned opposite anvil 766. A physician may hold tissue between anvil 766 and staple cartridge 768 as described in the present description. When ready to use the surgical instrument 750, the clinician may provide a trigger signal, for example, by pressing a trigger of the surgical instrument 750. In response to the trigger signal, the motor 754 may drive the displacement member distally along the axis. longitudinal geometry of end actuator 752 from a proximal stroke start position to a stroke start position distal to the stroke start position. As the displacement member translates distally, the i-profile beam 764 with a cutting element positioned at a distal end can cut tissue between the staple cartridge 768 and the anvil 766.

[0207] In various examples, the surgical instrument 750 may comprise a control circuit 760 programmed to control the distal translation of the displacement member, such as the i-profile beam 764, for example, based on one or more tissue conditions. - of. The 760 control circuit can be programmed to directly or indirectly sense fabric conditions such as thickness, comfort,

described me here. The 760 control circuit 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 best handle different tissue conditions. For example, when thicker tissue is present, the control circuit 760 can be programmed to translate the displacement member at a slower speed and/or at a lower power. When thinner fabric is present, control circuit 760 can be programmed to translate the displacement member at a higher speed and/or with greater power.

[0208] In some examples, the control circuit 760 may initially operate the motor 754 in an open circuit configuration for a first open circuit portion of a displacement member stroke. Based on a response from the 750 surgical instrument during the open circuit portion of the stroke, the 760 control circuit can select a trigger control program. The instrument's response may include a translation distance of the displacement member during the open-circuit portion, an elapsed time during the open-circuit portion, the power supplied to the motor 754 during the open-circuit portion, a sum of pulse widths of a motor drive signal, etc. After the open circuit portion, control circuit 760 may implement the selected trigger control program for a second portion of the displacement member stroke. For example, during the closed-loop portion of the stroke, control circuit 760 may modulate motor 754 based on translational data that describes a position of the displacement member in a closed-loop manner to translate the displacement member. at a constant speed. Additional details are disclosed in US Patent Application Serial No. 15/720,852, entitled SYSTEM AND METHODS FOR CONTROLLING A DISPLAY OF A SURGICAL INSTRUMENT, filed September 29, 2017, which is hereby incorporated by way of title. reference in its entirety.

[0209] Figure 19 is a schematic diagram of a surgical instrument 790 configured to control various functions in accordance with at least one aspect of this description. In one aspect, the surgical instrument 790 is programmed to control the distal translation of a displacement member, such as the i-profile beam 764. The surgical instrument 790 comprises an end actuator 792 which may comprise an anvil 766, a 764 i-profile beam and a 768 removable staple cartridge that is interchangeable with a 796 RF cartridge (shown in dashed line).

[0210] In one aspect, 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, the 638 sensors can be solid state switches that operate under the influence of light, such as optical sensors, infrared sensors, ultraviolet light sensors, among others. In addition, switches can be solid state devices such as transistors (eg FET, junction FET, MOSFET, bipolar and the like). In other implementations, 788 sensors may include conductorless electrical switches, ultrasonic switches, accelerometers, inertia sensors, and more.

[0211] In one aspect, the 784 position sensor can be implemented as an absolute positioning system, which comprises a rotating magnetic absolute positioning system implemented as a rotating, circular magnetic position sensor.

integrated system, ASSOSSEQFT, available from Austria Microsystems, AG. The 784 position sensor can interface with the 760 control circuit to provide an absolute positioning system. The position can include multiple Hall effect elements arranged 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 to calculate hyperbolic and trigonometric functions that require only addition, subtraction, bit shift, and lookup table operations.

[0212] In one aspect, the i-profile beam 764 may be implemented as a knife member that operatively supports a fabric cutting blade thereon and may additionally include tabs or anvil engagement features and engagement features. channel or a base. In one aspect, the 768 staple cartridge may be implemented as a standard (mechanical) surgical fastener cartridge. In one aspect, the 796 RF cartridge can be implemented as an RF cartridge. These and other sensor arrangements are described in commonly owned 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, which is incorporated herein by reference in its entirety.

[0213] The position, movement, displacement and/or translation of a linear displacement member, such as the beam with i 764 profile, 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 i-profile beam 764 is coupled to a longitudinally movable drive member, the position of the i-profile beam 764 can be determined by measuring the position of the longitudinally driven drive member mobile employing position sensor 784. Accordingly, in the following description, the position, displacement, and/or translation of the i-profile beam 764 can be obtained by position sensor 784, as described in the present description. A control circuit 760 may be programmed to control the translation of the displacement member, such as the i-profile beam 764, as described in the present description. Control circuit 760, in some examples, may comprise one or more microcontrollers, microprocessors, or other processors suitable for executing instructions that cause the processor or processors to control the displacement member, for example, the profiled beam in i 764, in the manner described. In one aspect, a timer/counter 781 provides an output signal, such as elapsed time or a digital count, to control circuit 760 to correlate the position of the i-profile beam 764 as determined by the position sensor 784 with the output of the timer/counter 781 so that the control circuit 760 can determine the position of the i-profile beam 764 at a specific time (t) relative to a start position. The 781 timer/counter can be configured to measure elapsed time, count external events, or measure external events.

[0214] Control circuit 760 may generate a motor setpoint signal 772. The motor setpoint signal 772 may be supplied to a motor control 758. Motor control 758 may comprise one or more circuits configured to provide a drive signal from motor 774 to motor 754 to drive motor 754, as described in the present description. In some examples, the 754 motor may be a DC motor with a brushed DC electric motor. For example, the speed of the 754 motor may be proportional to the 774 motor drive signal. In some examples, the 754 motor may be a brushless DC electric motor and the 774 motor drive signal may comprise a PWM signal supplied for one or more stator windings of motor 754. Also, in some examples, motor control 758 may be omitted, and control circuit 760 may generate motor drive signal 774 directly.

[0215] Motor 754 can be powered from a power source

762. Power source 762 may be or include a battery, supercapacitor, or any other suitable power source. The motor 754 may be mechanically coupled to the i-profile beam 764 via a transmission 756. The transmission 756 may include one or more gears or other connecting components to couple the motor 754 to the i-profile beam 764. A sensor The position sensor 784 can detect a position of the i-profile beam 764. The position sensor 784 may be or may include any type of sensor that is capable of generating position data that indicates a position of the i-profile beam 764. In In some examples, the position sensor 784 may include an encoder configured to provide a series of pulses to the control circuit 760 as the i-profile beam 764 translates distally and proximally. Control circuit 760 can track the pulses to determine the position of the i-profile beam 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 i-profile beam 764. Also, in some examples, the position sensor 784 can be omitted. When the 754 motor is a stepper motor, the 760 control circuit can track the position of the 764 i-profiled beam by aggregating the number and orientation of steps that the 2504 motor has been instructed to perform. . Position sensor 784 may be disposed on end actuator 792 or any other portion of the instrument.

[0216] The 760 control circuit can be in communication with one or more 788 sensors. The 788 sensors can be positioned on the 792 end actuator and adapted to work with the 790 surgical instrument to measure the various derived parameters such as distance span as a function of time, tissue compression as a function of time and anvil stress as a function of time. 788 sensors may comprise a magnetic sensor, a magnetic field sensor, a strain gauge, a pressure sensor, a force sensor, an inductive sensor such as an eddy current sensor, a resistive sensor, a sensor capacitive, an optical sensor, and/or any other sensors suitable for measuring one or more parameters of the end actuator 792. Sensors 788 may include one or more sensors.

[0217] The one or more sensors 788 may comprise a strain gauge, such as a micro strain gauge, configured to measure the magnitude of strain on anvil 766 during a pinched 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 tissue located therebetween.

[0218] The 788 sensors can be configured to measure the forces exerted on the 766 anvil by the closing drive system. For example, one or more sensors 788 may be at a point of interaction between a closure tube and anvil 766 to detect closure forces applied to anvil 766 by a closure tube. The forces exerted on the anvil 766 may be representative of the tissue compression experienced by the section of tissue captured between the anvil 766 and the staple cartridge.

768. The one or more sensors 788 can be positioned at various interaction points along the closing drive system to detect the closing forces applied to the anvil 766 by the closing drive system. The one or more sensors 788 may be sampled in real time during a gripping operation by a processor portion of control circuit 760. Control circuit 760 receives real-time sample measurements to provide and analyze time-based information and evaluate , in real time, the closing forces applied to the anvil 766.

[0219] A current sensor 786 can be used to measure the current drawn by the 754 motor. The force required to advance the i-profile beam 764 corresponds to the current drawn by the motor

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

[0220] A 794 RF power source is coupled to the 792 end actuator and is applied to the 796 RF cartridge when the 796 RF cartridge is loaded into the 792 end actuator in place of the 768 staple cartridge. control unit 760 controls the application of RF energy to the RF cartridge 796.

[0221] Additional details are disclosed 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, filed June 28, 2017, which is here incorporated as a reference in its entirety.

[0222] Figures 21 to 24 represent a surgical instrument driven by a 150010 motor for cutting and fixing that may or may not be reused. In the illustrated examples, the surgical instrument 150010 includes an enclosure 150012 comprising a handle assembly 150014 that is configured to be held, manipulated, and actuated by the physician. The 150012 cabinet is configured to be operatively attached to a 150200 interchangeable drive shaft assembly with a 150300 end actuator operatively coupled thereto that is configured to perform one or more surgical tasks or procedures. In accordance with the present description, various forms of interchangeable drive shaft assemblies can be effectively used in connection with robotically controlled surgical systems. The term "cabinet" may encompass an enclosure or similar portion of a robotic system that houses or otherwise operationally supports at least one drive system configured to generate and apply at least one control motion that can be used to drive drive shaft assemblies. The term "frame" may refer to a portion of a hand-held surgical instrument. The term "frame" may also represent a portion of a robotically controlled surgical instrument and/or a portion of the robotic system that may be used to operationally control the surgical instrument. The interchangeable drive shaft assemblies can be employed with various robotic systems, instruments, components, and methods disclosed in US Patent No. 9,072,535 entitled SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS, which is incorporated herein. as a reference in its entirety.

[0223] Figure 21 is a perspective view of a surgical instrument 150010 having an interchangeable drive shaft assembly 150200 operatively coupled thereto, in accordance with at least one aspect of this disclosure. The 150012 cabinet includes a 150300 end actuator comprising a surgical clamping and cutting device configured to operatively support a 150304 surgical staple cartridge therein. The 150012 cabinet can be configured for use in connection with drive shaft assemblies. interchangeable inserts that include end actuators that are adapted to hold different sizes and types of staple cartridges, and that have different lengths, sizes, and drive shaft types. The 150012 cabinet can be used effectively with a variety of interchangeable drive shaft assemblies including assemblies configured to apply other motion and forms of energy such as radio frequency (RF) energy, ultrasonic energy and/or motion to actuator arrays. end caps adapted for use in connection with various surgical applications and procedures. End actuators, drive shaft assemblies, cables, surgical instruments, and/or surgical instrument systems may utilize any suitable fastener, or fasteners, to secure tissue. For example, a fastener cartridge comprising a plurality of fasteners removably stored therein may be removably inserted into and/or attached to the end actuator of a drive shaft assembly.

[0224] Handle assembly 150014 may comprise a pair of interconnectable cable cabinet segments 150016, 150018 interconnected by screws, snap-fit elements, adhesive, etc. Cable cabinet segments 150016, 150018 cooperate to form a pistol grip portion 150019 that can be held and manipulated by the clinician. Handle assembly 150014 operatively supports a plurality of drive systems configured to generate and apply control movements to corresponding portions of the interchangeable drive shaft assembly that is operatively attached thereto. A screen can be provided below a cover

150045.

[0225] Figure 22 is an exploded assembly view of a portion of the surgical instrument 150010 of Figure 21, in accordance with at least one aspect of this description. The grip assembly 150014 may include a frame 150020 that operatively supports a plurality of drive systems. The 150020 frame can operationally support a 150030 "first" drive system or closing drive system, which can apply closing and opening motions to the 150200 interchangeable drive shaft assembly. The 150030 closing drive system can include an actuator as a 150032 closing trigger pivotally supported by the frame

150020. Closing trigger 150032 is pivotally coupled to grip assembly 150014 by pivot pin 150033 to allow closure trigger 150032 to be manipulated by a clinician. When the clinician holds the pistol grip portion 150019 of the 150014 grip assembly, the 150032 closing trigger can pivot from a home or "non-actuated" position to an "actuated" position, and more particularly, to a fully compressed or fully actuated position.

