JP2021508525A - Start of energy device - Google Patents

Abstract

Various systems and methods for controlling the activation of energy surgical instruments are disclosed. Advanced energy surgical instruments, such as electrosurgical instruments or ultrasonic surgical instruments, are one or more for detecting the condition or position of an end effector, arm, or other component of a surgical instrument. It can include a sensor assembly. The control circuit may be configured to control the activation of the surgical instrument according to the state or position of the components of the surgical instrument.

Description

(Cross-reference of related applications)
This application has priority over US Patent Non-Provisional Application No. 16 / 115,238, entitled "ACTIVATION OF ENERGY DEVICES," filed August 28, 2018, the entire disclosure of which is incorporated herein by reference. Claim profit.

This application is filed August 23, 2018, entitled "CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO TISSUE LOCATION", the entire disclosure of which is incorporated herein by reference under Article 119 (e) of the US Patent Act. Claims priority over US Provisional Patent Application No. 62 / 721,995.

This application is a U.S. provisional patent filed on August 23, 2018, entitled "SITUATIONAL AWARENESS OF ELECTROSURGICAL SYSTEMS", the entire disclosure of which is incorporated herein by reference under Article 119 (e) of the U.S. Patent Act. Claim priority over Application No. 62 / 721,998.

This application is filed on August 23, 2018, entitled "INTERRUPTION OF ENERGY DUE TO INADVERTENT CAPACTIVE COUPLING", the entire disclosure of which is incorporated herein by reference under Article 119 (e) of the US Patent Act. Claims priority over US Provisional Patent Application No. 62 / 721,999.

This application is entitled "BIPOLAR COMBINATION DEVICE THAT AUTOMATICALLY ADJUSTS PRESS PRESS ON ENERGY MODALITY", the entire disclosure of which is incorporated herein by reference under Article 119 (e) of the US Patent Act. Claims priority over US Provisional Patent Application No. 62 / 721,994 of the Japanese application.

This application is filed August 23, 2018, entitled "RADIO FREENCY ENERGY DEVICE FOR DELIVERING COMBINED ELECTRIC SIGNAL SIGNALS", the entire disclosure of which is incorporated herein by reference under Article 119 (e) of the US Patent Act. Claims priority over US Provisional Patent Application No. 62 / 721,996.

This application is further entitled "SMART ACTIVE OF AN ENERGY DEVICE BY ANOTHER DEVICE", which is incorporated herein by reference in its entirety under Article 119 (e) of the US Patent Act, June 30, 2018. US Provisional Patent Application No. 62 / 692,747 filed in Japan, US Provisional Patent Application No. 62 / 692,748, filed June 30, 2018, entitled "SMART ENERGY ARCHITECTURE", and "SMART ENERGY DEVICES" Claims priority over US Provisional Patent Application No. 62 / 692,768 filed June 30, 2018.

This application is further under Article 119 (e) of the United States Patent Act, entitled "TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM THE REFOR", the entire disclosure of which is incorporated herein by reference. U.S. Provisional Patent Application Nos. 62 / 640,417 of the Japanese filing, and U.S. Provisional Patent Application No. 62 / 640,415 of the March 8, 2018 application entitled "ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTOR SYSTEM THEREFOR" Claim the interests of priority.

This application is further under Article 119 (e) of the US Patent Act, entitled "CAPACITIIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS", the entire disclosure of which is incorporated herein by reference. US Provisional Patent Application No. 62 / 650,898 filed in Japan, US Provisional Patent Application No. 62 / 650,887 filed on March 30, 2018, entitled "SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES", "SMOKE EVACUATIONMO US Provisional Patent Application No. 62 / 650,882, filed March 30, 2018, entitled "INTERACTIVE SURGICAL PLATFORM", and US Provisional Patent, March 30, 2018, entitled "SURGICAL SMOKE EVACUATION SENSING AND CONTROLS" Claim the benefit of the priority of 62 / 650,877.

This application is also a US provisional patent filed on December 28, 2017, entitled "INTERACTIVE SURGICAL PLATFORM," in which the entire disclosure is incorporated herein by reference under Section 119 (e) of the US Patent Act. Application No. 62 / 611,341, U.S. Provisional Patent Application No. 62 / 611,340, filed December 28, 2017, entitled "CLOUD-BASED MEDICAL ANALYTICS", and December 2017, entitled "ROBOT ASSISTED SURGICAL PLATFORM". Claims the priority benefit of US Provisional Patent Application No. 62 / 611,339 filed on 28th May.

Surgical environments may require smart energy devices within a smart energy architecture environment.

In one general aspect, the surgical instrument comprises an ultrasonic blade, an arm that is pivotable with respect to the ultrasonic blade between open and closed positions, and a transducer assembly connected to the ultrasonic blade. Includes a sensor configured to sense the position of the arm between the open and closed positions, a transducer assembly and a control circuit connected to the sensor. The transducer assembly includes at least two piezoelectric elements configured to ultrasonically vibrate the ultrasonic blade. The control circuit is configured to activate the transducer assembly in response to the position of the arm relative to the threshold position detected by the sensor.

In another general aspect, the surgical instrument comprises an ultrasonic blade, an arm that is pivotable with respect to the ultrasonic blade between open and closed positions, and a transducer assembly connected to the ultrasonic blade. A first sensor configured to detect a first force when the arm transitions to the closed position and a second sensor configured to sense a second force when the arm transitions to the open position. Includes two sensors, a transducer assembly, a first sensor, and a control circuit connected to the second sensor. The transducer assembly includes at least two piezoelectric elements configured to ultrasonically vibrate the ultrasonic blade. The control circuit activates the transducer assembly in response to a first force on the first threshold sensed by the first sensor and a second force on the second threshold sensed by the second sensor. It is configured to let you.

In yet another general aspect, the surgical instrument comprises an ultrasonic blade, a transducer assembly connected to the ultrasonic blade, a sensor configured to sense force against it, and a transducer assembly and sensor. Includes a connected control circuit. The transducer assembly includes at least two piezoelectric elements configured to ultrasonically vibrate the ultrasonic blade. The control circuit is configured to activate the transducer assembly in response to a force with respect to the threshold force sensed by the sensor.

The features of the various aspects are described in detail within the appended claims. However, various aspects of both the mechanism and the method of operation, along with their further objectives and advantages, can be best understood by reference to the following description, in conjunction with the accompanying drawings below.
FIG. 6 is a block diagram of a computer-mounted interactive surgical system according to at least one aspect of the present disclosure. A surgical system used to perform a surgical procedure in an operating room according to at least one aspect of the present disclosure. A surgical hub paired with a visualization system, a robotic system, and an intelligent instrument according to at least one aspect of the present disclosure. FIG. 3 is a partial perspective view of a surgical hub housing and a generator module combo slidably acceptable within the drawer of the surgical hub housing according to at least one aspect of the present disclosure. FIG. 3 is a perspective view of a generation module combo with bipolar, ultrasonic, and unipolar contacts, and smoke exhaust components, according to at least one aspect of the present disclosure. Demonstrates the individual power bus attachments of a plurality of lateral docking ports of a laterally modular housing configured to accept a plurality of modules according to at least one aspect of the present disclosure. Demonstrates a vertically modular housing configured to accept multiple modules according to at least one aspect of the present disclosure. A modular device located in one or more operating rooms of a medical facility, or any room in a medical facility equipped with specialized equipment for surgical procedures, according to at least one aspect of the present disclosure. Shown is a surgical data network with a modular communication hub configured to connect. A computer-mounted interactive surgical system according to at least one aspect of the present disclosure is shown. Demonstrates a surgical hub with a plurality of modules connected to a modular control tower according to at least one aspect of the present disclosure. An aspect of a universal serial bus (USB) network hub device according to at least one aspect of the present disclosure is shown. A logic diagram of a control system for a surgical instrument or tool according to at least one aspect of the present disclosure is shown. Demonstrates a control circuit configured to control aspects of a surgical instrument or tool according to at least one aspect of the present disclosure. Demonstrates a combination logic circuit configured to control aspects of a surgical instrument or tool according to at least one aspect of the present disclosure. Demonstrates an order logic circuit configured to control aspects of a surgical instrument or tool according to at least one aspect of the present disclosure. FIG. 3 shows a block diagram of a surgical instrument programmed to control the distal translation of a displacement member according to at least one aspect of the present disclosure. It is a circuit diagram of a surgical instrument configured to control various functions according to at least one aspect of the present disclosure. A system configured to perform an adaptive ultrasonic blade control algorithm within a surgical data network with a modular communication hub according to at least one aspect of the present disclosure. An embodiment of a generator according to at least one aspect of the present disclosure is shown. A surgical system comprising a generator and various surgical instruments that can be used with the generator according to at least one aspect of the present disclosure. An end effector according to at least one aspect of the present disclosure. FIG. 2 is a diagram of the surgical system of FIG. 20 according to at least one aspect of the present disclosure. It is a model showing an operating branch current according to at least one aspect of the present disclosure. It is a structural diagram of the architecture of the generator according to at least one aspect of the present disclosure. It is a functional diagram of the architecture of the generator according to at least one aspect of the present disclosure. It is a functional diagram of the architecture of the generator according to at least one aspect of the present disclosure. It is a functional diagram of the architecture of the generator according to at least one aspect of the present disclosure. It is a structural and functional aspect of the generator according to at least one aspect of the present disclosure. It is a structural and functional aspect of the generator according to at least one aspect of the present disclosure. It is a circuit diagram of one aspect of an ultrasonic drive circuit. It is a circuit diagram of the control circuit according to at least one aspect of this disclosure. Shown is a simplified block schematic illustrating another electrical circuit housed within a modular ultrasonic surgical instrument according to at least one aspect of the present disclosure. A generator circuit divided into a plurality of stages according to at least one aspect of the present disclosure is shown. Shown is a generator circuit divided into a plurality of stages in which the first stage circuit is common to the second stage circuit according to at least one aspect of the present disclosure. It is a circuit diagram of one aspect of a drive circuit configured to drive a radio frequency current (RF) according to at least one aspect of the present disclosure. For surgical instruments, we show a control circuit that allows a dual generator system to switch between RF generator energy modality and ultrasonic generator energy modality. FIG. 5 shows a diagram of one aspect of a surgical instrument comprising a feedback system for use with the surgical instrument according to one aspect of the present disclosure. The basics of a digital compositing circuit, such as a direct digital compositing (DDS) circuit, configured to generate multiple waveforms for electrical signal waveforms for use in surgical instruments, according to at least one aspect of the present disclosure. Shows one aspect of the architecture. Shown is an aspect of a direct digital compositing (DDS) circuit configured to generate multiple waveforms of electrical signal waveforms for use in surgical instruments, according to at least one aspect of the present disclosure. Analog Waveforms According to At least One Aspect of the Disclosure One cycle of a discrete-time digital electrical signal waveform according to at least one aspect of the present disclosure (shown superimposed on a discrete-time digital electrical signal waveform for comparison purposes). Shown. A system of ultrasonic surgical instruments according to at least one aspect of the present disclosure is shown. A piezoelectric transducer according to at least one aspect of the present disclosure is shown. A piezoelectric transducer according to at least one aspect of the present disclosure is shown. A piezoelectric transducer according to at least one aspect of the present disclosure is shown. Illustrates a D31 ultrasonic transducer structure comprising an ultrasonic waveguide and one or more piezoelectric elements fixed to the ultrasonic waveguide according to at least one aspect of the present disclosure. A fracture view of an ultrasonic surgical instrument according to at least one aspect of the present disclosure is shown. An exploded view of the ultrasonic surgical instrument of FIG. 41 according to at least one aspect of the present disclosure is shown. A block diagram of a surgical system according to at least one aspect of the present disclosure is shown. FIG. 3 shows a perspective view of a surgical instrument comprising a sensor assembly configured to detect a user-worn magnetic reference according to at least one aspect of the present disclosure. FIG. 6 shows a cross-sectional view along lines 44-44 of a surgical instrument comprising a sensor assembly configured to detect an integrated magnetic reference according to at least one aspect of the present disclosure. A detailed view of the surgical instrument of FIG. 45A in the first position according to at least one aspect of the present disclosure is shown. A detailed view of the surgical instrument of FIG. 45A in a second position according to at least one aspect of the present disclosure is shown. FIG. 3 shows a perspective view of a surgical instrument comprising a sensor assembly configured to detect contact with an orthogonally oriented surgical instrument according to at least one aspect of the present disclosure. FIG. 3 shows a perspective view of a surgical instrument comprising a sensor assembly configured to detect contact with a laterally oriented surgical instrument according to at least one aspect of the present disclosure. It is a circuit diagram of the surgical instrument of FIG. 46A or FIG. 46B according to at least one aspect of the present disclosure. FIG. 3 shows a perspective view of a surgical instrument, including a sensor assembly configured to detect closure of the surgical instrument when it is in an open position, according to at least one aspect of the present disclosure. FIG. 3 shows a perspective view of a surgical instrument, including a sensor assembly configured to detect the closure of the surgical instrument when it is in the first closed position, according to at least one aspect of the present disclosure. FIG. 3 shows a perspective view of a surgical instrument, including a sensor assembly configured to detect closure of the surgical instrument when it is in a second closed position, according to at least one aspect of the present disclosure. FIG. 3 shows a perspective view of a surgical instrument comprising a sensor assembly configured to detect the opening of the surgical instrument according to at least one aspect of the present disclosure. A cross-sectional view taken along line 48B-48B of the surgical instrument of FIG. 49A according to at least one aspect of the present disclosure is shown. An exploded perspective view of the surgical instrument of FIG. 49A according to at least one aspect of the present disclosure is shown. A perspective view of the surgical instrument of FIG. 49A according to at least one aspect of the present disclosure is shown. A detailed view of a portion of FIG. 49D according to at least one aspect of the present disclosure is shown. FIG. 49A shows a perspective view of the inner surface of the arm of the surgical instrument of FIG. 49A according to at least one aspect of the present disclosure. FIG. 3 shows a perspective view of a surgical instrument comprising a sensor assembly comprising a pair of sensors for controlling the activation of the surgical instrument according to at least one aspect of the present disclosure. FIG. 3 shows a perspective view of a surgical instrument including a stop switch according to at least one aspect of the present disclosure. A perspective view of a retractor including a sensor according to at least one aspect of the present disclosure is shown. FIG. 3 shows a perspective view of a retractor including a display used at a surgical site according to at least one aspect of the present disclosure. A timeline representing situational awareness of a surgical hub according to at least one aspect of the present disclosure is shown.

The applicant of the present application owns the following US patent application filed on August 28, 2018, the entire disclosure of which is incorporated herein by reference.
U.S. Patent Application Reference No. END8536USNP2 / 180107-2, entitled "ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTOR SYSTEM THEREFOR",
-US Patent Application Reference No. END8560USNP2 / 180106-2, entitled "TEMPERATURE CONTORO OF ULTRASONIC END EFFECTOR AND CONTORL SYSTEM THEREFOR",
-US Patent Application Reference No. END8561USNP 1/180144-1, entitled "RADIO FREENCY ENERGY DEVICE FOR DELIVERING COMBINED ELECTRIC SIGNALS",
-US Patent Application Reference No. END8563USNP 1/180139-1, entitled "CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT ACCRDING TO TISSUE LOCATION",
-US Patent Application Reference No. END8563USNP2 / 180139-2, entitled "CONTROLLING ACTIVATION OF AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO THE PRESENCE OF TISSUE",
U.S. Patent Application Reference No. END8563USNP3 / 180139-3, entitled "DETERMINING TISSUE COMPOSITION VIA AN ULTRASONIC SYSTEM",
-US Patent Application Reference No. END8563USNP4 / 180139-4, entitled "DETERMINING THE STATE OF AN ULTRASONIC ELECTROMECHANICAL SYSTEM ACCORDING TO FREQUENCY SHIFT",
-US Patent Application Reference No. END8563USNP5 / 180139-5, entitled "DETERMINING THE STATE OF AN ULTRASONIC END EFFECTOR",
-US Patent Application Reference No. END8564USNP 1/1801401, entitled "Situational AWARENSS OF ELECTROSURGICAL SYSTEMS",
-US Patent Application Reference No. END8564USNP2 / 180140-2, entitled "MECHANIMSS FOR CONTROLLING DIFFERENT ELECTROMECANICAL SYSTEM SYSTEMS OF AN ELECTROSURGICAL INSTRUMENT",
U.S. Patent Application Reference No. END8564USNP3 / 180140-3, entitled "DECTION OF END EFFECTOR IMMERSION IN LIQUID",
-US Patent Application Reference No. END8565USNP 1/1801421-1, entitled "INTERRUPTION OF ENERGY DUE TO INADVERTENT CAPACTIVE COUPLING",
-US Patent Application Reference No. END8565USNP2 / 180142-2, entitled "INCREASING RADIO FREENCY TO CREATE PAD-LESS MONOPOLAR LOOP",
-US Patent Application Reference No. END8566USNP 1/180143-1 entitled "BIPOLAR COMBINATION DEVICE THAT AUTOMATICALLY ADJUSTS PRESURE BASED ON ENERGY MODALITY".

The applicant of the present application owns the following US patent application filed on August 23, 2018, the entire disclosure of which is incorporated herein by reference.
-US Provisional Patent Application No. 62 / 721,995, entitled "CONTROLLING AN ULTRASONIC SURGICAL INSTRUMENT ACCRDING TO TISSUE LOCATION",
-US Provisional Patent Application No. 62 / 721,998, entitled "SITUATIONAL AWARENESS OF ELECTROSURGICAL SYSTEMS",
-US Provisional Patent Application No. 62 / 721,999, entitled "INTERRUPTION OF ENERGY DUE TO INADVERTENT CAPACTIVE COUPLING",
・ US provisional patent application No. 62 / 721,994 entitled "BIPOLAR COMBINATION DEVICE THAT AUTOMATICALLY ADJUSTS PRESS PRESS ON ENERGY MODALITY", and ・ "RADIO FREQUEEN SIGN" No. 721,996.

The applicant of the present application owns the following US patent application filed June 30, 2018, the entire disclosure of which is incorporated herein by reference.
-US Provisional Patent Application No. 62 / 692,747, entitled "SMART ACTIVE OF AN ENERGY DEVICE BY ANOTHER DEVICE",
-US Provisional Patent Application No. 62 / 692,748, entitled "SMART ENERGY ARCHITECTURE",
-US Provisional Patent Application No. 62 / 692,768 entitled "SMART ENERGY DEVICES".

The applicant of the present application owns the following US patent application filed June 29, 2018, the entire disclosure of which is incorporated herein by reference.
U.S. Patent Application No. 16 / 024,090, entitled "CAPATICIVE COUPLED RETURN PATH PAD WITH Separable ARRAY ELEMENTS",
U.S. Patent Application No. 16 / 024,057, entitled "CONTROLLING A SURGICAL INSTRUMENT ACCRDING TO SENSED CLOSED CLOSEP PARAMETERS",
U.S. Patent Application No. 16 / 024,067, entitled "SYSTEMS FOR ADJUSTING END EFFECTOR PARAMETERS BASED ON PERIOPERATION INFORMATION",
U.S. Patent Application No. 16 / 024,075 entitled "SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING",
U.S. Patent Application No. 16 / 024,083 entitled "SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING",
U.S. Patent Application No. 16 / 024,094, entitled "SURGICAL SYSTEMS FOR DETECTING END EFFECTOR TISSUE DISTRIBUTION IRREGULARITIES",
U.S. Patent Application No. 16 / 024,138, entitled "SYSTEMS FOR DETECTING PROXIMITY OF SURGICAL END EFFECTOR TO CANCEROUS TISSUE",
U.S. Patent Application No. 16 / 024,150 entitled "SURGICAL INSTRUMENT CARTRIDGE SENSOR ASSEMBLES",
U.S. Patent Application No. 16 / 024,160 entitled "VARIABLE OUTPUT CARTRIDGE SENSOR ASSEMBLY",
U.S. Patent Application No. 16 / 024,124, entitled "SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE",
U.S. Patent Application No. 16 / 024,132, entitled "SURGICAL INSTRUMENT HAVING A FLEXIBLE CIRCUIT",
U.S. Patent Application No. 16 / 024, 141 entitled "SURGICAL INSTRUMENT WITH A TISSUE MARKING ASSEMBLY",
U.S. Patent Application No. 16 / 024, 162, entitled "SURGICAL SYSTEMS WITH PRIORIZED DATA TRANSMISSION CAPABILITIES",
U.S. Patent Application No. 16 / 024,066, entitled "SURGICAL EVACUATION SENSING AND MOTOR CONTROL",
U.S. Patent Application No. 16 / 024,096, entitled "SURGICAL EVACUATION SENSOR ARRANGEMENTS",
U.S. Patent Application No. 16 / 024,116, entitled "SURGICAL EVACUATION FLOW PATHS",
U.S. Patent Application No. 16 / 024,149 entitled "SURGICAL EVACUATION SENSING AND GENERATION CONTROLL",
U.S. Patent Application No. 16 / 024,180 entitled "SURGICAL EVACUATION SENSING AND DISPLAY",
・ US Pat. No. 16, entitled "COMMUNICATION OF SMOKE EVACUATION SYSTEM PARAMETERS TO HUB OR CLOUD IN SMOKE EVACUATION MODEL FOR FOR INTERACTIVE SURGICAL PLATFORM", US Pat.
U.S. Patent Application No. 16 / 024,258, entitled "SMOKE EVACUATION SYSTEM INCLUDING A SEGMENTED CONTROL CIRCUIT FOR INTERACTIVE SURGICAL PLATFORM",
U.S. Patent Application No. 5/02
-US Patent Application No. 16 / 024,273 entitled "DUAL IN-SERIES LARGE AND SMALL DROPLET FILERS".

The applicant of the present application owns the following US provisional patent application filed June 28, 2018, the entire disclosure of which is incorporated herein by reference.
-US Provisional Patent Application No. 62 / 691,228, entitled "A METHOD OF USING REINFORCED FLEX CIRCUITS WITH MULTIPLE SENSORS WITH ELECTROSURGICAL DEVICES",
-US Provisional Patent Application No. 62 / 691,227, entitled "CONTROLLING A SURGICAL INSTRUMENT ACCRDING TO SENSED CLOSED CLOSE PARAMETERS",
-US Provisional Patent Application No. 62 / 691,230, entitled "SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE",
-US Provisional Patent Application No. 62 / 691,219, entitled "SURGICAL EVACUATION SENSING AND MOTOR CONTROL",
・ US title "COMMUNICATION OF SMOKE EVACUATION SYSTEM PARAMETERS TO HUB OR CLOUD IN SMOKE EVACUATION MODEL FOR FOR INTERACTIVE SURGICAL PLATFORM"
-US Provisional Patent No. 62
-US Provisional Patent Application No. 62 / 691,251 entitled "DUAL IN-SERIES LARGE AND SMALL DROPLET FILERS".

The applicant of the present application owns the following US provisional patent application filed on April 19, 2018, of which the entire disclosure is incorporated herein by reference.
-US Provisional Patent Application No. 62 / 659,900 entitled "METHOD OF HUB COMMUNICATION".

The applicant of the present application owns the following US provisional patent application filed on March 30, 2018, the entire disclosure of which is incorporated herein by reference.
-US Provisional Patent Application No. 62 / 650,898, filed on March 30, 2018, entitled "CAPATICIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS",
US Provisional Patent Application No. 62 / 650,887, entitled "SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES",
-US Provisional Patent Application No. 62 / 650,882, entitled "SMOKE EVACUATION MODEL FOR INTERACTIVE SURGICAL PLATFORM",
-US Provisional Patent Application No. 62 / 650,877 entitled "SURGICAL SMOKE EVACUATION SENSING AND CONTORLS".

The applicant of the present application owns the following US patent application filed March 29, 2018, the entire disclosure of which is incorporated herein by reference.
U.S. Patent Application No. 15 / 940, 641, entitled "INTERACTIVE SURGICAL SYSTEMS WITH ENGRYPTED COMMUNICATION CAPABILITIES",
U.S. Patent Application No. 15 / 940,648 entitled "INTERACTIVE SURGICAL SYSTEM SYSTEM WITH CONDITION HANDLING OF DEVICES AND DATA CAPABILITIES",
U.S. Patent Application No. 15 / 940,656, entitled "SURGICAL HUB COORDINATION OF CONTROL AND COMMUNICATION OF OPERATION ROOM DEVICES",
U.S. Patent Application No. 15 / 940,666 entitled "SPATIAL AWARENSS OF SURGICAL HUBS IN OPERATING ROOMS",
U.S. Patent Application No. 15 / 940,670, entitled "COOPERATION UTILIZETION OF DATA DERIVED FROM SECONDARY SOURCES BY INTELLIGENT SURGICAL HUBS",
U.S. Patent Application No. 15 / 940,677, entitled "SURGICAL HUB CONTOROL ARRANGEMENTS",
U.S. Patent Application No. 15 / 940, 632, entitled "DATA STRIPPING METHOD TO INTERROGATE PAIENT RECORDS AND CREATE ANONYMIZED RECORD",
・ "COMMUNICATION HUB AND STORAGE DEVICE FOR STORING PARAMETERS AND STATUS OF A SURGICAL DEVICE TO BE SHARED WITH CLOUD BASED ANALYTICS US Pat.
US Patent Application No. 15 / 940,645, entitled "SELF DESCRIBING DATA PACKETS GENELATED AT AN ISSUING INSTRUMENT",
U.S. Patent Application No. 15 / 940,649 entitled "DATA PAIRING TO INTERCONNECT A DEVICE MEASURED PARAMETER WITH AN OUTCOME",
U.S. Patent Application No. 15 / 940,654, entitled "SURGICAL HUB Situational AWARENSS",
U.S. Patent Application No. 15 / 940,663, entitled "SURGICAL SYSTEM DISTRIBUTED PROCESSING",
U.S. Patent Application No. 15 / 940,668, entitled "AGGREGATION AND REPORTING OF SURGICAL HUB DATA",
U.S. Patent Application No. 15 / 940, 671, entitled "SURGICAL HUB SPARC AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER",
U.S. Patent Application No. 15 / 940,686 entitled "DISPLAY OF ALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LINEAR STAPLE LINE",
U.S. Patent Application No. 15 / 940,700 entitled "STERILE FIELD INTERACTIVE CONTROL DISPLAYS",
U.S. Patent Application No. 15 / 940,629 entitled "COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS",
U.S. Patent Application No. 15 / 940,704 entitled "USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT",
U.S. Patent Application No. 15 / 940,722, entitled "CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OF MONO-CHROMATIC LIGHT REFACTIVITY",
-US Patent Application No. 15 / 940,742 entitled "DUAL CMOS ARRAY IMAGING".
U.S. Patent Application No. 15 / 940,636 entitled "ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES",
U.S. Patent Application No. 15 / 940, 653, entitled "ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL HUBS",
U.S. Patent Application No. 15 / 940, 660, entitled "CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZETION AND RECOMMENDATIONS TO A USER",
-US Patent Application No. 15/9
U.S. Patent Application No. 15 / 940,694 entitled "CLOUD-BASED MEDICAL ANALYTICS FOR MEDICAL FACILITY SEGMENTED INDIVIDUALIZATION OF INSTRUMENT FUNCTION",
U.S. Patent Application No. 15 / 940,634, entitled "CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES",
U.S. Patent Application No. 15 / 940,706, entitled "DATA HANDLING AND PRIORIZATION IN A CLOUD ANALYTICS NETWORK",
-US Patent Application No. 15 / 940,675 entitled "CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES".
U.S. Patent Application No. 15 / 940,627, entitled "DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS",
U.S. Patent Application No. 15 / 940,637, entitled "COMMUNICATION ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS",
U.S. Patent Application No. 15 / 940,642, entitled "CONTROLS FOR ROBOT-ASSISTED SURGICAL PLATFORMS",
U.S. Patent Application No. 15 / 940,676, entitled "AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS",
U.S. Patent Application No. 15 / 940,680 entitled "CONTROLLERS FOR ROBOT-ASSISTED SURGICAL PLATFORMS",
U.S. Patent Application No. 15 / 940,683, entitled "COOPERATION SURGICAL ACTIONS FOR ROBOT-ASSISTED SURGICAL PLATFORMS",
US Pat. No. 15,940,690, entitled "DISPLAY ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS",
-US Patent Application No. 15 / 940,711 entitled "SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS".

The applicant of the present application owns the following US provisional patent application filed March 28, 2018, the entire disclosure of which is incorporated herein by reference.
US Provisional Patent Application No. 62 / 649,302, entitled "INTERACTIVE SURGICAL SYSTEMS WITH ENGRYPTED COMMUNICATION CAPABILITIES",
-US Provisional Patent Application No. 62 / 649,294 entitled "DATA STRIPPING METHOD TO INTERROGATE PAIENT RECORDS AND CREATE ANONYMIZED RECORD",
US Provisional Patent Application No. 62 / 649,300, entitled "SURGICAL HUB Situational AWARENSS",
-US Provisional Patent Application No. 62 / 649,309, entitled "SURGICAL HUB SPARC AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER",
US Provisional Patent Application No. 62 / 649,310, entitled "COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS",
-US Provisional Patent Application No. 62 / 649,291, entitled "USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED LIGHT",
-US Provisional Patent Application No. 62 / 649,296 entitled "ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES",
-US Provisional Patent Application No. 62 / 649,333, entitled "CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZETION AND RECOMMENDATIONS TO A USER",
-US Provisional Patent Application No. 62 / 649,327 entitled "CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES",
-US Provisional Patent Application No. 62 / 649,315 entitled "DATA HANDLING AND PRIORIZATION IN A CLOUD ANALYTICS NETWORK",
-US Provisional Patent Application No. 62 / 649,313, entitled "CLOUD Interface FOR COUPLED SURGICAL DEVICES",
-US Provisional Patent Application No. 62 / 649,320 entitled "DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS",
-US Provisional Patent Application No. 62 / 649,307, entitled "AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS",
-US Provisional Patent Application No. 62 / 649,323 entitled "SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS".

The applicant of the present application owns the following US provisional patent application filed March 8, 2018, of which the entire disclosure is incorporated herein by reference.
-US Provisional Patent Application No. 62 / 640,417 entitled "TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM THEREFOR",
-US Provisional Patent Application No. 62 / 640,415 entitled "ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THE REFOR".

The applicant of the present application owns the following US provisional patent application filed December 28, 2017, the entire disclosure of which is incorporated herein by reference.
-US Provisional Patent Application No. 62 / 611,341, entitled "INTERACTIVE SURGICAL PLATFORM",
-US Provisional Patent Application No. 62 / 611,340 entitled "CLOUD-BASED MEDICAL ANALYTICS",
-US Provisional Patent Application No. 62 / 611,339 entitled "ROBOT ASSISTED SURGICAL PLATFORM".

Prior to elaborating on the various aspects of surgical devices and generators, the illustrated examples are not limited in application or application to the details of the structure and arrangement of the parts shown in the accompanying drawings and description. It should be noted. The exemplary examples may be implemented in or incorporated into other embodiments, variants, and modifications, and may be implemented or implemented in a variety of ways. Furthermore, unless otherwise stated, the terms and expressions used herein have been selected for the convenience of the reader to illustrate exemplary examples and are not intended to limit them. .. In addition, one or more of the embodiments, embodiments, and / or examples described below, and any of the other embodiments, embodiments, and / or examples described below. It should be understood that it can be combined with one or more.

Various aspects are intended for improved ultrasonic surgical equipment, electrosurgical equipment, and generators for use with them. Aspects of ultrasonic surgical devices can be configured, for example, to transversely incis and / or coagulate tissue during a surgical procedure. Aspects of electrosurgical devices can be configured, for example, to transversely incis, coagulate, scale, weld and / or dry tissue during a surgical procedure.

Referring to FIG. 1, a computer-mounted interactive surgical system 100 includes one or more surgical systems 102 and a cloud-based system (eg, a cloud 104 that may include a remote server 113 connected to a storage device 105). ,including. Each surgical system 102 includes at least one surgical hub 106 that communicates with a cloud 104 that may include a remote server 113. In one embodiment, as shown in FIG. 1, the surgical system 102 is configured to communicate with each other and / or with the hub 106, a visualization system 108, a robot system 110, and a handheld intelligent surgical instrument 112. And, including. In some embodiments, the surgical system 102 may include M hubs 106, N visualization systems 108, O robot systems 110, and P handheld intelligent surgical instruments 112. , Where M, N, O, and P are integers greater than or equal to 1.

FIG. 3 shows an example of a surgical system 102 used to perform a surgical procedure on a patient lying on an operating table 114 in an operating room 116. The robot system 110 is used as part of the surgical system 102 in a surgical procedure. The robot system 110 includes a surgeon's console 118, a patient-side cart 120 (surgical robot), and a surgical robot hub 122. The patient-side cart 120 can operate at least one detachably coupled surgical tool 117 during a minimally invasive incision in the patient's body while the surgeon views the surgical site through the surgeon's console 118. .. An image of the surgical site can be obtained by the medical imaging device 124, which can be manipulated by the patient-side cart 120 to orient the imaging device 124. The robot hub 122 can be used to process images of the surgical site for subsequent display to the surgeon via the surgeon's console 118.

Other types of robot systems can be easily adapted for use with the surgical system 102. Various examples of robotic systems and surgical tools suitable for use with this disclosure are entitled "ROBOT ASSISTED SURGICAL PLATFORM" filed December 28, 2017, the entire disclosure of which is incorporated herein by reference. It is described in US Provisional Patent Application No. 62 / 611,339.

Various examples of cloud-based analyzes performed by Cloud 104 and suitable for use with this disclosure are described in "CLOUD-BASED MEDICAL" filed December 28, 2017, the entire disclosure of which is incorporated herein by reference. It is described in US Provisional Patent Application No. 62 / 611,340 entitled "ANALYTICS".

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

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

One or more illumination sources may be configured to radiate electromagnetic energy within the visible and invisible spectra. The visible spectrum, sometimes referred to as the optical spectrum or emission spectrum, is a portion of the electromagnetic spectrum visible to the human eye (ie, detectable by the human eye) and is sometimes referred to as visible light, or simply light. The typical human eye responds to wavelengths in the air from about 380 nm to about 750 nm.

The invisible spectrum (ie, the non-emissive spectrum) is a portion of the electromagnetic spectrum located below and above the visible spectrum (ie, wavelengths below about 380 nm and above about 750 nm). The invisible spectrum is not detectable by the human eye. Wavelengths above about 750 nm are longer than the red visible spectrum, which results in invisible infrared (IR), microwave, and radioelectromagnetic radiation. Wavelengths below about 380 nm are shorter than the violet spectrum, which results in invisible UV, X-ray, and gamma-ray electromagnetic radiation.

In various aspects, the imaging device 124 is configured for use in minimally invasive surgery. Examples of imaging devices suitable for use with the present disclosure include arthroscopy, vasoscope, bronchoscope, biliary tract, colonoscope, cytoscope, duodenalscope, endoscopy, esophagogastroduodenalscope (gastroscope). , Endoscope, laryngoscope, nasopharyngo-neproscope, sigmoid colonoscope, thoracoscope, and cystoscope, but not limited to these.

In one aspect, the imaging device uses multispectral monitoring to distinguish between topography and underlayer structure. A multispectral image captures image data within a specific wavelength range over an electromagnetic spectrum. Wavelengths can be separated by filters or by using devices that are sensitive to light from frequencies beyond the visible light range, such as IR and ultraviolet light. Spectral imaging can allow the extraction of additional information that the human eye cannot capture with its red, green, and blue receptors. The use of multispectral imaging is the "Advanced Imaging" of US Provisional Patent Application No. 62 / 611,341 entitled "INTERACTIVE SURGICAL PLATFORM" filed December 28, 2017, the entire disclosure of which is incorporated herein by reference. It is explained in detail in the section "Acquisition Module". Multispectral monitoring can be a useful tool for rearranging surgical fields to perform one or more of the above tests on treated tissue after one surgical operation has been completed.

It is self-evident that any surgery requires strict sterilization of the operating room and surgical instruments. The "surgical theater", that is, the strict hygiene and sterilization conditions required for operating rooms or treatment rooms, require the highest degree of sterilization of all medical devices and equipment. Part of the sterilization process is the need to sterilize anything that comes into contact with the patient or invades the sterilization field, including the imaging device 124 and its accessories and components. The sterile field can be considered as a specific area considered to be free of microorganisms, such as in a tray or on a sterile towel, or the sterile field is seen as the area immediately surrounding the patient prepared for the surgical procedure. It will be understood that it can be done. The sterile field may include washed team members wearing appropriate clothing, as well as all fixtures and fixtures within the area.

In various aspects, the visualization system 108 comprises one or more imaging sensors strategically placed relative to the sterile field and one or more image processing units, as shown in FIG. And one or more storage arrays and one or more displays. In one aspect, the visualization system 108 includes HL7, PACS, and EMR interfaces. For the various components of the visualization system 108, US Provisional Patent Application No. 62 / 611,341, entitled "INTERACTIVE SURGICAL PLATFORM", filed December 28, 2017, the entire disclosure of which is incorporated herein by reference. It is described in the section "Advanced Imaging Application Module".

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

In one aspect, the hub 106 sends diagnostic input or feedback input by a non-sterile operator located at the visualization tower 111 to the primary display 119 within the sterilization area in the sterilization field, which is a sterilization operation located on the operating table. It is also configured so that one can see it. In one embodiment, the input may be in the form of a modification to the snapshot displayed on the non-sterile display 107 or 109, which can be sent by the hub 106 to the primary display 119.

With reference to FIG. 2, the surgical instrument 112 is used as part of the surgical system 102 in the surgical procedure. The hub 106 is also configured to coordinate the flow of information to the display of the surgical instrument 112. For example, in US Provisional Patent Application No. 62 / 611,341, filed December 28, 2017, entitled "INTERACTIVE SURGICAL PLATFORM," the entire disclosure of which is incorporated herein by reference. Diagnostic input or feedback input by the non-sterile operator at the location of the visualization tower 111 may be sent to the surgical instrument display 115 by the hub 106 in the sterile field, where the diagnostic input or feedback is on the surgical instrument 112. It may be seen by the operator. For exemplary surgical instruments suitable for use with the surgical system 102, for example, the section "Surgical Instrument Hardware", the entire disclosure of which is incorporated herein by reference, and the year 2017 entitled "INTERACTIVE SURGICAL PLATFORM". It is described in US Provisional Patent Application No. 62 / 611,341 filed December 28.

With reference to FIG. 3, the hub 106 is shown communicating with the visualization system 108, the robot system 110, and the handheld intelligent surgical instrument 112. The hub 106 includes a hub display 135, an imaging module 138, a generator module 140, a communication module 130, a processor module 132, and a storage array 134. In a particular embodiment, as shown in FIG. 3, the hub 106 further includes a smoke exhaust module 126 and / or a suction / irrigation module 128.

During the surgical procedure, applying energy to the tissue for sealing and / or cutting generally involves flue gas, aspiration of excess fluid, and / or irrigation of the tissue. Fluids, power, and / or data lines from different sources are often entangled during the surgical procedure. Addressing this issue during a surgical procedure can result in the loss of valuable time. Untangling the lines may require pulling the lines out of their corresponding modules, which may require resetting the modules. The modular housing 136 of the hub provides a unified environment for managing power, data, and fluid lines, reducing the frequency of such line entanglements.

Aspects of the present disclosure present a surgical hub for use in surgical procedures involving application of energy to tissue at a surgical site. The surgical hub includes a hub housing and a generator module combo that is slidably acceptable within the docking station of the hub housing. The docking station includes data and power contacts. The generator module combo includes two or more of an ultrasonic energy generator component, a bipolar RF energy generator component, and a unipolar RF energy generator component housed in a single unit. In one aspect, the generator module combo further comprises a smoke exhaust component, at least one energy supply cable for connecting the generator module combo to the surgical instrument, and smoke generated by the application of therapeutic energy to the tissue. Includes at least one flue gas component configured to expel fluid, and / or particulates, and a fluid line extending from the remote surgery site to the flue gas component.

