U.S. patent application number 17/112362 was filed with the patent office on 2021-07-29 for system and methods for identifying vessels within tissue.
The applicant listed for this patent is Covidien LP. Invention is credited to Tyler J. Bagrosky, David M. Garrison, Daniel A. Joseph, Amanda H. Lennartz, Tracy J. Pheneger, Cornelia F. Twomey, Erin E. Wehrly, Jing Zhao.
Application Number | 20210228287 17/112362 |
Document ID | / |
Family ID | 1000005279410 |
Filed Date | 2021-07-29 |
United States Patent
Application |
20210228287 |
Kind Code |
A1 |
Lennartz; Amanda H. ; et
al. |
July 29, 2021 |
SYSTEM AND METHODS FOR IDENTIFYING VESSELS WITHIN TISSUE
Abstract
A method includes providing a graphical representation of a
surgical site, grasping the tissue of the patient with first and
second jaw members of an end effector including a location sensor,
irradiating a laser onto the grasped tissue at the first jaw
member, detecting scattered laser that has passed through the
grasped tissue, at the second jaw member, processing the scattered
laser to calculate a first frequency shift and to identify a vessel
which is encompassed within the grasped tissue, receiving location
information of the end effector from the location sensor,
synchronizing a location of the identified vessel within the
graphical representation based on the location information, and
displaying the identified vessel at the synchronized location in
the graphical representation.
Inventors: |
Lennartz; Amanda H.; (Erie,
CO) ; Joseph; Daniel A.; (Golden, CO) ;
Twomey; Cornelia F.; (Longmont, CO) ; Wehrly; Erin
E.; (Longmont, CO) ; Pheneger; Tracy J.;
(Longmont, CO) ; Garrison; David M.; (Longmont,
CO) ; Bagrosky; Tyler J.; (Arvada, CO) ; Zhao;
Jing; (Superior, CO) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Covidien LP |
Mansfield |
MA |
US |
|
|
Family ID: |
1000005279410 |
Appl. No.: |
17/112362 |
Filed: |
December 4, 2020 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
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62967238 |
Jan 29, 2020 |
|
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|
62967241 |
Jan 29, 2020 |
|
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|
62967246 |
Jan 29, 2020 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 2018/00904
20130101; A61B 2018/00404 20130101; A61B 2018/1452 20130101; A61B
2018/00791 20130101; A61B 2018/0063 20130101; A61B 5/0075 20130101;
A61B 2018/00827 20130101; A61B 18/18 20130101; A61B 5/489 20130101;
A61B 34/25 20160201; A61B 8/085 20130101; A61B 2018/00642 20130101;
A61B 6/032 20130101; A61B 2018/00892 20130101; A61B 6/504 20130101;
A61B 18/1445 20130101; A61B 2018/1807 20130101; A61B 2018/00875
20130101 |
International
Class: |
A61B 34/00 20060101
A61B034/00; A61B 18/14 20060101 A61B018/14; A61B 18/18 20060101
A61B018/18 |
Claims
1. A method for identifying a hidden vessel within tissue, the
method comprising: providing a graphical representation of a
surgical site; grasping the tissue of the patient with first and
second jaw members of an end effector including a location sensor;
irradiating a laser onto the grasped tissue at the first jaw
member; detecting scattered laser that has passed through the
grasped tissue, at the second jaw member; processing the scattered
laser to calculate a first frequency shift and to identify a vessel
which is encompassed within the grasped tissue; receiving location
information of the end effector from the location sensor;
synchronizing a location of the identified vessel within the
graphical representation based on the location information; and
displaying the identified vessel at the synchronized location in
the graphical representation.
2. The method of claim 1, wherein the vessel is identified based on
the first frequency shift.
3. The method of claim 1, wherein the first frequency shift is a
Raman shift.
4. The method of claim 1, further comprising: supplying energy to
the identified vessel through the end effector to seal the
identified vessel; irradiating the laser onto the identified vessel
after supplying the energy; and receiving scattered laser that has
passed through the identified vessel, at the second jaw member.
5. The method of claim 4, further comprising: processing the
scattered laser to calculate a second frequency shift after
supplying the energy.
6. The method of claim 5, further comprising: confirming whether or
not the identified vessel is sealed based on the second frequency
shift.
7. The method of claim 6, wherein the identified vessel is
confirmed to be sealed when the second frequency shift is
characteristic for a sealed vessel.
8. The method of claim 1, further comprising: generating an
electromagnetic wave.
9. The method of claim 8, further comprising: sensing the
electromagnetic wave, wherein the location information is based on
the sensed electromagnetic wave.
10. The method of claim 1, wherein the graphical representation is
a 3D model or a video image.
11. A system for identifying a hidden vessel within tissue, the
system comprising: an end effector configured to grasp tissue, the
end effector including a first jaw member and a second jaw member;
a laser source configured to irradiate a laser onto the grasped
tissue and fixed at the first jaw member; a light sensor configured
to receive scattered laser that has passed through the grasped
tissue, and fixed at the second jaw member; a location sensor
configured to detect location information of the end effector; a
processor configured to receive a graphical representation of a
surgical site, process the scattered laser to calculate a first
frequency shift and to identify a vessel, which is encompassed
within the grasped tissue, based on the first frequency shift, and
synchronize a location of the identified vessel within the
graphical representation based on the location information; and a
display configured to display the identified vessel at the
synchronized location in the graphical representation.
12. The system of claim 11, wherein the processor identifies the
vessel based on the first frequency.
13. The system of claim 11, wherein the first frequency shift is a
Raman shift.
14. The system of claim 11, further comprising: an energy supplier
configured to supply an energy to the end effector to seal the
identified vessel, wherein the laser source is further configured
to irradiate the laser onto the identified vessel after supplying
the energy, and wherein the light sensor is further configured to
receive scattered laser that has passed through the identified
vessel.
15. The system of claim 14, wherein the processor is further
configured to process the scattered laser to calculate a second
frequency shift after supplying the energy.
16. The system of claim 15, wherein the processor is further
configured to confirm whether or not the identified vessel is
sealed based on the second frequency shift.
17. The system of claim 16, wherein the processor confirms that the
identified vessel is sealed when the second frequency shift is
characteristic for a sealed vessel.
18. The system of claim 11, further comprising: an electromagnetic
wave generator configured to generate an electromagnetic wave.
19. The system of claim 18, further comprising: an electromagnetic
sensor configured to sense the electromagnetic wave, wherein the
location information is based on the sensed electromagnetic
wave.
20. The system of claim 11, wherein the graphical representation is
a three-dimensional model or a video image.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application claims the benefit of and priority to U.S.
Provisional patent Application Nos. 62/967,238; 62/967,241; and
62/967,246, filed on Jan. 29, 2020, the entire contents of each of
which is hereby incorporated herein by reference.
FIELD
[0002] The present disclosure is generally related to systems and
methods for identifying a location of vessel within tissue with a
light source, displaying the identified vessel at a proper
location, and/or confirming sealing of the identified vessel.
BACKGROUND
[0003] Surgical operations including laparoscopic operations
involve operations on tissue. During an operation, tissue can be
cut, coagulated, and/or sealed. Complications may occur when the
tissue includes vessels, such as blood, vile, or lymph vessels. For
example, when tissue is planned to be cut and the tissue includes a
blood vessel, the blood vessel might also be also cut and leak
blood or body fluid around the tissue, thereby causing
complication. Thus, identification of vessels, which are not seen
from outside or are hidden within the tissue, is advantageous.
[0004] During laparoscopic operations, a surgeon has a limited
view. Thus, display of hidden vessels at an appropriate place on a
display is also advantageous in increasing certainty of efficacy of
the surgical operations and decreasing potential harm to
patients.
[0005] Further, prior to or concurrently with surgical operations,
completion of sealing of vessel needs to be confirmed so as to also
increase certainty of efficacy of the surgical operations and
decrease potential harm to patients.
SUMMARY
[0006] This disclosure generally relates to identification of
vessels hidden within tissue, display of the identified vessels at
the proper location, and/or confirmation of sealing of vessels so
that performance and efficacy of surgical operations can be
increased.
[0007] Provided in accordance with aspects of the disclosure is a
method for identifying a vessel within tissue. The method includes
providing a graphical representation of a surgical site, grasping
the tissue of the patient with first and second jaw members of an
end effector including a location sensor, irradiating a laser onto
the grasped tissue at the first jaw member, detecting scattered
laser that has passed through the grasped tissue, at the second jaw
member, processing the scattered laser to calculate a first
frequency shift and to identify a vessel which is encompassed
within the grasped tissue, receiving location information of the
end effector from the location sensor, synchronizing a location of
the identified vessel within the graphical representation based on
the location information, and displaying the identified vessel at
the synchronized location in the graphical representation.
[0008] In an aspect of the disclosure, the vessel is identified
based on the first frequency shift.
[0009] In another aspect of the disclosure, the first frequency
shift is a Raman shift.
[0010] In another aspect of the disclosure, the method further
includes supplying energy to the identified vessel through the end
effector to seal the identified vessel, irradiating the laser onto
the identified vessel after supplying the energy, and receiving
scattered laser that has passed through the identified vessel, at
the second jaw member.
[0011] In still another aspect of the disclosure, the method
further includes processing the scattered laser to calculate a
second frequency shift after supplying the energy.
