BR112020013163B1 - SURGICAL INSTRUMENT WITH VARIATION OF RADIOFREQUENCY AND ULTRASONIC POWER LEVEL IN COOPERATION WITH A VARIABLE CLAMPING ARM PRESSURE TO OBTAIN A PREDEFINED HEAT FLOW OR POWER APPLIED TO THE TISSUE - Google Patents

Abstract

Surgical instruments and systems and methods for using the surgical instruments are disclosed. A surgical instrument comprises an end actuator comprising an ultrasonic blade and clamping arm, an electrode, an ultrasonic transducer and a sensor coupled to a control circuit. The electrode receives electrosurgical energy from a generator and applies the electrosurgical energy to the end actuator to weld tissue based on the generation of a drive signal by the generator. The ultrasonic transducer ultrasonically oscillates the ultrasonic blade in response to the drive signal. The control circuit receives a sensor signal indicative of a surgical parameter, determines a welding time of a surgical operation based on the sensor signal, and varies one or more of a clamping arm pressure applied by the clamping arm and a level of electrosurgical energy power to maintain one or more of a predefined heat flux or power applied to the tissue loaded in the end actuator.

Description

REFERENCE TO RELATED DEPOSIT REQUESTS

[001] This application claims the benefit of US non-provisional patent application serial no. 16/182,235, entitled VARIATION OF RADIO FREQUENCY AND ULTRASONIC POWER LEVEL IN COOPERATION WITH VARYING CLAMP ARM PRESSURE TO ACHIEVE PREDEFINED HEAT FLUX OR POWER APPLIED TO TISSUE, filed on November 6, 2018, the disclosure of which is incorporated into the present invention, by reference, in its entirety.

[002] The present application claims priority under 35 U.S.C. § 119(e) of US Provisional Patent Application No. 62/729,195, entitled ULTRASONIC ENERGY DEVICE WHICH VARIES PRESSURE APPLIED BY CLAMP ARM TO PROVIDE THRESHOLD CONTROL PRESSURE AT A CUT PROGRESSION LOCATION, deposited on September 10, 2018, the disclosure of which is incorporated herein, by reference, in its entirety.

[003] The present application also claims priority under 35 U.S.C. § 119(e) of US provisional patent application No. 62/692,747, entitled SMART ACTIVATION OF AN ENERGY DEVICE BY ANOTHER DEVICE, filed June 30, 2018, US provisional patent application No. 62/692,748, titled SMART ENERGY ARCHITECTURE, filed on June 30, 2018, and US provisional patent application No. 62/692,768, titled SMART ENERGY DEVICES, filed June 30, 2018 , the disclosure of each of which is incorporated herein, by way of reference, in its entirety.

[004] The present application claims priority under 35 U.S.C.§ 119(e) of US provisional patent application No. 62/659,900, entitled METHOD OF HUB COMMUNICATION, filed April 19, 2018, the disclosure of which is incorporated herein by title reference in its entirety.

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

[006] The present application also claims priority under 35 U.S.C.§ 119(e) of US provisional patent application serial no. 62/640,417, entitled TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR, filed on March 8, 2018 , and US provisional patent application serial No. 62/640,415, entitled ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR, filed on March 8, 2018, the respective disclosure of which is incorporated herein by reference, in its entirety .

[007] The present application also claims priority under 35 U.S.C.§ 119(e) of US provisional patent application serial no. 62/611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, of the provisional patent application US 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 disclosure of each of which is incorporated herein by reference, in its entirety.

BACKGROUND OF THE INVENTION

[008] The present invention relates to various surgical systems. Surgical procedures are typically performed in theaters or surgical operating rooms in a healthcare facility such as a hospital. A sterile field is typically created around the patient. The sterile field may include grooming team members, who are appropriately attired, and all furniture and accessories in the area. Various surgical devices and systems are used in the performance of a surgical procedure.

FIGURES

[009] The various aspects described herein, both with regard to the organization and the methods of operation, together with additional objects and advantages thereof, can be better understood with reference to the description presented below, considered in conjunction with the drawings in attached as follows.

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

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

[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 disclosure.

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

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

[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 disclosure.

[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 disclosure.

[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 disclosure.

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

[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 disclosure.

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

[0021] Figure 12 is a block diagram of a cloud computing system comprising a plurality of intelligent surgical instruments coupled to central surgical controllers that may connect to the cloud component of the cloud computing system in accordance with the least one aspect of the present disclosure.

[0022] Figure 13 is a functional module architecture of a cloud computing system, in accordance with at least one aspect of the present disclosure.

[0023] Figure 14 illustrates a diagram of a surgical system with situational awareness, in accordance with at least one aspect of the present disclosure.

[0024] Figure 15 is a timeline representing situational awareness of a central surgical controller, in accordance with at least one aspect of the present disclosure.

[0025] Figure 16 is a schematic diagram of a robotic surgical instrument configured to operate a surgical tool described therein, in accordance with at least one aspect of the present disclosure.

[0026] Figure 17 illustrates a block diagram of a surgical instrument programmed to control distal translation of the displacement member, in accordance with at least one aspect of the present disclosure.

[0027] Figure 18 is a schematic diagram of a surgical instrument configured to control various functions, in accordance with at least one aspect of the present disclosure.

[0028] Figure 19 illustrates an example of a generator, in accordance with at least one aspect of the present disclosure.

[0029] Figure 20 illustrates a structural view of a generator architecture, in accordance with at least one aspect of the present disclosure.

[0030] Figure 21 illustrates a generator circuit divided into multiple stages, with a first stage circuit being common to the second stage circuit, in accordance with at least one aspect of the present disclosure.

[0031] Figure 22 illustrates a diagram of an aspect of a surgical instrument comprising a feedback system for use with a surgical instrument, in accordance with an aspect of the present disclosure.

[0032] Figures 23A and 23B are graphs that include a graph of clamping force as a function of time and an associated graph that indicates the displacement at the coagulation and cutting site along the length of the blade as a function of time, in accordance with at least one aspect of the present disclosure.

[0033] Figures 24A and 24B represent electrode segments of the end actuator and an illustration of controlling the applied clamping force and electrosurgical energy provided by the end actuator, in accordance with at least one aspect of the present disclosure.

[0034] Figures 25A and 25B are graphs illustrating the control of energization or powering of electrosurgical electrodes, in accordance with at least one aspect of the present disclosure.

[0035] Figures 26A to 26E are a series of graphs illustrating adjusting the power level to obtain a predictable sealing time, in accordance with at least one aspect of the present disclosure.

[0036] Figures 27A to 27F are graphs and flow charts illustrating approaches for providing power according to power curves, in accordance with at least one aspect of the present disclosure.

DESCRIPTION

[0037] The applicant of this application holds the following US patent applications, filed on November 6, 2018, with the disclosure of each incorporated herein by reference, in its entirety:

[0038] • US patent application no. 16/182,224, entitled SURGICAL NETWORK, INSTRUMENT, AND CLOUD RESPONSES BASED ON VALIDATION OF RECEIVED DATASET AND AUTHENTICATION OF ITS SOURCE AND INTEGRITY;

[0039] • US patent application no. 16/182,230, entitled SURGICAL SYSTEM FOR PRESENTING INFORMATION INTERPRETED FROM EXTERNAL DATA;

[0040] • US patent application no. 16/182,233, entitled MODIFICATION OF SURGICAL SYSTEMS CONTROL PROGRAMS BASED ON MACHINE LEARNING;

[0041] • US patent application no. 16/182,239, entitled ADJUSTMENT OF DEVICE CONTROL PROGRAMS BASED ON STRATIFIED CONTEXTUAL DATA IN ADDITION TO THE DATA;

[0042] • US patent application no. 16/182,243, entitled SURGICAL HUB AND MODULAR DEVICE RESPONSE ADJUSTMENT BASED ON SITUATIONAL AWARENESS;

[0043] • US patent application no. 16/182,248, entitled DETECTION AND ESCALATION OF SECURITY RESPONSES OF SURGICAL INSTRUMENTS TO INCREASING SEVERITY THREATS;

[0044] • US patent application No. 16/182,251, entitled INTERACTIVE SURGICAL SYSTEM;

[0045] • US Patent Application No. 16/182,260, entitled AUTOMATED DATA SCALING, ALIGNMENT, AND ORGANIZING BASED ON PREDEFINED PARAMETERS WITHIN SURGICAL NETWORKS;

[0046] • US Patent Application No. 16/182,267, entitled SENSING THE PATIENT POSITION AND CONTACT UTILIZING THE MONOPOLAR RETURN PAD ELECTRODE TO PROVIDE SITUATIONAL AWARENESS TO A SURGICAL NETWORK;

[0047] • US Patent Application No. 16/182,249, entitled POWERED SURGICAL TOOL WITH PREDEFINED ADJUSTABLE CONTROL ALGORITHM FOR CONTROLLING END EFFECTOR PARAMETER;

[0048] • US Patent Application No. 16/182,246, entitled ADJUSTMENTS BASED ON AIRBORNE PARTICLE PROPERTIES;

[0049] • US Patent Application No. 16/182,256, entitled ADJUSTMENT OF A SURGICAL DEVICE FUNCTION BASED ON SITUATIONAL AWARENESS;

[0050] • US Patent Application No. 16/182,242, entitled REAL TIME ANALYSIS OF COMPREHENSIVE COST OF ALL INSTRUMENTATION USED IN SURGERY UTILIZING DATA FLUIDITY TO TRACK INSTRUMENTS THROUGH STOCKING AND IN-HOUSE PROCESSES;

[0051] • US Patent Application No. 16/182,255, entitled USAGE AND TECHNIQUE ANALYSIS OF SURGEON / STAFF PERFORMANCE AGAINST A BASELINE TO OPTIMIZE DEVICE UTILIZATION AND PERFORMANCE FOR BOTH CURRENT AND FUTURE PROCEDURES;

[0052] • US Patent Application No. 16/182,269, entitled IMAGE CAPTURING OF THE AREAS OUTSIDE THE ABDOMEN TO IMPROVE PLACEMENT AND CONTROL OF A SURGICAL DEVICE IN USE;

[0053] • US Patent Application No. 16/182,278, entitled COMMUNICATION OF DATA WHERE A SURGICAL NETWORK IS USING CONTEXT OF THE DATA AND REQUIREMENTS OF A RECEIVING SYSTEM / USER TO INFLUENCE INCLUSION OR LINKAGE OF DATA AND METADATA TO ESTABLISH CONTINUITY;

[0054] • US Patent Application No. 16/182,290, entitled SURGICAL NETWORK RECOMMENDATIONS FROM REAL TIME ANALYSIS OF PROCEDURE VARIABLES AGAINST A BASELINE HIGHLIGHTING DIFFERENCES FROM THE OPTIMAL SOLUTION;

[0055] • US Patent Application No. 16/182,232, entitled CONTROL OF A SURGICAL SYSTEM THROUGH A SURGICAL BARRIER;

[0056] • US Patent Application No. 16/182,227, entitled SURGICAL NETWORK DETERMINATION OF PRIORITIZATION OF COMMUNICATION, INTERACTION, OR PROCESSING BASED ON SYSTEM OR DEVICE NEEDS;

[0057] • US Patent Application No. 16/182,231, entitled WIRELESS PAIRING OF A SURGICAL DEVICE WITH ANOTHER DEVICE WITHIN A STERILE SURGICAL FIELD BASED ON THE USAGE AND SITUATIONAL AWARENESS OF DEVICES;

[0058] • US Patent Application No. 16/182,229, entitled ADJUSTMENT OF STAPLE HEIGHT OF AT LEAST ONE ROW OF STAPLES BASED ON THE SENSED TISSUE THICKNESS OR FORCE IN CLOSING;

[0059] • US Patent Application No. 16/182,234, entitled STAPLING DEVICE WITH BOTH COMPULSORY AND DISCRETIONARY LOCKOUTS BASED ON SENSED PARAMETERS;

[0060] • US Patent Application No. 16/182,240, entitled POWERED STAPLING DEVICE CONFIGURED TO ADJUST FORCE, ADVANCEMENT SPEED, AND OVERALL STROKE OF CUTTING MEMBER BASED ON SENSED PARAMETER OF FIRING OR CLAMPING; It is

[0061] • US Patent Application No. 16/182,238, entitled ULTRASONIC ENERGY DEVICE WHICH VARIES PRESSURE APPLIED BY CLAMP ARM TO PROVIDE THRESHOLD CONTROL PRESSURE AT A CUT PROGRESSION LOCATION.

[0062] The applicant of this application holds the following US patent applications filed on September 10, 2018, the disclosure of each of which is incorporated herein by reference, in its entirety:

[0063] • US provisional patent application No. 62/729,183, entitled A CONTROL FOR A SURGICAL NETWORK OR SURGICAL NETWORK CONNECTED DEVICE THAT ADJUSTS ITS FUNCTION BASED ON A SENSED SITUATION OR USAGE;

[0064] • US provisional patent application No. 62/729,177, entitled AUTOMATED DATA SCALING, ALIGNMENT, AND ORGANIZING BASED ON PREDEFINED PARAMETERS WITHIN A SURGICAL NETWORK BEFORE TRANSMISSION;

[0065] • US Provisional Patent Application No. 62/729,176, entitled INDIRECT COMMAND AND CONTROL OF A FIRST OPERATING ROOM SYSTEM THROUGH THE USE OF A SECOND OPERATING ROOM SYSTEM WITHIN A STERILE FIELD WHERE THE SECOND OPERATING ROOM SYSTEM HAS PRIMARY AND SECONDARY OPERATING MODES;

[0066] • US provisional patent application No. 62/729,185, entitled POWERED STAPLING DEVICE THAT IS CAPABLE OF ADJUSTING FORCE, ADVANCEMENT SPEED, AND OVERALL STROKE OF CUTTING MEMBER OF THE DEVICE BASED ON SENSED PARAMETER OF FIRING OR CLAMPING;

[0067] • US provisional patent application No. 62/729,184, entitled POWERED SURGICAL TOOL WITH A PREDEFINED ADJUSTABLE CONTROL ALGORITHM FOR CONTROLLING AT LEAST ONE END EFFECTOR PARAMETER AND A MEANS FOR LIMITING THE ADJUSTMENT;

[0068] • US provisional patent application No. 62/729,182, entitled SENSING THE PATIENT POSITION AND CONTACT UTILIZING THE MONO POLAR RETURN PAD ELECTRODE TO PROVIDE SITUATIONAL AWARENESS TO THE HUB;

[0069] • US provisional patent application No. 62/729,191, entitled SURGICAL NETWORK RECOMMENDATIONS FROM REAL TIME ANALYSIS OF PROCEDURE VARIABLES AGAINST A BASELINE HIGHLIGHTING DIFFERENCES FROM THE OPTIMAL SOLUTION;

[0070] • US provisional patent application No. 62/729,195, entitled ULTRASONIC ENERGY DEVICE WHICH VARIES PRESSURE APPLIED BY CLAMP ARM TO PROVIDE THRESHOLD CONTROL PRESSURE AT A CUT PROGRESSION LOCATION; It is

[0071] • US provisional patent application No. 62/729,186, entitled WIRELESS PAIRING OF A SURGICAL DEVICE WITH ANOTHER DEVICE WITHIN A STERILE SURGICAL FIELD BASED ON THE USAGE AND SITUATIONAL AWARENESS OF DEVICES.

[0072] The applicant of this application holds the following US patent applications, filed on August 28, 2018, with the disclosure of each incorporated herein by reference in its entirety:

[0073] • US patent application No. 16/115,214, entitled ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR;

[0074] • U patent application, no. 16/115,205, entitled TEMPERATURE CONTROL OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR;

[0075] • US Patent Application No. 16/115,233, entitled RADIO FREQUENCY ENERGY DEVICE FOR DELIVERING COMBINED ELECTRICAL SIGNALS;

[0076] • US Patent Application No. 16/115,208, entitled CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO TISSUE LOCATION;

[0077] • US Patent Application No. 16/115,220, entitled CONTROLLING ACTIVATION OF AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO THE PRESENCE OF TISSUE;

[0078] • US patent application No. 16/115,232, entitled DETERMINING TISSUE COMPOSITION VIA AN ULTRASONIC SYSTEM;

[0079] • US Patent Application No. 16/115,239, entitled DETERMINING THE STATE OF AN ULTRASONIC ELECTROMECHANICAL SYSTEM ACCORDING TO FREQUENCY SHIFT;

[0080] • US patent application No. 16/115,247, entitled DETERMINING THE STATE OF AN ULTRASONIC END EFFECTOR;

[0081] • US patent application No. 16/115,211, entitled SITUATIONAL AWARENESS OF ELECTROSURGICAL SYSTEMS;

[0082] • US patent application No. 16/115,226, entitled MECHANISMS FOR CONTROLLING DIFFERENT ELECTROMECHANICAL SYSTEMS OF AN ELECTROSURGICAL INSTRUMENT;

[0083] • US patent application No. 16/115,240, entitled DETECTION OF END EFFECTOR IMMERSION IN LIQUID;

[0084] • US Patent Application No. 16/115,249, entitled INTERRUPTION OF ENERGY DUE TO INADVERTENT CAPACITIVE COUPLING;

[0085] • US Patent Application No. 16/115,256, entitled INCREASING RADIO FREQUENCY TO CREATE PAD-LESS MONOPOLAR LOOP;

[0086] • US Patent Application No. 16/115,223, entitled BIPOLAR COMBINATION DEVICE THAT AUTOMATICALLY ADJUSTS PRESSURE BASED ON ENERGY MODALITY; It is

[0087] • US patent application No. 16/115,238, entitled ACTIVATION OF ENERGY DEVICES.

[0088] The applicant of this application holds the following US patent applications filed on August 23, 2018, the disclosure of each of which is incorporated herein by reference in its entirety:

[0089] • US provisional patent application No. 62/721,995, entitled CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO TISSUE LOCATION;

[0090] • US provisional patent application No. 62/721,998, entitled SITUATIONAL AWARENESS OF ELECTROSURGICAL SYSTEMS;

[0091] • US provisional patent application No. 62/721,999, entitled INTERRUPTION OF ENERGY DUE TO INADVERTENT CAPACITIVE COUPLING;

[0092] • US provisional patent application No. 62/721,994, entitled BIPOLAR COMBINATION DEVICE THAT AUTOMATICALLY ADJUSTS PRESSURE BASED ON ENERGY MODALITY; It is

[0093] • US provisional patent application No. 62/721,996, entitled RADIO FREQUENCY ENERGY DEVICE FOR DELIVERING COMBINED ELECTRICAL SIGNALS.

[0094] The applicant of this application holds the following US patent applications, filed on Friday, June 30, 2018, with the disclosure of each incorporated herein by reference in its entirety:

[0095] • US provisional patent application No. 62/692,747, entitled SMART ACTIVATION OF AN ENERGY DEVICE BY ANOTHER DEVICE;

[0096] • US provisional patent application no. 62/692,748, entitled SMART ENERGY ARCHITECTURE; It is

[0097] • US provisional patent application No. 62/692,768, entitled SMART ENERGY DEVICES.

[0098] The applicant of this application holds the following US patent applications filed on Friday, June 29, 2018, with the disclosure of each incorporated herein by reference in its entirety:

[0099] • US patent application serial no. 16/024,090, entitled CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS;

[00100] • US Patent Application Serial No. 16/024,057, entitled CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSED CLOSURE PARAMETERS;

[00101] • US Patent Application Serial No. 16/024,067, entitled SYSTEMS FOR ADJUSTING END EFFECTOR PARAMETERS BASED ON PERIOPERATIVE INFORMATION;

[00102] • US Patent Application Serial No. 16/024,075, entitled SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING;

[00103] • US Patent Application Serial No. 16/024,083, entitled SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING;

[00104] • US Patent Application Serial No. 16/024,094, entitled SURGICAL SYSTEMS FOR DETECTING END EFFECTOR TISSUE DISTRIBUTION IRREGULARITIES;

[00105] • US Patent Application Serial No. 16/024,138, entitled SYSTEMS FOR DETECTING PROXIMITY OF SURGICAL END EFFECTOR TO CANCEROUS TISSUE;

[00106] • US Patent Application Serial No. 16/024,150, entitled SURGICAL INSTRUMENT CARTRIDGE SENSOR ASSEMBLIES;

[00107] • US patent application serial no. 16/024,160, entitled VARIABLE OUTPUT CARTRIDGE SENSOR ASSEMBLY;

[00108] • US patent application serial no. 16/024,124, entitled SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE;

[00109] • US patent application serial no. 16/024,132, entitled SURGICAL INSTRUMENT HAVING A FLEXIBLE CIRCUIT;

[00110] • US Patent Application Serial No. 16/024,141, entitled SURGICAL INSTRUMENT WITH A TISSUE MARKING ASSEMBLY;

[00111] • US Patent Application Serial No. 16/024,162, entitled SURGICAL SYSTEMS WITH PRIORITIZED DATA TRANSMISSION CAPABILITIES;

[00112] • US patent application serial no. 16/024,066, entitled SURGICAL EVACUATION SENSING AND MOTOR CONTROL;

[00113] • US Patent Application Serial No. 16/024,096, entitled SURGICAL EVACUATION SENSOR ARRANGEMENTS;

[00114] • US patent application serial no. 16/024,116, entitled SURGICAL EVACUATION FLOW PATHS;

[00115] • US patent application serial no. 16/024,149, entitled SURGICAL EVACUATION SENSING AND GENERATOR CONTROL;

[00116] • US patent application serial no. 16/024,180, entitled SURGICAL EVACUATION SENSING AND DISPLAY;

[00117] • US Patent Application Serial No. 16/024,245, entitled COMMUNICATION OF SMOKE EVACUATION SYSTEM PARAMETERS TO HUB OR CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM;

[00118] • US Patent Application Serial No. 16/024,258, entitled SMOKE EVACUATION SYSTEM INCLUDING A SEGMENTED CONTROL CIRCUIT FOR INTERACTIVE SURGICAL PLATFORM;

[00119] • US Patent Application Serial No. 16/024,265, entitled SURGICAL EVACUATION SYSTEM WITH A COMMUNICATION CIRCUIT FOR COMMUNICATION BETWEEN A FILTER AND A SMOKE EVACUATION DEVICE; It is

[00120] • US patent application serial no. 16/024,273, entitled DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS.

[00121] The applicant of this application holds the following US provisional patent applications, filed on Thursday, June 28, 2018, the disclosure of each of which is incorporated herein by reference in its entirety:

[00122] • US provisional patent application serial no. 62/691,228, entitled A Method of using reinforced flex circuits with multiple sensors with electrosurgical devices;

[00123] • US provisional patent application serial no. 62/691,227, entitled controlling a surgical instrument according to sensed closure parameters;

[00124] • US provisional patent application serial no. 62/691,230, entitled SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE;

[00125] • US provisional patent application serial no. 62/691,219, entitled SURGICAL EVACUATION SENSING AND MOTOR CONTROL;

[00126] • 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;

[00127] • 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; It is

[00128] • US provisional patent application serial no. 62/691,251, entitled DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS.

