JP7263365B2 - Capacitively coupled return path pads with separable array elements - Google Patents

Description

(Cross reference to related applications)
This application is filed on Mar. 30, 2018 under 35 U.S.C. The prior filing date of U.S. Provisional Patent Application No. 62/650,898 is claimed.

This application is further incorporated under 35 U.S.C. U.S. Provisional Patent Application No. 62/650,887, U.S. Provisional Patent Application No. 62/650,877, filed March 30, 2018, entitled "SURGICAL SMOKE EVACUATION SENSING AND CONTROLS," and "SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM,” which claims the priority benefit of U.S. Provisional Patent Application No. 62/650,882, filed March 30, 2018.

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 Dec. 28, 2017, entitled "CLOUD-BASED MEDICAL ANALYTICS," and U.S. Provisional Patent Application No. 62/611,340, entitled "ROBOT ASSISTED SURGICAL PLATFORM," Dec. 12, 2017. It claims the benefit of priority from US Provisional Patent Application No. 62/611,339, filed May 28.

This application discloses, generally and in various aspects, inventions related to electrosurgical systems and return pads for electrosurgical systems.

Electrosurgical systems typically utilize a generator to deliver electrosurgical energy (e.g., alternating current at high frequency levels) to an active electrode, which applies the electrosurgical energy to the patient's body. do. Electrosurgical energy applied to the patient's body acts to heat the patient's tissue (to seal and/or cut the tissue), generally exits the patient's body, and is applied to the patient's body. to a return pad that may be connected or capacitively coupled to the patient's body. The return pad is connected to the return path wire and the return path wire is connected back to the generator. In other words, the return pad and return path wiring collectively form the electrical return path of the electrosurgical system.

One concern associated with electrosurgery is whether the distributed electrodes of the return pad are large enough and/or the amount of electrical energy introduced into the patient's body so that unnecessary burning of the patient can be avoided. Having sufficient surface area to adequately capture and deliver surgical energy, thereby avoiding unwanted burnout of the patient. The return pads are generally sized to keep the current density sufficiently low as the electrosurgical energy exits the patient. Otherwise, heat may build up within the patient and may result in combustion.

When electrosurgical energy is utilized to cut target tissue in a patient, one concern is that one or more nerves may be inadvertently damaged and/or severed during electrosurgery. Yes, and in some cases, patients experience muscle weakness, pain, numbness, numbness, and/or other undesirable consequences. Surgeons generally know where nerves are located and can therefore avoid them, but this is not always the case. For example, if an area of a patient is deformed, damaged, or otherwise deviates from what is considered normal, it is difficult to determine the location of a given nerve within that area. can be. If the location of a given nerve within an area is not readily recognizable, the likelihood of inadvertently damaging or cutting the nerve increases.

In one aspect, a return pad for an electrosurgical system is provided. The return pad comprises: a plurality of conductive members configured to receive radio frequency current applied to the patient; a plurality of sensing devices; and a neural control signal applied to the patient; and a plurality of sensing devices configured to sense at least one of motion of a patient's anatomical feature resulting from the application.

In another aspect, an electrosurgical system is provided. The electrosurgical system comprises a generator configured to provide an alternating current at a radio frequency, an instrument configured to apply the alternating current to a patient, a return pad capacitively coupling to the patient, comprising: a plurality of conductive members configured to conduct radio frequency current, the plurality of conductive members capacitively coupleable to the patient and selectively couplable to the generator; and the plurality of sensing devices. a plurality of sensing devices configured to sense at least one of a neural control signal applied to a patient and movement of an anatomical feature of the patient resulting from application of the neural control signal; and a conductor coupled to the return pad and the generator.

In yet another aspect, a return pad for an electrosurgical system is provided. The return pad comprises a plurality of electrodes configured to capacitively couple with a patient, a neural control signal applied to the patient, and movement of an anatomical feature of the patient resulting from application of the neural control signal. an array of sensing devices configured to sense at least one of them.

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. 22 is a partial perspective view of a surgical hub housing and of 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; 1 is a perspective view of a combination generator module with bipolar, ultrasonic, and monopolar contacts and a smoke evacuation component 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. 1 is a simplified block diagram of a generator configured to provide inductorless regulation, among other advantages, in accordance with at least one aspect of the present disclosure; FIG. 21 illustrates an example of a generator, one form of the generator of FIG. 20, in accordance with at least one aspect of the present disclosure; 1 illustrates an electrosurgical system according to at least one aspect of the present disclosure; 23 illustrates a return pad of the electrosurgical system of FIG. 22, according to at least one aspect of the present disclosure; FIG. 24 illustrates multiple electrodes of the return pad of FIG. 23 in accordance with at least one aspect of the present disclosure; 24 illustrates an arrangement of sensing devices in the return pad of FIG. 23, according to at least one aspect of the present disclosure; 4 illustrates a method for simultaneously applying neural stimulation signals and electrosurgical energy to a patient, according to 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. ______________, entitled "CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSED CLOSURE PARAMETERS", Attorney Docket No. END8543USNP/170760;
- U.S. Patent Application No. ______________, titled "SYSTEMS FOR ADJUSTING END EFFECTOR PARAMETERS BASED ON PERIOOPERATIVE INFORMATION", Attorney Docket No. END8543USNP1/170760-1,
- U.S. Patent Application No. ____________, entitled "SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING", Attorney Docket No. END8543USNP2/170760-2,
- U.S. Patent Application No. ______________, entitled "SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING", Attorney Docket No. END8543USNP3/170760-3,
- U.S. Patent Application No. ______________, entitled "SURGICAL SYSTEMS FOR DETECTING END EFFECTOR TISSUE DISTRIBUTION IRREGULARITIES", Attorney Docket No. END8543USNP4/170760-4,
- U.S. Patent Application No. ______________, title of invention "SYSTEMS FOR DETECTING PROXIMITY OF SURGICAL END EFFECTOR TO CANCEROUS TISSUE", Attorney Docket No. END8543USNP5/170760-5,
- U.S. Patent Application No. ______________, entitled "SURGICAL INSTRUMENT CARTRIDGE SENSOR ASSEMBLIES", Attorney Docket No. END8543USNP6/170760-6,
- U.S. Patent Application No. ____________, entitled "VARIABLE OUTPUT CARTRIDGE SENSOR ASSEMBLY", Attorney Docket No. END8543USNP7/170760-7,
- U.S. Patent Application No. ____________, entitled "SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE", Attorney Docket No. END8544USNP/170761,
- U.S. Patent Application No. ____________, entitled "SURGICAL INSTRUMENT HAVING A FLEXIBLE CIRCUIT", Attorney Docket No. END8544USNP1/170761-1,
- U.S. Patent Application No. ____________, titled "SURGICAL INSTRUMENT WITH A TISSUE MARKING ASSEMBLY", Attorney Docket No. END8544USNP2/170761-2,
- U.S. Patent Application No. ______________, entitled "SURGICAL SYSTEMS WITH PRIORITIZED DATA TRANSMISSION CAPABILITIES", Attorney Docket No. END8544USNP3/170761-3,
- U.S. Patent Application No. __________, entitled "SURGICAL EVACUATION SENSING AND MOTOR CONTROL", Attorney Docket No. END8545USNP/170762,
- U.S. Patent Application No. ____________, entitled "SURGICAL EVACUATION SENSOR ARRANGEMENTS", Attorney Docket No. END8545USNP1/170762-1,
- U.S. Patent Application No. ______________, entitled "SURGICAL EVACUATION FLOW PATHS", Attorney Docket No. END8545USNP2/170762-2,
- U.S. Patent Application No. ______________, entitled "SURGICAL EVACUATION SENSING AND GENERATOR CONTROL", Attorney Docket No. END8545USNP3/170762-3,
- U.S. Patent Application No. ____________, entitled "SURGICAL EVACUATION SENSING AND DISPLAY", Attorney Docket No. END8545USNP4/170762-4,
・ US Special Pensuit application No. ______________________________________________________________________________, The GICAL PLATFORM ", agent reference number END8546USNP / 170763,
- U.S. Patent Application No. __________, entitled "SMOKE EVACUATION SYSTEM INCLUDING A SEGMENTED CONTROL CIRCUIT FOR INTERACTIVE SURGICAL PLATFORM", Attorney Docket No. END8546USNP1/170763-1,
- U.S. Patent Application No. ____________, entitled "SURGICAL EVACUATION SYSTEM WITH A COMMUNICATION CIRCUIT FOR COMMUNICATION DEVICE, BETWEEN A FILTER AND A SMOKE EVACUATION DEVICE", Attorney Docket No. USN 47/67, and U.S. Patent Application No. USNP 47/854 No. _____________ of the Invention Name "DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS", agent reference number END8548USNP/170765.

The applicant of this application owns the following US provisional patent applications, filed June 28, 2018, the entire disclosures of each of which are incorporated herein by reference:
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. 62/691,227, entitled "CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSED CLOSURE PARAMETERS";
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";
U.S. Provisional Patent Application No. 62/691,262 entitled "SURGICAL EVACUATION SYSTEM WITH A COMMUNICATION CIRCUIT FOR COMMUNICATION DEVICE BETWEEN A FILTER AND A SMOKE EVACUATION DEVICE"; United States entitled "DROPLET FILTERS" Provisional Patent Application No. 62/691,251.

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

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 Publication No. 62/649,294 entitled "DATA STRIPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD";
U.S. Provisional Patent Application Publication No. 62/649,300 entitled "SURGICAL HUB SITUATIONAL AWARENESS";
U.S. Provisional Patent Application Publication No. 62/649,309 entitled "SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER";
U.S. Provisional Patent Application Publication No. 62/649,310 entitled "COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS";
U.S. Provisional Patent Application Publication 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 Publication No. 62/649,296 entitled "ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES";
U.S. Provisional Patent Application Publication No. 62/649,333 entitled "CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER";
U.S. Provisional Patent Application Publication No. 62/649,327 entitled "CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE MEASURES";
U.S. Provisional Patent Application Publication No. 62/649,315 entitled "DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK";
- U.S. Provisional Patent Application Publication No. 62/649,313 entitled "CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES";
U.S. Provisional Patent Application Publication No. 62/649,320 entitled "DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS";
U.S. Provisional Patent Application Publication No. 62/649,307 entitled "AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS"; No. 323.

At least some of the figures and descriptions of the present invention have been simplified to illustrate elements relevant to a clear understanding of the invention, but for purposes of clarity, other figures understood by those skilled in the art. may form part of the invention. However, because such elements are well known in the art and because they do not facilitate a better understanding of the invention, a description of such elements is not provided herein.

The following detailed description refers to the accompanying drawings which form a part hereof. In the figures, similar symbols and reference numerals generally indicate similar elements throughout the figures, unless content dictates otherwise. The illustrative aspects described in the Detailed Description, the Drawings, and the Claims are not meant to be limiting. Other aspects may be utilized, and other changes may be made, without departing from the scope of the technology presented herein.