In one aspect, the fluid line is the first fluid line and the second fluid line extends from the remote surgery site to the suction and irrigation module slidably received within the hub housing. In one aspect, the hub housing comprises a fluid interface.

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

Aspects of the present disclosure present a modular surgical enclosure for use in surgical procedures involving the application of energy to tissue. The modular surgical enclosure comprises a first energy generator module configured to generate a first energy to be applied to the tissue and a first docking port containing first data and power contacts. A first docking station, including a first docking station, the first energy generator module is slidably movable to electrically engage with power and data contacts, and the first energy generator module is: It is slidable and movable so as to disengage from the electrical engagement with the first power and data contacts.

In addition to the above, the modular surgical enclosure has a second energy generator module configured to generate a second energy to be applied to the tissue, which is different from the first energy, and a second. A second docking station with a second docking port containing the data and power contacts of the second energy generator module is slidably moved to electrically engage the power and data contacts. It is possible and the second energy generator module is slidably movable so as to disengage from the electrical engagement with the second power and data contacts.

In addition, the modular surgical enclosure is configured to facilitate communication between the first energy generator module and the second energy generator module, with a first docking port and a second docking. It also includes a communication bus to and from the port.

Referring to FIGS. 3-7, aspects of the present disclosure relating to a modular housing 136 of a hub that allows modular integration of a generator module 140, a smoke exhaust module 126, and a suction / irrigation module 128 are presented. Will be done. The modular housing 136 of the hub further facilitates bidirectional communication between the modules 140, 126, 128. As shown in FIG. 5, the generator module 140 is integrated into a single housing unit 139 that is slidably insertable into the modular housing 136 of the hub. It may be a generator module with sound wave components. As shown in FIG. 5, the generator module 140 may be configured to connect to a unipolar device 146, a bipolar device 147, and an ultrasonic device 148. Alternatively, the generator module 140 may include a series of unipolar, bipolar, and / or ultrasonic generator modules that interact via the modular housing 136 of the hub. The modular housing 136 of the hub allows multiple generators to be inserted and bidirectional between the generators docked in the modular housing 136 of the hub so that the multiple generators function as a single generator. It may be configured to facilitate communication.

In one aspect, the modular enclosure 136 of the hub comprises modular power and with external and wireless communication headers to allow removable mounting of modules 140, 126, 128 and bidirectional communication between them. A communication backplane 149 is provided.

In one aspect, the modular housing 136 of the hub includes a docking station or drawer 151, also referred to herein as a drawer, configured to slidably receive modules 140, 126, 128. FIG. 4 shows a partial perspective view of a surgical hub housing 136 and a generator module combo 145 slidably acceptable to the docking station 151 of the surgical hub housing 136. The docking port 152, which has power and data contacts behind the generator module combo 145, slides into a position within the corresponding docking station 151 of the modular enclosure 136 of the hub when the generator module combo 145 slides. The corresponding docking port 150 is configured to engage the power and data contacts of the corresponding docking station 151 of the modular enclosure 136 of the hub. In one aspect, the generator module combo 145 includes a bipolar, ultrasonic, and unipolar module and a smoke exhaust module integrated with a single housing unit 139, as shown in FIG.

In various aspects, the smoke exhaust module 126 includes a fluid line 154 that transports captured / recovered smoke and / or fluid away from the surgical site, eg, to the smoke exhaust module 126. The vacuum suction generated from the smoke exhaust module 126 can draw smoke into the opening of the utility conduit at the surgical site. The utility conduit connected to the fluid line may be in the form of a flexible tube terminated by a smoke exhaust module 126. Utility conduits and fluid lines define a fluid path extending towards the smoke exhaust module 126 received within the hub housing 136.

In various aspects, the suction / irrigation module 128 is coupled to a surgical tool that includes an aspiration fluid line and a suction fluid line. In one embodiment, the suction and suction fluid line is in the form of a flexible tube extending from the surgical site towards the suction / irrigation module 128. One or more drive systems may be configured to cause fluid irrigation and inhalation into and from the surgical site.

In one aspect, the surgical tool comprises a shaft having an end effector at its distal end, at least one energy treatment section associated with the end effector, a suction tube, and an irrigation tube. The suction tube can have an inlet port at its distal end, and the suction tube extends through the shaft. Similarly, the irrigation tube can extend through the shaft and can have an inlet port in close proximity to the energy delivery device. The energy delivery device is configured to deliver ultrasonic and / or RF energy to the surgical site and is first connected to the generator module 140 by a cable that extends through the shaft.

The irrigation pipe can communicate with the fluid source, and the suction pipe can communicate with the vacuum source. The fluid source and / or vacuum source may be housed in the suction / irrigation module 128. In one embodiment, the fluid source and / or vacuum source may be housed in the hub housing 136 separately from the suction / irrigation module 128. In such an embodiment, the fluid interface may be configured to connect the suction / irrigation module 128 to a fluid source and / or a vacuum source.

In one aspect, their corresponding docking stations on modules 140, 126, 128 and / or the modular housing 136 of the hub align the docking ports of the modules to the docking stations of the modular housing 136 of the hub. It may include an alignment mechanism configured to engage these corresponding components within. For example, as shown in FIG. 4, the generator module combo 145 is configured to slidably engage the corresponding bracket 156 of the corresponding docking station 151 of the modular housing 136 of the hub. Includes 155. The brackets work together to guide the docking port contacts of the generator module combo 145 into electrical engagement with the docking port contacts of the modular enclosure 136 of the hub.

In some embodiments, the drawer 151 of the modular housing 136 of the hub is the same or substantially the same size, and the module is adjusted to a size that is acceptable within the drawer 151. For example, the side brackets 155 and / or 156 may be larger or smaller depending on the size of the module. In another aspect, the drawer 151 is of different size and is designed to accommodate a particular module.

In addition, the contacts of a particular module may be locked to engage the contacts of a particular drawer to avoid inserting the module into a drawer with incompatible contacts.

As shown in FIG. 4, the docking port 150 of one drawer 151 is connected to the docking port 150 of another drawer 151 via a communication link 157, and the module is housed in the modular housing 136 of the hub. Two-way communication between them can be facilitated. Alternatively, or further, the docking port 150 of the modular housing 136 of the hub may facilitate wireless bidirectional communication between the modules housed in the modular housing 136 of the hub. For example, any suitable wireless communication such as Air Titan-Bluetooth may be used.

FIG. 6 shows the individual power bus attachments of the plurality of lateral docking ports of the laterally modular housing 160 configured to receive the plurality of modules of the surgical hub 206. The laterally modular housing 160 is configured to laterally receive and interconnect the modules 161. The module 161 is slidably inserted into the docking station 162 of the lateral modular housing 160, which includes a backplane for interconnecting the modules 161. As shown in FIG. 6, the module 161 is arranged laterally within the laterally modular housing 160. Alternatively, the module 161 may be arranged vertically within the laterally modular housing.

FIG. 7 shows a vertical modular housing 164 configured to receive multiple modules 165 of the surgical hub 106. The module 165 is slidably inserted into the docking station or drawer 167 of the vertical modular housing 164 including the backplane for interconnecting the modules 165. Although the drawer 167 of the vertical modular housing 164 is arranged vertically, in certain cases the vertical modular housing 164 may include a drawer arranged laterally. Further, the modules 165 can interact with each other via the docking port of the vertical modular housing 164. In the embodiment of FIG. 7, a display 177 for displaying data related to the operation of module 165 is provided. In addition, the vertical modular housing 164 includes a master module 178 that houses a plurality of submodules that are slidably received within the master module 178.

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

During the surgical procedure, it may be inefficient to remove the surgical device from the surgical field and replace it with another surgical device containing a different camera or different light source. Temporary loss of field of view in the surgical field can have undesired consequences. The modular imaging device of the present disclosure is configured to allow replacement of a light source module or camera module intermediate (midstream) during a surgical procedure without the need to remove the imaging device from the surgical field.

In one aspect, the imaging device comprises a tubular housing that includes a plurality of channels. The first channel is configured to slidably accept a camera module that may be configured to snap fit and engage with the first channel. The second channel is configured to slidably accept a light source module that may be configured to snap fit and engage with the second channel. In another embodiment, the camera module and / or light source module can be rotated to its final position within these corresponding channels. Screw engagement may be employed instead of snap fit engagement.

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

Various image processors and imaging devices suitable for use with the present disclosure are US Pat. Nos. 6, 2011, entitled "COMBINED SBI AND CONVENTIONAL IMAGE PROCESSOR," which are incorporated herein by reference in their entirety. It is described in No. 7,995,045. In addition, US Pat. No. 7,982,776, issued July 19, 2011, entitled "SBI MOTION ARTIFACT REMOVAL APPARATUS AND METHOD," which is incorporated herein by reference in its entirety, removes motion artifacts from image data. Describes various systems for doing so. Such a system can be integrated with the imaging module 138. In addition, the US Patent Application Publication No. 2011/0306840 published on December 15, 2011, entitled "CONTROLLABLE MAGNETIC SOURCE TO FIXTURE TO FIXTURE INTRACORPORTAL APPARATUS", and "SYSTEM FOR PERFORMING A MEMRAL 2014" Published US Patent Application Publication No. 2014/0243597, each of which is incorporated herein by reference in its entirety.

FIG. 8 shows a cloud-based system (eg, storage) of modular equipment located in one or more operating rooms of a medical facility, or in any room within a medical facility equipped with specialized equipment for surgical procedures. FIG. 6 shows a surgical data network 201 with a modular communication hub 203 configured to connect to a cloud 204) that may include a remote server 213 connected to device 205. In one aspect, the modular communication hub 203 comprises a network hub 207 and / or a network switch 209 that communicates with a network router. The modular communication hub 203 can also be connected to the local computer system 210 to provide local computer processing and data manipulation. The surgical data network 201 may be configured as passive, intelligent, or switchable. Passive surgical data networks act as conduits for data, allowing data to travel from one device (or segment) to another (or segment) and to cloud computing resources. The intelligent surgical data network allows traffic to pass through the monitored surgical data network and includes additional mechanisms that make up each port in the network hub 207 or network switch 209. Intelligent surgical data networks can be referred to as manageable hubs or switches. The switching hub reads the destination address of each packet and then forwards the packet to the correct port.

Modular devices 1a-1n arranged in the operating room may be connected to the modular communication hub 203. The network hub 207 and / or the network switch 209 can be connected to the network router 211 to connect the devices 1a to 1n to the cloud 204 or the local computer system 210. The data associated with the devices 1a-1n may be transferred to a cloud-based computer via a router for remote data processing and operation. The data associated with the devices 1a-1n may also be transferred to the local computer system 210 for local data processing and operation. Modular devices 2a-2m located in the same operating room may also be connected to the network switch 209. The network switch 209 can be connected to the network hub 207 and / or the network router 211 to connect the devices 2a to 2m to the cloud 204. The data associated with the devices 2a-2n may be transferred to the cloud 204 via the network router 211 for data processing and operation. The data associated with the devices 2a-2m may also be transferred to the local computer system 210 for local data processing and operation.

It will be appreciated that the surgical data network 201 can be extended by interconnecting the plurality of network hubs 207 and / or the plurality of network switches 209 with the plurality of network routers 211. The modular communication hub 203 may be housed in a modular control tower configured to receive a plurality of devices 1a-1n / 2a-2m. The local computer system 210 may also be housed in a modular control tower. The modular communication hub 203 is connected to the display 212 to display images acquired by some of the devices 1a-1n / 2a-2m, for example during a surgical procedure. In various aspects, the devices 1a-1n / 2a-2m include, among other modular devices that can be connected to the modular communication hub 203 of the surgical data network 201, for example, the imaging module 138 connected to an endoscope. , Generator module 140 connected to energy-based surgical equipment, smoke exhaust module 126, suction / irrigation module 128, communication module 130, processor module 132, storage array 134, surgical equipment connected to display, and / Alternatively, various modules such as non-contact sensor modules may be mentioned.

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

By applying cloud computer data processing technology to the data collected by the devices 1a-1n / 2a-2m, the surgical data network provides improved surgical outcomes, reduced costs, and improved patient satisfaction. After the tissue sealing and cutting procedure, at least some of the devices 1a-1n / 2a-2m can be used to observe the condition of the tissue and assess leakage or perfusion of the sealed tissue. .. At least one of the devices 1a-1n / 2a-2m to use cloud-based computing to examine data, including images of body tissue samples, for diagnostic purposes to identify medical conditions such as the effects of disease. Some can be used. This includes tissue and phenotypic localization and margin confirmation. Devices 1a-1n / 2a to identify the anatomical structure of the body using techniques such as overlaying images captured by multiple imaging devices and various sensors integrated with the imaging device. At least some of ~ 2 m can be used. Data collected by devices 1a-1n / 2a-2m, including image data, may be transferred to cloud 204 and / or local computer system 210 for data processing and operation, including image processing and operation. .. The data of surgical procedures by determining whether further treatments such as endoscopic interventions for tissue-specific sites and conditions, emerging technologies, targeted radiation, targeted interventions, and the application of precision robots can be performed. It can be analyzed to improve the results. Such data analysis may further employ prognostic processing, and whether using a standardized approach confirms surgical treatment and surgeon behavior or suggests modifications to surgical treatment and surgeon behavior. Can provide useful feedback for any of the above.

In one implementation, the operating room devices 1a-1n may be connected to the modular communication hub 203 via a wired or wireless channel, depending on the configuration of the devices 1a-1n with respect to the network hub. In one aspect, the network hub 207 may be implemented as a local network broadcaster acting on the physical layer of the Open Systems Interconnection (OSI) model. The network hub provides connectivity to devices 1a-1n located within the same operating room network. Network hub 207 collects data in packet form and sends them to the router in half-duplex mode. The network hub 207 does not store any medium access control / internet protocol (MAC / IP) for transferring device data. Only one of the devices 1a-1n can transmit data at a time via the network hub 207. The network hub 207 does not have a routing table or intelligence regarding the destination of information, and broadcasts all network data to the entire connection and to the remote server 213 (FIG. 9) on the cloud 204. The network hub 207 can detect basic network errors such as collisions, but broadcasting all the information to a plurality of ports poses a security risk and may cause a bottleneck.

In another implementation, the operating room devices 2a-2m may be connected to the network switch 209 via a wired or wireless channel. The network switch 209 functions within the data link layer of the OSI model. The network switch 209 is a multicast device for connecting devices 2a to 2m located in the same operating room to the network. The network switch 209 transmits data in the form of a frame to the network router 211 and functions in full-duplex mode. The plurality of devices 2a to 2m can simultaneously transmit data via the network switch 209. The network switch 209 stores and uses the MAC addresses of the devices 2a to 2m to transfer data.

The network hub 207 and / or network switch 209 is connected to the network router 211 to connect to the cloud 204. The network router 211 functions within the network layer of the OSI model. The network router 211 cloud the data packets received from the network hub 207 and / or the network switch 211 in order to further process and manipulate the data collected by any one or all of the devices 1a-1n / 2a-2m. Create a route to send to the base computer resource. The network router 211 is used to connect two or more different networks located at different locations, for example, different operating rooms in the same medical facility or different networks located in different operating rooms in different medical facilities. May be good. The network router 211 transmits packet form data to the cloud 204 and functions in full-duplex mode. Multiple devices can transmit data at the same time. The network router 211 uses an IP address to transfer data.

In one embodiment, the network hub 207 may be implemented as a USB hub that allows a plurality of USB devices to be connected to a host computer. A USB hub can extend a single USB port into several layers so that more ports are available to connect the device to the host system computer. The network hub 207 may include a wired or wireless capability for receiving information via a wired or wireless channel. In one aspect, a wireless USB short-range, high-bandwidth wireless communication protocol may be used for communication between devices 1a-1n and devices 2a-2m located in the operating room.

In another embodiment, operating room devices 1a-1n / 2a-2m exchange data over short distances from fixed and mobile devices (using short wavelength UHF radio waves in the ISM band 2.4-2.485 GHz). ), And can communicate with the modular communication hub 203 via the Bluetooth radio technology standard to build a personal area network (PAN). In another aspect, the operating room devices 1a-1n / 2a-2m are Wi-Fi (IEEE802.11 family), WiMAX (IEEE802.16 family), IEEE802.20, Long Term Evolution (LTE), and Ev. -DO, HSPA +, HSDPA +, HSUPA +, LTE, GSM, GPRS, CDMA, TDMA, DECT, and their Ethernet derivatives, as well as any other radio designated as 3G, 4G, 5G, and beyond It is possible to communicate with the modular communication hub 203 via a number of wireless or wired communication standards or protocols, including but not limited to wired protocols. The computing module may include a plurality of communication modules. For example, the first communication module may be dedicated to short-range wireless communication such as Wi-Fi and Bluetooth, and the second communication module may be GPS, EDGE, GPRS, CDMA, WiMAX, LTE, Ev-DO, etc. It may be dedicated to long-distance wireless communication.

The modular communication hub 203 can function as a central connection for one or all of the operating room devices 1a-1n / 2a-2m and handles a data type known as a frame. The frame carries the data generated by the devices 1a-1n / 2a-2m. When the frame is received by the modular communication hub 203, the frame is amplified and transmitted to the network router 211, which uses a number of wireless or wired communication standards or protocols described herein. Transfer this data to your cloud computing resources.

The modular communication hub 203 may be used as a stand-alone device or may be connected to compatible network hubs and network switches to form a larger network. The modular communication hub 203 is generally easy to install, configure, and maintain, making the modular communication hub 203 a good choice for networking operating room devices 1a-1n / 2a-2m.

FIG. 9 shows a computer-mounted interactive surgical system 200. The computer-mounted interactive surgical system 200 is, in many respects, similar to the computer-mounted interactive surgical system 100. For example, the computer-mounted interactive surgical system 200 includes one or more surgical systems 202 that are similar in many respects to the surgical system 102. Each surgical system 202 includes at least one surgical hub 206 that communicates with a cloud 204 that may include a remote server 213. In one aspect, the computer-mounted interactive surgical system 200 comprises a modular control tower 236 connected to multiple operating room devices, such as, for example, intelligent surgical instruments, robots, and other computerized devices located in the operating room. .. As shown in FIG. 10, the modular control tower 236 includes a modular communication hub 203 connected to the computer system 210. As illustrated in the embodiment of FIG. 9, the modular control tower 236 includes an imaging module 238 connected to the endoscope 239, a generator module 240 connected to the energy device 241, a smoke evacuator module 226, and suction / It is connected to the irrigation module 228, the communication module 230, the processor module 232, the storage array 234, the smart device / appliance 235 optionally connected to the display 237, and the non-contact sensor module 242. The operating room equipment is connected to cloud computing resources and data storage via a modular control tower 236. Robot hub 222 may also be connected to modular control tower 236 and cloud computing resources. Above all, the device / appliance 235, visualization system 208 may be connected to the modular control tower 236 via a wired or wireless communication standard or protocol described herein. The modular control tower 236 may be connected to a hub display 215 (eg, monitor, screen) to display and overlay images received from the imaging module, device / instrument display, and / or other visualization system 208. .. The hub display may also display data received from a device connected to the modular control tower along with images and overlay images.

FIG. 10 shows a surgical hub 206 with a plurality of modules connected to a modular control tower 236. The modular control tower 236 includes, for example, a modular communication hub 203 such as a network connection device and a computer system 210 for providing, for example, local processing, visualization, and imaging. As shown in FIG. 10, the modular communication hub 203 is connected in a hierarchical configuration in order to expand the number of modules (for example, devices) that can be connected to the modular communication hub 203, and the data associated with the modules is displayed. It can be transferred to computer system 210, cloud computing resources, or both. As shown in FIG. 10, each of the network hubs / switches in the modular communication hub 203 includes three downstream ports and one upstream port. Upstream network hubs / switches are connected to processors to provide communication connections to cloud computing resources and local displays 217. Communication to the cloud 204 can be done via either a wired or wireless communication channel.

The surgical hub 206 uses the non-contact sensor module 242 to measure the dimensions of the operating room and uses either an ultrasonic or laser non-contact measuring device to generate a map of the surgical site. "Surgical Hub Spatial Awarens With Operating Room" in US Provisional Patent Application No. 62 / 611,341 filed December 28, 2017, entitled "INTERACTIVE SURGICAL PLATFORM", which is incorporated herein by reference in its entirety. As described in the section, the ultrasound-based non-contact sensor module scans the operating room by transmitting a burst of ultrasound and receiving an echo as the burst of ultrasound reflects off the outer wall of the operating room. Here, the sensor module is configured to determine the size of the operating room and adjust the distance limit of the Bluetooth pairing. A laser-based non-contact sensor module, for example, transmits a laser light pulse, receives a laser light pulse reflected on the outer wall of the operating room, and compares the phase of the transmitted pulse to the received pulse in the operating room. The operating room is scanned by determining the size and adjusting the Pulsetooth pairing distance limit.

The computer system 210 includes a processor 244 and a network interface 245. The processor 244 is connected to the communication module 247, the storage 248, the memory 249, the non-volatile memory 250, and the input / output interface 251 via the system bus. The system bus is a 9-bit bus, industry standard architecture (ISA), microchannel architecture (MSA), extended ISA (EISA), intelligent drive electronics (IDE), VESA local bus (VLB), peripheral device interconnection (PCI), Any, but not limited to, USB, Advanced Graphics Port (AGP), Personal Computer Memory Card International Association Bus (PCMCIA), Small Computer System Interface (SCSI), or any other proprietary bus. It may be any of several types of bus structures (s), including memory buses or memory controllers, peripheral or external buses, and / or local buses that use different bus architectures.

The processor 244 may be any single-core or multi-core processor, such as that known by the Texas Instruments ARM Cortex trade name. In one aspect, the processor, for example, on-chip memory of up to 40 MHz 256 KB single cycle flash memory or other non-volatile memory, the details of which are available in the product data sheet, for improving performance above 40 MHz Prefetch buffer, 32KB single-cycle serial random access memory (SRAM), internal read-only memory with StaticrisWare® software (ROM), 2KB electrically erasable programmable read-only memory (EEPROM), and / or One or more pulse width modulation (PWM) modules, one or more orthogonal encoder input (QEI) analogs, one or more 12-bit analog-to-digital with 12 analog input channels It may be an LM4F230H5QR ARM Cortex-M4F processor core available from Texas Instruments, including a converter (ADC).

In one aspect, the processor 244 may include a safety controller that includes two controller families such as the TMS570 and RM4x, also known by the Texas Instruments Hercules ARM Cortex R4 trade name. The safety controller may be configured specifically for IEC 61508 and ISO 26262 safety limit applications to provide a highly integrated safety mechanism while providing scalable performance, connectivity, and memory choices. Good.

Examples of the system memory include volatile memory and non-volatile memory. A basic input / output system (BIOS) that includes a basic routine for transferring information between elements in a computer system, such as during startup, is stored in non-volatile memory. For example, the non-volatile memory may include a ROM, a programmable ROM (PROM), an electrically programmable ROM (EPROM), an EEPROM, or a flash memory. Examples of the volatile memory include a random access memory (RAM) that functions as an external cache memory. Further, the RAM includes SRAM, dynamic RAM (DRAM), synchronous DRAM (SDRAM), double data rate SDRAM (DDR SDRAM), enhanced SDRAM (ESRAM), synclink DRAM (SLRAM), direct rambus RAM (DRRAM), and the like. It is available in many forms of.

The computer system 210 also includes removable / non-removable volatile / non-volatile computer storage media such as disk storage. Disk storage includes, but is not limited to, devices such as 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 be a storage medium independently, or a compact disc ROM device (CD-ROM), a compact disc recordable drive (CD-R drive), a compact disc rewritable drive (CD-RW drive), and the like. Alternatively, an optical disk drive such as a digital versatile disk ROM drive (DVD-ROM) can be mentioned, but the present invention can be included in combination with other storage media not limited thereto. A removable or non-removable interface may be used to facilitate the connection of the disk storage device to the system bus.

It should be understood that the computer system 210 includes software that acts as an intermediary between the user and the basic computer resources described in the preferred operating environment. Examples of such software include operating systems. An operating system that can be stored on disk storage functions to control and allocate resources for the computer system. System applications take advantage of resource management by the operating system via program modules and program data stored either in system memory or on disk storage. It should be understood that the various components described herein can be implemented in different operating systems or combinations of operating systems.

The user inputs a command or information to the computer system 210 via an input device (s) connected to the I / O interface 251. Input devices include pointing devices such as mice, trackballs, stylus, and touchpads, keyboards, microphones, joysticks, gamepads, satellite dishes, scanners, TV tuner cards, digital cameras, digital video cameras, and webcams. However, it is not limited to these. These and other input devices connect to the processor through the system bus via the interface port (s). Examples of the interface port (s) include a serial port, a parallel port, a game port, and USB. The output device (s) use some of the same types of ports as the input device (s). Thus, for example, the USB port may be used to provide input to the computer system and output information from the computer system to the output device. Output adapters are provided to indicate the presence of some output devices, such as monitors, displays, speakers, and printers, among other output devices that require special adapters. Output adapters include, for example, but not limited to, video and sound cards that provide a means of connection between the output device and the system bus. Note that other devices and / or systems of devices, such as remote computers (s), provide both input and output functions.

The computer system 210 can operate in a networked environment that uses a logical connection to one or more remote computers or local computers, such as a cloud computer (s). The remote cloud computer (s) can be a personal computer, server, router, network PC, workstation, microprocessor-based device, peer device, or other common network node, typically a computer. Contains many or all of the elements described for the system. For brevity, only the memory storage device is shown along with the remote computer (s). The remote computer (s) are logically connected to the computer system via a network interface and then physically connected via a communication connection. Network interfaces include communication networks such as local area networks (LANs) and wide area networks (WANs). Examples of LAN technology include an optical fiber distributed data interface (FDDI), a copper wire distributed data interface (CDDI), Ethernet / IEEE802.3, Token Ring / IEEE802.5, and the like. WAN technology includes, but is not limited to, point-to-point links, integrated services digital networks (ISDN) and circuit switching networks such as and variants thereof, packet switching networks, and digital subscriber lines (DSL).

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

Communication connection (s) refers to the hardware / software used to connect the network interface to the bus. The communication connection is shown inside the computer system for the sake of illustration clarity, but the communication connection may be outside the computer system 210. For illustrative purposes only, the hardware / software required to connect to a network interface includes conventional telephone grade modems, cable modems, modems including DSL modems, ISDN adapters, and internal and external technologies such as Ethernet cards. Can be mentioned.

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

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

The USB network hub 300 device includes a serial interface engine 310 (SIE). The SIE310 is the front end of the USB network hub 300 hardware and handles most of the protocols described in Chapter 8 of the USB specification. The SIE310 typically understands signaling down to the transaction level. Functions covered by this include packet recognition, transaction reordering, SOP, EOP, SETET, and RESTUME signal detection / generation, clock / data separation, non-return-to-zero reversal (NRZI) data coding / decoding and bit stuffing, CRC Generation and check (tokens and data), packet ID (PID) generation, and check / decryption, and / or serial parallel / parallel serial conversion can be mentioned. 310 receives clock input 314 and suspend / resume logic as well to control communication between upstream USB transmit / receive ports 302 and downstream USB transmit / receive ports 304, 306, 308 via port logic circuits 320, 322, 324. It is connected to the frame timer 316 circuit and the hub repeater circuit 318. The SIE 310 is connected to the command decoder 326 via an interface logic for controlling commands from the serial EEPROM via the serial EEPROM interface 330.

In various aspects, the USB network hub 300 can connect 127 functions configured in up to 6 logical layers (hierarchies) to a single computer. In addition, the USB network hub 300 can be connected to all peripherals using four standardized wire cables that provide both communication and power distribution. The power configuration is a bus-powered mode and a self-powered mode. The USB network hub 300 is a bus power hub having either individual port power management or interlocking port power management, and a self-powered hub having either individual port power management or interlocking port power management. It may be configured to support one mode. In one aspect, using a USB cable, a USB network hub 300, the upstream USB transmit / receive port 302 is plugged into a USB host controller, and the downstream USB transmit / receive ports 304, 306, 308 connect a USB compatible device. It is exposed because of it.

Hardware for Surgical Instruments FIG. 12 shows a logical diagram of a surgical instrument or tool control system 470 according to one or more aspects of the present disclosure. System 470 includes a control circuit. The control circuit includes a microprocessor 461 with a processor 462 and a memory 468. For example, one or more of the sensors 472, 474, and 476 provide real-time feedback to the processor 462. The motor 482, driven by the motor drive 492, operably connects displacement members that are movable in the longitudinal direction and drives the clamp arm closing member. The tracking system 480 is configured to determine the position of a displacement member that is movable in the longitudinal direction. The position information is provided to the processor 462 which can be programmed or configured to determine the position of the drive member and the position of the closing member which are movable in the longitudinal direction. Additional motors may be provided in the tool driver interface to control the movement of the closure tube, rotation of the shaft, joint movement, or closure of the clamp arm, or any combination of the above. The display 473 may display various operating conditions of the appliance and may include a touch screen function for data entry. The information displayed on the display 473 can be overlaid with the image acquired via the endoscopic imaging module.

In one aspect, the microcontroller 461 may be any single-core or multi-core processor, such as that known by the Texas Instruments ARM Cortex trade name. In one aspect, the main microcontroller 461 improves performance to over 40 MHz, for example, on-chip memory of 256 KB single cycle flash memory up to 40 MHz or other non-volatile memory, the details of which are available in the product datasheet. Prefetch buffer for, 32KB single cycle SRAM, internal ROM with NonvolatilesWare® software, 2KB EEPROM, one or more PWM modules, one or more QEI analogs, and / Alternatively, it may be an LM4F230H5QR ARM Cortex-M4F processor core available from Texas Instruments, including one or more 12-bit ADCs with 12 analog input channels.

In one aspect, the microcontroller 461 may include a safety controller that includes two controller families such as the TMS570 and RM4x, also known by the Texas Instruments Hercules ARM Cortex R4 trade name. The safety controller may be configured specifically for IEC 61508 and ISO 26262 safety limit applications to provide a highly integrated safety mechanism while providing scalable performance, connectivity, and memory choices. Good.

The microcontroller 461 may be programmed to perform various functions such as a knife, joint movement system, clamp arm, or precise control of speed and position of the combination described above. In one aspect, the microcontroller 461 includes a processor 462 and memory 468. The electric motor 482 may be a brushed direct current (DC) motor with a gearbox and a mechanical connection to a joint movement or knife system. In one aspect, the motor drive 492 may be A3941 available from Allegro Microsystems, Inc. Other motor drives can be easily replaced for use in the tracking system 480 with an absolute positioning system. A detailed description of the absolute positioning system, which is incorporated herein by reference in its entirety, is entitled "SYSTEMS AND METHODS FOR CONTROLLING A SURGICAL STAPLING AND CUTTING INSTRUMENT" published October 19, 2017 in the United States Patent Application Publication No. 2017/2017. It is described in 0296213.

The microcontroller 461 may be programmed to provide precise control over the speed and position of the displacement member and joint movement system. Microcontroller 461 may be configured to calculate the response within the software of microcontroller 461. The calculated response is compared to the measured response of the actual system to give an "observed" response, which is used to determine the actual feedback. The observed response is a suitable adjusted value that balances the smooth and continuous nature of the simulated response with the measured response, which can detect external effects on the system.

In one aspect, the motor 482 may be controlled by a motor drive 492 and may be used by a surgical instrument or tool launch system. In various forms, the motor 482 may be, for example, a brushed DC drive motor having a maximum rotational speed of about 25,000 RPM. In another configuration, the motor 482 may include a brushless motor, a cordless motor, a synchronous motor, a stepper motor, or any other suitable electric motor. The motor drive 492 may include, for example, an H-bridge drive that includes a field effect transistor (FET). The motor 482 may be powered by a power assembly that is detachably mounted on the handle assembly or tool housing to supply control power to the surgical instrument or tool. The power assembly may include a battery that may include a large number of battery cells connected in series, which can be used as a power source to power a surgical instrument or tool. Under certain circumstances, the battery cells in the power assembly may be replaceable and / or rechargeable battery cells. In at least one example, the battery cell can be a lithium ion battery that can be connected to and separable from the power assembly.

The motor drive 492 may be A3941 available from Allegro Microsystems, Inc. The A3941 492 is a full bridge controller for use with an external N-channel power metal oxide semiconductor field effect transistor (MOSFET) specifically designed for inductive loads such as brushed DC motors. The drive 492 is equipped with a unique charge pump regulator, which provides full (> 10V) gate drive for battery voltages up to 7V, allowing the A3941 to operate with reduced gate drive up to 5.5V. To do. A bootstrap capacitor may be used to provide the above-mentioned battery supply voltage required for the N-channel MOSFET. The internal charge pump for high-side drive enables DC (100% duty cycle) operation. The full bridge can be driven in fast or slow decay mode using diodes or synchronous rectification. In slow decay mode, current recirculation is possible with both high-side and low-side FETs. The power FET is protected from shoot-through by a register-adjustable dead time. The integrated diagnostics indicate low voltage, overtemperature, and power bridge anomalies and can be configured to protect the power MOSFET under most short circuit conditions. Other motor drives can be easily replaced for use in the tracking system 480 with an absolute positioning system.

The tracking system 480 comprises a controlled motor drive circuit configuration with a position sensor 472 according to one aspect of the present disclosure. The position sensor 472 for the absolute positioning system provides a unique position signal corresponding to the position of the displacement member. In one aspect, the displacement member represents a longitudinally movable drive member comprising a rack of drive teeth for meshing and engaging with the corresponding drive gear of the gear reducer assembly. In another aspect, the displacement member represents a launching member that can be adapted and configured to include a rack of drive teeth. In yet another aspect, the displacement member represents a longitudinal displacement member for opening and closing the clamp arm, which may be adapted and configured to include a rack of drive teeth. In another aspect, the displacement member represents a clamp arm of a stapler, ultrasound, or electrosurgical device, or a clamp arm closing member configured to open and close the combination described above. Therefore, as used herein, the term displacement member is generally used to refer to any movable member of a surgical instrument or tool, such as a drive member, clamp arm, or any element that can be displaced. Will be done. Therefore, the absolute positioning system can actually track the displacement of the clamp arm by tracking the linear displacement of the drive member that is movable in the longitudinal direction.

In another aspect, the absolute positioning system may be configured to track the position of the clamp arm in the opening and closing process. In various other aspects, the displacement member may be connected to any position sensor 472 suitable for measuring linear displacement. Therefore, a drive member or clamp arm that is movable in the longitudinal direction, or a combination thereof, may be connected to any suitable linear displacement sensor. The linear displacement sensor may include a contact or non-contact displacement sensor. Linear displacement sensors include linear variable differential transformers (LVDTs), differential variable reluctance transducers (DVRTs), slide potentiometers, movable magnets and a series of straight lines. Magnetic sensing system with arranged Hall effect sensors, magnetic sensing system with fixed magnets and Hall effect sensors arranged on a series of movable straight lines, movable light sources and arranged on a series of straight lines It may include an optical detection system with a light diode or photodetector, an optical detection system with a fixed light source and a set of movable linearly arranged optical diodes or photodetectors, or any combination thereof. ..

The electric motor 482 may include a rotary shaft that operably interfaces with a gear assembly mounted in mesh engagement with a set or rack of drive teeth on the displacement member. The sensor element may be operably coupled to the gear assembly such that one rotation of the position sensor 472 element corresponds to some linear longitudinal translation of the displacement member. Gearing and sensor mechanisms can be connected to linear actuators by rack and pinion mechanisms, or to rotary actuators by spur gears or other connections. The power supply powers the absolute positioning system and the output indicator can display the output of the absolute positioning system. The displacement member represents a longitudinally movable drive member with a rack of drive teeth formed on it to mesh and engage with the corresponding drive gear of the gear reducer assembly. The displacement member represents a launching member that can move in the longitudinal direction to open and close the clamp arm.

One rotation of the sensor element attached to the position sensor 472 corresponds to a _{linear displacement d 1 in the longitudinal direction of the displacement member, and d 1} is the point "a" of the displacement member after one rotation of the sensor element connected to the displacement member. It is a linear distance in the longitudinal direction that moves from "" to the point "b". The sensor mechanism may be connected via gear deceleration resulting in the position sensor 472 completing one or more rotations for the full stroke of the displacement member. The position sensor 472 can complete a plurality of rotations with respect to the full stroke of the displacement member.

A series of switches (where n is an integer greater than 1), even when used alone, in combination with gear deceleration to provide a unique position signal for two or more rotations of the position sensor 472. May be used in. The state of the switch is fed back to the microcontroller 461, which applies the logic to the longitudinal displacement of the displacement member d ₁ + d ₂ +. .. .. Determine the unique position signal corresponding to d _n. The output of the position sensor 472 is provided to the microcontroller 461. The position sensor 472 of the sensor mechanism may include an analog rotation sensor such as a magnetic sensor, a potential difference meter, or an array of analog Hall effect elements that output a unique combination of position signals or values.

The position sensor 472 may include any number of magnetic sensing elements, such as magnetic sensors that are classified based on whether or not they measure the total magnetic field or vector component of the magnetic field. The technology used to produce both types of magnetic sensors involves many aspects of physics and electronics. Techniques used for magnetic field sensing include, among other things, probe coils, flux gates, optical pumping, nuclear precession, SQUID, Hall effect, anisotropic magnetic resistance, giant magnetic resistance, magnetic tunnel junctions, giant magnetic impedance. , Magnetic strain / piezoelectric composites, magnetic diodes, magnetic transistors, optical fibers, magnetic optics, and magnetic sensors based on microelectromechanical systems.

In one aspect, the position sensor 472 of the tracking system 480 with the absolute positioning system comprises a magnetic rotation absolute positioning system. The position sensor 472 may be implemented as an AS5055 EQFT single-chip gyromagnetic position sensor available from Austria Microsystems, AG. The position sensor 472 cooperates with the microcontroller 461 to provide an absolute positioning system. The position sensor 472 is a low voltage, low power component and includes four Hall effect elements in the region of the position sensor 472 located above the magnet. In addition, a high resolution ADC and smart power management controller are provided on the chip. Digit-by-digit method and boulder to implement a concise and efficient algorithm for computing hyperbolic and trigonometric functions that requires only addition, subtraction, bitshift, and table reference operations. A coordinate rotation digital computer (CORDIC) processor, also known as a Volder's algorithm, is provided. The angular position, alarm bits, and magnetic field information are transmitted to the microcontroller 461 via a standard serial communication interface such as a serial peripheral interface (SPI) interface. The position sensor 472 provides a 12-bit or 14-bit resolution. The position sensor 472 may be an AS5055 chip provided in a small QFN 16-pin 4 x 4 x 0.85 mm package.

The tracking system 480 with an absolute positioning system may include and / or may be programmed to implement a feedback controller such as a PID, state feedback, and adaptive controller. The power supply converts the signal from the feedback controller into a physical input to the system, in this case a voltage. Other examples include voltage, current, and force PWM. In addition to the position measured by the position sensor 472, other sensors (plurality) may be provided to measure the physical parameters of the physical system. In some embodiments, as the other sensor (s), the US Pat. No. 9, entitled "STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM," which is incorporated herein by reference in its entirety. , 345, 481, the United States Patent Application Publication No. 2014/0263552, published September 18, 2014, entitled "STAPLE CARTRIDGE TISSUE TISSUE TISSUE SENSOR SYSTEM," which is incorporated herein by reference in its entirety, and in its entirety. U.S. Patent Application No. 17/28 A sensor mechanism such as a thing can be mentioned. In a digital signal processing system, the absolute positioning system is connected to a digital data acquisition system, where the output of the absolute positioning system has a finite resolution and sampling frequency. Absolute positioning systems use algorithms such as weighted averages and theoretical control loops that drive the calculated response towards the measured response to combine the calculated response with the measured response. Can be equipped. In order to predict what the state and output of the physical system will be by knowing the inputs, the calculated response of the physical system takes into account properties such as mass, inertia, viscous friction, and induced resistance.

The absolute positioning system resets the displacement members, which may be required in conventional rotary encoders where the motor 482 simply counts the number of steps taken forward or backward to estimate the position of device actuators, drive bars, knives, etc. Provides the absolute position of the displacement member when the appliance is powered on, without retracting or advancing to the zero or home) position.

