JP7301846B2 - Tuning based on airborne particle properties - Google Patents

Description

(Cross reference to related applications)
This application claims the benefit of commonly-used U.S. Provisional Patent Application Serial No. 16/182,246, entitled "ADJUSTMENTS BASED ON AIRBORNE PARTICLE PROPERTIES," filed November 6, 2018, the entire disclosure of incorporated herein by reference.

This application is filed under 35 U.S.C. OR USAGE” filed on September 10, 2018 No. 62/729,183, the disclosure of which is hereby incorporated by reference in its entirety.

This application is further filed under 35 U.S.C. , U.S. Provisional Patent Application No. 62/692,748, filed June 30, 2018, entitled "SMART ENERGY ARCHITECTURE," and U.S. Provisional Patent Application No. 62, filed June 30, 2018, entitled "SMART ENERGY DEVICES." No./692,768, the entire contents of each of which are incorporated herein by reference.

This application further claims priority under 35 U.S.C. , the entire disclosure of which is incorporated herein by reference.

This application further qualifies under 35 U.S.C. , U.S. Provisional Patent Application No. 62/650,887, filed March 30, 2018, entitled "SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES," "SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM." filed on March 30, 2018 entitled U.S. Provisional Patent Application No. 62/650,882 and U.S. Provisional Patent Application No. 62/650,877, filed March 30, 2018, entitled "SURGICAL SMOKE EVACUATION SENSING AND CONTROLS" , the entire contents of each disclosure being incorporated herein by reference.

This application is further filed under 35 U.S.C. and U.S. Provisional Patent Application Serial No. 62/640,415, filed March 8, 2018, entitled "ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR," the entire contents of each disclosure. is incorporated herein by reference.

This application is further filed under 35 U.S.C. US Provisional Patent Application No. 62/611,340, filed December 28, 2017, entitled "ANALYTICS"; '339, the entire contents of each disclosure being incorporated herein by reference.

The present disclosure relates to surgical systems and devices. Clinical information can be collected and/or stored on a variety of different surgical devices before, during, and/or after surgery. Certain information may be useful to clinicians in making one or more clinical decisions before, during, and/or after surgery.

The various aspects described herein, both as to organization and method of operation, together with other objects and advantages thereof, may best be understood by reference to the following description taken in conjunction with the accompanying drawings below.
1 is a block diagram of a computer-implemented interactive surgical system, according to at least one aspect of the present disclosure; FIG. A surgical system used to perform a surgical procedure in an operating room, according to at least one aspect of the present disclosure. 1 is a surgical hub paired with a visualization system, a robotic system, and an intelligent instrument according to at least one aspect of the present disclosure; FIG. 122 is a partial perspective view of a surgical hub housing and a combination generator module slidably receivable within a drawer of the surgical hub housing in accordance with at least one aspect of the present disclosure; 1 is a perspective view of a combination generator module comprising bipolar, ultrasonic, and monopolar contacts and smoke evacuation components in accordance with at least one aspect of the present disclosure; FIG. 4 illustrates individual power bus attachments for multiple lateral docking ports of a lateral modular housing configured to receive multiple modules, in accordance with at least one aspect of the present disclosure; 1 illustrates a vertical modular housing configured to receive multiple modules, according to at least one aspect of the present disclosure; To connect to the cloud modular devices located in one or more surgical sites of a medical facility, or in any room within a medical facility with specialized equipment for surgical procedures, according to at least one aspect of the present disclosure. 1 shows a surgical data network with a modular communication hub configured in FIG. 1 illustrates a computer-implemented interactive surgical system, according to at least one aspect of the present disclosure; 1 illustrates a surgical hub comprising multiple modules coupled to a modular control tower, according to at least one aspect of the present disclosure; 1 illustrates one aspect of a Universal Serial Bus (USB) network hub device, in accordance with at least one aspect of the present disclosure; 1 is a block diagram of a cloud computing system including a plurality of smart surgical instruments coupled to a surgical hub that can be connected to cloud components of the cloud computing system, according to at least one aspect of the present disclosure; FIG. 1 is a functional module architecture of a cloud computing system, according to at least one aspect of the present disclosure; 1 is a diagram of a situation-aware surgical system, according to at least one aspect of the present disclosure; FIG. 4 is a timeline illustrating surgical hub situational awareness, in accordance with at least one aspect of the present disclosure; 1 is an elevational view of a surgical instrument including an end effector and a trigger, wherein the degree to which the end effector is closed is controlled by the degree to which the trigger is actuated, according to at least one aspect of the present disclosure; FIG. 17 is a pair of graphs illustrating end effector closure and transducer amplitude versus trigger angle for the surgical instrument of FIG. 16 in accordance with at least one aspect of the present disclosure; 1 is a schematic illustration of a surgical procedure with multiple devices in a surgical field, including a combination energy device, a surgical stapler, and an aspiration/irrigation device, according to at least one aspect of the present disclosure; FIG. , and a detailed plan view of a sterile field display including touch screen controls for coordinating surgical functions of multiple devices within the sterile field. FIG. 11 illustrates a display screen including recommendations to a clinician based on input from a context-aware surgical hub, according to at least one aspect of the present disclosure; FIG. 19B shows the display screen of FIG. 19A with recommendations shown at a high priority level based on the expected surgical action and input from a context-aware surgical hub, according to at least one aspect of the present disclosure; FIG. 4 is a block diagram illustrating intra-operative data correlated with expected outcome and further showing corresponding recommendations based on the expected outcome, in accordance with at least one aspect of the present disclosure; FIG. 1 is a schematic illustration of a surgical drainage system, according to at least one aspect of the present disclosure; FIG. 1 is a perspective view of a surgical system including a surgical drainage system in accordance with at least one aspect of the present disclosure; FIG. 1 is a schematic illustration of an ejector housing of an ejection system, in accordance with at least one aspect of the present disclosure; FIG. 4 is a series of graphs illustrating particulate concentration, fan speed, and energy device power versus time in accordance with at least one aspect of the present disclosure; 1 is an ultrasound passing particle detection system, according to at least one aspect of the present disclosure. 1 is an ultrasonic reflected particle detection system, according to at least one aspect of the present disclosure. 27 is a flowchart for detecting tissue surface information using the ultrasonic reflected particle detection system of FIG. 26, in accordance with at least one aspect of the present disclosure;

The applicant of this application owns the following U.S. patent applications filed November 6, 2018, the entire contents of each of which are incorporated herein by reference:
- U.S. patent application Ser. ITY",
U.S. Patent Application No. 16/182,230, entitled "SURGICAL SYSTEM FOR PRESENTING INFORMATION INTERPRETED FROM EXTERNAL DATA";
U.S. Patent Application No. 16/182,233, entitled "MODIFICATION OF SURGICAL SYSTEMS CONTROL PROGRAMS BASED ON MACHINE LEARNING";
- U.S. patent application Ser.
- U.S. patent application Ser.
- U.S. patent application Ser.
U.S. patent application Ser. No. 16/182,251, entitled "INTERACTIVE SURGICAL SYSTEM";
- U.S. patent application Ser.
- U.S. patent application Ser. ICAL NETWORK",
- U.S. patent application Ser.
- U.S. patent application Ser.
・U.S. patent application Ser. STOCKING AND IN-HOUSE PROCESSES”,
- U.S. patent application Ser. R BOTH CURRENT AND FUTURE PROCEDURES",
- U.S. patent application Ser.
- U.S. patent application Ser. NCE INCLUSION OR LINKAGE OF DATA AND METADATA TO ESTABLISH CONTINUITY" ,
- U.S. Patent Application No. 16/182,290, entitled "SURGICAL NETWORK RECOMMENDATIONS FROM REAL TIME ANALYSIS OF PROCEDURE VARIABLES OPTIMAL SOLUTION",
- U.S. Patent Application No. 16/182,232, entitled "CONTROL OF A SURGICAL SYSTEM THROUGH A SURGICAL BARRIER";
- U.S. patent application Ser.
- U.S. patent application Ser. WARENESS OF DEVICES",
- U.S. patent application Ser.
- U.S. patent application Ser.
- U.S. patent application Ser. ETER OF FIRING OR CLAMPING",
- U.S. patent application Ser. X OR POWER APPLIED TO TISSUE," and U.S. Patent Application No. 16 / 182,238, title of invention "ULTRASONIC ENERGY DEVICE WHICH VARIES PRESSURE APPLIED BY CLAMP ARM TO PROVIDE THRESHOLD CONTROL PRESSURE AT A CUT PROGRESSION LOCATION".

The applicant of this application owns the following U.S. patent applications filed September 10, 2018, the entire contents of each of which are incorporated herein by reference:
- U.S. Provisional Patent Application No. 62/729,183, entitled "A CONTROL FOR A SURGICAL NETWORK OR SURGICAL NETWORK CONNECTED DEVICE THAT ADJUSTS ITS FUNCTION BASED ON A SENSED SITU" ATION OR USAGE",
U.S. Provisional Patent Application No. 62/729,177 entitled "AUTOMATED DATA SCALING, ALIGNMENT, AND ORGANIZING BASED ON PREDEFINED PARAMETERS WITHIN A SURGICAL NETWORK BEFORE TRANSMISSION";
- U.S. Provisional Patent Application No. 62/729,176 entitled "INDIRECT COMMAND AND CONTROL OF A FIRST OPERATING ROOM SYSTEM THROUGH THE USE OF A SECOND OPERATING ROOM SYSTEM WITHIN A STERILE FI ELD WHERE THE SECOND OPERATING ROOM SYSTEM HAS PRIMARY AND SECONDARY OPERATING MODES",
- U.S. Provisional Patent Application No. 62/729,185 entitled "POWERED STAPLING DEVICE THAT IS CAPABLE OF ADJUSTING FORCE, ADVANCEMENT SPEED, AND OVERALL STROKE OF CUTTING MEMBER OF THE DEVIC" E BASED ON SENSED PARAMETER OF FIRING OR CLAMPING",
- U.S. Provisional Patent Application No. 62/729,184 entitled "POWERED SURGICAL TOOL WITH A PREDEFINED ADJUSTABLE CONTROL ALGORITHM FOR CONTROLLING AT LEAST ONE END EFFECTOR PARAMETER AND A MEANS FOR LIMITING THE ADJUSTMENT",
- U.S. Provisional Patent Application No. 62/729,182 entitled "SENSING THE PATIENT POSITION AND CONTACT UTILIZING THE MONO POLAR RETURN PAD ELECTRODE TO PROVIDE SITUATIONAL AWARENESS TO THE H";UB",
- U.S. Provisional Patent Application No. 62/729,191 entitled "SURGICAL NETWORK RECOMMENDATIONS FROM REAL TIME ANALYSIS OF PROCEDURE VARIABLES AGAINST A BASELINE HIGHLIGHTING DIFFERENCES FROM TH E OPTIMAL SOLUTION",
- U.S. Provisional Patent Application No. 62/729,195, titled "ULTRASONIC ENERGY DEVICE WHICH VARIES PRESSURE APPLIED BY CLAMP ARM TO PROVIDE THRESHOLD CONTROL PRESSURE AT A CUT PROGRESSION LO CATION,” and U.S. Provisional Patent Application No. 62/729, No. 186, title of the invention "WIRELESS PAIRING OF A SURGICAL DEVICE WITH ANOTHER DEVICE WITHIN A STERILE SURGICAL FIELD BASED ON THE USAGE AND SITUAL AWARENESS OF D EVICES".

The applicant of this application owns the following U.S. patent applications filed Aug. 28, 2018, the entire contents of each of which are incorporated herein by reference:
- U.S. patent application Ser.
- U.S. patent application Ser.
- U.S. patent application Ser.
U.S. Patent Application No. 16/115,208 entitled "CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO TISSUE LOCATION";
- U.S. patent application Ser.
- U.S. Patent Application No. 16/115,232, entitled "DETERMINING TISSUE COMPOSITION VIA AN ULTRASONIC SYSTEM"
- U.S. patent application Ser.
U.S. Patent Application No. 16/115,247, entitled "DETERMINING THE STATE OF AN ULTRASONIC END EFFECTOR",
- U.S. patent application Ser.
- U.S. patent application Ser.
- U.S. Patent Application No. 16/115,240, entitled "DETECTION OF END EFFECTOR IMMERSION IN LIQUID";
U.S. Patent Application No. 16/115,249, entitled "INTERRUPTION OF ENERGY DUE TO INADVERTENT CAPACITIVE COUPLING";
- US patent application Ser.
U.S. patent application Ser. No. 16/115,223, entitled "BIPOLAR COMBINATION DEVICE THAT AUTOMATICALLY ADJUSTS PRESSURE BASED ON ENERGY MODALITY"; ENERGY DEVICES ”.

The applicant of this application owns the following U.S. patent applications filed Aug. 23, 2018, the entire contents of each of which are incorporated herein by reference:
U.S. Provisional Patent Application No. 62/721,995 entitled "CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO TISSUE LOCATION";
U.S. Provisional Patent Application No. 62/721,998, entitled "SITUATIONAL AWARENESS OF ELECTROSURGICAL SYSTEMS";
U.S. Provisional Patent Application No. 62/721,999, entitled "INTERRUPTION OF ENERGY DUE TO INADVERTENT CAPACITIVE COUPLING";
U.S. Provisional Patent Application No. 62/721,994, entitled "BIPOLAR COMBINATION DEVICE THAT AUTOMATICALLY ADJUSTS PRESSURE BASED ON ENERGY MODALITY," and U.S. Provisional Patent Application No. 62/721,996, entitled "RADIO FREQUE." NCY ENERGY DEVICES FOR DELIVERING COMBINED ELECTRICAL SIGNALS".

The applicant of this application owns the following U.S. patent applications filed June 30, 2018, the entire contents of each of which are incorporated herein by reference:
U.S. Provisional Patent Application No. 62/692,747 entitled "SMART ACTIVATION OF AN ENERGY DEVICE BY ANOTHER DEVICE";
• US Provisional Patent Application No. 62/692,748, entitled "SMART ENERGY ARCHITECTURE," and • US Provisional Patent Application No. 62/692,768, entitled "SMART ENERGY DEVICES."

The applicant of this application owns the following U.S. patent applications, filed June 29, 2018, the entire contents of each of which are incorporated herein by reference:
U.S. Patent Application No. 16/024,090, entitled "CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS";
- U.S. patent application Ser.
- U.S. patent application Ser.
U.S. Patent Application No. 16/024,075, entitled "SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING";
U.S. Patent Application No. 16/024,083, entitled "SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING";
U.S. Patent Application No. 16/024,094 entitled "SURGICAL SYSTEMS FOR DETECTING END EFFECTOR TISSUE DISTRIBUTION IRREGULARITIES"
- U.S. patent application Ser.
U.S. Patent Application No. 16/024,150, entitled "SURGICAL INSTRUMENT CARTRIDGE SENSOR ASSEMBLIES";
- U.S. Patent Application No. 16/024,160, entitled "VARIABLE OUTPUT CARTRIDGE SENSOR ASSEMBLY";
- U.S. Patent Application No. 16/024,124, entitled "SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE";
- U.S. Patent Application No. 16/024,132, entitled "SURGICAL INSTRUMENT HAVING A FLEXIBLE CIRCUIT";
- U.S. Patent Application No. 16/024,141, entitled "SURGICAL INSTRUMENT WITH A TISSUE MARKING ASSEMBLY";
U.S. Patent Application No. 16/024,162, entitled "SURGICAL SYSTEMS WITH PRIORITIZED DATA TRANSMISSION CAPABILITIES";
U.S. Patent Application No. 16/024,066, entitled "SURGICAL EVACUATION SENSING AND MOTOR CONTROL";
U.S. Patent Application No. 16/024,096, entitled "SURGICAL EVACUATION SENSOR ARRANGEMENTS";
U.S. Patent Application No. 16/024,116, entitled "SURGICAL EVACUATION FLOW PATHS";
- U.S. Patent Application No. 16/024,149, entitled "SURGICAL EVACUATION SENSING AND GENERATOR CONTROL";
U.S. Patent Application No. 16/024,180, entitled "SURGICAL EVACUATION SENSING AND DISPLAY";
・ U.S. Equipment No. 16/204, 245, the name of the invention, “Communication OF SMOKE Evacuation System System TO HUB OR CLOUD IN SMOKE EVACUATION MOD MOD ULE FOR INTERACTIVE SURGICAL PLATFORM,
- U.S. patent application Ser.
U.S. patent application Ser. 16/024,273, The name is "DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS".

The applicant of this application owns the following U.S. provisional patent applications filed June 28, 2018, the entire contents of each of which are incorporated herein by reference:
U.S. Provisional Patent Application No. 62/691,228, entitled "A METHOD OF USING REINFORCED FLEX CIRCUITS WITH MULTIPLE SENSORS WITH ELECTROSURGICAL DEVICES";
- U.S. Provisional Patent Application No. 62/691,227, entitled "CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSED CLOSURE PARAMETERS";
U.S. Provisional Patent Application No. 62/691,230 entitled "SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE";
U.S. Provisional Patent Application No. 62/691,219 entitled "SURGICAL EVACUATION SENSING AND MOTOR CONTROL";
- U.S. Provisional Patent Application No. 62/691,257, entitled "COMMUNICATION OF SMOKE EVACUATION SYSTEM PARAMETERS TO HUB OR CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM" ,
U.S. Provisional Patent Application No. 62/691,262, entitled "SURGICAL EVACUATION SYSTEM WITH A COMMUNICATION CIRCUIT FOR COMMUNICATION BETWEEN A FILTER AND A SMOKE EVACUATION DEVICE," and Name "DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS"; U.S. Provisional Patent Application No. 62/691,251.

The applicant of this application owns the following U.S. provisional patent applications, filed April 19, 2018, the entire contents of each of which are incorporated herein by reference:
• US Provisional Patent Application No. 62/659,900, entitled "METHOD OF HUB COMMUNICATION."

The applicant of this application owns the following US provisional patent applications filed March 30, 2018, the entire disclosures of each of which are incorporated herein by reference:
U.S. Provisional Patent Application No. 62/650,898, filed March 30, 2018, entitled "CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS";
U.S. Provisional Patent Application No. 62/650,887, entitled "SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES";
U.S. Provisional Patent Application No. 62/650,882, entitled "SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM," and U.S. Provisional Patent Application No. 62/650,877, entitled "SURGICAL SMOKE EVACUATION SENSING AND CONTROLS ”.

The applicant of this application owns the following U.S. patent applications, filed March 29, 2018, the entire contents of each of which are incorporated herein by reference:
U.S. patent application Ser. No. 15/940,641 entitled "INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES"
- U.S. patent application Ser.
- U.S. patent application Ser.
- U.S. patent application Ser.
- U.S. patent application Ser.
U.S. patent application Ser. No. 15/940,677, entitled "SURGICAL HUB CONTROL ARRANGEMENTS";
- U.S. patent application Ser.
- U.S. Patent Application 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 ANA" LYTICS SYSTEMS",
- U.S. Patent Application No. 15/940,645, entitled "SELF DESCRIBING DATA PACKETS GENERATED AT AN ISSUING INSTRUMENT";
U.S. patent application Ser. No. 15/940,649, entitled "DATA PAIRING TO INTERCONNECT A DEVICE MEASURED PARAMETER WITH AN OUTCOME";
U.S. patent application Ser. No. 15/940,654, entitled "SURGICAL HUB SITUATIONAL AWARENESS";
U.S. patent application Ser. No. 15/940,663, entitled "SURGICAL SYSTEM DISTRIBUTED PROCESSING";
U.S. Patent Application No. 15/940,668, entitled "AGGREGATION AND REPORTING OF SURGICAL HUB DATA";
- U.S. patent application Ser.
U.S. Patent Application No. 15/940,686 entitled "DISPLAY OF ALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LINEAR STAPLE LINE";
- U.S. Patent Application No. 15/940,700, entitled "STERILE FIELD INTERACTIVE CONTROL DISPLAYS";
- U.S. patent application Ser. No. 15/940,629, entitled "COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS";
- U.S. Patent Application No. 15/940,704 entitled "USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT";
- U.S. patent application Ser.
U.S. patent application Ser. No. 15/940,742, entitled "DUAL CMOS ARRAY IMAGING,"
U.S. patent application Ser. No. 15/940,636, entitled "ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES";
U.S. patent application Ser. No. 15/940,653, entitled "ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL HUBS";
- U.S. Patent Application No. 15/940,660 entitled "CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER"
・ USA Public Permit Application No. 15/940, 679, the name of the invention, “CLOUD -BASED MEDICAL Analytics for Linking OF LOCAL USAGE TRENDS WITH THE THE THE THE THE THE T some time) N BEHAVIORS OF LARGER Data Set ",
U.S. patent application Ser.
U.S. Patent Application No. 15/940,634, entitled "CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES"
U.S. Patent Application No. 15/940,706, entitled "DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK";
- U.S. Patent Application No. 15/940,675, entitled "CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES";
U.S. patent application Ser.
U.S. patent application Ser.
- US patent application Ser.
- "U.S. patent application Ser.
U.S. patent application Ser.
U.S. patent application Ser.
U.S. patent application Ser. No. 15/940,690, entitled "DISPLAY ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS"; D-SURGICAL PLATFORMS".

The applicant of this application owns the following U.S. provisional patent applications filed March 28, 2018, the entire disclosures of each of which are incorporated herein by reference:
U.S. Provisional Patent Application No. 62/649,302 entitled "INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES";
U.S. Provisional Patent Application No. 62/649,294, entitled "DATA STRIPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD";
U.S. Provisional Patent Application No. 62/649,300, entitled "SURGICAL HUB SITUATIONAL AWARENESS";
U.S. Provisional Patent Application No. 62/649,309 entitled "SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER";
U.S. Provisional Patent Application No. 62/649,310, entitled "COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS";
U.S. Provisional Patent Application No. 62/649,291 entitled "USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT";
U.S. Provisional Patent Application No. 62/649,296, entitled "ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES,"
- U.S. Provisional Patent Application No. 62/649,333, entitled "CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER";
U.S. Provisional Patent Application No. 62/649,327 entitled "CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES";
U.S. Provisional Patent Application No. 62/649,315, entitled "DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK";
U.S. Provisional Patent Application No. 62/649,313, entitled "CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES";
U.S. Provisional Patent Application No. 62/649,320, entitled "DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS";
U.S. Provisional Patent Application No. 62/649,307, entitled "AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS," and U.S. Provisional Patent Application No. 62/649,323, entitled "SENSING ARRANGEMENTS FOR ROB." OT - Assisted Surgical Platforms".

The applicant of this application owns the following U.S. provisional patent applications filed March 8, 2018, the entire disclosures of each of which are incorporated herein by reference:
U.S. Provisional Patent Application No. 62/640,417, entitled "TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR," and U.S. Provisional Patent Application No. 62/640,415, entitled "ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR".

The applicant of this application owns the following US provisional patent applications filed December 28, 2017, the entire disclosures of each of which are incorporated herein by reference:
- U.S. Provisional Patent Application No. U.S. Provisional Patent Application No. 62/611,341, entitled "INTERACTIVE SURGICAL PLATFORM";
• US Provisional Patent Application No. 62/611,340, entitled "CLOUD-BASED MEDICAL ANALYTICS," and • US Provisional Patent Application No. 62/611,339, entitled "ROBOT ASSISTED SURGICAL PLATFORM."

Before describing various aspects of surgical devices and generators in detail, it is noted that the illustrated embodiments are not limited in application or use to the details of construction and arrangement of the parts set forth in the accompanying drawings and description. Please note. The illustrative embodiments may be practiced with or incorporated in other aspects, variations, and modifications, and may be practiced or carried out in various ways. Further, unless otherwise stated, the terms and expressions used herein have been chosen for the convenience of the reader for the purpose of describing the exemplary embodiments and not for purposes of limitation thereof. . Further, one or more of the aspects, implementations of aspects and/or examples described below may be combined with any one of the other aspects, implementations of aspects and/or examples described below. It will be appreciated that more than one can be combined.

Surgical Hub Referring to FIG. 1, a computer-implemented interactive surgical system 100 includes one or more surgical systems 102, a cloud-based system (eg, a cloud 104 that may include a remote server 113 coupled to a storage device 105), and a ,including. Each surgical system 102 includes at least one surgical hub 106 in communication with cloud 104 which may include remote servers 113 . In one example, as shown in FIG. 1, the surgical system 102 includes a visualization system 108, a robotic system 110, a handheld intelligent surgical instrument 112 configured to communicate with each other and/or with the hub 106; including. In some aspects, the surgical system 102 may include M hubs 106, N visualization systems 108, O robotic systems 110, and P handheld intelligent surgical instruments 112, Here, M, N, O, and P are integers of 1 or more.

In various aspects, the intelligent instrument 112 described herein with reference to FIGS. 18), suction/irrigation device 213104 (FIG. 18), sterile field display 213108 (FIG. 18), surgical device 213204 (FIGS. 19A and 19B), surgical drainage system 50400 (FIG. 21), electrosurgical instrument 50630 ( 22), evacuation system 50600 (FIG. 22), evacuation system 50900 (FIG. 23), scope 213501 (FIG. 25), and surgical device 213608 (FIG. 26). In such an example, a combination energy instrument 213100 (Fig. 18), a surgical stapler 213102 (Fig. 18), an aspiration/irrigation device 213104 (Fig. 18), a sterile field display 213108 (Fig. 18), a surgical device 213204 (Fig. 19A). and FIG. 19B), surgical evacuation system 50400 (FIG. 21), electrosurgical instrument 50630 (FIG. 22), evacuation system 50600 (FIG. 22), evacuation system 50900 (FIG. 23), scope 213501 (FIG. 25), and surgical Intelligent instruments 112 (eg, devices 1 _a -1 _n ), such as device 213608 (FIG. 26), are configured to operate within surgical data network 201, as described with reference to FIG. .

FIG. 2 illustrates one embodiment of surgical system 102 being used to perform a surgical procedure on a patient lying on operating table 114 within surgical operating room 116 . Robotic system 110 is used as part of surgical system 102 in a surgical procedure. Robotic system 110 includes a surgeon's console 118 , a patient-side cart 120 (surgical robot), and a surgical robot hub 122 . The patient-side cart 120 is capable of manipulating at least one releasably coupled surgical tool 117 while the surgeon views the surgical site via the surgeon's console 118 during minimally invasive incisions in the patient's body. . Images of the surgical site may be obtained by a medical imaging device 124 , which may be manipulated by the patient-side cart 120 to orient the imaging device 124 . The robotic hub 122 can be used to process images of the surgical site for subsequent display to the surgeon via the surgeon's console 118 .