[0012] In still another aspect of the disclosure, the method
further includes confirming whether or not the identified vessel is
sealed based on the second frequency shift. The identified vessel
is confirmed to be sealed when the second frequency shift is
characteristic for a sealed vessel.
[0013] In yet another aspect of the disclosure, the method further
includes generating an electromagnetic wave.
[0014] In yet another aspect of the disclosure, the method further
includes sensing the electromagnetic wave. The location information
is based on the sensed electromagnetic wave.
[0015] In still yet another aspect of the disclosure, the graphical
representation is a 3D model or a video image.
[0016] Provided in accordance with aspects of the disclosure is a
system for identifying a hidden vessel within tissue. The system
includes an end effector configured to grasp tissue, the end
effector including a first jaw member and a second jaw member, a
laser source configured to irradiate a laser onto the grasped
tissue and fixed at the first jaw member, a light sensor configured
to receive scattered laser that has passed through the grasped
tissue, and fixed at the second jaw member, a location sensor
configured to detect location information of the end effector, a
processor configured to receive a graphical representation of a
surgical site, process the scattered laser to calculate a first
frequency shift and to identify a vessel, which is encompassed
within the grasped tissue, based on the first frequency shift, and
synchronize a location of the identified vessel within the
graphical representation based on the location information, and a
display configured to display the identified vessel at the
synchronized location in the graphical representation.
[0017] In an aspect of the disclosure, the processor identifies the
vessel based on the first frequency.
[0018] In another aspect of the disclosure, the first frequency
shift is a Raman shift.
[0019] In another aspect of the disclosure, the system further
includes an energy supplier configured to supply energy to the end
effector to seal the identified vessel. The laser source is further
configured to irradiate the laser onto the identified vessel after
supplying the energy, and the light sensor is further configured to
receive scattered laser that has passed through the identified
vessel.
[0020] In still another aspect of the disclosure, the processor is
further configured to process the scattered laser to calculate a
second frequency shift after supplying the energy.
[0021] In still another aspect of the disclosure, the processor is
further configured to confirm whether or not the identified vessel
is sealed based on the second frequency shift.
[0022] In still another aspect of the disclosure, the processor
confirms that the identified vessel is sealed when the second
frequency shift is characteristic for a sealed vessel.
[0023] In still another aspect of the disclosure, the system
further includes an electromagnetic wave generator configured to
generate an electromagnetic wave.
[0024] In yet another aspect of the disclosure, the system further
includes an electromagnetic sensor configured to sense the
electromagnetic wave. The location information is based on the
sensed electromagnetic wave.
[0025] In yet still another aspect of the disclosure, the graphical
representation is a three-dimensional model or a video image.
[0026] The details of one or more aspects of the disclosure are set
forth in the accompanying drawings and the description below. Other
features, objects, and advantages of the techniques described in
this disclosure will be apparent from the description and drawings,
and from the claims.
BRIEF DESCRIPTION OF DRAWINGS
[0027] FIG. 1 is a block diagram of a surgical system for
identifying vessels according to aspects of the present
disclosure;
[0028] FIG. 2 is a perspective view of an energy-delivery device
including an end effector assembly in accordance with aspects of
the present disclosure;
[0029] FIGS. 3A and 3B are cross-sectional side views of an end
effector assembly of an energy delivery device having jaw members
for grasping tissue and blood vessels according to aspects of the
present disclosure;
[0030] FIG. 4 is a cross-sectional front view of the energy
delivery device of FIGS. 3A and 3B for identifying vessels in
tissue with an optical light source according to aspects of the
present disclosure;
[0031] FIG. 5 is a cross-sectional front view of an end effector
assembly of an energy delivery device having jaw members for
grasping tissue and blood vessels and identifying vessels in tissue
with a laser source according to embodiments of the present
disclosure;
[0032] FIG. 6 depicts raw laser speckle data in accordance with
aspects of the present disclosure;
[0033] FIG. 7 is a laser speckle contrast image (LSCI) illustrating
subsurface blood flows in tissue obtained based on laser speckle
data prior to vessel sealing according to aspects of the present
disclosure;
[0034] FIG. 8 is an LSCI illustrating subsurface blood flows of the
same portion of the tissue as FIG. 7 after vessel sealing;
[0035] FIG. 9 is a cross-sectional front view of an end effector
assembly of an energy delivery device having jaw members for
grasping tissue and blood vessels and identifying vessels in tissue
with a laser source based on Raman Shift according to aspects of
the present disclosure;
[0036] FIGS. 10A-10C are graphical representations of Raman Shifts
according to aspects of the present disclosure;
[0037] FIG. 11 is a flowchart illustrating a method for identifying
blood vessels based on optical light according to aspects of the
present disclosure;
[0038] FIG. 12 is a flowchart illustrating a method for identifying
blood vessels based on Raman shifts according to aspects of the
present disclosure; and
[0039] FIG. 13 is a flowchart illustrating a method for identifying
blood vessels based on laser speckle data according to aspects of
the present disclosure; and
[0040] FIG. 14 is a block diagram for a computing device according
to aspects of the present disclosure.
DETAILED DESCRIPTION
[0041] Surgical operations often involve operations to tissue that
includes vessels. When the tissue is to be cut or treated, the
vessels in the tissue should be sealed so as to prevent blood or
body fluid from leaking. Thus, identification of the vessels in the
tissue enhances performance of the surgical operations. Further,
prior to, concurrently with, or after the treatment of the tissue,
completeness of sealing vessels should be confirmed. Thus, the
present disclosure provides systems and methods for identifying
vessels, which are hidden within tissue, displaying the identified
vessel at an appropriate location, and/or confirming completeness
of the vessel seal.
[0042] Different types of light sources and light sensors may be
used to identify a location of a vessel. For example, an optical
light source or laser light source is employed in this disclosure,
although other light sources are also contemplated. Identification
of vessels may be based on optical light, reflected laser spectrum,
Raman shift, or in any other suitable manner. Corresponding
structures and methods are described in the following description
and in the drawings.
[0043] FIG. 1 shows a block diagram of a surgical system 100 for
identifying vessels according to embodiments of the present
disclosure. The surgical system 100 may use any type of energy to
seal tissue including mechanical energy, acoustic energy, thermal
energy, electrical energy, or electromagnetic (EM) energy (e.g.,
optical energy or radio frequency (RF) energy). The surgical system
100 may use EM waves to identify a location of one or more elements
of the surgical system 100 and synchronize the patient with a
three-dimensional (3D) model of a patient. Ultrasound may be used
by the surgical system 100 to identify a location of elements of
the surgical system 100. Further, the surgical system 100 may
identify a location of vessels hidden in tissue of interest,
synchronize the identified location of the vessel with the 3D
model, and display a graphical representation of the vessel at the
corresponding location in the 3D model in an augmented way. By
doing the above, the surgical system 100 helps clinicians to
perform surgical operations without unintentionally cutting or
otherwise damaging vessels, e.g., blood vessels.
[0044] In embodiments, the surgical system 100 may use EM waves to
identify a location of one or more elements of the surgical system
100 and synchronize the patient with a live video of a patient.
Further, the surgical system 100 may identify a location of vessels
hidden in tissue of interest, synchronize the identified location
of the vessel with the live video, and display a graphical
representation of the vessel at the corresponding location in the
live video in an augmented way. By doing the above, the surgical
system 100 helps clinicians to perform surgical operations without
unintentionally cutting or otherwise damaging vessels, e.g., blood
vessels.
[0045] Prior to or concurrently with surgical operations, a
three-dimensional (3D) model is generated to visually display
patient's anatomy. During an imaging/planning stage, a computer
utilizes computed tomography (CT) image data or other image data in
the Digital Imaging and Communications in Medicine (DICOM) format
or similar format, for generating and viewing a 3D model of the
patient's body. In embodiments, the 3D model may be generated in
real time based on the live video. The 3D model and image data
derived from the 3D model enables identification of the region of
interest (automatically, semi-automatically or manually), and
allows for the selection of a pathway to the region of interest.
More specifically, the CT scans are processed and assembled into a
3D volume, which is then utilized to generate the 3D model of the
patient's body. The surgical system 100 may include a memory 175 to
store the 3D model or receive the 3D model from another computer,
which has generated or stored the 3D model. The surgical system 100
may be coupled to a display 170 and cause the display 170 to
display the 3D model on its screen.
[0046] The surgical system 100 may include a power supply 110, an
energy output stage 120, and an instrument 130. The power supply
110 supplies power to the energy output stage 120, which generates
energy and provides the energy to the instrument 130. The
instrument 130, in turn, applies the generated energy to the tissue
190, which includes at least one vessel. For an RF-based
tissue-sealing system, the energy output stage 120 generates RF
energy and the instrument 130 applies the RF energy to the tissue
190 through at least one contact to seal the tissue 190. Various
other types of instruments 130 may be encompassed in this
disclosure as understood by a person having ordinary skill in the
art.
[0047] The surgical system 100 may also include a sensor 140, a
processor 160, a user interface 165, and display 170. The sensor
140 senses various parameters and/or properties of the RF energy
applied by the instrument 130 at the operating site and transmits
sensor signals representing the sensed parameters or properties of
the RF energy to the processor 160. The processor 160 processes the
sensor signals and generates control signals based on the processed
sensor signals to control the power supply 110 and/or the energy
output stage 120. For example, the processor 160 may regulate the
voltage or current output from the power supply 110 or the energy
output stage 120 based on the processed sensor signals.