[0226] The 150014 Handle Assembly and 150020 Frame can operationally support a 150080 Trigger Drive System configured to apply trigger motions to corresponding portions of the interchangeable drive shaft assembly attached thereto. The 150080 trigger drive system may employ a 150082 electric motor located in the 150019 pistol grip portion of the 150014 grip assembly. The 150082 electric motor may be a brushed DC motor that has a maximum rotational speed of approximately 25,000 RPM, for example. In other arrangements, the motor may include a brushless motor, a wireless motor, a synchronous motor, a stepper motor, or any other suitable electric motor. The electric motor 150082 may be powered by a power source 150090 which may comprise a removable power source 150092. The removable power source 150092 may comprise a proximal cabinet portion 150094 configured for attachment to a distal cabinet portion

150096. Proximal cabinet portion 150094 and distal cabinet portion 150096 are configured to operatively support a plurality of batteries 150098 therein. The 150098 batteries may each comprise, for example, a Li battery or other suitable battery. The 150096 distal cabinet portion is configured for removable operational attachment to a 150100 control circuit board that is operatively coupled to the electric motor.

150082. Multiple 150098 batteries connected in series can power the 150010 surgical instrument. The 150090 power supply can be replaceable and/or rechargeable. A 150043 screen, which is located below the 150045 cover, is electrically coupled to the 150100 control circuit board. The 150045 cover can be removed to expose the 150043 screen.

[0227] The 150082 electric motor may include a rotating drive shaft (not shown), which operationally interfaces with a 150084 gear reducer assembly mounted on a mating hitch with an assembly or rack. , of drive teeth 150122 in a longitudinally movable drive member 150120. The longitudinally movable drive member 150120 has a rack of drive teeth 150122 formed therein for mating engagement with a corresponding drive gear 150086 of the assembly reduce

gear torque 150084.

[0228] In use, a voltage polarity supplied by the 150090 power source can operate the 150082 electric motor clockwise, whereby the voltage polarity applied to the electric motor by the battery can be reversed in order to operate the electric motor 150082 counterclockwise. When the electric motor 150082 is rotated in one direction, the longitudinally movable drive member 150120 will be axially driven in the distal direction "DD". When electric motor 150082 is driven in the opposite rotary direction, longitudinally movable drive member 150120 will be axially driven in a proximal "DP" direction. The 150014 grip assembly may include a switch that can be configured to reverse the polarity applied to the 150082 electric motor by the power source.

150090. Handle assembly 150014 may include a sensor configured to sense the position of longitudinally movable drive member 150120 and/or the direction in which longitudinally movable drive member 150120 is being moved.

[0229] The 150082 electric motor drive can be controlled by a 150130 trip trigger that is pivotally supported on the 150014 grip assembly. The 150130 trip trigger can be pivoted between an unactuated position and a actuated position.

[0230] Referring again to Figure 21, the interchangeable drive shaft assembly 150200 includes an end actuator 150300 comprising an elongated channel 150302 configured to operatively support a surgical staple cartridge 150304 therein. The end actuator 150300 may include an anvil 150306 that is pivotally supported with respect to the elongated channel 150302. The interchangeable drive shaft assembly 150200 may include a pivot joint 150270.

The construction and operation of the 150300 End Actuator and the 150270 Articulating Joint are disclosed in US Patent Application Publication No. 2014/0263541 entitled ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK, which is incorporated herein by reference in its entirety. The interchangeable drive shaft assembly 150200 may include a housing or proximal nozzle 150201 comprised of nozzle portions 150202, 150203. The interchangeable drive shaft assembly 150200 may include a closure tube 150260 that extends along a shaft. "SA" drive shaft geometry that can be used to close and/or open anvil 150306 of end actuator 150300.

[0231] Again with reference to Figure 21, the closing tube 150260 is translated distally (direction "DD") to close the anvil 150306, for example, in response to the actuation of the closing trigger 150032 in the manner described in the previous reference mentioned in Patent Application Publication No. 2014/0263541. The anvil 150306 is opened by proximal translation of the closing tube 150260. In the open position of the anvil, the closing tube 150260 is moved to its proximal position.

[0232] Figure 23 is another exploded assembly view of portions of the interchangeable drive shaft assembly 150200, in accordance with at least one aspect of this disclosure. The interchangeable drive shaft assembly 150200 may include a trigger member 150220 supported for axial displacement within the back 150210. The trigger member 150220 includes an intermediate trigger drive shaft 150222 configured to attach to a portion of distal cut or knife bar 150280. The trigger member 150220 may be called a "second drive shaft" or a "second drive shaft assembly". Intermediate firing drive shaft 150222 may include a longitudinal slot 150223 at one end configured to receive a tab 150284 at proximal end 150282 of the knife bar

150280. Longitudinal slot 150223 and proximal end 150282 may be configured to allow relative movement therebetween and may comprise a sliding joint 150286. Sliding joint 150286 may allow the intermediate firing drive shaft 150222 of the firing member 150220 pivot the 150300 end actuator around the 150270 pivot joint without moving, or at least not substantially moving, the knife bar

150280. After the 150300 End Actuator is properly oriented, the 150222 Intermediate Fire Drive Shaft can be advanced distally until a side wall proximal to the longitudinal slot 150223 contacts tab 150284 to advance the pull bar. knife 150280 and fire a clip cartridge positioned inside the channel 150302. The back 150210 has an elongated opening or window 150213 inside it to facilitate mounting and insertion of the intermediate firing drive shaft 150222 inside the back 150210 After the 150222 Intermediate Fire Drive Shaft is inserted into the back, an upper frame segment 150215 can be hooked to the 150212 Drive Shaft Frame to enclose the 150222 Intermediate Fire Drive Shaft and knife bar 150280. A description of the operation of firing member 150220 can be found in US Patent Application Publication No. 2014/0263541. Backbone 150210 can be configured to slidably support a triggering member 150220 and the closing tube 150260 which extends around backside 150210. Backside 150210 can slidably support a hinge driver 150230.

[0233] The 150200 Interchangeable Drive Shaft Assembly may include a 150400 Clutch Assembly configured to selectively and releasably couple the 150230 linkage driver to the 150220 trigger member. locking 150402 positioned around triggering member 150220, wherein locking sleeve 150402 can be rotated between an engaged position, in which locking sleeve 150402 couples linkage driver 150230 to triggering member 150220, and a position disengaged, in which linkage driver 150230 is not operatively coupled to firing member 150220. When locking sleeve 150402? is in the engaged position, distal movement of trigger member 150220 can move linkage driver 150230 distally and, correspondingly, proximal movement of trigger member 150220 may move linkage driver 150230 proximally. When the locking sleeve 150402 is in the disengaged position, the movement of the trigger member 150220 is not transmitted to the linkage driver 150230 and, as a result, the trigger member 150220 can move independently of the linkage driver 150230. linkage 150230. Nozzle 150201 may be employed to operationally engage and disengage the linkage drive system with the trigger drive system in the various ways described in US Patent Application Publication No. 2014/0263541.

[0234] The interchangeable drive shaft assembly 150200 may comprise a slip ring assembly 150600 which may be configured to conduct electrical power to and/or from the end actuator 150300 and/or communicate signals to and/or from tir from the 150300 end actuator, for example. The slip ring assembly 150600 may comprise a proximal connector flange 150604 and a distal connector flange 150601 positioned within a slot defined in the mouthpiece portions 150202, 150203.

The proximal connector flange 150604 may comprise a first face and the distal connector flange 150601 may comprise a second face positioned adjacent and movable with respect to the first face.

The 150601 Distal Connector Flange can rotate relative to the 150604 Proximal Connector Flange around the axis of the "SA" drive shaft (Figure 21). Proximal connector flange 150604 may comprise a plurality of concentric or at least substantially concentric conductors 150602 defined on its first face.

A 150607 connector can be mounted on the proximal side of the 150601 distal connector flange and can have a plurality of contacts, with each contact corresponding to and in electrical contact with one of the 150602 conductors. relative rotation between the 150604 Proximal Connector Flange and the 150601 Distal Connector Flange while electrical contact is maintained between them.

The proximal connector flange 150604 can include an electrical connector 150606 that can place the 150602 leads in signal communication with a drive shaft circuit board, for example.

In at least one case, an electrical harness comprising a plurality of conductors may extend between electrical connector 150606 and the drive shaft circuit board.

The 150606 electrical connector can extend proximally through a connector opening defined in the chassis mounting flange.

US Patent Application Publication No. 2014/0263551, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, is incorporated herein by reference in its entirety.

US Patent Application Publication No. 2014/0263552, titled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, is incorporated herein by reference in its entirety.

Additional details regarding the 150600 slip ring assembly can be found in US Patent Application Publication No. 2014/0263541.

[0235] The interchangeable drive shaft assembly 150200 may include a proximal portion attachably mounted to the grip assembly 150014, and a distal portion that is rotatable about a longitudinal axis. The distal rotating portion of the drive shaft may be rotated with respect to the proximal portion around the slip ring assembly 150600. The distal connector flange 150601 of the slip ring assembly 150600 may be positioned on the distal rotating portion of the shaft. of drive.

[0236] Figure 24 is an exploded view of an aspect of an end actuator 150300 of the surgical instrument 150010 of Figure 21, in accordance with at least one aspect of this description. End actuator 150300 may include anvil 150306 and surgical staple cartridge 150304. Anvil 150306 may be coupled to an elongate channel 150302. Apertures 150199 may be defined in elongate channel 150302 to receive pins 150152 which extend from anvil 150306 to allow anvil 150306 to rotate from an open position to a closed position with respect to the elongated channel 150302 and surgical staple cartridge

150304. A trigger bar 150172 is configured to translate longitudinally into the end actuator 150300. The trigger bar 150172 may be constructed from a solid section or may include a laminated material comprising a stack of steel plates. steel. The trigger bar 150172 comprises an i-profile beam 150178 and a cutting edge 150182 at a distal end thereof. One end of the distally projecting firing bar 150172 may be attached to the i-profile beam 150178 to assist in spacing the anvil 306 from a surgical staple cartridge 150304 positioned in the elongated channel 150302 when the anvil 150306 is in a position closed. The i-profile beam 150178 may include a sharp cutting edge 150182 to cut the fabric as the i-profile beam 150178 is advanced distally by the trigger bar 150172. In operation, the i-profile beam 150178 can trigger or triggers surgical staple cartridge 150304. Surgical staple cartridge 150304 may include a molded cartridge body 150194 that retains a plurality of staples 150191 that rest on staple drivers 150192 within respective open staple cavities to top 150195. A wedge slider 150190 is driven distally by the i-profile beam 150178, sliding over a cartridge tray 150196 of the surgical staple cartridge 150304. The wedge slider 150190 cam shifts the clamp drivers 150192, to expel the clamps 150191 in deformation contact with the anvil 150306, while the cutting edge 150182 of the i-profile beam 150178 cuts the fabric ap right.

[0237] I-beam 150178 may include top pins 150180 that engage anvil 150306 during firing. The i-profile beam 150178 may include intermediate pins 150184 and a bottom base 150186 for engaging portions of the cartridge body 150194, cartridge tray 150196, and elongated channel 150302. When a surgical staple cartridge 150304 is positioned in the inside the elongated channel 150302, a slot 150193 defined in the cartridge body 150194 may be aligned with a longitudinal slot 150197 defined in the cartridge tray 150196 and a slot 150189 defined in the elongated channel 150302. In use, the i-profile beam 150178 can slide through aligned longitudinal slots 150193, 150197 and 150189, whereby, as indicated in Figure 24, the bottom base 150186 of the i-profile beam 150178 can engage a groove positioned along the bottom surface of the elongated channel

150302 along the length of the slot 150189, the middle pins 150184 can engage the top surfaces of the cartridge tray 150196 along the length of the longitudinal slot 150197, and the top pins 150180 can engage the anvil 150306. i 150178 can space or limit relative movement between the anvil 150306 and the surgical staple cartridge 150304 as the trigger bar 150172 is advanced distally to fire the staples of the surgical staple cartridge 150304 and/or make a tissue incision captured between the 150306 anvil and the 150304 surgical staple cartridge. The 150172 trigger bar and 150178 i-profile beam can be retracted proximally allowing the 150306 anvil to be opened to release the two stapled and cut tissue portions .

[0238] Figures 25A and 25B are a block diagram of a control circuit 150700 of the surgical instrument 150010 of Figure 21 encompassing two drawing sheets, in accordance with at least one aspect of this description. Referring primarily to Figures 25A and 25B, the grip assembly 150702 may include a motor 150714, which may be controlled by a motor driver 150715 and may be employed by the surgical instrument trigger system.