The following description of specific examples of the technology should not be used to limit its scope. Other examples, features, aspects, embodiments, and advantages of the present technology will become apparent to those skilled in the art from the following description, which is, by way of illustration, one of the best modes contemplated for carrying out the technology. will be As will be realized, the technology described herein is capable of other different and obvious aspects, all without departing from the technology. Accordingly, the drawings and description are to be regarded as illustrative rather than restrictive in nature.

Any one or more of the teachings, expressions, aspects, embodiments, examples, etc. described herein may be combined with any other teachings, expressions, aspects, embodiments, examples, etc. described herein. can be combined with any one or more of Accordingly, the teachings, expressions, aspects, embodiments, examples, etc., set forth below should not be considered in isolation from each other. Various suitable ways in which the teachings herein can be combined will become readily apparent to those skilled in the art in view of the teachings herein. Such modifications and variations are intended to fall within the scope of the claims.

Before describing various aspects of electrosurgical systems, return pads, and methods in detail, the various aspects disclosed herein in their application or use are illustrated in the accompanying drawings and description. It should be noted that the details of construction and arrangement of parts are not limiting. Rather, the disclosed aspects may be situated in or incorporated within other aspects, embodiments, variations and modifications thereof, and may be practiced or carried out in various ways. Accordingly, aspects of the electrosurgical systems, return pads and methods disclosed herein are exemplary in nature and are not intended to limit their scope or application. Furthermore, unless otherwise stated, the terms and expressions used herein have been chosen for the convenience of the reader, for the purpose of describing aspects, and are not intended to limit their scope. Furthermore, without limiting any one or more of the disclosed aspects, representations of aspects and/or examples thereof, other disclosed aspects, representations of aspects and/or examples thereof It should be understood that it can be combined with any one or more of

In addition, in the following description, terms such as inward, outward, upward, downward, upward, downward, left, right, inside, outside, etc. are words used for convenience and are interpreted as restrictive terms. It should be understood that it should not. The terms used herein are non-limiting so long as the devices, or portions thereof, described herein can be mounted or used in other orientations. Various aspects are described in more detail with reference to the drawings.

As described in more detail below, aspects of the invention may be implemented by a computer program stored on a computing device and/or computer readable medium. Computer-readable media may include discs, devices, and/or propagated signals.

Referring to FIG. 1, a computer-implemented interactive surgical system 100 includes one or more surgical systems 102 and a cloud-based system (e.g., cloud 104 that may include a remote server 113 coupled to storage device 105). ,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 device configured to communicate with each other and/or with the surgical hub 106. and an instrument 112 . 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. , 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 Publication 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 Publication 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 to (i.e., detectable by) 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 procedures. 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 sensitive to specific wavelengths, including light from 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 the "Advanced Imaging 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 will be appreciated what can be done. 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 Publication No. 62/611,341, entitled "INTERACTIVE SURGICAL PLATFORM," filed Dec. 28, 2017, the entire disclosure of which is incorporated herein by reference. , "Advanced Imaging Acquisition Module" section.

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. Visualization system 108 guided by surgical hub 106 is configured to coordinate information flow to the operator inside and outside the sterile field using displays 107, 109, and 119. FIG. For example, surgical hub 106 allows visualization system 108 to maintain a live signal feed of the surgical site on primary display 119 while capturing snapshots of the surgical site recorded by imaging device 124 on non-sterile display 107 or 109 . can be displayed. 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 surgical 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, which can be viewed by a sterile operator located at the operating table. It is also configured to be visible. In one example, the input may be in the form of modifications to a snapshot displayed on non-sterile display 107 or 109 that can be sent by surgical 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. Surgical hub 106 is also configured to coordinate information flow to the display of surgical instrument 112 . See, for example, US Provisional Patent Application Publication No. 62/611,341, filed Dec. 28, 2017, entitled "INTERACTIVE SURGICAL PLATFORM," the entire disclosure of which is incorporated herein by reference. Diagnostic input or feedback entered by the non-sterile operator at the visualization tower 111 may be sent by the surgical hub 106 to the surgical instrument display 115 within the sterile field, where the diagnostic input or feedback is input to the surgical instrument. may be viewed by 112 operators. Exemplary surgical instruments suitable for use with the surgical system 102 are described, for example, in the "Surgical Instrument Hardware" section and the 2017 publication entitled "INTERACTIVE SURGICAL PLATFORM", the entire disclosures of which are incorporated herein by reference. US Provisional Patent Application Publication No. 62/611,341, filed Dec. 28.

Referring now to FIG. 3 , surgical hub 106 is shown in communication with visualization system 108 , robotic system 110 and handheld intelligent surgical instrument 112 . Surgical hub 106 includes surgical hub display 135 , imaging module 138 , generator module 140 , communication module 130 , processor module 132 and storage array 134 . In certain aspects, the surgical 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 modular housing 136 of the surgical hub 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 surgical hub housing and a combination generator module slidably receivable within a docking station of the surgical hub housing. The docking station contains data and power contacts. A combination generator module comprises 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 surgical hub housing. In one aspect, a surgical hub housing includes a fluid 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 modular housing 136 of the surgical hub is configured to house various generators and facilitate two-way communication therebetween. One advantage of the modular housing 136 of the surgical hub 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; and the first energy generator module comprising: Slidably moveable out of electrical engagement with the first 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.

3-7, aspects of the present disclosure pertaining to surgical hub modular housing 136 that allows for modular integration of generator module 140, smoke evacuation module 126, and aspiration/irrigation module 128. is presented. The modular housing 136 of the surgical 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 monopolar device supported within a single housing unit 139 that is slidably insertable into the modular housing 136 of the surgical hub. and a generator module comprising an ultrasound 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 ultrasound generator modules interacting through the modular housing 136 of the surgical hub. Surgical Hub Modular Housing 136 allows for the insertion of multiple generators and generators docked into Surgical Hub Modular Housing 136 such that the multiple generators function as a single generator. may be configured to facilitate two-way communication between

In one aspect, surgical hub modular housing 136 is modular with external and wireless communication headers to allow removable attachment of modules 140, 126, 128 and bi-directional communication therebetween. A power and communication backplane 149 is provided.

In one aspect, surgical hub modular housing 136 includes a docking station or drawer 151, also referred to herein as a drawer, configured to slidably receive modules 140, 126, 128. . FIG. 4 shows a partial perspective view of surgical hub housing 136 and combination generator module 145 slidably receivable in docking station 151 of surgical hub housing 136 . A docking port 152 having power and data contacts on the rear side of the combination generator module 145 allows the combination generator module 145 to be slid into position within the corresponding docking station 151 of the modular housing 136 of the surgical hub. , the corresponding docking port 150 is configured to engage the power and data contacts of the corresponding docking station 151 of the modular housing 136 of the surgical hub. 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 . Utility conduits and fluid lines define fluid pathways that extend toward smoke evacuation module 126 received within surgical 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, a fluid source and/or vacuum source may be housed within surgical 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 modular housing 136 of the surgical hub align the docking ports of the modules to the modular housing of the surgical hub. Alignment mechanisms configured to engage their counterparts within the docking station of 136 may be included. For example, as shown in FIG. 4, the combination generator module 145 has sides configured to slidably engage corresponding brackets 156 of the corresponding docking station 151 of the modular housing 136 of the surgical hub. Includes partial bracket 155 . 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 modular housing 136 of the surgical hub.

In some aspects, the drawers 151 of the surgical 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 and housed within the modular housing 136 of the surgical hub. Two-way communication between modules can be facilitated. Alternatively or additionally, the docking ports 150 of the surgical hub modular housing 136 may facilitate wireless two-way communication between modules housed within the surgical 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 . See also U.S. Patent Application Publication No. 2011/0306840, published Dec. 15, 2011, entitled "CONTROLLABLE MAGNETIC SOURCE TO FIXTURE INTRACORPOREAL APPARATUS," and entitled "SYSTEM FOR PERFORMING A MINIMALLY INVASIVE SURGICAL 2." August 28, 4 Published US Patent Application Publication No. 2014/0243597 is incorporated herein by reference in its entirety for each disclosure.

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. Surgical 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 sends 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-bandwidth wireless communication protocol may be used for communication between devices 1a-1n and devices 2a-2m located in the operating room.

In another embodiment, operating room devices 1a-1n/2a-2m exchange data 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 E802.11 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 others designated 3G, 4G, 5G, and later can communicate with modular communication hub 203 via a number of wireless or wired communication standards or protocols, including, but not limited to, wireless and 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 evacuation module 226, aspiration/irrigation Coupled to module 228 , communications module 230 , processor module 232 , storage array 234 , smart device/appliance 235 optionally coupled to display 237 , and 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 is coupled to surgical 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. good too. The surgical 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 Publication No. 62/611,341, filed Dec. 28, 2017, entitled "INTERACTIVE SURGICAL PLATFORM," which is hereby incorporated by reference in its entirety; section, the ultrasound-based non-contact sensor module senses the operating room by transmitting bursts of ultrasound and receiving echoes when the bursts of ultrasound reflect off the exterior walls of the operating room. scanning, where a 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 Systems Interface (SCSI), or any other proprietary bus. It may be 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, processor 244 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 are specifically configured for IEC 61508 and ISO 26262 safety limit applications to provide advanced integrated safety mechanisms while offering scalable performance, connectivity, and memory options. may

System memory includes both volatile and nonvolatile 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 it may be included 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 others. 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, according to 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 surgical hub power logic 312 to manage 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 the frame timer 316 circuit and the surgical hub repeater circuit 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.

FIG. 12 shows a logic diagram of a control system 470 for a surgical instrument or tool, according to 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 a motor driver 492 operatively couples the longitudinally movable displacement member to drive the I-beam knife member. 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, the microcontroller 461 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 are specifically configured for IEC 61508 and ISO 26262 safety limit applications to provide advanced integrated safety mechanisms while offering scalable performance, connectivity, and memory options. may

Controller 461 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, microcontroller 461 includes processor 462 and memory 468 . The electric motor 482 may be a brushed direct current (DC) motor with a gearbox and a mechanical connection to 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 Oct. 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 according to 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 or tool, such as a drive member, firing member, firing bar, I-beam, or any element that can be displaced. used to refer generically to any member. 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. .