Other types of robotic systems can be readily adapted for use with surgical system 102 . Various examples of robotic systems and surgical tools suitable for use with the present disclosure can be found in "ROBOT ASSISTED SURGICAL PLATFORM," filed Dec. 28, 2017, the disclosure of which is incorporated herein by reference in its entirety. US Provisional Patent Application No. 62/611,339 entitled

Various examples of cloud-based analytics performed by the cloud 104 and suitable for use with the present disclosure are described in "CLOUD -BASED MEDICAL ANALYTICS", US Provisional Patent Application No. 62/611,340.

In various aspects, imaging device 124 includes at least one 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.

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

One or more illumination sources may be configured to emit electromagnetic energy within the visible and invisible spectrums. The visible spectrum, sometimes referred to as the optical spectrum or emission spectrum, is the portion of the electromagnetic spectrum that is visible to the human eye (i.e., can be detected by the human eye) and can be referred to as visible light, or simply light. is sometimes called A typical human eye responds to wavelengths in air from about 380 nm to about 750 nm.

The invisible spectrum (ie, non-emissive spectrum) is the portion of the electromagnetic spectrum that lies 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 above about 750 nm are longer than the red visible spectrum and these become invisible infrared (IR), microwave, and radio electromagnetic radiation. Wavelengths below about 380 nm are shorter than the violet spectrum and these become invisible ultraviolet, X-ray, and gamma-ray electromagnetic radiation.

In various aspects, imaging device 124 is configured for use in minimally invasive surgery. Examples of imaging devices suitable for use with the present disclosure include arthroscopes, angioscopes, bronchoscopes, cholangoscopes, colonoscopes, cytoscopes, duodenoscopes, enteroscopes, esophagogastroduodenoscopes (gastroscopes) , endoscopes, laryngoscopes, nasopharyngo-neproscopes, sigmoidoscopes, thoracoscopes, and ureteroscopes.

In one aspect, the imaging device uses multispectral monitoring to distinguish between topography and underlying structure. Multispectral imaging captures image data within specific wavelength ranges across the electromagnetic spectrum. Wavelengths can be separated by filters or by using instruments sensitive to specific wavelengths of light from frequencies above the visible light range, such as IR and ultraviolet light. Spectral imaging can allow the extraction of additional information that the human eye cannot capture with its red, green, and blue receptors. The use of multispectral imaging is described in U.S. Provisional Patent Application No. 62/611,341, entitled "INTERACTIVE SURGICAL PLATFORM," filed Dec. 28, 2017, the disclosure of which is incorporated herein by reference in its entirety. It is described in detail in the section "Advanced Imaging Acquisition Module". Multispectral monitoring can be a useful tool for repositioning the surgical field to perform one or more of the above-described tests on the treated tissue after one surgical task is completed.

It is self-evident that any surgical procedure requires rigorous sterilization of the operating room and surgical instruments. The stringent hygiene and sterilization conditions required in the "surgical theater", ie operating room or procedure room, require the utmost sterility of all medical devices and equipment. Part of that sterilization process is the need to sterilize anything that comes in contact with the patient or enters the sterile field, including imaging device 124 and its accessories and components. A sterile field may be considered a specific area considered free of microorganisms, such as in a tray or on a sterile towel, or a sterile field may be considered an area immediately surrounding a patient prepared for a surgical procedure. It will be appreciated that this can be done. A sterile field may include clean team members in appropriate clothing and all equipment and fixtures within the area.

In various aspects, the visualization system 108 includes one or more imaging sensors strategically placed relative to the sterile field, one or more image processing units, and one or more imaging sensors, as shown in FIG. It includes a storage array and one or more displays. In one aspect, the visualization system 108 includes HL7, PACS, and EMR interfaces. The various components of the visualization system 108 are described in U.S. Provisional Patent Application No. 62/611, entitled "INTERACTIVE SURGICAL PLATFORM," filed Dec. 28, 2017, the disclosure of which is hereby incorporated by reference in its entirety. 341, "Advanced Imaging Acquisition Module".

As shown in FIG. 2, primary display 119 is positioned within the sterile field so as to be visible to the operator of operating table 114 . Additionally, the visualization tower 111 is positioned outside the sterile field. The visualization tower 111 includes a first non-sterile display 107 and a second non-sterile display 109 facing away from each other. A visualization system 108 guided by hub 106 is configured to coordinate the flow of information to operators inside and outside the sterile field utilizing displays 107, 109, and 119. FIG. For example, hub 106 may cause visualization system 108 to display a snapshot of the surgical site recorded by imaging device 124 on non-sterile display 107 or 109 while maintaining a live image of the surgical site on primary display 119. can be done. A snapshot on a non-sterile display 107 or 109 can, for example, allow a non-sterile operator to perform diagnostic steps related to a surgical procedure.

In one aspect, the hub 106 transmits diagnostic input or feedback entered by a non-sterile operator at the visualization tower 111 within the sterile field to a primary display 119 within the sterile field where it can be viewed by a sterile operator at the operating table. It is also configured so that it can be seen. In one example, the input may be in the form of modifications to the snapshot displayed on non-sterile display 107 or 109 that can be sent by hub 106 to primary display 119 .

Referring to FIG. 2, surgical instrument 112 is used as part of surgical system 102 in a surgical procedure. Hub 106 is also configured to coordinate the flow of information to the display of surgical instrument 112 . For example, for coordinate information flow, see U.S. Provisional Patent Application No. 62/611,341, entitled "INTERACTIVE SURGICAL PLATFORM," filed Dec. 28, 2017, the disclosure of which is hereby incorporated by reference in its entirety. is further explained in Diagnostic input or feedback entered by a non-sterile operator at visualization tower 111 may be sent by hub 106 to surgical instrument display 115 within the sterile field, where diagnostic input or feedback is provided to the operator of surgical instrument 112. can be seen by An exemplary surgical instrument suitable for use with surgical system 102 is, for example, entitled "INTERACTIVE SURGICAL PLATFORM," filed Dec. 28, 2017, the disclosure of which is incorporated herein by reference in its entirety. It is described in US Provisional Patent Application No. 62/611,341 under the heading "Surgical Instrument Hardware".

Referring now to FIG. 3 , hub 106 is shown in communication with visualization system 108 , robotic system 110 and handheld intelligent surgical instrument 112 . Hub 106 includes hub display 135, imaging module 138, generator module 140 (which may include monopolar generator 142, bipolar generator 144, and/or ultrasonic generator 143), communication module 130, processor module 132, and Includes storage array 134 . In certain aspects, the hub 106 further includes a smoke evacuation module 126, an aspiration/irrigation module 128, and/or an OR mapping module 133, as shown in FIG.

During surgical procedures, the application of energy to tissue for sealing and/or cutting is commonly associated with smoke evacuation, aspiration of excess fluid, and/or irrigation of tissue. Fluid, power, and/or data lines from different sources often become entangled during surgical procedures. Valuable time may be lost in addressing this issue during a surgical procedure. Untangling the lines may require uncoupling the lines from their corresponding modules, which may require the modules to be reset. The hub's modular housing 136 provides a unified environment for managing power, data, and fluid lines, reducing the frequency of tangling between such lines.

Aspects of the present disclosure present a surgical hub for use in surgical procedures involving the application of energy to tissue at a surgical site. The surgical hub includes a hub housing and a combination generator module slidably receivable within a docking station of the hub housing. The docking station contains data and power contacts. A combination generator module includes two or more of an ultrasonic energy generator component, a bipolar RF energy generator component, and a unipolar RF energy generator component housed within a single unit. In one aspect, the combination generator module further comprises a smoke evacuation component, at least one energy delivery cable for connecting the combination generator module to a surgical instrument, and smoke generated by application of therapeutic energy to tissue. , at least one smoke evacuation component configured to evacuate fluids and/or particulates; and a fluid line extending from the remote surgical site to the smoke evacuation component.

In one aspect, the fluid line is a first fluid line and a second fluid line extends from a remote surgical site to an aspiration and irrigation module slidably received within the hub housing. In one aspect, the hub housing includes a fluidic interface.

Certain surgical procedures may require the application of more than one type of energy to tissue. One energy type may be more beneficial for cutting tissue, while another different energy type may be more beneficial for sealing tissue. For example, a bipolar generator can be used to seal tissue, while an ultrasonic generator can be used to cut the sealed tissue. Aspects of the present disclosure present a solution in which the hub's modular housing 136 is configured to accommodate different generators and facilitate two-way communication between them. One advantage of the hub's modular housing 136 is that it allows for quick removal and/or replacement of various modules.

Aspects of the present disclosure present a modular surgical housing for use in surgical procedures involving the application of energy to tissue. A modular surgical housing includes a first energy generator module configured to generate a first energy for application to tissue and a first docking port including first data and power contacts. a first docking station comprising: a first energy generator module slidably moveable into electrical engagement with the power and data contacts; and the first energy generator module comprising: Slidably moveable out of electrical engagement with the first power and data contact.

Further to the above, the modular surgical enclosure includes a second energy generator module configured to generate a second energy for application to the tissue, different from the first energy; a second docking station comprising a second docking port including data and power contacts of the second energy generator module slidably moved into electrical engagement with the power and data contacts; Yes, and the second energy generator module is slidably moveable out of electrical engagement with the second power and data contacts.

Additionally, the modular surgical enclosure includes a first docking port and a second docking port configured to facilitate communication between the first energy generator module and the second energy generator module. Further includes a communication bus to and from the port.

Referring to FIGS. 3-7, aspects of the present disclosure are presented for a hub modular housing 136 that allows for modular integration of the generator module 140, the smoke evacuation module 126, and the aspiration/irrigation module 128. be done. The modular housing 136 of the hub further facilitates two-way communication between the modules 140,126,128. As shown in FIG. 5, the generator module 140 is an integrated monopolar, bipolar, and ultra polar generator supported within a single housing unit 139 that is slidably insertable into the hub's modular housing 136 . It can be a generator module with an acoustic wave component. As shown in FIG. 5, the generator module 140 can be configured to connect to a monopolar device 146, a bipolar device 147, and an ultrasound device 148. FIG. Alternatively, the generator module 140 may comprise a series of monopolar, bipolar and/or ultrasonic generator modules interacting through the hub modular housing 136 . The modular housing 136 of the hub provides bi-directional switching between insertion of multiple generators and generators docked to the modular housing 136 of the hub so that the generators function as a single generator. may be configured to facilitate communication.

In one aspect, the hub's modular housing 136 is a modular power and power module with external and wireless communication headers to allow removable attachment of modules 140, 126, 128 and bi-directional communication therebetween. A communications backplane 149 is provided.

In one aspect, the hub modular housing 136 includes a docking station or drawer 151, also referred to herein as a drawer, configured to slidably receive the modules 140,126,128. FIG. 4 shows a partial perspective view of surgical hub housing 136 and combination generator module 145 slidably receivable in docking station 151 of surgical hub housing 136 . A docking port 152 with power and data contacts on the rear side of the combination generator module 145 is slid into position within the corresponding docking station 151 of the hub modular housing 136. Corresponding docking ports 150 are configured to engage power and data contacts of corresponding docking stations 151 of the hub modular housing 136 . In one aspect, the combination generator module 145 includes bipolar, ultrasonic, and monopolar modules and a smoke evacuation module integrated together in a single housing unit 139, as shown in FIG.

In various aspects, the smoke evacuation module 126 includes a fluid line 154 that carries captured/collected smoke and/or fluid away from the surgical site, eg, to the smoke evacuation module 126 . The vacuum suction generated by the smoke evacuation module 126 can draw smoke into the utility conduit openings at the surgical site. A utility conduit connected to the fluid line may be in the form of a flexible tube that terminates in the smoke evacuation module 126 . Utility conduits and fluid lines define fluid pathways that extend toward smoke evacuation module 126 received within hub housing 136 .

In various aspects, aspiration/irrigation module 128 is coupled to a surgical tool including a puncture fluid line and an aspiration fluid line. In one example, the puncture and aspiration fluid lines are in the form of flexible tubes that extend from the surgical site toward the aspiration/irrigation module 128 . One or more drive systems may be configured to cause irrigation and puncture of fluid to and from the surgical site.

In one aspect, a surgical tool includes a shaft having an end effector at its distal end, at least one energy treatment portion associated with the end effector, a puncture tube, and an irrigation tube. The puncture tube can have an entry port at its distal end and the puncture tube extends through the shaft. Similarly, an irrigation tube can extend through the shaft and have an inlet port proximate to the energy delivery device. The energy delivery instrument is configured to deliver ultrasonic and/or RF energy to the surgical site and is initially connected to generator module 140 by a cable extending through the shaft.

The irrigation tube can be in fluid communication with a fluid source and the puncture tube can be in fluid communication with a vacuum source. A fluid source and/or a vacuum source may be housed within the aspiration/irrigation module 128 . In one example, the fluid and/or vacuum source may be housed within hub housing 136 separately from aspiration/irrigation module 128 . In such examples, the fluid interface may be configured to connect the aspiration/irrigation module 128 to a fluid source and/or a vacuum source.

In one aspect, the modules 140 , 126 , 128 and/or their corresponding docking stations on the hub modular housing 136 align the docking ports of the modules to the docking stations of the hub modular housing 136 . may include alignment features configured to engage their counterparts therein. For example, as shown in FIG. 4, combination generator module 145 has side brackets configured to slidably engage corresponding brackets 156 of corresponding docking stations 151 of hub modular housing 136 . 155 included. The brackets cooperate to guide the docking port contacts of the combination generator module 145 into electrical engagement with the docking port contacts of the hub modular housing 136 .

In some aspects, the drawers 151 of the hub modular housing 136 are the same or substantially the same size, and the modules are sized to be received within the drawers 151 . For example, side brackets 155 and/or 156 may be larger or smaller depending on the size of the module. In other aspects, drawers 151 vary in size, each designed to accommodate a particular module.

Further, the contacts of a particular module may be adapted to engage the contacts of a particular drawer to avoid inserting a module into a drawer with incompatible contacts.

As shown in FIG. 4, the docking port 150 of one drawer 151 is coupled to the docking port 150 of another drawer 151 via a communication link 157 to accommodate modules contained within the modular housing 136 of the hub. can facilitate two-way communication between Alternatively or additionally, the docking ports 150 of the hub modular housing 136 may facilitate wireless two-way communication between modules housed within the hub modular housing 136 . Any suitable wireless communication may be used, such as, for example, Air Titan-Bluetooth.

FIG. 6 illustrates individual power bus attachments of multiple lateral docking ports of lateral modular housing 160 configured to receive multiple modules of surgical hub 206 . Lateral modular housing 160 is configured to laterally receive and interconnect modules 161 . Modules 161 are slidably inserted into docking stations 162 of lateral modular housings 160 that contain backplanes for interconnecting modules 161 . As shown in FIG. 6, the modules 161 are laterally arranged within the lateral modular housing 160 . Alternatively, modules 161 may be arranged vertically within a lateral modular housing.

FIG. 7 shows a vertical modular housing 164 configured to receive multiple modules 165 of surgical hub 106 . Modules 165 are slidably inserted into docking stations or drawers 167 of vertical modular housings 164 that contain backplanes for interconnecting modules 165 . Although the drawers 167 of the vertical modular housing 164 are vertically oriented, in certain cases the vertical modular housing 164 may include laterally oriented drawers. Additionally, modules 165 may interact with each other via docking ports in vertical modular housing 164 . In the embodiment of FIG. 7, a display 177 is provided for displaying data relating to the operation of module 165 . Additionally, vertical modular housing 164 includes master module 178 that houses a plurality of sub-modules that are slidably received within master module 178 .

In various aspects, the imaging module 138 includes a built-in video processor and modular light sources and is adapted for use with various imaging devices. In one aspect, the imaging device consists of a modular housing that can be assembled with a light source module and a camera module. The housing may be a disposable housing. In at least one embodiment, the disposable housing is removably coupled with the reusable controller, light source module, and camera module. The light source module and/or camera module can be selectively selected depending on the type of surgical procedure. In one aspect, the camera module includes a CCD sensor. In another aspect, the camera module includes a CMOS sensor. In another aspect, the camera module is configured for scanning beam imaging. Similarly, the light source module can be configured to deliver white light or different light depending on the surgical procedure.

During a surgical procedure, it can be inefficient to remove a surgical device from the surgical field and replace it with another surgical device that includes a different camera or different light source. Temporary loss of vision in the surgical field can have undesirable consequences. The modular imaging device of the present disclosure is configured to allow replacement of the light source module or camera module during a surgical procedure without having to remove the imaging device from the surgical field.

In one aspect, an imaging device comprises a tubular housing containing a plurality of channels. The first channel is configured to slidably receive a camera module that may be configured for snap fit engagement with the first channel. The second channel is configured to slidably receive a light source module that may be configured for snap fit engagement with the second channel. In another example, the camera modules and/or light source modules can be rotated to their final positions within their corresponding channels. A threaded engagement may be employed instead of a snap-fit engagement.

In various embodiments, multiple imaging devices are positioned at various locations within the surgical field to provide multiple views. Imaging module 138 may be configured to switch between imaging devices to provide an optimal field of view. In various aspects, imaging module 138 can be configured to integrate images from different imaging devices.

Various image processors and imagers suitable for use with the present disclosure are described in U.S. Patent No. 1, issued Aug. 9, 2011, entitled "COMBINED SBI AND CONVENTIONAL IMAGE PROCESSOR," which is incorporated herein by reference in its entirety. 7,995,045. Further, U.S. Patent No. 7,982,776, issued July 19, 2011, entitled "SBI MOTION ARTIFACT REMOVAL APPARATUS AND METHOD," which is incorporated herein by reference in its entirety, removes motion artifacts from image data. Various systems for doing so are described. Such systems may be integrated with imaging module 138 . See also U.S. Patent Application Publication No. 2011/0306840, published Dec. 15, 2011, entitled "CONTROLLABLE MAGNETIC SOURCE TO FIXTURE INTRACORPOREAL APPARATUS" and "SYSTEM FOR PERFORMING A MINIMALLY INVASIVE August 28, 2014 entitled "SURGICAL PROCEDURE" Published US Patent Application Publication No. 2014/0243597, each of which is hereby incorporated by reference in its entirety.

FIG. 8 illustrates a cloud-based system (e.g., storage device 205) of modular devices located in one or more surgical sites of a medical facility, or in any room within a medical facility with specialized equipment for surgical procedures. Shown is a surgical data network 201 comprising a modular communication hub 203 configured to connect to a cloud 204, which may include a remote server 213 coupled to. In one aspect, modular communication hub 203 comprises network hub 207 and/or network switch 209 in communication with a network router. Modular communication hub 203 can also be coupled to local computer system 210 to provide local computer processing and data manipulation. Surgical data network 201 may be configured as passive, intelligent, or switched. A passive surgical data network acts as a data conduit, allowing data to go from one device (or segment) to another and to cloud computing resources. The intelligent surgical data network includes additional features that allow traffic to pass through the monitored surgical data network and configure each port within network hub 207 or network switch 209 . An intelligent surgical data network may be referred to as a manageable hub or switch. The switching hub reads the destination address of each packet and then forwards the packet to the correct port.

Modular devices 1 a - 1 n located at the surgical site may be coupled to modular communication hub 203 . Network hub 207 and/or network switch 209 may be coupled to network router 211 to connect devices 1 a - 1 n to cloud 204 or local computer system 210 . Data associated with the devices 1a-1n can be transferred via routers to cloud-based computers for remote data processing and manipulation. Data associated with devices 1a-1n may also be transferred to local computer system 210 for local data processing and manipulation. Modular devices 2 a - 2 m located at the same surgical site may also be coupled to network switch 209 . Network switch 209 may be coupled to network hub 207 and/or network router 211 to connect devices 2 a - 2 m to cloud 204 . Data associated with devices 2a-2n may be transferred to cloud 204 via network router 211 for data processing and manipulation. Data associated with devices 2a-2m may also be transferred to local computer system 210 for local data processing and manipulation.

It will be appreciated that surgical data network 201 may be expanded by interconnecting multiple network hubs 207 and/or multiple network switches 209 with multiple network routers 211 . Modular communication hub 203 may be housed in a modular control tower configured to receive multiple devices 1a-1n/2a-2m. A local computer system 210 may also be housed in the modular control tower. Modular communication hub 203 is connected to display 212 to display images acquired by some of devices 1a-1n/2a-2m, eg, during a surgical procedure. In various aspects, the devices 1a-1n/2a-2m are among other modular devices that can be connected to the modular communication hub 203 of the surgical data network 201, for example, an imaging module 138 coupled to an endoscope, A generator module 140 coupled to an energy-based surgical device, a smoke evacuation module 126, an aspiration/irrigation module 128, a communication module 130, a processor module 132, a storage array 134, a surgical device coupled to a display, and/or Various modules may be included, such as a contactless sensor module.

In one aspect, the surgical data network 201 is a combination of network hub(s), network switch(es), and network router(s) that connect the devices 1a-1n/2a-2m to the cloud. can include Any one or all of the devices 1a-1n/2a-2m coupled to a network hub or network switch can collect data in real time and transfer the data to a cloud computer for data processing and manipulation. . It will be appreciated that cloud computing relies on shared computing resources to handle software applications rather than having local servers or personal devices. The term "cloud" may be used as a metaphor for "Internet," but the term is not so limited. Accordingly, the term "cloud computing" can be used herein to refer to "a type of Internet-based computing" in which various services such as servers, storage, and applications are , to modular communication hub 203 and/or computer system 210 located at the surgical site (e.g., fixed, mobile, temporary, or on-site operating room or space), and via the Internet to modular communication hub 203 and /or provided to a device connected to computer system 210; A cloud infrastructure may be maintained by a cloud service provider. In this context, a cloud service provider may be an entity that coordinates the use and control of devices 1a-1n/2a-2m located within one or more surgical sites. Cloud computing services can perform numerous calculations based on data collected by smart surgical instruments, robots, and other computerized devices located within the surgical field. Hub hardware allows multiple devices or connections to connect to a computer that communicates with cloud computing resources and storage devices.

By applying cloud computer data processing techniques to data collected by devices 1a-1n/2a-2m, surgical data networks provide improved surgical outcomes, reduced costs, and improved patient satisfaction. At least some of the devices 1a-1n/2a-2m can be used to monitor the condition of the tissue after the tissue sealing and cutting procedure to assess leakage or perfusion of the sealed tissue. . at least one of the devices 1a-1n/2a-2m for diagnostic examination of data comprising images of body tissue samples to identify medical conditions such as disease effects using cloud-based computing; Several can be used. This includes tissue and phenotype localization and margin confirmation. Devices 1a-1n/2a for identifying body anatomy using various sensors integrated with imaging devices and techniques such as overlaying images captured by multiple imaging devices. At least some of ~2 m can be used. Data collected by devices 1a-1n/2a-2m, including image data, may be transferred to cloud 204 or local computer system 210, or both, for data processing and manipulation, including image processing and manipulation. Data will be used to determine whether further treatments such as endoscopic interventions, emerging technologies, targeted radiation, targeted interventions, and precision robotic applications for tissue-specific sites and conditions can be performed. , can be analyzed to improve the outcome of surgical procedures. Such data analysis may further employ prognostic analysis processing, using a standardized approach to confirm surgical intervention and surgeon behavior, or suggest modifications to surgical intervention and surgeon behavior. can provide useful feedback for any of the

In one implementation, the surgical field devices 1a-1n may be connected to the modular communication hub 203 via wired or wireless channels, depending on the configuration of the devices 1a-1n relative to the network hub. Network hub 207 may, in one aspect, be implemented as a local network broadcast device that functions on top of the physical layer of the Open System Interconnection (OSI) model. A network hub provides connectivity to devices 1a-1n located within the same surgical site network. Network hub 207 collects the data in packet form and sends them to the router in half-duplex mode. Network hub 207 does not store any media access control/Internet Protocol (MAC/IP) for transferring device data. Only one of the devices 1a-1n can transmit data through the network hub 207 at a time. Network hub 207 does not have routing tables or intelligence about where to send information, it broadcasts all network data across each connection and to remote server 213 (FIG. 9) on cloud 204 . While the network hub 207 can detect basic network errors such as collisions, broadcasting all information to multiple ports can be a security risk and cause failure.

In another implementation, the surgical field devices 2a-2m may be connected to the network switch 209 via wired or wireless channels. Network switch 209 functions within the data link layer of the OSI model. The network switch 209 is a multicast device for connecting the devices 2a-2m located within the same surgical site to the network. Network switch 209 sends data in frames to network router 211 and functions in full-duplex mode. Multiple devices 2 a - 2 m can transmit data simultaneously through network switch 209 . Network switch 209 stores and uses the MAC addresses of devices 2a-2m to transfer data.

Network hub 207 and/or network switch 209 are coupled to network router 211 to connect to cloud 204 . Network router 211 functions within the network layer of the OSI model. Network router 211 may cloud data packets received from network hub 207 and/or network switch 211 for further processing and manipulation of data collected by any one or all of devices 1a-1n/2a-2m. Create a route to send to the base computer resource. Network router 211 may be used to connect two or more different networks located at different locations, such as different networks located at different surgical sites at the same medical facility, or at different surgical sites at different medical facilities. . Network router 211 transmits data in packet form to cloud 204 and functions in full-duplex mode. Multiple devices can transmit data simultaneously. Network routers 211 use IP addresses to transfer data.

In one embodiment, network hub 207 may be implemented as a USB hub that allows multiple USB devices to be connected to a host computer. A USB hub can expand a single USB port into several layers so that there are many ports available for connecting devices to a host system computer. Network hub 207 may include wired or wireless capabilities for receiving information over wired or wireless channels. In one aspect, a wireless USB short range high band wireless communication protocol may be used for communication between devices 1a-1n and devices 2a-2m located within the surgical site.