150010. In various forms, the 150714 motor can be a brushed direct current (DC) drive motor that has a maximum rotational speed of approximately 25,000 RPM. In other arrangements, the 150714 motor may include a brushless motor, a wireless motor, a synchronous motor, a stepper motor, or any other suitable electric motor. Motor driver 150715 may comprise an H-bridge driver comprising FETs 150719, for example. The 150714 motor can be powered by the 150706 power pack releasably mounted to the 150200 grip assembly to supply control power to the instrument.

surgical instrument 150010. The power pack 150706 may comprise a battery which may include multiple battery cells connected in series that may be used as the power source to power the surgical instrument 150010. In certain circumstances, the battery cells of the 150706 power pack may be replaceable and/or rechargeable. In at least one example, the battery cells may be Li batteries that may be detachably attachable to the 150706 power pack.

[0239] The 150704 Drive Shaft Assembly may include a 150722 Drive Shaft Assembly Controller that can communicate with a 150716 Safety Controller and a 150716 Power Management Controller via an interface, while the 150716 Drive Shaft Assembly drive assembly 150704 and power assembly 150706 are coupled to grip assembly 150702. For example, the interface may comprise a first interface portion 150725, which may include one or more electrical connectors for mating engagement with corresponding electrical connectors. of the drive shaft assembly, and a second interface portion 150727, which may include one or more electrical connectors for mating engagement with the corresponding electrical connectors of the power assembly to allow electrical communication between the power assembly controller. 150722 drive shaft and 150716 power management controller, while the shaft assembly 150704 drive assembly and 150706 power pack are coupled to the 150702 grip assembly. One or more communication signals may be transmitted through the interface to communicate one or more of the power requirements of the attached interchangeable drive shaft assembly. 150704 to the power management controller 150716. In response, the power management controller can modulate the battery power output of the controller.

power pack 150706, as described below in more detail, according to the power requirements of the 150704 fixed drive shaft assembly. Connectors may comprise switches that can be activated after mechanical coupling engagement of the drive assembly. 150702 Handle to the 150704 Drive Shaft Assembly and/or the 150706 Power Assembly to allow electrical communication between the 150722 Drive Shaft Assembly Controller and the 150716 Power Management Controller.

[0240] The interface can facilitate the transmission of one or more communication signals between the 150716 power management controller and the 150722 drive shaft assembly controller by routing such communication signals through a 150717 main controller located on grip assembly 150702, for example. In other circumstances, the interface may facilitate a direct line of communication between the 150716 power management controller and the 150722 drive shaft assembly controller through the 150702 grip assembly, while the 150702 drive shaft assembly controller drive shaft 150704 and power assembly 150706 are coupled to the grip assembly

150702.

[0241] The 150717 main controller can be any single-core or multi-core processor, such as those known under the tradename ARM Cortex available from Texas Instruments. In one aspect, the 150717 main controller may be a Core Cortex-M4F LM4F230H5QR ARM processor, available from Texas Instruments, for example, which comprises an integrated 256KB single-cycle flash memory, or other memory. up to 40 MHz, a prefetch buffer to optimize performance above 40 MHz, a 32 KB single-cycle serial random access memory (SRAM), an internal read-only memory (ROM) loaded with the StellarisWareO software, 2 KB electrically erasable programmable read-only memory (EEPROM), one or more pulse width modulation (PWM) modules, one or more analog quadrature encoder (QEI) inputs, one or more 12-bit analog-to-digital converters (ADC) with 12 analog input channels, details of which are available in the product data sheet.

[0242] The safety controller may be a safety controller platform comprising two controller-based families, such as TMS570 and RM4x, known under the tradename Hercules ARM Cortex R4, also available from Texas Instruments. The safety controller can be configured specifically for safety critical applications IEC 61508 and ISO 26262, among others, to provide advanced built-in safety features while providing scalable performance, connectivity and memory options.

[0243] The 150706 power package may include a power management circuit which may comprise the 150716 power management controller, a 150738 power modulator, and a 150736 current sensing circuit. The power management circuit may be configured to modulate battery power output based on the power requirements of the 150704 drive shaft assembly, while the 150704 drive shaft assembly and 150706 power assembly are coupled to the 150702 grip assembly. power management 150716 can be programmed to control the power modulator 150738 from the power output of the 150706 power pack and the current sensing circuit 150736 can be used to monitor the power output of the 150706 power pack to provide the 150716 power management controller with feedback

information on battery power output so that the 150716 power management controller can adjust the power output of the 150706 power pack to maintain a desired output. The 150716 power management controller and/or the 150722 drive shaft assembly controller may each comprise one or more processors and/or memory units that can store multiple software modules.

[0244] Surgical instrument 150010 (Figures 21 to 24) may comprise an output device 150742 which may include devices for providing sensory feedback to a user. Such devices may comprise, for example, visual feedback devices (eg, a liquid crystal display (LCD), LED indicators), auditory feedback devices (eg, a loudspeaker, a doorbell) or tactile feedback devices (eg haptic actuators). In certain circumstances, the output device 150742 may comprise a display 150743 which may be included in the grip assembly.

150702. The 150722 drive shaft assembly controller and/or the 150716 power management controller can provide feedback to a user of the 150010 surgical instrument via the 150742 output device. The interface can be configured to connect the 150722 drive shaft assembly controller and/or the 150716 power management controller to the 150742 output device. The 150742 output device may instead be integrated with the 150706 power package. In such circumstances, communication between output device 150742 and drive shaft assembly 150722 controller can be made through the interface, while drive shaft assembly 150704 is coupled to grip assembly 150702.

[0245] The 150700 control circuit comprises circuit segments configured to control the operations of the 150010 powered surgical instrument. A safety controller segment (segment 1) comprises a safety controller and the main controller segment 150717 (segment 2). ). The safety controller and/or the 150717 main controller are configured to interact with one or more additional circuit segments such as an acceleration segment, a display segment, a drive shaft segment, a encoder, a motor segment and a power segment.

Each of the circuit segments can be coupled to the safety controller and/or the main controller 150717. The main controller 150717 is also coupled to flash memory.

The 150717 main controller also comprises a serial communication interface.

Master controller 150717 comprises a plurality of inputs coupled, for example, to one or more circuit segments, a battery, and/or a plurality of switches.

The segmented circuit may be implemented by any suitable circuit, such as a printed circuit board assembly (PCBA) within the 150010 powered surgical instrument. It should be understood that the term processor , as used herein, includes any microprocessor, processor, controller, controllers, or other basic computing device that incorporates the functions of a computer's central processing unit (CPU) in an integrated circuit or at most a few integrated circuits.

The 150717 main controller is a multi-function programmable 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.

The 150700 control circuit can be configured to implement one or more of the processes described herein.

[0246] The acceleration segment (segment 3) comprises an accelerometer. The accelerometer is configured to detect movement or acceleration of the 150010 powered surgical instrument. Input from the accelerometer can be used to transition to and from a sleep mode, identify the surgical instrument orientation energized, and/or identify when the surgical instrument has been dropped. In some examples, the acceleration segment is coupled to the safety controller and/or the 150717 main controller.

[0247] The display segment (segment 4) comprises a screen connector coupled to the main controller 150717. The screen connector couples the main controller 150717 to a screen through one or more drivers of the screen's integrated circuits. The drivers of the display's integrated circuits may be integrated with the display and/or may be arranged separately from the display. The display may comprise any suitable display, such as, for example, an organic light-emitting diode (OLED) display, a liquid crystal display (LCD), and/or any other suitable display. In some examples, the screen segment is coupled to the safety controller.

[0248] The drive shaft segment (segment 5) comprises controls for a 150200 interchangeable drive shaft assembly (Figures 21 and 23) coupled to the 150010 surgical instrument (Figures 21 to 24) and/or one or more controls for a 150300 End Actuator coupled to the 150200 Interchangeable Drive Shaft Assembly. The Drive Shaft Segment comprises a Drive Shaft Connector configured to mate the 150717 Main Controller to a Drive Shaft PCBA. The drive shaft PCBA comprises a low-power microprocessor with a ferroelectric layer random access memory (FRAM), a toggle switch, a drive shaft release Hall-effect switch, and a PCBA EEPROM memory. of the drive shaft. The Drive Shaft PCBA EEPROM comprises one or more parameters, routines and/or programs specific to the 150200 Interchangeable Drive Shaft Assembly and/or the Drive Shaft PCBA. Drive Shaft PCBA can be coupled to the 150200 Interchangeable Drive Shaft Assembly and/or integral with the surgical instrument

150010. In some examples, the drive shaft segment comprises a second drive shaft EEPROM. The second drive shaft EEPROM comprises a plurality of algorithms, routines, parameters and/or other data that correspond to one or more 150200 drive shaft assemblies and/or 150300 end actuators that can interface with the 150010 powered surgical instrument.

[0249] The position encoder segment (segment 6) comprises one or more magnetic rotation angle position encoders. One or more rotation angle position magnetic encoders are configured to identify the rotational position of the 150714 motor, 150200 interchangeable drive shaft assembly (Figures 21 and 23), and/or instrument 150300 end actuator surgical 150010 (Figures 21 to 24). In some examples, rotation angle position magnetic encoders can be coupled to the safety controller and/or the 150717 main controller.

[0250] The motor circuit segment (segment 7) comprises a motor 150714 configured to control the movements of the powered surgical instrument 150010 (Figures 21 to 24). The 150714 motor is coupled to the 150717 main microcontroller processor by an H-bridge driver comprising one or more H-bridge field effect transistors (FETs) and a motor controller. The H bridge trigger is also coupled to the safety controller. A motor current sensor is coupled in series with the motor to measure the current draw from the motor. The motor current sensor is in signal communication with the 150717 main controller and/or the safety controller. In some examples, the 150714 motor is coupled to a motor electromagnetic interference (EMI) filter.

[0251] The motor controller controls a first motor flag and a second motor flag to indicate to the 150717 main controller the state and position of the 150714 motor. The 150717 main controller provides a high pulse width modulation (PWM) signal ), a PWM low signal, a direction signal, a synchronization signal and a motor reset signal to the motor controller via a buffer. The power segment is configured to supply a segment voltage to each of the circuit segments.

[0252] The power segment (segment 8) comprises a battery coupled to the safety controller, the main controller 150717 and additional circuit segments. The battery is coupled to the segmented circuit by a battery connector and a current sensor. The current sensor is configured to measure the total current draw of the segmented circuit. In some examples, one or more voltage converters are configured to supply predetermined voltage values to one or more circuit segments. For example, in some examples, the segmented circuit may comprise 3.3V voltage converters and/or 5V voltage converters. A voltage boost converter is configured to provide a voltage rise up to a predetermined amount. , such as up to 13 V. The voltage boost converter is configured to provide additional voltage and/or current during power-intensive operations and avoid blackout or low power conditions.

[0253] A plurality of switches are coupled to the safety controller and/or to the main controller 150717. The switches can be configured to control the operations of the surgical instrument 150010 (Figures 21 to 24), the segmented circuit and/or indicate an operation. - status of surgical instrument 150010. An ejection port switch and an ejection Hall-effect switch are configured to indicate the status of an ejection port. A plurality of toggle braces, such as, for example, a left pivot brace for the left side, a right pivot brace for the left side, a central pivot brace for the left side, a left pivot brace for the right side, a right pivot key for the right side and a central pivot switch for the right side are configured to control the pivot of a 150200 interchangeable drive shaft assembly (Figures 21 and 23) and/or or the 150300 End Actuator (Figures 21 to 24). A left-side reverse switch and a right-side reverse switch are coupled to the 150717 main controller. The left-side switches comprising the left pivot switch for the left side, the right pivot switch for the left side, the left-side pivot key and left-side reverse key are coupled to the 150717 main controller by a left-hand bend connector. The right-hand keys that comprise the right-hand pivot left wrench, the right-side pivot wrench, the right-side pivot center wrench, and the right-side reverse wrench are coupled to the 150717 main controller by a right flex connector. A tripping key, a tightening release key, and a key coupled to the drive shaft are coupled to the main controller.

150717.