The 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. A 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, which is the distance after one rotation of the sensor element coupled to the displacement member after the displacement member has moved from point "a". It is the linear longitudinal distance traveled 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 interfaces 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; U.S. Patent Application Publication No. 15/628,175, filed Jun. 20, 2017, entitled "TECHNIQUES FOR ADAPTIVE CONTROL OF MOTOR VELOCITY OF A SURGICAL STAPLING AND CUTTING INSTRUMENT," which is incorporated herein by reference. Sensor mechanisms such as those that 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 members, such 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 machine actuators, drive bars, knives, 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, can 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 or tool. The I-beam is configured to engage a wedge-shaped sled, which is configured to cam the staple driver upward 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 a control circuit 500 configured to control aspects of a surgical instrument or tool, according to one aspect of the present disclosure. Control circuit 500 can 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 non-volatile 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 one aspect of the present disclosure. Combinatorial logic 510 may 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 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 for 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 is operably coupled to firing motor drive assembly 604, which can be configured to transmit the firing motion generated by motor 602 to the end effector, specifically to displace the I-beam elements. may be concatenated. In certain examples, the firing motion generated by motor 602 deploys staples from a staple cartridge into tissue captured by an end effector and/or advances a cutting edge of an I-beam element, for example. , may cut the captured tissue. The I-beam element can 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 respective 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 greater 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 selects from cooperating with one of the plurality of motors of the surgical instrument or tool to cooperating with the other of the plurality of motors of the surgical instrument or tool. can be switched.

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 its 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 has 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 include 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, may be used to alert processor 622 of program instructions to use 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's I-beam, causing the processor to When 622 detects, for example, via sensor 630 that switch 614 is in second position 617, it can employ program instructions associated with closing the anvil, and processor 622, for example, causes sensor 630 to Upon detecting that switch 614 is in third position 618a or fourth position 618b via a program instruction associated with end effector articulation can be used.

FIG. 17 is a schematic illustration of a robotic surgical instrument 700 configured to manipulate the surgical tools described herein, according to 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, via a plurality of motors 704a-704e, rotates the anvil 716 and I-beam 714 (including the sharp cutting edge) portions of the end effector 702, the removable staple cartridge 718, the shaft 740. , as well as 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 731 provides an output signal, such as elapsed time or a digital count, to control circuit 710 to correlate the position of I-beam 714 determined by position sensor 734 with the output of timer/counter 731. , 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, the control circuit 710 can 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, motors 704a-704e may be brushless DC electric motors, with respective motor drive signals provided to one or more stator windings of 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 742a, and articulation 742b via respective transmission mechanisms 706a-706e. may The transmission mechanisms 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 can 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 tracks the position of I-beam 714 by summing the number and direction of steps that motor 704 is instructed to perform. can be done. The position sensor 734 can 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 setpoints 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 mechanism 706 a which is coupled to I-beam 714 . Transmission mechanism 706a includes moveable mechanical elements, such as rotating and firing members, for controlling movement of I-beam 714 distally and proximally along the longitudinal axis of end effector 702. FIG. 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 , which has 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 portion of end effector 702 . Control circuit 710 provides motor set points 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 744 b is coupled to transmission mechanism 706 b that is coupled to anvil 716 . Transmission mechanism 706b includes moveable mechanical elements such as rotating elements and closing 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 setpoints to motor control 708c, which 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 mechanism 706 c which is coupled to shaft 740 . Transmission mechanism 706c includes moveable mechanical elements, such as rotating elements, 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 setpoints to motor control 708d, which 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 mechanism 706d which is coupled to articulation member 742a. Transmission mechanism 706d includes moveable mechanical elements, such as articulation elements 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 an external influence is sometimes referred to as a 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. A position sensor 734 may interface 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 to determine tissue location 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 determines (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) can sense load and position on both articulation rods.

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 gripping conditions. 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 created 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 may indicate the thickness and/or fullness of tissue located therebetween. indicates

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 conductor-free 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 exerted by the closure tube on the anvil 716 . The force exerted on anvil 716 may be representative of the tissue compression experienced by tissue portions 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 assess the closing force applied to the clamp arm 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. The 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 near 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 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 found in U.S. Patent Application Publication No. 15/636,829, entitled "CLOSED LOOP VELOCITY CONTROL TECHNIQUES FOR ROBOTIC SURGICAL INSTRUMENT," filed June 29, 2017, which is incorporated herein by reference in its entirety. disclosed.

FIG. 18 shows a block diagram of a surgical instrument 750 programmed to control distal translation of a displacement member, according to 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 includes an anvil 766 , an I-beam 764 (including sharp cutting edges), and an end effector 752 that may include 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 is determined by measuring the position of the longitudinally movable drive member using position sensor 784. can do. 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, control circuitry 760 instructs one or more microcontrollers, microprocessors, or processors or processors to control the displacement member, eg, I-beam 764, in the manner described. may comprise other suitable processors for executing 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. so that control circuit 760 can 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 . A motor setpoint signal 772 may be provided to the 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 embodiments, 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 mechanism 756 . Transmission mechanism 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 circuit 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 can 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 can track the position of I-beam 764 by summing the number and direction of steps motor 754 is instructed to perform. The position sensor 784 can 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 vs. time, tissue compression vs. time, and anvil strain vs. 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 clamping 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 created 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, which may indicate the thickness and/or fullness of tissue located therebetween. indicates

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 exerted by the closure tube on the anvil 766 . The force exerted against 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 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 near a target velocity. Surgical instrument 750 can include a feedback controller, for example, one of any feedback controller including, but not limited to, PID, state feedback, LQR, and/or adaptive controllers. There may be. 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 drives displacement member, cutting member, or I-beam 764 by means of a gearbox and a brushed DC motor with mechanical connections to the articulation and/or knife system. is configured as Another example is an electric motor 754 that operates, eg, a displacement member and an articulation driver of an interchangeable shaft assembly. 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 the displacement member distally and proximally along the longitudinal axis of end effector 752 . The end effector 752 may comprise a pivotable anvil 766 and a staple cartridge 768 positioned opposite the anvil 766 when configured for use. A clinician may grasp tissue between anvil 766 and staple cartridge 768 as described herein. When instrument 750 is ready for use, the clinician may provide a firing signal, for example, by pressing the trigger of 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 disposed 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. may be provided. 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 Publication No. 15/720,852, entitled "SYSTEM AND METHODS FOR CONTROLLING A DISPLAY OF A SURGICAL INSTRUMENT," filed September 29, 2017, which is incorporated herein by reference in its entirety. disclosed in No.

FIG. 19 is a schematic illustration of a surgical instrument 790 configured to control various functions according to 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 can include an anvil 766, an I-beam 764, and a removable staple cartridge 768 that can 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. A position sensor 784 may interface 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, with an anvil engaging tab or feature and a passageway engaging feature or foot. may further include 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 described in the present application entitled "TECHNIQUES FOR ADAPTIVE CONTROL OF MOTOR VELOCITY OF A SURGICAL STAPLING AND CUTTING INSTRUMENT," filed June 20, 2017, which is hereby incorporated by reference in its entirety. See commonly assigned US Patent Application Publication 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 configuration, 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 is determined by measuring the position of the longitudinally movable drive member using position sensor 784. can do. 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, control circuitry 760 instructs one or more microcontrollers, microprocessors, or processors or processors to control the displacement member, eg, I-beam 764, in the manner described. may comprise other suitable processors for executing 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. so that control circuit 760 can 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 . A motor setpoint signal 772 may be provided to the 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 mechanism 756 . Transmission mechanism 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 circuit 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 can provide other signals indicative of I-beam 764 movement. Also, in some implementations, the position sensor 784 may be omitted. If the motor 754 is a stepper motor, the control circuit 760 can track the position of the I-beam 764 by summing the number and direction of steps the motor is instructed to perform. The position sensor 784 can be located within the end effector 792 or any other part 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 clamping 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 created 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, which may indicate the thickness and/or fullness of tissue located therebetween. indicate.

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 exerted by the closure tube on the anvil 766 . The force exerted against 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 anvil 766 by the closure drive system. One or more sensors 788 may be sampled in real-time during clamping operations by the processor portion 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 .

RF energy source 794 is coupled to end effector 792 and applied to RF cartridge 796 when RF cartridge 796 is loaded into end effector 792 in place of 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 Publication No. 2017, 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. 15/636,096.

FIG. 20 is a simplified block diagram of a generator 800 configured to provide, among other advantages, inductorless tuning. Additional details of generator 800 are described in U.S. Pat. Incorporated herein by reference. Generator 800 may include patient isolation stage 802 in communication with non-isolation stage 804 via power transformer 806 . A secondary winding 808 of the power transformer 806 is housed within the isolation stage 802 and is used for multiple applications including, for example, ultrasonic surgical instruments, RF electrosurgical instruments, and ultrasonic and RF energy modes that can be delivered singly or simultaneously. Tap configurations (e.g., center-tapped or non-center-tapped configurations) may be provided to define drive signal outputs 810a, 810b, 810c for delivering drive signals to various surgical instruments, such as functional surgical instruments. . Specifically, drive signal outputs 810a, 810c may output an ultrasonic drive signal (eg, a 420V root mean square [RMS] drive signal) to an ultrasonic surgical instrument, and drive signal output 810b may , 810 c may output an electrosurgical drive signal (eg, a 100 V RMS drive signal) to the RF electrosurgical instrument with drive signal output 810 b corresponding to the center tap of power transformer 806 .

In certain forms, ultrasonic and electrosurgical drive signals are provided to separate surgical instruments, and/or multi-function surgical instruments, etc. that have the ability to deliver both ultrasonic and electrosurgical energy to tissue. may be delivered simultaneously to a single surgical instrument. Electrosurgical signals provided to either dedicated electrosurgical instruments and/or combined multifunction ultrasound/electrosurgical instruments are either therapeutic or sub-therapeutic level signals and It will be appreciated that subquantitative signals can be used, for example, to monitor tissue or instrument conditions and provide feedback to the generator. For example, ultrasound and RF signals can be delivered separately or simultaneously from a generator having a single output port to provide the desired output signal to the surgical instrument, as discussed in more detail below. . Thus, the generator can combine ultrasonic energy and electrosurgical RF energy to deliver combined energy to a multi-function ultrasonic/electrosurgical instrument. Bipolar electrodes can be placed on one or both jaws of the end effector. One jaw may be driven by ultrasonic energy in addition to electrosurgical RF energy, acting simultaneously. Electrosurgical RF energy may be used for vessel sealing, while ultrasonic energy may be used to dissect tissue.

Non-isolated stage 804 may include a power amplifier 812 having an output connected to a primary winding 814 of power transformer 806 . In certain forms, power amplifier 812 may include a push-pull amplifier. For example, the non-isolation stage 804 may further include a logic device 816 for providing a digital output to a digital-to-analog converter (DAC) circuit 818 that subsequently provides a corresponding analog signal to the input of power amplifier 812 . . In particular forms, logic device 816 may include, for example, a programmable gate array (PGA), an FPGA, a programmable logic device (PLD), among other logic circuits. Therefore, the logic device 816 controls many parameters (e.g., frequency, waveform shape, waveform amplitude) can be controlled. In particular forms, and as described below, logic device 816, in conjunction with a processor (eg, a DSP as described below), implements a number of DSP-based and/or other control algorithms to control generator 800. can control the parameters of the drive signal output by .

