BR112020012781B1 - SURGICAL INSTRUMENT - Google Patents

Abstract

The present invention relates to a surgical instrument that includes an end actuator, a motor for opening and closing the jaws, a sensor configured to detect a tissue compression parameter associated with a tissue between the jaws, and a control circuit. control. The control circuit is configured to determine a value of the tissue compression parameter through the sensor as the grippers transition from the open configuration to the closed configuration, causing the motor to increase a transition time from the grippers to the closed configuration in the in case the tissue compression parameter value is above a first threshold, and provide feedback in case the tissue compression parameter value is below a second threshold.

Description

CROSS REFERENCE TO RELATED PATENT APPLICATIONS

[0001] This application claims the benefit of priority under 35 U.S.C. § 119 (e) to U.S. Provisional Patent Application Serial No. 62/691,227, entitled CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSED CLOSURE PARAMETERS, filed June 28, 2018 , the description of each of which is incorporated herein by way of reference, in its entirety.

[0002] This application claims the benefit of priority under 35 U.S.C.§ 119 (e) to US Provisional Patent Application No. 62/650,887, entitled SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES, filed March 30, 2018, to the patent application provisional US serial no. 62/650,877, titled SURGICAL SMOKE EVACUATION SENSING AND CONTROLS, filed on March 30, 2018, to provisional patent application serial no. 62/650,882, titled SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM, filed at March 30, 2018, and provisional patent application serial no. 62/650,898, entitled CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS, filed on March 30, 2018, the description of each of which is incorporated herein reference title, in its entirety.

[0003] This application also claims the benefit of priority under 35 U.S.C.§ 119(e) to U.S. Provisional Patent Application Serial No. 62/640,417, entitled TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR, filed March 8, 2018, and to provisional patent application serial no. 62/640,415, entitled ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR filed on March 8, 2018, the description of each of which is incorporated herein by way of reference, in its entirety.

[0004] The present application claims priority under 35 U.S.C.§ 119(e) to US Provisional Patent Application Serial No. 62/611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, to US Provisional Patent Application serial no. 62/611,340, titled CLOUD-BASED MEDICAL ANALYTICS, filed on December 28, 2017, and US provisional patent application serial no. 62/611,339, titled ROBOT ASSISTED SURGICAL PLATFORM, filed on December 28, 2017, the description of each of which is incorporated here by reference, in its entirety.

BACKGROUND OF THE INVENTION

[0005] The present invention relates to various surgical systems.

SUMMARY

[0006] A surgical instrument comprises an end actuator comprising claws transitional between an open configuration and a closed configuration; a motor operatively coupled to the grippers, the motor being configured to transition between the open configuration and the closed configuration of the grippers; a sensor configured to transmit at least one signal indicative of a tissue compression parameter associated with a tissue between the grippers; a control circuit coupled to the sensor and the motor. The control circuit is configured to: receive the at least one signal; determining a value of the tissue compression parameter based on the at least one signal as the claws transition from the open configuration to the closed configuration; causing the motor to increase a transition time from the claws to the closed configuration in case the value of the tissue compression parameter is above a first limit; and provide feedback in case the value of the tissue compression parameter is below a second threshold.

[0007] In another aspect, a surgical instrument includes an end actuator that has jaws transitionable between an open configuration and a closed configuration; one or more sensors disposed along a tissue contact surface of each of the claws, the one or more sensors being configured to detect contact with a tissue. The surgical instrument further includes a motor operatively coupled to the jaws, the motor being configured to transition between the open configuration and the closed configuration of the jaws; and a control circuit coupled to the one or more sensors and the motor. The control circuit is configured to: determine an initial contact point at which the fabric contacts the gripper contact surfaces; determine a separation between the claws at the initial point of contact; determining a degree of contact between the fabric contact surfaces and the fabric; causing the motor to transition the grippers to the closed configuration at a rate corresponding to the separation between the grippers and the degree of contact between the contact surfaces and the tissue at the initial point of contact; and causing the motor to adjust the rate at which the grippers are transitioned to the closed configuration in the event that a force exerted by the motor to transition the grippers to the closed configuration exceeds a limit, the limit corresponding to the separation between the grippers and the degree of contact between the fabric contact surfaces and the fabric at the point of initial contact.

[0008] In one aspect, a surgical instrument includes an end actuator with claws configured to transition between an open configuration and a closed configuration for gripping a tissue; and a contact sensor assembly configured to detect the fabric against the same; The surgical instrument further includes a position sensor configured to detect a configuration of the claws; a motor coupled to the grippers, the motor being configured to transition the grippers between the open configuration and the closed configuration; and a control circuit coupled to the contact sensor assembly, the position sensor and the motor. The control circuit is configured to: determine an initial contact point at which the fabric comes into contact with the grippers; determine the configuration of the claws through the position sensor at the initial contact point; determining an amount of tissue contact between the tissue and the grippers via the contact sensor assembly at the initial point of contact; setting a closing rate at which the motor transitions the grippers to the closed configuration according to the gripper configuration and the amount of tissue contact at the initial point of contact; define a closing limit according to the configuration of the claws and the amount of contact with the tissue at the initial point of contact; and controlling the motor in accordance with a force exerted by the motor to transition the grippers to the closed configuration relative to a threshold

FIGURES

[0009] Appeals from various aspects are presented with particularity in the attached claims. The various aspects, however, as regards both the organization and the methods of operation, together with additional objects and advantages thereof, may be better understood by reference to the description given below, considered in conjunction with the annexed drawings, as below.

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

[0011] Figure 2 is a surgical system being used to perform a surgical procedure in an operating room, in accordance with at least one aspect of the present description.

[0012] Figure 3 is a central surgical controller paired with a visualization system, a robotic system, and an intelligent instrument, in accordance with at least one aspect of the present description.

[0013] Figure 4 is a partial perspective view of a central surgical controller compartment, and a combination generator module that can be slidably received in a drawer of the central surgical controller compartment, according to at least one aspect of the present description.

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

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

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

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

[0018] Figure 9 illustrates a computer-implemented interactive surgical system, in accordance with at least one aspect of the present description.

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

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

[0021] Figure 12 illustrates a logical diagram of a control system for a surgical instrument or tool, in accordance with at least one aspect of the present description.

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

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

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

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

[0026] Figure 17 is a schematic diagram of a robotic surgical instrument configured to operate a surgical tool described therein, in accordance with at least one aspect of the present description.

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

[0028] Figure 19 is a schematic diagram of a surgical instrument configured to control various functions, in accordance with at least one aspect of the present description.

[0029] Figure 20 is a stroke length graph showing an example of a control system that modifies the stroke length of a grip assembly based on the joint angle.

[0030] Figure 21 is a closure tube assembly positioning chart showing an example of a control system modifying a longitudinal position of the closure tube assembly based on the pivot angle;

[0031] Figure 22 is a comparison of a stapling method that utilizes controlled tissue compression versus a stapling method without controlled tissue compression.

[0032] Figure 23 is a force graph shown in section A and a related displacement graph shown in section B, wherein the force graph and the displacement graph have an x axis defining time, a y axis of the displacement graph defines a displacement of a firing rod, and a y-axis of the force graph defines a torsional force detected in a motor configured to advance the firing rod.

[0033] Figure 24 is a schematic illustration of a tissue contact circuit showing completion of the circuit upon contact of a pair of spaced contact plates with the tissue.

[0034] Figure 25 is a perspective view of a surgical instrument having an interchangeable drive shaft assembly operatively coupled thereto, in accordance with at least one aspect of this description.

[0035] Figure 26 is an exploded view of a portion of the surgical instrument of Figure 25, in accordance with at least one aspect of this description.

[0036] Figure 27 is an exploded view of portions of the interchangeable drive shaft assembly, in accordance with at least one aspect of this description.

[0037] Figure 28 is an exploded view of an end actuator of the surgical instrument of Figure 25, in accordance with at least one aspect of this description.

[0038] Figure 29A is a block diagram of a control circuit of the surgical instrument of Figure 25 comprising two drawing sheets, in accordance with at least one aspect of this description.

[0039] Figure 29B is a block diagram of a control circuit of the surgical instrument of Figure 25 comprising two drawing sheets, in accordance with at least one aspect of this description.

[0040] Figure 30 is a block diagram of the control circuit of the surgical instrument of Figure 25 that illustrates interfaces between the handle assembly, the power assembly and the handle assembly and the interchangeable drive shaft assembly, in accordance with with at least one aspect of the present disclosure.

[0041] Figure 31 shows an example of a medical device that may include one or more aspects of the present invention.

[0042] Figure 32 represents an example of an end actuator of a medical device surrounding tissue, in accordance with one or more aspects of the present description.

[0043] Figure 33 represents an example of an end actuator of a medical device compressing tissue, in accordance with one or more aspects of the present description.

[0044] Figure 34 represents exemplary forces exerted by an end actuator of a tissue compressor medical device, in accordance with one or more aspects of the present description.

[0045] Figure 35 also represents exemplary forces exerted by an end actuator of a tissue compressor medical device, in accordance with one or more aspects of the present description.

[0046] Figure 36 represents an example of a tissue compression sensing system, in accordance with one or more aspects of the present description.

[0047] Figure 37 also represents an example of a tissue compression sensing system, in accordance with one or more aspects of the present description.

[0048] Figure 38 also represents an example of a tissue compression sensing system, in accordance with one or more aspects of the present description.

[0049] Figure 39 is also an example of a circuit diagram, in accordance with one or more aspects of the present description.

[0050] Figure 40 is also an example of a circuit diagram, in accordance with one or more aspects of the present description.

[0051] Figure 41 is a graph representing an example of frequency modulation in accordance with one or more aspects of the present description.

[0052] Figure 42 is a graph representing an RF compound in accordance with one or more aspects of the present description.

[0053] Figure 43 is a graph representing RF signals filtered in accordance with one or more aspects of the present description.

[0054] Figure 44 is a perspective view of a surgical instrument with a pivotable, interchangeable drive shaft.

[0055] Figure 45 is a side view of the tip of the surgical instrument.

[0056] Figures 46 to 50 are graphs plotting gap size over time (Figure 46), firing current over time (Figure 47), tissue compression over time (Figure 48), anvil deformation over time (Figure 49), and trigger strength over time (Figure 50).

[0057] Figure 51 is a graph plotting tissue displacement as a function of tissue compression for normal tissues.

[0058] Figure 52 is a graph plotting tissue displacement as a function of tissue compression to distinguish normal tissue and diseased tissue.

[0059] Figure 53 illustrates an embodiment of an end actuator comprising a first sensor and a second sensor.

[0060] Figure 54 is a logic diagram illustrating one embodiment of a process for adjusting the measurement of the first sensor based on input from the second sensor of the end actuator illustrated in Figure 53.

[0061] Figure 55 is a logic diagram illustrating one embodiment of a process for determining a lookup table for a first sensor based on input from a second sensor.

[0062] Figure 56 is a logic diagram illustrating one embodiment of a process for calibrating a first sensor in response to an input from a second sensor.

[0063] Figure 57 is a logic diagram illustrating one embodiment of a process for determining and displaying the thickness of a section of tissue clamped between an anvil and a staple cartridge of an end actuator.

[0064] Figure 58 is a logic diagram illustrating one embodiment of a process for determining and displaying the thickness of a tissue section secured between the anvil and the end actuator staple cartridge.

[0065] Figure 59 is a graph illustrating an adjusted Hall effect thickness measurement compared to an unmodified Hall effect thickness measurement.

[0066] Figure 60 illustrates an embodiment of an end actuator comprising a first sensor and a second sensor.

[0067] Figure 61 illustrates an embodiment of an end actuator comprising a first sensor and a plurality of second sensors.

[0068] Figure 62 is a logic diagram illustrating one embodiment of a process for adjusting a measurement from a first sensor in response to a plurality of secondary sensors.

[0069] Figure 63 illustrates an embodiment of a circuit configured to convert signals from a first sensor and a plurality of secondary sensors into digital signals receivable by a processor.

[0070] Figure 64 illustrates an embodiment of an end actuator comprising a plurality of sensors.

[0071] Figure 65 is a logic diagram illustrating one embodiment of a process for determining one or more tissue properties based on a plurality of sensors.

[0072] Figure 66 illustrates an embodiment of an end actuator comprising a plurality of sensors coupled to a second gripper member.

[0073] Figure 67 illustrates an embodiment of a staple cartridge comprising a plurality of sensors integrally formed therein.

[0074] Figure 68 is a logic diagram illustrating one embodiment of a process for determining one or more parameters of a section of tissue secured within an end actuator.

[0075] Figure 69 illustrates an embodiment of an end actuator comprising a plurality of redundant sensors.

[0076] Figure 70 is a logic diagram illustrating one embodiment of a process for selecting the most reliable output from among a plurality of redundant sensors.

[0077] Figure 71 illustrates an embodiment of an end actuator comprising a sensor that comprises a specific sampling rate to limit or eliminate false signals.

[0078] Figure 72 is a logic diagram illustrating one embodiment of a process for generating a thickness measurement for a section of fabric situated between an anvil and a staple cartridge of an end actuator.

[0079] Figures 73 and 74 illustrate an embodiment of an end actuator comprising a sensor for identifying staple cartridges of different types.

[0080] Figure 75 illustrates an aspect of a segmented flexible circuit configured to be fixedly attached to a claw member of an end actuator, in accordance with at least one aspect of the present description.

[0081] Figure 76 illustrates an aspect of a segmented flexible circuit configured to be mounted on a claw member of an end actuator, in accordance with at least one aspect of the present description.

[0082] Figure 77 illustrates an aspect of an end actuator configured to measure a span of GT fabric, in accordance with at least one aspect of the present description.

[0083] Figure 78 illustrates an aspect of an end actuator comprising a segmented flexible circuit, in accordance with at least one aspect of the present description.

[0084] Figure 79 illustrates the end actuator shown in Figure 78 with the gripper member clamping the tissue between the gripper member and the staple cartridge, in accordance with at least one aspect of the present description.

[0085] Figure 80 is a diagram of an absolute positioning system of a surgical instrument, in which the absolute positioning system comprises a controlled motor drive circuit arrangement comprising a sensor arrangement, in accordance with at least one aspect of the present description.

[0086] Figure 81 is a diagram of a position sensor comprising a magnetic rotary absolute positioning system, in accordance with at least one aspect of the present description.

[0087] Figure 82 is a cross-sectional view of an end actuator of a surgical instrument, showing a course of the trigger member in relation to tissue secured within the end actuator in accordance with at least one aspect of the present description.

[0088] Figure 83 is a first graph of two force closure plots (FTC) representing the force applied to a closing member to close on thick and thin tissue during a closing phase and a second graph of two plots of firing force (FTF) representing the force applied to a firing member to fire through thick and thin tissue during a firing phase.

[0089] Figure 84 is a graphic of a control system configured to provide progressive closure of a closing member during a firing stroke, when the travel member advances distally and engages a clamping arm to decrease the load of the closing force on the closing member at a desired speed and decreasing the firing force load on the firing member, in accordance with at least one aspect of the present description.

[0090] Figure 85 illustrates a proportional integral derivative (PID) controller feedback control system, in accordance with at least one aspect of the present description.

[0091] Figure 86 is a logical flowchart representing a process of a control program or a logical configuration for determining the speed of a closing member, in accordance with at least one aspect of the present description.

[0092] Figure 87 is a timeline showing situational awareness of a central surgical controller, in accordance with at least one aspect of the present description.

[0093] Figure 88 illustrates a block diagram of a surgical system configured to control a surgical function, in accordance with at least one aspect of the present description.

[0094] Figure 89 illustrates a schematic diagram of a situational awareness surgical instrument configured to control various functions, in accordance with at least one aspect of the present description.

[0095] Figure 90 is a logical flowchart representing a situational awareness-based algorithm for controlling a surgical function, in accordance with at least one aspect of the present description.

[0096] Figure 91 is a logical flowchart representing an algorithm for controlling a surgical function, in accordance with at least one aspect of the present description.

[0097] Figure 92 illustrates a portion of patient tissue comprising a tumor as well as surgical margins defined with respect to the tumor, in accordance with at least one aspect of the present description.

[0098] Figure 93 is a logical flowchart of a process representing a control program or a logical configuration for solving device selection problems, in accordance with at least one aspect of the present description.

[0099] Figure 94 illustrates a block diagram of a surgical system configured to determine the suitability of a surgical instrument based on device parameters and detected parameters, in accordance with at least one aspect of the present description.

[0100] Figure 95 illustrates a block diagram of a surgical instrument, in accordance with at least one aspect of the present description;

[0101] Figure 96 illustrates a logical flowchart of a process for controlling a surgical instrument according to the integrity of the trapped tissue, in accordance with at least one aspect of the present description.

[0102] Figure 97 illustrates a first graph representing the end actuator force to close versus the time for illustrative firing of a surgical instrument, in accordance with at least one aspect of the present description.

[0103] Figure 98 illustrates a second graph representing the end actuator force to close versus the time for an illustrative firing of a surgical instrument, in accordance with at least one aspect of the present description.

[0104] Figure 99 illustrates a logical flowchart of a process for controlling a surgical instrument according to the physiological type of the trapped tissue, in accordance with at least one aspect of the present description.

[0105] Figure 100A illustrates a side elevation view of an end actuator clamping parenchyma, with the end actuator being in the position of initial contact with the parenchyma, in accordance with at least one aspect of the present description.

[0106] Figure 100B illustrates a side elevation view of an end actuator clamping parenchyma, with the end actuator being closed, in accordance with at least one aspect of the present description.

[0107] Figure 101A illustrates a side elevation view of an end actuator clamping a vessel, with the end actuator being in the position of initial contact with the vessel, in accordance with at least one aspect of the present description.

[0108] Figure 101B illustrates a side elevation view of an end actuator clamping a vessel, with the end actuator being closed, in accordance with at least one aspect of the present description.

[0109] Figure 102 illustrates a first graph and a second graph representing the force of the end actuator to close and the closing speed, respectively, versus the time for illustrative shots of a surgical instrument pinching the parenchyma, according to at least least one aspect of the present description.

[0110] Figure 103 illustrates a third graph and a fourth graph representing the end actuator force to close and the closing speed, respectively, versus the time for illustrative shots of a surgical instrument clamping a vessel, according to at least least one aspect of the present description.

[0111] Figure 104 illustrates a fifth graph representing end actuator force to close and closing speed versus time for an illustrative firing of a surgical instrument, in accordance with at least one aspect of the present description.

[0112] Figure 105 illustrates a fifth graph representing end actuator force to close and closing speed versus time for an illustrative firing of a surgical instrument, in accordance with at least one aspect of the present description.

[0113] Figure 106 illustrates a fifth graph representing end actuator force to close and closing speed versus time for an illustrative firing of a surgical instrument, in accordance with at least one aspect of the present description.

[0114] Figure 107 illustrates a graph showing impedance versus time to determine when the claws of a surgical instrument contact tissue and/or staples, in accordance with at least one aspect of the present description.

[0115] Figure 108 illustrates a first graph representing various tissue closure thresholds for controlling closure of the end actuator, in accordance with at least one aspect of the present description.

[0116] Figure 109 illustrates a second graph representing various tissue closure thresholds for controlling closure of the end actuator, in accordance with at least one aspect of the present description.

[0117] Figure 110 is a logical flowchart of a process representing a control program or a logical configuration for adjusting a closure rate algorithm, in accordance with at least one aspect of the present description.

DESCRIPTION

[0118] The applicant of this application holds the following US patent applications, filed on June 29, 2018, the description of each of which is incorporated herein by reference in its entirety: • Patent application serial no. U.S. __________ , entitled CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS, attorney docket no. END8542USNP/170755; • US patent application serial no., entitled CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSED CLOSURE PARAMETERS, attorney document no. END8543USNP/170760; • US patent application serial no., entitled SYSTEMS FOR ADJUSTING END EFFECTOR PARAMETERS BASED ON PERIOPERATIVE INFORMATION, attorney document no. END8543USNP1/170760-1; • US patent application serial no., entitled SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING, attorney document no. END8543USNP2/170760-2; • US patent application serial no., entitled SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING, attorney document no. END8543USNP3/170760-3; • US patent application serial no., entitled SURGICAL SYSTEMS FOR DETECTING END EFFECTOR TISSUE DISTRIBUTION IRREGULARITIES, attorney document no. END8543USNP4/170760-4; • US patent application serial no., entitled SYSTEMS FOR DETECTING PROXIMITY OF SURGICAL END EFFECTOR TO CANCEROUS TISSUE system, attorney document no. END8543USNP5/170760-5; • US patent application serial no. __________, entitled SURGICAL INSTRUMENT CARTRIDGE SENSOR ASSEMBLIES, attorney document no. END8543USNP6/170760- 6; • US patent application serial no., entitled VARIABLE OUTPUT CARTRIDGE SENSOR ASSEMBLY, attorney document no. END8543USNP7/170760-7; • US patent application serial no. __________, entitled SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE, attorney document no. END8544USNP/170761; • US patent application serial no. __________, entitled SURGICAL INSTRUMENT HAVING A FLEXIBLE CIRCUIT, attorney document no. END8544USNP1/170761-1; • US patent application serial no. __________, entitled SURGICAL INSTRUMENT WITH A TISSUE MARKING ASSEMBLY, attorney document no. END8544USNP2/170761-2; • US patent application serial no., entitled SAFETY SURGICAL SYSTEMS WITH PRIORITIZED DATA TRANSMISSION CAPABILITIES, attorney document no. END8544USNP3/170761-3; • US patent application serial no. __________, entitled SURGICAL EVACUATION SENSING AND MOTOR CONTROL, attorney document no. END8545USNP/170762; • US patent application serial no. __________, entitled SURGICAL EVACUATION SENSOR ARRANGEMENTS, attorney document no. END8545USNP1/170762-1; • US patent application serial no. __________, entitled SURGICAL EVACUATION FLOW PATHS, attorney document no. END8545USNP2/170762-2; • US patent application serial no. __________, entitled SURGICAL EVACUATION SENSING AND GENERATOR CONTROL, attorney document no. END8545USNP3/170762-3; • US patent application serial no. __________, entitled SURGICAL EVACUATION SENSING AND DISPLAY, attorney document no. END8545USNP4/170762-4; • US patent application serial no. __________ , entitled COMMUNICATION OF SMOKE EVACUATION SYSTEM PARAMETERS TO HUB OR CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM, attorney document no. END8546USNP/170763; • US patent application serial no. __________, entitled SMOKE EVACUATION SYSTEM INCLUDING A SEGMENTED CONTROL CIRCUIT FOR INTERACTIVE SURGICAL PLATFORM, attorney document no. END8546USNP1/170763-1; • US patent application serial no. __________, entitled SURGICAL EVACUATION SYSTEM WITH A COMMUNICATION CIRCUIT FOR COMMUNICATION BETWEEN A FILTER AND A SMOKE EVACUATION DEVICE, attorney document no. END8547USNP/170764; and • US Patent Application Serial No. __________, entitled DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS, Attorney Document No. END8548USNP/170765.

[0119] The applicant of this application holds the following US provisional patent applications, filed on June 28, 2018, the description of each of which is incorporated herein by reference in its entirety: • US provisional patent application no. serial number 62/691,228, entitled A Method of using reinforced flex circuits with multiple sensors with electrosurgical devices; • US provisional patent application serial no. 62/691,230, entitled SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE; • US provisional patent application serial no. 62/691,219, entitled SURGICAL EVACUATION SENSING AND MOTOR CONTROL; • US provisional patent application serial no. 62/691,257, entitled COMMUNICATION OF SMOKE EVACUATION SYSTEM PARAMETERS TO HUB OR CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM; • US provisional patent application serial no. 62/691,262, entitled SURGICAL EVACUATION SYSTEM WITH A COMMUNICATION CIRCUIT FOR COMMUNICATION BETWEEN A FILTER AND A SMOKE EVACUATION DEVICE; and • US provisional patent application serial no. 62/691,251, entitled DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS.

[0120] The applicant of this application holds the following US patent applications, filed on March 29, 2018, the description of each of which is incorporated herein by reference in its entirety: • US patent application no. series 15/940,641, entitled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES; • US patent application serial no. 15/940,648, entitled INTERACTIVE SURGICAL SYSTEMS WITH CONDITION HANDLING OF DEVICES AND DATA CAPABILITIES; • US patent application serial no. 15/940,656, entitled SURGICAL HUB COORDINATION OF CONTROL AND COMMUNICATION OF OPERATING ROOM DEVICES; • US patent application serial no. 15/940,666, entitled SPATIAL AWARENESS OF SURGICAL HUBS IN OPERATING ROOMS; • US patent application serial no. 15/940,670, entitled COOPERATIVE UTILIZATION OF DATA DERIVED FROM SECONDARY SOURCES BY INTELLIGENT SURGICAL HUBS; • US patent application serial no. 15/940,677, entitled SURGICAL HUB CONTROL ARRANGEMENTS; • US Patent Application Serial No. 15/940,632, entitled DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD; • US Patent Application Serial No. 15/940,640, entitled COMMUNICATION HUB AND STORAGE DEVICE FOR STORING PARAMETERS AND STATUS OF A SURGICAL DEVICE TO BE SHARED WITH CLOUD BASED ANALYTICS SYSTEMS; • US patent application serial no. 15/940,645, entitled SELF DESCRIBING DATA PACKETS GENERATED AT AN ISSUING INSTRUMENT; • US Patent Application Serial No. 15/940,649, entitled DATA PAIRING TO INTERCONNECT A DEVICE MEASURED PARAMETER WITH AN OUTCOME; • US patent application serial no. 15/940,654, entitled SURGICAL HUB SITUATIONAL AWARENESS; • US patent application serial no. 15/940,663, entitled SURGICAL SYSTEM DISTRIBUTED PROCESSING; • US patent application serial no. 15/940,668, entitled AGGREGATION AND REPORTING OF SURGICAL HUB DATA; • US Patent Application Serial No. 15/940,671, entitled SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER; • US Patent Application Serial No. 15/940,686, entitled DISPLAY OF ALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LINEAR STAPLE LINE; • US patent application serial no. 15/940,700, entitled STERILE FIELD INTERACTIVE CONTROL DISPLAYS; • US patent application serial no. 15/940,629, entitled COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS; • US Patent Application Serial No. 15/940,704, entitled USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT; • US Patent Application Serial No. 15/940,722, entitled CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OF MONO-CHROMATIC LIGHT REFRACTIVITY; and • US Patent Application Serial No. 15/940,742, entitled DUAL CMOS ARRAY IMAGING.

[0121] The applicant of this application holds the following US patent applications, filed on March 29, 2018, the description of each of which is incorporated herein by reference in its entirety: • US patent application no. series 15/940,636, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES; • US patent application serial no. 15/940,653, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL HUBS; • US Patent Application Serial No. 15/940,660, entitled CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER; • US Patent Application Serial No. 15/940,679, entitled CLOUD-BASED MEDICAL ANALYTICS FOR LINKING OF LOCAL USAGE TRENDS WITH THE RESOURCE ACQUISITION BEHAVIORS OF LARGER DATA SET; • US Patent Application Serial No. 15/940,694, entitled CLOUD-BASED MEDICAL ANALYTICS FOR MEDICAL FACILITY SEGMENTED INDIVIDUALIZATION OF INSTRUMENT FUNCTION; • US Patent Application Serial No. 15/940,634, entitled CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES; • US patent application serial no. 15/940,706, entitled DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK; and • US Patent Application Serial No. 15/940,675, entitled CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES.

[0122] The applicant of this application holds the following US patent applications, filed on March 29, 2018, the description of each of which is incorporated herein by reference in its entirety: • US patent application no. series 15/940,627, entitled DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; • US Patent Application Serial No. 15/940,637, entitled COMMUNICATION ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; • US patent application serial no. 15/940,642, entitled CONTROLS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; • US patent application serial no. 15/940,676, entitled AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; • US patent application serial no. 15/940,680, entitled CONTROLLERS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; • US patent application serial no. 15/940,683, entitled COOPERATIVE SURGICAL ACTIONS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; • US patent application serial no. 15/940,690, entitled DISPLAY ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; and • US Patent Application Serial No. 15/940,711, entitled SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS.

[0123] The applicant of this application holds the following provisional US patent applications, filed on March 28, 2018, the description of each of which is incorporated herein by reference in its entirety: • US provisional patent application no. serial number 62/649,302, entitled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES; • US provisional patent application serial no. 62/649,294, entitled DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD; • US provisional patent application serial no. 62/649,300, entitled SURGICAL HUB SITUATIONAL AWARENESS; • US provisional patent application serial no. 62/649,309, entitled SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER; • US provisional patent application serial no. 62/649,310, entitled COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS; • US provisional patent application serial no. 62/649,291, entitled USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT; • US provisional patent application serial no. 62/649,296, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES; • US provisional patent application serial no. 62/649,333, entitled CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER; • US provisional patent application serial no. 62/649,327, entitled CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES; • US provisional patent application serial no. 62/649,315, entitled DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK; • US provisional patent application serial no. 62/649,313, entitled CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES; • US provisional patent application serial no. 62/649,320, entitled DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; • US provisional patent application serial no. 62/649,307, entitled AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; and • US provisional patent application serial no. 62/649,323, entitled SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS.

[0124] The applicant of this application holds the following US provisional patent applications, filed on April 19, 2018, the description of each of which is incorporated herein by reference in its entirety: • US provisional patent application no. No. 62/659,900, entitled METHOD OF HUB COMMUNICATION.

[0125] The applicant of this application holds the following provisional US patent applications, filed on March 30, 2018, the description of each of which is incorporated herein by reference in its entirety: • US provisional patent application no. serial number 62/650,887, entitled SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES; • US provisional patent application serial no. 62/650,877, entitled SURGICAL SMOKE EVACUATION SENSING AND CONTROLS; • US provisional patent application serial no. 62/650,882, entitled SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM; and • US Provisional Patent Application Serial No. 62/650,898, entitled CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS.

[0126] The applicant of this application holds the following provisional US patent applications, filed on March 8, 2018, the description of each of which is incorporated herein by reference in its entirety: • US provisional patent application no. serial number 62/640,417, entitled TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR; and • US provisional patent application serial no. 62/640,415, entitled ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR.

[0127] The applicant of this application holds the following provisional US patent applications, filed on December 28, 2017, the description of each of which is incorporated herein by reference in its entirety: • US provisional patent application no. serial number 62/611,341, entitled INTERACTIVE SURGICAL PLATFORM; • US provisional patent application serial no. 62/611,340, entitled CLOUD-BASED MEDICAL ANALYTICS; and • US provisional patent application serial no. 62/611,339, entitled ROBOT ASSISTED SURGICAL PLATFORM.

[0128] Before explaining in detail the various aspects of surgical instruments and generators, it should be noted that the illustrative examples are not limited, in terms of application or use, to the details of construction and arrangement of parts illustrated in the drawings and description attached. The illustrative examples may be implemented or incorporated in other aspects, variations and modifications, and may be practiced or performed in various ways. Furthermore, except where otherwise indicated, the terms and expressions used in the present invention have been chosen for the purpose of describing the illustrative examples for the convenience of the reader and not for the purpose of limiting the same. Furthermore, it should be understood that one or more of the aspects, aspect expressions, and/or examples described below may be combined with any one or more of the other aspects, aspect expressions, and/or examples described below.

[0129] Before explaining in detail the various aspects of surgical instruments and generators, it should be noted that the illustrative examples are not limited, in terms of application or use, to the details of construction and arrangement of parts illustrated in the drawings and description attached. The illustrative examples may be implemented or incorporated in other aspects, variations and modifications, and may be practiced or performed in various ways. Furthermore, except where otherwise indicated, the terms and expressions used in the present invention have been chosen for the purpose of describing the illustrative examples for the convenience of the reader and not for the purpose of limiting the same. Furthermore, it should be understood that one or more of the aspects, aspect expressions, and/or examples described below may be combined with any one or more of the other aspects, aspect expressions, and/or examples described below.

[0130] Certain exemplary aspects will now be described to provide a general understanding of the principles of structure, function, manufacture and use of the devices and methods described herein. One or more examples of these aspects are illustrated in the attached drawings. Those skilled in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are exemplary aspects without limitation, and that the scope of the various aspects is defined only by the claims. Features illustrated or described in relation to an exemplary aspect may be combined with features of other aspects. Such modifications and variations are intended to be included within the scope of the appended claims.

[0131] Referring to Figure 1, a computer-implemented interactive surgical system 100 includes one or more surgical systems 102 and a cloud-based system (e.g., cloud 104 that may include a remote server 113 coupled to a storage device 105). Each surgical system 102 includes at least one central surgical controller 106 communicating with the cloud 104 that may include a remote server 113. In one example, as illustrated in Figure 1, the surgical system 102 includes a visualization system 108, a robotic system 110, a smart handheld surgical instrument 112, which are configured to communicate with each other and/or the central controller 106. In some aspects, a surgical system 102 may include an M number of central controllers 106, an N number of visualization systems 108, an O number of robotic systems 110, and a P number of intelligent handheld surgical instruments 112, where M, N, O, and P are integers greater than or equal to one.

[0132] Figure 3 depicts an example of a surgical system 102 being used to perform a surgical procedure on a patient who is lying on an operating table 114 in a surgical operating room 116. A robotic system 110 is used in the surgical procedure as a part of the surgical system 102. The robotic system 110 includes a surgeon console 118, a patient cart 120 (surgical robot), and a surgical robotic central controller 122. The patient cart 120 can handle at least one attached surgical tool removably 117 through a minimally invasive incision in the patient's body while the surgeon views the surgical site through the surgeon's console 118. An image of the surgical site can be obtained by a medical imaging device 124, which can be manipulated by car of the patient 120 to guide the imaging device 124. The robotic central controller 122 may be used to process images of the surgical site for subsequent display to the surgeon via the surgeon console 118.

[0133] Other types of robotic systems can be readily adapted for use with the surgical system 102. Several examples of robotic systems and surgical instruments that are suitable for use with the present disclosure are described in provisional patent application serial no. 62/ 611,339, entitled ROBOT ASSISTED SURGICAL PLATFORM, filed on December 28, 2017, the description of which is incorporated herein by reference in its entirety.

[0134] Various examples of cloud-based analysis that are performed by cloud 104, and are suitable for use with the present disclosure, are described in US provisional patent application serial no. 62/611,340, entitled CLOUD-BASED MEDICAL ANALYTICS , deposited on December 28, 2017, the description of which is incorporated herein by reference, in its entirety.

[0135] 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.

[0136] The optical components of the imaging device 124 may include one or more lighting sources and/or one or more lenses. One or more lighting sources can be directed to illuminate portions of the surgical field. The one or more image sensors may receive reflected or refracted light from the surgical field, including reflected or refracted light from tissue and/or surgical instruments.

[0137] The one or more lighting sources can be configured to radiate electromagnetic energy in the visible spectrum as well as the invisible spectrum. The visible spectrum, sometimes called the optical spectrum or light spectrum, is that portion of the electromagnetic spectrum that is visible to (that is, can be detected by) the human eye and may be called visible light or simply light. A typical human eye will respond to wavelengths in air that are from about 380 nm to about 750 nm.

[0138] The invisible spectrum (i.e., the non-luminous spectrum) is that portion of the electromagnetic spectrum lying below and above the visible spectrum (i.e., wavelengths below about 380 nm and above about 750 nm). The invisible spectrum is not detectable by the human eye. Wavelengths greater than about 750 nm are longer than the visible red spectrum, and they render invisible infrared (IR), microwave, radio, and electromagnetic radiation. Wavelengths shorter than about 380 nm are shorter than the ultraviolet spectrum, and they become invisible ultraviolet, x-ray, and gamma-ray electromagnetic radiation.

[0139] In several aspects, the imaging device 124 is configured for use in a minimally invasive procedure. Examples of imaging devices suitable for use herein include, but are not limited to, an arthroscope, angioscope, bronchoscope, choledochoscope, colonoscope, cytoscope, duodenoscope, enteroscope, esophagus-duodenoscope (gastroscope), endoscope, laryngoscope, nasopharyngo- neproscope, sigmoidoscope, thoracoscope and ureteroscope.

[0140] In one aspect, the imaging device uses multiple spectrum monitoring to discriminate topography and underlying structures. A multispectral image is one that captures image data within wavelength ranges across the electromagnetic spectrum. Wavelengths can be separated by filters or through the use of instruments that are sensitive to specific wavelengths, including light of frequencies beyond the visible light range, for example, IR and ultraviolet light. Spectral imaging can allow the extraction of additional information that the human eye cannot capture with its receptors for the colors red, green and blue. The use of multispectral imaging is described in greater detail under the heading "Advanced Imaging Acquisition Module" in US provisional patent application serial no. 62/611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed December 28, 2017, the description of which is here incorporated by reference in its entirety. Multispectral monitoring can be a useful tool for relocating a surgical field after a surgical task is completed to perform one or more of the previously described tests on the treated tissue.

[0141] It is axiomatic that strict sterilization of the operating room and surgical equipment is necessary during any surgery. The strict hygiene and sterilization conditions required in an "operating room", i.e. an operating or treatment room, justify the highest possible sterilization of all medical devices and equipment. Part of this sterilization process is the need to sterilize anything that comes into contact with the patient or penetrates the sterile field, including the imaging device 124 and its connectors and components. It will be understood that the sterile field may be considered a specified area, such as within a tray or on a sterile towel, that is considered free of microorganisms, or the sterile field may be considered an area, immediately surrounding a patient, which was prepared for a surgical procedure. The sterile field may include grooming team members, who are appropriately attired, and all furniture and accessories in the area.

[0142] In various aspects, the visualization system 108 includes one or more imaging sensors, one or more image processing units, one or more storage arrays, and one or more screens that are strategically disposed relative to the sterile field, as illustrated in Figure 2. In one aspect, the visualization system 108 includes an interface for HL7, PACS and EMR. Various components of the visualization system 108 are described under the heading "Advanced Imaging Acquisition Module" in US Provisional Patent Application Serial No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed December 28, 2017, the description of which is incorporated herein for reference in its entirety.

[0143] As illustrated in Figure 2, a primary screen 119 is positioned in the sterile field to be visible to the operator on the operating table 114. Additionally, a viewing tower 111 is positioned outside the sterile field. The viewing tower 111 includes a first non-sterile screen 107 and a second non-sterile screen 109, which are opposite each other. The display system 108, guided by the central controller 106, is configured to utilize screens 107, 109, and 119 to coordinate the flow of information to operators inside and outside the sterile field. For example, the central controller 106 may cause the visualization system 108 to display a snapshot of a surgical site, as recorded by an imaging device 124, on a non-sterile screen 107 or 109, while maintaining a live feed of the surgical site on the main screen 119. The snapshot on the non-sterile screen 107 or 109 may allow a non-sterile operator to perform a diagnostic step relevant to the surgical procedure, for example.

[0144] In one aspect, the central controller 106 is also configured to route diagnostic input or feedback from a non-sterile operator in the viewing tower 111 to the primary display 119 within the sterile field, where it can be viewed by a sterile operator. on the operating table. In one example, the input may be in the form of a modification of the snapshot displayed on the non-sterile screen 107 or 109, which may be routed to the main screen 119 by the central controller 106.

[0145] Referring to Figure 2, a surgical instrument 112 is being used in the surgical procedure as part of the surgical system 102. The central controller 106 is also configured to coordinate the flow of information to a display of the surgical instrument 112. For example, in US provisional patent application serial no. 62/611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, the description of which is incorporated herein by reference in its entirety. A diagnostic input or feedback entered by a non-sterile operator into the viewing tower 111 may be routed by the central controller 106 to the surgical instrument display 115 in the sterile field, where it can be viewed by the surgical instrument operator 112. Exemplary surgical instruments that are Suitable for use with the Surgical System 102 are described under the heading "Surgical Instrument Hardware" and in Provisional Patent Application Serial No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed December 28, 2017, the description of which is incorporated herein as a reference in its entirety, for example.

[0146] Now referring to Figure 3, a central controller 106 is shown in communication with a visualization system 108, a robotic system 110, and an intelligent handheld surgical instrument 112. The central controller 106 includes a central controller display 135, an imaging module 138, a generator module 140, a communication module 130, a processor module 132, and a storage array 134. In certain aspects, as illustrated in Figure 3, the central controller 106 additionally includes a smoke evacuation module 126 and/or a suction/irrigation module 128.

[0147] During a surgical procedure, the application of energy to the tissue, for sealing and/or cutting, is generally associated with the evacuation of smoke, suction of excess fluid and/or irrigation of the tissue. Fluid, power, and/or data lines from different sources are often intertwined during the surgical procedure. Valuable time can be lost addressing this issue during a surgical procedure. To untangle the lines it may be necessary to disconnect the lines from their respective modules, which may require a reset of the modules. The modular central controller enclosure 136 provides a unified environment for managing power, data, and fluid lines, which reduces the frequency of intertwining between such lines.

[0148] Aspects of the present description present a central surgical controller for use in a surgical procedure involving the application of energy to tissue at a surgical site. The central surgical controller includes a central controller housing and a combined generator module slidably received in a docking station of the central controller housing. The docking station includes data and power contacts. The combined generator module includes two or more of an ultrasonic power generating component, a bipolar RF power generating component, and a monopolar RF power generating component that are housed in a single unit. In one aspect, the combined generator module also includes a smoke evacuation component, at least one cable for applying power to connect the combined generator module to a surgical instrument, at least one smoke evacuation component configured to evacuate smoke, fluid , and/or particulates generated by the application of therapeutic energy to the tissue, and a fluid line extending from the remote surgical site to the smoke evacuation component.

[0149] In one aspect, the fluid line is a first fluid line and a second fluid line extends from the remote surgical site to a suction and irrigation module slidably received in the central controller compartment. In one aspect, the central controller compartment comprises a fluidic interface.

[0150] Certain surgical procedures may require the application of more than one type of energy to the tissue. One type of energy may be more beneficial for cutting tissue, while a different type of energy may be more beneficial for sealing tissue. For example, a bipolar generator can be used to seal the tissue while an ultrasonic generator can be used to cut the sealed tissue. Aspects of the present disclosure present a solution in which a modular compartment of the central controller 136 is configured to accommodate different generators and facilitate interactive communication between them. One of the advantages of the modular central controller enclosure 136 is that it allows for rapid removal and/or replacement of multiple modules.

[0151] Aspects of the present description present a modular surgical compartment for use in a surgical procedure involving application of energy to tissue. The modular surgical compartment includes a first power generating module configured to generate a first power for application to tissue, and a first docking station comprising a first docking port including first data contacts and power contacts, the The first power generating module is slidingly movable in an electrical engagement with the power and data contacts and the first power generating module is slidingly movable out of the electrical engagement with the first power and data contacts.

[0152] In addition to the foregoing, the modular surgical compartment also includes a second energy generating module configured to generate a second energy, different from the first energy, for application to tissue, and a second docking station comprising a second docking port which includes second data and power contacts, the second power generating module being slidingly movable in an electrical engagement with the power and data contacts, and the second power generating module being slidingly movable outwardly of the electrical coupling with the second power and data contacts.

[0153] Additionally, the modular surgical cabinet also includes a communication bus between the first docking port and the second docking port, configured to facilitate communication between the first power generating module and the second power generating module.

[0154] With reference to Figures 3 to 7, aspects of the present description are presented for a modular central controller compartment 136 that allows modular integration of a generator module 140, a smoke evacuation module 126, and a suction/suction module. irrigation 128. The modular central controller housing 136 further facilitates interactive communication between the modules 140, 126, 128. As illustrated in Figure 5, the generator module 140 may be a generator module with integrated, supported monopolar, bipolar, and ultrasonic components. in a single cabinet unit 139 slider-insertable into the modular central controller housing 136. As illustrated in Figure 5, the generator module 140 can be configured to connect to a monopolar device 146, a bipolar device 147, and an ultrasonic device 148 Alternatively, the generator module 140 may comprise a series of monopolar, bipolar and/or ultrasonic generator modules that interact through the modular central controller housing 136. The modular central controller housing 136 may be configured to facilitate the insertion of multiple generators and interactive communication between the generators embedded in the modular central controller compartment 136 so that the generators act as a single generator.

[0155] In one aspect, the modular central controller housing 136 comprises a modular power and communication backplate 149 with external and wireless communication heads to allow removable attachment of modules 140, 126, 128 and interactive communication between the same.

[0156] In one aspect, the modular central controller compartment 136 includes docking stations, or drawers, 151, herein also called drawers, which are configured to slidingly receive modules 140, 126, 128. Figure 4 illustrates a partial perspective view of a central surgical controller housing 136, and a combined generator module 145 slidably received in a docking station 151 of the central surgical controller housing 136. A docking port 152 with power and data contacts in a rear side of the combined generator module 145 is configured to engage a corresponding docking port 150 with the power and data contacts of a corresponding docking station 151 of the central controller modular housing 136 as the combined generator module 145 is slid into position. into the corresponding docking station 151 of the central controller modular housing 136. In one aspect, the combined generator module 145 includes a bipolar, ultrasonic, and monopolar module and a smoke evacuation module integrated into a single cabinet unit 139, as illustrated in Figure 5.

[0157] In various aspects, the smoke evacuation module 126 includes a fluid line 154 that transports captured/collected fluid smoke away from a surgical site and to, for example, the smoke evacuation module 126. The suction The vacuum originating from the smoke evacuation module 126 can draw smoke into an opening of a utility conduit at the surgical site. The utility conduit, coupled to the fluid line, may be in the form of a flexible tube terminating at the smoke evacuation module 126. The utility conduit and fluid line define a fluid path extending toward the smoke evacuation module 126 which is received in the central controller compartment 136.

[0158] In various aspects, the suction/irrigation module 128 is coupled to a surgical tool comprising a fluid aspiration line and a fluid suction line. In one example, the aspiration and suction fluid lines are in the form of flexible tubes extending from the surgical site toward the suction/irrigation module 128. One or more drive systems may be configured to cause irrigation to occur. and aspiration of fluids to and from the surgical site.

[0159] In one aspect, the surgical tool includes a drive shaft having an end actuator at a distal end thereof and at least one energy treatment associated with the end actuator, a suction tube, and a suction tube. irrigation. The suction tube may have an inlet port at a distal end thereof and the suction tube extends through the drive shaft. Similarly, an irrigation tube may extend through the drive shaft and may have an inlet port near the power application implement. The power delivery implement is configured to deliver ultrasonic and/or RF energy to the surgical site and is coupled to the generator module 140 by a cable initially extending through the drive shaft.

[0160] The irrigation tube may be in fluid communication with a fluid source, and the aspiration tube may be in fluid communication with a vacuum source. The fluid source and/or vacuum source may be housed in the suction/irrigation module 128. In one example, the fluid source and/or vacuum source may be housed in the central controller compartment 136 separately from the fluid source module 136. suction/irrigation 128. In such an example, a fluid interface may be configured to connect the suction/irrigation module 128 to the fluid source and/or the vacuum source.

[0161] In one aspect, the modules 140, 126, 128 and/or their corresponding docking stations in the central controller modular housing 136 may include alignment features that are configured to align the docking ports of the mating modules with their counterparts. on the docking stations of the modular central controller housing 136. For example, as illustrated in Figure 4, the combined generator module 145 includes side brackets 155 that are configured to slidably engage corresponding brackets 156 of the corresponding docking station 151 of the housing. central controller modular housing 136. The brackets cooperate to guide the mating port contacts of the combined generator module 145 into an electrical engagement with the mating port contacts of the modular central controller housing 136.

[0162] In some aspects, the drawers 151 of the central controller modular compartment 136 are the same, or substantially the same size, and the modules are adjusted in size to be received in the drawers 151. For example, the side brackets 155 and/or or 156 can be larger or smaller depending on the size of the module. In other aspects, the drawers 151 are different in size and are each designed to accommodate a specific module.

[0163] Additionally, the contacts of a specific module may be switched to engage with the contacts of a specific drawer to avoid inserting a module into a drawer with contact mismatch.

[0164] As illustrated in Figure 4, the docking port 150 of a drawer 151 can be coupled to the docking port 150 of another drawer 151 via a communication link 157 to facilitate interactive communication between the modules housed in the modular compartment of central controller housing 136. Docking ports 150 of modular central controller housing 136 may alternatively or additionally facilitate wireless interactive communication between modules housed in modular central controller housing 136. Any suitable wireless communication may be used, such as Air Titan Bluetooth.

[0165] Figure 6 illustrates individual power bus connectors for a plurality of side docking ports of a side modular cabinet 160 configured to receive a plurality of modules from a central surgical controller 206. The side modular cabinet 160 is configured to receive and laterally interconnect the modules 161. The modules 161 are slidably inserted into the docking stations 162 of the lateral modular cabinet 160, which includes a backplate for interconnecting the modules 161. As illustrated in Figure 6, the modules 161 are arranged laterally in the side modular cabinet 160. Alternatively, the modules 161 can be arranged vertically in a side modular cabinet.

[0166] Figure 7 illustrates a vertical modular cabinet 164 configured to receive a plurality of modules 165 of the central surgical controller 106. The modules 165 are slidably inserted into docking stations, or drawers, 167 of the vertical modular cabinet 164, the which includes a back panel for interconnecting modules 165. Although the drawers 167 of the vertical modular cabinet 164 are arranged vertically, in certain cases, a vertical modular cabinet 164 may include drawers that are arranged laterally. Furthermore, the modules 165 can interact with each other through the docking ports of the vertical modular cabinet 164. In the example of Figure 7, a screen 177 is provided to show data relevant to the operation of the modules 165. Furthermore, the vertical modular cabinet 164 includes a master module 178 that houses a plurality of submodules that are slidably received in the master module 178.

[0167] In various aspects, the imaging module 138 comprises an integrated video processor and a modular light source and is adapted for use with various imaging devices. In one aspect, the imaging device is comprised of a modular enclosure that can be assembled with a light source module and a camera module. The cabinet may be a disposable cabinet. In at least one example, the disposable enclosure is removably coupled to a reusable controller, a light source module, and a camera module. The light source module and/or camera module can be selectively chosen depending on the type of surgical procedure. In one aspect, the camera module comprises a CCD sensor. In another aspect, the camera module comprises a CMOS sensor. In another aspect, the camera module is configured for imaging the scanned beam. Similarly, the light source module can be configured to provide white light or a different light depending on the surgical procedure.

[0168] During a surgical procedure, removing a surgical device from the surgical field and replacing it with another surgical device that includes a different camera or other light source may be inefficient. Temporarily losing sight of the surgical field can lead to undesirable consequences. The imaging device module of the present disclosure is configured to allow replacement of a light source module or a midstream camera module during a surgical procedure, without the need to remove the imaging device from the surgical field.

[0169] In one aspect, the imaging device comprises a tubular housing that includes a plurality of channels. A first channel is configured to slidingly receive the Camera module, which can be configured for a snap-fit fit with the first channel. A second channel is configured to slidingly receive the camera module, which can be configured for a snap-fit fit with the first channel. In another example, the camera module and/or the light source module may be rotated to a final position within their respective channels. A threaded coupler can be used instead of the press fit.

[0170] In several examples, multiple imaging devices are placed at different positions in the surgical field to provide multiple views. The imaging module 138 can be configured to switch between imaging devices to provide an optimal view. In various aspects, the imaging module 138 can be configured to integrate images from different imaging devices.

[0171] Various image processors and imaging devices suitable for use with the present disclosure are described in US Patent No. 7,995,045 entitled COMBINED SBI AND CONVENTIONAL IMAGE PROCESSOR, issued August 9, 2011, which is incorporated herein by way of reference in its entirety. Additionally, US Patent No. 7,982,776, entitled SBI MOTION ARTIFACT REMOVAL APPARATUS AND METHOD, issued July 19, 2011, which is incorporated herein by reference in its entirety, describes various systems for removing motion artifacts from image data. Such systems can be integrated with the imaging module 138. In addition, the publication of US patent application No. 2011/0306840, entitled CONTROLLABLE MAGNETIC SOURCE TO FIXTURE INTRACORPOREAL APPARATUS, published on December 15, 2011, and the publication of the application US Patent No. 2014/0243597, entitled SYSTEM FOR PERFORMING A MINIMALLY INVASIVE SURGICAL PROCEDURE, published on August 28, 2014, which are, the description of each of which, incorporated herein by reference in their entirety.

[0172] Figure 8 illustrates a surgical data network 201 comprising a central modular communications controller 203 configured to connect modular devices located in one or more operating rooms of a healthcare facility, or any environment in a healthcare facility. healthcare services specially equipped for surgical operations, to a cloud-based system (e.g., cloud 204 which may include a remote server 213 coupled to a storage device 205). In one aspect, the modular communication core controller 203 comprises a network core controller 207 and/or a network switch 209 communicating with a network router. The central modular communications controller 203 may also be coupled to a local computer system 210 to provide local computer processing and data manipulation. The surgical data network 201 can be configured as a passive, intelligent, or switching network. A passive surgical data network serves as a conduit for data, allowing data to be transmitted from one device (or thread) to another and to cloud computing resources. An intelligent surgical data network includes additional features to allow traffic passing through the surgical data network to be monitored and to configure each port on the central network controller 207 or network switch 209. An intelligent surgical data network may be called from a central controller or controllable switch. A central switching controller reads the destination address of each packet and then forwards the packet to the correct port.

[0173] Modular devices 1a to 1n located in the operating room may be coupled to the modular communication central controller 203. The central network controller 207 and/or the network switch 209 may be coupled to a network router 211 to connect devices 1a through 1n to cloud 204 or local computer system 210. Data associated with devices 1a through 1n can be transferred to cloud-based computers via the router for remote processing and manipulation of the data. Data associated with devices 1a through 1n may also be transferred to local computer system 210 for local data processing and manipulation. Modular devices 2a to 2m located in the same operating room can also be coupled to a network switch 209. The network switch 209 can be coupled to the central network controller 207 and/or the network router 211 to connect the devices 2a to 2m to cloud 204. Data associated with devices 2a to 2n may be transferred to cloud 204 via network router 211 for processing and manipulation of the data. Data associated with devices 2a to 2m may also be transferred to local computer system 210 for local data processing and manipulation.

[0174] It will be understood that the surgical data network 201 may be expanded by interconnecting multiple central network controllers 207 and/or multiple network switches 209 with multiple network routers 211. The central modular communications controller 203 may be contained in a modular control tower configured to receive multiple 1a to 1n/2a to 2m devices. The local computer system 210 may also be contained in a modular control tower. The central modular communication controller 203 is connected to a screen 212 to display images obtained by some of the devices 1a to 1n/2a to 2m, for example, during surgical procedures. In various aspects, devices 1a to 1n/2a to 2m may include, for example, various modules such as an imaging module 138 coupled to an endoscope, a generator module 140 coupled to a power-based surgical device, an evacuation module smoke filter 126, a suction/irrigation module 128, a communication module 130, a processor module 132, a storage array 134, a surgical device coupled to a display, and/or a contactless sensor module, among others modular devices that can be connected to the central modular communication controller 203 of the surgical data network 201.

[0175] In one aspect, the surgical data network 201 may comprise a combination of central network controllers, network switches, and network routers that connect devices 1a to 1n/2a to 2m to the cloud. Any or all of the 1a to 1n/2a to 2m devices coupled to the central network controller or network switch can collect real-time data and transfer the data to cloud computers for data processing and manipulation. It will be understood that cloud computing relies on sharing computing resources rather than having local servers or personal devices to handle software applications. The word "cloud" can be used as a metaphor for "the Internet", although the term is not limited as such. Consequently, the term "cloud computing" can be used here to refer to "a type of Internet-based computing" in which different services—such as servers, storage, and applications—are applied to the central modular communications controller 203 and /or to the computer system 210 located in the operating room (e.g., a fixed, mobile, temporary room or space, or operating field) and to devices connected to the central modular communications controller 203 and/or the computer system 210 through from Internet. Cloud infrastructure can be maintained by a cloud service provider. In this context, the cloud service provider may be the entity that coordinates the use and control of the 1a to 1n/2a to 2m devices located in one or more operating rooms. Cloud computing services can perform a large number of calculations based on data collected by intelligent surgical instruments, robots, and other computerized devices located in the operating room. Central controller hardware allows multiple devices or connections to be connected to a computer that communicates with cloud computing and storage resources.

[0176] Applying cloud computer data processing techniques to the data collected by devices 1a to 1n/2a to 2m, the surgical data network provides better surgical results, reduced costs, and improved patient satisfaction. At least some of the devices 1a to 1n/2a to 2m can be used to visualize tissue states to assess the occurrence of leaks or perfusion of sealed tissue following a tissue sealing and cutting procedure. At least some of the devices 1a to 1n/2a to 2m can be used to identify pathology, such as the effects of diseases, using cloud-based computing to examine data including images of body tissue samples for diagnostic purposes. This includes confirmation of tissue location and margin and phenotypes. At least some of the devices 1a to 1n/2a to 2m can be used to identify anatomical structures of the body using a variety of sensors integrated with imaging devices and techniques such as superimposing images captured by multiple imaging devices. Data collected by devices 1a to 1n/2a to 2m, including image data, may be transferred to the cloud 204 or the local computer system 210 or both for data processing and manipulation including image processing and manipulation. The data can be analyzed to improve the results of the surgical procedure by determining whether additional treatment, such as application of endoscopic intervention, emerging technologies, targeted radiation, targeted intervention, precise robotics to specific tissue sites and conditions, can be followed. Such data analysis can additionally use analytical processing of the results, and with the use of standardized approaches can provide beneficial standardized feedback to either confirm surgical treatments and surgeon behavior or suggest modifications to surgical treatments and surgeon behavior.

[0177] In one implementation, operating room devices 1a to 1n may be connected to the modular communication central controller 203 via a wired channel or a wireless channel depending on the configuration of devices 1a to 1n on a central operating room controller 203. network. The central network controller 207 may be implemented, in one aspect, as a local network transmission device that acts on the physical layer of the OSI ("open system interconnection") model. The central network controller provides connectivity to devices 1a through 1n located on the same network as the operating room. The central network controller 207 collects data in the form of packets and sends it to the router in half-duplex mode. The central network controller 207 does not store any media access control/Internet Protocol (MAC/IP) to transfer data from the device. Only one of devices 1a through 1n at a time can send data through the central network controller 207. The central network controller 207 has no routing tables or intelligence regarding where to send information and broadcasts all network data across each connection. and to a remote server 213 (Figure 9) via cloud 204. The central network controller 207 can detect basic network errors such as collisions, but having all the information broadcast to multiple input ports can be a security risk and cause strangulations.

[0178] In another implementation, operating room devices 2a to 2m may be connected to a network switch 209 via a wired or wireless channel. Network key 209 works at the data connection layer of the OSI model. Network switch 209 is a multicast device for connecting devices 2a to 2m located in the same operation center to the network. The network switch 209 sends data in the form of frames to the network router 211 and operates in full duplex mode. Multiple devices 2a to 2m can send data at the same time via network switch 209. Network switch 209 stores and uses MAC addresses of devices 2a to 2m to transfer data.

[0179] The central network controller 207 and/or the network switch 209 are coupled to the network router 211 for a connection to the cloud 204. The network router 211 functions at the network layer of the OSI model. The network router 211 creates a route to transmit data packets received from the central network controller 207 and/or the network switch 211 to a computer with cloud-based resources for further processing and manipulation of the data collected by any or all of the devices 1a to 1n/ 2a to 2m. Network router 211 can be used to connect two or more different networks located in different locations, such as different operating rooms of the same healthcare facility or different networks located in different operating rooms of different healthcare facilities. of health. The network router 211 sends data in the form of packets to the cloud 204 and operates in full duplex mode. Multiple devices can send data at the same time. The network router 211 uses IP addresses to transfer data.

[0180] In one example, the network core controller 207 can be implemented as a USB core controller, which allows multiple USB devices to be connected to a host computer. The USB core controller can expand a single USB port by multiple levels so that there are more ports available for connecting devices to the host system computer. The central network controller 207 may include wired or wireless capabilities for receiving information about a wired channel or a wireless channel. In one aspect, a wireless, broadband, short-range USB wireless radio communication protocol may be used for communication between devices 1a to 1n and devices 2a to 2m situated in the operating room.

[0181] In other examples, operating room devices 1a to 1n/2a to 2m may communicate with the central modular communications controller 203 via standard wireless Bluetooth technology to exchange data over short distances (with the using short-wavelength UHF radio waves in the ISM band 2.4 to 2.485 GHz) from fixed and mobile devices and building personal area networks (PANs). In other aspects, operating room devices 1a to 1n/2a to 2m may communicate with the modular communication central controller 203 via a number of wireless and wired communication standards or protocols, including but not limited to a, 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 Ethernet derivatives thereof, as well as any other wireless and wired protocols that are designated as 3G, 4G, 5G, and beyond. The computing module may include a plurality of communication modules. For example, a first communication module may be dedicated to short-range wireless communications such as Wi-Fi and Bluetooth, and a second communication module may be dedicated to longer-range wireless communications such as GPS, EDGE, GPRS, CDMA , WiMAX, LTE, Ev-DO and others.

[0182] The modular communications central controller 203 may serve as a central connection for one or all of the operating room devices 1a to 1n/2a to 2m and handles a type of data known as frames. The frames carry data generated by devices 1a to 1n/2a to 2m. When a frame is received by the central modular communications controller 203, it is amplified and transmitted to the network router 211, which transfers the data to cloud computing resources using a series of wireless communication standards or protocols. or wired, as described in the present invention.

[0183] The modular communications core controller 203 can be used as a stand-alone device or be connected to compatible network core controllers and network switches to form a larger network. The 203 modular communications central controller is generally easy to install, configure and maintain, making it a good choice for networking 1a to 1n/2a devices within 2m of the operating room.

[0184] Figure 9 illustrates a computer-implemented interactive surgical system 200. The computer-implemented interactive surgical system 200 is similar in many respects to the computer-implemented interactive surgical system 100. For example, the computer-implemented interactive surgical system per computer 200 includes one or more surgical systems 202, which are similar in many respects to surgical systems 102. Each surgical system 202 includes at least one central surgical controller 206 in communication with a cloud 204 that may include a remote server 213. In a In this aspect, the computer-implemented interactive surgical system 200 comprises a modular control tower 236 connected to multiple operating room devices, such as intelligent surgical instruments, robots, and other computerized devices located in the operating room. As shown in Figure 10, the modular control tower 236 comprises a modular communications central controller 203 coupled to a computer system 210. As illustrated in the example of Figure 9, the modular control tower 236 is coupled to an imaging module 238 which is coupled to an endoscope 239, a generator module 240 which is coupled to a power device 241, a smoke evacuation module 226, a suction/irrigation module 228, a communication module 230, a processor module 232, a storage array 234, a smart device/instrument 235 optionally coupled to a display 237, and a contactless sensor module 242. The operating room devices are coupled to cloud computing resources and data storage via the tower modular control tower 236. The robot central controller 222 can also be connected to the modular control tower 236 and cloud computing resources. Devices/Instruments 235, visualization systems 208, among others, can be coupled to the modular control tower 236 through wired or wireless communication standards or protocols, as described in the present invention. The modular control tower 236 may be coupled to a central controller display 215 (e.g., monitor, display) to display and overlay images received from the imaging module, device/instrument display, and/or other display systems 208. The central controller's screen can also display data received from devices connected to the modular control tower together with images and superimposed images.

[0185] Figure 10 illustrates a central surgical controller 206 comprising a plurality of modules coupled to the modular control tower 236. The modular control tower 236 comprises a modular communications central controller 203, e.g., a network connectivity device , and a computer system 210 for providing local processing, visualization, and imaging, for example. As shown in Figure 10, the modular communications core controller 203 may be connected in a layered configuration to expand the number of modules (e.g., devices) that may be connected to the modular communications core controller 203 and transfer data associated with the modules to computer system 210, cloud computing resources, or both. As shown in Figure 10, each of the central controllers/network switches in the modular communication central controller 203 includes three downstream ports and one upstream port. The central controller/upstream network switch is connected to a processor to provide a communication connection to the cloud computing resources and a local display 217. Communication with the cloud 204 may be done via a wired communication channel or wireless.

[0186] The central surgical controller 206 uses a non-contact sensor module 242 to measure the dimensions of the operating room and generate a map of the operating room using laser or ultrasonic type non-contact measuring devices. An ultrasound-based contactless sensor module scans the operating room by transmitting a burst of ultrasound and receiving the echo when it bounces off the perimeter of an operating room walls, as described under the heading “Surgical Hub Spatial Awareness Within an Operating Room" in US provisional patent application serial no. 62/611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, which is incorporated herein by reference in its entirety, in which the sensor module is configured to determine the size of the operating room and adjust Bluetooth pairing distance limits. A laser-based contactless sensor module scans the operating room transmitting pulses of laser light, receiving pulses of laser light that bounce off the walls of the operating room perimeter of the operating room, and comparing the phase of the transmitted pulse to the received pulse to determine the size of the operating room and to adjust Bluetooth pairing distance limits, for example.