[0254] Any suitable mechanical, electromechanical, or solid state switches may be employed to implement the plurality of switches, in any combination. For example, switches can limit switches operated by the movement of components associated with the 150010 surgical instrument (Figures 21 to 24) or the presence of an object. Such switches can be employed to control various functions associated with the 150010 surgical instrument. A limit switch is an electromechanical device consisting of an actuator mechanically linked to a set of contacts. When an object comes into contact with the actuator, the device operates the contacts to make or break an electrical connection. Limit switches are used in a variety of applications and environments because of their robustness, ease of installation and reliability of operation. They can determine the presence or absence, passage, positioning and end of displacement of an object. In other implementations, switches can be solid state switches that operate under the influence of a magnetic field such as Hall effect devices, magneto-resistive (MR) devices, giant magneto-resistive (GMR) devices, magnetometers, among others. In other implementations, the switches can be solid state switches that operate under the influence of light, such as optical sensors, infrared sensors, ultraviolet light sensors, among others. In addition, switches can be solid-state devices such as transistors (eg, FET, junction FET, metal oxide semiconductor FET (MOSFET), bipolar, and the like). Other switches may include wireless switches, ultrasonic switches, accelerometers, inertia sensors, among others.

[0255] Figure 26 is another block diagram of the 150700 control circuit of the surgical instrument of Figure 21 illustrating the interfaces between the 150702 grip assembly and the 150706 power assembly and between the 150702 grip assembly and the interchangeable drive shaft 150704, according to at least one aspect of this description.

The handle assembly 150702 may comprise a main controller 150717, a drive shaft assembly connector 150726 and a power assembly connector 150730. The power assembly 150706 may include a power assembly connector 150732, a power supply circuit 150734 power management which may comprise the 150716 power management controller, a 150738 power modulator, and a 150736 current sensing circuit. The drive shaft assembly connectors 150726, 150728 form a 150727 interface. 150734 power management module can be configured to modulate the power output of the 150707 battery based on the power requirements of the 150704 Interchangeable Drive Shaft Assembly while the 150704 Interchangeable Drive Shaft Assembly and 150706 Power Assembly are coupled to the assembly 150702 grip. The 150716 power management controller can be programmed to to control the power modulator 150738 from the power output of the power pack 150706 and the current sensing circuit 150736 can be used to monitor the power output of the power pack 150706 to provide the power management controller 150716 with feedback about 150707 battery power output so that the 150716 power management controller can adjust the power output of the 150706 power pack to maintain a desired output.

The 150704 Drive Shaft Assembly comprises a 150720 Drive Shaft Processor coupled to a 150721 Non-Volatile Memory and a 150728 Drive Shaft Assembly Connector to electrically couple the 150704 Drive Shaft Assembly to the 150702 Handle Assembly. of the 150726 drive shaft assembly, 150728 form the 150725 interface. The 150717 main controller, 150720 drive shaft processor, and/or 150716 power management controller can be configured to implement one or more of the processes described here.

[0256] Surgical instrument 150010 (Figures 21 to 24) may comprise an output device 150742 for sensory feedback to a user. These devices may comprise visual feedback devices (e.g. a monitor with an LCD screen, LED indicators), auditory feedback devices (e.g. a loudspeaker, a doorbell) or tactile feedback devices (e.g. , haptic actuators). In certain circumstances, the output device 150742 may comprise a screen 150743 which may be included in the grip assembly.

150702. The 150722 drive shaft assembly controller and/or the 150716 power management controller can provide feedback to a user of the 150010 surgical instrument via the 150742 output device. The 150727 interface can be configured to connect the controller from the 150722 drive shaft assembly and/or the 150716 power management controller to the 150742 output device. The 150742 output device can be integrated with the 150706 power assembly. The communication between the 150742 output device and the 150722 drive shaft assembly controller can be via the 150725 interface while the 150704 interchangeable drive shaft assembly is coupled to the 150702 grip assembly. Proximity detection of cancerous tissue

[0257] Cancer is a disease at the cellular level that involves disturbances in cellular control mechanisms. Tumor cells alter their metabolism to maintain unregulated cell proliferation and survival, but this transformation leaves the cells dependent on a constant supply of nutrients and energy. Cancer cells are shown to experience characteristic changes in their metabolic programs, including increased glucose uptake. Many cancer cells showed an increase in glycolysis (anaerobic metabolism), leading to decreased glucose and increased lactic acid in the interstitial fluid environment. Consequently, glucose levels in normal tissue are higher than in cancerous tissue. Furthermore, due to the increase in lactic acid levels in cancer tissue, the pH of cancerous tissue (hydrogen potential) is lower than the pH of normal tissue.

[0258] One of the popular cancer treatments is to perform the excision of cancerous tissue. As illustrated in Figure 27, a surgical instrument can be used to seal and cut tissue along a defined perimeter in healthy tissue around cancerous tissue. Tissue sealing can be achieved by applying energy (eg RF or ultrasonic) or by placing staples in the tissue. In a successful procedure, no cancer cells are detected at the outer edge of the tissue that was removed, which is known as a clear surgical margin.

[0259] Using various existing techniques, a surgeon can attempt to visually determine where tissue held by a surgical end actuator is located relative to a desired clear surgical margin. Obviously, such a visual determination can be ineffective. Furthermore, unintentionally disturbing the cancerous tissue by cutting through the cancerous tissue can have undesirable consequences. For example, cancer cells displaced by this process can migrate to other healthy tissue via the bloodstream, for example, causing the cancer to spread to other healthy tissue.

[0260] Aspects of the present description present various surgical instruments used in the treatment of cancer, which employ various sensors and algorithms to assess proximity to cancerous tissue and/or to assist a user in navigating a safe distance. in the opposite direction to the cancerous tissue prior to application of a cancer treatment by the end actuator.

[0261] Figure 29 is a logic flow diagram of a 26120 process representing a control program or a logic configuration for evaluating the proximity of a 26000 end actuator of a 26010 surgical instrument to cancerous tissue, in accordance with the least one aspect of the present description. In one aspect, as described in more detail below, process 26120 is carried out by a control circuit 500 (Figure 13). In another aspect, process 26120 may be executed by combinational logic circuit 510 (Figure 14). In yet another aspect, process 26120 may be executed by sequential logic circuit 520 (Figure 15).

[0262] Process 26120 measures 26123 a physiological parameter of the tissue in contact with the 26000 end actuator, the measured physiological parameter being one that indicates the proximity of the 26000 end actuator to the cancerous tissue. Process 26120 further alerts 26125 a user and/or aborts 26126 a tissue treatment if it is determined that the physiological parameter reaches or exceeds a predetermined threshold.

[0263] Figure 30 is a logic flow diagram of a 26020 process representing a control program or a logic configuration for evaluating the proximity of a 26000 end actuator of a 26010 surgical instrument to cancerous tissue, in accordance with the least one aspect of the present description. in a-

Indeed, as described in more detail below, process 26020 is performed by a control circuit 500 (Figure 13). In another aspect, process 26020 may be executed by combinational logic circuit 510 (Figure 14). In yet another aspect, process 26020 may be executed by sequential logic circuit 520 (Figure 15).

[0264] The 26000 end actuator, as illustrated in Figures 31 and 32, includes a 26471 sensor array configured to generate or provide sensor signals indicative of a tissue physiological parameter representing proximity to the end actuator. to cancer tissue. Figure 32 illustrates a 26470 control system that includes a control circuit coupled to the sensor array.

26471. The 26470 control system is configured to assess the proximity of the 26000 end actuator to cancer tissue based on sensor signals from the 26471 sensor array.

[0265] In one aspect, the physiological parameter is the tissue glucose level. A low glucose level indicates a close proximity of the end actuator to the cancerous tissue.

[0266] In another aspect, the physiological parameter is a pH level. A low pH level indicates close proximity of the end actuator to the cancerous tissue.

[0267] Figure 28 is a graph illustrating a physiological tissue parameter (Y axis) plotted as a function of the distance to a tumor (x axis). In the example of Figure 28, the physiological parameter decreases with an increase in proximity to the tumor. Examples of physiological parameters that exhibit such characteristics include glucose and pH, as described below in more detail. Other examples may involve a physiological parameter that increases with an increase in proximity to the tumor.

[0268] In the example of Figure 28, the tissue physiological parameter reaches a normal level (N) at a distance (d) from the tumor, which defines a clear margin, as illustrated in Figure 27. The normal level (N) represents a typical level of the physiological parameter in normal tissue.

[0269] The 26010 Surgical Instrument is similar in many respects to the 150010 Surgical Instrument. For example, the 26000 End Actuator and 26470 Control System are similar in many respects to the 150300 End Actuator and to the 470 control system (Figure 12), respectively. For the sake of brevity, components of the surgical instrument 26010 that are similar to the above-described components of the surgical instrument 150010 are not repeated in the present invention in detail.

[0270] The 26000 End Actuator includes a first jaw 26001 and a second jaw 26002 that extend from an interchangeable drive shaft assembly 150200. The End Actuator 26000 additionally includes an anvil 26009 (Figure 32) defined in the first jaw 26001 and a staple cartridge 26005 defined in the second jaw 26002. At least one of the first jaw 26001 and the second jaw 26002 is movable relative to the other to transition the end actuator 26000 between an open configuration and a closed configuration for holding tissue between the anvil 26009 and the staple cartridge 26005. In operation, a tissue treatment by the surgical instrument 26010 involves positioning staples of the staple cartridge 26005 by a triggering member 26011 in the gripped tissue. The positioned clamps are deformed by the 26009 anvil.

[0271] In various aspects, a surgical instrument, in accordance with the present description, may include an end actuator that treats tissue by applying RF or ultrasonic energy to the tissue. In many respects, the 26010 surgical instrument can be a hand-held surgical instrument. Alternatively, the 26010 surgical instrument can be incorporated into a robotic system as a component of a robotic arm. Additional details on robotic systems are disclosed in Provisional Patent Application No. 62/611,339, filed December 28, 2017, which is incorporated herein by reference in its entirety.

[0272] Measurement of the physiological parameter and assessment of the proximity of the 26000 End Actuator to the cancerous tissue may begin with the activation of the 26010 Surgical Instrument and can be continuously performed as long as the 26010 Surgical Instrument remains operational . Alternatively, as described in connection with the 26020 process, such activities can be triggered, for example, by the detection of a tissue held by the 26000 end actuator. In certain cases, such activities can be triggered by reaching or approaching a setting. closed.

[0273] The 26020 process detects 26021 if tissue is gripped by a 26000 surgical end actuator. Figure 20 illustrates an example of a tissue contact circuit that includes pressure or tissue contact sensors that determine when the grips of an end actuator initially comes into contact with the "T" fabric. Contacting the jaws with the fabric "T" closes an otherwise open detection circuit "SC" by making contact with a pair of opposing plates "P1, P2" provided on the jaw members.

[0274] Contact sensors may also include sensitive force transducers that determine the amount of force that is applied to the sensor, which can be assumed to be the same amount of force that is applied to the "T" fabric. Such force that is applied to the tissue can then be translated into an amount of tissue compression. In certain cases, measurement of the physiological parameter and assessment of the proximity of the 26000 End Actuator to the cancerous tissue may be triggered by reaching a predetermined tissue compression threshold.

[0275] Force transducers may include, and are not limited to, piezoelectric elements, piezoresistive elements, semiconductor or metal film strain gauges, inductive pressure sensors, capacitive pressure sensors, and potentiometric pressure transducers that use Bourdon tubes, capsules or bellows to drive a cleaning arm on a resistive element. Figure 20 and additional examples are further described in US patent no.

8,181,839, filed June 27, 2011, titled SURGICAL INSTRUMENT EMPLOYING SENSORS, issued May 5, 2012, the full disclosure of which is incorporated by reference into the present invention.

[0276] In certain cases, transitioning the 26000 End Actuator to a closed configuration may trigger the measurement of the physiological parameter and the assessment of the proximity of the 26000 End Actuator to the cancerous tissue. A tracking system 480 (Figures 12 and 32), which is configured to determine the position of a longitudinally movable displacement member that transmits closing motions to the end actuator 26000, may be employed in detecting the closed configuration.

[0277] The microcontroller 461 may query one or more readings from one or more of the sensors 472, 474, 476 in carrying out detection 26021. For example, the readings from the strain gauge sensor 474, which may be used to measure the force applied to tissue held by the 26000 End Actuator, may reflect whether the tissue is held by the 26000 End Actuator.

[0278] In either case, if it is determined 26021 that the fabric is held by the 26000 end actuator, or that a configuration

When closed position is achieved, the proximity of the end actuator 26000 to cancerous tissue can be verified 26023 based on a physiological parameter of the insured tissue. A 26471 sensor array that includes "n" sensors, where "n" is an integer greater than or equal to one, can be configured to provide the microcontroller with 461 sensor signals according to a tissue physiological parameter. which indicates the proximity of the 26000 End Actuator to the cancerous tissue.