[00129] The applicant of this application holds the following US provisional patent applications, filed on April 19, 2018, the disclosure of each of which is incorporated herein by reference, in its entirety:

[00130] • US provisional patent application serial no. 62/659,900, entitled METHOD OF HUB COMMUNICATION.

[00131] The applicant of this application holds the following US provisional patent applications, filed on Thursday, March 30, 2018, the disclosure of each of which is incorporated herein by reference in its entirety:

[00132] • US provisional patent application No. 62/650,898 filed on March 30, 2018, entitled CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS;

[00133] • US provisional patent application serial no. 62/650,887, entitled SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES;

[00134] • US provisional patent application serial no. 62/650,882, entitled SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM; It is

[00135] • US provisional patent application serial no. 62/650,877, entitled SURGICAL SMOKE EVACUATION SENSING AND CONTROLS.

[00136] The applicant of this application holds the following US patent applications filed on March 29, 2018, the disclosure of each of which is incorporated herein by reference in its entirety:

[00137] • US Patent Application Serial No. 15/940,641, entitled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES;

[00138] • US patent application serial no. 15/940,648, entitled INTERACTIVE SURGICAL SYSTEMS WITH CONDITION HANDLING OF DEVICES AND DATA CAPABILITIES;

[00139] • US Patent Application Serial No. 15/940,656, entitled SURGICAL HUB COORDINATION OF CONTROL AND COMMUNICATION OF OPERATING ROOM DEVICES;

[00140] • US patent application serial no. 15/940,666, entitled SPATIAL AWARENESS OF SURGICAL HUBS IN OPERATING ROOMS;

[00141] • US Patent Application Serial No. 15/940,670, entitled COOPERATIVE UTILIZATION OF DATA DERIVED FROM SECONDARY SOURCES BY INTELLIGENT SURGICAL HUBS;

[00142] • US patent application serial no. 15/940,677, entitled SURGICAL HUB CONTROL ARRANGEMENTS;

[00143] • US Patent Application Serial No. 15/940,632, entitled DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD;

[00144] • 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;

[00145] • US Patent Application Serial No. 15/940,645, entitled SELF DESCRIBING DATA PACKETS GENERATED AT AN ISSUING INSTRUMENT;

[00146] • US Patent Application Serial No. 15/940,649, entitled DATA PAIRING TO INTERCONNECT A DEVICE MEASURED PARAMETER WITH AN OUTCOME;

[00147] • US patent application serial no. 15/940,654, entitled SURGICAL HUB SITUATIONAL AWARENESS;

[00148] • US patent application serial no. 15/940,663, entitled SURGICAL SYSTEM DISTRIBUTED PROCESSING;

[00149] • US patent application serial no. 15/940,668, entitled AGGREGATION AND REPORTING OF SURGICAL HUB DATA;

[00150] • US Patent Application Serial No. 15/940,671, entitled SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER;

[00151] • US Patent Application Serial No. 15/940,686, entitled DISPLAY OF ALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LINEAR STAPLE LINE;

[00152] • US patent application serial no. 15/940,700, entitled STERILE FIELD INTERACTIVE CONTROL DISPLAYS;

[00153] • US patent application serial no. 15/940,629, entitled COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS;

[00154] • 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;

[00155] • US Patent Application Serial No. 15/940,722, entitled CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OF MONO-CHROMATIC LIGHT REFRACTIVITY;

[00156] • US patent application serial no. 15/940,742, entitled DUAL CMOS ARRAY IMAGING;

[00157] • US patent application serial no. 15/940,636, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES;

[00158] • US patent application serial no. 15/940,653, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL HUBS;

[00159] • US Patent Application Serial No. 15/940,660, entitled CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER;

[00160] • 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;

[00161] • US Patent Application Serial No. 15/940,694, entitled CLOUD-BASED MEDICAL ANALYTICS FOR MEDICAL FACILITY SEGMENTED INDIVIDUALIZATION OF INSTRUMENT FUNCTION;

[00162] • US Patent Application Serial No. 15/940,634, entitled CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES;

[00163] • US Patent Application Serial No. 15/940,706, entitled DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK;

[00164] • US patent application serial no. 15/940,675, entitled CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES;

[00165] • US Patent Application Serial No. 15/940,627, entitled DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;

[00166] • US Patent Application Serial No. 15/940,637, entitled COMMUNICATION ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;

[00167] • US Patent Application Serial No. 15/940,642, entitled CONTROLS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;

[00168] • US Patent Application Serial No. 15/940,676, entitled AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;

[00169] • US Patent Application Serial No. 15/940,680, entitled CONTROLLERS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;

[00170] • US patent application serial no. 15/940,683, entitled COOPERATIVE SURGICAL ACTIONS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;

[00171] • US Patent Application Serial No. 15/940,690, entitled DISPLAY ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; It is

[00172] • US Patent Application Serial No. 15/940,711, entitled SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS.

[00173] The applicant of this application holds the following US provisional patent applications, filed on Thursday, March 28, 2018, the disclosure of each of which is incorporated herein by reference in its entirety:

[00174] • US provisional patent application No. 62/649,302, entitled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES;

[00175] • US provisional patent application serial no. 62/649,294, entitled DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD;

[00176] • US provisional patent application serial no. 62/649,300, entitled SURGICAL HUB SITUATIONAL AWARENESS;

[00177] • US provisional patent application serial no. 62/649,309, entitled SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER;

[00178] • US provisional patent application No. 62/649,310, entitled COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS;

[00179] • US provisional patent application No. 62/649,291, entitled USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT;

[00180] • US provisional patent application No. 62/649,296, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES;

[00181] • US provisional patent application serial no. 62/649,333, entitled CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER;

[00182] • US provisional patent application serial no. 62/649,327, entitled CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES;

[00183] • US provisional patent application No. 62/649,315, entitled DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK;

[00184] • US provisional patent application serial no. 62/649,313, entitled CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES;

[00185] • US provisional patent application No. 62/649,320, entitled DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;

[00186] • US provisional patent application serial no. 62/649,307, entitled AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; It is

[00187] • US provisional patent application No. 62/649,323, entitled SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS.

[00188] The applicant of this application holds the following provisional US patent applications, filed on March 8, 2018, the disclosure of each of which is incorporated herein by reference in its entirety:

[00189] • US provisional patent application serial no. 62/640,417, entitled TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR; It is

[00190] • US provisional patent application serial no. 62/640,415, entitled ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR.

[00191] • The applicant of this application holds the following provisional US patent applications, filed on December 28, 2017, the disclosure of each of which is incorporated herein by reference in its entirety:

[00192] • US provisional patent application serial no. 62/611,341, entitled INTERACTIVE SURGICAL PLATFORM;

[00193] • US provisional patent application serial no. 62/611,340, entitled CLOUD-BASED MEDICAL ANALYTICS; It is

[00194] • US provisional patent application serial no. 62/611,339, entitled ROBOT ASSISTED SURGICAL PLATFORM.

[00195] 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. Central Surgical Controllers

[00196] 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 handheld and intelligent 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 a number of central controllers M 106, a number N 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.

[00197] In various aspects, the intelligent instruments 112, as described in the present invention with reference to Figures 1 to 7, can be implemented as ultrasonic surgical instruments and combined power surgical instruments 7012, as described in Figures 23A and 23B, 24A and 24B, 25A and 25B, 26A to 26E, 27A to 27F. Smart instruments 112 (e.g., devices 1a to 1n) such as ultrasonic/combination surgical instruments 7012 as described in Figures 23A and 23B, 24A and 24B, 25A and 25B, 26A to 26E, 27A to 27F are configured to operate in a surgical data network 201, as described with reference to Figure 8.

[00198] Figure 2 represents an example of a surgical system 102 being used to perform a surgical procedure on a patient who is lying on an operating table 114 in a surgical operating room 116. A robotic system 110 is used in the surgical procedure as a part of the surgical system 102. The robotic system 110 includes a surgeon console 118, a patient cart 120 (surgical robot), and a robotic surgical 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.

[00199] Other types of robotic systems can be readily adapted for use with the surgical system 102. Various examples of robotic systems and surgical instruments that are suitable for use with the present disclosure are described in provisional patent application serial no. 62/ 611,339, entitled ROBOT ASSISTED SURGICAL PLATFORM, filed on December 28, 2017, the disclosure of which is incorporated herein by reference in its entirety.

[00200] 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 disclosure of which is incorporated herein by reference, in its entirety.

[00201] In various aspects, the imaging device 124 includes at least one image sensor and one or more optical components. Suitable image sensors include, but are not limited to, charge-coupled device (CCD) sensors and complementary metal-oxide semiconductor (CMOS) sensors.

[00202] 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.

[00203] 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.

[00204] 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 become 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.

[00205] In several aspects, the imaging device 124 is configured for use in a minimally invasive procedure. Examples of imaging devices suitable for use with the present disclosure 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.

[00206] In one aspect, the imaging device employs 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 images 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 disclosure 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.

[00207] 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.

[00208] 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 U.S. Provisional Patent Application Serial No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed December 28, 2017, the disclosure of which is incorporated herein for reference in its entirety.

[00209] 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.

[00210] 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.

[00211] 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, the coordinated information flow is further described in US provisional patent application serial no. 62/611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on December 28, 2017, the contents of which are incorporated herein by reference in their 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" in US Provisional Patent Application Serial No. 62/611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed December 28, 2017, the disclosure of which is here incorporated by reference, in its entirety, for example.

[00212] 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 (which may include a monopolar generator 142, a bipolar generator 144, and/or an ultrasonic generator 143), a communication module 130, a processor module 132, and a storage array 134. In In certain aspects, as illustrated in Figure 3, the central controller 106 additionally includes a smoke evacuation module 126, a suction/irrigation module 128 and/or an OR mapping module 133.

[00213] 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.

[00214] Aspects of the present disclosure disclose 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 combination 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.

[00215] 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.

[00216] Certain surgical procedures may require the application of more than one type of energy to the tissue. One type of energy may be more beneficial for cutting the tissue, while a different type of energy may be more beneficial for sealing the 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.

[00217] Aspects of the present disclosure present a modular surgical compartment for use in a surgical procedure that involves applying 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.

[00218] In addition to the above, 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.

[00219] Additionally, the modular surgical compartment also includes a communication bus between the first docking port and the second docking port, configured to facilitate communication between the first power generating module and the second power generating module.

[00220] With reference to Figures 3 to 7, aspects of the present disclosure 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 compartment 136. The modular central controller compartment 136 may be configured to facilitate the insertion of multiple generators and. interactive communication between the generators coupled to the modular central controller compartment 136 so that the generators can act as a single generator.

[00221] In one aspect, the modular central controller housing 136 comprises a modular power and communication backplane 149 with external and wireless communication heads to allow removable attachment of modules 140, 126, 128 and interactive communication between the same.

[00222] In one aspect, the modular central controller compartment 136 includes docking stations, or drawers, 151, also referred to here as 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 on a rear side of the combined generator module 145 is configured to engage a corresponding docking port 150 with 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 in 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.

[00223] In various aspects, the smoke evacuation module 126 includes a fluid line 154 that transports captured/fluid-collected 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 the fluid line define a fluid path extending toward the smoke evacuation module 126 which is received in the central controller compartment 136.

[00224] 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.

[00225] 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.

[00226] 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 the vacuum source may be housed in the suction/irrigation module 128. In one example, the fluid source and/or the vacuum source may be housed in the central controller compartment 136 separately. of the suction/irrigation module 128. In such an example, a fluid interface may be configured to connect the suction/irrigation module 128 to the fluid source and/or the vacuum source.

[00227] 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.

[00228] 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 supports 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.

[00229] Additionally, the contacts of a specific module can be switched to engage with the contacts of a specific drawer to avoid inserting a module into a drawer with contact mismatch.

[00230] 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.

[00231] 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 rear panel 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.

[00232] 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.

[00233] 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.

[00234] 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.

[00235] In one aspect, the imaging device comprises a tubular enclosure 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.

[00236] In several examples, multiple imaging devices are placed in different positions in the surgical field to provide multiple views. The imaging module 138 can be configured to switch between imaging devices to provide an optimal view. In various aspects, the imaging module 138 can be configured to integrate images from different imaging devices.

[00237] 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 reference. 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 each incorporated herein by reference in their entirety.

[00238] 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 facility 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 features for allowing traffic to pass through the surgical data network to be monitored and for configuring each port on the central network controller 207 or network switch 209. An intelligent surgical data network may be referred to as 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.

[00239] 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.

[00240] 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, a smoke 126, a suction/irrigation module 128, a communication module 130, a processor module 132, a storage array 134, a surgical device coupled to a display, and/or a contactless sensor module, among other devices modules that can be connected to the central modular communication controller 203 of the surgical data network 201.

[00241] 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.

[00242] 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 disease, 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.

[00243] 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 about where to send information and transmits all network data through each connection and to a remote server 213 (Figure 9) in the cloud 204. The central network controller 207 can detect basic network errors such as collisions, but having all (admit) information transmitted to multiple input ports can be a security risk and cause strangulation.

[00244] 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.

[00245] 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 capabilities 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.

[00246] 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 system's host 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 can be used for communication between devices 1a to 1n and devices 2a to 2m situated in the operating room.

[00247] In other examples, operating room devices 1a to 1n/2a to 2m may communicate with the central modular communication 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 central modular communication 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.

[00248] 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.

[00249] The modular communication 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 Communication 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.

[00250] 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 robotic 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.

[00251] 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.

[00252] The central surgical controller 206 employs a non-contact sensor module 242 to measure the dimensions of the operating room and generate a map of the operating room using laser or ultrasonic type non-contact measuring devices. An ultrasound-based contactless sensor module scans the operating room by transmitting an ultrasound burst 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 perimeter walls. of the operating room, and comparing the phase of the transmitted pulse to the received pulse to determine the size of the operating room and to adjust Bluetooth pairing distance limits, for example.

[00253] Computer system 210 comprises a processor 244 and a network interface 245. The processor 244 is coupled to a communication 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.

[00254] 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 analog input channels, details of which are available in the product datasheet.

[00255] 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.

[00256] 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).

[00257] 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.

[00258] 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.

[00259] 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 device pointer such as a mouse, trackball, stylus, touchpad, keyboard, microphone, joystick, game pad, satellite card, scanner, TV tuner card, digital camera, digital video camera, web camera, and the like. These and other input devices connect to the processor via the system bus 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.

[00260] Computer system 210 can 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).

[00261] 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.

[00262] 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.

[00263] In various aspects, the devices/instruments 235 described with reference to Figures 9 and 10 can be implemented as ultrasonic surgical instruments and combined power surgical instruments 7012, as described in Figures 23A and 23B, 24A and 24B, 25A and 25B , 26A to 26E, 27A to 27F. Accordingly, the ultrasonic/combination surgical instrument 7012, as described in Figures 23A and 23B, 24A and 24B, 25A and 25B, 26A to 26E, 27A to 27F, is configured to interface with the modular control tower 236 and the surgical controller. central 206. Once connected to the central surgical controller 206, the ultrasonic/combination surgical instrument 7012, as described in Figures 23A and 23B, 24A and 24B, 25A and 25B, 26A through 26E, 27A through 27F, is configured to interface with the cloud 204, the server 213, other instruments connected to the central controller, the central controller screen 215, or the display system 209, or combinations thereof. Additionally, once connected to the central controller 206, the ultrasonic/combination surgical instrument 7012, as described in Figures 23A and 23B, 24A and 24B, 25A and 25B, 26A to 26E, 27A to 27F, can utilize the processing circuitry available in the central controller local computer system 210.

[00264] Figure 11 illustrates a functional block diagram of one aspect of a USB network central controller device 300, in accordance with at least one aspect of the present disclosure. In the illustrated aspect, the USB 300 network central controller device uses a TUSB2036 integrated circuit central controller available 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). .

[00265] 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.

[00266] 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) , CRC generation and verification (token and data), packet ID (PID) generation and verification/decoding, and/or series-to-parallel/parallel-to-series conversion. 310 receives a clock input 314 and is coupled to a suspend/resume and frame timer logic circuit 316 and a central controller replay circuit 318 to control communication between the upstream USB transceiver port 302 and the USB transceiver ports. downstream 304, 306, 308 through logic port circuits 320, 322, 324. The SIE 310 is coupled to a command decoder 326 through logic interface 328 to control commands from an EEPROM in series through an EEPROM interface in series 330.

[00267] 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.

[00268] Additional details regarding the structure and function of the central surgical controller and/or central surgical controller networks can be found in US provisional patent application No. 62/659,900, entitled METHOD OF HUB COMMUNICATION, filed April 19, 2018, which is incorporated herein by reference, in its entirety.

Cloud system hardware and functional modules

[00269] Figure 12 is a block diagram of the computer-implemented interactive surgical system in accordance with at least one aspect of the present disclosure. In one aspect, the computer-implemented interactive surgical system is configured to monitor and analyze data related to the operation of various surgical systems that include central surgical controllers, surgical instruments, robotic devices, and operating rooms or healthcare facilities. The computer-implemented interactive surgical system comprises a cloud-based data analysis system. Although the cloud-based data analysis system is described as a surgical system, it is not necessarily limited to that and could generally be a cloud-based medical system. As illustrated in Figure 12, the cloud-based data analysis system comprises a plurality of surgical instruments 7012 (may be the same or similar to instruments 112), a plurality of surgical core controllers 7006 (may be the same or similar to core controllers 106 ) and a surgical data network 7001 (may be the same or similar to the network 201) for coupling the central surgical controllers 7006 to the cloud 7004 (may be the same or similar to the cloud 204). Each of the plurality of central surgical controllers 7006 is communicably coupled to one or more surgical instruments 7012. The central controllers 7006 are also communicably coupled to the computer-implemented interactive surgical system cloud 7004 over the network 7001. The cloud 7004 is a remote centralized source of hardware and software for storing, manipulating, and communicating data generated based on the operation of various surgical systems. As shown in Figure 12, access to cloud 7004 is obtained through network 7001, which may be the Internet or some other suitable computer network. The core surgical controllers 7006 that are coupled to the cloud 7004 can be considered the client side of the cloud computing system (i.e., cloud-based data analysis system). The 7012 Surgical Instruments are paired with the 7006 Central Surgical Controllers for control and implementation of various surgical procedures or operations as described herein.

[00270] Additionally, surgical instruments 7012 may comprise transceivers for transmitting data to and from their corresponding central surgical controllers 7006 (which may also comprise transceivers). Combinations of surgical instruments 7012 and corresponding central controllers 7006 may indicate specific locations, such as operating rooms in healthcare facilities (e.g., hospitals), to provide medical operations. For example, the memory of a surgical hub controller 7006 may store location data. As shown in Figure 12, cloud 7004 comprises central servers 7013 (which may be the same or similar to remote server 113 in Figure 1 and/or remote server 213 in Figure 9), application servers for central controllers 7002, data analysis modules. data 7034 and an input/output ("I/O") interface 7007. The central servers 7013 of the cloud 7004 collectively manage the cloud computing system, which includes monitoring requests by client central surgical controllers 7006 and managing processing capacity from cloud 7004 to execute the orders. Each of the central servers 7013 comprises one or more processors 7008 coupled with suitable memory devices 7010 that may include a volatile memory such as random access memory (RAM) and a non-volatile memory such as magnetic storage devices. The memory devices 7010 may comprise machine-executable instructions that, when executed, cause the processors 7008 to execute the data analysis modules 7034 for cloud-based analysis, operations, recommendations, and other data operations described below. Additionally, processors 7008 may execute data analysis modules 7034 independently or in conjunction with central controller applications independently executed by central controllers 7006. Central servers 7013 also comprise aggregated medical databases 2212, which may reside in memory 2210 .

[00271] Based on connections to multiple central surgical controllers 7006 via network 7001, cloud 7004 can aggregate specific data data generated by multiple surgical instruments 7012 and their corresponding central controllers 7006. Such aggregated data may be stored in the aggregated medical databases 7011 of the cloud 7004. In particular, the cloud 7004 may advantageously perform data analysis and operations on the aggregated data to produce information and/or perform individual functions that individual central controllers 7006 do not. could achieve on their own. For this purpose, as shown in Figure 12, the cloud 7004 and the central surgical controllers 7006 are communicatively coupled to transmit and receive information. The I/O interface 7007 is connected to the plurality of central surgical controllers 7006 via network 7001. In this way, the I/O interface 7007 can be configured to transfer information between the central surgical controllers 7006 and the aggregated medical databases. 7011. Consequently, the I/O interface 7007 can facilitate read/write operations of the cloud-based data analysis system. Such read/write operations may be performed in response to requests from the central controllers 7006. These requests may be transmitted to the central controllers 7006 through the central controllers' applications. The 7007 I/O interface may include one or more high-speed data ports, which may include universal serial bus (USB) ports, IEEE 1394 ports, as well as Wi-Fi and Bluetooth I/O interfaces for connecting to cloud 7004 to central controllers 7006. Application servers for central controllers 7002 of cloud 7004 are configured to host and provide shared capabilities to software applications (e.g., central controller applications) run by central surgical controllers 7006. For example, the application servers for central controllers 7002 may manage requests submitted by applications for central controllers through central controllers 7006, control access to aggregated medical databases 7011, and perform load balancing. The 7034 data analysis modules are described in more detail with reference to Figure 13.

[00272] The specific cloud computing system configuration described in the present disclosure is designed specifically to address various issues raised in the context of medical operations and procedures performed using medical devices, such as surgical instruments 7012, 112. In particular, the surgical instruments 7012 may be digital surgical devices configured to interact with the cloud 7004 to implement techniques to improve the performance of surgical operations. Various surgical instruments 7012 and/or central surgical controllers 7006 may comprise touch-controlled user interfaces so that clinicians can control aspects of interaction between the surgical instruments 7012 and the cloud 7004. Other user interfaces suitable for control such as control interfaces Audio-controlled user interfaces can also be used.

