CN117479896A - System comprising a camera array deployable outside a channel of a tissue penetrating surgical device - Google Patents

Abstract

A camera system integrated in a trocar is disclosed. The camera system allows for a wide field of view of the internal surgical site and 3D mapping of fiducial markers during a laparoscopic procedure. Upon entering the patient, the camera system is configured to be deployable from a recessed position at the distal end of the trocar. In various aspects, the internal camera system is configured to maintain the trocar port clear to the surgical instrument and provide the surgical staff member with an increased view of the surgical environment.

Description

System comprising a camera array deployable outside a channel of a tissue penetrating surgical device

Cross Reference to Related Applications

The present application claims the benefit of U.S. 4, 14, 2021, U.S. provisional patent application No. 63/174,674 entitled "head UP DISPLAY" and U.S. provisional patent application No. 63/284,326 entitled "INTRAOPERATIVE DISPLAY FOR SURGICAL SYSTEMS", 2021, 11, 30, each of which is incorporated herein by reference in its entirety.

Background

The present disclosure relates to devices, systems, and methods for providing an augmented reality interactive experience during surgery. During surgery, it is desirable to provide an augmented reality interactive experience of a real-world environment in which objects residing in the real world are enhanced by superimposing computer-generated sensory information (sometimes across multiple sensory modalities, including visual, auditory, haptic, somatosensory, and olfactory). In the context of the present disclosure, the surgical field and the images of surgical instruments and other objects present in the surgical field are enhanced by superimposing computer-generated visual, auditory, tactile, somatosensory, olfactory, or other sensory information over the surgical field and the real world images of instruments or other objects present in the surgical field. The image may be streamed in real-time, or may be a still image.

Real world surgical instruments include a variety of surgical devices including energy, staplers, or a combination of energy and staplers. Energy-based medical devices include, but are not limited to, radio Frequency (RF) based monopolar and bipolar electrosurgical instruments, ultrasonic surgical instruments, combined RF electrosurgical and ultrasonic instruments, combined RF electrosurgical and mechanical staplers, and the like. Surgical stapler devices are surgical instruments used to cut and staple tissue in a variety of surgical procedures including bariatric, thoracic, colorectal, gynecological, urological and general procedures.

Disclosure of Invention

In various instances, the present disclosure provides a surgical system comprising a surgical device comprising: an axial passageway defining an outer diameter and an inner diameter; a proximal end; a distal end configured to penetrate tissue; a camera array comprising individual cameras connected in a ring configuration with elastic connections; a removable mounting trigger configured to extend the camera array from a first recessed position to a second deployed position from an inner diameter of the distal end of the axial passageway, wherein the camera array is positioned circumferentially about an outer diameter of the distal end of the axial passageway; augmented Reality (AR) devices; and a surgical hub communicatively coupled to the camera array and the AR device, wherein the surgical hub comprises control circuitry coupled to the memory, and wherein the control circuitry is configured to: receiving a plurality of video feeds from a camera array; identifying physical marks on the video feed; and displaying the physical marker on the AR display.

In various instances, the present disclosure provides a surgical device comprising: a camera array comprising individual cameras connected in a ring configuration with resilient connections, wherein the camera array is communicably coupleable to a surgical hub; an elongate penetrating member having a proximal end and a distal end, wherein the distal end further comprises a tissue penetrating tip; an axial passageway passing through the elongate penetrating member and the tissue penetrating tip, and wherein an inner diameter of the axial passageway is sized to accommodate the camera array in the first recessed position; and a removable mounting trigger configured to enable the camera array to extend from a first recessed position to a second deployed position of the inner diameter of the distal end of the elongate penetrating member, wherein the camera array is positioned circumferentially about the outer diameter of the distal end of the elongate penetrating member.

In various cases, the present disclosure provides a method for displaying a surgical site in a patient, the method comprising: receiving, by a surgical hub, a video feed from a camera located within a patient; identifying, by the surgical hub, a physical marker within the patient; determining, by the surgical hub, a target location based on the relationship to the physical marker; generating, by the surgical hub, a virtual element corresponding to the target location; and displaying, by an Augmented Reality (AR) device coupled to the surgical hub, the virtual element superimposed on the video feed on the AR display.

Drawings

The various aspects (both as to the surgical organization and method) described herein, together with further objects and advantages thereof, may best be understood by reference to the following description taken in connection with the accompanying drawings.

Fig. 1 is a block diagram of a computer-implemented interactive surgical system according to one aspect of the present disclosure.

Fig. 2 is a surgical system for performing a surgical procedure in an operating room according to one aspect of the present disclosure.

Fig. 3 is a surgical hub paired with a visualization system, robotic system, and intelligent instrument, according to one aspect of the present disclosure.

Fig. 4 illustrates a surgical data network including a modular communication hub configured to enable connection of modular devices located in one or more operating rooms of a medical facility or any room specially equipped for surgical procedures in the medical facility to a cloud, according to one aspect of the present disclosure.

Fig. 5 illustrates a computer-implemented interactive surgical system in accordance with an aspect of the present disclosure.

Fig. 6 illustrates a surgical hub including a plurality of modules coupled to a modular control tower according to one aspect of the present disclosure.

Fig. 7 illustrates an Augmented Reality (AR) system including an intermediate signal combiner positioned in a communication path between an imaging module and a surgical hub display, according to one aspect of the present disclosure.

Fig. 8 illustrates an Augmented Reality (AR) system including an intermediate signal combiner positioned in a communication path between an imaging module and a surgical hub display, according to one aspect of the present disclosure.

Fig. 9 illustrates an Augmented Reality (AR) device worn by a surgeon to transmit data to a surgical hub, according to one aspect of the present disclosure.

Fig. 10 illustrates a system for augmenting surgical instrument information using an augmented reality display according to one aspect of the present disclosure.

Fig. 11 illustrates a timeline of situational awareness surgery in accordance with an aspect of the present disclosure.

Fig. 12 illustrates a structured surface including a plurality of fiducial markers according to one aspect of the disclosure.

Fig. 13 illustrates a process for surface matching an external structure of a patient with fiducial markers according to one aspect of the disclosure.

Fig. 14 illustrates a process for surface matching an internal structure of a patient with fiducial markers according to one aspect of the present disclosure.

Fig. 15 illustrates a stereotactic frame external surgical alignment instrument for assisting a surgeon in performing a surgical procedure, according to one aspect of the present disclosure.

Fig. 16 illustrates a star-shaped fixed-platform external surgical alignment instrument for assisting a surgeon in performing a surgical procedure in accordance with one aspect of the present disclosure.

Fig. 17 illustrates a micro-table external surgical alignment instrument for assisting a surgeon in performing a surgical procedure in accordance with one aspect of the present disclosure.

Fig. 18 illustrates a flow chart for identifying an object based on a plurality of registration parameters in accordance with an aspect of the disclosure.

FIG. 19 illustrates a flow chart for classifying an unknown surgical instrument based on partial information of known and unknown parameters in accordance with an aspect of the present disclosure.

Fig. 20 illustrates a trocar including an internal camera system according to one aspect of the present disclosure.

Fig. 21 illustrates a reusable installation tool configured to be inserted into a proximal end of a trocar, deploying and retracting a camera system around an outer diameter of the trocar, according to one aspect of the present disclosure.

Fig. 22 illustrates a plurality of fiducial markers marked to a region of interest in a pre-operative Computed Tomography (CT) scan in accordance with an aspect of the present disclosure.

Fig. 23 illustrates a laparoscopic surgery utilizing a plurality of fiducial markers to assist a surgeon in locating a surgical site in accordance with an aspect of the present disclosure.

Fig. 24 illustrates physical markers applied by injecting indocyanine dyes into the vascular system of a patient, according to one aspect of the present disclosure.

Fig. 25 also illustrates an exemplary tissue injected with a dye and irradiated to illustrate vasculature, according to an aspect of the disclosure.

Fig. 26 illustrates a system configured to be able to monitor changes in pressure or fluid in a body cavity from impedance measurements of a probe, according to one aspect of the disclosure.

Fig. 27 illustrates an Infrared (IR) thermal detection system including an IR camera system configured to direct IR light onto a treatment region of tissue and identify temperature differences in a surgical environment, according to one aspect of the present disclosure.

Fig. 28 illustrates a surgical procedure employing three end effectors configured to grasp and transect tissue in accordance with an aspect of the present disclosure.

Fig. 29 illustrates a third end effector slid along tissue from a first position to a second position in accordance with an aspect of the present disclosure.

Fig. 30 illustrates a third end effector positioned adjacent to a second end effector in accordance with an aspect of the present disclosure.

Fig. 31 illustrates a surgical procedure including three static clamps and a dynamic clamp configured to transfer tissue between the static clamps, according to one aspect of the present disclosure.

Fig. 32 illustrates a logic flow diagram of a method for displaying a surgical site within a patient in accordance with an aspect of the present disclosure.

Corresponding reference characters indicate corresponding parts throughout the several views. The exemplifications set out herein illustrate various disclosed embodiments, in one form, and such exemplifications are not to be construed as limiting the scope of the invention in any manner.

Detailed Description

The applicant of the present application owns the following U.S. patent applications filed concurrently herewith, the disclosure of each of these patent applications being incorporated herein by reference in its entirety:

● U.S. patent application entitled "METHOD FOR INTRAOPERATIVE DISPLAY FORSURGICAL SYSTEMS"; agent case number END9352USNP1/210120-1M;

● U.S. patent application entitled "UTILIZATION OF SURGICAL DATA VALUES ANDSITUATIONAL AWARENESS TO CONTROL THE OVERLAY INSURGICAL FIELDVIEW"; agent case number END9352USNP2/210120-2;

● U.S. patent application entitled "SELECTIVE AND ADJUSTABLE MIXED REALITYOVERLAY IN SURGICAL FIELDVIEW"; agent case number END9352USNP3/210120-3;

● U.S. patent application entitled "RISK BASED PRIORITIZATION OF DISPLAY ASPECTSIN SURGICAL FIELDVIEW"; agent case number END9352USNP4/210120-4;

● U.S. patent application entitled "SYSTEMS AND METHODS FOR CONTROLLINGSURGICAL DATA OVERLAY"; agent case number END9352USNP5/210120-5;

● U.S. patent application entitled "SYSTEMS AND METHODS FOR CHANGING DISPLAYOVERLAY OF SURGICAL FIELDVIEW BASED ONTRIGGERING EVENTS"; agent case number END9352USNP6/210120-6;

● U.S. patent application entitled "CUSTOMIZATION OF OVERLAID DATA ANDCONFIGURATION"; agent case number END9352USNP7/210120-7;

● U.S. patent application entitled "INDICATION OF THE COUPLE PAIR OF REMOTECONTROLS WITH REMOTE DEVICES FUNCTIONS"; agent case number END9352USNP8/210120-8;

● U.S. patent application entitled "COOPERATIVE OVERLAYS OF INTERACTINGINSTRUMENTS WHICH RESULT IN BOTH OVERLAYS BEINGEFFECTED"; agent case number END9352USNP9/210120-9;

● U.S. patent application entitled "ANTICIPATION OF INTERACTIVE UTILIZATION OFCOMMON DATA OVERLAYS BY DIFFERENT USERS"; agent case number END9352USNP10/210120-10;

● U.S. patent application entitled "MIXING DIRECTLY VISUALIZED WITH RENDEREDELEMENTS TO DISPLAY BLENDED ELEMENTS AND ACTIONSHAPPENING ON-SCREEN AND OFF-SCREEN"; agent case number END9352USNP11/210120-11;

● U.S. patent application No. SYSTEM AND METHOD FOR TRACKING A PORTIONOF THE USER AS A PROXY FOR NON-monitor issue; agent case number END9352USNP12/210120-12;

● U.S. patent application entitled "UTILIZING CONTEXTUAL PARAMETERS OF ONE ORMORE SURGICAL DEVICES TO PREDICT A FREQUENCYINTERVAL FOR DISPLAYING SURGICAL INFORMATION"; agent case number END9352USNP13/210120-13;

● U.S. patent application entitled "INTRAOPERATIVE DISPLAY FOR SURGICALSYSTEMS"; agent case number END9352USNP15/210120-15;

● U.S. patent application entitled "ADAPTATION AND ADJUSTABILITY OR OVERLAIDINSTRUMENT INFORMATION FOR SURGICAL SYSTEMS"; agent case number END9352USNP16/210120-16; and

U.S. patent application entitled "MIXED REALITY FEEDBACK SYSTEMS THAT COOPERATE TO INCREASE EFFICIENT PERCEPTION OF COMPLEX DATA FEEDS"; agent case number END9352USNP17/210120-17.