Power may be supplied to the power rail of power amplifier 812 by a switch mode regulator 820, eg, a power converter. In certain forms, switch mode regulator 820 may include, for example, an adjustable buck regulator. The non-isolated stage 804 may further include a first processor 822, which in one form may be, for example, an Analog Devices ADSP-21469 SHARC DSP available from Analog Devices (Norwood, MA). A DSP processor may be included, although in various aspects any suitable processor may be used. In particular forms, DSP processor 822 may control operation of switch-mode regulator 820 in response to voltage feedback data that DSP processor 822 receives via ADC circuitry 824 from power amplifier 812 . In one form, for example, DSP processor 822 may receive as an input via ADC circuitry 824 a waveform envelope of a signal (eg, an RF signal) amplified by power amplifier 812 . DSP processor 822 may then control switch-mode regulator 820 (eg, via PWM output) such that the rail voltage supplied to power amplifier 812 tracks the waveform envelope of the amplified signal. . By dynamically modulating the rail voltage of power amplifier 812 based on the waveform envelope, the efficiency of power amplifier 812 can be significantly improved over fixed rail voltage amplifier schemes.

In particular forms, logic device 816 implements a digital synthesis circuit, such as a direct digital synthesizer control scheme, in conjunction with DSP processor 822 to control the waveform shape, frequency and/or amplitude of the drive signal output by generator 800. You may In one form, for example, logic device 816 implements DDS control by calling waveform samples stored in a dynamically updated lookup table (LUT), such as a RAM LUT that may be embedded within an FPGA. Algorithms may be implemented. This control algorithm is particularly useful in ultrasonic applications where an ultrasonic transducer, such as an ultrasonic transducer, can be driven by a distinct sinusoidal current at its resonant frequency. Since other frequencies can excite parasitic resonances, minimizing or reducing the total distortion of the operating branch currents can correspondingly minimize or reduce undesirable resonance effects. Since the waveform shape of the drive signal output by generator 800 is affected by various sources of distortion present in the output drive circuit (eg, power transformer 806, power amplifier 812), the voltage and current based on the drive signal The feedback data can be input to an algorithm, such as an error control algorithm executed by the DSP processor 822, which on a dynamic, progressive basis (e.g., real-time), retrieves the waveform samples stored in the LUT. The distortion is compensated by preferably pre-distorting or modifying the . In one form, the amount or degree of predistortion applied to the LUT samples may be based on the error between the calculated operating branch current and the desired current waveform shape, the error being determined on a sample-by-sample basis. In this way, the pre-distorted LUT samples, when processed by the drive circuit, produce an operating branch drive signal having the desired waveform shape (e.g., sinusoidal) to optimally drive the ultrasonic transducer. can occur. In such a form, the LUT waveform samples therefore do not represent the desired waveform shape of the drive signal, but rather to ultimately produce the desired waveform shape of the motion branch drive signal when distortion effects are taken into account. represents the shape waveform required for

The non-isolated stage 804 is coupled to the output of the power transformer 806 via respective isolation transformers 830, 832 for sampling the voltage and current, respectively, of the drive signal output by the generator 800. An ADC circuit 826 and a second ADC circuit 828 may also be included. In certain forms, the ADC circuits 826, 828 may be configured to sample at high speeds (eg, 80 megasamples per second [MSPS]) to allow oversampling of the drive signal. In one form, for example, the sampling rate of the ADC circuits 826, 828 may allow approximately 200x (depending on frequency) oversampling of the drive signal. In certain forms, the sampling operations of ADC circuits 826, 828 may be performed by a single ADC circuit that receives input voltage and current signals via bi-directional multiplexers. The use of high-speed sampling in the form of generator 800, among other things, is used to calculate the complex currents flowing through the operating branches, which can be used in certain forms to implement the DDS-based waveform shape control described above. ), which may enable accurate digital filtering of the sampled signal and calculation of real power consumption with high precision. Voltage and current feedback data output by ADC circuits 826 , 828 may be received and processed by logic device 816 (eg, first-come, first-served [FIFO] buffers, multiplexers, etc.) for subsequent processing by DSP processor 822 , for example. It may be stored in a data memory for reading. As noted above, voltage and current feedback data can be used as inputs to algorithms to pre-distort or modify LUT waveform samples on a dynamic and progressive basis. In certain forms, this is based on, or otherwise related to, the corresponding LUT samples output by the logic device 816 when the voltage and current feedback data pairs are obtained. Voltage and current feedback data pairs may need to be indexed. Synchronization of LUT samples with voltage and current feedback data in this manner contributes to the precise timing and stability of the predistortion algorithm.

In certain forms, voltage and current feedback data may be used to control the frequency and/or amplitude (eg, current amplitude) of the drive signal. For example, in one form, voltage and current feedback data may be used to determine the impedance phase. The frequency of the drive signal may then be controlled to minimize or reduce the difference between the determined impedance phase and the impedance phase set point (e.g., 0°), thus minimizing the effects of harmonic distortion. or reduce it and correspondingly improve the impedance phase measurement accuracy. The phase impedance and frequency control signal determination may be implemented, for example, in DSP processor 822 and the frequency control signal is provided as an input to the DDS control algorithm implemented by logic device 816 .

In another form, for example, current feedback data may be monitored to maintain the current amplitude of the drive signal at the current amplitude set point. The current amplitude setpoint may be specified directly or indirectly determined based on the specified voltage amplitude and power setpoints. In certain forms, control of current amplitude may be performed by a control algorithm, such as, for example, a proportional-integral-derivative (PID) control algorithm within DSP processor 822 . Variables controlled by the control algorithm include, for example, scaling of LUT waveform samples stored in logic device 816 and/or DAC circuit 818 via DAC circuit 834 to preferably control the current amplitude of the drive signal. (which feeds the input to power amplifier 812).

The unisolated stage 804 may further include a second processor 836 to provide user interface (UI) functionality, among other things. In one form, UI processor 836 may include, for example, an Atmel AT91SAM9263 processor with an ARM 926EJ-S core, available from Atmel Corporation (San Jose, Calif.). Examples of UI functionality supported by the UI processor 836 include audible and visual user feedback, communication with peripheral devices (e.g., via a USB interface), communication with footswitches, input devices (e.g., touch screen displays), as well as communication with output devices (eg, speakers). UI processor 836 may communicate with DSP processor 822 and logic device 816 (eg, via an SPI bus). UI processor 836 may primarily support UI functionality, but in certain forms it may also cooperate with DSP processor 822 to provide risk mitigation. For example, the UI processor 836 may be programmed to monitor various aspects of user input and/or other input (eg, touchscreen input, footswitch input, temperature sensor input), and error conditions When detected, the drive output of generator 800 can be disabled.

In certain forms, both DSP processor 822 and UI processor 836 may determine and monitor the operational state of generator 800, for example. With respect to DSP processor 822 , the operating state of generator 800 may represent, for example, which control and/or diagnostic processes are performed by DSP processor 822 . With respect to UI processor 836, the operating state of generator 800 may represent, for example, which elements of the user interface (eg, display screen, sounds) are presented to the user. DSP processor 822 and UI processor 836 may each separately maintain the current operating state of generator 800 and recognize and evaluate possible transitions from the current operating state. DSP processor 822 may act as the master in this relationship and determine when transitions between operating states occur. The UI processor 836 may recognize valid transitions between operational states, and may determine if a particular transition is appropriate. For example, when DSP processor 822 instructs UI processor 836 to transition to a particular state, UI processor 836 may verify that the requested transition is valid. If the transition between the requested states is determined to be invalid by the UI processor 836, the UI processor 836 may put the generator 800 into failure mode.

The unisolated stage 804 can further include a controller 838 for monitoring input devices (eg, capacitive touch sensors, capacitive touch screens used to turn generator 800 on and off). can. In particular forms, controller 838 may include at least one processor and/or other controller device in communication with UI processor 836 . In one form, for example, controller 838 is a processor (e.g., Meg168 8-bit controller available from Atmel) configured to monitor user input provided via one or more capacitive touch sensors. ). In one form, controller 838 may include a touchscreen controller (eg, QT5480 touchscreen controller available from Atmel) for controlling and managing acquisition of touch data from the capacitive touchscreen.

In certain forms, when the generator 800 is in a “power off” state, the controller 838 continues to receive operating power (eg, via a line from the power supply of the generator 800, such as the power supply 854 described below). may In this way, the controller 838 can continue to monitor the input device for turning the generator 800 on and off (eg, a capacitive touch sensor located on the front panel of the generator 800). When the generator 800 is in the power off state, the controller 838 can activate the power supply (e.g., one or two of the power supplies 854) if activation of an "on/off" input device by the user is detected. enabling the operation of the DC/DC voltage converter 856 above). As a result, the controller 838 can initiate a sequence to transition the generator 800 to the "power on" state. Conversely, if activation of an "on/off" input device is detected while generator 800 is in the power-on state, controller 838 may initiate a sequence to transition generator 800 to the power-off state. can. For example, in certain forms, controller 838 may report activation of an “on/off” input device to UI processor 836, which in turn is necessary for transitioning generator 800 to a power off state. process sequence. In this form, the controller 838 may not have a separate ability to remove power from the generator 800 after the power-on state of the generator 800 has been established.

In certain forms, controller 838 may cause generator 800 to provide audible or other sensory feedback to alert the user that a power-on or power-off sequence has been initiated. Such warnings may be provided at the start of a power-on or power-off sequence and prior to the start of other processes associated with the sequence.

In certain forms, the isolation stage 802 includes, for example, surgical instrument control circuitry (eg, control circuitry including handpiece switches) and non-isolation stages such as, for example, logic device 816, DSP processor 822, and/or UI processor 836. An instrument interface circuit 840 may be included to provide a communication interface between the components of 804 . Instrument interface circuitry 840 exchanges information with the components of non-isolated stage 804 via a communication link that maintains a suitable degree of electrical isolation between stages 802 and 804, such as, for example, an IR-based communication link. can. For example, a low dropout voltage regulator powered by an isolation transformer driven from the non-isolation stage 804 can be used to power the instrument interface circuit 840 .