In another embodiment, the surgical field devices 1a-1n/2a-2m exchange data from fixed and mobile devices over short distances (using short wavelength UHF radio waves in the 2.4-2.485 GHz ISM band). ), can communicate with the modular communication hub 203 via the Bluetooth wireless technology standard to build a personal area network (PAN). In other aspects, the surgical field devices 1a-1n/2a-2m support Wi-Fi (IEEE 802.11 family), WiMAX (IEEE 802.16 family), IEEE 802.20, long-term evolution, LTE), and Ev-DO, HSPA+, HSDPA+, HSUPA+, EDGE, GSM, GPRS, CDMA, TDMA, DECT and their Ethernet derivatives as well as any designated 3G, 4G, 5G and later Communicate with modular communication hub 203 via numerous wireless or wired communication standards or protocols, including but not limited to other wireless and wired protocols. A computing module may include multiple communication modules. For example, a first communication module may be dedicated to short-range wireless communications such as Wi-Fi and Bluetooth, and a second communication module may be dedicated to GPS, EDGE, GPRS, CDMA, WiMAX, LTE, Ev-DO, etc. It may be dedicated to long range wireless communication.

The modular communication hub 203 can serve as a central connection for one or all of the surgical field devices 1a-1n/2a-2m and handles data types known as frames. The frames have data generated by devices 1a-1n/2a-2m. When the frame is received by modular communication hub 203, it is amplified and transmitted to network router 211, which uses a number of wireless or wired communication standards or protocols, as described herein. to transfer this data to cloud computing resources.

Modular communication hub 203 may be used as a stand-alone device or may be connected to compatible network hubs and network switches to form a larger network. Modular communication hubs 203 are generally easy to install, configure, and maintain, making them an excellent choice for networking surgical field devices 1a-1n/2a-2m.

FIG. 9 shows a computer-implemented interactive surgical system 200 . Computer-implemented interactive surgical system 200 is similar in many respects to computer-implemented interactive surgical system 100 . For example, computer-implemented interactive surgical system 200 includes one or more surgical systems 202 that are similar in many respects to surgical system 102 . Each surgical system 202 includes at least one surgical hub 206 in communication with cloud 204 which may include remote server 213 . In one aspect, the computer-implemented interactive surgical system 200 includes a modular control tower 236 connected to multiple surgical site devices such as, for example, intelligent surgical instruments, robots, and other computerized devices located within the surgical site. Prepare. As shown in FIG. 10, modular control tower 236 comprises modular communication hub 203 coupled to computer system 210 . As illustrated in the embodiment of FIG. 9, modular control tower 236 includes imaging module 238 coupled to endoscope 239, generator module 240 coupled to energy device 241, smoke evacuator module 226, suction/ Coupled to an irrigation module 228 , a communications module 230 , a processor module 232 , a storage array 234 , a smart device/instrument 235 optionally coupled to a display 237 , and a contactless sensor module 242 . The surgical field devices are linked to cloud computing resources and data storage via modular control towers 236 . Robotic hub 222 may also be connected to modular control tower 236 and cloud computing resources. Among other things, devices/instruments 235, visualization system 208 may be coupled to modular control tower 236 via wired or wireless communication standards or protocols as described herein. Modular control tower 236 may be coupled to hub display 215 (e.g., monitor, screen) for displaying and overlaying images received from imaging modules, device/instrument displays, and/or other visualization systems 208. . The hub display may also display data received from devices connected to the modular control tower along with images and overlay images.

FIG. 10 shows surgical hub 206 comprising multiple modules coupled to modular control tower 236 . Modular control tower 236 includes a modular communication hub 203, eg, a network connection device, and a computer system 210, eg, for providing local processing, visualization, and imaging. As shown in FIG. 10, modular communication hubs 203 are connected in a hierarchical configuration to expand the number of modules (e.g., devices) that can be connected to modular communication hub 203 to store data associated with the modules. It can be transferred to computer system 210, cloud computing resources, or both. As shown in FIG. 10, each of the network hubs/switches within modular communication hub 203 includes three downstream ports and one upstream port. An upstream network hub/switch is connected to the processor to provide communication connections to cloud computing resources and local displays 217 . Communication to cloud 204 can be through either wired or wireless communication channels.

Surgical hub 206 uses non-contact sensor module 242 to measure the dimensions of the surgical field and generate a map of the surgical field using either ultrasonic or laser-based non-contact measurement devices. "Surgical Hub Spatial Awareness Within an Operating Room," in U.S. Provisional Patent Application No. 62/611,341, filed Dec. 28, 2017, entitled "INTERACTIVE SURGICAL PLATFORM," which is hereby incorporated by reference in its entirety. The ultrasound-based non-contact sensor module scans the surgical site by transmitting bursts of ultrasound and receiving echoes when the bursts of ultrasound reflect off the outer walls of the surgical site. where the sensor module is configured to determine the size of the surgical site and adjust the distance limit of the Bluetooth pairing. A laser-based non-contact sensor module, for example, transmits a laser light pulse, receives a laser light pulse that reflects off the outer wall of the surgical site, compares the phase of the transmitted pulse with the received pulse, and compares the phase of the surgical site. Scan the surgical site by determining the size and adjusting the Bluetooth pairing distance limit.

Computer system 210 includes processor 244 and network interface 245 . Processor 244 is coupled to communication module 247, storage device 248, memory 249, non-volatile memory 250, and input/output interface 251 through a system bus. The system bus is a 9-bit bus, Industrial Standard Architecture (ISA), Micro-Charmel Architecture (MSA), Extended ISA (EISA), Intelligent Drive Electronics (IDE). , VESA Local Bus (VLB), Peripheral Component Interconnect (PCI), USB, Advanced Graphics Port (AGP), Personal Computer Memory Card International Bus Association bus, PCMCIA), Small Computer Systems Interface (SCSI), or any other proprietary bus, using any of a variety of bus architectures It may be any of several types of bus structure(s), including a bus or memory controller, a peripheral or external bus, and/or a local bus.

Processor 244 may be any single-core or multi-core processor, such as those known under the trade name ARM Cortex manufactured by Texas Instruments. In one aspect, the processor has on-chip memory up to 40 MHz of 256 KB of single-cycle flash memory or other non-volatile memory, the details of which are available in the product datasheet, and a prefetch buffer to improve performance beyond 40 MHz. , 32 KB single-cycle serial random access memory (SRAM), internal read-only memory (ROM) with StellarisWare® software, 2 KB electrically erasable programmable erasable programmable read-only memory (EEPROM) and/or one or more pulse width modulation (PWM) modules, one or more quadrature encoder input (QEI) analog, It may be, for example, an LM4F230H5QR ARM Cortex-M4F processor core available from Texas Instruments that includes one or more 12-bit analog-to-digital converters (ADCs) with 12 analog input channels. .

In one aspect, the processor 244 may include a safety controller that includes two controller family families, such as the TMS570 and RM4x, also known by the trade designation Hercules ARM Cortex R4, also manufactured by Texas Instruments. Safety controllers may be configured specifically for IEC61508 and ISO26262 safety limit applications to provide advanced integrated safety features while offering scalable performance, connectivity, and memory options. good.

System memory includes both volatile and nonvolatile memory. The basic input/output system (BIOS), containing the basic routines to transfer information between elements within the computer system, such as during start-up, is stored in nonvolatile memory. For example, non-volatile memory can include ROM, programmable ROM (PROM), electrically programmable ROM (EPROM), EEPROM, or flash memory. Volatile memory includes random-access memory (RAM), which acts as external cache memory. Furthermore, RAM includes SRAM, dynamic RAM (dynamic RAM, DRAM), synchronous DRAM (synchronous DRAM, SDRAM), double data rate SDRAM (double data rate, DDR SDRAM), enhanced SDRAM (enhanced SDRAM, ESDRAM), sync link It is available in many forms such as DRAM (Synchlink DRAM, SLDRAM) and direct Rambus RAM (DRRAM).

Computer system 210 also includes removable/non-removable, volatile/non-volatile computer storage media, such as disk storage devices. Disk storage devices include, but are not limited to, devices such as magnetic disk drives, floppy disk drives, tape drives, Jaz drives, Zip drives, LS-60 drives, flash memory cards, or memory sticks. In addition, disc storage devices may include storage media separately or compact disc ROM devices (CD-ROM), compact disc recordable drives (CD-R Drives), compact disc rewritable In combination with other storage media including but not limited to a compact disc rewritable drive (CD-RW Drive) or an optical disc drive such as a digital versatile disc ROM drive (DVD-ROM) and can contain A removable or non-removable interface may be used to facilitate connection of the disk storage devices to the system bus.

It should be appreciated that computer system 210 includes software that acts as an intermediary between users and basic computer resources as described in the preferred operating environment. Such software includes an operating system. An operating system, which may be stored on the disk storage device, functions to control and allocate the computer system's resources. System applications take advantage of resource management by the operating system through program modules and program data stored either in system memory or on disk storage devices. It should be appreciated that the various components described herein can be implemented on various operating systems or combinations of operating systems.

A user enters commands or information into computer system 210 through input device(s) coupled to I/O interface 251 . Input devices include pointing devices such as mice, trackballs, styluses, and touchpads, keyboards, microphones, joysticks, gamepads, satellite dishes, scanners, TV tuner cards, digital cameras, digital video cameras, and webcams. include but are not limited to: These and other input devices connect to the processor through the system bus via the interface port(s). Interface port(s) include, for example, serial port, parallel port, game port, and USB. Output device(s) use some of the same types of ports as input device(s). Thus, for example, a USB port can be used to provide input to a computer system and output information from the computer system to an output device. Output adapters are provided to illustrate that there are some output devices such as monitors, displays, speakers, and printers, among other output devices that require special adapters. Output adapters include, by way of example and not limitation, video and sound cards that provide a means of connection between output devices and the system bus. Note that other devices and/or systems of devices, such as remote computer(s), provide both input and output functionality.

Computer system 210 can operate in a networked environment using logical connections to one or more remote or local computers, such as cloud computer(s). The remote cloud computer(s) can be personal computers, servers, routers, network PCs, workstations, microprocessor-based appliances, peer devices, or other general network nodes, etc., and are typically computers Includes many or all of the elements described for the system. For simplicity, only the memory storage device is shown along with the remote computer(s). Remote computer(s) are logically connected to the computer system through a network interface and then physically connected via a communications connection. The network interface encompasses communication networks such as local area networks (LAN) and wide area networks (WAN). LAN technologies include Fiber Distributed Data Interface (FDDI), Copper Distributed Data Interface (CDDI), Ethernet/IEEE 802.3, Token Ring/IEEE 802.5, and so on. WAN technologies include 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). but not limited to these.

In various aspects, the computer system 210 of FIG. 10, the imaging module 238 of FIGS. 9-10, and/or the visualization system 208, and/or the processor module 232 are image processors, image processing engines, media processors, or digital image processors. may include any dedicated digital signal processor (DSP) used to process the Image processors can increase speed and efficiency using parallel computing using single instruction multiple data (SIMD) or multiple instruction multiple data (MIMD) techniques. A digital image processing engine can perform a variety of tasks. The image processor may be a system on chip with a multi-core processor architecture.

Communication connection(s) refers to hardware/software used to connect a network interface to a bus. Although communication connections are shown internal to the computer system for clarity of illustration, the communication connections may be external to computer system 210 . By way of example only, the hardware/software required to connect to the network interface includes internal and external technologies such as modems such as regular telephone grade modems, cable modems, and DSL modems, ISDN adapters, and Ethernet cards. is mentioned.

In various aspects, the device/instrument 235 described with reference to FIGS. 9-10 includes a combination energy instrument 213100 (FIG. 18), a surgical stapler 213102 (FIG. 18), an aspiration/irrigation device 213104 (FIG. 18). , sterile field display 213108 (FIG. 18), surgical device 213204 (FIGS. 19A and 19B), surgical evacuation system 50400 (FIG. 21), electrosurgical instrument 50630 (FIG. 22), evacuation system 50600 (FIG. 22), evacuation It can be implemented as system 50900 (Fig. 23), scope 213501 (Fig. 25), and surgical device 213608 (Fig. 26). Thus, combination energy instrument 213100 (Fig. 18), surgical stapler 213102 (Fig. 18), aspiration/irrigation device 213104 (Fig. 18), sterile field display 213108 (Fig. 18), surgical device 213204 (Figs. 19A and 19B). , surgical evacuation system 50400 (FIG. 21), electrosurgical instrument 50630 (FIG. 22), evacuation system 50600 (FIG. 22), evacuation system 50900 (FIG. 23), scope 213501 (FIG. 25), and surgical device 213608 (FIG. 26 ) are configured to interface with modular control tower 236 and surgical hub 206 . Once connected to surgical hub 206, combination energy instrument 213100 (FIG. 18), surgical stapler 213102 (FIG. 18), aspiration/irrigation device 213104 (FIG. 18), sterile field display 213108 (FIG. 18), surgical Apparatus 213204 (FIGS. 19A and 19B), surgical evacuation system 50400 (FIG. 21), electrosurgical instrument 50630 (FIG. 22), evacuation system 50600 (FIG. 22), evacuation system 50900 (FIG. 23), scope 213501 (FIG. 25) ), and surgical device 213608 (FIG. 26) are configured to interface with cloud 204, server 213, other hub connection equipment, hub display 215, or visualization system 209, or combinations thereof. Further, once connected to hub 206, combination energy instrument 213100 (FIG. 18), surgical stapler 213102 (FIG. 18), aspiration/irrigation device 213104 (FIG. 18), sterile field display 213108 (FIG. 18), surgical Apparatus 213204 (FIGS. 19A and 19B), surgical evacuation system 50400 (FIG. 21), electrosurgical instrument 50630 (FIG. 22), evacuation system 50600 (FIG. 22), evacuation system 50900 (FIG. 23), scope 213501 (FIG. 25) ), and surgical device 213608 (FIG. 26) can utilize the processing circuitry available in hub local computer system 210 .

FIG. 11 illustrates a functional block diagram of one aspect of a USB network hub 300 device, in accordance with at least one aspect of the present disclosure. In the illustrated embodiment, USB network hub device 300 employs a TUSB2036 integrated circuit hub manufactured by Texas Instruments. The USB network hub 300 is a CMOS device that provides an upstream USB transmit/receive port 302 and up to three downstream USB transmit/receive ports 304, 306, 308 conforming to the USB 2.0 standard. The upstream USB transmit/receive port 302 is a differential root data port that includes a differential data minus (data minus, DM0) input paired with a differential data plus (DP0) input. The three downstream USB transmit/receive ports 304, 306, 308 are differential data ports, each port including differential data plus (DP1-DP3) outputs paired with differential data minus (DM1-DM3) outputs.

The USB network hub 300 device is implemented with a digital state machine instead of a microcontroller and does not require firmware programming. A fully compliant USB transceiver is integrated into the circuitry of the upstream USB transmit/receive port 302 and all downstream USB transmit/receive ports 304 , 306 , 308 . Downstream USB transmit/receive ports 304, 306, 308 support both high speed and low speed devices by automatically setting the slew rate according to the speed of the device attached to the port. The USB network hub 300 device may be configured in either bus-powered mode or self-powered mode and includes hub power logic 312 for managing power.

The USB network hub 300 device includes a serial interface engine 310 (SIE). The SIE 310 is the front end of the USB network hub 300 hardware and handles most of the protocols described in Chapter 8 of the USB specification. The SIE 310 typically understands signaling down to the transaction level. The functions it handles include packet recognition, transaction prioritization, detection/generation of SOP, EOP, RESET and RESUME signals, clock/data separation, non-return-to-zero invert (NRZI). data encoding/decoding and bit stuffing, CRC generation and verification (tokens and data), packet ID (PID) generation and verification/decoding, and/or serial-parallel-parallel-serial conversion. . 310 receives a clock input 314 and via port logic 320 , 322 , 324 suspend/suspend to control communication between the upstream USB transmit/receive port 302 and the downstream USB transmit/receive ports 304 , 306 , 308 . It is coupled to resume logic and frame timer 316 circuitry and hub repeater circuitry 318 . SIE 310 is coupled to command decoder 326 via interface logic 328 for controlling serial EEPROM commands via serial EEPROM interface 330 .

In various aspects, the USB network hub 300 can connect 127 functions organized in up to 6 logical layers (hierarchies) to a single computer. Additionally, the USB network hub 300 can connect to all peripherals using a standardized four wire cable that provides both communication and power distribution. The power configurations are bus power mode and self power mode. USB network hub 300 has four power management capabilities: a bus-powered hub with either individual port power management or ganged port power management, and a self-powered hub with either individual port power management or ganged port power management. can be configured to support two modes. In one aspect, using a USB cable, USB network hub 300, the upstream USB transmit/receive port 302 plugs into a USB host controller and the downstream USB transmit/receive ports 304, 306, 308 connect USB compatible devices. and so on.

Additional details regarding the structure and function of surgical hubs and/or networks of surgical hubs are provided in U.S. patent application filed April 19, 2018, entitled "METHOD OF HUB COMMUNICATION," the entire contents of which are incorporated herein by reference. It can be found in Provisional Patent Application No. 62/659,900.

Cloud System Hardware and Functional Modules FIG. 12 is a block diagram of a computer-implemented interactive surgical system, according to at least one aspect of the present disclosure. In one aspect, the computer-implemented interactive surgical system is configured to monitor and analyze data regarding the operation of various surgical systems, including surgical hubs, surgical instruments, robotic devices, and surgical sites or medical facilities. ing. Computer-implemented interactive surgical systems include cloud-based analysis systems. The cloud-based analysis system is described as a surgical system, but is not necessarily so limited and may be a cloud-based medical system. As shown in FIG. 12, the cloud-based analysis system includes a plurality of surgical instruments 7012 (which may be the same or similar to instrument 112) and a plurality of surgical instruments 7012 (which may be the same or similar to hub 106). A hub 7006 and a surgical data network 7001 (which may be the same as or similar to network 201) for coupling surgical hub 7006 to cloud 7004 (which may be the same or similar to cloud 204). Each of the plurality of surgical hubs 7006 are communicatively coupled to one or more surgical instruments 7012 . Hub 7006 is also communicatively coupled via network 7001 to cloud 7004 of computer-implemented interactive surgical systems. Cloud 7004 is a remote, centralized source of hardware and software for storing, manipulating, and communicating data generated based on the operation of various surgical systems. As shown in FIG. 12, access to cloud 7004 is achieved through network 7001, which may be the Internet or other suitable computer network. Surgical hub 7006 coupled to cloud 7004 can be considered the client side of the cloud computing system (ie, cloud-based analysis system). Surgical instrument 7012 is paired with surgical hub 7006 for controlling and performing various surgical procedures or actions described herein.

Additionally, surgical instruments 7012 may include transceivers for data transmission to and from corresponding surgical hubs 7006 (which may also include transceivers). The combination of surgical instrument 7012 and corresponding hub 7006 can indicate a particular location, such as a surgical site within a medical facility (eg, hospital) for providing medical surgery. For example, the memory of surgical hub 7006 can store position data. As shown in FIG. 12, cloud 7004 includes central server 7013 (which may be the same or similar to remote server 113 of FIG. 1 and/or remote server 213 of FIG. 9), hub application server 7002, data analysis module 7034, and an input/output (“I/O”) interface 7007 . Central server 7013 of cloud 7004 collectively manages the cloud computing system, including monitoring requests by client modules 7006 and managing the processing power of cloud 7004 to carry out the requests. Each of the central servers 7013 comprises one or more processors 7008 coupled to suitable memory devices 7010, which can include volatile memory such as random access memory (RAM) and non-volatile memory such as magnetic storage. . Memory device 7010 may contain machine-executable instructions that, when executed, cause processor 7008 to perform data analysis module 7034 for cloud-based data analysis, operations, recommendations, and other operations described below. . Further, processor 7008 can execute data analysis module 7034 either independently or in conjunction with hub applications executed independently by hub 7006 . Central server 7013 also includes an aggregated medical data database 2212 that may reside in memory 2210 .

Based on its connection to various surgical hubs 7006 via network 7001, cloud 7004 can aggregate data from specific data generated by various surgical instruments 7012 and their corresponding hubs 7006. can. Such aggregated data may be stored in aggregated medical data database 7011 in cloud 7004 . Specifically, the cloud 7004 can advantageously perform data analysis and operations on aggregated data to yield insights and/or perform functions that individual hubs 7006 cannot accomplish by themselves. can. To this end, as shown in FIG. 12, cloud 7004 and surgical hub 7006 are communicatively coupled to transmit and receive information. I/O interface 7007 is connected to multiple surgical hubs 7006 via network 7001 . In this manner, I/O interface 7007 may be configured to transfer information between surgical hub 7006 and database of aggregated medical data 7011 . Accordingly, the I/O interface 7007 can facilitate read/write operations of the cloud-based analysis system. Such read/write operations may be performed in response to requests from hub 7006 . These requests can be sent to hub 7006 via the hub application. The I/O interface 7007 may include one or more high-speed data ports, such as a Universal Serial Bus (USB) port, an IEEE 1394 port, and Wi-Fi for connecting the cloud 7004 to the hub 7006. A Bluetooth I/O interface may be mentioned. Hub application server 7002 of cloud 7004 is configured to host and provide shared functionality to software applications (eg, hub applications) executed by surgical hub 7006 . For example, hub application server 7002 may manage requests by hub applications through hub 7006, control access to aggregated medical data database 7011, and perform load balancing. Data analysis module 7034 is described in more detail with reference to FIG.

The configuration of the particular cloud computing system described in this disclosure specifically raises various issues in the context of medical surgeries and procedures performed using medical devices such as surgical instruments 7012, 112. designed to deal with In particular, surgical instrument 7012 may be a digital surgical device configured to interact with cloud 7004 to implement techniques to improve surgical outcomes. Various surgical instruments 7012 and/or surgical hubs 7006 may include touch-controlled user interfaces so that a clinician can control aspects of interaction between surgical instruments 7012 and cloud 7004 . Other suitable user interfaces for control may also be used, such as an audibly controlled user interface.

FIG. 13 is a block diagram illustrating the functional architecture of a computer-implemented interactive surgical system, according to at least one aspect of the present disclosure; The cloud-based analysis system includes multiple data analysis modules 7034 that can be executed by the processor 7008 of the cloud 7004 to provide data analysis solutions to problems that arise specifically in the medical field. As shown in FIG. 13, the functionality of the cloud-based data analysis module 7034 may be supported via a hub application 7014 hosted by a hub application server 7002 accessible on the surgical hub 7006. Cloud processor 7008 and hub application 7014 may work in conjunction to perform data analysis module 7034 . Application program interface (API) 7016 defines a set of protocols and routines corresponding to hub application 7014 . In addition, API 7016 manages the storage and retrieval of data into and from aggregated medical data database 7011 for the operation of application 7014 . Cache 7018 also stores data (eg, temporarily) and is coupled to API 7016 for more efficient retrieval of data used by application 7014 . The data analysis module 7034 of FIG. Contains modules. Other suitable data analysis modules may also be implemented by cloud 7004 according to some aspects. In one aspect, the data analysis module is used to make specific recommendations based on analysis of trends, outcomes, and other data.

For example, the data collection and aggregation module 7022 can identify salient features or configurations (e.g., trends), manage redundant data sets, and group by surgery, but not necessarily on the actual surgical date and surgeon. It can be used to generate self-describing data (eg, metadata), including storing data in unmatched paired datasets. In particular, paired data sets generated from the operation of surgical instrument 7012 may include applying binary classification, such as bleeding or non-bleeding events. More generally, a binary classification can be characterized as either a desirable event (eg, a successful surgical procedure) or an undesirable event (eg, misfired or misused surgical instrument 7012). Aggregated self-describing data may correspond to individual data received from various groups or subgroups of surgical hubs 7006 . Accordingly, data collection and aggregation module 7022 can generate aggregated metadata or other organized data based on raw data received from surgical hub 7006 . To this end, processor 7008 can be operatively coupled to hub application 7014 and aggregated medical data database 7011 to execute data analysis module 7034 . The data collection and aggregation module 7022 may store the aggregated organizational data in the aggregated medical data database 2212 .

A resource optimization module 7020 can be configured to analyze this aggregated data to determine the optimal use of resources for a particular medical facility or group of medical facilities. For example, resource optimization module 7020 can determine the optimal ordering point for surgical stapling instruments 7012 for a group of medical facilities based on the corresponding predicted demand for surgical stapling instruments 7012 . The resource optimization module 7020 can also evaluate resource usage or other operating configurations of various healthcare facilities to determine if resource usage can be improved. Similarly, recommendation module 7030 can be configured to analyze organizational data aggregated from data collection and aggregation module 7022 to provide recommendations. For example, the recommendation module 7030 may indicate to medical facilities (e.g., hospitals, etc.) that a particular surgical instrument 7012 should be upgraded to an improved version, e.g., based on a higher than expected error rate. health care providers). In addition, recommendation module 7030 and/or resource optimization module 7020 may recommend better supply chain parameters, such as product reorder points, for different surgical instruments 7012, their use, or procedural steps to improve surgical outcome. Suggestions can be provided. Medical facilities can receive such recommendations via corresponding surgical hubs 7006 . More specific recommendations regarding various surgical instrument 7012 parameters or configurations may also be provided. Hub 7006 and/or surgical instrument 7012 may each also have display screens that display data or recommendations provided by cloud 7004 .

Patient outcome analysis module 7028 can analyze surgical results associated with currently used operating parameters of surgical instrument 7012 . Patient outcome analysis module 7028 may also analyze and evaluate other potential operating parameters. In this regard, the recommendation module 7030 uses these other potential operating parameters to make recommendations based on yielding better surgical outcomes, such as better sealing or less bleeding. be able to. For example, recommendation module 7030 can send recommendations to surgical hub 7006 regarding when to use a particular cartridge in a corresponding stapling surgical instrument 7012 . Cloud-based analysis systems can therefore analyze the large-scale raw data collected while controlling for common variables and centralize (advantageously determined based on aggregated data) across multiple medical facilities. can be configured to provide targeted recommendations. For example, a cloud-based analytics system could help a single medical facility independently identify types of procedures, types of patients, numbers of patients, geographic similarities among providers using similar types of equipment, and more. can be analyzed, evaluated, and/or aggregated in ways that cannot be analyzed

Control program update module 7026 can be configured to implement various surgical instrument 7012 recommendations when the corresponding control program is updated. For example, the patient outcome analysis module 7028 can identify correlations linking certain control parameters with successful (or unsuccessful) outcomes. Such correlations may be addressed when an updated control program is sent to surgical instrument 7012 via control program update module 7026 . Updates to instruments 7012 sent via corresponding hubs 7006 may incorporate aggregated performance data collected and analyzed by data collection and aggregation module 7022 of cloud 7004 . Additionally, patient outcome analysis module 7028 and recommendation module 7030 can identify improved methods of using instrument 7012 based on aggregated performance data.