[0048] The sensor 140 is configured to measure various electrical
or electromechanical conditions at the operating site such as
tissue impedance, changes in tissue impedance, tissue temperature,
changes in tissue temperature, leakage current, applied voltage,
and applied current. The sensor 140 may sample, continuously
measure, and adjust one or more of these conditions so that the
processor 160 can continually adjust the energy output from the
power supply 110 and/or the energy output stage 120 during a
sealing procedure. For example, in an RF-based vessel sealing, the
sensor 140 may measure tissue impedance and the processor 160 may
adjust the voltage generated by the energy output stage 120.
[0049] The user interface 165 is coupled to the processor 160
allowing a user to control various parameters of the energy applied
to the tissue 190 during a surgical procedure. For example, the
user interface 165 may allow a user to manually set, regulate
and/or control one or more parameters of the energy delivered to
the tissue 190, such as voltage, current, power, frequency, and/or
algorithm control parameters, e.g., pulse width, duty cycle, crest
factor, and/or repetition rate.
[0050] The processor 160 may be designed to execute software
instructions, which are saved in the memory 175, for processing
data received from the user interface 165 and for outputting
control signals to the power supply 110 and/or the energy output
stage 120. The software instructions may be uploaded to or stored
in an internal memory of the processor 160, an internal or external
memory bank accessible by the processor 160 and/or an external
memory, e.g., an external hard drive, floppy diskette, or CD-ROM.
Control signals generated by the processor 160 may be converted to
analog signals by a digital-to-analog converter (DAC) (not shown)
before being applied to the power supply 110 and/or energy output
stage 120.
[0051] For embodiments of an RF-based tissue-sealing system, the
power supply 110 is a high-voltage DC power supply that produces RF
current. In these embodiments, the processor 160 transmits control
signals to the power supply to control the magnitudes of the RF
voltage and current output from the power supply 110. The energy
output stage 120 receives the RF current and generates one or more
algorithm control signals of RF energy. The processor 160 generates
algorithm control signals to regulate the parameters of the RF
energy, such as pulse width, duty cycle, crest factor, and
repetition rate. In other embodiments, the power supply 110 is an
AC power supply, and the energy output stage 120 may vary the
waveform of the AC signal generated by the power supply 110 to
achieve a desired waveform.
[0052] As described above, the surgical system 100 includes the
user interface 165, which includes an input device, such as a
keyboard or touch screen, through which a user enters data and
commands. The data may include the type of instrument, the type of
procedure, and/or the type of tissue. The commands may include
target effective voltage, current, or power level, or other
commands for controlling parameters of the energy that is delivered
from the energy output stage 120 to the instrument 130.
[0053] In embodiments, the user interface 165 may be incorporated
into the display 170. For example, the display 170 may be touch
sensitive and display graphical icons/representations to adjust
various parameters. In such configurations, a clinician adjusts
values of the various parameters by touching/holding/dragging icons
on the display 170.
[0054] The surgical system 100 may also include a light source,
e.g., an optical light source 150, and a light sensor 155. The
optical light source 150 emits optical light to the tissue 190 and
the light sensor 155 senses light, which has passed through or
reflected from the tissue 190. In embodiments, the light source 150
may be coupled to the energy output stage 120. The energy output
stage 120 may generate light that may be the same as the
electrosurgical energy applied to the tissue 190 to perform an
electrosurgical procedure (e.g., vessel sealing). Alternatively,
the energy output stage 120 may generate light that has parameters
that are different from the parameters of the electrosurgical
energy applied to the tissue 190.
[0055] The light sensor 155 generates a sensor signal or sensor
data based on the sensed light and transmits the sensor signal or
sensor data to the processor 160, which processes the sensor signal
or sensor data to determine the level of blood circulation in the
tissue 190 and to identify a location of vessels in the tissue 190.
For example, the processor 160 may determine the level of blood
circulation and a location of a vessel based on the magnitude,
phase, scatter, or Doppler effect of the sensor signal or the
sensed light.
[0056] The sensed light may also provide information about the
tissue type. For example, the sensed light may identify the tissue
as connective tissue, muscle tissue, nervous tissue, vascular
tissue, epithelial tissue, or any other tissue type or combination
of tissue types. The sensed light may also identify the vessel type
within the tissue 190. The vessel types include bile vessels, lymph
vessels, and blood vessels. The sensed light may distinguish the
type of blood vessel that resides in a given portion of tissue. The
types of blood vessels include arteries, arterioles, capillaries,
venules, and veins. The sensed light may also be used to identify
the condition of the tissue, such as whether the tissue is diseased
and/or damaged.
[0057] The surgical system 100 may determine the level of blood
circulation by sensing tissue parameters or properties that depend
on the level of blood circulation during a period exceeding one
cardiac cycle. In embodiments, the surgical system 100 may sample
tissue parameters or properties for multiple cardiac cycles to more
accurately determine the level of blood circulation. In other
embodiments, a cardiac signal, which is related to heart
contractions (e.g., an electrocardiographic signal), can be used to
evaluate the correlation between the parameters of the sensor
signal and the cardiac signal to more accurately assess the level
of blood circulation.
[0058] In an embodiment, the light source 150 may emit optical
light or radiate laser light. The light sensor 155 may be a charged
coupled device (CCD) or complementary metal-oxide semiconductor
(CMOS). The light sensor 155 may capture an image of the vessels
hidden in the tissue 190. The processor 160 may then analyze the
image and identify a location of the vessel. The processor 160 may
also utilize the sensed results from the sensor 140 together with
the image in identifying the location of the vessels.
[0059] In another embodiment, the light source 150 and the light
sensor 155 may be installed or incorporated into the instrument
130. For example, the instrument 130 may be a forceps, which has
two jaw members. The light source 150 may be installed on one of
the two jaw members and the light sensor 155 may be installed on
the other of the two jaw members, as described below with reference
to FIGS. 2-4 and 9. In yet another embodiment, the light source 150
and the light sensor 155 may both be installed or incorporated into
one of the two jaw members as described below with reference to
FIG. 5.
[0060] Continuing with reference to FIG. 1, when a patient is
placed on a surgical table for receiving a surgical operation, an
EM wave is generated by an EM wave generator 180. The processor 160
may control the EM wave generator 180 and perform intermittent
activation of the EM wave generator 180. The generated EM wave
surrounds the patient. An EM sensor 185, which is installed/fixed
on the instrument 130 a predetermined distance from its distal tip
or other point of reference, senses the strength of the EM wave at
the position of the instrument 130. Based on the strength of the EM
wave, the processor 160 is able to estimate a location of the
instrument 130 with respect to the EM coordinate system. The EM
sensor 185 may be installed on another element of the surgical
system 100 to monitor the spatial relationship within the surgical
system 100. The processor 160 may synchronize the EM coordinate
system with the coordinate system of the 3D model.
[0061] In embodiments, the EM sensor 185 may have a predetermined
spatial relationship with the light source 150 or the light sensor
155. When a location of the vessel is identified based on the
sensed results from the light sensor 155, the location of the
vessel may be also synchronized with the 3D model and a graphical
representation of the vessel may be displayed at the corresponding
location in the 3D model in an augmented way. Thus, when the 3D
model is moved or rotated, the graphical representation of the
vessel is correspondingly moved or rotated.
[0062] As an alternative or in addition to incorporating the
location of the vessel into the 3D model, a graphical
representation of the vessel may be displayed at the corresponding
location on a live video image of a surgical site, e.g., a video
image obtained from an endoscope and displayed on a surgical
display. The graphical representation may be overlaid or projected
onto the live video image in an augmented way. In embodiments where
video imaging is used, the location of the vessel may be
synchronized with the video image, e.g., tissue features, surgical
instrument(s), etc. within the video image, such that when the
video image is moved or rotated, the graphical representation of
the vessel is correspondingly moved or rotated.
[0063] After the instrument 130 seals the vessel, the light source
150 emits light to the grasped tissue between the jaw members and
the light sensor 155 senses the light, which is the light passing
through or reflected from the tissue 190. The processor 160
processes the sensed results from the light sensor 155. The vessel
identified after sealing is compared with the vessel identified
prior to sealing and/or with sealing parameters. In a case where
the dimensions, optical properties, etc. (absolute or relative to
the previously identified vessel) of the currently identified
vessel indicate that the currently identified vessel has been
sufficiently sealed, the processor 160 may confirm that the sealing
has been performed completely. Otherwise, the processor 160
determines that the sealing has not been performed completely and
informs the clinician to perform sealing again.
[0064] In embodiments, where the previously identified vessel is
sealed and cut along the seal such that the currently identified
vessel includes two sealed vessel portions, the processor 160 may
likewise confirm completeness of the sealing of the vessel
portions, e.g., based upon dimensions, optical properties, etc.
(absolute or relative to the previously identified vessel).
[0065] FIG. 2 shows a forceps 200 for vessel sealing according to
embodiments of the present disclosure. The forceps 200 includes a
housing 205, a handle assembly 210, a trigger assembly 220, a
rotatable assembly 230, and an end effector assembly 270. The end
effector assembly 270 may include any feature or combination of
features of jaw members. The components of the forceps 200 are
adapted to mutually cooperate to grasp, seal, divide and/or sense
tissue, e.g., tubular vessels and vascular tissue. In embodiments,
the trigger assembly 220 may be configured to actuate a cutting
function, e.g., a knife or electrical cutter, of the forceps 200 or
to actuate another component, as described below.
