JP7247196B2 - Control of Surgical Instruments by Sensed Closure Parameters - Google Patents

Description

(Cross reference to related applications)
This application is filed June 28, 2018 under 35 U.S.C. Priority is claimed to US Provisional Patent Application No. 62/691,227.

This application is further incorporated under 35 U.S.C. U.S. Provisional Patent Application No. 62/650,887, entitled "SURGICAL SMOKE EVACUATION SENSING AND CONTROLS," U.S. Provisional Patent Application No. 62/650,877, filed March 30, 2018, entitled "SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL and U.S. Provisional Patent Application No. 62/650,882, filed March 30, 2018, entitled "CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS," filed March 30, 2018. Priority benefit of 62/650,898 is claimed.

This application is further filed under 35 U.S.C. U.S. Provisional Patent Application No. 62/640,417, filed on May 31, 2018; Claim priority benefits.

This application is further subject to U.S. provisional patent application entitled "INTERACTIVE SURGICAL PLATFORM," filed Dec. 28, 2017, under 35 U.S.C. Application No. 62/611,341, U.S. Provisional Patent Application No. 62/611,340, filed December 28, 2017, entitled "CLOUD-BASED MEDICAL ANALYTICS," and U.S. Provisional Patent Application No. 62/611,340, entitled "ROBOT ASSISTED SURGICAL PLATFORM," December 2017. It claims the benefit of priority from US Provisional Patent Application No. 62/611,339, filed May 28.

(Field of Invention)
The present disclosure relates to various surgical systems.

In one aspect, a surgical instrument includes an end effector comprising jaws transitionable between an open configuration and a closed configuration; a motor configured to transition, a sensor configured to transmit at least one signal indicative of a tissue compression parameter associated with tissue between the jaws, and control circuitry coupled to the sensor and the motor. Prepare. The control circuit receives the at least one signal and determines a value of the tissue compression parameter based on the at least one signal when the jaws transition from the open configuration to the closed configuration, the value of the tissue compression parameter being the first threshold value. configured to cause the motor to increase the time to transition the jaws to the closed configuration responsive to whether the value of the tissue compression parameter is below the second threshold and to provide feedback responsive to whether be done.

In another aspect, a surgical instrument includes an end effector having jaws transitionable between an open configuration and a closed configuration and positioned along respective tissue contacting surfaces of the jaws to detect contact with tissue. and one or more sensors configured to. A surgical instrument is operably coupled to the jaws and coupled to a motor configured to transition the jaws between an open configuration and a closed configuration, and one or more sensors and a motor. and a control circuit. The control circuitry determines an initial contact point at which tissue contacts the tissue contacting surfaces of the jaws, determines the separation between the jaws at the initial contact point, determines the degree of contact between the tissue contacting surfaces and the tissue, The motor causes the jaws to transition to the closed configuration at a rate corresponding to the separation between the parts and the extent of tissue contact with the tissue contacting surface at the initial point of contact, and the motor causes the jaws to transition to the closed configuration. Causes the motor to adjust the speed at which the jaws are transitioned to the closed configuration according to whether the force exerted exceeds a threshold, the threshold being the distance between the jaws and the contact between the tissue contact surface and the tissue at the initial point of contact. It is configured to correspond to the degree.

In one aspect, a surgical instrument configured to sense tissue impinging thereon with an end effector having jaws configured to grasp tissue by transitioning between an open configuration and a closed configuration. and a contact sensor assembly. The surgical instrument includes a position sensor configured to sense a configuration of the jaws, a motor coupled to the jaws and configured to transition the jaws between an open configuration and a closed configuration, and a contact. Further includes a control circuit coupled to the sensor assembly, the position sensor, and the motor. The control circuit determines an initial contact point where tissue contacts the jaws, determines the configuration of the jaws via the position sensor at the initial contact point, and connects the tissue and the jaws via the contact sensor assembly at the initial contact point. determining the amount of tissue contact between the jaws and the amount of tissue contact between the jaws at the initial contact point, setting the closing speed at which the motor transitions the jaws to the closed configuration according to the configuration of the jaws and the amount of tissue contact at the initial point of contact; A closure threshold is set according to the configuration and amount of tissue contact and is configured to control the motor according to the force exerted by the motor to transition the jaws to the closed configuration relative to the threshold.

Features of various aspects are set forth with particularity in the appended claims. The various aspects, both as to organization and method of operation, however, together with further objects and advantages thereof, may best be understood by reference to the following description, taken in conjunction with the accompanying drawings, which follow.
1 is a block diagram of a computer-implemented interactive surgical system, according to at least one aspect of the present disclosure; FIG. A surgical system used to perform a surgical procedure in an operating room, according to at least one aspect of the present disclosure. 1 is a surgical hub paired with a visualization system, a robotic system, and an intelligent instrument according to at least one aspect of the present disclosure; FIG. 122 is a partial perspective view of a surgical hub housing and a combination generator module slidably receivable within a drawer of the surgical hub housing in accordance with at least one aspect of the present disclosure; 3 is a perspective view of a combination generator module comprising bipolar, ultrasonic, and monopolar contacts and smoke evacuation components in accordance with at least one aspect of the present disclosure; FIG. 4 illustrates individual power bus attachments for multiple lateral docking ports of a lateral modular housing configured to receive multiple modules, in accordance with at least one aspect of the present disclosure; 1 illustrates a vertical modular housing configured to receive multiple modules, according to at least one aspect of the present disclosure; Cloud modular devices located in one or more operating rooms of a healthcare facility, or any room within a healthcare facility with specialized equipment for surgical procedures, according to at least one aspect of the present disclosure. 1 illustrates a surgical data network with modular communication hubs configured to connect; 1 illustrates a computer-implemented interactive surgical system, according to at least one aspect of the present disclosure; 4 illustrates a surgical hub comprising multiple modules coupled to a modular control tower, according to at least one aspect of the present disclosure; 1 illustrates one aspect of a universal serial bus (USB) network hub device, in accordance with at least one aspect of the present disclosure; 1 illustrates a logic diagram of a control system for a surgical instrument or tool, according to at least one aspect of the present disclosure; FIG. 1 illustrates a control circuit configured to control aspects of a surgical instrument or tool, according to at least one aspect of the present disclosure; FIG. 11 illustrates a combinational logic circuit configured to control aspects of a surgical instrument or tool, according to at least one aspect of the present disclosure; FIG. 4 illustrates a sequential logic circuit configured to control aspects of a surgical instrument or tool, according to at least one aspect of the present disclosure; 1 illustrates a surgical instrument or tool comprising multiple motors that can be activated to perform various functions, in accordance with at least one aspect of the present disclosure; 1 is a schematic diagram of a robotic surgical instrument configured to operate a surgical tool described herein, according to at least one aspect of the present disclosure; FIG. FIG. 10 illustrates a block diagram of a surgical instrument programmed to control distal translation of a displacement member, according to at least one aspect of the present disclosure; 1 is a circuit diagram of a surgical instrument configured to control various functions in accordance with at least one aspect of the present disclosure; FIG. FIG. 4 is a stroke length graph illustrating an example control system that modifies the stroke length of the gripping assembly based on the articulation angle. FIG. 10 is a closure tube assembly positioning graph showing an example control system that modifies the longitudinal position of the closure tube assembly based on the articulation angle; FIG. FIG. 10 is a comparison of a stapling method with controlled tissue compression and a stapling method without controlled tissue compression; 3 is a force graph shown in Section A and an associated displacement graph shown in Section B, the force and displacement graphs having an x-axis defining time and the y-axis of the displacement graph being the travel displacement of the firing rod; and the y-axis of the force graph defines the sensed torsional force on the motor configured to advance the firing rod. FIG. 11 is a schematic diagram of a tissue contact circuit showing completion of the circuit upon contact with a pair of spaced apart contact plates. 1 is a perspective view of a surgical instrument having an interchangeable shaft assembly operably coupled thereto, according to at least one aspect of the present disclosure; FIG. 26 is an assembly shown in an exploded view of a portion of the surgical instrument of FIG. 25 in accordance with at least one aspect of the present disclosure; FIG. FIG. 4 is an assembly view showing a partial exploded view of an interchangeable shaft assembly, in accordance with at least one aspect of the present disclosure; 26 is an exploded view of an end effector of the surgical instrument of FIG. 25 in accordance with at least one aspect of the present disclosure; FIG. 26 is a block diagram of the control circuitry of the surgical instrument of FIG. 25, spanning two drawings, in accordance with at least one aspect of the present disclosure; FIG. 26 is a block diagram of the control circuitry of the surgical instrument of FIG. 25, spanning two drawings, in accordance with at least one aspect of the present disclosure; FIG. 26 is a block diagram of the control circuitry of the surgical instrument of FIG. 25 showing the interfaces between the handle assembly and the power supply assembly and between the handle assembly and the interchangeable shaft assembly in accordance with one at least one aspect of the present disclosure; FIG. is. 1 depicts an example medical device that may include one or more aspects of the present disclosure; FIG. FIG. 12 depicts an example end effector of a medical device encircling tissue, in accordance with one or more aspects of the present disclosure; FIG. 12 depicts an end effector of an example medical device for compressing tissue, in accordance with one or more aspects of the present disclosure; FIG. 11 depicts an example force exerted by an end effector of a medical device compressing tissue in accordance with one or more aspects of the present disclosure; FIG. 4 depicts an example force exerted by an end effector of a medical device compressing tissue, also in accordance with one or more aspects of the present disclosure; 1 depicts an example tissue compression sensor system in accordance with one or more aspects of the present disclosure; FIG. FIG. 4 also depicts an example tissue compression sensor system in accordance with one or more aspects of the present disclosure; FIG. 4 also depicts an example tissue compression sensor system in accordance with one or more aspects of the present disclosure; FIG. 4 also depicts an example circuit diagram in accordance with one or more aspects of the present disclosure. FIG. 4 also depicts an example circuit diagram in accordance with one or more aspects of the present disclosure. 4 is a graph depicting an example frequency modulation in accordance with one or more aspects of the disclosure; 4 is a graph depicting a synthesized RF signal, according to one or more aspects of the present disclosure; 4 is a graph depicting a filtered RF signal, in accordance with one or more aspects of the present disclosure; 1 is a perspective view of a surgical instrument with an articulatable exchangeable shaft; FIG. Fig. 3 is a side view of the tip of the surgical instrument; Void size over time (Fig. 46), firing current over time (Fig. 47), tissue compression over time (Fig. 48), anvil strain over time (Fig. 49), and trigger force over time. Figure 50 is a graph plotting changes over time (Figure 50). Void size over time (Fig. 46), firing current over time (Fig. 47), tissue compression over time (Fig. 48), anvil strain over time (Fig. 49), and trigger force over time. Figure 50 is a graph plotting changes over time (Figure 50). Void size over time (Fig. 46), firing current over time (Fig. 47), tissue compression over time (Fig. 48), anvil strain over time (Fig. 49), and trigger force over time. Figure 50 is a graph plotting changes over time (Figure 50). Void size over time (Fig. 46), firing current over time (Fig. 47), tissue compression over time (Fig. 48), anvil strain over time (Fig. 49), and trigger force over time. Figure 50 is a graph plotting changes over time (Figure 50). Void size over time (Fig. 46), firing current over time (Fig. 47), tissue compression over time (Fig. 48), anvil strain over time (Fig. 49), and trigger force over time. Figure 50 is a graph plotting changes over time (Figure 50). 1 is a graph plotting tissue displacement as a function of tissue compression for normal tissue. FIG. 4 is a graph plotting tissue displacement as a function of tissue compression to distinguish between normal and diseased tissue. FIG. 10 illustrates an embodiment of an end effector with a first sensor and a second sensor; FIG. 54 is a logic diagram illustrating one embodiment of a process for adjusting the reading of a first sensor based on input from a second sensor of the end effector shown in FIG. 53; FIG. 10 is a logic diagram illustrating one embodiment of a process for determining a lookup table for a first sensor based on input from a second sensor; FIG. 4 is a logic diagram illustrating one embodiment of a process for calibrating a first sensor in response to input from a second sensor; FIG. 100 is a logic diagram illustrating one embodiment of a process for determining and displaying the thickness of a portion of tissue grasped between an anvil of an end effector and a staple cartridge; FIG. 100 is a logic diagram illustrating one embodiment of a process for determining and displaying the thickness of a portion of tissue grasped between an anvil of an end effector and a staple cartridge; FIG. 10 is a graph showing a comparison of adjusted Hall effect thickness measurements and uncorrected Hall effect thickness measurements; FIG. FIG. 10 illustrates an embodiment of an end effector with a first sensor and a second sensor; FIG. 10 illustrates an embodiment of an end effector comprising a first sensor and multiple second sensors; FIG. 4 is a logic diagram illustrating one embodiment of a process for adjusting a primary sensor reading in response to multiple secondary sensors. [0010] Figure 1 illustrates one embodiment of circuitry configured to convert signals from a first sensor and a plurality of secondary sensors into digital signals receivable by a processor; FIG. 10 illustrates an embodiment of an end effector with multiple sensors; FIG. 10 is a logic diagram illustrating one embodiment of a process for determining one or more tissue properties based on multiple sensors; [00101] Fig. 10 illustrates an embodiment of an end effector comprising multiple sensors coupled to a second jaw member; FIG. 12A illustrates an embodiment of a staple cartridge with multiple sensors integrally formed therein; FIG. 10 is a logic diagram illustrating one embodiment of a process for determining one or more parameters of a portion of tissue grasped within an end effector; FIG. 10 illustrates another end effector embodiment with multiple redundant sensors. FIG. 10 is a logic diagram illustrating one embodiment of a process for selecting the most reliable output from multiple redundant sensors; FIG. 10 illustrates an embodiment of an end effector with sensors that include specific sampling rates that limit or eliminate spurious signals; FIG. 100 is a logic diagram illustrating one embodiment of a process for generating thickness measurements of a portion of tissue located between an anvil of an end effector and a staple cartridge; FIG. 10A illustrates an embodiment of an end effector with sensors for identifying different types of staple cartridges; FIG. 10A illustrates an embodiment of an end effector with sensors for identifying different types of staple cartridges; FIG. 13 illustrates one aspect of a segmented flexible circuit configured for fixed attachment to a jaw member of an end effector, in accordance with at least one aspect of the present disclosure; FIG. 12 illustrates one aspect of a segmented flexible circuit configured to attach to a jaw member of an end effector, in accordance with at least one aspect of the present disclosure; FIG. 12A illustrates one aspect of an end effector configured to measure tissue gap GT, in accordance with at least one aspect of the present disclosure; FIG. 12 illustrates one aspect of an end effector comprising a segmented flexible circuit, in accordance with at least one aspect of the present disclosure; FIG. 79 illustrates the end effector shown in FIG. 78 with jaw members grasping tissue between the jaw members and a staple cartridge in accordance with at least one aspect of the present disclosure; 1 is a diagram of an absolute positioning system for a surgical instrument comprising controlled motor drive circuitry comprising a sensor mechanism in accordance with at least one aspect of the present disclosure; FIG. 1 is a position sensor with a magnetic rotary absolute positioning system, in accordance with at least one aspect of the present disclosure; FIG. FIG. 122 is a cross-sectional view of an end effector of a surgical instrument illustrating a firing member stroke against tissue grasped within the end effector in accordance with at least one aspect of the present disclosure; The first graph of two closure force (FTC) plots depicting the force applied to the closure member to close on thick and thin tissue during the closure phase, and the first graph to penetrate thick and thin tissue during the firing phase. FIG. 4 is a second graph of two firing force (FTF) plots illustrating the force applied to the firing member to fire; FIG. According to at least one aspect of the present disclosure, the gradual closure of the closure member during the firing stroke where the firing member advances distally and couples into the gripping arm provides a desired closure force load on the closure member. is a graph of a control system configured to reduce the firing force load on the firing member by decreasing the rate of . 1 illustrates a proportional-integral-derivative (PID) controller feedback control system, in accordance with at least one aspect of the present disclosure; FIG. FIG. 10 is a logic flow diagram depicting a control program or logic configuration process for determining velocity of a closure member, in accordance with at least one aspect of the present disclosure; 4 is a timeline illustrating surgical hub situational awareness in accordance with at least one aspect of the present disclosure; 1 is a block diagram of a surgical system configured to control surgical functions in accordance with at least one aspect of the present disclosure; FIG. 1 is a block diagram of a situation-aware surgical system configured to control surgical functions, in accordance with at least one aspect of the present disclosure; FIG. FIG. 12 is a logic flow diagram depicting algorithm-based situational awareness for controlling surgical functions, in accordance with at least one aspect of the present disclosure; FIG. 10 is a logic flow diagram depicting an algorithm for controlling surgical functions, in accordance with at least one aspect of the present disclosure; FIG. 12 illustrates a portion of patient tissue including a tumor and surgical margins defined for the tumor, according to at least one aspect of the present disclosure; FIG. 4 is a logic flow diagram depicting the process background of a control program or logic configuration for addressing device selection issues, in accordance with at least one aspect of the present disclosure; 1 is a block diagram of a surgical system configured to determine adequacy of a surgical instrument based on device parameters and sensed parameters, in accordance with at least one aspect of the present disclosure; FIG. 1 is a block diagram of a surgical instrument in accordance with at least one aspect of the present disclosure; FIG. FIG. 12 is a logic flow diagram of a process for controlling a surgical instrument according to the integrity of grasped tissue, in accordance with at least one aspect of the present disclosure; 4 is a first graph depicting end effector force to closure versus time for an exemplary firing of a surgical instrument, according to at least one aspect of the present disclosure; FIG. 5 is a second graph depicting end effector force versus time for an exemplary firing of a surgical instrument, according to at least one aspect of the present disclosure; FIG. FIG. 12 is a logic flow diagram of a process for controlling a surgical instrument according to physiological type of grasped tissue, in accordance with at least one aspect of the present disclosure; FIG. 19 is a side elevational view of an end effector grasping soft tissue, with the end effector in a position of initial contact with the soft tissue, in accordance with at least one aspect of the present disclosure; FIG. 19 is a side elevational view of a soft tissue grasping end effector with the end effector closed in accordance with at least one aspect of the present disclosure; FIG. 13 is a side elevational view of an end effector grasping a vessel, with the end effector in a position of initial contact with the vessel, in accordance with at least one aspect of the present disclosure; FIG. 12 is a side view of a vessel grasping end effector with the end effector closed in accordance with at least one aspect of the present disclosure; FIGS. 2A and 2B are first and second graphs depicting an end effector force to close and a closing velocity, respectively, versus time for an exemplary firing of a soft tissue grasping surgical instrument, according to at least one aspect of the present disclosure; FIGS. be. FIGS. 4A and 4B are third and fourth graphs depicting an end effector force to close and a closing velocity, respectively, versus time for an exemplary firing of a surgical instrument to grasp a vessel, according to at least one aspect of the present disclosure; FIG. be. FIG. 12 illustrates a fifth graph depicting an end effector force to close and closing velocity versus time for an exemplary firing of a surgical instrument, in accordance with at least one aspect of the present disclosure; 6 is a fifth graph showing an end effector force to close and closing velocity, respectively, versus time for an exemplary firing of a surgical instrument, in accordance with at least one aspect of the present disclosure; 6 is a fifth graph showing an end effector force to close and closing velocity, respectively, versus time for an exemplary firing of a surgical instrument, in accordance with at least one aspect of the present disclosure; 4 is a graph depicting impedance versus time for determining when jaws of a surgical instrument contact tissue and/or staples in accordance with at least one aspect of the present disclosure; 4 is a first graph depicting various tissue closure thresholds for controlling end effector closure, according to at least one aspect of the present disclosure; FIG. 11 is a second graph depicting various tissue closure thresholds for controlling end effector closure, in accordance with at least one aspect of the present disclosure; FIG. 10 is a logic flow diagram depicting a process of control program or logic configuration for adjusting a closing rate algorithm, in accordance with at least one aspect of the present disclosure;

The applicant of this application owns the following US patent applications filed June 29, 2018, the entire disclosures of each of which are incorporated herein by reference:
U.S. Patent Application No. ____________, Attorney Docket No. END8542USNP/170755, entitled CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS;
U.S. Patent Application No. ____________, Attorney Docket No. END8543USNP/170760, entitled CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSED CLOSURE PARAMETERS;
U.S. Patent Application No. ____________, Attorney Docket No. END8543USNP1/170760-1, entitled SYSTEMS FOR ADJUSTING END EFFECTOR PARAMETERS BASED ON PERIOD PERATIVE INFORMATION;
U.S. Patent Application No. ______________, Attorney Docket No. END8543USNP2/170760-2, entitled SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING;
U.S. Patent Application No. ______________, Attorney Docket No. END8543USNP3/170760-3, entitled SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING;
U.S. Patent Application No. ____________, Attorney Docket No. END8543USNP4/170760-4, entitled SURGICAL SYSTEMS FOR DETECTING END EFFECTOR TISSUE DISTRIBUTION IRREGULARITIES;
U.S. Patent Application No. ____________, Attorney Docket No. END8543USNP5/170760-5, entitled SYSTEMS FOR DETECTING PROXIMITY OF SURGICAL END EFFECTOR TO CANCEROUS TISSUE;
U.S. Patent Application No. ______________, Attorney Docket No. END8543USNP6/170760-6, entitled SURGICAL INSTRUMENT CARTRIDGE SENSOR ASSEMBLIES;
U.S. Patent Application No. ____________, Attorney Docket No. END8543USNP7/170760-7-7, entitled VARIABLE OUTPUT CARTRIDGE SENSOR ASSEMBLY;
U.S. Patent Application No. ______________, Attorney Docket No. END8544USNP/170761, entitled SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE;
U.S. Patent Application No. ____________, Attorney Docket No. END8544USNP1/170761-1, entitled SURGICAL INSTRUMENT HAVING A FLEXIBLE CIRCUIT;
U.S. Patent Application No. ____________, Attorney Docket No. END8544USNP2/170761-2, entitled SURGICAL INSTRUMENT WITH A TISSUE MARKING ASSEMBLY;
U.S. Patent Application No. ____________, Attorney Docket No. END8544USNP3/170761-3, entitled SURGICAL SYSTEMS WITH PRIORITIZED DATA TRANSMISSION CAPABILITIES;
U.S. Patent Application No. ____________, Attorney Docket No. END8545USNP/170762, entitled SURGICAL EVACUATION SENSING AND MOTOR CONTROL;
U.S. Patent Application No. ______________, Attorney Docket No., END8545USNP1/170762-1, entitled SURGICAL EVACUATION SENSOR ARRANGEMENTS;
U.S. Patent Application No. ______________, Attorney Docket No. END8545USNP2/170762-2, entitled SURGICAL EVACUATION FLOW PATHS;
U.S. Patent Application No. ____________, Attorney Docket No. END8545USNP3/170762-3, entitled SURGICAL EVACUATION SENSING AND GENERATOR CONTROL;
U.S. Patent Application No. ____________, Attorney Docket No. END8545USNP4/170762-4, entitled SURGICAL EVACUATION SENSING AND DISPLAY;
- U.S. Patent Application No. ____________, Attorney Docket No. ______________, Attorney Docket No. ____________, entitled COMMUNICATION OF SMOKE EVACUATION SYSTEM PARAMETERS TO HUB OR CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM;
- U.S. Patent Application No. ____________, Attorney Docket No. END8546USNP1/170763-1, entitled "SMOKE EVACUATION SYSTEM INCLUDING A SEGMENTED CONTROL CIRCUIT FOR INTERACTIVE SURGICAL PLATFORM";
・ＳＵＲＧＩＣＡＬ ＥＶＡＣＵＡＴＩＯＮ ＳＹＳＴＥＭ ＷＩＴＨ Ａ ＣＯＭＭＵＮＩＣＡＴＩＯＮ ＣＩＲＣＵＩＴ ＦＯＲ ＣＯＭＭＵＮＩＣＡＴＩＯＮ ＢＥＴＷＥＥＮ Ａ ＦＩＬＴＥＲ ＡＮＤ Ａ ＳＭＯＫＥ ＥＶＡＣＵＡＴＩＯＮ ＤＥＶＩＣＥ」と題する、米国特許出願第＿＿＿＿＿＿＿＿＿＿号、代理人整理番号ＥＮＤ８５４７ＵＳＮＰ／１７０７６４、及び ・ＤＵＡＬ ＩＮ－ＳＥＲＩＥＳ ＬＡＲＧＥ ＡＮＤ ＳＭＡＬＬ ＤＲＯＰＬＥＴ ＦＩＬＴＥＲＳと題する, U.S. Patent Application No. __________, Attorney Docket No. END8548USNP/170765.

The applicant of this application owns the following US provisional patent applications filed June 28, 2018, the disclosures of each of which are incorporated herein by reference in their entirety:
U.S. Provisional Patent Application No. 62/691,228 entitled "A METHOD OF USING REINFORCED FLEX CIRCUITS WITH MULTIPLE SENSORS WITH ELECTROSURGICAL DEVICES";
U.S. Provisional Patent Application No. 62/691,230 entitled "SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE";
U.S. Provisional Patent Application No. 62/691,219 entitled "SURGICAL EVACUATION SENSING AND MOTOR CONTROL";
U.S. Provisional Patent Application No. 62/691,257 entitled "COMMUNICATION OF SMOKE EVACUATION SYSTEM PARAMETERS TO HUB OR CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM";
・「ＳＵＲＧＩＣＡＬ ＥＶＡＣＵＡＴＩＯＮ ＳＹＳＴＥＭ ＷＩＴＨ Ａ ＣＯＭＭＵＮＩＣＡＴＩＯＮ ＣＩＲＣＵＩＴ ＦＯＲ ＣＯＭＭＵＮＩＣＡＴＩＯＮ ＢＥＴＷＥＥＮ Ａ ＦＩＬＴＥＲ ＡＮＤ Ａ ＳＭＯＫＥ ＥＶＡＣＵＡＴＩＯＮ ＤＥＶＩＣＥ」と題する米国仮特許出願第６２／６９１，２６２号、及び ・「ＤＵＡＬ ＩＮ－ＳＥＲＩＥＳ ＬＡＲＧＥ ＡＮＤ ＳＭＡＬＬ ＤＲＯＰＬＥＴ ＦＩＬＴＥＲＳ」と題する米国Provisional Patent Application No. 62/691,251.

The applicant of this application owns the following US patent applications filed March 29, 2018, the entire disclosures of each of which are incorporated herein by reference:
U.S. Patent Application No. 15/940,641 entitled "INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES";
- U.S. patent application Ser.
U.S. Patent Application No. 15/940,656 entitled "SURGICAL HUB COORDINATION OF CONTROL AND COMMUNICATION OF OPERATING ROOM DEVICES";
- U.S. patent application Ser.
U.S. Patent Application No. 15/940,670 entitled "COOPERATIVE UTILIZATION OF DATA DERIVED FROM SECONDARY SOURCES BY INTELLIGENT SURGICAL HUBS";
- U.S. Patent Application No. 15/940,677 entitled "SURGICAL HUB CONTROL ARRANGEMENTS";
- U.S. patent application Ser.
U.S. Patent Application No. 164/94, entitled "COMMUNICATION HUB AND STORAGE DEVICE FOR STORING PARAMETERS AND STATUS OF A SURGICAL DEVICE TO BE SHARED WITH CLOUD BASED ANALYTICS SYSTEMS";
U.S. Patent Application No. 15/940,645, entitled "SELF DESCRIBING DATA PACKETS GENERATED 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 AWARENESS";
- 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 SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER"
U.S. Patent Application No. 15/940,686, entitled "DISPLAY OF ALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LINE 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 Ser.
US patent application Ser. No. 15/940,722, entitled "CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OF MONO-CHROMATIC LIGHT REFRACTIVITY," and US patent application Ser. No. 15/940,742, entitled "DUAL CMOS ARRAY IMAGING."

The applicant of this application owns the following US patent applications filed March 29, 2018, the entire disclosures of each of which are incorporated herein by reference:
U.S. patent application Ser. No. 15/940,636 entitled "ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES";
U.S. patent application Ser. No. 15/940,653 entitled "ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL HUBS";
- U.S. Patent Application No. 15/940,660 entitled "CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER"
- U.S. patent application Ser.
U.S. patent application Ser.
U.S. patent application Ser.
- U.S. Patent Application No. 15/940,706 entitled "DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK," and - U.S. Patent Application No. 15/940,675, entitled "CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES."

The applicant of this application owns the following US patent applications filed March 29, 2018, the entire disclosures of each of which are incorporated herein by reference:
- US patent application Ser.
- U.S. Patent Application No. 15/940,637, entitled "COMMUNICATION ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS";
- US patent application Ser.
- US patent application Ser.
- US patent application Ser.
U.S. patent application Ser.
U.S. Patent Application No. 15/940,690, entitled "DISPLAY ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS";

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

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

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

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

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

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

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

Certain illustrative aspects are set forth below to provide a general understanding of the principles of construction, function, manufacture, and use of the apparatus and methods disclosed herein. One or more examples of these aspects are illustrated in the accompanying drawings. Those skilled in the art will appreciate that the apparatus and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary aspects, the scope of which is defined only by the claims. you will understand. Features illustrated or described in connection with one exemplary aspect may be combined with features of other aspects. Such modifications and variations are intended to fall within the scope of the claims.

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

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

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

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

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

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

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

The invisible spectrum (ie, non-emissive spectrum) is the portion of the electromagnetic spectrum that lies below and above the visible spectrum (ie, wavelengths below about 380 nm and above about 750 nm). The invisible spectrum is not detectable by the human eye. Wavelengths above about 750 nm are longer than the red visible spectrum and these become invisible infrared (IR), microwave and radio electromagnetic radiation. Wavelengths less than about 380 nm are shorter than the violet spectrum and become invisible ultraviolet, X-ray, and gamma-ray electromagnetic radiation.

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

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

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

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

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

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

Referring to FIG. 2, surgical instrument 112 is used as part of surgical system 102 in a surgical procedure. Hub 106 is also configured to coordinate information flow to the display of 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 entered by a non-sterile operator at visualization tower 111 may be sent by hub 106 to surgical instrument display 115 within the sterile field, where the diagnostic input or feedback is input to surgical instrument 112 . It may be viewed by an operator. Exemplary surgical instruments suitable for use with surgical system 102 are described, for example, in the "Surgical Instrument Hardware" section and 2017 entitled "INTERACTIVE SURGICAL PLATFORM", the entire disclosures of which are incorporated herein by reference. No. 62/611,341, filed Dec. 28, 2003.

Referring now to FIG. 3 , hub 106 is shown in communication with visualization system 108 , robotic system 110 and handheld intelligent surgical instrument 112 . Hub 106 includes hub display 135 , imaging module 138 , generator module 140 , communication module 130 , processor module 132 and storage array 134 . In certain aspects, the hub 106 further includes a smoke evacuation module 126 and/or an aspiration/irrigation module 128, as shown in FIG.

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

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

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

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

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

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

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

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

In one aspect, the hub modular housing 136 is a modular power and A communications backplane 149 is provided.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Various image processors and imagers suitable for use with the present disclosure are described in U.S. Patent No. 1, issued Aug. 9, 2011, entitled "COMBINED SBI AND CONVENTIONAL IMAGE PROCESSOR," which is incorporated herein by reference in its entirety. 7,995,045. Further, U.S. Patent No. 7,982,776, issued July 19, 2011, entitled "SBI MOTION ARTIFACT REMOVAL APPARATUS AND METHOD," which is incorporated herein by reference in its entirety, removes motion artifacts from image data. Various systems for doing so are described. Such systems may be integrated with imaging module 138 .更に、「ＣＯＮＴＲＯＬＬＡＢＬＥ ＭＡＧＮＥＴＩＣ ＳＯＵＲＣＥ ＴＯ ＦＩＸＴＵＲＥ ＩＮＴＲＡＣＯＲＰＯＲＥＡＬ ＡＰＰＡＲＡＴＵＳ」と題する２０１１年１２月１５日公開の米国特許出願公開第２０１１／０３０６８４０号、及び「ＳＹＳＴＥＭ ＦＯＲ ＰＥＲＦＯＲＭＩＮＧ Ａ ＭＩＮＩＭＡＬＬＹ ＩＮＶＡＳＩＶＥ ＳＵＲＧＩＣＡＬ ＰＲＯＣＥＤＵＲＥ」と題する２０１４年８月２８日Published US Patent Application Publication No. 2014/0243597, the disclosure of each of which is hereby incorporated by reference in its entirety.

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

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

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

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

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

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

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

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

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

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

The modular communication hub 203 can serve as a central connection for one or all of the operating room devices 1a-1n/2a-2m and handles data types known as frames. The frames carry data generated by the devices 1a-1n/2a-2m. As frames are received by modular communication hub 203, the frames are amplified and transmitted to network router 211, which uses a number of wireless or wired communication standards or protocols described herein to transmit the frames. Transfer this data to cloud computing resources.

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

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

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

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

Computer system 210 includes processor 244 and network interface 245 . Processor 244 is coupled to communication module 247, storage 248, memory 249, non-volatile memory 250, and input/output interface 251 via a system bus. The system bus includes a 9-bit bus, Industry Standard Architecture (ISA), Micro Channel Architecture (MSA), Enhanced ISA (EISA), Intelligent Drive Electronics (IDE), VESA Local Bus (VLB), Peripheral Device Interconnect (PCI), Any, including 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. any of several types of bus structure(s) including a memory bus or memory controller, a peripheral or external bus, and/or a local bus using various bus architectures.

Processor 244 may be any single-core or multi-core processor, such as those known under the trade name ARM Cortex manufactured by Texas Instruments. In one aspect, the processor has on-chip memory, e.g., 256 KB of single-cycle flash memory or other non-volatile memory at up to 40 MHz, details of which are available in the product datasheet, to improve performance beyond 40 MHz. a prefetch buffer, 32 KB of single-cycle serial random access memory (SRAM), internal read-only memory (ROM) with StellarisWare® software, 2 KB of electrically erasable programmable read-only memory (EEPROM), and/or One or more pulse width modulation (PWM) modules, one or more quadrature encoder input (QEI) analog, 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 family families, such as the TMS570 and RM4x, also known by the trade designation Hercules ARM Cortex R4, also manufactured by Texas Instruments. Safety controllers may be specifically configured for IEC61508 and ISO26262 safety limit applications to provide advanced integrated safety mechanisms while offering scalable performance, connectivity, and memory options. good.

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

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, disc storage may refer to a storage medium, either independently or as a compact disc ROM device (CD-ROM), a compact disc recordable drive (CD-R drive), a compact disc rewritable drive (CD-RW drive), or in combination with other storage media including, but not limited to, an optical disk drive such as a Digital Versatile Disk ROM Drive (DVD-ROM). A removable or non-removable interface may be used to facilitate connection of the disk storage device to the system bus.

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

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

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

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

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

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

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

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

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

Surgical Instrument Hardware FIG. 12 illustrates a logic diagram of a surgical instrument or tool control system 470, in accordance with one or more aspects of the present disclosure. System 470 includes control circuitry. The control circuitry includes a microcontroller 461 with a processor 462 and memory 468 . For example, one or more of sensors 472 , 474 , 476 provide real-time feedback to processor 462 . A motor 482 driven by motor driver 492 is operatively connected to the longitudinally movable displacement member to drive the I-beam knife element. Tracking system 480 is configured to determine the position of the longitudinally moveable displacement member. The positional information is provided to processor 462, which may be programmed or configured to determine the position of the longitudinally movable drive member, as well as the positions of the firing member, firing bar, and I-beam knife elements. . Additional motors may be provided in the tool driver interface to control I-beam firing, obturator tube movement, shaft rotation, and articulation. The display 473 displays various operating conditions of the instrument and may include touch screen functionality for data entry. Information displayed on display 473 may be overlaid with images acquired via the endoscopic imaging module.

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

In one aspect, microcontroller 461 may include a safety controller that includes two controller family families, such as TMS570 and RM4x, also known by the trade designation Hercules ARM Cortex R4, also manufactured by Texas Instruments. Safety controllers may be specifically configured for IEC61508 and ISO26262 safety limit applications to provide advanced integrated safety mechanisms while offering scalable performance, connectivity, and memory options. good.

The microcontroller 461 may be programmed to perform various functions such as precise control over the speed and position of the knife and articulation system. In one aspect, microcontroller 461 includes processor 462 and memory 468 . Electric motor 482 may be a brushed direct current (DC) motor with a gearbox and mechanical connection to the articulation or knife system. In one aspect, motor driver 492 may be an A3941 available from Allegro Microsystems, Inc. Other motor drives can be easily substituted for use in tracking system 480 with an absolute positioning system. A detailed description of absolute positioning systems can be found in U.S. Patent Application Publication No. 2017, published October 19, 2017, entitled "SYSTEMS AND METHODS FOR CONTROLLING A SURGICAL STAPLING AND CUTTING INSTRUMENT," which is hereby incorporated by reference in its entirety. 0296213.

Microcontroller 461 may be programmed to provide precise control over the velocity and position of the displacement members and articulation system. The microcontroller 461 may be configured to calculate the response within the microcontroller 461 software. The calculated response is compared with the measured response of the actual system to obtain the "observed" response, which is used to determine the actual feedback. The observed response is a well-tuned value that balances the smooth, continuous nature of the simulated response with the measured response, which can detect external influences on the system.

In one aspect, motor 482 may be controlled by motor driver 492 and may be used by the firing system of a surgical instrument or tool. In various forms, motor 482 may be, for example, a brushed DC drive motor having a maximum rotational speed of approximately 25,000 RPM. In alternative configurations, motor 482 may include a brushless motor, cordless motor, synchronous motor, stepper motor, or any other suitable electric motor. Motor driver 492 may comprise, for example, an H-bridge driver including field effect transistors (FETs). Motor 482 may be powered by a power assembly releasably attached to the handle assembly or tool housing to provide control power to the surgical instrument or tool. The power assembly may include a battery that may include multiple battery cells connected in series that may be used as a power source to power a surgical instrument or tool. Under certain circumstances, the battery cells of the power assembly may be replaceable and/or rechargeable. In at least one example, the battery cells may be lithium ion batteries that may be connectable to and separable from the power assembly.

Motor driver 492 may be an A3941 available from Allegro Microsystems, Inc. The A3941 492 is a full-bridge controller for use with external N-channel power metal oxide semiconductor field effect transistors (MOSFETs) specifically designed for inductive loads such as brushed DC motors. Driver 492 includes an inherent charge pump regulator that provides full (>10V) gate drive for battery voltages up to 7V and allows the A3941 to operate with reduced gate drive down to 5.5V. do. Bootstrap capacitors may be used to provide the necessary battery supply voltages for the N-channel MOSFETs. An internal charge pump for the high side drive allows 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 through either the high-side FETs or the low-side FETs. The power FETs are protected from shoot-through by a resistor adjustable dead time. Integrated diagnostics indicate undervoltage, overtemperature, and power bridge faults and can be configured to protect power MOSFETs under most short circuit conditions. Other motor drives can be easily substituted for use in tracking system 480 with an absolute positioning system.

Tracking system 480 comprises controlled motor drive circuitry comprising position sensor 472 in accordance with at least one aspect of the present disclosure. A 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 engagement with a corresponding drive gear of the gear reducer assembly. In other aspects, the displacement member represents a firing member that may be adapted and configured to include a rack of drive teeth. In yet another aspect, the displacement member represents a firing bar or I-beam, each of which may be adapted and configured to include a rack of drive teeth. Accordingly, as used herein, the term displacement member refers to any movable member of a surgical instrument, such as a drive member, firing member, firing bar, I-beam, or any element that can be displaced. used generically to refer to In one aspect, a longitudinally movable drive member is coupled to the firing member, firing bar, and I-beam. Thus, the absolute positioning system can actually track the linear displacement of the I-beam by tracking the linear displacement of the longitudinally movable drive member. In various other aspects, the displacement member may be coupled to any position sensor 472 suitable for measuring linear displacement. Accordingly, the longitudinally movable drive member, firing member, firing bar, or I-beam, or combinations thereof, may be coupled to any suitable displacement sensor. Linear displacement sensors may include contact or non-contact displacement sensors. Linear displacement sensors include linear variable differential transformers (LVDTs), differential variable reluctance transducers (DVRTs), sliding potentiometers, movable magnets and a series of linear A magnetic sensing system comprising an arranged Hall effect sensor, a magnetic sensing system comprising a fixed magnet and Hall effect sensors arranged in a series of movable lines, a movable light source and a series of linearly arranged magnetic sensing systems It may comprise an optical detection system comprising a photodiode or photodetector, an optical detection system comprising a fixed light source and a series of movable linearly arranged photodiodes or photodetectors, or any combination thereof. .

Electric motor 482 may include a rotatable shaft that operably interfaces with a gear assembly that is mounted in meshing 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. The gearing and sensor mechanism can be connected to the linear actuator by a rack and pinion mechanism or to the rotary actuator by spur gears or other connections. A power supply can power the absolute positioning system and an output indicator can display the output of the absolute positioning system. The displacement member represents a longitudinally movable drive member having a rack of drive teeth formed thereon for meshing engagement with a corresponding drive gear of the gear reducer assembly. The displacement member represents a longitudinally movable firing member, firing bar, I-beam, or a combination thereof.

One rotation of the sensor element associated with the position sensor 472 corresponds to a longitudinal linear displacement d1 of the displacement member, where d1 is the displacement after the sensor element coupled to the displacement member has made one rotation. It is the linear longitudinal distance traveled from 'a' to point 'b'. The sensor mechanism may be connected via a gear reduction that results in the position sensor 472 completing one or more revolutions for a full stroke of the displacement member. The position sensor 472 can complete multiple revolutions for a full stroke of the displacement member.

A series of switches (where n is an integer greater than 1) may be used alone or in combination with gear reduction to provide a unique position signal for two or more revolutions of the position sensor 472. may be used in The state of the switch is fed back to the microcontroller 461, which applies logic to determine the longitudinal linear displacement of the displacement member d1+d2+ . . . Determine the unique position signal corresponding to dn. The output of position sensor 472 is provided to microcontroller 461 . The position sensor 472 of the sensor mechanism may comprise a magnetic sensor, an analog rotary sensor such as a potentiometer, or an array of analog Hall effect elements that output a unique combination of position signals or values.

Position sensor 472 may comprise any number of magnetic sensing elements, such as, for example, magnetic sensors classified based on whether they measure the total magnetic field or vector component of the magnetic field. The techniques used to produce both types of magnetic sensors involve many aspects of physics and electronics. Techniques used for sensing magnetic fields include, inter alia, searcher coils, fluxgates, optical pumping, nuclear precession, SQUIDs, Hall effect, anisotropic magnetoresistance, giant magnetoresistance, magnetic tunnel junctions, giant magnetoimpedance. , magnetostrictive/piezoelectric composites, magnetic diodes, magnetic transistors, optical fibers, magneto-optics, and micro-electromechanical systems-based magnetic sensors.

In one aspect, position sensor 472 of tracking system 480 comprising an absolute positioning system comprises a gyromagnetic absolute positioning system. Position sensor 472 may be implemented as an AS5055EQFT single-chip gyromagnetic position sensor available from Austria Microsystems, AG. Position sensor 472 cooperates with 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 area of the position sensor 472 located above the magnets. Additionally, a high resolution ADC and a smart power management controller are provided on-chip. To implement simple and efficient algorithms for computing hyperbolic and trigonometric functions, requiring only addition, subtraction, bit shift, and table lookup operations, digit-by-digit method and boulder A coordinate rotation digital computer (CORDIC) processor, also known as Volder's algorithm, is provided. Angular position, alarm bits, and magnetic field information are transmitted to microcontroller 461 via a standard serial communication interface, such as a serial peripheral interface (SPI) interface. Position sensor 472 provides 12-bit or 14-bit resolution. The position sensor 472 may be an AS5055 chip provided in a small QFN 16-pin 4x4x0.85mm package.

Tracking system 480, which includes an absolute positioning system, may include and/or be programmed to implement feedback controllers such as PID, state feedback, and adaptive controllers. A power supply converts the signal from the feedback controller into a physical input to the system, in this case voltage. Other examples include voltage, current and force PWM. In addition to the position measured by position sensor 472, other sensor(s) may be provided to measure physical parameters of the physical system. In some aspects, the other sensor(s) includes US Pat. , 345,481, U.S. Patent Application Publication No. 2014/0263552, published September 18, 2014, entitled "STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM," which is incorporated herein by reference in its entirety; US patent application Ser. Sensor mechanisms such as objects can be mentioned. In a digital signal processing system, an absolute positioning system is coupled to a digital data acquisition system, where the output of the absolute positioning system has finite resolution and sampling frequency. Absolute positioning systems use algorithms such as weighted averages and theoretical control loops to drive the calculated response toward the measured response, and compare and combine circuits to combine the calculated response with the measured response. can be provided. The calculated response of a physical system takes into account properties such as mass, inertia, viscous friction, and induced drag in order to predict what the state and output of the physical system will be given the inputs.

The absolute positioning system resets the displacement member, as might be required with a conventional rotary encoder where the motor 482 simply counts the number of steps taken forward or backward to estimate the position of the machine actuator, drive bar, knife, etc. It provides the absolute position of the displacement member at power up of the instrument without retraction or advancement to the zero (or home) position.

A sensor 474, such as a strain gauge or micro strain gauge, may be used to indicate one or more of the end effectors, such as the amplitude of strain exerted on the anvil during a clamping operation, which may indicate, for example, the closing force applied to the anvil. configured to measure parameters of The measured distortion is converted to a digital signal and provided to processor 462 . Alternatively, or in addition to sensor 474, sensor 476, such as, for example, a load sensor, may measure the closing force applied to the anvil by the closing drive system. For example, a sensor 476, such as a load sensor, can measure the firing force applied to the I-beam during the firing stroke of the surgical instrument. The I-beam is configured to engage a wedge-shaped sled, which is configured to cam the staple driver upwardly to force the staples into deforming contact with the anvil. The I-beam also includes a sharp cutting edge that can be used to cut tissue as the I-beam is advanced distally by the firing bar. Alternatively, current sensor 478 can be used to measure the current drawn by motor 482 . The force required to advance the firing member may correspond to the current drawn by motor 482, for example. The measured force is converted to a digital signal and provided to processor 462 .

In one form, a strain gauge sensor 474 can be used to measure the force exerted on tissue by the end effector. A strain gauge can be coupled to the end effector to measure the force exerted by the end effector on the tissue being treated. A system for measuring the force applied to the tissue grasped by the end effector includes a strain gauge sensor 474, such as a microstrain gauge configured to measure one or more parameters of the end effector. Prepare. In one aspect, the strain gauge sensor 474 can measure the amplitude or magnitude of strain exerted on the jaw members of the end effector during a grasping motion, which can be indicative of tissue compression. The measured strain is converted to a digital signal and provided to processor 462 of microcontroller 461 . Load sensor 476 can measure the force used to operate the knife element, for example, to cut tissue captured between the anvil and the staple cartridge. A magnetic field sensor can be used to measure the thickness of the captured tissue. Magnetic field sensor measurements may also be converted to digital signals and provided to processor 462 .

Measurements of tissue compression, tissue thickness, and/or force required to close the end effector on tissue, as measured by sensors 474, 476, respectively, are determined by the selected position of the firing member, and/or Or it can be used by the microcontroller 461 to characterize the corresponding value of the velocity of the firing member. In one example, memory 468 can store techniques, equations and/or lookup tables that can be used by microcontroller 461 in evaluation.

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

FIG. 13 illustrates control circuitry 500 configured to control aspects of a surgical instrument or tool, according to at least one aspect of the present disclosure. Control circuit 500 may be configured to implement various processes described herein. Control circuitry 500 may comprise a microcontroller comprising one or more processors 502 (eg, microprocessors, microcontrollers) coupled to at least one memory circuit 504 . Memory circuitry 504 stores machine-executable instructions that, when executed by processor 502, cause processor 502 to execute machine instructions to implement various processes described herein. Processor 502 may be any one of numerous single or multi-core processors known in the art. Memory circuit 504 may include volatile and nonvolatile storage media. 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 illustrates combinatorial logic 510 configured to control aspects of a surgical instrument or tool, according to at least one aspect of the present disclosure. Combinatorial logic 510 can be configured to implement various processes described herein. Combinatorial logic 510 is a finite state machine including combinatorial logic 512 configured to receive data associated with a surgical instrument or tool at input 514 , process the data through combinatorial logic 512 , and provide output 516 . can include

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

FIG. 16 shows a surgical instrument or tool with multiple motors that can be activated to perform various functions. In certain examples, a first motor can be activated to perform a first function, a second motor can be activated to perform a second function, and a third motor can be activated. A third motor can be activated to perform a third function, a fourth motor can be activated to perform a fourth function, and so on. In certain examples, multiple motors of robotic surgical instrument 600 can be individually activated to produce firing motion, closing motion, and/or articulation motion at the end effector. Firing motion, closing motion, and/or articulation motion can be transmitted to the end effector via, for example, a shaft assembly.

In certain examples, a surgical instrument system or tool may include firing motor 602 . Firing motor 602 may be operatively coupled to firing motor drive assembly 604, which may be configured to transmit firing motion generated by motor 602 to the end effector, specifically to displace the I-beam elements. In certain examples, the firing motion produced by motor 602 causes, for example, staples to be deployed from a staple cartridge into tissue captured by an end effector and/or to advance a cutting edge of an I-beam element to be captured. Tissue may be cut. The I-beam elements can also be retracted by reversing the direction of motor 602 .

In certain examples, a surgical instrument or tool may include a closure motor 603. Closure motor 603 is configured to transmit the closing motion generated by motor 603 to the end effector, specifically to displace the closure tube to close the anvil and compress tissue between the anvil and staple cartridge. It may be operatively connected with a closure motor drive assembly 605, which may be configured. The closing motion may cause the end effector to transition from an open configuration to an approximated configuration to capture tissue, for example. The end effector can be transitioned to the open position by reversing the direction of motor 603 .

In certain examples, a surgical instrument or tool may include, for example, one or more articulation motors 606a, 606b. The motors 606a, 606b can be operably coupled to corresponding articulation motor drive assemblies 608a, 608b that can be configured to transmit articulation motion generated by the motors 606a, 606b to the end effector. In certain examples, the articulation may, for example, articulate the end effector with respect to the shaft.

As noted above, a surgical instrument or tool may include multiple motors that may be configured to perform various independent functions. In certain examples, multiple motors of a surgical instrument or tool are activated independently or separately to perform one or more functions while other motors remain deactivated. can be implemented. For example, articulation motors 606a, 606b can be activated to articulate the end effector while firing motor 602 remains stopped. Alternatively, firing motor 602 can be activated to fire multiple staples and/or advance the cutting edge while articulation motor 606 is deactivated. Additionally, closure motor 603 may be activated simultaneously with firing motor 602 to distally advance the closure tube and I-beam elements, as described in more detail herein below.

In certain examples, a surgical instrument or tool may include a common control module 610 that can be used with multiple motors of the surgical instrument or tool. In certain examples, a common control module 610 can serve one of multiple motors at a time. For example, a common control module 610 may be individually connectable and disconnectable to multiple motors of the robotic surgical instrument. In certain examples, multiple motors of a surgical instrument or tool may share one or more common control modules, such as common control module 610 . In certain examples, multiple motors of a surgical instrument or tool can independently and selectively engage a common control module 610 . In certain examples, the common control module 610 is configured to selectively communicate with one of the motors of the surgical instrument or tool to the other of the motors of the surgical instrument or tool. You can switch.

In at least one example, common control module 610 selects between operable engagement with articulation motors 606a, 606b and operable engagement with either firing motor 602 or closing motor 603. can be switched. In at least one embodiment, as shown in FIG. 16, switch 614 can move or transition between multiple positions and/or states. For example, in a first position 616 the switch 614 may electrically couple the common control module 610 with the firing motor 602, and in a second position 617 the switch 614 may close the common control module 610. In a third position 618a the switch 614 may electrically couple the common control module 610 with the first articulation motor 606a and in a fourth position the switch 614 may be in electrical communication with the motor 603. At 618b, a switch 614 may electrically couple the common control module 610 with the second articulation motor 606b. In certain examples, a separate common control module 610 may be electrically coupled to firing motor 602, closing motor 603, and articulation motors 606a, 606b at the same time. In particular examples, switch 614 may be a mechanical switch, an electromechanical switch, a solid state switch, or any suitable switching mechanism.

Each of the motors 602, 603, 606a, 606b may include a torque sensor for measuring the output torque on the shaft of the motor. The force on the end effector may be sensed in any conventional manner, such as by a force sensor outside the jaws or by a torque sensor on the motor that actuates the jaws.

In various examples, as shown in FIG. 16, common control module 610 may include motor driver 626, which may include one or more H-bridge FETs. Motor drivers 626 may modulate power transferred from power supply 628 to motors coupled to common control module 610 based on, for example, input from microcontroller 620 (“controller”). In a particular example, as described above, the current drawn by the motors can be determined using, for example, the microcontroller 620 while the motors are coupled to the common control module 610 .

In particular examples, microcontroller 620 may include a microprocessor 622 (“processor”) and one or more non-transitory computer-readable media or memory units 624 (“memory”). In particular examples, memory 624 may store various program instructions that, when executed, may cause processor 622 to perform a number of functions and/or calculations described herein. can. In particular examples, one or more of memory units 624 may be coupled to processor 622, for example.

In particular examples, power supply 628 may be used to power microcontroller 620, for example. In certain examples, power source 628 may include a battery (or “battery pack” or “power pack”), such as a lithium-ion battery. In certain examples, the battery pack may be configured to be releasably attached to the handle to power surgical instrument 600 . Multiple battery cells connected in series may be used as power source 628 . In certain examples, power source 628 may be replaceable and/or rechargeable, for example.

In various examples, processor 622 can control motor drivers 626 to control the position, direction of rotation, and/or speed of motors coupled to common control module 610 . In certain examples, processor 622 may signal motor drivers 626 to stop and/or disable motors coupled to common control module 610 . The term "processor," as used herein, means any suitable microprocessor, microcontroller, or computer central processing unit (CPU) function integrated into one integrated circuit or up to several integrated circuits. It should be understood to include other basic computing devices integrated above. A processor is a general-purpose programmable device that accepts digital data as input, processes that data according to instructions stored in memory, and provides the results as output. This is an example of sequential digital logic since it has internal memory. Processors work with numbers and symbols represented in a binary number system.

In one example, processor 622 may be any single-core or multi-core processor, such as those known under the trade name ARM Cortex manufactured by Texas Instruments. In a particular example, microcontroller 620 may be, for example, the LM 4F230H5QR available from Texas Instruments. In at least one embodiment, Texas Instruments' LM4F230H5QR provides 256 KB of single-cycle flash memory or other non-volatile memory on-chip memory up to 40 MHz, performance up to 40 MHz, among other features readily available in product datasheets. 32 KB single-cycle SRAM, internal ROM with StellarisWare software, 2 KB EEPROM, one or more PWM modules, one or more QEI analog , ARM Cortex-M4F processor cores containing one or more 12-bit ADCs with 12 analog input channels. Other microcontrollers may be readily substituted for use with module 4410 . Accordingly, the present disclosure should not be limited in this context.