A cloud-based analytics system may include security features implemented by the cloud 7004 . These security features may be managed by authorization and security module 7024 . Each surgical hub 7006 can have associated unique credentials such as a username, password, and other suitable security credentials. These credentials may be stored in memory 7010 and associated with permitted cloud access levels. For example, based on providing correct credentials, surgical hub 7006 may be granted access to communicate with the cloud to a predetermined extent (e.g., transmit or receive certain defined types of information). can be used). To this end, the aggregated medical data database 7011 of the cloud 7004 may include a certified credential database for verifying the correctness of provided credentials. Different credentials may be associated with different levels of authorization for interaction with cloud 7004 , such as a predetermined access level for receiving data analytics generated by cloud 7004 .

Additionally, for security purposes, the cloud may maintain a database of hubs 7006, appliances 7012, and other devices that may include a "blacklist" of prohibited devices. Specifically, a blacklisted surgical hub 7006 may not be allowed to interact with the cloud, while a blacklisted surgical instrument 7012 may not pair with its corresponding hub 7006. When ringed, it may not have functional access to the corresponding hub 7006 and/or may be prevented from fully functioning. Additionally or alternatively, cloud 7004 may flag instruments 7012 based on non-compliance or other specified criteria. In this manner, counterfeit medical devices and inappropriate reuse of such devices across cloud-based analysis systems can be identified and addressed.

Surgical instruments 7012 may use wireless transceivers to transmit wireless signals that may represent, for example, authorization credentials for access to corresponding hub 7006 and cloud 7004 . Wired transceivers can also be used to transmit signals. Such authorization credentials can be stored in the respective memory device of surgical instrument 7012 . Authorization and security module 7024 can determine whether authorization credentials are correct or forged. Authorization and security module 7024 may also dynamically generate authorization credentials for enhanced security. Credentials may also be encrypted, such as by using hash-based encryption. Upon sending the appropriate authorization, the surgical instrument 7012 will send a signal to the corresponding hub 7006 and ultimately the cloud 7004 to indicate that the instrument 7012 is ready to acquire and transmit medical data. can be done. In response, cloud 7004 may transition to a state capable of receiving medical data for storage in aggregated medical data database 7011 . This readiness for data transmission can be indicated by, for example, a light indicator on instrument 7012 . Cloud 7004 can also send signals to surgical instruments 7012 to update their associated control programs. The cloud 7004 can send signals directed to specific classes of surgical instruments 7012 (eg, electrosurgical instruments) such that software updates to the control program are sent only to the appropriate surgical instruments 7012. . Additionally, the cloud 7004 may also be used to implement system-wide solutions to address local or global issues based on selective data transmission and authorization credentials. For example, if a group of surgical instruments 7012 is identified as having a common manufacturing defect, cloud 7004 may change the authorization credentials corresponding to this group to enforce operational lockout for this group.

A cloud-based analytics system may consult multiple medical facilities (e.g., medical facilities such as hospitals) to determine improved practices and recommend changes accordingly (e.g., via suggestion module 2030). monitoring. Accordingly, processor 7008 of cloud 7004 can analyze data associated with individual medical facilities to identify the facilities and aggregate that data with other data associated with other medical facilities. Groups may be defined based on similar operational behavior or geographic location, for example. In this manner, the cloud 7004 can provide broad analysis and recommendations to medical facility groups. Cloud-based analytics systems can also be used for enhanced situational awareness. For example, processor 7008 may predictively model the effect of recommendations on cost and effectiveness for a particular facility (relative to overall performance and/or various medical procedures). The costs and efficiencies associated with that particular facility can also be compared to corresponding local areas of other facilities or any other comparable facility.

Data classification and prioritization module 7032 may prioritize and classify data based on severity (eg, severity of medical events associated with the data, surprise, suspiciousness). This categorization and prioritization may be used in conjunction with other data analysis module 7034 functions described above to improve the cloud-based analysis and operations described herein. For example, data classification and prioritization module 7032 can assign priorities to data analysis performed by data collection and aggregation module 7022 and patient outcome analysis module 7028 . Different priority levels may be assigned to the cloud 7004 (corresponding to the level of urgency), such as escalation for expedited response, special handling, removal of aggregated medical data from the database 7011, or other suitable response. can result in a specific response from Further, if desired, cloud 7004 can send requests (eg, push messages) through hub application servers for additional data from corresponding surgical instruments 7012 . A push message can result in a notification displayed on the corresponding hub 7006 to request support or additional data. This push message may be required in situations where the cloud detects significant irregularities or outliers and the cloud cannot determine the cause of the irregularities. The central server 7013 triggers this push message in certain critical situations, such as when data is determined to differ from expected values by more than a predetermined threshold, or when security appears to have been involved. can be programmed as

In various aspects, the surgical instrument(s) 7012 described above with reference to FIGS. (Fig. 18), sterile field display 213108 (Fig. 18), surgical device 213204 (Figs. 19A and 19B), surgical evacuation system 50400 (Fig. 21), electrosurgical instrument 50630 (Fig. 22), evacuation system 50600 (Fig. 22), can be implemented as an evacuation system 50900 (Fig. 23), a scope 213501 (Fig. 25), and a surgical device 213608 (Fig. 26). Thus, combination energy instrument 213100 (Fig. 18), surgical stapler 213102 (Fig. 18), aspiration/irrigation device 213104 (Fig. 18), sterile field display 213108 (Fig. 18), surgical device 213204 (Figs. 19A and 19B). , surgical evacuation system 50400 (FIG. 21), electrosurgical instrument 50630 (FIG. 22), evacuation system 50600 (FIG. 22), evacuation system 50900 (FIG. 23), scope 213501 (FIG. 25), and surgical device 213608 (FIG. 26) is configured to interface with network 2001 and surgical hub 7006 configured to interface with cloud 7004 . Accordingly, the processing power provided by the central server 7013 and data analysis module 7034 is combined energy instrument 213100 (FIG. 18), surgical stapler 213102 (FIG. 18), aspiration/irrigation device 213104 (FIG. 18), sterile field display 213108 (FIG. 18), surgical device 213204 (FIGS. 19A and 19B), surgical evacuation system 50400 (FIG. 21), electrosurgical instrument 50630 (FIG. 22), evacuation system 50600 (FIG. 22), evacuation system 50900 (FIG. 23). ), scope 213501 (FIG. 25), and surgical device 213608 (FIG. 26).

Further details regarding cloud analytics systems are further described in U.S. Provisional Patent Application No. 62/659,900, filed April 19, 2018, entitled "METHOD OF HUB COMMUNICATION," which is incorporated herein by reference in its entirety. explained.

Situational Awareness An "intelligent" device that includes control algorithms responsive to sensed data can be an improvement over a "dumb" device that operates without considering sensed data. However, some sensed data may be incomplete or inconclusive when considered alone, i.e., without the context of the type of surgical procedure being performed or the type of tissue being operated on. There is Without knowing the treatment context (e.g., knowing the type of tissue being operated on or the type of procedure being performed), the control algorithm would have to operate the modular device given sensory data that does not contain a specific context. It may control imprecisely or sub-optimally. For example, the optimal method of control algorithms for controlling a surgical instrument in response to particular sensed parameters may vary depending on the particular tissue type being operated on. This is due to the fact that different tissue types have different properties (eg, resistance to tearing) and therefore respond differently to motions taken by the surgical instrument. Therefore, it may be desirable for the surgical instrument to behave differently even when the same measurement is sensed for a particular parameter. As one specific example, the optimal method of controlling a surgical stapling and severing instrument in response to sensing an unexpectedly high force to close its end effector depends on the type of tissue. is susceptible to or resistant to tearing. For tissue that is susceptible to tearing, such as lung tissue, the instrument's control algorithm optimally ramps down the motor in response to the unexpectedly high closing force to avoid tearing the tissue. For tissue that is resistant to tearing, such as gastric tissue, the instrument's control algorithm responds to an unexpectedly high closing force to ensure that the end effector is properly clamped to the tissue. Allows the motor to ramp up optimally. Without knowing whether lung tissue is clamped or stomach tissue is clamped, the control algorithm may make sub-optimal decisions.

One solution includes a system configured to derive information about a surgical procedure being performed based on data received from various data sources, and then control the paired modular devices accordingly. , utilizing a surgical hub. In other words, the surgical hub infers information about the surgical procedure from the received data and then controls the modular devices paired with the surgical hub based on the inferred context of the surgical procedure. It is configured. FIG. 14 shows a diagram of a situation-aware surgical system 5100, according to at least one aspect of the present disclosure. In some examples, data sources 5126 may include, for example, modular device 5102 (which may include sensors configured to detect parameters associated with the patient and/or the modular device itself), database 5122 (eg, EMR database containing patient records), and patient monitors 5124 (eg, blood pressure (BP) monitors and electrocardiogram (EKG) monitors).

Surgical hub 5104 may be similar to hub 106 in many respects, for example, surgical It may be configured to derive contextual information regarding treatment from the data. Contextual information inferred from the received data may include, for example, the type of surgical procedure being performed, the particular step of the surgical procedure being performed by the surgeon, the type of tissue being operated on, or the body cavity being treated. . This ability by some aspects of the surgical hub 5104 to derive or infer surgical procedure-related information from the received data may be referred to as "situational awareness." In one illustration, surgical hub 5104 can incorporate a situational awareness system, which is hardware and/or programming associated with surgical hub 5104 that derives contextual information related to a surgical procedure from received data.

The situational awareness system of surgical hub 5104 may be configured to derive contextual information from data received from data sources 5126 in a variety of different ways. In one illustration, the situational awareness system can: Including pattern recognition systems trained on training data, or machine learning systems (eg, artificial neural networks). In other words, a machine learning system can be trained to accurately derive contextual information about a surgical procedure from the input provided. In another example, the situational awareness system includes a lookup table that stores pre-characterized contextual information about a surgical procedure in association with one or more inputs (or ranges of inputs) corresponding to the contextual information. can contain. In response to interrogation by one or more inputs, the lookup table can return corresponding contextual information for the situational awareness system to control the modular device 5102 . In one illustration, the contextual information received by the situational awareness system of surgical hub 5104 is associated with a particular control adjustment or set of control adjustments for one or more modular devices 5102 . In another example, the situational awareness system generates or retrieves one or more control adjustments for one or more modular devices 5102 when contextual information is provided as input. Further machine learning systems, lookup tables , or other such systems.

Surgical hub 5104 incorporating a situational awareness system provides surgical system 5100 with many benefits. One benefit includes improved interpretation of sensed and collected data, which improves processing accuracy and/or use of data during the course of a surgical procedure. To return to the previous example, the context-aware surgical hub 5104 can determine what type of tissue is being operated on, and thus an unexpectedly high force to close the end effector of the surgical instrument. is detected, the context-aware surgical hub 5104 can properly ramp up or ramp down the motor of the surgical instrument for the tissue type.

As another example, the type of tissue being operated on can affect adjustments made to the compression rate and load threshold of a surgical stapling and cutting instrument for a particular tissue gap measurement. The context-aware surgical hub 5104 can deduce whether the surgical procedure being performed is a thoracic procedure or an abdominal procedure, which allows the surgical hub 5104 to use surgical stapling and severing instruments. It can be determined whether the tissue being clamped by the end effector is the lung (for thoracic surgery) or the stomach (for abdominal surgery). Surgical hub 5104 can then adjust the compression rate and load threshold of the surgical stapling and severing instrument appropriately for the tissue type.

As yet another example, the type of body cavity being operated on during an insufflation procedure can affect the function of the smoke evacuator. The context-aware surgical hub 5104 can determine if the surgical site is under pressure (by determining that the surgical procedure utilizes insufflation) and determine the procedure type. Because the procedure type is generally performed within a specific body cavity, the surgical hub 5104 can control the motor speed of the smoke evacuator appropriately for the body cavity being operated on. Accordingly, the context-aware surgical hub 5104 can provide a consistent amount of smoke evacuation for both thoracic and abdominal surgery.

As yet another example, the type of procedure being performed can affect the optimal energy level at which an ultrasonic surgical instrument or radio frequency (RF) electrosurgical instrument operates. For example, arthroscopic procedures require higher energy levels because the end effectors of ultrasonic surgical instruments or RF electrosurgical instruments are immersed in fluid. The context-aware surgical hub 5104 can determine whether the surgical procedure is an arthroscopic procedure. The surgical hub 5104 can then adjust the generator's RF power level or ultrasound amplitude (ie, “energy level”) to compensate for the fluid-filled environment. Relatedly, the type of tissue being operated on can affect the optimal energy level at which an ultrasonic or RF electrosurgical instrument operates. The context-aware surgical hub 5104 determines what type of surgical procedure is being performed and then customizes the energy levels of the ultrasonic or RF electrosurgical instruments, respectively, according to the expected tissue profile for the surgical procedure. can do. Additionally, the context-aware surgical hub 5104 may be configured to adjust the energy level of the ultrasonic or RF electrosurgical instrument over the course of the surgical procedure, not just on a procedure-by-procedure basis. The context-aware surgical hub 5104 determines which steps of the surgical procedure are being performed or are to be performed after which the generator and/or ultrasonic or RF electrosurgical instrument control algorithms are activated. It can be updated to set the energy level to a value appropriate for the expected tissue type according to the procedure of the surgical procedure.

As yet another example, surgical hub 5104 may draw data from additional data sources 5126 to improve the conclusions it draws from one data source 5126 . The context-aware surgical hub 5104 can augment the data received from the modular device 5102 with contextual information built about the surgical procedure from other data sources 5126 . For example, the context-aware surgical hub 5104 is configured to determine whether hemostasis has occurred (i.e., whether bleeding has stopped at the surgical site) according to video or image data received from a medical imaging device. obtain. However, in some cases the video or image data may not be deterministic. Thus, in one illustration, the surgical hub 5104 can communicate physiological measurements (eg, blood pressure sensed by a BP monitor communicatively connected to the surgical hub 5104) to the surgical hub 5104 (eg, It may be further configured to make a determination as to the integrity of the staple line or tissue weld compared to visual or image data of hemostasis (from a medical imaging device 124 (FIG. 2) coupled to the hemostat). In other words, the situational awareness system of surgical hub 5104 can consider physiological measurement data to provide additional context in analyzing visualization data. Additional context may be useful when visualization data may be inconclusive or incomplete on their own.

Another benefit is that it reduces the number of times medical personnel are required to interact with or control surgical system 5100 during the course of a surgical procedure. Certain steps include actively and automatically controlling paired modular devices 5102 . For example, the context-aware surgical hub 5104 can actively activate a generator to which an RF electrosurgical instrument is connected if it determines that a subsequent step in the procedure requires use of the instrument. By actively activating the energy source, the instrument can be ready for use as soon as the preceding steps of the procedure are completed.

As another example, the context-aware surgical hub 5104 anticipates that the surgeon will need to see if a current or subsequent step in the surgical procedure requires a different field of view or degree of magnification on the display. It can be determined according to the characteristic(s) at the surgical site to be performed. Surgical hub 5104 can then actively change the displayed field of view (eg, provided by the medical imaging device for visualization system 108) as appropriate so that the display remains 100% clear throughout the surgical procedure. will automatically adjust.

As yet another example, the context-aware surgical hub 5104 can determine which steps of a surgical procedure are being performed or are to be performed after that particular data or comparisons between data are necessary for that step of the surgical procedure. It can be determined whether Surgical hub 5104 may be configured to automatically invoke data screens based on the steps of the surgical procedure being performed without waiting for the surgeon to ask for specific information.

Another benefit includes checking for errors during surgical setup or during the course of a surgical procedure. For example, the context-aware surgical hub 5104 can determine whether the surgical site is properly or optimally set up for the surgical procedure to be performed. Surgical hub 5104 determines the type of surgical procedure being performed, retrieves (eg, from memory) the corresponding checklists, product locations, or setup needs, and then maps the current surgical site layout to the surgical Hub 5104 may be configured to compare to a standard layout for the type of surgical procedure determined to be performed. In one example, the surgical hub 5104 may store a list of items for the procedure scanned, for example, by a suitable scanner, and/or a list of devices paired with the surgical hub 5104 for a given surgical procedure. items and/or device's recommended or expected manifest. If there is a discontinuity between the listings, surgical hub 5104 may provide an alert indicating that a particular modular device 5102, patient monitor 5124, and/or other surgical item is missing. can be configured to In one illustration, surgical hub 5104 can be configured to determine the relative distance or position of modular device 5102 and patient monitor 5124 by, for example, proximity sensors. Surgical hub 5104 can compare the relative positions of the devices to the recommended or expected layout for a particular surgical procedure. If a discontinuity exists between layouts, surgical hub 5104 may be configured to provide a warning indicating that the current layout of the surgical procedure deviates from the recommended layout.

As another example, the context-aware surgical hub 5104 may indicate that the surgeon (or other medical personnel) has made a mistake or otherwise deviated from the required course of action during the course of a surgical procedure. can determine whether there is For example, the surgical hub 5104 determines the type of surgical procedure to be performed, retrieves (eg, from memory) a corresponding list of steps or sequences of instrument use, and then performs the procedure during the course of the surgical procedure. It may be configured to compare the steps or instruments being used with expected steps or instruments for the type of surgical procedure that surgical hub 5104 determined was being performed. In one example, surgical hub 5104 is configured to provide a warning indicating that an unexpected action has occurred or an unexpected device has been utilized at a particular step in a surgical procedure. obtain.

Overall, the situational awareness system for surgical hub 5104 coordinates surgical instruments (and other modular devices 5102) for the specific context of each surgical procedure (e.g., different tissue types). ), to improve surgical outcomes by validating behavior during surgical procedures. The Situational Awareness System also enables surgical intervention by automatically suggesting next steps, providing data, and coordinating displays and other modular devices 5102 within the surgical site according to the specific context of the procedure. Improves surgeon efficiency in performing procedures.

In one aspect, the modular device 5102 includes a combination energy instrument 213100 (FIG. 18), a surgical stapler 213102 (FIG. 18), an aspiration/irrigation device 213104 (FIG. 18), as described below with reference to FIGS. 18), sterile field display 213108 (FIG. 18), surgical device 213204 (FIGS. 19A and 19B), surgical evacuation system 50400 (FIG. 21), electrosurgical instrument 50630 (FIG. 22), evacuation system 50600 (FIG. 22). ), evacuation system 50900 (FIG. 23), scope 213501 (FIG. 25), and surgical device 213608 (FIG. 26). Thus, combination energy instrument 213100 (Fig. 18), surgical stapler 213102 (Fig. 18), aspiration/irrigation device 213104 (Fig. 18), sterile field display 213108 (Fig. 18), surgical device 213204 (Figs. 19A and 19B). , surgical evacuation system 50400 (FIG. 21), electrosurgical instrument 50630 (FIG. 22), evacuation system 50600 (FIG. 22), evacuation system 50900 (FIG. 23), scope 213501 (FIG. 25), and surgical device 213608 (FIG. 26) is configured to act as a data source 5126 and interact with database 5122 and patient monitor 5124 . Combination Energy Instrument 213100 (FIG. 18), Surgical Stapler 213102 (FIG. 18), Aspiration/Irrigation Device 213104 (FIG. 18), Sterile Field Display 213108 (FIG. 18), Surgical Device 213204 (FIGS. 19A and 19B), Surgical ejection system 50400 (FIG. 21), electrosurgical instrument 50630 (FIG. 22), ejection system 50600 (FIG. 22), ejection system 50900 (FIG. 23), scope 213501 (FIG. 25), and surgical device 213608 (FIG. 26). Modular device 5102 implemented as a device interacts with surgical hub 5104 to provide information (eg, data and control) to surgical hub 5104 and information (eg, data and control) from surgical hub 5104 is further configured to receive a

Referring now to FIG. 15, a timeline 5200 illustrating situational awareness of a hub such as, for example, surgical hub 106 or 206 (FIGS. 1-11) is shown. The timeline 5200 is an exemplary surgical procedure and contextual information that the surgical hubs 106, 206 can derive from the data received from the data sources at each step of the surgical procedure. Timeline 5200 is performed by nurses, surgeons, and other medical personnel during the course of a segmentectomy surgery, starting with setting up the surgical site and ending with transferring the patient to the post-operative recovery room. A typical step that might be taken is shown.

The context-aware surgical hub 106, 206 provides data throughout the course of a surgical procedure, including data generated each time a medical practitioner utilizes a modular device paired with the surgical hub 106, 206. Receive from source. The surgical hubs 106, 206 receive this data from paired modular devices and other data sources, and new data is received such as what steps of the procedure are being performed at any given time. Inferences (ie, contextual information) about the ongoing procedure can then be continuously derived. The situational awareness system of the surgical hub 106, 206 may, for example, record data regarding procedures to generate reports, verify steps being taken by medical personnel, collect data that may be relevant to a particular procedure step, or Provide a prompt (e.g., via a display screen), adjust the modular device based on context (e.g., activate a monitor, adjust the field of view (FOV) of a medical imaging device, or perform ultrasound surgical changing the energy level of the instrument or RF electrosurgical instrument), and any other such actions described above.

As a first step 5202 in this exemplary procedure, hospital personnel retrieve the patient's EMR from the hospital's EMR database. Based on selected patient data in the EMR, surgical hub 106, 206 determines that the procedure to be performed is a thoracic procedure.

In a second step 5204, personnel scan incoming medical supplies for treatment. The surgical hub 106, 206 cross-references the scanned supplies with lists of supplies utilized in various types of procedures to confirm that the mix of supplies corresponds to the thoracic procedure. In addition, the surgical hub 106, 206 can also determine that the procedure is not a wedging procedure (either the incoming product does not include the specific product required for a thoracic wedge procedure or otherwise (because it is either not compatible with wedge treatment).

In a third step 5206, medical personnel scan the patient's band via a scanner communicatively connected to the surgical hub 106,206. The surgical hub 106, 206 can then verify the patient's identity based on the scanned data.

In a fourth step 5208, the medical staff turns on the assistive device. The auxiliary devices utilized may vary with the type of surgical procedure and the technique used by the surgeon, but in this exemplary case they include smoke evacuators, inhalers, and medical imaging equipment. Upon activation, an auxiliary instrument that is a modular device can automatically pair with surgical hubs 106, 206 located within a particular proximity of the modular device as part of its initialization process. . The surgical hub 106, 206 can then derive contextual information about the surgical procedure by detecting the type of modular device paired with it during this preoperative or initialization phase. In this particular example, surgical hubs 106, 206 determine that the surgical procedure is a VATS procedure based on this particular combination of paired modular devices. Based on a combination of data from the patient's EMR, the list of medical supplies used in the surgery, and the type of modular device that connects to the hub, the surgical hubs 106, 206 are configured for the specific procedure to be performed by the surgical team. can be roughly estimated. Once the surgical hub 106, 206 knows what specific procedure is being performed, the surgical hub 106, 206 subsequently retrieves the steps for that procedure from memory or from the cloud and then retrieves the connected data source. Data subsequently received from (eg, the modular device and the patient monitor) can be cross-referenced to deduce which step of the surgical procedure the surgical team is performing.

In a fifth step 5210, personnel attach EKG electrodes and other patient monitoring devices to the patient. EKG electrodes and other patient monitoring devices can be paired with the surgical hub 106,206. Once the surgical hub 106, 206 begins receiving data from the patient monitor, the surgical hub 106, 206 confirms that the patient is at the surgical site.

In a sixth step 5212, medical personnel induce anesthesia in the patient. The surgical hub 106, 206 determines that the patient is under anesthesia based on data from the modular device and/or patient monitor including, for example, EKG data, blood pressure data, ventilator data, or combinations thereof. can be estimated. Completion of the sixth step 5212 completes the preoperative portion of the segmentectomy surgery and begins the surgical portion.

In a seventh step 5214, the lung of the patient being operated on is collapsed (while ventilation is switched to the contralateral lung). The surgical hub 106, 206 can, for example, deduce from the ventilator data that the patient's lung has collapsed. Surgical hub 106, 206 can compare the detection of a patient's lung collapse to the expected steps of the procedure (which can be accessed or read out in advance), thus allowing the surgical intervention of the procedure. Assuming that the segment has started, it can be determined that collapsing the lung is the first surgical step in this particular procedure.

In an eighth step 5216, a medical imaging device (eg, scope) is inserted and video footage from the medical imaging device is initiated. Surgical hubs 106, 206 receive medical imaging device data (ie, video or image data) through connections to medical imaging devices. Upon receiving the medical imaging device data, the surgical hub 106, 206 can determine that the laparoscopic portion of the surgical procedure has begun. Additionally, the surgical hub 106, 206 can determine that the particular procedure being performed is a segmentectomy as opposed to a lobectomy (based on the data received in the second step 5204 of the procedure). Note that wedging is already not considered by the surgical hubs 106, 206 on this basis). Data from the medical imaging device 124 (FIG. 2) is used (i.e., activated) by determining the angle at which the medical imaging device is oriented with respect to visualization of the patient's anatomy. , paired with the surgical hub 106, 206), and by monitoring the type of visualization device being used. Etc., can be used to determine contextual information about the type of treatment being performed in many different ways. For example, one technique for performing a VATS lobectomy places the camera above the diaphragm in the anterior inferior corner of the patient's thoracic cavity, while one technique for performing a VATS segmentectomy is to place the camera above the diaphragm. placed in the anterior intercostal position relative to the segmental cleft. For example, using pattern recognition or machine learning techniques, a situational awareness system can be trained to recognize the location of medical imaging devices based on visualizations of patient anatomy. As another example, one technique for performing VATS lobectomy utilizes a single medical imaging device, while another technique for performing VATS segmentectomy utilizes multiple cameras. As yet another example, one technique for performing a VATS segmentectomy utilizes an infrared light source (which may be communicatively coupled to the surgical hub as part of the visualization system) to visualize the segmental cleft. , which is not utilized in VATS lobectomy. By tracking any or all of this data from the medical imaging device, the surgical hub 106, 206 can be used for the specific type of surgical procedure being performed and/or the specific type of surgical procedure. technology can be determined.