[0066] The end effector assembly 270, which is described in various
configurations in connection with FIGS. 3A-3B, 4, 5, and 9,
generally includes two jaw members 275 and 285 disposed in opposing
relation relative to one another. One or both of the jaw members
275 and 285 are movable from a first position wherein the jaw
members 275 and 285 are disposed in spaced relation relative to one
another to a second position wherein the jaw members 275 and 285
cooperate to grasp tissue therebetween.
[0067] The forceps 200 includes an elongated shaft 250 having a
distal portion 260 configured to mechanically engage the end
effector assembly 270. The proximal portion 255 of the shaft 250 is
received within the housing 205. The rotatable assembly 230 is
mechanically associated with the shaft 250 such that rotational
movement of rotatable assembly 230 imparts similar rotational
movements to the shaft 250 that, in turn, rotates the end effector
assembly 270.
[0068] The handle assembly 210 includes a fixed handle 225 and a
movable handle 215. In embodiments, the fixed handle 225 is
integrally associated with the housing 205, and the movable handle
215 is selectively movable relative to the fixed handle 225. The
movable handle 215 of the handle assembly 210 is ultimately
connected to a drive assembly (not shown). As can be appreciated,
applying force to move the movable handle 215 toward the fixed
handle 225 pulls a drive sleeve of the drive assembly proximally to
impart movement to the jaw members 275 and 285 from the first
position, wherein the jaw members 275 and 285 are disposed in
spaced relation relative to one another, to the second position,
where the jaw members 275 and 285 cooperate to grasp tissue located
therebetween.
[0069] In embodiments, the end effector assembly 270 may be
configured as a unilateral assembly that includes a stationary jaw
member mounted in fixed relation to the shaft 250 and a pivoting
jaw member movably mounted about a pin 265. The jaw members 275 and
285 may be curved at various angles to facilitate manipulation of
tissue and/or to provide enhanced line-of-sight for accessing
targeted tissues. Alternatively, the forceps 200 may include a
bilateral assembly, e.g., both jaw members 275 and 285 move
relative to one another and shaft 250.
[0070] The forceps 200 further includes first and second switch
assemblies 235 and 240 configured to selectively provide energy to
the end effector assembly 270. More particularly, the first switch
assembly 235 may be configured to perform a first type of surgical
procedure (e.g., seal, cut, and/or sense) and a second switch
assembly 240 may be configured to perform a second type of surgical
procedure (e.g., seal, cut, and/or sense). It should be noted that
the presently-disclosed embodiments may include any number of
suitable switch assemblies and are not limited to the switch
assemblies 235 and 240. It should further be noted that the
presently-disclosed embodiments may be configured to perform any
suitable surgical procedure and are not limited to only sealing,
cutting and sensing. Further, as noted above, cutting may be
performed by actuation of the trigger assembly 220, e.g., for
mechanical cutting, in addition to or as an alternative to second
switch assembly 240.
[0071] The forceps 200 may include a controller 245. In
embodiments, the controller 245 may be provided as a separate
component coupled to the forceps 200 or integrated within the
forceps 200. The controller 245 may include any type of computing
device, computational circuit, or any type of processor or
processing circuit capable of executing a series of instructions
that are stored in a memory. The controller 245 may be configured
to control one or more operating parameters associated with an
energy source (e.g., the power supply 110 or the energy output
stage 120 of FIG. 1) based on one or more signals indicative of
user input, such as generated by the first and second switch
assemblies 235 and 240 and/or one or more separate, user-actuatable
buttons or switches. Examples of switch configurations that may be
suitable for use with the forceps 200 include, but are not limited
to, pushbutton, toggle, rocker, tactile, snap, rotary, slide and
thumbwheel. In embodiments, the forceps 200 may be selectively used
in either a monopolar mode or a bipolar mode by engagement of the
appropriate switch.
[0072] The first and second switch assemblies 235 and 240 may also
cooperate with the controller 245, which may be configured to
automatically trigger one of the switches to change between a first
mode (e.g., sealing mode) and a second mode (e.g., cutting mode)
upon the detection of one or more parameters or thresholds. In
embodiments, the controller 245 is configured to receive feedback
information, including various sensor feedback with regard to
temperature of tissue, electrical impedance of tissue, jaw closure
pressure, jaw positioning, and/or other various feedback
information, e.g., using Raman spectroscopy, laser speckle imaging,
optical imaging, fluorescence spectroscopy, and/or laser-induced
tissue fluorescence, and to control the energy source based on the
feedback information.
[0073] Embodiments of the present disclosure allow the jaw members
275 and 285 to seal and/or cut tissue using light energy and/or RF
energy. In embodiments, the controller 245 may include a feedback
loop that indicates when a tissue seal is complete based upon one
or more of the following parameters: tissue temperature, light
sensing, change in impedance of the tissue over time and/or changes
in the optical or electrical power or current applied to the tissue
over time, rate of change of these properties and combinations
thereof. An audible or visual feedback monitor may be employed to
convey information to the surgeon regarding the overall seal
quality and/or the completion of an effective tissue seal.
[0074] In embodiments, the light source 150 and the light sensor
155 of FIG. 1 may be installed in or fixedly incorporated into one
or both of the jaw members 275 and 285 of FIG. 2. When the jaw
members 275 and 285 move from the open position to the close
position to grasp tissue, the light source 150 emits light or
radiates laser to the grasped tissue and the light sensor 155
detects the reflected or scattered light to identify a location of
the vessel in the tissue. Details of vessel identification will be
described with respect to FIGS. 3A-13 below.
[0075] In embodiments, the surgical system 100 may be a robotic
surgical system, which includes one or more robotic arms. The
forceps 200 may be incorporated into or fixedly installed at one
robotic arm with modifications as understood by one of ordinary
skilled in the art to adapt a handheld device to one for use with a
robotic surgical system.
[0076] FIGS. 3A and 3B illustrate an energy delivery device 300
including two jaw members 310 and 320, which grasp and compress
tissue 330, according to embodiments of the present disclosure. The
energy delivery device 300 may be the end effector assembly 270 of
FIG. 2. The jaw members 310 and 320 include electrodes 305 and 315
that are electrically coupled to the energy output stage 120 of
FIG. 1. The electrodes 305 and 315 receive energy from the energy
output stage 120 and apply it to the tissue 330 and vessels 335
within the tissue 330 to perform surgical operations onto the
tissue 330 and seal the vessels 335.
[0077] As described above, the energy delivery device 300 may be
also used in identifying a location of the vessels 335 based on
blood circulation in a given volume of tissue 330. To evaluate
blood circulation, the given volume of tissue 330 is first grasped
between the jaw members 310 and 320 of the energy delivery device
300. The pressure that is applied to the tissue 330 by the jaw
members 310 and 320 is selected to provide electrical contacts
between the electrodes 305 and 315 and the tissue 330. However, the
amount of pressure applied to the tissue 330 may be lower than the
amount of pressure used to compress the tissue 330 during tissue
sealing. Then, a probing signal 325 (e.g., an RF signal) is applied
to the tissue 330 by the electrodes 305 and 315 and a response
signal (e.g., tissue impedance) is measured during one or more
cardiac cycles.
[0078] During the cardiac cycles, the pressure of the blood flowing
in the blood vessels 335 varies and, as a result, the relative
amount of blood in a given volume of tissue 330 also varies. For
example, as shown in FIG. 3A, during a first portion of the cardiac
cycle, the pressure of the blood flowing within the blood vessels
335 is at a low level and the volume of blood within the given
volume of the tissue 330 is at a low level. On the other hand, as
shown in FIG. 3B, during a second portion of the cardiac cycle, the
pressure of the blood flowing within the blood vessels 335 is at a
high level and the volume of blood within the given volume of
tissue 330 is at a high level. The volume of blood within the given
volume of tissue 330 may be measured by measuring the impedance of
the tissue 330 based on the probing signal 325 to the tissue 330
and sensing the response signal.
[0079] During a cardiac cycle, as the volume of blood in a given
volume of tissue increases, a force is applied to the jaw members
310 and 320 to urge the jaw members 310 and 320 apart from one
another. In embodiments, the surgical system 100 includes a motion
sensor configured to sense the change in distance between the jaw
members 310 and 320. This distance information may be used together
with the response signal 104 to evaluate the level of blood
circulation within a given volume of tissue 330.
[0080] As described above, a probing signal 325 is applied to the
vessels 335 and the response signal is measured over time to
identify the tissue 330 and/or the vessels 335 or to determine
parameters of the tissue 330 and/or the vessels 335. The response
signal may include the frequency and amplitude of an electrical
impedance of the tissue 330. If the frequency of the electrical
impedance correlates to the frequency of cardiac contractions, then
the vessels 335 are identified as a blood vessel. If the vessels
335 are identified as a blood vessel, the amplitude of the
electrical impedance would indicate the level of blood
circulation.
[0081] In embodiments, existence of a blood vessel in the tissue
330 may be determined first based on the response signal from the
probing signal 325. In a case when it is determined that the blood
vessel exists in the tissue 330, the location of the blood vessel
may then be identified, as detailed above. Existence of a blood
vessel in the tissue 330 may be also determined by measuring a
change in distance or force between the two jaw members 310 and
320.