A sensor 474, such as a strain gauge or microstrain gauge, can indicate, for example, one or more end effectors such as the amplitude of strain exerted on the anvil during clamping operation, which can indicate the closing force applied to the anvil. It is configured to measure the parameters of. The measured distortion is converted into a digital signal and provided to the processor 462. Instead of or in addition to the sensor 474, for example, a sensor 476, such as a load sensor, measures the closure force that the closure drive system exerts on a stapler in an ultrasound or electrosurgical instrument or an anvil in a clamp arm. Can be done. For example, a sensor 476, such as a load sensor, may be applied to a firing force applied to a closing member connected to a clamp arm of a surgical instrument or tool, or to tissue located within a jaw of an ultrasonic or electrosurgical instrument by the clamp arm. It is possible to measure the force to be applied. Alternatively, a current sensor 478 can be used to measure the current draw by the motor 482. The displacement member may also be configured to engage the clamp arm to open and close the clamp arm. The force sensor may be configured to measure the clamping force on the tissue. The force required to advance the displacement member may correspond, for example, to the current drawn by the motor 482. The measured force is converted into a digital signal and provided to the processor 462.

In one form, the strain gauge sensor 474 can be used to measure the force applied to the tissue by the end effector. A strain gauge can be attached to the end effector to measure the force of the end effector on the tissue to be treated. The system for measuring the force applied to the tissue gripped by the end effector is, for example, a strain gauge sensor 474, such as a micro strain gauge configured to measure one or more parameters of the end effector. To be equipped. In one aspect, the strain gauge sensor 474 can measure the amplitude or magnitude of strain exerted on the end effector jaw member during the gripping operation, which can indicate tissue compression. The measured distortion is converted into a digital signal and provided to the processor 462 of the microcontroller 461. The load sensor 476 can measure the force used to manipulate the knife element, for example, to cut the tissue trapped between the anvil and the staple cartridge. The load sensor 476 operates the clamp arm element, for example, to capture tissue between the clamp arm and the ultrasonic blade, or to capture tissue between the clamp arm and the jaws of an electrosurgical instrument. The force used to do this can be measured. Magnetic field sensors can be used to measure the thickness of captured tissue. The magnetic field sensor measurements can also be converted to digital signals and provided to the processor 462.

Measures of tissue compression, tissue thickness, and / or force required to close the end effector on the tissue, measured by sensors 474 and 476, respectively, are the selected position of the launching member and /. Alternatively, it can be used by the microcontroller 461 to characterize the corresponding value of the velocity of the launching member. In one example, memory 468 can store techniques, equations and / or look-up tables that can be used by microcontroller 461 during evaluation.

The surgical instrument or tool control system 470 may also include a wired or wireless communication circuit for communicating with a modular communication hub as shown in FIGS. 8-11.

FIG. 13 shows a control circuit 500 configured to control aspects of a surgical instrument or tool according to one aspect of the present disclosure. The control circuit 500 can be configured to implement the various processes described herein. The control circuit 500 can include a microcontroller having one or more processors 502 (eg, microprocessor, microcontroller) connected to at least one memory circuit 504. The memory circuit 504 stores machine executable instructions that, when executed by the processor 502, cause the processor 502 to execute machine instructions for implementing the various processes described herein. The processor 502 may be any one of a number of single or multi-core processors known in the art. The memory circuit 504 can include volatile and non-volatile storage media. The processor 502 may include an instruction processing unit 506 and an arithmetic unit 508. The instruction processing unit may be configured to receive instructions from the memory circuit 504 of the present disclosure.

FIG. 14 shows a combination logic circuit 510 configured to control aspects of a surgical instrument or tool according to one aspect of the present disclosure. The combination logic circuit 510 can be configured to implement the various processes described herein. The combination logic circuit 510 is a finite state machine containing the combination logic 512 configured to receive data associated with a surgical instrument or tool at input 514, process the data by combination logic 512, and provide output 516. May include.

FIG. 15 shows a sequence logic circuit 520 configured to control aspects of a surgical instrument or tool according to one aspect of the present disclosure. The order logic circuit 520 or combination logic 522 can be configured to implement the various processes described herein. The order logic circuit 520 may include a finite state machine. The sequential logic circuit 520 may include, for example, a combination logic 522, at least one memory circuit 524, and a clock 529. At least one memory circuit 524 can store the current state of the finite state machine. In a particular example, the order logic circuit 520 may be synchronous or asynchronous. Combination logic 522 is configured to receive data associated with a surgical instrument or tool from input 526, process the data by combination logic 522, and provide output 528. In another aspect, the circuit may include a combination of a processor (eg, processor 502 in FIG. 13) and a finite state machine that implements the various processes herein. In another aspect, the finite state machine can include a combination of a combination logic circuit (eg, combination logic circuit 510 in FIG. 14) and a sequence logic circuit 520.

FIG. 16 shows a circuit diagram of a surgical instrument 750 configured to control the distal translation of a displacement member according to one aspect of the present disclosure. In one aspect, the surgical instrument 750 is programmed to control the distal translation of the displacement member, such as the closing member 764. The surgical instrument 750 comprises an end effector 752 that may include a clamp arm 766, a closing member 764, and an ultrasonic blade 768 coupled to an ultrasonic transducer 769 driven by an ultrasonic generator 771.

The position, movement, displacement, and / or translation of a linear displacement member, such as the closing member 764, can be measured by an absolute positioning system, sensor mechanism, and position sensor 784. Since the closing member 764 is connected to a drive member that is movable in the longitudinal direction, the position of the closing member 764 is determined by measuring the position of the drive member that is movable in the longitudinal direction using the position sensor 784. Can be done. Therefore, in the following description, the position, displacement, and / or translation of the closing member 764 can be achieved by the position sensor 784 described herein. The control circuit 760 may be programmed to control the translation of the displacement member, such as the closing member 764. In some embodiments, the control circuit 760 commands one or more microcontrollers, microprocessors, or processors or multiple processors to control a displacement member, eg, a closure member 764, in the manner described. Other suitable processors for execution may be provided. In one aspect, the timer / counter 781 provides an output signal such as elapsed time or digital count to the control circuit 760 to correlate the position of the closing member 764 determined by the position sensor 784 with the output of the timer / counter 781. As a result, the control circuit 760 can determine the position of the closing member 764 at a specific time (t) with respect to the starting position. The timer / counter 781 may be configured to measure elapsed time, count external events, or measure the time of external events.

The control circuit 760 may generate the motor set value signal 772. The motor set value signal 772 may be provided to the motor controller 758. The motor controller 758 may include one or more circuits configured to provide the motor 754 with a motor drive signal 774 to drive the motor 754, as described herein. In some embodiments, the motor 754 may be a brushed DC electric motor. For example, the speed of the motor 754 may be proportional to the motor drive signal 774. In some examples, the motor 754 may be a brushless DC electric motor and the motor drive signal 774 may include PWM signals provided to one or more stator windings of the motor 754. Also, in some embodiments, the motor controller 758 may be omitted and the control circuit 760 may directly generate the motor drive signal 774.

The motor 754 can receive power from the energy source 762. The energy source 762 may be a battery, a supercapacitor, or any other suitable energy source, or may include it. The motor 754 may be mechanically connected to the closing member 764 via the transmission device 756. The transmission device 756 may include one or more gears or other connecting components for connecting the motor 754 to the closing member 764. The position sensor 784 can sense the position of the closing member 764. The position sensor 784 may be any type of sensor capable of generating position data indicating the position of the closing member 764, or may include it. In some examples, the position sensor 784 may include an encoder configured to provide a series of pulses to the control circuit 760 as the closure member 764 translates distally and proximally. The control circuit 760 may track the pulse to determine the position of the closing member 764. Other suitable position sensors, including, for example, proximity sensors may be used. Other types of position sensors can provide other signals indicating the movement of the closing member 764. Further, in some embodiments, the position sensor 784 may be omitted. If the motor 754 is a step motor, the control circuit 760 can track the position of the closing member 764 by summing the number and directions of steps instructed by the motor 754 to perform. The position sensor 784 can be located within the end effector 752 or at any other part of the instrument.

The control circuit 760 can communicate with one or more sensors 788. The sensor 788 is positioned on the end effector 752 and can be adapted to work with the surgical instrument 750 to measure various derived parameters such as clearance distance vs. time, tissue compression vs. time, and anvil strain vs. time. .. The sensor 788 is one or more of induction sensors such as magnetic sensors, magnetic field sensors, strain gauges, pressure sensors, force sensors, eddy current sensors, resistance sensors, capacitance sensors, optical sensors, and / or end effectors 752. Any other suitable sensor for measuring parameters may be provided. Sensor 788 may include one or more sensors.

One or more sensors 788 may include a strain gauge, such as a micro strain gauge, configured to measure the magnitude of strain on the clamp arm 766 during the clamped state. The strain gauge provides an electrical signal whose amplitude fluctuates with the magnitude of the strain. The sensor 788 may include a pressure sensor configured to detect the pressure generated by the presence of compressed tissue between the clamp arm 766 and the ultrasonic blade 768. The sensor 788 may be configured to detect the impedance of the tissue portion located between the clamp arm 766 and the ultrasonic blade 768, which impedance is the thickness of the tissue located between them and / or Indicates the degree of filling.

The sensor 788 may be configured to measure the force exerted on the clamp arm 766 by the closed drive system. For example, one or more sensors 788 may be located at the point of interaction between the closure tube and the clamp arm 766 to detect the closing force applied to the clamp arm 766 by the closure tube. .. The force exerted on the clamp arm 766 may represent the tissue compression received by the tissue section captured between the clamp arm 766 and the ultrasonic blade 768. One or more sensors 788 can be located at various points of interaction along the closure drive system to detect the closure force applied to the clamp arm 766 by the closure drive system. One or more sensors 788 may be sampled in real time during the clamping operation by the processor of control circuit 760. The control circuit 760 receives real-time sample measurements, provides and analyzes time-based information, and evaluates the closing force applied to the clamp arm 766 in real time.

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

The control circuit 760 may be configured to simulate the response of the actual system of the instrument with the software of the controller. The displacement member can be actuated to move the closing member 764 in the end effector 752 at or near the target speed. The surgical instrument 750 can include a feedback controller, the feedback controller being any one of any feedback controllers including, but not limited to, for example, PID, state feedback, LQR, and / or adaptive controllers. It may be one. The surgical instrument 750 can include a power source for converting signals from the feedback controller into physical inputs such as case voltage, PWM voltage, frequency modulation voltage, current, torque, and / or force.

The actual drive system for the surgical instrument 750 is such that a displacement member, cutting member, or closing member 764 is driven by a brushed DC motor with a gearbox and a mechanical connection to the joint movement and / or knife system. It is configured in. Another example is an electric motor 754 that operates a replaceable shaft assembly, eg, a displacement member and a joint motion driver. External effects are unmeasured and unpredictable effects, such as friction on tissues, surrounding bodies, and physical systems. Such external influences are sometimes referred to as drag acting against the electric motor 754. External influences, such as failures, can deviate the behavior of the physical system from the desired behavior of the physical system.

Various exemplary embodiments relate to a surgical instrument 750 with an end effector 752 having a motor-driven surgical encapsulation and cutting instrument. For example, the motor 754 may drive the displacement members distally and proximally along the longitudinal axis of the end effector 752. The end effector 752 may include a pivotable clamp arm 766 and, when configured for use, an ultrasonic blade 768 located on the opposite side of the clamp arm 766. The clinician may grip the tissue between the clamp arm 766 and the ultrasonic blade 768 as described herein. When ready to use the instrument 750, the clinician may provide a firing signal, for example by pressing the trigger on the instrument 750. In response to the firing signal, the motor 754 drives the displacement member distally along the longitudinal axis of the end effector 752 from the proximal stroke start position to the stroke end position distal to the stroke start position. be able to. As the displacement member translates distally, the closing member 764 with the cutting element located at the distal end can cut the tissue between the ultrasonic blade 768 and the clamp arm 766.

In various embodiments, the surgical instrument 750 comprises a control circuit 760 programmed to control the distal translation of a displacement member, such as a closure member 764, based on one or more tissue conditions. You may. The control circuit 760 may be programmed to sense tissue conditions such as thickness, either directly or indirectly, as described herein. The control circuit 760 may be programmed to select a control program based on the tissue state. The control program can describe the distal movement of the displacement member. Different control programs can be selected to better handle different tissue conditions. For example, in the presence of thicker tissue, control circuit 760 may be programmed to translate the displacement member at a slower speed and / or at a lower power. In the presence of thinner tissue, control circuit 760 may be programmed to translate the displacement member faster and / or at higher power.

In some embodiments, the control circuit 760 may first operate the motor 754 in an open loop configuration with respect to the first open loop portion of the displacement member stroke. Based on the response of the instrument 750 during the open loop portion of the stroke, the control circuit 760 may select a launch control program. The response of the instrument is the sum of the translational distance of the displacement member between the open loop portions, the time elapsed between the open loop portions, the energy provided to the motor 754 during the open loop portions, and the pulse width of the motor drive signal. And so on. After the open loop portion, the control circuit 760 may implement the selected launch control program for the second portion of the displacement member stroke. For example, during the closed loop portion of the stroke, the control circuit 760 may modulate the motor 754 in a closed loop manner based on translational data describing the position of the displacement member to translate the displacement member at a constant speed. Further details are incorporated herein by reference in its entirety, US Patent Application No. 15 / 720,852, entitled "SYSTEM AND METHODS FOR CONTOROLRING A DISPLAY OF A SURGICAL INSTRUMENT", filed September 29, 2017. It is disclosed in.

FIG. 17 is a schematic view of a surgical instrument 790 configured to control various functions according to one aspect of the present disclosure. In one aspect, the surgical instrument 790 is programmed to control the distal translation of the displacement member, such as the closing member 764. The surgical instrument 790 can be replaced with or interlocked with a clamp arm 766, a closing member 764, and one or more RF electrodes 796 (shown by dashed lines), an ultrasonic blade 768. It is provided with an end effector 792 which can be provided with. The ultrasonic blade 768 is connected to an ultrasonic converter 769 driven by an ultrasonic generator 771.

In one aspect, the sensor 788 may be implemented, among other things, as a limit switch, electromechanical device, solid switch, Hall effect device, MR device, GMR device, magnetometer. In other embodiments, the sensor 638 may be a solid-state switch that operates under the influence of light, especially light sensors, IR sensors, UV sensors, and the like. Further, the switch may be a solid-state device such as a transistor (eg, FET, junction FET, MOSFET, bipolar, etc.). In other implementations, the sensor 788 may include, among other things, a conductor-free switch, an ultrasonic switch, an accelerometer, and an inertial sensor.

In one aspect, the position sensor 784 may be implemented as an absolute positioning system comprising a magnetic rotation absolute positioning system implemented as an AS5055EQFT single chip magnetic rotation position sensor available from Austria Microsystems, AG. The position sensor 784 can cooperate with the control circuit 760 to provide an absolute positioning system. The position is located above the magnet and is provided to implement a concise and efficient algorithm for computing hyperbolic and trigonometric functions that requires only addition, subtraction, bitshift, and table reference operations. It may include multiple Hall effect elements connected to a CORDIC processor, also known as the digit-by-digit method and the boulder algorithm.

In some embodiments, the position sensor 784 may be omitted. If the motor 754 is a step motor, the control circuit 760 can track the position of the closing member 764 by summing the number and directions of steps instructed by the motor to perform. The position sensor 784 can be located within the end effector 792 or at any other part of the instrument.

The control circuit 760 can communicate with one or more sensors 788. The sensor 788 is positioned on the end effector 792 and may be adapted to work with the surgical instrument 790 to measure various derived parameters such as clearance distance vs. time, tissue compression vs. time, and anvil strain vs. time. .. The sensor 788 is one or more of induction sensors such as magnetic sensors, magnetic field sensors, strain gauges, pressure sensors, force sensors, eddy current sensors, resistance sensors, capacitance sensors, optical sensors, and / or end effectors 792. Any other suitable sensor for measuring parameters may be provided. Sensor 788 may include one or more sensors.

The RF energy source 794 is connected to the end effector 792 and is provided to operate when the RF electrode 796 is provided within the end effector 792 instead of the ultrasonic blade 768 or in conjunction with the ultrasonic blade 768. When applied to the RF electrode 796. For example, the ultrasonic blade may be made of conductive metal and used as a return path for electrosurgical RF currents. The control circuit 760 controls the delivery of RF energy to the RF electrode 796.

Further details are incorporated herein by reference in their entirety, "SURGICAL SYSTEM COUPLABLE WITH STAPLE CARTRIDGE AND RADIO FREQUENCY CARTRIDGE, AND METHOD OF USING US Pat. / 636,096.

Generator Hardware Adaptive Ultrasonic Blade Control Algorithm In various aspects, the smart ultrasonic energy device may include an adaptive algorithm for controlling the operation of the ultrasonic blade. In one aspect, the ultrasonic blade adaptive control algorithm is configured to identify tissue type and adjust device parameters. In one aspect, the ultrasonic blade control algorithm is configured to parameterize the tissue type. Algorithms for detecting the collagen / elasticity ratio of tissue to adjust the amplitude of the distal tip of the ultrasonic blade are described in the following sections of this disclosure. Various aspects of the smart ultrasonic energy device are described herein in connection with, for example, FIGS. 1-37. Therefore, the following description of the adaptive ultrasonic blade control algorithm should be read in conjunction with FIGS. 1-37 and related descriptions.

Identification of tissue type and adjustment of device parameters For certain surgical procedures, it is desirable to use an adaptive ultrasonic blade control algorithm. In one aspect, an adaptive ultrasonic blade control algorithm may be used to adjust the parameters of the ultrasonic device based on the type of tissue in contact with the ultrasonic blade. In one aspect, the parameters of the ultrasonic device may be adjusted based on the position of the tissue within the jaws of the ultrasonic end effector, eg, the position of the tissue between the clamp arm and the ultrasonic blade. The impedance of the ultrasonic transducer may be used to identify which proportion of tissue is located at the distal or proximal end of the end effector. The reaction of the ultrasonic device may be based on the type of tissue or the compressibility of the tissue. In another aspect, the parameters of the ultrasound device may be adjusted based on the type or parameterization of the identified tissue. For example, the mechanical displacement amplitude of the distal tip of the ultrasonic blade may be adjusted based on the ratio of collagen to the elastin tissue detected during the tissue identification procedure. The ratio of collagen to elastin tissue can be detected using a variety of techniques, including infrared (IR) surface reflectance and emissivity. The force exerted on the tissue by the clamp arm and / or the stroke of the clamp arm to create a gap and compression. The electrical conduction of the entire jaw with electrodes can be used to determine which proportion of the jaw is covered with tissue.

FIG. 18 shows a system 800 configured to perform an adaptive ultrasonic blade control algorithm within a surgical data network with a modular communication hub according to at least one aspect of the present disclosure. In one aspect, the generator module 240 is a US provisional patent application No. 62 /, filed June 30, 2018, entitled "SMART ACTION OF AN ENERGY DEVICE BY ANOTHER DEVICE", which is incorporated herein by reference in its entirety. As described in 692, 747, the generator module 24 is configured to execute the adaptive ultrasonic blade control algorithm (s) 802. In another aspect, the device / appliance 235 is configured to perform the adaptive ultrasonic blade control algorithm (s) 804 described above, as described in US Provisional Application No. 62 / 692,747. To. In another aspect, both device / appliance 235 and apparatus / appliance 235 perform the adaptive ultrasonic blade control algorithms 802,804 described above, as described in US Provisional Application 62 / 692,747. It is configured to do.

The generator module 240 may include a patient insulation stage that communicates with the non-insulation stage via a power transformer. The secondary windings of the power transformer are housed in an insulating stage and include, for example, ultrasonic surgical instruments, RF electrosurgical instruments, and multifunctional surgery including ultrasonic and RF energy modes that can be delivered independently or simultaneously. It may include a tap configuration (eg, center tap or non-center tap configuration) for defining a drive signal output to deliver the drive signal to various surgical instruments such as instruments. Specifically, the drive signal output unit can output an ultrasonic drive signal (for example, a 420 V root mean square (RMS) drive signal) to the radio frequency surgical instrument 241 and the drive signal output unit is RF. An electrosurgical drive signal (eg, a 100 V RMS drive signal) can be output to the RF electrosurgical instrument 241. Aspects of the generator module 240 will be described herein with reference to FIGS. 19-26B.

The generator module 240, and / or device / instrument 235, are described, for example, with reference to FIGS. 8-11, eg, intelligent surgical instruments, robots, and other computers located in the operating room. It is connected to a modular control tower 236 connected to a plurality of operating room devices such as a computer.

FIG. 19 is configured to be coupled to an ultrasonic instrument and further configured to perform an adaptive ultrasound blade control algorithm within a surgical data network with the modular communication hub shown in FIG. An embodiment of the generator 900, which is a form of the vessel, is shown. The generator 900 is configured to deliver multiple energy modality to the surgical instrument. The generator 900 provides RF and ultrasonic signals, either alone or simultaneously, to deliver energy to the surgical instrument. The RF signal and the ultrasonic signal may be provided alone or in combination, or may be provided at the same time. As mentioned above, at least one generator output unit has multiple energy modalities (eg, ultrasound, bipolar or unipolar RF, irreversible and / or reversible electroporation, and / or microwaves, among others, through a single port. Energy) can be delivered and these signals can be delivered to the end effector individually or simultaneously to treat the tissue. The generator 900 includes a processor 902 connected to the waveform generator 904. The processor 902 and the waveform generator 904 are configured to generate various signal waveforms based on information stored in a memory connected to the processor 902 (not shown for clarity of disclosure). The digital information associated with the waveform is provided to the waveform generator 904, which includes one or more DAC circuits to convert the digital input to an analog output. The analog output is supplied to amplifier 1106 for signal conditioning and amplification. The regulated and amplified output of the amplifier 906 is connected to the power transformer 908. The signal is connected across the power transformer 908 to the secondary side on the patient isolated side. The first signal of the first energy modality is provided between the terminals labeled _{ENERGY 1 and RETURN of the surgical instrument.} The second signal of the second energy modality is connected via a capacitor 910 and is provided between the terminals labeled _{ENERGY 2 and RETURN of the surgical instrument.} More than two energy modality may be output, so the subscript "n" _{can be used to indicate that up to n ENERGY n} terminals can be provided, where n is greater than one. It will be understood that it is a positive integer of. It will also be appreciated that a maximum of "n" return paths (RETURN _n ) may be provided without departing from the scope of the present disclosure.

The first voltage sensing circuit 912 is _{connected via terminals labeled ENERGY 1} and RETURN path and measures the output voltage between them. The second voltage sensing circuit 924 is _{connected via terminals labeled ENERGY 2} and RETURN paths and measures the output voltage between them. The current sensing circuit 914 is arranged in series with the RETURN section on the secondary side of the illustrated power transformer 908 to measure the output current of either energy modality. If different return paths are provided for each energy modality, a separate current sensing circuit must be provided for each return interval. The output of the first voltage sensing circuit 912 and the second voltage sensing circuit 924 is provided to the corresponding insulated transformers 916, 922, and the output of the current sensing circuit 914 is provided to another insulated transformer 918. The output of the insulated transformers 916, 928, 922 on the primary side (non-patient isolated side) of the power transformer 908 is provided to one or more ADC circuits 926. The digitized output of the ADC circuit 926 is provided to processor 902 for further processing and computation. The output voltage and output feedback information can be used to adjust the output voltage and current provided to the surgical instrument and to calculate the output impedance among several parameters. Input / output communication between the processor 902 and the patient isolation circuit is provided through the interface circuit 920. The sensor may also telecommunications with the processor 902 via the interface circuit 920.

In one aspect, the impedance is a _first voltage sensing circuit 912 connected via a terminal labeled _{ENERGY 1 / RETURN or a second} voltage sensing circuit connected via a terminal labeled ENERGY 2 / RETURN. The output of any of the circuits 924 can be determined by the processor 902 by dividing by the output of the current sensing circuit 914 located in series with the RETURN section on the secondary side of the power transformer 908. The output of the first voltage sensing circuit 912 and the second voltage sensing circuit 924 is provided to the separate insulated transformers 916, 922, and the output of the current sensing circuit 914 is provided to another insulated transformer 916. The digitized voltage and current sense measurements from the ADC circuit 926 are provided to processor 902 to calculate the impedance. As an example, the first energy modality ENERGY ₁ may be ultrasonic energy and the second energy modality ENERGY ₂ may be RF energy. Nevertheless, in addition to ultrasonic energy modality and bipolar or unipolar RF energy modality, other energy modality includes irreversible and / or reversible electropiercing and / or radiofrequency energy, among others. Also, the example illustrated in FIG. 19 shows that a single return path (RETURN) can be provided for more than one energy modality, but in other embodiments, multiple return paths RETURN _n can be provided. It may be provided to each energy modality ENERGY _n. Therefore, as described herein, the impedance of the ultrasonic converter may be measured by dividing the output of the first voltage sensing circuit 912 by the current sensing circuit 914, and the tissue impedance is the first. It may be measured by dividing the output of the voltage sensing circuit 924 of 2 by the current sensing circuit 914.

As shown in FIG. 19, a generator 900 containing at least one output port can power, for example, ultrasound, bipolar or unipolar RF, irreversible and /, depending on the type of tissue treatment performed. Or a power transformer having a single output and having multiple taps to provide to the end effector in the form of one or more energy modalities such as reversible electropiercing and / or microwave energy. A vessel 908 can be included. For example, the generator 900 uses either unipolar or bipolar RF electrosurgical electrodes to drive the RF electrodes for tissue encapsulation at high voltage and low current to drive the ultrasonic converter. Therefore, energy can be delivered at low voltage and high current, or with a solidification waveform for spot solidification. The output waveform from the generator 900 can be guided, switched, or filtered to provide frequency to the end effector of the surgical instrument. The connection to the output of the generator 900 of the ultrasonic transducer will preferably be located between the output labeled _{ENERGY 1 and RETURN as shown in FIG.} In one embodiment, the connection of the RF bipolar electrode to the output of the generator 900 would preferably be located between the output labeled _{ENERGY 2 and RETURN.} For unipolar outputs, a preferred connection would be an active electrode (eg, pencil type or other probe) to a suitable return pad connected to the _{ENERGY 2 output and the RETURN output.}

Further details are incorporated herein by reference in their entirety, entitled "TECHNIQUES FOR OPERATING GENERATIONOR FOR DIGITALLY GENERATION ELECTRIC SIGNAL WAVEFORMS AND SURGICAL INSTRUMENTS 2017 U.S.A. It is disclosed in the issue.

As used throughout this description, the term "radio" and its derivatives describe circuits, devices, systems, methods, techniques, communication channels, etc. that can communicate data through the use of modulated electromagnetic radiation over non-solid media. May be used for. The term does not mean that the devices involved do not include any wires, but in some embodiments they may not exist. Communication modules include Wi-Fi (IEEE802.11 family), WiMAX (IEEE802.16 family), IEEE802.20, Long Term Evolution (LTE), Ev-DO, HSPA +, HSDPA +, HSUPA +, EDGE, GSM, GPRS. , CDMA, TDMA, DECT, Bluetooth, their Ethernet derivatives, as well as any other radio and wired protocols designated as 3G, 4G, 5G, and beyond, but not limited to many radios. Alternatively, either a wired communication standard or a protocol may be implemented. The computing module may include a plurality of communication modules. For example, the first communication module may be dedicated to short-range wireless communication such as Wi-Fi and Bluetooth, and the second communication module may be GPS, EDGE, GPRS, CDMA, WiMAX, LTE, Ev-DO, etc. It may be dedicated to long-distance wireless communication.

As used herein, a processor or processing unit is an electronic circuit that performs operations on some external data source, usually memory or some other data stream. The term is used herein to refer to a central processor (central processing unit) within a system or computer system (particularly a system-on-chip (SoC)) that combines many dedicated "processors".

As used herein, a system or system-on-chip (SoC or SOC) on a chip is also known as an integrated circuit (also known as an "IC" or "chip") that integrates all components of a computer or other electronic system. Is). It can include digital, analog, mixed signals, and often high frequency features, all on a single substrate. The SoC integrates a microcontroller (or microprocessor) with modern peripherals such as graphics processing units (GPUs), Wi-Fi modules, or coprocessors. The SoC may or may not include a built-in memory.

As used herein, a microcontroller or controller is a system that integrates a microprocessor with peripheral circuits and memory. The microcontroller (or MCU of the microcontroller unit) may be implemented as a small computer on a single integrated circuit. This may be similar to the SoC, which may include a microcontroller as one of its components. The microcontroller can accommodate memory and programmable input / output peripherals along with one or more core processing units (CPUs). Program memory in the form of ferroelectric RAM, NOR flash, or OTP ROM, and small amounts of RAM are also often included on the chip. Microcontrollers can be employed for embedded applications, as opposed to personal computers or other general purpose microprocessors composed of various individual chips.

As used herein, the term controller or microcontroller may be a stand-alone IC or chip device that interfaces with peripheral devices. This may be a link between two parts of a computer or controller on an external device that controls the operation of the device (and its connection to the device).

Any of the processors or microcontrollers described herein may be any single-core or multi-core processor, such as those known by the Texas Instruments ARM Cortex trade name. In one aspect, the processor, for example, on-chip memory of up to 40 MHz 256 KB single cycle flash memory or other non-volatile memory, the details of which are available in the product data sheet, for improving performance above 40 MHz. Prefetch buffer, 32KB single-cycle serial random access memory (SRAM), internal read-only memory with StaticrisWare® software (ROM), 2KB electrically erasable programmable read-only memory (EEPROM), one or two One or more pulse width modulation (PWM) modules, one or more orthogonal encoder input (QEI) analogs, one or more 12-bit analog-to-digital converters (ADCs) with 12 analog input channels ), Which may be the LM4F230H5QR ARM Cortex-M4F processor core available from Texas Instruments.

In one aspect, the processor may include a safety controller that includes two controller family families, such as the TMS570 and RM4x, also known by the Texas Instruments Hercules ARM Cortex R4 trade name. The safety controller may be configured specifically for IEC 61508 and ISO 26262 safety limit applications to provide a highly integrated safety mechanism while providing scalable performance, connectivity, and memory choices. Good.

The modular device is connected to a module that is acceptable within the surgical hub (eg, described in connection with FIGS. 3 and 9) and to various modules to connect or pair with the corresponding surgical hub. Includes surgical equipment or instruments to obtain. Modular devices include, for example, intelligent surgical instruments, medical imaging devices, suction / irrigation devices, smoke evacuators, energy generators, ventilators, inhalers, and displays. The modular devices described herein can be controlled by control algorithms. The control algorithm is on the modular device itself, on the surgical hub to which a particular modular device is paired, or on both the modular device and the surgical hub (eg, via a distributed computing architecture). ), Can be executed. In some examples, the control algorithm of a modular device is to the data sensed by the modular device itself (ie, by a sensor in the modular device, on the modular device, or by a sensor connected to the modular device). Control the device based on. This data may be related to the patient undergoing surgery (eg, tissue characteristics or injection pressure) or the modular device itself (eg, the speed of the knife moving forward, the motor current, or the energy level). For example, a surgical staple fastening and cutting instrument control algorithm can control the speed at which the instrument motor penetrates tissue and drives the knife based on the resistance the knife encounters as the knife advances.

FIG. 20 shows a form of a surgical system 1000 comprising a generator 1100 and various surgical instruments 1104, 1106, 1108 that can be used with it, wherein the surgical instrument 1104 is an ultrasonic surgical instrument. The surgical instrument 1106 is an RF electrosurgical instrument and the multifunctional surgical instrument 1108 is a combined ultrasonic / RF electrosurgical instrument. Generator 1100 can be configured for use with a variety of surgical instruments. According to various forms, the generator 1100 integrates, for example, the ultrasonic surgical instrument 1104, the RF electrosurgical instrument 1106, and the RF energy and ultrasonic energy simultaneously delivered from the generator 1100. It may be configured for use with a variety of surgical devices of various types, including the instrument 1108. In the form of FIG. 20, the generator 1100 is shown separately from the surgical instruments 1104, 1106, 1108, but in one form, the generator 1100 is any of the surgical instruments 1104, 1106, 1108. It may be formed integrally with the heel to form an integrated surgical system. The generator 1100 includes an input device 1110 located on the front panel of the console of the generator 1100. The input device 1110 may include any suitable device that produces a signal suitable for programming the operation of the generator 1100. The generator 1100 may be configured for wired or wireless communication.

The generator 1100 is configured to drive a plurality of surgical instruments 1104, 1106, 1108. The first surgical instrument is an ultrasonic surgical instrument 1104, which includes a handpiece 1105 (HP), an ultrasonic converter 1120, a shaft 1126, and an end effector 1122. The end effector 1122 includes an ultrasonic blade 1128 and a clamp arm 1140 that are acoustically coupled to the ultrasonic converter 1120. The handpiece 1105 includes a trigger 1143 that operates the clamp arm 1140 and a combination of toggle buttons 1134a, 1134b, 1134c for energizing and driving the ultrasonic blade 1128 or other functions. The toggle buttons 1134a, 1134b, and 1134c can be configured to energize the ultrasonic converter 1120 using the generator 1100.

The generator 1100 is also configured to drive a second surgical instrument 1106. The second surgical instrument 1106 is an RF electrosurgical instrument, comprising a handpiece 1107 (HP), a shaft 1127, and an end effector 1124. The end effector 1124 includes electrodes in the clamp arms 1142a and 1142b and returns through the conductor portion of the shaft 1127. The electrodes are connected to a bipolar energy source in the generator 1100 and are energized by the bipolar energy source. The handpiece 1107 includes a trigger 1145 for operating the clamp arms 1142a and 1142b and an energy button 1135 for operating an energy switch for energizing the electrodes in the end effector 1124.

The generator 1100 is also configured to drive a multifunctional surgical instrument 1108. The multifunctional surgical instrument 1108 includes a handpiece 1109 (HP), a shaft 1129, and an end effector 1125. The end effector 1125 includes an ultrasonic blade 1149 and a clamp arm 1146. The ultrasonic blade 1149 is acoustically coupled to the ultrasonic transducer 1120. The handpiece 1109 includes a trigger 1147 that operates the clamp arm 1146 and a combination of toggle buttons 1137a, 1137b, 1137c for energizing and driving the ultrasonic blade 1149 or other function. The toggle buttons 1137a, 1137b, 1137c are such that the generator 1100 is used to energize the ultrasonic converter 1120, and the bipolar energy source similarly housed in the generator 1100 is used to energize the ultrasonic blade 1149. Can be configured.

Generator 1100 can be configured for use with a variety of surgical instruments. According to various forms, the generator 1100 integrates, for example, the ultrasonic surgical instrument 1104, the RF electrosurgical instrument 1106, and the RF energy and ultrasonic energy simultaneously delivered from the generator 1100. It may be configured for use with a variety of surgical devices of various types, including the instrument 1108. In the form of FIG. 20, the generator 1100 is shown separately from the surgical instruments 1104, 1106, 1108, but in another form, the generator 1100 is of the surgical instruments 1104, 1106, 1108. It may be integrally formed with any one to form an integrated surgical system. As mentioned above, the generator 1100 includes an input device 1110 located on the front panel of the console of the generator 1100. The input device 1110 may include any suitable device that produces a signal suitable for programming the operation of the generator 1100. The generator 1100 may also include one or more output devices 1112. Further embodiments of generators for digitally generating electrical signal waveforms, and surgical instruments, are described in US Patent Application Publication No. 2017-0086914-A1, which is incorporated herein by reference in its entirety. There is.

FIG. 21 shows the end effector 1122 of an exemplary ultrasonic device 1104 according to at least one aspect of the present disclosure. The end effector 1122 may include a blade 1128 that may be coupled to the ultrasonic transducer 1120 via a waveguide. As described herein, the blade 1128 can vibrate when driven by the ultrasonic transducer 1120 and can cut and / or solidify the tissue when in contact with the tissue. According to various aspects and, as illustrated in FIG. 21, the end effector 1122 may further include a clamp arm 1140 that may be configured to cooperate with the blade 1128 of the end effector 1122. Along with the blade 1128, the clamp arm 1140 may include a series of jaws. Clamp arm 1140 may be pivotally connected to the distal end of shaft 1126 of instrument portion 1104. Clamp arm 1140 may include clamp arm tissue pads 1163 that may be formed from TEFLON® or other suitable low friction material. The pad 1163 is mounted to cooperate with the blade 1128 so that the pivotal motion of the clamp arm 1140 positions the clamp pad 1163 in a substantially parallel relationship with and in contact with the blade 1128. Can be done. With this configuration, the piece of tissue to be clamped can be gripped between the tissue pad 1163 and the blade 1128. The tissue pad 1163 may comprise a serrated configuration that includes a plurality of gripping teeth 1161s that are axially spaced apart and extend proximally to improve tissue grip in cooperation with the blade 1128. The clamp arm 1140 can transition from the open position shown in FIG. 21 to the closed position (where the clamp arm 1140 is in contact with or close to the blade 1128) in any suitable manner. For example, handpiece 1105 may include a jaw closing trigger. When activated by a clinician, the jaw closure trigger can pivot the clamp arm 1140 in any suitable manner.

The generator 1100 can be activated to provide the drive signal to the ultrasonic transducer 1120 in any suitable manner. For example, the generator 1100 may include a foot switch 1430 (FIG. 22) connected to the generator 1100 via a foot switch cable 1432. The clinician may activate the ultrasonic transducer 1120 by depressing the footswitch 1430, thereby activating the ultrasonic transducer 1120 and the blade 1128. In addition to, or instead of, the footswitch 1430, some embodiments of the device 1104 may use one or more switches located on the handpiece 1105, which when activated. , The ultrasonic converter 1120 can be operated on the generator 1100. In one aspect, for example, one or more switches may include, for example, a pair of toggle buttons 1134a, 1134b, 1134c to determine the mode of operation of device 1104 (FIG. 20). For example, when the toggle button 1134a is pressed down, the ultrasonic generator 1100 can provide the maximum drive signal to the ultrasonic converter 1120 to cause the ultrasonic converter 1120 to generate the maximum ultrasonic energy output. By pressing the toggle button 1134b, the ultrasonic generator 1100 can provide a user-selectable drive signal to the ultrasonic transducer 1120, causing the ultrasonic transducer 1120 to generate less than maximum ultrasonic energy output. .. The device 1104 may additionally or alternatively include a second switch for indicating the position of the jaw closing trigger in order to operate the jaws, for example, via the clamp arm 1140 of the end effector 1122. Also, in some embodiments, the ultrasonic generator 1100 can be activated based on the position of the jaw closure trigger (eg, when the clinician pushes down on the jaw closure trigger to close the jaws via the clamp arm 1140). , Ultrasonic energy can be applied).

Further or / or one or more switches may include a toggle button 1134c that causes the generator 1100 to provide a pulse output when pressed down (FIG. 20). The pulses may be provided, for example, at any suitable frequency and classification. In certain embodiments, the power level of the pulse may be, for example, the power level (maximum, less than maximum) associated with the toggle buttons 1134a, 1134b.

It will be appreciated that device 1104 may include any combination of toggle buttons 1134a, 1134b, 1134c (FIG. 20). For example, device 1104 has only two toggle buttons, a toggle button 1134a for generating the maximum ultrasonic energy output and a toggle button 1134c for generating a pulse output at either the maximum or less power level each time. Can be configured to have. Thus, the drive signal output configuration of the generator 1100 may be five continuous signals, or any individual number of individual pulse signals (1, 2, 3, 4, or 5 times). In certain embodiments, the particular drive signal configuration may be controlled, for example, based on the EEPROM settings of the generator 1100 and / or the user's power level selection (s).

In certain embodiments, a two-position switch may be provided as an alternative to the toggle button 1134c (FIG. 20). For example, device 1104 may include a toggle button 1134a for generating continuous output at maximum power level and a two-position toggle button 1134b. In the first detent position, the toggle button 1134b may generate continuous output below the maximum power level, and in the second detent position, the toggle button 1134b (eg, maximum or maximum, depending on the EEPROM setting). A pulsed output may be generated (at any output level less than or equal to).