[00273] Figure 13 is a block diagram illustrating the functional architecture of the computer-implemented interactive surgical system, in accordance with at least one aspect of the present disclosure. The cloud-based data analysis system includes a plurality of data analysis modules 7034 that can be executed by the processors 7008 of the cloud 7004 to provide data analysis solutions to problems arising specifically in the medical field. As shown in Figure 13, the functions of the cloud-based data analysis modules 7034 can be supported through central controller applications 7014 hosted by central controller application servers 7002 that can be accessed on central surgical controllers 7006. cloud computing 7008 and central controller applications 7014 may operate together to execute data analysis modules 7034. Application programming interfaces (APIs) 7016 define the set of protocols and routines that correspond to central controller applications 7014. Additionally, APIs 7016 manage the storage and retrieval of data in/from aggregated medical data databases 7011 for the operations of applications 7014. Caches 7018 also store data (e.g., temporarily) and are coupled to APIs 7016 for more efficient retrieval of data used by applications 7014. Data analysis modules 7034 in Figure 13 include modules for resource optimization 7020, data collection and aggregation 7022, authorization and security 7024, updating control programs 7026, results analysis of patient 7028, recommendations 7030, and data classification and prioritization 7032. Other suitable data analysis modules could also be implemented by cloud 7004, in some respects. In one aspect, data analysis modules are used to make specific recommendations based on analysis of trends, results, and other data.

[00274] For example, the data collection and aggregation module 7022 could be used to generate self-descriptive data (e.g., metadata), including identifying notable features or configuration (e.g., trends), managing the data sets redundant and storing the data in paired data sets that can be grouped by surgery, but not necessarily keyed to surgical dates and actual surgeons. In particular, paired data sets generated from operations of surgical instruments 7012 may comprise application of a binary classification, e.g., a bleeding or non-bleeding event. More generally, the binary classification can be characterized as either a desirable event (e.g., a successful surgical procedure) or an undesirable event (e.g., an improperly used or misfired surgical instrument). The aggregated self-descriptive data may correspond to individual data received from multiple groups or subgroups of central surgical controllers 7006. Accordingly, the data collection and aggregation module 7022 may generate aggregated metadata or other organized data based on raw data received from of the central surgical controllers 7006. For this purpose, the processors 7008 may be operationally coupled to the central controller applications 7014 and the aggregated medical databases 7011 to execute the data analysis modules 7034. The data collection and aggregation module 7022 may store the aggregated organized data in aggregated medical databases 2212.

[00275] Resource optimization module 7020 may be configured to analyze this aggregated data to determine optimal resource utilization for a specific healthcare facility or group of healthcare facilities. For example, the resource optimization module 7020 may determine an optimal ordering point for surgical stapling instruments 7012 for a group of healthcare facilities based on corresponding forecasted demand for such instruments 7012. The resource optimization module 7020 It could also evaluate resource use or other operational settings of various health care facilities to determine whether resource use could be improved. Similarly, the recommendations module 7030 may be configured to analyze organized data aggregated from the data collection and aggregation module 7022 to provide recommendations. For example, the recommendations module 7030 could recommend to healthcare facilities (e.g., medical service providers such as hospitals) that a specific surgical instrument 7012 should be upgraded to an improved version based on an error rate of greater than expected, for example. Additionally, the recommendations module 7030 and/or the resource optimization module 7020 could recommend better supply chain parameters such as product repurchase points and provide suggestions for different surgical instruments, uses thereof, or procedural steps to improve surgical results. Healthcare facilities can receive such recommendations through corresponding 7006 central surgical controllers. More specific recommendations regarding parameters or configurations of various 7012 surgical instruments may also be provided. Central controllers 7006 and/or surgical instruments 7012 may also have display screens that display data or recommendations provided by cloud 7004.

[00276] The patient outcome analysis module 7028 may analyze surgical outcomes associated with currently used operating parameters of the surgical instruments 7012. The patient outcome analysis module 7028 may also analyze and evaluate other potential operating parameters. In this context, the 7030 recommendations module could recommend the use of these other potential operating parameters based on producing better surgical outcomes, such as better sealing or less bleeding. For example, the recommendations module 7030 could transmit recommendations to a central surgical controller 7006 about when to use a certain cartridge for a corresponding surgical stapling instrument 7012 . In this way, the cloud-based data analysis system, while controlling common variables, can be configured to analyze the large collection of raw data and provide centralized recommendations across multiple healthcare facilities (advantageously determined based on aggregated data ). For example, the cloud-based data analytics system could analyze, evaluate, and/or aggregate data based on type of medical practice, type of patient, number of patients, geographic similarity between medical providers, which medical providers/facilities use types similar instruments, etc., in a way that no single healthcare facility would be able to analyze independently.

[00277] Control program update module 7026 can be configured to implement various surgical instrument recommendations 7012 when corresponding control programs are updated. For example, the patient outcome analysis module 7028 could identify correlations linking specific control parameters to successful (or unsuccessful) outcomes. Such correlations can be resolved when updated control programs are transmitted to surgical instruments 7012 through the control program update module 7026. Updates to instruments 7012 that are transmitted through a corresponding central controller 7006 can incorporate aggregated performance data that has been collected. and analyzed by the data collection and aggregation module 7022 of the cloud 7004. Additionally, the patient outcomes analysis module 7028 and the recommendations module 7030 could identify improved methods of using the instruments 7012 based on the aggregated performance data.

[00278] The cloud-based data analysis system may include security features implemented by the cloud 7004. These security features may be managed by the authorization and security module 7024. Each central surgical controller 7006 may have unique credentials associated with it such as username, password, and other appropriate security credentials. These credentials may be stored in memory 7010 and be associated with a permitted cloud access level. For example, based on providing accurate credentials, a central surgical controller 7006 may be granted access to communicate with the cloud to a predetermined degree (e.g., it may only participate in transmitting or receiving certain defined types of information). . For this purpose, the aggregated physician databases 7011 of the cloud 7004 may comprise a database of authorized credentials to verify the accuracy of the provided credentials. Different credentials may be associated with different permission levels for interacting with cloud 7004, such as a predetermined access level for receiving data analytics generated by cloud 7004.

[00279] Additionally, for security purposes, the cloud could maintain a database of central controllers 7006, instruments 7012, and other devices that may comprise a "black list" of prohibited devices. In particular, a blacklisted central surgical controller 7006 may not be permitted to interact with the cloud, while blacklisted surgical instruments 7012 may not have functional access to a corresponding central controller 7006 and/or may be prevented from fully functioning. when paired with their corresponding central controller 7006. Additionally or alternatively, the cloud 7004 may identify instruments 7012 based on incompatibility or other specified criteria. In this way, counterfeit medical devices and inappropriate reuse of such devices throughout the cloud-based data analytics system can be identified and addressed.

[00280] Surgical instruments 7012 may use wireless transceivers to transmit wireless signals that may represent, for example, credentials for authorizing access to corresponding central controllers 7006 and cloud 7004. Wired transceivers may also be used to transmit signals. Such authorization credentials may be stored in the respective memory devices of the surgical instruments 7012. The authorization and security module 7024 may determine whether the authorization credentials are accurate or falsified. The 7024 authorization and security module can also dynamically generate authorization credentials for increased security. Credentials could also be encrypted, such as through the use of hash-based encryption. After transmitting the appropriate authorization, the surgical instruments 7012 may transmit a signal to the corresponding central controllers 7006 and finally to the cloud 7004, to indicate that the instruments 7012 are ready to obtain and transmit medical data. In response, cloud 7004 may transition to a state enabled to receive medical data for storage in aggregated medical databases 7011. This data transmission availability could be indicated by an indicator light on instruments 7012, for example. The cloud 7004 may also transmit signals to the surgical instruments 7012 to update their associated control programs. The cloud 7004 may transmit signals that are directed to a specific class of surgical instruments 7012 (e.g., electrosurgical instruments) so that software updates for control programs are transmitted only to the appropriate surgical instruments 7012 . Additionally, the 7004 cloud could be used to implement system-wide solutions to address local or global issues based on selective data transmission and authorization credentials. For example, if a group of surgical instruments 7012 is identified as having a common manufacturing defect, the cloud 7004 may change the authorization credentials corresponding to this group to implement an operational block of the group.

[00281] The cloud-based data analysis system may enable monitoring of multiple healthcare facilities (e.g., medical facilities such as hospitals) to determine improved practices and recommend changes (through the 2030 recommendations module, for example) appropriately. In this way, processors 7008 of cloud 7004 can analyze data associated with a healthcare facility to identify the facility and aggregate the data with other data associated with other healthcare facilities in a group. Groups could be defined based on similar operational practices or geographic location, for example. In this way, the cloud 7004 can provide analysis and recommendations regarding a group-wide healthcare facility. The cloud-based data analysis system could also be used to improve situational awareness. For example, the 7008 processors can predictively demonstrate the effects of recommendations on cost and effectiveness for a specific facility (in relation to operations and/or various general medical procedures). The cost and effectiveness associated with that specific facility can also be compared to a corresponding local region of other facilities or any other comparable facilities.

[00282] The data classification and prioritization module 7032 may prioritize and classify data based on severity (e.g., the severity of a medical event associated with the data, unpredictability, distrust). This classification and prioritization can be used in conjunction with the functions of the other 7034 data analysis modules described above to enhance the cloud-based data analysis and operations described herein. For example, the data classification and prioritization module 7032 may assign a priority to data analysis performed by the data collection and aggregation module 7022 and patient outcome analysis modules 7028. Different levels of prioritization may result in specific responses from the cloud 7004 (corresponding to a level of urgency), such as escalation to an expedited response, special processing, deletion from aggregated medical databases 7011, or other appropriate responses. Additionally, if necessary, the cloud 7004 may transmit a request (e.g., a push message) via the application servers to central controllers for additional data from corresponding surgical instruments 7012 . The automatic message may result in a notification displayed on the corresponding central controllers 7006 to request supporting or additional data. This automatic message may be necessary in situations where the cloud detects a significant irregularity or out-of-bounds results and the cloud cannot determine the cause of the irregularity. Central servers 7013 may be programmed to activate this automatic message in certain significant circumstances, such as when data is determined to differ from an expected value beyond a predetermined threshold, or when it appears that security has been understood, for example.

[00283] Additional details related to the cloud data analysis system can be found in US provisional patent application No. 62/659,900, entitled METHOD OF HUB COMMUNICATION, filed on April 19, 2018, which is incorporated herein by way of reference in its entirety.

Situational awareness

[00284] Although a "smart" device, including control algorithms responsive to sensed data, may be an improvement over a "dumb" device that operates without carrying sensed data, some sensed data may be incomplete or inconclusive when considered in isolation, that is, without the context of the type of surgical procedure being performed or the type of tissue undergoing surgery. Without knowing the context of the procedure (e.g., knowing the type of tissue being operated on, or the type of procedure being performed), the control algorithm may control the modular device incorrectly or suboptimally given the sensed data. without specific context. For example, the optimal way for a control algorithm to control a surgical instrument in response to a particular detected parameter may vary according to the particular tissue type being operated on. This is due to the fact that different types of tissue have different properties (e.g. tear resistance) and thus respond differently to actions performed by surgical instruments. Therefore, it may be desirable for a surgical instrument to perform different actions when the same measurement is detected for a specific parameter. As a specific example, the optimal way in which to control a surgical stapling and cutting instrument in response to the instrument sensing an unexpectedly high force to close its end actuator will vary depending on whether the type of tissue is susceptible or resistant to tearing. For tissues that are susceptible to tearing, such as lung tissue, the instrument's control algorithm would optimally slow the motor in response to an unexpectedly high closing force to prevent tissue tearing. For tissues that are resistant to tearing, such as stomach tissue, the instrument's control algorithm would optimally accelerate the motor in response to an unexpectedly high closing force to ensure that the end actuator is properly secured in the tissue. Without knowing whether lung or stomach tissue has been trapped, the control algorithm may make a decision that is less than what is considered ideal.

[00285] One solution utilizes a central surgical controller including a system configured to derive information about the surgical procedure being performed based on data received from various data sources, and then control paired modular devices accordingly. In other words, the central surgical controller is configured to infer information about the surgical procedure from received data and then control modular devices paired with the central surgical controller based on the inferred context of the surgical procedure. Figure 14 illustrates a diagram of a situational awareness surgical system 5100, in accordance with at least one aspect of the present disclosure. In some exemplifications, data sources 5126 include, for example, modular devices 5102 (which may include sensors configured to detect parameters associated with the patient and/or the modular device itself), databases 5122 (e.g., a database of EMR data containing the patient's medical record), and monitoring devices 5124 (e.g., a blood pressure (BP) monitor and an electrocardiography (ECG) monitor).

[00286] A central surgical controller 5104, which may be similar to the surgical controller 106 in many respects, may be configured to derive contextual information related to the surgical procedure from the data based on, for example, combination(s) specific data(s) received or in the specific order in which the data is received from data sources 5126. Contextual information inferred from the received data may include, for example, the type of surgical procedure being performed, the specific step of the surgical procedure that the surgeon is performing, the type of tissue being operated on, or the body cavity that is the subject of the procedure. This ability for some aspects of the central surgical controller 5104 to derive or infer surgical procedure-related information from received data may be called "situational awareness." In one exemplification, the central surgical controller 5104 may incorporate a situational awareness system, which is the hardware and/or programming associated with the central surgical controller 5104 that derives contextual information related to the surgical procedure based on the received data.

[00287] The situational awareness system of the central surgical controller 5104 may be configured to derive contextual information from data received from data sources 5126 in various ways. In one exemplification, the situational awareness system includes a pattern recognition system, or machine learning system (e.g., an artificial neural network), that has been trained on training data to correlate various inputs (e.g., data from databases 5122, patient monitoring devices 5124, and/or modular devices 5102) to corresponding contextual information regarding a surgical procedure. In other words, a machine learning system can be trained to accurately derive contextual information regarding a surgical procedure from the inputs provided. In another exemplification, the situational awareness system may include a lookup table that stores pre-characterized contextual information regarding a surgical procedure in association with one or more inputs (or ranges of inputs) corresponding to the contextual information. In response to a query with one or more inputs, the query table may return corresponding contextual information to the situational awareness system for controlling the 5102 Modular devices. In one exemplification, the contextual information received by the situational awareness system from the surgical controller central 5104, are associated with a specific control setting or set of control settings for one or more modular devices 5102. In another exemplification, the situational awareness system includes an additional machine learning system, lookup table, or other such system. type, generating or retrieving one or more control settings for one or more modular devices 5102, when provided with contextual information as input.

[00288] A central surgical controller 5104, which incorporates a situational awareness system, provides several benefits to the surgical system 5100. One benefit includes improving the interpretation of detected and captured data, which in turn improves processing accuracy and /or the use of data during the course of a surgical procedure. To return to a previous example, a central surgical controller 5104 having situational awareness could determine what type of tissue was being operated on; Therefore, when an unexpectedly high force is detected to close the surgical instrument end actuator, the situational awareness central surgical controller 5104 could correctly accelerate or decelerate the surgical instrument motor for the tissue type.

[00289] As another example, the type of tissue being operated on can affect the adjustments that are made to the load thresholds and compression rate of a surgical stapling and cutting instrument for a specific tissue gap measurement. A situational awareness central surgical controller 5104 could infer whether a surgical procedure being performed is a thoracic or abdominal procedure, allowing the central surgical controller 5104 to determine whether tissue is clamped by an end actuator of the surgical cutting and stapling instrument. it is lung tissue (for a thoracic procedure) or stomach tissue (for an abdominal procedure). The central surgical controller 5104 can then appropriately adjust the load thresholds and compression rate of the surgical cutting and stapling instrument for the tissue type.

[00290] As yet another example, the type of body cavity being operated on during an insufflation procedure can affect the function of a smoke evacuator. A situational awareness central surgical controller 5104 can determine whether the surgical site is under pressure (by determining that the surgical procedure is utilizing insufflation) and determine the type of procedure. As a type of procedure is generally performed in a specific body cavity, the central surgical controller 5104 can then appropriately control the speed of the smoke evacuator motor for the body cavity being operated on. In this way, a central situational awareness surgical controller 5104 can provide a consistent amount of smoke evacuation to both thoracic and abdominal procedures.

[00291] As yet another example, the type of procedure being performed can affect the ideal energy level for an ultrasonic surgical instrument or radio frequency (RF) electrosurgical instrument to operate. Arthroscopic procedures, for example, require higher energy levels because the end actuator of the ultrasonic surgical instrument, or RF electrosurgical instrument, is immersed in fluid. A situational awareness central surgical controller 5104 can determine whether the surgical procedure is an arthroscopic procedure. The central surgical controller 5104 can then adjust the RF power level or ultrasonic amplitude of the generator (i.e., the "power level") to compensate for the fluid-filled environment. Related to this, the type of tissue being operated on can affect the optimal energy level at which an ultrasonic surgical instrument or RF electrosurgical instrument operates. A central situational awareness surgical controller 5104 can determine what type of surgical procedure is being performed and then customize the energy level for the ultrasonic surgical instrument or RF electrosurgical instrument, respectively, according to the tissue profile expected to be performed. the surgical procedure. Additionally, a central situational awareness surgical controller 5104 may be configured to adjust the power level for the ultrasonic surgical instrument or RF electrosurgical instrument throughout the course of a surgical procedure, rather than just on a procedure-per-procedure basis. -procedure. A situational awareness central surgical controller 5104 may determine which step of the surgical procedure is being performed or will be performed subsequently and then update the control algorithms for the generator and/or ultrasonic surgical instrument or RF electrosurgical instrument to adjust the level of energy at an appropriate value for the type of tissue, according to the stage of the surgical procedure.

[00292] As yet another example, data may be extracted from additional data sources 5126 to enhance the conclusions that the central surgical controller 5104 extracts from a data source 5126. A central surgical controller with situational awareness 5104 may augment the data that it receives from modular devices 5102 contextual information that it has accumulated regarding the surgical procedure from other data sources 5126. For example, a central situational awareness surgical controller 5104 may be configured to determine whether hemostasis has occurred (i.e. , whether bleeding has stopped at a surgical site), according to video or image data received from a medical imaging device. However, in some cases, video or image data may be inconclusive. Therefore, in one exemplification, the surgical hub controller 5104 may be further configured to compare a physiological measurement (e.g., blood pressure detected by a BP monitor communicatively connected to the surgical hub controller 5104) with visual or image data from hemostasis (e.g., from a medical imaging device 124 (Figure 2) communicably coupled to the central surgical controller 5104) to make a determination about the integrity of the staple line or tissue union. In other words, the situational awareness system of the surgical core controller 5104 may consider physiological measurement data to provide additional context in analyzing the visualization data. Additional context can be useful when visualization data may be inconclusive or incomplete on its own.

[00293] Another benefit includes proactively and automatically controlling the paired modular devices 5102 according to the specific step of the surgical procedure being performed to reduce the number of times medical personnel are required to interact with or control the surgical system 5100 during the course of a surgical procedure. For example, a situational awareness central surgical controller 5104 may proactively activate the generator to which an RF electrosurgical instrument is connected if it is determined that a subsequent step of the procedure requires the use of the instrument. Proactively activating the power source allows the instrument to be ready for use as soon as the preceding step of the procedure is completed.

[00294] As another example, a central surgical controller provided with situational awareness 5104 could determine whether the current or subsequent step of the surgical procedure requires a different view or degree of screen magnification, according to the feature(s) in the surgical site that the surgeon is expected to need to see. The central surgical controller 5104 could then proactively change the displayed view (provided, for example, by a medical imaging device to the display system 108), so that the screen automatically adjusts throughout the surgical procedure.

[00295] As yet another example, a central surgical controller provided with situational awareness 5104 could determine which step of the surgical procedure is being performed or will be performed subsequently and whether specific data or comparisons between data will be required for that step of the surgical procedure. The central surgical controller 5104 can be configured to automatically call up screens based on data about the stage of the surgical procedure being performed, without waiting for the surgeon to request the specific information.

[00296] Another benefit includes checking for errors during the setup of the surgical procedure or during the course of the surgical procedure. For example, a situational awareness central surgical controller 5104 could determine whether the operating room is adequately or ideally configured for the surgical procedure to be performed. The central surgical controller 5104 may be configured to determine the type of surgical procedure being performed, retrieve corresponding checklists, product location, or configuration needs (e.g., from a memory), and then compare the current operating room layout with the default layout for the type of surgical procedure that the 5104 Central Surgical Controller determines is being performed. In one exemplification, the central surgical controller 5104 may be configured to compare the list of items for the procedure scanned by a suitable scanner 5132, for example, and/or a list of devices paired with the central surgical controller 5104 with a recommended or anticipated manifest. of items and/or devices for the given surgical procedure. If there are any discontinuities between the lists, the central surgical controller 5104 can be configured to provide an alert indicating that a specific modular device 5102, patient monitoring device 5124, and/or other surgical item are missing. In one exemplification, the central surgical controller 5104 may be configured to determine the position or relative distance of modular devices 5102 and patient monitoring devices 5124 via proximity sensors, for example. The central surgical controller 5104 can compare the relative positions of the devices with a recommended or anticipated layout for the specific surgical procedure. If there are any discontinuities between the layouts, the central surgical controller 5104 can be configured to provide an alert indicating that the current layout for the surgical procedure deviates from the recommended layout.

[00297] As another example, the situational awareness central surgical controller 5104 could determine whether the surgeon (or other medical personnel) was making an error or otherwise deviating from the expected course of action during the course of a procedure. surgical. For example, the central surgical controller 5104 may be configured to determine the type of surgical procedure being performed, retrieve the corresponding list of steps or order of equipment use (e.g., from a memory), and then compare the steps being performed or equipment being used during the course of the surgical procedure with the steps or equipment expected for the type of surgical procedure that the central surgical controller 5104 has determined is being performed. In one example, the central surgical controller 5104 may be configured to provide an alert indicating that an unexpected action is being performed or an unexpected device is being used at the specific step in the surgical procedure.

[00298] In general, the situational awareness system for the central surgical controller 5104 improves surgical procedure results by adjusting surgical instruments (and other modular devices 5102) to the specific context of each surgical procedure (such as adjusting to different types of tissue), and when validating actions during a surgical procedure. The situational awareness system also improves the surgeon's efficiency in performing surgical procedures by automatically suggesting next steps, providing data, and adjusting screens and other modular devices 5102 in the operating room according to the specific context of the procedure.

[00299] Referring now to Figure 15, a timeline 5200 is shown representing situational awareness of a central controller, such as the central surgical controller 106 or 206 (Figures 1 to 11), 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.

[00300] The situationally aware surgical core 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 core surgical controller 106 , 206. The central surgical controller 106, 206 may receive this data from the 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.

[00301] 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.

[00302] 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).

[00303] In the third step 5206, medical personnel scan the patient's band with a scanner that is communicably connected to the central surgical controller 106, 206. The central surgical controller 106, 206 can then confirm the patient's identity based on the scanned data.

[00304] In the fourth step 5208, medical personnel turn on the 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.

[00305] 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.

[00306] 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.

[00307] 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.

