U.S. patent application number 17/215986 was filed with the patent office on 2021-07-15 for cooperative utilization of data derived from secondary sources by intelligent surgical hubs.
The applicant listed for this patent is Ethicon LLC. Invention is credited to Jason L. Harris, Frederick E. Shelton, IV, David C. Yates.
Application Number | 20210212775 17/215986 |
Document ID | / |
Family ID | 1000005481952 |
Filed Date | 2021-07-15 |
United States Patent
Application |
20210212775 |
Kind Code |
A1 |
Shelton, IV; Frederick E. ;
et al. |
July 15, 2021 |
COOPERATIVE UTILIZATION OF DATA DERIVED FROM SECONDARY SOURCES BY
INTELLIGENT SURGICAL HUBS
Abstract
Various surgical hubs are disclosed. A surgical hub is for use
with a medical imaging device at a remote surgical site in a
surgical procedure. The surgical hub comprises a circuit configured
to: receive a livestream of the surgical site from the medical
imaging device; capture an image frame of a surgical step of the
surgical procedure from the livestream; derive information relevant
to the surgical step from data extracted from the image frame; and
overlay the information onto the livestream.
Inventors: |
Shelton, IV; Frederick E.;
(Hillsboro, OH) ; Harris; Jason L.; (Lebanon,
OH) ; Yates; David C.; (Morrow, OH) |
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Applicant: |
Name |
City |
State |
Country |
Type |
Ethicon LLC |
Guaynabo |
PR |
US |
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|
Family ID: |
1000005481952 |
Appl. No.: |
17/215986 |
Filed: |
March 29, 2021 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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15940670 |
Mar 29, 2018 |
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17215986 |
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62649302 |
Mar 28, 2018 |
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62611341 |
Dec 28, 2017 |
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62611340 |
Dec 28, 2017 |
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62611339 |
Dec 28, 2017 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 34/35 20160201;
A61B 90/37 20160201; A61B 2034/254 20160201; A61B 2017/00477
20130101; G16H 30/40 20180101; A61B 90/361 20160201; A61B 34/76
20160201; G16H 40/60 20180101; A61B 2034/305 20160201; A61B 34/25
20160201; A61B 2034/304 20160201; A61B 2017/00221 20130101; A61B
34/77 20160201; A61B 2017/00225 20130101; A61B 2034/302 20160201;
A61B 2017/00199 20130101 |
International
Class: |
A61B 34/00 20060101
A61B034/00; G16H 30/40 20060101 G16H030/40; A61B 34/35 20060101
A61B034/35 |
Claims
1. A surgical hub, comprising: a processor; and a memory coupled to
the processor, the memory storing instructions executable by the
processor to: receive first data from data sources, wherein the
first data is related to a surgical procedure, and the data sources
comprise one or more medical imaging devices in communication with
the surgical hub; determine contextual information related to the
surgical procedure based on the first data from the data sources;
and provide second data related to particular surgical procedural
steps through a display device based on the determined contextual
information.
2. The surgical hub of claim 1, wherein the first data comprises an
angle at which the one or more medical imaging devices are oriented
with respect to a visualization of a patient's anatomy.
3. The surgical hub of claim 1, wherein the first data comprises a
number of the one or more medical imaging devices being
utilized.
4. The surgical hub of claim 1, wherein the memory further stores
instructions executable by the processor to adjust the one or more
medical imaging devices based on the contextual information.
5. The surgical hub of claim 4, wherein adjusting the one or more
medical imaging devices comprises adjusting a field of view of the
one or more medical imaging devices.
6. The surgical hub of claim 1, wherein the contextual information
comprises at least one of a type of the surgical procedure, a type
of tissue being operated on during the surgical procedure, a body
cavity that is a subject of the surgical procedure, and a
particular technique being used for the surgical procedure.
7. The surgical hub of claim 1, wherein the memory further stores
instructions executable by the processor to provide suggestions
during a course of the surgical procedure.
8. The surgical hub of claim 1, wherein the data sources comprise a
patient monitoring device connected to the surgical hub.
9. The surgical hub of claim 1, wherein the data sources comprise
one or more modular devices, wherein the one or more modular
devices include a first surgical instrument and a second surgical
instrument.
10. The surgical hub of claim 9, further comprising a surgical
instrument controller, wherein the memory further stores
instructions executable by the processor to: track a progression of
the surgical procedure; determine whether a surgical step involving
the first surgical instrument is completed; responsive to
determining that the surgical step involving the first surgical
instrument is completed, sever a connection between the surgical
instrument controller and the first surgical instrument; and pair
the surgical instrument controller with the second surgical
instrument.
11. The surgical hub of claim 1, wherein the memory further stores
instructions executable by the processor to retrieve the second
data related to the particular surgical steps from the memory or a
cloud.
12. The surgical hub of claim 1, wherein the first data comprises a
type of staples used during the surgical procedure.
13. The surgical hub of claim 1, wherein the first data comprises a
sequence in which a surgical instrument is used during the surgical
procedure.
14. A surgical hub, comprising: a processor; and a memory coupled
to the processor, the memory storing instructions executable by the
processor to: receive first data from data sources, wherein the
first data is related to a surgical procedure; determine contextual
information related to the surgical procedure based on the first
data from the data sources; and provide second data related to
particular surgical procedural steps through a display device based
on the determined contextual information, wherein the data sources
comprise one or more modular devices, wherein the one or more
modular devices include a first surgical instrument and a second
surgical instrument, wherein the surgical hub further comprises a
surgical instrument controller, and wherein the memory further
stores instructions executable by the processor to: track a
progression of the surgical procedure; determine whether a surgical
step involving the first surgical instrument is completed;
responsive to determining that the surgical step involving the
first surgical instrument is completed, sever a connection between
the surgical instrument controller and the first surgical
instrument; and pair the surgical instrument controller with the
second surgical instrument.
15. The surgical hub of claim 14, wherein the data sources further
comprise one or more medical imaging devices in communication with
the surgical hub.
16. The surgical hub of claim 15, wherein the first data comprises
an angle at which the one or more medical imaging devices are
oriented with respect to a visualization of a patient's
anatomy.
17. The surgical hub of claim 15, wherein the first data comprises
a number of the one or more medical imaging devices being
utilized.
18. The surgical hub of claim 15, wherein the memory further stores
instructions executable by the processor to adjust the one or more
medical imaging devices based on the contextual information.
19. The surgical hub of claim 18, wherein adjusting the one or more
medical imaging devices comprises adjusting a field of view of the
one or more medical imaging devices.
20. The surgical hub of claim 14, wherein the memory further stores
instructions executable by the processor to provide suggestions
during a course of the surgical procedure.
Description
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation patent application
claiming priority under 35 U.S.C. .sctn. 120 to U.S. patent
application Ser. No. 15/940,670, titled COOPERATIVE UTILIZATION OF
DATA DERIVED FROM SECONDARY SOURCES BY INTELLIGENT SURGICAL HUBS,
filed Mar. 29, 2018, now U.S. Patent Application Publication No.
2019/0201116, which claims the benefit of priority under 35 U.S.C.
119(e) to U.S. Provisional Patent Application Ser. No. 62/649,302,
titled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION
CAPABILITIES, filed on Mar. 28, 2018, the disclosure of each of
which is herein incorporated by reference in its entirety.
[0002] This application is a continuation patent application
claiming priority under 35 U.S.C. .sctn. 120 to U.S. patent
application Ser. No. 15/940,670, titled COOPERATIVE UTILIZATION OF
DATA DERIVED FROM SECONDARY SOURCES BY INTELLIGENT SURGICAL HUBS,
filed Mar. 29, 2018, now U.S. Patent Application Publication No.
2019/0201116, which also claims the benefit of priority under 35
U.S.C. 119(e) to U.S. Provisional Patent Application Ser. No.
62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28,
2017, of U.S. Provisional Patent Application Ser. No. 62/611,340,
titled CLOUD-BASED MEDICAL ANALYTICS, filed Dec. 28, 2017, of U.S.
Provisional Patent Application Ser. No. 62/611,339, titled ROBOT
ASSISTED SURGICAL PLATFORM, filed Dec. 28, 2017, the disclosure of
each of which is herein incorporated by reference in its
entirety.
BACKGROUND
[0003] The present disclosure relates to various surgical systems.
Surgical procedures are typically performed in surgical operating
theaters or rooms in a healthcare facility such as, for example, a
hospital. A sterile field is typically created around the patient.
The sterile field may include the scrubbed team members, who are
properly attired, and all furniture and fixtures in the area.
Various surgical devices and systems are utilized in performance of
a surgical procedure.
SUMMARY
[0004] In one general aspect, a surgical hub is provided. The
surgical hub is for use with a medical imaging device at a remote
surgical site in a surgical procedure. The surgical hub comprises a
circuit configured to: receive a livestream of the surgical site
from the medical imaging device; capture an image frame of a
surgical step of the surgical procedure from the livestream; derive
information relevant to the surgical step from data extracted from
the image frame; and overlay the information onto the
livestream.
[0005] In another general aspect, another surgical hub is provided.
The surgical hub is for use with a medical imaging device at a
remote surgical site in a surgical procedure including surgical
steps. The surgical hub comprises a circuit configured to: receive
a livestream of the surgical site from the medical imaging device;
capture image frames of the surgical steps of the surgical
procedure from the livestream; and differentiate among the surgical
steps based on data extracted from the image frames.
[0006] In yet another general aspect, another surgical hub is
provided. The surgical hub is for use with a medical imaging device
at a remote surgical site in a surgical procedure. The surgical hub
comprises a circuit configured to: receive a livestream of the
surgical site from the medical imaging device; capture an image
frame from the livestream; detect a staple pattern in the image
frame; and identify the staple cartridge based on the staple
pattern. The staple pattern is defined by staples deployed from a
staple cartridge into tissue at the surgical site.
FIGURES
[0007] The features of various aspects are set forth with
particularity in the appended claims. The various aspects, however,
both as to organization and methods of operation, together with
further objects and advantages thereof, may best be understood by
reference to the following description, taken in conjunction with
the accompanying drawings as follows.
[0008] FIG. 1 is a block diagram of a computer-implemented
interactive surgical system, in accordance with at least one aspect
of the present disclosure.
[0009] FIG. 2 is a surgical system being used to perform a surgical
procedure in an operating room, in accordance with at least one
aspect of the present disclosure.
[0010] FIG. 3 is a surgical hub paired with a visualization system,
a robotic system, and an intelligent instrument, in accordance with
at least one aspect of the present disclosure.
[0011] FIG. 4 is a partial perspective view of a surgical hub
enclosure, and of a combo generator module slidably receivable in a
drawer of the surgical hub enclosure, in accordance with at least
one aspect of the present disclosure.
[0012] FIG. 5 is a perspective view of a combo generator module
with bipolar, ultrasonic, and monopolar contacts and a smoke
evacuation component, in accordance with at least one aspect of the
present disclosure.
[0013] FIG. 6 illustrates individual power bus attachments for a
plurality of lateral docking ports of a lateral modular housing
configured to receive a plurality of modules, in accordance with at
least one aspect of the present disclosure.
[0014] FIG. 7 illustrates a vertical modular housing configured to
receive a plurality of modules, in accordance with at least one
aspect of the present disclosure.
[0015] FIG. 8 illustrates a surgical data network comprising a
modular communication hub configured to connect modular devices
located in one or more operating theaters of a healthcare facility,
or any room in a healthcare facility specially equipped for
surgical operations, to the cloud, in accordance with at least one
aspect of the present disclosure.
[0016] FIG. 9 illustrates a computer-implemented interactive
surgical system, in accordance with at least one aspect of the
present disclosure.
[0017] FIG. 10 illustrates a surgical hub comprising a plurality of
modules coupled to the modular control tower, in accordance with at
least one aspect of the present disclosure.
[0018] FIG. 11 illustrates one aspect of a Universal Serial Bus
(USB) network hub device, in accordance with at least one aspect of
the present disclosure.
[0019] FIG. 12 illustrates a logic diagram of a control system of a
surgical instrument or tool, in accordance with at least one aspect
of the present disclosure.
[0020] FIG. 13 illustrates a control circuit configured to control
aspects of the surgical instrument or tool, in accordance with at
least one aspect of the present disclosure.
[0021] FIG. 14 illustrates a combinational logic circuit configured
to control aspects of the surgical instrument or tool, in
accordance with at least one aspect of the present disclosure.
[0022] FIG. 15 illustrates a sequential logic circuit configured to
control aspects of the surgical instrument or tool, in accordance
with at least one aspect of the present disclosure.
[0023] FIG. 16 illustrates a surgical instrument or tool comprising
a plurality of motors which can be activated to perform various
functions, in accordance with at least one aspect of the present
disclosure.
[0024] FIG. 17 is a schematic diagram of a robotic surgical
instrument configured to operate a surgical tool described herein,
in accordance with at least one aspect of the present
disclosure.
[0025] FIG. 18 illustrates a block diagram of a surgical instrument
programmed to control the distal translation of a displacement
member, in accordance with at least one aspect of the present
disclosure.
[0026] FIG. 19 is a schematic diagram of a surgical instrument
configured to control various functions, in accordance with at
least one aspect of the present disclosure.
[0027] FIG. 20 is a simplified block diagram of a generator
configured to provide inductorless tuning, among other benefits, in
accordance with at least one aspect of the present disclosure.
[0028] FIG. 21 illustrates an example of a generator, which is one
form of the generator of FIG. 20, in accordance with at least one
aspect of the present disclosure.
[0029] FIG. 22 illustrates a combination generator, in accordance
with at least one aspect of the present disclosure.
[0030] FIG. 23 illustrates a method of capturing data from a
combination generator and communicating the captured generator data
to a cloud-based system, in accordance with at least one aspect of
the present disclosure.
[0031] FIG. 24 illustrates a data packet of combination generator
data, in accordance with at least one aspect of the present
disclosure.
[0032] FIG. 25 illustrates an encryption algorithm, in accordance
with at least one aspect of the present disclosure.
[0033] FIG. 26 illustrates another encryption algorithm, in
accordance with at least one aspect of the present disclosure.
[0034] FIG. 27 illustrates yet another encryption algorithm, in
accordance with at least one aspect of the present disclosure.
[0035] FIG. 28 illustrates a high-level representation of a
datagram, in accordance with at least one aspect of the present
disclosure.
[0036] FIG. 29 illustrates a more detailed representation of the
datagram of FIG. 28, in accordance with at least one aspect of the
present disclosure.
[0037] FIG. 30 illustrates another representation of the datagram
of FIG. 28, in accordance with at least one aspect of the present
disclosure.
[0038] FIG. 31 illustrates a method of identifying surgical data
associated with a failure event and communicating the identified
surgical data to a cloud-based system on a prioritized basis, in
accordance with at least one aspect of the present disclosure.
[0039] FIG. 32 illustrates yet another representation of the
datagram of FIG. 28, in accordance with at least one aspect of the
present disclosure.
[0040] FIG. 33 illustrates a partial artificial timeline of a
surgical procedure performed in an operating room via a surgical
system, in accordance with at least one aspect of the present
disclosure.
[0041] FIG. 34 illustrates ultrasonic pinging of an operating room
wall to determine a distance between a surgical hub and the
operating room wall, in accordance with at least one aspect of the
present disclosure.
[0042] FIG. 35 is a logic flow diagram of a process depicting a
control program or a logic configuration for surgical hub pairing
with surgical devices of a surgical system that are located within
the bounds of an operating room, in accordance with at least one
aspect of the present disclosure.
[0043] FIG. 36 is a logic flow diagram of a process depicting a
control program or a logic configuration for selectively forming
and severing connections between devices of a surgical system, in
accordance with at least one aspect of the present disclosure.
[0044] FIG. 37 is a logic flow diagram of a process depicting a
control program or a logic configuration for selectively
reevaluating the bounds of an operating room after detecting a new
device, in accordance with at least one aspect of the present
disclosure.
[0045] FIG. 38 is a logic flow diagram of a process depicting a
control program or a logic configuration for selectively
reevaluating the bounds of an operating room after disconnection of
a paired device, in accordance with at least one aspect of the
present disclosure.
[0046] FIG. 39 is a logic flow diagram of a process depicting a
control program or a logic configuration for reevaluating the
bounds of an operating room by a surgical hub after detecting a
change in the position of the surgical hub, in accordance with at
least one aspect of the present disclosure.
[0047] FIG. 40 is a logic flow diagram of a process depicting a
control program or a logic configuration for selectively forming
connections between devices of a surgical system, in accordance
with at least one aspect of the present disclosure.
[0048] FIG. 41 is a logic flow diagram of a process depicting a
control program or a logic configuration for selectively forming
and severing connections between devices of a surgical system, in
accordance with at least one aspect of the present disclosure.
[0049] FIG. 42 illustrates a surgical hub pairing a first device
and a second device of a surgical system in an operating room, in
accordance with at least one aspect of the present disclosure.
[0050] FIG. 43 illustrates a surgical hub unpairing a first device
and a second device of a surgical system in an operating room, and
pairing the first device with a third device in the operating room,
in accordance with at least one aspect of the present
disclosure.
[0051] FIG. 44 is a logic flow diagram of a process depicting a
control program or a logic configuration for forming an severing
connections between devices of a surgical system in an operating
room during a surgical procedure based on progression of the steps
of the surgical procedure, in accordance with at least one aspect
of the present disclosure.
[0052] FIG. 45 is a logic flow diagram of a process depicting a
control program or a logic configuration for overlaying information
derived from one or more still frames of a livestream of a remote
surgical site onto the livestream, in accordance with at least one
aspect of the present disclosure.
[0053] FIG. 46 is a logic flow diagram of a process depicting a
control program or a logic configuration for differentiating among
surgical steps of a surgical procedure, in accordance with at least
one aspect of the present disclosure.
[0054] FIG. 47 is a logic flow diagram of a process 3230 depicting
a control program or a logic configuration for differentiating
among surgical steps of a surgical procedure, in accordance with at
least one aspect of the present disclosure.
[0055] FIG. 48 is a logic flow diagram of a process 3240 depicting
a control program or a logic configuration for identifying a staple
cartridge from information derived from one or more still frames of
staples deployed from the staple cartridge into tissue, in
accordance with at least one aspect of the present disclosure.
[0056] FIG. 49 is a partial view of a surgical system in an
operating room, the surgical system including a surgical hub that
has an imaging module in communication with an imaging device at a
remote surgical site, in accordance with at least one aspect of the
present disclosure.
[0057] FIG. 50 illustrates a partial view of stapled tissue that
received a first staple firing and a second staple firing arranged
end-to-end, in accordance with at least one aspect of the present
disclosure.
[0058] FIG. 51 illustrates three rows of staples deployed on one
side of a tissue stapled and cut by a surgical stapler, in
accordance with at least one aspect of the present disclosure.
[0059] FIG. 52 illustrates a non-anodized staple and an anodized
staple, in accordance with at least one aspect of the present
disclosure.
[0060] FIG. 53 is a logic flow diagram of a process depicting a
control program or a logic configuration for coordinating a control
arrangement between surgical hubs, in accordance with at least one
aspect of the present disclosure.
[0061] FIG. 54 illustrates an interaction between two surgical hubs
in an operating room, in accordance with at least one aspect of the
present disclosure.
[0062] FIG. 55 is a logic flow diagram of a process depicting a
control program or a logic configuration for coordinating a control
arrangement between surgical hubs, in accordance with at least one
aspect of the present disclosure.
[0063] FIG. 56 illustrates an interaction between two surgical hubs
in different operating rooms ("OR1" and "OR3"), in accordance with
at least one aspect of the present disclosure.
[0064] FIG. 57 illustrates a secondary display in an operating room
("OR3") showing a surgical site in a colorectal procedure, in
accordance with at least one aspect of the present disclosure.
[0065] FIG. 58 illustrates a personal interface or tablet in OR1
displaying the surgical site of OR3, in accordance with at least
one aspect of the present disclosure.
[0066] FIG. 59 illustrates an expanded view of the surgical site of
OR3 displayed on a primary display of OR1, in accordance with at
least one aspect of the present disclosure.
[0067] FIG. 60 illustrates a personal interface or tablet
displaying a layout of OR1 that shows available displays, in
accordance with at least one aspect of the present disclosure.
[0068] FIG. 61 illustrates a recommendation of a transection
location of a surgical site of OR3 made by a surgical operator in
OR1 via a personal interface or tablet in OR1, in accordance with
at least one aspect of the present disclosure.
[0069] FIG. 62 illustrates a timeline depicting situational
awareness of a surgical hub, in accordance with at least one aspect
of the present disclosure.
DESCRIPTION
[0070] Applicant of the present application owns the following U.S.
Provisional Patent Applications, filed on Mar. 28, 2018, each of
which is herein incorporated by reference in its entirety: [0071]
U.S. Provisional Patent Application Ser. No. 62/649,302, titled
INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION
CAPABILITIES; [0072] U.S. Provisional Patent Application Ser. No.
62/649,294, titled DATA STRIPPING METHOD TO INTERROGATE PATIENT
RECORDS AND CREATE ANONYMIZED RECORD; [0073] U.S. Provisional
Patent Application Ser. No. 62/649,300, titled SURGICAL HUB
SITUATIONAL AWARENESS; [0074] U.S. Provisional Patent Application
Ser. No. 62/649,309, titled SURGICAL HUB SPATIAL AWARENESS TO
DETERMINE DEVICES IN OPERATING THEATER; [0075] U.S. Provisional
Patent Application Ser. No. 62/649,310, titled COMPUTER IMPLEMENTED
INTERACTIVE SURGICAL SYSTEMS; [0076] U.S. Provisional Patent
Application Ser. No. 62/649,291, titled USE OF LASER LIGHT AND
RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED
LIGHT; [0077] U.S. Provisional Patent Application Ser. No.
62/649,296, titled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL
DEVICES; [0078] U.S. Provisional Patent Application Ser. No.
62/649,333, titled CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION
AND RECOMMENDATIONS TO A USER; [0079] U.S. Provisional Patent
Application Ser. No. 62/649,327, titled CLOUD-BASED MEDICAL
ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND REACTIVE
MEASURES; [0080] U.S. Provisional Patent Application Ser. No.
62/649,315, titled DATA HANDLING AND PRIORITIZATION IN A CLOUD
ANALYTICS NETWORK; [0081] U.S. Provisional Patent Application Ser.
No. 62/649,313, titled CLOUD INTERFACE FOR COUPLED SURGICAL
DEVICES; [0082] U.S. Provisional Patent Application Ser. No.
62/649,320, titled DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL
PLATFORMS; [0083] U.S. Provisional Patent Application Ser. No.
62/649,307, titled AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED
SURGICAL PLATFORMS; and [0084] U.S. Provisional Patent Application
Ser. No. 62/649,323, titled SENSING ARRANGEMENTS FOR ROBOT-ASSISTED
SURGICAL PLATFORMS.
[0085] Applicant of the present application owns the following U.S.
Patent Applications, filed on Mar. 29, 2018, each of which is
herein incorporated by reference in its entirety: [0086] U.S.
patent application Ser. No. 15/940,641, titled INTERACTIVE SURGICAL
SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES; now U.S. Pat.
No. 10,944,728; [0087] U.S. patent application Ser. No. 15/940,648,
titled INTERACTIVE SURGICAL SYSTEMS WITH CONDITION HANDLING OF
DEVICES AND DATA CAPABILITIES; [0088] now U.S. Patent Application
Publication No. 2019/0206004; [0089] U.S. patent application Ser.
No. 15/940,656, titled SURGICAL HUB COORDINATION OF CONTROL AND
COMMUNICATION OF OPERATING ROOM DEVICES; now U.S. Patent
Application Publication No. 2019/0201141; [0090] U.S. patent
application Ser. No. 15/940,666, titled SPATIAL AWARENESS OF
SURGICAL HUBS IN OPERATING ROOMS; now U.S. Patent Application
Publication No. 2019/0206551; [0091] U.S. patent application Ser.
No. 15/940,677, titled SURGICAL HUB CONTROL ARRANGEMENTS; now U.S.
Patent Application Publication No. 2019/0201143; [0092] U.S. patent
application Ser. No. 15/940,632, titled DATA STRIPPING METHOD TO
INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD; now U.S.
Patent Application Publication No. 2019/0205566; [0093] U.S. patent
application Ser. No. 15/940,640, titled COMMUNICATION HUB AND
STORAGE DEVICE FOR STORING PARAMETERS AND STATUS OF A SURGICAL
DEVICE TO BE SHARED WITH CLOUD BASED ANALYTICS SYSTEMS; now U.S.
Patent Application Publication No. 2019/0200863; [0094] U.S. patent
application Ser. No. 15/940,645, titled SELF DESCRIBING DATA
PACKETS GENERATED AT AN ISSUING INSTRUMENT; now U.S. Pat. No.
10,892,899; [0095] U.S. patent application Ser. No. 15/940,649,
titled DATA PAIRING TO INTERCONNECT A DEVICE MEASURED PARAMETER
WITH AN OUTCOME;--now U.S. Patent Application Publication No.
2019/0205567; [0096] U.S. patent application Ser. No. 15/940,654,
titled SURGICAL HUB SITUATIONAL AWARENESS; now U.S. Patent
Application Publication No. 2019/0201140; [0097] U.S. patent
application Ser. No. 15/940,663, titled SURGICAL SYSTEM DISTRIBUTED
PROCESSING; now U.S. Patent Application Publication No.
2019/0201033; [0098] U.S. patent application Ser. No. 15/940,668,
titled AGGREGATION AND REPORTING OF SURGICAL HUB DATA; now U.S.
Patent Application Publication No. 2019/0201115; [0099] U.S. patent
application Ser. No. 15/940,671, titled SURGICAL HUB SPATIAL
AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER; now U.S.
Patent Application Publication No. 2019/0201104; [0100] U.S. patent
application Ser. No. 15/940,686, titled DISPLAY OF ALIGNMENT OF
STAPLE CARTRIDGE TO PRIOR LINEAR STAPLE LINE; now U.S. Patent
Application Publication No. 2019/0201105; [0101] U.S. patent
application Ser. No. 15/940,700, titled STERILE FIELD INTERACTIVE
CONTROL DISPLAYS; now U.S. Patent Application Publication No.
2019/0205001; [0102] U.S. patent application Ser. No. 15/940,629,
titled COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS; now U.S.
Patent Application Publication No. 2019/0201112; [0103] U.S. patent
application Ser. No. 15/940,704, titled USE OF LASER LIGHT AND
RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTERED
LIGHT; now U.S. Patent Application Publication No. 2019/0206050;
[0104] U.S. patent application Ser. No. 15/940,722, titled
CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OF
MONO-CHROMATIC LIGHT REFRACTIVITY; now U.S. Patent Application
Publication No. 2019/0200905; and [0105] U.S. patent application
Ser. No. 15/940,742, titled DUAL CMOS ARRAY IMAGING; now U.S.
Patent Application Publication No. 2019/0200906.
[0106] Applicant of the present application owns the following U.S.
Patent Applications, filed on Mar. 29, 2018, each of which is
herein incorporated by reference in its entirety: [0107] U.S.
patent application Ser. No. 15/940,636, titled ADAPTIVE CONTROL
PROGRAM UPDATES FOR SURGICAL DEVICES; now U.S. Patent Application
Publication No. 2019/0206003; [0108] U.S. patent application Ser.
No. 15/940,653, titled ADAPTIVE CONTROL PROGRAM UPDATES FOR
SURGICAL DEVICES; now U.S. Patent Application Publication No.
2019/0201114; [0109] U.S. patent application Ser. No. 15/940,660,
titled CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND
RECOMMENDATIONS TO A USER;--now U.S. Patent Application Publication
No. 2019/0206555; [0110] U.S. patent application Ser. No.
15/940,679, titled CLOUD-BASED MEDICAL ANALYTICS FOR LINKING OF
LOCAL USAGE TRENDS WITH THE RESOURCE ACQUISITION BEHAVIORS OF
LARGER DATA SET; now U.S. Pat. No. 10,932,872; [0111] U.S. patent
application Ser. No. 15/940,694, titled CLOUD-BASED MEDICAL
ANALYTICS FOR MEDICAL FACILITY SEGMENTED INDIVIDUALIZATION OF
INSTRUMENT FUNCTION; now U.S. Patent Application Publication No.
2019/0201119; [0112] U.S. patent application Ser. No. 15/940,634,
titled CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND
AUTHENTICATION TRENDS AND REACTIVE MEASURES; now U.S. Patent
Application Publication No. 2019/0201138; [0113] U.S. patent
application Ser. No. 15/940,706, titled DATA HANDLING AND
PRIORITIZATION IN A CLOUD ANALYTICS NETWORK; now U.S. Patent
Application Publication No. 2019/0206561; and [0114] U.S. patent
application Ser. No. 15/940,675, titled CLOUD INTERFACE FOR COUPLED
SURGICAL DEVICES; now U.S. Pat. No. 10,849,697.
[0115] Applicant of the present application owns the following U.S.
Patent Applications, filed on Mar. 29, 2018, each of which is
herein incorporated by reference in its entirety: [0116] U.S.
patent application Ser. No. 15/940,627, titled DRIVE ARRANGEMENTS
FOR ROBOT-ASSISTED SURGICAL PLATFORMS; now U.S. Patent Application
Publication No. 2019/0201111; [0117] U.S. patent application Ser.
No. 15/940,637, titled COMMUNICATION ARRANGEMENTS FOR
ROBOT-ASSISTED SURGICAL PLATFORMS; now U.S. Patent Application
Publication No. 2019/0201139; [0118] U.S. patent application Ser.
No. 15/940,642, titled CONTROLS FOR ROBOT-ASSISTED SURGICAL
PLATFORMS; now U.S. Patent Application Publication No.
2019/0201113; [0119] U.S. patent application Ser. No. 15/940,676,
titled AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL
PLATFORMS; now U.S. Patent Application Publication No.
2019/0201142; [0120] U.S. patent application Ser. No. 15/940,680,
titled CONTROLLERS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; now U.S.
Patent Application Publication No. 2019/0201135; [0121] U.S. patent
application Ser. No. 15/940,683, titled COOPERATIVE SURGICAL
ACTIONS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; now U.S. Patent
Application Publication No. 2019/0201145; [0122] U.S. patent
application Ser. No. 15/940,690, titled DISPLAY ARRANGEMENTS FOR
ROBOT-ASSISTED SURGICAL PLATFORMS; now U.S. Patent Application
Publication No. 2019/0201118; and [0123] U.S. patent application
Ser. No. 15/940,711, titled SENSING ARRANGEMENTS FOR ROBOT-ASSISTED
SURGICAL PLATFORMS; now U.S. Patent Application Publication No.
2019/0201120.
[0124] Before explaining various aspects of surgical devices and
generators in detail, it should be noted that the illustrative
examples are not limited in application or use to the details of
construction and arrangement of parts illustrated in the
accompanying drawings and description. The illustrative examples
may be implemented or incorporated in other aspects, variations and
modifications, and may be practiced or carried out in various ways.
Further, unless otherwise indicated, the terms and expressions
employed herein have been chosen for the purpose of describing the
illustrative examples for the convenience of the reader and are not
for the purpose of limitation thereof. Also, it will be appreciated
that one or more of the following-described aspects, expressions of
aspects, and/or examples, can be combined with any one or more of
the other following-described aspects, expressions of aspects
and/or examples.
[0125] 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., the cloud 104 that may include a remote
server 113 coupled to a storage device 105). Each surgical system
102 includes at least one surgical hub 106 in communication with
the cloud 104 that may include a remote server 113. In one example,
as illustrated in FIG. 1, the surgical system 102 includes a
visualization system 108, a robotic system 110, and a handheld
intelligent surgical instrument 112, which are configured to
communicate with one another and/or the hub 106. In some aspects, a
surgical system 102 may include an M number of hubs 106, an N
number of visualization systems 108, an O number of robotic systems
110, and a P number of handheld intelligent surgical instruments
112, where M, N, O, and P are integers greater than or equal to
one.
[0126] FIG. 3 depicts an example of a surgical system 102 being
used to perform a surgical procedure on a patient who is lying down
on an operating table 114 in a surgical operating room 116. A
robotic system 110 is used in the surgical procedure as a part of
the surgical system 102. The robotic system 110 includes a
surgeon's console 118, a patient side cart 120 (surgical robot),
and a surgical robotic hub 122. The patient side cart 120 can
manipulate at least one removably coupled surgical tool 117 through
a minimally invasive incision in the body of the patient while the
surgeon views the surgical site through the surgeon's console 118.
An image of the surgical site can be obtained by a medical imaging
device 124, which can be manipulated by the patient side cart 120
to orient the imaging device 124. The robotic hub 122 can be used
to process the images of the surgical site for subsequent display
to the surgeon through the surgeon's console 118.
[0127] Other types of robotic systems can be readily adapted for
use with the surgical system 102. Various examples of robotic
systems and surgical tools that are suitable for use with the
present disclosure are described in U.S. Provisional Patent
Application Ser. No. 62/611,339, titled ROBOT ASSISTED SURGICAL
PLATFORM, filed Dec. 28, 2017, the disclosure of which is herein
incorporated by reference in its entirety.
[0128] Various examples of cloud-based analytics that are performed
by the cloud 104, and are suitable for use with the present
disclosure, are described in U.S. Provisional Patent Application
Ser. No. 62/611,340, titled CLOUD-BASED MEDICAL ANALYTICS, filed
Dec. 28, 2017, the disclosure of which is herein incorporated by
reference in its entirety.
[0129] In various aspects, the imaging device 124 includes at least
one image sensor and one or more optical components. Suitable image
sensors include, but are not limited to, Charge-Coupled Device
(CCD) sensors and Complementary Metal-Oxide Semiconductor (CMOS)
sensors.
[0130] The optical components of the imaging device 124 may include
one or more illumination sources and/or one or more lenses. The one
or more illumination sources may be directed to illuminate portions
of the surgical field. The one or more image sensors may receive
light reflected or refracted from the surgical field, including
light reflected or refracted from tissue and/or surgical
instruments.
[0131] The one or more illumination sources may be configured to
radiate electromagnetic energy in the visible spectrum as well as
the invisible spectrum. The visible spectrum, sometimes referred to
as the optical spectrum or luminous spectrum, is that portion of
the electromagnetic spectrum that is visible to (i.e., can be
detected by) the human eye and may be referred to as visible light
or simply light. A typical human eye will respond to wavelengths in
air that are from about 380 nm to about 750 nm.
[0132] The invisible spectrum (i.e., the non-luminous spectrum) is
that portion of the electromagnetic spectrum that lies below and
above the visible spectrum (i.e., wavelengths below about 380 nm
and above about 750 nm). The invisible spectrum is not detectable
by the human eye. Wavelengths greater than about 750 nm are longer
than the red visible spectrum, and they become invisible infrared
(IR), microwave, and radio electromagnetic radiation. Wavelengths
less than about 380 nm are shorter than the violet spectrum, and
they become invisible ultraviolet, x-ray, and gamma ray
electromagnetic radiation.
[0133] In various aspects, the imaging device 124 is configured for
use in a minimally invasive procedure. Examples of imaging devices
suitable for use with the present disclosure include, but not
limited to, an arthroscope, angioscope, bronchoscope,
choledochoscope, colonoscope, cytoscope, duodenoscope, enteroscope,
esophagogastro-duodenoscope (gastroscope), endoscope, laryngoscope,
nasopharyngo-neproscope, sigmoidoscope, thoracoscope, and
ureteroscope.
[0134] In one aspect, the imaging device employs multi-spectrum
monitoring to discriminate topography and underlying structures. A
multi-spectral image is one that captures image data within
specific wavelength ranges across the electromagnetic spectrum. The
wavelengths may be separated by filters or by the use of
instruments that are sensitive to particular wavelengths, including
light from frequencies beyond the visible light range, e.g., IR and
ultraviolet. Spectral imaging can allow extraction of additional
information the human eye fails to capture with its receptors for
red, green, and blue. The use of multi-spectral imaging is
described in greater detail under the heading "Advanced Imaging
Acquisition Module" in U.S. Provisional Patent Application Ser. No.
62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28,
2017, the disclosure of which is herein incorporated by reference
in its entirety. Multi-spectrum monitoring can be a useful tool in
relocating a surgical field after a surgical task is completed to
perform one or more of the previously described tests on the
treated tissue.
[0135] It is axiomatic that strict sterilization of the operating
room and surgical equipment is required during any surgery. The
strict hygiene and sterilization conditions required in a "surgical
theater," i.e., an operating or treatment room, necessitate the
highest possible 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 penetrates the
sterile field, including the imaging device 124 and its attachments
and components. It will be appreciated that the sterile field may
be considered a specified area, such as within a tray or on a
sterile towel, that is considered free of microorganisms, or the
sterile field may be considered an area, immediately around a
patient, who has been prepared for a surgical procedure. The
sterile field may include the scrubbed team members, who are
properly attired, and all furniture and fixtures in the area.
[0136] In various aspects, the visualization system 108 includes
one or more imaging sensors, one or more image-processing units,
one or more storage arrays, and one or more displays that are
strategically arranged with respect to the sterile field, as
illustrated in FIG. 2. In one aspect, the visualization system 108
includes an interface for HL7, PACS, and EMR.
[0137] Various components of the visualization system 108 are
described under the heading "Advanced Imaging Acquisition Module"
in U.S. Provisional Patent Application Ser. No. 62/611,341, titled
INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017, the disclosure
of which is herein incorporated by reference in its entirety.
[0138] As illustrated in FIG. 2, a primary display 119 is
positioned in the sterile field to be visible to an operator at the
operating table 114. In addition, a 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, which face away from each other. The visualization
system 108, guided by the hub 106, is configured to utilize the
displays 107, 109, and 119 to coordinate information flow to
operators inside and outside the sterile field. For example, the
hub 106 may cause the visualization system 108 to display a
snapshot of a surgical site, as recorded by an imaging device 124,
on a non-sterile display 107 or 109, while maintaining a live feed
of the surgical site on the primary display 119. The snapshot on
the non-sterile display 107 or 109 can permit a non-sterile
operator to perform a diagnostic step relevant to the surgical
procedure, for example.
[0139] In one aspect, the hub 106 is also configured to route a
diagnostic input or feedback entered by a non-sterile operator at
the visualization tower 111 to the primary display 119 within the
sterile field, where it can be viewed by a sterile operator at the
operating table. In one example, the input can be in the form of a
modification to the snapshot displayed on the non-sterile display
107 or 109, which can be routed to the primary display 119 by the
hub 106.
[0140] Referring to FIG. 2, a surgical instrument 112 is being used
in the surgical procedure as part of the surgical system 102. The
hub 106 is also configured to coordinate information flow to a
display of the surgical instrument 112. For example, in U.S.
Provisional Patent Application Ser. No. 62/611,341, titled
INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017, the disclosure
of which is herein incorporated by reference in its entirety. A
diagnostic input or feedback entered by a non-sterile operator at
the visualization tower 111 can be routed by the hub 106 to the
surgical instrument display 115 within the sterile field, where it
can be viewed by the operator of the surgical instrument 112.
Example surgical instruments that are suitable for use with the
surgical system 102 are described under the heading "Surgical
Instrument Hardware" and in U.S. Provisional Patent Application
Ser. No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed
Dec. 28, 2017, the disclosure of which is herein incorporated by
reference in its entirety, for example.
[0141] Referring now to FIG. 3, a hub 106 is depicted in
communication with a visualization system 108, a robotic system
110, and a handheld intelligent surgical instrument 112. The hub
106 includes a hub display 135, an imaging module 138, a generator
module 140, a communication module 130, a processor module 132, and
a storage array 134. In certain aspects, as illustrated in FIG. 3,
the hub 106 further includes a smoke evacuation module 126 and/or a
suction/irrigation module 128.
[0142] During a surgical procedure, energy application to tissue,
for sealing and/or cutting, is generally associated with smoke
evacuation, suction of excess fluid, and/or irrigation of the
tissue. Fluid, power, and/or data lines from different sources are
often entangled during the surgical procedure. Valuable time can be
lost addressing this issue during a surgical procedure. Detangling
the lines may necessitate disconnecting the lines from their
respective modules, which may require resetting the modules. The
hub modular enclosure 136 offers a unified environment for managing
the power, data, and fluid lines, which reduces the frequency of
entanglement between such lines.
[0143] Aspects of the present disclosure present a surgical hub for
use in a surgical procedure that involves energy application to
tissue at a surgical site. The surgical hub includes a hub
enclosure and a combo generator module slidably receivable in a
docking station of the hub enclosure. The docking station includes
data and power contacts. The combo generator module includes two or
more of an ultrasonic energy generator component, a bipolar RF
energy generator component, and a monopolar RF energy generator
component that are housed in a single unit. In one aspect, the
combo generator module also includes a smoke evacuation component,
at least one energy delivery cable for connecting the combo
generator module to a surgical instrument, at least one smoke
evacuation component configured to evacuate smoke, fluid, and/or
particulates generated by the application of therapeutic energy to
the tissue, and a fluid line extending from the remote surgical
site to the smoke evacuation component.
[0144] In one aspect, the fluid line is a first fluid line and a
second fluid line extends from the remote surgical site to a
suction and irrigation module slidably received in the hub
enclosure. In one aspect, the hub enclosure comprises a fluid
interface.