[0187] Computer system 210 comprises a processor 244 and a network interface 245. The processor 244 is coupled to a communications module 247, storage 248, memory 249, non-volatile memory 250, and input/output interface 251 through of a system bus. The system bus can be any of several types of bus structures, including the memory bus or memory controller, a peripheral bus or external bus, and/or local bus that uses any variety of available bus architectures including, but not limited to, not limited to, 9-bit bus, Industry Standard Architecture (ISA), Micro-Charmel Architecture (MSA), Extended ISA (EISA), Intelligent Drive Electronics (IDE), VESA Local Bus (VLB), Component Interconnect peripherals (PCI), USB, accelerated graphics port (AGP), PCMCIA (Personal Computer Memory Card International Association) bus, Small Computer Systems Interface (SCSI), or any another proprietary bus.

[0188] Processor 244 may be any single-core or multi-core processor, such as those known under the trade name ARM Cortex available from Texas Instruments. In one aspect, the processor may be a Core Cortex-M4F LM4F230H5QR ARM processor, available from Texas Instruments, for example, which comprises an integrated memory of 256 KB single-cycle flash memory, or other non-volatile memory, up to 40 MHz. , a look-ahead buffer to optimize performance above 40 MHz, a 32 KB single-cycle serial random access memory (SRAM), an internal read-only memory (ROM) loaded with the StellarisWare® program, 2 KB electrically erasable programmable readout (EEPROM), one or more pulse width modulation (PWM) modules, one or more analog quadrature encoder inputs (QEI), one or more analog to digital converters (ADC) 12-bit with 12 analogue input channels, details of which are available in the product datasheet.

[0189] In one aspect, the processor 244 may comprise a security controller comprising two controller-based families, such as TMS570 and RM4x, known under the trade name Hercules ARM Cortex R4, also by Texas Instruments. The safety controller can be configured specifically for IEC 61508 and ISO 26262 safety-critical applications, among others, to provide advanced integrated safety features while providing scalable performance, connectivity, and memory options.

[0190] System memory includes volatile memory and non-volatile memory. The basic input/output system (BIOS), containing the basic routines for transferring information between elements within the computer system, such as during startup, is stored in non-volatile memory. For example, non-volatile memory may include ROM, programmable ROM (PROM), electrically programmable ROM (EPROM), EEPROM, or flash memory. Volatile memory includes random access memory (RAM), which acts as external cache memory. Furthermore, RAM is available in many forms such as SRAM, dynamic RAM (DRAM), synchronous DRAM (SDRAM), double data rate SDRAM (DDR SDRAM), enhanced SDRAM (ESDRAM), Synchlink DRAM (SLDRAM), and direct RAM. Rambus RAM (DRRAM).

[0191] Computer system 210 also includes removable/non-removable, volatile/non-volatile computer storage media, such as, for example, disk storage. Disk storage includes, but is not limited to, devices such as a magnetic disk drive, floppy disk drive, tape drive, Jaz drive, Zip drive, LS-60 drive, flash memory card, or memory stick. drive). Additionally, the storage disk may include storage media separately or in combination with other storage media including, but not limited to, an optical disk drive such as a compact disk ROM device (CD-ROM) compact disk drive recordable (CD-R Drive), rewritable compact disc drive (CD-RW drive), or a digital versatile disk ROM drive (DVD-ROM). To facilitate the connection of disk storage devices to the system bus, a removable or non-removable interface can be used.

[0192] It is to be understood that computer system 210 includes software that acts as an intermediary between users and the basic computer capabilities described in a suitable operating environment. Such software includes an operating system. The operating system, which can be stored on disk storage, acts to control and allocate computer system resources. System applications benefit from management capabilities by the operating system through program modules and program data stored in system memory or disk storage. It is to be understood that various components described in the present invention can be implemented with various operating systems or combinations of operating systems.

[0193] A user enters commands or information into computer system 210 through input device(s) coupled to I/O interface 251. Input devices include, but are not limited to, a pointing device such as a mouse, trackball, stylus, touchpad, keyboard, microphone, joystick, game pad, satellite card, scanner, TV tuner card, digital camera, digital video camera, web camera, and the like. These and other input devices connect to the processor via the system bus through the interface port(s). Interface ports include, for example, a serial port, a parallel port, a game port, and a USB. Output devices use some of the same types of ports as input devices. Thus, for example, a USB port can be used to provide input to the computer system and to provide information from the computer system to an output device. An output adapter is provided to illustrate that there are some output devices such as monitors, screens, speakers, and printers, among other output devices, that require special adapters. Output adapters include, by way of illustration and not limitation, video and sound cards that provide a means of connection between the output device and the system bus. It should be noted that other devices and/or device systems, such as remote computers, provide input and output capabilities.

[0194] Computer system 210 may operate in a networked environment using logical connections with one or more remote computers, such as cloud computers, or local computers. Remote cloud computers may be a personal computer, server, router, network personal computer, workstation, microprocessor-based device, peer device, or other common network node, and the like, and typically include many or all of the elements described in relation to the computer system. For brevity, only one memory storage device is illustrated with the remote computer. Remote computers are logically connected to the computer system through a network interface and then physically connected through a communications connection. The network interface encompasses communication networks such as local area networks (LANs) and wide area networks (WANs). LAN technologies include Fiber Distributed Data Interface (FDDI), Copper Distributed Data Interface (CDDI), Ethernet/IEEE 802.3, Token Ring/IEEE 802.5, and the like. WAN technologies include, but are not limited to, point-to-point links, circuit-switched networks such as integrated services digital networks (ISDN) and variations thereof, packet-switched networks, and digital subscriber lines (DSL).

[0195] In various aspects, the computer system 210 of Figure 10, the imaging module 238 and/or display system 208, and/or the processor module 232 of Figures 9 to 10, may comprise an image processor, image processing engine, media processor, or any specialized digital signal processor (DSP) used for processing digital images. The image processor can employ parallel computing with single instruction multiple data (SIMD) or multiple instruction multiple data (MIMD) technologies to increase speed and efficiency. The digital image processing engine can perform a number of tasks. The image processor may be a system on an integrated circuit with multi-core processor architecture.

[0196] Communication connections refer to the hardware/software used to connect the network interface to the bus. Although the communications connection is shown for illustrative clarity within the computer system, it may also be external to the computer system 210. The hardware/software required for connection to the network interface includes, for illustrative purposes only, internal and external technologies such as modems, including regular telephone series modems, cable modems and DSL modems, ISDN adapters and Ethernet cards.

[0197] Figure 11 illustrates a functional block diagram of an aspect of a USB network central controller device 300, in accordance with at least one aspect of the present description. In the illustrated aspect, the USB 300 network central controller device uses a TUSB2036 integrated circuit central controller available from Texas Instruments. The USB network core controller 300 is a CMOS device that provides one upstream USB transceiver port 302 and up to three downstream USB transceiver ports 304, 306, 308 in compliance with the USB 2.0 specification. The upstream USB transceiver port 302 is a differential data root port comprising a "minus" differential data input (DM0) paired with a "plus" differential data input (DP0). The three downstream USB transceiver ports 304, 306, 308 are differential data ports, with each port including "plus" differential data outputs (DP1-DP3) paired with "minus" differential data outputs (DM1-DM3). .

[0198] The USB network core controller device 300 is implemented with a digital state machine instead of a microcontroller, and no firmware programming is required. Fully compatible USB transceivers are integrated into the circuitry for the upstream USB transceiver port 302 and all downstream USB transceiver ports 304, 306, 308. The downstream USB transceiver ports 304, 306, 308 support both full speed or low speed by automatically configuring the scan rate according to the speed of the device attached to the ports. The USB network core controller device 300 can be configured in bus-powered or self-powered mode and includes core power logic 312 to manage power.

[0199] The USB network core controller device 300 includes a serial interface engine 310 (SIE). The SIE 310 is the hardware front end of the USB 300 central network controller and handles most of the protocol described in chapter 8 of the USB specification. SIE 310 typically comprises signaling down to the transaction level. The functions it handles could include: packet recognition, transaction sequencing, SOP, EOP, RESET, and RESUME signal detection/generation, clock/data separation, non-reverse-zero data encoding/decoding (NRZI) , generation and verification of CRC (token and data), generation and verification/decoding of packet ID (PID), and/or series-parallel/parallel-series conversion. 310 receives a clock input 314 and is coupled to a sleep/resume and frame timer logic circuit 316 and a central controller repeater circuit 318 to control communication between the upstream USB transceiver port 302 and the ports of the downstream USB transceiver 304, 306, 308 through the logic circuits of ports 320, 322, 324. The SIE 310 is coupled to a command decoder 326 through the logic interface to control commands from a serial EEPROM through a EEPROM in 330 series.

[0200] In various aspects, the USB central network controller 300 can connect 127 functions configured in up to six logical layers (levels) to a single computer. Additionally, the USB 300 central network controller can connect all peripherals using a standardized four-wire cable that provides both communication and power distribution. The power settings are bus-powered and self-powered modes. The USB 300 network central controller can be configured to support four power management modes: a bus-powered central controller, with individual port power management or grouped port power management, and the self-powered central controller, with power management. individual port power or grouped port power management. In one aspect, using a USB cable, the USB network core controller 300, the upstream USB transceiver port 302 is plugged into a USB host controller, and the downstream USB transceiver ports 304, 306, 308 are exposed to connect compatible USB devices, and so on.

Surgical Instrument Hardware

[0201] Figure 12 illustrates a logic diagram of a module of a control system 470 of a surgical instrument or tool, in accordance with one or more aspects of the present description. System 470 comprises a control circuit. The control circuit includes a microcontroller 461 comprising a processor 462 and a memory 468. One or more of sensors 472, 474, 476, for example, provide real-time feedback to the processor 462. A motor 482, driven by a driver of engine 492, operatively couples a longitudinally movable displacement member to drive the cutting member of the I-beam. A tracking system 480 is configured to determine the position of the longitudinally movable displacement member. Position information is provided to processor 462, which may be programmed or configured to determine the position of the longitudinally movable drive member, as well as the position of a firing member, firing bar, and a cutting member of the I-beam. . Additional motors can be provided at the instrument driver interface to control I-beam firing, closure tube travel, drive shaft rotation, and articulation. A screen 473 displays a variety of instrument operating conditions and may include touch screen functionality for data entry. Information displayed on screen 473 may be overlaid with images captured through endoscopic imaging modules.

[0202] In one aspect, the microcontroller 461 may be any single-core or multi-core processor, such as those known under the trade name ARM Cortex available from Texas Instruments. In one aspect, the main microcontroller 461 may be an LM4F230H5QR ARM Cortex-M4F processor, available from Texas Instruments, for example, which comprises an integrated memory of 256 KB single-cycle flash memory, or other non-volatile memory, up to 40 MHz, a look-ahead buffer to optimize performance above 40 MHz, a 32 KB single-cycle serial random access memory (SRAM), an internal read-only memory (ROM) loaded with the StellarisWare® program, memory 2 KB programmable and erasable electrically read-only (EEPROM), one or more pulse width modulation (PWM) modules, one or more analogue quadrature encoder inputs (QEI), and/or one or more analog converters to 12-bit digital (ADC) with 12 analog input channels, details of which are available in the product datasheet.

[0203] In one aspect, the microcontroller 461 may comprise a safety controller comprising two controller-based families, such as TMS570 and RM4x known under the trade name Hercules ARM Cortex R4, also available from Texas Instruments. The safety controller can be configured specifically for IEC 61508 and ISO 26262 safety-critical applications, among others, to provide advanced integrated safety features while providing scalable performance, connectivity, and memory options.

[0204] The microcontroller 461 can be programmed to perform various functions, such as precisely controlling the speed and position of the joint and knife systems. In one aspect, the microcontroller 461 includes a processor 462 and a memory 468. The electric motor 482 may be a brushed direct current (DC) motor with a gearbox and mechanical connections with a linkage or scalpel system. In one aspect, a motor driver 492 may be an A3941 available from Allegro Microsystems, Inc. Other motor drivers may be readily substituted for use in the tracking system 480 comprising an absolute positioning system. A detailed description of an absolute positioning system is provided in US Patent Application Publication No. 2017/0296213, entitled SYSTEMS AND METHODS FOR CONTROLLING A SURGICAL STAPLING AND CUTTING INSTRUMENT, published October 19, 2017, which is incorporated herein into reference title in its entirety.

[0205] The microcontroller 461 can be programmed to provide precise control of the speed and position of the travel members and linkage systems. The microcontroller 461 may be configured to compute a response in the microcontroller 461 software. The computed response is compared to a measured response of the real system to obtain an "observed" response, which is used for actual feedback-based decisions. The observed response is a favorable and adjusted value, which balances the uniform and continuous nature of the simulated response with the measured response, which can detect external influences on the system.

[0206] In one aspect, the motor 482 may be controlled by the motor driver 492 and may be used by the firing system of the instrument or surgical tool. In various forms, motor 482 may be a brushed direct current (DC) drive motor, with a maximum rotational speed of approximately 25,000 RPM, for example. In other arrangements, the motor 482 may include a brushless motor, a wireless motor, a synchronous motor, a stepper motor, or any other suitable type of electric motor. Motor driver 492 may comprise an H-bridge driver comprising field effect transistors (FETs), for example. Motor 482 may be powered by a power assembly releasably mounted in the grip assembly or tool housing to provide control power to the instrument or surgical tool. The power supply assembly may comprise a battery that may include a plurality of battery cells connected in series, which may be used as the power source to power the instrument or surgical tool. In certain circumstances, the power pack battery cells may be replaceable and/or rechargeable. In at least one example, the battery cells may be lithium-ion batteries that may be attachable and separable from the power supply assembly.

[0207] The 492 motor driver may be an A3941, available from Allegro Microsystems, Inc. The 492 A3941 driver is a full bridge controller for use with external power semiconductor metal oxide field effect transistors (MOSFET). , N-channel, specifically designed for inductive loads such as brushed DC motors. The 492 driver comprises a unique charge pump regulator that provides full gate drive (>10 V) for batteries with voltages up to 7 V and allows the A3941 to operate with reduced gate drive, up to 5.5 V. A capacitor input drive can be used to supply the battery-in excess voltage required for the N-channel MOSFETs. An internal charge pump for the top-side drive allows direct current operation (100% duty cycle). The entire bridge can be driven in fast or slow decay modes using diodes or synchronized rectification. In slow drop mode, current recirculation can occur through a high-side or low-side FET. Power FETs are protected from the shoot-through effect by means of resistors with programmable dead time. Built-in diagnostics provide indication of undervoltage, overtemperature, and power bridge faults and can be configured to protect power MOSFETs under most short circuit conditions. Other motor drives can be readily substituted for use in the tracking system 480 comprising an absolute positioning system.

[0208] The tracking system 480 comprises a controlled motor drive circuit arrangement comprising a position sensor 472 in accordance with at least one aspect of the present description. Position sensor 472 for an absolute positioning system provides a unique position signal that corresponds to the location of a moving member. In one aspect, the displacement member represents a longitudinally movable drive member comprising a rack of drive teeth for engagement meshed with a corresponding drive gear of a gear reducer assembly. In other aspects, the displacement member represents the firing member, which may be adapted and configured to include a rack of drive teeth. In yet another aspect, the displacement member represents the firing bar or I-beam, each of which can be adapted and configured to include a rack of drive teeth. Accordingly, as used in the present invention, the term displacement member is used generically to refer to any movable member of the surgical instrument or tool, such as the drive member, the trigger member, the trigger bar, the beam with a profile in I, or any element that can be moved. In one aspect, the longitudinally movable drive member is coupled to the firing member, the firing bar and the I-beam. Consequently, the absolute positioning system can, in effect, track the linear displacement of the I-beam. I by tracking the linear displacement of the longitudinally movable drive member. In various other aspects, the displacement member may be coupled to any position sensor 472 suitable for measuring linear displacement. In this way, the longitudinally movable drive member, trigger member, trigger bar or I-beam, or combinations thereof, can be coupled to any suitable linear displacement sensor. Linear displacement sensors may include contact or non-contact displacement sensors. Linear displacement sensors may comprise Linear Variable Differential Transformers (LVDT), Differential Variable Reluctance Transducers (DVRT), a potentiometer, a magnetic detection system comprising a movable magnet and a linearly arranged array of Hall Effect Sensors, a magnetic detection system comprising a fixed magnet and a series of movable, linearly arranged Hall Effect Sensors, a movable optical detection system comprising a moving light source and a series of linearly arranged photodiodes or photodetectors, an optical detection system that comprises a fixed light source and a movable series of linearly arranged photodiodes or photodetectors, or any combination thereof.

[0209] The electric motor 482 may include a rotating drive shaft, which operatively interfaces with a gear assembly, which is mounted in coupling engagement with a set or rack of drive teeth on the drive member. A sensing element may be operatively coupled to a gear assembly such that a single revolution of the position sensing element 472 corresponds to some linear longitudinal translation of the displacement member. An arrangement of gears and sensors may be connected to the linear actuator through a rack and pinion arrangement, or to a rotary actuator, through a toothed wheel or other connection. A power source provides power to the absolute positioning system, and an output indicator can display the output of the absolute positioning system. The drive member represents the longitudinally movable drive member comprising a rack of drive teeth formed thereon for mesh engagement with a corresponding drive gear of the gear reducer assembly. The displacement member represents the longitudinally movable firing member, the firing bar, the I-beam, or combinations thereof.

[0210] A single revolution of the sensing element associated with position sensor 472 is equivalent to a longitudinal linear displacement of d1 of the displacement member, where d1 represents the longitudinal linear distance by which the displacement member moves from point "a" to point "b" after a single revolution of the sensing element coupled to the displacement member. The sensor arrangement may be connected via a gear reduction that results in the position sensor 472 completing one or more revolutions for the full stroke of the travel member. The position sensor 472 can complete multiple revolutions for the full stroke of the displacement member.

[0211] A series of switches, where n is an integer greater than one, may be employed alone or in combination with a gear reduction to provide a single position signal for more than one revolution of the position sensor 472. The state of the switches is transmitted back to the microcontroller 461 which applies logic to determine a single position signal corresponding to the longitudinal linear displacement of dl + d2 + ... dn of the displacement member. The output of the position sensor 472 is provided to the microcontroller 461. In various embodiments, the position sensor 472 of the sensor array may comprise a magnetic sensor, an analog rotary sensor such as a potentiometer, or a series of analog Hall effect elements. , which output a unique combination of position signals or values.

[0212] The position sensor 472 may comprise any number of magnetic sensing elements, such as, for example, magnetic sensors classified according to whether they measure the total magnetic field or the vector components of the magnetic field. The techniques used to produce both types of magnetic sensors span many aspects of physics and electronics. Technologies used for magnetic field detection include flowmeter, saturated flow, optical pumping, nuclear precession, SQUID, Hall effect, anisotropic magnetoresistance, giant magnetoresistance, magnetic tunnel junctions, giant magnetoimpedance, magnetostrictive/piesoelectric compounds, magnetodiode, magnetic transistor, fiber optics, magneto-optics and magnetic sensors based on microelectromechanical systems, among others.

[0213] In one aspect, the position sensor 472 for the tracking system 480 comprising an absolute positioning system comprises a magnetic rotating absolute positioning system. The 472 position sensor can be implemented as a single integrated circuit, magnetic, rotary position sensor, AS5055EQFT, available from Austria Microsystems, AG. The position sensor 472 interfaces with the microcontroller 461 to provide an absolute positioning system. The position sensor 472 is a low voltage, low power component and includes four effect elements in an area of the position sensor 472 located above a magnet. A high-resolution ADC and an intelligent power management controller are also provided on the integrated circuit. A CORDIC processor (digital computer for coordinate rotation), also known as the digit-by-digit method and Volder's algorithm, is provided to implement a simple and efficient algorithm for calculating hyperbolic and trigonometric functions that require only addition, subtraction, shift operations bits and lookup table. The angle position, alarm bits, and magnetic field information are transmitted through a standard serial communications interface, such as a serial peripheral interface (SPI), to the microcontroller 461. The position sensor 472 provides 12 or 14 bits of resolution. The 472 position sensor can be an AS5055 integrated circuit supplied in a small 16-pin QFN package whose measurement corresponds to 4x4x0.85 mm.

[0214] The tracking system 480 comprising an absolute positioning system may comprise and/or be programmed to implement a feedback controller, such as a PID, state feedback, and adaptive controller. A power source converts the feedback controller signal into a physical input to the system, in this case voltage. Other examples include a voltage, current, and power PWM. Other sensors may be provided to measure parameters of the physical system in addition to the position measured by position sensor 472. In some aspects, the other sensors may include sensor arrangements as described in US Patent No. 9,345,481 entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, granted May 24, 2016, which is incorporated by reference in its entirety herein; US Patent Application Serial No. 2014/0263552, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, published September 18, 2014, is incorporated by reference in its entirety herein; and US Patent Application Serial No. 15/628,175, entitled TECHNIQUES FOR ADAPTIVE CONTROL OF MOTOR VELOCITY OF A SURGICAL STAPLING AND CUTTING INSTRUMENT, submitted on June 20, 2017, is incorporated by reference in its entirety herein. In a digital signal processing system, an absolute positioning system is coupled to a digital data capture system where the output of the absolute positioning system will have a finite resolution and sampling frequency. The absolute positioning system may comprise a comparison and combination circuit for combining a computed response with a measured response through the use of algorithms, such as a weighted average and a theoretical control loop, that drive the calculated response toward the measured response. The computed response of the physical system considers properties such as mass, inertia, viscous friction, inductance resistance, etc., to predict what the states and outputs of the physical system will be, given the input.

[0215] The absolute positioning system provides absolute positioning of the displaced member upon activation of the instrument without having to retract or advance the longitudinally movable actuating member to the reset (zero or home) position, as may be required by encoders conventional rotary devices that merely count the number of progressive or regressive steps that the motor 482 has traveled to infer the position of an actuator device, drive bar, scalpel, and the like.

[0216] A sensor 474, such as, for example, a strain gauge or a microstress gauge, is configured to measure one or more parameters of the end actuator, such as, for example, the amplitude of the strain exerted on the anvil during a grasping operation, which may be indicative in relation to tissue compression. The measured effort is converted into a digital signal and provided to processor 462. Alternatively, or in addition to sensor 474, a sensor 476, such as a load sensor, can measure the closing force applied by the drive system. closure to the anvil. The sensor 476, such as a load sensor, can measure the trigger force applied to an i-beam in a trigger stroke of the surgical system or tool. The I-beam is configured to engage a wedge slider, which is configured to move the clamp drivers upward to force the clamps to deform upon contact with an anvil. The i-beam includes a sharp cutting edge that can be used to separate tissue as the i-beam is advanced distally by the firing bar. Alternatively, a current sensor 478 may be used to measure the current drawn by the motor 482. The force required to advance the firing member may correspond to the current drawn by the motor 482, for example. The measured force is converted into a digital signal and supplied to the 462 processor.

[0217] In one form, a strain measuring sensor 474 can be used to measure the force applied to the fabric by the end actuator. A strain gauge may be attached to the end actuator to measure the force applied to the tissue being treated by the end actuator. A system for measuring forces applied to tissue secured by the end actuator comprises a strain gauge sensor 474, such as, for example, a microstrain meter, which is configured to measure one or more parameters of the end actuator, for example. In one aspect, the strain gauge sensor 474 may measure the amplitude or magnitude of mechanical stress exerted on a gripper member of an end actuator during a grasping operation, which may be indicative of tissue compression. The measured effort is converted into a digital signal and provided to the processor 462 of a microcontroller 461. A load sensor 476 can measure the force used to operate the knife element, for example, to cut tissue captured between the anvil and the cartridge. of staples. A magnetic field sensor can be used to measure the thickness of captured tissue. The magnetic field sensor measurement can also be converted to a digital signal and provided to the 462 processor.

[0218] Measurements of tissue compression, tissue thickness, and/or force required to close the end actuator to the tissue, as respectively measured by sensors 474, 476, may be used by microcontroller 461 to characterize the selected position of the firing member and/or the corresponding velocity value of the firing member. In one case, a memory 468 may store a technique, an equation, and/or a look-up table that may be used by the microcontroller 461 in evaluation.

[0219] The control system 470 of the surgical instrument or tool may also comprise wired or wireless communication circuits for communicating with the central modular communication controller shown in Figures 8 to 11.

[0220] Figure 13 illustrates a control circuit 500 configured to control aspects of the surgical instrument or tool, in accordance with at least one aspect of this description. Control circuit 500 may be configured to implement various processes described herein. The control circuit 500 may comprise a microcontroller comprising one or more processors 502 (e.g., microprocessor, microcontroller) coupled to at least one memory circuit 504. The memory circuit 504 stores machine-executable instructions that, when executed by the processor 502, cause processor 502 to execute machine instructions to implement various of the processes described herein. Processor 502 may be any of a number of single-core or multi-core processors known in the art. The memory circuit 504 may comprise volatile and non-volatile storage media. The processor 502 may include an instruction processing unit 506 and an arithmetic unit 508. The instruction processing unit may be configured to receive instructions from the memory circuit 504 of the present disclosure.

[0221] Figure 14 illustrates a combinational logic circuit 510 configured to control aspects of the surgical instrument or tool, in accordance with at least one aspect of this description. Combinational logic circuit 510 may be configured to implement various processes described herein. The combinational logic circuit 510 may comprise a finite state machine comprising a combinational logic 512 configured to receive data associated with the instrument or surgical tool at an input 514, process the data by the combinational logic 512, and provide an output 516.

[0222] Figure 15 illustrates a sequential logic circuit 520 configured to control aspects of the instrument or surgical tool, in accordance with at least one aspect of this description. Sequential logic circuit 520 or combinational logic 522 may be configured to implement the process described herein. The sequential logic circuit 520 may comprise a finite state machine. The sequential logic circuit 520 may comprise a combinational logic 522, at least one memory circuit 524, a clock 529, and e.g. The at least one memory circuit 524 may store a current state of the finite state machine. In certain cases, the sequential logic circuit 520 may be synchronous or asynchronous. Combinational logic 522 is configured to receive data associated with the instrument or surgical tool from an input 526, process the data by combinational logic 522, and provide an output 528. In other aspects, the circuit may comprise a combination of a processor (e.g. , processor 502, Figure 13) and a finite state machine for implementing various processes of the present invention. In other aspects, the finite state machine may comprise a combination of a combinational logic circuit (e.g., a combinational logic circuit 510, Figure 14) and the sequential logic circuit 520.

[0223] Figure 16 illustrates a surgical instrument or tool comprising a plurality of motors that can be activated to perform various functions. In certain cases, a first engine may be activated to perform a first function, a second engine may be activated to perform a second function, a third engine may be activated to perform a third function, a fourth engine may be activated to perform a fourth function, and so on. In certain cases, the plurality of motors of the robotic surgical instrument 600 may be individually activated to cause firing, closing, and/or pivoting movements in the end actuator. The firing, closing and/or articulation movements can be transmitted to the end actuator through a drive shaft assembly, for example.

[0224] In certain cases, the surgical instrument or tool system may include a trigger motor 602. The trigger motor 602 may be operatively coupled to a trigger motor drive assembly 604, which may be configured to transmit motion firing movements generated by motor 602 to the end actuator, particularly to move the I-beam element. In certain cases, firing movements generated by firing motor 602 may cause the clamps to be positioned from the cartridge of staples in the fabric captured by the end actuator and/or the cutting edge of the I-beam element to be advanced to cut the captured fabric, for example. The I-beam element can be retracted by reversing the direction of the 602 motor.

[0225] In certain instances, the surgical instrument or tool may include a closing motor 603. The closing motor 603 may be operatively coupled to a closing motor drive assembly 605 that may be configured to transmit closing movements, generated by motor 603 to the end actuator, particularly to move a closing tube to close the anvil and compress the tissue between the anvil and the staple cartridge. Closing movements can cause the end actuator to transition from an open configuration to a rough configuration to capture tissue, for example. The end actuator can be transitioned to an open position by reversing the direction of the motor 603.

[0226] In certain cases, the surgical instrument or tool may include one or more joint motors 606a, 606b, for example. Motors 606a, 606b may be operatively coupled to linkage motor drive assemblies 608a, 608b, which may be configured to transmit linkage movements generated by motors 606a, 606b to the end actuator. In certain cases, pivoting movements may cause the end actuator to be pivoted relative to the drive shaft assembly, for example.

[0227] As described above, the surgical instrument or tool may include a plurality of motors that may be configured to perform various independent functions. In certain cases, the plurality of motors of the instrument or surgical tool may be activated individually or separately to perform one or more functions, while other motors remain inactive. For example, the linkage motors 606a, 606b may be activated to cause the end actuator to be articulated, while the trigger motor 602 remains inactive. Alternatively, the firing motor 602 may be activated to fire the plurality of staples, and/or advance the cutting edge, while the linkage motor 606 remains inactive. Furthermore, the closing motor 603 can be activated simultaneously with the firing motor 602 to cause the closing tube and the i-beam member to advance distally, as described in more detail later in this document.

[0228] In certain cases, the surgical instrument or tool may include a common control module 610 that may be used with a plurality of motors of the surgical instrument or tool. In certain cases, the common control module 610 may accommodate one of the plurality of motors at a time. For example, the common control module 610 may be attachable to and separable from the plurality of motors of the robotic surgical instrument individually. In certain cases, a plurality of motors of the instrument or surgical tool may share one or more common control modules, such as common control module 610. In certain cases, a plurality of motors of the instrument or surgical tool may be individually and selectively engaged to the common control module 610. In certain cases, the common control module 610 may be selectively switched between interfacing with one of a plurality of motors of the instrument or surgical tool to interfacing with another of the plurality of motors of the instrument or surgical tool.

[0229] In at least one example, the common control module 610 may be selectively switched between operational engagement with linkage motors 606a, 606B, and operational engagement with firing motor 602 or closing motor 603. In In at least one example, as illustrated in Figure 16, a switch 614 may be moved or transitioned between a plurality of positions and/or states. In the first position 616, the switch 614 can electrically couple the common control module 610 to the trigger motor 602; in a second position 617, the switch 614 may electrically couple the control module 610 to the closing motor 603; in a third position 618a, the switch 614 may electrically couple the common control module 610 to the first linkage motor 606a; and in a fourth position 618b, the switch 614 may electrically couple the common control module 610 to the second linkage motor 606b, for example. In certain cases, separate common control modules 610 may be electrically coupled to the firing motor 602, the closing motor 603, and the linkage motors 606a, 606b at the same time. In certain cases, the switch 614 may be a mechanical switch, an electromechanical switch, a solid state switch, or any suitable switching mechanism.

[0230] Each of the motors 602, 603, 606a, 606b may comprise a torque sensor for measuring the output torque on the motor drive shaft. The force on an end actuator can be sensed in any conventional way, such as by means of force sensors on the outer sides of the grippers or by a torque sensor on the motor that drives the grippers.

[0231] In various cases, as illustrated in Figure 16, the common control module 610 may comprise a motor driver 626 that may comprise one or more H-Bridge FETs. The motor driver 626 may modulate power transmitted from a power source 628 to a motor coupled to the common control module 610, based on an input from a microcontroller 620 (the "controller"), for example. In certain cases, the microcontroller 620 may be used to determine the current drawn by the motor, for example, while the motor is coupled to the common control module 610, as described above.

[0232] In certain examples, the microcontroller 620 may include a microprocessor 622 (the "processor") and one or more non-transitory computer-readable media or memory units 624 (the "memory"). In certain cases, memory 624 may store various program instructions that, when executed, may cause processor 622 to perform a plurality of functions and/or calculations described herein. In certain cases, one or more of the memory units 624 may be coupled to the processor 622, for example.

[0233] In certain cases, the power source 628 may be used to provide power to the microcontroller 620, for example. In certain cases, the power source 628 may comprise a battery (or "battery pack" or "power source"), such as a Li-ion battery, for example. In certain instances, the battery pack may be configured to be releasably mounted to the handle to provide power to the surgical instrument 600. Multiple battery cells connected in series may be used as the power source 628. In certain instances, the power supply 628 may be replaceable and/or rechargeable, for example.

[0234] In various cases, the processor 622 may control the motor driver 626 to control the position, direction of rotation, and/or speed of a motor that is coupled to the common control module 610. In certain cases, the processor 622 may signal motor driver 626 to stop and/or disable a motor that is coupled to common control module 610. It should be understood that the term "processor" as used herein includes any microprocessor, microcontroller, or other control device. Proper basic computing that incorporates the functions of a computer central processing unit (CPU) on an integrated circuit or, at most, a few integrated circuits. The processor is a multipurpose programmable device that accepts digital data as input, processes it according to instructions stored in its memory, and provides results as output. This is an example of sequential digital logic, as it has internal memory. Processors operate on numbers and symbols represented in the binary numeral system.

[0235] In one example, processor 622 may be any single-core or multi-core processor, such as those known by the trade name ARM Cortex from Texas Instruments. In certain cases, the 620 microcontroller may be an LM 4F230H5QR, available from Texas Instruments, for example. In at least one example, the Texas Instruments LM4F230H5QR is an ARM Cortex-M4F processor core comprising an integrated 256 KB single-cycle flash-type memory, or other non-volatile memory, up to 40 MHz, a look-ahead buffer for optimize performance above 40 MHz, a 32 KB single-cycle SRAM, an internal ROM loaded with StellarisWare® software, 2 KB EEPROM, one or more PWM modules, one or more QEI analogs, one or more ADCs 12-bit with 12 analog input channels, among other features that are readily available in the product data sheet. Other microcontrollers can be readily substituted for use with the 4410 module. Accordingly, the present description should not be limited in this context.

[0236] In certain cases, memory 624 may include program instructions for controlling each of the surgical instrument motors 600 that are attachable to common control module 610. For example, memory 624 may include program instructions for controlling the motor trigger 602, the closing motor 603 and the articulation motors 606a, 606b. Such program instructions may cause the processor 622 to control the firing, closing, and articulation functions in accordance with inputs from the control algorithms or programs of the instrument or surgical tool.

[0237] In certain cases, one or more mechanisms and/or sensors, such as sensors 630, may be used to alert processor 622 to program instructions that need to be used in a specific configuration. For example, sensors 630 may alert processor 622 to use program instructions associated with triggering, closing, and articulating the end actuator. In certain cases, the sensors 630 may comprise position sensors that may be used to detect the position of the switch 614, for example. Accordingly, the processor 622 can use the program instructions associated with triggering the I-beam of the end actuator upon detecting, through sensors 630, for example, that the switch 614 is in the first position 616; the processor 622 may use the program instructions associated with closing the anvil upon detection through the sensors 630, for example, that the switch 614 is in the second position 617; and the processor 622 may use the program instructions associated with the end actuator linkage upon detection through the sensors 630, for example, that the switch 614 is in the third or fourth position 618a, 618b.

[0238] Figure 17 is a schematic diagram of a robotic surgical instrument 700 configured to operate a surgical tool described therein, in accordance with at least one aspect of that description. The robotic surgical instrument 700 may be programmed or configured to control the distal/proximal translation of a displacing limb, the distal/proximal displacement of a closure tube, the rotation of the drive shaft, and articulation, either with a single type or multiple articulation drive links. In one aspect, the surgical instrument 700 may be programmed or configured to individually control a firing member, a closing member, a drive shaft member, and/or one or more pivot members. The surgical instrument 700 comprises a control circuit 710 configured to control motor-driven firing members, closing members, drive shaft members, and/or one or more pivot members.

[0239] In one aspect, the robotic surgical instrument 700 comprises a control circuit 710 configured to control an anvil 716 and an i-beam portion 714 (including a sharp cutting edge) of an end actuator 702, a cartridge of removable clips 718, a drive shaft 740 and one or more pivot members 742a, 742b via a plurality of motors 704a to 704e. A position sensor 734 may be configured to provide feedback about the I-beam 714 to the control circuit 710. Other sensors 738 may be configured to provide feedback to the control circuit 710. A timer/counter 731 provides timing information and count to the control circuit 710. A power source 712 may be provided to operate the motors 704a to 704e and a current sensor 736 provides motor current feedback to the control circuit 710. The motors 704a to 704e may be operated individually by the control circuit 710 in an open-loop or closed-loop feedback control.

[0240] In one aspect, the control circuit 710 may comprise one or more microcontrollers, microprocessors, or other processors suitable for executing instructions that cause the processor or processors to perform one or more tasks. In one aspect, a timer/counter 731 provides an output signal, such as elapsed time or a digital count, to the control circuit 710 to correlate the position of the i-profile beam 714, as determined by the position sensor 734, with the output of the timer/counter 731 so that the control circuit 710 can determine the position of the i-profile beam 714 at a specific time (t) relative to an initial position or time (t) when the i-profile beam i 714 is in a specific position relative to an initial position. The timer/counter 731 can be configured to measure elapsed time, count external events, or measure eternal events.

[0241] In one aspect, the control circuit 710 may be programmed to control functions of the end actuator 702 based on one or more tissue conditions. The control circuit 710 may be programmed to directly or indirectly sense tissue conditions, such as thickness, as described herein. Control circuit 710 may be programmed to select a firing control program or closing control program based on fabric conditions. A trigger control program can describe the distal movement of the displacement limb. Different trigger control programs can be selected to best address different tissue conditions. For example, when thicker tissue is present, control circuit 710 may be programmed to translate the travel member at a lower speed and/or with lower power. When finer tissue is present, control circuit 710 can be programmed to translate the travel member at a higher speed and/or with greater power. A closing control program may control the closing force applied to the tissue by the anvil 716. Other control programs control the rotation of the drive shaft 740 and the pivot members 742a, 742b.

[0242] In one aspect, the motor control circuit 710 can generate motor setpoint signals. Motor setpoint signals can be provided to multiple 708a through 708e motor controllers. The motor controllers 708a to 708e may comprise one or more circuits configured to provide motor drive signals to the motors 704a to 704e to drive the motors 704a to 704e as described herein. In some examples, motors 704a to 704e may be brushed direct current electric motors. For example, the speed of motors 704a to 704e may be proportional to respective motor drive signals. In some examples, motors 704a to 704e may be brushless DC electric motors, and respective motor drive signals may comprise a PWM signal provided to one or more stator windings of motors 704a to 704e. Furthermore, in some examples, the motor controllers 708a to 708e may be omitted and the control circuit 710 may directly generate the motor drive signals.

[0243] In one aspect, control circuit 710 may initially operate each of motors 704a to 704e in an open-loop configuration for a first open-loop portion of travel of the travel member. Based on the response of the robotic surgical instrument 700 during the open-loop portion of the stroke, the control circuit 710 may select a trigger control program in a closed-loop configuration. The instrument response may include a translation of the distance from the traveling member during the open-circuit portion, an elapsed time during the open-circuit portion, the energy supplied to one of the motors 704a to 704e during the open-circuit portion, a sum of pulse widths of a motor drive signal, etc. After the open circuit portion, control circuit 710 may implement the selected firing control program for a second portion of travel of the travel member. For example, during a portion of the closed-loop stroke, the control circuit 710 may modulate one of the motors 704a to 704e based on translating data describing a position of the closed-loop travel member to translate the travel member to a constant speed.

[0244] In one aspect, motors 704a to 704e may receive power from a power source 712. The power source 712 may be a DC power source driven by an alternating mains current power source, a battery, a super capacitor, or any other suitable power source. Motors 704a to 704e can be mechanically coupled to individual movable mechanical elements such as the I-beam 714, the anvil 716, the drive shaft 740, the linkage 742a and the linkage 742b, through respective transmissions 706a to 706e. Transmissions 706a to 706e may include one or more gears or other linkage components for coupling motors 704a to 704e to movable mechanical elements. A position sensor 734 may detect a position of the I-beam 714. The position sensor 734 may be or may include any type of sensor that is capable of generating position data that indicates a position of the I-beam 714 In some examples, the position sensor 734 may include an encoder configured to provide a series of pulses to the control circuit 710 as the I-beam 714 translates distally and proximally. The control circuit 710 may track the pulses to determine the position of the I-beam 714. Other suitable position sensors may be used, including, for example, a proximity sensor. Other types of position sensors may provide other signals that indicate movement of the I-beam 714. Additionally, in some examples, the position sensor 734 may be omitted. When any one of the motors 704a to 704e is a stepper motor, the control circuit 710 can track the position of the I-beam 714 by aggregating the number and direction of the steps that the motor 704 has been instructed to perform. The position sensor 734 may be located in the end actuator 702 or in any other portion of the instrument. The outputs of each of the motors 704a to 704e include a torque sensor 744a to 744e for detecting force and have an encoder for detecting the rotation of the drive shaft.

[0245] In one aspect, the control circuit 710 is configured to drive a firing member such as the I-beam portion 714 of the end actuator 702. The control circuit 710 provides a motor set point for a controlling the motor 708a, which provides a drive signal to the motor 704a. The motor output drive shaft 704a is coupled to a torque sensor 744a. The torque sensor 744a is coupled to a transmission 706a that is coupled to the I-beam 714. The transmission 706a comprises movable mechanical elements, such as rotating elements, and a firing member for distally and proximally controlling the movement of the profile beam. in i 714 along a longitudinal axis of the end actuator 702. In one aspect, the motor 704a may be coupled to the knife gear assembly, which includes a knife gear reduction assembly, which includes a first drive gear. knife drive gear and a second knife drive gear. A torque sensor 744a provides a trigger force feedback signal to the control circuit 710. The trigger force signal represents the force required to trigger or displace the i-beam 714. A position sensor 734 may be configured to provide the position of the i-beam 714 along the firing path or the position of the firing member as a feedback signal to the control circuit 710. The end actuator 702 may include additional sensors 738 configured to provide signals of feedback to the control circuit 710. When ready for use, the control circuit 710 may provide a trigger signal to the motor control 708a. In response to the trigger signal, the motor 704a may drive the firing member distally along the longitudinal axis of the end actuator 702 from a stroke start proximal position to a stroke end distal position relative to the stroke start position. course. As the displacement member translates distally, an I-beam 714 with a cutting member positioned at a distal end advances distally to cut tissue situated between the staple cartridge 718 and the anvil 716.

[0246] In one aspect, control circuit 710 is configured to actuate a closure member, such as the anvil portion 716 of end actuator 702. Control circuit 710 provides a motor set point for motor control. 708b, which provides a drive signal to the motor 704b. The output shaft of the 704b motor is coupled to a 744b torque sensor. The torque sensor 744b is coupled to a transmission 706b which is coupled to the anvil 716. The transmission 706b comprises movable mechanical elements, such as rotating elements and a closure member, to control the movement of the anvil 716 between the open and closed positions. In one aspect, the motor 704b is coupled to a closing gear assembly, which includes a closing reduction gear assembly that is supported in mesh engagement with the closing gear wheel. Torque sensor 744b provides a closing force feedback signal to control circuit 710. The closing force feedback signal represents the closing force applied to anvil 716. Position sensor 734 can be configured to provide the position of the closing member as a feedback signal to the control circuit 710. Additional sensors 738 in the end actuator 702 can provide the closing force feedback signal to the control circuit 710. A pivot slider 716 is positioned opposite the staple cartridge 718. When ready for use, control circuit 710 may provide a close signal to motor control 708b. In response to the closing signal, the motor 704b advances a closing member to clamp the tissue between the anvil 716 and the staple cartridge 718.

[0247] In one aspect, the control circuit 710 is configured to rotate a drive shaft member, such as the drive shaft 740, to rotate the end actuator 702. The control circuit 710 provides a motor set point to a motor control 708c, which provides a drive signal to the motor 704c. The output shaft of the 704c engine is coupled to a 744c torque sensor. The torque sensor 744c is coupled to a transmission 706c which is coupled to the shaft 740. The transmission 706c comprises movable mechanical elements, such as rotating elements, to control the rotation of the drive shaft 740 clockwise or counterclockwise until and above 360°. In one aspect, the motor 704c is coupled to the rotary drive assembly, which includes a tube gear segment that is formed over (or attached to) the proximal end of the proximal closure tube for engagement operable by a rotational gear assembly that is operationally supported on the tool mounting plate. The torque sensor 744c provides a rotational force feedback signal to the control circuit 710. The rotational force feedback signal represents the rotational force applied to the drive shaft 740. The position sensor 734 can be configured to provide the position of the closure member as a feedback signal to the control circuit 710. Additional sensors 738, such as a drive shaft encoder, may provide the rotational position of the drive shaft 740 to the control circuit 710.

[0248] In one aspect, the control circuit 710 is configured to articulate the end actuator 702. The control circuit 710 provides a motor set point for a motor control 708d, which provides a drive signal to the motor 704d. The output shaft of the 704d engine is coupled to a 744d torque sensor. Torque sensor 744d is coupled to a transmission 706d which is coupled to a pivot member 742a. The transmission 706d comprises movable mechanical elements, such as linkage elements, to control the articulation of the end actuator 702 ± 65°. In one aspect, the motor 704d is coupled to a pivot nut, which is pivotally seated on the proximal end portion of the distal column portion and is pivotably driven therein by a pivot gear assembly. The torque sensor 744d provides a linkage force feedback signal to the control circuit 710. The linkage force feedback signal represents the linkage force applied to the end actuator 702. The sensors 738, such as a linkage encoder , may provide the pivot position of the end actuator 702 to the control circuit 710.

[0249] In another aspect, the articulation function of the robotic surgical system 700 may comprise two articulation members, or links, 742a, 742b. These articulation members 742a, 742b are driven by separate discs at the robot interface (the rack), which are driven by the two motors 708d, 708e. When the separate firing motor 704a is provided, each pivot link 742a, 742b may be antagonistically driven relative to the other link to provide a resistive holding movement and load to the head when it is not moving and to provide a resistive holding movement. articulation when the head is articulated. Pivot members 742a, 742b attach to the head at a fixed radius when the head is rotated. Consequently, the mechanical advantage of the push-pull link changes when the head is rotated. This change in mechanical advantage may be more pronounced with other linkage drive systems.

[0250] In one aspect, the one or more motors 704a to 704e may comprise a brushed DC motor with a gearbox and mechanical connections to a firing member, closure member, or pivot member. Another example includes electric motors 704a to 704e that operate movable mechanical elements such as the displacement member, pivot links, shut-off tube and drive shaft. An external influence is an unmeasured and unpredictable influence of things such as tissue, surrounding bodies, and friction in the physical system. This external influence may be called drag, which acts in opposition to one of the electric motors 704a to 704e. External influence, such as drag, can cause the operation of the physical system to deviate from a desired operation of the physical system.

[0251] In one aspect, the position sensor 734 can be implemented as an absolute positioning system. In one aspect, the position sensor 734 may comprise an absolute rotary magnetic positioning system implemented as a single integrated circuit rotary magnetic position sensor, AS5055EQFT, available from Austria Microsystems, AG. The position sensor 734 may interface with the control circuit 710 to provide an absolute positioning system. The position may include multiple Hall effect elements located above a magnet and coupled to a CORDIC processor, also known as the digit-by-digit method and Volder's algorithm, which is provided to implement a simple and efficient algorithm for calculating hyperbolic and trigonometric functions which require only addition, subtraction, bit shift, and lookup table operations.

[0252] In one aspect, the control circuit 710 may be in communication with one or more sensors 738. The sensors 738 may be positioned on the end actuator 702 and adapted to work with the robotic surgical instrument 700 to measure various derived parameters. such as span distance in relation to time, tissue compression in relation to time, and anvil deformation in relation to time. The sensors 738 may comprise a magnetic sensor, a magnetic field sensor, a strain gauge, a load cell, a pressure sensor, a force sensor, a torque sensor, an inductive sensor such as an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor, and/or any other sensor suitable for measuring one or more parameters of the end actuator 702. The sensors 738 may include one or more sensors. Sensors 738 may be located on the staple cartridge platform 718 to determine tissue location using segmented electrodes. Torque sensors 744a to 744e can be configured to detect forces such as trigger force, closing force, and/or pivot force, among others. Accordingly, the control circuit 710 can detect (1) the closing load experienced by the distal closing tube and its position, (2) the firing member in the rack and its position, (3) which portion of the staple cartridge 718 has fabric therein, and (4) the load and position on both pivot rods.

[0253] In one aspect, the one or more sensors 738 may comprise a strain gauge, such as a microstrain gauge, configured to measure the magnitude of strain on anvil 716 during a stuck condition. The voltage meter provides an electrical signal whose amplitude varies with the magnitude of the voltage. The sensors 738 may comprise a pressure sensor configured to detect a pressure generated by the presence of tissue compressed between the anvil 716 and the staple cartridge 718. The sensors 738 may be configured to detect the impedance of a section of tissue situated between the anvil. 716 and the staple cartridge 718 which is indicative of the thickness and/or completeness of the tissue located between them.

[0254] In one aspect, sensors 738 may be implemented as one or more limit switches, electromechanical devices, solid state switches, Hall effect devices, magneto-resistive (MR) devices, giant magneto-resistive (GMR) devices, magnetometers, among others. In other implementations, sensors 738 can be implemented as solid-state switches that operate under the influence of light, such as optical sensors, infrared sensors, ultraviolet sensors, among others. Furthermore, switches can be solid-state devices such as transistors (e.g. FET, junction FET, MOSFET, bipolar and the like). In other implementations, sensors 738 may include conductorless electrical switches, ultrasonic switches, accelerometers, inertial sensors, and so on.

[0255] In one aspect, sensors 738 may be configured to measure the forces exerted on the anvil 716 by the closing drive system. For example, one or more sensors 738 may be at a point of interaction between the closure tube and anvil 716 to detect the closure forces applied by the closure tube to the anvil 716. The forces exerted on the anvil 716 may be representative of the tissue compression experienced by the section of tissue captured between the anvil 716 and the staple cartridge 718. The one or more sensors 738 may be positioned at various interaction points along the closure drive system to detect the closure forces applied to the anvil 716 by the closing drive system. The one or more sensors 738 may be sampled in real-time during a grasping operation by the control circuit processor 710. The control circuit 710 receives real-time sample measurements to provide and analyze time-based information and evaluate timely real, the closing forces applied to the anvil 716.

[0256] In one aspect, a current sensor 736 can be used to measure the current drawn by each of the motors 704a to 704e. The force required to advance any of the moving mechanical elements such as the I-beam 714 corresponds to the current drawn by one of the motors 704a to 704e. The force is converted to a digital signal and supplied to the control circuit 710. The control circuit 710 can be configured to simulate the response of the actual instrument system in the controller software. A displacement member may be actuated to move an I-beam 714 in the end actuator 702 at or near a target speed. The robotic surgical instrument 700 may include a feedback controller, which may be one or any of the feedback controllers, including, but not limited to, a PID, state feedback, linear quadratic (LQR) controller, and/or an adaptive controller. , for example. The robotic surgical instrument 700 may include a power source for converting the feedback controller signal into a physical input such as case voltage, PWM voltage, frequency modulated voltage, current, torque, and/or force, for example. Additional details are described in US Patent Application Serial No. 15/636,829, entitled CLOSED LOOP VELOCITY CONTROL TECHNIQUES FOR ROBOTIC SURGICAL INSTRUMENT, filed June 29, 2017, which is incorporated herein by reference in its entirety.

[0257] Figure 18 illustrates a block diagram of a surgical instrument 750 programmed to control distal translation of the displacement member, in accordance with an aspect of this description. In one aspect, the surgical instrument 750 is programmed to control the distal translation of a displacement member, such as the I-beam 764. The surgical instrument 750 comprises an end actuator 752 that may comprise an anvil 766, a beam with I-profile 764 (including a sharp cutting edge), and a removable staple cartridge 768.

[0258] The position, movement, displacement, and/or translation of a linear displacement member, such as I-beam 764, can be measured by an absolute positioning system, sensor arrangement, and a position sensor 784. Since the I-beam 764 is coupled to a longitudinally movable drive member, the position of the I-beam 764 can be determined by measuring the position of the longitudinally movable drive member using the position sensor 784 Consequently, in the following description, the position, displacement and/or translation of the I-beam 764 can be obtained by the position sensor 784, as described in the present invention. A control circuit 760 may be programmed to control the translation of the displacement member, such as the I-beam 764. The control circuit 760, in some examples, may comprise one or more microcontrollers, microprocessors, or other processors suitable for performing the instructions that cause the processor or processors to control the traveling member, e.g., the I-beam 764, in the manner described. In one aspect, a timer/counter 781 provides an output signal, such as elapsed time or a digital count, to the control circuit 760 to correlate the position of the I-beam 764 as determined by the position sensor 784 with the output. of the timer/counter 781 so that the control circuit 760 can determine the position of the I-beam 764 at a specific time (t) relative to an initial position. The 781 timer/counter can be configured to measure elapsed time, count external events, or measure eternal events.

[0259] The control circuit 760 may generate a motor setpoint signal 772. The motor setpoint signal 772 may be provided to a motor controller 758. The motor controller 758 may comprise one or more circuits configured to provide a drive signal from engine 774 to engine 754 to drive engine 754 as described in the present invention. In some examples, the motor 754 may be a DC motor with a brushed DC electric motor. For example, the speed of the motor 754 may be proportional to the motor drive signal 774. In some examples, the motor 754 may be a brushless DC electric motor and the motor drive signal 774 may comprise a PWM signal supplied to a or more stator windings of the motor 754. Furthermore, in some examples, the motor controller 758 may be omitted, and the control circuit 760 may generate the motor drive signal 774 directly.

[0260] The motor 754 may receive power from a power source 762. The power source 762 may be or include a battery, a super capacitor, or any other suitable power source. The motor 754 may be mechanically coupled to the I-beam 764 via a transmission 756. The transmission 756 may include one or more gears or other linkage components for coupling the motor 754 to the I-beam 764. A sensor position sensor 784 may detect a position of the I-beam 764. The position sensor 784 may be or may include any type of sensor that is capable of generating position data that indicates a position of the I-beam 764. For example, the position sensor 784 may include an encoder configured to provide a series of pulses to the control circuit 760 as the I-beam 764 translates distally and proximally. The control circuit 760 may track the pulses to determine the position of the I-beam 764. Other suitable position sensors may be used, including, for example, a proximity sensor. Other types of position sensors may provide other signals that indicate movement of the I-beam 764. Additionally, in some examples, the position sensor 784 may be omitted. When the motor 754 is a stepper motor, the control circuit 760 can track the position of the I-beam 764 by aggregating the number and orientation of the steps that the motor 754 has been instructed to perform. The position sensor 784 may be located in the end actuator 752 or in any other portion of the instrument.

[0261] The control circuit 760 may be in communication with one or more sensors 788. The sensors 788 may be positioned on the end actuator 752 and adapted to work with the surgical instrument 750 to measure various derived parameters, such as span distance. in relation to time, tissue compression in relation to time and anvil tension in relation to time. The sensors 788 may comprise a magnetic sensor, a magnetic field sensor, a strain gauge, a pressure sensor, a force sensor, an inductive sensor such as an eddy current sensor, a resistive sensor, a capacitive sensor, a optical and/or any other sensors suitable for measuring one or more parameters of the end actuator 752. The sensors 788 may include one or more sensors.

[0262] The one or more sensors 788 may comprise a strain gauge, such as a microstrain gauge, configured to measure the magnitude of tension on the anvil 766 during a gripping condition. The voltage meter provides an electrical signal whose amplitude varies with the magnitude of the voltage. The sensors 788 may comprise a pressure sensor configured to detect a pressure generated by the presence of tissue compressed between the anvil 766 and the staple cartridge 768. The sensors 788 may be configured to detect the impedance of a section of tissue situated between the anvil. 766 and the staple cartridge 768 which is indicative of the thickness and/or completeness of the tissue located between them.

[0263] Sensors 788 may be configured to measure forces exerted on anvil 766 by a closing drive system. For example, one or more sensors 788 may be at a point of interaction between a closure tube and anvil 766 to detect closure forces applied by a closure tube on anvil 766. The forces exerted on anvil 766 may be representative of tissue compression experienced by the section of tissue captured between the anvil 766 and the staple cartridge 768. The one or more sensors 788 may be positioned at various interaction points along the closure drive system to detect the applied closure forces. to anvil 766 by the closing drive system. The one or more sensors 788 may be sampled in real time during a grasping operation by a processor of the control circuit 760. The control circuit 760 receives real-time sample measurements to provide and analyze time-based information and evaluate, in real time, the closing forces applied to the anvil 766.

[0264] A current sensor 786 can be used to measure the current drawn by the motor 754. The force required to advance the I-beam 764 corresponds to the current drawn by the motor 754. The force is converted into a digital signal and provided to the 760 control circuit.

[0265] The control circuit 760 may be configured to simulate the response of the actual instrument system in the controller software. A displacement member may be actuated to move an I-beam 764 in the end actuator 752 at or near a target speed. The surgical instrument 750 may include a feedback controller, which may be one or any of the feedback controllers, including, but not limited to, a PID controller, status feedback, LQR, and/or an adaptive controller, for example. Surgical instrument 750 may include a power source to convert the feedback controller signal into a physical input such as case voltage, PWM voltage, frequency modulated voltage, current, torque, and/or force, for example.

[0266] The actual drive system of the surgical instrument 750 is configured to drive the traveling member, cutting member, or I-beam 764 by a brushed DC motor with gearbox and mechanical linkages to a drive system. joint and/or a knife. Another example is the electric motor 754 that operates the travel member and the pivot driver, for example, of an interchangeable drive shaft assembly. An external influence is an unmeasured and unpredictable influence of things such as tissue, surrounding bodies, and friction in the physical system. This external influence can be called drag, which acts in opposition to the 754 electric motor. External influence, such as drag, can cause the operation of the physical system to deviate from a desired operation of the physical system.

[0267] Various exemplary aspects are directed to a surgical instrument 750 comprising an end actuator 752 with motor-driven stapling and cutting surgical implements. For example, a motor 754 may drive a displacement member distally and proximally along a longitudinal axis of the end actuator 752. The end actuator 752 may comprise a pivotable anvil 766 and, when configured for use, an ultrasonic blade. 768 positioned on the opposite side of the anvil 766. A practitioner may hold tissue between the anvil 766 and the staple cartridge 768 as described in the present invention. When ready to use the instrument 750, the practitioner may provide a trigger signal, for example, by pressing a trigger of the instrument 750. In response to the trigger signal, the motor 754 may drive the displacement member distally along the longitudinal axis. of the end actuator 752 from a proximal start-of-stroke position to an end-of-stroke position distal to the start-of-stroke position. As the displacement member moves distally, the I-beam 764 with a cutting member positioned at a distal end may cut the tissue between the staple cartridge 768 and the anvil 766.

[0268] In various examples, the surgical instrument 750 may comprise a control circuit 760 programmed to control the distal translation of the displacement member, such as the I-beam 764, for example, based on one or more tissue conditions. . The control circuit 760 may be programmed to directly or indirectly sense tissue conditions, such as thickness, as described herein. Control circuit 760 may be programmed to select a control program based on tissue conditions. A trigger control program can describe the distal movement of the displacement limb. Different trigger control programs can be selected to best address different tissue conditions. For example, when thicker tissue is present, control circuit 760 may be programmed to translate the displacement member at a lower speed and/or with lower power. When finer tissue is present, control circuit 760 can be programmed to translate the travel member at a higher speed and/or with greater power.

[0269] In some examples, control circuit 760 may initially operate motor 754 in an open-loop configuration for a first open-loop portion of a stroke of the travel member. Based on a response from instrument 750 during the open circuit portion of the stroke, control circuit 760 may select a firing control program. The instrument response may include a translational distance of the travel member during the open-circuit portion, an elapsed time during the open-circuit portion, the power supplied to motor 754 during the open-circuit portion, a sum of pulse widths of a motor drive signal, etc. After the open circuit portion, control circuit 760 may implement the selected firing control program for a second portion of travel of the travel member. For example, during the closed-loop portion of the stroke, control circuit 760 may modulate motor 754 based on translational data describing a position of the travel member in a closed-loop manner to translate the travel member in a constant speed. Additional details are described in US Patent Application Serial No. 15/720,852, entitled SYSTEM AND METHODS FOR CONTROLLING A DISPLAY OF A SURGICAL INSTRUMENT, filed on September 29, 2017, which is incorporated herein by reference in its entirety.

[0270] Figure 19 is a schematic diagram of a surgical instrument 790 configured to control various functions in accordance with at least one aspect of this description. In one aspect, the surgical instrument 790 is programmed to control the distal translation of a displacement member, such as the I-beam 764. The surgical instrument 790 comprises an end actuator 792 that may comprise an anvil 766, a beam with I-profile 764 and a removable staple cartridge 768 that can be interchanged with an RF cartridge 796 (shown in dashed line).

[0271] In one aspect, sensors 788 can be implemented as a limit switch, electromechanical device, solid state switches, Hall effect devices, MR devices, GMR devices, magnetometers, among others. In other implementations, sensors 638 may be solid-state switches that operate under the influence of light, such as optical sensors, infrared sensors, ultraviolet sensors, among others. Furthermore, switches can be solid-state devices such as transistors (e.g. FET, junction FET, MOSFET, bipolar and the like). In other implementations, sensors 788 may include conductorless electrical switches, ultrasonic switches, accelerometers, inertial sensors, and so on.

[0272] In one aspect, the position sensor 784 can be implemented as an absolute positioning system, which comprises a rotary magnetic absolute positioning system implemented as a single integrated circuit rotary magnetic position sensor, AS5055EQFT, available from Austria Microsystems, AG. The position sensor 784 may interface with the control circuit 760 to provide an absolute positioning system. The position may include multiple Hall effect elements located above a magnet and coupled to a CORDIC processor, also known as the digit-by-digit method and Volder's algorithm, which is provided to implement a simple and efficient algorithm for calculating hyperbolic and trigonometric functions which require only addition, subtraction, bit shift, and lookup table operations.

[0273] In one aspect, the I-beam 764 may be implemented as a knife member comprising a knife body that operatively supports a fabric cutting blade thereon and may additionally include tabs or anvil engagement features. and channel engagement features or a base. In one aspect, the staple cartridge 768 can be implemented as a standard surgical (mechanical) staple cartridge. In one aspect, the RF cartridge 796 can be implemented as an RF cartridge. These and other sensor arrangements are described in Commonly Owned U.S. Patent Application Serial No. 15/628,175, entitled TECHNIQUES FOR ADAPTIVE CONTROL OF MOTOR VELOCITY OF A SURGICAL STAPLING AND CUTTING INSTRUMENT, filed June 20, 2017, which is incorporated herein by reference in its entirety.

[0274] The position, movement, displacement and/or translation of a linear displacement member, such as the I-beam 764, can be measured by an absolute positioning system, sensor arrangement and position sensor represented as the position sensor 784. As the I-beam 764 is coupled to the longitudinally movable drive member, the position of the I-beam 764 can be determined by measuring the position of the longitudinally movable drive member using the position sensor. position 784. Consequently, in the following description, the position, displacement and/or translation of the I-beam 764 can be obtained by the position sensor 784, as described in the present invention. A control circuit 760 may be programmed to control the translation of the displacement member, such as the I-beam 764, as described herein. The control circuit 760, in some examples, may comprise one or more microcontrollers, microprocessors, or other processors suitable for executing the instructions that cause the processor or processors to control the traveling member, e.g., the I-beam 764 , as described. In one aspect, a timer/counter 781 provides an output signal, such as elapsed time or a digital count, to the control circuit 760 to correlate the position of the I-beam 764 as determined by the position sensor 784 with the output. of the timer/counter 781 so that the control circuit 760 can determine the position of the I-beam 764 at a specific time (t) relative to an initial position. The 781 timer/counter can be configured to measure elapsed time, count external events, or measure eternal events.

[0275] The control circuit 760 may generate a motor setpoint signal 772. The motor setpoint signal 772 may be provided to a motor controller 758. The motor controller 758 may comprise one or more circuits configured to provide a drive signal from engine 774 to engine 754 to drive engine 754 as described in the present invention. In some examples, the motor 754 may be a DC motor with a brushed DC electric motor. For example, the speed of the motor 754 may be proportional to the motor drive signal 774. In some examples, the motor 754 may be a brushless DC electric motor and the motor drive signal 774 may comprise a PWM signal supplied to a or more stator windings of the motor 754. Furthermore, in some examples, the motor controller 758 may be omitted, and the control circuit 760 may generate the motor drive signal 774 directly.