[0082] FIG. 4 shows a cross-sectional front view of the energy
delivery device 300 of FIGS. 3A and 3B. In this embodiment, jaw
members 310 and 320 grasp and deform the tissue 330 by compressing
the tissue 330, e.g., extending or stretching the tissue 330 along
the length-wise axis of the tissue 330, to intensify the release of
elastin and collagen. The upper jaw member 310 includes a cavity
410, in which a light sensor 420 may be positioned. The cavity 410
may be filled with a transparent material so that light can pass
through. The bottom portion of the upper jaw member 310 is shaped
to mate with the rounded upper portion of the lower jaw member 320,
although other configurations are also contemplated such as
generally planar jaw surfaces or other complementary jaw
configurations.
[0083] The lower jaw member 320 includes an optical light source
430 and an aperture 440. The optical light source 430 emits optical
light 450, which passes through the tissue 330 via the aperture
440. In an aspect, the lower jaw member 320 may also include a
light distribution element (not shown) so that the optical light
450 may be uniformly transmitted to the tissue 330.
[0084] In an aspect, the light distribution element may be disposed
in the lower jaw member 320 by a predetermined distance from the
tissue 330. The light distribution element may include optical
fibers, lenses, and/or prisms optically coupled to the light source
430 via a light guide. The optical fibers may contain a grating
structure to distribute the optical light 450 out of the side of
the optical fibers along a predetermined length of the optical
fibers.
[0085] As the jaw members 310 and 320 are brought together to
deform the tissue 330, the two sides of the upper jaw member 310
stretch or extend the tissue 330, which is to be illuminated by the
optical light 450 across the upper portion of the lower jaw member
320. Consequently, the different layers of tissue 330 (e.g., the
opposite walls of the vessel 335 of FIGS. 3A and 3B) are made
thinner and are brought into contact with each other.
[0086] The propagation direction and the wavelength of the optical
light 450 are selected to provide the desired tissue penetration
depth by the optical light 450. Since neither the light
distribution element nor the jaw members 310 and 320 have direct
physical contact with the sealed vascular tissue, the sealed
vascular tissue never adheres to any portion of the jaw members 310
and 320. In this manner, the jaw members 310 and 320 and the light
distribution element avoid contamination by the sealed tissue
330.
[0087] When the optical light 450 passes through the grasped tissue
330, the optical light 450 is scattered or dispersed, and the
dispersed or scattered light 460 may be sensed by the light sensor
420, which may be a charged coupled device (CCD) or complementary
metal-oxide semiconductor (CMOS). The light sensor 420 may capture
an image of the vessels hidden in the tissue 330. The processor 160
of FIG. 1 may then analyze the image and identify locations of the
vessels.
[0088] For example, as described above, the sensed results from the
sensor 140 of FIG. 1 may be used to determine whether or not one or
more blood vessels exist in the grasped tissue 330. When it is
determined that a blood vessel exists within the grasped tissue
330, the optical light source 430 emits the optical light 450 to
identify the location of the blood vessel(s) in the grasped tissue
330. The processor 160 may also utilize the sensed results from the
sensor 140 of FIG. 1 together with the captured image in
identifying the location of the vessels. Further, after sealing the
vessel, the light source 430 also emits the optical light 450 so as
to confirm whether or not the sealing has been completed.
[0089] FIG. 5 illustrates an energy delivery device 500 for
identifying a vessel(s) in tissue with a laser source according to
embodiments of the present disclosure. The energy delivery device
500 may be of the end effector assembly 270 of the forceps 200 of
FIG. 2. Instead of having a light sensor and a light source being
fixedly installed on different jaw members as in FIG. 4, a laser
source 530 and a light sensor 540 are both fixedly installed in one
of two jaw members 510 and 520. As illustrated, the laser source
530 and the light sensor 540 are installed in the lower jaw member
520 but can be in the upper jaw member 510. Alternatively, the
light sensor 540 and/or the laser source 530 may be installed in a
robotic arm. The laser source 530 irradiates a laser 560, e.g.,
having a single frequency, into the grasped tissue 535, and the
light sensor 540 detects scattered light 565, which has been
reflected and scattered from the tissue 535.
[0090] The light sensor 540 may be an image sensor such as CCD or
CMOS array and may output the sensed results, which may be laser
speckle data for processing into laser speckle contrast images
(LSCIs). The LSCI allows a clinician to see a quantitative mapping
of local blood flow dynamics in a wide area so that the clinician
can quickly and accurately assess the blood flows within the tissue
330. Thus, clinicians can see which part of the internal organs
have blood vessels supplying blood so that the clinicians may be
able to identify a location of blood vessels by looking at the
LSCIs in real-time.
[0091] FIG. 6 depicts a representation of raw laser speckle data
600 detected from the tissue using a laser, e.g., from laser source
530, which may have one frequency. The light reflected and
scattered from the tissue may have different phases and amplitudes,
which add together to give a pattern in which its amplitude and
intensity vary randomly. Generally, the raw laser speckle pattern
has a Gaussian distribution pattern of intensity. Thus, the raw
laser speckle data 600 is not readily readable by a clinician and
it would be exceedingly difficult to analyze the raw laser speckle
data 600 in real time and identify objects in the raw laser speckle
data 600. For example, a box 610 is located at a position in the
raw laser speckle data 600 where a blood vessel is located. As
shown, it is difficult to identify a blood vessel at the box 610 in
the raw laser speckle data 600.
[0092] When there is a moving object in the area irradiated by the
laser source 530, the intensity fluctuates according to the
movement of the object (e.g., circulating red blood cells) and thus
forms a pattern different from the Gaussian distribution pattern.
The laser speckle contrast imaging techniques uses the speckle
patterns that are fluctuated by the moving objects or the
interference of many waves having the same frequency. By analyzing
the intensity fluctuation of these laser speckle patterns together
with time, velocity of the moving object can be identified. As a
result, the raw laser speckle data 600 of FIG. 6 can be converted
to an LSCI of FIGS. 7 and 8 utilizing the following techniques to
render an image that is useful to clinicians in practice.
[0093] The statistics of noise-like raw laser speckle data 600 is
related to speckle contrast K containing a time component.
Specifically, the speckle contrast K includes three variables x, y,
and t, where x, y, and t represent horizontal, vertical, and
temporal position in the sampling space of the laser light. The
speckle contrast K(x, y, t) may be defined by a ratio of the
standard deviation .sigma. to the mean intensity I as follows:
K .function. ( x , y , t ) = .sigma. .function. ( x , y , t ) AVG
.function. ( I .function. ( x , y , t ) ) , ##EQU00001##
where .sigma.(x, y, t) is the standard deviation of intensity in
spatial and time domain, I(x, y, t) is the intensity values of a
set of pixels adjacent to position (x, y, t) in spatial and time
domain, and AVG(I(x,y,t)) is the mean or average intensity of the
set of pixels adjacent to the position (x,y,t). In embodiments, the
set of pixels may be defined by a time series of intensity of an
individual pixel, pixels in a rectangular window in the (x, y)
plane at time t, or a consecutive cubic in the (x, y, t) space.
[0094] The depth of modulation of the speckle intensity
fluctuations generally gives some indication of how much of the
laser light is being scattered from moving objects and how much
from stationary objects. Further, the frequency spectrum of the
fluctuations depends on velocity distribution of the movements of
the moving objects. It follows that the speckle contrast K is
related to velocity of moving objects or simply subsurface blood
flows here. The speckle contrast K is then expressed as the
following equation:
K = [ .tau. c 2 .times. T .times. ( 1 - e ( - 2 .times. T .tau. c )
) ] 1 2 , ##EQU00002##
where T is an integration time and .tau..sub.c is a correlation
time. Velocity V is a reciprocal of the correlation time
.tau..sub.c. Thus, the speckle contrast K becomes:
K = [ 1 2 .times. T .times. V .times. ( 1 - e - 2 .times. TV ) ] 1
2 . ##EQU00003##
According to this equation, when the velocity V increases, the
exponential term e.sup.-2TV is going to be closer to zero and the
speckle contrast K is going to increase to a value which is less
than
1 2 .times. TV . ##EQU00004##
Since the velocity V is assumed to be greater than or equal to
zero, the speckle contrast K is greater than or equal to zero, and
bound by
1 2 .times. TV . ##EQU00005##
Based on the equation of the speckle contrast K and the velocity,
the squared value of the speckle contrast K is inversely
proportional to the velocity V, when assuming that the exponential
term e.sup.-2TV is comparatively small. Or, in other words, the
value
1 K 2 ##EQU00006##
is linearly proportional to the velocity V.
[0095] The processor 160 of the surgical system 100 (FIG. 1)
normalizes the value
1 K 2 .function. ( x , y , t ) ##EQU00007##
and converts the normalized value into intensity of a pixel (x, y)
of the laser speckle contrast image. Since
1 K 2 .function. ( x , y , t ) ##EQU00008##
is inversely proportional to the velocity V, if
1 K 2 .function. ( x , y , t ) ##EQU00009##
is small, the velocity is also small and intensity of the pixel (x,
y) is low and, if
1 K 2 .function. ( x , y , t ) ##EQU00010##
is large, me velocity V is correspondingly large and the intensity
of the pixel (x, y) is high. Thus, a portion of a vessel where the
blood flows slowly is illustrated darker than a portion of a vessel
where the blood flows faster. However, the way of converting laser
speckle into intensity is not limited by the equation presented
above as the above is provided as an example. Any correlation
between the laser speckle and intensity can be made within the
scope of this disclosure by a person having ordinary skill in this
art.
