CN111542886A - System for adjusting end effector parameters based on perioperative information - Google Patents

Abstract

A surgical system includes a surgical instrument, an end effector, a control circuit, and a sensor configured to transmit a sensor signal indicative of a closure parameter of the end effector. The control circuit is configured to adjust the closure rate of change parameter and the closure threshold parameter based on perioperative information received from the one or more data sources and sensor signals received from the sensor.

Description

Translated fromChinese

用于基于围术期信息调节端部执行器参数的系统System for adjusting end effector parameters based on perioperative information

相关申请的交叉引用CROSS-REFERENCE TO RELATED APPLICATIONS

本专利申请按照美国法典第35卷第119条(e)款的规定要求2018年6月28日提交的标题为“CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSED CLOSUREPARAMETERS”的美国临时专利申请序列号62/691,227的优先权权益，该临时专利申请的公开内容全文以引用方式并入本文。This patent application is filed pursuant to 35 U.S.C. § 119(e) under U.S. Provisional Patent Application Serial No. 62/691,227, filed June 28, 2018, entitled "CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSED CLOSUREPARAMETERS" Priority benefit, the disclosure of this provisional patent application is incorporated herein by reference in its entirety.

本申请按照美国法典第35卷第119条(e)款的规定要求2018年3月30日提交的标题为“SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES”的美国临时专利申请序列号62/650,887、2018年3月30日提交的标题为“SURGICAL SMOKE EVACUATION SENSINGAND CONTROLS”的美国临时专利申请序列号62/650,877、2018年3月30日提交的标题为“SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM”的美国临时专利申请序列号62/650,882和2018年3月30日提交的标题为“CAPACITIVE COUPLED RETURN PATHPAD WITH SEPARABLE ARRAY ELEMENTS”的美国临时专利申请序列号62/650,898的优先权权益，这些临时专利申请中的每个的公开内容全文以引用方式并入本文。This application is subject to U.S. Provisional Patent Application Serial No. 62/650,887, filed March 30, 2018, entitled "SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES," filed March 30, 2018, pursuant to 35 U.S.C. § 119(e) U.S. Provisional Patent Application Serial No. 62/650,877, filed March 30, entitled "SURGICAL SMOKE EVACUATION SENSINGAND CONTROLS," U.S. Provisional Patent Application Serial No. 62/650,877, filed March 30, 2018, entitled "SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM" Priority benefit of US Provisional Patent Application Serial No. 62/650,882, filed March 30, 2018, and entitled "CAPACITIVE COUPLED RETURN PATHPAD WITH SEPARABLE ARRAY ELEMENTS," the disclosure of each of these provisional patent applications The contents are incorporated herein by reference in their entirety.

本专利申请按照美国法典第35卷第119条(e)款的规定还要求2018年3月8日提交的标题为“TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEMTHEREFOR”的美国临时专利申请序列号62/640,417和2018年3月8日提交的标题为“ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR”的临时专利申请序列号62/640,415的优先权权益，这些临时专利申请中的每个的公开内容全文以引用方式并入本文。This patent application also claims U.S. Provisional Patent Application Serial No. 62/640,417, filed March 8, 2018, entitled "TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEMTHEREFOR," pursuant to 35 U.S.C. § 119(e) and the benefit of priority to provisional patent application Ser. No. 62/640,415, filed March 8, 2018, entitled "ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR," the disclosure of each of which is set forth in its entirety at Incorporated herein by reference.

本专利申请按照美国法典第35卷第119条(e)款的规定还要求2017年12月28日提交的标题为交互式外科平台(INTERACTIVE SURGICAL PLATFORM)的美国临时专利申请序列号62/611,341、2017年12月28日提交的标题为基于云的医学分析(CLOUD-BASED MEDICALANALYTICS)的美国临时专利申请序列号62/611,340和2017年12月28日提交的标题为机器人辅助的外科平台(ROBOT ASSISTED SURGICAL PLATFORM)的美国临时专利申请序列号62/611,339的优先权的权益，这些临时专利申请中的每个的公开内容全文以引用方式并入本文。This patent application also requires U.S. Provisional Patent Application Serial No. 62/611,341, filed December 28, 2017, entitled INTERACTIVE SURGICAL PLATFORM, U.S. Provisional Patent Application Serial No. 62/611,340, filed December 28, 2017, titled CLOUD-BASED MEDICALANALYTICS, and titled ROBOT ASSISTED, filed December 28, 2017 SURGICAL PLATFORM), the disclosure of each of which is incorporated herein by reference in its entirety.

背景技术Background technique

本公开涉及各种外科系统。The present disclosure relates to various surgical systems.

发明内容SUMMARY OF THE INVENTION

一种外科系统，该外科系统包括外科器械。该外科器械包括端部执行器，该端部执行器包括第一钳口和第二钳口。第一钳口被构造成能够相对于第二钳口运动。外科器械还包括马达，该马达被构造成能够根据闭合变化率参数和闭合阈值参数使第一钳口相对于第二钳口运动。外科器械还包括传感器，该传感器被配置成能够传输指示端部执行器的闭合参数的传感器信号。外科系统还包括通信地联接到传感器的控制电路。控制电路被配置成能够接收围术期信息，其中围术期信息包括围术期疾病、围术期治疗和外科手术的类型中的一者或多者。控制电路还被配置成能够从传感器接收传感器信号，并且基于围术期信息和传感器信号来确定对闭合变化率参数和闭合阈值参数的调节。A surgical system includes a surgical instrument. The surgical instrument includes an end effector including a first jaw and a second jaw. The first jaw is configured to be movable relative to the second jaw. The surgical instrument also includes a motor configured to move the first jaw relative to the second jaw according to the closure rate of change parameter and the closure threshold parameter. The surgical instrument also includes a sensor configured to transmit a sensor signal indicative of a closure parameter of the end effector. The surgical system also includes a control circuit communicatively coupled to the sensor. The control circuit is configured to receive perioperative information, wherein the perioperative information includes one or more of perioperative disease, perioperative treatment, and type of surgery. The control circuit is also configured to receive the sensor signal from the sensor and determine adjustments to the closure rate of change parameter and the closure threshold parameter based on the perioperative information and the sensor signal.

一种外科系统，该外科系统包括外科集线器，该外科集线器被配置成能够接收从云计算系统的远程数据库传输的围术期信息。外科集线器通信地联接到云计算系统。外科系统还包括通信地联接到外科集线器的外科器械。该外科器械包括端部执行器，该端部执行器包括第一钳口和第二钳口。第一钳口被构造成能够相对于第二钳口运动。端部执行器还包括马达，该马达被构造成能够根据从外科集线器接收的闭合控制程序的闭合变化率参数和闭合阈值参数使第一钳口相对于第二钳口运动。端部执行器还包括传感器，该传感器被配置成能够传输指示端部执行器的闭合参数的传感器信号。外科集线器还被配置成能够从传感器接收传感器信号，并且基于围术期信息和传感器信号来确定对闭合变化率参数和闭合阈值参数的调节。A surgical system includes a surgical hub configured to receive perioperative information transmitted from a remote database of a cloud computing system. The surgical hub is communicatively coupled to the cloud computing system. The surgical system also includes a surgical instrument communicatively coupled to the surgical hub. The surgical instrument includes an end effector including a first jaw and a second jaw. The first jaw is configured to be movable relative to the second jaw. The end effector also includes a motor configured to move the first jaw relative to the second jaw according to the closure rate of change parameter and the closure threshold parameter of the closure control program received from the surgical hub. The end effector also includes a sensor configured to transmit a sensor signal indicative of a closure parameter of the end effector. The surgical hub is also configured to receive sensor signals from the sensors and determine adjustments to the closure rate of change parameter and the closure threshold parameter based on the perioperative information and the sensor signals.

附图说明Description of drawings

各种方面的特征在所附权利要求书中进行了特别描述。然而，通过参考以下结合如下附图所作的说明可最好地理解所述多个方面(有关手术组织和方法)及其进一步的目的和优点。The various aspects are characterized with particularity in the appended claims. However, the various aspects (with respect to surgical tissue and methods) and their further objects and advantages are best understood by reference to the following description taken in conjunction with the following drawings.

图1为根据本公开的至少一个方面的计算机实现的交互式外科系统的框图。1 is a block diagram of a computer-implemented interactive surgical system in accordance with at least one aspect of the present disclosure.

图2为根据本公开的至少一个方面的用于在手术室中执行外科手术的外科系统。2 is a surgical system for performing a surgical procedure in an operating room in accordance with at least one aspect of the present disclosure.

图3为根据本公开的至少一个方面的与可视化系统、机器人系统和智能器械配对的外科集线器。3 is a surgical hub paired with a visualization system, a robotic system, and a smart instrument in accordance with at least one aspect of the present disclosure.

图4为根据本公开的至少一个方面的外科集线器壳体和可滑动地接纳在外科集线器壳体的抽屉中的组合发生器模块的局部透视图。4 is a partial perspective view of a surgical hub housing and a combined generator module slidably received in a drawer of the surgical hub housing in accordance with at least one aspect of the present disclosure.

图5为根据本公开的至少一个方面的具有双极、超声和单极触点以及排烟部件的组合发生器模块的透视图。5 is a perspective view of a combined generator module having bipolar, ultrasonic and monopolar contacts and a fume extraction component in accordance with at least one aspect of the present disclosure.

图6示出了根据本公开的至少一个方面的用于横向模块化外壳的多个横向对接端口的单个电力总线附接件，该横向模块化外壳被配置成能够可滑动地接纳多个模块。6 illustrates a single power bus attachment for multiple lateral docking ports of a lateral modular enclosure configured to slidably receive multiple modules in accordance with at least one aspect of the present disclosure.

图7示出了根据本公开的至少一个方面的被配置成能够可滑动地接纳多个模块的竖直模块化外壳。7 illustrates a vertical modular housing configured to slidably receive a plurality of modules in accordance with at least one aspect of the present disclosure.

图8示出了根据本公开的至少一个方面的包括模块化通信集线器的外科数据网络，该模块化通信集线器被配置成能够将位于医疗设施的一个或多个手术室中的模块化装置或专用于外科操作的医疗设施中的任何房间连接到云。8 illustrates a surgical data network including a modular communication hub configured to enable modular devices or dedicated Connect to the cloud from any room in a medical facility where surgical operations are performed.

图9为根据本公开的至少一个方面的计算机实现的交互式外科系统。9 is a computer-implemented interactive surgical system in accordance with at least one aspect of the present disclosure.

图10示出了根据本公开的至少一个方面的包括联接到模块化控制塔的多个模块的外科集线器。10 illustrates a surgical hub including a plurality of modules coupled to a modular control tower in accordance with at least one aspect of the present disclosure.

图11示出了根据本公开的至少一个方面的通用串行总线(USB)网络集线器装置的一个方面。11 illustrates an aspect of a Universal Serial Bus (USB) hub device in accordance with at least one aspect of the present disclosure.

图12示出了根据本公开的至少一个方面的外科器械或工具的控制系统的逻辑图。12 shows a logic diagram of a control system for a surgical instrument or tool in accordance with at least one aspect of the present disclosure.

图13示出了根据本公开的至少一个方面的被配置成能够控制外科器械或工具的各个方面的控制电路。13 illustrates a control circuit configured to control various aspects of a surgical instrument or tool in accordance with at least one aspect of the present disclosure.

图14示出了根据本公开的至少一个方面的被配置成能够控制外科器械或工具的各个方面的组合逻辑电路。14 illustrates a combinational logic circuit configured to control various aspects of a surgical instrument or tool in accordance with at least one aspect of the present disclosure.

图15示出了根据本公开的至少一个方面的被配置成能够控制外科器械或工具的各方面的时序逻辑电路。15 illustrates sequential logic circuitry configured to control various aspects of a surgical instrument or tool in accordance with at least one aspect of the present disclosure.

图16示出了根据本公开的至少一个方面的包括多个马达的外科器械或工具，多个马达可被激活以执行各种功能。16 illustrates a surgical instrument or tool that includes multiple motors that can be activated to perform various functions, according to at least one aspect of the present disclosure.

图17为根据本公开的至少一个方面的被配置成能够操作本文所述的外科工具的机器人外科器械的示意图。17 is a schematic illustration of a robotic surgical instrument configured to operate the surgical tools described herein in accordance with at least one aspect of the present disclosure.

图18示出了根据本公开的至少一个方面的被编程以控制位移构件的远侧平移的外科器械的框图。18 shows a block diagram of a surgical instrument programmed to control distal translation of a displacement member in accordance with at least one aspect of the present disclosure.

图19为根据本公开的至少一个方面的被配置成能够控制各个功能的外科器械的示意图。19 is a schematic illustration of a surgical instrument configured to control various functions in accordance with at least one aspect of the present disclosure.

图20为示出基于关节运动角度来修改夹持组件的行程长度的控制系统的示例的行程长度曲线图。20 is a stroke length graph illustrating an example of a control system that modifies the stroke length of the clamp assembly based on the articulation angle.

图21为示出基于关节运动角度来修改闭合管组件的纵向位置的控制系统的示例的闭合管组件定位曲线图；21 is a closed tube assembly positioning graph illustrating an example of a control system that modifies the longitudinal position of the closed tube assembly based on an articulation angle;

图22为利用受控组织压缩的缝合方法与未利用受控组织压缩的缝合方法的比较。Figure 22 is a comparison of a suturing method with controlled tissue compression and a suturing method without controlled tissue compression.

图23为在A部分中示出的力曲线图和在B部分中示出的相关的位移曲线图，其中力曲线图和位移曲线图具有限定时间的x轴，位移曲线图的y轴限定击发连杆的行进位移，并且力曲线图的y轴限定马达上感测到的扭力，该马达被构造成能够推进该击发连杆。23 is a force graph shown in Part A and the associated displacement graph shown in Part B, where the force graph and displacement graph have an x-axis defining time and a y-axis of the displacement graph defining firing The travel displacement of the rod, and the y-axis of the force graph defines the sensed torsional force on the motor configured to advance the firing rod.

图24为示出了在一对间隔开的接触板与组织接触时电路的完成的组织接触电路的示意图。24 is a schematic diagram of a completed tissue contact circuit showing the circuit as a pair of spaced-apart contact plates are in contact with tissue.

图25为根据本公开的至少一个方面的具有可操作地联接到其的可互换轴组件的外科器械的透视图。25 is a perspective view of a surgical instrument having an interchangeable shaft assembly operably coupled thereto in accordance with at least one aspect of the present disclosure.

图26为根据本公开的至少一个方面的图25的外科器械的一部分的分解组装图。26 is an exploded assembly view of a portion of the surgical instrument of FIG. 25 in accordance with at least one aspect of the present disclosure.

图27为根据本公开的至少一个方面的可互换轴组件的部分的分解组件视图。27 is an exploded assembly view of a portion of an interchangeable shaft assembly in accordance with at least one aspect of the present disclosure.

图28为根据本公开的至少一个方面的图25的外科器械的端部执行器的分解图。28 is an exploded view of the end effector of the surgical instrument of FIG. 25 in accordance with at least one aspect of the present disclosure.

图29A为根据本公开的至少一个方面的图25的跨越两个图页的外科器械的控制电路的框图。29A is a block diagram of a control circuit of the surgical instrument of FIG. 25 spanning two pages in accordance with at least one aspect of the present disclosure.

图29B为根据本公开的至少一个方面的图25的跨越两个图页的外科器械的控制电路的框图。29B is a block diagram of a control circuit of the surgical instrument of FIG. 25 spanning two pages in accordance with at least one aspect of the present disclosure.

图30为根据本公开的至少一个方面的图25的外科器械的控制电路的框图，其示出了柄部组件与功率组件之间、以及柄部组件与可互换轴组件之间的接口。30 is a block diagram of the control circuitry of the surgical instrument of FIG. 25 showing the interfaces between the handle assembly and the power assembly, and between the handle assembly and the interchangeable shaft assembly, in accordance with at least one aspect of the present disclosure.

图31描绘了可包括本公开的一个或多个方面的示例性医疗装置。31 depicts an exemplary medical device that may include one or more aspects of the present disclosure.

图32描绘了根据本公开的一个或多个方面的围绕组织的医疗装置的示例性端部执行器。32 depicts an exemplary end effector of a medical device surrounding tissue in accordance with one or more aspects of the present disclosure.

图33描绘了根据本公开的一个或多个方面的压缩组织的医疗装置的示例性端部执行器。33 depicts an exemplary end effector of a medical device compressing tissue in accordance with one or more aspects of the present disclosure.

图34描绘了根据本公开的一个或多个方面的由压缩组织的医疗装置的端部执行器施加的示例性力。34 depicts an exemplary force applied by an end effector of a medical device compressing tissue in accordance with one or more aspects of the present disclosure.

图35也描绘了根据本公开的一个或多个方面的由压缩组织的医疗装置的端部执行器施加的示例性力。35 also depicts an exemplary force applied by an end effector of a medical device compressing tissue in accordance with one or more aspects of the present disclosure.

图36描绘了根据本公开的一个或多个方面的示例性组织压缩传感器系统。36 depicts an exemplary tissue compression sensor system in accordance with one or more aspects of the present disclosure.

图37也描绘了根据本公开的一个或多个方面的示例性组织压缩传感器系统。37 also depicts an exemplary tissue compression sensor system in accordance with one or more aspects of the present disclosure.

图38也描绘了根据本公开的一个或多个方面的示例性组织压缩传感器系统。38 also depicts an exemplary tissue compression sensor system in accordance with one or more aspects of the present disclosure.

图39也为根据本公开的一个或多个方面的示例性电路图。39 is also an exemplary circuit diagram in accordance with one or more aspects of the present disclosure.

图40也为根据本公开的一个或多个方面的示例性电路图。40 is also an exemplary circuit diagram in accordance with one or more aspects of the present disclosure.

图41为描绘了根据本公开的一个或多个方面的示例性频率调制的曲线图。41 is a graph depicting exemplary frequency modulation in accordance with one or more aspects of the present disclosure.

图42为描绘了根据本公开的一个或多个方面的复合RF信号的曲线图。42 is a graph depicting a composite RF signal in accordance with one or more aspects of the present disclosure.

图43为描绘了根据本公开的一个或多个方面的滤波RF信号的曲线图。43 is a graph depicting a filtered RF signal in accordance with one or more aspects of the present disclosure.

图44为具有能够进行关节运动的可互换的轴的外科器械的透视图。44 is a perspective view of a surgical instrument with interchangeable articulating shafts.

图45为外科器械的末端的侧视图。Figure 45 is a side view of the tip of the surgical instrument.

图46至图50为绘制随时间变化的间隙尺寸(图46)、随时间变化的击发电流(图47)、随时间变化的组织压缩(图48)、随时间变化的砧座应变(图49)以及随时间变化的触发力(图50)的曲线图。Figures 46-50 are plots of gap size versus time (FIG. 46), firing current versus time (FIG. 47), tissue compression versus time (FIG. 48), anvil strain versus time (FIG. 49) ) and a graph of triggering force over time (Figure 50).

图51为针对正常组织绘制组织压缩随着组织位移变化的曲线图。Figure 51 is a graph plotting tissue compression as a function of tissue displacement for normal tissue.

图52为绘制组织压缩随着组织位移变化以区分正常组织和患病组织的曲线图。Figure 52 is a graph plotting tissue compression as a function of tissue displacement to differentiate between normal and diseased tissue.

图53示出了包括第一传感器和第二传感器的端部执行器的一个实施方案。Figure 53 shows one embodiment of an end effector including a first sensor and a second sensor.

图54为示出了用于基于来自图53中所示的端部执行器的第二传感器的输入来调节第一传感器的测量结果的过程的一个实施方案的逻辑图。54 is a logic diagram illustrating one embodiment of a process for adjusting measurements of a first sensor based on input from a second sensor of the end effector shown in FIG. 53 .

图55为示出了用于基于来自第二传感器的输入来确定第一传感器的查找表的过程的一个实施方案的逻辑图。55 is a logic diagram illustrating one embodiment of a process for determining a look-up table for a first sensor based on input from a second sensor.

图56为示出了用于响应于来自第二传感器的输入来校正第一传感器的过程的一个实施方案的逻辑图。56 is a logic diagram illustrating one embodiment of a process for calibrating a first sensor in response to input from a second sensor.

图57为示出了用于确定并且显示夹持在端部执行器的砧座和钉仓之间的组织区段的厚度的过程的一个实施方案的逻辑图。57 is a logic diagram illustrating one embodiment of a process for determining and displaying the thickness of a tissue segment clamped between an anvil and a staple cartridge of an end effector.

图58为示出了用于确定并且显示夹持在端部执行器的砧座和钉仓之间的组织区段的厚度的过程的一个实施方案的逻辑图。58 is a logic diagram illustrating one embodiment of a process for determining and displaying the thickness of a tissue segment clamped between an anvil and a staple cartridge of an end effector.

图59为示出与未修改的霍尔效应厚度测量结果进行比较的调节的霍尔效应厚度测量结果的曲线图。59 is a graph showing adjusted Hall effect thickness measurements compared to unmodified Hall effect thickness measurements.

图60示出了包括第一传感器和第二传感器的端部执行器的一个实施方案。Figure 60 shows one embodiment of an end effector including a first sensor and a second sensor.

图61示出了包括第一传感器和多个第二传感器的端部执行器的一个实施方案。Figure 61 shows one embodiment of an end effector including a first sensor and a plurality of second sensors.

图62为示出了用于响应于多个第二传感器来调节第一传感器的测量结果的过程的一个实施方案的逻辑图。62 is a logic diagram illustrating one embodiment of a process for adjusting measurements of a first sensor in response to a plurality of second sensors.

图63示出了被配置成能够将来自第一传感器和多个第二传感器的信号转换成能够由处理器接收的数字信号的电路的一个实施方案。63 illustrates one embodiment of a circuit configured to convert signals from a first sensor and a plurality of second sensors into digital signals that can be received by a processor.

图64示出了包括多个传感器的端部执行器的一个实施方案。Figure 64 shows one embodiment of an end effector that includes multiple sensors.

图65为示出了用于基于多个传感器来确定一个或多个组织特性的过程的一个实施方案的逻辑图。65 is a logic diagram illustrating one embodiment of a process for determining one or more tissue properties based on a plurality of sensors.

图66示出了包括联接到第二钳口构件的多个传感器的端部执行器的一个实施方案。Figure 66 shows one embodiment of an end effector including a plurality of sensors coupled to the second jaw member.

图67示出了包括一体地形成于其中的多个传感器的钉仓的一个实施方案。67 illustrates one embodiment of a staple cartridge including a plurality of sensors integrally formed therein.

图68为示出了用于确定夹持在端部执行器内的组织区段的一个或多个参数的过程的一个实施方案的逻辑图。68 is a logic diagram illustrating one embodiment of a process for determining one or more parameters of a tissue segment clamped within an end effector.

图69示出了包括多个冗余传感器的端部执行器的一个实施方案。Figure 69 shows one embodiment of an end effector that includes multiple redundant sensors.

图70为示出了用于选择来自多个冗余传感器的最可靠输出的过程的一个实施方案的逻辑图。70 is a logic diagram illustrating one embodiment of a process for selecting the most reliable output from multiple redundant sensors.

图71示出了包括传感器的端部执行器的一个实施方案，该传感器包括特定采样率以限制或消除假信号。Figure 71 shows one embodiment of an end effector that includes a sensor that includes a specific sampling rate to limit or eliminate glitches.

图72为示出了用于产生定位在端部执行器的砧座和钉仓之间的组织区段的厚度测量结果的过程的一个实施方案的逻辑图。72 is a logic diagram illustrating one embodiment of a process for generating thickness measurements of a tissue segment positioned between an anvil and a staple cartridge of an end effector.

图73和图74示出了包括用于识别不同类型的钉仓的传感器的端部执行器的一个实施方案。73 and 74 illustrate one embodiment of an end effector that includes sensors for identifying different types of staple cartridges.

图75示出了根据本公开的至少一个方面的被配置成能够固定地附接到端部执行器的钳口构件的分段柔性电路的一个方面。75 illustrates one aspect of a segmented flex circuit configured to be fixedly attachable to a jaw member of an end effector in accordance with at least one aspect of the present disclosure.

图76示出了根据本公开的至少一个方面的被配置成能够安装到端部执行器的钳口构件的分段柔性电路的一个方面。76 illustrates one aspect of a segmented flex circuit configured to be mountable to a jaw member of an end effector in accordance with at least one aspect of the present disclosure.

图77示出了根据本公开的至少一个方面的被构造成能够测量组织间隙GT的端部执行器的一个方面。77 illustrates an aspect of an end effector configured to measure tissue gap GT in accordance with at least one aspect of the present disclosure.

图78示出了根据本公开的至少一个方面的包括分段柔性电路的端部执行器的一个方面。78 illustrates an aspect of an end effector including a segmented flex circuit in accordance with at least one aspect of the present disclosure.

图79示出了根据本公开的至少一个方面的图78中示出的端部执行器，其中钳口构件将组织夹持在钳口构件和钉仓之间。79 illustrates the end effector shown in FIG. 78 with the jaw members clamping tissue between the jaw members and the staple cartridge, according to at least one aspect of the present disclosure.

图80为根据本公开的至少一个方面的外科器械的绝对定位系统的图，其中绝对定位系统包括受控马达驱动电路布置，该受控马达驱动电路布置包括传感器布置。80 is a diagram of an absolute positioning system for a surgical instrument according to at least one aspect of the present disclosure, wherein the absolute positioning system includes a controlled motor drive circuit arrangement including a sensor arrangement.

图81为根据本公开的至少一个方面的位置传感器的图，该位置传感器包括磁性旋转绝对定位系统。81 is a diagram of a position sensor including a magnetic rotary absolute positioning system in accordance with at least one aspect of the present disclosure.

图82为根据本公开的至少一个方面的外科器械的端部执行器的剖视图，其示出了相对于抓持在端部执行器内的组织的击发构件行程。82 is a cross-sectional view of an end effector of a surgical instrument showing stroke of the firing member relative to tissue grasped within the end effector, according to at least one aspect of the present disclosure.

图83为两个闭合力(FTC)曲线的第一曲线图(其描绘了在闭合阶段期间施加到闭合构件以在厚和薄组织上闭合的力)以及两个击发力(FTF)曲线的第二曲线图(其描绘了在击发阶段期间施加到击发构件以通过厚和薄组织进行击发的力)。Figure 83 is a graph of the first of two force-to-close (FTC) curves depicting the force applied to the closure member to close on thick and thin tissue during the closure phase, and of the two force-to-fire (FTF) curves A second graph (which depicts the force applied to the firing member to fire through thick and thin tissue during the firing phase).

图84为根据本公开的至少一个方面的控制系统的图，该控制系统被配置成能够在击发构件朝远侧推进并且联接到夹持臂时在击发行程期间提供闭合构件的逐渐闭合，以便以期望的速率降低闭合构件上的闭合力负载并减小击发构件上的击发力负载。84 is a diagram of a control system configured to provide gradual closing of the closure member during the firing stroke as the firing member is advanced distally and coupled to the clamp arm to provide a The desired rate reduces the closing force load on the closing member and reduces the firing force load on the firing member.

图85示出了根据本公开的至少一个方面的比例积分微分(PID)控制器反馈控制系统。85 illustrates a proportional-integral-derivative (PID) controller feedback control system in accordance with at least one aspect of the present disclosure.

图86为根据本公开的至少一个方面的描绘用于确定闭合构件的速度的控制程序或逻辑配置的过程的逻辑流程图。86 is a logic flow diagram of a process depicting a control program or logic configuration for determining the velocity of a closure member in accordance with at least one aspect of the present disclosure.

图87为根据本公开的至少一个方面的描绘外科集线器的态势感知的时间线。87 is a timeline depicting situational awareness of a surgical hub in accordance with at least one aspect of the present disclosure.

图88示出了根据本公开的至少一个方面的被配置成能够控制外科功能的外科系统的框图。88 shows a block diagram of a surgical system configured to control surgical functions in accordance with at least one aspect of the present disclosure.

图89示出了根据本公开的至少一个方面的被配置成能够控制外科功能的态势感知的外科系统的框图。89 shows a block diagram of a surgical system configured to be able to control situational awareness of surgical functions in accordance with at least one aspect of the present disclosure.

图90为根据本公开的至少一个方面的描绘用于控制外科功能的基于态势感知的算法的逻辑流程图。90 is a logic flow diagram depicting a situational awareness-based algorithm for controlling surgical functions in accordance with at least one aspect of the present disclosure.

图91为根据本公开的至少一个方面的描绘用于控制外科功能的算法的逻辑流程图。91 is a logic flow diagram depicting an algorithm for controlling surgical functions in accordance with at least one aspect of the present disclosure.

图92示出了根据本公开的至少一个方面的包括肿瘤以及相对于肿瘤限定的外科边缘的患者组织的一部分。92 illustrates a portion of patient tissue including a tumor and a surgical margin defined relative to the tumor in accordance with at least one aspect of the present disclosure.

图93为根据本公开的至少一个方面的描绘用于解决装置选择问题的控制程序或逻辑配置的过程的逻辑流程图。93 is a logic flow diagram of a process depicting a control program or logic configuration for addressing a device selection problem in accordance with at least one aspect of the present disclosure.

图94示出了根据本公开的至少一个方面的被配置成能够基于装置参数和感测到的参数来确定外科器械的适当性的外科系统的框图。94 illustrates a block diagram of a surgical system configured to be able to determine the appropriateness of a surgical instrument based on device parameters and sensed parameters in accordance with at least one aspect of the present disclosure.

图95示出了根据本公开的至少一个方面的外科器械的框图。95 shows a block diagram of a surgical instrument in accordance with at least one aspect of the present disclosure.

图96示出了根据本公开的至少一个方面的用于根据被夹持组织的完整性来控制外科器械的过程的逻辑流程图。96 illustrates a logic flow diagram of a process for controlling a surgical instrument based on the integrity of clamped tissue in accordance with at least one aspect of the present disclosure.

图97示出了根据本公开的至少一个方面的描绘了针对外科器械的示例性击发的端部执行器用于闭合的力随时间变化的第一曲线图。97 shows a first graph depicting force for closure of an exemplary fired end effector for a surgical instrument versus time in accordance with at least one aspect of the present disclosure.

图98示出了根据本公开的至少一个方面的描绘了针对外科器械的示例性击发的端部执行器用于闭合的力随时间变化的第二曲线图。98 shows a second graph depicting force for closure of an exemplary fired end effector for a surgical instrument as a function of time in accordance with at least one aspect of the present disclosure.

图99示出了根据本公开的至少一个方面的用于根据被夹持组织的生理类型来控制外科器械的过程的逻辑流程图。99 illustrates a logic flow diagram of a process for controlling a surgical instrument based on the physiological type of tissue being clamped, in accordance with at least one aspect of the present disclosure.

图100A示出了根据本公开的至少一个方面的端部执行器抓持实质的侧正视图，其中端部执行器处于与实质的初始接触位置。100A illustrates a side elevational view of an end effector grasping a substance with the end effector in an initial contact position with the substance in accordance with at least one aspect of the present disclosure.

图100B示出了根据本公开的至少一个方面的端部执行器抓持实质的侧正视图，其中端部执行器处于闭合状态。100B illustrates a side elevational view of an end effector grasping substance with the end effector in a closed state in accordance with at least one aspect of the present disclosure.

图101A示出了根据本公开的至少一个方面的端部执行器抓持脉管的侧正视图，其中端部执行器处于与脉管的初始接触位置。101A illustrates a side elevational view of an end effector grasping a vessel with the end effector in an initial contact position with the vessel in accordance with at least one aspect of the present disclosure.

图101B示出了根据本公开的至少一个方面的端部执行器抓持脉管的侧正视图，其中端部执行器处于闭合状态。101B illustrates a side elevation view of an end effector grasping a vessel with the end effector in a closed state in accordance with at least one aspect of the present disclosure.

图102示出了根据本公开的至少一个方面的分别描绘了针对抓持实质的外科器械的示例性击发的端部执行器用于闭合的力和闭合速度随时间变化的第一曲线图和第二曲线图。102 illustrates first and second graphs, respectively, depicting force and closing velocity versus time for an exemplary fired end effector for grasping a substantial surgical instrument for closure, respectively, in accordance with at least one aspect of the present disclosure. Graph.

图103示出了根据本公开的至少一个方面的分别描绘了针对抓持脉管的外科器械的示例性击发的端部执行器用于闭合的力和闭合速度随时间变化的第三曲线图和第四曲线图。103 illustrates a third graph and a first graph respectively depicting force and closing velocity versus time for an exemplary fired end effector for closure of a surgical instrument grasping a vessel in accordance with at least one aspect of the present disclosure. Four graphs.

图104示出了根据本公开的至少一个方面的描绘了针对外科器械的示例性击发的端部执行器用于闭合的力和闭合速度随时间变化的第五曲线图。104 shows a fifth graph depicting force and closing velocity for closure of an exemplary fired end effector for a surgical instrument as a function of time in accordance with at least one aspect of the present disclosure.

图105示出了根据本公开的至少一个方面的描绘了针对外科器械的示例性击发的端部执行器用于闭合的力和闭合速度随时间变化的第五曲线图。105 shows a fifth graph depicting force and closing velocity for closure of an exemplary fired end effector for a surgical instrument as a function of time in accordance with at least one aspect of the present disclosure.

图106示出了根据本公开的至少一个方面的描绘了针对外科器械的示例性击发的端部执行器用于闭合的力和闭合速度随时间变化的第五曲线图。106 shows a fifth graph depicting force and closing velocity for closure of an exemplary fired end effector for a surgical instrument as a function of time in accordance with at least one aspect of the present disclosure.

图107示出了根据本公开的至少一个方面的描绘了阻抗随时间变化的曲线图，以确定外科器械的钳口何时接触组织和/或钉。107 shows a graph depicting impedance versus time to determine when jaws of a surgical instrument contact tissue and/or staples in accordance with at least one aspect of the present disclosure.

图108示出了根据本公开的至少一个方面的描绘了用于控制端部执行器闭合的各种组织闭合阈值的第一曲线图。108 shows a first graph depicting various tissue closure thresholds for controlling end effector closure in accordance with at least one aspect of the present disclosure.

图109示出了根据本公开的至少一个方面的描绘了用于控制端部执行器闭合的各种组织闭合阈值的第二曲线图。109 shows a second graph depicting various tissue closure thresholds for controlling end effector closure in accordance with at least one aspect of the present disclosure.

图110为根据本公开的至少一个方面的描绘用于调节闭合速率算法的控制程序或逻辑配置的过程的逻辑流程图。110 is a logic flow diagram depicting a process for adjusting a control program or logic configuration of a closing rate algorithm in accordance with at least one aspect of the present disclosure.

具体实施方式Detailed ways

本专利申请的申请人拥有于2018年6月29日提交的以下美国专利申请，这些专利申请中的每个的公开内容以引用方式全文并入本文：The applicant of this patent application has the following US patent applications filed on June 29, 2018, the disclosures of each of which are incorporated herein by reference in their entirety:

·标题为“CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAYELEMENTS”的美国专利申请序列号__________，代理人案卷号为END8542USNP/170755；·U.S. Patent Application Serial No. __________ entitled "CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAYELEMENTS", Attorney's Docket No. END8542USNP/170755;

·标题为“CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSEDCLOSURE PARAMETERS”的美国专利申请序列号__________，代理人案卷号为END8543USNP/170760；·U.S. patent application serial number __________ titled "CONTROLLING A SURGICAL INSTRUMENT ACCORDING TO SENSEDCLOSURE PARAMETERS", attorney docket number END8543USNP/170760;

·标题为“SYSTEMS FOR ADJUSTING END EFFECTOR PARAMETERS BASED ONPERIOPERATIVE INFORMATION”的美国专利申请序列号__________，代理人案卷号为END8543USNP1/170760-1；·U.S. patent application serial number __________ titled "SYSTEMS FOR ADJUSTING END EFFECTOR PARAMETERS BASED ONPERIOPERATIVE INFORMATION", attorney docket number END8543USNP1/170760-1;

·标题为“SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING”的美国专利申请序列号__________，代理人案卷号为END8543USNP2/170760-2；·U.S. patent application serial number __________ titled "SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING", attorney docket number END8543USNP2/170760-2;

·标题为“SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING”的美国专利申请序列号__________，代理人案卷号为END8543USNP3/170760-3；·U.S. patent application serial number __________ titled "SAFETY SYSTEMS FOR SMART POWERED SURGICAL STAPLING", attorney docket number END8543USNP3/170760-3;

·标题为“SURGICAL SYSTEMS FOR DETECTING END EFFECTOR TISSUEDISTRIBUTION IRREGULARITIES”的美国专利申请序列号__________，代理人案卷号为END8543USNP4/170760-4；·U.S. patent application serial number __________ titled "SURGICAL SYSTEMS FOR DETECTING END EFFECTOR TISSUEDISTRIBUTION IRREGULARITIES", attorney docket number END8543USNP4/170760-4;

·标题为“SYSTEMS FOR DETECTING PROXIMITY OF SURGICAL END EFFECTOR TOCANCEROUS TISSUE”的美国专利申请序列号__________，代理人案卷号为END8543USNP5/170760-5；·U.S. patent application serial number __________ titled "SYSTEMS FOR DETECTING PROXIMITY OF SURGICAL END EFFECTOR TOCANCEROUS TISSUE", attorney docket number END8543USNP5/170760-5;

·标题为“SURGICAL INSTRUMENT CARTRIDGE SENSOR ASSEMBLIES”的美国专利申请序列号__________，代理人案卷号为END8543USNP6/170760-6；·U.S. patent application serial number __________ titled "SURGICAL INSTRUMENT CARTRIDGE SENSOR ASSEMBLIES", attorney docket number END8543USNP6/170760-6;

·标题为“VARIABLE OUTPUT CARTRIDGE SENSOR ASSEMBLY”的美国专利申请序列号__________，代理人案卷号为END8543USNP7/170760-7；U.S. Patent Application Serial No. __________ titled "VARIABLE OUTPUT CARTRIDGE SENSOR ASSEMBLY", Attorney Docket No. END8543USNP7/170760-7;

·标题为“SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE”的美国专利申请序列号__________，代理人案卷号为END8544USNP/170761；·U.S. Patent Application Serial No. __________ entitled "SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE", Attorney Docket No. END8544USNP/170761;

·标题为“SURGICAL INSTRUMENT HAVING A FLEXIBLE CIRCUIT”的美国专利申请序列号__________，代理人案卷号为END8544USNP1/170761-1；·US Patent Application Serial No. __________ entitled "SURGICAL INSTRUMENT HAVING A FLEXIBLE CIRCUIT", Attorney's Docket No. END8544USNP1/170761-1;

·标题为“SURGICAL INSTRUMENT WITH A TISSUE MARKING ASSEMBLY”的美国专利申请序列号__________，代理人案卷号为END8544USNP2/170761-2；·U.S. patent application serial number __________ titled "SURGICAL INSTRUMENT WITH A TISSUE MARKING ASSEMBLY", attorney docket number END8544USNP2/170761-2;

·标题为“SURGICAL SYSTEMS WITH PRIORITIZED DATA TRANSMISSIONCAPABILITIES”的美国专利申请序列号__________，代理人案卷号为END8544USNP3/170761-3；·U.S. patent application serial number __________ entitled "SURGICAL SYSTEMS WITH PRIORITIZED DATA TRANSMISSIONCAPABILITIES", attorney docket number END8544USNP3/170761-3;

·标题为“SURGICAL EVACUATION SENSING AND MOTOR CONTROL”的美国专利申请序列号__________，代理人案卷号为END8545USNP/170762；·U.S. patent application serial number __________ titled "SURGICAL EVACUATION SENSING AND MOTOR CONTROL", attorney docket number END8545USNP/170762;

·标题为“SURGICAL EVACUATION SENSOR ARRANGEMENTS”的美国专利申请序列号__________，代理人案卷号为END8545USNP1/170762-1；·U.S. Patent Application Serial No. __________ entitled "SURGICAL EVACUATION SENSOR ARRANGEMENTS", Attorney Docket No. END8545USNP1/170762-1;

·标题为“SURGICAL EVACUATION FLOW PATHS”的美国专利申请序列号__________，代理人案卷号为END8545USNP2/170762-2；·U.S. Patent Application Serial No. __________ entitled "SURGICAL EVACUATION FLOW PATHS", Attorney Docket No. END8545USNP2/170762-2;

·标题为“SURGICAL EVACUATION SENSING AND GENERATOR CONTROL”的美国专利申请序列号__________，代理人案卷号为END8545USNP3/170762-3；·U.S. patent application serial number __________ entitled "SURGICAL EVACUATION SENSING AND GENERATOR CONTROL", attorney docket number END8545USNP3/170762-3;

·标题为“SURGICAL EVACUATION SENSING AND DISPLAY”的美国专利申请序列号__________，代理人案卷号为END8545USNP4/170762-4；·U.S. patent application serial number __________ titled "SURGICAL EVACUATION SENSING AND DISPLAY", attorney docket number END8545USNP4/170762-4;

·标题为“COMMUNICATION OF SMOKE EVACUATION SYSTEM PARAMETERS TO HUBOR CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM”的美国专利申请序列号__________，代理人案卷号为END8546USNP/170763；·The US patent application serial number __________ entitled "COMMUNICATION OF SMOKE EVACUATION SYSTEM PARAMETERS TO HUBOR CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM", and the attorney's docket number is END8546USNP/170763;

·标题为“SMOKE EVACUATION SYSTEM INCLUDING A SEGMENTED CONTROLCIRCUIT FOR INTERACTIVE SURGICAL PLATFORM”的美国专利申请序列号__________，代理人案卷号为END8546USNP1/170763-1；·The US patent application serial number __________ entitled "SMOKE EVACUATION SYSTEM INCLUDING A SEGMENTED CONTROLCIRCUIT FOR INTERACTIVE SURGICAL PLATFORM", and the attorney's docket number END8546USNP1/170763-1;

·标题为“SURGICAL EVACUATION SYSTEM WITH A COMMUNICATION CIRCUIT FORCOMMUNICATION BETWEEN A FILTER AND A SMOKE EVACUATION DEVICE”的美国专利申请序列号__________，代理人案卷号为END8547USNP/170764；以及U.S. Patent Application Serial No. __________ entitled "SURGICAL EVACUATION SYSTEM WITH A COMMUNICATION CIRCUIT FORCOMMUNICATION BETWEEN A FILTER AND A SMOKE EVACUATION DEVICE" and Attorney Docket No. END8547USNP/170764; and

·标题为“DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS”的美国专利申请序列号__________，代理人案卷号为ND8548USNP/170765。· United States Patent Application Serial No. __________ entitled "DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS", Attorney Docket No. ND8548USNP/170765.

本专利申请的申请人拥有于2018年6月28日提交的以下美国临时专利申请，这些临时专利申请中的每个的公开内容以引用方式全文并入本文：The applicant of this patent application has the following US provisional patent applications filed on June 28, 2018, the disclosures of each of these provisional patent applications are incorporated herein by reference in their entirety:

·美国临时专利申请序列号62/691,228，其标题为一种使用具有具有电外科装置的多个传感器的增强柔性电路的方法(A Method of using reinforced flex circuitswith multiple sensors with electrosurgical devices)；US Provisional Patent Application Serial No. 62/691,228, entitled A Method of using reinforced flex circuits with multiple sensors with electrosurgical devices;

·美国临时专利申请序列号62/691,230，其标题为具有柔性电极的外科器械(SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE)；U.S. Provisional Patent Application Serial No. 62/691,230, entitled SURGICAL INSTRUMENT HAVING A FLEXIBLE ELECTRODE;

·美国临时专利申请序列号62/691,219，其标题为外科排抽感测和马达控制(SURGICAL EVACUATION SENSING AND MOTOR CONTROL)；U.S. Provisional Patent Application Serial No. 62/691,219, entitled SURGICAL EVACUATION SENSING AND MOTOR CONTROL;

·美国临时专利申请序列号62/691,257，其标题为将排烟系统参数传递至用于交互式外科平台的排烟模块中的集线器或云(COMMUNICATION OF SMOKE EVACUATION SYSTEMPARAMETERS TO HUB OR CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVESURGICAL PLATFORM)；U.S. Provisional Patent Application Serial No. 62/691,257, entitled COMMUNICATION OF SMOKE EVACUATION SYSTEMPARAMETERS TO HUB OR CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVESURGICAL PLATFORM);

·美国临时专利申请序列号62/691,262，其标题为具有用于过滤器和排烟装置之间的通信的通信电路的外科排抽系统(SURGICAL EVACUATION SYSTEM WITH ACOMMUNICATION CIRCUIT FOR COMMUNICATION BETWEEN A FILTER AND A SMOKEEVACUATION DEVICE)；以及U.S. Provisional Patent Application Serial No. 62/691,262, entitled SURGICAL EVACUATION SYSTEM WITH ACOMMUNICATION CIRCUIT FOR COMMUNICATION BETWEEN A FILTER AND A SMOKEEVACUATION DEVICE); and

·美国临时专利申请序列号62/691,251，其标题为双串联大型液滴过滤器和小型液滴过滤器(DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS)；U.S. Provisional Patent Application Serial No. 62/691,251, entitled DUAL IN-SERIES LARGE AND SMALL DROPLET FILTERS;

本专利申请的申请人拥有于2018年3月29日提交的以下美国专利申请，这些专利申请中的每个的公开内容以引用方式全文并入本文：The applicant of this patent application has the following U.S. patent applications filed on March 29, 2018, the disclosures of each of which are incorporated herein by reference in their entirety:

·美国专利申请序列号15/940,641，其标题为具有加密通信能力的交互式外科系统(INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES)；U.S. Patent Application Serial No. 15/940,641, entitled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES;

·美国专利申请序列号15/940,648，其标题为具有条件处理装置和数据能力的交互式外科系统(INTERACTIVE SURGICAL SYSTEMS WITH CONDITION HANDLING OF DEVICESAND DATA CAPABILITIES)；US Patent Application Serial No. 15/940,648, entitled INTERACTIVE SURGICAL SYSTEMS WITH CONDITION HANDLING OF DEVICESAND DATA CAPABILITIES;

·美国专利申请序列号15/940,656，其标题为手术室装置控制和通信的外科集线器协调(SURGICAL HUB COORDINATION OF CONTROL AND COMMUNICATION OF OPERATINGROOM DEVICES)；US Patent Application Serial No. 15/940,656, entitled SURGICAL HUB COORDINATION OF CONTROL AND COMMUNICATION OF OPERATINGROOM DEVICES;

·美国专利申请序列号15/940,666，其标题为手术室中的外科集线器的空间感知(SPATIAL AWARENESS OF SURGICAL HUBS IN OPERATING ROOMS)；US Patent Application Serial No. 15/940,666, entitled SPATIAL AWARENESS OF SURGICAL HUBS IN OPERATING ROOMS;

·美国专利申请序列号15/940,670，其标题为通过智能外科集线器从次级源导出的数据的协作利用(COOPERATIVE UTILIZATION OF DATA DERIVED FROM SECONDARYSOURCES BY INTELLIGENT SURGICAL HUBS)；U.S. Patent Application Serial No. 15/940,670, entitled COOPERATIVE UTILIZATION OF DATA DERIVED FROM SECONDARYSOURCES BY INTELLIGENT SURGICAL HUBS;

·美国专利申请序列号15/940,677，其标题为外科集线器控制布置方式；US Patent Application Serial No. 15/940,677, entitled Surgical Hub Control Arrangement;

·美国专利申请序列号15/940,632，其标题为数据询问患者记录并创建匿名记录的数据剥离方法(DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS ANDCREATE ANONYMIZED RECORD)；U.S. Patent Application Serial No. 15/940,632, entitled DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS ANDCREATE ANONYMIZED RECORD;

·美国专利申请序列号15/940,640，其标题为用于存储待与基于云的分析系统共享的外科装置的参数和状况的通信集线器和存储装置(COMMUNICATION HUB AND STORAGEDEVICE FOR STORING PARAMETERS AND STATUS OF A SURGICAL DEVICE TO BE SHAREDWITH CLOUD BASED ANALYTICS SYSTEMS)；US Patent Application Serial No. 15/940,640, entitled COMMUNICATION HUB AND STORAGE DEVICE FOR STORING PARAMETERS AND STATUS OF A SURGICAL DEVICE TO BE SHAREDWITH CLOUD BASED ANALYTICS SYSTEMS);

·美国专利申请序列号15/940,645，其标题为在发行器械处生成的自述数据包(SELF DESCRIBING DATA PACKETS GENERATED AT AN ISSUING INSTRUMENT)；U.S. Patent Application Serial No. 15/940,645, entitled SELF DESCRIBING DATA PACKETS GENERATED AT AN ISSUING INSTRUMENT;

·美国专利申请序列号15/940,649，其标题为用于将装置测量参数与结果互连的数据配对(DATA PAIRING TO INTERCONNECT A DEVICE MEASURED PARAMETER WITH ANOUTCOME)；US Patent Application Serial No. 15/940,649, entitled DATA PAIRING TO INTERCONNECT A DEVICE MEASURED PARAMETER WITH ANOUTCOME;

·美国专利申请序列号15/940,654，其标题为外科集线器态势感知(SURGICALHUB SITUATIONAL AWARENESS)；U.S. Patent Application Serial No. 15/940,654, entitled SURGICALHUB SITUATIONAL AWARENESS;

·美国专利申请序列号15/940,663，其标题为外科系统分布式处理(SURGICALSYSTEM DISTRIBUTED PROCESSING)；US Patent Application Serial No. 15/940,663, entitled SURGICAL SYSTEM DISTRIBUTED PROCESSING;

·美国专利申请序列号15/940,668，其标题为外科集线器数据的聚集和报告(AGGREGATION AND REPORTING OF SURGICAL HUB DATA)；US Patent Application Serial No. 15/940,668, entitled AGGREGATION AND REPORTING OF SURGICAL HUB DATA;

·美国专利申请序列号15/940,671，其标题为用于确定手术室中的装置的外科集线器空间感知(SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATINGTHEATER)；US Patent Application Serial No. 15/940,671, entitled SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATINGTHEATER;

·美国专利申请序列号15/940,686，其标题为显示将钉仓与先前线性钉线对齐(DISPLAY OF ALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LINEAR STAPLE LINE)；US Patent Application Serial No. 15/940,686, entitled DISPLAY OF ALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LINEAR STAPLE LINE;

·美国专利申请序列号15/940,700，其标题为无菌场交互式控制显示(STERILEFIELD INTERACTIVE CONTROL DISPLAYS)；U.S. Patent Application Serial No. 15/940,700, entitled STERILEFIELD INTERACTIVE CONTROL DISPLAYS;

·美国专利申请序列号15/940,629，其标题为计算机实现的交互式外科系统(COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS)；US Patent Application Serial No. 15/940,629, entitled COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS;

·美国专利申请序列号15/940,704，其标题为使用激光和红绿蓝显色来确定背散射光的特性(USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINEPROPERTIES OF BACK SCATTERED LIGHT)；U.S. Patent Application Serial No. 15/940,704, entitled USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINEPROPERTIES OF BACK SCATTERED LIGHT;

·美国专利申请序列号15/940,722，其标题为通过使用单色光折射率来表征组织不规则(CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OF MONO-CHROMATIC LIGHT REFRACTIVITY)；以及US Patent Application Serial No. 15/940,722, entitled CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OF MONO-CHROMATIC LIGHT REFRACTIVITY; and

·美国专利申请序列号15/940,742，其标题为双互补金属氧化物半导体(CMOS)阵列成像(DUAL CMOS ARRAY IMAGING)；US Patent Application Serial No. 15/940,742, entitled DUAL CMOS ARRAY IMAGING;

本专利申请的申请人拥有于2018年3月29日提交的以下美国专利申请，这些专利申请中的每个的公开内容以引用方式全文并入本文：The applicant of this patent application has the following U.S. patent applications filed on March 29, 2018, the disclosures of each of which are incorporated herein by reference in their entirety:

·美国专利申请序列号15/940,636，其标题为针对外科装置的自适应控制程序更新(ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES)；US Patent Application Serial No. 15/940,636, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES;

·美国专利申请序列号15/940,653，其标题为针对外科集线器的自适应控制程序更新(ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL HUBS)；U.S. Patent Application Serial No. 15/940,653, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL HUBS;

·美国专利申请序列号15/940,660，其标题为用于定制和向用户推荐的基于云的医学分析(CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONSTO A USER)；US Patent Application Serial No. 15/940,660, entitled CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATION STO A USER;

·美国专利申请序列号15/940,679，其标题为用于用于将本地使用趋势与较大数据集的资源采集行为链接的基于云的医学分析(CLOUD-BASED MEDICAL ANALYTICS FORLINKING OF LOCAL USAGE TRENDS WITH THE RESOURCE ACQUISITION BEHAVIORS OFLARGER DATA SET)；U.S. Patent Application Serial No. 15/940,679, entitled CLOUD-BASED MEDICAL ANALYTICS FORLINKING OF LOCAL USAGE TRENDS WITH THE RESOURCE ACQUISITION BEHAVIORS OFLARGER DATA SET);

·美国专利申请序列号15/940,694，其标题为用于将器械功能分段个性化的医疗设施的基于云的医学分析(CLOUD-BASED MEDICAL ANALYTICS FOR MEDICAL FACILITYSEGMENTED INDIVIDUALIZATION OF INSTRUMENT FUNCTION)；US Patent Application Serial No. 15/940,694, entitled CLOUD-BASED MEDICAL ANALYTICS FOR MEDICAL FACILITY SEGMENTED INDIVIDUALIZATION OF INSTRUMENT FUNCTION;

·美国专利申请序列号15/940,634，其标题为用于安全和认证趋势和反应性测量的基于云的医学分析(CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY ANDAUTHENTICATION TRENDS AND REACTIVE MEASURES)；U.S. Patent Application Serial No. 15/940,634, entitled CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY ANDAUTHENTICATION TRENDS AND REACTIVE MEASURES;

·美国专利申请序列号15/940,706，其标题为云分析网络中的数据处理和优先级(DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK)；以及U.S. Patent Application Serial No. 15/940,706, entitled DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK; and

·美国专利申请序列号15/940,675，其标题为用于联接的外科装置的云接口(CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES)；US Patent Application Serial No. 15/940,675, entitled CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES;

本专利申请的申请人拥有于2018年3月29日提交的以下美国专利申请，这些专利申请中的每个的公开内容以引用方式全文并入本文：The applicant of this patent application has the following U.S. patent applications filed on March 29, 2018, the disclosures of each of which are incorporated herein by reference in their entirety:

·美国专利申请序列号15/940,627，其标题为用于机器人辅助外科平台的驱动布置方式(DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS)；US Patent Application Serial No. 15/940,627, entitled DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;

·美国专利申请序列号15/940,637，其标题为用于机器人辅助外科平台的通信布置方式(COMMUNICATION ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS)；US Patent Application Serial No. 15/940,637, entitled COMMUNICATION ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;

·美国专利申请序列号15/940,642，其标题为用于机器人辅助外科平台的控制(CONTROLS FOR ROBOT-ASSISTED SURGICAL PLATFORMS)；U.S. Patent Application Serial No. 15/940,642, entitled CONTROLS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;

·美国专利申请序列号15/940,676，其标题为用于机器人辅助外科平台的自动工具调节(AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS)；U.S. Patent Application Serial No. 15/940,676, entitled AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;

·美国专利申请序列号15/940,680，其标题为用于机器人辅助外科平台的控制器(CONTROLLERS FOR ROBOT-ASSISTED SURGICAL PLATFORMS)；U.S. Patent Application Serial No. 15/940,680, entitled CONTROLLERS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;

·美国专利申请序列号15/940,683，其标题为用于机器人辅助外科平台的协作外科动作(COOPERATIVE SURGICAL ACTIONS FOR ROBOT-ASSISTED SURGICAL PLATFORMS)；U.S. Patent Application Serial No. 15/940,683, entitled COOPERATIVE SURGICAL ACTIONS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;

·美国专利申请序列号15/940,690，其标题为用于机器人辅助外科平台的显示器布置方式(DISPLAY ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS)；以及U.S. Patent Application Serial No. 15/940,690, entitled DISPLAY ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; and

·美国专利申请序列号15/940,711，其标题为用于机器人辅助外科平台的感测布置方式(SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS)。- US Patent Application Serial No. 15/940,711, entitled SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS.

本专利申请的申请人拥有于2018年3月28日提交的以下美国临时专利申请，这些临时专利申请中的每个的公开内容以引用方式全文并入本文：The applicant of this patent application has the following US provisional patent applications filed on March 28, 2018, the disclosures of each of these provisional patent applications are incorporated herein by reference in their entirety:

·美国临时专利申请序列号62/649,302，其标题为具有加密通信能力的交互式外科系统(INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATIONCAPABILITIES)；U.S. Provisional Patent Application Serial No. 62/649,302, entitled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES;

·美国临时专利申请序列号62/649,294，其标题为询问患者记录并创建匿名记录的数据剥离方法(DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS ANDCREATE ANONYMIZED RECORD)；U.S. Provisional Patent Application Serial No. 62/649,294, entitled DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS ANDCREATE ANONYMIZED RECORD;

·美国临时专利申请序列号62/649,300，其标题为外科集线器态势感知(SURGICAL HUB SITUATIONAL AWARENESS)；U.S. Provisional Patent Application Serial No. 62/649,300, entitled SURGICAL HUB SITUATIONAL AWARENESS;

·美国临时专利申请序列号62/649,309，其标题为用于确定手术室中的装置的外科集线器空间感知(SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES INOPERATING THEATER)；U.S. Provisional Patent Application Serial No. 62/649,309, entitled SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES INOPERATING THEATER;

·美国临时专利申请序列号62/649,310，其标题为计算机实现的交互式外科系统(COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS)；U.S. Provisional Patent Application Serial No. 62/649,310, entitled COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS;

·美国临时专利申请序列号62/649291，其标题为使用激光和红绿蓝显色来确定背散射光的特性(USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINEPROPERTIES OF BACK SCATTERED LIGHT)；U.S. Provisional Patent Application Serial No. 62/649,291, entitled USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINEPROPERTIES OF BACK SCATTERED LIGHT;

·美国临时专利申请序列号62/649,296，其标题为针对外科装置的自适应控制程序更新(ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES)；U.S. Provisional Patent Application Serial No. 62/649,296, entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES;

·美国临时专利申请序列号62/649,333，其标题为用于定制和向用户推荐的基于云的医学分析(CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION ANDRECOMMENDATIONS TO A USER)；U.S. Provisional Patent Application Serial No. 62/649,333, entitled CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION ANDRECOMMENDATIONS TO A USER;

·美国临时专利申请序列号62/649,327，其标题为用于安全和认证趋势和反应性测量的基于云的医学分析(CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY ANDAUTHENTICATION TRENDS AND REACTIVE MEASURES)；U.S. Provisional Patent Application Serial No. 62/649,327, entitled CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY ANDAUTHENTICATION TRENDS AND REACTIVE MEASURES;

·美国临时专利申请序列号62/649,315，其标题为云分析网络中的数据处理和优先级(DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK)；U.S. Provisional Patent Application Serial No. 62/649,315, entitled DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK;

·美国临时专利申请序列号62/649,313，其标题为用于联接的外科装置的云接口(CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES)；US Provisional Patent Application Serial No. 62/649,313, entitled CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES;

·美国临时专利申请序列号62/649,320，其标题为用于机器人辅助外科平台的驱动布置方式(DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS)；U.S. Provisional Patent Application Serial No. 62/649,320, entitled DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;

·美国临时专利申请序列号62/649,307，其标题为用于机器人辅助外科平台的自动工具调节(AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS)；以及U.S. Provisional Patent Application Serial No. 62/649,307, entitled AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; and

·美国临时专利申请序列号62/649,323，其标题为用于机器人辅助外科平台的感测布置方式(SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS)。- US Provisional Patent Application Serial No. 62/649,323, entitled SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS.

本专利申请的申请人拥有于2018年4月19日提交的以下美国临时专利申请，其公开内容全文以引用方式并入本文：The applicant of this patent application has the following U.S. Provisional Patent Application filed on April 19, 2018, the disclosures of which are incorporated herein by reference in their entirety:

·美国临时专利申请序列号62/659,900，其标题为集线器通信方法(METHOD OFHUB COMMUNICATION)；U.S. Provisional Patent Application Serial No. 62/659,900, entitled METHOD OFHUB COMMUNICATION;

本专利申请的申请人拥有于2018年3月30日提交的以下美国临时专利申请，这些临时专利申请中的每个的公开内容以引用方式全文并入本文：The applicant of this patent application has the following US provisional patent applications filed on March 30, 2018, the disclosures of each of these provisional patent applications are incorporated herein by reference in their entirety:

·美国临时专利申请序列号62/650,887，其标题为具有优化的感测能力的外科系统(SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES)；U.S. Provisional Patent Application Serial No. 62/650,887, entitled SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES;

·标题为“SURGICAL SMOKE EVACUATION SENSING AND CONTROLS”的美国临时专利申请序列号62/650,877；U.S. Provisional Patent Application Serial No. 62/650,877 entitled "SURGICAL SMOKE EVACUATION SENSING AND CONTROLS";

·标题为“SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM”的美国临时专利申请序列号62/650,882；以及U.S. Provisional Patent Application Serial No. 62/650,882 entitled "SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL PLATFORM"; and

·标题为“CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAYELEMENTS”的美国临时专利申请序列号62/650,898。- US Provisional Patent Application Serial No. 62/650,898 entitled "CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAYELEMENTS".

本专利申请的申请人拥有于2018年3月8日提交的以下美国临时专利申请，这些临时专利申请中的每个的公开内容以引用方式全文并入本文：The applicant of this patent application has the following US provisional patent applications filed on March 8, 2018, the disclosures of each of these provisional patent applications are hereby incorporated by reference in their entirety:

·美国临时专利申请序列号62/640,417，其标题为超声装置中的温度控制以及为此的控制系统(TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEMTHEREFOR)；以及U.S. Provisional Patent Application Serial No. 62/640,417, entitled TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEMTHEREFOR; and

·标题为“ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROLSYSTEM THEREFOR”的美国临时专利申请序列号62/640,415。- US Provisional Patent Application Serial No. 62/640,415 entitled "ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROLSYSTEM THEREFOR".

本专利申请的申请人拥有于2017年12月28日提交的以下美国临时专利申请，其中的每个的公开内容以引用方式全文并入本文：The applicant of the present patent application has the following U.S. Provisional Patent Applications filed on December 28, 2017, the disclosures of each of which are incorporated herein by reference in their entirety:

·美国临时专利申请序列号62/611,341，其标题为“交互式外科平台(INTERACTIVE SURGICAL PLATFORM)”；U.S. Provisional Patent Application Serial No. 62/611,341, entitled "INTERACTIVE SURGICAL PLATFORM";

·美国临时专利申请序列号62/611,340，其标题为基于云的医学分析(CLOUD-BASED MEDICAL ANALYTICS)；以及U.S. Provisional Patent Application Serial No. 62/611,340, entitled CLOUD-BASED MEDICAL ANALYTICS; and

·美国临时专利申请序列号62/611,339，其标题为机器人辅助的外科平台(ROBOTASSISTED SURGICAL PLATFORM)；U.S. Provisional Patent Application Serial No. 62/611,339, entitled ROBOTASSISTED SURGICAL PLATFORM;

在详细说明外科装置和发生器的各个方面之前，应该指出的是，示例性示例的应用或使用并不局限于附图和具体实施方式中所示出的部件的配置和布置方式的细节。示例性示例可以单独实现，或与其它方面、变更形式和修改形式结合在一起实现，并可以通过多种方式实践或执行。此外，除非另外指明，否则本文所用的术语和表达是为了方便读者而对示例性实施例进行描述而所选的，并非为了限制性的目的。而且，应当理解，以下描述的方面中的一个或多个、方面和/或示例的表达可以与以下描述的其它方面、方面和/或示例的表达中的任何一个或多个组合。Before describing various aspects of the surgical device and generator in detail, it should be noted that the application or use of the illustrative examples is not limited to the details of the configuration and arrangement of components shown in the accompanying drawings and detailed description. The illustrative examples can be implemented alone or in combination with other aspects, changes and modifications, and can be practiced or carried out in various ways. Furthermore, unless otherwise indicated, the terminology and expressions used herein have been chosen for the convenience of the reader in describing the exemplary embodiments and are not for the purpose of limitation. Furthermore, it should be understood that one or more of the aspects, aspects and/or examples of expressions described below may be combined with any one or more of the expressions of other aspects, aspects and/or examples described below.

在详细说明外科装置和发生器的各个方面之前，应该指出的是，示例性示例的应用或使用并不局限于附图和具体实施方式中所示出的部件的配置和布置方式的细节。示例性示例可以单独实现，或与其它方面、变更形式和修改形式结合在一起实现，并可以通过多种方式实践或执行。此外，除非另外指明，否则本文所用的术语和表达是为了方便读者而对示例性实施例进行描述而所选的，并非为了限制性的目的。而且，应当理解，以下描述的方面中的一个或多个、方面和/或示例的表达可以与以下描述的其它方面、方面和/或示例的表达中的任何一个或多个组合。Before describing various aspects of the surgical device and generator in detail, it should be noted that the application or use of the illustrative examples is not limited to the details of the configuration and arrangement of components shown in the accompanying drawings and detailed description. The illustrative examples can be implemented alone or in combination with other aspects, changes and modifications, and can be practiced or carried out in various ways. Furthermore, unless otherwise indicated, the terminology and expressions used herein have been chosen for the convenience of the reader in describing the exemplary embodiments and are not for the purpose of limitation. Furthermore, it should be understood that one or more of the aspects, aspects and/or examples of expressions described below may be combined with any one or more of the expressions of other aspects, aspects and/or examples described below.

现在将描述某些示例性方面，以提供对本发明所公开的设备和方法的结构、功能、制造和用途的原理的全面理解。这些方面的一个或多个示例在附图中示出。本领域的普通技术人员将会理解，本申请特别描述和在附图中示出的设备和方法为非限制性的示例性方面，并且多个方面的范围仅由权利要求书限定。结合一个示例性方面示出或描述的特征部可与其它方面的特征部进行组合。此类修改和变型旨在包括在权利要求书的范围内。Certain exemplary aspects will now be described in order to provide a thorough understanding of the principles of structure, function, manufacture, and use of the disclosed apparatus and methods. One or more examples of these aspects are illustrated in the accompanying drawings. Those of ordinary skill in the art will understand that the apparatus and methods particularly described herein and illustrated in the accompanying drawings are by way of non-limiting exemplary aspects and that the scope of the various aspects is limited only by the claims. Features shown or described in connection with one exemplary aspect may be combined with features of other aspects. Such modifications and variations are intended to be included within the scope of the claims.

参见图1，计算机实现的交互式外科系统100包括一个或多个外科系统102和基于云的系统(例如，可包括联接到存储装置105的远程服务器113的云104)。每个外科系统102包括与可包括远程服务器113的云104通信的至少一个外科集线器106。在一个示例中，如图1中所示，外科系统102包括可视化系统108、机器人系统110和手持式智能外科器械112，其被配置成能够彼此通信并且/或者与集线器106通信。在一些方面，外科系统102可包括M数量的集线器106、N数量的可视化系统108、O数量的机器人系统110和P数量的手持式智能外科器械112，其中M、N、O和P为大于或等于一的整数。1, a computer-implemented interactivesurgical system 100 includes one or moresurgical systems 102 and a cloud-based system (eg,cloud 104 that may include aremote server 113 coupled to storage 105). Eachsurgical system 102 includes at least onesurgical hub 106 in communication with thecloud 104 , which may include aremote server 113 . In one example, as shown in FIG. 1 ,surgical system 102 includesvisualization system 108 ,robotic system 110 , and hand-held intelligentsurgical instrument 112 configured to communicate with each other and/or withhub 106 . In some aspects,surgical system 102 may include M number ofhubs 106, N number ofvisualization systems 108, O number ofrobotic systems 110, and P number of hand-held intelligentsurgical instruments 112, where M, N, O, and P are greater than or An integer equal to one.

图3示出了用于对平躺在外科手术室116中的手术台114上的患者执行外科手术的外科系统102的示例。机器人系统110在外科手术中用作外科系统102的一部分。机器人系统110包括外科医生的控制台118、患者侧推车120(外科机器人)和外科机器人集线器122。当外科医生通过外科医生的控制台118观察外科部位时，患者侧推车120可通过患者体内的微创切口操纵至少一个可移除地联接的外科工具117。外科部位的图像可通过医疗成像装置124获得，该医疗成像装置可由患者侧推车120操纵以定向成像装置124。机器人集线器122可用于处理外科部位的图像，以随后通过外科医生的控制台118显示给外科医生。FIG. 3 shows an example of asurgical system 102 for performing a surgical procedure on a patient lying flat on an operating table 114 in asurgical operating room 116 . Therobotic system 110 is used as part of thesurgical system 102 in a surgical procedure. Therobotic system 110 includes a surgeon'sconsole 118 , a patient side cart 120 (surgical robot), and a surgicalrobotic hub 122 . Thepatient side cart 120 can maneuver the at least one removably coupledsurgical tool 117 through a minimally invasive incision in the patient while the surgeon views the surgical site through the surgeon'sconsole 118 . Images of the surgical site may be obtained by amedical imaging device 124 , which may be maneuvered by thepatient side cart 120 to orient theimaging device 124 . Therobotic hub 122 may be used to process images of the surgical site for subsequent display to the surgeon via the surgeon'sconsole 118 .

其它类型的机器人系统可容易地适于与外科系统102一起使用。适用于本公开的机器人系统和外科工具的各种示例在2017年12月28日提交的标题为机器人辅助的外科平台(ROBOT ASSISTED SURGICAL PLATFORM)的美国临时专利申请序列号62/611,339中有所描述，该专利的公开内容全文以引用方式并入本文。Other types of robotic systems may be readily adapted for use withsurgical system 102 . Various examples of robotic systems and surgical tools suitable for use in the present disclosure are described in US Provisional Patent Application Serial No. 62/611,339, filed December 28, 2017, entitled ROBOT ASSISTED SURGICAL PLATFORM , the disclosure of this patent is incorporated herein by reference in its entirety.