In particular examples, memory 624 may contain program instructions for controlling each of the motors of surgical instrument 600 coupleable to a common control module 610 . For example, memory 624 may contain program instructions for controlling firing motor 602, closing motor 603, and articulation motors 606a, 606b. Such program instructions may cause processor 622 to control the firing, closing, and articulating functions according to inputs from an algorithm or control program of the surgical instrument or tool.

In particular examples, one or more mechanisms and/or sensors, such as sensor 630, can be used to alert processor 622 to use program instructions that should be used in a particular setting. . For example, sensor 630 can alert processor 622 to use program instructions related to end effector firing, closing, and articulation. In particular examples, sensor 630 may comprise a position sensor that may be used to sense the position of switch 614, for example. Thus, when processor 622 detects, for example, via sensor 630 that switch 614 is in first position 616, processor 622 can employ program instructions associated with firing the end effector I-beam, causing processor 622 to can use program instructions associated with closing the anvil upon detecting, for example, via sensor 630 that switch 614 is in second position 617, processor 622, for example, via sensor 630, Upon detecting that the switch 614 is in the third position 618a or the fourth position 618b, program instructions associated with end effector articulation can be used.

FIG. 17 is a schematic illustration of a robotic surgical instrument 700 configured to manipulate surgical tools described herein, according to at least one aspect of the present disclosure. Robotic surgical instrument 700 uses either single or multiple articulation drive connections to perform distal/proximal translation of displacement members, distal/proximal displacement of obturator tubes, rotation of shafts, and articulation. It may be programmed or configured to control movement. In one aspect, surgical instrument 700 may be programmed or configured to individually control the firing member, closure member, shaft member, and/or one or more articulation members. Surgical instrument 700 includes a control circuit 710 configured to control a motorized firing member, closure member, shaft member, or one or more articulation members.

In one aspect, the robotic surgical instrument 700 can, via a plurality of motors 704a-704e, the anvil 716 and I-beam 714 (including sharp cutting edges) portions of the end effector 702, removable staple cartridge 718, shaft 740, and a control circuit 710 configured to control one or more articulation members 742a, 742b. Position sensor 734 may be configured to provide position feedback of I-beam 714 to control circuit 710 . Other sensors 738 may be configured to provide feedback to control circuit 710 . Timer/counter 731 provides timing and counting information to control circuit 710 . An energy source 712 may be provided to operate the motors 704 a - 704 e , and a current sensor 736 provides motor current feedback to the control circuit 710 . Motors 704a-704e can be individually operated by control circuit 710 in open-loop or closed-loop feedback control.

In one aspect, the control circuit 710 comprises one or more microcontrollers, microprocessors, or processors or other suitable devices for executing instructions that cause one or more processors to perform one or more tasks. A processor may be provided. In one aspect, timer/counter circuit 731 provides an output signal, such as elapsed time or a digital count, to control circuit 710 to indicate the position of I-beam 714 as determined by position sensor 734 as the output of timer/counter circuit 731 . Correlating so that control circuit 710 determines the position of I-beam 714 at a particular time (t) relative to the starting position or time (t) when I-beam 714 is at a particular position relative to the starting position. can do. Timer/counter 731 may be configured to measure elapsed time, count external events, or time external events.

In one aspect, control circuit 710 may be programmed to control the function of end effector 702 based on one or more tissue conditions. Control circuitry 710 may be programmed to sense tissue conditions, such as thickness, either directly or indirectly, as described herein. Control circuit 710 may be programmed to select a firing control program or a closing control program based on tissue condition. A firing control program can describe the distal movement of the displacement member. Different firing control programs can be selected to better treat different tissue conditions. For example, if thicker tissue is present, control circuitry 710 may be programmed to translate the displacement member at a slower speed and/or with less power. If thinner tissue is present, the control circuit 710 may be programmed to translate the displacement member at a higher speed and/or with a higher power. A closure control program may control the closure force applied to tissue by anvil 716 . Other control programs control the rotation of shaft 740 and articulation members 742a, 742b.

In one aspect, control circuit 710 may also generate a motor setpoint signal. Motor setpoint signals may be provided to various motor controllers 708a-708e. The motor controllers 708a-708e comprise one or more circuits configured to provide motor drive signals to the motors 704a-704e to drive the motors 704a-704e, as described herein. may In some embodiments, motors 704a-704e may be brushed DC electric motors. For example, the speed of motors 704a-704e may be proportional to their respective motor drive signals. In some embodiments, the motors 704a-704e may be brushless DC electric motors, with respective motor drive signals provided to one or more stator windings of the motors 704a-704e using PWM may include a signal. Also, in some embodiments, the motor controllers 708a-708e may be omitted and the control circuit 710 may directly generate the motor drive signals.

In one aspect, the control circuit 710 may initially operate each of the motors 704a-704e in an open loop configuration for a first open loop portion of the stroke of the displacement member. Based on the response of robotic surgical instrument 700 during the open-loop portion of the stroke, control circuit 710 may select a closed-loop configuration firing control program. The response of the instrument includes the translational distance of the displacement member during the open loop portion, the time elapsed during the open loop portion, the energy provided to one of the motors 704a-704e during the open loop portion, the motor For example, the total pulse width of the drive signal may be mentioned. After the open loop portion, control circuit 710 may implement the selected firing control program for the second portion of the displacement member stroke. For example, during the closed-loop portion of the stroke, control circuit 710 modulates one of motors 704a-704e in a closed-loop manner based on translational data describing the position of the displacement member to translate the displacement member at a constant velocity. You may let

In one aspect, the motors 704a-704e may receive power from the energy source 712. Energy source 712 may be a DC power source powered by mains AC power, batteries, supercapacitors, or any other suitable energy source. Motors 704a-704e are mechanically coupled to respective movable mechanical elements such as I-beam 714, anvil 716, shaft 740, articulation member 742a and articulation member 742b via respective transmissions 706a-706e. you can The transmissions 706a-706e may include one or more gears or other coupling components for coupling the motors 704a-704e to the movable mechanical elements. Position sensor 734 may sense the position of I-beam 714 . Position sensor 734 may be or include any type of sensor capable of generating position data indicative of the position of I-beam 714 . In some examples, position sensor 734 may include an encoder configured to provide a series of pulses to control circuit 710 as I-beam 714 translates distally and proximally. Control circuit 710 may track the pulses to determine the position of I-beam 714 . Other suitable position sensors may be used including, for example, proximity sensors. Other types of position sensors may provide other signals indicative of I-beam 714 movement. Also, in some implementations, the position sensor 734 may be omitted. If any of motors 704a-704e are stepper motors, control circuit 710 may track the position of I-beam 714 by summing the number and direction of steps that motor 704 is instructed to perform. . A position sensor 734 may be located within the end effector 702 or any other portion of the instrument. Each output of the motors 704a-704e includes a torque sensor 744a-744e for sensing force and has an encoder for sensing rotation of the drive shaft.

In one aspect, control circuitry 710 is configured to drive a firing member, such as the I-beam 714 portion of end effector 702 . Control circuit 710 provides motor settings to motor control 708a, and motor control 708a provides drive signals to motor 704a. The output shaft of motor 704a is coupled to torque sensor 744a. Torque sensor 744 a is coupled to transmission 706 a which is coupled to I-beam 714 . Transmission device 706 a includes moveable mechanical elements such as rotating and firing members for controlling movement of distal and proximal I-beams 714 along the longitudinal axis of end effector 702 . In one aspect, motor 704a may be coupled to a knife gear assembly that includes a knife gear reduction set that includes a first knife drive gear and a second knife drive gear. Torque sensor 744 a provides a firing force feedback signal to control circuit 710 . The firing force signal represents the force required to fire or displace I-beam 714 . Position sensor 734 may be configured to provide the position of I-beam 714 or the position of the firing member along the firing stroke as a feedback signal to control circuit 710 . End effector 702 may include additional sensors 738 configured to provide feedback signals to control circuitry 710 . When ready for use, control circuit 710 can provide a fire signal to motor control 708a. In response to the firing signal, motor 704a drives the firing member distally along the longitudinal axis of end effector 702 from a proximal stroke start position to a stroke end position distal to the stroke start position. be able to. As the firing member translates distally, I-beam 714 with a cutting element positioned at its distal end advances distally to cut tissue located between staple cartridge 718 and anvil 716 .

In one aspect, control circuit 710 is configured to drive a closure member, such as anvil 716 of end effector 702 . Control circuit 710 provides motor settings to motor control 708b, which provides drive signals to motor 704b. The output shaft of motor 704b is coupled to torque sensor 744b. Torque sensor 744b is coupled to transmission device 706b which is coupled to anvil 716 . Transmission device 706b includes moveable mechanical elements such as rotating elements and closure members for controlling movement of anvil 716 from open and closed positions. In one aspect, the motor 704b is coupled to a closure gear assembly that includes a closure reduction gear set supported in meshing engagement with a closure spur gear. Torque sensor 744 b provides a closing force feedback signal to control circuit 710 . The closing force feedback signal represents the closing force applied to anvil 716 . Position sensor 734 may be configured to provide the position of the closure member as a feedback signal to control circuit 710 . An additional sensor 738 in end effector 702 can provide a closure force feedback signal to control circuit 710 . A pivotable anvil 716 is positioned opposite staple cartridge 718 . When ready for use, control circuit 710 can provide a close signal to motor control 708b. In response to the closure signal, motor 704 b advances closure member to grasp tissue between anvil 716 and staple cartridge 718 .

In one aspect, control circuit 710 is configured to rotate a shaft member, such as shaft 740 , to rotate end effector 702 . Control circuit 710 provides motor settings to motor control 708c, which in turn provides drive signals to motor 704c. The output shaft of motor 704c is coupled to torque sensor 744c. Torque sensor 744 c is coupled to transmission 706 c which is coupled to shaft 740 . Transmission 706c comprises a moveable mechanical element, such as a rotating element, to control clockwise or counterclockwise rotation of shaft 740 through 360 degrees and beyond. In one aspect, the motor 704c was formed on (or attached to) the proximal end of the proximal closure tube to be operably engaged by a rotating gear assembly operably supported on the tool mounting plate. attached) to a rotary transmission assembly including a tubular gear segment. Torque sensor 744 c provides a rotational force feedback signal to control circuit 710 . The rotational force feedback signal is representative of the rotational force applied to shaft 740 . Position sensor 734 may be configured to provide the position of the closure member as a feedback signal to control circuit 710 . Additional sensors 738 , such as shaft encoders, may provide the rotational position of shaft 740 to control circuit 710 .

In one aspect, control circuit 710 is configured to articulate end effector 702 . Control circuit 710 provides motor settings to motor control 708d, and motor control provides drive signals to motor 704d. The output shaft of motor 704d is coupled to torque sensor 744d. Torque sensor 744d is coupled to transmission 706d that is coupled to articulation member 742a. Transmission device 706d comprises a moveable mechanical element, such as an articulation element for controlling ±65° articulation of end effector 702 . In one aspect, the motor 704d is coupled to an articulation nut that is rotatably journalled on the proximal end portion of the distal spine portion and articulated on the proximal end portion of the distal spine portion. It is rotatably driven by a motion gear assembly. Torque sensor 744 d provides an articulation force feedback signal to control circuit 710 . The articulation force feedback signal represents the articulation force applied to the end effector 702 . A sensor 738 , such as an articulation encoder, may provide the articulation position of end effector 702 to control circuit 710 .

In another aspect, the articulation features of the robotic surgical system 700 may include two articulation members, or connections 742a, 742b. These articulation members 742a, 742b are driven by separate discs on a robot interface (rack) driven by two motors 708d, 708e. When separate firing motors 704a are provided, to provide resistive holding motion and load to the head when the head is not moving, and to provide articulation when the head is articulating: Each of the articulation links 742a, 742b can be driven antagonistically with respect to the other link. Articulation members 742a, 742b are attached to the head at a fixed radius as the head rotates. Therefore, as the head rotates, the mechanical efficiency of the push-pull connection changes. This change in mechanical efficiency may be more pronounced in other articulating joint drive systems.

In one aspect, one or more of the motors 704a-704e may comprise brushed DC motors with gearboxes and mechanical connections to the firing, closing, or articulating members. Another example includes electric motors 704a-704e that operate movable mechanical elements such as displacement members, articulation connections, closed tubes, and shafts. External influences are unmeasured and unpredictable influences such as friction on tissues, surroundings and physical systems. Such external influences are sometimes referred to as drag acting against one of the electric motors 704a-704e. External influences, such as disturbances, can cause the behavior of a physical system to deviate from the desired behavior of the physical system.

In one aspect, position sensor 734 may be implemented as an absolute positioning system. In one aspect, the position sensor 734 may comprise a gyromagnetic absolute positioning system implemented as an AS5055EQFT single-chip gyromagnetic position sensor available from Austria Microsystems, AG. Position sensor 734 may cooperate with control circuitry 710 to provide an absolute positioning system. The position is located above the magnet and provided to implement simple and efficient algorithms for computing hyperbolic and trigonometric functions, requiring only addition, subtraction, bit-shifting, and table lookup operations. It may include multiple Hall effect elements coupled to the CORDIC processor, also known as the digit-by-digit method and the Boulder algorithm.

In one aspect, control circuitry 710 may communicate with one or more sensors 738 . Sensors 738 are positioned on end effector 702 and adapted to operate with robotic surgical instrument 700 to measure various derived parameters such as gap distance vs. time, tissue compression vs. time, and anvil strain vs. time. may Sensors 738 may be magnetic sensors, magnetic field sensors, strain gauges, load cells, pressure sensors, force sensors, torque sensors, inductive sensors such as eddy current sensors, resistive sensors, capacitive sensors, optical sensors, and/or one of end effector 702. or any other suitable sensor for measuring two or more parameters. Sensor 738 may include one or more sensors. A sensor 738 may be positioned on the deck of the staple cartridge 718 for determining tissue position using segmented electrodes. Torque sensors 744a-744e may be configured to sense forces such as firing forces, closing forces, and/or articulation forces, among others. Thus, the control circuit 710 can determine (1) the closure load experienced by the distal obturator tube and its position, (2) the firing member in the rack and its position, and (3) which portion of the staple cartridge 718 has tissue thereon. and (4) the load and position on both articulation rods can be sensed.

In one aspect, the one or more sensors 738 may comprise strain gauges, such as micro strain gauges configured to measure the amount of strain in the anvil 716 during the gripping condition. A strain gauge provides an electrical signal whose amplitude varies with the amount of strain. Sensor 738 may comprise a pressure sensor configured to detect pressure caused by the presence of compressed tissue between anvil 716 and staple cartridge 718 . Sensor 738 may be configured to detect the impedance of a portion of tissue located between anvil 716 and staple cartridge 718, which impedance may be measured by the thickness and/or integrity of tissue located between them. show gender.

In one aspect, sensor 738 is implemented as one or more limit switches, electromechanical devices, solid state switches, Hall effect devices, magnetoresistive (MR) devices, giant magnetoresistive (GMR) devices, magnetometers, among others. may be In other implementations, sensor 738 may be implemented as a solid-state switch that operates under the influence of light, such as an optical sensor, an IR sensor, an ultraviolet sensor, among others. Additionally, the switch may be a solid state device such as a transistor (eg, FET, junction FET, MOSFET, bipolar, etc.). In other implementations, sensors 738 may include conductorless switches, ultrasonic switches, accelerometers, and inertial sensors, among others.

In one aspect, sensor 738 may be configured to measure the force exerted on anvil 716 by the closing drive system. For example, one or more sensors 738 may be located at the point of interaction between the closure tube and the anvil 716 to detect the closure force applied to the anvil 716 by the closure tube. The force exerted on anvil 716 may represent tissue compression experienced by a portion of tissue captured between anvil 716 and staple cartridge 718 . One or more sensors 738 may be positioned at various interaction points along the closure drive system to detect the closing force applied to anvil 716 by the closure drive system. One or more sensors 738 may be sampled in real-time during clamping operations by the processor of control circuit 710 . The control circuit 710 receives real-time sample measurements to provide and analyze time-based information to evaluate the closing force applied to the anvil 716 in real-time.

In one aspect, a current sensor 736 can be used to measure the current drawn by each of the motors 704a-704e. The force required to advance any of the movable mechanical elements, such as I-beam 714, corresponds to the current drawn by one of motors 704a-704e. This force is converted to a digital signal and provided to control circuit 710 . The control circuit 710 may be configured to simulate the actual system response of the instrument in the controller software. The displacement member can be actuated to move the I-beam 714 within the end effector 702 at or about a target velocity. The robotic surgical instrument 700 can include a feedback controller, for example, any feedback controller including, but not limited to, PID, state feedback, linear-quadratic (LQR), and/or adaptive controllers. may be any one of Robotic surgical instrument 700 can include a power supply for converting signals from the feedback controller into physical inputs such as, for example, case voltage, PWM voltage, frequency modulated voltage, current, torque, and/or force. . Further details are disclosed in U.S. patent application Ser. No. 15/636,829, entitled "CLOSED LOOP VELOCITY CONTROL TECHNIQUES FOR ROBOTIC SURGICAL INSTRUMENT," filed Jun. 29, 2017, which is incorporated herein by reference in its entirety. It is

FIG. 18 shows a block diagram of a surgical instrument 750 programmed to control distal translation of a displacement member, according to at least one aspect of the present disclosure. In one aspect, surgical instrument 750 is programmed to control distal translation of a displacement member such as I-beam 764 . Surgical instrument 750 comprises an anvil 766 , an I-beam 764 (which includes a sharp cutting edge), and an end effector 752 that may comprise a removable staple cartridge 768 .

The position, movement, displacement and/or translation of a linear displacement member such as I-beam 764 can be measured by absolute positioning system, sensor mechanism and position sensor 784 . Since I-beam 764 is coupled to a longitudinally movable drive member, the position of I-beam 764 can be determined by measuring the position of the longitudinally movable drive member utilizing position sensor 784 . can be done. Accordingly, in the discussion below, position, displacement, and/or translation of I-beam 764 may be accomplished by position sensor 784 as described herein. Control circuitry 760 may be programmed to control translation of a displacement member such as I-beam 764 . In some embodiments, the control circuit 760 commands one or more microcontrollers, microprocessors, or processors or processors to control the displacement member, e.g., I-beam 764, in the manner described. Other suitable processors may be provided for execution. In one aspect, timer/counter 781 provides an output signal, such as elapsed time or a digital count, to control circuit 760 to correlate the position of I-beam 764 as determined by position sensor 784 with the output of timer/counter 781. Control circuit 760 can then determine the position of I-beam 764 at a particular time (t) relative to the starting position. Timer/counter 781 may be configured to measure elapsed time, count external events, or time external events.

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

Motor 754 may receive power from energy source 762 . Energy source 762 may be or include a battery, supercapacitor, or any other suitable energy source. Motor 754 may be mechanically coupled to I-beam 764 via transmission 756 . Transmission 756 may include one or more gears or other coupling components for coupling motor 754 to I-beam 764 . A position sensor 784 may sense the position of the I-beam 764 . Position sensor 784 may be or include any type of sensor capable of generating position data indicative of the position of I-beam 764 . In some examples, position sensor 784 may include an encoder configured to provide a series of pulses to control circuit 760 as I-beam 764 translates distally and proximally. Control circuitry 760 may track the pulses to determine the position of I-beam 764 . Other suitable position sensors may be used including, for example, proximity sensors. Other types of position sensors may provide other signals indicative of I-beam 764 movement. Also, in some implementations, the position sensor 784 may be omitted. If motor 754 is a stepper motor, control circuit 760 may track the position of I-beam 764 by summing the number and direction of steps motor 754 is instructed to perform. A position sensor 784 may be located within the end effector 752 or any other portion of the instrument.

Control circuitry 760 may communicate with one or more sensors 788 . A sensor 788 may be positioned on the end effector 752 and adapted to work with the surgical instrument 750 to measure various derived parameters such as gap distance and time, tissue compression and time, and anvil strain and time. . Sensor 788 may include one or more of magnetic sensors, magnetic field sensors, strain gauges, pressure sensors, force sensors, inductive sensors such as eddy current sensors, resistive sensors, capacitive sensors, optical sensors, and/or end effector 752 . Any other suitable sensor for measuring parameters may be provided. Sensor 788 may include one or more sensors.

The one or more sensors 788 may comprise strain gauges, such as micro strain gauges configured to measure the amount of strain in the anvil 766 during gripping conditions. A strain gauge provides an electrical signal whose amplitude varies with the amount of strain. Sensor 788 may comprise a pressure sensor configured to detect pressure caused by the presence of compressed tissue between anvil 766 and staple cartridge 768 . Sensor 788 may be configured to detect the impedance of a portion of tissue located between anvil 766 and staple cartridge 768 indicative of the thickness and/or integrity of the tissue located between them.

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

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

The control circuit 760 may be configured to simulate the actual system response of the instrument in the controller software. The displacement member can be actuated to move the I-beam 764 within the end effector 752 at or about a target velocity. Surgical instrument 750 may include a feedback controller, for example, any one of any feedback controller including, but not limited to, PID, state feedback, LQR, and/or adaptive controllers. can be one. Surgical instrument 750 can include a power supply to convert signals from feedback controllers into physical inputs such as, for example, case voltage, PWM voltage, frequency modulated voltage, current, torque, and/or force.

The actual drive system of surgical instrument 750 is such that the displacement member, cutting member, or I-beam 764 is driven by a gearbox and a brushed DC motor with mechanical connections to the articulation and/or knife system. is configured to Another example is an electric motor 754 that operates displacement members and articulation drivers of, for example, interchangeable shaft assemblies. External influences are unmeasured and unpredictable influences such as friction on tissues, surroundings, and physical systems. Such external influences are sometimes referred to as disturbances acting against electric motor 754 . External influences, such as disturbances, can cause the behavior of a physical system to deviate from the desired behavior of the physical system.

Various exemplary aspects are directed to a surgical instrument 750 comprising an end effector 752 having motorized surgical stapling and cutting means. For example, motor 754 may drive displacement members distally and proximally along the longitudinal axis of end effector 752 . End effector 752 may comprise a pivotable anvil 766 and a staple cartridge 768 positioned opposite anvil 766 when configured for use. A clinician can grasp tissue between anvil 766 and staple cartridge 768 as described herein. When the instrument 750 is ready for use, the clinician may provide a firing signal, for example by pressing the trigger of the instrument 750 . In response to the firing signal, motor 754 drives the displacement member distally along the longitudinal axis of end effector 752 from a proximal stroke start position to a stroke end position distal to the stroke start position. be able to. As the displacement member is translated distally, an I-beam 764 having a cutting element positioned at its distal end can cut tissue between staple cartridge 768 and anvil 766 .

In various embodiments, surgical instrument 750 has control circuitry 760 programmed to control distal translation of a displacement member, eg, I-beam 764, based on one or more tissue conditions. You may prepare. Control circuitry 760 may be programmed to sense tissue conditions, such as thickness, either directly or indirectly, as described herein. Control circuit 760 may be programmed to select a firing control program based on tissue condition. A firing control program can describe the distal movement of the displacement member. Different firing control programs can be selected to better treat different tissue conditions. For example, if thicker tissue is present, control circuitry 760 may be programmed to translate the displacement member at a slower speed and/or with less power. If thinner tissue is present, the control circuit 760 may be programmed to translate the displacement member at a higher speed and/or with a higher power.

In some embodiments, control circuit 760 may initially operate motor 754 in an open loop configuration for a first open loop portion of the stroke of the displacement member. Based on the response of instrument 750 during the open-loop portion of the stroke, control circuit 760 may select a firing control program. The response of the instrument includes the translational distance of the displacement member during the open loop portion, the time elapsed during the open loop portion, the energy provided to the motor 754 during the open loop portion, and the total pulse width of the motor drive signal. etc. can be mentioned. After the open loop portion, control circuit 760 may implement the selected firing control program for the second portion of the displacement member stroke. For example, during the closed-loop portion of the stroke, control circuit 760 may closed-loop modulate motor 754 based on translation data describing the position of the displacement member to translate the displacement member at a constant velocity. Further details can be found in U.S. patent application Ser. disclosed in

FIG. 19 is a schematic illustration of a surgical instrument 790 configured to control various functions, according to at least one aspect of the present disclosure. In one aspect, surgical instrument 790 is programmed to control distal translation of a displacement member such as I-beam 764 . Surgical instrument 790 includes an end effector 792 that may include an anvil 766, an I-beam 764, and a removable staple cartridge 768 that may be replaced with an RF cartridge 796 (shown in dashed lines).

In one aspect, sensor 788 may be implemented as a limit switch, electromechanical device, solid state switch, Hall effect device, MR device, GMR device, magnetometer, among others. In other implementations, sensor 638 may be a solid-state switch that operates under the influence of light, such as a light sensor, IR sensor, UV sensor, among others. Additionally, the switch may be a solid state device such as a transistor (eg, FET, junction FET, MOSFET, bipolar, etc.). In other implementations, sensors 788 may include conductorless switches, ultrasonic switches, accelerometers, and inertial sensors, among others.

In one aspect, the position sensor 784 may be implemented as an absolute positioning system comprising a gyromagnetic absolute positioning system implemented as an AS5055EQFT single-chip gyromagnetic position sensor available from Austria Microsystems, AG. Position sensor 784 may cooperate with control circuitry 760 to provide an absolute positioning system. The position is located above the magnet and provided to implement simple and efficient algorithms for computing hyperbolic and trigonometric functions, requiring only addition, subtraction, bit-shifting, and table lookup operations. It may include multiple Hall effect elements coupled to the CORDIC processor, also known as the digit-by-digit method and the Boulder algorithm.

In one aspect, the I-beam 764 may be implemented as a knife member comprising a knife body operably supporting a tissue cutting blade thereon, and further including an anvil engaging tab or mechanism and a passageway engaging mechanism or foot. OK. In one aspect, staple cartridge 768 may be implemented as a standard (mechanical) surgical fastener cartridge. In one aspect, RF cartridge 796 may be implemented as an RF cartridge. These and other sensor configurations are incorporated herein by reference in their entirety in the filed Jun. 20, 2017, entitled "TECHNIQUES FOR ADAPTIVE CONTROL OF MOTOR VELOCITY OF A SURGICAL STAPLING AND CUTTING INSTRUMENT," Commonly owned US patent application Ser. No. 15/628,175.

The position, movement, displacement, and/or translation of a linear displacement member such as I-beam 764 can be measured by an absolute positioning system, sensor arrangement, and position sensor represented as position sensor 784 . Since I-beam 764 is coupled to a longitudinally movable drive member, the position of I-beam 764 can be determined by measuring the position of the longitudinally movable drive member using position sensor 784 . can be done. Accordingly, in the discussion below, position, displacement, and/or translation of I-beam 764 may be accomplished by position sensor 784 as described herein. Control circuitry 760 may be programmed to control translation of a displacement member such as I-beam 764 as described in the present invention. In some embodiments, the control circuit 760 commands one or more microcontrollers, microprocessors, or processors or processors to control the displacement member, e.g., I-beam 764, in the manner described. Other suitable processors may be provided for execution. In one aspect, timer/counter 781 provides an output signal, such as elapsed time or a digital count, to control circuit 760 to correlate the position of I-beam 764 as determined by position sensor 784 with the output of timer/counter 781. Control circuit 760 can then determine the position of I-beam 764 at a particular time (t) relative to the starting position. Timer/counter 781 may be configured to measure elapsed time, count external events, or time external events.

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

Motor 754 may receive power from energy source 762 . Energy source 762 may be or include a battery, supercapacitor, or any other suitable energy source. Motor 754 may be mechanically coupled to I-beam 764 via transmission 756 . Transmission 756 may include one or more gears or other coupling components for coupling motor 754 to I-beam 764 . A position sensor 784 may sense the position of the I-beam 764 . Position sensor 784 may be or include any type of sensor capable of generating position data indicative of the position of I-beam 764 . In some examples, position sensor 784 may include an encoder configured to provide a series of pulses to control circuit 760 as I-beam 764 translates distally and proximally. Control circuitry 760 may track the pulses to determine the position of I-beam 764 . Other suitable position sensors may be used including, for example, proximity sensors. Other types of position sensors may provide other signals indicative of I-beam 764 movement. Also, in some implementations, the position sensor 784 may be omitted. If motor 754 is a stepper motor, control circuit 760 may track the position of I-beam 764 by summing the number and direction of steps the motor is commanded to take. The position sensor 784 may be located within the end effector 792 or any other portion of the instrument.

Control circuitry 760 may communicate with one or more sensors 788 . A sensor 788 may be positioned on the end effector 792 and adapted to work with the surgical instrument 790 to measure various derived parameters such as gap distance vs. time, tissue compression vs. time, and anvil strain vs. time. . Sensors 788 may include one or more of magnetic sensors, magnetic field sensors, strain gauges, pressure sensors, force sensors, inductive sensors such as eddy current sensors, resistive sensors, capacitive 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 one or more sensors 788 may comprise strain gauges, such as micro strain gauges, configured to measure the amount of strain in the anvil 766 during gripping conditions. A strain gauge provides an electrical signal whose amplitude varies with the amount of strain. Sensor 788 may comprise a pressure sensor configured to detect pressure caused by the presence of compressed tissue between anvil 766 and staple cartridge 768 . Sensor 788 may be configured to detect the impedance of a portion of tissue located between anvil 766 and staple cartridge 768 indicative of the thickness and/or integrity of the tissue located between them.

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

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

An RF energy source 794 is coupled to the end effector 792 and applied to the RF cartridge 796 when the RF cartridge 796 is loaded into the end effector 792 in place of the staple cartridge 768 . Control circuitry 760 controls the delivery of RF energy to RF cartridge 796 .

Further details can be found in U.S. Patent Application No. 15, entitled "SURGICAL SYSTEM COUPLABLE WITH STAPLE CARTRIDGE AND RADIO FREQUENCY CARTRIDGE, AND METHOD OF USING SAME," filed June 28, 2017, which is incorporated herein by reference in its entirety. /636,096.

FIG. 20 shows a stroke length graph 20740 showing how the control system can modify the stroke length of the closure tube assembly based on the articulation angle θ. Such stroke length modification is the corrected stroke length (e.g., y (defined along the axis). The corrected stroke length defines the length of distal movement of the closure tube assembly to close the end effector jaws, which is dependent on the articulation angle θ. It also prevents the closure tube assembly from moving excessively and causing damage to the surgical instrument.

For example, as shown in stroke length graph 20740, the stroke length of the closure tube assembly is approximately 0.250 inches when the end effector is not articulated, and the articulation angle θ is approximately 60 inches. degrees, the corrected stroke length is approximately 0.242 inches. Such measurements are provided by way of example only and may include any of various angles and corresponding stroke lengths and corrected stroke lengths without departing from the scope of this disclosure. can. Furthermore, the relationship between the joint motion angle θ and the corrected stroke length is non-linear, and as the joint motion angle increases, the rate at which the corrected stroke length decreases also increases. For example, the reduction in stroke length after correction for joint motion between 45 degrees and 60 degrees is greater than the reduction in stroke length after correction for joint motion between 0 degrees and 15 degrees. In this approach, the control system adjusts the length of the stroke based on the articulation angle θ to limit damage to the surgical device (e.g., jamming the distal end of the closure tube assembly in a distal position). Although prevented, the distal obturator can still be advanced during articulation, thereby at least partially closing the jaws.

FIG. 21 shows a closure tube assembly positioning graph 20750 showing one manner in which the control system modifies the longitudinal position of the closure tube assembly based on the articulation angle θ. Such modification of the longitudinal position of the closure tube assembly causes the closure tube assembly to be articulated by an articulation angle θ ( defined along the x-axis). The correct distance that the closure tube assembly is retracted proximally prevents distal advancement of the distal closure tube, thereby maintaining the jaws in an open position during articulation. By retracting the closure tube assembly proximally a compensating distance during articulation, the closure tube assembly is stroked starting from a proximally retracted position to close the jaws when the closure assembly is actuated. can travel the length of

For example, as shown in closure tube assembly positioning graph 20750, the corrected distance is zero when the end effector is not articulated, and the corrected distance is about 0.0 when the articulation angle θ is about 60 degrees. 008 inches. In this example, the closure tube assembly is retracted by a correction distance of 0.008 inches during articulation. Thus, to close the jaws, the closure tube assembly can be advanced the length of stroke starting from this retracted position. Such measurements are provided for example purposes only, and may include any of a variety of angles and corresponding correction distances without departing from the scope of the present disclosure. As shown in FIG. 21, the relationship between the joint motion angle θ and the correction distance is nonlinear, and as the joint motion angle θ increases, the ratio of the lengthening of the correction distance also increases. For example, the increase in correction distance from 45 degrees to 60 degrees is greater than the increase in correction distance from zero degrees to 15 degrees.

When grasping patient tissue, the force exerted through a grasping device (eg, a linear stapler) can reach unacceptably high levels. For example, if a constant closing velocity is employed, the force may become large enough to cause excessive trauma to the grasped tissue, causing deformation of the grasping device, resulting in Acceptable tissue spacing may not be maintained across the stapling path. FIG. 22 illustrates power applied to tissue during compression with a constant anvil closing rate (i.e., not utilizing controlled tissue compression (CTC)) and power applied during compression with a variable anvil closing rate (i.e., with CTC). Fig. 3 is a graph showing power applied to tissue; The closure rate may be adjusted to control tissue compression such that the power applied to the tissue remains constant over a portion of the compression. The peak power delivered to tissue according to FIG. 22 is much lower when variable anvil closure speed is utilized. Based on the applied power, the force exerted by the surgical device (a force-related or force-proportional parameter) can be calculated. Power in this regard is such that when a force exerted through a surgical device, such as the jaws of a linear stapler, causes the jaws to spread out and are in a fully closed position, the tissue gaps are closed for stapling. It may be limited to not exceed a yield force or pressure that is no longer within an acceptable range along the entire length. For example, the jaws should be parallel or close enough so that the tissue gap remains within an acceptable or target range for all staple locations along the length of the jaws. Further, limiting the power exerted avoids or at least minimizes trauma or damage to tissue.

In FIG. 22, the total energy exerted in the method without CTC is the same as the total energy exerted in the method with CTC, i.e. the area under the power curve in FIG. 22 is the same or substantially are the same. However, the difference in the power profile utilized is quite large as the peak power is much lower in the CTC example than in the CTC example.

Power limiting is achieved in embodiments using CTC by slowing the closing speed as indicated by line 20760 . Note that the compression time B' is longer than the closing time B. As shown in FIG. 22, devices and methods that provide a constant closure rate (i.e., without CTC) have the same 1 mm tissue gap as devices and methods that provide a variable closure rate (i.e., with CTC). Achieving the same 50 lb compression force. Devices and methods that provide a constant closure rate can achieve the desired compressive force in the tissue gap in a shorter period of time compared to devices and methods that use variable closure rates, which is shown in FIG. will result in a spike in tissue applied power, as shown in . In contrast, the exemplary embodiment shown in CTC slows down the closing speed and limits the amount of power applied to the tissue from exceeding a certain level. By limiting the power applied to the tissue, tissue trauma can be minimized for systems and methods that do not use CTCs.

FIG. 22 and additional examples can be found in DEVICE AND METHOD FOR CONTROLLING COMPRESSION OF TISSUE, filed June 1, 2012, published Aug. 6, 2013, the disclosure of which is incorporated herein by reference in its entirety. Further described in US Pat. No. 8,499,992.

In some aspects, the control system assists the control system to determine the position of the E-beam and/or the articulation of the firing shaft and appropriately control the at least one motor based on such determinations. Multiple predefined force thresholds may be included. For example, the force thresholds can vary according to the length of travel of a firing bar configured to translate the firing shaft, such force thresholds being one or more parameters in communication with the control system. can be compared with the measured torsional force of the motor. A comparison of the measured torsional force to a force threshold can provide a method that the control system can rely on to determine the position of the E-beam and/or the articulation of the end effector. This allows the control system to appropriately control (e.g., reduce or deactivate torsional loads) one or more motors to ensure proper firing of the firing assembly and articulation of the end effector. as well as prevent damage to the system.

FIG. 23 shows a force versus displacement graph 20800 that includes the measured force in section A related to the measured displacement in section B. FIG. Sections A and B both have x-axes that define time (eg, seconds). The y-axis of section B defines the travel displacement (eg, in millimeters) of the firing rod, and the y-axis of section A defines the force applied to the firing bar thereby advancing the firing shaft. As shown in Section A, movement of the firing bar within a first articulation range 20902 (eg, approximately the first 12 mm of movement) articulates the end effector. For example, at the 12 mm displacement position, the end effector is fully articulated to the right and is mechanically unable to articulate further. As a result of full articulation, the torsional force on the motor increases and the control system can sense an articulation force peak 20802 above the predefined articulation threshold 20804 as shown in Section A. The control system can include two or more predefined joint motion thresholds 20804 for sensing two or more maximum joint motion directions (eg, left joint motion and right joint motion). After the control system detects a joint motion force peak 20802 that exceeds a predetermined joint motion threshold 20804, the control system may reduce or stop motor activation, thereby at least protecting the motor from damage.

After the firing bar is advanced beyond the range of articulation 20902, a shift mechanism within the surgical stapler can cause distal movement of the firing shaft by moving the firing bar further distally. For example, as shown in Section B, about 12 mm to 70 mm of translation displacement can advance the E-beam along firing stroke 20904 and cut tissue trapped between the jaws, Other travel lengths are within the scope of this disclosure. In this example, the E-beam maximum firing stroke position 20906 occurs at 70 mm of travel. At this point, the E-beam or knife abuts the distal end of the cartridge or jaw, thereby increasing the torsional force on the motor and causing the knife travel force peak 20806 as shown in Section A to be sensed by the control system. . As shown in Section A, the control system includes a motor threshold 20808 and a knife movement threshold 20810 that diverges from the motor threshold 20808 and decreases (eg, non-linearly) as the E-beam approaches the maximum firing stroke position 20906. be able to.

The control system applies the sensed motor torsional force during at least the last portion 20907 of the distal travel of the E-beam (eg, the last ten percent of the firing stroke 904) before reaching the maximum firing stroke position 20906. can be configured to monitor. While monitoring along such a final portion 20907 of the distal travel, the control system can reduce torsional forces on the motors, thereby reducing the load on the E-beam. This can prevent damage to a surgical stapler containing the E-beam by reducing the load on the E-beam as it approaches the maximum firing stroke position 20906, thereby preventing damage to the cartridge or jaws. E-beam impact on the posterior tip is reduced. As discussed above, such an impact causes a knife travel force peak 20806 that may exceed the knife travel threshold 20810, but will not exceed the motor threshold 20808 and thus will not damage the motor. . Therefore, the control system stops the motor operation before the knife travel force peak 20806 exceeds the knife travel threshold 20810 and the knife travel force peak 20806 exceeds the motor threshold 20808, thereby protecting the motor from damage. Additionally, increasing the knife movement threshold 20810 reduction prevents the control system from inferring in advance that the E-beam has reached the maximum firing stroke position 20906 .

After the control system detects a knife movement force peak 20806 that exceeds the knife movement threshold 20810, the control system can ascertain the position of the E-beam (eg, 70 mm displacement and/or the end of the firing stroke 20904), such that The firing bar can be retracted based on knowing the displacement position to reset the E-beam at the most proximal position 20908 (eg, 0 mm displacement). At the most proximal position 20908, a knife retraction force peak 20812 exceeding a predefined knife retraction threshold 20814 as shown in Section A can be sensed by the control system. At this point, the control system can recalibrate if necessary, and subsequent advancement of the firing rod in the distal direction (e.g., approximately 12 mm in length) will move the shifter from the firing bar to the E-beam. The position of the E-beam can be related to being in the home position for disengagement. Once disengaged, movement of the firing bar through the range of articulation 20902 again causes articulation of the end effector.

Accordingly, the control system controls the movement of the firing bar and compares such sensed torsional forces to a plurality of thresholds to determine the position of the E-beam or the articulation angle of the end effector, thereby activating the motor. Appropriate controls can be used to prevent damage to the motor, and can also verify firing bar and/or E-beam positioning.

As noted above, a tissue contact sensor or pressure sensor determines when the jaw members first contact tissue "T". This allows the surgeon to determine the initial thickness of tissue "T" and/or the thickness of tissue "T" prior to grasping. In any of the aspects of the surgical instrument described above, as shown in FIG. 24, contact of the jaw members with tissue "T" is achieved by a pair of opposing plates "P1, P2" provided on the jaw members. closes the otherwise open sense circuit "SC" by establishing contact with . The contact sensor may also include a force sensitive transducer that determines the amount of force applied to the sensor, which can be assumed to be the same as the amount of force applied to tissue "T". . After such force is applied to the tissue, it may be translated into an amount of tissue compression. The force sensor measures the amount of compression experienced by the tissue and provides the surgeon with information regarding the force applied to the tissue "T". Excessive tissue compression can adversely affect the tissue "T" being operated on. For example, excessive compression of the tissue "T" can lead to tissue necrosis and, in certain procedures, to staple line failure. Information regarding the pressure applied to tissue "T" allows the surgeon to better determine that excessive pressure is not being applied to tissue "T".

Any contact sensor disclosed herein, including but not limited to, is located on the inner surface of the jaws that closes an otherwise open sensing circuit when in contact with tissue. may include electrical contacts. The contact sensor may also include a force sensitive transducer that detects when the tissue being grasped resists compression. Force transducers include, but are not limited to, piezoelectric elements, piezoresistive elements, metal film or semiconductor strain gauges, inductive pressure sensors, capacitive pressure sensors, and for driving wiper arms on resistive elements. Potentiometric transducers using Bourdon tubes, capsules or bellows can be mentioned.

In one aspect, any one of the aforementioned surgical instruments may include one or more piezoelectric elements for detecting changes in pressure generated on the jaw members. Piezoelectric devices are bi-directional transducers that convert stress into electrical potential. The elements may consist of metallized quartz or ceramics. During operation, when stress is applied to the crystal, the charge distribution in the material changes, generating a voltage across the material. A piezoelectric element may be used to indicate the amount of pressure exerted on tissue "T" after either one or both of the jaw members are in contact with tissue "T" and contact is established.

In one aspect, any one of the foregoing surgical instruments may include or comprise one or more metal strain gauges disposed within or on a portion of its body. may Metallic strain gauges work on the principle that the resistance of a material depends on its length, width and thickness. Therefore, when the material of a metal strain gauge is strained, the resistance of the material changes. Thus, a resistor built into a circuit made of this material converts strain into a change in electrical signal. Desirably, the strain gauge may be positioned on the surgical instrument such that pressure applied to tissue affects the strain gauge.

Alternatively, in another aspect, one or more semiconductor strain gauges may be used in a manner similar to the metallic strain gauges described above, but with a different mode of conversion. During operation, the resistance of the material changes as the crystal lattice structure of the semiconductor strain gauge deforms as a result of the applied stress. The observed phenomenon is sometimes referred to as the "piezoresistive effect".

In yet another aspect, any one of the aforementioned surgical instruments may include one or more inductive pressure sensors to convert pressure or force into motion of the inductive elements relative to each other. may or may have it. Movement of the inductive elements relative to each other changes the overall inductance or inductive coupling. A capacitive pressure transducer likewise converts pressure or force into movement of a capacitive element that changes the overall capacitance.

In yet another aspect, any one of the foregoing surgical instruments includes one or two surgical instruments for converting pressure or force into motion of a capacitive element that changes overall capacitance. It may include or comprise any of the above capacitive pressure transducers.

In one aspect, any one of the aforementioned surgical instruments may include or comprise one or more mechanical pressure transducers for converting pressure or force into motion. good too. In use, movement of the mechanical element is used to deflect the pointer or dial on the gauge. Movement of this pointer or dial can represent the pressure or force applied to the tissue "T". Examples of mechanical elements include, but are not limited to, Bourdon tubes, capsules or bellows. By way of example, mechanical elements may be combined with other measuring and/or sensing elements such as potentiometer pressure transducers. In this embodiment the mechanical element is coupled with the wiper on the variable resistor. In use, the pressure or force is converted into mechanical motion that deflects the wiper on the potentiometer to reflect the applied pressure or force, thereby changing resistance and reflecting the applied pressure or force. good too.

The combination of the above aspects, particularly the gap and tissue contact sensors, provides feedback and/or real-time information to the surgeon regarding the condition of the surgical site and/or target tissue "T". For example, information regarding the initial thickness of tissue "T" can guide the surgeon in selecting the appropriate staple size, and information regarding the grasped thickness of tissue "T" can guide the selected The surgeon can be informed if the staples are formed properly and the amount of compression or strain on the tissue "T" can be determined using information regarding the initial thickness of the tissue "T" and the grasped thickness. may be determined, and information related to strain for tissue "T" may also be used to avoid excessive strain values and/or stapling overly strained tissue.

Additionally, a force sensor may be used to provide the surgeon with the amount of pressure being applied to the tissue. A surgeon may use this information to avoid applying excessive pressure to tissue "T" that has experienced excessive strain.

24 and additional examples, filed June 27, 2011, entitled "SURGICAL INSTRUMENT EMPLOYING SENSORS," published May 5, 2012, the entire disclosure of which is incorporated herein by reference. No. 8,181,839, which is hereby incorporated by reference.

Specific aspects are shown and described to provide an understanding of the structure, function, manufacture, and use of the disclosed apparatus and methods. Features shown or described in one embodiment may be combined with features of other embodiments, and modifications and variations are within the scope of this disclosure.

The terms "proximal" and "distal" refer to the clinician manipulating the handle of the surgical instrument, "proximal" referring to the portion closer to the clinician and "distal" referring to the portion closer to the clinician. Point to the far part. Because surgical instruments can be used in a variety of orientations and positions, for convenience the spatial terms "vertical," "horizontal," "top," and "bottom" used with respect to the drawings are defined and/or absolute. not intended to be

Exemplary devices and methods are provided for performing laparoscopic and minimally invasive surgical procedures. However, such devices and methods can be used in other surgical procedures and applications, including, for example, open surgery. Surgical instruments may be inserted through natural orifices or through incisions or punctures made in tissue. The working or end effector portion of the instrument can be inserted directly into the body or through an access device having a working channel through which the end effector and elongated shaft of the surgical instrument can be advanced. can.

25-28 depict a motorized cutting and fastening surgical instrument 150010 that may or may not be reused. In the illustrated example, the surgical instrument 150010 includes a housing 150012 with a handle assembly 150014 configured to be grasped, manipulated and actuated by a clinician. Housing 150012 is configured to operably attach to interchangeable shaft assembly 150200 to which end effector 150300 configured to perform one or more surgical tasks or procedures is operably coupled. there is According to the present disclosure, various forms of interchangeable shaft assemblies may be effectively used in conjunction with robotic surgical systems. Accordingly, the term "housing" encloses or operably supports at least one drive system configured to generate and apply at least one control motion that can be used to actuate the interchangeable shaft assembly. , a housing or similar portion of a robotic system. The term "frame" may refer to a portion of a handheld surgical instrument. The term "frame" may also refer to a portion of a robotic surgical instrument and/or a robotic system that may be used to operatively control a surgical instrument. Interchangeable shaft assemblies are used in various robots disclosed in U.S. Pat. No. 9,072,535, entitled "SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STABLE DEPLOYMENT ARRANGEMENTS," which is incorporated herein by reference in its entirety. It may be used with systems, devices, components, and methods.

FIG. 25 is a perspective view of a surgical instrument 150010 having an operably coupled interchangeable shaft assembly 150200, according to at least one aspect of the present disclosure. Housing 150012 includes an end effector 150300 comprising a surgical cutting and fastening device configured to operably support surgical staple cartridge 150304 therein. The housing 150012 includes an end effector adapted to support various sizes and types of staple cartridges and for use in connection with interchangeable shaft assemblies having various shaft lengths, sizes and types. may be configured to The housing 150012 is an end effector configuration adapted for use with other motions and other forms of energy such as radio frequency (RF) energy, ultrasonic energy and/or motion in connection with various surgical applications and procedures. may be used with a variety of interchangeable shaft assemblies, including assemblies configured to accommodate End effectors, shaft assemblies, handles, surgical instruments, and/or surgical instrument systems can utilize any suitable fasteners to fasten tissue. For example, a fastener cartridge comprising a plurality of fasteners removably stored therein may be removably inserted and/or attached to the end effector of the shaft assembly.

The handle assembly 150014 may comprise a pair of interconnectable handle housing segments 150016, 150018 that may be interconnected with screws, snap mechanisms, adhesives, or the like. Handle housing segments 150016, 150018 cooperate to form a pistol grip portion 150019 that can be grasped and manipulated by a clinician. The handle assembly 150014 operatively supports a plurality of drive systems configured to generate and apply controlled motion to corresponding portions of interchangeable shaft assemblies operatively attached to the handle assembly. ing. A display may be provided below cover 150045 .

FIG. 26 is an illustration of an assembly shown in an exploded view of a portion of the surgical instrument 150010 of FIG. 25, according to at least one aspect of the present disclosure. The handle assembly 150014 may include a frame 150020 that operably supports multiple drive systems. The frame 150020 can operably support a “first” or closing drive system 150030 , which can apply closing and opening motions to the interchangeable shaft assembly 150200 . Closure drive system 150030 may include an actuator such as closure trigger 150032 pivotally supported by frame 150020 . Closure trigger 150032 is pivotally coupled to handle assembly 150014 by pivot pin 150033 to allow closure trigger 150032 to be manipulated by a clinician. As the clinician grasps the pistol grip portion 150019 of the handle assembly 150014, the closure trigger 150032 moves from the starting or "unactuated" position to the "actuated" position, more specifically the fully compressed or It can be pivoted to a fully actuated position.

The handle assembly 150014 and frame 150020 may operatively support a firing drive system 150080 configured to apply firing motion to corresponding portions of the interchangeable shaft assemblies attached thereto. Firing drive system 150080 may utilize an electric motor 150082 located in pistol grip portion 150019 of handle assembly 150014 . Electric motor 150082 may be, for example, a brushed DC motor having a maximum rotational speed of approximately 25,000 RPM. In other configurations, the motor may include a brushless motor, cordless motor, synchronous motor, stepper motor, or any other suitable electric motor. Electric motor 150082 may be powered by power supply 150090 which may comprise a removable power pack 150092 . A removable power pack 150092 may comprise a proximal housing portion 150094 configured to attach to a distal housing portion 150096 . Proximal housing portion 150094 and distal housing portion 150096 are configured to operatively support a plurality of batteries 150098 therein. Batteries 150098 may each include, for example, lithium ion (LI) or other suitable batteries. Distal housing portion 150096 is configured to be removably and operably attached to control circuit board 150100 , which is operably coupled to electric motor 150082 . Several batteries 150098 connected in series can power the surgical instrument 150010 . Power source 150090 may be replaceable and/or rechargeable. Display 150043 located below cover 150045 is electrically coupled to control circuit board 150100 . Cover 150045 may be removed to expose display 150043 .

The electric motor 150082 is a rotatable shaft (not shown) operably associated with a gear reducer assembly 150084 mounted in meshing engagement with a set or rack of drive teeth 150122 on a longitudinally movable drive member 150120. ). A longitudinally movable drive member 150120 has a rack of drive teeth 150122 formed thereon for meshing engagement with a corresponding drive gear 150086 of the gear reducer assembly 150084 .

In use, the voltage polarity provided by the power supply 150090 may cause the electric motor 150082 to operate in a clockwise direction, whereas the voltage polarity applied by the battery to the electric motor 150082 may cause the electric motor 150082 to operate in a counterclockwise direction. can also be flipped to When electric motor 150082 is rotated in one direction, longitudinally movable drive member 150120 will be axially driven in distal direction "DD". When the electric motor 150082 is driven in the opposite rotational direction, the longitudinally movable drive member 150120 will be driven axially in the proximal direction "PD". Handle assembly 150014 may include a switch that may be configured to reverse the polarity applied to electric motor 150082 by power supply 150090 . The handle assembly 150014 may include sensors configured to detect the position of the longitudinally movable drive member 150120 and/or the direction in which the longitudinally movable drive member 150120 is moved.

Actuation of electric motor 150082 may be controlled by firing trigger 150130 pivotally supported on handle assembly 150014 . Firing trigger 150130 may be pivoted between an unactuated position and an actuated position.

Returning to FIG. 25, replaceable shaft assembly 150200 includes an end effector 150300 comprising an elongated channel 150302 configured to operatively support surgical staple cartridge 150304 therein. End effector 150300 may include an anvil 150306 pivotally supported relative to elongated channel 150302 . Interchangeable shaft assembly 150200 may include articulation joint 150270 . The configuration and operation of the end effector 150300 and articulation joint 150270 are described in U.S. Patent Application Publication No. 2014/0263541, entitled "ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK," which is incorporated herein by reference in its entirety. ing. Interchangeable shaft assembly 150200 may include a proximal housing or nozzle 150201 comprised of nozzle portions 150202,150203. Interchangeable shaft assembly 150200 may include a closure tube 150260 extending along shaft axis SA, which may be utilized to close and/or open anvil 150306 of end effector 150300.

Returning to FIG. 25, the closure tube 150260 is moved distally (direction "DD ”) to close anvil 150306 . Anvil 150306 is opened by translating closure tube 150260 proximally. In the open position of the anvil, the closure tube 150260 is moved to its proximal position.

FIG. 27 is another exploded assembly view of a portion of the interchangeable shaft assembly 150200, in accordance with at least one aspect of the present disclosure. Interchangeable shaft assembly 150200 may include a firing member 150220 supported for axial movement within spine 150210 . Firing member 150220 includes an intermediate firing shaft 150222 configured to attach to a distal cutting portion or knife bar 150280 . Firing member 150220 is sometimes referred to as a "second shaft" or "second shaft assembly." Intermediate firing shaft 150222 may include a longitudinal slot 150223 at its distal end configured to receive tab 150284 at proximal end 150282 of knife bar 150280 . Longitudinal slot 150223 and proximal end 150282 may be configured to allow relative movement therebetween and may include slip joint 150286 . The slip joint 150286 may allow the intermediate firing shaft 150222 of the firing member 150220 to articulate the end effector 150300 about the articulation joint 150270 without moving, or at least substantially not moving, the knife bar 150280 . Once end effector 150300 is properly oriented, intermediate firing shaft 150222 is advanced distally to advance knife bar 150280 into channel 150302 until the proximal sidewall of longitudinal slot 150223 contacts tab 150284 . A positioned staple cartridge can be fired. Spine 150210 has an elongated opening or window 150213 therein to facilitate assembly and insertion of intermediate firing shaft 150222 into spine 150210 . Once intermediate firing shaft 150222 is inserted therein, top frame segment 150215 can be engaged with shaft frame 150212 to enclose intermediate firing shaft 150222 and knife bar 150280 therein. The operation of firing member 150220 can be found in US Patent Application Publication No. 2014/0263541. Spine 150210 may be configured to slidably support firing member 150220 and a closure tube 150260 extending around spine 150210 . Spine 150210 may slidably support articulation driver 150230 .