The applicant of the present application owns the following U.S. patent applications, the disclosure of each of which is incorporated herein by reference in its entirety:

U.S. patent application Ser. No. 16/209,423, entitled "METHOD OF COMPRESSING TISSUE WITHIN A STAPLING DEVICE AND SIMULTANNEOUSLY DISPLAYING THE LOCATION OF THE TISSUE WITHIN THE JAWS", now U.S. patent application publication No. US-2019-0200981-A1;

U.S. patent application Ser. No. 16/209,453, entitled "METHOD FOR CONTROLLING SMART ENERGY DEVICES," now U.S. patent application publication No. US-2019-0201046-A1.

Before explaining aspects of the surgical device and generator in detail, it should be noted that the illustrative examples are not limited in their application or use to the details of construction and arrangement of parts illustrated in the accompanying drawings and description. The illustrative examples may be implemented alone or in combination with other aspects, variations and modifications and may be practiced or carried out in various ways. Furthermore, unless otherwise indicated, the terms and expressions employed herein have been chosen for the purpose of describing the illustrative examples for the convenience of the reader and are not for the purpose of limitation. Moreover, it is to be understood that the expression of one or more of the aspects, and/or examples described below may be combined with any one or more of the expression of other aspects, and/or examples described below.

Various aspects relate to a screen display for a surgical system for various energy and surgical stapler-based medical devices. Energy-based medical devices include, but are not limited to, radio Frequency (RF) based monopolar and bipolar electrosurgical instruments, ultrasonic surgical instruments, combined RF electrosurgical and ultrasonic instruments, combined RF electrosurgical and mechanical staplers, and the like. The surgical stapler device includes a combination surgical stapler having an electrosurgical device and/or an ultrasonic device. Aspects of the ultrasonic surgical device may be configured to transect and/or coagulate tissue, for example, during a surgical procedure. Aspects of the electrosurgical device may be configured for transecting, coagulating, sealing, welding, and/or desiccating tissue, for example, during surgery. Aspects of the surgical stapler device can be configured to transect and staple tissue during a surgical procedure, and in some aspects, the surgical stapler device can be configured to deliver RF energy to tissue during a surgical procedure. The electrosurgical device is configured to deliver therapeutic and/or non-therapeutic RF energy to tissue. The elements of the surgical stapler device, electrosurgical device, and ultrasonic device may be used in combination in a single surgical instrument.

In various aspects, the present disclosure provides an on-screen display of real-time information to an OR team during surgery. In accordance with various aspects of the present disclosure, a number of new and unique screen displays are provided to display various visual information feedback to an OR team on a screen. In accordance with the present disclosure, visual information may include one or more various visual media, whether audible or silent. Generally, visual information includes still photography, movie photography, video or audio recordings, graphic arts, visual aids, models, displays, visual presentation services, and supporting processes. Visual information may be conveyed on any number of display options, such as, for example, a main OR screen, the energy OR surgical stapler device itself, a tablet computer, augmented reality glasses, and the like.

In various aspects, the present disclosure provides a large number of possible lists of options to communicate visual information to an OR team in real-time without providing excessive visual information to the OR team. For example, in various aspects, the present disclosure provides a screen display of visual information to enable a surgeon OR other member of an OR team to selectively activate the screen display, such as an icon surrounding a screen option, to manage a large amount of visual information. The active display may be determined using one or a combination of factors, which may include an energy-based (e.g., electrosurgical, ultrasound) or mechanical-based (e.g., stapler) surgical device in use, estimating the risk associated with a given display, the degree of experience of the surgeon, the surgeon's choice, and so forth. In other aspects, the visual information may include a large amount of data superimposed or overlaid into the surgical field to manage the visual information. In various aspects described below, overlapping images that require video analysis and tracking are included in order to properly overlay data. In contrast to static icons, visual information data transmitted in this manner may provide additional useful visual information to the OR team in a more concise and easily understood manner.

In various aspects, the present disclosure provides techniques for selectively activating a screen display, such as an icon surrounding the screen, to manage visual information during a surgical procedure. In other aspects, the present disclosure provides techniques for determining an active display using one or a combination of various factors. In various aspects, techniques according to the present disclosure may include selecting an energy-based OR mechanical-based surgical device for use as an active display, estimating risk associated with a given display, utilizing the experience level of a surgeon OR OR team making the selection, and so forth.

In other aspects, techniques according to the present disclosure may include overlaying or overlaying a large amount of data onto a surgical field of view to manage visual information. The various display arrangements described in this disclosure relate to superimposing various visual representations of surgical data on a live stream of a surgical field of view. As used herein, the term overlay includes semi-transparent overlays, partial overlays, and/or moving overlays. The graphic overlay may be in the form of a transparent graphic, a translucent graphic, or an opaque graphic, or a combination of transparent, translucent, and opaque elements or effects. Further, the superimposed layers may be positioned on or at least partially on or near objects in the surgical field such as, for example, end effectors and/or critical surgical structures. Some display arrangements may include changes in one or more display elements of the superimposed layers, including changes in color, size, shape, display time, display location, display frequency, highlighting, or combinations thereof, based on changes in display priority values. A graphical overlay is rendered on top of the active display monitor to quickly and efficiently communicate important information to the OR team.

In other aspects, techniques according to the present disclosure may include overlapping images that require analysis of video and tracking in order to properly overlay visual information data. In other aspects, techniques according to the present disclosure may include transmitting rich visual information instead of simple static icons, thereby providing additional visual information to the OR team in a more concise and easily understood manner. In other aspects, the visual overlay may be used in combination with an audible and/or somatosensory overlay (such as thermal, chemical and mechanical devices, and combinations thereof).

The following description relates generally to devices, systems, and methods that provide an Augmented Reality (AR) interactive experience during surgery. In this context, the surgical field and the images of surgical instruments and other objects present in the surgical field are enhanced by superimposing computer-generated visual, auditory, tactile, somatosensory, olfactory, or other sensory information on the surgical field, the real world images of instruments and other objects present in the surgical field. The image may be streamed in real-time, or may be a still image. Augmented reality is a technology for rendering and displaying virtual or "augmented" virtual objects, data, or visual effects superimposed on a real environment. The real environment may include a surgical field of view. A virtual object superimposed on a real environment may be represented as anchored or in a set position relative to one or more aspects of the real environment. In a non-limiting example, if a real world object leaves the real environment field of view, then a virtual object anchored to the real world object will also leave the augmented reality field of view.

The various display arrangements described in this disclosure relate to superimposing various visual representations of surgical data on a live stream of a surgical field of view. As used herein, the term overlay includes semi-transparent overlays, partial overlays, and/or moving overlays. Further, the superimposed layers may be positioned on or at least partially on or near objects in the surgical field such as, for example, end effectors and/or critical surgical structures. Some display arrangements may include changes in one or more display elements of the superimposed layers, including changes in color, size, shape, display time, display location, display frequency, highlighting, or combinations thereof, based on changes in display priority values.

As described herein, AR is an enhanced version of the real physical world, achieved through the use of digital visual elements, sounds, or other sensory stimuli delivered via technology. Virtual Reality (VR) is a computer-generated environment with scenes and objects that appear to be real, so that users feel themselves immersed in their surroundings. The environment is perceived by a device called a virtual reality headset or helmet. Both Mixed Reality (MR) and AR are considered immersive techniques, but they are not identical. MR is an extension of mixed reality, allowing real and virtual elements to interact in an environment. While AR often adds digital elements to a real-time view through the use of cameras, MR experiences combine elements of both AR and VR, in which real world and digital objects interact.

In an AR environment, one or more computer-generated virtual objects may be displayed with one or more real (i.e., so-called "real world") elements. For example, real-time images or videos of the surrounding environment may be displayed on a computer screen display along with one or more overlaid virtual objects. Such virtual objects may provide supplemental information about the environment or generally enhance the user's perception and participation in the environment. Instead, real-time images or videos of the surrounding environment may additionally or alternatively enhance user engagement with virtual objects shown on the display.

Apparatus, systems, and methods in the context of the present disclosure enhance images received from one or more imaging devices during a surgical procedure. The imaging device may include various endoscopes, AR devices, and/or cameras used during non-invasive and minimally invasive surgery to provide images during open surgery. The image may be streamed in real-time, or may be a still image. The devices, systems, and methods enhance images of a real-world surgical environment by overlaying virtual objects or representations of data and/or real objects on the real-world surgical environment, thereby providing an augmented reality interactive experience. The augmented reality experience may be viewed on a display and/or AR device that allows a user to view the overlaid virtual object on the real world surgical environment. The display may be located in the operating room or remote from the operating room. AR devices are worn on the head of a surgeon or other operating room personnel and typically include two stereoscopic display lenses or screens, one for each eye of the user. Natural light can pass through two transparent or translucent display lenses so that aspects of the real environment are visible, while also projecting light so that the virtual object is visible to the user of the AR device.

Two or more displays and AR devices may be used in a coordinated manner, such as a first display or AR device controlling one or more additional displays or AR devices in a defined character control system. For example, when the display or AR device is activated, the user may select a role (e.g., surgeon, surgical assistant, nurse, etc. during surgery) and the display or AR device may display information related to the role. For example, the surgical assistant may have a virtual representation of the displayed instrument that the surgeon needs when performing the next step of the surgical procedure. The surgeon's attention to the current step may see different display information than the surgical assistant.

While there are many known screen displays and warnings, the present disclosure provides many new and unique augmented reality interactive experiences during surgery. Such augmented reality interactive experiences include visual, auditory, tactile, somatosensory, olfactory, or other sensory feedback information to a surgical team inside or outside the operating room. Virtual feedback information superimposed on the real world surgical environment may be provided to an Operating Room (OR) team, including personnel internal to the OR, including, but not limited to, for example, a stick surgeon, a surgeon assistant, a swabbing personnel, an anesthesiologist, and a round nurse, among others. The virtual feedback information may be transmitted over any number of display options, such as a master OR screen display, AR device, energy OR surgical stapler instrument, tablet computer, augmented reality glasses, device, and the like.

Fig. 1 shows a computer-implemented interactive surgical system 1 comprising one or more surgical systems 2 and a cloud-based system 4. The cloud-based system 4 may include a remote server 13 coupled to the storage 5. Each surgical system 2 includes at least one surgical hub 6 in communication with the cloud 4. For example, the surgical system 2 may include a visualization system 8, a robotic system 10, and a hand-held intelligent surgical instrument 12, each configured to communicate with each other and/or with the hub 6. In some aspects, the surgical system 2 may include M hubs 6, N visualization systems 8, O robotic systems 10, and P smart handheld surgical instruments 12, where M, N, O and P are integers greater than or equal to 1. The computer-implemented interactive surgical system 1 may be configured to provide an augmented reality interactive experience during a surgical procedure as described herein.