由云104执行并且适用于本公开的基于云的分析的各种示例描述于2017年12月28日提交的标题为“基于云的医疗分析(CLOUD-BASED MEDICAL ANALYTICS)”的美国临时专利申请序列号62/611,340中，其公开内容全文以引用方式并入本文。Various examples of cloud-based analytics performed by thecloud 104 and suitable for use in the present disclosure are described in US Provisional Patent Application Serial , entitled "CLOUD-BASED MEDICAL ANALYTICS", filed on Dec. 28, 2017 Ser. No. 62/611,340, the disclosure of which is incorporated herein by reference in its entirety.

在各种方面，成像装置124包括至少一个图像传感器和一个或多个光学部件。合适的图像传感器包括但不限于电荷耦合器件(CCD)传感器和互补金属氧化物半导体(CMOS)传感器。In various aspects,imaging device 124 includes at least one image sensor and one or more optical components. Suitable image sensors include, but are not limited to, charge coupled device (CCD) sensors and complementary metal oxide semiconductor (CMOS) sensors.

成像装置124的光学部件可包括一个或多个照明源和/或一个或多个透镜。一个或多个照明源可被引导以照明外科场地的多部分。一个或多个图像传感器可接收从外科场地反射或折射的光，包括从组织和/或外科器械反射或折射的光。Optical components ofimaging device 124 may include one or more illumination sources and/or one or more lenses. One or more illumination sources may be directed to illuminate portions of the surgical field. The one or more image sensors may receive light reflected or refracted from the surgical site, including light reflected or refracted from tissue and/or surgical instruments.

一个或多个照明源可被配置成能够辐射可见光谱中的电磁能以及不可见光谱。可见光谱(有时被称为光学光谱或发光光谱)是电磁光谱中对人眼可见(即，可被其检测)的那部分，并且可被称为可见光或简单光。典型的人眼将对空气中约380nm至约750nm的波长作出响应。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 or luminescence spectrum) is that portion of the electromagnetic spectrum that is visible to (ie, detectable 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 from about 380 nm to about 750 nm.

不可见光谱(即，非发光光谱)是电磁光谱的位于可见光谱之下和之上的部分(即，低于约380nm且高于约750nm的波长)。人眼不可检测到不可见光谱。大于约750nm的波长长于红色可见光谱，并且它们变为不可见的红外(IR)、微波和无线电电磁辐射。小于约380nm的波长比紫色光谱短，并且它们变为不可见的紫外、x射线和γ射线电磁辐射。The invisible spectrum (ie, the non-luminescent spectrum) is the portion of the electromagnetic spectrum that lies below and above the visible spectrum (ie, wavelengths below about 380 nm and above about 750 nm). The invisible spectrum is not detectable by the human eye. Wavelengths 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.

在各种方面，成像装置124被配置用于微创规程中。适用于本公开的成像装置的示例包括但不限于关节镜、血管镜、支气管镜、胆道镜、结肠镜、细胞检查镜、十二指镜、肠窥镜、食道-十二指肠镜(胃镜)、内窥镜、喉镜、鼻咽-肾内窥镜、乙状结肠镜、胸腔镜和子宫内窥镜。In various aspects, theimaging device 124 is configured for use in minimally invasive procedures. Examples of imaging devices suitable for use in the present disclosure include, but are not limited to, arthroscopes, angioscopes, bronchoscopes, choledochoscopes, colonoscopes, cytoscopes, duodenoscopes, enteroscopes, esophago-duodenoscopes (gastroscopes) ), endoscopy, laryngoscopy, nasopharyngeal-renal endoscopy, sigmoidoscopy, thoracoscopy and hysteroscopy.

在一个方面，成像装置采用多光谱监测来辨别形貌和底层结构。多光谱图像是捕集跨电磁波谱的特定波长范围内的图像数据的图像。可通过滤波器或通过使用对特定波长敏感的器械来分离波长，特定波长包括来自可见光范围之外的频率的光，例如IR和紫外。光谱成像可允许提取人眼未能用其红色，绿色和蓝色的受体捕集的附加信息。多光谱成像的使用在2017年12月28日提交的标题为“交互式外科平台(INTERACTIVE SURGICALPLATFORM)”的美国临时专利申请序列号62/611,341的标题“高级成像采集模块(AdvancedImaging Acquisition Module)”下更详细地描述，该专利的公开内容全文以引用方式并入本文。在完成外科任务以对处理过的组织执行一个或多个先前所述测试之后，多光谱监测可以是用于重新定位外科场地的有用工具。In one aspect, the imaging device employs multispectral monitoring to discern topography and underlying structure. A multispectral image is an image that captures image data across a specific wavelength range of the electromagnetic spectrum. The wavelengths can be separated by filters or by using instruments that are sensitive to specific wavelengths, including light from frequencies outside the visible range, such as IR and UV. Spectral imaging may allow extracting additional information that the human eye fails to capture with its red, green and blue receptors. Use of Multispectral Imaging under the title "Advanced Imaging Acquisition Module" in U.S. Provisional Patent Application Serial No. 62/611,341, filed December 28, 2017, entitled "INTERACTIVE SURGICAL PLATFORM" Described in more detail, the disclosure of this patent is incorporated herein by reference in its entirety. Multispectral monitoring can be a useful tool for repositioning the surgical field after completing a surgical task to perform one or more of the previously described tests on the treated tissue.

不言自明的是，在任何外科期间都需要对手术室和外科设备进行严格消毒。在“外科室”(即，手术室或治疗室)中所需的严格的卫生和消毒条件需要所有医疗装置和设备的最高可能的无菌性。该灭菌过程的一部分是需要对接触患者或穿透无菌场的任何物质进行灭菌，包括成像装置124及其附接件和部件。应当理解，无菌场可被认为是被认为不含微生物的指定区域，诸如在托盘内或无菌毛巾内，或者无菌场可被认为是已准备用于外科手术的患者周围的区域。无菌场可包括被恰当地穿着的擦洗的团队构件，以及该区域中的所有家具和固定件。It goes without saying that strict sterilization of operating rooms and surgical equipment is required during any surgical procedure. The stringent hygiene and sterilization conditions required in the "surgical room" (ie, operating room or treatment room) require the highest possible sterility of all medical devices and equipment. Part of this sterilization process is the need to sterilize anything that comes into contact with the patient or penetrates the sterile field, including theimaging device 124 and its attachments and components. It should be understood that a sterile field may be considered a designated area that is considered to be free of microorganisms, such as within a tray or sterile towel, or a sterile field may be considered an area around a patient that is ready for surgery. A sterile field may include properly dressed scrubbing team members, as well as all furniture and fixtures in the area.

在各种方面，可视化系统108包括一个或多个成像传感器、一个或多个图像处理单元、一个或多个存储阵列、以及一个或多个显示器，其相对于无菌场进行策略布置，如图2中所示。在一个方面，可视化系统108包括用于HL7、PACS和EMR的界面。可视化系统108的各种部件在2017年12月28日提交的标题为“交互式外科平台(INTERACTIVE SURGICALPLATFORM)”的美国临时专利申请序列号62/611,341的标题“高级成像采集模块(AdvancedImaging Acquisition Module)”下有所描述，该专利申请的公开内容全文以引用方式并入本文。In various aspects,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, strategically arranged relative to the sterile field, as shown in FIG. shown in 2. In one aspect,visualization system 108 includes interfaces for HL7, PACS, and EMR. The various components ofvisualization system 108 are described in US Provisional Patent Application Serial No. 62/611,341, filed December 28, 2017, entitled "INTERACTIVE SURGICAL PLATFORM," and entitled "Advanced Imaging Acquisition Module." ” described below, the disclosure of this patent application is incorporated herein by reference in its entirety.

如图2中所示，主显示器119被定位在无菌场中，以对在手术台114处的操作者可见。此外，可视化塔111被定位在无菌场之外。可视化塔111包括彼此背离的第一非无菌显示器107和第二非无菌显示器109。由集线器106引导的可视化系统108被配置成能够利用显示器107、109和119来将信息流协调到无菌场内侧和外侧的操作者。例如，集线器106可使成像系统108在非无菌显示器107或109上显示由成像装置124记录的外科部位的快照，同时保持外科部位在主显示器119上的实时馈送。非无菌显示器107或109上的快照可允许非无菌操作者例如执行与外科手术相关的诊断步骤。As shown in FIG. 2 , themain display 119 is positioned in the sterile field to be visible to the operator at the operating table 114 . Furthermore, the visualization tower 111 is positioned outside the sterile field. The visualization tower 111 includes a firstnon-sterile display 107 and a secondnon-sterile display 109 facing away from each other.Visualization system 108, directed byhub 106, is configured to utilizedisplays 107, 109, and 119 to coordinate the flow of information to operators inside and outside the sterile field. For example,hub 106 may enableimaging system 108 to display a snapshot of the surgical site recorded byimaging device 124 onnon-sterile display 107 or 109 while maintaining a real-time feed of the surgical site onmain display 119 . A snapshot on thenon-sterile display 107 or 109 may allow a non-sterile operator to perform, for example, diagnostic steps related to surgery.

在一个方面，集线器106还被配置成能够将由非无菌操作者在可视化塔111处输入的诊断输入或反馈路由至无菌场内的主显示器119，其中可由操作台上的无菌操作员查看。在一个示例中，输入可以是对显示在非无菌显示器107或109上的快照的修改形式，其可通过集线器106路由到主显示器119。In one aspect, thehub 106 is also configured to be able to route diagnostic input or feedback entered at the visualization tower 111 by a non-sterile operator to themain display 119 within the sterile field, where it can be viewed by a sterile operator on the console . In one example, the input may be a modified form of a snapshot displayed on thenon-sterile display 107 or 109 , which may be routed through thehub 106 to themain display 119 .

参见图2，外科器械112作为外科系统102的一部分在外科手术中使用。集线器106还被配置成能够协调流向外科器械112的显示器的信息流。例如，在2017年12月28日提交的标题为“交互式外科平台(INTERACTIVE SURGICAL PLATFORM)”的美国临时专利申请序列号62/611,341，其公开内容全文以引用方式并入本文。由非无菌操作者在可视化塔111处输入的诊断输入或反馈可由集线器106路由至无菌场内的外科器械显示器115，其中外科器械112的操作者可观察到该输入或反馈。适用于外科系统102的示例性外科器械描述于2017年12月28日提交的标题为“交互式外科平台(INTERACTIVE SURGICAL PLATFORM)”的美国临时专利申请序列号62/611,341的标题“外科器械硬件(Surgical Instrument Hardware)”下，该专利的公开内容以引用方式全文并入本文。Referring to FIG. 2 , thesurgical instrument 112 is used in a surgical procedure as part of thesurgical system 102 . Thehub 106 is also configured to coordinate the flow of information to the display of thesurgical instrument 112 . For example, US Provisional Patent Application Serial No. 62/611,341, filed December 28, 2017, entitled "INTERACTIVE SURGICAL PLATFORM," the disclosure of which is incorporated herein by reference in its entirety. Diagnostic input or feedback entered at visualization tower 111 by a non-sterile operator may be routed byhub 106 to surgical instrument display 115 within the sterile field, where the operator ofsurgical instrument 112 may observe the input or feedback. Exemplary surgical instruments suitable for use withsurgical system 102 are described in U.S. Provisional Patent Application Serial No. 62/611,341, filed December 28, 2017, entitled "SURGICAL INSTRUMENT HARDWARE (INTERACTIVE SURGICAL PLATFORM)," Surgical Instrument Hardware", the disclosure of this patent is incorporated herein by reference in its entirety.

现在参见图3，集线器106被描绘为与可视化系统108、机器人系统110和手持式智能外科器械112通信。集线器106包括集线器显示器135、成像模块138、发生器模块140、通信模块130、处理器模块132和存储阵列134。在某些方面，如图3中所示，集线器106还包括排烟模块126和/或抽吸/冲洗模块128。Referring now to FIG. 3 ,hub 106 is depicted in communication withvisualization system 108 ,robotic system 110 , and hand-held intelligentsurgical instrument 112 . Thehub 106 includes ahub display 135 , animaging module 138 , agenerator module 140 , acommunication module 130 , aprocessor module 132 and astorage array 134 . In certain aspects, as shown in FIG. 3 , thehub 106 also includes afume extraction module 126 and/or a suction/flush module 128 .

在外科手术期间，用于密封和/或切割的对组织的能量施加通常与排烟、抽吸过量流体和/或冲洗组织相关。来自不同来源的流体管线、功率管线和/或数据管线通常在外科手术期间缠结。在外科手术期间解决该问题可丢失有价值的时间。断开管线可需要将管线与其相应的模块断开连接，这可需要重置模块。集线器模块化壳体136提供用于管理功率管线、数据管线和流体管线的统一环境，这降低了此类管线之间缠结的频率。During surgical procedures, the application of energy to tissue for sealing and/or cutting is often associated with fume extraction, aspiration of excess fluid, and/or irrigation of tissue. Fluid, power, and/or data lines from different sources often become tangled during surgery. Valuable time can be lost addressing this issue during surgery. Disconnecting a line may require disconnecting the line from its corresponding module, which may require resetting the module. The hubmodular housing 136 provides a unified environment for managing power, data, and fluid lines, which reduces the frequency of tangles between such lines.

本公开的各方面提供了用于外科手术的外科集线器，该外科手术涉及将能量施加到外科部位处的组织。外科集线器包括集线器壳体和可滑动地接纳在集线器壳体的对接底座中的组合发生器模块。对接底座包括数据触点和功率触点。组合发生器模块包括座置在单个单元中的超声能量发生器部件、双极RF能量发生器部件和单极RF能量发生器部件中的两个或更多个。在一个方面，组合发生器模块还包括排烟部件，用于将组合发生器模块连接到外科器械的至少一根能量递送缆线、被配置成能够排出通过向组织施加治疗能量而产生的烟雾、流体和/或颗粒的至少一个排烟部件、以及从远程外科部位延伸至排烟部件的流体管线。Aspects of the present disclosure provide a surgical hub for use in surgical procedures involving the application of energy to tissue at a surgical site. The surgical hub includes a hub housing and a combined generator module slidably received in a docking base of the hub housing. The docking base includes data contacts and power contacts. The combined 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 seated in a single unit. In one aspect, the combination generator module further includes a fume extraction component for connecting the combination generator module to at least one energy delivery cable of a surgical instrument, configured to expel smoke generated by applying therapeutic energy to tissue, At least one fume extraction component for fluids and/or particles, and a fluid line extending from the remote surgical site to the fume extraction component.

在一个方面，流体管线是第一流体管线，并且第二流体管线从远程外科部位延伸至可滑动地接纳在集线器壳体中的抽吸和冲洗模块。在一个方面，集线器壳体包括流体接口。In one aspect, the fluid line is a first fluid line and the second fluid line extends from the remote surgical site to an aspiration and irrigation module slidably received in the hub housing. In one aspect, the hub housing includes a fluid interface.

某些外科手术可需要将多于一种能量类型施加到组织。一种能量类型可更有利于切割组织，而另一种不同的能量类型可更有利于密封组织。例如，双极发生器可用于密封组织，而超声发生器可用于切割密封的组织。本公开的各方面提供了一种解决方案，其中集线器模块化壳体136被配置成能够容纳不同的发生器，并且有利于它们之间的交互式通信。集线器模块化壳体136的优点之一是能够快速地移除和/或更换各种模块。Certain surgical procedures may require the application of more than one type of energy to tissue. One type of energy may be more beneficial for cutting tissue, while a different type of energy may be more beneficial for sealing tissue. For example, a bipolar generator can be used to seal tissue, while an ultrasonic generator can be used to cut the sealed tissue. Aspects of the present disclosure provide a solution in which the hubmodular housing 136 is configured to accommodate different generators and facilitate interactive communication between them. One of the advantages of the hubmodular housing 136 is the ability to quickly remove and/or replace the various modules.

本公开的方面提供了在涉及将能量施加到组织的外科手术中使用的模块化外科壳体。模块化外科壳体包括第一能量发生器模块，该第一能量发生器模块被配置成能够生成用于施加到组织的第一能量，和第一对接底座，该第一对接底座包括第一对接端口，该第一对接端口包括第一数据和功率触点，其中第一能量发生器模块可滑动地运动成与该功率和数据触点电接合，并且其中第一能量发生器模块可滑动地运动出与第一功率和数据触点电接合。Aspects of the present disclosure provide modular surgical housings for use in surgical procedures involving the application of energy to tissue. The modular surgical housing includes a first energy generator module configured to generate a first energy for application to tissue, and a first docking base including a first docking station a port, the first docking port including first data and power contacts, wherein the first energy generator module is slidably movable into electrical engagement with the power and data contacts, and wherein the first energy generator module is slidably movable out is in electrical engagement with the first power and data contacts.

对上文进行进一步描述，模块化外科壳体还包括第二能量发生器模块，该第二能量发生器模块被配置成能够生成不同于第一能量的第二能量以用于施加到组织，和第二对接底座，该第二对接底座包括第二对接端口，该第二对接端口包括第二数据和功率触点，其中第二能量发生器模块可滑动地运动成与功率和数据触点电接合，并且其中第二能量发生器模块可滑动地运动出与第二功率和数据触点电接合。Further described above, the modular surgical housing further includes a second energy generator module configured to generate a second energy different from the first energy for application to tissue, and A second docking base that includes a second docking port that includes second data and power contacts, wherein the second energy generator module is slidably movable into electrical engagement with the power and data contacts , and wherein the second energy generator module is slidably moved out of electrical engagement with the second power and data contacts.

此外，模块化外科壳体还包括在第一对接端口和第二对接端口之间的通信总线，其被配置成能够有利于第一能量发生器模块和第二能量发生器模块之间的通信。Additionally, the modular surgical housing 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.

参见图3-7，本公开的各方面被呈现为集线器模块化壳体136，其允许发生器模块140、排烟模块126和抽吸/冲洗模块128的模块化集成。集线器模块化壳体136还有利于模块140、126、128之间的交互式通信。如图5中所示，发生器模块140可为具有集成的单极部件、双极部件和超声部件的发生器模块，该部件被支撑在可滑动地插入到集线器模块化壳体136中的单个外壳单元139中。如图5中所示，发生器模块140可被配置成能够连接到单极装置146、双极装置147和超声装置148。另选地，发生器模块140可包括通过集线器模块化壳体136进行交互的一系列单极发生器模块、双极发生器模块和/或超声发生器模块。集线器模块化壳体136可被配置成能够有利于多个发生器的插入和对接到集线器模块化壳体136中的发生器之间的交互通信，使得发生器将充当单个发生器。Referring to FIGS. 3-7 , aspects of the present disclosure are presented as a hubmodular housing 136 that allows for modular integration ofgenerator module 140 ,fume extraction module 126 , and suction/irrigation module 128 . The hubmodular housing 136 also facilitates interactive communication between themodules 140 , 126 , 128 . As shown in FIG. 5 ,generator module 140 may be a generator module with integrated monopolar, bipolar, and ultrasonic components supported in a single unit slidably inserted into hubmodular housing 136 in thehousing unit 139. As shown in FIG. 5 ,generator module 140 may be configured to be connectable tomonopolar device 146 ,bipolar device 147 , andultrasound device 148 . Alternatively,generator module 140 may include a series of monopolar generator modules, bipolar generator modules, and/or ultrasonic generator modules that interact through hubmodular housing 136 . The hubmodular housing 136 may be configured to facilitate insertion of multiple generators and interactive communication between generators docked into the hubmodular housing 136 such that the generators will act as a single generator.

在一个方面，集线器模块化壳体136包括具有外部和无线通信接头的模块化功率和通信底板149，以实现模块140、126、128的可移除附接件以及它们之间的交互通信。In one aspect, the hubmodular housing 136 includes a modular power andcommunication backplane 149 with external and wireless communication connections to enable removable attachment of themodules 140, 126, 128 and intercommunication between them.

在一个方面，集线器模块化壳体136包括对接底座或抽屉151(本文也称为抽屉)，其被配置成能够可滑动地接纳模块140、126、128。图4示出了可滑动地接纳在外科集线器壳体136的对接底座151中的外科集线器壳体136和组合发生器模块145的局部透视图。在组合发生器模块145的背面上具有功率和数据触点的对接端口152被配置成能够当组合发生器模块145滑动到集线器模块壳体136的对应的对接底座151内的适当位置时，将对应的对接端口150与集线器模块化壳体136的对应对接底座151的功率和数据触点接合。在一个方面，组合发生器模块145包括一起集成到单个外壳单元139中的双极、超声和单极模块以及排烟模块，如图5中所示。In one aspect, the hubmodular housing 136 includes a docking base or drawer 151 (also referred to herein as a drawer) configured to slidably receive themodules 140 , 126 , 128 . FIG. 4 shows a partial perspective view ofsurgical hub housing 136 and combinedgenerator module 145 slidably received indocking base 151 ofsurgical hub housing 136 . Thedocking ports 152 with power and data contacts on the back of thecombinatorial generator module 145 are configured so that when thecombinatorial generator module 145 is slid into position within thecorresponding docking base 151 of thehub module housing 136, the corresponding Thedocking port 150 of the hub engages the power and data contacts of thecorresponding docking base 151 of the hubmodular housing 136 . In one aspect, the combinedgenerator module 145 includes bipolar, ultrasonic and monopolar modules and a fume extraction module integrated together into asingle housing unit 139, as shown in FIG. 5 .

在各种方面，排烟模块126包括流体管线154，该流体管线154将捕集/收集的烟雾和/或流体从外科部位传送到例如排烟模块126。源自排烟模块126的真空抽吸可将烟雾吸入外科部位处的公用导管的开口中。联接到流体管线的公用导管可以是端接在排烟模块126处的柔性管的形式。公用导管和流体管线限定朝向可滑动地接纳在集线器壳体136中的排烟模块126延伸的流体路径。In various aspects, thefume extraction module 126 includes afluid line 154 that conveys trapped/collected smoke and/or fluid from the surgical site to, for example, thefume extraction module 126 . Vacuum suction from thefume extraction module 126 may draw fume into the opening of the common conduit at the surgical site. The common conduit coupled to the fluid line may be in the form of a flexible pipe terminated at thefume extraction module 126 . Common conduits and fluid lines define a fluid path extending toward thefume extraction module 126 slidably received in thehub housing 136 .

在各种方面，抽吸/冲洗模块128联接到包括吸出流体管线和抽吸流体管线的外科工具。在一个示例中，吸出流体管线和抽吸流体管线为从外科部位朝向抽吸/冲洗模块128延伸的柔性管的形式。一个或多个驱动系统可被配置成能够冲洗到外科部位的流体和从外科部位抽吸流体。In various aspects, the aspiration/irrigation module 128 is coupled to a surgical tool that includes an aspiration fluid line and an aspiration fluid line. In one example, the aspiration and aspiration fluid lines are in the form of flexible tubes extending from the surgical site toward the aspiration/irrigation module 128 . One or more drive systems may be configured to be capable of flushing fluid to and aspirating fluid from the surgical site.

在一个方面，外科工具包括轴，该轴具有在其远侧端部处的端部执行器以及与端部执行器、吸出管和冲洗管相关联的至少一种能量处理。吸出管可在其远侧端部处具有入口，并且吸出管延伸穿过轴。类似地，吸出管可延伸穿过轴并且可具有邻近能量递送工具的入口。能量递送工具被配置成能够将超声能量和/或RF能量递送至外科部位，并且通过初始延伸穿过轴的缆线联接到发生器模块140。In one aspect, a 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, aspiration tube, and irrigation tube. The aspiration tube may have an inlet at its distal end and the aspiration tube extends through the shaft. Similarly, the aspiration tube can extend through the shaft and can have an inlet adjacent to the energy delivery tool. The energy delivery tool is configured to deliver ultrasonic energy and/or RF energy to the surgical site and is coupled togenerator module 140 by a cable that initially extends through the shaft.

冲洗管可与流体源流体连通，并且吸出管可与真空源流体连通。流体源和/或真空源可座置在抽吸/冲洗模块128中。在一个示例中，流体源和/或真空源可独立于抽吸/冲洗模块128座置在集线器壳体136中。在此类示例中，流体接口能够将抽吸/冲洗模块128连接到流体源和/或真空源。The flush tube may be in fluid communication with the fluid source, and the aspiration tube may be in fluid communication with the vacuum source. A fluid source and/or a vacuum source may be seated in the aspiration/irrigation module 128 . In one example, the fluid source and/or vacuum source may be seated in thehub housing 136 independently of the suction/irrigation module 128 . In such examples, the fluid interface can connect the aspiration/irrigation module 128 to a fluid source and/or a vacuum source.

在一个方面，集线器模块化壳体136上的模块140、126、128和/或其对应的对接底座可包括对齐特征部，该对齐特征部被配置成能够将模块的对接端口对齐成与其在集线器模块化壳体136的对接底座中的对应端口接合。例如，如图4中所示，组合发生器模块145包括侧支架155，侧支架155被配置成能够与集线器模块化壳体136的对应的对接底座151的对应支架156可滑动地接合。支架配合以引导组合发生器模块145的对接端口触点与集线器模块化壳体136的对接端口触点电接合。In one aspect, themodules 140, 126, 128 and/or their corresponding docking bases on the hubmodular housing 136 may include alignment features configured to align the modules' docking ports with their docking ports in the hub Corresponding ports in the docking base of themodular housing 136 engage. For example, as shown in FIG. 4 , combinedgenerator module 145 includesside brackets 155 configured to slidably engage withcorresponding brackets 156 ofcorresponding docking bases 151 of hubmodular housing 136 . The brackets cooperate to guide the docking port contacts of the combinedgenerator module 145 in electrical engagement with the docking port contacts of the hubmodular housing 136 .

在一些方面，集线器模块化壳体136的抽屉151为相同的或大体上相同的大小，并且模块的大小被调节为接纳在抽屉151中。例如，侧支架155和/或156可根据模块的大小而更大或更小。在其它方面，抽屉151的大小不同，并且各自被设计成容纳特定模块。In some aspects, thedrawers 151 of the hubmodular housing 136 are the same or substantially the same size, and the modules are sized to be received in thedrawers 151 . For example,side brackets 155 and/or 156 may be larger or smaller depending on the size of the module. In other aspects, thedrawers 151 vary in size and are each designed to accommodate a particular module.

此外，可对特定模块的触点进行键控以与特定抽屉的触点接合，以避免将模块插入到具有不匹配触点的抽屉中。Additionally, the contacts of a particular module can be keyed to engage the contacts of a particular drawer to avoid inserting a module into a drawer with mismatched contacts.

如图4中所示，一个抽屉151的对接端口150可通过通信链路157联接到另一个抽屉151的对接端口150，以有利于座置在集线器模块化壳体136中的模块之间的交互式通信。另选地或附加地，集线器模块化壳体136的对接端口150可有利于座置在集线器模块化壳体136中的模块之间的无线交互通信。可采用任何合适的无线通信，诸如例如Air Titan-Bluetooth。As shown in FIG. 4 , thedocking port 150 of onedrawer 151 may be coupled to thedocking port 150 of anotherdrawer 151 by acommunication link 157 to facilitate interaction between modules seated in the hubmodular housing 136 communication. Alternatively or additionally, thedocking port 150 of the hubmodular housing 136 may facilitate wireless interactive communication between modules seated in the hubmodular housing 136 . Any suitable wireless communication may be employed, such as, for example, Air Titan-Bluetooth.

图6示出了用于横向模块化外壳160的多个横向对接端口的单个功率总线附接件，该横向模块化外壳160被配置成能够可滑动地接纳外科集线器206的多个模块。横向模块化外壳160被配置成能够横向可滑动地接纳和互连模块161。模块161可滑动地插入到横向模块化外壳160的对接底座162中，该横向模块化外壳160包括用于互连模块161的底板。如图6中所示，模块161横向布置在横向模块化外壳160中。另选地，模块161可竖直地布置在横向模块化外壳中。FIG. 6 illustrates a single power bus attachment for multiple lateral docking ports of lateralmodular housing 160 configured to slidably receive multiple modules ofsurgical hub 206 . The lateralmodular housing 160 is configured to laterally slidably receive andinterconnect modules 161 . Themodules 161 are slidably inserted into thedocking bases 162 of the lateralmodular housing 160 , which includes a backplane for interconnecting themodules 161 . As shown in FIG. 6 ,modules 161 are arranged laterally in lateralmodular housing 160 . Alternatively, themodules 161 may be arranged vertically in a transverse modular housing.

图7示出了被配置成能够可滑动地接纳外科集线器106的多个模块165的竖直模块化外壳164。模块165可滑动地插入到竖直模块化外壳164的对接底座或抽屉167中，该竖直模块化外壳164包括用于互连模块165的底板。尽管竖直模块化外壳164的抽屉167竖直布置，但在某些情况下，竖直模块化外壳164可包括横向布置的抽屉。此外，模块165可通过竖直模块化外壳164的对接端口彼此交互。在图7的示例中，提供了用于显示与模块165的操作相关的数据的显示器177。此外，竖直模块化外壳164包括主模块178，该主模块座置可滑动地接纳在主模块178中的多个子模块。FIG. 7 shows a verticalmodular housing 164 configured to slidably receive a plurality ofmodules 165 ofsurgical hub 106 . Themodules 165 are slidably inserted into docking bases ordrawers 167 of a verticalmodular housing 164 that includes a base plate for interconnecting themodules 165 . Although thedrawers 167 of the verticalmodular housing 164 are arranged vertically, in some cases the verticalmodular housing 164 may include laterally arranged drawers. Additionally, themodules 165 may interact with each other through the docking ports of the verticalmodular housing 164 . In the example of FIG. 7 , adisplay 177 is provided for displaying data related to the operation of themodule 165 . Additionally, the verticalmodular housing 164 includes amain module 178 that houses a plurality of sub-modules slidably received in themain module 178 .

在各种方面，成像模块138包括集成视频处理器和模块化光源，并且适于与各种成像装置一起使用。在一个方面，成像装置由可装配有光源模块和相机模块的模块化外壳构成。外壳可为一次性外壳。在至少一个示例中，一次性外壳可移除地联接到可重复使用的控制器、光源模块和相机模块。光源模块和/或相机模块可根据外科手术的类型选择性地选择。在一个方面，相机模块包括CCD传感器。在另一方面，相机模块包括CMOS传感器。在另一方面，相机模块被配置用于扫描波束成像。同样，光源模块可被配置成能够递送白光或不同的光，这取决于外科手术。In various aspects, theimaging module 138 includes an integrated video processor and a modular light source and is suitable for use with various imaging devices. In one aspect, the imaging device consists of a modular housing that can be fitted with a light source module and a camera module. The housing may be a disposable housing. In at least one example, the disposable housing is removably coupled to the reusable controller, light source module, and camera module. The light source module and/or the camera module can be selectively selected according to the type of surgery. In one aspect, the camera module includes a CCD sensor. In another aspect, the camera module includes a CMOS sensor. In another aspect, the camera module is configured for scanning beam imaging. Likewise, the light source module can be configured to deliver white light or different light, depending on the surgical procedure.

在外科手术期间，从外科场地移除外科装置并用包括不同相机或不同光源的另一外科装置替换外科装置可为低效的。暂时失去对外科场地的视线可导致不期望的后果。本公开的模块成像装置被配置成能够允许在外科手术期间中流替换光源模块或相机模块，而不必从外科场地移除成像装置。During a surgical procedure, it can be inefficient to remove the surgical device from the surgical field and replace it with another surgical device that includes a different camera or a different light source. Temporary loss of sight to the surgical field can lead to undesired consequences. The modular imaging device of the present disclosure is configured to allow midstream replacement of a light source module or camera module during a surgical procedure without having to remove the imaging device from the surgical site.

在一个方面，成像装置包括包括多个通道的管状外壳。第一通道被配置成能够可滑动地接纳相机模块，该相机模块可被配置用于与第一通道按扣配合接合。第二通道被配置成能够可滑动地接纳光源模块，该光源模块可被配置用于与第二通道按扣配合接合。在另一个示例中，相机模块和/或光源模块可在其相应通道内旋转到最终位置。可采用螺纹接合代替按扣配合接合。In one aspect, an imaging device includes a tubular housing that includes a plurality of channels. The first channel is configured to slidably receive a camera module that can be configured for snap-fit engagement with the first channel. The second channel is configured to slidably receive a light source module that can be configured for snap-fit engagement with the second channel. In another example, the camera module and/or the light source module may be rotated to a final position within their respective channels. A threaded engagement may be used instead of a snap fit engagement.

在各种示例中，多个成像装置被放置在外科场地中的不同位置以提供多个视图。成像模块138可被配置成能够在成像装置之间切换以提供最佳视图。在各种方面，成像模块138可被配置成能够集成来自不同成像装置的图像。In various examples, multiple imaging devices are placed at different locations in the surgical field to provide multiple views.Imaging module 138 may be configured to switch between imaging devices to provide the best view. In various aspects,imaging module 138 may be configured to be able to integrate images from different imaging devices.

适用于本公开的各种图像处理器和成像装置描述于2011年8月9日公布的标题为组合SBI和常规图像处理器(COMBINED SBI AND CONVENTIONAL IMAGE PROCESSOR)美国专利7,995,045中，该专利以引用方式全文并入本文。此外，2011年7月19日公布的标题为SBI运动伪影去除设备和方法(SBI MOTION ARTIFACT REMOVAL APPARATUS AND METHOD)的美国专利7,982,776描述了用于从图像数据中去除运动伪影的各种系统，该专利以引用方式全文并入本文。此类系统可与成像模块138集成。此外，2011年12月15日公布的标题为“CONTROLLABLE MAGNETIC SOURCE TO FIXTURE INTRACORPOREAL APPARATUS”的美国专利申请公布No.2011/0306840和2014年8月28日公布的标题为“SYSTEM FOR PERFORMING AMINIMALLY INVASIVE SURGICAL PROCEDURE”的美国专利申请公布No.2014/0243597，这些专利申请中的每个的公开内容以引用方式全文并入本文。Various image processors and imaging devices suitable for use in the present disclosure are described in US Patent 7,995,045, entitled COMBINED SBI AND CONVENTIONAL IMAGE PROCESSOR, issued August 9, 2011, which is incorporated by reference The full text is incorporated herein. Additionally, US Patent 7,982,776, entitled SBI MOTION ARTIFACT REMOVAL APPARATUS AND METHOD, issued July 19, 2011, describes various systems for removing motion artifacts from image data, This patent is incorporated herein by reference in its entirety. Such systems may be integrated withimaging module 138 . In addition, U.S. Patent Application Publication No. 2011/0306840 published on December 15, 2011 and entitled "CONTROLLABLE MAGNETIC SOURCE TO FIXTURE INTRACORPOREAL APPARATUS" and published on August 28, 2014 and entitled "SYSTEM FOR PERFORMING AMINIMALLY INVASIVE SURGICAL PROCEDURE" ," US Patent Application Publication No. 2014/0243597, the disclosures of each of these patent applications are incorporated herein by reference in their entirety.

图8示出了包括模块化通信集线器203的外科数据网络201，该模块化通信集线器203被配置成能够将位于医疗设施的一个或多个手术室中的模块化装置或专门配备用于外科操作的医疗设施中的任何房间连接到基于云的系统(例如，可包括联接到存储装置205的远程服务器213的云204)。在一个方面，模块化通信集线器203包括与网络路由器通信的网络集线器207和/或网络交换机209。模块化通信集线器203还可联接到本地计算机系统210以提供本地计算机处理和数据操纵。外科数据网络201可被配置为无源的、智能的或交换的。无源外科数据网络充当数据的管道，从而使其能够从一个装置(或区段)转移到另一个装置(或区段)以及云计算资源。智能外科数据网络包括附加特征，以使得能够监测穿过外科数据网络的流量并配置网络集线器207或网络交换器209中的每个端口。智能外科数据网络可被称为可管理的集线器或交换器。交换集线器读取每个包的目标地址，并且然后将包转发到正确的端口。FIG. 8 shows asurgical data network 201 including amodular communication hub 203 configured to enable modular devices located in one or more operating rooms of a medical facility or specially equipped for surgical procedures Any room in the medical facility is connected to a cloud-based system (eg,cloud 204 that may includeremote server 213 coupled to storage 205). In one aspect, themodular communication hub 203 includes anetwork hub 207 and/or anetwork switch 209 in communication with a network router.Modular communication hub 203 may also be coupled tolocal computer system 210 to provide local computer processing and data manipulation.Surgical data network 201 may be configured as passive, intelligent, or switched. A passive surgical data network acts as a conduit for data, enabling it to be transferred from one device (or segment) to another as well as cloud computing resources. The intelligent surgical data network includes additional features to enable monitoring of traffic across the surgical data network and configuration of each port in thenetwork hub 207 ornetwork switch 209 . An intelligent surgical data network may be referred to as a manageable hub or switch. The switching hub reads the destination address of each packet and then forwards the packet to the correct port.

位于手术室中的模块化装置1a-1n可联接到模块化通信集线器203。网络集线器207和/或网络交换机209可联接到网络路由器211以将装置1a-1n连接至云204或本地计算机系统210。与装置1a-1n相关联的数据可经由路由器传输到基于云的计算机，用于远程数据处理和操纵。与装置1a-1n相关联的数据也可被传输至本地计算机系统210以用于本地数据处理和操纵。位于相同手术室中的模块化装置2a-2m也可联接到网络交换机209。网络交换机209可联接到网络集线器207和/或网络路由器211以将装置2a-2m连接至云204。与装置2a-2n相关联的数据可经由网络路由器211传输到云204以用于数据处理和操纵。与装置2a-2m相关联的数据也可被传输至本地计算机系统210以用于本地数据处理和操纵。Modular devices 1 a - 1 n located in the operating room may be coupled to themodular communication hub 203 .Network hub 207 and/ornetwork switch 209 may be coupled tonetwork router 211 to connect devices 1 a - 1 n to cloud 204 orlocal computer system 210 . Data associated with the devices 1a-1n may be transmitted via routers to cloud-based computers for remote data processing and manipulation. Data associated with devices 1a-1n may also be transmitted tolocal computer system 210 for local data processing and manipulation. Modular devices 2a-2m located in the same operating room may also be coupled to thenetwork switch 209.Network switch 209 may be coupled tonetwork hub 207 and/ornetwork router 211 to connect devices 2a-2m to cloud 204. Data associated with devices 2a-2n may be transmitted vianetwork router 211 to cloud 204 for data processing and manipulation. Data associated with devices 2a-2m may also be transmitted tolocal computer system 210 for local data processing and manipulation.

应当理解，可通过将多个网络集线器207和/或多个网络交换机209与多个网络路由器211互连来扩展外科数据网络201。模块化通信集线器203可被包含在模块化控制塔中，该模块化控制塔被配置成能够可滑动地接纳多个装置1a-1n/2a-2m。本地计算机系统210也可包含在模块化控制塔中。模块化通信集线器203连接到显示器212以显示例如在外科手术期间由装置1a-1n/2a-2m中的一些获得的图像。在各种方面，装置1a-1n/2a-2m可包括例如各种模块，诸如联接到内窥镜的成像模块138、联接到基于能量的外科装置的发生器模块140、排烟模块126、抽吸/冲洗模块128、通信模块130、处理器模块132、存储阵列134、连接到显示器的外科装置、和/或可连接到外科数据网络201的模块化通信集线器203的其它模块化装置中的非接触传感器模块。It should be appreciated that thesurgical data network 201 may be extended by interconnectingmultiple network hubs 207 and/or multiple network switches 209 withmultiple network routers 211 . Themodular communication hub 203 may be included in a modular control tower configured to slidably receive a plurality of devices 1a-1n/2a-2m.Local computer system 210 may also be included in the modular control tower. Themodular communication hub 203 is connected to the display 212 to display images obtained by some of the devices 1a-1n/2a-2m, for example, during a surgical procedure. In various aspects, devices 1a-1n/2a-2m may include, for example, various modules such asimaging module 138 coupled to an endoscope,generator module 140 coupled to an energy-based surgical device,smoke extraction module 126, smoke extraction Non-inspiration/irrigation module 128 ,communication module 130 ,processor module 132 ,storage array 134 , surgical device connected to a display, and/or other modular devices connectable tomodular communication hub 203 ofsurgical data network 201 Touch sensor module.

在一个方面，外科数据网络201可包括将装置1a-1n/2a-2m连接至云的(一个或多个)网络集线器、(一个或多个)网络交换机和(一个或多个)网络路由器的组合。联接到网络集线器或网络交换机的装置1a-1n/2a-2m中的任何一个或全部可实时收集数据并将数据传输到云计算机中以进行数据处理和操纵。应当理解，云计算依赖于共享计算资源，而不是使用本地服务器或个人装置来处理软件应用程序。可使用“云”一词作为“互联网”的隐喻，尽管该术语不受此限制。因此，本文可使用术语“云计算”来指“基于互联网的计算的类型”，其中将不同的服务(诸如服务器、存储器和应用程序)递送至位于外科室(例如，固定、运动、临时或现场手术室或空间)中的模块化通信集线器203和/或计算机系统210以及通过互联网连接至模块化通信集线器203和/或计算机系统210的装置。云基础设施可由云服务提供方维护。在这种情况下，云服务提供方可以是协调位于一个或多个手术室中的装置1a-1n/2a-2m的使用和控制的实体。云计算服务可基于由智能外科器械、机器人和位于手术室中的其它计算机化装置所收集的数据来执行大量计算。集线器硬件使多个装置或连接能够连接到与云计算资源和存储器通信的计算机。In one aspect, thesurgical data network 201 may include a network of hub(s), network switch(s), and network router(s) that connect the devices 1a-1n/2a-2m to the cloud combination. Any or all of the devices 1a-1n/2a-2m coupled to a network hub or network switch may collect data in real time and transmit the data to a cloud computer for data processing and manipulation. It should be understood that cloud computing relies on sharing computing resources, rather than using local servers or personal devices to process software applications. The term "cloud" can be used as a metaphor for "internet", although the term is not so limited. Accordingly, the term "cloud computing" may be used herein to refer to a "type of Internet-based computing" in which different services (such as servers, storage, and applications) are delivered to a surgical site (eg, stationary, mobile, ad hoc, or on-site) Amodular communication hub 203 and/orcomputer system 210 in an operating room or space) and devices connected to themodular communication hub 203 and/orcomputer system 210 via the Internet. Cloud infrastructure may be maintained by cloud service providers. In this case, the cloud service provider may be the entity that coordinates the use and control of the devices 1a-1n/2a-2m located in one or more operating rooms. Cloud computing services can perform extensive computations based on data collected by intelligent surgical instruments, robots, and other computerized devices located in operating rooms. Hub hardware enables multiple devices or connections to connect to a computer that communicates with cloud computing resources and storage.

对由装置1a-1n/2a-2m所收集的数据应用云计算机数据处理技术，外科数据网络提供改善的外科结果，降低的成本和改善的患者满意度。可采用装置1a-1n/2a-2m中的至少一些来观察组织状态以评估在组织密封和切割规程之后密封的组织的渗漏或灌注。可采用装置1a-1n/2a-2m中的至少一些来识别病理学，诸如疾病的影响，使用基于云的计算检查包括用于诊断目的的身体组织样本的图像的数据。这包括组织和表型的定位和边缘确认。可采用装置1a-1n/2a-2m中的至少一些使用与成像装置和技术(诸如叠加由多个成像装置捕集的图像)集成的各种传感器来识别身体的解剖结构。由装置1a-1n/2a-2m收集的数据(包括图像数据)可被传输到云204或本地计算机系统210或两者以用于数据处理和操纵，包括图像处理和操纵。可分析数据以通过确定是否可继续进行进一步治疗(诸如内窥镜式干预、新兴技术、靶向辐射、靶向干预和精确机器人对组织特异性位点和条件的应用来改善外科手术结果。此类数据分析可进一步采用结果分析处理，并且使用标准化方法可提供有益反馈以确认外科治疗和外科医生的行为，或建议修改外科治疗和外科医生的行为。Applying cloud computer data processing technology to the data collected by the devices 1a-1n/2a-2m, the Surgical Data Network provides improved surgical outcomes, reduced costs and improved patient satisfaction. At least some of the devices 1a-1n/2a-2m may be employed to observe tissue status to assess leakage or perfusion of the sealed tissue following the 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 disease, using cloud-based computing to examine data including images of body tissue samples for diagnostic purposes. This includes localization and edge confirmation of tissues and phenotypes. At least some of the devices 1a-1n/2a-2m may be employed to identify the anatomy of the body using various sensors integrated with imaging devices and techniques, such as overlaying images captured by multiple imaging devices. Data (including image data) collected by devices 1a-1n/2a-2m may be transmitted to cloud 204 orlocal computer system 210 or both for data processing and manipulation, including image processing and manipulation. Data can be analyzed to improve surgical outcomes by determining whether further treatments such as endoscopic interventions, emerging technologies, targeted radiation, targeted interventions, and precision robotics can be applied to tissue-specific sites and conditions. This Class data analysis can be further processed with outcome analysis, and the use of standardized methods can provide useful feedback to confirm surgical treatment and surgeon behavior, or recommend modifications to surgical treatment and surgeon behavior.

在一个具体实施中，手术室装置1a-1n可通过有线信道或无线信道连接至模块化通信集线器203，这取决于装置1a-1n至网络集线器的配置。在一个方面，网络集线器207可被实现为在开放式系统互连(OSI)模型的物理层上工作的本地网络广播装置。该网络集线器提供与位于同一手术室网络中的装置1a-1n的连接。网络集线器207以包的形式收集数据，并以半双工模式将其发送至路由器。网络集线器207不存储用于传输装置数据的任何媒体访问控制/因特网协议(MAC/IP)。装置1a-1n中的仅一个可一次通过网络集线器207发送数据。网络集线器207没有关于在何处发送信息并在每个连接上广播所有网络数据以及通过云204向远程服务器213(图9)广播所有网络数据的路由表或智能。网络集线器207可以检测基本网络错误诸如冲突，但将所有信息广播到多个端口可带来安全风险并导致瓶颈。In one implementation, the operating room devices 1a-1n may be connected to themodular communication hub 203 through wired channels or wireless channels, depending on the configuration of the devices 1a-1n to the network hub. In one aspect, thehub 207 may be implemented as a local network broadcaster operating at the physical layer of the Open Systems Interconnection (OSI) model. The network hub provides connections to devices 1a-1n located in the same operating room network. Thenetwork hub 207 collects the data in packets and sends it to the router in half-duplex mode. Thenetwork hub 207 does not store any Media Access Control/Internet Protocol (MAC/IP) used to transmit device data. Only one of the devices 1a-1n can send data through thenetwork hub 207 at a time. Thenetwork hub 207 has no routing tables or intelligence about where to send the information and broadcast all network data on each connection and through thecloud 204 to the remote server 213 (FIG. 9). Thenetwork hub 207 can detect basic network errors such as collisions, but broadcasting all information to multiple ports can introduce security risks and cause bottlenecks.

在另一个具体实施中，手术室装置2a-2m可通过有线信道或无线信道连接到网络交换机209。网络交换机209在OSI模型的数据链路层中工作。网络交换机209是用于将位于相同手术室中的装置2a-2m连接到网络的多点广播装置。网络交换机209以帧的形式向网络路由器211发送数据并且以全双工模式工作。多个装置2a-2m可通过网络交换机209同时发送数据。网络交换机209存储并使用装置2a-2m的MAC地址来传输数据。In another implementation, the operating room devices 2a-2m may be connected to thenetwork switch 209 through a wired channel or a wireless channel. Thenetwork switch 209 operates in the data link layer of the OSI model. Thenetwork switch 209 is a multicast device for connecting the devices 2a-2m located in the same operating room to the network.Network switch 209 sends data to networkrouter 211 in frames and operates in full duplex mode. Multiple devices 2a-2m can transmit data through thenetwork switch 209 simultaneously. Thenetwork switch 209 stores and uses the MAC addresses of the devices 2a-2m to transmit data.

网络集线器207和/或网络交换机209联接到网络路由器211以连接到云204。网络路由器211在OSI模型的网络层中工作。网络路由器211创建用于将从网络集线器207和/或网络交换机211接收的数据包发射至基于云的计算机资源的路由，以进一步处理和操纵由装置1a-1n/2a-2m中的任一者或所有收集的数据。可采用网络路由器211来连接位于不同位置的两个或更多个不同的网络，诸如例如同一医疗设施的不同手术室或位于不同医疗设施的不同手术室的不同网络。网络路由器211以包的形式向云204发送数据并且以全双工模式工作。多个装置可以同时发送数据。网络路由器211使用IP地址来传输数据。Network hub 207 and/ornetwork switch 209 are coupled tonetwork router 211 to connect to cloud 204 . Thenetwork router 211 works in the network layer of the OSI model.Network router 211 creates routes for transmitting packets received fromnetwork hub 207 and/ornetwork switch 211 to cloud-based computer resources for further processing and manipulation by any of devices 1a-1n/2a-2m or all collected data. Thenetwork router 211 may be employed to connect two or more different networks located in different locations, such as, for example, different operating rooms of the same medical facility or different networks located in different operating rooms of different medical facilities.Network router 211 sends data to cloud 204 in packets and operates in full duplex mode. Multiple devices can send data simultaneously. Thenetwork router 211 uses the IP address to transmit data.

在一个示例中，网络集线器207可被实现为USB集线器，其允许多个USB装置连接到主机。USB集线器可以将单个USB端口扩展到多个层级，以便有更多端口可用于将装置连接到主机系统计算机。网络集线器207可包括用于通过有线信道或无线信道接收信息的有线或无线能力。在一个方面，无线USB短距离、高带宽无线无线电通信协议可用于装置1a-1n和位于手术室中的装置2a-2m之间的通信。In one example, thenetwork hub 207 may be implemented as a USB hub that allows multiple USB devices to connect to a host. A USB hub can expand a single USB port to multiple levels so that more ports are available for connecting devices to a host system computer. Thenetwork hub 207 may include wired or wireless capabilities for receiving information over wired or wireless channels. In one aspect, a wireless USB short-range, high-bandwidth wireless radio communication protocol may be used for communication between devices 1a-1n and devices 2a-2m located in the operating room.

在其它示例中，手术室装置1a-1n/2a-2m可经由蓝牙无线技术标准与模块化通信集线器203通信，以用于在短距离(使用ISM频带中的2.4至2.485GHz的短波长UHF无线电波)从固定装置和运动装置交换数据以及构建个人局域网(PAN)。在其它方面，手术室装置1a-1n/2a-2m可经由多种无线或有线通信标准或协议与模块化通信集线器203通信，包括但不限于Wi-Fi(IEEE 802.11系列)、WiMAX(IEEE 802.16系列)、IEEE 802.20、长期演进(LTE)和Ev-DO、HSPA+、HSDPA+、HSUPA+、EDGE、GSM、GPRS、CDMA、TDMA、DECT、及其以太网衍生物、以及指定为3G、4G、5G和以上的任何其它无线和有线协议。计算模块可包括多个通信模块。例如，第一通信模块可专用于较短距离的无线通信诸如Wi-Fi和蓝牙，并且第二通信模块可专用于较长距离的无线通信，诸如GPS、EDGE、GPRS、CDMA、WiMAX、LTE、Ev-DO等。In other examples, the operating room devices 1a-1n/2a-2m may communicate with themodular communication hub 203 via the Bluetooth wireless technology standard for short wavelength UHF radios over short distances (using 2.4 to 2.485 GHz in the ISM band Waves) to exchange data from stationary and mobile devices and build Personal Area Networks (PANs). In other aspects, the operating room devices 1a-1n/2a-2m can communicate with themodular communication hub 203 via a variety of wireless or wired communication standards or protocols, including but not limited to Wi-Fi (IEEE 802.11 series), WiMAX (IEEE 802.16 Series), IEEE 802.20, Long Term Evolution (LTE) and Ev-DO, HSPA+, HSDPA+, HSUPA+, EDGE, GSM, GPRS, CDMA, TDMA, DECT, and their Ethernet derivatives, and designated as 3G, 4G, 5G and Any other wireless and wired protocols above. The computing module may include multiple communication modules. For example, the first communication module may be dedicated to shorter range wireless communications such as Wi-Fi and Bluetooth, and the second communication module may be dedicated to longer range wireless communication such as GPS, EDGE, GPRS, CDMA, WiMAX, LTE, Ev-DO et al.

模块化通信集线器203可用作手术室装置1a-1n/2a-2m中的一者或全部的中心连接，并且处理被称为帧的数据类型。帧携带由装置1a-1n/2a-2m生成的数据。当模块化通信集线器203接收到帧时，其被放大并发射至网络路由器211，该网络路由器211通过使用如本文所述的多个无线或有线通信标准或协议将数据传输到云计算资源。Themodular communication hub 203 may serve as a central connection for one or all of the operating room devices 1a-1n/2a-2m and handle a type of data known as a frame. Frames carry data generated by devices 1a-1n/2a-2m. When the frame is received by themodular communication hub 203, it is amplified and transmitted to thenetwork router 211, which transmits the data to the cloud computing resource using various wireless or wireline communication standards or protocols as described herein.

模块化通信集线器203可用作独立装置或连接到兼容的网络集线器和网络交换机以形成更大的网络。模块化通信集线器203通常易于安装、配置和维护，使得其成为对手术室装置1a-1n/2a-2m进行联网的良好选项。Modular communication hub 203 can be used as a stand-alone device or connected to compatible network hubs and network switches to form larger networks. Themodular communication hub 203 is generally easy to install, configure and maintain, making it a good option for networking the operating room devices 1a-1n/2a-2m.

图9示出了计算机实现的交互式外科系统200。计算机实现的交互式外科系统200在许多方面类似于计算机实现的交互式外科系统100。例如，计算机实现的交互式外科系统200包括在许多方面类似于外科系统102的一个或多个外科系统202。每个外科系统202包括与可包括远程服务器213的云204通信的至少一个外科集线器206。在一个方面，计算机实现的交互式外科系统200包括模块化控制塔236，该模块化控制塔236连接到多个手术室装置，诸如例如智能外科器械、机器人和位于手术室中的其它计算机化装置。如图10中所示，模块化控制塔236包括联接到计算机系统210的模块化通信集线器203。如图9的示例中所示，模块化控制塔236联接到内窥镜239的成像模块238、联接到能量装置241的发生器模块240、排烟器模块226、抽吸/冲洗模块228、通信模块230、处理器模块232、存储阵列234、任选地联接到显示器237的智能装置/器械235、和非接触传感器模块242。手术室装置经由模块化控制塔236联接到云计算资源和数据存储。机器人集线器222也可连接到模块化控制塔236和云计算资源。装置/器械235、可视化系统208等等可经由有线或无线通信标准或协议联接到模块化控制塔236，如本文所述。模块化控制塔236可联接到集线器显示器215(例如，监测器、屏幕)以显示和叠加从成像模块、装置/器械显示器和/或其它可视化系统208接收的图像。集线器显示器还可结合图像和叠加图像来显示从连接到模块化控制塔的装置接收的数据。FIG. 9 shows a computer-implemented interactivesurgical system 200 . The computer-implemented interactivesurgical system 200 is similar to the computer-implemented interactivesurgical system 100 in many respects. For example, computer-implemented interactivesurgical system 200 includes one or more surgical systems 202 that are similar in many respects tosurgical system 102 . Each surgical system 202 includes at least onesurgical hub 206 in communication with thecloud 204 , which may include aremote server 213 . In one aspect, the computer-implemented interactivesurgical system 200 includes amodular control tower 236 connected to a plurality of operating room devices, such as, for example, smart surgical instruments, robots, and other computerized devices located in the operating room . As shown in FIG. 10 ,modular control tower 236 includesmodular communication hub 203 coupled tocomputer system 210 . As shown in the example of FIG. 9,modular control tower 236 is coupled toimaging module 238 ofendoscope 239,generator module 240 coupled toenergy device 241,smoke evacuator module 226, suction/irrigation module 228,communication Module 230 ,processor module 232 ,storage array 234 , smart device/instrument 235 optionally coupled todisplay 237 , andcontactless sensor module 242 . The operating room equipment is coupled to cloud computing resources and data storage via themodular control tower 236 .Robotic hub 222 may also be connected tomodular control tower 236 and cloud computing resources. Devices/instruments 235, visualization system 208, etc. may be coupled tomodular control tower 236 via wired or wireless communication standards or protocols, as described herein.Modular control tower 236 may be coupled to hub display 215 (eg, monitor, screen) to display and overlay images received from imaging modules, device/instrument displays, and/or other visualization systems 208 . The hub display may also combine images and overlay images to display data received from devices connected to the modular control tower.

图10示出了包括联接到模块化控制塔236的多个模块的外科集线器206。模块化控制塔236包括模块化通信集线器203(例如，网络连接性装置)和计算机系统210，以提供例如本地处理、可视化和成像。如图10中所示，模块化通信集线器203可以分层配置连接以扩展可连接到模块化通信集线器203的模块(例如，装置)的数量，并将与模块相关联的数据传输至计算机系统210、云计算资源或两者。如图10中所示，模块化通信集线器203中的网络集线器/交换机中的每个包括三个下游端口和一个上游端口。上游网络集线器/交换机连接至处理器以提供与云计算资源和本地显示器217的通信连接。与云204的通信可通过有线或无线通信信道进行。FIG. 10 showssurgical hub 206 including multiple modules coupled tomodular control tower 236 .Modular control tower 236 includes modular communication hub 203 (eg, network connectivity device) andcomputer system 210 to provide, eg, local processing, visualization, and imaging. As shown in FIG. 10 , themodular communication hub 203 can be connected in a hierarchical configuration to expand the number of modules (eg, devices) that can be connected to themodular communication hub 203 and transmit data associated with the modules to thecomputer system 210 , cloud computing resources, or both. As shown in FIG. 10, each of the network hubs/switches inmodular communication hub 203 includes three downstream ports and one upstream port. An upstream hub/switch is connected to the processor to provide a communication connection with cloud computing resources and thelocal display 217 . Communication with thecloud 204 may be through wired or wireless communication channels.

外科集线器206采用非接触传感器模块242来测量手术室的尺寸，并且使用超声或激光型非接触测量装置来生成外科室的标测图。基于超声的非接触传感器模块通过发射一阵超声波并在其从手术室的围墙弹回时接收回波来扫描手术室，如在2017年12月28日提交的标题为“交互式外科平台(INTERACTIVE SURGICAL PLATFORM)”的美国临时专利申请序列号62/611,341中的标题“手术室内的外科集线器空间感知(Surgical Hub SpatialAwareness Within an Operating Room)”下所述，该专利全文以引用方式并入本文，其中传感器模块被配置成能够确定手术室的大小并调节蓝牙配对距离限制。基于激光的非接触传感器模块通过发射激光脉冲、接收从手术室的围墙弹回的激光脉冲，以及将发射脉冲的相位与所接收的脉冲进行比较来扫描手术室，以确定手术室的尺寸并调节蓝牙配对距离限制。Surgical hub 206 employsnon-contact sensor modules 242 to measure the dimensions of the operating room, and uses an ultrasonic or laser type non-contact measurement device to generate a map of the surgical room. Ultrasound-based non-contact sensor module scans operating rooms by emitting a burst of ultrasound and receiving echoes as it bounces off the walls of the operating room, as described in a December 28, 2017 submission titled "INTERACTIVE SURGICAL PLATFORM)" is described under the title "Surgical Hub SpatialAwareness Within an Operating Room" in U.S. Provisional Patent Application Serial No. 62/611,341, which is incorporated herein by reference in its entirety, wherein the sensor The module is configured to be able to determine the size of the operating room and adjust the Bluetooth pairing distance limit. The laser-based non-contact sensor module scans the operating room by emitting laser pulses, receiving laser pulses bouncing off the walls of the operating room, and comparing the phase of the emitted pulses with the received pulses to determine the size and condition of the operating room Bluetooth pairing distance limit.

计算机系统210包括处理器244和网络接口245。处理器244经由系统总线联接到通信模块247、存储装置248、存储器249、非易失性存储器250和输入/输出接口251。系统总线可为若干类型的总线结构中的任一者，该总线结构包括存储器总线或存储器控制器、外围总线或外部总线、和/或使用任何各种可用总线架构的本地总线，包括但不限于9位总线、工业标准架构(ISA)、微型Charmel架构(MSA)、扩展ISA(EISA)、智能驱动电子器件(IDE)、VESA本地总线(VLB)、外围部件互连(PCI)、USB、高级图形端口(AGP)、个人计算机存储卡国际协会总线(PCMCIA)、小型计算机系统接口(SCSI)或任何其它外围总线。Computer system 210 includesprocessor 244 andnetwork interface 245 .Processor 244 is coupled via a system bus tocommunication module 247 ,storage device 248 ,memory 249 ,non-volatile memory 250 , and input/output interface 251 . The system bus can be any of several types of bus structures, including a memory bus or memory controller, a peripheral bus or external bus, and/or a local bus using any of the various available bus architectures, including but not limited to 9-bit bus, Industry 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 System Interface (SCSI) or any other peripheral bus.

处理器244可为任何单核或多核处理器，诸如由德克萨斯器械公司(TexasInstruments)提供的商品名为ARM Cortex的那些处理器。在一个方面，处理器可为购自例如德克萨斯器械公司(Texas Instruments)LM4F230H5QR ARM Cortex-M4F处理器核心，其包括256KB的单循环闪存或其它非易失性存储器(最多至40MHZ)的片上存储器、用于改善40MHz以上的性能的预取缓冲器、32KB单循环序列随机存取存储器(SRAM)、装载有

软件的内部只读存储器(ROM)、2KB电可擦除可编程只读存储器(EEPROM)、和/或一个或多个脉宽调制(PWM)模块、一个或多个正交编码器输入(QEI)模拟、具有12个模拟输入信道的一个或多个12位模数转换器(ADC)，其细节可见于产品数据表。Processor 244 may be any single-core or multi-core processor, such as those offered by Texas Instruments under the tradename ARM Cortex. In one aspect, the processor may be a LM4F230H5QR ARM Cortex-M4F processor core available from, for example, Texas Instruments, which includes 256KB of single-cycle flash or other non-volatile memory (up to 40MHZ) On-chip memory, prefetch buffer for improved performance above 40MHz, 32KB single-cycle sequential random access memory (SRAM), loaded with

Internal Read Only Memory (ROM) for software, 2KB Electrically Erasable Programmable Read Only Memory (EEPROM), and/or 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 (ADCs) with 12 analog input channels, details of which can be found in the product data sheet.

在一个方面，处理器244可包括安全控制器，该安全控制器包括两个基于控制器的系列(诸如TMS570和RM4x)，已知同样由德克萨斯器械公司(Texas Instruments)生产的商品名为Hercules ARM Cortex R4。安全控制器可被配置成能够专门用于IEC 61508和ISO26262安全关键应用等等，以提供先进的集成安全特征部，同时递送可定标的性能、连接性和存储器选项。In one aspect, theprocessor 244 may include a safety controller including two series of controllers based (such as the TMS570 and RM4x) known under the trade names also produced by Texas Instruments For Hercules ARM Cortex R4. The safety controller can be configured to be dedicated to IEC 61508 and ISO26262 safety critical applications, among others, to provide advanced integrated safety features while delivering scalable performance, connectivity and memory options.

系统存储器包括易失性存储器和非易失性存储器。基本输入/输出系统(BIOS)(包含诸如在启动期间在计算机系统内的元件之间传输信息的基本例程，)存储在非易失性存储器中。例如，非易失性存储器可包括ROM、可编程ROM(PROM)、电可编程ROM(EPROM)、EEPROM或闪存。易失存储器包括充当外部高速缓存存储器的随机存取存储器(RAM)。此外，RAM可以多种形式可用，诸如SRAM、动态RAM(DRAM)、同步DRAM(SDRAM)、双数据速率SDRAM(DDRSDRAM)増强SDRAM(ESDRAM)、同步链路DRAM(SLDRAM)和直接Rambus RAM(DRRAM)。System memory includes volatile memory and nonvolatile memory. A basic input/output system (BIOS), which contains the basic routines for transferring information between elements within a computer system, such as during startup, is stored in non-volatile memory. For example, nonvolatile memory may include ROM, programmable ROM (PROM), electrically programmable ROM (EPROM), EEPROM, or flash memory. Volatile memory includes random access memory (RAM) that acts as external cache memory. Additionally, RAM is available in various forms such as SRAM, Dynamic RAM (DRAM), Synchronous DRAM (SDRAM), Double Data Rate SDRAM (DDRSDRAM), Enhanced SDRAM (ESDRAM), Synchronous Link DRAM (SLDRAM), and Direct Rambus RAM ( DRRAM).

计算机系统210还包括可移除/不可移除的、易失性/非易失性的计算机存储介质，诸如例如磁盘存储器。磁盘存储器包括但不限于诸如装置如磁盘驱动器、软盘驱动器、磁带驱动器、Jaz驱动器、Zip驱动器、LS-60驱动器、闪存存储卡或内存条。此外，磁盘存储器可包括单独地或与其它存储介质组合的存储介质，包括但不限于光盘驱动器诸如光盘ROM装置(CD-ROM)、光盘可记录驱动器(CD-R驱动器)、光盘可重写驱动器(CD-RW驱动器)或数字通用磁盘ROM驱动器(DVD-ROM)。为了有利于磁盘存储装置与系统总线的连接，可使用可移除或非可移除接口。Computer system 210 also includes removable/non-removable, volatile/non-volatile computer storage media, such as, for example, disk storage. Disk storage includes, but is not limited to, devices such as disk drives, floppy disk drives, tape drives, Jaz drives, Zip drives, LS-60 drives, flash memory cards, or memory sticks. In addition, magnetic disk storage may include storage media alone or in combination with other storage media, including but not limited to optical disk drives such as compact disk ROM devices (CD-ROMs), compact disk recordable drives (CD-R drives), compact disk rewritable drives (CD-RW drive) or digital versatile disk ROM drive (DVD-ROM). To facilitate the connection of the disk storage device to the system bus, removable or non-removable interfaces may be used.

应当理解，计算机系统210包括充当用户与在合适的操作环境中描述的基本计算机资源之间的中介的软件。此类软件包括操作系统。可存储在磁盘存储装置上的操作系统用于控制并分配计算机系统的资源。系统应用程序利用操作系统通过存储在系统存储器或磁盘存储装置中的程序模块和程序数据来管理资源。应当理解，本文所述的各种部件可用各种操作系统或操作系统的组合来实现。It should be understood thatcomputer system 210 includes software that acts as an intermediary between a user and the underlying computer resources described in a suitable operating environment. Such software includes operating systems. An operating system, which may be stored on disk storage, is used to control and allocate the resources of the computer system. System applications utilize the operating system to manage resources through program modules and program data stored in system memory or disk storage. It should be understood that the various components described herein may be implemented with various operating systems or combinations of operating systems.

用户通过联接到I/O接口251的(一个或多个)输入装置将命令或信息输入到计算机系统210中。输入装置包括但不限于指向装置，诸如鼠标、触控球、触笔、触摸板、键盘、麦克风、操纵杆、游戏垫、卫星盘、扫描仪、电视调谐器卡、数字相机、数字摄像机、幅材相机等。这些和其它输入装置经由(一个或多个)接口端口通过系统总线连接到处理器。(一个或多个)接口端口包括例如串口、并行端口、游戏端口和USB。(一个或多个)输出装置使用与(一个或多个)输入装置相同类型的端口。因此，例如，USB端口可用于向计算机系统提供输入并将信息从计算机系统输出到输出装置。提供了输出适配器来说明在其它输出装置中存在需要特殊适配器的一些输出装置(如监测器、显示器、扬声器和打印机。输出适配器以举例的方式包括但不限于提供输出装置和系统总线之间的连接装置的视频和声卡。应当指出，其它装置或装置诸如(一个或多个)远程计算机的系统提供了输入能力和输出能力两者。A user enters commands or information intocomputer system 210 through input device(s) coupled to I/O interface 251 . Input devices include, but are not limited to, pointing devices such as mice, touch balls, styluses, touch pads, keyboards, microphones, joysticks, game pads, satellite dishes, scanners, TV tuner cards, digital cameras, digital video cameras, material camera, etc. These and other input devices are connected to the processor through the system bus via interface port(s). The interface port(s) include, for example, serial ports, parallel ports, game ports, and USB. The output device(s) use the same type of ports as the input device(s). Thus, for example, a USB port can be used to provide input to a computer system and output information from the computer system to an output device. Output adapters are provided to illustrate that there are some output devices (such as monitors, displays, speakers, and printers) that require special adapters among other output devices. Output adapters include, by way of example, but are not limited to, providing a connection between an output device and a system bus The device's video and sound cards. It should be noted that other devices or systems such as remote computer(s) provide both input and output capabilities.

计算机系统210可使用与一个或多个远程计算机(诸如(一个或多个)云计算机)或本地计算机的逻辑连接在联网环境中操作。(一个或多个)远程云计算机可为个人计算机、服务器、路由器、网络PC、工作站、基于微处理器的器具、对等装置或其它公共网络节点等，并且通常包括相对于计算机系统所述的元件中的许多或全部。为简明起见，仅示出了具有(一个或多个)远程计算机的存储器存储装置。(一个或多个)远程计算机通过网络接口在逻辑上连接到计算机系统，并且然后经由通信连接物理连接。网络接口涵盖通信网络诸如局域网(LAN)和广域网(WAN)。LAN技术包括光纤分布式数据接口(FDDI)、铜分布式数据接口(CDDI)、以太网/IEEE 802.3、令牌环/IEEE 802.5等。WAN技术包括但不限于点对点链路、电路交换网络如综合业务数字网络(ISDN)及其变体、分组交换网络和数字用户管线(DSL)。Computer system 210 may 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) may be personal computers, servers, routers, network PCs, workstations, microprocessor-based appliances, peer-to-peer devices, or other public network nodes, etc., and generally include the computer systems described with respect to many or all of the elements. For simplicity, only the memory storage device is shown with the remote computer(s). The remote computer(s) are logically connected to the computer system through a network interface, and then physically connected via a communication connection. Network interfaces encompass 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-switched networks such as Integrated Services Digital Network (ISDN) and variants thereof, packet-switched networks, and Digital Subscriber Line (DSL).

在各种方面，图10的计算机系统210、成像模块238和/或可视化系统208、和/或图9-10的处理器模块232可包括图像处理器、图像处理引擎、媒体处理器、或用于处理数字图像的任何专用数字信号处理器(DSP)。图像处理器可采用具有单个指令、多数据(SIMD)或多指令、多数据(MIMD)技术的并行计算以提高速度和效率。数字图像处理引擎可执行一系列任务。图像处理器可为具有多核处理器架构的芯片上的系统。In various aspects,computer system 210,imaging module 238 and/or visualization system 208 of FIG. 10, and/orprocessor module 232 of FIGS. 9-10 may include an image processor, an image processing engine, a media processor, or a Any dedicated digital signal processor (DSP) for processing digital images. Image processors may employ parallel computing with single instruction, multiple data (SIMD) or multiple instruction, multiple data (MIMD) techniques to increase speed and efficiency. A digital image processing engine can perform a series of tasks. The image processor may be a system-on-a-chip with a multi-core processor architecture.