[00308] 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 ways, including by determining the angle at which the medical imaging device is oriented relative to the view. of the patient's anatomy, monitoring the number or medical imaging devices being used (i.e., which are activated and paired with the central surgical controller 106, 206) and monitoring the types of visualization devices used. For example, a technique for performing a VATS lobectomy places the camera in the lower anterior corner of the patient's 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.

[00309] 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., after 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.

[00310] 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.

[00311] 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.

[00312] 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.

[00313] 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.

[00314] 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 various data sources that are communicably coupled to the controller. central surgical 106, 206.

[00315] Situational awareness is further described in US provisional patent application serial No. 62/659,900, entitled METHOD OF HUB COMMUNICATION, filed on April 19, 2018, 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 disclosed 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.

[00316] In one aspect, as described later in this document with reference to Figures 24 to 40, the modular device 5102 is implemented as combined ultrasonic surgical instruments and power surgical instruments 7012, as described in Figures 23A and 23B, 24A and 24B , 25A and 25B, 26A to 26E, 27A to 27F. Accordingly, the modular device 5102 implemented as an ultrasonic surgical instrument and combined power surgical instrument 7012, as described in Figures 23A and 23B, 24A and 24B, 25A and 25B, 26A to 26E, 27A to 27F, are configured to operate as a data source 5126 and to interact with the database 5122 and the patient monitoring devices 5124. The modular device 5102 implemented as an ultrasonic surgical instrument and combined power surgical instrument 7012, as described in Figures 23A and 23B, 24A and 24B, 25A and 25B, 26A to 26E, 27A to 27F, are further configured to interact with the central surgical controller 5104 to provide information (e.g., data and control) to the central surgical controller 5104 and receive information (e.g., data and control) from the 5104 Central Surgical Controller.

Generator Hardware

[00317] Figure 16 is a schematic diagram of a robotic surgical instrument 700 configured to operate a surgical tool described herein, in accordance with an aspect of this disclosure. The robotic surgical instrument 700 can 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, or one or more pivot members, or combinations thereof. Surgical instrument 700 comprises a control circuit 710 configured to control motor-driven firing members, closing members, drive shaft members, or one or more pivot members, or combinations thereof.

[00318] In one aspect, the robotic surgical instrument 700 comprises a control circuit 710 configured to control a gripping arm 716 and a closing member 714, a portion of an end actuator 702, an ultrasonic blade 718 coupled to a transducer ultrasonic 719 excited by an ultrasonic generator 721, a drive shaft 740, and one or more pivot members 742a, 742b through a plurality of motors 704a to 704e. A position sensor 734 may be configured to provide feedback about the position of the closure member 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.

[00319] 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 closure member 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 closing member 714 at a specific time (t) relative to a starting position or the time (t) when the closing member 714 is in a specific position relative to an initial position. The 731 timer/counter can be configured to measure elapsed time, count external events, or measure external events.

[00320] 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 can control the closing force applied to the fabric by the clamping arm 716. Other control programs control the rotation of the drive shaft 740 and the pivot members 742a, 742b.

[00321] 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.

[00322] 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 a stroke 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 power supplied to one of the motors 704a to 704e during the open circuit portion, a sum of pulse widths of a motor drive signal, etc. After 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.

[00323] 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 main current power source, a battery, a super capacitor, or any other suitable power source. Motors 704a to 704e may be mechanically coupled to individual movable mechanical elements such as the closure member 714, the clamping arm 716, drive shaft 740, 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 closure member 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 closure member 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 closure member 714 translates distally and proximally. The control circuit 710 may track the pulses to determine the position of the closure member 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 closure member 714. Additionally, in some examples, the position sensor 734 may be omitted. When any of the motors 704a to 704e is a stepper motor, the control circuit 710 can track the position of the closure member 714 by aggregating the number and direction of 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.

[00324] In one aspect, the control circuit 710 is configured to actuate a firing member, such as the closing member portion 714 of the end actuator 702. The control circuit 710 provides a motor set point for a control of engine 708a, which provides a drive signal to engine 704a. The motor output drive shaft 704a is coupled to a torque sensor 744a. The torque sensor 744a is coupled to a transmission 706a which is coupled to the closure member 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 closure member 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 knife drive gear and a second gear. knife drive. 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 closure member 714. A position sensor 734 can be configured to provide the position of the closure member 714 along the firing stroke 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 feedback signals to the control circuit 710. When ready for use, the control circuit 710 can 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 closing member 714 translates distally, the clamping arm 716 closes toward the ultrasonic blade 718.

[00325] In one aspect, the control circuit 710 is configured to actuate a closure member, such as the clamping arm portion 716 of the end actuator 702. The control circuit 710 provides a motor set point for a control of engine 708b, which provides a drive signal to engine 704b. The motor output drive shaft 704b is coupled to a torque sensor 744b. The torque sensor 744b is coupled to a transmission 706b which is coupled to the clamping arm 716. The transmission 706b comprises movable mechanical elements such as rotating elements and a closing member for controlling the movement of the clamping arm 716 from the open and closed. 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 clamping arm 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. The pivotable clamping arm 716 is positioned opposite the ultrasonic blade 718. When ready for use, the control circuit 710 can provide a close signal to the motor control 708b. In response to the closing signal, the motor 704b advances a closing member to clamp the tissue between the clamping arm 716 and the ultrasonic blade 718.

[00326] 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 drive 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 drive 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. up to 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.

[00327] 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.

[00328] 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 with respect to the other link to provide a resistive holding movement and a load to the head when it is not moving and to provide a 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 and pull connection changes when the head is rotated. This change in mechanical advantage may be more pronounced with other linkage drive systems.

[00329] 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.

[00330] 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.

[00331] 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 clamping arm 716 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 ultrasonic blade 718 has tissue in it, and (4) the load and position on both pivot rods.

[00332] 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 pinched 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 gripping arm 716 and the ultrasonic blade 718. The sensors 738 may be configured to detect the impedance of a section of tissue situated between the clamping arm 716 and the ultrasonic blade 718 which is indicative of the thickness and/or completeness of the tissue located between them.

[00333] 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, the 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, and inertial sensors, among others.

[00334] In one aspect, sensors 738 can be configured to measure the forces exerted on the clamping arm 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 clamping arm 716 to detect closing forces applied by the closing tube to clamping arm 716. The forces exerted on the clamping arm clamping 716 may be representative of the tissue compression experienced by the section of tissue captured between the clamping arm 716 and the ultrasonic blade 718. The one or more sensors 738 may be positioned at various interaction points along the closure drive system to detect the closing forces applied to the clamping arm 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 clamping arm 716.

[00335] 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 movable mechanical elements such as the closure member 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 the closure member 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 disclosed in US Patent Application Serial No. 15/636,829, entitled CLOSED LOOP VELOCITY CONTROL TECHNIQUES FOR ROBOTIC SURGICAL INSTRUMENT, filed on June 29, 2017, which is incorporated herein by reference in its entirety.

[00336] Figure 17 illustrates a schematic diagram of a surgical instrument 750 configured to control distal translation of the displacement member in accordance with an aspect of the present disclosure. In one aspect, the surgical instrument 750 is programmed to control the distal translation of the displacement member as the closing member 764. The surgical instrument 750 comprises an end actuator 752 which may comprise a clamping arm 766, a closing member 764 and an ultrasonic blade 768 coupled to an ultrasonic transducer 769 driven by an ultrasonic generator 771.

[00337] The position, movement, displacement, and/or translation of a linear displacement member, such as closure member 764, can be measured by an absolute positioning system, sensor arrangement, and a position sensor 784. Because the closure member 764 is coupled to a longitudinally movable drive member, the position of the closure member 764 can be determined by measuring the position of the longitudinally movable drive member employing the position sensor 784. Accordingly, in the following description , the position, displacement and/or translation of the closure member 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 closure member 764. The control circuit 760, in some examples, may comprise one or more microcontrollers, microprocessors, or other processors suitable for executing instructions. which cause the processor or processors to control the displacement member, e.g., the closure member 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 closure member 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 closure member 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.

[00338] 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.

[00339] 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 closure member 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 closure member 764. A position sensor 784 may detect a position of the closure member 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 closure member 764. In some examples, the position sensor 784 may include an encoder configured to provide a series of pulses to the control circuit 760 as the closure member 764 translates distally and proximally. The control circuit 760 may track the pulses to determine the position of the closure member 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 closure member 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 closure member 764 by aggregating the number and orientation of 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.

[00340] 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.

[00341] The one or more sensors 788 may comprise a strain gauge, such as a microstrain gauge, configured to measure the magnitude of strain on the clamping arm 766 during a clamped 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 gripping arm 766 and the ultrasonic blade 768. The sensors 788 may be configured to detect the impedance of a section of tissue situated between the clamping arm 766 and the ultrasonic blade 768 which is indicative of the thickness and/or completeness of the tissue located between them.

[00342] Sensors 788 can be configured to measure the forces exerted on the clamping arm 766 by the closing drive system. For example, one or more sensors 788 may be at a point of interaction between the closure tube and clamping arm 766 to detect closing forces applied by a clamping tube to clamping arm 766. The forces exerted on the clamping arm 766. The clamping arm 766 may be representative of the tissue compression experienced by the section of tissue captured between the clamping arm 766 and the ultrasonic blade 768. The one or more sensors 788 may be positioned at various interaction points along the closure drive system. to detect the closing forces applied to the clamping arm 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 in real time, the closing forces applied to the clamping arm 766.

[00343] A current sensor 786 can be employed to measure the current drawn by the motor 754. The force required to advance the closing member 764 corresponds to the current drawn by the motor 754. The force is converted into a digital signal and supplied to the circuit control 760.

[00344] The control circuit 760 can be configured to simulate the response of the actual instrument system in the controller software. A displacement member may be actuated to move a closure member 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. The 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.

[00345] The actual drive system of the surgical instrument 750 is configured to drive the moving member, the cutting member or the closing member 764, by a brushed DC motor, with gearbox and mechanical connections to a system of joint and/or 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.

[00346] Various exemplary aspects are directed to a surgical instrument 750 comprising an end actuator 752 with motor-driven sealing 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 clamping arm 766 and, when configured for use, a ultrasonic blade 768 positioned on the opposite side of the clamping arm 766. A clinician can hold tissue between the clamping arm 766 and the ultrasonic blade 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 closing member 764 with a cutting member positioned at a distal end, can cut the tissue between the ultrasonic blade 768 and the clamping arm 766.

[00347] 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 closing member 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 control program can describe the distal movement of the displacement limb. Different control programs can be selected to best treat 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.

[00348] In some examples, the control circuit 760 may initially operate the motor 754 in an open-loop configuration by a first open-loop portion of a stroke of the displacement 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 disclosed 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.

[00349] Figure 18 illustrates a schematic diagram of a surgical instrument 750 configured to control distal translation of the displacement member in accordance with an aspect of the present disclosure. In one aspect, the surgical instrument 750 is programmed to control the distal translation of the displacement member as the closing member 764. The surgical instrument 750 comprises an end actuator 752 which may comprise a clamping arm 766, a closing member 764 and an ultrasonic blade 768 coupled to an ultrasonic transducer 769 driven by an ultrasonic generator 771.

[00350] The position, movement, displacement, and/or translation of a linear displacement member, such as closure member 764, can be measured by an absolute positioning system, sensor arrangement, and a position sensor 784. Because the closure member 764 is coupled to a longitudinally movable drive member, the position of the closure member 764 can be determined by measuring the position of the longitudinally movable drive member employing the position sensor 784. Accordingly, in the following description , the position, displacement and/or translation of the closure member 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 closure member 764. The control circuit 760, in some examples, may comprise one or more microcontrollers, microprocessors, or other processors suitable for executing instructions. which cause the processor or processors to control the displacement member, e.g., the closure member 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 closure member 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 closure member 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.

[00351] 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.

[00352] 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 closure member 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 closure member 764. A position sensor 784 may detect a position of the closure member 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 closure member 764. In some examples, the position sensor 784 may include an encoder configured to provide a series of pulses to the control circuit 760 as the closure member 764 translates distally and proximally. The control circuit 760 may track the pulses to determine the position of the closure member 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 closure member 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 closure member 764 by aggregating the number and orientation of 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.

[00353] 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.

[00354] The one or more sensors 788 may comprise a strain gauge, such as a microstrain gauge, configured to measure the magnitude of strain on the clamping arm 766 during a clamped 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 gripping arm 766 and the ultrasonic blade 768. The sensors 788 may be configured to detect the impedance of a section of tissue situated between the clamping arm 766 and the ultrasonic blade 768 which is indicative of the thickness and/or completeness of the tissue located between them.

[00355] Sensors 788 can be configured to measure the forces exerted on the clamping arm 766 by the closing drive system. For example, one or more sensors 788 may be at a point of interaction between the closure tube and clamping arm 766 to detect closing forces applied by a clamping tube to clamping arm 766. The forces exerted on the clamping arm 766. The clamping arm 766 may be representative of the tissue compression experienced by the section of tissue captured between the clamping arm 766 and the ultrasonic blade 768. The one or more sensors 788 may be positioned at various interaction points along the closure drive system. to detect the closing forces applied to the clamping arm 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 in real time, the closing forces applied to the clamping arm 766.

[00356] A current sensor 786 can be employed to measure the current drawn by the motor 754. The force required to advance the closing member 764 corresponds to the current drawn by the motor 754. The force is converted into a digital signal and supplied to the circuit control 760.

[00357] The control circuit 760 can be configured to simulate the response of the actual instrument system in the controller software. A displacement member may be actuated to move a closure member 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. The 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.

[00358] The actual drive system of the surgical instrument 750 is configured to drive the moving member, the cutting member or the closing member 764, by a brushed DC motor, with gearbox and mechanical connections to a system of joint and/or 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.

[00359] Various exemplary aspects are directed to a surgical instrument 750 comprising an end actuator 752 with motor-driven sealing 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 clamping arm 766 and, when configured for use, a ultrasonic blade 768 positioned on the opposite side of the clamping arm 766. A clinician can hold tissue between the clamping arm 766 and the ultrasonic blade 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 closing member 764 with a cutting member positioned at a distal end, can cut the tissue between the ultrasonic blade 768 and the clamping arm 766.

[00360] 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 closing member 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 control program can describe the distal movement of the displacement limb. Different control programs can be selected to best treat different tissue conditions. For example, when thicker tissue is present, control circuit 760 may be programmed to translate the travel 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.

[00361] In some examples, the control circuit 760 may initially operate the motor 754 in an open-loop configuration by a first open-loop portion of a stroke of the displacement 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 disclosed 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.

[00362] Figure 18 is a schematic diagram of a surgical instrument 790 configured to control various functions in accordance with an aspect of the present disclosure. In one aspect, the surgical instrument 790 is programmed to control the distal translation of a displacement member such as the closing member 764. The surgical instrument 790 comprises an end actuator 792 which may comprise a gripping arm 766, a closing member 764, and an ultrasonic blade 768 that can be interchanged with or function in conjunction with one or more RF electrodes 796 (shown in dashed line). The ultrasonic blade 768 is coupled to an ultrasonic transducer 769 driven by an ultrasonic generator 771.

[00363] 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, the 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.

[00364] In one aspect, the position sensor 784 can be implemented as an absolute positioning system, which comprises 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 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.

[00365] In some examples, position sensor 784 may be omitted. When the motor 754 is a stepper motor, the control circuit 760 can track the position of the closure member 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.

[00366] 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.

[00367] An RF energy source 794 is coupled to the end actuator 792 and is applied to the RF electrode 796 when the RF electrode 796 is provided in the end actuator 792 in place of the ultrasonic blade 768 or to work in conjunction with the 768 ultrasonic blade. For example, the ultrasonic blade is made of electrically conductive metal and can be employed as the return path for RF electrosurgical current. Control circuit 760 controls the delivery of RF energy to RF electrode 796.

[00368] Additional details are disclosed in US Patent Application Serial No. 15/636,096, entitled SURGICAL SYSTEM COUPLABLE WITH STAPLE CARTRIDGE AND RADIO FREQUENCY CARTRIDGE, AND METHOD OF USING SAME, filed June 28, 2017, which is incorporated herein for reference in its entirety.

[00369] Figure 19 illustrates an example of a generator 900, which is one form of a generator configured to couple to an ultrasonic instrument and further configured to execute adaptive ultrasonic blade control algorithms in a surgical data network comprising a controller modular communication center. Generator 900 is configured to provide multiple modalities of power to a surgical instrument. Generator 900 provides ultrasonic and RF signals to power a surgical instrument, independently or simultaneously. Ultrasonic and RF signals can be provided alone or in combination and can be provided simultaneously. As indicated above, at least one generator output can provide multiple modalities of energy (e.g., ultrasonic, bipolar or monopolar RF, irreversible and/or reversible electroporation, and/or microwave energy, among others) through a single port, and these signals can be provided separately or simultaneously to the end actuator to treat tissue. The generator 900 comprises a processor 902 coupled to a waveform generator 904. The processor 902 and the waveform generator 904 are configured to generate various signal waveforms based on information stored in a memory coupled to the processor 902 , not shown for clarity of disclosure. Digital information associated with a waveform is provided to waveform generator 904 which includes one or more DAC circuits for converting the digital input to an analog output. The analog output is fed to a 1106 amplifier for signal conditioning and amplification. The conditioned and amplified output of amplifier 906 is coupled to a power transformer 908. Signals are coupled by power transformer 908 to the secondary side, which is on the patient isolation side. A first signal of a first power modality is supplied to the surgical instrument between the terminals labeled POWER1 and RETURN. A second signal of a second energy modality is coupled by a capacitor 910 and is supplied to the surgical instrument between the terminals labeled POWER2 and RETURN. It will be recognized that more than two modes of energy may be emitted and therefore the subscript "n" may be used to designate that up to n terminals of ENERGY may be provided, where n is a positive integer greater than 1. It will also be recognized that up to "n" return trajectories, RETURNn may be provided without departing from the scope of the present disclosure.

[00370] A second voltage detection circuit 912 is coupled across the terminals labeled POWER1 and the RETURN path to measure the output voltage between them. A second voltage detection circuit 924 is coupled across the terminals labeled POWER2 and the RETURN path to measure the output voltage between them. A current sensing circuit 914 is arranged in series with the RETURN leg of the secondary side of the power transformer 908 as shown to measure the output current for any power modality. If different return paths are provided for each power modality, then a separate current sensing circuit would be provided on each return leg. The outputs of the first and second voltage sensing circuits 912, 924 are provided to respective isolation transformers 916, 922 and the output of the current sensing circuit 914 is provided to another isolation transformer 918. The outputs of the isolation transformers 916 , 928, 922 on the primary side of the power transformer 908 (non-isolated patient side) are provided to one or more ADC circuits 926. The digitized output of the ADC circuit 926 is provided to the processor 902 for further processing and computation. The output voltages and output current feedback information can be employed to adjust the output voltage and current supplied to the surgical instrument, and to compute the output impedance, among other parameters. Input/output communications between the processor 902 and the patient's isolated circuits are provided through an interface circuit 920. The sensors may also be in electrical communication with the processor 902 through the interface circuit 920.

[00371] In one aspect, the impedance may be determined by the processor 902 by dividing the output of the first voltage sensing circuit 912 coupled over the terminals labeled POWER1/RETURN or the second voltage sensing circuit 924 coupled over the terminals identified as POWER2/RETURN, by the output of the current sensing circuit 914 disposed in series with the RETURN leg of the secondary side of the power transformer 908. The outputs of the first and second voltage sensing circuits 912, 924 are provided to separate the isolation transformers 916, 922 and the output of the current sensing circuit 914 is provided to another isolation transformer 916. Digitized voltage and current sensing measurements from the ADC circuit 926 are provided to the processor 902 to compute the impedance. As an example, the first energy modality ENERGY1 may be ultrasonic energy and the second energy modality ENERGY2 may be RF energy. However, in addition to ultrasonic and bipolar or monopolar RF energy modalities, other energy modalities include irreversible and/or reversible electroporation and/or microwave energy, among others. Furthermore, although the example illustrated in Figure 19 shows a single RETURN return trajectory that can be provided for two or more energy modalities, in other aspects, multiple RETURN return trajectories may be provided for each energy modality ENERGIAn. Thus, as described herein, ultrasonic transducer impedance can be measured by dividing the output of the first voltage sensing circuit 912 by the current sensing circuit 914 and tissue impedance can be measured by dividing the output of the second voltage sensing circuit. 924 by current sensing circuit 914.

[00372] As shown in Figure 19, the generator 900 comprising at least one output port may include a power transformer 908 with a single output and with multiple taps for providing power in the form of one or more energy modalities, such as ultrasonic , bipolar or monopolar RF, irreversible and/or reversible electroporation and/or microwave energy, among others, for example, to the end actuator depending on the type of tissue treatment being performed. For example, generator 900 may provide power at higher voltage and lower current to drive an ultrasonic transducer, at lower voltage and higher current to drive RF electrodes to seal tissue, or with a coagulation waveform for spot coagulation using electrosurgical electrodes. monopolar or bipolar RF. The output waveform of the generator 900 may be steered, switched, or filtered to provide the frequency to the end actuator of the surgical instrument. The connection of an ultrasonic transducer to the output of generator 900 would preferably be located between the output labeled POWER1 and RETURN, as shown in Figure 18. In one example, a connection of bipolar RF electrodes to the output of generator 900 would preferably be located between the output identified as ENERGY2 and the RETURN. In the case of a monopolar output, the preferred connections would be active electrode (e.g. light beam or other probe) to the POWER2 output and a suitable return block connected to the RETURN output.

[00373] Additional details are disclosed in US Patent Application Publication No. 2017/0086914 entitled TECHNIQUES FOR OPERATING GENERATOR FOR DIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMS AND SURGICAL INSTRUMENTS, which was published on March 30, 2017, which is incorporated herein by title reference in its entirety.

[00374] As used throughout this description, the term "wireless" and its derivatives may be used to describe circuits, devices, systems, methods, techniques, communication channels, etc., that can communicate data through the use of electromagnetic radiation modulated through a non-solid medium. The term does not imply that the associated devices do not contain any wires, although in some respects they may not. The communication module may implement any of a number of wireless and wired communication standards or protocols, including, but not limited to, Wi-Fi (IEEE 802.11 family), WiMAX (IEEE 802.16 family), IEEE 802.20, evolution (LTE, "long-term evolution"), Ev-DO, HSPA+, HSDPA+, HSUPA+, EDGE, GSM, GPRS, CDMA, TDMA, DECT, Bluetooth, Ethernet derivatives thereof, as well as any other protocols without wired and wired which are designated as 3G, 4G, 5G, and beyond. The computing module 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.