[0096] Further, the intensities of pixels resulted from the LSCI
processes may be normalized, formatted for display, stored, and
passed to other processes such as noise reduction, pseudo color
rendering, or fusion with white light image, etc.
[0097] The optical image 700 of FIG. 7 may be generated by an
optical light sensor (e.g., the light sensor 420 of FIG. 4) prior
to vessel sealing and prior to clamping of the tissue. The location
710 of FIG. 7 corresponds to the location of the box 610 of FIG. 6.
The optical image 700 is readily usable by a clinician to see blood
vessels in the whole view of the image and to identify a location
of the vessel at the location 710, while the box 610 of the raw
laser speckle data 600 of FIG. 6 does not show legible vessels. The
optical image 700 may be overlaid on an image from other modalities
or displayed over another image in a manner of augmented reality
Based on the optical image 700, clinicians may seal the identified
vessel prior to or concurrently with a surgical operation. The
optical image 700 shows there are a blood vessel and probably a
blood flow at the location 710.
[0098] FIG. 8 shows an LSCI 800 after sealing the vessel. The
location 810 corresponds to the location of the box 610 of FIG. 6
and the location 710 of FIG. 7. As shown, there is no blood flow at
the location 810, meaning that the blood vessel at the location 810
has no blood flow and thus has been sealed completely. Thus, by
comparing an LSCI, which has been obtained prior to vessel sealing,
with the LSCI 800, which has been obtained after the vessel
sealing, the surgical system may be able to confirm that vessel
sealing has been completed.
[0099] In embodiments, identification of the locations of vessels
and confirmation of vessel sealing may be performed based on Raman
spectroscopy, which enables rapidly capturing the molecular
environment of tissues without destroying or altering the tissues.
FIG. 9 illustrates an energy delivery device 900 for identifying
vessel in tissue based on Raman shifts. The energy delivery device
900 includes first and second jaw members 910 and 920 configured to
grasp tissue 935. The second jaw member 920 includes a laser source
930 having at least one frequency and the first jaw member 910
includes a light sensor 970.
[0100] The laser source 930 irradiates a laser light 960 onto the
grasped tissue 935. The laser light 960 may include a laser having
a frequency of 375 nm and/or 405 nm. When the laser light 960
passes through the grasped tissue 935, it is scattered. The light
sensor 970 then detects or senses the scattered light 965. The
light sensor 970 may include a microscope 975, a spectroscope 980,
and a detector 985. The microscope 975 may be able to extract
information in a minute area less than or equal to 1 .mu.m with a
help of a filter. The spectroscope 980 may incorporate an
appropriate diffraction grating to obtain a corresponding spectral
resolution so that the detector 985 may be able to detect a Raman
shift.
[0101] Raman spectroscopy generates information-rich spectra that,
when combined with chemometrics, provide powerful insight into the
molecular diversity within tissue. For example, information
regarding amino acids (e.g., amide bonds between amino acids and
their tertiary structure) can be extracted and analyzed based on
the Raman spectroscopy.
[0102] When a laser light 960 is irradiated on tissue by the laser
source 930, photons are absorbed and scattered by the tissue 935.
The Raman effect arises when an energy incident to the tissue 935
is different from an energy scattered by the tissue 935. Different
constituents have different Raman effects. With this difference, a
photonic energy shift occurs in the scattered light 965. For
example, when the incident energy is larger than the scattered
energy, Stokes scatter occurs, and when the incident energy is
smaller than the scattered energy, anti-Stokes scatter occurs.
Since the energy shift is small, Raman shift is calculated by
subtracting a reciprocal of the wavelength scattered from a
reciprocal of the wavelength incident, namely:
.upsilon. = 1 .lamda. incident - 1 .lamda. s .times. c .times. a
.times. t .times. t .times. e .times. r .times. e .times. d ,
##EQU00011##
where .upsilon. is a Raman shift in wave number,
.lamda..sub.incident is a wavelength of the light incident to the
tissue, and .lamda..sub.scattered is a wavelength of the light
scattered by the tissue. Thus, the wave number of the Raman shift
has a unit of
1 distance ##EQU00012##
or cm.sup.-1.
[0103] For example, Raman bands corresponding to C--C stretch of
proline (855 cm.sup.-1), C--C stretch of hydroxyproline (874
cm.sup.-1), C--N stretch of proline (919 cm.sup.-1), proline (1043
cm.sup.-1), and Amide 3 (1245-1270 cm.sup.-1) are notable. The
hydroxyproline and two proline peaks are specifically Raman
collagen assignments confirming a collagen presence. Non-collagen
rich tissue indicative of biological tissue includes bands
corresponding to cholesterols (699 cm.sup.-1), phenlalanine (1003
cm.sup.-1), C--H deformation of proteins (1262 cm.sup.-1) and
carbohydrates (1342 cm.sup.-1), amide II (1480 cm.sup.-1), and
amide I (1663 cm.sup.-1).
[0104] For exemplary purposes only, spectra showing an abundance
value greater than 0.6 of a collagen rich end-member were selected
and the mean of these spectra was then calculated for each graph.
These means were then compared between healthy and sealed areas to
identify changes in the collagen environment due to sealing via a
difference spectrum. Sealed porcine blood vessel tissue, for
example, have shown changes in the 1252-1261 cm.sup.-1 peaks and a
shift to lower wave-numbers in the 1447 cm.sup.-1 peak. The
1600-1650 cm.sup.-1 Amide 1 band showed a shift to higher
wave-numbers. For bowel tissues, only the samples which were sealed
with no compression and at 0.2 mega pascal (MPa) compression were
used for comparison as these sample maps included more than 3
spectra which met the threshold requirements. The changes in the
collagen rich spectra between sealed and healthy areas were less
pronounced in the porcine bowel tissue samples when compared to
sealed blood vessels. In comparison to sealed blood vessels, bowel
tissue sealed at 0.2 MPa compression pressure demonstrated similar
trends in the protein band shifts, specifically in the three broad
protein bands, 1245-1270, 1445, and 1665 cm.sup.-1, corresponding
to the Amide 3, CH.sub.2 bending, and Amide 1 bands, respectively,
though less distinct. In bowel tissue sealed without compression,
band shift trends included the 1245 and 1665 cm.sup.-1 Amide 3 and
Amide 1 band, respectively; however, less dramatic shifts were seen
in other protein bands (FIGS. 10A-10C).
[0105] Referring to FIGS. 10A-10C, Raman spectra are shown of
healthy, RF-sealed collagen rich tissue areas from RF sealed
porcine blood vessel (FIG. 10A), RF-sealed porcine bowel tissue
without compression (FIG. 10B), and at 0.20 MPa compression
pressure (FIG. 10C). The 1313 cm.sup.-1, 1324 cm.sup.-1, 1252-1261
cm.sup.-1 and 1600-1690 cm.sup.-1 peaks are highlighted
corresponding to the CH.sub.3CH.sub.2 twisting and wagging mode of
collagen, respectively; Amide 3 and Amide 1 (nonreducible collagen
crosslinks at lower wavenumbers and reducible collagen crosslinks
at higher wavenumbers) respectively.
[0106] For thermal denaturing of collagen, the 1660 cm.sup.-1 band
is shifted to higher wave-numbers in the sealed tissue area,
thereby suggesting an increase in reducible crosslinks and a
decrease of non-reducible cross links within the collagen.
Additionally, a shift in the 1302 cm.sup.-1 peak to higher
wave-numbers has been identified in collagen thermal denaturing.
Changes in the 1313 cm.sup.-1 and 1324 cm.sup.-1 peaks signifying
changes in the CH.sub.3CH.sub.2 twisting and wagging modes of
collagen also demonstrated a disruption to the native collagen.
Lastly, the apparent shift of the 1252-1261 cm.sup.-1 peaks to
lower frequencies also implicate crosslinks may have been reduced
or broken. RF sealing of the porcine bowel tissue demonstrated less
pronounced differences; however, sealing performed at 0.2 MPa
compression pressure demonstrated many of the same changes,
including shifts in the 1252-1261, 1313, 1324, 1443, and 1660
cm.sup.-1 bands, seen in the sealed blood vessels, again indicating
a denaturing of collagen and, more specifically, a decrease in
non-reducible cross links and an increase in reducible cross links
as seen in FIG. 10C.
[0107] This molecular restructuring appears to be less collagen
dependent as shown in the Raman difference plots in FIG. 10B with
collagen difference spectrum highlighting fewer distinct band
shifts in compressed tissue versus non-compressed tissue. This may
be attributed to more collagen bond restructuring with the
additional mechanical pressure during sealing introduced with
tissue compression.
[0108] As described above, the blood vessel has its own
characteristics in frequency shifts (i.e., Raman shifts) based on
molecular bonds (e.g., CH.sub.2 bond, amino bond, etc.) and
structure (e.g., CH.sub.3CH.sub.2 twist and wagging mode of
collagen). When the blood vessel is sealed, its molecular bonds and
structure are changed, thereby changing characteristics of the
Raman shifts. Thus, based on frequency shifts in Raman
spectroscopy, blood vessels may be identified and sealing of the
blood vessels can be confirmed in vitro. Further, the Raman spectra
may identify strong or weak seal by conducting Raman spectroscopy
over the sealing area.