[0145] Certain surgical procedures may require the application of
more than one energy type to the tissue. One energy type may be
more beneficial for cutting the tissue, while another different
energy type may be more beneficial for sealing the tissue. For
example, a bipolar generator can be used to seal the tissue while
an ultrasonic generator can be used to cut the sealed tissue.
Aspects of the present disclosure present a solution where a hub
modular enclosure 136 is configured to accommodate different
generators, and facilitate an interactive communication
therebetween. One of the advantages of the hub modular enclosure
136 is enabling the quick removal and/or replacement of various
modules.
[0146] Aspects of the present disclosure present a modular surgical
enclosure for use in a surgical procedure that involves energy
application to tissue. The modular surgical enclosure includes a
first energy-generator module, configured to generate a first
energy for application to the tissue, and a first docking station
comprising a first docking port that includes first data and power
contacts, wherein the first energy-generator module is slidably
movable into an electrical engagement with the power and data
contacts and wherein the first energy-generator module is slidably
movable out of the electrical engagement with the first power and
data contacts,
[0147] Further to the above, the modular surgical enclosure also
includes a second energy-generator module configured to generate a
second energy, different than the first energy, for application to
the tissue, and a second docking station comprising a second
docking port that includes second data and power contacts, wherein
the second energy-generator module is slidably movable into an
electrical engagement with the power and data contacts, and wherein
the second energy-generator module is slidably movable out of the
electrical engagement with the second power and data contacts.
[0148] In addition, the modular surgical enclosure also includes a
communication bus between the first docking port and the second
docking port, configured to facilitate communication between the
first energy-generator module and the second energy-generator
module.
[0149] Referring to FIGS. 3-7, aspects of the present disclosure
are presented for a hub modular enclosure 136 that allows the
modular integration of a generator module 140, a smoke evacuation
module 126, and a suction/irrigation module 128. The hub modular
enclosure 136 further facilitates interactive communication between
the modules 140, 126, 128. As illustrated in FIG. 5, the generator
module 140 can be a generator module with integrated monopolar,
bipolar, and ultrasonic components supported in a single housing
unit 139 slidably insertable into the hub modular enclosure 136. As
illustrated in FIG. 5, the generator module 140 can be configured
to connect to a monopolar device 146, a bipolar device 147, and an
ultrasonic device 148. Alternatively, the generator module 140 may
comprise a series of monopolar, bipolar, and/or ultrasonic
generator modules that interact through the hub modular enclosure
136. The hub modular enclosure 136 can be configured to facilitate
the insertion of multiple generators and interactive communication
between the generators docked into the hub modular enclosure 136 so
that the generators would act as a single generator.
[0150] In one aspect, the hub modular enclosure 136 comprises a
modular power and communication backplane 149 with external and
wireless communication headers to enable the removable attachment
of the modules 140, 126, 128 and interactive communication
therebetween.
[0151] In one aspect, the hub modular enclosure 136 includes
docking stations, or drawers, 151, herein also referred to as
drawers, which are configured to slidably receive the modules 140,
126, 128. FIG. 4 illustrates a partial perspective view of a
surgical hub enclosure 136, and a combo generator module 145
slidably receivable in a docking station 151 of the surgical hub
enclosure 136. A docking port 152 with power and data contacts on a
rear side of the combo generator module 145 is configured to engage
a corresponding docking port 150 with power and data contacts of a
corresponding docking station 151 of the hub modular enclosure 136
as the combo generator module 145 is slid into position within the
corresponding docking station 151 of the hub module enclosure 136.
In one aspect, the combo generator module 145 includes a bipolar,
ultrasonic, and monopolar module and a smoke evacuation module
integrated together into a single housing unit 139, as illustrated
in FIG. 5.
[0152] In various aspects, the smoke evacuation module 126 includes
a fluid line 154 that conveys captured/collected smoke and/or fluid
away from a surgical site and to, for example, the smoke evacuation
module 126. Vacuum suction originating from the smoke evacuation
module 126 can draw the smoke into an opening of a utility conduit
at the surgical site. The utility conduit, coupled to the fluid
line, can be in the form of a flexible tube terminating at the
smoke evacuation module 126. The utility conduit and the fluid line
define a fluid path extending toward the smoke evacuation module
126 that is received in the hub enclosure 136.
[0153] In various aspects, the suction/irrigation module 128 is
coupled to a surgical tool comprising an aspiration fluid line and
a suction fluid line. In one example, the aspiration and suction
fluid lines are in the form of flexible tubes extending from the
surgical site toward the suction/irrigation module 128. One or more
drive systems can be configured to cause irrigation and aspiration
of fluids to and from the surgical site.
[0154] In one aspect, the surgical tool includes a shaft having an
end effector at a distal end thereof and at least one energy
treatment associated with the end effector, an aspiration tube, and
an irrigation tube. The aspiration tube can have an inlet port at a
distal end thereof and the aspiration tube extends through the
shaft. Similarly, an irrigation tube can extend through the shaft
and can have an inlet port in proximity to the energy deliver
implement. The energy deliver implement is configured to deliver
ultrasonic and/or RF energy to the surgical site and is coupled to
the generator module 140 by a cable extending initially through the
shaft.
[0155] The irrigation tube can be in fluid communication with a
fluid source, and the aspiration tube can be in fluid communication
with a vacuum source. The fluid source and/or the vacuum source can
be housed in the suction/irrigation module 128. In one example, the
fluid source and/or the vacuum source can be housed in the hub
enclosure 136 separately from the suction/irrigation module 128. In
such example, a fluid interface can be configured to connect the
suction/irrigation module 128 to the fluid source and/or the vacuum
source.
[0156] In one aspect, the modules 140, 126, 128 and/or their
corresponding docking stations on the hub modular enclosure 136 may
include alignment features that are configured to align the docking
ports of the modules into engagement with their counterparts in the
docking stations of the hub modular enclosure 136. For example, as
illustrated in FIG. 4, the combo generator module 145 includes side
brackets 155 that are configured to slidably engage with
corresponding brackets 156 of the corresponding docking station 151
of the hub modular enclosure 136. The brackets cooperate to guide
the docking port contacts of the combo generator module 145 into an
electrical engagement with the docking port contacts of the hub
modular enclosure 136.
[0157] In some aspects, the drawers 151 of the hub modular
enclosure 136 are the same, or substantially the same size, and the
modules are adjusted in size to be received in the drawers 151. For
example, the side brackets 155 and/or 156 can be larger or smaller
depending on the size of the module. In other aspects, the drawers
151 are different in size and are each designed to accommodate a
particular module.
[0158] Furthermore, the contacts of a particular module can be
keyed for engagement with the contacts of a particular drawer to
avoid inserting a module into a drawer with mismatching
contacts.
[0159] As illustrated in FIG. 4, the docking port 150 of one drawer
151 can be coupled to the docking port 150 of another drawer 151
through a communications link 157 to facilitate an interactive
communication between the modules housed in the hub modular
enclosure 136. The docking ports 150 of the hub modular enclosure
136 may alternatively, or additionally, facilitate a wireless
interactive communication between the modules housed in the hub
modular enclosure 136. Any suitable wireless communication can be
employed, such as for example Air Titan-Bluetooth.
[0160] FIG. 6 illustrates individual power bus attachments for a
plurality of lateral docking ports of a lateral modular housing 160
configured to receive a plurality of modules of a surgical hub 206.
The lateral modular housing 160 is configured to laterally receive
and interconnect the modules 161. The modules 161 are slidably
inserted into docking stations 162 of lateral modular housing 160,
which includes a backplane for interconnecting the modules 161. As
illustrated in FIG. 6, the modules 161 are arranged laterally in
the lateral modular housing 160. Alternatively, the modules 161 may
be arranged vertically in a lateral modular housing.
[0161] FIG. 7 illustrates a vertical modular housing 164 configured
to receive a plurality of modules 165 of the surgical hub 106. The
modules 165 are slidably inserted into docking stations, or
drawers, 167 of vertical modular housing 164, which includes a
backplane for interconnecting the modules 165. Although the drawers
167 of the vertical modular housing 164 are arranged vertically, in
certain instances, a vertical modular housing 164 may include
drawers that are arranged laterally. Furthermore, the modules 165
may interact with one another through the docking ports of the
vertical modular housing 164. In the example of FIG. 7, a display
177 is provided for displaying data relevant to the operation of
the modules 165. In addition, the vertical modular housing 164
includes a master module 178 housing a plurality of sub-modules
that are slidably received in the master module 178.
[0162] In various aspects, the imaging module 138 comprises an
integrated video processor and a modular light source and is
adapted for use with various imaging devices. In one aspect, the
imaging device is comprised of a modular housing that can be
assembled with a light source module and a camera module. The
housing can be a disposable housing. In at least one example, the
disposable housing is removably coupled to a reusable controller, a
light source module, and a camera module. The light source module
and/or the camera module can be selectively chosen depending on the
type of surgical procedure. In one aspect, the camera module
comprises a CCD sensor. In another aspect, the camera module
comprises a CMOS sensor. In another aspect, the camera module is
configured for scanned beam imaging. Likewise, the light source
module can be configured to deliver a white light or a different
light, depending on the surgical procedure.
[0163] During a surgical procedure, removing a surgical device from
the surgical field and replacing it with another surgical device
that includes a different camera or a different light source can be
inefficient. Temporarily losing sight of the surgical field may
lead to undesirable consequences. The module imaging device of the
present disclosure is configured to permit the replacement of a
light source module or a camera module midstream during a surgical
procedure, without having to remove the imaging device from the
surgical field.
[0164] In one aspect, the imaging device comprises a tubular
housing that includes a plurality of channels. A first channel is
configured to slidably receive the camera module, which can be
configured for a snap-fit engagement with the first channel. A
second channel is configured to slidably receive the light source
module, which can be configured for a snap-fit engagement with the
second channel. In another example, the camera module and/or the
light source module can be rotated into a final position within
their respective channels. A threaded engagement can be employed in
lieu of the snap-fit engagement.
[0165] In various examples, multiple imaging devices are placed at
different positions in the surgical field to provide multiple
views. The imaging module 138 can be configured to switch between
the imaging devices to provide an optimal view. In various aspects,
the imaging module 138 can be configured to integrate the images
from the different imaging device.
[0166] Various image processors and imaging devices suitable for
use with the present disclosure are described in U.S. Pat. No.
7,995,045, titled COMBINED SBI AND CONVENTIONAL IMAGE PROCESSOR,
which issued on Aug. 9, 2011, which is herein incorporated by
reference in its entirety. In addition, U.S. Pat. No. 7,982,776,
titled SBI MOTION ARTIFACT REMOVAL APPARATUS AND METHOD, which
issued on Jul. 19, 2011, which is herein incorporated by reference
in its entirety, describes various systems for removing motion
artifacts from image data. Such systems can be integrated with the
imaging module 138. Furthermore, U.S. Patent Application
Publication No. 2011/0306840, titled CONTROLLABLE MAGNETIC SOURCE
TO FIXTURE INTRACORPOREAL APPARATUS, which published on Dec. 15,
2011, and U.S. Patent Application Publication No. 2014/0243597,
titled SYSTEM FOR PERFORMING A MINIMALLY INVASIVE SURGICAL
PROCEDURE, which published on Aug. 28, 2014, each of which is
herein incorporated by reference in its entirety.
[0167] FIG. 8 illustrates a surgical data network 201 comprising a
modular communication hub 203 configured to connect modular devices
located in one or more operating theaters of a healthcare facility,
or any room in a healthcare facility specially equipped for
surgical operations, to a cloud-based system (e.g., the cloud 204
that may include a remote server 213 coupled to a storage device
205). In one aspect, the modular communication hub 203 comprises a
network hub 207 and/or a network switch 209 in communication with a
network router. The modular communication hub 203 also can be
coupled to a local computer system 210 to provide local computer
processing and data manipulation. The surgical data network 201 may
be configured as passive, intelligent, or switching. A passive
surgical data network serves as a conduit for the data, enabling it
to go from one device (or segment) to another and to the cloud
computing resources. An intelligent surgical data network includes
additional features to enable the traffic passing through the
surgical data network to be monitored and to configure each port in
the network hub 207 or network switch 209. An intelligent surgical
data network may be referred to as a manageable hub or switch. A
switching hub reads the destination address of each packet and then
forwards the packet to the correct port.
[0168] Modular devices 1a-1n located in the operating theater may
be coupled to the modular communication hub 203. The network hub
207 and/or the network switch 209 may be coupled to a network
router 211 to connect the devices 1a-1n to the cloud 204 or the
local computer system 210. Data associated with the devices 1a-1n
may be transferred to cloud-based computers via the router for
remote data processing and manipulation. Data associated with the
devices 1a-1n may also be transferred to the local computer system
210 for local data processing and manipulation. Modular devices
2a-2m located in the same operating theater also may be coupled to
a network switch 209. The network switch 209 may be coupled to the
network hub 207 and/or the network router 211 to connect to the
devices 2a-2m to the cloud 204. Data associated with the devices
2a-2n may be transferred to the cloud 204 via the network router
211 for data processing and manipulation. Data associated with the
devices 2a-2m may also be transferred to the local computer system
210 for local data processing and manipulation.
[0169] It will be appreciated that the surgical data network 201
may be expanded by interconnecting multiple network hubs 207 and/or
multiple network switches 209 with multiple network routers 211.
The modular communication hub 203 may be contained in a modular
control tower configured to receive multiple devices 1a-1n/2a-2m.
The local computer system 210 also may be contained in a modular
control tower. The modular communication hub 203 is connected to a
display 212 to display images obtained by some of the devices
1a-1n/2a-2m, for example during surgical procedures. In various
aspects, the devices 1a-1n/2a-2m may include, for example, various
modules such as an imaging module 138 coupled to an endoscope, a
generator module 140 coupled to an energy-based surgical device, a
smoke evacuation module 126, a suction/irrigation module 128, a
communication module 130, a processor module 132, a storage array
134, a surgical device coupled to a display, and/or a non-contact
sensor module, among other modular devices that may be connected to
the modular communication hub 203 of the surgical data network
201.
[0170] In one aspect, the surgical data network 201 may comprise a
combination of network hub(s), network switch(es), and network
router(s) connecting the devices 1a-1n/2a-2m to the cloud. Any one
of or all of the devices 1a-1n/2a-2m coupled to the network hub or
network switch may collect data in real time and transfer the data
to cloud computers for data processing and manipulation. It will be
appreciated that cloud computing relies on sharing computing
resources rather than having local servers or personal devices to
handle software applications. The word "cloud" may be used as a
metaphor for "the Internet," although the term is not limited as
such. Accordingly, the term "cloud computing" may be used herein to
refer to "a type of Internet-based computing," where different
services-such as servers, storage, and applications--are delivered
to the modular communication hub 203 and/or computer system 210
located in the surgical theater (e.g., a fixed, mobile, temporary,
or field operating room or space) and to devices connected to the
modular communication hub 203 and/or computer system 210 through
the Internet. The cloud infrastructure may be maintained by a cloud
service provider. In this context, the cloud service provider may
be the entity that coordinates the usage and control of the devices
1a-1n/2a-2m located in one or more operating theaters. The cloud
computing services can perform a large number of calculations based
on the data gathered by smart surgical instruments, robots, and
other computerized devices located in the operating theater. The
hub hardware enables multiple devices or connections to be
connected to a computer that communicates with the cloud computing
resources and storage.
[0171] Applying cloud computer data processing techniques on the
data collected by the devices 1a-1n/2a-2m, the surgical data
network provides improved surgical outcomes, reduced costs, and
improved patient satisfaction. At least some of the devices
1a-1n/2a-2m may be employed to view tissue states to assess leaks
or perfusion of sealed tissue after a tissue sealing and cutting
procedure. At least some of the devices 1a-1n/2a-2m may be employed
to identify pathology, such as the effects of diseases, using the
cloud-based computing to examine data including images of samples
of body tissue for diagnostic purposes. This includes localization
and margin confirmation of tissue and phenotypes. At least some of
the devices 1a-1n/2a-2m may be employed to identify anatomical
structures of the body using a variety of sensors integrated with
imaging devices and techniques such as overlaying images captured
by multiple imaging devices. The data gathered by the devices
1a-1n/2a-2m, including image data, may be transferred to the cloud
204 or the local computer system 210 or both for data processing
and manipulation including image processing and manipulation. The
data may be analyzed to improve surgical procedure outcomes by
determining if further treatment, such as the application of
endoscopic intervention, emerging technologies, a targeted
radiation, targeted intervention, and precise robotics to
tissue-specific sites and conditions, may be pursued. Such data
analysis may further employ outcome analytics processing, and using
standardized approaches may provide beneficial feedback to either
confirm surgical treatments and the behavior of the surgeon or
suggest modifications to surgical treatments and the behavior of
the surgeon.
[0172] In one implementation, the operating theater devices 1a-1n
may be connected to the modular communication hub 203 over a wired
channel or a wireless channel depending on the configuration of the
devices 1a-1n to a network hub. The network hub 207 may be
implemented, in one aspect, as a local network broadcast device
that works on the physical layer of the Open System Interconnection
(OSI) model. The network hub provides connectivity to the devices
1a-1n located in the same operating theater network. The network
hub 207 collects data in the form of packets and sends them to the
router in half duplex mode. The network hub 207 does not store any
media access control/Internet Protocol (MAC/IP) to transfer the
device data. Only one of the devices 1a-1n can send data at a time
through the network hub 207. The network hub 207 has no routing
tables or intelligence regarding where to send information and
broadcasts all network data across each connection and to a remote
server 213 (FIG. 9) over the cloud 204. The network hub 207 can
detect basic network errors such as collisions, but having all
information broadcast to multiple ports can be a security risk and
cause bottlenecks.
[0173] In another implementation, the operating theater devices
2a-2m may be connected to a network switch 209 over a wired channel
or a wireless channel. The network switch 209 works in the data
link layer of the OSI model. The network switch 209 is a multicast
device for connecting the devices 2a-2m located in the same
operating theater to the network. The network switch 209 sends data
in the form of frames to the network router 211 and works in full
duplex mode. Multiple devices 2a-2m can send data at the same time
through the network switch 209. The network switch 209 stores and
uses MAC addresses of the devices 2a-2m to transfer data.
[0174] The network hub 207 and/or the network switch 209 are
coupled to the network router 211 for connection to the cloud 204.
The network router 211 works in the network layer of the OSI model.
The network router 211 creates a route for transmitting data
packets received from the network hub 207 and/or network switch 211
to cloud-based computer resources for further processing and
manipulation of the data collected by any one of or all the devices
1a-1n/2a-2m. The network router 211 may be employed to connect two
or more different networks located in different locations, such as,
for example, different operating theaters of the same healthcare
facility or different networks located in different operating
theaters of different healthcare facilities. The network router 211
sends data in the form of packets to the cloud 204 and works in
full duplex mode. Multiple devices can send data at the same time.
The network router 211 uses IP addresses to transfer data.
[0175] In one example, the network hub 207 may be implemented as a
USB hub, which allows multiple USB devices to be connected to a
host computer. The USB hub may expand a single USB port into
several tiers so that there are more ports available to connect
devices to the host system computer. The network hub 207 may
include wired or wireless capabilities to receive information over
a wired channel or a wireless channel. In one aspect, a wireless
USB short-range, high-bandwidth wireless radio communication
protocol may be employed for communication between the devices
1a-1n and devices 2a-2m located in the operating theater.
[0176] In other examples, the operating theater devices 1a-1n/2a-2m
may communicate to the modular communication hub 203 via Bluetooth
wireless technology standard for exchanging data over short
distances (using short-wavelength UHF radio waves in the ISM band
from 2.4 to 2.485 GHz) from fixed and mobile devices and building
personal area networks (PANs). In other aspects, the operating
theater devices 1a-1n/2a-2m may communicate to the modular
communication hub 203 via a number of wireless or wired
communication standards or protocols, including but not limited to
Wi-Fi (IEEE 802.11 family), WiMAX (IEEE 802.16 family), IEEE
802.20, long-term evolution (LTE), and Ev-DO, HSPA+, HSDPA+,
HSUPA+, EDGE, GSM, GPRS, CDMA, TDMA, DECT, and Ethernet derivatives
thereof, as well as any other wireless and wired protocols that are
designated as 3G, 4G, 5G, and beyond. The computing module may
include a plurality of communication modules. For instance, a first
communication module may be dedicated to shorter-range wireless
communications such as Wi-Fi and Bluetooth, and a second
communication module may be dedicated to longer-range wireless
communications such as GPS, EDGE, GPRS, CDMA, WiMAX, LTE, Ev-DO,
and others.
[0177] The modular communication hub 203 may serve as a central
connection for one or all of the operating theater devices
1a-1n/2a-2m and handles a data type known as frames. Frames carry
the data generated by the devices 1a-1n/2a-2m. When a frame is
received by the modular communication hub 203, it is amplified and
transmitted to the network router 211, which transfers the data to
the cloud computing resources by using a number of wireless or
wired communication standards or protocols, as described
herein.
[0178] The modular communication hub 203 can be used as a
standalone device or be connected to compatible network hubs and
network switches to form a larger network. The modular
communication hub 203 is generally easy to install, configure, and
maintain, making it a good option for networking the operating
theater devices 1a-1n/2a-2m.
[0179] FIG. 9 illustrates a computer-implemented interactive
surgical system 200. The computer-implemented interactive surgical
system 200 is similar in many respects to the computer-implemented
interactive surgical system 100. For example, the
computer-implemented interactive surgical system 200 includes one
or more surgical systems 202, which are similar in many respects to
the surgical systems 102. Each surgical system 202 includes at
least one surgical hub 206 in communication with a cloud 204 that
may include a remote server 213. In one aspect, the
computer-implemented interactive surgical system 200 comprises a
modular control tower 236 connected to multiple operating theater
devices such as, for example, intelligent surgical instruments,
robots, and other computerized devices located in the operating
theater. As shown in FIG. 10, the modular control tower 236
comprises a modular communication hub 203 coupled to a computer
system 210. As illustrated in the example of FIG. 9, the modular
control tower 236 is coupled to an imaging module 238 that is
coupled to an endoscope 239, a generator module 240 that is coupled
to an energy device 241, a smoke evacuator module 226, a
suction/irrigation module 228, a communication module 230, a
processor module 232, a storage array 234, a smart
device/instrument 235 optionally coupled to a display 237, and a
non-contact sensor module 242. The operating theater devices are
coupled to cloud computing resources and data storage via the
modular control tower 236. A robot hub 222 also may be connected to
the modular control tower 236 and to the cloud computing resources.
The devices/instruments 235, visualization systems 208, among
others, may be coupled to the modular control tower 236 via wired
or wireless communication standards or protocols, as described
herein. The modular control tower 236 may be coupled to a hub
display 215 (e.g., monitor, screen) to display and overlay images
received from the imaging module, device/instrument display, and/or
other visualization systems 208. The hub display also may display
data received from devices connected to the modular control tower
in conjunction with images and overlaid images.
[0180] FIG. 10 illustrates a surgical hub 206 comprising a
plurality of modules coupled to the modular control tower 236. The
modular control tower 236 comprises a modular communication hub
203, e.g., a network connectivity device, and a computer system 210
to provide local processing, visualization, and imaging, for
example. As shown in FIG. 10, the modular communication hub 203 may
be connected in a tiered configuration to expand the number of
modules (e.g., devices) that may be connected to the modular
communication hub 203 and transfer data associated with the modules
to the computer system 210, cloud computing resources, or both. As
shown in FIG. 10, each of the network hubs/switches in the modular
communication hub 203 includes three downstream ports and one
upstream port. The upstream network hub/switch is connected to a
processor to provide a communication connection to the cloud
computing resources and a local display 217. Communication to the
cloud 204 may be made either through a wired or a wireless
communication channel.
[0181] The surgical hub 206 employs a non-contact sensor module 242
to measure the dimensions of the operating theater and generate a
map of the surgical theater using either ultrasonic or laser-type
non-contact measurement devices. An ultrasound-based non-contact
sensor module scans the operating theater by transmitting a burst
of ultrasound and receiving the echo when it bounces off the
perimeter walls of an operating theater as described under the
heading "Surgical Hub Spatial Awareness Within an Operating Room"
in U.S. Provisional Patent Application Ser. No. 62/611,341, titled
INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017, which is herein
incorporated by reference in its entirety, in which the sensor
module is configured to determine the size of the operating theater
and to adjust Bluetooth-pairing distance limits. A laser-based
non-contact sensor module scans the operating theater by
transmitting laser light pulses, receiving laser light pulses that
bounce off the perimeter walls of the operating theater, and
comparing the phase of the transmitted pulse to the received pulse
to determine the size of the operating theater and to adjust
Bluetooth pairing distance limits, for example.
[0182] The computer system 210 comprises a processor 244 and a
network interface 245. The processor 244 is coupled to a
communication module 247, storage 248, memory 249, non-volatile
memory 250, and input/output interface 251 via a system bus. The
system bus can be any of several types of bus structure(s)
including the memory bus or memory controller, a peripheral bus or
external bus, and/or a local bus using any variety of available bus
architectures including, but not limited to, 9-bit bus, Industrial
Standard Architecture (ISA), Micro-Charmel Architecture (MSA),
Extended ISA (EISA), Intelligent Drive Electronics (IDE), VESA
Local Bus (VLB), Peripheral Component Interconnect (PCI), USB,
Advanced Graphics Port (AGP), Personal Computer Memory Card
International Association bus (PCMCIA), Small Computer Systems
Interface (SCSI), or any other proprietary bus.
[0183] The processor 244 may be any single-core or multicore
processor such as those known under the trade name ARM Cortex by
Texas Instruments. In one aspect, the processor may be an
LM4F230H5QR ARM Cortex-M4F Processor Core, available from Texas
Instruments, for example, comprising an on-chip memory of 256 KB
single-cycle flash memory, or other non-volatile memory, up to 40
MHz, a prefetch buffer to improve performance above 40 MHz, a 32 KB
single-cycle serial random access memory (SRAM), an internal
read-only memory (ROM) loaded with StellarisWare.RTM. software, a 2
KB electrically erasable programmable read-only memory (EEPROM),
and/or one or more pulse width modulation (PWM) modules, one or
more quadrature encoder inputs (QEI) analogs, one or more 12-bit
analog-to-digital converters (ADCs) with 12 analog input channels,
details of which are available for the product datasheet.
[0184] In one aspect, the processor 244 may comprise a safety
controller comprising two controller-based families such as TMS570
and RM4x, known under the trade name Hercules ARM Cortex R4, also
by Texas Instruments. The safety controller may be configured
specifically for IEC 61508 and ISO 26262 safety critical
applications, among others, to provide advanced integrated safety
features while delivering scalable performance, connectivity, and
memory options.
[0185] The system memory includes volatile memory and non-volatile
memory. The basic input/output system (BIOS), containing the basic
routines to transfer information between elements within the
computer system, such as during start-up, is stored in non-volatile
memory. For example, the non-volatile memory can include ROM,
programmable ROM (PROM), electrically programmable ROM (EPROM),
EEPROM, or flash memory. Volatile memory includes random-access
memory (RAM), which acts as external cache memory. Moreover, RAM is
available in many forms such as SRAM, dynamic RAM (DRAM),
synchronous DRAM (SDRAM), double data rate SDRAM (DDR SDRAM),
enhanced SDRAM (ESDRAM), Synchlink DRAM (SLDRAM), and direct Rambus
RAM (DRRAM).
[0186] The computer system 210 also includes
removable/non-removable, volatile/non-volatile computer storage
media, such as for example disk storage. The disk storage includes,
but is not limited to, devices like a magnetic disk drive, floppy
disk drive, tape drive, Jaz drive, Zip drive, LS-60 drive, flash
memory card, or memory stick. In addition, the disk storage can
include storage media separately or in combination with other
storage media including, but not limited to, an optical disc drive
such as a compact disc ROM device (CD-ROM), compact disc recordable
drive (CD-R Drive), compact disc rewritable drive (CD-RW Drive), or
a digital versatile disc ROM drive (DVD-ROM). To facilitate the
connection of the disk storage devices to the system bus, a
removable or non-removable interface may be employed.
[0187] It is to be appreciated that the computer system 210
includes software that acts as an intermediary between users and
the basic computer resources described in a suitable operating
environment. Such software includes an operating system. The
operating system, which can be stored on the disk storage, acts to
control and allocate resources of the computer system. System
applications take advantage of the management of resources by the
operating system through program modules and program data stored
either in the system memory or on the disk storage. It is to be
appreciated that various components described herein can be
implemented with various operating systems or combinations of
operating systems.
[0188] A user enters commands or information into the computer
system 210 through input device(s) coupled to the I/O interface
251. The input devices include, but are not limited to, a pointing
device such as a mouse, trackball, stylus, touch pad, keyboard,
microphone, joystick, game pad, satellite dish, scanner, TV tuner
card, digital camera, digital video camera, web camera, and the
like. These and other input devices connect to the processor
through the system bus via interface port(s). The interface port(s)
include, for example, a serial port, a parallel port, a game port,
and a USB. The 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 to output information from
the computer system to an output device. An output adapter is
provided to illustrate that there are some output devices like
monitors, displays, speakers, and printers, among other output
devices that require special adapters. The output adapters include,
by way of illustration and not limitation, video and sound cards
that provide a means of connection between the output device and
the system bus. It should be noted that other devices and/or
systems of devices, such as remote computer(s), provide both input
and output capabilities.
[0189] The computer system 210 can operate in a networked
environment using logical connections to one or more remote
computers, such as cloud computer(s), or local computers. The
remote cloud computer(s) can be a personal computer, server,
router, network PC, workstation, microprocessor-based appliance,
peer device, or other common network node, and the like, and
typically includes many or all of the elements described relative
to the computer system. For purposes of brevity, only a memory
storage device is illustrated with the remote computer(s). The
remote computer(s) is logically connected to the computer system
through a network interface and then physically connected via a
communication connection. The network interface encompasses
communication networks such as local area networks (LANs) and wide
area networks (WANs). LAN technologies include Fiber Distributed
Data Interface (FDDI), Copper Distributed Data Interface (CDDI),
Ethernet/IEEE 802.3, Token Ring/IEEE 802.5 and the like. WAN
technologies include, but are not limited to, point-to-point links,
circuit-switching networks like Integrated Services Digital
Networks (ISDN) and variations thereon, packet-switching networks,
and Digital Subscriber Lines (DSL).
[0190] In various aspects, the computer system 210 of FIG. 10, the
imaging module 238 and/or visualization system 208, and/or the
processor module 232 of FIGS. 9-10, may comprise an image
processor, image-processing engine, media processor, or any
specialized digital signal processor (DSP) used for the processing
of digital images. The image processor may employ parallel
computing with single instruction, multiple data (SIMD) or multiple
instruction, multiple data (MIMD) technologies to increase speed
and efficiency. The digital image-processing engine can perform a
range of tasks. The image processor may be a system on a chip with
multicore processor architecture.
[0191] The communication connection(s) refers to the
hardware/software employed to connect the network interface to the
bus. While the communication connection is shown for illustrative
clarity inside the computer system, it can also be external to the
computer system 210. The hardware/software necessary for connection
to the network interface includes, for illustrative purposes only,
internal and external technologies such as modems, including
regular telephone-grade modems, cable modems, and DSL modems, ISDN
adapters, and Ethernet cards.
[0192] 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 aspect, the USB network hub
device 300 employs a TUSB2036 integrated circuit hub by Texas
Instruments. The USB network hub 300 is a CMOS device that provides
an upstream USB transceiver port 302 and up to three downstream USB
transceiver ports 304, 306, 308 in compliance with the USB 2.0
specification. The upstream USB transceiver port 302 is a
differential root data port comprising a differential data minus
(DM0) input paired with a differential data plus (DP0) input. The
three downstream USB transceiver ports 304, 306, 308 are
differential data ports where each port includes differential data
plus (DP1-DP3) outputs paired with differential data minus
(DM1-DM3) outputs.
[0193] The USB network hub 300 device is implemented with a digital
state machine instead of a microcontroller, and no firmware
programming is required. Fully compliant USB transceivers are
integrated into the circuit for the upstream USB transceiver port
302 and all downstream USB transceiver ports 304, 306, 308. The
downstream USB transceiver ports 304, 306, 308 support both
full-speed and low-speed devices by automatically setting the slew
rate according to the speed of the device attached to the ports.
The USB network hub 300 device may be configured either in
bus-powered or self-powered mode and includes a hub power logic 312
to manage power.
[0194] 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 protocol described in
chapter 8 of the USB specification. The SIE 310 typically
comprehends signaling up to the transaction level. The functions
that it handles could include: packet recognition, transaction
sequencing, SOP, EOP, RESET, and RESUME signal
detection/generation, clock/data separation, non-return-to-zero
invert (NRZI) data encoding/decoding and bit-stuffing, CRC
generation and checking (token and data), packet ID (PID)
generation and checking/decoding, and/or
serial-parallel/parallel-serial conversion. The 310 receives a
clock input 314 and is coupled to a suspend/resume logic and frame
timer 316 circuit and a hub repeater circuit 318 to control
communication between the upstream USB transceiver port 302 and the
downstream USB transceiver ports 304, 306, 308 through port logic
circuits 320, 322, 324. The SIE 310 is coupled to a command decoder
326 via interface logic to control commands from a serial EEPROM
via a serial EEPROM interface 330.
[0195] In various aspects, the USB network hub 300 can connect 127
functions configured in up to six logical layers (tiers) to a
single computer. Further, 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-powered and self-powered modes. The USB network hub 300 may
be configured to support four modes of power management: a
bus-powered hub, with either individual-port power management or
ganged-port power management, and the self-powered hub, with either
individual-port power management or ganged-port power management.
In one aspect, using a USB cable, the USB network hub 300, the
upstream USB transceiver port 302 is plugged into a USB host
controller, and the downstream USB transceiver ports 304, 306, 308
are exposed for connecting USB compatible devices, and so
forth.
Surgical Instrument Hardware
[0196] FIG. 12 illustrates a logic diagram of a control system 470
of a surgical instrument or tool in accordance with one or more
aspects of the present disclosure. The system 470 comprises a
control circuit. The control circuit includes a microcontroller 461
comprising a processor 462 and a memory 468. One or more of sensors
472, 474, 476, for example, provide real-time feedback to the
processor 462. A motor 482, driven by a motor driver 492, operably
couples a longitudinally movable displacement member to drive the
I-beam knife element. A tracking system 480 is configured to
determine the position of the longitudinally movable displacement
member. The position information is provided to the processor 462,
which can be programmed or configured to determine the position of
the longitudinally movable drive member as well as the position of
a firing member, firing bar, and I-beam knife element. Additional
motors may be provided at the tool driver interface to control
I-beam firing, closure tube travel, shaft rotation, and
articulation. A display 473 displays a variety of operating
conditions of the instruments and may include touch screen
functionality for data input. Information displayed on the display
473 may be overlaid with images acquired via endoscopic imaging
modules.
[0197] In one aspect, the microcontroller 461 may be any
single-core or multicore processor such as those known under the
trade name ARM Cortex by Texas Instruments. In one aspect, the main
microcontroller 461 may be an LM4F230H5QR ARM Cortex-M4F Processor
Core, available from Texas Instruments, for example, comprising an
on-chip memory of 256 KB single-cycle flash memory, or other
non-volatile memory, up to 40 MHz, a prefetch buffer to improve
performance above 40 MHz, a 32 KB single-cycle SRAM, and internal
ROM loaded with StellarisWare.RTM. software, a 2 KB EEPROM, one or
more PWM modules, one or more QEI analogs, and/or one or more
12-bit ADCs with 12 analog input channels, details of which are
available for the product datasheet.
[0198] In one aspect, the microcontroller 461 may comprise a safety
controller comprising two controller-based families such as TMS570
and RM4x, known under the trade name Hercules ARM Cortex R4, also
by Texas Instruments. The safety controller may be configured
specifically for IEC 61508 and ISO 26262 safety critical
applications, among others, to provide advanced integrated safety
features while delivering scalable performance, connectivity, and
memory options.
[0199] The microcontroller 461 may be programmed to perform various
functions such as precise control over the speed and position of
the knife and articulation systems. In one aspect, the
microcontroller 461 includes a processor 462 and a memory 468. The
electric motor 482 may be a brushed direct current (DC) motor with
a gearbox and mechanical links to an articulation or knife system.
In one aspect, a motor driver 492 may be an A3941 available from
Allegro Microsystems, Inc. Other motor drivers may be readily
substituted for use in the tracking system 480 comprising an
absolute positioning system. A detailed description of an absolute
positioning system is described in U.S. Patent Application
Publication No. 2017/0296213, titled SYSTEMS AND METHODS FOR
CONTROLLING A SURGICAL STAPLING AND CUTTING INSTRUMENT, which
published on Oct. 19, 2017, which is herein incorporated by
reference in its entirety.
[0200] The microcontroller 461 may be programmed to provide precise
control over the speed and position of displacement members and
articulation systems. The microcontroller 461 may be configured to
compute a response in the software of the microcontroller 461. The
computed response is compared to a measured response of the actual
system to obtain an "observed" response, which is used for actual
feedback decisions. The observed response is a favorable, tuned
value that balances the smooth, continuous nature of the simulated
response with the measured response, which can detect outside
influences on the system.
[0201] In one aspect, the motor 482 may be controlled by the motor
driver 492 and can be employed by the firing system of the surgical
instrument or tool. In various forms, the motor 482 may be a
brushed DC driving motor having a maximum rotational speed of
approximately 25,000 RPM. In other arrangements, the motor 482 may
include a brushless motor, a cordless motor, a synchronous motor, a
stepper motor, or any other suitable electric motor. The motor
driver 492 may comprise an H-bridge driver comprising field-effect
transistors (FETs), for example. The motor 482 can be powered by a
power assembly releasably mounted to the handle assembly or tool
housing for supplying control power to the surgical instrument or
tool. The power assembly may comprise a battery which may include a
number of battery cells connected in series that can be used as the
power source to power the surgical instrument or tool. In certain
circumstances, the battery cells of the power assembly may be
replaceable and/or rechargeable. In at least one example, the
battery cells can be lithium-ion batteries which can be couplable
to and separable from the power assembly.
[0202] The 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 brush DC motors. The driver 492 comprises
a unique charge pump regulator that provides full (>10 V) gate
drive for battery voltages down to 7 V and allows the A3941 to
operate with a reduced gate drive, down to 5.5 V. A bootstrap
capacitor may be employed to provide the above battery supply
voltage required for 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 modes using diode or
synchronous rectification. In the slow decay mode, current
recirculation can be through the high-side or the lowside FETs. The
power FETs are protected from shoot-through by resistor-adjustable
dead time. Integrated diagnostics provide indications of
undervoltage, overtemperature, and power bridge faults and can be
configured to protect the power MOSFETs under most short circuit
conditions. Other motor drivers may be readily substituted for use
in the tracking system 480 comprising an absolute positioning
system.
[0203] The tracking system 480 comprises a controlled motor drive
circuit arrangement comprising a position sensor 472 according to
one aspect of this disclosure. The position sensor 472 for an
absolute positioning system provides a unique position signal
corresponding to the location of a 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 a gear reducer
assembly. In other aspects, the displacement member represents the
firing member, which could be adapted and configured to include a
rack of drive teeth. In yet another aspect, the displacement member
represents a firing bar or the I-beam, each of which can be adapted
and configured to include a rack of drive teeth. Accordingly, as
used herein, the term displacement member is used generically to
refer to any movable member of the surgical instrument or tool such
as the drive member, the firing member, the firing bar, the I-beam,
or any element that can be displaced. In one aspect, the
longitudinally movable drive member is coupled to the firing
member, the firing bar, and the I-beam. Accordingly, the absolute
positioning system can, in effect, 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. Thus, the
longitudinally movable drive member, the firing member, the firing
bar, or the I-beam, or combinations thereof, may be coupled to any
suitable linear displacement sensor. Linear displacement sensors
may include contact or non-contact displacement sensors. Linear
displacement sensors may comprise linear variable differential
transformers (LVDT), differential variable reluctance transducers
(DVRT), a slide potentiometer, a magnetic sensing system comprising
a movable magnet and a series of linearly arranged Hall effect
sensors, a magnetic sensing system comprising a fixed magnet and a
series of movable, linearly arranged Hall effect sensors, an
optical sensing system comprising a movable light source and a
series of linearly arranged photo diodes or photo detectors, an
optical sensing system comprising a fixed light source and a series
of movable linearly, arranged photo diodes or photo detectors, or
any combination thereof.
[0204] The electric motor 482 can 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. A sensor element may be operably coupled to a gear assembly
such that a single revolution of the position sensor 472 element
corresponds to some linear longitudinal translation of the
displacement member. An arrangement of gearing and sensors can be
connected to the linear actuator, via a rack and pinion
arrangement, or a rotary actuator, via a spur gear or other
connection. A power source supplies power to the absolute
positioning system and an output indicator may display the output
of the absolute positioning system. The displacement member
represents the longitudinally movable drive member comprising a
rack of drive teeth formed thereon for meshing engagement with a
corresponding drive gear of the gear reducer assembly. The
displacement member represents the longitudinally movable firing
member, firing bar, I-beam, or combinations thereof.
[0205] A single revolution of the sensor element associated with
the position sensor 472 is equivalent to a longitudinal linear
displacement d1 of the of the displacement member, where d1 is the
longitudinal linear distance that the displacement member moves
from point "a" to point "b" after a single revolution of the sensor
element coupled to the displacement member. The sensor arrangement
may be connected via a gear reduction that results in the position
sensor 472 completing one or more revolutions for the full stroke
of the displacement member. The position sensor 472 may complete
multiple revolutions for the full stroke of the displacement
member.