[00375] As used in the present invention a processor or processing unit is an electronic circuit that performs operations on some external data source, generally memory or some other data stream. The term is used in the present invention to refer to the central processor (central processing unit) in a computer system or systems (specifically systems on a chip (SoCs)) that combine several specialized "processors".

[00376] As used herein, a system on a chip or system on chip (SoC or SOC) is an integrated circuit (also known as an "IC" or "chip") that integrates all of the components of a computer or other electronic systems . It can contain digital, analog, mixed and often radio frequency functions — all on a single substrate. An SoC integrates a microcontroller (or microprocessor) with advanced peripherals such as a graphics processing unit (GPU), i-Fi module, or coprocessor. An SoC may or may not contain internal memory.

[00377] As used herein, a microcontroller or controller is a system that integrates a microprocessor with peripheral circuits and memory. A microcontroller (or MCU for microcontroller unit) can be implemented as a small computer on a single integrated circuit. It can be similar to an SoC; an SoC may include a microcontroller as one of its components. A microcontroller may contain one or more core processing units (CPUs) along with memory and programmable input/output peripherals. Program memory in the form of ferroelectric RAM, NOR flash, or OTP ROM is also often included on the chip, as well as a small amount of RAM. Microcontrollers can be used for integrated applications, in contrast to microprocessors used in personal computers or other general-purpose applications that consist of several discrete integrated circuits.

[00378] As used in the present invention, the term controller or microcontroller can be an independent chip or IC (integrated circuit) device that interfaces with a peripheral device. This may be a link between two parts of a computer or a controller on an external device that manages the operation of (and connection to) that device.

[00379] Any of the processors or microcontrollers in the present invention can be any implemented by any single-core or multi-core processor, such as those known under the trade name ARM Cortex by Texas Instruments. In one 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 analog input channels, details of which are available in the product datasheet.

[00380] In one aspect, the processor 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.

[00381] Modular devices include modules (as described in connection with Figures 3 and 9, for example) that are receivable within a central surgical controller and surgical devices or instruments that can be connected to the various modules in order to connect or pair with corresponding surgical hub controller. Modular devices include, for example, smart surgical instruments, medical imaging devices, suction/irrigation devices, smoke evacuators, power generators, ventilators, insufflators, and displays. The modular devices described here can be controlled by control algorithms. The control algorithms may be executed on the modular device itself, on the central surgical controller to which the specific modular device is paired, or on both the modular device and the central surgical controller (e.g., via a distributed computing). being operated (e.g., tissue properties or inflation pressure) or to the modular device itself (e.g., the rate at which a knife is being advanced, the motor current, or the energy levels. Control algorithm for a surgical stapling and cutting instrument can control the rate at which the instrument's motor drives its knife through tissue according to the resistance encountered by the knife as it advances.

[00382] Figure 20 is a simplified block diagram of an aspect of the generator 1100 to provide inductorless tuning as described above, among other benefits. Referring to Figure 20, the generator 1100 may comprise a patient isolated stage 1520 in communication with a non-isolated stage 1540 via a power transformer 1560. A secondary winding 1580 of the power transformer 1560 is contained in the isolated stage 1520 and may comprise a tapped configuration (e.g., a center-tapped or non-center-tapped configuration) for defining drive signal outputs 1600a, 1600b, 1600c to provide drive signals for different surgical devices, such as an ultrasonic surgical device. 1104 and an electrosurgical device 1106. In particular, the drive signal outputs 1600a, 1600b and 1600c may provide a drive signal (e.g., a 420V RMS drive signal) to an ultrasonic instrument 1104, and the signal outputs 1600a, 1600b, and 1600c may provide a drive signal (e.g., a 100V RMS drive signal) to an electrosurgical device 1106, with the output 1600b corresponding to the center tap of the power transformer 1560. The non-isolated stage 1540 may comprise a power amplifier 1620 that has an output connected to a primary winding 1640 of the power transformer 1560. In certain aspects, the power amplifier 1620 may comprise a push-pull type amplifier, for example. The non-isolated stage 1540 may further comprise a programmable logic device 1660 for providing a digital output to a digital-to-analog converter (DAC) 1680 which, in turn, provides a corresponding analog signal to an input of the power amplifier 1620 In certain aspects, the programmable logic device 1660 may comprise a field programmable gate array (FPGA), for example. The programmable logic device 1660, by controlling the input of the power amplifier 1620 through the DAC 1680, can therefore control any of a number of parameters (e.g., frequency, waveform, waveform amplitude) of drive signals appearing at drive signal outputs 1600a, 1600b, and 1600c. In certain aspects and as discussed below, the programmable logic device 1660, in conjunction with a processor (e.g., the processor 1740 discussed below), may implement a number of control algorithms based on digital signal processing (PSD) and/or or other control algorithms for control parameters of drive signals provided by generator 1100.

[00383] Power may be supplied to a power amplifier supply rail 1620 by a switch mode regulator 1700. In certain aspects, the switch mode regulator 1700 may comprise an adjustable voltage regulator, for example. As discussed above, the non-isolated stage 1540 may further comprise a processor 1740 which, in one aspect may comprise a PSD processor such as an ADSP-21469 SHARC DSP, available from Analog Devices, Norwood, Mass., USA, for example. . In certain aspects, the processor 1740 may control the operation of the switch mode power converter 1700 responsive to voltage feedback data received from the power amplifier 1620 by the processor 1740 via an analog-to-digital converter (ADC) 1760 In one aspect, for example, the processor 1740 may receive as input, via the ADC 1760, the waveform envelope of a signal (e.g., an RF signal) that is amplified by the power amplifier 1620. The processor. 1740 may then control the switch mode regulator 1700 (e.g., via a pulse-width modulated (PWM) output) so that the rail voltage supplied to the power amplifier 1620 follows the waveform envelope of the amplified signal. By dynamically modulating the rail voltage of the power amplifier 1620 based on the waveform envelope, the efficiency of the power amplifier 1620 can be significantly improved over a fixed rail voltage amplifier scheme. The 1740 processor can be configured for wired or wireless communication.

[00384] In certain aspects, the programmable logic device 1660, in conjunction with the processor 1740, may implement a direct digital synthesizer ("DDS") control scheme to control the waveform, frequency and/or or the amplitude of drive signals emitted by generator 1100. In one aspect, for example, programmable logic device 1660 may implement a DDS control algorithm by retrieving waveform samples stored in a lookup table ("LUT " - look-up table) dynamically updated, like a RAM LUT that can be integrated into an FPGA. This control algorithm is particularly useful for ultrasonic applications in which an ultrasonic transducer, such as the 1120 ultrasonic transducer, can be driven by a clean sinusoidal current at its resonant frequency. Since other frequencies can excite parasitic resonances, minimizing or reducing the total distortion of the motion branch current can correspondingly minimize or reduce the undesirable effects of the resonance. Because the waveform shape of a drive signal provided by generator 1100 is impacted by various sources of distortion present in the output drive circuit (e.g., power transformer 1560, power amplifier 1620), data from Voltage and current feedback based on the drive signal can be provided to an algorithm, such as an error control algorithm implemented by the PSD 1740 processor, which compensates for distortion by appropriately pre-distorting or modifying the waveform samples stored in the LUT in a dynamic and continuous manner (e.g. in real time). In one aspect, the amount or degree of pre-distortion applied to the LUT samples may be based on the error between a computed motion branch current and a desired current waveform, with the error being determined on a basis of sample by sample. In this way, the pre-distorted LUT samples, when processed through the drive circuit, can result in a motion branch drive signal that has the desired waveform (e.g., sinusoidal) to optimally drive the transducer. ultrasonic. In such aspects, the LUT waveform samples will therefore not represent the desired waveform of the drive signal, but rather the waveform that is necessary to ultimately produce the desired waveform of the signal. of the movement branch, when distortion effects are taken into account.

[00385] The non-isolated stage 1540 may additionally comprise an ADC 1780 and an ADC 1800 coupled to the output of the power transformer 1560 through respective isolation transformers, 1820 and 1840, to respectively sample the voltage and current of drive signals emitted by the generator 1100. In certain aspects, the ADCs 1780 and 1800 can be configured to sample at high speeds (e.g., 80 Msps) to enable oversampling of the drive signals. In one aspect, for example, the sampling speed of the 1780 and 1800 ADCs can enable approximately 200X oversampling (depending on the drive frequency) of the drive signals. In certain aspects, sampling operations of the ADCs 1780, 1800 may be performed by a single ADC receiving input voltage and current signals through a bidirectional multiplexer. The use of high-speed sampling in aspects of the generator 1100 may enable, among other things, calculation of the complex current flowing through the motion branch (which may be used in certain aspects to implement the DDS-based waveform control described above), accurate digital filtering of sampled signals, and calculation of actual power consumption with a high degree of accuracy. Voltage and current feedback data provided by the ADCs 1780 and 1800 may be received and processed (e.g., FIFO buffer storage, multiplexing) by the programmable logic device 1660 and stored in data memory for subsequent retrieval, e.g. , by processor 1740. As noted above, voltage and current feedback data can be used as input to an algorithm for pre-distorting or modifying waveform samples in the LUT, in a dynamic and continuous manner. In certain aspects, this may require that each stored voltage and current feedback data pair be indexed based on, or otherwise associated with, a corresponding LUT sample that was provided by programmable logic device 1660 when the data pair of voltage and current feedback was captured. Synchronizing the LUT samples with the voltage and current feedback data in this way contributes to the correct timing and stability of the pre-distortion algorithm.

[00386] In certain aspects, voltage and current feedback data can be used to control the frequency and/or amplitude (e.g., current amplitude) of drive signals. In one aspect, for example, the voltage and current feedback data can be used to determine the phase of the impedance, e.g., the phase difference between the voltage and current drive signals. The frequency of the drive signal can then be controlled to minimize or reduce the difference between the determined impedance phase and an impedance phase set point (e.g., 0°), thereby minimizing or reducing the effects of harmonic distortion. and correspondingly enhancing the accuracy of the impedance phase measurement. Phase impedance determination and a frequency control signal may be implemented in processor 1740, for example, with the frequency control signal being provided as input to a DDS control algorithm implemented by programmable logic device 1660.

[00387] The phase of the impedance can be determined using Fourier analysis. In one aspect, the phase difference between the drive signals of the generated voltage Vg(t) and the generated current Ig(t) can be determined using the fast Fourier transform (FFT) or the discrete Fourier transform. (DFT) as set out below:

[00388] Evaluation of the Fourier transform at the sinusoid frequency produces:

[00389] Other approaches include weighted least squares estimation, Kalman filtering, and space- and vector-based techniques. Virtually all of the processing in an FFT or DFT technique can be performed in the digital domain with the aid of the two-channel high-speed ADC, 1780, 1800, for example. In one technique, digital signal samples of voltage and current signals are Fourier transformed with an FFT or a DFT. The phase angle Φ at any point in time can be calculated by:

[00390] Where Φ is the phase angle, f is the frequency, t is the time, and Φ0 is the phase at t = 0.

[00391] Another technique for determining the phase difference between voltage signals Vg(t) and current Ig(t) is the zero-crossing method and produces highly accurate results. For voltage signals Vg(t) and current Ig(t) having the same, each zero crossing from negative to positive of the voltage signal Vg(t) triggers the start of a pulse, while each zero crossing from negative to positive of the current signal Ig(t) triggers the end of the pulse. The result is a train of pulses with a pulse width proportional to the phase angle between the voltage signal and the current signal. In one aspect, the pulse train can be passed through an averaging filter to produce a measure of the phase difference. Furthermore, if positive to negative zero crossings are also used in a similar way, and the results averaged, any effects of DC and harmonic components can be reduced. In one implementation, analog voltage Vg(t) and current Ig(t) signals are converted to digital signals that are high if the analog signal is positive and low if the analog signal is negative. Highly accurate phase estimates require sharp transitions between highs and lows. In one aspect, a Schmitt trigger together with an RC stabilization network can be used to convert analog signals into digital signals. In other aspects, an edge-triggered RS flip-flop circuit and auxiliaries can be used. In yet another aspect, the zero-crossing technique can use an eXclusive (XOR) gate.

[00392] Other techniques for determining the phase difference between voltage and current signals include Lissajous figures and image monitoring; methods such as the three-voltmeter method, the "crossed-coil" method, the vector voltmeter and vector impedance methods; and the use of standard phase instruments, phase-locked loops, and other techniques as described in Phase Measurement, Peter O'Shea, 2000 CRC Press LLC, <http://www.engnetbase. com>, which is incorporated herein by reference.

[00393] In another aspect, for example, current feedback data may be monitored so as to maintain the current amplitude of the drive signal at a current amplitude set point. The current amplitude setpoint can be specified directly or determined indirectly based on the specified setpoints for voltage and power amplitude. In certain aspects, control of the current amplitude may be implemented by the control algorithm, such as a proportional-integral-derivative (PID) control algorithm, in the processor 1740. The variables controlled by the control algorithm to adequately control the current amplitude of the drive signal may include, for example, scaling the LUT waveform samples stored in the programmable logic device 1660 and/or the full-scale output voltage of the DAC circuit 1680 (which provides input to the drive amplifier). power 1620) through a DAC 1860 circuit.

[00394] The non-isolated stage 1540 may further contain a processor 1900 to provide, among other things, user interface (UI) functionality. In one aspect, the processor 1900 may comprise an Atmel AT91 SAM9263 processor with an ARM 926EJ-S core, available from Atmel Corporation of San Jose, California, USA, for example. Examples of UI functionality supported by processor 1900 may include audible and visual user feedback, communication with peripheral devices (e.g., via a universal serial bus (USB) interface), communication with footswitch 1430, communication with a data input device 2150 (e.g., a touch screen) and communicating with an output device 2140 (e.g., a speaker). The processor 1900 may communicate with the processor 1740 and the programmable logic device (e.g., via serial peripheral interface (SPI) buses). Although the UI processor 1900 may primarily support UI functionality, it may also coordinate with the PSD processor 1740 to implement risk mitigation in certain ways. For example, processor 1900 may be programmed to monitor various aspects of user inputs and/or other inputs (e.g., touch screen inputs 2150, footswitch inputs 1430, temperature sensor inputs 2160) and may disable the 1100 generator drive output when an error condition is detected.

[00395] Figure 21 illustrates a generator circuit 3500 partitioned into multiple stages, wherein a first stage circuit 3504 is common to the second stage circuit 3506, in accordance with at least one aspect of the present disclosure. In one aspect, the surgical instruments of the surgical system 1000 described herein may comprise generator circuit 3500 divided into multiple stages. For example, the surgical instruments of the surgical system 1000 may comprise the generator circuit 3500 divided into at least two circuits: the first stage circuit 3504 and the second stage amplification circuit 3506 allowing operation of high frequency RF energy only, energy ultrasonic only, and/or a combination of RF energy and ultrasonic energy. A combination modular drive shaft assembly 3514 will be powered by the common first stage circuit 3504 located in a grip assembly 3512 and the second modular stage circuit 3506 integral with the modular drive shaft assembly 3514. As previously discussed in this description In connection with the surgical instruments of the surgical system 1000, a battery assembly 3510 and the drive shaft assembly 3514 are configured to connect mechanically and electrically to the handle assembly 3512. The end actuator assembly is configured to mechanically and electrically connect to drive shaft assembly 3514.

[00396] As shown in the example of Figure 21, the battery pack portion 3510 of the surgical instrument comprises a first control circuit 3502, which includes the previously described control circuit 3200. The grip assembly 3512, which connects to the battery pack 3510, comprises a first common drive stage circuit 3420. As previously discussed, the first drive stage circuit 3420 is configured to drive high frequency ultrasonic current (RF). ), and sensor loads. The output of the first common drive stage circuit 3420 may drive any of the second stage circuits 3506 such as the second ultrasonic drive stage circuit 3430, the second high frequency current (RF) drive stage circuit 3432, and /or the second sensor drive stage circuit 3434. The first common drive stage circuit 3420 detects which second stage circuit 3506 is situated in the drive shaft assembly 3514 when the drive shaft assembly 3514 is connected to the assembly. handle assembly 3512. After the drive shaft assembly 3514 is connected to the handle assembly 3512, the first common drive stage circuit 3420 determines which of the second stage circuits 3506 (e.g., the second ultrasonic drive stage circuit 3430, the second RF drive stage circuit 3432, and/or the second sensor drive stage circuit 3434) is located in the drive shaft assembly 3514. Information is provided to the control circuit 3200 located in the drive shaft assembly. handle 3512 to provide a suitable digital waveform to the second stage circuit 3506 to drive the appropriate load, e.g., ultrasonic, RF, or sensor. It will be understood that identification circuits may be included in various assemblies 3516 in the third stage circuit 3508 such as the ultrasonic transducer 1120, the electrodes 3074a, 3074b, or the sensors 3440. Thus, when a third stage circuit 3508 is connected to a second stage circuit 3506, the second stage circuit 3506 recognizes the type of load that is required based on the identification information.

[00397] Figure 22 illustrates a diagram of a surgical system 4000, which represents an aspect of the surgical system 1000, which comprises a feedback system for use with any of the surgical instruments of the surgical system 1000, which may include or implement many of the characteristics described in the present invention. The surgical system 4000 may include a generator 4002 coupled to a surgical instrument that includes an end actuator 4006, which may be activated when a physician operates a trigger 4010. In various aspects, the end actuator 4006 may include an ultrasonic blade to apply ultrasonic vibration to perform surgical coagulation/cutting treatments on living tissue. In other aspects, the end actuator 4006 may include electrically conductive elements coupled to a high-frequency electrosurgical current power source for performing surgical coagulation or cauterization treatments on living tissue and a mechanical knife with a sharp edge or an ultrasonic blade for perform cutting treatments on living tissue. When the trigger 4010 is actuated, a force sensor 4012 may generate a signal that indicates the amount of force that is applied to the trigger 4010. In addition to, or instead of, a force sensor 4012, the surgical instrument may include a sensor position 4013, which may generate a signal indicating the position of the trigger 4010 (e.g., how far the trigger has been pressed or otherwise actuated). In one aspect, the position sensor 4013 may be a sensor positioned with the outer tubular sheath or a reciprocating tubular actuation member situated within the outer tubular sheath of the surgical instrument. In one aspect, the sensor may be a Hall effect sensor or any suitable transducer that varies its output voltage in response to a magnetic field. The Hall effect sensor can be used for proximity switching, positioning, speed detection and current detection applications. In one aspect, the Hall effect sensor works like an analog transducer, directly returning a voltage. With a known magnetic field, its distance from the Hall plate can be determined.

[00398] A control circuit 4008 may receive signals from sensors 4012 and/or 4013. The control circuit 4008 may include any suitable analog or digital circuit components. The control circuit 4008 may also communicate with the generator 4002 and/or the transducer 4004 to modulate the power supplied to the end actuator 4006 and/or the generator level or the amplitude of the ultrasonic blade of the end actuator 4006 based on on the force applied to the trigger 4010 and/or the position of the trigger 4010 and/or the position of the outer tubular sheath described above relative to a reciprocating tubular actuation member situated within the outer tubular sheath (e.g., as measured by a combination Hall effect sensor and magnet). For example, the more force is applied to the trigger 4010, the more energy and/or greater ultrasonic blade amplitude can be supplied to the end actuator 4006. In various aspects, the force sensor 4012 can be replaced by a multiplex switch. positions.

[00399] In various aspects, the end actuator 4006 may include a claw or gripping mechanism. When trigger 4010 is initially actuated, the gripping mechanism may close, trapping fabric between a gripping arm and end actuator 4006. As the force applied to the trigger increases (e.g., as detected by force sensor 4012), control circuit 4008 may increase the power supplied to end actuator 4006 by transducer 4004 and/or the generator level or ultrasonic blade amplitude generated at end actuator 4006. In one aspect, the position of the trigger, as detected by the position sensor 4013 or the position of the gripper or clamping arm as detected by position sensor 4013 (e.g., with a Hall effect sensor) may be used by control circuit 4008 to set the power and/or amplitude of the end actuator 4006. For example, as the trigger is further moved toward a fully actuated position, or the gripper or gripper arm moves further toward the ultrasonic blade (or end actuator 4006), the energy and/or amplitude of the end actuator 4006 can be increased.

[00400] In various aspects, the surgical instrument of the surgical system 4000 may also include one or more feedback devices to indicate the amount of power supplied to the end actuator 4006. For example, a speaker 4014 may output a signal indicative of the energy of the end actuator. According to various aspects, the speaker 4014 can emit a series of pulse sounds, where the frequency of the sounds indicates the energy. In addition to or instead of the speaker 4014, the surgical instrument may include a visual display 4016. The visual display 4016 may indicate end actuator power according to any suitable method. For example, visual display 4016 may include an array of LEDs, wherein end actuator power is indicated by the number of illuminated LEDs. Speaker 4014 and/or visual display 4016 may be driven by control circuit 4008. In various aspects, the surgical instrument may include a ratchet device connected to trigger 4010. The ratchet device may generate an audible sound the more force is applied to the trigger 4010, providing an indirect indication of end actuator power. The surgical instrument may include other features that may increase safety. For example, control circuit 4008 may be configured to prevent power from being supplied to end actuator 4006 beyond a predetermined threshold. Additionally, control circuit 4008 may implement a delay between the time that a change in end actuator power is indicated (e.g., by speaker 4014 or display 4016) and the time that the change in end actuator power is indicated. End actuator is provided. This way, a clinician can be well aware that the level of ultrasonic energy that must be delivered to the 4006 tip actuator is about to change.

[00401] In one aspect, the generator 1000 is configured to digitally generate the electrical signal waveform in such a way that the desired, using a predetermined number of phase points stored in a look-up table, digitize the waveform. The phase points can be stored in a defined table in a memory, a field programmable gate array (FPGA), or any suitable non-volatile memory.

Advanced power device control algorithms

[00402] Various control algorithms for ultrasonic surgical instruments and combined energy surgical instruments (e.g., ultrasonic/monopolar surgical instruments, monopolar/bipolar surgical instruments, ultrasonic/bipolar surgical instruments, and other such combined energy devices) are described herein. invention. For the sake of clarity, the surgical instruments will be referred to as surgical instrument 7012 in this section of the present disclosure, although the disclosure in this section may also apply to other surgical instruments mentioned above, such as surgical instrument 112, 700.