In some embodiments, the RF electrosurgical end effector 1124, 1125 (FIG. 20) may also include a pair of electrodes. The electrodes may communicate with the generator 1100, for example via a cable. Electrodes can be used, for example, to measure the impedance of tissue pieces present between the clamp arms 1142a, 1146 and the blades 1142b, 1149. The generator 1100 may provide a signal (eg, a non-therapeutic signal) to the electrodes. The impedance of the tissue piece can be found, for example, by monitoring the current, voltage, etc. of the signal.

In various aspects, the generator 1100 may include several distinct functional elements such as the modules and / or blocks shown in FIG. 22, which is a diagram of the surgical system 1000 of FIG. Various functional elements or modules may be configured to drive different types of surgical devices 1104, 1106, 1108. For example, the ultrasonic generator module can drive an ultrasonic device such as the ultrasonic device 1104. The electrosurgical / RF generator module can drive the electrosurgical device 1106. The module can generate the corresponding drive signal to drive the surgical devices 1104, 1106, 1108. In various aspects, the ultrasonic generator module and / or the electrosurgery / RF generator module may each be formed integrally with the generator 1100. Alternatively, one or more of the modules may be provided as separate circuit modules electrically connected to the generator 1100. (Modules are shown with virtual lines to illustrate this option). Also, in some embodiments, the electrosurgery / RF generator module may be formed integrally with the ultrasound generator module and vice versa.

According to the described embodiment, the ultrasonic generator module may generate a drive signal or a plurality of drive signals of a specific voltage, current, and frequency (eg, 55,500 cycles / second, or Hz). The drive signal or the plurality of drive signals may be provided to an ultrasonic device 1104, in particular a converter 1120 capable of operating, for example, as described above. In one aspect, the generator 1100 can be configured to generate a drive signal for a particular voltage, current, and / or frequency output signal that can be stepped with high resolution, accuracy, and reproducibility.

According to the aspects described, the electrosurgery / RF generator module uses radio frequency (RF) energy to deliver a drive signal or multiple drive signals with sufficient output power to perform a bipolar electrosurgery procedure. Can be generated. In bipolar electrosurgery applications, for example, the drive signal may be provided, for example, to the electrodes of electrosurgical device 1106, as described above. Thus, the generator 1100 can be configured for therapeutic purposes by applying sufficient electrical energy to the tissue to treat the tissue (eg, coagulation, ablation, tissue welding, etc.).

The generator 1100 may include, for example, an input device 2150 (FIG. 25B) located on the front panel of the console of the generator 1100. The input device 2150 can include any suitable device that produces a signal suitable for programming the operation of the generator 1100. During operation, the user can use the input device 2150 to program the operation of the generator 1100 or otherwise control it. The input device 2150 is housed by the generator (eg, in the generator) to control the operation of the generator 1100 (eg, the operation of the ultrasonic generator module and / or the electrosurgery / RF generator module). It may include any suitable device that produces a signal that can be used (by one or more processors). In various aspects, the input device 2150 includes one or more of buttons, switches, thumbwheels, keyboards, keypads, touch screen monitors, pointing devices, remote connections to general purpose or dedicated computers. In another aspect, the input device 2150 may include a suitable user interface, such as, for example, one or more user interface screens displayed on a touch screen monitor. Thus, with the input device 2150, the user can use, for example, the current (I), voltage (V), of the drive signal or plurality of drive signals generated by the ultrasonic generator module and / or the electrosurgical / RF generator module. Various operating parameters of the generator, such as frequency (f) and / or duration (T), can be set or programmed.

The generator 1100 may also include, for example, an output device 2140 (FIG. 25B) located on the front panel of the generator 1100 console. The output device 2140 includes one or more devices for providing sensory feedback to the user. Such devices may include, for example, a visual feedback device (eg, LCD display screen, LED indicator), an audible feedback device (eg, speaker, buzzer) or a tactile feedback device (eg, tactile activator).

Specific modules and / or blocks of generator 1100 may be described as examples, but more or less numbers of modules and / or blocks may be used, which may still be within the scope of the embodiment. Let's understand. Further, for ease of description, various aspects may be described with respect to the module and / or block, such module and / or block being one or more hardware components such as a processor. Digital signal processors (DSPs), programmable logic mechanisms (PLDs), application-specific integrated circuits (ASICs), circuits, registers and / or software components such as programs, subroutines, logic and / or hardware components. And software components may be implemented in combination.

In one aspect, the ultrasound generator drive module and the electrosurgery / RF drive module 1110 (FIG. 20) are one or more embedded applications implemented as firmware, software, hardware, or any combination thereof. May include. Modules can include various executable modules such as software, programs, data, drivers, application program interfaces (APIs), and so on. The firmware can be stored in bitmasked read-only memory (ROM) or non-volatile memory (NVM) such as flash memory. In various implementations, the flash memory can be stored by storing the firmware in ROM. NVMs are, for example, programmable ROMs (PROMs), erasable programmable ROMs (EPROMs), electrically erasable programmable ROMs (EEPROMs), or dynamic RAMs (DRAMs), double data rate DRAMs (DDRAMs), and / or synchronous DRAMs. Other types of memory may be included, including a battery-backed random access memory (RAM) such as a DRAM).

In one aspect, the module executes program instructions for monitoring various measurable characteristics of devices 1104, 1106, 1108 and corresponds output drive signals or plurality for operating devices 1104, 1106, 1108. Includes hardware components implemented as a processor for producing output drive signals. In an embodiment in which the generator 1100 is used with the device 1104, the drive signal may drive the ultrasonic transducer 1120 in cutting and / or coagulation mode. The electrical properties of the device 1104 and / or tissue may be measured and used to control the mode of operation of the generator 1100 and / or may be provided as feedback to the user. In an embodiment in which the generator 1100 is used with the device 1106, the drive signal may supply electrical energy (eg, RF energy) to the end effector 1124 in cutting, solidifying and / or drying modes. The electrical properties of the device 1106 and / or tissue may be measured and used to control the mode of operation of the generator 1100 and / or may be provided as feedback to the user. In various aspects, as mentioned above, the hardware components can be implemented as DSPs, PLDs, ASICs, circuits, and / or registers. In one aspect, the processor stores and executes computer software program instructions to drive various components of devices 1104, 1106, 1108, such as the ultrasonic converter 1120 and end effectors 1122, 1124, 1125. It may be configured to generate a function output signal.

Electromechanical ultrasonic systems include ultrasonic converters, waveguides, and ultrasonic blades. Electromechanical ultrasonic systems have an initial resonant frequency defined by the physical properties of the ultrasonic converter, waveguide, and ultrasonic blade. _{The ultrasonic converter is excited by an AC voltage V g} (t) and current _Ig (t) signal equal to the resonant frequency of the electromechanical ultrasonic system. When the electromechanical ultrasonic system resonates, _{the phase difference between the voltage V g} (t) signal and the current _Ig (t) signal is zero. In other words, at resonance, the inductive impedance is equal to the capacitive impedance. As the ultrasonic blade heats up, compliance with the ultrasonic blade (modeled as equivalent capacitance) changes the resonant frequency of the electromechanical ultrasonic system. Therefore, the inductive impedance is no longer equal to the capacitive impedance, which causes a mismatch between the drive frequency and the resonant frequency of the electromechanical ultrasonic system. Here the system operates "off-resonance". The mismatch between the drive frequency and the resonance frequency manifests itself as a phase difference between the _{voltage V g} (t) signal and the current _{Ig (t) signal applied to the ultrasonic transducer.} The generator electronics _{can easily monitor the phase difference between the voltage V g} (t) signal and the current _Ig (t) signal and continuously keep the drive frequency until the phase difference becomes zero again. Can be adjusted. At this point, the new drive frequency is equal to the new resonant frequency of the electromechanical ultrasonic system. Phase and / or frequency changes can be used as indirect measurements of ultrasonic blade temperature.

As shown in FIG. 23, the electromechanical properties of the ultrasonic transducer are a first branch with capacitance and a second with series-connected inductance, resistance, and capacitance that defines the electromechanical properties of the resonator. It may be modeled as an equivalent circuit that includes an "behavior" branch. Known ultrasonic generators may include an adjusting inductor to tune out the capacitance at a resonant frequency so that substantially all of the generator drive signal current flows within the operating branch. Therefore, by using a regulating inductor, the drive signal current of the generator represents the operating branch current, so that the generator can control its drive signal to maintain the resonant frequency of the ultrasonic transducer. The tuned inductor can also transform the phase impedance plot of the ultrasonic transducer to improve the frequency fixation capability of the generator. However, the adjusting inductor must be compatible with the particular capacitance of the ultrasonic transducer at the operating resonant frequency. In other words, different ultrasonic transducers with different capacitances require different adjusting inductors.

FIG. 23 shows an equivalent circuit 1500 of an ultrasonic converter such as an ultrasonic converter 1120 according to one aspect. Circuit 1500 has a first "working" branch with _{series-connected inductance L s} , resistance R _s , and capacitance C _s , and a second with _{capacitance C 0} , which defines the electromechanical properties of the resonator. Includes a capacitive branch of. Flows through the operating current _I m (t) is the first branch, with the current _{I g (t) ~I m (} t) flows through the capacitive branch, the driving current _I g (t) is the generator It may be received from the drive voltage V _g (t). Control of the electromechanical properties of the ultrasonic transducer may be achieved by suitably controlling _Ig (t) and V _{g (t).} As mentioned above, the known generator architecture has a _{capacitance C 0} at the resonant frequency within the parallel resonant circuit so that substantially all of the _{generator's current output Ig (t) flows through the operating branch. Can include an adjusting inductor Lt} (shown by a virtual line in FIG. 23) for tune-out. In this method, control of the operating branch current _Im (t) _{is achieved by controlling the current output Ig} (t) of the generator. The adjusting inductor L _{t is unique to the capacitance C 0} of the ultrasonic converter, but different ultrasonic converters with different static capacitances require _{different adjusting inductor L t.} Further, since the adjusting inductor L _t matches the nominal value of the _{capacitance C 0} at a single resonance frequency, _{accurate control of the operating branch current Im} (t) is guaranteed only at that frequency. Precise control of the operating branch current is compromised as the frequency drops due to the temperature of the transducer.

Various aspects of the generator 1100 may monitor the operation branch current I _{m (t)} without resorting to adjust inductor L _t. Rather, the generator 1100 dynamically and continuously (eg, in real time) during the application of power for a particular ultrasonic surgical device 1104 to determine the value of the _{operating branch current Im (t).} Capacitance C ₀ measurements can be used (along with drive signal voltage and current feedback data). Thus, these aspects of the generator 1100, not only in a single resonant frequency determined by the nominal value of the capacitance C _0, or is adjusted to any value of the capacitance C ₀ at an arbitrary frequency It is possible to provide virtual tuning to simulate a resonating system.

FIG. 24 is a simplified block diagram of one aspect of the generator 1100 to provide the inductorless adjustment described above, among other advantages. 25A-25C show the architecture of the generator 1100 of FIG. 24 in one aspect. Referring to FIG. 24, the generator 1100 may include a patient insulation stage 1520 that communicates with a non-insulation stage 1540 via a power transformer 1560. The secondary winding 1580 of the power transformer 1560 is included in the insulation stage 1520 and may include a tap configuration (eg, center tap or non-center tap configuration), eg, for ultrasonic surgical equipment 1104 and electrosurgery. A drive signal output unit 1600a, 1600b, 1600c for outputting a drive signal to various surgical devices such as the device 1106 is defined. In particular, the drive signal output units 1600a, 1600b, 1600c may output a drive signal (for example, a 420V RMS drive signal) to the ultrasonic surgical apparatus 1104, and the drive signal output units 1600a, 1600b, 1600c are electric. A drive signal (eg, a 100 V RMS drive signal) may be output to the surgical device 1106, where the output unit 1600b corresponds to the center tap of the power transformer 1560. The non-insulated stage 1540 can include a power amplifier 1620 having an output section connected to the primary winding 1640 of the power transformer 1560. In certain embodiments, the power amplifier 1620 may include, for example, a push-pull amplifier. The non-isolated stage 1540 may further include a programmable logic mechanism 1660 for supplying digital output to the digital-to-analog converter (DAC) 1680, followed by the digital-to-analog converter (DAC) 1680. The analog signal to be used is supplied to the input unit of the power amplifier 1620. In certain embodiments, the programmable logic mechanism 1660 can include, for example, a field programmable gate array (FPGA). The programmable logic mechanism 1660 controls the input of the power amplifier 1620 via the DAC1680, resulting in a number of parameters (eg, frequency, waveform shape) of the drive signal appearing in the drive signal output units 1600a, 1600b, 1600c. , Waveform amplitude) can be controlled. In certain embodiments, and as described below, along with a programmable logic mechanism 1660, a processor (eg, a processor 1740 described below), many digital signal processing (DSP) -based and / or other control algorithms. Can be executed to control the parameters of the drive signal output by the generator 1100.

Power can be supplied to the bus of the power amplifier 1620 by the switch mode regulator 1700. In certain embodiments, the switch mode regulator 1700 may include, for example, an adjustable back regulator. As mentioned above, the non-insulated stage 1540 can further include a processor 1740, which, in one aspect, includes a DSP processor such as the ADSP-21469 SHARC DSP available from Analog Devices (Norwood, Mass.), For example. Can include. In certain embodiments, the processor 1740 may control the operation of the switch mode power converter 1700 in response to voltage feedback data received by the processor 1740 from the power amplifier 1620 via an analog-to-digital converter (ADC) 1760. it can. For example, in one aspect, the processor 1740 can receive the waveform envelope of a signal (eg, an RF signal) amplified by the power amplifier 1620 as an input via the ADC 1760. Processor 1740 subsequently controls the switch mode regulator 1700 (eg, via pulse width modulation (PWM) output) so that the rail voltage supplied to the power amplifier 1620 tracks the waveform envelope of the amplified signal. Can be done. By dynamically modulating the rail voltage of the power amplifier 1620 based on the waveform envelope, the efficiency of the power amplifier 1620 can be significantly improved compared to a fixed rail voltage amplifier scheme. Processor 1740 may be configured for wired or wireless communication.

In a particular embodiment and as described in more detail in connection with FIGS. 26A-26B, the programmable logic mechanism 1660, along with the processor 1740, directly executes a digital synthesizer (DDS) control scheme to generate. The waveform shape, frequency, and / or amplitude of the drive signal output by the device 1100 can be controlled. In one aspect, for example, the programmable logic mechanism 1660 controls the DDS by calling a waveform sample stored in a dynamically updated look-up table (LUT), such as a RAM LUT, which may be built into the FPGA. Algorithm 2680 (FIG. 26A) can be executed. This control algorithm is particularly useful in ultrasonic applications where an ultrasonic converter, such as the ultrasonic converter 1120, can be driven by a distinct sinusoidal current at its resonant frequency. Minimization or reduction of the total distortion of the operating branch current can correspondingly minimize or reduce the undesired resonance effect, as other frequencies can excite the parasitic resonance. The waveform shape of the drive signal output by the generator 1100 can be influenced by various distortion sources present in the output drive circuit (eg, power transformer 1560, power amplifier 1620), and thus the voltage and current based on the drive signal. Feedback data can be input to algorithms such as the error control algorithm executed by the processor 1740, which is a dynamic, ongoing-based (eg, in real-time), LUT-stored waveform sample. Compensate for distortion by properly pre-distorting or correcting. In one aspect, the amount or degree of pre-strain applied to the LUT sample may be based on the error between the calculated operating branch current and the desired current waveform shape, the error being determined on a sample-by-sample basis. In this way, the pre-distorted LUT sample, when processed by the drive circuit, provides an operating branch drive signal with the desired waveform shape (eg, sinusoidal) in order to optimally drive the ultrasonic transducer. Can occur. Therefore, in such an embodiment, the LUT waveform sample is required to finally generate an operating branch drive signal of the desired waveform, taking into account the distortion effect rather than the desired waveform shape of the drive signal. Represents the waveform shape.

The non-insulated stage 1540 is connected to the output of the power transformer 1560 via the insulated transformers 1820 and 1840, respectively, in order to sample the voltage and current of the drive signal output by the generator 1100. ADC 1800 can be further included. In certain embodiments, the ADC 1780 and 1800 can be configured to sample at high speeds (eg, 80 Mbps) to allow oversampling of drive signals. In one aspect, for example, the sampling rate of ADC1780, 1800 can allow oversampling of about 200 times the drive signal (depending on the drive frequency). In certain embodiments, the sampling operation of the ADC 1780 and 1800 can be performed by a single ADC that receives the input voltage and current signals via a bidirectional multiplexer. The use of fast sampling in the aspect of the generator 1100 is, among other things, the calculation of complex currents flowing through the operating branch, which can be used in certain embodiments to perform the DDS-based waveform shape control described above), sampled. It is possible to enable accurate digital filtering of the signal and highly accurate calculation of actual power consumption. The voltage and current feedback data output by the ADC 1780 and 1800 may be received and processed by the programmable logic mechanism 1660 (eg, FIFO buffering, multiplexing), eg for subsequent reads by the processor 1740. In addition, it may be stored in the data memory. As mentioned above, the voltage and current feedback data can be used as input to the algorithm to pre-distort or modify the LUT waveform sample on a dynamic and progressive basis. In a particular aspect, this is in the corresponding LUT sample where each stored voltage and current feedback data pair was output by the programmable logic mechanism 1660 when the voltage and current feedback data pair was acquired. It may need to be indexed based on or otherwise associated with it. The synchronization of the LUT sample with the voltage and current feedback data in this way contributes to the accurate timing and stability of the pre-distortion algorithm.

In certain embodiments, the voltage and current feedback data can be used to control the frequency and / or amplitude (eg, current amplitude) of the drive signal. In one aspect, for example, voltage and current feedback data can be used to determine the impedance phase, eg, the phase difference between the voltage-driven signal and the current-driven signal. The frequency of the drive signal is then controlled to minimize or reduce the difference between the determined impedance phase and the impedance phase set value (eg 0 °), thereby minimizing the effect of harmonic distortion. Alternatively, it can be reduced and the impedance phase measurement accuracy can be improved accordingly. The determination of the phase impedance and the frequency control signal may be performed, for example, in the processor 1740, and the frequency control signal is supplied as an input to the DDS control algorithm executed by the programmable logic mechanism 1660.

The impedance phase can be determined by Fourier analysis. In one aspect, _{the phase difference between the generator voltage V g} (t) drive signal and the generator current _Ig (t) drive signal is the Fast Fourier Transform (FFT) or Discrete Fourier Transform (DFT) as follows: Can be determined using.

By evaluating the Fourier transform at the frequency of the sinusoidal wave, the following can be obtained.

Other approaches include weighted least squares estimation, Kalman filtering, and space vector-based techniques. Virtually all of the processing in the FFT or DFT technology may be performed within the digital domain using, for example, a two-channel fast ADC 1780, 1800. In one technique, digital signal samples of voltage and current signals are Fourier transformed by FFT or DFT. The phase angle φ at any time point can be calculated by the following formula:

式中、φは位相角であり、ｆは周波数であり、ｔは時間であり、φ_０は、ｔ＝０における位相である。

In the equation, φ is the phase angle, f is the frequency, t is the time, and φ ₀ is the phase at t = 0.

Another technique for determining the phase difference between a voltage V _g (t) signal and a current _Ig (t) signal is the zero crossing method, which produces accurate results. If voltage V _{g (t)} signal and the current I _{g (t)} signal having the same frequency, the zero crossing of the positive from the negative voltage signal V _{g (t)} triggers the beginning of the pulse, while the current signal _{Each negative to positive zero intersection of Ig} (t) triggers the end of the pulse. The result is a pulse train with a pulse width proportional to the phase angle between the voltage and current signals. In one aspect, the pulse train can be passed through an averaging filter to obtain a phase difference measurement. In addition, positive to negative zero intersections are used in a similar manner and the results can be averaged to reduce any effects of DC and harmonic components. In one embodiment, the analog voltage V _g (t) signal and the current _Ig (t) signal are converted to a high digital signal if the analog signal is positive and a low digital signal if the analog signal is negative. .. High-precision phase evaluation requires a rapid transition between high and low. In one aspect, a Schmitt trigger can be used with an RC stabilized network to convert an analog signal to a digital signal. In other embodiments, edge-triggered RS flip-flops and auxiliary circuits may be used. In yet another aspect, the zero crossing technique may use an eXcrusive OR (XOR) gate.

Other techniques for determining the phase difference between a voltage signal and a current signal include methods such as lithage diagram and image monitoring, trivoltmeter, cross-coil, vector voltmeter, and vector impedance. Also referred to herein are phase measurements, phase lock loops, Phase Measurement, Peter O'Shea, 2000 CRC Press LLC, <http: // www. engagebase. com> includes other techniques described.

In another aspect, for example, current feedback data can be monitored to maintain the current amplitude of the drive signal at the current amplitude set value. The current amplitude set value may be directly specified, or may be indirectly determined based on the specified voltage amplitude and power set value. In certain embodiments, control of the current amplitude can be performed by a control algorithm, such as a proportional calculus (PID) control algorithm within the processor 1740. Variables controlled by the control algorithm to properly control the current amplitude of the drive signal include, for example, scaling of the LUT waveform sample stored in the programmable logic mechanism 1660 and / or DAC1680 via DAC1860 (which). Can supply the input to the power amplifier 1620).

The non-insulated stage 1540 may further include a processor 1900, among other things, to provide user interface (UI) functionality. In one aspect, the processor 1900 can include, for example, an Atmel AT91 SAM9263 processor having an ARM926EJ-S core available from Atmel Corporation (San Jose, California). Examples of UI features supported by processor 1900 include auditory and visual user feedback, communication with peripherals (eg, via a universal serial bus (USB) interface), communication with footswitch 1430, and input. Communication with the device 2150 (eg, touch screen display) and communication with the output device 2140 (eg, speaker) can be mentioned. Processor 1900 can communicate with Processor 1740 and programmable logic mechanisms (eg, via the Serial Peripheral Interface (SPI) bus). Processor 1900 can primarily support UI functionality, but it can also work with processor 1740 to achieve risk mitigation in certain embodiments. For example, processor 1900 may be programmed to monitor various aspects of user input and / or other inputs (eg, touch screen input 2150, footswitch 1430 input, temperature sensor input 2160) and is erroneous. When the state is detected, the drive output of the generator 1100 can be invalidated.

In certain embodiments, both processor 1740 (FIG. 24, 25A) and processor 1900 (FIG. 24, 25B) can determine and monitor the operating state of the generator 1100. For processor 1740, the operating state of generator 1100 can determine, for example, which control and / or diagnostic process is performed by processor 1740. For the processor 1900, the operating state of the generator 1100 can determine, for example, which element of the user interface (eg, display screen, sound) is provided to the user. Processors 1740 and 1900 maintain the current operating state of the generator 1100 separately and recognize and evaluate possible transitions from the current operating state. Processor 1740 can act as a master in this relationship and determine when transitions between operating states occur. Processor 1900 can recognize valid transitions between operating states and can verify that a particular transition is appropriate. For example, when processor 1740 commands processor 1900 to transition to a particular state, processor 1900 can confirm that the requested transition is valid. If the transition between states requested by processor 1900 is determined to be invalid, processor 1900 may put generator 1100 into failure mode.

The non-insulated stage 1540 is a controller 1960 (FIG. 24, FIG. 24, for monitoring the input device 2150 (eg, a capacitive touch sensor used to turn the generator 1100 on and off, a capacitive touch screen). FIG. 25B) can be further included. In certain embodiments, the controller 1960 may include at least one processor and / or other controller device that communicates with the processor 1900. In one aspect, for example, controller 1960 is a processor configured to monitor user input provided via one or more capacitive touch sensors (eg, Mega168 8 available from Atmel). A bit controller) can be provided. In one aspect, the controller 1960 can include a touch screen controller (eg, a QT5480 touch screen controller available from Atmel) for controlling and managing the acquisition of touch data from a capacitive touch screen.

In a particular embodiment, when the generator 1100 is in the "power off" state, the controller 1960 delivers operating power (eg, via a line from the power source of the generator 1100, such as power supply 2110 (FIG. 24) described below). You can continue to receive. In this way, the controller 1960 can continue to monitor the input device 2150 for turning the generator 1100 on and off (eg, a capacitive touch sensor located on the front panel of the generator 1100). When the generator 1100 is in the "power off" state, the controller 1960 can power up when it detects that the user has activated the "on / off" input device 2150 (eg, 1 of power supply 2110). Enable the operation of one or more DC / DC voltage converters 2130 (FIG. 24)). As a result, the controller 1960 can initiate a sequence for transitioning the generator 1100 to the "powered on" state. Conversely, if activation of the "on / off" input device 2150 is detected while the generator 1100 is in the "power on" state, the controller 1960 is a sequence for transitioning the generator 1100 to the "power off" state. Can be started. In certain embodiments, for example, the controller 1960 can report the activation of the "on / off" input device 2150 to the processor 1900, which subsequently causes the generator 1100 to transition to the "power off" state. Executes the processing sequence required for. In such an embodiment, the controller 1960 may not have an independent capability to cause power removal from the generator 1100 after its "powered on" state has been established.

In certain embodiments, the controller 1960 can cause the generator 1100 to provide auditory or other sensory feedback to warn the user that a "power on" or "power off" sequence has begun. Such warnings may be provided at the beginning of a "power on" or "power off" sequence, and before the start of other processes associated with the sequence.

In certain embodiments, the insulating stage 1520 comprises, for example, a control circuit of a surgical device (eg, a control circuit with a handpiece switch) and components of the non-insulated stage 1540 (eg, programmable logic mechanism 1660, processor 1740). , And / or a device interface circuit 1980 to provide a communication interface with (such as processor 1900). The instrument interface circuit 1980 provides the components and information of the non-insulated stage 1540 via a communication link that maintains an appropriate degree of electrical insulation between the stages 1520 and 1540, such as an infrared (IR) based communication link. Can be exchanged. For example, a low dropout voltage regulator powered by an insulated transformer driven from a non-insulated stage 1540 can be used to power the appliance interface circuit 1980.

In one aspect, the instrument interface circuit 1980 can include a programmable logic mechanism 2000 (eg FPGA) that communicates with the signal conditioning circuit 2020 (FIGS. 24 and 25C). The signal conditioning circuit 2020 can be configured to receive a periodic signal (eg, a 2 kHz square wave) from the programmable logic mechanism 2000 to generate a bipolar call signal having the same frequency. The call signal can be generated using, for example, a bipolar current source supplied by a differential amplifier. The call signal is transmitted to the surgical device control circuit (eg, by using a conductive pair in a cable that connects the generator 1100 to the surgical device) and the state or configuration of the control circuit. Can be monitored to determine. For example, a control circuit may have one or more characteristics of the calling signal (eg, amplitude, etc.) such that the state or configuration of the control circuit can be individually identified based on one or more characteristics. A large number of switches, registers, and / or diodes may be included to modify the rectification. For example, in one aspect, the signal conditioning circuit 2020 may include an ADC for generating a sample of the voltage signal that appears between the inputs of the control circuit generated by the passage of the call signal. The programmable logic mechanism 2000 (or one component of the non-insulated stage 1540) can subsequently determine the state or configuration of the control circuit based on the ADC sample.

In one aspect, the instrument interface circuit 1980 is associated with a programmable logic mechanism 2000 (or other element of the instrument interface circuit 1980), located inside the surgical device, or otherwise associated with the surgical device. A first data circuit interface 2040 can be provided that enables information exchange with the first data circuit. In certain embodiments, for example, the first data circuit 2060 is in a cable integrally attached to the handpiece of the surgical device, or an adapter for interfacing a particular surgical device type or model with the generator 1100. It may be placed inside. In certain embodiments, the first data circuit may include a non-volatile storage device, such as an electrically erasable programmable read-only memory (EEPROM) device. In a particular embodiment and again with reference to FIG. 24, the first data circuit interface 2040 can be implemented separately from the programmable logic mechanism 2000, with the programmable logic mechanism 2000 and the first data circuit. Suitable circuits (eg, individual logic mechanisms, processors) that allow communication between them can be provided. In another aspect, the first data circuit interface 2040 may be integral with the programmable logic mechanism 2000.

In certain embodiments, the first data circuit 2060 can store information about the particular surgical device with which the first data circuit 2060 is associated. Such information can include, for example, model numbers, serial numbers, number of operations in which the surgical device has been used, and / or other types of information. This information is read by the instrument interface circuit 1980 (eg, by the programmable logic mechanism 2000) and presented to the user via the output device 2140 and / or controls the function or operation of the generator 1100. For this purpose, it may be transferred to the components of the non-isolated stage 1540 (eg, programmable logic mechanism 1660, processor 1740, and / or processor 1900). Further, any kind of information can be transmitted to the first data circuit 2060 via the first data circuit interface 2040 for storage in the first data circuit 2060 (eg, programmable). (Using Logic Mechanism 2000). Such information can include, for example, the latest number of operations in which the surgical device has been used, and / or the date and / or time of its use.

As mentioned above, the surgical instrument may be removable from the handpiece to facilitate instrument compatibility and / or disposability (eg, instrument 1106 may be removable from handpiece 1107. May be). In such cases, known generators may have limited ability to recognize the particular instrument configuration being used and to optimize control and diagnostic processes accordingly. However, adding a readable data circuit to the surgical instrument to address this issue is problematic from a compatibility standpoint. For example, designing a surgical device to maintain backward compatibility with a generator that lacks the required data reading capabilities is impractical, for example, due to different signal schemes, design complexity, and cost. In some cases. Other aspects of the instrument economically use data circuits that can be implemented in existing surgical instruments and minimize design changes to maintain compatibility between surgical instruments and modern generator platforms. Address these concerns by doing so.

Further, aspects of the generator 1100 can allow communication with instrument-based data circuits. For example, the generator 1100 may be configured to communicate with a second data circuit (eg, a data circuit) housed within a surgical instrument instrument (eg, instrument 1104, 1106, or 1108). The instrument interface circuit 1980 can include a second data circuit interface 2100 that enables this communication. In one aspect, the second data circuit interface 2100 can include a tristate digital interface, but other interfaces can also be used. In certain embodiments, the second data circuit can be generally any circuit for transmitting and / or receiving data. In one aspect, for example, a second data circuit may store information about the particular surgical instrument to which this circuit is associated. Such information can include, for example, model numbers, serial numbers, number of movements in which surgical instruments have been used, and / or any other type of information. Further or / or any kind of information can be transmitted to the second data circuit via the second data circuit interface 2100 for storage in the second data circuit (eg, programmable). Using logic mechanism 2000). Such information may include, for example, the latest number of movements in which the instrument has been used, and / or the date and / or time of its use. In certain embodiments, the second data circuit can transmit data acquired by one or more sensors (eg, appliance-based temperature sensors). In certain embodiments, the second data circuit can receive data from the generator 1100 and provide the user with a display (eg, LED display or other visible display) based on the received data.

In certain embodiments, the second data circuit and the second data circuit interface 2100 do not need to be provided with additional conductors for this purpose (eg, dedicated conductors of the cable connecting the handpiece to the generator 1100). It can be configured to achieve communication between the programmable logic mechanism 2000 and the second data circuit. In one aspect, a one-wire bus communication scheme implemented on existing cabling, for example, one of the conductors used transmits a call signal from the signal conditioning circuit 2020 to the control circuit in the handpiece. Can be used to transfer information to and from a second data circuit. In this way, the originally necessary design changes or modifications of the surgical device are minimized or reduced. Moreover, the presence of a second data circuit is a necessary data read, as various types of communication can be performed over common physical channels (with or without frequency band separation). It is "invisible" to the non-functional generator and can therefore allow backward compatibility of surgical instruments.

In certain embodiments, the insulation stage 1520 may include at least one blocking capacitor 2960-1 (FIG. 25C) connected to the drive signal output section 1600b to prevent the patient from being energized with DC current. A single blocking capacitor may be required to comply with, for example, medical regulations or standards. Although failures in single capacitor designs are relatively rare, such failures can nevertheless have negative consequences. In one aspect, a second blocking capacitor 2960-2 is provided in series with the blocking capacitor 2960-1, and a current leak from a point between the blocking capacitors 2960-1 and 2960-2 is induced, for example, by a leakage current. It can be monitored by an ADC 2980 for sampling the current voltage. The sample may be received, for example, by the programmable logic mechanism 2000. Based on the change in leakage current (shown by the voltage sample in the embodiment of FIG. 24), the generator 1100 can determine when at least one of the blocking capacitors 2960-1 and 2960-2 has failed. Therefore, the aspect of FIG. 24 can provide benefits for a single capacitor design with a single failure point.

In certain embodiments, the non-insulated stage 1540 may include a power source 2110 for outputting DC power at suitable voltages and currents. The power supply may include, for example, a 400 W power supply for outputting a 48 VDC system voltage. As mentioned above, the power supply 2110 receives the output of the power supply and produces one or more DCs at the voltage and current required by the various components of the generator 1100. A / DC voltage converter 2130 can be further provided. As mentioned above in connection with controller 1960, one or more of the DC / DC voltage converters 2130 are when the controller 1960 detects the activation of the "on / off" input device 2150 by the user. An input may be received from the controller 1960 to enable the operation or activation of the DC / DC voltage converter 2130.

26A-26B show specific functional and structural aspects of one aspect of the generator 1100. Feedback indicating the current and voltage output from the secondary winding 1580 of the power transformer 1560 is received by the ADC 1780 and 1800, respectively. As shown, the ADC 1780 and 1800 can be implemented as a 2-channel ADC and at high speed (eg 80 mps) to allow oversampling of the drive signal (eg approximately 200 times oversampling) The feedback signal can be sampled. Current and voltage feedback signals can be properly tuned in the analog domain prior to processing by ADC1780 and 1800 (eg amplification, filtering). Current and voltage feedback samples from ADC1780 and 1800 can be individually buffered and then multiplexed or interleaved within a single data stream within block 2120 of programmable logic mechanism 1660. In the aspects of FIGS. 26A-26B, the programmable logic mechanism 1660 comprises an FPGA.

The multiplexed current and voltage feedback samples can be received by a parallel data acquisition port (PDAP) implemented within block 2144 of processor 1740. The PDAP can include a packing unit for performing any of the many methods for correlating a multiplexed feedback sample with a memory address. In one aspect, for example, the feedback sample corresponding to a particular LUT sample output by the programmable logic mechanism 1660 is one or more memory addresses associated with or indexed by the LUT address of the LUT sample. Can be remembered at. In another aspect, the feedback sample corresponding to a particular LUT sample output by the programmable logic mechanism 1660 can be stored in a common storage location along with the LUT address of the LUT sample. In any case, the feedback sample can be stored so that the address of the LUT sample from which a particular set of feedback samples is derived can then be confirmed. As mentioned above, synchronization of the LUT sample address and feedback sample thus contributes to the accurate timing and stability of the pre-distortion algorithm. A direct memory access (DMA) controller implemented in block 2166 of processor 1740 is a feedback sample (and arbitrary LUT sample address data where applicable) at a designated storage location 2180 (eg, internal RAM) of processor 1740. Can be memorized.

Block 2200 of processor 1740 can perform a pre-distortion algorithm to pre-distort or modify a LUT sample stored in a programmable logic mechanism 1660 on a dynamic ongoing basis. As mentioned above, the LUT sample pre-distortion can compensate for various causes of distortion present in the output drive circuit of the generator 1100. The pre-distorted LUT sample therefore, when processed by the drive circuit, produces a drive signal with the desired waveform shape (eg, sinusoidal) in order to optimally drive the ultrasonic transducer.

In block 2220 of the pre-distortion algorithm, the current flowing through the operating branch of the ultrasonic transducer is determined. Operation branch currents, for example, current and voltage feedback samples (which, when suitably scaled, may represent the I _g and V _g models above in FIG. 23) stored in the storage location 2180, ultrasonic transducer Based on the value of the transducer capacitance C ₀ (measured or a priori known), and the known value of the drive frequency, it can be determined using Kirchhoff's current law. An operating branch current sample in each set of stored current and voltage feedback samples associated with the LUT sample can be determined.

In block 2240 of the pre-distortion algorithm, each operating branch current sample determined in block 2220 is compared with a sample of the desired current waveform shape to determine the difference between the samples being compared or the sample amplitude error. For this determination, a sample of the current waveform shape may be supplied from, for example, a waveform shape LUT2260 containing an amplitude sample for one cycle of the desired current waveform shape. A particular sample of the desired current waveform shape from the LUT 2260 used for comparison can be determined by the LUT sample address associated with the operating branch current sample used for comparison. Therefore, the input of the operating branch current to block 2240 can be synchronized with the input of its associated LUT sample address to block 2240. Therefore, the LUT sample stored in the programmable logic mechanism 1660 and the LUT sample stored in the waveform shape LUT2260 can have equivalent numerical values. In certain embodiments, the desired current waveform shape represented by the LUT sample stored in the waveform shape LUT2260 can be a fundamental sinusoidal wave. Other waveform shapes may be desirable. With one or more other drive signals at other wavelengths, such as third harmonics to drive at least two mechanical resonances, for example in lateral or other modes of beneficial vibration. It is conceivable that a basic sine wave can be used to drive the major longitudinal motion of the overlapping ultrasonic converters.

Each value of the sample amplitude error determined at block 2240, along with an index of its associated LUT address, can be transmitted to the LUT of the programmable logic mechanism 1660 (shown in block 2280 of FIG. 26A). LUT2280 (or other control block of programmable logic mechanism 1660) based on the value of the sample amplitude error and its associated address (and optionally the value of the sample amplitude error for the same LUT address received earlier). ) Can pre-distort or modify the value of the LUT sample stored in the LUT address, thereby reducing or minimizing the sample amplitude error. Such pre-distortion or correction of each LUT sample in an iterative manner over the entire range of LUT addresses will cause the output current waveform shape of the generator to be the desired current waveform shape represented by the waveform shape LUT2260 sample. It will be understood to match or match.

Current and voltage amplitude measurements, power measurements, and impedance measurements can be determined at block 2300 of processor 1740 based on current and voltage feedback samples stored in storage location 2180. Prior to determining these numbers, the feedback sample is scaled appropriately and, in certain embodiments, processed through a suitable filter 2320 to remove, for example, noise and induced harmonic components generated by the data acquisition process. be able to. The filtered voltage and current samples can therefore substantially represent the fundamental frequency of the generator drive output signal. In certain embodiments, the filter 2320 may be a finite impulse response (FIR) filter applied in the frequency domain. Such an embodiment can use the Fast Fourier Transform (FFT) of the output drive signal current and voltage signals. In certain embodiments, the resulting frequency spectrum can be used to provide additional generator function. In one aspect, for example, the ratio of the second and / or third harmonic components to the fundamental frequency component can be used as a diagnostic index.

At block 2340 (FIG. 26B), a root mean square (RMS) calculation is applied to the sample size of the current feedback sample, which represents an integer of the drive signal cycle, to generate a _{measurement Irms that represents the drive signal output current.} obtain.

At block 2360, a root mean square (RMS) calculation can be applied to the sample size of the voltage feedback sample, which represents an integer of the drive signal cycle, to determine the _{measured value Vrms} , which represents the drive signal output voltage.

In block 2380, the current and voltage feedback samples may be one by one multiplied, average calculation is applied to samples representing the integer number of cycles of the drive signal, the measured value P _r of the actual output power of the generator is determined ..

In block 2400, the measured value _{P a} of apparent output power of the generator may be determined as the product _{V rms · I} rms.

At block 2420, the measured value Z _m of the magnitude of the load impedance can be determined as the quotient V _rms / _Irms.

In certain embodiments, blocks 2340,2360,2380,2400, and numerical _I rms is determined in _{2420, V rms, P r,} P a, and _{Z m} is any of a number of control and / or diagnostic process Can be used by generator 1100 to carry out. In certain aspects, any of these numbers may be placed in a suitable communication interface (eg, a USB interface), eg, via an output device 2140 integrated with the generator 1100, or an output device 2140 connected to the generator 1100. Can be communicated to the user through. Various diagnostic processes include, for example, handpiece integration, equipment integration, equipment mounting integration, equipment overload, equipment overload approach, poor frequency fixation, overvoltage condition, overcurrent condition, overpower condition, poor voltage sensing. , Current sensing failure, audible index failure, visual index failure, short circuit state, power supply failure, or blocking capacitor failure, but is not limited to these.