[0206] A series of switches, where n is an integer greater than
one, may be employed alone or in combination with a gear reduction
to provide a unique position signal for more than one revolution of
the position sensor 472. The state of the switches are fed back to
the microcontroller 461 that applies logic to determine a unique
position signal corresponding to the longitudinal linear
displacement d1+d2+ . . . dn of the displacement member. The output
of the position sensor 472 is provided to the microcontroller 461.
The position sensor 472 of the sensor arrangement may comprise a
magnetic sensor, an analog rotary sensor like a potentiometer, or
an array of analog Hall-effect elements, which output a unique
combination of position signals or values.
[0207] The position sensor 472 may comprise any number of magnetic
sensing elements, such as, for example, magnetic sensors classified
according to whether they measure the total magnetic field or the
vector components of the magnetic field. The techniques used to
produce both types of magnetic sensors encompass many aspects of
physics and electronics. The technologies used for magnetic field
sensing include search coil, fluxgate, optically pumped, nuclear
precession, SQUID, Hall-effect, anisotropic magnetoresistance,
giant magnetoresistance, magnetic tunnel junctions, giant
magnetoimpedance, magnetostrictive/piezoelectric composites,
magnetodiode, magnetotransistor, fiber-optic, magneto-optic, and
microelectromechanical systems-based magnetic sensors, among
others.
[0208] In one aspect, the position sensor 472 for the tracking
system 480 comprising an absolute positioning system comprises a
magnetic rotary absolute positioning system. The position sensor
472 may be implemented as an AS5055EQFT single-chip magnetic rotary
position sensor available from Austria Microsystems, AG. The
position sensor 472 is interfaced with the microcontroller 461 to
provide an absolute positioning system. The position sensor 472 is
a low-voltage and low-power component and includes four Hall-effect
elements in an area of the position sensor 472 that is located
above a magnet. A high-resolution ADC and a smart power management
controller are also provided on the chip. A coordinate rotation
digital computer (CORDIC) processor, also known as the
digit-by-digit method and Volder's algorithm, is provided to
implement a simple and efficient algorithm to calculate hyperbolic
and trigonometric functions that require only addition,
subtraction, bitshift, and table lookup operations. The angle
position, alarm bits, and magnetic field information are
transmitted over a standard serial communication interface, such as
a serial peripheral interface (SPI) interface, to the
microcontroller 461. The position sensor 472 provides 12 or 14 bits
of resolution. The position sensor 472 may be an AS5055 chip
provided in a small QFN 16-pin 4.times.4.times.0.85 mm package.
[0209] The tracking system 480 comprising an absolute positioning
system may comprise and/or be programmed to implement a feedback
controller, such as a PID, state feedback, and adaptive controller.
A power source converts the signal from the feedback controller
into a physical input to the system: in this case the voltage.
Other examples include a PWM of the voltage, current, and force.
Other sensor(s) may be provided to measure physical parameters of
the physical system in addition to the position measured by the
position sensor 472. In some aspects, the other sensor(s) can
include sensor arrangements such as those described in U.S. Pat.
No. 9,345,481, titled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR
SYSTEM, which issued on May 24, 2016, which is herein incorporated
by reference in its entirety; U.S. Patent Application Publication
No. 2014/0263552, titled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR
SYSTEM, which published on Sep. 18, 2014, which is herein
incorporated by reference in its entirety; and U.S. patent
application Ser. No. 15/628,175, titled TECHNIQUES FOR ADAPTIVE
CONTROL OF MOTOR VELOCITY OF A SURGICAL STAPLING AND CUTTING
INSTRUMENT, filed Jun. 20, 2017, which is herein incorporated by
reference in its entirety. 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 will have a finite resolution and sampling frequency. The
absolute positioning system may comprise a compare-and-combine
circuit to combine a computed response with a measured response
using algorithms, such as a weighted average and a theoretical
control loop, that drive the computed response towards the measured
response. The computed response of the physical system takes into
account properties like mass, inertial, viscous friction,
inductance resistance, etc., to predict what the states and outputs
of the physical system will be by knowing the input.
[0210] The absolute positioning system provides an absolute
position of the displacement member upon power-up of the
instrument, without retracting or advancing the displacement member
to a reset (zero or home) position as may be required with
conventional rotary encoders that merely count the number of steps
forwards or backwards that the motor 482 has taken to infer the
position of a device actuator, drive bar, knife, or the like.
[0211] A sensor 474, such as, for example, a strain gauge or a
micro-strain gauge, is configured to measure one or more parameters
of the end effector, such as, for example, the amplitude of the
strain exerted on the anvil during a clamping operation, which can
be indicative of the closure forces applied to the anvil. The
measured strain is converted to a digital signal and provided to
the processor 462. Alternatively, or in addition to the sensor 474,
a sensor 476, such as, for example, a load sensor, can measure the
closure force applied by the closure drive system to the anvil. The
sensor 476, such as, for example, a load sensor, can measure the
firing force applied to an I-beam in a firing stroke of the
surgical instrument or tool. The I-beam is configured to engage a
wedge sled, which is configured to upwardly cam staple drivers to
force out staples into deforming contact with an anvil. The I-beam
also includes a sharpened cutting edge that can be used to sever
tissue as the I-beam is advanced distally by the firing bar.
Alternatively, a current sensor 478 can be employed to measure the
current drawn by the motor 482. The force required to advance the
firing member can correspond to the current drawn by the motor 482,
for example. The measured force is converted to a digital signal
and provided to the processor 462.
[0212] In one form, the strain gauge sensor 474 can be used to
measure the force applied to the tissue by the end effector. A
strain gauge can be coupled to the end effector to measure the
force on the tissue being treated by the end effector. A system for
measuring forces applied to the tissue grasped by the end effector
comprises a strain gauge sensor 474, such as, for example, a
micro-strain gauge, that is configured to measure one or more
parameters of the end effector, for example. In one aspect, the
strain gauge sensor 474 can measure the amplitude or magnitude of
the strain exerted on a jaw member of an end effector during a
clamping operation, which can be indicative of the tissue
compression. The measured strain is converted to a digital signal
and provided to a processor 462 of the microcontroller 461. A load
sensor 476 can measure the force used to operate the knife element,
for example, to cut the tissue captured between the anvil and the
staple cartridge. A magnetic field sensor can be employed to
measure the thickness of the captured tissue. The measurement of
the magnetic field sensor also may be converted to a digital signal
and provided to the processor 462.
[0213] The measurements of the tissue compression, the tissue
thickness, and/or the force required to close the end effector on
the tissue, as respectively measured by the sensors 474, 476, can
be used by the microcontroller 461 to characterize the selected
position of the firing member and/or the corresponding value of the
speed of the firing member. In one instance, a memory 468 may store
a technique, an equation, and/or a lookup table which can be
employed by the microcontroller 461 in the assessment.
[0214] The control system 470 of the surgical instrument or tool
also may comprise wired or wireless communication circuits to
communicate with the modular communication hub as shown in FIGS.
8-11.
[0215] FIG. 13 illustrates a control circuit 500 configured to
control aspects of the surgical instrument or tool according to one
aspect of this disclosure. The control circuit 500 can be
configured to implement various processes described herein. The
control circuit 500 may comprise a microcontroller comprising one
or more processors 502 (e.g., microprocessor, microcontroller)
coupled to at least one memory circuit 504. The memory circuit 504
stores machine-executable instructions that, when executed by the
processor 502, cause the processor 502 to execute machine
instructions to implement various processes described herein. The
processor 502 may be any one of a number of single-core or
multicore processors known in the art. The memory circuit 504 may
comprise volatile and non-volatile storage media. The processor 502
may include an instruction processing unit 506 and an arithmetic
unit 508. The instruction processing unit may be configured to
receive instructions from the memory circuit 504 of this
disclosure.
[0216] FIG. 14 illustrates a combinational logic circuit 510
configured to control aspects of the surgical instrument or tool
according to one aspect of this disclosure. The combinational logic
circuit 510 can be configured to implement various processes
described herein. The combinational logic circuit 510 may comprise
a finite state machine comprising a combinational logic 512
configured to receive data associated with the surgical instrument
or tool at an input 514, process the data by the combinational
logic 512, and provide an output 516.
[0217] FIG. 15 illustrates a sequential logic circuit 520
configured to control aspects of the surgical instrument or tool
according to one aspect of this disclosure. The sequential logic
circuit 520 or the combinational logic 522 can be configured to
implement various processes described herein. The sequential logic
circuit 520 may comprise a finite state machine. The sequential
logic circuit 520 may comprise a combinational logic 522, at least
one memory circuit 524, and a clock 529, for example. The at least
one memory circuit 524 can store a current state of the finite
state machine. In certain instances, the sequential logic circuit
520 may be synchronous or asynchronous. The combinational logic 522
is configured to receive data associated with the surgical
instrument or tool from an input 526, process the data by the
combinational logic 522, and provide an output 528. In other
aspects, the circuit may comprise a combination of a processor
(e.g., processor 502, FIG. 13) and a finite state machine to
implement various processes herein. In other aspects, the finite
state machine may comprise a combination of a combinational logic
circuit (e.g., combinational logic circuit 510, FIG. 14) and the
sequential logic circuit 520.
[0218] FIG. 16 illustrates a surgical instrument or tool comprising
a plurality of motors which can be activated to perform various
functions. In certain instances, a first motor can be activated to
perform a first function, a second motor can be activated to
perform a second function, 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 instances, the
plurality of motors of robotic surgical instrument 600 can be
individually activated to cause firing, closure, and/or
articulation motions in the end effector. The firing, closure,
and/or articulation motions can be transmitted to the end effector
through a shaft assembly, for example.
[0219] In certain instances, the surgical instrument system or tool
may include a firing motor 602. The firing motor 602 may be
operably coupled to a firing motor drive assembly 604 which can be
configured to transmit firing motions, generated by the motor 602
to the end effector, in particular to displace the I-beam element.
In certain instances, the firing motions generated by the motor 602
may cause the staples to be deployed from the staple cartridge into
tissue captured by the end effector and/or the cutting edge of the
I-beam element to be advanced to cut the captured tissue, for
example. The I-beam element may be retracted by reversing the
direction of the motor 602.
[0220] In certain instances, the surgical instrument or tool may
include a closure motor 603. The closure motor 603 may be operably
coupled to a closure motor drive assembly 605 which can be
configured to transmit closure motions, generated by the motor 603
to the end effector, in particular to displace a closure tube to
close the anvil and compress tissue between the anvil and the
staple cartridge. The closure motions may cause the end effector to
transition from an open configuration to an approximated
configuration to capture tissue, for example. The end effector may
be transitioned to an open position by reversing the direction of
the motor 603.
[0221] In certain instances, the surgical instrument or tool may
include one or more articulation motors 606a, 606b, for example.
The motors 606a, 606b may be operably coupled to respective
articulation motor drive assemblies 608a, 608b, which can be
configured to transmit articulation motions generated by the motors
606a, 606b to the end effector. In certain instances, the
articulation motions may cause the end effector to articulate
relative to the shaft, for example.
[0222] As described above, the surgical instrument or tool may
include a plurality of motors which may be configured to perform
various independent functions. In certain instances, the plurality
of motors of the surgical instrument or tool can be individually or
separately activated to perform one or more functions while the
other motors remain inactive. For example, the articulation motors
606a, 606b can be activated to cause the end effector to be
articulated while the firing motor 602 remains inactive.
Alternatively, the firing motor 602 can be activated to fire the
plurality of staples, and/or to advance the cutting edge, while the
articulation motor 606 remains inactive. Furthermore, the closure
motor 603 may be activated simultaneously with the firing motor 602
to cause the closure tube and the I-beam element to advance
distally as described in more detail hereinbelow.
[0223] In certain instances, the surgical instrument or tool may
include a common control module 610 which can be employed with a
plurality of motors of the surgical instrument or tool. In certain
instances, the common control module 610 may accommodate one of the
plurality of motors at a time. For example, the common control
module 610 can be couplable to and separable from the plurality of
motors of the robotic surgical instrument individually. In certain
instances, a plurality of the motors of the surgical instrument or
tool may share one or more common control modules such as the
common control module 610. In certain instances, a plurality of
motors of the surgical instrument or tool can be individually and
selectively engaged with the common control module 610. In certain
instances, the common control module 610 can be selectively
switched from interfacing with one of a plurality of motors of the
surgical instrument or tool to interfacing with another one of the
plurality of motors of the surgical instrument or tool.
[0224] In at least one example, the common control module 610 can
be selectively switched between operable engagement with the
articulation motors 606a, 606b and operable engagement with either
the firing motor 602 or the closure motor 603. In at least one
example, as illustrated in FIG. 16, a switch 614 can be moved or
transitioned between a plurality of positions and/or states. In a
first position 616, the switch 614 may electrically couple the
common control module 610 to the firing motor 602; in a second
position 617, the switch 614 may electrically couple the common
control module 610 to the closure motor 603; in a third position
618a, the switch 614 may electrically couple the common control
module 610 to the first articulation motor 606a; and in a fourth
position 618b, the switch 614 may electrically couple the common
control module 610 to the second articulation motor 606b, for
example. In certain instances, separate common control modules 610
can be electrically coupled to the firing motor 602, the closure
motor 603, and the articulations motor 606a, 606b at the same time.
In certain instances, the switch 614 may be a mechanical switch, an
electromechanical switch, a solid-state switch, or any suitable
switching mechanism.
[0225] Each of the motors 602, 603, 606a, 606b may comprise a
torque sensor to measure the output torque on the shaft of the
motor. The force on an end effector may be sensed in any
conventional manner, such as by force sensors on the outer sides of
the jaws or by a torque sensor for the motor actuating the
jaws.
[0226] In various instances, as illustrated in FIG. 16, the common
control module 610 may comprise a motor driver 626 which may
comprise one or more H-Bridge FETs. The motor driver 626 may
modulate the power transmitted from a power source 628 to a motor
coupled to the common control module 610 based on input from a
microcontroller 620 (the "controller"), for example. In certain
instances, the microcontroller 620 can be employed to determine the
current drawn by the motor, for example, while the motor is coupled
to the common control module 610, as described above.
[0227] In certain instances, the microcontroller 620 may include a
microprocessor 622 (the "processor") and one or more non-transitory
computer-readable mediums or memory units 624 (the "memory"). In
certain instances, the memory 624 may store various program
instructions, which when executed may cause the processor 622 to
perform a plurality of functions and/or calculations described
herein. In certain instances, one or more of the memory units 624
may be coupled to the processor 622, for example.
[0228] In certain instances, the power source 628 can be employed
to supply power to the microcontroller 620, for example. In certain
instances, the power source 628 may comprise a battery (or "battery
pack" or "power pack"), such as a lithium-ion battery, for example.
In certain instances, the battery pack may be configured to be
releasably mounted to a handle for supplying power to the surgical
instrument 600. A number of battery cells connected in series may
be used as the power source 628. In certain instances, the power
source 628 may be replaceable and/or rechargeable, for example.
[0229] In various instances, the processor 622 may control the
motor driver 626 to control the position, direction of rotation,
and/or velocity of a motor that is coupled to the common control
module 610. In certain instances, the processor 622 can signal the
motor driver 626 to stop and/or disable a motor that is coupled to
the common control module 610. It should be understood that the
term "processor" as used herein includes any suitable
microprocessor, microcontroller, or other basic computing device
that incorporates the functions of a computer's central processing
unit (CPU) on an integrated circuit or, at most, a few integrated
circuits. The processor is a multipurpose, programmable device that
accepts digital data as input, processes it according to
instructions stored in its memory, and provides results as output.
It is an example of sequential digital logic, as it has internal
memory. Processors operate on numbers and symbols represented in
the binary numeral system.
[0230] In one instance, the processor 622 may be any single-core or
multicore processor such as those known under the trade name ARM
Cortex by Texas Instruments. In certain instances, the
microcontroller 620 may be an LM 4F230H5QR, available from Texas
Instruments, for example. In at least one example, the Texas
Instruments LM4F230H5QR is an ARM Cortex-M4F Processor Core
comprising an on-chip memory of 256 KB single-cycle flash memory,
or other non-volatile memory, up to 40 MHz, a prefetch buffer to
improve performance above 40 MHz, a 32 KB single-cycle SRAM, an
internal ROM loaded with StellarisWare.RTM. software, a 2 KB
EEPROM, one or more PWM modules, one or more QEI analogs, one or
more 12-bit ADCs with 12 analog input channels, among other
features that are readily available for the product datasheet.
Other microcontrollers may be readily substituted for use with the
module 4410. Accordingly, the present disclosure should not be
limited in this context.
[0231] In certain instances, the memory 624 may include program
instructions for controlling each of the motors of the surgical
instrument 600 that are couplable to the common control module 610.
For example, the memory 624 may include program instructions for
controlling the firing motor 602, the closure motor 603, and the
articulation motors 606a, 606b. Such program instructions may cause
the processor 622 to control the firing, closure, and articulation
functions in accordance with inputs from algorithms or control
programs of the surgical instrument or tool.
[0232] In certain instances, one or more mechanisms and/or sensors
such as, for example, sensors 630 can be employed to alert the
processor 622 to the program instructions that should be used in a
particular setting. For example, the sensors 630 may alert the
processor 622 to use the program instructions associated with
firing, closing, and articulating the end effector. In certain
instances, the sensors 630 may comprise position sensors which can
be employed to sense the position of the switch 614, for example.
Accordingly, the processor 622 may use the program instructions
associated with firing the I-beam of the end effector upon
detecting, through the sensors 630 for example, that the switch 614
is in the first position 616; the processor 622 may use the program
instructions associated with closing the anvil upon detecting,
through the sensors 630 for example, that the switch 614 is in the
second position 617; and the processor 622 may use the program
instructions associated with articulating the end effector upon
detecting, through the sensors 630 for example, that the switch 614
is in the third or fourth position 618a, 618b.
[0233] FIG. 17 is a schematic diagram of a robotic surgical
instrument 700 configured to operate a surgical tool described
herein according to one aspect of this disclosure. The robotic
surgical instrument 700 may be programmed or configured to control
distal/proximal translation of a displacement member,
distal/proximal displacement of a closure tube, shaft rotation, and
articulation, either with single or multiple articulation drive
links. In one aspect, the surgical instrument 700 may be programmed
or configured to individually control a firing member, a closure
member, a shaft member, and/or one or more articulation members.
The surgical instrument 700 comprises a control circuit 710
configured to control motor-driven firing members, closure members,
shaft members, and/or one or more articulation members.
[0234] In one aspect, the robotic surgical instrument 700 comprises
a control circuit 710 configured to control an anvil 716 and an
I-beam 714 (including a sharp cutting edge) portion of an end
effector 702, a removable staple cartridge 718, a shaft 740, and
one or more articulation members 742a, 742b via a plurality of
motors 704a-704e. A position sensor 734 may be configured to
provide position feedback of the I-beam 714 to the control circuit
710. Other sensors 738 may be configured to provide feedback to the
control circuit 710. A timer/counter 731 provides timing and
counting information to the control circuit 710. An energy source
712 may be provided to operate the motors 704a-704e, and a current
sensor 736 provides motor current feedback to the control circuit
710. The motors 704a-704e can be operated individually by the
control circuit 710 in an open-loop or closed-loop feedback
control.
[0235] In one aspect, the control circuit 710 may comprise one or
more microcontrollers, microprocessors, or other suitable
processors for executing instructions that cause the processor or
processors to perform one or more tasks. In one aspect, a
timer/counter 731 provides an output signal, such as the elapsed
time or a digital count, to the control circuit 710 to correlate
the position of the I-beam 714 as determined by the position sensor
734 with the output of the timer/counter 731 such that the control
circuit 710 can determine the position of the I-beam 714 at a
specific time (t) relative to a starting position or the time (t)
when the I-beam 714 is at a specific position relative to a
starting position. The timer/counter 731 may be configured to
measure elapsed time, count external events, or time external
events.
[0236] In one aspect, the control circuit 710 may be programmed to
control functions of the end effector 702 based on one or more
tissue conditions. The control circuit 710 may be programmed to
sense tissue conditions, such as thickness, either directly or
indirectly, as described herein. The control circuit 710 may be
programmed to select a firing control program or closure control
program based on tissue conditions. A firing control program may
describe the distal motion of the displacement member. Different
firing control programs may be selected to better treat different
tissue conditions. For example, when thicker tissue is present, the
control circuit 710 may be programmed to translate the displacement
member at a lower velocity and/or with lower power. When thinner
tissue is present, the control circuit 710 may be programmed to
translate the displacement member at a higher velocity and/or with
higher power. A closure control program may control the closure
force applied to the tissue by the anvil 716. Other control
programs control the rotation of the shaft 740 and the articulation
members 742a, 742b.
[0237] In one aspect, the control circuit 710 may generate motor
set point signals. The motor set point signals may be provided to
various motor controllers 708a-708e. The motor controllers
708a-708e may 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. In some examples, the motors
704a-704e may be brushed DC electric motors. For example, the
velocity of the motors 704a-704e may be proportional to the
respective motor drive signals. In some examples, the motors
704a-704e may be brushless DC electric motors, and the respective
motor drive signals may comprise a PWM signal provided to one or
more stator windings of the motors 704a-704e. Also, in some
examples, the motor controllers 708a-708e may be omitted and the
control circuit 710 may generate the motor drive signals
directly.
[0238] 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 a stroke of the displacement member.
Based on the response of the robotic surgical instrument 700 during
the open-loop portion of the stroke, the control circuit 710 may
select a firing control program in a closed-loop configuration. The
response of the instrument may include a translation distance of
the displacement member during the open-loop portion, a time
elapsed during the open-loop portion, the energy provided to one of
the motors 704a-704e during the open-loop portion, a sum of pulse
widths of a motor drive signal, etc. After the open-loop portion,
the control circuit 710 may implement the selected firing control
program for a second portion of the displacement member stroke. For
example, during a closed-loop portion of the stroke, the control
circuit 710 may modulate one of the motors 704a-704e based on
translation data describing a position of the displacement member
in a closed-loop manner to translate the displacement member at a
constant velocity.
[0239] In one aspect, the motors 704a-704e may receive power from
an energy source 712. The energy source 712 may be a DC power
supply driven by a main alternating current power source, a
battery, a super capacitor, or any other suitable energy source.
The motors 704a-704e may be mechanically coupled to individual
movable mechanical elements such as the I-beam 714, anvil 716,
shaft 740, articulation 742a, and articulation 742b via respective
transmissions 706a-706e. The transmissions 706a-706e may include
one or more gears or other linkage components to couple the motors
704a-704e to movable mechanical elements. A position sensor 734 may
sense a position of the I-beam 714. The position sensor 734 may be
or include any type of sensor that is capable of generating
position data that indicate a position of the I-beam 714. In some
examples, the position sensor 734 may include an encoder configured
to provide a series of pulses to the control circuit 710 as the
I-beam 714 translates distally and proximally. The control circuit
710 may track the pulses to determine the position of the I-beam
714. Other suitable position sensors may be used, including, for
example, a proximity sensor. Other types of position sensors may
provide other signals indicating motion of the I-beam 714. Also, in
some examples, the position sensor 734 may be omitted. Where any of
the motors 704a-704e is a stepper motor, the control circuit 710
may track the position of the I-beam 714 by aggregating the number
and direction of steps that the motor 704 has been instructed to
execute. The position sensor 734 may be located in the end effector
702 or at any other portion of the instrument. The outputs of each
of the motors 704a-704e include a torque sensor 744a-744e to sense
force and have an encoder to sense rotation of the drive shaft.
[0240] In one aspect, the control circuit 710 is configured to
drive a firing member such as the I-beam 714 portion of the end
effector 702. The control circuit 710 provides a motor set point to
a motor control 708a, which provides a drive signal to the motor
704a. The output shaft of the motor 704a is coupled to a torque
sensor 744a. The torque sensor 744a is coupled to a transmission
706a which is coupled to the I-beam 714. The transmission 706a
comprises movable mechanical elements such as rotating elements and
a firing member to control the movement of the I-beam 714 distally
and proximally along a longitudinal axis of the end effector 702.
In one aspect, the motor 704a may be coupled to the knife gear
assembly, which includes a knife gear reduction set that includes a
first knife drive gear and a second knife drive gear. A torque
sensor 744a provides a firing force feedback signal to the control
circuit 710. The firing force signal represents the force required
to fire or displace the I-beam 714. A position sensor 734 may be
configured to provide the position of the I-beam 714 along the
firing stroke or the position of the firing member as a feedback
signal to the control circuit 710. The end effector 702 may include
additional sensors 738 configured to provide feedback signals to
the control circuit 710. When ready to use, the control circuit 710
may provide a firing signal to the motor control 708a. In response
to the firing signal, the motor 704a may drive the firing member
distally along the longitudinal axis of the end effector 702 from a
proximal stroke start position to a stroke end position distal to
the stroke start position. As the firing member translates
distally, an I-beam 714, with a cutting element positioned at a
distal end, advances distally to cut tissue located between the
staple cartridge 718 and the anvil 716.
[0241] In one aspect, the control circuit 710 is configured to
drive a closure member such as the anvil 716 portion of the end
effector 702. The control circuit 710 provides a motor set point to
a motor control 708b, which provides a drive signal to the motor
704b. The output shaft of the motor 704b is coupled to a torque
sensor 744b. The torque sensor 744b is coupled to a transmission
706b which is coupled to the anvil 716. The transmission 706b
comprises movable mechanical elements such as rotating elements and
a closure member to control the movement of the anvil 716 from the
open and closed positions. In one aspect, the motor 704b is coupled
to a closure gear assembly, which includes a closure reduction gear
set that is supported in meshing engagement with the closure spur
gear. The torque sensor 744b provides a closure force feedback
signal to the control circuit 710. The closure force feedback
signal represents the closure force applied to the anvil 716. The
position sensor 734 may be configured to provide the position of
the closure member as a feedback signal to the control circuit 710.
Additional sensors 738 in the end effector 702 may provide the
closure force feedback signal to the control circuit 710. The
pivotable anvil 716 is positioned opposite the staple cartridge
718. When ready to use, the control circuit 710 may provide a
closure signal to the motor control 708b. In response to the
closure signal, the motor 704b advances a closure member to grasp
tissue between the anvil 716 and the staple cartridge 718.
[0242] In one aspect, the control circuit 710 is configured to
rotate a shaft member such as the shaft 740 to rotate the end
effector 702. The control circuit 710 provides a motor set point to
a motor control 708c, which provides a drive signal to the motor
704c. The output shaft of the motor 704c is coupled to a torque
sensor 744c. The torque sensor 744c is coupled to a transmission
706c which is coupled to the shaft 740. The transmission 706c
comprises movable mechanical elements such as rotating elements to
control the rotation of the shaft 740 clockwise or counterclockwise
up to and over 360.degree.. In one aspect, the motor 704c is
coupled to the rotational transmission assembly, which includes a
tube gear segment that is formed on (or attached to) the proximal
end of the proximal closure tube for operable engagement by a
rotational gear assembly that is operably supported on the tool
mounting plate. The torque sensor 744c provides a rotation force
feedback signal to the control circuit 710. The rotation force
feedback signal represents the rotation force applied to the shaft
740. The position sensor 734 may be configured to provide the
position of the closure member as a feedback signal to the control
circuit 710. Additional sensors 738 such as a shaft encoder may
provide the rotational position of the shaft 740 to the control
circuit 710.
[0243] In one aspect, the control circuit 710 is configured to
articulate the end effector 702. The control circuit 710 provides a
motor set point to a motor control 708d, which provides a drive
signal to the motor 704d. The output shaft of the motor 704d is
coupled to a torque sensor 744d. The torque sensor 744d is coupled
to a transmission 706d which is coupled to an articulation member
742a. The transmission 706d comprises movable mechanical elements
such as articulation elements to control the articulation of the
end effector 702 .+-.65.degree.. In one aspect, the motor 704d is
coupled to an articulation nut, which is rotatably journaled on the
proximal end portion of the distal spine portion and is rotatably
driven thereon by an articulation gear assembly. The torque sensor
744d provides an articulation force feedback signal to the control
circuit 710. The articulation force feedback signal represents the
articulation force applied to the end effector 702. Sensors 738,
such as an articulation encoder, may provide the articulation
position of the end effector 702 to the control circuit 710.
[0244] In another aspect, the articulation function of the robotic
surgical system 700 may comprise two articulation members, or
links, 742a, 742b. These articulation members 742a, 742b are driven
by separate disks on the robot interface (the rack) which are
driven by the two motors 708d, 708e. When the separate firing motor
704a is provided, each of articulation links 742a, 742b can be
antagonistically driven with respect to the other link in order to
provide a resistive holding motion and a load to the head when it
is not moving and to provide an articulation motion as the head is
articulated. The articulation members 742a, 742b attach to the head
at a fixed radius as the head is rotated. Accordingly, the
mechanical advantage of the push-and-pull link changes as the head
is rotated. This change in the mechanical advantage may be more
pronounced with other articulation link drive systems.
[0245] In one aspect, the one or more motors 704a-704e may comprise
a brushed DC motor with a gearbox and mechanical links to a firing
member, closure member, or articulation member. Another example
includes electric motors 704a-704e that operate the movable
mechanical elements such as the displacement member, articulation
links, closure tube, and shaft. An outside influence is an
unmeasured, unpredictable influence of things like tissue,
surrounding bodies, and friction on the physical system. Such
outside influence can be referred to as drag, which acts in
opposition to one of electric motors 704a-704e. The outside
influence, such as drag, may cause the operation of the physical
system to deviate from a desired operation of the physical
system.
[0246] In one aspect, the position sensor 734 may be implemented as
an absolute positioning system. In one aspect, the position sensor
734 may comprise a magnetic rotary absolute positioning system
implemented as an AS5055EQFT single-chip magnetic rotary position
sensor available from Austria Microsystems, AG. The position sensor
734 may interface with the control circuit 710 to provide an
absolute positioning system. The position may include multiple
Hall-effect elements located above a magnet and coupled to a CORDIC
processor, also known as the digit-by-digit method and Volder's
algorithm, that is provided to implement a simple and efficient
algorithm to calculate hyperbolic and trigonometric functions that
require only addition, subtraction, bitshift, and table lookup
operations.
[0247] In one aspect, the control circuit 710 may be in
communication with one or more sensors 738. The sensors 738 may be
positioned on the end effector 702 and adapted to operate with the
robotic surgical instrument 700 to measure the various derived
parameters such as the gap distance versus time, tissue compression
versus time, and anvil strain versus time. The sensors 738 may
comprise a magnetic sensor, a magnetic field sensor, a strain
gauge, a load cell, a pressure sensor, a force sensor, a torque
sensor, an inductive sensor such as an eddy current sensor, a
resistive sensor, a capacitive sensor, an optical sensor, and/or
any other suitable sensor for measuring one or more parameters of
the end effector 702. The sensors 738 may include one or more
sensors. The sensors 738 may be located on the staple cartridge 718
deck to determine tissue location using segmented electrodes. The
torque sensors 744a-744e may be configured to sense force such as
firing force, closure force, and/or articulation force, among
others. Accordingly, the control circuit 710 can sense (1) the
closure load experienced by the distal closure tube and its
position, (2) the firing member at the rack and its position, (3)
what portion of the staple cartridge 718 has tissue on it, and (4)
the load and position on both articulation rods.
[0248] In one aspect, the one or more sensors 738 may comprise a
strain gauge, such as a micro-strain gauge, configured to measure
the magnitude of the strain in the anvil 716 during a clamped
condition. The strain gauge provides an electrical signal whose
amplitude varies with the magnitude of the strain. The sensors 738
may comprise a pressure sensor configured to detect a pressure
generated by the presence of compressed tissue between the anvil
716 and the staple cartridge 718. The sensors 738 may be configured
to detect impedance of a tissue section located between the anvil
716 and the staple cartridge 718 that is indicative of the
thickness and/or fullness of tissue located therebetween.
[0249] In one aspect, the sensors 738 may be implemented as one or
more limit switches, electromechanical devices, solid-state
switches, Hall-effect devices, magneto-resistive (MR) devices,
giant magneto-resistive (GMR) devices, magnetometers, among others.
In other implementations, the sensors 738 may be implemented as
solid-state switches that operate under the influence of light,
such as optical sensors, IR sensors, ultraviolet sensors, among
others. Still, the switches may be solid-state devices such as
transistors (e.g., FET, junction FET, MOSFET, bipolar, and the
like). In other implementations, the sensors 738 may include
electrical conductorless switches, ultrasonic switches,
accelerometers, and inertial sensors, among others.
[0250] In one aspect, the sensors 738 may be configured to measure
forces exerted on the anvil 716 by the closure drive system. For
example, one or more sensors 738 can be at an interaction point
between the closure tube and the anvil 716 to detect the closure
forces applied by the closure tube to the anvil 716. The forces
exerted on the anvil 716 can be representative of the tissue
compression experienced by the tissue section captured between the
anvil 716 and the staple cartridge 718. The one or more sensors 738
can be positioned at various interaction points along the closure
drive system to detect the closure forces applied to the anvil 716
by the closure drive system. The one or more sensors 738 may be
sampled in real time during a clamping operation by the processor
of the control circuit 710. The control circuit 710 receives
real-time sample measurements to provide and analyze time-based
information and assess, in real time, closure forces applied to the
anvil 716.
[0251] In one aspect, a current sensor 736 can be employed 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 the I-beam 714 corresponds to the current drawn by one of
the motors 704a-704e. The force is converted to a digital signal
and provided to the control circuit 710. The control circuit 710
can be configured to simulate the response of the actual system of
the instrument in the software of the controller. A displacement
member can be actuated to move an I-beam 714 in the end effector
702 at or near a target velocity. The robotic surgical instrument
700 can include a feedback controller, which can be one of any
feedback controllers, including, but not limited to a PID, a state
feedback, a linear-quadratic (LQR), and/or an adaptive controller,
for example. The robotic surgical instrument 700 can include a
power source to convert the signal from the feedback controller
into a physical input such as case voltage, PWM voltage, frequency
modulated voltage, current, torque, and/or force, for example.
Additional details are disclosed in U.S. patent application Ser.
No. 15/636,829, titled CLOSED LOOP VELOCITY CONTROL TECHNIQUES FOR
ROBOTIC SURGICAL INSTRUMENT, filed Jun. 29, 2017, which is herein
incorporated by reference in its entirety.
[0252] FIG. 18 illustrates a block diagram of a surgical instrument
750 programmed to control the distal translation of a displacement
member according to one aspect of this disclosure. In one aspect,
the surgical instrument 750 is programmed to control the distal
translation of a displacement member such as the I-beam 764. The
surgical instrument 750 comprises an end effector 752 that may
comprise an anvil 766, an I-beam 764 (including a sharp cutting
edge), and a removable staple cartridge 768.
[0253] The position, movement, displacement, and/or translation of
a linear displacement member, such as the I-beam 764, can be
measured by an absolute positioning system, sensor arrangement, and
position sensor 784. Because the I-beam 764 is coupled to a
longitudinally movable drive member, the position of the I-beam 764
can be determined by measuring the position of the longitudinally
movable drive member employing the position sensor 784.
Accordingly, in the following description, the position,
displacement, and/or translation of the I-beam 764 can be achieved
by the position sensor 784 as described herein. A control circuit
760 may be programmed to control the translation of the
displacement member, such as the I-beam 764. The control circuit
760, in some examples, may comprise one or more microcontrollers,
microprocessors, or other suitable processors for executing
instructions that cause the processor or processors to control the
displacement member, e.g., the I-beam 764, in the manner described.
In one aspect, a timer/counter 781 provides an output signal, such
as the elapsed time or a digital count, to the control circuit 760
to correlate the position of the I-beam 764 as determined by the
position sensor 784 with the output of the timer/counter 781 such
that the control circuit 760 can determine the position of the
I-beam 764 at a specific time (t) relative to a starting position.
The timer/counter 781 may be configured to measure elapsed time,
count external events, or time external events.
[0254] The control circuit 760 may generate a motor set point
signal 772. The motor set point signal 772 may be provided to a
motor controller 758. The motor controller 758 may comprise one or
more circuits configured to provide a motor drive signal 774 to the
motor 754 to drive the motor 754 as described herein. In some
examples, the motor 754 may be a brushed DC electric motor. For
example, the velocity of the motor 754 may be proportional to the
motor drive signal 774. In some examples, the motor 754 may be a
brushless DC electric motor and the motor drive signal 774 may
comprise a PWM signal provided to one or more stator windings of
the motor 754. Also, in some examples, the motor controller 758 may
be omitted, and the control circuit 760 may generate the motor
drive signal 774 directly.
[0255] The motor 754 may receive power from an energy source 762.
The energy source 762 may be or include a battery, a super
capacitor, or any other suitable energy source. The motor 754 may
be mechanically coupled to the I-beam 764 via a transmission 756.
The transmission 756 may include one or more gears or other linkage
components to couple the motor 754 to the I-beam 764. A position
sensor 784 may sense a position of the I-beam 764. The position
sensor 784 may be or include any type of sensor that is capable of
generating position data that indicate a position of the I-beam
764. In some examples, the position sensor 784 may include an
encoder configured to provide a series of pulses to the control
circuit 760 as the I-beam 764 translates distally and proximally.
The control circuit 760 may track the pulses to determine the
position of the I-beam 764. Other suitable position sensors may be
used, including, for example, a proximity sensor. Other types of
position sensors may provide other signals indicating motion of the
I-beam 764. Also, in some examples, the position sensor 784 may be
omitted. Where the motor 754 is a stepper motor, the control
circuit 760 may track the position of the I-beam 764 by aggregating
the number and direction of steps that the motor 754 has been
instructed to execute. The position sensor 784 may be located in
the end effector 752 or at any other portion of the instrument.
[0256] The control circuit 760 may be in communication with one or
more sensors 788. The sensors 788 may be positioned on the end
effector 752 and adapted to operate with the surgical instrument
750 to measure the various derived parameters such as gap distance
versus time, tissue compression versus time, and anvil strain
versus time. The sensors 788 may comprise a magnetic sensor, a
magnetic field sensor, a strain gauge, a pressure sensor, a force
sensor, an inductive sensor such as an eddy current sensor, a
resistive sensor, a capacitive sensor, an optical sensor, and/or
any other suitable sensor for measuring one or more parameters of
the end effector 752. The sensors 788 may include one or more
sensors.
[0257] The one or more sensors 788 may comprise a strain gauge,
such as a micro-strain gauge, configured to measure the magnitude
of the strain in the anvil 766 during a clamped condition. The
strain gauge provides an electrical signal whose amplitude varies
with the magnitude of the strain. The sensors 788 may comprise a
pressure sensor configured to detect a pressure generated by the
presence of compressed tissue between the anvil 766 and the staple
cartridge 768. The sensors 788 may be configured to detect
impedance of a tissue section located between the anvil 766 and the
staple cartridge 768 that is indicative of the thickness and/or
fullness of tissue located therebetween.
[0258] The sensors 788 may be is configured to measure forces
exerted on the anvil 766 by a closure drive system. For example,
one or more sensors 788 can be at an interaction point between a
closure tube and the anvil 766 to detect the closure forces applied
by a closure tube to the anvil 766. The forces exerted on the anvil
766 can be representative of the tissue compression experienced by
the tissue section captured between the anvil 766 and the staple
cartridge 768. The one or more sensors 788 can be positioned at
various interaction points along the closure drive system to detect
the closure forces applied to the anvil 766 by the closure drive
system. The one or more sensors 788 may be sampled in real time
during a clamping operation by a processor of the control circuit
760. The control circuit 760 receives real-time sample measurements
to provide and analyze time-based information and assess, in real
time, closure forces applied to the anvil 766.
[0259] A current sensor 786 can be employed to measure the current
drawn by the motor 754. The force required to advance the I-beam
764 corresponds to the current drawn by the motor 754. The force is
converted to a digital signal and provided to the control circuit
760.
[0260] The control circuit 760 can be configured to simulate the
response of the actual system of the instrument in the software of
the controller. A displacement member can be actuated to move an
I-beam 764 in the end effector 752 at or near a target velocity.
The surgical instrument 750 can include a feedback controller,
which can be one of any feedback controllers, including, but not
limited to a PID, a state feedback, LQR, and/or an adaptive
controller, for example. The surgical instrument 750 can include a
power source to convert the signal from the feedback controller
into a physical input such as case voltage, PWM voltage, frequency
modulated voltage, current, torque, and/or force, for example.
[0261] The actual drive system of the surgical instrument 750 is
configured to drive the displacement member, cutting member, or
I-beam 764, by a brushed DC motor with gearbox and mechanical links
to an articulation and/or knife system. Another example is the
electric motor 754 that operates the displacement member and the
articulation driver, for example, of an interchangeable shaft
assembly. An outside influence is an unmeasured, unpredictable
influence of things like tissue, surrounding bodies and friction on
the physical system. Such outside influence can be referred to as
drag which acts in opposition to the electric motor 754. The
outside influence, such as drag, may cause the operation of the
physical system to deviate from a desired operation of the physical
system.