[0109] By finding a Raman shift, which is only identified in blood
vessels, the same can be identified and, by finding another Raman
shift, which can be found only in sealed vessels, sealing of the
vessels can be confirmed.
[0110] FIG. 11 shows a flowchart illustrating a method 1100 for
identifying blood vessels and confirming sealing of blood vessels
based on optical light. The method 1100 starts by providing to a
surgical system a 3D model of a patient in step 1105. The 3D model
may include a region of interest in the patient based on CT image
data or other image data in the DICOM format. In an embodiment, a
live video may be provided to show anatomical structures or the 3D
model may be generated from a live video. The surgical system may
include EM tracking sensors fixedly or slidably installed on an end
effector having two jaw members.
[0111] In step 1110, the end effector grasps tissue of interest
with two jaw members. One jaw member may include an optical light
source and the other jaw member may include a light sensor. In step
1115, the optical light source illuminates an optical light to the
tissue. When the optical light passes through the tissue, the light
is scattered and the light sensor receives the light, which has
passed through and been scattered by the grasped tissue in step
1120. The light sensor may be a CCD or CMOS and generate an image
based on the received light.
[0112] In step 1125, the received light is processed to identify
blood vessel(s). In an aspect, the generated image may be processed
to identify the blood vessel(s).
[0113] As described above, an EM tracking sensor is installed on
one of the two jaw members such that the location of the optical
light source or the light sensor may be estimated by the EM
tracking sensor. Further, in consideration of the estimated
location, the location of the identified blood vessel(s) may be
identified. In step 1130, the location of the identified blood
vessel(s) may be synchronized with the 3D model. In other words,
the location of the identified blood vessel in the real world is
mapped to the 3D model of the patient, so that the corresponding
location of the identified blood vessel in the 3D model can be
calculated.
[0114] In step 1135, the identified blood vessel(s) is displayed,
as a graphical representation, at the calculated location with
respect to the 3D model on a display. Thus, the clinicians
performing a surgical operation may be able to locate a surgical
device at a proper position based on the synchronized location of
the identified blood vessel(s) as displayed in the display.
[0115] After positioning the surgical device at the proper
location, surgical energy may be supplied to the tissue via the
surgical device to seal the identified blood vessel(s) in step
1340. In an aspect, the surgical energy may be RF, microwave, or
electromagnetic energy.
[0116] After sealing the tissue, proper sealing of the identified
vessel(s) can be confirmed. In this regard, the grasped tissue is
illuminated again by the optical light source in step 1145. Then,
the light sensor again receives the light, which has passed through
and been scattered by the grasped tissue in step 1150.
[0117] In step 1155, the received light is processed to identify
vessel(s), which corresponds to the identified vessel in step
1125.
[0118] In step 1160, it is determined whether or not the identified
vessel(s) has been sealed completely. As described above in step
1125, the received light may be used to generate an image. In this
regard, prior to sealing, a first image may be generated and, after
sealing, a second image may be generated. Based on image
processing, a vessel may be identified in the first and second
images. The identified vessel in the first image is then compared
with the corresponding vessel in the second image. In a case when
the dimensions, optical properties, etc. (absolute or relative to
the previously identified vessel) of the currently identified
vessel indicate that the currently identified vessel has been
sufficiently sealed, the sealing of the identified vessel is
confirmed.
[0119] Image processing is not limited to the above-described ways
but may be performed in other ways, which are readily appreciated
by a person having ordinary skill in the art, to confirm
completeness of sealing of the identified vessel.
[0120] When it is not confirmed that the identified vessel has been
completely sealed, the method 1100 goes to step 1140 to further
perform sealing of the identified vessel. When the sealing is
confirmed in step 1160, the method 1100 is ended.
[0121] FIG. 12 shows a flowchart illustrating a method for
identifying blood vessel(s) based on Raman shifts. The method 1200
starts by providing to a surgical system a 3D model of a patient in
step 1205. In an embodiment, a live video may be provided to show
anatomical structures or the 3D model may be generated from a live
video. The 3D model may include a region of interest in the patient
based on CT image data or other image data in the DICOM format. The
surgical system may include EM tracking sensors fixedly or slidably
installed on one of two jaw members of an end effector.
[0122] In step 1210, the end effector grasps tissue of interest
with the two jaw members. A laser source is installed on one of the
two jaw members and a light sensor is installed on the other one of
the two jaw members. In step 1215, the laser source irradiates a
laser light, which may include one or more frequencies, to the
grasped tissue. When the laser light is irradiated into the grasped
tissue, the laser light is scattered while passing through the
grasped tissue. The scattered laser light is detected by the light
sensor in step 1220.
[0123] The scattered laser light includes frequency shift data,
which is Raman shifts. When there is a difference between received
energy and emitting energy by the grasped tissue, such the
difference is expressed in frequency shifts. Further, when
molecular structure or composition is changed, the frequency shift
also changes. That is, the Raman shift, the received scattered
laser is processed to identify blood vessel(s) in step 1225. Since
the blood vessel(s) has a specific frequency shift different from
the other tissue elements, the blood vessel(s) can be identified by
combining areas where the specific frequency shift is detected.
[0124] As described above, an EM tracking sensor is installed
either one of the two jaw members. As described in step 1230 of
FIG. 12, the location of the identified blood vessel(s) may be
synchronized with the 3D model in step 1230.
[0125] In step 1235, the location of the identified blood vessel(s)
is displayed on a display with respect to the 3D model. Thus, the
clinicians performing a surgical operation may be able to locate a
surgical device at a proper position based on the synchronized
location of the identified blood vessel(s) as displayed in the
display.
[0126] After positioning the surgical device at the proper
location, surgical energy may be supplied to the tissue via the
surgical device to seal the identified blood vessel(s) in step
1240. In an aspect, the surgical energy may be RF, microwave, or
electromagnetic energy.
[0127] After sealing the tissue, it is necessary to confirm that
the identified vessel(s) has been sealed properly prior to or
concurrently with further treatment to the tissue. In this regard,
the laser source irradiates the laser light again onto the grasped
tissue in step 1245. Then, the light sensor again detects the
scattered light, which has passed through the grasped tissue and
has been scattered by the grasped tissue in step 1250.
[0128] In step 1255, the detected scattered laser is processed to
identify vessel(s), which corresponds to the identified vessel(s)
in step 1225.
[0129] In step 1260, it is determined whether or not the identified
vessel(s) has been sealed completely. As described above in step
1225, the detected laser may be processed to generate an image. In
this regard, prior to sealing, a first image may be generated and,
after sealing, a second image may be generated. Based on image
processing, a vessel may be identified in the first and second
images. The identified vessel in the first image is then compared
with the corresponding identified vessel in the second image. In a
case when the dimensions, optical properties, etc. (absolute or
relative to the previously identified vessel) of the currently
identified vessel indicate that the currently identified vessel has
been sufficiently sealed, the sealing of the identified vessel is
confirmed.
[0130] Image processing is not limited to the above-described ways
but may be performed in other ways, which are readily appreciated
by a person having ordinary skill in the art, to confirm
completeness of sealing of the identified vessel.
[0131] When it is not confirmed that the identified vessel has been
completely sealed, the method 1200 goes to step 1240 to further
perform sealing of the identified vessel. When the sealing is
confirmed in step 1260, the method 1200 is ended.
[0132] FIG. 13 shows a flowchart illustrating a method 1300 for
identifying blood vessel(s) and confirming sealing of blood
vessel(s) based on laser speckle data. The method 1300 starts by
providing to a surgical system a 3D model of a patient in step
1305. In an embodiment, a live video may be provided to show
anatomical structures or the 3D model may be generated from a live
video. The 3D model may include a region of interest in the patient
based on CT image data or other image data in the DICOM format. The
surgical system may include EM tracking sensors fixedly or slidably
installed on one of two jaw members of an end effector.
[0133] In step 1310, the end effector grasps tissue of interest
with the two jaw members. A laser source and a light sensor are
installed on only one of the two jaw members. In step 1315, the
laser source irradiates a laser light, which includes only one
frequency, to the grasped tissue. When the laser light is
irradiated into the grasped tissue, the laser light is scattered
and reflected off from the surface of the grasped tissue. The
scattered laser light is detected by the light sensor in step
1320.
[0134] The scattered laser light includes laser speckle data, which
includes intensity fluctuation data. When there is a moving object
in the area irradiated by the laser source, the intensity
fluctuates according to the movement of the moving object (e.g.,
circulating red blood cells) and thus forms a pattern different
from the Gaussian distribution pattern. By analyzing the intensity
fluctuation of these laser speckle patterns together with time,
velocity of the moving object can be identified. Based on the
velocity of the red blood cells, a blood vessel may be identified.
In this way, the laser speckle data is processed to identify blood
vessel(s) based on the laser speckle data or patterns in step
1325.
[0135] As described in step 1230 of FIG. 12, the location of the
identified blood vessel(s) may be synchronized with the 3D model in
step 1330.
[0136] As described above, an EM tracking sensor is installed the
one jaw member, where the laser light source and the light sensor
are installed. In step 1335, the location of the identified blood
vessel(s) is displayed on a display with respect to the 3D model.
Thus, the clinicians performing a surgical operation may be able to
locate a surgical device at a proper position based on the
synchronized location of the identified blood vessel as displayed
in the display.
[0137] After positioning the surgical device at the proper
location, surgical energy may be supplied to the tissue via the
surgical device to seal the identified blood vessel(s) in step
1340. In an aspect, the surgical energy may be RF, microwave, or
electromagnetic energy.