In one form, instrument interface circuitry 840 may include logic circuitry 842 (eg, logic circuitry, programmable logic circuitry, PGA, FPGA, PLD) in communication with signal conditioning circuitry 844 . Signal conditioning circuitry 844 may be configured to receive a periodic signal (eg, a 2 kHz square wave) from logic circuitry 842 to generate a bipolar interrogation signal having the same frequency. The interrogation signal can be generated using, for example, a bipolar current source fed by a differential amplifier. The interrogation signal is communicated to the surgical instrument control circuitry (eg, using conductive pairs in the cable connecting the generator 800 to the surgical instrument) and monitored to determine the state or configuration of the control circuitry. good too. The control circuit may include a number of switches, resistors, and/or diodes, and interrogation signals such that the state or configuration of the control circuit is individually identifiable based on one or more characteristics. may modify one or more properties (eg, amplitude, rectification) of . For example, in one form, the signal conditioning circuit 844 may include an ADC circuit for generating samples of the voltage signal appearing across the input of the control circuit resulting from the path traversed by the interrogation signal. Logic circuitry 842 (or a component of non-isolation stage 804) may then determine the state or configuration of the control circuitry based on the ADC circuitry samples.

In one form, the instrument interface circuit 840 includes a first data circuit interface 846 and a logic circuit 842 (or other elements of the instrument interface circuit 840) located within the surgical instrument or otherwise. and the first data circuit associated with the . In certain forms, for example, the first data circuit is in a cable integrally attached to a surgical instrument handpiece, or in a cable for interfacing with a particular surgical instrument type or model having a generator 800 . It may be disposed within the adapter. The first data circuit may be implemented in any suitable manner, for example communicating with the generator according to any suitable protocol, including those described herein with respect to the first data circuit. good too. In certain forms, the first data circuit may include a non-volatile storage device, such as an EEPROM device. In certain forms, the first data circuit interface 846 may be implemented separately from the logic circuit 842 and may include suitable circuitry (eg, separate logic devices, processors) to interface the logic circuit 842 with the first data circuit interface 846 . may enable communication between the data circuits of the Alternatively, first data circuit interface 846 may be integral with logic circuit 842 .

In certain forms, the first data circuit may store information regarding the particular surgical instrument with which the first data circuit is associated. Such information may include, for example, model number, serial number, number of operations in which the surgical instrument was used, and/or any other type of information. This information is read by the instrument interface circuit 840 (eg, by the logic device 842) for presentation to a user via an output device and/or for control of the function or operation of the generator 800. It may be communicated to components of isolation stage 804 (eg, logic device 816, DSP processor 822, and/or UI processor 836). Additionally, any type of information may be communicated to the first data circuit (eg, using logic circuit 842 ) for internal storage via first data circuit interface 846 . Such information may include, for example, the number of most recent surgeries in which the surgical instrument was used and/or the date and/or time of its use.

As noted above, the surgical instrument may be removable from the handpiece to facilitate interchangeability and/or disposability of the instrument (e.g., multi-function surgical instruments may be removable from the handpiece). obtain). In such cases, conventional generators may be limited in their ability to recognize the particular instrument configuration being used and correspondingly optimize the control and diagnostic processes. However, adding a readable data circuit to the surgical instrument to address this issue is problematic from a compatibility standpoint. For example, it may not be practical to design a surgical instrument to be backward compatible with generators that lack the necessary data read functionality, due to, for example, different signal schemes, design complexity and cost. be. The instrument configurations discussed herein are designed to economically use data circuitry that may be implemented in existing surgical instruments and to maintain compatibility between surgical instruments and modern generator platforms. Address these concerns by minimizing changes.

In addition, configurations of generator 800 may enable communication with instrument-based data circuits. For example, generator 800 can be configured to communicate with a second data circuit contained within an instrument (eg, a multi-function surgical instrument). In some forms, the second data circuit is implemented in many similarities to those of the first data circuit described herein. Instrument interface circuitry 840 may include a second data circuitry interface 848 to facilitate this communication. In one form, the second data circuit interface 848 may include a tri-state digital interface, although other interfaces may also be used. In particular forms, the second data circuit may generally be any circuit for transmitting and/or receiving data. In one form, for example, the second data circuit may store information regarding the particular surgical instrument with which the second data circuit is associated. Such information may include, for example, model number, serial number, number of operations in which the surgical instrument was used, and/or any other type of information.

In some forms, the second data circuit may store information regarding electrical and/or ultrasonic properties of an associated ultrasonic transducer, end effector, or ultrasonic drive system. For example, a first data circuit may indicate a burn-in frequency slope as described herein. Additionally or alternatively, any type of information may be communicated to the second data circuit for internal storage via the second data circuit interface 848 (eg, using logic circuit 842). ). Such information may include, for example, the number of most recent operations in which the device was used and/or the date and/or time of its use. In certain forms, the second data circuit may transmit data acquired by one or more sensors (eg, instrument-based temperature sensors). In certain forms, the second data circuit may receive data from generator 800 and provide an indication (eg, a light emitting diode indication or other visible indication) to the user based on the received data.

In a particular form, the second data circuit and second data circuit interface 848 are such that communication between the logic circuit 842 and the second data circuit requires additional conductors for this purpose (e.g., a hand piece). can be provided without the need to provide a dedicated conductor of the cable connecting the to the generator 800 . In one aspect, for example, one of the conductors used uses a one-wire bus communication scheme implemented over existing cabling, such as sending an interrogation signal from the signal conditioning circuit 844 to the control circuit at the handpiece. can be used to transfer information to and from a second data circuit. In this manner, design changes or modifications to the surgical instrument that may otherwise be required are minimized or reduced. Furthermore, the presence of the second data circuit is "invisible" to generators that do not have the necessary data reading capabilities, as different types of communications carried out over a common physical channel can be frequency band separated. , thus allowing backward compatibility of surgical instruments.

In certain forms, isolation stage 802 may include at least one blocking capacitor 850-1 connected to drive signal output 810b to prevent direct current from passing through the patient. A single blocking capacitor may, for example, be required to comply with medical regulations or standards. Although failures in single-capacitor designs are relatively rare, such failures can nonetheless have negative consequences. In one form, a second blocking capacitor 850-2 may be provided in series with blocking capacitor 850-1 such that current leakage from a point between blocking capacitors 850-1 and 850-2 is induced by the leakage current. is monitored by an ADC circuit 852 to sample the voltage applied. The samples may be received by logic circuitry 842, for example. Generator 800 determines when at least one of blocking capacitors 850-1, 850-2 fails based on changes in leakage current (as indicated by voltage samples) to provide a single point of failure. can provide benefits over single-capacitor designs with

In certain forms, the non-isolated stage 804 may include a power supply 854 for delivering DC power at a suitable voltage and current. The power supply may include, for example, a 400W power supply to deliver a 48VDC system voltage. Power supply 854 includes one or more DC/DC voltage converters 856 for receiving the output of the power supply and producing DC outputs at voltages and currents required by the various components of generator 800 . You can prepare more. As described above in connection with controller 838 , one or more of DC/DC voltage converters 856 are activated by controller 838 when user activation of an “on/off” input device is detected by controller 838 . An input may be received from 838 to enable operation or activation of the DC/DC voltage converter 856 .

FIG. 21 shows an example of generator 900, which is one form of generator 800 (FIG. 20). Generator 900 is configured to deliver multiple energy modalities to a surgical instrument. Generator 900 either singly or simultaneously provides RF and ultrasound signals for delivering energy to the surgical instrument. RF and ultrasound signals may be provided alone, in combination, or may be provided simultaneously. As noted above, at least one generator output may transmit multiple energy modalities (e.g., ultrasound, bipolar or monopolar RF, irreversible and/or reversible electroporation, and/or microwave, among others) through a single port. energy) can be delivered, and these signals can be delivered to the end effector individually or simultaneously to treat the tissue.

Generator 900 comprises a processor 902 coupled to a waveform generator 904 . Processor 902 and waveform generator 904 are configured to generate various signal waveforms based on information (not shown for clarity of disclosure) stored in memory coupled to processor 902. Digital information associated with the waveform is provided to waveform generator 904, which includes one or more DAC circuits to convert the digital input to analog output. The analog output is provided to amplifier 1106 for signal conditioning and amplification. The regulated and amplified output of amplifier 906 is coupled to power transformer 908 . The signal is coupled across power transformer 908 to the secondary on the patient-isolated side. A first signal of a first energy modality is provided between terminals labeled ENERGY ₁ and RETURN of the surgical instrument. A second signal of the second energy modality is coupled across capacitor 910 and provided between terminals labeled ENERGY ₂ and RETURN of the surgical instrument. More than two energy modalities may be output, so the subscript "n" can be used to denote that up to n ENERGYn terminals can be provided, where n is greater than one. It will be understood to be a positive integer. It will also be appreciated that up to 'n' return paths (RETURNn) may be provided without departing from the scope of the present disclosure.

A first voltage sensing circuit 912 is coupled across terminals labeled ENERGY ₁ and the RETURN path to measure the output voltage therebetween. A second voltage sensing circuit 924 is coupled across terminals labeled ENERGY ₂ and the RETURN path to measure the output voltage therebetween. A current sensing circuit 914 is arranged in series with the RETURN leg of the secondary side of the illustrated power transformer 908 to measure the output current of either energy modality. If different return paths are provided for each energy modality, separate current sensing circuits must be provided for each return leg. The outputs of first voltage sensing circuit 912 and second voltage sensing circuit 924 are provided to isolation transformers 916 , 922 respectively, and the output of current sensing circuit 914 is provided to another isolation transformer 918 . The outputs of isolation transformers 916 , 928 , 922 on the primary side (non-patient isolated side) of power transformer 908 are provided to one or more ADC circuits 926 . The digitized output of ADC circuitry 926 is provided to processor 902 for further processing and calculations. Output voltage and output current feedback information can be used to adjust the output voltage and current provided to the surgical instrument and to calculate the output impedance, among other parameters. Input/output communication between processor 902 and patient isolation circuitry is provided through interface circuitry 920 . Sensors may also be in electrical communication with processor 902 via interface circuitry 920 .

In one aspect, the impedance is controlled by either the first voltage sensing circuit 912 coupled across the terminals labeled ENERGY ₁ /RETURN or the second voltage sensing circuit 924 coupled across the terminals labeled ENERGY ₂ /RETURN. This output may be determined by processor 902 by dividing by the output of current sensing circuit 914 placed in series with the RETURN leg of the secondary of power transformer 908 . The outputs of the first voltage sensing circuit 912 and the second voltage sensing circuit 924 are provided to separate isolation transformers 916 , 922 and the output of the current sensing circuit 914 is provided to another isolation transformer 916 . Digitized voltage and current sensing measurements from ADC circuitry 926 are provided to processor 902 for calculating impedance. As an example, the first energy modality ENERGY ₁ may be ultrasonic energy and the second energy modality ENERGY ₂ may be RF energy. Yet, in addition to ultrasound energy modalities and bipolar or monopolar RF energy modalities, other energy modalities include irreversible and/or reversible electroporation and/or microwave energy, among others. Also, while the example illustrated in FIG. 21 shows that a single return path RETURN may be provided for two or more energy modalities, in other aspects multiple return paths RETURNn may be provided for each It may be provided to the energy modality ENERGYn. Thus, as described herein, the impedance of the ultrasound transducer may be measured by dividing the output of the first voltage sensing circuit 912 by the current sensing circuit 914, and the tissue impedance is the second It may be measured by dividing the voltage sensing circuit 924 output by 2 by the current sensing circuit 914 .