[0262] Various example aspects are directed to a surgical
instrument 750 comprising an end effector 752 with motor-driven
surgical stapling and cutting implements. For example, a motor 754
may drive a displacement member distally and proximally along a
longitudinal axis of the end effector 752. The end effector 752 may
comprise a pivotable anvil 766 and, when configured for use, a
staple cartridge 768 positioned opposite the anvil 766. A clinician
may grasp tissue between the anvil 766 and the staple cartridge
768, as described herein. When ready to use the instrument 750, the
clinician may provide a firing signal, for example by depressing a
trigger of the instrument 750. In response to the firing signal,
the motor 754 may drive the displacement member distally along the
longitudinal axis of the end effector 752 from a proximal stroke
begin position to a stroke end position distal of the stroke begin
position. As the displacement member translates distally, an I-beam
764 with a cutting element positioned at a distal end, may cut the
tissue between the staple cartridge 768 and the anvil 766.
[0263] In various examples, the surgical instrument 750 may
comprise a control circuit 760 programmed to control the distal
translation of the displacement member, such as the I-beam 764, for
example, based on one or more tissue conditions. The control
circuit 760 may be programmed to sense tissue conditions, such as
thickness, either directly or indirectly, as described herein. The
control circuit 760 may be programmed to select a firing control
program based on tissue conditions. A firing control program may
describe the distal motion of the displacement member. Different
firing control programs may be selected to better treat different
tissue conditions. For example, when thicker tissue is present, the
control circuit 760 may be programmed to translate the displacement
member at a lower velocity and/or with lower power. When thinner
tissue is present, the control circuit 760 may be programmed to
translate the displacement member at a higher velocity and/or with
higher power.
[0264] In some examples, the control circuit 760 may initially
operate the motor 754 in an open loop configuration for a first
open loop portion of a stroke of the displacement member. Based on
a response of the instrument 750 during the open loop portion of
the stroke, the control circuit 760 may select a firing control
program. The response of the instrument may include, a translation
distance of the displacement member during the open loop portion, a
time elapsed during the open loop portion, energy provided to the
motor 754 during the open loop portion, a sum of pulse widths of a
motor drive signal, etc. After the open loop portion, the control
circuit 760 may implement the selected firing control program for a
second portion of the displacement member stroke. For example,
during the closed loop portion of the stroke, the control circuit
760 may modulate the motor 754 based on translation data describing
a position of the displacement member in a closed loop manner to
translate the displacement member at a constant velocity.
Additional details are disclosed in U.S. patent application Ser.
No. 15/720,852, titled SYSTEM AND METHODS FOR CONTROLLING A DISPLAY
OF A SURGICAL INSTRUMENT, filed Sep. 29, 2017, which is herein
incorporated by reference in its entirety.
[0265] FIG. 19 is a schematic diagram of a surgical instrument 790
configured to control various functions according to one aspect of
this disclosure. In one aspect, the surgical instrument 790 is
programmed to control distal translation of a displacement member
such as the I-beam 764. The surgical instrument 790 comprises an
end effector 792 that may comprise an anvil 766, an I-beam 764, and
a removable staple cartridge 768 which may be interchanged with an
RF cartridge 796 (shown in dashed line).
[0266] In one aspect, sensors 788 may be implemented as a limit
switch, electromechanical device, solid-state switches, Hall-effect
devices, MR devices, GMR devices, magnetometers, among others. In
other implementations, the sensors 638 may be solid-state switches
that operate under the influence of light, such as optical sensors,
IR sensors, ultraviolet sensors, among others. Still, the switches
may be solid-state devices such as transistors (e.g., FET, junction
FET, MOSFET, bipolar, and the like). In other implementations, the
sensors 788 may include electrical conductorless switches,
ultrasonic switches, accelerometers, and inertial sensors, among
others.
[0267] In one aspect, the position sensor 784 may be implemented as
an absolute positioning system comprising a magnetic rotary
absolute positioning system implemented as an AS5055EQFT
single-chip magnetic rotary position sensor available from Austria
Microsystems, AG. The position sensor 784 may interface with the
control circuit 760 to provide an absolute positioning system. The
position may include multiple Hall-effect elements located above a
magnet and coupled to a CORDIC processor, also known as the
digit-by-digit method and Volder's algorithm, that is provided to
implement a simple and efficient algorithm to calculate hyperbolic
and trigonometric functions that require only addition,
subtraction, bitshift, and table lookup operations.
[0268] In one aspect, the I-beam 764 may be implemented as a knife
member comprising a knife body that operably supports a tissue
cutting blade thereon and may further include anvil engagement tabs
or features and channel engagement features or a foot. In one
aspect, the staple cartridge 768 may be implemented as a standard
(mechanical) surgical fastener cartridge. In one aspect, the RF
cartridge 796 may be implemented as an RF cartridge. These and
other sensors arrangements are described in commonly owned U.S.
patent application Ser. No. 15/628,175, titled TECHNIQUES FOR
ADAPTIVE CONTROL OF MOTOR VELOCITY OF A SURGICAL STAPLING AND
CUTTING INSTRUMENT, filed Jun. 20, 2017, which is herein
incorporated by reference in its entirety.
[0269] The position, movement, displacement, and/or translation of
a linear displacement member, such as the I-beam 764, can be
measured by an absolute positioning system, sensor arrangement, and
position sensor represented as position sensor 784. Because the
I-beam 764 is coupled to the longitudinally movable drive member,
the position of the I-beam 764 can be determined by measuring the
position of the longitudinally movable drive member employing the
position sensor 784. Accordingly, in the following description, the
position, displacement, and/or translation of the I-beam 764 can be
achieved by the position sensor 784 as described herein. A control
circuit 760 may be programmed to control the translation of the
displacement member, such as the I-beam 764, as described herein.
The control circuit 760, in some examples, may comprise one or more
microcontrollers, microprocessors, or other suitable processors for
executing instructions that cause the processor or processors to
control the displacement member, e.g., the I-beam 764, in the
manner described. In one aspect, a timer/counter 781 provides an
output signal, such as the elapsed time or a digital count, to the
control circuit 760 to correlate the position of the I-beam 764 as
determined by the position sensor 784 with the output of the
timer/counter 781 such that the control circuit 760 can determine
the position of the I-beam 764 at a specific time (t) relative to a
starting position. The timer/counter 781 may be configured to
measure elapsed time, count external events, or time external
events.
[0270] The control circuit 760 may generate a motor set point
signal 772. The motor set point signal 772 may be provided to a
motor controller 758. The motor controller 758 may comprise one or
more circuits configured to provide a motor drive signal 774 to the
motor 754 to drive the motor 754 as described herein. In some
examples, the motor 754 may be a brushed DC electric motor. For
example, the velocity of the motor 754 may be proportional to the
motor drive signal 774. In some examples, the motor 754 may be a
brushless DC electric motor and the motor drive signal 774 may
comprise a PWM signal provided to one or more stator windings of
the motor 754. Also, in some examples, the motor controller 758 may
be omitted, and the control circuit 760 may generate the motor
drive signal 774 directly.
[0271] The motor 754 may receive power from an energy source 762.
The energy source 762 may be or include a battery, a super
capacitor, or any other suitable energy source. The motor 754 may
be mechanically coupled to the I-beam 764 via a transmission 756.
The transmission 756 may include one or more gears or other linkage
components to couple the motor 754 to the I-beam 764. A position
sensor 784 may sense a position of the I-beam 764. The position
sensor 784 may be or include any type of sensor that is capable of
generating position data that indicate a position of the I-beam
764. In some examples, the position sensor 784 may include an
encoder configured to provide a series of pulses to the control
circuit 760 as the I-beam 764 translates distally and proximally.
The control circuit 760 may track the pulses to determine the
position of the I-beam 764. Other suitable position sensors may be
used, including, for example, a proximity sensor. Other types of
position sensors may provide other signals indicating motion of the
I-beam 764. Also, in some examples, the position sensor 784 may be
omitted. Where the motor 754 is a stepper motor, the control
circuit 760 may track the position of the I-beam 764 by aggregating
the number and direction of steps that the motor has been
instructed to execute. The position sensor 784 may be located in
the end effector 792 or at any other portion of the instrument.
[0272] The control circuit 760 may be in communication with one or
more sensors 788. The sensors 788 may be positioned on the end
effector 792 and adapted to operate with the surgical instrument
790 to measure the various derived parameters such as gap distance
versus time, tissue compression versus time, and anvil strain
versus time. The sensors 788 may comprise a magnetic sensor, a
magnetic field sensor, a strain gauge, a pressure sensor, a force
sensor, an inductive sensor such as an eddy current sensor, a
resistive sensor, a capacitive sensor, an optical sensor, and/or
any other suitable sensor for measuring one or more parameters of
the end effector 792. The sensors 788 may include one or more
sensors.
[0273] The one or more sensors 788 may comprise a strain gauge,
such as a micro-strain gauge, configured to measure the magnitude
of the strain in the anvil 766 during a clamped condition. The
strain gauge provides an electrical signal whose amplitude varies
with the magnitude of the strain. The sensors 788 may comprise a
pressure sensor configured to detect a pressure generated by the
presence of compressed tissue between the anvil 766 and the staple
cartridge 768. The sensors 788 may be configured to detect
impedance of a tissue section located between the anvil 766 and the
staple cartridge 768 that is indicative of the thickness and/or
fullness of tissue located therebetween.
[0274] The sensors 788 may be is configured to measure forces
exerted on the anvil 766 by the closure drive system. For example,
one or more sensors 788 can be at an interaction point between a
closure tube and the anvil 766 to detect the closure forces applied
by a closure tube to the anvil 766. The forces exerted on the anvil
766 can be representative of the tissue compression experienced by
the tissue section captured between the anvil 766 and the staple
cartridge 768. The one or more sensors 788 can be positioned at
various interaction points along the closure drive system to detect
the closure forces applied to the anvil 766 by the closure drive
system. The one or more sensors 788 may be sampled in real time
during a clamping operation by a processor portion of the control
circuit 760. The control circuit 760 receives real-time sample
measurements to provide and analyze time-based information and
assess, in real time, closure forces applied to the anvil 766.
[0275] A current sensor 786 can be employed to measure the current
drawn by the motor 754. The force required to advance the I-beam
764 corresponds to the current drawn by the motor 754. The force is
converted to a digital signal and provided to the control circuit
760.
[0276] An RF energy source 794 is coupled to the end effector 792
and is applied to the RF cartridge 796 when the RF cartridge 796 is
loaded in the end effector 792 in place of the staple cartridge
768. The control circuit 760 controls the delivery of the RF energy
to the RF cartridge 796.
[0277] Additional details are disclosed in U.S. patent application
Ser. No. 15/636,096, titled SURGICAL SYSTEM COUPLABLE WITH STAPLE
CARTRIDGE AND RADIO FREQUENCY CARTRIDGE, AND METHOD OF USING SAME,
filed Jun. 28, 2017, which is herein incorporated by reference in
its entirety.
Generator Hardware
[0278] FIG. 20 is a simplified block diagram of a generator 800
configured to provide inductorless tuning, among other benefits.
Additional details of the generator 800 are described in U.S. Pat.
No. 9,060,775, titled SURGICAL GENERATOR FOR ULTRASONIC AND
ELECTROSURGICAL DEVICES, which issued on Jun. 23, 2015, which is
herein incorporated by reference in its entirety. The generator 800
may comprise a patient isolated stage 802 in communication with a
non-isolated stage 804 via a power transformer 806. A secondary
winding 808 of the power transformer 806 is contained in the
isolated stage 802 and may comprise a tapped configuration (e.g., a
center-tapped or a non-center-tapped configuration) to define drive
signal outputs 810a, 810b, 810c for delivering drive signals to
different surgical instruments, such as, for example, an ultrasonic
surgical instrument, an RF electrosurgical instrument, and a
multifunction surgical instrument which includes ultrasonic and RF
energy modes that can be delivered alone or simultaneously. In
particular, drive signal outputs 810a, 810c may output an
ultrasonic drive signal (e.g., a 420V root-mean-square (RMS) drive
signal) to an ultrasonic surgical instrument, and drive signal
outputs 810b, 810c may output an RF electrosurgical drive signal
(e.g., a 100V RMS drive signal) to an RF electrosurgical
instrument, with the drive signal output 810b corresponding to the
center tap of the power transformer 806.
[0279] In certain forms, the ultrasonic and electrosurgical drive
signals may be provided simultaneously to distinct surgical
instruments and/or to a single surgical instrument, such as the
multifunction surgical instrument, having the capability to deliver
both ultrasonic and electrosurgical energy to tissue. It will be
appreciated that the electrosurgical signal, provided either to a
dedicated electrosurgical instrument and/or to a combined
multifunction ultrasonic/electrosurgical instrument may be either a
therapeutic or sub-therapeutic level signal where the
sub-therapeutic signal can be used, for example, to monitor tissue
or instrument conditions and provide feedback to the generator. For
example, the ultrasonic and RF signals can be delivered separately
or simultaneously from a generator with a single output port in
order to provide the desired output signal to the surgical
instrument, as will be discussed in more detail below. Accordingly,
the generator can combine the ultrasonic and electrosurgical RF
energies and deliver the combined energies to the multifunction
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, working simultaneously. The ultrasonic energy may be
employed to dissect tissue, while the electrosurgical RF energy may
be employed for vessel sealing.
[0280] The non-isolated stage 804 may comprise a power amplifier
812 having an output connected to a primary winding 814 of the
power transformer 806. In certain forms, the power amplifier 812
may comprise a push-pull amplifier. For example, the non-isolated
stage 804 may further comprise a logic device 816 for supplying a
digital output to a digital-to-analog converter (DAC) circuit 818,
which in turn supplies a corresponding analog signal to an input of
the power amplifier 812. In certain forms, the logic device 816 may
comprise a programmable gate array (PGA), a FPGA, programmable
logic device (PLD), among other logic circuits, for example. The
logic device 816, by virtue of controlling the input of the power
amplifier 812 via the DAC circuit 818, may therefore control any of
a number of parameters (e.g., frequency, waveform shape, waveform
amplitude) of drive signals appearing at the drive signal outputs
810a, 810b, 810c. In certain forms and as discussed below, the
logic device 816, in conjunction with a processor (e.g., a DSP
discussed below), may implement a number of DSP-based and/or other
control algorithms to control parameters of the drive signals
output by the generator 800.
[0281] Power may be supplied to a power rail of the power amplifier
812 by a switch-mode regulator 820, e.g., a power converter. In
certain forms, the switch-mode regulator 820 may comprise an
adjustable buck regulator, for example. The non-isolated stage 804
may further comprise a first processor 822, which in one form may
comprise a DSP processor such as an Analog Devices ADSP-21469 SHARC
DSP, available from Analog Devices, Norwood, Mass., for example,
although in various forms any suitable processor may be employed.
In certain forms the DSP processor 822 may control the operation of
the switch-mode regulator 820 responsive to voltage feedback data
received from the power amplifier 812 by the DSP processor 822 via
an ADC circuit 824. In one form, for example, the DSP processor 822
may receive as input, via the ADC circuit 824, the waveform
envelope of a signal (e.g., an RF signal) being amplified by the
power amplifier 812. The DSP processor 822 may then control the
switch-mode regulator 820 (e.g., via a PWM output) such that the
rail voltage supplied to the power amplifier 812 tracks the
waveform envelope of the amplified signal. By dynamically
modulating the rail voltage of the power amplifier 812 based on the
waveform envelope, the efficiency of the power amplifier 812 may be
significantly improved relative to a fixed rail voltage amplifier
schemes.
[0282] In certain forms, the logic device 816, in conjunction with
the DSP processor 822, may implement a digital synthesis circuit
such as a direct digital synthesizer control scheme to control the
waveform shape, frequency, and/or amplitude of drive signals output
by the generator 800. In one form, for example, the logic device
816 may implement a DDS control algorithm by recalling waveform
samples stored in a dynamically updated lookup table (LUT), such as
a RAM LUT, which may be embedded in an FPGA. This control algorithm
is particularly useful for ultrasonic applications in which an
ultrasonic transducer, such as an ultrasonic transducer, may be
driven by a clean sinusoidal current at its resonant frequency.
Because other frequencies may excite parasitic resonances,
minimizing or reducing the total distortion of the motional branch
current may correspondingly minimize or reduce undesirable
resonance effects. Because the waveform shape of a drive signal
output by the generator 800 is impacted by various sources of
distortion present in the output drive circuit (e.g., the power
transformer 806, the power amplifier 812), voltage and current
feedback data based on the drive signal may be input into an
algorithm, such as an error control algorithm implemented by the
DSP processor 822, which compensates for distortion by suitably
pre-distorting or modifying the waveform samples stored in the LUT
on a dynamic, ongoing basis (e.g., in real time). In one form, the
amount or degree of pre-distortion applied to the LUT samples may
be based on the error between a computed motional branch current
and a desired current waveform shape, with the error being
determined on a sample-by-sample basis. In this way, the
pre-distorted LUT samples, when processed through the drive
circuit, may result in a motional branch drive signal having the
desired waveform shape (e.g., sinusoidal) for optimally driving the
ultrasonic transducer. In such forms, the LUT waveform samples will
therefore not represent the desired waveform shape of the drive
signal, but rather the waveform shape that is required to
ultimately produce the desired waveform shape of the motional
branch drive signal when distortion effects are taken into
account.
[0283] The non-isolated stage 804 may further comprise a first ADC
circuit 826 and a second ADC circuit 828 coupled to the output of
the power transformer 806 via respective isolation transformers
830, 832 for respectively sampling the voltage and current of drive
signals output by the generator 800. In certain forms, the ADC
circuits 826, 828 may be configured to sample at high speeds (e.g.,
80 mega samples per second (MSPS)) to enable oversampling of the
drive signals. In one form, for example, the sampling speed of the
ADC circuits 826, 828 may enable approximately 200.times.
(depending on frequency) oversampling of the drive signals. In
certain forms, the sampling operations of the ADC circuit 826, 828
may be performed by a single ADC circuit receiving input voltage
and current signals via a two-way multiplexer. The use of
high-speed sampling in forms of the generator 800 may enable, among
other things, calculation of the complex current flowing through
the motional branch (which may be used in certain forms to
implement DDS-based waveform shape control described above),
accurate digital filtering of the sampled signals, and calculation
of real power consumption with a high degree of precision. Voltage
and current feedback data output by the ADC circuits 826, 828 may
be received and processed (e.g., first-in-first-out (FIFO) buffer,
multiplexer) by the logic device 816 and stored in data memory for
subsequent retrieval by, for example, the DSP processor 822. As
noted above, voltage and current feedback data may be used as input
to an algorithm for pre-distorting or modifying LUT waveform
samples on a dynamic and ongoing basis. In certain forms, this may
require each stored voltage and current feedback data pair to be
indexed based on, or otherwise associated with, a corresponding LUT
sample that was output by the logic device 816 when the voltage and
current feedback data pair was acquired. Synchronization of the LUT
samples and the voltage and current feedback data in this manner
contributes to the correct timing and stability of the
pre-distortion algorithm.
[0284] In certain forms, the voltage and current feedback data may
be used to control the frequency and/or amplitude (e.g., current
amplitude) of the drive signals. In one form, for example, voltage
and current feedback data may be used to determine impedance phase.
The frequency of the drive signal may then be controlled to
minimize or reduce the difference between the determined impedance
phase and an impedance phase setpoint (e.g., 0.degree.), thereby
minimizing or reducing the effects of harmonic distortion and
correspondingly enhancing impedance phase measurement accuracy. The
determination of phase impedance and a frequency control signal may
be implemented in the DSP processor 822, for example, with the
frequency control signal being supplied as input to a DDS control
algorithm implemented by the logic device 816.
[0285] In another form, for example, the current feedback data may
be monitored in order to maintain the current amplitude of the
drive signal at a current amplitude setpoint. The current amplitude
setpoint may be specified directly or determined indirectly based
on specified voltage amplitude and power setpoints. In certain
forms, control of the current amplitude may be implemented by
control algorithm, such as, for example, a
proportional-integral-derivative (PID) control algorithm, in the
DSP processor 822. Variables controlled by the control algorithm to
suitably control the current amplitude of the drive signal may
include, for example, the scaling of the LUT waveform samples
stored in the logic device 816 and/or the full-scale output voltage
of the DAC circuit 818 (which supplies the input to the power
amplifier 812) via a DAC circuit 834.
[0286] The non-isolated stage 804 may further comprise a second
processor 836 for providing, among other things user interface (UI)
functionality. In one form, the UI processor 836 may comprise an
Atmel AT91SAM9263 processor having an ARM 926EJ-S core, available
from Atmel Corporation, San Jose, Calif., for example. Examples of
UI functionality supported by the UI processor 836 may include
audible and visual user feedback, communication with peripheral
devices (e.g., via a USB interface), communication with a foot
switch, communication with an input device (e.g., a touch screen
display) and communication with an output device (e.g., a speaker).
The UI processor 836 may communicate with the DSP processor 822 and
the logic device 816 (e.g., via SPI buses). Although the UI
processor 836 may primarily support UI functionality, it may also
coordinate with the DSP processor 822 to implement hazard
mitigation in certain forms. For example, the UI processor 836 may
be programmed to monitor various aspects of user input and/or other
inputs (e.g., touch screen inputs, foot switch inputs, temperature
sensor inputs) and may disable the drive output of the generator
800 when an erroneous condition is detected.
[0287] In certain forms, both the DSP processor 822 and the UI
processor 836, for example, may determine and monitor the operating
state of the generator 800. For the DSP processor 822, the
operating state of the generator 800 may dictate, for example,
which control and/or diagnostic processes are implemented by the
DSP processor 822. For the UI processor 836, the operating state of
the generator 800 may dictate, for example, which elements of a UI
(e.g., display screens, sounds) are presented to a user. The
respective DSP and UI processors 822, 836 may independently
maintain the current operating state of the generator 800 and
recognize and evaluate possible transitions out of the current
operating state. The DSP processor 822 may function as the master
in this relationship and determine when transitions between
operating states are to occur. The UI processor 836 may be aware of
valid transitions between operating states and may confirm if a
particular transition is appropriate. For example, when the DSP
processor 822 instructs the UI processor 836 to transition to a
specific state, the UI processor 836 may verify that requested
transition is valid. In the event that a requested transition
between states is determined to be invalid by the UI processor 836,
the UI processor 836 may cause the generator 800 to enter a failure
mode.
[0288] The non-isolated stage 804 may further comprise a controller
838 for monitoring input devices (e.g., a capacitive touch sensor
used for turning the generator 800 on and off, a capacitive touch
screen). In certain forms, the controller 838 may comprise at least
one processor and/or other controller device in communication with
the UI processor 836. In one form, for example, the controller 838
may comprise a processor (e.g., a Meg168 8-bit controller available
from Atmel) configured to monitor user input provided via one or
more capacitive touch sensors. In one form, the controller 838 may
comprise a touch screen controller (e.g., a QT5480 touch screen
controller available from Atmel) to control and manage the
acquisition of touch data from a capacitive touch screen.
[0289] In certain forms, when the generator 800 is in a "power off"
state, the controller 838 may continue to receive operating power
(e.g., via a line from a power supply of the generator 800, such as
the power supply 854 discussed below). In this way, the controller
838 may continue to monitor an input device (e.g., a capacitive
touch sensor located on a front panel of the generator 800) for
turning the generator 800 on and off. When the generator 800 is in
the power off state, the controller 838 may wake the power supply
(e.g., enable operation of one or more DC/DC voltage converters 856
of the power supply 854) if activation of the "on/off" input device
by a user is detected. The controller 838 may therefore initiate a
sequence for transitioning the generator 800 to a "power on" state.
Conversely, the controller 838 may initiate a sequence for
transitioning the generator 800 to the power off state if
activation of the "on/off" input device is detected when the
generator 800 is in the power on state. In certain forms, for
example, the controller 838 may report activation of the "on/off"
input device to the UI processor 836, which in turn implements the
necessary process sequence for transitioning the generator 800 to
the power off state. In such forms, the controller 838 may have no
independent ability for causing the removal of power from the
generator 800 after its power on state has been established.
[0290] In certain forms, the controller 838 may cause the generator
800 to provide audible or other sensory feedback for alerting the
user that a power on or power off sequence has been initiated. Such
an alert may be provided at the beginning of a power on or power
off sequence and prior to the commencement of other processes
associated with the sequence.
[0291] In certain forms, the isolated stage 802 may comprise an
instrument interface circuit 840 to, for example, provide a
communication interface between a control circuit of a surgical
instrument (e.g., a control circuit comprising handpiece switches)
and components of the non-isolated stage 804, such as, for example,
the logic device 816, the DSP processor 822, and/or the UI
processor 836. The instrument interface circuit 840 may exchange
information with components of the non-isolated stage 804 via a
communication link that maintains a suitable degree of electrical
isolation between the isolated and non-isolated stages 802, 804,
such as, for example, an IR-based communication link. Power may be
supplied to the instrument interface circuit 840 using, for
example, a low-dropout voltage regulator powered by an isolation
transformer driven from the non-isolated stage 804.
[0292] In one form, the instrument interface circuit 840 may
comprise a logic circuit 842 (e.g., logic circuit, programmable
logic circuit, PGA, FPGA, PLD) in communication with a signal
conditioning circuit 844. The signal conditioning circuit 844 may
be configured to receive a periodic signal from the logic circuit
842 (e.g., a 2 kHz square wave) to generate a bipolar interrogation
signal having an identical frequency. The interrogation signal may
be generated, for example, using a bipolar current source fed by a
differential amplifier. The interrogation signal may be
communicated to a surgical instrument control circuit (e.g., by
using a conductive pair in a cable that connects the generator 800
to the surgical instrument) and monitored to determine a state or
configuration of the control circuit. The control circuit may
comprise a number of switches, resistors, and/or diodes to modify
one or more characteristics (e.g., amplitude, rectification) of the
interrogation signal such that a state or configuration of the
control circuit is uniquely discernable based on the one or more
characteristics. In one form, for example, the signal conditioning
circuit 844 may comprise an ADC circuit for generating samples of a
voltage signal appearing across inputs of the control circuit
resulting from passage of interrogation signal therethrough. The
logic circuit 842 (or a component of the non-isolated stage 804)
may then determine the state or configuration of the control
circuit based on the ADC circuit samples.
[0293] In one form, the instrument interface circuit 840 may
comprise a first data circuit interface 846 to enable information
exchange between the logic circuit 842 (or other element of the
instrument interface circuit 840) and a first data circuit disposed
in or otherwise associated with a surgical instrument. In certain
forms, for example, a first data circuit may be disposed in a cable
integrally attached to a surgical instrument handpiece or in an
adaptor for interfacing a specific surgical instrument type or
model with the generator 800. The first data circuit may be
implemented in any suitable manner and may communicate with the
generator according to any suitable protocol, including, for
example, as described herein with respect to the first data
circuit. In certain forms, the first data circuit may comprise 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 comprise suitable
circuitry (e.g., discrete logic devices, a processor) to enable
communication between the logic circuit 842 and the first data
circuit. In other forms, the first data circuit interface 846 may
be integral with the logic circuit 842.
[0294] In certain forms, the first data circuit may store
information pertaining to the particular surgical instrument with
which it is associated. Such information may include, for example,
a model number, a serial number, a number of operations in which
the surgical instrument has been used, and/or any other type of
information. This information may be read by the instrument
interface circuit 840 (e.g., by the logic circuit 842), transferred
to a component of the non-isolated stage 804 (e.g., to logic device
816, DSP processor 822, and/or UI processor 836) for presentation
to a user via an output device and/or for controlling a function or
operation of the generator 800. Additionally, any type of
information may be communicated to the first data circuit for
storage therein via the first data circuit interface 846 (e.g.,
using the logic circuit 842). Such information may comprise, for
example, an updated number of operations in which the surgical
instrument has been used and/or dates and/or times of its
usage.
[0295] As discussed previously, a surgical instrument may be
detachable from a handpiece (e.g., the multifunction surgical
instrument may be detachable from the handpiece) to promote
instrument interchangeability and/or disposability. In such cases,
conventional generators may be limited in their ability to
recognize particular instrument configurations being used and to
optimize control and diagnostic processes accordingly. The addition
of readable data circuits to surgical instruments to address this
issue is problematic from a compatibility standpoint, however. For
example, designing a surgical instrument to remain backwardly
compatible with generators that lack the requisite data reading
functionality may be impractical due to, for example, differing
signal schemes, design complexity, and cost. Forms of instruments
discussed herein address these concerns by using data circuits that
may be implemented in existing surgical instruments economically
and with minimal design changes to preserve compatibility of the
surgical instruments with current generator platforms.
[0296] Additionally, forms of the generator 800 may enable
communication with instrument-based data circuits. For example, the
generator 800 may be configured to communicate with a second data
circuit contained in an instrument (e.g., the multifunction
surgical instrument). In some forms, the second data circuit may be
implemented in a many similar to that of the first data circuit
described herein. The instrument interface circuit 840 may comprise
a second data circuit interface 848 to enable this communication.
In one form, the second data circuit interface 848 may comprise a
tri-state digital interface, although other interfaces may also be
used. In certain 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
pertaining to the particular surgical instrument with which it is
associated. Such information may include, for example, a model
number, a serial number, a number of operations in which the
surgical instrument has been used, and/or any other type of
information.
[0297] In some forms, the second data circuit may store information
about the electrical and/or ultrasonic properties of an associated
ultrasonic transducer, end effector, or ultrasonic drive system.
For example, the first data circuit may indicate a burn-in
frequency slope, as described herein. Additionally or
alternatively, any type of information may be communicated to
second data circuit for storage therein via the second data circuit
interface 848 (e.g., using the logic circuit 842). Such information
may comprise, for example, an updated number of operations in which
the instrument has been used and/or dates and/or times of its
usage. In certain forms, the second data circuit may transmit data
acquired by one or more sensors (e.g., an instrument-based
temperature sensor). In certain forms, the second data circuit may
receive data from the generator 800 and provide an indication to a
user (e.g., a light emitting diode indication or other visible
indication) based on the received data.
[0298] In certain forms, the second data circuit and the second
data circuit interface 848 may be configured such that
communication between the logic circuit 842 and the second data
circuit can be effected without the need to provide additional
conductors for this purpose (e.g., dedicated conductors of a cable
connecting a handpiece to the generator 800). In one form, for
example, information may be communicated to and from the second
data circuit using a one-wire bus communication scheme implemented
on existing cabling, such as one of the conductors used transmit
interrogation signals from the signal conditioning circuit 844 to a
control circuit in a handpiece. In this way, design changes or
modifications to the surgical instrument that might otherwise be
necessary are minimized or reduced. Moreover, because different
types of communications implemented over a common physical channel
can be frequency-band separated, the presence of a second data
circuit may be "invisible" to generators that do not have the
requisite data reading functionality, thus enabling backward
compatibility of the surgical instrument.
[0299] In certain forms, the isolated stage 802 may comprise at
least one blocking capacitor 850-1 connected to the drive signal
output 810b to prevent passage of DC current to a patient. A single
blocking capacitor may be required to comply with medical
regulations or standards, for example. While failure in
single-capacitor designs is relatively uncommon, such failure may
nonetheless have negative consequences. In one form, a second
blocking capacitor 850-2 may be provided in series with the
blocking capacitor 850-1, with current leakage from a point between
the blocking capacitors 850-1, 850-2 being monitored by, for
example, an ADC circuit 852 for sampling a voltage induced by
leakage current. The samples may be received by the logic circuit
842, for example. Based changes in the leakage current (as
indicated by the voltage samples), the generator 800 may determine
when at least one of the blocking capacitors 850-1, 850-2 has
failed, thus providing a benefit over single-capacitor designs
having a single point of failure.
[0300] In certain forms, the non-isolated stage 804 may comprise a
power supply 854 for delivering DC power at a suitable voltage and
current. The power supply may comprise, for example, a 400 W power
supply for delivering a 48 VDC system voltage. The power supply 854
may further comprise one or more DC/DC voltage converters 856 for
receiving the output of the power supply to generate DC outputs at
the voltages and currents required by the various components of the
generator 800. As discussed above in connection with the controller
838, one or more of the DC/DC voltage converters 856 may receive an
input from the controller 838 when activation of the "on/off" input
device by a user is detected by the controller 838 to enable
operation of, or wake, the DC/DC voltage converters 856.
[0301] FIG. 21 illustrates an example of a generator 900, which is
one form of the generator 800 (FIG. 20). The generator 900 is
configured to deliver multiple energy modalities to a surgical
instrument. The generator 900 provides RF and ultrasonic signals
for delivering energy to a surgical instrument either independently
or simultaneously. The RF and ultrasonic signals may be provided
alone or in combination and may be provided simultaneously. As
noted above, at least one generator output can deliver multiple
energy modalities (e.g., ultrasonic, bipolar or monopolar RF,
irreversible and/or reversible electroporation, and/or microwave
energy, among others) through a single port, and these signals can
be delivered separately or simultaneously to the end effector to
treat tissue. The generator 900 comprises a processor 902 coupled
to a waveform generator 904. The processor 902 and waveform
generator 904 are configured to generate a variety of signal
waveforms based on information stored in a memory coupled to the
processor 902, not shown for clarity of disclosure. The digital
information associated with a waveform is provided to the waveform
generator 904 which includes one or more DAC circuits to convert
the digital input into an analog output. The analog output is fed
to an amplifier 1106 for signal conditioning and amplification. The
conditioned and amplified output of the amplifier 906 is coupled to
a power transformer 908. The signals are coupled across the power
transformer 908 to the secondary side, which is in the patient
isolation side. A first signal of a first energy modality is
provided to the surgical instrument between the terminals labeled
ENERGY1 and RETURN. A second signal of a second energy modality is
coupled across a capacitor 910 and is provided to the surgical
instrument between the terminals labeled ENERGY2 and RETURN. It
will be appreciated that more than two energy modalities may be
output and thus the subscript "n" may be used to designate that up
to n ENERGYn terminals may be provided, where n is a positive
integer greater than 1. It also will be appreciated that up to "n"
return paths RETURNn may be provided without departing from the
scope of the present disclosure.
[0302] A first voltage sensing circuit 912 is coupled across the
terminals labeled ENERGY1 and the RETURN path to measure the output
voltage therebetween. A second voltage sensing circuit 924 is
coupled across the terminals labeled ENERGY2 and the RETURN path to
measure the output voltage therebetween. A current sensing circuit
914 is disposed in series with the RETURN leg of the secondary side
of the power transformer 908 as shown to measure the output current
for either energy modality. If different return paths are provided
for each energy modality, then a separate current sensing circuit
should be provided in each return leg. The outputs of the first and
second voltage sensing circuits 912, 924 are provided to respective
isolation transformers 916, 922 and the output of the current
sensing circuit 914 is provided to another isolation transformer
918. The outputs of the isolation transformers 916, 928, 922 in the
on the primary side of the power transformer 908 (non-patient
isolated side) are provided to a one or more ADC circuit 926. The
digitized output of the ADC circuit 926 is provided to the
processor 902 for further processing and computation. The output
voltages and output current feedback information can be employed to
adjust the output voltage and current provided to the surgical
instrument and to compute output impedance, among other parameters.
Input/output communications between the processor 902 and patient
isolated circuits is provided through an interface circuit 920.
Sensors also may be in electrical communication with the processor
902 by way of the interface circuit 920.
[0303] In one aspect, the impedance may be determined by the
processor 902 by dividing the output of either the first voltage
sensing circuit 912 coupled across the terminals labeled
ENERGY1/RETURN or the second voltage sensing circuit 924 coupled
across the terminals labeled ENERGY2/RETURN by the output of the
current sensing circuit 914 disposed in series with the RETURN leg
of the secondary side of the power transformer 908. The outputs of
the first and second voltage sensing circuits 912, 924 are provided
to separate isolations transformers 916, 922 and the output of the
current sensing circuit 914 is provided to another isolation
transformer 916. The digitized voltage and current sensing
measurements from the ADC circuit 926 are provided the processor
902 for computing impedance. As an example, the first energy
modality ENERGY1 may be ultrasonic energy and the second energy
modality ENERGY2 may be RF energy. Nevertheless, in addition to
ultrasonic and bipolar or monopolar RF energy modalities, other
energy modalities include irreversible and/or reversible
electroporation and/or microwave energy, among others. Also,
although the example illustrated in FIG. 21 shows 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 energy modality ENERGYn. Thus, as described herein, the
ultrasonic transducer impedance may be measured by dividing the
output of the first voltage sensing circuit 912 by the current
sensing circuit 914 and the tissue impedance may be measured by
dividing the output of the second voltage sensing circuit 924 by
the current sensing circuit 914.
[0304] As shown in FIG. 21, the generator 900 comprising at least
one output port can include a power transformer 908 with a single
output and with multiple taps to provide power in the form of one
or more energy modalities, such as ultrasonic, bipolar or monopolar
RF, irreversible and/or reversible electroporation, and/or
microwave energy, among others, for example, to the end effector
depending on the type of treatment of tissue being performed. For
example, the generator 900 can deliver energy with higher voltage
and lower current to drive an ultrasonic transducer, with lower
voltage and higher current to drive RF electrodes for sealing
tissue, or with a coagulation waveform for spot coagulation using
either monopolar or bipolar RF electrosurgical electrodes. The
output waveform from the generator 900 can be steered, switched, or
filtered to provide the frequency to the end effector of the
surgical instrument. The connection of an ultrasonic transducer to
the generator 900 output would be preferably located between the
output labeled ENERGY1 and RETURN as shown in FIG. 21. In one
example, a connection of RF bipolar electrodes to the generator 900
output would be preferably located between the output labeled
ENERGY2 and RETURN. In the case of monopolar output, the preferred
connections would be active electrode (e.g., pencil or other probe)
to the ENERGY2 output and a suitable return pad connected to the
RETURN output.
[0305] Additional details are disclosed in U.S. Patent Application
Publication No. 2017/0086914, titled TECHNIQUES FOR OPERATING
GENERATOR FOR DIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMS AND
SURGICAL INSTRUMENTS, which published on Mar. 30, 2017, which is
herein incorporated by reference in its entirety.
[0306] As used throughout this description, the term "wireless" and
its derivatives may be used to describe circuits, devices, systems,
methods, techniques, communications channels, etc., that may
communicate data through the use of modulated electromagnetic
radiation through a non-solid medium. The term does not imply that
the associated devices do not contain any wires, although in some
aspects they might not. The communication module may implement any
of a number of wireless or wired communication standards or
protocols, including but not limited to 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, Ethernet derivatives thereof, as well as any other
wireless and wired protocols that are designated as 3G, 4G, 5G, and
beyond. The computing module may include a plurality of
communication modules. For instance, a first communication module
may be dedicated to shorter range wireless communications such as
Wi-Fi and Bluetooth and a second communication module may be
dedicated to longer range wireless communications such as GPS,
EDGE, GPRS, CDMA, WiMAX, LTE, Ev-DO, and others.
[0307] As used herein a processor or processing unit is an
electronic circuit which performs operations on some external data
source, usually memory or some other data stream. The term is used
herein to refer to the central processor (central processing unit)
in a system or computer systems (especially systems on a chip
(SoCs)) that combine a number of specialized "processors."
[0308] 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 components of a computer or other electronic
systems. It may contain digital, analog, mixed-signal, and often
radio-frequency functions-all on a single substrate. A SoC
integrates a microcontroller (or microprocessor) with advanced
peripherals like graphics processing unit (GPU), Wi-Fi module, or
coprocessor. A SoC may or may not contain built-in memory.
[0309] As used herein, a microcontroller or controller is a system
that integrates a microprocessor with peripheral circuits and
memory. A microcontroller (or MCU for microcontroller unit) may be
implemented as a small computer on a single integrated circuit. It
may be similar to a SoC; an SoC may include a microcontroller as
one of its components. A microcontroller may contain one or more
core processing units (CPUs) along with memory and programmable
input/output peripherals. Program memory in the form of
Ferroelectric RAM, NOR flash or OTP ROM is also often included on
chip, as well as a small amount of RAM. Microcontrollers may be
employed for embedded applications, in contrast to the
microprocessors used in personal computers or other general purpose
applications consisting of various discrete chips.
[0310] As used herein, the term controller or microcontroller may
be a stand-alone IC or chip device that interfaces with a
peripheral device. This may be a link between two parts of a
computer or a controller on an external device that manages the
operation of (and connection with) that device.
[0311] Any of the processors or microcontrollers described herein,
may be implemented by any single core or multicore processor such
as those known under the trade name ARM Cortex by Texas
Instruments. In one aspect, the processor may be an LM4F230H5QR ARM
Cortex-M4F Processor Core, available from Texas Instruments, for
example, comprising on-chip memory of 256 KB single-cycle flash
memory, or other non-volatile memory, up to 40 MHz, a prefetch
buffer to improve performance above 40 MHz, a 32 KB single-cycle
serial random access memory (SRAM), internal read-only memory (ROM)
loaded with StellarisWare.RTM. software, 2 KB electrically erasable
programmable read-only memory (EEPROM), one or more pulse width
modulation (PWM) modules, one or more quadrature encoder inputs
(QEI) analog, one or more 12-bit Analog-to-Digital Converters (ADC)
with 12 analog input channels, details of which are available for
the product datasheet.
[0312] In one aspect, the processor may comprise a safety
controller comprising two controller-based families such as TMS570
and RM4x known under the trade name Hercules ARM Cortex R4, also by
Texas Instruments. The safety controller may be configured
specifically for IEC 61508 and ISO 26262 safety critical
applications, among others, to provide advanced integrated safety
features while delivering scalable performance, connectivity, and
memory options.