[0138] After sealing the tissue, it is confirmed that the
identified vessel has been sealed properly prior to or concurrently
with further treatment to the tissue. In this regard, the laser
source irradiates the laser light again onto the grasped tissue in
step 1345. Then, the light sensor again detects the light, as laser
speckle data, which is scattered and reflected off from the surface
of the grasped tissue in step 1350.
[0139] In step 1355, the received laser speckle data is processed
to identify vessel(s), which corresponds to the identified
vessel(s) in step 1325.
[0140] In step 1360, it is determined whether or not the identified
vessel(s) has been sealed completely. As described above in step
1325, the detected laser speckle data may be processed to generate
an image including intensity corresponding to movements of the red
blood cells. In this regard, prior to sealing, a first image may be
generated and, after sealing, a second image may be generated.
Based on image processing, a vessel may be identified in the first
and second images. The identified vessel in the first image is then
compared with the corresponding identified vessel in the second
image. In a case when the dimensions, optical properties, etc.
(absolute or relative to the previously identified vessel) of the
currently identified vessel indicate that the currently identified
vessel has been sufficiently sealed, the sealing of the identified
vessel is confirmed.
[0141] Image processing is not limited to the above-described ways
but may be performed in other ways, which are readily appreciated
by a person having ordinary skill in the art, to confirm
completeness of sealing of the identified vessel. For example,
ultrasound imaging modality may be used to detect a flow rate
before, during, and after the sealing and to confirm completion of
the sealing.
[0142] When it is not confirmed that the identified vessel has been
completely sealed, the method 1300 goes to step 1340 to further
perform sealing of the identified vessel. When sealing is confirmed
in step 1360, the method 1300 is ended.
[0143] FIG. 14 is a block diagram for a computing device 1400
representative of combination of the processor 160, the display
170, the user interface 165, and the memory 175 of FIG. 1 or the
controller 245 of FIG. 2 in accordance with embodiments of the
present disclosure. The computing device 1400 may include, by way
of non-limiting examples, server computers, desktop computers,
laptop computers, notebook computers, sub-notebook computers,
netbook computers, netpad computers, set-top computers, handheld
computers, Internet appliances, mobile smartphones, tablet
computers, personal digital assistants, video game consoles,
embedded computers, and autonomous vehicles. Those of skill in the
art will recognize that many smartphones are suitable for use in
the system described herein. Suitable tablet computers include
those with booklet, slate, and convertible configurations, known to
those of skill in the art.
[0144] In embodiments, the computing device 1400 includes an
operating system configured to perform executable instructions. The
operating system is, for example, software, including programs and
data, which manages the device's hardware and provides services for
execution of applications. Those of skill in the art will recognize
that suitable server operating systems include, by way of
non-limiting examples, FreeBSD, OpenBSD, NetBSD.RTM., Linux,
Apple.RTM. Mac OS X Server.RTM., Oracle.RTM. Solaris.RTM., Windows
Server.RTM., and Novell.RTM. NetWare.RTM.. Those of skill in the
art will recognize that suitable personal computer operating
systems include, by way of non-limiting examples, Microsoft.RTM.
Windows.RTM., Apple.RTM. Mac OS X.RTM., UNIX.RTM., and UNIX-like
operating systems such as GNU/Linux.RTM.. In embodiments, the
operating system is provided by cloud computing. Those of skill in
the art will also recognize that suitable mobile smart phone
operating systems include, by way of non-limiting examples,
Nokia.RTM. Symbian.RTM. OS, Apple.RTM. iOS.RTM., Research In
Motion.RTM. BlackBerry OS.RTM., Google.RTM. Android.RTM.,
Microsoft.RTM. Windows Phone.RTM. OS, Microsoft.RTM. Windows
Mobile.RTM. OS, Linux.RTM., and Palm.RTM. WebOS.RTM..
[0145] In embodiments, the computing device 1400 may include a
storage 1410. The storage 1410 is one or more physical apparatus
used to store data or programs on a temporary or permanent basis.
In embodiments, the storage 1410 may be volatile memory and
requires power to maintain stored information. In embodiments, the
storage 1410 may be non-volatile memory and retains stored
information when the computing device 1400 is not powered. In
embodiments, the non-volatile memory includes flash memory. In
embodiments, the non-volatile memory includes dynamic random-access
memory (DRAM). In embodiments, the non-volatile memory includes
ferroelectric random-access memory (FRAM). In embodiments, the
non-volatile memory includes phase-change random access memory
(PRAM). In embodiments, the storage 1410 includes, by way of
non-limiting examples, CD-ROMs, DVDs, flash memory devices,
magnetic disk drives, magnetic tapes drives, optical disk drives,
and cloud computing-based storage. In embodiments, the storage 1410
may be a combination of devices such as those disclosed herein.
[0146] The computing device 1400 further includes a processor 1430,
an extension 1440, a display 1450, an input device 1460, and a
network card 1470. The processor 1430 is a brain to the computing
device 1400. The processor 1430 executes instructions which
implement tasks or functions of programs. When a user executes a
program, the processor 1430 reads the program stored in the storage
1410, loads the program on the RAM, and executes instructions
prescribed by the program.
[0147] The processor 1430 may include a microprocessor, central
processing unit (CPU), application specific integrated circuit
(ASIC), arithmetic coprocessor, graphic processor, or image
processor, each of which is electronic circuitry within a computer
that carries out instructions of a computer program by performing
the basic arithmetic, logical, control and input/output (I/O)
operations specified by the instructions.
[0148] In embodiments, the extension 1440 may include several
ports, such as one or more universal serial buses (USBs), IEEE 1394
ports, parallel ports, and/or expansion slots such as peripheral
component interconnect (PCI) and PCI express (PCIe). The extension
1440 is not limited to the list but may include other slots or
ports that can be used for appropriate purposes. The extension 1440
may be used to install hardware or add additional functionalities
to a computer that may facilitate the purposes of the computer. For
example, a USB port can be used for adding additional storage to
the computer and/or an IEEE 1394 may be used for receiving
moving/still image data.
[0149] In embodiments, the display 1450 may be a cathode ray tube
(CRT), a liquid crystal display (LCD), or light emitting diode
(LED). In embodiments, the display 1450 may be a thin film
transistor liquid crystal display (TFT-LCD). In embodiments, the
display 1450 may be an organic light emitting diode (OLED) display.
In various embodiments, the OLED display is a passive-matrix OLED
(PMOLED) or active-matrix OLED (AMOLED) display. In embodiments,
the display 1450 may be a plasma display. In embodiments, the
display 1450 may be a video projector. In embodiments, the display
may be interactive (e.g., having a touch screen or a sensor such as
a camera, a 3D sensor, etc.) that can detect user
interactions/gestures/responses and the like.
[0150] In still embodiments, the display 1450 is a combination of
devices such as those disclosed herein.
[0151] A user may input and/or modify data via the input device
1460 that may include a keyboard, a mouse, or any other device with
which the use may input data. The display 1450 displays data on a
screen of the display 1450. The display 1450 may be a touch screen
so that the display 1450 can be used as an input device.
[0152] The network card 1470 is used to communicate with other
computing devices, wirelessly or via a wired connection. Through
the network card 1470, the computing device 1400 may receive,
modify, and/or update data from and to a managing server.
[0153] The embodiments disclosed herein are examples of the
disclosure and may be embodied in various forms. For instance,
although certain embodiments herein are described as separate
embodiments, each of the embodiments herein may be combined with
one or more of the other embodiments herein. Specific structural
and functional details disclosed herein are not to be interpreted
as limiting, but as a basis for the claims and as a representative
basis for teaching one skilled in the art to variously employ the
present disclosure in virtually any appropriately detailed
structure. Like reference numerals may refer to similar or
identical elements throughout the description of the figures.
[0154] Any of the herein described methods, programs, algorithms or
codes may be converted to, or expressed in, a programming language
or computer program. The terms "programming language" and "computer
program," as used herein, each include any language used to specify
instructions to a computer, and include (but is not limited to) the
following languages and their derivatives: Assembler, Basic, Batch
files, BCPL, C, C+, C++, C#, Delphi, Fortran, Java, JavaScript,
machine code, operating system command languages, Pascal, Perl,
PL1, scripting languages, Visual Basic, meta-languages which
themselves specify programs, and all first, second, third, fourth,
fifth, or further generation computer languages. Also included are
database and other data schemas, and any other meta-languages. No
distinction is made between languages which are interpreted,
compiled, or use both compiled and interpreted approaches. No
distinction is made between compiled and source versions of a
program. Thus, reference to a program, where the programming
language could exist in more than one state (such as source,
compiled, object, or linked) is a reference to any and all such
states. Reference to a program may encompass the actual
instructions and/or the intent of those instructions.
[0155] It should be understood that various aspects disclosed
herein may be combined in different combinations than the
combinations specifically presented in the description and
accompanying drawings. It should also be understood that, depending
on the example, certain acts or events of any of the processes or
methods described herein may be performed in a different sequence,
may be added, merged, or left out altogether (e.g., all described
acts or events may not be necessary to carry out the techniques).
In addition, while certain aspects of this disclosure are described
as being performed by a single module or unit for purposes of
clarity, it should be understood that the techniques of this
disclosure may be performed by a combination of units or modules
associated with, for example, a medical device.
* * * * *