Fig. 2 shows an example of a surgical system 2 for performing a surgical procedure on a patient lying on an operating table 14 in a surgical room 16. The robotic system 10 is used as part of the surgical system 2 during surgery. The robotic system 10 includes a surgeon's console 18, a patient side cart 20 (surgical robot), and a surgical robotic hub 22. When the surgeon views the surgical site through the surgeon's console 18 or an Augmented Reality (AR) device 66 worn by the surgeon, the patient-side cart 20 may manipulate at least one removably coupled surgical tool 17 through a minimally invasive incision in the patient. An image of the surgical site of the minimally invasive surgical procedure (e.g., a still image or a live image streamed in real time) may be obtained by the medical imaging device 24. The patient side cart 20 may maneuver the imaging device 24 to orient the imaging device 24. An image of the open surgical procedure may be obtained by the medical imaging device 96. The robotic hub 22 processes the image of the surgical site for subsequent display on the surgeon's console 18 or on an AR device 66 worn by the surgeon or to other personnel in the surgical room 16.

The optical components of imaging device 24, 96 or AR device 66 may include one or more illumination sources and/or one or more lenses. One or more illumination sources may be directed to illuminate multiple portions of the surgical field. The one or more image sensors may receive light reflected or refracted from tissue and instruments in the surgical field.

In various aspects, the imaging device 24 is configured for use in minimally invasive surgery. Examples of imaging devices suitable for use in the present disclosure include, but are not limited to, arthroscopes, angioscopes, bronchoscopes, choledochoscopes, colonoscopes, cytoscopes, duodenoscopes, enteroscopes, esophageal-duodenal scopes (gastroscopes), endoscopes, laryngoscopes, nasopharyngeal-renal endoscopes, sigmoidoscopes, thoracoscopes, and hysteroscopes. In various aspects, the imaging device 96 is configured for use in open (invasive) surgery.

In various aspects, the visualization system 8 includes one or more imaging sensors, one or more image processing units, one or more storage arrays, and one or more displays strategically placed relative to the sterile field. In one aspect, the visualization system 8 includes interfaces for HL7, PACS, and EMR. In one aspect, the imaging device 24 may employ multispectral monitoring to distinguish between topography and underlying structures. Multispectral images capture image data over a specific range of wavelengths across the electromagnetic spectrum. Wavelengths, including light from frequencies outside the visible range, such as IR and ultraviolet, are separated by filters or devices sensitive to the particular wavelengths. Spectral imaging can extract information that is not visible to the human eye. Multispectral monitoring can reposition the surgical field after completion of the surgical task to perform a test on the treated tissue.

Fig. 2 shows the main display 19 positioned in the sterile field to be visible to an operator at the operating table 14. The visualization tower 11 is positioned outside the sterile zone and comprises a first non-sterile display 7 and a second non-sterile display 9 facing away from each other. The visualization system 8 guided by the hub 6 is configured to be able to coordinate the information flow to operators inside and outside the sterile field using the displays 7, 9, 19. For example, hub 6 may cause visualization system 8 to display AR images of the surgical site recorded by imaging devices 24, 96 on non-sterile displays 7, 9 or by AR device 66, while maintaining a real-time feed of the surgical site on primary display 19 or AR device 66. For example, the non-sterile displays 7, 9 may allow a non-sterile operator to perform diagnostic steps related to surgery.

Fig. 3 shows the surgical hub 6 in communication with the visualization system 8, the robotic system 10, and the hand-held intelligent surgical instrument 12. Hub 6 includes a hub display 35, an imaging module 38, a generator module 40, a communication module 30, a processor module 32, a memory array 34, and an operating room mapping module 33. The hub 6 further comprises a smoke evacuation module 26 and/or a suction/flushing module 28. In various aspects, the imaging module 38 includes an AR device 66 and the processor module 32 includes an integrated video processor and augmented reality modeler (e.g., as shown in fig. 10). The modular light source may be adapted for use with a variety of imaging devices. In various examples, multiple imaging devices may be placed at different locations in the surgical field to provide multiple views (e.g., non-invasive, minimally invasive, or open surgery). The imaging module 38 may be configured to be switchable between imaging devices to provide an optimal view. In various aspects, imaging module 38 may be configured to be able to integrate images from different imaging devices and provide an augmented reality interactive experience during a surgical procedure as described herein.

Fig. 4 shows a surgical data network 51 including a modular communication hub 53 configured to enable connection of modular devices located in one or more operating rooms/rooms of a medical facility to a cloud-based system. Cloud 54 may include a remote server 63 (fig. 5) coupled to storage 55. Modular communication hub 53 includes a network hub 57 and/or a network switch 59 in communication with a network router 61. Modular communication hub 53 is coupled to local computer system 60 to process data. The modular devices 1a-1n located in the operating room may be coupled to a modular communication hub 53. The network hub 57 and/or the network switch 59 may be coupled to a network router 61 to connect the devices 1a-1n to the cloud 54 or the local computer system 60. The data associated with the devices 1a-1n may be transmitted via routers to cloud-based computers for remote data processing and manipulation. The operating room devices 1a-1n may be connected to the modular communication hub 53 by a wired channel or a wireless channel. The surgical data network 51 environment may be used to provide an augmented reality interactive experience during a surgical procedure as described herein, and in particular to provide an augmented image in a surgical field of view to one or more remote displays 58.

Fig. 5 illustrates a computer-implemented interactive surgical system 50. The computer-implemented interactive surgical system 50 is similar in many respects to the computer-implemented interactive surgical system 1. The computer-implemented interactive surgical system 50 includes one or more surgical systems 52 that are similar in many respects to the surgical system 2. Each surgical system 52 includes at least one surgical hub 56 in communication with a cloud 54, which may include a remote server 63. In one aspect, the computer-implemented interactive surgical system 50 includes a modular control tower 23 that is connected to a plurality of operating room devices, such as intelligent surgical instruments, robots, and other computerized devices located in an operating room. As shown in fig. 6, modular control tower 23 includes a modular communication hub 53 coupled to a computer system 60.

Returning to fig. 5, modular control tower 23 is coupled to imaging module 38 (which is coupled to endoscope 98), generator module 27 (which is coupled to energy device 99), smoke extractor module 76, suction/irrigation module 78, communication module 13, processor module 15, storage array 16, smart device/appliance 21 (which is optionally coupled to display 39), and sensor module 29. The operating room devices are coupled to cloud computing resources, such as servers 63, data storage 55, and display 58, via modular control tower 23. The robotic hub 72 may also be connected to the modular control tower 23 and to the server 63, the data storage 55, and the display 58. The device/instrument 21, visualization system 58, etc. may be coupled to the modular control tower 23 via a wired or wireless communication standard or protocol, as described herein. The modular control tower 23 may be coupled to a hub display 65 (e.g., monitor, screen) to display the received enhanced images, including overlaid virtual objects in the real surgical field received from the imaging module 38, the device/instrument display 39, and/or other visualization system 58. Hub display 65 may also display data received from devices connected to modular control tower 23 in combination with the image and the overlay image.

Fig. 6 shows a surgical hub 56 that includes a plurality of modules coupled to the modular control tower 23. The modular control tower 23 includes a modular communication hub 53 (e.g., a network connectivity device) and a computer system 60 to provide, for example, enhanced local processing, visualization, and imaging of surgical information. Modular communication hub 53 may be hierarchically configured to connect to extend the number of modules (e.g., devices) that may be connected to modular communication hub 53 and to transmit data associated with the modules to computer system 60, cloud computing resources, or both. Each of the hubs 57/switches 59 in the modular communications hub 53 may include three downstream ports and one upstream port. The upstream hub 57/switch 59 is connected to the processor 31 to provide a communication connection with cloud computing resources and a local display 67. Communication with cloud 54 may be through a wired or wireless communication channel.

The computer system 60 includes a processor 31 and a network interface 37. The processor 31 is coupled to a communication module 41, a storage device 45, a memory 46, a non-volatile memory 47 and an input/output interface 48 via a system bus. The system bus may be any of several types of bus structures including a memory bus or memory controller, a peripheral bus or external bus, and/or a local bus using any of a variety of available bus architectures.

The processor 31 includes an augmented reality modeler (e.g., as shown in fig. 10) and may be implemented as a single or multi-core processor, such as those provided by texas instruments (Texas Instruments) under the trade name ARM Cortex. In one aspect, the processor may be a single-cycle processor core, including 256KB, available from, for example, texas instruments (Texas Instruments) LM4F230H5QR ARM Cortex-M4F processor coreOn-chip memory for flash or other non-volatile memory (up to 40 MHz), prefetch buffer for improved execution above 40MHz, 32KB single cycle Sequential Random Access Memory (SRAM), load withInternal read-only memory (ROM) of software, 2KB electrically erasable programmable read-only memory (EEPROM), and/or one or more Pulse Width Modulation (PWM) modules, one or more Quadrature Encoder Inputs (QEI) analog, one or more 12-bit analog-to-digital converters (ADC) with 12 analog input channels, the details of which can be seen in the product data sheet.

The system memory includes volatile memory and nonvolatile memory. A basic input/output system (BIOS), containing the basic routines to transfer information between elements within the computer system, such as during start-up, is stored in nonvolatile memory. For example, the 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. In addition, RAM is available in a variety of forms, such as SRAM, dynamic RAM (DRAM), synchronous DRAM (SDRAM), dual data rate SDRAM (DDR SDRAM) Enhanced SDRAM (ESDRAM), synchronous Link DRAM (SLDRAM), and Direct Rambus RAM (DRRAM).

Computer system 60 also includes removable/non-removable, volatile/nonvolatile computer storage media such as, for example, magnetic disk storage. Disk storage includes, but is not limited to, devices such as magnetic disk drives, floppy disk drives, tape drives, jaz drives, zip drives, LS-60 drives, flash memory cards, or memory sticks. In addition, the disk storage can 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 recordable drive (CD-R drive), compact disk rewritable drive (CD-RW drive) or a digital versatile disk ROM drive (DVD-ROM). To facilitate connection of the disk storage devices to the system bus, a removable or non-removable interface may be used.

In various aspects, the computer system 60 of fig. 6, the imaging module 38 and/or the visualization system 58 and/or the processor module 15 of fig. 4-6 may include an image processor, an image processing engine, a Graphics Processing Unit (GPU), a media processor, or any special-purpose Digital Signal Processor (DSP) for processing digital images. The image processor may employ parallel computation with single instruction, multiple data (SIMD) or multiple instruction, multiple data (MIMD) techniques to increase speed and efficiency. The digital image processing engine may perform a series of tasks. The image processor may be a system on a chip having a multi-core processor architecture.

Fig. 7 shows an augmented reality system 263 that includes an intermediate signal combiner 64 positioned in the communication path between the imaging module 38 and the surgical hub display 67. The signal combiner 64 combines audio and/or image data received from the imaging module 38 and/or the AR device 66. The surgical hub 56 receives the combined data from the combiner 64 and superimposes the data provided to the display 67 on which the superimposed data is displayed. Imaging device 68 may be a digital video camera and audio device 69 may be a microphone. The signal combiner 64 may include a wireless heads-up display adapter to couple to an AR device 66 placed in the communication path of the display 67 to the console, allowing the surgical hub 56 to superimpose data on the display 67.

Fig. 8 illustrates an Augmented Reality (AR) system including an intermediate signal combiner positioned in a communication path between an imaging module and a surgical hub display. Fig. 8 shows AR device 66 worn by surgeon 73 to transmit data to surgical hub 56. Peripheral information of AR device 66 does not include active video. Instead, the peripheral information includes only the device settings or signals that do not have the same refresh rate requirements. The interaction may augment the surgeon's 73 information based on linking with preoperative Computed Tomography (CT) or other data linked in the surgical hub 56. The AR device 66 may identify structures, such as querying whether the instrument is contacting a nerve, vessel, or adhesion. The AR device 66 may include preoperative scan data, optical views, tissue interrogation features obtained throughout the procedure, and/or processing in the surgical hub 56 for providing answers. The surgeon 73 may dictate notes to the AR device 66 for storage in the hub storage device 45 with the patient data for later reporting or follow-up.