At a ninth step 5218, the surgical team begins the incision step of the procedure. The surgical hub 106, 206 receives data from the RF or ultrasound generator indicating that the energy device is being fired, so presuming that the surgeon is in the process of cutting and separating the patient's lungs. can be done. The surgical hub 106, 206 cross-references the received data with the readout steps of the surgical procedure and is fired at this point in the process (i.e., after the previously-discussed steps of the procedure are completed). It can be determined that the energy device present is compatible with the lancing process. In certain examples, the energy instrument can be an energy tool attached to a robotic arm of a robotic surgical system.

At a tenth step 5220, the surgical team proceeds to the ligation step of the procedure. The surgical hub 106, 206 receives data from the surgical stapling and severing instrument indicating that the instrument has been fired, so it can be inferred that the surgeon is ligating the artery and vein. Similar to the previous step, the surgical hub 106, 206 can derive this estimate by cross-referencing the receipt of data from the surgical stapling and severing instrument with the read out steps in the process. . In certain examples, the surgical instrument may be a surgical tool attached to a robotic arm of a robotic surgical system.

In an eleventh step 5222, the segmental excision portion of the treatment is performed. The surgical hub 106, 206 can infer that the surgeon is transecting parenchyma based on data from the surgical stapling and cutting instrument, including data from its cartridge. Cartridge data may correspond, for example, to the size or type of staples being fired by the instrument. Since different types of staples are utilized with different types of tissue, the cartridge data can indicate the type of tissue being stapled and/or transected. In this case, the type of staple being fired is applied to parenchymal tissue (or other similar tissue types), which causes the surgical hub 106, 206 to assume that the segmentectomy portion of the procedure is being performed. be able to.

Subsequently, in a twelfth step 5224, a knot dissection step is performed. The surgical hub 106, 206 infers that the surgical team is incising the nodule and performing a leak test based on data received from the generator indicating RF or ultrasonic instruments are being fired. can be done. For this particular procedure, the RF or ultrasonic instruments utilized after the parenchymal tissue is transected correspond to the knototomy process, which allows the surgical hub 106, 206 to make this estimate. Become. Surgeons routinely combine surgical stapling/cutting instruments with surgical energy (i.e., RF or ultrasound) depending on the particular step of the procedure, as different instruments are better suited to specific tasks. Note alternating between instruments. Thus, the particular sequence in which stapling/cutting instruments and surgical energy instruments are used can indicate which step of the procedure the surgeon is performing. Further, in certain instances, one or more steps of the surgical procedure may be performed using robotic tools and/or one or more steps of the surgical procedure may be performed using hand-held surgical instruments. The surgeon(s) may, for example, alternate between robotic tools and handheld surgical instruments and/or may use the devices simultaneously, for example. Upon completion of the twelfth step 5224, the incision is closed and the post-operative portion of the procedure begins.

In a thirteenth step 5226, the patient's anesthesia is disabled. The surgical hub 106, 206 can deduce that the patient is emerging from anesthesia, for example, based on ventilator data (ie, the patient's breathing rate begins to increase).

Finally, a fourteenth step 5228 is for medical personnel to remove various patient monitors from the patient. Therefore, the surgical hub 106, 206 can assume that the patient is being transported to the recovery room when the hub loses EKG, BP, and other data from the patient monitor. As can be seen from this exemplary procedure description, surgical hubs 106, 206 may perform a given surgical procedure based on data received from various data sources communicatively coupled with surgical hubs 106, 206. can be determined or estimated when each step of is being performed.

In various aspects, combination energy instrument 213100 (FIG. 18), surgical stapler 213102 (FIG. 18), aspiration/irrigation device 213104 (FIG. 18), sterile field display 213108 (FIG. 18), surgical device 213204 (FIGS. 19A and 19B), surgical evacuation system 50400 (FIG. 21), electrosurgical instrument 50630 (FIG. 22), evacuation system 50600 (FIG. 22), evacuation system 50900 (FIG. 23), scope 213501 (FIG. 25), and surgical device. 213608 (FIG. 26) is configured to operate with contextual awareness within a hub environment, such as surgical hub 106 or 206 (FIGS. 1-11), for example, as shown in timeline 5200. FIG. Situational awareness is further described in U.S. Provisional Patent Application No. 62/659,900, filed April 19, 2018, entitled "METHOD OF HUB COMMUNICATION," which is incorporated herein by reference in its entirety. . In certain examples, operation of a robotic surgical system, including, for example, various robotic surgical systems disclosed herein, is based on its situational awareness and/or feedback from its components and/or from the cloud 104. can be controlled by the hub 106, 206 based on the information in the

ADAPTIVE CONTROL SCHEME AND INTERACTIVE SYSTEM CONTROL In various aspects, a computer system, such as, for example, a surgical hub computer system, revolves around the captured data to extract a deeper context, and then utilizes this deeper context. , may be configured to improve the display of actionable items for the operator. A deeper context is metadata in which data from different sources and/or data acquired at different times (e.g., before surgery, during surgery, after surgery) are combined to determine relationships and/or correlations. and data combinations. In one example, the context of the data may be informed by the Surgical Hub's situational awareness during a surgical procedure, which may include process-specific or time-limited adjustments and/or actions such as recommendations to clinicians. Items can be indicated. The system may be configured to implement an adjustable control scheme with interdependent control aspects. For example, the system can be configured to provide interactive system control for adaptive control schemes based on captured data.

In one aspect, the surgical hub or controls of a device connected to the hub can be configured to adjust its function (or cause its function to be adjusted) based on sensed conditions or usage. The function may set one or more thresholds (e.g., maximum power level limit and minimum power level limit) of surgical function, e.g., by adjusting the scale or degree of surgical function (e.g., power level or clamp force). By adjusting the operation of the resulting surgical function (e.g., changing the energy modality), by adjusting the type of measurement to affect the surgical function (e.g., from on-off activation). (up to variable activation under operator control) and/or by adjusting the complementary motion to the surgical function (eg, adjusting the clamping force based on the selected energy modality). Additional examples of adjustments to surgical function are described herein.

In one aspect, the type of measurement can vary between detecting and measuring the degree of on-off actuation, such as with strain gauges or Hall effect sensors. For example, an actuator for a surgical function functions as an on-off actuator in a first mode corresponding to a first surgical condition and as a degree-based actuator in a second mode corresponding to a second surgical condition. can do. A degree-based actuator may be configured to adjust, for example, the length and/or force of the firing stroke, the amount of closure and/or clamping force of the end effector, and/or the type and/or level of energy actuation. In one aspect, activation and/or deactivation thresholds are for precision-use surgical procedures or general-use surgical procedures, which may be signaled, for example, based on time in the procedure and/or by the system's situational awareness. can be adjusted based on

In one aspect, the Surgical Hub to prioritize visual presentation on a display within an operating room or surgical site of actionable contextual secondary information gleaned from data available during a procedure. can be configured. Prioritization can be based, for example, on certainty and/or importance of actionable information. In one aspect, activation or toggling icons of actionable information may include highlighting when the normal graphical interface is not highlighted. The display may be, for example, on the surgical device or the main display (eg, the display connected to the surgical hub).

In certain instances, a clinician may desire to use a surgical device for multiple surgical functions. For example, surgical devices can be used to coagulate blood vessels, cut tissue, and/or seal tissue. The control scheme of the surgical device can be adjusted to accomplish these different functions. For example, different power levels or thresholds can be used. Additionally or alternatively, different energy modalities (eg, ultrasound, bipolar, and monopolar) can be utilized. It may be desirable to switch between different surgical functions quickly and without resorting to complex controls over the surgical device and/or remote console. In certain instances, it may be desirable to perform such control scheme adjustments and adaptations with existing surgical devices and/or using surgical devices with minimal input controls, i.e., actuators. be.

In certain aspects, the surgical system can be configured to perform automatic switching of control based on conditions monitored within the procedure. A single input control or actuator can be utilized to provide different surgical functions. The available surgical functions operable on the input control may depend on the surgical step or condition of the surgical procedure. In various examples, a context-aware surgical hub or a surgical device connected to the hub can determine surgical steps and/or conditions from its contextual awareness. Accordingly, the system can be configured to adjust the device's control scheme based on the contextual awareness of the user's intent. In one example, in a first surgical condition (determined by surgical hub situational awareness), the power level of the transducer may be defined by a first range, and in a second surgical condition (surgical hub situation determined by recognition), the power level of the transducer may be defined by a second, different range. Additionally or alternatively, in a first surgical condition (determined by situational awareness of the surgical hub), the combination energy device can operate in a combination mode, and in a second surgical condition (determined by determined by the situational awareness of the surgical hub), the combination energy device can operate in ultrasonic mode without applying electrosurgical energy. Different surgical functions can be performed by a single actuator, which can include smart or intelligent actuators that gain information from the surgical hub's situational awareness.

In one aspect, a surgical device can include an actuator configured to receive an input. The surgical device is configured to receive a signal indicative of a surgical condition from the context-aware surgical hub, receive an actuation signal from the actuator in response to the input, and perform a surgical function in response to the actuation signal. and a control circuit. The surgical functions are a first surgical function when the surgical condition corresponds to the first surgical condition and a second surgical function when the surgical condition corresponds to the second surgical condition. , can include The second surgical condition can be different than the first surgical condition and the second surgical function can be different than the first surgical function. In another aspect, a non-transitory medium storing computer readable instructions, when executed, causes a machine, such as an intelligent surgical device, to receive a signal indicative of a surgical condition from a context-aware surgical hub and perform a surgical procedure. An actuation signal may be received in response to an input applied to an actuator of the device, and a surgical function may be performed in response to the actuation signal. The surgical functions are a first surgical function when the surgical condition corresponds to the first surgical condition and a second surgical function when the surgical condition corresponds to the second surgical condition. , can include The second surgical condition can be different than the first surgical condition and the second surgical function can be different than the first surgical function. Adjustments and adaptations of alternative control schemes are further described herein.

As further described herein, the functions of the controls, e.g., actuators, can be transferred to secondary controls of other instruments, surgical steps, and/or surgical devices currently in use in the surgical field. may be adjusted based on one or more factors, including the input of . As further described herein, such factors can be determined, at least in part, from situational awareness.

In some applications, the degree of displacement of an actuator of a surgical device and/or the input force applied to the actuator can affect the power (eg, amplitude) limits of the surgical device. Referring now to FIG. 16, the energy device 213000 can include a first actuation button 213002 and a second actuation button 213004. As shown in FIG. In various examples, a first actuation button 213002 can correspond to a first power level and a second actuation button 213004 can correspond to a second power level. For example, a first actuation button 213002 can have a higher or maximum power level that can correspond to a cutting mode, and a second actuation button 213004 can correspond to a coagulation mode. , lower or minimum power levels. In such examples, the first actuation button 213002 can be referred to as the "cut button" and the second actuation button 213004 can be referred to as the "coagulation button."

The actuation buttons 213002, 213004 can have a spring-biased aspect that allows the actuation buttons 213002, 213004 to act as on-off switches and also to detect the force applied by the operator to the actuation buttons. In one aspect, the actuation buttons 213002, 213004 have a first or normal actuation that occupies a certain portion of the button's range of motion and a second or altered actuation that occupies another portion of the button's range of motion. be able to. For example, the first 70-80% of the button's range of motion can provide energy activation, and the remaining portion of the button's range of motion can regulate the energy level. In such an example, if the clinician compresses either of the actuation buttons 213002, 213004 further by overcoming the higher biasing force, the buttons will change function and only apply cutting or coagulating energy levels. power level can be increased from the level set on the generator without For example, the power level can be increased by one level as the activation button moves to the rest of the button's range of motion. In this operation, high force actuation acts to activate the energy and increase the power level of the energy.

In one aspect, the surgical functions controlled by the actuation buttons 213002, 213004 may depend on the position of the end effector 213006 and/or the closure trigger 213008. For example, with further reference to FIG. 16, movement of closure trigger 213008 through a first range of motion (ie, over a first angle θ ₁ ) causes end effector 213006 to close a first amount, a first distance a. can bring Movement of the closure trigger 213008 through a second range of motion (ie, over a second angle θ 2 ₂ ) can cause the end effector 213006 to close a second amount, a second distance b. In a particular example, the first amount can correspond to closing movement of jaws 213010, 213012 and the second amount can correspond to clamping movement of jaws 213010, 213012. The first jaw 213010 can be a clamp arm, which in certain examples can move relative to the second jaw 213012 . In other examples, only the second jaw 213012 and/or both jaws 213010, 213012 can be moved by the closure trigger 213008 to close and/or clamp the end effector 213006.

First actuation button 213002 and/or second actuation button 213004 can perform different surgical functions based on the position of closure trigger 213008 and/or clamp arm 213010 . For example, if the actuation button 213002, 213004 is activated while the jaws 213010, 213012 of the end effector 213006 are between the fully open threshold and the partially closed threshold (e.g., 2/3 of the total closed range is closed), actuation Buttons 213002, 213004 can have respective first energy levels. Further, if the jaws 213010, 213012 are moved beyond the partial closure threshold (e.g., beyond 2/3 closure), the first and second actuation buttons 213002, 213004 activate their respective second energy levels. can have The second energy level of each button 213002,213004 may be higher than the corresponding first energy level of the respective activation button 213002,213004. The energy level may be higher as the jaws 213010, 213012 are closed further, eg, when the jaws 213010, 213012 actively clamp tissue between them.

A pair of graphs 213020, 213022 showing jaw closure and transducer amplitude versus trigger angle (θ) for energy device 213000 are shown in FIG. Referring to graph 213020, the control algorithm of energy device 213000 is configured to adjust the amplitude of the ultrasound transducer according to the trigger angle (θ), the degree to which closure trigger 213008 (FIG. 16) is depressed. The amplitude can be adjusted with one or more thresholds, such as the trigger angle threshold 213024 shown in FIG.

More specifically, during a first range of motion of the closure trigger 213008 (eg, over a first trigger displacement angle θ ₁ ), the first actuation button 213002 activates energy at a first maximum threshold Max _a . and a second activation button 213004 can activate energy at a first minimum threshold Min _a . During a second range of motion of the closure trigger 213008 (eg, over a second trigger displacement angle θ ₂ ), the first actuation button 213002 can activate energy at a second maximum threshold Max _b ; 2 activation button 213004 can activate energy at a second minimum threshold Min _b . In the illustrated graph 213022, the first minimum threshold Min _a differs from the second minimum threshold Min _b , and the first maximum threshold Max _a differs from the second maximum threshold Max _b . More specifically, the first minimum threshold Min _a is less than the second minimum threshold Min _b and the first maximum threshold Max _a is less than the second maximum threshold Max _b .

As shown in FIG. 17, the first minimum threshold Min _a constitutes 30% of the transducer amplitude limit and the second minimum threshold Min _b constitutes 75% of the transducer amplitude limit. In addition, the second maximum threshold Max _b constitutes 100% of the transducer amplitude limit and the first maximum threshold Max _a constitutes only 40% of the transducer amplitude limit. Other thresholds are possible. For example, the second minimum threshold Min _b may be less than the first maximum threshold Max _a .

In still other examples, the first minimum threshold Min _a may be greater than the second minimum threshold Min _b and/or the first maximum threshold Max _a may be greater than the second maximum threshold Max _b . good too. In yet another example, if the trigger displacement angle exceeds the trigger angle threshold 213024, only one of the limits can be adjusted. For example, the second actuation button 213004 can maintain a first minimum threshold Min _a during the entire range of motion of the closure trigger 213008, including angles θ ₁ and θ ₂ . In other words, regardless of the position of the first jaw 213010 and/or the closure trigger 213008, the amplitude of the transducer when the second actuation button 213004 is pressed can be maintained at 30%. Additionally or alternatively, one or more of the limits can be adjusted with additional trigger angle thresholds.

Referring now to graph 213020, the closure speed of closure trigger 213008 may also be adjusted based on the detected surgical condition and/or surgical process. For example, the closure trigger 213008 may be closed at a first rate during a first range of motion over a first trigger displacement range θ ₁ , and the closure trigger 213008 may be closed at a second speed over a second trigger displacement range θ ₂ . It can be closed at a second speed during the range of motion. More specifically, the first velocity corresponding to slope a/area A may continue until closure trigger 213008 crosses trigger angle threshold 213024 . In the illustrated configuration, trigger angle threshold 213024 corresponds to 75% end effector closure. In other examples, the trigger angle threshold 213024 may define, for example, less than 75% or greater than 75% end effector closure, eg, 2/3 closure and/or 90% closure. Once the trigger angle threshold 213024 is reached, the closing speed can be increased to the second speed in zone B until the closing trigger 213008 is 100% closed. In another example, the closing speed can be decreased when the trigger angle threshold 213024 is reached. Additionally or alternatively, the closing speed may be adjusted with additional trigger angle thresholds.

In various examples, the position of the closure trigger 213008 can indicate the surgical state of the surgical procedure. For example, the closure trigger 213008 may remain open during a first surgical procedure, may be closed to a first degree during a second surgical procedure, and may be closed to a first degree during a third surgical procedure. It may be closed to a degree of two. For example, open jaws can be used to cauterize blood vessels, partially closed jaws can be used to coagulate tissue, and/or fully closed jaws can be used to cut tissue. can do. By monitoring the position of the closure trigger 213008, the control circuit determines the surgical condition and/or process and, based on the detected condition and/or process, the surgical function of the device connected to the hub, i.e. configured to regulate power levels; Situational awareness can further inform the decision. For example, during certain types of surgical procedures and/or when treating certain types of tissue, the maximum and/or minimum threshold(s) and/or trigger angle threshold(s) are first may be adjusted in a way that the maximum and/or minimum threshold(s) and/or trigger angle threshold ( ) may be adjusted in a second manner. For example, lung tissue and stomach tissue may require different responses. Additionally or alternatively, arteries and veins may require different thresholds. Situational awareness can determine surgical procedure and/or tissue type.

In various examples, one or more controls and/or actuators of the surgical device may be adjusted based on another control/actuator on the surgical device. Activating a first control/actuator can cause a second control/actuator to have coordinated functionality. Referring again to FIG. 16, for example, if the jaws 213010, 213012 of the energy device 213000 are wide open and energy is activated via one of the activation buttons 213002, 213004, the surgical system will, for example, is about to use the instrument in a first surgical function, such as a posterior cut, or otherwise determine it. Accordingly, the minimum power level and maximum power level (eg, amplitude) can be set to normal levels for the first surgical function. When the jaws 213010, 213012 of the energy device 213000 are more than half open, the energy activation button(s) 213002, 213004 can only activate the ultrasonic response. However, when jaws 213010, 213012 are more than half closed, energy device 213000 can function in a standard combined ultrasound-electrosurgical mode. As yet another example, the jaws 213010, 213012 of the energy device 213000 are fully clamped at the highest level of compression when ultrasonic energy is being applied and the user can hold the maximum energy activation button 213002 actuated. , the energy modality can automatically shift from ultrasound to electrosurgical RF if more pressure is required via the closure trigger 213008 and the energy device 213000 applies at the clamping jaws 213010. The applied pressure can be further increased.

In one aspect, the controls can be adjusted according to other instruments currently in use at the same surgical site. For example, if the secondary energy device is within the field of view (e.g., the field of view of the scope) and a predetermined sequence of keys and/or control actuators has been actuated, the surgical hub will control the primary energy device as well. It can be adjusted within the field of view. In one example, when the closure trigger and energy button are actuated on the primary energy device and the secondary device is within the field of view, the secondary energy device's scalable adjustment control is used to adjust the power level of the primary energy device. can be controlled. In such instances, a control on the secondary energy device may be used to increase or decrease the intensity of the generator powering the primary energy device. Such remote control of surgical functions may be enabled only when predetermined sequences of surgical acts are performed and/or only during certain steps of a surgical procedure in various instances. can.

In another example, abutment or contact between surgical devices can allow one of the surgical devices to adjust the controls of the other surgical device. For example, if a second surgical device is in contact with a first surgical device, the particular action or combination of actions performed by or on the second surgical device is , a control algorithm to regulate the functioning of the first surgical device. For example, when the jaws of the second surgical device are in the fully open configuration, the jaws can depress an activation button on the first surgical device and then adjust the adjustment on the second surgical device. The controller can be used to change the power level of the first surgical device, such as the power provided by the generator, for example. Once the desired level is set, the second surgical device may be removed from contact with the first surgical device. The first and second surgical devices can then operate as normal devices at the newly set power levels. In one example, the continuity sensor can be configured to detect contact between surgical devices.

In one aspect, the control of the surgical device may be adjusted according to the steps of the surgical procedure being performed. Situational awareness can inform the surgical hub of current and/or next steps in a surgical procedure. For example, based on previous surgical actions and/or sequence of use of the surgical device(s) and/or generator(s), the surgical hub may determine whether the procedure is currently a knotectomy step, a vessel transverse It can be determined which particular step of a particular surgical procedure is being performed, such as whether it is in a cutting step or otherwise. If the Surgical Hub determines that the energy device being used is in fine dissection mode, the system will set the function of the energy device button to a different setting (e.g., a lower power setting for use in this procedure step). can be automatically adjusted to In one implementation, the surgical hub and/or generator can determine procedure-specific steps or context.

In another implementation, the system provides procedure-specific Processes or contexts can be learned and predicted. In such a learning mode, the generator, in one aspect, does not pre-implement any automatic tuning into the controller. Rather, after monitoring the same clinician's behavior over a predetermined number of procedures involving the same steps, the surgical device automatically modifies button usage based on monitored and past usage by the clinician. can do. In various examples, the surgical device can send notifications to the clinician when the functions of the controls are adjusted. For example, the surgical device may provide audible notifications (e.g., beeps or verbal clarifications), visual cues (e.g., flashing lights and/or words on a screen), and/or tactile alerts (e.g., vibration of the surgical device). and/or movement or part of the surgical device, such as the actuator button itself). In other examples, the surgical hub can recommend adjustments to the controls. Recommendations from surgical hubs are further described herein.

In various aspects, controls of surgical hubs, surgical instruments, and other devices may be adjusted based on the screen running on the sterile field display. Controls of the surgical device may be adjusted based on the displayed information. In one aspect, the controls that normally control the panning of the visualization device (e.g., scope) or adjustment of the focus of the visualization device can be configured to adjust magnification when, for example, a hyperspectral imaging overlay is active. Hyperspectral imaging is disclosed in U.S. patent application Ser. No. 15/940, filed March 29, 2018, entitled "CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OF MONO-CHROMATIC LIGHT REFRACTIVITY," the entire contents of which are incorporated herein by reference. , 722.

As another example, controls on the handle of a surgical instrument within the field of view of the sterile field display can be adjusted by selection on the sterile field display. Further, adjustments can be based on situational awareness in various examples. For example, the system determines that a particular surgical device is being utilized and that the system allows the functionality of that surgical device to be controlled from a second device, such as a display screen within the sterile field. be able to. Referring now to FIG. 18, a surgical procedure involving combination energy instrument 213100, surgical stapler 213102, aspiration/irrigation device 213104, and sterile field display 213108 is shown. Combination energy device 213100 includes a single energy button 213110 configured to implement different energy modalities. For example, combination energy device 213100 can operate in bipolar mode, monopolar mode, ultrasonic mode, and/or various combinations thereof (eg, mixed mode). In one example, combination energy device 213100 can operate in monopolar-bipolar mode. In another example, the combination energy device 213100 can operate in ultrasonic bipolar mode, and in yet another example, the combination energy device can operate in ultrasonic monopolar mode. Various energy modalities can be applied sequentially and/or mixed simultaneously.

In one aspect, the controls on the handle of the surgical instrument within the field of view of sterile field display 213108 can be adjusted by selection on sterile field display 213108 . For example, combination energy instrument 213100 includes a single button 213110 that can be configured to apply energy to selectively cut and coagulate tissue. The energy modality activated by button 213110 can be adjusted by selection on sterile field display 213108 .

In one aspect, the energy-activated button 213110 changes or otherwise indicates when the sterile field display 213108 is being used to change the function of the button 213110 and/or the sterile field display 213108 is shared with the button 213110. Having controls can have indicators. For example, the combination energy device 213100 can change color and/or otherwise change its appearance when adjusted from a secondary device, such as the sterile field display 213108 (e.g., energy activation button 213110 and/or illuminated with flashing and/or pulsed lights) on the handle and/or the energy activated button 213110 itself. In one example, the button 213110 can have a normal red hue projected through the light channel from the multi-colored LED to represent the cutting function, and a blue hue projected from the multi-colored LED to represent the coagulating function. It can be projected through an optical channel. Button 213110 that was red may change to purple when sterile field display 213108 changes surgical function to mixed energy modality, for example. In various examples, the interface areas on the sterile field display 213108 also correspond to indicate that the functions between the controls displayed on the surgical field display 213108 and the combination energy device 213100 are linked. A color indicator (eg, a purple word and/or highlighting if the button 213110 is illuminated with a purple hue) may be included.

Various surgical instruments can be controlled in different ways, depending on the number and type of buttons/actuators thereon and the desired surgical function of the surgical instrument. For example, if the surgical instrument includes two buttons (eg, a first button corresponding to a first power level suitable for coagulation and a second button corresponding to a second power level suitable for cutting). , sterile field display 213108 may be configured to coordinate the functions of the first and second buttons. For example, one of the buttons may be utilized to activate monopolar energy, while the other button may be configured to activate mixed energy. In such examples, the buttons change when the sterile field display 213108 is being used to change the functionality of the buttons and/or an indicator that the sterile field display 213108 has shared control of the buttons. (eg, colored LEDs). The indicator can convey the energy modality selected and/or how the energy modality was selected. For example, a first button may include a red hue LED and a second button may include a blue hue LED. If the first button is configured to activate the mixed energy modality, the red hue LED may become purple hue. Additionally, the interface area on the sterile field display 213108 can include a purple indicator.

In various examples, the sterile field display 213108 can allow the clinician to toggle the functionality of the buttons on the handle of the combination energy device 213100. In such an example, the colors of the two buttons may be reversed. In another example, the function of buttons can be changed. For example, the second button (e.g., previously associated with a power level suitable for cutting tissue) can be changed to an energy-activated button (e.g., previously associated with a power level suitable for coagulating tissue), The first button (which corresponded to the appropriate power level) can be changed to a power level adjustment control. In such an example, the sterile field display 213108 can indicate the newly selected power level each time the power level adjustment control is activated. For example, the sterile field display 213108 can utilize blinking icons to indicate changes in generator power level. A second button activation (now functioning as an energy activation button) can then be used to activate and deactivate energy at the newly set power level.