Block 2440 of processor 1740 can implement a phase control algorithm for determining and controlling the impedance phase of an electrical load (eg, an ultrasonic converter) driven by generator 1100. As described above, the effect of harmonic distortion is affected by controlling the frequency of the drive signal to minimize or reduce the difference between the determined impedance phase and the impedance phase set value (eg 0 °). It can be minimized or reduced to improve the accuracy of phase measurement.

The phase control algorithm receives the current and voltage feedback samples stored in storage location 2180 as inputs. Prior to using them in phase control algorithms, the feedback samples are scaled appropriately and, in certain embodiments, suitable filters 2460 (to remove noise from the data acquisition process and induced harmonic components, for example). It may be processed through the same filter 2320). The filtered voltage and current samples can therefore substantially represent the fundamental frequency of the generator drive output signal.

Block 2480 of the phase control algorithm determines the current through the operating branch of the ultrasonic transducer. This determination may be the same as that described above in connection with block 2220 of the pre-distortion algorithm. Therefore, the output of block 2480 can be an operating branch current sample for each set of stored current and voltage feedback samples associated with the LUT sample.

In block 2500 of the phase control algorithm, the impedance phase is determined based on the synchronized inputs of the operating branch current sample and the corresponding voltage feedback sample determined in block 2480. In a particular aspect, the impedance phase is determined as the average of the impedance phase measured at the rising edge of the waveform and the impedance phase measured at the falling edge of the waveform.

In block 2520 of the phase control algorithm, the impedance phase value determined in block 2220 is compared with the phase set value 2540 to determine the difference or phase error between the values to be compared.

In the phase control algorithm block 2560 (FIG. 26A), the frequency output for controlling the frequency of the drive signal is based on the value of the phase error determined by the block 2520 and the magnitude of the impedance determined by the block 2420. It is judged. In order to maintain the impedance phase determined in block 2500 at the phase set value (eg, zero phase error), the frequency output value can be continuously adjusted by block 2560 and transferred to the DDS control block 2680 (discussed below). In certain embodiments, the impedance phase can be adjusted to a 0 ° phase setting. In this way, any amount of harmonic distortion is centered around the top of the voltage waveform, improving the accuracy of phase impedance determination.

Block 2580 of processor 1740 is driven to control drive signal current, voltage, and power according to user-specified settings or requirements specified by other processes or algorithms performed by generator 1100. An algorithm for modulating the current amplitude of the signal can be implemented. Control of these numbers can be achieved, for example, by scaling the LUT sample of the LUT2280 and / or by adjusting the full-scale output voltage of the DAC1680 (which supplies the input to the power amplifier 1620) via the DAC1860. it can. Block 2600 (which, in certain embodiments, can be implemented as a PID controller) can receive current feedback samples (which can be appropriately scaled and filtered) as input from storage location 2180. The current feedback sample is compared _{to the "current demand" Id} value determined by a controlled variable (eg, current, voltage, or power) to determine if the drive signal is supplying the required current. Can be done. In embodiments the drive signal current is controlled variables, current demand _{I d} can be designated directly by the current setpoint 2620A _{(I sp).} For example, the RMS value of the current feedback data (determined by block 2340) can be compared to _{a user-specified RMS current set value I sp to determine the appropriate controller action.} For example, if the current feedback data _{shows an RMS value lower than the current set value I sp} , the LUT scaling and / or the full scale output voltage of the DAC1680 may be adjusted by the block 2600 to increase the drive signal current. Conversely, if the current feedback data _{shows an RMS value higher than the current set value I sp} , the block 2600 may adjust the LUT scaling and / or the DAC1680 full scale output voltage to reduce the drive signal current. Good.

In embodiments the driving signal voltage is the control variable, current demand I _d, for example, maintain the desired voltage set value 2620B (V _sp) when the magnitude Z _m of the measured load impedance at block 2420 is given It can be specified indirectly based on the current required to do so (eg, _Id = V _sp / Z _m ). Similarly, in an embodiment the drive signal power is controlled variables, current demand _{I d,} for example to maintain a desired power setting 2620C to _{(P sp)} when given a voltage _{V rms} measured in block 2360 Can be specified indirectly based on the current required for (eg _Id = P _sp / V _rms ).

Block 2680 (FIG. 26A) can implement a DDS control algorithm to control the drive signal by recalling the LUT sample stored in the LUT 2280. In certain embodiments, the DDS control algorithm may be a Numerically Controlled Oscillator (NCO) algorithm for generating waveform samples at a fixed clock rate using point (storage location) skipping techniques. The NCO algorithm can implement a phase accumulator, or frequency / phase converter, that acts as an address pointer for recalling the LUT sample from the LUT 2280. In one aspect, the phase accumulator can be a D-step size, modulo N phase accumulator, where D is a positive integer representing a frequency control value and N is the number of LUT samples in the LUT2280. For example, a frequency control value of D = 1 can cause, for example, a phase accumulator to continuously specify all addresses of the LUT 2280 to produce a waveform output that duplicates the waveform stored in the LUT 2280. If D> 1, the phase accumulator can skip the address of the LUT2280 to produce a waveform output with a higher frequency. Thereby, the frequency of the waveform generated by the DDS control algorithm can therefore be controlled by appropriately changing the frequency control value. In certain embodiments, the frequency control value can be determined based on the output of the phase control algorithm implemented in block 2440. The output of block 2680 can supply the input of DAC1680, which then supplies the corresponding analog signal to the input of power amplifier 1620.

Block 2700 of processor 1740 dynamically modulates the rail voltage of the power amplifier 1620 based on the waveform envelope of the amplified signal, thereby improving the efficiency of the power amplifier 1620, a switch mode converter control algorithm. Can be carried out. In certain embodiments, the characteristics of the waveform envelope can be determined by monitoring one or more signals contained in the power amplifier 1620. In one aspect, for example, the characteristics of the waveform envelope can be determined by monitoring the minimum value of the drain voltage (eg MOSFET drain voltage) modulated according to the envelope of the amplified signal. The minimum voltage signal can be generated, for example, by a voltage minimum detector connected to the drain voltage. The minimum voltage signal is sampled by the ADC 1760 and the output minimum voltage sample may be received in block 2720 of the switch mode converter control algorithm. Based on the value of the minimum voltage sample, the block 2740 may control the PWM signal output by the PWM generator 2760, which in turn controls the rail voltage supplied to the power amplifier 1620 by the switch mode regulator 1700. .. In certain embodiments, the rail voltage can be modulated according to the waveform envelope characterized by the minimum voltage sample, as long as the value of the minimum voltage sample is less than the minimum target 2780 input to block 2720. For example, when the minimum voltage sample exhibits a low envelope power level, block 2740 supplies a low rail voltage to the power amplifier 1620, and the full rail voltage is supplied only when the minimum voltage sample exhibits a maximum envelope power level. You may. When the minimum voltage sample is below the minimum target 2780, the block 2740 may keep the rail voltage at a minimum value suitable to ensure proper operation of the power amplifier 1620.

FIG. 27 is a schematic view of one aspect of an electrical circuit 2900 suitable for driving an ultrasonic converter such as an ultrasonic converter 1120 according to at least one aspect of the present disclosure. The electric circuit 2900 includes an analog multiplexer 2980. The analog multiplexer 2980 multiplexes various signals from upstream channels SCL-A, SDA-A such as ultrasonic waves, batteries, and power control circuits. The current sensor 2982 is connected in series with the return or ground section of the power supply circuit and measures the current supplied by the power supply. The field effect transistor (FET) temperature sensor 2984 provides an ambient temperature. The pulse width modulation (PWM) watchdog timer 2988 automatically causes a system reset if the main program fails to provide a periodic system reset. It is provided to automatically reset the electrical circuit 2900 if it hangs or freezes due to a software or hardware failure. It will be appreciated that the electrical circuit 2900 can be configured as an RF driver circuit for driving an ultrasonic converter or for driving an RF electrode such as, for example, the electrical circuit 3600 shown in FIG. Therefore, referring again to FIG. 27, the electric circuit 2900 can be used to alternately drive both the ultrasonic transducer and the RF electrode. When driven at the same time, a filter circuit may be provided in the corresponding first stage circuit 3404 (FIG. 30) so as to select either an ultrasonic waveform or an RF waveform. Such filtering techniques are described in co-owned US Publication No. 2017/0086910, entitled TECHNIQUES FOR CIRCUIT TOPOLOGIES FOR COMBINED GENERATION, which is incorporated herein by reference in its entirety.

Drive circuit 2896 provides left and right ultrasonic energy outputs. The digital signal representing the signal waveform is supplied to the SCL-A and SDA-A inputs of the analog multiplexer 2980 from a control circuit such as the control circuit 3200 (FIG. 28). The digital / analog converter 2990 (DAC) converts a digital input into an analog output and drives a PWM circuit 2992 connected to the oscillator 2994. The PWM circuit 2992 provides a first signal to the first gate drive circuit 2996a connected to the first transistor output stage 2998a to drive the first ultrasonic (left) energy output. The PWM circuit 2992 also provides a second signal to the second gate drive circuit 2996b connected to the second transistor output stage 2998b to drive the second ultrasonic (right) energy output. The voltage sensor 2999 is connected between the ultrasonic left / right output terminals to measure the output voltage. The drive circuit 2896, the first drive circuit 2996a and the second drive circuit 2996b, and the first transistor output stage 2998a and the second transistor output stage 2998b define a first stage amplifier circuit. During operation, the control circuit 3200 (FIG. 28) generates a digital waveform 4300 (FIG. 37) using circuits such as the direct digital compositing (DDS) circuits 4100 and 4200 (FIGS. 35 and 36). The DAC2990 receives the digital waveform 4300, converts it into an analog waveform, which is received and amplified by the first stage amplifier circuit.

FIG. 28 is a schematic diagram of a control circuit 3200, such as a control circuit 3212, according to at least one aspect of the present disclosure. The control circuit 3200 is located within the housing of the battery assembly. The battery assembly is an energy source for various local power sources 3215. The control circuit connects the main processor 3214 connected to various downstream circuits via the interface master 3218 by, for example, the outputs SCL-A and SDA-A, SCL-B and SDA-B, SCL-C and SDA-C. Be prepared. In one embodiment, the interface master 3218 is a universal serial interface such as ^{I 2} C serial interface. The main processor 3214 is also configured to drive a switch 3224 via general purpose input / output (GPIO) 3220, a display 3226 (eg, an LCD display), and various indicators 3228 via GPIO 3222. The watchdog processor 3216 is provided to control the main processor 3214. The switch 3230 is provided in series with the battery 3211 to activate the control circuit 3212 when the battery assembly is inserted into the handle assembly of the surgical instrument.

In one aspect, the main processor 3214 is connected to the electrical circuit 2900 (FIG. 27) by output terminals SCL-A, SDA-A. The main processor 3214 includes, for example, a memory for storing a table of digitized drive signals or waveforms transmitted to the electrical circuit 2900 to drive the ultrasonic converter 1120. In another aspect, the main processor 3214 may generate a digital waveform and transmit it to electrical circuit 2900, or it may store the digital waveform for later transmission to electrical circuit 2900. The main processor 3214 is also RF driven by the output terminals SCL-B, SDA-B, and various sensors by the output terminals SCL-C, SDA-C (eg, Hall effect sensor, ferrofluid (MRF) sensor, etc.). May be provided. In one aspect, the main processor 3214 is configured to sense the presence of an ultrasonic drive circuit and / or an RF drive circuit to enable suitable software and user interface functions.

In one aspect, the main processor 3214 may be, for example, the LM 4F230H5QR available from Texas Instruments. In at least one example, Texas Instruments' LM4F230H5QR improves on-chip memory, performance of 256KB single-cycle flash memory up to 40MHz or other non-volatile memory, among other mechanisms readily available from product datasheets. Prefetch buffer, 32KB single-cycle serial random access memory (SRAM), internal read-only memory with StaticrisWare® software (ROM), 2KB electrically erasable programmable read-only memory (EEPROM), 1 One or more pulse width modulation (PWM) modules, one or more orthogonal encoder input (QED) analogs, one or more 12-bit analog-to-digital converters with 12 analog input channels An ARM Cortex-M4F processor core that includes an ADC. Other processors may be readily substituted, and therefore this disclosure should not be limited to this context.

FIG. 29 shows a simplified block schematic showing another electrical circuit 3300 housed within a modular ultrasonic surgical instrument 3334, according to at least one aspect of the present disclosure. The electric circuit 3300 includes a processor 3302, a clock 3330, a memory 3326, a power supply 3304 (for example, a battery), a switch 3306 such as a metal oxide semiconductor field effect transistor (MOSFET) power supply switch, a drive circuit 3308 (PLL), a transformer 3310, and a signal. A smoothing circuit 3312 (also called a matching circuit, which can be a tank circuit, for example), a sensing circuit 3314, a converter 1120, and an ultrasonic blade (eg, an ultrasonic blade, which can also be referred to herein simply as a waveguide). Includes shaft assemblies (eg, shaft assemblies 1126, 1129) with ultrasonic transmission waveguides terminated at 1128, 1149).

Breaking Dependence on High Voltage (120VAC) Input Power (Characteristics of Common Ultrasonic Cutting Devices) One feature of the disclosure is the use of low voltage switching throughout the wave forming process and just before the transformer stage. It is the amplification of the drive signal limited to. For this reason, in one aspect of the present disclosure, power is derived only from batteries or groups of batteries that are small enough to fit either within the handle assembly. State-of-the-art battery technology provides powerful batteries with a height and width of a few centimeters and a depth of a few millimeters. By combining the features of the present disclosure to provide a self-contained and self-powered ultrasonic device, a reduction in manufacturing cost can be achieved.

The output of the power supply 3304 is supplied to the processor 3302 to supply power. The processor 3302 receives and outputs signals and also functions according to the custom logic executed by the processor 3302 or according to a computer program, as described below. As mentioned above, the electrical circuit 3300 can also include a memory 3326, preferably a random access memory (RAM), for storing computer-readable instructions and data.

The output of power supply 3304 is also directed to switch 3306, which has a duty cycle controlled by processor 3302. By controlling the on-time of the switch 3306, the processor 3302 can determine the total amount of power finally delivered to the converter 1120. In one aspect, the switch 3306 is a MOSFET, but other switches and switching configurations are similarly adaptable. The output of switch 3306 is supplied to a drive circuit 3308 that includes, for example, a phase detection phase-locked loop (PLL) and / or a lowpass filter and / or a voltage controlled oscillator. The output of switch 3306 is sampled by processor 3302 to determine _{the voltage and current (V IN} and I _{IN, respectively) of the output signal.} These values are used in the feedback architecture to tune the pulse width modulation of switch 3306. For example, the duty cycle of switch 3306 can vary from about 20% to about 80% depending on the desired actual output from switch 3306.

The drive circuit 3308 that receives the signal from the switch 3306 includes an oscillator circuit that converts the output of the switch 3306 into an electrical signal with an ultrasonic frequency, for example 55 kHz (VCO). As mentioned above, this smoothed version of the ultrasonic waveform is finally fed to the ultrasonic converter 1120 to generate a resonant sine wave along the ultrasonic transmission waveguide.

At the output of drive circuit 3308, there is a transformer 3310 capable of boosting a low voltage signal (s) to a higher voltage. Note that upstream switching is performed at low (eg, battery-powered) voltage prior to transformer 3310, which until now was not possible with ultrasonic cutting and cauterizing equipment. This is due, at least in part, to the fact that the device favorably uses low on-resistance MOSFET switching devices. Low on-resistance MOSFET switches are advantageous because they generate lower switching loss and less heat than conventional MOSFET devices and can pass higher currents. Therefore, the switching stage (pre-transformer) can be characterized as low voltage / high current. To ensure a lower on-resistance of the amplifier MOSFET (s), the MOSFETs (s) are operated at, for example, 10V. In such cases, a separate 10 VDC power supply can be used to supply the MOSFET gate, ensuring that the MOSFET is completely on and a reasonably low on-resistance is achieved. In one aspect of the disclosure, the transformer 3310 boosts the battery voltage to a root mean square (RMS) of 120V. Transformers are not described in detail here as they are known in the art.

In the described circuit configuration, deterioration of circuit components can have a negative effect on the circuit performance of the circuit. One factor that directly affects the performance of components is heat. Known circuits generally monitor switching temperatures (eg MOSFET temperatures). However, due to technological advances in MOSFET design and corresponding reductions in size, MOSFET temperature is no longer a valid indicator of circuit load and heat. Therefore, according to at least one aspect of the present disclosure, the sensing circuit 3314 senses the temperature of the transformer 3310. This temperature sensing is advantageous because the transformer 3310 operates at or near its maximum temperature during use of the device. The additional temperature will destroy the core material, such as ferrite, which can cause permanent damage. The present disclosure of the transformer 3310, for example, by reducing the drive power in the transformer 3310, signaling the user, turning off the power, pulsing the power, or other suitable response. Can respond to the highest temperature.

In one aspect of the disclosure, the processor 3302 is communicatively connected to an end effector (eg 1122, 1125), which arranges the material so that it is in physical contact with an ultrasonic blade (eg 1128, 1149). Used to do. The end-effector, there is provided a sensor for measuring the clamping force value (present within a known range), based on the received clamping force value, the processor 3302 changes the operating voltage V _M. The temperature sensor 3332 may be communicably connected to the processor 3302, where the processor 3302 is from the temperature sensor 3336 to the blade, because a high force value combined with a set operating speed can result in a high blade temperature. It can operate to receive and interpret a signal indicating the current temperature and to determine the target frequency of blade motion based on the received temperature. In another aspect, a force sensor, such as a strain gauge or pressure sensor, can be connected to a trigger (eg, 1143, 1147) to measure the force applied to the trigger by the user. In another aspect, a force sensor, such as a strain gauge or pressure sensor, may be connected to the switch button so that the displacement strength corresponds to the force applied to the switch button by the user.

According to at least one aspect of the present disclosure, the PLL portion of the drive circuit 3308 connected to the processor 3302 can determine the frequency of waveguide motion and transmit that frequency to the processor 3302. Processor 3302 stores this frequency value in memory 3326 when the device is turned off. By reading the clock 3330, the processor 3302 can determine the elapsed time since the device was shut off and, if the elapsed time is less than a predetermined value, read the last frequency of the waveguide motion. .. The device can then be started at the last frequency, which is presumably the optimum frequency for the current load.

Modular Battery-powered Handheld Surgical Instruments with Multi-Stage Generator Circuits In another aspect, the present disclosure provides modular battery-powered handheld surgical instruments with multi-stage generator circuits. Surgical instruments including battery assemblies, handle assemblies, and shaft assemblies are disclosed, which are configured to be mechanically and electrically connected to the handle assembly. The battery assembly includes a control circuit configured to generate a digital waveform. The handle assembly includes a first stage circuit configured to receive a digital waveform, convert the digital waveform to an analog waveform, and amplify the analog waveform. The shaft assembly includes a second stage circuit connected to the first stage circuit for receiving, amplifying and applying the analog waveform to the load device.

In one aspect, the present disclosure comprises a control circuit including a battery, a memory connected to the battery, and a memory and a processor connected to the battery, the processor being configured to generate a digital waveform; The first stage circuit includes a first stage circuit connected to a processor, the first stage circuit includes a digital / analog (DAC) converter and a first stage amplifier circuit, and the DAC receives a digital waveform and converts the digital waveform into an analog waveform. The first stage amplifier circuit is configured to receive and amplify the analog waveform; as well as to receive the analog waveform, amplify the analog waveform, and apply the analog waveform to the load device. Provides a surgical instrument that comprises a shaft assembly that includes a second stage circuit connected to a first stage amplifier circuit, the battery assembly and the shaft assembly being configured to be mechanically and electrically connected to the handle assembly. To do.

The loading device may include any one of an ultrasonic transducer, electrodes, or sensors, or any combination thereof. The first-stage circuit may include a first-stage ultrasonic drive circuit and a first-stage high-frequency current drive circuit. The control circuit may be configured to drive the first stage ultrasonic drive circuit and the first stage high frequency current drive circuit individually or simultaneously. The first-stage ultrasonic drive circuit may be configured to be connected to the second-stage ultrasonic drive circuit. The second stage ultrasonic drive circuit may be configured to be connected to an ultrasonic converter. The first-stage high-frequency current drive circuit may be configured to be connected to the second-stage high-frequency drive circuit. The second stage high frequency drive circuit may be configured to be connected to an electrode.

The first stage circuit may include a first stage sensor drive circuit. The first-stage sensor drive circuit may be configured with respect to the second-stage sensor drive circuit. The second stage sensor drive circuit may be configured to connect to the sensor.

In another aspect, the present disclosure comprises a control circuit including a battery, a memory connected to the battery, and a memory and a processor connected to the battery, the processor being configured to generate a digital waveform, a battery assembly. Includes a common first-stage circuit connected to the processor, a common first-stage circuit contains a digital-to-analog (DAC) converter and a common first-stage amplifier circuit, which receives a digital waveform and receives a digital waveform. The common first-stage amplifier circuit is configured to receive and amplify the analog waveform; as well as the handle assembly; which receives the analog waveform, amplifies the analog waveform, and analog. In order to apply the waveform to the load device, a shaft assembly including a second stage circuit connected to a common first stage amplifier circuit is provided, and the battery assembly and the shaft assembly are mechanically and electrically connected to the handle assembly. Provides surgical instruments that are configured in.

The loading device may include any one of an ultrasonic transducer, electrodes, or sensors, or any combination thereof. A common first stage circuit may be configured to drive an ultrasonic, high frequency current, or sensor circuit. The common first-stage drive circuit may be configured to be connected to a second-stage ultrasonic drive circuit, a second-stage high-frequency drive circuit, or a second-stage sensor drive circuit. The second stage ultrasonic drive circuit may be configured to be connected to an ultrasonic converter, the second stage high frequency drive circuit may be configured to be connected to an electrode, and the second stage sensor drive circuit may be configured to be connected to a sensor. It is configured as follows.

In another aspect, the present disclosure is a control circuit comprising a memory connected to a processor, wherein the processor is configured to generate a digital waveform; a common first stage circuit connected to the processor. Including, a common first stage circuit is configured to receive a digital waveform, convert the digital waveform to an analog waveform, and amplify the analog waveform; and to receive and amplify the analog waveform. Provided with a shaft assembly that includes a second stage circuit connected to a common first stage circuit, the shaft assembly provides a surgical instrument that is configured to be mechanically and electrically connected to the handle assembly.

A common first stage circuit may be configured to drive an ultrasonic, high frequency current, or sensor circuit. The common first-stage drive circuit may be configured to be connected to a second-stage ultrasonic drive circuit, a second-stage high-frequency drive circuit, or a second-stage sensor drive circuit. The second stage ultrasonic drive circuit may be configured to be connected to an ultrasonic converter, the second stage high frequency drive circuit may be configured to be connected to an electrode, and the second stage sensor drive circuit may be configured to be connected to a sensor. It is configured as follows.

FIG. 30 shows a generator circuit 3400 divided into a first stage circuit 3404 and a second stage circuit 3406 according to at least one aspect of the present disclosure. In one aspect, the surgical instrument of the surgical system 1000 described herein may include a generator circuit 3400 divided into multiple stages. For example, the surgical instrument of the surgical system 1000 is a first stage of amplification that allows the operation of at least two circuits, namely RF energy only, ultrasonic energy only, and / or a combination of RF energy and ultrasonic energy. A generator circuit 3400 divided into 3404 and a second stage circuit 3406 may be provided. The combination modular shaft assembly 3414 may be powered by a common first stage circuit 3404 located within the handle assembly 3412 and a modular second stage circuit 3406 integrated with the modular shaft assembly 3414. As described above throughout this description in connection with the surgical instruments of the surgical system 1000, the battery assembly 3410 and the shaft assembly 3414 are configured to be mechanically and electrically connected to the handle assembly 3412. The end effector assembly is configured to be mechanically and electrically connected to the shaft assembly 3414.

With reference to FIG. 30, the generator circuit 3400 is divided into a plurality of stages located within a plurality of modular assemblies of surgical instruments such as the surgical instruments of the surgical system 1000 described herein. .. In one aspect, the control stage circuit 3402 may be located within the battery assembly 3410 of the surgical instrument. The control stage circuit 3402 is a control circuit 3200 described in connection with FIG. 28. The control circuit 3200 includes a processor 3214 including an internal memory 3217 (FIG. 30) (eg, volatile and non-volatile memory) and is electrically connected to the battery 3211. The battery 3211 supplies electric power to the first stage circuit 3404, the second stage circuit 3406, and the third stage circuit 3408, respectively. As mentioned above, the control circuit 3200 produces a digital waveform 4300 (FIG. 37) using the circuits and techniques described in connection with FIGS. 35 and 36. With reference to FIG. 30 again, the digital waveform 4300 may be configured to drive ultrasonic transducers, radio frequency (eg, RF) electrodes, or a combination thereof individually or simultaneously. When driven at the same time, a filter circuit may be provided in the corresponding first stage circuit 3404 so as to select either an ultrasonic waveform or an RF waveform. Such filtering techniques are described in co-owned US Publication No. 2017/0086910, entitled TECHNIQUES FOR CIRCUIT TOPOLOGIES FOR COMBINED GENERATION, which is incorporated herein by reference in its entirety.

The first stage circuit 3404 (eg, first stage ultrasonic drive circuit 3420, first stage RF drive circuit 3422, and first stage sensor drive circuit 3424) is located within the handle assembly 3412 of the surgical instrument. The control circuit 3200 provides an ultrasonic drive signal to the first stage ultrasonic drive circuit 3420 via the outputs SCL-A and SDA-A of the control circuit 3200. The first stage ultrasonic drive circuit 3420 will be described in detail in connection with FIG. 27. The control circuit 3200 provides an RF drive signal to the first stage RF drive circuit 3422 via the outputs SCL-B and SDA-B of the control circuit 3200. The first stage RF drive circuit 3422 will be described in detail in connection with FIG. The control circuit 3200 provides a sensor drive signal to the first stage sensor drive circuit 3424 via the outputs SCL-C and SDA-C of the control circuit 3200. In general, each of the first stage circuits 3404 includes a digital / analog (DAC) converter and a first stage amplifier for driving the second stage circuit 3406. The output of the first stage circuit 3404 is provided to the input of the second stage circuit 3406.

The control circuit 3200 is configured to detect which module is plugged into the control circuit 3200. For example, the control circuit 3200 determines whether the first stage ultrasonic drive circuit 3420, the first stage RF drive circuit 3422, or the first stage sensor drive circuit 3424 located in the handle assembly 3412 is connected to the battery assembly 3410. It is configured to detect. Similarly, each of the first stage circuits 3404 can detect which second stage circuit 3406 is connected to it, and that information is used to determine the type of signal waveform to generate in the control circuit 3200. Returned to. Similarly, each of the second stage circuits 3406 can detect which third stage circuit 3408 or component is connected to it, and that information is used to determine the type of signal waveform to generate. It is returned to the control circuit 3200.

In one aspect, the second stage circuit 3406 (eg, ultrasonic driven second stage circuit 3430, RF driven second stage circuit 3432, and sensor driven second stage circuit 3434) is located within the shaft assembly 3414 of the surgical instrument. To do. The first stage ultrasonic drive circuit 3420 provides a signal to the second stage ultrasonic drive circuit 3430 via the output US left / US right. The second stage ultrasonic drive circuit 3430 can include, for example, a transformer, a filter, an amplifier, and / or a signal conditioning circuit. The first stage radio frequency (RF) current drive circuit 3422 provides a signal to the second stage RF drive circuit 3432 via the output RF left / RF right. In addition to the transformer and blocking capacitor, the second stage RF drive circuit 3432 may further include a filter, an amplifier, and a signal conditioning circuit. The first-stage sensor drive circuit 3424 provides a signal to the second-stage sensor drive circuit 3434 via the output sensor 1 / sensor 2. The second stage sensor drive circuit 3434 may include a filter, an amplifier, and a signal adjustment circuit depending on the type of sensor. The output of the second stage circuit 3406 is provided to the input of the third stage circuit 3408.

In one aspect, the third stage circuit 3408 (eg, ultrasonic transducers 1120, RF electrodes 3074a, 3074b, and sensor 3440) may be located within various assemblies 3416 of the surgical instrument. In one aspect, the second stage ultrasonic drive circuit 3430 provides a drive signal to the piezoelectric stack of the ultrasonic transducer 1120. In one aspect, the ultrasound transducer 1120 is located within the ultrasound transducer assembly of the surgical instrument. However, in other embodiments, the ultrasonic transducer 1120 may be located within the handle assembly 3412, shaft assembly 3414, or end effector. In one aspect, the second stage RF drive circuit 3432 provides a drive signal to the RF electrodes 3074a, 3074b, which are located approximately within the end effector portion of the surgical instrument. In one aspect, the second stage sensor drive circuit 3434 provides drive signals to various sensors 3440 located throughout the surgical instrument.

FIG. 31 shows a generator circuit 3500 divided into a plurality of stages, in which the first stage circuit 3504 is common to the second stage circuit 3506, according to at least one aspect of the present disclosure. In one aspect, the surgical instrument of the surgical system 1000 described herein may include a generator circuit 3500 divided into multiple stages. For example, the surgical instruments of the surgical system 1000 have at least two circuits, namely radio frequency (RF) energy only, ultrasonic energy only, and / or amplifications that allow the operation of a combination of RF energy and ultrasonic energy. A generator circuit 3500 divided into a first-stage circuit 3504 and a second-stage circuit 3506 may be provided. The combination modular shaft assembly 3514 may be powered by a common first stage circuit 3504 located within the handle assembly 3512 and a modular second stage circuit 3506 integrated with the modular shaft assembly 3514. As mentioned above throughout this description in connection with the surgical instruments of the surgical system 1000, the battery assembly 3510 and the shaft assembly 3514 are configured to be mechanically and electrically connected to the handle assembly 3512. The end effector assembly is configured to be mechanically and electrically connected to the shaft assembly 3514.

As shown in the embodiment of FIG. 31, the battery assembly 3510 portion of the surgical instrument comprises a first control circuit 3502 including the control circuit 3200 described above. The handle assembly 3512 connected to the battery assembly 3510 includes a common first stage drive circuit 3420. As mentioned above, the first stage drive circuit 3420 is configured to drive ultrasonic waves, radio frequency (RF) currents, and sensor loads. The output of the common first-stage drive circuit 3420 is a second-stage circuit 3506 such as a second-stage ultrasonic drive circuit 3430, a second-stage radio frequency (RF) current drive circuit 3432, and / or a second-stage sensor drive circuit 3434. Any one of them can be driven. The common first stage drive circuit 3420 detects which second stage circuit 3506 is located within the shaft assembly 3514 when the shaft assembly 3514 is connected to the handle assembly 3512. When the shaft assembly 3514 is connected to the handle assembly 3512, the common first stage drive circuit 3420 is replaced by a second stage circuit 3506 (eg, second stage ultrasonic drive circuit 3430, second stage RF drive circuit 3432, and / Alternatively, it is determined which one of the second stage sensor drive circuits 3434) is located in the shaft assembly 3514. This information is located within the handle assembly 3512 to supply the appropriate digital waveform 4300 (FIG. 37) to the second stage circuit 3506 to drive the appropriate load (eg ultrasound, RF, or sensor). Provided to the control circuit 3200. It will be appreciated that various assemblies 3516 within the third stage circuit 3508, such as ultrasonic transducers 1120, electrodes 3074a, 3074b, or sensors 3440, may include identification circuits. Therefore, when the third-stage circuit 3508 is connected to the second-stage circuit 3506, the second-stage circuit 3506 knows the type of load required based on the identification information.

FIG. 32 is a schematic representation of an aspect of an electrical circuit 3600 configured to drive a radio frequency current (RF) according to at least one aspect of the present disclosure. The electric circuit 3600 includes an analog multiplexer 3680. The analog multiplexer 3680 multiplexes various signals from upstream channels SCL-A, SDA-A such as RF, batteries, and power control circuits. The current sensor 3682 is connected in series with the return or ground section of the power supply circuit and measures the current supplied by the power supply. The field effect transistor (FET) temperature sensor 3864 provides the ambient temperature. The pulse width modulation (PWM) watchdog timer 3688 automatically causes a system reset if the main program fails to provide a periodic system reset. It is provided to automatically reset the electrical circuit 3600 if it hangs or freezes due to a software or hardware failure. It will be appreciated that the electrical circuit 3600 can be configured, for example, to drive the RF electrodes or to drive the ultrasonic converter 1120, as described with respect to FIG. 27. Therefore, referring again to FIG. 32, the electrical circuit 3600 can be used to drive both the ultrasonic waves and the RF electrodes alternately.

Drive circuit 3686 provides left and right RF energy outputs. The digital signal representing the signal waveform is supplied to the SCL-A and SDA-A inputs of the analog multiplexer 3680 from a control circuit such as the control circuit 3200 (FIG. 28). The digital-to-analog converter 3690 (DAC) converts a digital input into an analog output and drives a PWM circuit 3692 connected to the oscillator 3694. The PWM circuit 3692 provides a first signal to the first gate drive circuit 3696a connected to the first transistor output stage 3698a to drive the first RF + (left side) energy output. The PWM circuit 3692 also provides a second signal to the second gate drive circuit 3696b connected to the second transistor output stage 3698b to drive the second RF (right) energy output. The voltage sensor 3699 is connected between the RF left / RF output terminals to measure the output voltage. The drive circuit 3686, the first drive circuit 3696a and the second drive circuit 3696a, and the first transistor output stage 3698a and the second transistor output stage 3698b define a first stage amplifier circuit. During operation, the control circuit 3200 (FIG. 28) generates a digital waveform 4300 (FIG. 37) using circuits such as the direct digital compositing (DDS) circuits 4100 and 4200 (FIGS. 35 and 36). The DAC3690 receives the digital waveform 4300, converts it into an analog waveform, which is received and amplified by the first stage amplifier circuit.

Referring now to FIG. 33, a control circuit 3900 for operating an RF generator circuit 3902 powered by a battery 3901 for use with a surgical instrument is shown according to at least one aspect of the present disclosure. Surgical instruments are configured to perform surgical coagulation / cutting on biological tissue using both ultrasonic vibration and high frequency current, and surgical coagulation on biological tissue using high frequency current. ..

FIG. 33 is a control circuit that allows the dual generator system to switch between the energy modality of the RF generator circuit 3902 and the energy modality of the ultrasonic generator circuit 3920 for the surgical instruments of the surgical system 1000. 3900 is shown. In one aspect, the current threshold in the RF signal is detected. When the tissue impedance is low, the high frequency current through the tissue is high when RF energy is used as a treatment source for the tissue. According to one aspect, the visual indicator 3912 or light located on the surgical instrument of the surgical system 1000 may be configured to be turned on during this high current period. When the current falls below the threshold, the visual indicator 3912 is turned off. Therefore, as shown in the control circuit 3900 shown in FIG. 33, the phototransistor 3914 can be configured to detect the transition from the on state to the off state and release the RF energy. Therefore, when the energy button is released and the energy switch 3926 is opened, the control circuit 3900 is reset and both the RF generator circuit 3902 and the ultrasonic generator circuit 3920 are kept off.

With reference to FIG. 39, in one aspect, a method of managing the RF generator circuit 3902 and the ultrasonic generator circuit 3920 is provided. The RF generator circuit 3902 and / or the ultrasonic generator circuit 3920 may include, for example, the handle assembly 1109 of the multifunctional electrosurgical instrument 1108, the ultrasonic transducer / RF generator assembly 1120, the battery assembly, the shaft assembly 1129 and /. Alternatively, it may be located in the nozzle. The control circuit 3900 is kept in the reset state when the energy switch 3926 is off (eg, open). Therefore, when the energy switch 3926 is opened, the control circuit 3900 is reset and both the RF generator circuit 3902 and the ultrasonic generator circuit 3920 are turned off. When the energy switch 3926 is pressed and the energy switch 3926 is engaged (eg, closed), RF energy is delivered to the tissue and the visual indicator 3912 operated by the current sensing step-up transformer 3904 has a tissue impedance. Lights up while low. The light from the visual indicator 3912 provides a logical signal to keep the ultrasonic generator circuit 3920 off. Once the tissue impedance increases above the threshold and the high frequency current through the tissue decreases below the threshold, the visual indicator 3912 turns off and the light shifts to the off state. The logic signal generated by this transition turns off the relay 3908, which turns off the RF generator circuit 3902 and turns on the ultrasonic generator circuit 3920 to complete the solidification and disconnect cycle.

Continuing with reference to FIG. 39, in one aspect, the dual generator circuit configuration is an onboard RF generator circuit 3902 powered by a battery 3901 for one modality and, for example, for multifunctional electrosurgical use. A second onboard ultrasonic generator circuit 3920 that may be onboard within the handle assembly 1109, battery assembly, shaft assembly 1129, nozzle, and / or ultrasonic transducer / RF generator assembly 1120 of instrument 1108. And are used. The ultrasonic generator circuit 3920 is also powered by battery 3901. In various aspects, the RF generator circuit 3902 and the ultrasonic generator circuit 3920 may be integral or separable components of the handle assembly 1109. According to various aspects, having dual RF / ultrasonic generator circuits 3902, 3920 as part of the handle assembly 1109 can eliminate the need for complex wiring. The RF / ultrasonic generator circuits 3902, 3920 may be configured to provide the full functionality of an existing generator while simultaneously utilizing the functionality of the cordless generator system.

Either type of system can have separate control over modality that is not communicating with each other. The surgeon activates RF and ultrasound separately and optionally. Another approach is to provide a fully integrated communication scheme that shares algorithms for managing buttons, tissue status, instrument operating parameters (eg jaw closure, force, etc.) and tissue treatment. .. Various combinations of this integration can be implemented to provide the appropriate level of functionality and performance.

As described above, in one aspect, the control circuit 3900 includes an RF generator circuit 3902 powered by the battery 3901, comprising a battery as an energy source. As shown, the RF generator circuit 3902 is connected to two conductive surfaces referred to herein as electrodes 3906a, 3906b (ie, active electrode 3906a and return electrode 3906b), and the electrodes 3906a, 3906b are connected to RF energy (ie, RF energy (ie, active electrode 3906a and return electrode 3906b)). For example, it is configured to be driven by a high frequency current). The first winding 3910a of the step-up transformer 3904 is connected in series to one pole of the bipolar RF generator circuit 3902 and the return electrode 3906b. In one aspect, the first winding 3910a and the return electrode 3906b are connected to the negative electrode of the bipolar RF generator circuit 3902. The other pole of the bipolar RF generator circuit 3902 is connected to the active electrode 3906a through the switch contact 3909 of the relay 3908 or is moved by an electromagnet 3936 to operate the switch contact 3909 any suitable piece of iron. It is connected to an electromagnetic switch. When the electromagnet 3936 is energized, the switch contact 3909 closes, and when the electromagnet 3936 is de-energized, the switch contact 3909 opens. When the switch contacts are closed, RF current flows through a conductive tissue (not shown) located between the electrodes 3906a and 3906b. In one aspect, it will be appreciated that the active electrode 3906a is connected to the positive electrode of the bipolar RF generator circuit 3902.

The visual indicator circuit 3905 includes a step-up transformer 3904, a series register R2, and a visual indicator 3912. The visual indicator 3912 may be adapted for use with surgical instruments 1108 and other electrosurgical systems and tools such as those described herein. The first winding 3910a of the step-up transformer 3904 is connected in series with the return electrode 3906b, and the second winding 3910b of the step-up transformer 3904 is a visual indicator containing a register R2 and, for example, a NE-2 neon valve. It is connected in series with the 3912.