[0276] The motor 754 may receive power from a power source 762. The power source 762 may be or include a battery, a super capacitor, or any other suitable power source. The motor 754 may be mechanically coupled to the I-beam 764 via a transmission 756. The transmission 756 may include one or more gears or other linkage components for coupling the motor 754 to the I-beam 764. A sensor position sensor 784 may detect a position of the I-beam 764. The position sensor 784 may be or may include any type of sensor that is capable of generating position data that indicates a position of the I-beam 764. For example, the position sensor 784 may include an encoder configured to provide a series of pulses to the control circuit 760 as the I-beam 764 translates distally and proximally. The control circuit 760 may track the pulses to determine the position of the I-beam 764. Other suitable position sensors may be used, including, for example, a proximity sensor. Other types of position sensors may provide other signals that indicate movement of the I-beam 764. Additionally, in some examples, the position sensor 784 may be omitted. When the motor 754 is a stepper motor, the control circuit 760 may track the position of the I-beam 764 by aggregating the number and orientation of the steps that the motor has been instructed to perform. The position sensor 784 may be located in the end actuator 792 or in any other portion of the instrument.

[0277] The control circuit 760 may be in communication with one or more sensors 788. The sensors 788 may be positioned on the end actuator 792 and adapted to work with the surgical instrument 790 to measure various derived parameters, such as span distance. in relation to time, tissue compression in relation to time and anvil tension in relation to time. The sensors 788 may comprise a magnetic sensor, a magnetic field sensor, a strain gauge, a pressure sensor, a force sensor, an inductive sensor such as an eddy current sensor, a resistive sensor, a capacitive sensor, a optical and/or any other sensors suitable for measuring one or more parameters of the end actuator 792. The sensors 788 may include one or more sensors.

[0278] The one or more sensors 788 may comprise a strain gauge, such as a microstrain gauge, configured to measure the magnitude of tension on the anvil 766 during a gripping condition. The voltage meter provides an electrical signal whose amplitude varies with the magnitude of the voltage. The sensors 788 may comprise a pressure sensor configured to detect a pressure generated by the presence of tissue compressed between the anvil 766 and the staple cartridge 768. The sensors 788 may be configured to detect the impedance of a section of tissue situated between the anvil. 766 and the staple cartridge 768 which is indicative of the thickness and/or completeness of the tissue located between them.

[0279] Sensors 788 can be configured to measure the forces exerted on the anvil 766 by the closing drive system. For example, one or more sensors 788 may be at a point of interaction between a closure tube and anvil 766 to detect closure forces applied by a closure tube on anvil 766. The forces exerted on anvil 766 may be representative of tissue compression experienced by the section of tissue captured between the anvil 766 and the staple cartridge 768. The one or more sensors 788 may be positioned at various interaction points along the closure drive system to detect the applied closure forces. to anvil 766 by the closing drive system. The one or more sensors 788 may be sampled in real time during a grasp operation by a processor portion of the control circuit 760. The control circuit 760 receives real-time sample measurements to provide and analyze time-based information and evaluate , in real time, the closing forces applied to the anvil 766.

[0280] A current sensor 786 can be used to measure the current drawn by the motor 754. The force required to advance the I-beam 764 corresponds to the current drawn by the motor 754. The force is converted into a digital signal and provided to the 760 control circuit.

[0281] An RF power source 794 is coupled to the end actuator 792 and is applied to the RF cartridge 796 when the RF cartridge 796 is loaded into the end actuator 792 in place of the clamp cartridge 768. The control circuit 760 controls the delivery of RF energy to the RF cartridge 796.

[0282] Additional details are described in US Patent Application Serial No. 15/636,096, entitled SURGICAL SYSTEM COUPLABLE WITH STAPLE CARTRIDGE AND RADIO FREQUENCY CARTRIDGE, AND METHOD OF USING SAME, filed June 28, 2017, which is incorporated herein for reference in its entirety.

[0283] Figure 20 illustrates a stroke length chart 20740 that shows how a control system can modify the stroke length of a closure tube assembly based on the pivot angle θ. Such stroke length modification includes shortening the stroke length to a compensated stroke length (e.g., defined along the y axis) as the pivot angle θ increases (e.g., defined along the x axis). Compensated stroke length defines a stroke length of the shut-off tube assembly in the distal direction to close the jaws of an end actuator, which depends on the pivot angle θ and prevents excessive displacement of the shut-off tube assembly, causing damage to the surgical device.

[0284] For example, as shown in stroke length chart 20740, the stroke length of the shut-off tube assembly to close the jaws is approximately 0.250 inches when the end actuator is not hinged and the compensated stroke length is of approximately 0.242 inches when the pivot angle θ is approximately 60 degrees. Such measurements are provided as examples only and may include any of a variety of angles and corresponding stroke lengths and compensated stroke lengths without departing from the scope of this description. Furthermore, the relationship between joint angles θ and compensated stroke lengths is nonlinear and the rate at which the compensated stroke length decreases increases as the pivot angle increases. For example, the decrease in compensated stroke lengths between 45 and 60 degrees of articulation is greater than the decrease in compensated stroke lengths between zero and 15 degrees of articulation. Although with this approach the control system is adjusting the stroke length based on the pivot angle θ to prevent damage to the surgical device (e.g., trapping the distal end of the closure tube assembly in a distal position), advancement of the Distal closure tube is still permitted during articulation, potentially at least partially closing the jaws.

[0285] Figure 21 illustrates a positioning chart of the closure tube assembly 20750 that shows an aspect in which a control system modifies a longitudinal position of a closure tube assembly based on the pivot angle; Such modification of the longitudinal position of the closure tube assembly includes proximally retracting the closure tube assembly by an offset distance (e.g., defined along the y axis) as the end actuator articulates and based on the articulation angle. θ (e.g. defined along the x axis). The offset distance that the closure tube assembly is proximally retracted prevents distal advancement of the distal closure tube thereby maintaining the jaws in the open position during articulation. Through proximal retraction of the closure tube assembly by the compensation distance during articulation, the closure tube assembly can travel the stroke length from the proximally retracted position to close the jaws after activation of the closure assembly

[0286] For example, as shown in the positioning chart of the 20750 closure tube assembly, the compensation distance when the end actuator is not hinged is zero and the compensation distance when the hinge angle θ is approximately 60 degrees is approximately 0.008 inches. In this example, the shut-off tube assembly is retracted an offset distance of 0.008 inches during pivoting. In this way, to close the jaws, the closure tube assembly can advance the stroke length from this retracted position. Such measurements are provided for example purposes only and may include any of a variety of angles and corresponding offset distances without departing from the scope of the description. As shown in Figure 21, the relationship between the joint angle θ and the offset distance is nonlinear and the speed at which the offset distance grows increases as the joint angle θ increases. For example, the increase in compensation distance between 45 degrees and 60 degrees is greater than the increase in compensation distance between zero degrees and 15 degrees.

[0287] During grasping of the patient's tissue, the forces exerted through the grasping device, for example, a linear stapler, and the tissue may reach an unacceptably high level. For example, when a constant rate of closure is employed, the force may become high enough to cause excess trauma to the trapped tissue and may cause deformation of the gripping device such that an acceptable tissue gap is not maintained throughout the closure. stapling trajectory. Figure 22 is a graph illustrating the power applied to the tissue during compression at a constant rate of anvil closure rate (i.e., no controlled tissue compression (CTC)) versus the power applied to the tissue during compression at a rate variable anvil closure (i.e. with CTC). The rate of closure can be adjusted to control compression of the tissue so that the energy imparted to the tissue remains constant over a portion of the compression. The peak power transmitted to the tissue according to Figure 22 is much lower when a variable rate of anvil closure is used. Based on the energy imparted, the force exerted by the surgical device (or a parameter related to or proportional to the force) can be calculated. In this sense, the power may be limited such that the force exerted through the surgical device, for example through the jaws of a linear stapler, does not exceed a yield force or pressure that results in the jaws opening, so that the fabric gap is not within an acceptable range along the entire length of the staple when in the fully closed position. For example, the jaws must be parallel or close enough so that the tissue gap remains within the acceptable or target range for all staple positions along the entire length of the jaws. Additionally, limiting the power exerted prevents, or at least reduces, trauma or tissue damage.

[0288] In Figure 22, the total energy exerted in the method without CTC is the same as the total energy exerted in the method with CTC, that is, the areas under the power curves in Figure 22 are equal or substantially equal. The difference in the power profiles used is, however, substantial, since the peak power is much lower in the example with CTC compared to the example without CTC.

[0289] Power limitation is obtained in the example with CTC by reducing the closing rate, as illustrated by line 20760. Note that the compression time B' is greater than the closing time B. As illustrated in Figure 22 , a device and method that provides a constant closure rate (i.e.; no CTC) achieves the same 50 pounds of compression force in the same 1 mm tissue gap as the device and method that provides a variable closure rate ( i.e. with CTC). Although the device and method that provides a constant closure rate can achieve the compression force in the desired tissue gap in a shorter period of time compared to a device and method that uses a variable closure rate, this results in peak of power applied to the tissue, as shown in Figure 22. In contrast, the example aspect illustrated with CTC begins to reduce the closure rate to limit the amount of power applied to the tissue below a certain level. By limiting the power applied to the tissue, trauma to the tissue can be minimized relative to the system and method that does not use CTC.

[0290] Figure 22 and additional exemplifications are further described in U.S. Patent No. 8,499,992, filed on June 1, 2012, entitled DEVICE AND METHOD FOR CONTROLLING COMPRESSION OF TISSUE, which was issued on August 6, 2013, which full description is incorporated herein by reference.

[0291] In some aspects, a control system may include a plurality of predefined force limits that assist the control system in determining a position of an E-beam and/or pivot angle of a firing drive shaft. and appropriately controlling at least one engine based on such determination. For example, force limits may change depending on a firing bar stroke length configured to move the firing drive shaft, and such force limits may be compared to a measured torsional force of the one or more motors in communication with the control system. Comparing measured torsional forces against force limits can provide a reliable way for the control system to determine a location of the E-beam and/or end actuator linkage. This may allow the control system to adequately control one or more motors (e.g., reduce or stop torsional loads) to ensure firing of the end actuator firing and linkage assembly, as well as prevent damage to the system, as will be described in more detail below.

[0292] Figure 23 illustrates a force and displacement graph 20800 including forces measured in section A that are related to displacements measured in section B. Both sections A and B have a geometric x axis that defines time (e.g., seconds ). The y-axis of section B defines a displacement (e.g., in millimeters) of a firing rod and the y-axis of section A defines a force applied to the firing bar to advance the firing drive axis. As shown in section A, displacement of the firing bar within a first pivot range 20902 (e.g., a first path of approximately 12 mm) causes the end actuator to pivot. For example, in the 12 mm offset position, the end actuator is fully hinged to the right and is mechanically incapable of articulating further. As a result of being in full articulation, the torsional force on the motor will increase and the control system may detect a peak articulation force 20802 that exceeds a predefined articulation threshold 20804, as shown in section A. The control system may include more of a predefined articulation limit 20804 to detect more than one maximum articulation direction (e.g., left articulation and right articulation). After the control system detects a peak linkage force 20802 that exceeds the predetermined linkage limit 20804, the control system may reduce or prevent actuation of the motor thereby at least protecting the motor from damage.

[0293] After the firing bar advances beyond pivot range 20902, a travel mechanism within the surgical stapler may cause additional distal displacement of the firing bar to cause distal displacement of the firing drive shaft. For example, as shown in section B, displacement between approximately 12 mm and 70 mm path can cause the E-beam to advance along a firing path 20904 and cut tissue captured between the jaws; however, other offset lengths are within the scope of this description. In this example, a maximum firing stroke position 20906 of the E-beam occurs at 70 mm. At this point, the E-beam or knife is contiguous to a distal end of the cartridge or gripper, thereby increasing the torsional forces on the motor and causing a peak displacement force of the knife 20806, as shown in Sect. A, be detected by the control system. As shown in section A, the control system may include a motor boundary 20808 and a knife end path boundary 20810 that branches from the motor boundary 20808 and decreases (e.g., non-linearly) as the beam with profile at E approaches the maximum firing stroke position 20906.

[0294] The control system may be configured to monitor the detected torsional force of the motor during at least the last portion of the distal travel 20907 (e.g., last 10 percent of the firing stroke 904) of the E-beam before reach the maximum firing stroke position 20906. While monitoring along the last part of the distal travel 20907, the control system can cause the motor to reduce torsional forces to thereby reduce the load on the E-beam. can protect the surgical stapler from damage, including the E-beam, reducing the loads on the E-beam as the E-beam approaches the maximum firing strike position 20906, thereby reducing the impact of beam with E-profile at the distal end of the cartridge or claw. As mentioned above, this impact may cause a peak travel force of knife 20806, which may exceed the travel limit of knife 20810 but not the limit of motor 20808 so as not to damage the motor. In this way, the control system can stop actuation of the motor after the peak displacement force of the knife 20806 exceeds the displacement threshold of the knife 20810 and before the peak displacement force of the knife 20806 exceeds the threshold of the motor 20808, thus protecting the engine from damage. Furthermore, the increasing reduction in the knife travel limit 20810 prevents the control system from preliminarily thinking that the E-beam has reached the maximum firing stroke position 20906.

[0295] After the control system has detected a peak knife displacement force 20806 that exceeds the knife displacement limit 20810, the control system can confirm an E-profile beam position (e.g., at 70 mm travel and/or at the end of the firing stroke 20904) and may retract the firing bar based on this known offset position to reset the E-beam to the most proximal position 20908 (e.g., 0 mm offset). At the most proximal position 20908, a peak knife retraction force 20812 that exceeds a predefined knife retraction threshold 20814, as shown in section A, can be detected by the control system. At this point, the control system can recalibrate, if necessary, and associate the position of the E-beam as being in an initial position where subsequent advancement of the firing rod in the distal direction (e.g., approximately 12 mm in length) will cause cause the shifter to disengage the E-beam from the trigger bar. Once disengaged, travel of the firing bar within the 20902 pivot range will again cause the end actuator to pivot.

[0296] In this way, the control system can detect torsional forces in the motor that controls the travel of the firing bar and compare these detected torsional forces with a plurality of limits to determine an E-beam position or joint angle of the end actuator and thus adequately control the motor to avoid damage to the motor, as well as confirm the positioning of the shooting bar and/or E-beam.

[0297] As described above, tissue contact or pressure sensors determine when the gripper members initially contact the tissue "T". This allows a surgeon to determine the initial "T" tissue thickness and/or the "T" tissue thickness prior to grasping. In either aspect of the surgical instrument described above, as seen in Figure 24, contact of the gripper limbs with the tissue "T" closes a sensing circuit "SC" that is otherwise open, establishing contact with a pair of plates. "P1, P2" counters provided on the gripper members. Contact sensors may also include sensitive force transducers that determine the amount of force being applied to the sensor, which can be assumed to be the same amount of force being applied to the tissue "T". This force being applied to the tissue can then be converted into an amount of tissue compression. Force sensors measure the amount of compression a tissue is under and provide the surgeon with information about the force applied to the tissue "T". Excessive tissue compression can have a negative impact on the "T" tissue being operated on. For example, excessive compression of the "T" tissue can result in tissue necrosis and, in certain procedures, staple line failure. Information regarding the pressure being applied to the "T" tissue allows a surgeon to better determine whether excessive pressure is being applied to the "T" tissue.

[0298] Any of the contact sensors disclosed herein may include, but is not limited to, electrical contacts placed on an inner surface of a gripper that, when in contact with tissue, close a sensing circuit that is otherwise open . Contact sensors can also include sensitive force transducers that detect when the tissue being clamped first resists compression. Force transducers may include, but are not limited to, piezoelectric elements, piezoresistive elements, metal film or semiconductor strain gauges, inductive pressure sensors, capacitive pressure sensors, and potentiometric pressure transducers that use bourbon tubes, capsules, or bellows to drive a wiper arm on a resistive element.

[0299] In one aspect, any of the aforementioned surgical instruments may include one or more piezoelectric elements to detect a change in pressure occurring in the claw limbs. Piezoelectric elements are bidirectional transducers that convert voltage into an electrical potential. Elements may consist of metallized quartz or ceramic. In operation, when voltage is applied to the crystals there is a change in the charge distribution of the material resulting in a generation of voltage throughout the material. Piezoelectric elements can be used to indicate when either or both gripper members come into contact with the fabric "T" and the amount of pressure exerted on the fabric "T" after a contact is established.

[0300] In one aspect, any of the aforementioned surgical instruments may include or be provided with one or more metallic strain gauges placed within or on a portion of the body thereof. Metal strain gauges operate on the principle that material strength depends on length, width and thickness. Consequently, when the material of the metallic strain gauge undergoes deformation, the resistance of the material changes. In this way, a resistor made of this material embedded in a circuit will convert voltage to a change in an electrical signal. Desirably, the strain gauge can be placed on the Surgical Instruments so that pressure applied to the tissue affects the strain gauge.

[0301] Alternatively, in another aspect, one or more semiconductor strain gauges may be used in a similar manner as the metallic strain gauge described above, although the mode of transduction is different. In operation, when a crystal lattice structure of the semiconductor strain gauge is deformed as a result of an applied voltage, the resistance of the material changes. This phenomenon is called piezoresistive effect.

[0302] In yet another aspect, any of the aforementioned surgical instruments may include or be provided with one or more inductive pressure sensors to transduce pressure or force into movement of inductive elements relative to each other. This movement of the inductive elements relative to each other changes the overall inductance or inductive coupling. Capacitive pressure transducers also transduce pressure or force into moving capacitive elements relative to each other, changing the overall capacitance.

[0303] In yet another aspect, any of the aforementioned surgical instruments may include or be provided with one or more capacitive pressure transducers to transduce pressure or force into movement of capacitive elements relative to each other, changing an overall capacitance.

[0304] In one aspect, any of the aforementioned surgical instruments may include or be provided with one or more mechanical pressure transducers to transduce pressure or force into motion. In use, a movement of a mechanical element is used to deflect a pointer or disc on a meter. This movement of the pointer or disc may be representative of the pressure or force applied to the "T" tissue. Examples of mechanical elements include, but are not limited to, bourbon tubes, capsules, or bellows. By way of example, mechanical elements can be coupled with other sensing and/or measuring elements, such as a potentiometer pressure transducer. In this example the mechanical element is coupled with a wiper over the variable resistor. In use, the pressure or force can be converted into mechanical movement that deflects said wiper in the potentiometer thus changing the resistance to reflect the applied pressure or force.

[0305] The combination of the above aspects, in particular, the combination of gap and tissue contact sensors, provides the surgeon with feedback information and/or real-time information regarding the condition of the operating site and/or target tissue." T". For example, information about the initial thickness of the "T" tissue can guide the surgeon in selecting an appropriate staple size, information about the trapped thickness of the "T" tissue can inform the surgeon whether the selected staple will form correctly, related information The initial thickness and clamped thickness of the "T" fabric can be used to determine the amount of compression or tension in the "T" fabric, and information related to the tension in the "T" fabric can be used in this tension to avoid compressing fabrics with excessive values deformation and/or stapling fabrics that have suffered excessive tension.

[0306] Additionally, force sensors can be used to provide the surgeon with the amount of pressure applied to the tissue. The surgeon can use this information to avoid applying excessive pressure to the "T" tissue or stapling to the "T" tissue that has been under excessive tension.

[0307] Figure 24 and additional exemplifications are further described in US Patent No. 8,181,839, filed June 27, 2011, entitled SURGICAL INSTRUMENT EMPLOYING SENSORS, granted May 5, 2012, the description of which is incorporated into reference title in the present invention.

[0308] Certain aspects are shown and described to provide an understanding of the structure, function, manufacture and use of the described devices and methods. Features shown or described in an example may be combined with features of other examples and modifications and variations are within the scope of this description.

[0309] The terms "proximal" and "distal" refer to a doctor who manipulates the handle of the surgical instrument, with the term "proximal" referring to the portion closest to the doctor and the term "distal" referring to the portion located furthest from the doctor. For convenience, the spatial terms "vertical", "horizontal", "up" and "down" used in connection with the drawings are not intended to be limiting and/or absolute, because surgical instruments can be used in many orientations and positions.

[0310] Exemplary devices and methods for performing laparoscopic and minimally invasive surgical procedures are provided. Such devices and methods, however, can be used in other surgical procedures and applications including open surgical procedures, for example. Surgical instruments can be inserted through a natural orifice or through an incision or perforation formed in the tissue. The functional portions or end actuator portions of the instruments can be inserted directly into the body or through an access device that has a functional channel through which the end actuator and the elongated drive shaft of the surgical instrument can be advanced.

[0311] Figures 25 to 28 illustrate a surgical instrument driven by a motor 150010 for cutting and fixing that may or may not be reused. In the illustrated examples, the surgical instrument 150010 includes a cabinet 150012 comprising a handle assembly 150014 that is configured to be picked up, manipulated and actuated by the practitioner. The enclosure 150012 is configured for operative attachment to an interchangeable drive shaft assembly 150200 that has an end actuator 150300 operatively coupled thereto that is configured to perform one or more surgical tasks or procedures. According to the present disclosure, various forms of interchangeable drive shaft assemblies can be effectively used in connection with robotically controlled surgical systems. The term "enclosure" may encompass an enclosure or similar portion of a robotic system that houses or otherwise operationally supports at least one drive system configured to generate and apply at least one control movement that can be used to drive the sets of drive shaft. The term "frame" may refer to a portion of a hand-held surgical instrument. The term "structure" may also represent a portion of a robotically controlled surgical instrument and/or a portion of the robotic system that can be used to operatively control the surgical instrument. The interchangeable drive shaft assemblies described herein can be used with various robotic systems, instruments, components, and methods described in U.S. Patent No. 9,072,535, entitled SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS, which is incorporated herein by reference. reference in its entirety.

[0312] Figure 25 is a perspective view of a surgical instrument 150010 having an interchangeable drive shaft assembly 150200 operatively coupled thereto, in accordance with at least one aspect of this description. The cabinet 150012 includes an end actuator 150300 comprising a surgical cutting and clamping device configured to operatively support a surgical staple cartridge 150304 therein. The 150012 enclosure can be configured for use in connection with interchangeable drive shaft assemblies that include end actuators that are adapted to support different sizes and types of staple cartridges, and that have different lengths, sizes and types of drive shafts. drive. The 150012 enclosure can be used effectively with a variety of interchangeable drive shaft assemblies including assemblies configured to apply other motion and forms of energy such as radio frequency (RF) energy, ultrasonic energy, and/or motion to actuator arrangements. tips adapted for use in various applications and surgical procedures. End actuators, drive shaft assemblies, handles, surgical instruments and/or surgical instrument systems may utilize any suitable fastener or fasteners to secure tissue. For example, a fastener cartridge comprising a plurality of fasteners removably stored therein may be removably inserted into and/or secured to the end actuator of a drive shaft assembly.

[0313] The grip assembly 150014 may comprise a pair of interconnectable grip housing segments 150016 and 150018 interconnected by screws, press fit elements, adhesive, etc. The grip housing segments 150016, 150018 cooperate to form a portion of the pistol grip 150019 that can be gripped and manipulated by the clinician. The grip assembly 150014 operatively supports a plurality of drive systems configured to generate and apply control movements to corresponding portions of the interchangeable drive shaft assembly that is operatively attached thereto. A monitor can be provided below a 150045 cover.

[0314] Figure 26 is an exploded assembly view of a portion of the surgical instrument 150010 of Figure 25, in accordance with at least one aspect of this description. The grip assembly 150014 may include a frame 150020 that operatively supports a plurality of drive systems. The structure 150020 may operationally support a "first" drive system or closing drive system 150030, which may apply closing and opening movements to the interchangeable drive shaft assembly 150200. The closing drive system 150030 may include an actuator such as a closing trigger 150032 pivotably supported by the frame 150020. The closing trigger 150032 is pivotally coupled to the grip assembly 150014 by a pivot pin 150033 to allow the closing trigger 150032 to be manipulated by a practitioner. When the practitioner holds the pistol grip portion 150019 of the grip assembly 150014, the closing trigger 150032 may pivot from an initial or "non-actuated" position to an "actuated" position and, more particularly, to a fully compressed or completely activated.

[0315] The grip assembly 150014 and the frame 150020 may operatively support a firing drive system 150080 configured to apply firing motions to corresponding portions of the interchangeable drive shaft assembly attached thereto. The firing drive system 150080 may employ an electric motor 150082 located in the pistol grip portion 150019 of the grip assembly 150014. The electric motor 150082 may be a brushed direct current (DC) motor having a maximum rotational speed of approximately 25,000 rpm, for example. In other arrangements, the motor may include a brushless motor, a wireless motor, a synchronous motor, a stepper motor, or any other suitable electric motor. The electric motor 150082 may be powered by a power source 150090 which may comprise a removable power source 150092. The removable power source 150092 may comprise a portion of the proximal housing 150094 that is configured for attachment to a portion of the distal housing 150096. The proximal compartment portion 150094 and the distal compartment portion 150096 are configured to operatively support a plurality of batteries 150098. Each of the batteries 150098 may comprise, for example, a lithium-ion ("LI") battery or other suitable battery. . The distal housing portion 150096 is configured for removable operative attachment to a control circuit board 150100 that is operatively coupled to the electric motor 150082. Multiple batteries 150098 connected in series can power the surgical instrument 150010. The power source 150090 may be replaceable and/or rechargeable. A monitor 150043, which is situated below the cover 150045, is electrically coupled to the control circuit board 150100. The cover 150045 can be removed to expose the monitor 150043.

[0316] The electric motor 150082 may include a rotating drive shaft (not shown), which operatively interfaces with a gear reducer assembly 150084 mounted in coupling coupling with a set, or rack, of drive teeth 150122 in a longitudinally movable drive member 150120. The longitudinally movable drive member 150120 has a drive tooth rack 150122 formed therein for coupling engagement with a corresponding drive gear 150086 of the gear reducer assembly 150084.

[0317] In use, a voltage polarity supplied by the power source 150090 can operate the electric motor 150082 in a clockwise direction, and the voltage polarity applied to the electric motor by the battery can be reversed so as to operate the electric motor 150082 in the clockwise direction. anticlockwise. When the electric motor 150082 is rotated in one direction, the longitudinally movable drive member 150120 will be axially activated in the distal direction "DD". When the electric motor 150082 is driven in the opposite rotary direction, the longitudinally movable drive member 150120 will be axially driven in the proximal "DP" direction. The handle assembly 150014 may include a switch that may be configured to reverse the polarity applied to the electric motor 150082 by the power source 150090. The handle assembly 150014 may include a sensor configured to detect the position of the longitudinally movable drive member 150120 and /or the direction in which the longitudinally movable drive member 150120 is being moved.

[0318] The drive of the electric motor 150082 may be controlled by a firing trigger 150130 that is pivotably supported on the grip assembly 150014. The firing trigger 150130 may be pivoted between a non-actuated position and an actuated position.

[0319] Returning to Figure 25, the interchangeable drive shaft assembly 150200 includes an end actuator 150300 comprising an elongated channel 150302 configured to operatively support within it a surgical staple cartridge 150304. The end actuator 150300 may include an anvil 150306 that is pivotably supported relative to the elongated channel 150302. The interchangeable drive shaft assembly 150200 may include a pivot joint 150270. The construction and operation of the end actuator 150300 and the pivot joint 150270 are shown in US patent application publication No. 2014/0263541, entitled ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK, which is incorporated herein by reference in its entirety. The interchangeable drive shaft assembly 150200 may include a proximal housing or nozzle 150201 comprised of nozzle portions 150202, 150203. The interchangeable drive shaft assembly 150200 may include a closure tube 150260 that extends along a geometric axis of the SA drive shaft that can be used to close and/or open the anvil 150306 of the end actuator 150300.

[0320] Returning to Figure 25, the closure tube 150260 is translated distally ("DD" direction) to close the anvil 150306, for example, in response to actuation of the closure trigger 150032 in the manner described in the previously mentioned reference of the publication of patent application no. 2014/0263541. The anvil 150306 is opened by proximally translating the closure tube 150260. In the open position of the anvil, the closure tube 150260 of the drive shaft is moved to its proximal position.

[0321] Figure 27 is another view of the exploded assembly of portions of the interchangeable drive shaft assembly 150200, in accordance with at least one aspect of this description. The interchangeable drive shaft assembly 150200 may include a firing member 150220 supported for axial displacement within the central column 150210. The firing member 150220 includes an intermediate firing drive shaft 150222 configured to connect to a portion distal cutting member or cutting bar 150280. Firing member 150220 may be called a "second drive shaft" or a "second drive shaft assembly". The intermediate firing drive shaft 150222 may include a longitudinal slot 150223 at its end configured to receive a tab 150284 at the proximal end 150282 of the cutting bar 150280. The longitudinal slot 150223 and the proximal end 150282 may be configured to permit relative movement. between them and may comprise a sliding joint 150286. The sliding joint 150286 may allow the intermediate firing drive shaft 150222 of the firing member 150220 to pivot the end actuator 150300 about the pivoting joint 150270 without moving, or at least without substantially moving the cutting bar 150280. When the end actuator 150300 has been properly oriented, the intermediate firing drive shaft 150222 may be advanced distally until a proximal side wall of the longitudinal slot 150223 contacts the flap 150284 to advance the cutting bar 150280 and fire a staple cartridge positioned within the channel 150302. The center column 150210 has an elongated opening or window 150213 within it to facilitate assembly and insertion of the mid-shot drive shaft 150222 into the interior. of the center column 150210. When the mid-fire drive shaft 150222 has been inserted therein, an upper segment of the frame 150215 may be engaged with the drive shaft frame 150212 to enclose the mid-fire drive shaft 150222 and the cutting bar 150280. Operation of firing member 150220 can be seen in US patent application publication No. 2014/0263541. The center column 150210 may be configured to slideably support a firing member 150220 and the closure tube 150260 extending around the center column 150210. The center column 150210 may slidely support a pivot driver 150230.

[0322] The interchangeable drive shaft assembly 150200 may include a clutch assembly 150400 configured to selectively and releasably couple the pivot driver 150230 to the firing member 150220. The clutch assembly 150400 includes a locking ring or sleeve 150402 positioned around the firing member 150220, wherein the locking sleeve 150402 can be rotated between an engaged position, wherein the locking sleeve 150402 couples the pivot driver 150230 to the firing member 150220, and a disengaged position, wherein the pivot driver 150230 is not operably coupled to the firing member 150220. When the locking sleeve 150402 is in the engaged position, distal movement of the firing member 150220 may move the pivot driver 150230 in a distal direction and, correspondingly, proximal movement of the firing member 150220 may move the pivot driver 150230 proximally. When the locking sleeve 150402 is in the disengaged position, the movement of the firing member 150220 is not transmitted to the pivot driver 150230 and, as a result, the firing member 150220 can move independently of the pivot driver 150230. The nozzle 150201 can be used to operatively engage and disengage the linkage drive system with the firing drive system in the various ways described in US patent application publication No. 2014/0263541.

[0323] The interchangeable drive shaft assembly 150200 may comprise a slip ring assembly 150600 that may be configured to conduct electrical power to and/or from the end actuator 150300 and/or communicate signals to the end actuator 150300 and/or or from it, for example. The slip ring assembly 150600 may comprise a proximal connector flange 150604 and a distal connector flange 150601 positioned within a slot defined in the nozzle portions 150202, 150203. The proximal connector flange 150604 may comprise a first face and the of the distal connector 150601 may comprise a second face positioned adjacent and movable with respect to the first face. The distal connector flange 150601 can rotate relative to the proximal connector flange 150604 around the axis of the SA-SA drive shaft (Figure 25). The proximal connector flange 150604 may comprise a plurality of concentric or at least substantially concentric conductors 150602 defined on its first face. A connector 150607 may be mounted on the proximal side of the distal connector flange 150601 and may have a plurality of contacts, each contact corresponding to and being in electrical contact with one of the conductors 150602. This arrangement allows for relative rotation between the proximal connector 150604 and the distal connector flange 150601, while electrical contact is maintained between them. The proximal connector flange 150604 may include an electrical connector 150606 that may place the conductors 150602 in signal communication with a drive shaft circuit board, for example. In at least one case, an electrical harness comprising a plurality of conductors may extend between the electrical connector 150606 and the drive shaft circuit board. The electrical connector 150606 may extend proximally through a connector opening defined in the chassis mounting flange. US Patent Application Publication No. 2014/0263551, entitled "STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM", is incorporated herein by reference in its entirety. US Patent Application Publication No. 2014/0263552, entitled "STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM", is incorporated herein by reference in its entirety. Additional details regarding the slip ring assembly 150600 can be found in US Patent Application Publication No. 2014/0263541.

[0324] The interchangeable drive shaft assembly 150200 may include a proximal portion attachably mounted to the grip assembly 150014, and a distal portion that is rotatable about a longitudinal geometric axis. The distal rotating portion of the drive shaft may be rotated relative to the proximal portion about the slip ring assembly 150600. The distal connector flange 150601 of the slip ring assembly 150600 may be positioned on the distal rotating portion of the drive shaft.

[0325] Figure 28 is an exploded view of an aspect of an end actuator 150300 of the surgical instrument 150010 of Figure 25, in accordance with at least one aspect of this description. The end actuator 150300 may include the anvil 150306 and the surgical staple cartridge 150304. The anvil 150306 may be coupled to an elongated channel 150302. Openings 150199 may be defined in the elongated channel 150302 to receive pins 150152 extending from the anvil 150306 to allow the anvil 150306 to rotate from an open position to a closed position relative to the elongated channel 150302 and surgical staple cartridge 150304. A firing bar 150172 is configured to translate longitudinally into the end actuator 150300. The firing bar 150172 may be constructed in a solid section or may include a laminated material comprising, for example, a stack of steel plates. The firing bar 150172 comprises an "I" profile beam 150178 and a cutting edge 150182 at a distal end thereof. One end of the distally projecting firing bar 150172 may be attached to the I-beam 150178 to assist in spacing the anvil 150306 from a surgical staple cartridge 150304 positioned in the elongated channel 150302 when the anvil 150306 is in a closed position. The I-beam 150178 may include a sharp cutting edge 150182, which may be used to separate tissue, as the I-beam 150178 is advanced distally by the trigger bar 150172. In operation, the I-beam 150178 150178 may or may fire surgical staple cartridge 150304. Surgical staple cartridge 150304 may include a molded cartridge body 150194 that holds a plurality of staples 150191 that rest upon staple drivers 150192 within respective open staple cavities. upward 150195. A wedge slider 150190 is driven distally by the I-beam 150178, sliding over a cartridge tray 150196 of the surgical staple cartridge 150304. The wedge slider 150190 cams the staple drivers upward. 150192, to expel the staples 150191 into deformation contact with the anvil 150306, while the cutting edge 150182 of the I-beam 150178 cuts the tight fabric.

[0326] The I-beam 150178 may include upper pins 150180 that engage the anvil 150306 during firing. The I-beam 150178 may include intermediate pins 150184 and a bottom foot 150186 for engaging portions of the cartridge body 150194, the cartridge tray 150196, and the elongated channel 150302. When a surgical staple cartridge 150304 is Positioned within the elongated channel 150302, a slot 150193 defined in the cartridge body 150194 may be aligned with a longitudinal slot 150197 defined in the cartridge tray 150196 and a slot 150189 defined in the elongated channel 150302. In use, the I-beam 150178 can slide through the aligned longitudinal slots 150193, 150197 and 150189, wherein, as indicated in Figure 28, the base 150186 of the I-beam 150178 can engage a groove positioned along the lower surface of the elongated channel 150302 along the length of the slot 150189, the middle pins 150184 may engage the upper surfaces of the cartridge tray 150196 along the length of the longitudinal slot 150197, and the upper pins 150180 may engage the anvil 150306. The I-beam 150178 may space or limit the relative movement between the anvil 150306 and the surgical staple cartridge 150304 as the firing bar 150172 is advanced distally so as to fire the staples of the surgical staple cartridge 150304 and/or make an incision in the tissue captured between the anvil 150306 and the surgical staple cartridge 150304. The firing bar 150172 and the I-beam 150178 can be retracted proximally allowing the anvil 150306 to be opened to release the two stapled and cut portions of tissue.

[0327] Figures 29A and 29B represent a block diagram of a control circuit 150700 of the surgical instrument 150010 of Figure 25 spanning two drawing sheets, in accordance with at least one aspect of this description. Referring primarily to Figures 29A and 29B, a handle assembly 150702 may include a motor 150714, which may be controlled by a motor driver 150715 and may be used by the surgical instrument firing system 150010. In various forms, the motor 150714 may be a brushed direct current (DC) drive motor with a maximum rotational speed of approximately 25,000 RPM. In other arrangements, motor 150714 may include a brushless motor, a wireless motor, a synchronous motor, a stepper motor, or any other suitable type of electric motor. Motor driver 150715 may comprise an H-bridge driver comprising field effect transistors (FETs) 150719, for example. The motor 150714 may be powered by the power assembly 150706 releasably mounted to the grip assembly 150200 to provide control power to the surgical instrument 150010. The power assembly 150706 may comprise a battery that may include a plurality of battery cells connected in series, which may be used as the power source to power the surgical instrument 150010. In certain circumstances, the battery cells of the power pack 150706 may be replaceable and/or rechargeable. In at least one example, the battery cells may be lithium ion batteries that may be separably attachable to the power pack 150706.

[0328] The drive shaft assembly 150704 may include a drive shaft assembly controller 150722 that may communicate with a safety controller and a power management controller 150716 through an interface, while the drive shaft assembly 150704 and power assembly 150706 are coupled to handle assembly 150702. For example, the interface may comprise a first interface portion 150725, which may include one or more electrical connectors for mating engagement with corresponding electrical connectors of the shaft assembly. drive shaft, and a second interface portion 150727, which may include one or more electrical connectors for mating engagement with corresponding electrical connectors of the power assembly, to enable electrical communication between the drive shaft assembly controller 150722 and the power management controller 150716, while the drive shaft assembly 150704 and the power assembly 150706 are coupled to the grip assembly 150702. One or more communication signals may be transmitted through the interface to communicate one or more of the power requirements of the fixed interchangeable drive shaft assembly 150704 to the power management controller 150716. In response, the power management controller may modulate the battery power output of the power assembly 150706, as described below in more detail, in accordance with the power requirements of the attached drive shaft assembly 150704. The connectors may comprise switches that can be activated upon engagement by mechanical coupling of the grip assembly 150702 to the drive shaft assembly 150704 and/or the power assembly 150706 to allow electrical communication between the 150722 drive shaft assembly controller and the 150716 power management controller.

[0329] The interface may facilitate the transmission of the one or more communication signals between the power management controller 150716 and the drive shaft assembly controller 150722 by routing these communication signals through a main controller 150717 located in the assembly grip 150702, for example. In other circumstances, the interface may facilitate a direct line of communication between the power management controller 150716 and the drive shaft assembly controller 150722 through the grip assembly 150702, while the drive shaft assembly 150704 and the drive shaft assembly power supply 150706 are coupled to the grip assembly 150702.

[0330] Main controller 150717 may be any single-core or multi-core processor, such as those known under the trade name ARM Cortex by Texas Instruments. In one aspect, the main controller 150717 may be a Core Cortex-M4F LM4F230H5QR ARM processor, available from Texas Instruments, for example, which comprises an integrated memory of 256 KB single-cycle flash memory, or other non-volatile memory, up to 40 MHz, a look-ahead buffer to optimize performance above 40 MHz, a 32 KB single-cycle serial random access memory (SRAM), an internal read-only memory (ROM) loaded with the StellarisWare® program, memory 2 KB electrically erasable programmable read only (EEPROM), one or more pulse width modulation (PWM) modules, one or more analog quadrature encoder inputs (QEI), one or more analog to digital converters ( 12-bit ADC) with 12 analog input channels, details of which are available in the product datasheet.

[0331] The safety controller may be a safety controller platform comprising two controller-based families, such as TMS570 and RM4x, known under the trade name Hercules ARM Cortex R4, also by Texas Instruments. The safety controller can be configured specifically for IEC 61508 and ISO 26262 safety-critical applications, among others, to provide advanced integrated safety features while providing scalable performance, connectivity, and memory options.

[0332] Power assembly 150706 may include a power management circuit that may comprise power management controller 150716, a power modulator 150738, and a current sensing circuit 150736. The power management circuit may be configured to modulate battery power output based on the power needs of the drive shaft assembly 150704, while the drive shaft assembly 150704 and the power assembly 150706 are coupled to the grip assembly 150702. The power management controller 150716 may be programmed to control the power modulator 150738 of the power output of the power pack 150706 and the current sensing circuit 150736 may be used to monitor the power output of the power pack 150706 to provide feedback to the power management controller 150716 over the power output of the battery so that the power management controller 150716 can adjust the power output of the power pack 150706 to maintain a desired output. The power management controller 150716 and/or the drive shaft assembly controller 150722 may each comprise one or more processors and/or memory units that may store various software modules.

[0333] Surgical instrument 150010 (Figures 25 to 28) may comprise an output device 150742 that may include devices for providing sensory feedback to a user. Such devices may comprise, for example, visual feedback devices (e.g., a monitor with an LCD screen, LED indicators), auditory feedback devices (e.g., a speaker, a buzzer) or tactile feedback devices (e.g., e.g. haptic actuators). In certain circumstances, the output device 150742 may comprise a display 150743 that may be included in the grip assembly 150702. The drive shaft assembly controller 150722 and/or the power management controller 150716 may provide feedback to a user of the surgical instrument 150010 through the output device 150742. The interface may be configured to connect the drive shaft assembly controller 150722 and/or the power management controller 150716 to the output device 150742. The output device 150742 may instead instead, be integrated with the power assembly 150706. In these circumstances, communication between the output device 150742 and the drive shaft assembly controller 150722 can be done through the interface, while the drive shaft assembly 150704 is coupled to grip assembly 150702.

[0334] Control circuit 150700 comprises circuit segments configured to control the operations of the energized surgical instrument 150010. A safety controller segment (segment 1) comprises a safety controller and the main controller segment 150717 (segment 2). The safety controller and/or the main controller 150717 are configured to interact with one or more additional circuit segments such as an acceleration segment, a display segment, a drive shaft segment, an encoder segment, a motor segment , and a food segment. Each of the circuit segments may be coupled to the safety controller and/or the main controller 150717. The main controller 150717 is also coupled to a flash memory. The 150717 main controller also comprises a serial communication interface. The main controller 150717 comprises a plurality of inputs coupled, for example, to one or more circuit segments, a battery, and/or a plurality of switches. The segmented circuit may be implemented by any suitable circuit, such as, for example, a printed circuit board assembly (PCBA) within the powered surgical instrument 150010. It should be understood that the term processor as used herein includes any microprocessor, processor, controller, controllers, or other basic computing device that incorporates the functions of a computer's central processing unit (CPU) into an integrated circuit or at most a few integrated circuits. The 150717 main controller is a multipurpose programmable device that accepts digital data as input, processes it according to instructions stored in its memory, and provides results as output. This is an example of sequential digital logic, as it has internal memory. Control circuit 150700 may be configured to implement one or more of the processes described herein.

[0335] The acceleration segment (segment 3) comprises an accelerometer. The accelerometer is configured to detect movement or acceleration of the energized surgical instrument 150010. Input from the accelerometer may be used to transition to and from a sleep mode, identify the orientation of the energized surgical instrument, and/or or identify when the surgical instrument is dropped. In some examples, the acceleration segment is coupled to the safety controller and/or the main controller 150717.

[0336] The screen or display segment (segment 4) comprises a screen connector coupled to the main controller 150717. The screen connector couples the primary controller 150717 to a screen through one or more drivers of the screen's integrated circuits. The drivers of the screen's integrated circuits may be integrated with the screen and/or may be located separately from the screen. The screen may comprise any suitable screen, such as, for example, an organic light emitting diode (OLED) screen, a liquid crystal display (LCD), and/or any other suitable screen. In some examples, the screen segment is coupled to the safety controller.

[0337] The drive shaft segment (segment 5) comprises controls for an interchangeable drive shaft assembly 150200 (Figures 25 and 27) coupled to the surgical instrument 150010 (Figures 25 to 28) and/or one or more controls for a end actuator 150300 coupled to interchangeable drive shaft assembly 150200. The drive shaft segment comprises a drive shaft connector configured to couple the main controller 150717 to a drive shaft PCBA. The drive shaft PCBA comprises a low-power microprocessor with a ferroelectric random access memory (FRAM), a toggle switch, a drive shaft release Hall effect switch, and a drive shaft PCBA EEPROM memory . The drive shaft PCBA EEPROM comprises one or more parameters, routines, and/or programs specific to the 150200 interchangeable drive shaft assembly and/or the drive shaft PCBA. The drive shaft PCBA may be coupled to the interchangeable drive shaft assembly 150200 and/or integral with the surgical instrument 150010. In some examples, the drive shaft segment comprises a second drive shaft EEPROM. The second drive shaft EEPROM comprises a plurality of algorithms, routines, parameters and/or other data that correspond to one or more sets of drive shafts 150200 and/or end actuators 150300 that may interface with the powered surgical instrument 150010 .

[0338] The position encoder segment (segment 6) comprises one or more magnetic rotation angle position encoders. One or more magnetic rotation angle position encoders are configured to identify the rotational position of the motor 150714, an interchangeable drive shaft assembly 150200 (Figures 25 and 27), and/or an end actuator 150300 of the surgical instrument 150010 (Figures 25 to 28). In some examples, magnetic rotation angle position encoders may be coupled to the safety controller and/or the main controller 150717.

[0339] The motor circuit segment (segment 7) comprises a motor 150714 configured to control the movements of the energized surgical instrument 150010 (Figures 25 to 28). The motor 150714 is coupled to the main microcontroller processor 150717 by an H-bridge driver comprising one or more H-bridge field effect transistors (FETs) and a motor controller. The H-bridge driver is also coupled to the safety controller. A motor current sensor is coupled in series with the motor to measure the current drain from the motor. The motor current sensor is in signal communication with the 150717 main controller and/or the safety processor. In some examples, the 150714 engine is coupled to an engine electromagnetic interference (EMI) filter.

[0340] The motor controller controls a first motor flag and a second motor flag to indicate the state and position of the motor 150714 to the main controller 150717. The main controller 150717 provides a high pulse width modulation (PWM) signal ), a PWM low signal, a direction signal, a synchronization signal, and a motor reset signal to the motor controller through a buffer. The power segment is configured to supply a segment voltage to each of the circuit segments.

[0341] The power segment (segment 8) comprises a battery coupled to the safety controller, the main controller 150717, and additional circuit segments. The battery is coupled to the segmented circuit by a battery connector and a current sensor. The current sensor is configured to measure the total current draw of the segmented circuit. In some examples, one or more voltage converters are configured to provide predetermined voltage values to one or more circuit segments. For example, in some examples, the segmented circuit may comprise 3.3 V voltage converters and/or 5 V voltage converters. A voltage amplification converter is configured to provide a voltage rise up to a predetermined amount, such as , for example, up to 13 V. The voltage boost converter is configured to provide additional voltage and/or current during power-intensive operations and prevent blackout or low power conditions.

[0342] A plurality of switches are coupled to the safety controller and/or the main controller 150717. The switches may be configured to control the operations of the surgical instrument 150010 (Figures 25 to 28), the segmented circuit, and/or indicate a surgical instrument status 150010. An ejection port switch and a Hall effect switch for ejection are configured to indicate the state of an ejection port. A plurality of pivot keys, such as, for example, a left-side pivot key for the left side, a right-side pivot key for the left side, a center pivot key for the left side, a left-side pivot key left pivot switch for the right side, a right pivot switch for the right side, and a center pivot switch for the right side are configured to control the articulation of a 150200 interchangeable drive shaft assembly (Figures 25 and 27 ) and/or the 150300 end actuator (Figures 25 and 28). A left-side reverse switch and a right-side reverse switch are coupled to the main controller 150717. The left-side switches comprising the left-side pivot switch for the left side, the right-side pivot switch for the left side , the center pivot switch for the left side and the reverse switch for the left side are coupled to the primary controller 150717 by a left bend connector. The right side switches comprising the left pivot switch for the right side, the right pivot switch for the right side, the center pivot switch for the right side, and the right side reverse switch are coupled to the 150717 main controller by a right-hand bend connector. A trigger switch, a grip release switch, and a key engaged with the drive shaft are coupled to the 150717 main controller.

[0343] Any suitable mechanical, electromechanical, or solid-state switches may be used to implement the plurality of switches, in any combination. For example, the switches may limit the switches operated by the movement of components associated with the surgical instrument 150010 (Figures 25 through 28) or the presence of an object. These switches can be used to control various functions associated with the 150010 Surgical Instrument. A limit switch is an electromechanical device consisting of an actuator mechanically linked to a set of contacts. When an object comes into contact with the actuator, the device operates the contacts to make or break an electrical connection. Limit switches are used in a variety of applications and environments because of their robustness, ease of installation, and reliability of operation. They can determine the presence or absence, passage, positioning and end of displacement of an object. In other implementations, the switches may be solid-state switches that operate under the influence of a magnetic field such as Hall effect devices, magnetoresistive (MR) devices, giant magnetoresistive (GMR) devices, magnetometers, among others. In other implementations, the switches may be solid-state switches that operate under the influence of light, such as optical sensors, infrared sensors, ultraviolet sensors, among others. Furthermore, the switches can be solid-state devices such as transistors (e.g., FET, junction FET, metal-oxide semiconductor FET (MOSFET), bipolars, and the like). Other switches may include wireless switches, ultrasonic switches, accelerometers, inertial sensors, among others.

[0344] Figure 30 is another block diagram of the control circuit 150700 of the surgical instrument of Figure 25 that illustrates the interfaces between the handle assembly 150702 and the power assembly 150706 and between the handle assembly 150702 and the power assembly. interchangeable drive shaft 150704, in accordance with at least one aspect of the present description. The grip assembly 150702 may comprise a main controller 150717, a drive shaft assembly connector 150726, and a power assembly connector 150730. The power assembly 150706 may include a power assembly connector 150732, a power management circuit power management circuit 150734 which may comprise power management controller 150716, a power modulator 150738, and a current sensing circuit 150736. Drive shaft assembly connectors 150730, 150732 form an interface 150727. Power management circuit 150734 can be configured to modulate the output power of the battery 150707 based on the power needs of the interchangeable drive shaft assembly 150704 while the interchangeable drive shaft assembly 150704 and power assembly 150706 are coupled to the grip assembly 150702. power management controller 150716 may be programmed to control the power modulator 150738 of the power output of the power pack 150706 and the current sensing circuit 150736 may be used to monitor the power output of the power pack 150706 to provide feedback to the power management controller 150716 over the power output of the battery 150707 so that the power management controller 150716 can adjust the power output of the power pack 150706 to maintain a desired output. The drive shaft assembly 150704 comprises a drive shaft processor 150720 coupled to a non-volatile memory 150721 and a drive shaft assembly connector 150728 for electrically coupling the drive shaft assembly 150704 to the grip assembly 150702. The connectors of the drive shaft assembly 150726, 150728 form an interface 150725. The main controller 150717, the drive shaft processor 150720, and/or the power management controller 150716 may be configured to implement one or more of the processes described herein.

[0345] The surgical instrument 150010 (Figures 25 to 28) may comprise an output device 150742 for sensory feedback to a user. These devices may comprise visual feedback devices (e.g., an LCD monitor, LED indicators), auditory feedback devices (e.g., a speaker, a buzzer), or tactile feedback devices (e.g., actuators). haptics). In certain circumstances, the output device 150742 may comprise a screen 150743 that may be included in the grip assembly 150702. The drive shaft assembly controller 150722 and/or the power management controller 150716 may provide feedback to a user of the surgical instrument 150010 through the output device 150742. The interface 150727 may be configured to connect the drive shaft assembly controller 150722 and/or the power management controller 150716 to the output device 150742. The output device 150742 may be integrated with the power assembly 150706. Communication between the output device 150742 and the drive shaft assembly controller 150722 can be done through the interface 150725 while the interchangeable drive shaft assembly 150704 is coupled to the grip assembly 150702. Having described a control circuit 150700 (Figures 29A, 29B and 6) for controlling the operation of the surgical instrument 150010 (Figures 25 through 28), the description now turns to various configurations of the surgical instrument 150010 (Figures 25 through 28) and the 150700 control circuit.

[0346] Referring to Figure 31, a surgical stapler 151000 may include a handle component 151002, a drive shaft component 151004, and an end actuator component 151006. The surgical stapler 151000 is constructed and equipped similarly to the instrument surgical for cutting and fixation driven by motor 150010 described in connection with Figure 25. Accordingly, for the sake of brevity and clarity, the details of operation and construction will not be repeated here. The 151006 End Actuator can be used to compress, cut, or staple fabric. Referring now to Figure 32, the end actuator 151030 may be positioned by a practitioner to encircle the tissue 151032 prior to compression, cutting or stapling. As shown in Figure 32, compression may not be applied to the tissue when preparing the end actuator for use. Referring now to Figure 33, by engaging the handle (e.g., handle 151002) of the surgical stapler, the practitioner can use the end actuator 151030 to compress the tissue 151032. In one aspect, the tissue 151032 can be compressed until its maximum limit, as shown in Figure 33.

[0347] Referring to Figure 34, various forces may be applied to fabric 151032 by end actuator 151030. For example, vertical forces F1 and F2 may be applied by anvil 151034 and channel structure 151036 of end actuator 151030 to the extent wherein the fabric 151032 is compressed between the two. Referring now to Figure 35, diagonal forces and/or lateral forces may also be applied to fabric 151032 when compressed by end actuator 151030. For example, force F3 may be applied. For purposes of operating a medical device, such as a surgical stapler 151000, it may be desirable to detect or calculate the various forms of compression being applied to tissues by the end actuator. For example, knowledge of lateral or vertical compression may allow the end actuator to apply a stapling operation more precisely and accurately, or it may inform the surgical stapler operator so that the surgical stapler can be used more safely. and convenient.

[0348] Compression through fabric 151032 can be determined from an impedance of fabric 151032. At various levels of compression, impedance Z of fabric 151032 can increase or decrease. By applying a voltage V and a current I to fabric 151032, the impedance Z of fabric 151032 can be determined at various compression levels. For example, impedance Z can be calculated by dividing the applied voltage V by the current I.

[0349] Now referring to Figure 36, in one aspect, an RF electrode 151038 may be positioned in the end actuator 151030 (e.g., in a clip cartridge, knife, or channel structure of the end actuator 151030). Additionally, an electrical contact 151040 may be positioned on the anvil 151034 of the end actuator 151030. In one aspect, the electrical contact may be positioned on the channel structure of the end actuator. As the tissue 151032 is compressed between the anvil 151034 and, for example, the channel structure 151036 of the end actuator 151030, an impedance Z of the tissue 151032 changes. The vertical compression of the tissue 151042 caused by the end actuator 151030 can be measured depending on the Z impedance of the 151032 tissue.

[0350] Referring now to Figure 37, in one aspect, an electrical contact 151044 may be positioned on an opposite end of the anvil 151034 of the end actuator 151030 as the RF electrode 151038 is positioned. As the tissue 151032 is compressed between the anvil 151034 and, for example, the channel structure 151036 of the end actuator 151030, an impedance Z of the tissue 151032 changes. The lateral tissue compression 151046 caused by the end actuator 151030 can be measured depending on the Z impedance of the 151032 tissue.

[0351] Now referring to Figure 38, in one aspect, the electrical contact 151050 may be positioned on the anvil 151034 and the electrical contact 151052 may be positioned on an opposite end of the end actuator 151030 in the channel structure 151036. The electrode of RF 151048 may be positioned laterally to the center of the end actuator 151030. As the tissue 151032 is compressed between the anvil 151034 and, for example, the channel structure 151036 of the end actuator 151030, an impedance Z of the tissue 151032 changes. Lateral compression or angular compressions 151054 and 151056 on each side of the RF electrode 151048 may be caused by the end actuator 151030 and may be measured as a function of different Z impedances of the tissue 151032, based on the relative positioning of the RF electrode 151048 and of electrical contacts 151050 and 151052.

[0352] Now referring to Figure 39, the frequency generator 151222 may receive power or current from a power source 151221, and may provide one or more RF signals to one or more RF electrodes 151224. As discussed above, the One or more RF electrodes may be positioned at various locations or components on the end actuator or surgical stapler, such as a staple cartridge or a channel structure. One or more electrical contacts, such as electrical contacts 151226 or 151228 may be positioned on a channel structure or on an anvil of an end actuator. Additionally, one or more filters, such as filters 151230 or 151232, may be communicatively coupled to electrical contacts 151226 or 151228. Filters 151230 and 151232 may filter one or more RF signals provided by frequency generator 151222, prior to coupling. to a single return path 151234. A voltage V and a current I associated with one or more RF signals can be used to calculate an impedance Z associated with a tissue that can be compressed and/or communicatively coupled between the one or more electrodes of RF 151224 and electrical contacts 151226 or 151228.

[0353] Referring further to Figure 39, various components of the tissue compression sensing system described herein may be located in a handle 151236 of a surgical stapler. For example, as shown in circuit diagram 151220a, frequency generator 151222 may be located in handle 151236, and receive power from power source 151221. Also, current I1 and current I2 may be measured in a corresponding return path. to electrical contacts 151228 and 151226. Using a voltage V applied between the supply and return paths, impedances Z1 and Z2 can be calculated. Z1 may correspond to a tissue impedance a tablet and/or be communicatively coupled between one or more RF electrodes 151224 and electrical contact 151228. Furthermore, Z2 may correspond to a tissue impedance a tablet and/or be coupled so communication between one or more RF electrodes 151224 and electrical contact 151226. Applying the formulas and Z1=V/I1 and Z2=V/I2, the impedances Z1 and Z2 corresponding to the different levels of compression of a tissue compressed by an end actuator can be calculated.

[0354] Referring now to Figure 40, one or more aspects of the present disclosure are described in circuit diagram 151250. In one implementation, a power source in a handle 151252 of a surgical stapler may supply power to a frequency generator 151254 The frequency generator 151254 can generate one or more RF signals. The one or more RF signals may be multiplexed or superimposed in a multiplexer 151256, which may be on a drive shaft 151258 of the surgical stapler. In this way, two or more RF signals can be superimposed (or, for example, grouped or modulated together) and transmitted to the end actuator. The one or more RF signals may energize one or more RF electrodes 151260 in an end actuator 151262 (e.g., positioned in a staple cartridge) of the surgical stapler. A tissue (not shown) may be compressed and/or communicatively coupled between the one or more RF electrodes, and one or more electrical contacts 151260. For example, the tissue may be compressed and/or communicatively coupled between the one or more RF electrodes 151260 and the electrical contact 151264 positioned on a channel structure of the end actuator 151262 or the electrical contact 151266 positioned on an anvil of the end actuator 151262. A filter 151268 may be communicatively coupled to the electrical contact 151264, and a filter 151270 may be communicatively coupled to electrical contact 151266.

[0355] A voltage V and a current I associated with one or more RF signals can be used to calculate an impedance Z associated with a tissue that can be compressed between the staple cartridge (and communicatively coupled to one or more electrodes of RF 151260) and the channel structure or anvil (and communicatively coupled to one or more electrical contacts 151264 or 151266).

[0356] In one aspect, various components of the tissue compression sensing system described in the present invention may be located on a drive shaft 151258 of the surgical stapler. For example, as shown in circuit diagram 151250 (and in addition to frequency generator 151254), an impedance calculator 151272, a controller 151274, a non-volatile memory 151276, and a communication channel 151278 may be located on the drive 151258. In one example, the frequency generator 151254, the impedance calculator 151272, the controller 151274, the non-volatile memory 151276, and the communication channel 151278 may be positioned on a circuit board on the drive shaft 151258.

[0357] The two or more RF signals can be returned on a common path through the electrical contacts. Additionally, the two or more RF signals may be filtered prior to joining the RF signals into the common path to differentiate separate tissue impedances represented by the two or more RF signals. Current I1 and current I2 can be measured in a return path corresponding to electrical contacts 151264 and 151266. Using a voltage V applied between the supply and return paths, impedances Z1 and Z2 can be calculated. Z1 may correspond to a compressed tissue impedance and/or be communicatively coupled between one or more RF electrodes 151260 and electrical contact 151264. Furthermore, Z2 may correspond to a compressed tissue impedance and/or be communicatively coupled between one or more RF electrodes 151260 and electrical contact 151266. By applying the formulas Z1=V/I1 and Z2=V/I2, the impedances Z1 and Z2 corresponding to different compressions of a tissue compressed by an end actuator 151262 can be calculated . In the example, impedances Z1 and Z2 can be calculated using the 151272 impedance calculator. Impedances Z1 and Z2 can be used to calculate various levels of tissue compression.

[0358] Now referring to Figure 41, a frequency graph 151290 is shown. Frequency graph 151290 shows a frequency modulation to group two RF signals. The two RF signals can be bundled together before reaching the RF electrodes in an end actuator as described above. For example, an RF signal with frequency 1 and an RF signal with frequency 2 can be grouped together. Referring now to Figure 42, the resulting pooled RF signal is shown in a frequency graph 151300. The composite signal shown in the frequency graph 151300 includes the two RF signals of the combined frequency graph 151290. Now referring to Figure 43, a 151400 frequency graph is shown. Frequency graph 151400 shows RF signals with Frequencies 1 and 2, after they have been filtered (through, for example, filters 151268 and 151270). The resulting RF signals can be used to make impedance calculations or measurements separately or in a return path as described above.

[0359] In one aspect, filters 151268 and 151270 may be High Q filters, such that the filter range is narrow (e.g., Q=10). Q can be defined through Center Frequency (Wo)/Bandwidth (BW) where Q=Wo/BW. In an example, Frequency 1 might be 150 kHz and Frequency 2 might be 300 kHz. A viable impedance measurement range may be 100 kHz - 20 MHz. In several examples, other sophisticated techniques such as correlation, quadrature detection, etc. can be used to separate the RF signals.

[0360] With the use of one or more of the techniques and features described in the present invention, a single energized electrode in a staple cartridge or in an isolated knife of an end actuator can be used to make multiple tissue compression measurements simultaneously . If two or more RF signals are superimposed or multiplexed (or nested or modulated), they can be transmitted along a single feed side of the end actuator and can return either over the channel structure or anvil of the end actuator. If a filter is built into the channel and anvil contacts before they join the common return path, the tissue impedance represented by both paths could be differentiated. This can provide a measure of vertical tissue vs. lateral tissue compression. Additionally, this approach can provide proximal and distal tissue compression depending on filter placement and location of metal return trajectories. A frequency generator and signal processor may be located on one or more chips on a circuit board or a subboard (which may already exist in a surgical stapler).

[0361] In one aspect, the present disclosure provides an instrument 150010 (described with respect to Figures 25 to 30) configured with various detection systems. Consequently, for the sake of brevity and clarity, details of operation and construction will not be repeated here. In one aspect, the sensing system includes a viscoelasticity/rate of change sensor system for monitoring knife acceleration, impedance rate of change, and tissue contact rate of change. In one example, the rate of change of knife acceleration can be used as a measure of tissue type. In another example, the rate of change of impedance can be measured with a pulse sensor and can be employed as a measure for compressibility. Finally, the rate of change of tissue contact can be measured with a sensor based on the knife firing rate to measure tissue flow.

[0362] The rate of change of a detected or otherwise established parameter, the amount of time required for a tissue parameter to reach an asymptotic steady-state value, is a separate measurement in itself, and may be more valuable than than the detected parameter from which it is derived. To improve the measurement of tissue parameters, such as waiting a predetermined amount of time before taking a measurement, the present disclosure provides a new technique for employing the derivative of the measurement as the rate of change of the tissue parameter.

[0363] The derivative or rate of change measurement technique becomes more useful with the understanding that there is no single measurement that can be employed alone to dramatically improve staple formation. This is the combination of multiple measurements that make the measurements valid. In the case of the fabric gap, it is useful to know how much of the claw is covered with fabric to make the gap measurement relevant. The rate of impedance change measurements can be combined with the deformation measurements at the anvil to relate the force and compression applied to the tissue clamped between the end actuator gripper members such as the anvil and the staple cartridge. The measured rate of change can be employed by the endo-surgical device to determine tissue type and not just tissue compression. Although stomach and lung tissue are sometimes of similar thickness, and even have similar compression properties, when lung tissue is calcified, an instrument may be able to distinguish these types of tissue by employing a combination of measurements such as airflow, compression , applied force, the tissue contact area, and the rate of change of compression or rate of change of gap. If any of these measurements were used alone, it may be difficult for the endosurgical device to distinguish one tissue type from another. The rate of change in compression can also be useful in allowing the device to determine whether the tissue is "normal" or whether an abnormality exists. Measuring not only how much time has passed, but the variation of the sensor signals and determining the derivative of the signal would provide another measurement to allow the endosurgical device to measure the signal. Information about the rate of change can also be employed in determining when a steady state has been reached to signal the next step in a process. For example, after squeezing the tissue between the gripper members of the end actuator such as the anvil and the staple cartridge, when the tissue compression reaches a steady state (e.g., about 15 seconds), an indicator or the trigger to start device triggering can be enabled.