[0313] Modular devices include the modules (as described in
connection with FIGS. 3 and 9, for example) that are receivable
within a surgical hub and the surgical devices or instruments that
can be connected to the various modules in order to connect or pair
with the corresponding surgical hub. The modular devices include,
for example, intelligent surgical instruments, medical imaging
devices, suction/irrigation devices, smoke evacuators, energy
generators, ventilators, insufflators, and displays. The modular
devices described herein can be controlled by control algorithms.
The control algorithms can be executed on the modular device
itself, on the surgical hub to which the particular modular device
is paired, or on both the modular device and the surgical hub
(e.g., via a distributed computing architecture). In some
exemplifications, the modular devices' control algorithms control
the devices based on data sensed by the modular device itself
(i.e., by sensors in, on, or connected to the modular device). This
data can be related to the patient being operated on (e.g., tissue
properties or insufflation pressure) or the modular device itself
(e.g., the rate at which a knife is being advanced, motor current,
or energy levels). For example, a control algorithm for a surgical
stapling and cutting instrument can control the rate at which the
instrument's motor drives its knife through tissue according to
resistance encountered by the knife as it advances.
Long Distance Communication and Condition Handling of Devices and
Data
[0314] Surgical procedures are performed by different surgeons at
different locations, some with much less experience than others.
For a given surgical procedure, there are many parameters that can
be varied to attempt to realize a desired outcome. For example, for
a given surgical procedure which utilizes energy supplied by a
generator, the surgeon often relies on experience alone for
determining which mode of energy to utilize, which level of output
power to utilize, the duration of the application of the energy,
etc., in order to attempt to realize the desired outcome. To
increase the likelihood of realizing desired outcomes for a
plurality of different surgical procedures, each surgeon should be
provided with best practice recommendations which are based on
important relationships identified within large, accurate data sets
of information associated with multiple surgical procedures
performed in multiple locations over time. However, there are many
ways that such data sets can be rendered compromised, inaccurate,
and/or unsecure, thereby calling into question the applicability of
the best practice recommendations derived therefrom. For example,
for data sent from a source to a cloud-based system, the data can
be lost while in transit to the cloud-based system, the data can be
corrupted while in transit to the cloud-based system, the
confidentiality of the data can be comprised while in transit to
the cloud-based system, and/or the content of the data can be
altered while in transit to the cloud-based system.
[0315] A plurality of operating rooms located in multiple locations
can each be equipped with a surgical hub. When a given surgical
procedure is performed in a given operating room, the surgical hub
can receive data associated with the surgical procedure and
communicate the data to a cloud-based system. Over time, the
cloud-based system will receive large data sets of information
associated with the surgeries. The data can be communicated from
the surgical hubs to the cloud-based system in a manner which
allows for the cloud-based system to (1) verify the authenticity of
the communicated data, (2) authenticate each of the respective
surgical hubs which communicated the data, and (3) trace the paths
the data followed from the respective surgical hubs to the
cloud-based system.
[0316] Accordingly, in one aspect, the present disclosure provides
a surgical hub for transmitting generator data associated with a
surgical procedure to a cloud-based system communicatively coupled
to a plurality of surgical hubs. The surgical hub comprises a
processor and a memory coupled to the processor. The memory stores
instructions executable by the processor to receive data from a
generator, encrypt the data, generate a message authentication code
(MAC) based on the data, generate a datagram comprising the
encrypted data, the generated MAC, a source identifier, and a
destination identifier, and transmit the datagram to a cloud-based
system. The data is structured into a data packet comprising at
least two of the following fields: a field that indicates the
source of the data, a unique time stamp, a field indicating an
energy mode of the generator, a field indicating the power output
of the generator, and a field indicating a duration of the power
output of the generator. The datagram allows for the cloud-based
system to decrypt the encrypted data of the transmitted datagram,
verify integrity of the data based on the MAC, authenticate the
surgical hub as the source of the datagram, and validate a
transmission path followed by the datagram between the surgical hub
and the cloud-based system.
[0317] In various aspects, the present disclosure provides a
control circuit to transmit generator data associated with a
surgical procedure to a cloud-based system communicatively coupled
to a plurality of surgical hubs, as described above. In various
aspects, the present disclosure provides a non-transitory
computer-readable medium storing computer-readable instructions
which, when executed, causes a machine to transmit generator data
associated with a surgical procedure to a cloud-based system
communicatively coupled to a plurality of surgical hubs, as
described above.
[0318] In another aspect, the present disclosure provides a
cloud-based system communicatively coupled to a plurality of
surgical hubs. Each surgical hub is configured to transmit
generator data associated with a surgical procedure to the
cloud-based system. The cloud-based system comprises a processor
and a memory coupled to the processor. The memory stores
instructions executable by the processor to receive a datagram
generated by a surgical hub, decrypt the encrypted generator data
of the received datagram, verify integrity of the generator data
based on the MAC, authenticate the surgical hub as the source of
the datagram, and validate a transmission path followed by the
datagram between the surgical hub and the cloud-based system. The
datagram comprises generator data captured from a generator
associated with the surgical hub, a MAC generated by the surgical
hub based on the generator data, a source identifier, and a
destination identifier. The generator data has been encrypted by
the surgical hub. The encrypted generator data has been structured
into a data packet comprising at least two of the following fields:
a field that indicates the source of the data, a unique time stamp,
a field indicating an energy mode, a field indicating power output,
and a field indicating a duration of applied power.
[0319] In various aspects, the present disclosure provides a
control circuit to transmit generator data associated with a
surgical procedure to the cloud-based system. In various aspects,
the present disclosure provides a non-transitory computer-readable
medium storing computer-readable instructions which, when executed,
causes a machine to transmit generator data associated with a
surgical procedure to the cloud-based system.
[0320] In another aspect, the present disclosure provides a method,
comprising capturing data from a combination generator of a
surgical hub during a surgical procedure, wherein the combination
generator is configured to supply two or more different modes of
energy. Encrypting the captured generator data, generating a MAC
based on the captured generator data, generating a datagram
comprising the encrypted generator data, the MAC, a source
identifier, and a destination identifier, and communicating the
datagram from the surgical hub to a cloud-based system. The
datagram allows for the cloud-based system to authenticate
integrity of the communicated generator data, authenticate the
surgical hub as a source of the datagram, and determine a
communication path followed by the datagram between the surgical
hub and the cloud-based system.
[0321] By sending captured generator data from a plurality of
different surgical hubs to a cloud-based system, the cloud-based
system is able to quickly build large data sets of information
associated with multiple surgical procedures performed in multiple
locations over time. Furthermore, due to the composition of the
respective datagrams, for a given datagram, the cloud-based system
is able to determine whether the datagram was originally sent by
one of the surgical hubs (source validation), thereby providing an
indication that the generator data received at the cloud-based
system is legitimate data. For the given datagram, the cloud-based
system is also able to determine whether the generator data
received at the cloud-based system is identical to the generator
data sent by the given surgical hub (data integrity), thereby
allowing for the authenticity of the received generator data to be
verified. Additionally, for the given datagram, the cloud-based
system is also able to re-trace the communication path followed by
the datagram, thereby allowing for enhanced troubleshooting if a
datagram received by the cloud-based system was originally sent
from a device other than the surgical hubs and/or if the content of
the datagram was altered while in transit to the cloud-based
system. Notably, the present disclosure references generator data
in particular. Here, the present disclosure should not be limited
as being able to process only generator data. For example, the
surgical hub 206 and/or the cloud-based system 205 may process data
received from any component (e.g., imaging module 238, generator
module 240, smoke evacuator module 226, suction/irrigation module
228, communication module 230, processor module 232, storage array
234, smart device/instrument 235, non-contact sensor module 242,
robot hub 222, a non-robotic surgical hub 206, wireless smart
device/instrument 235, visualization system 208) of the surgical
system 202 that is coupled to the surgical hub 206 and/or data from
any devices (e.g., endoscope 239, energy device 241) coupled
to/through such components (e.g., see FIGS. 9-10), in a similar
manner as discussed herein.
[0322] Unfortunately, the outcome of a surgical procedure is not
always optimal. For example, a failure event such as a surgical
device failure, an unwanted tissue perforation, an unwanted
post-operative bleeding, or the like can occur. The occurrence of a
failure event can be attributed to any of a variety of different
people and devices, including one or more surgeons, one or more
devices associated with the surgery, a condition of the patient,
and combinations thereof. When a given failure event occurs, it is
not always clear regarding who or what caused the failure event or
how the occurrence of the failure event can be mitigated in
connection with a future surgery.
[0323] During a given surgical procedure, a large amount of data
associated with the surgical procedure can be generated and
captured. All of the captured data can be communicated to a
surgical hub, and the captured data can be time-stamped either
before or after being received at the surgical hub. When a failure
event associated with the surgical procedure is detected and/or
identified, it can be determined which of the captured data is
associated with the failure event and/or which of the captured data
is not associated with the failure event. In making this
determination, the failure event can be defined to include a period
of time prior to the detection/identification of the failure event.
Once the determination is made regarding the captured data
associated with the failure event, the surgical hub can separate
the captured data associated with the failure event from all other
captured data, and the captured data can be separated based on
tagging, flagging, or the like. The captured data associated with
the failure event can then be chronologized based on the
time-stamping and the defined time period applicable to the failure
event. The chronologized captured data can then be communicated to
a cloud-based system on a prioritized basis for analysis, where the
prioritized basis is relative to the captured data which is not
associated with the failure event. Whether or not the analysis
identifies a device associated with the surgical procedure as the
causation of the failure event, the surgical hub can tag the device
for removal of the device from future use, further analysis of the
device, and/or to return the device to the manufacturer.
[0324] When a given surgical procedure is performed, a large amount
of data associated with the surgical procedure can be generated and
captured. All of the captured data can be communicated to a
surgical hub, where the information can be stripped of all
"personal" associations. The captured data can be time-stamped
before being received at the surgical hub, after being received at
the surgical hub, before being stripped of the "personal"
associations, or after being stripped of the "personal"
associations. The surgical hub can communicate the stripped data to
the cloud-based system for subsequent analysis. Over time, the
cloud-based system will receive large data sets of information
associated with the surgeries. Accordingly, in one aspect, the
present disclosure provides a surgical hub for prioritizing
surgical data associated with a surgical procedure to a cloud-based
system communicatively coupled to a plurality of surgical hubs. The
surgical hub comprises a processor and a memory coupled to the
processor. The memory stores instructions executable by the
processor to capture surgical data, wherein the surgical data
comprises data associated with a surgical device, time-stamp the
captured surgical data, identify a failure event, identify a time
period associated with the failure event, isolate failure event
surgical data from surgical data not associated with the failure
event based on the identified time period, chronologize the failure
event surgical data by time-stamp, encrypt the chronologized
failure event surgical data, generate a datagram comprising the
encrypted failure event surgical data, and transmit the datagram to
a cloud-based system. The datagram is structured to include a field
which includes a flag that prioritizes the encrypted failure event
surgical data over other encrypted data of the datagram. The
datagram allows for the cloud-based system to decrypt the encrypted
failure event surgical data, focus analysis on the failure event
surgical data rather than surgical data not associated with the
failure event, and flag the surgical device associated with the
failure event for at least one of the following: removal from an
operating room, return to a manufacturer, or future inoperability
in the cloud-based system.
[0325] In various aspects, the present disclosure provides a
control circuit to prioritize surgical data associated with a
surgical procedure to a cloud-based system communicatively coupled
to a plurality of surgical hubs. In various aspects, the present
disclosure provides a non-transitory computer-readable medium
storing computer-readable instructions which, when executed, causes
a machine to prioritize surgical data associated with a surgical
procedure to a cloud-based system communicatively coupled to a
plurality of surgical hubs.
[0326] In another aspect, the present disclosure provides a method,
comprising capturing data during a surgical procedure,
communicating the captured data to a surgical hub, time-stamping
the captured data, identifying a failure event associated with the
surgical procedure, determining which of the captured data is
associated with the failure event, separating the captured data
associated with the failure event from all other captured data,
chronologizing the captured data associated with the failure event,
and communicating the chronologized captured data to a cloud-based
system on a prioritized basis.
[0327] By capturing the large amount of data associated with the
surgical procedure, and with having the captured data time-stamped,
the portion of the captured data which is relevant to the
detected/identified failure event can be more easily isolated from
all of the other captured data, thereby allowing for a more focused
subsequent analysis on just the relevant captured data. The data
associated with the failure event can then be chronologized (this
requires less processing power than chronologizing all of the
captured data), thereby allowing for the events leading up to the
detection/identification of the failure event to be more easily
considered during the subsequent analysis of the failure event. The
chronologized data can then be communicated to the cloud-based
system (this requires less communication resources than
communicating all of the captured data at the same time) on a
prioritized basis, thereby allowing for the focused subsequent
analysis of the fault event to be performed by the cloud-based
system in a more time-sensitive manner.
[0328] To help ensure that the best practice recommendations are
developed based on accurate data, it would be desirable to ensure
that the generator data received at the cloud-based system is the
same as the generator data communicated to the cloud-based system.
Also, to help to be able to determine the cause of a failure event
as quickly as possible, it would be desirable to ensure that
surgical data associated with the failure event is communicated to
the cloud-based system in a prioritized manner (relative to
surgical data not associated with the failure event) so that
analysis of the surgical data can be performed in an expedited
manner.
[0329] Aspects of a system and method for communicating data
associated with a surgical procedure are described herein. As shown
in FIG. 9, various aspects of the computer implemented interactive
surgical system 200 includes a device/instrument 235, a generator
module 240, a modular control tower 236, and a cloud-based system
205. As shown in FIG. 10, the device/instrument 235, the generator
module 240, and the modular control tower 236 are
components/portions of a surgical hub 206.
[0330] In various aspects, the generator module 240 of the surgical
hub 206 can supply radio-frequency energy such as monopolar
radio-frequency energy, bipolar radio-frequency energy, and
advanced bipolar energy and/or ultrasonic energy to a
device/instrument 235 for use in a surgical procedure. Thus, the
generator module 240 may be referred to as a combination generator.
An example of such a combination generator is shown in FIG. 22,
where the combination generator 3700 is shown as including a
monopolar module 3702, a bipolar module 3704, an advanced bipolar
module 3706, and an ultrasound module 3708. When utilized during a
surgical procedure, the respective energy modules (e.g., 3702,
3704, 3706, and/or 3708) of the combination generator 3700 can
provide generator data such as type of energy supplied to the
device instrument (e.g., radio-frequency energy, ultrasound energy,
radio-frequency energy and ultrasound energy), type of
radio-frequency energy (e.g., monoplar, bipolar, advanced bipolar),
frequency, power output, duration, etc., to the data communication
module 3710 of the combination generator 3700.
[0331] FIG. 23 illustrates various aspects of a method of capturing
data from a combination generator 3700 and communicating the
captured generator data to a cloud-based system 205. Notably, as
discussed herein, the present disclosure should not be limited to
processing generator data. As such, the method of FIG. 23 similarly
extends to other types of data received from other components
coupled to the surgical hub 206 (e.g., imaging module data, smoke
evacuator data, suction/irrigation data, device/instrument data).
The method comprises (1) capturing 3712 data from a combination
generator 3700 of a surgical hub 206 during a surgical procedure,
wherein the combination generator 3700 is configured to supply two
or more different modes of energy; (2) encrypting 3714 the captured
generator data; (3) generating 3716 a MAC based on the captured
generator data; (4) generating 3718 a datagram comprising the
encrypted generator data, the MAC, a source identifier, and a
destination identifier; and (5) communicating 3720 the datagram
from the surgical hub 206 to a cloud-based system 205, wherein the
datagram allows for the cloud-based system 205 to (i) authenticate
integrity of the communicated generator data, (ii) authenticate the
surgical hub as a source of the datagram, and (iii) determine a
communication path followed by the datagram between the surgical
hub 206 and the cloud-based system 205.
[0332] More specifically, once the generator data is received at
the data communication module 3710 of the combination generator
3700, the generator data can be communicated to the modular
communication hub 203 of the surgical hub 206 for subsequent
communication to the cloud-based system 205. The data communication
module 3710 can communicate the generator data to the modular
communication hub 203 serially over a single communication line or
in parallel over a plurality of communication lines, and such
communication can be performed in real time or near real time.
Alternatively, such communication can be performed in batches.
[0333] According to various aspects, prior to communicating the
generator data to the modular communication hub 203, a component of
the combination generator 3700 (e.g., the data communication module
3710) can organize the generator data into data packets. An example
of such a data packet is shown in FIG. 24, where the data packet
3722 includes a preamble 3724 or self-describing data header which
defines what the data is (e.g., combination generator data--CGD)
and fields which indicate where the generator data came from [e.g.,
combination generator ID number 3726--(e.g., 017), a unique time
stamp 3728 (e.g., 08:27:16), the energy mode utilized 3730 (e.g.,
RF, U, RF+U), the type of radio-frequency energy or radio frequency
mode 3732 (e.g., MP, BP, ABP), the frequency 3734 (e.g., 500 Khz),
the power output 3736 (e.g., 30 watts), the duration of applied
power 3738 (e.g., 45 milliseconds), and an
authentication/identification certificate of the data point 3740
(e.g., 01101011001011)]. The example data packet 3722 may be
considered a self-describing data packet, and the combination
generator 3700 and other intelligent devices (e.g., the surgical
hub 206) can use the self-describing data packets to minimize data
size and data-handling resources. Again, as discussed herein, the
present disclosure should not be limited to processing generator
data received from a combination generator 3700. As such, the data
packet 3722 of FIG. 24 similarly extends to other types of data
received from other components coupled to the surgical hub 206. In
one aspect, the data packet 3722 may comprise data associated with
endoscope 239 (e.g., image data) received from a component of the
imaging module 238. In another aspect, the data packet 3722 may
comprises data associated with an evacuation system (e.g.,
pressures, particle counts, flow rates, motor speeds) received from
a component of the smoke evacuator module 226. In yet another
aspect, the data packet 3722 may comprise data associated with a
device/instrument (e.g., temperature sensor data, firing data,
sealing data) received from a component of the device/instrument
235. In various other aspects, the data packet 3722 may similarly
comprise data received from other components coupled to the
surgical hub 206 (e.g., suction/irrigation module 228, non-contact
sensor module 242)
[0334] Additionally, the data communication module 3710 can
compress the generator data and/or encrypt the generator data prior
to communicating the generator data to the modular communication
hub 203. The specific method of compressing and/or encrypting can
be the same as or different from the compressing and/or encrypting
which may be performed by the surgical hub 206 as described in more
detail below.
[0335] The modular communication hub 203 can receive the generator
data communicated from the combination generator 3700 (e.g., via
the data communication module 3710), and the generator data can be
subsequently communicated to the cloud-based system 205 (e.g.,
through the Internet). According to various aspects, the modular
communication hub 203 can receive the generator data through a
hub/switch 207/209 of the modular communication hub 203 (See FIG.
10), and the generator data can be communicated to the cloud-based
system 205 by a router 211 of the modular communication hub 203
(See FIG. 10). The generator data may be communicated in real time,
near real time, or in batches to the cloud-based system 205 or may
be stored at the surgical hub 206 prior to being communicated to
the cloud-based system 205. The generator data can be stored, for
example, at the storage array 234 or at the memory 249 of the
computer system 210 of the surgical hub 206.
[0336] In various aspects, for instances where the generator data
received at the modular communication hub 203 is not encrypted,
prior to the received generator data being communicated to the
cloud-based system 205, the generator data is encrypted to help
ensure the confidentiality of the generator data, either while it
is being stored at the surgical hub 206 or while it is being
transmitted to the cloud 204 using the Internet or other computer
networks. According to various aspects, a component of the surgical
hub 206 utilizes an encryption algorithm to convert the generator
data from a readable version to an encoded version, thereby forming
the encrypted generator data. The component of the surgical hub 206
which utilizes/executes the encryption algorithm can be, for
example, the processor module 232, the processor 244 of the
computer system 210, and/or combinations thereof. The
utilized/executed encryption algorithm can be a symmetric
encryption algorithm and/or an asymmetric encryption algorithm.
[0337] Using a symmetric encryption algorithm, the surgical hub 206
would encrypt the generator data using a shared secret (e.g.,
private key, passphrase, password). In such an aspect, a recipient
of the encrypted generator data (e.g., cloud-based system 205)
would then decrypt the encrypted generator data using the same
shared secret. In such an aspect, the surgical hub 206 and the
recipient would need access to and/or knowledge of the same shared
secret. In one aspect, a shared secret can be generated/chosen by
the surgical hub 206 and securely delivered (e.g., physically) to
the recipient before encrypted communications to the recipient.
[0338] Alternatively, using an asymmetric encryption algorithm, the
surgical hub 206 would encrypt the generator data using a public
key associated with a recipient (e.g., cloud-based system 205).
This public key could be received by the surgical hub 206 from a
certificate authority that issues a digital certificate certifying
the public key as owned by the recipient. The certificate authority
can be any entity trusted by the surgical hub 206 and the
recipient. In such an aspect, the recipient of the encrypted
generator data would then decrypt the encrypted generator data
using a private key (i.e., known only by the recipient) paired to
the public key used by the surgical hub 206 to encrypt the
generator data. Notably, in such an aspect, the encrypted generator
data can only be decrypted using the recipient's private key.
[0339] According to aspects of the present disclosure, components
(e.g., surgical device/instrument 235, energy device 241, endoscope
239) of the surgical system 202 are associated with unique
identifiers, which can be in the form of serial numbers. As such,
according to various aspects of the present disclosure, when a
component is coupled to a surgical hub 206, the component may
establish a shared secret with the surgical hub 206 using the
unique identifier of the coupled component as the shared secret.
Further, in such an aspect, the component may derive a checksum
value by applying a checksum function/algorithm to the unique
identifier and/or other data being communicated to the surgical hub
206. Here, the checksum function/algorithm is configured to output
a significantly different checksum value if there is a modification
to the underlying data.
[0340] In one aspect, the component may initially encrypt the
unique identifier of a coupled component using a public key
associated with the surgical hub (e.g., received by the component
from the surgical hub 206 upon/after connection) and communicate
the encrypted unique identifier to the surgical hub 206. In other
aspects, the component may encrypt the unique identifier and the
derived checksum value of a coupled component using a public key
associated with the surgical hub 206 and communicate the encrypted
unique identifier and linked/associated checksum value to the
surgical hub 206.
[0341] In yet other aspects, the component may encrypt the unique
identifier and a checksum function/algorithm using a public key
associated with the surgical hub 206 and communicate the encrypted
unique identifier and the checksum function/algorithm to the
surgical hub 206. In such aspects, the surgical hub 206 would then
decrypt the encrypted unique identifier or the encrypted unique
identifier and the linked/associated checksum value or the
encrypted unique identifier and the checksum function/algorithm
using a private key (i.e., known only by the surgical hub 206)
paired to the public key used by the component to encrypt the
unique identifier.
[0342] Since the encrypted unique identifier can only be decrypted
using the surgical hub's 206 private key and the private key is
only known by the surgical hub, this is a secure way to communicate
a shared secret (e.g., the unique identifier of the coupled
component) to the surgical hub 206. Further, in aspects where a
checksum value is linked to/associated with the unique identifier,
the surgical hub 206 may apply the same checksum function/algorithm
to the decrypted unique identifier to generate a validating
checksum value. If the validating checksum value matches the
decrypted checksum value, the integrity of the decrypted unique
identifier is further verified. Further, in such aspects, with a
shared secret established, the component can encrypt future
communications to the surgical hub 206, and the surgical hub 206
can decrypt the future communications from the component using the
shared secret (e.g., the unique identifier of the coupled
component). Here, according to various aspects, a checksum value
may be derived for and communicated with each communication between
the component and the surgical hub 206 (e.g., the checksum value
based on the communicated data or at least a designated portion
thereof). Here, a checksum function/algorithm (e.g., known by the
surgical hub 206 and/or component or communicated when establishing
the shared secret between the surgical hub 206 and the component as
described above) may be used to generate validating checksum values
for comparison with communicated checksum values to further verify
the integrity of communicated data in each communication.
[0343] Notably, asymmetric encryption algorithms may be complex and
may require significant computational resources to execute each
communication. As such, establishing the unique identifier of the
coupled component as the shared secret is not only quicker (e.g.,
no need to generate a shared secret using a pseudorandom key
generator) but also increases computational efficiency (e.g.,
enables the execution of faster, less complex symmetric encryption
algorithms) for all subsequent communications. In various aspects,
this established shared secret may be utilized by the component and
surgical hub 206 until the component is decoupled from the surgical
hub (e.g., surgical procedure ended).
[0344] According to other aspects of the present disclosure,
components (e.g., surgical device/instrument 235, energy device
241, endoscope 239) of the surgical system 202 may comprise
sub-components (e.g., handle, shaft, end effector, cartridge) each
associated with its own unique identifier. As such, according to
various aspects of the present disclosure, when a component is
coupled to the surgical hub 206, the component may establish a
shared secret with the surgical hub 206 using a unique
compilation/string (e.g., ordered or random) of the unique
identifiers associated with the sub-components that combine to form
the coupled component. In one aspect, the component may initially
encrypt the unique compilation/string of the coupled component
using a public key associated with the surgical hub 206 and
communicate the encrypted unique compilation/string to the surgical
hub 206. In such an aspect, the surgical hub 206 would then decrypt
the encrypted unique compilation/string using a private key (i.e.,
known only by the surgical hub 206) paired to the public key used
by the component to encrypt the unique compilation/string. Since
the encrypted unique compilation/string can only be decrypted using
the surgical hub's 206 private key and the private key is only
known by the surgical hub 206, this is a secure way to communicate
a shared secret (e.g., the unique compilation/string of the coupled
component) to the surgical hub 206. Further, in such an aspect,
with a shared secret established, the component can encrypt future
communications to the surgical hub 206, and the surgical hub 206
can decrypt the future communications from the component using the
shared secret (e.g., the unique compilation/string of the coupled
component).
[0345] Again, asymmetric encryption algorithms may be complex and
may require significant computational resources to execute each
communication. As such, establishing the unique compilation/string
of the coupled component (i.e., readily combinable by the
component) as the shared secret is not only quicker (e.g., no need
to generate a shared secret using a pseudorandom key generator) but
also increases computational efficiency (e.g., enables the
execution of faster, less complex symmetric encryption algorithms)
for all subsequent communications. In various aspects, this
established shared secret may be utilized by the component and
surgical hub 206 until the component is decoupled from the surgical
hub 206 (e.g., surgical procedure ended). Furthermore, in such an
aspect, since various sub-components may be reusable (e.g., handle,
shaft, end effector) while other sub-components may not be reusable
(e.g., end effector, cartridge) each new combination of
sub-components that combine to form the coupled component provide a
unique compilation/string usable as a shared secret for component
communications to the surgical hub 206.
[0346] According to further aspects of the present disclosure,
components (e.g., surgical device/instrument 235, energy device
241, endoscope 239) of the surgical system 202 are associated with
unique identifiers. As such, according to various aspects of the
present disclosure, when a component is coupled to the surgical hub
206, the surgical hub 206 may establish a shared secret with a
recipient (e.g., cloud-based system 205) using the unique
identifier of the coupled component. In one aspect, the surgical
hub 206 may initially encrypt the unique identifier of a coupled
component using a public key associated with the recipient and
communicate the encrypted unique identifier to the recipient. In
such an aspect, the recipient would then decrypt the encrypted
unique identifier using a private key (i.e., known only by the
recipient) paired to the public key used by the surgical hub 206 to
encrypt the unique identifier. Since the encrypted unique
identifier can only be decrypted using the recipient's private key
and the private key is only known by the recipient, this is a
secure way to communicate a shared secret (e.g., the unique
identifier of the coupled component) to the recipient (e.g.,
cloud-based system). Further in such an aspect, with a shared
secret established, the surgical hub 206 can encrypt future
communications to the recipient (e.g., cloud-based system 205), and
the recipient can decrypt the future communications from the
surgical hub 206 using the shared secret (e.g., the unique
identifier of the coupled component).
[0347] Notably, asymmetric encryption algorithms may be complex and
may require significant computational resources to execute each
communication. As such, establishing the unique identifier of the
coupled component (i.e., already available to the surgical hub 206)
as the shared secret is not only quicker (e.g., no need to generate
a shared secret using a pseudorandom key generator) but also
increases computational efficiency by, for example, enabling the
execution of faster, less complex symmetric encryption algorithms
for all subsequent communications. In various aspects, this
established shared secret may be utilized by the surgical hub 206
until the component is decoupled from the surgical hub (e.g.,
surgical procedure ended).
[0348] According to yet further aspects of the present disclosure,
components (e.g., surgical device/instrument 235, energy device
241, endoscope 239) of the surgical system 202 may comprise
sub-components (e.g., handle, shaft, end effector, cartridge) each
associated with its own unique identifier. As such, according to
various aspects of the present disclosure, when a component is
coupled to the surgical hub 206, the surgical hub 206 may establish
a shared secret with a recipient (e.g., cloud-based system 205)
using a unique compilation/string (e.g., ordered or random) of the
unique identifiers associated with the sub-components that combine
to form the coupled component.
[0349] In one aspect, the surgical hub 206 may initially encrypt
the unique compilation/string of the coupled component using a
public key associated with the recipient and communicate the
encrypted unique compilation/string to the recipient. In such an
aspect, the recipient would then decrypt the encrypted unique
compilation/string using a private key (i.e., known only by the
recipient) paired to the public key used by the surgical hub 206 to
encrypt the unique compilation/string. Since the encrypted unique
compilation/string can only be decrypted using the recipient's
private key and the private key is only known by the recipient,
this is a secure way to communicate a shared secret (e.g., the
unique compilation/string of the coupled component) to the
recipient. With a shared secret established, the surgical hub 206
can encrypt future communications to the recipient (e.g.,
cloud-based system 205), and the recipient can decrypt the future
communications from the surgical hub 206 using the shared secret
(e.g., the unique compilation/string of the coupled component).
Again, asymmetric encryption algorithms may be complex and may
require significant computational resources to execute each
communication. As such, establishing the unique compilation/string
of the coupled component (i.e., readily combinable by the surgical
hub 206) as the shared secret is not only quicker (e.g., no need to
generate a shared secret using a pseudorandom key generator) but
also increases computational efficiency (e.g., enables the
execution of faster, less complex symmetric encryption algorithms)
for all subsequent communications.
[0350] In various aspects, this established shared secret may be
utilized by the surgical hub 206 until the component is decoupled
from the surgical hub (e.g., surgical procedure ended).
Furthermore, in such an aspect, since various sub-components may be
reusable (e.g., handle, shaft, end effector) while other
sub-components may not be reusable (e.g., end effector, cartridge)
each new combination of sub-components that combine to form the
coupled component provide a unique compilation/string usable as a
shared secret for surgical hub 206 communications to the
recipient.
[0351] In some aspects, an encrypt-then-MAC (EtM) approach may be
utilized to produce the encrypted generator data. An example of
this approach is shown in FIG. 25, where the non-encrypted
generator data (i.e., the plaintext 3742, e.g., data packet 3722)
is first encrypted 3743 (e.g., via key 3746) to produce a
ciphertext 3744 (i.e., the encrypted generator data), then a MAC
3745 is produced based on the resulting ciphertext 3744, the key
3746, and a MAC algorithm (e.g., a hash function 3747). More
specifically, the ciphertext 3744 is processed through the MAC
algorithm using the key 3746. In one aspect similar to symmetric
encryption discussed herein, the key 3746 is a secret key
accessible/known by the surgical hub 206 and the recipient (e.g.,
cloud-based system 205). In such an aspect, the secret key is a
shared secret associated with/chosen by the surgical hub 206, a
shared secret associated with/chosen by the recipient, or a key
selected via a pseudorandom key generator. For this approach, as
shown generally at 3748, the encrypted generator data (i.e., the
ciphertext 3744) and the MAC 3745 would be communicated together to
the cloud-based system 205.
[0352] In other aspects, an encrypt-and-MAC (E&M) approach may
be utilized to produce the encrypted generator data. An example of
this approach is shown in FIG. 26, where the MAC 3755 is produced
based on the non-encrypted generator data (i.e., the plaintext
3752, e.g., data packet 3722), a key 3756, and a MAC algorithm
(e.g., a hash function 3757). More specifically, the plaintext 3752
is processed through the MAC algorithm using the key 3756. In one
aspect similar to symmetric encryption discussed herein, the key
3756 is a secret key accessible/known by the surgical hub 206 and
the recipient (e.g., cloud-based system 205). In such an aspect,
the secret key is a shared secret associated with/chosen by the
surgical hub 206, a shared secret associated with/chosen by the
recipient, or a key selected via a pseudorandom key generator.
Further, in such an aspect, the non-encrypted generator data (i.e.,
the plaintext 3752, e.g., data packet 3722) is encrypted 3753
(e.g., via key 3756) to produce a ciphertext 3754. For this
approach, as shown generally at 3758, the MAC 3755 (i.e., produced
based on the non-encrypted generator data) and the encrypted
generator data (i.e., the ciphertext 3754) would be communicated
together to the cloud-based system 205.
[0353] In yet other aspects, a MAC-then-encrypt (MtE) approach may
be utilized to produce the encrypted generator data. An example of
this approach is shown in FIG. 27, where the MAC 3765 is produced
based on the non-encrypted generator data (i.e., the plaintext
3762), a key 3766, and a MAC algorithm (e.g., a hash function
3767). More specifically, the plaintext 3762 is processed through
the MAC algorithm using the key 3766. In one aspect similar to
symmetric encryption discussed herein, the key 3766 is a secret key
accessible/known by the surgical hub 206 and the recipient (e.g.,
cloud-based system 205). In such an aspect, the secret key is a
shared secret associated with/chosen by the surgical hub 206, a
shared secret associated with/chosen by the recipient, or a key
selected via a pseudorandom key generator. Next, the non-encrypted
generator data (i.e., the plaintext 3762) and the MAC 3765 are
together encrypted 3763 (e.g., via key 3766) to produce a
ciphertext 3764 based on both. For this approach, as shown
generally at 3768, the ciphertext 3764 (i.e., which includes the
encrypted generator data and the encrypted MAC 3765) would be
communicated to the cloud-based system 205.
[0354] In alternative aspects, the key used to encrypt the
non-encrypted generator data (e.g., FIG. 25 and FIG. 26) or the
non-encrypted generator data and the MAC (e.g., FIG. 27) may be
different from the key (e.g., keys 3746, 3756, 3766) used to
produce the MAC. For example, the key used to encrypt the
non-encrypted generator data (e.g., FIG. 25 and FIG. 26) or the
non-encrypted generator data and the MAC (e.g., FIG. 27) may be a
different shared secret or a public key associated with the
recipient.
[0355] In lieu of utilizing the MAC to provide for a subsequent
assurance of data integrity to the cloud-based system 205,
according to other aspects, the surgical hub 206 can utilize a
digital signature to allow the cloud-based system 205 to
subsequently authenticate integrity of the communicated generator
data. For example, the processor module 232 and/or the processor
244 of the computer system 210 can utilize one or more algorithms
to generate a digital signature associated with the generator data,
and the cloud-based system 205 can utilize an algorithm to
determine the authenticity of the received generator data. The
algorithms utilized by the processor module 232 and/or the
processor 244 of the computer system 210 can include: (1) a key
generation algorithm that selects a private key uniformly at random
from a set of possible private keys, where the key generation
algorithm outputs the private key and a corresponding public key;
and (2) a signing algorithm that, given the generator data and a
private key, produces a digital signature associated with the
generator data. The cloud-based system 205 can utilize a signature
verifying algorithm that, given the received generator data, public
key, and digital signature, can accept the received generator data
as authentic if the digital signature is determined to be authentic
or consider the generator data to be compromised or altered if the
digital signature is not determined to be authentic.
[0356] According to other aspects of the present disclosure, the
surgical hub 206 can utilize a commercial authentication program
(e.g., Secure Hash Algorithm, SHA-2 comprising SHA-256) to provide
for a subsequent assurance of data integrity of the communicated
generator data to the cloud-based system 205.
[0357] After the generator data has been encrypted (e.g., via EtM,
E&M, MtE), a component of the surgical hub 206 can communicate
the encrypted generator data to the cloud-based system 205. The
component of the surgical hub 206 which communicates the encrypted
generator data to the cloud-based system 205 can be, for example,
the processor module 232, a hub/switch 207/209 of the modular
communication hub 203, the router 211 of the modular communication
hub 203, the communication module 247 of the computer system 210,
etc.
[0358] According to various aspects, the communication of the
encrypted generator data through the Internet can follow an IP
which: (1) defines datagrams that encapsulate the encrypted
generator data to be delivered and/or (2) defines addressing
methods that are used to label the datagram with source and
destination information. A high-level representation of an example
datagram 3770 is shown in FIG. 28, where the datagram 3770 includes
a header 3772 and a payload 3774, and in other aspects also may
include a trailer (not shown). A more detailed representation of an
example datagram 3780 is shown in FIG. 29, where the header 3782
can include fields for information such as, for example, the IP
address of the source 3786 which is sending the datagram (e.g., the
router 211 of the modular communication hub 203), the IP address of
the destination 3788 which is to receive the datagram (e.g., the
cloud 204 and/or the remote server 213 associated with the
cloud-based system 205), a type of service designation (not shown),
a header length 3790, a payload length 3792, and a checksum value
3794. In such an aspect, the surgical hub 206 may further apply a
checksum function/algorithm to the non-encrypted generator data
(i.e., the plaintext 3742, e.g., data packet 3722) or at least a
portion of the non-encrypted generator data (e.g., combination
generator ID 3726) to derive the checksum value 3794. Here, the
checksum function/algorithm is configured to output a significantly
different checksum value if there is any modification (e.g., even a
slight change) to the underlying data (e.g., generator data). After
decryption of the encrypted generator data by its recipient (e.g.,
cloud-based system 205), the recipient may apply the same checksum
function/algorithm to the decrypted generator data to generate a
validating checksum value. If the validating checksum value matches
the checksum value 3794 (i.e., stored in the header 3782 of the
received datagram 3780), the integrity of the received generator
data is further verified. The payload 3784 may include the
encrypted generator data 3796 and can also include padding 3798 if
the encrypted generator data 3796 is less than a specified payload
length. Notably, the communicated encrypted generator data 3796 may
comprise a MAC as discussed in FIGS. 25, 26, and 27 above (e.g.,
references 3748, 3758, and 3768, respectively). In some aspects,
the header 3782 can further include a specific path the datagram is
to follow when the datagram is communicated from the surgical hub
206 to the cloud-based system 205 (e.g., from IP address of the
source, to IP address of at least one intermediate network
component (e.g., specified routers, specified servers), to IP
address of the destination).
[0359] According to various aspects, prior to the generator data
being encrypted, the generator data can be time-stamped (if not
already time-stamped by the combination generator 3700) and/or the
generator data can be compressed (if not already compressed by the
combination generator 3700). Time-stamping allows for the
cloud-based system 205 to correlate the generator data with other
data (e.g., stripped patient data) which may be communicated to the
cloud-based system 205. The compression allows for a smaller
representation of the generator data to be subsequently encrypted
and communicated to the cloud-based system 205. For the
compression, a component of the surgical hub 206 can utilize a
compression algorithm to convert a representation of the generator
data to a smaller representation of the generator data, thereby
allowing for a more efficient and economical encryption of the
generator data (e.g., less data to encrypt utilizes less processing
resources) and a more efficient and economical communication of the
encrypted generator data (e.g., smaller representations of the
generator data within the payload of the datagrams (e.g., FIGS. 28
and 29) allow for more generator data to be included in a given
datagram, for more generator data to be communicated within a given
time period, and/or for generator data to be communicated with
fewer communication resources). The component of the surgical hub
206 which utilizes/executes the compression algorithm can be, for
example, the processor module 232, the processor 244 of the
computer system, and/or combinations thereof. The utilized/executed
compression algorithm can be a lossless compression algorithm or a
lossy compression algorithm.
[0360] Once the generator data and the MAC for a given datagram has
been received at the cloud-based system 205 (e.g., FIG. 25,
reference 3748; FIG. 26, reference 3758; and FIG. 27, reference
3768), the cloud-based system 205 can decrypt the encrypted
generator data from the payload of the communicated datagram to
realize the communicated generator data.
[0361] In one aspect, referring back to FIG. 25, the recipient
(e.g., cloud-based system 205) may, similar to the surgical hub
206, process the ciphertext 3744 through the same MAC algorithm
using the same known/accessible secret key to produce an
authenticating MAC. If the received MAC 3745 matches this
authenticating MAC, the recipient (e.g., cloud-based system 205)
may safely assume that the ciphertext 3744 has not been altered and
is from the surgical hub 206. The recipient (e.g., cloud-based
system 205) may then decrypt the ciphertext 3744 (e.g., via key
3746) to realize the plaintext 3742 (e.g., data packet comprising
generator data).
[0362] In another aspect, referring back to FIG. 26, the recipient
(e.g., cloud-based system 205) may decrypt the ciphertext 3754
(e.g., via key 3756) to realize the plaintext 3752 (e.g., data
packet comprising generator data). Next, similar to the surgical
hub 206, the recipient (e.g., cloud-based system 205) may process
the plaintext 3752 through the same MAC algorithm using the same
known/accessible secret key to produce an authenticating MAC. If
the received MAC 3755 matches this authenticating MAC, the
recipient (e.g., cloud-based system 205) may safely assume that the
plaintext 3752 has not been altered and is from the surgical hub
206.