[00403] In various aspects, a control algorithm for a surgical instrument 7012 can be configured to obtain a constant heat flow along the length of the ultrasonic blade of the surgical instrument 7012. The control algorithm can be applied by a control circuit and/or a central surgical controller. The control circuit may execute a local computer-executable program/algorithm of the surgical instrument 7012 or receive a suitable algorithm (e.g., impedance ratio algorithm) from the central surgical controller and/or the cloud computing system. Alternatively, the central surgical controller can execute the algorithm remotely to the 7012 surgical instrument. The constant heat flow can advantageously improve the quality of tissue coagulation, cutting, or sealing. Surgical instrument 7012 could be an ultrasonic and bipolar or combined energy surgical instrument. The control algorithm may involve determining or adjusting the clamping force in proportion to the progression of surgical coagulation of the tissue grasped by the surgical instrument 7012. Additionally, the control algorithm could involve variable changes, such as the clamping arm pressure applied. over a portion of tissue that was loaded into the end actuator, to produce constant heat flow along the length of the blade.

[00404] In particular, the power of the electrosurgical energy provided by the surgical instrument generator 7012, as well as the clamping arm pressure applied can be adjusted or determined to achieve a predefined heat flow. Additionally or alternatively, these can be adjusted to obtain a predefined amount of power to be applied to the tissue. For example, the control algorithm may comprise varying the level of RF and ultrasonic power provided by the generator in conjunction with varying the clamping arm pressure to obtain a predefined heat flow or power applied to the tissue. The heat flow could be constant or almost constant throughout the tissue welding time in relation to a surgical treatment cycle. The variation implemented by the control algorithm may be based on at least one parameter, which may include, for example, tissue impedance, the natural frequency of the blade, temperature, or some other parameter (e.g., tissue operating parameter). Additionally or alternatively, variation in clamping pressure and power level may be based on a heat flow controlled limit. This heat flow-controlled threshold can be dynamic, such that the threshold adjusts along the length of the blade based on the progression of surgical cutting and coagulation. This progression can be assessed by the corresponding focal point, which can be indicative of whether a fibrin clot for coagulation is well formed or not, for example. Consequently, a constant heat flow along the length of the blade could be generated, with the clamping force applied being proportional or corresponding to the coagulation.

[00405] The control algorithm can also be configured to obtain constant heat flow by adjusting power over a series of sequential impedance set points based on the time required to obtain a set point, in order to imitate the increase in impedance. In other words, once the 7012 surgical instrument generator progressively delivers power according to predetermined power curves (which define a relationship between the power delivered to the tissue and the tissue impedance), the control circuit can be configured to determine whether the tissue impedance reaches a certain amount in a certain time. When a certain quality is achieved, the generator can be idle for a period of time and/or switch to a different power curve. If the given quality is not achieved, the generator may switch to a different type of power curve at that time or after the control circuit determines that the given quality will not or is unlikely to be achieved. Additionally or alternatively, the control circuit could select power curves based on the prediction that application of the selected power curve could cause the tissue impedance to reach a specific impedance level at a specific time in the surgical treatment cycle. .

[00406] Tissue impedance or adjustment target points may be dependent on the next target point and/or the time required to reach the last adjustment point. That is, for a series of tissue impedance points, each point can be determined based on its neighboring points, which can be located immediately before or after the point in question. Other points in the series can also be used to determine the value of the point in question. Each set point is defined as a tissue impedance target with an associated power level. For the series of impedance target points, as the application of power by the generator causes the tissue impedance to reach the point in question, the next tissue impedance target and power level can be determined. The subsequent impedance target point can be determined or adjusted based on the total tissue impedance level at that point in the surgical treatment cycle and the time required to reach the previous impedance target point. Setpoints may include a predefined time, such as a dwell time, at the impedance target points before the control circuit determines the next adjustment.

[00407] In executing the control algorithm, the control circuit and/or central surgical controller may cause the end actuator of the surgical instrument 7012 to progressively close during the application of a constant or near-constant clamping force or pressure to the tissue gripped along the length of the ultrasonic blade. That is, the control circuit and/or central surgical controller may adjust the closure of the end actuator to account for changes in the clamping force applied to the tissue that result from the progression of surgical cutting and/or coagulation treatment. For example, as the grasped tissue is coagulated and cut at the proximal portion of the end actuator, the corresponding proximal sections of tissue may experience greater clamping pressure applied due to the advancement of surgical cutting/coagulation. This way, as the control circuit and/or central surgical controller senses or determines the progression of this cutting/coagulation action (e.g., through sealing or focal spot welding), it can adjust by increasing the clamping force. applied to the distal sections of the tissue. This way, each section of the gripped fabric can experience uniform clamping pressure. As the location of the coagulation/cutting focal point moves along the length of the end actuator, the clamping force applied can be further adjusted. Additionally or alternatively, the clamping arm (alternatively called the first claw) of the end actuator may be curved so as to accentuate or amplify the clamping force.

[00408] Due to the fact that the curved clamping arm could result in different clamping pressure applied to the tissue, the control algorithm can be performed to compensate for this deflection of the clamping arm. In this way, as the end actuator gradually reaches its full closing stroke, the control circuit and/or central surgical controller can execute the control algorithm to compensate for this deflection in order to provide constant clamping tissue pressure or almost constant along the length of the blade (alternatively called the second claw of the end actuator). Consequently, the end actuator can apply relatively greater clamping force to the distal portions of the end actuator when the tissue is being treated in a proximal to distal direction. Additionally, deflection of the clamping arm can cause variation in heat flow along the length of the end actuator. To address this, the control algorithm may involve selectively energizing surgical treatment electrodes (e.g., the RF electrodes on the tip actuator) to compensate for or account for this variation. Specifically, the RF electrodes may be segmented into proximal and distal segments and the control circuit and/or central surgical controller could control the generator to selectively energize the RF electrode segments, as appropriate, to obtain a uniform heat flow. and constant or approximately uniform and constant.

[00409] The control circuit and/or central surgical controller may be configured to execute the control algorithm to control the energization of the segmented surgical treatment electrodes. For example, the electrodes may comprise two pairs of RF electrodes on each claw of the end actuator. The control circuit can control energization in conjunction with progressive closure of the clamping arm/first gripper to obtain a constant current density across the end actuator. Each of the two pairs of RF electrodes can be called a proximal and distal electrode array, respectively, and can be energized as a array. The control circuit may control the generator to sequentially energize the proximal and distal electrode array such that an equal current density is generated or created in both the proximal and distal portions. In one aspect, the control circuit and/or central surgical controller may energize the proximal electrode array while causing the end actuator to compress the tissue in a first clamp pressure, which results in a predefined current density. When the measured tissue impedance (e.g., measured via a pressure sensor, resistive, or other suitable sensor on the end actuator) reaches or exceeds a predetermined threshold, the control circuit and/or central surgical controller may energize the assembly. electrode array and de-energize or cease applying power to the proximal electrode array. Simultaneously or substantially simultaneously, the clamping force applied by the clamping arm/first gripper can be increased to recreate the predefined current density in the distal area where the distal electrode array is situated. In this way, both sets of proximal and distal electrodes can be energized or sequentially powered. Furthermore, this sequential energization can occur in conjunction with the application of variable clamping force. Additionally or alternatively, as the proximal electrode array provides electrosurgical energy to treat tissue, the distal electrode array may simultaneously receive power from the generator at a lower power level for preheating. That is, the distal portion of the tip actuator can be preheated while the proximal portion is used to treat the tissue. Similarly, the proximal portion of the end actuator can also be preheated.

[00410] Surgical instrument 7012 may have a tissue (e.g., blood vessel) sealing mode in which specific tissue impedance change over time or rate of increase and predictable clotting time interval are targeted. . During operation of the 7012 energy-based surgical instrument, tissue impedance can be selectively increased to "starve" the coagulation cycle. Put differently, through the application of electrosurgical energy according to tissue impedance target points and dwell time, the progression of the coagulation cycle can be dynamically interrupted or "deprived" as needed to obtain the desired impedance change rate and clotting time interval. In this way, the generator can adjust power by incrementing or cycling through different power or load curves based on impedance set target points with associated power levels and dwell times between level switching or power curves. power in order to obtain a full clotting time interval. Total clotting time may include changes in rates of impedance rise, as discussed in more detail below. In one aspect, a rate of increase in impedance such as 50 Ohms (Q) per second can be achieved by adjusting the dwell time at each target to a target time interval such as 2 seconds (e.g., if applying the level or current power curve, otherwise increase the impedance to 100 Q) or by increasing the number of targets and spacing them in increments specified as 50 Q increments, so that each level or power curve is applied until the next 50 Q target is hit.

[00411] Additionally, selectively obtaining rates of increase in tissue impedance can be performed to achieve a predictable seal time as measured by a surgical coagulation cycle. For example, the generator may apply power to the tissue according to a first power curve (e.g., specifying a maximum power of 200 watts) to achieve the target of 100 Q with a dwell time interval of four seconds. After reaching 100 Q and remaining for 4 seconds, the generator can obtain the application of a series of levels or power curves. Each power level or curve can be determined and applied until reaching a next impedance target point with an associated power level and dwell time, in which the impedance target points progressively increase by 100 Q (i.e., each point is 100 Q greater than the last one). By controlling the generator in this way, at each impedance target point in question, the applied power level or curve can be changed in accordance with the next impedance target point. The next impedance point may have an associated power level and dwell time before the next impedance point is determined, which may be based on the total tissue impedance level and the time required to obtain the target impedance point at question. By adjusting the impedance rise rates according to these dynamically determined impedance target points, a predictable sealing time could be achieved, such as a 7 second cycle time in the currently described example.

[00412] Surgical instrument 7012 may be configured to deliver a composite electrosurgical energy comprising ultrasonic and RF energy to separate the treated tissue from a relatively hard or rigid substructure, such as the patient's bone. To determine when this specific combination of electrosurgical energy should be applied, the 788 sensors can determine and monitor the natural or resonant frequency of the waveguide (and the blade at which the waveguide terminates). The waveguide natural frequency can be equivalent to adjusting the drive frequency produced by the generator. In particular, sensors 788 may detect when the natural frequency experiences a wave or phase shift to determine when the end actuator may impact a rigid substructure (e.g., bone, relatively harder layer of soft tissue, etc.) . Once this impact or contact is determined, the generator can be controlled to delay both the ultrasonic blade amplitude and the RF power level. That is, the generator can reduce the transducer current used to vibrate the ultrasonic blade and the power transmitted to the RF electrodes. Consequently, the 7012 surgical instrument can adequately separate tissue from a harder substructure with the use of ultrasonic energy to supplement the heat generated by the application of RF energy when the control circuit and/or central surgical controller detects bone or tissue differences. moles based on the ultrasonic resonance frequency. The control algorithm could also be configured to detect and delay the application of electrosurgical energy by detecting contact with non-woven objects such as when clips, underlying staples are encountered, or when the surgical instrument 7012 comes into contact with another instrument.

[00413] As stated above, surgical instrument 7012 could be a combined surgical instrument, such as a combined monopolar/bipolar electrosurgical instrument, wherein the type of electrosurgical energy could be ultrasonic, RF, or some other suitable energy modality. In monopolar mode, the patient being treated acts as the return path or electrical ground (e.g., via the return block on the patient's skin) while in bipolar mode, the ultrasonic blade acts as the second pole for transmission of electrosurgical energy. Bipolar modality may generally be preferred for more controlled localized electrosurgical energy applications. In this context, the control circuit and/or central surgical controller may execute the control algorithm to change the frequency of the monopolar electrosurgical energy so that it is non-therapeutic (outside the treatment range) to monitor aspects of the bipolar modality or system. Therefore, in aspects where the 7012 surgical instrument functions as a bipolar tool, such as surgical scissors, the performance of the control algorithm can provide improved nerve detection. Specifically, bipolar and monopolar energy modalities could be applied simultaneously or nearly simultaneously to monopolar energy supplied to the end actuator at a non-therapeutic frequency as feedback for the application of bipolar energy. For example, the generator may provide a trigger signal for nerve stimulation, such as a biphasic signal at 100 to 1,000 hertz (Hz) to stimulate the patient's nerves in which the monopolar energy circuit delivers monopolar energy at a non-therapeutic frequency, while The bipolar power circuit provides bipolar power in a range of 200 kilohertz (kHz) to 3 megahertz (MHz). In this way, the non-therapeutic monopolar component can be used as feedback to the control circuit and/or central surgical controller to determine the proximity of the tip actuator to the patient's nerves. With the use of determined nerve proximity, the surgical instrument can minimize inadvertent cutting of nerves by bipolar scissors. Alternatively, the supplied bipolar energy could be fed back to the monopolar energy.

[00414] Additionally, surgical instrument 7012 can regulate the application of bipolar electrosurgical energy based on the change in impedance resulting from the application of monopolar electrosurgical energy. Specifically, the control circuit and/or central surgical controller may execute the control algorithm to monitor the relative change of the monopolar energy impedance such that the bipolar energy control settings are controlled. The sensors 788, the control circuit, and/or the central surgical controller may detect or determine impedance based on a signal transmitted through the monopolar power circuit. For example, impedance could be determined by dividing the output of the voltage sensing circuit by the monopolar current sensing circuit. Bipolar control settings could be settings that define how bipolar power is delivered to the end actuator. In this way, execution of the control algorithm can result in bipolar power control using monitored monopolar impedance as regulation of the bipolar power level based on changes in the determined monopolar impedance. For example, given an applied clamping arm pressure of 14 to 17 pounds of tip load, the generator can switch from zero power mode to full power mode as 200 Watt (W) and use monopolar to measure the increase of relative impedance (for example, to a specific threshold, such as 80 Q) to control when to switch to a time-based control setting. That is, in the transition from 0 to 200 W, the determined change of 80 Q can be used to trigger a change in the time-based bipolar power control setting that specifies the application of a constant amount of power, such as 100 W, during a predetermined period of time. Alternatively, the given change of 80 Q could cause a proportional step energy decrease, such as a decrease in total power that is proportional to the increase in monopolar impedance.

[00415] Surgical instrument 7012 could also be a combined surgical instrument such as a combined monopolar/ultrasonic electrosurgical instrument in which monopolar energy is used to detect or monitor surgical treatment using the ultrasonic modality. In particular, the operating frequency of the monopolar power can be changed to monitor aspects of the ultrasonic power modality. For example, monopolar energy could be initially emitted at a therapeutic frequency level and switched to a lower non-therapeutic frequency and power level to obtain tissue impedance measurements, which can be used to monitor the delivery of ultrasonic energy. Although absolute impedance values may not be useful, changes in tissue impedance values can be compared with expected changes in tissue impedance resulting from electrosurgical treatment to detect tissue treatment effects of the ultrasonic energy delivered. In other words, as the tissue is being treated by ultrasonic energy, there may be an expected change in tissue impedance. The control circuit and/or central surgical controller may be configured to determine whether the tissue effects caused by the ultrasonic treatment are consistent with the expected change using the change in frequency of the monopolar energy, such as by switching to a frequency level not therapeutic.

[00416] Changing the operating frequency of the monopolar power modality to monitor the ultrasonic power modality can also be achieved by switching the drive frequency to a very high level, such as greater than 10 MHz to enable tissue monitoring. In this way, the change in monopolar frequency could be used to monitor the therapeutic effect on tissue resulting from another energy modality such as the ultrasonic energy modality, as discussed above. Some situations may result in undesirable parasitic impedances. However, the higher drive frequencies of the monopolar power modality may beneficially negate or minimize parasitic or parasitic capacitance arising from the use of a monopolar return pad (e.g., MEGADYNE™ MEGA SOFT™ Reusable Patient Return Electrode). However, relatively higher therapeutic monopolar frequencies can also operate effectively even with the monopolar power set at lower levels to detect tissue impedances. As stated above, alternatively, the generator may drive the monopolar output at lower frequencies and subtherapeutic currents for detection of ultrasonic treatment and the associated effects on the treated tissue. Lower frequencies may not result in many parasitic effects due to corrugations, cable length and other such reasons, but detection or monitoring of the ultrasonic energy modality may be limited by the use of the monopolar return block.

[00417] Although at least some portion of the control algorithm (or algorithms) disclosed herein may be performed by central surgical controllers (alone or in conjunction with associated control circuits of surgical instruments), the functions of the control algorithm (or algorithms) are described as performed by the control circuits for the sake of clarity. Also for clarity, the surgical instrument control circuit 7012 in this portion of the present disclosure is identified as a labeled control circuit 710, although control circuit 710 may be the same or similar to control circuits 760, 3200, 3502, 4008 The control circuit 710 may be a part of the generator 4002 itself (referred to as the generator 4002 for clarity although the generator 4002 may be the same or similar to the generator 140, 145, 240, 721, 771, 900, 1100) or another. part of the surgical instrument 7012 that is remote from the generator 4002. In various aspects, the surgical instrument 7012 (e.g., ultrasonic surgical instrument) as described in Figures 23A and 23B, 24A and 24B, 25A and 25B, 26A to 26E, 27A at 27F, is configured to operate with situational awareness in a central controller environment, such as the central surgical controller 106 or 206 (Figures 1 to 11), for example, as shown in timeline 5200.

[00418] Figures 23A and 23B are graphs 203500, 203520 that include a graph 203500 of clamping force versus time and an associated graph 203520 that indicates the displacement at the coagulation and cutting site along the length of the blade as a function of the time in accordance with at least one aspect of the present disclosure. As shown in Figures 23A and 23B, increasing the clamping force as it increases to the coagulation/cutting site (e.g., coagulation/cutting focal point) in ultrasonic blade displacements can result in better coupling of the tissue to the ultrasonic blade. The focal point can move from proximal to distal or from distal to proximal depending on the direction of surgical treatment, for example. Furthermore, the focal point may represent the progress of a fibrin clot toward coagulation, for example. The clamping arm of the surgical instrument 7012 could be displaced, tilted or also curved to accentuate or amplify the pressure experienced by the tissue, which results from the application of clamping force. The focal point as well as a total sealing or welding time of the surgical operation could be determined by control circuit 710 based on a sensor signal (e.g., from sensor 788) indicative of a surgical parameter, such as tissue impedance. , natural frequency, temperature or some suitable tissue parameter. The control circuit 710 could increase the pressure of the clamping arm based on the sensor signal. The change in clamping force as a function of the surgical coagulation/cutting site could be controlled by the control circuit 710 in conjunction with a variation in the level of electrosurgical power provided by the generator in order to achieve a predefined heat flow or power applied to the tissue .

[00419] Heat flow could be implemented by control circuit 710 as a heat flow control limit that may remain the same or change throughout the duration of the surgical operation performed by surgical instrument 7012, such as based on the progression of coagulation /surgical cut. For example, the control circuit 710 could adjust the heat flow control limit based on the given coagulation focal point, focal point progression, and/or cutting progression. Predefined heat flow can beneficially improve the quality of surgical treatment, such as the tissue seal that is formed. In Figure 23A, the x axis represents time over the course of a surgical cycle while the y axis represents the applied clamping force. In this way, the time spanning time t0 to time t10 can define a surgical cycle of the surgical instrument 7012. Clamping force can be measured in suitable units such as pounds (lb). As shown in graph 203500, the y axis 203510 has annotations for a maximum and minimum clamping force level.

[00420] Dashed line 203502 represents the force applied by the clamping arm over time and tracks the application of force by the clamping arm, from the minimum force at time t0 to the maximum force at time t10. The value or amount of the clamping force may be a function of the process of the tissue coagulation process, which could be tracked based on the location of the coagulation/cutting focal point on the end actuator as it extends from time t0 at time t10. As illustrated by dashed line 203502, the applied clamping force increases as tissue coagulation/cutting action is detected. The dashed line 203502 reaches the maximum force at a point close to time t6, where the force remains at its maximum level until time t10. The dashed and dotted line 203504 represents the tissue impedance measured in relation to the surgical cycle. As can be seen in graph 203500, the measured tissue impedance decreases from its initial level at time t0 to the lowest point around time t3, demonstrating the drop in impedance that results from the start of surgical treatment (the so-called "bathtub" shaped portion of the impedance curve). After time t3, the tissue impedance line 203504 increases as the tissue being treated begins to dry. This desiccation results in an increase in tissue impedance. Figure 23A shows how this increase in tissue impedance line 203504 corresponds to an increase in the applied clamping force line 203502. The increase in applied force can aid in tissue cutting and welding of denatured tissue as the surgical cycle progresses. is completed. Furthermore, the clamping arm can be curved to accentuate tissue pressure resulting from the increased clamping force. Additionally, the end actuator can progressively close while providing constant or near-constant tissue clamping pressure along the length of the end actuator or ultrasonic blade. Constant or near-constant clamping pressure is represented by the solid line 203506, which may correspond to the pressure applied to the leading edge of the end actuator where surgical coagulation and cutting occurs. This way, the solid line 203506 remains at an approximately constant level, with minimal or no fluctuations.

[00421] Figure 23B shows that the focal point of the surgical cutting and coagulation operation on the tissue moves along the length of the ultrasonic blade or second claw 203524 (similar to or equal to the ultrasonic blade 718, 768 or other ultrasonic blades described above ) throughout the course of the surgical cycle. As shown in Figure 23B, the focal point moves in a proximal-to-distal direction over time, but the focal point can also move in a distal-to-proximal direction. The progress of the tissue cutting/coagulation focal point throughout the surgical cycle can be represented by the black dots 203522A, 203522B to 203522N, whose advancement corresponds to the advancement of time through the surgical cycle between the points at time t0 to time t10. That is, each of the black dots 203522A, 203522B through 203522N corresponds to a point in time in the surgical cycle and also represents tissue seal formation and/or tissue treatment progress. For example, the black dots could represent a coagulation focus or focal point determined by control circuit 710 based on a signal from sensor 788. The sensor signal may be indicative of a surgical parameter such as tissue impedance, a frequency nature of the ultrasonic blade, temperature or some other tissue parameter. Based on the sensor signal, the control circuit 710 can determine the progression of the tissue sealing/welding/coagulation focal point and further determine a tissue welding/sealing time for a surgical operation that is performed by the surgical instrument 7012.

[00422] Additionally, control circuit 710 may be configured to control the end actuator closing system while compensating for deflection of the clamping arm, which may result from the curved shape of the end actuator. For example, control circuit 710 could mechanically adjust the force applied by the gripping arm to compensate for any disproportionate force exerted based on the curvature of the gripping arm, so that a constant or nearly constant tissue pressure is provided along the length of the end actuator. Additionally, control circuit 710 may selectively energize different segments (e.g., proximal and distal) of RF electrodes such as RF electrodes 796 to compensate for or adjust heat flow variation caused by deflection of the clamping arm, as described. in more detail below. The control circuit 710 may be configured to determine the cut/weld focal point based on one or more of the resonant frequency and electrical continuity feedback measurements. A constant heat flow along the length of the 203524 ultrasonic blade can also be achieved. For example, as tissue is cut and coagulated in the proximal sections of the tip actuator, the level of electrosurgical energy delivered is relatively higher in these proximal sections. Accordingly, the control circuit 710 can execute the control algorithm to increase the clamping force in the distal sections, which results in a higher current density in the distal sections that can compensate for the relatively lower power level in the distal sections. In this way, the heat flow and pressure experienced by the tissue across the ultrasonic blade 203524 can be constant and/or consistent with the heat flow control limit. Control circuit 710 may receive, from a sensor 788, a sensor signal indicative of a surgical parameter. The surgical parameter can be tissue impedance, a natural frequency of the ultrasonic blade, temperature, or a tissue parameter. The welding time of the surgical operation can be determined by the control circuit 710 based on the sensor signal. The control circuit 710 may vary one or more of a clamping arm pressure applied by the clamping arm and a power level of electrosurgical energy to maintain one or more of a predefined heat flux or power applied to the tissue loaded in the actuator. far end.