(一个或多个)通信连接是指用于将网络接口连接到总线的硬件/软件。虽然示出了通信连接以便在计算机系统内进行示例性澄清，但其也可位于计算机系统210的外部。连接到网络接口所必需的硬件/软件仅出于示例性目的包括内部和外部技术，诸如调制解调器，包括常规的电话级调制解调器、电缆调制解调器和DSL调制解调器、ISDN适配器和以太网卡。The communication connection(s) refers to the hardware/software used to connect the network interface to the bus. Although shown for example clarification within the computer system, the communication connection may also be located external to thecomputer system 210 . The hardware/software necessary to connect to the network interface includes, for exemplary purposes only, internal and external technologies, such as modems, including conventional telephone-grade modems, cable and DSL modems, ISDN adapters, and Ethernet cards.

图11示出了根据本公开的至少一个方面的USB网络集线器300装置的一个方面的功能框图。在例示的方面，USB网络集线器装置300采用得克萨斯器械公司(TexasInstruments)的TUSB2036集成电路集线器。USB网络集线器300是根据USB 2.0规范提供上游USB收发器端口302和多达三个下游USB收发器端口304、306、308的CMOS装置。上游USB收发器端口302为差分根数据端口，其包括与差分数据正(DM0)输入配对的差分数据负(DP0)输入。三个下游USB收发器端口304、306、308为差分数据端口，其中每个端口包括与差分数据负(DM1-DM3)输出配对的差分数据正(DP1-DP3)输出。11 shows a functional block diagram of one aspect of aUSB hub 300 device in accordance with at least one aspect of the present disclosure. In an illustrative aspect, theUSB hub device 300 employs a TUSB2036 integrated circuit hub from Texas Instruments. TheUSB hub 300 is a CMOS device that provides an upstreamUSB transceiver port 302 and up to three downstreamUSB transceiver ports 304, 306, 308 in accordance with the USB 2.0 specification. The upstreamUSB transceiver port 302 is a differential root data port that includes a differential data negative (DP0) input paired with a differential data positive (DM0) input. The three downstreamUSB transceiver ports 304, 306, 308 are differential data ports, where each port includes a differential data positive (DP1-DP3) output paired with a differential data negative (DM1-DM3) output.

USB网络集线器300装置用数字状态机而不是微控制器来实现，并且不需要固件编程。完全兼容的USB收发器集成到用于上游USB收发器端口302和所有下游USB收发器端口304、306、308的电路中。下游USB收发器端口304、306、308通过根据附接到端口的装置的速度自动设定转换速率来支持全速度装置和低速装置两者。USB网络集线器300装置可被配置成能够处于总线供电模式或自供电模式，并且包括用于管理功率的集线器功率逻辑312。TheUSB hub 300 device is implemented with a digital state machine rather than a microcontroller, and does not require firmware programming. A fully compliant USB transceiver is integrated into the circuitry for the upstreamUSB transceiver port 302 and all downstreamUSB transceiver ports 304 , 306 , 308 . The downstreamUSB transceiver ports 304, 306, 308 support both full-speed devices and low-speed devices by automatically setting the slew rate according to the speed of the device attached to the port. TheUSB hub 300 device may be configured to be capable of being in a bus-powered mode or a self-powered mode, and includeshub power logic 312 for managing power.

USB网络集线器300装置包括串行接口引擎310(SIE)。SIE 310是USB网络集线器300硬件的前端，并处理USB规范第8章中描述的大多数协议。SIE 310通常包括多达交易级别的信令。其处理的功能可包括：包识别、事务排序、SOP、EOP、RESET和RESUME信号检测/生成、时钟/数据分离、不返回到零反转(NRZI)数据编码/解码和数位填充、CRC生成和校验(令牌和数据)、包ID(PID)生成和校验/解码、和/或串行并行/并行串行转换。310接收时钟输入314并且联接到暂停/恢复逻辑和帧定时器316电路以及集线器中继器电路318，以通过端口逻辑电路320、322、324控制上游USB收发器端口302和下游USB收发器端口304、306、308之间的通信。SIE 310经由接口逻辑联接到命令解码器326，以经由串行EEPROM接口330来控制来自串行EEPROM的命令。TheUSB hub 300 device includes a serial interface engine 310 (SIE). TheSIE 310 is the front end of theUSB hub 300 hardware and handles most of the protocols described inChapter 8 of the USB specification.SIE 310 typically includes up to transaction level signaling. The functions it handles can include: packet identification, transaction sequencing, SOP, EOP, RESET and RESUME signal detection/generation, clock/data separation, non-return to zero inversion (NRZI) data encoding/decoding and bit stuffing, CRC generation and Check (token and data), packet ID (PID) generation and check/decode, and/or serial-to-parallel/parallel-to-serial conversion. 310 receivesclock input 314 and couples to suspend/resume logic andframe timer 316 circuit andhub repeater circuit 318 to control upstreamUSB transceiver port 302 and downstreamUSB transceiver port 304 throughport logic circuits 320, 322, 324 , 306, 308 communication.SIE 310 is coupled via interface logic to commanddecoder 326 to control commands from the serial EEPROM viaserial EEPROM interface 330 .

在各种方面，USB网络集线器300可将配置在多达六个逻辑层(层级)中的127功能连接至单个计算机。此外，USB网络集线器300可使用提供通信和电力分配两者的标准化四线电缆连接到所有外装置。功率配置为总线供电模式和自供电模式。USB网络集线器300可被配置成能够支持四种功率管理模式：具有单独端口功率管理或成套端口功率管理的总线供电集线器，以及具有单独端口功率管理或成套端口功率管理的自供电集线器。在一个方面，使用USB电缆将USB网络集线器300、上游USB收发器端口302插入USB主机控制器中，并且将下游USB收发器端口304、306、308暴露以用于连接USB兼容装置等。In various aspects, theUSB hub 300 can connect 127 functions configured in up to six logical layers (hierarchies) to a single computer. Additionally, theUSB hub 300 can be connected to all external devices using a standardized four-wire cable that provides both communication and power distribution. The power configuration is bus-powered and self-powered. TheUSB hub 300 can be configured to support four power management modes: a bus-powered hub with individual port power management or set of port power management, and a self-powered hub with individual port power management or set of port power management. In one aspect,USB hub 300, upstreamUSB transceiver port 302 is plugged into a USB host controller using a USB cable, and downstreamUSB transceiver ports 304, 306, 308 are exposed for connecting USB compatible devices, and the like.

外科器械硬件Surgical Instrument Hardware

图12示出了根据本公开的一个或多个方面的外科器械或工具的控制系统470的逻辑图。系统470包括控制电路。该控制电路包括微控制器461，该微控制器包括处理器462和存储器468。例如，传感器472、474、476中的一个或多个向处理器462提供实时反馈。由马达驱动器492驱动的马达482可操作地联接纵向可运动的位移构件以驱动I形梁刀元件。跟踪系统480被配置成能够确定纵向可运动的位移构件的位置。将位置信息提供给处理器462，该处理器可被编程或配置成能够确定纵向可运动的驱动构件的位置以及击发构件、击发杆和I形梁刀元件的位置。附加马达可设置在工具驱动器接口处，以控制I形梁击发、闭合管行进、轴旋转和关节运动。显示器473显示器械的多种操作条件并且可包括用于数据输入的触摸屏功能。显示在显示器473上的信息可叠加有经由内窥镜式成像模块获取的图像。12 shows a logic diagram of acontrol system 470 for a surgical instrument or tool in accordance with one or more aspects of the present disclosure.System 470 includes control circuitry. The control circuit includes amicrocontroller 461 that includes a processor 462 and amemory 468 . For example, one or more of thesensors 472 , 474 , 476 provide real-time feedback to the processor 462 . Amotor 482 driven by amotor driver 492 operably couples the longitudinally movable displacement member to drive the I-beam knife element. Thetracking system 480 is configured to be able to determine the position of the longitudinally movable displacement member. The position information is provided to processor 462, which may be programmed or configured to determine the position of the longitudinally movable drive member and the position of the firing member, firing rod, 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.Display 473 displays various operating conditions of the instrument and may include touch screen functionality for data entry. The information displayed on thedisplay 473 may be superimposed with images acquired via the endoscopic imaging module.

在一个方面，微控制器461可为任何单核或多核处理器，诸如已知的由德克萨斯器械公司(Texas Instruments)生产的商品名为ARM Cortex的那些。在一个方面，主微控制器461可为购自例如德克萨斯器械公司(Texas Instruments)的LM4F230H5QR ARM Cortex-M4F处理器核心，其包括256KB的单循环闪存或其它非易失性存储器(最多至40MHZ)的片上存储器、用于改善40MHz以上的性能的预取缓冲器、32KB单循环SRAM、装载有

软件的内部ROM、2KB的EEPROM、一个或多个PWM模块、一个或多个QEI模拟、和/或具有12个模拟输入信道的一个或多个12位ADC，其细节可见于产品数据表。In one aspect,microcontroller 461 can be any single-core or multi-core processor, such as those known under the tradename ARM Cortex from Texas Instruments. In one aspect, themain microcontroller 461 may be a LM4F230H5QR ARM Cortex-M4F processor core available from, for example, Texas Instruments, which includes 256KB of single-cycle flash or other non-volatile memory (up to to 40MHz) on-chip memory, prefetch buffer for improved performance above 40MHz, 32KB single-cycle SRAM, loaded with

Software's internal ROM, 2KB of 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 can be found in the product data sheet.

在一个方面，微控制器461可包括安全控制器，该安全控制器包括两个基于控制器的系列(诸如TMS570和RM4x)，已知同样由德克萨斯器械公司(Texas Instruments)生产的商品名为Hercules ARM Cortex R4。安全控制器可被配置成能够专门用于IEC 61508和ISO26262安全关键应用等等，以提供先进的集成安全特征部，同时递送可定标的性能、连接性和存储器选项。In one aspect,microcontroller 461 may include a safety controller including two families of controllers based (such as the TMS570 and RM4x) known as commercial products also produced by Texas Instruments Named the Hercules ARM Cortex R4. The safety controller can be configured to be dedicated to IEC 61508 and ISO26262 safety critical applications, among others, to provide advanced integrated safety features while delivering scalable performance, connectivity and memory options.

可对微控制器461进行编程以执行各种功能，诸如对刀和关节运动系统的速度和位置的精确控制。在一个方面，微控制器461包括处理器462和存储器468。电动马达482可为有刷直流(DC)马达，其具有齿轮箱以及至关节运动或刀系统的机械链路。在一个方面，马达驱动器492可为可购自Allegro微系统公司(Allegro Microsystems,Inc)的A3941。其它马达驱动器可容易地被替换以用于包括绝对定位系统的跟踪系统480中。绝对定位系统的详细描述在2017年10月19日公布的标题为用于控制外科缝合和切割器械的系统和方法(SYSTEMS AND METHODS FOR CONTROLLING A SURGICAL STAPLING AND CUTTINGINSTRUMENT)的美国专利申请公布2017/0296213中有所描述，该专利申请全文以引用方式并入本文。Themicrocontroller 461 can be programmed to perform various functions, such as precise control of the speed and position of the knife and articulation system. In one aspect,microcontroller 461 includes processor 462 andmemory 468 .Electric motor 482 may be a brushed direct current (DC) motor with a gearbox and mechanical link to an articulation or knife system. In one aspect, themotor driver 492 may be A3941 available from Allegro Microsystems, Inc. Other motor drives can be easily replaced for use intracking system 480 including an absolute positioning system. A detailed description of the absolute positioning system is in US Patent Application Publication 2017/0296213, published October 19, 2017, entitled SYSTEMS AND METHODS FOR CONTROLLING A SURGICAL STAPLING AND CUTTING INSTRUMENT, entitled SYSTEMS AND METHODS FOR CONTROLLING A SURGICAL STAPLING AND CUTTING INSTRUMENT As described, this patent application is incorporated herein by reference in its entirety.

微控制器461可被编程为提供对位移构件和关节运动系统的速度和位置的精确控制。微控制器461可被配置成能够计算微控制器461的软件中的响应。将计算的响应与实际系统的所测量响应进行比较，以获得“观察到的”响应，其用于实际反馈决定。观察到的响应为有利的调谐值，该值使所模拟响应的平滑连续性质与所测量响应均衡，这可检测对系统的外部影响。Themicrocontroller 461 can be programmed to provide precise control of the speed and position of the displacement member and articulation system. Themicrocontroller 461 may be configured to be able to calculate the responses in the software of themicrocontroller 461 . The calculated response is compared to the measured response of the actual system to obtain the "observed" response, which is used for actual feedback decisions. The observed response is a favorable tuning value that equalizes the smooth continuous nature of the simulated response with the measured response, which can detect external influences on the system.

在一个方面，马达482可由马达驱动器492控制并可被外科器械或工具的击发系统采用。在各种形式中，马达482可为具有大约25,000RPM的最大旋转速度的有刷DC驱动马达。在其他布置中，马达482可包括无刷马达、无绳马达、同步马达、步进马达或任何其他合适的电动马达。马达驱动器492可包括例如包括场效应晶体管(FET)的H桥驱动器。马达482可通过可释放地安装到柄部组件或工具外壳的功率组件来供电，以用于向外科器械或工具供应控制功率。功率组件可包括电池，该电池可以包括串联连接的、可用作功率源以为外科器械或工具提供电力的多个电池单元。在某些情况下，功率组件的电池单元可以是可替换的和/或可再充电的。在至少一个示例中，电池单元可为锂离子电池，其可联接到功率组件并且可与功率组件分离。In one aspect,motor 482 may be controlled bymotor driver 492 and may be employed by a firing system of a surgical instrument or tool. In various forms, themotor 482 may be a brushed DC drive motor with a maximum rotational speed of approximately 25,000 RPM. In other arrangements, themotor 482 may comprise a brushless motor, a cordless motor, a synchronous motor, a stepper motor, or any other suitable electric motor.Motor driver 492 may include, for example, an H-bridge driver including field effect transistors (FETs).Motor 482 may 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 can include a battery, which can include a plurality of battery cells connected in series that can be used as a power source to provide power to a surgical instrument or tool. In some cases, 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 that can be coupled to and detachable from the power assembly.

马达驱动器492可为可购自Allegro微系统公司(Allegro Microsystems,Inc)的A3941。A3941 492为全桥控制器，其用于与针对电感负载(诸如有刷DC马达)特别设计的外部N信道功率金属氧化物半导体场效应晶体管(MOSFET)一起使用。驱动器492包括独特的电荷泵调整器，其为低至7V的电池电压提供完整的(>10V)栅极驱动并且允许A3941在低至5.5V的减小的栅极驱动下操作。可采用自举电容器来提供N信道MOSFET所需的上述电池供电电压。高边驱动装置的内部电荷泵允许直流(100％占空比)操作。可使用二极管或同步整流在快衰减模式或慢衰减模式下驱动全桥。在慢衰减模式下，电流再循环可穿过高边或低边FET。通过电阻器可调式空载时间保护功率FET不被击穿。整体诊断提供欠压、过热和功率桥故障的指示，并且可被配置成能够在大多数短路条件下保护功率MOSFET。其它马达驱动器可容易地被替换以用于包括绝对定位系统的跟踪系统480中。Themotor driver 492 may be A3941 available from Allegro Microsystems, Inc. TheA3941 492 is a full bridge controller for use with external N-channel power metal oxide semiconductor field effect transistors (MOSFETs) specially designed for inductive loads such as brushed DC motors.Driver 492 includes a unique charge pump regulator that provides full (>10V) gate drive for battery voltages as low as 7V and allows the A3941 to operate at reduced gate drive as low as 5.5V. A bootstrap capacitor can be used to provide the above-mentioned battery supply voltage required for the N-channel MOSFET. The internal charge pump of the high-side driver allows DC (100% duty cycle) operation. The full bridge can be driven in either fast decay mode or slow decay mode using diodes or synchronous rectification. In slow decay mode, current recirculation can pass through the high-side or low-side FET. Power FETs are protected from breakdown by resistor-adjustable dead time. Integral 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 drives can be easily replaced for use intracking system 480 including an absolute positioning system.

跟踪系统480包括根据本公开的至少一个方面的包括位置传感器472的受控马达驱动电路布置方式。用于绝对定位系统的位置传感器472提供对应于位移构件的位置的独特位置信号。在一个方面，位移构件表示纵向可运动的驱动构件，其包括用于与齿轮减速器组件的对应驱动齿轮啮合接合的驱动齿的齿条。在其它方面，位移构件表示击发构件，该击发构件可被适配和配置成能够包括驱动齿的齿条。在又一个方面，位移构件表示击发杆或I形梁，每一者可被适配和配置成能够包括驱动齿的齿条。因此，如本文所用，术语位移构件通常用于指外科器械或工具的任何可运动的构件诸如驱动构件、击发构件、击发杆、I形梁或可进行移位的任何元件。在一个方面，纵向可运动的驱动构件联接到击发构件、击发杆和I形梁。因此，绝对定位系统实际上可通过跟踪纵向可运动的驱动构件的线性位移来跟踪I形梁的线性位移。在各种其它方面，位移构件可联接到适于测量线性位移的任何位置传感器472。因此，纵向可运动的驱动构件、击发构件、击发杆或I形梁或它们的组合可联接到任何合适的线性位移传感器。线性位移传感器可包括接触式位移传感器或非接触式位移传感器。线性位移传感器可包括线性可变差分变压器(LVDT)、差分可变磁阻换能器(DVRT)、滑动电位计、包括可运动磁体和一系列线性布置的霍尔效应传感器的磁感测系统、包括固定磁体和一系列可运动的线性布置的霍尔效应传感器的磁感测系统、包括可运动光源和一系列线性布置的光电二极管或光电检测器的光学感测系统、包括固定光源和一系列可运动的线性布置的光电二极管或光电检测器的光学感测系统、或它们的任何组合。Tracking system 480 includes a controlled motor drive circuit arrangement includingposition sensor 472 in accordance with at least one aspect of the present disclosure. Aposition sensor 472 for an absolute positioning system provides a unique position signal corresponding to the position of the displacement member. In one aspect, the displacement member represents a longitudinally movable drive member that includes a rack of drive teeth for meshing engagement with corresponding drive gears of the gear reducer assembly. In other aspects, the displacement member represents a firing member that can be adapted and configured to include a rack of drive teeth. In yet another aspect, the displacement member represents a firing rod or an I-beam, each of which may be adapted and configured to include a rack of drive teeth. Thus, as used herein, the term displacement member is generally used to refer to any movable member of a surgical instrument or tool such as a drive member, firing member, firing rod, 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 rod, and the I-beam. Thus, the absolute positioning system can actually track the linear displacement of the I-beam by tracking the linear displacement of the longitudinally movable drive member. In various other aspects, the displacement member may be coupled to anyposition sensor 472 suitable for measuring linear displacement. Accordingly, the longitudinally movable drive member, firing member, firing rod or I-beam, or combination thereof, may be coupled to any suitable linear displacement sensor. Linear displacement sensors may include contact displacement sensors or non-contact displacement sensors. Linear displacement sensors may include linear variable differential transformers (LVDTs), differential variable reluctance transducers (DVRTs), sliding potentiometers, magnetic sensing systems including movable magnets and a series of linearly arranged Hall effect sensors, Magnetic sensing system comprising a fixed magnet and a series of movable linearly arranged Hall effect sensors, optical sensing system comprising a movable light source and a series of linearly arranged photodiodes or photodetectors, comprising a fixed light source and a series of Optical sensing system of movable linearly arranged photodiodes or photodetectors, or any combination thereof.

电动马达482可包括可操作地与齿轮组件交接的可旋转轴，该齿轮组件与驱动齿的组或齿条啮合接合安装在位移构件上。传感器元件可以可操作地联接到齿轮组件，使得位置传感器472元件的单次旋转对应于位移构件的一些线性纵向平移。传动装置和传感器的布置方式可经由齿条和小齿轮布置方式连接至线性致动器，或者经由正齿轮或其它连接方式连接至旋转致动器。功率源为绝对定位系统供电，并且输出指示器可显示绝对定位系统的输出。位移构件表示纵向可运动的驱动构件，该纵向可运动的驱动构件包括形成于其上的驱动齿的齿条，以用于与齿轮减速器组件的对应驱动齿轮啮合接合。位移构件表示纵向可运动的击发构件、击发杆、I形梁或它们的组合。Theelectric motor 482 may include a rotatable shaft operatively interfacing with a gear assembly mounted on the displacement member in meshing engagement with a set or rack of drive teeth. The sensor element may be operably coupled to the gear assembly such that a single rotation of theposition sensor 472 element corresponds to some linear longitudinal translation of the displacement member. The transmission and sensor arrangement may be connected to a linear actuator via a rack and pinion arrangement, or to a rotary actuator via a spur gear or other connection. The power source powers the absolute positioning system, and the output indicator shows the output of the absolute positioning system. The displacement member represents a longitudinally movable drive member including a rack of drive teeth formed thereon for meshing engagement with a corresponding drive gear of the gear reducer assembly. Displacement members represent longitudinally movable firing members, firing rods, I-beams, or combinations thereof.

与位置传感器472相关联的传感器元件的单次旋转等同于位移构件的纵向线性位移d1，其中d1为在联接到位移构件的传感器元件的单次旋转之后位移构件从点“a”运动到点“b”的纵向线性距离。可经由齿轮减速连接传感器布置方式，该齿轮减速使得位置传感器472针对位移构件的全行程仅完成一次或多次旋转。位置传感器472可针对位移构件的全行程完成多次旋转。A single rotation of the sensor element associated withposition sensor 472 is equivalent to the longitudinal linear displacement d1 of the displacement member, where d1 is the movement of the displacement member from point "a" to point "after a single rotation of the sensor element coupled to the displacement member b" longitudinal linear distance. The sensor arrangement may be connected via gear reduction such that theposition sensor 472 only completes one or more revolutions for the full travel of the displacement member. Theposition sensor 472 may complete multiple rotations for the full travel of the displacement member.

可单独或结合齿轮减速采用一系列开关(其中n为大于一的整数)以针对位置传感器472的多于一次旋转提供独特位置信号。开关的状态被馈送回微控制器461，该微控制器应用逻辑以确定对应于位移构件的纵向线性位移d1+d2+…dn的独特位置信号。位置传感器472的输出被提供给微控制器461。该传感器布置方式的位置传感器472可包括磁性传感器、模拟旋转传感器(如电位差计)、模拟霍尔效应元件的阵列，该霍尔效应元件的阵列输出位置信号或值的独特组合。A series of switches (where n is an integer greater than one) may be employed alone or in combination with gear reduction to provide a unique position signal for more than one rotation of theposition sensor 472 . The state of the switch is fed back to themicrocontroller 461, which applies logic to determine a unique position signal corresponding to the longitudinal linear displacement d1+d2+...dn of the displacement member. The output ofposition sensor 472 is provided tomicrocontroller 461 . Theposition sensor 472 of this sensor arrangement may include a magnetic sensor, an analog rotary sensor (eg, a potentiometer), an array of analog Hall effect elements that output a unique combination of position signals or values.

位置传感器472可包括任何数量的磁性感测元件，诸如例如根据它们是否测量磁场的总磁场或矢量分量而被分类的磁性传感器。用于产生上述两种类型磁性传感器的技术涵盖物理学和电子学的多个方面。用于磁场感测的技术包括探查线圈、磁通门、光泵、核旋、超导量子干涉仪(SQUID)、霍尔效应、各向异性磁电阻、巨磁电阻、磁性隧道结、巨磁阻抗、磁致伸缩/压电复合材料、磁敏二极管、磁敏晶体管、光纤、磁光，以及基于微机电系统的磁性传感器等等。Position sensor 472 may include any number of magnetic sensing elements, such as, for example, magnetic sensors classified according to whether they measure the total magnetic or vector component of the magnetic field. The techniques used to create the two types of magnetic sensors described above cover many aspects of physics and electronics. Technologies for magnetic field sensing include probe coils, fluxgates, optical pumps, nuclear spins, superconducting quantum interferometers (SQUIDs), Hall effect, anisotropic magnetoresistance, giant magnetoresistance, magnetic tunnel junction, giant magneto Impedance, magnetostrictive/piezoelectric composites, magneto-sensitive diodes, magneto-sensitive transistors, optical fibers, magneto-optical, and MEMS-based magnetic sensors, etc.

在一个方面，用于包括绝对定位系统的跟踪系统480的位置传感器472包括磁性旋转绝对定位系统。位置传感器472可被实现为AS5055EQFT单片磁性旋转位置传感器，其可购自奥地利微系统公司(Austria Microsystems,AG)。位置传感器472与微控制器461交接，以提供绝对定位系统。位置传感器472为低电压和低功率部件，并且包括位于磁体上的位置传感器472的区域中的四个霍尔效应元件。在芯片上还提供了高分辨率ADC和智能功率管理控制器。提供了坐标旋转数字计算机(CORDIC)处理器(也被称为逐位法和Volder算法)以执行简单有效的算法来计算双曲线函数和三角函数，其仅需要加法、减法、数位位移和表格查找操作。角位置、报警位和磁场信息通过标准串行通信接口(诸如串行外围接口(SPI)接口)发射到微控制器461。位置传感器472提供12或14位分辨率。位置传感器472可为以小QFN 16引脚4×4×0.85mm封装提供的AS5055芯片。In one aspect, theposition sensor 472 for thetracking system 480 including the absolute positioning system includes a magnetic rotary absolute positioning system.Position sensor 472 may be implemented as an AS5055EQFT monolithic magnetic rotary position sensor, available from Austria Microsystems, AG.Position sensor 472 interfaces withmicrocontroller 461 to provide an absolute positioning system. Theposition sensor 472 is a low voltage and low power component and includes four Hall effect elements located in the area of theposition sensor 472 on the magnet. A high-resolution ADC and an intelligent power management controller are also provided on-chip. Coordinate Rotation Digital Computer (CORDIC) processors (also known as bitwise and Volder's algorithms) are provided to perform simple and efficient algorithms to compute hyperbolic and trigonometric functions that require only addition, subtraction, digit shifts and table lookups operate. Angular position, alarm bits, and magnetic field information are transmitted tomicrocontroller 461 through a standard serial communication interface, such as a Serial Peripheral Interface (SPI) interface.Position sensor 472 provides 12 or 14 bit resolution.Position sensor 472 may be an AS5055 chip provided in a small QFN 16-pin 4x4x0.85mm package.

包括绝对定位系统的跟踪系统480可包括并且/或者可被编程以实现反馈控制器，诸如PID、状态反馈和自适应控制器。功率源将来自反馈控制器的信号转换为对系统的物理输入：在这种情况下为电压。其它示例包括电压、电流和力的PWM。除了由位置传感器472所测量的位置之外，可提供(一个或多个)其它传感器来测量物理系统的物理参数。在一些方面，(一个或多个)其它传感器可包括传感器布置方式，诸如在以下专利中所述的那些：2016年5月24日发布的标题为钉仓组织厚度传感器系统(STAPLE CARTRIDGE TISSUETHICKNESS)的美国专利9,345,481，该专利全文以引用方式并入本文；2014年9月18日公布的标题为钉仓组织厚度传感器系统(STAPLE CARTRIDGE TISSUE THICKNESS)的美国专利申请公布2014/0263552，该专利全文以引用方式并入本文；以及2017年6月20日提交的标题为用于外科缝合和切割器械的马达速度的自适应控制的技术(TECHNIQUES FOR ADAPTIVECONTROL OF MOTOR VELOCITY OF A SURGICAL STAPLING AND CUTTING INSTRUMENT)的美国专利申请序列号15/628,175，该专利申请全文以引用方式并入本文。在数字信号处理系统中，绝对定位系统联接到数字数据采集系统，其中绝对定位系统的输出将具有有限分辨率和采样频率。绝对定位系统可包括比较和组合电路，以使用算法(诸如加权平均和理论控制环路)将计算响应与测量响应进行组合，该算法驱动计算响应朝向所测量的响应。物理系统的计算响应将特性如质量、惯性、粘性摩擦、电感电阻考虑在内，以通过得知输入预测物理系统的状态和输出。Tracking system 480, including an absolute positioning system, may include and/or may be programmed to implement feedback controllers, such as PID, state feedback, and adaptive controllers. The power source converts the signal from the feedback controller into a physical input to the system: voltage in this case. Other examples include PWM of voltage, current and force. In addition to the position measured byposition sensor 472, other sensor(s) may be provided to measure physical parameters of the physical system. In some aspects, the other sensor(s) may include sensor arrangements, such as those described in the following patent: STAPLE CARTRIDGE TISSUETHICKNESS, issued May 24, 2016, entitled STAPLE CARTRIDGE TISSUETHICKNESS US Patent 9,345,481, which is incorporated herein by reference in its entirety; US Patent Application Publication 2014/0263552, entitled STAPLE CARTRIDGE TISSUE THICKNESS, published September 18, 2014, which is incorporated by reference in its entirety and U.S. Patent entitled TECHNIQUES FOR ADAPTIVE CONTROL OF MOTOR VELOCITY OF A SURGICAL STAPLING AND CUTTING INSTRUMENT, filed June 20, 2017 Application Serial No. 15/628,175, which is incorporated herein 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 limited resolution and sampling frequency. The absolute positioning system may include comparison and combination circuits to combine the calculated and measured responses using algorithms (such as weighted averages and theoretical control loops) that drive the calculated responses towards the measured responses. The calculated response of a physical system takes into account properties such as mass, inertia, viscous friction, inductive resistance, to predict the state and output of the physical system by knowing the inputs.

因此，绝对定位系统在器械上电时提供位移构件的绝对位置，并且不使位移构件回缩或推进至如常规旋转编码器可需要的复位(清零或本位)位置，这些编码器仅对马达482采取的向前或向后的步骤数进行计数以推断装置致动器、驱动棒、刀等等的位置。Thus, the absolute positioning system provides the absolute position of the displacement member when the instrument is powered on, and does not retract or advance the displacement member to the reset (zero or home) position as may be required by conventional rotary encoders, which are 482 The number of forward or backward steps taken is counted to deduce the position of device actuators, drive rods, knives, etc.

传感器474(诸如，例如应变仪或微应变仪)被配置成能够测量端部执行器的一个或多个参数，诸如例如在夹持操作期间施加在砧座上的应变的振幅，该振幅可以指示施加到砧座的闭合力。将测得的应变转换成数字信号并提供给处理器462。另选地或除了传感器474之外，传感器476(诸如负荷传感器)可以测量由闭合驱动系统施加到砧座的闭合力。传感器476诸如负荷传感器可以测量在外科器械或工具的击发行程中施加到I形梁的击发力。I形梁被构造成能够接合楔形滑动件，该楔形滑动件被构造成能够使钉驱动器向上凸轮运动以将钉推出以与砧座变形接触。I形梁还包括锋利切割刃，当通过击发杆向远侧推进I形梁时，该切割刃可用于切断组织。另选地，可以采用电流传感器478来测量由马达482消耗的电流。推进击发构件所需的力可对应于例如由马达482消耗的电流。将测得的力转换成数字信号并提供给处理器462。Sensors 474 (such as, for example, strain gauges or micro-strain gauges) are 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 the clamping operation, which amplitude may indicate The closing force applied to the anvil. The measured strain is converted into a digital signal and provided to processor 462 . Alternatively or in addition tosensor 474,sensor 476, such as a load cell, may measure the closing force applied to the anvil by the closing drive system.Sensors 476, such as load cells, may measure the firing force applied to the I-beam during the firing stroke of the surgical instrument or tool. The I-beam is configured to engage a wedge-shaped slide configured to cam up the staple driver to push the staples into deforming contact with the anvil. The I-beam also includes a sharp cutting edge that can be used to sever tissue when the I-beam is advanced distally by the firing rod. Alternatively,current sensor 478 may be employed to measure the current drawn bymotor 482 . The force required to advance the firing member may correspond to the current drawn bymotor 482, for example. The measured force is converted into a digital signal and provided to processor 462 .

在一种形式中，应变仪传感器474可用于测量由端部执行器施加到组织的力。应变计可联接到端部执行器以测量正由端部执行器处理的组织上的力。用于测量施加到由端部执行器抓持的组织的力的系统包括应变仪传感器474，诸如例如微应变仪，其被配置成能够测量例如端部执行器的一个或多个参数。在一个方面，应变仪传感器474可测量在夹持操作期间施加到端部执行器的钳口构件上的应变的振幅或量值，这可指示组织压缩。将测得的应变转换成数字信号并将其提供到微控制器461的处理器462。负荷传感器476可测量用于操作刀元件例如以切割被捕集在砧座和钉仓之间的组织的力。可采用磁场传感器来测量捕集的组织的厚度。磁场传感器的测量值也可被转换成数字信号并提供给处理器462。In one form, thestrain gauge sensor 474 may be used to measure the force applied to the tissue by the end effector. Strain gauges can be coupled to the end effector to measure forces on tissue being processed by the end effector. The system for measuring force applied to tissue grasped by the end effector includes astrain gauge sensor 474, such as, for example, a microstrain gauge configured to measure, for example, one or more parameters of the end effector. In one aspect, thestrain gauge sensor 474 can measure the amplitude or magnitude of the strain applied to the jaw member of the end effector during a clamping operation, which can be indicative of tissue compression. The measured strain is converted into a digital signal and provided to the processor 462 of themicrocontroller 461 .Load cell 476 may measure the force used to operate the knife element, eg, to cut tissue trapped between the anvil and the staple cartridge. A magnetic field sensor can be employed to measure the thickness of the trapped tissue. The magnetic field sensor measurements may also be converted into digital signals and provided to processor 462 .

微控制器461可使用分别由传感器474、476测量的组织压缩、组织厚度和/或闭合端部执行器所需的力的测量来表征击发构件的所选择的位置和/或击发构件的速度的对应值。在一个实例中，存储器468可存储可由微控制器461在评估中所采用的技术、公式和/或查找表。Microcontroller 461 may use measurements of tissue compression, tissue thickness, and/or force required to close the end effector, measured bysensors 474, 476, respectively, to characterize the selected position of the firing member and/or the velocity of the firing member. corresponding value. In one example,memory 468 may store techniques, formulas, and/or look-up tables that may be employed bymicrocontroller 461 in evaluation.

外科器械或工具的控制系统470还可包括有线或无线通信电路以与模块化通信集线器通信，如图8-11中所示。Thecontrol system 470 of the surgical instrument or tool may also include wired or wireless communication circuitry to communicate with the modular communication hub, as shown in Figures 8-11.

图13示出了根据本公开的至少一个方面的被配置成能够控制外科器械或工具的各方面的控制电路500。控制电路500可被配置成能够实现本文所述的各种过程。电路500可以包括微控制器，该微控制器包括联接到至少一个存储器电路504的一个或多个处理器502(例如，微处理器、微控制器)。存储器电路504存储机器可执行指令，所述机器可执行指令在由处理器502执行时使处理器502执行机器指令以实现本文所述的各种过程。处理器502可为本领域中已知的多种单核或多核处理器中的任一种。存储器电路504可以包括易失性存储介质和非易失性存储介质。处理器502可以包括指令处理单元506和运算单元508。指令处理单元可以被配置成能够从本公开的存储器电路504接收指令。13 illustrates acontrol circuit 500 configured to control various aspects of a surgical instrument or tool in accordance with at least one aspect of the present disclosure. Thecontrol circuit 500 may be configured to implement the various processes described herein.Circuit 500 may include a microcontroller including one or more processors 502 (eg, microprocessors, microcontrollers) 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 the machine instructions to implement the various processes described herein. Processor 502 may be any of a variety of single-core or multi-core processors known in the art. The memory circuit 504 may include volatile storage media and non-volatile storage media. The processor 502 may include aninstruction processing unit 506 and an arithmetic unit 508 . The instruction processing unit may be configured to receive instructions from the memory circuit 504 of the present disclosure.

图14示出了根据本公开的至少一个方面的被配置成能够控制外科器械或工具的各方面的组合逻辑电路510。组合逻辑电路510可被配置成能够实现本文所述的各种过程。组合逻辑电路510可包括有限状态机，该有限状态机包括组合逻辑512，该组合逻辑512被配置成能够在输入514处接收与外科器械或工具相关联的数据，通过组合逻辑512处理数据并提供输出516。14 illustrates acombinational logic circuit 510 configured to control various aspects of a surgical instrument or tool in accordance with at least one aspect of the present disclosure.Combinatorial logic circuit 510 may be configured to implement the various processes described herein.Combinatorial logic circuit 510 may include a finite state machine includingcombinatorial logic 512 configured to receive data associated with a surgical instrument or tool at input 514, process the data throughcombinatorial logic 512 and provide output 516.

图15示出了根据本公开的至少一个方面的被配置成能够控制外科器械或工具的各方面的时序逻辑电路520。时序逻辑电路520或组合逻辑522可被配置成能够实现本文所述的各种过程。时序逻辑电路520可包括有限状态机。时序逻辑电路520可包括例如组合逻辑522、至少一个存储器电路524和时钟529。至少一个存储器电路524可以存储有限状态机的当前状态。在某些情况下，时序逻辑电路520可以是同步的或异步的。组合逻辑522被配置成能够从输入526接收与外科器械或工具相关联的数据，通过组合逻辑522处理数据并提供输出528。在其它方面，电路可包括处理器(例如，处理器502，图13)和有限状态机的组合以实现本文的各种过程。在其它实施方案中，有限状态机可以包括组合逻辑电路(例如，组合逻辑电路510，图14)和时序逻辑电路520的组合。15 illustratessequential logic circuitry 520 configured to control various aspects of a surgical instrument or tool in accordance with at least one aspect of the present disclosure.Sequential logic circuit 520 or combinational logic 522 may be configured to implement the various processes described herein.Sequential logic circuit 520 may include a finite state machine.Sequential logic circuit 520 may include, for example, combinational logic 522 , at least one memory circuit 524 , and clock 529 . At least one memory circuit 524 may store the current state of the finite state machine. In some cases,sequential logic circuit 520 may be synchronous or asynchronous. Combinatorial logic 522 is configured to receive data associated with a surgical instrument or tool from input 526 , process the data through combinatorial logic 522 and provideoutput 528 . In other aspects, a circuit may include a combination of a processor (eg, processor 502, Figure 13) and a finite state machine to implement the various processes herein. In other embodiments, the finite state machine may include a combination of combinational logic circuitry (eg,combinational logic circuitry 510 , FIG. 14 ) andsequential logic circuitry 520 .

图16示出了包括可被激活以执行各种功能的多个马达的外科器械或工具。在某些情况下，第一马达可被激活以执行第一功能，第二马达可被激活以执行第二功能，并且第三马达可被激活以执行第三功能。在某些情况下，机器人外科器械600的多个马达可被单独地激活以导致端部执行器中的击发运动、闭合运动、和/或关节运动。击发运动、闭合运动、和/或关节运动可例如通过轴组件传输到端部执行器。Figure 16 illustrates a surgical instrument or tool that includes multiple motors that can be activated to perform various functions. In some cases, a first motor may be activated to perform a first function, a second motor may be activated to perform a second function, and a third motor may be activated to perform a third function. In some cases, the multiple motors of the roboticsurgical instrument 600 may be individually activated to cause firing motion, closing motion, and/or articulation in the end effector. Firing motion, closing motion, and/or articulation can be transmitted to the end effector, for example, through a shaft assembly.

在某些情况下，外科器械系统或工具可包括击发马达602。击发马达602可操作地联接到击发马达驱动组件604，该击发马达驱动组件可被构造成能够将由马达602生成的击发运动传输到端部执行器，具体地用于使I形梁元件移位。在某些情况下，由马达602生成的击发运动可导致例如钉从钉仓部署到由端部执行器捕集的组织内并且/或者导致I形梁元件的切割刃被推进以切割所捕集组织。I形梁元件可通过反转马达602的方向而回缩。In some cases, the surgical instrument system or tool may include a firingmotor 602 . The firingmotor 602 is operably coupled to a firingmotor drive assembly 604, which can be configured to transmit the firing motion generated by themotor 602 to the end effector, in particular for displacing the I-beam elements. In some cases, the firing motion generated bymotor 602 may cause, for example, deployment of staples from the staple cartridge into tissue captured by the end effector and/or cause the cutting edge of the I-beam element to be advanced to cut the captured organize. The I-beam elements can be retracted by reversing the direction of themotor 602 .

在某些情况下，外科器械或工具可包括闭合马达603。闭合马达603可以可操作地联接到闭合马达驱动组件605，该闭合马达驱动组件605被配置成能够将由马达603生成的闭合运动传输到端部执行器，具体地用于移置闭合管以闭合砧座并且压缩砧座和钉仓之间的组织。闭合运动可使例如端部执行器从打开构型转变成接近构型以捕集组织。端部执行器可通过反转马达603的方向而转变到打开位置。In some cases, the surgical instrument or tool may include aclosure motor 603 . Theclosure motor 603 may be operably coupled to a closure motor drive assembly 605 configured to transmit the closure motion generated by themotor 603 to the end effector, in particular for displacing the closure tube to close the anvil seat and compress the tissue between the anvil and the staple cartridge. The closing motion may, for example, transition the end effector from an open configuration to an approximated configuration to capture tissue. The end effector can be transitioned to the open position by reversing the direction of themotor 603 .

在某些情况下，外科器械或工具可包括例如一个或多个关节运动马达606a、606b。马达606a、606b可以可操作地联接到相应的关节运动马达驱动组件608a、608b，该关节运动马达驱动组件可被配置成能够将由马达606a、606b生成的关节运动传输到端部执行器。在某些情况下，关节运动可使端部执行器相对于轴进行关节运动，例如。In some cases, the surgical instrument or tool may include, for example, one ormore articulation motors 606a, 606b. Themotors 606a, 606b can be operably coupled to respective articulationmotor drive assemblies 608a, 608b, which can be configured to transmit the articulation generated by themotors 606a, 606b to the end effector. In some cases, articulation allows the end effector to articulate relative to the axis, eg.

如上所述，外科器械或工具可包括多个马达，该多个马达可被配置成能够执行各种独立功能。在某些情况下，外科器械或工具的多个马达可被单独地或独立地激活以执行一个或多个功能，而其它马达保持非活动的。例如，关节运动马达606a、606b可被激活以使端部执行器进行关节运动，而击发马达602保持非活动的。另选地，击发马达602可被激活以击发多个钉并且/或者推进切割刃，而关节运动马达606保持非活动的。此外，闭合马达603可与击发马达602同时启动，以使闭合管和I形梁元件朝远侧推进，如下文更详细地描述。As mentioned above, a surgical instrument or tool may include multiple motors that may be configured to perform various independent functions. In some cases, multiple motors of a surgical instrument or tool may be activated individually or independently to perform one or more functions, while other motors remain inactive. For example, thearticulation motors 606a, 606b may be activated to articulate the end effector, while the firingmotor 602 remains inactive. Alternatively, the firingmotor 602 may be activated to fire the plurality of staples and/or advance the cutting edge, while the articulation motor 606 remains inactive. Additionally, theclosure motor 603 can be activated simultaneously with the firingmotor 602 to advance the closure tube and I-beam member distally, as described in more detail below.

在某些情况下，外科器械或工具可包括公共控制模块610，该公共控制模块610可与外科器械或工具的多个马达一起使用。在某些情况下，公共控制模块610每次可调节多个马达中的一个。例如，公共控制模块610可单独地联接到外科器械的多个马达并且可从外科器械的多个马达分离。在某些情况下，外科器械或工具的多个马达可共用一个或多个公共控制模块诸如公共控制模块610。在某些情况下，外科器械或工具的多个马达可独立地和选择性地接合公共控制模块610。在某些情况下，公共控制模块610可从与外科器械或工具的多个马达中的一个交接切换到与外科器械或工具的多个马达中的另一个交接。In some cases, the surgical instrument or tool can include acommon control module 610 that can be used with multiple motors of the surgical instrument or tool. In some cases, thecommon control module 610 may adjust one of the plurality of motors at a time. For example, thecommon control module 610 may be individually coupled to and detachable from the plurality of motors of the surgical instrument. In some cases, multiple motors of a surgical instrument or tool may share one or more common control modules such ascommon control module 610 . In some cases, multiple motors of a surgical instrument or tool may independently and selectively engage thecommon control module 610 . In some cases, thecommon control module 610 may switch from interfacing with one of the plurality of motors of the surgical instrument or tool to interfacing with another of the plurality of motors of the surgical instrument or tool.

在至少一个示例中，公共控制模块610可在可操作地接合关节运动马达606a、606b与可操作地接合击发马达602或闭合马达603之间选择性地切换。在至少一个示例中，如图16中所示，开关614可在多个位置和/或状态之间运动或转变。在第一位置616中，开关614可以将公共控制模块610电联接到击发马达602；在第二位置617中，开关614可以将公共控制模块610电联接到闭合马达603；在第三位置618a中，开关614可以将公共控制模块610电联接到第一关节运动马达606a；并且在第四位置618b中，开关614可以将公共控制模块610电联接到例如第二关节运动马达606b。在某些情况下，单独的公共控制模块610可同时电联接到击发马达602、闭合马达603和关节运动马达606a、606b。在某些情况下，开关614可为机械开关、机电开关、固态开关、或任何合适的开关机构。In at least one example, thecommon control module 610 is selectively switchable between operatively engaging thearticulation motors 606a, 606b and operatively engaging the firingmotor 602 or theclosing motor 603. In at least one example, as shown in FIG. 16 , theswitch 614 can move or transition between a plurality of positions and/or states. In thefirst position 616, theswitch 614 may electrically couple thecommon control module 610 to the firingmotor 602; in thesecond position 617, theswitch 614 may electrically couple thecommon control module 610 to theclosing motor 603; in the third position 618a , theswitch 614 may electrically couple thecommon control module 610 to thefirst articulation motor 606a; and in thefourth position 618b, theswitch 614 may electrically couple thecommon control module 610 to, for example, the second articulation motor 606b. In some cases, separatecommon control modules 610 may be electrically coupled to firingmotor 602,closure motor 603, andarticulation motors 606a, 606b simultaneously. In some cases, switch 614 may be a mechanical switch, an electromechanical switch, a solid state switch, or any suitable switching mechanism.

马达602、603、606a、606b中的每个可包括扭矩传感器以测量马达的轴上的输出扭矩。可以任何常规方式感测端部执行器上的力，诸如通过钳口的外侧上的力传感器或通过用于致动钳口的马达的扭矩传感器来感测端部执行器上的力。Each of themotors 602, 603, 606a, 606b may include a torque sensor to measure the output torque on the shaft of the motor. The force on the end effector may be sensed in any conventional manner, such as by a force sensor on the outside of the jaws or by a torque sensor of a motor used to actuate the jaws.

在各种情况下，如图16中所示，公共控制模块610可包括马达驱动器626，该马达驱动器626可包括一个或多个H桥场效应FET。马达驱动器626可例如基于得自微控制器620(“控制器”)的输入来调节从功率源628发射到联接到公共控制模块610的马达的电力。在某些情况下，当马达联接到公共控制模块610时，可例如采用微控制器620来确定由马达消耗的电流，如上所述。In various cases, as shown in FIG. 16, thecommon control module 610 may include amotor driver 626, which may include one or more H-bridge field effect FETs. Themotor driver 626 may regulate the power transmitted from thepower source 628 to the motors coupled to thecommon control module 610 , eg, based on input from the microcontroller 620 (“controller”). In some cases, when the motor is coupled to thecommon control module 610, themicrocontroller 620 may be employed, for example, to determine the current drawn by the motor, as described above.

在某些情况下，微控制器620可包括微处理器622(“处理器”)和一个或多个非暂态计算机可读介质或存储单元624(“存储器”)。在某些情况下，存储器624可存储各种程序指令，该各种程序指令在被执行时可使处理器622执行本文所述的多个功能和/或计算。在某些情况下，存储器单元624中的一个或多个可例如联接到处理器622。In some cases,microcontroller 620 may include a microprocessor 622 ("processor") and one or more non-transitory computer-readable media or storage units 624 ("memory"). In some cases,memory 624 may store various program instructions that, when executed, may causeprocessor 622 to perform various functions and/or calculations described herein. In some cases, one or more ofmemory units 624 may be coupled toprocessor 622, for example.

在某些情况下，功率源628可例如用于为微控制器620供电。在某些情况下，功率源628可包括电池(或者“电池组”或“功率组”)，诸如锂离子电池，例如。在某些情况下，电池组可被配置成能够可释放地安装到柄部以用于给外科器械600供电。可将多个串联连接的电池单元用作功率源628。在某些情况下，功率源628可为例如可替换的和/或可再充电的。In some cases,power source 628 may be used topower microcontroller 620, for example. In some cases,power source 628 may include a battery (or "battery pack" or "power pack"), such as a lithium-ion battery, for example. In some cases, the battery pack may be configured to be releasably mountable to the handle for powering thesurgical instrument 600 . Multiple battery cells connected in series may be used aspower source 628 . In some cases,power source 628 may be replaceable and/or rechargeable, for example.

在各种情况下，处理器622可控制马达驱动器626以控制联接到公共控制器610的马达的位置、旋转方向、和/或速度。在某些情况下，处理器622可发信号通知马达驱动器626，以停止和/或停用联接到公共控制器610的马达。应当理解，如本文所用的术语“处理器”包括任何合适的微处理器、微控制器、或将计算机的中央处理单元(CPU)的功能结合在一个集成电路或至多几个集成电路上的其它基础计算装置。处理器是多用途的可编程装置，该装置接收数字数据作为输入，根据其存储器中存储的指令来处理输入，然后提供结果作为输出。因为处理器具有内部存储器，所以是顺序数字逻辑的示例。处理器的操作对象是以二进制数字系统表示的数字和符号。In various cases,processor 622 may controlmotor driver 626 to control the position, rotational direction, and/or speed of motors coupled tocommon controller 610 . In some cases,processor 622 may signalmotor driver 626 to stop and/or deactivate motors coupled tocommon controller 610 . It should be understood that the term "processor" as used herein includes any suitable microprocessor, microcontroller, or other device that combines the functions of a computer's central processing unit (CPU) on one integrated circuit or at most several integrated circuits Basic computing device. A processor is a multipurpose programmable device that receives digital data as input, processes the input according to instructions stored in its memory, and then provides the result as an output. Because the processor has internal memory, it is an example of sequential digital logic. The processor operates on numbers and symbols represented by the binary number system.

在一个实例中，处理器622可为任何单核或多核处理器，诸如已知的由德克萨斯器械公司(Texas Instruments)生产的商品名为ARM Cortex的那些。在某些情况下，微控制器620可以是例如可购自Texas Instruments的LM 4F230H5QR。在至少一个示例中，TexasInstruments LM4F230H5QR为ARM Cortex-M4F处理器芯，其包括：256KB的单循环闪存或其它非易失性存储器(最多至40MHZ)的片上存储器、用于改善40MHz以上的性能的预取缓冲器、32KB的单循环SRAM、装载有

软件的内部ROM、2KB的EEPROM、一个或多个PWM模块、一个或多个QEI模拟、具有12个模拟输入信道的一个或多个12位ADC、以及易得的其它特征。可容易地换用其它微控制器，以与模块4410一起使用。因此，本公开不应限于这一上下文。In one example,processor 622 may be any single-core or multi-core processor, such as those known under the trade name ARM Cortex by Texas Instruments. In some cases,microcontroller 620 may be, for example, an LM 4F230H5QR available from Texas Instruments. In at least one example, the TexasInstruments LM4F230H5QR is an ARM Cortex-M4F processor core that includes: 256KB of single-cycle flash or other non-volatile memory (up to 40MHZ) of on-chip memory, pre-built for improved performance above 40MHz fetch buffer, 32KB of single-cycle SRAM, loaded with

Internal ROM for software, 2KB of EEPROM, one or more PWM modules, one or more QEI analogs, one or more 12-bit ADCs with 12 analog input channels, and other features readily available. Other microcontrollers can easily be exchanged for use with module 4410. Therefore, the present disclosure should not be limited in this context.

在某些情况下，存储器624可包括用于控制可联接到公共控制器610的外科器械600的马达中的每个的程序指令。例如，存储器624可包括用于控制击发马达602、闭合马达603和关节运动马达606a、606b的程序指令。此类程序指令可致使处理器622根据来自外科器械或工具的算法或控制程序的输入来控制击发、闭合和关节运动功能。In some cases,memory 624 may include program instructions for controlling each of the motors ofsurgical instrument 600 that may be coupled tocommon controller 610 . For example,memory 624 may include program instructions for controlling firingmotor 602, closingmotor 603, andarticulation motors 606a, 606b. Such program instructions may cause theprocessor 622 to control firing, closure and articulation functions according to input from an algorithm or control program of the surgical instrument or tool.

在某些情况下，一个或多个机构和/或传感器(诸如，传感器630)可用于警示处理器622应当在特定设定中使用的程序指令。例如，传感器630可警示处理器622使用与击发、闭合和关节运动端部执行器相关联的程序指令。在某些情况下，传感器630可包括例如可用于感测开关614的位置的位置传感器。因此，处理器622可以在例如通过传感器630检测到开关614处于第一位置616时使用与击发端部执行器的I形梁相关联的程序指令；处理器622可以在例如通过传感器630检测到开关614处于第二位置617时使用与闭合砧座相关联的程序指令；并且处理器622可以在例如通过传感器630检测到开关614处于第三位置618a或第四位置618b时使用与使端部执行器进行关节运动相关联的程序指令。In some cases, one or more mechanisms and/or sensors, such assensor 630, may be used to alertprocessor 622 of program instructions that should be used in a particular setting. For example,sensor 630 may alertprocessor 622 to use program instructions associated with firing, closing, and articulating the end effector. In some cases,sensor 630 may include, for example, a position sensor that may be used to sense the position ofswitch 614 . Thus, theprocessor 622 may use program instructions associated with firing the I-beam of the end effector when theswitch 614 is detected in thefirst position 616, for example, by thesensor 630; 614 is in thesecond position 617 using program instructions associated with closing the anvil; and theprocessor 622 may use the program instructions associated with causing the end effector when theswitch 614 is detected in the third position 618a or thefourth position 618b, for example, by thesensor 630 Program instructions associated with joint motion.

图17为根据本公开的至少一个方面的被构造成能够操作本文所述的外科工具的机器人外科器械700的示意图。机器人外科器械700可被编程或配置为控制位移构件的远侧/近侧平移、闭合管的远侧/近侧位移、轴旋转、以及具有单个或多个关节运动驱动连杆的关节运动。在一个方面，外科器械700可被编程或配置为单独地控制击发构件、闭合构件、轴构件、和/或一个或多个关节运动构件。外科器械700包括控制电路710，该控制电路被配置成能够控制马达驱动的击发构件、闭合构件、轴构件、和/或一个或多个关节运动构件。17 is a schematic illustration of a roboticsurgical instrument 700 configured to operate the surgical tools described herein in accordance with at least one aspect of the present disclosure. Roboticsurgical instrument 700 may be programmed or configured to control distal/proximal translation of displacement members, distal/proximal displacement of closure tubes, shaft rotation, and articulation with single or multiple articulation drive links. In one aspect,surgical instrument 700 may be programmed or configured to individually control the firing member, closure member, shaft member, and/or one or more articulation members.Surgical instrument 700 includescontrol circuitry 710 configured to control a motor-driven firing member, closure member, shaft member, and/or one or more articulation members.

在一个方面，机器人外科器械700包括控制电路710，该控制电路被配置成能够经由多个马达704a-704e来控制端部执行器702的砧座716和I形梁714(包括锋利切割刃)部分，可移除钉仓718、轴740、以及一个或多个关节运动构件742a、742b。位置传感器734可被配置成能够向控制电路710提供I形梁714的位置反馈。其他传感器738可被配置成能够向控制电路710提供反馈。定时器/计数器731向控制电路710提供定时和计数信息。可提供能量源712以操作马达704a-704e，并且电流传感器736向控制电路710提供马达电流反馈。马达704a-704e可通过控制电路710在开环或闭环反馈控制中单独操作。In one aspect, the roboticsurgical instrument 700 includes acontrol circuit 710 configured to control the anvil 716 and I-beam 714 (including sharp cutting edge) portions of theend effector 702 via the plurality ofmotors 704a-704e , thestaple cartridge 718,shaft 740, and one ormore articulation members 742a, 742b are removable. Theposition sensor 734 may be configured to provide feedback of the position of the I-beam 714 to thecontrol circuit 710 .Other sensors 738 may be configured to provide feedback to thecontrol circuit 710 . Timer/counter 731 provides timing and count information to controlcircuit 710 . Anenergy source 712 may be provided to operate themotors 704a - 704e and acurrent sensor 736 provides motor current feedback to thecontrol circuit 710 .Motors 704a - 704e may be individually operated in open loop or closed loop feedback control bycontrol circuit 710 .

在一个方面，控制电路710可包括用于执行致使一个或多个处理器执行一个或多个任务的指令的一个或多个微控制器、微处理器或其它合适的处理器。在一个方面，定时器/计数器731向控制电路710提供输出信号，诸如耗用的时间或数字计数，以将如由位置传感器734确定的I形梁714的位置与定时器/计数器731的输出相关联，使得控制电路710可确定I形梁714在特定时间(t)相对于起始位置的位置或I形梁714处于相对于起始位置的特定位置时的时间(t)。定时器/计数器731可被配置成能够测量所耗用的时间、计数外部事件或时间外部事件。In one aspect,control circuitry 710 may include one or more microcontrollers, microprocessors, or other suitable processors for executing instructions that cause one or more processors to perform one or more tasks. In one aspect, the timer/counter 731 provides an output signal, such as an elapsed time or a digital count, to thecontrol circuit 710 to correlate the position of the I-beam 714 as determined by theposition sensor 734 with the output of the timer/counter 731 Linked so that thecontrol circuit 710 can determine the position of the I-beam 714 at a particular time (t) relative to the starting position or the time (t) when the I-beam 714 is at a particular position relative to the starting position. The timer/counter 731 may be configured to measure elapsed time, count external events, or time external events.

在一个方面，控制电路710可被编程为基于一个或多个组织状况来控制端部执行器702的功能。控制电路710可以被编程为直接或间接地感测组织状况，诸如厚度，如本文所述。控制电路710可以被编程为基于组织状况选择击发控制程序或闭合控制程序。击发控制程序可以描述位移构件的远侧运动。可以选择不同的击发控制程序以更好地处理不同的组织状况。例如，当存在较厚的组织时，控制电路710可以被编程为以较低的速度和/或以较低的功率平移位移构件。当存在较薄的组织时，控制电路710可以被编程为以较高的速度和/或以较高的功率平移位移构件。闭合控制程序可控制由砧座716施加到组织的闭合力。其它控制程序控制轴740和关节运动构件742a、742b的旋转。In one aspect,control circuitry 710 may be programmed to control the function ofend effector 702 based on one or more tissue conditions.Control circuitry 710 may be programmed to directly or indirectly sense tissue conditions, such as thickness, as described herein. Thecontrol circuit 710 may be programmed to select a firing control sequence or a closure control sequence based on tissue conditions. The firing control program can describe the distal movement of the displacement member. Different firing control programs can be selected to better handle different tissue conditions. For example, when thicker tissue is present, thecontrol circuit 710 may be programmed to translate the displacement member at a lower speed and/or at a lower power. When thinner tissue is present, thecontrol circuit 710 can be programmed to translate the displacement member at a higher speed and/or at a higher power. The closure control program may control the closure force applied by the anvil 716 to the tissue. Other control programs control the rotation of theshaft 740 and thearticulation members 742a, 742b.

在一个方面，控制电路710可生成马达设定点信号。马达设定点信号可以被提供给各种马达控制器708a-708e。马达控制器708a-708e可以包括一个或多个电路，这些电路被配置成能够向马达704a-704e提供马达驱动信号，以驱动马达704a-704e，如本文所述。在一些示例中，马达704a-704e可为有刷DC电动马达。例如，马达704a-704e的速度可与相应的马达驱动信号成比例。在一些示例中，马达704a-704e可为无刷DC电动马达，并且相应的马达驱动信号可包括提供给马达704a-704e的一个或多个定子绕组的PWM信号。而且，在一些示例中，可以省略马达控制器708a-708e，并且控制电路710可以直接生成马达驱动信号。In one aspect, thecontrol circuit 710 may generate a motor setpoint signal. Motor setpoint signals may be provided to various motor controllers 708a-708e. The motor controllers 708a-708e may include one or more circuits configured to provide motor drive signals to themotors 704a-704e to drive themotors 704a-704e, as described herein. In some examples, themotors 704a-704e may be brushed DC electric motors. For example, the speed of themotors 704a-704e may be proportional to the corresponding motor drive signal. In some examples, themotors 704a-704e may be brushless DC electric motors, and the corresponding motor drive signals may include PWM signals provided to one or more stator windings of themotors 704a-704e. Also, in some examples, the motor controllers 708a-708e may be omitted, and thecontrol circuit 710 may directly generate the motor drive signals.

在一个方面，控制电路710可以针对位移构件的行程的第一开环部分初始以开环构型操作马达704a-704e中的每个。基于在行程的开环部分期间机器人外科器械700的响应，控制电路710可以选择处于闭环构型的击发控制程序。器械的响应可以包括在开环部分期间位移构件的平移距离、在开环部分期间耗用的时间、在开环部分期间提供给马达704a-704e中的一者的能量、马达驱动信号的脉冲宽度之和等。在开环部分之后，控制电路710可以对位移构件行程的第二部分实现所选择的击发控制程序。例如，在行程的闭环部分期间，控制电路710可以基于以闭环方式描述位移构件的位置的平移数据来调制马达704a-704e中的一者，以使位移构件以恒定速度平移。In one aspect, thecontrol circuit 710 may initially operate each of themotors 704a-704e in an open-loop configuration for a first open-loop portion of the displacement member's travel. Based on the response of the roboticsurgical instrument 700 during the open-loop portion of the stroke, thecontrol circuit 710 may select a firing control program in a closed-loop configuration. The response of the instrument may include the translation distance of the displacement member during the open loop portion, the time elapsed during the open loop portion, the energy supplied to one of themotors 704a-704e during the open loop portion, the pulse width of the motor drive signal Sum etc. After the open loop portion, thecontrol circuit 710 may implement the selected firing control routine for the second portion of the displacement member travel. For example, during the closed-loop portion of the stroke, thecontrol circuit 710 may modulate one of themotors 704a-704e to translate the displacement member at a constant velocity based on translation data describing the position of the displacement member in a closed-loop fashion.

在一个方面，马达704a-704e可从能量源712接收电力。能量源712可为由主交流功率源、电池、超级电容器或任何其它合适的能量源驱动的DC功率源。马达704a-704e可经由相应的传动装置706a-706e机械地联接到单独的可运动机械元件，诸如I形梁714、砧座716、轴740、关节运动742a和关节运动742b。变速器706a-706e可以包括一个或多个齿轮或其它连杆部件，以将马达704a-704e联接到可运动机械元件。位置传感器734可感测I形梁714的位置。位置传感器734可为或包括能够生成指示I形梁714的位置的位置数据的任何类型的传感器。在一些示例中，位置传感器734可包括编码器，该编码器被配置成能够在I形梁714向远侧和向近侧平移时向控制电路710提供一系列脉冲。控制电路710可跟踪脉冲以确定I形梁714的位置。可使用其它合适的位置传感器，包括例如接近传感器。其他类型的位置传感器可提供指示I形梁714的运动的其他信号。而且，在一些示例中，可省略位置传感器734。在马达704a-704e中的任一个是步进马达的情况下，控制电路710可以通过聚合马达704已被命令执行的步骤的数量和方向来跟踪I形梁714的位置。位置传感器734可位于端部执行器702中或器械的任何其他部分处。马达704a-704e中的每个的输出包括用于感测力的扭矩传感器744a-744e，并且具有用于感测驱动轴的旋转的编码器。In one aspect,motors 704a - 704e may receive power fromenergy source 712 . Theenergy source 712 may be a DC power source driven by a main AC power source, a battery, a supercapacitor, or any other suitable energy source.Motors 704a-704e may be mechanically coupled to separate movable mechanical elements, such as I-beam 714, anvil 716,shaft 740, articulation 742a, andarticulation 742b, viarespective transmissions 706a-706e. Thetransmissions 706a-706e may include one or more gears or other linkage members to couple themotors 704a-704e to the movable mechanical elements. Theposition sensor 734 may sense the position of the I-beam 714 .Position sensor 734 may be or include any type of sensor capable of generating position data indicative of the position of I-beam 714 . In some examples,position sensor 734 may include an encoder configured to provide a series of pulses to controlcircuit 710 as I-beam 714 is translated distally and proximally. Thecontrol circuit 710 can track the pulses to determine the position of the I-beam 714 . Other suitable position sensors may be used, including, for example, proximity sensors. Other types of position sensors may provide other signals indicative of movement of the I-beam 714 . Also, in some examples,position sensor 734 may be omitted. Where any of themotors 704a-704e is a stepper motor, thecontrol circuit 710 can track the position of the I-beam 714 by aggregating the number and direction of steps that the motor 704 has been commanded to perform.Position sensor 734 may be located inend effector 702 or at any other portion of the instrument. The output of each of themotors 704a-704e includes atorque sensor 744a-744e for sensing force, and has an encoder for sensing rotation of the drive shaft.

在一个方面，控制电路710被配置成能够驱动击发构件诸如端部执行器702的I形梁714部分。控制电路710向马达控制708a提供马达设定点，该马达控制向马达704a提供驱动信号。马达704a的输出轴联接到扭矩传感器744a。扭矩传感器744a联接到与I形梁714联接的传动装置706a。传动装置706a包括可运动的机械元件诸如旋转元件和击发构件，以控制I形梁714沿端部执行器702的纵向轴线朝远侧和近侧的运动。在一个方面，马达704a可联接到刀齿轮组件，该刀齿轮组件包括刀齿轮减速组，该刀齿轮减速组包括第一刀驱动齿轮和第二刀驱动齿轮。扭矩传感器744a向控制电路710提供击发力反馈信号。击发力信号表示击发或移位I形梁714所需的力。位置传感器734可被配置成能够将I形梁714沿击发行程的位置或击发构件的位置作为反馈信号提供给控制电路710。端部执行器702可包括被配置成能够向控制电路710提供反馈信号的附加传感器738。当准备好使用时，控制电路710可向马达控制708a提供击发信号。响应于击发信号，马达704a可沿端部执行器702的纵向轴线将击发构件从近侧行程开始位置朝远侧驱动至行程开始位置远侧的行程结束位置。在击发构件朝远侧平移时，具有定位在远侧端部处的切割元件的I形梁714朝远侧推进以切割位于钉仓718和砧座716之间的组织。In one aspect, thecontrol circuit 710 is configured to drive a firing member such as the I-beam 714 portion of theend effector 702 .Control circuit 710 provides motor setpoints to motor control 708a, which provides drive signals tomotor 704a. The output shaft ofmotor 704a is coupled totorque sensor 744a.Torque sensor 744a is coupled totransmission 706a coupled to I-beam 714 . Thetransmission 706a includes movable mechanical elements such as rotating elements and firing members to control the distal and proximal movement of the I-beam 714 along the longitudinal axis of theend effector 702 . In one aspect, themotor 704a may be coupled to a knife gear assembly that includes a knife gear reduction set including a first knife drive gear and a second knife drive gear.Torque sensor 744a provides a firing force feedback signal to controlcircuit 710 . The firing force signal represents the force required to fire or displace the I-beam 714 . Theposition 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 thecontrol circuit 710 . Theend effector 702 may includeadditional sensors 738 configured to provide feedback signals to thecontrol circuit 710 . When ready for use,control circuit 710 may provide a firing signal to motor control 708a. In response to the firing signal, themotor 704a may drive the firing member distally along the longitudinal axis of theend effector 702 from a proximal start of stroke position to an end of stroke position distal to the start of stroke position. As the firing member is translated distally, the I-beam 714 with the cutting element positioned at the distal end is advanced distally to cut tissue between thestaple cartridge 718 and the anvil 716 .

在一个方面，控制电路710被配置成能够驱动闭合构件，诸如端部执行器702的砧座716部分。控制电路710向马达控制708b提供马达设定点，该马达控制708b向马达704b提供驱动信号。马达704b的输出轴联接到扭矩传感器744b。扭矩传感器744b联接到与砧座716联接的传动装置706b。传动装置706b包括可运动机械元件诸如旋转元件和闭合构件，以控制砧座716从打开位置和闭合位置的运动。在一个方面，马达704b联接到闭合齿轮组件，该闭合齿轮组件包括被支撑成与闭合正齿轮啮合接合的闭合减速齿轮组。扭矩传感器744b向控制电路710提供闭合力反馈信号。闭合力反馈信号表示施加到砧座716的闭合力。位置传感器734可被配置成能够将闭合构件的位置作为反馈信号提供给控制电路710。端部执行器702中的附加传感器738可向控制电路710提供闭合力反馈信号。可枢转砧座716被定位成与钉仓718相对。当准备好使用时，控制电路710可向马达控制708b提供闭合信号。响应于闭合信号，马达704b推进闭合构件以将组织抓持在砧座716和钉仓718之间。In one aspect, thecontrol circuit 710 is configured to drive a closure member, such as the anvil 716 portion of theend effector 702 .Control circuit 710 provides motor setpoints to motor control 708b, which provides drive signals tomotor 704b. The output shaft ofmotor 704b is coupled to torque sensor 744b. Torque sensor 744b is coupled totransmission 706b coupled to anvil 716 . Thetransmission 706b includes movable mechanical elements such as rotating elements and closing members to control the movement of the anvil 716 from the open and closed positions. In one aspect, themotor 704b is coupled to a closing gear assembly that includes a closing reduction gear set supported in meshing engagement with the closing spur gear. Torque sensor 744b provides a closing force feedback signal to controlcircuit 710 . The closing force feedback signal represents the closing force applied to the anvil 716 . Theposition sensor 734 may be configured to provide the position of the closure member as a feedback signal to thecontrol circuit 710 . Anadditional sensor 738 in theend effector 702 may provide a closing force feedback signal to thecontrol circuit 710 . The pivotable anvil 716 is positioned opposite thestaple cartridge 718 . When ready for use,control circuit 710 may provide a close signal to motor control 708b. In response to the closure signal, themotor 704b advances the closure member to grasp tissue between the anvil 716 and thestaple cartridge 718.