As shown in FIG. 21, the generator 900, including at least one output port, provides power, e.g., ultrasound, bipolar or monopolar RF, irreversible and/or or reversible electroporation, and/or a power transformer having a single output and having multiple taps to provide an end effector in the form of one or more energy modalities such as microwave energy. A device 908 can be included. For example, the generator 900 drives RF electrodes for tissue sealing using either monopolar or bipolar RF electrosurgical electrodes with high voltage and low current to drive the ultrasonic transducer. Energy can be delivered at low voltage and high current for spot coagulation, or in a coagulation waveform for spot coagulation. The output waveform from generator 900 may be induced, switched, or filtered to provide frequencies to the end effector of the surgical instrument. The connection of the ultrasonic transducer to the generator 900 output will preferably be located between the output labeled ENERGY ₁ and RETURN as shown in FIG. In one embodiment, the connection to the output of the RF bipolar electrode generator 900 will preferably be located between the output labeled ENERGY ₂ and RETURN. For unipolar outputs, the preferred connections would be active electrodes (eg pencil or other probes) to suitable return pads connected to the ENERGY ₂ and RETURN outputs.

Further details can be found in U.S. Patent Application Publication No. 47/0891, published March 30, 2017, entitled TECHNIQUES FOR OPERATING GENERATOR FOR DIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMS AND SURGICAL INSTRUMENTS, which is incorporated herein by reference in its entirety. disclosed in No.

FIG. 22 shows an electrosurgical system 60000 according to at least one aspect of the present disclosure. Electrosurgical system 60000 includes a generator 60002 , an electrosurgical instrument 60004 and a return pad 60006 . Generator 60002 supplies alternating current at a high frequency level to electrosurgical instrument 60004 via first conductor/cable 60008 . Electrosurgical instrument 60004 includes an electrode tip (ie, an active electrode) that can be placed in target tissue of a patient. Electrosurgical instrument 60004 receives alternating current from generator 60002 and delivers alternating current to target tissue of patient 60010 via the electrode tip. The alternating current is received at the target tissue, and resistance from the tissue produces heat that produces the desired effect (eg, sealing and/or cutting) at the surgical site. Alternating current is conducted through the patient's body and ultimately received by return pad 60006 . The alternating current received by the return pad 60006 is carried back to the generator 60002 via the second conductor/cable 60012 to complete the closed path that the alternating current follows.

According to various aspects, generator 60002 is similar to generator 900 described above and may include, for example, a processor and waveform generator similar to processor 902 and waveform generator 904 described above.

The electrosurgical instrument 60004 is for monopolar operation in which electrosurgical energy supplied by the generator 60002 is introduced into the patient's tissue by the active electrode of the surgical instrument 60004 and returned to the generator 60002 via the return pad 6006. may be configured. According to various aspects, electrosurgical instrument 60004 includes a handpiece or pencil and an electrode tip. The electrode tip functions as the active electrode of electrosurgical system 60000 and introduces electrosurgical energy to target tissue of patient 60010 . Specifically, an electrical discharge is delivered from the electrode tip to the patient 60010 to cause heating of the patient's 60010 cellular material in close contact with or adjacent to the electrode tip. Heating of tissue occurs at a reasonably high temperature such that electrosurgical instrument 60004 can be used to perform electrosurgery.

FIG. 23 shows a return pad 60006 of the electrosurgical system 60000 of FIG. 22, according to at least one aspect of the present disclosure. The return pad 60006 may be similar to the MEGA SOFT® patient return electrodes commercially available from Megadyne Medical Products, but the return pad 60006 may include a sleeve or cover 60014, separated from the patient's body by a small distance. may be capacitively coupled with the patient's body, and differ in that they are configured to carry a constant amount of electrical current that is introduced into the patient's body by the electrosurgical instrument 60004. .

Instead of a single return electrode, the return pad includes a plurality of electrodes 60016 (see FIG. 24), which can be capacitively coupled to the patient's body to allow the electrosurgical instrument 60004 to return to the patient. The return pads 60006 differ from the MEGA SOFT® patient return electrodes available from Megadyne Medical Products in that they are collectively configured to carry a constant amount of electrical current that is introduced into the body of the patient. They are different. With this capacitive coupling, the patient's body effectively acts as one plate of the capacitor and the electrodes of the return pad collectively effectively act as the other plate of the capacitor. A more detailed description of capacitive coupling can be found, for example, in U.S. Pat. ELECTRODE", and US Pat. No. 6,582,424, issued June 24, 2003, entitled "CAPACITIVE REUSABLE ELECTROSURGICAL RETURN ELECTRODE." Although return pad 60006 is shown in FIG. 23 as being substantially rectangular, it will be appreciated that return pad 60006 may be of any suitable shape.

FIG. 24 shows multiple electrodes 60016 of the return pad 60006 of FIG. 23, according to at least one aspect of the present disclosure. For clarity, the sleeve or cover 60014 of return pad 60006 is not shown in FIG. Although four electrodes 60016 are shown in FIG. 24, it will be appreciated that return pad 60006 may include any number of electrodes 60016 . For example, return pad 60006 includes 16 electrodes 60016, according to various aspects. Also, while the individual electrodes 60016 are shown in FIG. 24 as being substantially rectangular, it will be appreciated that the individual electrodes may be of any suitable shape.

The electrode 60016 of the return pad 60006 can be considered a return electrode of the electrosurgical system 60000 of FIG. , can also be viewed as segmented electrodes. Electrodes 60016 of return pad 60006 may also be coupled together to effectively act as one large electrode. For example, according to various aspects, each of the electrodes 60016 of the return pad 60006 can be connected to the input of the switching device 60020 by a respective conductive member 60018, as shown in FIG. When the switching device 60020 is in the open position as shown in FIG. 24, the respective electrodes 60016 of the return pad 60006 are not only decoupled from each other, but also from the patient's body and/or the generator 60002. be done. In contrast, when switching device 60020 is in the closed position, respective electrodes 60016 of return pad 60006 are coupled together to effectively act as one large electrode.

Switching device 60020 may be controlled by processing circuitry (eg, processing circuitry of electrosurgical system generator 60002, processing circuitry of surgical hub 206, processing circuitry of surgical hub 106, etc.). For the sake of simplicity, processing circuitry is not shown in FIG. According to various aspects, the switching device 60020 shown in FIG. 24 can be incorporated into the return pad 60006. According to another aspect, the switching device 60006 shown in FIG. 24 can be incorporated into the second conductor/cable 60012 of the electrosurgical system 60000 of FIG. Return pad 60006 may also include multiple sensing devices 60022 (see FIG. 25).

By being able to couple multiple electrodes 60016 together for use during an electrosurgical procedure, the overall effective size of the electrodes 60016 of the return pad 60006 is sufficiently large and/or the current density is kept sufficiently low to It will have sufficient surface area to mitigate the potential for any unwanted burning of the patient 60010 .

FIG. 25 illustrates an arrangement of sensing devices 60022 of return pad 60006 of FIG. 23, according to at least one aspect of the present disclosure. For clarity, the sleeve or cover 60014 of return pad 60006 is not shown in FIG. According to various aspects, the number of sensing devices 60022 corresponds to the number of electrodes 60016 such that there is one sensing device 60022 for each electrode 60016 and each sensing device 60022 is associated with a corresponding electrode 60016. Mounted or integrated. However, while the number of sensing devices 60022 shown in FIG. For example, for embodiments of the return pad 60006 that include 16 electrodes 60016, the return pad 60006 may include only 4 or 8 sensing devices 60022. Although the sensing device 60022 is shown in FIG. 25 as being centered on the corresponding electrode 60016, the sensing device 60022 may be positioned on any portion of the corresponding electrode 60016 and may be positioned on different electrodes 60016. It will be appreciated that it may be arranged differently.

Sensing device 60022 is configured to sense unipolar neural control signals applied to the patient and/or movement of anatomical features of the patient resulting from application of the neural control signals (eg, muscle spasms). . The unipolar neural control signal may be applied by electrosurgical instrument 60004 of electrosurgical system 60000 of FIG. 22, or may be applied by different surgical instruments coupled to different generators. Each sensing device 60022 may include, for example, a pressure sensor, an accelerometer, or combinations thereof, and may also include signals indicative of detected neural control signals and/or signals indicative of detected movement of anatomical features of the patient. is configured to output Such pressure sensors may include, for example, piezoresistive strain gauges, capacitive pressure sensors, electromagnetic pressure sensors and/or piezoelectric pressure sensors. Such accelerometers may include, for example, mechanical accelerometers, capacitive accelerometers, piezoelectric accelerometers, electromagnetic accelerometers, and/or micro-electromechanical system (MEMS) accelerometers. Each output signal of each sensing device 60022 may be in the form of an analog signal and/or a digital signal.

By using Coulomb's law and the respective positions of the active electrodes of the electrosurgical instrument 60004, the patient's body and the respective sensing devices 60022, detected neural control signals and/or movements of the patient's anatomical features Each output signal of each sensing device 60022 indicative of can be analyzed to determine the location of nerves within the patient's body. Coulomb's law is E=K(Q/r ² ), where E is the threshold current required in the nerve to stimulate the nerve, K is a constant, and Q is the nerve stimulation electrode is the minimum current from and r is the distance from the nerve. The farther the nerve stimulation electrode is from the nerve, the proportionally higher current is required to stimulate the nerve. Therefore, constant current stimulation can be used to estimate the distance from the nerve stimulation electrode to the nerve. Generally, the strength of each of the output signals of each sensing device 60022 indicates how close or far each sensing device 60022 is from the stimulated nerve of patient 60010 .

According to various aspects, the analysis of the respective output signals of the respective sensing devices 60022 can be performed by processing circuitry of the generator 60002 of the electrosurgical system 60000 of FIG. 22, generator 60002 of the electrosurgical system 60000 of FIG. may be performed by separate neuromonitoring system processing circuitry, surgical hub 106 processing circuitry, surgical hub 206 processing circuitry, and the like. Analysis can be performed in real time or near real time. According to various aspects, each output signal serves as an input to a unipolar neural stimulation algorithm executed by a processing circuit.