The AR device 66 worn by the surgeon 73 is linked to the surgical hub 56 with audio and visual information to avoid the need for superposition and to allow the display information to be customized around the perimeter of the field of view. The AR device 66 provides a signal from the device (e.g., instrument), answers queries about device settings or location information linked to the video to identify quadrants or locations. The AR device 66 has audio control and audio feedback from the AR device 66. The AR device 66 is able to interact with all other systems in the operating room and has feedback and interaction available wherever the surgeon 73 looks. For example, the AR device 66 may receive voice or gesture initiated commands and inquiries from the surgeon, and the AR device 66 may provide feedback in the form of one or more modalities including audio, visual, or tactile touches.

Fig. 9 shows a surgeon 73 wearing AR device 66, a patient 74, and a camera 96 may be included in operating room 75. The AR device 66 worn by the surgeon 73 may be used to present virtual objects superimposed on a real-time image of the surgical field to the surgeon 73 via an augmented reality display 89 or via a hub-connected display 67. The real-time image may include a portion of the surgical instrument 77. The virtual object may not be visible to other people (e.g., surgical assistants or nurses) within the operating room 75, although they may also be wearing the AR device 66. Even if another person is viewing operating room 75 using AR device 66, that person may not see the virtual object or be able to see the virtual object in the augmented reality shared with surgeon 73, or be able to see a modified version of the virtual object (e.g., according to a unique customization to surgeon 73) or be able to see a different virtual object.

The virtual objects and/or data may be configured to appear on a portion of the surgical instrument 77 or in a surgical field captured by the imaging module 38, by the imaging device 68 during minimally invasive surgery, and/or by the camera 96 during open surgery. In the illustrated example, the imaging module 38 is a laparoscopic camera that provides a real-time feed of the surgical field during minimally invasive surgery. The AR system may present a virtual object that is fixed to a real object regardless of the perspective of one or more observers (e.g., surgeon 73) of the AR system. For example, the virtual object may be visible to an observer of the AR system inside the operating room 75, and not visible to an observer of the AR system outside the operating room 75. When an observer enters operating room 75, the virtual object may be displayed to the observer outside operating room 75. The augmented image may be displayed on the surgical hub display 67 or the augmented reality display 89.

The AR device 66 may include one or more screens or lenses, such as a single screen or two screens (e.g., one screen for each eye of the user). The screen may allow light to pass through the screen such that aspects of the real environment are visible when the virtual object is displayed. The virtual object may be made visible to the surgeon 73 by projected light. The virtual object may appear to have some degree of transparency or may be opaque (i.e., occlude aspects of the real environment).

The AR system may be viewable to one or more observers and may include differences between views available to one or more observers while maintaining some aspects common between views. For example, the heads-up display may change between two views, while virtual objects and/or data may be fixed to real objects or regions in the two views. Aspects, such as color, illumination, or other changes of the object, may be changed between views without changing the fixed location of the at least one virtual object.

The user may consider virtual objects and/or data presented in the AR system as opaque or as including a degree of transparency. In one example, a user may interact with a virtual object, such as by moving the virtual object from a first location to a second location. For example, the user may move the object with his own hand. This may be accomplished virtually in an AR system by determining that the hand has moved to a position coincident with or adjacent to the object (e.g., using one or more cameras that may be mounted on the AR device 66, such as AR device camera 79 or a separate camera 96, and which may be static or controllable to move) and causing the object to move in response. The virtual aspect may comprise a virtual representation of the real world object or may comprise a visual effect, such as a lighting effect or the like. The AR system may include rules that govern the behavior of the virtual object, such as subjecting the virtual object to gravity or friction, or may include other predefined rules that exclude real world physical constraints (e.g., floating objects, perpetuation, etc.). The AR device 66 may include a camera 79 (not confused with camera 96, separate from the AR device 66) located on the AR device 66. The AR device camera 79 or camera 96 may include an infrared camera, an infrared filter, a visible light filter, multiple cameras, a depth camera, and the like. The AR device 66 may project the virtual item on a representation of the real environment so as to be viewable by the user.

The AR device 66 may be used in an operating room 75 during surgery, for example, performed on a patient 74 by a surgeon 73. The AR device 66 may project or display virtual objects such as virtual objects during surgery to enhance the vision of the surgeon. The surgeon 73 may view the virtual object using the AR device 66, a remote control for the AR device 66, or may interact with the virtual object, such as using a hand to "interact" with the virtual object or a gesture recognized by a camera 79 of the AR device 66. The virtual object may augment a surgical tool, such as surgical instrument 77. For example, the virtual object may appear (to the surgeon 73 viewing the virtual object through the AR device 66) to be coupled to or maintained a fixed distance from the surgical instrument 77. In another example, the virtual object may be used to guide a surgical instrument 77 and may appear to be fixed to the patient 74. In some examples, the virtual object may react to movement of other virtual objects or real world objects in the surgical field of view. For example, the virtual object may be changed while the surgeon is manipulating a surgical instrument that is proximate to the virtual object.

The augmented reality display system imaging device 38 captures a real image of the surgical field during the surgical procedure. The augmented reality displays 89, 67 present a superposition of the operational aspects of the surgical instrument 77 over the real image of the surgical field. Surgical instrument 77 includes communication circuitry 231 to communicate operational aspects and functional data from surgical instrument 77 to AR device 66 via communication circuitry 233 on AR device 66. Although surgical instrument 77 and AR device 66 are shown as RF wireless communication between circuits 231, 233 as indicated by arrow B, C, other communication techniques (e.g., wired, ultrasonic, infrared, etc.) may be employed. The overlay is related to the operational aspects of the active visualization of the surgical instrument 77. The overlay combines aspects of tissue interaction in the surgical field with functional data from the surgical instrument 77. The processor portion of AR device 66 is configured to receive operational aspects and functional data from surgical instrument 77, determine overlays relating to the operation of surgical instrument 77, and combine tissue aspects in the surgical field with functional data from surgical instrument 77. The enhanced image indicates warnings regarding device performance considerations, warnings of incompatible usage, warnings regarding incomplete capture. Incompatible uses include tissue out of range conditions and tissue not properly balanced within the jaws of the end effector. The additional enhanced image provides an indication of an incident, including an indication of tissue tension and an indication of foreign object detection. Other enhanced image indicates device status overlay and instrument indication.

Fig. 10 illustrates a system 83 for enhancing a surgical field image with information using an AR display 89 in accordance with at least one aspect of the present disclosure. The system 83 may be used to perform the techniques described below, for example, by using the processor 85. The system 83 includes one aspect of the AR device 66 that may communicate with a database 93. The AR device 66 includes a processor 85, a memory 87, an AR display 89, and a camera 79. The AR device 66 may include a sensor 90, a speaker 91, and/or a haptic controller 92. Database 93 may include an image store 94 or a pre-operative plan store 95.

The processor 85 of the AR device 66 includes an augmented reality modeler 86. The augmented reality modeler 86 may be used by the processor 85 to create an augmented reality environment. For example, the augmented reality modeler 86 may receive an image of an instrument in a surgical field of view, such as from the camera 79 or the sensor 90, and create an augmented reality environment to fit within a displayed image of the surgical field of view. In another example, physical objects and/or data may be superimposed on the surgical field of view and/or the surgical instrument image, and the augmented reality modeler 86 may use the physical objects and data to present an augmented reality display of the virtual objects and/or data in the augmented reality environment. For example, the augmented reality modeler 86 may use or detect an instrument at a surgical site of a patient and present virtual objects and/or data on the surgical instrument and/or images of the surgical site in a surgical field captured by the camera 79. The AR display 89 may display an AR environment superimposed on a real environment. Display 89 may display virtual objects and/or data using AR device 66, such as a fixed location in an AR environment.

The AR device 66 may include a sensor 90, such as an infrared sensor. The camera 79 or sensor 90 may be used to detect movements, such as gestures by a surgeon or other user, which the processor 85 may interpret as user attempts or intended interactions with the virtual target. The processor 85 may identify objects in the real environment, such as by using the processing information received by the camera 79. In other aspects, the sensor 90 may be a tactile, auditory, chemical, or thermal sensor to generate corresponding signals that may be combined with various data feeds to create an enhanced environment. The sensors 90 may include binaural audio sensors (spatial sound), inertial measurement sensors (accelerometers, gyroscopes, magnetometers), environmental sensors, depth camera sensors, hand-eye tracking sensors, and voice command recognition functions.

For example, during a surgical procedure, the AR display 89 may present virtual features corresponding to physical features hidden by anatomical aspects of the patient, such as within the surgical field, while allowing the surgical field to be viewed through the AR display 89. The virtual feature may have a virtual position or orientation corresponding to a first physical position or orientation of the physical feature. In one example, the virtual position or orientation of the virtual feature may include an offset from a first physical position or orientation of the physical feature. The offset may include a predetermined distance from the augmented reality display, a relative distance from the augmented reality display to an anatomical aspect, and the like.

In one example, the AR device 66 may be a single AR device. In one aspect, AR device 66 may be a Hololens 2AR device manufactured by Microsoft corporation of Redmond, wash. The AR device 66 includes goggles with lenses and binaural audio features (spatial sound), inertial measurement devices (accelerometers, gyroscopes, magnetometers), environmental sensors, depth and video cameras, hand-eye tracking, and voice command recognition functions. It provides an improved field of view with high resolution by using a mirror to guide the waveguide in front of the wearer's eye. The image can be magnified by changing the angle of the mirror. It also provides eye tracking to identify the user and adjust the lens width for the particular user.

In another example, the AR device 66 may be a Snapchat Spectacles 3AR device. The AR device is able to capture paired images and recreate a 3D depth map, add virtual effects, and replay 3D video. The AR device includes two HD cameras to capture 3D photos and videos at 60fps while four built-in microphones record immersive high-fidelity audio. The images from the two cameras combine to build a geometric map around the user's real world, providing a new perception of depth. The photos and videos may be synchronized to the external display device wirelessly.

In yet another example, AR device 66 may be a Google Glass 2AR device. The AR device provides inertial measurement (accelerometer, gyroscope, magnetometer) information superimposed on the lens (outside the field of view) to supplement the information.

In another example, the AR device 66 may be Amazon's Echo Frames AR device. The AR device has no camera/display. The microphone and speaker are connected to Alexa. The AR device provides less functionality than a heads-up display.

In yet another example, AR device 66 may be a North (Google) Focals AR device. The AR device provides notification push/smart watch simulation; inertial measurement, screen overlay of information (weather, calendar, messages), voice control (Alexa) integration. The AR device provides a basic heads-up display function.

In another example, the AR device 66 may be an Nreal AR device. The AR device includes spatial sound, two ambient cameras, photo cameras, IMU (accelerometer, gyroscope), ambient light sensor, proximity sensor functions. Nebula projects application information onto the lens.

In various other examples, AR device 66 may be any of the following commercially available AR devices: magic Leap 1, epson Moverio, vuzix Blade AR, zenFone AR, microsoft AR eyeglass prototype, eyeTap to generate light collinear with ambient light directly into the retina. For example, the beam splitter makes the same light seen by the eye available for computer processing and superimposing information. AR visualization systems include HUDs, contact lenses, glasses, virtual Reality (VR) headphones, virtual retinal displays, operating room displays, and/or smart contact lenses (biomimetic lenses).

The multi-user interface for AR device 66 includes a virtual retinal display (such as a raster display drawn directly on the retina rather than on a screen in front of the eye), a smart television, a smart phone, and/or a spatial display (such as a Sony spatial display system).