在一个方面，控制电路710被配置成能够使轴构件诸如轴740旋转，以使端部执行器702旋转。控制电路710向马达控制708c提供马达设定点，该马达控制708c向马达704c提供驱动信号。马达704c的输出轴联接到扭矩传感器744c。扭矩传感器744c联接到变速器706c，该变速器706c联接到轴740。变速器706c包括可运动机械元件诸如旋转元件，以控制轴740顺时针或逆时针旋转360°以上。在一个方面，马达704c联接到旋转变速器组件，该旋转变速器组件包括管齿轮区段，该管齿轮区段形成于(或附接到)近侧闭合管的近侧端部上，以通过可操作地支撑在工具安装板上的旋转齿轮组件可操作地接合。扭矩传感器744c向控制电路710提供旋转力反馈信号。旋转力反馈信号表示施加到轴740的旋转力。位置传感器734可被配置成能够将闭合构件的位置作为反馈信号提供给控制电路710。附加传感器738诸如轴编码器可向控制电路710提供轴740的旋转位置。In one aspect, thecontrol circuit 710 is configured to rotate a shaft member, such as theshaft 740 , to rotate theend effector 702 .Control circuit 710 provides motor setpoints to motor control 708c, which provides drive signals tomotor 704c. The output shaft ofmotor 704c is coupled to torque sensor 744c. Torque sensor 744c is coupled totransmission 706c , which is coupled toshaft 740 . Thetransmission 706c includes movable mechanical elements, such as rotating elements, to control the clockwise or counterclockwise rotation of theshaft 740 over 360°. In one aspect, themotor 704c is coupled to a rotary derailleur assembly that includes a tube gear section formed on (or attached to) a proximal end of the proximal closure tube to be operable by A rotating gear assembly is operatively engaged with a rotating gear assembly that is supported on the tool mounting plate. Torque sensor 744c provides a rotational force feedback signal to controlcircuit 710 . The rotational force feedback signal represents the rotational force applied to theshaft 740 . Theposition sensor 734 may be configured to provide the position of the closure member as a feedback signal to thecontrol circuit 710 .Additional sensors 738 such as shaft encoders may provide the rotational position of theshaft 740 to thecontrol circuit 710 .

在一个方面，控制电路710被配置成能够使端部执行器702进行关节运动。控制电路710向马达控制708d提供马达设定点，该马达控制708d向马达704d提供驱动信号。马达704d的输出轴联接到扭矩传感器744d。扭矩传感器744d联接到变速器706d，该变速器706d联接到关节运动构件742a。变速器706d包括可运动的机械元件诸如关节运动元件，以控制端部执行器702±65°的关节运动。在一个方面，马达704d联接到关节运动螺母，该关节运动螺母可旋转地轴颈连接在远侧脊部的近侧端部部分上并且通过关节运动齿轮组件在其上可旋转地驱动。扭矩传感器744d向控制电路710提供关节运动力反馈信号。关节运动力反馈信号表示施加到端部执行器702的关节运动力。传感器738(诸如关节运动编码器)可向控制电路710提供端部执行器702的关节运动位置。In one aspect, thecontrol circuit 710 is configured to enable articulation of theend effector 702 .Control circuit 710 provides motor setpoints to motor control 708d, which provides drive signals tomotor 704d. The output shaft ofmotor 704d is coupled to torque sensor 744d. Torque sensor 744d is coupled totransmission 706d, which is coupled to articulation member 742a. Thetransmission 706d includes movable mechanical elements, such as articulation elements, to control the ±65° articulation of theend effector 702 . In one aspect, themotor 704d is coupled to an articulation nut rotatably journaled on the proximal end portion of the distal spine and rotatably driven thereon by an articulation gear assembly. Torque sensor 744d provides an articulation force feedback signal to controlcircuit 710 . The articulation force feedback signal represents the articulation force applied to theend effector 702 . Asensor 738 , such as an articulation encoder, may provide the articulation position of theend effector 702 to thecontrol circuit 710 .

在另一方面，机器人外科系统700的关节运动功能可包括两个关节运动构件或连杆742a、742b。这些关节运动构件742a、742b由两个马达708d、708e所驱动的机器人接口(齿条)上的单独的盘驱动。当提供单独的击发马达704a时，关节运动连杆742a、742b中的每个可相对于另一个连杆进行拮抗驱动，以便在头部未运动时向头部提供阻力保持运动和负载，并且在头部进行关节运动时提供关节运动。当头部旋转时，关节运动构件742a、742b以固定的半径附接到头部。因此，当头部旋转时，推拉连杆的机械优点发生变化。机械优点的该变化对于其它关节运动连杆驱动系统可更明显。In another aspect, the articulation function of the roboticsurgical system 700 may include two articulation members orlinks 742a, 742b. Thesearticulation members 742a, 742b are driven by separate disks on a robotic interface (rack) driven by twomotors 708d, 708e. When aseparate firing motor 704a is provided, each of thearticulation links 742a, 742b can be actuated antagonistically with respect to the other link to provide resistance to the head to maintain motion and load when the head is not moving, and when the head is not moving. Provides joint motion as the head articulates. Thearticulation members 742a, 742b are attached to the head with a fixed radius as the head rotates. Therefore, when the head rotates, the mechanical advantage of the push-pull link changes. This change in mechanical advantage may be more pronounced for other articulation link drive systems.

在一个方面，一个或多个马达704a-704e可包括具有齿轮箱的有刷DC马达和与击发构件、闭合构件或关节运动构件的机械链路。另一个示例包括操作可运动机械元件诸如位移构件、关节运动连杆、闭合管和轴的电动马达704a-704e。外部影响是事物如组织、周围身体和摩擦对物理系统的未测量的、不可预测的影响。此类外部影响可被称为曳力，其相对电动马达704a-704e中的一个作用。外部影响诸如曳力可导致物理系统的操作偏离物理系统的期望操作。In one aspect, one or more of themotors 704a-704e may include a brushed DC motor with a gearbox and a mechanical link with a firing member, closure member, or articulation member. Another example includeselectric motors 704a-704e that operate movable mechanical elements such as displacement members, articulation links, closure tubes, and shafts. External influences are the unmeasured, unpredictable effects of things such as tissue, the surrounding body, and friction on a physical system. Such external influences may be referred to as drag forces, which act against one of theelectric motors 704a-704e. External influences such as drag forces can cause the operation of the physical system to deviate from the desired operation of the physical system.

在一个方面，位置传感器734可被实现为绝对定位系统。在一个方面，位置传感器734可包括磁性旋转绝对定位系统，该磁性旋转绝对定位系统被实现为AS5055EQFT单片磁性旋转位置传感器，其可购自奥地利微系统公司(Austria Microsystems,AG)。位置传感器734可与控制电路710交接，以提供绝对定位系统。位置可包括位于磁体上方并联接到CORDIC处理器的多个霍尔效应元件，该CORDIC处理器也被已知为逐位方法和Volder算法，提供该CORDIC处理器以实现用于计算双曲线函数和三角函数的简单有效的算法，双曲线函数和三角函数仅需要加法操作、减法操作、数位位移操作和表格查找操作。In one aspect, theposition sensor 734 may be implemented as an absolute positioning system. In one aspect, theposition sensor 734 may comprise a magnetic rotary absolute positioning system implemented as an AS5055EQFT monolithic magnetic rotary position sensor, available from Austria Microsystems, AG.Position sensor 734 may interface withcontrol circuit 710 to provide an absolute positioning system. The location may include a plurality of Hall effect elements located above the magnets and connected to a CORDIC processor, also known as the bitwise method and Volder algorithm, provided to implement for computing hyperbolic functions and Simple and efficient algorithms for trigonometric, hyperbolic and trigonometric functions requiring only addition, subtraction, digit shift and table lookup operations.

在一个方面，控制电路710可与一个或多个传感器738通信。传感器738可定位在端部执行器702上并且适于与机器人外科器械700一起操作以测量各种衍生参数，诸如间隙距离对时间、组织压缩与时间、以及砧座应变与时间。传感器738可包括磁性传感器、磁场传感器、应变仪、负荷传感器、压力传感器、力传感器、扭矩传感器、电感式传感器诸如涡流传感器、电阻式传感器、电容式传感器、光学传感器和/或用于测量端部执行器702的一个或多个参数的任何其他合适的传感器。传感器738可包括一个或多个传感器。传感器738可位于钉仓718平台上，以使用分段电极来确定组织位置。扭矩传感器744a-744e可被配置成能够感测力诸如击发力、闭合力和/或关节运动力等。因此，控制电路710可感测(1)远侧闭合管所经历的闭合负载及其位置，(2)在齿条处的击发构件及其位置，(3)钉仓718的上面具有组织的部分，以及(4)两个关节运动杆上的负载和位置。In one aspect, thecontrol circuit 710 may be in communication with one ormore sensors 738 .Sensors 738 may be positioned onend effector 702 and adapted to operate with roboticsurgical instrument 700 to measure various derived parameters, such as gap distance versus time, tissue compression versus time, and anvil strain versus time.Sensors 738 may include magnetic sensors, magnetic field sensors, strain gauges, load sensors, pressure sensors, force sensors, torque sensors, inductive sensors such as eddy current sensors, resistive sensors, capacitive sensors, optical sensors, and/or for measuring tip Any other suitable sensor for one or more parameters ofactuator 702 .Sensors 738 may include one or more sensors.Sensors 738 may be located on thestaple cartridge 718 platform to determine tissue location using segmented electrodes.Torque sensors 744a-744e may be configured to sense forces such as firing forces, closing forces, and/or articulation forces, among others. Thus, thecontrol circuit 710 can sense (1) the closing load experienced by the distal closure tube and its position, (2) the firing member at the rack and its position, (3) the portion of thestaple cartridge 718 having tissue thereon , and (4) the loads and positions on the two articulating rods.

在一个方面，一个或多个传感器738可包括应变仪诸如微应变仪，该应变仪被配置成能够在夹持条件期间测量砧座716中的应变的量值。应变仪提供电信号，该电信号的振幅随着应变量值而变化。传感器738可包括压力传感器，该压力传感器被配置成能够检测由砧座716和钉仓718之间的压缩组织的存在所生成的压力。传感器738可被配置成能够检测位于砧座716与钉仓718之间的组织区段的阻抗，该阻抗指示位于其间的组织的厚度和/或完全性。In one aspect, the one ormore sensors 738 may include strain gauges, such as micro-strain gauges, configured to measure the magnitude of the strain in the anvil 716 during clamping conditions. A strain gauge provides an electrical signal whose amplitude varies with the value of the strain.Sensor 738 may include a pressure sensor configured to detect pressure generated by the presence of compressed tissue between anvil 716 andstaple cartridge 718 . Thesensor 738 may be configured to detect the impedance of the tissue segment between the anvil 716 and thestaple cartridge 718, the impedance being indicative of the thickness and/or integrity of the tissue therebetween.

在一个方面，传感器738可实现为一个或多个限位开关、机电装置、固态开关、霍尔效应装置、磁阻(MR)装置、巨磁电阻(GMR)装置、磁力计等等。在其它具体实施中，传感器738可被实现为在光的影响下操作的固态开关，诸如光学传感器、IR传感器、紫外线传感器等等。同样，开关可为固态装置，诸如晶体管(例如，FET、结型FET、MOSFET、双极型晶体管等)。在其它具体实施中，传感器738可包括无电导体开关、超声开关、加速度计和惯性传感器等等。In one aspect,sensor 738 may be implemented as one or more limit switches, electromechanical devices, solid state switches, Hall effect devices, magnetoresistive (MR) devices, giant magnetoresistive (GMR) devices, magnetometers, and the like. In other implementations, thesensor 738 may be implemented as a solid state switch that operates under the influence of light, such as an optical sensor, an IR sensor, an ultraviolet sensor, and the like. Likewise, the switches may be solid state devices such as transistors (eg, FETs, junction FETs, MOSFETs, bipolar transistors, etc.). In other implementations, thesensors 738 may include electrical conductorless switches, ultrasonic switches, accelerometers, inertial sensors, and the like.

在一个方面，传感器738可被配置成能够测量由闭合驱动系统施加在砧座716上的力。例如，一个或多个传感器738可位于闭合管和砧座716之间的交互点处，以检测由闭合管施加到砧座716的闭合力。施加在砧座716上的力可表示捕集在砧座716和钉仓718之间的组织区段所经历的组织压缩。一个或多个传感器738可沿闭合驱动系统定位在各种交互点处，以检测由闭合驱动系统施加到砧座716的闭合力。一个或多个传感器738可在夹持操作期间由控制电路710的处理器实时取样。控制电路710接收实时样本测量结果以提供和分析基于时间的信息，并实时评估施加到砧座716的闭合力。In one aspect, thesensor 738 may be configured to measure the force exerted on the anvil 716 by the closed drive system. For example, one ormore sensors 738 may be located at the point of interaction between the closure tube and the anvil 716 to detect the closing force applied to the anvil 716 by the closure tube. The force exerted on the anvil 716 may represent the tissue compression experienced by the tissue segment trapped between the anvil 716 and thestaple cartridge 718 . One ormore sensors 738 may be positioned at various points of interaction along the closure drive system to detect the closure force applied to the anvil 716 by the closure drive system. The one ormore sensors 738 may be sampled in real time by the processor of thecontrol circuit 710 during the clamping operation. Thecontrol circuit 710 receives real-time sample measurements to provide and analyze time-based information and to evaluate the closing force applied to the anvil 716 in real-time.

在一个方面，电流传感器736可用于测量由马达704a-704e中的每个所消耗的电流。推进可运动的机械元件(诸如I形梁714)中的任一者所需的力对应于由马达704a-704e中的一个所消耗的电流。将该力转换成数字信号并将其提供给处理电路710。控制电路710可被配置成能够模拟器械的实际系统在控制器的软件中的响应。可致动位移构件以将端部执行器702中的I形梁714以目标速度或接近目标速度运动。机器人外科系统700可包括反馈控制器，该反馈控制器可为任何反馈控制器中的一者，包括但不限于例如PID、状态反馈、线性平方(LQR)和/或自适应控制器。机器人外科器械700可包括功率源，以例如将来自反馈控制器的信号转换成物理输入，诸如外壳电压、PWM电压、频率调制电压、电流、扭矩和/或力。附加细节公开于2017年6月29日提交的标题为用于机器人外科器械的闭环速度控制技术(CLOSED LOOP VELOCITY CONTROL TECHNIQUES FOR ROBOTIC SURGICAL INSTRUMENT)的美国专利申请序列号15/636,829中，该专利全文以引用方式并入本文。In one aspect, acurrent sensor 736 may be used to measure the current drawn by each of themotors 704a-704e. The force required to propel any of the movable mechanical elements, such as the I-beam 714, corresponds to the current drawn by one of themotors 704a-704e. This force is converted into a digital signal and provided toprocessing circuit 710 . Thecontrol circuit 710 may be configured to simulate the response of the actual system of the instrument in the software of the controller. The displacement member can be actuated to move the I-beam 714 in theend effector 702 at or near the target velocity. Roboticsurgical system 700 may include a feedback controller, which may be one of any feedback controller, including but not limited to, for example, PID, state feedback, linear square (LQR), and/or adaptive controller. Roboticsurgical instrument 700 may include a power source to, for example, convert signals from a feedback controller into physical inputs such as housing voltage, PWM voltage, frequency modulated voltage, current, torque, and/or force. Additional details are disclosed in U.S. Patent Application Serial No. 15/636,829, filed June 29, 2017, entitled CLOSED LOOP VELOCITY CONTROL TECHNIQUES FOR ROBOTIC SURGICAL INSTRUMENT, the entirety of which begins with Incorporated herein by reference.

图18示出了根据本公开的至少一个方面的被编程以控制位移构件的远侧平移的外科器械750的框图。在一个方面，外科器械750被编程为控制位移构件诸如I形梁764的远侧平移。外科器械750包括端部执行器752，该端部执行器可包括砧座766、I形梁764(包括锋利切割刃)和可移除钉仓768。18 shows a block diagram of asurgical instrument 750 programmed to control distal translation of a displacement member in accordance with at least one aspect of the present disclosure. In one aspect, thesurgical instrument 750 is programmed to control the distal translation of a displacement member such as the I-beam 764 .Surgical instrument 750 includes anend effector 752 that may include ananvil 766 , an I-beam 764 (including a sharp cutting edge), and a removablestaple cartridge 768 .

线性位移构件诸如I形梁764的位置、运动、位移和/或平移可通过绝对定位系统、传感器布置和位置传感器784来测量。由于I形梁764联接到纵向可运动的驱动构件，因此I形梁764的位置可通过采用位置传感器784测量纵向可运动的驱动构件的位置来确定。因此，在以下描述中，I形梁764的位置、位移和/或平移可通过如本文所述的位置传感器784来实现。控制电路760可以被编程为控制位移构件诸如I形梁764的平移。在一些示例中，控制电路760可包括用于执行使一个或多个处理器以所述方式控制位移构件(例如，I形梁764)的指令的一个或多个微控制器、微处理器或其他合适的处理器。在一个方面，定时器/计数器781向控制电路760提供输出信号，诸如耗用时间或数字计数，以将如由位置传感器784确定的I形梁764的位置与定时器/计数器781的输出相关联，使得控制电路760可确定I形梁764在特定时间(t)相对于起始位置的位置。定时器/计数器781可被配置成能够测量所耗用的时间，对外部事件进行计数或测定外部事件的时间。The position, motion, displacement, and/or translation of a linear displacement member such as I-beam 764 may be measured by an absolute positioning system, sensor arrangement, andposition sensor 784 . Since I-beam 764 is coupled to the longitudinally movable drive member, the position of I-beam 764 can be determined by measuring the position of the longitudinally movable drive member usingposition sensor 784 . Accordingly, in the following description, the position, displacement and/or translation of the I-beam 764 may be achieved by theposition sensor 784 as described herein.Control circuitry 760 may be programmed to control the translation of displacement members such as I-beams 764 . In some examples,control circuitry 760 may include one or more microcontrollers, microprocessors, or other suitable processors. In one aspect, timer/counter 781 provides output signals, such as elapsed time or digital counts, to controlcircuit 760 to correlate the position of I-beam 764 as determined byposition sensor 784 with the output of timer/counter 781 , so that thecontrol circuit 760 can determine the position of the I-beam 764 relative to the starting position at a particular time (t). Timer/counter 781 may be configured to measure elapsed time, count external events or time external events.

控制电路760可生成马达设定点信号772。马达设定点信号772可被提供给马达控制器758。马达控制器758可包括被配置成能够向马达754提供马达驱动信号774以驱动马达754的一个或多个电路，如本文所述。在一些示例中，马达754可为有刷DC电动马达。例如，马达754的速度可与马达驱动信号774成比例。在一些示例中，马达754可为无刷DC电动马达，并且马达驱动信号774可以包括提供给马达754的一个或多个定子绕组的PWM信号。而且，在一些示例中，可以省略马达控制器758，并且控制电路760可以直接生成马达驱动信号774。Control circuit 760 may generatemotor setpoint signal 772 . Themotor setpoint signal 772 may be provided to themotor controller 758 . Themotor controller 758 may include one or more circuits configured to provide amotor drive signal 774 to themotor 754 to drive themotor 754, as described herein. In some examples,motor 754 may be a brushed DC electric motor. For example, the speed of themotor 754 may be proportional to themotor drive signal 774 . In some examples,motor 754 may be a brushless DC electric motor, andmotor drive signal 774 may include a PWM signal provided to one or more stator windings ofmotor 754 . Also, in some examples,motor controller 758 may be omitted andcontrol circuit 760 may generatemotor drive signal 774 directly.

马达754可从能量源762接收电力。能量源762可以是或包括电池、超级电容器或任何其它合适的能量源。马达754可经由传动装置756机械地联接到I形梁764。传动装置756可包括用于将马达754联接到I形梁764的一个或多个齿轮或其他连杆部件。位置传感器784可感测I形梁764的位置。位置传感器784可为或包括能够生成指示I形梁764的位置的位置数据的任何类型的传感器。在一些示例中，位置传感器784可包括编码器，该编码器被配置成能够在I形梁764向远侧和向近侧平移时向控制电路760提供一系列脉冲。控制电路760可跟踪脉冲以确定I形梁764的位置。可使用其它合适的位置传感器，包括例如接近传感器。其他类型的位置传感器可提供指示I形梁764的运动的其他信号。而且，在一些示例中，可省略位置传感器784。在马达754是步进马达的情况下，控制电路760可通过聚合马达754已被指示执行的步骤的数量和方向来跟踪I形梁764的位置。位置传感器784可位于端部执行器752中或器械的任何其他部分处。Motor 754 may receive power fromenergy source 762 .Energy source 762 may be or include a battery, supercapacitor, or any other suitable energy source.Motor 754 may be mechanically coupled to I-beam 764 viatransmission 756 .Transmission 756 may include one or more gears or other linkage members forcoupling motor 754 to I-beam 764 . Aposition sensor 784 may sense the position of the I-beam 764 .Position sensor 784 may be or include any type of sensor capable of generating position data indicative of the position of I-beam 764 . In some examples,position sensor 784 may include an encoder configured to provide a series of pulses to controlcircuit 760 as I-beam 764 is translated distally and proximally. Thecontrol circuit 760 can track the pulses to determine the position of the I-beam 764 . Other suitable position sensors may be used, including, for example, proximity sensors. Other types of position sensors may provide other signals indicative of movement of the I-beam 764 . Also, in some examples,position sensor 784 may be omitted. Wheremotor 754 is a stepper motor,control circuit 760 can track the position of I-beam 764 by aggregating the number and direction of steps themotor 754 has been instructed to perform.Position sensor 784 may be located inend effector 752 or at any other portion of the instrument.

控制电路760可与一个或多个传感器788通信。传感器788可定位在端部执行器752上并且适于与外科器械750一起操作以测量各种衍生参数，诸如间隙距离与时间、组织压缩与时间，以及砧座应变与时间。传感器788可包括磁性传感器、磁场传感器、应变仪、压力传感器、力传感器、电感式传感器(诸如涡流传感器)、电阻式传感器、电容式传感器、光学传感器和/或用于测量端部执行器752的一个或多个参数的任何其他合适的传感器。传感器788可包括一个或多个传感器。Control circuitry 760 may be in communication with one ormore sensors 788 .Sensor 788 may be positioned onend effector 752 and adapted to operate withsurgical instrument 750 to measure various derived parameters, such as gap distance versus time, tissue compression versus time, and anvil strain versus time.Sensors 788 may include magnetic sensors, magnetic field sensors, strain gauges, pressure sensors, force sensors, inductive sensors (such as eddy current sensors), resistive sensors, capacitive sensors, optical sensors, and/or sensors for measuringend effector 752 any other suitable sensor for one or more parameters.Sensors 788 may include one or more sensors.

一个或多个传感器788可包括应变仪诸如微应变仪，该应变仪被配置成能够在夹持条件期间测量砧座766中的应变的量值。应变仪提供电信号，该电信号的振幅随着应变量值而变化。传感器788可包括压力传感器，该压力传感器被配置成能够检测由砧座766和钉仓768之间的压缩组织的存在所生成的压力。传感器788可被配置成能够检测位于砧座766与钉仓768之间的组织区段的阻抗，该阻抗指示位于其间的组织的厚度和/或完全性。The one ormore sensors 788 may include strain gauges, such as micro-strain gauges, configured to measure the magnitude of strain in theanvil 766 during clamping conditions. A strain gauge provides an electrical signal whose amplitude varies with the value of the strain.Sensor 788 may include a pressure sensor configured to detect pressure generated by the presence of compressed tissue betweenanvil 766 andstaple cartridge 768 . Thesensor 788 may be configured to detect the impedance of the tissue segment between theanvil 766 and thestaple cartridge 768, the impedance being indicative of the thickness and/or integrity of the tissue therebetween.

传感器788可被配置成能够测量由闭合驱动系统施加在砧座766上的力。例如，一个或多个传感器788可位于闭合管和砧座766之间的交互点处，以检测由闭合管施加到砧座766的闭合力。施加在砧座766上的力可表示捕集在砧座766和钉仓768之间的组织区段所经历的组织压缩。一个或多个传感器788可沿闭合驱动系统定位在各种交互点处，以检测由闭合驱动系统施加到砧座766的闭合力。一个或多个传感器788可在夹持操作期间由控制电路760的处理器实时取样。控制电路760接收实时样本测量结果以提供和分析基于时间的信息，并实时评估施加到砧座766的闭合力。Sensor 788 may be configured to measure the force exerted onanvil 766 by the closed drive system. For example, one ormore sensors 788 may be located at the point of interaction between the closure tube and theanvil 766 to detect the closing force applied to theanvil 766 by the closure tube. The force exerted on theanvil 766 may represent the tissue compression experienced by the tissue segment trapped between theanvil 766 and thestaple cartridge 768 . One ormore sensors 788 may be positioned at various points of interaction along the closure drive system to detect the closure force applied to theanvil 766 by the closure drive system. The one ormore sensors 788 may be sampled in real time by the processor of thecontrol circuit 760 during the clamping operation. Thecontrol circuit 760 receives real-time sample measurements to provide and analyze time-based information and to evaluate the closing force applied to theanvil 766 in real-time.

可采用电流传感器786来测量由马达754消耗的电流。推进I形梁764所需的力对应于由马达754消耗的电流。将该力转换成数字信号并将其提供给控制电路760。Acurrent sensor 786 may be employed to measure the current drawn by themotor 754 . The force required to advance the I-beam 764 corresponds to the current drawn by themotor 754 . This force is converted into a digital signal and provided to controlcircuit 760 .

控制电路760可被配置成能够在控制器的软件中模拟器械的实际系统的响应。可致动位移构件以将端部执行器752中的I形梁764以目标速度或接近目标速度运动。外科器械750可包括反馈控制器，该反馈控制器可为任何反馈控制器中的一者，包括但不限于例如PID、状态反馈、LQR和/或自适应控制器。外科器械750可包括功率源，以例如将来自反馈控制器的信号转换为物理输入，诸如外壳电压、PWM电压、频率调制电压、电流、扭矩和/或力。Thecontrol circuit 760 may be configured to simulate the response of the actual system of the instrument in the software of the controller. The displacement member can be actuated to move the I-beam 764 in theend effector 752 at or near the target velocity.Surgical instrument 750 may include a feedback controller, which may be one of any feedback controller, including but not limited to, for example, PID, state feedback, LQR, and/or an adaptive controller.Surgical instrument 750 may include a power source to, for example, convert signals from a feedback controller into physical inputs such as housing voltage, PWM voltage, frequency modulated voltage, current, torque, and/or force.

外科器械750的实际驱动系统被配置成能够通过具有齿轮箱和与关节运动和/或刀系统的机械连接件的有刷直流马达来驱动位移构件、切割构件或I形梁764。另一示例为操作例如可互换轴组件的位移构件和关节运动驱动器的电动马达754。外部影响是事物如组织、周围身体和摩擦对物理系统的未测量的、不可预测的影响。这种外部影响可被称为相对电动马达754作用的曳力。外部影响诸如曳力可导致物理系统的操作偏离物理系统的期望操作。The actual drive system of thesurgical instrument 750 is configured to be able to drive the displacement member, cutting member or I-beam 764 by a brushed DC motor with a gearbox and mechanical connection to the articulation and/or knife system. Another example is anelectric motor 754 that operates displacement members and articulation drives such as interchangeable shaft assemblies. External influences are the unmeasured, unpredictable effects of things such as tissue, the surrounding body, and friction on a physical system. This external influence may be referred to as the drag force acting against theelectric motor 754 . External influences such as drag forces can cause the operation of the physical system to deviate from the desired operation of the physical system.

各种示例性方面涉及外科器械750，其包括具有马达驱动的外科缝合和切割工具的端部执行器752。例如，马达754可沿着端部执行器752的纵向轴线朝远侧和朝近侧驱动位移构件。端部执行器752可包括可枢转砧座766，并且当被构造用于使用时，钉仓768与砧座766相对定位。临床医生可将组织抓持砧座766与钉仓768之间，如本文所述。当准备好使用器械750时，临床医生可例如通过按下器械750的触发器来提供击发信号。响应于该击发信号，马达754可沿端部执行器752的纵向轴线将位移构件从近侧行程开始位置朝远侧驱动到行程开始位置远侧的行程结束位置。当位移构件朝远侧平移时，带有定位在远侧端部处的切割元件的I形梁764可切割钉仓768与砧座766之间的组织。Various exemplary aspects relate to asurgical instrument 750 including anend effector 752 having a motor-driven surgical stapling and cutting tool. For example, themotor 754 may drive the displacement member distally and proximally along the longitudinal axis of theend effector 752 . Theend effector 752 can include apivotable anvil 766 with astaple cartridge 768 positioned opposite theanvil 766 when configured for use. The clinician can grasp tissue between theanvil 766 and thestaple cartridge 768, as described herein. When theinstrument 750 is ready to be used, the clinician may provide a firing signal, eg, by depressing the trigger of theinstrument 750 . In response to the firing signal, themotor 754 may drive the displacement member distally along the longitudinal axis of theend effector 752 from the proximal start of stroke position to an end of stroke position distal to the start of stroke position. The I-beam 764 with cutting elements positioned at the distal end may cut tissue between thestaple cartridge 768 and theanvil 766 as the displacement member is translated distally.

在各种示例中，外科器械750可包括控制电路760，该控制电路被编程为基于一个或多个组织状况控制位移构件(诸如I形梁764)的远侧平移。控制电路760可以被编程为直接或间接地感测组织状况，诸如厚度，如本文所述。控制电路760可被编程为基于组织状况来选择击发控制程序。击发控制程序可以描述位移构件的远侧运动。可以选择不同的击发控制程序以更好地处理不同的组织状况。例如，当存在较厚的组织时，控制电路760可以被编程为以较低的速度和/或以较低的功率平移位移构件。当存在较薄的组织时，控制电路760可以被编程为以较高的速度和/或以较高的功率平移位移构件。In various examples,surgical instrument 750 may includecontrol circuitry 760 programmed to control the distal translation of a displacement member, such as I-beam 764, based on one or more tissue conditions.Control circuitry 760 may be programmed to directly or indirectly sense tissue conditions, such as thickness, as described herein.Control circuitry 760 may be programmed to select a firing control program based on tissue conditions. The firing control program can describe the distal movement of the displacement member. Different firing control programs can be selected to better handle different tissue conditions. For example, when thicker tissue is present, thecontrol circuit 760 may be programmed to translate the displacement member at a lower speed and/or at a lower power. When thinner tissue is present, thecontrol circuit 760 can be programmed to translate the displacement member at a higher speed and/or at a higher power.

在一些示例中，控制电路760可针对位移构件的行程的第一开环部分初始以开环构型来操作马达754。基于在行程的开环部分期间器械750的响应，控制电路760可选择击发控制程序。器械的响应可以包括在开环部分期间位移构件的平移距离、在开环部分期间耗用的时间、在开环部分期间提供给马达754的能量、马达驱动信号的脉冲宽度之和等。在开环部分之后，控制电路760可以对位移构件行程的第二部分实施所选择的击发控制程序。例如，在行程的闭环部分期间，控制电路760可基于描述位移构件的位置的平移数据以闭环方式来调节马达754，以使位移构件以恒定速度平移。附加细节公开于2017年9月29日提交的标题为用于控制外科器械的显示器的系统和方法(SYSTEM AND METHODS FOR CONTROLLINGA DISPLAY OF A SURGICAL INSTRUMENT)的美国专利申请序列号15/720,852中，该专利申请全文以引用方式并入本文。In some examples, thecontrol circuit 760 may initially operate themotor 754 in an open-loop configuration for a first open-loop portion of the displacement member's travel. Based on the response of theinstrument 750 during the open loop portion of the stroke, thecontrol circuit 760 may select a firing control program. The response of the instrument may include the translation distance of the displacement member during the open loop portion, the time elapsed during the open loop portion, the energy supplied to themotor 754 during the open loop portion, the sum of the pulse widths of the motor drive signal, and the like. After the open loop portion, thecontrol circuit 760 may implement the selected firing control routine for the second portion of the displacement member travel. For example, during the closed-loop portion of the stroke, thecontrol circuit 760 may adjust themotor 754 in a closed-loop fashion based on translational data describing the position of the displacement member to translate the displacement member at a constant velocity. Additional details are disclosed in US Patent Application Serial No. 15/720,852, filed September 29, 2017, entitled SYSTEM AND METHODS FOR CONTROLLINGA DISPLAY OF A SURGICAL INSTRUMENT, which patent The entirety of the application is incorporated herein by reference.

图19为根据本公开的至少一个方面的被配置成能够控制各个功能的外科器械790的示意图。在一个方面，外科器械790被编程为控制位移构件诸如I形梁764的远侧平移。外科器械790包括端部执行器792，该端部执行器可以包括砧座766、I形梁764和可移除钉仓768，该可移除钉仓可以与RF仓796(以虚线示出)互换。19 is a schematic illustration of asurgical instrument 790 configured to control various functions in accordance with at least one aspect of the present disclosure. In one aspect, thesurgical instrument 790 is programmed to control the distal translation of a displacement member such as the I-beam 764 .Surgical instrument 790 includes anend effector 792, which can include ananvil 766, an I-beam 764, and a removablestaple cartridge 768, which can be combined with an RF cartridge 796 (shown in phantom) exchange.

在一个方面，传感器788可被实现为限位开关、机电装置、固态开关、霍尔效应装置、MR装置、GMR装置、磁力计等等。在其它具体实施中，传感器638可被实现为在光的影响下操作的固态开关，诸如光学传感器、IR传感器、紫外线传感器等等。同样，开关可为固态装置，诸如晶体管(例如，FET、结型FET、MOSFET、双极型晶体管等)。在其他具体实施中，传感器788可包括无电导体开关、超声开关、加速度计和惯性传感器等等。In one aspect, thesensors 788 may be implemented as limit switches, electromechanical devices, solid state switches, Hall effect devices, MR devices, GMR devices, magnetometers, and the like. In other implementations, the sensor 638 may be implemented as a solid state switch that operates under the influence of light, such as an optical sensor, an IR sensor, an ultraviolet sensor, and the like. Likewise, the switches may be solid state devices such as transistors (eg, FETs, junction FETs, MOSFETs, bipolar transistors, etc.). In other implementations, thesensors 788 may include electrical conductorless switches, ultrasonic switches, accelerometers, inertial sensors, and the like.

在一个方面，位置传感器784可被实现为绝对定位系统，该绝对定位系统包括被实现为AS5055EQFT单片磁性旋转位置传感器的磁性旋转绝对定位系统，其可购自奥地利微系统公司(Austria Microsystems,AG)。位置传感器784与控制电路760交接，以提供绝对定位系统。位置可包括位于磁体上方并联接到CORDIC处理器的多个霍尔效应元件，该CORDIC处理器也被已知为逐位方法和Volder算法，提供该CORDIC处理器以实现用于计算双曲线函数和三角函数的简单有效的算法，双曲线函数和三角函数仅需要加法操作、减法操作、数位位移操作和表格查找操作。In one aspect,position sensor 784 may be implemented as an absolute positioning system including a magnetic rotary absolute positioning system implemented as an AS5055EQFT monolithic magnetic rotary position sensor, available from Austria Microsystems, AG ).Position sensor 784 interfaces withcontrol circuit 760 to provide an absolute positioning system. The location may include a plurality of Hall effect elements located above the magnets and connected to a CORDIC processor, also known as the bitwise method and Volder algorithm, provided to implement for computing hyperbolic functions and Simple and efficient algorithms for trigonometric, hyperbolic and trigonometric functions requiring only addition, subtraction, digit shift and table lookup operations.

在一个方面，I形梁764可被实现为包括刀主体的刀构件，该刀主体将组织切割刀片可操作地支撑在其上，并且该I形梁还可包括砧座接合插片或特征部以及通道接合特征部或脚部。在一个方面，钉仓768可被实现为标准(机械)外科紧固件仓。在一个方面，RF仓796可被实现为RF仓。这些和其他传感器布置在2017年6月20日提交的标题为“TECHNIQUESFOR ADAPTIVE CONTROL OF MOTOR VELOCITY OF A SURGICAL STAPLING AND CUTTINGINSTRUMENT”的共同拥有的美国专利申请序列号15/628,175中描述，该专利全文以引用方式并入本文。In one aspect, the I-beam 764 can be implemented as a knife member including a knife body operably supporting the tissue cutting blade thereon, and the I-beam can also include anvil engagement tabs or features and channel engagement features or feet. In one aspect,staple cartridge 768 may be implemented as a standard (mechanical) surgical fastener cartridge. In one aspect,RF bin 796 may be implemented as an RF bin. These and other sensor arrangements are described in commonly owned US Patent Application Serial No. 15/628,175, filed June 20, 2017, entitled "TECHNIQUESFOR ADAPTIVE CONTROL OF MOTOR VELOCITY OF A SURGICAL STAPLING AND CUTTING INSTRUMENT," which is incorporated by reference in its entirety. method is incorporated herein.

线性位移构件诸如I形梁764的位置、运动、位移和/或平移可通过绝对定位系统、传感器布置和表示为位置传感器784的位置传感器来测量。由于I形梁764联接到纵向可运动的驱动构件，因此I形梁764的位置可通过采用位置传感器784测量纵向可运动的驱动构件的位置来确定。因此，在以下描述中，I形梁764的位置、位移和/或平移可通过如本文所述的位置传感器784来实现。控制电路760可以被编程为控制位移构件诸如I形梁764的平移，如本文所述。在一些示例中，控制电路760可包括用于执行使一个或多个处理器以所述方式控制位移构件(例如，I形梁764)的指令的一个或多个微控制器、微处理器或其他合适的处理器。在一个方面，定时器/计数器781向控制电路760提供输出信号，诸如耗用时间或数字计数，以将如由位置传感器784确定的I形梁764的位置与定时器/计数器781的输出相关联，使得控制电路760可确定I形梁764在特定时间(t)相对于起始位置的位置。定时器/计数器781可被配置成能够测量所耗用的时间，对外部事件进行计数或测定外部事件的时间。The position, motion, displacement, and/or translation of a linear displacement member such as I-beam 764 may be measured by an absolute positioning system, a sensor arrangement, and a position sensor designated asposition sensor 784 . Since I-beam 764 is coupled to the longitudinally movable drive member, the position of I-beam 764 can be determined by measuring the position of the longitudinally movable drive member usingposition sensor 784 . Accordingly, in the following description, the position, displacement and/or translation of the I-beam 764 may be achieved by theposition sensor 784 as described herein.Control circuitry 760 may be programmed to control the translation of displacement members, such as I-beams 764, as described herein. In some examples,control circuitry 760 may include one or more microcontrollers, microprocessors, or other suitable processors. In one aspect, timer/counter 781 provides output signals, such as elapsed time or digital counts, to controlcircuit 760 to correlate the position of I-beam 764 as determined byposition sensor 784 with the output of timer/counter 781 , so that thecontrol circuit 760 can determine the position of the I-beam 764 relative to the starting position at a particular time (t). Timer/counter 781 may be configured to measure elapsed time, count external events or time external events.

控制电路760可生成马达设定点信号772。马达设定点信号772可被提供给马达控制器758。马达控制器758可包括被配置成能够向马达754提供马达驱动信号774以驱动马达754的一个或多个电路，如本文所述。在一些示例中，马达754可为有刷DC电动马达。例如，马达754的速度可与马达驱动信号774成比例。在一些示例中，马达754可为无刷DC电动马达，并且马达驱动信号774可以包括提供给马达754的一个或多个定子绕组的PWM信号。而且，在一些示例中，可以省略马达控制器758，并且控制电路760可以直接生成马达驱动信号774。Control circuit 760 may generatemotor setpoint signal 772 . Themotor setpoint signal 772 may be provided to themotor controller 758 . Themotor controller 758 may include one or more circuits configured to provide amotor drive signal 774 to themotor 754 to drive themotor 754, as described herein. In some examples,motor 754 may be a brushed DC electric motor. For example, the speed of themotor 754 may be proportional to themotor drive signal 774 . In some examples,motor 754 may be a brushless DC electric motor, andmotor drive signal 774 may include a PWM signal provided to one or more stator windings ofmotor 754 . Also, in some examples,motor controller 758 may be omitted andcontrol circuit 760 may generatemotor drive signal 774 directly.

马达754可从能量源762接收电力。能量源762可以是或包括电池、超级电容器或任何其它合适的能量源。马达754可经由传动装置756机械地联接到I形梁764。传动装置756可包括用于将马达754联接到I形梁764的一个或多个齿轮或其他连杆部件。位置传感器784可感测I形梁764的位置。位置传感器784可为或包括能够生成指示I形梁764的位置的位置数据的任何类型的传感器。在一些示例中，位置传感器784可包括编码器，该编码器被配置成能够在I形梁764向远侧和向近侧平移时向控制电路760提供一系列脉冲。控制电路760可跟踪脉冲以确定I形梁764的位置。可使用其它合适的位置传感器，包括例如接近传感器。其他类型的位置传感器可提供指示I形梁764的运动的其他信号。而且，在一些示例中，可省略位置传感器784。在马达754是步进马达的情况下，控制电路760可通过聚合该马达已被指示执行的步骤的数量和方向来跟踪I形梁764的位置。位置传感器784可位于端部执行器792中或器械的任何其他部分处。Motor 754 may receive power fromenergy source 762 .Energy source 762 may be or include a battery, supercapacitor, or any other suitable energy source.Motor 754 may be mechanically coupled to I-beam 764 viatransmission 756 .Transmission 756 may include one or more gears or other linkage members forcoupling motor 754 to I-beam 764 . Aposition sensor 784 may sense the position of the I-beam 764 .Position sensor 784 may be or include any type of sensor capable of generating position data indicative of the position of I-beam 764 . In some examples,position sensor 784 may include an encoder configured to provide a series of pulses to controlcircuit 760 as I-beam 764 is translated distally and proximally. Thecontrol circuit 760 can track the pulses to determine the position of the I-beam 764 . Other suitable position sensors may be used, including, for example, proximity sensors. Other types of position sensors may provide other signals indicative of movement of the I-beam 764 . Also, in some examples,position sensor 784 may be omitted. Wheremotor 754 is a stepper motor,control circuit 760 can track the position of I-beam 764 by aggregating the number and direction of steps the motor has been instructed to perform.Position sensor 784 may be located inend effector 792 or at any other portion of the instrument.

控制电路760可与一个或多个传感器788通信。传感器788可定位在端部执行器792上并且适于与外科器械790一起操作以测量各种衍生参数，诸如间隙距离与时间、组织压缩与时间，以及砧座应变与时间。传感器788可包括磁性传感器、磁场传感器、应变仪、压力传感器、力传感器、电感式传感器(诸如涡流传感器)、电阻式传感器、电容式传感器、光学传感器和/或用于测量端部执行器792的一个或多个参数的任何其他合适的传感器。传感器788可包括一个或多个传感器。Control circuitry 760 may be in communication with one ormore sensors 788 .Sensor 788 may be positioned onend effector 792 and adapted to operate withsurgical instrument 790 to measure various derived parameters such as gap distance and time, tissue compression and time, and anvil strain and time.Sensors 788 may include magnetic sensors, magnetic field sensors, strain gauges, pressure sensors, force sensors, inductive sensors (such as eddy current sensors), resistive sensors, capacitive sensors, optical sensors, and/or sensors for measuringend effector 792 any other suitable sensor for one or more parameters.Sensors 788 may include one or more sensors.

一个或多个传感器788可包括应变仪诸如微应变仪，该应变仪被配置成能够在夹持条件期间测量砧座766中的应变的量值。应变仪提供电信号，该电信号的振幅随着应变量值而变化。传感器788可包括压力传感器，该压力传感器被配置成能够检测由砧座766和钉仓768之间的压缩组织的存在所生成的压力。传感器788可被配置成能够检测位于砧座766与钉仓768之间的组织区段的阻抗，该阻抗指示位于其间的组织的厚度和/或完全性。The one ormore sensors 788 may include strain gauges, such as micro-strain gauges, configured to measure the magnitude of strain in theanvil 766 during clamping conditions. A strain gauge provides an electrical signal whose amplitude varies with the value of the strain.Sensor 788 may include a pressure sensor configured to detect pressure generated by the presence of compressed tissue betweenanvil 766 andstaple cartridge 768 . Thesensor 788 may be configured to detect the impedance of the tissue segment between theanvil 766 and thestaple cartridge 768, the impedance being indicative of the thickness and/or integrity of the tissue therebetween.

传感器788可被配置成能够测量由闭合驱动系统施加在砧座766上的力。例如，一个或多个传感器788可位于闭合管和砧座766之间的交互点处，以检测由闭合管施加到砧座766的闭合力。施加在砧座766上的力可表示捕集在砧座766和钉仓768之间的组织区段所经历的组织压缩。一个或多个传感器788可沿闭合驱动系统定位在各种交互点处，以检测由闭合驱动系统施加到砧座766的闭合力。一个或多个传感器788可在夹持操作期间由控制电路760的处理器部分实时取样。控制电路760接收实时样本测量结果以提供和分析基于时间的信息，并实时评估施加到砧座766的闭合力。Sensor 788 may be configured to measure the force exerted onanvil 766 by the closed drive system. For example, one ormore sensors 788 may be located at the point of interaction between the closure tube and theanvil 766 to detect the closing force applied to theanvil 766 by the closure tube. The force exerted on theanvil 766 may represent the tissue compression experienced by the tissue segment trapped between theanvil 766 and thestaple cartridge 768 . One ormore sensors 788 may be positioned at various points of interaction along the closure drive system to detect the closure force applied to theanvil 766 by the closure drive system. The one ormore sensors 788 may be sampled in real time by the processor portion of thecontrol circuit 760 during the clamping operation. Thecontrol circuit 760 receives real-time sample measurements to provide and analyze time-based information and to evaluate the closing force applied to theanvil 766 in real-time.

可采用电流传感器786来测量由马达754消耗的电流。推进I形梁764所需的力对应于由马达754消耗的电流。将该力转换成数字信号并将其提供给控制电路760。Acurrent sensor 786 may be employed to measure the current drawn by themotor 754 . The force required to advance the I-beam 764 corresponds to the current drawn by themotor 754 . This force is converted into a digital signal and provided to controlcircuit 760 .

当RF仓796代替钉仓768被装载在端部执行器792中时，RF能量源794联接到端部执行器792并且被施加到RF仓796。控制电路760控制RF能量到RF仓796的递送。WhenRF cartridge 796 is loaded inend effector 792 in place ofstaple cartridge 768 ,RF energy source 794 is coupled to endeffector 792 and applied toRF cartridge 796 .Control circuitry 760 controls the delivery of RF energy toRF bin 796 .

附加细节公开于2017年6月28日提交的美国专利申请序列号15/636,096，其标题为可与钉仓和射频仓联接的外科系统及其使用方法(SURGICAL SYSTEM COUPLABLE WITHSTAPLE CARTRIDGE AND RADIO FREQUENCY CARTRIDGE,AND METHOD OF USING SAME)，该专利全文以引用方式并入本文。Additional details are disclosed in US Patent Application Serial No. 15/636,096, filed June 28, 2017, entitled SURGICAL SYSTEM COUPLABLE WITHSTAPLE CARTRIDGE AND RADIO FREQUENCY CARTRIDGE, AND METHOD OF USING SAME), which is hereby incorporated by reference in its entirety.

图20示出了行程长度曲线图20740，其示出了控制系统可如何基于关节运动角度θ来修改闭合管组件的行程长度。行程长度的此类修改包括随着关节角度θ的增加(例如，沿着x轴限定)而将行程长度缩短到补偿行程长度(例如，沿y轴限定)。补偿行程长度限定了闭合管组件在远侧方向上的行进长度，以闭合端部执行器的钳口，该补偿的行程长度取决于关节运动角度θ，并防止闭合管组件的过度行进对外科装置造成损坏。20 shows astroke length graph 20740 showing how the control system may modify the stroke length of the closure tube assembly based on the articulation angle Θ. Such modification of the stroke length includes shortening the stroke length to a compensation stroke length (eg, as defined along the y-axis) as the joint angle θ increases (eg, as defined along the x-axis). The compensated stroke length defines the length of travel of the closure tube assembly in the distal direction to close the jaws of the end effector, the compensated stroke length depends on the articulation angle θ and prevents excessive travel of the closure tube assembly to the surgical device cause damage.

例如，如行程长度曲线图20740所示，当端部执行器未进行关节运动时，闭合管组件闭合钳口的行程长度为约0.250英寸，而当关节运动角度θ为约60度时，补偿行程长度为约0.242英寸。此类测量结果仅作为示例提供，并且在不脱离本公开的范围的情况下，可包括各种角度和对应行程长度以及补偿行程长度中的任一者。此外，关节运动角度θ与补偿行程长度之间的关系为非线性的，并且补偿行程长度的缩短速率随着关节运动角度的增加而增加。例如，补偿行程长度在45度和60度关节运动之间的减小大于补偿行程长度在0度和15度关节运动之间的减小。尽管利用这种方法，控制系统基于关节运动角度θ来调节行程长度以防止损坏外科装置(例如，将闭合管组件的远侧端部卡在远侧位置)，但仍然允许远侧闭合管在关节运动期间推进，从而可能至少部分地闭合钳口。For example, as shown in thestroke length graph 20740, when the end effector is not articulated, the stroke length of the closing jaws of the closure tube assembly is about 0.250 inches, and when the articulation angle θ is about 60 degrees, the compensated stroke The length is about 0.242 inches. Such measurements are provided by way of example only, and may include any of various angles and corresponding stroke lengths and compensated stroke lengths without departing from the scope of the present disclosure. Furthermore, the relationship between the articulation angle θ and the compensation stroke length is non-linear, and the rate of shortening of the compensation stroke length increases as the articulation angle increases. For example, a decrease in compensated stroke length between 45 degrees and 60 degrees of articulation is greater than a decrease in compensated travel length between 0 and 15 degrees of articulation. Although with this approach, the control system adjusts the stroke length based on the articulation angle θ to prevent damage to the surgical device (eg, trapping the distal end of the closure tube assembly in the distal position), it still allows the distal closure tube to move at the joint. Advancing during the movement makes it possible to at least partially close the jaws.

图21示出了闭合管组件定位曲线图20750，其示出控制系统基于关节运动角度θ修改闭合管组件的纵向位置的一个方面。闭合管组件的纵向位置的此类修改包括当端部执行器进行关节运动时并且基于关节运动角度θ(例如，沿x轴限定)使闭合管组件朝近侧回缩补偿距离(例如，沿y轴限定)。闭合管组件朝近侧回缩的补偿距离防止远侧闭合管朝远侧推进，从而在关节运动期间将钳口保持在打开位置。通过在关节运动期间使闭合管组件朝近侧回缩补偿距离，闭合管组件可从近侧回缩位置开始行进行程长度，以在激活闭合组件时闭合钳口。21 shows a closure tubeassembly positioning graph 20750 illustrating one aspect of the control system modifying the longitudinal position of the closure tube assembly based on the articulation angle Θ. Such modification of the longitudinal position of the closure tube assembly includes retracting the closure tube assembly proximally by a compensation distance (eg, along the y axis) when the end effector is articulated and based on the articulation angle θ (eg, defined along the x-axis). axis limit). The compensation distance of proximal retraction of the closure tube assembly prevents distal advancement of the distal closure tube, thereby maintaining the jaws in the open position during articulation. By retracting the closure tube assembly proximally by a compensation distance during articulation, the closure tube assembly can travel a length of travel from the proximally retracted position to close the jaws when the closure assembly is activated.

例如，如闭合管组件定位曲线图20750所示，当端部执行器未进行关节运动时的补偿距离为零，并且当关节运动角度θ为约60度时的补偿距离为约0.008英寸。在该示例中，闭合管组件在关节运动期间回缩0.008英寸的补偿距离。因此，为了闭合钳口，闭合管组件可从该回缩位置开始推进行程长度。此类测量结果仅出于示例的目的提供，并且在不脱离本公开的范围的情况下可包括各种角度和对应的补偿距离中的任一者。如图21所示，关节运动角度θ与补偿距离之间的关系为非线性的，并且补偿距离延长的速率随关节运动角度θ的增加而增加。例如，补偿距离在45度和60度之间的增加大于补偿距离在0度和15度之间的增加。For example, as shown in the closed tubeassembly positioning graph 20750, the compensation distance is zero when the end effector is not articulated, and the compensation distance is about 0.008 inches when the articulation angle Θ is about 60 degrees. In this example, the closure tube assembly retracts a compensation distance of 0.008 inches during articulation. Thus, to close the jaws, the closure tube assembly may be advanced the length of travel from this retracted position. Such measurements are provided for example purposes only, and may include any of various angles and corresponding compensation distances without departing from the scope of the present disclosure. As shown in FIG. 21 , the relationship between the articulation angle θ and the compensation distance is non-linear, and the rate at which the compensation distance lengthens increases as the articulation angle θ increases. For example, the increase in the compensation distance between 45 degrees and 60 degrees is greater than the increase in the compensation distance between 0 degrees and 15 degrees.

当夹持患者组织时，通过夹持装置(例如，线性缝合器)施加的力和组织可达到不可接受的高水平。例如，当采用恒定的闭合速率时，该力可变得足够高以对被夹持组织造成过度创伤，并且可在夹持装置中造成变形，使得在整个缝合路径上不保持可接受的组织间隙。图22为示出在压缩期间以恒定砧座闭合速率(即，不使用受控组织压缩(CTC))施加到组织的功率相对于和在压缩期间以可变砧座闭合速率(即，使用CTC)施加到组织的功率的曲线图。可调节闭合速率以控制组织压缩，使得施加到组织中的功率在压缩的一部分上保持恒定。当利用可变砧座闭合速率时，根据图22施加到组织中的峰值功率低得多。基于所施加的功率，可计算由外科装置施加的力(或与力相关或成比例的参数)。就这一点而言，可限制功率，使得通过外科装置(例如，通过线性缝合器的钳口)施加的力不超过导致钳口张开的屈服力或压力，使得当处于完全闭合位置时，组织间隙不在沿整个缝合长度的可接受范围内。例如，钳口应平行或足够接近平行，使得组织间隙对于沿钳口的整个长度的所有钉位置保持在可接受或目标范围内。此外，对所施加的功率的限制避免或至少最小化对组织的创伤或损伤。When gripping patient tissue, the force and tissue applied by the gripping device (eg, linear stapler) can reach unacceptably high levels. For example, when a constant closure rate is employed, the force can become high enough to cause excessive trauma to the clamped tissue and can cause deformation in the clamping device such that an acceptable tissue gap is not maintained throughout the suturing path . 22 is a graph showing power applied to tissue at a constant anvil closure rate (ie, without controlled tissue compression (CTC)) during compression versus and during compression at a variable anvil closure rate (ie, with CTC) ) graph of the power applied to the tissue. The closure rate can be adjusted to control tissue compression such that the power applied to the tissue remains constant over a portion of the compression. When utilizing a variable anvil closure rate, the peak power applied to the tissue according to Figure 22 is much lower. Based on the applied power, the force (or a force-related or proportional parameter) applied by the surgical device can be calculated. In this regard, power can be limited so that the force applied by the surgical device (eg, by the jaws of a linear stapler) does not exceed the yield force or pressure that causes the jaws to open, so that when in the fully closed position, the tissue The gap is not acceptable along the entire suture length. For example, the jaws should be parallel or sufficiently near-parallel that the tissue clearance remains within an acceptable or target range for all staple positions along the entire length of the jaws. Furthermore, the limitation of the applied power avoids or at least minimizes trauma or damage to the tissue.

在图22中，在不使用CTC的方法中施加的总能量与在使用CTC的方法中施加的总能量相同，即，图22的功率曲线下的面积相同或基本上相同。然而，所利用的功率分布的差异很大，因为与不使用CTC的示例相比，使用CTC的示例中的峰值功率要低得多。In Figure 22, the total energy applied in the method without CTC is the same as the total energy applied in the method using CTC, ie, the area under the power curve of Figure 22 is the same or substantially the same. However, the power distribution utilized differs greatly, as the peak power is much lower in the example with CTC compared to the example without CTC.

在使用CTC的示例中，功率的限制通过减慢闭合速率来实现，如线20760所示。应当注意，压缩时间B’长于闭合时间B。如图22所示，提供恒定闭合速率(即，不使用CTC)的装置和方法在与提供可变闭合速率(即，使用CTC)的装置和方法相同的1mm组织间隙下实现相同的50lb压缩力。虽然与使用可变闭合速率的装置和方法相比，提供恒定闭合速率的装置和方法可在较短时间段内在期望的组织间隙处实现压缩力，但这产生施加到组织的功率的峰值，如图22所示。相比之下，使用CTC所示的示例性方面开始减慢闭合速率，以将施加到组织的功率量限制在某一水平以下。通过限制施加到组织的功率，可以相对于不使用CTC的系统和方法使组织创伤最小化。In the example using CTC, the limitation of power is achieved by slowing down the closing rate, as shown byline 20760. It should be noted that the compression time B' is longer than the closing time B. As shown in Figure 22, the device and method providing a constant closure rate (ie, without the use of CTC) achieved the same 50 lb compressive force at the same 1 mm tissue gap as the device and method providing a variable closure rate (ie, with a CTC) . Although devices and methods that provide a constant closure rate may achieve compressive force at the desired tissue gap in a shorter period of time than devices and methods that use a variable closure rate, this produces peaks in power applied to the tissue, such as shown in Figure 22. In contrast, the exemplary aspects shown using CTC begin to slow down the closure rate to limit the amount of power applied to the tissue below a certain level. By limiting the power applied to the tissue, tissue trauma can be minimized relative to systems and methods that do not use CTCs.

图22和附加的示例在2012年6月1日提交的标题为“DEVICE AND METHOD FORCONTROLLING COMPRESSION OF TISSUE”的美国专利No.8,499,992中进一步描述，该专利公布于2013年8月6日，其全部公开内容以引用方式并入本文。Figure 22 and additional examples are further described in US Patent No. 8,499,992, entitled "DEVICE AND METHOD FORCONTROLLING COMPRESSION OF TISSUE," filed June 1, 2012, and published August 6, 2013, the entire disclosure of which is The contents are incorporated herein by reference.

在一些方面，控制系统可包括多个预定义的力阈值，所述多个预定义的力阈值帮助控制系统确定电子束的位置和/或击发轴的关节运动角度并且基于此类确定适当地控制至少一个马达。例如，力阈值可根据被配置成能够平移击发轴的击发杆的行进长度而改变，并且此类力阈值可与与控制系统通信的一个或多个马达的所测量的扭力进行比较。所测量的扭力与力阈值的比较可为控制系统提供确定电子束的位置和/或端部执行器的关节运动的可靠方式。这可允许控制系统适当地控制一个或多个马达(例如，减小或停止扭转负载)以确保击发组件的正确击发和端部执行器的关节运动，以及防止对系统的损坏，如将在下文更详细地描述。In some aspects, the control system may include a plurality of predefined force thresholds that help the control system determine the position of the electron beam and/or the angle of articulation of the firing shaft and control appropriately based on such determinations at least one motor. For example, force thresholds may vary based on the length of travel of a firing rod configured to translate the firing shaft, and such force thresholds may be compared to the measured torque of one or more motors in communication with the control system. Comparison of the measured torque to force thresholds can provide the control system with a reliable way to determine the position of the electron beam and/or the articulation of the end effector. This may allow the control system to appropriately control one or more motors (eg, reduce or stop torsional loads) to ensure proper firing of the firing assembly and articulation of the end effector, as well as prevent damage to the system, as will be described below described in more detail.

图23示出了力和位移曲线图20800，其包括A部分中与B部分中的所测量的位移相关的所测量的力。A部分和B部分均具有限定时间的x轴(例如，秒)。B部分的y轴限定击发连杆的行进位移(例如，以毫米为单位)，并且A部分的y轴限定施加到击发杆的力，从而推进击发轴。如A部分所示，击发杆在第一关节运动范围20902内的行进(例如，行进的第一约12mm)导致端部执行器进行关节运动。例如，在12mm位移位置处，端部执行器完全向右进行关节运动并且机械上不能进一步进行关节运动。由于处于完全关节运动，马达上的扭力将增加，并且控制系统可感测到关节运动力峰值20802超过预定义的关节运动阈值20804，如A部分所示。控制系统可包括多于一个预定义的关节运动阈值20804，以用于感测多于一个的最大关节运动方向(例如，左关节运动和右关节运动)。在控制系统检测到超过预先确定的关节运动阈值20804的关节运动力峰值20802之后，控制系统可减小或停止马达的致动，从而保护至少马达免受损坏。Figure 23 shows a force anddisplacement graph 20800 that includes the measured force in part A relative to the measured displacement in part B. Both Part A and Part B have an x-axis defining time (eg, seconds). The y-axis of section B defines the travel displacement (eg, in millimeters) of the firing rod, and the y-axis of section A defines the force applied to the firing rod, thereby advancing the firing shaft. As shown in Part A, travel of the firing rod within the first articulation range 20902 (eg, the first approximately 12 mm of travel) causes the end effector to articulate. For example, at the 12mm displacement position, the end effector is fully articulated to the right and mechanically unable to articulate further. Due to being in full articulation, the torque on the motor will increase and the control system can sense that thepeak articulation force 20802 exceeds apredefined articulation threshold 20804, as shown in part A. The control system may include more than onepredefined articulation threshold 20804 for sensing more than one maximum articulation direction (eg, left and right articulation). After the control system detects apeak articulation force 20802 that exceeds apredetermined articulation threshold 20804, the control system may reduce or stop actuation of the motor, thereby protecting at least the motor from damage.

在击发杆推进超过关节运动范围20902之后，外科缝合器内的移位机构可导致击发杆的进一步远侧行进以导致击发轴的远侧行进。例如，如B部分所示，在约12mm和70mm的行进位移之间行进可导致电子束沿击发行程20904推进并切割捕集在钳口之间的组织，然而，其他行进长度也在本公开的范围内。在该示例中，电子束的最大击发行程位置20906发生在70mm行进处。此时，电子束或刀邻接仓或钳口的远侧端部，从而增加马达上的扭力并导致控制系统感测到如A部分所示的刀行进力峰值20806。如A部分所示，控制系统可包括马达阈值20808和刀行进阈值20810的末端，该刀行进阈值从马达阈值20808分支并且随着电子束接近最大击发行程位置20906而减小(例如，非线性地)。After the firing rod is advanced beyond thearticulation range 20902, a displacement mechanism within the surgical stapler can cause further distal travel of the firing rod to cause distal travel of the firing shaft. For example, as shown in Section B, travel between approximately 12 mm and 70 mm of travel displacement can cause the electron beam to advance along thefiring stroke 20904 and cut tissue trapped between the jaws, however, other travel lengths are also within the scope of this disclosure within the range. In this example, the maximumfiring stroke position 20906 of the electron beam occurs at 70 mm of travel. At this point, the electron beam or knife abuts the distal end of the cartridge or jaw, increasing the torque on the motor and causing the control system to sense a knifetravel force peak 20806 as shown in Part A. As shown in Section A, the control system may include amotor threshold 20808 and the end of aknife travel threshold 20810 that branches off from themotor threshold 20808 and decreases (eg, non-linearly) as the electron beam approaches the maximum firing stroke position 20906 ).

控制系统可被配置成能够在电子束到达最大击发行程位置20906之前，在电子束的远侧行程20907的至少最后一部分(例如，击发行程904的最后10％)期间监测感测到的马达扭力。当沿着远侧行程20907的此类最后部分监测时，控制系统可使马达减小扭力，从而减小电子束上的负载。这可通过在电子束接近最大击发行程位置20906时减少电子束上的负载来保护外科缝合器(包括电子束)免受损坏，从而减少电子束对仓或钳口的远侧端部的冲击。如上所述，此类冲击可产生刀行进力峰值20806，该刀行进力峰值可超过刀行进阈值20810但不超过马达阈值20808，从而不损坏马达。因此，控制系统可在刀行进力峰值20806超过刀行进阈值20810之后并且在刀行进力峰值20806超过马达阈值20808之前停止马达的致动，从而保护马达免受损坏。此外，刀行进阈值20810的逐渐减小防止控制系统初步认为电子束已达到最大击发行程位置20906。The control system can be configured to monitor the sensed motor torque during at least the last portion of the electron beam's distal travel 20907 (eg, the last 10% of the firing travel 904) before the electron beam reaches the maximumfiring travel position 20906. When monitoring along such a final portion of thedistal stroke 20907, the control system may cause the motor to reduce torque, thereby reducing the load on the electron beam. This may protect the surgical stapler (including the electron beam) from damage by reducing the load on the electron beam as it approaches the maximumfiring stroke position 20906, thereby reducing the impact of the electron beam on the distal end of the cartridge or jaw. As discussed above, such an impact can generate a knifetravel force peak 20806 that can exceed theknife travel threshold 20810 but not exceed themotor threshold 20808 so as not to damage the motor. Accordingly, the control system may stop actuation of the motor after the peakknife travel force 20806 exceeds theknife travel threshold 20810 and before the peakknife travel force 20806 exceeds themotor threshold 20808, thereby protecting the motor from damage. Additionally, the gradual decrease in theknife travel threshold 20810 prevents the control system from initially deeming that the electron beam has reached the maximumfiring stroke position 20906.

在控制系统检测到刀行进力峰值20806超过刀行进阈值20810之后，控制系统可确认电子束的位置(例如，在70mm位移处和/或在击发行程20904结束处)，并且可基于此类已知的位移位置回缩击发杆以将电子束在最近侧位置20908(例如，0mm位移)处复位。在最近侧位置20908处，控制系统可感测到超过预定义刀回缩阈值20814的刀回缩力峰值20812，如A部分所示。此时，如果需要，控制系统可重新校准，并且将电子束的位置关联为处于原始位置，在该原始位置处击发连杆在远侧方向上的后续推进(例如，约12mm长)将导致移位器使电子束与击发杆脱离接合。一旦脱离接合，击发杆在关节运动范围20902内行进将再次引起端部执行器的关节运动。After the control system detects that the knifetravel force peak 20806 exceeds theknife travel threshold 20810, the control system can confirm the position of the electron beam (eg, at the 70mm displacement and/or at the end of the firing stroke 20904), and can based on such known The displacement position retracts the firing rod to reset the electron beam at the proximal-most position 20908 (eg, 0 mm displacement). At theproximal-most position 20908, the control system may sense a kniferetraction force peak 20812 that exceeds a predefinedknife retraction threshold 20814, as shown in part A. At this point, if desired, the control system can be recalibrated and correlate the position of the electron beam as being at the home position where subsequent advancement of the firing rod in the distal direction (eg, about 12mm long) will result in displacement The positioner disengages the electron beam from the firing rod. Once disengaged, travel of the firing rod within thearticulation range 20902 will again cause articulation of the end effector.

因此，控制系统可感测控制击发杆的行进的马达上的扭力，并且将此类感测到的扭力与多个阈值进行比较以确定电子束的位置或端部执行器的关节运动角度，从而适当地控制马达以防止对马达的损坏，以及确认击发杆和/或电子束的定位。Thus, the control system can sense the torque on the motor that controls the travel of the firing rod, and compare such sensed torque to a number of thresholds to determine the position of the electron beam or the articulation angle of the end effector, thereby Properly control the motor to prevent damage to the motor, and to confirm the positioning of the firing rod and/or electron beam.

如上所述，组织接触或压力传感器确定钳口构件何时最初与组织“T”接触。这使得外科医生能够在夹持之前确定组织“T”的初始厚度和/或组织“T”的厚度。在上述外科器械方面的任一个中，如图24所示，钳口构件与组织“T”的接触通过建立与设置在钳口构件上的一对相对的板“P1、P2”的接触来闭合原本断开的感测电路“SC”。接触传感器还可包括确定施加到传感器的力的量的力敏换能器，该力的量可被假设为与施加到组织“T”的力的量相同。然后可将施加到组织的此类力转换成一定量的组织压缩。力传感器测量组织所承受的压缩量，并且向外科医生提供关于施加到组织“T”的力的信息。过度组织压缩可对正被手术的组织“T”产生负面影响。例如，组织“T”的过度压缩可导致组织坏死，并且在某些规程中导致钉线故障。关于施加到组织“T”的压力的信息使得外科医生能够更好地确定未向组织“T”施加过度的压力。As mentioned above, the tissue contact or pressure sensor determines when the jaw members initially make contact with tissue "T". This enables the surgeon to determine the initial thickness of the tissue "T" and/or the thickness of the tissue "T" prior to clamping. In any of the surgical instrument aspects described above, as shown in Figure 24, the contact of the jaw members with tissue "T" is closed by establishing contact with a pair of opposing plates "P1, P2" disposed on the jaw members Originally disconnected sensing circuit "SC". The touch sensor may also include a force-sensitive transducer that determines the amount of force applied to the sensor, which may be assumed to be the same amount of force applied to tissue "T". Such forces applied to the tissue can then be translated into some amount of tissue compression. The force sensor measures the amount of compression experienced by the tissue and provides information to the surgeon about the force applied to the tissue "T". Excessive tissue compression can negatively affect the tissue "T" being operated on. For example, excessive compression of tissue "T" can lead to tissue necrosis and, in some procedures, staple line failure. Information about the pressure applied to tissue "T" enables the surgeon to better determine that undue pressure is not being applied to tissue "T".

本文所公开的接触传感器中的任一个可包括但不限于放置在钳口的内表面上的电触点，该钳口在与组织接触时闭合原本断开的感测电路。接触传感器还可包括力敏换能器，该力敏换能器检测被夹持的组织何时首先抵抗压缩。力换能器可包括但不限于压电元件、压阻元件、金属膜或半导体应变仪、电感式压力传感器、电容式压力传感器，以及使用弹簧管、胶囊或波纹管来驱动电阻元件上的弧刷臂的电位压力换能器。Any of the contact sensors disclosed herein may include, but are not limited to, electrical contacts placed on the inner surfaces of the jaws that, when in contact with tissue, close an otherwise open sensing circuit. The contact sensor may also include a force-sensitive transducer that detects when the clamped tissue first resists compression. Force transducers may include, but are not limited to, piezoelectric elements, piezoresistive elements, metal film or semiconductor strain gauges, inductive pressure sensors, capacitive pressure sensors, and the use of spring tubes, capsules, or bellows to drive arcs on resistive elements Potential pressure transducer for the brush arm.