Interchangeable shaft assembly 150200 may include a clutch assembly 150400 configured to selectively and removably couple articulation driver 150230 to firing member 150220 . Clutch assembly 150400 includes a locking collar or locking sleeve 150402 positioned about firing member 150220 in an engaged position where locking sleeve 150402 couples articulation driver 150230 to firing member 150220; Articulation driver 150230 can be rotated between a disengaged position in which articulation driver 150230 is not operably coupled to firing member 150220 . When locking sleeve 150402 is in its engaged position, distal movement of firing member 150220 can cause articulation driver 150230 to move distally and, correspondingly, Movement in the proximal direction can cause the articulation driver 150230 to move in the proximal direction. When locking sleeve 150402 is in its disengaged position, movement of firing member 150220 is not transmitted to articulation driver 150230, thereby moving firing member 150220 independently of articulation driver 150230. can be made The nozzle 150201 can be used to operatively engage and disengage the articulation drive system and the firing drive system in various manners described in US Patent Application Publication No. 2014/0263541. can.

The replaceable shaft assembly 150200 can include a slip ring assembly 150600 that, for example, conducts power to and/or from the end effector 150300 and/or extends to the end effector 150300. /or can be configured to communicate signals from the end effector 150300; The slip ring assembly 150600 can comprise a proximal connector flange 150604 and a distal connector flange 150601 disposed within slots defined in the nozzle portions 150202,150203. The proximal connector flange 150604 can comprise a first surface and the distal connector flange 150601 can have a second surface positioned adjacent the first surface and movable relative to the first surface. be prepared. Distal connector flange 150601 can rotate relative to proximal connector flange 150604 about shaft axis SA-SA (FIG. 25). The proximal connector flange 150604 can comprise a plurality of concentric, or at least substantially concentric, conductors 150602 defined on a first surface thereof. Connector 150607 may be attached to the proximal side of distal connector flange 150601 and may have a plurality of contacts, each contact corresponding to and making electrical contact with one of conductors 150602. are doing. Such a configuration allows proximal connector flange 150604 and distal connector flange 150601 to rotate relative to each other while maintaining electrical contact therebetween. The proximal connector flange 150604 can include, for example, an electrical connector 150606 that allows the conductors 150602 to communicate with the shaft circuit board. In at least one instance, a wiring harness comprising multiple conductors may extend between the electrical connector 150606 and the shaft circuit board. The electrical connector 150606 may extend proximally through a connector opening defined in the chassis mounting flange. US Patent Application Publication No. 2014/0263551 entitled "STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM" is incorporated herein by reference in its entirety. US Patent Application Publication No. 2014/0263552 entitled "STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM" is hereby incorporated by reference in its entirety. Further details regarding the slip ring assembly 150600 may be found in US Patent Application Publication No. 2014/0263541.

Interchangeable shaft assembly 150200 may include a proximal portion that is fixedly attached to handle assembly 150014 and a distal portion that is rotatable about its longitudinal axis. The rotatable distal shaft portion can be rotated about the slip ring assembly 150600 relative to the proximal portion. A distal connector flange 150601 of the slip ring assembly 150600 can be positioned within the rotatable distal shaft portion.

28 is an exploded view of one aspect of the end effector 150300 of the surgical instrument 150010 of FIG. 25, in accordance with at least one aspect of the present disclosure. End effector 150300 may include an anvil 150306 and a surgical staple cartridge 150304 . Anvil 150306 may be coupled to elongated channel 150302 . Anvil 150306 is pivoted from an open position to a closed position relative to elongate channel 150302 and surgical staple cartridge 150304 by defining opening 150199 in elongated channel 150302 to receive pin 150152 extending from anvil 150306. can make it possible. Firing bar 150172 is configured to longitudinally translate into end effector 150300 . Firing bar 150172 may be constructed from one solid piece or may comprise laminated material comprising a stack of steel plates. Firing bar 150172 includes an I-beam 150178 and a cutting edge 150182 at its distal end. Attaching the distally projecting end of firing bar 150172 to I-beam 150178 spaces the anvil 150306 from surgical staple cartridge 150304 positioned within elongated channel 150302 when anvil 150306 is in the closed position. 150306 can be assisted. I-beam 150178 may include a sharp cutting edge 150182 for cutting tissue as I-beam 150178 is distally advanced by firing bar 150172 . In operation, I-beam 150178 may or may fire surgical staple cartridge 150304 . The surgical staple cartridge 150304 can include a molded cartridge body 150194 that retains a plurality of staples 150191 mounted on a staple driver 150192 within each upwardly opening staple recess 150195 . Wedge sled 150190 is driven distally by I-beam 150178 to slide over cartridge tray 150196 of surgical staple cartridge 150304 . Wedge sled 150190 cams staple driver 150192 upward to force staple 150191 into deforming contact with anvil 150306 while cutting edge 150182 of I-beam 150178 cuts the gripped tissue.

I-beam 150178 may include a top pin 150180 that engages anvil 150306 during firing. The I-beam 150178 may include a central pin 150184 and a bottom foot 150186 for engaging cartridge body 150194 , cartridge tray 150196 , and a portion of elongated channel 150302 . Slots 150193 defined within cartridge body 150194, longitudinal slots 150197 defined within cartridge tray 150196, and longitudinal slots 150197 defined within elongate channel 150302 when surgical staple cartridge 150304 is disposed within elongated channel 150302. It can be aligned with slot 150189 . In use, I-beam 150178 can slide through aligned longitudinal slots 150193, 150197, and 150189, and as shown in FIG. It can engage a groove running along the bottom surface of the elongated channel 150302 along its length, and the central pin 150184 engages the top surface of the cartridge tray 150196 along the length of the longitudinal slot 150197. and the upper pin 150180 can engage the anvil 150306 . I-beam 150178 as firing bar 150172 advances distally to fire staples from surgical staple cartridge 150304 and/or dissect tissue captured between anvil 150306 and surgical staple cartridge 150304 may space or limit relative movement between anvil 150306 and surgical staple cartridge 150304 . Firing bar 150172 and I-beam 150178 are retracted proximally, thereby opening anvil 150306 and allowing the two stapled and severed tissue portions to be released.

29A and 29B are block diagrams of control circuitry 150700 of surgical instrument 150010 of FIG. 25 spanning two figures, according to at least one aspect of the present disclosure. Referring primarily to FIGS. 29A and 29B, handle assembly 150702 may include motor 150714, which may be controlled by motor driver 150715 and utilized by the firing system of surgical instrument 150010. can do. In various forms, motor 150714 may be a brushed DC drive motor having a maximum rotational speed of approximately 25,000 RPM. In alternative configurations, motor 150714 may include a brushless motor, cordless motor, synchronous motor, stepper motor, or any other suitable electric motor. Motor driver 150715 may comprise, for example, an H-bridge driver including field effect transistor (FET) 150719 . The motor 150714 may be powered by a power supply assembly 150706 releasably attached to the handle assembly 150200 for supplying control power to the surgical instrument 150010 . The power assembly 150706 may comprise multiple batteries connected in series that may be used as a power source to power the surgical instrument 150010 . Under certain circumstances, the battery cells of power assembly 150706 may be replaceable and/or rechargeable. In at least one example, the battery cells may be lithium ion batteries that may be separately connectable to the power supply assembly 150706 .

The shaft assembly 150704 includes a shaft assembly controller 150722 that can communicate with the safety controller and power management controller 150716 via an interface while the shaft assembly 150704 and power supply assembly 150706 are coupled to the handle assembly 150702. be able to. For example, the interface may be compliant to allow electrical communication between shaft assembly controller 150722 and power management controller 150716 while shaft assembly 150704 and power supply assembly 150706 are coupled to handle assembly 150702 . A first interface portion 150725, which may include one or more electrical connectors for interlocking engagement with a shaft assembly electrical connector and one for interlocking engagement with a corresponding power assembly electrical connector. and a second interface portion 150727 which may include one or more electrical connectors. One or more communication signals can be sent via the interface to communicate one or more power requirements of the attached replaceable shaft assembly 150704 to the power management controller 150716. Accordingly, the power management controller may modulate the power output of the battery of power supply assembly 150706 according to the power requirements of the attached shaft assembly 150704, as described in further detail below. The connector is actuated after mechanical interlocking engagement of handle assembly 150702 to shaft assembly 150704 and/or power assembly 150706 to provide electrical communication between shaft assembly controller 150722 and power management controller 150716. Enabling has a switch.

The interface provides one or more communication signals between the power management controller 150716 and the shaft assembly controller 150722, for example, by routing the communication signals through the main controller 150717 in the handle assembly 150702. can facilitate the transmission of Under other circumstances, the interface is between power management controller 150716 and shaft assembly controller 150722 through handle assembly 150702 while shaft assembly 150704 and power supply assembly 150706 are coupled to handle assembly 150702. in some cases to facilitate direct line communication.

Main controller 150717 may be any single-core or multi-core processor, such as that known by Texas Instruments under the trade name ARM Cortex. In one aspect, the main controller 150717 has on-chip memory of 256 KB single-cycle flash memory or other non-volatile memory up to 40 MHz, for example, details of which are available in the product datasheet, improving performance beyond 40 MHz. 32 KB single-cycle serial random access memory (SRAM), internal read-only memory (ROM) with StellarisWare® software, 2 KB electrically erasable programmable read-only memory (EEPROM), 1 or two or more pulse width modulation (PWM) modules, one or more quadrature encoder input (QEI) analog, one or more 12-bit analog-to-digital converters with 12 analog input channels (ADC), LM4F230H5QR ARM Cortex-M4F processor core available from Texas Instruments.

The safety controller may be a safety controller platform comprising two controller-based families, such as the TMS570 and RM4x, also known as the Texas Instruments brand name Hercules ARM Cortex R4. Safety controllers may be configured specifically for IEC61508 and ISO26262 safety limit applications to provide advanced integrated safety mechanisms while offering scalable performance, connectivity, and memory options. good.

Power supply assembly 150706 may include power management circuitry, which may include power management controller 150716 , power modulator 150738 , and current sensing circuit 150736 . While the shaft assembly 150704 and power supply assembly 150706 are coupled to the handle assembly 150702, the power management circuitry may be configured to modulate the power output of the battery based on the power requirements of the shaft assembly 150704. The power management controller 150716 can be programmed to control the power modulator 150738 of the power output of the power supply assembly 150706 and utilizes the current sensing circuit 150736 to monitor the power output of the power supply assembly 150706 to Feedback regarding the power output of the battery can be provided to the power management controller 150716 so that the power management controller 150716 can adjust the power output of the power supply assembly 150706 to maintain the desired output. Power management controller 150716 and/or shaft assembly controller 150722 may each comprise one or more processors and/or memory units capable of storing a number of software modules.

Surgical instrument 150010 (FIGS. 25-28) may include output device 150742, which may include devices for providing sensory feedback to the user. Such devices may include, for example, visual feedback devices (eg, LCD display screens, LED indicators), audible feedback devices (eg, speakers, buzzers) or tactile feedback devices (eg, tactile actuators). Under certain circumstances, the output device 150742 may comprise a display 150743 that may be included in the handle assembly 150702. Shaft assembly controller 150722 and/or power management controller 150716 can provide feedback to a user of surgical instrument 150010 via output device 150742. The interface may be configured to connect shaft assembly controller 150722 and/or power management controller 150716 to output device 150742 . Output device 150742 may alternatively be integrated with power supply assembly 150706 . Under such circumstances, while shaft assembly 150704 is coupled to handle assembly 150702, communication between output device 150742 and shaft assembly controller 150722 may be accomplished via the interface.

Control circuitry 150700 comprises circuit segments configured to control operation of powered surgical instrument 150010 . The safety controller segment (segment 1) comprises a safety controller and a main controller 150717 segment (segment 2). The safety controller and/or main controller 150717 are configured to interact with one or more additional circuit segments such as an acceleration segment, display segment, shaft segment, encoder segment, motor segment, and power segment. there is Each of the circuit segments may be coupled to a safety controller and/or main controller 150717. Main controller 150717 is also coupled to the flash memory. Main controller 150717 also includes a serial communication interface. The main controller 150717 comprises multiple inputs coupled to, for example, one or more circuit segments, a battery, and/or multiple switches. The segmentation circuitry may be implemented by any suitable circuitry, such as, for example, a printed circuit board assembly (PCBA) within powered surgical instrument 150010 . The term processor, as used herein, means any microprocessor, processor, controller or controllers, or central processing unit (CPU) of a computer that combines the functions of a single integrated circuit or It should be understood to include other basic computing devices incorporated on several integrated circuits in . Main controller 150717 is a multi-purpose programmable device that accepts digital data as input, processes that data according to instructions stored in memory, and provides the results as output. This is an example of sequential digital logic since it has internal memory. Control circuitry 150700 may be configured to implement one or more processes described herein.

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

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

Shaft segment (Segment 5) is a control and/or replaceable shaft assembly for replaceable shaft assembly 150200 (FIGS. 25 and 27) coupled to surgical instrument 150010 (FIGS. 25-28). It includes one or more controls for the end effector 150300 coupled to 150200. The shaft segment includes a shaft connector configured to couple the main controller 150717 to the shaft PCBA. The shaft PCBA includes a low power microcontroller with ferroelectric random access memory (FRAM), articulation switches, shaft release Hall effect switches, and shaft PCBA EEPROM. The Shaft PCBA EEPROM contains one or more parameters, routines and/or programs specific to the replaceable shaft assembly 150200 and/or Shaft PCBA. Shaft PCBA may be coupled to interchangeable shaft assembly 150200 and/or may be integral with surgical instrument 150010 . In some examples, the shaft segment comprises a second shaft EEPROM. A second shaft EEPROM stores a plurality of algorithms, routines, parameters, and/or other data corresponding to one or more shaft assemblies 150200 and/or end effectors 150300 that may be associated with the powered surgical instrument 150010. including.

The position encoder segment (segment 6) comprises one or more magnetic angular rotary position encoders. One or more magnetic angular rotary position encoders may be incorporated into the motor 150714, interchangeable shaft assembly 150200 (FIGS. 25 and 27), and/or end effector 150300 of the surgical instrument 150010 (FIGS. 25-28). is configured to identify the rotational position of the In some examples, a magnetic angular rotary position encoder may be coupled to the safety controller and/or the main controller 150717.

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

Motor controller controls a first motor flag and a second motor flag to indicate the status and position of motor 150714 to main controller 150717 . The main controller 150717 provides pulse width modulated (PWM) high, PWM low, direction, sync and motor reset signals to the motor controller through buffers. The power segments are configured to provide segment voltages to each of the circuit segments.

The power segment (segment 8) comprises a battery coupled to the safety controller, main controller 150717, and additional circuit segments. The batteries are connected to the segmentation circuit by battery connectors and current sensors. A current sensor is configured to measure the total current drawn by the segmentation circuit. In some examples, one or more voltage converters are configured to provide predetermined voltage values to one or more circuit segments. For example, in some examples the segmentation circuit may comprise a 3.3V voltage converter and/or a 5V voltage converter. The boost converter is configured to provide a boost voltage up to a predetermined amount, eg, up to 13V. A boost converter is configured to provide additional voltage and/or current during power intensive operations to prevent brownouts or low power conditions.

A plurality of switches are coupled to the safety controller and/or main controller 150717 . The switches may be configured to control the operation of the segmented circuit, the surgical instrument 150010 (FIGS. 25-28), and/or indicate the status of the surgical instrument 150010. FIG. The emergency exit door switch and hall effect switch for emergency exit are configured to indicate the status of the emergency exit door. A plurality of articulation switches, such as, for example, a left articulation left switch, a left articulation right switch, a left articulation center switch, a right articulation left switch, a right articulation right switch, and a right articulation midswitch, are interchangeable shafts. It is configured to control articulation of assembly 150200 (FIGS. 25 and 27) and/or end effector 150300 (FIGS. 25 and 28). A left flip switch and a right flip switch are coupled to main controller 150717 . A left switch comprising a left articulation left switch, a left articulation right switch, a left articulation center switch, and a left flip switch is coupled to the main controller 150717 by a left flexible connector. A right switch comprising a right articulation left switch, a right articulation right switch, a right articulation center switch, and a right flip switch is coupled to the main controller 150717 by a right flexible connector. A firing switch, a release switch, and a shaft engagement switch are coupled to main controller 150717 .

Multiple switches may be implemented in any combination using any suitable mechanical, electromechanical, or solid state switches. For example, the switch may be a limit switch actuated by movement of a component associated with surgical instrument 150010 (FIGS. 25-28) or the presence of a subject. Such switches can be used to control various functions associated with surgical instrument 150010 . A limit switch is an electromechanical device consisting of an actuator in mechanical communication with a set of contacts. When an object contacts the actuator, the device manipulates the contact to make or break an electrical connection. Due to their ruggedness, ease of installation, and reliability of operation, limit switches are used in a wide variety of applications and environments. A limit switch can determine the presence, absence, passage, placement, and end of movement of an object. In other implementations, the switch is a solid-state switch that operates under the influence of a magnetic field, such as a Hall effect device, a magnetoresistive (MR) device, a giant magnetoresistive (GMR) device, a magnetometer, among others. may In other implementations, the switch may be a solid-state switch that operates under the influence of light, such as an optical sensor, an infrared sensor, an ultraviolet sensor, among others. Further, the switch may be a solid state device such as a transistor (eg, FET, junction FET, metal oxide semiconductor FET (MOSFET), bipolar, etc.). Other switches may include wireless switches, ultrasonic switches, accelerometers, inertial sensors, among others.

30 shows the interface between the handle assembly 150702 and the power assembly 150706, and the interface between the handle assembly 150702 and the replaceable shaft assembly 150704, according to at least one aspect of the present disclosure. 150700 is another block diagram of the surgical instrument control circuit 150700. FIG. Handle assembly 150702 may comprise main controller 150717 , shaft assembly connector 150726 and power assembly connector 150730 . The power assembly 150706 may include a power assembly connector 150732 and power management circuitry 150734 which may comprise a power management controller 150716, a power modulator 150738 and a current sensing circuit 150736. Shaft assembly connectors 150730 , 150732 form interface 150727 . While interchangeable shaft assembly 150704 and power supply assembly 150706 are coupled to handle assembly 150702, power management circuitry 150734 modulates the power output of battery 150707 based on the power requirements of interchangeable shaft assembly 150704. can be configured to For example, the power management controller 150716 can be programmed to control the power modulator 150738 of the power output of the power supply assembly 150706, and the current sensing circuit 150736 monitors the power output of the power supply assembly 150706 to Feedback regarding the power output of 150707 can be utilized to provide power management controller 150716 so that power management controller 150716 can adjust the power output of power supply assembly 150706 to maintain the desired output. Shaft assembly 150704 includes shaft processor 150720 coupled to non-volatile memory 150721 and shaft assembly connector 150728 to electrically couple shaft assembly 150704 to handle assembly 150702 . Shaft assembly connectors 150726 , 150728 form interface 150725 . Main controller 150717, shaft processor 150720 and/or power management controller 150716 may be configured to implement one or more of the processes described herein.

Surgical instrument 150010 (FIGS. 25-28) may include an output device 150742 that provides sensory feedback to the user. Such devices may include visual feedback devices (eg, LCD display screens, LED indicators), audible feedback devices (eg, speakers, buzzers) or tactile feedback devices (eg, tactile actuators). Under certain circumstances, the output device 150742 may comprise a display 150743 that may be included in the handle assembly 150702. Shaft assembly controller 150722 and/or power management controller 150716 may provide feedback to the user of surgical instrument 150010 via output device 150742 . Interface 150727 may be configured to connect shaft assembly controller 150722 and/or power management controller 150716 to output device 150742 . Output device 150742 may be integrated with power assembly 150706 . While interchangeable shaft assembly 150704 is coupled to handle assembly 150702, communication between output device 150742 and shaft assembly controller 150722 may be accomplished via interface 150725. Having described control circuitry 150700 (FIGS. 29A-29B and FIG. 6) for controlling the operation of surgical instrument 150010 (FIGS. 25-28), the present disclosure will now proceed to surgical instrument 150010 (FIGS. 25-28). 28) and turn to various configurations of the control circuit 150700. FIG.

Referring to FIG. 31, a surgical stapler 151000 may include a handle component 151002, a shaft component 151004 and an end effector component 151006. Surgical stapler 151000 is constructed and equipped similarly to motorized surgical cutting and fastening instrument 150010 described in connection with FIG. Therefore, for the sake of brevity and clarity, operational and structural details are not repeated here. End effector 151006 may be used to compress, cut, or staple tissue. Referring now to FIG. 32, the end effector 151030 may be positioned by the physician to encircle tissue 151032 prior to compression, cutting, or stapling. As shown in FIG. 32, no compression may be applied to the tissue while preparing the end effector for use. Referring now to FIG. 33, by engaging a handle (eg, handle 151002) of a surgical stapler, the physician may use end effector 151030 to compress tissue 151032. As shown in FIG. In one aspect, the tissue 151032 may be compressed to its maximum threshold, as shown in FIG.

Referring to FIG. 34, various forces may be applied to tissue 151032 by end effector 151030 . For example, when tissue 151032 is compressed between anvil 151034 and channel frame 151036 of end effector 151030, normal forces F1 and F2 may be applied to anvil 151034 and channel frame 151036. Referring now to FIG. 35, various oblique and/or lateral forces may be applied to tissue 151032 as it is compressed by end effector 151030 . For example, force F3 may be applied. For purposes of manipulating a medical device, such as the surgical stapler 151000, it may be desirable to sense or calculate various forms of compression being applied to tissue by an end effector. For example, knowing vertical or lateral compression may allow the end effector to apply the staple motion more precisely or more accurately, or to use the surgical stapler better or safer. In some cases, the operator is informed of the surgical stapler so that it can be

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

36, in one aspect, RF electrodes 151038 may be positioned on the end effector 151030 (eg, on the staple cartridge, knife, or channel frame of the end effector 151030). Additionally, electrical contacts 151040 may be positioned on the anvil 151034 of the end effector 151030 . In one aspect, the electrical contacts may be positioned on the channel frame of the end effector. As tissue 151032 is compressed between anvil 151034 of end effector 151030 and, for example, channel frame 151036, the impedance Z of tissue 151032 changes. Vertical tissue compression 151042 caused by end effector 151030 may be measured as a function of impedance Z of tissue 151032 .

Referring now to FIG. 37, in one aspect, when the RF electrode 151038 is positioned, the electrical contact 151044 may be positioned on the opposite end of the anvil 151034 of the end effector 151030 . As tissue 151032 is compressed between anvil 151034 of end effector 151030 and, for example, channel frame 151036, impedance Z of tissue 151032 changes. Lateral tissue compression 151046 caused by end effector 151030 may be measured as a function of impedance Z of tissue 151032 .

38, in one aspect, electrical contact 151050 may be positioned on anvil 151034 and electrical contact 151052 may be positioned on the opposite end of end effector 151030 in channel frame 151036. good. RF electrodes 151048 may be positioned laterally in the middle of the end effector 151030 . As tissue 151032 is compressed between anvil 151034 of end effector 151030 and, for example, channel frame 151036, impedance Z of tissue 151032 changes. Lateral compression 151054 or angular compression 151056 on either side of the RF electrode 151048 may be caused by the end effector 151030 to vary the tissue 151032 based on the relative positioning of the RF electrode 151048, electrical contacts 151050 and 151052. It may be measured as a function of impedance Z.

As shown in FIG. 39, frequency generator 151222 may receive power or current from power source 151221 and may provide one or more RF signals to one or more RF electrodes 151224. . As discussed above, one or more RF electrodes may be positioned at various locations or components on an end effector or surgical stapler, such as a staple cartridge or channel frame. One or more electrical contacts, such as electrical contacts 151226 or 151228, may be positioned on the channel frame or anvil of the end effector. Additionally, one or more filters, such as filters 151230 or 151232, may be communicatively coupled with electrical contacts 151226 or 151228. FIG. Filters 151230 and 151232 may filter one or more RF signals provided by frequency generator 151222 before combining them into a single return path 151234 . Voltage V and current I associated with one or more RF signals may be compressed and/or communicable between one or more RF electrodes 151224 and electrical contacts 151226 or 151228. It may be used to calculate the impedance Z associated with the tissue that may be bound.

Still referring to FIG. 39, various components of the tissue compression sensor systems described herein may be positioned within the handle 151236 of the surgical stapler. For example, as shown in circuit diagram 151220a, frequency generator 151222 may be located within handle 151236 and receive power from power source 151221 . Also, current I1 and current I2 can be measured on the return paths corresponding to electrical contacts 151228 and 151226. FIG. Using the voltage V applied between the supply and return paths, impedances Z1 and Z2 can be calculated. Z1 may correspond to the impedance of tissue compressed and/or communicatively coupled between one or more of the RF electrodes 151224 and the electrical contacts 151228 . Additionally, Z2 may correspond to the impedance of tissue compressed and/or communicatively coupled between one or more of the RF electrodes 151224 and the electrical contacts 151226 . Applying the equations Z1=V/I1 and Z2=V/I2, impedances Z1 and Z2 corresponding to different compression levels of tissue compressed by the end effector can be calculated.

Referring now to FIG. 40 , one or more aspects of the present disclosure are illustrated in circuit diagram 151250 . In one implementation, a power supply at handle 151252 of the surgical stapler may power frequency generator 151254 . Frequency generator 151254 may generate one or more RF signals. One or more RF signals may be multiplexed or superimposed in multiplexer 151256, which may be in shaft 151258 of the surgical stapler. In this manner, two or more RF signals can be superimposed (or nested or modulated together, for example) and transmitted to the end effector. The one or more RF signals may energize one or more RF electrodes 151260 (eg, positioned within a staple cartridge) on the end effector 151262 of the surgical stapler. Tissue (not shown) may be compressed and/or communicatively coupled between one or more RF electrodes 151260 and one or more electrical contacts. For example, tissue may be compressed between one or more RF electrodes 151260 and electrical contacts 151264 positioned within the channel frame of the end effector 151262 or electrical contacts 151266 positioned within the anvil of the end effector 151262. may be connected and/or communicatively coupled. Filter 151268 may be communicatively coupled to electrical contacts 151264 and filter 151270 may be communicatively coupled to electrical contacts 151266 .

Voltage V and current I associated with one or more RF signals are applied to the staple cartridge (and may be communicatively coupled to one or more RF electrodes 151260) and the channel frame or anvil (electrical contact 151264 or 151266, which may be communicatively coupled to one or more of 151264 or 151266).

In one aspect, the various components of the tissue compression sensor system described herein can be disposed within the shaft 151258 of the surgical stapler. For example, as shown in circuit diagram 151250 (and in addition to frequency generator 151254), impedance calculator 151272, controller 151274, non-volatile memory 151276, and communication channel 151278 may be disposed within shaft 151258. In one embodiment, frequency generator 151254, impedance calculator 151272, controller 151274, non-volatile memory 151276, and communication channel 151278 may be located on a circuit board within shaft 151258.

Two or more RF signals can be returned on a common path via electrical contacts. Furthermore, in order to differentiate the separate tissue impedances represented by the two or more RF signals, the two or more RF signals are filtered before they join on a common path. can be Current I1 and current I2 can be measured on the return paths corresponding to electrical contacts 151264 and 151266. FIG. Using the voltage V applied between the supply and return paths, impedances Z1 and Z2 can be calculated. Z1 may correspond to the impedance of tissue compressed and/or communicatively coupled between one or more of RF electrodes 151260 and electrical contacts 151264 . Additionally, Z2 may correspond to the impedance of tissue compressed and/or communicatively coupled between one or more of the RF electrodes 151260 and the electrical contacts 151266 . Applying the equations Z1=V/I1 and Z2=V/I2, impedances Z1 and Z2 corresponding to different compressions of tissue compressed by end effector 151262 can be calculated. In an embodiment, impedances Z1 and Z2 may be calculated by impedance calculator 151272. Impedances Z1 and Z2 can be used to calculate various levels of tissue compression.

Referring now to Figure 41, a frequency graph 151290 is shown. Frequency graph 151290 shows frequency modulation nesting two RF signals. The two RF signals may be nested before reaching the RF electrodes on the end effector, as described above. For example, an RF signal with frequency 1 and an RF signal with frequency 2 can be nested together. Referring now to FIG. 42, the resulting nested RF signal is shown in frequency graph 151300. FIG. The combined signal shown in frequency graph 151300 includes the two RF signals of frequency graph 151290 combined. Referring now to Figure 43, a frequency graph 151400 is shown. Frequency graph 151400 shows RF signals having frequency 1 and frequency 2 after being filtered (eg, by filters 151268 and 151270). The resulting RF signal can be used to make separate impedance calculations or measurements on the return path, as described above.

In one aspect, filters 151268 and 151270 may be high Q filters such that the filter range may be narrow (eg, Q=10). Q may be defined by center frequency (Wo)/bandwidth (BW), where Q=Wo/BW. In one example, frequency 1 may be 150 kHz and frequency 2 may be 300 kHz. A viable impedance measurement range can be from 100 kHz to 20 MHz. Other sophisticated techniques such as correlation, quadrature detection, etc. may be used in various embodiments to separate the RF signals.

Using one or more of the techniques and features described herein, a single energized electrode on the staple cartridge or isolated knife of the end effector can simultaneously perform multiple tissue compression measurements. can be used to do When two or more RF signals are superimposed or multiplexed (or nested or modulated), they can be transmitted to the single power side of the end effector and the end effector channel frame or anvil. If a filter is incorporated at the junction of the anvil and channel before they join the common return path, the tissue impedances presented by both paths can be differentiated. This can provide a measure of vertical versus lateral tissue compression. This method may also provide proximal and distal tissue compression depending on the placement of the filter and the location of the metal return path. The frequency generator and signal processor may be located on one or more chips on a circuit board or sub-board (which may already be present in the surgical stapler).

In one aspect, the present disclosure provides an instrument 150010 (described in connection with FIGS. 25-30) configured with various sensing systems. Therefore, for the sake of brevity and clarity, operational and structural details are not repeated here. In one aspect, the sensing system includes a viscoelasticity/rate sensing system to monitor knife acceleration, impedance rate of change, and tissue contact rate of change. In one example, the rate of change of knife acceleration can be used as a measure of tissue type. In another example, the rate of change of impedance can be measured with a pulse sensor and used as a measure of compressibility. Finally, the rate of change of tissue contact can be measured with a sensor that measures tissue flow based on knife firing rate.

The rate of change of the detected parameter, or how long it takes for the tissue parameter to reach its asymptotic steady-state value, as defined in another way, is itself a separate measurement, and the detection from which it is derived can be more valuable than the parameters specified. To improve tissue parameter measurements, such as waiting a predetermined amount of time before making a measurement, the present disclosure provides novel techniques for using the derivative of the measurement, such as the rate of change of the tissue parameter.

Differential techniques or rate of change measurements are most useful with the understanding that no single measurement can be used alone to dramatically improve staple formation. It is the combination of measurements that make the measurement valid. In the case of tissue gaps, it is useful to know how much of the jaw is covered by tissue in order to make the relevant gap measurements. Impedance rate-of-change measurements may be combined with strain measurements at the anvil to relate force and compression applied to tissue grasped between jaw members of an end effector, such as an anvil and a staple cartridge. Rate of change measurements can be used by endosurgical devices to determine tissue type as well as tissue compression. Although stomach tissue and lung tissue sometimes have similar thicknesses, and even similar compression properties when lung tissue is calcified, the instrument can be used to measure gap, compression, applied force, and tissue contact area. , and compression rate of change or gap rate of change, it may be possible to distinguish between these tissue types. If either of these measurements were used alone, it would be difficult for an endosurgical device to distinguish between tissue types. The rate of change of compression can also help enable the device to determine whether the tissue is "normal" or whether an abnormality exists. Measuring the variability of the sensor signal as well as the elapsed time and determining the derivative of the signal would provide another measurement that would allow the endosurgical device to measure that signal. Rate of change information can also be used to determine when steady state has been reached and signal the next step in the process. For example, after grasping tissue between jaw members of an end effector, such as an anvil and a staple cartridge, an indicator or trigger is available to initiate firing of the device when tissue compression reaches a steady state (eg, about 15 seconds). can be made

Also provided herein are methods, devices, and systems for time-dependent evaluation of sensor data that determine stability, creep, and viscoelastic properties of tissue during surgical instrument operation. Surgical instruments such as the stapler shown in FIG. 25 measure operating parameters such as jaw gap size or distance, firing current, tissue compression, amount of jaws covered by tissue, anvil strain, and trigger force. A variety of sensors can be included to do this. These sensed measurements are important for automated control of surgical instruments and for providing feedback to the clinician.

The examples shown in connection with FIGS. 30-49 can be used to measure various derived parameters such as gap distance vs. time, tissue compression vs. time, and anvil strain vs. time. Motor current may be monitored using a current sensor in series with battery 2308 .

Turning now to FIG. 44, a motorized surgical cutting and fastening instrument 151310 that may or may not be reused is depicted. Motorized surgical cutting and fastening instrument 151310 is constructed and equipped similarly to motorized surgical cutting and fastening instrument 150010 described in connection with FIGS. In the example shown in FIG. 44, the instrument 151310 includes a housing 151312 with a handle assembly 151314 configured to be grasped, manipulated and actuated by a clinician. Housing 151312 is configured for operable attachment to interchangeable shaft assembly 151500 to which surgical end effector 151600 configured to perform one or more surgical tasks or procedures is operably coupled. It is Motorized surgical cutting and fastening instrument 151310 is constructed and equipped similarly to motorized surgical cutting and fastening instrument 150010 described in connection with FIGS. , the details of operation and structure are not repeated here.

The housing 151312 depicted in FIG. 44 is connected with a replaceable shaft assembly 151500 including an end effector 151600 comprising a surgical cutting and fastening device configured to operably support a surgical staple cartridge 151304 therein. are shown. The housing 151312 includes an end effector adapted to support various sizes and types of staple cartridges for use in connection with interchangeable shaft assemblies having various shaft lengths, sizes, types, etc. It may be configured as Additionally, the housing 151312 is also adapted for use with other motions and other forms of energy such as radio frequency (RF) energy, ultrasonic energy and/or motion in connection with various surgical applications and procedures. It may also be used with a variety of other interchangeable shaft assemblies, including assemblies configured to accommodate different end effector configurations. Additionally, the end effector, shaft assembly, handle, surgical instrument, and/or surgical instrument system may utilize any suitable fastener to fasten tissue. For example, a fastener cartridge comprising a plurality of fasteners removably stored therein may be removably inserted and/or attached to the end effector of the shaft assembly.

FIG. 44 shows surgical instrument 151310 with interchangeable shaft assembly 151500 operably coupled thereto. In the illustrated configuration, the handle housing forms a pistol grip portion 151319 that can be grasped and manipulated by a clinician. The handle assembly 151314 operatively includes therein a plurality of drive systems configured to produce various controlled motions and apply to corresponding portions of interchangeable shaft assemblies operably attached to the handle assembly. supported by A trigger 151332 is operatively associated with the pistol grip to control various of these control movements.

With continued reference to FIG. 44, replaceable shaft assembly 151500 includes a surgical end effector 151600 having an elongated channel 151302 configured to operably support staple cartridge 151304 therein. End effector 151600 may further include an anvil 151306 pivotally supported relative to elongated channel 151302 .

The inventors believe that the derived parameters may be more useful in controlling surgical instruments such as the instrument illustrated in FIG. 44 than the sensed parameters that underlie the derived parameters. I found Non-limiting examples of derived parameters include the rate of change of the detected parameter (e.g. jaw gap distance) and the elapsed time for the tissue parameter to reach an asymptotic steady state value (e.g. 15 seconds ). Derived parameters such as rates of change are particularly useful because they dramatically improve measurement accuracy and also provide information that is otherwise not directly apparent from the detected parameters. For example, impedance (e.g., tissue compression) rate of change can be combined with anvil strain to relate compression and force, allowing the microcontroller to determine tissue type as well as amount of tissue compression. becomes possible. This example is only an example, any derived parameter may be combined with one or more detected parameters to determine tissue type (e.g., stomach and lung), tissue health (calcification, and normal), and more accurate information regarding the operational status of the surgical device (eg, grasp complete). Different tissues have unique viscoelastic properties and unique rates of change, so these and other parameters described herein are useful indicators for monitoring and automatically adjusting surgical procedures. becomes.

FIG. 46 is an exemplary graph showing changes in gap distance over time, where the gap is the space occupied by grasped tissue between the jaws. The vertical (y) axis is distance and the horizontal (x) axis is time. Specifically, referring to FIGS. 44 and 45, the gap distance 151340 is the distance between the end effector anvil 151306 and the elongated channel 151302 . In the open jaw position, at time 0, the gap 151340 between the anvil 151306 and the elongate member is at its maximum distance. The width of the gap 151340 decreases as the anvil 151306 closes, such as while grasping tissue. Since tissue has non-uniform elasticity, the gap distance rate of change may vary. For example, some tissue types exhibit rapid compression early, resulting in a faster rate of change. However, as the tissue is continuously compressed, the viscoelastic properties of the tissue may reduce the rate of change until the tissue is no longer compressible, at which time the gap distance remains substantially constant. become. The gap decreases over time as tissue is crushed between anvil 151306 of end effector 151340 and staple cartridge 151304 . For example, magnetic field sensors, strain gauges, pressure sensors, force sensors, inductive sensors such as eddy current sensors, resistive sensors, capacitive sensors, optical sensors, and/or any other suitable sensors, such as those shown in FIGS. One or more sensors described in association measure the gap distance "d" between anvil 151306 and staple cartridge 151304 over time "t", as graphically represented in FIG. may be adapted and configured to The rate of change of gap distance "d" over time "t" is the slope of the curve shown in FIG. 46, slope=Δd/Δt.

FIG. 47 is an exemplary graph showing end effector jaw firing current. The vertical (y) axis is current and the horizontal (x) axis is time. As discussed herein, a surgical instrument and/or its microcontroller, such as shown and described with respect to FIG. may include a current sensor that detects the current utilized for For example, as tissue resistance increases, the instrument's electric motor may require more current to grasp, cut, and/or staple tissue. Conversely, as the resistance decreases, the electric motor may require less current to grasp, cut, and/or staple tissue. As a result, the firing current can be used as an approximation of tissue resistance. Detected currents can be used alone or more preferably in combination with other measurements to provide feedback regarding the target tissue. Still referring to FIG. 47, during some operations, such as stapling, the firing current is initially high at time 0, but decreases over time. Current may increase over time as the motor draws more current to overcome the increasing mechanical load during operation of other devices. Additionally, the rate of change of firing current can be used as an indicator that tissue is transitioning from one state to another. Therefore, the firing current and, in particular, the rate of change of the firing current can be used to monitor device operation. The firing current decreases over time as the knife cuts through the tissue. The rate of change of firing current may vary if the tissue being cut presents greater or lesser resistance due to tissue properties or sharpness of the knife 151305 (FIG. 45). As the cutting conditions vary, the work done by the motor will vary, resulting in varying firing current over time. A current sensor may be utilized to measure the firing current over time while the knife 151305 is firing, as graphically represented in FIG. For example, motor current may be monitored using a current sensor. The current sensor may be adapted and configured to measure the motor firing current "i" over time "t", as graphically represented in FIG. The rate of change of firing current “i” over time “t” is the slope of the curve shown in FIG. 47, slope=Δi/Δt.

FIG. 48 is an exemplary graph of changes in impedance over time. The vertical (y) axis is impedance and the horizontal (x) axis is time. At time 0, the impedance is low, but rises with time as tissue pressure increases following manipulation (eg, grasping and stapling). The tissue between the anvil 151306 of the end effector 151340 and the staple cartridge 151304 is cut with a knife or sealed using RF energy between electrodes located between the anvil 151306 of the end effector 151340 and the staple cartridge 151304. Therefore, the rate of change fluctuates with time. For example, as tissue is cut, the electrical impedance rises and reaches infinity when the tissue is completely severed by the knife. Also, if the end effector 151340 includes electrodes coupled to a source of RF energy, the electrical impedance of the tissue will rise as energy is delivered through the tissue between the anvil 151306 of the end effector 151340 and the staple cartridge 151304. . The electrical impedance increases as the energy passing through the tissue desiccates the tissue by evaporating the water in the tissue. Ultimately, when a suitable amount of energy is delivered to the tissue, the impedance rises to very high values, or to infinity if the tissue is disrupted. Additionally, as shown in FIG. 48, different tissues may have unique compression properties that distinguish them, such as compressibility. Tissue impedance may be measured by driving a sub-therapeutic RF current through tissue grasped between first jaw member 9014 and second jaw member 9016 . One or more electrodes may be positioned on either or both anvil 151306 and staple cartridge 151304 . Tissue compression/impedance of tissue between anvil 151306 and staple cartridge 151304 can be measured over time as graphically represented in FIG. For example, magnetic field sensors, strain gauges, pressure sensors, force sensors, inductive sensors such as eddy current sensors, resistive sensors, capacitive sensors, optical sensors, and/or any other suitable sensors, such as those shown in FIGS. The sensors described in association may be adapted and configured to measure tissue compression/impedance. The sensor may be adapted and configured to measure tissue impedance "Z" over time "t", as graphically represented in FIG.

FIG. 49 is an exemplary graph of strain over time for anvil 151306 (FIGS. 44, 45). The vertical (y) axis is strain and the horizontal (x) axis is time. For example, during stapling, the strain on the anvil 151306 is initially high, but decreases as the tissue reaches steady state and less pressure is exerted on the anvil 151306 . The rate of change in strain of the anvil 151306 is measured by either anvil 151306 or staple cartridge 151304 (FIGS. 44, 45) to measure the pressure or strain exerted on tissue grasped between anvil 151306 and staple cartridge 151304. may be measured by pressure sensors or strain gauges positioned on either or both. Anvil 151306 strain may be measured over time as graphically represented in FIG. The rate of change of strain "S" over time "t" is the slope of the curve shown in FIG. 49, slope=ΔS/Δt.

FIG. 50 is an exemplary graph of changes in trigger force over time. The vertical (y) axis is trigger force and the horizontal (x) axis is time. In certain examples, the trigger force is gradual and provides tactile feedback to the clinician. Thus, at time 0, the trigger 151320 (FIG. 44) pressure may be at its lowest value, and the trigger pressure may increase until the operation (eg, grasping, cutting, or stapling) is completed. The rate of change of trigger force was measured using instrument 151310 (Fig. 45) to measure the force required to drive knife 151305 (Fig. 44) can be measured by a pressure sensor or strain gauge positioned on the trigger 151302 of the handle 151319 of FIG. Trigger 151332 force can be measured over time as graphically represented in FIG. The rate of change of strain trigger force "F" over time "t" is the slope of the curve shown in FIG. 50, slope=ΔF/Δt.

For example, stomach tissue and lung tissue can be distinguished even though these tissues may have similar thicknesses and similar compression properties when lung tissue is calcified. Stomach tissue and lung tissue can be distinguished by analyzing jaw gap distance, tissue compression, applied force, tissue contact area, rate of change in compression, and rate of change in jaw gap. For example, FIG. 51 shows graphs of tissue pressure "P" for various tissues and tissue displacement for various tissues. The vertical (y) axis is tissue pressure and the horizontal (x) axis is tissue displacement. Distinguishing tissues using the amount of tissue displacement when tissue pressure reaches a predetermined threshold, such as 0.50-100 pounds per square inch (psi), as well as the rate of tissue displacement before reaching the threshold. can be done. For example, vascular tissue reaches a given pressure threshold with less tissue displacement and a faster rate of change than colon, lung, or stomach tissue. In addition, the rate of change (tissue pressure versus displacement) of vascular tissue is nearly asymptotic at thresholds of 50-100 psi, whereas the colon, lung, and stomach are not asymptotic at thresholds of 50-100 psi. As will be appreciated, any pressure threshold may be used, such as, for example, 1-1000 psi, more preferably 10-500 psi, and more preferably even 50-100 psi. Additionally, multiple or progressive thresholds may be used to provide further resolution of tissue types with similar viscoelastic properties.

The compression rate of change may also allow the microcontroller to determine whether the tissue is "normal" or whether an abnormality, such as calcification, is present. For example, referring to FIG. 52, compression of calcified lung tissue follows a different curve than compression of normal lung tissue. Therefore, tissue displacement and the rate of change of tissue displacement can be used to diagnose calcified lung tissue and/or distinguish it from normal lung tissue.

Additionally, certain detected measurements may benefit from additional sensory input. For example, in the case of jaw gap, knowing how much of the jaw is covered by tissue can make the gap measurement more useful and accurate. If a small portion of the jaw is covered by tissue, tissue compression may appear to be less than if the entire jaw is covered by tissue. Therefore, jaw coverage can be considered by the microcontroller when analyzing tissue compression and other sensed parameters.

In certain situations, elapsed time may also be an important parameter. Measuring elapsed time along with detected parameters and derivative parameters (eg, rate of change) provide additional useful information. For example, if the rate of change of the jaw gap remains constant after a set period of time (eg, 5 seconds), this parameter may have reached an asymptotic value.

Rate of change information is also useful for determining when steady state has been reached and for signaling the next step in the process. For example, during grasping, when tissue compression reaches a steady state, e.g., no significant rate of change occurs after a set period of time, the microcontroller alerts the clinician to initiate the next step in the operation, such as firing staples. can send a signal to the display to Alternatively, the microcontroller can be programmed to automatically initiate the next step of operation (eg, staple firing) once a steady state is reached.

Similarly, the rate of change of impedance can be combined with anvil strain to relate force and compression. The rate of change would allow the device to determine the tissue type rather than simply measuring compression values. For example, the stomach and lungs sometimes have similar thicknesses and even similar compression properties when the lungs are calcified.

A combination of one or more sensed parameters and derived parameters provides a more reliable and accurate assessment of tissue type and tissue health, leading to more effective device monitoring, control, and clinicians. allow feedback to

FIG. 53 shows one embodiment of an end effector 152000 comprising a first sensor 152008a and a second sensor 152008b. End effector 152000 is similar to end effector 150300 described above. End effector 152000 includes a first jaw member or anvil 152002 pivotally coupled to a second jaw member 152004 . Second jaw member 152004 is configured to receive staple cartridge 152006 therein. Staple cartridge 152006 contains a plurality of staples (not shown). A plurality of staples can be deployed from staple cartridge 152006 during a surgical procedure. End effector 152000 includes a first sensor 152008a. First sensor 152008a is configured to measure one or more parameters of end effector 152000 . For example, in one embodiment, first sensor 152008a is configured to measure gap 152010 between anvil 152002 and second jaw member 152004 . First sensor 152008a may comprise, for example, a Hall effect sensor configured to detect magnetic fields generated by magnets 152012 embedded in second jaw member 152004 and/or staple cartridge 152006 . As another example, in one embodiment, the first sensor 152008a is coupled to the anvil 152002 by the second jaw member 152004 and/or by tissue grasped between the anvil 152002 and the second jaw member 152004. It is configured to measure one or more forces exerted.

End effector 152000 includes a second sensor 152008b. Second sensor 152008b is configured to measure one or more parameters of end effector 152000 . For example, in various embodiments, the second sensor 152008b may comprise a strain gauge configured to measure the amount of strain in the anvil 152002 during the gripped condition. A strain gauge provides an electrical signal whose amplitude varies with the amount of strain. In various embodiments, for example, the first sensor 152008a and/or the second sensor 152008b are magnetic sensors, such as Hall effect sensors, strain gauges, pressure sensors, force sensors, inductive sensors, such as eddy current sensors; A resistive sensor, a capacitive sensor, an optical sensor, and/or any other suitable sensor for measuring one or more parameters of the end effector 152000 may be included. The first sensor 152008a and the second sensor 152008b may be arranged in a series configuration and/or a parallel configuration. In a series configuration, the second sensor 152008b may be configured to directly influence the output of the first sensor 152008a. In a parallel configuration, the second sensor 152008b may be configured to indirectly affect the output of the first sensor 152008a.

In one embodiment, the one or more parameters measured by the first sensor 152008a are related to the one or more parameters measured by the second sensor 152008b. For example, in one embodiment, first sensor 152008a is configured to measure gap 152010 between anvil 152002 and second jaw member 152004 . Gap 152010 represents the thickness and/or compressibility of the portion of tissue grasped between anvil 152002 and staple cartridge 152006 . First sensor 152008a may comprise, for example, a Hall effect sensor configured to detect a magnetic field generated by magnet 152012 coupled to second jaw member 152004 and/or staple cartridge 152006 . A single point measurement accurately represents the thickness of the compressed tissue in the case of a calibrated full engagement of the tissue, but a partial engagement of the tissue between the anvil 152002 and the second jaw member 152004. may lead to inaccurate results. Partial meshing of tissue, either proximal partial meshing or distal partial meshing, changes the gripping geometry of the anvil 152002 .

In some embodiments, the second sensor 152008b is one or two sensors that indicate the type of tissue engagement, e.g., full engagement, partial proximal engagement, and/or partial distal engagement. configured to detect one or more parameters. The measurement of the second sensor 152008b adjusts the measurement of the first sensor 152008a to accurately represent the true compressed tissue thickness at the proximally or distally positioned partial bite. may be used for For example, in one embodiment, the second sensor 152008b comprises a strain gauge, eg, a micro strain gauge, configured to monitor the amount of strain in the anvil during the gripped condition. The magnitude of strain in the anvil 152002 is the output of a first sensor 152008a, such as a Hall effect sensor, to accurately represent the true compressed tissue thickness at the proximally or distally positioned partial bite. used to modify the The first sensor 152008a and the second sensor 152008b may be measured in real time during the gripping motion. Real-time measurements allow time-based information to be analyzed by, for example, a primary processor (eg, processor 462 (Fig. 12)) and recognize tissue features and grasp positioning to determine tissue thickness. It can be used to select one or more algorithms and/or lookup tables to dynamically adjust the measurements.

In some embodiments, the thickness measurement of first sensor 152008a may be provided to an output device of surgical instrument 150010 coupled to end effector 152000 . For example, in one embodiment, end effector 152000 is coupled to surgical instrument 150010 that includes a display (eg, display 473 (FIG. 12)). The measurements of the first sensor 152008a are provided to a processor, eg, a primary processor. The primary processor adjusts the measurements of the first sensor 152008a based on the measurements of the second sensor 152008b to provide a true tissue representation of the portion of tissue grasped between the anvil 152002 and the staple cartridge 152006. Reflect thickness. The primary processor outputs the adjusted tissue thickness measurement and an indication of full or partial occlusion to the display. The operator may decide whether to deploy staples within staple cartridge 152006 based on the displayed value.

In some embodiments, the first sensor 152008a and the second sensor 152008b are arranged such that, for example, the first sensor 152008a is positioned inside the patient at the treatment site and the second sensor 152008b is positioned outside the patient. may be located in different environments, such as The second sensor 152008b may be configured to calibrate and/or modify the output of the first sensor 152008a. First sensor 152008a and/or second sensor 152008b may comprise, for example, environmental sensors. Environmental sensors may comprise, for example, temperature sensors, humidity sensors, pressure sensors, and/or any other suitable environmental sensors.

Figure 54 is a logic diagram illustrating one embodiment of a process 152020 for adjusting the reading of a first sensor 152008a based on input from a second sensor 152008b. A first signal 152022a is captured by a first sensor 152008a. The first signal 152022a may be adjusted based on one or more predetermined parameters such as, for example, smoothing functions, lookup tables, and/or any other suitable adjustment parameters. A second signal 152022b is captured by a second sensor 152008b. Second signal 152022b may be adjusted based on one or more predetermined adjustment parameters. A first signal 152022a and a second signal 152022b are provided to a processor, eg, a primary processor. The processor adjusts the measurements of the first sensor 152008a, as represented by the first signal 152022a, based on the second signal 152022b from the second sensor. For example, in one embodiment, the first sensor 152008a comprises a Hall effect sensor and the second sensor 152008b comprises a strain gauge. The distance measurement of the first sensor 152008a is adjusted by the amount of strain measured by the second sensor 152008b to determine the integrity of the tissue engagement at the end effector 152000. FIG. The adjusted measurements are displayed 152026 to the operator, for example by a display embedded in the surgical instrument 150010 .

Figure 55 is a logic diagram illustrating one embodiment of a process 152030 for determining a lookup table for a first sensor 152008a based on input from a second sensor 152008b. A first sensor 152008a captures a signal 152022a indicative of one or more parameters of the end effector 152000 . The first signal 152022a may be adjusted based on one or more predetermined parameters such as, for example, smoothing functions, lookup tables, and/or any other suitable adjustment parameters. A second signal 152022b is captured by a second sensor 152008b. Second signal 152022b may be adjusted based on one or more predetermined adjustment parameters. A first signal 152022a and a second signal 152022b are provided to a processor, eg, a primary processor. The processor selects a lookup table from one or more available lookup tables 152034a, 152034b based on the value of the second signal. A selected lookup table is used to convert the first signal into a thickness measurement of tissue located between anvil 152002 and staple cartridge 152006 . The adjusted measurements are displayed 152026 to the operator, for example by a display embedded in the surgical instrument 150010 .

Figure 56 is a logic diagram illustrating one embodiment of a process 152040 for calibrating a first sensor 152008a in response to input from a second sensor 152008b. First sensor 152008a is configured to capture signal 152022a indicative of one or more parameters of end effector 152000 . The first signal 152022a may be adjusted based on one or more predetermined parameters such as, for example, smoothing functions, lookup tables, and/or any other suitable adjustment parameters. A second signal 152022b is captured by a second sensor 152008b. Second signal 152022b may be adjusted based on one or more predetermined adjustment parameters. A first signal 152022a and a second signal 152022b are provided to a processor, eg, a primary processor. The primary processor calibrates 152042 the first signal 152022a in response to the second signal 152022b. The first signal 152022a is calibrated 152042 to reflect the integrity of the tissue engagement at the end effector 152000 . The calibrated signal is displayed 152026 to the operator, for example by a display embedded in the surgical instrument 150010 .