[0364] Also provided herein are methods, devices, and systems for the time-dependent evaluation of sensor data to determine the stability, creep, and viscoelastic characteristics of tissue during operation of the surgical instrument. A surgical instrument, such as the stapler illustrated in Figure 25, may include a variety of sensors to measure operating parameters such as claw gap size or distance, trigger current, tissue compression, amount of claw that is covered by tissue, anvil deformation, and trigger force, to name a few. These detected measurements are important for automatic control of the surgical instrument and for providing feedback to the clinician.

[0365] The examples shown in relation to Figures 30 to 49 can be employed to measure various derived parameters, such as gap distance as a function of time, tissue compression as a function of time, and anvil deformation as a function of time. Motor current can be monitored by employing a current sensor in series with the 2308 battery.

[0366] Turning now to Figure 44, it is shown that a motor-driven cutting and clamping surgical instrument 151310 may or may not be reused. The motor-driven cutting and fixing surgical instrument 151310 is similarly constructed and equipped as the motor-driven cutting and fixing surgical instrument 150010 described with respect to Figures 25 to 30. In the example illustrated in Figure 44, the instrument 151310 includes a housing 151312 comprising a handle assembly 151314 that is configured to be picked up, manipulated and actuated by the practitioner. Housing 151312 is configured for operative attachment to an interchangeable drive shaft assembly 151500 that has a surgical end actuator 151600 operatively coupled thereto that is configured to perform one or more surgical tasks or procedures. Since the motor-driven cutting and fixing surgical instrument 151310 is similarly constructed and equipped as the motor-driven cutting and fixing surgical instrument 150010 described with respect to Figures 25 through 30, for clarity and brevity the details operation and construction will not be repeated in this document.

[0367] The housing 151312 shown in Figure 44 is shown in relation to an interchangeable drive shaft assembly 151500 that includes an end actuator 151600 that comprises a surgical cutting and clamping device that is configured to operatively support a cartridge of surgical staples 151304 on it. Enclosure 151312 can be configured for use in connection with interchangeable drive shaft assemblies that include end actuators that are adapted to support different sizes and types of staple cartridges, have different lengths, sizes, and drive shaft types , etc. Furthermore, housing 151312 can also be used effectively with a variety of other interchangeable drive shaft assemblies including those assemblies that are configured to apply other motions and forms of energy such as radio frequency (RF) energy, ultrasonic energy and/or movement to end actuator arrangements adapted for use in various applications and surgical procedures. Additionally, end actuators, drive shaft assemblies, handles, surgical instruments and/or surgical instrument systems may use any one or more suitable fasteners to secure tissue. For example, a fastener cartridge comprising a plurality of fasteners removably stored therein may be removably inserted into and/or secured to the end actuator of a drive shaft assembly.

[0368] Figure 44 illustrates surgical instrument 151310 with an interchangeable drive shaft assembly 151500 operably coupled thereto. In the illustrated arrangement, the grip housing forms a portion of the pistol grip 151319 that can be wielded and manipulated by the practitioner. The grip assembly 151314 operatively supports, within it, a plurality of drive systems, which are configured to generate and apply various control movements to corresponding portions of the interchangeable drive shaft assembly that is operatively attached thereto. Trigger 151332 is operatively associated with the pistol grip to control several of these control movements.

[0369] Still referring to Figure 44, the interchangeable drive shaft assembly 151500 includes a surgical end actuator 151600 comprising an elongated channel 151302 that is configured to operatively support within it a staple cartridge 151304. The end actuator 151600 may additionally include an anvil 151306 that is pivotally supported relative to the elongated channel 151302.

[0370] The inventors have found that the derived parameters may be even more useful for controlling a surgical instrument, such as the instrument illustrated in Figure 44, than the detected parameter(s) from which the derived parameter is based. Some non-limiting examples of derived parameters include the rate of change of a sensed parameter (e.g., claw gap distance) and how long it takes before a tissue parameter reaches a steady-state value (e.g., asymptotic value). 15 seconds). Derived parameters, such as rate of change, are particularly useful because they dramatically improve measurement accuracy and also provide information that is not otherwise evident directly from the detected parameters. For example, the rate of impedance change (i.e., compression of the tissue) can be combined with the deformation in the anvil to relate to compression and force, which allows the microcontroller to determine the type of tissue and not just the amount tissue compression. This example is illustrative only, and any derived parameters can be combined with one or more detected parameters to provide more accurate information about tissue types (e.g., stomach versus lung), tissue health (calcified versus normal), and operational status of the surgical device (e.g., full grasp). Different tissues have unique viscoelastic properties and rates of change, making these and other parameters discussed here useful clues for automatically monitoring and adjusting a surgical procedure.

[0371] Figure 46 is an illustrative graph showing the gap distance over time, where the gap is the space between the claws being occupied by the trapped tissue. The vertical drive axis (y) is distance and the horizontal drive axis (x) is time. Specifically, with reference to Figures 44 and 45, the span distance 151340 is the distance between the anvil 151306 and the elongated channel 151302 of the end actuator. In the open position of the claw, at time zero, the gap 151340 between the anvil 151306 and the elongated member is at its maximum distance. The width of the gap 151340 decreases as the anvil 151306 closes, such as during tissue gripping. The rate of change of gap distance may vary as the fabric has non-uniform resilience. For example, certain tissue types may initially show rapid compression, resulting in a faster rate of change. However, as the fabric is continually compressed, the viscoelastic properties of the fabric can cause the rate of change to decrease until the fabric can no longer be compressed, at which point the gap distance remains substantially constant. The gap decreases over time as the tissue is squeezed between the anvil 151306 and the staple cartridge 151304 of the end actuator 151340. The one or more sensors described with respect to Figures 31 to 43, e.g. a magnetic field sensor, a strain gauge, a pressure sensor, a force sensor, an inductive sensor, such as, for example, an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor, and/or or any other suitable sensor, may be adapted and configured to measure the distance of the gap "d" between the anvil 151306 and the staple cartridge 151304 over time "t" as graphed in Figure 46. The rate of change of the distance of span "d" over time "t" is the slope of the curve shown in Figure 46, where the slope = Δd/Δt.

[0372] Figure 47 is an illustrative graph showing the firing current of the end actuator claws. The vertical geometric axis (y) is current and the horizontal geometric axis (x) is time. As discussed herein, the surgical instrument and/or microcontroller, as shown and described in connection with Figure 25, may include a current sensor that detects the current used during various operations, such as grasping, cutting, and/or stapling. of the fabric. For example, when tissue resistance increases, the instrument's electric motor may require more current to clamp, cut and/or staple the tissue. Similarly, if the resistance is lower, the electric motor may require less current to clamp, cut and/or staple the tissue. As a result, trigger current can be used as an approximation of tissue resistance. The detected current can be used alone or, more preferably, in conjunction with other measurements to provide feedback about the target tissue. Still referring to Figure 47, during some operations, such as stapling, the trigger current is high at time zero, but decreases over time. During other device operations, the current may increase over time if the motor draws more current to overcome the increase in mechanical load. Additionally, the rate of change of the firing current can be used as an indicator of whether the tissue is transitioning from one state to another. Consequently, the trigger current, and in particular the rate of change of the trigger current, can be used to monitor the operation of the device. The firing current decreases over time as the knife cuts the fabric. The rate of change of the trigger current may vary if the fabric being cut offers more or less resistance due to properties of the fabric or the edge of the knife 151305 (Figure 45). As cutting conditions vary, the work being done by the motor varies and therefore the trip current will vary over time. A current sensor can be used to measure the trigger current over time while the knife 151305 is fired as graphically represented in Figure 47. For example, the motor current can be monitored by employing a current sensor. Current sensors can be adapted and configured to measure the motor trip current "i" over time "t", as graphed in Figure 47. The rate of change of trip current "i" over time "t" is the slope of the curve shown in Figure 47, where the slope = Δi / Δt.

[0373] Figure 48 is a graph illustrating impedance over time. The vertical geometric axis (y) is impedance and the horizontal geometric axis (x) is time. At time zero, impedance is low, but increases over time as pressure increases from tissue manipulation (e.g., gripping and stapling). The rate of change varies over time as the tissue between the anvil 151306 and the staple cartridge 151304 of the end actuator 151340 is cut by the knife or is sealed using RF energy between the electrodes located between the anvil 151306 and the staple cartridge 151304 of the end actuator 151340. For example, when the fabric is cut, the electrical impedance increases and reaches infinity when the fabric is completely cut by the knife. Also, if the tip actuator 151340 includes electrodes coupled to an RF energy source, the electrical impedance of the tissue increases as energy is distributed through the tissue between the anvil 151306 and the staple cartridge 151304 of the tip actuator 151340. .Electrical impedance increases as energy through the fabric dries the fabric by vaporizing moisture in the fabric. Eventually, when an adequate amount of energy is applied to the tissue, the impedance increases to a very high or infinite value when the tissue is cut. Additionally, as illustrated in Figure 48, different fabrics can have unique compression properties, such as compression ratio, that distinguish fabrics. Tissue impedance can be measured by directing a sub-therapeutic RF current through tissue clamped between the first and second gripper members 9014, 9016. One or more electrodes can be positioned on one or the other or both of the anvil 151306 and staple cartridge 151304. Tissue impedance/compression between anvil 151306 and staple cartridge 151304 can be measured over time as graphed in Figure 48. The sensors described with respect to Figures 31 to 43 such as a magnetic field sensor, a strain gauge, a pressure sensor, a force sensor, an inductive sensor, such as an eddy current sensor, a resistive sensor, a capacitive sensor, a optical sensor, and/or any other suitable sensor, can be adapted and configured to measure tissue impedance/compression. The sensors can be adapted and configured to measure tissue impedance "Z" over time "t", as graphically represented in Figure 48.

[0374] Figure 49 is a graph illustrating the deformation of anvil 151306 (Figures 44, 45) over time. The vertical geometric axis (y) is deformation and the horizontal geometric axis (x) is time. During stapling, for example, the deformation of anvil 151306 is initially high, but decreases as the tissue reaches a stable state and exerts less pressure on anvil 151306. The rate of change of deformation of anvil 151306 can be measured by a pressure sensor or strain gauge positioned on one or both of the anvil 151306 and the staple cartridge 151304 (Figures 44, 45) to measure the pressure or strain applied to tissue trapped between the anvil 151306 and the staple cartridge 151304. deformation of anvil 151306 can be measured over time as represented graphically in Figure 49. The rate of change of strain "S" over time "t" is the slope of the curve shown in Figure 49, where slope = ΔS / Δt.

[0375] Figure 50 is a graph illustrating trigger force over time. The vertical axis (y) is trigger force and the horizontal axis (x) is time. In certain examples, the trigger force is progressive, to provide the clinician with tactile feedback. Therefore, at a zero time, trigger pressure 151320 (Figure 44) may be at its lowest value and trigger pressure may increase until completion of the operation (e.g., gripping, cutting, or stapling). The rate of change of the trigger force may be measured by a pressure sensor or strain gauge positioned on the trigger 151302 of the handle 151319 of the instrument 151310 (Figure 44) to measure the force required to drive the knife 151305 (Figure 45) through the tissue trapped between the anvil 151306 and the staple cartridge 151304. The force of the trigger 151332 can be measured over time as represented graphically in Figure 50. The rate of change of the tension force in the trigger "F" over time" t" is the slope of the curve shown in Figure 50, where the slope = ΔF / Δt.

[0376] For example, stomach and lung tissue can be differentiated, although these tissues have similar thicknesses, and may have similar compression properties if the lung tissue is calcified. Lung and stomach tissues can be distinguished by analyzing the distance from the claw gap, tissue compression, force is applied, tissue contact area, rate of compression, and rate of change of the claw gap. For example, Figure 51 shows a graph of pressure "P" versus tissue displacement for various tissues. The vertical geometric axis (y) is tissue pressure and the horizontal geometric axis (x) is tissue displacement. When tissue pressure reaches a predetermined limit, such as 50 to 100 pounds per square inch (psi), the amount of tissue displacement as well as the rate of tissue displacement before reaching the tissue limit can be used to differentiate tissues. . For example, blood vessel tissue reaches the predetermined pressure threshold with less tissue displacement and with a faster rate of change than colon, lung, or stomach tissue. Furthermore, the rate of change (tissue pressure over displacement) for blood vessel tissue is nearly asymptotic at a limit of 50 to 100 psi, whereas the rate of change for the colon, lung, and stomach is not asymptotic at a limit of 50 to 100 psi. limit of 50 to 100 psi. As will be understood, any pressure limit may be used such as, for example, between 1 and 1,000 psi, more preferably between 10 and 500 psi, and even more preferably between 50 and 100 psi. Additionally, multiple thresholds or progressive thresholds can be used to provide more resolution as to tissue types that have similar viscoelastic properties.

[0377] The rate of change in compression may also allow the microcontroller to determine whether the tissue is "normal" or whether an abnormality such as calcification exists. For example, with reference to Figure 52, compression of calcified tissue follows a different lung curve than compression of normal lung tissue. Tissue displacement and rate of change of tissue displacement, therefore, can be used to diagnose and/or differentiate calcified lung tissue from normal lung tissue.

[0378] Additionally, certain detected measurements may benefit from additional sensory input. For example, in the case of the claw gap, knowing how much of the claw is covered with fabric can make measuring the gap more useful and accurate. If a small portion of the claw is covered by tissue, the compression of the tissue may appear less than if the entire claw were covered by tissue. This way, the amount of gripper coverage can be taken into consideration by the microcontroller when analyzing tissue compression and other detected parameters.

[0379] In certain circumstances, elapsed time may also be an important parameter. Measuring the amount of time that has passed, along with detected parameters, and derived parameters (e.g., rate of change) provides additional useful information. For example, if the rate of change of the claw gap remains constant after a set period of time (e.g., 5 seconds), then the parameter may have reached its asymptotic value.

[0380] Rate of change information is also useful in determining when a stable state has been reached, thereby signaling the next step in a process. For example, during grasping, when tissue compression reaches a stable state—e.g., negligible rate of change after a set period of time—the microcontroller can send a signal to the monitor to alert the clinician to initiate the next step in the operation, such as clamp firing. Alternatively, the microcontroller can be programmed to automatically initiate the next stage of operation (e.g. clamp firing) once a stable state is reached.

[0381] Similarly, the rate of change of impedance can be combined with the deformation in the anvil to relate force and compression. The measured rate of change would allow the device to determine the type of tissue and not just measure the compression value. For example, the stomach and lung sometimes have similar thicknesses, and even more similar compressive properties, if the lung is calcified.

[0382] Combining one or more detected parameters with derived parameters provides a more reliable and accurate assessment of tissue types and tissue health, and allows for better monitoring, device control, and feedback to the clinician.

[0383] Figure 53 illustrates an embodiment of an end actuator 152000 comprising a first sensor 152008a and a second sensor 152008b. The 152000 end actuator is similar to the 150300 end actuator described above. The end actuator 152000 comprises a first claw member, or anvil, 152002 pivotally coupled to a second claw member 152004. The claw member 152004 is configured to receive within it a staple cartridge 152006. The staple cartridge 152006 152006 comprises a plurality of staples (not shown). The plurality of staples is implantable from the staple cartridge 152006 during a surgical operation. The end actuator 152000 comprises a first sensor 152008a. The first sensor 152008a is configured to measure one or more parameters of the end actuator 152000. In one embodiment, for example, the first sensor 152008a is configured to measure the gap 152010 between the anvil 152002 and the second gripper member 152004. The first sensor 152008a may comprise, for example, a Hall effect sensor configured to detect a magnetic field generated by a magnet 152012 incorporated into the second gripper member 152004 and/or the staple cartridge 152006. As another example, in one embodiment, the first sensor 152008a is configured to measure one or more forces exerted on the anvil 152002 by the second gripper member 152004 and/or the tissues trapped between the anvil 152002 and the second gripper member 152004.

[0384] The end actuator 152000 comprises a second sensor 152008b. The second sensor 152008b is configured to measure one or more parameters of the end actuator 152000. For example, in various embodiments, the second sensor 152008b may comprise a strain gauge configured to measure the magnitude of the strain on the anvil 152002 during a stuck condition. The voltage meter provides an electrical signal whose amplitude varies with the magnitude of the voltage. In various embodiments, the first sensor 152008a and/or the second sensor 152008b may comprise, for example, a magnetic sensor such as a Hall effect sensor, a strain gauge, a pressure sensor, a force sensor, an inductive sensor such as, for example, an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor, and/or any other sensors suitable for measuring one or more parameters of the end actuator 152000. The first sensor 152008a and the second sensor 152008b may be arranged in a series configuration and/or a parallel configuration. In a series configuration, the second sensor 152008b can be configured to directly affect the output of the first sensor 152008a. In a parallel configuration, the second sensor 152008b can be configured to indirectly affect the output of the first sensor 152008a.

[0385] In one embodiment, one or more parameters measured by the first sensor 152008a are related to one or more parameters measured by the second sensor 152008b. In one embodiment, for example, the first sensor 152008a is configured to measure the gap 152010 between the anvil 152002 and the second gripper member 152004. The gap 152010 is representative of the thickness and/or compressibility of a section of tissue trapped between the anvil 152002 and the staple cartridge 152006. The first sensor 152008a may comprise, for example, a Hall effect sensor configured to detect a magnetic field generated by the magnet 152012 coupled to the second claw member 152004 and/or the staple cartridge 152006. The single-site measurement accurately describes the thickness of the compressed tissue for a calibrated full tissue bite, but may provide inaccurate results when a partial tissue bite is placed between the anvil 152002 and the second claw member 152004. A partial bite of tissue, whether a proximal partial bite or a distal partial bite, alters the gripping geometry of the anvil 152002.

[0386] In some embodiments, the second sensor 152008b is configured to detect one or more parameters indicative of a type of tissue bite, e.g., a full bite, a proximal partial bite, and/or a distal partial bite. The measurement from the second sensor 152008b can be used to adjust the measurement from the first sensor 152008a to accurately represent the true compressed tissue thickness of a partial bite in proximal or distal positioning. In one embodiment, for example, the second sensor 152008b comprises a strain gauge, such as a microstrain gauge, configured to monitor the amplitude of strain on the anvil during a stuck condition. The amplitude of the effort of the anvil 152002 is used to modify the output of the first sensor 152008a, for example, a Hall effect sensor, to accurately represent the true thickness of the compressed tissues of a partial bite in proximal or distal positioning. The first sensor 152008a and the second sensor 152008b can be measured in real time during a grasping operation. Real-time measurement allows time-based information to be analyzed, for example, by a primary processor (processor 462 (Figure 12), for example), and used to select one or more algorithms and/or lookup tables to recognize tissue characteristics and grip positioning to dynamically adjust tissue thickness measurements.

[0387] In some embodiments, the thickness measurement of the first sensor 152008a may be provided to an output device of a surgical instrument 150010 coupled to the end actuator 152000. In one embodiment, for example, the end actuator 152000 is coupled to the surgical instrument 150010 comprising a screen (e.g., screen 473 (Figure 12)). The measurement from the first sensor 152008a is provided to a processor, e.g., the primary processor. The primary processor adjusts the measurement from the first sensor 152008a based on the measurement from the second sensor 152008b to reflect the true tissue thickness of a section of tissue clamped between the anvil 152002 and the staple cartridge 152006. The primary processor outputs to the screen the adjusted tissue thickness measurement and an indication of full or partial bite. An operator can determine whether or not to deploy staples in the 152006 staple cartridge based on the displayed values.

[0388] In some embodiments, the first sensor 152008a and the second sensor 152008b may be located in different environments, for example, the first sensor 152008a being located inside a patient, at a treatment site, and the second sensor 152008b being located external to the patient. The second sensor 152008b may be configured to calibrate and/or modify the output of the first sensor 152008a. The first sensor 152008a and/or the second sensor 152008b may comprise, for example, an environmental sensor. The environmental sensors may comprise, for example, temperature sensors, humidity sensors, pressure sensors and/or any other suitable environmental sensor.

[0389] Figure 54 is a logic diagram illustrating one embodiment of a process 152020 for adjusting the measurement of a first sensor 152008a based on input from a second sensor 152008b. A first signal 152022a is captured by the first sensor 152008a. The first signal 152022a may be conditioned based on one or more predetermined parameters, such as a smoothing function, a look-up table, and/or any other suitable conditioning parameters. A second signal 152022b is captured by the second sensor 152008b. The second signal 152022b may be conditioned based on one or more predetermined conditioning parameters. The first signal 152022a and the second signal 152022b are provided to a processor, such as the primary processor. The processor adjusts the measurement of the first sensor 152008a, as represented by the first signal 152022a, based on the second signal 152022b originating from the second sensor. In one embodiment, for example, the first sensor 152008a comprises a Hall effect sensor and the second sensor 152008b comprises a strain gauge. The distance measurement from the first sensor 152008a is adjusted by the amplitude of the effort measured by the second sensor 152008b to determine the completeness of the tissue bite in the end actuator 152000. The adjusted measurement 152026 is displayed to an operator by means of, for example, a screen incorporated into the 150010 surgical instrument.

[0390] Figure 55 is a logic diagram illustrating an embodiment of a process 152030 for determining a lookup table for a first sensor 152008a based on input from a second sensor 152008b. The first sensor 152008a captures a signal indicative 152022a of one or more parameters of the end actuator 152000. The first signal 152022a may be conditioned based on one or more predetermined parameters, such as a smoothing function, a look-up table, and /or any other suitable conditioning parameters. A second signal 152022b is captured by the second sensor 152008b. The second signal 152022b may be conditioned based on one or more predetermined conditioning parameters. The first signal 152022a and the second signal 152022b are provided to a processor, such as the primary processor. The processor selects a lookup table from one or more available lookup tables 152034a, 152034b, based on the value of the second signal. The selected look-up table is used to convert the first signal into a thickness measurement of the tissues situated between the anvil 152002 and the staple cartridge 152006. The adjusted measurement 152026 is displayed to an operator via, for example, a built-in display to surgical instrument 150010.

[0391] Figure 56 is a logic diagram illustrating one embodiment of a process 152040 for calibrating a first sensor 152008a in response to an input from a second sensor 152008b. The first sensor 152008a is configured to capture a signal 152022a indicative of one or more parameters of the end actuator 152000. The first signal 152022a may be conditioned based on one or more predetermined parameters such as, for example, a smoothing function, a table query and/or any other suitable conditioning parameters. A second signal 152022b is captured by the second sensor 152008b. The second signal 152022b may be conditioned based on one or more predetermined conditioning parameters. The first signal 152022a and the second signal 152022b are provided to a processor, such as the primary processor. The primary processor calibrates 152042 the first signal 152022a in response to the second signal 152022b. The first signal 152022a is calibrated 152042 to reflect the completeness of the tissue capture pressure in the end actuator 152000. The calibrated signal 152026 is displayed to an operator through, for example, a screen incorporated into the surgical instrument 150010.

[0392] Figure 57 is a logic diagram illustrating an embodiment of a process 152050 for determining and displaying the thickness of a section of tissue secured between the anvil 152002 and the staple cartridge 152006 of the end actuator 152000. The process 152050 comprises obtaining a Hall effect voltage 152052, for example, through a Hall effect sensor situated at the distal tip of the anvil 152002. The Hall effect voltage 152052 is supplied to an analog-to-digital converter 152054 and converted into a digital signal. The digital signal is supplied to a processor, such as the primary processor. The primary processor calibrates 152056 the curve input of the Hall effect voltage signal 152052. A stress meter 152058, such as a microstress meter, is configured to measure one or more parameters of the end actuator 152000, such as, for example, the amplitude of the effort exerted on the anvil 152002 during a grasping operation. The measured effort is converted 152060 into a digital signal and provided to the processor, such as the primary processor. The primary processor uses one or more algorithms and/or look-up tables to adjust the Hall effect tension 152052 in response to the strain measured by the strain gauge 152058 to reflect the true thickness and completeness of the bite of the tissues held by the anvil 152002 and the staple cartridge 152006. The adjusted thickness 152026 is displayed to an operator via, for example, a screen incorporated into the surgical instrument 150010.

[0393] In some embodiments, the surgical instrument may additionally comprise a load cell or sensor 152082. The load sensor 152082 may be located, for example, in the drive shaft assembly 150200, described above, or in the housing 150012, also described above. Figure 58 is a logic diagram illustrating one embodiment of a process 152070 for determining and displaying the thickness of a section of tissue secured between the anvil 152002 and the staple cartridge 152006 of the end actuator 152000. The process comprises obtaining an effect tension Hall 152072, for example, through a Hall effect sensor located at the distal tip of the anvil 152002. The Hall effect voltage 152072 is supplied to an analog-to-digital converter 152074 and converted into a digital signal. The digital signal is supplied to a processor, such as the primary processor. The primary processor calibrates 152076 the curve input of the Hall effect voltage signal 152072. A stress meter 152078, such as a microstress meter, is configured to measure one or more parameters of the end actuator 152000, such as, for example, the amplitude of the effort exerted on the anvil 152002 during a grasping operation. The measured effort is converted 152080 into a digital signal and provided to the processor, such as the primary processor. The load sensor 152082 measures the gripping force of the anvil 152002 against the staple cartridge 152006. The measured gripping force is converted 152084 into a digital signal and provided to the processor, such as the primary processor. The primary processor uses one or more algorithms and/or look-up tables to adjust the Hall effect voltage 152072 in response to the stress measured by the strain gauge 152078 and the gripping force measured by the load sensor 152082 to reflect the true thickness and completeness of the bite of the tissues held by the anvil 152002 and the staple cartridge 152006. The adjusted thickness 152026 is displayed to an operator by means of, for example, a screen incorporated into the surgical instrument 150010.

[0394] Figure 59 is a graph 152090 illustrating an adjusted Hall thickness measurement 152092, compared to an unmodified Hall thickness measurement 152094. As shown in Figure 59, the unmodified Hall thickness measurement 152094 indicates measurement of thicker tissues as the single sensor is not able to compensate for partial distal/proximal bites that result in incorrect thickness measurements. The adjusted thickness measurement 152092 is generated, for example, by the process 152050 illustrated in Figure 57. The adjusted Hall thickness measurement 152092 is calibrated based on input from one or more additional sensors, such as a gauge. effort. The adjusted Hall thickness 152092 reflects the true thickness of the tissues located between an anvil 152002 and a staple cartridge 152006.

[0395] Figure 60 illustrates an embodiment of an end actuator 152100 comprising a first sensor 152108a and a second sensor 152108b. The end actuator 152100 is similar to the end actuator 152000 illustrated in Figure 53. The end actuator 152100 comprises a first claw member, or anvil, 152102 pivotally coupled to a second claw member 152104. The claw member 152104 is configured to receive within it a staple cartridge 152106. The end actuator 152100 comprises a first sensor 152108a coupled to the anvil 152102. The first sensor 152108a is configured to measure one or more parameters of the end actuator 152100 such as, for example, the gap 152110 between the anvil 152102 and the staple cartridge 152106. The gap 152110 may correspond, for example, to a thickness of tissue trapped between the anvil 152102 and the staple cartridge 152106. The first sensor 152108a may comprise any sensor suitable for measure one or more end actuator parameters. In various embodiments, for example, the first sensor 152108a may comprise a magnetic sensor, such as a Hall effect sensor, a strain gauge, a pressure sensor, an inductive sensor, such as an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor and/or any other suitable sensor.

[0396] In some embodiments, the end actuator 152100 comprises a second sensor 152108b. The second sensor 152108b is coupled to the second gripper member 152104 and/or the staple cartridge 152106. The second sensor 152108b is configured to detect one or more parameters of the end actuator 152100. In some embodiments, for example, the second sensor 152108b is configured to detect one or more instrument conditions such as, for example, a color of the staple cartridge 152106 coupled to the second gripper member 152104, a length of the staple cartridge 152106, a gripping condition of the end actuator 152100, the number of uses/number of uses remaining of end actuator 152100 and/or staple cartridge 152106, and/or any other suitable instrument condition. The second sensor 152108b may comprise any sensor suitable for detecting one or more conditions of the instrument such as, for example, a magnetic sensor such as a Hall effect sensor, a strain gauge, a pressure sensor, an inductive sensor such as a eddy currents, a resistive sensor, a capacitive sensor, an optical sensor and/or any other suitable sensor.

[0397] The end actuator 152100 can be used in conjunction with any of the processes shown in Figures 54 to 57. In one embodiment, for example, the input from the second sensor 152108b can be used to calibrate the input from the first sensor 152108a. The second sensor 152108b may be configured to detect one or more parameters of the staple cartridge 152106, such as the color and/or length of the staple cartridge 152106. The detected parameters, such as the color and/or length of the cartridge of staples 152106, may correspond to one or more cartridge properties such as, for example, the height of the cartridge holder, the useful/optimal tissue thickness for the staple cartridge and/or the staple pattern in the staple cartridge 152106. The known parameters of the staple cartridge 152106 can be used to adjust the thickness measurement provided by the first sensor 152108a. For example, if the staple cartridge 152106 has a higher support height, the thickness measurement provided by the first sensor 152108a may be reduced to compensate for the additional support height. The adjusted thickness may be displayed to an operator, for example, via a screen attached to the surgical instrument 150010.

[0398] Figure 61 illustrates an embodiment of an end actuator 152150 comprising a first sensor 152158 and a plurality of second sensors 152160a, 152160b. The end actuator 152150 comprises a first claw member, or anvil, 152152 and a second claw member 152154. The claw member 152154 is configured to receive a staple cartridge 152156. The anvil 152152 is pivotally movable relative to the second member. clamp 152154, for clamping tissue between the anvil 152152 and the staple cartridge 152156. The anvil comprises a first sensor 152158. The first sensor 152158 is configured to detect one or more parameters of the end actuator 152150, such as the gap 152110 between the anvil 152152 and the staple cartridge 152156. The gap 152110 may correspond, for example, to a thickness of tissue trapped between the anvil 152152 and the staple cartridge 152156. The first sensor 152158 may comprise any sensor suitable for measuring a or more end actuator parameters. In various embodiments, for example, the first sensor 152158 may comprise a magnetic sensor, such as a Hall effect sensor, a strain gauge, a pressure sensor, an inductive sensor, such as an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor and/or any other suitable sensor.

[0399] In some embodiments, the end actuator 152150 comprises a plurality of secondary sensors 152160a, 152160b. The secondary sensors 152160a, 152160b are configured to detect one or more parameters of the end actuator 152150. In some embodiments, for example, the secondary sensors 152160a, 152160b are configured to measure an amplitude of the effort exerted on the anvil 152152 during a lifting procedure. prehension. In various embodiments, the secondary sensors 152160a, 152160b may comprise a magnetic sensor, such as a Hall effect sensor, a strain gauge, a pressure sensor, an inductive sensor, such as an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor and/or any other suitable sensor. Secondary sensors 152160a, 152160b may be configured to measure one or more identical parameters at different locations on anvil 152152, different parameters at identical locations on anvil 152152, and/or different parameters at different locations on anvil 152152.

[0400] Figure 62 is a logic diagram illustrating an embodiment of a process 152170 for adjusting a measurement from a first sensor 152158 in response to a plurality of secondary sensors 152160a, 152160b. In one embodiment, the Hall effect voltage is obtained 152172, for example, by a Hall effect sensor. The Hall effect voltage is converted 152174 by an analog-to-digital converter. The converted Hall effect voltage signal is calibrated 152176. The calibrated curve represents the thickness of a tissue section situated between the anvil 152152 and the staple cartridge 152156. A plurality of secondary measurements are obtained 152178a, 152178b by a plurality of sensors secondary components such as, for example, a plurality of strain gauges. The input of the strain gauges is converted 152180a, 152180b into one or more digital signals, for example, by a plurality of electronic μStrain conversion circuits. The calibrated Hall effect voltage and the plurality of secondary measurements are provided to a processor, such as the primary processor. The primary processor uses the secondary measurements to adjust 152182 the Hall effect voltage, for example, by applying an algorithm and/or using one or more look-up tables. The adjusted Hall effect voltage represents the true thickness and completeness of capture pressure of the tissue held by the anvil 152152 and the staple cartridge 152156. The adjusted thickness 152026 is displayed to an operator via, for example, a screen incorporated into the surgical instrument 150010.

[0401] Figure 63 illustrates an embodiment of a circuit 152190 configured to convert signals from the first sensor 152158 and the plurality of secondary sensors 152160a, 152160b into digital signals receivable by a processor such as, for example, the primary processor. Circuit 152190 comprises an analog-to-digital converter 152194. In some embodiments, the analog-to-digital converter 152194 comprises an 18-bit, 4-channel analog-to-digital converter. Those skilled in the art will recognize that the analog-to-digital converter 152194 may comprise any suitable number of channels and/or bits to convert one or more inputs from analog to digital. Circuit 152190 comprises one or more level shifting resistors 152196 configured to receive an input from the first sensor 152158 such as, for example, a Hall effect sensor. The 152196 level shift resistors adjust the input of the first sensor, shifting the value to a higher or lower voltage depending on the input. The 152196 level-shift resistors provide the level-shifted input from the 152158 first sensor to the analog-to-digital converter.

[0402] In some embodiments, a plurality of secondary sensors 152160a, 152160b are coupled to a plurality of bridges 152192a, 152192b within circuit 152190. The plurality of bridges 152192a, 152192b may provide filtering of input from the plurality of secondary sensors 152160a , 152160b. After filtering the input signals, the plurality of bridges 152192a, 152192b provides the inputs from the plurality of secondary sensors 152160a, 152160b to the analog-to-digital converter 152194. In some embodiments, a switch 152198 coupled to one or more level shifting resistors may be coupled to the analog-to-digital converter 152194. The switch 152198 is configured to calibrate one or more of the input signals, such as an input from a Hall effect sensor. Switch 152198 may be engaged to provide one or more level shift signals to adjust the input of one or more of the sensors, such as to calibrate the input of a Hall effect sensor. In some embodiments, adjustment is not necessary, and switch 152198 is left in the open position to decouple the level shift resistors. The switch 152198 is coupled to the analog-to-digital converter 152194. The analog-to-digital converter 152194 provides an output to one or more processors, such as the primary processor. The primary processor calculates one or more parameters of the end actuator 152150 based on input from the analog-to-digital converter 152194. In one embodiment, for example, the primary processor calculates a thickness of tissues located between the anvil 152152 and the staple cartridge. 152156, based on input from one or more sensors 152158, 152160a, 152160b.

[0403] Figure 64 illustrates an embodiment of an end actuator 152200 comprising a plurality of sensors 152208a to 152208d. The end actuator 152200 comprises an anvil 152202 pivotally coupled to a second gripper member 152204. The gripper member 152204 is configured to receive within it a staple cartridge 152206. The anvil 152202 comprises a plurality of sensors 152208a to 152208d about the same. The plurality of sensors 152208a to 152208d are configured to detect one or more parameters of the end actuator 152200, such as the anvil 152202. The plurality of sensors 152208a to 152208d may comprise one or more identical sensors and/or different sensors. The plurality of sensors 152208a to 152208d may comprise, for example, magnetic sensors such as a Hall effect sensor, strain gauges, pressure sensors, inductive sensors such as an eddy current sensor, resistive sensors, capacitive sensors, optical sensors, and so on. /or any other suitable sensors or combinations thereof. In one embodiment, for example, the plurality of sensors 152208a to 152208d may comprise a plurality of strain gauges.

[0404] In one embodiment, the plurality of sensors 152208a to 152208d allows a robust tissue thickness detection process to be implemented. By detecting various parameters along the length of the anvil 152202, the plurality of sensors 152208a to 152208d allow a surgical instrument, such as surgical instrument 150010, to calculate the thickness of the tissues in the claws, regardless of the bite, e.g. , a partial or total bite. In some embodiments, the plurality of sensors 152208a to 152208d comprise a plurality of strain gauges. The plurality of strain gauges is configured to measure mechanical stress at various points on the anvil 152202. The amplitude and/or slope of the mechanical stress at each of the plurality of points on the anvil 152202 can be used to determine the thickness of tissue disposed between anvil 152202 and staple cartridge 152206. The plurality of strain gauges may be configured to optimize maximum amplitude and/or slope differences based on gripping dynamics to determine thickness, positioning of the fabric and/or the material properties of the fabric. Time-based monitoring of the plurality of sensors 152208a to 152208d during grasping enables a processor, such as the primary processor, to use algorithms and look-up tables to recognize tissue characteristics and grasping positions and dynamically adjust the end actuator 152200 and/or the tissue trapped between the anvil 152202 and the staple cartridge 152206.

[0405] Figure 65 is a logic diagram illustrating an embodiment of a process 152220 for determining one or more tissue properties based on a plurality of sensors 152208a to 152208d. In one embodiment, a plurality of sensors 152208a to 152208d generate, from 152222a to 152222d, a plurality of signals indicative of one or more parameters of the end actuator 152200. The plurality of generated signals are converted, from 152224a to 152224d, into signals digital data and fed to a processor. In one embodiment, for example, comprising the plurality of strain gauges, the plurality of μStrain (microstrain) conversion electronic circuits converts, 152224a to 152224d, the strain gauge signals into digital signals. Digital signals are supplied to a processor, such as the primary processor. The primary processor determines 152226 one or more characteristics of the tissue based on the plurality of signals. The processor may determine one or more characteristics of the tissue by applying an algorithm and/or a look-up table. One or more tissue characteristics are displayed 152026 to an operator, for example, by a screen incorporated into the surgical instrument 150010.

[0406] Figure 66 illustrates an embodiment of an end actuator 152250 comprising a plurality of sensors 152260a to 152260d coupled to a second gripper member 3254. The end actuator 152250 comprises an anvil 152252 pivotally coupled to a second gripper member. gripper 152254. The anvil 152252 is movable relative to the second gripper member 152254 to clamp together one or more materials, such as a section of fabric 152264. The second gripper member 152254 is configured to receive a staple cartridge 152256 A first sensor 152258 is coupled to the anvil 152252. The first sensor is configured to detect one or more parameters of the end actuator 152150, such as the gap 152110 between the anvil 152252 and the staple cartridge 152256. The gap 152110 may correspond, for example, to a thickness of tissue trapped between the anvil 152252 and the staple cartridge 152256. The first sensor 152258 may comprise any sensor suitable for measuring one or more parameters of the end actuator. In various embodiments, for example, the first sensor 152258 may comprise a magnetic sensor, such as a Hall effect sensor, a strain gauge, a pressure sensor, an inductive sensor, such as an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor and/or any other suitable sensor.

[0407] A plurality of secondary sensors 152260a to 152260d are coupled to the second gripper member 152254. The plurality of secondary sensors 152260a to 152260d may be formed integrally with the second gripper member 152254 and/or the clamp cartridge 152256. In a embodiment, for example, the plurality of secondary sensors 152260a to 152260d are disposed on an outer row of the staple cartridge 152256 (see Figure 67). The plurality of secondary sensors 152260a to 152260d are configured to detect one or more parameters of the end actuator 152250 and/or a tissue section 152264 secured between the anvil 152252 and the staple cartridge 152256. The plurality of secondary sensors 152260a to 152260d may comprise any sensors suitable for detecting one or more parameters of the end actuator 152250 and/or the fabric section 152264 such as, for example, magnetic sensors, such as a Hall effect sensor, strain gauges, pressure sensors, inductive sensors, such as an eddy current sensor, resistive sensors, capacitive sensors, optical sensors and/or any other suitable sensors or combinations thereof. The plurality of secondary sensors 152260a to 152260d may comprise identical sensors and/or different sensors.

[0408] In some embodiments, the plurality of secondary sensors 152260a to 152260d comprise dual-purpose elements of sensors and tissue stabilizers. The plurality of secondary sensors 152260a to 152260d comprise electrodes and/or sensing geometries configured to create a stabilized tissue condition when the plurality of secondary sensors 152260a to 152260d are engaged with a section of tissue 152264, such as during an operation. grip. In some embodiments, one or more of the plurality of secondary sensors 152260a to 152260d may be replaced with non-detecting tissue stabilizing elements. Secondary sensors 152260a to 152260d create a stabilized tissue condition by controlling tissue flow, staple formation, and/or other tissue conditions during a gripping, stapling, and/or other treatment process.

[0409] Figure 67 illustrates an embodiment of a staple cartridge 152270 comprising a plurality of sensors 152272a to 152272h integrally formed therein. Staple cartridge 152270 comprises a plurality of rows containing a plurality of staple storage holes therein. One or more of the holes in the outer row 152278 are replaced by a sensor of the plurality of sensors 152272a to 152272h. A cut-out section is shown to illustrate a sensor 152272f coupled to a metal sensor wire 152276b. The sensor metal wires 152276a, 152276b may comprise a plurality of metal wires for coupling the plurality of sensors 152272a to 152272h to one or more circuits of a surgical instrument, such as surgical instrument 150010. In some embodiments, one or more Among the plurality of sensors 152272a to 152272h comprise dual-purpose elements of sensors and tissue stabilizers, having electrodes and/or sensing geometries configured to provide tissue stabilization. In some embodiments, the plurality of sensors 152272a to 152272h may be replaced by and/or co-populated with a plurality of tissue stabilizing elements. Tissue stabilization can be provided, for example, by controlling tissue flow and/or staple formation during a grasping and/or stapling process. The plurality of sensors 152272a to 152272h provide signals to one or more circuits of the surgical instrument 150010 to enhance feedback on stapling performance and/or tissue thickness detection.

[0410] Figure 68 is a logic diagram illustrating one embodiment of a process 152280 for determining one or more parameters of a section of fabric 152264 secured within an end actuator such as, for example, the end actuator 152250 illustrated in Figure 66 In one embodiment, a first sensor 152258 is configured to detect one or more parameters of the end actuator 152250 and/or the tissue section 152264 located between the anvil 152252 and the staple cartridge 152256. A first signal is generated 152282 by the first sensors 152258. The first signal is indicative of the one or more parameters detected by the first sensor 152258. One or more secondary sensors 152260 are configured to detect one or more parameters of the end actuator 152250 and/or the fabric section 152264. The secondary sensors 152260 may be configured to detect the same parameters, additional parameters, or parameters different from those detected by the first sensor 152258. Secondary signals 152284 are generated by the secondary sensors 152260. The secondary signals 152284 are indicative of the one or more parameters detected by the secondary sensors 152260. first signal and secondary signals are provided to a processor such as the primary processor. The processor adjusts 152286 the first signal generated by the first sensor 152258 based on the input generated by the secondary sensors 152260. The adjusted signal may be indicative, for example, of the true thickness of a tissue section 152264 and the completeness of the bite. The adjusted signal is displayed 152026 to an operator via, for example, a screen incorporated into the surgical instrument 150010.

[0411] Figure 69 illustrates an embodiment of an end actuator 152300 comprising a plurality of redundant sensors 152308a, 152308b. The end actuator 152300 comprises a first claw member, or anvil, 152302 pivotally coupled to a second claw member 152304. The second claw member 152304 is configured to receive within it a staple cartridge 152306. The anvil 152302 is movable relative to the staple cartridge 152306 to clamp a material, such as a section of fabric, between the anvil 152302 and the staple cartridge 152306. A plurality of sensors 152308a, 152308b are coupled to the anvil. The plurality of sensors 152308a, 152308b are configured to detect one or more parameters of the end actuator 152300 and/or a section of tissue situated between the anvil 152302 and the staple cartridge 152306. In some embodiments, the plurality of sensors 152308a, 152308b is configured to detect a gap 152310 between the anvil 152302 and the staple cartridge 152306. The gap 152310 may correspond, for example, to the thickness of the tissue located between the anvil 152302 and the staple cartridge 152306. The plurality of sensors 152308a, 152308b can detect the gap 152310 by, for example, detecting a magnetic field generated by a magnet 152312 coupled to the second claw member 152304.

[0412] In some embodiments, the plurality of sensors 152308a, 152308b comprise redundant sensors. The redundant sensors are configured to detect the same properties of the end actuator 152300 and/or a section of tissue situated between the anvil 152302 and the staple cartridge 152306. The redundant sensors may comprise, for example, Hall effect sensors configured to detect the gap 152310 between the anvil 152302 and the staple cartridge 152306. The redundant sensors provide signals representative of one or more parameters that allow a processor, such as the primary processor, to evaluate multiple inputs and determine the most reliable input . In some embodiments, redundant sensors are used to reduce noise, false signals and/or drift. Each of the redundant sensors can be measured in real time during grasping, allowing time-based information to be analyzed and algorithms and/or look-up tables to recognize tissue characteristics and grip positioning dynamically. The input of one or more of the redundant sensors may be adjusted and/or selected to identify the true tissue thickness and bite of a section of tissue located between the anvil 152302 and the staple cartridge 152306.

[0413] Figure 70 is a logic diagram illustrating an embodiment of a process 152320 for selecting the most reliable output from among a plurality of redundant sensors such as, for example, the plurality of sensors 152308a, 152308b illustrated in Figure 69. In one embodiment, a first signal is generated by a first sensor 152308a. The first signal is converted 152322a by an analog-to-digital converter. One or more additional signals are generated by one or more redundant sensors 152308b. The one or more additional signals are converted 152322b by an analog-to-digital converter. The converted signals are supplied to a processor such as the primary processor. The primary processor evaluates 152324 the redundant inputs to determine the most reliable output. The most reliable output can be selected based on one or more parameters such as algorithms, lookup tables, inputs from additional sensors, and/or instrument conditions. After selecting the most reliable output, the processor may adjust the output based on one or more additional sensors to reflect, for example, the true thickness and capture pressure of a section of tissue located between anvil 152302 and staple cartridge 152306 The most reliable adjusted output is displayed 152026 to an operator via, for example, a screen incorporated into the surgical instrument 150010.

[0414] Figure 71 illustrates an embodiment of an end actuator 152350 comprising a sensor 152358 that comprises a specific sampling rate to limit or eliminate false signals. The end actuator 152350 comprises a first claw member, or anvil, 152352 pivotally coupled to a second claw member 152354. The claw member 152354 is configured to receive within it a staple cartridge 152356. The staple cartridge 152356 152356 contains a plurality of staples that can be applied to a section of tissue located between the anvil 152352 and the staple cartridge 152356. A sensor 152358 is coupled to the anvil 152352. The sensor 152358 is configured to detect one or more parameters of the actuator. end 152350 such as the gap 152364 between the anvil 152352 and the staple cartridge 152356. The gap 152364 may correspond to the thickness of a material such as a section of tissue and/or the completeness of a bite of material situated between the anvil 152352 and the staple cartridge 152356. The sensor 152358 may comprise any sensor suitable for detecting one or more parameters of the end actuator 152350 such as, for example, a magnetic sensor, such as a Hall effect sensor, a meter strain, a pressure sensor, an inductive sensor such as an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor and/or any other suitable sensor.

[0415] In one embodiment, the sensor 152358 comprises a magnetic sensor configured to detect a magnetic field generated by an electromagnetic source 152360 coupled to the second gripper member 152354 and/or the staple cartridge 152356. The electromagnetic source 152360 generates a magnetic field detected by sensor 152358. The strength of the detected magnetic field may correspond, for example, to the thickness and/or completeness of a tissue bite located between the anvil 152352 and the staple cartridge 152356. In some embodiments, the electromagnetic source 152360 generates a signal at a known frequency such as, for example, 1 MHz. In other embodiments, the signal generated by the electromagnetic source 152360 may be adjustable based on, for example, the type of staple cartridge 152356 installed in the second gripper member 152354, in one or more additional sensors, an algorithm and/or one or more parameters.

[0416] In one embodiment, a signal processor 152362 is coupled to the end actuator 152350, such as anvil 152352. The signal processor 152362 is configured to process the signal generated by the sensor 152358 to eliminate false signals and to reinforce the input from sensor 152358. In some embodiments, the signal processor 152362 may be located separately from the end actuator 152350, such as in the handle 150014 of the surgical instrument 150010. In some embodiments, the signal processor 152362 is formed integrally with and/or comprises an algorithm executed by a general processor such as the primary processor. The signal processor 152362 is configured to process the signal from the sensor 152358 at a frequency substantially equal to the frequency of the signal generated by the electromagnetic source 152360. In one embodiment, for example, the electromagnetic source 152360 generates a signal at a frequency of 1 MHz The signal is detected by sensor 152358. Sensor 152358 generates a signal indicative of the detected magnetic field, which is provided to signal processor 152362. The signal is processed by signal processor 152362 at a frequency of 1 MHz to eliminate false signals. The processed signal is supplied to a processor such as the primary processor. The primary processor correlates the received signal to one or more parameters of the end actuator 152350, such as the gap 152364 between the anvil 152352 and the staple cartridge 152356.

[0417] Figure 72 is a logic diagram illustrating one embodiment of a process 152370 for generating a thickness measurement for a section of fabric situated between an anvil and a staple cartridge of an end actuator, such as the end actuator. end 152350 illustrated in Figure 71. In one embodiment of process 152370, a signal is generated 152372 by a modulated electromagnetic source 152360. The generated signal may comprise, for example, a 1 MHz signal. A magnetic sensor 152358 is configured to detect 152374 the signal generated by the electromagnetic source 152360. The magnetic sensor 152358 generates a signal indicative of the detected magnetic field and provides the signal to a signal processor 152362. The signal processor 152362 processes 152376 the signal to remove noise, false signals and/or to reinforce the signal. The processed signal is fed to an analog-to-digital converter for conversion 152378 into a digital signal. The digital signal can be calibrated 152380, for example, by applying an algorithm and/or a calibration curve input lookup table. Signal processing 152376, conversion 152378, and calibration 152380 may be performed by one or more circuits. The calibrated signal is displayed 152026 to a user via, for example, a screen formed integrally with the surgical instrument 150010.

[0418] Figures 73 and 74 illustrate an embodiment of an end actuator 152400 comprising a sensor 152408 for identifying staple cartridges 152406 of different types. The end actuator 152400 comprises a first claw member, or anvil, 152402 pivotally coupled to a second claw member or elongated channel 152404. The elongated channel 152404 is configured to operatively hold therein a cartridge of surgical staples. 152406. The end actuator 152400 additionally comprises the sensor 152408 located in the proximal area. Sensor 152408 may be any of an optical sensor, a magnetic sensor, an electrical sensor, or any other suitable sensor.

[0419] Sensor 152408 may be operable to detect a property of staple cartridge 152406 and thereby identify the type of staple cartridge 152406. Figure 74 illustrates an example where sensor 152408 is an optical emitter and detector 152410. The body of the staple cartridge 152406 may have different colors such that the color identifies the type of the staple cartridge 152406. An optical emitter and detector 152410 may be operable to interrogate the color of the body of the staple cartridge 152406. In the illustrated example , the optical emitter and detector 152410 can detect white 152412 by receiving reflected light in the red, green and blue spectrums at equal intensity. The optical emitter and detector 152410 can detect red 152414 by receiving very little reflected light in the green and blue spectrums, while receiving light in the red spectrum at a greater intensity.

[0420] Alternatively or additionally, the optical emitter and detector 152410, or other suitable sensor 152408, may interrogate and identify some other symbol or marking on the staple cartridge 152406. The symbol or marking may be any of a bar code, a format or character, a color-coded emblem or any other suitable marking. Information read by sensor 152408 may be communicated to a microcontroller in surgical device 150010, such as a microcontroller (microcontroller 461 (Figure 12), for example). The microcontroller can be configured to communicate information about the 152406 staple cartridge to the instrument operator. For example, the identified staple cartridge 152406 may not be suitable for a given application; in this case, the instrument operator may be informed, and/or an instrument function is inappropriate. In this instance, the microcontroller can optionally be configured to disable a function of the surgical instrument that can be disabled. Alternatively or additionally, the microcontroller may be configured to inform the operator of the surgical instrument 150010 about parameters of the type of staple cartridge 152406 identified, such as the length of the staple cartridge 152406, or information about the staples, such as height and length.

[0421] Figure 75 illustrates an aspect of a segmented flexible circuit 153430 configured to securely attach to a claw member 153434 of an end actuator. The segmented flexible circuit 153430 comprises a distal segment 153432a and lateral segments 153432b, 153432c that include individually addressable sensors to enable detection of the presence of local tissue. Segments 153432a, 153432b, 153432c are individually addressable to detect tissue and to measure tissue parameters based on individual sensors located within each of segments 153432a, 153432b, 153432c. Segments 153432a, 153432b, 153432c of segmented flexible circuit 153430 are mounted on gripper member 153434 and are electrically coupled to a power source such as an electrical circuit through conductive electrical members 153436. A Hall effect sensor 153438, or any sensor suitable magnet, is located at a distal end of the gripper member 153434. The Hall effect sensor 153438 operates in conjunction with a magnet to provide a measurement of an opening defined by the gripper member 153434 which otherwise may be called a a gap of tissue, as particularly shown in Figure 77. The segmented flexible circuit 153430 can be used to measure tissue thickness, force, displacement, compression, tissue impedance, and tissue location within a end actuator.

[0422] Figure 76 illustrates an aspect of a segmented flexible circuit 153440 configured to be mounted on a claw member 153444 of an end actuator. The segmented flexible circuit 153440 comprises a distal segment 153442a and lateral segments 153442b, 153442c that include individually addressable sensors for tissue control. Segments 153442a, 153442b, 153442c are individually addressable for treating tissue and for reading individual sensors located within each of segments 153442a, 153442b, 153442c. Segments 153442a, 153442b, 153442c of segmented flexible circuit 153440 are mounted on gripper member 153444 and are electrically coupled to a power source via electrically conductive members 153446. A Hall effect sensor 153448, or other suitable magnetic sensor, is provided at a distal end of the gripper member 153444. The Hall effect sensor 153448 operates in conjunction with a magnet to provide a measurement of an opening defined by the gripper member 153444 of the end actuator or fabric gap, as shown with particularity in Figure 77. Additionally, a plurality of lateral asymmetric temperature sensors 153450a, 153450b are mounted on or formally integrated into the segmented flexible circuit 153440 to provide tissue temperature feedback to the control circuit. The 153440 Segmented Flexible Circuit can be used to measure tissue thickness, force, displacement, compression, tissue impedance, and tissue location within an extremity actuator.

[0423] Figure 77 illustrates an aspect of an end actuator 153460 configured to measure a span of GT fabric. The end actuator 153460 comprises a gripper member 153462 and a gripper member 153444. The flexible circuit 153440, as described in Figure 76, is mounted on the gripper member 153444. The flexible circuit 153440 comprises a Hall effect sensor 153448 that operates with a magnet 153464 mounted on gripper member 153462 to measure the GT fabric gap. This technique may be employed to measure the gap defined between the gripper member 153444 and the gripper member 153462. The gripper member 153462 may be a staple cartridge.

[0424] Figure 78 illustrates an aspect of an end actuator 153470 comprising a segmented flexible circuit 153468. The end actuator 153470 comprises a gripper member 153472 and a clip cartridge 153474. The segmented flexible circuit 153468 is mounted on the member of gripper member 153472. Each of the sensors disposed within segments 1 to 5 is configured to detect the presence of tissue positioned between the gripper member 153472 and the staple cartridge 153474 and represents tissue zones 1 to 5. In the configuration shown In Figure 78, end actuator 153470 is shown in an open position ready to receive or clamp tissue between gripper member 153472 and staple cartridge 153474. Segmented flexible circuit 153468 can be used to measure tissue thickness, the force, displacement, compression, tissue impedance, and tissue location within the 153470 end actuator.

[0425] Figure 79 illustrates the end actuator 153470, shown in Figure 78, with the gripper member 153472 clamping the fabric 153476 between the gripper member 153472, e.g., the anvil and the staple cartridge. As shown in Figure 79, fabric 153476 is positioned between segments 1 to 3 and represents fabric zones 1 to 3. Consequently, fabric 153476 is detected by the sensors in segments 1 to 3 and the absence of fabric (empty) is detected in section 153469 by segments 4 and 5. Information regarding the presence and absence of tissue 153476 positioned within certain segments 1 through 3 and 4 and 5, respectively, is communicated to a control circuit, as described herein, through, by example, interface circuits. The control circuit is configured to detect tissue situated in segments 1 to 3. It will be recognized that segments 1 to 5 may contain any suitable magnetic temperature, force/pressure and/or Hall effect sensors to measure tissue parameters situated in certain segments 1 to 5 and electrodes to deliver energy to tissue situated in certain segments 1 to 5. Segmented flexible circuit 153468 can be used to measure tissue thickness, force, displacement, compression, tissue impedance and the location of the fabric inside the 153470 end actuator.

[0426] Figure 80 is a diagram of an absolute positioning system 153100 that can be used with a surgical instrument or a system in accordance with the present description. The absolute positioning system 153100 comprises a controlled motor drive circuit arrangement comprising a sensor arrangement 153102 in accordance with at least one aspect of the present disclosure. The sensor arrangement 153102 of an absolute positioning system 153100 provides a unique position signal that corresponds to the location of a displacement member 153111. In one aspect, the displacement member 153111 represents the longitudinally movable drive member coupled to the cutting instrument. or knife (e.g., a cutting instrument, an I-beam and/or I-beam 153514 (Figure 82)). In other aspects, the displacement member 153111 represents the firing member coupled to the cutting instrument or knife, which may be adapted and configured to include a rack of drive teeth. In yet another aspect, the displacement member 153111 represents the firing bar or an I-beam, each of which may be adapted and configured to include a rack of drive teeth.

[0427] Accordingly, as used in the present invention, the term "displacement member" is used generically to refer to any movable member of a surgical instrument or system as described herein, such as a driving member, a firing member, a firing bar, a cutting instrument, a knife and/or an I-beam or any element that can be moved. Consequently, the absolute positioning system 153100 can, in effect, track the displacement of the I-beam 153514 of the cutting instrument (Figure 82) by tracking the displacement of a longitudinally movable drive member. In various other aspects, displacement member 153111 may be coupled to any suitable sensor for measuring displacement. In this way, the longitudinally movable drive member, firing member, firing bar or I-beam, or combinations thereof, can be coupled to any suitable displacement sensor. Displacement sensors may include contact or non-contact displacement sensors. The displacement sensors may comprise linear variable differential transformers ("LVDT"), differential variable reluctance transducers ("DVRT"), a slide potentiometer, a magnetic detection system comprising a movable magnet and a plurality of Hall effect sensors arranged in a linearly movable manner, a magnetic detection system comprising a fixed magnet and a plurality of Hall effect sensors arranged in a linearly movable manner, an optical detection system comprising a source of moving light and an array of photodiodes or photodetectors arranged in a linearly movable manner, or an optical detection system comprising a fixed light source and an array of photodiodes or photodetectors arranged in a linearly movable manner, or any combination thereof.

[0428] An electric motor 153120 may include a rotary drive shaft 153116, which operatively interfaces with a gear assembly 153114, which is mounted in coupling engagement with a set, or rack, of drive teeth on the displacement member 153111. A sensing element 153126 may be operatively coupled to the gear assembly 153114 such that a single revolution of the sensing element 153126 corresponds to some linear longitudinal translation of the displacement member 153111. An arrangement of gears and sensors 153118 may be connected to the linear actuator through a rack and pinion arrangement, or to a rotary actuator, through a sprocket or other connection. A power source 153129 provides power to the absolute positioning system 153100 and an output indicator 153128 may show the output of the absolute positioning system 153100.

[0429] A single revolution of the sensing element 153126 associated with the position sensor 153112 is equivalent to a longitudinal displacement d1 of the displacement member 153111, where d1 is the longitudinal distance by which the displacement member 153111 moves from point "a" to point "b" after a single revolution of the sensing element 153126 coupled to the displacement member 153111. The sensor arrangement 153102 may be connected via a gear reduction that results in the completion of one or more revolutions by the position sensor 153112 of the full stroke of the travel member 153111. The position sensor 153112 can complete multiple revolutions of the full stroke of the travel member 153111.

[0430] A series of switches 153122a to 153122n, where n is an integer greater than one, may be used alone or in combination with gear reduction to provide a single position signal for more than one revolution of the position sensor 153112. The state of switches 153122a to 153122n is fed back to a controller 153110 that applies logic to determine a single position signal that corresponds to the longitudinal displacement d1 + d2 + ... dn of the displacement member 153111. The output 153124 of the position sensor 153112 is provided to the controller 153110. The position sensor 153112 of the sensor arrangement 153102 may comprise a magnetic sensor, an analog rotary sensor such as a potentiometer, an array of analog Hall effect elements, which output a unique combination of signals or values of position. The controller 153110 may be contained within a master controller or may be contained within a compartment of the tool mounting portion of a surgical instrument or a system in accordance with the present description.

[0431] The absolute positioning system 153100 provides absolute positioning of the travel member 153111 upon energization of the surgical instrument or system without having to retract or advance the drive member 153111 to the reset (zero or home) position, such as This may be the case with conventional rotary encoders that merely count the number of progressive or regressive steps that the motor 153120 has traveled to infer the position of an actuator device, drive bar, scalpel, and the like.

[0432] Controller 153110 can be programmed to perform various functions, such as precisely controlling the speed and position of the linkage and knife systems. In one aspect, the controller 153110 includes a processor 153108 and a memory 153106. The electric motor 153120 may be a brushed direct current motor with a gearbox and mechanical connections with a linkage or knife system. In one aspect, a 153110 motor driver may be an A3941 available from Allegro Microsystems, Inc. Other motor drivers may be readily substituted for use in the 153100 absolute positioning system.

[0433] Controller 153110 may be programmed to provide precise control of the speed and position of travel member 153111 and linkage systems. The 153110 controller may be configured to compute a response in the 153110 controller software. The computed response is compared to a measured response of the real system to obtain an "observed" response, which is used for actual feedback-based decisions. The observed response is a favorable and adjusted value, which balances the uniform and continuous nature of the simulated response with the measured response, which can detect external influences on the system.

[0434] The absolute positioning system 153100 may comprise and/or be programmed to implement a feedback controller, such as a PID, state feedback, and adaptive controller. A power source 153129 converts the signal from the feedback controller into a physical input to the system, in this case, voltage. Other examples include pulse width modulation (PWM) of voltage, current, and force. Other sensors 153118 may be provided to measure physical parameters of the physical system in addition to the position measured by position sensor 153112. In a digital signal processing system, an absolute positioning system 153100 is coupled to a digital data capture system wherein the output of the absolute positioning system 153100 will have a finite resolution and sampling frequency. The absolute positioning system 153100 may comprise a comparison and combination circuit for combining a computed response with a measured response through the use of algorithms, such as a weighted average, and a theoretical control closed loop, which drives a computed response toward the response measure. The computed response of the physical system considers properties such as mass, inertia, viscous friction, inductance resistance, etc., to predict what the states and outputs of the physical system will be, given the input.

[0435] The 153110 motor driver may be an A3941, available from Allegro Microsystems, Inc. The 153110 A3941 driver is a full-bridge controller for use with metal oxide semiconductor field effect transistors (MOSFETs). field effect transistors) N-channel external power, specifically designed for inductive loads such as brushed DC motors. The 153110 driver comprises a unique charge pump regulator, which provides full gate drive (>10 V) for batteries voltages up to 7 V and enables the A3941 to operate with reduced gate drive, up to 5.5 V. A Input drive capacitor can be used to supply the above battery-supplied voltage required for the N-channel MOSFETs. An internal charge pump for the top-side drive allows direct current operation (100% duty cycle). The entire bridge can be driven in fast or slow decay modes using diodes or synchronized rectification. In slow drop mode, current recirculation can occur through a high-side or low-side FET. Power FETs are protected from the shoot-through effect by means of resistors with programmable dead time. Built-in diagnostics provide indication of undervoltage, overtemperature, and power bridge faults and can be configured to protect power MOSFETs under most short circuit conditions. Other motor drivers can be immediately replaced for use in the 153100 absolute positioning system.