[0279] If it is determined 26024 that the proximity of the end actuator to cancerous tissue reaches or exceeds a predetermined threshold, steps may be taken to alert 26025 a surgical operator and/or 26026 cancel a tissue treatment.

[0280] Microcontroller 461 can alert the surgical operator through screen 473, for example. Other audible, tactile and/or visual means may also be employed. The microcontroller 461 may also take measures to prevent tissue sealing. For example, microcontroller 461 can signal motor driver 492 to disable motor 482.

[0281] In various aspects, one or more of processes 26020 and 26120 are implemented by program instructions stored in memory 468, which can be executed by processor 462 to perform one or more of the steps of processes 26020 and 26120. Microcontroller 461 may also employ neural networks, lookup tables, defined functions, and/or real-time input from a cloud-based system 104 (Figure 1) in performing one or more of process steps 26020 and 26120.

[0282] In one example, the microcontroller 461 may employ a lookup table or a defined function, which may be stored in memory 468, to correlate sensor signals from the sensor array 26471 with tissue physiological parameter values. if-

insured. Lookup tables can also define a proximity index to assess the proximity of the 26000 End Actuator to the cancerous tissue based on determined physiological parameter values or, more directly, based on received sensor signals. Figure 33 illustrates an example of proximity index 26030, which correlates sensor signal readings (R1-n) received by microcontroller 461 from sensor array 26471 with corresponding distances (D1-n) between the extremity and cancerous tissue.

[0283] In several cases, the measurement of the physiological parameter of the tissue and/or the assessment of the proximity of a 26000 End Actuator to the cancerous tissue are triggered by a user input. A user interface such as screen 473 may be employed to receive and transmit user input to microcontroller 461, for example.

[0284] In addition to detecting the proximity of an end actuator to cancerous tissue, it is desirable to provide a direction to navigate the end actuator sufficiently in the opposite direction to the cancerous tissue. Figure 34 is a logic flow diagram of a 26040 process representing a control program or logic configuration for navigating a 26050 end actuator in the opposite direction to cancerous tissue. The 26050 End Actuator is similar in many respects to the 26000 End Actuator. For example, the 26010 Surgical Instrument can be equipped with a 26050 End Actuator in place of the 26000 End Actuator.

[0285] Process 26040 may run alone or in combination with process 26020, or at least a portion thereof. In many respects, the 26040 process is performed by a control circuit of a 26470 control system communicating with sensors 26055, 26056 on opposite sides 26053, 26054 of a 26050 end actuator. Sensors 26055, 26056 are spaced and separated by a transection path defined by a longitudinal axis "L" extending along an elongated channel configured to accommodate a transection member movable therethrough. The 26055, 26056 sensors are configured to provide sensor signals that correspond to a physiological parameter indicative of the proximity of the 26050 End Actuator to cancerous tissue.

[0286] Process 26040 may be executed by program instructions stored in memory 468, which may be executed by processor 462 to perform process 26040. Microcontroller 461 may also employ neural networks, lookup tables, defined functions, and/or or real-time input from a cloud-based system 104 (Figure 1) in performing process 26040.

[0287] Process 26040 includes receiving 26041 sensor signals from sensors 26055, 26056. If it is determined 26042 that the sensor signals represent physiological parameter values greater than or equal to a predetermined threshold, process 26040 allows 26043 a treatment application to the fabric by the end actuator

26050. On the other hand, if it is determined 26044 that the sensor signals represent physiological parameter values less than or equal to the predetermined threshold, the 26040 process instructs 26045 the user to move the end actuator in any suitable direction.

[0288] In addition to the above, if it is determined 26046 that a first sensor signal represents a physiological parameter value greater than or equal to the predetermined threshold, while a second sensor signal represents a value less than the predetermined threshold. finished, process 26040 instructs the user to move end actuator 26050 in a first direction 26061. On the other hand, if 26048 is determined that the second sensor signal represents a physiological parameter value greater than or equal to the predetermined threshold, while the first sensor signal represents a value less than the predetermined threshold, process 26040 instructs the user to move end actuator 26050 in a second direction 26062, opposite the first direction 26061.

[0289] As illustrated in Figure 35, the longitudinal axis "L" defines a first side 26053 and a second side 26054. The first direction 26061 extends in the opposite direction to the longitudinal axis "L" on the first side. 26053, while the second direction 26062 extends in the opposite direction to the longitudinal axis "L" on the second side 26054.

[0290] Figure 36 is a graph illustrating sensor signals from sensors 26055, 26056 that represent the values of a tissue physiological parameter (Y axis axis) plotted as a function of time (x axis axis) for three different positions ( Position A, Position B, Position C) of the 26050 End Actuator in relation to the cancerous tissue. The physiological parameter is the tissue glucose level. As described above, a low glucose level indicates close proximity to cancer tissue. Alternatively, the physiological parameter may be the pH level. A low pH level indicates close proximity to cancerous tissue.

[0291] In various examples, an extremity actuator, in accordance with at least one aspect of the present disclosure, may include sensors that measure two or more physiological parameters indicative of proximity to cancerous tissue. For example, an end actuator may include one or more glucose sensors and one or more pH sensors. Sensor signals from different types of sensors can be received by the 461 microcontroller to assess proximity to cancerous tissue.

[0292] At position A, sensor signals 26057, 26058 from sensors 26055, 26056 are greater than or equal to the predetermined threshold "N". Consequently, it can be concluded that the cancerous tissue is far enough away from the 26050 end actuator. Consequently, the 461 microcontroller can inform the surgical operator that it is safe to treat the tissue held by the end actuator.

26050

[0293] At position C, signals 26057, 26058 from sensors 26055, 26056 are less than the predetermined threshold "N". Consequently, it can be concluded that the tumor is on, or at least close to, the transection path 26052 between sensors 26055, 26056. Consequently, the microcontroller 461 can instruct the surgical operator to release the gripped tissue, and reposition the 26050 end actuator by moving it to the side in either direction before applying a treatment to the fabric.

[0294] In position B, sensor signal 26057 from sensor 26055 is below predetermined threshold "N", while sensor signal 26058 from sensor 26056 is greater than predetermined threshold "N". Consequently, it can be concluded that the tumor extends over the first side 56053 of the 26050 end actuator. Consequently, the 461 microcontroller can instruct the surgical operator to release the gripped tissue, and reposition the 26050 end actuator. moving it in the second direction 26062 away from the cancerous tissue, before treating the tissue.

[0295] In several examples, the sensor signals are directly proportional to the physiological parameter detected by the sensors. In other equivalent examples, however, the sensor signals may be inversely proportional to the physiological parameter detected by the sensors. In such other examples, the sensor signals decrease as proximity to the cancerous tissue increases. however

Therefore, an inverter can be used to invert the sensor signals received.

[0296] In various aspects, with reference to Figures 32, 35 and 36, the microcontroller 461 additionally processes the sensor signals from sensors 26055, 26056 by subtracting one sensor signal from the other sensor signal. The resulting delta can be further analyzed to determine the direction in which the 26050 End Actuator should be moved. As illustrated in Figure 36, in position A and position C, the sensor signals practically cancel each other out. However, at position B in Figure 36, a positive at delta 26059 is detected. The positive delta transition indicates that cancerous tissue extends on the first side 26053 of the end actuator 26050, but not on the second side 26054. Also, whether the delta 26059 is above or below zero can give an indication as to the desired direction. of motion for the 26050 end actuator.

[0297] With sensors 26055, 26056, as illustrated in the example of Figure 35, the microcontroller 461 is able to assess the relevant proximity to cancerous tissue and determine how to navigate away from the direction of cancerous tissue. In another example, a sensor array may include more than two sensors. In one example, a sensor array may include, in addition to sensors 26055, 26056, a third sensor on a distal portion of the end actuator.

[0298] In various respects, as illustrated in Figure 37, a 26070 end actuator can be equipped with a 26080 sensor array that includes six sensors (Sen; to Sens): two proximal sensors (Sen; and Sens), two sensors medial (Sen? and Sens) and two distal sensors (Sen; and Sens). The added sensors enable the 461 microcontroller, among other things, to more accurately predict the position of the 26070 end actuator relative to tissue.

of the cancerous.

[0299] The 26070 End Actuator is similar in many respects to the 26000, 26050 End Actuators. For example, the 26070 End Actuator includes a first jaw 26071 and a second jaw 26072. At least one of the first jaw 26071 and the second jaw 26072 is movable relative to the other to hold fabric therebetween.

[0300] In addition to the above, the 26070 end actuator includes an anvil defined in the second jaw 26072 and a staple cartridge 26075 defined in the first jaw 26071. To treat the tissue held by the end actuator 26070, the staples are positioned from the staple cartridge 26075 into the gripped tissue and are deformed by the anvil. To cut the fabric, a transection member is moved relative to an elongated slot that defines a transection path 26073 for the transection member. The transection path 26073 defines two opposite sides 26076, 26077 of the end actuator 26070.

[0301] In addition to the above, sensor array 26080 is similar in many ways to sensor array 26471. For example, sensor array 26080 can also be coupled to microcontroller 461. Sensor array 26080 includes six sensors (Sen , Sens) configured to provide the 461 microcontroller with sensor signals according to a tissue physiological parameter that indicates the proximity of the 26070 end actuator to the cancerous tissue. In other examples, the 26080 sensor array, like the 26471 sensor array, can include more or less than six sensors.

[0302] Sensors in the 26080 sensor array are spaced and arranged on outer edges 26078, 26079 of the staple cartridge

26075. In the example of Figure 37, Sen'1, Sen? and Sen; are arranged on side 26076 while Sena, Sens and Sens are arranged on side 26077.

In other words, the 26052 transection path spans between the sensors of the 26080 sensor array.

[0303] In several examples, the differential between the sensor signals and the average of the signals can provide knowledge of the tumor proximity. If a signal indicates that a sensor is over a tumor, the differential between that sensor and the other sensors will provide knowledge of whether the tumor is along one side (not undergoing transection) or through the trajectory of a tumor. transection (submitted to transection). If the difference between the signals and the mean is small but the mean is high, then the entire end actuator is over the tumor.

[0304] Figures 38 and 41 are graphs that illustrate the sensor signals from Sen sensors; a Sens plotted on the Y-axis as a function of time on the x-axis. Sensor signals from Sen sensors, Sens measure a physiological parameter that changes with a change in the distance to the cancerous tissue. Therefore, Sen's sensor signals; a Sens represent a tissue physiological parameter indicative of the position of the 26070 end actuator relative to the cancerous tissue.

[0305] Error! No string specified. The physiological parameter of Figures 38 and 41 is one that decreases with an increase in proximity to the cancerous tissue, but the sensor signals from the Sen, to Sens sensors were passed through an inverter. Positions A through C of Figure 38 and positions A through E of Figure 40 each represent a distinct position of the end actuator 26070 in relation to the cancerous tissue.

[0306] In the examples of Figures 38 and 41, an average (AVG) of the sensor signals can calculate the microcontroller 461 from the formula: AVG SÉ Sen, + Sen, + Sen; ... Sen, n , where Sen represents the sensor signal values in time (t) and where (n) represents the number of sensors.

[0307] Then, the 461 microcontroller can employ a formula: Dilsen, — AVG|<X where (n) is an integer greater than zero, where (AVG) is the average of the sensor signals, and where ( x) is a predetermined threshold, to determine the proximity of the 26070 End Actuator to the cancerous tissue. If the formula yields a result below the predetermined threshold (x), as illustrated in Positions A of Figures 38 and 41, the microcontroller 461 authorizes a tissue treatment by the end actuator 26070. At positions B through D of Figure 38 and positions B to E of Figure 41, the formula yields a result that is greater than the predetermined threshold (x) indicating that one or more of the sensors are within close proximity to the cancerous tissue.

[0308] The 461 microcontroller can compare the sensor signal from each of the Sen sensors, the Sens with the average of the sensor signals (AVG) to assess the proximity of the Sen sensors; a Sens to cancerous tissue. The proximity of the 26070 end actuator to the tissue can be inferred from the assessed proximity of the Sen:a Sens sensors to the cancerous tissue. Sensors that provide sensor signals greater than (AVG) can be identified as sensors positioned in close proximity to the cancerous tissue. Other mathematical formulas can be applied to sensor signals from Sen sensors; a Senç to check the proximity of the Sen: a Sens sensors to the cancerous tissue.