Other AR technologies may include, for example, AR capture devices and software applications, AR creation devices and software applications, and AR cloud devices and software applications. The AR capture device and software applications include, for example, apple polycyam application u binary 6 (Mirrorworld using display. Land app), the user can scan and obtain 3D images of the real world (to create a 3D model). AR creation devices and software applications include, for example, adobe Aero, vuforia, ARToolKit, google ARCore, apple arcet, MAXST, aurasma, zappar, blippar. AR cloud devices and software applications include, for example, facebook, google (world geometry, object recognition, predictive data), amazon AR cloud (business), microsoft Azure, samsung Project Whare, niantic, magic Leap.

Situational awareness refers to the ability of some aspects of a surgical system to determine or infer information related to a surgical procedure from data received from databases and/or instruments. The information may include the type of surgery being performed, the type of tissue being operated on, or the body cavity being the subject of the surgery. With context information associated with the surgical procedure, the surgical system may, for example, improve the manner in which the surgical system controls the modular devices (e.g., robotic arms and/or robotic surgical tools) connected thereto, and provide context information or advice to the surgeon during the course of the surgical procedure.

Fig. 11 shows a time axis of a situation awareness surgical procedure. Fig. 11 shows an exemplary surgical timeline 5200 and context information that the surgical hub 5104 may derive from data received from the data source 5126 at each step of the surgical procedure. The time axis 5200 depicts typical steps that nurses, surgeons and other medical personnel will take during a segmental lung removal procedure, starting from the establishment of an operating room and until the patient is transferred to a post-operative recovery room. The situation aware surgical hub 5104 receives data from the data source 5126 throughout the surgical procedure, including data generated each time a medical professional utilizes the modular device 5102 paired with the surgical hub 5104. The surgical hub 5104 can receive this data from the paired modular device 5102 and other data sources 5126 and continually derive inferences about ongoing surgery (i.e., background information), such as which step of the surgery to perform at any given time, as new data is received. The situational awareness system of the surgical hub 5104 can, for example, record data related to the procedure used to generate the report, verify steps that medical personnel are taking, provide data or cues (e.g., via a display screen) that may be related to a particular procedure, adjust the modular device 5102 based on context (e.g., activate a monitor, adjust the FOV of a medical imaging device, or change the energy level of an ultrasonic surgical instrument or RF electrosurgical instrument), and take any other such action described herein.

First 5202, a hospital staff member retrieves the patient's EMR from the hospital's EMR database. Based on patient data selected in the EMR, the surgical hub 5104 determines that the procedure to be performed is a thoracic procedure.

Second 5204, the staff member scans the incoming medical supplies for the procedure. The surgical hub 5104 cross-compares the scanned supplies with the list of supplies utilized in the various types of protocols and confirms that the combination of supplies corresponds to the chest protocol. In addition, the surgical hub 5104 can also determine that the procedure is not a wedge procedure (because the incoming supplies lack certain supplies required for, or otherwise do not correspond to, a chest wedge procedure).

Third 5206, the medical personnel scans the patient belt via a scanner 5128 communicatively connected to the surgical hub 5104. The surgical hub 5104 may then confirm the identity of the patient based on the scanned data.

Fourth 5208, the medical staff opens the auxiliary equipment. The auxiliary devices utilized may vary depending on the type of surgery and the technique to be used by the surgeon, but in this exemplary case they include smoke evacuators, insufflators and medical imaging devices. When activated, the ancillary equipment as the modular device 5102 may automatically pair with the surgical hub 5104 located in a specific vicinity of the modular device 5102 as part of its initialization process. The surgical hub 5104 may then derive background information about the surgical procedure by detecting the type of modular device 5102 paired therewith during this pre-operative or initialization phase. In this particular example, the surgical hub 5104 determines that the surgical procedure is based on the VATS procedure of this particular combination of paired modular devices 5102. Based on a combination of data from the patient's EMR, a list of medical supplies to be used in the procedure, and the type of modular device 5102 connected to the hub, the surgical hub 5104 can generally infer the particular procedure that the surgical team will perform. Once the surgical hub 5104 knows the particular procedure being performed, the surgical hub 5104 can retrieve the procedure from memory or the cloud and then cross-reference the data it subsequently receives from the connected data sources 5126 (e.g., the modular device 5102 and the patient monitoring device 5124) to infer the procedure being performed by the surgical team.

Fifth 5210, the staff attaches EKG electrodes and other patient monitoring devices 5124 to the patient. The EKG electrode and other patient monitoring device 5124 can be paired with the surgical hub 5104. As the surgical hub 5104 begins to receive data from the patient monitoring device 5124, the surgical hub 5104 thus confirms that the patient is in the operating room.

Sixth 5212, medical personnel induce anesthesia in patients. The surgical hub 5104 may infer that the patient is under anesthesia based on data (including EKG data, blood pressure data, ventilator data, or a combination thereof) from the modular device 5102 and/or the patient monitoring device 5124. At the completion of the sixth step 5212, the preoperative portion of the lung segmental resection procedure is completed and the operative portion begins.

Seventh 5214, collapse of the lungs of the patient being operated on (while ventilation is switched to the contralateral lung). The surgical hub 5104 may infer from the ventilator data that the patient's lungs have collapsed. The surgical hub 5104 can infer that the surgical portion of the procedure has begun, as it can compare the detection of the patient's lung collapse to the expected steps of the procedure (which can be previously accessed or retrieved), thereby determining that collapsing the lung is a surgical step in that particular procedure.

Eighth 5216, a medical imaging device 5108 (e.g., an endoscope) is inserted and video from the medical imaging device is activated. The surgical hub 5104 receives medical imaging device data (i.e., still image data or live streaming video in real time) through its connection with the medical imaging device. After receiving the medical imaging device data, the surgical hub 5104 may determine that the laparoscopic portion of the surgical procedure has begun. In addition, the surgical hub 5104 may determine that the particular procedure being performed is a segmental resection, rather than a pneumonectomy (note that the surgical hub 5104 has excluded wedge-shaped procedures based on the data received at the second step 5204 of the procedure). The data from the medical imaging device 124 (fig. 2) may be used to determine background information related to the type of procedure being performed in a number of different ways, including by determining the angle of the visual orientation of the medical imaging device relative to the patient's anatomy, monitoring the number of medical imaging devices utilized (i.e., activated and paired with the surgical hub 5104), and monitoring the type of visualization device utilized.

For example, one technique for performing a vat lobectomy places the camera in the lower anterior corner of the patient's chest over the septum, while one for performing a vat segmented resection places the camera in an anterior intercostal position relative to the segmented slit. For example, using pattern recognition or machine learning techniques, the situational awareness system may be trained to recognize the positioning of the medical imaging device from the visualization of the patient anatomy. As another example, one technique for performing a vat lobectomy utilizes a single medical imaging apparatus, while another technique for performing a vat segmented excision utilizes multiple cameras. As another example, a technique for performing vat segmental resections utilizes an infrared light source (which may be communicatively coupled to a surgical hub as part of a visualization system) to visualize segmental slots that are not used in vat pulmonary resections. By tracking any or all of this data from the medical imaging device 5108, the surgical hub 5104 can thus determine the particular type of surgical procedure being performed and/or the technique for the particular type of surgical procedure.

Ninth 5218, the surgical team begins the anatomic steps of the procedure. The surgical hub 5104 can infer that the surgeon is in the process of dissecting to mobilize the patient's lungs because it receives data from the RF generator or ultrasound generator indicating that the energy instrument is being fired. The surgical hub 5104 can cross-reference the received data with a retrieval step of the surgical procedure to determine that the energy instrument fired at that point in the method (i.e., after completion of the previously discussed surgical step) corresponds to an anatomical step.

Tenth 5220, the surgical team proceeds to the ligation step of the procedure. The surgical hub 5104 can infer that the surgeon is ligating arteries and veins because it receives data from the surgical stapling and severing instrument indicating that the instrument is being fired. Similar to the previous steps, the surgical hub 5104 can derive the inference by cross-referencing the receipt of data from the surgical stapling and severing instrument with the retrieval steps in the method.

Eleventh 5222, a segmental resection portion of the procedure is performed. The surgical hub 5104 infers that the surgeon is transecting soft tissue based on data from the surgical instrument, including data from the staple cartridge. The cartridge data may correspond to the size or type of staples fired by the instrument. The cartridge data may indicate the type of tissue being stapled and/or transected for different types of staples employed in different types of tissue. The type of staples being fired is used for soft tissue or other tissue types to enable the surgical hub 5104 to infer that a segmental resection procedure is being performed.

Twelfth 5224, the node dissection step is performed. The surgical hub 5104 may infer that the surgical team is dissecting a node and performing a leak test based on data received from the generator indicating that an RF or ultrasonic instrument is being fired. For this particular procedure, the use of an RF or ultrasonic instrument after transecting the soft tissue corresponds to a node dissection step, which allows the surgical hub 5104 to make this inference. It should be noted that the surgeon switches back and forth between surgical stapling/cutting instruments and surgical energy (i.e., RF or ultrasonic) instruments periodically, depending on the particular step in the procedure, as the different instruments are better suited for the particular task. Thus, the particular sequence in which the stapling/severing instrument and the surgical energy instrument are used may dictate the steps of the procedure that the surgeon is performing. At the completion of the twelfth step 5224, the incision is closed and the post-operative portion of the procedure begins.

Thirteenth 5226, the patient is reversed from anesthesia. For example, the surgical hub 5104 may infer that the patient is waking from anesthesia based on ventilator data (i.e., the patient's respiration rate begins to increase).

Finally, fourteenth 5228, the medical personnel remove various patient monitoring devices 5124 from the patient. Thus, when the surgical hub 5104 loses EKG, BP and other data from the patient monitoring device 5124, the hub can infer that the patient is being transferred to the recovery room. The surgical hub 5104 can determine or infer when each step of a given surgical procedure occurs from data received from various data sources 5126 communicatively coupled to the surgical hub 5104.

In addition to using patient data from the EMR database to infer the type of surgical procedure to be performed, the situational awareness surgical hub 5104 may also use patient data to generate control adjustments for the paired modular device 5102, as shown in a first step 5202 of the timeline 5200 shown in fig. 11.

The present disclosure describes methods and systems for tracking tissue, identifying marked regions of interest, and generating virtual elements indicative of the regions of interest in an augmented reality environment.

Registration of physical space parameters

In various aspects, fiducial markers may be used to virtually or physically mark the patient to aid the surgeon in performing the procedure. Surgery may require the patient to undergo a pre-operative fiducial marking procedure.

Fig. 12 shows an example of a structured surface 18000 including a plurality of fiducial markers. A plurality of points 18010a-d are identified and marked onto the structured surface 18000. A computing system, such as remote server 63 (fig. 5) or surgical hub 56 (fig. 6), evaluates the structure surface and assigns fiducial markers 18010a-d based on a Target Registration Error (TRE) model 18008. The TRE model uses the sample dataset to estimate the placement of fiducial markers 18010a-d. 18002 shows an initial view of the structural surface 18000. 18004 shows a TRE model representation of the structural surface 18000. The transformation 18006 illustrates the final placement of the fiducial markers 18010a-d of the structural surface 18000.

Fig. 13 shows a process 18020 for surface matching an external structure of a patient with fiducial markers. A computing system, such as remote server 63 (fig. 5) or surgical hub 56 (fig. 6) system, generates 18022 an initial mapping of the surface based on the digital representation of the surface. The system uses facial recognition features such as eyes and nose bridge to identify 18024 a plurality of anatomical landmarks 18028 to map distances between surfaces and points. Based on the determined distance between anatomical landmarks 18028, the system generates 18026 fiducial markers 18030.

Fig. 14 shows a process 18040 for surface matching the internal structure 18044 of a patient with fiducial markers 18042. The internal structure is displayed on an output display 18046 that allows the technician to mark the area of the internal structure 1804 with a stylus 18048. Fiducial marker 18042 may correspond to a path or location of the surgical procedure.