During operation, when the switch contact 3909 of the relay 3908 opens, the active electrode 3906a is separated from the positive electrode of the bipolar RF generator circuit 3902 and passes through the tissue, the return electrode 3906b, and the first winding 3910a of the step-up transformer 3904. No current flows. Therefore, the visual indicator 3912 is not energized and does not emit light. When the switch contact 3909 of the relay 3908 is closed, the active electrode 3906a is connected to the positive electrode of the bipolar RF generator circuit 3902, thereby passing through the tissue, the return electrode 3906b, and the first winding 3910a of the step-up transformer 3904. An electric current can flow to operate on the tissue, for example, to cut and cauterize the tissue.

The first current flows through the first winding 3910a as a function of the impedance of the tissue located between the active electrode 3906a and the return electrode 3906b, and flows through the first winding 3910a of the step-up transformer 3904. Provides a voltage of 1. The boosted second voltage is induced throughout the second winding 3910b of the step-up transformer 3904. The secondary voltage appears throughout the register R2, and when the current through the tissue is greater than a predetermined threshold, the visual indicator 3912 is energized to light the neon bulb. It will be appreciated that circuit and component values are exemplary and not limited. When the switch contact 3909 of relay 3908 closes, current flows through the tissue and the visual indicator 3912 is turned on.

Referring here to the energy switch 3926 portion of the control circuit 3900, when the energy switch 3926 is in the open position, the logic high is applied to the input of the first inverter 3928 and the logic low is of the two inputs of the AND gate 3932. Applies to one of. Therefore, the output of the AND gate 3932 is low and the transistor 3934 is off, preventing current from flowing through the windings of the electromagnet 3936. When the electromagnet 3936 is in the non-energized state, the switch contact 3909 of the relay 3908 remains open, preventing current from flowing through the electrodes 3906a and 3906b. The logical low output of the first inverter 3928 is also applied to the second inverter 3930 to raise the output and reset the flip-flop 3918 (eg, D-type flip-flop). At this time, the Q output becomes low, the circuit of the ultrasonic generator circuit 3920 is turned off, and the circuit is turned off.

出力はハイになり、ＡＮＤゲート３９３２の他の入力に適用される。

The output goes high and applies to the other inputs of AND Gate 3932.

When the user presses the energy switch 3926 on the instrument handle to apply energy to the tissue between the electrodes 3906a and 3906b, the energy switch 3926 closes and applies a logic row to the input of the first inverter 3928, which is A logic high is applied to the other inputs of the AND gate 3932 to raise the output of the AND gate 3932 and turn on the transistor 3934. In the on state, the transistor 3934 conducts and sinks a current through the winding of the electromagnet 3936 to energize the electromagnet 3936 and closes the switch contact 3909 of the relay 3908. As mentioned above, when the switch contact 3909 is closed, when the tissue is located between the electrodes 3906a and 3906b, the current passes through the electrodes 3906a, 3906b and the first winding 3910a of the step-up transformer 3904. Can flow.

As described above, the magnitude of the current flowing through the electrodes 3906a and 3906b depends on the impedance of the tissue located between the electrodes 3906a and 3906b. First, the impedance of the tissue is low and the magnitude of the current through the structure and the first winding 3910a is high. Therefore, the voltage applied to the second winding 3910b is high enough to turn on the visual indicator 3912. The light emitted by the visual indicator 3912 turns on the phototransistor 3914, which pulls the input of the inverter 3916 low and makes the output of the inverter 3916 high. The high input applied to the CLK of the flip-flop 3918 is the Q of the flip-flop 3918 or

出力に影響を与えず、Ｑ出力はローのままであり、

Does not affect the output, the Q output remains low,

出力はハイのままである。したがって、視覚インジケータ３９１２は通電されたままであり、超音波発生器回路３９２０はオフとなり、多機能型電気外科用器具の超音波変換器３９２２及び超音波ブレード３９２４は起動しなくなる。

The output remains high. Therefore, the visual indicator 3912 remains energized, the ultrasonic generator circuit 3920 is turned off, and the ultrasonic transducer 3922 and ultrasonic blade 3924 of the multifunctional electrosurgical instrument are not activated.

When the tissue between the electrodes 3906a and 3906b dries due to the heat generated by the current flowing through the tissue, the impedance of the tissue increases and the current through it decreases. As the current through the first winding 3910a decreases, so does the voltage across the second winding 3910b, and when the voltage falls below the minimum threshold required to operate the visual indicator 3912, the visual indicator 3912 and the phototransistor 3914 Is turned off. When the phototransistor 3914 is turned off, the logic high is applied to the input of the inverter 3916, the logic low is applied to the CLK input of the flip-flop 3918, the logic high is applied to the Q output, and the logic low is applied to the input.

出力にクロックする。Ｑ出力における論理ハイによって、超音波発生器回路３９２０がオンになり、超音波変換器３９２２及び超音波ブレード３９２４を起動させて電極３９０６ａと電極３９０６ａとの間に位置する組織の切断を開始させる。超音波発生器回路３９２０がオンになるのと同時に又はほぼ同時に、フリップフロップ３９１８の

Clock to output. The logic high in the Q output turns on the ultrasonic generator circuit 3920 and activates the ultrasonic transducer 3922 and the ultrasonic blade 3924 to start cutting the tissue located between the electrodes 3906a and 3906a. At the same time as or approximately at the same time that the ultrasonic generator circuit 3920 is turned on, the flip-flop 3918

出力はローになり、ＡＮＤゲート３９３２の出力をローにして、トランジスタ３９３４をオフにし、それにより、電磁石３９３６を非通電にして、リレー３９０８のスイッチ接点３９０９を開いて電極３９０６ａ、３９０６ｂを通る電流の流れを遮断する。

The output goes low, the output of the AND gate 3932 goes low, the transistor 3934 is turned off, thereby de-energizing the electromagnet 3936 and opening the switch contact 3909 of the relay 3908 to allow the current to pass through the electrodes 3906a and 3906b. Block the flow.

While the switch contact 3909 of the relay 3908 is open, no current flows through the electrodes 3906a, 3906b, the tissue, and the first winding 3910a of the step-up transformer 3904. Therefore, no voltage is generated over the second winding 3910b and no current flows through the visual indicator 3912.

Q of flip-flop 3918 and while the user holds the energy switch 3926 on the instrument handle and keeps the energy switch 3926 closed.

出力の状態は同じままである。したがって、双極ＲＦ発生器回路３９０２から電極３９０６ａ、３９０６ｂを通って電流が流れていない間は、超音波ブレード３９２４は起動した状態を維持してエンドエフェクタのジョーの間の組織を切断し続ける。ユーザが器具ハンドルのエネルギースイッチ３９２６を解放すると、エネルギースイッチ３９２６が開いて、第１のインバータ３９２８の出力はローになり、第２のインバータ３９３０の出力はハイになってフリップフロップ３９１８をリセットし、Ｑ出力をローにして超音波発生器回路３９２０をオフにする。同時に、

The state of the output remains the same. Therefore, while no current is flowing from the bipolar RF generator circuit 3902 through the electrodes 3906a and 3906b, the ultrasonic blade 3924 remains activated and continues to cut tissue between the end effector jaws. When the user releases the energy switch 3926 on the instrument handle, the energy switch 3926 opens, the output of the first inverter 3928 goes low, the output of the second inverter 3930 goes high and resets the flip-flop 3918. Set the Q output to low and turn off the ultrasonic generator circuit 3920. at the same time,

出力はハイになり、ここで回路はオフ状態になって、ユーザが器具ハンドル上のエネルギースイッチ３９２６を作動させて、エネルギースイッチ３９２６を閉じ、電極３９０６ａと電極３９０６ｂとの間に位置する組織に電流を印加し、上述のように組織にＲＦエネルギーを印加し、組織に超音波エネルギーを印加するサイクルを繰り返す準備が整う。

The output goes high, where the circuit is turned off and the user activates the energy switch 3926 on the instrument handle, closes the energy switch 3926 and currents the tissue located between the electrodes 3906a and 3906b. Is applied, RF energy is applied to the tissue as described above, and the cycle of applying ultrasonic energy to the tissue is ready to be repeated.

FIG. 34 is a surgical system 1000 that includes a feedback system for use with any one of the surgical instruments of the surgical system 1000 that may include or implement many of the features described herein. It is a figure of the surgical system 4000 which represents one aspect. The surgical system 4000 may include a generator 4002 connected to a surgical instrument that includes an end effector 4006 that can be activated when the clinician operates the trigger 4010. In various aspects, the end effector 4006 can include an ultrasonic blade for delivering ultrasonic vibrations to perform a surgical coagulation / cutting procedure on living tissue. In another aspect, the end effector 4006 performs a cutting procedure on the living tissue and a conductive element connected to a high frequency current energy source for electrosurgery to perform a surgical coagulation or cauterization on the living tissue. It may include either a mechanical knife or an ultrasonic blade, which has a sharp edge for the purpose. When the trigger 4010 is activated, the force sensor 4012 can generate a signal indicating the amount of force applied to the trigger 4010. In addition to, or instead of, the force sensor 4012, the surgical instrument may generate a signal indicating the position of the trigger 4010 (eg, how deeply the trigger was pressed or otherwise actuated). The position sensor 4013 can be included. In one aspect, the position sensor 4013 may be a sensor positioned with the outer tubular sheath or a reciprocating tubular actuating member located within the outer tubular sheath of the surgical instrument. In one aspect, the sensor may be a Hall effect sensor or any suitable transducer that changes its output voltage in response to a magnetic field. Hall effect sensors can be used in proximity switching, positioning, velocity sensing and current sensing applications. In one aspect, the Hall effect sensor acts as an analog converter and returns the voltage directly. A known magnetic field can be used to determine the distance from the hole plate.

The control circuit 4008 can receive a signal from the sensor 4012 and / or 4013. The control circuit 4008 may include any suitable analog or digital circuit components. The control circuit 4008 further communicates with the generator 4002 and / or the converter 4004 to force the force applied to the trigger 4010 and / or the position of the trigger 4010 and / or the reciprocating tubular actuation located within the outer tubular sheath. The power delivered to the end effector 4006 and / or the generator level or super of the end effector 4006 based on the position of the outer tubular sheath with respect to the member (eg, measured by a combination of a Hall effect sensor and a magnet). The ultrasonic blade amplitude can be modulated. For example, when a greater force is applied to the trigger 4010, more power and / or higher ultrasonic blade amplitude can be delivered to the end effector 4006. According to various aspects, the force sensor 4012 may be replaced by a multi-position switch.

According to various aspects, the end effector 4006 may include a clamp or a clamp mechanism. When the trigger 4010 is first actuated, the clamping mechanism can be closed to clamp the tissue between the clamp arm and the end effector 4006. As the force applied to the trigger increases (eg, as sensed by the force sensor 4012), the control circuit 4008 is provided around the power and / or end effector 4006 delivered by the transducer 4004 to the end effector 4006. The transducer level or ultrasonic blade amplitude can be increased. In one aspect, the trigger position sensed by the position sensor 4013 or the clamp or clamp arm position sensed by the position sensor 4013 (eg, using a Hall effect sensor) sets the power and / or amplitude of the end effector 4006. Can be used by the control circuit 4008 to do so. For example, if the trigger is further moved towards the fully actuated position, or if the clamp or clamp arm is further moved towards the ultrasonic blade (or end effector 4006), the power and / or amplitude of the end effector 4006 will increase. obtain.

According to various aspects, the surgical instrument of the surgical system 4000 can also include one or more feedback devices to indicate the amount of power delivered to the end effector 4006. For example, the speaker 4014 can emit a signal indicating the power of the end effector. According to various aspects, the speaker 4014 can emit a series of pulsed sounds, the frequency of which indicates power. In addition to or instead of the speaker 4014, the surgical instrument can include a visual display 4016. The visual display 4016 can show the power of the end effector according to any suitable method. For example, the visual display 4016 may include a series of LEDs, where the power of the end effector is indicated by the number of illuminated LEDs. The speaker 4014 and / or the visual display 4016 may be driven by the control circuit 4008. According to various aspects, the surgical instrument can include a ratchet device connected to a trigger 4010. When a stronger force is applied to the trigger 4010, the ratchet device can generate an audible sound to provide an indirect indicator of the power of the end effector. Surgical instruments can include other mechanisms that can enhance safety. For example, the control circuit 4008 may be configured to prevent power from being delivered to the end effector 4006 beyond a predetermined threshold. The control circuit 4008 also provides a delay between the time when the end effector power change is indicated (eg, by the speaker 4014 or the visual display 4016) and the time when the end effector power change is delivered. Can be done. In this way, the clinician can afford to warn that the level of ultrasonic output delivered to the end effector 4006 is about to change.

In one aspect, the ultrasonic or high frequency current generator of the surgical system 1000 digitally digitizes the electrical signal waveform so that it digitizes the waveform using a predetermined number of phase points stored in the lookup table. It can be configured to occur. Phase points may be stored in a table defined in memory, a field programmable gate array (FPGA), or any suitable non-volatile memory. FIG. 35 shows an aspect of a basic architecture for a digital compositing circuit such as the Direct Digital Compositing (DDS) Circuit 4100, which is configured to generate multiple waveforms for an electrical signal waveform. The generator software and digital control can instruct the FPGA to scan the address in the look-up table 4104, which in turn provides various digital input values to the DAC circuit 4108 that feeds the power amplifier. The address may be scanned according to the desired frequency. The use of such a look-up table 4104 can be supplied within the tissue, or within a transducer, RF electrode, multiple transducers, simultaneously within multiple RF electrodes, or within a combination of RF and ultrasonic instruments. , Makes it possible to generate various types of waveforms. In addition, a plurality of look-up tables 4104 representing the plurality of waveforms can be created, stored, and applied from the generator to the tissue.

The waveform signal is the output current, output voltage of the ultrasonic transducer and / or RF electrode, or a plurality of them (for example, two or more ultrasonic converters and / or two or more RF electrodes). Alternatively, it may be configured to control at least one of the output powers. Further, if the surgical instrument comprises an ultrasonic component, the waveform signal may be configured to drive at least two vibration modes of the ultrasonic transducer of at least one surgical instrument. Thus, the generator may be configured to provide the waveform signal to at least one surgical instrument, which responds to at least one of the plurality of waveforms in the table. Note that the waveform signals provided to the two surgical instruments may include two or more waveforms. The table may contain information related to multiple waveforms, and the table may be stored in the generator. In one embodiment or embodiment, the table may be a direct digital compositing table and may be stored in the FPGA of the generator. The table may be addressed by any method that is convenient for categorizing waveforms. According to one aspect, the table, which can be a direct digital compositing table, is addressed according to the frequency of the waveform signal. Further, the information related to the plurality of waveforms may be stored in the table as digital information.

The analog electrical signal waveform is the output current, output of the ultrasonic converter and / or RF electrode, or multiple of them (eg, two or more ultrasonic converters and / or two or more RF electrodes). It may be configured to control at least one of the voltage or output power. Further, if the surgical instrument comprises an ultrasonic component, the analog electrical signal waveform may be configured to drive at least two vibration modes of the ultrasonic transducer of at least one surgical instrument. Therefore, the generator circuit may be configured to provide an analog electrical signal waveform to at least one surgical instrument, the analog electrical signal waveform being at least one of the plurality of waveforms stored in the look-up table 4104. Corresponds to one waveform. Note that the analog electrical signal waveforms provided for the two surgical instruments may include two or more waveforms. The look-up table 4104 may contain information related to a plurality of waveforms, and the look-up table 4104 may be stored in either the generator circuit or the surgical instrument. In one embodiment or embodiment, the lookup table 4104 may be a direct digital compositing table, which may be stored in the FPGA of the generator circuit or surgical instrument. The look-up table 4104 may be addressed by any method that is convenient for categorizing waveforms. According to one aspect, the lookup table 4104, which may be a direct digital compositing table, is addressed according to the frequency of the desired analog electrical signal waveform. Further, the information related to the plurality of waveforms may be stored in the lookup table 4104 as digital information.

With the widespread use of digital technology in instrumentation systems and communication systems, digital control methods that generate multiple frequencies from a reference frequency have evolved and are called direct digital compositing. The basic architecture is shown in FIG. In this simplified block diagram, the DDS circuit is connected to the processor, controller, or logic mechanism of the generator circuit, and a memory circuit located within the generator circuit of the surgical system 1000. The DDS circuit 4100 includes an address counter 4102, a look-up table 4104, a register 4106, a DAC circuit 4108, and a filter 4112. Stable clock f _c is received by the address counter 4102, a register 4106, a programmable read-only storing one or more integer number of cycles of a sine wave (or any other waveform) in the look-up table 4104 Drives a memory (PROM). When the address counter 4102 steps through the storage location, the value stored in the lookup table 4104 is written to the register 4106 connected to the DAC circuit 4108. The corresponding digital amplitude of the signal at the storage location of the look-up table 4104 subsequently drives the DAC circuit 4108 to generate the analog output signal 4110. The spectral purity of the analog output signal 4110 is mainly determined by the DAC circuit 4108. Phase noise is of basically the reference clock f _c. The first analog output signal 4110 output from the DAC circuit 4108 is filtered by the filter 4112, and the second analog output signal 4114 output by the filter 4112 is an amplifier having an output connected to the output of the generator circuit. Will be provided to. The second analog output signal has a frequency of _out .

Since the DDS circuit 4100 is a sampled data system, problems associated with sampling such as quantization noise, aliasing, and filtering must be taken into consideration. For example, the higher harmonics at the output of a phase-locked loop (PLL) -based synthesizer can be filtered, while the higher harmonics at the DAC circuit 4108 output frequency wrap to the Nyquist bandwidth, making them unfilterable. To do. Look-up table 4104 contains signal data for integers of cycles. The final output frequency f _out, by changing the reference clock frequency f _c, or PROM may be changed by reprogramming.

The DDS circuit 4100 may include a plurality of look-up tables 4104, which stores a waveform represented by a predetermined number of samples, and the samples define a predetermined waveform shape. Therefore, a plurality of waveforms having a unique shape can be stored in a plurality of look-up tables 4104 to provide various tissue treatments based on instrument settings or tissue feedback. Examples of waveforms are high crested RF electrical signal waveforms for surface tissue coagulation, low crested RF electrical signal waveforms for deeper tissue penetration, and electrical signal waveforms that promote effective modified coagulation. Can be mentioned. In one aspect, the DDS circuit 4100 can create multiple waveform look-up tables 4104, which is desired during tissue treatment procedures (eg, "on the fly" based on user or sensor inputs or in real time). Switching between the various waveforms stored in the individual look-up table 4104 can be made based on the tissue effect and / or tissue feedback of.

Therefore, switching between waveforms can be based on, for example, tissue impedance and other factors. In another aspect, the look-up table 4104 can store electrical signal waveforms (ie, trapezoidal or square waves) that are formed to maximize the power delivered into the tissue each cycle. In another aspect, the look-up table 4104 can store a synchronized waveform so that the waveform delivers RF and ultrasonic drive signals while the multifunctional surgical instrument of the surgical system 1000. Maximize power delivery by. In yet another aspect, the look-up table 4104 can store an electrical signal waveform that simultaneously drives ultrasonic and RF therapeutic and / or sub-therapeutic energy while maintaining a lock on the ultrasonic frequency. Custom waveforms specific to the various instruments and their tissue effects can be stored in the non-volatile memory of the generator circuit or in the non-volatile memory of the surgical system 1000 (eg EEPROM) and are also multifunctional surgical instruments. Is fetched when connecting to the generator circuit. An example of an exponentially decaying sinusoidal curve used in many high wave high rate "solidification" waveforms is shown in FIG.

A more flexible and effective implementation of the DDS circuit 4100 uses a digital circuit called a Numerically Controlled Oscillator (NCO). A block diagram of a more flexible and effective digital compositing circuit, such as the DDS circuit 4200, is shown in FIG. In this simplified block diagram, the DDS circuit 4200 is connected to the processor, controller, or logic mechanism of the generator, and to the memory circuit located in either the generator or the surgical instrument of the surgical system 1000. ing. The DDS circuit 4200 includes a load register 4202, a parallel delta phase register 4204, an adder circuit 4216, a phase register 4208, a look-up table 4210 (phase-amplitude converter), a DAC circuit 4212, and a filter 4214. The adder circuit 4216 and the phase register 4208 form part of the phase accumulator 4206. Clock frequency _{f c} is applied to the phase register 4208 and the DAC circuit 4212. Load register 4202 receives an adjustment word which specifies the output frequency as a fraction of the reference clock frequency signal f _c. The output of the load register 4202 is provided to the parallel delta phase register 4204 along with the adjustment word M.

DDS circuit 4200, a sample clock for generating a clock frequency _{f c,} the phase accumulator 4206, and the look-up table 4210 (e.g., a phase - amplitude converter) including. The contents of the phase accumulator 4206, is updated once every clock cycle _{f c.} When the phase accumulator 4206 is updated, the digital number M stored in the parallel delta phase register 4204 is added to the number in the phase register 4208 by the adder circuit 4216. The number in the parallel delta phase register 4204 is 00. .. .. 01, and the initial content of the phase accumulator 4206 is 00. .. .. Assume that it is 00. The phase accumulator 4206 has a clock cycle of 00. .. .. Updated as 01. If the phase accumulator 4206 is 32-bit wide, then the phase accumulator 4206 is 00. .. .. 232 clock cycles (more than 4 billion) are required to return to 00, and the cycles are repeated.

The truncated output 4218 of the phase accumulator 4206 is provided to the lookup table 4210 of the phase-amplitude converter, and the output of the lookup table 4210 is connected to the DAC circuit 4212. The truncated output 4218 of the phase accumulator 4206 serves as an address to a sinusoidal (or cosine) look-up table. The addresses in the look-up table correspond to the 0 ° to 360 ° phase points in the sine wave. Look-up table 4210 contains the corresponding digital amplitude information for one complete cycle of the sine wave. Therefore, the look-up table 4210 maps the phase information from the phase accumulator 4206 to the digital amplitude word, which in turn drives the DAC circuit 4212. The output of the DAC circuit is the first analog signal 4220, which is filtered by the filter 4214. The output of the filter 4214 is a second analog signal 4222 provided to a power amplifier connected to the output of the generator circuit.

In one aspect, any suitable waveform in which the digitizable waveform is in the range 256 (28) to 281, 474, 976, 710, 656 (248) (where n is a positive integer, as shown in Table 1). Despite the number of 2n phase points, the electrical signal waveform may be digitized to 1024 (210) phase points. Electrical signal waveform may be represented as A _{n (theta n),} the amplitude A _n which is normalized at point n is represented by the phase angle theta _n, called phase point at point n. The number of individual phase points n determines the adjustment resolution of the DDS circuit 4200 (and the DDS circuit 4100 shown in FIG. 35).

Table 1 identifies the digitized electrical signal waveforms at a number of phase points.

The generator circuit algorithm and digital control circuit scan the address in the look-up table 4210, which in turn provides various digital input values to the filter 4214 and the DAC circuit 4212 that feeds the power amplifier. The address may be scanned according to the desired frequency. By using the lookup table, it is converted into an analog output signal by the DAC circuit 4212, filtered by the filter 4214, amplified by the power amplifier connected to the output of the generator circuit, and supplied to the tissue in the form of RF energy. It is possible to generate various types of shapes that can be applied to the tissue in the form of ultrasonic vibrations that are supplied to the or ultrasonic converter and deliver energy to the tissue in the form of heat. The output of the amplifier can be applied, for example, to a single RF electrode, multiple RF electrodes at the same time, a single ultrasonic converter, multiple ultrasonic converters at the same time or a combination of RF converters and ultrasonic converters. it can. In addition, multiple waveform tables can be created, stored and applied to tissue from the generator circuit.

Referring again to FIG. 35, for n = 32 and M = 1, the phase accumulator 4206 steps through 232 possible outputs before overflowing and restarting. The corresponding output wave frequency is equal to the input clock frequency divided by 232. When M = 2, the phase register 1708 "rolls over" at twice the speed and the output frequency doubles. This can be generalized as follows:

In the case of a phase accumulator 4206 configured to store n-bits (n is generally in the range 24-32 in most DDS systems, but as mentioned above, n may be selected from a wide range of choices. ), There are 2 ⁿ possible phase points. The digital word M in the delta phase register represents the amount by which the phase accumulator increments with each clock cycle. If f _c is the clock frequency, the frequency of the output sine wave is equal to or less.

The above equation is known as the DDS "adjustment equation". The frequency resolution of the system

と等しいことに留意されたい。ｎ＝３２では、分解能は４０億における一部よりも高い。ＤＤＳ回路４２００の一態様では、位相アキュムレータ４２０６外の全てのビットがルックアップテーブル４２１０に伝えられるわけではなく、切り捨てられて、例えば、最初の１３〜１５個の最上位ビット（ＭＳＢ）のみが残される。これはルックアップテーブル４２１０のサイズを低減し、かつ周波数分解能に影響を及ぼさない。位相の切り捨ては、少量だが許容できる位相雑音の量のみを最終出力に追加する。

Note that is equal to. At n = 32, the resolution is higher than part of the 4 billion. In one aspect of the DDS circuit 4200, not all bits outside the phase accumulator 4206 are transmitted to the look-up table 4210 and are truncated, leaving, for example, only the first 13 to 15 most significant bits (MSB). Is done. This reduces the size of the look-up table 4210 and does not affect the frequency resolution. Phase truncation adds only a small but acceptable amount of phase noise to the final output.

The electrical signal waveform may be characterized by current, voltage, or power at a given frequency. Further, if the surgical instrument of the surgical system 1000 comprises an ultrasonic component, the electrical signal waveform may be configured to drive at least two vibration modes of the ultrasonic transducer of at least one surgical instrument. Therefore, the generator circuit may be configured to provide the electrical signal waveform to at least one surgical instrument, which is stored in the look-up table 4210 (or the look-up table 4104 of FIG. 35). It is characterized by a predetermined waveform. The electrical signal waveform may be a combination of two or more waveforms. The look-up table 4210 may include information related to a plurality of waveforms. In one embodiment or embodiment, the look-up table 4210 may be generated by the DDS circuit 4200 and may also be referred to directly as a digital compositing table. The DDS operates by the first storage operation of a large repetitive waveform in the onboard memory. The cycle of the waveform (sine, triangle, square, arbitrary) is represented by a predetermined number of phase points and can be stored in memory, as shown in Table 1. Once the waveform is stored in memory, it can be generated at a very accurate frequency. The direct digital synthesis table can be stored in the non-volatile memory of the generator circuit and / or implemented with the FPGA circuit in the generator circuit. The look-up table 4210 may be addressed by any suitable technique that is convenient for categorizing waveforms. According to one aspect, the look-up table 4210 is addressed according to the frequency of the electrical signal waveform. Further, the information related to the plurality of waveforms may be stored as digital information in the memory or as a part of the look-up table 4210.

In one aspect, the generator circuit may be configured to simultaneously deliver electrical signal waveforms to at least two surgical instruments. The generator circuit is also configured to provide electrical signal waveforms (which can be characterized by two or more waveforms) simultaneously to two surgical instruments via a single output channel of the generator circuit. May be done. For example, in one aspect, the electrical signal waveform includes a first electrical signal (eg, an ultrasonic drive signal) that drives an ultrasonic converter, a second RF drive signal, and / or a combination thereof. Further, the electrical signal waveform may include a plurality of ultrasonic drive signals, a plurality of RF drive signals, and / or a combination of a plurality of ultrasonic drive signals and RF drive signals.

Further, the method of operating the generator circuit according to the present disclosure includes generating an electrical signal waveform and providing the generated electrical signal waveform to any one of the surgical instruments of the surgical system 1000. Generating an electrical signal waveform involves receiving information related to the electrical signal waveform from a memory. The generated electrical signal waveform includes at least one waveform. Further, providing the generated electrical signal waveform to at least one surgical instrument includes simultaneously providing the electrical signal waveform to at least two surgical instruments.

The generator circuits described herein may allow the generation of various types of direct digital compositing tables. Examples of RF / electrosurgical signal waveforms generated by generator circuits that are suitable for treating various tissues include RF signals with high frequency (which can be used for surface coagulation in RF mode) and low frequency. RF signals with (which can be used for deeper tissue penetration) and waveforms that promote efficient modified coagulation can be mentioned. The generator circuit can also generate multiple waveforms directly using the digitally synthesized look-up table 4210 and can switch between specific waveforms based on the desired tissue effect on the fly. Switching may be based on tissue impedance and / or other factors.

In addition to the traditional sinusoidal / cosine waveform, the generator circuit may be configured to generate a waveform (s) (ie, trapezoidal or square wave) that maximizes power to the tissue at each cycle. If the generator circuit contains a circuit topology that allows the RF and ultrasonic signals to be driven simultaneously, then the generator circuit will be loaded when driving the RF and ultrasonic signals simultaneously. It is possible to provide a waveform (s) that are synchronized to maximize the power delivered and to maintain the ultrasonic frequency lock. In addition, custom waveforms specific to the instrument and its tissue effects can be stored in non-volatile memory (NVM) or in the EEPROM of the instrument, and any one of the surgical instruments of the surgical system 1000 is generated in the generator circuit. Can be fetched when connecting to.

The DDS circuit 4200 may include a plurality of look-up tables 4104, and the look-up table 4210 stores a waveform represented by a predetermined number of phase points (sometimes called a sample), and the phase points are predetermined waveforms. Define the shape of. Therefore, a plurality of waveforms having a unique shape can be stored in a plurality of look-up tables 4210 to provide various tissue treatments based on instrument settings or tissue feedback. Examples of waveforms are high crested RF electrical signal waveforms for surface tissue coagulation, low crested RF electrical signal waveforms for deeper tissue penetration, and electrical signal waveforms that promote effective modified coagulation. Can be mentioned. In one aspect, the DDS circuit 4200 can create multiple waveform look-up tables 4210 as desired during tissue treatment procedures (eg, "on the fly" based on user or sensor inputs or in real time). Switching between the various waveforms stored in the various look-up tables 4210 can be made based on the tissue effect and / or tissue feedback of.

Therefore, switching between waveforms can be based on, for example, tissue impedance and other factors. In another aspect, the look-up table 4210 can store electrical signal waveforms (ie, trapezoidal or square waves) that are formed to maximize the power delivered into the tissue each cycle. In another aspect, the lookup table 4210 can store synchronized waveforms, so that when this waveform delivers RF and ultrasonic drive signals, it is among the surgical instruments of the surgical system 1000. Maximize power delivery by any one. In yet another aspect, the look-up table 4210 can store an electrical signal waveform that simultaneously drives ultrasonic and RF therapeutic and / or sub-therapeutic energy while maintaining a lock on the ultrasonic frequency. In general, the output waveform may be in the form of a sine wave, a cosine wave, a pulse wave, a square wave, or the like. Nevertheless, more complex custom waveforms specific to different instruments and their tissue effects can be stored in the non-volatile memory of the generator circuit or in the non-volatile memory of the surgical instrument (eg EEPROM). It can also be fetched when connecting surgical instruments to the generator circuit. An example of a custom waveform is an exponentially decaying sinusoidal waveform used for many high wave height "solidification" waveforms, as shown in FIG.

FIG. 37 shows one cycle of the discrete-time digital electrical signal waveform 4300 according to at least one aspect of the present disclosure of the analog waveform 4304 (shown superimposed on the discrete-time digital electrical signal waveform 4300 for comparison purposes). The horizontal axis represents time (t) and the vertical axis represents digital phase points. The digital-electric signal waveform 4300 is, for example, a digital discrete-time version of the desired analog waveform 4304. Digital electrical signal waveform 4300, representing the amplitude of each clock cycle _{T clk} over one cycle or period _{T o,} it is generated by storing the amplitude and phase point 4302. Digital electrical signal waveform 4300, by any suitable digital processing circuitry, is generated over one period T _o. The amplitude phase point is a digital word stored in the memory circuit. In the embodiment shown in FIGS. 35 and 36, the digital word is a 6-bit word capable of storing amplitude phase points with a resolution of 26 or 64 bits. It will be appreciated that the examples shown in FIGS. 35 and 36 are for illustration purposes and the resolution can be much higher in a practical implementation. Digital amplitude phase point 4302 over one cycle _{T o} is, for example, as a string of a string word look-in up table 4104,4210, as described in connection with FIGS. 35 and 36, are stored in memory. Also Figure 35, as described with respect to FIG. 36, in order to generate an analog waveform 4304 of the analog version, amplitude phase point 4302 is read sequentially from memory at 0 to T _o for each clock cycle _{T clk,} And it is converted by DAC circuits 4108 and 4212. Additional cycles may be generated by reading in desired and may 0~T over cycle or period of only _o, repeated amplitude phase point 4302 of the digital electric signal waveform 4300. The smooth analog version of the analog waveform 4304 is achieved by filtering the output of DAC circuits 4108, 4212 with filters 4112, 4214 (FIGS. 35 and 36). The filtered analog output signals 4114, 4222 (FIGS. 35 and 36) are applied to the input of the power amplifier.

Ultrasound Surgical Instrument Architecture Figure 38 illustrates one aspect of the ultrasonic system 137010. One aspect of the ultrasonic system 137010 includes an ultrasonic signal generator 137012 coupled to an ultrasonic transducer 137014, a handpiece assembly 137060 with a handpiece housing 137016, and an ultrasonic blade 137050. The ultrasonic transducer 137014, known as the "range van stack", generally includes a conversion portion 137018, a first resonator or end bell 137020, a second resonator or forebell 137022, and auxiliary components. .. In various aspects, the ultrasonic transducer 137014 is preferably an integral multiple (nλ / 2) of half the length of one system wavelength, as described in more detail below. The acoustic assembly 137024 can include an ultrasonic transducer 137014, a mount 137020, a speed converter 137028, and a surface 137030.

It will be appreciated herein that the terms "proximal" and "distal" are used for clinicians holding the handpiece assembly 137060. Therefore, the ultrasonic blade 137050 is distal to the more proximal handpiece assembly 137060. For convenience and clarity, it will be further understood that spatial terms such as "upper" and "lower" are also used herein for clinicians grasping the handpiece assembly 137060. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limited and absolute.

The distal end of the end bell 137020 is connected to the proximal end of the conversion unit 137018, and the proximal end of the forebell 137022 is connected to the distal end of the conversion unit 137018. The forebell 137022 and the endbell 137020 have a length determined by a number of variables, which include the thickness of the transducer 137018, the density of the materials used to make the endbell 137020 and the forebell 137022. The modulus of elasticity and the resonant frequency of the ultrasonic transducer 137014 are included. The forebell 137022 may be tapered inward from the proximal end to its distal end to amplify the amplitude of the ultrasonic vibrations of the speed converter 137028, or the forebell 137022 may not have amplification. May be good.

With reference to FIG. 38 again, the end bell 137020 can include a threaded member extending from it, which threaded member is configured to be screwably engaged with a threaded opening in the forebell 137022. Can be done. In various embodiments, the piezoelectric element, such as the piezoelectric element 137032, may be compressed between the end bell 137020 and the forebell 137022, for example when the end bell 137020 and the forebell 137022 are assembled together. The piezoelectric element 137032 may be made from any suitable material, such as, for example, lead zirconate titanate, lead metaniodate, lead titanate, and / or, for example, any suitable piezoelectric crystalline material.

In various embodiments, the transducer 137014 can further comprise electrodes such as a positive electrode 137034 and a negative electrode 137036, as discussed in more detail below, eg, one or more of these electrodes. Can be configured to create potentials at both ends of the piezoelectric element 137032. Each of the positive electrode 137034, the negative electrode 137036, and the piezoelectric element 137032 can include a hole through the center, which hole can be configured to receive the threaded member of the end bell 137020. In various aspects, the positive and negative electrodes 13703 are electrically connected to the wires 137038 and 137040, respectively, and the wires 137038 and 137040 are placed in the cable 137042 and the ultrasonic signal generator 137012 of the ultrasonic system 137010. Can be electrically connected to.

In various embodiments, the ultrasonic transducer 137014 of the acoustic assembly 137024 converts the electrical signal from the ultrasonic signal generator 137012 into mechanical energy, which is primarily the ultrasonic transducer 137014 and the end effector 137050. It results in longitudinal vibrational motion at the ultrasonic frequency. The ultrasonic surgical generator 137012 may include, for example, a generator 1100 (FIG. 18) or a generator 137012 (FIG. 38). When the acoustic assembly 137024 is energized, a vibrating motion standing wave is generated through the acoustic assembly 137024. A suitable vibration frequency range can be from about 20 Hz to 120 kHz, a suitable vibration frequency range can be from about 30 kHz to 70 kHz, and one example of an operating vibration frequency can be from about 55.5 kHz.

The amplitude of the oscillating motion at any point along the acoustic assembly 137024 may vary depending on where the oscillating motion is measured along the acoustic assembly 137024. In a vibrating motion standing wave, the minimum or zero intersection is commonly referred to as the nodal node (ie, where the motion is usually minimal), and in the standing wave the absolute value maximum or peak is. , Commonly referred to as wave belly (ie, where exercise is usually maximal). The distance between the crest point and the nearest wave node is a quarter wavelength (λ / 4).

As outlined above, wires 137038 and 137040 transmit electrical signals from the ultrasonic signal generator 137012 to the positive and 137034 and 137036 negative electrodes. The piezoelectric element 137032 is energized by an electrical signal supplied by an ultrasonic signal generator 137012 in response to, for example, a foot switch 137044 for generating an acoustic standing wave in the acoustic assembly 137024. The electrical signal causes disturbances in the piezoelectric element 137032 in the form of repeated small displacements that result in a large compressive force in the material. The repeated small displacements cause the piezoelectric element 137032 to continuously expand and contract along the axis of the voltage gradient, producing a longitudinal wave of ultrasonic energy.

In various aspects, the ultrasonic energy generated by the transducer 137014 can be transmitted to the ultrasonic blade 137050 via the ultrasonic transmission waveguide 137046 through the acoustic assembly 137024. The components of the acoustic assembly 137024 are acoustically coupled to the ultrasonic blade 137050 so that the acoustic assembly 137024 supplies energy to the ultrasonic blade 137050. For example, the distal end of the ultrasonic transducer 137014 may be acoustically connected to the proximal end of the ultrasonic transmission waveguide 137046 on the surface 137030 by a threaded connection such as a stud 137048.

The components of the acoustic assembly 137024 can be acoustically adjusted so that the length of either assembly is an integral multiple (nλ / 2) of the half wavelength, where the wavelength λ is in the equation. A preselected wavelength of the acoustic assembly 137024, or a working longitudinal vibration drive frequency fd, where n is any positive integer. It is also conceivable that the acoustic assembly 137024 may incorporate any suitable arrangement of acoustic elements.

The ultrasonic blade 137050 can have a length substantially equal to an integral multiple of one system half wavelength (λ / 2). The distal end of the ultrasonic blade 137050, 137052, may be disposed at or at least near the wave counterbore to provide the maximum, or at least nearly maximum longitudinal vibration width of the distal end. .. When the transducer assembly is energized, in various aspects, the distal end of the blade 137050, 137052, has a peak-to-peak range of approximately 10 to 500 microns, and preferably approximately 30 to 150 microns, for example, at a given vibration frequency. It may be configured to move within the range of.

As outlined above, the ultrasonic blade 137050 may be coupled to the ultrasonic transmission waveguide 137046. In various embodiments, the ultrasonic blade 137050 and the ultrasonic transmission waveguide 137846 as shown are, for example, Ti6Al4V (titanium alloy containing aluminum and vanadium), aluminum, stainless steel, and / or any other suitable. It is formed as a single unit structure made of a material suitable for transmitting ultrasonic energy, such as a material. Alternatively, the ultrasonic blade 137050 is separable (and of a different composition) from the ultrasonic transmission waveguide 137046, for example by studs, welds, adhesives, rapid connections, or other suitable known methods. It may be joined. The ultrasonic transmission waveguide 137046 may have a length substantially equal to, for example, an integral multiple of one system half wavelength (λ / 2). The ultrasonic transmission waveguide 137046 may be preferably made from a solid core shaft made of a material that efficiently propagates ultrasonic energy, such as a titanium alloy (ie, Ti6Al4V) or an aluminum alloy.