In yet another example, button 213110 and/or other buttons on combination energy device 213100 may be changed from on-off activation functionality to pressure-sensitive activation functionality. For example, a higher level of force applied to button 213110 may be configured to increase the intensity of energy activation, such as by increasing the power level based on the force applied to button 213110 . Additionally, the sterile field display 213108 can be used to change the individual on/off functionality of buttons 213110 to pressure sensitive adjustment functionality. Additionally, the sterile field display 213108 and button(s) 213110 may utilize different indications when the power level is changed. For example, the intensity of light emitted from the button(s) may change as the pressure sensitive activation adjusts the power level of the combination energy device 213100 . Additionally, the sterile field display 213108 can show colors synchronized with the colors of the buttons 213110 to indicate current functionality and pairing.

In various examples, a surgical hub can be configured to provide recommendations to a clinician during a surgical procedure. For example, a surgical hub can aggregate data from multiple sources to determine a recommended surgical action. In various examples, recommendations can be based on the surgical hub's situational awareness. The relevance or importance of recommendations may depend on the surgical context or scenario. For example, general recommendations may be stepped up to higher levels based on data obtained by various data sources and/or sensors. Surgical hubs can aggregate a substantial amount of information, so it is recommended for clinicians to avoid overloading them with too much data at any given time. Prioritization can be useful. For example, if the clinician is constantly interrupted by recommendations (some or many of which are irrelevant and/or not useful), the clinician may ignore the hub's recommendations entirely and/or You may disable the recommended settings for your hub. By prioritizing recommendations based on situational awareness, the clinician can be well informed regarding actionable and/or time sensitive items.

In various instances, the importance of recommendations may depend on the location of the surgical device. For example, operable aspects can be highlighted or emphasized to the clinician. Additionally, non-enabled and/or non-critical aspects may be separately displayed and/or selectively hidden from view. If the location of the surgical device indicates that the recommendation is actionable by the clinician, the surgical hub may highlight the recommendation, while recommendations that are not actionable may be displayed more individually, and/or may be selectively hidden from view. In such instances, actionable recommendations are selectively communicated to the clinician, thereby enabling the clinician to consider the value of such recommendations in a timely manner.

In various examples, for example, a surgical system can include a screen configured to selectively display recommendations to a clinician in an operating room. The surgical system can also include a control circuit communicatively coupled to the screen and a context-aware surgical hub, the control circuit receiving a signal indicative of a surgical condition from the context-aware surgical hub. , is configured to determine a priority level of recommendation based on the surgical condition and communicate the priority level of recommendation via the display. In various examples, the control circuit comprises a processor and a memory communicatively coupled to the processor, the memory storing instructions, the instructions being used by the surgical hub to context-aware a signal indicative of a surgical condition. determining a priority level of the recommendation based on the surgical condition; and communicating the priority level of the recommendation via the display. In various examples, the non-transitory computer readable medium stores computer readable instructions that, when executed, provide a machine, such as an intelligent surgical device, with a context-aware surgical hub that indicates a surgical condition. to determine a priority level of recommendations based on surgical conditions and to communicate the priority level of recommendations via a display.

In various aspects, the surgical system may be configured to notify the clinician when certain aspects of the contextual information are enabled. For example, FIGS. 19A and 19B illustrate input from a context-aware surgical hub such as surgical hub 106 (FIGS. 1-3) or surgical hub 206 (FIG. 10) or surgical hub 7006 (FIG. 12). Shown is a display screen 213200 containing recommendations 213202, 213202' for clinicians based on. In various examples, display screen 213200 includes a user interface overlay on display screen 213200 that provides context-sensitive recommendations. For example, the surgical system may highlight data feeds with actionable icons to indicate that the underlying contextual information has actionable aspects. In various examples, a recommendation feed may always be present, but recommendations are highlighted only if they are actionable. Recommendations may be emphasized by, for example, highlighting, blinking, and/or marking. In another example, the recommendation feed is displayed only if it contains actionable items.

As shown in FIG. 19B, recommendation 213202' is highlighted to indicate a high priority level based on the expected surgical action and input from the context-aware surgical hub. More specifically, in FIG. 19A, surgical device 213204 is shown in a first position generally proximate diseased area 213206 of lung 213208 . In FIG. 19B, surgical device 213204 is moving toward lesion area 213206 . Based on the trajectory of the surgical device 213204 and/or the position of the surgical device 213204, the surgical system determines that the recommendation 213202 from FIG. Recommendation 213202' can be highlighted. In other words, changes in the position of surgical device 213204 change the confidence of context-based recommendations. A high confidence level corresponds to a high priority level for recommendation 213202'.

An actionable aspect or actionable item may, in certain instances, be the modification of an instrument function parameter selected by a user. For example, if fragile tissue is detected by the system, the system can recommend adjustments to protect the tissue. In one example, the surgical system can recommend reducing the target clamping load of the stapler. Additionally or alternatively, the surgical system can recommend the use of surgical support materials such as, for example, buttresses or tissue thickness compensators. As another example, if the system detects co-morbidities and mendicants, e.g., patient co-morbidities that affect healing, the system will allow the user to adjust compression latency and utilize adjuncts. and/or to instruct or suggest the use of smaller staples.

In one aspect, an enabling aspect may be the automatic overlay of procedure-critical information during device placement. For example, referring again to FIGS. 19A and 19B, display screen 213200 is configured to label and/or call out lesion areas 213206 and/or nodules near the surgical device. In various aspects, automatic features can be toggled on and off according to user preferences. Similarly, the recommendation feed can be toggled between on and off. In various examples, recommendations are displayed only when they are feasible and/or when they are elevated to a priority level above a predefined threshold pre-programmed and/or adjusted by the operator. obtain.

In one aspect, the system may be configured to highlight data feeds that have a direct impact on the current surgical process or action. Relevant data within a surgical context can affect how a clinician performs one or more of the subsequent functional tasks. For example, data feeds related to blood pressure readings may be highlighted in certain instances, such as when blood pressure readings are abnormally high or low. Abnormally high or low blood pressure can affect how clinicians use energy devices to perform large vessel transections. Thus, in various examples, blood pressure data can be highlighted when situational awareness indicates that the clinician is preparing to perform a transection. As another example, the system can be configured to monitor the return path link to the patient. For example, if the return path link is restricted and a monopolar electrosurgical instrument is being utilized for dissection or mobilization, the return path link data can be highlighted for the clinician.

In yet another embodiment, the near-infrared (NIR) fluorescence of indocyanine green (ICG) imaging is determined by situational awareness and/or contextual cues detected by one or more sensors at the surgical site. Possible items may be highlighted based on them. NIR fluorescence can be used to visualize, for example, anatomy, perfusion and perfusion defects, and the lymphatic system. Due to the high penetration depth of NIR light, the distribution of ICG can be visualized to depths of less than 10 mm below the tissue surface. In liver surgery, the system can be used to visualize liver metastases or primary tumors in the liver. Exemplary uses include:
Visualization of perfusion (so that the ischemic area can be more easily and efficiently displayed in real-time and/or perfusion can be checked, for example at an anastomosis, so that the surgeon can intraoperatively for rapid perfusion assessment of the resected area and for rapid perfusion assessment of subsequent anastomoses, e.g. movement), visualization of liver segments, and interdisciplinary use in laparoscopic, endoscopic, and open surgery;
Visualization of the anatomy of the biliary system, which allows rapid and reliable identification of the anatomy of the gallbladder, e.g. in cholecystectomy, reduces surgical duration and Not only is it easier to distinguish from the bile duct, intraoperative bile leakage can be displayed on the ICG, e.g. after partial hepatectomy;
Visualization of hepatocellular carcinoma and metastases, including intraoperative visualization of hepatocellular carcinoma and metastases on or below the surface of the liver, diagnosis of micrometastases down to the millimeter range at or near the surface, easier resection margins and visualization of the lymphatic system (which, for example, allows real-time visualization of the entire tumor-draining lymphatic system and avoids nuclear medicine imaging, with a detection rate of Comparable to established methods of lymph node visualization), localization of lymphatic leakage, interdisciplinary use in e.g. gynecology, urology, and general surgery.

NIR/ICG visualization can be provided, for example, by the OPAL1® technology from KARL STORZ, which is described, for example, at www. karlstorz. com/ie/en/nir-icg-near-infrared-fluorescence. It is described in htm. NIR/ICG data may also be emphasized or highlighted to the clinician when visualization is important to how the surgeon performs subsequent steps based on situational awareness and anticipated surgical steps. good.

In another embodiment, the surgical system performs alternative imaging or imaging when the surgical system detects that the imaging or analysis system is detecting something related to the current step or current task of the surgical device. It can be configured to highlight the analysis system. For example, the system can highlight a Laser Doppler Scanned Array feature when a dissecting instrument is about to intersect a critical vessel or underlying structure. As another example, the system may highlight computed tomography (CT) imaging when the stapler appears to be placed within the limits of the marginal tissue area. Various recommendations to the clinician can be communicated on the display screen within the sterile field. In various examples, one or more recommendations are further provided with audible and/or tactile presentation in the sterile field, such as verbal alerts and/or beeps when the recommendations are actionable and/or time dependent. can be emphasized.

In various examples, a recommendation can be made when the recommendation can be made within a predetermined time and/or number of surgical steps. For example, a recommendation may be actionable if it is performed within the next few minutes (eg, 1-2 minutes) of treatment. In certain instances, a recommendation may be actionable if it is performed, for example, within 5, 10, or 30 seconds following treatment. The time frame can be determined, for example, by the reaction skills of the clinician. In certain examples, a first type of emphasis for recommendations may be provided at a first time, and a second type of emphasis provided later if the recommendations are more time sensitive/urgent. may be In yet another example, recommendations may be provided when related to the predicted next surgical procedure based on the clinician's situational awareness. In other examples, recommendations may be provided in two steps before they should be implemented. The reader will appreciate that various time-based and process-based settings for actionable recommendations may be pre-defined and/or adjusted by the clinician and/or operator. In certain instances, actionable recommendations may be required, such as during a surgical training session, for example. In other examples, the actionable recommendations may be optional and/or customizable by the clinician.

In various aspects, a surgical system can be configured to implement a data bridge for clinicians. Various techniques are described herein for interfacing data in a surgical hub to a display for use by a clinician. For example, intraoperative surgical data can contribute to the implementation and tracking of postoperative care metrics.

FIG. 20 shows a block diagram 213300 showing intra-operative surgical data 213302 being correlated with expected outcomes 213304 and corresponding recommendations 213306 being provided. For example, intra-operative surgical data 213302 may be correlated with previous results to determine expected outcome 213304 based on intra-operative surgical data 213302 to provide clinician(s) with primary concerns, recommendations, and inform potential best practices. In addition, intraoperative surgical data 213302 can be correlated with previous case history to predict outcomes for care metrics flagged by operators or organizations such as hospitals or medical systems. Predicted outcomes 213304 based on data correlation include, for example, patient length of stay, readmission rate, reoperation rate, time to chest tube removal, time to colonic movement, and insurance number, type, and extent , or other clinically coded events (eg, bleeding-related complications, ICD-9 or ICD-10 codes corresponding to blood transfusions, etc.). Additionally, intra-operative data sets can, in some aspects, cover all available primary and secondary data sources from the procedure (eg, EMR, situational awareness learning, video, etc.).

Block diagram 213300 refers to a low anterior resection (LAR) procedure when the tumor is located deep in the patient's pelvis. Emission information that can be obtained from video and/or various sensors, for example, indicates sub-optimal margins, which corresponds to an increased likelihood of cancer recurrence. The launch information also indicates that the colon is under considerable tension, corresponding to an increased risk of leakage. Furthermore, the launch information indicates that the launch line is not vertical, which corresponds to increased time to colonic mobility. Intraoperative Surgical Data 213302 also monitors procedure time. In the example of Figure 20, the procedure time is characterized as "extremely long" with extensive incisions and considerable colonic manipulation. These factors also combine to address an increased likelihood of cancer recurrence. The data bridge may also capture additional data such as, for example, drugs delivered and/or patient demographics, which may further accommodate various expected outcomes and/or co-morbidities. . Based on the various predicted outcomes 213304, the Surgical Hub may provide various recommendations for post-operative care, such as aggressive oncology follow-up treatment, rectal drain placement, increased dietary restrictions, and hospital cost analysis. can. Expected length-of-stay (LOS) can provide information regarding hospital bed allocation and/or requirements.

In various aspects, the surgical system can be configured to detect the motion, velocity, acceleration, and/or orientation of elements such as particulate matter and/or aerosol particles within the scope's field of view (FOV), for example. By detecting one or more of these characteristics, the surgical system can increase the depth of data that can be extracted during a surgical procedure and/or provide insight into aspects of the surgical procedure for the clinician. can be clarified. For example, the system may be configured to determine active actionable events for the clinician's attention.

Fluid flow characteristics at the surgical site may be an actionable item or an indicator of adjustment for the surgical hub and/or clinician. Fluid streams include, for example, streams of smoke, insufflation fluid, blood, contrast agents, and/or dyes. In various examples, fluid flow characteristics may correspond to different surgical events, such as increased fuming during energy therapy, bleeding detection, perfusion assessment, and/or anastomotic leak detection. Recommendations can be provided based on actionable items determined by the detected property or properties of the fluid flow. However, without detecting and/or monitoring one or more characteristics of the fluid flow, it can be difficult to determine various actionable items and corresponding recommendations.

In various examples, by detecting and/or monitoring one or more fluid flow characteristics, increased data depth can be derived for analysis by the surgical hub. As a result, actionable items can be identified and/or conveniently identified, and corresponding recommendations can be timely provided and/or implemented. In certain examples, the surgical hub may automatically perform adjustments and/or notify the clinician of actionable items.

In one aspect, a surgical system includes a sensor configured to detect characteristics of airborne particles in a fluid within an abdominal cavity of a patient; a surgical device configured to perform a surgical function; and a memory communicatively coupled to the sensor, the control circuit communicatively coupled to the sensor and the surgical device. A control circuit may be configured to receive an input signal from the sensor indicative of a property of airborne particles in the fluid and, in response to the input signal, provide an output signal to the surgical device indicative of an adjustment to the surgical function. Surgical systems can be configured, for example, to detect airborne particulates and aerosols within insufflation gas within the body (eg, the abdomen). In one aspect, detection methods include, for example, optical methods, laser refraction methods, ultrasound methods, and/or magnetic resonance methods. In one aspect, functional adjustments include, for example, affecting generator power levels, space ventilation, degree of smoke evacuation, degree of filtration, and/or application of a secondary condenser to induce condensation. can be mentioned. In one aspect, the adjustment involves proportionally increasing systems that were already active, adding a second effect or function to systems that were already active, and/or completely swapping one operation or function to another system. can bring you out. Various adjustments are further described herein.

Detecting one or more characteristics of fluid flow at the surgical site can involve one or more measurement systems and/or methods as further described herein. For example, optical measurement systems and/or ultrasonic measurement systems can be employed. The optical measurement system may be, for example, Laser Doppler Velometry (LDV) or Laser Doppler Flowmetry (LDF), Particle Image Velocimetry (PIV), and/or Indocyanine Green, as further described herein. (ICG) near-infrared (NIR) fluorescence. Ultrasound measurement systems include, for example, non-contact pass-through ultrasound detection and non-contact reflected ultrasound detection, which are also described further herein. Various techniques for detecting and/or imaging particle streams include smoke detection and emission control, aerosol and particulate differentiation, hemorrhage detection, perfusion assessment to identify anatomical structures, dye identification, disrupted It can be employed in many surgical applications, such as discriminating surface reflections on surfaces and identifying flowing, leaking, and/or exuding fluids on surfaces. Various surgical applications are further described herein.

LDVs, often referred to as LDFs in clinical or medical applications, use the Doppler shift in a laser beam to measure the velocity of transparent or translucent fluid streams and/or the linear or oscillatory motion of opaque reflective surfaces. Technology. In one example, two beams of collimated, monochromatic and coherent laser light traverse the fluid flow to be measured. Two beams are usually obtained by splitting a single beam, thereby ensuring coherence between the two beams. Lasers with wavelengths in the visible spectrum (390-750 nm), such as He--Ne, Argon-ion, and/or laser diodes, can be used so that the beam path can be observed. In other examples, wavelengths outside of the visible spectrum can be utilized to avoid, for example, distracting the clinician and/or interfering with other imaging/visualization systems. A transmissive optical element focuses the two beams so that they intersect at the focal points of the beams. Intersecting beams can interfere and produce, for example, a set of linear fringes. As particles entrained in the fluid pass through the stripes, they reflect light, which is then collected by receiving optics and focused onto a photodetector. The reflected light varies in intensity and its frequency is equal to the Doppler shift between the incident and scattered light and is therefore proportional to the component of particle velocity in the plane of the two beams. When the LDV sensor is aligned with the flow so that the stripes are perpendicular to the flow direction, the electrical signal from the photodetector is proportional to the total particle velocity. By combining three devices with different wavelengths (eg, a He—Ne laser, an argon ion laser, and a laser diode laser), all three flow velocity components can be measured simultaneously in various examples.

In various examples, PIV systems can be utilized to determine two- or three-dimensional vector fields of fluid flow. PIV is an optical method of flow visualization that can be used to obtain instantaneous velocity measurements and related properties in fluids. The fluid contains tracer particles that are assumed to faithfully follow the flow dynamics of the fluid. A fluid with entrained particles is illuminated so that the particles are visible, and the motion of the particles is used to calculate the velocity and direction of the flow (velocity field). PIV sensors are used in cameras such as digital cameras with charge-coupled device (CCD) chips, strobes or lasers with optical arrangements that limit the physical area illuminated, e.g., to convert a light beam into a line or sheet. cylindrical lenses, synchronizers that act as external triggers for control of the camera and laser, and seeding or tracer particles within the fluid under examination. A fiber optic cable or liquid light guide can connect the laser to the lens setup and PIV software can be used to post-process the optical images, for example.

In two-dimensional PIV applications, a laser light sheet of light scattering particles is illuminated through two successive frames, which are captured to produce a two-dimensional map of particle movement and motion vectors. For stereo PIV or 3D PIV, two or more cameras can be utilized at predetermined angles to each other to capture two consecutive frames, and another camera allows out-of-plane measurements. can be configured as In one aspect, time-resolved particle tracking can allow evaluation of particle trajectories or paths, as well as determination of particle volume and velocity.

Surgical applications of the optical particle detection and tracking techniques and systems described herein can include, for example, smoke detection applications, bleeding detection applications, perfusion assessment applications, and dye identification applications. Various exemplary applications are further described herein.

In one application, detection of the presence and/or concentration of smoke in an internal cavity, such as an abdominal cavity, is used for speed control of insufflation equipment, for speed control or activation of smoke evacuation equipment, and/or generator algorithms. It can be used to adapt parameters to minimize smoke generation. Smoke evacuation systems are further described herein.

In various examples, the surgical hub can be communicatively coupled to the smoke evacuation system. Smoke is often generated during surgical procedures utilizing one or more energy devices. Energy devices use energy to affect tissue. As further described herein, in energy devices energy is supplied by a generator. Energy devices include devices with tissue-contacting electrodes, such as electrosurgical devices with one or more radio frequency (RF) electrodes, and devices with vibrating surfaces, such as ultrasonic devices with ultrasonic blades. In electrosurgical devices, a generator is configured to generate an oscillating current to energize the electrodes. In the ultrasonic device, the generator is configured to generate ultrasonic vibrations to energize the ultrasonic blade.

Many surgical systems include a surgical evacuation system that captures smoke resulting from a surgical procedure and directs the captured smoke away from the clinician(s) and/or patient(s) through filters and exhaust ports. use. For example, an evacuation system may be configured to evacuate smoke generated during an electrosurgical procedure. The reader may refer to such an evacuation system as a "smoke evacuation system," although such an evacuation system is intended to expel not only smoke from the surgical site, but more. It will be appreciated that it may be configured Throughout this disclosure, the "smoke" emitted by the emission system is not limited to smoke only. Rather, the smoke evacuation system disclosed herein can be used to evacuate a variety of fluids including liquids, gases, vapor, smoke, steam, or combinations thereof. The fluid may be of biological origin and/or introduced to the surgical site from an external source during the procedure. Fluids can include, for example, water, saline, lymph, blood, exudate, and/or purulent discharge. Additionally, the fluid may contain particulates or other material (eg, cellular material or debris) that is expelled by the evacuation system. For example, such microparticles can be suspended in a fluid. An exemplary smoke evacuation system and various subassemblies and/or components thereof are shown in FIGS. 21-23. Smoke evacuation systems are further described in U.S. patent application Ser. It is

In certain examples, the processor can be located within an ejector housing of a surgical ejection system. For example, referring to FIG. 21, processor 50408 and memory 50410 therefor are located within ejector housing 50440 of surgical ejection system 50400 . Processor 50408 is in signal communication with motor driver 50428 , various internal sensors 50430 , display 50442 , memory 50410 and communication device 50418 . Communication device 50418 may include a transceiver configured to communicate over physical wires or wirelessly. Communication device 50418 may further include one or more additional transceivers. The transceiver may include a cellular modem, a wireless mesh network transceiver, a Wi-Fi® transceiver, a low power wide area (LPWA) transceiver, and/or a near field communication transceiver (NFC). , but not limited to. Communication devices 50418 include mobile phones, sensor systems (e.g. environment, location, motion, etc.) and/or sensor networks (wired and/or wireless), computing systems (e.g. servers, workstation computers, desktop computers, laptops top computers, tablet computers (such as iPad® and Galaxy Tab®), ultra-portable computers, ultra-mobile computers, netbook computers, and/or sub-notebook computers, or the like, or In at least one aspect of the disclosure, one of the devices may be a coordinator node.

The transceivers receive serial transmit data from processor 50408 via respective universal asynchronous transceivers (UARTs), modulate the serial transmit data onto RF carriers to generate transmit RF signals, and transmit via respective antennas. may be configured to transmit the transmit RF signal. The transceiver(s) receives, via respective antennas, a received RF signal comprising an RF carrier modulated with serial received data, demodulates the received RF signal to extract serial received data, and performs serial reception. It is further configured to provide data to respective UARTs to processor 50408 . Each RF signal has an associated carrier frequency and an associated channel bandwidth. Channel bandwidth is associated with carrier frequency, transmitted data, and/or received data. Each RF carrier frequency and channel bandwidth is associated with the operating frequency range(s) of the transceiver(s). Each channel bandwidth is further associated with a wireless communication standard and/or protocol that the transceiver(s) may comply with. In other words, each transceiver uses a selected wireless communication standard and/or protocol, such as IEEE 802.11a/b/g/n and/or Zigbee routing for Wi-Fi. An implementation of IEEE 802.15.4 for wireless mesh networks may be supported.

A communication device 50418 can allow the processor 50408 within the surgical drainage system 50400 to communicate with other devices within the surgical system. For example, the communication device 50418 may include one or more external sensors 50432, one or more surgical devices 50444, one or more hubs 50448, one or more clouds 50446, and/or one or more additional surgical systems and /or Wired and/or wireless communication to the tool may be enabled. The reader will readily appreciate that surgical drainage system 50400 of FIG. 21 may be incorporated into an intelligent electrosurgical system in certain instances. The surgical drainage system 50400 also includes a pump 50450 such as its pump motor 50451 , a drainage conduit 50436 and an exhaust port 50452 . Various pumps, exhaust conduits, and vents are further described herein. Surgical drainage system 50400 can also include sensing and intelligent controls. The sensing and intelligent control device includes sensor algorithms and communication algorithms that facilitate communication between the smoke evacuation system and other devices to adapt the algorithm's control program.

Surgical drainage system 50400 can be programmed to monitor one or more parameters of the surgical system and can be configured to monitor the processor of the surgical hub and/or the surgical device and/or surgical drainage system connected to the hub. Surgical functions may be affected based on one or more algorithms stored in memory in signal communication with processor 50408 within 50400 . Various exemplary aspects disclosed herein may be implemented by such an algorithm, for example. See, for example, U.S. Patent Application Serial No. 16/16, entitled "SURGICAL EVACUATION SENSING AND MOTOR CONTROL," filed Jun. 29, 2018, the entire contents of which are incorporated herein by reference for intelligent surgical evacuation systems and adjustment algorithms. 024,066.

An electrosurgical system can include a signal generator, an electrosurgical instrument, a return electrode, and a surgical drainage system. The generator may be an RF wave generator that produces RF electrical energy. Connected to the electrosurgical instrument is a utility conduit. A utility conduit includes a cable that communicates electrical energy from the signal generator to the electrosurgical instrument. Utility conduits also include vacuum hoses that carry trapped and/or collected smoke and/or fluid away from the surgical site. Such an exemplary electrosurgical system 50601 is shown in FIG. More specifically, electrosurgical system 50601 includes a generator 50640, an electrosurgical instrument 50630, a return electrode 50646, and an evacuation system 50600. Electrosurgical instrument 50630 includes a handle 50632 and a distal conduit opening 50634 fluidly coupled to suction hose 50636 of evacuation system 50600 . Electrosurgical instrument 50630 also includes electrodes powered by generator 50640 . A first electrical connection 50642 , eg, a wire, extends from the electrosurgical instrument 50630 to the generator 50640 . A second electrical connection 50644 , eg a wire, extends from the generator 50646 to the electrode, ie the return electrode 50646 . In other examples, electrosurgical instrument 50630 may be a bipolar electrosurgical instrument. A distal conduit opening 50634 on the electrosurgical instrument 50630 is fluidly connected to a suction hose 50636 that extends to a filter end cap 50603 of a filter located within the ejector housing 50618 of the ejection system 50600 .

In other examples, the distal conduit opening 50634 of the drainage system 50600 may be on a separate handpiece or tool from the electrosurgical instrument 50630. For example, evacuation system 50600 can include a surgical tool that is not coupled to generator 50640 and/or does not include a tissue-energizing surface. In certain examples, distal conduit opening 50634 of drainage system 50600 can be releasably attached to an electrosurgical tool. For example, the evacuation system 50600 can include a clip-on or snap-on conduit terminating at the distal conduit opening, which can be releasably attached to the surgical tool.