[0309] In addition to the above, additional information can also be inferred from the spatial relationship of Sen sensors; a Sens on the 26070 end actuator. Figure 39 is a logic flow diagram of a 26090 process representing a control program or logic configuration that provides instructions for navigating an end actuator with respect to cancerous tissue, where the instructions are based on the spatial relationship of sensors on the end actuator that report readings indicative of the sensors' close proximity to cancer tissue. Process 26090 can be run by microcontroller 461 based on sensor readings from Sen sensors, Sens. The 26090 process includes receiving 26091 sensor signals from the Sen: to Sen: sensors and determining 26092, based on the formulas described above, the sensors in close proximity to the cancerous tissue. Additionally, the 26090 process includes providing 26092 instructions for navigating a 26050 end actuator in the opposite direction to the cancerous tissue based on the relative location of the sensors in close proximity to the cancerous tissue on the 26050 end actuator.

[0310] Position C of Figure 38 and Position B of Figure 41 illustrate an example that implements the process 26090 of Figure 39. In Position C of Figure 38 and Position B of Figure 41, the Sen readings; and Sen, are greater than (AVG), while the remaining sensors report readings below (AVG). Furthermore, Sen; and Sen, are situated in a distal portion of the end actuator 26070 on opposite sides 26076 and 26077. Consequently, it can be concluded that the cancerous tissue extends over the transection path 26073, and is mainly situated in front of the actuator. 26070 end cap. In response, the 461 microcontroller may instruct the surgical operator to release the gripped tissue and move the 26070 end actuator back to reach a clear margin before re-gripping the tissue.

[0311] Position D of Figure 38 illustrates another example that implements the process 26090 of Figure 39. In Position D of Figure 38, the readings of Sen3 and Sen? are greater than (AVG), while the remaining sensors report readings below (AVG). Also, Sen? and Sen; are positioned on the same side 26076 as the end actuator.

26070. Consequently, it can be concluded that the cancerous tissue extends on the 26076 side of the end actuator

26070. Since the readings from the Sena, Sens and Sens sensors, which are situated on the 26077 side, indicate that these sensors are not in close proximity to the cancerous tissue, the 461 microcontroller can instruct the surgical operator to release the held tissue and move the 26070 end actuator in a direction opposite to the 26073 transection path on the 26077 side in order to achieve a clear margin on the 26076 side.

[0312] Figure 40 is a logic flow diagram of a 26190 process representing a control program or a logic configuration that provides instructions for navigating an end actuator with respect to cancerous tissue, the instructions being based on the spatial relationship and comparison between values of sensor readings in the extremity actuator that report readings indicative of the sensors' close proximity to cancer tissue. Process 26190 can be executed by microcontroller 461 based on sensor readings from Sen sensors: to Sens. The 26190 process includes receiving 26191 sensor signals from the Sen: to Sen: sensors and determining 26192, based on the formulas described above, the sensors in close proximity to the cancerous tissue. Additionally, the 26190 process includes providing 26193 instructions to navigate a 26070 end actuator in the opposite direction to cancerous tissue based on the relative location and relative values of sensor readings in close proximity to the cancerous tissue in the 26070 end actuator. .

[0313] Position E of Figure 41 provides an example that implements process 26190. In Position E of Figure 41, the readings of Sen, Sen? and Sen;z are all greater than or equal to (AVG), while the remaining sensors report readings below (AVG). In addition, the

Sen, Sen? and Sen;z are all positioned on the 26076 side of the 26070 end actuator. Consequently, it can be concluded that cancerous tissue extends on the 26076 side of the end actuator

26070. Also, reading Sen? is greater than Sen's reading. Also, Sen's reading? is greater than the reading of Sen3z. Since Sen, is positioned between Sen, and Sen3 on the same side 26076, can it be concluded that the cancerous tissue extends on the 26076 side of the end actuator 26070 in a position closer to Sen? than Sen; and Sen;.

[0314] In various examples, sensors from a sensor array such as the 26471 Sensor Array and/or the 26080 Sensor Array can be integrated into a staple cartridge and driven through metal portions of the staple cartridge. which, when mounted with an end actuator, engage contactor plates that transmit power and/or data.

[0315] In several examples, the physiological parameter of tissue that is measured by the sensors of a sensor array, in accordance with the present description, is pH. As discussed above, lactic acid is a by-product of the process of glycolysis (anaerobic metabolism) that is carried out by cancer tissue that leads to decreased glucose and increased lactic acid in the interstitial fluid environment.

[0316] In several examples, the physiological tissue parameter that is measured by the sensors of an array of sensors, in accordance with the present description, is glucose. As described above, glucose levels were measured to be very low in tumor microenvironments (0.1 to 0.4 mM). In normal tissue, glucose levels can be in the range of about 3.3 to 5.5 MM.

[0317] In several examples, the sensors of an array of sensors, according to the present description, are Clark type sensors, which can be used to measure glucose levels based on the reaction.

tion of oxygen with an enzyme. Clark-type sensors use a built-in surface of immobilized glucose oxidase to catalyze the oxidation of beta-D glucose to produce gluconic acid and hydrogen peroxide. The hydrogen peroxide is oxidized at a catalytic anode (usually platinum) that induces an electron transfer proportional to the number of glucose molecules present.

[0318] Figures 42 and 43 illustrate an example of glucose sensor printed on 26200 thick film that can be employed with an array of sensors of the present description. This configuration uses iridium-doped carbon ink, which has high specificity for detecting glucose that is unobscured by other common interfering chemicals (eg, ascorbic acid). The 26200 sensor comprises an electrode diameter of -1 mm. In one example, as illustrated in Figure 43, the 26200 sensor includes a 26202 Ir-carbon auxiliary electrode and 26203 Ir-carbon working electrode, an Ag/AgCl 26204 reference electrode, and a lead block of silver 26205. In addition, the 26200 sensor additionally includes a 26206 insulating layer. Additional details of the 26200 sensor are described in a journal publication for Shen J al. et al, entitled Sensors and Actuators B: Chemical, 2007, V125(1), pages 16 to 113, which is incorporated herein in its entirety by way of reference. As illustrated in Figures 44 to 45, with an applied potential of 0.2 to 0.3 V, a response current of -15 to 20 uA can be observed with a 5 mM increase in glucose.

[0319] In various aspects, the sensors of an array of sensors, in accordance with the present description, may be placed in a staple cartridge. An adhesive mask can be embedded with the sensors at predetermined locations. In many respects, the sensors are attached to the protrusions on the staple cartridge so that the sensors are positioned higher than a staple cartridge cartridge platform to ensure tissue contact. The adhesive mask could be created in bulk using screen printing technology on a polyester substrate, for example. Conductive blocks can be printed in a common location.

[0320] In several examples, in addition to cancer tissue proximity detection, an end actuator of the present description can also be configured to target different types of cancer in specific tissues. As indicated in the journal publication for Altenberg B and Greulich KO, Genomics 84(2004) pages 1014 to

1020, which is incorporated herein by reference, in its entirety, certain cancers are characterized by an overexpression of glycolysis genes, while other cancers are not characterized by an overexpression of glycolysis genes. Accordingly, an end actuator of the present description can be equipped with an array of sensors with a high specificity for cancerous tissue characterized by an overexpression of glycolysis genes such as lung cancer or liver cancer.

[0321] In various aspects, sensor readings from an array of sensors, in accordance with the present description, are communicated by the surgical instrument to a central surgical controller (e.g., central surgical controller 106, 206) for further analysis and/or for situational recognition. situational recognition

[0322] Situational recognition is the ability of some aspects of a surgical system to determine or infer information related to a surgical procedure from data received from databases and/or instruments. The information may include the type of procedure that is performed, the type of tissue that is operated on, or the body cavity that is the object of the procedure. With the information

contextual information related to the surgical procedure, the surgical system can, for example, improve the way in which it controls the modular devices (e.g. a robotic arm and/or robotic surgical tool) that are connected to it and provide information or contextualized suggestions for the surgeon during the course of the surgical procedure.

[0323] Figure 46 shows a timeline 5200 that represents the situational recognition of a central controller, such as the central surgical controller 106 or 206, for example. Timeline 5200 is an illustrative surgical procedure and the contextual information that the central surgical controller 106, 206 can derive from data received from data sources at each step in the surgical procedure. The 5200 timeline represents the typical steps that would be taken by nurses, surgeons, and other medical personnel during the course of a lung segmentectomy procedure, starting with the operating room setup and ending with the transfer. of the patient to a recovery room in the postoperative period.

[0324] Situational awareness from a central surgical controller 106, 206 receives data from data sources throughout the course of the surgical procedure, including data generated each time medical personnel use a modular device that is paired with the central operating room 106, 206. The central surgical controller 106, 206 can receive this data from the paired modular devices and other data sources and continually derive inferences (i.e., contextual information) about the procedure in progress as new data is received. , such as which step of the procedure is being performed at any given time. The situational awareness system of the central surgical controller 106, 206 is capable of, for example, recording data regarding the procedure to generate reports, verifying steps being taken by medical personnel, providing data or warnings (for example, through a display screen) that may be pertinent to the specific step of the procedure, adjust the modular devices based on context (e.g. activate monitors, adjust the field of view (FOV) of the medical imaging device, or change the level energy input from an ultrasonic surgical instrument or RF electrosurgical instrument), and take any other action described above.

[0325] In the first step 5202, in this illustrative procedure, hospital staff members retrieve the patient's electronic medical record (PEP) from the hospital's PEP database. Based on the PEP patient selection data, the central surgical controller 106, 206 determines that the procedure to be performed is a thoracic procedure.

[0326] In second step 5204, team members scan the entry of medical supplies for the procedure. The central surgical controller 106, 206 cross-references the scanned supplies with a list of supplies that are used in various types of procedures and confirms that the mix of supplies corresponds to a thoracic procedure. Additionally, the central surgical controller 106, 206 is also able to determine that the procedure is not a wedge resection procedure (because the inlet supplies lack certain supplies that are required for a thoracic wedge resection procedure). or, otherwise, that the inlet supplies do not correspond to a thoracic wedge resection procedure).

[0327] In the third step 5206, medical personnel scan the patient's band with a scanner that is communicably connected to the central surgical controller 106, 206. The central surgical controller 106, 206 can then confirm the patient's identity with based on scanned data.

[0328] In the fourth step 5208, the medical personnel switch 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, ancillary devices that are modular devices can automatically pair with the central surgical controller 106, 206 that is situated within a specific neighborhood of the modular devices as part of their startup process. The central surgical controller 106, 206 can then derive contextual information about the surgical procedure by detecting the types of modular devices paired with it during this preoperative or startup phase. In this particular example, the central surgical controller 106, 206 determines that the surgical procedure is a VATS (video-assisted thoracic surgery) procedure based on this specific combination of paired modular devices. Based on the combination of electronic patient record (PEP) data, the list of medical supplies to be used in the procedure, and the type of modular devices that connect to the central controller, the central surgical controller 106 , 206 can, in general, infer the specific procedure that the surgical team will perform. After the central surgical controller 106, 206 recognizes which specific procedure is being performed, the central surgical controller 106, 206 can then retrieve the steps of that process from memory or from the cloud and then cross-reference the data that subsequently receives from connected data sources (eg modular devices and patient monitoring devices) to infer which stage of the surgical procedure the surgical team is performing.

[0329] In the fifth step 5210, team members attach electrocardiogram (ECG) electrodes and other patient monitoring devices to the patient. ECG electrodes and other patient monitoring devices are capable of pairing with the central surgical controller 106, 206. As the central surgical controller 106, 206 begins to receive data from the patient monitoring devices, the central surgical controller 106, 206 thereby confirming that the patient is in the operating room.

[0330] In the sixth step 5212, medical personnel induce anesthesia on the patient. The central surgical controller 106, 206 can infer that the patient is under anesthesia based on data from modular devices and/or patient monitoring devices, including ECG data, blood pressure data, ventilator data, or combinations thereof, for example. After the completion of the sixth step 5212, the preoperative portion of the lung segmentectomy procedure is completed and the operative portion begins.

[0331] In the seventh step 5214, the lung of the patient being operated on is retracted (while ventilation is switched to the contralateral lung). The central surgical controller 106, 206 can infer from the ventilator data that the patient's lung has been retracted, for example. The central surgical controller 106, 206 can infer that the operative portion of the procedure has begun when it can compare the detection of the patient's lung collapse to the expected steps of the procedure (which can be accessed or retrieved earlier) and thus determine that lung retraction is the first operative step in this specific procedure.