FIG. 57 is a logic diagram illustrating one embodiment of a process 152050 for determining and displaying the thickness of a portion of tissue grasped between the anvil 152002 of the end effector 152000 and the staple cartridge 152006. FIG. Process 152050 includes acquiring a Hall effect voltage 152052, eg, through a Hall effect sensor located at the distal tip of anvil 152002. Hall effect voltage 152052 is provided to analog-to-digital converter 152054 and converted to a digital signal. A digital signal is provided to a processor, such as a primary processor. The primary processor calibrates 152056 the curve input of the Hall effect voltage 152052 signal. Strain gauges 152058, eg, micro strain gauges, are configured to measure one or more parameters of end effector 152000, eg, the amount of strain exerted on anvil 152002 during a grasping motion. ing. The measured distortion is converted to a digital signal 152060 and provided to a processor, such as a primary processor. The primary processor uses one or more algorithms and/or lookup tables to adjust the Hall effect voltage 152052 in response to the strain measured by the strain gauge 152058, thereby adjusting the anvil 152002 and staple cartridge 152006. reflects the true thickness of the tissue grasped by and the integrity of its bite. The adjusted thickness is displayed 152026 to the operator, eg, by a display embedded in surgical instrument 150010 .

In some embodiments, the surgical instrument can further comprise a load cell or load sensor 152082. The load sensor 152082 may be located, for example, within the shaft assembly 150200 described above or within the housing 150012 also described above. FIG. 58 is a logic diagram illustrating one embodiment of a process 152070 for determining and displaying the thickness of a portion of tissue grasped between the anvil 152002 of the end effector 152000 and the staple cartridge 152006. FIG. The process includes acquiring a Hall effect voltage 152072, eg, through a Hall effect sensor located at the distal tip of the anvil 152002. Hall effect voltage 152072 is provided to analog-to-digital converter 152074 and converted to a digital signal. A digital signal is provided to a processor, such as a primary processor. The primary processor calibrates 152076 the curve input of the Hall effect voltage 152072 signal. A strain gauge 152078, eg, a micro strain gauge, is configured to measure one or more parameters of the end effector 152000, eg, the amount of strain exerted on the anvil 152002 during a grasping motion. . The measured distortion is converted to a digital signal 152080 and provided to a processor, such as a primary processor. Load sensor 152082 measures the gripping force of anvil 152002 against staple cartridge 152006 . The measured gripping force is converted to a digital signal 152084 and provided to a processor, such as a primary processor. The primary processor, using one or more algorithms and/or lookup tables, responds to the strain measured by strain gauge 152078 and the gripping force measured by load sensor 152082 to determine the Hall effect voltage Adjusting 152072 reflects the true thickness of the tissue grasped by the anvil 152002 and staple cartridge 152006 and the integrity of its engagement. The adjusted thickness is displayed 152026 to the operator, eg, by a display embedded in surgical instrument 150010 .

FIG. 59 is a graph 152090 showing a comparison of adjusted Hall effect thickness measurements 152092 and uncorrected Hall effect thickness measurements 152094 . Since a single sensor cannot compensate for partial distal/proximal engagement resulting in inaccurate thickness measurements, an uncorrected The Hall effect thickness measurement 152094 represents a thicker tissue measurement. Adjusted thickness measurements 152092 are generated, for example, by process 152050 shown in FIG. Hall effect thickness measurements 152092 are calibrated based on input from one or more additional sensors, such as strain gauges. The adjusted Hall effect thickness 152092 reflects the true thickness of tissue located between the anvil 152002 and staple cartridge 152006 .

FIG. 60 shows an embodiment of an end effector 152100 comprising a first sensor 152108a and a second sensor 152108b. End effector 152100 is similar to end effector 152000 shown in FIG. End effector 152100 includes a first jaw member or anvil 152102 pivotally coupled to a second jaw member 152104 . Second jaw member 152104 is configured to receive staple cartridge 152106 therein. End effector 152100 includes a first sensor 152108a coupled to anvil 152102 . The first sensor 152108a is configured to measure one or more parameters of the end effector 152100, such as the gap 152110 between the anvil 152102 and the staple cartridge 152106, for example. Gap 152110 can correspond, for example, to the thickness of tissue grasped between anvil 152102 and staple cartridge 152106 . The first sensor 152108a may comprise any suitable sensor that measures one or more parameters of the end effector. For example, in various embodiments, the first sensor 152108a may be a magnetic sensor such as a Hall effect sensor, a strain gauge, a pressure sensor, an inductive sensor such as an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor and/or any Other suitable sensors may be provided.

In some embodiments, the end effector 152100 comprises a second sensor 152108b. Second sensor 152108b is coupled to second jaw member 152104 and/or staple cartridge 152106 . Second sensor 152108b is configured to sense one or more parameters of end effector 152100 . For example, in some embodiments, the second sensor 152108b may detect, for example, the color of the staple cartridge 152106 coupled to the second jaw member 152104, the length of the staple cartridge 152106, the grasping state of the end effector 152100, the end Configured to detect one or more instrument states, such as effector 152100 and/or staple cartridge 152106, number of uses/number of uses remaining, and/or any other suitable instrument state. The second sensor 152108b may be a magnetic sensor such as a Hall effect sensor, an inductive sensor such as a strain gauge, a pressure sensor, an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor, and/or any other suitable sensor. Any suitable sensor for detecting one or more instrument conditions may be provided.

End effector 152100 may be used in conjunction with any of the processes shown in Figures 54-57. For example, in one embodiment, the input from the second sensor 152108b may be used to calibrate the input of the first sensor 152108a. A second sensor 152108b may be configured to detect one or more parameters of the staple cartridge 152106 such as, for example, the color and/or length of the staple cartridge 152106 . The detected parameters, such as the color and/or length of the staple cartridge 152106, may be, for example, the height of the cartridge deck, the thickness of tissue available/optimal for the staple cartridge, and/or the pattern of staples within the staple cartridge 152106. etc., may correspond to one or more characteristics of the cartridge. Known parameters of staple cartridge 152106 may be used to adjust the thickness measurement provided by first sensor 152108a. For example, if the staple cartridge 152106 has a higher deck height, the thickness measurement provided by the first sensor 152108a may be reduced to compensate for the additional deck height. The adjusted thickness may be displayed to the operator through a display coupled to surgical instrument 150010, for example.

FIG. 61 shows an embodiment of an end effector 152150 comprising a first sensor 152158 and a plurality of second sensors 152160a, 152160b. End effector 152150 includes a first jaw member or anvil 152152 and a second jaw member 152154 . Second jaw member 152154 is configured to receive staple cartridge 152156 . Anvil 152152 is pivotally movable relative to second jaw member 152154 to grasp tissue between anvil 152152 and staple cartridge 152156 . The anvil has a first sensor 152158 . First sensor 152158 is configured to detect one or more parameters of end effector 152150, such as, for example, gap 152110 between anvil 152152 and staple cartridge 152156. Gap 152110 can correspond, for example, to the thickness of tissue grasped between anvil 152152 and staple cartridge 152156 . First sensor 152158 may comprise any suitable sensor that measures one or more parameters of the end effector. For example, in various embodiments, the first sensor 152158 may be a magnetic sensor such as a Hall effect sensor, a strain gauge, a pressure sensor, an inductive sensor such as an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor, and/or any other suitable sensors may be provided.

In some embodiments, the end effector 152150 comprises multiple secondary sensors 152160a, 152160b. Secondary sensors 152160 a , 152160 b are configured to detect one or more parameters of end effector 152150 . For example, in some embodiments, secondary sensors 152160a, 152160b are configured to measure the amount of strain exerted on anvil 152152 during a grasping procedure. In various embodiments, the secondary sensors 152160a, 152160b are magnetic sensors such as Hall effect sensors, strain gauges, pressure sensors, inductive sensors such as eddy current sensors, resistive sensors, capacitive sensors, optical sensors, and/or any Other suitable sensors may be provided. The secondary sensors 152160a, 152160b may measure one or more of the same parameter at different positions of the anvil 152152, different parameters at the same position of the anvil 152152, and/or different parameters at different positions of the anvil 152152. may be configured to

FIG. 62 is a logic diagram illustrating one embodiment of a process 152170 for adjusting measurements of a first sensor 152158 in response to multiple secondary sensors 152160a, 152160b. In one embodiment, the Hall effect voltage is obtained by a Hall effect sensor 152172, for example. The Hall effect voltage is converted 152174 by an analog-to-digital converter. The converted Hall effect voltage signal is calibrated 152176. The calibrated curve represents the thickness of the portion of tissue located between anvil 152152 and staple cartridge 152156. FIG. A plurality of secondary measurements are obtained 152178a, 152178b by a plurality of secondary sensors, eg, a plurality of strain gauges. The strain gauge inputs are converted into one or more digital signals 152180a, 152180b, for example, by a plurality of electronic μ strain conversion circuits. The calibrated Hall effect voltage and the plurality of secondary measurements are provided to a processor, such as a primary processor. The primary processor utilizes the secondary measurements to adjust the Hall effect voltage 152182, for example by applying an algorithm and/or applying one or more lookup tables. The adjusted Hall effect voltage represents the true thickness of tissue grasped between anvil 152152 and staple cartridge 152156 and the integrity of its engagement. The adjusted thickness is displayed 152026 to the operator, eg, by a display embedded in surgical instrument 150010 .

FIG. 63 illustrates one embodiment of a circuit 152190 configured to convert signals from a first sensor 152158 and a plurality of secondary sensors 152160a, 152160b into digital signals receivable by a processor, such as a primary processor. showing. Circuitry 152190 comprises analog-to-digital converter 152194 . In some embodiments, analog-to-digital converter 152194 comprises a 4-channel 18-bit analog-to-digital converter. Those skilled in the art will appreciate that analog-to-digital converter 152194 may comprise any suitable number of channels and/or bits for converting one or more inputs from analog signals to digital signals. be. Circuitry 152190 comprises one or more level shifting resistors 152196 configured to accept input from a first sensor 152158, eg, a Hall effect sensor. Level shifting resistor 152196 adjusts the input from the first sensor to shift the value to a higher or lower voltage depending on the input. A level shifting resistor 152196 provides a level shifted input from the first sensor 152158 to the analog to digital converter.

In some embodiments, multiple secondary sensors 152160 a , 152160 b are coupled to multiple bridges 152192 a , 152192 b in circuit 152190 . Multiple bridges 152192a, 152192b may provide filtering of input from multiple secondary sensors 152160a, 152160b. After filtering the input signals, multiple bridges 152192a, 152192b provide inputs from multiple secondary sensors 152160a, 152160b to an analog-to-digital converter 152194 . In some embodiments, a switch 152198 coupled to one or more level shifting resistors may be coupled to analog-to-digital converter 152194 . Switch 152198 is configured to calibrate one or more input signals, such as inputs from Hall effect sensors. Switch 152198 may be engaged to provide one or more level shifting signals to adjust one or more input signals of the sensor, for example to calibrate the input of the Hall effect sensor. good. In some embodiments, adjustment is not required and switch 152198 is left open to disconnect the level shifting resistor. Switch 152198 is coupled to analog-to-digital converter 152194 . Analog-to-digital converter 152194 provides output to one or more processors, such as a primary processor. Primary processor calculates one or more parameters of end effector 152150 based on the input from analog-to-digital converter 152194 . For example, in one embodiment, the primary processor calculates the thickness of tissue located between anvil 152152 and staple cartridge 152156 based on inputs from one or more sensors 152158, 152160a, 152160b. .

FIG. 64 illustrates one embodiment of an end effector 152200 comprising multiple sensors 152208a-152208d. End effector 152200 includes an anvil 152202 pivotally coupled to second jaw member 152204 . Second jaw member 152204 is configured to receive staple cartridge 152206 therein. Anvil 152202 includes a plurality of sensors 152208a-152208d thereon. A plurality of sensors 152208a-152208d are configured to sense one or more parameters of the end effector 152200, such as the anvil 152202, for example. The plurality of sensors 152208a-152208d may comprise one or more identical sensors and/or different sensors. The plurality of sensors 152208a-152208d may be, for example, magnetic sensors such as Hall effect sensors, strain gauges, pressure sensors, inductive sensors such as eddy current sensors, resistive sensors, capacitive sensors, optical sensors, and/or any other suitable sensors. A sensor, or a combination thereof, may be provided. For example, in one embodiment, multiple sensors 152208a-152208d may comprise multiple strain gauges.

In one embodiment, multiple sensors 152208a-152208d enable a robust tissue thickness sensing process. By sensing various parameters along the length of the anvil 152202, the plurality of sensors 152208a-152208d are adapted to a surgical instrument, eg, a surgical instrument 150010, regardless of engagement, eg, partial engagement or full engagement. Allows the instrument to calculate tissue thickness within the jaw. In some embodiments, multiple sensors 152208a-152208d comprise multiple strain gauges. A plurality of strain gauges are configured to measure strain at various points on anvil 152202 . The strain magnitude and/or slope at each of the various points on the anvil 152202 can be used to determine the thickness of the tissue between the anvil 152202 and the staple cartridge 152206. The plurality of strain gauges is configured to optimize the maximum difference in magnitude and/or gradient based on grasping dynamics to determine tissue thickness, tissue placement, and/or material properties. may Through time-based monitoring of multiple sensors 152208a-152208d during grasping, a processor, such as a primary processor, utilizes algorithms and look-up tables to recognize tissue features and grasping locations, end effector 152200, and/or dynamically adjust the tissue grasped between the anvil 152202 and the staple cartridge 152206.

FIG. 65 is a logic diagram illustrating one embodiment of a process 152220 for determining one or more tissue characteristics based on multiple sensors 152208a-152208d. In one embodiment, the plurality of sensors 152208a-152208d generate a plurality of signals 152222a-152222d indicative of one or more parameters of the end effector 152200. A plurality of generated signals are converted to digital signals 152224a-152224d and provided to a processor. For example, in one embodiment including multiple strain gauges, multiple electronic μ-strain (micro-strain) conversion circuits 152224a-152224d convert strain gauge signals to digital signals. A digital signal is provided to a processor, such as a primary processor. The primary processor determines 152226 one or more tissue characteristics based on the plurality of signals. The processor may determine one or more tissue characteristics by applying algorithms and/or lookup tables. One or more tissue features are displayed 152026 to the operator, for example by a display embedded in the surgical instrument 150010 .

FIG. 66 shows an embodiment of an end effector 152250 comprising a plurality of sensors 152260a-152260d coupled to second jaw member 3254. FIG. End effector 152250 includes an anvil 152252 pivotally coupled to second jaw member 152254 . Anvil 152252 is moveable relative to second jaw member 152254 to grasp one or more substances, such as a portion of tissue 152264, therebetween. Second jaw member 152254 is configured to receive staple cartridge 152256 . A first sensor 152258 is coupled to anvil 152252 . The first sensor is configured to detect one or more parameters of the end effector 152150 such as, for example, the gap 152110 between the anvil 152252 and the staple cartridge 152256. Gap 152110 can correspond, for example, to the thickness of tissue grasped between anvil 152252 and staple cartridge 152256 . First sensor 152258 may comprise any suitable sensor that measures one or more parameters of the end effector. For example, in various embodiments, the first sensor 152258 may be a magnetic sensor such as a Hall effect sensor, a strain gauge, a pressure sensor, an inductive sensor such as an eddy current sensor, a resistive sensor, a capacitive sensor, an optical sensor, and/or any other suitable sensors may be provided.

A plurality of secondary sensors 152260 a - 152260 d are coupled to second jaw member 152254 . A plurality of secondary sensors 152260 a - 152260 d may be integrally formed with the second jaw member 152254 and/or staple cartridge 152256 . For example, in one embodiment, a plurality of secondary sensors 152260a-152260d are disposed on the outer rows of staple cartridge 152256 (see FIG. 67). A plurality of secondary sensors 152260a-152260d are configured to detect one or more parameters of the end effector 152250 and/or a portion of tissue 152264 grasped between the anvil 152252 and the staple cartridge 152256. It is The plurality of secondary sensors 152260a-152260d may be, for example, magnetic sensors such as Hall effect sensors, strain gauges, pressure sensors, inductive sensors such as eddy current sensors, resistive sensors, capacitive sensors, optical sensors, and/or any other sensors. Any suitable sensor for detecting one or more parameters of end effector 152250 and/or tissue portion 152264 may be provided, such as suitable sensors, or combinations thereof. Multiple secondary sensors 152260a-152260d may comprise the same sensor and/or different sensors.

In some embodiments, the plurality of secondary sensors 152260a-152260d comprise dual purpose sensors and tissue stabilizing elements. The plurality of secondary sensors 152260a-152260d are electrodes and configured to create a stable tissue condition when the plurality of secondary sensors 152260a-152260d are engaged with the portion of tissue 152264, such as during a grasping motion. /or with sensing features. In some embodiments, one or more of the plurality of secondary sensors 152260a-152260d may be replaced with insensitive tissue stabilizing elements. Secondary sensors 152260a-152260d create stable tissue conditions by controlling tissue flow, staple formation, and/or other conditions during grasping, stapling, and/or other treatment processes.

FIG. 67 illustrates one embodiment of a staple cartridge 152270 with multiple sensors 152272a-152272h integrally formed therein. Staple cartridge 152270 comprises multiple rows containing multiple holes for storing staples therein. One or more of the holes in the outer row 152278 are replaced with one of the plurality of sensors 152272a-152272h. A cutaway portion is shown to show sensor 152272f coupled to sensor wire 152276b. Sensor wires 152276a, 152276b may comprise multiple wires for coupling multiple sensors 152272a-152272h to one or more circuits of a surgical instrument, such as surgical instrument 150010, for example. In some embodiments, one or more of the plurality of sensors 152272a-152272h have dual purpose electrodes and/or sensing geometries configured to provide tissue stabilization. A sensor and a tissue stabilizing element are provided. In some embodiments, multiple sensors 152272a-152272h may be replaced and/or co-located with multiple tissue stabilizing elements. Tissue stabilization may be provided, for example, by controlling tissue flow and/or staple formation during the grasping and/or stapling process. A plurality of sensors 152272a-152272h provide signals to one or more circuits of surgical instrument 150010 to improve stapling performance and/or tissue thickness sensing feedback.

68 is a logic diagram illustrating one embodiment of a process 152280 for determining one or more parameters of a portion of tissue 152264 grasped within an end effector, such as end effector 152250 shown in FIG. be. In one embodiment, the first sensor 152258 is configured to detect one or more parameters of the end effector 152250 and/or the tissue portion 152264 located between the anvil 152252 and the staple cartridge 152256. It is A first signal 152282 is generated by a first sensor 152258 . The first signal is indicative of one or more parameters detected by first sensor 152258 . The one or more secondary sensors 152260 are configured to detect one or more parameters of the end effector 152250 and/or the tissue portion 152264 . The secondary sensor 152260 may be configured to detect the same parameters as the first sensor 152258, additional parameters, or different parameters. Secondary signal 152284 is generated by secondary sensor 152260 . Secondary signal 152284 is indicative of one or more parameters detected by secondary sensor 152260 . The first signal and the secondary signal are provided to a processor, such as a primary processor. The processor adjusts 152286 the first signal generated by the first sensor 152258 based on the input generated by the secondary sensor 152260 . The adjusted signal may indicate, for example, the thickness of the tissue portion 152264 and the integrity of the bite. The conditioned signal is displayed 152026 to the operator, for example by a display embedded in the surgical instrument 150010 .

FIG. 69 shows an embodiment of an end effector 152300 with multiple redundant sensors 152308a, 152308b. End effector 152300 includes a first jaw member or anvil 152302 pivotally coupled to a second jaw member 152304 . Second jaw member 152304 is configured to receive staple cartridge 152306 therein. Anvil 152302 is moveable relative to staple cartridge 152306 to grasp material, such as a portion of tissue, between anvil 152302 and staple cartridge 152306 . A plurality of sensors 152308a, 152308b are coupled to the anvil. The plurality of sensors 152308a, 152308b are configured to detect one or more parameters of the end effector 152300 and/or a portion of tissue located between the anvil 152302 and the staple cartridge 152306. In some embodiments, the plurality of sensors 152308a, 152308b are configured to detect a gap 152310 between the anvil 152302 and the staple cartridge 152306. Gap 152310 can correspond, for example, to the thickness of tissue located between anvil 152302 and staple cartridge 152306 . A plurality of sensors 152308a, 152308b may detect the gap 152310 by, for example, detecting magnetic fields generated by magnets 152312 coupled to the second jaw member 152304. As shown in FIG.

In some embodiments, the plurality of sensors 152308a, 152308b comprise redundant sensors. The redundant sensors are configured to detect the same characteristic of the end effector 152300 and/or the portion of tissue located between the anvil 152302 and the staple cartridge 152306 . A redundant sensor may comprise, for example, a Hall effect sensor configured to detect a gap 152310 between anvil 152302 and staple cartridge 152306 . Redundant sensors provide signals representing one or more parameters that allow a processor, such as a primary processor, to evaluate multiple inputs and determine the most reliable input. In some embodiments, redundant sensors are used to reduce noise, spurious signals, and/or drift. Each redundant sensor is measured in real-time during grasping to analyze time-based information, allowing algorithms and/or lookup tables to dynamically recognize tissue features and grasp positioning. may Inputs of one or more of the redundant sensors are adjusted and/or selected to measure the true tissue thickness and engagement of the portion of tissue located between the anvil 152302 and the staple cartridge 152306. may be identified.

FIG. 70 is a logic diagram illustrating one embodiment of a process 152320 for selecting the most reliable output from multiple redundant sensors, eg, multiple sensors 152308a, 152308b shown in FIG. In one embodiment, the first signal is generated by a first sensor 152308a. The first signal is converted 152322a by an analog-to-digital converter. One or more additional signals are generated by one or more redundant sensors 152308b. One or more additional signals are converted 152322b by analog-to-digital converters. The transformed signal is provided to a processor, such as a primary processor. The primary processor evaluates redundant inputs to determine the most reliable output 152324. The most reliable output may be selected based on one or more parameters such as, for example, algorithms, lookup tables, input from additional sensors, and/or instrument status. After selecting the most reliable output, the processor may, for example, use one or more to reflect the true thickness and engagement of the portion of tissue located between the anvil 152302 and the staple cartridge 152306. The output may be adjusted based on additional sensors in the . The conditioned most reliable output is displayed 152026 to the operator, eg, by a display embedded in surgical instrument 150010 .

FIG. 71 shows an embodiment of an end effector 152350 with a sensor 152358 with a unique sampling rate that limits or eliminates spurious signals. End effector 152350 includes a first jaw member or anvil 152352 pivotally coupled to a second jaw member 152354 . Second jaw member 152354 is configured to receive staple cartridge 152356 therein. Staple cartridge 152356 houses a plurality of staples that can be delivered to a portion of tissue located between anvil 152352 and staple cartridge 152356 . Sensor 152358 is coupled to anvil 152352 . Sensor 152358 is configured to detect one or more parameters of end effector 152350 such as, for example, gap 152364 between anvil 152352 and staple cartridge 152356 . Gap 152364 may correspond to the thickness of material, eg, a portion of tissue, and/or the integrity of the engagement of material located between anvil 152352 and staple cartridge 152356 . Sensors 152358 may include, for example, magnetic sensors such as Hall effect sensors, strain gauges, pressure sensors, inductive sensors such as eddy current sensors, resistive sensors, capacitive sensors, optical sensors, and/or any other suitable sensor. Any suitable sensor for sensing one or more parameters of effector 152350 may be provided.

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

In one embodiment, signal processor 152362 is coupled to end effector 152350, such as anvil 152352, for example. Signal processor 152362 is configured to process the signal generated by sensor 152358 to eliminate spurious signals and boost the input from sensor 152358 . In some embodiments, the signal processor 152362 may be located separately from the end effector 152350, such as within the handle 150014 of the surgical instrument 150010, for example. In some embodiments, the signal processor 152362 is integrally formed with and/or includes algorithms executed by a general purpose processor, eg, a primary processor. Signal processor 152362 is configured to process the sensor 152358 signal at a frequency substantially equal to the frequency of the signal generated by electromagnetic wave source 152360 . For example, in one embodiment, electromagnetic wave source 152360 produces a signal at a frequency of 1 MHz. The signal is detected by sensor 152358 . Sensor 152358 produces a signal indicative of the detected magnetic field that is provided to signal processor 152362 . The signal is processed by a signal processor 152362 at a frequency of 1 MHz to eliminate spurious signals. The processed signal is provided to a processor, such as a primary processor. The primary processor correlates the received signal to one or more parameters of the end effector 152350, such as the gap 152364 between the anvil 152352 and the staple cartridge 152356, for example.

72 illustrates logic illustrating one embodiment of a process 152370 for generating thickness measurements of a portion of tissue located between an anvil of an end effector, such as the end effector 152350 shown in FIG. 71, and a staple cartridge; It is a diagram. In one embodiment of process 152370, the signal is generated 152372 by a source 152360 of modulated electromagnetic waves. The generated signal may include, for example, a 1 MHz signal. Magnetic sensor 152358 is configured 152374 to detect signals generated by electromagnetic wave source 152360 . Magnetic sensor 152358 generates a signal indicative of the detected magnetic field and provides the signal to signal processor 152362 . A signal processor 152362 processes the signal 152376 to remove noise, remove spurious signals, and/or boost the signal. The processed signal is provided to an analog-to-digital converter 152378 for conversion to a digital signal. Digital signals may be calibrated 152380, for example, by application of calibration curve entry algorithms and/or lookup tables. Signal processing 152376, transformation 152378, and calibration 152380 may be performed by one or more circuits. The calibrated signal is displayed 152026 to the user, eg, by a display integrally formed with surgical instrument 150010 .

73 and 74 illustrate one embodiment of an end effector 152400 with sensors 152408 that distinguish between different types of staple cartridges 152406. FIG. End effector 152400 includes a first jaw member or anvil 152402 pivotally coupled to a second jaw member or elongated channel 152404 . Elongated channel 152404 is configured to operatively support staple cartridge 152406 therein. End effector 152400 further comprises sensor 152408 located in the proximal region. Sensor 152408 can be either an optical sensor, a magnetic sensor, an electrical sensor, or any other suitable sensor.

Sensor 152408 may be operable to detect characteristics of staple cartridge 152406 and thereby identify the type of staple cartridge 152406 . FIG. 74 shows an example where sensor 152408 is light emitter/detector 152410 . The body of staple cartridge 152406 may be of different colors such that the color identifies the type of staple cartridge 152406 . Light emitter/detector 152410 may be operable to interrogate the color of staple cartridge 152406 body. In the illustrated example, the light emitter/detector 152410 can detect white color 152412 by receiving reflected light in the red, green, and blue spectra of equal intensity. The light emitter/detector 152410 can detect red color 152414 by receiving very little reflected light in the green and blue spectrums, while receiving higher intensity light in the red spectrum.

Alternatively, or in addition, the light emitter/detector 152410, or another suitable sensor 152408, can interrogate and identify some other symbol or mark on the staple cartridge 152406. The symbols or indicia can be any one of barcodes, shapes or letters, color-coded patterns, or any other suitable indicia. Information read by sensor 152408 can be communicated to a microcontroller of surgical device 150010, such as a microcontroller (eg, microcontroller 461 (FIG. 12)). The microcontroller can be configured to communicate information regarding the staple cartridge 152406 to the instrument operator. For example, the identified staple cartridge 152406 may not be suitable for a given application, in which case the instrument operator may be notified and/or the instrument functioning may be inappropriate. . In such instances, the microcontroller can optionally be configured to disable the functionality of the surgical instrument. Alternatively, or in addition, the microcontroller may provide the operator of the surgical instrument 150010 with parameters of the identified staple cartridge 152406 type, such as length of the staple cartridge 152406, or height and length, for example. , stapling information.

FIG. 75 illustrates one aspect of a segmented flexible circuit 153430 configured for fixed attachment to a jaw member 153434 of an end effector. The segmented flexible circuit 153430 comprises a distal segment 153432a and lateral segments 153432b, 153432c containing individually addressable sensors to provide localized tissue presence detection. Segments 153432a, 153432b, 153432c are individually addressable for detecting tissue and measuring tissue parameters based on individual sensors located within each of segments 153432a, 153432b, 153432c. Segments 153432a, 153432b, 153432c of segmented flexible circuit 153430 are attached to jaw member 153434 and are electrically coupled via conductive elements 153436 to an energy source, such as an electrical circuit. A Hall effect sensor 153438 or any suitable magnetic sensor is located at the distal end of jaw member 153434 . A Hall effect sensor 153438 works in conjunction with a magnet to provide a measurement of the opening defined by jaw members 153434, otherwise shown in detail in FIG. 77, otherwise referred to as the tissue gap. The segmented flexible circuit 153430 may be used to measure tissue thickness, force, displacement, compression, tissue impedance, and tissue location within the end effector.

FIG. 76 illustrates one aspect of a segmented flexible circuit 153440 configured to attach to a jaw member 153444 of an end effector. Segmented flexible circuit 153440 comprises a distal segment 153442a containing individually addressable sensors and lateral segments 153442b, 153442c for tissue control. Segments 153442a, 153442b, 153442c are individually addressable for treating tissue and for reading individual sensors located within each of segments 153442a, 153442b, 153442c. Segments 153442a, 153442b, 153442c of segmented flexible circuit 153440 are attached to jaw members 153444 and electrically coupled to an energy source via conductive elements 153446. FIG. A Hall effect sensor 153448 or other suitable magnetic sensor is provided at the distal end of jaw member 153444 . A Hall effect sensor 153448 works in conjunction with a magnet to provide a measurement of the opening or tissue gap defined by the end effector jaw members 153444 shown in detail in FIG. In addition, multiple lateral asymmetric temperature sensors 153450a, 153450b are mounted on or formally integrated with segmented flexible circuit 153440 to provide tissue temperature feedback to the control circuit. The segmented flexible circuit 153440 may be used to measure tissue thickness, force, displacement, compression, tissue impedance, and tissue location within the end effector.

FIG. 77 illustrates one variation of an end effector 153460 configured to measure tissue gap _GT . End effector 153460 includes jaw member 153462 and jaw member 153444 . A flexible circuit 153440 illustrated in FIG. 76 is attached to jaw member 153444 . Flexible circuit 153440 includes Hall effect sensor 153448 that works in conjunction with magnet 153464 attached to jaw member 153462 to measure tissue gap _GT . Such techniques can be utilized to measure the aperture defined between jaw members 153444 and 153462. FIG. Jaw member 153462 may be a staple cartridge.

FIG. 78 illustrates one aspect of an end effector 153470 that includes a segmented flexible circuit 153468. FIG. End effector 153470 includes jaw member 153472 and staple cartridge 153474 . Segmented flexible circuit 153468 is attached to jaw member 153472 . Each of the sensors disposed within segments 1-5 are configured to detect the presence of tissue positioned between jaw member 153472 and staple cartridge 153474 and represent tissue areas 1-5. . 78, end effector 153470 is shown in an open position ready to receive or grasp tissue between jaw member 153472 and staple cartridge 153474. In the configuration shown in FIG. The segmented flexible circuit 153468 may be used to measure tissue thickness, force, displacement, compression, tissue impedance, and tissue location within the end effector 153470 .

FIG. 79 illustrates the end effector 153470 shown in FIG. 78 with the jaw members 153472 gripping tissue 153476 between the jaw members 153472, eg, the anvil, and the staple cartridge. As shown in FIG. 79, tissue 153476 is positioned between segments 1-3 and represents tissue areas 1-3. Thus, tissue 153476 is detected by sensors in segments 1-3 and the absence of tissue (empty condition) is detected in interval 153469 by segments 4-5. Information regarding the presence and absence of tissue 153476 positioned within particular segments 1-3 and 4-5, respectively, is communicated to control circuitry as described herein, eg, via interface circuitry. The control circuit is configured to detect tissue located within segments 1-3. Segments 1-5 may include any suitable temperature, force/pressure, and/or Hall effect magnetic sensors for measuring tissue parameters of tissue located within a particular segment 1-5 and a particular segment 1 It will be appreciated that electrodes for delivering energy to tissue located within .about.5 may be housed. The segmented flexible circuit 153468 may be used to measure tissue thickness, force, displacement, compression, tissue impedance, and tissue location within the end effector 153470 .

FIG. 80 is a diagram of an absolute positioning system 153100 that can be used with surgical instruments or systems according to the present disclosure. Absolute positioning system 153100 comprises controlled motor drive circuitry comprising sensor mechanism 153102 in accordance with at least one aspect of the present disclosure. Sensor mechanism 153102 for absolute positioning system 153100 provides a unique position signal corresponding to the position of displacement member 153111 . In one aspect, displacement member 153111 represents a longitudinally movable drive member coupled to a cutting instrument or knife (eg, cutting instrument, I-beam, and/or I-beam 153514 (FIG. 82)). In other aspects, displacement member 153111 represents a firing member coupled to a cutting instrument or knife, which may be adapted and configured to include a rack of drive teeth. In yet another aspect, displacement member 153111 represents a firing bar or I-beam, each of which may be adapted and configured to include a rack of drive teeth.

Thus, as used herein, the term displacement member refers to surgical instruments such as drive members, firing members, firing bars, cutting instruments, knives, and/or I-beams, or any element that can be displaced. or used generically to refer to any moving member of the system. Thus, the absolute positioning system 153100 can actually track the displacement of the I-beam 153514 (Fig. 82) by tracking the displacement of the longitudinally movable drive member. In various other aspects, displacement member 153111 may be coupled to any sensor suitable for measuring displacement. Accordingly, the longitudinally movable drive member, firing member, firing bar, or I-beam, or combinations thereof, may be coupled to any suitable displacement sensor. Displacement sensors may include contact or non-contact displacement sensors. The displacement sensors are linear variable differential transformers (LVDTs), differential variable reluctance transducers (DVRTs), sliding potentiometers, movable magnets and a series of linear arrays. A magnetic sensing system comprising a fixed magnet and a series of movable linearly arranged Hall effect sensors, a movable light source and a series of linearly arranged lights It may comprise an optical detection system with diodes or photodetectors, or an optical detection system with a fixed light source and a series of movable linearly arranged photodiodes or photodetectors, or any combination thereof. .

Electric motor 153120 may include a rotatable shaft 153116 in operative association with a gear assembly 153114 mounted in meshing engagement with a set or rack of drive teeth on displacement member 153111 . Sensor element 153126 may be operably coupled to gear assembly 153114 such that one rotation of sensor element 153126 corresponds to some linear longitudinal translation of displacement member 153111 . The gearing and sensor 153118 arrangement can be connected to the linear actuator by a rack and pinion arrangement or to the rotary actuator by spur gears or other connections. A power supply 153129 can power the absolute positioning system 153100 and an output indicator 153128 can display the output of the absolute positioning system 153100 .

One rotation of the sensor element 153126 associated with the position sensor 153112 corresponds to a longitudinal displacement _d1 of the displacement member 153111, where _d1 is after one rotation of the sensor element 153126 coupled to the displacement member 153111. 153111 is the longitudinal distance traveled from point "a" to point "b". The sensor mechanism 153102 may be connected via gear reduction that results in the position sensor 153112 completing one or more revolutions for a full stroke of the displacement member 153111 . Position sensor 153112 can complete multiple rotations for a full stroke of displacement member 153111 .

A series of switches 153122a-153122n (where n is an integer greater than 1) may be used alone or in gear reduction to provide unique position signals for two or more rotations of the position sensor 153112. may be used in combination with The states of switches 153122a-153122n are fed back to controller 153110, which applies logic to determine the longitudinal displacement of displacement member 153111 d ₁ +d ₂ + . . . Determine the unique position signal corresponding to _dn . Output 153124 of position sensor 153112 is provided to controller 153110 . The position sensor 153112 of the sensor mechanism 153102 may comprise a magnetic sensor, an analog rotary sensor such as a potentiometer, an array of analog Hall effect elements, which output a unique combination of position signals or values. The controller 153110 may be housed within a master controller or within an instrument mount housing of a surgical instrument or system according to the present disclosure.

The absolute positioning system 153100 includes a displacement member 153111 such as would be required in a conventional rotary encoder where the motor 153120 simply counts the number of steps taken forward or backward to estimate the position of the machine actuator, drive bar, knife, etc. Provides absolute position of the displacement member 153111 at power up of the surgical instrument or system without retraction or advancement to a reset (zero or home) position.

The controller 153110 may be programmed to perform various functions such as precision control over the speed and position of the knife and articulation system. In one aspect, controller 153110 includes processor 153108 and memory 153106 . The electric motor 153120 may be a brushed DC motor with a gearbox and a mechanical connection to the articulation or knife system. In one aspect, the motor driver 153110 may be an A3941 available from Allegro Microsystems, Inc. Other motor drivers can be easily substituted for use with the absolute positioning system 153100.

Controller 153110 may be programmed to provide precise control over the velocity and position of displacement member 153111 and the articulation system. The controller 153110 may be configured to calculate the response within the controller's 153110 software. The calculated response is compared with the measured response of the actual system to obtain the "observed" response, which is used to determine the actual feedback. The observed response is a well-tuned value that balances the smooth, continuous nature of the simulated response with the measured response, which can detect external influences on the system.

Absolute positioning system 153100 may comprise and/or be programmed to implement feedback controllers such as PID, state feedback, and adaptive controllers. The power supply 153129 converts the signal from the feedback controller into a physical input to the system, in this case voltage. Other examples include pulse width modulation (PWM) of voltage, current and force. In addition to the position measured by position sensor 153112, other sensor(s) 153118 may be provided to measure physical parameters of the physical system. In a digital signal processing system, an absolute positioning system 153100 is coupled to a digital data acquisition system, where the output of absolute positioning system 153100 has finite resolution and sampling frequency. The Absolute Positioning System 153100 compares and combines the calculated responses with the measured responses using algorithms such as weighted averages and theoretical control loops that drive the calculated responses towards the measured responses. circuit. The calculated response of a physical system takes into account properties such as mass, inertia, viscous friction, and induced drag in order to predict what the state and output of the physical system will be given the inputs.

Motor driver 153110 may be an A3941 available from Allegro Microsystems, Inc. The A3941 Driver 153110 is a full-bridge controller for use with external N-channel power metal oxide semiconductor field effect transistors (MOSFETs) specifically designed for inductive loads such as brushed DC motors. Driver 153110 includes an inherent charge pump regulator that provides full (>10V) gate drive for battery voltages up to 7V and allows the A3941 to operate with reduced gate drive down to 5.5V. do. Bootstrap capacitors may be used to provide the necessary battery supply voltages for the N-channel MOSFETs. An internal charge pump for the high side drive allows 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 through either the high-side FETs or the low-side FETs. The power FETs are protected from shoot-through by a resistor adjustable dead time. Integrated diagnostics indicate undervoltage, overtemperature, and power bridge faults and can be configured to protect power MOSFETs under most short circuit conditions. Other motor drivers can be easily substituted for use with the absolute positioning system 153100.

FIG. 81 is a diagram of a position sensor 153200 for an absolute positioning system 153100' comprising a magnetic rotary absolute positioning system, in accordance with at least one aspect of the present disclosure. Absolute positioning system 153100' is similar in many respects to absolute positioning system 153100. Position sensor 153200 may be implemented as an AS5055EQFT single-chip gyromagnetic position sensor available from Austria Microsystems, AG. Position sensor 153200 cooperates with controller 153110 to provide absolute positioning system 153100'. The position sensor 153200 is a low voltage, low power component, for example, a position sensor 153200 located above a magnet positioned on a rotating element associated with a displacement member such as a knife drive gear and/or a closing drive gear. region 153230 includes four Hall effect elements 153228A, 153228B, 153228C, 153228D so that displacement of the firing member and/or closure member can be precisely tracked. A high resolution ADC 153232 and a smart power management controller 153238 are also provided on-chip. As the digit-by-digit method and Volder's algorithm to implement concise and efficient algorithms for computing hyperbolic and trigonometric functions, requiring only addition, subtraction, bit-shifting, and table lookup operations. A CORDIC processor 153236 (short for Coordinate Rotation Digital Computer) is provided. Angular position, alarm bits, and magnetic field information are transmitted to controller 153110 via a standard serial communication interface such as SPI interface 153234 . The position sensor 153200 provides 12-bit or 14-bit resolution. The position sensor 153200 may be an AS5055 chip provided in a small QFN16 pin 4x4x0.85mm package.

Hall effect elements 153228A, 153228B, 153228C, 153228D are placed directly above the rotating magnet. The Hall effect is a well-known effect and will not be described in detail here for convenience, but in general the Hall effect is the voltage difference between an electrical conductor across a current in the conductor and a magnetic field perpendicular to the current. (Hall voltage). The Hall coefficient is defined as the ratio of the induced electric field and the current density times the applied magnetic field. Since its value depends on the type, number and properties of the charge carriers that make up the current, the Hall coefficient characterizes the materials that make up the conductor. In the AS5055 position sensor 153200, Hall effect elements 153228A, 153228B, 153228C, 153228D can produce voltage signals indicative of the absolute position of the magnet in degrees over one revolution of the magnet. This angle value is a unique position signal, calculated by the CORDIC Processor 153236 and stored in a register or memory onboard the AS5055 Position Sensor 153200. Angular values indicative of the position of the magnet over one revolution are provided to the controller 153110 in various techniques, eg, at power up or when requested by the controller 153110 .

The AS5055 Position Sensor 153200 requires only a few external components to operate when connected to the Controller 153110. A simple application using a single power supply requires 6 wires, 2 wires for power and 4 wires 153240 for SPI interface 153234 with controller 153110 . A seventh connection may be added to send an interrupt to the controller 153110 to signal that a new valid angle can be read. On power-up, the AS5055 Position Sensor 153200 performs the entire power-up sequence, including one angle measurement. Completion of this cycle is indicated as INT output 153242 and the angle value is stored in an internal register. When this output is set, the AS5055 Position Sensor 153200 pauses and goes into sleep mode. Controller 153110 can respond to INT requests on INT output 153242 by reading angle values from AS5055 position sensor 153200 via SPI interface 153234 . When the angle value is read by controller 153110, INT output 153242 is cleared again. Also, sending a "read angle" command to the position sensor 153200 via the SPI interface 153234 by the controller 153110 automatically powers up the chip and initiates another angle measurement. As soon as Controller 153110 has finished reading the angle value, INT Output 153242 is cleared and the new result is stored in the Angle Register. Completion of the angle measurement is again indicated by setting the INT output 153242 and the corresponding flag in the status register.

Due to the AS5055 Position Sensor 153200 measurement principle, only a single angle measurement is performed in a very short time (~600 μs) after each power up sequence. As soon as one angle measurement is completed, the AS5055 Position Sensor 153200 pauses and transitions to the power off state. On-chip filtering of angle values by digital averaging is not implemented because it requires multiple angle measurements, resulting in longer power-up times, which is undesirable for low power applications. Angular jitter may be reduced by averaging several angular samples in controller 153110 . For example, averaging 4 samples reduces the jitter by 6 dB (50%).

82 is a cross-sectional view of an end effector 153502 showing the firing stroke of an I-beam 153514 against tissue 153526 grasped within the end effector 153502, in accordance with at least one aspect of the present disclosure. End effector 153502 is configured to work with any surgical instrument or system according to the present disclosure. End effector 153502 comprises anvil 153516 and elongated channel 153503 with staple cartridge 153518 positioned within elongated channel 153503 . Firing bar 153520 is translatable distally and proximally along longitudinal axis 153515 of end effector 153502 . When the end effector 153502 is not articulated, the end effector 153502 is aligned with the shaft of the instrument. An I-beam 153514 containing a cutting edge 153509 is shown at the distal portion of firing bar 153520 . Wedge sled 153513 is positioned within staple cartridge 153518 . As I-beam 153514 translates distally, cutting edge 153509 may contact and cut tissue 153526 positioned between anvil 153516 and staple cartridge 153518 . I-beam 153514 also contacts wedge sled 153513 and pushes it distally, bringing wedge sled 153513 into contact with staple driver 153511 . The staple driver 153511 is pushed up into the table 153505 to advance the staple 153505 through the tissue and into the pocket 153507 defined in the anvil 153516, which forms the staple 153505.

An exemplary I-beam 153514 firing stroke is illustrated by chart 153529 in alignment with end effector 153502 . Exemplary tissue 153526 is also shown aligned with end effector 153502 . A firing member stroke may include a stroke start position 153527 and an end stroke position 153528 . During the firing stroke of I-beam 153514 , I-beam 153514 may advance distally from stroke start position 153527 to stroke end position 153528 . I-beam 153514 is shown at one exemplary location at stroke start position 153527 . Firing member stroke chart 153529 for I-beam 153514 illustrates five firing member stroke regions 153517, 153519, 153521, 153523, 153525. At first firing stroke region 153517, I-beam 153514 may begin to advance distally. In the first firing stroke region 153517, I-beam 153514 may contact wedge sled 153513 and begin to move it distally. However, while in the first region, cutting edge 153509 may not contact tissue and wedge thread 153513 may not contact staple driver 153511 . After overcoming static friction, the force driving I-beam 153514 in first region 153517 may be substantially constant.

In the second firing member stroke region 153519, the cutting edge 153509 may contact tissue 153526 and begin cutting. Also, wedge sled 153513 may begin to contact staple driver 153511 to drive staple 153505 . The force driving I-beam 153514 may begin to rise. As shown, the initially impinged tissue may be compressed and/or become thinner due to the manner in which the anvil 153516 pivots relative to the staple cartridge 153518 . In the third firing member stroke region 153521 , cutting edge 153509 may continuously contact and cut tissue 153526 and wedge sled 153513 may repeatedly contact staple driver 153511 . The force driving the I-beam 153514 may level off within the third region 153521 . By the fourth firing stroke region 153523, the force driving I-beam 153514 may begin to drop. For example, tissue in the portion of the end effector 153502 corresponding to the fourth firing region 153523 may be less compressed than tissue closer to the pivot point of the anvil 153516, requiring less force to cut. Also, cutting edge 153509 and wedge thread 153513 may reach the edge of tissue 153526 while in fourth region 153523 . When I-beam 153514 reaches fifth region 153525, tissue 153526 may be completely cut. Wedge sled 153513 may contact one or more staple drivers 153511 at or near the edge of the tissue. The force driving the I-beam 153514 through the fifth region 153525 may be reduced, and in some examples may be comparable to the force driving the I-beam 153514 within the first region 153517. . At the end of the firing member's stroke, the I-beam 153514 may reach the end-of-stroke position 153528 . The positioning of firing member stroke regions 153517, 153519, 153521, 153523, 153525 in FIG. 82 is merely an example. In some examples, different regions may start at different locations along the longitudinal axis 153515 of the end effector based on, for example, tissue positioning between the anvil 153516 and staple cartridge 153518 .

80-82, positioned within the master controller of the surgical instrument for stapling and/or dissecting tissue captured within the end effector 153502. An electric motor 153120 may be utilized to advance and/or retract the shaft assembly's firing system, including the I-beam 153514, relative to the shaft assembly's end effector 153502. I-beam 153514 may be advanced or retracted at a desired velocity or within a desired range of velocities. Controller 153110 may be configured to control the velocity of I-beam 153514 . Controller 153110 may control I-beam 153514 based on various parameters of power supplied to electric motor 153120, such as, for example, voltage and/or current, and/or other operating parameters of electric motor 153120 or external influences. It can be configured to predict velocity. Controller 153110 also determines the current current of I-beam 153514 based on previous values of current and/or voltage supplied to electric motor 153120 and/or previous states of the system, such as velocity, acceleration, and/or position. It can be configured to predict velocity. Controller 153110 may be configured to sense the velocity of I-beam 153514 utilizing the absolute positioning sensor system described herein. The controller compares the predicted velocity of I-beam 153514 with the sensed velocity of I-beam 153514 to determine whether power to electric motor 153120 should be increased to increase the velocity of I-beam 153514. and/or should be decreased to reduce the velocity of I-beam 153514 .

The forces acting on I-beam 153514 may be determined using various techniques. The force of I-beam 153514 may be determined by measuring the current of motor 153120, which is based on the load experienced by I-beam 153514 as it advances distally. The force of the I-beam 153514 may be determined by positioning strain gauges on the drive member, firing member, I-beam 153514, firing bar, and/or on the proximal end of the cutting blade 153509. The force of the I-beam 153514 monitors the actual position of the I-beam 153514 moving at a speed predicted based on the current set speed of the motor 153120 after a predetermined elapsed time period _T1 , and determines the actual position of the I-beam 153514. , may be determined by comparing to the predicted position of I-beam 153514 based on the current set speed of motor 153120 at the end of time period _T1 . Therefore, if the actual position of I-beam 153514 is less than the predicted position of I-beam 153514, the force on I-beam 153514 is greater than the nominal force. Conversely, if the actual position of I-beam 153514 exceeds the expected position of I-beam 153514, the force on I-beam 153514 is less than the nominal force. The difference between the actual and expected position of I-beam 153514 is proportional to the deviation of the force on I-beam 153514 from the nominal force.

Before turning to the description of the closure tube and firing member closed loop control technique, the description briefly refers to FIG. FIG. 83 shows a graph 153600 depicting two force-to-close (FTC) plots 153606, 153608 depicting the force applied to the closure member to close on thick and thin tissue during the closing phase, and a graph 153600 depicting thick and thin tissue during the firing phase. 153601 is a graph 153601 depicting two firing force (FTF) plots 153622, 153624 depicting forces applied to a firing member to fire to penetrate tissue; Referring to FIG. 83, a graph 153600 of forces applied to thick and thin tissue during the closing stroke to close the end effector 153502 against tissue grasped between the anvil 153516 and staple cartridge 153518. An example is depicted, where the closure force is plotted as a function of time. Closure force plots 153606, 153608 are plotted on two axes. The vertical axis 153602 represents the closing force (FTC) of the end effector 153502 in Newtons (N). The horizontal axis 153604 shows time in seconds and is labeled t ₀ -t ₁₃ for clarity of illustration. A first closure force plot 153606 is an example of the force applied to thick tissue during the closure stroke to close the end effector 153502 against tissue grasped between the anvil 153516 and staple cartridge 153518; Plot 153608 of 2 is an example of the force applied to thin tissue during the closing stroke to close the end effector 153502 against tissue grasped between the anvil 153516 and staple cartridge 153518 . The first closing force plot 153606 and the second closing force plot 153608 are divided into three phases: closing stroke (closed), waiting interval (waiting), and firing stroke (firing). During the closure stroke, the closure tube is translated distally (direction “DD”) to move anvil 153516 relative to, for example, staple cartridge 153518 in response to actuation of the closure stroke by the closure motor. In other examples, the closure stroke involves moving the staple cartridge 153518 relative to the anvil 153516 in response to actuation of the closure motor, and in other examples the closure stroke is responsive to actuation of the closure motor. , staple cartridge 153518 and anvil 153516 are moved. Referring to the first closing force plot 153606, the closing force 153610 in the closing stroke increases from 0 to a maximum force F ₁ from time t ₀ to t ₁ . Referring to the second closing force graph 153608, the closing force 153616 during the closing stroke increases from 0 to a maximum force F ₃ from time t ₀ -t ₁ . The relative difference between the maximum forces F ₁ and F ₃ is due to the difference in closing force required for thick versus thin tissue, with more force required to close the anvil over thick tissue versus thin tissue. A large force is required.

A first closure force plot 153606 and a second closure force plot 153608 show that the closure force within the end effector 153502 increases during the initial gripping period ending at time (t ₁ ). The closing force reaches a maximum force (F ₁ , F ₃ ) at time (t ₁ ). The initial gripping period can be, for example, about 1 second. A waiting interval may be applied before beginning the firing stroke. The waiting section allows for fluid evacuation from tissue compressed by the end effector 153502, which reduces the thickness of the compressed tissue, resulting in a smaller gap and waiting section between the anvil 153516 and staple cartridge 153518. Resulting in a lower closing force at the end. Referring to the first closing force plot 153606, there is a slight drop in closing force 153612 from _F1 to _F2 during the waiting interval _t1 - _t4 . Similarly, referring to the second closing force plot 153608, the closing force 153618 drops slightly from _F3 to _F4 during the waiting interval _t1 - _t4 . In some embodiments, a waiting interval (t ₁ -t ₄ ) selected from the range of about 10 seconds to about 20 seconds is typically used. In the example first closure force plot 153606 and second closure force plot 153608, a time period of approximately 15 seconds is used. After the waiting interval is the firing stroke, which lasts for a period of time selected from, for example, about 3 seconds to, for example, about 5 seconds. Closure force decreases as the I-beam 153514 is advanced relative to the end effector during the firing stroke. As shown by the closure forces 153614, 153620 of the first closure force plot 153606 and the second closure force plot 153608, the closure force 153614, 153620 exerted on the closure tube sharply increases from about time _t4 to about time _t5 . to Time _t4 represents the moment when I-beam 153514 couples into anvil 153516 and begins to experience a closing load. Therefore, the closing force decreases as the firing force increases, as shown by the first firing force plot 153622 and the second firing force plot 153624.

FIG. 83 also shows a graph 153601 of a first firing force plot 153622 and a second firing force plot 153624 plotting the force applied to advance the I-beam 153514 during the firing stroke of a surgical instrument or system according to the present disclosure. is illustrated. Firing force plots 153622, 153624 are plotted on two axes. The vertical axis 153626 indicates the firing force in Newtons (N) applied to advance the I-beam 153514 during the firing stroke. I-beam 153514 is configured to advance the knife or cutting element and propel the driver to deploy staples during the firing stroke. Horizontal axis 153605 shows time in seconds on the same time scale as horizontal axis 153604 of graph 153600 above.

As previously described, the closure tube force drops sharply from time t ₄ to about time t ₅ , as indicated by first firing force plot 153622 and second firing force plot 153624. , represents the moment when the I-beam 153514 couples into the anvil 153516 and begins to load and the closing force decreases as the firing force increases. I-beam 153514 is advanced from the stroke start position at time t ₄ to the stroke end position at t ₈ -t ₉ of thin tissue force plot 153624 and t ₁₃ of thick tissue force plot 153622 . As the I-beam 153514 is advanced distally during the firing stroke, the closure assembly relinquishes control of the staple cartridge 153518 and anvil 153516 to the firing assembly, thereby increasing firing force and decreasing closure force. Let

In the thick tissue firing force plot 153622 during the firing interval (firing), the plot 153622 is divided into three separate segments. The first segment 153628 shows the launch force as it increases from 0 at _t4 to a peak force _F'1 just before _t5 . The first segment 153628 is the firing force during the early stages of the firing stroke, as the I-beam 153514 advances distally from the top of the closing ramp until the I-beam 153514 contacts tissue. A second segment 153630 shows the firing force in the second stage of the firing stroke, as the I-beam 153514 advances distally to deploy staples and cut tissue. In the second phase of the firing stroke, the firing force drops from _F'1 to _F'2 at approximately _t12 . The third segment 153632 shows the firing force during the third or final stage of the firing stroke, as the I-beam 153514 leaves the tissue and advances to the end of the stroke in an area free of tissue. In the third stage of the firing stroke, the firing power drops from _F'2 to zero (0) at approximately _t13 , when I-beam 153514 reaches the end of the stroke. In summary, during the firing stroke, the firing force rises dramatically as the I-beam 153514 enters the tissue area and gradually decreases within the tissue area during stapling and cutting operations until the I-beam 153514 penetrates the tissue area. It drops dramatically when exiting and entering a tissue-free area at the end of the stroke.