在一个方面，前述外科器械中的任一个可包括一个或多个压电元件以检测在钳口构件上发生的压力变化。压电元件是将应力转换成电势的双向换能器。元件可由金属化石英或陶瓷组成。在操作中，当向晶体施加应力时，材料的电荷分布发生变化，从而导致整个材料上生成电压。压电元件可用于指示钳口构件中的任一个或两个何时与组织“T”接触以及在建立接触之后施加在组织“T”上的压力的量。In one aspect, any of the foregoing surgical instruments may include one or more piezoelectric elements to detect changes in pressure that occur on the jaw members. Piezoelectric elements are bidirectional transducers that convert stress into electrical potential. The elements may be composed of metallized quartz or ceramic. In operation, when stress is applied to the crystal, the charge distribution of the material changes, causing a voltage to develop across the material. Piezoelectric elements may be used to indicate when either or both of the jaw members are in contact with tissue "T" and the amount of pressure applied on tissue "T" after contact is established.

在一个方面，前述外科器械中的任一者可包括或设置有一个或多个金属应变仪，该一个或多个金属应变仪放置在外科器械的主体的一部分内或其主体的一部分上。金属应变仪的工作原理是材料的电阻取决于长度、宽度和厚度。因此，当金属应变仪的材料经历应变时，材料的电阻改变。因此，由这种材料制成的电阻器结合到电路中，将使应变转换为电信号的变化。有利地，应变仪可放置在外科器械上，使得施加到组织的压力影响该应变仪。In one aspect, any of the foregoing surgical instruments may include or be provided with one or more metal strain gauges placed within or on a portion of the body of the surgical instrument. Metal strain gauges work on the principle that the resistance of a material depends on length, width and thickness. Therefore, when the material of the metal strain gauge experiences strain, the resistance of the material changes. Therefore, a resistor made of this material incorporated into a circuit would convert the strain into a change in an electrical signal. Advantageously, the strain gauge can be placed on the surgical instrument such that the pressure applied to the tissue affects the strain gauge.

另选地，在另一方面，可以与上述金属应变仪类似的方式使用一个或多个半导体应变仪，但换能模式不同。在操作中，当半导体应变仪的晶格结构由于所施加的应力而变形时，材料的电阻改变。该现象被称为压阻效应。Alternatively, in another aspect, one or more semiconductor strain gauges may be used in a similar manner to the metallic strain gauges described above, but with different transduction modes. In operation, as the lattice structure of the semiconductor strain gauge deforms due to the applied stress, the resistance of the material changes. This phenomenon is called the piezoresistive effect.

在另一方面，前述外科器械中的任一者可包括或设置有一个或多个感应压力传感器，以将压力或力转换成感应元件相对于彼此的运动。感应元件相对于彼此的这种运动改变了总体电感或电感耦合。电容式压力换能器类似地将压力或力转换成电容元件相对于彼此的运动，从而改变总电容。In another aspect, any of the foregoing surgical instruments may include or be provided with one or more inductive pressure sensors to convert pressure or force into motion of the inductive elements relative to each other. This movement of the inductive elements relative to each other changes the overall inductance or inductive coupling. Capacitive pressure transducers similarly convert pressure or force into motion of capacitive elements relative to each other, thereby changing the overall capacitance.

在又一方面，前述外科器械中的任何一者可包括或设置有一个或多个电容式压力换能器，以将压力或力转换成电容元件相对于彼此的运动，从而改变总电容。In yet another aspect, any of the foregoing surgical instruments may include or be provided with one or more capacitive pressure transducers to convert pressure or force into motion of capacitive elements relative to each other, thereby changing the overall capacitance.

在一个方面，前述外科器械中的任一者可包括或设置有一个或多个机械压力换能器，以将压力或力转换成运动。在使用中，机械元件的运动用于使计量器上的指针或刻度盘偏转。指针或刻度盘的这种运动可表示施加到组织“T”的压力或力。机械元件的示例包括但不限于弹簧管、胶囊或波纹管。以举例的方式，机械元件可与其他测量和/或感测元件诸如电位计压力换能器联接。在该示例中，机械元件与可变电阻器上的弧刷联接。在使用中，压力或力可转换成机械运动，该机械运动使电位计上的弧刷件偏转，从而改变电阻以反映所施加的压力或力。In one aspect, any of the aforementioned surgical instruments may include or be provided with one or more mechanical pressure transducers to convert pressure or force into motion. In use, the movement of the mechanical element is used to deflect the pointer or dial on the gauge. This movement of the pointer or dial may represent pressure or force applied to the tissue "T". Examples of mechanical elements include, but are not limited to, spring tubes, capsules, or bellows. By way of example, the mechanical element may be coupled with other measuring and/or sensing elements such as potentiometric pressure transducers. In this example, the mechanical element is coupled with the arc brush on the variable resistor. In use, the pressure or force can be converted into mechanical motion which deflects the brush member on the potentiometer, thereby changing the resistance to reflect the applied pressure or force.

上述方面的组合，尤其是间隙和组织接触传感器的组合，为外科医生提供关于手术部位和/或靶组织“T”的状况的反馈信息和/或实时信息。例如，关于组织“T”的初始厚度的信息可引导外科医生选择适当的钉尺寸，关于组织“T”的夹持厚度的信息可让外科医生知道所选择的钉是否将适当地成形，与组织“T”的初始厚度和夹持厚度相关的信息可用于确定组织“T”上的压缩或应变的量，并且与组织“T”上的应变相关的信息可使用该应变以避免将组织压缩到过度应变值和/或避免缝合已经历过度应变的组织。Combinations of the above aspects, especially the combination of gap and tissue contact sensors, provide the surgeon with feedback and/or real-time information about the condition of the surgical site and/or target tissue "T". For example, information about the initial thickness of the tissue "T" may guide the surgeon to select an appropriate staple size, and information about the clamping thickness of the tissue "T" may allow the surgeon to know whether the selected staple will be properly shaped, consistent with the tissue "T". Information related to the initial thickness of the "T" and the clamping thickness can be used to determine the amount of compression or strain on the tissue "T", and information related to the strain on the tissue "T" can use this strain to avoid compressing the tissue to Excessive strain values and/or avoid suturing tissue that has experienced excessive strain.

另外，力传感器可用于向外科医生提供施加到组织的压力的量。外科医生可使用该信息以避免对组织“T”施加过度压力或避免缝合已经历过度应变的组织“T”。Additionally, force sensors can be used to provide the surgeon with the amount of pressure applied to the tissue. The surgeon can use this information to avoid applying undue pressure to tissue "T" or to avoid suturing tissue "T" that has experienced excessive strain.

图24和附加的示例在2011年6月27日提交的标题为“SURGICAL INSTRUMENTEMPLOYING SENSORS”的美国专利No.8,181,839中进一步描述，该专利公布于2012年5月5日，其全部公开内容以引用方式并入本文。Figure 24 and additional examples are further described in US Patent No. 8,181,839, entitled "SURGICAL INSTRUMENTEMPLOYING SENSORS," filed June 27, 2011, and published May 5, 2012, the entire disclosure of which is incorporated by reference in its entirety. Incorporated herein.

示出并且描述了某些方面以提供对所公开的装置和方法的结构、功能、制造和使用的理解。在一个示例中示出或描述的特征可与其它示例的特征组合，并且修改和变型在本公开的范围内。Certain aspects are shown and described to provide an understanding of the structure, function, manufacture, and use of the disclosed apparatus and methods. Features shown or described in one example may be combined with features of other examples, and modifications and variations are within the scope of the present disclosure.

术语“近侧”和“远侧”相对于操纵外科器械的柄部的临床医生，其中“近侧”是指更靠近临床医生的部分，并且“远侧”是指距临床医生更远的部分。为了方便起见，相对于图使用的空间术语“竖直”、“水平”、“向上”和“向下”并非旨在是限制性的和/或绝对的，因为外科器械可用于许多定向和位置。The terms "proximal" and "distal" are relative to the clinician manipulating the handle of the surgical instrument, where "proximal" refers to the portion closer to the clinician and "distal" refers to the portion further from the clinician . For convenience, the spatial terms "vertical", "horizontal", "upward" and "downward" are not intended to be limiting and/or absolute with respect to the figures, as surgical instruments may be used in many orientations and positions .

提供了用于执行腹腔镜式和微创外科手术的示例性装置和方法。然而，此类装置和方法可用于其它外科手术和应用，包括例如开放式外科手术。外科器械可穿过自然孔口或穿过形成在组织中的切口或穿刺孔被插入。器械的工作部分或端部执行器部分可被直接插入身体中或者通过具有工作通道的进入装置插入，外科器械的端部执行器和细长轴可穿过该工作通道推进。Exemplary devices and methods for performing laparoscopic and minimally invasive surgical procedures are provided. However, such devices and methods can be used in other surgical procedures and applications, including, for example, open surgery. Surgical instruments can be inserted through a natural orifice or through an incision or puncture hole formed in the tissue. The working or end effector portion of the instrument can be inserted directly into the body or through an access device having a working channel through which the end effector and elongated shaft of the surgical instrument can be advanced.

图25至图28描绘用于切割和紧固的马达驱动的外科器械150010，其可重复使用或可不重复使用。在例示的示例中，外科器械150010包括外壳150012，该外壳包括被构造成能够由临床医生抓持、操纵并且致动的柄部组件150014。外壳150012被构造用于可操作地附接到可互换轴组件150200，该可互换轴组件具有可操作地联接到其上的端部执行器150300，该端部执行器被构造成能够执行一种或多种外科任务或外科手术。根据本公开，可结合机器人控制的外科系统有效地采用各种形式的可互换轴组件。术语“外壳”可涵盖容纳或以其他方式可操作地支撑至少一个驱动系统的机器人系统的外壳或类似部分，该至少一个驱动系统被构造成能够生成并且施加可用于致动可互换轴组件的至少一个控制运动。术语“框架”可指手持式外科器械的一部分。术语“框架”还可表示机器人控制的外科器械的一部分和/或机器人系统的可用于可操作地控制外科器械的一部分。可互换轴组件可与标题为“SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENTARRANGEMENTS”的美国专利No.9,072,535中公开的各种机器人系统、器械、部件和方法一起使用，该专利全文以引用方式并入本文。25-28 depict a motor-drivensurgical instrument 150010 for cutting and fastening, which may or may not be reusable. In the illustrated example, thesurgical instrument 150010 includes ahousing 150012 that includes ahandle assembly 150014 that is configured to be grasped, manipulated, and actuated by a clinician.Housing 150012 is configured for operative attachment to aninterchangeable shaft assembly 150200 having anend effector 150300 operably coupled thereto, the end effector being configured to execute One or more surgical tasks or surgical procedures. In accordance with the present disclosure, various forms of interchangeable shaft assemblies may be effectively employed in conjunction with robotically controlled surgical systems. The term "housing" may encompass a housing or similar portion of a robotic system that houses or otherwise operatively supports at least one drive system configured to generate and apply a At least one control movement. The term "frame" may refer to a portion of a hand-held surgical instrument. The term "frame" may also refer to a portion of a robotically controlled surgical instrument and/or a portion of a robotic system that may be used to operatively control a surgical instrument. Interchangeable shaft assemblies may be used with various robotic systems, instruments, components and methods disclosed in US Patent No. 9,072,535, entitled "SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENTARRANGEMENTS," which is incorporated herein by reference in its entirety.

图25为根据本公开的至少一个方面的具有可操作地联接到其的可互换轴组件150200的外科器械150010的透视图。外壳150012包括端部执行器150300，该端部执行器包括被构造成能够在其中可操作地支撑外科钉仓150304的外科切割和紧固装置。外壳150012可被构造用于与可互换轴组件结合使用，该可互换轴组件包括端部执行器，该端部执行器适于支撑不同尺寸和类型的钉仓，具有不同的轴长度、尺寸和类型。外壳150012可与各种可互换轴组件一起使用，包括被构造成能够将其他运动和形式的能量(诸如射频(RF)能量、超声能量和/或运动)施加到端部执行器布置的组件，该端部执行器布置适于与各种外科应用和规程结合使用。端部执行器、轴组件、柄部、外科器械和/或外科器械系统可利用任何合适的一个紧固件或多个紧固件来紧固组织。例如，包括可移除地被存储在其中的多个紧固件的紧固件仓能够可移除地插入轴组件的端部执行器中和/或附接到轴组件的端部执行器。25 is a perspective view of asurgical instrument 150010 having aninterchangeable shaft assembly 150200 operably coupled thereto in accordance with at least one aspect of the present disclosure.Housing 150012 includes anend effector 150300 that includes a surgical cutting and fastening device configured to operably support a surgicalstaple cartridge 150304 therein. Thehousing 150012 can be configured for use in conjunction with an interchangeable shaft assembly including an end effector adapted to support different sizes and types of staple cartridges with different shaft lengths, size and type. Thehousing 150012 can be used with a variety of interchangeable shaft assemblies, including those configured to enable application of other motions and forms of energy, such as radio frequency (RF) energy, ultrasonic energy, and/or motion, to the end effector arrangement , the end effector arrangement is suitable for use in conjunction with various surgical applications and procedures. The end effector, shaft assembly, handle, surgical instrument, and/or surgical instrument system may utilize any suitable fastener or fasteners to fasten tissue. For example, a fastener cartridge including a plurality of fasteners removably stored therein can be removably inserted into and/or attached to the end effector of the shaft assembly.

柄部组件150014可包括一对可互连柄部外壳段150016、150018，该对柄部外壳段通过螺钉、按扣特征部、粘合剂等互连。柄部外壳段150016、150018配合以形成可被临床医生抓握和操纵的手枪式握把部150019。柄部组件150014可操作地支撑多个驱动系统，该多个驱动系统被构造成能够生成控制运动并且将控制运动施加到可操作地附接到其的可互换轴组件的对应部分。显示器可设置在覆盖件150045下方。Thehandle assembly 150014 can include a pair of interconnectable handlehousing segments 150016, 150018 interconnected by screws, snap features, adhesives, and the like. Thehandle housing segments 150016, 150018 cooperate to form apistol grip portion 150019 that can be grasped and manipulated by a clinician. Thehandle assembly 150014 operably supports a plurality of drive systems configured to generate and apply control motion to corresponding portions of the interchangeable shaft assembly operably attached thereto. A display may be provided below thecover 150045.

图26为根据本公开的至少一个方面的图25的外科器械150010的一部分的分解组件视图。柄部组件150014可包括可操作地支撑多个驱动系统的框架150020。框架150020可操作地支撑“第一”或闭合驱动系统150030，该“第一”或闭合驱动系统可将闭合和打开运动施加到可互换轴组件150200。闭合驱动系统150030可包括致动器，诸如由框架150020枢转地支撑的闭合触发器150032。闭合触发器150032通过枢轴销150033枢转地联接到柄部组件150014，以使得闭合触发器150032能够由临床医生操纵。当临床医生抓持柄部组件150014的手枪式握把部150019时，闭合触发器150032可从启动或“未致动”位置枢转到“致动”位置并且更具体地枢转到完全压缩或完全致动位置。26 is an exploded assembly view of a portion of thesurgical instrument 150010 of FIG. 25 in accordance with at least one aspect of the present disclosure. Thehandle assembly 150014 can include aframe 150020 that operably supports a plurality of drive systems. Theframe 150020 operably supports a "first" or closingdrive system 150030 that can impart closing and opening motions to theinterchangeable shaft assembly 150200. Theclosure drive system 150030 may include an actuator, such as aclosure trigger 150032 pivotally supported by theframe 150020 . Theclosure trigger 150032 is pivotally coupled to thehandle assembly 150014 by apivot pin 150033 to enable theclosure trigger 150032 to be manipulated by the clinician. When the clinician grasps thepistol grip portion 150019 of thehandle assembly 150014, theclosure trigger 150032 can be pivoted from an activated or "unactuated" position to an "actuated" position and more specifically to fully compressed or fully actuated position.

柄部组件150014和框架150020可操作地支撑击发驱动系统150080，该击发驱动系统被构造成能够将击发运动施加到附接到其的可互换轴组件的对应部分。击发驱动系统150080可采用位于柄部组件150014的手枪式握把部150019中的电动马达150082。电动马达150082可为具有例如约25,000RPM的最大旋转速度的直流有刷马达。在其它构造中，马达可包括无刷马达、无绳马达、同步马达、步进马达、或任何其它合适的电动马达。电动马达150082可由功率源150090供电，该功率源可包括可移除电源组150092。可移除电源组150092可包括被构造成能够附接到远侧外壳部分150096的近侧外壳部分150094。近侧外壳部分150094和远侧外壳部分150096被构造成能够在其中可操作地支撑多个电池150098。电池150098可各自包括例如锂离子(LI)或其他合适的电池。远侧外壳部分150096被配置用于以可移除方式可操作地附接到可操作地联接到电动马达150082的控制电路板150100。串联连接的若干电池150098可向外科器械150010供电。功率源150090可为可替换的和/或可再充电的。位于覆盖件150045下方的显示器150043电联接到控制电路板150100。可移除覆盖件150045以暴露显示器150043。Thehandle assembly 150014 andframe 150020 operably support afiring drive system 150080 configured to apply firing motion to corresponding portions of the interchangeable shaft assemblies attached thereto. The firingdrive system 150080 may employ anelectric motor 150082 located in thepistol grip portion 150019 of thehandle assembly 150014. Theelectric motor 150082 may be a brushed DC motor with a maximum rotational speed of, for example, about 25,000 RPM. In other configurations, the motor may comprise a brushless motor, a cordless motor, a synchronous motor, a stepper motor, or any other suitable electric motor. Theelectric motor 150082 may be powered by apower source 150090, which may include aremovable power pack 150092. Theremovable power pack 150092 can include aproximal housing portion 150094 configured to be attachable to adistal housing portion 150096.Proximal housing portion 150094 anddistal housing portion 150096 are configured to operably support a plurality ofbatteries 150098 therein. Thebatteries 150098 may each include, for example, lithium ion (LI) or other suitable batteries. Thedistal housing portion 150096 is configured for removably operative attachment to thecontrol circuit board 150100 operatively coupled to theelectric motor 150082.Several batteries 150098 connected in series can power thesurgical instrument 150010.Power source 150090 may be replaceable and/or rechargeable. Thedisplay 150043 located under thecover 150045 is electrically coupled to thecontrol circuit board 150100.Cover 150045 can be removed to exposedisplay 150043.

电动马达150082可包括与齿轮减速器组件150084可操作地交接的可旋转轴(未示出)，该齿轮减速器组件被安装成与纵向可运动的驱动构件150120上的驱动齿150122的组或齿条啮合接合。纵向可运动的驱动构件150120具有形成在其上的驱动齿150122的齿条，以用于与齿轮减速器组件150084的对应驱动齿轮150086啮合接合。Theelectric motor 150082 may include a rotatable shaft (not shown) operatively interfacing with agear reducer assembly 150084 mounted to interface with the set or teeth ofdrive teeth 150122 on the longitudinallymovable drive member 150120 The strip engages. The longitudinallymovable drive member 150120 has a rack ofdrive teeth 150122 formed thereon for meshing engagement with corresponding drive gears 150086 of thegear reducer assembly 150084.

在使用中，功率源150090所提供的电压极性可沿顺时针方向操作电动马达150082，其中由电池施加给电动马达的电压极性可被反转，以便沿逆时针方向操作电动马达150082。当电动马达150082在一个方向上旋转时，纵向可运动的驱动构件150120将在远侧方向“DD”上被轴向地驱动。当电动马达150082在相反的旋转方向上被驱动时，纵向可运动的驱动构件150120将在近侧方向“PD”上被轴向地驱动。柄部组件150014可包括开关，该开关可被配置成能够使由功率源150090施加到电动马达150082的极性反转。柄部组件150014可包括传感器，该传感器被配置成能够检测纵向可运动的驱动构件150120的位置和/或纵向可运动的驱动构件150120正在运动的方向。In use, the polarity of the voltage provided by thepower source 150090 can operate theelectric motor 150082 in a clockwise direction, wherein the polarity of the voltage applied to the electric motor by the battery can be reversed to operate theelectric motor 150082 in a counter-clockwise direction. When theelectric motor 150082 is rotated in one direction, the longitudinallymovable drive member 150120 will be driven axially in the distal direction "DD". When theelectric motor 150082 is driven in the opposite rotational direction, the longitudinallymovable drive member 150120 will be driven axially in the proximal direction "PD". Thehandle assembly 150014 can include a switch that can be configured to reverse the polarity applied by thepower source 150090 to theelectric motor 150082. Thehandle assembly 150014 may include a sensor configured to detect the position of the longitudinallymovable drive member 150120 and/or the direction in which the longitudinallymovable drive member 150120 is moving.

电动马达150082的致动可由被枢转地支撑在柄部组件150014上的击发触发器150130控制。击发触发器150130可在未致动位置和致动位置之间枢转。Activation of theelectric motor 150082 may be controlled by a firingtrigger 150130 pivotally supported on thehandle assembly 150014. The firingtrigger 150130 is pivotable between an unactuated position and an actuated position.

重新转到图25，可互换轴组件150200包括端部执行器150300，该端部执行器包括被构造成能够在其中可操作地支撑外科钉仓150304的细长通道150302。端部执行器150300可包括砧座150306，该砧座相对于细长通道150302被枢转地支撑。可互换轴组件150200可包括关节运动接头150270。端部执行器150300和关节运动接头150270的构造和操作在标题为“ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK”的美国专利申请公布No.2014/0263541中阐述，该专利申请公布全文以引用方式并入本文。可互换轴组件150200可包括近侧外壳或喷嘴150201，该近侧外壳或喷嘴由喷嘴部分150202、150203构成。可互换轴组件150200可包括可被利用以闭合和/或打开端部执行器150300的砧座150306的沿着轴轴线SA延伸的闭合管150260。25, theinterchangeable shaft assembly 150200 includes anend effector 150300 that includes anelongated channel 150302 configured to operably support a surgicalstaple cartridge 150304 therein. Theend effector 150300 can include ananvil 150306 pivotally supported relative to theelongated channel 150302.Interchangeable shaft assembly 150200 may includearticulation joint 150270 . The construction and operation ofend effector 150300 and articulation joint 150270 are set forth in US Patent Application Publication No. 2014/0263541 entitled "ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK", which is incorporated herein by reference in its entirety .Interchangeable shaft assembly 150200 may include a proximal housing ornozzle 150201 comprised ofnozzle portions 150202, 150203. Theinterchangeable shaft assembly 150200 can include aclosure tube 150260 extending along the shaft axis SA that can be utilized to close and/or open theanvil 150306 of theend effector 150300.

重新转到图25，闭合管150260朝远侧(方向“DD”)平移以例如响应于闭合触发器150032的致动而以前述参考文献美国专利申请公布No.2014/0263541中所述的方式闭合砧座150306。通过朝近侧平移闭合管150260来打开砧座150306。在砧座打开位置，闭合管150260运动至近侧位置。Turning back to Figure 25, theclosure tube 150260 is translated distally (direction "DD") to close in the manner described in the aforementioned reference US Patent Application Publication No. 2014/0263541, eg, in response to actuation of theclosure trigger 150032Anvil 150306. Theanvil 150306 is opened by translating theclosure tube 150260 proximally. In the anvil open position, theclosure tube 150260 is moved to the proximal position.

图27为根据本公开的至少一个方面的可互换轴组件150200的部分的另一分解组件视图。可互换轴组件150200可包括被支撑用于在脊150210内的轴向行进的击发构件150220。击发构件150220包括被构造成能够附接到远侧切割部分或刀杆150280的中间击发轴150222。击发构件150220可被称为“第二轴”和/或“第二轴组件”。中间击发轴150222可在远侧端部中包括纵向狭槽150223，该纵向狭槽被构造成能够接纳刀杆150280的近侧端部150282上的插片150284。纵向狭槽150223和近侧端部150282可被构造成能够允许该两者之间的相对运动并且可包括滑动接头150286。滑动接头150286可允许击发构件150220的中间击发轴150222在不运动或至少基本上不运动刀杆150280的情况下使端部执行器150300围绕关节运动接头150270进行关节运动。一旦端部执行器150300已合适地取向，中间击发轴150222便可朝远侧推进，直到纵向狭槽150223的近侧侧壁接触插片150284以推进刀杆150280并击发定位在通道150302内的钉仓为止。脊150210在其中具有细长开口或窗口150213，以便于将中间击发轴150222组装和插入脊150210中。一旦中间击发轴150222已被插入脊中，顶部框架段150215就可与轴框架150212接合，以封闭其中的中间击发轴150222和刀杆150280。击发构件150220的操作可见于美国专利申请公布No.2014/0263541中。脊150210可被构造成能够可滑动地支撑击发构件150220和围绕脊150210延伸的闭合管150260。脊150210可以可滑动地支撑关节运动驱动器150230。27 is another exploded assembly view of a portion of aninterchangeable shaft assembly 150200 in accordance with at least one aspect of the present disclosure.Interchangeable shaft assembly 150200 can include a firingmember 150220 supported for axial travel withinspine 150210. The firingmember 150220 includes anintermediate firing shaft 150222 configured to be attachable to the distal cutting portion orshank 150280. The firingmember 150220 may be referred to as the "second shaft" and/or the "second shaft assembly." Theintermediate firing shaft 150222 can include alongitudinal slot 150223 in the distal end configured to receive thetab 150284 on theproximal end 150282 of theknife bar 150280. Thelongitudinal slot 150223 and theproximal end 150282 can be configured to allow relative movement therebetween and can include a sliding joint 150286. The sliding joint 150286 may allow theintermediate firing shaft 150222 of the firingmember 150220 to articulate theend effector 150300 about the articulation joint 150270 without moving, or at least substantially moving, theshank 150280 . Once theend effector 150300 has been properly oriented, theintermediate firing shaft 150222 may be advanced distally until the proximal sidewall of thelongitudinal slot 150223 contacts thetabs 150284 to advance theshank 150280 and fire the staples positioned within thechannel 150302 until the warehouse. Thespine 150210 has an elongated opening orwindow 150213 therein to facilitate assembly and insertion of theintermediate firing shaft 150222 into thespine 150210. Once theintermediate firing shaft 150222 has been inserted into the spine, thetop frame segment 150215 can engage theshaft frame 150212 to enclose theintermediate firing shaft 150222 and theknife bar 150280 therein. The operation of the firingmember 150220 can be found in US Patent Application Publication No. 2014/0263541. Thespine 150210 can be configured to slidably support the firingmember 150220 and theclosure tube 150260 extending around thespine 150210.Ridge 150210 may slidably supportarticulation driver 150230.

可互换轴组件150200可包括被构造成能够选择性地且可释放地将关节运动驱动器150230联接到击发构件150220的离合器组件150400。离合器组件150400包括围绕击发构件150220定位的锁定衬圈或锁定套筒150402，其中锁定套筒150402可在接合位置和脱离接合位置之间旋转，在接合位置处，锁定套筒150402将关节运动驱动器150230联接到击发构件150220，在脱离接合位置处，关节运动驱动器150230未可操作地联接到击发构件150220。当锁定套筒150402处于接合位置时，击发构件150220的远侧运动可使关节运动驱动器150230朝远侧运动；并且相应地，击发构件150220的近侧运动可使关节运动驱动器150230朝近侧运动。当锁定套筒150402处于脱离接合位置时，击发构件150220的运动不传输到关节运动驱动器150230；并且因此，击发构件150220可独立于关节运动驱动器150230运动。喷嘴150201可用于以在美国专利申请公布No.2014/0263541中描述的各种方式来使关节运动驱动系统与击发驱动系统可操作地接合和脱离接合。Theinterchangeable shaft assembly 150200 can include aclutch assembly 150400 configured to selectively and releasably couple thearticulation driver 150230 to the firingmember 150220. Theclutch assembly 150400 includes a locking collar or lockingsleeve 150402 positioned about the firingmember 150220, wherein the lockingsleeve 150402 is rotatable between an engaged position and a disengaged position where the lockingsleeve 150402 articulates thedriver 150230 Coupled to the firingmember 150220, in the disengaged position, thearticulation driver 150230 is not operatively coupled to the firingmember 150220. When the lockingsleeve 150402 is in the engaged position, distal movement of the firingmember 150220 can move thearticulation driver 150230 distally; and correspondingly, proximal movement of the firingmember 150220 can move thearticulation driver 150230 proximally. When the lockingsleeve 150402 is in the disengaged position, the motion of the firingmember 150220 is not transmitted to thearticulation driver 150230;Nozzle 150201 can be used to operably engage and disengage the articulation drive system from the firing drive system in the various manners described in US Patent Application Publication No. 2014/0263541.

可互换轴组件150200可包括滑环组件150600，该滑环组件可被构造成能够例如将电力传导到端部执行器150300和/或从该端部执行器传导电力，和/或将信号传达到端部执行器150300和/或从该端部执行器传达信号。滑环组件150600可包括定位在限定于喷嘴部分150202、150203中的狭槽内的近侧连接器凸缘150604和远侧连接器凸缘150601。近侧连接器凸缘150604可包括第一面，并且远侧连接器凸缘150601可包括与第一面相邻定位且可相对于第一面运动的第二面。远侧连接器凸缘150601可围绕轴轴线SA-SA(图25)相对于近侧连接器凸缘150604旋转。近侧连接器凸缘150604可包括限定在其第一面中的多个同心或至少基本上同心的导体150602。连接器150607可安装在远侧连接器凸缘150601的近侧侧面上，并且可具有多个触点，其中每个触点对应于导体150602中的一个并与之电接触。这种布置在保持近侧连接器凸缘150604和远侧连接器凸缘150601之间的电接触的同时允许这两个凸缘之间的相对旋转。近侧连接器凸缘150604可包括可例如使导体150602与轴电路板进行信号通信的电连接器150606。在至少一个实例中，包括多个导体的线束可在电连接器150606和轴电路板之间延伸。电连接器150606可朝近侧延伸穿过限定在底盘安装凸缘中的连接器开口。标题为“STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM”的美国专利申请公开No.2014/0263551的全文以引用方式并入本文。标题为“STAPLE CARTRIDGETISSUE THICKNESS SENSOR SYSTEM”的美国专利申请公开No.2014/0263552的全文以引用方式并入本文。有关滑环组件150600的更多细节可见于美国专利申请公开No.2014/0263541。Interchangeable shaft assembly 150200 may include slip ring assembly 150600 that may be configured to conduct power to and/or fromend effector 150300, for example, and/or communicate signals Signals are communicated to and/or from theend effector 150300. The slip ring assembly 150600 can include aproximal connector flange 150604 and adistal connector flange 150601 positioned within slots defined in thenozzle portions 150202, 150203. Theproximal connector flange 150604 can include a first face, and thedistal connector flange 150601 can include a second face positioned adjacent the first face and movable relative to the first face.Distal connector flange 150601 is rotatable relative toproximal connector flange 150604 about shaft axis SA-SA (FIG. 25). Theproximal connector flange 150604 can include a plurality of concentric or at least substantiallyconcentric conductors 150602 defined in a first face thereof. Theconnector 150607 can be mounted on the proximal side of thedistal connector flange 150601 and can have a plurality of contacts, wherein each contact corresponds to and is in electrical contact with one of theconductors 150602. This arrangement allows relative rotation between theproximal connector flange 150604 and thedistal connector flange 150601 while maintaining electrical contact between the two flanges. Theproximal connector flange 150604 may includeelectrical connectors 150606 that may, for example, place theconductors 150602 in signal communication with the shaft circuit board. In at least one example, a wire harness including a plurality of conductors can extend between theelectrical connector 150606 and the shaft circuit board. Theelectrical connector 150606 can extend proximally through a connector opening defined in the chassis mounting flange. US Patent Application Publication No. 2014/0263551 entitled "STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM" is incorporated herein by reference in its entirety. US Patent Application Publication No. 2014/0263552 entitled "STAPLE CARTRIDGETISSUE THICKNESS SENSOR SYSTEM" is incorporated herein by reference in its entirety. More details on slip ring assembly 150600 can be found in US Patent Application Publication No. 2014/0263541.

可互换轴组件150200可包括可固定地安装到柄部组件150014的近侧部分，以及可围绕纵向轴线旋转的远侧部分。可旋转远侧轴部分可围绕滑环组件150600相对于近侧部分旋转。滑环组件150600的远侧连接器凸缘150601可定位在可旋转的远侧轴部分内。Interchangeable shaft assembly 150200 can include a proximal portion that is fixedly mountable to handleassembly 150014, and a distal portion that is rotatable about a longitudinal axis. The rotatable distal shaft portion is rotatable about the slip ring assembly 150600 relative to the proximal portion. Thedistal connector flange 150601 of the slip ring assembly 150600 can be positioned within the rotatable distal shaft portion.

图28为根据本公开的至少一个方面的图25的外科器械150010的端部执行器150300的一方面的分解视图。端部执行器150300可包括砧座150306和外科钉仓150304。砧座150306可联接到细长通道150302。孔150199可限定在细长通道150302中，以接纳从砧座150306延伸的销150152，以便允许砧座150306相对于细长通道150302和外科钉仓150304从打开位置枢转到闭合位置。击发杆150172被构造成能够纵向平移到端部执行器150300中。击发杆150172可由一个实心部分构成，或者可包括层合材料，该层合材料包括钢板叠堆。击发杆150172包括I形梁150178和在其远侧端部处的切割刃150182。击发杆150172的远侧突出端部可附接到I形梁150178，以在砧座150306处于闭合位置时有助于将砧座150306与定位在细长通道150302中的外科钉仓150304间隔开。I形梁150178可包括锋利切割刃150182，当通过击发杆150172向远侧推进I形梁150178时，该切割刃切断组织。在操作中，I形梁150178可击发外科钉仓150304。外科钉仓150304可包括模塑的仓体150194，该仓体保持多个钉150191，这些多个钉安置在钉驱动器150192上，这些钉驱动器位于相应向上打开的钉腔150195中。楔形滑动件150190由I形梁150178朝远侧驱动，从而在外科钉仓150304的仓托盘150196上滑动。楔形滑动件150190使钉驱动器150192向上进行凸轮运动，以将钉150191挤出成与砧座150306变形接触，同时I形梁150178的切割刃150182切断被夹持组织。28 is an exploded view of an aspect of theend effector 150300 of thesurgical instrument 150010 of FIG. 25 in accordance with at least one aspect of the present disclosure. Theend effector 150300 can include ananvil 150306 and a surgicalstaple cartridge 150304.Anvil 150306 can be coupled toelongated channel 150302.Apertures 150199 can be defined inelongated channels 150302 to receivepins 150152 extending fromanvil 150306 to allow pivoting ofanvil 150306 relative toelongated channel 150302 and surgicalstaple cartridge 150304 from an open position to a closed position. The firingrod 150172 is configured to translate longitudinally into theend effector 150300. The firingrod 150172 may be constructed of a solid portion, or may comprise a laminate comprising a stack of steel sheets. The firingrod 150172 includes an I-beam 150178 and acutting edge 150182 at its distal end. The distally projecting end of the firingrod 150172 can be attached to the I-beam 150178 to help space theanvil 150306 apart from the surgicalstaple cartridge 150304 positioned in theelongated channel 150302 when theanvil 150306 is in the closed position. The I-beam 150178 can include asharp cutting edge 150182 that severes tissue when the I-beam 150178 is advanced distally by the firingrod 150172. In operation, the I-beam 150178 can fire the surgicalstaple cartridge 150304. The surgicalstaple cartridge 150304 can include a moldedcartridge body 150194 that holds a plurality ofstaples 150191 disposed onstaple drivers 150192 in corresponding upwardly openstaple cavities 150195. Thewedge slide 150190 is driven distally by the I-beam 150178 to slide over thecartridge tray 150196 of the surgicalstaple cartridge 150304. Thewedge slide 150190 cams thestaple driver 150192 upward to extrude thestaples 150191 into deformed contact with theanvil 150306 while thecutting edge 150182 of the I-beam 150178 severes the clamped tissue.

I形梁150178可包括在击发期间与砧座150306接合的上部销150180。I形梁150178可包括与仓体150194、仓托盘150196和细长通道150302的各部分接合的中间销150184和底部基座150186。当外科钉仓150304定位在细长通道150302内时，限定在仓体150194中的狭槽150193可与限定在仓托盘150196中的纵向狭槽150197以及限定在细长通道150302中的狭槽150189对齐。在使用中，I形梁150178可滑动穿过对齐的纵向狭槽150193、150197和150189，其中，如图28所示，I形梁150178的底部基座150186可沿着狭槽150189的长度与沿着细长通道150302的底表面延伸的沟槽接合，中间销150184可沿着纵向狭槽150197的长度与仓托盘150196的顶表面接合，并且上部销150180可与砧座150306接合。在击发杆150172朝远侧推进以从外科钉仓150304击发钉和/或切入在砧座150306和外科钉仓150304之间捕集的组织时，I形梁150178可隔开或限制砧座150306和外科钉仓150304之间的相对运动。击发杆150172和I形梁150178可朝近侧回缩，从而允许打开砧座150306，以释放两个缝合和切断的组织部分。The I-beam 150178 may include anupper pin 150180 that engages theanvil 150306 during firing. The I-beam 150178 may include anintermediate pin 150184 and abottom base 150186 that engage thecartridge body 150194 , thecartridge tray 150196 , and portions of theelongated channel 150302 . When the surgicalstaple cartridge 150304 is positioned within theelongated channel 150302, theslot 150193 defined in thecartridge body 150194 can be aligned with the longitudinal slot 150197 defined in thecartridge tray 150196 and theslot 150189 defined in theelongated channel 150302 . In use, the I-beam 150178 can be slid through the alignedlongitudinal slots 150193, 150197 and 150189, wherein, as shown in FIG. Themiddle pin 150184 can engage the top surface of themagazine tray 150196 along the length of the longitudinal slot 150197, and theupper pin 150180 can engage with theanvil 150306, engaging the groove extending from the bottom surface of theelongated channel 150302. The I-beam 150178 can space or confine theanvil 150306 and the Relative movement between surgicalstaple cartridges 150304. The firingrod 150172 and I-beam 150178 can be retracted proximally, allowing theanvil 150306 to be opened to release the two stapled and severed tissue portions.

图29A和图29B为根据本公开的至少一个方面的图25的跨越两个图页的外科器械150010的控制电路150700的框图。主要参见图29A和图29B，柄部组件150702可包括马达150714，该马达可由马达驱动器150715控制，并可由外科器械150010的击发系统使用。在各种形式中，马达150714可为具有约25,000RPM的最大旋转速度的直流有刷驱动马达。在其他布置中，马达150714可包括无刷马达、无绳马达、同步马达、步进马达或任何其他合适的电动马达。马达驱动器150715可包括例如包括场效应晶体管(FET)150719的H桥驱动器。马达150714可由功率组件150706供电，该功率组件可释放地安装到柄部组件150200，以用于向外科器械150010供应控制功率。功率组件150706可包括电池，该电池可包括串联连接的、可用作功率源为外科器械150010供电的多个电池单元。在某些情况下，功率组件150706的电池单元可为可替换的和/或可再充电的。在至少一个示例中，电池单元可为可分离地联接到功率组件150706的锂离子电池。29A and 29B are block diagrams of thecontrol circuitry 150700 of thesurgical instrument 150010 of FIG. 25 spanning two pages in accordance with at least one aspect of the present disclosure. Referring primarily to FIGS. 29A and 29B , thehandle assembly 150702 can include amotor 150714 that can be controlled by amotor driver 150715 and that can be used by the firing system of thesurgical instrument 150010. In various forms, themotor 150714 may be a DC brush drive motor with a maximum rotational speed of about 25,000 RPM. In other arrangements, themotor 150714 may comprise a brushless motor, a cordless motor, a synchronous motor, a stepper motor, or any other suitable electric motor. Themotor driver 150715 may include, for example, an H-bridge driver including a field effect transistor (FET) 150719 .Motor 150714 may be powered bypower assembly 150706 releasably mounted to handleassembly 150200 for supplying control power tosurgical instrument 150010. Thepower assembly 150706 can include a battery, which can include a plurality of battery cells connected in series that can be used as a power source to power thesurgical instrument 150010. In some cases, the battery cells of thepower assembly 150706 may be replaceable and/or rechargeable. In at least one example, the battery cells may be lithium-ion batteries detachably coupled to thepower assembly 150706.

轴组件150704可包括轴组件控制器150722，该轴组件控制器可在轴组件150704与功率组件150706联接到柄部组件150702时，通过接口与安全控制器和功率管理控制器150716通信。例如，接口可包括第一接口部分150725和第二接口部分150727，其中第一接口部分可包括用于与对应的轴组件电连接器实现联接接合的一个或多个电连接器，第二接口部分可包括用于与对应的功率组件电连接器实现联接接合的一个或多个电连接器，从而在轴组件150704与功率组件150706联接到柄部组件150702时，允许轴组件控制器150722与功率管理控制器150716之间进行电通信。可通过接口传输一个或多个通信信号，以将附接的可互换轴组件150704的一个或多个功率要求传送到功率管理控制器150716。作为响应，功率管理控制器可根据附接轴组件150704的功率要求，调节功率组件150706的电池的功率输出，如下文更详细地描述。连接器可包括开关，这些开关可在柄部组件150702机械联接接合到轴组件150704和/或功率组件150706，以允许轴组件控制器150722与功率管理控制器150716之间进行电通信之后被启动。Shaft assembly 150704 can includeshaft assembly controller 150722 that can communicate with safety controller andpower management controller 150716 through an interface whenshaft assembly 150704 andpower assembly 150706 are coupled to handleassembly 150702. For example, the interface can include afirst interface portion 150725 and asecond interface portion 150727, wherein the first interface portion can include one or more electrical connectors for coupling engagement with corresponding shaft assembly electrical connectors, the second interface portion One or more electrical connectors may be included for coupling engagement with corresponding power assembly electrical connectors to allowshaft assembly controller 150722 to communicate with power management whenshaft assembly 150704 andpower assembly 150706 are coupled to handleassembly 150702 There is electrical communication between thecontrollers 150716. One or more communication signals may be transmitted over the interface to communicate one or more power requirements of the attachedinterchangeable shaft assembly 150704 to thepower management controller 150716. In response, the power management controller may adjust the power output of the battery of thepower assembly 150706 according to the power requirements of the attachedshaft assembly 150704, as described in more detail below. The connectors can include switches that can be activated after thehandle assembly 150702 is mechanically coupled to theshaft assembly 150704 and/or thepower assembly 150706 to allow electrical communication between theshaft assembly controller 150722 and thepower management controller 150716.

例如，接口将一个或多个通信信号路由通过位于柄部组件150702中的主控制器150717，由此可利于在功率管理控制器150716与轴组件控制器150722之间传送这类通信信号。在其他情况下，当轴组件150704和功率组件150706联接到柄部组件150702时，接口可有利于功率管理控制器150716与轴组件控制器150722之间的直接通信线路穿过柄部组件150702。For example, the interface routes one or more communication signals through themain controller 150717 located in thehandle assembly 150702, thereby facilitating the transfer of such communication signals between thepower management controller 150716 and theshaft assembly controller 150722. In other cases, when theshaft assembly 150704 and thepower assembly 150706 are coupled to thehandle assembly 150702, the interface may facilitate direct communication lines between thepower management controller 150716 and theshaft assembly controller 150722 through thehandle assembly 150702.

主控制器150717可以是任何单核或多核处理器，诸如由德克萨斯器械公司(TexasInstruments)提供的商品名为ARM Cortex的那些处理器。在一个方面，主控制器150717可为例如购自德克萨斯器械公司(Texas Instruments)的LM4F230H5QR ARM Cortex-M4F处理器内核，其包括：256KB的单循环闪存或其他非易失性存储器(最多至40MHZ)的片上存储器、用于使性能改善超过40MHz的预取缓冲器、32KB的单循环串行随机存取存储器(SRAM)、装载有

软件的内部只读存储器(ROM)、2KB的电可擦除可编程只读存储器(EEPROM)、一个或多个脉宽调制(PWM)模块、一个或多个正交编码器输入(QEI)模拟、具有12个模拟输入信道的一个或多个12位模数转换器(ADC)，其细节可见于产品数据表。Themain controller 150717 may be any single-core or multi-core processor, such as those offered by Texas Instruments under the tradename ARM Cortex. In one aspect, themain controller 150717 may be, for example, the LM4F230H5QR ARM Cortex-M4F processor core available from Texas Instruments, which includes: 256KB of single-cycle flash or other non-volatile memory (up to up to 40MHz) on-chip memory, prefetch buffer for improved performance beyond 40MHz, 32KB of single-cycle serial random access memory (SRAM), loaded with

Internal Read Only Memory (ROM) for software, 2KB of Electrically Erasable Programmable Read Only Memory (EEPROM), one or more Pulse Width Modulation (PWM) modules, one or more Quadrature Encoder Input (QEI) emulation , One or more 12-bit analog-to-digital converters (ADCs) with 12 analog input channels, details of which can be found in the product data sheet.

安全控制器可以是包括两个基于控制器的系列(诸如TMS570和RM4x，已知同样由Texas Instruments生产且商品名为Hercules ARM Cortex R4)的安全控制器平台。安全控制器可被配置成能够专门用于IEC 61508和ISO 26262安全关键应用等等，以提供先进的集成安全特征部，同时递送可定标的性能、连接性和存储器选项。The safety controller may be a safety controller platform including two controller-based families such as TMS570 and RM4x, also known by Texas Instruments under the trade name Hercules ARM Cortex R4. The safety controller can be configured to be dedicated to IEC 61508 and ISO 26262 safety critical applications, among others, to provide advanced integrated safety features while delivering scalable performance, connectivity and memory options.

功率组件150706可包括功率管理电路，该功率管理电路可包括功率管理控制器150716、功率调制器150738和电流感测电路150736。在轴组件150704与功率组件150706联接到柄部组件150702时，功率管理电路可被配置成能够基于轴组件150704的功率要求调节电池的功率输出。功率管理控制器150716可被编程用于控制功率调制器150738调节功率组件150706的功率输出，电流感测电路150736可用于监测功率组件150706的功率输出，以便为功率管理控制器150716提供与电池的功率输出有关的反馈，使得功率管理控制器150716可调节功率组件150706的功率输出以维持理想的输出。功率管理控制器150716和/或轴组件控制器150722各自可包括可存储多个软件模块的一个或多个处理器和/或存储器单元。Power component 150706 may include power management circuitry, which may includepower management controller 150716 ,power modulator 150738 , andcurrent sensing circuitry 150736 . When theshaft assembly 150704 and thepower assembly 150706 are coupled to thehandle assembly 150702, the power management circuit can be configured to be able to adjust the power output of the battery based on the power requirements of theshaft assembly 150704. Thepower management controller 150716 can be programmed to control thepower modulator 150738 to regulate the power output of thepower component 150706, and thecurrent sensing circuit 150736 can be used to monitor the power output of thepower component 150706 in order to provide thepower management controller 150716 with power to the battery Feedback on the outputs is provided so that thepower management controller 150716 can adjust the power output of thepower components 150706 to maintain the desired output.Power management controller 150716 and/orshaft assembly controller 150722 may each include one or more processors and/or memory units that may store multiple software modules.

外科器械150010(图25-图28)可包括输出装置150742，该输出装置可包括用于将感官反馈提供给用户的装置。此类装置可包括例如视觉反馈装置(例如，LCD显示屏、LED指示器)、音频反馈装置(例如，扬声器、蜂鸣器)或触觉反馈装置(例如，触觉致动器)。在某些情况下，输出装置150742可包括显示器150743，该显示器可包含在柄部组件150702中。轴组件控制器150722和/或功率管理控制器150716可通过输出装置150742向外科器械150010的用户提供反馈。接口可被配置成能够将轴组件控制器150722和/或功率管理控制器150716连接到输出装置150742。作为替代，输出装置150742可与功率组件150706集成。在此类情况下，当轴组件150704联接到柄部组件150702时，输出装置150742与轴组件控制器150722之间的通信可通过接口实现。Surgical instrument 150010 (FIGS. 25-28) can include anoutput device 150742, which can include means for providing sensory feedback to a user. Such devices may include, for example, visual feedback devices (eg, LCD displays, LED indicators), audio feedback devices (eg, speakers, buzzers), or haptic feedback devices (eg, haptic actuators). In some cases, theoutput device 150742 can include adisplay 150743, which can be included in thehandle assembly 150702.Shaft assembly controller 150722 and/orpower management controller 150716 may provide feedback to a user ofsurgical instrument 150010 viaoutput device 150742. The interface may be configured to connect theshaft assembly controller 150722 and/or thepower management controller 150716 to theoutput device 150742. Alternatively, theoutput device 150742 may be integrated with thepower assembly 150706. In such a case, when theshaft assembly 150704 is coupled to thehandle assembly 150702, communication between theoutput device 150742 and theshaft assembly controller 150722 may be accomplished through an interface.

控制电路150700包括被配置成能够控制电动外科器械150010的操作的电路段。安全控制器段(段1)包括安全控制器和主控制器150717段(段2)。安全控制器和/或主控制器150717被配置成能够与一个或多个附加电路段(诸如加速度段、显示器段、轴段、编码器段、马达段和功率段)相互作用。电路段中的每个都可联接到安全控制器和/或主控制器150717。主控制器150717还联接到闪存存储器。主控制器150717还包括串行通信接口。主控制器150717包括联接到例如一个或多个电路段、电池和/或多个开关的多个输入。分段电路可通过任何合适的电路(诸如，电动外科器械150010内的印刷电路板组件(PCBA))来实施。应当理解，本文使用的术语“处理器”包括任一种微处理器、处理器、微控制器、控制器，或者将计算机的中央处理单元(CPU)的功能结合到一个集成电路或最多几个集成电路上的其它基础计算装置。主控制器150717是多用途的可编程装置，该装置接收数字数据作为输入，根据其存储器中存储的指令来处理输入，并提供结果作为输出。因为处理器具有内部存储器，所以是顺序数字逻辑的示例。控制电路150700可被配置成能够实现本文所述的一个或多个过程。Control circuit 150700 includes circuit segments configured to control the operation of poweredsurgical instrument 150010. The safety controller segment (segment 1) includes the safety controller and themain controller 150717 segment (segment 2). The safety controller and/ormain controller 150717 is configured to be able to interact with one or more additional circuit segments, such as the acceleration segment, display segment, shaft segment, encoder segment, motor segment, and power segment. Each of the circuit segments may be coupled to a safety controller and/or amaster controller 150717. Themain controller 150717 is also coupled to flash memory. Themain controller 150717 also includes a serial communication interface. Themain controller 150717 includes multiple inputs coupled to, for example, one or more circuit segments, batteries, and/or multiple switches. The segmented circuit may be implemented by any suitable circuit, such as a printed circuit board assembly (PCBA) within the poweredsurgical instrument 150010. It should be understood that the term "processor" as used herein includes any type of microprocessor, processor, microcontroller, controller, or computer that combines the functions of a central processing unit (CPU) of a computer into one integrated circuit or up to several Other basic computing devices on integrated circuits. Themain controller 150717 is a multipurpose programmable device that receives digital data as input, processes the input according to instructions stored in its memory, and provides results as output. Because the processor has internal memory, it is an example of sequential digital logic. Thecontrol circuit 150700 may be configured to implement one or more of the processes described herein.

加速度段(段3)包括加速度计。加速度计被配置成能够检测电动外科器械150010的运动或加速度。来自加速度计的输入可用于例如转换到休眠模式和从休眠模式转换到其他模式、识别电动外科器械的取向，并且/或者识别外科器械何时已被放下。在一些示例中，加速度段联接到安全控制器和/或主控制器150717。The acceleration segment (segment 3) includes an accelerometer. The accelerometer is configured to detect motion or acceleration of the poweredsurgical instrument 150010 . Input from the accelerometer may be used, for example, to transition to and from a sleep mode to other modes, identify the orientation of a powered surgical instrument, and/or identify when a surgical instrument has been lowered. In some examples, the acceleration segment is coupled to the safety controller and/or themain controller 150717.

显示器段(段4)包括联接到主控制器150717的显示器连接器。显示器连接器通过显示器的一个或多个集成电路驱动器将主控制器150717联接到显示器。显示器的集成电路驱动器可与显示器集成，并且/或者可与显示器分开定位。显示器可包括任一种合适的显示器，诸如有机发光二极管(OLED)显示器、液晶显示器(LCD)和/或任何其他合适的显示器。在一些示例中，显示器段联接到安全控制器。The display segment (Segment 4) includes a display connector coupled to themain controller 150717. The display connector couples themain controller 150717 to the display through one or more integrated circuit drivers for the display. The integrated circuit driver for the display may be integrated with the display and/or may be located separately from the display. The display may comprise any suitable display, such as an organic light emitting diode (OLED) display, a liquid crystal display (LCD), and/or any other suitable display. In some examples, the display segment is coupled to the safety controller.

轴段(段5)包括用于联接到外科器械150010(图25至图28)的可互换轴组件150200(图25和图27)的控件，和/或用于联接到可互换轴组件150200的端部执行器150300的一个或多个控件。轴段包括轴连接器，该轴连接器被配置成能够将主控制器150717联接到轴PCBA。轴PCBA包括具有铁电随机存取存储器(FRAM)、关节运动开关、轴释放霍尔效应开关和轴PCBA EEPROM的低功率微控制器。轴PCBA EEPROM包括特定于可互换轴组件150200和/或轴PCBA的一个或多个参数、例程和/或程序。轴PCBA可联接到可互换轴组件150200和/或与外科器械150010集成。在一些示例中，轴段包括第二轴EEPROM。第二轴EEPROM包括对应于可与电动外科器械150010交接的一个或多个轴组件150200和/或端部执行器150300的多个算法、例程、参数和/或其他数据。Shaft segment (Segment 5) includes controls for coupling to interchangeable shaft assembly 150200 (FIGS. 25 and 27) of surgical instrument 150010 (FIGS. 25-28) and/or for coupling to interchangeable shaft assembly One or more controls of the 150200end effector 150300. The shaft segment includes a shaft connector configured to couple themain controller 150717 to the shaft PCBA. The shaft PCBA includes a low power microcontroller with ferroelectric random access memory (FRAM), articulation switches, shaft release Hall effect switches, and shaft PCBA EEPROM. The shaft PCBA EEPROM includes one or more parameters, routines and/or programs specific to theinterchangeable shaft assembly 150200 and/or the shaft PCBA. Shaft PCBA may be coupled tointerchangeable shaft assembly 150200 and/or integrated withsurgical instrument 150010. In some examples, the shaft segment includes a second shaft EEPROM. The second shaft EEPROM includes a number of algorithms, routines, parameters and/or other data corresponding to one ormore shaft assemblies 150200 and/or endeffectors 150300 that may interface with the poweredsurgical instrument 150010.

位置编码器段(段6)包括一个或多个磁性角旋转位置编码器。一个或多个磁性角旋转位置编码器被配置成能够识别外科器械150010(图25至图28)的马达150714、可互换轴组件150200(图25和图27)和/或端部执行器150300的旋转位置。在一些示例中，磁性角旋转位置编码器可联接到安全控制器和/或主控制器150717。The position encoder section (section 6) includes one or more magnetic angular rotary position encoders. One or more magnetic angular rotary position encoders configured to identify themotor 150714 of the surgical instrument 150010 (FIGS. 25-28), the interchangeable shaft assembly 150200 (FIGS. 25 and 27), and/or theend effector 150300 rotation position. In some examples, a magnetic angular rotary position encoder may be coupled to the safety controller and/or themain controller 150717.

马达电路段(段7)包括被配置成能够控制电动外科器械150010(图25至图28)的运动的马达150714。马达150714通过包括一个或多个H桥场效应晶体管(FET)的H桥驱动器和马达控制器联接到主微控制器处理器150717。H桥驱动器也联接到安全控制器。马达电流传感器与马达串联联接，用于测量马达的电流消耗。马达电流传感器与主控制器150717和/或安全控制器进行信号通信。在一些示例中，马达150714联接到马达电磁干扰(EMI)滤波器。The motor circuit segment (segment 7) includes amotor 150714 that is configured to control the movement of the powered surgical instrument 150010 (FIGS. 25-28). Themotor 150714 is coupled to themain microcontroller processor 150717 through an H-bridge driver and motor controller including one or more H-bridge field effect transistors (FETs). The H-bridge driver is also coupled to the safety controller. A motor current sensor is connected in series with the motor to measure the current consumption of the motor. The motor current sensor is in signal communication with themain controller 150717 and/or the safety controller. In some examples, themotor 150714 is coupled to a motor electromagnetic interference (EMI) filter.

马达控制器控制第一马达标记和第二马达标记，以向主控制器150717指示马达150714的状态和位置。主控制器150717通过缓冲器向马达控制器提供脉宽调制(PWM)高信号、PWM低信号、方向信号、同步信号和马达复位信号。功率段被构造成向电路段中的每一者提供段电压。The motor controller controls the first motor flag and the second motor flag to indicate to themaster controller 150717 the state and position of themotor 150714. Themain controller 150717 provides a pulse width modulation (PWM) high signal, a PWM low signal, a direction signal, a sync signal and a motor reset signal to the motor controller through a buffer. The power section is configured to provide a section voltage to each of the circuit sections.

功率段(段8)包括联接到安全控制器、主控制器150717和附加电路段的电池。电池通过电池连接器和电流传感器联接到分段电路。电流传感器被构造成测量分段电路的总电流消耗。在一些示例中，一个或多个电压转换器被构造成向一个或多个电路段提供预先确定的电压值。例如，在一些示例中，分段电路可包括3.3V的电压转换器和/或5V的电压转换器。升压转换器被构造成提供最高为预先确定的量(诸如，最高至13V)的升压电压。升压转换器被构造成在功率密集操作期间提供附加的电压和/或电流，并且能够防止电压降低状况或低功率状况。The power segment (segment 8) includes the battery coupled to the safety controller,main controller 150717 and additional circuit segments. The battery is coupled to the segment circuit through a battery connector and a current sensor. The current sensor is configured to measure the total current consumption of the segmented circuit. In some examples, one or more voltage converters are configured to provide predetermined voltage values to one or more circuit segments. For example, in some examples, the segment circuit may include a 3.3V voltage converter and/or a 5V voltage converter. The boost converter is configured to provide a boost voltage up to a predetermined amount, such as up to 13V. The boost converter is configured to provide additional voltage and/or current during power-intensive operation, and to be able to prevent voltage drop conditions or low power conditions.

多个开关联接到安全控制器和/或主控制器150717。这些开关可被配置成能够控制外科器械150010(图25至图28)的操作、分段电路的操作，并且/或者指示外科器械150010的状态。用于应急的应急门开关和霍尔效应开关被构造成指示应急门的状态。多个关节运动开关(诸如，左侧向左关节运动开关、左侧向右关节运动开关、左侧向中心关节运动开关、右侧向左关节运动开关、右侧向右关节运动开关和右侧向中心关节运动开关)被配置成能够控制可互换轴组件150200(图25和图27)和/或端部执行器150300(图25和图28)的关节运动。左侧换向开关和右侧换向开关联接到主控制器150717。左侧开关(包括左侧向左关节运动开关、左侧向右关节运动开关、左侧向中心关节运动开关和左侧换向开关)通过左挠性连接器联接到主控制器150717。右侧开关(包括右侧向左关节运动开关、右侧向右关节运动开关、右侧向中心关节运动开关和右侧换向开关)通过右挠性连接器联接到主控制器150717。击发开关、夹持释放开关和轴接合开关联接到主控制器150717。A number of switches are coupled to the safety controller and/or themain controller 150717. These switches may be configured to control operation of surgical instrument 150010 ( FIGS. 25-28 ), operation of segmented circuits, and/or to indicate the status ofsurgical instrument 150010 . The emergency door switch and the Hall effect switch for emergency are configured to indicate the state of the emergency door. Multiple articulation switches (such as left articulation switch left, right articulation left switch, center left articulation switch, left articulation switch right, right articulation switch right, and right articulation switch A center-to-center articulation switch) is configured to control the articulation of the interchangeable shaft assembly 150200 (FIGS. 25 and 27) and/or the end effector 150300 (FIGS. 25 and 28). The left and right reversing switches are coupled to themain controller 150717. The left switches (including left articulation switch left, right articulation switch left, center articulation switch left, and reversing switch left) are coupled to themain controller 150717 through a left flexible connector. The right switches (including the right left articulation switch, the right right articulation switch, the right center articulation switch, and the right reversing switch) are coupled to themain controller 150717 through the right flexible connector. The firing switch, grip release switch, and shaft engagement switch are coupled to themain controller 150717.

任何合适的机械开关、机电开关或固态开关可以任意组合，用于实现多个开关。例如，开关可为利用与外科器械150010(图25至图28)相关联的部件的运动或存在某个物体来操作的限位开关。此类开关可用于控制与外科器械150010相关联的各种功能。限位开关是由机械地连接到一组触点的致动器构成的机电装置。当某个物体与致动器接触时，该装置操作触点以形成或断开电连接。限位开关不仅耐用、安装简便，还操作可靠，故适用于多种应用和环境。限位开关可确定物体的存在或不存在、经过、定位、以及物体行程的结束。在其他具体实施中，开关可以是在磁场影响下操作的固态开关，诸如霍尔效应装置、磁阻(MR)装置、巨磁阻(GMR)装置、磁力计等等。在其他具体实施中，开关可以是在光影响下操作的固态开关，诸如光学传感器、红外线传感器、紫外线传感器及其他。同样，开关可以是固态装置，诸如晶体管(例如，FET、结型FET、金属氧化物半导体FET(MOSFET)、双极型晶体管等)。其他开关可包括无线开关、超声开关、加速度计、惯性传感器及其他。Any suitable mechanical, electromechanical, or solid state switches may be used in any combination to implement multiple switches. For example, the switch may be a limit switch that is operated using movement of a component associated with surgical instrument 150010 (FIGS. 25-28) or the presence of an object. Such switches may be used to control various functions associated withsurgical instrument 150010. A limit switch is an electromechanical device consisting of an actuator mechanically connected to a set of contacts. When an object comes into contact with the actuator, the device operates the contacts to make or break an electrical connection. Durable, easy to install, and reliable in operation, limit switches are suitable for a variety of applications and environments. Limit switches determine the presence or absence of an object, passage, positioning, and the end of an object's travel. In other implementations, the switches may be solid state switches that operate under the influence of a magnetic field, such as Hall effect devices, magnetoresistive (MR) devices, giant magnetoresistive (GMR) devices, magnetometers, and the like. In other implementations, the switches may be solid state switches that operate under the influence of light, such as optical sensors, infrared sensors, ultraviolet sensors, and others. Likewise, the switches may be solid state devices such as transistors (eg, FETs, junction FETs, metal oxide semiconductor FETs (MOSFETs), bipolar transistors, etc.). Other switches may include wireless switches, ultrasonic switches, accelerometers, inertial sensors, and others.

图30为根据本公开的至少一个方面的图25的外科器械的控制电路150700的另一个框图，其示出了柄部组件150702与功率组件150706之间、以及柄部组件150702与可互换轴组件150704之间的接口。柄部组件150702可包括主控制器150717、轴组件连接器150726和功率组件连接器150730。功率组件150706可包括功率组件连接器150732、功率管理电路150734，该功率管理电路可包括功率管理控制器150716、功率调制器150738和电流感测电路150736。轴组件连接器150730、150732形成接口150727。功率管理电路150734可被配置成能够在可互换轴组件150704与功率组件150706联接到柄部组件150702时，基于可互换轴组件150704的功率要求调节电池150707的功率输出。功率管理控制器150716可被编程用于控制功率调制器150738调节功率组件150706的功率输出，并且电流感测电路150736可用于监测功率组件150706的功率输出，以便为功率管理控制器150716提供与电池150707的功率输出有关的反馈，使得功率管理控制器150716可调节功率组件150706的功率输出以维持理想的输出。轴组件150704包括轴处理器150720，该轴处理器联接到非易失性存储器150721和轴组件连接器150728以将轴组件150704电联接到柄部组件150702。轴组件连接器150726、150728形成接口150725。主控制器150717、轴处理器150720和/或功率管理控制器150716可被配置成能够实现本文所述的过程中的一者或多者。30 is another block diagram of thecontrol circuit 150700 of the surgical instrument of FIG. 25 showing between thehandle assembly 150702 and thepower assembly 150706, and between thehandle assembly 150702 and the interchangeable shaft, in accordance with at least one aspect of the present disclosure Interface betweencomponents 150704. Thehandle assembly 150702 may include amain controller 150717, ashaft assembly connector 150726, and apower assembly connector 150730.Power assembly 150706 may includepower assembly connector 150732,power management circuitry 150734, which may includepower management controller 150716,power modulator 150738, andcurrent sensing circuitry 150736. Theshaft assembly connectors 150730, 150732 form aninterface 150727. Thepower management circuit 150734 can be configured to adjust the power output of thebattery 150707 based on the power requirements of theinterchangeable shaft assembly 150704 when theinterchangeable shaft assembly 150704 and thepower assembly 150706 are coupled to thehandle assembly 150702. Thepower management controller 150716 can be programmed to control thepower modulator 150738 to regulate the power output of thepower component 150706, and thecurrent sensing circuit 150736 can be used to monitor the power output of thepower component 150706 to provide thepower management controller 150716 with thebattery 150707 Feedback about the power output of thepower management controller 150716 allows thepower management controller 150716 to adjust the power output of thepower components 150706 to maintain the desired output.Shaft assembly 150704 includes shaft handler 150720 coupled tonon-volatile memory 150721 and shaft assembly connector 150728 to electrically coupleshaft assembly 150704 to handleassembly 150702. Theshaft assembly connectors 150726, 150728 form theinterface 150725.Main controller 150717, axis processor 150720, and/orpower management controller 150716 may be configured to implement one or more of the processes described herein.

外科器械150010(图25至图28)可包括用于将感官反馈提供给用户的输出装置150742。此类装置可以包括视觉反馈装置(例如，LCD显示屏、LED指示器)、听觉反馈装置(例如，扬声器、蜂鸣器)或触觉反馈装置(例如，触觉致动器)。在某些情况下，输出装置150742可包括显示器150743，该显示器可包含在柄部组件150702中。轴组件控制器150722和/或功率管理控制器150716可通过输出装置150742向外科器械150010的用户提供反馈。接口150727可被配置成能够将轴组件控制器150722和/或功率管理控制器150716连接到输出装置150742。输出装置150742可与功率组件150706集成。当可互换轴组件150704联接到柄部组件150702时，输出装置150742与轴组件控制器150722之间的通信可通过接口150725实现。在描述用于控制外科器械150010(图25至图28)的操作的控制电路150700(图29A、图29B和图6)后，本公开现在转向外科器械150010(图25至图28)和控制电路150700的各种配置。Surgical instrument 150010 (FIGS. 25-28) may include anoutput device 150742 for providing sensory feedback to the user. Such devices may include visual feedback devices (eg, LCD displays, LED indicators), auditory feedback devices (eg, speakers, buzzers), or haptic feedback devices (eg, haptic actuators). In some cases, theoutput device 150742 can include adisplay 150743, which can be included in thehandle assembly 150702.Shaft assembly controller 150722 and/orpower management controller 150716 may provide feedback to a user ofsurgical instrument 150010 viaoutput device 150742. Theinterface 150727 may be configured to connect theshaft assembly controller 150722 and/or thepower management controller 150716 to theoutput device 150742. Theoutput device 150742 can be integrated with thepower assembly 150706. When theinterchangeable shaft assembly 150704 is coupled to thehandle assembly 150702, communication between theoutput device 150742 and theshaft assembly controller 150722 can be accomplished through theinterface 150725. Having described the control circuit 150700 ( FIGS. 29A , 29B and 6 ) for controlling the operation of the surgical instrument 150010 ( FIGS. 25-28 ), the present disclosure now turns to the surgical instrument 150010 ( FIGS. 25-28 ) and thecontrol circuit 150700 in various configurations.

参见图31，外科缝合器151000可包括柄部部件151002、轴部件151004和端部执行器部件151006。外科缝合器151000被类似地构造和配备为结合图25所述的马达驱动的外科切割和紧固器械150010。因此，为方便和清楚起见，此处将不重复对操作和构造的细节。端部执行器151006可用于压缩、切割或缝合组织。现在参见图32，在进行压缩、切割或缝合之前，医师可将端部执行器151030定位成围绕组织151032。如图32所示，在准备使用端部执行器时，不可对组织施加压缩。现在参见图33，通过与外科缝合器的柄部(例如，柄部151002)接合，医师可使用端部执行器151030来压缩组织151032。在一个方面，组织151032可被压缩到其最大阈值，如图33所示。Referring to FIG. 31 ,surgical stapler 151000 can include handlemember 151002 ,shaft member 151004 andend effector member 151006 .Surgical stapler 151000 is similarly constructed and equipped as motor-driven surgical cutting andfastening instrument 150010 described in connection with FIG. 25 . Therefore, for the sake of convenience and clarity, details of operation and construction will not be repeated here. Theend effector 151006 can be used to compress, cut or staple tissue. Referring now to Figure 32, the physician may position theend effector 151030 around thetissue 151032 prior to compression, cutting or stapling. As shown in Figure 32, no compression should be applied to the tissue in preparation for use of the end effector. Referring now to FIG. 33, a physician may use anend effector 151030 to compresstissue 151032 by engaging with a handle of a surgical stapler (eg, handle 151002). In one aspect,tissue 151032 may be compressed to its maximum threshold, as shown in FIG. 33 .

参见图34，可通过端部执行器151030将各种力施加到组织151032。例如，当组织151032在端部执行器151030的砧座151034和通道框架151036之间被压缩时，可通过砧座和通道框架施加垂直力F1和F2。现在参见图35，当组织151032被端部执行器151030压缩时，还可向该组织施加各种对角线力和/或横向力。例如，可施加力F3。为了操作医疗装置诸如外科缝合器151000，可期望感测或计算由端部执行器施加到组织的各种形式的压缩。例如，已知垂直或横向压缩可允许端部执行器更精确或准确地实施钉操作或者可通知外科缝合器的操作者，使得能够更正确或安全地使用外科缝合器。34, various forces can be applied totissue 151032 through theend effector 151030. For example, as thetissue 151032 is compressed between theanvil 151034 and thechannel frame 151036 of theend effector 151030, vertical forces F1 and F2 may be applied through the anvil and the channel frame. Referring now to FIG. 35 , as thetissue 151032 is compressed by theend effector 151030, various diagonal and/or lateral forces may also be applied to the tissue. For example, force F3 may be applied. In order to operate a medical device, such as thesurgical stapler 151000, it may be desirable to sense or calculate various forms of compression applied to tissue by the end effector. For example, it is known that vertical or lateral compression may allow the end effector to more precisely or accurately perform staple manipulation or may inform the operator of the surgical stapler so that the surgical stapler can be used more correctly or safely.