Fig. 15-17 illustrate an external surgical alignment instrument for assisting a surgeon in performing a surgical procedure. Fig. 15 shows a stereotactic frame 18060, fig. 16 shows a star-shaped fixed platform 18080, and fig. 17 shows a micro-stage 18100. The surgical hub 56 (fig. 6) may record and sort the size of the external surgical auxiliary device and assign fiducial markers to multiple points on the surgical auxiliary device. The surgical hub 56 may then align the fiducial markers of the external surgical alignment instrument with the surface markers on the patient.

In various aspects, the surgical hub 56 (fig. 6) is configured to track the position and location of the surgical instruments 12 (fig. 1, 2), 21 (fig. 5, 6) in the operating room 16 (fig. 2). The surgical instrument 12, 21 may include a plurality of fiducial markers strategically placed on the housing of the instrument 12, 21 to communicate specific parameters of the instrument 12, 21. The fiducial markers may be used by an active tracking system in combination with an Infrared (IR) light source. Additionally, the surgical instrument 12, 21 may include a sensor that indicates when the surgical instrument 12, 21 is in use and when the surgical instrument 12, 21 is within the patient. In one aspect, the trocar may include one or more internal patient sensors that indicate when the device is inserted into a body cavity. Once the trocar determines that the surgical instrument 12, 21 is within the body cavity of the patient, the trocar may automatically or manually detect and track the position of the other surgical instrument 12, 21. The trocar may include an internal camera system that identifies fiducial markers on the other surgical instrument 12, 21. The internal camera system may receive commands to position the end effector and mark the end effector with a marker relative to the tip of the trocar. The marker provides a registration point that may be used to monitor the tip of the end effector throughout the surgical procedure and may be associated with a virtual element presented on the AR display 89 of the AR device 66 (fig. 10). In cases where the tip of the end effector may be out of view of the internal camera system, the virtual element may continuously display the tracked position of the end effector tip based on the markers.

Prior to surgery, all surgical instruments 12 (fig. 1, 2), 21 (fig. 5, 6) are classified according to a number of parameters including mass, size, length, shape, associated surgery, hand position for surgery, etc. Fig. 18 shows a flow chart for identifying an object based on a plurality of registration parameters. In various aspects, the surgical hub detects physical characteristics of a camera-receiving object from one or more objects in an operating room. The camera provides 18122 raw imaging data of the object. The surgical hub performs 18124 image processing to remove image backface or blur and perform edge detection. Once the surgical hub performs image processing, the surgical hub compares 18126 the detected object to the catalog of objects. The surgical hub examines 18128 the attributes of each object and determines 18130 the object that most closely meets the identified image parameters.

FIG. 19 illustrates a flow chart 18140 for classifying an unknown surgical instrument based on partial information of known and unknown parameters. The object recognition system may be implemented by the remote server 63 (fig. 5) or the surgical hub 56 (fig. 6). The object recognition system may not be able to positively determine the object, but may narrow it down to multiple candidates. The system inputs 18142 part of the object information and evaluates the object using known parameters. If the system determines the physical characteristics of the object, it may perform 18144 a geometric uncertainty analysis. If the system determines the geometric characteristics of the object, the system may perform 18146 a physical uncertainty analysis 18146. However, if the system does not have sufficient information, the system may need manual identification and categorize the object as unknown 18148.

In various aspects, the surgical hub receives spatial and physical parameters associated with an operating room or external environment. The physical parameters may be registered with a particular room or environment. In various aspects, the external environment may be classified according to certain characteristics, such as a sterile or non-sterile environment; a preoperative, operating or post-operative room; and specific equipment within the room (e.g., MRI, CT scanner).

A trocar including an outside diameter mounted camera system keeps the port of the instrument clear and increases the field of view

The present disclosure also describes a camera system integrated into a trocar. The camera system allows for a wide field of view of the internal surgical site and 3D mapping of fiducial markers during laparoscopic surgery. Upon entering the patient, the camera system is configured to be deployable from a recessed position at the distal end of the trocar. In various aspects, the internal camera system is configured to maintain the trocar port clear to the surgical instrument and provide the surgical staff with an increased view of the surgical environment.

Fig. 20 shows a trocar 18160 including an internal camera system 18166. The internal camera system 18166 includes a plurality of cameras 18166a-n connected together using resilient members 18168. The resilient connector 18168 allows the camera system 18166 to be folded together and assembled through a passageway defined in the center of the trocar. In various aspects, the camera system 18166 emits light in the non-visible spectrum, allowing the cameras 18166a-n to detect various types of fiducial markers (e.g., IR fiducial markers). When the internal camera system 18166 is deployed at 18160a, the camera system 18166 is attached to the outer diameter 18170 of the distal end 18162 of the trocar 18160. The internal camera system 18166 is in the retracted position 18160b when the trocar is inserted into and removed from the body cavity of the patient. In the retracted position 18160b, the camera system 18166 is recessed and attached to the inner diameter 18172 of the distal end 18162 of the trocar 18160.

Referring to fig. 20 and 21, fig. 21 illustrates a reusable installation tool 18176 configured to be inserted into the proximal end 18164 of the trocar 18160, deploying and retracting the camera system 18166 about the outer diameter 18170 of the trocar 18160. The camera system 18166 is communicatively coupled to the surgical hub 56 (fig. 6) via a wired or wireless connection. In a wireless configuration, each camera 18166a-n may have its own power source (e.g., a rechargeable battery), and the camera system 18166 may have a single external power source connected to each camera 18166a-n by an elastically deformable wired connection. In a wired configuration, a wired connection may be inserted into the trocar 18160 from the outside at the same time as the trocar 18160 is inserted, thereby maintaining the inside diameter of the trocar 18160 clear to the surgical instrument. The camera system 18160 may be attached to the outer diameter of the trocar 18160 by compression and friction of an elastic connector (a magnet in the case of a metal trocar) or a separate connector on the outer diameter of the trocar 18160.

Fig. 21 also shows a profile 18178a of the mounting plunger 18174a in a fully depressed position. The tapered distal end 18158 of the trocar 18160 releases the camera system 18166. Plunger 18174b is pulled in a proximal direction, which causes tapered distal end 18158 to push the camera system along outer diameter 18170 of trocar 18160. As the plunger 18174c continues to retract in the proximal direction, the camera system 18166 is attached to the outer diameter 18170 of the trocar 18160. The reusable installation tool 18176 is removed so that laparoscopic surgery can begin.

Fiducial marker-based pre-operative computed tomography with real-time 3D model update for improved sub-process tracking Photographic (CT) scanning

The present disclosure also describes a system configured to generate a 3D model for a surgeon to navigate through internal tissue structures of a patient. The system identifies and marks target tissue or structures of interest in a pre-operative CT scan. The system generates an initial 3D model based on CT scans that the surgeon uses to help them navigate the internal structure. The 3D model may be continuously updated in real-time based on additional data points received during surgery. In one aspect, the system can determine the proximity of the distance to the surgical instrument and update the model to reflect the tissue movement or change in tissue position.

In various aspects, the system generates a 3D rendering of the internal organizational structure with virtual elements and displays the 3D model on an augmented reality display. The system may generate a real-time feed of the surgical environment or provide virtual elements superimposed on a real-world real-time feed of the surgical site. In various aspects, the 3D model indicates a region of interest, a region to avoid. Additionally, the markers may indicate tissue that needs to be sealed or difficult to find tissue, such as pulmonary veins and pulmonary arteries.

Fig. 22 shows a plurality of fiducial markers 18180 marked to the region of interest in a pre-operative CT scan. Fiducial markers may be placed to create a centroid at critical structure 18182. The centroid value is determined based on the relative distance between each fiducial marker in the set.

Fig. 23 illustrates a laparoscopic surgical procedure utilizing a plurality of fiducial markers to assist a surgeon in locating a surgical site. The preoperative determination of critical structures 18184 is typically a close approximation of the structure location, but may not be an accurate location. In various aspects, an internal camera may be used in conjunction with the fiducial markers to provide real-time updated locations of the critical structures 18186 with updated models or updated fiducial markers. In various aspects, fiducial markers are located on the surgical instrument 18190 and help provide updated positions 18186 based on relationships between other points. The surgical instrument may also include an integrated mapping sensor 18188.

Tracking tissue movement and position using physical markers in laparoscopic surgery

The present disclosure also describes various methods and systems for marking and tracking tissue movement using physical markers. The tracking system includes a camera system configured to be able to detect and track physical markers. In various aspects, the physical indicia includes magnetic ink, visible ink in the visible spectrum, invisible ink in the invisible spectrum, or other ink that is detectable by the camera system.

Fig. 24 shows the physical markers applied by injecting indocyanine dye 18202 into the vascular system of a patient. The dye 18202 is illuminated by a light source 18204 that allows the camera 18206 to capture and record vascular structures of the tissue 18210. In one aspect, the light source 18204 can be a fluorescent light source. The camera system 18206 may use various light frequencies or lasers to visualize the dye 18202. The camera system 18206 is further configured to identify various overlapping paths of ink and display the 3D rendering on the output display 18208. In various aspects, the vasculature may be used like a fingerprint to uniquely identify a structure and track the structure as it moves. Additionally, preoperative CT imaging may be used to assist the system in generating a 3D map of the structure. Dyes can also be used to track organs and alert the operator when he is about to grasp highly vascularized tissue. Fig. 25 also shows an exemplary tissue that is injected with a dye and irradiated to show the vasculature.

In various aspects, the light source 18204 can emit light at wavelengths outside the visible spectrum, such as IR. Additionally, the dye 18202 may include magnetic ink as a marker to distinguish regions of interest within and outside of the field of view of the camera 18206. In one aspect, the dye 18202 may be sprayed into the surgical field in a splash of the invisible spectrum so that the body can easily absorb the dye 18202. The splash generation allows the camera 18206 to easily track the unique pattern of the position and movement of the tissue 18210.

Tracking of intraoperative non-stationary physical markers for measuring anatomical or surgical events

The present disclosure also describes a system configured to be able to track tissue or anatomical structures without physically fixing anatomical markers. Physical markers are commonly used to track tissue or anatomical structures, but there are circumstances that prevent the use of this method, such as recently sealed tissue. The system uses temperature and impedance to track tissue with non-stationary markers.

Fig. 26 illustrates a system 18300 configured to monitor changes in pressure or fluid in a body cavity based on impedance measurements of the probe 18302. The probe 18302 is coupled to the surgical instrument 18304 and measures impedance values based on pressure generated by fluids and/or gases in the body cavity 18306. The surgical hub 56 (fig. 6) may be coupled to the surgical instrument 18304 and configured to determine whether a pressure change exists in the body cavity 18306. The pressure change indicates that a leak is present in body lumen 18306. The probe 18302 is configured to maintain a fixed gap to measure pressure changes at the potential leak location 18308.

In addition, surgical hub 56 (fig. 6) may notify the surgical staff of the detected leak by generating an alert via the AR content. In one aspect, the virtual element may be presented on an AR display 89 of AR device 66 (fig. 10) anchored to the location of the detected event. The virtual element may be identified using a contrasting color that is solid, sparkling, or translucent. The virtual element may be accompanied by a text alert identifying the event type and/or the event severity.

Fig. 27 illustrates an Infrared (IR) thermal detection system 18310 including an IR camera system 18312 configured to direct IR light 18314 onto a treatment region of tissue 18316 and to identify temperature differences in a surgical environment 18304. In one aspect, the IR camera system 18312 may be configured to be able to identify the location of the leak in the pressurized cavity from temperature changes of the air surrounding the leak. The body cavity is pressurized with air that is cooler or hotter than the fluid in the peritoneal cavity. The IR camera system 18312 will observe the leak by looking at the gas at a temperature that is hotter or colder than the cavity. In response to the leak detection, the surgical hub 56 may issue a notification to the surgical personnel.