The electrosurgical instrument 50630 delivers electrical energy to target tissue of a patient to cut that tissue and/or cauterize blood vessels in/near the target tissue, as described herein. is configured to Specifically, an electrical discharge is provided to the patient by the electrode tip to cause heating of the patient's cellular material in close contact with or adjacent to the electrode tip. Heating of tissue occurs at a reasonably high temperature such that electrosurgical instrument 50630 can be used to perform electrosurgery. A return electrode 50646, or return pad, is placed under the patient during the surgical procedure to complete the circuit and provide a return electrical path to the generator 50640 for energy entering the patient's body. good.

Heating of a patient's cellular material by the electrode tip, or cauterization of a blood vessel to prevent bleeding, results in the emission of smoke to the location where the cauterization occurs, as further described herein. often become. In such instances, the evacuation system 50600 is configured to capture smoke emitted during the surgical procedure because the evacuation conduit opening 50634 is near the electrode tip. Vacuum suction may draw smoke through the electrosurgical instrument 50630 into the conduit opening 50634 and into the suction hose 50636 towards the ejector housing 50618 of the evacuation system 50600 . In various examples, the electrosurgical system 50601 and/or the ejection system 50600 can include control circuitry including a processor and memory as described herein with respect to the control schematic diagram of FIG.

Referring now to Figure 23, another ejector housing 50918 for the ejection system 50900 is shown. Ejector housing 50918 defines a flow path 50904 between an inlet 50922 to ejector housing 50918 and an outlet 50924 from ejector housing 50918 . Intermediate inlet 50922 and outlet 50924, fluid trap 50960, filter 50970, and pump 50906 are arranged in series. Ejector housing 50918 may include sockets or receptacles 50971 sized to receive modular fluid traps and/or replaceable filters 50970 . At diverter valve 50934 , fluid can be directed into condenser 50935 of fluid trap 50960 and smoke can travel towards filter 50970 . In certain examples, the fluid trap 50960 can include baffles such as baffle 50964 and/or splatter screens such as screen 50962 to prevent trapped fluid from splattering out of the fluid trap 50960, for example. Filters 50970 include pleated ultra-low permeation air (ULPA) filters 50942 and charcoal filters 50944 . Sealed conduits or tubes 50905 extend between the various series of components. Ejector housing 50918 also includes sensors 50830, 50832, 50836, 50838, 50840, 50846, 50848, 50850, 50852, and 50854, which are herein incorporated by reference in their entireties. US patent application Ser.

Still referring to FIG. 23, the ejector housing 50918 also includes a centrifugal blower mechanism 50980 and a recirculation valve 50990. Recirculation valve 50990 can be selectively opened and closed to recirculate fluid through fluid trap 50960 . For example, if the fluid detection sensor 50836 detects fluid, the recirculation valve 50990 can open such that fluid is directed away from the filter 50970 and back into the fluid trap 50960 . If the fluid detection sensor 50836 detects no fluid, the valve 50990 can be closed such that smoke is directed into the filter 50970 . When fluid is recirculated through recirculation valve 50990 , fluid may be drawn through recirculation conduit 50982 . A centrifugal blower mechanism 50980 engages the recirculation conduit 50982 to create a recirculation suction force within the recirculation conduit 50982 . More specifically, when the recirculation valve 50990 is opened and the pump 50906 is activated, the suction force generated by the pump 50906 downstream of the filter 50970 causes rotation of the first centrifugal blower, or tumbling basket 50984. , which can be moved into a second centrifugal blower or a second tumbling basket 50986 that draws recirculation fluid through a recirculation valve 50990 into a fluid trap 50960 .

In various aspects of the present disclosure, the control schematic of FIG. 21 can be utilized with various surgical systems, ejection systems, sensor systems and ejector housings of FIGS.

Smoke expelled from a surgical site can include liquids, aerosols, and/or gases, and/or contain different chemical and/or physical properties, such as particulate matter and particles of different sizes and/or densities. It can contain substances with specific properties. Different types of substances drained from a surgical site can affect the efficiency of a surgical drainage system and its pumps. Additionally, certain types of substances may require the pump to draw excessive power and/or may damage the pump's motor.

Power supplied to the pump may be adjusted to control the flow rate of smoke through the evacuation system based on input from one or more sensors along the flow path. The output from the sensor may be a condition or quality of the smoke evacuation system and/or one or more characteristics of the exhaled smoke such as, for example, material types and proportions, particulate chemistry, density, and/or size. can be shown. In one aspect of the disclosure, the pressure difference between two pressure sensors in the evacuation system can indicate the condition of the area between them, such as, for example, the condition of filters, fluid traps, and/or the overall system condition. Based on the sensor input, the operating parameters of the motor of the pump can be adjusted by changing the current supplied to the motor and/or a duty cycle configured to change the motor speed.

In one aspect of the present disclosure, by adjusting the flow rate of smoke through the exhaust system, the efficiency of the filter can be improved and/or the motor can be protected from burnout.

Surgical evacuation systems can include one or more particle counters or particle sensors to detect the size and/or concentration of particulates within the smoke. Referring again to FIG. 23, particle sensors 50838 and 50848 are shown. The reader will readily appreciate that a variety of particle measurement means are possible. For example, particle sensors can be optical sensors, laser sensors, photoelectric sensors, ionization sensors, electrostatic sensors, and/or combinations thereof. Various particle sensors are further described herein.

In various examples, the speed of the motor, and thus the speed of the pump, can be adjusted based on the particulate concentration detected by one or more particle sensors within the surgical drainage system. For example, if the particle sensor(s) detect an increase in the concentration of particulates in the flow path, this may correspond to an increase in the amount of smoke in the flow path, so the speed of the motor is increased to Velocity can be increased to draw more fluid from the surgical site into the smoke evacuation system. Similarly, if the particle sensor(s) detect a decrease in the particulate concentration in the flow path, this may correspond to a decrease in the amount of smoke in the flow path, so the speed of the motor is reduced and the pump is turned on. Velocity can be reduced to reduce suction from the surgical site. Additional and alternative adjustment algorithms for surgical drainage systems are further described herein. Further, in certain examples, based on sensor data from the smoke evacuation system, the generator within the surgical system adjusts the amount of smoke generated at the surgical site, as further described herein. can be controlled.

In addition to particle sensors positioned along the flow path of the surgical drainage system, the system may include one or more sensors for detecting particulate concentrations within the surrounding chamber, e.g., the operating room or surgical site. can. Referring again to FIG. 23, an air quality particle sensor 50852 is mounted on the exterior surface of the exhaust housing 50918. Alternate locations for the air quality particle sensor 50852 are also envisioned.

In at least one example, the particle sensor can be positioned downstream of the filter, and in certain examples can be positioned at or near the outlet of the filter. For example, particle sensor 50848 is positioned downstream of filter 50970 and pump 50906 in smoke evacuation system 50900 . Because the particle sensor 50848 is positioned downstream of the filter(s) 50970, the particle sensor is configured to confirm that the filter(s) 50970 have removed sufficient particulates from the smoke. In various examples, such sensors can be adjacent to the exhaust port 50924 of the ejector housing 50918. In one aspect of the disclosure, an electrostatic particle sensor may be utilized. For example, the vent 50924 can include an electrostatic particulate sensor, and the exhaust flows past the filtration system downstream to the surgical site before being exhausted.

Particulate concentrations detected by one or more sensors of a surgical drainage system can be communicated to a clinician in many different ways. For example, the exhaust housing 50918 and/or the exhaust device can include indicators such as one or more lights and/or display screens. For example, an LED on the ejector housing 50918 may change color (eg, from blue to red) depending on the volume of particulate detected by the sensor(s). In other examples, indicators can include alarms or warnings, which can be tactile, audible, and/or visual, for example. In such an example, when the ambient air particulate concentration detected by an air quality sensor (e.g., particle sensor 50852) exceeds a threshold amount, the clinician(s) within the surgical site may indicate the indicator(s). can be notified by

In certain examples, a surgical drainage system may include an optical sensor. Optical sensors can include electronic sensors that convert light or changes in light into electronic signals. Optical sensors can utilize light scattering methods to detect and count particles in smoke to determine the concentration of particles in the smoke. In various examples, the light is laser-based. For example, in one example, the laser light source is configured to illuminate the particles as they move through the detection chamber. As the particles pass through the beam of the laser, the light source is refracted, blocked, redirected and/or absorbed. The scattered light is recorded by a photodetector and the recorded light is analyzed. For example, the recorded light can be converted into an electrical signal indicative of particle size and quantity corresponding to the particulate concentration in smoke. Particulate concentration in smoke can be calculated in real time by, for example, a laser light sensor. In one aspect of the present disclosure, at least one of particle sensors 50838, 50848, 50852 is a laser light sensor. A variety of alternative sensing technologies and sensor configurations are herein incorporated by reference in its entirety, in the US filed June 29, 2018, entitled "SURGICAL EVACUATION SENSING AND MOTOR CONTROL." Further described in patent application Ser. No. 16/024,066.

Based on the presence and concentration of smoke within the abdominal cavity, generator algorithms can be adapted to minimize or control smoke production. For example, information/knowledge obtained from previous surgical events such as previous firings and/or energy activations can be used to adjust one or more parameters of the generator control algorithm. Referring now to FIG. 24, a series of graphs 213400, 213402, and 213404 are depicted in which particle count 213406, fan speed 213408, and energy device power 213410 are plotted against time (t). Particle number 213406 may be detected by various sensors and/or detection techniques disclosed herein. One or more surgical functions and/or one or more devices may be adjusted in response to the detected particle count 213406 corresponding to the smoke concentration at the surgical site (eg, within the patient's internal cavity). Additionally, the type and/or degree of adjustment may depend on knowledge gained during previous firings and/or activations.

Energy device power 213410 is supplied during a first activation 213412 from time _t0 to time _t2 and during a second activation 213414 from time _t5 to time _t7 . The knowledge gained during the first start-up 213412 can be used to adjust the control algorithm of the control circuit applied during the second start-up 213414 . The control circuitry may be included in the surgical hub and/or smoke evacuator, for example, as shown in the control schematic of FIG.

Still referring to FIG. 24, when the energy device is activated for the first activation 213412, the energy device power 213410 is set to the default power level 213430 and the particle count 213406 is set towards the first threshold 213416. start to increase. The default power level 213430 may be a clinician-selected power level. For example, a default power level 213430 may be pre-programmed into the surgical device and/or at the surgical hub. In certain examples, the surgical device may be configured to operate at different predetermined power levels depending on the actuators and/or control buttons activated by the clinician.

At time t ₁ , as the first activation 213412 continues, the particle count 213406 increases beyond the first threshold 213416 and reaches a peak value 213418 at time t ₂ when the first activation 213412 ends. Control circuitry in signal communication with the smoke evacuator is configured to perform a first adjustment 213420 in response to the particle count 213406 exceeding the first threshold 213416 at time t ₁ . For example, the control circuit is configured to increase fan speed 213408 from a low setting 213426 to a high setting 213428 .

After the first activation 213412 ends at time _t2 , the particle count 213406 can begin to decrease from the peak value 213418. However, the smoke evacuator may continue to operate at the high setting 213428 until time _t3 when the particle count 213406 falls below the first threshold 213416. In response to the particle count 213406 decreasing below the first threshold 213416, the fan speed 213408 can be decreased to a low setting 213426, and in various examples the particle count 213406 decreases to zero at time _t4 . Fan speed 213408 can then be turned off. In other examples, the smoke evacuator can include additional velocities that can correspond to additional particle count thresholds and/or can be proportional to the particle count of 213,406, for example. In various examples, the smoke evacuator can operate at a very low setting and/or cycle on/off when in sleep or hibernation mode where the particle count is zero and/or below a minimum threshold.

At time _t5 when the second activation 213414 begins, the particle count 213406 begins to increase again and the fan speed 213408 can be set to the low setting 213426 to extract smoke from the surgical site. In various examples, the smoke evacuator may be activated in response to activation of the energy device before any smoke is detected. As shown in FIG. 24, in a particular example, the particle count 213406 can continue to increase during the second start-up 213414 and while the fan speed 213408 is set to the low setting 213426, and the second start-up As 213414 continues, at time _t6 , the particle count 213406 increases above the first threshold 213416 again. When the control circuit performs the first adjustment 213420 again, the particle count 213406 again follows the virtual curve 213424 and reaches a peak value 213418 at time _t7 when the second activation 213414 ends. However, in response to the particle count 213406 again exceeding the first threshold 213416 at time _t6 during the second activation 213416, the control circuit adapts the control algorithm to be different from the first adjustment 213420. It is configured to perform a second adjustment 213422.

For example, in addition to increasing the fan speed 213408 from a low setting 213426 to a high setting 213428 at time _t6 , the control circuit is configured to decrease the energy device power 213410 to less than the default power level 213430. . For example, a clinician-actuated control may correspond to a preset power level 213430, while the surgical hub's control circuitry may adjust the energy device's power 213430 to a regulated power level 213432. The adjusted power level 213432 of FIG. 24 is less than the default power level 213430. In other examples, adjustments controlled by the hub may be performed, for example, by applying pulses of various durations and/or frequencies (e.g., pulse width modulation and/or pulse frequency modulation), and/or energy modalities. Energy device power 213410 may be increased, such as by adjusting, and/or energy device power may be adjusted in other ways.

A second adjustment 213422 can be learned or developed based on the system's response to the first adjustment 213420 . For example, if the peak value 213418 obtained while performing the first adjustment 213420 is still considered too high and/or obstructs the clinician's vision and/or applies energy to the tissue, for example. The control circuit may seek different adjustments if deemed to be associated with undesirable results, such as interfering with the . As described herein, the second adjustment 213422 consists of the first adjustment 213422 (i.e. adjusting the fan speed 213408 from the low setting 213426 to the high setting 213428) plus an additional including the adjustment of In other examples, the second adjustment 213422 can replace the first adjustment 213420 .

In certain examples, the second adjustment 213422 may adjust the threshold and/or degree of the first adjustment 213420. For example, the second adjustment 213422 may include increasing the fan speed 213408 to a higher level than the high setting 213428. In various examples, the second adjustment 213422 can include modifications to the first adjustment 213420 proportional to the desired effect. For example, if the first adjustment 213410 increases the fan speed 213408 by 10% to reduce smoke density by 10%, then the second adjustment 213422 reduces the fan speed 213408 by 15% to reduce smoke density by the desired 15%. can be done.

The first and second adjustments described herein are exemplary adjustments. Adjustments may include, for example, changing the power level of the generator, the power level of the smoke evacuator, the ventilation of the space, and the degree and/or type of filtration and/or condensation induction in the smoke evacuation system.

As described herein, techniques for improving particle identification and tracking, which can, for example, determine fluid directionality and velocity, can be utilized in a variety of surgical applications. For example, improved techniques can be used for smoke detection applications, as described further herein. Additionally or alternatively, based on smoke directionality and/or velocity, the surgical system can clear smoke more quickly and then slow down to minimize noise in the operating room (OR). Additionally, it may be configured to adjust the smoke exhaust motor control. As another example, the system can increase insufflation recirculation to expel particulates from the involved surgical field. For example, if the sensor detects that smoke is moving toward a treatment area where the clinician is actively working and/or treating, it may increase circulation within the cavity, causing interfering particulates (i.e., It may be desirable to quickly move smoke) away from the treatment area.

In one application, improved techniques for identifying and tracking particles can be used for bleeding detection. Based on the directionality and velocity of the flow, the control circuitry and/or surgical hub can determine and/or recommend subsequent steps to address the bleeding. In another application, the improved techniques for particle identification and tracking can be used for tissue perfusion assessment. Perfusion assessment can be used, for example, to identify anatomical structures. In one example, NIR illumination of ICG can be used to image perfusion in lung segments. Such perfusion visualization can be used, for example, to identify/define an intersegmental plane for segmentectomy. The control circuitry and/or surgical hub can then determine and/or recommend subsequent steps. For example, the control circuitry and/or surgical hub can recommend specific surgical devices and/or locations. In certain examples, the control circuitry and/or surgical hub can guide the surgical device to a desired location.

In one application, improved techniques for particle identification and detection may be used in conjunction with dye transfer, allowing the system to highlight leak paths. For example, the leak size and location can be determined. In one example, leak testing an anastomosis may identify a leak path from the colon to the abdomen. In various examples, the identification of leakage pathways can inform a clinician's decision-making process. For example, recommendations can be provided to the clinician regarding how and/or when to address the leak path. In certain examples, the contextual information provided by the hub can influence the recommendations provided to the clinician. Contextual information can be ascertained, for example, in the current pressure within the colonic dye fluid, tissue viability from computed tomography (CT) imaging and/or instrument manipulation forces, and/or electronic medical records (EHR). Complicating patient-specific factors can be taken into account to indicate the potential for functional leakage. Recommendations are made by identification of detected associations (e.g., leak size, "suture edge skin deformation" or location of leak relative to lateral edge of intersection/stapled corner, and/or detected in circular stapler). and suggesting viable products to reinforce the anastomosis based on the compressive load). Additionally or alternatively, recommendations may include suggestions to apply reinforcing agents such as fibrin, thrombin, and/or oxidized regenerated cellulose (ORC), for example. Additionally or alternatively, the recommendations may include suggestions to overcast or restaple a portion of the line due to tissue tension or collateral blood supply issues, for example.

In various examples, detecting one or more properties of fluid flow at the surgical site can involve one or more of the various measurement systems and/or techniques described further herein. Optical measurement systems such as laser Doppler velocimetry (LDV) or laser Doppler flowmeter (LDF), particle image velocimetry (PIV), and/or near-infrared (NIR) fluorescence of indocyanine green (ICG) can be utilized, for example. In other examples, instead of a camera/optical measurement system, detection and/or measurement can utilize alternative sensing arrays for tracking particles. Ultrasonic measurement systems such as, for example, non-contact pass-through ultrasonic detection and non-contact reflected ultrasonic detection can be utilized, for example.

In one aspect, non-contact pass-through ultrasound can be utilized for particle detection. Referring to the transsonic particle detection system 213500 of FIG. 25, the ultrasound emitter 213502 can be positioned within the patient's body (eg, intraperitoneally) similar to an optical scope. In various examples, emitter 213502 can be positioned on the distal end of scope 213501 of the imaging system. The scope can include a camera that observes the surgical site and transmits the field of view to a display that can be viewed by the clinician. Scopes include arthroscopic scopes, angioscopes, bronchoscopes, biliary scopes, colonoscopes, cytoscopes, duodenoscopes, colonoscopes, esophagoduodenoscopes (gastroscopes), endoscopes, laryngoscopes, include, but are not limited to, nasopharyngeal-renal pelvis, sigmoidoscopy, thoracoscopy, ureteroscopy, and endoscopy. In other examples, emitter 213502 can be a separate and distinct device from the scope. The ultrasonic emitter 213502 is configured to transmit a homogeneous sound curtain that passes through the fluid 213504 (e.g., moving particles such as smoke particles and/or vapor aerosols) and is received on the opposite side of the fluid 213504. received by machine 213506. The receiver 213506 can be disposed on a surgical device, such as, for example, the end effector and/or the distal nose of a staple cartridge 213508 received within an elongated channel of the end effector. In other examples, receiver 213506 may be located on a separate and distinct surgical tool. As various sound waves pass from emitter 213502 through fluid 213504 , certain waves may be blocked by fluid 213504 . Based on the acoustic waves received by the receiver 213506, the ultrasound-transmissive particle detection system 213500 is configured to determine the Doppler shift, i.e., the acceleration or deceleration of the velocity of the acoustic waves, corresponding to the properties of the fluid flow. .

Surgical applications of the Ultrasonic Particle Detection System 213500 include smoke detection applications, including, for example, detection of velocity, directionality, and concentration of particulates in a flow, and detection of flow pattern and/or dispersion velocity; Emission control. Surgical applications also include differentiating between aerosol particles and particulates (eg, differentiating smoke from vapor). Such distinctions may be used, for example, to adjust the smoke evacuation system, such as altering the fluid flow path to accommodate aerosols in the flow path, which may damage the particulate filter if not properly extracted. can be useful in some cases. Additional surgical applications for particle detection and monitoring are further described herein, such as, for example, ultrasound techniques utilizing the Trans-Ultrasound Particle Detection System 213500. Additionally, the surgical system and/or its control circuitry may be configured to utilize information from such ultrasound passing particle detection systems to coordinate and/or suggest surgical functions during a surgical procedure.

In one aspect, non-contact reflected sound detection can be utilized for particle detection. Referring now to Figure 26, an ultrasonic reflected particle detection system 213600 is shown. Similar to the ultrasound transmission technique described above with respect to FIG. However, this ultrasound reflected particle detection system 213600 differs from the ultrasound passing particle detection system 213500 in that the emitter 213602 and receiver 213606 are co-located on the same surgical device 213608 . In other examples, emitter 213602 and receiver 213606 can be located on separate devices, but positioned adjacent to each other. In various examples, surgical device 213608 can be, for example, a scope such as device 213502 (FIG. 25).

Ultrasonic reflected particle detection system 213600 is configured to detect reflected acoustic waves. The reflection and refraction of sound waves depend on the surface properties of tissue T targeted by surgical device 213608 . Because the surgical device 213608 is not in contact with the tissue T, it is configured to sense the surface of the tissue T, e.g., surface features of the tissue T, rather than sensing deep properties/features of the tissue T. . For example, referring to flowchart 213650 of FIG. 27, at block 213652 data from emitter 213602 and receiver 213606 regarding sound wave characteristics is obtained and at block 213654 provided to control circuitry for analysis. The control circuitry is configured to determine tissue surface information at block 213656 . Various control circuits for receiving input signals, calculating tissue surface information, and providing outputs can be incorporated into the various control circuits described herein. For example, algorithms for determining tissue surface information from input signals can be stored in memory of the various control circuits described herein.

Surgical applications of ultrasonic reflectance particle detection systems include, for example, discrimination of surface reflections of disrupted surfaces and detection of fluid or exudate on tissue surfaces. For example, sound reflections indicative of disrupted or disrupted surface tissue features can be used to detect unhealthy tissue features such as infection, adhesions, scarring, remodeling, and cancer. Such tissue features cause increased refraction and attenuation of ultrasound waves compared to healthy tissue, which typically defines a more interrupted tissue surface and thus a continuous uninterrupted surface. It can correspond to the tissue surface. Fluid or exudate on the surface of tissue can also produce different Doppler effects on sound waves directed at the surface, producing sound reflections that differ from those of solid tissue surfaces. Furthermore, the more fluid that is present, the greater the sound absorption coefficient that the fluid can induce by absorbing some of the energy of the sound wave. In addition, the Doppler effect on sound waves results in a Doppler wave shift of the sound waves depending on whether the fluid is moving toward or away from the transmitter and receiver. The directionality of fluid flow can be detected. In various examples, by varying the range of frequencies emitted by the transmitter, the system can further refine, for example, the surface tension, modulus, and/or viscosity of the detected fluid. Accordingly, surgical systems or control circuitry may be configured to utilize information from such ultrasonic reflected particle detection systems to coordinate and/or suggest surgical functions during a surgical procedure.

In various aspects, the system uses various techniques described herein for identification and detection of particles along a flow path, e.g. It can be configured to monitor being removed/drained or filtered and replaced by an irrigation/insufflation system. In certain examples, the system can be configured to detect particles in the extracted gas and directly measure their flow rate. In one aspect, the ultrasound passing arrays may be placed, for example, at intersections between passages extracting insufflation gas or filtering insufflation gas. Such arrays can be configured to detect passing particles and thus can be used to determine the type and concentration of particles passing through the array. An alternative to the ultrasound passing array is a laser counter array that may be similarly arranged. A laser counter array can measure the refraction of light from a blocked laser light wave, or particle, passing from one side of the passageway to the other.

In various examples, vortex currents can be used in combination with either the ultrasound passing arrays or the laser counter arrays described above. Vortices are configured to detect the size of particles and their flow rate, rather than simply using the presence or concentration of particles given a given flow rate. When using a vortex flow meter, there are no moving parts or elements in the flow that are required to measure the flow. Advantageously, this can improve the ability to clean and reuse the detection system and/or minimize accumulation of bodily fluids within the detection system, for example.

Various aspects of the subject matter described herein are illustrated in the following numbered examples.
Example 1 - A surgical system comprising a sensor configured to detect characteristics of airborne particles in fluid within a patient's abdominal cavity, a surgical device configured to perform a surgical function, and a processor and a memory storing instructions, the instructions for receiving an input signal from the sensor indicative of a property of airborne particles in the fluid; a control circuit executable by the processor to provide an output signal indicative of the adjustment to the surgical device.

[0033] Example 2 - The surgical system of Example 1, wherein the sensor includes at least one of an optical sensor, laser sensor, ultrasonic sensor, magnetic resonance sensor, and eddy current sensor.

Example 3 - As in any one of Examples 1 and 2, wherein the properties of suspended particles in the fluid include at least one of particle type, particle size, particle concentration, particle velocity, and particle direction surgical system.

Example 4—Adjustment to Surgical Function Proportionally Increases Surgical Function Based on Properties of Suspended Particles in Fluid, Adds ancillary Surgical Function to Surgical Function, and Surgical Function with an alternative surgical function.

Example 5 - A surgical device comprises a generator configured to power an energy device at a power level, and adjustments to the surgical function adjust the power level supplied from the generator to the energy device The surgical system of any one of Examples 1-4, comprising:

Example 6 - Examples 1-4 wherein the surgical device comprises a smoke evacuator comprising a pump configured to operate at a speed, and the adjustment to the surgical function comprises adjusting the speed of the pump A surgical system according to any one of the preceding claims.

Example 7 - Any of Examples 1-4, wherein the surgical device comprises a smoke evacuator comprising a filtration system, and the adjustment to the surgical function comprises adjusting a flow path through the filtration system of the smoke evacuator 10. The surgical system of claim 1.

Example 8 - The surgical procedure of Example 7, wherein the filtration system comprises a particulate filter, and the flow path is diverted through the particulate filter when the input signal indicates an increased particulate concentration of suspended particles in the fluid. system.