可以从组织151032的阻抗确定穿过组织151032的压缩。在各种压缩水平下，组织151032的阻抗Z可以增加或减小。通过将电压V和电流I施加到组织151032，可以在各种压缩水平下确定组织151032的阻抗Z。例如，可以通过将施加的电压V除以电流I来计算阻抗Z。Compression throughtissue 151032 can be determined from the impedance oftissue 151032. At various levels of compression, the impedance Z oftissue 151032 may increase or decrease. By applying voltage V and current I totissue 151032, the impedance Z oftissue 151032 can be determined at various levels of compression. For example, the impedance Z can be calculated by dividing the applied voltage V by the current I.

现在参见图36，在一个方面，RF电极151038可定位在端部执行器151030上(例如，在端部执行器151030的钉仓、刀或通道框架上)。此外，电触点151040可以定位在端部执行器151030的砧座151034上。在一个方面，电触点可以定位在端部执行器的通道框架上。当组织151032在端部执行器151030的砧座151034与例如通道框架151036之间被压缩时，组织151032的阻抗Z改变。由端部执行器151030引起的垂直组织压缩151042可以作为组织151032的阻抗Z的函数来测量。Referring now to FIG. 36, in one aspect,RF electrodes 151038 can be positioned on the end effector 151030 (eg, on the cartridge, knife, or channel frame of the end effector 151030). Additionally,electrical contacts 151040 can be positioned on theanvil 151034 of theend effector 151030. In one aspect, the electrical contacts can be positioned on the channel frame of the end effector. As thetissue 151032 is compressed between theanvil 151034 of theend effector 151030 and, for example, thechannel frame 151036, the impedance Z of thetissue 151032 changes. Thevertical tissue compression 151042 caused by theend effector 151030 can be measured as a function of the impedance Z of thetissue 151032.

现在参见图37，在一个方面，当定位RF电极151038时，电触点151044可以定位在端部执行器151030的砧座151034的相对端上。当组织151032在端部执行器151030的砧座151034与例如通道框架151036之间被压缩时，组织151032的阻抗Z改变。由端部执行器151030引起的横向组织压缩151046可以作为组织151032的阻抗Z的函数来测量。Referring now to FIG. 37 , in one aspect, when theRF electrodes 151038 are positioned, theelectrical contacts 151044 can be positioned on opposite ends of theanvil 151034 of theend effector 151030. As thetissue 151032 is compressed between theanvil 151034 of theend effector 151030 and, for example, thechannel frame 151036, the impedance Z of thetissue 151032 changes. Thelateral tissue compression 151046 caused by theend effector 151030 can be measured as a function of the impedance Z of thetissue 151032.

现在参见图38，在一个方面，电触点151050可以定位在砧座151034上，并且电触点151052可以定位在通道框架151036处的端部执行器151030的相对端上。RF电极151048可以横向于端部执行器151030的中心定位。当组织151032在端部执行器151030的砧座151034与例如通道框架151036之间被压缩时，组织151032的阻抗Z改变。RF电极151048任一侧的横向压缩151054或角度压缩151056可以由端部执行器151030引起，并且可以基于RF电极151048和电触点151050和151052的相对定位作为组织151032的不同阻抗Z的函数来测量。Referring now to FIG. 38 , in one aspect,electrical contacts 151050 can be positioned on theanvil 151034 andelectrical contacts 151052 can be positioned on opposite ends of theend effector 151030 at thechannel frame 151036 . The RF electrode 151048 may be positioned transverse to the center of theend effector 151030. As thetissue 151032 is compressed between theanvil 151034 of theend effector 151030 and, for example, thechannel frame 151036, the impedance Z of thetissue 151032 changes.Lateral compression 151054 orangular compression 151056 on either side of the RF electrode 151048 can be caused by theend effector 151030 and can be measured as a function of the different impedance Z of thetissue 151032 based on the relative positioning of the RF electrode 151048 andelectrical contacts 151050 and 151052 .

现在参见图39，频率发生器151222可以从功率源151221接收功率或电流，并且可以将一个或多个RF信号供应给一个或多个RF电极151224。如上所述，一个或多个RF电极可以定位在端部执行器或外科缝合器上的各种位置或部件处，诸如钉仓或通道框架。一个或多个电触点，诸如电触点151226或151228可以定位在端部执行器的通道框架或砧座上。此外，一个或多个滤波器(诸如滤波器151230或151232)可以通信地联接到电触点151226或151228。滤波器151230和151232可以在接合单个返回路径151234之前对由频率发生器151222提供的一个或多个RF信号进行滤波。与一个或多个RF信号相关联的电压V和电流I可用于计算与组织相关联的阻抗Z，该组织可在一个或多个RF电极151224与电触点151226或151228之间被压缩和/或通信地联接。Referring now to FIG. 39,frequency generator 151222 can receive power or current frompower source 151221 and can supply one or more RF signals to one ormore RF electrodes 151224. As described above, one or more RF electrodes may be positioned at various locations or components on the end effector or surgical stapler, such as a staple cartridge or channel frame. One or more electrical contacts, such aselectrical contacts 151226 or 151228, can be positioned on the channel frame or anvil of the end effector. Additionally, one or more filters, such asfilter 151230 or 151232, may be communicatively coupled toelectrical contacts 151226 or 151228.Filters 151230 and 151232 may filter one or more RF signals provided byfrequency generator 151222 before joining single return path 151234. Voltage V and current I associated with one or more RF signals can be used to calculate impedance Z associated with tissue that can be compressed and/or between one ormore RF electrodes 151224 andelectrical contacts 151226 or 151228 or communicatively linked.

仍然参见图39，本文描述的组织压缩传感器系统的各种部件可位于外科缝合器的柄部151236中。例如，如电路图151220a所示，频率发生器151222可以位于柄部151236中并从功率源151221接收功率。另外，可以在对应于电触点151228和151226的返回路径上测量电流I1和电流I2。使用在供应路径和返回路径之间施加的电压V可以计算阻抗Z1和Z2。Z1可以对应于在RF电极151224和电触点151228中的一个或多个之间被压缩和/或通信地联接的组织的阻抗。此外，Z2可以对应于在RF电极151224和电触点151226中的一个或多个之间被压缩和/或通信地联接的组织的阻抗。应用公式Z1＝V/I1和Z2＝V/I2可以计算对应于由端部执行器压缩的组织的不同压缩水平的阻抗Z1和Z2。Still referring to Figure 39, various components of the tissue compression sensor system described herein may be located in the handle 151236 of the surgical stapler. For example, as shown in circuit diagram 151220a,frequency generator 151222 may be located in handle 151236 and receive power frompower source 151221. Additionally, current I1 and current I2 may be measured on return paths corresponding toelectrical contacts 151228 and 151226. Impedances Z1 and Z2 can be calculated using the voltage V applied between the supply and return paths. Z1 may correspond to the impedance of the tissue compressed and/or communicatively coupled between theRF electrodes 151224 and one or more of theelectrical contacts 151228. Additionally, Z2 may correspond to the impedance of the tissue compressed and/or communicatively coupled between theRF electrodes 151224 and one or more of theelectrical contacts 151226. Impedances Z1 and Z2 corresponding to different compression levels of tissue compressed by the end effector can be calculated using the formulae Z1 =V/I1 and Z2 = V/I2.

现在参见图40，在电路图151250中描述了本公开的一个或多个方面。在一个具体实施中，外科缝合器的柄部151252处的功率源可以向频率发生器151254提供功率。频率发生器151254可以生成一个或多个RF信号。一个或多个RF信号可以在多路复用器151256处被多路复用或叠加，该多路复用器可以在外科缝合器的轴151258中。这样，两个或更多个RF信号可以被叠加(或者，例如，嵌套或一起调制)并且被传输到端部执行器。一个或多个RF信号可以为在外科缝合器的端部执行器151262(例如，定位在钉仓中)处的一个或多个RF电极151260供电。组织(未示出)可以在RF电极151260中的一个或多个与一个或多个电触点之间被压缩和/或通信地联接。例如，组织可以在一个或多个RF电极151260和定位在端部执行器151262的通道框架中的电触点151264或定位在端部执行器151262的砧座中的电触点151266之间被压缩和/或通信地联接。滤波器151268可以通信地联接到电触点151264，并且滤波器151270可以通信地联接到电触点151266。Referring now to FIG. 40 , one or more aspects of the present disclosure are described in circuit diagram 151250 . In one implementation, a power source at thehandle 151252 of the surgical stapler can provide power to thefrequency generator 151254.Frequency generator 151254 may generate one or more RF signals. One or more RF signals may be multiplexed or superimposed atmultiplexer 151256, which may be in theshaft 151258 of the surgical stapler. In this way, two or more RF signals can be superimposed (or, eg, nested or modulated together) and transmitted to the end effector. The one or more RF signals can power one ormore RF electrodes 151260 at theend effector 151262 of the surgical stapler (eg, positioned in the staple cartridge). Tissue (not shown) may be compressed and/or communicatively coupled between one or more of theRF electrodes 151260 and one or more electrical contacts. For example, tissue can be compressed between one ormore RF electrodes 151260 andelectrical contacts 151264 positioned in the channel frame of theend effector 151262 orelectrical contacts 151266 positioned in the anvil of theend effector 151262 and/or communicatively linked.Filter 151268 can be communicatively coupled toelectrical contact 151264 andfilter 151270 can be communicatively coupled toelectrical contact 151266.

与一个或多个RF信号相关联的电压V和电流I可以用于计算与组织相关联的阻抗Z，该组织可以在钉仓(并且通信地联接到一个或多个RF电极151260)和通道框架或砧座(并且通信地联接到电触点151264或151266中的一个或多个)之间被压缩。The voltage V and current I associated with the one or more RF signals can be used to calculate the impedance Z associated with the tissue that can be in the staple cartridge (and communicatively coupled to the one or more RF electrodes 151260) and the channel frame or the anvil (and communicatively coupled to one or more of theelectrical contacts 151264 or 151266) are compressed.

在一个方面，本文所述的组织压缩传感器系统的各种部件可位于外科缝合器的轴151258中。例如，如电路图151250所示(并且除了频率发生器151254之外)，阻抗计算器151272、控制器151274、非易失性存储器151276和通信通道151278可以位于轴151258中。在一个示例中，频率发生器151254、阻抗计算器151272、控制器151274、非易失性存储器151276和通信通道151278可以定位在轴151258中的电路板上。In one aspect, various components of the tissue compression sensor systems described herein can be located in theshaft 151258 of the surgical stapler. For example, as shown in circuit diagram 151250 (and in addition to frequency generator 151254),impedance calculator 151272,controller 151274,non-volatile memory 151276, andcommunication channel 151278 may be located inshaft 151258. In one example,frequency generator 151254 ,impedance calculator 151272 ,controller 151274 ,non-volatile memory 151276 , andcommunication channel 151278 may be positioned on a circuit board inshaft 151258 .

两个或更多个RF信号可以经由电触点在公共路径上返回。此外，可以在公共路径上接合RF信号之前对两个或更多个RF信号进行滤波，以区分由两个或更多个RF信号表示的单独的组织阻抗。可以在对应于电触点151264和151266的返回路径上测量电流I1和电流I2。使用在供应路径和返回路径之间施加的电压V可以计算阻抗Z1和Z2。Z1可以对应于在RF电极151260和电触点151264中的一个或多个之间被压缩和/或通信地联接的组织的阻抗。此外，Z2可以对应于在RF电极151260和电触点151266中的一个或多个之间被压缩和/或通信地联接的组织的阻抗。应用公式Z1＝V/I1和Z2＝V/I2可以计算对应于由端部执行器151262压缩的组织的不同压缩的阻抗Z1和Z2。在示例中，阻抗Z1和Z2可以由阻抗计算器151272计算。阻抗Z1和Z2可用于计算组织的各种压缩水平。Two or more RF signals may return on a common path via the electrical contacts. Additionally, the two or more RF signals may be filtered prior to joining the RF signals on the common path to distinguish individual tissue impedances represented by the two or more RF signals. Current I1 and current I2 may be measured on return paths corresponding toelectrical contacts 151264 and 151266. Impedances Z1 and Z2 can be calculated using the voltage V applied between the supply and return paths. Z1 may correspond to the impedance of the tissue that is compressed and/or communicatively coupled between theRF electrode 151260 and one or more of theelectrical contacts 151264. Additionally, Z2 may correspond to the impedance of the tissue compressed and/or communicatively coupled between theRF electrode 151260 and one or more of theelectrical contacts 151266. Impedances Z1 and Z2 corresponding to different compressions of tissue compressed by theend effector 151262 can be calculated using the formulas Z1 =V/I1 and Z2 =V/I2. In an example, impedances Z1 and Z2 may be calculated byimpedance calculator 151272 . Impedances Z1 and Z2 can be used to calculate various compression levels of the tissue.

现在参见图41，示出了频率曲线图151290。频率曲线图151290示出了嵌套两个RF信号的频率调制。如上所述，两个RF信号可在到达端部执行器处的RF电极之前嵌套。例如，具有频率1的RF信号和具有频率2的RF信号可嵌套在一起。现在参见图42，在频率曲线图151300中示出了所得的嵌套RF信号。频率曲线图151300中所示的复合信号包括复合的频率曲线图151290的两个RF信号。现在参见图43，示出了频率曲线图151400。频率曲线图151400示出了在被滤波(通过例如滤波器151268和151270)之后具有频率1和频率2的RF信号。所得的RF信号可用于在返回路径上进行单独的阻抗计算或测量，如上所述。Referring now to FIG. 41, afrequency graph 151290 is shown.Frequency graph 151290 shows frequency modulation of two RF signals nested. As mentioned above, the two RF signals can be nested before reaching the RF electrodes at the end effector. For example, an RF signal withfrequency 1 and an RF signal withfrequency 2 can be nested together. Referring now to FIG. 42, the resulting nested RF signal is shown in afrequency plot 151300. The composite signal shown infrequency graph 151300 includes the two RF signals ofcomposite frequency graph 151290. Referring now to FIG. 43, afrequency graph 151400 is shown.Frequency graph 151400 shows the RFsignal having frequency 1 andfrequency 2 after being filtered (by, eg, filters 151268 and 151270). The resulting RF signal can be used for a separate impedance calculation or measurement on the return path, as described above.

在一个方面，滤波器151268和151270可以是高Q滤波器，使得滤波器范围可以是窄的(例如，Q＝10)。Q可以由中心频率(Wo)/带宽(BW)限定，其中Q＝Wo/BW。在一个示例中，频率1可以是150kHz，并且频率2可以是300kHz。可行的阻抗测量范围可以是100kHz-20MHz。在各种示例中，可使用诸如相关、正交检测等的其它复杂技术来分离RF信号。In one aspect, filters 151268 and 151270 can be high-Q filters such that the filter range can be narrow (eg, Q=10). Q may be defined by center frequency (Wo)/bandwidth (BW), where Q=Wo/BW. In one example,frequency 1 may be 150 kHz andfrequency 2 may be 300 kHz. A feasible impedance measurement range can be 100kHz-20MHz. In various examples, other complex techniques such as correlation, quadrature detection, etc. may be used to separate the RF signals.

使用本文描述的一种或多种技术和特征，钉仓上的单个通电电极或端部执行器的隔离刀可用于同时进行多个组织压缩测量。如果两个或更多个RF信号被叠加或多路复用(或嵌套或调制)，则它们可以在端部执行器的单个功率侧向下传输，并且可以在通道框架或端部执行器的砧座上返回。如果在砧座和通道触点接合到公共返回路径之前将过滤器构建到砧座和通道触点中，则可以区分由两个路径表示的组织阻抗。这可以提供垂直组织与侧向组织压缩的量度。这种方法还可根据过滤器的放置和金属回路的位置来提供近侧和远侧组织压缩。频率发生器和信号处理器可以位于电路板或子板(可能已经存在于外科缝合器中)上的一个或多个芯片上。Using one or more of the techniques and features described herein, a single energized electrode on a staple cartridge or an isolated blade of an end effector can be used to perform multiple tissue compression measurements simultaneously. If two or more RF signals are superimposed or multiplexed (or nested or modulated), they can be transmitted down a single power side of the end effector and can be transmitted at the channel frame or end effector return on the anvil. If the filter is built into the anvil and channel contacts before they engage in a common return path, the tissue impedance represented by the two paths can be distinguished. This can provide a measure of vertical versus lateral tissue compression. This approach can also provide proximal and distal tissue compression depending on the placement of the filter and the location of the metal loop. The frequency generator and signal processor may be located on one or more chips on a circuit board or daughter board (which may already be present in the surgical stapler).

在一个方面，本公开提供了被配置成具有各种感测系统的器械150010(结合图25至图30所述)。因此，为方便和清楚起见，此处将不重复对操作和构造的细节。在一个方面，感测系统包括粘弹性/变化率感测系统，以监测刀加速度、阻抗变化率和组织接触变化率。在一个示例中，刀加速度的变化率可以用作组织类型的量度。在另一个示例中，阻抗的变化率可以用脉冲传感器测量，并且可以用作可压缩性的量度。最后，可利用基于刀击发率的传感器来测量组织接触变化率以测量组织流动。In one aspect, the present disclosure provides instrument 150010 (described in conjunction with FIGS. 25-30 ) configured with various sensing systems. Therefore, for the sake of convenience and clarity, details of operation and construction will not be repeated here. In one aspect, the sensing system includes a viscoelastic/rate of change sensing system to monitor blade acceleration, rate of change of impedance, and rate of change of tissue contact. In one example, the rate of change of knife acceleration can be used as a measure of tissue type. In another example, the rate of change of impedance can be measured with a pulse sensor and can be used as a measure of compressibility. Finally, the rate of change in tissue contact can be measured using a blade firing rate based sensor to measure tissue flow.

感测参数的变化率或另外说明的是，组织参数达到渐近稳态值需要多长时间，其本身是单独的测量，并且可能比其衍生的感测参数更有价值。为了增强组织参数的测量，诸如在进行测量之前等待预先确定量的时间，本公开提供了一种用于采用该测量衍生的新颖技术，诸如组织参数的变化率。The rate of change of the sensed parameter, or otherwise, how long it takes for the tissue parameter to reach an asymptotic steady-state value, is a separate measure in itself and may be more valuable than the sensed parameter from which it is derived. To enhance the measurement of tissue parameters, such as waiting a predetermined amount of time before taking a measurement, the present disclosure provides a novel technique for employing the measurements derived, such as the rate of change of tissue parameters.

衍生技术或变化率测量变得最有用，应理解，不存在单独的测量可以单独采用以显著改善钉形成。多种测量的组合使测量有效。在组织间隙的情况下，了解有多少钳口被组织覆盖以使间隙测量相关是有帮助的。阻抗的变化率测量可以与砧座中的应变测量结合，以将施加到抓握于端部执行器的钳口构件(诸如砧座和钉仓)之间的组织的力和压力相关联。内窥镜外科装置可以采用变化率测量来确定组织类型而不仅仅是组织压缩。虽然胃和肺组织有时具有相似的厚度，甚至在肺组织钙化时具有相似的压缩特性，但是器械可以通过采用诸如间隙、压缩、施加的力、组织接触区域、压缩变化率或间隙变化率的测量的组合来区分这些组织类型。如果单独使用这些测量结果中的任何一个，则内窥镜外科装置可能难以将一种组织类型与另一种组织类型区分开来。压缩变化率也可能有助于使装置确定组织是否“正常”或是否存在某些异常。不仅要测量已经过了多少时间，而且要测量传感器信号的变化并确定信号的衍生将提供另一种测量以使得内窥镜外科装置能够测量信号。还可以采用变化率信息来确定何时达到稳态以发信号通知过程中的下一步骤。例如，在将组织抓握在端部执行器(诸如砧座和钉仓)的钳口构件之间之后，当组织压缩达到稳态(例如，大约15秒)时，开始击发装置的指示器或触发器可以被启用。Derivative techniques or rate-of-change measurements become most useful, it being understood that there are no separate measurements that can be taken alone to significantly improve nail formation. The combination of multiple measurements makes the measurement effective. In the case of tissue gaps, it is helpful to know how many jaws are covered by tissue to correlate gap measurements. The rate-of-change measurements of impedance can be combined with strain measurements in the anvil to correlate forces and pressures applied to tissue grasped between the jaw members of the end effector, such as the anvil and the staple cartridge. Endoscopic surgical devices can employ rate-of-change measurements to determine tissue type rather than just tissue compression. Although stomach and lung tissue sometimes have similar thicknesses, and even have similar compression properties when lung tissue is calcified, instruments can be combination to distinguish these tissue types. If any of these measurements are used alone, endoscopic surgical devices may have difficulty distinguishing one tissue type from another. The rate of change in compression may also help the device to determine if the tissue is "normal" or if there is some abnormality. Not only measuring how much time has passed, but measuring the change in the sensor signal and determining the derivation of the signal will provide another measure to enable the endoscopic surgical device to measure the signal. The rate of change information can also be employed to determine when steady state is reached to signal the next step in the process. For example, after grasping tissue between the jaw members of an end effector (such as an anvil and a staple cartridge), when tissue compression reaches a steady state (eg, about 15 seconds), start firing the device's indicator or Triggers can be enabled.

本文还提供了用于对传感器数据进行时间依赖性评估以确定外科器械操作期间组织的稳定性、蠕变和粘弹性特征的方法、装置和系统。外科器械，诸如图25中所示的缝合器，可以包括用于测量操作参数(诸如钳口间隙尺寸或距离、击发电流、组织压缩、被组织覆盖的钳口的量、砧座应变和触发力等等)的各种传感器。这些感测的测量对于外科器械的自动控制和向临床医生提供反馈是重要的。Also provided herein are methods, devices, and systems for time-dependent evaluation of sensor data to determine stability, creep, and viscoelastic characteristics of tissue during surgical instrument manipulation. Surgical instruments, such as the stapler shown in FIG. 25, may include tools for measuring operating parameters such as jaw gap size or distance, firing current, tissue compression, amount of jaws covered by tissue, anvil strain, and trigger force. etc.) of various sensors. These sensed measurements are important for automatic control of surgical instruments and for providing feedback to clinicians.

可以采用结合图30至图49示出的示例来测量各种衍生的参数，诸如间隙距离与时间、组织压缩与时间、以及砧座应变与时间。可采用与电池2308串联的电流传感器监测马达电流。Various derived parameters, such as gap distance versus time, tissue compression versus time, and anvil strain versus time, may be measured using the examples shown in conjunction with FIGS. 30-49 . Motor current can be monitored using a current sensor in series with battery 2308.

现在转到图44，其描绘了可重复使用或可不重复使用的马达驱动外科切割和紧固器械151310。马达驱动外科切割和紧固器械151310被类似地构造和配备为结合图25至图30所述的马达驱动外科切割和紧固器械150010。在图44所示示例中，器械151310包括外壳151312，该外壳包括被构造成能够由临床医生抓持、操纵并致动的柄部组件151314。外壳151312被构造用于可操作地附接到可互换轴组件151500，该可互换轴组件具有可操作地联接到其的外科端部执行器151600，该外科端部执行器被构造成能够执行一种或多种外科任务或外科手术。由于马达驱动外科切割和紧固器械151310被类似地构造和配备为结合图25至图30所述的马达驱动外科切割和紧固器械150010，为方便和清楚起见，此处将不重复对操作和构造的细节。Turning now to FIG. 44, a motor-driven surgical cutting andfastening instrument 151310, which may or may not be reusable, is depicted. The motor-driven surgical cutting andfastening instrument 151310 is similarly constructed and equipped as the motor-driven surgical cutting andfastening instrument 150010 described in connection with FIGS. 25-30 . In the example shown in Figure 44, theinstrument 151310 includes ahousing 151312 that includes ahandle assembly 151314 that is configured to be grasped, manipulated, and actuated by a clinician.Housing 151312 is configured for operative attachment to aninterchangeable shaft assembly 151500 having a surgical end effector 151600 operably coupled thereto that is configured to enable Perform one or more surgical tasks or surgical procedures. Since the motor-driven surgical cutting andfastening instrument 151310 is similarly constructed and equipped as the motor-driven surgical cutting andfastening instrument 150010 described in connection with FIGS. 25-30, for the sake of convenience and clarity, the descriptions of operations and procedures will not be repeated here. Construction details.

图44描绘的外壳151312结合可互换轴组件151500示出，该可互换轴组件包括端部执行器151600，该端部执行器包括被构造成能够在其中可操作地支撑外科钉仓151304的外科切割和紧固装置。外壳151312可被配置用于与可互换轴组件结合使用，该可互换轴组件包括端部执行器，该端部执行器适于支撑不同尺寸和类型的钉仓，具有不同的轴长度、尺寸和类型等。另外，外壳151312还可有效地用于多种其他可互换轴组件，其包括被构造成能够将其他运动和形式的能量(诸如射频(RF)能量、超声能量和/或运动)施加到适合与各种外科应用和规程结合使用的端部执行器布置的那些组件。此外，该端部执行器、轴组件、柄部、外科器械和/或外科器械系统可利用任意合适的紧固件来紧固组织。例如，包括可移除地被存储在其中的多个紧固件的紧固件仓能够可移除地插入轴组件的端部执行器中和/或附接到轴组件的端部执行器。Thehousing 151312 depicted in FIG. 44 is shown in conjunction with aninterchangeable shaft assembly 151500 that includes an end effector 151600 including a surgicalstaple cartridge 151304 configured to operably support therein Surgical cutting and fastening device. Thehousing 151312 can be configured for use in conjunction with an interchangeable shaft assembly that includes an end effector adapted to support different sizes and types of staple cartridges with different shaft lengths, size and type, etc. Additionally, thehousing 151312 is also effective for use with a variety of other interchangeable shaft assemblies, including those configured to enable application of other motions and forms of energy, such as radio frequency (RF) energy, ultrasonic energy, and/or motion, to a suitable Those components of end effector arrangements used in connection with various surgical applications and procedures. Additionally, the end effector, shaft assembly, handle, surgical instrument, and/or surgical instrument system may utilize any suitable fasteners to secure tissue. For example, a fastener cartridge including a plurality of fasteners removably stored therein can be removably inserted into and/or attached to the end effector of the shaft assembly.

图44示出了可互换轴组件151500可操作地联接到其的外科器械151310。在示出的布置中，柄部外壳形成可被临床医生抓持和操纵的手枪式握把部151319。柄部组件151314在其中可操作地支撑多个驱动系统，该多个驱动系统被构造成能够生成各种控制运动并将各种控制运动施加到可操作地附接到其的可互换轴组件的对应部分。触发器151332可操作地与手枪式握把部相关联，用于控制各种这些控制运动。Figure 44 shows thesurgical instrument 151310 to which theinterchangeable shaft assembly 151500 is operably coupled. In the arrangement shown, the handle housing forms apistol grip portion 151319 that can be grasped and manipulated by the clinician. Thehandle assembly 151314 operably supports therein a plurality of drive systems configured to generate and apply various control motions to an interchangeable shaft assembly operably attached thereto the corresponding part of .Trigger 151332 is operably associated with the pistol grip portion for controlling various of these control movements.

继续参见图44，可互换轴组件151500包括外科端部执行器151600，该外科端部执行器包括被构造成能够在其中可操作地支撑钉仓151304的细长通道151302。端部执行器151600还可包括砧座151306，该砧座相对于细长通道151302被枢转地支撑。44, theinterchangeable shaft assembly 151500 includes a surgical end effector 151600 that includes anelongated channel 151302 configured to operably support astaple cartridge 151304 therein. The end effector 151600 may also include ananvil 151306 that is pivotally supported relative to theelongated channel 151302.

本发明人已经发现，对于控制外科器械(诸如图44中所示的器械)，衍生参数甚至可比衍生参数所基于的一个或多个感测参数更有用。衍生参数的非限制性示例包括感测参数的变化率(例如，钳口间隙距离)以及在组织参数达到渐近稳态值(例如，15秒)之前经过的时间长度。衍生参数(诸如变化率)特别有用，因为它们显著提高了测量精度，并且还提供了直接来自感测参数的信息。例如，阻抗(即，组织压缩)变化率可以与砧座中的应变组合，以将压缩和力相关联，这使得微控制器能够确定组织类型而不仅仅是组织压缩量。该示例仅是示例性的，并且任何衍生参数可以与一个或多个感测参数组合，以提供关于组织类型(例如，胃与肺)、组织健康(钙化与正常)和外科装置操作状态的更准确信息(例如，夹持完成)。不同的组织具有独特的粘弹性和独特的变化率，使得本文讨论的这些和其它参数成为用于监测和自动调节外科手术的有用标记。The inventors have discovered that for controlling a surgical instrument, such as the instrument shown in Figure 44, derived parameters can be even more useful than one or more sensed parameters on which the derived parameters are based. Non-limiting examples of derived parameters include the rate of change of the sensed parameter (eg, jaw gap distance) and the length of time that elapses before the tissue parameter reaches an asymptotic steady-state value (eg, 15 seconds). Derived parameters such as rate of change are particularly useful because they significantly improve measurement accuracy and also provide information directly from the sensed parameter. For example, the rate of change in impedance (ie, tissue compression) can be combined with strain in the anvil to correlate compression and force, which enables the microcontroller to determine tissue type rather than just the amount of tissue compression. This example is exemplary only, and any derived parameter can be combined with one or more sensed parameters to provide more information about tissue type (eg, stomach vs. lung), tissue health (calcified vs. normal), and surgical device operating status. Accurate information (eg clamping completed). Different tissues have unique viscoelastic properties and unique rates of change, making these and other parameters discussed herein useful markers for monitoring and self-adjusting surgical procedures.

图46为示出间隙距离随时间变化的示例性曲线图，其中间隙是由被夹持组织占据的钳口之间的间隔。垂直(y)轴为距离，并且水平(x)轴为时间。具体地，参见图44和图45，间隙距离151340是端部执行器的砧座151306与细长通道151302之间的距离。在打开钳口位置，在时间零点，砧座151306与细长构件之间的间隙151340处于其最大距离。间隙151340的宽度随砧座151306的闭合而减小，诸如在组织夹持期间。间隙距离变化率可以变化，因为组织具有不均匀的弹性。例如，某些组织类型最初可能显示出快速压缩，从而导致更快的变化速率。然而，随着组织被连续压缩，组织的粘弹性可导致变化率降低，直到组织不能被进一步压缩，此时间隙距离将保持基本恒定。随着组织在端部执行器151340的砧座151306和钉仓151304之间被挤压，间隙随时间变化而减小。结合图31至图43描述的一个或多个传感器，诸如磁场传感器、应变仪、压力传感器、力传感器、电感式传感器(诸如，涡流传感器)、电阻式传感器、电容式传感器、光学传感器和/或任何其他合适的传感器可被适配和配置成能够测量砧座151306与钉仓151304之间的随时间“t”变化的间隙距离“d”，如图46中以图形方式表示。间隙距离“d”随时间“t”的变化率是图46所示曲线的斜率，其中斜率＝Δd/Δt。FIG. 46 is an exemplary graph showing gap distance versus time, where the gap is the spacing between jaws occupied by the clamped tissue. The vertical (y) axis is distance and the horizontal (x) axis is time. Specifically, referring to Figures 44 and 45, theclearance distance 151340 is the distance between theanvil 151306 of the end effector and theelongated channel 151302. In the open jaw position, at time zero, thegap 151340 between theanvil 151306 and the elongated member is at its maximum distance. The width of thegap 151340 decreases as theanvil 151306 is closed, such as during tissue clamping. The rate of change in gap distance can vary because tissue has non-uniform elasticity. For example, certain tissue types may initially show rapid compression, resulting in a faster rate of change. However, as the tissue is continuously compressed, the viscoelastic properties of the tissue can cause the rate of change to decrease until the tissue cannot be compressed further, at which point the gap distance will remain substantially constant. The gap decreases over time as tissue is squeezed between theanvil 151306 of theend effector 151340 and thestaple cartridge 151304. One or more of the sensors described in connection with FIGS. 31-43 , such as magnetic field sensors, strain gauges, pressure sensors, force sensors, inductive sensors (such as eddy current sensors), resistive sensors, capacitive sensors, optical sensors, and/or Any other suitable sensor may be adapted and configured to measure the gap distance "d" between theanvil 151306 and thestaple cartridge 151304 as a function of time "t", as graphically represented in FIG. 46 . The rate of change of gap distance "d" with time "t" is the slope of the curve shown in Figure 46, where slope = Δd/Δt.

图47为示出端部执行器钳口的击发电流的示例性曲线图。垂直(y)轴为电流，并且水平(x)轴为时间。如本文所述，如结合图25所示和所述，外科器械和/或其微控制器可包括电流传感器，该电流传感器检测在各种操作(诸如夹持、切割和/或缝合组织)期间利用的电流。例如，当组织电阻增加时，器械的电动马达可能需要更多的电流来夹持、切割和/或缝合组织。类似地，如果电阻较低，则电动马达可需要较少的电流来夹持、切割和/或缝合组织。因此，击发电流可被用作组织电阻的近似值。感测到的电流可单独使用或更优选地与其他测量结果结合使用，以提供关于靶组织的反馈。仍然参见图47，在一些操作(诸如缝合)期间，击发电流最初在时间零点较高，但随时间变化而减小。在其他装置操作期间，如果马达消耗更多电流以克服逐渐增加的机械负载，则电流可随时间变化而增加。此外，击发电流的变化率可用作组织从一种状态向另一状态转变的指示器。因此，击发电流，特别是击发电流的变化率可用于监测装置操作。当刀切穿组织时，击发电流随时间变化而降低。如果正被切割的组织由于组织特性或刀151305(图45)的锐度而提供更多或更少的电阻，则击发电流的变化率可变化。当切割条件变化时，马达所做的功变化，因此将随时间变化而改变击发电流。当刀151305正在击发时，可采用电流传感器来测量随时间变化的击发电流，如图47中以图形方式表示。例如，可采用电流传感器监测马达电流。电流传感器可被适配和配置成能够测量随时间“t”变化的马达击发电流“i”，如图47中以图形方式表示。击发电流“i”随时间“t”的变化率是图47所示曲线的斜率，其中斜率＝Δi/Δt。47 is an exemplary graph showing firing current of an end effector jaw. The vertical (y) axis is current and the horizontal (x) axis is time. As described herein, as shown and described in connection with FIG. 25, the surgical instrument and/or its microcontroller may include a current sensor that detects during various operations, such as clamping, cutting, and/or stapling tissue current used. For example, as the resistance of the tissue increases, the electric motor of the instrument may require more current to grip, cut and/or staple the tissue. Similarly, if the resistance is lower, the electric motor may require less current to clamp, cut, and/or staple tissue. Therefore, the firing current can be used as an approximation of tissue resistance. The sensed current can be used alone or, more preferably, in combination with other measurements to provide feedback about the target tissue. Still referring to Figure 47, during some operations, such as suturing, the firing current is initially high at time zero, but decreases over time. During operation of other devices, the current may increase over time if the motor draws more current to overcome the increasing mechanical load. In addition, the rate of change of firing current can be used as an indicator of tissue transition from one state to another. Therefore, the firing current, especially the rate of change of the firing current, can be used to monitor device operation. As the knife cuts through tissue, the firing current decreases over time. The rate of change of firing current may vary if the tissue being cut provides more or less resistance due to tissue properties or the sharpness of the knife 151305 (FIG. 45). When the cutting conditions change, the work done by the motor changes and therefore will change the firing current over time. While theblade 151305 is firing, a current sensor may be employed to measure the firing current over time, as graphically represented in FIG. 47 . For example, a current sensor may be used to monitor motor current. The current sensor may be adapted and configured to measure the motor firing current "i" as a function of time "t", as graphically represented in FIG. 47 . The rate of change of firing current "i" with time "t" is the slope of the curve shown in Figure 47, where slope = Δi/Δt.

图48为阻抗随时间变化的示例性曲线图。垂直(y)轴为阻抗，并且水平(x)轴为时间。在时间零点阻抗较低，但阻抗随着组织压力在操纵(例如，夹持和缝合)下增加而随时间增加。变化率随时间变化，因为端部执行器151340的砧座151306和钉仓151304之间的组织被刀切断或使用位于端部执行器151340的砧座151306和钉仓151304之间的电极之间的RF能量密封。例如，随着组织被切割，电阻抗增加，并且当组织被刀完全切断时，电阻抗达到无穷大。另外，如果端部执行器151340包括联接到RF能量源的电极，则随着能量通过端部执行器151340的砧座151306和钉仓151304之间的组织递送，组织的电阻抗增加。随着通过组织的能量通过蒸发组织中的水分而干燥组织，电阻抗增加。最终，当将合适量的能量递送到组织时，阻抗在组织被切断时增加到非常高的值或无穷大。此外，如图48所示，不同的组织可具有区分组织的独特的压缩特性，诸如压缩速率。可通过驱动亚治疗射频电流通过抓持在第一钳口构件9014和第二钳口构件9016之间的组织来测量组织阻抗。一个或多个电极可定位在砧座151306和钉仓151304中的任一者或两者上。可测量砧座151306与钉仓151304之间的组织的随时间变化的组织压缩/阻抗，如图48中以图形方式表示。结合图31至图43所述的传感器，诸如磁场传感器、应变仪、压力传感器、力传感器、电感式传感器(诸如，涡流传感器)、电阻式传感器、电容式传感器、光学传感器和/或任何其他合适的传感器可被适配和配置成能够测量组织压缩/阻抗。传感器可被适配和配置成能够测量随时间“t”变化的组织阻抗“Z”，如图48中以图形方式表示的。48 is an exemplary graph of impedance versus time. The vertical (y) axis is impedance and the horizontal (x) axis is time. Impedance is low at time zero, but increases over time as tissue pressure increases under manipulation (eg, clamping and suturing). The rate of change varies over time as the tissue between theanvil 151306 of theend effector 151340 and thestaple cartridge 151304 is severed by the knife or using the electrode located between theanvil 151306 of theend effector 151340 and the staple cartridge RF energy sealed. For example, as the tissue is cut, the electrical impedance increases, and when the tissue is completely cut by the knife, the electrical impedance reaches infinity. Additionally, if theend effector 151340 includes electrodes coupled to a source of RF energy, as energy is delivered through the tissue between theanvil 151306 and thestaple cartridge 151304 of theend effector 151340, the electrical impedance of the tissue increases. The electrical impedance increases as the energy passing through the tissue dries the tissue by evaporating the water in the tissue. Ultimately, when the appropriate amount of energy is delivered to the tissue, the impedance increases to a very high value or infinity as the tissue is severed. Furthermore, as shown in Figure 48, different tissues may have unique compression characteristics, such as compression rates, that differentiate the tissues. Tissue impedance can be measured by driving a sub-therapeutic radio frequency current through the tissue grasped between the first jaw member 9014 and the second jaw member 9016. One or more electrodes can be positioned on either or both of theanvil 151306 and thestaple cartridge 151304. Time-varying tissue compression/impedance of the tissue between theanvil 151306 and thestaple cartridge 151304 can be measured, as graphically represented in FIG. 48 . Sensors such as magnetic field sensors, strain gauges, pressure sensors, force sensors, inductive sensors (such as eddy current sensors), resistive sensors, capacitive sensors, optical sensors, and/or any other suitable sensor described in connection with FIGS. 31-43 The sensors can be adapted and configured to measure tissue compression/impedance. The sensor may be adapted and configured to measure tissue impedance "Z" as a function of time "t", as graphically represented in FIG. 48 .

图49是砧座151306(图44、图45)应变随时间变化的示例性曲线。垂直(y)轴为应变，并且水平(x)轴为时间。在缝合期间，例如，砧座151306应变初始较高，但随着组织达到稳态而减小，并且对砧座151306施加较小的压力。砧座151306应变的变化率可由定位在砧座151306和钉仓151304(图44、图45)中的任一者或两者上的压力传感器或应变仪测量，以测量施加到抓持在砧座151306和钉仓151304之间的组织的压力或应变。可测量随时间变化的砧座151306应变，如图49中以图形方式表示。应变“S”随时间“t”的变化率是图49所示曲线的斜率，其中斜率＝ΔS/Δt。49 is an exemplary plot of strain versus time for anvil 151306 (FIGS. 44, 45). The vertical (y) axis is strain and the horizontal (x) axis is time. During stapling, for example, theanvil 151306 strain is initially high, but decreases as the tissue reaches steady state, and less pressure is applied to theanvil 151306. The rate of change of the strain of theanvil 151306 may be measured by pressure sensors or strain gauges positioned on either or both of theanvil 151306 and the staple cartridge 151304 (FIGS. 44, 45) to measure the amount of strain applied to gripping the anvil Compression or strain of tissue between 151306 andstaple cartridge 151304.Anvil 151306 strain can be measured as a function of time, as graphically represented in FIG. 49 . The rate of change of strain "S" with time "t" is the slope of the curve shown in Figure 49, where slope = ΔS/Δt.

图50是触发力随时间变化的示例性曲线图。垂直(y)轴为触发力，并且水平(x)轴为时间。在某些示例中，触发力是渐进的，以向临床医生提供触觉反馈。因此，在时间零点，触发器151320(图44)压力可处于其最低处，并且触发器压力可增加，直到完成操作(例如，夹持、切割或缝合)。可通过定位在器械151310(图44)的柄部151319的触发器151302上的压力传感器或应变仪测量触发力的变化率，以测量驱动刀151305(图45)通过抓持在砧座151306和钉仓151304之间的组织所需的力。可测量触发器151332的随时间变化的力，如图50中以图形方式表示。应变触发力“F”随时间“t”的变化率为图50所示曲线的斜率，其中斜率＝ΔF/Δt。50 is an exemplary graph of trigger force versus time. The vertical (y) axis is trigger force, and the horizontal (x) axis is time. In some examples, the trigger force is progressive to provide haptic feedback to the clinician. Thus, at time zero, trigger 151320 (FIG. 44) pressure can be at its lowest point, and trigger pressure can be increased until the operation (eg, clamping, cutting, or stapling) is complete. The rate of change in trigger force can be measured by a pressure sensor or strain gauge positioned on thetrigger 151302 of thehandle 151319 of the instrument 151310 (FIG. 44) to measure the drive knife 151305 (FIG. 45) by gripping theanvil 151306 and the staples The force required for the tissue between thebins 151304. The force over time of thetrigger 151332 can be measured, as graphically represented in FIG. 50 . The rate of change of strain trigger force "F" over time "t" is the slope of the curve shown in Figure 50, where slope = ΔF/Δt.

例如，即使胃和肺组织可具有类似的厚度，这些组织也可被区分，并且如果肺组织钙化，这些组织可具有类似的压缩特性。可通过分析钳口间隙距离、组织压缩、所施加的力、组织接触面积、压缩变化率和钳口间隙变化率来区分胃和肺组织。例如，图51示出了组织压力“P”随着各种组织的组织位移变化的曲线图。垂直(y)轴为组织压力，并且水平(x)轴为组织位移。当组织压力达到预先确定的阈值(诸如50磅每平方英寸至100磅每平方英寸(psi))时，可使用组织位移量以及组织位移在达到阈值之前的速率来区分组织。例如，血管组织以比结肠、肺或胃组织更小的组织位移和更快的变化速率达到预先确定的压力阈值。此外，血管组织的变化率(组织压力除以位移)在50psi至100psi的阈值下几乎渐近，而结肠、肺和胃的变化率在50psi至100psi的阈值下不是渐近的。应当理解，可使用任何压力阈值，诸如介于1psi和1000psi之间，更优选地介于10psi和500psi之间，并且还更优选地介于50psi和100psi之间。此外，可使用多个阈值或渐进式阈值来提供具有类似粘弹性的组织类型的进一步分辨率。For example, stomach and lung tissue can be differentiated even though they can have similar thicknesses, and if lung tissue is calcified, these tissues can have similar compressive properties. Stomach and lung tissue can be differentiated by analyzing jaw gap distance, tissue compression, applied force, tissue contact area, rate of change in compression, and rate of change in jaw gap. For example, Figure 51 shows a graph of tissue pressure "P" as a function of tissue displacement for various tissues. The vertical (y) axis is tissue pressure and the horizontal (x) axis is tissue displacement. When tissue pressure reaches a predetermined threshold, such as 50 pounds per square inch to 100 pounds per square inch (psi), the amount of tissue displacement and the rate at which the tissue is displaced prior to reaching the threshold can be used to differentiate tissue. For example, vascular tissue reaches a predetermined pressure threshold with less tissue displacement and a faster rate of change than colon, lung, or stomach tissue. Furthermore, the rate of change of vascular tissue (tissue pressure divided by displacement) was nearly asymptotic at the threshold of 50 psi to 100 psi, whereas the rate of change of colon, lung and stomach was not asymptotic at the threshold of 50 psi to 100 psi. It should be understood that any pressure threshold may be used, such as between 1 psi and 1000 psi, more preferably between 10 psi and 500 psi, and still more preferably between 50 psi and 100 psi. Additionally, multiple thresholds or progressive thresholds can be used to provide further resolution of tissue types with similar viscoelastic properties.

压缩变化率还可使微控制器能够确定组织是否“正常”或是否存在一些异常，诸如钙化。例如，参见图52，钙化肺组织的压缩遵循与正常肺组织的压缩不同的曲线。因此，组织位移和组织位移的变化率可用于诊断和/或区分钙化肺组织与正常肺组织。The rate of change in compression also enables the microcontroller to determine if the tissue is "normal" or if there is some abnormality, such as calcification. For example, see Figure 52, compression of calcified lung tissue follows a different curve than compression of normal lung tissue. Therefore, tissue displacement and the rate of change in tissue displacement can be used to diagnose and/or differentiate calcified lung tissue from normal lung tissue.

此外，某些感测到的测量结果可受益于附加的感官输入。例如，就钳口间隙而言，知道有多少钳口被组织覆盖可使间隙测量结果更有用且更准确。如果钳口的一小部分覆盖在组织中，则组织压缩可看起来小于整个钳口覆盖在组织中的情况。因此，当分析组织压缩和其他感测到的参数时，可由微控制器考虑钳口覆盖的量。Additionally, certain sensed measurements may benefit from additional sensory input. For example, in the case of jaw gap, knowing how many jaws are covered by tissue can make gap measurements more useful and accurate. If a small portion of the jaw is covered in tissue, tissue compression may appear less than if the entire jaw is covered in tissue. Thus, the amount of jaw coverage can be taken into account by the microcontroller when analyzing tissue compression and other sensed parameters.

在某些情况下，实耗时间也可为重要参数。测量经过了多少时间，连同感测到的参数和导数参数(例如，变化率)，提供了更有用的信息。例如，如果钳口间隙变化率在设定的时间段(例如，5秒)之后保持恒定，则参数可能已经达到其渐近值。In some cases, elapsed time can also be an important parameter. Measuring how much time has elapsed, along with sensed parameters and derivative parameters (eg, rate of change), provides more useful information. For example, if the jaw gap change rate remains constant after a set period of time (eg, 5 seconds), the parameter may have reached its asymptotic value.

变化率信息对于确定何时达到稳态从而发信号通知过程中的下一步骤而言也是有用的。例如，在夹持期间，当组织压缩达到稳定状态(例如，在设定的时间段之后不发生显著的变化速率)时，微控制器可向显示器发送信号，从而警示临床医生开始手术中的下一个步骤，诸如钉击发。另选地，微控制器可被编程为一旦达到稳态就自动开始下一个手术阶段(例如，钉击发)。The rate of change information is also useful for determining when steady state is reached to signal the next step in the process. For example, during clamping, when tissue compression reaches a steady state (eg, no significant rate of change occurs after a set period of time), the microcontroller may send a signal to the display, alerting the clinician to the initiation of an intraoperative lower A step such as nail firing. Alternatively, the microcontroller can be programmed to automatically begin the next surgical phase (eg, staple firing) once steady state is reached.

类似地，阻抗变化率可与砧座中的应变组合，以将力和压缩相关联。变化率将允许装置确定组织类型而不是仅测量压缩值。例如，如果肺钙化，则胃和肺有时具有类似的厚度，并且甚至具有类似的压缩特性。Similarly, the rate of resistance change can be combined with the strain in the anvil to correlate force and compression. The rate of change will allow the device to determine tissue type rather than just measure compression values. For example, if the lungs are calcified, the stomach and lungs sometimes have similar thicknesses and even similar compression properties.

一个或多个感测到的参数与导出的参数的组合提供了对组织类型和组织健康的更可靠和准确的评估，并且允许更好的装置监测、控制和临床医生反馈。The combination of one or more sensed parameters and derived parameters provides a more reliable and accurate assessment of tissue type and tissue health, and allows for better device monitoring, control, and clinician feedback.

图53示出了包括第一传感器152008a和第二传感器152008b的端部执行器152000的一个实施方案。端部执行器152000类似于上述端部执行器150300。端部执行器152000包括枢转地联接到第二钳口构件152004的第一钳口构件或砧座152002。第二钳口构件152004被构造成能够在其中接纳钉仓152006。钉仓152006包括多个钉(未示出)。该多个钉可在外科手术期间从钉仓152006部署。端部执行器152000包括第一传感器152008a。第一传感器152008a被配置成能够测量端部执行器152000的一个或多个参数。例如，在一个实施方案中，第一传感器152008a被配置成能够测量砧座152002与第二钳口构件152004之间的间隙152010。第一传感器152008a可包括例如霍尔效应传感器，该霍尔效应传感器被配置成能够检测由嵌入第二钳口构件152004和/或钉仓152006中的磁体152012生成的磁场。又如，在一个实施方案中，第一传感器152008a被配置成能够测量由第二钳口构件152004和/或夹持在砧座152002和第二钳口构件152004之间的组织施加于砧座152002上的一个或多个力。Figure 53 shows one embodiment of anend effector 152000 that includes afirst sensor 152008a and asecond sensor 152008b. Theend effector 152000 is similar to theend effector 150300 described above. Theend effector 152000 includes a first jaw member oranvil 152002 pivotally coupled to asecond jaw member 152004. Thesecond jaw member 152004 is configured to receive a staple cartridge 152006 therein. The staple cartridge 152006 includes a plurality of staples (not shown). The plurality of staples can be deployed from staple cartridge 152006 during surgery. Theend effector 152000 includes afirst sensor 152008a. Thefirst sensor 152008a is configured to measure one or more parameters of theend effector 152000. For example, in one embodiment, thefirst sensor 152008a is configured to measure thegap 152010 between theanvil 152002 and thesecond jaw member 152004. Thefirst sensor 152008a may comprise, for example, a Hall effect sensor configured to detect the magnetic field generated by themagnets 152012 embedded in thesecond jaw member 152004 and/or the staple cartridge 152006. As another example, in one embodiment, thefirst sensor 152008a is configured to measure application of theanvil 152002 by thesecond jaw member 152004 and/or tissue clamped between theanvil 152002 and thesecond jaw member 152004 one or more forces on .

端部执行器152000包括第二传感器152008b。第二传感器152008b被配置成能够测量端部执行器152000的一个或多个参数。例如，在各种实施方案中，第二传感器152008b可包括应变仪，该应变仪被配置成能够测量夹持状态期间的砧座152002中的应变量值。应变仪提供电信号，该电信号的振幅随着应变量值而变化。在各种实施方案中，第一传感器152008a和/或第二传感器152008b可包括例如磁传感器(诸如霍尔效应传感器)、应变仪、压力传感器、力传感器、电感式传感器(诸如涡流传感器)、电阻式传感器、电容式传感器、光学传感器和/或用于测量端部执行器152000的一个或多个参数的任何其他合适的传感器。第一传感器152008a和第二传感器152008b可被布置成串联构型和/或并联构型。在串联构型中，第二传感器152008b可被配置成能够直接影响第一传感器152008a的输出。在并联构型中，第二传感器152008b可被配置成能够间接影响第一传感器152008a的输出。Theend effector 152000 includes asecond sensor 152008b. Thesecond sensor 152008b is configured to measure one or more parameters of theend effector 152000. For example, in various embodiments, thesecond sensor 152008b can include a strain gauge configured to measure the amount of strain in theanvil 152002 during the clamped state. A strain gauge provides an electrical signal whose amplitude varies with the value of the strain. In various embodiments, thefirst sensor 152008a and/or thesecond sensor 152008b may include, for example, magnetic sensors (such as Hall effect sensors), strain gauges, pressure sensors, force sensors, inductive sensors (such as eddy current sensors), resistance sensor, capacitive sensor, optical sensor, and/or any other suitable sensor for measuring one or more parameters of theend effector 152000. Thefirst sensor 152008a and thesecond sensor 152008b may be arranged in a series configuration and/or a parallel configuration. In the series configuration, thesecond sensor 152008b can be configured to directly affect the output of thefirst sensor 152008a. In the parallel configuration, thesecond sensor 152008b can be configured to indirectly affect the output of thefirst sensor 152008a.

在一个实施方案中，由第一传感器152008a测量的一个或多个参数与由第二传感器152008b测量的一个或多个参数相关。例如，在一个实施方案中，第一传感器152008a被配置成能够测量砧座152002与第二钳口构件152004之间的间隙152010。间隙152010表示夹持在砧座152002和钉仓152006之间的组织区段的厚度和/或可压缩性。第一传感器152008a可包括例如霍尔效应传感器，该霍尔效应传感器被配置成能够检测由联接到第二钳口构件152004和/或钉仓152006的磁体152012生成的磁场。单个位置处的测量精确地描述了经校正的组织的完全咬合的压缩组织厚度，但在组织的部分咬合设置在砧座152002与第二钳口构件152004之间时可提供不精确的结果。组织的部分咬合(近侧部分咬合或远侧部分咬合)改变砧座152002的夹持几何形状。In one embodiment, one or more parameters measured by thefirst sensor 152008a are related to one or more parameters measured by thesecond sensor 152008b. For example, in one embodiment, thefirst sensor 152008a is configured to measure thegap 152010 between theanvil 152002 and thesecond jaw member 152004. Thegap 152010 represents the thickness and/or compressibility of the tissue segment clamped between theanvil 152002 and the staple cartridge 152006. Thefirst sensor 152008a may comprise, for example, a Hall effect sensor configured to detect the magnetic field generated by themagnet 152012 coupled to thesecond jaw member 152004 and/or the staple cartridge 152006. Measurements at a single location accurately describe the corrected full occlusal compressed tissue thickness of tissue, but may provide inaccurate results when a partial occlusion of tissue is disposed between theanvil 152002 and thesecond jaw member 152004. Partial occlusion of tissue (proximal partial occlusion or distal partial occlusion) changes the gripping geometry of theanvil 152002.

在一些实施方案中，第二传感器152008b被配置成能够检测指示组织咬合类型(例如，完全咬合、部分近侧咬合和/或部分远侧咬合)的一个或多个参数。第二传感器152008b的测量结果可用于调节第一传感器152008a的测量结果以精确地表示近侧或远侧定位的部分咬合的真实压缩组织厚度。例如，在一个实施方案中，第二传感器152008b包括应变仪诸如微应变仪，该应变仪被配置成能够监测夹持状态期间的砧座中的应变振幅。砧座152002的应变振幅用于修改第一传感器152008a(例如，霍尔效应传感器)的输出，以精确地表示近侧或远侧定位的部分咬合的真实压缩组织厚度。可在夹持操作期间实时地测量第一传感器152008a和第二传感器152008b。实时测量结果允许基于时间的信息例如由主处理器(例如，处理器462(图12))进行分析，并且用于选择一个或多个算法和/或查找表，由此识别组织特性和夹持定位，以动态地调节组织厚度测量结果。In some embodiments, thesecond sensor 152008b is configured to detect one or more parameters indicative of a type of tissue occlusion (eg, full occlusion, partial proximal occlusion, and/or partial distal occlusion). The measurements from thesecond sensor 152008b can be used to adjust the measurements from thefirst sensor 152008a to accurately represent the true compressed tissue thickness of the proximally or distally positioned partial occlusion. For example, in one embodiment, thesecond sensor 152008b includes a strain gauge, such as a microstrain gauge, configured to monitor the strain amplitude in the anvil during the clamped state. The strain amplitude of theanvil 152002 is used to modify the output of thefirst sensor 152008a (eg, a Hall effect sensor) to accurately represent the true compressed tissue thickness of the proximally or distally positioned partial occlusion. Thefirst sensor 152008a and thesecond sensor 152008b can be measured in real time during the clamping operation. The real-time measurements allow time-based information to be analyzed, eg, by a host processor (eg, processor 462 (FIG. 12)), and used to select one or more algorithms and/or look-up tables, thereby identifying tissue characteristics and clamping Positioning to dynamically adjust tissue thickness measurements.

在一些实施方案中，可将第一传感器152008a的组织测量结果提供给联接到端部执行器152000的外科器械150010的输出装置。例如，在一个实施方案中，端部执行器152000联接到包括例如显示器(例如，显示器473(图12))的外科器械150010。将第一传感器152008a的测量结果提供给处理器，例如，主处理器。主处理器基于第二传感器152008b的测量结果调节第一传感器152008a的测量结果，以反映夹持在砧座152002与钉仓152006之间的组织区段的真实组织厚度。主处理器将调节的组织厚度测量结果和完全或部分咬合的指示输出到显示器。操作者可基于显示的值来确定是否部署钉仓152006中的钉。In some embodiments, the tissue measurements of thefirst sensor 152008a can be provided to an output device of thesurgical instrument 150010 coupled to theend effector 152000. For example, in one embodiment,end effector 152000 is coupled tosurgical instrument 150010 that includes, for example, a display (eg, display 473 (FIG. 12)). The measurements of thefirst sensor 152008a are provided to a processor, eg, a main processor. The main processor adjusts the measurements of thefirst sensor 152008a based on the measurements of thesecond sensor 152008b to reflect the true tissue thickness of the tissue segment clamped between theanvil 152002 and the staple cartridge 152006. The main processor outputs the adjusted tissue thickness measurement and an indication of full or partial occlusion to the display. The operator can determine whether to deploy the staples in the staple cartridge 152006 based on the displayed value.

在一些实施方案中，第一传感器152008a和第二传感器152008b可定位在不同的环境中，诸如第一传感器152008a定位在患者体内的治疗部位处并且第二传感器152008b定位在患者的外部。第二传感器152008b可被配置成能够校正和/或修改第一传感器152008a的输出。第一传感器152008a和/或第二传感器152008b可包括例如环境传感器。环境传感器可包括例如温度传感器、湿度传感器、压力传感器、和/或任何其它合适的环境传感器。In some embodiments, thefirst sensor 152008a and thesecond sensor 152008b can be positioned in different environments, such as thefirst sensor 152008a is positioned at the treatment site within the patient and thesecond sensor 152008b is positioned outside the patient. Thesecond sensor 152008b may be configured to correct and/or modify the output of thefirst sensor 152008a. Thefirst sensor 152008a and/or thesecond sensor 152008b may include, for example, environmental sensors. Environmental sensors may include, for example, temperature sensors, humidity sensors, pressure sensors, and/or any other suitable environmental sensors.

图54为示出了用于基于来自第二传感器152008b的输入来调节第一传感器152008a的测量结果的过程152020的一个实施方案的逻辑图。通过第一传感器152008a捕集第一信号152022a。可基于一个或多个预先确定的参数(诸如，平滑函数、查找表和/或任何其他合适的调节参数)调节第一信号152022a。通过第二传感器152008b捕集第二信号152022b。可基于一个或多个预先确定的调节参数调节第二信号152022b。将第一信号152022a和第二信号152022b提供给处理器，诸如主处理器。处理器基于来自第二传感器的第二信号152022b调节由第一信号152022a表示的第一传感器152008a的测量结果。例如，在一个实施方案中，第一传感器152008a包括霍尔效应传感器并且第二传感器152008b包括应变仪。通过由第二传感器152008b测量的应变振幅调节第一传感器152008a的距离测量结果，以确定端部执行器152000中的组织咬合的完全性。将调节的测量结果通过例如嵌入在外科器械150010中的显示器显示152026给操作者。Figure 54 is a logic diagram illustrating one embodiment of aprocess 152020 for adjusting measurements from afirst sensor 152008a based on input from asecond sensor 152008b. Thefirst signal 152022a is captured by thefirst sensor 152008a. Thefirst signal 152022a may be adjusted based on one or more predetermined parameters, such as smoothing functions, look-up tables, and/or any other suitable adjustment parameters. Thesecond signal 152022b is captured by thesecond sensor 152008b. Thesecond signal 152022b may be adjusted based on one or more predetermined adjustment parameters. Thefirst signal 152022a and thesecond signal 152022b are provided to a processor, such as a main processor. The processor adjusts the measurement of thefirst sensor 152008a represented by thefirst signal 152022a based on thesecond signal 152022b from the second sensor. For example, in one embodiment, thefirst sensor 152008a includes a Hall effect sensor and thesecond sensor 152008b includes a strain gauge. The distance measurement of thefirst sensor 152008a is adjusted by the strain amplitude measured by thesecond sensor 152008b to determine the completeness of the tissue occlusion in theend effector 152000. The adjusted measurements are displayed 152026 to the operator via, for example, a display embedded in thesurgical instrument 150010.

图55为示出了用于基于来自第二传感器152008b的输入来确定第一传感器152008a的查找表的过程152030的一个实施方案的逻辑图。第一传感器152008a捕集指示端部执行器152000的一个或多个参数的信号152022a。可基于一个或多个预先确定的参数(诸如，平滑函数、查找表和/或任何其他合适的调节参数)调节第一信号152022a。通过第二传感器152008b捕集第二信号152022b。可基于一个或多个预先确定的调节参数调节第二信号152022b。将第一信号152022a和第二信号152022b提供给处理器，诸如主处理器。处理器基于第二信号的值从一个或多个可用查找表152034a、152034b选择查找表。所选择的查找表用于将第一信号转换成定位在砧座152002与钉仓152006之间的组织的厚度测量结果。将调节的测量结果通过例如嵌入在外科器械150010中的显示器显示152026给操作者。Figure 55 is a logic diagram illustrating one embodiment of aprocess 152030 for determining a lookup table for afirst sensor 152008a based on input from asecond sensor 152008b. Thefirst sensor 152008a captures asignal 152022a indicative of one or more parameters of theend effector 152000. Thefirst signal 152022a may be adjusted based on one or more predetermined parameters, such as smoothing functions, look-up tables, and/or any other suitable adjustment parameters. Thesecond signal 152022b is captured by thesecond sensor 152008b. Thesecond signal 152022b may be adjusted based on one or more predetermined adjustment parameters. Thefirst signal 152022a and thesecond signal 152022b are provided to a processor, such as a main processor. The processor selects a lookup table from the one or more available lookup tables 152034a, 152034b based on the value of the second signal. The selected lookup table is used to convert the first signal into a thickness measurement of tissue positioned between theanvil 152002 and the staple cartridge 152006. The adjusted measurements are displayed 152026 to the operator via, for example, a display embedded in thesurgical instrument 150010.

图56为示出了用于响应于来自第二传感器152008b的输入来校正第一传感器152008a的过程152040的一个实施方案的逻辑图。第一传感器152008a被配置成能够捕集指示端部执行器152000的一个或多个参数的信号152022a。可基于一个或多个预先确定的参数(诸如，平滑函数、查找表和/或任何其他合适的调节参数)调节第一信号152022a。通过第二传感器152008b捕集第二信号152022b。可基于一个或多个预先确定的调节参数调节第二信号152022b。将第一信号152022a和第二信号152022b提供给处理器，诸如主处理器。主处理器响应于第二信号152022b来校正152042第一信号152022a。校正152042第一信号152022a以反映端部执行器152000中的组织咬合的完全性。将校正的信号通过例如嵌入在外科器械150010中的显示器显示152026给操作者。Figure 56 is a logic diagram illustrating one embodiment of aprocess 152040 for correcting afirst sensor 152008a in response to input from asecond sensor 152008b. Thefirst sensor 152008a is configured to capture asignal 152022a indicative of one or more parameters of theend effector 152000. Thefirst signal 152022a may be adjusted based on one or more predetermined parameters, such as smoothing functions, look-up tables, and/or any other suitable adjustment parameters. Thesecond signal 152022b is captured by thesecond sensor 152008b. Thesecond signal 152022b may be adjusted based on one or more predetermined adjustment parameters. Thefirst signal 152022a and thesecond signal 152022b are provided to a processor, such as a main processor. The main processor corrects 152042 thefirst signal 152022a in response to thesecond signal 152022b. Thefirst signal 152022a is corrected 152042 to reflect the completeness of tissue occlusion in theend effector 152000. The corrected signal is displayed 152026 to the operator via, for example, a display embedded in thesurgical instrument 150010.

图57为示出了用于确定并且显示夹持在端部执行器152000的砧座152002和钉仓152006之间的组织区段的厚度的过程152050的一个实施方案的逻辑图。过程152050包括通过例如定位在砧座152002的远侧末端处的霍尔效应传感器获得霍尔效应电压152052。将霍尔效应电压152052提供给模数转换器152054并且转换成数字信号。将该数字信号提供给处理器，诸如主处理器。主处理器校正152056霍尔效应电压152052信号的曲线输入。应变仪152058(诸如，微应变仪)被配置成能够测量端部执行器152000的一个或多个参数，诸如夹持操作期间施加于砧座152002上的应变的振幅。将测量的应变转换152060成数字信号并且提供给处理器，诸如主处理器。主处理器响应于由应变仪152058测量的应变来利用一个或多个算法和/或查找表调节霍尔效应电压152052，以反映由砧座152002和钉仓152006夹持的组织的真实厚度和咬合完全性。将调节的厚度通过例如嵌入在外科器械150010中的显示器显示152026给操作者。57 is a logic diagram illustrating one embodiment of aprocess 152050 for determining and displaying the thickness of a tissue segment clamped between theanvil 152002 and the staple cartridge 152006 of theend effector 152000.Process 152050 includes obtaining aHall effect voltage 152052 by, for example, a Hall effect sensor positioned at the distal tip of theanvil 152002. TheHall effect voltage 152052 is provided to an analog todigital converter 152054 and converted to a digital signal. The digital signal is provided to a processor, such as a main processor. The main processor corrects the curve input of the 152056Hall effect voltage 152052 signal. Astrain gauge 152058, such as a microstrain gauge, is configured to measure one or more parameters of theend effector 152000, such as the amplitude of the strain applied to theanvil 152002 during a clamping operation. The measured strain is converted 152060 into a digital signal and provided to a processor, such as a main processor. The main processor utilizes one or more algorithms and/or look-up tables to adjust theHall effect voltage 152052 in response to the strain measured by thestrain gauge 152058 to reflect the true thickness and occlusion of the tissue held by theanvil 152002 and staple cartridge 152006 completeness. The adjusted thickness is displayed 152026 to the operator via, for example, a display embedded in thesurgical instrument 150010.

在一些实施方案中，外科器械还可包括负荷元件或负荷传感器152082。负荷传感器152082可定位在例如轴组件150200中(如上所述)或者外壳150012中(也如上所述)。图58为示出了用于确定并且显示夹持在端部执行器152000的砧座152002和钉仓152006之间的组织区段的厚度的过程152070的一个实施方案的逻辑图。该过程包括通过例如定位在砧座152002的远侧末端处的霍尔效应传感器获得霍尔效应电压152072。将霍尔效应电压152072提供给模数转换器152074并且转换成数字信号。将该数字信号提供给处理器，诸如主处理器。主处理器校正152076霍尔效应电压152072信号的曲线输入。应变仪152078(诸如，微应变仪)被配置成能够测量端部执行器152000的一个或多个参数，诸如夹持操作期间施加于砧座152002上的应变的振幅。将测量的应变转换152080成数字信号并且提供给处理器，诸如主处理器。负荷传感器152082测量砧座152002相对于钉仓152006的夹持力。将测量的夹持力转换152084成数字信号并且提供给处理器，诸如主处理器。主处理器响应于由应变仪152078测量的应变和由负荷传感器152082测量的夹持力来利用一个或多个算法和/或查找表调节霍尔效应电压152072，以反映由砧座152002和钉仓152006夹持的组织的真实厚度和咬合完全性。将调节的厚度通过例如嵌入在外科器械150010中的显示器显示152026给操作者。In some embodiments, the surgical instrument may also include a load element orload sensor 152082.Load cell 152082 may be positioned, for example, in shaft assembly 150200 (as described above) or in housing 150012 (as also described above). 58 is a logic diagram illustrating one embodiment of aprocess 152070 for determining and displaying the thickness of the tissue segment clamped between theanvil 152002 and the staple cartridge 152006 of theend effector 152000. The process includes obtaining aHall effect voltage 152072 by, for example, a Hall effect sensor positioned at the distal tip of theanvil 152002. TheHall effect voltage 152072 is provided to an analog todigital converter 152074 and converted to a digital signal. The digital signal is provided to a processor, such as a main processor. The main processor corrects the curve input of the 152076Hall effect voltage 152072 signal. Astrain gauge 152078, such as a microstrain gauge, is configured to measure one or more parameters of theend effector 152000, such as the amplitude of the strain applied to theanvil 152002 during a clamping operation. The measured strain is converted 152080 into a digital signal and provided to a processor, such as a main processor. Theload cell 152082 measures the clamping force of theanvil 152002 relative to the staple cartridge 152006. The measured clamping force is converted 152084 to a digital signal and provided to a processor, such as a main processor. The main processor adjusts theHall effect voltage 152072 using one or more algorithms and/or look-up tables in response to the strain measured by thestrain gauge 152078 and the clamping force measured by theload cell 152082 to reflect the use of theanvil 152002 and the staple cartridge 152006 True thickness and occlusal completeness of clamped tissue. The adjusted thickness is displayed 152026 to the operator via, for example, a display embedded in thesurgical instrument 150010.