As shown in FIG. 25, according to various aspects, output signals of respective sensing devices 60022 can be input to multiple-input single-output switching devices 60024 (eg, multiplexers) via respective conductive members 60026. . By controlling the selection signals S ₀ , S ₁ to the multiple-input single-output switching device 60024, the multiple-input single-output switching device 60024 selects one of the output signals of each sensing device 60024 for the above analysis. can be controlled to output only one For example, referring to FIG. 25, by setting the select signals S ₀ , S ₁ to 0, 0, the output signal from sensing device 60022 associated with electrode 60016 in the upper left corner of FIG. It can be output by a multiple-input single-output switching device 60024 for analysis by the circuit. By setting the selection signals S ₀ , S ₁ to 0, 1, the output signal from sensing device 60022 associated with electrode 60016 in the upper right corner of FIG. 25 is multi-input for analysis by applicable processing circuitry. It can be output by a single output switching device 60024 . By setting the select signals S ₀ , S ₁ to 1, 0, the output signal from sensing device 60022 associated with electrode 60016 in the lower left corner of FIG. 25 is multi-input for analysis by applicable processing circuitry. It can be output by a single output switching device 60024 . By setting the selection signals S ₀ , S ₁ to 1, 1, the output signal from sensing device 60022 associated with electrode 60016 in the lower right corner of FIG. 25 is multi-input for analysis by applicable processing circuitry. It can be output by a single output switching device 60024 .

Select signals S ₀ , S ₁ may be, for example, processing circuitry of generator 60002 of electrosurgical system 60000 of FIG. 22, processing circuitry of a neuromonitoring system separate from generator 60002 of electrosurgical system 60000 of FIG. Multiple-input single-output switching device 60024 may be supplied by processing circuitry, such as processing circuitry of surgical hub 206 , processing circuitry of surgical hub 106 . Processing circuitry is not shown in FIG. 25 for simplicity. By providing the various selection signals at a sufficiently fast rate, the output signal of each sensing device allows timely analysis of all of the output signals of each sensing device to determine the location of the stimulated nerve. can be effectively scanned at a speed that allows

According to various aspects, the multiple-input single-output switching device 60024 shown in FIG. 25 can be incorporated into the return pad 60006. According to another aspect, the multiple-input single-output switching device 60024 shown in FIG. 25 can be incorporated into the second conductor/cable 60012 of the electrosurgical system 60000 of FIG.

The control of multiple-input single-output switching device 60024 was described above in the context of a four-input single-output switching device corresponding to four sensing devices 60022 shown in FIG. In aspects where there are more than five sensing devices 60022 (eg, sixteen sensing devices), the output signals of more than five sensing devices 60022 will be input to the multiple-input single-output switching device 60024, and three or more of select signals (eg, S ₀ , S ₁ , S ₂ and S ₃ ) are required to control the output of multiple-input single-output switching device 60024 .

In embodiments where the output signal of sensing device 60024 is an analog signal, the output of multiple-input single-output switching device 60024 is subjected to analog-to-digital converter 60026 (FIG. 25) prior to performing analysis of the output signal by applicable processing circuitry. ) into a corresponding digital signal.

By incorporating an array of sensing devices 60022 into the plurality of electrodes 60016 of the return pad 60006, the location of the patient's nerves relative to the electrode tips of the electrosurgical instrument 60004 can be determined. The determined nerve location may be presented to the surgeon, thereby allowing the surgeon to inadvertently damage or excise the nerve while utilizing the electrode tip to cut the target tissue of the patient 60010. is reduced.

According to various aspects, sensing of neural control signals and/or movement of anatomical features of the patient by the sensing device 60022 can be performed while the electrodes 60016 of the return pad 60006 are coupled to each other or from each other. It can be executed while free. For example, with respect to performing detection that the respective electrodes 60016 of the return pad 60006 are decoupled from each other after positioning the patient 60010 on the operating table but before beginning the surgical procedure: The return pad 60006 can be placed in a “sense mode” by controlling the switching device 60020 shown in FIG. 24 to decouple respective electrodes 60016 of the return pad 60006 from each other. While the respective electrodes 60016 are decoupled from each other, nerves and/or nerve bundles can be stimulated with the electrosurgical instrument 60004 described above, and the respective output signals of the sensing devices 60022 of the return pads 60006 are the nerve, Nerve fascicles and/or their associated nerve nexus may be analyzed as described above to identify where they are located. Those positions are determined by the monopolar neural stimulation algorithm profile, which can reside, for example, in memory circuits of generator 60002, in memory circuits of different generators coupled to surgical instruments other than electrosurgical instrument 60004, and the like. can be entered. When those locations are entered into a monopolar nerve stimulation algorithm profile, they are effectively isolated from the capacitive actuation of the electrodes 60016 of the return pad 60006 to reduce nerve and/or stress during tissue cutting procedures. It is used as a sense node in the monopolar nerve stimulation algorithm profile to notify the surgeon when the nerve bundle is approaching the surgeon. According to various aspects, the surgeon can be informed of the proximal location of nerves and/or nerve bundles via audible alerts, visual alerts, vibration alerts, and the like.

As described in further detail below in connection with FIG. 26, according to various aspects, when it comes to performing detection that respective electrodes 60016 of return pad 60006 are coupled together, FIG. The generator 60002 of the T.22 electrosurgical system 60000 is capable of generating a high frequency waveform (alternating current at radio frequencies) that is modulated onto a carrier wave, the carrier wave being of a sufficiently low frequency to stimulate the patient's nerves. belongs to. This allows neural control signals and/or motion sensing of anatomical features to occur simultaneously with capacitive coupling between respective electrodes 60016 of return pad 60006 and the patient's body. By applying a particular waveform to the patient 60010 and sensing a particular response, there is certainty that the motion of the anatomical feature is the result of that waveform being applied and not simply some general motion. obtained at a high standard. Modulation can be adjusted over time to stimulate different nerve sizes. According to various aspects, modulation is performed to enable applicable processing circuitry to determine from the signal the distance of nerves and/or nerve fascicles without having to continuously stimulate the nerves and/or nerve fascicles. It can be changed in amplitude over time.

FIG. 26 illustrates a method 60030 for simultaneously applying neural stimulation signals and electrosurgical energy to a patient, according to at least one aspect of the present disclosure. As a first step 60032 in this exemplary procedure, the generator 60002 generates a high frequency level alternating current as a high frequency waveform. According to various aspects, the waveform generator of generator 60002 performs this step.

In a second step 60034 the generator 60002 generates a low frequency waveform configured to stimulate the patient's nerves. According to various aspects, the low frequency waveform is a unipolar neural control signal and the waveform generator of generator 60002 performs this step.

In a third step 60036, generator 60002 utilizes the high frequency waveform generated in step 60032 to modulate the low frequency waveform generated in step 60034 to form a composite waveform. According to various aspects, the waveform generator of generator 60002 performs this step. According to another embodiment, the processing circuitry of generator 60002 performs this step.

In a fourth step 60038 the generator 60002 supplies the composite waveform generated in step 60036 to the electrosurgical instrument 60004 .

In a fifth step 60040 , electrodes (ie, active electrodes) of electrosurgical instrument 60004 apply the composite waveform to patient 60010 . The high frequency waveform acts to heat target tissue of the patient 60010 and exits the patient's body before being received by the electrodes 60016 of the return pad 60006 . The low frequency waveforms act to stimulate the patient's nerves and/or induce movement (eg, muscle spasms) of the patient's anatomical features resulting from the application of the neural control signal.

In a sixth step 60042, the plurality of electrodes 60016 coupled together via the switching device 60020 receive electrosurgical energy exiting the patient's body, and the respective conductive member 60018, the switching device 60020 and the second conductors/cables 60012 pass the electrosurgical energy back to the generator 60002 .

In a seventh step 60044, the sensing device 60022 senses the unipolar neural control signal applied to the patient 60010 and/or movement of an anatomical feature of the patient 60010 resulting from the application of the neural control signal (e.g., muscle spasm). ) and generate corresponding respective output signals. The output of each sensing device 60022 is sampled as described above and forwarded to processing circuitry for analysis. The processing circuitry may be, for example, the processing circuitry of generator 60002 of electrosurgical system 60000 of FIG. 22, the processing circuitry of generator 60002 of electrosurgical system 60000 of FIG. It can be a processing circuit of a neuromonitoring system separate from the device 60002 .

In an eighth step 60046, applicable processing circuitry analyzes the output signal to determine where nerves, nerve bundles and/or nerve nexus associated with the output signal are located. As noted above, according to various aspects, each output signal can serve as an input to a monopolar neurostimulation algorithm executed by a processing circuit, the monopolar neurostimulation algorithm allowing a surgeon to It acts to help prevent cutting or damaging nerve bundles and/or nerve nexuses.

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

Example 1 - A return pad of an electrosurgical system, a plurality of conductive members configured to receive radio frequency current applied to a patient, and a plurality of sensing devices, the plurality of sensing devices applied to the patient. and a plurality of sensing devices configured to sense at least one of a neural control signal applied to the patient and movement of an anatomical feature of the patient resulting from application of the neural control signal.

[0040] Example 2 - The return pad of Example 1, wherein the plurality of conductive members is further configured to capacitively couple with a patient.

Example 3 - Example 1, further comprising a switching device configured to selectively decouple at least one of the plurality of conductive members from another one of the plurality of conductive members Or the return pad according to 2.

[0040] Embodiment 4 - The return pad of any one of Embodiments 1-3, further comprising a switching device configured to selectively decouple each of the conductive members from one another.

[0051] Example 5 - The return pad of any one of Examples 1-4, further comprising a switching device configured to selectively decouple the plurality of conductive members from the patient.

[0052] Embodiment 6 - The return pad of any one of Embodiments 1-5, further comprising a switching device configured to selectively decouple the plurality of conductive members from the generator.

[0053] Example 7 - The return pad of any one of Examples 1-6, further comprising a switching device configured to selectively couple each of the plurality of conductive members to the generator.

Example 8 - The return pad of any one of Examples 1-7, wherein the plurality of sensing devices is configured as an array of sensing devices.

Example 9 - The return pad of any one of Examples 1-8, wherein each of the plurality of sensing devices is coupled to a corresponding one of the plurality of conductive members.

Example 10 - The return pad of any one of Examples 1-9, wherein each of the plurality of conductive members is coupled to a corresponding one of the plurality of sensing devices.

Example 11 - As in any one of Examples 1-10, wherein at least one of the plurality of sensing devices includes one of a pressure sensor, an accelerometer, and a pressure sensor and an accelerometer. Return pad as described.

[0051] Example 12 - The return pad of any one of Examples 1-11, wherein each of the plurality of sensing devices is further configured to output a signal indicative of its detection.

Example 13 - A generator configured to provide an alternating current at a radio frequency, an instrument configured to apply the alternating current to a patient, and a return pad capacitively coupleable to the patient, wherein the radio frequency current a plurality of conductive members capacitively coupleable to a patient and selectively couplable to a generator; and a plurality of sensing devices, wherein a plurality of sensing devices configured to sense at least one of a neural control signal applied to a patient and movement of an anatomical feature of the patient resulting from application of the neural control signal. An electrosurgical system comprising a pad and a conductor coupled to a return pad and a generator.