In one aspect, the IR camera system 18312 may determine that the tissue region was recently sealed. The sealed tissue may be at different temperatures and allow the IR camera system 18312 to differentiate the sealed tissue into sensitive treatment areas. The surgical hub 56 (fig. 6) may present a virtual element superimposed on top of the treatment area to indicate to the surgeon that the sealing tissue was most recently treated and is a sensitive area.

The sealed tissue is identified based on a predetermined tissue temperature threshold at which the tissue is sealed. The tissue temperature may slowly cool, however, the IR camera system 18312 may mark the area with a non-stationary mark that is maintained even after the tissue temperature drops below the initial threshold temperature.

Motion tracking system configured to control and adjust a surgical instrument to prevent excessive tension on tissue

The present disclosure also describes a tissue tracking system for preventing undue tension from being placed on tissue. The system is configured to track markers indicative of motion, force, and tension applied to tissue at a particular location. Surgical hub 56 (fig. 6) may continuously monitor tissue tension and movement parameters. The surgical hub 56 may determine that the tissue tension at a particular location has reached a predetermined threshold and provide a notification to one or more AR devices 66 (fig. 10).

Fig. 28 illustrates a surgical procedure 18350 employing three end effectors 18352, 18354, 18356 configured to grasp and transect tissue 18360. Tissue 18360 is initially grasped at two points by first end effector 18352 and second end effector 18356. The AR device 66 (fig. 10) may indicate the initial position in which the end effectors 18352, 18356 should be located. The initial distance 18358 between the first end effector 18352 and the second end effector 18356 is determined based on the force applied to the tissue 18360. The second end effector 18356 is configured to transect the tissue 18360 and a third end effector 18354 is required to compensate for the increase in tissue tension.

Fig. 29 shows third end effector 18354 slid along tissue from first position 18354a to second position 18354 b. The surgical staff monitors the position of the third end effector 18354 so that it is properly positioned to compensate for the increase in tension. In various aspects, the AR device 66 (fig. 10) may highlight tissue 18360 when the tension of the tissue exceeds a predetermined tension threshold. The surgeon may reposition the third end effector 18354 such that the tissue 18360 is no longer highlighted and indicates that the tissue tension is back within a predetermined threshold. In various aspects, the surgeon may receive feedback in the handle or joystick to indicate when repositioning is needed and when the new position is satisfactory.

Fig. 30 shows a third end effector 18354 positioned adjacent to the second end effector 18356. Upon transection of tissue 18360 by the second end effector, the tissue tension will be within a predetermined threshold based on the initial distance 18358 (fig. 28).

Fig. 31 illustrates a surgical procedure 18370 employing three static clamps 18372, 18274, 18378 and a dynamic clamp 18376 configured to transfer tissue between the static clamps 18372, 18274, 18378. The first clamp 18372 is a static clamp configured to hold the end of the tissue 18386 and prevent tensioning or pulling beyond the region of interest 18382. The second clamp 18374 and the third clamp 18378 are positioned according to a predetermined distance such that the tissue maintains a predetermined tension. The second clamp 18374 and third clamp 18378 are static but can open and close to pull new tissue 18386 between the fixed distances 18380. Fourth clamp 18376 is a dynamic clamp and is configured to pull tissue 18386 between second clamp 18374 and third clamp 18378 and reduce tension between first clamp 18372 and second clamp 18374. Fourth clamp 18376 repositions tissue 18386 to reduce excess tension at 18384, as indicated by the graphical highlighting. The AR device 66 (fig. 10) may provide a similar highlighting to indicate excessive tissue tension.

Fig. 32 shows a logic flow diagram of a method 18400 for displaying a surgical site within a patient. According to the method 18400, the surgical hub 56 (fig. 6) receives 18402 video feeds from one or more cameras located within the patient. The surgical hub 56 identifies 18404 one or more physical markers within the patient. The surgical hub 56 determines 18406 a target location based on the relationship to the one or more physical markers. The surgical hub 56 generates 18408 a virtual element corresponding to the target location. An AR device 66 (fig. 10) coupled to the surgical hub 56 (fig. 6) displays 18410 virtual elements superimposed on the video feed on an Augmented Reality (AR) display 79 (fig. 10).

In one aspect of the method 18400, the video feed is a wide-angle view stitched together from at least two video feeds. In another aspect, according to method 18400, one or more physical markers are visible under illumination from a light source outside the visible spectrum. In another aspect of the method 18400, the one or more physical markers are fiducial markers assigned in a pre-operative Computed Tomography (CT) scan. In yet another aspect of the method 18400, the target location is continuously updated in real-time on the Augmented Reality (AR) device 66 (fig. 10).

Various additional aspects of the subject matter described herein are set forth in the following numbered embodiments:

example 1: a surgical system comprising a surgical device, the surgical device comprising: an axial passageway defining an outer diameter and an inner diameter; a proximal end; a distal end configured to penetrate tissue; a camera array comprising individual cameras connected in a ring configuration with elastic connections; a removable mounting trigger configured to extend the camera array from a first recessed position to a second deployed position of the inner diameter of the distal end of the axial passageway, wherein the camera array is positioned circumferentially about the outer diameter of the distal end of the axial passageway; augmented Reality (AR) devices; and a surgical hub communicatively coupled to the camera array and the AR device, wherein the surgical hub comprises control circuitry coupled to a memory, and wherein the control circuitry is configured to: receiving a plurality of video feeds from the camera array; identifying physical marks on the video feed; and displaying the physical marker on the AR display.

Example 2: the surgical system of embodiment 1, wherein the video feed is a wide angle view stitched together from each of the respective cameras.

Example 3: the surgical system of any of embodiments 1-2, wherein the physical marking is visible under illumination from a light source outside of the visible spectrum.

Example 4: the surgical system of any of embodiments 1-3, wherein the physical marker is a dye.

Example 5: the surgical system of any of embodiments 1-4, wherein the physical marker is a fiducial marker assigned in a pre-operative Computed Tomography (CT) scan.

Example 6: the surgical system of any one of embodiments 1-5, wherein the physical marker is configured to indicate a target location of a surgical procedure.

Example 7: the surgical system of embodiment 6, wherein the target location is continuously updated on the AR device in real-time.

Example 8: the surgical system of embodiment 7, wherein the target location is updated based on a relationship of the surgical instrument and the physical marker.

Example 9: a surgical device, the surgical device comprising: a camera array comprising individual cameras connected in a ring configuration with resilient connections, wherein the camera array is communicably coupleable to a surgical hub; an elongate penetrating member having a proximal end and a distal end, wherein the distal end further comprises a tissue penetrating tip; an axial passageway passing through the elongate penetrating member and the tissue penetrating tip, and wherein an inner diameter of the axial passageway is sized to accommodate the camera array in a first recessed position; and a removable mounting trigger configured to enable the camera array to extend from a first recessed position to a second deployed position of the inner diameter of the distal end of the elongate penetrating member, wherein the camera array is positioned circumferentially about an outer diameter of the distal end of the elongate penetrating member.

Example 10: the surgical device of embodiment 9, wherein the camera array is communicably coupled with the surgical hub via a wireless communication protocol.

Example 11: the surgical device of embodiment 10, wherein the camera array is powered by a rechargeable battery.

Example 12: the surgical device of any one of embodiments 9-11, wherein the camera array is communicably coupled to the surgical hub via a wired communication protocol.

Example 13: the surgical device of embodiment 12, wherein the camera array is powered by a wired external power source comprising a wire extending along the outer diameter of the elongate penetrating member.

Example 14: the surgical device of any one of embodiments 9-13, wherein the camera array is attached to the outer diameter of the distal end of the elongate penetrating member in a squeeze and friction configuration.

Example 15: the surgical device of any of embodiments 9-14, wherein in the second deployed position, the camera array does not occupy space of the inner diameter of the axial passageway.

Example 16: a method for displaying a surgical site within a patient, the method comprising: receiving, by a surgical hub, a video feed from a camera located within a patient; identifying, by the surgical hub, a physical marker within the patient; determining, by the surgical hub, a target location based on the relationship with the physical marker; generating, by the surgical hub, a virtual element corresponding to the target location; and displaying, by an Augmented Reality (AR) device coupled to the surgical hub, the virtual element superimposed on the video feed on an AR display.

Example 17: the method of embodiment 16, wherein the video feed is a wide angle view stitched together from at least two video feeds.

Example 18: the method of any one of embodiments 16 to 17, wherein the physical mark is visible under illumination from a light source outside the visible spectrum.

Example 19: the method of any one of embodiments 16 to 18, wherein the physical marker is a fiducial marker assigned in a pre-operative Computed Tomography (CT) scan.

Example 20: the method of any of embodiments 16-19, wherein the target location is continuously updated in real-time on an Augmented Reality (AR) device.

While various forms have been illustrated and described, it is not the intention of the applicant to restrict or limit the scope of the appended claims to such detail. Many modifications, variations, changes, substitutions, combinations, and equivalents of these forms may be made by one skilled in the art without departing from the scope of the disclosure. Furthermore, the structure of each element associated with the described form may alternatively be described as a means for providing the function performed by the element. In addition, where materials for certain components are disclosed, other materials may be used. It is, therefore, to be understood that the foregoing detailed description and the appended claims are intended to cover all such modifications, combinations, and variations as fall within the scope of the disclosed forms of the invention. The appended claims are intended to cover all such modifications, variations, changes, substitutions, modifications and equivalents.

The foregoing detailed description has set forth various forms of the apparatus and/or methods via the use of block diagrams, flowcharts, and/or examples. Insofar as such block diagrams, flowcharts, and/or examples contain one or more functions and/or operations, it will be understood by those within the art that each function and/or operation within such block diagrams, flowcharts, or examples can be implemented, individually and/or collectively, by a wide range of hardware, software, firmware, or virtually any combination thereof. Those skilled in the art will recognize that some aspects of the forms disclosed herein may be equivalently implemented in integrated circuits, as one or more computer programs running on one or more computers (e.g., as one or more programs running on one or more computer systems), as one or more programs running on one or more processors (e.g., as one or more programs running on one or more microprocessors), as firmware, or as virtually any combination thereof, and that designing the circuitry and/or writing the code for the software and/or hardware would be well within the skill of one of skill in the art in light of this disclosure. In addition, those skilled in the art will appreciate that the mechanisms of the subject matter described herein are capable of being distributed as a program product or products in a variety of forms, and that an illustrative form of the subject matter described herein applies regardless of the particular type of signal bearing media used to actually carry out the distribution.

Instructions for programming logic to perform the various disclosed aspects can be stored within a memory in a system, such as Dynamic Random Access Memory (DRAM), cache, flash memory, or other memory. Furthermore, the instructions may be distributed via a network or by 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 diskettes, optical disks, compact disk read-only memories (CD-ROMs), and magneto-optical disks, read-only memories (ROMs), random Access Memories (RAMs), erasable programmable read-only memories (EPROMs), electrically erasable programmable read-only memories (EEPROMs), magnetic or optical cards, flash memory, or a tangible, machine-readable storage device for use in transmitting information over the internet via electrical, optical, acoustic, or other form of propagated signals (e.g., carrier waves, infrared signals, digital signals, etc.). Thus, a non-transitory computer-readable medium includes any type of tangible machine-readable medium suitable for storing or transmitting electronic instructions or information in a form readable by a machine (e.g., a computer).