[00423] Figures 24A and 24B represent electrode segments of the end actuator and an illustration of controlling the applied clamping force and electrosurgical energy provided by the end actuator, in accordance with at least one aspect of the present disclosure. Figure 24A shows the 203540 end actuator in an open configuration. End actuator 203540 may be the same or similar to the suitable end actuator described above, such as end actuator 702, 752, 792, 4006, or some other suitable end actuator. As shown in Figure 24A, the end actuator 203540 comprises two claws including the first claw (e.g., the clamping arm) 203542 and the second ultrasonic claw/blade 203544 (the same or similar to the ultrasonic blade 203524). Clamping arm 203542 may be the same or similar to any suitable clamping arm described above, such as clamping arm 716, 766, or some other suitable clamping arm. Each of the first and second claws 203542, 203544 comprises electrosurgical electrodes 203546A to 203546D, 203548A to 203548D, respectively. Electrosurgical electrodes 203546A to 203546D, 203548A to 203548D may be the same or similar to RF electrodes such as RF electrodes 796 or any other suitable electrodes described above. Electrosurgical electrodes 203546A to 203546D, 203548A to 203548D can each be segmented into proximal and distal portions or segments. For example, electrodes 203546A and 203546B, 203548A and 203548B may form a pair or segment of proximal electrodes on the first and second claws 203542, 203544, respectively. Similarly, electrodes 203546C and 203546D, 203546C and 203546D may form a pair or segment of distal electrodes on the first and second claws 203542, 203544, respectively. In this way, electrodes 203546A and 203546B, 203548A and 203548B can be longitudinally segmented. Longitudinally segmented electrodes can generate a constant current density.

[00424] The control circuit 710 may be configured to execute a control algorithm to control the application of power to the segmented electrodes 203546A and 203546B, 203548A and 203548B by the generator 4002 in conjunction with controlling the progressive closure of the clamping arm 203542 to obtain a constant or nearly constant current density throughout the end actuator 203540. Figure 24B illustrates an example of this. In Figure 24B, the end actuator 203560 applies different clamping pressure on the fabric 203570 based on the different clamping forces that result from the different closing angles of the end actuator θ1, θ2. In particular, control circuit 710 may control end actuator 203560 to compress tissue 203570 to a first clamp pressure (which could be predetermined or dynamically determined) while simultaneously controlling generator 4002 to energize the proximal electrode array. 203546A and 203546B, 203548A and 203548B in order to create a first predefined current density. Generator 4002 could provide power to one of the pair of proximal electrodes individually or to both pairs together. Furthermore, the generator 4002 could power the end actuator claws individually or by simply applying the pair of power electrodes 203546A and 203546B to the first claw 203542, powering them together or together. In this way, the control circuit 710 can energize the electrode segments 203546A to 203546D, 203548A to 203548D based on a progressive closing stroke of the clamping arm 203542.

[00425] A tissue impedance signal (or signals indicative of current and voltage) may be provided by sensor 788 (e.g., pressure sensor, resistive, or other suitable sensor) and transmitted to control circuit 10 as feedback. When the control circuit 710 determines that the tissue impedance has reached a predetermined or dynamically determined threshold, the control circuit 710 may control the end actuator 203560 and the generator 4002 to change one or more of the clamping force and the clamping level. power (e.g. achieving constant heat flux and/or heat flux control limit). In particular, the end actuator 20 3560 can be controlled to apply an increased claw pressure that is greater than the first claw pressure. Simultaneously or within the same period of time, control circuit 710 controls generator 4002 to turn off the proximal electrode pair and instead provides power to one of the distal electrode pair individually or to both pairs together. That is, generator 4002 powers one or more of the distal electrode segment 203546C and 203546D, 203546C and 203546D. In this way, the same current density in the tethered tissue can be obtained for the distal electrodes or a portion of the end actuator 203560 as the proximal electrodes or a portion of the end actuator 203560. The current density could be predetermined or dynamically determined, as appropriate. As depicted in Figures 24A and 24B, increasing the clamping load pressure on the fabric 203570 corresponds to an increase in the angle between the clamping arm/first gripper 203562 and the ultrasonic blade/second gripper 203564 to decrease from θ1 to θ2. Also as shown in Figures 24A and 24B, the first and second claws 203562, 203564 pivot about the pivot point 203568 to implement the closing stroke of the end actuator.

[00426] Figures 25A and 25B are graphics 203580, 203600 illustrating the control of energization or power supply of electrosurgical electrodes 203546A to 203546D, 203548A 203548D, in accordance with at least one aspect of the present disclosure. As discussed above, the control circuit 710 may be configured to execute the control algorithm to control the end actuator 203560 and the generator 4002 to produce or generate a constant current density. During treatment of the proximal portion of the end actuator 203560, the control circuit 710 may control the end actuator to compress the tissue 203570 in the proximal portion to a first clamping pressure. Simultaneously or in the same period of time, the generator 4002 can supply power to only the proximal electrode pairs 203546A and 203546B, 203548A and 203548B to surgically treat the proximal section. One or both of the electrodes on the first and second claws 203562, 203564 could be energized so that one or both of the first pair of proximal electrodes 203546A and 203546B and the second pair of proximal electrodes 203548A and 203548B could be energized. After surgical treatment of the proximal portion, the generator 4002 may provide power to the distal electrodes 203546C and 203546D, 203548C and 203548D to treat the distal portion of the tip actuator 203560. One or both of the electrodes on the first and second claws 203562, 203564 could be energized so that one or both of the first pair of distal electrodes 203546A and 203546B and the second pair of distal electrodes 203548A and 203548B could be energized. In this way, electrosurgical electrodes 203546A to 203546D, 203548A to 203548D can be sequentially energized by generator 4002.

[00427] Figure 25A illustrates the delivery of power to the proximal electrodes (called electrode pair "a") and then distal electrodes (called electrode pair "b") sequentially as the clamping pressure experienced by fabric 203570 is increased in a corresponding manner. The x-axis 203582 of graph 203580 indicates the time, as in units of seconds, that can span the duration of a surgical cycle. The y-axes 203584, 203585 respectively indicate the power level, as expressed as a percentage of maximum power (100%) and clamping pressure experienced by fabric 203570 (e.g., measured in pounds). Graph 203580 represents the sequence of proximal electrode pairs "a" 203546A and 203546B, 203548A and 203548B being activated and treating the tissue for a first period of time indicated on the x axis 203582 followed by distal electrode pairs "b" 203546C and 203546D, 203548C and 203548D being activated and treating the tissue for a second period of time indicated on the x axis. The rectangular function in graph 203580 illustrates this sequential energization. Generator 4002 first powers "a" electrode pairs 203546A and 203546B, 203548A and 203548B according to power level line 203586, turns off "a", then powers "b" electrode pairs 203546C and 203546D, 203548C and 203548D according to the power level line 203588, and finally disables "b". Simultaneously or within the same period of time, control circuit 710 may control end actuator 203560 to apply clamping pressure at level P1 at the same time as electrode pairs "a" are activated and apply clamping pressure at level P2 while electrode pairs "b" are activated. This application of clamping pressure is represented by clamping pressure line 203590. Upon completion of surgical treatment of the proximal and distal portions, generator 4002 stops providing power and end actuator 203560 returns to the open configuration.

[00428] Figure 25B illustrates the preheating of the distal electrode pairs "b" 203546C and 203546D, 203548C and 203548D. Consequently, while the proximal portion of the end actuator 203560 is being treated, the control circuit 710 may also control the generator 4002 to preheat the distal portion. In other words, during the time spanning the activation of the "a" electrode pairs 203546A and 203546B, 203548A and 203548B, the generator 4002 can supply power to the "b" distal electrode pairs 203546C and 203546D, 203548C and 203548D at a level of lower power to facilitate surgical treatment in the proximal portion after completion of surgical treatment in the proximal portion. Chart 203600 represents this. The x-axis 203602 of graph 203600 indicates time, as in units of seconds, which may encompass the duration of a surgical cycle. The y-axes 203604, 203605 respectively indicate the power level, as expressed as a percentage of maximum power (100%), and the clamping pressure experienced by fabric 203570 (e.g., measured in pounds). Power level line 203606 of graph 203600 shows sequential activation of electrode pairs "a" in a similar manner to power level line 203586. Power level line 203608 shows similar activation of electrode pairs "b" , except that the generator 4002 can supply power to the "b" distal electrode pairs 203546C and 203546D, 203548C and 203548D at a lower power level, e.g., 20% of the maximum power (100%) applied at peak of the rectangular function. This lower applied power level allows the distal portion of the 203560 tip actuator to be preheated prior to treatment. Simultaneously or within the same period of time, control circuit 710 controls end actuator 203560 to apply clamping pressure at level P1 and level P2 as represented by clamping pressure line 203610. Additionally, control circuit 710 may control the generator 4002 in an opposite manner so that the proximal portion of the end actuator 203560 is preheated prior to treatment.

[00429] Figures 26A to 26E are a series of graphs 203620, 203640, 203660, 203680, 203700 that illustrate adjusting the power level to obtain a predictable seal time, in accordance with at least one aspect of the present disclosure. The x axis 203622, 203642, 203662, 203682, 203702 indicates the tissue impedance which can be measured in units of Ohms (Q). The y axis 203624, 203644, 203664, 203684, 203704 indicates the level of power applied by generator 4002. Graphs 203620, 203640, 203660, 203680, 203700 demonstrate how a series of sequential impedance points can be adjusted to mimic a rise impedance that corresponds to a specific tissue clotting time. By achieving a target impedance rise rate and predictable clotting time range for the surgical instrument (e.g., in vessel sealing mode), a safer or otherwise better tissue seal can be achieved. Each impedance point in the sequential series can be defined based on the next target power level and/or impedance, as well as the time in the surgical cycle required to reach the immediately preceding or other previously defined impedance points. Upon reaching a specific impedance point, the control circuit 710 may determine the next impedance set point and associated power level to obtain and/or maintain a desired increase in tissue impedance. In particular, the control circuit 710 may be configured to control the increase in tissue impedance such that the tissue impedance 203570 is changed according to an impedance versus time curve ("curved bathtub curve") that resembles the shape of a "bathtub". The impedance versus time curve can be characterized by an initial drop in tissue impedance following the initial application of electrosurgical energy until stabilization (minimum point), which is followed by an increase in tissue impedance corresponding to desiccation of the 203570 tissue. total or contemporaneous tissue impedance level relative to this bathtub-shaped impedance curve, as evaluated by sensor 788 and a control circuit 710, may also be used to adjust the next impedance set point.

[00430] The power level associated with each impedance point can be determined based on a power level that obtains a subsequent impedance point that tracks a different impedance versus time curve compared to the bathtub-shaped impedance curve standard. The different impedance curve can be less aggressive (although it can also be more) than the bathtub curve, for example. In this way, as each impedance point in the series is reached and each associated power level is determined according to the impedance versus time curve, a desired increase in impedance can be imitated. This increase in impedance may correspond to the drying of the 203570 fabric, except that the increase can be adjusted relative to the standard bathtub curve so that an improved fabric seal can be achieved. Additionally or alternatively, by dynamically determining impedance set points and associated power levels, control circuit 710 can implement surgical treatment according to a predictable clotting time interval. The associated power level is determined for each impedance set point can be one or more power values. In particular, the associated power level can be determined according to a load or power curve. The power curve may be a predetermined power curve stored in the memory of the surgical instrument 7012, a dynamically determined power curve according to a mathematical model or equation (e.g., a change in the variables used in the equation to determine power, or a completely different equation), or some other suitable means, for example.

[00431] Consequently, the impedance point can be dynamically determined or directed to obtain a selective impedance increase. As discussed above, by controlling the rate of increase in tissue impedance 203570 in this manner, tissue coagulation can be more predictable and improved. Additionally, there may be a dwell time between adjacent impedance set points in the series. This residence time between impedance points can "deprive" the coagulation cycle. That is, during the dwell time, the generator 4002 may not provide any power to the end actuator 203560 so that the impedance of the tissue 203570 does not change significantly during the dwell time. The graph 203620 may show a natural load or power curve (e.g., curve representing power level as a function of tissue impedance) as indicated by the plotted applied power line 203626. The applied power line 203620 also shows the time of permanence. The natural power curve may be the desired impedance versus time curve that includes a desired increase in impedance that is obtained dynamically as the impedance points in the series are adjusted. In particular, graph 203640 depicts the first impedance set point in the series of sequential impedance points.

[00432] The first set point occurs at 100 Q, so that the generator 4002 delivers the associated power level rising to a maximum power such as 200 Watts (w) to obtain 100 Q. The level (or levels) of associated power could be determined based on: applying a power curve stored in the memory of the surgical instrument 7012, corresponding central surgical controller and/or cloud; apply a specific segment or portion of a power curve; or determine a suitable level by reference to the desired natural power curve. As can be seen in graph 203640, the first corresponding power curve is applied as represented by the applied power line 203646 to incrementally mimic the natural power curve. The applied power line 203646 also shows the dwell time. In this way, the desired rate of increase and the natural power curve can be used as a guide in conjunction with the elapsed time to determine the next impedance point and associated power level. The remainder of the first power curve or power level (or levels) is generally represented by the dotted line 203648. After reaching the first impedance set point at 100 Q, the generator 4002 may remain for a suitable period of time. This dwell time may be preset or contemporaneously determined by control circuit 710 and may be useful for temporarily pausing or slowing down the clotting cycle. During the dwell time, the control circuit 710 can evaluate the progress of tissue coagulation, which can be compared to the desired natural power curve, for example. The dwell time can be four seconds, for example. After remaining for four seconds, control circuit 710 may determine the next impedance set point to be 200 Q based on various factors such as reference to the last 100 Q set point, an estimated next impedance set point, and/or the desired natural power curve (e.g., the total or contemporaneous natural impedance level of tissue 203570 relative to the natural power curve).

[00433] Additionally, control circuit 710 may determine that the corresponding power level is less than 200 W, such as according to a second power curve that gradually reduces the power level to below 200 W. This second curve of power or power level (or levels) may be different from the first power curve or power level (or levels) Similar to the first impedance set point, generator 4002 may provide power to mimic or follow a rate of increase of desired impedance and/or according to the natural power curve. That is, the generator 4002 may provide power such that the second impedance set point is anticipated to be reached in a desired amount of time. The graph 203660 includes an applied power line 203666, which shows the application of this associated second power by the generator 4002 to achieve 200 Q and the dwell time. The remainder of the second power curve or power level (or levels) is generally represented by the dotted line 203668. After the impedance reaches 200 Q, the control circuit 710 can determine the amount of dwell time that is appropriate. For example, control circuit 710 may determine that generator 4002 must remain for 1 second to stop tissue clotting. The control circuit 710 may further determine that the next impedance target point is set at 300 Q as the impedance reaches 200 Q. As discussed above, the 300 Q may be determined based on factors such as reference to the last set point. 200 Q setting, an estimated next impedance point, and/or a desired natural power curve. The third power curve or associated power level (or levels) to be applied by the generator 4002 may be determined by reference to, or in accordance with, an impedance rate of increase and/or natural power curve as described above. . The third power curve or power level (or levels) can be used to change the relative rate of change of the power level as a function of impedance, as shown in graph 203680. The remainder of the third power curve or level (or levels) ) of power is generally represented by the dotted line 203688.

[00434] After remaining for 1 second, the generator 4002 can deliver power according to the third power curve or corresponding power level (or levels) until reaching the next impedance set point of 300 Q. This is illustrated by the graph 203680. In graph 203680, the applied power line 203686 represents the energy supply according to the third power curve or power level (or levels) and the determined residence time. Similar to that described above, the control circuit 710 may implement a predetermined or contemporaneously determined dwell time after reaching about 300 Q. Additionally, the control circuit 710 may determine that the next impedance point to be adjusted is from 400 Q based on the various factors described above. Additionally, control circuit 710 may change/determine that the corresponding power level is a fourth power curve or power level (or levels). Generator 4002 may provide power according to this fourth power curve or power level (or levels), as represented by applied power line 203706, until reaching the next impedance set point. The remainder of the second power curve or power level (or levels) is generally represented by the dotted line 203708. After the tissue impedance reaches the 300 Q set point, the control circuit 710 may determine that the next set point setting is 400 Q, similar to determining impedance points earlier in the series. After reaching 400 Q, the control circuit 710 can determine that tissue coagulation is complete and therefore terminate the coagulation process. This is illustrated by graph 203700. More or fewer impedance set points can be used as appropriate. Based on the use of these series of dynamically determined impedance set points and associated power, the control circuit 710 can mimic a desired impedance increase so as to obtain a predictable clotting time interval. Impedance points and dwell time can be used to help determine an "improvised" or contemporaneously determined power curve. In other words, generator 4002 may apply segments or portions of different power curves and/or power level (or levels), as appropriate. Although Figures 26A through 26E describe the use of dwell time, in other respects, dwell time may not be used. In the surgical cycle depicted in Figures 26A to 26E, a total dwell time of 7 seconds can be achieved during the surgical cycle with a difference of 100 Q between adjacent impedance set points to obtain the desired impedance increase rate. Other desired increase rates could be achieved as well by changing the dwell time to 2 seconds or by using 50 Q differences between adjacent impedance set points, for example.

[00435] In this way, the control circuit 710 can execute an impedance ratio algorithm, which could be programmed into the memory of the surgical instrument 7012 or received by a central surgical controller or cloud computing system. In particular, the control circuit 710 may receive a first tissue impedance point (e.g., given the first tuning impedance point), determine a first power level of electrosurgical energy that corresponds to the first tissue impedance point, control the generator to deliver the electrosurgical energy at the first power level, determine a second tissue impedance point, adjust the first power level to a second power level of the electrosurgical energy based on a time interval to reach the second point tissue impedance; control the generator to supply the electrosurgical energy at the second power level. More tissue impedance points in the series of impedance points could be determined or targeted to achieve an increase in selective impedance. For example, control circuit 710 may determine a third tissue impedance point and determine the second tissue impedance point based on the third tissue impedance point and a corresponding time interval to reach the first tissue impedance point. . The control circuit 710 may determine the third impedance point and the associated power level after controlling the generator 4002 to provide electrosurgical energy to reach the second impedance point.

[00436] Dwell time can also be implemented. For example, the control circuit 710 may remain for a while before adjusting from the first to the second power level and determining the third tissue impedance point. Further, for example, the control circuit may control the generator 4002 to apply power in accordance with the following: applying a first power level to reach a first tissue impedance point; ending the application of the first power level during a first dwell time; determine, through the control circuit, a second tissue impedance point; apply a second power level to reach the second tissue impedance point; ending the application of the second power level during a second dwell time; determine, through the control circuit, a third tissue impedance point; and applying a third power level to reach the third tissue impedance point to obtain the target rate of impedance increase. The generator may additionally terminate the application of the third power level during a third dwell time, determine a fourth tissue impedance point; and apply a fourth power level to reach the fourth tissue impedance point. As discussed above, series tuning impedance points can be determined based on previous impedance points and the electrosurgical energy delivery time to reach those points. Therefore, the third and fourth impedance points can be determined based on a first and second impedance points and a time to reach them. The time to obtain the impedance points (e.g., first, second, and third points) may correspond to a predetermined clotting time interval.

[00437] Figures 27A to 27F are graphs and flowcharts 203720, 203740, 203760, 203780, 203800, 203820, which illustrate approaches for providing power according to power curves, in accordance with at least one aspect of the present disclosure. More details regarding such approaches can be found in US Patent No. 9,737,355, entitled CONTROLLING IMPEDANCE RISE IN ELECTROSURGICAL MEDICAL DEVICES, which is incorporated herein by reference into the present invention in its entirety; and in patent application publication No. US 20180036065, entitled METHODS AND SYSTEMS FOR ADVANCED HARMONIC ENERGY, which is incorporated herein by reference in the present invention, in its entirety.

[00438] Figure 27A shows an aspect of a graph 203720 showing exemplary power curves 203726, 203728, 203730. The graph 203720 comprising an impedance x-axis 203722 indicates increasing tissue impedances from left to right. A y-axis of power 203724 indicates increasing power from bottom to top. Each of the power curves 203726, 203728, 203730 may define a set of power levels, on the power y-axis 203724, that correspond to a plurality of possible detected tissue impedances, on the impedance x-axis 203722. In general , power curves can take different shapes, and this is illustrated in Figure 27A. Power curve 203726 is shown with a gradual shape, while power curves 203728, 203730 are shown with curved shapes. It will be understood that power curves used by various aspects may take any useful continuous or non-continuous format. The rate of power delivery or aggressiveness of a power curve can be indicated by its position on the graph 203720. For example, power curves that provide higher power for a given tissue impedance can be considered more aggressive. Consequently, between two power curves, the curve positioned higher on the power axis 203724 may be the more aggressive. It will be understood that some power curves may overlap.

[00439] The aggressiveness of two power curves can be compared according to any suitable method. For example, a first power curve may be considered more aggressive than a second power curve over a given range of potential tissue impedances if the first power curve has a higher delivered power that corresponds to at least half of the range. of possible tissue impedances. Furthermore, for example, a first power curve may be considered more aggressive than a second power curve over a given range of possible tissue impedances if the area under the first curve across the range is greater than the area under the second curve along the strip. Equivalently, when power curves are expressed discretely, a first power curve can be considered more aggressive than a second power curve with respect to a given set of possible tissue impedances if the sum of the power values for the first power curve with respect to the set of possible tissue impedances is greater than the sum of the power values for the second power curve with respect to the set of possible tissue impedances.

[00440] Some aspects of the surgical instrument 7012 comprise a positive temperature coefficient (PTC) material positioned between one or more of the electrodes of the claws 203562, 203564. The PTC material may have an impedance profile that remains relatively low and relatively constant until it reaches a threshold or trip temperature, at which point the impedance of the PTC material may increase. In use, the PTC material can be placed in contact with the tissue while power is applied. The firing temperature of the PTC material can be selected to correspond to a tissue temperature indicating completion of welding or coagulation. Consequently, as a welding or coagulation process is completed, the temperature of the PTC material may increase, causing a corresponding increase in the impedance of the PTC material. This additional series impedance, in series with the tissue, can cause a decrease in the power actually delivered to the 203570 tissue.