In the embodiment illustrated in FIG. 38, the ultrasonic transmission waveguide 137046 comprises a plurality of stabilized silicone rings or compatible supports 137056 located at, or at least in the vicinity of, a plurality of wave nodes. The silicone ring 137506 can attenuate unwanted vibrations and isolate the ultrasonic energy from the exterior 137058 which at least partially surrounds the waveguide 137046, whereby the ultrasonic energy is at the distal end of the ultrasonic blade 137050. Ensures flow up to 137052 with maximum efficiency in the longitudinal direction.

As shown in FIG. 38, the exterior 137058 may be connected to the distal end of the handpiece assembly 137060. The exterior 137058 generally includes an adapter or nose cone 137062 and an elongated tubular member 137064. The tubular member 137064 has an opening that is attached to and / or extends from the adapter 137062 and extends longitudinally through it. In various embodiments, the exterior 137058 may be screwed onto the distal end of the housing 137016 or snap-fitted. In at least one embodiment, the ultrasonic transmission waveguide 137046 extends through the opening of the tubular member 137064, and the silicone ring 137056 contacts the side wall of the opening to internally provide the ultrasonic transmission waveguide 137046. Can be separated. In various aspects, the adapter 137062 of the exterior 137058 is preferably constructed of, for example, Ultem®, and the tubular member 137064 is made of, for example, stainless steel. In at least one embodiment, the ultrasonic transmission waveguide 137046 may have a polymeric material surrounding it, for example, to separate the ultrasonic transmission waveguide from external contact.

As described above, the voltage source or power source can be operably connected to one or more piezoelectric elements of the transducer, and the potential applied to each of the piezoelectric elements causes the piezoelectric element to operate. It can be expanded and contracted in the longitudinal direction, or vibrated. Similarly, as described above, the voltage potential can be periodic, and in various aspects the voltage potential is a system of components comprising, for example, a transducer 137014, a waveguide 137846, and an ultrasonic blade 137050. It can be cyclically cycled at the same or almost the same frequency as the resonance frequency of. However, in various aspects, one particular piezoelectric element within the transducer may contribute more to the standing wave of longitudinal vibration than the other piezoelectric element within the transducer. More specifically, longitudinal strain profiles that can control or limit longitudinal displacement can occur within the transducer, and thus especially when the system oscillates at or near the resonant frequency. A part of the piezoelectric element can contribute to the standing wave of vibration.

The piezoelectric element 137032 is configured in a "Langevin stack", in which the piezoelectric elements 137032 and their working electrodes 137034 and 137036 (both transducers 137014) are alternately arranged. The mechanical vibration of the activated piezoelectric element 137032 propagates along the longitudinal axis of the transducer 137014 and is connected to the end of the waveguide 137046 via an acoustic assembly 137024. Such a mode of operation of a piezoelectric device is often described as the D33 mode of the device, in particular a ceramic piezoelectric device containing, for example, lead zirconate titanate, lead metaniodate, or lead titanate. The D33 mode of this ceramic piezoelectric element is illustrated in FIGS. 39A-39C.

FIG. 39A shows a piezoelectric element 137200 manufactured from a ceramic piezoelectric material. Piezoelectric ceramic materials are polycrystalline materials consisting of a plurality of separate microcrystalline domains. Each microcrystalline domain has a polarization axis, and the domain can expand or contract along this axis depending on the applied electric field. However, in the original ceramic, the polarization axes of the microcrystalline domain are randomly arranged, so there is no net piezoelectric effect in the bulk ceramic. The net reorientation of the axis of polarization can be induced by exposing the ceramic to temperatures above the Curie temperature of the material and placing the material in a strong electric field. Once the sample temperature is lowered below the Curie temperature, most of the separate polarization axes will be reoriented and fixed in the bulk polarization direction. FIG. 39A illustrates such a piezoelectric element 137200 after being polarized along the induced electric field axis P. Although the non-polarizing piezoelectric element 137200 lacks a net piezoelectric axis, the polarization element 137200 can be described as having a polarization axis d3 parallel to the induced electric field axis P direction. For perfection, the axis orthogonal to the d3 axis can be called the d1 axis. The dimensions of the piezoelectric element 137200 are labeled as length (length, L), width (width, W), and thickness (thickness, T).

39B and 39C illustrate the mechanical deformation of the piezoelectric element 137200 that can be induced by subjecting the piezoelectric element 137200 to an working electric field E oriented along the d3 (or P) axis. FIG. 39B illustrates the effect of the electric field E having the same direction as the polarization field P along the d3 axis on the piezoelectric element 137205. As illustrated in FIG. 39B, the piezoelectric element 137205 can be deformed by expanding along the d3 axis while compressing along the d1 axis. FIG. 39C illustrates the effect of the electric field E having a direction opposite to the polarization field P along the d3 axis on the piezoelectric element 137210. As illustrated in FIG. 39C, the piezoelectric element 137210 can be deformed by compressing along the d3 axis while expanding along the d1 axis. Vibrational coupling along the d3 axis while applying an electric field along the d3 axis can be referred to as D33 coupling or activation of the piezoelectric element using the D33 mode. The transducer 137014 illustrated in FIG. 1 can use the D33 mode of the piezoelectric element 137032 to transmit mechanical vibrations to the ultrasonic blade 137050 along the waveguide 46. Since the piezoelectric element also deforms along the d1 axis, vibrational coupling along the d1 axis during application of an electric field along the d3 axis can also be an effective source of mechanical vibration. Such a bond can be referred to as a D31 bond or activation of the piezoelectric element using the D31 mode.

As illustrated by FIGS. 39A-39C, the lateral elongation of the piezoelectric elements 137200, 137205, 137210 during operation in D31 mode can be mathematically modeled by the following equation.

In the formula, L, W, and T indicate the length, width, and thickness dimensions of the piezoelectric element, respectively. V _d31 represents the voltage applied to the piezoelectric element operating in the D31 mode. The amount of lateral expansion obtained from the D31 coupling described above is represented by ΔL (ie, expansion of the piezoelectric element along the length dimension) and ΔW (ie, expansion of the piezoelectric element along the width dimension). To. Additionally, the lateral expansion equation models the relationship between ΔL and ΔW and the applied voltage V _d31. Disclosed below are aspects of an ultrasonic surgical instrument based on D31 activation by a piezoelectric element.

As described below, in various embodiments, the ultrasonic surgical instrument is operably coupled to a transducer and a transducer, an end effector, and a waveguide in between, which are configured to generate longitudinal vibrations. A surgical instrument having a transducer base plate (eg, a transducer mounting portion) can be provided. In certain embodiments, the transducer can also generate vibrations that can be transmitted to the end effector, such as the transducer base plate, waveguide, end effector, and / or for ultrasonic surgery. Various other components of the instrument can be driven at or near the resonant frequency. In resonant conditions, for example, longitudinal strain patterns, or longitudinal stress patterns, can develop in transducers, waveguides, and / or end effectors. In various embodiments, such longitudinal strain patterns, or longitudinal stress patterns, are sinusoidal, or at least substantially, along the length of the transducer base plate, waveguide, and / or end effector. The longitudinal strain or longitudinal stress can be varied by the sinusoidal technique. In at least one embodiment, for example, the longitudinal strain pattern can have maximum peaks and zero points, and the strain values can vary non-linearly between such peaks and zero points.

FIG. 40 shows an ultrasonic wave comprising an ultrasonic waveguide 137252 attached to an ultrasonic transducer 137264 by a bonding material configured such that the ultrasonic surgical instrument 137250 operates in D31 mode, according to one aspect of the present disclosure. The surgical instrument 137250 is illustrated. The ultrasonic transducer 137264 includes first and second piezoelectric elements 137254a, 137254b attached to the ultrasonic waveguide 137252 by a coupling material. Piezoelectric elements 137254a, 137254b include conductive plates 137256a, 137256b for electrically connecting to one pole (eg, usually a high voltage) of a voltage source suitable for driving the piezoelectric elements 137254a, 137254b. The pole on the opposite side of the voltage source is electrically connected to the ultrasonic waveguide 137252 by conductive joints 137258a, 137258b. In one aspect, the conductive plates 137256a, 137256b are connected to the positive electrode of the voltage source, and the conductive joints 137258a, 137258b are electrically connected to the ground potential through the metal ultrasonic waveguide 137252. In one aspect, the ultrasonic waveguide 137252 is made of titanium or a titanium alloy (ie, Ti6Al4V) and the piezoelectric elements 137254a, 137254b are made of PZT. The polling axes (P) of the piezoelectric elements 137254a and 137254b are indicated by directional arrows 137260. The axis of motion of the ultrasonic waveguide 137252 that responds to the excitation of the piezoelectric elements 137254a and 137245b is the motion of the distal end of the ultrasonic waveguide 137252, which is generally called the ultrasonic blade portion of the ultrasonic waveguide 137252. It is indicated by the arrow 137262. The motion axis 137262 is orthogonal to the polling axis (P) 137260.

As shown in FIG. 38, in a conventional D33 ultrasonic transducer structure, the bolted piezoelectric element 137032 utilizes electrodes 137034, 137036 to create electrical contact for both sizes of each piezoelectric element 137033. .. However, the D31 architecture 137250 according to one aspect of the present disclosure uses different techniques to create electrical contact to both sides of each of the piezoelectric elements 137254a, 137254b. Various techniques for providing electrical contact to the piezoelectric elements 137254a, 137254b include coupling a conductive element (eg, wire) to the free surface of each piezoelectric element 137254a, 137254b for high potential connection, and soldering. Conductive epoxy, or other techniques described herein, may be used to couple the piezoelectric elements 137254a, 137254b to an ultrasonic waveguide for ground connection 137252. Compression can be used to maintain electrical contact with the acoustic train without making permanent connections. As a result, the thickness of the device can be increased, so that it is necessary to control so as to avoid damage to the piezoelectric elements 137254a and 137254b. With weak compression, the spark gap can damage the piezoelectric elements 137254a, 137254b, and with strong compression, local mechanical wear can damage the piezoelectric elements 137254a, 137254b. In other techniques, metal spring contacts can be used to create electrical contacts with piezoelectric elements 137254a, 137254b. Other techniques may include foamed resin packing covered with metal leaf, conductive foamed resin, solder. In some embodiments, the electrical connections to both sides of the piezoelectric elements 137254a, 137254b have a D31 acoustic train configuration. An electrical ground connection can be made for a metal ultrasonic waveguide 137252, and if there is electrical contact between the piezoelectric elements 137254a, 137254b and the ultrasonic waveguide 137252, the waveguide is conductive. Show sex.

As shown in FIG. 38, in a conventional D33 ultrasonic transducer structure, the bolts provide compression that acoustically couples the piezoelectric ring to the ultrasonic waveguide. The D31 architecture 137250 according to one aspect of the present disclosure uses a variety of different techniques to acoustically connect the piezoelectric elements 137254a, 137254b to the ultrasonic waveguide 137252. Further details are disclosed in US Patent Application No. 15 / 679,940, entitled "ULTRASONIC TRANSDUCER TECHNIQUES FOR ULTRASONIC SURGICAL INSTRUMENT", filed August 17, 2017, which is incorporated herein by reference in its entirety. There is.

Figures 41-42 exemplify various views of the ultrasonic surgical instrument 137400. In various aspects, the surgical instrument 137400 can generally be embodied as a pair of ultrasonic shearers. In an embodiment in which the ultrasonic surgical instrument 137400 is embodied as a pair of ultrasonic shearers, the surgical instrument 137400 is pivotally connected (eg, by a clasp) to a second arm 137412b at pivot point 137413. The first arm 137412a that has been made can be included. The first arm 137412a was positioned at its distal end, including a collaborative surface (eg, a pad) configured to collaborate with an ultrasonic blade 137415 extending distally from the second arm 137412b. Includes clamp arm 137416. The clamp arm 137416 and the ultrasonic blade 137415 can collectively define the end effector 137410. Activating the first arm 137412a in the first direction causes the clamp arm 137416 to pivot towards the ultrasonic blade 137415, and actuating the first arm 137412a in the second direction causes the clamp arm 137416 to superimpose. It pivots away from the ultrasonic blade 137415. In some embodiments, the clamp arm 13716 further comprises a pad constructed from a polymer or other elastic material and engaged with an ultrasonic blade 137415. The surgical instrument 137400 further includes a transducer assembly as described above with respect to FIGS. 38-40. Transducer assemblies can be arranged, for example, in a D31 or D33 architecture. The surgical instrument 137400 and a housing 137414 surrounding various components of the ultrasonic system 137010 (FIG. 38), including first and second piezoelectric elements 137419a, 137419b of the ultrasonic transducers 137418 arranged in a D31 architecture. , Transducer base plate 137428 (eg, transducer mounting portion) with a flat surface on the opposite side to receive the piezoelectric elements 137419a, 137419b, and conduction to transfer vibration from the ultrasonic transducer 137418 to the ultrasonic blade 137415 in the longitudinal direction. A wave tube 137417 is further provided. Further, the surgical instrument 137400 can be connected to an ultrasonic signal generator for driving the ultrasonic transducer 137418 as described above. The waveguide 137417 comprises a plurality of wave nodes (ie, points located at the minimum or zero intersection of vibrating motion standing waves) or at least a plurality of stabilized silicone rings or elastic supports 137411 positioned close to it. Can be done. The elastic support 137411 is configured to dampen unwanted lateral vibrations to ensure that the ultrasonic energy is transmitted longitudinally to the ultrasonic blade 137415. The waveguide 137417 extends through the housing 137414 and the second arm 137412b and terminates outside the housing 137414 at the ultrasonic blade 137415. The ultrasonic blade 137415 and the clamp arm 137416 are collaborative elements configured to grip the tissue, allowing the end effector 137410 to clamp and cut / coagulate the tissue. When the clamp arm 137416 is moved toward the ultrasonic blade 137415, the tissue placed between them is brought into contact with the clamp arm 137415, and the ultrasonic blade 137415 can operate on the gripped tissue. When the ultrasonic blade 137415 ultrasonically vibrates against the gripped tissue, the ultrasonic blade 137415 generates a frictional force that coagulates the tissue and finally along the cutting length of the ultrasonic blade 137415. Disconnect.

The cutting length of the surgical instrument 137400 corresponds to the length of the collaborative surface of the ultrasonic blade 137415 of the clamp arm 137416 and the clamp arm 137416. The tissue held between the ultrasonic blade 137415 and the cooperating surface of the clamp arm 137416 for a sufficient period of time is cut by the ultrasonic blade 137415 as described above. Corresponding parts of the ultrasonic blade 137415 and the clamp arm 137416 can have various shapes. In various aspects, the ultrasonic blade 137415 and / or the clamp arm 137416 may have a substantially linear shape or may have a curvature. In some embodiments, the portion of the clamp arm 137416 configured to bring the tissue into contact with the ultrasonic blade 137415 corresponds to the shape of the ultrasonic blade 137415, whereby the clamp arm 137416 is aligned with it.

Various further details regarding the ultrasonic transducer assembly and the ultrasonic shearing machine are incorporated herein by reference in their entirety, entitled "ULTRASONIC TRANSDUCER TECHNIQUES FOR ULTRASONIC SURGICAL INSTRUMENT", filed August 17, 2017. It can be found in US Patent Application No. 15 / 679,940.

Advanced Energy Device Activation Options FIG. 43 shows a block diagram of the surgical system 137500 according to at least one aspect of the present disclosure. The surgical system 137500 may include, for example, the surgical system 1000 shown in FIG. 20 and / or the ultrasonic surgical instrument system 137010 shown in FIG. 38. The surgical system 137500 may include a surgical instrument 137400 such as an ultrasonic surgical instrument 1104 (FIG. 18) or an ultrasonic surgical instrument 137300 (FIG. 29) that can be electrically connected to an electrosurgical generator 137504. The electrosurgical generator 137504 is capable of generating ultrasonic energy, unipolar or bipolar high frequency (RF) energy, other types of energy, and / or combinations thereof for driving the surgical instrument 137400. Generator 1100 (FIG. 18) or generator 137012 (FIG. 38) and the like.

In the aspect shown in FIG. 43, the surgical instrument 137400 comprises a transducer assembly 137510 with at least two piezoelectric elements. The transducer assembly 137510 is described in connection with FIGS. 38-40 so that when the transducer assembly 137510 is activated, the transducer assembly 137510 can ultrasonically vibrate the ultrasonic blade 137512. Operatively connected to 137512. The transducer assembly 137510 is then electrically connected to the generator 137504 and receives energy from it. Thus, when energized by the generator 137504, the transducer assembly 137510 is configured to ultrasonically vibrate the ultrasonic blade 137512 to cut and / or coagulate the tissue captured by the surgical instrument 137400.

In another aspect, the surgical instrument 137400 comprises one or more electrodes 796 (FIG. 17) or other conductive elements located at the end effector 792 (FIG. 17). The electrode 796 is then electrically connected to the generator 137504 and receives energy from it. When energized by the generator 137504, the electrode 796 applies RF energy to cut and / or coagulate the tissue captured by the surgical instrument 137400, as described in connection with FIG. It is composed.

The surgical instrument 137400 further includes a control circuit 137506 that is communicably connected to the sensor 137508 and communicably connected to the generator 137504. The control circuit 137506 is, for example, a processor, a microcontroller, an application specific integrated circuit (ASIC), a field programmable gate array (FPGA) connected to primary and / or secondary computer memory for executing instructions stored in memory. ), And other such devices can be included. The sensor 137508 is configured to sense the characteristics of the environment and / or the surgical instrument 137400 and provide an output corresponding to the presence or magnitude of the sensed characteristics. The control circuit 137506 is then configured to selectively control the activation of the transducer assembly 137510 and / or the electrode 796, depending on whether the perceived properties are above or below the threshold. To. In other words, the control circuit 137506 is configured to control the activation of the transducer assembly 137510 and / or the electrode 796 according to the sensor output with respect to the threshold. In one aspect, the threshold is stored in the memory of the surgical instrument 137400 and can be acquired by the control circuit 137506 and compared with the output signal from the sensor 137508.

In various other embodiments, the control circuit 137506 and / or the sensor 137508 may be external to the surgical instrument 137400. In these examples, the control circuit 137 506 and / or sensor 137,508 is any wired communications protocols ^{(e.g., I} 2 C) or a wireless communication protocol (e.g., Bluetooth) via, can communicate and / or to the generator 137504 with each other Includes hardware and / or software suitable for achieving a particular communication protocol that can be connected to. In yet another example, the generator 137504 may be integral with the surgical instrument 137400 and is located inside, rather than outside the surgical instrument 137400, as shown in FIGS. 18 and 38. It may be incorporated in another way.

Figures 44-45C show various diagrams of surgical instruments 137400, including sensor assembly 137508 configured to detect magnetic reference 137404 according to at least one aspect of the present disclosure. See also FIG. 43 in the following description of FIGS. 44-45C. In one aspect, the sensor assembly 137508 includes a sensor 137402 configured to detect the position or state (eg, opening and closing) of the surgical instrument 137400 by detecting the corresponding position or position of the magnetic reference 137404. The sensor 137402 can include, for example, a Hall effect sensor configured to detect the position of the magnetic reference 137404 relative to it. Therefore, the magnetic reference 137404 is configured such that its position corresponds to the position and / or condition of the surgical instrument 137400. The Hall effect sensor is configured to detect, for example, a Hall element configured to detect the relative distance between the magnetic reference 137404 and the sensor 137402, or a multidimensional position or orientation of the magnetic reference 137404 with respect to the sensor 137402. Multiple Hall element assemblies (eg, Infineon Technologies TLV493D-A1B6 3D magnetic sensor) can be included. Further, the Hall effect sensor is a linear Hall effect sensor (ie, a Hall effect sensor whose output changes linearly with magnetic flux density) or a threshold Hall effect sensor (ie, a Hall effect sensor whose output drops sharply as the magnetic flux density decreases). ) Can be included.

In the aspect shown in FIG. 44, the magnetic reference 137404 includes a wearable magnet 137406. Thus, the sensor 137402 is configured to detect, for example, the relative position of the wearable magnet 137406 when worn by the surgeon's hand. In various aspects, the relative position of the wearable magnet 137406 with respect to the sensor 137402 can include, for example, the relative distance between the wearable magnet 137406 and the sensor 137402 and / or the relative orientation of the wearable magnet 137406 with respect to the sensor 137402. .. In one embodiment, the wearable magnet 137406 may be incorporated into or placed in or on a ring that is worn on the surgeon's finger (eg, on a surgical glove). In another embodiment, the wearable magnet 137406 can be attached to or integrated with a wearable surgical glove by the surgeon. In these embodiments, when the wearable magnet 137406 is located in the surgeon's hand and the surgeon's hand grips the arm 137412 of the surgical instrument 137400 during use, the position of the wearable magnet 137406 detected by the sensor 137402 is the surgical instrument. 137400. Corresponds to the relative position of the arm 137412. By sensing the relative position of the arm 137412 of the surgical instrument 137400, the control circuit 137506 determines whether the surgical instrument 137400 is open, closed, or in an intermediate position between them. Can be done.

In another example, the positions of the wearable magnet 137406 and the sensor 137402 may be reversed from the above aspects. In other words, the magnet can be positioned on or within the surgical instrument 137400, and the sensor 137402 may be positioned above or mounted by the surgeon (eg, as described above). Incorporated into a ring or surgical glove). Otherwise, this exemplary function works in a similar manner to the examples described above.

In the embodiment shown in FIGS. 45A-45C, the magnetic reference 137404 includes an integrated magnet 137408 positioned within or on a movable component of a surgical instrument 137400, such as an arm 137412. Therefore, the sensor 137402 is configured to detect the relative position of the integrated magnet 137408 within the arm 137412 of the surgical instrument 137400. The integrated magnet 137408 and the sensor 137402 can be arranged such that the integrated magnet 137408 moves with respect to the sensor 137402 by opening and closing the surgical instrument 137400, respectively. In the illustrated embodiment, the integrated magnet 137408 may be positioned on or within the movable arm 137712 of the surgical instrument 137400, and the sensor 137402 may be positioned on or within the housing 137414 of the surgical instrument 137400. In these aspects, the position of the integrated magnet 137408 detected by the sensor 137402 corresponds to the relative position of the arm 137412 of the surgical instrument 137400. By sensing the relative position of the arm 137412 of the surgical instrument 137400, the control circuit 137506 determines whether the surgical instrument 137400 is open, closed, or in an intermediate position between them. Can be done.

In another example, the positions of the integrated magnet 137408 and the sensor 137402 may be reversed from the above aspects. In other words, the integrated magnet 137408 may be positioned on or within the housing 137414 of the surgical instrument 137400, and the sensor 137402 is of the corresponding movable component of the surgical instrument 137400 being tracked (eg, arm 137421). It can be positioned above or within it. Otherwise, this exemplary function works in a similar manner to the examples described above.

The sensor 137402 is configured to generate an output corresponding to the position of the magnetic reference 137404 relative to it (eg, the distance between the magnetic reference 137404 and the sensor 137402 and / or the orientation of the magnetic reference 137404 with respect to the sensor 137402). There is. Thus, when the magnetic reference 137404 and / or the sensor 137402 move relative to each other when the surgical instrument 137400 is closed, opened, or otherwise manipulated by the surgeon, the sensor 137400 The relative position of the magnetic reference 137404 can be detected according to the sensed magnetic field of the magnetic reference 137404. Sensor 137402 can then generate an output corresponding to the perceived magnetic field of magnetic reference 137404. In one aspect in which the sensor 137402 includes a Hall effect sensor, the sensor output may be a voltage, the magnitude of the output voltage corresponding to the strength of the magnetic field from the magnetic reference 137404 sensed by the sensor 137402.

In one aspect, the control circuit 137506 is configured to receive the output from the sensor 137402 and then compare the output of the sensor 137402 to the threshold. The control circuit 137506 can further activate or deactivate the surgical instrument 137400 according to the comparison between the output of the sensor 137402 and the threshold. The threshold can be predetermined or set, for example, by the user of the surgical instrument 137400. The output of sensor 137402 can correspond to the position of the arm of the surgical instrument 137400 (directly as in the embodiment shown in FIGS. 45A-45C or indirectly as in the embodiment shown in FIG. 44). Next, the position of the clamp arm 137416 (FIG. 41) with respect to the ultrasonic blade 137512 is controlled. Thus, the output of the sensor 137402 corresponds, for example, to the position of the clamp arm 137416 of the surgical instrument 137402 between the open and closed positions. Further, in these examples, the threshold may correspond to the threshold distance between the magnetic reference 137404 and the sensor 137402. FIG. 45B can represent, for example, the open position of the surgical instrument 137400 (ie, the integrated magnet 137408 is not within the threshold distance to the sensor 137402). FIG. 45C can represent, for example, the closed position of the surgical instrument 137400 (ie, the integrated magnet 137408 is within a threshold distance to the sensor 137402).

In one embodiment, the control circuit 137506 can determine whether the magnetic reference 137404 is located below the threshold distance from the sensor 137402. In this example, if the control circuit 137506 determines that the sensor output exceeds the threshold, the control circuit 137506 can activate the surgical instrument 137400. In another example, the control circuit 137506 can determine whether the magnetic reference 137404 is located above a threshold distance from the sensor 137402. In this example, if the control circuit 137506 determines that the voltage output of the sensor 137402 is below the threshold, the control circuit 137506 can activate the surgical instrument 137400. The control circuit 137506 signals the generator 137504 to energize the transducer assembly 137510 and / or the RF electrode 796 to cut and / or coagulate the tissue captured by the surgical instrument 137400. Activates the surgical instrument 137400. In short, in some embodiments, the control circuit 137506 may be configured to determine if the surgical instrument 137400 is sufficiently closed and, in the former case, activate the surgical instrument 137400.

In another aspect, the control circuit 137506 prompts the user or surges the data if it determines that the surgical instrument 137400 is sufficiently closed, as described in connection with FIGS. 1-11. It may be configured to take other actions, such as transmitting to the hub 106. In yet another aspect, the control circuit 137506 has the surgical instrument 137400 fully open or is the surgical instrument 137400 in a specific position (or range of positions) between the open and closed positions. Can be configured to determine. If the surgical instrument 137400 is in a defined position (s) or within that position, the control circuit 137506 may activate the surgical instrument 137400, stop the surgical instrument 137400, or variously accordingly. Other actions can be performed.

In some embodiments, the control circuit 137506 detects tapping, friction, and other types of motion based on the amplitude, frequency, and / or direction of motion of magnetic reference 137404 detected via sensor 137402. It can be configured as follows. Such motion can be detected because the change in magnetic field intensity over time detected by sensor 137402 is characterized (empirically or otherwise) and can be defined for different types of motion. .. For example, the tapping motion can be detected according to the frequency detected in the change in magnetic field detected by the sensor 137402 in a direction substantially perpendicular to the longitudinal axis of the surgical instrument 137400. As another example, the frictional motion may be detectable according to the frequency detected in the change in magnetic field detected by the sensor 137402 in a direction substantially parallel to the longitudinal axis of the surgical instrument 137400. In some embodiments, the control circuit 137506 may be configured to change the state, mode, and / or characteristics of the surgical instrument 137400 according to the detected movement. For example, the control circuit 137506 may be configured to activate the surgical instrument 137400 upon detecting tap motion via the sensor 137402.

46A-46B show perspective views of a surgical instrument 137400, including a sensor assembly 137508 configured to detect contact, according to at least one aspect of the present disclosure, and FIG. 47 shows a corresponding circuit diagram. See also FIG. 43 in the following description of FIGS. 46A-47. In one aspect, the sensor assembly 137508 can include a touch sensor 137420 configured to detect forces, contacts, and / or pressures on it. The touch sensor 137420 can include, for example, a force sensor register (FSR) 137421. In the illustration shown in FIG. 46A, the touch sensor 137420 is laterally oriented with respect to the longitudinal axis of the surgical instrument 137400. In this example, the touch sensor 137420 defines a surface extending perpendicular to the longitudinal axis of the surgical instrument 137400 from the housing 137414. In another exemplary example shown in FIG. 46B, the touch sensor 137420 extends along the side surface (s) of the housing 137414. In this example, the touch sensor 137420 may be integrated with the housing 137414 of the surgical instrument 137400 or may be positioned on the housing 137414 of the surgical instrument 137400. In any of these examples, the touch sensor 137420 is used by the surgeon (eg, to control one or more functions of the surgical instrument 137400), eg, the transducer assembly 137510 of the surgical instrument 137400. It can be activated or otherwise provided with input to the surgical instrument 137400.

In one aspect in which the touch sensor 137420 includes the FSR 137421 shown in FIG. 47, the surgical instrument 137400 may include a circuit that controls the activation of an electrosurgical generator 137426 that is electrically connectable to the surgical instrument 137400. In this example, the FSR 137421 is electrically connected to an analog-to-digital converter (ADC) 137422 and a control circuit 137424 (eg, a microcontroller or ASIC). When a force F is applied to the FSR 137421, the voltage output of the FSR 137721 changes accordingly. The ADC 137422 then converts the analog signal from the FSR 137421 into a digital signal, which is then supplied to the control circuit 137424. In one example, the control circuit 137424 then compares the received signal (which indicates the output voltage of the FSR 137421, which in turn indicates the force F or pressure experienced by the FSR 137421) with the threshold to activate the electrosurgical generator 137426. It can be determined whether or not. In one example, if the received signal exceeds a threshold, the control circuit 137424 sends the signal to the electrosurgical generator 137426 to activate it and energize the transducer assembly 137510 and / or the RF electrode 796. , The tissue captured by the surgical instrument 137400 can be cut and / or coagulated. In another example, the control circuit 137424 transmits the output of the FSR 137421 or its signal to the control circuit of the electrosurgical generator 137426, and then uses the received signal (indicating the force F or pressure experienced by the FSR 137421) as a threshold. By comparison, it can be determined whether or not to activate the electrosurgical generator 137426. If the received signal exceeds a threshold, the control circuit of the electrosurgical generator 137426 supplies the electrosurgical generator 137426 with energy to the transducer assembly 137510 of the surgical instrument 137400, which is electrically connected (eg,). , Can be started (via the drive signal). In short, in some embodiments, the control circuit 137506 can determine if a sufficient amount of force is being applied to the touch sensor 137420 and thereby activate the transducer assembly 137510.

48A-48C show perspective views of a surgical instrument 137400, including a sensor assembly 137429 configured to detect closure of the surgical instrument 137400 according to at least one aspect of the present disclosure. See also FIG. 43 in the following description of FIGS. 48A-48C. In one aspect, the closure sensor assembly 137429 is a closure sensor 137430 configured to detect when the arm 137412 of the surgical instrument 137400 is in the closed position, in some embodiments the surgical instrument 137400 is in the closed position. A closure sensor 137430 configured to later detect whether additional force is being applied to the arm 137412 can be included. In one example, the closure sensor 137430 includes a two-stage tactile switch, and when the arm of the surgical instrument is in the closed position, in the first stage, additional force or after the arm 137412 of the surgical instrument 137400 is in the closed position It is configured to detect when pressure is applied, and in the second stage, when additional force or pressure is applied after the arm 137412 of the surgical instrument 137400 is in the closed position. .. Such a closure sensor 137430 can allow the surgical instrument 137400 to be closed, for example, without necessarily automatically activating the transducer assembly 137510 and / or the RF electrode 796.

In an embodiment shown in FIG. 48a through 48c, when the arm 137 412 an arm 137 412 is rotated to the closed position from the open position by rotating in a first direction _{R 1} (FIG. 48A) (FIG. 48B), the arms 137,412 The closure sensor 137430 is positioned on the housing 137414 so that is engaged with the closure sensor 137430. When the arm 137412 is in the closed position, the arm 137412 can be bottomed with respect to the housing 137414 (enclosure) and / or the closure sensor 137430. When the surgical instrument 137400 is opened (or not closed), or when the arm 137412 of the surgical instrument 137400 is closed but no additional force is applied, the closure sensor 137430 is shown in FIG. 48B. As shown, it can be in the first position or in the first state. Arms 137,412 of the surgical instrument 137 400 is closed, the additional force _{F 1} is applied to the arm 137 412, as shown in FIG. 48C, the closure sensor 137,430 can be in a second position or a second state. _{In some embodiments, the arm 137412 may be at a first angle θ 1} from the housing 137414 when the arm 137412 is in the initial closed position, and when a force F ₁ is applied to the arm 137412 in the initial closed position, the force F ₁ presses the closure sensor 137430 and the arm 137412 is at a second angle θ ₂ from the housing 137414.

In one aspect, the output of the closure sensor 137430 may vary depending on the location and / or state of the closure sensor 137430. In other words, when the closure sensor 137430 is in the first state, it can provide a first output to the control circuit 137506 of the surgical instrument 137400, and when the closure sensor 137430 is in the second state, the surgical instrument. A second output can be provided to the control circuit 137506 of 137400. Therefore, the closure sensor 137430 detects (i) whether the surgical instrument 137400 is closed and (ii) whether an additional force is applied when the surgical instrument 137400 is closed. Can be configured as In one aspect, the transducer assembly 137510 and / or the RF electrode 796 can be activated and / or supplied with energy only when the closure sensor 137430 is in the second state / position. This aspect allows the surgeon to operate the surgical instrument 137400 solely by manipulating the arm 137412 without losing the ability to grip and manipulate tissue without activation of the transducer assembly 137510 and / or RF electrode 796. To.

In one aspect, the control circuit 137506 receives the output from the closure sensor 137430 and then compares the output of the closure sensor 137430 with a threshold to determine if the closure sensor 137430 is in the second position / state. It is configured to do. The threshold can be predetermined or set, for example, by the user of the surgical instrument 137400. The closure sensor 137430 detects whether the arm 137412 of the surgical instrument 137400 is closed, and further whether additional force is applied to the arm 137412 when the arm 137412 is closed. In the illustration, the output of the closure sensor 137430 changes accordingly. Further, in these examples, the threshold can correspond to the threshold force applied to the arm 137412 (ie, the closure sensor 137430) after the arm 137412 is closed. For example, if the control circuit 137506 determines that the output of the closure sensor 137430 exceeds a threshold, the control circuit 137506 sends a signal to the generator 137504 to start supplying energy to the transducer assembly. , Transducer assembly 137510 and / or RF electrode 796 can be activated. In short, in some embodiments, the control circuit 137506 can determine if a sufficient amount of force is applied to the closing arm 137412 of the surgical instrument 137400, and if so, if force is applied. Activate the transducer assembly 137510 and / or RF electrode 796.

49A-49F show various views of a surgical instrument 137400, including a sensor assembly 137439 configured to detect an opening in the surgical instrument 137400 according to at least one aspect of the present disclosure. See also FIG. 43 in the following description of FIGS. 49A-49F. In one embodiment, the opening sensor assembly 137,439 includes an open sensor 137440 configured to detect when the arm 137,412 of the surgical instrument 137 400 has been rotated to the open position in the second direction _{R 2.} In one example, the open sensor 137440 includes a tactile switch (eg, a one-step tactile switch) configured to detect when the arm 137412 of the surgical instrument 137400 is in a sufficiently open position. The open sensor 137440 is fully or fully open, for example, to allow the surgical instrument 137400 to perform posterior (anterior) scoring and other surgical techniques used to apply electrical or ultrasonic energy to unclamped tissue. It can be used to energize the surgical instrument 137400 when in the position, and when the surgical instrument 137400 is open to any degree, the surgical instrument 137400 is not energized.

In various embodiments, the open sensor 137440 may be positioned at or adjacent to the pivot point 137413 of the surgical instrument 137400. In one aspect shown in FIGS. 49A-49F, the open sensor 137440 is positioned within the recess 137443 on the first lateral portion of the housing 137414. The corresponding tab 137442 is located on the second lateral portion of the housing 137414 and travels through the recess 137443 to contact the open sensor 137440, with the clamp arm 137416 of the surgical instrument 137400 fully open. It is configured to contact the release sensor 137440 and apply _{force F 2} when it is opened (ie, at least at a particular angle). The open sensor 137440 can be in the first position or first state when the open sensor 137440 is not in contact with the tab 137442. As shown in FIG. 49D, when the arm 137412 of the surgical instrument 137400 is opened at an angle sufficient to allow the tab 137422 to contact the open sensor 137440, the open sensor 137440 is placed in a second position or in a second state. Can be in. In one aspect, the output of the open sensor 137440 may vary depending on the position and / or state of the open sensor 137440. In other words, when the open sensor 137440 is in the first state, it can provide a first output to the control circuit 137506 of the surgical instrument 137400, and when the open sensor 137440 is in the second state, the surgical instrument. A second output can be provided to the control circuit 137506 of 137400. Therefore, the opening sensor 137440 includes at least a (e.g., by the force _{F 2} applied thereto) or open sensor 137440 is triggered, or to an angle that is activated, detects whether the surgical instrument 137 400 is opened can do. In one aspect, the transducer assembly 137510 and / or RF electrode 796 can be activated and / or energized only when the sensor is in the second state / position, as described above.

In one aspect, the control circuit 137506 is configured to receive an output from the open sensor 137440 and compare the output of the open sensor 137440 with a threshold value such that the open sensor 137440 is in a second position / state. Corresponds to. The threshold can be predetermined or set, for example, by the user of the surgical instrument 137400. In the above example, where the open sensor 137440 detects whether the arm 137420 of the surgical instrument 137400 is open at a particular angle, the output of the open sensor 137440 changes accordingly. Further, in these examples, the threshold value may correspond to the threshold angle at which the arm 137412 of the surgical instrument 137400 is located. In one aspect, if the control circuit 137506 determines that the output of the open sensor 137440 exceeds the threshold, the control circuit 137506 starts supplying energy to the transducer assembly 137510 and / or the RF electrode 796 of the generator 137504. The transducer assembly 137510 and / or the RF electrode 796 can be activated by sending a signal to the generator 137504. In short, in some embodiments, the control circuit 137506 can determine if the arm 137412 of the surgical instrument 137400 is open at a sufficient angle, and if so, then Activate the transducer assembly 137510 and / or the RF electrode 796.

In certain embodiments, the sensor assemblies for activating the surgical instrument 137400 described above in connection with FIGS. 44-49F can be implemented in various combinations with each other. For example, FIG. 50 shows surgery in which sensor assembly 137508 includes both closed sensor assembly 137429 described in relation to FIGS. 48A-48C and open sensor assembly 137439 described in relation to FIGS. 49A-49F. An example of the tool 137400 is shown. Various aspects of the sensor assembly 137508 described herein are intended to provide ancillary and / or alternative methods for invoking and / or providing an input to a surgical instrument 137400. Can be combined together within 137400. It should be noted that the illustration shown in FIG. 50 is intended to be merely an example, and other examples of the surgical instrument 137400 may include any other combination of the sensor assembly 137508 described above.

FIG. 51 shows a perspective view of a surgical instrument including a stop control 137450 according to at least one aspect of the present disclosure. In various embodiments, the surgical instrument 137400 activates or stops one or more of the various sensors of the surgical instrument 137400, such as the various sensor assemblies 137508 described above in connection with FIGS. 44-49F. It may include stop control 137450 for control. The stop control 137450 may include, for example, a physical toggle or switch located on the housing 137414 of the surgical instrument 137400, or a touch screen display. The stop control 137450 may be communicably connected to the control circuit 137506 of the surgical instrument 137400, and in response to an input from the stop control 137450, the control circuit 137506 stops, for example, the sensor assembly 137508 controlled by the stop control 137450. Or ignore the output from the sensor assembly 137508 controlled by the stop control unit 137450, or take no action on it.

With reference to FIGS. 41-51, the surgical instrument 137400 may further include indicators such as LEDs, displays, and other such output devices. The indicator can be connected to and controlled by control circuit 137506. In some embodiments, the control circuit 137506 may be configured to activate the indicator in response to an input received from the sensor assembly 137508. For example, the control circuit 137506 may be configured to activate the indicator when the control circuit 137506 determines that the surgical instrument 137400 is in the closed position (eg, as perceived via the sensor assembly 137508).