The thin tissue force plot 153624 follows a similar pattern as the thick tissue force plot 153622 . Thus, in the first phase of the firing stroke, firing force 153634 increases dramatically from 0 to _F'3 at approximately _t5 . In the second stage of the firing stroke, the firing force 153636 decreases uniformly from _F'3 to _F'4 at approximately _t8 . In the final stages of the firing stroke the firing force 153638 drops dramatically from _F'4 to 0 from _t8 - _t9 .

The moment the I-beam 153514 couples into the anvil 153516 and begins to load and the closing force decreases as the firing power increases, as shown in the first firing power plot 153622 and the second firing power plot 153624. To overcome the sudden drop in closure force from time t ₄ to about time t ₅ , the obturator tube is advanced distally while a firing member such as I-beam 153514 is advanced distally can be A closure tube is represented as a transmission element that applies a closure force to anvil 153516 . As described herein, the control circuit applies the motor settings to the motor control, which applies the motor control signal to the motor to drive the transmission element and distally advance the obturator tube. to apply a closing force to the anvil 153516. A torque sensor coupled to the output shaft of the motor can be used to measure the force applied to the closure tube. Alternatively, the closing force may be measured with strain gauges, load cells, or other suitable force sensors.

FIG. 84 illustrates a closing member (e.g., closing member) as the firing member (e.g., I-beam 153514) advances distally and couples within a grasping arm (e.g., anvil 153516), according to at least one aspect of the present disclosure. 153950 is a view of a control system 153950 configured to provide gradual closure to a tube) to reduce the closure force load on the closure member at a desired rate and reduce the firing force load on the firing member. In one aspect, control system 153950 may be implemented as a nested PID feedback controller. A PID controller is a control-loop feedback mechanism (controller) for continuously calculating an error value as the difference between a desired setpoint and a measured process variable, with proportional, integral, and derivative terms (P , I, and D). Nested PID controller feedback control system 153950 includes primary controller 153952 in primary (outer) feedback loop 153954 and secondary controller 153955 in secondary (inner) feedback loop 153956 . Primary controller 153952 may be PID controller 153972 as shown in FIG. 84 and secondary controller 153955 may also be PID controller 153972 as shown in FIG. Primary controller 153952 controls primary process 153958 and secondary controller 153955 controls secondary process 153960 . The output 153966 (output) of the primary process 153958 is subtracted from the primary set point SP ₁ by a first adder 153962 . First adder 153962 produces a single sum output signal that is applied to primary controller 153952 . The output of primary controller 153952 is secondary set point _SP2 . The output 153968 of the secondary process 153960 is subtracted from the secondary set point _SP2 by a second adder 153964 .

In the context of controlling the displacement of the closure tube, the control system 153950 will assume that the primary set point SP ₁ is the desired closure force value and the primary controller 153952 will receive the closure force from a torque sensor coupled to the output of the closure motor. , may be configured to determine the motor speed of the closing motor set point _SP2 . Alternatively, the closing force may be measured with strain gauges, load cells, or other suitable force sensors. The closure motor speed setpoint SP ₂ is compared to the actual speed of the closure tube as determined by secondary controller 153955 . The actual velocity of the closed tube can be determined by comparing the measurement of the closed tube displacement using a position sensor and the elapsed time measurement using a timer/counter. Other techniques such as linear or rotary encoders can be used to measure the displacement of the closed tube. The output 153968 of secondary process 153960 is the actual velocity of the closed tube. This closure tube velocity output 153968 is provided to a primary process 153958 that determines the force acting on the closure tube and is fed back to a summer 153962 that subtracts the measured closure force from the primary set point _SP1 . The primary set point SP ₁ may be an upper threshold or a lower threshold. Based on the output of summer 153962, primary controller 153952 controls the speed and direction of the closed tube motor. The secondary controller 153955 is based on the actual velocity of the closed tube as measured by the secondary process 153960 and a secondary set point _SP2 based on a comparison of the actual firing power to upper and lower firing power thresholds. to control the speed of the closing motor.

FIG. 85 illustrates a PID feedback control system 153970, according to at least one aspect of the present disclosure. Primary controller 153952 or secondary controller 153955 or both may be implemented as PID controller 153972 . In one aspect, the PID controller 153972 may include a proportional element 153974 (P), an integral element 153976 (I), and a derivative element 153978 (D). The outputs of P element 153974, I element 153976 and D element 153978 are added by adder 153986 which provides control variable u(t) to process 153980. The output of process 153980 is the process variable y(t). Summer 153984 calculates the difference between the desired setpoint r(t) and the measured process variable y(t). PID controller 153972 provides an error value e(t ) (e.g., the difference between the closure force threshold and the measured closure force), calculated by the proportional component 153974 (P), the integral component 153976 (I), and the derivative component 153978 (D), respectively. Apply corrections based on proportional, integral, and derivative terms. PID controller 153972 attempts to minimize error e(t) over time by adjusting control variables u(t) (eg, velocity and direction of the closed tube).

According to the PID algorithm, the "P" element 153974 corresponds to the current value of the error. For example, if the error is large and positive, the control output will also be large and positive. According to the present disclosure, the error term e(t) is different between the desired closure force and the measured closure force of the closure tube. The "I" element 153976 corresponds to the past value of the error. For example, if the current output is not strong enough, the error integral accumulates over time and the controller responds by applying stronger action. The 'D' element 153978 corresponds to the possible future trend of the error based on its current rate of change. For example, returning to the P example above, if a large positive control output succeeds in driving the error closer to zero, it also puts the process on a path to a large negative error in the near future. In this case the derivative becomes negative and the D module reduces the strength of the motion to prevent this overshoot.

It will be appreciated that other variables and setpoints may be monitored and controlled according to feedback control systems 153950, 153970. For example, the adaptive closure member velocity control algorithm described herein provides, among other things, the parameters of firing member stroke position, firing member load, cutting element displacement, cutting element velocity, closure tube stroke position, closure tube load. At least two of them can be measured.

FIG. 86 is a logic flow diagram depicting a control program or logic configuration process 153990 for determining closure member velocity, in accordance with at least one aspect of the present disclosure. A control circuit of a surgical instrument or system according to the present disclosure is configured 153992 to determine the actual closure force of the closure member. The control circuit compares the actual closing force to a threshold closing force 153994 and determines a setpoint velocity for displacing the closing member 153996 based on this comparison. A control circuit controls the actual speed of the closure member 153998 based on the setpoint speed.

84 and 85, in one aspect, the control circuit comprises a proportional, integral and derivative (PID) feedback control system 153950, 153970. The PID feedback control system 153950, 153970 comprises a primary PID feedback loop 153954 and a secondary PID feedback loop 153956. The primary feedback loop 153954 determines a first error between the actual closure force of the closure member and the threshold closure force _SP1 and sets the closure member speed set point _SP2 based on the first error. A secondary feedback loop 153956 determines a second error between the actual velocity of the closure member and the setpoint velocity and controls the velocity of the closure member based on the second error.

In one aspect, the threshold closure force _SP1 includes an upper threshold and a lower threshold. The setpoint speed _SP2 is configured to advance the closure member distally when the actual closure force is less than the lower threshold, the setpoint speed is configured to advance the closure member distally when the actual closure force is greater than the lower threshold. Sometimes configured to retract the closure member proximally. In one aspect, the set point speed is configured to hold the closure member in place when the actual closure force is between the upper threshold and the lower threshold.

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

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

The functions or processes 153990 described herein may be performed by any of the processing circuits described herein. Aspects of the powered surgical instrument may be practiced without the specific details disclosed herein. Some aspects are shown in block diagram form, rather than in detail.

Portions of the disclosure may be represented as instructions that operate on data stored in computer memory. An algorithm refers to a self-consistent sequence of steps leading to a desired result, where "steps" take the form of electrical or magnetic signals capable of being stored, transferred, combined, compared and otherwise manipulated. A physical quantity that can be manipulated. These signals may also be referred to as bits, values, elements, symbols, characters, terms or numbers. These and similar terms may be associated with the appropriate physical quantities and are merely convenient labels applied to these quantities.

In general, various aspects described herein may be implemented by various types of "electrical circuit". Consequently, an "electrical circuit" is defined as an electrical circuit comprising at least one individual electrical circuit, an electrical circuit comprising at least one integrated circuit, an electrical circuit comprising at least one application-specific integrated circuit, a computer program forming electrical circuits, memory devices forming general-purpose computing devices (e.g., general-purpose computers or processors configured with a computer program that executes, at least in part, the processes and/or devices described herein); for example, in the form of random access memory) and/or electrical circuits forming a communication device (eg, a modem, a communication switch, or an optoelectronic device). These aspects can be implemented in analog or digital form, or a combination thereof.

The foregoing description sets forth aspects of apparatus and/or processes through the use of block diagrams, flowcharts, and/or examples, which may include one or more features and/or acts. Each function and/or act in such block diagrams, flowcharts, or examples may be individually and/or collectively implemented by a wide variety of hardware, software, firmware, or substantially any combination thereof. be able to. In one aspect, some portions of the subject matter described herein include application specific integrated circuits (ASICs), field programmable gate arrays (FPGAs), digital signal processors (DSPs), programmable logic devices (PLDs), It may be implemented via circuits, registers and/or software components such as programs, subroutines, logic and/or a combination of hardware and software components. Logic gates or other integrated forms. Some aspects of the forms disclosed herein, whether in whole or in part, as one or more computer programs running on one or more computers (e.g., as one or more programs running on one or more computer systems), as one or more programs running on one or more processors (e.g., one or as one or more programs running on two or more microprocessors), as firmware, or substantially any combination thereof, equivalently implemented in an integrated circuit, and It will be appreciated by those skilled in the art that designing circuits and/or writing software and/or firmware code is within the skill of those skilled in the art in view of the present disclosure.

The mechanisms of the disclosed subject matter are capable of being distributed as program products in a variety of forms, and exemplary aspects of the subject matter described herein are specific to the particular software used to accomplish the distribution. is used regardless of the type of signal-carrying medium. Examples of signal-bearing media include: recordable-type media, floppy disks, hard disk drives, compact discs (CDs), digital video discs (DVDs), digital tapes, computer memory, etc., as well as transmission-type media such as digital and/or analog communication media (eg, fiber optic cables, waveguides, wired communication links, wireless communication links (eg, transmitters, receivers, transmission logic, reception logic, etc.).

The foregoing description of these aspects has been presented for purposes of description and illustration. It is not intended to be exhaustive or to be limited to the precise forms disclosed. Modifications or variations are possible in light of the above teachings. These aspects were chosen and described in order to illustrate principles and practical applications, thereby enabling a person skilled in the art to utilize the various aspects, together with various modifications, as suitable for the particular applications envisioned. It is what is done. It is intended that the claims presented herewith define the overall scope.

Situational Awareness Situational awareness is the ability of some aspects of a surgical system to determine or infer information related to a surgical procedure from data received from a database and/or instruments. Information may include the type of procedure being performed, the type of tissue being operated on, or the body cavity being treated. Contextual information related to a surgical procedure allows the surgical system, for example, to control modular devices (e.g., robotic arms and/or robotic surgical tools) connected thereto to contextualize the surgeon during the course of the surgical procedure. The method of providing information or suggestions can be improved.

Referring now to FIG. 87, a timeline 5200 is depicted showing situational awareness of a hub, such as surgical hub 106 or 206, for example. Timeline 5200 is an exemplary surgical procedure and contextual information that surgical hubs 106, 206 can derive from data received from data sources at each step of the surgical procedure. Timeline 5200 is taken by nurses, surgeons, and other medical personnel during the course of a segmentectomy surgery, beginning with setting up the operating room and ending with transferring the patient to the post-operative recovery room. A typical process that might be followed is shown.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Situational awareness is further described 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. In certain examples, operation of a robotic surgical system, including, for example, various robotic surgical systems disclosed herein, is based on its situational awareness and/or feedback from its components and/or from the cloud 104. can be controlled by the hub 106, 206 based on the information in the

Safety System for Smart Powered Surgical Stapling Various aspects of the present disclosure provide internal driving of a surgical instrument in response to tissue parameters sensed via one or more sensors of the surgical instrument. An improved safety system capable of adapting, controlling and/or tuning motion is directed. According to at least one aspect, forces detected via one or more sensors at the jaws of the end effector are used to perform one or more subsequent/further functions of the end effector. may be large enough to prevent According to another aspect, prevent one or more subsequent/further functions of the end effector from being performed, such as within the jaws of the end effector, via one or more sensors. Objects made of metal may also be detected. FIG. 88 shows a surgical system 23000 comprising a surgical instrument 23002, a surgical hub 23004 and a user interface 23006. FIG. In such aspects, the surgical instrument 23002 may include one or more sensors 23008, and the parameters detected by the one or more sensors 23008 of the surgical instrument 23002 are associated with the surgical hub. may be transmitted/communicated (eg, wirelessly) to control circuitry 23010 of 23004 . Further, in such aspects, the surgical hub 23004 performs surgical functions (e.g., dissecting, grasping, coagulating, stapling, cutting) associated with components of the surgical instrument 23002 (e.g., end effectors, shafts, etc.). , rotation, articulation, etc.) can be safely performed based on parameters sensed by one or more sensors 23008 of the surgical instrument 23002. In particular, in such an aspect, the surgical hub 23004 displays the result(s) associated with the determination (i.e., warnings related to the surgical function, reasons why the surgical function is blocked, etc.) on the user interface 23006. may be configured to communicate/communicate to Moreover, according to various aspects, the various user interfaces disclosed herein are selectable to proceed with the surgical function, albeit for reasons that support any warning and/or prevention. User interface features (eg, override element 23012) may also be included. Notably, in such aspects, such user interface features (eg, override element 23012) may not be displayed (eg, performing a surgical function may endanger the patient).

89 in accordance with various aspects of the present disclosure, a surgical system 23100 includes control circuitry and (23112, 23122, 23132 and/or 23142, eg, in phantom lines to indicate any position(s)). ), a user interface (23118, 23128, 23138, 23148 and/or 23158, e.g., in phantom to indicate any position), e.g., handle assembly 23110, shaft assembly 23120, and end effector assembly. a surgical instrument 23102 including 23130; In such aspects, control circuitry is incorporated into one or more components of surgical instrument 23102 (eg, handle assembly 23110, shaft assembly 23120 and/or end effector assembly 23130, etc.). (eg, 23112, 23122, and/or 23132) and/or may be incorporated (eg, 23142) into a surgical hub 23140 that is paired (eg, wirelessly) with a surgical instrument 23102. In particular, according to various aspects, surgical instrument 23102 and/or surgical hub 23140 may be a context-aware surgical instrument and/or a context-aware surgical hub. Situational awareness is derived from data received from a database (e.g., historical data associated with a surgical procedure, e.g., 23149 and/or 23150) and/or data received from a surgical instrument (e.g., sensor data during a surgical procedure). Refers to the ability of a surgical system, eg, 23100, to determine or extrapolate information regarding a procedure. For example, the determined or inferred information can include the type of procedure to be performed, the type of tissue to be operated on, the body cavity to be treated, and the like. Based on such contextual information associated with the surgical procedure, the surgical system can, for example, control the paired surgical instrument 23102 or components thereof (eg, 23110, 23120 and/or 23130). and/or (eg, via user interfaces 23118, 23128, 23138, 23148 and/or 23158) may provide contextual information or suggestions to the surgeon throughout the course of the surgical procedure. Further details regarding situational awareness can be found, for example, under the heading "Situational Awareness".

Also in FIG. 89 according to one aspect, a context-aware surgical hub 23140 is paired (eg, wirelessly) with a surgical instrument 23102 utilized to perform a surgical procedure. In such aspects, the surgical instrument 23102 includes a first jaw, a second jaw pivotally coupled to the first jaw, and the functions of the end effector 23130 (e.g., cutting, grasping). end effector assembly 23130 including a sensor 23134 configured to detect parameters associated with holding, coagulating, cutting, stapling, etc.) and transmitting the detected parameters to control circuitry 23142 of surgical hub 23140. may be provided.

Further, in such aspects, the surgical instrument 23102 senses parameters associated with the function (eg, rotation, articulation, etc.) of the shaft assembly 23120 and passes the sensed parameters to the control circuitry 23142 of the surgical hub 23140. A shaft assembly 23120 including a sensor 23124 configured to transmit may also be included. In particular, sensors referenced herein and in other disclosed aspects are a plurality of sensors configured to detect a plurality of parameters associated with a plurality of end effector assemblies and/or shaft assembly functions. It should be understood that the Further, in such aspects, therefore, surgical hub control circuitry 23142 is also configured to receive detected parameters (eg, sensor data) from such sensors 23134 and/or 23124 throughout the course of a surgical procedure. may be

The sensed parameter may be a function of the associated end effector assembly 23130 (eg, dissecting, grasping, coagulating, cutting, stapling, etc.) and/or a function of the associated shaft assembly 23120 (eg, rotating, articulating, etc.). exercise, etc.) is performed. Surgical hub control circuitry 23142 may be further configured to receive data from an internal database (eg, surgical hub database 23149) and/or an external database (eg, from cloud database 23150). According to various aspects, data received from internal and/or external databases may be based on procedure data (eg, steps to perform a surgical procedure) and/or historical data (eg, historical data associated with a surgical procedure). data indicating the parameters predicted by

In various aspects, the procedure data may include current/recognized standard treatment procedures for the surgical procedure, and the historical data is historical data associated with the surgical procedure (e.g., system-defined constraints). may include preferred/ideal parameters and/or preferred/ideal parameter ranges based on. Based on the received data (eg, sensor data, internal and/or external data, etc.), the surgical hub control circuitry 23142 continuously derives inferences (eg, contextual information) regarding the ongoing surgical procedure. may be configured to That is, the context-aware surgical hub may, for example, record data about a surgical procedure for generating reports, verify steps taken by a surgeon to perform a surgical procedure, data that may be relevant to a particular procedure step, or provide prompts (e.g., via a surgical hub and/or a user interface associated with the surgical instrument, e.g., 23148, 23158, 23118, 23128 and/or 23138), control functions of the surgical instrument, etc. may be configured to According to various aspects, the context-aware surgical hub 23140 (eg, after a first surgical function of the end effector assembly 23130 or shaft assembly 23120 has been performed) retrieves data from the internal database 23149 and/or the external database 23150 A next surgical function to be performed based on the received treatment data may be estimated.

Further, in such aspects, the context-aware surgical hub 23140 may use detected parameters (e.g., , received from sensors 23134 and/or 23124 in response to the initial surgical function) can be evaluated. Here, if the detected parameters do not exceed the preferred/ideal parameters and/or are within the respective preferred/ideal parameter ranges, then the situational awareness surgical hub 23140 performs the following surgical functions: and/or may not prevent/control from performing subsequent surgical functions. Alternatively, if the detected parameters exceed the preferred/ideal parameters and/or are not within the respective preferred/ideal parameter ranges, then the situational awareness surgical hub 23140 determines that the next surgical function is to be performed. can be proactively prevented.

According to another aspect of the present disclosure, the context-aware surgical hub 23140 communicates that a particular surgical function is being attempted/requested/performed (e.g., the surgical instrument 23102 components, eg, 23130 and/or 23120). In such an aspect, the context-aware surgical hub 23140 provides specific surgical functions to the inferred next surgical procedure to ensure adherence to current/recognized standard of care procedures. You can compare it with the function. In that case, the situational awareness surgical hub 23140 then uses the detected parameters (as described) before allowing a particular surgical function (eg, as described) to proceed. can be evaluated. Otherwise, the situational awareness surgical hub 23140 may block the specific surgical function from being performed, or prevent the specific surgical function from being performed until an override is received. (eg, via user interfaces 23 158, 23148, 23138, 23128, and/or 23118, see, eg, selectable user interface element 23012 in FIG. 88). In such aspects, if an override is received, the context-aware surgical hub 23140 can subsequently evaluate the detected parameter before allowing the particular surgical function to proceed.

Referring again to FIG. 89 according to another aspect, the context-aware surgical instrument 23102 may be utilized to perform surgical procedures. In such aspects, the surgical instrument 23102 may comprise a handle assembly 23110, a shaft assembly 23120 and an end effector assembly 23130. The end effector assembly 23130 includes a first jaw, a second jaw pivotally coupled to the first jaw, and a function of the end effector assembly 23130 (e.g., cutting, grasping, coagulating). , cutting, stapling, etc.) and passing the detected parameters to control circuitry (23112, 23122, 23132 and/or 23142), e.g. and a sensor 23134 configured to transmit to the .

For example, in such aspects the detected parameters may be transmitted to the control circuit 23132 of the end effector assembly 23130 . Here, end effector assembly control circuitry 23132 may be configured to receive sensed parameters (eg, sensor data) from sensors 23134 over the course of a surgical procedure. Sensed parameters may be received each time the associated end effector assembly 23130 function (eg, dissecting, grasping, coagulating, cutting, stapling, etc.) is performed.

The end effector assembly 23130 may receive data from internal databases (eg, end effector memory 23136) and/or external databases (eg, from surgical hub database 23149 through surgical hub 23140 and from cloud database 23150) throughout the course of a surgical procedure. may be further configured to receive a According to various aspects, the data received from the internal and/or external database includes staple cartridge data (eg, size and/or type of staples associated with a staple cartridge positioned within the end effector assembly) and/or or historical data (eg, data indicating predicted tissue and/or types of tissue to be stapled having such size and/or type based on historical data). In various aspects, the received data includes staples of such sizes and/or types, or such predicted tissues and/or types of tissues, based on historical data (e.g., system-defined constraints). may include preferred/ideal parameters and/or preferred/ideal parameter ranges associated with . Based on the received data (eg, sensor data, internal and/or external data, etc.), the end effector control circuitry 23132 is configured to continuously derive inferences (eg, contextual information) regarding the ongoing surgical procedure. may be In particular, according to an alternative aspect, the sensor 23134 of the end effector assembly 23130 associates detected parameters with another surgical instrument 23102 component, such as the handle assembly 23110 and/or the shaft assembly 23120. may be sent to a separate control circuit (eg, 23112 and/or 23122). In such aspects, control circuitry for other surgical instrument components (e.g., 23112 and/or 23122) may be similarly configured to perform various aspects of end effector control circuitry 23132 described above. good. Further, according to various aspects, the shaft assembly 23120 of the surgical instrument 23102 detects parameters associated with the function of the shaft assembly 23120 (e.g., rotation, articulation, etc.) and uses the detected parameters to: It may also include a sensor 23124 configured to send control circuitry (eg, 23112) that is similarly configured to perform various aspects of the end effector control circuitry 23132 described above. Finally, the context-aware surgical instrument 23102 may, for example, be configured to alert its user of the discrepancy (e.g., via the user interface 23138 of the end effector assembly 23130, the configuration of another surgical instrument 23102). A user interface associated with a surgical hub 23140 coupled to a surgical instrument 23102 via elements such as shaft assembly 23120 and/or handle assembly 23110 user interfaces (eg, 23128 and/or 23118) and/or 23148 and/or 23158). For example, discrepancies include detected parameters that are preferred/ideal parameters associated with these sizes and/or types of staples, or their expected tissues and/or tissue types, and/or preferred / Exceeding ideal parameter ranges. As a further example, the context-aware surgical instrument 23102 may be configured to control the functionality of the surgical instrument 23102 based on discrepancies. According to at least one aspect, the context-aware surgical instrument 23102 can block surgical functions based on discrepancies.

Context-Aware Functionality Control As emphasized herein, various aspects of the present disclosure perform a function (e.g., grab), detect parameters associated with that function, and utilize context-aware aspects. and, via a control circuit, that detected parameter is below or above a predefined parameter (e.g., considered ideal/preferred), or within a predefined range for that parameter (e.g., normal and taking action in response to the detected parameter being outside the predefined parameter and/or the predefined parameter range (ie, stop function(s), alert the user, inform the user of possible causes, etc.) to a surgical instrument. For example, FIG. 90 shows that control circuitry receives 23202 sensed parameter(s) associated with a surgical function to be performed by a surgical instrument and retrieves 23204 situational awareness data from internal and/or external databases. , illustrates an algorithm 23200 that implements such aspects. The control circuit then evaluates 23206 the detected parameters in view of the situational awareness data and performs 23208 actions based on the evaluation.

According to various aspects of the present disclosure, forces detected at the jaws of the end effector assembly (eg, via one or more sensors) are detected by one or more of the end effector assemblies. may be of such magnitude that it prevents subsequent/further functions of the from being performed. For example, referring back to FIG. 12, force may be detected via sensors 474, 476 and/or 478. FIG. In such aspects, the sensor 474 may be a strain gauge coupled to the end effector, the strain gauge indicating the closing force being applied to the jaw(s) of the end effector. ) to measure the magnitude/amplitude of the distortion at the Further, in such aspects, sensor 476 may be a load sensor configured to measure the closing force exerted on the jaws by the closing drive system. Further, in such aspects, sensor 478 may be a current sensor configured to measure the current drawn by the motor that correlates to the closing force applied to the jaws. Additionally or as a further example, referring back to FIG. 17, force may be detected via sensors 744a and/or 744b. In such aspects, sensors 744a and/or 744b may be torque sensors configured to provide a firing force feedback signal representative of the closing force applied to the jaws by the closing drive system.

In one aspect, referring back to FIG. 58, a load sensor 152082 (eg, located within the shaft assembly or handle assembly) is configured to detect load after attaching the shaft assembly to the handle assembly. may be In such aspects, the detected load may exceed the predefined load and/or the predetermined load range. In such aspects, for example, referring to FIG. 89, a control circuit associated with a surgical instrument (eg, 23132, 23122 and/or 23112 incorporated into a component of the surgical instrument, or a surgical 23142) built into the hub evaluates the detected loads and uses situational awareness (e.g., based on historical data) to determine if the shaft assembly and/or end effector assembly is damaged. / can determine that it must be damaged. In such aspects, the control circuitry records the unique identifier associated with the shaft assembly 23120 and/or the end effector assembly 23130 and uses that unique identifier for further uses and/or to the handle assembly 23110. It may be configured to designate attachment as prohibited.

In another aspect, for example, referring to FIG. 89, a control circuit associated with a surgical instrument (eg, 23132, 23122 and/or 23112 incorporated into a component of the surgical instrument or coupled to a surgical hub). 23142) evaluates the forces detected/sensed at the jaws (e.g., via one or more sensors as described) and determines the firing function/cycle of the end effector assembly. may be configured to determine to block the Specifically, the control circuit uses situational awareness (e.g., based on historical data) to determine the force detected/sensed at the jaws (e.g., detected before the firing function/cycle begins). exceeds a predefined force and/or a predefined range of forces. In such aspects, the control circuit may be configured to prevent the firing function/cycle from starting. Further, in such aspects, referring again to FIG. 89, the control circuit (eg, the user interface 23138, 23128 and/or 23118 of the surgical instrument components and/or the user interface associated with the surgical hub) 23148 and/or 23158) to alert the user that the firing function/cycle cannot be performed and/or inform the user of possible causes. In accordance with various aspects, the control circuit initiates a firing function/cycle when the force detected/sensed at the jaws drops to a predefined force and/or falls within a predefined range of forces. can be configured to allow initiation.

In another aspect, for example, referring to FIG. 89, a control circuit associated with a surgical instrument (eg, 23132, 23122 and/or 23112 incorporated into a component of the surgical instrument or coupled to a surgical hub). 23142) evaluates the forces detected/sensed at the jaws (e.g., via one or more sensors, e.g., load sensors, torque sensors, etc., as described). , may be initially determined to enable the firing function/cycle of the end effector assembly. However, after initiating a fire function/cycle, the control circuit uses situational awareness (e.g., based on historical data) to determine if the force to fire (e.g., detected during the fire function/cycle) is , a predefined firing force and/or a predefined firing force range may be determined to be exceeded. In such aspects, the control circuit may be configured to stop the firing function/cycle (eg, prevent the firing function/cycle from continuing). Further, in such embodiments, referring again to FIG. 89, the control circuit provides a warning to the surgeon (e.g., a surgical via the user interfaces 23138, 23128 and/or 23118 of the instrument components and/or the user interfaces 23148 and/or 23158 associated with the surgical hub). According to various aspects, the control circuit receives an override command (eg, via the user interface(s), see FIG. 88, selectable user interface element 23012) to perform the firing function/cycle. may be further configured to allow the . In such aspects, the control circuit uses situational awareness (eg, based on historical data) to determine if the second firing force (eg, detected during continued firing functions/cycles) It may be determined that two predetermined firing powers and/or a range of second predetermined firing powers (eg, a higher threshold) are exceeded. In such aspects, the control circuit may be configured to stop the firing function/cycle again, alert the surgeon, and/or receive an override command as described.

In another aspect, for example, referring to FIG. 89, a control circuit associated with a surgical instrument (eg, 23132, 23122 and/or 23112 incorporated into a component of the surgical instrument or coupled to a surgical hub). 23142) may evaluate forces detected/sensed at the jaw (eg, via one or more sensors as described). Additionally, the control circuit may further evaluate the forces detected/sensed within the shaft assembly (ie, via one or more sensors as described). Here, according to various aspects, the control circuit reciprocates forces detected/sensed at the jaws and/or forces detected/sensed within the shaft assembly while the surgical procedure is being performed. You can refer to it. According to such aspects, the control circuit uses situational awareness (e.g., based on treatment data and/or historical data) to determine whether the detected/sensed forces within the shaft assembly are pre-defined shaft forces and /or It may be determined that a predefined shaft force range is exceeded. In one example, the shaft assembly may comprise a specialized shaft assembly configured for use with specific tissue types in specific surgical procedures. In such aspects, the control circuit uses situational awareness (e.g., based on treatment data and/or historical data) to determine if the force detected/sensed within the specialized shaft assembly is too high (e.g., prior defined shaft force and/or range of predefined shaft forces associated with a special shaft assembly), and/or the force detected/sensed at the jaws is not the predefined force, and/or It may be determined that it is not within a predefined range (eg, a predicted force historically associated with the surgical procedure being performed). In such aspects, the control circuit may be configured to stop the firing function/cycle (eg, prevent the firing function/cycle from starting and/or continuing). Further, in such embodiments, referring back to FIG. 89, the control circuit provides a warning to the surgeon (e.g., user interface of the surgical instrument component) regarding shaft force and/or ranges of shaft force that exceed limits. 23138, 23128 and/or 23118 and/or via user interfaces 23148 and/or 23158 associated with the surgical hub). In various aspects, the alert alerts the surgeon to, for example, removing a specialized shaft assembly 23120 from the handle assembly 23110 and attaching it to the handle assembly 23110 of another shaft assembly (e.g., detected/sensed force and In some cases, the surgeon is informed of the configured regular reloading of the tissue encountered. In such aspects, the control circuit may be configured to allow the firing function/cycle to begin and/or continue when the appropriate shaft assembly is attached.

In another aspect, for example, referring to FIG. 89, a control circuit associated with a surgical instrument (eg, 23132, 23122 and/or 23112 incorporated into a component of the surgical instrument or coupled to a surgical hub). 23142) may assess the forces detected/sensed at the jaw during the surgical procedure (eg, via one or more sensors as described). In accordance with such aspects, the control circuit uses contextual awareness (eg, based on treatment and/or historical data) to determine tissue creep latency at a particular thickness being grasped during a surgical procedure. be below a predefined creep latency and/or range of predefined creep latencies associated with a particular tissue. Stated another way, considering FIGS. 83 and 84 herein, the initial force to close decays faster than expected and creep stability is reached at a lower force to close. obtain. In such aspects, the control circuit may be configured to stop the firing function/cycle (eg, prevent the firing function/cycle from starting and/or continuing). Further, in such aspects, referring again to FIG. 89, the control circuitry (eg, user interfaces 23138, 23128 and/or 23118 of components of the surgical instrument and/or user interfaces associated with the surgical hub) 23148 and/or 23158) may be configured to provide a warning to the surgeon regarding reduced creep latency. In various aspects, a warning is provided to the surgeon, e.g., to remove an end effector assembly, e.g., 23130, from the handle assembly and to process another end effector assembly, e.g., tissue with a detected creep latency. The surgeon may be informed to attach the configured end effector assembly) to the handle assembly 23110. In such aspects, the control circuitry may be configured to allow the firing function/cycle to begin and/or continue when the appropriate end effector assembly is attached.

In another aspect, for example, referring to FIG. 89, a control circuit associated with a surgical instrument (eg, 23132, 23122 and/or 23112 incorporated into a component of the surgical instrument or coupled to a surgical hub). 23142) may evaluate detected/sensed forces at the jaw (eg, via one or more sensors as described). Additionally, the control circuitry may further evaluate the detected/sensed position (ie, via one or more sensors) relative to the articulating member. For example, referring back to FIG. 12, the position can be detected/sensed by a sensor 472 coupled to the articulating member. In one aspect, sensor 472 may be a position sensor configured to measure linear displacement, where a single rotation of the sensor element corresponds to a specific linear displacement of the articulating member. In another example, referring back to FIG. 17, position may be sensed/detected by a position sensor 734 located within the end effector. Here, position sensor 734 may be a sensor configured to provide a series of pulses trackable by control circuitry to determine the position of the articulating member. Here, according to various aspects, the control circuit cross-references the detected/sensed force at the jaws and/or the detected/sensed position with respect to the articulating member undergoing the surgical procedure. good too. According to such aspects, the control circuit uses situational awareness (eg, based on treatment data and/or historical data) to determine whether the articulation member is in a predetermined advanced position and/or range of predetermined advanced positions. may be determined (eg, within the shaft assembly) to have advanced beyond . In various aspects, the predetermined advanced position and/or the range of predetermined advanced positions can be correlated to the closing force detected/sensed at the jaws. In such an aspect, beyond a specified predetermined advance position, the control circuit stops the firing function/cycle (e.g., prevents the firing function/cycle from starting and/or continuing). ) can be configured as follows: Further, in such aspects, referring again to FIG. 89, the control circuitry (eg, user interfaces 23138, 23128 and/or 23118 of components of the surgical instrument and/or user interfaces associated with the surgical hub) 23148 and/or 23158) may be configured to provide warnings to the surgeon as to advance positions and/or ranges of advance positions beyond limits. In various aspects, the warning may inform the surgeon to consider retracting the articulation member to and/or within a predetermined advanced position. Here, in one embodiment, a given advanced position and/or a range of given advanced positions has a history-achieved desired and/or successful firing function/cycle with respect to a corresponding closing force. can. In such aspects, the control circuitry may be configured to allow the firing function/cycle to begin and/or continue when the proper forward position is achieved.

In another aspect, for example, referring to FIG. 89, a control circuit associated with a surgical instrument (eg, 23132, 23122 and/or 23112 incorporated into a component of the surgical instrument or coupled to a surgical hub). 23142) may assess the forces detected/sensed at the jaw during the surgical procedure (eg, via one or more sensors as described). In accordance with such aspects, the control circuit uses situational awareness (eg, based on treatment data and/or historical data) to determine whether the force to close is being grasped during the surgical procedure. may be determined to exceed a predefined force-to-close and/or a range of predefined force-to-close associated with the tissue. Stated another way, in light of FIGS. 83 and 84 herein, the detected/sensed force to close is expected to allow the firing function/cycle to proceed. higher than In such aspects, the control circuit may be configured to stop the firing function/cycle (eg, prevent the firing function/cycle from starting and/or continuing). Further, in such embodiments, referring again to FIG. 89, the control circuit alerts the surgeon (e.g., user interfaces 23138, 23128 and/or user interfaces of surgical instrument components) of increased force to close. or 23118 and/or via user interfaces 23148 and/or 23158 associated with the surgical hub). In various aspects, the warning may notify the surgeon to consider adjusting the firing motor speed. In one example, if the particular tissue is hard tissue, the warning may suggest that the surgeon slow down the firing motor to avoid tearing the hard tissue. In such aspects, the down-adjustment may be based on historical data associated with the surgical procedure being performed. In another example, if the particular tissue is soft tissue with low shear strength, the alert suggests that the surgeon adjust the firing motor speed to ensure that the tissue is properly grasped. obtain. In such aspects, upregulation may be based on historical data associated with the surgical procedure being performed. In such aspects, the control circuitry may be configured to allow the firing function/cycle to begin and/or continue when the appropriate firing motor speed is set.

In another aspect, for example, referring to FIG. 89, a control circuit associated with a surgical instrument (eg, 23132, 23122 and/or 23112 incorporated into a component of the surgical instrument or coupled to a surgical hub). 23142) may assess the forces detected/sensed at the jaw during the surgical procedure (eg, via one or more sensors as described). According to such aspects, the control circuit uses situational awareness (e.g., based on treatment data and/or historical data) to allow periodic forces on the launch system to be pre-defined during a surgical procedure. It may be determined that the cyclic force and/or a predefined cyclic force range is exceeded. Stated another way, the detected/sensed periodic force may be higher than expected, indicating an impending motor failure based on historical data. In such aspects, the control circuitry may be configured to stop the firing function/cycle (eg, prevent initiation of the firing function/cycle and/or continued advancement). Further, in such embodiments, referring again to FIG. 89, the control circuit will alert the surgeon (e.g., to the user interface of the surgical instrument component) regarding elevated cyclic forces and possible motor failure. 23138, 23128 and/or 23118 and/or via user interfaces 23148 and/or 23158 associated with the surgical hub). According to various aspects, the control circuit receives an override command (eg, via the user interface, see, eg, FIG. 88, selectable user interface element 23012) and the firing function/cycle continues. may be further configured to allow In such aspects, the control circuit continues to monitor whether the cyclic force on the firing system exceeds the predefined cyclic force and/or the predefined cyclic force range during the surgical procedure. be able to. In such aspects, the control circuit may be configured to stop the firing function/cycle again, alert the surgeon, and/or receive an override command as described.

According to another aspect of the present disclosure, for example, referring to FIG. 89, a control circuit (eg, 23132, 23122 and/or 23112 incorporated into or coupled to a component of the surgical instrument) associated with the surgical instrument. 23142) may evaluate detected/sensed forces at the jaws (eg, via one or more sensors as described). Additionally, the control circuit may further evaluate the force/torque for articulating the end effector assembly 23130 . In such aspects, the articulation force/torque drives one or more sensors (e.g., a force sensor associated with the articulation member, a torque sensor associated with the articulation member, a torque sensor associated with the articulation member, a may be detected via a current sensor associated with a motor configured as such). For example, referring back to FIG. 17, articulation force/torque may be detected/sensed by torque sensors 744d and/or 744e coupled to the articulation drive system. Additionally and/or alternatively, referring again to FIG. 17, articulation force/torque may be correlated to the current drawn by motors 704d and/or 704e, as measured by sensor 736. FIG. Here, according to various aspects, the control circuit cross-references detected/sensed forces at the jaws and/or detected articulation forces/torques on the articulating member undergoing the surgical procedure. You may According to such aspects, the control circuit uses situational awareness (eg, based on treatment and/or historical data) to determine the articulation forces/torques sensed for the articulation members at the predefined joints. Exceeding a motion force/torque and/or a predefined joint motion force/torque range may be determined. In various aspects, a predefined articulation force/torque and/or a predefined articulation force/torque range may correlate to forces detected/sensed at the jaws. In such aspects, the control circuit is configured to stop articulation of the end effector assembly (e.g., prevent continued articulation) when a specified articulation force/torque is exceeded. may Further, in such embodiments, referring again to FIG. 89, the control circuit provides warnings to the surgeon (e.g., user of surgical instrument components) regarding ultrasonic force/torque and/or articulation force/torque ranges. via interfaces 23138, 23128 and/or 23118 and/or user interfaces 23148 and/or 23158 associated with the surgical hub). According to various aspects, the control circuit receives an override command (eg, via a user interface, see, eg, FIG. 88, selectable user interface element 23012) to continue the firing function/cycle. may be further configured to allow for In such aspects, the control circuitry may continue to monitor whether the articulation force/torque exceeds the predefined articulation force/torque and/or the predefined articulation force/torque range during the surgical procedure. can. In such aspects, the control circuitry may be configured to stop articulation, alert the surgeon, and/or receive an override command as described.

According to yet another aspect of the present disclosure, for example, referring to FIG. 89, a control circuit (eg, 23132, 23122 and/or 23112 incorporated into or coupled to a component of the surgical instrument) associated with the surgical instrument. 23142) may evaluate detected/sensed forces at the jaws (eg, via one or more sensors as described). Additionally, the control circuit may further evaluate the force/torque for rotating the shaft assembly 23120 (eg, shaft member). In such aspects, the rotational force/torque is detected by one or more sensors (e.g., a force sensor associated with the rotating/shaft member, a torque sensor associated with the rotating/shaft member, a rotating/shaft member). such as a current sensor associated with a motor configured to rotate). For example, referring back to FIG. 17, rotational force/torque may be detected/sensed by a torque sensor 744c coupled to the rotational/shaft member drive system. Additionally and/or alternatively, referring again to FIG. 17, the rotational force/torque may be correlated to the current drawn by motor 704c as measured by sensor 736. Here, according to various aspects, the control circuit cross-references detected/sensed forces at the jaws and/or detected rotational forces/torques with respect to the rotating/shaft member on which the surgical procedure is being performed. You may According to such aspects, the control circuit uses situational awareness (e.g., based on treatment data and/or historical data) to determine whether the detected rotational force/torque on the rotational/shaft member is a predetermined rotational force. It may be determined that the force/torque and/or pre-defined rotational force/torque ranges are exceeded. In various aspects, the predefined rotational force/torque and/or the predefined rotational force/torque range can be correlated to the force detected/sensed at the jaws. In other aspects, the predefined rotational force/torque and/or the predefined rotational force/torque range may correspond to the force/torsion that the rotating/shaft member itself can withstand. In such aspects, the control circuit is configured to stop rotation of the shaft assembly (e.g., prevent continued rotation/rotation of the shaft member) when a specified rotational force/torque is exceeded. may be Further, in such embodiments, referring again to FIG. 89, the control circuit provides a warning to the surgeon (e.g., a user of the surgical instrument component) regarding excessive torque/torque and/or range of torque/torque. via interfaces 23138, 23128 and/or 23118 and/or user interfaces 23148 and/or 23158 associated with the surgical hub). According to various aspects, the control circuit receives an override command (eg, via a user interface, see, eg, FIG. 88, selectable user interface element 23012) to prevent rotation from continuing. It may be further configured to allow. In such aspects, the control circuit can continue to monitor whether the rotational force/torque exceeds the predefined rotational force/torque and/or the predefined rotational force/torque range during the surgical procedure. . In such aspects, the control circuit may be configured to stop rotation again, alert the surgeon, and/or receive an override command as described.

According to yet another aspect of the present disclosure, for example, referring to FIG. 89, control circuitry associated with a surgical instrument (eg, 23132, 23122 and/or 23112 incorporated into components of the surgical instrument, and 23142), which is incorporated into the combined surgical hub, evaluates the opening force detected/sensed at the jaws (e.g., via one or more sensors as described) so that the jaws It may be configured to determine to prevent opening. Specifically, the control circuit uses situational awareness (e.g., based on historical data) to determine whether the detected/sensed opening force at the jaw is a predefined opening force and/or It may be determined that the range is exceeded. In such aspects, the control circuitry may be configured to maintain the jaws in a gripped or partially gripped position. Further, in such aspects, referring again to FIG. 89, the control circuit (eg, the user interface 23138, 23128 and/or 23118 of the surgical instrument components and/or the user interface associated with the surgical hub) 23148 and/or 23158 via 23148 and/or 23158) to alert the user that the jaws cannot be opened and/or inform the user of possible causes (e.g., if the user detects/ so that it can attempt to reduce the sensed opening force). According to various aspects, the control circuit causes the jaws to open when the detected/sensed opening force on the jaws is reduced to a predefined opening force and/or within a predefined opening force range. may be configured to allow

Short Circuit Detection and Functionality Control According to various other aspects of the present disclosure, the functionality of the surgical instrument may be controlled based on one or more sensors configured to detect short circuits. good. That is, if a metal object is detected within the jaws, at least one surgical instrument function/operation (eg, cutting, coagulating, etc.) may be blocked/inhibited. For example, FIG. 91 shows an algorithm 23300 for implementing such aspects, wherein the control circuit receives 23302 detected parameter(s) indicative of a short circuit. The control circuit may also retrieve 23304 internal and/or external database data. The control circuit then evaluates the detected parameter(s) and/or database data 23306 and takes action 23308 based on the evaluation.

Referring again to FIG. 89 according to aspects of the present disclosure, surgical system 23100 includes control circuitry and (23112, 23122, 23132 and/or 23142, eg, in phantom to indicate any position(s)). , a user interface (23118, 23128, 23138, 23148 and/or 23158, e.g., in phantom to indicate any position), e.g., handle assembly 23110, shaft assembly 23120, and end effector assembly 23130. A surgical instrument 23100 may be provided. In such aspects, the control circuit controls one or more components (eg, handle assembly 23110, shaft assembly 23120 and/or end effector assembly 23130, etc.) and/or may be incorporated into a surgical hub 23140 (eg, 23142) that is paired (eg, wirelessly) with the surgical instrument 23102. In such aspects, the end effector assembly 23130 includes a first jaw, a second jaw pivotally coupled to the first jaw, and a function of the end effector assembly 23130 (e.g., (e.g., cutting, grasping, coagulating, cutting, stapling, etc.) and transmitting the detected parameters to a control circuit (e.g., 23112, 23122, 23132 and/or 23142). A sensor 23134 may also be included. In various aspects, the first jaw may include an anvil and the second jaw may comprise an elongated channel configured to receive a staple cartridge. Further, in such aspects, the surgical instrument 23102 senses parameters associated with the function (eg, rotation, articulation, etc.) of the shaft assembly 23120 and applies the sensed parameters to control circuits (eg, 23112, 23112, 23112, 23112, etc.). 23122, 23132 and/or 23142) may further comprise a shaft assembly 23120 that includes a sensor 23124 configured to transmit to 23122, 23132 and/or 23142). In such aspects, the control circuitry may be configured to receive detected parameters (eg, sensor data) from such sensors, eg, 23134 and/or 23124, throughout the course of a surgical procedure. The sensed parameters may indicate the function of the associated end effector assembly 23130 (eg, dissecting, grasping, coagulating, cutting, stapling, etc.) and/or the function of the associated shaft assembly 23120 (eg, rotating, articulating, etc.). ) is executed. The control circuitry may be controlled from an internal database (e.g., in the memory of a component of surgical instrument 23136, 23126 and/or 23116, or from surgical hub database 23149) and/or from an external database (e.g., surgical hub database 23149, cloud database). 23150) may be further configured to receive data. According to various aspects, the data received from the internal and/or external database is based on procedure data (eg, steps to perform a surgical procedure) and/or historical data (eg, historical data associated with the surgical procedure). data indicating expected parameters). In various aspects, the procedure data may include current/recognized standard of care procedures for surgical procedures, and the historical data may include historical data (e.g., system-defined constraints) associated with the surgical procedure. based preferred/ideal parameters and/or preferred/ideal parameter ranges. Based on the received data (e.g., sensor data, internal and/or external data, etc.), control circuitry (e.g., 23112, 23122, 23132 and/or 23142) makes inferences (e.g., contextual information) regarding ongoing procedures. may be configured to derive continuously. That is, the surgical instrument may, for example, record data regarding a surgical procedure for generating reports, verify steps taken by a surgeon to perform a surgical procedure, and provide data or prompts that may be relevant to a particular procedure step. (e.g., via user interfaces 23148 and/or 23158 associated with the surgical hub and/or user interfaces 23138, 23128 and/or 23118 associated with the surgical instrument) to provide functionality of the surgical instrument 23102 may be configured to control the

In one aspect, referring back to FIG. 89, during and/or after grasping the target tissue between the jaws of the end effector assembly, the control circuitry (23112, 23122, 23132 and/or 23142) , may be configured to check continuity between the jaws before allowing subsequent functions (eg, firing, coagulation, etc.). Here, according to various aspects, a surgical instrument comprises an electrosurgical instrument comprising electrodes on at least one of the jaws (e.g., integrated with an anvil and/or staple cartridge) good. In such aspects, it may be difficult to treat tissue grasped between the jaws with electrosurgical energy (eg, RF energy) if a short exists between the electrodes. In one example, a conductive object (eg, clip, staple, metal element, etc.) between the electrodes can provide continuity between the jaws. In another example, if there is not enough gap between the jaws (eg, after grasping the target tissue), the electrodes may contact to provide continuity between the jaws. Referring again to FIG. 53, for example, in one aspect of the present disclosure the sensor 152008a is configured to measure the gap between the jaws of the end effector. In such an aspect, the first jaw sensor 152008a was generated by the second jaw magnet 152012 to measure the gap between the first and second jaws. A Hall effect sensor configured to detect a magnetic field may be provided. In particular, the gap can represent the thickness of tissue grasped between the first jaw and the second jaw. Here, if continuity exists between the jaws, undesirable surgical consequences (eg, incomplete tissue treatment, excessive heating of conductive objects, etc.) may result.

According to one aspect (eg, bipolar mode), the first jaw may include an anvil and the second jaw is an elongated channel configured to receive a staple cartridge as shown in FIG. may be provided. In one example, the staple cartridge may include an active electrode for delivering electrosurgical energy (eg, RF energy) to the grasped tissue, and at least a portion of the anvil can act as a return electrode. In another example, the anvil may include an active electrode for delivering electrosurgical energy (eg, RF energy) to the grasped tissue, and at least a portion of the elongated channel may act as a return electrode. According to another aspect (eg, monopolar mode), the first jaw may include an anvil and the second jaw may comprise an elongated channel configured to receive a staple cartridge. . In one example, the staple cartridge may include an active electrode for delivering electrosurgical energy (e.g., RF energy) to the grasped tissue, and a return electrode (e.g., ground pad) may be on the patient's body. They may be arranged separately. In another example, the anvil may include an active electrode for delivering electrosurgical energy (e.g., RF energy) to the grasped tissue, and a return electrode (e.g., ground pad) is separate on the patient's body. may be placed in Various configurations for detecting shorts are described in U.S. Pat. No. 9,554,854, entitled "DETECTING SHORT CIRCUITS IN ELECTROSURGICAL MEDICAL DEVICES," the entire disclosure of which is incorporated herein by reference. ing.

Referring again to FIG. 89 according to various aspects, control circuitry (23112, 23122, 23132 and/or 23142) may be configured to check continuity in a number of ways. In one aspect, a sensor, e.g., 23134, incorporated into a generator that produces electrosurgical energy and/or a surgical instrument detects when the impedance between the electrodes drops below a threshold for a threshold period of time (i.e., a short circuit). impedance). Now referring back to FIG. 48, a sensor, eg, 23134, may be configured to measure impedance over time. In one example, when the electrode hits the line of conductive staples, the current can spike, while the impedance and voltage drop sharply. In another embodiment, the continuity may exist as a current sink with minimal voltage changes. Various alternative methods for checking continuity/detecting shorts, such as those described in U.S. Pat. is expressly incorporated herein by (eg, comparing impedance values at different positions within a pulse of a series of pulses).

In such aspects, if continuity is detected, a conductive object (eg, clip, staple, staple line, metal element, etc.) is present/exposed within the tissue grasped between the jaws. there may be. In particular, such conductive objects may be from current and/or previous surgical procedures. In such aspects, the control circuitry alerts the surgeon regarding the detection of a conductive object (e.g., the user interfaces 23138, 23128 and/or 23118 of the surgical instrument components and/or the detection of the conductive object). via a user interface 23148 and/or 23158 associated with the surgical hub for . For example, the warning suggests that the surgeon reposition the end effector assembly 23130 so that the electrodes are not in contact with any conductive objects and/or remove conductive objects that cause shorts. may According to various aspects, the control circuit receives an override command, for example, via a user interface (see, eg, FIG. 88, selectable user interface element 23012), a conductive object (eg, clip , staples, staple lines, metal elements, etc.) are detected, it may be further configured to allow subsequent functions (eg, cutting, coagulation, etc.).

According to one aspect, the control circuitry (23112, 23122, 23132 and/or 23142) may be configured to check continuity to avoid laterally dissecting the clip. In such an aspect, after a short circuit is detected, the control circuit alerts the surgeon (e.g., user interfaces 23138, 23128 and/or user interfaces of surgical instrument components) regarding the detection of conductive objects between the jaws. 23118 and/or via user interfaces 23148 and/or 23158 associated with the surgical hub). In one aspect, the surgeon can adjust the sensitivity of the control circuit via a user interface (eg, an interactive user interface element on the surgical instrument, surgical hub, generator, etc.). In such aspects, based on the adjustment, the control circuit may be configured to prevent firing if a conductive object is detected between the jaws.

Referring again to FIG. 89 according to another aspect, control circuitry 23142 may be incorporated into a surgical hub 23140 that is paired (eg, wirelessly) with an electrosurgical instrument 23102 . In such aspects, surgical hub 23140 may be pre-loaded with surgeon/user settings for detection of conductive objects between the jaws. In one example, the surgeon/user setting includes blocking firing if a conductive object is detected between the jaws. In another example, the surgeon/user setting includes warning before allowing firing if a conductive object is detected between the jaws. In yet another aspect, the surgeon/user settings include allowing the surgeon/user to override the warning. In yet another aspect, the surgeon/user settings include a temporary reset, allowing the surgeon/user to remedy the situation (e.g., move jaws, remove conductive objects, etc.) before checking continuity again. including a temporary reset that allows you to

Referring again to FIG. 89 for yet another aspect, the control circuitry (23112, 23122, 23132 and/or 23142) may be configured to check continuity as the staple line is intentionally crossed. . Here, in some surgical procedures, when it is beneficial to have intersecting staple lines to ensure continuous transverse incisions (e.g. pneumonectomy, especially wedges from multiple angles, sleeve procedures, etc.) There is In such aspects, after continuity is detected, the control circuit alerts (e.g., provides an audible and/or visual cue to) the surgeon regarding the detection of a conductive object (e.g., an existing staple line) between the jaws. ) (eg, via the user interfaces 23138, 23128 and/or 23118 of the surgical instrument components and/or via the user interfaces 23148 and/or 23158 associated with the surgical hub) may be configured.