[00441] It will be understood that during the coagulation or welding process, tissue impedance, in general, may increase. In some aspects, tissue impedance may show a sudden increase in impedance indicating successful coagulation. The increase may be due to physiological changes in the tissue, a material with PTC reaching its trigger limit, etc. The amount of energy that may be required to cause the sudden increase in impedance may be related to the thermal mass of the tissue 203570 actuated. The thermal mass of any given tissue portion, in turn, may be related to the type and amount of tissue 203570 in said portion. The material with PTC could be used to determine a welding time of a surgical operation performed by the surgical instrument 7012. Additionally, monitoring of the material with PTC or other sensors 788 in the end actuator 203560 can be performed by the control circuit 710 to determine a focal point/focal point of coagulation and the progression of surgical treatment (e.g. cutting). Based on these determinations, the control circuit 710 may adjust a heat flow control limit along the length of the ultrasonic blade 203564.

[00442] Various aspects can use this sudden increase in tissue impedance to select a suitable power curve for a given tissue portion. For example, the generator 4012 may select and apply successively more aggressive power curves until the tissue impedance reaches an impedance threshold that indicates that the surge has occurred. For example, reaching the impedance limit may indicate that coagulation is progressing adequately with the currently applied power curve. The impedance threshold can be a tissue impedance value, a rate of change of tissue impedance, and/or a combination of impedance and rate of change. For example, the impedance limit may be reached when a certain impedance value and/or rate of change is observed. In various aspects, different power curves may have different impedance limits, as described in the present invention.

[00443] Figure 27B shows one aspect of a process flow 203740 for applying one or more power curves to a tissue portion of tissue 203570. Any suitable number of power curves may be used. The power curves can be successively applied in order of aggressiveness until one of the power curves drives the tissue to the impedance limit. In step 203742, generator 4002 may apply a first power curve. According to various aspects, the first power curve can be selected to provide power at a relatively low rate. For example, the first power curve can be selected to prevent tissue cauterization with the expected smallest and most vulnerable tissue portions.

[00444] The first power curve can be applied to tissue 203570 in any suitable manner. For example, generator 4002 may generate a drive signal that implements the first power curve. The power curve can be implemented by modulating the power of the drive signal. The power of the drive signal can be modulated in any suitable way. For example, the voltage and/or current of the signal can be modulated. Furthermore, in various aspects, the drive signal may be pulsed. For example, the generator 4002 can modulate the average power by changing the frequency, pulse width, duty cycle, etc., of the drive signal. The drive signal may be provided to the electrodes of the first and second gripper members 203562, 203564.

[00445] During application of the first power curve, generator 4002 may monitor the total power supplied to tissue 203570. The impedance of tissue 203570 may be compared to the impedance threshold at one or more power thresholds. There may be any suitable number of power limits, which may be selected according to any suitable methodology. For example, energy thresholds can be selected to correspond to known points where different tissue types reach the impedance threshold. In step 203744, generator 4002 may determine whether the total energy supplied to fabric 203570 has met or exceeded a first energy threshold. If the total power has not yet reached the first power limit, the generator 4002 may continue to apply the first power curve at 203742.

[00446] If the total energy has reached the first energy limit, the generator 4002 can determine whether the impedance limit has been reached (step 203746). As described above, the impedance limit may be a predetermined rate of impedance change (e.g., increase) of a predetermined impedance, or a combination of the two. If the impedance limit is reached, the generator 4002 may continue to apply the first power curve in step 203742. For example, reaching the impedance limit in the first power curve may indicate that the aggressiveness of the first power curve is sufficient to cause proper coagulation or welding.

[00447] In the case where the impedance limit is not reached in step 203746, the generator 4002 may step up to the next most aggressive power curve in step 203748 and apply the power curve as the current power curve in 203742. In In some respects, scaling up to the next more aggressive power curve may comprise applying a multiplier to a less aggressive power curve, such as the previously implemented power curve. When the next power limit is reached in step 203744, the generator 4002 can again determine whether the impedance limit is reached in step 203746. If it is not reached, the generator 4002 can again step up to the next, more aggressive power curve. in step 203748 and provide this power curve in step 203742.

[00448] Process flow 203740 may continue until stopped. For example, process flow 3740 may be stopped when the impedance limit is reached in step 203746. After reaching the impedance limit, generator 4002 may apply the then-current power curve until coagulation or welding is completed. Additionally, for example, process flow 203740 may be stopped after exhausting all available power curves. Any suitable number of power curves can be used. If the more aggressive power curve fails to drive the tissue to the impedance limit, the 4002 generator may continue to apply the more aggressive power curve until the process is otherwise stopped (e.g., by a physician or the reach a final energy limit).

[00449] In various aspects, process flow 203740 may continue until an interrupt threshold occurs. The interrupt limit may indicate that coagulation and/or welding is complete. For example, the interrupt threshold may be based on one or more of tissue impedance, tissue temperature, tissue capacitance, tissue inductance, elapsed time, etc. Upon interruption, the surgical instrument 7012 and/or surgical hub controller 5104 may generate an audible tone indicating the interruption. This may be a single breaking threshold, or in many ways different power curves may have different breaking thresholds. According to various aspects, different power curves may use different impedance limits. For example, process flow 203740 may transition from a first to a second power curve if the first power curve fails to drive tissue up to a first tissue impedance limit and may subsequently shift from the second. for a third power curve if the second power curve fails to drive the tissue to a second impedance limit. In some aspects, instead of proceeding through the power curves in order, the generator 4002 may skip one or more power curves. For example, if the tissue impedance at the end of a power curve exceeds a jump threshold, then the generator 4002, instead of proceeding to the next power curve, may jump to a more aggressive power curve (e.g. , a power curve that delivers the most energy for a given tissue impedance).

[00450] In some aspects that use a pulsed drive signal, generator 4002 may apply one or more composite load curves to the drive signal and ultimately to the tissue. Composite load curves, like other power curves described in the present invention, can define a level of power to be delivered to the tissue as a function of a measured tissue property or properties. Composite load curves can additionally define pulse characteristics, such as pulse width, in terms of measured tissue properties (e.g., impedance, applied current, applied voltage, temperature, reflectivity, force applied to the tissue, etc.) .

[00451] Figure 27C is a graph 203760 showing the power and impedance characteristics of an aspect of a drive signal that may be provided by generator 4002 during a first mode. In Figure 27C, impedance is indicated on the x axis 203762 and power is indicated on the y axis 203764. During the first mode, the generator 4002 may be configured to deliver a first limit of power 203766 to the tissue while the tissue impedance is below a threshold impedance 203768 for the mode. If the tissue impedance exceeds the impedance limit 203768 for the first mode, the generator 4002 may limit the power supplied to a second power limit 203770. In various aspects, the second power limit 3770 may be less than the maximum power at which generator 4002 is configured to apply to tissue. In this way, the first mode can prepare tissue 203570 for greater power application in later modes. The application period for the first mode can be any suitable value including, for example, a second. It will be understood that the drive signal may be pulsed during application of the first mode. For example, the first mode may be applied as a single pulse lasting the duration of the application time period for the first mode, or in multiple shorter pulses. In aspects using multiple pulses in the first mode, each pulse may conform to impedance-determined limits for the power of the drive signal as described.

[00452] Figure 27D is a graph 203780 showing the power and impedance characteristics of an aspect of a drive signal that may be provided by generator 4002 during a second mode. In Figure 27D, impedance is indicated on the x axis 203782 and power is indicated on the y axis 203784. In the second mode, the generator 4002 provides a relatively high power level at the lowest tissue impedances expected to be encountered. For example, in some aspects, the total available power of generator 4002 (203786 in Figure 27D) may be provided at tissue impedances below the threshold impedance 203790 for the second mode. Above the impedance limit 203790, the power may be reduced below a second power limit 203788 in order to limit the rate of increase in impedance. In some respects, the second power limit 203788 is greater than the second power limit 203770 of the first mode. Furthermore, it will be understood that the impedance limit 203768 of the first mode and the impedance limit 203790 of the second mode may be the same or may take on different values depending on the implementation. The application period of the second mode may be longer than that of the first mode in order to allow the energy supplied to act on the tissue. For example, in some aspects, the application period of the second period is between four and five seconds. It will be understood that the trigger signal may also be provided as a single pulse lasting the duration of the application period and/or as multiple pulses. Again, when multiple pulses are used, each pulse can adapt to impedance-determined limits for drive signal power.

[00453] Figure 27E is a graph 203800 showing an example of a typical load curve for a generator configured to provide power to an electrosurgical system of the present disclosure. In particular, Figure 27E provides additional details of various electrical readings of the surgical instrument system that is subjected to the sealing procedure during surgery. The left vertical axis represents power (W) and voltage (V), the right vertical axis represents current (A), and the horizontal axis represents load impedance (Ohms). Voltage curve 203802, current curve 203804, and power curve 203806 are shown as functions of load impedance. As shown, the amount of power and voltage applied to the tissue typically reaches an insurmountable limit, even at ever-increasing load impedances. Alternatively, the amount of energy applied to tissue at a surgical site has a noticeable effect only up to certain load impedance levels, and after a certain impedance threshold, such as 175 Q, the application of more power or prolonged power typically has little or no benefit. Chart 203800 provides additional detail on why exceeding the transition impedance limit, as shown in chart 203800, generally represents the cutoff point at which power must continue to be applied.

[00454] Figure 27F is a graph 203820 showing an example of a power profile of a tapered load curve concept, with additional power characteristics superimposed. In Figure 27F, curve 203822, as shown by the thick line, represents a measurement of voltage as a function of load impedance in the tissue. Curve 203824, as shown by the midline, represents a measure of the calculated power applied to the tissue as a function of load impedance. The calculated power may be the measure of the power that is determined by the power system of the surgical instrument 7012, while the curve 203826, as shown by the dashed line, represents the effective or actual power applied to the tissue. As shown, both curves show a power taper that is gradually reduced. This may be caused by power being realized per duty cycle at different rates over time, i.e. through pulse width modulation. Curve 203828, as shown by the thin line, represents a current measurement. The current scale is shown on the right side, while the power and voltage scale are shown on the left.

Examples

[00455] Various aspects of the subject matter described in this document are defined in the following numbered examples:

[00456] Example 1 - A surgical instrument comprising an end actuator, an electrode, an ultrasonic transducer, a sensor coupled to a control circuit and the control circuit coupled to the end actuator. The end actuator comprises: an ultrasonic blade configured to oscillate ultrasonically against the tissue; and a clamping arm configured to pivot relative to the ultrasonic blade. The electrode is configured to receive electrosurgical energy from a generator and to apply the received electrosurgical energy to the tip actuator for welding tissue based on the generator that generates a drive signal. The ultrasonic transducer is acoustically coupled to the ultrasonic blade. The ultrasonic transducer is configured to ultrasonically oscillate the ultrasonic blade in response to the drive signal. The sensor is configured to output a signal indicative of a surgical parameter to the control circuit. The control circuit is configured to: receive the sensor signal; determining a welding time of a surgical operation performed by the surgical instrument based on the sensor signal; and varying one or more of a clamping arm pressure applied by the clamping arm and a power level of electrosurgical energy to maintain one or more of a predefined heat flux or power applied to the tissue loaded in the end actuator.

[00457] Example 2 - The surgical instrument of Example 1, wherein the surgical parameter is one or more of tissue impedance, a natural frequency of the ultrasonic blade, temperature and a tissue parameter.

[00458] Example 3 - The surgical instrument of Examples 1 or 2, wherein the control circuit is further configured to vary one or more of the clamping arm pressure applied by the clamping arm and the power level of the electrosurgical energy with based on a heat flow control limit.

[00459] Example 4 - The surgical instrument of Example 3, wherein the control circuit is further configured to adjust the heat flow control limit along a length of the ultrasonic blade based on one or more of a set point. focus of coagulation and a progression of a surgical cut.

[00460] Example 5 - The surgical instrument of Examples 1, 2, 3 or 4, the electrode comprising a plurality of electrodes positioned longitudinally to generate a constant current density.

[00461] Example 6 - The surgical instrument of Example 5, wherein the control circuit is further configured to energize the plurality of electrodes sequentially to generate a first current density in a proximal portion of the plurality of electrodes and a second current density in a distal portion of the plurality of electrodes, and the first and second current densities are equal.

[00462] Example 7 - The surgical instrument of Example 5, further comprising the generator configured to supply the electrosurgical energy to the end actuator, wherein the control circuit is further configured to control the generator to energize the plurality of electrodes by supplying a first power level to a first portion of the plurality of electrodes and a second power level to a second portion of the plurality of electrodes and wherein the first power level is less than the second power level.

[00463] Example 8 - The surgical instrument of Examples 1, 2, 3, 4, 5, 6 or 7, wherein the clamping arm is an offset clamping arm and a control circuit is additionally configured to increase the pressure of the clamping arm based on the sensor signal.

[00464] Example 9 - A surgical system comprising a central surgical controller configured to receive an impedance rate algorithm transmitted from a cloud computing system and a surgical instrument communicatively coupled to the central surgical controller. The central surgical controller is communicatively coupled to the cloud computing system. The surgical instrument comprises an end actuator, an electrode, an ultrasonic transducer and a control circuit. The end actuator comprises an ultrasonic blade configured to oscillate ultrasonically against the tissue; and a clamping arm configured to pivot relative to the ultrasonic blade. The electrode is configured to receive electrosurgical energy from a generator and apply the received electrosurgical energy to the end actuator to weld tissue based on the generator generating a drive signal. The ultrasonic transducer is acoustically coupled to the ultrasonic blade. The ultrasonic transducer is configured to ultrasonically oscillate the ultrasonic blade in response to the drive signal. The control circuit is coupled to the end actuator. The control circuit is configured to perform the impedance rate algorithm to: receive a first tissue impedance point; determining a first power level of the electrosurgical energy that corresponds to the first tissue impedance point; controlling the generator to supply the electrosurgical energy at the first power level; determine a second tissue impedance point; adjusting the first power level to a second power level of the electrosurgical energy based on a time interval to reach the second tissue impedance point; and controlling the generator to provide the electrosurgical energy at the second power level.

[00465] Example 10 - The surgical system of Example 9, wherein the control circuit is configured to execute the impedance rate algorithm to additionally determine a third tissue impedance point; and determining the second tissue impedance point based on the third tissue impedance point and a corresponding time interval to reach the first tissue impedance point.

[00466] Example 11 - The surgical system of Example 10, wherein the control circuit is configured to execute the impedance rate algorithm to further determine the third tissue impedance point and a third power level of the electrosurgical energy corresponding to the third tissue impedance point by controlling the generator to provide the electrosurgical energy at the second power level to reach the second tissue impedance point.

[00467] Example 12 - The surgical system of Example 11, wherein the control circuit is configured to execute the impedance ratio algorithm to further adjust the third tissue impedance point based on a total tissue impedance level and in the time interval to reach the second tissue impedance point.

[00468] Example 13 - The surgical system of Example 10, wherein the control circuit is configured to execute the impedance rate algorithm to further determine a dwell time and control the generator to deliver the electrosurgical energy at the first power level for the dwell time before adjusting the first power level to the second power level of electrosurgical energy and determining the third tissue impedance point.

[00469] Example 14 - The surgical system of Examples 9, 10, 11, 12 or 13, wherein the electrode comprises a plurality of electrode segments positioned longitudinally to generate a constant current density.

[00470] Example 15 - The surgical system of Example 14, wherein the control circuit is configured to execute the impedance rate algorithm to further energize the plurality of electrode segments based on a progressive closing stroke of the clamping arm .

[00471] Example 16 - A method of using a surgical instrument to deliver electrosurgical energy in accordance with a target impedance increase rate, the surgical instrument comprising an end actuator, a generator, an electrode configured to supply the energy electrosurgical blade to the end actuator, an ultrasonic transducer acoustically coupled to the ultrasonic blade, and a control circuit coupled to the end actuator. The generator is configured to provide electrosurgical power to the tip actuator based on the generation of a drive signal. The ultrasonic transducer is configured to ultrasonically oscillate the ultrasonic blade in response to the drive signal. The end actuator comprises an ultrasonic blade configured to oscillate ultrasonically against the tissue; and a clamping arm configured to pivot relative to the ultrasonic blade. The method comprises: controlling, by the control circuit, the generator to apply power in accordance with a tissue impedance algorithm comprising the steps of: applying, via the generator, a first power level to reach a first impedance point of the fabric; terminate, by means of the generator, the application of the first power level during a first dwell time; determine, through the control circuit, a second tissue impedance point; applying, through the generator, a second power level to reach a second tissue impedance point; terminate, by means of the generator, the application of the second power level during a second dwell time; determine, through the control circuit, a third tissue impedance point; and applying, via the generator, a third power level to reach the third tissue impedance point to obtain the desired impedance increase rate.

[00472] Example 17 - The method of Example 16, which further comprises: interrupting, by means of the generator, the application of the third power level during a third dwell time; determine, through the control circuit, a fourth tissue impedance point; and apply, through the generator, a fourth power level to reach a fourth tissue impedance point.

[00473] Example 18 - The method of Example 17, wherein the third and fourth tissue impedance points are determined based on one or more of the first and second tissue impedance points and a time to obtain each between the first and second tissue impedance points.

[00474] Example 19 - The method of Examples 16, 17 or 18, wherein a time to obtain the first, second and third tissue impedance points corresponds to a predetermined clotting time interval.

[00475] Example 20 - The method of Examples 16, 17, 18 or 19, wherein the electrode comprises a plurality of electrode segments positioned longitudinally to generate a constant current density.

[00476] Although various forms have been illustrated and described, it is not the applicant's intention to restrict or limit the scope of the appended claims to such detail. Numerous modifications, variations, changes, substitutions, combinations and equivalents of these forms can be implemented and will occur to those skilled in the art without departing from the scope of the present disclosure. Furthermore, the structure of each element associated with the form can alternatively be described as a means to provide the function performed by the element. Additionally, where materials are disclosed for certain components, other materials may be used. It should be understood, therefore, that the foregoing description and the appended claims are intended to cover all such modifications, combinations and variations falling within the scope of the presented embodiments. The attached claims are intended to cover all such modifications, variations, alterations, substitutions, modifications and equivalents.

[00477] 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 disclosed 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 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 disclosure. 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.

[00478] Instructions used to program logic to perform various disclosed aspects 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).

[00479] 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 that includes 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.

[00480] 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.

[00481] 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.

[00482] 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.

[00483] 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 UnionTelecommunication 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.

[00484] Unless expressly stated otherwise, as is evident from the foregoing disclosure, it is understood that throughout the foregoing disclosure, 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 of the computer system into 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.

[00485] One or more components may be called in the present invention "configured for", "configurable for", "operable/operational for", "adapted/adaptable for", "capable of", "conformable/conformed to", 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.

[00486] The terms "proximal" and "distal" are used in the present invention with reference to a doctor who manipulates the handle portion of a 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.

[00487] Persons skilled in the art will recognize that, in general, the terms used herein, and particularly in the appended claims (e.g., bodies of the 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.

[00488] 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 typically be 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 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.). 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".

[00489] With respect to the attached claims, those skilled in the art will understand that the operations mentioned therein can, in general, be carried out 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.

[00490] 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 appearance. Furthermore, specific features, structures or characteristics may be combined in any suitable manner in one or more aspects.

[00491] 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 disclosure as explicitly set forth herein supersedes any conflicting material incorporated into the present invention by reference. Any material, or portion thereof, that is incorporated herein by reference but which conflicts with existing definitions, statements, or other promotional materials set forth herein is incorporated herein only to the extent that there is no conflict between the incorporated material and existing promotional material.

[00492] In summary, numerous benefits have been described that result from the use of 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 disclosed. 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 (8)

1. Surgical instrument (750), characterized in that it comprises: an end actuator (752) comprising: an ultrasonic blade (768) configured to oscillate ultrasonically against tissue; and a clamping arm (766) configured to pivot relative to the ultrasonic blade (768); an electrode (796) configured to receive electrosurgical energy from a generator (794) and apply the received electrosurgical energy to the end actuator (752) to weld a tissue based on the generator (794) that generates a drive signal; an ultrasonic transducer (769) acoustically coupled to the ultrasonic blade (768), the ultrasonic transducer (769) being configured to ultrasonically oscillate the ultrasonic blade (768) in response to the drive signal; a sensor (788) coupled to a control circuit (760), wherein the sensor (788) is configured to output a signal indicative of a surgical parameter to the control circuit (760); and the control circuit (760) coupled to the end actuator (752), wherein the control circuit (760) is configured to: receive the sensor signal; determining a welding time of a surgical operation performed by the surgical instrument (750) based on the sensor signal; and varying a clamping arm (766) pressure applied by the clamping arm (766) to maintain one or more of a predefined heat flux or power applied to the tissue loaded in the end actuator (752). 2. Surgical instrument (750), according to claim 1, characterized by the fact that the surgical parameter is one or more of tissue impedance, a natural frequency of the ultrasonic blade (768), temperature and a tissue parameter. 3. Surgical instrument (750) according to claim 1 or 2, characterized in that the control circuit (760) is further configured to vary the clamping arm pressure (766) applied by the clamping arm (766 ) based on a heat flow control limit. 4. Surgical instrument (750) according to claim 3, characterized by the fact that the control circuit (760) is further configured to adjust the control limit of heat flow along a length of the ultrasonic blade (768 ) based on one or more of a coagulation focal point and a progression of a surgical cut. 5. Surgical instrument (750), according to any one of claims 1 to 4, characterized by the fact that the electrode (796) comprises a plurality of electrodes (796) positioned longitudinally to generate a constant current density. 6. The surgical instrument (750) of claim 5, wherein the control circuit (760) is further configured to energize the plurality of electrodes (796) sequentially to generate a first current density in a portion proximal portion of the plurality of electrodes (796) and a second current density in a distal portion of the plurality of electrodes (796), and the first and second current densities are equal. 7. Surgical instrument (750), according to claim 5, characterized by the fact that it additionally comprises the generator (794) configured to supply the electrosurgical energy to the end actuator (752), the control circuit (760) being is further configured to control the generator (794) to energize the plurality of electrodes (796) providing a first power level to a first portion of the plurality of electrodes (796) and a second power level to a second portion of the plurality of electrodes (796) (796), and the first power level is lower than the second power level. 8. Surgical instrument (750) according to any one of claims 1 to 7, characterized in that the clamping arm (766) is a displaced clamping arm (766) and a control circuit (760) is additionally configured to increase clamping arm pressure (766) based on sensor signal (788).