[0363] In yet another aspect, referring back to FIG. 27, the
recipient (e.g., cloud-based system 205) may decrypt the ciphertext
3764 (e.g., via key 3766) to realize the plaintext 3762 (e.g., data
packet comprising generator data) and the MAC 3765. Next, similar
to the surgical hub 206, the recipient (e.g., cloud-based system
205) may process the plaintext 3762 through the same MAC algorithm
using the same known/accessible secret key to produce an
authenticating MAC. If the received MAC 3765 matches this
authenticating MAC, the recipient (e.g., cloud-based system 205)
may safely assume that the plaintext 3762 has not been altered and
is from the surgical hub 206.
[0364] In alternative aspects, the key used to encrypt the
non-encrypted generator data (e.g., FIG. 25 and FIG. 26) or the
non-encrypted generator data and the MAC (e.g., FIG. 27) may be
different from the key (e.g., keys 3746, 3756, 3766) used to
produce the MAC. For example, the key used to encrypt the
non-encrypted generator data (e.g., FIG. 25 and FIG. 26) or the
non-encrypted generator data and the MAC (e.g., FIG. 27) may be a
different shared secret or a public key associated with the
recipient. In such aspects, referring to FIG. 25, the recipient
(e.g., cloud-based system 205) may, after verifying the
authenticating MAC via key 3746 (described above), then decrypt the
ciphertext 3744 (e.g., via the different shared secret or private
key associated with the recipient) to realize the plaintext 3742
(e.g., data packet comprising generator data). In such aspects,
referring to FIG. 26, the recipient may decrypt the ciphertext 3754
(e.g., via the different shared secret or private key associated
with the recipient) to realize the plaintext 3752 (e.g., data
packet comprising generator data), then verify the authenticating
MAC via key 3756 (described above). In such aspects, referring to
FIG. 27, the recipient may decrypt the ciphertext 3764 (e.g., via
the different shared secret or private key associated with the
recipient) to realize the plaintext 3762 (e.g., data packet
comprising generator data) and the MAC 3765, then verify the
authenticating MAC via key 3766 (described above).
[0365] In sum, referring to FIGS. 25-27, if an authenticating MAC,
as determined/calculated by the cloud-based system 205, is the same
as the MAC which was received with the datagram, the cloud-based
system 205 can have confidence that the received generator data is
authentic (i.e., it is the same as the generator data which was
communicated by the surgical hub 206) and that the data integrity
of the communicated generator data has not been compromised or
altered. As described above, the recipient may further apply the
plaintext 3742, 3752, 3762, or at least a portion thereof to the
same checksum function/algorithm (i.e., used by the surgical hub
206) to generate a validating checksum value to further verify the
integrity of the generator data based on the checksum value stored
in the header of the communicated datagram.
[0366] Additionally, based on the decrypted datagram, the IP
address of the source (e.g., FIG. 29, reference 3786) which
originally communicated the datagram to the cloud-based system 205
can be determined from the header of the communicated datagram. If
the determined source is a recognized source, the cloud-based
system 205 can have confidence that the generator data originated
from a trusted source, thereby providing source authentication and
even more assurance of the data integrity of the generator data.
Furthermore, since each router the datagram passed through in route
to the cloud-based system 205 includes its IP address with its
forwarded communication, the cloud-based system 205 is able to
trace back the path followed by the datagram and identify each
router which handled the datagram. The ability to identify the
respective routers can be helpful in instances where the content of
the datagram received at the cloud-based system 205 is not the same
as the content of the datagram as originally communicated by the
surgical hub 206. For aspects where the communication path was
pre-specified and included in the header of the communicated
datagram, the ability to identify the respective routers can allow
for path validation and provide additional confidence of the
authenticity of the received generator data.
[0367] Furthermore, according to various aspects, after
authenticating the received generator data, the cloud-based system
205 can communicate a message (e.g., a handshake or similar
message) to the surgical hub 206 via the Internet or another
communication network, confirming/guaranteeing that the datagram
communicated from the surgical hub 206 was received intact by the
cloud-based system 205, thereby effectively closing the loop for
that particular datagram.
[0368] Aspects of the above-described communication method, and/or
variations thereof, can also be employed to communicate data other
than generator data to the cloud-based system 205 and/or to
communicate generator data and/or other data from the surgical hub
206 to systems and/or devices other than the cloud-based system
205. For example, according to various aspects, the generator data
and/or other data can be communicated from the surgical hub 206 to
a hand-held surgical device/instrument (e.g., wireless
device/instrument 235), to a robotic interface of a surgical
device/instrument (e.g., robot hub 222) and/or to other servers,
including servers (e.g., similar to server 213) associated with
other cloud-based systems (e.g., similar to cloud-based system 205)
in accordance with the above-described communication method. For
example, in certain instances, an EEPROM chip of a given surgical
instrument can initially be provided with merely an electronic chip
device ID. Upon connection of the given surgical instrument to the
combination generator 3700, data can be downloaded from the
cloud-based system 205 to the surgical hub 206 and subsequently to
the EEPROM of the surgical instrument in accordance with the
above-described communication method.
[0369] In addition to communicating generator data to the
cloud-based system 205, the surgical hub 206 can also utilize the
above-described method of communication, and/or variations thereof,
to communicate data other than generator data to the cloud-based
system 205. For example, the surgical hub 206 can also communicate
other information associated with the surgical procedure to the
cloud-based system 205. Such other information can include, for
example, the type of surgical procedure being performed, the name
of the facility where the surgical procedure is being performed,
the location of the facility where the surgical procedure is being
performed, an identification of the operating room within the
facility where the surgical procedure is being performed, the name
of the surgeon performing the surgical procedure, the age of the
patient, and data associated with the condition of the patient
(e.g., blood pressure, heart rate, current medications). According
to various aspects, such other information may be stripped of all
information which could identify the specific surgery, the patient,
or the surgeon, so that the information is essentially anonymized
for further processing and analysis by the cloud-based system 205.
In other words, the stripped data is not correlated to a specific
surgery, patient, or surgeon. The stripped information can be
communicated to the cloud-based system 205 either together with or
distinct from the communicated generator data.
[0370] For instances where the stripped/other data is to be
communicated apart from the generator data, the stripped/other data
can be time-stamped, compressed, and/or encrypted in a manner
identical to or different from that described above regarding the
generator data, and the surgical hub 206 may be
programmed/configured to generate a datagram which includes the
encrypted stripped/other information in lieu of the encrypted
generator data. The datagram can then be communicated from the
surgical hub 206 through the Internet to the cloud-based system 205
following an IP which: (1) defines datagrams that encapsulate the
encrypted stripped/other data to be delivered, and (2) defines
addressing methods that are used to label the datagram with source
and destination information.
[0371] For instances where the stripped/other information is to be
communicated with the generator data, the stripped/other data can
be time-stamped, compressed, and/or encrypted in a manner identical
to or different from that described above regarding the generator
data, and the surgical hub 206 may be programmed/configured to
generate a datagram which includes both the encrypted generator
data and the encrypted stripped/other information. An example of
such a datagram in shown in FIG. 30, where the payload 3804 of the
datagram 3800 is divided into two or more distinct payload data
portions (e.g., one for the encrypted generator data 3834, one for
the encrypted stripped/other information 3836), with each portion
having an identifying bit (e.g., generator data (GD) 3806, other
data (OD) 3812), the associated encrypted data 3808, 3814, and the
associated padding 3810, 3816, if needed, respectively. Further, as
shown in FIG. 30, the header 3802 may be the same as (e.g., IP
address source 3818, IP address destination 3820, header length
3822) or different from the header 3782 described with reference to
the datagram 3780 shown in FIG. 29. For example, the header 3802
may be different in that the header 3802 further includes a field
designating the number of payload data portions 3824 (e.g., 2)
included in the payload 3804 of the datagram 3800. The header 3802
can also be different in that it can include fields designating the
payload length 3826, 3830 and the checksum value 3828, 2832 for
each payload data portion 3834, 3836, respectively. Although only
two payload data portions are shown in FIG. 30, it will be
appreciated that the payload 3804 of the datagram 3800 may include
any quantity/number of payload data portions (e.g., 1, 2, 3, 4, 5),
where each payload data portion includes data associated with a
different aspect of the surgical procedure. The datagram 3800 can
then be communicated from the surgical hub 206 through the Internet
to the cloud-based system 205 following an IP which: (1) defines
datagrams that encapsulate the encrypted generator data and the
encrypted stripped/other data to be delivered, and (2) defines
addressing methods that are used to label the datagram with source
and destination information.
[0372] As set forth above, it is an unfortunate reality that the
outcomes of all surgical procedures are not always optimal and/or
successful. For instances where a failure event is detected and/or
identified, a variation of the above-described communication
methods can be utilized to isolate surgical data which is
associated with the failure event (e.g., failure event surgical
data) from surgical data which is not associated with the failure
event (e.g., non-failure event surgical data) and communicate the
surgical data which is associated with the failure event (e.g.,
failure event data) from the surgical hub 206 to the cloud-based
system 205 on a prioritized basis for analysis. According to one
aspect of the present disclosure, failure event surgical data is
communicated from the surgical hub 206 to the cloud-based system
205 on a prioritized basis relative to non-failure event surgical
data.
[0373] FIG. 31 illustrates various aspects of a system-implemented
method of identifying surgical data associated with a failure event
(e.g., failure event surgical data) and communicating the
identified surgical data to a cloud-based system 205 on a
prioritized basis. The method comprises (1) receiving 3838 surgical
data at a surgical hub 206, wherein the surgical data is associated
with a surgical procedure; (2) time-stamping 3840 the surgical
data; (3) identifying 3842 a failure event associated with the
surgical procedure; (4) determining 3844 which of the surgical data
is associated with the failure event (e.g., failure event surgical
data); (5) separating 3846 the surgical data associated with the
failure event from all other surgical data (e.g., non-failure event
surgical data) received at the surgical hub 206; (6) chronologizing
3848 the surgical data associated with the failure event; (7)
encrypting 3850 the surgical data associated with the failure
event; and (8) communicating 3852 the encrypted surgical data to a
cloud-based system 205 on a prioritized basis.
[0374] More specifically, various surgical data can be captured
during a surgical procedure and the captured surgical data, as well
as other surgical data associated with the surgical procedure, can
be communicated to the surgical hub 206. The surgical data can
include, for example, data associated with a surgical
device/instrument (e.g., FIG. 9, surgical device/instrument 235)
utilized during the surgery, data associated with the patient, data
associated with the facility where the surgical procedure was
performed, and data associated with the surgeon. Either prior to or
subsequent to the surgical data being communicated to and received
by the surgical hub 206, the surgical data can be time-stamped
and/or stripped of all information which could identify the
specific surgery, the patient, or the surgeon, so that the
information is essentially anonymized for further processing and
analysis by the cloud-based system 205.
[0375] Once a failure event has been detected and/or identified
(e.g., which can be either during or after the surgical procedure),
the surgical hub 206 can determine which of the surgical data is
associated with the failure event (e.g., failure event surgical
data) and which of the surgical data is not associated with the
surgical event (e.g., non-failure event surgical data). According
to one aspect of the present disclosure, a failure event can
include, for example, a detection of one or more misfired staples
during a stapling portion of a surgical procedure. For example, in
one aspect, referring to FIG. 9, an endoscope 239 may take
snapshots while a surgical device/instrument 235 comprising an end
effector including a staple cartridge performs a stapling portion
of a surgical procedure. In such an aspect, an imaging module 238
may compare the snapshots to stored images and/or images downloaded
from the cloud-based system 205 that convey correctly fired staples
to detect a misfired staple and/or evidence of a misfired staple
(e.g., a leak). In another aspect, the imaging module 238 may
analyze the snapshots themselves to detect a misfired staple and/or
evidence of a misfired staple. In one alternative aspect, the
surgical hub 206 may communicate the snapshots to the cloud-based
system 205, and a component of the cloud-based system 205 may
perform the various imaging module functions described above to
detect a misfired staple and/or evidence of a misfired staple and
to report the detection to the surgical hub 206. According to
another aspect of the present disclosure, a failure event can
include a detection of a tissue temperature which is below the
expected temperature during a tissue-sealing portion of a surgical
procedure and/or a visual indication of excessive bleeding or
oozing following a surgical procedure (e.g., FIG. 9, via endoscope
239). For example, in one aspect, referring to FIG. 9, the surgical
device/instrument 235 may comprise an end effector, including a
temperature sensor and the surgical hub 206, and/or the cloud-based
system may compare at least one temperature detected by the
temperature sensor (e.g., during a tissue-sealing portion of a
surgical procedure) to a stored temperature and/or a range of
temperatures expected and/or associated with that surgical
procedure to detect an inadequate/low sealing temperature. In
another aspect, an endoscope 239 may take snapshots during a
surgical procedure. In such an aspect, an imaging module 238 may
compare the snapshots to stored images and/or images downloaded
from the cloud-based system 205 that convey tissue correctly sealed
at expected temperatures to detect evidence of an
improper/insufficient sealing temperature (e.g., charring,
oozing/bleeding). Further, in such an aspect, the imaging module
238 may analyze the snapshots themselves to detect evidence of an
improper/insufficient sealing temperature (e.g., charring,
oozing/bleeding). In one alternative aspect, the surgical hub 206
may communicate the snapshots to the cloud-based system 205, and a
component of the cloud-based system 205 may perform the various
imaging module functions described above to detect evidence of an
improper/insufficient sealing temperature and to report the
detection to the surgical hub 206. According to the various aspects
described above, in response to the detected and/or identified
failure event, the surgical hub 206 may download a program from the
cloud-based system 205 for execution by the surgical
device/instrument 235 that corrects the detected issue (i.e.,
program that alters surgical device/instrument parameters to
prevent misfired staples, program that alters surgical
device/instrument parameters to ensure correct sealing
temperature).
[0376] In some aspects, a failure event is deemed to cover a
certain time period, and all surgical data associated with that
certain time period can be deemed to be associated with the failure
event.
[0377] After the surgical data associated with the failure event
has been identified, the identified surgical data (e.g., failure
event surgical data) can be separated or isolated from all of the
other surgical data associated with the surgical procedure (e.g.,
non-failure event surgical data). The separation can be realized,
for example, by tagging or flagging the identified surgical data,
by storing the identified surgical data apart from all of the other
surgical data associated with the surgical procedure, or by storing
only the other surgical data while continuing to process the
identified surgical data for subsequent prioritized communication
to the cloud-based system 205. According to various aspects, the
tagging or flagging of the identified surgical data can occur
during the communication process when the datagram is generated as
described in more detail below.
[0378] The time-stamping of all of the surgical data (e.g., either
before or after the surgical data is received at the surgical hub)
can be utilized by a component of the surgical hub 206 to
chronologize the identified surgical data associated with the
failure event. The component of the surgical hub 206 which utilizes
the time-stamping to chronologize the identified surgical data can
be, for example, the processor module 232, the processor 244 of the
computer system 210, and/or combinations thereof. By chronologizing
the identified surgical data, the cloud-based system 205 and/or
other interested parties can subsequently better understand the
conditions which were present leading up to the occurrence of the
failure event and possibly pinpoint the exact cause of the failure
event, thereby providing the knowledge to potentially mitigate a
similar failure event from occurring during a similar surgical
procedure performed at a future date.
[0379] Once the identified surgical data has been chronologized,
the chronologized surgical data may be encrypted in a manner
similar to that described above with respect to the encryption of
the generator data. Thus, the identified surgical data can be
encrypted to help ensure the confidentiality of the identified
surgical data, either while it is being stored at the surgical hub
206 or while it is being transmitted to the cloud-based system 205
using the Internet or other computer networks. According to various
aspects, a component of the surgical hub 206 utilizes an encryption
algorithm to convert the identified surgical data from a readable
version to an encoded version, thereby forming the encrypted
surgical data associated with the failure event (e.g., FIGS.
25-27). The component of the surgical hub which utilizes the
encryption algorithm can be, for example, the processor module 232,
the processor 244 of the computer system 210, and/or combinations
thereof. The utilized encryption algorithm can be a symmetric
encryption algorithm or an asymmetric encryption algorithm.
[0380] After the identified surgical data has been encrypted, a
component of the surgical hub can communicate the encrypted
surgical data associated with the failure event (e.g., encrypted
failure event surgical data) to the cloud-based system 205. The
component of the surgical hub which communicates the encrypted
surgical data to the cloud-based system 205 can be, for example,
the processor module 232, a hub/switch 207/209 of the modular
communication hub 203, the router 211 of the modular communication
hub 203, or the communication module 247 of the computer system
210. According to various aspects, the communication of the
encrypted surgical data (e.g., encrypted failure event surgical
data) through the Internet can follow an IP which: (1) defines
datagrams that encapsulate the encrypted surgical data to be
delivered, and (2) defines addressing methods that are used to
label the datagram with source and destination information. The
datagram can be similar to the datagram shown in FIG. 29 or the
datagram shown in FIG. 30, but can be different in that either the
header or the payload of the datagram can include a field which
includes a flag or a tag which identifies the encrypted surgical
data (e.g., encrypted failure event surgical data) as being
prioritized relative to other non-prioritized surgical data (e.g.,
encrypted non-failure event surgical data). An example of such a
datagram is shown in FIG. 32, where the payload 3864 of the
datagram 3860 includes a field which indicates (e.g., a prioritized
designation 3834) that the payload 3864 includes prioritized
surgical data (e.g., combination generator data 3868). According to
various aspects, the payload 3864 of the datagram 3860 can also
include non-flagged/non-tagged/non-prioritized surgical data 3836
(e.g., other surgical data 3874) as shown in FIG. 32.
[0381] According to various aspects, prior to the identified
surgical data (e.g., failure event surgical data) being encrypted,
the identified surgical data can be compressed (if not already
compressed by the source(s) of the relevant surgical data). The
compression allows for a smaller representation of the surgical
data associated with the failure event to be subsequently encrypted
and communicated to the cloud-based system 205. For the
compression, a component of the surgical hub 206 can utilize a
compression algorithm to convert a representation of the identified
surgical data to a smaller representation of the identified
surgical data, thereby allowing for a more efficient and economical
encryption of the identified surgical data (less data to encrypt
utilizes less processing resources) and a more efficient and
economical communication of the encrypted surgical data (smaller
representations of the surgical data within the payload of the
datagrams allow for more identified surgical data to be included in
a given datagram, for more identified surgical data to be
communicated within a given time period, and/or for identified
surgical data to be communicated with fewer communication
resources). The component of the surgical hub 206 which utilizes
the compression algorithm can be, for example, the processor module
232, the processor 244 of the computer system 210, and/or
combinations thereof. The utilized compression algorithm can be a
lossless compression algorithm or a lossy compression
algorithm.
[0382] In instances where other non-prioritized surgical data
(e.g., non-failure event surgical data) is to be communicated with
prioritized surgical data (e.g., failure event surgical data), the
other non-prioritized surgical data can be time-stamped,
compressed, and/or encrypted in a manner identical to or different
from that described above regarding the surgical data identified as
associated with a failure event (e.g., failure event surgical
data), and the surgical hub 206 may be programmed/configured to
generate a datagram which includes both the encrypted prioritized
surgical data (e.g., encrypted failure event surgical data) and the
encrypted other non-prioritized surgical data (e.g., encrypted
non-failure event surgical data). For example, in light of FIG. 32,
the payload 3864 of the datagram 3860 may be divided into two or
more distinct payload data portions (e.g., one for the prioritized
surgical data 3834, one for the non-prioritized surgical data
3836), with each portion having an identifying bit (e.g., generator
data (GD) 3866, other data (OD) 3872), the associated encrypted
data (e.g., encrypted prioritized surgical data 3868, encrypted
non-prioritized surgical data 3874), and the associated padding
3870, 3876, if needed, respectively. Further, similar to FIG. 30,
the header 3862 may be the same as (e.g., IP address source 3878,
IP address destination 3880, header length 3882) or different from
the header 3782 described with reference to the datagram 3780 shown
in FIG. 29. For example, the header 3862 may be different in that
the header 3862 further includes a field designating the number of
payload data portions 3884 (e.g., 2) included in the payload 3864
of the datagram 3860. The header 3862 can also be different in that
it can include fields designating the payload length 3886, 3890 and
the checksum value 3888, 2892 for each payload data portion 3834,
3836, respectively. Although only two payload data portions are
shown in FIG. 32, it will be appreciated that the payload 3864 of
the datagram 3860 may include any quantity/number of payload data
portions (e.g., 1, 2, 3, 4, 5), where each payload data portion
includes data associated with a different aspect of the surgical
procedure. The datagram 3860 can then be communicated from the
surgical hub 206 through the Internet to the cloud-based system 205
following an IP which: (1) defines datagrams that encapsulate the
encrypted generator data and the encrypted stripped/other data to
be delivered, and (2) defines addressing methods that are used to
label the datagram with source and destination information.
[0383] In some aspects, once a failure event associated with a
surgical procedure has been identified, the surgical hub 206 and/or
the cloud-based system 205 can subsequently flag or tag a surgical
device/instrument 235 which was utilized during the surgical
procedure for inoperability and/or removal. For example, in one
aspect, information (e.g., serial number, ID) associated with the
surgical device/instrument 235 and stored at the surgical hub 206
and/or the cloud-based system 205 can be utilized to effectively
block the surgical device/instrument 235 from being used again
(e.g., blacklisted). In another aspect, information (e.g., serial
number, ID) associated with the surgical device/instrument can
initiate the printing of a shipping slip and shipping instructions
for returning the surgical device/instrument 235 back to a
manufacturer or other designated party so that a thorough
analysis/inspection of the surgical device/instrument 235 can be
performed (e.g., to determine the cause of the failure). According
to various aspects described herein, once the cause of a failure is
determined (e.g., via the surgical hub 206 and/or the cloud-based
system 205), the surgical hub 206 may download a program from the
cloud-based system 205 for execution by the surgical
device/instrument 235 that corrects the determined cause of the
failure (i.e., program that alters surgical device/instrument
parameters to prevent the failure from occurring again).
[0384] According to some aspects, the surgical hub 206 and/or the
cloud-based system 205 can also provide/display a reminder (e.g.,
via hub display 215 and/or surgical device/instrument display 237)
to administrators, staff, and/or other personnel to physically
remove the surgical device/instrument 235 from the operating room
(e.g., if detected as still present in the operating room) and/or
to send the surgical device/instrument 235 to the manufacturer or
the other designated party. In one aspect, the reminder may be set
up to be provided/displayed periodically until an administrator can
remove the flag or tag of the surgical device/instrument 235 from
the surgical hub 206 and/or the cloud-based system 205. According
to various aspects, an administrator may remove the flag or tag
once the administrator can confirm (e.g., system tracking of the
surgical device/instrument 235 via its serial number/ID) that the
surgical device/instrument 235 has been received by the
manufacturer or the other designated party. By using the
above-described method to flag and/or track surgical data
associated with a failure event, a closed loop control of the
surgical data associated with the failure event and/or with a
surgical device/instrument 235 can be realized. Additionally, in
view of the above, it will be appreciated that the surgical hub 206
can be utilized to effectively manage the utilization (or
non-utilization) of surgical devices/instruments 235 which have or
potentially could be utilized during a surgical procedure.
[0385] In various aspects of the present disclosure, the surgical
hub 206 and/or cloud-based system 205 may want to control which
components (e.g., surgical device/instrument 235, energy device
241) are being utilized in its interactive surgical system 100/200
to perform surgical procedures (e.g., to minimize future failure
events, to avoid the use of unauthorized or knock-off
components).
[0386] As such, in various aspects of the present disclosure, since
an interactive surgical system 100 may comprise a plurality of
surgical hubs 106, a cloud-based system 105 and/or each surgical
hub 106 of the interactive surgical system 100 may want to track
component-surgical hub combinations utilized over time. In one
aspect, upon/after a component (See FIG. 9, e.g., surgical
device/instrument 235, energy device 241) is connected to/used with
a particular surgical hub 106 (e.g., surgical device/instrument 235
wired/wirelessly connected to the particular surgical hub 106,
energy device 241 connected to the particular surgical hub 106 via
generator module 240), the particular surgical hub 106 may
communicate a record/block of that connection/use (e.g., linking
respective unique identifiers of the connected devices) to the
cloud-based system 105 and/or to the other surgical hubs 106 in the
interactive surgical system 100. For example, upon/after the
connection/use of an energy device 241, a particular surgical hub
106 may communicate a record/block (e.g., linking a unique
identifier of the energy device 241 to a unique identifier of a
generator module 240 to a unique identifier of the particular
surgical hub 106) to the cloud-based system 105 and/or other
surgical hubs 106 in the interactive surgical system 100. In such
an aspect, if this is the first time the component (e.g., energy
device) is connected to/used with a surgical hub 106 in the
interactive surgical system 100, the cloud-based system 105 and/or
each surgical hub 106 of the interactive surgical system 100 may
store the record/block as a genesis record/block. In such an
aspect, the genesis record/block stored at the cloud-based system
105 and/or each surgical hub 106 may comprise a time stamp.
However, in such an aspect, if this is not the first time the
component (e.g., energy device 241) has been connected to/used with
a surgical hub 106 in the interactive surgical system 100, the
cloud-based system 105 and/or each surgical hub 106 of the
interactive surgical system may store the record/block as a new
record/block in a chain of record/blocks associated with the
component. In such an aspect, the new record/block may comprise a
cryptographic hash of the most recently communicated record/block
stored at the cloud-based system 105 and/or each surgical hub 106,
the communicated linkage data, and a time stamp. In such an aspect,
each cryptographic hash links each new record/block (e.g., each use
of the component) to its prior record/block to form a chain
confirming the integrity of each prior record/block(s) back to an
original genesis record/block (e.g., first use of the component).
According to such an aspect, this blockchain of records/blocks may
be developed at the cloud-based system 105 and/or each surgical hub
106 of the interactive surgical system 100 to permanently and
verifiably tie usage of a particular component to one or more than
one surgical hub 106 in the interactive surgical system 100 over
time. Here, according to another aspect, this approach may be
similarly applied to sub-components (e.g., handle, shaft, end
effector, cartridge) of a component when/after the component is
connected to/used with a particular surgical hub 106 of an
interactive surgical system 100.
[0387] According to various aspects of the present disclosure, the
cloud-based system 105 and/or each surgical hub 106 may utilize
such records/blocks to trace usage of a particular component and/or
a sub-component back to its initial usage in the interactive
surgical system 100. For example, if a particular component (e.g.,
surgical device/instrument 235) is flagged/tagged as related to a
failure event, the cloud-based system 105 and/or a surgical hub 106
may analyze such records/blocks to determine whether past usage of
that component and/or a sub-component of that component contributed
to or caused the failure event (e.g., overused). In one example,
the cloud-based system 105 may determine that a sub-component
(e.g., end effector) of that component may actually be
contributing/causing the failure event and then tag/flag that
component for inoperability and/or removal based on the
determination.
[0388] According to another aspect, the cloud-based system 205
and/or surgical hub 206 may control which components (e.g.,
surgical device/instrument 235, energy device 241) are being
utilized in an interactive surgical system 200 to perform surgical
procedures by authenticating the component and/or its
supplier/manufacturer. In one aspect, the supplier/manufacturer of
a component may associate a serial number and a source ID with the
component. In such an aspect, the supplier/manufacturer may
create/generate a private key for the serial number, encrypt the
serial number with the private key, and store the encrypted serial
number and the source ID on an electronic chip (e.g., memory) in
the component prior to shipment to a surgical site. Here,
upon/after connection of the component to a surgical hub 206, the
surgical hub 206 may read the encrypted serial number and the
source ID from the electronic chip. In response, the surgical hub
206 may send a message (i.e., comprising the encrypted serial
number) to a server of the supplier/manufacturer associated with
the source ID (e.g., directly or via the cloud-based system 205).
In such an aspect, the surgical hub 206 may encrypt the message
using a public key associated with that supplier/manufacturer. In
response, the surgical hub 206 may receive a message (i.e.,
comprising the private key the supplier/manufacturer generated
for/associated with that encrypted serial number) from the
supplier/manufacturer server (e.g., directly or via the cloud-based
system 205). In such an aspect, the supplier/manufacturer server
may encrypt the message using a public key associated with the
surgical hub 206. Further, in such an aspect, the surgical hub 206
may then decrypt the message (e.g., using a private key paired to
the public key used to encrypt the message) to reveal the private
key associated with the encrypted serial number. The surgical hub
206 may then decrypt the encrypted serial number, using that
private key, to reveal the serial number. Further, in such an
aspect, the surgical hub 206 may then compare the decrypted serial
number to a comprehensive list of authorized serial numbers (e.g.,
stored at the surgical hub 206 and/or the cloud-based system and/or
downloaded from the cloud-based system, e.g., received separately
from the supplier/manufacturer) and permit use of the connected
component if the decrypted serial number matches an authorized
serial number. Initially, such a process permits the surgical hub
206 to authenticate the supplier/manufacturer. In particular, the
surgical hub 206 encrypted the message comprising the encrypted
serial number using a public key associated with the
supplier/manufacturer. As such, receiving a response message (i.e.,
comprising the private key) authenticates the supplier/manufacturer
to the surgical hub 206 (i.e., otherwise the supplier/manufacturer
would not have access to the private key paired to the public key
used by the surgical hub 206 to encrypt the message, and the
supplier/manufacturer would not have been able to associate the
encrypted serial number received in the message to its already
generated private key). Furthermore, such a process permits the
surgical hub 206 to authenticate the connected component/device
itself. In particular, the supplier/manufacturer (e.g., just
authenticated) encrypted the serial number of the component using
the delivered private key. Upon secure receipt of the private key,
the surgical hub 206 is able to decrypt the encrypted serial number
(i.e., read from the connected component), which authenticates the
component and/or its association with the supplier/manufacturer
(i.e., only that private key as received from that
supplier/manufacturer would decrypt the encrypted serial number).
Nonetheless, the surgical hub 206 further verifies the component as
authentic (e.g., compares the decrypted serial number to a
comprehensive list of authorized serial numbers received separately
from the supplier/manufacturer). Notably, such aspects as described
above can alternatively be performed by the cloud-based system 205
and/or a combination of the cloud-based system 205 and the surgical
hub 206 to control which components (e.g., surgical
device/instrument 235, energy device 241) are being utilized in an
interactive surgical system 200 (e.g., to perform surgical
procedures) by authenticating the component and/or its
supplier/manufacturer. In one aspect, such described approaches may
prevent the use of knock-off component(s) within the interactive
surgical system 200 and ensure the safety and well-being of
surgical patients.
[0389] According to another aspect, the electronic chip of a
component (e.g., surgical device/instrument 235, energy device 241)
may store (e.g., in memory) data associated with usage of that
component (i.e., usage data, e.g., number of uses with a limited
use device, number of uses remaining, firing algorithms executed,
designation as a single-use component). In such an aspect, the
surgical hub 206 and/or the cloud-based system 205, upon/after
connection of the component to the interactive surgical system, may
read such usage data from the memory of a component and write back
at least a portion of that usage data for storage (e.g., in memory
249) at the surgical hub 206 and/or for storage at the cloud-based
system 205 (e.g., individually and/or under a blockchain approach
discussed herein). According to such an aspect, the surgical hub
206 and/or the cloud-based system 205, upon/after a subsequent
connection of that component to the interactive surgical system,
may again read such usage data and compare that usage to previously
stored usage data. Here, if a discrepancy exists or if a
predetermined/authorized usage has been met, the surgical hub 206
and/or the cloud-based system 205 may prevent use of that component
(e.g., blacklisted, rendered inoperable, flagged for removal) on
the interactive surgical system 200. In various aspects, such an
approach prevents bypass of the encryption chip systems. If the
component's electronic chip/memory has been tampered with (e.g.,
memory reset, number of uses altered, firing algorithms altered,
single-use device designated as a multi-use device), a discrepancy
will exist, and the component's use will be
controlled/prevented.
[0390] Additional details are disclosed in U.S. Patent Application
Publication No. 2017/0086914, entitled TECHNIQUES FOR OPERATING
GENERATOR FOR DIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMS AND
SURGICAL INSTRUMENTS, which is incorporated herein by reference in
its entirety.
Surgical Hub Coordination of Device Pairing in an Operating
Room
[0391] One of the functions of the surgical hub 106 is to pair
(also referred to herein as "connect" or "couple") with other
components of the surgical system 102 to control, gather
information from, or coordinate interactions between the components
of the surgical system 102. Since the operating rooms of a hospital
are likely in close physical proximity to one another, a surgical
hub 106 of a surgical system 102 may unknowingly pair with
components of a surgical system 102 in a neighboring operating
room, which would significantly interfere with the functions of the
surgical hub 106. For example, the surgical hub 106 may
unintentionally activate a surgical instrument in a different
operating room or record information from a different ongoing
surgical procedure in a neighboring operating room.
[0392] Aspects of the present disclosure present a solution,
wherein a surgical hub 106 only pairs with detected devices of the
surgical system 102 that are located within the bounds of its
operating room.
[0393] Furthermore, the surgical hub 106 relies on its knowledge of
the location of other components of the surgical system 102 within
its operating room in making decisions about, for example, which
surgical instruments should be paired with one another or
activated. A change in the position of the surgical hub 106 or
another component of the surgical system 102 can be
problematic.
[0394] Aspects of the present disclosure further present a solution
wherein the surgical hub 106 is configured to reevaluate or
redetermine the bounds of its operating room upon detecting that
the surgical hub 106 has been moved. Aspects of the present
disclosure further present a solution wherein the surgical hub 106
is configured to redetermine the bounds of its operating room upon
detection of a potential device of the surgical system 102, which
can be an indication that the surgical hub 106 has been moved.
[0395] In various aspects, a surgical hub 106 is used with a
surgical system 102 in a surgical procedure performed in an
operating room. The surgical hub 106 comprises a control circuit
configured to determine the bounds of the operating room, determine
devices of the surgical system 102 located within the bounds of the
operating room, and pair the surgical hub 106 with the devices of
the surgical system 102 located within the bounds of the operating
room.
[0396] In one aspect, the control circuit is configured to
determine the bounds of the operating room after activation of the
surgical hub 106. In one aspect, the surgical hub 106 includes a
communication circuit configured to detect and pair with the
devices of the surgical system located within the bounds of the
operating room. In one aspect, the control circuit is configured to
redetermine the bounds of the operating room after a potential
device of the surgical system 102 is detected. In one aspect, the
control circuit is configured to periodically determine the bounds
of the operating room.
[0397] In one aspect, the surgical hub 106 comprises an operating
room mapping circuit that includes a plurality of non-contact
sensors configured to measure the bounds of the operating room.
[0398] In various aspects, the surgical hub 106 includes a
processor and a memory coupled to the processor. The memory stores
instructions executable by the processor to pair the surgical hub
with devices of the surgical system 102 located within the bounds
of the operating room, as described above. In various aspects, the
present disclosure provides a non-transitory computer-readable
medium storing computer-readable instructions which, when executed,
cause a machine to pair the surgical hub 106 with devices of the
surgical system 102 located within the bounds of the operating
room, as described above.
[0399] FIGS. 35 and 36 are logic flow diagrams of processes
depicting control programs or logic configurations for pairing the
surgical hub 106 with devices of the surgical system 102 located
within the bounds of the operating room, as described above.
[0400] The surgical hub 106 performs a wide range of functions that
requires short- and long-range communication, such as assisting in
a surgical procedure, coordinating between devices of the surgical
system 102, and gathering and transmitting data to the cloud 104.
To properly perform its functions, the surgical hub 106 is equipped
with a communication module 130 capable of short-range
communication with other devices of the surgical system 102. The
communication module 130 is also capable of long-range
communication with the cloud 104.
[0401] The surgical hub 106 is also equipped with an operating-room
mapping module 133 which is capable of identifying the bounds of an
operating room, and identifying devices of the surgical system 102
within the operating room. The surgical hub 106 is configured to
identify the bounds of an operating room, and only pair with or
connect to potential devices of the surgical system 102 that are
detected within the operating room.
[0402] In one aspect, the pairing comprises establishing a
communication link or pathway. In another aspect, the pairing
comprises establishing a control link or pathway.
[0403] An initial mapping or evaluation of the bounds of the
operating room takes place during an initial activation of the
surgical hub 106. Furthermore, the surgical hub 106 is configured
to maintain spatial awareness during operation by periodically
mapping its operating room, which can be helpful in determining if
the surgical hub 106 has been moved. The reevaluation 3017 can be
performed periodically or it can be triggered by an event such as
observing a change in the devices of the surgical system 102 that
are deemed within the operating room. In one aspect, the change is
detection 3010 of a new device that was not previously deemed as
within the bounds of the operating room, as illustrated in FIG. 37.
In another aspect, the change is a disappearance, disconnection, or
un-pairing of a paired device that was previously deemed as
residing within the operating room, as illustrated in FIG. 38. The
surgical hub 106 may continuously monitor 3035 the connection with
paired devices to detect 3034 the disappearance, disconnection, or
un-pairing of a paired device.
[0404] In other aspects, reevaluation triggering events can be, for
example, changes in surgeons' positions, instrument exchanges, or
sensing of a new set of tasks being performed by the surgical hub
106.
[0405] In one aspect, the evaluation of the bounds of the room by
the surgical hub 106 is accomplished by activation of a sensor
array of the operating-room mapping module 133 within the surgical
hub 106 which enables it to detect the walls of the operating
room.
[0406] Other components of the surgical system 102 can be made to
be spatially aware in the same, or a similar, manner as the
surgical hub 106. For example, a robotic hub 122 may also be
equipped with an operating-room mapping module 133.
[0407] The spatial awareness of the surgical hub 106 and its
ability to map an operating room for potential components of the
surgical system 102 allows the surgical hub 106 to make autonomous
decisions about whether to include or exclude such potential
components as part of the surgical system 102, which relieves the
surgical staff from dealing with such tasks. Furthermore, the
surgical hub 106 is configured to make inferences about, for
example, the type of surgical procedure to be performed in the
operating room based on information gathered prior to, during,
and/or after the performance of the surgical procedure. Examples of
gathered information include the types of devices that are brought
into the operating room, time of introduction of such devices into
the operating room, and/or the devices sequence of activation.
[0408] In one aspect, the surgical hub 106 employs the
operating-room mapping module 133 to determine the bounds of the
surgical theater (e.g., a fixed, mobile, or temporary operating
room or space) using either ultrasonic or laser non-contact
measurement devices.
[0409] Referring to FIG. 34, ultrasound based non-contact sensors
3002 can be employed to scan the operating theater by transmitting
a burst of ultrasound and receiving the echo when it bounces off a
perimeter wall 3006 of an operating theater to determine the size
of the operating theater and to adjust Bluetooth pairing distance
limits. In one example, the non-contact sensors 3002 can be Ping
ultrasonic distance sensors, as illustrated in FIG. 34.
[0410] FIG. 34 shows how an ultrasonic sensor 3002 sends a brief
chirp with its ultrasonic speaker 3003 and makes it possible for a
micro-controller 3004 of the operating-room mapping module 133 to
measure how long the echo takes to return to the ultrasonic
sensor's ultrasonic microphone 3005. The micro-controller 3004 has
to send the ultrasonic sensor 3002 a pulse to begin the
measurement. The ultrasonic sensor 3002 then waits long enough for
the micro-controller program to start a pulse input command. Then,
at about the same time the ultrasonic sensor 3002 chirps a 40 kHz
tone, it sends a high signal to the micro-controller 3004. When the
ultrasonic sensor 3002 detects the echo with its ultrasonic
microphone 3005, it changes that high signal back to low. The
micro-controller's pulse input command measures the time between
the high and low changes and stores its measurement in a variable.
This value can be used along with the speed of sound in air to
calculate the distance between the surgical hub 106 and the
operating-room wall 3006.
[0411] In one example, as illustrated in FIG. 33, a surgical hub
106 can be equipped with four ultrasonic sensors 3002, wherein each
of the four ultrasonic sensors is configured to assess the distance
between the surgical hub 106 and a wall of the operating room 3000.
A surgical hub 106 can be equipped with more or less than four
ultrasonic sensors 3002 to determine the bounds of an operating
room.
[0412] Other distance sensors can be employed by the operating-room
mapping module 133 to determine the bounds of an operating room. In
one example, the operating-room mapping module 133 can be equipped
with one or more photoelectric sensors that can be employed to
assess the bounds of an operating room. In one example, suitable
laser distance sensors can also be employed to assess the bounds of
an operating room. Laser-based non-contact sensors may scan the
operating theater by transmitting laser light pulses, receiving
laser light pulses that bounce off the perimeter walls of the
operating theater, and comparing the phase of the transmitted pulse
to the received pulse to determine the size of the operating
theater and to adjust Bluetooth pairing distance limits.
[0413] Referring to the top left corner of FIG. 33, a surgical hub
106 is brought into an operating room 3000. The surgical hub 106 is
activated at the beginning of the set-up that occurs prior to the
surgical procedure. In the example of FIG. 33, the set-up starts at
an actual time of 11:31:14 (EST) based on a real-time clock.
However, at the stated procedure set-up start time, the surgical
hub 106 starts 3001 an artificial randomized real-time clock timing
scheme at artificial real time 07:36:00 to protect private patient
information.
[0414] At artificial real time 07:36:01, the operating-room mapping
module 133 employs the ultrasonic distance sensors to
ultrasonically ping the room (e.g., sends out a burst of ultrasound
and listens for the echo when it bounces off the perimeter walls of
the operating room as described above) to verify the size of the
operating room and to adjust pairing distance limits.