[0332] In the eighth step 5216, the medical imaging device (eg, a viewing device) is inserted and video from the medical imaging device is started. The central surgical controller 106, 206 receives data from the imaging device.

medical imaging (i.e. video or image data) through its connection to the medical imaging device.

Upon receipt of data from the medical imaging device, the central surgical controller 106, 206 can determine which portion of the laparoscopic surgical procedure has been initiated.

Additionally, the central surgical controller 106, 206 may determine that the specific procedure being performed is a segmentectomy rather than a lobectomy (note that a wedge resection procedure has already been ruled out by the central surgical controller 106, 206 based on the data received in the second step 5204 of the procedure). Data from the medical imaging device 124 (Figure 2) can be used to determine contextual information about the type of procedure being performed in a number of different ways, including by determining the angle at which the medical imaging device is oriented in regarding viewing the patient's anatomy, monitoring the number or medical imaging devices being used (i.e., which are activated and paired with the central operating room 106, 206), and monitoring the types of imaging devices visualization 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 anterior to the segment fissure. .

Using 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, one technique for performing a VATS lobectomy uses a single medical imaging device, while another technique for performing a segmentectomy

VATS uses multiple cameras. As yet another example, a technique for performing a VATS segmentectomy uses an infrared light source (which can be communicably coupled to the central surgical controller as part of the visualization system) to visualize the segment fissure, which is not used in a VATS lobectomy. By tracking any or all of this data from the medical imaging device, the central surgical controller 106, 206 can thus determine the specific type of surgical procedure being performed and/or the technique being used for a specific type of surgical procedure.

[0333] In the ninth step 5218 of the procedure, the surgical team starts the dissection step. The central surgical controller 106, 206 can infer that the surgeon is in the process of dissecting to mobilize the patient's lung because he receives data from the RF or ultrasonic generator that indicates that an energy instrument is being fired. The central surgical controller 106, 206 can cross-reference the received data with the retrieved steps of the surgical procedure to determine that a power instrument is being fired at that point in the process (i.e., after completion of the previously discussed steps of the procedure) corresponds to the dissection stage. In certain cases, the power instrument may be a power tool mounted on a robotic arm of a robotic surgical system.

[0334] In the tenth step 5220 of the procedure, the surgical team proceeds to the ligation step. The central surgical controller 106, 206 can infer that the surgeon is ligating the arteries and veins because he receives data from the surgical stapling and cutting instrument indicating that the instrument is being triggered. Similar to the previous step, the central surgical controller 106, 206 can derive this inference by crossing the reception data from the surgical stapling and cutting instrument with the steps retrieved in the process. In certain cases, the surgical instrument may be a surgical tool mounted on a robotic arm of a robotic surgical system.

[0335] In the eleventh step 5222, the segmentectomy portion of the procedure is performed. The central surgical controller 106, 206 can infer that the surgeon is performing the parenchyma transection based on data from the surgical stapling and cutting instrument, including data from its cartridge. Cartridge data may correspond to the size or type of staple being fired by the instrument, for example. As different types of staples are used for different types of tissue, the cartridge data can thus indicate the type of tissue being stapled and/or tranced. In this case, the type of staple that is fired is used for the parenchyma (or other similar types of tissue), which allows the central surgical controller 106, 206 to infer which segmentectomy portion of the procedure is being performed. .

[0336] In the twelfth step 5224, the node dissection step is then performed. The central surgical controller 106, 206 can infer that the surgical team is dissecting the node and performing a leak test based on data received from the generator that indicates which ultrasonic or RF instrument is being triggered. For this specific procedure, an RF or ultrasonic instrument being used after the parenchyma has undergone transection corresponds to the node dissection step, which allows the central surgical controller 106, 206 to make this inference. It should be noted that surgeons regularly switch between surgical stapling/cutting instruments and surgical energy instruments (i.e., RF or ultrasonic) depending on the specific step in the procedure because different instruments are better suited for specific tasks. Therefore, the specific sequence in which cutting/stapling instruments and surgical energy instruments are used may indicate which step of the procedure the surgeon is performing. Furthermore, in certain cases, robotic tools can be used for one or more steps in a surgical procedure and/or hand-held surgical instruments can be used for one or more steps in a surgical procedure. The surgeon can switch between robotic tools and hand-held surgical instruments and/or can use the devices simultaneously, for example. Upon completion of the twelfth step 5224, the incisions are closed and the postoperative portion of the process begins.

[0337] In the thirteenth step 5226, the patient's anesthesia is reversed. The central surgical controller 106, 206 can infer that the patient is emerging from anesthesia based on ventilator data (i.e., the patient's respiratory rate begins to increase), for example.

[0338] Finally, in the fourteenth step 5228 is that the medical personnel removes the various patient monitoring devices from the patient. The central surgical controller 106, 206 can thus infer that the patient is being transferred to a recovery room when the central controller loses ECG, blood pressure and other data from patient monitoring devices. As can be seen from the description of this illustrative procedure, the central surgical controller 106, 206 can determine or infer when each step of a given surgical procedure is taking place according to data received from the various data sources that are communicably coupled to the central surgical controller 106, 206.

[0339] Situational recognition is further described in

US Provisional Patent Application Serial No. 62/611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed December 28, 2017, which is incorporated herein by reference in its entirety. In certain cases, the operation of a robotic surgical system, including the various robotic surgical systems disclosed herein, for example, may be controlled by the central controller 106, 206 based on its situational recognition and/or feedback provided by its components. and/or based on information from cloud 104. Examples

[0340] Various aspects of the matter described in this description are presented in the following numbered examples:

[0341] Example 1 - A surgical instrument is revealed. The surgical instrument comprises an end actuator and a control circuit. The end actuator comprises a first jaw, a second jaw movable with respect to the first jaw to hold tissue therebetween, an anvil, a staple cartridge comprising staples implantable in the tissue, the staples being deformable by the anvil, and a sensor configured to provide a sensor signal in accordance with a physiological parameter of the tissue. The control circuit is coupled to the sensor, and the control circuit is configured to receive the sensor signal and assess the sensor's proximity to cancerous tissue based on the sensor signal.

[0342] Example 2 - The surgical instrument of Example 1, the control circuitry being additionally configured to generate an alert in case the proximity of the sensor to the cancerous tissue reaches or exceeds a predetermined threshold.

[0343] Example 3 - The surgical instrument of either of Examples 1 and 2, the control circuitry being additionally configured to prevent positioning of the clamps in the event that the proximity of the sensor to the cancerous tissue reaches or exceeds a predetermined threshold.

[0344] Example 4 - The surgical instrument of any one of Examples 1 to 3, which additionally comprises a motor configured to cause the clamps to be positioned, whereby the control circuit is additionally configured to prevent activation of the motor in the event the physiological parameter value reaches or exceeds a predetermined threshold.

[0345] Example 5 - The surgical instrument of any one of Examples 1 to 4, the physiological parameter being the tissue glucose level.

[0346] Example 6 - The surgical instrument of any one of Examples 1 to 4, the physiological parameter being the tissue pH level.

[0347] Example 7 - The surgical instrument of any one of Examples 1 to 6, the sensor being a Clark type sensor.

[0348] Example 8 - The surgical instrument of any one of Examples 1 to 7, the control circuitry being additionally configured to provide instructions to move the end actuator in a predetermined direction away from the cancerous tissue.

[0349] Example 9 - A surgical stapling instrument is revealed. The surgical stapling instrument comprises an end actuator and a control circuit. The end actuator comprises a first jaw, a second jaw movable with respect to the first jaw to hold tissue between them, an anvil, a staple cartridge comprising staples implantable in the tissue, the staples being deformable by the anvil, and a sensor configured to provide a sensor signal according to a physiological parameter indicative of the sensor's proximity to cancerous tissue. The control circuit is coupled to the sensor, and the control circuit is configured to receive the sensor signal, determine a physiological parameter value based on the sensor signal, and compare the physiological parameter value to a predetermined threshold.

[0350] Example 10 - The surgical stapling instrument of Example 9, the control circuitry being additionally configured to generate an alert based on the comparison of the physiological parameter value with a predetermined threshold.

[0351] Example 11 - The surgical stapling instrument of any of Examples 9 and 10, the control circuitry being additionally configured to prevent positioning of the clamps in the event that the physiological parameter value reaches or exceeds the threshold predetermined.

[0352] Example 12 - The surgical stapling instrument of any one of Examples 9 to 11, which additionally comprises a motor configured to cause the positioning of the staples, whereby the control circuit is additionally configured to prevent activation of the motor in the event the value of the physiological parameter reaches or exceeds the predetermined threshold.

[0353] Example 13 - The surgical stapling instrument of any one of Examples 9 to 12, the physiological parameter being the tissue glucose level.

[0354] Example 14 - The surgical stapling instrument of any one of Examples 9 to 12, the physiological parameter being the tissue pH level.

[0355] Example 15 - The surgical stapling instrument of any one of Examples 9 to 14, the sensor being a Clark type sensor.

[0356] Example 16 - The surgical stapling instrument of any one of Examples 9 to 15, the control circuitry being further configured to provide instructions to move the end actuator in a predetermined direction away from the cancerous tissue.

[0357] Example 17 - A surgical instrument is revealed. The surgical instrument comprises an end actuator and a control circuit. The end actuator comprises a first jaw, a second jaw movable with respect to the first jaw to hold tissue therebetween, an anvil, a staple cartridge comprising staples implantable in the tissue, the staples being deformable by the anvil, and a set of sensors configured to deliver sensor signals according to a physiological parameter indicative of the proximity of the sensors to the cancerous tissue. The sensor array comprises a first sensor on a first side of a longitudinal axis extending through the staple cartridge, and a second sensor on a second side of the longitudinal axis. The control circuit is coupled to the sensor array, whereby the control circuit is configured to receive a first sensor signal from the first sensor, receive a second sensor signal from the second sensor, determine determining a first physiological parameter value based on the first sensor signal, determining a second physiological parameter value based on the second sensor signal, and comparing the first value and the second value to a predetermined threshold.

[0358] Example 18 - The surgical instrument of Example 17, where the control circuit is additionally configured to provide instructions to move the end actuator in a first direction in case the first value but not the second value, reaching or exceeding the predetermined threshold, and the first direction extending in the opposite direction to the longitudinal axis on the first side.

[0359] Example 19 - The surgical instrument of Example 18, the control circuitry being additionally configured to provide instructions to move the end actuator in a second direction in case the second value but not the first value, reaching or exceeding the predetermined threshold, and the second direction extending in the opposite direction to the longitudinal axis on the second side.

[0360] Example 20 - The surgical instrument of Example 19, where the control circuit is additionally configured to approve the position of the end actuator in case the first value and the second value are below the predetermined threshold.

[0361] The preceding 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 may be implemented , individually and/or collectively, across 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 disclosed herein, in whole or in part, may be equivalently implemented on integrated circuits, such as one or more computer programs running on one or more computers (e.g. , 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 one skilled in the art, in light of this description. Furthermore, those skilled in the art will understand that the mechanisms of the subject matter described herein may be distributed as one or more program products in a variety of ways and that a form illustrative of the subject matter described herein is applicable irrespective of the specific type of means of signal transmission used to effectively carry out the distribution.

[0362] The instructions used to program the logic to perform various aspects revealed may 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 may include any mechanism for storing or transmitting information in a form readable by a machine (e.g., a computer), but is not limited to, floppy disks, optical discs, memory-only compact discs, etc. read-only memory (CD-ROMs), and optical discs-dynamos discs, read-only memory (ROM), random access memory (RAM), erasable programmable read-only memory (EPROM), erasable programmable read-only memory (EEPROM), magnetic or optical cards, flash memory, or a tangible machine-readable storage media used in transmitting information over the Internet via electrical, optical, acoustic, or other forms of propagated signals ( e.g. carrier waves, infrared signal, digital signals, etc.). Accordingly, non-transient computer-readable media includes any type of machine-readable media suitable for storing or transmitting electronic instructions or information in a legible form.

readable by a machine (eg a computer).