As used in any aspect herein, the term "control circuitry" may refer to, for example, hardwired circuitry, programmable circuitry (e.g., a computer processor including one or more separate instruction processing cores, processing units, processors, microcontrollers, microcontroller units, controllers, digital Signal Processors (DSPs), programmable Logic Devices (PLDs), programmable Logic Arrays (PLAs), field Programmable Gate Arrays (FPGAs)), state machine circuitry, firmware storing instructions executed by the programmable circuitry, and any combination thereof. The control circuitry may be implemented collectively or individually as circuitry forming part of a larger system, such as an Integrated Circuit (IC), an Application Specific Integrated Circuit (ASIC), a system-on-a-chip (SoC), a desktop computer, a laptop computer, a tablet computer, a server, a smart phone, or the like. Thus, as used herein, "control circuitry" includes, but is not limited to, electronic circuitry having at least one discrete circuit, electronic circuitry having at least one integrated circuit, electronic circuitry having at least one application specific integrated circuit, electronic circuitry forming 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 implements the methods and/or apparatus described herein, or a microprocessor configured by a computer program that at least partially implements the methods and/or apparatus described herein), electronic circuitry forming a memory device (e.g., forming a random access memory), and/or electronic circuitry forming a communication device (e.g., a modem, communication switch, or optoelectronic device). Those skilled in the art will recognize that the subject matter described herein may be implemented in analog or digital fashion, or some combination thereof.

As used in any aspect herein, the term "logic" may refer to an application, software, firmware, and/or circuitry configured to be capable of performing any of the foregoing operations. The software may be embodied as software packages, code, instructions, instruction sets, and/or data recorded on a non-transitory computer readable storage medium. The firmware may be embodied as code, instructions or a set of instructions and/or data that are hard-coded (e.g., non-volatile) in a memory device.

As used in any aspect herein, the terms "component," "system," "module," and the like can refer to a control circuit, a computer-related entity, hardware, a combination of hardware and software, or software in execution.

As used in any aspect herein, an "algorithm" refers to an organized sequence of steps leading to a desired result, wherein "step" refers to the manipulation of physical quantities and/or logical states, which may, but need not, take the form of electrical or magnetic signals capable of being stored, transferred, combined, compared, and otherwise manipulated. Are often used to refer to signals such as bits, values, elements, symbols, characters, terms, numbers, or the like. These and similar terms may be associated with the appropriate physical quantities and are merely convenient labels applied to these quantities and/or conditions.

The network may comprise a packet switched network. The communication devices may be capable of communicating with each other using the selected packet switched network communication protocol. One exemplary communication protocol may include an ethernet communication protocol that may be capable of allowing communication using transmission control protocol/internet protocol (TCP/IP). The ethernet protocol may conform to or be compatible with the ethernet Standard titled "IEEE 802.3Standard" published by the Institute of Electrical and Electronics Engineers (IEEE) at month 12 of 2008 and/or a higher version of the Standard. Alternatively or additionally, the communication devices may be capable of communicating with each other using an x.25 communication protocol. The x.25 communication protocol may conform to or be compatible with standards promulgated by the international telecommunications union telecommunication standardization sector (ITU-T). Alternatively or additionally, the communication devices may be capable of communicating with each other using a frame relay communication protocol. The frame relay communication protocol may conform to or be compatible with standards promulgated by the international telegraph and telephone Consultation Committee (CCITT) and/or the American National Standards Institute (ANSI). Alternatively or additionally, the transceivers may be capable of communicating with each other using an Asynchronous Transfer Mode (ATM) communication protocol. The ATM communication protocol may conform to or be compatible with the ATM standard promulgated by the ATM forum at month 8 of 2001 under the name "ATM-MPLS Network Interworking 2.0" and/or a higher version of the standard. Of course, different and/or later developed connection oriented network communication protocols are likewise contemplated herein.

Unless specifically stated otherwise as apparent from the above disclosure, it is appreciated that throughout the above disclosure, discussions utilizing terms such as "processing," "computing," "calculating," "determining," "displaying" or the like, refer to the action and processes of a computer system, or similar electronic computing device, that manipulates and transforms data represented as physical (electronic) quantities within the computer system's registers and memories into other data similarly represented as physical quantities within the computer system memories or registers or other such information storage, transmission or display devices.

One or more components may be referred to herein as "configured to be capable of", "configurable to", "operable/operative", "adapted/adaptable", "capable of", "conformable/conforming to", and the like. Those skilled in the art will recognize that "configured to be capable of" may generally encompass active and/or inactive and/or standby components unless the context indicates otherwise.

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

Those skilled in the art will recognize that, in general, terms used herein, and particularly in the appended claims (e.g., bodies of the appended claims) are generally intended to be "open" terms (e.g., the term "including" should be construed as "including but not limited to," the term "having" should be construed as "having at least," the term "comprising" should be construed as "including but not limited to," etc.). It will be further understood by those with skill in the art that if a specific number of an introduced claim recitation is intended, such an intent will be explicitly recited in the claim, and in the absence of such recitation no such intent is present. For example, as an aid to understanding, the following appended claims may contain usage of the introductory phrases "at least one" and "one or more" to introduce claim(s). However, the use of such phrases should not be construed to imply that the introduction of a claim recitation by the indefinite articles "a" or "an" limits any particular claim containing such introduced claim recitation to claims containing only one such recitation, even when the same claim includes the introductory phrases "one or more" or "at least one" and indefinite articles such as "a" or "an" (e.g., "a" and/or "an" should typically be interpreted to mean "at least one" or "one or more"); the same holds true for the use of definite articles used to introduce claim recitations.

In addition, even if a specific number of an introduced claim recitation is explicitly recited, those skilled in the art will recognize that such recitation should typically be interpreted to mean at least the recited number (e.g., the bare recitation of "two recitations," without other modifiers, typically means at least two recitations, or two or more recitations). Moreover, in those instances where a convention analogous to "at least one of A, B and C, etc." is used, in general such a construction is intended in the sense one having skill in the art would understand the convention (e.g., "a system having at least one of A, B and C" would include but not be limited to systems having only a, only B, only C, A and B together, a and C together, B and C together, and/or A, B and C together, etc.). In those instances where a convention analogous to "A, B or at least one of C, etc." is used, in general such a construction is intended in the sense one having skill in the art would understand the convention (e.g., "a system having at least one of A, B or C" shall include but not be limited to systems having only a, only B, only C, A and B together, a and C together, B and C together, and/or A, B and C together, etc.). It will be further understood by those within the art that, in general, unless the context indicates otherwise, disjunctive words and/or phrases presenting two or more alternative terms in the detailed description, claims, or drawings should be understood to encompass the possibility of including one of the terms, either of the terms, or both. For example, the phrase "a or B" will generally be understood to include the possibility of "a" or "B" or "a and B".

For the purposes of the appended claims, those skilled in the art will understand that the operations recited therein can generally be performed in any order. Additionally, while various operational flow diagrams are set forth in one or more sequences, it should be understood that various operations may be performed in other sequences than the illustrated sequences, or may be performed concurrently. Examples of such alternative ordering may include overlapping, staggered, interrupted, reordered, incremental, preparatory, supplemental, simultaneous, reverse, or other altered ordering unless the context dictates otherwise. Moreover, unless the context dictates otherwise, terms such as "responsive to," "related to," or other past-type adjectives are generally not intended to exclude such variants.

It is worth mentioning that any reference to "an aspect", "an example" means that a particular feature, structure or characteristic described in connection with the aspect is included in at least one aspect. Thus, the appearances of the phrases "in one aspect," "in an example," and "in an example" in various places throughout this specification are not necessarily all referring to the same aspect. Furthermore, the particular features, structures, or characteristics may be combined in any suitable manner in one or more aspects.

Any patent application, patent, non-patent publication, or other disclosure material referred to in this specification and/or listed in any application data sheet is incorporated herein by reference, as if the incorporated material was not inconsistent herewith. Accordingly, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.

In summary, many of the benefits resulting from employing the concepts described herein have been described. The foregoing detailed description of one or more forms has been presented for purposes of illustration and description. It is not intended to be exhaustive or to limit the invention to the precise form disclosed. Modifications or variations of the present invention are possible in light of the above teachings. One or more of the forms selected and described are chosen to illustrate principles and practical application to thereby enable one of ordinary skill in the art to utilize various forms and various modifications as are suited to the particular use contemplated. The claims filed herewith are intended to define the full scope.

Claims (20)

1. A surgical system, comprising:

a surgical device, the surgical device comprising:

an axial passageway defining an outer diameter and an inner diameter;

a proximal end;

a distal end configured to penetrate tissue;

a camera array comprising individual cameras connected in a ring configuration with elastic connections;

a removable mounting trigger configured to extend the camera array from a first recessed position to a second deployed position of the inner diameter of the distal end of the axial passageway, wherein the camera array is positioned circumferentially about the outer diameter of the distal end of the axial passageway;

augmented Reality (AR) devices; and

a surgical hub communicatively coupled to the camera array and the AR device, wherein the surgical hub comprises control circuitry coupled to a memory, and wherein the control circuitry is configured to:

receiving a plurality of video feeds from the camera array;

identifying physical marks on the video feed; and

the physical marker is displayed on the AR display.

2. The surgical system of claim 1, wherein the video feed is a wide angle view stitched together from each of the respective cameras.

3. The surgical instrument of claim 1, wherein the physical mark is visible under illumination from a light source outside of the visible spectrum.

4. The surgical system of claim 1, wherein the physical marker is a dye.

5. The surgical system of claim 1, wherein the physical marker is a fiducial marker assigned in a pre-operative Computed Tomography (CT) scan.

6. The surgical system of claim 1, wherein the physical marker is configured to indicate a target location of a surgical procedure.

7. The surgical system of claim 6, wherein the target location is continuously updated in real-time on the AR device.

8. The surgical system of claim 7, wherein the target location is updated based on a relationship of a surgical instrument and the physical marker.

9. A surgical device, comprising:

a camera array comprising individual cameras connected in a ring configuration with resilient connections, wherein the camera array is communicably coupleable to a surgical hub;

An elongate penetrating member having a proximal end and a distal end, wherein the distal end further comprises a tissue penetrating tip;

an axial passageway passing through the elongate penetrating member and the tissue penetrating tip, and wherein an inner diameter of the axial passageway is sized to accommodate the camera array in a first recessed position; and

a removable mounting trigger configured to enable the camera array to extend from a first recessed position of the inner diameter of the distal end of the elongate penetrating member to a second deployed position, wherein the camera array is positioned circumferentially about an outer diameter of the distal end of the elongate penetrating member.

10. The surgical device of claim 9, wherein the camera array is communicably coupled with the surgical hub via a wireless communication protocol.

11. The surgical device of claim 10, wherein the camera array is powered by a rechargeable battery.

12. The surgical device of claim 9, wherein the camera array is communicably coupled to the surgical hub via a wired communication protocol.

13. The surgical device of claim 12, wherein the camera array is powered by a wired external power source comprising a wire extending along the outer diameter of the elongate penetrating member.

14. The surgical device of claim 9, wherein the camera array is attached to the outer diameter of the distal end of the elongate penetrating member in a squeeze and friction configuration.

15. The surgical device of claim 9, wherein in the second deployed position, the camera array does not occupy space of the inner diameter of the axial passage.

16. A method for displaying a surgical site within a patient, the method comprising:

receiving, by a surgical hub, a video feed from a camera located within a patient;

identifying, by the surgical hub, a physical marker within the patient;

determining, by the surgical hub, a target location based on the relationship with the physical marker;

generating, by the surgical hub, a virtual element corresponding to the target location; and

the virtual element superimposed on the video feed is displayed on an Augmented Reality (AR) display by an AR device coupled to the surgical hub.

17. The method of claim 16, wherein the video feed is a wide angle view stitched together from at least two video feeds.

18. The method of claim 16, wherein the physical mark is visible under illumination from a light source outside of the visible spectrum.

19. The method of claim 16, wherein the physical marker is a fiducial marker assigned in a pre-operative Computed Tomography (CT) scan.

20. The method of claim 16, wherein the target location is continuously updated in real-time on an Augmented Reality (AR) device.