[0436] Figure 81 is a diagram of a position sensor 153200 of an absolute positioning system 153100, comprising a rotary magnetic absolute positioning system, in accordance with at least one aspect of this description. The 153100' absolute positioning system is similar in many respects to the 153100 absolute positioning system. The 153200 position sensor can be implemented as a rotary, magnetic, single integrated circuit position sensor, AS5055EQFT, available from Austria Microsystems , AG. The 153200 position sensor interfaces with the 153110 controller to provide the 153100 absolute positioning system. The 153200 position sensor is a low voltage, low power component and includes four Hall effect elements 153228A, 153228B, 153228C, 153228D in an area 153230 of position sensor 153200 that is situated above a magnet situated on a rotating element associated with a displacement member such as, for example, the cutting drive gear, and/or the closing drive gear, so that the displacement of a firing member and/or a closing member can be accurately tracked. A 153232 high-resolution ADC converter and a 153238 intelligent power management controller are also featured on the integrated circuit. A CORDIC 153236 (Coordinate Rotation Digital Computer) processor, also known as the digit-by-digit method and Volder algorithm, is provided to implement a simple and efficient algorithm for computing hyperbolic and trigonometric functions that require only operations addition, subtraction, bit shift and look-up table. Angular position, alarm bits, and magnetic field information are transmitted through a standard serial communications interface, such as a 153234 SPI interface, to the 153110 controller. The 153200 position sensor provides 12 or 14 bits of resolution. The 153200 position sensor can be an AS5055 integrated circuit supplied in a small 16-pin QFN package whose measurement corresponds to 4x4x0.85 mm.

[0437] Hall effect elements 153228A, 153228B, 153228C, 153228D are located directly above the rotating magnet. The Hall effect is a well-known effect and for convenience will not be described in detail here, however, in general, the Hall effect produces a voltage difference (the Hall voltage) across an electrical conductor transverse to an electrical current in the conductor and a magnetic field perpendicular to the current. The Hall coefficient is defined as the ratio between the induced electric field and the product of the current density and the applied magnetic field. It is a characteristic of the material from which the conductor is made, as its value depends on the type, number and properties of the charge carriers that make up the current. In the AS5055 153200 position sensor, the Hall effect elements 153228A, 153228B, 153228C, 153228D are capable of producing a voltage signal indicative of the absolute positioning of the magnet in terms of the angle with respect to a single revolution of the magnet. This angle value, which is a unique position signal, is calculated by the CORDIC 153236 processor and stored integrated into the AS5055 153200 position sensor in a register or memory. The angle value that is indicative of the position of the magnet during one revolution is provided to the controller 153110 in a variety of techniques, for example, upon energization or upon demand from the controller 153110.

[0438] The AS5055 153200 position sensor requires only a few external components to operate when connected to the 153110 controller. Six wires are required for a simple application using a single power supply: two wires for power and four 153240 wires for the 153234 SPI interface with the 153110 controller. A seventh connection can be added to send an interrupt signal to the 153110 controller that a new valid angle can be read. Upon power-up, the AS5055 153200 position sensor performs a complete power-up sequence, including an angle measurement. Completion of this cycle is indicated as an INT 153242 output, and the angle value is stored in an internal register. Once this output is configured, the AS5055 153200 position sensor goes into sleep mode. The controller 153110 can respond to the INT request at the INT output 153242 by reading the angle value from the AS5055 position sensor 153200 through the SPI interface 153234. After the angle value is read by the controller 153110, the INT output 153242 is released again. Sending a "read angle" command over the 153234 SPI interface via the 153110 controller to the 153200 position sensor also automatically energizes the integrated circuit and initiates another angle measurement. Once the 153110 controller has completed reading the angle value, the INT 153242 output is released and a new result is stored in the angle register. The completion of this angle measurement is again indicated by the definition of output INT 153242 and the corresponding identification in the status register.

[0439] Due to the measurement principle of the AS5055 153200 position sensor, only a single angle measurement is performed in a very short time (~600 μs) after each power-up sequence. As soon as an angle measurement is completed, the AS5055 153200 position sensor enters the de-energized state. There is no digital averaging angle value filter implemented in the integrated circuit, as this would require more than one angle measurement and, consequently, a longer power-up time, which is not desired in low power applications. Angle variation can be reduced by averaging multiple angle samples on the 153110 controller. For example, an average of four samples reduces the variation by 6 dB (50%).

[0440] Figure 82 is a cross-sectional view of an end actuator 153502 showing an I-beam 153514 triggering a stroke relative to fabric 153526 secured within the end actuator 153502, in accordance with at least one aspect. of this description. End actuator 153502 is configured to operate with any of the surgical instruments or systems in accordance with the present description. The end actuator 153502 comprises an anvil 153516, an elongated channel 153503 with a staple cartridge 153518 positioned in the elongated channel 153503. A firing bar 153520 is translatable distally and proximally along a longitudinal geometric axis 153515 of the end actuator 153502. When the 153502 end actuator is not articulated, the 153502 end actuator is in line with the instrument drive shaft. An I-beam 153514 comprising a cutting edge 153509 is illustrated on a distal portion of the firing bar 153520. A wedge slider 153513 is positioned in the staple cartridge 153518. As the I-beam 153514 translates distally, , the cutting edge 153509 contacts and can cut the tissue 153526 positioned between the anvil 153516 and the staple cartridge 153518. Additionally, the I-beam 153514 contacts the wedge slider 153513 and pushes it distally, causing the wedge slider 153513 to contact the staple drivers 153511. The staple drivers 153511 may be driven into the staples 153505, causing the staples 153505 to advance through the fabric and into pockets 153507 defined in the anvil 153516, which formats staples 153505.

[0441] A firing stroke of the exemplary I-beam 153514 is illustrated by a graphic 153529 aligned with the end actuator 153502. The exemplary fabric 153526 is also shown aligned with the end actuator 153502. The stroke of the firing member may comprise a stroke start position 153527 and a stroke end position 153528. During a firing stroke of the I-beam 153514, the I-beam 153514 may be advanced distally from the stroke start position 153527 to the stroke end position 153528. I-beam 153514 is shown at an example location of a stroke start position 153527. I-beam 153514 firing member stroke chart 153529 illustrates five travel regions of travel. firing member 153517, 153519, 153521, 153523, 153525. In a first region of firing stroke 153517, the I-beam 153514 may begin to advance distally. In the first firing stroke region 153517, the I-beam 153514 may contact the wedge slider 153513 and begin to move it distally. While in the first region, however, the cutting edge 153509 may not contact the fabric and the wedge slider 153513 may not contact a staple driver 153511. After static friction is overcome, the force required to actuate the I-beam 153514 in the first region 153517 may be substantially constant.

[0442] In the second region of travel of the firing member 153519, the cutting edge 153509 may begin to contact and cut the fabric 153526. Additionally, the wedge slider 153513 may begin to contact the staple drivers 153511 to drive the 153505 clamps. The force required to drive the 153514 I-beam may begin to increase gradually. As shown, the initially encountered tissue may be compressed and/or thinner due to the way in which the anvil 153516 rotates relative to the staple cartridge 153518. In the third region of the travel of the firing member 153521, the cutting edge 153509 may continuously enter into contact and cut fabric 153526 and the wedge slider 153513 may repeatedly contact the clamp drivers 153511. The force required to drive the I-beam 153514 may reach the plateau in the third region 153521. In the fourth region of travel 153523, the force required to actuate the 153514 I-Beam may begin to decrease. For example, the tissue in the portion of the end actuator 153502 corresponding to the fourth firing region 153523 may be less compressed than the tissue closest to the anvil pivot point 153516, requiring less force to cut. Furthermore, the cutting edge 153509 and the wedge slider 153513 can reach the end of the fabric 153526 while in the fourth region 153523. When the I-beam 153514 reaches the fifth region 153525, the fabric 153526 can be completely separated. Wedge slider 153513 may contact one or more staple drivers 153511 at or near the end of the fabric. The force to advance the I-beam 153514 through the fifth region 153525 may be reduced and, in some examples, may be similar to the force to drive the I-beam 153514 through the first region 153517. At the completion of the member's travel 82 is just an example. In some examples, the different regions may begin at different positions along the longitudinal axis of the end actuator 153515, for example, based on tissue positioning between the anvil 153516 and the staple cartridge 153518.

[0443] As discussed above and with reference now to Figures 80 to 82, the electric motor 153120 positioned within the surgical instrument master controller may be used to advance and/or retract the drive shaft assembly firing system, including I-beam 153514 relative to end actuator 153502 of the drive shaft assembly in order to staple and/or cut fabric captured within end actuator 153502. I-beam 153514 can be advanced or retracted at a desired speed, or within a range of desired speeds. The controller 153110 may be configured to control the speed of the I-beam 153514. The controller 153110 may be configured to predict the speed of the I-beam 153514 based on various parameters of the power supplied to the electric motor 153120, such as voltage and/or current, for example, and/or other operating parameters of the 153120 electric motor or external influences. The controller 153110 can be configured to predict the current speed of the I-beam 153514 based on previous values of current and/or voltage supplied to the electric motor 153120 and/or previous system states such as speed, acceleration and/or or position. Controller 153110 can be configured to sense the speed of I-beam 153514 using the absolute positioning sensor system described herein. The controller can be configured to compare the predicted speed of the I-beam 153514 and the detected speed of the I-beam 153514 to determine whether power to the electric motor 153120 should be increased in order to increase the speed of the beam. with I profile 153514 and/or reduced, in order to reduce the speed of the beam with I profile 153514.

[0444] The force acting on I-beam 153514 can be determined using various techniques. The force on the I-beam 153514 can be determined by measuring the current of the motor 153120, wherein the current of the motor 153120 is based on the load on the I-beam 153514 as it advances distally. The strength of the I-beam 153514 can be determined by positioning a strain gauge on the drive member, the firing member, the I-beam 153514, the firing bar, and/or a proximal end of the cutting edge 153509. The strength of the I-beam 153514 can be determined by monitoring the actual position of the I-beam 153514 moving at an expected speed based on the current set speed of the motor 153120 after a predetermined period of time T1 elapsed time and by comparing the actual position of I-beam 153514 to the expected position of I-beam 153514 based on the current set speed of engine 153120 at the end of period T1. Therefore, if the actual position of the 153514 I-beam is less than the expected position of the 153514 I-beam, the force on the 153514 I-beam is greater than a nominal force. On the other hand, if the actual position of the 153514 I-beam is greater than the expected position of the 153514 I-beam, the force on the 153514 I-beam is less than the nominal force. The difference between the actual and expected positions of the 153514 I-beam is proportional to the deviation of the force on the 153514 I-beam from the nominal force.

[0445] Before beginning a description of closed-loop control techniques of the closure tube and firing member, the description briefly returns to Figure 83. Figure 83 is a graph 153600 representing two closure force plots ( FTC) 153606, 153608 representing the force applied to a closing member to close over thick and thin tissue during a closing phase, and a graph 153601 of two firing force plots (FTF) 153622, 153624 representing the applied force to a firing member for firing through thick and thin tissue during a firing phase. Referring to Figure 83, graph 153600 shows an example of the force applied to thick and thin tissue during a closing stroke to close end actuator 153502 relative to tissue trapped between anvil 153516 and staple cartridge 153518, wherein the closing force is plotted as a function of time. Closing force plots 153606, 153608 are plotted on two geometric axes. A vertical axis 153602 indicates the closing force (FTC) of the end actuator 153502 in Newtons (N). A horizontal geometric axis 153604 indicates time in seconds and is marked from t0 to t13 for clarity of description. The first closing force plot 153606 is an example of the force applied to the thick tissue during a closing stroke to close the end actuator 153502 relative to the tissue trapped between the anvil 153516 and the staple cartridge 153518 and a second plot 153608 is an example of the force applied to thin tissue during a closing stroke to close end actuator 153502 relative to tissue trapped between anvil 153516 and staple cartridge 153518. The first and second closing force plots 153606, 153608 are divided into three phases, a closing course (CLOSING), a waiting period (WAIT) and a tripping course (TRIG). During the closing stroke, a closing tube is translated distally ("DD" direction) to move the anvil 153516, for example, relative to the staple cartridge 153518 in response to actuation of the closing stroke by a closing motor. In other cases, the closing stroke involves movement of the staple cartridge 153518 relative to an anvil 153516 in response to actuation of the closing motor, and in other cases, the closing stroke involves movement of the staple cartridge 153518 and the anvil 153516 in response to the closing motor activation. With reference to the first closing force plot 153606, during the closing stroke, the closing force 153610 increases from 0 to a maximum force F1 from time t0 to t1. With reference to the second closing force graph 153608, during the closing stroke, the closing force 153616 increases from 0 to a maximum force F3 from time t0 to t1. The relative difference between the maximum forces F1 and F3 is due to the difference in the closing force required for thick tissue relative to thin tissue, where a greater force is required to close the anvil over thick tissue relative to thin tissue.

[0446] The first and second closing force plots 153606, 153608 indicate that the closing force on the end actuator 153502 increases during an initial grip period ending at a time (t1). The closing force reaches a maximum force (F1, F3) at time (t1). The initial grasp period may be about one second, for example. A waiting period may be applied before starting a firing course. The waiting period allows fluid to escape from the compressed tissue by the end actuator 153502, which reduces the thickness of the compressed tissue producing a smaller gap between the anvil 153516 and the staple cartridge 153518 and a reduction in closing force. at the end of the waiting period. Referring to the first closing force 153606 plot, there is a nominal drop in closing force 153612 from F1 to F2 during the holding period between t1 and t4. Similarly, with reference to the second closing force plot 153608, the closing force 153618 nominally drops from F3 to F4 during the holding period between t1 and t4. In some examples, a waiting period (t1 to t4) selected from a range of about 10 seconds to about 20 seconds is typically used. In the example of the first and second closing force plots 153606, 153608, a period of about 15 seconds is used. The hold period is followed by the trigger stroke, which typically lasts a period selected from a range of about 3 seconds, for example, to about 5 seconds, for example. The clamping force decreases as the 153514 I-beam is advanced relative to the end actuator through the firing stroke. As indicated by the closing force 153614, 153620 of the first and second closing force plots 153606, 153608, respectively, the closing force 153614, 153620 exerted on the closing tube drops precipitously from the time of about t4 to the time of about from t5. Time t4 represents the moment at which the i-profile beam 153514 couples to the anvil 153516 and begins to assume the closing load. Consequently, the closing force decreases as the firing force increases as shown by the first and second firing force plots 153622, 153624.

[0447] Figure 83 also represents a graph 153601 of the first and second firing force plots 153622, 153624 which plot the force applied to advance the I-beam 153514 during the firing stroke of a surgical instrument or system in accordance with the present description. The firing force plots 153622, 153624 are plotted on two geometric axes. A vertical geometric axis 153626 indicates the firing force, in Newtons (N), applied to advance the i-profile beam 153514 during the firing stroke. The 153514 I-beam is configured to advance a knife or cutting element and encourage drivers to deploy the clamps during the firing stroke. A horizontal geometric axis 153605 indicates time in seconds on the same time scale as the horizontal geometric axis 153604 of the top chart 153600.

[0448] As previously described, the force of the closing tube drops precipitously from time t4 to time about t5, which represents the moment at which the i-profile beam 153514 couples to the anvil 153516 and begins to receive the load and closing force decreases as the firing force increases, as shown by the first and second firing force plots 153622, 153624. I-beam 153514 is advanced from the stroke start position at time t4 to the stroke end positions between t8 and t9 for plotting the trigger force 153624 for the thin tissue and at t13 for plotting the trigger force 153622 for the thick tissue. As the I-beam 153514 is advanced distally during the firing stroke, the closure assembly hands over control of the staple cartridge 153518 and the anvil 153516 to the firing assembly, which causes the firing force to increase. and the closing force decreases.

[0449] In the thick tissue firing force plot 153622, during the firing period (FIRING), the plot 153622 is divided into three distinct segments. A first segment 153628 indicates the firing force, as it increases from 0 to t4 to a peak force F'1 just before t5. The first segment 153628 is the firing force during the initial phase of the firing stroke when the i-beam 153514 advances distally from the top of the closing ramp until the i-beam 153514 contacts the tissue. A second segment 153630 indicates the firing force during a second phase of the firing stroke in which the i-beam 153514 is advancing distally deploying staples and cutting tissue. During the second phase of the firing stroke, the firing force drops from F'1 to F'2 at about t12. A third segment 153632 indicates the firing force during the third and final phase of the firing stroke when the i-beam 153514 leaves the fabric and advances to the end of the stroke in a zone without fabric. During the third phase of the firing stroke, the firing force drops from F’2 to zero (0) at about t13 where the i-beam 153514 reaches the end of stroke. In summary, during the firing stroke, the firing force increases dramatically as the 153514 I-beam enters a fabric zone, decreases steadily in the fabric zone during the stapling and cutting operation, and drops sharply as the I-beam 153514 exits the fabric zone and enters a non-fabric zone at the end of its travel.

[0450] The firing force plot of the thin tissue 153624 follows a similar pattern to the firing force plot of the thick tissue 153622. Thus, during the first phase of the firing stroke, the firing force 153634 increases dramatically from 0 to F'3 at about t5. During the second phase of the firing stroke, the firing force 153636 drops steadily from F'3 to F'4 at about t8. During the final phase of the firing stroke, the firing force 153638 drops drastically from F’4 to 0 between t8 and t9.

[0451] To overcome the drastic drop in closing force from time t4 to about time t5, which represents the moment when the I-beam 153514 engages the anvil 153516 and begins to receive the load and closing force decreases as the firing force increases, as shown by the first and second firing force plots 153622, 153624, the closure tube can be advanced distally as the firing member, such as the I-beam 153514 , advances distally. The closing tube is represented as the transmission element that applies a closing force to the anvil 153516. As described herein, a control circuit applies motor set points to the motor control that applies a motor control signal to the motor to actuating the transmission member and advancing the closure tube distally to apply a closing force to the anvil 153516. A torque sensor coupled to a motor output drive shaft can be used to measure the force applied to the closure tube. In other aspects, the closing force can be measured with a strain gauge, a load cell or other suitable force sensors.

[0452] Figure 84 is a diagram of a control system 153950 configured to provide progressive closure of a closure member (e.g., a closure tube) when the firing member (e.g., the I-beam 153514) advances distally and is coupled to a clamping arm (e.g., anvil 153516) to decrease the closing force load on the closing member at a desired speed and decrease the firing force load on the firing member, so accordance with at least one aspect of the present description. In one aspect, the control system 153950 can be implemented as a nested PID feedback controller. A PID controller is a control loop (controller) feedback mechanism to continuously calculate an error value as the difference between a desired set point and a measured process variable and apply a correction based on proportional, integral, and derivative terms (sometimes indicated P, I, and D respectively). The feedback control system of the nested PID controller 153950 includes a primary controller 153952, in a primary (external) feedback circuit 153954, and a secondary controller 153955 in a secondary (internal) feedback circuit 153956. The primary controller 153952 may be a PID controller 153972 as shown in Figure 84, and the secondary controller 153955 may also be a PID controller 153972 as shown in Figure 85. The primary controller 153952 controls a primary process 153958 and the secondary controller 153955 controls a secondary process 153960. The output 153966 of the primary processor 153958 (OUTPUT) is subtracted from a primary set point SP1 by a first adder 153962. The first adder 153962 produces a single output sum signal that is applied to the primary controller 153952. The output of the primary controller 153952 is the secondary setpoint SP2. The output 153968 of the secondary processor 153960 is subtracted from a primary set point SP2 by a first adder 153964.

[0453] In the context of controlling closure tube displacement, the control system 153950 may be configured such that the primary set point SP1 is a desired closure force value and the primary controller 153952 is configured to receive the force from the torque sensor coupled to the closing motor output and determine a motor speed from the SP2 set point for the closing motor. In other aspects, the closing force can be measured with strain gauges, load cells, or other suitable force sensors. The SP2 closure motor speed set point is compared to the actual speed of the closure tube, which is determined by the secondary controller 153955. The actual speed of the closure tube can be measured by comparing the displacement of the closure tube with the sensor position and measuring the elapsed time with a timer/counter. Other techniques such as linear or rotary encoders can be used to measure closure tube displacement. Output 153968 from secondary process 153960 is the actual speed of the shutoff tube. This closure tube speed output 153968 is provided to the primary processor 153958 which determines the force acting on the closure tube and is fed back to the adder 153962 which subtracts the measured closure force from the primary set point SP1. The SP1 master setpoint can be an upper threshold or a lower threshold. Based on the output of the adder 153962, the primary controller 153952 controls the speed and direction of the shut-off tube motor as described here. The secondary controller 153955 controls the speed of the closing motor based on the actual speed of the closing tube measured by the secondary process 153960 and the secondary setpoint SP2, which is based on a comparison of the upper and lower limits of the trigger force and of the actual firing force.

[0454] Figure 85 illustrates a PID feedback control system 153970, in accordance with at least one aspect of this description. The primary controller 153952 or the secondary controller 153955, or both, may be implemented as a PID controller 153972. In one aspect, the PID controller 153972 may comprise a proportional element 153974 (P), an integral element 153976 (I), and a derivative element 153978 (D). The outputs of P, I and D elements 153974, 153976, 153978 are summed by an adder 153986, which provides the control variable u(t) to process 153980. The output of process 153980 is the process variable y(t). An adder 153984 calculates the difference between a desired set point r(t) and a measured process variable y(t). The 153972 PID controller continuously calculates an error value e(t) (e.g. the difference between the closing force limit and the measured closing force) as the difference between a desired set point r(t) (e.g. , the closing force limit) and the measured process variable y(t) (for example, the speed and direction of the closing tube) and applies a correction based on the proportional, integral and derivative terms calculated by the proportional element 153974 ( P), the integral element 153976 (I), and the derivative element 153978 (D), respectively. The 153972 PID controller attempts to minimize the error e(t) over time by adjusting the control variable u(t) (for example, the speed and direction of the shutoff tube).

[0455] According to the PID algorithm, the "P" element 153974 represents the present values of the error. For example, if the error is large and positive, the control output will also be large and positive. According to the present description, the error term e(t) is the difference between the desired closing force and the measured closing force of the closing tube. The "I" element 153976 represents the values passed from the error. For example, if the current output is not strong enough, the error integral will accumulate over time, and the controller will respond by applying a stronger action. The "D" element 153978 represents possible future trends of the error, based on its actual rate of change. For example, continuing example P above, when the large positive control output manages to bring the error closer to zero, it also puts the process into a large negative error mode in the near future. In this case, the derivative becomes negative and module D reduces the strength of the action to avoid this excess.

[0456] It will be understood that other variables and set points may be monitored and controlled in accordance with feedback control systems 153950, 153970. For example, the adaptive closure member speed control algorithm described herein may mediate by least two of the following parameters: the location of travel of the firing member, the load of the firing member, the displacement of the cutting element, the speed of the cutting element, the location of travel of the shut-off tube, the load of the closure, among others.

[0457] Figure 86 is a logic flowchart depicting a process 153990 of a control program or a logic configuration for determining the speed of a closure member, in accordance with at least one aspect of the present description. A control circuit of a surgical instrument or a system according to the present description is configured to determine 153992 the actual closing force of a closing member. The control circuit compares 153994 the actual closing force to a threshold closing force and determines 153996 a set point speed for moving the closing member based on the comparison. The control circuit controls 153998 the actual speed of the closure member based on the set point speed.

[0458] Now also referring to Figures 84 and 85, in one aspect, the control circuit comprises a proportional, integral and derivative (PID) feedback control system 153950, 153970. The PID feedback control system 153950, 153970 comprises a primary PID 153954 feedback loop and a secondary PID 153956 feedback loop. The primary feedback loop 153954 determines a first error between the actual closing force of the closing member and a limiting closing force SP1 and sets the speed set point of the closing member SP2 based on the first error. Secondary feedback circuit 153956 determines a second error between the actual speed of the closure member and the setpoint speed of the closure member and sets the speed of the closure member based on the second error.

[0459] In one aspect, the limit closing force SP1 comprises an upper limit and a lower limit. The SP2 setpoint speed is set to advance the closing member distally when the actual closing force is less than the lower limit, and the setpoint speed is set to retract the closing member proximally when the actual closing force is greater than the lower limit. In one aspect, the set point speed is configured to hold the closing member in place when the actual closing force is between the upper and lower limits.

[0460] In one aspect, the control system further comprises a force sensor (e.g., any of sensors 472, 474, 476 (Figure 12), for example) coupled to the control circuit. A force sensor is configured to measure the closing force. In one aspect, the force sensor comprises a torque sensor coupled to an output drive shaft of a motor coupled to the closure member. In one aspect, the force sensor comprises a strain gauge coupled to the closure member. In one aspect, the force sensor comprises a load cell coupled to the closure member. In one aspect, the control system comprises a position sensor coupled to the closure member, wherein the position sensor is configured to measure the position of the closure member.

[0461] In one aspect, the control system comprises a first motor configured to couple the closure member and the control circuit is configured to advance the closure member during at least a portion of a firing stroke.

[0462] The functions or processes 153990 described in the present invention can be performed by any of the processing circuits described herein. Aspects of the powered surgical instrument can be practiced without the specific details described here. Some aspects were shown as block diagrams rather than details.

[0463] Portions of this description may be presented in terms of instructions that operate on data stored in a computer memory. An algorithm refers to a self-consistent sequence of steps that lead to the desired result, where a "step" refers to the manipulation of physical quantities that can take the form of electrical or magnetic signals that can be stored, transferred, combined, compared, and manipulated in any other way. These signals can be called bits, values, elements, symbols, characters, terms, numbers. These terms and similar terms can be associated with appropriate physical quantities and are merely convenient identifications applied to those quantities.

[0464] In general, the aspects described herein, which can be implemented, individually and/or collectively, by a wide range of hardware, software, firmware, or any combination thereof, can be viewed as being comprised of several types of "electrical circuits". Accordingly, the term "electrical circuit" includes electrical circuits that have at least one isolated electrical circuit, electrical circuits that have at least one integrated circuit, electrical circuits that have at least one integrated circuit for a specific application, electrical circuits that form a general-purpose computing configured by a computer program (e.g., a general-purpose computer or processor configured by a computer program that at least partially executes processes and/or devices described herein, electrical circuits that form a memory device (e.g., forms of random access memory) and/or electrical circuits that form a communications device (e.g. a modem, routers or optical-electrical equipment). These aspects may be implemented in analog or digital form, or combinations thereof .

[0465] The aforementioned description presented aspects of the devices and/or processes through the use of block diagrams, flowcharts, and/or examples, which may contain one or more functions and/or operations. Each function and/or operation within such block diagrams, flowcharts or examples can be implemented, individually and/or collectively, by a wide range of hardware, software, firmware or virtually any combination thereof. In one aspect, various portions of the subject matter described herein can be implemented by means of application-specific integrated circuits (ASICs), field programmable gate arrays (FPGAs), digital signal processors (DSPs), programmable logic devices (PLDs), circuits, registers and/or software components, e.g. programs, subroutines, logic and/or combinations of hardware and software components. Logic gates or other integrated formats. Some aspects described herein, in whole or in part, may be equivalently implemented on integrated circuits, as one or more computer programs running on one or more computers (for example, as one or more programs running on one or more computer systems). computer), as one or more programs operating on one or more processors (e.g., as one or more programs operating on one or more microprocessors), as firmware, or virtually any combination thereof, and which design the circuitry and /or writing code for the software and firmware would be within the scope of practice of a person skilled in the art in light of this description.

[0466] The mechanisms of the subject matter described may be distributed as a program product in a variety of forms, and an illustrative aspect of the subject matter described herein is applicable regardless of the specific type of signal transmission media used to actually perform the distribution. Examples of a signal transmission medium include, but are not limited to, the following: a recordable-type medium such as a floppy disk, a hard disk drive, a compact disc (CD), a digital video disc (DVD), a tape digital, a computer memory, etc.; and a transmission-type medium, such as a digital and/or analog communications medium (e.g., a fiber optic cable, a waveguide, a wired communications link, a wireless communications link (e.g., transmitter, receiver, transmission logic, reception logic, etc.).

[0467] The aforementioned description of one or more aspects has been presented for purposes of illustration and description. This description is not intended to be exhaustive nor to limit the invention to the precise form described. Modifications or variations are possible in light of the above teachings. These aspects have been chosen and described for the purpose of illustrating the principles and practical application and thus enabling the person skilled in the art to use the various aspects and with various modifications as may be convenient for the specific use contemplated. The attached claims are intended to define the overall scope.

Situational awareness

[0468] Situational awareness is the ability of some aspects of a surgical system to determine or infer information related to a surgical procedure from data received from databases and/or instruments. The information may include the type of procedure being performed, the type of tissue being operated on, or the body cavity that is the subject of the procedure. With contextual information related to the surgical procedure, the surgical system can, for example, improve the way in which it controls modular devices (e.g. a robotic arm and/or robotic surgical instrument) that are connected to it and provide information or contextualized suggestions to the surgeon during the course of the surgical procedure.

[0469] Now referring to 87, a timeline 5200 is shown that represents situational awareness of a central controller, such as the central surgical controller 106 or 206, for example. The timeline 5200 is an illustrative surgical procedure and the contextual information that the central surgical controller 106, 206 can derive from the data received from the data sources at each step in the surgical procedure. Timeline 5200 represents the typical steps that would be taken by nurses, surgeons, and other medical personnel during the course of a lung segmentectomy procedure, beginning with setting up the operating room and ending with transferring the patient to an operating room. post-operative recovery.

[0470] The situational awareness of a central surgical controller 106, 206 receives data from data sources throughout the course of the surgical procedure, including data generated each time medical personnel use a modular device that is paired with the central surgical controller 106, 206. The central surgical controller 106, 206 may receive this data from paired modular devices and other data sources and continually derive inferences (i.e., contextual information) about the ongoing procedure as new data is received, such as which step of the procedure is being performed at any given time. The situational awareness system of the central surgical controller 106, 206 is capable of, for example, recording data regarding the procedure to generate reports, verifying the steps being taken by medical personnel, providing data or warnings (e.g., via a display screen). display) that may be pertinent to the specific step of the procedure, adjust modular devices based on context (e.g., activate monitors, adjust the field of view (FOV) of the medical imaging device, or change the power level of a ultrasonic surgical instrument or RF electrosurgical instrument), and take any other action described above.

[0471] In the first step 5202, in this illustrative procedure, hospital staff members retrieve the patient's electronic medical record (EPR) from the hospital's EMR database. Based on the patient selection data in the PEP, the central surgical controller 106, 206 determines that the procedure to be performed is a thoracic procedure.

[0472] In the second step 5204, team members scan the incoming medical supplies for the procedure. The central surgical controller 106, 206 cross-references the scanned supplies with a list of supplies that are used in various types of procedures and confirms that the mix of supplies corresponds to a thoracic procedure. Additionally, the central surgical controller 106, 206 is also capable of determining that the procedure is not a wedge procedure (because the input supplies have an absence of certain supplies that are required for a thoracic wedge procedure or otherwise that input supplies do not correspond to a thoracic wedge procedure).

[0473] In the third step 5206, medical personnel scan the patient's band with a CT scanner that is communicably connected to the central surgical controller 106, 206. The central surgical controller 106, 206 can then confirm the patient's identity based on the scanned data.

[0474] In the fourth step 5208, medical personnel turn on auxiliary equipment. The auxiliary equipment being used may vary depending on the type of surgical procedure and the techniques being used by the surgeon, but in this illustrative case they include a smoke evacuator, an insufflator and a medical imaging device. When activated, auxiliary equipment that is modular devices can automatically pair with the central surgical controller 106, 206 that is located within a specific vicinity of the modular devices as part of its initialization process. The central surgical controller 106, 206 can then derive contextual information about the surgical procedure by detecting the types of modular devices that correspond to it during this pre-operative or initialization phase. In this particular example, the central surgical controller 106, 206 determines that the surgical procedure is a VATS (video-assisted thoracic surgery) procedure based on this specific combination of paired modular devices. Based on a combination of electronic patient record (EPR) data, the list of medical supplies to be used in the procedure, and the type of modular devices that connect to the central controller, the surgical central controller 106, 206 can generally , infer the specific procedure that the surgical team will perform. Once the central surgical controller 106, 206 recognizes which specific procedure is being performed, the central surgical controller 106, 206 can then retrieve the steps of that process from a memory or from the cloud and then cross-reference the data it subsequently receives from the connected data sources (e.g., modular devices and patient monitoring devices) to infer which step of the surgical procedure the surgical team is performing.

[0475] In the fifth step 5210, team members attach electrocardiogram (ECG) electrodes and other patient monitoring devices to the patient. The ECG electrodes and other patient monitoring devices are capable of pairing with the surgical hub controller 106, 206. As the surgical hub controller 106, 206 begins to receive data from the patient monitoring devices, the surgical hub controller 106, 206 This confirms that the patient is in the operating room.

[0476] In the sixth step 5212, medical personnel induced anesthesia in the patient. The surgical hub 106, 206 may infer that the patient is under anesthesia based on data from the modular devices and/or patient monitoring devices, including ECG data, blood pressure data, ventilator data, or combinations thereof. same, for example. After completion of the sixth step 5212, the preoperative portion of the lung segmentectomy procedure is completed and the operative portion begins.

[0477] In the seventh step 5214, the lung of the patient being operated on is retracted (while ventilation is switched to the contralateral lung). The surgical hub controller 106, 206 may infer from the ventilator data that the patient's lung has been retracted, for example. The central surgical controller 106, 206 can infer that the operative portion of the procedure has begun when it can compare the detection of the patient's lung collapse to the expected steps of the procedure (which can be accessed or retrieved previously) and thus determine that the retraction of the lung is the first operative step in this specific procedure.

[0478] In the eighth step 5216, the medical imaging device (e.g., a display device) is inserted and video from the medical imaging device is started. The central surgical controller 106, 206 receives data from the medical imaging device (i.e., video data or images) through its connection to the medical imaging device. Upon receipt of data from the medical imaging device, the central surgical controller 106, 206 may determine that the laparoscopic portion of the surgical procedure has begun. Additionally, the central surgical controller 106, 206 may determine that the specific procedure being performed is a segmentectomy rather than a lobectomy (note that a wedge procedure has already been ruled out by the central surgical controller 106, 206 based on data received in the second procedure step 5204). Data from the medical imaging device 124 (Figure 2) can be used to determine contextual information about the type of procedure being performed in a number of different ways, including by determining the angle at which the medical imaging device is oriented in In relation to viewing the patient's anatomy, monitor the number of medical imaging devices being used (i.e., that are activated and paired with the central surgical controller 106, 206), and monitor the types of visualization devices used. For example, a technique for performing a VATS lobectomy places the camera in the lower anterior corner of the patient's thoracic cavity above the diaphragm, while a technique for performing a VATS segmentectomy places the camera in an anterior intercostal position relative to the fissure of the segment. Using standard recognition or machine learning techniques, for example, the situational recognition system can be trained to recognize the positioning of the medical imaging device according to the visualization of the patient's anatomy. As another example, one technique for performing a VATS lobectomy uses a single medical imaging device, while another technique for performing a VATS segmentectomy uses multiple cameras. As yet another example, a technique for performing a VATS segmentectomy uses an infrared light source (which may be communicably coupled to the central surgical controller as part of the visualization system) to visualize the segment fissure, which is not used in a VATS lobectomy. By tracking any or all of this data from the medical imaging device, the central surgical controller 106, 206 can thus determine the specific type of surgical procedure being performed and/or the technique being used for a specific type of procedure. surgical.

[0479] In the ninth step 5218 of the procedure, the surgical team begins the dissection stage. The central surgical controller 106, 206 can infer that the surgeon is in the process of dissecting to mobilize the patient's lung because it receives data from the RF or ultrasonic generator that indicates that an energy instrument is being fired. The central surgical controller 106, 206 may cross-reference the received data with the retrieved steps of the surgical procedure to determine that a power instrument being fired at that point in the process (i.e., upon completion of the previously discussed steps of the procedure) corresponds to the dissection. In certain cases, the power instrument may be a power tool mounted on a robotic arm of a robotic surgical system.

[0480] In the tenth step 5220 of the procedure, the surgical team proceeds to the bonding step. The central surgical controller 106, 206 can infer that the surgeon is ligating the arteries and veins because it receives data from the surgical stapling and cutting instrument indicating that the instrument is being fired. Similar to the previous step, the central surgical controller 106, 206 can derive this inference by crossing the reception data from the surgical stapling and cutting instrument with the steps retrieved in the process. In certain cases, the surgical instrument may be a surgical tool mounted on a robotic arm of a robotic surgical system.

[0481] In the eleventh step 5222, the segmentectomy portion of the procedure is performed. The central surgical controller 106, 206 can infer that the surgeon is transecting the parenchyma based on data from the surgical cutting and stapling instrument, including data from its cartridge. Cartridge data may correspond to the size or type of staple being fired by the instrument, for example. As different types of staples are used for different types of tissue, the cartridge data can thus indicate the type of tissue being stapled and/or transected. In this case, the type of clamp that is fired is used for parenchyma (or other similar types of tissue), which allows the central surgical controller 106, 206 to infer which segmentectomy portion of the procedure is being performed.

[0482] In the twelfth step 5224, the node dissection step is then performed. The central surgical controller 106, 206 can infer that the surgical team is dissecting the node and performing a leak test based on data received from the generator that indicates which ultrasonic or RF instrument is being fired. For this specific procedure, an RF or ultrasonic instrument being used after the parenchyma has been transected corresponds to the node dissection step, which allows the central surgical controller 106, 206 to make this inference. It should be noted that surgeons regularly switch between surgical stapling/cutting instruments and surgical energy instruments (i.e., RF or ultrasonic) depending on the specific step in the procedure because different instruments are better adapted for specific tasks. Therefore, the specific sequence in which the cutting/stapling instruments and surgical power instruments are used can indicate which step of the procedure the surgeon is performing. Additionally, in certain cases, robotic tools may be used for one or more steps in a surgical procedure and/or handheld surgical instruments may be used for one or more steps in the surgical procedure. The surgeon can switch between robotic tools and handheld surgical instruments and/or can use the devices simultaneously, for example. After completion of the twelfth step 5224, the incisions are closed and the post-operative portion of the process begins.

[0483] In the thirteenth step 5226, the patient's anesthesia is reversed. The surgical hub controller 106, 206 may infer that the patient is emerging from anesthesia based on ventilator data (i.e., the patient's respiratory rate begins to increase), for example.

[0484] Finally, in the fourteenth step 5228 is that medical personnel remove the various patient monitoring devices from the patient. The central surgical controller 106, 206 can thus infer that the patient is being transferred to a recovery room when the central controller loses ECG, blood pressure, and other data from the patient monitoring devices. As can be seen from the description of this illustrative procedure, the central surgical controller 106, 206 can determine or infer when each step of a given surgical procedure is occurring in accordance with data received from the various data sources that are communicably coupled. to the central surgical controller 106, 206.

[0485] Situational awareness is further described in US provisional patent application serial No. 62/611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, which is incorporated herein by reference in its entirety. In certain instances, the operation of a robotic surgical system, including the various robotic surgical systems described herein, for example, may be controlled by the central controller 106, 206 based on its situational awareness and/or feedback from components thereof and/or based on information from cloud 104.

Intelligent surgical stapling safety systems equipped with motor

[0486] Various aspects of the present disclosure are directed to improved safety systems capable of adapting, controlling, and/or adjusting internal drive operations of a surgical instrument in response to tissue parameters detected through one or more of a sensor of the surgical instrument. According to at least one aspect, a force detected, by means of one or more of a sensor, on the jaws of an end actuator may be of a magnitude that prohibits one or more of a subsequent/additional functionality of the end actuator. be carried out. According to another aspect, a metallic object may be detected, by means of one or more of a sensor, such as within the jaws of the end actuator which prohibits one or more of a subsequent/additional functionality of the end actuator from being performed. Figure 88 illustrates a surgical system 23000 comprising a surgical instrument 23002, a central surgical controller 23004, and a user interface 23006. In such an aspect, the surgical instrument 23002 may comprise one or more of one sensor 23008 and the parameters detected by the one or more sensors 23008 of the surgical instrument 23002 may be transmitted/communicated (e.g., wirelessly) to a control circuit 23010 of the central surgical controller 23004. Furthermore, in such an aspect, the central surgical controller 23004 may be configured to determine whether a surgical function (e.g., dissect, clamp, coagulate, staple, cut, rotate, articulate, etc.) associated with a component (e.g., end actuator, drive shaft, etc.) of the surgical instrument 23002 can be performed safely based on parameters detected by one or more of one sensor 23008 of the surgical instrument 23002. Notably, in this regard, the central surgical controller 23004 may be configured to transmit/communicate one or more results (i.e., an associated warning to the surgical function, a reason why the surgical function is impeded, etc.) associated with this determination of the user interface 23006. Additionally, according to various aspects, various user interfaces disclosed herein may comprise a selectable user interface feature (e.g., cancellation element 23012) to proceed with the surgical function despite any warnings and/or reasons supporting prevention. Notably, in such aspects, such a user interface feature (e.g., cancel element 23012) may not be displayed (e.g., performing the surgical function may endanger the patient).

[0487] Referring to Figure 89, in accordance with various aspects of the present description, a surgical system 23100 may comprise a control circuit (23112, 23122, 23132 and/or 23142, e.g., in dashed line to show optional locations) , a user interface (23118, 23128, 23138, 23148 and/or 23158, e.g., in dashed line to show optional locations), and a surgical instrument 23102 including, for example, a handle assembly 23110, a shaft assembly 23110, a drive 23120 and an end actuator assembly 23130. In such aspects, the control circuit may be integrated into one or more than one component (e.g., the handle assembly 23110, the drive shaft assembly 23120 and/or the end actuator assembly 23130, etc.) of the surgical instrument 23102 (e.g., 23112, 23122, 23142, and/or 23132) and/or integrated into a central surgical controller 23140 (e.g., 23142) paired (e.g., without wire) with the surgical instrument 23102. Notably, in various aspects, the surgical instrument 23102 and/or the surgical core controller 23140 may be a situationally aware surgical instrument and/or a situationally aware core surgical controller. Situational awareness refers to the ability of a surgical system, e.g., 23100, to determine or infer information related to a surgical procedure from data received from databases (e.g., historical data associated with a surgical procedure , e.g., 23149 and/or 23150) and/or surgical instruments (e.g., sensor data during a surgical procedure). For example, the determined or inferred information may include the type of procedure being performed, the type of tissue being operated on, the body cavity that is the subject of the procedure, etc. Based on this contextual information related to the surgical procedure, the surgical system may, for example, control a paired surgical instrument 23102 or a component thereof (e.g., 23110, 23120 and/or 23130) and/or provide contextualized information or suggestions to a surgeon throughout the course of the surgical procedure (e.g., via user interface 23118, 23128, 23138, 23148 and/or 23158). Additional details regarding situational awareness can be found, for example, above under the heading "Situational Awareness".

[0488] Also in Figure 89, in accordance with one aspect, a situationally aware surgical core controller 23140 is paired (e.g., wirelessly) with a surgical instrument 23102 being used to perform a surgical procedure. In one such aspect, the surgical instrument 23102 may comprise an end actuator assembly 23130, including a first claw, a second claw pivotally coupled to the first claw, and a sensor 23134 configured to detect a parameter associated with a function (e.g., example, dissecting, holding, coagulating, cutting, stapling, etc.) of the end actuator assembly 23130 and to transmit the sensed parameters to a control circuit 23142 of the central surgical controller 23140.

[0489] Additionally, in such an aspect, the surgical instrument 23102 may further comprise a drive shaft assembly 23120 that includes a sensor 23124 configured to detect a parameter associated with a function (e.g., rotation, articulation, etc.) of the assembly of drive shaft 23120 and to transmit the detected parameter to the control circuit 23142 of the central surgical controller 23140. Notably, it is to be understood that a sensor, as mentioned herein and in other aspects described, may comprise a plurality of sensors configured to detect a plurality of parameters associated with a plurality of end actuator assembly and/or drive shaft assembly functions. Thus, further, in one such aspect, the central surgical controller control circuit 23142 may be configured to receive sensed parameters (e.g., sensor data) from such sensors 23134 and/or 23124 throughout the course of the procedure. surgical.

[0490] A sensed parameter may be received each time an associated end actuator assembly function 23130 (e.g., dissection, grasping, coagulation, cutting, stapling, etc.) and/or a drive shaft assembly function associated 23120 (e.g. rotation, articulation, etc.) is performed. The control circuit of the central surgical controller 23142 may be further configured to receive data from an internal database (e.g., a database from the central surgical controller 23149) and/or an external database (e.g., from from a cloud database 23150) throughout the course of the surgical procedure. In various aspects, data received from internal and/or external databases may comprise procedural data (e.g., steps to perform the surgical procedure) and/or historical data (e.g., data indicating expected parameters based on data history associated with the surgical procedure).

[0491] In various aspects, the procedural data may comprise current/recognized standard of care procedures for the surgical procedure and the historical data may comprise preferred/ideal parameters and/or preferred/ideal parameter ranges based on historical data associated with the procedure surgical (e.g. system-defined constraints). Based on the received data (e.g., sensor data, internal and/or external data, etc.), the control circuitry of the surgical hub 23142 may be configured to continuously derive inferences (e.g., contextual information) about the procedure. surgery in progress. That is, the central surgical controller with situational awareness of the situation can be configured to, for example, record data relating to the surgical procedure to generate reports, verify the steps being taken by the surgeon to perform the surgical procedure, provide data or warnings (e.g., via a user interface associated with the situationally aware central surgical controller and/or the surgical instrument, e.g., 23148, 23158, 23118, 23128, and/or 23138) that may be pertinent to a particular procedural step , control a surgical instrument function, etc. In various aspects, the situationally aware surgical core controller 23140 may (e.g., after an initial surgical function of the end actuator assembly 23130 or drive shaft assembly 23120 is performed) infer a next surgical function to be performed with procedural data base received from an internal database 23149 and/or an external database 23150.

[0492] Additionally, in such an aspect, the situationally aware surgical core controller 23140 may evaluate sensed parameters (e.g., received from sensors 23134 and/or 23124 in response to the initial surgical function) based on historical data received from from the internal database 23149 and/or the external database 23150 (e.g., preferred/optimal parameters). Here, if the detected parameters do not exceed the preferred/ideal parameters and/or are within the respective preferred/ideal parameter ranges, the situationally aware central surgical controller 23140 may allow the next surgical function to be performed and/or not impede/ control that the next surgical function is performed. Alternatively, if the detected parameters exceed the preferred/ideal parameters and/or are not within the respective preferred/ideal parameter ranges, the situationally aware central surgical controller 23140 may proactively prevent execution of the next surgical function.

[0493] In accordance with another aspect of the present disclosure, the situationally aware surgical core controller 23140 may receive a communication (e.g., from a component, e.g., 23130 and/or 23120, of the surgical instrument 23102) that a function specific surgery is being attempted/requested/performed. In such an aspect, the situationally aware central surgical controller 23140 can compare that specific surgical function with an inferred next surgical function to ensure that current/recognized standard of care procedures are being adhered to. If so, the situationally aware central surgical controller 23140 may then evaluate detected parameters (e.g., as described) before allowing the specific surgical function to proceed (as described). Otherwise, the situationally aware central surgical controller 23140 may prevent that specific surgical function from being performed or prevent that specific surgical function from being performed until a cancellation is received (e.g., via a user interface 23, 158, 23148 , 23138, 23128 and/or 23118, see, for example, Figure 88, selectable user interface element 23012). In such an aspect, if the cancellation is received, the situationally aware central surgical controller 23140 may then evaluate detected parameters before allowing the specific surgical function to proceed (as described).

[0494] Again referring to Figure 89, according to another aspect, a situational awareness surgical instrument 23102 may be used to perform a surgical procedure. In such an aspect, the surgical instrument 23102 also includes a handle assembly 23110, a drive shaft assembly 23120, and an end actuator 23130. The end actuator assembly 23130 may include a first claw, a second pivotably coupled claw and to the first claw, and a sensor 23134 configured to detect a parameter associated with a function (e.g., dissect, hold, coagulate, cut, staple, etc.) of the end actuator assembly 23130 and to transmit the detected parameters to a circuit (23112, 23122, 23132 and/or 23142, for example, in dashed line to show optional locations.

[0495] For example, in such an aspect, the detected parameter may be transmitted to a control circuit 23132 of the end actuator assembly 23130. Here, the end actuator assembly of the control circuit 23132 may be configured to receive detected parameters (e.g., sensor data) from sensor 23134 throughout the course of the surgical procedure. A sensed parameter may be received each time an associated function of the 23130 end actuator assembly (e.g., dissection, fixation, coagulation, cutting, stapling, etc.) is performed.

[0496] The end actuator assembly 23130 may be further configured to receive data from an internal database (e.g., a memory of the end actuator 23136) and/or an external database (e.g., a cloud database 23150 via a central surgical controller 23140, a central surgical controller database 23149, etc.) throughout the course of the surgical procedure. In various aspects, the data received from the internal and/or external databases may comprise staple cartridge data (e.g., staple sizes and/or types associated with a staple cartridge positioned in the end actuator assembly). and/or historical data (e.g., data indicating expected tissue and/or staple types to be stapled with the historical data). In various aspects, the data received may comprise preferred/ideal parameters and/or preferred/ideal parameter ranges associated with those staple sizes and/or types or those expected tissues and/or tissue types based on historical data (e.g. example, system-defined constraints). Based on the received data (e.g., sensor data, internal and/or external data, etc.), the end actuator control circuit 23132 may be configured to continuously derive inferences (e.g., contextual information) about the procedure surgery in progress. Notably, according to an alternative aspect, the sensor 23134 of the end actuator assembly 23130 may transmit the detected parameter to a control circuit (e.g., 23112 and/or 23122) associated with another component of the surgical instrument 23102, e.g. , the handle assembly 23110 and/or the drive shaft assembly 23120. In such an aspect, that other surgical instrument component control circuit (e.g., 23112 and/or 23122) may be similarly configured to perform the various aspects of the 23132 end actuator control circuit as described above. Furthermore, in various aspects, the drive shaft assembly 23120 of the surgical instrument 23102 may include a sensor 23124 configured to detect a parameter associated with a function (e.g., rotation, articulation, etc.) of the drive shaft assembly. 23120 and transmitting the detected parameter to a control circuit (e.g., 23112) similarly configured to perform the various aspects of the control circuit of the end actuator 23132 as described above. Ultimately, the situational awareness surgical instrument 23102 may be configured to, for example, alert its user to a discrepancy (e.g., via a user interface 23138 of the end actuator assembly 23130, via a user interface ( e.g. 23128 and/or 23118) from another surgical instrument component 23102, e.g., the drive shaft assembly 23120 and/or the handle assembly 23110 and/or via a user interface 23148 and/or 23158 associated with a central surgical controller 23140 coupled to the surgical instrument 23102). For example, the discrepancy may include a detected parameter that exceeds an ideal/preferred parameter and/or a range of preferred/ideal parameters associated with those staple sizes and/or types or with the expected tissues and/or tissue types. As another example, the situational awareness sound surgical instrument 23102 may be configured to control a discrepancy-based surgical instrument function 23102. According to at least one aspect, the situational awareness surgical instrument 23102 may avoid a surgical function based on a discrepancy.

Functionality control with situational awareness

[0497] As highlighted herein, various aspects of the present disclosure pertain to a surgical instrument that performs a function (e.g., grasping) by detecting a parameter associated with that function, using situational awareness aspects to evaluate, by a control circuit , if that detected parameter is below or exceeds a predefined parameter (e.g. considered ideal/preferred) or is below or exceeds a predefined range (e.g. considered normal) for that parameter and performs an action (e.g. stops a function or more functions, alerts the user, informs the user of possible causes, etc.) in response to the detected parameter being outside the preset parameter and/or preset parameter/range. For example, Figure 90 illustrates an algorithm 23200 for implementing these aspects in which a control circuit receives one or more sensed parameters associated with a surgical function performed by a surgical instrument 23202 and retrieves situational awareness data from an internal database and /or external 23204. The control circuit then evaluates the detected parameter(s) in view of the situational awareness data 23206 and performs an action based on the evaluation 23208.

[0498] In accordance with various aspects of the present disclosure, a detected force (e.g., through one or more than one sensor) on the jaws of an end actuator assembly may be of a magnitude that prohibits one or more than one subsequent/additional functionality of the end actuator assembly is performed. For example, referring back to Figure 12, force may be detected by means of sensors 474, 476 and/or 478. In one such aspect, sensor 474 may be a strain gauge coupled to the end actuator with the gauge being strain gauge is configured to measure the magnitude/amplitude of strain on one or more end actuator jaws, which is indicative of closing forces being applied to the jaws. Additionally, in such an aspect, sensor 476 may be a load sensor configured to measure a closing force applied to the grippers by a closing drive system. Still further, in one such aspect, sensor 478 may be a current sensor configured to measure a current drawn by the motor, which correlates to a closing force applied to the grippers. In addition to or as another example, referring back to Figure 17, force can be detected by means of sensors 744a and/or 744b. In one such aspect, sensor 744a and/or 744b may be a torque sensor configured to provide a trigger force feedback signal that represents the closing force being applied to the jaws by the closing drive system.

[0499] In one aspect, referring back to Figure 58, a load sensor 152082 (e.g., positioned on the drive shaft assembly or the handle assembly) may be configured to detect a load, after attaching the drive shaft to the grip assembly. In such an aspect, the detected load may exceed a predefined load and/or a predefined load range. In such an aspect, with reference to Figure 89, for example, a control circuit associated with the surgical instrument (e.g., integrated into a component of the surgical instrument 23132, 23122, and/or 23112 or a central surgical controller 23142 coupled) may assess that it has detected load and determine, with the use of situational awareness (e.g., based on historical data), that the drive shaft assembly and/or end actuator assembly is/is expected to be damaged. In this aspect, the control circuit may be configured to record a unique identifier associated with the drive shaft assembly 23120 and/or the end actuator assembly 23130 and designate this unique identifier as prohibited from further use and/or attachment to the grip assembly 23110.

[0500] In another aspect, with reference to Figure 89, for example, a control circuit associated with the surgical instrument (e.g., integrated into a surgical instrument component 23132, 23122, and/or 23112 or a central surgical controller 23142 coupled) may be configured to evaluate a detected force on the grippers (e.g., through one or more than one sensor as described) and determine the impediment of a function/trigger cycle of the end actuator assembly. In particular, the control circuit may determine, with the use of situational awareness (e.g., based on historical data), that the force detected on the grippers (e.g., detected before a function/trigger cycle begins) exceeds a predefined force and/or a predefined force range. In this regard, the control circuit can be configured to prevent the trigger function/cycle from starting. Furthermore, in such an aspect, again with reference to Figure 89, the control circuit may be configured to alert the user (e.g., via a user interface of a component of the surgical instrument 23138, 23128 and/or 23118 and/or or a user interface associated with a central surgical controller 23148 and/or 23158) that the function/trigger cycle cannot be performed and/or inform the user of possible causes (e.g., so that the user can attempt to reduce the force detected in the grippers). According to various aspects, the control circuit may be configured to allow the trigger function/cycle to begin if the force detected on the grippers is reduced to the preset force and/or within the preset force range.

[0501] In another aspect, with reference to Figure 89, for example, a control circuit associated with the surgical instrument (e.g., integrated into a surgical instrument component 23132, 23122, and/or 23112 or a central surgical controller 23142 coupled) can evaluate a detected force on the grippers (e.g. via one or more than one sensor, e.g. load sensor, a torque sensor, etc. as described) and initially determine whether to allow a function/trigger cycle of the end actuator assembly. However, after the trigger function/cycle has begun, the control circuit may determine, with the use of situational awareness (e.g., based on historical data), that a force to trip (e.g., detected during the function /firing cycle) exceeds a predefined force for firing and/or a predefined force range for firing. In such an aspect, the control circuit may be configured to interrupt the trigger function/cycle (e.g., prevent the trigger function/cycle from continuing). Furthermore, in such an aspect, again with reference to Figure 89, the control circuit may be configured to provide an alert to the surgeon (e.g., via a user interface of a component of the surgical instrument 23138, 23128 and/or 23118 and/or a user interface associated with a central surgical controller 23148 and/or 23158) regarding the trigger force or trigger force range exceeded. In various aspects, the control circuit may be further configured to receive a cancel command (e.g., via user interface(s), see, e.g., Figure 88, selectable user interface element 23012) to allow the trigger function/cycle to continue. In this regard, the control circuit may determine, with the use of situational awareness (e.g., based on historical data), that a second trigger force (e.g., detected during the continued firing function/cycle) exceeds a second preset force for triggering and/or a second predefined force range for triggering (e.g. higher limits). In such an aspect, the control circuit may be configured to prevent the function/trigger cycle again, alert the surgeon, and/or receive a cancel command as described.

[0502] In another aspect, with reference to Figure 89, for example, a control circuit associated with the surgical instrument (e.g., integrated into a surgical instrument component 23132, 23122, and/or 23112 or a central surgical controller 23142 coupled) can evaluate a force detected on the grippers (e.g., through one or more than one sensor as described). Furthermore, the control circuit may additionally evaluate a force detected within the drive shaft assembly (i.e., through one or more than one sensor as described). Here, in various respects, the control circuit may cross-reference the force detected in the grippers and/or the force detected within the drive shaft assembly with the surgical procedure being performed. In this regard, the control circuit may determine, using situational awareness (e.g., based on procedural and/or historical data), that the detected force within the drive shaft assembly exceeds a predefined drive shaft force. and/or a predefined drive shaft force range. In one example, the drive shaft assembly may comprise a specialized drive shaft assembly configured for use with a specific tissue type in a specific surgical procedure. In this regard, the control circuit may determine, using situational awareness (e.g., based on procedural and/or historical data), that the detected force on the specialized drive shaft assembly is too high (e.g., exceeds the force predefined drive shaft force range and/or the predefined drive shaft force range associated with the specialized drive shaft assembly) and/or that the force detected at the grippers is not a predefined force and/or within a predefined range (e.g. example, an expected force historically associated with the surgical procedure being performed). In such an aspect, the control circuit may be configured to interrupt a trigger function/cycle (e.g., prevent the trigger function/cycle from starting and/or continuing). Furthermore, in such an aspect, again with reference to Figure 89, the control circuit may be configured to provide an alert to the surgeon (e.g., via a user interface of a component of the surgical instrument 23138, 23128 and/or 23118 and/or a user interface associated with a central surgical controller 23148 and/or 23158) regarding the drive shaft force and/or the drive shaft range exceeded. In several respects, the alert may inform the surgeon to consider removing the specialized drive shaft assembly, e.g., 23120, the 23110 grip assembly, and attaching another drive shaft assembly (e.g., a regular reload configured for the forces detected and the tissue being encountered) to the grip assembly 23110. In this regard, the control circuit may be configured to allow the firing function/cycle to begin and/or continue when a suitable drive shaft assembly is attached.

[0503] In another aspect, with reference to Figure 89, for example, a control circuit associated with the surgical instrument (e.g., integrated into a surgical instrument component 23132, 23122, and/or 23112 or a central surgical controller 23142 coupled) can evaluate a force detected on the grippers (e.g., through one or more than one sensor as described) during a surgical procedure. Accordingly, the control circuit may determine, with the use of situational awareness (e.g., based on procedural and/or historical data), that a tissue creep dwell time is below a tissue creep dwell time. predefined creep rate and/or predefined creep waiting time interval associated with a specific thickness and specific tissue being clamped during the surgical procedure. Stated another way, in light of Figure 83 and 84 in the present invention, an initial closing force may have decayed and achieved creep stability at a lower closing force faster than expected. In such an aspect, the control circuit may be configured to interrupt a trigger function/cycle (e.g., prevent the trigger function/cycle from starting and/or continuing). Furthermore, in such an aspect, again with reference to Figure 89, the control circuit may be configured to provide an alert to the surgeon (e.g., via a user interface of a component of the surgical instrument 23138, 23128 and/or 23118 and/or a user interface associated with a central surgical controller 23148 and/or 23158) with respect to the abbreviated creep wait time. In several respects, the alert may inform the surgeon to consider removing the end actuator assembly, e.g., 23130 from the grip assembly, and attaching another end actuator assembly (e.g., an end actuator assembly configured to treat fabrics that have the creep hold time detected) to the handle assembly 23110. In this regard, the control circuit may be configured to allow the trigger function/cycle to begin and/or continue when an end actuator assembly suitable is fixed.

[0504] In another aspect, with reference to Figure 89, for example, a control circuit associated with the surgical instrument (e.g., integrated into a surgical instrument component 23132, 23122, and/or 23112 or a central surgical controller 23142 coupled) can evaluate a force detected on the grippers (e.g., through one or more than one sensor as described). Furthermore, the control circuit may additionally evaluate a position detected by an articulating member (i.e., through one or more than one sensor). For example, referring back to Figure 12, position can be detected by sensor 472 coupled to the pivot member. In one aspect, sensor 472 may be a position sensor configured to measure linear displacement, wherein a single rotation of a sensor element corresponds to a specific linear displacement of the pivot member. In another example, referring back to Figure 17, position can be detected by position sensor 734 located in the end actuator. Here, position sensor 734 may be a proximity sensor or a sensor configured to provide a series of pulses trackable by the control circuit to determine a position of the pivot member. Here, in various respects, the control circuit may cross-reference the detected force on the claws and/or the detected position within the articulating member with the surgical procedure being performed. According to this aspect, the control circuit may determine, with the use of situational awareness (e.g., based on procedural and/or historical data), that the detected position for the articulating member indicates that the articulating member has forward (e.g., within the drive shaft assembly) beyond a predetermined feed position and/or a predetermined feed position range. In various aspects, the predetermined feed position and/or the predetermined feed position range may be correlated to the closing force detected in the jaws. In such an aspect, with the designated predetermined feed position exceeded, the control circuit may be configured to interrupt a trigger function/cycle (e.g., prevent the trigger function/cycle from starting and/or continuing). Furthermore, in such an aspect, again with reference to Figure 89, the control circuit may be configured to provide an alert to the surgeon (e.g., via a user interface of a component of the surgical instrument 23138, 23128 and/or 23118 and/or a user interface associated with a central surgical controller 23148 and/or 23158) with respect to the predetermined advancement position and/or the predetermined advancement position range exceeded. In several respects, the alert may inform the surgeon to consider retracting the hinge member to the predetermined advancement position and/or the predetermined advancement position range. Here, in an example, the predetermined advance position and/or the predetermined advance position range may have historically realized and/or desired functions/trigger cycles suitable for the corresponding closing force. In this regard, the control circuit may be configured to allow the trigger function/cycle to begin and/or continue when a suitable forward position is reached.

[0505] In another aspect, with reference to Figure 89, for example, a control circuit associated with the surgical instrument (e.g., integrated into a surgical instrument component 23132, 23122, and/or 23112 or a central surgical controller 23142 coupled) can evaluate a force detected on the grippers (e.g., through one or more than one sensor as described) during a surgical procedure. According to this aspect, the control circuit may determine, with the use of situational awareness (e.g., based on procedural and/or historical data), that a closing force is above a predefined closing force range and /or a predefined closing force associated with a specific tissue being clamped during the surgical procedure. Put another way, in light of Figures 83 and 84 in the present invention, the force detected for closing is greater than expected to allow a function/trigger cycle to proceed. In such an aspect, the control circuit may be configured to interrupt a trigger function/cycle (e.g., prevent the trigger function/cycle from starting and/or continuing). Furthermore, in such an aspect, again with reference to Figure 89, the control circuit may be configured to provide an alert to the surgeon (e.g., via a user interface of a component of the surgical instrument 23138, 23128 and/or 23118 and/or a user interface associated with a central surgical controller 23148 and/or 23158) in relation to the high closing force. In several respects, the alert may inform the surgeon to consider adjusting a firing motor speed. In one example, if the specific tissue is rigid tissue, the alert may suggest that the surgeon adjust the trigger motor speed downward to prevent tearing of the rigid tissue. In such an aspect, downward adjustment may be based on historical data associated with the surgical procedure being performed. In another example, if the specific tissue is tissue with weak shear strength, the alert may suggest that the surgeon adjust the speed of the firing motor to ensure that the tissue is adequately clamped. In such an aspect, the upward adjustment may be based on historical data associated with the surgical procedure being performed. In such aspects, the control circuit may be configured to allow the trigger function/cycle to initiate and/or continue when a suitable trigger motor speed is set.