[0363] As used in any aspect of the present invention, the term "control circuit" may refer to, for example, a set of wired, programmable circuits (e.g., a computer processor comprising one or plus individual instruction processing cores, processing unit, processor, microcontroller, microcontroller unit, controller, digital signal processor (PSD), programmable logic device (PLD), programmable logic array (PLA), or array programmable gates (FPGA)), state machine circuits, firmware that stores instructions executed by the programmable circuit, and any combination thereof. The control circuit may, collectively or individually, be incorporated as an electrical circuit that is part of a larger system, e.g. an integrated circuit (IC), an application-specific integrated circuit (ASIC), a system on-chip (SoC), desktop computers, laptop computers, tablet computers, servers, smart phones, etc. Accordingly, 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 application-specific integrated circuit, 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 described herein, or a microprocessor configured by a computer program that at least partially executes the processes and/or devices described herein), electrical circuits that form a memory device (e.g., memory forms of random access), and/or electrical circuits that form a communications device (e.g., a modem, communication switch, cation, or optical-electrical equipment). Those skilled in the art will recognize that the subject matter described herein may be implemented in an analog or digital fashion, or in some combination thereof.

[0364] As used in any aspect of the present invention, the term "logic" may refer to an application, software, firmware, and/or circuit configured to perform any of the aforementioned operations. The software may be embodied as a software package, code, instructions, instruction sets, and/or data recorded on computer-readable, non-transient storage media. Firmware can be embedded as code, instructions or sets of instructions and/or data that are hard-coded (eg, non-volatile) in memory devices.

[0365] As used in any aspect of the present invention, the terms "component", "system", "module" and the like may refer to a computer-related entity, whether hardware, a combination of hardware and software, software or running software.

[0366] As used herein 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 can, though not necessarily, take the form of electrical or magnetic signals that can be stored, transferred, combined, compared, and otherwise manipulated. It is common usage 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 those quantities and/or states.

[0367] 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 example communications protocol may include an Ethernet communications protocol that may be capable of enabling communication using a transmission control protocol/Internet protocol (TCP/IP). The Ethernet protocol may conform 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 additionally, communication devices may be able to communicate with each other using an X.25 communications protocol. The X.25 communications protocol can conform to or be compatible with a standard promulgated by the International Telecommunication Union-Telecommunication Standardization Sector (ITU-T). Alternatively or additionally, the communication devices may be able to communicate with each other using a frame-relay communications protocol. The frame-relay communications protocol may conform or be compliant 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, the transceivers may be able to communicate with each other using an ATM ("asynchronous transfer mode") communication protocol. The ATM communication protocol may conform or be compatible with an ATM standard published by the ATM forum titled "ATM-MPLS Network Interworking 2.0" published in August 2001, and/or later versions.

of that pattern. Of course, different and/or post-developed connection-oriented network communication protocols are also contemplated in the present invention.

[0368] Unless expressly stated to the contrary, as is evident from the preceding description, it is understood that throughout the preceding description, discussions that use terms such as "processing", or "computation", or "calculus ", or "determination", or "display", or the like, refer to the action and processes of a computer, or similar electronic computing device, that manipulates and transforms the data represented in the form of physical quantities. (electronic) in computer records and memories in other data similarly represented in the form of physical quantities in computer memories or records, or in other similar devices for storing, transmitting or displaying information .

[0369] One or more components may be called in the present invention "configured for", "configurable for", "operable/operable for", "adapted/adaptable for", "capable of", "conformable/ shaped for", etc. Those skilled in the art will recognize that "configured for" can generally encompass active-state components and/or idle-state components and/or standby-state components, unless the context dictates otherwise.

[0370] The terms "proximal" and "distal" are used in the present invention with reference to a physician who manipulates the handle portion of the surgical instrument. The term "proximal" refers to the portion closest to the physician, and the term "distal" refers to the portion located away from the physician. It will also be understood that, for the sake of convenience and clarity, spatial terms such as "vertical", "horizontal", "upwards" and "downwards" may be used in the present invention in connection with the drawings. However, surgical instruments

cos can be used in many orientations and positions, and these terms are not intended to be limiting and/or absolute.

[0371] Persons skilled in the art will recognize that, in general, terms used herein, and particularly in the appended claims (e.g. bodies of appended claims) are generally intended as "open" terms (e.g., the term "including" shall be interpreted as "including, but not limited to", the term "having" shall be interpreted as "having at least", the term "includes" shall be interpreted as "includes, but is not limited to", etc.). It will further be understood by those skilled in the art that if a specific number of an introduced claim mention is intended, such intent will be expressly mentioned in the claim and, in the absence of such mention, no intent will be present. For example, as an aid to understanding, the following attached claims may contain the use of the introductory phrases "at least one" and "one or more" to introduce claim mentions. However, the use of such phrases should not be interpreted as implying that the introduction of a mention of the claim by the indefinite articles "a, ones" or "an, an" limits any specific claim containing the mention of the claim. introduced to claims that contain only such a mention, even when the same claim includes the introductory phrases "one or more" or "not minus one" and indefinite articles, such as "a, a" or "a, a" (e.g. eg, "one, ones" and/or "one, ones" should typically be interpreted to mean "at least one" or "one or more"); the same goes for the use of definite articles used to introduce the claims of claim.

[0372] Furthermore, even if a specific number of an introduced claim mention is explicitly mentioned, those skilled in the art will recognize that this mention needs to be typed.

interpreted to mean at least the number mentioned (eg, the mere mention of "two mentions", without other modifiers, typically means at least two mentions, or two or more mentions). Furthermore, in cases where a convention analogous to "at least one of A, B, and C, etc." is used, this construction is generally intended to have the sense in which the convention would be understood by (for For example, "a system that has at least one of A, B, and C" would include, but not be limited to, systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and/or A, B and C together, etc.). In cases where a convention analogous to "at least one of A, B, or C, etc." is used, this construction is usually intended to have the sense in which the convention would be understood by (e.g., "a system that has at least one of A, B, and C" would include, but not be limited to, systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and/or A, B and C together, etc.). It will further be understood by those skilled in the art that typically a disjunctive word and/or phrase having two or more alternative terms, whether in the description, claims or drawings, is to be understood as contemplating the possibility of including one of the terms , either or both terms, unless the context dictates otherwise. For example, the phrase "A or B" will typically be understood to include the possibilities of "A" or "B" or "AeB".

[0373] With regard to the appended claims, those skilled in the art will understand that the operations mentioned therein can, in general, be performed in any order. Furthermore, although various operational flow diagrams are presented in one or more sequences, it should be understood that the various operations may be performed in orders other than those illustrated, or may be performed simultaneously.

Examples of such alternative orderings may include overlapping, interleaved, interrupted, reordered, incremental, preparatory, supplementary, simultaneous, inverse, or other variant orderings, unless the context dictates otherwise. Furthermore, terms such as "responsive to," "related to," or other adjectival participles are not generally intended to exclude these variants, unless the context dictates otherwise.

[0374] It is worth noting that any reference to "one (1) aspect", "an aspect", "an exemplification" or "one (1) exemplification"", and the like means that a particular feature, structure or characteristic described in connection with the aspect is included in at least one aspect. Thus, the use of expressions such as "in one (1) aspect", "in one aspect", "in one exemplification", "in one (1) example", in various places throughout this descriptive report does not necessarily refer to the same aspect. Furthermore, specific features, structures or features can be combined in any suitable way in one or more aspects.

[0375] Any patent application, patent, non-patent publication or other descriptive material mentioned in this specification and/or mentioned in any application data sheet is hereby incorporated by reference, to the extent that the embedded materials are not inconsistent with this. Accordingly, and to the extent necessary, the description as explicitly presented herein supersedes any conflicting material incorporated into the present invention by reference. Any material, or portions thereof, which is incorporated herein by reference, but which conflicts with existing definitions, statements, or other descriptive materials presented herein, is incorporated herein only to the extent that there is no conflict. between the embedded material and the existing description material.

[0376] In summary, numerous benefits have been described that result from employing the concepts described here.

The aforementioned description of one or more embodiments has been presented for purposes of illustration and description.

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

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

One or more modalities have been chosen and described for the purpose of illustrating the principles and practical application to thereby allow the skilled artisan to use the various modalities and with various modifications as may be convenient for the specific contemporary use. plowed.

The attached claims are intended to define the global scope.

Claims (20)

1. Surgical instrument characterized in that it comprises: an end actuator comprising: a first gripper; a second jaw movable relative to the first jaw for holding the fabric therebetween; an anvil; a staple cartridge comprising staples deployable into tissue, the staples being deformable by the anvil; and a sensor configured to provide a sensor signal in accordance with a physiological parameter of the tissue; a control circuit coupled to the sensor, the control circuit being configured to: receive the sensor signal; and assessing the proximity of the sensor to the cancerous tissue based on the sensor signal. 2. Surgical instrument, according to claim 1, characterized in that the control circuit is additionally configured to generate an alert in the event that the proximity of the sensor to the cancerous tissue reaches or exceeds a predetermined threshold. 3. Surgical instrument according to claim 1, characterized in that the control circuit is additionally configured to prevent the positioning of the clamps in the event that the proximity of the sensor to the cancerous tissue reaches or exceeds a predetermined threshold. 4. Surgical instrument, according to claim 1, characterized in that it additionally comprises a motor configured to cause the positioning of the staples, and the control circuit is additionally configured to prevent the activation of the motor. tor in case the physiological parameter value reaches or exceeds a predetermined threshold. 5. Surgical instrument, according to claim 1, characterized in that the physiological parameter is the glucose level in the tissue. Surgical instrument according to claim 1, characterized in that the physiological parameter is the pH level of the tissue. 7. Surgical instrument according to claim 1, characterized in that the sensor is a Clark type sensor. A surgical instrument according to claim 1, characterized in that the control circuit is further configured to provide instructions for moving the end actuator in a predetermined direction away from the cancerous tissue. 9. Surgical stapling instrument, characterized in that it comprises: an end actuator comprising: a first gripper; a second jaw movable relative to the first jaw for holding the fabric therebetween; an anvil; a staple cartridge comprising staples deployable into tissue, the staples being deformable by the anvil; and a sensor configured to provide a sensor signal in accordance with a physiological parameter indicative of the proximity of the sensor to the cancerous tissue; a control circuit coupled to the sensor, the control circuit being configured to: receive the sensor signal; determining a physiological parameter value based on the sensor signal; and comparing the physiological parameter value to a predetermined threshold. 10. Surgical instrument according to claim 9, characterized in that the control circuit is additionally configured to generate an alert based on the comparison of the physiological parameter value with a predetermined threshold. 11. Surgical instrument, according to claim 9, characterized in that the control circuit is additionally configured to prevent the positioning of the clamps in the event that the value of the physiological parameter reaches or exceeds the predetermined threshold. 12. Surgical instrument according to claim 9, characterized in that it additionally comprises a motor configured to cause the positioning of the clamps, the control circuit being additionally configured to prevent the activation of the motor in the event that the parameter value physiological condition reaches or exceeds the predetermined threshold. 13. Surgical instrument according to claim 9, characterized in that the physiological parameter is the glucose level in the tissue. Surgical instrument according to claim 9, characterized in that the physiological parameter is the pH level of the tissue. 15. Surgical instrument according to claim 9, characterized in that the sensor is a Clark type sensor. A surgical instrument according to claim 9, characterized in that the control circuit is further configured to provide instructions to move the end actuator in a predetermined direction away from the cancerous tissue. 17. Surgical instrument characterized by comprising: an end actuator comprising: a first claw; a second jaw movable relative to the first jaw for holding the fabric therebetween; an anvil; a staple cartridge comprising staples deployable into tissue, the staples being deformable by the anvil; and a sensor assembly configured to provide sensor signals in accordance with a physiological parameter indicative of the proximity of the sensors to the cancerous tissue, the sensor assembly comprising: a first sensor on a first side of a longitudinal geometric axis extending through the staple cartridge; and a second sensor on a second side of the longitudinal axis; a control circuit coupled to the sensor array, the control circuit being configured to: receive a first sensor signal from the first sensor; receiving a second sensor signal from the second sensor; determining a first physiological parameter value based on the first sensor signal; determining a second physiological parameter value based on the second sensor signal; and comparing the first value and the second value against a predetermined threshold. 18. Surgical instrument according to claim 17, characterized in that the control circuit is additionally configured to provide instructions to move the end actuator in a first direction in the case of the first value but not the second value. , reaching or exceeding the predetermined threshold, and with the first direction extending in the opposite direction to the longitudinal axis on the first side. 19. Surgical instrument according to claim 18, characterized in that the control circuit is additionally configured to provide instructions to move the end actuator in a second direction in case the second value but not the first value , reaching or exceeding the predetermined threshold, and the second direction extending in the opposite direction to the longitudinal axis on the second side. 20. Surgical instrument according to claim 19, characterized in that the control circuit is additionally configured to approve the position of the end actuator in case the first value and the second value are below the predetermined threshold.