图59为示出与未修改的霍尔效应厚度测量结果152094进行比较的调节的霍尔效应厚度测量结果152092的曲线图152090。如图59所示，未修改的霍尔效应厚度测量结果152094指示较厚的组织测量结果，因为单个传感器不能补偿部分远侧/近侧咬合，所述部分远侧/近侧咬合导致不正确的厚度测量结果。通过例如图57所示的过程152050生成调节的厚度测量结果152092。基于来自一个或多个附加传感器(诸如，应变仪)的输入来校正调节的霍尔效应厚度测量结果152092。调节的霍尔效应厚度152092反映定位在砧座152002与钉仓152006之间的组织的真实厚度。59 is agraph 152090 showing the adjusted Halleffect thickness measurement 152092 compared to the unmodified Halleffect thickness measurement 152094. As shown in Figure 59, the unmodified HallEffect thickness measurement 152094 indicates a thicker tissue measurement because a single sensor cannot compensate for the partial distal/proximal occlusion that results in an incorrect Thickness measurement results. The adjustedthickness measurement 152092 is generated by, for example, theprocess 152050 shown in FIG. 57 . Adjusted Halleffect thickness measurements 152092 are corrected based on input from one or more additional sensors, such as strain gauges. The adjustedHall effect thickness 152092 reflects the true thickness of the tissue positioned between theanvil 152002 and the staple cartridge 152006.

图60示出了包括第一传感器152108a和第二传感器152108b的端部执行器152100的一个实施方案。端部执行器152100类似于图53中所示的端部执行器152000。端部执行器152100包括枢转地联接到第二钳口构件152104的第一钳口构件或砧座152102。第二钳口构件152104被配置成能够在其中接纳钉仓152106。端部执行器152100包括联接到砧座152102的第一传感器152108a。第一传感器152108a被配置成能够测量端部执行器152100的一个或多个参数，诸如砧座152102与钉仓152106之间的间隙152110。间隙152110可对应于例如夹持在砧座152102和钉仓152106之间的组织的厚度。第一传感器152108a可包括任何合适的传感器，以用于测量端部执行器的一个或多个参数。例如，在各种实施方案中，第一传感器152108a可包括磁传感器(诸如霍尔效应传感器)、应变仪、压力传感器、电感式传感器(诸如涡流传感器)、电阻式传感器、电容式传感器、光学传感器和/或任何其他合适的传感器。Figure 60 shows one embodiment of anend effector 152100 that includes afirst sensor 152108a and asecond sensor 152108b. Theend effector 152100 is similar to theend effector 152000 shown in FIG. 53 . Theend effector 152100 includes a first jaw member oranvil 152102 pivotally coupled to asecond jaw member 152104. Thesecond jaw member 152104 is configured to receive astaple cartridge 152106 therein. Theend effector 152100 includes afirst sensor 152108a coupled to theanvil 152102. Thefirst sensor 152108a is configured to measure one or more parameters of theend effector 152100, such as thegap 152110 between theanvil 152102 and thestaple cartridge 152106. Thegap 152110 may correspond to the thickness of tissue clamped between theanvil 152102 and thestaple cartridge 152106, for example. Thefirst sensor 152108a may comprise any suitable sensor for measuring one or more parameters of the end effector. For example, in various embodiments, thefirst sensor 152108a may include a magnetic sensor (such as a Hall effect sensor), a strain gauge, a pressure sensor, an inductive sensor (such as an eddy current sensor), a resistive sensor, a capacitive sensor, an optical sensor and/or any other suitable sensor.

在一些实施方案中，端部执行器152100包括第二传感器152108b。第二传感器152108b联接到第二钳口构件152104和/或钉仓152106。第二传感器152108b被配置成能够检测端部执行器152100的一个或多个参数。例如，在一些实施方案中，第二传感器152108b被配置成能够检测一个或多个器械状态，诸如联接到第二钳口构件152104的钉仓152106的颜色、钉仓152106的长度、端部执行器152100的夹持状态、端部执行器152100和/或钉仓152106的使用次数/剩余使用次数和/或任何其他合适的器械状态。第二传感器152108b可包括用于检测一个或多个器械状态的任何合适的传感器，诸如磁传感器(诸如霍尔效应传感器)、应变仪、压力传感器、电感式传感器(诸如涡流传感器)、电阻式传感器、电容式传感器、光学传感器和/或任何其他合适的传感器。In some embodiments, theend effector 152100 includes asecond sensor 152108b. Thesecond sensor 152108b is coupled to thesecond jaw member 152104 and/or thestaple cartridge 152106. Thesecond sensor 152108b is configured to detect one or more parameters of theend effector 152100. For example, in some embodiments, thesecond sensor 152108b is configured to detect one or more instrument states, such as the color of thestaple cartridge 152106 coupled to thesecond jaw member 152104, the length of thestaple cartridge 152106, the end effector The clamping state of the 152100, the number of uses/the number of uses remaining of theend effector 152100 and/or thestaple cartridge 152106, and/or any other suitable instrument state. Thesecond sensor 152108b may comprise any suitable sensor for detecting one or more instrument states, such as magnetic sensors (such as Hall effect sensors), strain gauges, pressure sensors, inductive sensors (such as eddy current sensors), resistive sensors , capacitive sensors, optical sensors and/or any other suitable sensor.

端部执行器152100可与图54至图57所示的过程中的任一者一起使用。例如，在一个实施方案中，来自第二传感器152108b的输入可用于校正第一传感器152108a的输入。第二传感器152108b可被配置成能够检测钉仓152106的一个或多个参数，诸如钉仓152106的颜色和/或长度。检测到的参数(诸如钉仓152106的颜色和/或长度)可对应于仓的一个或多个特性，诸如仓平台的高度、用于钉仓的可用/最佳组织厚度和/或钉仓152106中的钉图案。钉仓152106的已知参数可用于调节由第一传感器152108a提供的厚度测量结果。例如，如果钉仓152106具有较高的平台高度，则可减小由第一传感器152108a提供的厚度测量结果以补偿增加的平台高度。可将调节的厚度通过例如联接到外科器械150010的显示器显示给操作者。Theend effector 152100 can be used with any of the procedures shown in FIGS. 54-57. For example, in one embodiment, the input from thesecond sensor 152108b can be used to correct the input from thefirst sensor 152108a. Thesecond sensor 152108b can be configured to detect one or more parameters of thestaple cartridge 152106, such as the color and/or length of thestaple cartridge 152106. The detected parameters, such as the color and/or length of thestaple cartridge 152106, may correspond to one or more characteristics of the cartridge, such as the height of the cartridge deck, the available/optimal tissue thickness for the staple cartridge, and/or thestaple cartridge 152106 Nail pattern in . Known parameters of thestaple cartridge 152106 can be used to adjust the thickness measurement provided by thefirst sensor 152108a. For example, if thestaple cartridge 152106 has a higher deck height, the thickness measurement provided by thefirst sensor 152108a can be reduced to compensate for the increased deck height. The adjusted thickness may be displayed to the operator via, for example, a display coupled tosurgical instrument 150010.

图61示出了包括第一传感器152158和多个第二传感器152160a、152160b的端部执行器152150的一个实施方案。端部执行器152150包括第一钳口构件或砧座152152和第二钳口构件152154。第二钳口构件152154被配置成能够接纳钉仓152156。砧座152152可相对于第二钳口构件152154枢转地运动以将组织夹持在砧座152152与钉仓152156之间。砧座包括第一传感器152158。第一传感器152158被配置成能够检测端部执行器152150的一个或多个参数，诸如砧座152152与钉仓152156之间的间隙152110。间隙152110可对应于例如夹持在砧座152152和钉仓152156之间的组织的厚度。第一传感器152158可包括任何合适的传感器，以用于测量端部执行器的一个或多个参数。例如，在各种实施方案中，第一传感器152158可包括磁传感器(诸如霍尔效应传感器)、应变仪、压力传感器、电感式传感器(诸如涡流传感器)、电阻式传感器、电容式传感器、光学传感器和/或任何其他合适的传感器。Figure 61 shows one embodiment of anend effector 152150 that includes afirst sensor 152158 and a plurality ofsecond sensors 152160a, 152160b. Theend effector 152150 includes a first jaw member oranvil 152152 and asecond jaw member 152154. Thesecond jaw member 152154 is configured to receive thestaple cartridge 152156. Theanvil 152152 is pivotally movable relative to thesecond jaw member 152154 to clamp tissue between theanvil 152152 and thestaple cartridge 152156. The anvil includes afirst sensor 152158 . Thefirst sensor 152158 is configured to detect one or more parameters of theend effector 152150, such as thegap 152110 between theanvil 152152 and thestaple cartridge 152156. Thegap 152110 may correspond to the thickness of the tissue clamped between theanvil 152152 and thestaple cartridge 152156, for example. Thefirst sensor 152158 may comprise any suitable sensor for measuring one or more parameters of the end effector. For example, in various embodiments, thefirst sensor 152158 may include a magnetic sensor (such as a Hall effect sensor), a strain gauge, a pressure sensor, an inductive sensor (such as an eddy current sensor), a resistive sensor, a capacitive sensor, an optical sensor and/or any other suitable sensor.

在一些实施方案中，端部执行器152150包括多个第二传感器152160a、152160b。第二传感器152160a、152160b被配置成能够检测端部执行器152150的一个或多个参数。例如，在一些实施方案中，第二传感器152160a、152160b被配置成能够测量夹持规程期间施加于砧座152152上的应变振幅。在各种实施方案中，第二传感器152160a、152160b可包括磁传感器(诸如霍尔效应传感器)、应变仪、压力传感器、电感式传感器(诸如涡流传感器)、电阻式传感器、电容式传感器、光学传感器和/或任何其他合适的传感器。第二传感器152160a、152160b可被配置成能够测量砧座152152的不同位置处的一个或多个相同参数、砧座152152上的相同位置处的不同参数和/或砧座152152上的不同位置处的不同参数。In some embodiments, theend effector 152150 includes a plurality ofsecond sensors 152160a, 152160b. Thesecond sensors 152160a, 152160b are configured to detect one or more parameters of theend effector 152150. For example, in some embodiments, thesecond sensor 152160a, 152160b is configured to measure the strain amplitude applied to theanvil 152152 during the clamping procedure. In various embodiments, thesecond sensors 152160a, 152160b can include magnetic sensors (such as Hall effect sensors), strain gauges, pressure sensors, inductive sensors (such as eddy current sensors), resistive sensors, capacitive sensors, optical sensors and/or any other suitable sensor. Thesecond sensor 152160a, 152160b can be configured to measure one or more of the same parameter at different locations on theanvil 152152, different parameters at the same location on theanvil 152152, and/or at different locations on theanvil 152152 different parameters.

图62为示出了用于响应于多个第二传感器152160a、152160b来调节第一传感器152158的测量结果的过程152170的一个实施方案的逻辑图。在一个实施方案中，例如通过霍尔效应传感器获得152172霍尔效应电压。通过模数转换器转换152174霍尔效应电压。校正152176所转换的霍尔效应电压信号。校正曲线表示定位在砧座152152与钉仓152156之间的组织区段的厚度。通过多个第二传感器(诸如，多个应变仪)获得152178a、152178b的多个第二测量结果。将应变仪的输入例如通过多个电子μStrain转换电路转换152180a、152180b成一个或多个数字信号。将校正的霍尔效应电压和多个第二测量结果提供给处理器，诸如主处理器。主处理器利用第二测量结果并且例如通过应用算法和/或利用一个或多个查找表来调节152182霍尔效应电压。调节的霍尔效应电压表示由砧座152152和钉仓152156夹持的组织的真实厚度和咬合的完全性。将调节的厚度通过例如嵌入在外科器械150010中的显示器显示152026给操作者。62 is a logic diagram illustrating one embodiment of aprocess 152170 for adjusting measurements of afirst sensor 152158 in response to a plurality ofsecond sensors 152160a, 152160b. In one embodiment, the 152172 Hall effect voltage is obtained, for example, by a Hall effect sensor. 152174 Hall effect voltages are converted by an analog-to-digital converter. Correct the Hall effect voltage signal converted by 152176. The calibration curve represents the thickness of the tissue segment positioned between theanvil 152152 and thestaple cartridge 152156. A plurality of second measurements of 152178a, 152178b are obtained by a plurality of second sensors, such as a plurality of strain gauges. The input of the strain gauge is converted 152180a, 152180b into one or more digital signals, eg, by a plurality of electronic μStrain conversion circuits. The corrected Hall effect voltage and the plurality of second measurements are provided to a processor, such as a main processor. The main processor uses the second measurement and adjusts the 152182 Hall effect voltage, eg, by applying an algorithm and/or using one or more look-up tables. The adjusted Hall effect voltage represents the true thickness of the tissue held by theanvil 152152 and thestaple cartridge 152156 and the completeness of the bite. The adjusted thickness is displayed 152026 to the operator via, for example, a display embedded in thesurgical instrument 150010.

图63示出了电路152190的一个实施方案，该电路被配置成能够将来自第一传感器152158和多个第二传感器152160a、152160b的信号转换成可由处理器(诸如，主处理器)接收的数字信号。电路152190包括模数转换器152194。在一些实施方案中，模数转换器152194包括4通道、18位模数转换器。本领域中的技术人员将会认识到，模数转换器152194可包括任何合适的通道数和/或位数以将一个或多个输入从模拟信号转换成数字信号。电路152190包括一个或多个电平转换电阻器152196，该电平转换电阻器被配置成能够接收来自第一传感器152158(诸如，霍尔效应传感器)的输入。电平转换电阻器152196调节来自第一传感器的输入，由此根据该输入将该值转换成较高或较低电压。电平转换电阻器152196将来自第一传感器152158的电平转换输入提供给模数转换器。Figure 63 shows one embodiment of acircuit 152190 configured to convert signals from thefirst sensor 152158 and the plurality ofsecond sensors 152160a, 152160b into digital numbers that can be received by a processor, such as a main processor Signal.Circuit 152190 includes analog-to-digital converter 152194. In some embodiments, the analog-to-digital converter 152194 includes a 4-channel, 18-bit analog-to-digital converter. Those skilled in the art will recognize that the analog-to-digital converter 152194 may include any suitable number of channels and/or bits to convert one or more inputs from analog to digital signals.Circuit 152190 includes one or morelevel shifting resistors 152196 configured to receive input from afirst sensor 152158, such as a Hall effect sensor.Level shifting resistor 152196 adjusts the input from the first sensor, thereby converting the value to a higher or lower voltage depending on the input. Alevel shifting resistor 152196 provides the level shifting input from thefirst sensor 152158 to the analog to digital converter.

在一些实施方案中，多个第二传感器152160a、152160b联接到电路152190内的多个桥152192a、152192b。多个桥152192a、152192b可对来自多个第二传感器152160a、152160b的输入提供滤波。在对输入信号滤波之后，多个桥152192a、152192b将来自多个第二传感器152160a、152160b的输入提供给模数转换器152194。在一些实施方案中，联接到一个或多个电平转换电阻器的开关152198可联接到模数转换器152194。开关152198被配置成能够校正输入信号中的一个或多个，诸如来自霍尔效应传感器的输入。开关152198可用于提供一个或多个电平转换信号，以调节传感器中的一个或多个的输入，诸如由此来校正霍尔效应传感器的输入。在一些实施方案中，调节并非必需的，并且开关152198保持在打开位置以使电平转换电阻器脱离。开关152198联接到模数转换器152194。模数转换器152194将输出提供给一个或多个处理器，诸如主处理器。主处理器基于来自模数转换器152194的输入来计算端部执行器152150的一个或多个参数。例如，在一个实施方案中，主处理器基于来自一个或多个传感器152158、152160a、152160b的输入来计算定位在砧座152152与钉仓152156之间的组织的厚度。In some embodiments, the plurality ofsecond sensors 152160a, 152160b are coupled to the plurality of bridges 152192a, 152192b within thecircuit 152190. The plurality of bridges 152192a, 152192b may provide filtering of the input from the plurality ofsecond sensors 152160a, 152160b. After filtering the input signal, the plurality of bridges 152192a, 152192b provide input from the plurality ofsecond sensors 152160a, 152160b to the analog-to-digital converter 152194. In some implementations,switch 152198 coupled to one or more level shifting resistors can be coupled to analog todigital converter 152194.Switch 152198 is configured to be able to correct one or more of the input signals, such as input from a Hall effect sensor.Switch 152198 may be used to provide one or more level shifting signals to adjust the input of one or more of the sensors, such as to correct the input of a Hall effect sensor thereby. In some embodiments, adjustment is not necessary, and switch 152198 remains in the open position to disengage the level shifting resistors.Switch 152198 is coupled to analog todigital converter 152194. The analog-to-digital converter 152194 provides the output to one or more processors, such as a main processor. The main processor calculates one or more parameters of theend effector 152150 based on the input from the analog todigital converter 152194. For example, in one embodiment, the main processor calculates the thickness of the tissue positioned between theanvil 152152 and thestaple cartridge 152156 based on input from the one ormore sensors 152158, 152160a, 152160b.

图64示出了包括多个传感器152208a-152208d的端部执行器152200的一个实施方案。端部执行器152200包括枢转地联接到第二钳口构件152204的砧座152202。第二钳口构件152204被构造成能够在其中接纳钉仓152206。砧座152202包括其上的多个传感器152208a-152208d。多个传感器152208a-152208d被配置成能够检测端部执行器152200(诸如砧座152202)的一个或多个参数。多个传感器152208a-152208d可包括一个或多个相同传感器和/或不同传感器。多个传感器152208a-152208d可包括例如磁传感器(诸如霍尔效应传感器)、应变仪、压力传感器、电感式传感器(诸如涡流传感器)、电阻式传感器、电容式传感器、光学传感器和/或任何其他合适的传感器或者它们的组合。例如，在一个实施方案中，多个传感器152208a-152208d可包括多个应变仪。Figure 64 shows one embodiment of anend effector 152200 that includes a plurality ofsensors 152208a-152208d. Theend effector 152200 includes ananvil 152202 pivotally coupled to thesecond jaw member 152204. Thesecond jaw member 152204 is configured to receive astaple cartridge 152206 therein.Anvil 152202 includes a plurality ofsensors 152208a-152208d thereon. The plurality ofsensors 152208a-152208d are configured to detect one or more parameters of theend effector 152200, such as theanvil 152202. The plurality ofsensors 152208a-152208d may include one or more of the same sensor and/or different sensors. The plurality ofsensors 152208a-152208d may include, for example, magnetic sensors (such as Hall effect sensors), strain gauges, pressure sensors, inductive sensors (such as eddy current sensors), resistive sensors, capacitive sensors, optical sensors, and/or any other suitable sensors or their combination. For example, in one embodiment, the plurality ofsensors 152208a-152208d may include a plurality of strain gauges.

在一个实施方案中，多个传感器152208a-152208d允许实现鲁棒性组织厚度感测过程。通过检测沿砧座152202的长度的各个参数，多个传感器152208a-152208d允许外科器械(诸如，外科器械150010)计算钳口中的组织厚度，而无论咬合如何，例如，部分咬合或完全咬合。在一些实施方案中，多个传感器152208a-152208d包括多个应变仪。多个应变仪被配置成能够测量砧座152202上的各个点处的应变。砧座152202上的各个点中的每个处的应变振幅和/或斜率可用于确定砧座152202与钉仓152206之间的组织的厚度。多个应变仪可被配置成能够基于夹持动力学来优化最大振幅和/或斜率差，以确定厚度、组织布置、和/或组织的材料特性。夹持期间的多个传感器152208a-152208d的基于时间的监测允许处理器(诸如，主处理器)利用算法和查找表来识别组织特性和夹持位置并且动态地调节端部执行器152200和/或夹持在砧座152202与钉仓152206之间的组织。In one embodiment,multiple sensors 152208a-152208d allow for a robust tissue thickness sensing process. By detecting various parameters along the length of theanvil 152202, the plurality ofsensors 152208a-152208d allow a surgical instrument, such assurgical instrument 150010, to calculate the thickness of tissue in the jaws regardless of occlusion, eg, partial or full occlusion. In some embodiments, the plurality ofsensors 152208a-152208d includes a plurality of strain gauges. A plurality of strain gauges are configured to measure strain at various points on theanvil 152202. The strain amplitude and/or slope at each of the various points on theanvil 152202 can be used to determine the thickness of the tissue between theanvil 152202 and thestaple cartridge 152206. The plurality of strain gauges may be configured to enable optimization of maximum amplitude and/or slope differences based on clamping dynamics to determine thickness, tissue placement, and/or material properties of tissue. Time-based monitoring ofmultiple sensors 152208a-152208d during gripping allows a processor (such as a main processor) to utilize algorithms and look-up tables to identify tissue properties and gripping location and dynamically adjustend effector 152200 and/or Tissue clamped between theanvil 152202 and thestaple cartridge 152206.

图65为示出了用于基于多个传感器152208a-152208d来确定一个或多个组织特性的过程152220的一个实施方案的逻辑图。在一个实施方案中，多个传感器152208a-152208d生成152222a-152222d指示端部执行器152200的一个或多个参数的多个信号。将多个生成的信号转换152224a-152224d成数字信号并且提供给处理器。例如，在包括多个应变仪的一个实施方案中，多个电子μStrain(微应变)转换电路将应变仪信号转换152224a-152224d成数字信号。将数字信号提供给处理器，诸如主处理器。主处理器基于该多个信号来确定152226一个或多个组织特性。该处理器可通过应用算法和/或查找表来确定一个或多个组织特性。将该一个或多个组织特性通过例如嵌入在外科器械150010中的显示器显示152026给操作者。65 is a logic diagram illustrating one embodiment of aprocess 152220 for determining one or more tissue characteristics based on a plurality ofsensors 152208a-152208d. In one embodiment, the plurality ofsensors 152208a-152208d generate a plurality ofsignals 152222a-152222d indicative of one or more parameters of theend effector 152200. The plurality of generated signals are converted 152224a-152224d into digital signals and provided to the processor. For example, in one embodiment that includes multiple strain gauges, multiple electronic μStrain (microstrain) conversion circuits convert the strain gauge signals 152224a-152224d into digital signals. The digital signal is provided to a processor, such as a main processor. The main processor determines 152226 one or more tissue characteristics based on the plurality of signals. The processor may determine one or more tissue properties by applying algorithms and/or look-up tables. The one or more tissue properties are displayed 152026 to the operator via, for example, a display embedded in thesurgical instrument 150010.

图66示出了包括联接到第二钳口构件3254的多个传感器152260a-152260d的端部执行器152250的一个实施方案。端部执行器152250包括枢转地联接到第二钳口构件152254的砧座152252。砧座152252可相对于第二钳口构件152254运动以在两者间夹持一种或多种材料，诸如组织区段152264。第二钳口构件152254被构造成能够接纳钉仓152256。第一传感器152258联接到砧座152252。第一传感器被配置成能够检测端部执行器152150的一个或多个参数，诸如砧座152252与钉仓152256之间的间隙152110。间隙152110可对应于例如夹持在砧座152252和钉仓152256之间的组织的厚度。第一传感器152258可包括任何合适的传感器，以用于测量端部执行器的一个或多个参数。例如，在各种实施方案中，第一传感器152258可包括磁传感器(诸如霍尔效应传感器)、应变仪、压力传感器、电感式传感器(诸如涡流传感器)、电阻式传感器、电容式传感器、光学传感器和/或任何其他合适的传感器。FIG. 66 shows one embodiment of anend effector 152250 including a plurality of sensors 152260a-152260d coupled to the second jaw member 3254. Theend effector 152250 includes ananvil 152252 pivotally coupled to thesecond jaw member 152254.Anvil 152252 is movable relative tosecond jaw member 152254 to grip one or more materials, such astissue segment 152264, therebetween. Thesecond jaw member 152254 is configured to receive thestaple cartridge 152256. Thefirst sensor 152258 is coupled to theanvil 152252. The first sensor is configured to detect one or more parameters of theend effector 152150, such as thegap 152110 between theanvil 152252 and thestaple cartridge 152256. Thegap 152110 may correspond to the thickness of the tissue clamped between theanvil 152252 and thestaple cartridge 152256, for example. Thefirst sensor 152258 may comprise any suitable sensor for measuring one or more parameters of the end effector. For example, in various embodiments, thefirst sensor 152258 can include a magnetic sensor (such as a Hall effect sensor), a strain gauge, a pressure sensor, an inductive sensor (such as an eddy current sensor), a resistive sensor, a capacitive sensor, an optical sensor and/or any other suitable sensor.

多个第二传感器152260a-152260d联接到第二钳口构件152254。多个第二传感器152260a-152260d可与第二钳口构件152254和/或钉仓152256一体地形成。例如，在一个实施方案中，多个第二传感器152260a-152260d设置在钉仓152256的外侧排上(参见图67)。多个第二传感器152260a-152260d被配置成能够检测端部执行器152250和/或夹持在砧座152252与钉仓152256之间的组织区段152264的一个或多个参数。多个第二传感器152260a-152260d可包括用于检测端部执行器152250和/或组织区段152264的一个或多个参数的任何合适的传感器，例如，磁传感器(诸如霍尔效应传感器)、应变仪、压力传感器、电感式传感器(诸如涡流传感器)、电阻式传感器、电容式传感器、光学传感器和/或任何其他合适的传感器或者它们的组合。多个第二传感器152260a-152260d可包括相同的传感器和/或不同的传感器。A plurality of second sensors 152260a-152260d are coupled to thesecond jaw member 152254. The plurality of second sensors 152260a-152260d may be integrally formed with thesecond jaw member 152254 and/or thestaple cartridge 152256. For example, in one embodiment, a plurality of second sensors 152260a-152260d are disposed on the outer row of staple cartridges 152256 (see Figure 67). The plurality of second sensors 152260a-152260d are configured to detect one or more parameters of theend effector 152250 and/or thetissue segment 152264 clamped between theanvil 152252 and thestaple cartridge 152256. The plurality of second sensors 152260a-152260d may include any suitable sensors for detecting one or more parameters of theend effector 152250 and/or thetissue segment 152264, eg, magnetic sensors (such as Hall effect sensors), strain gauges, pressure sensors, inductive sensors (such as eddy current sensors), resistive sensors, capacitive sensors, optical sensors, and/or any other suitable sensor or combination thereof. The plurality of second sensors 152260a-152260d may include the same sensor and/or different sensors.

在一些实施方案中，多个第二传感器152260a-152260d包括两用传感器和组织稳定元件。多个第二传感器152260a-152260d包括电极和/或感测几何结构，该电极和/或感测几何结构被配置成能够当多个第二传感器152260a-152260d例如在夹持操作期间与组织区段152264接合时产生稳定组织状态。在一些实施方案中，多个第二传感器152260a-152260d中的一个或多个可由非感测组织稳定元件替换。第二传感器152260a-152260d通过控制夹持、缝合和/或其他处理过程期间的组织流动、钉变形和/或其他组织状态来产生稳定组织状态。In some embodiments, the plurality of second sensors 152260a-152260d include dual-purpose sensors and tissue stabilization elements. The plurality of second sensors 152260a-152260d include electrodes and/or sensing geometries configured to enable the plurality of second sensors 152260a-152260d to interact with the tissue segment, eg, during aclamping operation 152264 Produces a stable tissue state when engaged. In some embodiments, one or more of the plurality of second sensors 152260a-152260d may be replaced by a non-sensing tissue stabilization element. The second sensors 152260a-152260d create stable tissue states by controlling tissue flow, staple deformation, and/or other tissue states during clamping, stapling, and/or other procedures.

图67示出了包括一体地形成于其中的多个传感器152272a-152272h的钉仓152270的一个实施方案。钉仓152270包括多个排，该多个排包含多个孔以用于在其中存储钉。外侧排152278中的一个或多个孔由多个传感器152272a-152272h中的一个替换。剖面部分被示出以图解说明联接到传感器线152276b的传感器152272f。传感器线152276a、152276b可包括多个线以用于将多个传感器152272a-152272h联接到外科器械(诸如，外科器械150010)的一个或多个电路。在一些实施方案中，多个传感器152272a-152272h中的一个或多个包括两用传感器和组织稳定元件，该两用传感器和组织稳定元件具有被配置成能够提供组织稳定的电极和/或感测几何结构。在一些实施方案中，多个传感器152272a-152272h可由多个组织稳定元件替换和/或占据。可通过例如控制夹持和/或缝合过程期间的组织流动和/或钉成形来提供组织稳定。多个传感器152272a-152272h将信号提供给外科器械150010的一个或多个电路，以增强缝合性能和/或组织厚度感测的反馈。Figure 67 illustrates one embodiment of astaple cartridge 152270 including a plurality ofsensors 152272a-152272h integrally formed therein. Thestaple cartridge 152270 includes a plurality of rows containing a plurality of holes for storing staples therein. One or more holes in theouter row 152278 are replaced by one of the plurality ofsensors 152272a-152272h. Sectional portion is shown to illustratesensor 152272f coupled tosensor wire 152276b.Sensor wires 152276a, 152276b may include multiple wires for couplingmultiple sensors 152272a-152272h to one or more circuits of a surgical instrument, such assurgical instrument 150010. In some embodiments, one or more of the plurality ofsensors 152272a-152272h includes a dual-purpose sensor and tissue stabilization element having electrodes and/or sensing configured to provide tissue stabilization geometry structure. In some embodiments, the plurality ofsensors 152272a-152272h may be replaced and/or occupied by a plurality of tissue stabilization elements. Tissue stabilization can be provided, for example, by controlling tissue flow and/or staple formation during clamping and/or stapling procedures. A plurality ofsensors 152272a-152272h provide signals to one or more circuits ofsurgical instrument 150010 to enhance feedback of stapling performance and/or tissue thickness sensing.

图68为示出了用于确定夹持在端部执行器(诸如图66所示的端部执行器152250)内的组织区段152264的一个或多个参数的过程152280的一个实施方案的逻辑图。在一个实施方案中，第一传感器152258被配置成能够检测端部执行器152250和/或定位在砧座152252与钉仓152256之间的组织区段152264的一个或多个参数。通过第一传感器152258生成152282第一信号。第一信号指示由第一传感器152258检测的一个或多个参数。一个或多个第二传感器152260被配置成能够检测端部执行器152250和/或组织区段152264的一个或多个参数。如同第一传感器152258，第二传感器152260可被配置成能够检测相同的参数、附加的参数或不同的参数。通过第二传感器152260生成第二信号152284。第二信号152284指示由第二传感器152260检测的一个或多个参数。将第一信号和第二信号提供给处理器，诸如主处理器。处理器基于由第二传感器152260生成的输入来调节152286由第一传感器152258生成的第一信号。调节的信号可指示例如组织区段152264的真实厚度和咬合完全性。将调节的信号通过例如嵌入在外科器械150010中的显示器显示152026给操作者。Figure 68 is logic illustrating one embodiment of aprocess 152280 for determining one or more parameters of atissue segment 152264 retained within an end effector, such as theend effector 152250 shown in Figure 66 picture. In one embodiment, thefirst sensor 152258 is configured to detect one or more parameters of theend effector 152250 and/or thetissue segment 152264 positioned between theanvil 152252 and thestaple cartridge 152256. Thefirst signal 152282 is generated by thefirst sensor 152258. The first signal is indicative of one or more parameters detected by thefirst sensor 152258. The one or moresecond sensors 152260 are configured to detect one or more parameters of theend effector 152250 and/or thetissue segment 152264. As with thefirst sensor 152258, thesecond sensor 152260 can be configured to detect the same parameter, additional parameters, or a different parameter. Thesecond signal 152284 is generated by thesecond sensor 152260 . Thesecond signal 152284 is indicative of one or more parameters detected by thesecond sensor 152260. The first signal and the second signal are provided to a processor, such as a main processor. Theprocessor conditions 152286 the first signal generated by thefirst sensor 152258 based on the input generated by thesecond sensor 152260. The adjusted signal may indicate, for example, the true thickness and occlusal completeness of thetissue segment 152264. The adjusted signal is displayed 152026 to the operator via, for example, a display embedded in thesurgical instrument 150010.

图69示出了包括多个冗余传感器152308a、152308b的端部执行器152300的一个实施方案。端部执行器152300包括枢转地联接到第二钳口构件152304的第一钳口构件或砧座152302。第二钳口构件152304被配置成能够在其中接纳钉仓152306。砧座152302可相对于钉仓152306运动以将材料(诸如，组织区段)抓持在砧座152302与钉仓152306之间。多个传感器152308a、152308b联接到砧座。多个传感器152308a、152308b被配置成能够检测端部执行器152300和/或定位在砧座152302与钉仓152306之间的组织区段的一个或多个参数。在一些实施方案中，多个传感器152308a、152308b被配置成能够检测砧座152302与钉仓152306之间的间隙152310。间隙152310可对应于例如定位在砧座152302和钉仓152306之间的组织的厚度。多个传感器152308a、152308b可通过例如检测由联接到第二钳口构件152304的磁体152312生成的磁场来检测间隙152310。Figure 69 shows one embodiment of anend effector 152300 that includes multipleredundant sensors 152308a, 152308b. Theend effector 152300 includes a first jaw member oranvil 152302 pivotally coupled to asecond jaw member 152304. Thesecond jaw member 152304 is configured to receive astaple cartridge 152306 therein. Theanvil 152302 is movable relative to thestaple cartridge 152306 to grasp material, such as a tissue segment, between theanvil 152302 and thestaple cartridge 152306. A plurality ofsensors 152308a, 152308b are coupled to the anvil. The plurality ofsensors 152308a, 152308b are configured to detect one or more parameters of theend effector 152300 and/or the tissue segment positioned between theanvil 152302 and thestaple cartridge 152306. In some embodiments, the plurality ofsensors 152308a, 152308b are configured to detect thegap 152310 between theanvil 152302 and thestaple cartridge 152306. Thegap 152310 may correspond to the thickness of tissue positioned between theanvil 152302 and thestaple cartridge 152306, for example. The plurality ofsensors 152308a, 152308b can detect thegap 152310 by, for example, detecting a magnetic field generated by amagnet 152312 coupled to thesecond jaw member 152304.

在一些实施方案中，多个传感器152308a、152308b包括冗余传感器。冗余传感器被配置成能够检测端部执行器152300和/或定位在砧座152302与钉仓152306之间的组织区段的相同特性。冗余传感器可包括例如霍尔效应传感器，该霍尔效应传感器被配置成能够检测砧座152302与钉仓152306之间的间隙152310。冗余传感器提供表示一个或多个参数的信号，从而允许处理器(例如，主处理器)评估多个输入并且确定最可靠的输入。在一些实施方案中，冗余传感器用于降低噪声、假信号、和/或漂移。可在夹持期间实时地测量冗余传感器中的每个，由此允许分析基于时间的信息并且利用算法和/或查找表来动态地识别组织特性和夹持定位。可调节和/或选择冗余传感器中的一个或多个的输入以识别真实组织厚度和定位在砧座152302与钉仓152306之间的组织区段的咬合。In some embodiments, the plurality ofsensors 152308a, 152308b comprise redundant sensors. The redundant sensors are configured to detect the same characteristics of theend effector 152300 and/or the tissue segment positioned between theanvil 152302 and thestaple cartridge 152306. The redundant sensor may include, for example, a Hall effect sensor configured to detect thegap 152310 between theanvil 152302 and thestaple cartridge 152306. Redundant sensors provide signals representing one or more parameters, allowing a processor (eg, a main processor) to evaluate multiple inputs and determine the most reliable input. In some embodiments, redundant sensors are used to reduce noise, glitches, and/or drift. Each of the redundant sensors can be measured in real-time during clamping, thereby allowing time-based information to be analyzed and the use of algorithms and/or look-up tables to dynamically identify tissue properties and clamp positioning. The input of one or more of the redundant sensors may be adjusted and/or selected to identify true tissue thickness and occlusion of the tissue segment positioned between theanvil 152302 and thestaple cartridge 152306.

图70为示出了用于选择来自多个冗余传感器(诸如，图69中所示的多个传感器152308a、152308b)的最可靠输出的过程152320的一个实施方案的逻辑图。在一个实施方案中，通过第一传感器152308a生成第一信号。通过模数转换器转换152322a第一信号。通过一个或多个冗余传感器152308b生成一个或多个附加的信号。通过模数转换器转换152322b该一个或多个附加的信号。将转换的信号提供给处理器，诸如主处理器。主处理器评估152324冗余输入以确定最可靠的输出。最可靠的输出可基于一个或多个参数来选择，例如，算法、查找表、得自另外传感器的输入、和/或器械状态。在选择最可靠的输出之后，处理器可基于一个或多个附加的传感器来调节输出，以反映例如定位在砧座152302与钉仓152306之间的组织区段的真实厚度和咬合。将调节的最可靠输出通过例如嵌入在外科器械150010中的显示器显示152026给操作者。70 is a logic diagram illustrating one embodiment of aprocess 152320 for selecting the most reliable output from multiple redundant sensors, such as themultiple sensors 152308a, 152308b shown in FIG. 69 . In one embodiment, the first signal is generated by thefirst sensor 152308a. Convert the 152322a first signal by an analog-to-digital converter. One or more additional signals are generated by one or moreredundant sensors 152308b. The one or more additional signals are converted 152322b by an analog-to-digital converter. The converted signal is provided to a processor, such as a main processor. The main processor evaluates 152324 redundant inputs to determine the most reliable output. The most reliable output may be selected based on one or more parameters, eg, algorithms, look-up tables, inputs from additional sensors, and/or instrument status. After selecting the most reliable output, the processor may adjust the output based on one or more additional sensors to reflect, for example, the true thickness and occlusion of the tissue segment positioned between theanvil 152302 and thestaple cartridge 152306. The most reliable output of the adjustment is displayed 152026 to the operator via, for example, a display embedded in thesurgical instrument 150010.

图71示出了包括传感器152358的端部执行器152350的一个实施方案，该传感器包括特定采样率以限制或消除假信号。端部执行器152350包括可枢转地联接到第二钳口构件152354的第一钳口构件或砧座152352。第二钳口构件152354被构造成能够在其中接纳钉仓152356。钉仓152356包括多个钉，所述多个钉可被递送到定位在砧座152352与钉仓152356之间的组织区段。传感器152358联接到砧座152352。传感器152358被配置成能够检测端部执行器152350的一个或多个参数，诸如砧座152352与钉仓152356之间的间隙152364。间隙152364可对应于材料(诸如，组织区段)的厚度和/或定位在砧座152352与钉仓152356之间的材料的咬合完全性。传感器152358可包括用于检测端部执行器152350的一个或多个参数的任何合适的传感器，例如，磁传感器(诸如霍尔效应传感器)、应变仪、压力传感器、电感式传感器(诸如涡流传感器)、电阻式传感器、电容式传感器、光学传感器和/或任何其他合适的传感器。Figure 71 shows one embodiment of anend effector 152350 that includes asensor 152358 that includes a specific sampling rate to limit or eliminate glitches. Theend effector 152350 includes a first jaw member oranvil 152352 pivotally coupled to asecond jaw member 152354. Thesecond jaw member 152354 is configured to receive astaple cartridge 152356 therein. Thestaple cartridge 152356 includes a plurality of staples that can be delivered to a tissue segment positioned between theanvil 152352 and thestaple cartridge 152356.Sensor 152358 is coupled toanvil 152352. Thesensor 152358 is configured to detect one or more parameters of theend effector 152350, such as thegap 152364 between theanvil 152352 and thestaple cartridge 152356. Thegap 152364 may correspond to the thickness of the material (such as a tissue segment) and/or the occlusal integrity of the material positioned between theanvil 152352 and thestaple cartridge 152356.Sensors 152358 may include any suitable sensors for detecting one or more parameters ofend effector 152350, eg, magnetic sensors (such as Hall effect sensors), strain gauges, pressure sensors, inductive sensors (such as eddy current sensors) , resistive sensors, capacitive sensors, optical sensors and/or any other suitable sensor.

在一个实施方案中，传感器152358包括磁传感器，该磁传感器被配置成能够检测由联接到第二钳口构件152354和/或钉仓152356的电磁源152360生成的磁场。电磁源152360生成被传感器152358检测的磁场。检测到的磁场的强度可对应于例如定位在砧座152352和钉仓152356之间的组织的厚度和/或咬合完全性。在一些实施方案中，电磁源152360生成已知频率(诸如，1MHz)的信号。在其他实施方案中，由电磁源152360生成的信号可基于例如安装在第二钳口构件152354中的钉仓152356的类型、一个或多个附加的传感器、算法和/或一个或多个参数来调节。In one embodiment, thesensor 152358 comprises a magnetic sensor configured to detect the magnetic field generated by theelectromagnetic source 152360 coupled to thesecond jaw member 152354 and/or thestaple cartridge 152356.Electromagnetic source 152360 generates a magnetic field that is detected bysensor 152358. The strength of the detected magnetic field may correspond to, for example, the thickness and/or occlusal integrity of tissue positioned between theanvil 152352 and thestaple cartridge 152356. In some embodiments, theelectromagnetic source 152360 generates a signal of a known frequency, such as 1 MHz. In other embodiments, the signal generated by theelectromagnetic source 152360 may be based on, for example, the type ofstaple cartridge 152356 installed in thesecond jaw member 152354, one or more additional sensors, algorithms, and/or one or more parameters adjust.

在一个实施方案中，信号处理器152362联接到端部执行器152350，诸如砧座152352。信号处理器152362被配置成能够处理由传感器152358生成的信号，以消除假信号并且增强来自传感器152358的输入。在一些实施方案中，信号处理器152362可被定位成独立于端部执行器152350，诸如定位在外科器械150010的柄部150014中。在一些实施方案中，信号处理器152362与由通用处理器(诸如，主处理器)执行的算法一体地形成并且/或者包括该算法。信号处理器152362被配置成能够处理来自传感器152358的某一频率的信号，该频率基本上等同于由电磁源152360生成的信号的频率。例如，在一个实施方案中，电磁源152360生成1MHz频率的信号。通过传感器152358检测该信号。传感器152358生成信号，该信号指示提供给信号处理器152362的检测到的磁场。该信号由信号处理器152362在1MHz的频率下进行处理以消除假信号。将处理的信号提供给处理器，诸如主处理器。主处理器使所接收到的信号与端部执行器152350的一个或多个参数(诸如，砧座152352与钉仓152356之间的间隙152364)相关联。In one embodiment, thesignal processor 152362 is coupled to theend effector 152350, such as theanvil 152352. Thesignal processor 152362 is configured to process the signals generated by thesensor 152358 to eliminate false signals and enhance the input from thesensor 152358. In some embodiments, thesignal processor 152362 can be positioned independently of theend effector 152350, such as in thehandle 150014 of thesurgical instrument 150010. In some embodiments, thesignal processor 152362 is integral with and/or includes an algorithm executed by a general purpose processor, such as a main processor.Signal processor 152362 is configured to process signals fromsensor 152358 at a frequency substantially equal to the frequency of the signal generated byelectromagnetic source 152360. For example, in one embodiment, theelectromagnetic source 152360 generates a signal at a frequency of 1 MHz. This signal is detected bysensor 152358.Sensor 152358 generates a signal indicative of the detected magnetic field provided to signalprocessor 152362. This signal is processed bysignal processor 152362 at a frequency of 1 MHz to remove glitches. The processed signals are provided to a processor, such as a main processor. The main processor correlates the received signal with one or more parameters of theend effector 152350, such as thegap 152364 between theanvil 152352 and thestaple cartridge 152356.

图72为示出了用于产生定位在端部执行器(诸如，图71中所示的端部执行器152350)的砧座和钉仓之间的组织区段的厚度测量结果的过程152370的一个实施方案的逻辑图。在过程152370的一个实施方案中，通过调制的电磁源152360生成152372信号。生成的信号可包括例如1MHz信号。磁传感器152358被配置成能够检测152374由电磁源152360生成的信号。磁传感器152358生成指示检测到的磁场的信号并且将该信号提供给信号处理器152362。信号处理器152362处理152376该信号以移除噪音、假信号并且/或者增强该信号。将处理的信号提供给模数转换器以用于转换152378成数字信号。可例如通过应用校正曲线输入算法和/或查找表来校正152380该数字信号。信号处理152376、转换152378和校正152380可由一个或多个电路来执行。将校正的信号通过例如与外科器械150010一体地形成的显示器显示152026给用户。72 is a diagram illustrating aprocess 152370 for generating thickness measurements of a tissue segment positioned between the anvil and the staple cartridge of an end effector, such as theend effector 152350 shown in FIG. 71 . Logic diagram of one embodiment. In one embodiment of theprocess 152370, the 152372 signal is generated by the modulatedelectromagnetic source 152360. The generated signal may include, for example, a 1 MHz signal.Magnetic sensor 152358 is configured to detect 152374 the signal generated byelectromagnetic source 152360.Magnetic sensor 152358 generates a signal indicative of the detected magnetic field and provides the signal to signalprocessor 152362. Thesignal processor 152362processes 152376 the signal to remove noise, glitches and/or enhance the signal. The processed signal is provided to an analog to digital converter forconversion 152378 to a digital signal. The digital signal may be corrected 152380, eg, by applying a correction curve input algorithm and/or a look-up table.Signal processing 152376,conversion 152378, andcorrection 152380 may be performed by one or more circuits. The corrected signal is displayed 152026 to the user via, for example, a display integrally formed with thesurgical instrument 150010.

图73和图74示出了包括用于识别不同类型的钉仓152406的传感器152408的端部执行器152400的一个实施方案。端部执行器152400包括枢转地联接到第二钳口构件或细长通道152404的第一钳口构件或砧座152402。细长通道152404被构造成能够在其中可操作地支撑钉仓152406。端部执行器152400还包括定位在近侧区域中的传感器152408。传感器152408可为光学传感器、磁传感器、电传感器或任何其他合适的传感器中的任一个。73 and 74 illustrate one embodiment of anend effector 152400 that includes sensors 152408 for identifying different types of staple cartridges 152406. Theend effector 152400 includes a first jaw member or anvil 152402 pivotally coupled to a second jaw member or elongated channel 152404. The elongated channel 152404 is configured to operably support the staple cartridge 152406 therein. Theend effector 152400 also includes a sensor 152408 positioned in the proximal region. Sensor 152408 may be any of an optical sensor, a magnetic sensor, an electrical sensor, or any other suitable sensor.

传感器152408可操作以检测钉仓152406的特性并且由此识别钉仓152406类型。图74示出了传感器152408为光学发射器和检测器152410的示例。钉仓152406的主体可具有不同的颜色，使得颜色识别钉仓152406类型。光学发射器和检测器152410可操作以询问钉仓152406主体的颜色。在例示的示例中，光学发射器和检测器152410可通过接收到红色、绿色和蓝色光谱中的等强度的反射光来检测白色152412。光学发射器和检测器152410可通过接收到绿色和蓝色光谱中极少的反射光同时接收到红色光谱中较高强度的光来检测红色152414。The sensor 152408 is operable to detect characteristics of the staple cartridge 152406 and thereby identify the staple cartridge 152406 type. FIG. 74 shows an example where the sensor 152408 is an optical emitter and detector 152410. The main body of the staple cartridge 152406 may have different colors such that the color identifies the staple cartridge 152406 type. The optical emitter and detector 152410 is operable to interrogate the color of the staple cartridge 152406 body. In the illustrated example, the optical emitter and detector 152410 may detect white 152412 by receiving reflected light of equal intensity in the red, green and blue light spectrum. Optical emitter and detector 152410 can detect red 152414 by receiving very little reflected light in the green and blue spectrum while receiving higher intensity light in the red spectrum.

另选地或除此之外，光学发射器和检测器152410或另一个合适的传感器152408可询问和识别钉仓152406上的一些其他符号或标记。符号或标记可为条形码、形状或字符、颜色编码的标志、或任何其他合适的标记中的任一者。可将由传感器152408读取的信息传送给外科装置150010中的微控制器，诸如微控制器(例如，微控制器461(图12))。微控制器可被配置成能够将有关钉仓152406的信息传送给器械的操作者。例如，所识别的钉仓152406可能不适用于给定应用；在这种情况下，器械的操作者可被告知，并且/或者该器械的功能不合适。在这种情况下，微控制器可任选地被配置成能够禁用外科器械可被禁用的功能。另选地或除此之外，微控制器可被配置成能够向外科器械150010的操作者通知所识别的钉仓152406类型的参数，诸如钉仓152406的长度，或有关钉的信息(诸如，高度和长度)。Alternatively or in addition, the optical emitter and detector 152410 or another suitable sensor 152408 may interrogate and identify some other symbol or marking on the staple cartridge 152406. The symbols or indicia can be any of barcodes, shapes or characters, color-coded logos, or any other suitable indicia. Information read by sensor 152408 may be communicated to a microcontroller insurgical device 150010, such as a microcontroller (eg, microcontroller 461 (FIG. 12)). The microcontroller can be configured to communicate information about the staple cartridge 152406 to the operator of the instrument. For example, the identified staple cartridge 152406 may not be suitable for a given application; in such a case, the operator of the instrument may be informed, and/or the function of the instrument is not appropriate. In this case, the microcontroller may optionally be configured to disable functions that the surgical instrument may disable. Alternatively or additionally, the microcontroller may be configured to be able to notify the operator of thesurgical instrument 150010 of parameters of the identified staple cartridge 152406 type, such as the length of the staple cartridge 152406, or information about the staples (such as, height and length).

图75示出了被配置成能够固定地附接至端部执行器的钳口构件153434的分段柔性电路153430的一个方面。分段柔性电路153430包括远侧段153432a和横向段153432b、153432c，其包括用于提供局部组织存在检测的可单独寻址的传感器。段153432a、153432b、153432c可单独寻址以检测组织并且基于位于段153432a、153432b、153432c中的每个内的单个传感器测量组织参数。分段柔性电路153430的段153432a、153432b、153432c被安装到钳口构件153434并且经由导电元件153436电联接到能量源诸如电路。霍尔效应传感器153438或任何合适的磁性传感器位于钳口构件153434的远侧端部上。霍尔效应传感器153438结合磁体操作，以提供对由钳口构件153434限定的孔的测量，该孔也可被称为组织间隙，如图77中特别示出的那样。分段柔性电路153430可用于测量端部执行器内的组织厚度、力、位移、压缩、组织阻抗和组织位置。Figure 75 shows one aspect of asegmented flex circuit 153430 configured to be fixedly attachable to ajaw member 153434 of an end effector. Thesegmented flex circuit 153430 includes adistal segment 153432a andlateral segments 153432b, 153432c that include individually addressable sensors for providing localized tissue presence detection.Segments 153432a, 153432b, 153432c are individually addressable to detect tissue and measure tissue parameters based on a single sensor located within each ofsegments 153432a, 153432b, 153432c.Segments 153432a, 153432b, 153432c ofsegmented flex circuit 153430 are mounted tojaw members 153434 and electrically coupled to an energy source such as an electrical circuit viaconductive elements 153436. AHall effect sensor 153438 or any suitable magnetic sensor is located on the distal end ofjaw member 153434. TheHall effect sensor 153438 operates in conjunction with a magnet to provide a measurement of the aperture defined by thejaw members 153434, which may also be referred to as the tissue gap, as particularly shown in FIG. 77 . Thesegmented flex circuit 153430 can be used to measure tissue thickness, force, displacement, compression, tissue impedance, and tissue position within the end effector.

图76示出了被配置成能够安装到端部执行器的钳口构件153444的分段柔性电路153440的一个方面。分段柔性电路153440包括具有用于组织控制的可单独寻址的传感器的远侧段153442a和横向段153442b、153442c。段153442a、153442b、153442c可单独寻址以处理组织并且读取位于段153442a、153442b、153442c中的每个内的单个传感器。分段柔性电路153440的段153442a、153442b、153442c被安装到钳口构件153444并且通过导电元件153446电联接到能量源。霍尔效应传感器153448或其他合适的磁性传感器设置在钳口构件153444的远侧端部上。霍尔效应传感器153448结合磁体操作，以提供对由端部执行器的钳口构件153444限定的孔或组织间隙的测量，如图77中特别示出的那样。另外，多个横向非对称温度传感器153450a、153450b安装在分段式柔性电路153440上或与其一体地形成，以向控制电路提供组织温度反馈。分段柔性电路153440可用于测量端部执行器内的组织厚度、力、位移、压缩、组织阻抗和组织位置。76 shows one aspect of asegmented flex circuit 153440 configured to be mountable to thejaw member 153444 of an end effector. Thesegmented flex circuit 153440 includes adistal segment 153442a andlateral segments 153442b, 153442c with individually addressable sensors for tissue control.Segments 153442a, 153442b, 153442c are individually addressable to process tissue and read individual sensors located within each ofsegments 153442a, 153442b, 153442c.Segments 153442a, 153442b, 153442c ofsegmented flex circuit 153440 are mounted tojaw member 153444 and electrically coupled to the energy source throughconductive elements 153446. AHall effect sensor 153448 or other suitable magnetic sensor is provided on the distal end ofjaw member 153444. TheHall effect sensor 153448 operates in conjunction with a magnet to provide a measurement of the hole or tissue gap defined by thejaw members 153444 of the end effector, as particularly shown in FIG. 77 . Additionally, a plurality of laterallyasymmetric temperature sensors 153450a, 153450b are mounted on or integrally formed with thesegmented flex circuit 153440 to provide tissue temperature feedback to the control circuit. Thesegmented flex circuit 153440 can be used to measure tissue thickness, force, displacement, compression, tissue impedance, and tissue position within the end effector.

图77示出了被配置成能够测量组织间隙G_T的端部执行器153460的一个方面。端部执行器153460包括钳口构件153462和钳口构件153444。图76中所述的柔性电路153440被安装到钳口构件153444。柔性电路153440包括霍尔效应传感器153448，该霍尔效应传感器结合安装到钳口构件153462的磁体153464操作以测量组织间隙G_T。该技术可用于测量限定于钳口构件153444和钳口构件153462之间的孔。钳口构件153462可为钉仓。Figure 77 shows one aspect of an end effector₁₅₃₄₆₀ configured to measure tissue gap GT.End effector 153460 includesjaw member 153462 andjaw member 153444. Theflex circuit 153440 depicted in FIG. 76 is mounted to thejaw member 153444. Theflexible circuit 153440 includes aHall effect sensor 153448 that operates in conjunction with amagnet 153464 mounted to thejaw member 153462 to measure the tissue gap_GT . This technique can be used to measure the hole defined betweenjaw member 153444 andjaw member 153462. Thejaw member 153462 can be a staple cartridge.

图78示出了包括分段柔性电路153468的端部执行器153470的一个方面。端部执行器153470包括钳口构件153472和钉仓153474。分段柔性电路153468被安装到钳口构件153472。设置在段1-5内的每个传感器被配置成能够检测定位在钳口构件153472和钉仓153474之间的组织的存在并且表示组织区域1-5。在图78所示的构型中，端部执行器153470被示出为处于准备好接收或抓持钳口构件153472和钉仓153474之间的组织的打开位置。分段柔性电路153468可用于测量端部执行器153470内的组织厚度、力、位移、压缩、组织阻抗和组织位置。78 shows an aspect of anend effector 153470 that includes asegmented flex circuit 153468. Theend effector 153470 includes ajaw member 153472 and astaple cartridge 153474.Segmented flex circuit 153468 is mounted tojaw member 153472. Each sensor disposed within segments 1-5 is configured to detect the presence of tissue positioned betweenjaw member 153472 andstaple cartridge 153474 and to represent tissue regions 1-5. In the configuration shown in FIG. 78, theend effector 153470 is shown in an open position ready to receive or grasp tissue between thejaw members 153472 and thestaple cartridge 153474. Thesegmented flex circuit 153468 can be used to measure tissue thickness, force, displacement, compression, tissue impedance, and tissue position within theend effector 153470.

图79示出了图78所示的端部执行器153470，其中钳口构件153472将组织153476夹持在钳口构件153472(例如，砧座)和钉仓之间。如图79所示，组织153476被定位在段1-3之间并且表示组织区域1-3。因此，组织153476由段1-3中的传感器检测，并且通过段4-5在区段153469中检测组织的不存在(空)。与分别定位于某些段1-3和4-5内的组织153476的存在和不存在有关的信息经由例如接口电路被传送到如本文所述的控制电路。控制电路被配置成能够检测位于段1-3中的组织。应当理解，段1-5可包括测量位于某些段1至5内的组织的组织参数的任何合适的温度、力/压力和/或霍尔效应磁性传感器以及将能量递送到位于某些段1-5中的组织的电极。分段柔性电路153468可用于测量端部执行器153470内的组织厚度、力、位移、压缩、组织阻抗和组织位置。Figure 79 shows theend effector 153470 shown in Figure 78 withjaw members 153472 clampingtissue 153476 between jaw members 153472 (eg, anvil) and the staple cartridge. As shown in Figure 79,tissue 153476 is positioned between segments 1-3 and represents tissue regions 1-3. Thus,tissue 153476 is detected by the sensors in segments 1-3, and the absence (empty) of tissue is detected insegment 153469 by segments 4-5. Information regarding the presence and absence oftissue 153476 located within certain segments 1-3 and 4-5, respectively, is communicated to control circuitry as described herein via, for example, interface circuitry. The control circuit is configured to detect tissue located in segments 1-3. It should be appreciated that segments 1-5 may include any suitable temperature, force/pressure and/or Hall effect magnetic sensors that measure tissue parameters of tissue located within certain segments 1-5 and deliver energy to certain segments 1 -5 electrodes in the tissue. Thesegmented flex circuit 153468 can be used to measure tissue thickness, force, displacement, compression, tissue impedance, and tissue position within theend effector 153470.

图80为可与根据本公开的外科器械或系统一起使用的绝对定位系统153100的示意图。绝对定位系统153100包括根据本公开的至少一个方面的包括传感器布置153102的受控马达驱动电路布置。用于绝对定位系统153100的传感器布置153102提供对应于位移构件153111的位置的独特位置信号。在一个方面，位移构件153111表示联接到切割器械或刀(例如，切割器械、I形梁和/或I形梁153514(图82))的纵向可运动的驱动构件。在其他方面，位移构件153111表示击发构件，该击发构件联接到切割器械或刀，该切割器械或刀可被适配和配置成能够包括驱动齿的齿条。在又一个方面，位移构件153111表示击发杆或I形梁，该击发杆或I形梁中的每个可被适配和配置成能够包括驱动齿的齿条。80 is a schematic diagram of anabsolute positioning system 153100 that can be used with a surgical instrument or system according to the present disclosure. Theabsolute positioning system 153100 includes a controlled motor drive circuit arrangement including a sensor arrangement 153102 in accordance with at least one aspect of the present disclosure. The sensor arrangement 153102 for theabsolute positioning system 153100 provides a unique position signal corresponding to the position of thedisplacement member 153111. In one aspect,displacement member 153111 represents a longitudinally movable drive member coupled to a cutting instrument or knife (eg, cutting instrument, I-beam, and/or I-beam 153514 (FIG. 82)). In other aspects,displacement member 153111 represents a firing member coupled to a cutting instrument or knife that can be adapted and configured to include a rack of drive teeth. In yet another aspect,displacement member 153111 represents a firing rod or I-beam, each of which can be adapted and configured to include a rack of drive teeth.

因此，如本文所用，术语位移构件一般用来指如本文所述的外科器械或系统的任何可运动构件，诸如驱动构件、击发构件、击发杆、切割器械、刀和/或I形梁，或可被移位的任何元件。因此，绝对定位系统153100实际上可通过跟踪纵向可运动的驱动构件的位移来跟踪切割器械I形梁153514(图82)的位移。在各种其他方面，位移构件153111可联接到适于测量位移的任何传感器。因此，纵向可运动的驱动构件、击发构件、击发杆或I形梁或它们的组合可联接到任何合适的位移传感器。位移传感器可包括接触式位移传感器或非接触式位移传感器。位移传感器可包括线性可变差分变压器(LVDT)、差分可变磁阻换能器(DVRT)、滑动电位计、包括可运动磁体和一系列线性布置的霍尔效应传感器的磁感测系统、包括固定磁体和一系列可运动的线性布置的霍尔效应传感器的磁感测系统、包括可运动光源和一系列线性布置的光电二极管或光电检测器的光学感测系统、或包括固定光源和一系列可运动的线性布置的光电二极管或光电检测器的光学感测系统、或它们的任何组合。Thus, as used herein, the term displacement member is generally used to refer to any movable member of a surgical instrument or system as described herein, such as a drive member, firing member, firing rod, cutting instrument, knife, and/or I-beam, or Any element that can be displaced. Thus, theabsolute positioning system 153100 can actually track the displacement of the cutting instrument I-beam 153514 (FIG. 82) by tracking the displacement of the longitudinally movable drive member. In various other aspects, thedisplacement member 153111 can be coupled to any sensor suitable for measuring displacement. Accordingly, the longitudinally movable drive member, firing member, firing rod or I-beam or combination thereof may be coupled to any suitable displacement sensor. The displacement sensors may include contact displacement sensors or non-contact displacement sensors. Displacement sensors may include linear variable differential transformers (LVDTs), differential variable reluctance transducers (DVRTs), sliding potentiometers, magnetic sensing systems including movable magnets and a series of linearly arranged Hall effect sensors, including Magnetic sensing systems comprising a fixed magnet and a series of moveable linearly arranged Hall effect sensors, optical sensing systems comprising a moveable light source and a series of linearly arranged photodiodes or photodetectors, or a fixed light source and a series of Optical sensing system of movable linearly arranged photodiodes or photodetectors, or any combination thereof.

电动马达153120可包括与齿轮组件153114可操作地交接的可旋转轴153116，该齿轮组件安装成与位移构件153111上的驱动齿的组或齿条啮合接合。传感器元件153126可操作地联接到齿轮组件153114，使得传感器元件153126的单次旋转对应于位移构件153111的一些线性纵向平移。齿轮传动装置和传感器153118的布置可经由齿条和小齿轮布置方式连接至线性致动器，或者经由正齿轮或其他连接方式连接至旋转致动器。功率源153129将电力供应到绝对定位系统153100，并且输出指示器153128可显示绝对定位系统153100的输出。Theelectric motor 153120 may include a rotatable shaft 153116 operatively interfacing with agear assembly 153114 mounted in meshing engagement with a set or rack of drive teeth on thedisplacement member 153111.Sensor element 153126 is operably coupled togear assembly 153114 such that a single rotation ofsensor element 153126 corresponds to some linear longitudinal translation ofdisplacement member 153111. The arrangement of gearing andsensor 153118 may be connected to a linear actuator via a rack and pinion arrangement, or to a rotary actuator via a spur gear or other connection. Apower source 153129 supplies power to theabsolute positioning system 153100, and anoutput indicator 153128 can display the output of theabsolute positioning system 153100.

与位置传感器153112相关联的传感器元件153126的单次旋转等同于位移构件153111的纵向位移d₁，其中d₁为在联接到位移构件153111的传感器元件153126的单次旋转之后位移构件153111从点“a”运动到点“b”的纵向距离。可经由齿轮减速连接传感器布置153102，该齿轮减速使得位置传感器153112针对位移构件153111的全行程完成一次或多次旋转。位置传感器153112可针对位移构件153111的全行程完成多次旋转。A single rotation of thesensor element 153126 associated with the position sensor 153112 is equivalent to the longitudinal displacement d₁ of thedisplacement member 153111 , where d₁ is thedisplacement member 153111 from the point "a" moves the longitudinal distance to point "b". The sensor arrangement 153102 may be connected via a gear reduction that causes the position sensor 153112 to complete one or more revolutions for the full travel of thedisplacement member 153111. The position sensor 153112 can complete multiple rotations for the full travel of thedisplacement member 153111.

一系列开关153122a-153122n(其中n为大于一的整数)可单独或结合齿轮减速使用以针对位置传感器153112的不止一次旋转提供独特位置信号。开关153122a-153122n的状态被馈送回控制器153110，该控制器应用逻辑以确定对应于位移构件153111的纵向位移d₁+d₂+…d_n的独特位置信号。位置传感器153112的输出153124被提供给控制器153110。传感器布置153102的位置传感器153112可包括磁性传感器、模拟旋转传感器(比如电位计)、模拟霍尔效应元件的阵列，该模拟霍尔效应元件的阵列输出位置信号或值的独特组合。控制器153110可包含在主控制器内或可包含在根据本公开的外科器械或系统的工具安装部分外壳内。A series of switches 153122a-153122n (where n is an integer greater than one) can be used alone or in combination with gear reduction to provide a unique position signal for more than one rotation of the position sensor 153112. The states of switches 153122a-153122n are fed back tocontroller 153110, which applies logic to determine a unique position signal corresponding to longitudinal displacement d₁ +d₂ +...d_n ofdisplacement member 153111 . Theoutput 153124 of the position sensor 153112 is provided to thecontroller 153110. The position sensors 153112 of the sensor arrangement 153102 may include magnetic sensors, analog rotational sensors (such as potentiometers), an array of analog Hall effect elements that output a unique combination of position signals or values.Controller 153110 may be contained within a main controller or may be contained within a tool mounting portion housing of a surgical instrument or system according to the present disclosure.

绝对定位系统153100在外科器械或系统上电时提供位移构件153111的绝对位置，而不使位移构件153111回缩或推进到如常规旋转编码器可能需要的复位(清零或本位)位置，这些常规旋转编码器仅对马达153120采取的向前或向后的步骤数进行计数以推断装置致动器、驱动棒、刀等的位置。Theabsolute positioning system 153100 provides the absolute position of thedisplacement member 153111 when the surgical instrument or system is powered up without retracting or advancing thedisplacement member 153111 to a reset (zeroed or home) position as may be required by conventional rotary encoders that The rotary encoder simply counts the number of forward or backward steps taken by themotor 153120 to infer the position of the device actuators, drive rods, knives, etc.

可对控制器153110进行编程以执行各种功能，诸如对刀和关节运动系统的速度和位置的精确控制。在一个方面，控制器153110包括处理器153108和存储器153106。电动马达153120可为有刷直流马达，其具有齿轮箱以及到关节运动或刀系统的机械链接。在一个方面，马达驱动器153110可为可购自Allegro微系统公司(Allegro Microsystems,Inc)的A3941。其他马达驱动器可容易地被替换以用于绝对定位系统153100中。Thecontroller 153110 can be programmed to perform various functions, such as precise control of the speed and position of the knife and articulation system. In one aspect,controller 153110 includesprocessor 153108 andmemory 153106. Theelectric motor 153120 may be a brushed DC motor with a gearbox and mechanical link to the articulation or knife system. In one aspect, themotor driver 153110 may be A3941 available from Allegro Microsystems, Inc. Other motor drives can easily be replaced for use in theabsolute positioning system 153100.

控制器153110可被编程为提供对位移构件153111和关节运动系统的速度和位置的精确控制。控制器153110可被配置成能够计算控制器153110的软件中的响应。将计算的响应与实际系统的所测量响应进行比较，以获得“观察到的”响应，其用于实际反馈决定。观察到的响应为有利的调谐值，该值使所模拟响应的平滑连续性质与所测量响应均衡，其可检测对系统的外部影响。Thecontroller 153110 can be programmed to provide precise control of the speed and position of thedisplacement member 153111 and the articulation system. Thecontroller 153110 may be configured to be able to calculate the response in the software of thecontroller 153110. The calculated response is compared to the measured response of the actual system to obtain the "observed" response, which is used for actual feedback decisions. The observed response is a favorable tuning value that equalizes the smooth continuous nature of the simulated response with the measured response, which can detect external influences on the system.

绝对定位系统153100可包括并且/或者可被编程以实现反馈控制器，诸如PID、状态反馈和自适应控制器。功率源153129将来自反馈控制器的信号转换为对系统的物理输入，在这种情况下为电压。其它示例包括电压、电流和力的脉宽调制(PWM)。除了位置传感器153112所测量的位置之外，可提供一个或多个其他传感器153118以测量物理系统的物理参数。在数字信号处理系统中，绝对定位系统153100联接到数字数据采集系统，其中绝对定位系统153100的输出将具有有限分辨率和采样频率。绝对定位系统153100可包括比较和组合电路，以使用算法(诸如加权平均和理论控制环路)将计算响应与测量响应进行组合，该算法朝向测量响应驱动计算响应。物理系统的计算响应将特性如质量、惯性、粘性摩擦、电感电阻等考虑在内，以通过得知输入预测物理系统的状态和输出。Theabsolute positioning system 153100 may include and/or may be programmed to implement feedback controllers, such as PID, state feedback, and adaptive controllers. Thepower source 153129 converts the signal from the feedback controller into a physical input to the system, in this case a voltage. Other examples include pulse width modulation (PWM) of voltage, current and force. In addition to the position measured by the position sensor 153112, one or moreother sensors 153118 may be provided to measure physical parameters of the physical system. In a digital signal processing system, theabsolute positioning system 153100 is coupled to a digital data acquisition system, where the output of theabsolute positioning system 153100 will have limited resolution and sampling frequency. Theabsolute positioning system 153100 may include comparison and combination circuits to combine the calculated and measured responses using algorithms (such as weighted averages and theoretical control loops) that drive the calculated responses towards the measured responses. The computational response of a physical system takes into account properties such as mass, inertia, viscous friction, inductive resistance, etc., to predict the state and output of the physical system by knowing the inputs.

马达驱动器153110可为可购自Allegro微系统公司(Allegro Microsystems,Inc)的A3941。A3941驱动器153110为全桥控制器，其用于与针对电感负载(诸如有刷直流马达)特别设计的外部N沟道功率金属氧化物半导体场效应晶体管(MOSFET)一起使用。驱动器153110包括独特的电荷泵稳压器，其为低至7V的电池电压提供完整的(>10V)栅极驱动并且允许A3941在低至5.5V的减速栅极驱动下工作。可采用自举电容器提供N沟道MOSFET所需的上述电池供电电压。高边驱动装置的内部电荷泵允许直流(100％占空比)操作。可使用二极管或同步整流在快衰减模式或慢衰减模式下驱动全桥。在慢衰减模式下，电流再循环可穿过高边或低边FET。通过电阻器可调式空载时间保护功率FET不被击穿。整体诊断指示欠压、过热和功率桥故障，并且可被配置成能够在大多数短路状况下保护功率MOSFET。其他马达驱动器可容易地被替换以用于绝对定位系统153100中。Themotor driver 153110 may be A3941 available from Allegro Microsystems, Inc. TheA3941 driver 153110 is a full bridge controller for use with external N-channel power metal oxide semiconductor field effect transistors (MOSFETs) specially designed for inductive loads such as brushed DC motors.Driver 153110 includes a unique charge pump regulator that provides full (>10V) gate drive for battery voltages as low as 7V and allows the A3941 to operate down to 5.5V with reduced gate drive. A bootstrap capacitor can be used to provide the above-mentioned battery supply voltage required by the N-channel MOSFET. The internal charge pump of the high-side driver allows DC (100% duty cycle) operation. The full bridge can be driven in either fast decay mode or slow decay mode using diodes or synchronous rectification. In slow decay mode, current recirculation can pass through the high-side or low-side FET. Power FETs are protected from breakdown by resistor-adjustable dead time. Overall diagnostics indicate undervoltage, overtemperature, and power bridge failures, and can be configured to protect the power MOSFETs in most short-circuit conditions. Other motor drives can easily be replaced for use in theabsolute positioning system 153100.