[0506] In another aspect, with reference to Figure 89, for example, a control circuit associated with the surgical instrument (e.g., integrated into a surgical instrument component 23132, 23122, and/or 23112 or a central surgical controller 23142 coupled) can evaluate a force detected on the grippers (e.g., through one or more than one sensor as described) during a surgical procedure. According to this aspect, the control circuit may determine, with the use of situational awareness (e.g., based on procedural and/or historical data), that a cyclic force on the firing system is above a predefined cyclic force. and/or a predefined cyclic force range during the surgical procedure. In other words, the detected cyclic force is greater than expected and may be indicative of imminent engine failure based on historical data. In such an aspect, the control circuit may be configured to interrupt a trigger function/cycle (e.g., prevent the trigger function/cycle from starting and/or continuing). Furthermore, in such an aspect, again with reference to Figure 89, the control circuit may be configured to provide an alert to the surgeon (e.g., via a user interface of a component of the surgical instrument 23138, 23128 and/or 23118 and/or a user interface associated with a central surgical controller 23148 and/or 23158) regarding high cyclic force and possible engine failure. In various aspects, the control circuit may be further configured to receive a cancel command (e.g., via the user interface, see, e.g., Figure 88, selectable user interface element 23012) to allow the function/trigger cycle continue. In this regard, the control circuit may continue to monitor whether the cyclic force on the firing system is above a predefined cyclic force and/or a predefined cyclic force range during the surgical procedure. In such an aspect, the control circuit may be configured to prevent the function/trigger cycle again, alert the surgeon, and/or receive a cancel command as described.

[0507] According to another aspect of the present description, with reference to Figure 89, for example, a control circuit associated with the surgical instrument (e.g., integrated into a component of the surgical instrument 23132, 23122, and/or 23112 or a coupled central surgical controller 23142) may evaluate a detected force on the grippers (e.g., via one or more than one sensor as described). Furthermore, the control circuit may additionally evaluate a force/torque to pivot the end actuator assembly 23130. In such an aspect, the pivot force/torque may be detected by means of one or more than one sensor (e.g., a force sensor associated with a pivot member, a torque sensor associated with the pivot member, a Current sensor associated with a motor configured to drive the pivot member, etc.). For example, referring again to Figure 17, linkage force/torque may be detected by torque sensors 744d and/or 744e coupled to a linkage drive system. In addition to and/or alternatively, again with reference to Figure 17, the pivot force/torque may be correlated to a current drawn by motors 704d and/or 704e as measured by sensor 736. Here, in various respects, the circuit control system may cross-reference the force detected in the grippers and/or the joint force/torque detected within the articulating member with the surgical procedure being performed. According to this aspect, the control circuit may determine, using situational awareness (e.g., based on procedural and/or historical data), that the detected joint force/torque for the joint member exceeds a force/torque of predefined joint and/or a predefined joint force/torque range. In various aspects, the predefined joint force/torque and/or the predefined joint force/torque range can be correlated to the force detected in the grippers. In such an aspect, with a designated joint torque force exceeded, the control circuit may be configured to stop the joints of the end actuator assembly (e.g., to prevent the joints from continuing). Furthermore, in such an aspect, again with reference to Figure 89, the control circuit may be configured to provide an alert to the surgeon (e.g., via a user interface of a component of the surgical instrument 23138, 23128 and/or 23118 and/or a user interface associated with a central surgical controller 23148 and/or 23158) with respect to the exceeded joint force/torque and/or the exceeded joint force/torque range. In various aspects, the control circuit may be further configured to receive a cancel command (e.g., via the user interface, see, e.g., Figure 88, selectable user interface element 23012) to allow the articulation continue. In this regard, the control circuit may continue to monitor whether the joint force/torque is above the preset joint force/torque and/or the preset joint force/torque range during the surgical procedure. In such an aspect, the control circuit may be configured to prevent rejoining, alert the surgeon, and/or receive a cancel command as described.

[0508] According to yet another aspect of the present description, with reference to Figure 89, for example, a control circuit associated with the surgical instrument (e.g., integrated into a component of the surgical instrument 23132, 23122, and/or 23112 or a coupled central surgical controller 23142) may evaluate a detected force on the grippers (e.g., via one or more than one sensor as described). Furthermore, the control circuit may additionally evaluate a force/torque to rotate the drive shaft assembly 23120 (e.g., drive shaft member). In such an aspect, the rotational force/torque may be detected by means of one or more of a sensor (e.g., a force sensor associated with a drive/rotational shaft member, a torque sensor associated with the drive/rotation shaft, a current sensor associated with a motor configured to rotate the drive/rotation shaft member, etc.). For example, referring back to Figure 17, rotational force/torque can be detected by torque sensor 744c coupled to a drive system of the drive/rotation shaft member. In addition to and/or alternatively, again with reference to Figure 17, the rotational force/torque may be correlated to a current drawn by motor 704c as measured by sensor 736. Here, in various respects, the control circuit may do cross-reference the force detected on the grippers and/or the rotational force/torque detected within the drive/rotation shaft member with the surgical procedure being performed. According to this aspect, the control circuit may determine, using situational awareness (e.g., based on procedural and/or historical data), that the detected rotational force/torque for the drive/rotation shaft member exceeds a predefined rotation force/torque and/or a predefined rotation force/torque range. In various aspects, the predefined rotational force/torque and/or the predefined rotational force/torque range can be correlated to the force detected on the grippers. In other aspects, the predefined rotational force/torque and/or the predefined rotational force/torque range may correspond to a force/torsion that the drive/rotation shaft member itself is capable of withstanding. In such an aspect, with a designated rotation torque force exceeded, the control circuit may be configured to stop rotation of the end actuator assembly (e.g., to prevent rotations of the drive/rotation shaft member from continuing). . Furthermore, in such an aspect, again with reference to Figure 89, the control circuit may be configured to provide an alert to the surgeon (e.g., via a user interface of a component of the surgical instrument 23138, 23128 and/or 23118 and/or a user interface associated with a central surgical controller 23148 and/or 23158) with respect to the exceeded rotational force/torque and/or the exceeded rotational force/torque range. In various aspects, the control circuit may be further configured to receive a cancel command (e.g., via the user interface, see, e.g., Figure 88, selectable user interface element 23012) to allow the rotation continue. In this regard, the control circuit may continue to monitor whether the rotational force/torque is above the preset rotational force/torque and/or the preset rotational force/torque range during the surgical procedure. In such an aspect, the control circuit may be configured to prevent rotation again, alert the surgeon, and/or receive a cancel command as described.

[0509] In accordance with yet another aspect of the present description, with reference to Figure 89, for example, a control circuit associated with the surgical instrument (e.g., integrated into a component of the surgical instrument 23132, 23122, and/or 23112 or a coupled central surgical controller 23142) may be configured to evaluate a detected opening force on the jaws (e.g., via one or more than one sensor as described) and determine whether to prevent opening of the jaws. In particular, the control circuit may determine, using situational awareness (e.g., based on historical data), that the detected opening force on the grippers exceeds a predefined opening force and/or an opening force range. preset. In such an aspect, the control circuit may be configured to maintain the grippers in a clamped or partially clamped position. Furthermore, in such an aspect, again with reference to Figure 89, the control circuit may be configured to alert the user (e.g., via a user interface of a component of the surgical instrument 23138, 23128 and/or 23118 and/or or a user interface associated with a central surgical controller 23148 and/or 23158) that the jaws cannot be opened and/or informs the user of possible causes (e.g., so that the user can attempt to reduce the opening force detected in the claws). In various aspects, the control circuit may be configured to allow the jaws to open if the detected opening force on the jaws is reduced to the preset opening force and/or within the preset opening force range.

Short detection and functionality control

[0510] According to various other aspects of the present disclosure, the functionality of a surgical instrument can be controlled based on one or more of a sensor configured to detect a short. That is, if a metallic object is detected within the claws, at least one function/performance of the surgical instrument (e.g. cutting, coagulation, etc.) can be prevented/prohibited. For example, Figure 91 illustrates an algorithm 23300 for implementing such aspects in which a control circuit receives one or more detected parameters indicative of a short circuit 23302. The control circuit may also retrieve data from the internal database and/or external 23304. The control circuit then evaluates the detected parameter or parameters and/or the data from the database 23306 and performs an action based on the evaluation 23308.

[0511] Referring again to Figure 89, in accordance with various aspects of the present description, a surgical system 23100 may comprise a control circuit (23112, 23122, 23132 and/or 23142, e.g., in dashed line to show optional locations ), a user interface (23118, 23128, 23138, 23148 and/or 23158, e.g., in dashed line to show optional locations), and a surgical instrument 23100 including, for example, a handle assembly 23110, a shaft assembly drive assembly 23120 and an end actuator assembly 23130. In such aspects, the control circuit may be integrated into one or more than one component (e.g., the handle assembly 23110, the drive shaft assembly 23120 and/or the end actuator assembly 23130, etc.) of the surgical instrument 23102 (e.g., 23112, 23122, 23142, and/or 23132) and/or integrated into a paired central surgical controller 23140 (e.g., 23142) (e.g., wireless) with the surgical instrument 23102. In these aspects, the end actuator assembly 23130 may include a first claw, a second claw pivotally coupled to the first claw, and a sensor 23134 configured to detect a parameter associated with a function ( e.g., dissecting, holding, coagulating, cutting, stapling, etc.) of the end actuator assembly 23130 and to transmit the detected parameter to a control circuit (e.g., 23112, 23122, 23132, and/or 23142). In various aspects, the first gripper may comprise a fixed gripper and the second gripper may comprise an elongated channel configured to receive a staple cartridge. Additionally, in such an aspect, the surgical instrument 23102 may further comprise a drive shaft assembly 23120 that includes a sensor 23124 configured to detect a parameter associated with a function (e.g., rotation, articulation, etc.) of the drive shaft assembly. drive 23120 and to transmit the detected parameter to the control circuit (e.g., 23112, 23122, 23132, and/or 23142). In such aspects, the control circuit may be configured to receive detected parameters (e.g., sensor data) from such sensors, e.g., 23134 and/or 23124, throughout the course of a surgical procedure. A detected parameter may be received each time an associated end actuator assembly function 23130 (e.g., dissection, grasping, coagulation, cutting, stapling, etc.) and/or an associated drive shaft assembly function 23120 ( e.g. rotation, articulation, etc.) is performed. The control circuit may be further configured to receive data from an internal database (e.g., in the memory of a surgical instrument component 23136, 23126 and/or 23116 or a central surgical controller database 23149) and/or an external database (e.g., from a central surgical controller database 23149, a cloud database 23150, etc.) throughout the surgical procedure. In various aspects, data received from internal and/or external databases may comprise procedural data (e.g., steps to perform the surgical procedure) and/or historical data (e.g., data indicating expected parameters based on data history associated with the surgical procedure). In various respects, the procedural data may comprise current/recognized standard of care procedures for the surgical procedure and the historical data may comprise preferred/ideal parameters and/or preferred/ideal parameter ranges based on historical data associated with the surgical procedure (e.g. example, system-defined constraints). Based on the received data (e.g., sensor data, internal and/or external data, etc.), the control circuit (e.g., 23112, 23122, 23132, and/or 23142) can be configured to continually derive inferences (e.g. contextual information) about the ongoing procedure. That is, the surgical instrument may be configured to, for example, record data regarding the surgical procedure to generate reports, verify the steps being taken by the surgeon to perform the surgical procedure, provide data or warnings (e.g., through a user interface associated with the central surgical controller 23148 and/or 23158 and/or the surgical instrument 23138, 23128, and/or 23118) that may be pertinent to a certain procedural step, controlling a function of the surgical instrument 23102, etc.

[0512] Again with reference to Figure 89, in one aspect, during and/or after grasping target tissue between the jaws of the end actuator assembly, the control circuit (23112, 23122, 23132 and/or 23142) may be configured to, before enabling a subsequent function (e.g. triggering, coagulation, etc.), check continuity between the jaws. Here, in various aspects, the surgical instrument may comprise an electrosurgical instrument comprising an electrode in at least one of the claws (e.g., integrated into the anvil and/or staple cartridge). In such aspects, if a short exists between the electrodes, it may be difficult to treat tissue trapped between the claws with electrosurgical energy (e.g., RF energy). In one example, a conductive object (e.g., a clip, clamp, metal element, etc.) between the electrodes can result in continuity between the claws. In another example, if sufficient space does not exist between the claws (e.g., after clamping the target tissue) the electrodes may touch resulting in continuity between the claws. Again referring to Figure 53, for example, in one aspect of the present disclosure the sensor 152008a is configured to measure a Gap between the jaws of the end actuator. In one such aspect, the sensor 152008a of the first claw may comprise a Hall effect sensor configured to detect a magnetic field generated by the magnet 152012 of the second claw to measure the gap between the first claw and the second claw. Notably, the gap may be representative of the thickness of the tissue trapped between the first claw and the second claw. Here, if there is continuity between the claws, an undesirable surgical outcome may result (e.g., incomplete tissue treatment, excessive heating of the conductive object, etc.).

[0513] According to one aspect (e.g., bipolar mode), the first gripper may comprise a fixed gripper and the second gripper may comprise an elongated channel configured to receive a staple cartridge, as is shown in Figure 25. In an For example, the staple cartridge may comprise an active electrode for delivering electrosurgical energy (e.g., RF energy) to the clamped tissue and at least a portion of the anvil may act as a return electrode. In another example, the anvil may comprise an active electrode for delivering electrosurgical energy (e.g., RF energy) to the trapped tissue and at least a portion of the elongated channel may act as a return electrode. According to another aspect (e.g., monopolar mode), the first gripper may comprise a fixed gripper and the second gripper may comprise an elongated channel configured to receive a staple cartridge. In one example, the staple cartridge may comprise an active electrode for delivering electrosurgical energy (e.g., RF energy) to the clamped tissue and a return electrode (e.g., grounding plate) may be separately located on the patient's body. In another example, the anvil may comprise an active electrode for delivering electrosurgical energy (e.g., RF energy) to the trapped tissue and a return electrode (e.g., grounding plate) may be separately located on the patient's body. Various configurations for detecting short circuits are described in US Patent No. 9,554,854, entitled DETECTING SHORT CIRCUITS IN ELECTROSURGICAL MEDICAL DEVICES, the description of which is incorporated herein by reference.

[0514] Again with reference to Figure 89, in various aspects, the control circuit (23112, 23122, 23132 and/or 23142) may be configured to check continuity in various ways. In one aspect, a generator that produces the electrosurgical energy and/or a sensor, e.g., 23134, integrated into the surgical instrument may be configured to detect when the impedance between the electrodes falls below a threshold value for a time-out period ( i.e. impedance drops which indicates a short). Here, again with reference to Figure 48, the sensor, for example 23134, can be configured to measure impedance over time. In one example, when electrodes encounter a line of conductive clamps, current may rise, while impedance and voltage drop sharply. In another example, continuity may present itself as a current collector with minimal voltage changes. Various alternative methods for checking continuity/detecting a short, such as those described in US Patent No. 9,554,854, entitled DETECTING SHORT CIRCUITS IN ELECTROSURGICAL MEDICAL DEVICES, are expressly incorporated herein by reference (e.g., comparing impedance values in different positions within a pulse of a series of pulses).

[0515] In such aspects, if continuity is detected, a conductive object (e.g., a clip, a staple, a line of staples, a metal element, etc.) may be present/exposed in the tissue held between the claws. Notably, such a conductive object may be from the current surgical procedure and/or a previous surgical procedure. In such an aspect, the control circuit may be configured to provide an alert to the surgeon (e.g., via a user interface of a component of the surgical instrument 23138, 23128 and/or 23118 and/or a user interface associated with a central surgical controller 23148 and/or 23158) in relation to detection of the conductive object. For example, the alert may suggest that the surgeon reposition the 23130 tip actuator assembly so that the electrodes are not in contact with any conductive object and/or remove the conductive object causing the short circuit. In various aspects, the control circuit may be further configured to receive a cancel command (e.g., via the user interface, see, e.g., Figure 88, selectable user interface element 23012) to enable the function (e.g., cutting, coagulation, etc.) despite detection of the conductive object (e.g., clip, clamp, staple line, metal element, etc.).

[0516] According to one aspect, the control circuit (23112, 23122, 23132 and/or 23142) may be configured to check continuity to prevent clip transection. In such an aspect, after a short is detected, the control circuit may be configured to provide an alert to the surgeon (e.g., via a user interface of a component of the surgical instrument 23138, 23128 and/or 23118 and/or a user interface associated with a central surgical controller 23148 and/or 23158) in relation to detecting a conductive object between the jaws. In one aspect, the surgeon can adjust the sensitivity of the control circuit through a user interface (e.g., an interactive user interface element on the surgical instrument, the central surgical controller, a generator, etc.). In such an aspect, based on the adjustment, the control circuit can be configured to prevent triggering if a conductive object is detected between the claws.

[0517] Again referring to Figure 89, according to another aspect, the control circuit 23142 may be integrated into a central surgical controller 23140 paired (e.g., wirelessly) with the electrosurgical instrument 23102. In such an aspect, the surgical cube 23140 can be preloaded with surgeon/user settings regarding the detection of a conductive object between the jaws. In one example, a surgeon/user configuration comprises avoiding firing if a conductive object is detected between the claws. In another example, a surgeon/user configuration comprises warning before allowing firing if a conductive object is detected between the jaws. In yet another aspect, a surgeon/user configuration comprises allowing the surgeon/user to cancel an alert. In yet another aspect, a surgeon/user configuration comprises a temporary reset that allows the surgeon/user to remedy the situation (e.g., move the claws, remove the conductive object) before rechecking continuity.

[0518] Again referring to Figure 89, in accordance with yet another aspect, the control circuit (23112, 23122, 23132 and/or 23142) may be configured to check continuity for deliberately crossing a clamp line. Here, in some surgical procedures, it may be beneficial to have crossing staple lines to ensure a contiguous transection (e.g., lung resections, especially multi-angle wedges, sleeve procedures, etc.). In one such aspect, after continuity is detected, the control circuit may be configured to provide an alert (e.g., audible and/or visual) to the surgeon (e.g., via a user interface of a component of the instrument). surgical 23138, 23128, and/or 23118 and/or a user interface associated with a central surgical controller 23148 and/or 23158) in relation to detecting a conductive object (e.g., line of existing staples) between the jaws.

[0519] Again with reference to Figure 89, according to other aspects, the control circuit (23112, 23122, 23132 and/or 23142) may be configured to receive data from an internal database (e.g., in memory a surgical instrument component 23136, 23126 and/or 23116 or a central surgical controller database 23149) and/or an external database (e.g., from a central surgical controller database 23149, a database in cloud 23150, etc.) throughout the surgical procedure. According to various aspects, data received from internal and/or external databases may comprise surgical history data (e.g., data on previous surgical procedures performed on the patient, data on the current surgical procedure, etc.). In an example, surgical history data may indicate that staples were used in a previous surgery and/or where staples were used, and current surgical procedure data may indicate whether a clip applicator was used to apply clips. Based on the received data (e.g., surgical history data, etc.), the control circuit (23112, 23122, 23132, and/or 23142) may be configured to continuously derive inferences (e.g., contextual information) about the procedure being performed. course. That is, the surgical instrument 23120 may be aware of the situation and may be configured to, for example, infer/determine that a detected continuity may be a clip line from a previous surgical procedure or a clip from the current surgical procedure. As another example, if the patient has never had a surgical procedure performed, a clip applicator has not been used in the current surgical procedure, and a clip cartridge has been fired in the current surgical procedure, the control circuit may be configured to infer/determine that the object Conductor detected between the claws is a previous clamp line. As another example, if the patient has never had a surgical procedure, a clip applicator has been used in the current procedure, and no staple cartridge has yet been fired in the current surgical procedure, the control circuit can be configured to infer/determine that the conductive object detected between the claws is a clip.

Examples

[0520] Various aspects of the subject matter described herein under the heading "SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING" are defined in the following Examples:

[0521] Example 1 - A surgical system comprises a control circuit and a surgical instrument. The surgical instrument comprises a handle assembly, a drive shaft assembly extending distally from the handle assembly, and an end actuator assembly coupled to a distal end of the drive shaft assembly. The end actuator assembly comprises a first claw, a second claw pivotally coupled to the first claw, and a sensor. The sensor is configured to detect a parameter associated with an end actuator function and transmit the detected parameter to the control circuit. The control circuit is configured to analyze the detected parameter based on a system-defined constraint and prevent at least one function of the surgical instrument based on the result of the analysis. The surgical system further comprises a user interface configured to provide a current state regarding at least one prevented function of the surgical instrument.

[0522] Example 2 - The surgical system of Example 1, wherein the constraint defined by the system comprises at least one of a predefined parameter or a range of predefined parameters based on historical data associated with a surgical procedure being performed by the surgical system.

[0523] Example 3 - The surgical system of Example 1 or 2, wherein the current state comprises a first message that the at least one function of the surgical instrument is prevented and a second message indicating a reason why the at least one function is prevented. of the surgical instrument is prevented.

[0524] Example 4 - The surgical system of Examples 1, 2 or 3, wherein the user interface comprises a user interface element selectable to override the control circuit to enable at least one function of the surgical instrument.

[0525] Example 5 - The surgical system of Examples 1, 2, 3 or 4, wherein the sensor comprises a force sensor coupled to the end actuator, wherein the detected parameter comprises a force applied to at least one of the first claw or second claw of the end actuator, and wherein the at least one function prevented through the control circuit comprises one or more than one to prevent the use of a connected drive shaft, preventing the initiation of a firing cycle, preventing the end actuator pivot, preventing rotation of the drive shaft or preventing one or more of the first claw or second claw from opening.

[0526] Example 6 - The surgical system of Examples 1, 2, 3, 4 or 5, wherein the function of the end actuator associated with the detected parameter comprises a clamping function and wherein the at least one function of the surgical instrument is prevented through the control circuit comprises one or more of a dissection function, a coagulation function, a clamp function or a cutting function.

[0527] Example 7 - The surgical system of Examples 1, 2, 3, 4, 5 or 6, further comprising a central surgical controller communicatively coupled to the surgical instrument, the central surgical controller comprising the control circuit.

[0528] Example 8 - The surgical system of Example 7, one of the handle assembly or the central surgical controller comprising the user interface.

[0529] Example 9 - The surgical system of Examples 1, 2, 3, 4, 5, 6, 7 or 8, wherein one of the handle assemblies, drive shaft assembly or end actuator assembly of the surgical instrument comprises the control circuit.

[0530] Example 10 - The surgical system of Example 1, 2, 3, 4, 5, 6, 7, 8 or 9, wherein the drive shaft assembly comprises a sensor configured to detect an associated drive shaft parameter to an axis function and transmit the detected drive axis parameter to the control circuit. The control circuit is further configured to prevent the at least one function of the surgical instrument further based on the detected drive axis parameter.

[0531] Example 11 - A surgical system comprises a central surgical controller and a surgical instrument communicatively coupled to the central surgical controller. The surgical instrument comprises a handle assembly, a drive shaft assembly extending distally from the handle assembly, and an end actuator assembly coupled to a distal end of the drive shaft assembly. The end actuator assembly comprises a first claw, a second claw pivotally coupled to the first claw, and a sensor. The sensor is configured to detect a parameter associated with an end actuator function and transmit the detected parameter to the central surgical controller. The central surgical controller comprises a processor and memory coupled to the processor. The memory stores instructions executable by the processor to analyze the detected parameter based on a system-defined constraint and prevent at least one function of the surgical instrument based on an analysis result. The surgical system further comprises a user interface configured to provide a current state regarding at least one prevented function of the surgical instrument.

[0532] Example 12 - The surgical system of Example 11, wherein the constraint defined by the system comprises at least one of a predefined parameter or a range of predefined parameters based on historical data associated with a surgical procedure being performed by the surgical system.

[0533] Example 13 - The surgical system of Example 11 or 12, wherein the current state comprises a first message that the at least one function of the surgical instrument is prevented and a second message indicating a reason why the at least one function is prevented. of the surgical instrument is prevented.

[0534] Example 14 - The surgical system of Examples 11, 12 or 13, wherein the user interface comprises a user interface element selectable to override the central surgical controller to enable at least one function of the surgical instrument.

[0535] Example 15 - The surgical system of Examples 11, 12, 13 or 14, wherein the sensor comprises a force sensor coupled to the end actuator, wherein the detected parameter comprises a force applied to at least one of the first claw or second claw of the end actuator, and wherein the at least one function prevented via the central surgical controller comprises one or more than one to prevent the use of a connected drive shaft, preventing the initiation of a firing cycle, preventing the end actuator pivot, preventing rotation of the drive shaft or preventing one or more of the first claw or second claw from opening.

[0536] Example 16 - The surgical system of Examples 11, 12, 13, 14 or 15, wherein the function of the end actuator associated with the detected parameter comprises a clamping function and wherein the at least one function of the surgical instrument is prevented through the central surgical controller comprises one or more of a dissection function, a coagulation function, a clamp function or a cutting function.

[0537] Example 17 - The surgical system of Example 11, 12, 13, 14, 15, or 16, at least one of the handle assembly or the central surgical controller comprising the user interface.

[0538] Example 18 - The surgical system of Example 11,12, 13, 14, 15, 16 or 17, wherein the drive shaft assembly comprises a sensor configured to detect a drive shaft parameter associated with a function of the axis and transmit the detected drive axis parameter to the central surgical controller. The Memory additionally stores instructions executable by the processor to prevent the at least one function of the surgical instrument additionally based on the detected drive axis parameter.

[0539] Example 19 - A non-transitory computer-readable medium stores computer-readable instructions that, when executed, cause a machine to analyze a detected parameter, associated with a function of an end actuator of a surgical system, based in a system-defined constraint, the surgical system including a handle assembly, a drive shaft assembly extending distally from the handle assembly, and an end actuator assembly coupled to a distal end of the drive shaft assembly. The end actuator assembly comprises a first claw, a second claw pivotally coupled to the first claw, and a sensor configured to detect the detected parameter and transmit the detected parameter to the machine. The instructions, when executed, additionally cause the machine to bypass at least one function of the surgical system based on an analysis result, and generate a user interface. The user interface provides a current state regarding at least one prevented function of the surgical system.

[0540] Example 20 - the non-transitory computer-readable media of Example 19 further comprises instructions that, when executed, further cause the machine to generate a cancel element in the user interface. The cancellation element is selectable to enable at least one function of the surgical system.

Intelligent surgical stapling safety systems equipped with motor Security systems to evaluate operational parameters

[0541] Various aspects of the present disclosure are directed to improved safety systems capable of adapting, controlling, and/or adjusting internal drive operations of a surgical instrument in response to tissue parameters detected through one or more of a sensor of the surgical instrument. More specifically, several aspects are aimed at detecting and indicating a match of current device parameters to detected tissue parameters.

[0542] For example, detected tissue parameters may include a tissue type, a tissue thickness, a tissue stiffness, a position of the tissue on a patient's anatomy, the vascularity of the tissue, etc., and device parameters Current information may include cartridge color, cartridge type, auxiliary compounds, staple charge, gap, rate of fire, etc. Thus, according to aspects of the present description, physiological detection may indicate inappropriate use of a device or a component thereof and/or inappropriate positioning of the device.

[0543] In an example, an inappropriate use of a surgical instrument or a component thereof and/or an inappropriate positioning of the surgical instrument may be determined, through an associated control circuit, based on physiological detection detected through one or more than one sensor on the end actuator jaws. In such an example, after improper use is determined and/or improper positioning is determined, the associated control circuit may prevent one or more of a functionality (e.g., clipping) of the end actuator from being performed. Furthermore, in this example, the associated control circuit may enable one or more end actuator functionality if the associated control circuit determines that the surgical instrument or component thereof and/or the positioning of the surgical instrument has been rectified ( (e.g., inadequate staple cartridge replaced, surgical instrument repositioned, etc.) or a cancellation was received (e.g., via a user interface on the surgical instrument, on a central surgical controller attached to the surgical instrument, in the operating room, etc. .)

[0544] Referring to Figure 94, in accordance with various aspects of the present description, a surgical system 24200 may comprise a control circuit (24212, 24222, 24232 and/or 24242, e.g., in dashed line to show optional locations) , a user interface (24214, 24224, 22234, 24244 and/or 24254, e.g., in dashed line to show optional locations), and a surgical instrument 24202. Surgical instrument 24202 includes a plurality of components, such as Component-A 24216 to N-Component 24218 of 24210 end actuator assembly and likewise, in abbreviated form for illustration purposes, Component-A (CA) to N-Component (C-N) of 24220 drive shaft assembly and grip 24230, respectively. In various aspects, each component of surgical instrument 24202 may comprise at least one device parameter. For example, Component-A 24216 of end actuator assembly 24210 may include parameters PAa through PAn 24217, Component-N 24218 of end actuator assembly 24210 may include parameters PNa through PNn 24219, and so on. As another example, each of C-A through C-N of drive shaft assembly 24220 and each of C-A through C-N of grip assembly 24230 may similarly include at least one device parameter. Each component can be configured to transmit its respective device parameters to the control circuit. The surgical instrument 24202 further includes a sensor (24213, 24223, and/or 24233) configured to detect a tissue parameter associated with a function of the surgical instrument and transmit the detected tissue parameters to the control circuit. The control circuit can be configured to analyze the detected tissue parameter in cooperation with each respective device parameter based on the predefined constrictions of the system.

[0545] Again with reference to Figure 94, the control circuit 24212, 24222 and/or 24232 (e.g., shown as an element of the end actuator assembly 24210, the drive shaft assembly 24220, and the grip assembly 24230, respectively) may, in various aspects, be integrated into one or more of one of a plurality of components (e.g., a handle of the grip assembly 24230, a drive shaft of the drive shaft assembly 24220, and an actuator of end actuator assembly 24210, an end actuator assembly clamp cartridge, etc.) of surgical instrument 24202 or integrated into a central surgical controller 24240 (e.g., 24242) paired (e.g., in wireless mode) wire) to the surgical instrument 24202. Similarly, the sensor or sensors 24213, 24223 and/or 24233; the user interface 24214, 24224 and/or 24234; and memory 24215, 24225, and/or 24235 (e.g., shown as elements of the end actuator assembly 24210, the drive shaft assembly 24220, and the grip assembly 24230, respectively) may, in various aspects, be integrated into one or more of one of the plurality of components. Notably, in various aspects, the surgical instrument 24202 and/or the central surgical controller 24240 may be a situationally aware surgical instrument and/or a situationally aware central surgical controller. Situational awareness refers to the ability of a surgical system, e.g., 24200, to determine or infer information related to a surgical procedure from data received from databases (e.g., historical data associated with a surgical procedure ) and/or surgical instruments (e.g. sensor data during a surgical procedure). For example, the determined or inferred information may include the type of procedure being performed, the type of tissue being operated on, the body cavity that is the subject of the procedure, etc. Based on such contextual information related to the surgical procedure, the surgical system may, for example, control a paired surgical instrument or a component thereof and/or provide contextualized information or suggestions to a surgeon throughout the course of the surgical procedure.

[0546] In accordance with one aspect, a situationally aware central surgical controller (e.g., 24240) is paired (e.g., wirelessly) with a surgical instrument 24202 being used to perform a surgical procedure. In such an aspect, the surgical instrument 24202 may comprise a plurality of components, including an end actuator (e.g., Component-A 24216). The end actuator 24216 may comprise a first claw, a second claw pivotally coupled to the first claw, a cutting blade, and an integrated sensor 24213 configured to detect a tissue parameter associated with a function (e.g., dissect, clamp , coagulate, cut, staple, etc.) of the end actuator 24216, and transmit the detected tissue parameters to a control circuit 24242 of the central surgical controller 24240. Each of the plurality of components of the surgical instrument 24202 (e.g., N-component 24218, e.g., a staple cartridge, etc.), including end actuator 24216, is also configured to transmit its respective device parameter or parameters (e.g., 24219 and 24217, respectively) to the surgical controller central 24240. Notably, it should be understood that a sensor (e.g., 24213), as mentioned herein and in other aspects described, may comprise a plurality of sensors configured to detect a plurality of tissue parameters associated with a plurality of set functions. of end actuator 24216. Thus, in addition, in this aspect, the control circuit of the central surgical controller 24242 may be configured to receive such parameter data (e.g., detected tissue parameter(s), device of each component including the end actuator, etc.) throughout the course of the surgical procedure. A detected tissue parameter can be received each time an associated end actuator function (e.g., dissection, grasping, coagulation, cutting, stapling, etc.) is to be performed. The central surgical controller control circuit 24242 may be further configured to receive data from an internal database (e.g., a central surgical controller database 24249) and/or an external database (e.g., from from a cloud database 24269) throughout the course of the surgical procedure. In various aspects, data received from internal databases 24249 and/or external databases 24269 may comprise procedural data (e.g., steps to perform the surgical procedure, data indicating respective device parameters associated with the surgical procedure) and/or historical data (e.g., data indicating expected tissue parameters based on historical data associated with the surgical procedure, patient surgical history data, etc.). In various aspects, the procedural data may comprise current/recognized standard of care procedures for the surgical procedure and the historical data may comprise preferred/optimal tissue parameters and/or preferred/optimal tissue parameter ranges for each tissue parameter received with based on historical data associated with the surgical procedure (e.g. system-defined restrictions). Based on the received data (e.g., parameter data, internal and/or external data, etc.), the control circuitry of the surgical hub 24242 may be configured to continuously derive inferences (e.g., contextual information) about the procedure. surgery in progress. That is, the central surgical controller with situational awareness can be configured to, for example, record data relating to the surgical procedure to generate reports, verify the steps being taken by the surgeon to perform the surgical procedure, provide data or warnings (e.g. example, through a user interface associated with the central surgical controller 24244 and/or 24254 and/or the surgical instrument 24214, 24224, and/or 24234) that may be pertinent to a particular procedural step, controlling a function of the surgical instrument, etc.

[0547] According to another aspect, a surgical instrument with situational awareness (e.g., 24202) may be used to perform a surgical procedure. In such an aspect, as described herein, the surgical instrument 24202 may comprise a plurality of components, including an end actuator 24216. The end actuator may comprise a first claw, a second claw pivotally coupled to the first claw, a cutting, and an integrated sensor 24213 configured to detect a tissue parameter associated with a function (e.g., dissect, clamp, coagulate, cut, staple, etc.) of the end actuator 24216, and transmit the detected tissue parameters to a control circuit. Notably, in such an aspect, the detected tissue parameter may be transmitted to an integrated control circuit 24212 of the end actuator 24216. Each of the plurality of components of the surgical instrument (e.g., the component controller 24218, e.g. , clamp cartridge, etc.), including end actuator 24216, is configured to transmit its respective device parameter(s) to the control circuit of the integrated end actuator 24212. In this aspect, the control circuit integrated with the actuator end point 24212 may be configured to receive such parameter data (e.g., detected tissue parameter(s), device parameter(s) of each component including the end actuator, etc.) over the course of the surgical procedure. A detected tissue parameter can be received each time an associated end actuator function (e.g., dissection, grasping, coagulation, cutting, stapling, etc.) is to be performed. The control circuit integrated into the end actuator 24212 may be further configured to receive data from an internal database (e.g., memory end actuator 24215) and/or an external database (e.g., from a cloud database 24269 via a central surgical controller 24240, a central surgical controller database 24249, etc.) during the course of the surgical procedure. In various aspects, data received from and/or internal and/or external databases may comprise staple cartridge data (e.g., staple sizes and/or types associated with a staple cartridge (e.g., 24218) for which a device parameter or parameters were received by the end actuator control circuit 24212) and/or in historical data (e.g., data indicating expected tissue and/or staple types to be stapled based on the data historical). In various aspects, the internal and/or external data may comprise preferred/optimal tissue parameters and/or preferred/optimal tissue parameter ranges for each device parameter received based on historical data associated with the surgical procedure (e.g., restrictions defined by the system). In one example, the internal and/or external data may comprise preferred/ideal tissue parameters and/or preferred/ideal fabric parameter ranges for expected fabrics and/or tissue types or for the associated staple sizes and/or types. to the staple cartridge device parameter (for example, 24218) based on historical data (for example, system-defined constraints). Based on the received data (e.g., parameter data, internal and/or external data, etc.), the end actuator control circuit 24212 may be configured to continuously derive inferences (e.g., contextual information) about the procedure in progress. Notably, according to an alternative aspect, the integrated sensor 24213 of the end actuator 24216 may transmit the detected tissue parameter(s) to an associated control circuit (e.g., 24222 and/or 24232). to another component of the surgical instrument, e.g., a handle of the handle assembly 24230. In such an aspect, that other surgical instrument component control circuit (e.g., 24222 and/or 24232) may be similarly configured to perform the various aspects of the 24212 end actuator control circuit as described above. Ultimately, the situational awareness surgical instrument (e.g., 24202) may be configured to, for example, alert its user (e.g., via an end actuator user interface 24214, via a another surgical instrument component 24224 and/or 24234, e.g., the handle of the handle assembly 24230, or via a user interface 24244 associated with a central surgical controller 24240 coupled to the surgical instrument 24202) of a discrepancy. For example, the discrepancy may include a detected tissue parameter that exceeds an ideal/preferred tissue parameter and/or a range of preferred/ideal tissue parameters associated with those staple sizes and/or types or with the tissues and/or expected tissue types. As another example, the situational awareness sound surgical instrument (e.g., 24202) may be configured to control a discrepancy-based surgical instrument function. According to at least one aspect, the situationally aware surgical instrument (e.g., 24202) may prevent a surgical function based on a discrepancy.

Improper device positioning

[0548] According to various aspects of the present disclosure, physiological detection (e.g., detected through one or more than one sensor) may indicate device positioning problems. More specifically, according to these aspects, a physiological incompatibility may be present within/between a first claw and a second claw of an end actuator (e.g., after grasping) and additional functionality (e.g., coagulation, cutting, stapling, etc.) of the end actuator may be prohibited/prevented.

[0549] According to various aspects, the surgical procedure may comprise resection of target tissue (e.g., a tumor). Referring to Figure 92, for example, a portion of patient tissue 24000 may comprise a tumor 24002. In such an aspect, a surgical margin 24004 may be defined around the tumor 24002. Notably, during a surgical procedure, it is ideal to avoid and/or minimize resection of healthy tissue surrounding a tumor. However, to ensure complete tumor removal, current standard/recognized procedures of care associated with this surgical procedure may endorse resection of a predetermined surgical margin defined by a distance around the tumor and/or defined predetermined surgical margin range. for a distance band around the tumor. In one aspect, the endorsed surgical margin may be tumor dependent (e.g., based on tumor type, tumor size, etc.). In another aspect, the endorsed surgical margin may depend on the extent of microinvasion of the tumor into the surrounding tissue. In other respects, the endorsed surgical margin may be correlated with improved long-term survival based on historical data associated with that tumor and/or that surgical procedure. In still other aspects, an associated control circuit (e.g., in the view of Figure 94, in the surgical instrument, in a component of the surgical instrument 24212, 24222, 24232, in a central surgical controller coupled to the surgical instrument 24242, etc.) may proactively adjust an endorsed surgical margin based on data received from an internal database 24215, 24225 and/or 24235 and/or external database 24249 and/or 24269 (e.g., patient surgical history data, data from the patient medical history, standard of care procedures for recurrent tumors, etc. from the cloud, from a central surgical controller, etc.). In this regard, returning to Figure 92, a normally endorsed surgical margin (e.g., 24004) can be changed by a determined amount/distance (e.g., 24010) to an adjusted surgical margin (e.g., 24012) based on the data received. (e.g., this patient's surgical data and/or medical history data may suggest that the tumor may have further invaded the surrounding tissue, that the patient may already have a case of recurrent tumor, etc.)

[0550] Furthermore, in several aspects, after a target surgical margin (e.g., 24004 and/or 24012) is established for a surgical procedure, it may be difficult to efficiently and/or accurately identify and resect the tumor and/or its margin. surgical target during a surgical procedure. Referring again to Figure 94, in accordance with various aspects of the present disclosure, an end actuator (e.g., 24216) of a surgical instrument 24202 may comprise a first sensor (e.g., 24213) configured to measure a first signal and transmit the first signal to an associated control circuit (e.g., in the surgical instrument, in a component of the surgical instrument 24212, 24222, and/or 24232, in a central surgical controller coupled to the surgical instrument 24242, etc.). In one such aspect, a second sensor configured to measure a second signal and transmit the second signal to the associated control circuit may be positioned on/in the tumor (see Figure 92, e.g., 24006, from a central position relative to the tumor). tumor) before using the surgical instrument to resect the tumor. Here, according to several aspects, the second sensor can be separated from the surgical instrument. Furthermore, and/or alternatively, in such an aspect, the second sensor may comprise a sensor positioned at a periphery of the tumor (see Figure 92, e.g., 24008) prior to use of the surgical instrument to resect the tumor. According to another aspect, a plurality of second sensors can be positioned around the periphery of the tumor. Here, in these aspects, the control circuit may be configured to dynamically calculate a distance between the first sensor and the second sensor based on the first signal and the second signal. In various aspects, the first sensor may be positioned in/near the cutting blade of the end actuator. Additional exemplary methods for detecting a target surgical margin are described in U.S. Patent Application Publication No. 2016/0192960, entitled SYSTEM AND METHOD FOR A TISSUE RESECTION MARGIN MEASUREMENT DEVICE, the description of which is incorporated herein by reference.

[0551] In one example, if the second sensor is positioned over/inside the tumor (e.g., in a central position, 24006), the control circuit may be further configured to determine a margin of distance between the second sensor and the target surgical margin established for the surgical procedure. In such an example, the control circuit may compare the dynamically calculated distance (e.g., between the first sensor and the second sensor) to this determined margin distance to efficiently and accurately locate the end actuator (e.g., cutting blade). ) at the target surgical margin (for example, when the dynamically calculated distance is equal to or substantially equal to the determined margin distance, the end actuator is correctly positioned). The control circuit may be configured to utilize such a technique to efficiently and accurately locate the end actuator (e.g., the cutting blade) around the target surgical margin (e.g., during resection).

[0552] In another example, if the second sensor is positioned at the periphery of the tumor or a plurality of second sensors are positioned around a periphery of the tumor, e.g., 24008, the control circuit may be further configured to determine a margin distance between the second sensor or sensors and the target surgical margin established for the surgical procedure. In such an example, the control circuit may compare the dynamically calculated distance (e.g., between the first sensor and the second sensor) to this determined margin distance to efficiently and accurately locate the end actuator (e.g., cutting blade). ) at the target surgical margin (for example, when the dynamically calculated distance is equal to or substantially equal to the determined margin distance, the end actuator is correctly positioned). The control circuit may be configured to utilize such a technique to efficiently and accurately locate the end actuator (e.g., the cutting blade) around the target surgical margin (e.g., during resection). Such an appearance may be beneficial when the tumor is abnormally shaped.

[0553] Again with reference to Figure 94, in various aspects, the control circuit may be configured to inform the surgeon (e.g., in real time via a user interface on the surgical instrument 24214, 24224 and/or 24234, a user interface on a central surgical controller coupled to the surgical instrument 24244 and/or a user interface on the operating room 24254, etc.) when the end actuator (e.g., or the cutting blade thereof) is located /positioned appropriately relative to the target surgical margin (e.g., 24004 and/or 24012). For example, the user interface may comprise at least one of i) a video image of the surgical site with a digital overlay indicating the target surgical margin for the surgeon to visually confirm that the end actuator (e.g., 24216) is positioned in the target surgical margin and/or navigate the end actuator (e.g., or the cutting blade) relative to the target surgical margin, ii) haptic feedback on the surgical instrument itself 24202 to indicate that the end actuator cutting blade is positioned at the target surgical margin and/or iii) auditory feedback to indicate that the tip actuator cutting blade is positioned at the target surgical margin.

[0554] Again referring to Figure 94, according to additional aspects, the control circuit may be configured to prevent the surgical instrument 24202 from firing if the end actuator (e.g., cutting blade) is too close and/or within a cancerous margin (e.g., within the target surgical margin, to close surrounding micro-invaded tissue by the tumor, etc.). In accordance with such aspects, the control circuit may be further configured to receive an override command (e.g., via the user interface on the surgical instrument 24214, 24224 and/or 24234, a user interface on a coupled central surgical controller to the surgical instrument 24244 and/or a user interface in the operating room 24254, etc.) to allow firing to continue. In one example, this user interface may comprise a selectable user interface element to allow firing to continue, e.g., 24251. In this aspect, the control circuit may continue to track the end actuator (e.g., or the cutting blade of the same) in relation to the cancerous margin. Additionally, in such an aspect, the control circuit may be configured to prevent firing again, alert the surgeon, and/or receive a cancel command as described. In other aspects, the control circuit may be configured to prevent firing until a reset event occurs (e.g., opening the end actuator jaws and repositioning the end actuator jaws relative to the cancerous margin).

[0555] Again referring to Figure 94, in accordance with other aspects of the present disclosure, one or more of a sensor of a surgical system 24200 may detect blood flow through tissue trapped between/within a first claw and a second claw. of an end actuator (e.g. 24216). For example, a doppler image detector (e.g., integrated into the end actuator 24213, coupled to a central surgical controller, e.g., a parameter sensing component 24253 comprising a doppler image detector, etc.) can be configured to locate and identify blood vessels that would not otherwise be visible at a surgical site (e.g., by means of a red, green and/or blue laser) and a stain contrast analysis can be performed to determine the amount and/or speed of blood flow through such blood vessels. Notably, in one example, it may be desired to seal some blood vessels (e.g., associated with a tumor) but not seal others (e.g., associated with healthy tissues/organs). In this way, an associated control circuit (e.g., in the surgical instrument, in a component of the surgical instrument 24212, 24, 222 and/or 24232, in a central surgical controller coupled to the surgical instrument 24242, etc.) can be configured to prevent the surgical instrument 24202 to fire if blood flow exceeds a predetermined amount and/or speed of blood flow. In accordance with such aspects, the control circuit may be further configured to receive an override command (e.g., via the user interface on the surgical instrument 24214, 24224 and/or 24234, a user interface on a coupled central surgical controller to the surgical instrument 24244 and/or a user interface in the operating room 24254, etc.) to allow triggering to continue (e.g., if blood flow is associated with the tumor). In one example, such a user interface may comprise a selectable user interface element to allow firing to continue, e.g., 24251. In this aspect, the control circuit may continue to monitor blood flow from the trapped tissue. Additionally, in such an aspect, the control circuit may be configured to prevent firing again, alert the surgeon, and/or receive a cancel command as described. According to other aspects, the control circuit may be configured to prevent firing until a reset event occurs (e.g., opening the jaws and repositioning the jaws of the end actuator relative to the blood vessel comprising a blood flow that exceeds the predefined amount and/or blood flow velocity).

[0556] Again referring to Figure 94, in accordance with other aspects of the present disclosure, one or more of a sensor of a surgical system 24200 may detect an increase in blood pressure concomitant with and/or immediately after grasping the tissue between/ within a first claw and a second claw of an end actuator (e.g., 24216). For example, a blood pressure monitor (e.g., coupled to the central surgical controller, e.g., parameter sensing component 24253 comprising a blood pressure monitor, etc.) may detect the increase in blood pressure contemporaneous with the grasp. According to several aspects, the 24200 surgical system is equipped with situational awareness and can infer that the detected increase in blood pressure was caused by the gripping of tissue between/within the jaws of the end actuator. For example, a blood vessel comprising critical blood flow may have been captured between/within the claws, resulting in restricted blood flow. Thus, in various aspects, an associated control circuit (e.g., in the surgical instrument, in a component of the surgical instrument 24212, 24, 222 and/or 24232, in a central surgical controller coupled to the surgical instrument 24242, etc. ) may be configured to prevent a surgical instrument 24202 from firing if the increase in blood pressure exceeds a predetermined amount and/or a predetermined range. In accordance with such aspects, the control circuit may be further configured to receive an override command (e.g., via the user interface on the surgical instrument 24214, 24224 and/or 24234, a user interface on a coupled central surgical controller to the surgical instrument 24244 and/or a user interface in the operating room 24254, etc.) to allow triggering to continue (e.g., the surgeon observes that blood pressure has decreased while tissue is still attached, the situational awareness surgical system attributes the increase in blood pressure to another cause, etc.). In one example, such a user interface may comprise a selectable user interface element to allow triggering to continue, e.g., 24251. In such an aspect, the control circuit may continue to monitor the patient's blood pressure. Additionally, in such an aspect, the control circuit may be configured to prevent firing again, alert the surgeon, and/or receive a cancel command as described. In other aspects, the control circuit may be configured to prevent firing until a reset event occurs (e.g., opening of the jaws and repositioning of the end actuator jaws relative to the trapped tissue).

[0557] Again with reference to Figure 94, in accordance with other aspects of the present disclosure, one or more of a sensor of a surgical system can detect a substantial nerve bundle within tissue trapped between a first claw and a second claw of an actuator. endpoint (e.g. 24216). For example, a heart rate monitor (e.g., integrated into the end actuator 24213, coupled to the central surgical controller, e.g., sensing parameter component 24253 comprising a heart rate monitor, etc.) may detect an increase in heart rate. concomitant with and/or immediately after grasping the tissue between/within the first claw and the second claw. In various respects, the surgical system 24200 is provided with situational awareness and can infer that the detected increase in heart rate, in the context of data received from an internal database 24215, 24225, 24235, 24249 and/or database external 24249 and/or 24269 (e.g., anatomical information associated with the surgical site of the surgical procedure being performed) were caused by tissue tightening between/within the end actuator jaws. In accordance with such aspects, an associated control circuit (e.g., in the surgical instrument, in a component of the surgical instrument 24212, 24, 222 and/or 24232, in a central surgical controller coupled to the surgical instrument 24242, etc.) may be configured to prevent a surgical instrument 24202 from firing based on inference. Furthermore, in accordance with such aspects, the control circuit may be configured to receive a cancel command (e.g., via the user interface on the surgical instrument 24214, 24224 and/or 24234, a user interface on a surgical controller central coupled to the surgical instrument 24244 and/or a user interface in the operating room 24254, etc.) to allow triggering to continue (e.g., the surgeon observes that the patient's heart rate has decreased while tissue is still attached, the surgical system with situational awareness attributes the increase in heart rate to another cause, etc.). In one example, such a user interface may comprise a selectable user interface element to allow triggering to continue, e.g., 24251. In such an aspect, the control circuit may continue to monitor the patient's heart rate. Additionally, in such an aspect, the control circuit may be configured to prevent firing again, alert the surgeon, and/or receive a cancel command as described. In other aspects, the control circuit may be configured to prevent firing until a reset event occurs (e.g., opening of the jaws and repositioning of the end actuator jaws relative to the trapped tissue).

[0558] Again referring to Figure 94, in accordance with other aspects of the present description, one or more of a sensor of a surgical system 24200 may detect that a surgical instrument 24202 is in contact with an energized device (e.g., a surgical instrument /RF device). In one example, the surgical instrument and the powered device may be communicatively coupled to a central surgical controller 24240 in the surgical system 24200. For example, referring back to Figure 9, a device/instrument 235 as well as a power device 241 may be coupled to a modular control tower 236 of a central surgical controller 206. In such an example, either a generator 240 producing the electrosurgical energy for the energized device 241 and/or a sensor integrated in the energized device may be configured to detect when the Impedance associated with the energized device falls below a threshold value for a timeout period (e.g., impedance drops indicating a short). Similar to Figure 48, an integrated sensor of the powered device can be configured to measure impedance over time. Various alternative methods for detecting a short, such as those described in US Patent No. 9,554,854, entitled DETECTING SHORT CIRCUITS IN ELECTROSURGICAL MEDICAL DEVICES, are expressly incorporated herein by reference (e.g., comparing impedance values at different positions within one pulse of a series of pulses). In various aspects, the surgical system 24200 is provided with situational awareness and can infer that a detected short, in the context of data received from an internal database 24215, 24225, 24235, 24249 and/or external 24249 and/or 24269 (e.g., procedural data indicating that a step and/or the current step of the surgical procedure involves the use of a separate surgical instrument, e.g., an electrosurgical instrument/device), was caused by the separate surgical instrument (e.g., a conductive surface of the surgical instrument may be in contact with the energized device causing the short). In accordance with such aspects, an associated control circuit (e.g., in the surgical instrument, in a component of the surgical instrument 24212, 24, 222 and/or 24232, in the central surgical controller coupled to the surgical instrument and the energized device 24242, etc. ) can be configured to prevent a surgical instrument 24202 from firing based on inference. If a short exists, it may be difficult to treat (e.g., coagulate) tissue with electrosurgical energy (e.g., RF energy) and an undesirable surgical outcome may result (e.g., incomplete tissue treatment, excessive heating of the conductive object, etc.). In such a context, the control circuit may be configured to inform the surgeon (e.g., in real time via a user interface on the surgical instrument 24214, 24224 and/or 24234, a user interface on a coupled central surgical controller to the surgical instrument 24244, and/or a user interface in the operating room 24254, etc.) that the short exists and that the firing of the surgical instrument 24202 has been suspended. Furthermore, in accordance with such aspects, the control circuit may be configured to receive a cancel command (e.g., via the user interface on the surgical instrument 24214, 24224 and/or 24234, a user interface on a surgical controller central unit coupled to the surgical instrument 24244 and/or a user interface in the operating room 24254, etc.) to allow triggering to continue (e.g., the surgeon checks that there is no short, the target tissue comprises a low impedance, etc.) . In one example, such a user interface may comprise a selectable user interface element to allow triggering to continue, e.g., 24251. In this aspect, the control circuit may continue to monitor for a short. Additionally, in such an aspect, the control circuit may be configured to prevent firing again, alert the surgeon, and/or receive a cancel command as described. According to other aspects, the control circuit may be configured to prevent triggering until a reset event occurs (e.g., surgical instrument repositioned relative to the energized device such that they are no longer in contact).

Inappropriate selection of device/proposed use

[0559] According to various aspects of the present description, physiological detection (e.g., detected through one or more than one sensor) may indicate surgical device/instrument selection problems. More specifically, according to these aspects, an incompatibility between surgical device and tissue may be present and additional functionality (e.g., coagulation, cutting, stapling, etc.) of the end actuator may be prohibited/prevented.

[0560] Referring once again to Figure 94, in accordance with one aspect of the present description, a control circuit (e.g., in a surgical instrument component 24212, 24, 222 and/or 24232, in a central surgical controller coupled to surgical instrument 24242, etc.) may be configured to provide a warning if a tissue-specific stapler (e.g., a vascular stapler) and any combination of information detected (e.g., detected through one or more than one sensor) suggests that the target tissue may be unsuitable (e.g., contraindicated) for that specific tissue stapler.

[0561] Figure 93 illustrates an example of security process 24100 for addressing issues with device selection in accordance with various aspects of the present disclosure. 94) of a surgical system (e.g., 24200 of Figure 94). According to other aspects, the security process 24100 may be executed/implemented (e.g., during a surgical procedure) by a control circuit associated with a situationally aware surgical instrument (e.g., 24212, 24222, and/or 24232 of Figure 94) of a surgical system (e.g., 24200 of Figure 94).

[0562] Referring to Figure 93, a tissue identification process 24108 may receive inputs comprising a device selection 24102 (e.g., a choice of stapler, e.g., a stapler suitable for parenchyma firing, a stapler suitable for triggering of vascular vessels, a stapler suitable for triggering bronchial tubes, etc.), various measurements of the device 24104 detected by one or more than one sensor (e.g., angle of closure of the end actuator, length of tissue in contact with the end actuator , force to close/compression curve, etc.) and situationally aware information 24106 (e.g., procedure information, surgeon bias, etc.).

[0563] In the view of Figure 93, at device selection 24102, the control circuit that executes/implements security process 24100 may be configured to receive a device parameter from a selected stapler/device and/or associated device parameters to each component (e.g., staple cartridge) of the selected stapler/device to indicate device selection. For example, device parameters associated with a staple cartridge may include a cartridge type, a cartridge color, adjuncts to the cartridge, a cartridge staple load limit, a gap range for the cartridge, a rate of fire for cartridge, etc. According to one aspect, the device parameter(s) may be transmitted by the stapler/device to the control circuit after coupling to the surgical system. According to alternative aspects, device selection may be entered via a user interface (e.g., associated with a central surgical controller and/or in the operating room, e.g., 24244 and/or 24254 of Figure 94) and/or or received from an internal and/or external database (e.g., data regarding the surgical procedure being performed and/or available surgical instruments 24249 and/or 24269 of Figure 94).

[0564] Additionally in the view of Figure 93, measurements from device 24104 can be detected through one or more than one sensor (e.g., as described in Figures 17, 18, 53, 78, etc.) associated with an actuator. end (e.g., Component-A, 24216 of Figure 94) and/or other components of the surgical instrument (e.g., Component-N, 24218 of Figure 94, e.g., a staple cartridge). For example, one or more of a fabric sensor may be positioned and configured to check continuity and/or measure fabric impedance along the length of the end actuator to evaluate a length of fabric in contact with the end actuator ( e.g., sensor or sensors 738 of Figure 17 for determining tissue location using segmented electrodes and/or measuring tissue impedance, sensors 153468 of Figure 78 for determining the presence of tissue along the length of the end actuator, etc. .). As a further example, one or more than one sensor may be positioned and configured to detect/estimate the closing angle of the end/claw actuator (e.g., a displacement sensor, e.g., a position sensor 734 of Figure 17 , to detect the displacement of a grip actuator/drive member, gap sensor, e.g., sensor 152008a of Figure 53, to detect a gap between a first claw and a second claw of the end actuator, etc.). As a further example, one or more of a sensor may be positioned and configured to detect a force to compress/close the tissue between the first gripper and the second gripper (e.g., force sensor, e.g., sensor 738 of Figure 17 comprising a force sensor, on the surface of the fabric of the first gripper and/or second gripper for detecting forces when the fabric is gripped, sensor, e.g., current sensor 736 of Figure 17, for detecting the current consumption of the limb. drive correlated to forces applied to the tissue, torque sensor, e.g. 744b of Figure 17, to measure a closing force, etc.). Various additional aspects of detecting an end actuator closing angle, a length of tissue in contact with the end actuator, and a closing/compressing force curve have been discussed elsewhere in this document.

[0565] Next, in the view of Figure 93, surgical recognition information 24106 may, in light of Figure 94, be received through internal databases 24249 and/or external databases 24269 associated with a central surgical controller. 24242 and/or through internal databases 24215, 24225, 24235 and/or external databases 24249, 24269 associated with a surgical instrument 24202, etc.

[0566] Returning to Figure 93, tissue identification process 24108 is configured to determine a type of tissue encountered by the surgical instrument (e.g., parenchyma, vessel, bronchi, etc.). In one example, tissue identification process 24108 may determine that the tissue type is parenchyma based on various inputs (e.g., tissue contact detected along the length of the jaws when the jaws are fully open, closing curve versus opening suggests tissue consistent with parenchyma, etc.). In another example, tissue identification process 24108 may determine that the tissue type is a vessel (e.g., PA/PV) based on various inputs (e.g., tissue contact detected almost immediately during closure, tissue contact detected as only over a small area of the stapler and is detected as bounded on the distal side, closure forces detected initially suggest a tissue structure consistent with a vessel, etc.). In another example, the tissue identification process 24108 may determine that the tissue type is bronchial based on various inputs (e.g., tissue contact detected almost immediately during closure, tissue contact detected over a small area of the stapler and is detected as bounded on both the distal and proximal sides, initially detected closing forces suggest a tissue structure consistent with bronchi, etc.). In various aspects, such tissue type determinations may further be based on tissue parameters comprising a tissue thickness, a tissue stiffness, a tissue location (e.g., with respect to the patient), and vascularity in the tissue detected by and/or derived from measurements taken through one or more sensors described herein. Notably, tissue identification process 24108 may further evaluate such initial tissue determinations in the context of additional inputs (e.g., stapler choice, surgical procedure information, surgeon biases, etc.) before arriving at an output/result. tissue identification. This situational recognition ultimately results in the output/result of tissue identification. Here, various aspects for identifying a found tissue have been discussed elsewhere in this document (e.g., an example of thoracic surgery, etc.).

[0567] Again referring to Figure 93, the tissue identification output/result may be used to determine whether the selected stapler/device and/or each component of the selected stapler/device (e.g., staple cartridge, drive shaft , etc.) 24110 is ideal for surgical procedure. In this aspect, the control circuit may receive additional information 24112 from internal and/or external databases (e.g., referring to Figure 94, internal databases 24249 and/or external databases 24269 associated with a central surgical controller 24242, internal databases 24215, 24225, 24235 and/or external databases 24249, 24269 associated with a surgical instrument 24202, etc.). More specifically, additional information 24112 may comprise other available staplers, other available power devices, other stapler components (e.g., staple cartridges, drive shafts, etc.) available for use with the selected stapler/device, etc. According to at least one aspect, availability may be subject to current inventory at the surgical site. Notably, additional information 24112 may also comprise device parameters associated with each other available stapler, each other available power device, each other stapler component available for use with the selected stapler/device, etc.

[0568] According to various aspects, when evaluating whether the selected stapler/device is optimal 24110, the control circuit that executes/implements the security process 24100 may be configured to analyze each detected tissue parameter (e.g., detected through of one or more than one sensor described herein) in cooperation with each received device parameter associated with the stapler/device 24102 selected based on system-defined constraints. Furthermore, in accordance with such aspects, the control circuit may be configured to analyze each detected tissue parameter (e.g., detected through one or more of a sensor described herein) with the received device parameters associated with each other stapler. available, other power device available, other stapler component available for use with the selected stapler/device, etc., based on system-defined constraints. In accordance with such aspects, the control circuit may be configured to determine whether one or more of the other available staplers, the other available power devices, and/or the other stapler components available for use with the stapler/device selected are more optimal than the selected stapler/device 24102 and/or selected stapler/device 24102 components based on detected tissue parameters.

[0569] In various aspects, one or more detected tissue parameters may comprise, for example, a tissue type, a tissue thickness, a tissue stiffness, a tissue location, a vascularity in the tissue, etc. and a received device parameter may comprise, for example, a type of staple cartridge, a color of the staple cartridge, attachments to the staple cartridge, a gripping load limit of the staple cartridge, a clearance range for the cartridge of staples and a rate of fire for the staple cartridge, etc. In various aspects, a system-defined constraint (e.g., based on historical data and/or procedural data accessed in the situationally aware surgical system) may comprise preferred/optimal tissue parameters and/or preferred tissue parameter ranges. /ideals for each received device parameter. For example, a preferred/ideal tissue thickness and/or preferred/ideal tissue thickness range may be associated with each staple cartridge color. In this example, each color of the staple cartridge may indicate the types and/or sizes of staples in the staple cartridge. Here, a staple cartridge comprising short staples may not be ideal for thick fabric. According to additional aspects, a system-defined constraint (e.g., based on historical data and/or procedural data accessed in the situationally aware surgical system) may comprise a preferred/optimal grip load limit and/or threshold range. of preferential/ideal gripping load for each type of tissue detected. For example, each staple cartridge associated with its respective staple load limit can indicate the types of fabric that can be optimally stapled. Here, various combinations of received device parameters (e.g. staple cartridge type, staple cartridge color, staple cartridge adjuncts, staple cartridge gripping load limit, gap range for the staple cartridge, staple cartridge firing rate, etc.) and detected tissue parameters (e.g., tissue type, tissue thickness, tissue stiffness, tissue location, vascularity in the tissue, etc.) and constraints defined by the established system ( for example, associated with received device parameters and/or detected tissue parameters based on historical data and/or procedural data accessed in the situationally aware surgical system) are contemplated by the present description.

[0570] Again with reference to Figure 93, if it is determined that the selected device 24102 is optimal, the control circuit that executes/implements the safety process 24100 can be configured to initially do nothing (e.g., recommend later) and/or document that the analysis was performed 24114. Instead, if it is determined that the selected device 24102 is not ideal, the control circuit may be configured to determine whether a safety issue 24116 exists. According to various aspects, When evaluating whether a security issue exists with the selected stapler/device 24102, the control circuit may be configured to analyze each detected tissue parameter in cooperation with each received device parameter associated with the selected stapler/device 24102 based on defined constraints. by the system.