[0415] At artificial real time 07:36:03, the data is stripped and
time-stamped. At artificial real time 07:36:05, the surgical hub
106 begins pairing devices located only within the operating room
3000 as verified using ultrasonic distance sensors 3002 of the
operating-room mapping module 133. The top right corner of FIG. 33
illustrates several example devices that are within the bounds of
the operating room 3000 and are paired with the surgical hub 106,
including a secondary display device 3020, a secondary hub 3021, a
common interface device 3022, a powered stapler 3023, a video tower
module 3024, and a powered handheld dissector 3025. On the other
hand, secondary hub 3021', secondary display device 3020', and
powered stapler 3026 are all outside the bounds of the operating
room 3000 and, accordingly, are not paired with the surgical hub
106.
[0416] In addition to establishing a communication link with the
devices of the surgical system 102 that are within the operating
room, the surgical hub 106 also assigns a unique identification and
communication sequence or number to each of the devices. The unique
sequence may include the device's name and a time stamp of when the
communication was first established. Other suitable device
information may also be incorporated into the unique sequence of
the device.
[0417] As illustrated in the top left corner of FIG. 33, the
surgical hub 106 has determined that the operating room 3000 bounds
are at distances a, -a, b, and -b from the surgical hub 106. Since
Device "D" is outside the determined bounds of its operating room
3000, the surgical hub 106 will not pair with the Device "D." FIG.
35 is an example algorithm illustrating how the surgical hub 106
only pairs with devices within the bounds of its operating room.
After activation, the surgical hub 106 determines 3007 bounds of
the operating room using the operating-room mapping module 133, as
described above. After the initial determination, the surgical hub
106 continuously searches for or detects 3008 devices within a
pairing range. If a device is detected 3010, the surgical hub 106
then determines 3011 whether the detected device is within the
bounds of the operating room. The surgical hub 106 pairs 3012 with
the device if it is determined that the device is within the bounds
of the operating room. In certain instances, the surgical hub 106
will also assign 3013 an identifier to the device. If, however, the
surgical hub 106 determines that the detected device is outside the
bounds of the operating room, the surgical hub 106 will ignore 3014
the device.
[0418] Referring to FIG. 36, after an initial determination of the
bounds of the room, and after an initial pairing of devices located
within such bounds, the surgical hub 106 continues to detect 3015
new devices that become available for pairing. If a new device is
detected 3016, the surgical hub 106 is configured to reevaluate
3017 the bounds of the operating room prior to pairing with the new
device. If the new device is determined 3018 to be within the newly
determined bounds of the operating room, then the surgical hub 106
pairs with the device 3019 and assigns 3030 a unique identifier to
the new device. If, however, the surgical hub 106 determines that
the new device is outside the newly determined bounds of the
operating room, the surgical hub 106 will ignore 3031 the
device.
[0419] For pairing, the operating-room mapping module 133 contains
a compass and integrated Bluetooth transceiver. Other communication
mechanisms, which are not significantly affected by the hospital
environment or geographical location, can be employed. Bluetooth
Low Energy (BLE) beacon technology can currently achieve indoor
distance measurements with accuracy of about 1-2 meters, with
improved accuracy in closer proximities (within 0-6 meters).
[0420] To improve the accuracy of the distance measurements, a
compass is used with the BLE. The operating-room mapping module 133
utilizes the BLE and the compass to determine where modules are
located in relation to the patient. For example, two modules facing
each other (detected by compass) with greater than one meter
distance between them may clearly indicate that the modules are on
opposite sides of the patient. The more "Hub"-enabled modules that
reside in the operating room, the greater the achievable accuracy
becomes due to triangulation techniques.
[0421] In the situations where multiple surgical hubs 106, modules,
and/or other peripherals are present in the same operating room, as
illustrated in the top right corner of FIG. 33, the operating-room
mapping module 133 is configured to map the physical location of
each module that resides within the operating room. This
information could be used by the user interface to display a
virtual map of the room, enabling the user to more easily identify
which modules are present and enabled, as well as their current
status. In one aspect, the mapping data collected by surgical hubs
106 are uploaded to the cloud 104, where the data are analyzed for
identifying how an operating room is physically setup, for
example.
[0422] The surgical hub 106 is configured to determine a device's
location by assessing transmission radio signal strength and
direction. For Bluetooth protocols, the Received Signal Strength
Indication (RSSI) is a measurement of the received radio signal
strength. In one aspect, the devices of the surgical system 102 can
be equipped with USB Bluetooth dongles.
[0423] The surgical hub 106 may scan the USB Bluetooth beacons to
get distance information. In another aspect, multiple high-gain
antennas on a Bluetooth access point with variable attenuators can
produce more accurate results than RSSI measurements. In one
aspect, the hub is configured to determine the location of a device
by measuring the signal strength from multiple antennas.
Alternatively, in some examples, the surgical hub 106 can be
equipped with one or more motion sensor devices configured to
detect a change in the position of the surgical hub 106.
[0424] Referring to the bottom left corner of FIG. 33, the surgical
hub 106 has been moved from its original position, which is
depicted in dashed lines, to a new position closer to the device
"D," which is still outside the bounds of the operating room 3000.
The surgical hub 106 in its new position, and based on the
previously determined bounds of the operating room, would naturally
conclude that the device "D" is a potential component of the
surgical system 102. However, the introduction of a new device is a
triggering event for reevaluation 3017 of the bounds of the
operating room, as illustrated in the example algorithm of FIGS.
35, 37. After performing the reevaluation, the surgical hub 106
determines that the operating room bounds have changed. Based on
the new bounds, at distances a.sub.new, -a.sub.new, b.sub.new, and
-b.sub.new, the surgical hub 106 concludes that it has been moved
and that the Device "D" is outside the newly determined bounds of
its operating room. Accordingly, the surgical hub 106 will still
not pair with the Device "D."
[0425] In one aspect, one or more of the processes depicted in
FIGS. 35-39 can be executed by a control circuit of a surgical hub
106, as depicted in FIG. 10 (processor 244). In another aspect, one
or more of the processes depicted in FIGS. 35-39 can be executed by
a cloud computing system 104, as depicted in FIG. 1. In yet another
aspect, one or more of the processes depicted in FIGS. 35-39 can be
executed by at least one of the aforementioned cloud computing
systems 104 and/or a control circuit of a surgical hub 106 in
combination with a control circuit of a modular device, such as the
microcontroller 461 of the surgical instrument depicted in FIG. 12,
the microcontroller 620 of the surgical instrument depicted in FIG.
16, the control circuit 710 of the robotic surgical instrument 700
depicted in FIG. 17, the control circuit 760 of the surgical
instruments 750, 790 depicted in FIGS. 18-19, or the controller 838
of the generator 800 depicted in FIG. 20.
Spatial Awareness of Surgical Hubs in Operating Rooms
[0426] During a surgical procedure, a surgical instrument such as
an ultrasonic or an RF surgical instrument can be coupled to a
generator module 140 of the surgical hub 106. In addition, a
separate surgical instrument controller such as a foot, or hand,
switch or activation device can be used by an operator of the
surgical instrument to activate the energy flow from the generator
to the surgical instrument. Multiple surgical instrument
controllers and multiple surgical instruments can be used
concurrently in an operating room. Pressing or activating the wrong
surgical instrument controller can lead to undesirable
consequences. Aspects of the present disclosure present a solution
in which the surgical hub 106 coordinates the pairing of surgical
instrument controllers and surgical instruments to ensure patient
and operator safety.
[0427] Aspects of the present disclosure are presented for a
surgical hub 106 configured to establish and sever pairings between
components of the surgical system 102 within the bounds of the
operating room to coordinate flow of information and control
actions between such components. The surgical hub 106 can be
configured to establish a pairing between a surgical instrument
controller and a surgical instrument that reside within the bounds
of an operating room of surgical hub 106.
[0428] In various aspects, the surgical hub 106 can be configured
to establish and sever pairings between components of the surgical
system 102 based on operator request or situational and/or spatial
awareness. The hub situational awareness is described in greater
detail below in connection with FIG. 62.
[0429] Aspects of the present disclosure are presented for a
surgical hub for use with a surgical system in a surgical procedure
performed in an operating room. The surgical hub includes a control
circuit that selectively forms and severs pairings between devices
of the surgical system. In one aspect, the hub includes a control
circuit is configured to pair the hub with a first device of the
surgical system, assign a first identifier to the first device,
pair the hub with a second device of the surgical system, assign a
second identifier to the second device, and selectively pair the
first device with the second device. In one aspect, the surgical
hub includes a storage medium, wherein the control circuit is
configured to store a record indicative of the pairing between the
first device and the second device in the storage medium. In one
aspect, the pairing between the first device and the second device
defines a communication pathway therebetween. In one aspect, the
pairing between the first device and the second device defines a
control pathway for transmitting control actions from the second
device to the first device.
[0430] Further to the above, in one aspect, the control circuit is
further configured to pair the hub with a third device of the
surgical system, assign a third identifier to the third device,
sever the pairing between the first device and the second device,
and selectively pair the first device with the third device. In one
aspect, the control circuit is further configured to store a record
indicative of the pairing between the first device and the third
device in the storage medium. In one aspect, the pairing between
the first device and the third device defines a communication
pathway therebetween. In one aspect, the pairing between the first
device and the third device defines a control pathway for
transmitting control actions from the third device to the first
device.
[0431] In various aspects, the surgical hub includes a processor
and a memory coupled to the processor. The memory stores
instructions executable by the processor to selectively form and
sever pairings between the devices of the surgical system, as
described above. In various aspects, the present disclosure
provides a non-transitory computer-readable medium storing
computer-readable instructions which, when executed, cause a
machine to selectively form and sever pairings between the devices
of the surgical system, as described above. FIGS. 40 and 41 are
logic flow diagrams of processes depicting control programs or
logic configurations for selectively forming and severing pairings
between the devices of the surgical system, as described above.
[0432] In one aspect, the surgical hub 106 establishes a first
pairing with a surgical instrument and a second pairing with the
surgical instrument controller. The surgical hub 106 then links the
pairings together allowing the surgical instrument and the surgical
instrument controller to operate with one another. In another
aspect, the surgical hub 106 may sever an existing communication
link between a surgical instrument and a surgical instrument
controller, then link the surgical instrument to another surgical
instrument controller that is linked to the surgical hub 106.
[0433] In one aspect, the surgical instrument controller is paired
to two sources. First, the surgical instrument controller is paired
to the surgical hub 106, which includes the generator module 140,
for control of its activation. Second, the surgical instrument
controller is also paired to a specific surgical instrument to
prevent inadvertent activation of the wrong surgical
instrument.
[0434] Referring to FIGS. 40 and 42, the surgical hub 106 may cause
the communication module 130 to pair 3100 or establish a first
communication link 3101 with a first device 3102 of the surgical
system 102, which can be a first surgical instrument. Then, the hub
may assign 3104 a first identification number to the first device
3102. This is a unique identification and communication sequence or
number that may include the device's name and a time stamp of when
the communication was first established.
[0435] In addition, the surgical hub 106 may then cause the
communication module 130 to pair 3106 or establish a second
communication link 3107 with a second device 3108 of the surgical
system 102, which can be a surgical instrument controller. The
surgical hub 106 then assigns 3110 a second identification number
to the second device 3108.
[0436] In various aspects, the steps of pairing a surgical hub 106
with a device may include detecting the presence of a new device,
determining that the new device is within bounds of the operating
room, as described above in greater detail, and only pairing with
the new device if the new device is located within the bounds of
the operating room.
[0437] The surgical hub 106 may then pair 3112 or authorize a
communication link 3114 to be established between the first device
3102 and the second device 3108, as illustrated in FIG. 42. A
record indicative of the communication link 3114 is stored by the
surgical hub 106 in the storage array 134. In one aspect, the
communication link 3114 is established through the surgical hub
106. In another aspect, as illustrated in FIG. 42, the
communication link 3114 is a direct link between the first device
3102 and the second device 3108.
[0438] Referring to FIGS. 41 and 43, the surgical hub 106 may then
detect and pair 3120 or establish a third communication link 3124
with a third device 3116 of the surgical system 102, which can be
another surgical instrument controller, for example. The surgical
hub 106 may then assign 3126 a third identification number to the
third device 3116.
[0439] In certain aspects, as illustrated in FIG. 43, the surgical
hub 106 may then pair 3130 or authorize a communication link 3118
to be established between the first device 3102 and the third
device 3116, while causing the communication link 3114 to be
severed 3128, as illustrated in FIG. 43. A record indicative of the
formation of the communication link 3118 and severing of the
communication link 3114 is stored by the surgical hub 106 in the
storage array 134. In one aspect, the communication link 3118 is
established through the surgical hub 106. In another aspect, as
illustrated in FIG. 43, the communication link 3118 is a direct
link between the first device 3102 and the third device 3116.
[0440] As described above, the surgical hub 106 can manage an
indirect communication between devices of the surgical system 102.
For example, in situations where the first device 3102 is a
surgical instrument and the second device 3108 is a surgical
instrument controller, an output of the surgical instrument
controller can be transmitted through the communication link 3107
to the surgical hub 106, which may then transmit the output to the
surgical instrument through the communication link 3101.
[0441] In making a decision to connector sever a connection between
devices of the surgical system 102, the surgical hub 106 may rely
on perioperative data received or generated by the surgical hub
106. Perioperative data includes operator input, hub-situational
awareness, hub-spatial awareness, and/or cloud data. For example, a
request can be transmitted to the surgical hub 106 from an operator
user-interface to assign a surgical instrument controller to a
surgical instrument. If the surgical hub 106 determines that the
surgical instrument controller is already connected to another
surgical instrument, the surgical hub 106 may sever the connection
and establish a new connection per the operator's request.
[0442] In certain examples, the surgical hub 106 may establish a
first communication link between the visualization system 108 and
the primary display 119 to transmit an image, or other information,
from the visualization system 108, which resides outside the
sterile field, to the primary display 119, which is located within
the sterile field. The surgical hub 106 may then sever the first
communication link and establish a second communication link
between a robotic hub 122 and the primary display 119 to transmit
another image, or other information, from the robotic hub 122 to
the primary display 119, for example. The ability of the surgical
hub 106 to assign and reassign the primary display 119 to different
components of the surgical system 102 allows the surgical hub 106
to manage the information flow within the operating room,
particularly between components inside the sterile field and
outside the sterile field, without physically moving these
components.
[0443] In another example that involves the hub-situational
awareness, the surgical hub 106 may selectively connect or
disconnect devices of the surgical system 102 within an operating
room based on the type of surgical procedure being performed or
based on a determination of an upcoming step of the surgical
procedure that requires the devices to be connected or
disconnected. The hub situational awareness is described in greater
detail below in connection with FIG. 62.
[0444] Referring to FIG. 44, the surgical hub 106 may track 3140
the progression of surgical steps in a surgical procedure and may
coordinate pairing and unpairing of the devices of the surgical
system 102 based upon such progression. For example, the surgical
hub 106 may determine that a first surgical step requires use of a
first surgical instrument, while a second surgical step, occurring
after completion of the first surgical step, requires use of a
second surgical instrument. Accordingly, the surgical hub 106 may
assign a surgical instrument controller to the first surgical
instrument for the duration of the first surgical step. After
detecting completion 3142 of the first surgical step, the surgical
hub 106 may cause the communication link between the first surgical
instrument and the surgical instrument controller to be severed
3144. The surgical hub 106 may then assign the surgical instrument
controller to the second surgical instrument by pairing 3146 or
authorizing the establishment of a communication link between the
surgical instrument controller and the second surgical
instrument.
[0445] Various other examples of the hub-situational awareness,
which can influence the decision to connect or disconnect devices
of the surgical system 102, are described in greater detail below
in connection with FIG. 62.
[0446] In certain aspects, the surgical hub 106 may utilize its
spatial awareness capabilities, as described in greater detail
elsewhere herein, to track progression of the surgical steps of a
surgical procedure and autonomously reassign a surgical instrument
controller from one surgical instrument to another surgical
instrument within the operating room of the surgical hub 106. In
one aspect, the surgical hub 106 uses Bluetooth pairing and compass
information to determine the physical position of the components of
the surgical system 102.
[0447] In the example illustrated in FIG. 2, the surgical hub 106
is paired with a first surgical instrument held by a surgical
operator at the operating table and a second surgical instrument
positioned on a side tray. A surgical instrument controller can be
selectively paired with either the first surgical instrument or the
second surgical instrument. Utilizing the Bluetooth pairing and
compass information, the surgical hub 106 autonomously assigns the
surgical instrument controller to the first surgical instrument
because of its proximity to the patient.
[0448] After completion of the surgical step that involved using
the first surgical instrument, the first surgical instrument may be
returned to the side tray or otherwise moved away from the patient.
Detecting a change in the position of the first surgical
instrument, the surgical hub 106 may sever the communication link
between the first surgical instrument and the surgical instrument
controller to protect against unintended activation of the first
surgical instrument by the surgical instrument controller. The
surgical hub 106 may also reassign the surgical instrument
controller to another surgical instrument if the surgical hub 106
detects that it has been moved to a new position at the operating
table.
[0449] In various aspects, devices of the surgical system 102 are
equipped with an easy hand-off operation mode that would allow one
user to give activation control of a device they currently control
to another surgical instrument controller within reach of another
operator. In one aspect, the devices are equipped to accomplish the
hand-off through a predetermined activation sequence of the devices
that causes the devices that are activated in the predetermined
activation sequence to pair with one another.
[0450] In one aspect, the activation sequence is accomplished by
powering on the devices to be paired with one another in a
particular order. In another aspect, the activation sequence is
accomplished by powering on the devices to be paired with one
another within a predetermined time period. In one aspect, the
activation sequence is accomplished by activating communication
components, such as Bluetooth, of the devices to be paired with one
another in a particular order. In another aspect, the activation
sequence is accomplished by activating communication components,
such as Bluetooth, of the devices to be paired within one another
within a predetermined time period.
[0451] Alternatively, the hand-off can also be accomplished by a
selection of a device through one of the surgical-operator input
devices. After the selection is completed, the next activation by
another controller would allow the new controller to take
control.
[0452] In various aspects, the surgical hub 106 can be configured
to directly identify components of the surgical system 102 as they
are brought into an operating room. In one aspect, the devices of
the surgical system 102 can be equipped with an identifier
recognizable by the surgical hub 106, such as, for example, a bar
code or an RFID tag. NFC can also be employed. The surgical hub 106
can be equipped with a suitable reader or scanner for detecting the
devices brought into the operating room.
[0453] The surgical hub 106 can also be configured to check and/or
update various control programs of the devices of the surgical
system 102. Upon detecting and establishing a communication link of
a device of the surgical system 102, the surgical hub 106 may check
if its control program is up to date. If the surgical hub 106
determines that a later version of the control program is
available, the surgical hub 106 may download the latest version
from the cloud 104 and may update the device to the latest version.
The surgical hub 106 may issue a sequential identification and
communication number to each paired or connected device.
Cooperative Utilization of Data Derived from Secondary Sources by
Intelligent Surgical Hubs
[0454] In a surgical procedure, the attention of a surgical
operator must be focused on the tasks at hand. Receiving
information from multiple sources, such as, for example, multiple
displays, although helpful, can also be distracting. The imaging
module 138 of the surgical hub 106 is configured to intelligently
gather, analyze, organize/package, and disseminate relevant
information to the surgical operator in a manner that minimizes
distractions.
[0455] Aspects of the present disclosure are presented for
cooperative utilization of data derived from multiple sources, such
as, for example, an imaging module 138 of the surgical hub 106. In
one aspect, the imaging module 138 is configured to overlay data
derived from one or more sources onto a livestream destined for the
primary display 119, for example. In one aspect, the overlaid data
can be derived from one or more frames acquired by the imaging
module 138. The imaging module 138 may commandeer image frames on
their way for display on a local display such as, for example, the
primary display 119. The imaging module 138 also comprises an image
processor that may preform an array of local image processing on
the commandeered images.
[0456] Furthermore, a surgical procedure generally includes a
number of surgical tasks which can be performed by one or more
surgical instruments guided by a surgical operator or a surgical
robot, for example. Success or failure of a surgical procedure
depends on the success or failure of each of the surgical tasks.
Without relevant data on the individual surgical tasks, determining
the reason for a failed surgical procedure is a question of
probability.
[0457] Aspects of the present disclosure are presented for
capturing one or more frames of a livestream of a surgical
procedure for further processing and/or pairing with other data.
The frames may be captured at the completion of a surgical task
(also referred to elsewhere herein as "surgical step") to assess
whether the surgical task was completed successfully. Furthermore,
the frames, and the paired data, can be uploaded to the cloud for
further analysis.
[0458] In one aspect, one or more captured images are used to
identify at least one previously completed surgical task to
evaluate the outcome of the surgical task. In one aspect, the
surgical task is a tissue-stapling task. In another aspect, the
surgical task is an advanced energy transection.
[0459] FIG. 45 is a logic flow diagram of a process 3210 depicting
a control program or a logic configuration for overlaying
information derived from one or more still frames of a livestream
of a remote surgical site onto the livestream. The process 3210
includes receiving 3212 a livestream of a remote surgical site from
a medical imaging device 124, for example, capturing 3214 at least
one image frame of a surgical step of the surgical procedure from
the livestream, deriving 3216 information relevant to the surgical
step from data extracted from the at least one image frame, and
overlaying 3218 the information onto the livestream.
[0460] In one aspect, the still frames can be of a surgical step
performed at the remote surgical site. The still frames can be
analyzed for information regarding completion of the surgical step.
In one aspect, the surgical step comprises stapling tissue at the
surgical site. In another aspect, the surgical task comprises
applying energy to tissue at the surgical site.
[0461] FIG. 46 is a logic flow diagram of a process 3220 depicting
a control program or a logic configuration for differentiating
among surgical steps of a surgical procedure. The process 3220
includes receiving 3222 a livestream of a surgical site from a
medical imaging device 124, for example, capturing 3224 at least
one first image frame of a first surgical step of the surgical
procedure from the livestream, deriving 3226 information relevant
to the first surgical step from data extracted from the at least
one image frame, capturing 3228 at least one second image frame of
a second surgical step of the surgical procedure from the
livestream, and differentiating 3229 among the first surgical step
and the second surgical step based on the at least one first image
frame and the at least one second image frame.
[0462] FIG. 47 is a logic flow diagram of a process 3230 depicting
a control program or a logic configuration for differentiating
among surgical steps of a surgical procedure. The process 3232
includes receiving 3232 a livestream of the surgical site from a
medical imaging device 124, for example, capturing 3234 image
frames of the surgical steps of the surgical procedure from the
livestream and differentiating 3236 among the surgical steps based
on data extracted from the image frames.
[0463] FIG. 48 is a logic flow diagram of a process 3240 depicting
a control program or a logic configuration for identifying a staple
cartridge from information derived from one or more still frames of
staples deployed from the staple cartridge into tissue. The process
3240 includes receiving 3242 a livestream of the surgical site from
medical imaging device 124, for example, capturing 3244 an image
frame from the livestream, detecting 3246 a staple pattern in the
image frame, wherein the staple pattern is defined by staples
deployed from a staple cartridge into tissue at the surgical site.
The process 3240 further includes identifying 3248 the staple
cartridge based on the staple pattern.
[0464] In various aspects, one or more of the steps of the
processes 3210, 3220, 3230, 3240 can be executed by a control
circuit of an imaging module of a surgical hub, as depicted in
FIGS. 3, 9, 10. In certain examples, the control circuit may
include a processor and a memory coupled to the processor, wherein
the memory stores instructions executable by the processor to
perform one or more of the steps of the processes 3210, 3220, 3230,
3240. In certain examples, a non-transitory computer-readable
medium stores computer-readable instructions which, when executed,
cause a machine to perform one or more of the steps of the
processes 3210, 3220, 3230, 3240. For economy, the following
description of the processes 3210, 3220, 3230, 3240 will be
described as being executed by the control circuit of an imaging
module of a surgical hub; however, it should be understood that the
execution of the processes 3210, 3220, 3230, 3240 can be
accomplished by any of the aforementioned examples.
[0465] Referring to FIGS. 34 and 49, a surgical hub 106 is in
communication with a medical imaging device 124 located at a remote
surgical site during a surgical procedure. The imaging module 138
receives a livestream of the remote surgical site transmitted by
the imaging device 124 to a primary display 119, for example, in
accordance with steps 3212, 3222, 3232, 3242.
[0466] Further to the above, the imaging module 138 of the surgical
hub 106 includes a frame grabber 3200. The frame grabber 3200 is
configured to capture (i.e., "grabs") individual, digital still
frames from the livestream transmitted by the imaging device 124,
for example, to a primary display 119, for example, during a
surgical procedure, in accordance with steps 3214, 3224, 3234,
3244. The captured still frames are stored and processed by a
computer platform 3203 (FIG. 49) of the imaging module 138 to
derive information about the surgical procedure. Processing of the
captured frames may include performance of simple operations, such
as histogram calculations, 2D filtering, and arithmetic operations
on arrays of pixels to the performance of more complex tasks, such
as object detection, 3D filtering, and the like.
[0467] In one aspect, the derived information can be overlaid onto
the livestream. In one aspect, the still frames and/or the
information resulting from processing the still frames can be
communicated to a cloud 104 for data aggregation and further
analysis.
[0468] In various aspects, the frame grabber 3200 may include a
digital video decoder and a memory for storing the acquired still
frames, such as, for example, a frame buffer. The frame grabber
3200 may also include a bus interface through which a processor can
control the acquisition and access the data and a general purpose
1/O for triggering image acquisition or controlling external
equipment.
[0469] As described above, the imaging device 124 can be in the
form of an endoscope, including a camera and a light source
positioned at a remote surgical site, and configured to provide a
livestream of the remote surgical site at the primary display 119,
for example.
[0470] In various aspects, image recognition algorithms can be
implemented to identify features or objects in still frames of a
surgical site that are captured by the frame grabber 3200. Useful
information pertaining to the surgical steps associated with the
captured frames can be derived from the identified features. For
example, identification of staples in the captured frames indicates
that a tissue-stapling surgical step has been performed at the
surgical site. The type, color, arrangement, and size of the
identified staples can also be used to derive useful information
regarding the staple cartridge and the surgical instrument employed
to deploy the staples. As described above, such information can be
overlaid on a livestream directed to a primary display 119 in the
operating room.
[0471] The image recognition algorithms can be performed at least
in part locally by the computer platform 3203 (FIG. 49) of the
imaging module 138. In certain instances, the image recognition
algorithms can be performed at least in part by the processor
module 132 of the surgical hub 106. An image database can be
utilized in performance of the image recognition algorithms and can
be stored in a memory 3202 of the computer platform 3203.
Alternatively, the imaging database can be stored in the storage
array 134 (FIG. 3) of the surgical hub 106. The image database can
be updated from the cloud 104.
[0472] An example image recognition algorithm that can be executed
by the computer platform 3203 may include a key points-based
comparison and a region-based color comparison. The algorithm
includes: receiving an input at a processing device, such as, for
example, the computer platform 3203; the input, including data
related to a still frame of a remote surgical site; performing a
retrieving step, including retrieving an image from an image
database and, until the image is either accepted or rejected,
designating the image as a candidate image; performing an image
recognition step, including using the processing device to perform
an image recognition algorithm on the still frame and candidate
images in order to obtain an image recognition algorithm output;
and performing a comparison step, including: if the image
recognition algorithm output is within a pre-selected range,
accepting the candidate image as the still frame and if the image
recognition algorithm output is not within the pre-selected range,
rejecting the candidate image and repeating the retrieving, image
recognition, and comparison steps.
[0473] Referring to FIGS. 50-52, in one example, a surgical step
involves stapling and cutting tissue. FIG. 50 depicts a still frame
3250 of a stapled and cut tissue T. A staple deployment 3252
includes staples 3252', 3252'' from a first staple cartridge. A
second staple deployment 3254 includes staples 3254', 3254'' from a
second staple cartridge. A proximal portion 3253 of the staple
deployment 3252 overlaps with a distal portion 3255 of the staple
deployment 3254. Six rows of staples were deployed in each
deployment. Tissue T was cut between the third and fourth rows of
each deployment, but only one side of the stapled tissue T is fully
shown.
[0474] In various aspects, the imaging module 138 identifies one or
more of the staples 3252', 3252'', 3254', 3254'' in the still frame
3250, which were absent in a previous still frame captured by the
frame grabber 3200. The imaging module 138 then concludes that a
surgical stapling and cutting instrument has been used at the
surgical site.
[0475] In the example of FIG. 50, the staple deployment 3252
includes two different staples 3252', 3252''. Likewise, the staple
deployment 3254 includes two different staples 3254', 3254''. For
brevity, the following description focuses on the staples 3252',
3252'', but is equally applicable to the staples 3254', 3254''. The
staples 3252', 3252'' are arranged in a predetermined pattern or
sequence that forms a unique identifier corresponding to the staple
cartridge that housed the staples 3252', 3252''. The unique pattern
can be in a single row or multiple rows of the staples 3250. In one
example, the unique pattern can be achieved by alternating the
staples 3252', 3252'' at a predetermined arrangement.
[0476] In one aspect, multiple patterns can be detected in a firing
of staples. Each pattern can be associated with a unique
characteristic of the staples, the staple cartridge that housed the
staples, and/or the surgical instrument that was employed to fire
the staple. For example, a firing of staples may include patterns
that represent staple form, staple size, and/or location of the
firing.
[0477] In the example, of FIG. 50, the imaging module 138 may
identify a unique pattern of the staples 3252 from the still frame
3250. A database storing staple patterns and corresponding
identification numbers of staple cartridges can then be explored to
determine an identification number of a staple cartridge that
housed the staples 3252.
[0478] The patterns of the example of FIG. 50 are based on only two
different staples; however, other aspects may include three or more
different staples. The different staples can be coated with
different coatings, which can be applied to the staples by one or
more of the following methods: anodizing, dying, electro-coating,
photoluminescent coating, application of nitrides, methyl
methacylate, painting, powder coating, coating with paraffins, oil
stains or phosphor coatings, the use of hydroxyapatite, polymers,
titanium oxinitrides, zinc sulfides, carbides, etc. It should be
noted that, while the listed coatings are fairly specific as
disclosed herein, other coatings known in the art to distinguish
the staple are within the contemplated scope of the present
disclosure.
[0479] In the example of FIGS. 50-52, the staples 3252' are
anodized staples, while the staples 3252'' are non-anodized
staples. In one aspect, the different staples may comprise two or
more different colors. Different metal staples may comprise
magnetic or radioactive staple markers that differentiate them from
unmarked staples.
[0480] FIG. 51 illustrates a staple deployment 3272 deployed into
tissue from a staple cartridge via a surgical instrument. Only
three staple rows 3272a, 3272b, 3272c are depicted in FIG. 51. The
rows 3272a, 3272b, 3272c are arranged between a medial line, where
the tissue was cut, and a lateral line at the tissue edge. For
clarity, the inner row 3272a of staples is redrawn separately to
the left and the outer two rows 3272b, 3272c are redrawn separately
to the right. A proximal end 3273 and a distal end portion of the
staple deployment 3272 are also redrawn in FIG. 51 for clarity.
[0481] The staple deployment 3272 includes two different staples
3272', 3272'' that are arranged in predetermined patterns that
serve various functions. For example, the inner row 3272a comprises
a pattern of alternating staples 3272', 3272'', which defines a
metric for distance measurements in the surgical field. In other
words, the pattern of the inner row 3272a acts as a ruler for
measuring distances, which can be helpful in accurately determining
the position of a leak, for example. The outer rows 3272b, 3272c
define a pattern that represents an identification number of the
staple cartridge that housed the staples 3272', 3272''.
[0482] Furthermore, unique patterns at the ends of the staple
deployment 3272 identify the proximal end portion 3273 and distal
end portion 3275. In the example of FIG. 51, a unique arrangement
of three staples 3272'' identifies the distal end 3275, while a
unique arrangement of four staples 3272'' identifies the proximal
end 3273. Identification of the proximal and distal ends of a
staple deployment allows the imaging module 128 to distinguish
between different staple deployments within a captured frame, which
can be useful in pointing the source of a leak, for example.
[0483] In various aspects, the imaging module 138 may detect a
sealed tissue in a still frame of a remote surgical site captured
by the frame grabber 3200. Detection of the sealed tissue can be
indicative of a surgical step that involves applying therapeutic
energy to tissue.
[0484] Sealing tissue can be accomplished by the application of
energy, such as electrical energy, for example, to tissue captured
or clamped within an end effector of a surgical instrument in order
to cause thermal effects within the tissue. Various mono-polar and
bi-polar RF surgical instruments and harmonic surgical instruments
have been developed for such purposes. In general, the delivery of
energy to captured tissue can elevate the temperature of the tissue
and, as a result, the energy can at least partially denature
proteins within the tissue. Such proteins, like collagen, for
example, can be denatured into a proteinaceous amalgam that
intermixes and fuses, or seals, together as the proteins
renature.
[0485] Accordingly, sealed tissue has a distinct color and/or shape
that can be detected by the imaging module 138 using image
recognition algorithms, for example. In addition, smoke detection
at the surgical site can indicate that therapeutic energy
application to the tissue is in progress.
[0486] Further to the above, the imaging module 138 of the surgical
hub 106 is capable of differentiating between surgical steps of a
surgical procedure based on the captured frames. As described
above, a still frame that comprises fired staples is indicative of
a surgical step involving tissue stapling, while a still frame that
comprises a sealed tissue is indicative of a surgical step
involving energy application to tissue.
[0487] In one aspect, the surgical hub 106 may selectively overlay
information relevant to a previously completed surgical task onto
the livestream. For example, the overlaid information may comprise
image data from a still frame of the surgical site captured during
the previously completed surgical task. Furthermore, guided by
common landmark locations at the surgical site, the imaging module
138 can interlace one image frame to another to establish and
detect surgical locations and relationship data of a previously
completed surgical task.
[0488] In one example, the surgical hub 106 is configured to
overlay information regarding a potential leak in a tissue treated
by stapling or application of therapeutic energy in a previously
completed surgical task. The potential leak can be spotted by the
imaging module 138 during the processing of a still frame of the
tissue. The surgical operator can be alerted about the leak by
overlaying information about the potential leak onto the
livestream.
[0489] In various aspects, still frames of an end effector of a
surgical instrument at a surgical site can be used to identify the
surgical instrument. For example, the end effector may include an
identification number that can be recognized by the imaging module
138 during image processing of the still frame. Accordingly, the
still frames captured by the imaging module 138 may be used to
identify a surgical instrument utilized in a surgical step of a
surgical procedure. The still frames may also include useful
information regarding the performance of the surgical instrument.
All such information can be uploaded to the cloud 104 for data
aggregation and further analysis.
[0490] In various examples, the surgical hub 106 may also
selectively overlay information relevant to a current or upcoming
surgical task, such as an anatomical location or a surgical
instrument suitable for the surgical task.
[0491] The imaging module 138 may employ various images and edge
detection techniques to track a surgical site where a surgical
instrument was used to complete a surgical task. Success or failure
of the surgical task can then be assessed. For example, a surgical
instrument can be employed to seal and/or cut tissue at the
surgical site. A still frame of the surgical site can be stored in
the memory 3202 or the storage array 134 of the surgical hub 106,
for example, upon completion of the surgical task.
[0492] In the following surgical step, the quality of the seal can
be tested via different mechanisms. To ensure that the testing is
accurately applied to the treated tissue, the stored still frame of
the surgical site is overlaid onto the livestream in search of a
match. Once a match is found, the testing can take place. One or
more additional still frames can be taken during the testing, which
can be later analyzed by the imaging module 138 of the surgical hub
106. The testing mechanisms include bubble detection, bleeding
detection, dye detection (where a dye is employed at the surgical
site), and/or burst stretch detection (where a localized strain is
applied adjacent to an anastomosis site), for example.
[0493] The imaging module 138 may capture still frames of the
response of the treated tissue to these tests, which can be stored
in the memory 3202 or the storage array 134 of the surgical hub
106, for example. The still frames can be stored alone or in
combination with other data, such as, for example, data from the
surgical instrument that performed the tissue treatment. The paired
data can also be uploaded to the cloud 104 for additional analysis
and/or pairing.
[0494] In various aspects, the still frames captured by the frame
grabber 3200 can be processed locally, paired with other data, and
can also be transmitted to the cloud 104. The size of the processed
and/or transmitted data will depend on the number of captured
frames. In various aspects, the rate at which the frame grabber
3200 captures the still frames from the livestream can be varied in
an effort to reduce the size of the data without sacrificing
quality.
[0495] In one aspect, the frame-capturing rate may depend on the
type of surgical task being performed. Certain surgical tasks may
need a higher number of still frames than others for an evaluation
of success or failure. The frame-capturing rate can be scalded to
accommodate such needs.
[0496] In one aspect, the frame-capturing rate is dependent upon
the detected motion of the imaging device 124. In use, an imaging
device 124 may target one surgical site for a period of time.
Observing no or minor changes in the still frames captured while
the imaging device 124 is not being moved, the imaging module 138
may reduce the frame-capturing rate of the frame grabber 3200. If
the situation changes, however, where frequent motion is detected,
the imaging module 138 may respond by increasing the
frame-capturing rate of the frame grabber 3200. In other words, the
imaging module 138 may be configured to correlate the
frame-capturing rate of the frame grabber 3200 with the detected
degree of motion of the imaging device 124.
[0497] For additional efficiency, only portions of the still
frames, where motion is detected, need to be stored, processed,
and/or transmitted to the cloud 104. The imaging module 138 can be
configured to select the portions of the still frames where motion
is detected. In one example, motion detection can be achieved by
comparing a still frame to a previously captured still frame. If
movement is detected, the imaging module 138 may cause the frame
grabber 3200 to increase the frame-capturing rate, but only the
portions where motion is detected are stored, processed, and/or
transmitted to the cloud 104.
[0498] In another aspect, the data size can be managed by scaling
the resolution of the captured information based on the area of the
screen where the focal point is or where end effectors are located,
for example. The remainder of the screen could be captured at a
lower resolution.
[0499] In one aspect, the corners of the screen and the edges could
generally be captured at a lower resolution. The resolution,
however, can be scalded up if an event of significance is
observed.
[0500] During a surgical procedure, the surgical hub 106 can be
connected to various operating-room monitoring devices, such as,
for example, heart rate monitors and insufflation pumps. Data
collected from these devices can improve the situational awareness
of the surgical hub 106. The hub situational awareness is described
in greater detail below in connection with FIG. 62.
[0501] In one example, the surgical hub 106 can be configured to
utilize patient data received from a heart rate monitor connected
along with data regarding the location of the surgical site to
assess proximity of the surgical site to sensory nerves. An
increase in the patient's heart rate, when combined with anatomical
data indicating that the surgical site is in a region high in
sensory nerves, can be construed as an indication of sensory nerve
proximity. Anatomical data can be available to the surgical hub 106
through accessing patient records (e.g., an EMR database containing
patient records).
[0502] The surgical hub 106 may be configured to determine the type
of surgical procedure being performed on a patient from data
received from one or more of the operating-room monitoring devices,
such as, for example, heart rate monitors and insufflation pumps.
Abdominal surgical procedures generally require insufflation of the
abdomen, while insufflation is not required in theoretic surgery.
The surgical hub 106 can be configured to determine whether a
surgical procedure is an abdominal or a thoracic surgical procedure
by detecting whether the insufflation pump is active. In one
aspect, the surgical hub 106 may be configured to monitor
insufflation pressure on the output side of the insufflation pump
in order to determine whether the surgical procedure being
performed is one that requires insufflation.
[0503] The surgical hub 106 may also gather information from other
secondary devices in the operating room to assess, for example,
whether the surgical procedure is a vascular or avascular
procedure.
[0504] The surgical hub 106 may also monitor AC current supply to
one or more of its components to assess whether a component is
active. In one example, the surgical hub 106 is configured to
monitor AC current supply to the generator module to assess whether
the generator is active, which can be an indication that the
surgical procedure being performed is one that requires application
of energy to seal tissue.
[0505] In various aspects, secondary devices in the operating room
that are incapable of communication with the surgical hub 106 can
be equipped with communication interface devices (communication
modules) that can facilitate pairing of these devices with the
surgical hub 106. In one aspect, the communication interface
devices may be configured to be bridging elements, which would
allow them two-way communication between the surgical hub 106 and
such devices.
[0506] In one aspect, the surgical hub 106 can be configured to
control one or more operational parameters of a secondary device
through a communication interface device. For example, the surgical
hub 106 can be configured to increase or decrease the insufflation
pressure through a communication interface device coupled to an
insufflation device.
[0507] In one aspect, the communication interface device can be
configured to engage with an interface port of the device. In
another aspect, the communication interface device may comprise an
overlay or other interface that directly interacts with a control
panel of the secondary device. In other aspects, the secondary
devices, such as, for example, the heart rate monitor and/or the
insufflation devices, can be equipped with integrated communication
modules that allow them to pair with the hub for two-way
communication therewith.
[0508] In one aspect, the surgical hub 106 can also be connected
through a communication interface device, for example, to muscle
pads that are connected to the neuro-stim detection devices to
improve resolution of a nerve-sensing device.