Referring again to FIG. 89 for other aspects, control circuitry (23112, 23122, 23132 and/or 23142) maintains internal databases (e.g., surgical instrument component memories 23136, 23126 and 23142) throughout the course of a surgical procedure. 23116 or surgical hub database 23149), and/or an external database (eg, surgical hub database 23149, cloud database 23150, etc.). According to various aspects, the data received from the internal and/or external database includes historical surgical data (e.g., data regarding previous surgical procedures performed on the patient, data regarding current surgical procedures, etc.). can contain. In one example, historical surgical data may indicate that staples were used in previous surgeries and/or where staples were used, and current surgical data may be clipped to apply clips. It may indicate whether pliers were used. Based on the received data (e.g., historical surgical data, etc.), the control circuitry (23112, 23122, 23132 and/or 23142) continuously derives inferences (e.g., contextual information) regarding the ongoing procedure. may be configured to That is, the surgical instrument 23120 may optionally recognize, for example, presume that the detected continuity may be a staple line from a previous surgical procedure or a clip from a current surgical procedure. / may be configured to determine. As another example, if the patient has never had a surgical procedure, the clip applier has not been used in the current surgical procedure, and the staple cartridge has been fired in the current surgical procedure, the control The circuitry may be configured to deduce/determine that a conductive object detected between the jaws is a previous staple line. As yet another example, if the patient has never had a surgical procedure, the clip applier is being used in the current procedure, and the staple cartridge has not yet been fired in the current surgical procedure, the control The circuitry may be configured to infer/determine that a conductive object detected between the jaws is a clip.

(Example)
Various aspects of the subject matter described herein under the heading "Safety System for Smart Powered Surgical Stapling" are described in the examples below.
Example 1 - A surgical system comprises a control circuit and a surgical instrument. The surgical instrument includes a handle assembly, a shaft assembly extending distally from the handle assembly, and an end effector assembly coupled to a distal end of the shaft assembly. The end effector assembly includes a first jaw, a second jaw pivotally coupled to the first jaw, and a sensor. The sensor is configured to sense parameters associated with the function of the end effector and transmit the sensed parameters to the control circuitry. The control circuitry is configured to analyze the sensed parameter based on system defined constraints and inhibit at least one function of the surgical instrument based on the results of the analysis. The surgical system further comprises a user interface configured to provide current status regarding at least one blocked function of the surgical instrument.

Example 2 - The system-defined constraints include at least one of a predefined parameter or a predefined parameter range based on historical data associated with surgical procedures being performed by the surgical system. A surgical system according to Example 1.

Example 3 - The current state includes a first message that at least one function of the surgical instrument is blocked and a second message that indicates why at least one function of the surgical instrument is blocked. The surgical system of example 1 or 2, comprising:

Example 4 - The surgical procedure of Example 1, 2 or 3, wherein the user interface comprises user interface elements selectable to override the control circuitry to enable at least one function of the surgical instrument. system for.

Example 5--The sensor comprises a force sensor coupled to the end effector, the detected parameter being the force applied to at least one of the first jaw or the second jaw of the end effector. At least one function that is inhibited via the control circuitry includes: inhibiting use of the attached shaft; inhibiting a firing cycle from starting; inhibiting articulation of the end effector; Example 1, including one or more of blocking rotation or blocking one or more of the first jaw or the second jaw from opening , 2, 3 or 4.

Example 6 - End effector functions associated with sensed parameters include grasping functions, and at least one function of the surgical instrument inhibited via the control circuit is cutting, coagulating, stapling A surgical system according to example 1, 2, 3, 4, or 5, including one or more of the functions, or cutting functions.

Example 7 - The surgical system of Example 1, 2, 3, 4, 5, or 6, further comprising a surgical hub communicatively coupled to the surgical instrument, the surgical hub comprising control circuitry.

Example 8 - The surgical system of Example 7, wherein one of the handle assembly or surgical hub comprises a user interface.

Example 9 - Example 1, 2, 3, 4, 5, 6, 7 or 8, wherein one of the handle assembly, shaft assembly, or end effector assembly of the surgical instrument comprises a control circuit The surgical system according to .

Example 10 - The shaft assembly comprises a sensor configured to detect a shaft parameter associated with the function of the shaft and transmit the detected shaft parameter to the control circuit, Examples 1, 2, 3, The surgical system according to 4, 5, 6, 7, 8 or 9. The control circuit is further configured to inhibit at least one function of the surgical instrument further based on the sensed shaft parameter.

Example 11 - A surgical system includes a surgical hub and a surgical instrument communicatively coupled to the surgical hub. The surgical instrument includes a handle assembly, a shaft assembly extending distally from the handle assembly, and an end effector assembly coupled to a distal end of the shaft assembly. The end effector assembly includes a first jaw, a second jaw pivotally coupled to the first jaw, and a sensor. The sensor is configured to detect parameters associated with the function of the end effector and transmit the detected parameters to the surgical hub. The surgical hub includes a processor and memory coupled to the processor. The memory stores instructions executable by the processor to analyze the detected parameter based on the system defined constraints and inhibit at least one function of the surgical instrument based on the results of the analysis. The surgical system further comprises a user interface configured to provide current status regarding at least one blocked function of the surgical instrument.

Example 12 - The system-defined constraints include at least one of a predefined parameter or a predefined parameter range based on historical data associated with surgical procedures being performed by the surgical system. A surgical system according to Example 11.

Example 13 - The current state includes a first message that at least one function of the surgical instrument is blocked and a second message indicating why at least one function of the surgical instrument is blocked. The surgical system of example 11 or 12, comprising:

Example 14 - According to example 11, 12 or 13, wherein the user interface comprises a user interface element selectable to override the surgical hub to enable at least one function of the surgical instrument surgical system.

Example 15 - The sensor comprises a force sensor coupled to the end effector, the detected parameters comprising force applied to at least one of the first jaw or the second jaw of the end effector , the at least one function that is blocked via the surgical hub is to prevent use of the attached shaft, prevent the firing cycle from starting, prevent articulation of the end effector, prevent the shaft from Example 11 including one or more of blocking rotation or preventing one or more of the first jaw or the second jaw from opening , 12, 13 or 14.

Example 16 - End effector functions associated with sensed parameters include grasping functions, and at least one function of a surgical instrument blocked through a surgical hub includes cutting functions, coagulating functions, stapling 16. A surgical system according to example 11, 12, 13, 14 or 15, including one or more of a clamping function or a cutting function.

Example 17 - The surgical system of example 11, 12, 13, 14, 15 or 16, wherein at least one of the handle assembly or surgical hub comprises a user interface.

Example 18 - The shaft assembly comprises a sensor configured to detect a shaft parameter associated with the function of the shaft and transmit the detected shaft parameter to the surgical hub, example 11, 12, 13 , 14, 15, 16 or 17. The memory further stores instructions executable by the processor to further inhibit at least one function of the surgical instrument further based on the detected shaft parameter.

Example 19 - A non-transitory computer readable medium stores computer readable instructions which, when executed, cause a machine to relate to functions of an end effector of a surgical system based on system defined constraints. a surgical system comprising: a handle assembly; a shaft assembly extending distally from the handle assembly; and a distal end of the shaft assembly. and an end effector assembly. An end effector assembly detects a first jaw, a second jaw pivotally coupled to the first jaw, a detected parameter, and transmits the detected parameter to the machine. a sensor configured to: The instructions, when executed, cause the machine to further inhibit at least one function of the surgical system and generate a user interface based on the results of the analysis. The user interface provides current status regarding at least one blocked function of the surgical system.

The non-transitory computer-readable media of Examples 20-19 further include instructions that, when executed, cause a machine to generate an override element on a user interface. The override element is selectable to enable at least one function of the surgical system.

SAFETY SYSTEM FOR SMART POWERED SURGICAL STAPLING United States Patent Application 20080020000 Kind Code: A1 Various aspects of the present disclosure respond to tissue parameters sensed via one or more sensors of a surgical instrument. As such, it is directed to an improved safety system capable of adapting, controlling, and/or synchronizing the internal drive motion of a surgical instrument. More specifically, various aspects are directed to sensing tissue parameters and validating current device parameters to the sensed tissue parameters.

For example, sensed tissue parameters may include tissue type, tissue thickness, tissue stiffness, tissue location on the patient's anatomy, tissue vascularization, etc. Current device parameters These may include cartridge color, cartridge type, aids, grip load, clearance, rate of fire, and the like. Thus, according to aspects of the present disclosure, physiological sensing may indicate improper use of the device or its components, and/or improper positioning of the apparatus.

In one example, improper use of the surgical instrument or components thereof and/or improper positioning of the surgical instrument is detected via one or more sensors in the jaws of the end effector. may be determined via associated control circuitry based on the physiological sensing. In such embodiments, after determining improper use and/or determining improper positioning, the associated control circuitry causes one or more functions of the end effector (e.g., stapling) to be performed. can prevent it from being done. Further, in such examples, the associated control circuitry determines that the positioning of the surgical instrument or component thereof and/or the surgical instrument has been modified (e.g., improper replacement of the staple cartridge, repositioning of the surgical instrument, etc.) or an override is received (eg, on the surgical instrument, on a surgical hub coupled to the surgical instrument, via a user interface located in the operating room) , the associated control circuitry may enable one or more functions of the end effector.

Referring to FIG. 94 according to various aspects of the present disclosure, a surgical system 24200 includes control circuitry and (24212, 24222, 24232 and/or 24242, eg, in phantom to indicate any location(s)). , a user interface (24214, 24224, 22234, 24244 and/or 24254, eg, in phantom to show any location(s)), and a surgical instrument 24202. Surgical instrument 24202 comprises components A-24216 through component-N 24218 of end effector assembly 24210 as well as configurations of shaft assembly 24220 and handle assembly 24230, respectively, in omitted form for purposes of illustration. It includes multiple components such as component-A (CA) through component-N (CN). In various aspects, each component of surgical instrument 24202 can include at least one device parameter. For example, components A-24216 of end effector assembly 24210 can include parameters PAa-PAn 24217, components-N 24218 of end effector assembly 24210 can include parameters PNa-PNn 24219, and so on. . As another example, each of CA through CN of shaft assembly 24220 and CA through CN of handle assembly 24230 can similarly include at least one device parameter. Each component can be configured to send its corresponding device parameter to the control circuit. Surgical instrument 24202 further includes sensors (24213, 24223 and/or 24233) configured to detect tissue parameters associated with the functioning of the surgical instrument and transmit the detected tissue parameters to control circuitry. . The control circuitry may be configured to analyze the detected tissue parameters in conjunction with each respective device parameter based on system defined constraints.

Referring again to FIG. 94, control circuits 24212, 24222 and/or 24232 (e.g., shown as elements of end effector assembly 24210, shaft assembly 24220 and handle assembly 24230, respectively) may, in various aspects, be used in surgical applications. one or more of the components of the instrument 24202 (e.g., the handle of the handle assembly 24230, the shaft of the shaft assembly 24220, the end effector of the end effector assembly 24210, the staple cartridge of the end effector assembly, etc.) ), or into a surgical hub 24240 that is paired (eg, wirelessly) with a surgical instrument 24202 (eg, 24242). Similarly, sensor(s) 24213, 24223 and/or 24233, user interface 24214, 24224 and/or 24234 and memory 24215, 24225 and/or 24235 (e.g., end effector assembly 24210, shaft assembly 24220 and shown as an element of the handle assembly 24230) may be incorporated into one or more of the components in various aspects. In particular, according to various aspects, surgical instrument 24202 and/or surgical hub 24240 may be a context-aware surgical instrument and/or a context-aware surgical hub. Situational awareness determines information related to the surgical procedure from data received from the database (e.g., historical data associated with the surgical procedure) and/or data received from the surgical instrument (e.g., sensor data during the surgical procedure). Or refers to the ability of a surgical system (eg, 24200) to estimate. For example, the determined or inferred information can include the type of procedure to be performed, the type of tissue to be manipulated, the body cavity to be treated, and the like. Based on such contextual information associated with a surgical procedure, the surgical system can, for example, control paired surgical instruments or components thereof and/or provide information to the surgeon throughout the course of the surgical procedure. Information or suggestions applicable to the situation can be provided.

According to one aspect, a context-aware surgical hub (eg, 24240) is paired (eg, wirelessly) with a surgical instrument 24202 utilized to perform a surgical procedure. In such aspects, the surgical instrument 24202 may comprise multiple components including an end effector (eg component A-24216). The end effector 24216 includes a first jaw, a second jaw pivotally coupled to the first jaw, a cutting blade, and functions of the end effector 24216 (e.g., cutting, grasping, coagulating). , cutting, stapling, etc.) and transmitting the detected tissue parameter to control circuitry 24242 of surgical hub 24240. . Multiple components of surgical instrument 24202 including end effector 24216 (eg, Component-N 24218, eg, staple cartridge, etc.) transmit respective device parameters (eg, 24219 and 24217, respectively) to surgical hub 24240 is configured as In particular, sensors (eg, 24213) as referenced herein and in other disclosed aspects are a plurality of sensors configured to detect a plurality of tissue parameters associated with a plurality of end effectors 24216. It should be understood that the Further, in such aspects, therefore, surgical hub control circuitry 24242 also provides such parameter data (e.g., sensed tissue parameter(s), end effector, etc.) to each component, including the end effector, throughout the course of a surgical procedure. device parameters, etc.). Sensed tissue parameters may be received each time an associated end effector function (eg, dissecting, grasping, coagulating, cutting, stapling, etc.) is performed. Surgical hub control circuitry 24242 may be further configured to receive data from an internal database (eg, surgical hub database 24249) and/or an external database (eg, from cloud database 24269). According to various aspects, the data received from internal database 24249 and/or external database 24269 includes procedure data (e.g., data indicative of steps to perform a surgical procedure, respective device parameters associated with the surgical procedure) and/or or historical data (eg, data indicative of tissue parameters predicted based on historical data associated with surgical procedures, patient historical surgical data, etc.). In various aspects, the procedure data may include current/recognized standard treatment procedures for surgical procedures, and the historical data may include historical data (e.g., system-defined constraints) associated with the surgical procedure. based preferred/ideal tissue parameter ranges for each received device parameter. Based on the received data (eg, parameter data, internal and/or external data, etc.), surgical hub control circuitry 24242 continuously derives inferences (eg, contextual information) regarding the ongoing surgical procedure. may be configured to That is, the context-aware surgical hub may, for example, record data regarding a surgical procedure for generating reports, verify steps taken by a surgeon to perform a surgical procedure, data that may be relevant to a particular procedure step, or providing prompts (eg, via user interfaces 24244 and/or 24254 associated with the surgical hub and/or user interfaces 24214, 24224 and/or 24234 associated with the surgical instrument) to It may be configured to control functions and the like.

According to another aspect, a context-aware surgical instrument (eg, 24202) may be utilized to perform a surgical procedure. In such aspects, the surgical instrument 24202 may comprise multiple components, including the end effector 24216, as described herein. The end effector includes a first jaw, a second jaw pivotally coupled to the first jaw, a cutting blade, and the functions of the end effector 24216 (e.g., cutting, grasping, coagulating, an integrated sensor 24213 configured to detect a tissue parameter associated with cutting, stapling, etc.) and communicate the detected tissue parameter to a control circuit. Specifically, in such aspects, the detected tissue parameters may be transmitted to the integrated control circuitry 24212 of the end effector 24216 . Each of the plurality of components of the surgical instrument including the end effector 24216 (eg, Component-N 24218, eg, staple cartridge, etc.) is configured to transmit its respective device parameters to the integrated end effector control circuit 24212. ing. In such aspects, integrated end effector control circuitry 24212 provides such parameter data (e.g., sensed tissue parameter(s), end effector-containing component device data) throughout the course of a surgical procedure. parameter(s)). Sensed tissue parameters may be received each time the associated end effector function (eg, dissecting, grasping, coagulating, cutting, stapling, etc.) is performed. Integrated end effector control circuitry 24212 communicates data from an internal database (e.g., end effector memory 24215) and/or an external database (e.g., surgical hub database 24249 through surgical hub 24240 to cloud database 24269) throughout the course of a surgical procedure. (from). According to various aspects, the data received from the internal database and/or the external database is stored in staple cartridge data (e.g., staple cartridge (e.g., 24218) device parameter(s) received by end effector control circuit 24212). associated staple size and/or type), and/or historical data (e.g., predicted tissue and/or tissue type to be stapled at such size and/or type based on historical data). data pointing to). In various aspects, the internal and/or external data provide preferred/ideal tissue parameter ranges for each received device parameter based on historical data (e.g., system-defined constraints) associated with the surgical procedure. can contain. In one embodiment, internal and/or external data may be preferred/ideal tissue parameters and/or preferred/ideal tissue parameter ranges for predicted tissue and/or tissue type, or historical data. Preferred/ideal tissue parameter ranges for staple size and/or type associated with staple cartridge (eg, 24218) device parameters may be included (eg, based on system-defined constraints). Based on the received data (e.g., parameter data, internal data and/or external data, etc.), the end effector control circuitry 24212 is configured to continuously derive inferences (e.g., contextual information) regarding the ongoing procedure. may be In particular, according to an alternative aspect, the integrated sensor 24213 of the end effector 24216 associates the detected tissue parameter(s) with another surgical instrument component, such as the handle of the handle assembly 24230. 24222 and/or 24232). In such aspects, control circuitry for other surgical instrument components (eg, 24222 and/or 24232) are similarly configured to perform various aspects of end effector control circuitry 24212 as described above. may Finally, the context-aware surgical instrument (e.g., 24202) alerts its user of the discrepancy (e.g., through the user interface of the end effector 24214, to another surgical instrument component, e.g., the handle assembly 24230). via user interfaces 24224 and/or 24234 of the handle, or via user interface 24244 associated with surgical hub 24240 coupled to surgical instrument 24202). For example, discrepancies may include detected tissue parameters associated with staples of these sizes and/or types, or preferred/ideal tissue parameters associated with their expected tissue and/or tissue type, and/or or exceeding preferred/ideal tissue parameter ranges. As a further example, a context-aware surgical instrument (eg, 24202) may be configured to control the functionality of the surgical instrument based on the discrepancy. According to at least one aspect, a context-aware surgical instrument (eg, 24202) can block surgical functions based on discrepancies.

Improper Device Placement According to various aspects of the present disclosure, physiological sensing (eg, detected via one or more sensors) may indicate device placement concerns. More specifically, according to such aspects, there may be a physiological incompatibility within/between the first and second jaws of the end effector (e.g., after gripping); Further functions of the end effector (eg, coagulation, cutting, stapling, etc.) may be inhibited/prevented.

According to various aspects, a surgical procedure can include resection of target tissue (eg, a tumor). Referring to FIG. 92, for example, a portion of patient tissue 24000 may contain a tumor 24002 . In such aspects, surgical margins 24004 may be defined around tumor 24002 . In particular, it would be ideal to avoid and/or minimize resection of healthy tissue surrounding a tumor during a surgical procedure. However, to ensure complete removal of a tumor, current/recognized standard therapeutic procedures associated with that surgical procedure require a predetermined surgical margin defined by the distance surrounding the tumor, and/or May approve resection of predetermined surgical margins defined by the range of distances surrounding the tumor. In one aspect, the approved surgical margin may be tumor dependent (eg, based on tumor type, tumor size, etc.). In another aspect, the approved surgical margin may depend on the extent of tumor microinvasion into surrounding tissue. In other aspects, approved surgical margins may be correlated with improved long-term survival based on historical data associated with the tumor and/or surgical procedure. In still other aspects, associated control circuits (eg, 24212, 24222, 24232 within a component of the surgical instrument, considering FIG. 94, within the surgical instrument, surgical 24242) receives data from internal 24215, 24225 and/or 24235 and/or from external databases 24249 and/or 24269 (e.g., from the cloud, patient historical surgical data from surgical hubs, etc.; Approved surgical margins may be preemptively adjusted based on historical data, standard treatment procedures for recurrent tumors). In such aspects, referring back to FIG. 92, the normal final surgical margins (eg, 24004) are compared to the adjusted surgical margins (eg, 24012) based on such received data. may be changed by an amount/distance (e.g., 24010) determined by the patient (e.g., the patient's surgical and/or historical data suggest that the tumor may have affected the surrounding tissue even slightly). may suggest that the patient may already have a case of recurrent tumor, etc.).

Further, in various aspects, after target surgical margins (e.g., 24004 and/or 24012) have been established for a surgical procedure, surgical margins of a tumor and/or its targets can be efficiently and/or accurately determined during surgical procedures. can be difficult to identify and resect. 94 in accordance with various aspects of the present disclosure, an end effector (eg, 24216) of surgical instrument 24202 measures a first signal and associated control circuitry (eg, a surgical A first sensor (e.g., 24213) configured to transmit a first signal to 24212, 24222, and/or 24232 within a component of the instrument, 24242 within a surgical hub coupled to the surgical instrument. may be provided. In such aspects, a second sensor configured to measure the second signal and transmit the second signal to an associated control circuit uses a surgical instrument to resect the tumor. Anteriorly, it may be placed on/in the tumor (see FIG. 92, eg 24006, central location relative to the tumor). Here, according to various aspects, the second sensor may be separate from the surgical instrument. Additionally and/or alternatively, in such aspects, the second sensor may comprise a sensor positioned around the tumor prior to using the surgical instrument to resect the tumor. (See FIG. 92, eg, 24008). According to another aspect, a plurality of second sensors may be positioned around the perimeter of the tumor. wherein, in such aspects, the control circuit is configured to dynamically calculate the distance between the first sensor and the second sensor based on the first signal and the second signal; may According to various aspects, a first sensor may be positioned at/near the cutting blade of the end effector. A further exemplary method for detecting target surgical margins is disclosed in U.S. Patent Application Publication No. 2003/0031004, entitled "SYSTEM AND METHOD FOR A TISSUE RESECTION MARGIN MEASUREMENT DEVICE," the disclosure of which is incorporated herein by reference in its entirety. 2016/0192960.

In one example, if the second sensor is positioned on/in the tumor (e.g., central location 24006), the control circuit controls the second sensor and the target surgical margin established for the surgical procedure. may be further configured to determine a margin distance between In such an example, the control circuit compares the dynamically calculated distance (e.g., between the first sensor and the second sensor) to its determined margin distance to determine the end effector ( cutting blade) can be efficiently and accurately positioned at the target surgical margin (e.g., when the dynamically calculated distance is equal or substantially equal to the determined margin distance, the end effector is properly positioned). The control circuitry may be configured to utilize such techniques to efficiently and accurately position the end effector (eg, cutting blade) around the target surgical margin (eg, during resection).

In another example, if the second sensor is positioned around the periphery of the tumor, or multiple second sensors are placed around the periphery of the tumor, e.g. and a target surgical margin established for the surgical procedure. In such an example, the control circuit compares the dynamically calculated distance (e.g., between the first sensor and the second sensor) to the determined margin distance to allow the end effector to The target surgical margin can be efficiently and accurately positioned (eg, the end effector is properly positioned when the dynamically calculated distance equals or substantially equals the determined margin distance). The control circuitry may be configured to utilize such techniques to efficiently and accurately position the end effector (eg, cutting blade) around the target surgical margin (eg, during resection). Such aspects may be beneficial when the tumor has an abnormal shape.

Referring again to FIG. 94, according to various aspects, the control circuit determines that the end effector (eg, or its cutting blade) has/ When positioned, it may be configured to notify the surgeon (e.g., via user interfaces 24214, 24224 and/or 24234 on the surgical instrument, user interface 24244 on a surgical hub coupled to the surgical instrument). , and/or in real-time, such as via an operating room user interface 24254). For example, the user interface may i) visually confirm that the end effector (eg, 24216) is positioned at the target surgical margin and/or position the end effector (eg, or its cutting blade) at the target surgical margin. ii) a video image of the surgical site with a digital overlay showing the target surgical margin to the surgeon to move against; There may be at least one of tactile feedback on the 24202 itself, and/or iii) auditory feedback indicating that the cutting blade of the end effector has been positioned at the target surgical margin.

Referring again to FIG. 94 in accordance with further aspects, the control circuit may cause the end effector (e.g., cutting blade) to move the end effector (e.g., cutting blade) to the cancer margin (e.g., inside the target surgical margin and adjacent to the surrounding tissue slightly affected by the tumor). can be configured to prevent the surgical instrument 24202 from firing if it is too close to and/or within range of. In accordance with such aspects, the control circuit receives an override command (e.g., user interface 24214, 24224 and/or 24234 on the surgical instrument, user interface on a surgical hub coupled to the surgical instrument). 24244 and/or via an operating room user interface 24254) to allow firing to continue. In one example, such a user interface may include a user interface element, eg, 24251, selectable to allow firing to continue. In such aspects, the control circuitry can continue to monitor the end effector (eg, its cutting blade) for cancer margins. Further, in such aspects, the control circuitry may be configured to stop firing again, alert the surgeon, and/or receive an override command as described. According to another aspect, the control circuit is configured to prevent firing until a reset event occurs (eg, opening the end effector jaws and repositioning the end effector jaws relative to the cancer margin). may be

Referring again to FIG. 94 according to another aspect of the present disclosure, one or more sensors of the surgical system 24200 may detect the pressure between the first and second jaws of the end effector (eg, 24216). Blood flow through tissue grasped between may be detected (eg, 24216). For example, a Doppler imaging detector (e.g., 24213 incorporated on an end effector coupled to a surgical hub, such as a parameter sensing component 24253 with a Doppler imaging detector, etc.) otherwise at the surgical site (e.g., , red, green, and/or blue laser light) and perform speckle contrast analysis to determine blood flow through such vessels. can be determined. In particular, in one example, it may be desirable to seal some blood vessels (eg, associated with tumors) but not others (eg, associated with healthy tissues/organs). Accordingly, associated control circuits (eg, in a surgical instrument, within components 24212, 24, 222, and/or 24232 of the surgical instrument, within a surgical hub 24242 coupled to the surgical instrument, etc.) can be configured to prevent the surgical instrument 24202 from firing if the blood flow exceeds a predetermined amount and/or velocity. In accordance with such aspects, the control circuit provides override commands (e.g., user interface on surgical instruments 24214, 24224 and/or 24234, user interface 24244 on a surgical hub coupled to the surgical instrument, and/or or via user 24254 in the operating room) to allow firing to continue (eg, if blood flow is associated with a tumor). In one example, such a user interface may include a user interface element, eg, 24251, selectable to allow firing to continue. In such embodiments, the control circuitry can continue to monitor the grasped tissue for blood flow. Further, in such aspects, the control circuitry may be configured to stop firing again, alert the surgeon, and/or receive an override command as described. According to another aspect, the control circuit causes a reset event to occur (e.g., opening the jaws of the end effector and moving the end effector to a vessel with blood flow exceeding a predetermined amount and/or velocity of blood flow). may be configured to block firing until the jaws are repositioned).

Referring again to FIG. 94 according to another aspect of the present disclosure, one or more sensors of the surgical system 24200 may detect the pressure between the first and second jaws of the end effector (eg, 24216). An increase in blood pressure may be detected concurrently with and/or immediately after grasping the tissue between. For example, a blood pressure monitor (eg, a parameter sensing component 24253 comprising a blood pressure monitor, eg, coupled to a surgical hub) may detect an increase in blood pressure upon grasping. According to various aspects, the surgical system 24200 is context-aware and infers that the detected increase in blood pressure was caused by grasping tissue between/within the jaws of the end effector. obtain. For example, vessels containing critical blood flow may become trapped between/within the jaws, resulting in constricted blood flow. As such, according to various aspects, associated control circuitry (e.g., 24212, 24, 222 and/or 24232 in surgical instrument components, surgical instrument coupled surgical hub 24242 in ) may be configured to prevent surgical instrument 24202 from firing if the blood pressure rise exceeds a predetermined amount and/or a predetermined range. According to such aspects, the control circuit may issue an override command (e.g., user interface 24214, 24224 and/or 24234 on the surgical instrument and/or a user interface on a surgical hub coupled to the surgical instrument). 24244, and/or via an operating room user interface 24254) to allow firing to continue. (For example, the surgeon observes that blood pressure has decreased while tissue is still being grasped, and optionally the surgical system recognizes that the increased blood pressure has other causes, etc.). In one example, such a user interface may include a user interface element, eg, 24251, selectable to allow firing to continue. In such an aspect, the control circuit can continue to monitor the patient's blood pressure. Further, in such aspects, the control circuitry may be configured to stop firing again, alert the surgeon, and/or receive an override command as described. According to another aspect, the control circuitry is configured to prevent firing until a reset event occurs (eg, opening the jaws and repositioning the jaws of the end effector relative to the grasped tissue). may be

Referring again to FIG. 94 according to another aspect of the present disclosure, one or more sensors of the surgical system are positioned between the first and second jaws of the end effector (eg, 24216). It is possible to detect important nerve bundles in the tissue grasped by the . For example, a heart rate monitor (e.g., 24213 integrated onto an end effector coupled to a surgical hub, a parameter sensing component 24253 including a heart rate monitor, etc.) is connected to the first jaw and the second jaw. An increase in heart rate may be detected at the same time and/or immediately after grasping the tissue between. According to various aspects, the surgical system 24200 is context-aware and receives data from internal 24215, 24225, 24235, 24249 and/or external databases 24249 and/or 24269 (e.g., surgical operation of the surgical procedure being performed). anatomical information associated with the site), the detected increase in heart rate is caused by grasping tissue between/within the jaws of the end effector. good. According to such aspects, associated control circuits (e.g., 24212, 24 222 and/or 24232 in a surgical instrument component within a surgical instrument component, within a surgical hub coupled to the surgical instrument) 24242, etc.) can be configured to prevent the surgical instrument 24202 from firing inferentially. Further in accordance with such aspects, the control circuit may issue override commands (e.g., user interface 24214, 24224 and/or 24234 on the surgical instrument, user interface 24244 on a surgical hub coupled to the surgical instrument, and/or an operating room user interface 24254, etc.) to allow firing to continue (e.g., the surgeon observes that the patient's heart rate has decreased while the tissue is still grasped). However, the surgical system may be configured to be context aware if it attributes the heart rate to another cause). In one example, such a user interface may include a user interface element, eg, 24251, selectable to allow firing to continue. In such an aspect, the control circuit can continue to monitor the patient's heart rate. Further, in such aspects, the control circuitry may be configured to stop firing again, alert the surgeon, and/or receive an override command as described. According to another aspect, the control circuitry is configured to prevent firing until a reset event occurs (eg, opening the jaws and repositioning the jaws of the end effector relative to the grasped tissue). may be configured to be

94 according to another aspect of the present disclosure, one or more sensors of the surgical system 24200 are in contact with the device (e.g., RF instrument/device) to which the surgical instrument 24202 is energized. can detect that In one example, surgical instruments and energized devices may be communicatively coupled to surgical hub 24240 within surgical system 24200 . For example, referring back to FIG. 9 , device/instrument 235 as well as energy device 241 may be coupled to modular control tower 236 of surgical hub 206 . In such embodiments, the generator 240 that produces electrosurgical energy in the energized device 241 and/or the sensor incorporated in the energized device is such that the impedance associated with the energized device is below the threshold. It may be configured to detect below a threshold for a period of time (eg, impedance drop indicating a short circuit). Similar to FIG. 48, an integral sensor in the energized device may be configured to measure impedance over time. Various alternative methods for detecting short circuits, such as those described in U.S. Pat. expressly incorporated herein by reference (eg, comparing impedance values at different positions within a pulse of a series of pulses, etc.). According to various aspects, the surgical system 24200 is context-aware and the detected short circuit is data received from internal 24215, 24225, 24235, 24249 and/or external databases 24249 and/or 24269 (e.g., surgical procedure associated with the use of a separate surgical instrument (e.g., electrosurgical instruments/devices) in the context of treatment data indicating that a particular step and/or current step of (eg, a conductive surface of the surgical instrument comes into contact with an energizing device, causing a short circuit). According to such aspects, the associated control circuitry (e.g., 24212, 24, 222 and/or 24232 in components of the surgical instrument and energized devices in the surgical instrument) is coupled to the surgical instrument. 24242 in a surgical hub such as ), can be configured to prevent the surgical instrument 24202 from firing inferentially. If a short circuit exists, it may be difficult to treat (e.g., coagulate) tissue with electrosurgical energy (e.g., RF energy), with undesirable surgical consequences (e.g., incomplete tissue treatment, conductive objects, etc.). such as excessive heating). In such a context, the control circuit may (e.g., via a user interface 24214, 24224 and/or 24234 on a surgical hub coupled to surgical instrument 24244 and/or a user interface in operating room 24254, etc.) real-time). may be configured to notify the surgeon that a short circuit exists and firing of surgical instrument 24202 has been interrupted. Further in accordance with such aspects, the control circuit may issue override commands (e.g., user interface 24214, 24224 and/or 24234 on the surgical instrument, user interface 24244 on a surgical hub coupled to the surgical instrument, and/or via the operating room user interface 24254) to allow firing to continue (e.g., the surgeon verifies that there is no short circuit and that the target tissue contains low impedance). etc.). In one example, such a user interface may include a user interface element, eg, 24251, selectable to allow firing to continue. In such an aspect, the control circuit can continue to monitor for shorts. Further, in such aspects, the control circuitry may be configured to stop firing again, alert the surgeon, and/or receive an override command as described. According to another aspect, the control circuit prevents firing until a reset event occurs (e.g., the repositioned surgical instrument is repositioned relative to the energized device such that it no longer makes contact). It may be configured as

Inappropriate Device Selection/Suggested Uses According to various aspects of the present disclosure, physiological sensing (eg, detected via one or more sensors) May indicate selection concerns. More specifically, according to such aspects, there may be a mismatch between the surgical instrument and the tissue, inhibiting/preventing further functions of the end effector (eg, coagulating, cutting, stapling, etc.). may occur.

94 according to one aspect of the present disclosure, control circuitry within a surgical hub coupled to surgical instrument 24242 (eg, within components of surgical instruments 24212, 24, 222 and/or 24232) , a tissue-specific stapler (e.g., a vascular stapler), and any combination of sensed information (e.g., detected via one or more sensors) determines that the target tissue is tissue-specific It may be configured to provide a warning if it suggests that the stapler may be inappropriate (eg, indicate the opposite).

FIG. 93 illustrates an example safety process 24100 for addressing device selection concerns in accordance with various aspects of the present disclosure. According to at least one aspect, the safety process 24100 is executed/implemented by control circuitry associated with a situation-aware surgical hub (eg, 24242, FIG. 94) of a surgical system (eg, 24200, FIG. 94). may also be used (eg, during a surgical procedure). According to another aspect, the safety process 24100 is controlled by a control circuit associated with a situation-aware surgical instrument (eg, 24212, 24222 and/or 24232 in FIG. 94) of a surgical system (eg, 24200 in FIG. 94). may be performed/performed (eg, during a surgical procedure).

Referring to FIG. 93, the tissue identification process 24108 includes a device selection 24102 (e.g., stapler selection, e.g., stapler suitable for firing soft tissue, stapler suitable for firing blood vessels, stapler suitable for firing bronchi). staplers, etc.), various device measurements 24104 detected by one or more sensors (e.g., end effector closure angle, length of tissue in contact with the end effector, proximity/compression curve, etc.); and contextual awareness information 24106 (eg, surgical information, surgeon preferences, etc.) may be received.

93, at device selection 24102, the control circuitry executing/enforcing safety process 24100 selects device parameters from the selected stapler/apparatus and/or each component of the selected stapler/apparatus (e.g., may be configured to receive device parameters associated with the staple cartridge) to direct device selection. For example, device parameters associated with a staple cartridge may include cartridge type, cartridge color, auxiliaries to the cartridge, cartridge gripping load limit, cartridge clearance range, cartridge firing rate, and the like. According to one aspect, the device parameters may be transmitted by the stapler/device to the control circuit when coupled to the surgical system. According to alternative aspects, the device selection may be input via a user interface (e.g., associated with a surgical hub and/or operating room, e.g., 24244 and/or 24254 in FIG. 94), and/or may be received from an internal and/or external database (eg, data regarding surgical procedures being performed and/or surgical instruments available, eg, 24249 and/or 24269 in FIG. 94).

Still considering FIG. 93, device measurements 24104 may be measured by the end effector (eg, component-A, 24216 in FIG. 94) and/or other components of the surgical instrument (eg, component-N, 24216 in FIG. 94). 24218 (e.g., staple cartridge) via one or more sensors (e.g., as described herein in FIGS. 17, 18, 53, 78, etc.) . For example, one or more tissue sensors may check continuity along the length of the end effector and/or measure tissue impedance to assess the length of tissue in contact with the end effector. may be positioned and configured to measure (e.g., sensor(s) 738 of FIG. 17 to determine tissue position using split electrodes, and/or tissue along the length of the end effector). such as sensor 153468 of FIG. 78 that measures tissue impedance to determine presence). As a further example, one or more sensors may be positioned and configured to detect/estimate the closing angle of the jaws/end effector (e.g., displacement of the gripping actuator/drive member). 17, a gap sensor detecting the gap between the first and second jaws of the end effector, such as sensor 152008a in FIG. 53). As a further example, one or more sensors may be positioned and configured to detect a tissue compression/closure force between the first jaw and the second jaw. (e.g. sensor 738 in FIG. 17 comprising force sensors, e.g., force sensors, on the tissue surface of the first jaw and/or the second jaw to detect the force when the tissue is grasped, tissue 17, such as current sensor 736 in FIG. 17; torque sensors for measuring closing force, such as 744b in FIG. 17). Various additional aspects for detecting end effector closure angle, length of tissue in contact with the end effector, and closing/compressing force are described elsewhere herein.

93, surgical identification information 24106 may be transferred via internal database 24249 and/or external database 24269 associated with surgical hub 24242 and/or to surgical instrument 24202 in light of FIG. It may be received via associated internal 24215, 24225, 24235 and/or external databases 24249, 24269.

Returning to FIG. 93, tissue identification process 24108 is configured to determine tissue types encountered by surgical instruments (eg, soft tissue, vessels, blood vessels, bronchi, etc.). In one example, the tissue identification process 24108 uses various inputs (e.g., when the jaws are fully open, detected tissue contact, closure and opening curves along the length of the jaws, The tissue type may be determined to be soft tissue based on, for example, suggesting that it matches soft tissue. In another example, the tissue identification process 24108 uses various inputs (e.g., tissue contact detected almost immediately during closure, detected only over a small area of the stapler, and detected separated distally). In some cases, the tissue type is determined to be vascular (eg, PA/PV) based on tissue contact, such as that the initially detected closure force suggests that the tissue architecture is consistent with a vessel. In yet another example, the tissue identification process 24108 uses various inputs (e.g., tissue contact detected almost immediately during closure, detected only over a small area of the stapler, and detected both distally and proximally). The tissue type may be determined to be bronchial based on delimited detected tissue contact, early detected closure forces, suggesting tissue architecture consistent with bronchial tubes, etc. According to various aspects, such tissue type determinations include tissue thickness, tissue stiffness, tissue location (eg, relative to the patient), and one or two of the parameters described herein. It may be further based on tissue parameters including angiogenesis in the tissue detected and/or derived from measurements obtained by the above sensors. In particular, the tissue identification process 24108 includes such initial tissue determinations in the context of further inputs (e.g., stapler selection, surgical information, surgeon preferences, etc.) before arriving at tissue identification outputs/results. may be further evaluated. Such situational awareness ultimately yields the output/result of tissue identification. Various aspects for identifying tissue encountered here are further discussed elsewhere herein (eg, in the example of thoracic surgery, etc.).

Referring back to FIG. 93, the tissue identification output/result may indicate that the selected stapler/apparatus and/or each component of the selected stapler/apparatus (e.g., staple cartridge, shaft, etc.) is performing the surgical procedure. may be utilized to determine 24110 whether it is optimal for In such aspects, the control circuitry may access internal and/or external databases (eg, referring to FIG. 94, internal 24249 and/or external database 24269 associated with surgical hub 24242 and/or surgical instrument 24202). Further information 24112 may be received from internal 24215, 24225, 24235 and/or external databases 24249, 24269 associated with the . More specifically, additional information 24112 may include other available staplers, other available energy devices, other stapler components (eg, staple cartridges, shafts, etc.). According to at least one aspect, availability may be subject to current inventory at the surgical site. In particular, the additional information 24112 may also include each other available stapler, each other available energy device, each other stapler component available for use with the selected stapler/device, etc. can include

According to various aspects, when evaluating 24110 whether the selected stapler/apparatus is optimal, the control circuitry that executes/enforces the safety process 24100 determines the selected stapler/apparatus based on system-defined constraints. analyze each detected tissue parameter (eg, detected via one or more sensors described herein) in conjunction with each received device parameter associated with device 24102; It may be configured as Additionally, in accordance with such aspects, the control circuitry may select each other available stapler, each other available energy device, and the selected stapler/device to utilize with the selected stapler/device based on system-defined constraints. Each detected tissue parameter (e.g., detected via one or more sensors described herein), with received device parameters associated with each other possible stapler component. ) may be configured to analyze the In accordance with such aspects, the control circuit may, based on the sensed tissue parameter, determine the To determine if one or more of the available other stapler components are more optimal than the selected stapler/apparatus 24102 and/or components of the selected stapler/apparatus 24102 may be configured.

In various aspects, the detected tissue parameter(s) may include, for example, tissue type, tissue thickness, tissue stiffness, tissue location, angiogenesis within the tissue, etc. Device parameters may include, for example, staple cartridge type, staple cartridge color, auxiliaries to staple cartridge, staple cartridge grip load limit, staple cartridge gap range, staple cartridge firing rate, and the like. According to various aspects, system-defined constraints (eg, based on historical and/or procedural data accessed in the context-aware surgical system) determine preferred/ideal tissue parameters for each received device parameter. and/or preferred/ideal tissue parameter ranges. For example, a preferred/ideal tissue thickness and/or a preferred/ideal tissue thickness range may be associated with each staple cartridge color. In such examples, the color of each staple cartridge may indicate the type and/or size of staples within the staple cartridge. Here, staple cartridges containing short staples may not be optimal for thick tissue. According to a further aspect, system-defined constraints (eg, based on historical and/or procedural data accessed in the context-aware surgical system) are preferred/ideal for each detected tissue type. grip load limits and/or preferred/ideal grip load limit ranges. For example, each staple cartridge associated with a respective grasping load limit may indicate the type of tissue in which staples can be optimally stapled. Here, received device parameters (e.g., staple cartridge type, staple cartridge color, auxiliaries to staple cartridge, staple cartridge gripping load limit, staple cartridge gap range, staple cartridge firing rate, etc.), and detection defined tissue parameters (e.g., tissue type, tissue thickness, tissue stiffness, tissue location, vascularization within tissue, etc.) and established system-defined constraints (e.g., in a situational awareness surgical system). associated with received device parameters and/or detected tissue parameters based on accessed historical data and/or treatment data) is contemplated by the present disclosure.

Referring again to FIG. 93, if the selected device 24102 is determined to be optimal, the control circuitry executing/implementing the safety process 24100 initially does nothing (eg, recommends later), and/or It may be configured 24114 to demonstrate that the analysis has been performed. Alternatively, if the selected device 24102 is determined to be non-optimal, the control circuitry may be configured 24116 to determine if a safety issue exists. According to various aspects, when evaluating whether a safety issue exists with the selected stapler/apparatus 24102, the control circuit associates the selected stapler/apparatus 24102 with the may be configured to analyze each detected tissue parameter in conjunction with each received device parameter.

Similar to the above, detected tissue parameters may include, for example, tissue type, tissue thickness, tissue stiffness, tissue location, angiogenesis within tissue, etc., and received device parameters may include, for example, , staple cartridge type, staple cartridge color, auxiliaries to staple cartridge, staple cartridge grip load limit, staple cartridge gap range, staple cartridge firing rate, and the like. According to various aspects, system-defined constraints (eg, based on historical and/or procedural data accessed in a context-aware surgical system) determine preferred/ideal tissue parameters and /or may include preferred/ideal tissue parameter ranges. For example, a preferred/ideal tissue thickness and/or a preferred/ideal tissue thickness range may be associated with each staple cartridge color. In such examples, the color of each staple cartridge may indicate the type and/or size of staples within the staple cartridge. Continuing the example now, the received device parameters of the selected stapler/apparatus 24102 include staple cartridge color (e.g., indicating short staples), and the detected tissue parameters are associated with the selected stapler/apparatus. 24102 Staple Cartridge Colors Associated with Staple Cartridge Colors and/or Selected Staples/Devices if Tissue Thickness Exceeds Preferred/Ideal Tissue Thickness Range 24102 has security issues. Utilization of an inappropriate staple cartridge can lead to poor and/or undesirable results (eg, stapling, oozing, bleeding, etc.). In such an example, the control circuitry alerts the surgeon of the safety issue 24118 (eg, via user interface 24214, 24224 and/or 24234 on the selected stapler/apparatus, see FIG. via a user interface 24244 associated with the surgical hub, via an operating room user interface 24254, etc.). In such aspects, the control circuit receives the override command 24120 and instructs the user associated with the surgical hub (e.g., via the user interface 24214, 24224 and/or 24234 on the selected stapler/apparatus) to It may be further configured to allow the surgical procedure to proceed via the interface 24244, such as via an operating room user interface 24254). In one example, referring to FIG. 94, such a user interface may include selectable user interface elements, eg, 24251, to allow, for example, to continue. In an alternative aspect, in response to the alert, the surgeon can correct the notified safety issue (e.g., replace the inappropriate staple cartridge with another staple cartridge) and at this point , the device selection safety process 24100 may be executed/implemented again.

Similar to the above, according to a further aspect, system-defined constraints (eg, based on historical and/or procedural data accessed in the context-aware surgical system) are defined for each tissue type detected. A preferred/ideal gripping load limit and/or a preferred/ideal gripping load limit range may be included. For example, each staple cartridge associated with a respective grasping load limit may indicate the type of tissue in which staples can be optimally stapled. Continuing the example now, the received device parameters of the selected stapler/apparatus 24102 include its staple cartridge grasping load limit, and the tissue identified by the tissue identification process 24108 has a higher grasping load limit. There are safety issues with the stapler/apparatus 24102 selected, given the type of tissue that requires a staple cartridge with . Utilization of an inappropriate staple cartridge can lead to poor and/or undesirable results (eg, stapling, oozing, bleeding, etc.). In such an example, the control circuitry alerts the surgeon of the safety issue 24118 (eg, via user interface 24214, 24224 and/or 24234 on the selected stapler/apparatus, see FIG. via a user interface 24244 associated with the surgical hub, via an operating room user interface 24254, etc.). In such aspects, the control circuit receives override command 24120 (e.g., via user interface 24214, 24224, and/or 24234 on the selected stapler/apparatus, and controls the user interface associated with the surgical hub). 24244, via an operating room user interface 24254, etc.) to allow the surgical procedure to proceed. In one example, referring to FIG. 94, such a user interface may include selectable user interface elements, eg, 24251, to allow treatment to continue. In an alternative aspect, in response to the warning, the surgeon may (e.g., replace an inappropriate staple cartridge with another staple cartridge), at which point the device selection safety process 24100 is executed/implemented again. can be Again, received device parameters (e.g., staple cartridge type, staple cartridge color, auxiliaries to staple cartridge, staple cartridge grip load limit, staple cartridge gap range, staple cartridge firing rate, etc.), and Detected tissue parameters (e.g., tissue type, tissue thickness, tissue stiffness, tissue location, angiogenesis within tissue, etc.) and established system-defined constraints (e.g., context-aware surgical system associated with the received device parameters and/or detected tissue parameters based on historical data and/or treatment data accessed in ) is contemplated by the present disclosure.

Referring again to FIG. 93, if it is determined 24116 that there are no safety issues with the selected stapler/apparatus, the control circuitry implementing/performing the safety process 24100 is configured to provide recommendations 24122 to the surgeon. may be According to at least one aspect of the present disclosure, other available staplers, other available energy devices, and/or other stapler components (e.g., available for use with the selected stapler/apparatus) staple cartridge, shaft, etc.) 24112 is more optimal or optional, the control circuit alerts the surgeon to its availability (e.g., referring to FIG. 94, on the selected stapler/device). via the user interface 24214, 24224 and/or 24234 of the surgical hub, via the user interface 24244 associated with the surgical hub, via the operating room user interface 24254, etc.), recommending its use in the current surgical procedure. may be configured to In such aspects, the control circuit may be configured to operate in the operating room (e.g., via user interface 24214, 24224 and/or 24234 on the selected stapler/apparatus, via user interface 24244 associated with the surgical hub). may be further configured to receive acceptance of the recommendation, such as via the user interface 24254 of the If accepted, the control circuit selects other available staplers, other available energy devices, and/or other stapler components 24112 (eg, components AN of FIG. 94, such as , staple cartridges, shafts, etc.) available for use with the selected stapler/apparatus 24124. Upon rejection, the control circuitry may be configured to terminate the device selection safety algorithm 24126 and/or execute subsequent processes.

According to various other aspects, although specifically discussed with respect to staplers/devices herein, the disclosure should not be so limited. More specifically, the disclosed aspects provide energy devices (e.g., RF instruments and/or ultrasonic surgical instruments) and/or their respective components and/or endoscopic devices and/or their respective It applies equally to other surgical instruments that include components of.

(Example)
Various aspects of the subject matter described herein are set forth under the heading "Safety System for Smart Powered Surgical Stapling" in the Examples below.
Example 1 - A surgical system includes a control circuit and a surgical instrument. A surgical instrument includes a plurality of components and a sensor. Each of the plurality of components of the surgical instrument includes device parameters. Each component is configured to transmit its respective device parameter to the control circuit. The sensor is configured to detect a tissue parameter associated with the proposed function of the surgical instrument and transmit the detected tissue parameter to the control circuit. The control circuitry is configured to analyze the detected tissue parameters in conjunction with each respective device parameter based on system defined constraints. The surgical system further comprises a user interface configured to indicate whether a surgical instrument including multiple components is suitable to perform the proposed function.

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

Example 3—The surgical instrument component includes a staple cartridge, and the device parameters are: staple cartridge type, staple cartridge color, auxiliaries to staple cartridge, staple cartridge gripping load limit, staple cartridge gap range, and the firing rate of the staple cartridge.

Example 4—A component of a surgical instrument includes an end effector, and detected tissue parameters include the closing angle of the end effector on tissue, the length of tissue in contact with the tissue contacting surface of the end effector, and the 4. The surgical system of example 1, 2, or 3, comprising at least one of a force for compressing tissue of .

[0053] Example 5 - The surgical system of Example 4, wherein the control circuitry is further configured to identify the tissue as soft tissue, blood vessel, or bronchi based on the at least one detected tissue parameter.

Example 6 - The control circuit is further configured to recommend at least one alternative component for use with the surgical instrument to perform the proposed function, Examples 1, 2, 3, 6. Surgical system according to 4 or 5.

Example 7 - Examples 1, 2, 3, 4, 5, wherein the system-defined constraints include at least one of a predetermined tissue parameter or a predetermined tissue parameter range associated with each transmitted device parameter Or the surgical system according to 6.

Example 8 - According to example 1, 2, 3, 4, 5, 6, or 7, wherein the control circuit is further configured to block the proposed function when a system defined constraint is exceeded. surgical system.

[00100] Example 9 - The surgical system of Example 8, wherein the user interface comprises user interface elements selectable to override the control circuitry to enable the proposed functionality of the surgical instrument.

Example 10 - The proposed function of the surgical instrument is to perform one or more of grasping tissue, coagulating tissue, cutting tissue, and stapling tissue. The surgical system of Example 1, 2, 3, 4, 5, 6, 7, 8, or 9, comprising:

Embodiment 11 - Embodiment 1, 2, 3, 4, 5, 6, 7, 8, 9 or further comprising a surgical hub communicatively coupled to the surgical instrument, wherein the surgical hub comprises control circuitry 11. The surgical system according to 10.

Example 12 - The surgical system of Example 11, wherein one of the surgical instrument or surgical hub comprises a user interface.

Example 13 - A surgical system comprises a surgical hub and a surgical instrument communicatively coupled to the surgical hub. A surgical instrument includes a plurality of components and a sensor. Each of the plurality of components of the surgical instrument includes device parameters. Each component is configured to transmit its respective device parameters to the surgical hub. The sensor is configured to detect tissue parameters associated with the proposed function of the surgical instrument and transmit the detected tissue parameters to the surgical hub. The surgical hub includes a processor and memory coupled to the processor. The memory stores instructions executable by the processor to analyze detected tissue parameters in conjunction with each respective device parameter based on system defined constraints. The surgical system further comprises a user interface configured to indicate whether a surgical instrument including multiple components is suitable to perform the proposed function.

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

Example 15—A component of a surgical instrument includes a staple cartridge, and the device parameters are staple cartridge type, staple cartridge color, auxiliaries to staple cartridge, staple cartridge gripping load limit, staple cartridge gap range, and the firing rate of the staple cartridge.

Example 16—A component of a surgical instrument includes an end effector, and the detected tissue parameters include the closing angle of the end effector on tissue, the length of tissue in contact with the tissue contacting surface of the end effector, and the 16. The surgical system of example 13, 14 or 15, comprising at least one of a force for compressing tissue of .

Example 17 - An example wherein the instructions are further executable by the processor of the surgical hub to recommend at least one alternative component for use with the surgical instrument to perform the proposed function 17. The surgical system according to 13, 14, 15 or 16.

Example 18 - In Example 13, 14, 15, 16 or 17, the instructions are further executable by the processor of the surgical hub to block the proposed function when system defined constraints are exceeded. The described surgical system.

Example 19 - A non-transitory computer readable medium stores computer readable instructions which, when executed, cause a machine to generate a plurality of surgical instruments of a surgical system based on system defined constraints. Analyzing the detected tissue parameters in conjunction with the device parameters of each of the components, the detected tissue parameters being associated with the proposed function of the surgical instrument. Surgical systems include surgical instruments that include multiple components. Each component is configured to send its respective device parameters to the machine. The surgical system further includes a sensor configured to detect the detected tissue parameter and transmit the detected tissue parameter to the machine. The instructions, when executed, further cause the machine to generate a user interface that provides an indication of whether a surgical instrument comprising multiple components is suitable for performing the proposed function of the surgical system. .

Example 20 - The instructions of example 19, wherein the instructions, when executed, further cause the machine to generate selectable override elements on the user interface to enable the proposed functionality of the surgical instrument Non-Transitory Computer-Readable Medium.

Surgical instrument control by sensed closure parameters Compression ratio for determining tissue integrity can be detected and used to adjust or influence various operating parameters that determine how the surgical instrument functions. The speed at which the jaws of a surgical instrument are transitioned from an open position to a closed position to grasp tissue therebetween may be defined as the grasping speed or the closing speed. In various aspects, the closure speed may be variable or constant during the example course of jaw closure. A threshold against which certain parameters associated with jaw closure are compared may be defined as a closure threshold.