[0571] Similar to that described above, a detected tissue parameter may comprise, for example, a tissue type, a tissue thickness, a tissue stiffness, a tissue location, a vascularity in the tissue, etc. and a received device parameter may comprise, for example, a type of staple cartridge, a color of the staple cartridge, attachments to the staple cartridge, a staple load limit of the staple cartridge, a gap range for the staple cartridge of staples and a rate of fire for the staple cartridge, etc. In various aspects, a system-defined constraint (e.g., based on historical data and/or procedural data accessed in the situationally aware surgical system) may comprise preferred/optimal tissue parameters and/or preferred tissue parameter ranges. /ideals for each received device parameter. For example, a preferred/ideal tissue thickness and/or preferred/ideal tissue thickness range may be associated with each staple cartridge color. In this example, each color of the staple cartridge may indicate the types and/or sizes of staples in the staple cartridge. Here, continuing the example, if a device parameter received from the selected stapler/device 24102 comprises a staple cartridge color (e.g., indicating short staples) and the detected tissue parameter indicates a tissue thickness that exceeds the tissue thickness preferred/optimal tissue thickness range and/or the preferred/optimal tissue thickness range associated with the color of the staple cartridge of the selected stapler/device 24102, a safety issue exists with the selected stapler/device 24102. Using an inappropriate staple cartridge may lead to less than satisfactory results and/or undesirable results (e.g., failed stapling, oozing, bleeding, etc.). In such a case, the control circuit may be configured to alert the surgeon 24118 (e.g., with reference to Figure 94, via a user interface on the selected stapler/device 24214, 24224 and/or 24234, via a user associated with the central surgical controller 24244, via a user interface in the operating room 24254, etc.) of the security issue. In this aspect, the control circuit may be further configured to receive an override command 24120 (e.g., via the user interface on the selected stapler/device 24214, 24224 and/or 24234, via the user interface associated with the surgical controller central 24244, via a user interface in the operating room 24254, etc.) to allow the surgical process to proceed. In an example, with reference to Figure 94, this user interface may comprise a selectable user interface element to allow the procedure to continue, e.g., 24251. In an alternative aspect, in response to the warning, the surgeon may correct the observed security problem (e.g., replacing the inadequate staple cartridge with another staple cartridge) at the point at which the 24100 security device selection process can be performed/implemented again.

[0572] Similar to that described above, according to additional aspects, a system-defined constraint (e.g., based on historical data and/or procedural data accessed in the situationally aware surgical system) may comprise a preferred grip load limit /ideal and/or preferred/ideal grip load limit range for each type of tissue detected. For example, each staple cartridge associated with its respective staple load limit can indicate the types of fabric that can be optimally stapled. Here, continuing the example, if a device parameter received from the selected stapler/device 24102 comprises its cartridge staple load limit and the tissue identified by the tissue identification process 24108 indicates a tissue type that requires a staple cartridge with a higher gripping load limit, a safety issue exists with the selected stapler/device 24102. Using an inappropriate staple cartridge may lead to less than satisfactory results and/or undesired results (e.g., failed stapling, sagging , bleeding, etc.). In such a case, the control circuit may be configured to alert the surgeon 24118 (e.g., with reference to Figure 94, via a user interface on the selected stapler/device 24214, 24224 and/or 24234, via a user associated with the central surgical controller 24244, via a user interface in the operating room 24254, etc.) of the security issue. In this aspect, the control circuit may be further configured to receive an override command 24120 (e.g., via the user interface on the selected stapler/device 24214, 24224 and/or 24234, via the user interface associated with the surgical controller central 24244, via a user interface in the operating room 24254, etc.) to allow the surgical process to proceed. In an example, with reference to Figure 94, this user interface may comprise a selectable user interface element to allow the procedure to continue, e.g., 24251. In an alternative aspect, in response to the warning, the surgeon may correct the observed security problem (e.g., replacing the inadequate staple cartridge with another staple cartridge) at the point at which the security device selection process 24100 can be performed/implemented again. Again, various combinations of incoming device parameters (e.g., staple cartridge type, staple cartridge color, staple cartridge adjuncts, staple cartridge staple load limit, gap range for the staple cartridge) staples, staple cartridge firing rate, etc.) and detected tissue parameters (e.g., tissue type, tissue thickness, tissue stiffness, tissue location, vascularity in the tissue, etc.) and system-defined constraints established (e.g., associated with received device parameters and/or detected tissue parameters based on historical data and/or procedural data accessed in the situationally aware surgical system) are contemplated by the present description.

[0573] Referring back to Figure 93, if it is determined that a safety issue does not exist with the selected stapler/device 24116, the control circuit that performs/implements the safety process 24100 may be configured to provide a recommendation to the surgeon 24122. In accordance with at least one aspect of the present disclosure, if another available stapler, another available power device, and/or another stapler component (e.g., staple cartridge, drive shaft, etc. available for use with the selected stapler/device) 24112 is more ideal or optional, the control circuit may be configured to alert the surgeon (e.g., referring to Figure 94, via a user interface on the selected stapler/device 24214, 24224 and /or 24234, through a user interface associated with the surgical cube 24244, through a user interface in the operating room 24254, etc.) of their availability and recommend their use in the current surgical procedure. In this regard, the control circuit may be further configured to receive an acceptance (e.g., via the user interface on the selected stapler/device 24214, 24224 and/or 24234, via the user interface associated with the central surgical controller 24244, via a user interface in the operating room 24254, etc.) of the recommendation. Upon acceptance, the control circuit may be configured to present an infomercial 24124 regarding the other available stapler, the other available power device, and/or the other stapler component (e.g., referring to Figure 94, Components A to N, e.g. staple cartridge, drive shaft, etc. available for use with the selected stapler/device) 24112 which is more ideal. Upon rejection, the control circuit may be configured to terminate 24126 the device selection safety algorithm and/or perform a subsequent process.

[0574] In accordance with several other aspects, although discussed specifically with respect to a stapler/device of the present invention, the present description should not be so limited. More specifically, the described aspects are equally applicable to other Surgical Instruments including energy devices (e.g. RF energy and/or Ultrasonic Surgical Instruments) and/or their respective components and/or endoscopic devices and/or their respective components.

Examples

[0575] Various aspects of the subject matter described herein under the heading "SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING" are defined in the following Examples:

[0576] Example 1 - A surgical system comprises a control circuit and a surgical instrument. The surgical instrument comprises a plurality of components and a sensor. Each of the plurality of components of the surgical instrument comprises a device parameter. Each component is configured to transmit its respective device parameter to the control circuit. The sensor is configured to detect a tissue parameter associated with a proposed function of the surgical instrument and transmit the detected tissue parameter to the control circuit. The control circuit is configured to analyze the detected tissue parameter in cooperation with each respective device parameter based on a constraint defined by the system. The surgical system further comprises a user interface configured to indicate whether the surgical instrument comprising the plurality of components is suitable for performing the proposed function.

[0577] Example 2 - The surgical system of Example 1, wherein the detected tissue parameter comprises at least one of a tissue type, a tissue thickness, a tissue stiffness, a tissue location, or the vascularization of the tissue .

[0578] Example 3 - The surgical system of Example 1 or 2, wherein a component of the surgical instrument includes a staple cartridge, and wherein the device parameter includes at least one of a type of staple cartridge, a color of the staple cartridge, staple cartridge auxiliary compounds, a staple cartridge gripping load limit, a gap range for the staple cartridge, and a rate of fire for the staple cartridge.

[0579] Example 4 - The surgical system of Example 1, 2 or 3, wherein a component of the surgical instrument includes an end actuator, and wherein the detected tissue parameter comprises at least one of a closing angle of the end actuator. end in the fabric, a length of the fabric in contact with a fabric contacting surface of the end actuator, and a force to compress the fabric in the end actuator.

[0580] Example 5 - The surgical system of Example 4, wherein the control circuit is additionally configured to identify the tissue as parenchyma, vessel or bronchi based on at least one detected tissue parameter.

[0581] Example 6 - The surgical system of Example 1, 2, 3, 4 or 5, wherein the control circuit is additionally configured to recommend at least one alternative component for use with the surgical instrument to perform the proposed function.

[0582] Example 7 - The surgical system of Example 1, 2, 3, 4, 5 or 6, wherein the constraint defined by the system comprises at least one of a predetermined tissue parameter or a predetermined tissue parameter range associated with each transmitted device parameter.

[0583] Example 8 - The surgical system of Example 1, 2, 3, 4, 5, 6 or 7, with the control circuit being additionally configured to avoid the proposed function when the restriction defined by the system is exceeded.

[0584] Example 9 - The surgical system of Example 8, the user interface comprising a selectable user interface element to override the control circuit to enable the proposed function of the surgical instrument.

[0585] Example 10 - The surgical system of Example 1, 2, 3, 4, 5, 6, 7, 8, or 9, wherein the proposed function of the surgical instrument comprises one or more of one of tissue grasping, coagulation fabric, fabric cutting, and fabric stapling.

[0586] Example 11 - The surgical system of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9 or 10, further comprising a central surgical controller communicatively coupled to the surgical instrument, the central surgical controller comprising the control circuit.

[0587] Example 12 - The surgical system of Example 11, wherein one of the surgical instrument or the central surgical controller comprises the user interface.

[0588] Example 13 - A surgical system comprises a central surgical controller and a surgical instrument communicatively coupled to the central surgical controller. The surgical instrument comprises a plurality of components and a sensor. Each of the plurality of components of the surgical instrument comprises a device parameter. Each component is configured to transmit its respective device parameter to the central surgical controller. The sensor is configured to detect a tissue parameter associated with a proposed function of the surgical instrument and transmit the detected tissue parameter to the central surgical controller. The central surgical controller comprises a processor and memory coupled to the processor. The memory stores instructions executable by the processor to analyze the detected tissue parameter in cooperation with each respective device parameter based on a system-defined constraint. The surgical system further comprises a user interface configured to indicate whether the surgical instrument comprising the plurality of components is suitable for performing the proposed function.

[0589] Example 14 - The surgical system of Example 13, wherein the detected tissue parameter comprises at least one of a tissue type, a tissue thickness, a tissue stiffness, a tissue location, or the vascularization of the tissue .

[0590] Example 15 - The surgical system of Example 13 or 14, wherein a component of the surgical instrument includes a staple cartridge, and wherein the device parameter includes at least one of a type of staple cartridge, a color of the staple cartridge, staple cartridge auxiliary compounds, a staple cartridge gripping load limit, a gap range for the staple cartridge, and a rate of fire for the staple cartridge.

[0591] Example 16 - The surgical system of Example 13, 14 or 15, wherein a component of the surgical instrument includes an end actuator, and wherein the detected tissue parameter comprises at least one of a closing angle of the end actuator. end in the fabric, a length of the fabric in contact with a fabric contacting surface of the end actuator, and a force to compress the fabric in the end actuator.

[0592] Example 17 - The surgical system of Example 13, 14, 15, or 16, wherein the instructions are additionally executable by the central surgical controller processor to recommend at least one alternative component for use with the surgical instrument to perform the function proposal.

[0593] Example 18 - The surgical system of Example 13, 14, 15, 16 or 17, wherein the instructions are additionally executable by the central surgical controller processor to prevent the proposed function when the restriction defined by the system is exceeded.

[0594] Example 19 - Non-transitory computer-readable media stores computer-readable instructions that, when executed, cause a machine to analyze a detected tissue parameter in cooperation with a device parameter of each of a plurality of fabric components. a surgical instrument of a surgical system, based on a constraint defined by the system, with the detected tissue parameter being associated with a proposed function of the surgical instrument. The surgical system includes the surgical instrument that includes a plurality of components. Each component is configured to transmit its respective parameter from the device to the machine. The surgical system further includes a sensor configured to detect the detected tissue parameter and transmit the detected tissue parameters to the machine. The instructions, when executed, further cause the machine to generate a user interface, the user interface providing an indication of whether the surgical instrument including the plurality of components is suitable for performing the proposed function of the surgical system.

[0595] Example 20 - The non-transitory computer-readable media of Example 19, wherein the instructions, when executed, additionally cause the machine to generate a cancel element in the user interface, the cancel element being selectable to allow the proposed function of the surgical instrument.

Control a surgical instrument according to detected closing parameters Compression Ratio to Determine Fabric Integrity

[0596] In various aspects, a surgical instrument can detect a variety of different variables or parameters associated with the closure of the jaws of the surgical instrument, which in turn can be used to adjust or affect various operating parameters that dictate how the surgical instrument functions. . The rate at which the jaws of a surgical instrument are transitioned from the open position to the closed position to grip the tissue between them can be defined as the gripping rate or closing rate. In various respects, the rate of closure may be variable or constant during the course of an instance of jaw closure. A limit against which a specific parameter associated with gripper closure is compared can be defined as a closing limit.

[0597] Clamping the tissue to an inadequate closure rate or to inadequate closure limits may result in damage to the tissue (e.g., the tissue may be torn due to the jaws applying too much force to the tissue) and/or operational failures by the instrument surgical (e.g., staples may be malformed due to tissue not being held securely by the jaws as the staples are fired). Accordingly, in some aspects, the surgical instrument is configured to detect the characteristics of the tissue being gripped by the surgical instrument and adjust the closure rate(s), closure limit(s), and other operating parameters. correspondingly. Additionally, each surgical procedure may involve multiple different tissue types and/or tissues with different characteristics. Accordingly, in some aspects, the surgical instrument is configured to dynamically detect tissue characteristics each time a tissue is clamped and adjust the closure rate(s), the closure limit(s), and other operating parameters accordingly.

[0598] The present description provides at least one solution, being that a surgical instrument is configured to detect parameters associated with compression of the tissue being clamped by the end actuator. The surgical instrument can additionally be configured to differentiate between tissues that have different integrities according to the detected tissue compression characteristics. The motor can then be controlled to affect the closure rate of the gripper and/or provide feedback to the user based on tissue integrity. For example, the surgical instrument may be configured to decrease the closure rate of the jaws if the detected tissue compression characteristics indicate that the tissue is rigid and/or provide a suggestion to the user to use adjunctive reinforcement if the tissue compression characteristics indicate that the fabric has low shear strength.

[0599] Figure 95 is a block diagram of a surgical instrument 21000, in accordance with at least one aspect of the present description. In one aspect, a surgical instrument 21000 includes a control circuit 21002 coupled to a motor 21006, a user interface 21010, and a sensor or sensors 21004. The motor 21006 is coupled to an end actuator 21008 such that the motor 21006 does 25) of the end actuator 21008 transition between a first configuration or open configuration and a second configuration or closed configuration, as is discussed in relation to Figure 26, for example. The sensor or sensors 21004 may be communicably coupled to the control circuit 21002 such that the control circuit 21002 receives data and/or signals therefrom. The control circuit 21002 may be communicably coupled to the motor 21006 such that the control circuit 21002 controls the operation of the motor 21006 according to, for example, data and/or signals received from the sensor or sensors 21004. user interface 21010 includes a device configured to provide feedback to a user of the surgical instrument, such as a screen or a speaker.

[0600] In various aspects, the sensor or sensors 21004 may be configured to detect the compression parameters of a tissue trapped in the end actuator. In one aspect, the sensor or sensors 21004 may be configured to detect the force to close (FTC) of the jaws of the end actuator 21008, that is, the force exerted to transition the jaws from the open configuration to the closed configuration. For example, the sensor or sensors 21004 may include a motor current sensor configured to detect the current drawn by the motor, as discussed with respect to Figures 12, 18 or 19. For direct current motors, the current drawn by the motor corresponds to to the motor torque (e.g., the torque of the output drive shaft of the motor 21006), which is representative of the FTC of the end actuator 21008. The FTC of the end actuator 21008 corresponds to the tissue compression of the trapped tissue because it represents the force transmitted from the end actuator 21008 to the attached fabric as the end actuator 21008 closes over the fabric. The more force is being applied to the tissue, the more the tissue is being compressed. In another aspect, the sensor or sensors 21004 includes a first electrode disposed on the end actuator 21008 that is configured to receive an RF signal from a corresponding second electrode, as is discussed with respect to Figures 36 to 38. The impedance Electricity of a tissue may correspond to tissue thickness, which in turn may correspond to tissue compression of the trapped tissue. In yet another aspect, the sensor or sensors 21004 include a force-sensitive transducer that is configured to determine the amount of force being applied to the sensor or sensors 21004, as is discussed with respect to Figure 24. Similar to the above discussion in Regarding FTC, the force detected by the transducer represents the force transmitted from the end actuator 21008 to the trapped tissue as the end actuator 21008 closes over the tissue. The more force is being applied to the tissue, the more the tissue is being compressed. The user interface 21010 includes a device configured to provide feedback to a user of the surgical instrument, such as a screen or a speaker. In still other aspects, the sensor or sensors 21004 may include various combinations of the aforementioned sensors and other such sensors capable of detecting compression parameters associated with a secured tissue in the end actuator. For example, an end actuator, such as end actuator 15200 depicted in Figure 53, may include a first sensor 152008a comprising a force-sensitive transducer and a second sensor 152008b comprising an impedance sensor.

[0601] The control circuit 21002 can be configured to adjust the closing rate of the jaws of the end actuator 21008 to accommodate different types of fabric. Control circuit 21002 may be configured to monitor the compression force exerted on the tissue (e.g., FTC) or another parameter associated with tissue compression (e.g., tissue impedance) during an initial period of compression and, based on in the rate of change of the tissue compression parameter, adjust the claw closing rate or time accordingly. For example, it may be beneficial to reduce the closure rate or increase the closure time for more viscoelastic fabrics, rather than applying full compression force over a short period of time, as discussed above with respect to Figure 22.

[0602] Figure 96 illustrates a logical flowchart of a process 21050 for controlling a surgical instrument according to the integrity of the trapped tissue, in accordance with at least one aspect of the present description. In the following description of process 21050, reference is also made to Figure 95. The illustrated process can be performed, for example, by the control circuit 21002 of the surgical instrument 21000. Consequently, the control circuit 21002 that executes the process receives 21052 data and/or signals (e.g., digital or analog) from the sensor or sensors 21004 pertaining to a tissue compression parameter so detected. In various aspects, the tissue compression parameter may include a parameter associated with a characteristic, type, property and/or state of a tissue being operated on; a parameter associated with an internal operation and/or a property of the surgical instrument 21000; or a component thereof. In one aspect, the tissue compression parameter may include, for example, the FTC of the end actuator 21008. In another aspect, the tissue compression parameter may include, for example, the thickness of the attached tissue. The control circuit 21002 may receive 21052 data relating to a tissue compression parameter as one or more distinct values transmitted by the sensor or sensors 21004, a signal transmitted by the sensor or sensors 21004 which may then be correlated to the value(s). associate(s), and so on.

[0603] Accordingly, control circuit 21002 determines how the value of the detected tissue compression parameter compares to one or more thresholds and then generates a response accordingly. In one aspect, the control circuit 21002 determines 21054 the value of the detected tissue compression parameter with respect to a first threshold. For example, control circuit 21002 may determine 21054 whether the detected tissue compression parameter exceeds or is greater than a first upper limit. In one aspect, if the detected tissue compression parameter exceeds the first threshold, then the process proceeds along the SIM branch 21050 and the control circuit 21002 controls 21056 the motor 21006 to increase the period of time taken to close the jaws of the end actuator 21008. The control circuit 21002 may control 21056 the motor 21006 to increase the gripper closing time, for example, by decreasing the rate at which the grippers are closed, increasing the time that gripper movement is paused after the initial tightening of the tissue (i.e., the waiting time for tissue creep) or the reduction of the stabilization threshold to end the grasping phase. If the detected tissue compression parameter does not exceed the first threshold, process 21050 will proceed along the NO branch, and in various respects, process 21050 may terminate or process 21050 may continue and control circuit 21002 may compare the value of detected tissue compression to one or more additional thresholds or continues receiving 21052 tissue parameter data and/or signals.

[0604] In another aspect, the control circuit 21002 further determines 21058 the value of the detected tissue compression parameter with respect to a second threshold. For example, the control circuit 21002 may determine 21058 whether the detected tissue compression parameter is below or less than a second or lower threshold. In one aspect, if the detected tissue parameter is below the second threshold, then the process proceeds along the SIM branch 21050 and the control circuit 21002 provides corresponding feedback 21060 through, for example, the user interface 21010. The feedback provided 21060 may include, for example, visual feedback provided through a screen or audio feedback provided by a speaker. In one aspect, the feedback may suggest that the user perform one or more corrective actions to improve the situation resulting in the detected tissue compression parameter being unexpectedly low. Such corrective action may include, for example, the use of auxiliary reinforcement (i.e., a tissue thickness compensator), as is described in US Patent Application No. 8,657,176, entitled TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER, which is incorporated herein by reference. The adjunctive reinforcement may, in various aspects, comprise a layer or series of layers of compressible material configured to adapt and/or apply an additional compressive force to the tissue captured between the anvil 150306 (Figure 25) and the staple cartridge 150304 (Figure 25). ).

[0605] The limits discussed above may include, for example, values for the parameter(s) detected by the sensor or sensors 21004 and/or derived from the parameter(s) detected by the sensor or sensors 21004 (e.g. the time rate change of a detected parameter). In aspects where the tissue compression parameter includes FTC, the end actuator 21008, the first limit may indicate the delinearization above which the clamped tissue is considered rigid. Stiff tissue may be relatively prone to tearing, due to the mechanical actions of the grippers on the tissue or, for lung tissue, during reinflation. Additionally, the second limit may indicate the delinearization below which the trapped tissue is considered to have a weak shear force (i.e., being soft). Fabric that has poor shear strength may be relatively difficult for end actuator 21008 to firmly grip or otherwise hold in place during clipping and/or firing of the cutting member (i.e., I-beam 150178 with cutting edge 150182).

[0606] It should be noted that although the steps of the specific example of process 21050 in Figure 96 are shown as having occurred in a certain order or sequence, this representation is for illustrative purposes only and not a specific sequence of process 21050 is intended, to unless a specific sequence of specific steps is explicitly required from the above description. For example, in other aspects of process 21050, control circuit 21002 may determine 21058 whether the detected tissue compression parameter is below a second or lower threshold, before determining 21054 whether the detected tissue compression parameter exceeds a first or upper limit.

[0607] Figure 97 illustrates a first graph 21100 representing FTC end actuator 21104 versus time 21102 for illustrative shots from a surgical instrument 21000, in accordance with at least one aspect of the present description. In the following description of the first graph 21100, reference is also made to Figures 95 and 96. The first graph 21100 represents a first shot 21110 and a second shot 21114, which are illustrative shots by a surgical instrument 21000 controlled by a control circuit 21002 which performs the process 21050 described above with respect to Figure 96. In this illustrative example, the first threshold 21106 includes a specific FTC time rate of change (i.e., ΔFTC) and the second threshold 21108 includes a specific FTC. In various aspects, the limits 21106, 21108 may be fixed or predetermined values, defined with respect to one or more other variables, or programmed or configured by a user of the surgical instrument 21000.

[0608] For the first shot 21110, the control circuit 21002 that performs the process illustrated in Figure 96 receives 21052 the tissue compression parameter data and/or signals and determines 21058 that the FTC falls below the second threshold 21108 in time t1. Accordingly, the control circuit 21002 provides 21060 feedback to the user, including a suggestion for the user to take certain actions and/or indicating that the end actuator 21008 is gripping a fabric that has a low shear strength. In one aspect, the feedback provided 21060 may include a suggestion that the user release and retrigger the surgical instrument 21000 with a tissue compensator (e.g., a tissue compensator described in U.S. Patent Application No. 8,657,176) applied to the actuator. edge 21008 to reinforce and/or compensate for the low shear strength of the fabric. In one aspect, the control circuit 21002 may further be configured to cause the motor 21006 to stop by closing the jaws of the end actuator 21008 if the FTC is below the second threshold. In another aspect, the control circuit 21002 may be configured to provide a suggestion to the user to stop closing the jaws of the end actuator 21008 if the FTC is below the second threshold. The feedback provided 21060 may take a variety of forms, including, for example, an instruction displayed on the operating room screen 107, 109, 119 (Figure 2) and/or on the surgical instrument screen, an audible message emitted by a loud -speaker located in the operating room and/or on the surgical instrument, tactile feedback through the surgical instrument or combinations thereof.

[0609] For the second shot 21114 (which may be a shot using a tissue compensator subsequent to the first shot 21110), the control circuit 21002 executing the process 21050 illustrated in Figure 96 receives 21052 the data and/or signals from the control parameter. tissue compression and does not cause the FTC to fall below the second limit or exceed the first limit at any point during the course of closure of the end actuator 21008. Consequently, the control circuit 21002 does not affect the closure rate of the gripper, providing feedback to the user, or take any other such action.

[0610] Figure 98 illustrates a second graph 21116 that represents the FTC end actuator 21102 versus time 21104 for an illustrative firing of a surgical instrument 21000, in accordance with at least one aspect of the present description. In the following description of the second graph 21116, reference is also made to Figures 95 and 96. The second graph 21116 represents a third shot 21118 which is an illustrative shot by a surgical instrument 21000 controlled by a control circuit 21002 that executes the process 21050 described above in relation to Figure 96. In this illustrative example, the first limit 21106 includes an FTC-specific time rate of change (i.e., ΔFTC).

[0611] For the third shot 21116, the control circuit 21002 that performs the process illustrated in Figure 96 receives 21052 the tissue compression parameter data and/or signals and determines 21058 that the FTC falls below the first threshold 21106 in time t2. Accordingly, the control circuit 21002 controls 21056 the motor 21006 to increase the clamp closing time, such as decreasing the clamp closing rate, which correspondingly reduces the rate at which the FTC 21102 increases. Increasing the clamp closing time can be beneficial to, for example, prevent it from causing damage to rigid tissue by preventing a greater amount of force from being exerted on the tissue for a short period of time. In one aspect, the first limit 21106 may include a standard FTC rate of change (ΔFTCD), that is, the standard or baseline FTC rate for a surgical instrument 21000 absent any modifications to the FTC by a control algorithm in accordance with with the type of fabric and other parameters. In this regard, if the FTC experienced by the surgical instrument 21000 during a surgical procedure exceeds the FTCD, then the control circuit 21002 executing the process 21050 may control 21056 the motor 21006 to increase the clamp closing time.

[0612] The time in which the control circuit 21002 executing the aforementioned algorithm or process compares the parameter detected by the sensor or sensors 21004 with one or more thresholds may include a discrete instance during the firing stroke of the surgical instrument 21000, a series of discrete instances during the firing course and/or a continuous time interval during the firing course. The tissue compression parameter monitored by control circuit 21002 and compared to a threshold may include, for example, an FTC value (e.g., the second threshold 21108 depicted in Figure 97) or a ΔFTC value (e.g., the first limit 21106 represented in Figures 97 and 98).

[0613] In one aspect, the control circuit 21002 may be further configured to store data related to the shots of the surgical instrument 21000 and then optionally use the data from the previous shots to adjust an algorithm for determining the tissue integrity of a trapped tissue. . For example, data from previous shots can be used to adjust the first and/or second limits of the process 21050 depicted in Figure 96. In one aspect, the surgical instrument 21000 can be configured to pair with a central surgical controller 106 (Figures 1 to 3) running a situational awareness system as described above under the title "Situational Awareness" and described in US Patent Application No. 15/940,654 entitled SURGICAL HUB SITUATIONAL AWARENESS filed March 29, 2018, which is here incorporated by reference in the present invention in its entirety. In this aspect, the situational recognition system can determine the type of tissue being operated on during the surgical procedure and adjust the algorithm to determine the tissue integrity of a trapped tissue accordingly. In another aspect, the surgical instrument 21000 may be configured to receive user input indicating the type of tissue being operated on and adjust the algorithm to determine the integrity of the tissue accordingly. For example, the surgical instrument 21000 may be configured to adjust the first and/or second limits of the process 21050 depicted in Figure 96 of default values according to the type of tissue inserted by the user.

[0614] The techniques described above allow the surgical instrument 21000 to avoid damaging trapped tissue and avoid operational failures (e.g., malformed staples) resulting from claw closure rates that are inadequate or non-optimal for the specific characteristics of the tissue being operated on. . Additionally, the techniques described above optimize the ability of the surgical instrument to adequately respond to tissue characteristics encountered during the course of a surgical procedure.

Initial tissue contact to determine tissue type

[0615] Clamping the tissue at an inadequate closure rate or with inadequate closure limits may result in damage to the tissue (e.g., the tissue may be torn due to the jaws applying too much force to the tissue) and/or operational failures by the instrument surgical (e.g., staples may be malformed due to tissue not being held securely by the jaws as the staples are fired). Accordingly, in some aspects, the surgical instrument is configured to detect the characteristics of the tissue being gripped by the surgical instrument and adjust the closure rate(s), closure limit(s), and other operating parameters. correspondingly. Additionally, each surgical procedure may involve multiple different tissue types and/or tissues with different characteristics. Accordingly, in some aspects, the surgical instrument is configured to dynamically detect tissue characteristics each time a tissue is clamped and adjust the closure rate(s), the closure limit(s), and other operating parameters accordingly.

[0616] The present description provides at least one solution, being that a surgical instrument is configured to characterize the tissue type of the tissue being clamped according to the degree of contact of the tissue against the surfaces of the claws and the relative positions of the claws in the initial point in contact with the tissue. The jaw closure rate and the threshold for adjusting the jaw closure rate can then be adjusted to levels suitable for the tissue type characterized by the detected degree of tissue contact and the detected position of the jaws. For example, the surgical instrument may be configured to differentiate between parenchyma and vessels because parenchyma comes into contact to a greater degree with the claw surfaces and the claws at a greater angle at the point of initial contact compared to the vessels. The surgical instrument can then control the motor to affect the claw closure rate and adjust the threshold in accordance with the type of tissue detected.

[0617] Referring again to Figure 95, in one aspect, a surgical instrument 21000 includes a control circuit 21002 coupled to a motor 21006, a user interface 21010, and a sensor (or sensors) 21004. The motor 21006 is coupled to an end actuator 21008 such that the motor 21006 causes the claws (e.g., the anvil 150306 and/or channel 150302 of the surgical instrument 150010 depicted in Figure 25) of the end actuator 21008 to transition between a first configuration or open configuration and a second closed configuration or configuration, as is discussed in relation to Figure 26. The sensor or sensors 21004 may be communicably coupled to the control circuit 21002 such that the control circuit 21002 receives data and/or signals from the same. The control circuit 21002 may be communicably coupled to the motor 21006 such that the control circuit 21002 controls the operation of the motor 21006 according to, for example, data and/or signals received from the sensor or sensors 21004.

[0618] In various aspects, the sensor or sensors 21004 may be configured to detect physical contact of a tissue against the surface of the jaws of the end actuator 21008. In one aspect, the sensor or sensors 21004 may include one or more sensors of tissue contact surfaces arranged along the tissue contact surfaces of the 21008 end actuator, such as the anvil and the cartridge or channel. Tissue contact sensors may include, for example, a plurality of sensors or segments of a segmented circuit disposed sequentially along the surfaces of the grippers that are configured to determine whether tissue is positioned against them, as discussed above with respect to to Figures 75 to 79. In one aspect, the sensor or sensors 21004 include a plurality of electrodes that are each configured to receive an RF signal from a corresponding electrode disposed on the opposing claw, as is discussed in connection with Figures 36 to 38. Accordingly, the control circuit 21002 can perform continuity tests along the length of the end actuator 21008 to determine that tissue is present at the locations corresponding to each electrode that is capable of receiving the signal from its corresponding electrode (because a signal transmission medium, i.e. a tissue, needs to be situated between them for an electrode to receive the signal from its corresponding electrode). In another aspect, the sensor or sensors 21004 include a plurality of force-sensitive transducers that are each configured to determine the amount of force being applied to the sensor or sensors 21004, as discussed with respect to Figure 24. Accordingly, control circuit 21002 may determine that tissue is present at locations corresponding to each force-sensitive transducer that is detecting a non-zero force against it. In other aspects, the sensor or sensors 21004 include a plurality of load cells, pressure sensors, and/or other sensors configured to detect physical contact therewith. Similar to the above discussion regarding the force sensitive transducer, the control circuit 21002 may determine that fabric is present at the locations corresponding to each load cell, pressure sensor and/or other sensor that is detecting a different force. from zero. In yet another aspect, the sensor or sensors 21004 include a current sensor that is configured to detect the amount of electrical current being drawn by the motor 21006, as is discussed with respect to Figures 12, 18 or 19. Accordingly, the circuit of control 21002 may determine the point at which the jaws of the end actuator 21008 initially contact the tissue according to the time at which the current drawn by the motor 21006 increases to compensate for the increased clamp load experienced by the motor 21006 when the claws come into contact with tissue and begin to exert a gripping force against it, as discussed in relation to Figure 83 (i.e., the FTC increases 153610, 153616 as the claws grip the tissue and the FTC corresponds to the motor current ). The various aspects described earlier in this document can be used, individually or in combination with other aspects, to determine the initial point of contact between the end actuator 21008 and the tissue being stapled and/or the degree of contact between the tissue and the actuator. end point 21008.

[0619] Figure 99 illustrates a logical flowchart of a process 21200 for controlling a surgical instrument according to the physiological type of the trapped tissue, in accordance with at least one aspect of the present description. In the following description of process 21200, reference is also made to Figure 95. The illustrated process can be performed, for example, by the control circuit 21002 of the surgical instrument 21000. Accordingly, the control circuit 21002 that executes the illustrated process 21200 receives 21202 fabric contact data and/or signals from the sensor or sensors 21004, such as the fabric contact sensors discussed above and depicted in Figures 100A to 101B. The received tissue contact data and/or signals 21202 indicate whether the tissue is in contact with at least one of the sensors 21004. Accordingly, the control circuit 21002 may determine 21204 the initial point of contact between the end actuator 21008 and the tissue being trapped. In one aspect, the control circuit 21002 determines 21204 when initial tissue contact occurs by detecting when at least one of the sensors 21004 disposed on each of the grippers detects tissue contact against it.

[0620] Consequently, the control circuit 21002 determines 21206 the position of the claws at the initial tissue contact point. In one aspect, the control circuit 21002 is communicably coupled to a Hall Effect sensor disposed on one of the claws of the end actuator 21008 that is configured to detect the relative position of a corresponding magnetic element disposed on the opposite claw, as is discussed in relation to Figure 77. The control circuit 21002 can then determine the position of the claws 21206 according to the detected distance or gap between them. In another aspect, the control circuit 21002 is communicably coupled to a position sensor that is configured to detect the absolute or relative position of a closure tube that is configured to close the jaws as the closure tube is actuated to from a first or proximal position to a second or distal position, as discussed in relation to Figures 20 to 21 and 25. The control circuit 21002 may then determine 21206 the position of the grippers in accordance with the detected position of the tube. closure. In yet another aspect, the control circuit 21002 is communicably coupled to an angle sensor, such as an Infineon Technologies TLE5012B 360° angle sensor, configured to detect the angle at which at least one of the claws is oriented. The control circuit 21002 may then determine 21206 the position of the grippers according to the detected angle at which the gripper or grippers are oriented.

[0621] Accordingly, the control circuit 21002 determines 21208 the degree of contact between the held tissue and the tissue contacting surface or surfaces of the grippers. The degree of contact with the tissue may correspond to the number or ratio of sensors 21004 that detected the presence (or absence) of the tissue, as is discussed with respect to Figure 79. In one aspect, the control circuit 21002 may determine the degree of fabric contact according to the ratio of the sensor or sensors 21004 that detected the presence of fabric and the sensor or sensors 21004 that did not detect the presence of fabric.

[0622] Accordingly, the control circuit 21002 applies 21210 control parameters to the motor 21006 according to the determined position 21206 of the claws and the determined degree 21208 of contact with the tissue. Motor control parameters may include, for example, time to close the jaws and/or closing limit(s). In one aspect, the control circuit 21002 may be configured to perform a run-time calculation and/or access a memory (e.g., a lookup table) to retrieve motor control parameters (e.g., the rate of gripper closure and closing limit) associated with the specific position of the grippers and the particular degree of contact with the tissue detected through the various sensors. In various aspects, control circuit 21002 may control motor 21006 to adjust the clamp closing time, e.g., adjust the rate at which the grippers are transitioned from the open position to the closed position, adjust the time interval at which The grippers are paused after initial tissue engagement (i.e., tissue creep dwell time) and/or adjustment of the stabilization threshold that ends the clamping phase. In various aspects, the closing limit(s) may include, for example, the maximum allowable FTC, the 21008 end actuator, or the rate of change of the FTC (i.e., ΔFTC) at which the circuit control module 21002 to motor 21006 that drives jaw closure or performs other actions as discussed above under the heading "Compression Rate to Determine Tissue Integrity." The control circuit 21002 may then control the motor 21206 according to the control parameter set of the motor 21210 via the process 21200.

[0623] The position of the grippers and the degree of tissue contact at the initial point of tissue contact corresponds to the thickness or geometry of the tissue being held, which in turn corresponds to the physiological type of the tissue. In this way, the control circuit 21002 can be configured to distinguish between tissue types and then adjusted 21210 to control the parameters for the motor 21006 accordingly. For example, control circuit 21002 may be configured to determine whether parenchyma or vascular tissue has been trapped by end actuator 21008 and then adjust 21210 motor control parameters that are appropriate for the type of tissue detected.

[0624] In some aspects, the clamp closure rate may be selected for each tissue type to maintain the maximum FTC and/or ΔFTC under a certain closure limit, which may likewise be selected for each tissue type. In one aspect, the control circuit 21002 may be configured to institute a minimum grip rate so that the closing movement of the jaws is never permanently interrupted. In one aspect, control circuit 21002 may be configured to control maximum dwell times to ensure that clamp closure progresses at at least a standard rate. In one aspect, the control circuit 21002 may be configured to stop the motor 21006 and/or provide feedback to the user when the closing limit or limits are exceeded or otherwise run aground during use of the surgical instrument 21000.

[0625] It should be noted that although the steps of the specific example of process 21200 in Figure 99 are shown as having occurred in a certain order or sequence, this representation is for illustrative purposes only and not a specific sequence of process 21200 is intended, to unless a specific sequence of specific steps is explicitly required from the above description. For example, in other aspects of process 21200, control circuit 21002 may determine 21208 the degree of contact with fabric 21206 before determining the position of the gripper at the initial point of contact.

[0626] Figures 100A and 101B illustrate various side elevation views of an end actuator 21008 holding parenchyma 21030 and a vessel 21032, in initial tissue contact positions and in closed positions, in accordance with at least one aspect of the this description. In the aspect shown, the end actuator 21008 includes a plurality of tissue contact sensors 21016 disposed along the tissue contact surfaces of the grippers, which include the anvil 21012 and the channel 21014. In other aspects, the end actuator 21008 tissue contact sensors 21016 may be arranged along a cartridge 150304 (Figure 25), in addition to or instead of being disposed along channel 21014 of surgical instrument 21000. For brevity, tissue contact sensors 21016 will be discussed as being disposed along channel 21014 in the following description; however, it should be noted that the concepts discussed in the present invention also apply to aspects where tissue contact sensors 21016 are disposed along the cartridge 150304. The tissue contact sensors 21016 may include, for example, impedance, load cells, force sensitive transducers and combinations thereof, as discussed above. The tissue contact sensors 21016 can be delineated into activated sensors 21018 (i.e., sensors that detect the presence of tissue) and non-activated sensors 21020 (i.e., sensors that do not detect the presence of tissue) during use of the instrument surgical 21000 in a surgical procedure.

[0627] Figures 100A and 101A illustrate the initial point of contact of the end actuator 21008 with the parenchyma 21030 and a vessel 21032, respectively. In one aspect, the initial point of contact between the end actuator 21008 and a tissue can be defined as the point at which there is at least one activated sensor 21018 on both the anvil 21012 and the channel 21014. As described above, the tissue types can be differentiated according to the position of the claws (i.e., the anvil 21012 and/or the channel 21014) and the degree of contact between the tissue and the claws at the point of initial contact with the tissue. For example, Figures 100A and 101A illustrate how parenchyma 21030 and a vessel 21032 can be differentiated based on the proportion of activated sensors 21018 at the initial tissue contact point. That is, grasping a vessel 21032 results in fewer activated sensors 21018 compared to grasping the parenchyma 21030. It should also be noted that the number of activated tissue sensors 21018 in the anvil 21012 and in the canal 21014 does not need to be equal at the point initial tissue contact. As another example, Figures 100A and 101A illustrate how parenchyma 21030 and a vessel 21032 can be differentiated based on the angle at which the anvil 21012 is oriented relative to the canal 21014 at the point of initial tissue contact. That is, the anvil 21012 is oriented at a first angle θ1 at the point of initial contact with the parenchyma 21030 and at a second angle θ2 at the point of initial contact with the vessel 21032. The differences between the proportion of activated sensors 21018 and the angle in which the anvil 21012 is oriented can be used individually or in combination (e.g., by the process 21200 illustrated in Figure 99) to characterize the physiological type of tissue being clamped and then set the appropriate claw closure rate. , closure limits and other motor control parameters for the fabric type.

[0628] Figures 100B and 101B illustrate the point at which the end actuator 21008 has the parenchyma and a vessel 21032 fully attached 21030, respectively. As can be seen, the change in the number or proportion of activated sensors 21018 and non-activated sensors 21020 when the end actuator 21008 clamps the fabric in the same way can be used to determine the type of fabric and/or physical characteristics of the fabric, the degree to which the tissue is compressed and/or the distance between the anvil 21012 and the canal 21014 and various other parameters. For example, a vessel 21032 deforms much more than the parenchyma 21030 when fully clamped, which results in a relatively greater change in the number of activated sensors 21018 when the end actuator 21008 clamps the vessel 21032. In some aspects, a circuit of control may perform a process to determine the tissue type (i.e., physiological type of tissue or tissue with certain physical characteristics) according to the change or rate of change in the number of activated sensors 21018 when the end actuator 21008 is clamped. In some aspects, a control circuit may perform a process to determine the degree to which the fabric is compressed and/or deformed according to the change or rate of change in the number of activated sensors 21018 when the end actuator 21008 is clamped.

[0629] In some aspects where the surgical instrument 21000 includes a control circuit 21002 performing the process 21200 described above in Figure 99, when the control circuit 21002 determines that the claws 21013 have initially contacted tissue, the control circuit control 21002 can be configured to detect or measure the separation between the jaws θ and the length or degree of tissue contact between the fabric and the jaws L. The closure limits (e.g., the FTC limit or ΔFTC), the initial speed closing speed(s) and the set closing speed(s) (i.e., the closing speed(s) at which the jaws 21013 are closed after a closing limit is exceeded) can each of these, be a function of θ and L. As depicted in Figures 100A and B, the claw separation can be defined as θ1 and the degree of tissue contact can be defined as L1 at the point of initial contact with a first tissue ( e.g. parenchyma 21030). As depicted in Figures 101A and B, the claw separation can be defined as θ2 and the degree of tissue contact can be defined as L2 at the point of initial contact with a second tissue (e.g., a 21032 vessel). Consequently, in some aspects where θ1 > θ and L1 > L2, the FTCp limit of the FTC parenchyma > the FTCv limit of the FTC vessel; the ΔFTCp limit of the parenchyma ΔFTC > the ΔFTCv limit of the vessel angular coefficient; and the initial closure velocity of the VV1 vessel > the initial closure velocity of the VP1 parenchyma. The operational differences between these limits are discussed in more detail below with respect to Figures 102 and 103.

[0630] Figure 102 illustrates a first graph 21300 and a second graph 21302 representing the FTC end actuator 21304 and the closing speed 21306, respectively, versus time 21308 for illustrative shots of a surgical instrument 21000 grasping the parenchyma 21030, of accordance with at least one aspect of the present description. In the following description of the first graph 21300 and the second graph 21302, reference should also be made to Figures 95 and 99 to 100B. The illustrative shots described herein are intended to demonstrate the concepts discussed above in relation to Figures 95 and 99 to 100B and should not be construed as limiting in any way.

[0631] A first shot of a surgical instrument 21000 may be represented by a first FTC curve 21310 and a corresponding first velocity curve 21310', which illustrate the change in FTC and closing speed over time during the course of the first shot. , respectively. The first firing may represent, for example, a standard firing of the surgical instrument 21000 or a firing of the surgical instrument 21000 that does not include a control circuit 21002 executing the process 21200 depicted in Figure 99. When firing of the surgical instrument 21000 is initiated, the control circuit 21002 controls the motor 21006 to begin driving the anvil 21014 from its open position, which causes the closing speed of the anvil 21012 to increase drastically 21318 until reaching a first or standard closing speed vd1. As the anvil 21012 is fired from the open position, it comes into contact with the trapped tissue which, for this specific firing, is the parenchyma 21030. As the anvil 21012 comes into contact with the tissue being clamped at time t0, the FTC increases 21312 from an initial FTC (e.g., zero) to a peak 21314 at time t1. At time t1, the control circuit 21002 of the surgical instrument 21000 determines that the FTC has reached or exceeded an FTC limit (which may be, for example, a standard limit regardless of tissue type) and controls the motor 21006 by stopping the movement of the anvil 21012, causing the closing speed to drop 21320 to zero. The movement of the anvil 21012 may be paused for a period p1, during which the closing speed is maintained 21322 at zero. During the pause, the FTC gradually decreases 21316 as the trapped tissue relaxes.

[0632] A second shot of a surgical instrument 21000 may be represented by a second FTC curve 21324 and a corresponding first velocity curve 21324', which illustrate the change in FTC and closing speed over time during the course of the second shot. , respectively. In contrast to the first shot, the second shot may represent, for example, a shot of the surgical instrument 21000 that includes a control circuit 21002 that performs the process depicted in Figure 99. When the shot of the surgical instrument 21000 is initiated, the circuit control 21002 controls the motor 21006 to begin driving the anvil 21014 from its open position, which causes the closing speed of the anvil 21014 to increase drastically 21336. Due to the relative thickness and/or geometry of the parenchyma 21030, the The initial point of contact between the tissue (i.e., parenchyma 21030) and the claws 21013 occurs shortly after the anvil 21012 begins to be driven by the motor 21006; Therefore, the control circuit 21002 that executes the process 21200 depicted in Figure 99 is able to determine almost immediately that the parenchyma 21030 is being clamped and, correspondingly, set the time to close the grippers, the limit(s) of closing and other closing parameters at a relatively early point in the closing process. Accordingly, the control circuit 21002 controls the motor 21006 to cause the closing speed of the anvil 21014 to increase sharply 21336 to an initial closing speed vp1 specific to the parenchymal tissue 21320.

[0633] As the anvil 21012 is fired from the open position, it comes into contact with the trapped tissue which, for this specific firing, is the parenchyma 21030. As the anvil 21012 comes into contact with the tissue that is being trapped at time t0, the FTC increases 21326 from an initial FTC (e.g. zero) to a first peak 21328 at time t2. It should be noted that the FTC increases 21326 more slowly during the second shot, compared to the first shot, because the control circuit 21002 executing process 21200 has selected an initial closing speed or first vp1 in the second shot that is appropriate for the type of tissue being fixed, which reduces the amount of force exerted on the tissue compared to an unmodified shot from the surgical instrument 21000. At time t2, the control circuit 21002 of the surgical instrument 21000 determines that the FTC has reached or exceeded a FTC limit, FTCp (which had been set by the control circuit 21002 at or after t0 when the control circuit 21002 determined that the parenchymal tissue 21030 was being tightened). The parenchymal FTC limit FTCp may represent, for example, the maximum force that can be safely or desirably exerted on the parenchymal tissue 21030. Accordingly, the control circuit 21002 controls the motor 21006 to stop the movement of the anvil 21012, causing with the closing speed falling 21338 to zero. The movement of the anvil 21012 may be paused for a period p2, during which the closing speed is maintained 21340 at zero. During the pause, the FTC gradually decreases 21330 as the trapped tissue relaxes. The pause duration p2 may be equal to a standard pause duration (e.g., p1) or a closing parameter selected by the control circuit 21002 for the parenchymal tissue 21030.

[0634] After the pause duration p2 has elapsed in time t3, the control circuit 21002 re-engages the motor 21006 and resumes closing the anvil 21012. Consequently, the closing speed increases 21342 to a second closing speed vp2. In some aspects, after the parenchymal FTC limit FTCp is exceeded for the first time, the control circuit 21002 reduces the closing speed at which the anvil 21012 is closed to a second closing speed vp2 specific to the parenchymal tissue 21030, where vp2 < vp1. The control circuit 21002 may be configured to close the anvil 21012 at a lower speed subsequent to the FTCp limit of the parenchymal FTC being exceeded because this may indicate that the tissue is thicker, stiffer, or more resistant to the closing forces of the anvil. 21012 than expected for the type of tissue detected. Therefore, it may be desirable to reduce the speed of closure to attempt to reduce the amount of closure forces subsequently exerted on the tissue being secured.

[0635] As the anvil 21012 resumes closing at time t3, the FTC again begins to increase until peaking 21332 at time t4 and once again reaches or exceeds the strength limit of the FTCp parenchyma. At time t4, the control circuit 21002 of the surgical instrument 21000 determines that the FTC has reached or exceeded the FTC limit, FTCp. Consequently, the control circuit 21002 controls the motor 21006 to stop the movement of the anvil 21012, causing the closing speed to fall 21346 to zero. The movement of the anvil 21012 may be paused for a period p3, during which the closing speed is maintained 21348 at zero. During the pause, the FTC gradually decreases 21334 as the trapped tissue relaxes.

[0636] Figure 103 illustrates a third graph 21350 and a fourth graph 21352 depicting the FTC end actuator 21354 and the closing speed 21356, respectively, versus time 21358 for illustrative shots of a surgical instrument 21000 grasping the vessel 21032, of accordance with at least one aspect of the present description. In the following description of the third graph 21350 and the second graph 21352, reference should also be made to Figures 95, 99, 101A to B. The illustrative shots described herein are intended to demonstrate the concepts discussed above in relation to Figures 95, 99 , 101A and B and should not be construed as limiting in any way.

[0637] A third shot of a surgical instrument 21000 may be represented by a third FTC curve 21360 and a corresponding first velocity curve 21360', which illustrate the change in FTC and closing speed over time during the course of the third shot. , respectively. The third shot may represent, for example, a standard shot of the surgical instrument 21000 or a shot of the surgical instrument 21000 that does not include a control circuit 21002 performing the process depicted in Figure 99. When the shot of the surgical instrument 21000 is initiated, the Control circuit 21002 controls motor 21006 to begin driving anvil 21014 from its open position, which causes the closing speed of anvil 21012 to increase drastically 21370 until reaching a first or standard closing speed vd2. The initial closing speed vd2 may or may not be the same as the initial closing speed vd1 in Figure 102. As the anvil 21012 is moved from the open position, it travels for a period of time before making contact with the trapped tissue which, for this particular shot, it is a vessel 21032. It should be noted that this contrasts with shots in which the surgical instrument 21000 is gripping the parenchyma 21030, as depicted in Figure 102. Because a vessel 21032 is relatively thin, the anvil 21012 generally must travel a distance before making initial contact with vessel 21032, whereas parenchyma 21032 is generally thicker than vessel 21032 and therefore anvil 21012 generally almost immediately makes initial contact with vessel 21032. Therefore, the FTC is initially null 21362 because the anvil 21012 travels for a period of time without coming into contact with the tissue. After the anvil 21012 contacts the tissue at time t0, the FTC increases 21364 from an initial or flat FTC 21376 (e.g., zero) to a peak 21366 at time t2. At time t2, the control circuit 21002 of the surgical instrument 21000 determines that the FTC has reached or exceeded an FTC limit (which may be, for example, a standard limit regardless of tissue type) and controls the motor 21006 by stopping the movement of the anvil 21012, causing the closing speed to drop 21372 to zero. The movement of the anvil 21012 may be paused for a period p4, during which the closing speed is maintained 21374 at zero. During the pause, the FTC gradually decreases 21368 as the trapped tissue relaxes.

[0638] A fourth shot from a surgical instrument 21000 may be represented by a second FTC curve 21375 and a corresponding first velocity curve 21375', which illustrate the change in FTC and closing speed over time during the course of the second shot. , respectively. In contrast to the first shot, the fourth shot may represent, for example, a shot of the surgical instrument 21000 that includes a control circuit 21002 that executes the process 21200 depicted in Figure 99. When the shot of the surgical instrument 21000 is initiated, the control circuit 21002 controls the motor 21006 to begin driving the anvil 21014 from its open position, which causes the closing speed of the anvil 21014 to increase drastically 21386. Due to the relative thinness and/or geometry of the vessel 21032 ( compared to, for example, the parenchyma 21030), the initial point of contact between the tissue (i.e., the vessel 21032) and the claws 21013 does not occur until after the anvil 21012 has been driven by the motor 21006 for a period of time ; therefore, the control circuit 21002 executing the process 21200 depicted in Figure 99 is not capable of determining that a vessel 21032 is being clamped and correspondingly sets the time to close the grippers, the closing limit(s) and other appropriate closing parameters until the closing process has been carried out for a period of time. Since the anvil 21012 does not come into contact with the finer tissue of the vessel 21032 for a period of time and therefore the control circuit 21002 cannot detect which type of tissue is being trapped, the control circuit 21002 controls the motor 21006 to cause the anvil closing speed 21014 to increase sharply 21386 to the standard speed vd.

[0639] As the anvil 21012 is actuated from the open position, the FTC is initially flat 21376 because the anvil 21012 moves for a period of time without contacting the tissue. After the anvil 21012 contacts the tissue at time t0, the FTC increases 21378 from an initial FTC (e.g., zero). After contacting the vessel 21032, the control circuit 21002 executing the process 21200 illustrated in Figure 99 is able to determine that a vessel 21032 is being clamped and correspondingly sets the time to close the grippers, the threshold(s) closing(s) and other closing parameters at that point in the closing process. At time t1, control circuit 21002 determines that ΔFTC has reached or exceeded a threshold of ΔFTC, ΔFTCv (which had been set by control circuit 21002 at or after t0 when control circuit 21002 determined that a vessel 21032 was being trapped ). The vessel ΔFTC limit, ΔFTCv, may represent, for example, the maximum rate of force change that can be safely or desirably exerted on a vessel tissue 21032. Accordingly, the control circuit 21002 controls the motor 21006 to dropping 21388 the closure velocity to a vessel closure velocity vv1 that is specific to the vessel tissue 2032, where vv1 < vd.

[0640] As the anvil 21012 advances at the slower velocity of vessel closure vv1, the FTC increases 21380 more slowly than previously until reaching the peak 21382 at time t3. At time t3, control circuit 21002 determines that the FTC has reached or exceeded an NDG threshold, NDGv (which had been set by control circuit 21002 at or after t0 when control circuit 21002 determines that a vessel 21032 is being trapped ). The FTC limit of the vessel, FTCv, may represent, for example, the maximum force that can be safely or desirably exerted on a tissue of the vessel 21032. Consequently, the control circuit 21002 controls the motor 21006 to stop the movement of the vessel. anvil 21012, causing the closing speed to drop 21932 to zero. The movement of the anvil 21012 may be paused for a period p5, during which the closing speed is maintained 21394 at zero. During the pause, the FTC gradually decreases 21384 as the trapped tissue relaxes. The pause duration p5 may be equal to a standard pause duration (e.g., p1) or a closure parameter selected by the control circuit 21002 for the vessel tissue 21032.

[0641] In summary, Figures 102 and 103 highlight the different ways in which a surgical instrument 21000 functions with and without a control circuit 21002 that performs the process 21200 illustrated in Figure 99.

[0642] Figure 104 illustrates a fifth graph 21400 representing the FTC end actuator 21402 and closing speed 21404 versus time 21406 for an illustrative firing of a surgical instrument, in accordance with at least one aspect of the present description. In the following description of the fifth graph 21400 reference should also be made to Figures 95 and 99 to 101B. The illustrative shots described herein are intended to demonstrate the concepts discussed above in relation to Figures 95 and 99 to 101B and should not be construed as limiting in any way.

[0643] A fifth shot of a surgical instrument 21000 may be represented by a fifth FTC curve 21408 and a corresponding fifth velocity curve 21408', which illustrate the change in FTC and closing speed over time during the course of the fifth shot. , respectively. The fifth shot may represent, for example, a shot of the surgical instrument 21000 that includes a control circuit 21002 that performs the process depicted in Figure 99. When the shot of the surgical instrument 21000 is initiated, the control circuit 21002 controls the motor 21006 to start driving the anvil 21014 from its open position, which causes the closing speed of the anvil 21014 to increase drastically 21416 up to a certain plateau 21418 of a specific closing speed. As the 21012 anvil closes, the FTC increases 21412 until it reaches its peak 21410 at a specific time. From peak 21412, the FTC decreases 21414 until the fabric is fully trapped, at which point the control circuit 21002 controls the motor 21006 to stop closing the anvil 21012 and the closing speed drops 21420 to zero.

[0644] The fifth shot thus represents a shot of the surgical instrument 21000 with no part of the FTC limit, the ΔFTC limit, or any other closing limit being reached or exceeded during the closure of the jaws 21013. In other words, the fifth shot remains within all control parameters during the course of closing jaws 21013. In this way, control circuit 21002 does not pause anvil 21012, adjust the closing speed of anvil 21012, or take any other corrective action during the claw closing course 21013.

[0645] Figure 105 illustrates a sixth graph 21422 representing the FTC end actuator 21402 and closing speed 21404 versus time 21406 for an illustrative firing of a surgical instrument, in accordance with at least one aspect of the present description. In the following description of the sixth graph 21422 reference should also be made to Figures 95 and 99 to 101B. The illustrative shots described herein are intended to demonstrate the concepts discussed above in relation to Figures 95 and 99 to 101B and should not be construed as limiting in any way.

[0646] A sixth shot of a surgical instrument 21000 may be represented by a sixth FTC curve 21424 and a corresponding sixth velocity curve 21424', which illustrate the change in FTC and closing speed over time during the course of the sixth shot. , respectively. The sixth shot may represent, for example, a shot of the surgical instrument 21000 that includes a control circuit 21002 that executes the process 21200 depicted in Figure 99. When the shot of the surgical instrument 21000 is initiated, the control circuit 21002 controls the motor 21006 to begin driving the anvil 21014 from its open position, which causes the closing speed of the anvil 21014 to increase drastically 21432 until it reaches a specific closing speed. As the 21012 anvil closes, the FTC increases 21428 until it reaches its peak 21426 at a specific time. In this specific case, the operator of the surgical instrument 21000 elects to open the jaws 21013 of the surgical instrument 21000 in order to readjust the tissue therein. In this way, the closing speed drops 21434 until it reaches a negative closing speed, indicating that the jaws 21013 are being opened to, for example, easily allow the fabric to be readjusted within the jaws 21013. The closing speed then returns 21436 to back to zero, the 21013 claws stopped. Correspondingly, the FTC decreases 21430 to zero as the claws 21013 are released from the fabric.

[0647] Figure 106 illustrates a seventh graph 21438 representing the FTC end actuator 21402 and closing speed 21404 versus time 21406 for an illustrative firing of a surgical instrument, in accordance with at least one aspect of the present description. In the following description of the seventh graph 21438 reference should also be made to Figures 95 and 99 to 101B. The illustrative shots described herein are intended to demonstrate the concepts discussed above in relation to Figures 95 and 99 to 101B and should not be construed as limiting in any way.

[0648] A seventh shot from a surgical instrument 21000 may be represented by a seventh FTC curve 21440 and a corresponding seventh velocity curve 21440', which illustrate the change in FTC and closing speed over time during the course of the seventh shot. , respectively. The seventh shot may represent, for example, a shot of the surgical instrument 21000 that includes a control circuit 21002 that executes the process 21200 depicted in Figure 99. When the shot of the surgical instrument 21000 is initiated, the control circuit 21002 controls the motor 21006 to start driving the anvil 21014 from its open position, which causes the closing speed of the anvil 21014 to increase drastically 21450 until reaching a first closing speed v1. As the 21012 anvil closes, the FTC raises 21442 until time t1. At time t1, control circuit 21002 determines that ΔFTC has reached or exceeded the ΔFTC threshold, ΔFTCT, which may be a standard ΔFTC threshold or a ΔFTC threshold for a particular physiological tissue type detected by control circuit 21002. according to the process 21200 depicted in Figure 99. As another example, the ΔFTCT may be set by another process executed by the control circuit 21002 and/or another control circuit of the surgical instrument 2100 in response to other detected parameters or in accordance with another algorithm. For example, if clamp closure is occurring within the operating parameters of the process 21200 illustrated in Figure 99, but another sensor and/or process of the surgical instrument 21000 determines that the tissue to be clamped nevertheless deviates from the expected clamping parameters. in some way (e.g., the fabric is thicker or thinner than expected for the given fabric type) and then sets the time to close the jaws 21013, the closing limit(s), and so on. control parameters, consequently. In one example, a second sensor detects at time t1 that the tissue is thinner than expected. Consequently, the control circuit 21002 defines a new ΔFTCT (which, in this example, is smaller than the previous ΔFTCT), which the control circuit 21002 determines is being achieved or exceeded at time t1.

[0649] Consequently, the control circuit 21002 controls the motor 21006 to decrease 21452 the closing speed of the anvil 21012 to a second closing speed v2, where v1 > v2. From t1 onwards, the drop in closing speed results in the FTC increasing 21444 at a slower rate. The FTC increases 21444 until it reaches a peak 21446 below the FTC limit, FTCT and then decreases after that. As the seventh shot remains within all closing parameters after t1, the closing speed is maintained 21454 at the second closing speed v2 until the tissue is fully clamped, at which point the control circuit 21002 controls the motor 21006 to stop closing the anvil 21012 and the closing speed drops 21456 to zero.

[0650] Figure 107 illustrates a graph 21500 that shows impedance 21502 versus time 21504 to determine when the claws of a surgical instrument contact tissue and/or staples, in accordance with at least one aspect of the present description. In the following description of the seventh graph 21438 reference should also be made to Figure 95. As discussed above, the sensor or sensors 21004 that are configured to detect the degree of compression of a tissue held by the end actuator 21008 and/or are configured to detect initial contact with a tissue may include, for example, impedance sensors. The impedance and/or rate of change of tissue impedance, as detected by the impedance sensor or sensors, can be used to determine the state of the tissue being clamped. For example, if the detected impedance has a plateau 21506 at a ZOC impedance that indicates an open circuit condition, then a control circuit 21002 coupled to impedance sensors can determine whether the claws are open and/or are in contact with a tissue. As another example, when the initially detected impedance decreases 21508 from the open circuit impedance ZOC, then a control circuit 21002 coupled to the impedance sensors can determine that initial contact with a tissue has been made. As another example, as the sensed impedance decreases 21510 from the open circuit impedance ZOC, the shape of the impedance versus time curve and/or the rate of change of the sensed impedance can be utilized by a control circuit 21002 coupled to the sensors. impedance to determine the compression rate of the tissue and/or the degree to which the tissue is being compressed. As yet another example, if the sensed impedance drops 21512 to zero, then a control circuit 21002 coupled to impedance sensors can determine whether the end actuator claws 21008 have contacted a clamp, which shorts out the sensing system. of impedance.

Examples

[0651] Various aspects of the subject described here under the title "Controlling a surgical instrument according to sensed closure parameters" are presented in the following examples:

[0652] Example 1 - A surgical instrument comprises an end actuator comprising claws transitional between an open configuration and a closed configuration. The surgical instrument further comprises a motor operatively coupled to the claws. The motor is configured to transition the jaws between the open configuration and the closed configuration. The surgical instrument further comprises a sensor configured to transmit at least one signal indicative of a tissue compression parameter associated with a tissue between the claws. The surgical instrument further comprises a control circuit coupled to the sensor and the motor. The control circuit is configured to receive at least one signal, determine a tissue compression parameter value based on the at least one signal as the grippers transition from the open configuration to the closed configuration, cause the motor to increase a time to transition the grippers to the closed configuration according to whether the tissue compression parameter value is above a first threshold, and provide feedback according to whether the tissue compression parameter value is below a second threshold .

[0653] Example 2 - The surgical instrument of Example 1, where the tissue compression parameter comprises a force exerted by the motor to transition the claws to the closed configuration.

[0654] Example 3 - The surgical instrument of Example 1, wherein the tissue compression parameter comprises a time change rate of a force exerted by the motor to transition the claws to the closed configuration.

[0655] Example 4 - The surgical instrument, according to Examples 1, 2, or 3, with the feedback comprising a suggestion for adjunctive reinforcement.

[0656] Example 5 - The surgical instrument of Example 1, 2, 3 or 4, in which the control circuit is configured to increase the transition time of the claws to the closed configuration by decreasing a rate at which the motor makes the transition of the jaws to the closed configuration.

[0657] Example 6 - The surgical instrument of Example 1, 2, 3 or 4, in which the control circuit is configured to increase the transition time of the claws to the closed configuration by increasing the time interval in which the motor stops while transitioning the grips to the closed configuration.

[0658] Example 7 - The surgical instrument of Example 1, 2, 3 or 4, wherein the control circuit is configured to increase the transition time of the claws to the closed configuration by reducing a stabilization threshold to stop the motor when transitioning the grips to the closed configuration.