[0509] Furthermore, the surgical hub 106 can also be configured to
manage operating room supplies. Different surgical procedures
require different supplies. For example, two different surgical
procedures may require different sets of surgical instruments.
Certain surgical procedures may involve using a robotic system,
while others may not. Furthermore, two different surgical
procedures may require staple cartridges that are different in
number, type, and/or size. Accordingly, the supplies brought into
the operating room can provide clues as to the nature of the
surgical procedure that will be performed.
[0510] In various aspects, the surgical hub 106 can be integrated
with an operating room supplies scanner to identify items pulled
into the operating room and introduced into the sterile field. The
surgical hub 106 may utilize data from the operating room supplies
scanner, along with data from the devices of the surgical system
102 that are paired with the surgical hub 106, to autonomously
determine the type of surgical procedure that will be performed. In
one example, the surgical hub 106 may record a list of serial
numbers of the smart cartridge that are going to be used in the
surgical procedure. During the surgical procedure, the surgical hub
106 may gradually remove the staples that have been fired, based on
information collected from the staple cartridge chips. In one
aspect, the surgical hub 106 is configured to make sure that all
the items are accounted for at the end of the procedure.
Surgical Hub Control Arrangements
[0511] In a surgical procedure, a second surgical hub may be
brought into an operating room already under the control of a first
surgical hub. The second surgical hub can be, for example, a
surgical robotic hub brought into the operating room as a part of a
robotic system. Without coordination between the first and second
surgical hubs, the robotic surgical hub will attempt to pair with
all the other components of the surgical system 102 that are within
the operating room. The confusion arising from the competition
between two hubs in a single operating room can lead to undesirable
consequences. Also, sorting out the instrument distribution between
the hubs during the surgical procedure can be time consuming.
[0512] Aspects of the present disclosure are presented for a
surgical hub for use with a surgical system in a surgical procedure
performed in an operating room. A control circuit of the surgical
hub is configured to determine the bounds of the operating room and
establish a control arrangement with a detected surgical hub
located within the bounds of the operating room.
[0513] In one aspect, the control arrangement is a peer-to-peer
arrangement. In another aspect, the control arrangement is a
master-slave arrangement. In one aspect, the control circuit is
configured to select one of a master mode of operation or a slave
mode of operation in the master-slave arrangement. In one aspect,
the control circuit is configured to surrender control of at least
one surgical instrument to the detected surgical hub in the slave
mode of operation.
[0514] In one aspect, the surgical hub includes an operating room
mapping circuit that includes a plurality of non-contact sensors
configured to measure the bounds of the operating room.
[0515] In various aspects, the surgical hub includes a processor
and a memory coupled to the processor. The memory stores
instructions executable by the processor to coordinate a control
arrangement between surgical hubs, as described above. In various
aspects, the present disclosure provides a non-transitory
computer-readable medium storing computer-readable instructions
which, when executed, cause a machine to coordinate a control
arrangement between surgical hubs, as described above.
[0516] Aspects of the present disclosure are presented for a
surgical system comprising two independent surgical hubs that are
configured to interact with one another. Each of the hubs has their
own linked surgical devices and the control designation of and
distribution of where data is recorded and processed. This
interaction causes one or both hubs to change how they were
behaving before the interaction. In one aspect, the change involves
a redistribution of devices previously assigned to each of the
hubs. In another aspect, the change involves establishing a
master-slave arrangement between the hubs. In yet another aspect,
the change can be a change in the location of the processing shared
between the hubs.
[0517] FIG. 53 is a logic flow diagram of a process depicting a
control program or a logic configuration for coordinating a control
arrangement between surgical hubs. The process of FIG. 53 is
similar in many respects to the process of FIG. 35 except that the
process of FIG. 53 addresses detection of a surgical hub by another
surgical hub. As illustrated in FIG. 53, the surgical hub 106
determines 3007 the bounds of the operating room. After the initial
determination, the surgical hub 106 continuously searches for or
detects 3008 devices within a pairing range. If a device is
detected 3010, and if the detected device is located 3011 within
the bounds of the operating room, the surgical hub 106 pairs 3012
with the device and assigns 3013 an identifier to the device. If
through an initial interaction, as described below in greater
detail, the surgical hub 106 determines 3039 that the device is
another surgical hub, a control arrangement is established 3040
therebetween.
[0518] Referring to FIG. 54, a robotic surgical hub 3300 enters an
operating room already occupied by a surgical hub 3300. The robotic
surgical hub 3310 and the surgical hub 3300 are similar in many
respects to other surgical hubs described in greater detail
elsewhere herein, such as, for example, the surgical hubs 106. For
example, the robotic surgical hub 3310 includes non-contact sensors
configured to measure the bounds of the operating room, as
described in greater detail elsewhere herein in connection with
FIGS. 33, 34.
[0519] As the robotic surgical hub 3310 is powered up, it
determines the bounds of the operating room and begins to pair with
other components of the surgical system 102 that are located within
the bounds of the operating room. The robotic surgical hub 3310
pairs with a robotic advanced energy tool 3311, a robotic stapler
3312, a monopolar energy tool 3313, and a robotic visualization
tower 3314, which are all located within the bounds of the
operating room. The surgical hub 3300 is already paired with a
handheld stapler 3301, a handheld powered dissector 3302, a
secondary display 3303, a surgeon interface 3304, and a
visualization tower 3305. Since the handheld stapler 3301, the
handheld powered dissector 3302, the secondary display 3303, the
surgeon interface 3304, and the visualization tower 3305 are
already paired with the surgical hub 3300, such devices cannot pair
with another surgical hub without permission from the surgical hub
3300.
[0520] Further to the above, the robotic surgical hub 3310 detects
and/or is detected by the surgical hub 3300. A communication link
is established between the communication modules of the surgical
hubs 3300, 3310. The surgical hubs 3300, 3310 then determine the
nature of their interaction by determining a control arrangement
therebetween. In one aspect, the control arrangement can be a
master-slave arrangement. In another aspect, the control
arrangement can be a peer-to-peer arrangement.
[0521] In the example of FIG. 54, a master-slave arrangement is
established. The surgical hubs 3300, 3310 request permission from a
surgical operator for the robotic surgical hub 3310 to take control
of the operating room from the surgical hub 3300. The permission
can be requested through a surgeon interface or console 3304. Once
permission is granted, the robotic surgical hub 3310 requests the
surgical hub 3300 to transfer control to the robotic surgical hub
3310.
[0522] Alternatively, the surgical hubs 3300, 3310 can negotiate
the nature of their interaction without external input based on
previously gathered data. For example, the surgical hubs 3300, 3310
may collectively determine that the next surgical task requires use
of a robotic system. Such determination may cause the surgical hub
3300 to autonomously surrender control of the operating room to the
robotic surgical hub 3310. Upon completion of the surgical task,
the robotic surgical hub 3310 may then autonomously return the
control of the operating room to surgical hub 3300.
[0523] The outcome of the interaction between the surgical hubs
3300, 3310 is illustrated on the right of FIG. 54. The surgical hub
3300 has transferred control to the robotic surgical hub 3310,
which has also taken control of the surgeon interface 3304 and the
secondary display 3303 from the surgical hub 3300. The robotic
surgical hub 3310 assigns new identification numbers to the newly
transferred devices. The surgical hub 3300 retains control the
handheld stapler 3301, the handheld powered dissector 3302, and
visualization tower 3305. In addition, the surgical hub 3300
performs a supporting role, wherein the processing and storage
capabilities of the surgical hub 3300 are now available to the
robotic surgical hub 3310.
[0524] FIG. 55 is a logic flow diagram of a process depicting a
control program or a logic configuration for coordinating a control
arrangement between surgical hubs. In various aspects, two
independent surgical hubs will interact with one another in a
predetermined manner to assess the nature of their relationship. In
one example, after establishing 3321 a communication link, the
surgical hubs exchange 3322 data packets. A data packet may include
type, identification number, and/or status of a surgical hub. A
data packet may further include a record of devices under control
of the surgical hub and/or any limited communication connections,
such as data ports for other secondary operating room devices.
[0525] The control arrangement between the surgical hubs is then
determined 3323 based on input from a surgical operator or
autonomously between the surgical hubs. The surgical hubs may store
instructions as to how to determine a control arrangement
therebetween. The control arrangement between two surgical hubs may
depend on the type of surgical procedure being performed. The
control arrangement between two surgical hubs may depend on their
types, identification information, and/or status. The control
arrangement between two surgical hubs may depend on the devices
paired with the surgical hubs. The surgical hubs then redistribute
3324 the devices of the surgical system 102 therebetween based upon
the determined control arrangement.
[0526] In the master-slave arrangement, the record communication
can be unidirectional from the slave hub to the master hub. The
master hub may also require the slave hub to hand-off some of its
wireless devices to consolidate communication pathways. In one
aspect, the slave hub can be relegated to a relay configuration
with the master hub originating all commands and recording all
data. The slave hub can remain linked to the master hub for a
distributed sub-processing of the master hub commands, records,
and/or controls. Such interaction expands the processing capacity
of the dual linked hubs beyond the capabilities of the master hub
by itself.
[0527] In a peer-to-peer arrangement, each surgical hub may retain
control of its devices. In one aspect, the surgical hubs may
cooperate in controlling a surgical instrument. In one aspect, an
operator of the surgical instrument may designate the surgical hub
that will control the surgical instrument at the time of its
use.
[0528] Referring generally to FIGS. 56-61, the interaction between
surgical hubs can be extended beyond the bounds of the operating
room. In various aspects, surgical hubs in separate operating rooms
may interact with one another within predefined limits. Depending
on their relative proximity, surgical hubs in separate operating
rooms may interact through any suitable wired or wireless data
communication network such as Bluetooth and WiFi. As used here, a
"data communication network" represents any number of physical,
virtual, or logical components, including hardware, software,
firmware, and/or processing logic configured to support data
communication between an originating component and a destination
component, where data communication is carried out in accordance
with one or more designated communication protocols over one or
more designated communication media.
[0529] In various aspects, a first surgical operator in a first
operating room may wish to consult a second surgical operator in a
second operating room, such as in case of an emergency. A temporary
communication link may be established between the surgical hubs of
the first and second operating room to facilitate the consult while
the first and second surgical operators remain in their respective
operating rooms.
[0530] The surgical operator being consulted can be presented with
a consult request through the surgical hub in his/her operating
room. If the surgical operator accepts, he/she will have access to
all the data compiled by the surgical hub requesting the consult.
The surgical operator may access all previously stored data,
including a full history of the procedure. In addition, a
livestream of the surgical site at the requesting operating room
can be transmitted through the surgical hubs to a display at the
receiving operating room.
[0531] When a consult request begins, the receiving surgical hub
begins to record all received information in a temporarily storage
location, which can be a dedicated portion of the storage array of
the surgical hub. At the end of the consult, the temporary storage
location is purged from all the information. In one aspect, during
a consult, the surgical hub records all accessible data, including
blood pressure, ventilation data, oxygen stats, generator settings
and uses, and all patient electronic data. The recorded data will
likely be more than the data stored by the surgical hub during
normal operation, which is helpful in providing the surgical
operator being consulted with as much information as possible for
the consult.
[0532] Referring to FIG. 56, a non-limiting example of an
interaction between surgical hubs in different operating rooms is
depicted. FIG. 56 depicts an operating room OR 1 that includes a
surgical system 3400 supporting a thoracic segmentectomy and a
second operating room OR 3 that includes a surgical system 3410
supporting a colorectal procedure. The surgical system 3400
includes surgical hub 3401, surgical hub 3402, and robotic surgical
hub 3403. The surgical system 3400 further includes a personal
interface 3406, a primary display 3408, and secondary displays
3404, 3405. The surgical system 3410 includes a surgical hub 3411
and a secondary display 3412. For clarity, several components of
the surgical systems 3400, 3410 are removed.
[0533] In the example of FIG. 56, the surgical operator of OR 3 is
requesting a consult from the surgical operator of OR 1. A surgical
hub 3411 of the OR 3 transmits the consult request to one of the
surgical hubs of the OR 1, such as the surgical hub 3401. In OR 1,
the surgical hub 3401 presents the request at a personal interface
3406 held by the surgical operator. The consult is regarding
selecting an optimal location of a colon transection. The surgical
operator of OR 1, through a personal interface 3406, recommends an
optimal location for the transection site that avoids a highly
vascular section of the colon. The recommendation is transmitted in
real time through the surgical hubs 3401, 3411. Accordingly, the
surgical operator is able to respond to the consult request in real
time without having to leave the sterile field of his own operating
room. The surgical operator requesting the consult also did not
have to leave the sterile field of OR 3.
[0534] If the surgical hub 3401 is not in communication with the
personal interface 3406, it may relay the message to another
surgical hub such as, for example, the surgical hub 3402 or the
robotic surgical hub 3403. Alternatively, the surgical hub 3401 may
request control of the personal interface 3406 from another
surgical hub.
[0535] In any event, if the surgical operator of OR 1 decides to
accept the consult request, a livestream, or frames, of a surgical
site 3413 of the colorectal procedure of OR 3 is transmitted to OR
1 through a connection established between the surgical hubs 3401,
3411, for example. FIG. 57 illustrates a livestream of the surgical
site 3413 displayed on a secondary display of OR 3. The surgical
hubs 3401, 3411 cooperate to transmit the livestream of the
surgical site of OR 3 to the personal interface 3406 of the OR 1,
as illustrated in FIG. 58.
[0536] Referring to FIGS. 59-61, the surgical operator may expand
the laparoscopic livestream from OR 3 onto the primary display 3405
in OR 1, for example, through the controls of the personal
interface 3406. The personal interface 3406 allows the surgical
operator to select a destination for the livestream by presenting
the surgical operator with icons that represent the displays that
are available in OR 1, as illustrated in FIG. 60. Other navigation
controls 3407 are available to the surgical operator through the
personal interface 3406, as illustrated in FIG. 61. For example,
the personal interface 3406 includes navigation controls for
adjusting the livestream of the surgical site of OR 3 in OR 1 by
the surgical operator moving his or her fingers on the livestream
displayed on the personal interface 3406. To visualize the high
vasculature regions, the consulted surgical operator may change the
view of the livestream from OR 3 through the personal interface
3406 to an advanced imaging screen. The surgical operator may then
manipulate the image in multiple planes to see the vascularization
using a wide-angle multi-spectral view, for example.
[0537] As illustrated in FIG. 61, the surgical operator also has
access to an array of relevant information 3420, such as, for
example, heart rate, blood pressure, ventilation data, oxygen
stats, generator settings and uses, and all patient electronic data
of the patient in OR 3.
Situational Awareness
[0538] Situational awareness is the ability of some aspects of a
surgical system to determine or infer information related to a
surgical procedure from data received from databases and/or
instruments. The information can include the type of procedure
being undertaken, the type of tissue being operated on, or the body
cavity that is the subject of the procedure. With the contextual
information related to the surgical procedure, the surgical system
can, for example, improve the manner in which it controls the
modular devices (e.g., a robotic arm and/or robotic surgical tool)
that are connected to it and provide contextualized information or
suggestions to the surgeon during the course of the surgical
procedure.
[0539] Referring now to FIG. 62, a timeline 5200 depicting
situational awareness of a hub, such as the surgical hub 106 or
206, for example, is depicted. The timeline 5200 is an illustrative
surgical procedure and the contextual information that the surgical
hub 106, 206 can derive from the data received from the data
sources at each step in the surgical procedure. The timeline 5200
depicts the typical steps that would be taken by the nurses,
surgeons, and other medical personnel during the course of a lung
segmentectomy procedure, beginning with setting up the operating
theater and ending with transferring the patient to a
post-operative recovery room.
[0540] The situationally aware surgical hub 106, 206 receives data
from the data sources throughout the course of the surgical
procedure, including data generated each time medical personnel
utilize a modular device that is paired with the surgical hub 106,
206. The surgical hub 106, 206 can receive this data from the
paired modular devices and other data sources and continually
derive inferences (i.e., contextual information) about the ongoing
procedure as new data is received, such as which step of the
procedure is being performed at any given time. The situational
awareness system of the surgical hub 106, 206 is able to, for
example, record data pertaining to the procedure for generating
reports, verify the steps being taken by the medical personnel,
provide data or prompts (e.g., via a display screen) that may be
pertinent for the particular procedural step, adjust modular
devices based on the context (e.g., activate monitors, adjust the
field of view of the medical imaging device, or change the energy
level of an ultrasonic surgical instrument or RF electrosurgical
instrument), and take any other such action described above.
[0541] As the first step S202 in this illustrative procedure, the
hospital staff members retrieve the patient's EMR from the
hospital's EMR database. Based on select patient data in the EMR,
the surgical hub 106, 206 determines that the procedure to be
performed is a thoracic procedure.
[0542] In the second step S204, the staff members scan the incoming
medical supplies for the procedure. The surgical hub 106, 206
cross-references the scanned supplies with a list of supplies that
are utilized in various types of procedures and confirms that the
mix of supplies corresponds to a thoracic procedure. Further, the
surgical hub 106, 206 is also able to determine that the procedure
is not a wedge procedure (because the incoming supplies either lack
certain supplies that are necessary for a thoracic wedge procedure
or do not otherwise correspond to a thoracic wedge procedure).
[0543] In the third step S206, the medical personnel scan the
patient band via a scanner that is communicably connected to the
surgical hub 106, 206. The surgical hub 106, 206 can then confirm
the patient's identity based on the scanned data.
[0544] In the fourth step S208, the medical staff turns on the
auxiliary equipment. The auxiliary equipment being utilized can
vary according to the type of surgical procedure and the techniques
to be used by the surgeon, but in this illustrative case, they
include a smoke evacuator, insufflator, and medical imaging device.
When activated, the auxiliary equipment that are modular devices
can automatically pair with the surgical hub 106, 206 that is
located within a particular vicinity of the modular devices as part
of their initialization process. The surgical hub 106, 206 can then
derive contextual information about the surgical procedure by
detecting the types of modular devices that pair with it during
this pre-operative or initialization phase. In this particular
example, the surgical hub 106, 206 determines that the surgical
procedure is a VATS procedure based on this particular combination
of paired modular devices. Based on the combination of the data
from the patient's EMR, the list of medical supplies to be used in
the procedure, and the type of modular devices that connect to the
hub, the surgical hub 106, 206 can generally infer the specific
procedure that the surgical team will be performing. Once the
surgical hub 106, 206 knows what specific procedure is being
performed, the surgical hub 106, 206 can then retrieve the steps of
that procedure from a memory or from the cloud and then
cross-reference the data it subsequently receives from the
connected data sources (e.g., modular devices and patient
monitoring devices) to infer what step of the surgical procedure
the surgical team is performing.
[0545] In the fifth step S210, the staff members attach the EKG
electrodes and other patient monitoring devices to the patient. The
EKG electrodes and other patient monitoring devices are able to
pair with the surgical hub 106, 206. As the surgical hub 106, 206
begins receiving data from the patient monitoring devices, the
surgical hub 106, 206 thus confirms that the patient is in the
operating theater.
[0546] In the sixth step S212, the medical personnel induce
anesthesia in the patient. The surgical hub 106, 206 can infer that
the patient is under anesthesia based on data from the modular
devices and/or patient monitoring devices, including EKG data,
blood pressure data, ventilator data, or combinations thereof, for
example. Upon completion of the sixth step S212, the pre-operative
portion of the lung segmentectomy procedure is completed and the
operative portion begins.
[0547] In the seventh step S214, the patient's lung that is being
operated on is collapsed (while ventilation is switched to the
contralateral lung). The surgical hub 106, 206 can infer from the
ventilator data that the patient's lung has been collapsed, for
example. The surgical hub 106, 206 can infer that the operative
portion of the procedure has commenced, as it can compare the
detection of the patient's lung collapsing to the expected steps of
the procedure (which can be accessed or retrieved previously) and
thereby determine that collapsing the lung is the first operative
step in this particular procedure.
[0548] In the eighth step S216, the medical imaging device (e.g., a
scope) is inserted and video from the medical imaging device is
initiated. The surgical hub 106, 206 receives the medical imaging
device data (i.e., video or image data) through its connection to
the medical imaging device. Upon receipt of the medical imaging
device data, the surgical hub 106, 206 can determine that the
laparoscopic portion of the surgical procedure has commenced.
Further, the surgical hub 106, 206 can determine that the
particular procedure being performed is a segmentectomy, as opposed
to a lobectomy (note that a wedge procedure has already been
discounted by the surgical hub 106, 206 based on data received at
the second step S204 of the procedure). The data from the medical
imaging device 124 (FIG. 2) can be utilized to determine contextual
information regarding the type of procedure being performed in a
number of different ways, including by determining the angle at
which the medical imaging device is oriented with respect to the
visualization of the patient's anatomy, monitoring the number of
medical imaging devices being utilized (i.e., that are activated
and paired with the surgical hub 106, 206), and monitoring the
types of visualization devices utilized. For example, one technique
for performing a VATS lobectomy places the camera in the lower
anterior corner of the patient's chest cavity above the diaphragm,
whereas one technique for performing a VATS segmentectomy places
the camera in an anterior intercostal position relative to the
segmental fissure. Using pattern recognition or machine learning
techniques, for example, the situational awareness system can be
trained to recognize the positioning of the medical imaging device
according to the visualization of the patient's anatomy. As another
example, one technique for performing a VATS lobectomy utilizes a
single medical imaging device, whereas another technique for
performing a VATS segmentectomy utilizes multiple cameras. As yet
another example, one technique for performing a VATS segmentectomy
utilizes an infrared light source (which can be communicably
coupled to the surgical hub as part of the visualization system) to
visualize the segmental fissure, which is not utilized in a VATS
lobectomy. By tracking any or all of this data from the medical
imaging device, the surgical hub 106, 206 can thereby determine the
specific type of surgical procedure being performed and/or the
technique being used for a particular type of surgical
procedure.
[0549] In the ninth step S218, the surgical team begins the
dissection step of the procedure. The surgical hub 106, 206 can
infer that the surgeon is in the process of dissecting to mobilize
the patient's lung because it receives data from the RF or
ultrasonic generator indicating that an energy instrument is being
fired. The surgical hub 106, 206 can cross-reference the received
data with the retrieved steps of the surgical procedure to
determine that an energy instrument being fired at this point in
the process (i.e., after the completion of the previously discussed
steps of the procedure) corresponds to the dissection step. In
certain instances, the energy instrument can be an energy tool
mounted to a robotic arm of a robotic surgical system.
[0550] In the tenth step S220, the surgical team proceeds to the
ligation step of the procedure. The surgical hub 106, 206 can infer
that the surgeon is ligating arteries and veins because it receives
data from the surgical stapling and cutting instrument indicating
that the instrument is being fired. Similarly to the prior step,
the surgical hub 106, 206 can derive this inference by
cross-referencing the receipt of data from the surgical stapling
and cutting instrument with the retrieved steps in the process. In
certain instances, the surgical instrument can be a surgical tool
mounted to a robotic arm of a robotic surgical system.
[0551] In the eleventh step S222, the segmentectomy portion of the
procedure is performed. The surgical hub 106, 206 can infer that
the surgeon is transecting the parenchyma based on data from the
surgical stapling and cutting instrument, including data from its
cartridge. The cartridge data can correspond to the size or type of
staple being fired by the instrument, for example. As different
types of staples are utilized for different types of tissues, the
cartridge data can thus indicate the type of tissue being stapled
and/or transected. In this case, the type of staple being fired is
utilized for parenchyma (or other similar tissue types), which
allows the surgical hub 106, 206 to infer that the segmentectomy
portion of the procedure is being performed.
[0552] In the twelfth step S224, the node dissection step is then
performed. The surgical hub 106, 206 can infer that the surgical
team is dissecting the node and performing a leak test based on
data received from the generator indicating that an RF or
ultrasonic instrument is being fired. For this particular
procedure, an RF or ultrasonic instrument being utilized after
parenchyma was transected corresponds to the node dissection step,
which allows the surgical hub 106, 206 to make this inference. It
should be noted that surgeons regularly switch back and forth
between surgical stapling/cutting instruments and surgical energy
(i.e., RF or ultrasonic) instruments depending upon the particular
step in the procedure because different instruments are better
adapted for particular tasks. Therefore, the particular sequence in
which the stapling/cutting instruments and surgical energy
instruments are used can indicate what step of the procedure the
surgeon is performing. Moreover, in certain instances, robotic
tools can be utilized for one or more steps in a surgical procedure
and/or handheld surgical instruments can be utilized for one or
more steps in a surgical procedure. The surgeon(s) can alternate
between robotic tools and handheld surgical instruments and/or can
use the devices concurrently, for example. Upon completion of the
twelfth step S224, the incisions are closed up and the
post-operative portion of the procedure begins.
[0553] In the thirteenth step S226, the patient's anesthesia is
reversed. The surgical hub 106, 206 can infer that the patient is
emerging from the anesthesia based on the ventilator data (i.e.,
the patient's breathing rate begins increasing), for example.
[0554] Lastly, in the fourteenth step S228, the medical personnel
remove the various patient monitoring devices from the patient. The
surgical hub 106, 206 can thus infer that the patient is being
transferred to a recovery room when the hub loses EKG, BP, and
other data from the patient monitoring devices. As can be seen from
the description of this illustrative procedure, the surgical hub
106, 206 can determine or infer when each step of a given surgical
procedure is taking place according to data received from the
various data sources that are communicably coupled to the surgical
hub 106, 206.
[0555] Situational awareness is further described in U.S.
Provisional Patent Application Ser. No. 62/611,341, entitled
INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017, which is
incorporated by reference herein in its entirety. In certain
instances, operation of a robotic surgical system, including the
various robotic surgical systems disclosed herein, for example, can
be controlled by the surgical hub 106, 206 based on its situational
awareness and/or feedback from the components thereof and/or based
on information from the cloud 102.
[0556] Various aspects of the subject matter described herein are
set out in the following numbered examples.
[0557] Various aspects of the subject matter described herein are
set out in the following numbered examples.
[0558] Example 1. A surgical hub for use with a medical imaging
device at a remote surgical site in a surgical procedure, wherein
the surgical hub comprises a circuit configured to: receive a
livestream of the surgical site from the medical imaging device;
capture an image frame of a surgical step of the surgical procedure
from the livestream; derive information relevant to the surgical
step from data extracted from the image frame; and overlay the
information onto the livestream.
[0559] Example 2. The surgical hub of Example 1, wherein the
information is regarding completion of the surgical step.
[0560] Example 3. The surgical hub of any one of Examples 1-2,
wherein the surgical step comprises deploying staples from a staple
cartridge into tissue at the surgical site.
[0561] Example 4. The surgical hub of any one of Examples 1-3,
wherein the information identifies the staple cartridge.
[0562] Example 5. The surgical hub of any one of Examples 1-4,
wherein the information comprises a serial number of the staple
cartridge.
[0563] Example 6. The surgical hub of any one of Examples 1-5,
wherein the information identifies a leak at the surgical site.
[0564] Example 7. The surgical hub of anyone of Examples 1-7,
wherein the information identifies the surgical step.
[0565] Example 8. A surgical hub for use with a medical imaging
device at a remote surgical site in a surgical procedure including
surgical steps, wherein the surgical hub comprises a circuit
configured to: receive a livestream of the surgical site from the
medical imaging device; capture image frames of the surgical steps
of the surgical procedure from the livestream; and differentiate
among the surgical steps based on data extracted from the image
frames.
[0566] Example 9. The surgical hub of Example 8, derive information
regarding completion of the surgical steps from the data extracted
from the image frames.
[0567] Example 10. The surgical hub of anyone of Examples 8-9,
wherein one of the surgical steps comprises deploying staples from
a staple cartridge into tissue at the surgical site.
[0568] Example 11. The surgical hub of anyone of Examples 8-10,
wherein the information identifies the staple cartridge.
[0569] Example 12. The surgical hub of any one of Examples 8-11,
wherein the information comprises a serial number of the staple
cartridge.
[0570] Example 13. The surgical hub of any one of Examples 8-12,
wherein the information identifies a leak at the surgical site.
[0571] Example 14. The surgical hub of anyone of Examples 8-10,
wherein another one of the surgical steps comprises applying energy
to tissue at the surgical site.
[0572] Example 15. A surgical hub for use with a medical imaging
device at a remote surgical site in a surgical procedure, wherein
the surgical hub comprises a circuit configured to: receive a
livestream of the surgical site from the medical imaging device;
capture an image frame from the livestream; detect a staple pattern
in the image frame, wherein the staple pattern is defined by
staples deployed from a staple cartridge into tissue at the
surgical site; and identify the staple cartridge based on the
staple pattern.
[0573] Example 16. The surgical hub of Example 15, wherein the
staple pattern corresponds to a serial number of the staple
cartridge.
[0574] Example 17. The surgical hub of any one of Examples 15-16,
wherein the staples comprise a first staple and a second staple
different than the first staple.
[0575] Example 18. The surgical hub of any one of Examples 15-17,
wherein the first staple is comprised of a non-ionized
material.
[0576] Example 19. The surgical hub of any one of Examples 15-18,
wherein the second staple is comprised of an ionized material.
[0577] Example 20. The surgical hub of any one of Examples 15-19,
wherein the staple pattern is defined in a plurality of rows of
staples.
[0578] While several forms have been illustrated and described, it
is not the intention of the applicant to restrict or limit the
scope of the appended claims to such detail. Numerous
modifications, variations, changes, substitutions, combinations,
and equivalents to those forms may be implemented and will occur to
those skilled in the art without departing from the scope of the
present disclosure. Moreover, the structure of each element
associated with the described forms can be alternatively described
as a means for providing the function performed by the element.
Also, where materials are disclosed for certain components, other
materials may be used. It is therefore to be understood that the
foregoing description and the appended claims are intended to cover
all such modifications, combinations, and variations as falling
within the scope of the disclosed forms. The appended claims are
intended to cover all such modifications, variations, changes,
substitutions, modifications, and equivalents.
[0579] The foregoing detailed description has set forth various
forms of the devices and/or processes via the use of block
diagrams, flowcharts, and/or examples. Insofar as such block
diagrams, flowcharts, and/or examples contain one or more functions
and/or operations, it will be understood by those within the art
that each function and/or operation within such block diagrams,
flowcharts, and/or examples can be implemented, individually and/or
collectively, by a wide range of hardware, software, firmware, or
virtually any combination thereof. Those skilled in the art will
recognize that some aspects of the forms disclosed herein, in whole
or in part, can be equivalently implemented in integrated circuits,
as one or more computer programs running on one or more computers
(e.g., as one or more programs running on one or more computer
systems), as one or more programs running on one or more processors
(e.g., as one or more programs running on one or more
microprocessors), as firmware, or as virtually any combination
thereof, and that designing the circuitry and/or writing the code
for the software and or firmware would be well within the skill of
one of skill in the art in light of this disclosure. In addition,
those skilled in the art will appreciate that the mechanisms of the
subject matter described herein are capable of being distributed as
one or more program products in a variety of forms, and that an
illustrative form of the subject matter described herein applies
regardless of the particular type of signal bearing medium used to
actually carry out the distribution.
[0580] Instructions used to program logic to perform various
disclosed aspects can be stored within a memory in the system, such
as dynamic random access memory (DRAM), cache, flash memory, or
other storage. Furthermore, the instructions can be distributed via
a network or by way of other computer readable media. Thus a
machine-readable medium may include any mechanism for storing or
transmitting information in a form readable by a machine (e.g., a
computer), but is not limited to, floppy diskettes, optical disks,
compact disc, read-only memory (CD-ROMs), and magneto-optical
disks, read-only memory (ROMs), random access memory (RAM),
erasable programmable read-only memory (EPROM), electrically
erasable programmable read-only memory (EEPROM), magnetic or
optical cards, flash memory, or a tangible, machine-readable
storage used in the transmission of information over the Internet
via electrical, optical, acoustical or other forms of propagated
signals (e.g., carrier waves, infrared signals, digital signals,
etc.). Accordingly, the non-transitory computer-readable medium
includes any type of tangible machine-readable medium suitable for
storing or transmitting electronic instructions or information in a
form readable by a machine (e.g., a computer).
[0581] As used in any aspect herein, the term "control circuit" may
refer to, for example, hardwired circuitry, programmable circuitry
(e.g., a computer processor comprising one or more individual
instruction processing cores, processing unit, processor,
microcontroller, microcontroller unit, controller, digital signal
processor (DSP), programmable logic device (PLD), programmable
logic array (PLA), or field programmable gate array (FPGA)), state
machine circuitry, firmware that stores instructions executed by
programmable circuitry, and any combination thereof. The control
circuit may, collectively or individually, be embodied as circuitry
that forms part of a larger system, for example, an integrated
circuit (IC), an application-specific integrated circuit (ASIC), a
system on-chip (SoC), desktop computers, laptop computers, tablet
computers, servers, smart phones, etc. Accordingly, as used herein
"control circuit" includes, but is not limited to, electrical
circuitry having at least one discrete electrical circuit,
electrical circuitry having at least one integrated circuit,
electrical circuitry having at least one application specific
integrated circuit, electrical circuitry forming a general purpose
computing device configured by a computer program (e.g., a general
purpose computer configured by a computer program which at least
partially carries out processes and/or devices described herein, or
a microprocessor configured by a computer program which at least
partially carries out processes and/or devices described herein),
electrical circuitry forming a memory device (e.g., forms of random
access memory), and/or electrical circuitry forming a
communications device (e.g., a modem, communications switch, or
optical-electrical equipment). Those having skill in the art will
recognize that the subject matter described herein may be
implemented in an analog or digital fashion or some combination
thereof.
[0582] As used in any aspect herein, the term "logic" may refer to
an app, software, firmware and/or circuitry configured to perform
any of the aforementioned operations. Software may be embodied as a
software package, code, instructions, instruction sets and/or data
recorded on non-transitory computer readable storage medium.
Firmware may be embodied as code, instructions or instruction sets
and/or data that are hard-coded (e.g., nonvolatile) in memory
devices.
[0583] As used in any aspect herein, the terms "component,"
"system," "module" and the like can refer to a computer-related
entity, either hardware, a combination of hardware and software,
software, or software in execution.
[0584] As used in any aspect herein, an "algorithm" refers to a
self-consistent sequence of steps leading to a desired result,
where a "step" refers to a manipulation of physical quantities
and/or logic states which may, though need not necessarily, take
the form of electrical or magnetic signals capable of being stored,
transferred, combined, compared, and otherwise manipulated. It is
common usage 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.
[0585] A network may include a packet switched network. The
communication devices may be capable of communicating with each
other using a selected packet switched network communications
protocol. One example communications protocol may include an
Ethernet communications protocol which may be capable permitting
communication using a Transmission Control Protocol/Internet
Protocol (TCP/IP). The Ethernet protocol may comply or be
compatible with the Ethernet standard published by the Institute of
Electrical and Electronics Engineers (IEEE) titled "IEEE 802.3
Standard", published in December, 2008 and/or later versions of
this standard. Alternatively or additionally, the communication
devices may be capable of communicating with each other using an
X.25 communications protocol. The X.25 communications protocol may
comply or be compatible with a standard promulgated by the
International Telecommunication Union-Telecommunication
Standardization Sector (ITU-T). Alternatively or additionally, the
communication devices may be capable of communicating with each
other using a frame relay communications protocol. The frame relay
communications protocol may comply or be compatible with a standard
promulgated by Consultative Committee for International Telegraph
and Telephone (CCITT) and/or the American National Standards
Institute (ANSI). Alternatively or additionally, the transceivers
may be capable of communicating with each other using an
Asynchronous Transfer Mode (ATM) communications protocol. The ATM
communications protocol may comply or be compatible with an ATM
standard published by the ATM Forum titled "ATM-MPLS Network
Interworking 2.0" published August 2001, and/or later versions of
this standard. Of course, different and/or after-developed
connection-oriented network communication protocols are equally
contemplated herein.
[0586] Unless specifically stated otherwise as apparent from the
foregoing disclosure, it is appreciated that, throughout the
foregoing disclosure, discussions using terms such as "processing,"
"computing," "calculating," "determining," "displaying," or the
like, refer to the action and processes of a computer system, or
similar electronic computing device, that manipulates and
transforms data represented as physical (electronic) quantities
within the computer system's registers and memories into other data
similarly represented as physical quantities within the computer
system memories or registers or other such information storage,
transmission or display devices.
[0587] One or more components may be referred to herein as
"configured to," "configurable to," "operable/operative to,"
"adapted/adaptable," "able to," "conformable/conformed to," etc.
Those skilled in the art will recognize that "configured to" can
generally encompass active-state components and/or inactive-state
components and/or standby-state components, unless context requires
otherwise.
[0588] The terms "proximal" and "distal" are used herein with
reference to a 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 away from the clinician. It will be further
appreciated that, for convenience and clarity, spatial terms such
as "vertical", "horizontal", "up", and "down" may be used herein
with respect to the drawings. However, surgical instruments are
used in many orientations and positions, and these terms are not
intended to be limiting and/or absolute.
[0589] Those skilled in the art will recognize that, in general,
terms used herein, and especially in the appended claims (e.g.,
bodies of the appended claims) are generally intended as "open"
terms (e.g., the term "including" should be interpreted as
"including but not limited to," the term "having" should be
interpreted as "having at least," the term "includes" should be
interpreted as "includes but is not limited to," etc.). It will be
further understood by those within the art that if a specific
number of an introduced claim recitation is intended, such an
intent will be explicitly recited in the claim, and in the absence
of such recitation no such intent is present. For example, as an
aid to understanding, the following appended claims may contain
usage of the introductory phrases "at least one" and "one or more"
to introduce claim recitations. However, the use of such phrases
should not be construed to imply that the introduction of a claim
recitation by the indefinite articles "a" or "an" limits any
particular claim containing such introduced claim recitation to
claims containing only one such recitation, even when the same
claim includes the introductory phrases "one or more" or "at least
one" and indefinite articles such as "a" or "an" (e.g., "a" and/or
"an" should typically be interpreted to mean "at least one" or "one
or more"); the same holds true for the use of definite articles
used to introduce claim recitations.
[0590] In addition, even if a specific number of an introduced
claim recitation is explicitly recited, those skilled in the art
will recognize that such recitation should typically be interpreted
to mean at least the recited number (e.g., the bare recitation of
"two recitations," without other modifiers, typically means at
least two recitations, or two or more recitations). Furthermore, in
those instances where a convention analogous to "at least one of A,
B, and C, etc." is used, in general such a construction is intended
in the sense one having skill in the art would understand the
convention (e.g., "a system having at least one of A, B, and C"
would include but not be limited to systems that have A alone, B
alone, C alone, A and B together, A and C together, B and C
together, and/or A, B, and C together, etc.). In those instances
where a convention analogous to "at least one of A, B, or C, etc."
is used, in general such a construction is intended in the sense
one having skill in the art would understand the convention (e.g.,
"a system having at least one of A, B, or C" would include but not
be limited to systems that have A alone, B alone, C alone, A and B
together, A and C together, B and C together, and/or A, B, and C
together, etc.). It will be further understood by those within the
art that typically a disjunctive word and/or phrase presenting two
or more alternative terms, whether in the description, claims, or
drawings, should be understood to contemplate the possibilities of
including one of the terms, either of the terms, or both terms
unless context dictates otherwise. For example, the phrase "A or B"
will be typically understood to include the possibilities of "A" or
"B" or "A and B."
[0591] With respect to the appended claims, those skilled in the
art will appreciate that recited operations therein may generally
be performed in any order. Also, although various operational flow
diagrams are presented in a sequence(s), it should be understood
that the various operations may be performed in other orders than
those which are illustrated, or may be performed concurrently.
Examples of such alternate orderings may include overlapping,
interleaved, interrupted, reordered, incremental, preparatory,
supplemental, simultaneous, reverse, or other variant orderings,
unless context dictates otherwise. Furthermore, terms like
"responsive to," "related to," or other past-tense adjectives are
generally not intended to exclude such variants, unless context
dictates otherwise.
[0592] It is worthy to note that any reference to "one aspect," "an
aspect," "an exemplification," "one exemplification," and the like
means that a particular feature, structure, or characteristic
described in connection with the aspect is included in at least one
aspect. Thus, appearances of the phrases "in one aspect," "in an
aspect," "in an exemplification," and "in one exemplification" in
various places throughout the specification are not necessarily all
referring to the same aspect. Furthermore, the particular features,
structures or characteristics may be combined in any suitable
manner in one or more aspects.
[0593] Any patent application, patent, non-patent publication, or
other disclosure material referred to in this specification and/or
listed in any Application Data Sheet is incorporated by reference
herein, to the extent that the incorporated materials is not
inconsistent herewith. As such, and to the extent necessary, the
disclosure as explicitly set forth herein supersedes any
conflicting material incorporated herein by reference. Any
material, or portion thereof, that is said to be incorporated by
reference herein, but which conflicts with existing definitions,
statements, or other disclosure material set forth herein will only
be incorporated to the extent that no conflict arises between that
incorporated material and the existing disclosure material.
[0594] In summary, numerous benefits have been described which
result from employing the concepts described herein. The foregoing
description of the one or more forms has been presented for
purposes of illustration and description. It is not intended to be
exhaustive or limiting to the precise form disclosed. Modifications
or variations are possible in light of the above teachings. The one
or more forms were chosen and described in order to illustrate
principles and practical application to thereby enable one of
ordinary skill in the art to utilize the various forms and with
various modifications as are suited to the particular use
contemplated. It is intended that the claims submitted herewith
define the overall scope.
* * * * *