Smart Retractor FIG. 52 shows a perspective view of the Retractor 137600, including sensor 137602, according to at least one aspect of the present disclosure. In various aspects, the retractor 137600 for fixing the surgical site opening 137650 can include a removable or integrally attached sensor 137602. In one aspect, the sensor 137602 can be removably fixed to the retractor 137600 via a magnet. The sensor 137602 may be configured to detect when the retractor 137600 is tapped, joyed, moved, or otherwise operated by a user (eg, a surgeon). In one example, the sensor 137602 can include a vibration sensor configured to detect vibration or movement by a retractor 137600 to which the sensor 137602 is attached (eg, ADIS16223 digital axial vibration sensor). In one aspect, the sensor 137602 may be reusable. That is, the sensor 137602 can maintain its effectiveness throughout the sterilization process (the sensor 137602 is attached to a retractor 137600 in the surgical field and is therefore used in surgical procedures when reused. Will be sterilized afterwards). The sensor 137602 can be configured to detect different types of motion or motion (eg, tap) of the user according to the amplitude, frequency, and / or direction of the detected motion or vibration of the retractor 137600.

The sensor 137602 can be configured to transmit a signal indicating the detected vibration or motion of the retractor 137600. In one aspect, the sensor 137602 may be communicably connected to a surgical instrument 137606 (eg, surgical or electrosurgical instrument) and / or another device (eg, generator), eg, via a wired connection 137604. .. Based on the movement or movement detected by the sensor 137602, the sensor 137602 changes the state of the surgical instrument (s) 137606 and / or other devices (s) communicatively connected to the sensor 137602. Can be done. The state of the surgical instrument (s) 137606 and / or other device (s) is, for example, the mode of the instrument (s) 137606 and / or the device (s), or the instrument (s) 137606 and / Or can correspond to the characteristics of the device (s). For example, if the sensor 137602 detects that the retractor 137600 is tapped, the sensor 137602 can send a signal to a surgical instrument 137606 communicatively connected to the sensor 137602, which signal is surgical. The instrument 137606 is changed from the inactive state to the activated state (or vice versa). As another example, when sensor 137602 detects that the retractor 137600 is touched, sensor 137602 signals a generator communicably connected to it to change from stop mode to start mode (or vice versa). Can be transmitted to the surgical generator. In some embodiments, the retractor sensor 137602 may be configured to transmit data and / or signals to the surgical hub 106, as described in connection with FIGS. 1-11. Thereby, as described above, various actions can be taken, such as controlling the surgical instrument (s) 137606 and / or other devices (s).

FIG. 53 shows a perspective view of a retractor 137902, including a display used at surgical site 137900, according to at least one aspect of the present disclosure. Surgical retractor 137902 helps surgeons and operating room professionals keep incisions or wounds open during surgery. Surgical retractor 137902 helps retain the underlying organ or tissue, allowing doctors / nurses better visibility and access to exposed areas. Retractor 137902 can include a display 137904, or other control device configured to display warnings and / or information related to the surgery being performed, and is an instrument used during the course of surgery. Alternatively, it provides a means of controlling the device, or an environment in which surgery is performed (eg, an operating room) and performs other such functions. In the illustrated embodiment, the control device is integrated with the retractor 137902. In another aspect, the control device can include, for example, a portable electronic device including a touch screen display (eg, a tablet computer) that can be detachably attached to the retractor 137902. In yet another aspect, the control device includes a flexible sticker display that can be attached to the patient's body / skin or another surface.

In one aspect, the controller provides the user with an input device (eg, a keypad, a capacitive touch screen, or a combination thereof) for receiving input from the user and warnings, information, or other output. Output devices (eg, displays), energy sources (eg, coin batteries, batteries, photovoltaic batteries, or combinations thereof), control devices, surgical instruments, devices in the operating room (eg, FIGS. 1-. 11. A network interface for a communication protocol (eg, Wi-Fi, Bluetooth) for communicably connecting to a surgical hub 106) and / or other device (surgical or other device). Including the controller. The control device can be configured to provide a graphical user interface (GUI) for displaying information to the user (eg, a surgeon) and receiving input or commands from the user. In one aspect, the controller further comprises a light source 137906 (eg, an array of LEDs) configured to illuminate the surgical field of view 137908 in which the retractor 137902 is utilized for fixation.

In one aspect, the control device is removable and secure to the surgical retractor 137902. In another aspect, the controller is integrated with a retractor 137902 that defines a "smart" surgical retractor 137902. The smart surgical retractor 137902 may include an input display operated by the smart surgical retractor 137902. The smart surgical retractor 137902 may include a wireless communication device for communicating with a device connected to a generator module connected to a surgical hub. Using the input display of the smart surgical retractor 137902, the surgeon can adjust the power level or mode of the generator module to cut and / or coagulate the tissue. When using auto-on / off for energy delivery on the closure of the end effector on the tissue, the auto-on / off state is indicated by a light, screen, or other device located on the smart retractor housing. You may. The power used may be changed and displayed.

In various aspects, the controller may be configured to control various functions of the surgical instrument communicatively connected to the controller, such as power parameters (eg, electrosurgical instruments and / or ultrasonic instruments). Power parameters, or, for example, the "cutting" and "coagulation" modes of the electrosurgical instrument, or the operating mode of the surgical instrument, such as automatic). In various aspects, the control device may be configured to display information related to the surgery performed and / or the device used during the course of the surgery. Information includes the temperature of the ultrasonic blade (end effector), warnings or warnings that occur during the course of surgery, or the location of nerves in the surgical field. Warnings or alerts can be generated, for example, by a surgical hub 106 to which a surgical instrument and / or a surgical instrument (or other modular surgical device) is communicatively connected. In various aspects, the control device can be configured to control the function of the environment in which the surgical procedure is being performed (eg, the operating room), such as the intensity and / or position of field lights in the operating room.

In various aspects, the control device senses which surgical instrument or other device is in the vicinity of the control device and then controls the operation of any surgical instrument or other device connected to the control device. It may be configured to pass to the control device. In one aspect, the smart surgical retractor 137902 uses which device / instrument the surgeon uses via a surgical hub 106, RFID, or device / instrument or other device located on the smart surgical retractor 137902. It is possible to detect or know what is being done, and to provide an appropriate display. Warnings and alerts may be triggered depending on the situation. Other features include displaying the temperature, nerve monitoring, light source, or fluorescence of the ultrasonic blade. The light source 137906 may be used to illuminate the surgical field of view 137908 and charge the optical cell on a single-use sticker display attached to the smart retractor 137902. In another aspect, the smart surgical retractor 137902 may include augmented reality projected onto the patient's anatomy (eg, a venous viewer).

In another aspect, the control device may include a smart flexible sticker display that can be attached to the patient's body / skin. The smart flexible sticker display can be attached to the patient's body / skin, for example, between areas exposed by a surgical retractor. In one aspect, the smart flexible sticker display may be powered by light, an onboard battery, or a ground pad. The flexible sticker display can communicate with the device via short range radio (eg, Bluetooth) and can provide read, power lock, or power change. The smart flexible sticker display also includes an optical cell for using ambient light energy to power the smart flexible sticker display. The flexible sticker display includes a control panel user interface display 137904, which allows the surgeon to control a control device or other module connected to a surgical hub.

Various further details regarding the smart retractor are entitled "DISPLAY OF ALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LINEAR STAPLE LINE" filed March 29, 2018, which is incorporated herein by reference in its entirety. It can be found in US Patent Application No. 15 / 940,686.

Situational Awareness With reference to FIG. 54, a timeline 5200 indicating situational awareness of a hub, such as a surgical hub 106 or 206 (FIGS. 1-11), is shown. Timeline 5200 is an exemplary surgical procedure and contextual information that the surgical hubs 106, 206 can derive from data received from a data source at each step of the surgical procedure. Timeline 5200 is taken by nurses, surgeons, and other healthcare professionals in the process of lung segment resection surgery, which begins with the establishment of an operating room and ends with the transfer of the patient to the postoperative recovery room. Here is a typical process that would be.

Situation Aware Surgical Hubs 106, 206 are data sources that include data generated each time a healthcare professional uses a modular device paired with Surgical Hubs 106, 206 throughout the surgical procedure. Receive from. Surgical hubs 106, 206 receive this data from paired modular devices and other data sources to receive new data such as which step of the procedure is being performed at any given time. Once done, estimates (ie, contextual information) about ongoing treatment can be continuously derived. The situation-aware system of surgical hubs 106, 206, for example, records data about the procedure to generate a report, validates the steps taken by healthcare professionals, data that may be relevant to a particular procedure step, or Providing a prompt (eg, via a display screen), adjusting a modular device based on context (eg, activating a monitor, adjusting the visibility (FOV) of a medical imaging device, or for ultrasound surgery It is possible to perform any of the above operations, such as changing the energy level of the instrument or RF electrosurgical instrument).

As a first step 5202 in this exemplary procedure, the hospital staff reads the patient's EMR from the hospital's EMR database. Based on selected patient data in the EMR, surgical hubs 106, 206 determine that the procedure performed is a thoracic procedure.

In the second step 5204, the staff scans incoming medical supplies for treatment. Surgical hubs 106, 206 cross-reference the scanned supplies with a list of supplies used in various types of procedures to ensure that the mix of supplies corresponds to the thoracic procedure. In addition, the surgical hubs 106, 206 can also determine that the procedure is not a wedge procedure (the incoming supplies do not contain the specific supplies required for the thoracic wedge procedure, or otherwise the thoracic Either because it does not support wedge treatment).

In step 5206, the healthcare professional scans the patient's band via a scanner communicatively connected to the surgical hubs 106, 206. Subsequently, the surgical hubs 106, 206 can confirm the patient's identification information based on the scanned data.

In step 4 5208, the medical staff turns on the assistive device. Auxiliary devices utilized may vary depending on the type of surgical procedure and the technique used by the surgeon, but in this exemplary case, these include smoke evacuators, inhalers, and medical imaging devices. Upon activation, the modular device, the auxiliary device, can be automatically paired with surgical hubs 106, 206 located within a particular neighborhood of the modular device as part of its initialization process. .. The surgical hubs 106, 206 can then derive contextual information about the surgical procedure by detecting the type of modular device paired with it before or during this preoperative or initialization stage. In this particular embodiment, surgical hubs 106, 206 determine that the surgical procedure is VATS surgery based on this particular combination of paired modular devices. Based on the combination of data from the patient's EMR, the list of medical supplies used in the surgery, and the type of modular device connected to the hub, the surgical hubs 106, 206 generally describe the specific procedure performed by the surgical team. Can be estimated. When the surgical hubs 106, 206 know what specific procedure is being performed, the surgical hubs 106, 206 are subsequently connected, reading the procedure steps from memory or from the cloud. Data subsequently received from other data sources (eg, modular and patient monitoring devices) can be cross-referenced to estimate which step of the surgical procedure is being performed by the surgical team.

In the fifth step 5210, the staff attaches the EKG electrode and other patient monitoring device to the patient. EKG electrodes and other patient monitoring devices can be paired with surgical hubs 106, 206. When the surgical hubs 106, 206 start receiving data from the patient monitoring device, the surgical hubs 106, 206 confirm that the patient is in the operating room.

In step 5212, the healthcare professional induces anesthesia in the patient. Surgical hubs 106, 206 indicate that the patient is under anesthesia, based on data from modular and / or patient monitoring devices, including, for example, EKG data, blood pressure data, ventilator data, or a combination thereof. Can be estimated. When the sixth step 5212 is completed, the preoperative part of the lung segment resection surgery is completed and the surgical part is started.

In step 5214, the operated patient's lungs are collapsed (while ventilation is switched to the contralateral lungs). Surgical hubs 106, 206 can, for example, estimate from ventilator data that the patient's lungs have collapsed. Surgical hubs 106, 206 can compare the detection of collapse of the patient's lungs with the expected steps of the procedure (which can be pre-accessed or read) so that the surgical part of the procedure It can be presumed that it has begun, thereby collapsing the lungs, which can be determined to be the first surgical step in this particular procedure.

In the eighth step 5216, a medical imaging device (eg, a scope) is inserted and a video image from the medical imaging device is started. Surgical hubs 106, 206 receive medical imaging device data (ie, video or image data) through a connection to a medical imaging device. Upon receiving the medical imaging device data, the surgical hubs 106, 206 can determine that the laparoscopic portion of the surgical procedure has begun. In addition, surgical hubs 106, 206 can determine that the particular procedure being performed is a segmental resection as opposed to a lobectomy (in the data received in the second step 5204 of the procedure). Note that the wedge procedure has already been discounted by the surgical hubs 106, 206). The data from the medical imaging device 124 (FIG. 2) has been used (ie, activated) by determining the angle of the medical imaging device that is oriented with respect to the visualization of the patient's anatomical structure. Among many different methods, including by monitoring the number or medical imaging device (paired with surgical hubs 106, 206) and by monitoring the type of visualization device used. Can be used to determine contextual information about the type of treatment being performed from. For example, one technique for performing a VATS lobectomy is to place the camera above the diaphragm in the anterior inferior corner of the patient's thoracic cavity, while one technique for performing a VATS segmental resection is a camera. Is placed at the anterior intercostal position with respect to the segmental fissure. For example, using pattern recognition or machine learning techniques, a situation recognition system can be trained to recognize the location of a medical imaging device based on a visualization of the patient's anatomical structure. As another example, one technique for performing VATS lobectomy utilizes a single medical imaging device, while another technique for performing VATS segmental resection utilizes multiple cameras. As yet another example, one technique for performing VATS segmental resection uses an infrared light source (which can be communicatively connected to a surgical hub as part of a visualization system) to visualize segmental fissures. , This is not used in VATS lobectomy. By tracking any or all of this data from a medical imaging device, surgical hubs 106, 206 are used for a particular type of surgical procedure in progress and / or a particular type of surgical procedure. You can determine which technology you have.

In step 5218, the surgical team initiates the procedure incision step. The surgical hubs 106, 206 are presumed to be in the process of the surgeon incising and separating the patient's lungs to receive data from the RF or ultrasound generator indicating that the energy device is being fired. Can be done. Surgical hubs 106, 206 cross-reference the received data with the read process of the surgical procedure and the energy fired at this point in the process (ie, after the procedure of the procedure described above is complete). It can be determined that the instrument is compatible with the incision process. In certain examples, the energy instrument can be an energy tool attached to the robot arm of a robotic surgical system.

In step 10 5220, the surgical team proceeds to the procedure ligation step. Since the surgical hubs 106, 206 receive data from surgical staples and cutting instruments indicating that the instrument is being fired, it can be presumed that the surgeon is ligating the arteries and veins. Similar to the previous step, surgical hubs 106, 206 can derive this estimate by cross-referencing the reception of data from surgical staples and cutting instruments with the steps in the read process. .. In certain examples, the surgical instrument can be a surgical tool attached to the robot arm of a robotic surgical system.

In step 5222, a partial excision of the treated area is performed. Surgical hubs 106, 206 can be presumed that the surgeon is making a transverse incision in parenchymal tissue based on data from surgical staples and cutting instruments, including data from the cartridge. The data in the cartridge can correspond, for example, to the size or type of staple fired by the instrument. Since different types of staples are utilized for different types of tissue, the cartridge data can indicate the type of tissue that has been stapled and / or traversed. In this case, the type of staple fired is used for parenchymal tissue (or other similar tissue type), thereby presuming that surgical hubs 106, 206 are performing a segmental resection of the procedure. Can be done.

Subsequently, in the twelfth step 5224, a nodule incision step is performed. Surgical hubs 106, 206 are presumed to have a surgical team incising a nodule and performing a leak test based on data received from a generator indicating that an RF or ultrasonic instrument is being fired. Can be done. For this particular procedure, the RF or ultrasound instrument used after the parenchymal tissue has been transversely incised corresponds to a nodular incision step, which allows surgical hubs 106, 206 to make this estimate. It will be possible. Surgeons regularly staple / cut instruments and surgical energy (ie, RF or ultrasound), depending on the particular step during the procedure, because different instruments better fit to a particular task. Note that it alternates between the instrument and the device. Thus, the particular sequence in which stapled / cutting instruments and surgical energy instruments are used can indicate which step of the procedure the surgeon is performing. In addition, in certain cases, robotic tools can be used for one or more steps during a surgical procedure and / or handheld surgical instruments for one or more steps during a surgical procedure. Can be used. The surgeon (s) can, for example, alternate between the robot tool and the handheld surgical instrument in sequence and / or, for example, the device can be used simultaneously. Upon completion of the twelfth step 5224, the incision is closed and the postoperative portion of the procedure begins.

In step 5226, the patient's anesthesia is reversed. Surgical hubs 106, 206 can be estimated, for example, based on ventilator data (ie, the patient's respiratory rate begins to increase) that the patient is awakening from anesthesia.

Finally, the fourteenth step 5228 is for the healthcare professional to remove various patient monitoring devices from the patient. Therefore, surgical hubs 106, 206 can presume that the patient is being transferred to the recovery room when the hub loses other data from the EKG, BP, and patient monitoring device. As can be seen from the description of this exemplary procedure, the surgical hubs 106, 206 are given a given surgical procedure, based on data received from various data sources communicatively connected to the surgical hubs 106, 206. It is possible to determine or estimate when each step of is occurring.

Situational awareness is further described in US Provisional Patent Application No. 62 / 659,900, entitled "METHOD OF HUB COMMUNICATION," filed April 19, 2018, which is incorporated herein by reference in its entirety. .. In certain examples, the behavior of a robotic surgical system, including, for example, the various robotic surgical systems disclosed herein, is based on its situational awareness and / or feedback from its components, and / or from the cloud 102. Can be controlled by hubs 106, 206 based on the information in.

Although several forms have been exemplified and described, it is not the applicant's intent to limit or limit the accompanying "claims" to such details. A number of modifications, modifications, changes, substitutions, combinations and equivalents of these forms can be implemented and will be conceived by those skilled in the art without departing from the scope of the present disclosure. Further, the structure of each element associated with the form described can be described alternative as a means for providing the functionality performed by that element. Also, although the material is disclosed for a particular component, other materials may be used. Therefore, the above description and the appended claims are intended to cover all such modifications, combinations, and modifications as included within the scope of the disclosed form. I want you to understand. The appended claims are intended to cover all such modifications, modifications, changes, substitutions, modifications, and equivalents.

The above detailed description has described various forms of equipment and / or processes using block diagrams, flowcharts, and / or examples. As long as such block diagrams, flowcharts, and / or embodiments include one or more functions and / or operations, it is appreciated by those skilled in the art that such block diagrams, flowcharts, and / or Each function and / or operation included in the embodiments can be implemented individually and / or collectively by a variety of hardware, software, firmware, or virtually any combination thereof. To those skilled in the art, all or part of some of the embodiments disclosed herein may be as one or more computer programs running on one or more computers (eg, 1). As one or more programs running on one or more computer systems (as one or more programs running on one or more computer systems) (eg, as one or more programs running on one or more processors) Can be equivalently implemented on an integrated circuit as one or more programs running on a microprocessor, as firmware, or as virtually any combination thereof, and designing the circuit. And / or writing code for software and / or firmware will be understood to be within the skill of those skilled in the art in light of the present disclosure. Further, as will be appreciated by those skilled in the art, the mechanisms of subject matter described herein can be distributed in a variety of forms as one or more program products, which are described herein. The specific forms of the described subject matter are used regardless of the particular type of signal carrier used in the actual distribution.

Instructions used to program logic to perform various disclosed aspects can be stored in in-system memory such as dynamic random access memory (DRAM), cache, flash memory, or other storage. In addition, instructions can be distributed over the network or by other computer-readable media. Therefore, the machine-readable medium may include any mechanism for storing or transmitting information in a form readable by a machine (for example, a computer), such as a floppy diskette, an optical disk, a compact disk, or a read-only memory (CD). -ROM), as well as magnetic optical disks, read-only memory (ROM), random access memory (RAM), erasable programmable read-only memory (EPROM), electrically erasable programmable read-only memory (EEPROM), magnetic or optical cards, Tangible machine readable used to transmit information over the Internet via flash memory or electrical, optical, acoustic, or other forms of propagating signals (eg, carriers, infrared signals, digital signals, etc.) Not limited to storage. Thus, non-transitory computer-readable media include any type of tangible machine-readable medium suitable for storing or transmitting electronic instructions or information in a form readable by a machine (eg, a computer).

As used in any aspect of the specification, the term "control circuit" refers, for example, to a hard-wired circuit, a programmable circuit (eg, a computer processor containing one or more individual instruction processing cores, a processing unit). By a processor, microcontroller, microcontroller unit, controller, digital signal processor (DSP), programmable logic mechanism (PLD), programmable logic array (PLA), or field programmable gate array (FPGA)), state mechanical circuit, programmable circuit. It can refer to a firmware that stores the instructions to be executed, and any combination thereof. Control circuits can be collectively or individually, for example, integrated circuits (ICs), application-specific integrated circuits (ASICs), system-on-chip (SoC), desktop computers, laptop computers, tablet computers, servers, smartphones, etc. , Can be embodied as a circuit that forms part of a larger system. Therefore, as used herein, the "control circuit" is an electric circuit having at least one individual electric circuit, an electric circuit having at least one integrated circuit, and an electric circuit having at least one integrated circuit for a specific application. A circuit, a general-purpose computing device composed of a computer program (for example, a general-purpose computer composed of a computer program that executes at least a part of the process and / or the device described in the present specification, or a process described in the present specification. And / or electrical circuits that form a computer program that at least partially executes the device, electrical circuits that form a memory device (eg, in the form of a random access memory), and / or a communication device (eg, a communication device). Examples include, but are not limited to, electrical circuits that form modems, communication switches, or optical-electrical equipment. Those skilled in the art will recognize that the subjects described herein may be realized in analog or digital forms or some combination thereof.

As used in any aspect of the specification, the term "logic" may refer to an application, software, firmware, and / or circuit configured to perform any of the aforementioned operations. The software may be embodied as software packages, codes, instructions, instruction sets, and / or data recorded on non-temporary computer-readable storage media. The firmware may be embodied as code, instructions, or instruction sets in a memory device, and / or as hard-coded (eg, non-volatile) data.

As used in any aspect of the specification, the terms "component", "system", "module", etc. are either hardware, a combination of hardware and software, software, or running software. Can point to a computer-related entity.

As used in any aspect of the specification, an "algorithm" refers to a self-consistent sequence of steps that leads to a desired result, and a "step" is, but is not necessarily necessary, a memory, transfer, combination, Refers to the manipulation of physical quantities and / or logical states that can be in the form of electrical or magnetic signals that can be compared and manipulated differently. It is common practice to refer to these signals as bits, values, elements, symbols, letters, terms, numbers, and so on. These and similar terms may be associated with appropriate physical quantities and are simply convenient labels that apply to these quantities and / or conditions.

The network may include a packet switching network. Communication devices can communicate with each other using selected packet-switched network communication protocols. One exemplary communication protocol includes an Ethernet communication protocol that can enable communication using a transmission control protocol / Internet Protocol (TCP / IP). The Ethernet protocol conforms to or is compatible with the December 2008 title "IEEE 802.3 Standard" published by the Institute of Electrical and Electronics Engineers (IEEE), and / or later versions of the Ethernet standard. There can be sex. Alternatively or additionally, the communication device is X.I. Twenty-five communication protocols can be used to communicate with each other. X. The 25 communication protocols may conform to or be compatible with the standards promulgated by the International Telecommunication Union-Telecommunication Standardization Sector (ITU-T). Alternatively or additionally, the communication devices can communicate with each other using the Frame Relay communication protocol. The Frame Relay communication protocol conforms to or is compatible with standards promulgated by the Consultative Committee for International Telegraph and Telephone (CCITT) and / or the American National Standards Institute (ANSI). Alternatively or additionally, the transmitters and receivers may be able to communicate 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 published in August 2001 under the title "ATM-MPLS Network Interworking 2.0" by the ATM Forum and / or later versions of this standard. .. Not surprisingly, connection-oriented network communication protocols developed differently and / or later are equally contemplated herein.

Unless otherwise stated, as is clear from the above disclosure, throughout the above disclosure, "process," "calculate," "calculate," "determine," "display," etc. Discussions that use the term refer to data expressed as a physical (electronic) quantity in a computer system's memory or memory as a physical quantity in the computer's memory or register or such information storage, transmission, or display. It will be appreciated that it refers to the operation and processing of a computer system or similar electronic computing device that manipulates and transforms into other similarly represented data.

One or more components are "configured to", "configurable to", and "operable / as" herein. "Operaable / operative to", "adapted / adaptive", "able to", "conformable / conformable" to) ”and so on. Those skilled in the art will generally appreciate that "configured as" is an active component and / or an inactive component and / or a standby component, unless the context should be interpreted in other ways. You will understand that it can contain elements.

The terms "proximal" and "distal" are used herein with reference to the clinician operating the handle portion of the surgical instrument. The term "proximal" refers to the part closest to the clinician, and the term "distal" refers to the part located away from the clinician. It will be further understood that for convenience and clarity, spatial terms such as "vertical", "horizontal", "top", and "bottom" may be used for drawings herein. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limited and / or absolute.

Those skilled in the art generally intend that the terms used herein, and in particular in the appended claims (eg, the text of the appended claims), are generally "open" terms. The term "including" should be interpreted as "including but not limited to" and the term "having". Should be interpreted as "having at least" and the term "includes" should be interpreted as "includes but is not limited to" You will understand that it should be done, etc.). In addition, if a particular number is intended in the introduced claim recitation, such intent is clearly stated in the claim, and in the absence of such intent, such intent does not exist. However, those skilled in the art will understand. For example, as an aid to understanding, the following claims introduce the introductory phrases "at least one" and "one or more" and the claims. May be included to do. However, the use of such a phrase is an introductory phrase such as "one or more" or "at least one" in the same claim, even if the claim description is introduced by the indefinite definite article "a" or "an". And any particular claim, including such an introduced claim statement, is limited to a claim that includes only one such claim, even if it contains the indefinite definite "a" or "an". Should not be construed as suggesting (eg, "a" and / or "an" should usually be construed as meaning "at least one" or "one or more". ). The same is true when introducing claims using definite articles.

Moreover, even if a particular number is specified in the introduced claims, such statement should typically be construed to mean at least the number stated. , Will be recognized by those skilled in the art (eg, if there is a mere "two entries" with no other modifiers, then generally at least two entries, or two or more statements. Means matter). Further, when a notation similar to "at least one of A, B, C, etc." is used, such syntax is generally intended in the sense that one of ordinary skill in the art will understand the notation (eg, for example. , "A system having at least one of A, B, and C", but is not limited to, A only, B only, C only, both A and B, both A and C, B and Includes systems with both C and / or all of A, B and C, etc.). When a notation similar to "at least one of A, B, C, etc." is used, such syntax is generally intended to mean that one of ordinary skill in the art will understand the notation (eg, "" A system having at least one of A, B, or C "is, but is not limited to, A only, B only, C only, both A and B, both A and C, B and C. Includes systems with both and / or all of A, B and C, etc.). Moreover, typically any selective word and / or phrase representing two or more selective terms is used in the specification unless the context requires other meanings. It is understood that it is intended to include one of those terms, any of those terms, or both, whether in the claims, in the claims, or in the drawings. Those skilled in the art will understand that it should be. For example, the phrase "A or B" will typically be understood to include the possibility of "A" or "B" or "A and B".

With respect to the appended claims, one of ordinary skill in the art will appreciate that the actions cited herein can generally be performed in any order. In addition, although the flow charts of various operations are shown in a sequence (s), it is understood that the various operations may be performed in an order other than those illustrated, or may be performed at the same time. It should be. Examples of such alternative ordering are duplicates, alternations, interrupts, reordering, incremental, preliminary, additional, simultaneous, reverse, or other different ordering, unless the context requires other meanings. May include. In addition, terms such as "responding to", "related to", or other past tense adjectives may generally exclude such variants unless they should be interpreted in other ways in the context. Not intended.

Any reference to "one aspect", "aspect", "exemplification", "one example", etc. includes a particular mechanism, structure, or property described in connection with that aspect in at least one aspect. It is worth noting that it means. Therefore, the terms "in one aspect", "in an embodiment", "in an example", and "in an example" found in various places throughout the specification do not necessarily all refer to the same aspect. Moreover, certain features, structures, or properties can be combined in any suitable manner in one or more embodiments.

Any patent application, patent, non-patent publication, or other disclosed material referenced herein and / or listed in any application datasheet is to the extent that the material incorporated is consistent with this specification. , Incorporated herein by reference. As such, and to the extent necessary, the disclosures expressly set forth herein shall supersede any contradictory statements incorporated herein by reference. Any content that conflicts with current definitions, views, or other disclosures described herein, or parts thereof, shall be incorporated herein by reference, but with reference and current disclosure. It shall be referred to only to the extent that there is no contradiction with.

In summary, many benefits have been described as a result of using the concepts described herein. The above description in one or more forms is presented for purposes of illustration and description. It is not intended to be inclusive or limited to the exact form disclosed. In view of the above teachings, modifications or modifications are possible. One or more forms exemplify the principles and practical applications, thereby making various forms available to those skilled in the art as suitable for the particular application conceived, along with various modifications. Therefore, it has been selected and described. The claims presented with this specification are intended to define the overall scope.

Various aspects of the subject matter described herein are described in the numbered examples below.

Example 1. Surgical instruments include an ultrasonic blade, an arm that is pivotable with respect to the ultrasonic blade between the open and closed positions, a transducer assembly connected to the ultrasonic blade, and an open and closed position. Includes a sensor configured to sense the position of the arm in between, a transducer assembly and a control circuit connected to the sensor. The transducer assembly includes at least two piezoelectric elements configured to ultrasonically vibrate the ultrasonic blade. The control circuit is configured to activate the transducer assembly according to the position of the arm relative to the threshold position detected by the sensor.

Example 2. The surgical instrument according to Example 1, wherein the first sensor includes a Hall effect sensor.

Example 3. The surgical instrument according to Example 2, wherein the arm comprises a magnet that can be detected by a Hall effect sensor.

Example 4. The surgical instrument according to Example 2, wherein the Hall effect sensor is configured to detect a magnet disposed to the user.

Example 5. The surgical instrument according to any one of Examples 1 to 4, wherein the threshold position corresponds to the open position.

Example 6. The surgical instrument according to any one of Examples 1 to 5, wherein the threshold position corresponds to the closed position.

Example 7. Surgical instruments include an ultrasonic blade, an arm that is pivotable with respect to the ultrasonic blade between open and closed positions, a transducer assembly connected to the ultrasonic blade, and the arm transitions to the closed position. A first sensor sometimes configured to sense a first force, a second sensor configured to sense a second force when the arm shifts to the open position, and a transducer assembly. It includes a first sensor and a control circuit connected to the second sensor. The transducer assembly includes at least two piezoelectric elements configured to ultrasonically vibrate the ultrasonic blade. The control circuit is a transducer depending on the first force sensed by the first sensor with respect to the first threshold value and the second force sensed by the second sensor with respect to the second threshold value. It is configured to launch the assembly.

Example 8. The surgical instrument according to Example 7, wherein the first sensor comprises a tactile switch.

Example 9. The surgical instrument according to Example 8, wherein the tactile switch comprises a two-stage tactile switch.

Example 10. The surgical instrument according to Example 9, wherein the first threshold corresponds to the second stage of the two-stage tactile switch.

Example 11. The first sensor is any one of Examples 7-10, which is disposed on the housing of the surgical instrument so that the arm abuts on the first sensor as the arm transitions to the closed position. Surgical instruments described in.

Example 12. The surgical instrument according to any one of Examples 7 to 11, wherein the second sensor comprises a tactile switch.

Example 13. The surgical instrument according to Example 12, wherein the tactile switch comprises a one-step tactile switch.

Example 14. The surgical instrument according to any one of Examples 7 to 13, wherein the second threshold value corresponds to a force other than zero.

Example 15. The second sensor is disposed adjacent to a rotation point between the arm and the ultrasonic blade so that the arm abuts on the second sensor as the arm transitions to the open position. The surgical instrument according to any one of 7 to 14.

Example 16. Surgical instruments include an ultrasonic blade, a transducer assembly connected to the ultrasonic blade, a sensor configured to sense force against itself, a transducer assembly and a control circuit connected to the sensor. The transducer assembly includes at least two piezoelectric elements configured to ultrasonically vibrate the ultrasonic blade. The control circuit is configured to activate the transducer assembly in response to a force with respect to the threshold force sensed by the sensor.

Example 17. The surgical instrument according to Example 16, wherein the sensor comprises a force sensing register.

Example 18. The surgical instrument according to Example 16 or 17, wherein the control circuit is configured to activate the transducer assembly when the force sensed by the sensor exceeds a threshold force.

Example 19. The surgical instrument according to any one of Examples 16 to 18, wherein the sensor is disposed on the outer surface of the surgical instrument.

Example 20. The output of the sensor varies according to the degree of force on itself, and the control circuit is configured to activate the transducer assembly in response to the output of the sensor with respect to a threshold representing a threshold force, any of Examples 16-19. The surgical instrument described in one.

[Implementation mode]
(1) Surgical instrument
With ultrasonic blade,
An arm that can be pivoted with respect to the ultrasonic blade between the open position and the closed position,
A transducer assembly coupled to the ultrasonic blade, the transducer assembly comprising at least two piezoelectric elements configured to ultrasonically vibrate the ultrasonic blade.
A sensor configured to detect the position of the arm between the open position and the closed position.
A control circuit including the transducer assembly and a control circuit connected to the sensor is configured to activate the transducer assembly according to the position of the arm with respect to a threshold position detected by the sensor. Surgical instruments.
(2) The surgical instrument according to the first embodiment, wherein the sensor includes a Hall effect sensor.
(3) The surgical instrument according to embodiment 2, wherein the arm includes a magnet that can be detected by the Hall effect sensor.
(4) The surgical instrument according to embodiment 2, wherein the Hall effect sensor is configured to detect a magnet placed on the user.
(5) The surgical instrument according to the first embodiment, wherein the threshold position corresponds to the open position.

(6) The surgical instrument according to the first embodiment, wherein the threshold position corresponds to the closed position.
(7) Surgical instruments
With ultrasonic blade,
An arm that can be pivoted with respect to the ultrasonic blade between the open position and the closed position,
A transducer assembly connected to the ultrasonic blade, the transducer assembly comprising at least two piezoelectric elements configured to ultrasonically vibrate the ultrasonic blade.
A first sensor configured to sense a first force as the arm transitions to the closed position.
A second sensor configured to sense a second force as the arm transitions to the open position.
The transducer assembly, the first sensor, and a control circuit connected to the second sensor, wherein the control circuit is the first with respect to the first threshold value sensed by the first sensor. A surgical instrument configured to activate the transducer assembly in response to the force of the transducer and the second force with respect to the second threshold value sensed by the second sensor.
(8) The surgical instrument according to embodiment 7, wherein the first sensor includes a tactile switch.
(9) The surgical instrument according to embodiment 8, wherein the tactile switch includes a two-step tactile switch.
(10) The surgical instrument according to embodiment 9, wherein the first threshold value corresponds to the second stage of the two-stage tactile switch.

(11) The first sensor is arranged on the housing of the surgical instrument so that the arm comes into contact with the first sensor when the arm shifts to the closed position. The surgical instrument according to aspect 7.
(12) The surgical instrument according to embodiment 7, wherein the second sensor includes a tactile switch.
(13) The surgical instrument according to embodiment 12, wherein the tactile switch includes a one-step tactile switch.
(14) The surgical instrument according to embodiment 7, wherein the second threshold corresponds to a force other than zero.
(15) The second sensor is adjacent to a rotation point between the arm and the ultrasonic blade so that the arm comes into contact with the second sensor when the arm shifts to the open position. The surgical instrument according to the seventh embodiment, which is arranged in the same manner.

(16) Surgical instrument
With ultrasonic blade,
A transducer assembly coupled to the ultrasonic blade, the transducer assembly comprising at least two piezoelectric elements configured to ultrasonically vibrate the ultrasonic blade.
A sensor configured to sense force against itself,
It comprises the transducer assembly and a control circuit connected to the sensor, the control circuit being configured to activate the transducer assembly in response to the force with respect to the threshold force sensed by the sensor. , Surgical instruments.
(17) The surgical instrument according to embodiment 16, wherein the sensor includes a force sensing register.
(18) The surgical instrument according to embodiment 16, wherein the control circuit is configured to activate the transducer assembly when the force sensed by the sensor exceeds the threshold force.
(19) The surgical instrument according to embodiment 16, wherein the sensor is arranged on the outer surface of the surgical instrument.
(20) The output of the sensor varies according to the degree of force with respect to it, and the control circuit is configured to activate the transducer assembly in response to the output of the sensor with respect to a threshold representing the threshold force. The surgical instrument according to embodiment 16.

Claims (20)

It ’s a surgical instrument,
With ultrasonic blade,
An arm that can be pivoted with respect to the ultrasonic blade between the open position and the closed position,
A transducer assembly coupled to the ultrasonic blade, the transducer assembly comprising at least two piezoelectric elements configured to ultrasonically vibrate the ultrasonic blade.
A sensor configured to detect the position of the arm between the open position and the closed position.
A control circuit including the transducer assembly and a control circuit connected to the sensor is configured to activate the transducer assembly according to the position of the arm with respect to a threshold position detected by the sensor. Surgical instruments. The surgical instrument according to claim 1, wherein the sensor includes a Hall effect sensor. The surgical instrument according to claim 2, wherein the arm includes a magnet that can be detected by the Hall effect sensor. The surgical instrument according to claim 2, wherein the Hall effect sensor is configured to detect a magnet placed on the user. The surgical instrument according to claim 1, wherein the threshold position corresponds to the open position. The surgical instrument according to claim 1, wherein the threshold position corresponds to the closed position. It ’s a surgical instrument,
With ultrasonic blade,
An arm that can be pivoted with respect to the ultrasonic blade between the open position and the closed position,
A transducer assembly connected to the ultrasonic blade, the transducer assembly comprising at least two piezoelectric elements configured to ultrasonically vibrate the ultrasonic blade.
A first sensor configured to sense a first force as the arm transitions to the closed position.
A second sensor configured to sense a second force as the arm transitions to the open position.
The transducer assembly, the first sensor, and a control circuit connected to the second sensor, wherein the control circuit is the first with respect to the first threshold value sensed by the first sensor. A surgical instrument configured to activate the transducer assembly in response to the force of the transducer and the second force with respect to the second threshold value sensed by the second sensor. The surgical instrument according to claim 7, wherein the first sensor includes a tactile switch. The surgical instrument according to claim 8, wherein the tactile switch includes a two-step tactile switch. The surgical instrument according to claim 9, wherein the first threshold value corresponds to the second stage of the two-stage tactile switch. 7. The first sensor is disposed on the housing of the surgical instrument so that the arm abuts on the first sensor as the arm transitions to the closed position. Described surgical instruments. The surgical instrument according to claim 7, wherein the second sensor includes a tactile switch. The surgical instrument according to claim 12, wherein the tactile switch includes a one-step tactile switch. The surgical instrument according to claim 7, wherein the second threshold value corresponds to a non-zero force. The second sensor is arranged adjacent to a rotation point between the arm and the ultrasonic blade so that the arm comes into contact with the second sensor when the arm shifts to the open position. The surgical instrument according to claim 7, which is provided. It ’s a surgical instrument,
With ultrasonic blade,
A transducer assembly coupled to the ultrasonic blade, the transducer assembly comprising at least two piezoelectric elements configured to ultrasonically vibrate the ultrasonic blade.
A sensor configured to sense force against itself,
It comprises the transducer assembly and a control circuit connected to the sensor, the control circuit being configured to activate the transducer assembly in response to the force with respect to the threshold force sensed by the sensor. , Surgical instruments. The surgical instrument according to claim 16, wherein the sensor includes a force sensing register. 16. The surgical instrument of claim 16, wherein the control circuit is configured to activate the transducer assembly when the force sensed by the sensor exceeds the threshold force. The surgical instrument according to claim 16, wherein the sensor is arranged on the outer surface of the surgical instrument. The output of the sensor varies according to the degree of force with respect to it, and the control circuit is configured to activate the transducer assembly in response to the output of the sensor with respect to a threshold representing the threshold force. The surgical instrument according to claim 16.

Images