[00130] Example 14 - The electrosurgical system of Example 13, further comprising a multiple-input single-output switching device coupled to each of the plurality of sensing devices.

Example 15—The electrosurgical system of Example 14, further comprising an analog-to-digital converter coupled to the multiple-input single-output switching device.

Example 16 - A generator generates alternating current as a high frequency waveform, generates a low frequency waveform configured to stimulate nerves in a patient, and utilizes the high frequency waveform to modulate the low frequency waveform to produce a composite waveform. The electrosurgical system of any one of Examples 1-15, further configured to form and deliver the composite waveform to an instrument.

[00130] Example 17 - The electrosurgical system of any one of Examples 1-16, wherein the generator is further configured to amplitude modulate the low frequency waveform to form the composite waveform.

Example 18 - A return pad of an electrosurgical system comprising a plurality of electrodes configured to capacitively couple with a patient and an array of sensing devices comprising a neural control signal applied to the patient and the nerve A return pad comprising an array of sensing devices configured to sense at least one of movement of an anatomical feature of a patient resulting from application of a control signal.

[00130] Example 19 - The return pad of example 18, wherein each sensing device of the array of sensing devices is configured to output a signal indicative of its sensing.

Example 20 - The return pad of Example 18 or 19, wherein each sensing device of the array of sensing devices is positioned over a corresponding one of the plurality of electrodes.

Although several forms have been illustrated and described, it is not the applicant's intention to limit or limit the appended claims to such recitations. Numerous modifications, variations, changes, permutations, combinations and equivalents of these forms can be implemented and will occur to those skilled in the art without departing from the scope of this disclosure. Further, the structure of each element associated with the described form can be alternatively described as a means for providing the function performed by that element. Also, although materials are disclosed for particular components, other materials may be used. Accordingly, the above description and appended claims are intended to cover all such modifications, combinations, and variations as included within the scope of the disclosed forms. Please understand. The appended claims are intended to cover all such modifications, variations, variations, substitutions, modifications and equivalents.

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 implemented as 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., as one or more programs running on one or more microprocessors), as firmware, or substantially any combination thereof, and can be equivalently implemented on an integrated circuit; , designing circuits, and/or writing software and/or firmware code are 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 throughout this description, the term "wireless" and its derivatives describe circuits, devices, systems, methods, techniques, communication channels, etc. that can communicate data through the use of modulated electromagnetic radiation over non-solid media. may be used for This term does not imply that the associated device does not contain any wires, although in some aspects they may not be present. Communication modules include Wi-Fi (IEEE 802.11 family), WiMAX (IEEE 802.16 family), IEEE 802.20, Long Term Evolution (LTE), Ev-DO, HSPA+, HSDPA+, HSUPA+, EDGE, GSM, GPRS, CDMA, TDMA, DECT, Bluetooth, their Ethernet derivatives, as well as any other wireless and wireline protocols designated 3G, 4G, 5G, and beyond. Any of a number of wireless or wired communication standards or protocols may be implemented. 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.

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

As used herein, a system-on-a-chip or system-on-chip (SoC or SOC) is an integrated circuit (also known as an "IC" or "chip" that integrates all the components of a computer or other electronic system). is available). It can include digital, analog, mixed signal, and often radio frequency functionality all on a single substrate. SoCs integrate microcontrollers (or microprocessors) with modern peripherals such as graphics processing units (GPUs), Wi-Fi modules, or co-processors. The SoC may or may not include embedded memory.

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

As used herein, the term controller or microcontroller may be a standalone IC or chip device that interfaces with peripheral devices. This may be the link between the two parts of the computer or controller on the external device that manages the operation of that device (and the connection with the device).

Any processor or microcontroller described herein 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. 1 or 2 prefetch buffers, 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) One or more pulse width modulation (PWM) modules, one or more quadrature encoder input (QEI) analog, one or more 12-bit analog-to-digital converters (ADC) with 12 analog input channels ), including the LM4F230H5QR ARM Cortex-M4F processor core available from Texas Instruments.

In one aspect, the processor may include a safety controller that includes two controller family families, such as the TMS570 and RM4x, also known by the trade name Hercules ARM Cortex R4, also manufactured by Texas Instruments. Safety controllers are specifically configured for IEC 61508 and ISO 26262 safety limit applications to provide advanced integrated safety mechanisms while offering scalable performance, connectivity, and memory options. may

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 conforms to or is 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. possible. 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 conforms to or is compatible with the ATM standard and/or later versions of this standard published in August 2001 by the ATM Forum under the title "ATM-MPLS Network Interworking 2.0". obtain. 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 refer to data represented as physical (electronic) quantities in the registers and memory of a computer system, as well as data represented as physical (electronic) quantities in the memory or registers of a computer system or other such information storage, transmission, or display device. It will be understood to refer to the operations and processes of a computer system or similar electronic computing device that manipulates and transforms other data that are likewise 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 components, unless the context requires otherwise. will recognize that it may include

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. For convenience and clarity, spatial terms such as "vertical", "horizontal", "top", "bottom", "left" and "right" are used herein with reference to the drawings. It will further be appreciated that the However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and/or absolute.

Modular devices are connected to various modules for connection or pairing with corresponding surgical hubs (e.g., described in connection with FIGS. 3 and 9) receivable within a surgical hub. a surgical device or instrument to obtain. Modular devices include, for example, intelligent surgical instruments, medical imaging devices, suction/irrigation devices, smoke evacuators, energy generators, ventilators, inhalers, and displays. The modular devices described herein can be controlled by control algorithms. Control algorithms may be implemented on the modular device itself, on the surgical hub with which the particular modular device is paired, or on both the modular device and the surgical hub (e.g., via a distributed computing architecture). ), can be executed. In some examples, the control algorithm for the modular device is based on data sensed by the modular device itself (i.e., by sensors within, on, or connected to the modular device). control the device based on This data may relate to the patient (eg, tissue properties or injection pressure) during surgery or the modular device itself (eg, advancing knife speed, motor current, or energy level). For example, a control algorithm for a surgical stapling and severing instrument can control the speed at which the instrument's motor drives the knife through tissue based on the resistance encountered by the knife as it advances.

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 expressly recited in the claim; and in the absence of such a statement, such intent does not exist. 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.

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 expressing 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 terms, 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 return pad for an electrosurgical system comprising:
a plurality of conductive members configured to receive radio frequency current applied to a patient;
a plurality of sensing devices,
a neural control signal applied to the patient;
a plurality of sensing devices configured to sense at least one of motion of the patient's anatomical feature resulting from application of the neural control signal.
Clause 2. The return pad of clause 1, wherein the plurality of electrically conductive members are further configured to capacitively couple with the patient.
(3) The embodiment further comprising a switching device configured to selectively decouple at least one of said plurality of conductive members from another one of said plurality of conductive members. 1. The return pad according to 1.
Clause 4. The return pad of clause 1, further comprising a switching device configured to selectively decouple each of the conductive members from one another.
Clause 5. The return pad of clause 1, further comprising a switching device configured to selectively decouple the plurality of conductive members from the patient.

Clause 6. The return pad of clause 1, further comprising a switching device configured to selectively decouple the plurality of conductive members from the generator.
Clause 7. The return pad of clause 1, further comprising a switching device configured to selectively couple each of said plurality of conductive members to a generator.
Aspect 8. The return pad of aspect 1, wherein the plurality of sensing devices is configured as an array of sensing devices.
Aspect 9. The return pad of aspect 1, wherein each of the plurality of sensing devices is coupled to a corresponding one of the plurality of conductive members.
Aspect 10. The return pad of aspect 1, wherein each of the plurality of conductive members is coupled to a corresponding one of the plurality of sensing devices.

(11) at least one of the plurality of sensing devices;
a pressure sensor;
an accelerometer;
2. The return pad of embodiment 1, including one of a pressure sensor and an accelerometer.
Clause 12. The return pad of clause 1, wherein each of the plurality of sensing devices is further configured to output a signal indicative of its detection.
(13) An electrosurgical system comprising:
a generator configured to supply alternating current at a radio frequency;
a device configured to apply said alternating current to a patient;
A return pad capacitively coupling to the patient, comprising:
a plurality of conductive members configured to conduct radio frequency current, the plurality of conductive members capacitively coupleable to a patient and selectively couplable to the generator;
a plurality of sensing devices,
a neural control signal applied to the patient;
a return pad comprising a plurality of sensing devices configured to sense at least one of movement of the patient's anatomical features resulting from application of the neural control signal;
an electrosurgical system comprising: a conductor coupled to the return pad and the generator.
14. The electrosurgical system of claim 13, further comprising a multiple-input single-output switching device coupled to each of the plurality of sensing devices.
15. The electrosurgical system of claim 14, further comprising an analog-to-digital converter coupled to the multiple-input single-output switching device.

(16) The generator includes:
generating the alternating current as a high frequency waveform;
generating a low frequency waveform configured to stimulate nerves of the patient;
modulating the low frequency waveform using the high frequency waveform to form a composite waveform;
14. An electrosurgical system according to embodiment 13, further configured to supply the composite waveform to the instrument.
Clause 17. The electrosurgical system of clause 14, wherein the generator is further configured to amplitude modulate the low frequency waveform to form the composite waveform.
(18) A return pad for an electrosurgical system comprising:
a plurality of electrodes configured for capacitive coupling with a patient;
An array of sensing devices,
a neural control signal applied to the patient;
and an array of sensing devices configured to sense at least one of movement of the patient's anatomical features resulting from application of the neural control signal.
Clause 19. The return pad of clause 18, wherein each sensing device in the array of sensing devices is configured to output a signal indicative of its sensing.
(20) The return pad of embodiment 18, wherein each sensing device in the array of sensing devices is positioned over a corresponding one of the plurality of electrodes.

Claims (3)

An electrosurgical system comprising:
a generator configured to supply alternating current at a radio frequency;
a device configured to apply said alternating current to a patient;
A return pad capacitively coupling to the patient, comprising:
a plurality of conductive members configured to conduct radio frequency current, the plurality of conductive members capacitively coupleable to a patient and selectively couplable to the generator;
a plurality of sensing devices,
a neural control signal applied to the patient , the neural control signal being a low frequency waveform ;
a return pad comprising a plurality of sensing devices configured to sense at least one of movement of the patient's anatomical features resulting from application of the neural control signal;
a conductor coupled to the return pad and the generator ;
The generator is
generating the alternating current as a high frequency waveform;
generating a low frequency waveform configured to stimulate nerves of the patient;
Amplitude modulating the low frequency waveform with the high frequency waveform to form a composite waveform;
An electrosurgical system further configured to deliver the composite waveform to the instrument . The electrosurgical system of any preceding claim, further comprising a multiple-input single-output switching device coupled to each of the plurality of sensing devices. An electrosurgical system according to claim 2 , further comprising an analog-to-digital converter coupled to the multiple-input single-output switching device.

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