[0659] Example 8 - A surgical instrument comprising an end actuator. The end actuator comprises grippers transitionable between an open configuration and a closed configuration and one or more sensors disposed along a tissue contact surface of each of the grippers. The one or more sensors are configured to detect contact with a fabric. The surgical instrument further comprises a motor operatively coupled to the claws. The motor is configured to transition the jaws between the open configuration and the closed configuration. The surgical instrument further comprises a control circuit coupled to one or more sensors and the motor. The control circuit is configured to determine an initial contact point at which the fabric contacts the fabric-contacting surfaces of the grippers, determine a separation between the grippers at the initial contact point, determine a degree of contact between the grippers surfaces in contact with the fabric and fabric, causes the motor to transition the grippers to the closed configuration at a rate corresponding to the separation between the grippers and the degree of contact between the surfaces in contact with the fabric and the fabric in the initial contact point and causes the motor to adjust the rate at which the grippers are transferred to the closed configuration depending on whether a force exerted by the motor to transition the grippers to the closed configuration exceeds a threshold. The threshold corresponds to the separation between the grippers and the degree of contact between the fabric contact surfaces and the fabric at the initial point of contact.

[0660] Example 9 - The surgical instrument of Example 8, the one or more sensors comprising pressure sensors.

[0661] Example 10 - The surgical instrument of Example 8, the one or more sensors comprising impedance sensors.

[0662] Example 11 - The surgical instrument of Example 8, 9, or 10, with the separation between the claws comprising an angle between the claws.

[0663] Example 12 - The surgical instrument of Example 8, 9 or 10, with the separation between the claws comprising a gap between the claws.

[0664] Example 13 - A surgical instrument comprising an end actuator. The end actuator comprises grippers configured to transition between an open configuration and a closed configuration for holding a tissue and a contact sensor assembly configured to detect the tissue against it. The surgical instrument further comprises a position sensor configured to detect a configuration of the claws and a motor coupled to the claws. The motor is configured to transition the grippers between the open configuration and the closed configuration. The surgical instrument further comprises a control circuit coupled to the contact sensor assembly, the position sensor and the motor. The control circuit is configured to determine an initial contact point at which the fabric contacts the grippers, determine the configuration of the grippers via the position sensor at the initial contact point, determine an amount of fabric contact between the fabric and the grippers through the sensor assembly contact at the initial contact point, set a closing rate at which the motor transitions the grippers to the closed configuration according to the gripper configuration and the amount of tissue contact at the contact point initial, set a closing limit according to the gripper configuration and the amount of tissue contact at the initial contact point, and control the motor according to a force exerted by the motor to transition the grippers to the closed configuration relative to to a limit.

[0665] Example 14 - The surgical instrument of Example 13, the sensor assembly comprising a pressure sensor.

[0666] Example 15 - The surgical instrument of Example 13, the sensor assembly comprising an impedance sensor.

[0667] Example 16 - The surgical instrument of example 13, 14, or 15, with the configuration of the claws corresponding to an angle between the claws.

[0668] Example 17 - The surgical instrument of example 13, 14, or 15, with the configuration of the claws corresponding to a gap between the claws.

Systems to adjust end actuator parameters based on pre-operative information

[0669] Aspects of the present description are presented for adjusting the closing limit and closing rate implemented by a closing control program executed by a control circuit of a surgical instrument, wherein the adjustment is made based on pre-determined information. operatives. Adjusting the closure limits may be an example of situational awareness performance by the computer-implemented interactive surgical system (including one or more surgical systems 102 and cloud-based medical analysis system, such as cloud 104, 204, which is referred to as cloud 104 for the sake of clarity). For example, closure limits may be adjusted to a patient-specific closure limit based on perioperative information received from cloud 104 or determined by surgical centers or surgical instruments. As used herein, perioperative information comprises preoperative, intraoperative, and postoperative information.

[0670] Pre-operative information refers to information received before performing a surgical operation with a surgical instrument, while intra-operative information refers to information received during a surgical operation (e.g., while a step of the surgical operation is being performed ). In particular, the computer-implemented interactive surgical system may determine or infer end actuator closure parameters, such as an appropriate end actuator closure threshold and closure rate algorithm, for specific portable intelligent surgical instruments. Such inferences may be based on contextual information related to a surgical procedure to be performed and related to the corresponding patient. Contextual information may include or be determined based on perioperative information. Surgical Instruments may be any suitable type of surgical instrument described in the present description, such as surgical instrument 112, 600, 700, 750, 790, 150010. For the sake of clarity, surgical instrument 112 is mentioned.

[0671] Perioperative information, such as diseases and treatments diagnosed perioperatively, may affect the properties or characteristics of the tissue being treated by the surgical instrument 112. For example, a patient may have previously been diagnosed with cancer and received radiation treatments to treat the cancer. Consequently, this preoperative information would indicate that the patient's tissue may have an increased stiffness characteristic. However, the currently applied closure control program may not account for this increased stiffness. Consequently, using the closure control program to perform a surgical procedure according to a general closure rate algorithm could result in unnecessary trauma or tissue injury due to excessive compression of the patient's tissue. Additionally, during a surgical operation, intraoperative information can be analyzed, such as identifying which tissue type among multiple potential tissue types is being treated. Different types of fabric may also have different fabric characteristics such as fabric stiffness. Consequently, changes in intraoperative information can be used to perform intraoperative adjustments alternatively or in addition to perioperative adjustments. In short, closure control programs may not consider that different closure rate limits should be applied depending on perioperative information such as tissue type, surgical procedure being performed, and surgical steps already performed.

[0672] It may be desirable for a surgical instrument to consider different types of tissues and the various characteristics of these different types of tissues when a surgical operation is performed with the surgical instrument 112. In particular, it may be desirable for the surgical instrument 112 to effectively determine the tissue type and the characteristics of that tissue type before the clinician performs a surgical operation with the surgical instrument, as well as during the performance of a surgical operation.

[0673] Accordingly, in some aspects, a cloud-based medical analysis system (e.g., computer-implemented interactive surgical system 100) is provided, in which perioperative information can be considered to determine the type of tissue to be treated and the characteristics of the treated tissue before treatment. For example, the surgical procedure to be performed and other patient information may be instances of preoperative information retrieved before the surgical procedure is performed. Previously performed steps of a surgical operation, other surgical history, and a change in tissue type are examples of intraoperative information that may be considered. In general, this perioperative information can be used in conjunction with sensor signals indicative of a closure parameter to determine, infer, or adjust end actuator parameters (e.g., rate of change and closure limit) of the surgical instrument 112 The end actuator may be any end actuator described herein, such as the end actuator 702, 151600, 150300, 151340, 152000, 152100, 152150, 152200, 152300, 152350, 152400, 153460, 15347 0, 153502. By For the sake of clarity, end actuator 702 is mentioned.

[0674] Analysis of perioperative information for situational recognition related to closure rate can be achieved in several ways. Based on perioperative information, a control circuit such as control circuit 500, 710, 760, 150700 (discussed above in connection with Figures 12, Figure 15, Figure 17, and Figures 29A and B) of a surgical instrument could adjust the rate of change of inputs and closing limits used in the selected closing control program. For the sake of clarity, control circuit 500 is referenced. Control circuit 500 may also select a different control program based on perioperative information. Additionally or alternatively, a central surgical controller such as the central surgical controller 106, 206 (referred to as the central surgical controller 106 for clarity) may receive perioperative information from the cloud 104 or the surgical instrument 112. For example, the central surgical controller 106 may receiving a patient's electronic medical record (EMR) from cloud 104 or initial tissue thickness measurements, which are determined based on tissue contact or pressure sensors (as shown in Figure 24, for example) from the surgical instrument 112.

[0675] The central surgical controller 106 may then analyze the received perioperative information. Based on this analysis, the central surgical controller 106 may then transmit a signal to the surgical instrument 112 to adjust the input change rate and closure limits used in the selected closure control program. The central surgical controller 106 may also instruct the surgical instrument 112 to select a different closing control program, such as by the control circuit selecting a different control program. The selection of a different control program may be based on a signal received from the central controller 106 or by the surgical instrument 112 receiving an updated control program from the central controller 106. The cloud 104 may also perform analysis to adjust the rate of closing and maximum limit used. In particular, the cloud processors 104 may analyze perioperative information to determine tissue type and characteristics to alter inputs to a closure control program or select a different suitable closure control program to be executed by the surgical instrument, e.g. example.

[0676] In this way, the surgical instrument 112 can be instructed by the cloud 104 (via the central controller 106, for example) to apply a suitable closure rate algorithm and maximum closure limit. The tissue type and characteristics can be further determined based on a sensor signal indicative of a closure parameter. The sensors may be fabric contact or pressure sensors, force sensors, motor current sensors, position sensors, load sensors or other suitable sensors such as sensors 472, 474, 476, 630, 734, 736, 738, 744a-744e, 784, 788, 152408, 153102, 153112, 153118, 153126, 153200, 153438, 153448, 153450a, 153450b, 153474, described above. For the sake of clarity, the 474 sensor is mentioned. Sensor 474 is configured to transmit a sensor signal indicative of a parameter of surgical instrument 112. Some types of perioperative information may be stored in cloud 104 prior to determining tissue type and characteristics. For example, patient EMRs may be stored in cloud memory 104 (e.g., cloud databases). In general, surgical instruments 112, centers 106, or cloud 104 can analyze perioperative information to determine tissue type and situational awareness characteristics.

[0677] Therefore, the tissue type and characteristics determined based on perioperative information can be used to proactively adjust the closure rate and upper limit used. That is, perioperative information can be used to predict more effective closure parameters (e.g., end actuator parameters 702) so that the closure control program applied by surgical instrument 112 uses a closure rate and threshold. that consider the specific characteristics of the patient and the type of tissue. Accordingly, the use of closure rate and situational threshold recognition as described herein may advantageously allow the surgical instrument 112 to apply an adjusted closure rate and threshold without overcompressing the tissue to be treated. Super compression may be based on the first and second gripper members of the end actuator 702. A first and second gripper members may be the first gripper member 152002, 152152, 152154 and the second gripper member 152204, 152254, 152304, respectively, for example. The first and second claw members may also refer to the anvil 716, 766 and the staple cartridge 718, 768. For the sake of clarity, the first claw member is called 152002 while the second claw member is called of 152204. The first and second gripper members 152002, 152004 may define an end actuator opening 702, which is defined as the distance between the gripper element member 152002 and the second gripper member 152004.

[0678] Unnecessary tissue damage or trauma from excessive compression may occur when the opening of the end actuator 702 is unnecessarily small, for example. Reducing or preventing such excessive compression can be achieved by adjustment using perioperative information and/or sensor signals from sensors 474. Additionally, compression applied during measurements of initial closure parameters, such as based on load sensor 474 ( measurement of the closing force) and in the positioned sensor 474 (measurement of the position of the first gripper member 152002 and second gripper member 152004) can be minimized. In general, the sensors 474 may be configured to measure the closing force exerted by the end actuator 702 of the surgical instrument 112. In addition to proactively inferring characteristics and tissue type from perioperative information, one or more of the surgical instruments 112, controller central 106 and cloud 104 may use measurements detected by sensors 474 (as shown in Figure 12) to check or make other adjustments to the applied closing force, closing rate, and closing limit if necessary. Specifically, contact sensors can be used to determine the thickness of the undeformed fabric. Furthermore, the load sensor 474 in combination with the position sensor 474 can be used to determine the thickness of the fabric based on the applied closing force relative to the position of the first gripper member 152002 and the second gripper member 152004, respectively. These additional checks or adjustments can be performed pre- or intra-operatively.

[0679] The situational awareness closing parameter can be performed continuously. In this way, the physician or surgeon can use this perioperative information to continually adjust the closure parameters of the end actuator 702 (e.g., from a closure control program) as appropriate (e.g., when steps in a surgical procedure are carried out). For example, perioperative information may be used to adjust the closing parameters of the end actuator 702 when it is determined, based on clinical history (e.g., a surgeon's routine practice), that the next step in the surgical procedure that is being performed involves vascular tissue. In this situation, the situationally aware surgical instrument 112 can apply closing force with a constant closing change rate. Such perioperative information may be used in conjunction with a sensor signal indicative of a closure parameter of the surgical instrument 112 to adjust the closure parameters of the end actuator 702 (e.g., closure change rate and closure limit of a control). Perioperative information, like intraoperative information, may indicate that the patient has previously been treated with radiotherapy.

[0680] Based on this information, control circuit 500 can infer increased tissue stiffness, which is a tissue characteristic that can be considered throughout the steps of the surgical procedure. In one example, this increased tissue stiffness may be used perioperative information to supplement a sensor signal indicative of tissue thickness so that adjustment to a more appropriate value of the closure parameter of the end actuator 702 can be achieved. Perioperative information may also indicate that the surgical procedure being applied is a lobectomy procedure, which could be determined from data stored in the cloud 104. Based on knowledge of the lobectomy procedure, it can be determined that the possible tissue types to be treated (e.g., stapled) include blood vessels, bronchial tissue, and parenchymal tissue.

[0681] Consequently, based on perioperative information, the specific tissue type and characteristics of the tissue currently being treated by the surgical instrument 112 can be predicted or inferred prior to initiating therapeutic tissue treatment. For example, considering the initial tissue thickness (measured when the tissue currently being treated contacts the tip actuator 702) in conjunction with treatment, diagnosis, and patient information may allow an inference that previously irradiated parenchymal tissue is being treated. Because the type and characteristics of the tissue being treated can be determined contextually before the surgical procedure begins, the closure control program implemented by the control circuit 500 of the surgical instrument 112 can be advantageously adjusted (e.g., by changing the parameters input according to inferences from tissue type or characteristics) or changed (e.g., selecting a different control program) before the start of therapeutic treatment. Specifically, the maximum tissue closure limit can be decreased to address the stiffness and fragility of the irradiated parenchyma being treated. Maximum limit can refer to a maximum closing force that can be applied or a maximum closing change rate. Additionally, the closure algorithm of the closure control program could also be adjusted to apply a slower, more conservative closure rate based on the identification of irradiated parenchyma.

[0682] Furthermore, it can be determined whether the surgical instrument 112 is a suitable stapling surgical instrument 112 for the irradiated parenchyma, for example. If perioperative information indicates that the selected surgical instrument 112 is not suitable for its intended use, an alert may be generated. For example, if it can be inferred, based on perioperative information, that the tissue currently being treated is bronchial tissue and an inappropriate vascular stapling surgical instrument 112 is selected, a warning will be generated to the physician. In general, the surgical instrument 112 may generate an alert based on a determined, predicted, or inferred inconsistency between the type of surgical instrument, the perioperative information, and the sensor signal. Furthermore, as discussed above, intraoperative information can also be used for adjustments during the overall surgical procedure. For example, the current step in a general procedure operation may be treating rigid bronchial tissue, which would normally result in a slower rate of closure. Additional adjustments can also be made after an initial adjustment. Specifically, additional adjustments can be made during the operation, such as adjusting the slower closure rate to a faster closure rate when additional intraoperative information (e.g., sensed information) is analyzed and it is inferred that the force to close applied to the currently applied closing algorithm must be modified or adjusted. Such adjustments can also be made post-operatively in certain circumstances.

[0683] Therefore, closure rate and thresholds may benefit based on tissue type, tissue characteristics, and perioperative information determined prior to initiation or during therapeutic treatment. Accordingly, this adjustment can advantageously avoid or minimize tissue damage resulting from excessive strain and facilitate proper formation of staples from a surgical stapling instrument 112.

[0684] Figures 108 and 109 are graphs 22000, 22100 illustrating various end actuator closure limit functions that can be used based on perioperative information and which illustrate an adjusted end actuator closure control algorithm in accordance with with various aspects of the present description. Graph 22100 is an enlarged view of graph 22000. In Figures 108 and 109, the force to clamp or close (FTC), which can be understood as the clamping force applied to the end actuator 702, is indicated on the y axis 22002 , 22102 of graphs 22000, 22100. The time elapsed or covering a surgical cycle is indicated on the geometric axis x 22004, 22104. The geometric axis x 22004 of Figure 108 Indicates that the cycle covers 13 seconds, for example. In contrast, the 22104 x axis of Figure 109 spans a little less than 2 seconds. As shown in Figure 108, a standard universal tissue closure limit function (denoted as FTCd 22006) can be generally applied to control the end actuator 702 that closes surgical instruments 112 used in generic surgical procedures.

[0685] Other limits more conservative than the FTCd 22006 standard are also shown in graphs 22000, 22100. However, less conservative limits could also be used. As represented by FTCL1 22008 and FTCL2 22010, more conservative closing limits are employable to reduce the closing force of the surgical instrument relative to the standard closing force function. The FTCL1 22008 and FTCL2 22010 may be thresholds that are stored in a memory of the surgical instrument 112, the central controller 106, or the cloud 104. Additionally or alternatively, the FTCd 22006 could be dynamically adjusted at a suitable point during the surgical cycle. The dynamic adjustment could be performed by the control circuit 500, the corresponding central controller 106 or the cloud 104. Furthermore, the graphs 22000, 22100 indicate the corresponding slopes of the different closing limit functions FTCd, FTCL1 and FTCL2 22006, 22008 , 22010. Because closure limits can vary as a function of time in the corresponding surgical cycle, the slope of a closure limit can be constant throughout or change as appropriate during the surgical cycle.

[0686] In other words, the instantaneous rate of change defined by the specific closure limit function may be different between different time intervals in the surgical cycle. For example, the particular closure threshold function may define a relatively slower rate of increase around the beginning of the surgical cycle and a relatively faster rate of increase around the middle of the surgical cycle. The closing limit functions ΔFTCd, ΔFTCL1 and ΔFTCL2 22106, 22108, 22110 are magnified in the views of the functions FTCd, FTCL1 and FTCL2 22006, 22008, 22010 and illustrate the corresponding slopes of the closing limit functions. From the appearance of Figure 109, it can be seen that the slope is constant, although the slope can change as appropriate. The closing change rate can be adjusted according to a selected closing threshold function. An example adjustment is illustrated by the "x" in Figures 108 and 109 and is shown larger in the enlarged view of graph 22100. In this example, the closing change rate as represented by lines 22012, 22112 is adjusted so that they do not exceed ΔFTCL2 22110.

[0687] In one aspect, a motor such as motor 482, 704a to 704e, 754, 150082, 150714 of surgical instrument 112 can move the first claw member 152002 relative to the second claw member 152004 of the end actuator 702. By For the sake of clarity, the 482 engine is mentioned. The motor 482 can move or close the end actuator 702 according to the closing change rate, represented by lines 22012, 22112, and the selected closing threshold. For this purpose, the control circuit 500 may adjust a current drawn by the motor 482 to change the speed or torque of the motor 482 based on the selected threshold. For example, graphs 22000, 22100 illustrate how control circuit 500 can adjust motor 482 at point "x" (as indicated in graphs) such that the closing rate of change parameter of surgical instrument 112 is changed to remain within the selected FTCL2 22010 limit. The FTCL2 22010, which may be a patient-specific limit, can be selected and determined based on perioperative information.

[0688] The limits of FTC 22006, 22008, 22010 depicted in graphs 22000, 22100 may be parameters of different or the same closure control programs executed by control circuit 500. These closure control programs may be stored locally in memory of the surgical instrument 112 or stored remotely on the central controller 106 or cloud 104. In general, the closing limit functions define how the closing limits are changed as a function of time in a cycle, so that the instantly applicable closing limit be indicated for any point in time during the cycle. Closing limits can define a maximum closing force that can be applied to close the end actuator jaws or a maximum rate of change of the closing force used, for example. Figure 108 illustrates the use of limits as maximum rates of change of the closing force used. At a selected point in time in graphs 22000, 22100, lines 22012, 22112 plotted against time on the x-axis 22004, 22104 and FTC on the y-axis 22002, 22102 indicate the instantaneous force applied to close the jaws 152002, 152004 at that time .

[0689] As illustrated by line 22012, the applied force increases over time from time zero to time t1, after which the rate of increase decreases to zero and then to a decreasing force rate. Just before time t2, the rate of decrease is much steeper. After time t2, the force applied to close the jaws begins to transition to a zero rate before decreasing again at a non-zero rate. As illustrated by line 22112 of graph 22100, the closing force applied to close the jaws 152002, 152004 is increasing between time zero and a time slightly before 0.5 seconds (shown on x-axis 22104). At the time corresponding to "x" in graph 22100, control circuit 500 may adjust motor 482 to adjust the selected closing algorithm so that the rate of increase of closing is decreased. In this way, the motor 482 can be controlled by the control circuit 500 to stay within the selected patient-specific ΔFTCL2 22110 limit. Furthermore, as shown in graph 22100, after the time corresponding to "x", the slower rate of increase of the applied closing force becomes a constant rate.

[0690] In one aspect, the same total amount of FTC applied can be applied during a surgical cycle. However, the force applied to close the end actuator may be applied more gradually or immediately as appropriate. This is illustrated by the rate of change represented by the closing rate of change lines such as lines 22012, 22112. Although Figure 109 shows each of the three thresholds represented ΔFTCd, ΔFTCL1, and ΔFTCL2 22106, 22108, 22110 as magnified in the FTCd views , FTCL1 and FTCL2 22006, 22008, 22010, in some respects, ΔFTCd, ΔFTCL1 and ΔFTCL2 22106, 22108, 22110, represent different closure limit functions. In other words, the control circuit 500 can adjust from any of the FTCd, FTCL1 and FTCL2 limits 22006, 22008, 22010 to the ΔFTCd, ΔFTCL1 and ΔFTCL2 limits 22106, 22108, 22110, which would be completely different limits in this situation.

[0691] As discussed above, it is possible for the slope of a closure threshold function to change during a surgical cycle. In such circumstances, the dynamic slope can be adjusted consistently or individually throughout the entire surgical cycle. In general, a closing limit parameter adjustment can be achieved by changing the current closing control program parameter (e.g., by control circuit 500 directly changing a closing limit function being implemented by control circuit 500) or switching to a new closing control program completely. Switching or adjustment may be performed by control circuit 500, central controller 106, or cloud 104 based on perioperative information. For example, control circuit 500 may switch from the current control program to a second closure control program received from cloud 104. The second closure control program may also be transmitted from cloud 104 to central controller 106.

[0692] As discussed above, one or more of the surgical instrument 112 used to treat tissue, the corresponding central controller 106, and the cloud 104 may be used to receive, infer, or determine perioperative information to determine, infer, or predict the type and characteristics of the tissue currently being treated therapeutically. These inferences and predictions from closing situational awareness are useful for adjusting the closing rate of change limits. Therefore, in addition to FTCd, ΔFTCd 22006, 22106, graphs 22000, 21000 show, for example, a second tissue closure change rate of the threshold function FTCL1, ΔFTCL1 22008, 22108, which the closure algorithm used by the surgical instrument 112 can automatically embed. That is, the surgical instrument 112 may adjust the inputs to the current closure control program or adjust to a different control program to be executed by the control circuit 500. For example, the situationally aware central surgical controller 106 may determine that The currently applied surgical procedure is a lung surgical procedure based on the target area which is in the chest cavity. In turn, the thoracic cavity can be inferred as the target area based on the ventilation output of another device used in the operating room, for example. Thus, it is determined that the type of tissue treated is lung tissue. Consequently, the surgical instrument 112 can adapt to the use of the standard closure limit function FTCL1 22008, 22108 for lung tissue from the FTCd limit 22006, 22106, which was used previously. Such adjustments can be made during the surgical cycle that covers the y axis 22004, 22104.

[0693] For example, the situationally aware surgical core controller 106 may predict that the patient's lung will comprise relatively brittle tissue. Consequently, a closing limit function could be adjusted to a lower FTC limit function, as depicted in Figures 108 and 109. The closing limit could be a maximum allowable FTC value applied by the end actuator or a rate of change of FTC maximum allowed, for example. The inference of relatively high stiffness of lung tissue can be confirmed by other perioperative information. For example, a patient's EMR stored in the cloud 104 may be analyzed to determine that the patient has previously been diagnosed with cancer and has undergone radiation treatments. This type of preoperative information can be used to infer that tissue characteristics of lung tissue include relatively high stiffness and significant fluid content (e.g., percentage of water in the tissue).

[0694] In addition to confirming the initial prediction, perioperative information could also be used to adapt from an inaccurate initial prediction. For example, the surgical instrument 112 could be applying a suboptimal closure algorithm based on an erroneous assumption that the tissue has more elasticity than it actually does. In this situation, preoperative information from the patient's history can be used as part of a correction for the erroneous assumption. In general, perioperative information can be used in conjunction with sensor signals indicative of a closure parameter. Advantageously, perioperative information could confirm an initial closure algorithm determined based on sensor signals or could be used to adjust the initial closure algorithm to a different, more suitable closure algorithm. For example, the sensor signal may be indicative of the relationship between the applied detected closing force and the Open position of the end actuator 702 (e.g., the position of the first claw 152002 relative to the second claw 152004). This signal can be used to determine tissue stiffness and can be used in conjunction with other perioperative information to adjust the closure algorithm before or during the surgical procedure.

[0695] Accordingly, graphs 22000, 22100 of Figures 108 and 109 show that the default FTCL1 lung tissue threshold function can be further adjusted based on specific patient characteristics. As illustrated in Figures 108 and 109, the surgical instrument can further adjust from the FTCL1 22008 to FTCL2 22010 or FTCd 22006 threshold function, for example, based on patient-specific perioperative information. This way, adjustment could occur before the surgical procedure begins or during the surgical procedure. Furthermore, tuning could be done from FTCd 22006 to FTCL2 22010, or the FTCL2 22010 limit function could simply be implemented directly. Adjustment is possible between any of the available closure limit functions based on perioperative information.

[0696] Although Figures 108 and 109 illustrate adjustment to lower limits, adjustment to higher limits is also possible. The threshold functions shown in Figures 108 and 109 may correspond to specific control processes, which may be implemented by a specific closure control program. Alternatively, the control processes could correspond to different closure control programs. The control circuit 500 may directly modify the selected closing control algorithm itself or switch to a different closing control algorithm, for example. That is, the closing threshold function for a specific closing control algorithm or a specific applied closing change rate, represented by lines 22012, 22112, for example, can be modified. Modification of the closure limit function can be performed during a surgical procedure based on perioperative information. Furthermore, threshold functions may also be a function of some other parameter in addition to or in addition to time, such as the size of the clamp used, for example.

[0697] Additionally or alternatively, the closing adjustment may comprise simply adjusting the inputs to a closing limit function. For example, if a tissue characteristic such as tissue thickness is an input to a closure threshold function, perioperative information can be used to predictively or inferentially modify the inputs so that the output closure thresholds are modified according to the predicted or inferred tissue thickness input. In this way, the applied closure threshold function can be modified based on perioperative information. As discussed above, the applied closing limit function is defined by the applied closing control algorithm. Additionally, the closure force lines or applied FTC 22012, 22112 can be adjusted based on perioperative information.

[0698] In one aspect, the closing force lines or FTC 22012, 22112 represent a closing rate of change parameter of the corresponding closing control program executed by control circuit 500. The FTC line 22012, 22112 is also defined by the applied closing control algorithm. In one aspect, the applied closing force can be dynamically adjusted during the cycle of a surgical procedure being performed, as indicated by the "x" in Figures 108 and 109. This dynamic adjustment could also be an application of situational awareness. In other words, perioperative information can be incorporated to infer or predict adjustments in threshold or threshold function during the surgical procedure. In this way, as shown in Figures 108 and 109, at the moment or moments corresponding to the "x" indicated in Figures 108 and 109, the applied FTC is adjusted or modified to remain within the corresponding instantaneous closing limit. In summary, the applied closure control algorithm can comprise a closure threshold function and a closure change rate, both of which can be adjusted based on perioperative information.

[0699] In general, adjustment to different closure limits or different closure limit functions can be performed based on a determined, inferred or predicted characteristic or type, or type of tissue to be treated. As discussed above, tissue characteristics or types can be determined, inferred, or predicted based on perioperative information. Adjustment to another closing limit can be understood as adjusting a maximum limit in relation to a maximum torque generated by the motor 482 of the surgical instrument 112 or a rate of change of the motor speed. Several examples of perioperative information can be used to determine, infer, or predict tissue type or characteristics. For example, the amount of water, muscle properties, and tissue vasculature can influence the closure rate algorithm (including closure threshold) that would be applied. In one aspect, these properties, as well as other tissue type and characteristic properties, are used to determine the FTCD 22006 standard closure limit or any other initial parameter of the closure control program.

[0700] Thus, high vasculature can be a tissue characteristic used to infer a standard closure threshold function with relatively low slope. Additionally, to determine the initial parameters of the control program, preoperative information such as the surgical procedure being applied and surgical history (e.g., the typical routine of the clinician performing the procedure with respect to the surgical steps of the procedure) is used. , can be used to infer that vascular tissue with high hemoglobin content is being targeted, so the rate of closure change applied by the surgical instrument can be adjusted to be slower. Therefore, these properties can be used to determine the parameters of the control program pre- and intraoperatively. Additionally, perioperative information could be used to confirm that an appropriate vascular stapler is being used for the procedure on the vascular tissue.

[0701] Figure 110 is a flow chart 22200 of an aspect of adjusting a closure rate algorithm by the computer-implemented interactive surgical system 100, in accordance with an aspect of the present disclosure. In step 22202, the current closure algorithm is determined. This may refer to determining the closure control program currently executed by the control circuit 500 of a surgical instrument 112. As described above in connection with Figures 108 and 109, the current closure algorithm or control program may include a function closing limit parameter (e.g. closing limit parameter) and applied closing force (FTC) function (e.g. closing rate of change parameter). Flowchart 22200 continues next to step 22204, where preoperative information is received and analyzed. As discussed above, preoperative information may include initial tissue thickness based on tissue contact sensors 474, patient history, including prior diagnoses and treatments (e.g., listed in an EMR record of patient information stored in the central or cloud controller), clinical history, such as the surgeon's typical surgical routine, identified surgical instrument and associated materials, and identified current surgical procedure. This preoperative information can be used to determine, infer, or predict tissue type or characteristics in step 22206.

[0702] For example, the initial undeformed thickness of the fabric, measured by fabric contact sensors 474, can be used to determine an initial closure algorithm. Preoperative information, such as the patient's history of lung problems, can be used to determine that the current surgical procedure being performed is a thoracic procedure and the tissue type is pulmonary tissue. This preoperative information can further be used to determine an adjustment to the initial closure algorithm. Additionally or alternatively, an initial tissue stiffness measured by comparing a non-therapeutic (or near-non-therapeutic) initial tissue compression measurement and a closure member position measurement (e.g., the position of the first and second claws tip actuator) could also be used in conjunction with preoperative information. Preoperative ventilation information received from a ventilation device in the operating room could further be used to infer that the current procedure is thoracic. Other preoperative information can also be used to further predict the specific thoracic procedure being performed. For example, based on the patient's EMR record in the cloud indicating that the patient has cancer, it can be inferred at step 22206 that the thoracic procedure is a lung lobectomy to excise cancerous tissue in a lung lobe.

[0703] Additionally, the patient's EMR record may further indicate that the patient's history indicates that the patient has previously undergone radiation treatments for cancer. In this situation, it can be inferred or predicted that the irradiated lung tissue would be rigid, but also susceptible to the application of monopolar RF energy by the surgical instrument 112, for example. This would be an example of an inferred tissue characteristic. Additionally, the inference that a lung lobectomy is being performed can also be used to determine that possible tissues for stapling by the surgical instrument 112 include blood vessels (PA/PV), bronchi, and parenchyma. In step 22208, adjustments to the current closure algorithm are determined based on preoperative information and applied. As discussed above, the closure limit and applied FTC can be adjusted based on tissue type and characteristics. For example, high tissue stiffness may require a more conservative and slower rate of change of the applied FTC (e.g., as represented by FTC lines 22012, 22112), as well as a closure limit that generally yields a lower maximum limit ( for example, represented by FTCL2 22010 and ΔFTCL2 22110).

[0704] The upper limit may indicate the limit at which the first and second claw members 152002, 152004 are in a position sufficient for the surgical instrument 112 to fire staples. A relatively thicker tissue may correspond to a slower closing force change rate and also a higher maximum closing threshold, for example. Additionally, tissue type or structure may be inferred based on the given surgical procedure and clinical history to identify further closure algorithm adjustments in step 22208. For example, the clinical history of the treating surgeon may indicate a practice of treat the blood vessels first. It can be inferred that the tissue type and structure are vascular lung tissues with high blood content (i.e., high vasculature). Based on this inferred tissue type and characteristic information, it could be determined that adjusting for a slower applied FTC rate of change would be beneficial. In short, the adjustments in the current closure algorithm are determined based on the information inferred and applied in step 22208. Consequently, the current surgical operation can be performed with the surgical instrument 112 using the adjusted flow closure algorithm.

[0705] Flowchart 22200 then proceeds to decision operation 22210, in which it is determined whether any steps of the identified surgical procedure are missing. If there are no steps remaining (i.e., the answer to decision operation 22210 is no), flowchart 22200, in some respects, ends. However, if the answer to decision operation 22210 is affirmative, there are other steps of the surgical procedure remaining. Therefore, the current state of flowchart 22200 is intraoperation. In this case, the flowchart continues to step 22212, where intraoperative information can be received and analyzed. For example, intraoperative information may indicate that the type of tissue treated during this stage of the surgical procedure is parenchyma. In particular, it can be confirmed that the tissue is parenchymal based on clinical history, for example. This inference can be made in conjunction with measurements from the fabric contact sensor 474 and the load sensor 474 versus measurements of the closure member position. Additionally, the clinical history may indicate that the treating surgeon routinely completes a pulmonary fissure (a double fold of visceral pleura that folds into the lung parenchymal compartment) after dissection with a monopolar RF energy surgical instrument. In this situation, it can be inferred, based on the previously completed monopolar RF dissection, that the current stage of the surgical procedure is the lung parenchymal tissue.

[0706] Additionally, the central surgical controller 106 can determine whether the surgical instrument 112 being used is a stapler suitable for parenchymal shots, for example. Initial measurements of the fabric contact sensor 474 may indicate that the fabric is relatively thick, such as based on the fabric contacting the length of the first and second gripper members 152002, 152004 when the end actuator 702 is fully open (at maximum claw opening), which may be consistent with the parenchyma. Additionally, load sensing measurements 474 versus position of the closure member, as represented by a closure versus opening curve of the gripper, may indicate relatively high stiffness of the fabric. This stiffness characteristic may be consistent with irradiated parenchyma, a prediction that can be confirmed by reference to patient EMR data in the cloud. In this way, for example in Step 22212, sensor signals and perioperative information could be used together.

[0707] Based on this received and analyzed intraoperative information, it can be determined in decision operation 22214 that further adjustment is necessary. Conversely, if the answer is no in decision operation 22214, the flowchart returns to decision operation 22210. When the answer in decision operation 22214 is yes, the tissue type and tissue characteristics are inferred as determining the structure of the parenchymal tissue and stiffness characteristics, similar to those described above in step 22206. Subsequently, adjustments to the currently applied closure algorithm can be determined and applied in step 22208. In particular, the inference that the rigid and brittle parenchymal tissue being treated may cause adjustment to a slower, more conservative rate of change of the applied closing force.

[0708] Consequently, the current closure algorithm can be adjusted to an algorithm that minimizes the closure threshold and rate of change. That is, the adjusted limit may have a reduced maximum closing force limit, a more gradual rate of change in closing force, a reduced rate of change of the closing force limit, or some combination or subcombination of the above. In situations where the doctor inadvertently exceeds the closing limit, a waiting time may be instituted, for example. Exceeding the closure limit may indicate that the tissue or material being compressed is too thick to fire staples, for example, so this dwell time may be necessary. Thus, the waiting time may allow some tissue material or fluid in the end actuator 702 to evacuate or exit. After a suitable waiting time, it is determined that the tissue can be adequately compressed to achieve an appropriate end actuator configuration 702 so that the surgical stapling instrument 112 can fire staples. Due to the fact that the adjusted closing algorithm is more conservative, a long waiting time can be used. However, the physician can override this long waiting time or the conservative adjusted closure algorithm by manually selecting a faster use of the claw protocol on the surgical instrument 112.

[0709] After applying this modified closure algorithm to the parenchymal tissue in step 22208, the flow diagram again proceeds to decision operation 22210. Here, the answer may be yes again because there are remaining steps of the surgical procedure. For example, the lobectomy procedure may then proceed to a vessel clamping step. Again, in step 22212, intraoperative information is received and analyzed. For example, the central surgical controller may determine that the clinician has selected a vascular stapler surgical instrument. Furthermore, an initial measurement from the fabric contact sensors 474 may indicate that fabric contact occurs almost immediately during closure. Additionally, tissue contact can be determined to encompass a small area of the vascular stapler 112 and is delimited on the distal side of the stapler 112. Measurements from the load sensor 474 can also indicate a compatible tissue structure. Furthermore, it can be inferred that the tissue may have relatively low stiffness that may be consistent with a pulmonary vessel. Additionally, the clinical history may indicate that the treating surgeon typically uses a 112 vascular stapler for blood vessels as the subsequent step to completing the pulmonary fissure. Thus, intraoperative information, in conjunction with closure parameter sensor signals, for example, can be used to infer tissue type and characteristics. In particular, the vessel tissue may be predicted to be treated based on the specific characteristics of the selected vascular stapler 112. Initial tissue contact and load sensor measurements 474 may confirm this initial prediction, for example.

[0710] Consequently, it can be determined in decision operation 22214 that further adjustment is required, which causes the flow chart 22200 to proceed to step 22206. In step 22206, it can be inferred that the tissue is a blood vessel tissue with relatively low thickness and stiffness. Consequently, flowchart 22200 proceeds to step 22208, where the previously applied conservative closure algorithm is adjusted to a normal closure algorithm. A normal closing algorithm may comprise a constant closing change rate. Additionally, the closure threshold may be greater than the threshold used in the control algorithm for parenchymal tissue. In other words, the normal closure algorithm can achieve a higher maximum applied closure force and the rate of closure change can be faster than in parenchymal tissue. The surgical instrument may also inform the physician about adjustment to the normal closure algorithm through a suitable indicator, such as a light-emitting diode (LED) indicator displaying a specific color. In another example, it may be determined in step 22206 that the patient has a complete cleft lung. Consequently, no staples would have been fired into parenchymal tissue during the surgical procedure. In response to this determination, the surgical instrument may ask the physician to confirm that this inference is correct, such as through a display of the surgical instrument. The physician can then manually select an appropriate closure control algorithm for this step or stage of the surgical procedure. Additionally or alternatively, the surgical instrument 112 may default to a conservative closure algorithm because the inferences made in step 22206 may not be definitive. In any case, the adjusted closure algorithm is applied in step 22208.

[0711] Continuing the description of the lung lobectomy procedure example, the flowchart proceeds to decision operation 22210. In decision operation 22210, it can be determined that there are remaining steps of the surgical procedure. Consequently, in step 22212, intraoperative information is received and analyzed. Based on intraoperative information, it can be inferred that the type of tissue to be treated is bronchial tissue. Furthermore, the initial tissue contact sensor 474 measurements could indicate that the tissue trapped between the end actuator 702 contacts the first and second gripper members 152002, 152004 almost immediately during the initial closure of the end actuator. 702 and that such contact corresponds to a small area of the surgical stapling instrument 112. Furthermore, such contact is delimited on both sides of the claw members 152002 and 152004.

[0712] Consequently, it can be predicted that this tissue contact scenario corresponds to bronchial tissue. As discussed above, these initial measurements of the tissue contact sensor 474 may be non-therapeutic or nearly non-therapeutic. Additionally, measurements from the closing load sensor 474, represented by a closing versus opening curve of the gripper, may indicate a rigid tissue structure that is consistent with bronchial tissue. The indication from the surgical procedure history that a 112 vascular stapler has already been used in the surgical procedure may also mean that it is likely that parenchymal staple shots have already been performed and that significant use of monopolar RF energy has occurred. This surgical procedure history considered in conjunction with the physician's history, for example, can be used to predict whether the surgeon is treating bronchial tissue. This prediction would be consistent with the surgeon's routine practice of stapling the bronchus as the last step of a lobectomy procedure. Based on analysis of this type and other appropriate intraoperative information in step 22212, it may be determined in decision operation 22214 that further adjustment is required. Since the answer to decision operation 22214 is yes, the flowchart proceeds to step 22206, where it is inferred that the treated tissue is bronchial tissue with a normal tissue stiffness and thickness.

[0713] In one aspect, it may be easy to conclude that the treated tissue is bronchial tissue because the surgical instrument 112 is configured for only a specific tissue type. For example, the surgical instrument 112 may only be adaptable for firing staples that are used for bronchi. On the other hand, the surgical instrument 112 may only be adaptable for firing staples that are used for parenchymal tissue. In this scenario, an alert may be generated by the surgical instrument 112 because the surgeon is attempting to treat bronchial tissue with staples used exclusively for parenchymal tissue. This warning may be an auditory warning, a visual warning or some other suitable warning. In another example, a warning may be provided by a vascular stapler 112 if the vascular stapler 112 is selected for use with bronchial tissue. As discussed above, it can be determined based on perioperative information that the tissue to be treated is bronchial tissue against which the vascular stapler is contraindicated. Similarly, other perioperative information, such as closure loads and stapler cartridge selection, can be used to provide warnings when surgical instruments 112 are used for tissue types or characteristics with which they are not compatible. As discussed above, inferences made using perioperative information can be made in conjunction with sensor signals from closure parameters. In all situations, safety checks can be implemented to ensure that the surgical instrument 112 being used is safe for the tissue being treated.

[0714] According to the inferred tissue type and characteristics, in step 22208, an adjustment is made to the current closing algorithm. Although it may be determined that a constant closure rate is adequate, the closure rate may be adjusted to be faster or slower depending on the inferred characteristics of the bronchial tissue, for example. The closing limit can be modified in the same or similar way. Furthermore, the current closing algorithm may also be adjusted so that if and when the surgical instrument 112 exceeds the instantly applicable closing limit, a longer dwell time is automatically activated or suggested. For example, this waiting time for bronchial tissue may be longer than the waiting time used for parenchymal tissue. As discussed above, the surgeon is informed of the selected setting for the closure algorithm via LED indicators, for example. A physician override command for the longer hold time is also possible so that the surgeon can fire the stapler surgical instrument 112 in appropriate circumstances. Flowchart 22200 then proceeds to step 22212, where it can be determined that no other steps of the surgical procedure remain.

[0715] In one aspect, the flowchart 22200 may be implemented by the control circuit. However, in other aspects, flowchart 22200 may be implemented by central surgical controller 106 or cloud 104. Additionally, although steps 22204 and 22212 are described in terms of preoperative information and intraoperative information, respectively, they are not limited in that way. manner. Specifically, general perioperative information can be received and analyzed, rather than specific preoperative or intraoperative information. As discussed above, perioperative information encompasses pre-, intra-, and postoperative information. Furthermore, sensor signals can be used in conjunction with perioperative information for contextual and inferential adjustments of the closure algorithm.

Examples

[0716] Various aspects of the subject matter described herein under the heading "SYSTEMS FOR ADJUSTING END EFFECTOR PARAMETERS BASED ON PREOPERATIVE INFORMATION" are defined in the following Examples:

[0717] Example 1 - A surgical system comprises a surgical instrument. The surgical instrument comprises an end actuator comprising a first claw and a second claw. The first claw is configured to move relative to the second claw. The surgical instrument further comprises a motor configured to move the first claw relative to the second claw in accordance with a rate of change of closure parameter and a limit of closure parameter. The surgical instrument further comprises a sensor configured to transmit a sensor signal indicative of a closure parameter of the end actuator. The surgical system further comprises a control circuit communicatively coupled to the sensor. The control circuit is configured to receive perioperative information, wherein the perioperative information comprises one or more of a perioperative disease, a perioperative treatment, and a type of surgical procedure. The control circuit is further configured to receive the sensor signal from the sensor and determine an adjustment for the closure rate of change parameter and the closure limit parameter based on the perioperative information and the sensor signal.

[0718] Example 2 - The surgical system of Example 1, wherein the control circuit is further configured to determine a characteristic of a tissue to be treated by the surgical instrument based on one or more of the perioperative information and the sensor signal.

[0719] Example 3 - The surgical system of Example 2, wherein the tissue characteristic comprises one or more of a tissue type characteristic, muscular characteristic, vasculature characteristic, water content characteristic, stiffness characteristic and thickness.

[0720] Example 4 - The surgical system of Example 1, 2, or 3, wherein the control circuit is additionally configured to change a motor speed based on the setting determined for the closing rate of change parameter and the parameter closing limit.

[0721] Example 5 - The surgical system of Example 1, 2, 3 or 4, wherein the control circuit is additionally configured to generate an alert based on an inconsistency between a type of surgical instrument and one or more of the perioperative information and the sensor signal.

[0722] Example 6 - The surgical system of Example 1, 2, 3, 4 or 5, wherein the perioperative information additionally comprises one or more of one type of tissue to be treated by the surgical instrument, a characteristic of the tissue, a history clinical and a type of staple cartridge for use with the surgical instrument.

[0723] Example 7 - The surgical system of Example 1, 2, 3, 4, 5, or 6, wherein the closing limit parameter is a maximum closing force limit and the control circuit is further configured to disable the motor for a predetermined period of time, based on reaching the maximum closing force limit.

[0724] Example 8 - A surgical system comprises a central surgical controller configured to receive perioperative information transmitted from a remote database of a cloud computing system. The central surgical controller is communicatively coupled to the cloud computing system. The surgical system further comprises a surgical instrument communicatively coupled to the central surgical controller. The surgical instrument comprises an end actuator comprising a first claw and a second claw. The first claw is configured to move relative to the second claw. The end actuator further comprises a motor configured to move the first gripper relative to the second gripper in accordance with a changing parameter closure rate and a closure limit parameter of a closure control program received from the surgical controller. central. The end actuator further comprises a sensor configured to transmit a sensor signal indicative of a closing parameter of the end actuator. The central surgical controller is further configured to receive the sensor signal from the sensor and determine an adjustment for the closure rate of change parameter and the closure limit parameter based on the perioperative information and the sensor signal.

[0725] Example 9 - The surgical system of Example 8, wherein the closure control program is a first closure control program, the central surgical controller is additionally configured to transmit a second closure control program to the surgical instrument, and the second closing control program sets the adjustment for the closing rate of change parameter and the adjustment for the closing limit parameter.

[0726] Example 10 - The surgical system of Example 9, wherein the cloud computing system is configured to transmit the second closure control program to the central surgical controller, and the adjustment for the closure change rate parameter and the closure limit parameter of the second control program is adjusted based on perioperative information.

[0727] Example 11 - The surgical system of Example 8, 9 or 10, wherein the surgical instrument is configured to generate an alert based on an inconsistency between a type of surgical instrument and one or more of the perioperative information and the signal of the sensor.

[0728] Example 12 - The surgical system of Example, 8, 9, 10, or 11, wherein the closing limit parameter is a maximum closing force limit and the central surgical controller is additionally configured to disable the motor by a predetermined period of time, based on reaching the maximum closing force limit.

[0729] Example 13 - The surgical system of example 8, 9, 10, 11, or 12, wherein the perioperative information comprises one or more of a perioperative disease, a perioperative treatment, a type of surgical procedure, a clinical history, a type of surgical instrument, a type of tissue being treated by the surgical instrument, and a characteristic of the tissue.

[0730] Example 14 - The surgical system of example 9, wherein the central surgical controller is additionally configured to change a motor speed based on the setting determined for the closure change rate parameter and the closure limit parameter .

[0731] Example 15 - A surgical instrument comprising an end actuator comprising a first claw and a second claw. The first claw is configured to move relative to the second claw. The surgical instrument further comprises a motor configured to move the first claw relative to the second claw in accordance with a closing rate of change parameter and a closing limit parameter of a first closing control program received from a controller. central surgery. The surgical instrument further comprises a sensor configured to transmit a sensor signal indicative of a closing parameter of the end actuator and a control circuit communicatively coupled to the sensor and the motor. The control circuit is configured to receive the sensor signal from the sensor and determine an adjustment for the closure rate of change parameter and the closure limit parameter based on perioperative information and the sensor signal.

[0732] Example 16 - The surgical system of Example 15, wherein the surgical instrument is configured to generate an alert based on an inconsistency between a type of surgical instrument and one or more of the perioperative information and the sensor signal.

[0733] Example 17 - The surgical system of Example 15 or 16, wherein the control circuit is further configured to switch from the first closure control program to a second closure control program received from a computer computing system. cloud and change a motor speed based on the second closing control program.

[0734] Example 18 - The surgical instrument of example 15, 16 or 17, wherein the control circuit is further configured to determine a characteristic and type of a tissue to be treated by the surgical instrument based on one or more of the information perioperative data and sensor signal.

[0735] Example 19 - The surgical system of Example 15, 16, 17, or 18, where the closing limit parameter is a maximum limit of the closing force.

[0736] Example 20 - The surgical system of Example 19, where the closing limit parameter is a maximum limit of the closing force.

[0737] In various aspects, the sensors of a sensor array in accordance with the present disclosure may be placed in a staple cartridge. An adhesive mask can be embedded with the sensors in predetermined locations. In various aspects, the sensors are attached to projections on the staple cartridge such that the sensors are positioned higher than a cartridge platform of the staple cartridge to ensure tissue contact. The adhesive mask can be created in bulk using screen printing technology on a polyester substrate, for example. Conductive blocks can be printed in a common location.

[0738] In several examples, in addition to detecting proximity to cancerous tissue, an end actuator of the present disclosure can also be configured to target specific types of cancer in specific tissues. As indicated in the journal publication Altenberg B and Greulich KO, Genomics 84 (2004) pp. 1014-1020, which is incorporated herein by reference in its entirety, certain types of cancer are characterized by an overexpression of glycolysis genes, while other types of cancer are not characterized by an overexpression of glycolysis genes. Accordingly, an end actuator of the present disclosure can be equipped with a set of sensors with high specificity for cancerous tissues characterized by an overexpression of glycolysis genes, such as lung cancer or liver cancer.

[0739] In various aspects, sensor readings from a sensor array in accordance with the present disclosure are communicated by the surgical instrument to a central surgical controller (e.g., central surgical controller 106, 206) for further analysis and/or or for situational awareness.

[0740] The preceding detailed description presented various forms of the devices and/or processes through the use of block diagrams, flowcharts and/or examples. Although these block diagrams, flowcharts and/or examples contain one or more functions and/or operations, it will be understood by those skilled in the art that each function and/or operation within these block diagrams, flowcharts and/or examples can be implemented, individually. and/or collectively, across a wide range of hardware, software, firmware or virtually any combination thereof. Those skilled in the art will recognize, however, that some aspects of the aspects described herein, in whole or in part, may be equivalently implemented on integrated circuits, as one or more computer programs running on one or more computers (e.g., as one or more programs running on one or more computer systems), as one or more programs running on one or more processors (e.g., as one or more programs running on one or more microprocessors), as firmware, or as virtually any combination thereof, and that designing the circuitry and/or writing the code for the software and firmware would be within the scope of practice of one skilled in the art, in light of this description. Furthermore, those skilled in the art will understand that the mechanisms of the subject matter described herein may be distributed as one or more program products in a variety of forms and that an illustrative form of the subject matter described herein is applicable regardless of the specific type of data transmission medium. signals used to effectively carry out distribution.

[0741] Instructions used to program logic to perform various aspects described may be stored in a memory in the system, such as dynamic random access memory (DRAM), cache, flash memory, or other storage. Additionally, instructions may be distributed over a network or through other computer-readable media. Thus a machine-readable medium may include any mechanism for storing or transmitting information in a form readable by a machine (e.g., a computer), but is not limited to, floppy disks, optical discs, read-only memory compact disk ( CD-ROMs), and optical disks-dynamo disks, read-only memory (ROM), random access memory (RAM), erasable programmable read-only memory (EPROM), electrically erasable programmable read-only memory (EEPROM), cards magnetic or optical devices, flash memory, or a tangible machine-readable storage medium used in the transmission of information over the Internet via an electrical, optical, acoustic cable, or other forms of propagated signals (e.g., carrier waves, infrared signal, digital signals, etc.). Accordingly, non-transitory computer-readable media includes any type of machine-readable media suitable for storing or transmitting electronic instructions or information in a form readable by a machine (e.g., a computer).

[0742] As used in any aspect of the present invention, the term "control circuit" may refer to, for example, a set of wired circuits, programmable circuits (e.g., a computer processor comprising one or more cores individual instruction processing unit, processing unit, processor, microcontroller, microcontroller unit, controller, digital signal processor (DSP), programmable logic device (PLD), programmable logic array (PLA), or field programmable gate array ( FPGA)), state machine circuits, firmware that stores instructions executed by the programmable circuit, and any combination thereof. The control circuit may, collectively or individually, be incorporated as an electrical circuit that is part of a larger system, e.g., an integrated circuit (IC), an application-specific integrated circuit (ASIC), a system-on-chip (SoC) ), desktop computers, laptop computers, tablet computers, servers, smart headphones, etc. Accordingly, as used in the present invention, "control circuit" includes, but is not limited to, electrical circuits that have at least one discrete electrical circuit, electrical circuits that have at least one integrated circuit, electrical circuits that have at least one discrete electrical circuit application-specific integrated, electrical circuits that form a general-purpose computing device configured by a computer program (e.g., a general-purpose computer configured by a computer program that at least partially executes processes and/or devices described herein, or a microprocessor configured by a computer program that at least partially executes the processes and/or devices described herein), electrical circuits that form a memory device (e.g., forms of random access memory), and/or electrical circuits that form a communications device (for example, a modem, communications switch, or optical-electrical equipment). Those skilled in the art will recognize that the subject matter described herein can be implemented in analog or digital mode, or in some combination thereof.

[0743] As used in any aspect of the present invention, the term "logic" may refer to an application, software, firmware and/or circuit configured to perform any of the aforementioned operations. The software may be embodied as a software package, code, instructions, instruction sets and/or data recorded on non-transitory computer-readable storage media. Firmware may be embodied as code, instructions or sets of instructions, and/or data that are hard-coded (e.g., non-volatile) in memory devices.

[0744] As used in any aspect of the present invention, the terms "component", "system", "module" and the like may refer to a computer-related entity, whether hardware, a combination of hardware and software, software or running.

[0745] As used herein in one aspect of the present invention, an "algorithm" refers to the self-consistent sequence of steps that lead to the desired result, where a "step" refers to the manipulation of physical quantities and/or logical states that can, although they need not necessarily, take the form of electrical or magnetic signals that can be stored, transferred, combined, compared and manipulated in any other way. It is common usage to call these signals bits, values, elements, symbols, characters, terms, numbers or the like. These terms and similar terms may be associated with appropriate physical quantities and are merely convenient identifications applied to such quantities and/or states.

[0746] A network may include a packet switched network. Communication devices may be capable of communicating with each other using a selected packet switched network communications protocol. An exemplary communications protocol may include an Ethernet communications protocol that may be capable of enabling communication using a transmission control protocol/Internet protocol (TCP/IP). The Ethernet protocol may conform to or be compatible with the Ethernet standard published by the Institute of Electrical and Electronics Engineers (IEEE) entitled "IEEE 802.3 Standard" published in December 2008 and/or later versions of this standard. Alternatively or additionally, the communication devices may be able to communicate with each other using an X.25 communications protocol. The X.25 communications protocol may conform to or be compatible with a standard promulgated by the International Telecommunication Union-Telecommunication Standardization Sector (ITU-T). Alternatively or additionally, the communication devices may be able to communicate with each other using a frame-relay communications protocol. The frame-relay communications protocol may conform to or be compatible with a standard promulgated by the Consultative Committee for International Telegraph and Telephone (CCITT) and/or the American National Standards Institute (ANSI). Alternatively or additionally, the transceivers may be able to communicate with each other using an ATM ("asynchronous transfer mode" communication protocol). The ATM communication protocol may conform to or be compatible with an ATM standard published by the ATM forum entitled "ATM-MPLS Network Interworking 2.0" published in August 2001, and/or later versions of that standard. Obviously, different and/or post-developed connection-oriented network communication protocols are also contemplated in the present invention.

[0747] Unless expressly stated otherwise, as is evident from the foregoing description, it is understood that throughout the foregoing description, discussions using terms such as "processing", or "computation", or "calculation", or " determination", or "display", or similar, refer to the action and processes of a computer, or similar electronic computing device, that manipulates and transforms data represented in the form of physical (electronic) quantities in records and memories computer in other data similarly represented in the form of physical quantities in computer memories or records, or in other similar information storage, transmission or display devices.

[0748] One or more components may be referred to in the present invention as "configured for", "configurable for", "operable for", "adapted for", "capable of", "conformable for", etc. Those skilled in the art will recognize that "configured for" may generally encompass components in an active state and/or components in an inactive state and/or components in a standby state, except where the context dictates otherwise.

[0749] The terms "proximal" and "distal" are used in the present invention with reference to a physician who manipulates the handle portion of the surgical instrument. The term "proximal" refers to the portion closest to the physician, and the term "distal" refers to the portion located in the direction away from the physician. It will also be understood that, for the sake of convenience and clarity, spatial terms such as "vertical", "horizontal", "up" and "down" may be used in the present invention with respect to the drawings. However, surgical instruments can be used in many orientations and positions, and these terms are not intended to be limiting and/or absolute.

[0750] Persons skilled in the art will recognize that, in general, terms used herein, and particularly in the appended claims (e.g., bodies of appended claims) are generally intended as "open" terms (e.g., the term "including" shall be construed as "including, but not limited to", the term "having" shall be construed as "having at least", the term "includes" shall be construed as "includes, but is not limited to ", etc.). It will further be understood by those skilled in the art that, when a specific number of an introduced claim statement is intended, such intention will be expressly mentioned in the claim and, in the absence of such mention, no intention will be present. For example, as an aid to understanding, the following attached claims may contain use of the introductory phrases "at least one" and "one or more" to introduce claim mentions. However, the use of such phrases should not be interpreted as implying that the introduction of a mention of the claim by the indefinite articles "a, ones" or "a, ones" limits any specific claim containing the introduced claim mention to claims containing only such mention, even when the same claim includes the introductory phrases "one or more" or "at least one" and indefinite articles such as "one, ones" or "a, ones" (e.g., "one, ones" and /or "one" should typically be interpreted as meaning "at least one" or "one or more"); the same goes for the use of definite articles used to introduce claims.

[0751] The terms "comprises" (and any form of understands, such as "comprises" and "which understands"), "has" (and any form of has, such as "has" and "which has"), "includes" (and any form of includes, such as "includes" and "which includes") and "contains" (and any form of contains, such as "contains" and "which contains") are unrestricted linking verbs. As a result, a system, device or surgical apparatus that "comprises", "has", "includes" or "contains" one or more elements has those one or more elements, but is not limited to having only those one or more elements. Likewise, an element of a surgical system, device or apparatus that "comprises", "has", "includes" or "contains" one or more features possesses those one or more features, but is not limited to possessing only those one or more features. or more resources.

[0752] Furthermore, even if a specific number of an introduced claim statement is explicitly mentioned, those skilled in the art will recognize that such mention needs to be typically interpreted as meaning at least the mentioned number (e.g., the mere mention of "two mentions", without other modifiers, typically means at least two mentions, or two or more mentions). Furthermore, in cases where a convention analogous to "at least one of A, B, and C, etc." is used, this construction is generally intended to have the sense in which the convention would be understood by (e.g., "a system that has at least one of A, B, and C" would include, but is not limited to, systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and/ or A, B and C together, etc.). In cases in which a convention analogous to "at least one of A, B, or C, etc." is used, this construction is generally intended to have the sense in which the convention would be understood by (e.g., "a system that has at least one of A, B, and C" would include, but not be limited to, systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and/or A , B and C together, etc.). It will further be understood by those skilled in the art that typically a word and/or a disjunctive phrase presenting two or more alternative terms, whether in the description, the claims or the drawings, should be understood as contemplating the possibility of including one of the terms, any of the terms or both terms, except when the context determines to indicate otherwise. For example, the phrase "A or B" will typically be understood as including the possibilities of "A" or "B" or "A and B".

[0753] With respect to the attached claims, those skilled in the art will understand that the operations mentioned therein can generally be performed in any order. Furthermore, although various operational flow diagrams are presented in one or more sequences, it should be understood that the various operations may be performed in orders other than those illustrated, or may be performed simultaneously. Examples of such alternative orderings may include overlapping, interleaved, interrupted, reordered, incremental, preparatory, supplementary, simultaneous, inverse, or other variant orderings, except where the context dictates otherwise. Furthermore, terms such as "responsive to", "related to" or other adjective participles are not generally intended to exclude these variants, except when the context dictates otherwise.

[0754] It is worth noting that any reference to "one (1) aspect", "an aspect", "an exemplification" or "one (1) exemplification", and the like means that a particular feature, structure or characteristic described in connection with the aspect is included in at least one aspect. Accordingly, the use of expressions such as "in one (1) aspect", "in one aspect", "in an exemplification", "in one (1) exemplification", in various places throughout this specification does not necessarily refer to the same aspect. Furthermore, specific features, structures or characteristics may be combined in any suitable manner in one or more aspects.

[0755] Any patent application, patent, non-patent publication or other disclosure material mentioned in this specification and/or mentioned in any application data sheet is incorporated herein by reference, to the extent that the incorporated materials are not inconsistent with it. Accordingly, and to the extent necessary, the description as explicitly set forth herein supersedes any conflicting material incorporated into the present invention by reference. Any material, or portion thereof, which is incorporated herein by reference but which conflicts with the existing definitions, statements, or other descriptive materials set forth herein is incorporated herein only to the extent that there is no conflict between the incorporated material and the existing description material.

[0756] In summary, numerous benefits have been described that result from employing the concepts described in this document. The aforementioned description of one or more embodiments has been presented for purposes of illustration and description. This description is not intended to be exhaustive nor to limit the invention to the precise form described. Modifications or variations are possible in light of the above teachings. One or more embodiments have been chosen and described for the purpose of illustrating the principles and practical application and thereby enabling one skilled in the art to use the various modalities and with various modifications as may be convenient for the specific use contemplated. The attached claims are intended to define the overall scope.

Claims (6)

1. Surgical instrument (21000), comprising: an end actuator (21008) comprising claws (150304, 150306) transitionable between an open configuration and a closed configuration; a motor (21006) operatively coupled to the grippers (150304, 150306), the motor (21006) being configured to transition the grippers (150304, 150306) between the open configuration and the closed configuration; a sensor (21004) configured to transmit at least one signal indicative of a tissue compression parameter associated with a tissue between the grippers (150304, 150306); and a control circuit (21002) coupled to the sensor (21004) and the motor (21006), wherein the control circuit (21002) is configured to: receive (21052) the at least one signal; determining (21054) a value of the tissue compression parameter based on the at least one signal as the claws (150304, 150306) transition from the open configuration to the closed configuration; causing (21056) the motor (21006) to increase a transition time of the grippers (150304, 150306) to the closed configuration according to whether the value of the tissue compression parameter is above a first threshold; and characterized by the fact that the control circuit (21002) is configured to: provide (21060) feedback according to whether the value of the tissue compression parameter is below a second threshold, the feedback comprising a suggestion for reinforcement adjunct when the tissue compression parameter value is below the second limit. 2. Surgical instrument (21000), according to claim 1, characterized by the fact that the tissue compression parameter comprises a force exerted by the motor (21006) to transition the claws (150304, 150306) to the closed configuration . 3. Surgical instrument (21000), according to claim 1 or 2, characterized by the fact that the tissue compression parameter comprises a rate of change in time of a force exerted by the motor (21006) to transition the claws (150304, 150306) for the closed configuration. 4. Surgical instrument (21000), according to any one of claims 1 to 3, characterized by the fact that the control circuit (21002) is configured to increase the transition time of the claws (150304, 150306) to the closed configuration decreasing a rate at which the motor (21006) transitions the grippers (150304, 150306) to the closed configuration. 5. Surgical instrument (21000), according to any one of claims 1 to 4, characterized by the fact that the control circuit (21002) is configured to increase the transition time of the claws (150304, 150306) to the closed configuration increasing a length of time that the motor (21006) is paused when it transitions from the grippers (150304, 150306) to the closed configuration. 6. Surgical instrument (21000), according to any one of claims 1 to 5, characterized by the fact that the control circuit (21002) is configured to increase the transition time of the claws (150304, 150306) to the closed configuration reducing a stabilization limit to stop the motor (21006) when transitioning the grippers (150304, 150306) to the closed configuration.