Grasping tissue with an inadequate closing velocity or grasping with an inadequate closing threshold can result in tissue damage (e.g., due to excessive force applied to the tissue). and/or may cause motion impairment by the surgical instrument (e.g., due to tissue not being held securely by the jaws as the staples are fired). may distort the staple). Thus, in some aspects, the surgical instrument detects characteristics of the tissue being grasped by the surgical instrument and adjusts the closure rate(s), closure threshold(s), and other actions accordingly. configured to adjust parameters. Further, each surgical procedure may involve multiple different tissue types and/or tissue with different characteristics. Thus, in some aspects, the surgical instrument adjusts the tissue pressure each time the tissue is grasped and adjusts the closure speed(s), closure threshold(s), and other operating parameters accordingly. is configured to dynamically detect features of

The present disclosure provides at least one solution in which a surgical instrument is configured to detect parameters related to compression of tissue being grasped by an end effector. The surgical instrument may be further configured to distinguish between tissues exhibiting different consistency according to detected tissue compression characteristics. The motor can then be controlled to affect the closing speed of the jaws and/or to provide feedback to the user according to tissue integrity. For example, slowing the closure rate of the jaws if the detected tissue compression characteristic indicates that the tissue is stiff and/or if the tissue compression characteristic indicates that the tissue has a low shear strength, a supplemental stiffener. can be configured to provide suggestions to the user to take advantage of.

FIG. 95 shows a perspective view of a surgical instrument 21000 in accordance with at least one aspect of the present disclosure. In one aspect, surgical instrument 21000 includes control circuitry 21002 coupled to motor 21006 , user interface 21010 , and sensor(s) 21004 . Motor 21006 causes jaws of end effector 21008 (eg, anvil 150306 and/or channel 150302 of surgical instrument 150010 shown in FIG. 25) to be in a first open configuration, eg, as discussed with respect to FIG. Coupled to end effector 21008 for transitioning to and from the second closed configuration. Sensor(s) 21004 may be communicatively coupled to control circuitry 21002 such that control circuitry 21002 receives data and/or signals. Control circuitry 21002 may be communicatively coupled to motor 21006 such that control circuitry 21002 controls operation of motor 21006 according to data and/or signals received from sensor(s) 21004, for example. User interface 21010 includes devices configured to provide feedback to a user of the surgical instrument, such as a display or speaker.

In various aspects, the sensor(s) 21004 can be configured to detect compression parameters of tissue grasped with the end effector. In one aspect, the sensor(s) 21004 detects the force to close the jaws (FTC) of the end effector 21008, i.e. the force applied to transition the jaws from an open configuration to a closed configuration. can be configured as For example, sensor(s) 21004 may include a motor current sensor configured to detect current drawn by the motor, as discussed with respect to FIG. 12, FIG. 18, or FIG. For a DC motor, the current drawn by the motor corresponds to the motor torque (eg, torque on the output shaft of motor 21006), which is representative of the FTC of end effector 21008. As the end effector 21008 closes on tissue, the FTC of the end effector 21008 corresponds to the tissue compression of the grasped tissue since it represents the force transmitted from the end effector 21008 to the grasped tissue. are doing. The greater the force applied to the tissue, the more the tissue will be compressed. In another aspect, the sensor(s) 21004 are on the end effector 21008 configured to receive RF signals from corresponding second electrodes, as described in connection with FIGS. a first electrode positioned in the . The electrical impedance of tissue can correspond to the thickness of that tissue, which can correspond to the tissue compression of the grasped tissue. In yet another aspect, the sensor(s) 21004 includes a force responsive transducer configured to determine the amount of force being applied to the sensor(s) 21004 as discussed with respect to FIG. . Similar to the FTC discussion above, when the end effector 21008 closes on tissue, the force detected by the transducer represents the force transmitted from the end effector 21008 to the grasped tissue. The greater the force applied to the tissue, the more the tissue will be compressed. User interface 21010 includes devices configured to provide feedback to a user of the surgical instrument, such as a display or speaker. In still other aspects, the sensor(s) 21004 may vary from those described above and other such sensors capable of detecting compression parameters associated with tissue grasped with the end effector. May contain combinations. For example, an end effector, such as the end effector 15200 shown in FIG. 53, can include a first sensor 152008a comprising a force responsive transducer and a second sensor 152008b comprising an impedance sensor.

Control circuitry 21002 may be configured to adjust the closing speed of the jaws of end effector 21008 to accommodate different tissue types. Control circuitry 21002 monitors the compressive force exerted on the tissue (eg, FTC), or another parameter (eg, tissue impedance) associated with tissue compression (eg, tissue impedance), over an initial compression period to Based on the rate of change of the parameter, it can be configured to adjust the closing speed or time of the jaws accordingly. For example, as discussed above with respect to FIG. 22, rather than applying the full compressive force for a short period of time, reducing the closing speed or increasing the closing time for more viscoelastic tissue. can be beneficial.

FIG. 96 depicts a logic flow diagram of a process 21050 for controlling a surgical instrument according to the integrity of grasped tissue, according to at least one aspect of the present disclosure. See also FIG. 95 in the following description of process 21050. FIG. The illustrated process may be performed by control circuitry 21002 of surgical instrument 21000, for example. Accordingly, the control circuitry 21002 implementing the process receives 21052 data and/or signals (eg, digital or analog) from the sensor(s) 21004 associated with the tissue compression parameter sensed thereby. In various aspects, tissue compression parameters are parameters associated with the characteristics, types, properties and/or conditions of the tissue being operated on, parameters associated with internal motions and/or characteristics of the surgical instrument 21000 or their It can contain constituents. In one aspect, the tissue compression parameter can include, for example, the FTC of the end effector 21008. In another aspect, the tissue compression parameter can include, for example, the thickness of the grasped tissue. The control circuit 21002 can then correlate data regarding the tissue compression parameter as one or more discrete values transmitted by the sensor(s) 21004, the associated value(s). yes) 21052 capable of receiving the signal transmitted by 21004;

Accordingly, control circuitry 21002 determines how to compare the value of the sensed tissue compression parameter to one or more thresholds and then generate a response accordingly. In one aspect, the control circuit 21002 determines 21054 the value of the sensed tissue compression parameter against a first threshold. For example, the control circuit 21002 can determine 21054 whether the sensed tissue compression parameter exceeds or is greater than a first threshold or an upper threshold. In one aspect, if the sensed tissue compression parameter exceeds the first threshold, the process 21050 proceeds along the yes branch and the control circuit 21002 controls the motor 21006 to control 21056 the jaws of the end effector 21008. increase the length of time to close the Control circuitry 21002 may, for example, decrease the speed at which the jaws are closed, increase the length of time that jaw movement is paused after initial grasping of tissue (i.e., tissue creep latency), or The motor 21006 can be controlled 21056 to increase the closing time of the jaws by lowering the stabilization threshold for ending the grip phase. If the sensed tissue compression parameter does not exceed the first threshold, then process 21050 proceeds along the NO branch, and in various aspects process 21050 may end or process 21050 continues. Alternatively, control circuitry 21002 may compare the value of sensed tissue compression to one or more additional thresholds or continue to receive 21052 tissue parameter data and/or signals.

In another aspect, the control circuit 21002 further determines 21058 the value of the sensed tissue compression parameter against a second threshold. For example, the control circuit 21002 can determine 21058 whether the sensed tissue compression parameter is less than or less than the second threshold. In one aspect, if the sensed tissue parameter falls below the second threshold, the process 21050 proceeds along the yes branch and the control circuit 21002 provides 21060 corresponding feedback via, for example, the user interface 21010. The 21060 feedback provided can include, for example, visual feedback provided via a display or audio feedback provided by a speaker. In one aspect, the feedback may suggest that the user take one or more corrective actions to remedy situations in which the sensed tissue compression parameter is unexpectedly low. Such corrective action can be, for example, supplemental reinforcement as disclosed in U.S. Pat. utilizing a material (ie, a tissue thickness compensator). The supplemental stiffeners, in various aspects, are configured to accommodate and/or apply additional compressive force to tissue captured between the anvil 150306 (Fig. 25) and the staple cartridge 150304 (Fig. 25). It can include a layer or series of layers of compressible material.

The thresholds discussed above are, for example, parameter(s) 21004 sensed by sensor(s) 21004 and/or derivative values of parameter(s) sensed by sensor(s) 21004 (eg, rate of change of the sensed parameter over time). In aspects where the tissue compression parameter includes the FTC of the end effector 21008, a first threshold may indicate a description above which the grasped tissue is considered tight. Hard tissue may be relatively prone to tearing, either due to the mechanical action of the jaws on the tissue, or due to re-expansion of the lung tissue. Additionally, a second threshold may indicate a statement that the grasped tissue is considered to have low shear strength (ie, is soft). Tissue with low shear strength may be firmly grasped in place by the end effector 21008 or otherwise held during stapling and/or firing of the cutting member (i.e., I-beam 150178 with cutting edge 150182). It can be relatively difficult to hold in the way.

Although certain example steps of process 21050 of FIG. 96 are shown as occurring in a particular order or sequence, such depiction is for illustrative purposes only and the specific order of the particular steps is shown. Note that no particular order of processes 21050 is intended unless is clearly required from the above discussion. For example, in another aspect of the process 21050, the control circuit 21002 determines 21054 whether the sensed tissue compression parameter exceeds the first threshold or the upper threshold before determining 21054 whether the sensed tissue compression parameter exceeds the second threshold. , or below a lower threshold 21058 .

FIG. 97 shows a first graph 21100 showing end effector FTC 21104 and time 21102 for an exemplary firing of surgical instrument 21000, according to at least one aspect of the present disclosure. See also FIGS. 95-96 in the following description of the first graph 21100. FIG. First graph 21100 illustrates exemplary firings by surgical instrument 21000 controlled by control circuit 21002 performing process 21050 described above with respect to FIG. In this illustrative example, first threshold 21106 includes a particular time rate of change of FTC (ie, ΔFTC), and second threshold 21108 includes a particular FTC. In various aspects, the thresholds 21106, 21108 may be defined in terms of one or more other variables or programmed or set by a user of surgical instrument 21000.

96 receives tissue compression parameter data and/or signals 21052 and determines that the FTC falls below a second threshold 21108 at time _t1. 21058. Accordingly, the control circuitry 21002 provides feedback 21060 to the user, including suggestions for the user to take a particular action and/or an indication that the end effector 21008 is grasping tissue with low shear strength. In one aspect, the feedback 21060 provided is a tissue corrector applied to the end effector 21008 to reinforce and/or correct low shear strength tissue (e.g., US Pat. The tissue compensator described) may suggest that the user release the surgical instrument 21000 and fire it again. In one aspect, the control circuit 21002 can be further configured to cause the motor 21006 to stop closing the jaws of the end effector 21008 when the FTC falls below a second threshold. In another aspect, the control circuit 21002 may be configured to suggest that the user stop closing the jaws of the end effector 21008 if the FTC falls below a second threshold. The 21060 feedback provided may be, for example, prompts displayed on operating room displays 107, 109, 119 (FIG. 2) and/or surgical instrument displays, via speakers located in the operating room and/or surgical instrument. It can take various forms including an emitted audible message, tactile feedback via the surgical instrument, or a combination thereof.

For a second shot 21114 (which may be a shot that utilizes a tissue compensator after the first shot 21110), the control circuit 21002 executing process 21050 shown in FIG. or receive a signal 21052 and do not determine that the FTC falls below the second threshold or exceeds the first threshold at any point in the process of closing the end effector 21008 . Therefore, the control circuit 21002 does not affect the closing speed of the jaws, provides feedback to the user, or performs any other such action.

FIG. 98 illustrates a second graph 21116 showing burst time 21104 of end effector FTC 21102 for exemplary firing of surgical instrument 21000, according to at least one aspect of the present disclosure. See also FIGS. 95-96 in the following description of the second graph 21116. FIG. A second graph 21116 shows an exemplary firing 21118 by surgical instrument 21000 controlled by control circuit 21002 performing process 21050 described above with respect to FIG. In this illustrative example, the first threshold 21106 comprises the rate of change of the FTC over a particular time period (ie, ΔFTC).

In a third firing 21116, control circuitry 21002, which performs the process illustrated in FIG. 96, receives tissue compression parameter data and/or signals 21052 and determines ΔFTC exceeds first threshold 21106 at time _t2 . 21058. Accordingly, the control circuit 21002 controls the motor 21006 to increase the jaw closure time 21056, such as by decreasing the jaw closure speed, and correspondingly also decreases the rate at which the FTC 21102 increases. Increasing the jaw closure time may be beneficial, for example, to avoid causing damage to hard tissue by preventing a greater amount of force being exerted on the tissue for a short period of time. In one aspect, the first threshold 21106 is the rate of change of the FTC ( _ΔFTCD ) default value, i. , or a baseline FTC ratio. In this aspect, during a surgical procedure, if the FTC experienced by surgical instrument 21000 exceeds FTC _D , control circuitry 21002 executing process 21050 may control motor 21006 to increase 21056 jaw closure time. can.

During the firing stroke of surgical instrument 21000, the time at which control circuitry 21002, which implements the algorithm or process described above, compares the parameters sensed by sensor(s) 21004 to one or more threshold values. A series of discrete instantiations in between and/or successive time intervals during the firing stroke can be included. The tissue compression parameter monitored by the control circuit 21002 and compared to a threshold is, for example, an FTC value (eg, a second threshold 21108 shown in FIG. 97) or a ΔFTC value (eg, a second threshold 21108 shown in FIGS. 97-98). threshold 21106) of 1 can be included.

In one aspect, control circuitry 21002 stores data associated with firing surgical instrument 21000 and then optionally utilizes data from previous firings to effect tissue alignment of the grasped tissue. It can be further configured to adjust the algorithm for determining gender. For example, data from previous firings can be utilized to adjust the first and/or second thresholds of process 21050 shown in FIG. In one aspect, filed Mar. 29, 2018, entitled "SURGICAL HUB SITUAL AWARENESS", as described above under the heading "Situational Awareness" and incorporated herein by reference in its entirety. 15/940,654, surgical instrument 21000 is configured to mate with surgical hub 106 (FIGS. 1-3) that implements a situational awareness system. In some cases. In this manner, the situational awareness system can determine the type of tissue being operated on during a surgical procedure and adjust the algorithm for determining the integrity of the grasped tissue accordingly. In another aspect, surgical instrument 21000 may be configured to receive user input indicating the type of tissue being operated on and adjust the algorithm for determining tissue integrity accordingly. . For example, surgical instrument 21000 may be configured to adjust the first and/or second thresholds of process 21050 shown in FIG. 96 from default values according to the tissue type entered by the user.

With the techniques described above, the surgical instrument 21000 avoids damage to the tissue being grasped, resulting from jaw closure velocities that are inappropriate for the particular characteristics of the tissue being operated on or that are not ideal. Allows to prevent malfunctions (e.g. misformed staples). In addition, the techniques described herein improve the ability of surgical instruments to respond appropriately to tissue characteristics encountered during the course of a surgical procedure.

Initial Tissue Contact to Determine Tissue Type and/or obstruction of movement by surgical instruments (e.g., staples because the tissue is not held securely by the jaws when the staples are fired). can be transformed). Thus, in some aspects, the surgical instrument detects characteristics of the tissue being grasped by the surgical instrument and adjusts the closure rate(s), closure threshold(s), and other actions accordingly. configured to adjust parameters. Further, each surgical procedure may involve multiple different tissue types and/or tissue with different characteristics. Thus, in some aspects, the surgical instrument adjusts the tissue pressure each time the tissue is grasped and adjusts the closure speed(s), closure threshold(s), and other operating parameters accordingly. is configured to dynamically detect features of

The present disclosure provides at least one solution in which a surgical instrument is gripped according to the degree of tissue contact with the surfaces of the jaws and the relative position of the jaws at the initial point of contact with the tissue. is structured to characterize the organizational type of the organization The jaw closing speed and the threshold for adjusting the jaw closing speed are then set to appropriate levels for the tissue type characterized by the detected degree of tissue contact and the detected jaw position. can do. For example, the surgical instrument is configured to distinguish between soft tissue and blood vessels because the soft tissue contacts the surface of the jaws to a greater degree and the jaws contact at a greater angle at the initial point of contact compared to blood vessels. can be The surgical instrument can then control the motor to affect the closing speed and adjustment threshold of the jaws depending on the type of tissue detected.

Referring again to FIG. 95 , in one aspect, surgical instrument 21000 includes control circuitry 21002 coupled to motor 21006 , user interface 21010 , and sensor 21004 . Motor 21006 moves jaws of end effector 21008 (eg, anvil 150306 and/or channel 150302 of surgical instrument 150010 shown in FIG. 25) into a first or open configuration, as discussed with respect to FIG. A motor 21006 is coupled to the end effector 21008 to transition between the second or closed configuration. Sensor(s) 21004 may be communicatively coupled to control circuitry 21002 such that control circuitry 21002 receives data and/or signals. Control circuitry 21002 controls operation of motor 21006, for example, according to data and/or signals received from sensor(s) 21004, such that control circuitry 21002 controls operation of motor 21006, for example, according to data and/or signals received from sensor load 21004. , may be communicatively coupled to motor 21006 .

In various aspects, the sensor(s) 21004 can be configured to detect physical contact of tissue against the jaw surfaces of the end effector 21008 . In one aspect, the sensor(s) 21004 can include one or more tissue contact sensors positioned along the tissue contacting surface of the end effector 21008, such as an anvil and cartridge or channel. Tissue contact sensors are along the surface of the jaws, each configured to determine whether tissue is positioned to impinge thereon, for example, as discussed above with respect to FIGS. It may include multiple sensors or segments of the segmentation circuit arranged in series. In one aspect, the sensor(s) 21004 comprises a plurality of electrodes each configured to receive RF signals from corresponding electrodes positioned on opposing jaws, as discussed with respect to FIGS. including. Accordingly, the control circuit 21002 performs a continuity test along the length of the end effector 21008 to determine if there is tissue at a location corresponding to each electrode where a signal can be received from that corresponding electrode. (because a signal transmission medium, ie tissue, must be placed between the electrodes in order to receive the signal from its corresponding electrode). In another aspect, the sensor(s) 21004 is a plurality of force sensors each configured to determine an amount of force being applied to the sensor(s) 21004, as described with respect to FIG. Includes reactive converter. Accordingly, control circuitry 21002 can determine that tissue is present at a location corresponding to each force responsive transducer detecting a non-zero force thereon. In other aspects, the sensor(s) 21004 includes multiple load cells, pressure sensors, and/or other sensors configured to detect physical contact therewith. Similar to the discussion above regarding force responsive transducers, control circuitry 21002 determines that tissue is present at a location corresponding to each load cell, pressure sensor, and/or other sensor detecting a non-zero force thereon. can do. In yet another aspect, sensor(s) 21004 includes a current sensor configured to detect the amount of current drawn by motor 21006, as discussed with respect to FIGS. Thus, control circuit 21002 controls motor 21006 as described with respect to FIG. 83 (i.e., FTC increases when jaws grip tissue 153610, 153616, FTC corresponds to motor current). increases the current drawn by to compensate for the increased gripping load experienced by the motor 21006 as the jaws contact tissue, and the jaws of the end effector 21008 initially move as they begin to exert a gripping force against it. can determine the point of contact with the tissue at The various aspects described above may be used individually or in conjunction with other aspects to determine the initial point of contact between the end effector 21008 and the tissue being grasped and/or the degree of contact between the tissue and the end effector 21008. Can be used in combination.

FIG. 99 illustrates a logic flow diagram of a process 21200 for controlling a surgical instrument according to physiological type of tissue grasped, according to at least one aspect of the present disclosure. See also FIG. 95 in the description of process 21200 below. The illustrated process may be performed by control circuitry 21002 of surgical instrument 21000, for example. Thus, the control circuit 21002 implementing the illustrated process 21200 receives tissue contact data and/or signals from sensor(s) 21004, such as the tissue contact sensors discussed above and depicted in FIGS. 100A-101B. 21202. Received 21202 tissue contact data and/or signals indicate whether tissue is contacting at least one of sensors 21004 . Accordingly, the control circuit 21002 can determine 21204 the initial point of contact between the end effector 21008 and the tissue being grasped. In one aspect, the control circuitry 21002 determines when initial tissue contact occurs 21204 by detecting when at least one of the sensors 21004 located on each of the jaws detects tissue contact thereon. .

Accordingly, control circuitry 21002 determines 21206 the position of the jaws at the initial tissue contact point. In one aspect, the control circuit 21002 is configured to detect relative positions of corresponding magnetic elements disposed on opposing jaws of the jaws of the end effector 21008, as discussed with respect to FIG. communicatively coupled to a Hall effect sensor disposed on one of them. Accordingly, the control circuit 21002 can determine 21206 the position of the jaws according to the sensed distance or gap therebetween. In another aspect, the control circuit 21002 controls when the closure tube is driven from a first or proximal position to a second or distal position, as discussed with respect to FIGS. Communicatively coupled to a position sensor configured to detect an absolute or relative position of a closure tube configured to close the jaws. Accordingly, the control circuit 21002 can determine 21206 the position of the jaws according to the sensed position of the closed tube. In yet another aspect, the control circuit 21002 is communicatively coupled to an angle sensor, such as the TLE5012B 360° angle sensor from Infineon Technologies, configured to detect the angle at which at least one of the jaws is oriented. . Accordingly, the control circuit 21002 can determine 21206 the position of the jaws according to the sensed angle at which the jaw(s) are oriented.

Accordingly, control circuitry 21002 determines 21208 the degree of contact between the grasped tissue and the tissue-contacting surfaces of the jaws. The degree of tissue contact may correspond to the number or percentage of sensors 21004 that detected the presence (or absence) of tissue as discussed with respect to FIG. In one aspect, the control circuit 21002 can determine the degree of tissue contact according to the ratio of the sensor(s) 21004 that detected the presence of tissue to the sensor(s) 21004 that did not detect the presence of tissue. .

Accordingly, the control circuit 21002 sets 21210 control parameters for the motor 21006 according to the determined jaw 21206 position and the determined degree of tissue contact 21208 . Motor control parameters can include, for example, a time to close the jaws and/or a closure threshold. In one aspect, the control circuit 21002 sets motor control parameters (e.g., jaw closure velocity and closure threshold) associated with particular positions of the jaws and particular degrees of tissue contact sensed via various sensors. It can be configured to access a memory (eg, a lookup table) to obtain. In various aspects, the control circuitry 21002 controls, for example, adjusting the speed at which the jaws are transitioned from an open position to a closed position, adjusting the speed of the jaws after initial grasping of tissue (i.e., tissue creep latency). The motor 21006 can be controlled to adjust the jaw closure time by adjusting the length of time that is paused and/or adjusting the stabilization threshold for ending the grasping phase. In various aspects, the closure threshold(s) is, for example, the control circuit 21002 stops the motor 21006 driving the closing of the jaws, or, for example, the compression ratio for determining tissue integrity. Other actions may include the maximum allowable FTC end effector 21008 or the rate of change for the FTC (ie, ΔFTC), as discussed above under the headings. Control circuit 21002 can then control motor 21206 according to motor control parameter set 21210 by process 21200 .

The position of the jaws at the initial point of contact with the tissue and the degree of contact with the tissue corresponds to the thickness or geometry of the tissue to be grasped, which corresponds to the physiological type of tissue. there is Accordingly, the control circuit 21002 may be configured 21210 to distinguish between tissue types and then set the control parameters of the motor 21006 accordingly. For example, the control circuit 21002 may be configured to determine whether soft tissue or vascular tissue is being grasped by the end effector 21008, and then set 21210 appropriate motor control parameters for the detected tissue type.

In some aspects, the closing speed of the jaws can be selected for each tissue type to maintain maximum FTC and/or to maintain ΔFTC below a particular A threshold value may also be selected for each tissue type. In one aspect, the control circuit 21002 can be configured to set a minimum grip ratio such that the closing motion of the jaws is not permanently stopped. In one aspect, control circuitry 21002 may be configured to control the maximum dwell time to ensure that jaw closure proceeds at least at a prescribed rate. In one aspect, the control circuit 21002 stops the motor 21006 and/or provides feedback to the user when the closure threshold(s) is exceeded or otherwise stalled during use of the surgical instrument 21000. can be configured to

Although certain example steps of process 21200 of FIG. 99 are shown as occurring in a particular order or sequence, such depiction is for illustrative purposes only and the particular order of the particular steps is shown in FIG. Note that no particular order of process 21200 is intended unless explicitly required from the above discussion. For example, in another aspect of the process 21200, the control circuit 21002 can determine 21208 the degree of tissue contact prior to determining 21206 the position of the jaws at the initial contact point.

100A-101B show various side elevation views of an end effector 21008 grasping soft tissue 21030 and vessel 21032 in both initial tissue contact and closed positions, according to at least one aspect of the present disclosure. show. In the depicted embodiment, end effector 21008 includes a plurality of tissue contact sensors 21016 disposed along the tissue contacting surface of the jaws, including anvil 21012 and channel 21014 . In other aspects, the tissue contact sensor 21016 may be disposed along the cartridge 150304 (FIG. 25) in addition to or instead of being disposed along the channel 21014 of the surgical instrument 21000. For simplicity, tissue contact sensor 21016 will be discussed as being disposed along channel 21014 in the following description. However, it should be noted that the concepts discussed herein apply equally to the manner in which the tissue contact sensor 21016 is disposed along the cartridge 150304. Tissue contact sensors 21016 can include, for example, impedance sensors, load cells, force responsive transducers, and combinations thereof, as discussed above. The tissue contact sensor 21016 is connected to an active sensor 21018 (i.e., a sensor that senses the presence of tissue) and a non-active sensor 21020 (i.e., a sensor that does not sense the presence of tissue) during use of the surgical instrument 21000 in a surgical procedure. It can be shown visually.

FIGS. 100A and 101A substantially illustrate initial contact points of end effector 21008 with soft tissue 21030 and blood vessel 21032, respectively. In one aspect, the initial point of contact between the end effector 21008 and tissue can be defined as the point at which there is at least one actuation sensor 21018 on both the anvil 21012 and the channel 21014. As noted above, tissue types can be distinguished according to the location of the jaws (ie, anvil 21012 and/or channel 21014) and the degree of contact with the jaws at the initial tissue-to-tissue contact point. For example, FIGS. 100A and 101A show how soft tissue 21030 and blood vessels 21032 can be distinguished based on the percentage of actuation sensor 21018 at the initial tissue contact point. That is, grasping the blood vessel 21032 will result in fewer sensors 21018 being activated versus grasping the soft tissue 21030 . It is further noted that the number of activated tissue sensors 21018 on the anvil 21012 and the number of activated tissue sensors 21018 on the channel 21014 may not be equal at the initial tissue contact point. As a further example, FIGS. 100A and 101A show how soft tissue 21030 and blood vessel 21032 can be distinguished based on the angle at which anvil 21012 is oriented with respect to channel 21014 at the initial tissue contact point. . That is, anvil 21012 is oriented at a first angle θ ₁ at its initial point of contact with soft tissue 21030 and at a second angle θ ₂ at its initial point of contact with vessel 21032 . Differences in the percentage of sensors 21018 that are actuated and the difference in the angle at which the anvil 21012 is oriented may be used individually or in combination (eg, by process 21200 shown in FIG. 99) to determine the amount of tissue being grasped. The physiological type can be characterized and then the appropriate jaw closure speed, closure threshold, and other motor control parameters for the tissue type can be set.

Figures 100B and 101B show a position in which the end effector 21008 fully grasps the soft tissue 21030 and vessel 21032, respectively. As can be seen there, changes in the number or proportion of activated sensors 21018 and deactivated sensors 21020 as the end effector 21008 grasps tissue can similarly be used to determine tissue type and/or tissue physics. properties, the degree to which tissue is compressed, and/or the distance between anvil 21012 and channel 21014, as well as various other parameters can be determined. For example, the vessel 21032 deforms more than the soft tissue 21030 when fully grasped, such that the number of sensors 21018 that are actuated as the end effector 21008 grasps the vessel 21032 is relatively large. will change. In some aspects, the control circuit determines the tissue type (i.e., physiological tissue type or specific physical characteristic) according to a change or rate of change in the number of sensors 21018 that are activated when the end effector 21008 is grasped. organization) can be performed. In some aspects, the control circuit performs the process of determining the degree to which tissue is compressed and/or deformed according to a change or rate of change in the number of sensors 21018 that are activated when grasping the end effector 21008. can be done.

In some aspects, surgical instrument 21000 includes control circuitry 21002 that performs process 21200 described in FIG. Circuitry 21002 may be configured to detect or measure the separation θ between the jaws and the length or degree of tissue contact L between the tissue and the jaws. The closure threshold (e.g., FTC threshold or ΔFTC threshold), initial closure velocity, and adjusted closure velocity(s) (i.e., closure velocity(s) at which jaws 21013 are closed after the closure threshold is exceeded) are can be functions of θ and L, respectively. As shown in FIGS. 100A-100B, at the point of initial contact with the first tissue (eg, soft tissue 21030), the jaw separation can be defined as θ ₁ and the degree of tissue contact is L can be defined as ₁ . 101A-B, at the initial point of contact with a second tissue (eg, blood vessel 21032), the jaw separation can be defined as θ ₂ and the degree of tissue contact is L ₂ can be defined as Thus, in some aspects where θ ₁ >θ ₂ and L ₁ >L ₂ , substantially soft tissue FTC threshold FTC _p >vessel FTC threshold FTC _v and soft tissue ΔFTC threshold ΔFTC _p >vessel gradient threshold ΔFTC _v , and vessel initial closure velocity v _V1 > soft tissue initial closure velocity v _P1 . The functional differences between these thresholds are discussed in more detail below with respect to FIGS. 102-103.

FIG. 102 shows first graphs 21300 and 21308 depicting end effector FTC 21304 and closing velocity 21306, respectively, and time 21308 for exemplary firing of surgical instrument 21000 grasping soft tissue 21030, according to at least one aspect of the present disclosure. A second graph 21302 is shown. In the following description of first graph 21300 and second graph 21302, reference should be made to FIGS. 95 and 99-100B. The exemplary launches described herein are for the purpose of demonstrating the concepts discussed above in connection with FIGS. 95 and 99-100B and are not to be construed as limiting in any way. shouldn't.

A first firing of surgical instrument 21000 can be represented by a first FTC curve 21310 and a corresponding first velocity curve 21310, which show changes in FTC and closure velocity over time during the course of the first firing. . The first firing may represent, for example, a default firing of surgical instrument 21000 or surgical instrument 21000 that does not include control circuitry 21002 that performs process 21200 shown in FIG. When the firing of surgical instrument 21000 is initiated, control circuit 21002 controls motor 21006 to begin driving anvil 21014 from its open position, setting the closing speed of anvil 21012 to the initial or default closing speed v _{d1 .} to 21318. As the anvil 21012 is driven from the open position, it contacts the grasped tissue, which is soft tissue 21030 for this particular firing. As the anvil 21012 contacts the grasped tissue at time _t0 , the FTC increases 21312 from an initial FTC (eg, zero) to a peak 21314 at time _t1 . At time t ₁ , control circuitry 21002 of surgical instrument 21000 determines that the FTC has reached or exceeded an FTC threshold (eg, which may be a defined threshold independent of tissue type), and the motor 21006 controls the anvil 21012 to stop moving, reducing the closing speed to zero 21320 . Movement of the anvil 21012 may be paused for a duration _p1 , during which the closing velocity is maintained at zero 21322. During rest, FTC gradually decreases 21316 as the grasped tissue relaxes.

A second firing of surgical instrument 21000 is represented by a second FTC curve 21324 and a corresponding first velocity curve 21324' showing changes in FTC and closure velocity over time during the course of the second firing. be able to. A second firing, as opposed to a first firing, can represent firing of a surgical instrument 21000 that includes a control circuit 21002 that performs the process shown in FIG. 99, for example. Once firing of surgical instrument 21000 is initiated, control circuit 21002 controls motor 21006 to begin driving anvil 21014 from its open position and rapidly increase 21336 the speed of anvil 21014 closing. Due to the relative thickness and/or geometry of soft tissue 21030, the initial point of contact between tissue (ie, soft tissue 21030) and jaws 21013 occurs shortly after anvil 21012 begins to be driven by motor 21006. Thus, the control circuit 21002 executing the process 21200 shown in FIG. 99 almost immediately determines that the soft tissue 21030 is being grasped and correspondingly determines the time to close the jaws, the closure threshold ( ), and other closure parameters can be set relatively early in the closure process. Accordingly, control circuitry 21002 controls motor 21006 to ramp 21336 the closing velocity of anvil 21014 to the initial closing velocity v _p1 inherent to soft tissue 21320 .

As the anvil 21012 is driven from the open position, it contacts the grasped tissue, which is soft tissue 21030 for this particular firing. As the anvil 21012 contacts the grasped tissue at time _t0 , the FTC increases 21326 from an initial FTC (eg, zero) to a first peak 21328 at time _t2 . The FTC increases 21326 over time for the second shot compared to the first shot, because the control circuit 21002 executing process 21200 is held back for the second shot. to select a first or initial closure velocity v _p1 appropriate for the type of tissue present, which reduces the amount of force exerted on the tissue compared to unmodified firing of surgical instrument 21000. Please note that At time t ₂ , control circuitry 21002 of surgical instrument 21000 sets FTC to FTC threshold FTC _p (set by control circuitry 21002 when control circuitry 21002 determines that soft tissue 21030 is being grasped, or after t _{0 )} . determined) has been reached or exceeded. A soft tissue FTC threshold FTC _p can represent, for example, the maximum force that can be safely or desirably exerted on soft tissue 21030 . Accordingly, the control circuit 21002 controls the motor 21006 to stop moving the anvil 21012 and reduce 21338 the closing speed to zero. Movement of the anvil 21012 may be paused for a duration _p2 , during which the closing velocity is maintained at zero 21340. During rest, FTC gradually decreases 21330 as the grasped tissue relaxes. Pause duration p ₂ may equal a default pause duration (eg, p ₁ ) selected by control circuit 21002 for soft tissue 21030 or a closure parameter.

After dwell duration p ₂ has elapsed at time t ₃ , control circuit 21002 reengages motor 21006 and resumes closing anvil 21012 . Therefore, the closing speed increases 21342 to the second closing speed _vp2 . In some aspects, after first exceeding the soft tissue FTC threshold FTC _p , the control circuit 21002 reduces the closing speed at which the anvil 21012 is closed to a second closing speed v _p2 specific for the soft tissue 21030; In this case v _p2 <v _p1 . The control circuit 21002 can be configured to close the anvil 21012 at a lower rate after the soft tissue FTC threshold FTC _p is exceeded because it is faster than expected for the detected tissue type. also may indicate that the tissue is thicker or otherwise more resistant to the closure force from the anvil 21012 . Therefore, it may be desirable to reduce the closing speed in order to attempt to reduce the amount of closing force that is subsequently exerted on the tissue being grasped.

When anvil 21012 resumes closure at time _t3 , FTC begins to increase again until it reaches 21332 at time _t4 , once again reaching or exceeding the soft tissue threshold FTC _p . At time _t4 , control circuitry 21002 of surgical instrument 21000 determines that the FTC has reached or exceeded FTC threshold FTC _p . Accordingly, the control circuit 21002 causes the motor 21006 to stop moving the anvil 21012 and reduce 21346 the closing speed to zero. Movement of the anvil 21012 may be paused for duration _p3 , during which the closing velocity is maintained at zero 21348. During rest, the FTC gradually decreases 21334 as the grasped tissue relaxes.

FIG. 103 shows a third graph 21350 and a fourth graph showing end effector FTC 21354 and closure rate 21356, respectively, and time 21358 for an exemplary firing of surgical instrument 21000 grasping vessel 21032, according to at least one aspect of the present disclosure. shows a graph 21352 of . In the following discussion of third graph 21350 and second graph 21352, reference should also be made to FIGS. 95, 99 and 101A-101B. The exemplary launches described herein are for the purpose of demonstrating the concepts discussed above with respect to FIGS. 95, 99, 101A-101B and should be construed as limiting in any way. isn't it.

A third firing of surgical instrument 21000 is represented by a third FTC curve 21360 and a corresponding first velocity curve 21360' showing changes in FTC and closure velocity over time during the course of the third firing. be able to. The third firing may represent, for example, a default firing of surgical instrument 21000 or a firing of surgical instrument 21000 that does not include control circuitry 21002 that performs the process depicted in FIG. When firing of surgical instrument 21000 is initiated, control circuit 21002 controls motor 21006 to begin driving anvil 21014 from its open position and to set the closing speed of anvil 21012 to the initial or default closing speed v _d2 . to 21370. The initial closing velocity v _d2 may or may not be equal to the initial closing velocity v _d1 in FIG. When anvil 21012 is driven from the open position, it moves for a period of time before contacting the grasped tissue, which for this particular firing is vessel 21032 . Note that this is in contrast to firing where surgical instrument 21000 is gripping soft tissue 21030, as depicted in FIG. Because the blood vessel 21032 is relatively thin, the anvil 21012 generally needs to travel a certain distance before making initial contact with the blood vessel 21032, while the soft tissue 21032 is generally thicker than the blood vessel 21032, so the anvil 21012 may be relatively thin. 21012 makes contact with vessel 21032 almost immediately. Thus, the FTC is initially flat 21362 as the anvil 21012 moves for a period of time without contacting tissue. As the anvil 21012 contacts tissue at time t ₀ , the FTC increases 21364 from an initial or flat 21376 FTC (eg, zero) to a peak 21366 at time t ₂ . At time t ₂ , control circuitry 21002 of surgical instrument 21000 determines that the FTC has reached or exceeded an FTC threshold (eg, which may be a defined threshold independent of tissue type) and motor 21006 stops movement of the anvil 21012 to reduce the closing velocity to zero 21372. Movement of anvil 21012 may be paused for duration _p4 , during which closing velocity is maintained at zero 21374 . During rest, FTC gradually decreases 21368 as the grasped tissue relaxes.

A fourth firing of surgical instrument 21000 is represented by a second FTC curve 21375 and a corresponding first velocity curve 21375' showing changes in FTC and closure velocity over time during the course of the second firing. can be done. In contrast to the first firing, the fourth firing may represent firing of a surgical instrument 21000 that includes control circuitry 21002 that performs process 21200 shown in FIG. 99, for example. Once firing of surgical instrument 21000 is initiated, control circuit 21002 controls motor 21006 to begin driving anvil 21014 from its open position and rapidly increase 21386 the speed of anvil 21014 closing. Due to the relative thinness and/or geometry of the vessel 21032 (eg, compared to the soft tissue 21030), the initial point of contact between the tissue (ie, vessel 21032) and the jaws 21013 may occur when the anvil 21012 is in contact with the motor 21006. will not occur until it is driven for a period of time by Accordingly, the control circuit 21002 executing the process 21200 shown in FIG. 99 will determine that the vessel 21032 is being grasped until the closure process has been performed for a period of time and will correspondingly extend the jaws. Time to close, closure threshold(s), and other suitable closure parameters cannot be set. Control circuit 21002 controls anvil 21014 because anvil 21012 does not contact the thinner tissue of blood vessel 21032 for a period of time and control circuit 21002 is therefore unable to detect the type of tissue being grasped. 21386 motor 21006 to rapidly increase the closing speed of the to the specified value speed _vd .

When the anvil 21012 is driven from the open position, the FTC is initially flat 21376 because the anvil 21012 moves over a period of time without contacting tissue. When the anvil 21012 contacts tissue at time _t0 , the FTC increases 21378 from the initial FTC (eg, zero). After contacting the vessel 21032, the control circuit 21002 executing the process 21200 shown in FIG. and other closing parameters at that point in the closing process. At time t ₁ , control circuit 21002 causes ΔFTC to reach ΔFTC threshold ΔFTC _v (set by control circuit 21002 at or after t ₀ when control circuit 21002 determines that vessel 21032 is being grasped). It is determined that it has been reached or exceeded. The vascular ΔFTC threshold ΔFTC _v can represent, for example, the maximum rate of change in force that can be safely or desirably exerted on the tissue of the vessel 21032 . Accordingly, control circuit 21002 controls motor 21006 to decrease 21388 the closure velocity to vessel 2032 tissue-specific vessel closure velocity v _v1 , where v _v1 <v _d .

As the anvil 21012 advances at the lower vessel closure velocity _vv1 , the FTC increases 21382 and ever more 21380 until it peaks at time _t3 . At time t ₃ , the control circuit 21002 causes the FTC to reach the FTC threshold FTC _v (set by the control circuit 21002 at or after t ₀ when the control circuit 21002 determines that the vessel 21032 is being grasped). It is determined that it has reached or exceeded this. Vascular FTC threshold FTC _v can represent, for example, the maximum force that can be safely or desirably applied to the tissue of vessel 21032 . Accordingly, the control circuit 21002 causes the motor 21006 to stop moving the anvil 21012 and reduce 21932 the closing speed to zero. Movement of the anvil 21012 may be paused for duration _p5 , during which the closing velocity is maintained at zero 21394. During rest, FTC gradually decreases 21384 as the grasped tissue relaxes. Pause duration p ₅ may be equal to a default pause duration (eg, p ₁ ) or closure parameter selected by control circuit 21002 for vessel 21032 tissue.

In summary, FIGS. 102-103 highlight different ways in which surgical instrument 21000 functions with and without control circuit 21002 performing process 21200 shown in FIG.

FIG. 104 illustrates a fifth graph 21400 showing end effector FTC 21402 and closing velocity 21404, respectively, and time 21406 for an exemplary firing of a surgical instrument, according to at least one aspect of the present disclosure. See also FIGS. 95 and 99-101B in the following discussion of fifth graph 21400. FIG. The exemplary launches described herein are for the purpose of demonstrating the concepts discussed above in connection with FIGS. 95 and 99-101B and are not to be construed as limiting in any way. shouldn't.

A fifth firing of the surgical instrument 21000 is shown by a fifth FTC curve 21408 and a corresponding fifth velocity curve 21408' showing changes in FTC and closure velocity over time during the course of the fifth firing. can be represented. A fifth firing may represent, for example, firing of surgical instrument 21000 including control circuitry 21002 that performs the process depicted in FIG. When firing of surgical instrument 21000 is initiated, control circuit 21002 controls motor 21006 to begin driving anvil 21014 from its open position and to set the closing speed of anvil 21014 so that it is at a particular closing speed. Rapidly increase 21418 until leveling off 21416 . When the anvil 21012 closes, the FTC increases 21410 until it peaks 21412 at a particular time. From the peak 21412, the FTC decreases 21414 until the tissue is fully grasped, at which point the control circuit 21002 controls the motor 21006 to stop closing the anvil 21012 and reduce the closing speed to zero 21420. .

Thus, the fifth firing represents a firing of surgical instrument 21000 that does not reach or exceed either the FTC threshold, the ΔFTC threshold, or any other closure threshold during jaws 21013 closure. In other words, the fifth shot remains within all control parameters during jaw 21013 closure. Accordingly, the control circuit 21002 allows the anvil 21012 to adjust the closing speed of the anvil 21012 or take any other corrective action during jaw 21013 closure.

FIG. 105 illustrates a sixth graph 21422 showing end effector FTC 21402 versus time 21406 and closing velocity 21404 versus time 21406 for an exemplary firing of a surgical instrument, according to at least one aspect of the present disclosure. See also FIGS. 95 and 99-101B in the following description of the sixth graph 21422. FIG. The exemplary launches described herein are for the purpose of demonstrating the concepts discussed above in connection with FIGS. 95 and 99-101B and are not to be construed as limiting in any way. shouldn't.

A sixth firing of surgical instrument 21000 is represented by a sixth FTC curve 21424 and a corresponding sixth velocity curve 21424', which show changes in FTC and closure velocity over time during the course of the sixth firing. be able to. A sixth firing may represent, for example, firing of surgical instrument 21000 including control circuitry 21002 performing process 21200 depicted in FIG. When the firing of surgical instrument 21000 is initiated, control circuit 21002 controls motor 21006 to begin driving anvil 21014 from its open position to a closing speed of anvil 21014 until it reaches a specified closing speed. to 21432. As the anvil 21012 closes, the FTC increases 21426 until it reaches a peak 21428 at a particular time. In this particular example, the operator of surgical instrument 21000 chooses to open jaws 21013 of surgical instrument 21000 to recondition tissue therein. Accordingly, the closing velocity decreases 21434 until it reaches a negative closing velocity, which, for example, causes the jaws 21013 to open to facilitate tissue reconditioning within the jaws 21013. indicates that The closing speed then returns to zero 21436 and the jaws 21013 stop. Correspondingly, the FTC decreases to zero 21430 when the jaws 21013 are released from the tissue.

FIG. 106 illustrates a seventh graph 21438 showing end effector FTC 21402 versus time 21406 and closing velocity 21404 versus time 21406 for an exemplary firing of a surgical instrument, according to at least one aspect of the present disclosure. See also FIG. 95 and FIGS. 99-101B in the following description of the seventh graph 21438. FIG. The exemplary launches described herein are for the purpose of demonstrating the concepts discussed above in connection with FIGS. 95 and 99-101B and are not to be construed as limiting in any way. shouldn't.

A seventh firing of surgical instrument 21000 is shown by a seventh FTC curve 21440 and a corresponding seventh velocity curve 21440' showing changes in FTC and closure velocity over time during the course of the seventh firing. can be represented. A seventh firing may represent, for example, firing surgical instrument 21000 including control circuitry 21002 that performs process 21200 depicted in FIG. When firing of surgical instrument 21000 is initiated, control circuit 21002 controls motor 21006 to begin driving anvil 21014 from its open position, increasing the closing speed of anvil 21014 to a first closing speed _v1 . 21450 to increase rapidly. When anvil 21012 closes, FTC increases 21442 until time _t1 . At time t ₁ , the control circuit 21002 sets the ΔFTC threshold ΔFTC, which can be either the default ΔFTC threshold or the ΔFTC threshold, for the particular physiological tissue type detected by the control circuit 21002 according to the process 21200 depicted in FIG. Determine whether _{the T} threshold is reached or exceeded. As another example, ΔFTC _T is set by another process performed by control circuitry 21002 and/or another control circuitry of surgical instrument 2100 in response to other sensed parameters or according to another algorithm. can also For example, while jaw closure progresses within the operating parameters of process 21200 illustrated in FIG. deviates from expected parameters in some way (e.g., the tissue is thicker or thinner than expected for a given tissue type), in this case it is time to close jaws 21013 , closure thresholds, and other control parameters accordingly. In one example, the second sensor detects at time _t1 that the tissue is thinner than expected. Accordingly, control circuit 21002 sets a new ΔFTC _T (lower than the previous ΔFTC _T in this example), which control circuit 21002 then determines is reached or exceeded at time t ₁ . .

Accordingly, the control circuit 21002 controls the motor 21006 to reduce 21452 the closing speed of the anvil 21012 to a second closing speed _v2 , where _v1 > _v2 . From t ₁ , the decrease in closure rate causes the FTC to increase at a slower rate 21444 . FTC increases 21444 until it reaches a peak 21446 below the FTC threshold FTC _T , then decreases. Since the seventh firing remained within all closure parameters after _t1 , the closure velocity is maintained at the second closure velocity _v2 until the tissue is fully grasped 21454 and control circuit 21002 , controls the motor 21006 to stop closing the anvil 21012 and the closing speed drops to zero 21456.

FIG. 107 shows a graph 21500 depicting impedance 21502 versus time 21504 for determining when jaws of a surgical instrument contact tissue and/or staples, according to at least one aspect of the present disclosure. See also FIG. 95 in the description of the seventh graph 21438. FIG. Sensor(s) configured to detect the degree of compression of the tissue grasped by the end effector 21008 and/or to detect initial contact with tissue, as discussed above 21004 can include, for example, an impedance sensor. The impedance and/or the rate of change of impedance of the tissue sensed by the impedance sensor(s) can be used to determine the condition of the tissue being grasped. For example, if the sensed impedance has a plateau state 21506 in impedance _ZOC indicating an open circuit condition, the control circuit 21002 coupled to the impedance sensor indicates that the jaws are open and/or are in contact with tissue. It can be determined that no As another example, when the sensed impedance first decreases 21508 from the open circuit impedance _ZOC , the control circuitry 21002 coupled to the impedance sensor can determine that initial contact with tissue has been made. As another example, the control circuit 21002 coupled to the impedance sensor detects when the sensed impedance decreases from the open circuit impedance _ZOC 21510, the shape of the impedance curve and time, and/or the rate of change of the sensed impedance. can be used to determine the rate of tissue compression and/or the degree to which the tissue is compressed. As yet another example, when the sensed impedance drops to zero 21512, the control circuit 21002 coupled to the impedance sensor determines that the jaws of the end effector 21008 are in contact with the staples shorting the impedance detection system. can judge.

(Example)
Various aspects of the subject matter described herein under the heading "Controlling a Surgical Instrument According to Sensed Closure Parameters" are described in the examples below.
Example 1 - A surgical instrument comprises an end effector comprising jaws transitionable between an open configuration and a closed configuration. The surgical instrument further includes a motor operably coupled to the jaws. A motor is configured to transition the jaws between the open configuration and the closed configuration. The surgical instrument further comprises a sensor configured to transmit at least one signal indicative of a tissue compression parameter associated with tissue between the jaws. The surgical instrument further includes control circuitry coupled to the sensor and the motor. The control circuit receives at least one signal and determines a value of the tissue compression parameter based on the at least one signal when the jaws transition from the open configuration to the closed configuration, the value of the tissue compression parameter being the first causes the motor to increase the time to transition the jaws to the closed configuration and provides feedback depending on whether the value of the tissue compression parameter falls below the second threshold. is configured to

Example 2 - The surgical instrument of Example 1, wherein the tissue compression parameter includes force exerted by the motor to transition the jaws to the closed configuration.

Example 3 - The surgical instrument of Example 1, wherein the tissue compression parameter comprises the rate of change over time of the force exerted by the motor to transition the jaws to the closed configuration.

Example 4 - The surgical instrument of Example 1, 2 or 3, wherein the feedback includes suggestions for supplemental stiffeners.

Example 5 - The control circuit is configured to increase the time to transition the jaws to the closed configuration by decreasing the speed at which the motor transitions the jaws to the closed configuration, Examples 1, 2, 5. The surgical instrument according to 3 or 4.

Example 6 - The control circuit is configured to increase the time to transition the jaws to the closed configuration by increasing the length of time the motor is idle when transitioning the jaws to the closed configuration. The surgical instrument of example 1, 2, 3 or 4, wherein the surgical instrument comprises:

Example 7 - The control circuit is configured to increase the time for the motor to transition the jaws to the closed configuration by lowering the stabilization threshold for stopping transitioning the jaws to the closed configuration. The surgical instrument of example 1, 2, 3 or 4, wherein the surgical instrument comprises:

Example 8 - A surgical instrument comprises an end effector. The end effector includes jaws transitionable between an open configuration and a closed configuration, and one or more sensors positioned along the tissue contacting surface of each of the jaws. One or more sensors are configured to detect contact with tissue. The surgical instrument further includes a motor operably coupled to the jaws. A motor is configured to transition the jaws between the open configuration and the closed configuration. The surgical instrument further includes control circuitry coupled to the one or more sensors and motors. The control circuitry determines an initial contact point at which tissue contacts the tissue contacting surfaces of the jaws, determines the separation between the jaws at the initial contact point, and determines the degree of contact between the tissue contacting surfaces and the tissue. , to cause the motor to transition the jaws to the closed configuration at a rate corresponding to the separation between the jaws at the initial point of contact and the degree of contact between the tissue-contacting surface and the tissue. The motor is configured to adjust the speed at which the jaws are transitioned to the closed configuration depending on whether the force exerted by the motor exceeds a threshold value. The threshold corresponds to the distance between the jaws at the initial contact point and the degree of contact between the tissue contact surface and the tissue.

Example 9 - The surgical instrument of Example 8, wherein the one or more sensors comprise pressure sensors.

Example 10 - The surgical instrument of Example 8, wherein the one or more sensors comprise impedance sensors.

Example 11 - The surgical instrument of Example 8, 9 or 10, wherein the spacing between the jaws comprises an angle between the jaws.

Example 12 - The surgical instrument of Example 8, 9 or 10, wherein the inter-jaw spacing comprises an inter-jaw gap.

Example 13 - A surgical instrument comprises an end effector. The end effector includes jaws configured to grasp tissue by transitioning between an open configuration and a closed configuration, and a contact sensor assembly configured to sense tissue impinging thereon. The surgical instrument further includes a position sensor configured to sense configuration of the jaws and a motor coupled to the jaws. A motor is configured to transition the jaws between the open configuration and the closed configuration. The surgical instrument further includes a control circuit coupled to the contact sensor assembly, the position sensor, and the motor. The control circuit determines an initial contact point where tissue contacts the jaws, determines the configuration of the jaws via the position sensor at the initial contact point, and connects the tissue and the jaws via the contact sensor assembly at the initial contact point. determines the amount of tissue contact between the jaws at the initial contact point, sets the closing speed at which the motor transitions the jaws to the closed configuration according to the configuration of the jaws and the amount of tissue contact at the initial contact point, and A closure threshold is set according to the configuration and amount of tissue contact and is configured to control the motor according to the force exerted by the motor to transition the jaws to the closed configuration relative to the threshold.

Example 14 - The surgical instrument of Example 13, wherein the sensor assembly comprises a compression sensor.

Example 15 - The surgical instrument of Example 13, wherein the sensor assembly comprises an impedance sensor.

Example 16 - The surgical instrument of Examples 13, 14, or 15, wherein the configuration of the jaws corresponds to the angle between the jaws.

Example 17 - The surgical instrument of Example 13, 14, or 15, wherein the configuration of the jaws corresponds to the gap between the jaws.

SYSTEM FOR ADJUSTING END EFFECTOR PARAMETERS BASED ON PRE-OPERATIVE INFORMATION Aspects of the present disclosure are presented for adjustment of closure thresholds and closure rates implemented by a closure control program executed by a control circuit of a surgical instrument. , this adjustment is based on preoperative information. Adjustment of the closure threshold may be performed by a computer-implemented interactive surgical system (one or more surgical systems 102 and a cloud-based analytical medical system such as clouds 104, 204, referred to as cloud 104 for clarity). ) may be an example of performing situational awareness. For example, the closure threshold can be adjusted for patient-specific closure thresholds based on perioperative information received from cloud 104 or determined by a surgical hub or surgical instrument. As used herein, perioperative information includes preoperative information, intraoperative information, and postoperative information.

Preoperative information refers to information received prior to the performance of a surgical procedure using surgical instruments, while intraoperative information is received during the surgical procedure (e.g., while one step of the surgical procedure is being performed). information. Specifically, a computer-implemented interactive surgical system can determine or estimate end effector closure parameters, such as appropriate end effector closure thresholds and closure rate algorithms, particularly for handheld intelligent surgical instruments. Such inferences can be based on contextual information related to the surgical procedure being performed and related to the corresponding patient. Contextual information may include or be determined based on perioperative information. The surgical instrument may be any suitable surgical instrument described in this disclosure, such as surgical instruments 112, 600, 700, 750, 790, 150010. For clarity, reference is made to surgical instrument 112 .