Example 9 - Any of Examples 7 and 8, wherein the filtration system comprises a condenser and the flow path is diverted through the condenser when the input signal indicates an increase in the aerosol concentration of suspended particles in the fluid. 10. The surgical system of claim 1.

Example 10 - Any one of Examples 1-4, wherein the surgical device comprises an operating room vent and the adjustment to the surgical function comprises adjusting the operating room vent to increase ventilation therethrough A surgical system according to one.

Embodiment 11 - The pre-control circuit receives a plurality of input signals indicative of a plurality of properties of suspended particles in the fluid, the plurality of input signals comprising the input signal; 11. The surgical system of any one of Examples 1-10, further configured to, in response, provide an output signal to the surgical device indicative of an adjustment to the surgical function.

Example 12 - A non-transitory medium storing computer readable instructions which, when executed, cause a surgical device to:
receiving an input signal from a sensor that is characteristic of airborne particles in fluid within the patient's peritoneal cavity;
providing an output signal indicative of an adjustment to a surgical function to the surgical device in response to the input signal.

[00130] Example 13 - The non-transitory medium of Example 12, wherein the computer readable instructions, when executed, cause the surgical device to provide an output signal to the generator to adjust the power level of the generator.

Example 14 - The non-transitory of example 12, wherein the computer readable instructions, when executed, cause the surgical device to provide an output signal to the smoke evacuator to adjust the speed of the smoke evacuator pump. medium.

Example 15 - The non-transitory of example 12, wherein the computer readable instructions, when executed, cause the surgical device to provide an output signal to the smoke evacuator to adjust the flow path through the smoke evacuator. medium.

Example 16 - An example in which the computer readable instructions, when executed, cause the surgical device to adjust surgical function by altering surgical function in proportion to changes in the properties of airborne particles in a fluid A non-transitory medium according to any one of 12-15.

Example 17 - Any of Examples 12-16, wherein the computer readable instructions, when executed, cause the surgical device to adjust surgical functions by adding ancillary surgical functions in combination with surgical functions. 1. A non-transitory medium according to one.

Example 18 - Any one of Examples 12-17, wherein the computer readable instructions, when executed, cause the surgical device to adjust a surgical function by replacing the surgical function with an alternative surgical function A non-transitory medium as described in .

Example 19 - A method of receiving an input signal from a sensor indicative of characteristics of airborne particles in a fluid within a patient's abdominal cavity and adjusting a surgical device to a surgical function in response to the input signal automatically providing an indicative output signal to a surgical device.

Example 20 - Receiving from the sensor a second input signal indicative of a property of suspended particles in the fluid at a time after receiving the input signal;
automatically providing a second output signal to the second surgical device indicative of an adjustment to the surgical function of the second surgical device in response to the second input signal; 20. The method of example 19, wherein the two surgical devices are different than the first surgical device.

Embodiment 21 - An actuator configured to receive an input, a control circuit for receiving a signal indicative of a surgical condition from a situation-aware surgical hub, and an actuation signal from the actuator in response to the input and performing a surgical function in response to the actuation signal, wherein the surgical function is a surgical The surgical function includes a first surgical function when the condition corresponds to the first surgical condition and the surgical function includes a second surgical function when the surgical condition corresponds to the second surgical condition. , the second surgical condition is different from the first surgical condition and the second surgical function is different from the first surgical function.

[00130] Example 22 - The surgical apparatus of Example 21, wherein the context-aware surgical hub includes a context-aware module and the surgical condition includes a step in the surgical procedure.

Example 23 - The surgical device according to any one of Examples 21 and 22, wherein the surgical condition comprises identification of a set of surgical devices currently in use at the surgical site.

Example 24 - The surgical device of any one of Examples 21-23, wherein the surgical condition comprises the location of a portion of the surgical device.

Example 25 - The surgical device of any one of Examples 21-24, wherein the surgical condition comprises a jaw position of an end effector of the surgical device.

Example 26 - the actuator is movable through a first range of motion from a first position to a second position and through a second range of motion from a second position to a third position; Implementation wherein movement of the actuator in the first range of motion is configured to initiate a surgical function and movement of the actuator in the second range of motion is configured to measure the extent of the surgical function A surgical device according to any one of Examples 21-25.

Embodiment 27—Further comprising a Hall effect sensor configured to determine the position of the actuator, wherein the first surgical function comprises actuation and the second surgical function is activation of the actuator detected by the Hall effect sensor 27. The surgical device of any one of Examples 21-26, including adjusting the degree of actuation based on position.

Embodiment 28—Further comprising a strain gauge operably coupled to the actuator, the strain gauge configured to determine an input force applied to the actuator, the first surgical function comprising actuation, the 27. The surgical device according to any one of Examples 21-26, wherein the surgical function of 2 includes adjusting the degree of actuation based on the input force detected by the strain gauge.

Example 29 - A first surgical function is limited by a first maximum threshold and a first minimum threshold, a second surgical function comprises a second maximum threshold and a second minimum threshold, and a second The surgical device of any one of Examples 21-28, wherein the one maximum threshold is different from the second maximum threshold and the first minimum threshold is different from the second minimum threshold.

Example 30 - According to any one of Examples 21-29, wherein the first surgical condition corresponds to a full-use surgical procedure and the second surgical condition corresponds to a precision-use surgical procedure surgical equipment.

Example 31 - The surgical device of any one of Examples 21-30, wherein the actuator comprises at least one of a button, switch, toggle, trigger, lever, dial, and knob.

[00403] Example 32 - The surgical apparatus of any one of Examples 21-31, wherein the control circuitry comprises a processor and memory communicatively coupled to the processor.

Embodiment 33 - A non-transitory medium storing computer readable instructions which, when executed, cause a surgical device to receive a signal indicative of a surgical condition from a context-aware surgical hub receiving an actuation signal in response to an input applied to an actuator of the surgical device; and performing a surgical function in response to the actuation signal, the surgical function The surgical function includes a first surgical function when the condition corresponds to the first surgical condition and the surgical function includes a second surgical function when the surgical condition corresponds to the second surgical condition. , the second surgical condition is different from the first surgical condition and the second surgical function is different from the first surgical function, a non-temporary medium.

Example 34 - A control circuit comprising a screen configured to selectively display recommendations to a clinician in an operating room, a control circuit, a processor, and a memory in signal communication with the processor wherein the memory stores instructions, the instructions receiving a signal indicative of a surgical condition from a situation-aware surgical hub and determining a priority level of recommendations based on the surgical condition. and communicating a recommended priority level via the screen, executable by the processor.

[00430] Example 35 - The system of example 34, wherein the control circuitry is further configured to select one or more recommendations from the plurality of possible recommendations based on the surgical condition.

Example 36 - The control circuit is further configured to adjust the priority level of the recommendation based on the expected surgical action, wherein the expected surgical action is based on the surgical condition, according to example 35. System as described.

Example 37 - The system of Example 36, wherein the expected surgical action is based on the position of the surgical device at the surgical site.

[0043] Example 38 - The system of any one of Examples 34-37, wherein the high priority level is communicated with at least one of marking, highlighting, highlighting, and blinking.

Example 39 - The system of any one of Examples 34-38, wherein the screen is positioned on the surgical device.

[00403] Example 40 - The system of any one of Examples 34-39, further comprising an imaging system including a video monitor positionable in an operating room, wherein the screen is positioned on the video monitor.

Although several forms have been illustrated and described, it is not the applicant's intention to limit or limit the scope of the appended claims to such details. Many modifications, variations, alterations, permutations, combinations and equivalents of these forms can be implemented and will occur to those skilled in the art without departing from the scope of this disclosure. Further, the structure of each element associated with the described form can be alternatively described as a means for providing the function performed by that element. Also, although materials are disclosed for particular components, other materials may be used. Accordingly, the above description and appended claims are intended to cover all such modifications, combinations, and variations as included within the scope of the disclosed forms. Please understand. The appended claims are intended to cover all such modifications, variations, alterations, substitutions, modifications and equivalents.

The foregoing detailed description has set forth various aspects of apparatus and/or processes through block diagrams, flowcharts, and/or examples. To the extent such block diagrams, flowcharts and/or examples include one or more functions and/or operations, one of ordinary skill in the art may understand each function and function included in such block diagrams, flowcharts and/or examples. It will be appreciated that the operations may be implemented individually and/or collectively by various hardware, software, firmware, or virtually any combination thereof. One skilled in the art will appreciate that all or part of some aspects of the forms disclosed herein can be implemented as one or more computer programs running on one or more computers (e.g., one or more as one or more programs running on a computer system), as one or more programs running on one or more processors (e.g., as one or more programs running on one or more microprocessors), can equally be implemented in an integrated circuit as firmware, or virtually any combination thereof, and designing the circuit and/or writing code for the software and/or firmware, given the present disclosure are within the skill of those in the art. Further, the features of the subject matter described herein are capable of being distributed as one or more program products in a variety of forms, and the exemplary forms of the subject matter described herein may be implemented in a variety of ways. It will be understood by those skilled in the art that this applies regardless of the particular type of signal-bearing medium used to carry out the.

The instructions used to program the logic to perform the various disclosed aspects are stored in memory within the system, such as dynamic random access memory (DRAM), cache, flash memory, or other storage devices. obtain. Additionally, the instructions may be distributed over a network or by other computer-readable media. Thus, a machine-readable medium can include any mechanism for storing or transmitting information in a form readable by a machine (e.g., a computer), including floppy diskettes, optical discs, compact discs, read-only memory ( CD-ROM), magneto-optical discs, read-only memory (ROM), random-access memory (RAM), erasable programmable read-only memory (EPROM), electrically erasable programmable read-only memory (EEPROM), magnetic or optical cards , flash memory, or tangible machines used to transmit information over the Internet via electrical, optical, acoustic, or other forms of propagated signals (e.g., carrier waves, infrared signals, digital signals, etc.) It is not limited to readable storage. Accordingly, non-transitory computer-readable media include any type of tangible machine-readable medium suitable for storing or transmitting electronic instructions or information in a form readable by a machine (eg, a computer).

As used in any aspect herein, the term "control circuitry" includes, for example, hardwired circuits, programmable circuits (e.g., computer processors including one or more individual instruction processing cores, processing units, processors, implemented by microcontrollers, microcontroller units, controllers, digital signal processors (DSPs), programmable logic units (PLDs), programmable logic arrays (PLAs), or field programmable gate arrays (FPGAs), state machine circuits, programmable circuits It can refer to firmware that stores instructions, and any combination thereof. Control circuits, collectively or individually, may be, for example, integrated circuits (ICs), application-specific integrated circuits (ASICs), system-on-chips (SoCs), desktop computers, laptop computers. , tablet computers, servers, smart phones, etc., as circuits forming part of a larger system. Thus, as used herein, the term “control circuit” includes an electrical circuit having at least one discrete electrical circuit, an electrical circuit having at least one integrated circuit, an electrical circuit having at least one application specific integrated circuit, A circuit, a general-purpose computing device configured with a computer program (e.g., a general-purpose computer configured with a computer program that executes, at least in part, a process and/or apparatus described herein, or a process described herein) and/or a microprocessor configured by a computer program that at least partially executes the device); , modems, communications switches, or opto-electrical devices). Those skilled in the art will recognize that the subject matter described herein may be implemented in analog or digital form, or some combination thereof.

As used in any aspect herein, the term "logic" may refer to applications, software, firmware, and/or circuitry configured to perform any of the operations described above. Software may be embodied as software packages, code, instructions, instruction sets, and/or data recorded on a non-transitory computer-readable storage medium. Firmware may be embodied as code, instructions or sets of instructions in a memory device, and/or hard-coded (eg, non-volatile) data.

As used in any aspect of this specification, the terms "component," "system," "module," etc. may be in hardware, a combination of hardware and software, software, or software in execution. It can refer to some computer-related entity.

As used in any aspect herein, "algorithm" refers to a self-consistent sequence of steps leading to a desired result; Refers to the comparison and manipulation of physical quantities and/or logical states, which may take the form of electrical or magnetic signals capable of being otherwise manipulated. It is common practice to refer to these signals as bits, values, elements, symbols, characters, terms, numbers, or the like. These and similar terms may be associated with appropriate physical quantities and are merely convenient labels applied to these quantities and/or states.

The network may include packet-switched networks. The communication devices can communicate with each other using a selected packet-switched network communication protocol. One exemplary communication protocol may include the Ethernet communication protocol, which may enable communication using Transmission Control Protocol/Internet Protocol (TCP/IP). The Ethernet protocol may conform to or be compatible with the Ethernet standard entitled "IEEE 802.3 Standard" published December 2008 by the Institute of Electrical and Electronics Engineers (IEEE) and/or later versions of this standard. can be. Alternatively or additionally, the communication device may V.25 communication protocol can be used to communicate with each other. X. The V.25 communication protocol may conform to or be compatible with standards promulgated by the International Telecommunication Union-Telecommunication Standardization Sector (ITU-T). Alternatively or additionally, the communication devices can communicate with each other using a frame relay communication protocol. The frame relay communication protocol may conform to or be compatible with standards 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 the Asynchronous Transfer Mode (ATM) communication protocol. The ATM communication protocol may conform to or be compatible with the ATM standard published in August 2001 by the ATM Forum under the title "ATM-MPLS Network Interworking 2.0" and/or later versions of this standard. . Of course, different and/or later developed connection-oriented network communication protocols are equally contemplated herein.

Unless expressly specified otherwise, terms such as "process", "calculate", "compute", "determine", "display", etc. are used throughout the foregoing disclosure as is apparent from the foregoing disclosure. Discussion using the term refers to data represented as physical (electronic) quantities in the registers and memory of a computer system, as well as data represented as physical (electronic) quantities in the memory or registers of a computer system or other such information storage, transmission, or display device. It will be understood to refer to the operations and processes of a computer system or similar electronic computing device that manipulates and transforms data into other data that are likewise represented as physical quantities.

As used herein, one or more components are “configured to”, “configurable to”, “operable/operating as "operable/operative to", "adapted/adaptable", "able to", "conformable/conformed to" ” and so on. Those skilled in the art will understand that "configured to" generally refers to active components and/or inactive components and/or standby components, unless the context requires otherwise. It will be understood that it may contain components.

The terms "proximal" and "distal" are used herein with reference to the clinician manipulating the handle portion of the surgical instrument. The term "proximal" refers to the portion closest to the clinician and the term "distal" refers to the portion located farther from the clinician. It will further be appreciated that for convenience and clarity, spatial terms such as "vertical," "horizontal," "above," and "below" may be used herein with respect to the drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and/or absolute.

Those skilled in the art will appreciate that terms generally used herein, and particularly in the appended claims (e.g., in the appended claim text), are generally intended as "non-limiting" terms. is (eg, the term "including" is to be interpreted as "including but not limited to" and the term "having" is to be interpreted as "having at least" and that the term "includes" should be interpreted as "including but not limited to," etc.). Moreover, those skilled in the art will appreciate that where a particular number is intended in the claim statements introduced, such intention is expressly recited in the claim and, in the absence of such statement, such intent does not exist. will be done. For example, as an aid to understanding, the following appended claims may contain the introductory phrases "at least one" and "one or more" to introduce claim recitation. However, the use of such phrases when introducing claim recitations by the indefinite article "a" or "an" may be used even if the introductory phrases "one or more" or "at least one" are used within the same claim. and even when the indefinite articles "a" or "an" are included (e.g., "a" and/or "an" usually mean "at least one" or "one or more ), any particular claim containing such an introduced claim recitation should be construed to suggest that the scope of the claim containing only one such recitation is limited. isn't it. the same holds true where the definite article is used to introduce claim recitations.

Further, even if a specific number is specified in an introduced claim statement, such statement should typically be construed to mean at least the stated number. but will be recognized by those skilled in the art (e.g., where there is simply a statement "two statements" without other modifiers, usually there are at least two statements, or two or more statements matter). Further, where notations like "at least one of A, B, and C, etc." are used, such syntax is generally intended in the sense that a person skilled in the art would understand the notation ( For example, "a system having at least one of A, B, and C" includes, but is not limited to, A only, B only, C only, both A and B, both A and C , both B and C, and/or all of A and B and C, etc.). Where notations like "at least one of A, B, or C, etc." are used, such syntax is generally intended in the sense that one skilled in the art would understand the notation (e.g., A "system having at least one of A, B, or C" includes, but is not limited to, A only, B only, C only, both A and B, both A and C, B and C, and/or all of A and B and C, etc.). Typically, any disjunctive word and/or phrase representing two or more alternative terms, whether in the specification or in a claim, unless the context requires otherwise. It should be understood that the possibility is intended to include one of the terms, either of the terms, or both, whether within the scope of or within the drawings. It will be further understood by those skilled in the art. For example, the phrase "A or B" will typically be understood to include the possibilities of "A" or "B" or "A and B."

With regard to the claims appended hereto, those skilled in the art will understand that the operations recited herein can generally be performed in any order. Additionally, while the flow diagrams of various acts are depicted in sequence(s), it is understood that the various acts may occur in orders other than those illustrated, or may occur simultaneously. It should be. Examples of such alternative orderings include overlapping, interleaving, interrupting, reordering, progressive, preliminary, complementary, simultaneous, inverse, or other different orderings, unless the context requires otherwise. can include Further, terms such as "responding to", "relating to", or other past tense adjectives are generally intended to exclude such variations unless the context dictates otherwise. not intended.

Any reference to "an aspect," "an aspect," "exemplary," "an example," etc., includes at least one aspect that has a particular function, structure, or characteristic described in connection with that aspect. It is worth noting that Thus, the phrases "in one aspect," "in an aspect," "in an example," and "in an example" appearing in various places throughout this specification are not necessarily all referring to the same aspect. Moreover, the particular features, structures or characteristics may be combined in any suitable manner in one or more aspects.

Any patent applications, patents, non-patent publications, or other disclosure material referenced herein and/or listed in any application data sheet is, to the extent the material incorporated herein, is not inconsistent with this specification. , incorporated herein by reference. Therefore, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting statements incorporated herein by reference. Any material, or portion thereof, that is incorporated herein by reference but is inconsistent with any current definitions, opinions, or other disclosures set forth herein shall be deemed to be a shall be incorporated only to the extent that there is no contradiction between

In summary, the many benefits that result from using the concepts described herein have been described. The foregoing description of one or more aspects has been presented for the purposes of illustration and description. It is not intended to be exhaustive or to be limited to the precise forms disclosed. Modifications or variations are possible in light of the above teachings. The one or more embodiments are intended to illustrate principles and practical applications, thereby enabling a person skilled in the art to utilize the various forms, along with various modifications, as suitable for the particular use envisioned. selected and described. It is intended that the claims presented herewith define the overall scope.

[Mode of implementation]
(1) A surgical system comprising:
a sensor configured to detect characteristics of airborne particles in fluid within a patient's peritoneal cavity;
a surgical device configured to perform a surgical function;
A control circuit comprising a processor and a memory storing instructions, the instructions comprising:
receiving an input signal from the sensor indicative of properties of the suspended particles in the fluid;
providing an output signal to the surgical device indicative of an adjustment to the surgical function in response to the input signal;
a control circuit executable by the processor to perform:
(2) The surgical system of Clause 1, wherein the sensor includes at least one of an optical sensor, a laser sensor, an ultrasonic sensor, a magnetic resonance sensor, and a vortex shedding sensor.
Clause 3. The surgical system of clause 1, wherein the properties of the suspended particles in the fluid include at least one of particle type, particle size, particle concentration, particle velocity, and particle direction.
(4) said adjustment to said surgical function proportionally increases said surgical function based on the properties of said suspended particles in said fluid; adding ancillary surgical functions to said surgical function; , and replacing the surgical function with an alternative surgical function.
(5) said surgical device comprises a generator configured to power an energy device at a power level, said adjustment to said surgical function being provided from said generator to said energy device; 2. The surgical system of embodiment 1, comprising adjusting the power level.

(6) wherein the surgical device comprises a smoke evacuator comprising a pump configured to operate at a speed, and wherein said adjustment to said surgical function comprises adjusting said speed of said pump; A surgical system according to aspect 1.
Embodiment 1, wherein said surgical device comprises a smoke evacuator comprising a filtration system, and wherein said adjustment to said surgical function comprises adjusting a flow path of said smoke evacuator through said filtration system. The surgical system described in .
Embodiment 7 wherein said filtration system comprises a particulate filter, said flow path being bypassed through said particulate filter when said input signal indicates an increase in particulate concentration of suspended particles in said fluid. The surgical system described in .
Embodiment 7 wherein said filtration system comprises a condenser, said flow path being diverted through said condenser when said input signal indicates an increase in aerosol concentration of suspended particles in said fluid. The surgical system described in .
Aspect 10. Aspect 1, wherein the surgical device comprises an operating room vent, and wherein the adjustment to the surgical function comprises adjusting the operating room vent to increase ventilation therethrough. surgical system.

(11) The control circuit
receiving a plurality of input signals indicative of a plurality of properties of suspended particles in said fluid, said plurality of input signals comprising said input signals;
providing to the surgical device the output signal indicative of the adjustment to the surgical function in response to the plurality of input signals;
2. The surgical system of embodiment 1, further configured to perform:
(12) A non-transitory medium storing computer readable instructions, which when executed cause the surgical device to:
receiving an input signal from a sensor that is characteristic of airborne particles in fluid within the patient's peritoneal cavity;
providing a surgical device with an output signal indicative of an adjustment to a surgical function in response to the input signal.
13. The non-transitory method of claim 12, wherein the computer readable instructions, when executed, cause the surgical device to provide the output signal to the generator to adjust the power level of the generator. medium.
Clause 14. The computer readable instructions of clause 12, wherein the computer readable instructions, when executed, cause the surgical device to provide the output signal to the smoke evacuator to adjust the speed of the smoke evacuator pump. non-transitory medium.
Clause 15. Aspect 15, wherein the computer readable instructions, when executed, cause the surgical device to provide the output signal to the smoke evacuator to adjust a flow path through the smoke evacuator. non-transitory medium.

(16) the computer readable instructions, when executed, instruct the surgical device to perform the surgical function by altering the surgical function in proportion to changes in properties of the airborne particles in the fluid; 13. The non-transitory medium of embodiment 12, which is conditioned.
Clause 17. A clause 17, wherein the computer readable instructions, when executed, cause the surgical device to adjust the surgical function by adding ancillary surgical functions in combination with the surgical function. non-transitory medium of
18. The method of claim 12, wherein the computer readable instructions, when executed, cause the surgical device to adjust the surgical function by replacing the surgical function with an alternative surgical function. Temporary medium.
(19) A method comprising:
receiving an input signal from a sensor that is characteristic of airborne particles in fluid within the patient's peritoneal cavity;
and automatically providing an output signal to the surgical device indicative of an adjustment to a surgical function of the surgical device in response to the input signal.
(20) receiving from the sensor a second input signal indicative of a property of the suspended particles in the fluid at a time after receiving the input signal;
and automatically providing a second output signal to the second surgical device indicative of an adjustment to the surgical function of the second surgical device in response to the second input signal. 20. The method of embodiment 19, wherein said second surgical device is different than said first surgical device.

Claims (10)

A surgical system,
a sensor configured to detect characteristics of airborne particles in fluid within a patient's peritoneal cavity;
a surgical device configured to perform a surgical function;
A control circuit comprising a processor and a memory storing instructions, the instructions comprising:
receiving an input signal from the sensor indicative of the property of the suspended particles in the fluid;
providing an output signal to the surgical device indicative of an adjustment to the surgical function in response to the input signal;
a control circuit executable by the processor to perform
The surgical system, wherein the surgical device comprises a smoke evacuator comprising a filtration system, and wherein the adjustment to the surgical function comprises adjusting a flow path of the smoke evacuator through the filtration system. The surgical system of any one of the preceding claims, wherein the sensor includes at least one of an optical sensor, a laser sensor, an ultrasonic sensor, a magnetic resonance sensor, and an eddy current sensor. The surgical system of claim 1, wherein the properties of the suspended particles in the fluid include at least one of particle type, particle size, particle concentration, particle velocity, and particle direction. said adjustment to said surgical function proportionally increasing said surgical function based on said properties of said suspended particles in said fluid; adding an ancillary surgical function to said surgical function; The surgical system of claim 1, including at least one of replacing the surgical function with an alternative surgical function. wherein the surgical device comprises a generator configured to power an energy device at a power level, wherein the adjustment to the surgical function is the power level supplied from the generator to the energy device. 2. The surgical system of claim 1, comprising adjusting the . The surgical system of claim 1, wherein the smoke evacuator comprises a pump configured to operate at a speed, and wherein the adjustment to the surgical function comprises adjusting the speed of the pump. . 2. The filtration system of claim 1, wherein the filtration system comprises a particulate filter, the flow path being bypassed through the particulate filter when the input signal indicates an increased particulate concentration of the suspended particles in the fluid. surgical system. 2. The filtration system of claim 1 , wherein the filtration system comprises a condenser, the flow path being diverted through the condenser when the input signal indicates an increase in aerosol concentration of the airborne particles in the fluid. surgical system. A surgical system,
a sensor configured to detect characteristics of airborne particles in fluid within a patient's peritoneal cavity;
a surgical device configured to perform a surgical function;
A control circuit comprising a processor and a memory storing instructions, the instructions comprising:
receiving an input signal from the sensor indicative of the property of the suspended particles in the fluid;
providing an output signal to the surgical device indicative of an adjustment to the surgical function in response to the input signal;
a control circuit executable by the processor to perform
The surgical system, wherein the surgical device comprises an operating room vent, and wherein the adjustment to the surgical function comprises adjusting the operating room vent to increase ventilation therethrough. A surgical system,
a sensor configured to detect characteristics of airborne particles in fluid within a patient's peritoneal cavity;
a surgical device configured to perform a surgical function;
A control circuit comprising a processor and a memory storing instructions, the instructions comprising:
receiving an input signal from the sensor indicative of the property of the suspended particles in the fluid;
providing an output signal to the surgical device indicative of an adjustment to the surgical function in response to the input signal;
a control circuit executable by the processor to perform
The control circuit
receiving a plurality of input signals indicative of a plurality of properties of the suspended particles in the fluid, wherein the plurality of input signals includes the input signals;
providing to the surgical device the output signal indicative of the adjustment to the surgical function in response to the plurality of input signals;
a surgical system further configured to perform

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