Perioperative information, such as perioperatively diagnosed diseases and treatments, may affect properties or characteristics of tissue being treated by surgical instrument 112 . For example, the patient may have been previously diagnosed with cancer and undergoing radiation therapy to treat the cancer. This perioperative information thus indicates that the patient's tissue may be characterized by increased stiffness. However, currently applied closure control programs may not address this increased stiffness. Therefore, using a closure control program to perform a surgical procedure according to a common closure rate algorithm may result in unnecessary trauma or damage to the tissue due to excessive compression of the patient's tissue. Additionally, intraoperative information may be analyzed during a surgical procedure, such as by identifying which tissue type of multiple potential tissue types is being treated. Different types of tissue may also have different tissue characteristics, such as tissue stiffness. Accordingly, changes in perioperative information may be used to perform intraoperative adjustments instead of or in addition to perioperative adjustments. In short, the closure control program does not assume that different closure rate thresholds should be applied depending on perioperative information such as tissue type, surgical procedure, and surgical steps already performed. .

It may be desirable for the surgical instrument to take into account the tissue types on which surgical procedures are to be performed with the surgical instrument 112, and various characteristics of such different tissue types. Specifically, surgical instrument 112 effectively determines a tissue type and characteristics of that tissue type prior to and during a surgical procedure performed by a clinician with the surgical instrument. may be desirable.

Accordingly, in some aspects, a cloud-based analytical medicine system (eg, computer-implemented interactive surgical system 100) is provided in which perioperative information is used to determine the type of tissue to be treated and the type of tissue to be treated prior to treatment. may be considered to determine the characteristics of the tissue in question. For example, the surgical procedure to be performed and other patient information may be a case of perioperative information obtained before the surgical procedure was performed. Previously performed steps of surgery, other surgical histories, and changes in tissue type are examples of perioperative information that may be considered. In general, this perioperative information may be used in conjunction with sensor signals indicative of closure parameters for determining, estimating or adjusting end effector parameters (e.g., closure rate and closure threshold) of surgical instrument 112. The end effector may be any end effector described in this disclosure, such as end effectors 702, 151600, 150300, 151340, 152000, 152100, 152150, 152200, 152300, 152350, 152400, 153460, 153470, 153502 . For clarity, reference is made to end effector 702 .

Analyzing perioperative information for situational awareness related to closure velocity can be accomplished in a number of ways. Based on the perioperative information, the surgical instrument's control circuitry, such as control circuitry 500, 710, 760, 150700 (discussed above in connection with FIGS. 12, 15, 17 and 29A-29B) may: , the closure rate and closure threshold inputs used in the selected closure control program. For clarity, reference is made to control circuit 500 . The control circuit 500 can also select different control programs based on perioperative information. Additionally or alternatively, a surgical hub, such as surgical hubs 106 , 206 (referred to as surgical hub 106 for clarity) receives perioperative information from cloud 104 or surgical instrument 112 . You may For example, the surgical hub 106 may generate the cloud 104, or this from initial tissue thickness measurements determined based on tissue contact or pressure sensors (eg, as shown in FIG. 24) of the surgical instrument 112. A patient's electronic medical record (EMR) may be received.

Surgical hub 106 can then analyze the received perioperative information. Based on this analysis, surgical hub 106 can then send signals to surgical instrument 112 to adjust the closure rate of change and closure threshold inputs used in the selected closure control program. Surgical hub 106 may also direct surgical instrument 112 to select a different closure control program, such as by having the control circuit select a different control program. Selection of a different control program may be based on a signal received from hub 106 or a signal received by surgical instrument 112 receiving an updated control program from hub 106 . Cloud 104 can also perform analysis to adjust the closing speed and maximum thresholds used. Specifically, the processor of the cloud 104 analyzes the perioperative information to, for example, change the inputs to the closure control program or recommend a different preferred closure control program to be performed by the surgical instrument. Tissue types and characteristics can be determined for selection.

In this manner, surgical instrument 112 may be instructed by cloud 104 (eg, via hub 106) to apply a suitable closure rate algorithm and maximum closure threshold. Tissue type and characteristics may be further determined based on sensor signals indicative of closure parameters. The sensor may be a tissue contact or pressure sensor, force sensor, motor current sensor, position sensor, load sensor, or any of the sensors 472, 474, 476, 630, 734, 736, 738, 744a-744e, 784, 788, 152408, Other suitable sensors such as 153102, 153112, 153118, 153126, 153200, 153438, 153448, 153450a, 153450b, 153474 may be used. For clarity, reference is made to sensor 474 . Sensor 474 is configured to transmit a sensor signal indicative of a parameter of surgical instrument 112 . Some types of perioperative information may be stored in the cloud 104 prior to determining tissue type and characteristics. For example, patient EMRs may be stored in a memory of cloud 104 (eg, a cloud database). In general, surgical instrument 112, hub 106, or cloud 104 can analyze perioperative information to determine tissue type and characteristics for situational awareness.

Accordingly, tissue type and characteristics determined based on perioperative information may be used to proactively adjust the closure rate and maximum threshold used. That is, perioperative information may be used to predict more effective closure parameters (e.g., end effector 702 parameters) so that the closure control program applied by surgical instrument 112 may be better suited to the tissue being treated. Closure rates and thresholds that take into account patient-specific tissue characteristics and types will be used. Therefore, by using the closure velocity and threshold situational awareness described herein, the surgical instrument 112 can apply the adjusted closure velocity and threshold without over-compressing the tissue to be treated. can be advantageously enabled. Excessive compression may also be due to the first and second jaw members of end effector 702 . The first and second jaw members may be, for example, first jaw members 152002, 152152, 152154 and second jaw members 152204, 152254, 152304. First and second jaw members may also refer to anvils 716,766 and staple cartridges 718,768. For clarity, the first jaw member is referred to as 152002 while the second jaw member is referred to as 152204. First jaw member 152002 and second jaw member 152004 may define an opening in end effector 702 defined as the distance between first jaw member 152002 and second jaw member 152004 .

For example, if the end effector 702 opening is unnecessarily small, unnecessary tissue damage or trauma from overcompression may occur. Reducing or preventing such overcompression may be accomplished by adjusting using perioperative information from sensor 474 and/or sensor signals. Also, the compression applied during the initial closure parameter measurement is determined based on load sensor 474 (which measures closure force) and position sensor 474 (which measures the position of first jaw member 152002 and second jaw member 152004). You can also minimize it. Generally, sensor 474 may be configured to measure the closing force exerted by end effector 702 of surgical instrument 112 . In addition to pro-actively inferring tissue characteristics and types from perioperative information, one or more of surgical instrument 112, hub 106 and cloud 104 (as shown in FIG. 12) may include sensor Sensed measurements from 474 may be used to verify or make further adjustments to the applied closure force, closure velocity, and closure threshold as needed. Specifically, a contact sensor can be used to determine the thickness of undeformed tissue. A load sensor 474 in combination with the position sensor 474 is also used to determine tissue thickness based on the applied closure force relative to the respective positions of the first jaw member 152002 and the second jaw member 152004. may be These verifications or further adjustments can be performed preoperatively or intraoperatively.

Closure parameter context awareness may be performed continuously. Accordingly, a clinician or surgeon may continuously provide perioperative information (e.g., when a surgical procedure is performed) to appropriately adjust the closure parameters (e.g., a closure control program) of the end effector 702. may be used. Perioperative information is used to 702 closure parameters may also be adjusted. In such situations, the context-aware surgical instrument 112 may apply the closure force at a constant rate of closure change. Such perioperative information may be used in conjunction with sensor signals indicative of closure parameters of surgical instrument 112 to adjust closure parameters of end effector 702 (e.g., closure rate and closure threshold of a control program). good. Perioperative information, such as intraoperative information, may indicate that the patient was previously treated with radiation therapy.

Based on this information, control circuit 500 can estimate an increase in tissue stiffness, a characteristic of tissue that can be considered throughout the course of a surgical procedure. In one embodiment, this increased tissue stiffness is used to supplement the sensor signal indicative of tissue thickness so that a more appropriate adjustment to the end effector 702 closure parameter value can be achieved. It may be period information. Perioperative information may also indicate that the surgical procedure applied is a lobectomy procedure, which may be determined from data stored in cloud 104 . Based on knowledge of lobectomy procedures, it may be identified that types of tissue that can be treated (eg, stapled) include blood vessels, bronchial tissue, and soft tissue.

Accordingly, based on perioperative information, the unique tissue type and characteristics of tissue currently being treated by surgical instrument 112 may be predicted or estimated prior to initiation of therapeutic treatment of the tissue. For example, considering the initial tissue thickness (measured when the tissue currently being treated first contacts the end effector 702) in conjunction with treatment, diagnostic, and patient information, to date It may allow inference that the irradiated soft tissue is being treated. Since the type and characteristics of the tissue being treated can be contextually determined prior to beginning a surgical procedure, the closure control program implemented by control circuitry 500 of surgical instrument 112 can be implemented prior to beginning a therapeutic procedure. Additionally, it can be advantageously adjusted (eg, by changing input parameters according to the estimated tissue type or characteristics) or changed (eg, by selecting a different control program). Specifically, the maximum tissue closure threshold may be lowered to address the stiffness and fragility of the irradiated soft tissue being treated. A maximum threshold can refer to the maximum closure force that can be applied, or the maximum rate of closure change. Additionally, the closure algorithm of the closure control program may also be adjusted to apply a slower, more conservative closure rate based on the identification of irradiated soft tissue.

It can also be determined whether the surgical instrument 112 is, for example, an appropriate stapling surgical instrument 112 for irradiated soft tissue. A warning may be generated if the perioperative information indicates that the selected surgical instrument 112 is unsuitable for its intended use. For example, if the tissue currently being treated is bronchial tissue and it can be inferred based on perioperative information that an inappropriate vessel stapling surgical instrument 112 has been selected, a warning is given to the clinician. generated. In general, surgical instrument 112 may generate alerts based on determined, predicted, or inferred discrepancies between surgical instrument type, perioperative information, and sensor signals. Furthermore, as discussed above, intraoperative information can also be used for adjustments throughout the surgical procedure. For example, current steps in total procedure surgery may treat hard bronchial tissue, which will typically result in slower closure rates. Additionally, further adjustments may be made after the initial adjustment. Specifically, when additional intraoperative information (e.g., sensed information) is analyzed and it is deduced that the closing force applied to the currently applied closure algorithm should be modified or adjusted, Further adjustments can be made during surgery to adjust the slower closure speed to the faster closure speed. Such adjustments may also be made post-operatively in certain circumstances.

Accordingly, closure rates and thresholds may be beneficially adjusted based on determined tissue type, tissue characteristics, and perioperative information prior to initiation of therapeutic treatment or during therapeutic treatment. As such, this adjustment can advantageously avoid or minimize tissue damage due to excessive strain and facilitate proper formation of staples from stapling surgical instrument 112 .

108 and 109 are graphs 22000 illustrating various end effector closure threshold functions that may be used based on perioperative information, and graphs 22100 illustrating an adjusted end effector closure control algorithm, according to various aspects of the present disclosure. is. Graph 22100 is enlarged to take into account graph 22000 . 108 and 109, the Force to Grasp or Close (FTC), which can be understood as the gripping force applied to the end effector 702, is plotted on the y-axes 22002, 22102 of the graphs 22000, 22100. It is shown. Elapsed time in or over a surgical cycle is shown on the x-axis 22004, 22104. FIG. The x-axis 22004 of FIG. 108, for example, shows that the cycle spans 13 seconds. In contrast, the x-axis 22104 of FIG. 109 is less than 2 seconds. As shown in FIG. 108, a default universal tissue closure threshold function (denoted as FTC _d 22006) is used to control closure of end effector 702 of surgical instrument 112 used in typical surgical procedures. may be applied to

Other thresholds that are more conservative than the default FTC _d 22006 are also shown in graphs 22000,22100. However, less conservative thresholds can be used. A more conservative closure threshold, as represented by FTC _L1 22008 and FTC _L2 22010, can be used to reduce the closure force of the surgical instrument relative to the default closure force function. FTC _L1 22008 and FTC _L2 22010 may be thresholds stored in memory of surgical instrument 112 , hub 106 or cloud 104 . Additionally or alternatively, FTC _d2 22006 may be dynamically adjusted at suitable times during the surgical cycle. Dynamic adjustments may be performed by control circuitry 500 , corresponding hub 106 or cloud 104 . Graphs 22000 , 22100 also show the corresponding slopes of different closure threshold functions FTC _d , FTC _L1 , and FTC _L2 22006 , 22008 , 22010 . Since the closure threshold may vary as a function of time in the corresponding surgical cycle, the slope of the closure threshold may be constant throughout the surgical cycle or may vary as needed.

In other words, the instantaneous rate of change defined by a particular closure threshold function may differ between different time ranges in a surgical cycle. For example, a particular closure threshold function may define a relatively slow rate of increase at the beginning of a surgical cycle and a relatively fast rate of increase about the middle of the surgical cycle. The closure threshold functions ΔFTC _d 22106, ΔFTC _L1 22108 and ΔFTC _L2 22110 are scaled in the diagrams of functions FTC _d 22006, _L1 22008 and FTC _L2 22010 to illustrate the corresponding slopes of the closure threshold functions. In the embodiment of Figure 109, the slope is constant, but it can be seen that the slope can vary as appropriate. The rate of closure change can be adjusted according to a selected closure threshold function. An example of adjustment is illustrated by "x" in FIGS. In this example, the rate of closure change as represented by lines 22012, 22112 is adjusted so that ΔFTC _L2 22110 is not exceeded.

In one aspect, motors such as motors 482 , 704 a - 704 e , 754 , 150082 , 150714 of surgical instrument 112 can move first jaw member 152002 relative to second jaw member 152004 of end effector 702 . can. For clarity, reference is made to motor 482 . Motor 482 may move or close end effector 702 according to a closure rate of change as represented by lines 22012, 22112 and according to a selected closure threshold. To this end, control circuit 500 may adjust the current drawn by motor 482 to vary the speed or torque of motor 482 based on selected thresholds. For example, the graphs 22000, 22100 show that the control circuit 500 changes the closure rate parameter of the surgical instrument 112 to remain within the selected threshold FTC _L2 22010 at time "x" (as shown in the graph). shows how the motor 482 can be adjusted at . FTC _L2 22010, which may be a patient-specific threshold, may be selected and determined based on perioperative information.

The FTC thresholds 22006 , 22008 , 22010 shown in graphs 22000 , 22100 may be parameters of different or the same closure control program executed by control circuit 500 . These closure control programs may be stored locally in the memory of surgical instrument 112 or stored remotely on hub 106 or cloud 104 . In general, the closure threshold function defines how the closure threshold changes as a function of time in the cycle such that for any point in the cycle the instantaneously applicable closure threshold is indicated. A closure threshold may define, for example, a maximum closure force that may be applied to close the end effector jaws, or a maximum rate of change in closure force used. FIG. 108 illustrates using a threshold as the maximum rate of change of closure force used. At selected time points on the graphs 22000, 22100, lines 22012, 22112 plotted against time on the x-axes 22004, 22104 and FTC on the y-axes 22002, 22102 indicate the jaw 152002 at that time point in time. , 152004 are shown.

As indicated by line 22012, the applied force increases over time from time zero to time _t1 , after which the rate of increase reaches zero and then reaches a constant rate of decreasing force. Shortly before time _t2 , the rate of decrease is very steep. After time _t2 , the force applied to close the jaws begins to transition to a zero rate and then decreases at a non-zero rate. As indicated by line 22112 of graph 22100, the applied closing force to close jaws 152002, 152004 increases from time zero to just before 0.5 seconds (shown on x-axis 22104). ). At times corresponding to "x" on graph 22100, control circuit 500 may adjust motor 482 to adjust the selected closing algorithm such that the rate of increase in closing decreases. In this manner, motor 482 can be controlled by control circuit 500 to remain within the selected patient-specific threshold ΔFTC _L2 22110 . Additionally, as shown in graph 22100, after a time corresponding to 'x', the slower rate of increase in the applied closure force is at a constant rate.

In one aspect, the same total amount of FTC applied may be applied during a surgical cycle. However, the force applied to close the end effector may be applied more gradually or immediately if desired. This is illustrated by the rate of change represented by the closing rate of change in lines 22012, 22112, and so on. FIG. 109 shows each of the three illustrated thresholds ΔFTC _d 22106, ΔFTC _L1 22108 and ΔFTC _L2 22110 as scaled in the FTC _d 22006, FTC _L1 22008 and FTC _L2 22010 diagrams, some aspect, ΔFTC _d 22106, ΔFTC _L1 22108 and ΔFTC _L2 22110 represent different closure threshold functions. In other words, the control circuit 500 may adjust from any one of the thresholds FTC _d 22006, FTC _L1 22008 and FTC _L2 22010 to the thresholds ΔFTC _d 22106, ΔFTC _L1 22108 and ΔFTC _L2 22110, which in this situation are completely different thresholds in

As mentioned above, the slope of the closure threshold function can change during one surgical cycle. In such situations, the dynamic gradient can be adjusted consistently or individually throughout the surgical cycle. In general, adjustment of the closure threshold parameters will either change the parameters of the current closure control program (eg, by the control circuit 500 directly changing the closure threshold function implemented by the control circuit 500) or a new closure entirely. It can be achieved by switching to the control program. Switching or adjustment may be performed by control circuit 500, hub 106, or cloud 104 based on perioperative information. For example, control circuit 500 may switch from the current control program to a second closed control program received from cloud 104 . A second closure control program may also be sent from cloud 104 to hub 106 .

As described above, one or more of the surgical instruments 112 used to treat the tissue are used to determine, estimate the type and characteristics of the tissue currently being therapeutically treated. , or to predict, the corresponding hub 106 and cloud 104 may be used to receive, estimate or determine perioperative information. These closure situation awareness inferences and predictions are useful for adjusting closure rate of change thresholds. Thus, in addition to FTC _d 22006, ΔFTC _d 22106, graphs 22000, 21000 can be automatically incorporated by, for example, a closure algorithm used by surgical instrument 112, e.g., a second tissue closure rate threshold Functions FTC _L1 22008, ΔFTC _L1 22108 are also shown. That is, surgical instrument 112 can adjust the input to the current closure control program or adjust to a different control program executed by control circuit 500 . For example, the context-aware surgical hub 106 may determine that the surgical procedure currently being applied is lung surgery based on the target area within the thoracic cavity. The thoracic cavity can then be estimated as the target region, for example, based on ventilation output from another device used in the operating room. Accordingly, the type of tissue to be treated is determined to be lung tissue. Accordingly, the surgical instrument 112 can be adjusted to use a default closure threshold function FTC _L1 22008, 22108 for lung tissue from the previously used thresholds FTC _d 22006, 22106 . Such adjustments may be made during a surgical cycle across the y-axes 22004,22104.

For example, the situational awareness surgical hub 106 may predict that the patient's lungs contain relatively fragile tissue. Therefore, as shown in FIGS. 108 and 109, the closure threshold function can be adjusted to a lower FTC threshold function. The closure threshold can be, for example, the maximum allowable FTC value applied by the end effector, or the maximum allowable FTC rate of change. The inference of relatively high stiffness of lung tissue may be confirmed by other perioperative information. For example, a patient's EMR stored in cloud 104 may be analyzed to determine that the patient has been previously diagnosed with cancer and has undergone radiation therapy. Using this type of preoperative information, tissue characteristics of lung tissue can be deduced, including relatively high stiffness and significant fluid content (eg, percentage of water in tissue).

In addition to confirming initial predictions, perioperative information can also be used to adapt to inaccurate initial predictions. For example, surgical instrument 112 may apply a suboptimal closure algorithm based on the incorrect assumption that tissue is softer than it actually is. In such situations, pre-operative information of the patient's history may be used as part of the correction for incorrect assumptions. In general, perioperative information may be used in conjunction with sensor signals indicative of closure parameters. Advantageously, the perioperative information can confirm the initial closure algorithm determined based on the sensor signal, or may be used to adjust the initial closure algorithm to a different, more suitable closure algorithm. . For example, the sensor signal can indicate the relationship between the sensed applied closure force and the open position of the end effector 702 (eg, the position of the first jaw 152002 relative to the second jaw 152004). Such signals can be used to determine tissue stiffness and are used in conjunction with other perioperative information to adjust closure algorithms before or during surgery. In some cases.

Accordingly, the graphs 22000, 22100 of FIGS. 108 and 109 show that the default lung tissue threshold function FTC _L1 can be further adjusted based on patient-specific tissue characteristics. As shown in FIGS. 108 and 109, the surgical instrument can further adjust the threshold function FTC _L1 22008 to FTC _L2 22010 or FTC _d 22006 based on, for example, patient specific perioperative information. . Accordingly, adjustments may be made before the surgical procedure begins or during the surgical procedure. Additionally, adjustments may be made from FTC _d 22006 to FTC _L2 22010, or threshold function FTCL2 22010, or threshold function FTC _L2 22010 may simply be implemented directly. Adjustments in any of the available closure threshold functions are possible based on perioperative information.

Figures 108 and 109 can be adjusted for lower thresholds as well as for higher thresholds. The threshold functions shown in FIGS. 108 and 109 may correspond to specific control processes that may be implemented by specific closure control programs. Alternatively, the control process can correspond to different closure control programs. The control circuit 500 may, for example, directly change the selected closure control algorithm itself or switch to a different closure control algorithm. That is, the closure threshold function for a particular closure control algorithm or for a particular applied closure change rate represented by lines 22012, 22112 may be modified. Modification of the closure threshold function can be performed during the surgical procedure based on perioperative information. The threshold function may also be a function of some further parameter other than or in addition to time, such as the staple size used.

Additionally or alternatively, adjusting the closure may simply adjust the input to the closure threshold function. For example, if a tissue feature such as tissue thickness is the input to the closure threshold function, the perioperative information is used to modify the output closure threshold according to the predicted or estimated tissue thickness input. As such, the input may be modified by prediction or by inference. Therefore, the applied closure threshold function can be modified based on perioperative information. As discussed above, the applied closure threshold function is defined by the applied closure control algorithm. Also, the applied FTC or closure force line 22012, 22112 may be adjusted based on perioperative information.

In one aspect, the FTC or closure force lines 22012, 22112 represent the closure rate parameters of the corresponding closure control program executed by the control circuit 500. The FTC lines 22012, 22112 are also defined by the closing control algorithm applied. In one aspect, the applied closure force can be dynamically adjusted during the cycle of surgical procedures performed, as indicated by the "x" in FIGS. This dynamic adjustment may also be the application of situational awareness. In other words, perioperative information may be incorporated to estimate or predict adjustments to thresholds or threshold functions in surgical procedures. Thus, as shown in FIGS. 108 and 109, at the time or times corresponding to the "x" displayed in FIGS. adjusted or modified to stay within the threshold. In sum, the applied closure control algorithm can include both a closure threshold function and a closure rate of change, both of which can be adjusted based on perioperative information.

In general, adjustments to different closure thresholds or different closure threshold functions may be performed based on determined, estimated or predicted characteristics or types of tissue being treated. As discussed above, tissue characteristics or types can be determined, estimated, or predicted based on perioperative information. Adjustments to another closure threshold can be understood as adjusting the maximum threshold to the maximum torque produced by motor 482 of surgical instrument 112 or the rate of change of motor speed. Various examples of perioperative information can be used to determine, estimate, or predict tissue types or tissue characteristics. For example, tissue water content, muscle properties, and vasculature can affect the closure rate algorithm (including closure threshold) that is applied. In one aspect, these characteristics, as well as other tissue types and tissue characteristic characteristics, are used to determine the default closure threshold FTC _D 22006 or any other initial closure control program parameter.

Thus, advanced vasculature may be a tissue feature used to estimate a default closure threshold function that has a relatively low slope. In addition to determining initial control program parameters, pre-operative information such as the surgical procedure being applied and surgical history (e.g., typical routines of clinicians performing procedures for the surgical steps of the procedure) are used. Assuming that vascular tissue with high hemoglobin content is being targeted, then the closure rate applied by the surgical instrument can be adjusted to be slower. Therefore, these characteristics can be used to determine control program parameters preoperatively and intraoperatively. Perioperative information may also be used to confirm that a suitable vascular stapler is being used to treat vascular tissue.

FIG. 110 is a flow diagram 22200 of one aspect of adjusting a closure rate algorithm by computer-implemented interactive surgical system 100, according to one aspect of the present disclosure. At step 22202, the current closing algorithm is determined. This may refer to determining the closure control program currently being executed by control circuitry 500 of surgical instrument 112 . As described above in connection with FIGS. 108 and 109, current closure algorithms or control programs include a closure threshold function (eg, a closure threshold parameter) and an applied closure force (FTC) function (eg, a closure rate parameter). ) may be included. Flow diagram 22200 continues to step 22204, where preoperative information is received and analyzed. As discussed above, pre-operative information includes patient history (e.g., on patient information EMR records stored in a hub or cloud) including initial tissue thickness based on tissue contact sensor 474, previous diagnoses and treatments. ), clinician history such as the surgeon's typical surgical routine, identified surgical instruments and related materials, and identified current surgical procedures. This preoperative information can be used to determine, estimate or predict tissue type or tissue characteristics at step 22206 .

For example, the initial pre-deformation tissue thickness measured by tissue contact sensor 474 may be used to determine the initial closure algorithm. Preoperative information, such as patient history of lung problems, may be used to determine that the current surgical procedure being performed is a thoracic procedure and the tissue type is lung tissue. This preoperative information may be further used to determine adjustments to the initial closure algorithm. Additionally or alternatively, non-therapeutic (or semi-non-therapeutic) initial tissue compression measurements and closure member position measurements (e.g., end effector first and second jaw positions) may be used. It can also be used in conjunction with previous information. Pre-operative information on ventilation received from ventilators in the operating room can be further used to deduce that the current procedure is the thorax. Other preoperative information may also be used to further predict the particular breast procedure to be performed. For example, based on patient EMR records in the cloud that indicate that the patient has cancer, it can be deduced at step 22206 that the chest procedure is a lobectomy and that cancerous tissue within the lung lobes can be resected.

Additionally, the patient EMR record can further indicate that the patient history indicates that the patient has previously received radiation therapy for cancer. In such a situation, it may be assumed or predicted that the irradiated lung tissue will be stiff but susceptible to application of monopolar RF energy by surgical instrument 112, for example. This is an example of an inferred tissue feature. The inference that a lobectomy is being performed may also determine that tissues that can be stapled by surgical instrument 112 include blood vessels (PA/PV), bronchi, and soft tissue. At step 22208, adjustments to the current closure algorithm are determined based on preoperative information and applied. As discussed above, the closure threshold and the applied FTC may be adjusted based on tissue type and tissue characteristics. For example, high tissue stiffness generally outputs a more conservative rate of change of applied FTC (e.g., as represented by FTC lines 22012, 22112) as well as a lower maximum threshold (e.g., FTC _L2 22010 and ΔFTC _L2 22110).

The maximum threshold may indicate the threshold at which the first and second jaw members 152002, 152004 are at a sufficient position relative to the surgical instrument 112 to fire staples. Thicker tissue may, for example, correspond to a slower rate of closure force change, and may correspond, for example, to a generally higher maximum closure threshold. The tissue type or structure may also be inferred based on the surgical procedure and clinician history determined to identify other closure algorithm adjustments at step 22208 . For example, the clinician history of the treating surgeon may indicate the case of treating a vessel first. The tissue type and structure can be presumed to be vascular pulmonary tissue with high blood content (ie, high vasculature). Based on this estimated tissue type and characteristic information, it can be determined that adjustments to the FTC rate of change that are applied more slowly are beneficial. In summary, adjustments to the current closure algorithm are determined based on the estimated information and applied at step 22208. Thus, current surgery can be performed with surgical instrument 112 using the adjusted current closure algorithm.

Flow diagram 22200 then proceeds to decision operation 22210 where it is determined if any steps of the identified surgical procedure remain. If no steps remain (ie, the answer to decision operation 22210 is no), flow diagram 22200 ends in some aspects. However, if the answer to decision operation 22210 is yes, further steps in the surgical procedure remain. Therefore, the current state of flow diagram 22200 is in surgery. In this case, the flow diagram proceeds to step 22212, where intra-operative information may be received and analyzed. For example, intraoperative information may indicate that the type of tissue treated in this step of the surgical procedure is soft tissue. Specifically, the tissue may be presumed to be soft tissue, for example, based on the clinician's history. This inference can be made in conjunction with tissue contact sensor 474 measurements and load sensor 474 and closure member position measurements. In addition, clinician histories indicate that after incision with a monopolar RF energy surgical instrument, the treating surgeon modeled lung fissures (double folds of visceral folds that fold inward to cover the soft tissue of the lung). You can also indicate that it will be completed as expected. In such a situation, based on previously completed unipolar RF dissections, it may be assumed that the current step in the surgical procedure is the soft tissue of the lung.

Additionally, surgical hub 106 may determine whether surgical instrument 112 being used is a suitable stapler for firing into soft tissue, for example. Initial tissue contact sensor 474 measurements are based on tissue contacting the length of first and second jaw members 152002, 152004 when end effector 702 is fully open (at maximum jaw opening). , may indicate that the tissue is relatively thick, which may be consistent with soft tissue. Further, the load sensor 474 for closure member position measurements as represented by the closure compared to the jaw opening curve may indicate relatively high tissue stiffness. Such stiffness characteristics can be consistent with irradiated soft tissue, a prediction that can be confirmed by looking at patient EMR data in the cloud. In this way, for example, at step 22212, sensor signals and perioperative information can be used together.

Based on this received and analyzed intra-operative information, it can be determined at decision operation 22214 that further adjustments are necessary. On the other hand, if the answer is no at decision operation 22214 , the flow diagram returns to decision operation 22210 . When the answer at determine operation 22214 is yes, tissue type and tissue characteristics are presumed, such as determining soft tissue texture and stiffness characteristics similar to those described above in step 22206 . Adjustments to the currently applied closing algorithm can then be determined and applied at step 22208 . Specifically, the inference that hard and fragile soft tissue is being treated can result in adjustment of the applied closure force to a slower, more conservative rate of change.

Therefore, current closure algorithms can be adjusted to algorithms that minimize closure thresholds and rates of change. That is, the adjusted threshold may comprise a reduction in maximum closure force threshold, a slower rate of change in closure force, a reduction in rate of change in closure force threshold, or some combination or subcombination of the above. In situations where the clinician inadvertently exceeds the closure threshold, for example, a waiting period can be provided. This waiting time may be necessary when the closure threshold is exceeded, which may indicate that the tissue or material being compressed is too thick to fire staples, for example. Accordingly, the wait time may allow some tissue material or fluid within the end effector 702 to evacuate or exit. During a suitable waiting time, it is determined that the tissue can be properly compressed to achieve proper end effector 702 configuration so that stapling surgical instrument 112 can fire staples. A long waiting time can be used because the adjusted closing algorithm is more conservative. However, the clinician may be able to override this long wait time or conservative adjusted closure algorithm by manually selecting the use of a more rapid grasping protocol on the surgical instrument 112. .

Once this modified closure algorithm has been applied to the soft tissue at step 22208 , the flow diagram proceeds again to decision operation 22210 . Here the answer may again be yes as there are remaining steps in the surgical procedure. For example, a lobectomy procedure can then proceed to a vessel stapling step. Again, at step 22212 intra-operative information is received and analyzed. For example, the surgical hub can determine that the clinician has selected a vascular stapler surgical instrument. Also, initial measurements from tissue contact sensor 474 may indicate that tissue contact occurs almost immediately during closure. Additionally, tissue contact may be determined to encompass a small area of vascular stapler 112 and may be defined distal to stapler 112 . Load sensor 474 measurements may also indicate conforming tissue structure. Additionally, it can be assumed that the tissue may have a relatively low stiffness that may be consistent with pulmonary vessels. Additionally, the clinician's history may indicate that the treating surgeon used a vascular stapler 112 for the vessel as a step after completing the lung fissure. Thus, intraoperative information may be used, for example, in conjunction with closure parameter sensor signals to estimate tissue type and tissue characteristics. In particular, vascular tissue may be expected to be treated based on the particular characteristics of the vascular stapler 112 selected. Initial tissue contact and load sensor 474 measurements, for example, can confirm this initial prediction.

As a result, it may be determined at decision operation 22214 that further adjustments are needed, which causes flow diagram 22200 to proceed to step 22206 . At step 22206, the tissue may be estimated to be vascular tissue with relatively low tissue thickness and stiffness. Accordingly, flow diagram 22200 proceeds to step 22208, where the previously applied conservative closure algorithm is adjusted to the normal closure algorithm. A normal closure algorithm may include a constant closure change rate. The closure threshold may also be higher than the threshold used in the soft tissue control algorithm. In other words, the normal closure algorithm can reach a higher maximum applied closure force and the rate of closure change may be faster than for soft tissue. The surgical instrument can also notify the clinician of adjustments to the normal closure algorithm via a suitable indicator, such as a light emitting diode (LED) indicator that displays a particular color. In another example, it may be determined at step 22206 that the patient has a complete lung fissure. Therefore, there is no soft tissue staple firing still performed in surgical procedures. In response to this determination, the surgical instrument can prompt the clinician via the surgical instrument display to confirm this inference is correct. The clinician can then manually select the appropriate closure control algorithm for this step or stage of the surgical procedure. Additionally or alternatively, surgical instrument 112 may be the default for a conservative closure algorithm, as the inferences made in step 22206 may not be final. In either case, the adjusted closure algorithm is applied at step 22208.

Continuing with the example lobectomy procedure, the flow diagram proceeds to decision operation 22210 . At determine operation 22210, it may be determined that there are remaining steps in the surgical procedure. Accordingly, at step 22212, intraoperative information is received and analyzed. Based on intraoperative information, it can be deduced that the type of tissue being treated is bronchial tissue. Further, the initial tissue contact sensor 474 measurement indicates that tissue grasped between the end effectors 702 almost immediately contacts the first and second jaw members 152002, 152004 during initial closure of the end effectors 702, such that It may be shown that good contact corresponds to a small area of stapling surgical instrument 112 . Also, such contacts are defined on opposite sides of the jaw members 152002,152004.

As a result, this tissue contact scenario can be expected to correspond to bronchial tissue. As discussed above, these initial tissue contact sensor 474 measurements may be non-therapeutic or semi-non-therapeutic. Additionally, closure load sensor 474 measurements represented by closure compared to closure opening curves may indicate a firm tissue structure consistent with bronchial tissue. An indication by surgical history that the vascular stapler 112 has already been used in a surgical procedure also indicates that soft tissue staple firing has already occurred, likely resulting in significant monopolar RF energy usage. may mean. This surgical treatment history may be used, for example, to predict that a physician will treat bronchial tissue. This prediction would be consistent with a surgeon's routine practice of stapling the bronchi as the last step in a lobectomy procedure. Based on analyzing this type of and other suitable intra-operative information at step 22212, it can be determined at decision operation 22214 that further adjustments are needed. Since the answer to decision operation 22214 is yes, the flow diagram proceeds to step 22206 where the treated tissue is presumed to be bronchial tissue with normal tissue stiffness and thickness.

In one aspect, surgical instrument 112 may be configured only for specific tissue types, making it easier to conclude that the treated tissue is bronchial tissue. For example, surgical instrument 112 may be adaptable to fire staples used in the bronchi. Conversely, surgical instrument 112 may be adaptable to fire staples for use in soft tissue. In that scenario, an alert may be generated by surgical instrument 112 as the surgeon attempts to treat bronchial tissue with staples used for soft tissue. This warning may be audible, visual, or some other suitable warning. In another example, a warning may be provided by the vascular stapler 112 when the vascular stapler 112 is selected for use with bronchial tissue. As discussed above, it can be determined based on perioperative information that the tissue being treated is bronchial tissue and that vascular staplers are contraindicated. Similarly, other perioperative information, such as closure load and stapler cartridge selection, may be used to provide warnings when surgical instrument 112 is used against tissue types or features to which it is not applicable. may be As discussed above, inferences made using perioperative information may be made in conjunction with closure parameter sensor signals. In all situations, safety checks may be performed to ensure that the surgical instrument 112 being used is safe for the tissue being treated.

Adjustments to the current closure algorithm are made at step 22208 according to the estimated tissue type and characteristics. A constant closure rate may be determined to be suitable, but the closure rate may be adjusted to be faster or slower, for example, depending on the estimated tissue characteristics of the bronchi. The closure threshold can be modified in the same or similar manner. Additionally, the current chain algorithm may be adjusted to automatically enable or suggest a longer wait time if the surgical instrument 112 exceeds the immediately applicable closure threshold. For example, this waiting time for bronchial tissue may be longer than the waiting time used for soft tissue. As discussed above, the surgeon informs the closure algorithm of the selected adjustment, eg, via an LED indicator. A clinician override for a longer wait time is also possible so that the surgeon may be authorized to fire the stapler surgical instrument 112 in the appropriate circumstances. Flow diagram 22200 may then proceed to step 22212 where it may be determined that no further steps of the surgical procedure remain.

In one aspect, flow diagram 22200 may be implemented by control circuitry. However, in other aspects, flow diagram 22200 may be implemented by surgical hub 106 or cloud 104 . Additionally, steps 22204 and 22212 are described with respect to preoperative and intraoperative information, respectively, but are not so limited. Specifically, perioperative information may be received and analyzed in its entirety rather than specific preoperative or intraoperative information. As discussed above, perioperative information includes preoperative, intraoperative, and postoperative information. Additionally, sensor signals may be used in conjunction with perioperative information for contextual and reference closure algorithm adjustments.

(Example)
Various aspects of the subject matter described herein under the heading "System for Adjusting End Effector Parameters Based on Preoperative Information" are presented in the examples below.
Example 1 - A surgical system comprises a surgical instrument. A surgical instrument includes an end effector that includes a first jaw and a second jaw. The first jaw is configured to move relative to the second jaw. The surgical instrument further comprises a motor configured to move the first jaw relative to the second jaw according to the closure rate parameter and the closure threshold parameter. The surgical instrument further comprises a sensor configured to transmit a sensor signal indicative of a closure parameter of the end effector. The surgical system further includes a control circuit communicatively coupled to the sensor. The control circuitry is configured to receive perioperative information including one or more of perioperative disease, perioperative therapy, and surgical procedure types. The control circuit is further configured to receive the sensor signal from the sensor and determine adjustments to the closure rate parameter and the closure threshold parameter based on the perioperative information and the sensor signal.

Example 2 - the control circuit is further configured to determine characteristics of the tissue to be treated by the surgical instrument based on one or more of the perioperative information and the sensor signal; A surgical system according to Example 1.

Example 3 - The tissue characteristics include one or more of tissue type characteristics, muscle characteristics, vasculature characteristics, water content characteristics, firmness characteristics, and thickness characteristics, A surgical system according to Example 2.

Example 4 - According to example 1, 2 or 3, wherein the control circuit is further configured to change the speed of the motor based on the determined adjustments to the closure rate parameter and the closure threshold parameter surgical system.

Example 5 - The control circuit is further configured to generate an alert based on a discrepancy between the type of surgical instrument and one or more of the perioperative information and the sensor signal, implemented A surgical system according to Examples 1, 2, 3 or 4.

Example 6 - Perioperative information includes one or two of the following: type of tissue to be treated by the surgical instrument, tissue characteristics, clinician history, and type of staple cartridge for use with the surgical instrument The surgical system of example 1, 2, 3, 4, or 5, further comprising one or more.

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

Example 8 - A surgical system comprises a surgical hub configured to receive perioperative information transmitted from a remote database of a cloud computing system. A surgical hub is communicatively coupled to the cloud computing system. The surgical system further includes a surgical instrument communicatively coupled to the surgical hub. A surgical instrument includes an end effector that includes a first jaw and a second jaw. The first jaw is configured to move relative to the second jaw. The end effector further comprises a motor configured to move the first jaw relative to the second jaw according to a closure rate of change parameter and a closure threshold parameter of a closure control program received from the surgical hub. . The end effector further comprises a sensor configured to transmit a sensor signal indicative of a closing parameter of the end effector. The surgical hub is further configured to receive the sensor signal from the sensor and determine adjustments to the closure rate parameter and the closure threshold parameter based on the perioperative information and the sensor signal.

Example 9 - The closure control program is a first closure control program, the surgical hub is further configured to transmit a second closure control program to the surgical instrument, and the second closure control program is Example 8. The surgical system of Example 8, wherein <tb> defines an adjustment to a closure rate parameter and an adjustment to a closure threshold parameter.

Example 10 - A cloud computing system is configured to transmit a second closure control program to a surgical hub, wherein adjustments to the closure rate parameter and adjustments to the closure threshold parameter of the second control program are The surgical system of Example 9, wherein the surgical system is adjusted based on phase information.

Example 11 - The surgical instrument is configured to generate an alert based on discrepancies between the surgical instrument type and one or more of the perioperative information and the sensor signal, implemented A surgical system according to Example 8, 9 or 10.

Example 12 - An example wherein the closure threshold parameter is a maximum closure force threshold and the surgical hub is further configured to disable the motor for a predetermined period of time based on reaching the maximum closure force threshold 12. The surgical system according to 8, 9, 10 or 11.

Example 13 - Perioperative information includes perioperative disease, perioperative treatment, type of surgical procedure, clinician history, type of surgical instrument, type of tissue treated by surgical instrument, and tissue characteristics 13. The surgical system of Example 8, 9, 10, 11, or 12, comprising one or more of:

Example 14 - The surgical hub of Example 9, wherein the surgical hub is further configured to change the speed of the motor based on the determined adjustments to the closure rate parameter and the closure threshold parameter system.

Example 15 - A surgical instrument comprises an end effector comprising a first jaw and a second jaw. The first jaw is configured to move relative to the second jaw. The surgical instrument has a motor configured to move the first jaw relative to the second jaw according to a closure rate parameter and a closure threshold parameter of the first closure control program received from the surgical hub. Further prepare. The surgical instrument further comprises a sensor configured to transmit a sensor signal indicative of a closing parameter of the end effector, and control circuitry communicatively coupled to the sensor and the motor. A control circuit is configured to receive the sensor signal from the sensor and determine adjustments to the closure rate parameter and the closure threshold parameter based on the perioperative information and the sensor signal.

Example 16 - The surgical instrument is configured to generate an alert based on discrepancies between the surgical instrument type and one or more of the perioperative information and the sensor signal, implemented A surgical system according to Example 15.

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

Example 18 - The control circuit is further configured to determine characteristics and types of tissue to be treated by the surgical instrument based on one or more of the perioperative information and the sensor signal The surgical system of example 15, 16 or 17, wherein

Example 19 - The surgical system of Example 15, 16, 17 or 18, wherein the closure threshold parameter is a maximum closure force threshold.

Example 20 - The surgical system of Example 19, wherein the closure threshold parameter is the maximum closure force threshold.

In various aspects, sensors of a particular sensor array can be positioned on the staple cartridge in accordance with the present disclosure. An adhesive mask may embed the sensor in place. In various aspects, the sensor is mounted to a ridge on the staple cartridge such that the sensor is positioned higher than the cartridge deck of the staple cartridge to ensure contact with tissue. An adhesive mask can be formed en bloc on a polyester substrate using, for example, screen printing techniques. Conductive pads may be printed at common locations.

In various embodiments, in addition to proximate detection to cancerous tissue, the end effectors of the present disclosure can also be configured to target specific cancer types within specific tissues. Altenberg Band and Greulich KO, journal Genomics 84 (2004) pp. 13-14, which is incorporated herein by reference in its entirety. 1014-1020, certain cancers are characterized by overexpression of glycolytic genes, whereas other cancers are not characterized by overexpression of glycolytic genes. Thus, the end effectors of the present disclosure can be equipped with sensor sequences with high specificity for cancerous tissue characterized by overexpression of glycolytic genes, such as lung or liver cancer.

In various aspects, sensor readings of sensor arrays according to the present disclosure are communicated by the surgical instrument to a surgical hub (eg, surgical hubs 106, 206) for additional analysis and/or situational awareness.

The foregoing detailed description has described various aspects of apparatus and/or processes using block diagrams, flowcharts, and/or examples. To the extent such block diagrams, flowcharts, and/or embodiments include one or more functions and/or operations, it should be understood by those skilled in the art that such block diagrams, flowcharts, and/or examples Each function and/or operation included in the embodiments may be implemented individually and/or collectively by various hardware, software, firmware, or virtually any combination thereof. Those skilled in the art will appreciate that all or part of some aspects of the forms disclosed herein can be understood as one or more computer programs (e.g., one or more computer programs) running on one or more computers. as one or more programs running on one or more computer systems), as one or more programs running on one or more processors (e.g., one or more as one or more programs running on a microprocessor), as firmware, or substantially any combination thereof, equivalently embodied on an integrated circuit; , and/or writing software and/or firmware code is within the skill of one of ordinary skill in the art in view of the present disclosure. Moreover, those skilled in the art will appreciate that the subject matter described herein may be distributed in a variety of forms as one or more program products, and is incorporated herein by reference. The specific forms of subject matter described are used regardless of the particular type of signal-bearing medium used to implement the distribution.

Instructions used to program logic to perform various disclosed aspects may be stored in system memory such as dynamic random access memory (DRAM), cache, flash memory, or other storage. Additionally, the instructions may be distributed over a network or by other computer-readable media. Thus, a machine-readable medium can include any mechanism for storing or transmitting information in a form readable by a machine (e.g., a computer), including floppy diskettes, optical discs, compact discs, read-only memories (CDs), -ROM), as well as magneto-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, Any tangible, machine-readable material used to transmit information over the Internet via flash memory or electrical, optical, acoustic, or other form of propagated signal (e.g., carrier wave, infrared signal, digital signal, etc.) Not limited to storage. Accordingly, non-transitory computer-readable media include any type of tangible machine-readable medium suitable for storing or transmitting electronic instructions or information in a form readable by a machine (eg, a computer).

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

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

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

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

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

Unless expressly specified otherwise, terms such as "process", "calculate", "calculate", "determine", "display", etc. are used throughout the foregoing disclosure as is apparent from the foregoing disclosure. Discussions using the term manipulate data represented as physical (electronic) quantities within the registers and memory of a computer system, and manipulate data within the memory or registers of a computer system or any such information storage, transmission, or display device. It will be understood to refer to the operations and processing of a computer system or similar electronic computing device that transforms it into other data that are similarly represented as physical quantities.

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

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

Those skilled in the art will appreciate that the terms used herein generally, and particularly in the appended claims (e.g., the appended claim text), are generally intended as "open" terms. (e.g., the term "including" is to be interpreted as "including but not limited to"; the term "having" is to be interpreted as "including but not limited to"); should be interpreted as "having at least" and the term "includes" should be interpreted as "includes but is not limited to" should be done, etc.). Moreover, where a particular number is intended in an introduced claim recitation, such intent is clearly set forth in the claim; , will be understood by those skilled in the art. For example, as an aid to understanding, the following appended claims use the introductory phrases "at least one" and "one or more" to introduce claim recitations. may be included to However, the use of such phrases when introducing claim recitations by the indefinite article "a" or "an" may be used even if the introductory phrases "one or more" or "at least one" are used within the same claim. and any particular claim containing such an introduced claim recitation is limited to the claim containing only one such recitation, even if the indefinite articles "a" or "an" are included. (e.g., "a" and/or "an" should generally be construed to mean "at least one" or "one or more ). the same holds true where the definite article is used to introduce claim recitations.

The terms "comprise" (any form of comprise, such as "comprises" and "comprising"), "have" (any form of have, such as "has" and "having"), "comprise ( "include" (any form of include, such as "includes" and "including") and "contain" (any form of contain, such as "contains" and "containing") are open linkage is a verb. As a result, a surgical system, device, or apparatus that “comprises,” “has,” “includes,” or “contains” one or more elements has one or more of those elements but not one of them. You are not limited to having only one or more. Similarly, a system, device, or element of apparatus that “comprises,” “has,” “includes,” or “contains” one or more features has those one or more features but does not include those one or more features. It is not limited to having only the above features.

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

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

Any reference to "an aspect", "an aspect", "exemplary", "an example", etc., includes in at least one aspect the particular feature, structure, or property described in connection with that aspect. It is worth noting that it means Thus, the appearances of the phrases "in one aspect," "in an aspect," "in an example," and "in an example" in various places throughout this specification do not necessarily all refer to the same aspect. Moreover, the particular features, structures or characteristics may be combined in any suitable manner in one or more aspects.

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

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

[Mode of implementation]
(1) A surgical instrument comprising:
an end effector comprising jaws transitionable between an open configuration and a closed configuration;
a motor operably coupled to the jaws and configured to transition the jaws between the open configuration and the closed configuration;
a sensor configured to transmit at least one signal indicative of a tissue compression parameter associated with tissue between the jaws;
A control circuit coupled to the sensor and the motor, comprising:
receiving the at least one signal;
determining a value of the tissue compression parameter based on the at least one signal when the jaws transition from the open configuration to the closed configuration;
responsive to whether the value of the tissue compression parameter exceeds a first threshold, causing the motor to increase the time to transition the jaws to the closed configuration; and and a control circuit configured to provide feedback depending on whether the threshold of is below.
Clause 2. The surgical instrument of clause 1, wherein the tissue compression parameter includes a force exerted by the motor to transition the jaws to the closed configuration.
Clause 3. The surgical instrument of clause 1, wherein the tissue compression parameter comprises a time rate of change of force exerted by the motor to transition the jaws to the closed configuration.
Clause 4. The surgical instrument of clause 1, wherein the feedback includes suggestions for supplemental stiffeners.
(5) the control circuit is configured to increase the time for transitioning the jaws to the closed configuration by decreasing the rate at which the motor transitions the jaws to the closed configuration; A surgical instrument according to embodiment 1.

(6) the control circuit controls the time for transitioning the jaws to the closed configuration by increasing the amount of time the motor is idled when transitioning the jaws to the closed configuration; 2. The surgical instrument of embodiment 1, wherein the surgical instrument is configured to multiply.
(7) the control circuit increases the time for the motor to transition the jaws to the closed configuration by lowering a stabilization threshold for stopping the jaws from transitioning to the closed configuration; 2. The surgical instrument of embodiment 1, wherein the surgical instrument is configured to:
(8) A surgical instrument comprising:
an end effector,
a jaw transitionable between an open configuration and a closed configuration;
an end effector comprising one or more sensors disposed along the tissue contacting surface of each of the jaws and configured to detect contact with tissue;
a motor operably coupled to the jaws and configured to transition the jaws between the open configuration and the closed configuration;
a control circuit coupled to the one or more sensors and the motor, comprising:
determining an initial point of contact where the tissue contacts the tissue contacting surface of the jaw;
determining the separation between the jaws at the initial point of contact;
determining the degree of contact between the tissue contacting surface and the tissue;
causing the motor to transition the jaws to the closed configuration at a rate corresponding to the separation between the jaws at the initial point of contact and the degree of contact between the tissue contacting surface and the tissue;
configured to cause the motor to adjust the speed at which the jaws transition to the closed configuration depending on whether the force exerted by the motor to transition the jaws to the closed configuration exceeds a threshold value; a control circuit;
The surgical instrument, wherein the threshold value corresponds to the distance between the jaws at the initial point of contact and the degree of contact between the tissue contacting surface and the tissue.
Clause 9. The surgical instrument of Clause 8, wherein the one or more sensors comprise pressure sensors.
Aspect 10. The surgical instrument of aspect 8, wherein the one or more sensors comprise an impedance sensor.

Clause 11. The surgical instrument of clause 8, wherein the distance between the jaws comprises an angle between the jaws.
Clause 12. The surgical instrument of clause 8, wherein the spacing between the jaws comprises a gap between the jaws.
(13) A surgical instrument comprising:
an end effector,
jaws configured to grasp tissue by transitioning between an open configuration and a closed configuration;
a contact sensor assembly configured to sense the tissue impinging thereon; an end effector comprising: a contact sensor assembly;
a position sensor configured to sense a configuration of the jaw;
a motor coupled to the jaws and configured to transition the jaws between the open configuration and the closed configuration;
A control circuit coupled to the contact sensor assembly, the position sensor and the motor, comprising:
determining an initial point of contact where the tissue contacts the jaw;
determining the configuration of the jaw via the position sensor at the initial point of contact;
determining an amount of tissue contact between the tissue and the jaws via the contact sensor assembly at the initial point of contact;
setting a closing speed at which the motor transitions the jaws to the closed configuration according to the configuration of the jaws at the initial point of contact and the amount of tissue contact;
setting a closure threshold according to the configuration of the jaws and the amount of tissue contact at the initial point of contact;
and a control circuit configured to control the motor according to the force exerted by the motor to transition the jaws to the closed configuration relative to a threshold.
Clause 14. The surgical instrument of Clause 13, wherein the sensor assembly comprises a pressure sensor.
Clause 15. The surgical instrument of Clause 13, wherein the sensor assembly comprises an impedance sensor.

Clause 16. The surgical instrument of Clause 13, wherein the configuration of the jaws corresponds to an angle between the jaws.
Clause 17. The surgical instrument of Clause 13, wherein the configuration of the jaws corresponds to a gap between the jaws.

Claims (5)

A surgical instrument,
an end effector comprising jaws capable of performing a closing motion from an open configuration to a closed configuration in which the tissue is fully closed ;
a motor operably coupled to the jaws and configured to cause the jaws to perform the closing movement from the open configuration to the closed configuration;
to transmit at least one signal indicative of a tissue compression parameter associated with tissue between the jaws during the closing movement of the jaws from the open configuration toward the closed configuration; a configured sensor;
A control circuit coupled to the sensor and the motor, comprising:
receiving the at least one signal;
determining a value of the tissue compression parameter based on the at least one signal during the closing movement of the jaws from the open configuration toward the closed configuration;
controlling the motor to increase the time during which the jaws perform the closing motion from the open configuration to the closed configuration when the value of the tissue compression parameter exceeds a first threshold; and and a control circuit configured to provide feedback when the value of the parameter is below a second threshold. The surgical instrument of Claim 1, wherein the tissue compression parameter comprises a force exerted on tissue by the jaws as the jaws perform the closing motion . The surgical instrument of Claim 1, wherein the tissue compression parameter comprises a time rate of change of force exerted by the jaws on tissue as the jaws perform the closing motion . 2. The control circuit is configured to increase the time for which the jaws perform the closing motion by decreasing the speed at which the motor causes the jaws to perform the closing motion . The surgical instrument according to . The control circuit causes the jaws to perform the closing motion by increasing the length of time the motor is idled when the motor causes the jaws to perform the closing motion. The surgical instrument of claim 1, wherein the surgical instrument is configured to increase the

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