图81为根据本公开的至少一个方面的绝对定位系统153100’的位置传感器153200的示意图，该绝对定位系统包括磁性旋转绝对定位系统。绝对定位系统153100'在许多方面类似于绝对定位系统153100。位置传感器153200可被实现为AS5055EQFT单片磁性旋转位置传感器，其可购自奥地利微系统公司(Austria Microsystems,AG)。位置传感器153200与控制器153110交接，以提供绝对定位系统153100’。位置传感器153200是低电压和低功率部件，并且在位置传感器153200的区域153230中包括四个霍尔效应元件153228A、153228B、153228C、153228D，该区域位于磁体上方，该磁体定位在与位移构件(诸如刀驱动齿轮和/或闭合驱动齿轮)相关联的旋转元件上，使得可以精确地跟踪击发构件和/或闭合构件的位移。在芯片上也提供了高分辨率ADC 153232和智能型功率管理控制器153238。CORDIC处理器153236(用于坐标旋转数字计算机(Coordinate Rotation DIgital Computer))，也称为逐位法和Volder算法，被设定为实现简单有效的算法来计算双曲线函数和三角函数，这些函数仅需要加法操作、减法操作、位位移操作和表查找操作。角位置、报警位和磁场信息通过标准串行通信接口诸如SPI接口153234传送到控制器153110。位置传感器153200提供12或14位分辨率。位置传感器153200可为以小QFN 16引脚4×4×0.85mm封装提供的AS5055芯片。81 is a schematic diagram of aposition sensor 153200 of an absolute positioning system 153100' including a magnetic rotary absolute positioning system in accordance with at least one aspect of the present disclosure. Absolute positioning system 153100' is similar toabsolute positioning system 153100 in many respects.Position sensor 153200 may be implemented as an AS5055EQFT monolithic magnetic rotary position sensor, available from Austria Microsystems, AG.Position sensor 153200 interfaces withcontroller 153110 to provide absolute positioning system 153100'. Theposition sensor 153200 is a low voltage and low power component and includes fourHall effect elements 153228A, 153228B, 153228C, 153228D in aregion 153230 of theposition sensor 153200 located above a magnet positioned in contact with a displacement member such as The knife drive gear and/or the closure drive gear) are associated with rotating elements so that the displacement of the firing member and/or the closure member can be accurately tracked. A high-resolution ADC 153232 and an intelligentpower management controller 153238 are also provided on-chip. The CORDIC processor 153236 (for the Coordinate Rotation DIgital Computer), also known as the bitwise and Volder algorithms, is designed to implement simple and efficient algorithms to compute hyperbolic and trigonometric functions that only Addition operations, subtraction operations, bit shift operations, and table lookup operations are required. Angular position, alarm bits and magnetic field information are communicated to thecontroller 153110 via a standard serial communication interface such as theSPI interface 153234. ThePosition Sensor 153200 offers 12 or 14 bit resolution. Theposition sensor 153200 is available as an AS5055 chip in a small QFN 16-pin 4×4×0.85mm package.

霍尔效应元件153228A、153228B、153228C、153228D位于旋转磁体正上方。霍尔效应是众所周知的效应，并且为了方便，本文中将不对其进行详细描述，但是，通常，霍尔效应在整个电导体上产生横向于导体中的电流的电压差(霍尔电压)以及垂直于电流的磁场。霍尔系数被定义为感应电场与电流密度和所施加磁场的乘积的比率。其为从中制备导体的材料的特性，因为其值取决于构成电流的电荷载体的类型、数目和性能。在AS5055位置传感器153200中，霍尔效应元件153228A、153228B、153228C、153228D能够产生电压信号，其指示根据磁体经过单次旋转的角度的磁体的绝对位置。由CORDIC处理器153236计算角度的这个值(其为独特位置信号)，并且将其以机载方式存储在寄存器或存储器中的AS5055位置传感器153200上。在多种技术中，如在上电时或在控制器153110发出请求时，向控制器153110提供角度的值，其指示经过一次旋转的磁体的位置。Hall effect elements 153228A, 153228B, 153228C, 153228D are located directly above the rotating magnets. The Hall effect is a well-known effect and for convenience will not be described in detail herein, however, in general, the Hall effect produces a voltage difference across an electrical conductor (Hall voltage) transverse to the current in the conductor as well as perpendicular to the the magnetic field of the current. The Hall coefficient is defined as the ratio of the induced electric field to the product of the current density and the applied magnetic field. It is a property of the material from which the conductor is made, as its value depends on the type, number and properties of the charge carriers that make up the current. In theAS5055 position sensor 153200, theHall effect elements 153228A, 153228B, 153228C, 153228D are capable of producing a voltage signal that indicates the absolute position of the magnet according to the angle through which the magnet has passed a single rotation. This value of the angle, which is a unique position signal, is calculated by theCORDIC processor 153236 and stored onboard on theAS5055 position sensor 153200 in a register or memory. In various techniques, such as at power-up or upon request from thecontroller 153110, thecontroller 153110 is provided with an angle value that indicates the position of the magnet through one rotation.

AS5055位置传感器153200在连接至控制器153110时仅需要几个外部部件就可操作。使用单一功率源的简单应用需要六根电线：两根电线用于功率，四根电线153240用于与控制器153110交接的SPI接口153234。可加入第七连接，以便向控制器153110发送中断以通知可读取新的有效角度。在上电时，AS5055位置传感器153200执行完全上电序列，包括一个角度测量结果。该循环的完成指示为INT输出153242，并且角度值存储在内部寄存器中。一旦设定了这一输出，AS5055位置传感器153200就暂停为休眠模式。控制器153110可通过SPI接口153234从AS5055位置传感器153200读取角度值来响应INT输出153242处的INT请求。一旦控制器153110读取了角度值，就再次清除INT输出153242。由控制器153110通过SPI接口153234向位置传感器153200发送“读取角度”命令也自动使芯片上电并且启动另一个角度测量。控制器153110一完成角度值的读取，就清除INT输出153242并且将新的结果存储在角度寄存器中。通过设定INT输出153242和状态寄存器中的对应标记再次指示角度测量的完成。TheAS5055 position sensor 153200 requires only a few external components to operate when connected to thecontroller 153110. A simple application using a single power source requires six wires: two wires for power and fourwires 153240 for theSPI interface 153234 that interfaces with thecontroller 153110. A seventh connection can be added to send an interrupt tocontroller 153110 to notify that a new valid angle can be read. At power-up, theAS5055 position sensor 153200 performs a full power-up sequence, including an angle measurement. The completion of the loop is indicated asINT output 153242 and the angle value is stored in an internal register. Once this output is set, theAS5055 position sensor 153200 is suspended into sleep mode. Thecontroller 153110 can respond to the INT request atINT output 153242 by reading the angle value from theAS5055 position sensor 153200 through theSPI interface 153234. Once thecontroller 153110 has read the angle value, it clears theINT output 153242 again. Sending a "read angle" command bycontroller 153110 toposition sensor 153200 viaSPI interface 153234 also automatically powers up the chip and initiates another angle measurement. As soon as thecontroller 153110 finishes reading the angle value, it clears theINT output 153242 and stores the new result in the angle register. Completion of the angle measurement is again indicated by setting theINT output 153242 and the corresponding flag in the status register.

由于AS5055位置传感器153200的测量原理，每个上电序列之后，在非常短的时间(～600μs)内仅执行单次角度测量。一个角度的测量一完成，AS5055位置传感器153200就暂停为掉电状态。未实现根据数字平均化的角度值的片上过滤，因为这将需要不止一个角度测量并且因此需要更长加电时间，这在低功率应用中是不期望的。可通过在控制器153110中对若干角度样品进行平均来减少角度抖动。例如，平均四个采样可使抖动减少6dB(50％)。Due to the measurement principle of theAS5055 position sensor 153200, only a single angle measurement is performed in a very short time (~600μs) after each power-up sequence. As soon as the measurement of an angle is completed, theAS5055 position sensor 153200 is suspended in a power-down state. On-chip filtering based on digitally averaged angle values is not implemented, as this would require more than one angle measurement and therefore longer power-up times, which is undesirable in low power applications. Angular jitter can be reduced by averaging several angular samples incontroller 153110. For example, averaging four samples can reduce jitter by 6dB (50%).

图82为根据本公开的至少一个方面的端部执行器153502的剖视图，其示出了相对于抓持在端部执行器153502内的组织153526的I形梁153514击发行程。端部执行器153502被配置成能够与根据本公开的任何外科器械或系统一起操作。端部执行器153502包括砧座153516和细长通道153503，其中钉仓153518定位在细长通道153503中。击发杆153520能够沿着端部执行器153502的纵向轴线153515朝远侧和朝近侧平移。当端部执行器153502不进行关节运动时，端部执行器153502与器械的轴成一直线。在击发构件153520的远侧部分处示出了包括切割刃153509的I形梁153514。楔形滑动件153513定位在钉仓153518中。当I形梁153514朝远侧平移时，切割刃153509接触并可切割定位在砧座153516与钉仓153518之间的组织153526。而且，I形梁153514接触楔形滑动件153513并将其朝远侧推动，从而致使楔形滑动件153513接触钉驱动器153511。钉驱动器153511可以被向上驱动到钉153505中，从而致使钉153505推进穿过组织并进入限定在砧座153516中的凹坑153507中，该凹坑使钉153505成形。82 is a cross-sectional view of theend effector 153502 showing the firing stroke of the I-beam 153514 relative totissue 153526 grasped within theend effector 153502, according to at least one aspect of the present disclosure. Theend effector 153502 is configured to be operable with any surgical instrument or system in accordance with the present disclosure. Theend effector 153502 includes ananvil 153516 and anelongated channel 153503 with astaple cartridge 153518 positioned in theelongated channel 153503. The firingrod 153520 can be translated distally and proximally along thelongitudinal axis 153515 of theend effector 153502. When theend effector 153502 is not articulating, theend effector 153502 is aligned with the axis of the instrument. An I-beam 153514 including acutting edge 153509 is shown at the distal portion of the firingmember 153520. Thewedge slide 153513 is positioned in thestaple cartridge 153518. As the I-beam 153514 is translated distally, thecutting edge 153509 contacts and can cuttissue 153526 positioned between theanvil 153516 and thestaple cartridge 153518. Also, the I-beam 153514 contacts and pushes thewedge slide 153513 distally, causing thewedge slide 153513 to contact thestaple driver 153511. Thestaple driver 153511 can be driven up into thestaples 153505, causing thestaples 153505 to be advanced through tissue and into pockets 153507 defined in theanvil 153516, which shape thestaples 153505.

示例性I形梁153514击发行程由与端部执行器153502对齐的图表153529示出。还示出了与端部执行器153502对齐的示例性组织153526。击发构件行程可包括行程开始位置153527和行程结束位置153528。在I形梁153514击发行程期间，I形梁153514可以从行程开始位置153527朝远侧推进到行程结束位置153528。I形梁153514示出在行程开始位置153527的一个示例性位置处。I形梁153514击发构件行程图表153529示出了五个击发构件行程区域153517、153519、153521、153523、153525。在第一击发行程区域153517中，I形梁153514可以开始朝远侧推进。在第一击发行程区域153517中，I形梁153514可以接触楔形滑动件153513并开始朝远侧运动它。然而，在第一区域中，切割刃153509可以不接触组织，并且楔形滑动件153513可以不接触钉驱动器153511。在克服静摩擦力之后，在第一区域153517中驱动I形梁153514的力可以是基本恒定的。An exemplary I-beam 153514 firing stroke is shown bygraph 153529 aligned withend effector 153502.Exemplary tissue 153526 aligned with theend effector 153502 is also shown. The firing member stroke may include astroke start position 153527 and anend stroke position 153528. During the firing stroke of the I-beam 153514, the I-beam 153514 can be advanced distally from thestroke start position 153527 to thestroke end position 153528. The I-beam 153514 is shown at one exemplary position of thestroke start position 153527. The I-beam 153514 firingmember travel chart 153529 shows five firingmember travel areas 153517, 153519, 153521, 153523, 153525. In the first region of firingstroke 153517, the I-beam 153514 may begin to advance distally. In the firstfiring stroke region 153517, the I-beam 153514 can contact thewedge slide 153513 and begin to move it distally. However, in the first region, thecutting edge 153509 may not contact the tissue and thewedge slide 153513 may not contact thestaple driver 153511. After overcoming the static friction force, the force driving the I-beam 153514 in thefirst region 153517 may be substantially constant.

在第二击发构件行程区域153519中，切割刃153509可以开始接触并切割组织153526。而且，楔形滑动件153513可以开始接触钉驱动器153511以驱动钉153505。驱动I形梁153514的力可以开始斜升。如图所示，由于砧座153516相对于钉仓153518枢转的方式，起初遇到的组织可以被压缩和/或变薄。在第三击发构件行程区域153521中，切割刃153509可以连续地接触并切割组织153526，并且楔形滑动件153513可以重复地接触钉驱动器153511。驱动I形梁153514的力可以在第三区域153521中平稳。通过第四击发行程区域153523，驱动I形梁153514的力可能开始下降。例如，端部执行器153502的对应于第四击发区域153523的部分中的组织可以比更靠近砧座153516的枢转点的组织压缩得更少，从而需要更少的切割力。而且，切割刃153509和楔形滑动件153513可以在第四区域153523中时到达组织153526的端部。当I形梁153514到达第五区域153525时，组织153526可以被完全切断。楔形滑动件153513可以在组织的端部处或附近接触一个或多个钉驱动器153511。可以减小使I形梁153514推进通过第五区域153525的力，并且在一些示例中，该力可以类似于在第一区域153517中驱动I形梁153514的力。在击发构件行程结束时，I形梁153514可以到达行程结束位置153528。图82中的击发构件行程区域153517、153519、153521、153523、153525的定位仅是一个示例。在一些示例中，例如，基于组织在砧座153516和钉仓153518之间的定位，不同区域可以沿着端部执行器纵向轴线153515在不同位置处开始。In the second firingmember travel region 153519, thecutting edge 153509 can begin to contact and cut thetissue 153526. Also, thewedge slide 153513 can come into contact with thestaple driver 153511 to drive thestaples 153505. The force driving the I-beam 153514 can begin to ramp up. As shown, due to the manner in which theanvil 153516 pivots relative to thestaple cartridge 153518, initially encountered tissue may be compressed and/or thinned. In the third firingmember travel region 153521, thecutting edge 153509 can continuously contact and cut thetissue 153526, and thewedge slide 153513 can repeatedly contact thestaple drivers 153511. The force driving the I-beam 153514 may level off in thethird region 153521. Through the fourthfiring stroke region 153523, the force driving the I-beam 153514 may begin to drop. For example, tissue in the portion of theend effector 153502 corresponding to thefourth firing region 153523 may compress less than tissue closer to the pivot point of theanvil 153516, requiring less cutting force. Also, thecutting edge 153509 and thewedge slide 153513 can reach the end of thetissue 153526 when in thefourth region 153523. When the I-beam 153514 reaches thefifth region 153525, thetissue 153526 can be completely severed. Thewedge slider 153513 can contact one or morestaple drivers 153511 at or near the ends of the tissue. The force that propels the I-beam 153514 through thefifth region 153525 can be reduced, and in some examples, can be similar to the force that drives the I-beam 153514 in thefirst region 153517. At the end of the firing member travel, the I-beam 153514 may reach the end oftravel position 153528. The positioning of the firingmember travel areas 153517, 153519, 153521, 153523, 153525 in Figure 82 is but one example. In some examples, different regions may begin at different locations along the end effectorlongitudinal axis 153515, eg, based on the positioning of tissue between theanvil 153516 and thestaple cartridge 153518.

如上所述并且现在参见图80至图82，可利用定位在外科器械的主控制器内的电动马达153120来使轴组件的击发系统(包括I形梁153514)相对于轴组件的端部执行器153502推进和/或回缩，以便缝合和/或切入在端部执行器153502内捕集的组织。I形梁153514可以期望的速度或在期望的速度范围内推进或回缩。控制器153110可被配置成能够控制I形梁153514的速度。控制器153110可被配置成能够基于例如向电动马达153120提供的功率的各种参数(诸如电压和/或电流)和/或电动马达153120的其他操作参数或外部影响来预测I形梁153514的速度。控制器153110可被配置成能够基于向电动马达153120提供的电流和/或电压的先前值和/或系统的先前状态(如速度、加速度和/或位置)来预测I形梁153514的当前速度。控制器153110可被配置成能够利用本文所述的绝对定位传感器系统感测I形梁153514的速度。控制器可被配置成能够将I形梁153514的预测速度与I形梁153514的感测速度进行比较，以确定是否应当增加电动马达153120的功率以便增加I形梁153514的速度并且/或者减小功率以便减小I形梁153514的速度。As described above and referring now to FIGS. 80-82 , the firing system of the shaft assembly (including the I-beam 153514 ) may be positioned relative to the end effector of the shaft assembly using anelectric motor 153120 positioned within the main controller of thesurgical instrument 153502 is advanced and/or retracted for stapling and/or cutting into tissue captured withinend effector 153502. The I-beam 153514 can be advanced or retracted at a desired speed or within a desired range of speeds. Thecontroller 153110 may be configured to control the speed of the I-beam 153514. Thecontroller 153110 may be configured to be able to predict the speed of the I-beam 153514 based on, for example, various parameters of the power supplied to the electric motor 153120 (such as voltage and/or current) and/or other operating parameters of theelectric motor 153120 or external influences . Thecontroller 153110 may be configured to predict the current speed of the I-beam 153514 based on previous values of current and/or voltage provided to theelectric motor 153120 and/or previous states of the system (eg, speed, acceleration, and/or position). Thecontroller 153110 may be configured to sense the speed of the I-beam 153514 using the absolute positioning sensor system described herein. The controller may be configured to be able to compare the predicted speed of the I-beam 153514 to the sensed speed of the I-beam 153514 to determine whether the power of theelectric motor 153120 should be increased in order to increase the speed of the I-beam 153514 and/or decrease power in order to reduce the speed of the I-beam 153514.

可以使用各种技术来确定作用在I形梁153514上的力。I形梁153514力可通过测量马达153120电流来确定，其中马达153120电流基于I形梁153514当期朝远侧推进时所经历的负载。可通过将应变仪定位在驱动构件、击发构件、I形梁153514、击发杆和/或切割刃153509的近侧端部上来确定I形梁153514力。可通过监测以基于在预先确定的经过时间段T₁之后马达153120的当前设定速度的预期速度运动的I形梁153514的实际位置并且将I形梁153514的实际位置与基于时间段T₁结束处马达153120的当前设定速度的I形梁153514的预期位置进行比较来确定I形梁153514力。因此，如果I形梁153514的实际位置小于I形梁153514的预期位置，则I形梁153514上的力大于标称力。相反，如果I形梁153514的实际位置大于I形梁153514的预期位置，则I形梁153514上的力小于标称力。I形梁153514的实际位置和预期位置之间差值跟I形梁153514上的力与标称力的偏差成比例。Various techniques can be used to determine the force acting on the I-beam 153514. The I-beam 153514 force can be determined by measuring themotor 153120 current, where themotor 153120 current is based on the load experienced by the I-beam 153514 while advancing distally. The I-beam 153514 force can be determined by positioning strain gauges on the proximal end of the drive member, firing member, I-beam 153514, firing rod, and/or cuttingedge 153509. This may be accomplished by monitoring the actual position of the I-beam 153514 moving at an expected speed based on the current set speed of themotor 153120 after_a predetermined elapsed time period T1 and comparing the actual position of the I-beam 153514 with the actual position based_on the time period T1 The I-beam 153514 force is determined by comparing the expected position of the I-beam 153514 at the current set speed of themotor 153120. Therefore, if the actual position of the I-beam 153514 is less than the expected position of the I-beam 153514, the force on the I-beam 153514 is greater than the nominal force. Conversely, if the actual position of the I-beam 153514 is greater than the expected position of the I-beam 153514, the force on the I-beam 153514 is less than the nominal force. The difference between the actual and expected position of the I-beam 153514 is proportional to the deviation of the force on the I-beam 153514 from the nominal force.

在转向对闭合管和击发构件的闭环控制技术的描述之前，描述简要地转向图83。图83为描绘两个闭合力(FTC)曲线153606、153608的曲线图153600(其描绘了在闭合阶段期间施加到闭合构件以在厚和薄组织上闭合的力)以及描绘两个击发力(FTF)曲线153622、153624的曲线图153601(其描绘了在击发阶段期间施加到击发构件以通过厚和薄组织进行击发的力)。参见图83，曲线图153600描绘了在闭合行程期间施加到厚和薄组织以相对于抓持在砧座153516和钉仓153518之间的组织闭合端部执行器153502的力的示例，其中闭合力被绘制为时间的函数。在两个轴上绘制闭合力曲线153606、153608。垂直轴153602指示以牛顿(N)为单位的端部执行器153502的闭合力(FTC)。水平轴153604指示以秒为单位的时间，并且为了描述清楚起见标记为t₀至t₁₃。第一闭合力曲线153606是在闭合行程期间施加到厚组织以相对于抓持在砧座153516和钉仓153518之间的组织闭合端部执行器153502的力的示例，并且第二曲线153608是在闭合行程期间施加到薄组织以相对于抓持在砧座153516和钉仓153518之间的组织闭合端部执行器153502的力的示例。第一闭合力曲线153606和第二闭合力曲线153608被分为三个阶段：闭合行程(CLOSE)、等待周期(WAIT)和击发行程(FIRE)。在闭合行程期间，闭合管朝远侧(方向“DD”)平移以响应于闭合马达对闭合行程的致动，使砧座153516例如相对于钉仓153518运动。在其他情况下，闭合行程涉及响应于闭合马达的致动使钉仓153518相对于砧座153516运动，并且在其他情况下，闭合行程涉及响应于闭合马达的致动而运动钉仓153518和砧座153516。参考第一闭合力曲线153606，在闭合行程期间，闭合力153610从时间t₀到t₁从0增加到最大力F₁。参考第二闭合力曲线153608，在闭合行程期间，闭合力153616从时间t₀到t₁从0增加到最大力F₃。最大力F₁和F₃之间的相对差是由于厚组织相对于薄组织所需的闭合力的差值引起的，其中与薄组织相比，需要更大的力才能将砧座闭合到厚组织上。The description briefly turns to FIG. 83 before turning to the description of the closed-loop control technique of the closed tube and firing member. Figure 83 is agraph 153600 depicting two force of closure (FTC) curves 153606, 153608 (which depict the force applied to the closure member to close on thick and thin tissue during the closure phase) and two firing forces (Graph 153601 of FTF) curves 153622, 153624 (which depict the force applied to the firing member during the firing phase to fire through thick and thin tissue). Referring to FIG. 83, agraph 153600 depicts an example of the force applied to thick and thin tissue to close theend effector 153502 relative to tissue grasped between theanvil 153516 and thestaple cartridge 153518 during the closing stroke, wherein the closing force is plotted as a function of time. The closing force curves 153606, 153608 are plotted on both axes. Thevertical axis 153602 indicates the force to close (FTC) of theend effector 153502 in Newtons (N). The horizontal axis 153604 indicates time in seconds and is labeled t₀ to t₁₃ for clarity of description. The firstclosing force curve 153606 is an example of the force applied to thick tissue during the closing stroke to close theend effector 153502 relative to tissue grasped between theanvil 153516 and thestaple cartridge 153518, and the second curve 153608 is at An example of the force applied to thin tissue to close theend effector 153502 against tissue grasped between theanvil 153516 and thestaple cartridge 153518 during the closing stroke. The firstclosing force curve 153606 and the second closing force curve 153608 are divided into three phases: closing stroke (CLOSE), waiting period (WAIT), and firing stroke (FIRE). During the closing stroke, the closure tube is translated distally (direction "DD") to move theanvil 153516, eg, relative to thestaple cartridge 153518, in response to actuation of the closing stroke by the closing motor. In other cases, the closing stroke involves moving thestaple cartridge 153518 relative to theanvil 153516 in response to actuation of the closing motor, and in other cases, the closing stroke involves moving thestaple cartridge 153518 and the anvil in response to actuation of theclosing motor 153516. Referring to the firstclosing force curve 153606, during the closing stroke, the closing force₁₅₃₆₁₀ increases from 0 to the maximum force F1 from time_t0 to_t1 . Referring to the second closing force curve 153608, during the closing stroke, the closing force₁₅₃₆₁₆ increases from 0 to the maximum force F3 from time_t0 to_t1 ._The relative difference between the maximum forces F1 and_F3 is due to the difference in the closing force required for thick tissue versus thin tissue, where more force is required to close the anvil to a thick tissue compared to thin tissue. Organizationally.

第一闭合力曲线153606和第二闭合力曲线153608指示端部执行器153502中的闭合力在时间(t₁)处结束的初始夹持时间段期间增加。闭合力在时间(t₁)处达到最大力(F₁,F₃)。初始夹持时间段可例如为约一秒。可以在启动击发行程之前施加等待周期。等待周期允许流体从被端部执行器153502压缩的组织流出，这减小了压缩组织的厚度，从而在砧座153516和钉仓153518之间产生了较小的间隙，并且在等待周期结束时减小了闭合力。参考第一闭合力曲线153606，在t₁至t₄之间的等待周期期间，闭合力153612从F₁到F₂出现标称下降。类似地，参考第二闭合力曲线153608，在t₁至t₄之间的等待周期期间，闭合力153618从F₃到F₄标称地下降。在一些示例中，通常采用选自约10秒至约20秒的范围的等待周期(t₁至t₄)。在示例性第一闭合力曲线153606和第二闭合力曲线153608中，采用约15秒的时间段。等待周期在击发行程之后，该击发行程通常持续选自例如约3秒至例如约5秒的范围的时间段。随着I形梁153514相对于端部执行器推进通过击发行程，闭合力减小。分别如第一闭合力曲线153606和第二闭合力曲线153608的闭合力153614、153620所指示，施加在闭合管上的闭合力153614、153620从约时间t₄到约时间t₅急剧下降。时间t₄表示I形梁153514联接到砧座153516中并开始承受闭合负载的时刻。因此，如第一击发力曲线153622和第二击发力曲线153624所示，闭合力随着击发力增加而减小。The firstclosing force curve 153606 and the second closing force curve 153608 indicate that the closing force in theend effector 153502 increased during the initial clamping period ending at time (t₁ ). The closing force reaches a maximum force (F₁ , F₃ ) at time (t₁ ). The initial clamping period may be, for example, about one second. A waiting period may be applied before initiating the firing stroke. The wait period allows fluid to flow out of the tissue compressed by theend effector 153502, which reduces the thickness of the compressed tissue, thereby creating a smaller gap between theanvil 153516 and thestaple cartridge 153518, and reducing the amount of pressure at the end of the wait period. Reduced closing force. Referring to the first closing force curve₁₅₃₆₀₆ , during the waiting period between_t1 and t4, the closing force₁₅₃₆₁₂ experiences_a nominal drop from F1 to F2. Similarly, referring to the second closing force curve₁₅₃₆₀₈ , the closing force₁₅₃₆₁₈ drops nominally from F3 to_F4 during the waiting period between_t1 and t4. In some examples, a wait period (t₁ to t₄ ) selected from the range of about 10 seconds to about 20 seconds is typically employed. In the exemplary firstclosing force curve 153606 and second closing force curve 153608, a time period of about 15 seconds is employed. The waiting period follows the firing stroke, which typically lasts for a time period selected from the range of, eg, about 3 seconds to, eg, about 5 seconds. The closing force decreases as the I-beam 153514 advances through the firing stroke relative to the end effector. Closingforces 153614, 153620 exerted_on the closing tube decrease sharply from about time t4 to about time t5, as indicated by the closing forces₁₅₃₆₁₄ , 153620 of the firstclosing force curve 153606 and second closing force curve 153608, respectively. Time t₄ represents the moment when the I-beam 153514 is coupled into theanvil 153516 and begins to experience the closing load. Thus, as shown by the firstfiring force curve 153622 and the secondfiring force curve 153624, the closing force decreases as the firing force increases.

图83还描绘了根据本公开的第一击发力曲线153622和第二击发力曲线153624的曲线图153601，其绘制了在外科器械或系统的击发行程期间施加以推进I形梁153514的力。在两个轴上绘制击发力曲线153622、153624。垂直轴153626指示在击发行程期间施加以推进I形梁153514的以牛顿(N)为单位的击发力。I形梁153514被构造成能够推进刀或切割元件并且在击发行程期间激励驱动器以部署钉。水平轴153605以与上部曲线图153600的水平轴153604相同的时间标度指示以秒为单位的时间。83 also depicts agraph 153601 of a firstfiring force curve 153622 and a secondfiring force curve 153624 that plot the force applied to advance the I-beam 153514 during the firing stroke of the surgical instrument or system in accordance with the present disclosure . Firing force curves 153622, 153624 are plotted on both axes. Thevertical axis 153626 indicates the firing force in Newtons (N) applied to advance the I-beam 153514 during the firing stroke. The I-beam 153514 is configured to advance the knife or cutting element and actuate the driver to deploy the staples during the firing stroke. Thehorizontal axis 153605 indicates time in seconds on the same time scale as the horizontal axis 153604 of theupper graph 153600.

如前所述，闭合管力从时间t₄到约时间t₅急剧下降，这表示I形梁153514联接到砧座153516中并开始承受负载并且闭合力随着击发力的增加而减小的时刻，如第一击发力曲线153622和第二击发力曲线153624所示。当I形梁153514从时间t₄时的行程开始位置推进，对于薄组织，击发力曲线153624到t₈和t₉之间的行程结束位置，以及对于厚组织，击发力曲线153622到t₁₃时的行程结束位置。当I形梁153514在击发行程期间向远侧推进时，闭合组件将对钉仓153518和砧座153516的控制交给击发组件，这导致击发力增加而闭合力减小。As previously mentioned, the closing tube force drops sharply from time t₄ to about time t₅ , which indicates that the I-beam 153514 is coupled into theanvil 153516 and begins to bear the load and the closing force decreases as the firing force increases time, as shown in the firstfiring force curve 153622 and the secondfiring force curve 153624. As the I-beam₁₅₃₅₁₄ advances from the start of stroke position at time t4, the firing force curve₁₅₃₆₂₄ to the end of travel position between t8 and t9 for thin tissue, and the firing force curve₁₅₃₆₂₂ to t for thick tissue The end of the trip at_13:00 . As the I-beam 153514 is advanced distally during the firing stroke, the closure assembly hands control of thestaple cartridge 153518 andanvil 153516 to the firing assembly, which results in an increase in the firing force and a decrease in the closing force.

在厚组织击发力曲线153622中，在击发周期(FIRE)期间，曲线153622被分成三个不同段。第一段153628指示在击发力从t₄处的0增加到恰好在t₅之前的峰值力F₁’时的击发力。第一段153628是在击发行程的初始阶段期间的击发力，其中I形梁153514从闭合斜坡的顶部朝远侧推进直到I形梁153514接触组织。第二段153630指示在击发行程的第二阶段期间的击发力，其中I形梁153514正在朝远侧推进，从而部署钉并切割组织。在击发行程的第二阶段期间，击发力在约t₁₂处从F₁’下降到F₂’。第三段153632指示在击发行程的第三阶段和最后阶段期间的击发力，其中I形梁153514离开组织并推进到无组织区域中的行程终点。在击发行程的第三阶段期间，击发力在约t₁₃处从F₂’下降到零(0)，其中I形梁153514到达行程终点。总之，在击发行程期间，当I形梁153514进入组织区域时，击发力急剧上升，在缝合和切割操作期间，击发力在组织区域中稳定下降，而当I形梁153514离开组织区域并在行程终点进入无组织区域时，击发力急剧下降。In the thick tissue firingforce curve 153622, during the firing cycle (FIRE), thecurve 153622 is divided into three distinct segments. Thefirst segment 153628 indicates the firing force as the firing force increases from 0 at t₄ to the peak force F₁ ′ just before t₅ . Thefirst segment 153628 is the firing force during the initial phase of the firing stroke, where the I-beam 153514 is advanced distally from the top of the closure ramp until the I-beam 153514 contacts tissue. Thesecond segment 153630 indicates the firing force during the second stage of the firing stroke, where the I-beam 153514 is being advanced distally, deploying the staples and cutting tissue. During the_second stage of the firing stroke, the firing force drops from F1_' to F2' at about_t12 . Thethird segment 153632 indicates the firing force during the third and final stage of the firing stroke, where the I-beam 153514 leaves the tissue and advances to the end of the stroke in the disorganized region. During the third stage of the firing stroke, the firing force drops from F2' to zero (₀ ) at about_t13 , where the I-beam 153514 reaches the end of the stroke. In summary, during the firing stroke, the firing force rose sharply as the I-beam 153514 entered the tissue area, during the stapling and cutting operations, the firing force decreased steadily in the tissue area, and as the I-beam 153514 exited the tissue area and At the end of the stroke into the unstructured area, the firing force drops sharply.

薄组织击发力曲线153624遵循与厚组织击发力曲线153622相同的图案。因此，在击发行程的第一阶段期间，击发力153634在约t₅处从0急剧增加到F₃’。在击发行程的第二阶段期间，击发力153636在约t₈处从F₃’稳定下降到F₄’。在击发行程的最后阶段期间，击发力153638在t₈和t₉之间从F’₄急剧下降到0。Thin tissue firingforce curve 153624 follows the same pattern as thick tissue firingforce curve 153622. Thus, during the first stage of the firing stroke, the firing force₁₅₃₆₃₄ increases sharply from₀ to F3' at approximately t5. During the second stage_of the firing stroke, the firing force₁₅₃₆₃₆ dropped steadily from F3' to_F4 ' at about t8. During the final stage of the firing stroke, the firing force₁₅₃₆₃₈ dropped sharply from_F'4 to₀ between t8 and t9.

为了克服闭合力从时间t₄到约时间t₅的急剧下降，这表示I形梁153514联接到砧座153516中并开始承受负载并且闭合力随着击发力的增加而减小的时刻，如第一击发力曲线153622和第二击发力曲线153624所示，闭合管可在击发构件(诸如I形梁153514)朝远侧推进的同时朝远侧推进。闭合管被表示为将闭合力施加到砧座153516的传动装置元件。如本文所述，控制电路将马达设定点施加到马达控制，该马达控制将马达控制信号施加到马达，以驱动传动装置元件并使闭合管朝远侧前进，以向砧座153516施加闭合力。联接到马达的输出轴的扭矩传感器可用于测量施加到闭合管的力。在其他方面，闭合力可用应变仪、负荷传感器或其他合适的力传感器来测量。_In order to overcome the sharp drop in closing force from time t4 to about time t5, this represents the moment when the I-beam₁₅₃₅₁₄ is coupled into theanvil 153516 and begins to experience load and the closing force decreases with increasing firing force, as in As shown in the firstfiring force curve 153622 and the secondfiring force curve 153624, the closure tube can be advanced distally at the same time the firing member (such as the I-beam 153514) is advanced distally. The closure tube is represented as the actuator element that applies the closure force to theanvil 153516. As described herein, the control circuit applies a motor setpoint to a motor control that applies a motor control signal to the motor to drive the actuator element and distally advance the closure tube to apply a closure force to theanvil 153516 . A torque sensor coupled to the output shaft of the motor can be used to measure the force applied to the closed tube. In other aspects, the closing force may be measured with strain gauges, load cells, or other suitable force sensors.

图84为根据本公开的至少一个方面的控制系统153950的示意图，该控制系统被配置成能够在击发构件(例如，I形梁153514)朝远侧推进并且联接到夹持臂(例如，砧座153516)时提供闭合构件(例如，闭合管)的逐渐闭合，从而以期望的速率降低闭合构件上的闭合力负载并减小击发构件上的击发力负载。在一个方面，控制系统153950可被实现为嵌套PID反馈控制器。PID控制器是控制环路反馈机构(控制器)，其用于将误差值连续地计算为期望的设定点和测量的过程变量之间的差值，并基于比例、积分和导数项(有时分别表示为P、I和D)施加校正。嵌套PID控制器反馈控制系统153950包括初级(外部)反馈环路153954中的主控制器153952和次级(内部)反馈环路153956中的次级控制器153955。主控制器153952可为如图84中所示的PID控制器153972，并且次级控制器153955也可为如图85中所示的PID控制器153972。主控制器153952控制初级过程153958，并且次级控制器153955控制次级过程153960。初级过程153958的输出153966(OUTPUT)为从主设定点SP₁减去第一求和器153962。第一求和器153962产生施加到主控制器153952的单个和输出信号。主控制器153952的输出为次级设定点SP₂。次级过程153960的输出153968为从次级设定点SP₂减去第二求和器153964。84 is a schematic diagram of acontrol system 153950 configured to be capable of distally advancing a firing member (eg, I-beam 153514 ) and coupled to a clamping arm (eg, an anvil) in accordance with at least one aspect of the present disclosure 153516) to provide gradual closure of the closure member (eg, closure tube) to reduce the closure force load on the closure member and the firing force load on the firing member at a desired rate. In one aspect, thecontrol system 153950 may be implemented as a nested PID feedback controller. A PID controller is a control loop feedback mechanism (controller) that is used to continuously calculate the error value as the difference between the desired set point and the measured process variable, based on proportional, integral and derivative terms (sometimes Denoted as P, I and D, respectively) Correction is applied. Nested PID controllerfeedback control system 153950 includesprimary controller 153952 in primary (outer)feedback loop 153954 andsecondary controller 153955 in secondary (inner)feedback loop 153956. Theprimary controller 153952 may be thePID controller 153972 as shown in FIG. 84 , and thesecondary controller 153955 may also be thePID controller 153972 as shown in FIG. 85 .Primary controller 153952 controlsprimary process 153958 andsecondary controller 153955 controlssecondary process 153960. The output 153966 (OUTPUT) of theprimary process 153958 is the subtraction of the_firstsummer 153962 from the main set point SP1. Thefirst summer 153962 produces a single sum output signal that is applied to themain controller 153952. The output of the primary controller₁₅₃₉₅₂ is the secondary set point SP2. Theoutput 153968 of thesecondary process 153960 is the_secondsummer 153964 subtracted from the secondary set point SP2.

在控制闭合管的位移的情形中，控制系统153950可被配置成使得主设定点SP₁为期望的闭合力值，并且主控制器153952被配置成能够从联接到闭合马达的输出的扭矩传感器接收闭合力并且确定闭合马达的设定点SP₂马达速度。在其它方面，闭合力可用应变仪、负荷传感器或其它合适的力传感器来测量。将闭合马达速度设定点SP₂与闭合管的实际速度进行比较，该实际速度由次级控制器153955确定。闭合管的实际速度可以通过比较闭合管与位置传感器的位移并用计时器/计数器测量耗用的时间来测量。可采用其它技术诸如线性编码器或旋转编码器来测量闭合管的位移。次级过程153960的输出153968为闭合管的实际速度。将该闭合管速度输出153968提供给初级过程153958，该初级过程确定作用于闭合管上的力并反馈回到加法器153962，该加法器从主设定点SP₁减去测量的闭合力。主设定点SP₁可为上限阈值或下限阈值。基于加法器153962的输出，主控制器153952如本文所述控制闭合管马达的速度和方向。次级控制器153955基于由次级过程153960测量的闭合管的实际速度和次级设定点SP₂来控制闭合马达的速度，该速度基于实际击发力与击发力上限阈值和下限阈值的比较。In the case of controlling the displacement of the closure tube, thecontrol system 153950 can be configured such that the master set point SP1 is the desired closing force value, and the master controller₁₅₃₉₅₂ is configured to enable the torque sensor from a torque sensor coupled to the output of the closure motor The closing force is received and the set point SP₂ motor speed of the closing motor is determined. In other aspects, the closing force may be measured with strain gauges, load cells, or other suitable force sensors. The closing motor speed setpoint SP₂ is compared to the actual speed of the closing tube, which is determined by thesecondary controller 153955. The actual velocity of the closed tube can be measured by comparing the displacement of the closed tube with the position sensor and measuring the elapsed time with a timer/counter. Other techniques such as linear encoders or rotary encoders may be employed to measure the displacement of the closed tube. Theoutput 153968 of thesecondary process 153960 is the actual velocity of the closed tube. This closedtube speed output 153968 is provided to aprimary process 153958 which determines the force acting on the closed tube and feeds back to a summer₁₅₃₉₆₂ which subtracts the measured closure force from the main set point SP1. The main set point SP₁ may be an upper threshold or a lower threshold. Based on the output of theadder 153962, themain controller 153952 controls the speed and direction of the closed tube motor as described herein. Thesecondary controller 153955 controls the speed of the closing motor based on the actual speed of the closing tube measured by thesecondary process 153960 and the secondary set point SP₂ , which speed is based on the actual firing force and the firing force upper and lower thresholds. Compare.

图85示出了根据本公开的至少一个方面的PID反馈控制系统153970。主控制器153952或次级控制器153955或两者可被实现为PID控制器153972。在一个方面，PID控制器153972可包括比例元件153974(P)、积分元件153976(I)和导数元件153978(D)。P元件153974、I元件153976、D元件153978的输出由求和器153986求和，该求和器向过程153980提供控制变量u(t)。过程153980的输出为过程变量y(t)。求和器153984计算期望的设定点r(t)和测量的过程变量y(t)之间的差值。PID控制器153972将误差值e(t)(例如，闭合力阈值和测得的闭合力之间的差值)连续地计算为期望的设定点r(t)(例如，闭合力阈值)与测量的过程变量y(t)(例如，闭合管的速度和方向)之间的差值，并且基于分别由比例元件153974(P)、积分元件153976(I)和导数元件153978(D)计算出的比例、积分和导数项来施加校正。PID控制器153972尝试通过调节控制变量u(t)(例如，闭合管的速度和方向)来最小化随时间变化的误差e(t)。85 illustrates a PIDfeedback control system 153970 in accordance with at least one aspect of the present disclosure.Primary controller 153952 orsecondary controller 153955 or both may be implemented asPID controller 153972. In one aspect, thePID controller 153972 may include a proportional element 153974 (P), an integral element 153976 (I), and a derivative element 153978 (D). The outputs ofP element 153974, Ielement 153976,D element 153978 are summed bysummer 153986, which provides control variable u(t) toprocess 153980. The output ofprocess 153980 is the process variable y(t). Asummer 153984 calculates the difference between the desired set point r(t) and the measured process variable y(t). ThePID controller 153972 continuously calculates the error value e(t) (eg, the difference between the closing force threshold and the measured closing force) as the desired setpoint r(t) (eg, the closing force threshold) and the The difference between the measured process variables y(t) (e.g., velocity and direction of the closed tube), and based on those calculated by proportional element 153974 (P), integral element 153976 (I), and derivative element 153978 (D), respectively The proportional, integral and derivative terms are used to apply the correction. ThePID controller 153972 attempts to minimize the time-varying error e(t) by adjusting the control variables u(t) (eg, the speed and direction of the closed tube).

根据PID算法，“P”元件153974计算误差的当前值。例如，如果误差为大的且为正的，那么控制输出也将为大的和正的。根据本公开，误差项e(t)在闭合管的期望闭合力和所测量的闭合力之间是不同的。“I”元件153976计算误差的过去值。例如，如果当前输出不够强，那么误差的积分会随着时间推移而累积，并且控制器将通过施加更强的动作进行响应。“D”元件153978根据其当前的变化率计算该误差的未来可能趋势。例如，在继续上述P示例的情况下，当大的正控制输出成功地使误差更接近于零时，它也将过程置于最近的将来的大的负误差的路径中。在这种情况下，导数变为负，并且D模块减小动作的强度以防止该过冲。According to the PID algorithm, the "P"element 153974 calculates the current value of the error. For example, if the error is large and positive, the control output will also be large and positive. According to the present disclosure, the error term e(t) differs between the expected closing force of the closed tube and the measured closing force. The "I"element 153976 calculates the past value of the error. For example, if the current output is not strong enough, the integral of the error will accumulate over time and the controller will respond by applying a stronger action. The "D"element 153978 calculates the likely future trend of this error based on its current rate of change. For example, continuing the P example above, when a large positive control output successfully brings the error closer to zero, it also puts the process in the path of a large negative error in the nearest future. In this case, the derivative becomes negative and the D module reduces the intensity of the action to prevent this overshoot.

应当理解，可根据反馈控制系统153950、153970来监测和控制其他变量和设定点。例如，本文所述的自适应闭合构件速度控制算法可测量以下参数中的至少两个：击发构件行程位置、击发构件负载、切割元件的位移、切割元件的速度、闭合管行程位置、闭合管负载等等。It should be understood that other variables and set points may be monitored and controlled in accordance with thefeedback control systems 153950, 153970. For example, the adaptive closing member speed control algorithms described herein may measure at least two of the following parameters: firing member stroke position, firing member load, displacement of cutting element, speed of cutting element, closed tube travel position, closed tube load and many more.

图86为根据本公开的至少一个方面的描绘用于确定闭合构件的速度的控制程序或逻辑配置的过程153990的逻辑流程图。根据本公开的外科器械或系统的控制电路被配置成能够确定153992闭合构件的实际闭合力。控制电路比较153994实际闭合力与阈值闭合力，并且基于该比较来确定153996设定点速度以移位闭合构件。控制电路基于设定点速度来控制153998闭合构件的实际速度。86 is a logic flow diagram depicting aprocess 153990 of a control program or logic configuration for determining the velocity of a closure member in accordance with at least one aspect of the present disclosure. A control circuit of a surgical instrument or system according to the present disclosure is configured to be able to determine 153992 the actual closing force of the closing member. The control circuit compares 153994 the actual closing force to the threshold closing force and determines 153996 a setpoint speed based on the comparison to displace the closing member. The control circuit controls the actual speed of the 153998 closing member based on the set point speed.

现在还参见图84和图85，在一个方面，控制电路包括比例、积分和微分(PID)反馈控制系统153950、153970。PID反馈控制系统153950、153970包括主要PID反馈环路153954和次级PID反馈环路153956。主要反馈环路153954确定闭合构件的实际闭合力与阈值闭合力SP₁之间的第一误差并基于该第一误差来设定闭合构件速度设定点SP₂。次级反馈环路153956确定闭合构件的实际速度与闭合构件的设定点速度之间的第二误差并基于该第二误差来设定闭合构件速度。Referring now also to FIGS. 84 and 85, in one aspect, the control circuit includes proportional, integral, and derivative (PID)feedback control systems 153950, 153970. The PIDfeedback control system 153950, 153970 includes a primaryPID feedback loop 153954 and a secondaryPID feedback loop 153956. Theprimary feedback loop 153954 determines a first error between the actual closing force of the closing member and the threshold closing force SP₁ and sets the closing member speed setpoint SP₂ based on the first error. Thesecondary feedback loop 153956 determines a second error between the actual speed of the closure member and the setpoint speed of the closure member and sets the closure member speed based on the second error.

在一个方面，阈值闭合力SP₁包括上限阈值和下限阈值。设定点速度SP₂被构造成能够在实际闭合力小于下限阈值时将闭合构件朝远侧推进，并且设定点速度被构造成能够在实际闭合力大于下限阈值时使闭合构件朝近侧回缩。在一个方面，设定点速度被构造成能够当实际闭合力在上限阈值和下限阈值之间时将闭合构件保持就位。In one aspect, the threshold closing force SP1 includes_an upper threshold and a lower threshold._The setpoint speed SP2 is configured to advance the closing member distally when the actual closing force is less than the lower threshold, and the setpoint speed is configured to retract the closing member proximally when the actual closing force is greater than the lower threshold. shrink. In one aspect, the set point speed is configured to hold the closing member in place when the actual closing force is between an upper threshold and a lower threshold.

在一个方面，控制系统还包括联接到控制电路的力传感器(例如，传感器472、474、476(图12)中的任一个)。力传感器被配置成能够测量该闭合力。在一个方面，力传感器包括扭矩传感器，该扭矩传感器联接到马达的输出轴，该马达联接到闭合构件。在一个方面，力传感器包括联接到闭合构件的应变仪。在一个方面，力传感器包括联接到闭合构件的负荷传感器。在一个方面，控制系统包括联接到闭合构件的位置传感器，其中位置传感器被构造成能够测量闭合构件的位置。In one aspect, the control system further includes a force sensor (eg, any ofsensors 472, 474, 476 (FIG. 12)) coupled to the control circuit. The force sensor is configured to measure the closing force. In one aspect, the force sensor includes a torque sensor coupled to an output shaft of a motor coupled to the closure member. In one aspect, the force sensor includes a strain gauge coupled to the closure member. In one aspect, the force sensor includes a load sensor coupled to the closure member. In one aspect, the control system includes a position sensor coupled to the closure member, wherein the position sensor is configured to measure the position of the closure member.

在一个方面，控制系统包括第一马达，该第一马达被构造成能够联接到闭合构件，并且控制电路被配置成能够在击发行程的至少一部分期间推进闭合构件。In one aspect, the control system includes a first motor configured to be coupled to the closure member and the control circuit configured to advance the closure member during at least a portion of the firing stroke.

本文所述的功能或方法153990可由本文所述的任何处理电路执行。可以在没有本文公开的具体细节的情况下实践机动外科器械的各方面。一些方面已被显示为框图而不是细节。The functions ormethods 153990 described herein may be performed by any of the processing circuits described herein. Aspects of the motorized surgical instrument may be practiced without the specific details disclosed herein. Some aspects have been shown as block diagrams rather than details.

本公开的部分可以呈现为对存储在计算机存储器中的数据进行操作的指令。算法是指导致所需结果的步骤的自相容序列，其中“步骤”是指物理量的操纵，物理量可以采用能被存储、转移、组合、比较和以其它方式操纵的电或磁信号的形式。这些信号可以称为位、值、元素、符号、字符、项、数字。这些和类似的术语可与适当的物理量相关联并且仅仅是应用于这些量的方便的标签。Portions of the present disclosure may be presented as instructions to operate on data stored in computer memory. An algorithm refers to a self-consistent sequence of steps leading to a desired result, where "step" refers to the manipulation of physical quantities, which may take the form of electrical or magnetic signals capable of being stored, transferred, combined, compared, and otherwise manipulated. These signals may be called bits, values, elements, symbols, characters, terms, numbers. These and similar terms may be associated with the appropriate physical quantities and are merely convenient labels applied to these quantities.

一般来讲，可以用多种硬件、软件、固件或它们的任何组合单独和/或共同实现的本文所述的各方面可以被看作是由多种类型的“电子电路”组成。因此，“电子电路”包括具有至少一个离散电路的电子电路、具有至少一个集成电路的电子电路、具有至少一个专用集成电路的电子电路、形成由计算机程序配置的通用计算设备的电子电路(例如，至少部分地实施本文描述的过程和/或设备的由计算机程序配置的通用计算机或处理器)、形成存储器设备(例如，随机存取存储器的形式)的电子电路，和/或形成通信设备(例如，调制解调器、通信开关或光电设备)的电子电路。这些方面可以模拟或数字形式或其组合来实现。In general, the various aspects described herein, which can be implemented individually and/or together in various hardware, software, firmware, or any combination thereof, can be considered to be composed of various types of "electronic circuits." Thus, an "electronic circuit" includes an electronic circuit having at least one discrete circuit, an electronic circuit having at least one integrated circuit, an electronic circuit having at least one application specific integrated circuit, an electronic circuit forming a general-purpose computing device configured by a computer program (eg, A general-purpose computer or processor configured by a computer program that implements, at least in part, the processes and/or devices described herein), electronic circuits that form memory devices (eg, in the form of random access memory), and/or communications devices (eg, , modems, communication switches or optoelectronic devices) electronic circuits. These aspects may be implemented in analog or digital form or a combination thereof.

前面的描述已经经由使用框图、流程图和/或示例阐述了装置和/或过程的各方面，这些方面可包含一个或多个功能和/或操作。此类框图、流程图或示例内的每个功能和/或操作可通过各种硬件、软件、固件或其实际上的任何组合来单独和/或共同地实现。在一个方面，本文所述的主题的若干部分可经由专用集成电路(ASIC)、现场可编程门阵列(FPGA)、数字信号处理器(DSP)、可编程逻辑器件(DSP)、电路、寄存器和/或软件部件(例如，程序、子例程、逻辑和/或硬件和软件部件的组合)、逻辑门或其他集成格式来实现。本文公开的一些方面可作为在一台或多台计算机上运行的一个或多个计算机程序(例如，作为在一个或多个计算机系统上运行的一个或多个程序)，作为在一个或多个处理器上运行的一个或多个程序(例如，作为在一个或多个微处理器上运行的一个或多个程序)，作为固件，或作为实际上它们的任何组合全部或部分地在集成电路中等效地实现，并且根据本公开，设计电路和/或编写软件和/或硬件的代码将在本领域技术人员的技术范围内。The foregoing description has set forth, through the use of block diagrams, flowcharts, and/or examples, various aspects of apparatuses and/or processes, which may include one or more functions and/or operations. Each function and/or operation within such block diagrams, flowcharts, or examples may be implemented individually and/or collectively by various hardware, software, firmware, or virtually any combination thereof. In one aspect, portions of the subject matter described herein may be implemented via application specific integrated circuits (ASICs), field programmable gate arrays (FPGAs), digital signal processors (DSPs), programmable logic devices (DSPs), circuits, registers, and and/or software components (eg, programs, subroutines, logic, and/or a combination of hardware and software components), logic gates, or other integrated formats. Some aspects disclosed herein can be implemented as one or more computer programs running on one or more computers (eg, as one or more programs running on one or more computer systems), as one or more computer programs running on one or more computer systems One or more programs running on a processor (for example, as one or more programs running on one or more microprocessors), as firmware, or as virtually any combination thereof in whole or in part on an integrated circuit are equivalently implemented in, and in light of this disclosure, designing circuits and/or coding software and/or hardware would be within the skill of those skilled in the art.

本文公开的主题的机构能够作为多种形式的程序产品进行分布，并且本文所述主题的示例性方面适用，而不管用于实际实施分布的信号承载介质的具体类型是什么。信号承载介质的示例包括如下：可录式介质，诸如软盘、硬盘驱动器、光盘(CD)、数字视频光盘(DVD)、数字磁带、计算机存储器等；和传输式介质，诸如数字和/或模拟通信介质(例如，光纤缆线、波导、有线通信链路、无线通信链路(例如，发射器、接收器、传输逻辑、接收逻辑)等)。The mechanisms of the subject matter disclosed herein can be distributed as program products in many forms, and exemplary aspects of the subject matter described herein apply regardless of the specific type of signal bearing medium used to actually implement the distribution. Examples of signal bearing media include the following: recordable media, such as floppy disks, hard drives, compact discs (CDs), digital video discs (DVDs), digital tapes, computer memory, etc.; and transmission media, such as digital and/or analog communications Medium (eg, fiber optic cable, waveguide, wired communication link, wireless communication link (eg, transmitter, receiver, transmit logic, receive logic), etc.).

为了举例说明和描述的目的，已经提供了这些方面的上述说明。这些具体实施方式并非意图为详尽的或限定到本发明所公开的精确形式。可以按照上述教导内容对本发明进行修改或变型。所选择和描述的这些方面是为了示出原理和实际应用，从而使得本领域的普通技术人员能够利用各方面，并且在适合设想的具体应用的情况下进行修改。与此一同提交的权利要求书旨在限定完整范围。The foregoing description of these aspects has been provided for the purposes of illustration and description. These detailed descriptions are not intended to be exhaustive or to be limited to the precise forms disclosed. Modifications and variations of the present invention are possible in light of the above teachings. The aspects 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 aspects and to modify them as are suited to the particular application contemplated. The claims filed herewith are intended to define the full scope.

态势感知situational awareness

态势感知是指外科系统的一些方面的根据从数据库和/或器械接收的数据来确定或推断与外科手术相关的信息的能力。该信息可包括正在进行的规程的类型、正在接受手术的组织的类型或作为规程的对象的体腔。利用与外科手术相关的背景信息，外科系统可例如改善该外科系统控制连接到其的模块化装置(例如，机器人臂和/或机器人外科工具)的方式，并且在外科手术的过程期间向外科医生提供背景信息或建议。Situational awareness refers to the ability of some aspects of a surgical system to determine or infer information relevant to a surgical procedure from data received from databases and/or instruments. This information may include the type of procedure being performed, the type of tissue being operated on, or the body cavity that is the subject of the procedure. Using contextual information related to a surgical procedure, a surgical system can, for example, improve the way the surgical system controls a modular device (eg, a robotic arm and/or a robotic surgical tool) connected to it, and the surgeon during the procedure of the surgical procedure Provide background information or advice.

现在参见图87，其示出了描绘集线器(例如，外科集线器106或206)的态势感知的时间轴5200。时间轴5200是说明性的外科手术以及外科集线器106、206可以从外科手术中每个步骤从数据源接收的数据导出的背景信息。时间轴5200描绘了护士、外科医生和其它医疗人员在肺段切除规程期间将采取的典型步骤，从建立手术室开始到将患者转移到术后恢复室为止。Referring now to FIG. 87, atimeline 5200 depicting situational awareness of a hub (eg,surgical hub 106 or 206) is shown.Timeline 5200 is an illustrative surgical procedure and contextual information thatsurgical hubs 106, 206 may derive from data received from data sources at each step in the surgical procedure.Timeline 5200 depicts the typical steps nurses, surgeons, and other medical personnel will take during a segmentectomy procedure, starting with the establishment of the operating room and ending with the transfer of the patient to the post-operative recovery room.

态势感知外科集线器106、206在整个外科手术过程中从数据源接收数据，包括每次医疗人员利用与外科集线器106、206配对的模块化装置时生成的数据。外科集线器106、206可从已配对的模块化装置和其他数据源接收该数据，并且在接收新数据时不断导出关于正在进行的规程的推论(即，背景信息)，诸如在任何给定时间执行规程的哪个步骤。外科集线器106、206的态势感知系统能够例如记录与用于生成报告的过程相关的数据，验证医务人员正在采取的步骤，提供可能与特定规程步骤相关的数据或提示(例如，经由显示屏)，基于背景调节模块化装置(例如，激活监测器，调节医学成像装置的视场(FOV)，或者改变超声外科器械或RF电外科器械的能量水平)，以及采取上述任何其它此类动作。The situational awarenesssurgical hubs 106 , 206 receive data from data sources throughout the surgical procedure, including data generated each time a medical staff utilizes a modular device paired with thesurgical hubs 106 , 206 .Surgical hubs 106, 206 may receive this data from paired modular devices and other data sources, and continually derive inferences (ie, contextual information) about ongoing procedures as new data is received, such as performed at any given time which step of the procedure. The situational awareness system of thesurgical hub 106, 206 can, for example, record data related to the process used to generate the report, verify the steps medical personnel are taking, provide data or prompts (e.g., via a display screen) that may be related to a particular procedure step, Modular devices are adjusted based on context (eg, activating a monitor, adjusting the field of view (FOV) of a medical imaging device, or changing the energy level of an ultrasonic surgical instrument or RF electrosurgical instrument), and taking any other such actions described above.

作为该示例性规程中的第一步5202，医院工作人员从医院的EMR数据库中检索患者的EMR。基于EMR中的选择的患者数据，外科集线器106、206确定待执行的规程是胸腔规程。As afirst step 5202 in this exemplary procedure, hospital staff retrieves the patient's EMR from the hospital's EMR database. Based on the selected patient data in the EMR, thesurgical hub 106, 206 determines that the procedure to be performed is a thoracic procedure.

第二步5204，工作人员扫描用于规程的进入的医疗用品。外科集线器106、206与在各种类型的规程中使用的用品列表交叉引用扫描的用品，并确认供应的混合物对应于胸腔规程。另外，外科集线器106、206还能够确定规程不是楔形规程(因为进入的用品缺乏胸腔楔形规程所需的某些用品，或者在其它方面不对应于胸腔楔形规程)。In asecond step 5204, the staff scans the incoming medical supplies for the procedure. Thesurgical hub 106, 206 cross-references the scanned supplies with the list of supplies used in the various types of procedures and confirms that the supplied mix corresponds to the thoracic procedure. Additionally, thesurgical hub 106, 206 can also determine that the procedure is not a wedge procedure (because the incoming supplies lack certain supplies required for a thoracic wedge procedure, or otherwise do not correspond to a thoracic wedge procedure).

第三步5206，医疗人员经由可通信地连接到外科集线器106、206的扫描器来扫描患者频带。然后，外科集线器106、206可基于所扫描的数据来确认患者的身份。In athird step 5206, the medical staff scans the patient frequency band via a scanner communicatively connected to thesurgical hub 106, 206. Thesurgical hub 106, 206 can then confirm the identity of the patient based on the scanned data.

第四步5208，医务工作人员打开辅助设备。所利用的辅助设备可根据外科手术的类型和外科医生待使用的技术而变化，但在此示例性情况下，它们包括排烟器、吹入器和医学成像装置。当激活时，作为其初始化过程的一部分，作为模块化装置的辅助设备可以自动与位于模块化装置特定附近的外科集线器106、206配对。然后，外科集线器106、206可通过检测在该术前阶段或初始化阶段期间与其配对的模块化装置的类型来导出关于外科手术的背景信息。在该具体示例中，外科集线器106、206确定外科手术是基于配对模块化装置的该特定组合的VATS规程。基于来自患者的EMR的数据的组合，规程中使用的医疗用品的列表以及连接到集线器的模块化装置的类型，外科集线器106、206通常可推断外科小组将执行的具体规程。一旦外科集线器106、206知道正在执行什么具体规程，外科集线器106、206便可从存储器或云中检索该规程的步骤，然后交叉参照其随后从所连接的数据源(例如，模块化装置和患者监测装置)接收的数据，以推断外科团队正在执行的外科手术的什么步骤。In thefourth step 5208, the medical staff turns on the auxiliary equipment. The auxiliary devices utilized may vary depending on the type of surgery and the technique to be used by the surgeon, but in this exemplary case they include smoke extractors, insufflators, and medical imaging devices. When activated, as part of its initialization process, auxiliary devices that are modular devices may automatically pair withsurgical hubs 106, 206 located in a specific vicinity of the modular device. Thesurgical hub 106, 206 may then derive contextual information about the surgical procedure by detecting the type of modular device paired with it during this preoperative or initialization phase. In this particular example, thesurgical hub 106, 206 determines that the surgical procedure is based on the VATS procedure of this particular combination of paired modular devices. Based on a combination of data from the patient's EMR, the list of medical supplies used in the procedure, and the type of modular device connected to the hub, thesurgical hub 106, 206 can typically infer the specific procedure the surgical team will perform. Once thesurgical hub 106, 206 knows what specific procedure is being performed, thesurgical hub 106, 206 can retrieve the procedure's steps from memory or the cloud and then cross-reference it with subsequent data from connected data sources (eg, modular devices and patients). monitoring device) to infer what steps of the surgical procedure the surgical team is performing.

第五步5210，工作人员成员将EKG电极和其它患者监测装置附接到患者。EKG电极和其它患者监测装置能够与外科集线器106、206配对。当外科集线器106、206开始从患者监测装置接收数据时，外科集线器106、206因此确认患者在手术室中。In afifth step 5210, the staff member attaches the EKG electrodes and other patient monitoring devices to the patient. EKG electrodes and other patient monitoring devices can be paired withsurgical hubs 106 , 206 . When thesurgical hub 106, 206 begins to receive data from the patient monitoring device, thesurgical hub 106, 206 thus confirms that the patient is in the operating room.

第六步5212，医疗人员诱导患者麻醉。外科集线器106、206可基于来自模块化装置和/或患者监测装置的数据(包括例如EKG数据、血压数据、呼吸机数据、或它们的组合)推断患者处于麻醉下。在第六步5212完成时，肺分段切除规程的术前部分完成，并且手术部分开始。In thesixth step 5212, the medical staff induces anesthesia of the patient. Thesurgical hubs 106, 206 may infer that the patient is under anesthesia based on data from the modular device and/or the patient monitoring device, including, for example, EKG data, blood pressure data, ventilator data, or a combination thereof. Upon completion of thesixth step 5212, the preoperative portion of the lung segmental resection procedure is completed and the surgical portion begins.

第七步5214，折叠正在操作的患者肺部(同时通气切换到对侧肺)。例如，外科集线器106、206可从呼吸机数据推断出患者的肺已经塌缩。外科集线器106、206可推断规程的手术部分已开始，因为其可将患者的肺部塌缩的检测与规程的预期步骤(可先前访问或检索)进行比较，从而确定使肺塌缩是该特定规程中的第一手术步骤。Seventh step 5214, the lung of the patient being operated on is folded (while ventilation is switched to the contralateral lung). For example, thesurgical hub 106, 206 may infer from the ventilator data that the patient's lungs have collapsed. Thesurgical hub 106, 206 can infer that the surgical portion of the procedure has begun, as it can compare the detection of the patient's lung collapse to the expected steps of the procedure (which may have been previously accessed or retrieved) to determine that collapsing the lung is the specific The first surgical step in the protocol.

第八步5216，插入医疗成像装置(例如，内窥镜)，并启动来自医疗成像装置的视频。外科集线器106、206通过其与医疗成像装置的连接来接收医疗成像装置数据(即，视频或图像数据)。在接收到医疗成像装置数据之后，外科集线器106、206可确定外科手术的腹腔镜式部分已开始。另外，外科集线器106、206可确定正在执行的特定规程是分段切除术，而不是叶切除术(注意，楔形规程已经基于外科集线器106、206基于在规程的第二步5204处接收到的数据而排除)。来自医疗成像装置124(图2)的数据可用于以多种不同的方式确定与正在执行的规程类型相关的背景信息，包括通过确定医疗成像装置相对于患者解剖结构的可视化取向的角度，监测所利用的医疗成像装置的数量(即，被激活并与外科集线器106、206配对)，以及监测所利用的可视化装置的类型。例如，一种用于执行VATS肺叶切除术的技术将摄像机放置在隔膜上方的患者胸腔的下前拐角中，而一种用于执行VATS分段切除术的技术将摄像机相对于分段裂缝放置在前肋间位置。例如，使用模式识别或机器学习技术，可对态势感知系统进行训练，以根据患者解剖结构的可视化识别医疗成像装置的定位。作为另一个示例，一种用于执行VATS肺叶切除术的技术利用单个医疗成像装置，而用于执行VATS分段切除术的另一种技术利用多个摄像机。作为另一示例，一种用于执行VATS分段切除术的技术利用红外光源(其可作为可视化系统的一部分可通信地联接到外科集线器)以可视化不用于VATS肺部切除术中的分段裂隙。通过从医疗成像装置跟踪这些数据中的任何或所有，外科集线器106、206因此可确定正在进行的外科手术的具体类型和/或用于特定类型的外科手术的技术。In aneighth step 5216, a medical imaging device (eg, an endoscope) is inserted and video from the medical imaging device is initiated. Thesurgical hub 106, 206 receives medical imaging device data (ie, video or image data) through its connection to the medical imaging device. After receiving the medical imaging device data, thesurgical hub 106, 206 may determine that the laparoscopic portion of the surgical procedure has begun. Additionally, thesurgical hub 106, 206 may determine that the particular procedure being performed is a segmentectomy, not a lobectomy (note that the wedge procedure has been based on the data received at thesecond step 5204 of the procedure based on thesurgical hub 106, 206 and excluded). Data from the medical imaging device 124 (FIG. 2) can be used to determine contextual information related to the type of procedure being performed in a number of different ways, including by determining the angle of the medical imaging device relative to the visualization orientation of the patient's anatomy, monitoring the The number of medical imaging devices utilized (ie, activated and paired with thesurgical hub 106, 206), and the type of visualization device utilized for monitoring. For example, one technique for performing a VATS lobectomy places the camera in the lower anterior corner of the patient's thorax above the diaphragm, while one technique for performing a VATS segmentectomy places the camera relative to the segmental fissure Anterior intercostal position. For example, using pattern recognition or machine learning techniques, situational awareness systems can be trained to recognize the location of medical imaging devices based on visualizations of patient anatomy. As another example, one technique for performing a VATS lobectomy utilizes a single medical imaging device, while another technique for performing a VATS segmentectomy utilizes multiple cameras. As another example, one technique for performing a VATS segmentectomy utilizes an infrared light source (which may be communicatively coupled to a surgical hub as part of a visualization system) to visualize segmental fissures not used in VATS pneumonectomy . By tracking any or all of these data from the medical imaging device, thesurgical hub 106, 206 can thus determine the specific type of surgery being performed and/or the technique used for that particular type of surgery.

第九步5218，外科团队开始规程的解剖步骤。外科集线器106、206可推断外科医生正在解剖以调动患者的肺，因为其从RF发生器或超声发生器接收指示正在击发能量器械的数据。外科集线器106、206可将所接收的数据与外科手术的检索步骤交叉，以确定在过程中的该点处(即，在先前讨论的规程步骤完成之后)击发的能量器械对应于解剖步骤。在某些情况下，能量器械可为安装到机器人外科系统的机械臂的能量工具。In aninth step 5218, the surgical team begins the dissection step of the protocol. Thesurgical hub 106, 206 can infer that the surgeon is dissecting to mobilize the patient's lungs because it receives data from the RF generator or ultrasound generator indicating that the energy instrument is being fired. Thesurgical hub 106, 206 may intersect the received data with the retrieval step of the surgical procedure to determine that the energy instrument fired at that point in the procedure (ie, after the previously discussed procedure steps are completed) corresponds to the dissection step. In some cases, the energy instrument may be an energy tool mounted to a robotic arm of a robotic surgical system.

第十步5220，外科团队继续进行规程的结扎步骤。外科集线器106、206可推断外科医生正在结扎动脉和静脉，因为其从外科缝合和切割器械接收指示器械正在被击发的数据。与先前步骤相似，外科集线器106、206可通过将来自外科缝合和切割器械的数据的接收与该过程中的检索步骤进行交叉引用来推导该推论。在某些情况下，外科器械可以是安装到机器人外科系统的机器人臂的外科工具。In atenth step 5220, the surgical team continues with the ligation step of the protocol. Thesurgical hub 106, 206 can infer that the surgeon is ligating arteries and veins because it receives data from the surgical stapling and cutting instruments indicating that the instruments are being fired. Similar to the previous steps, thesurgical hub 106, 206 may derive this inference by cross-referencing the receipt of data from the surgical stapling and cutting instruments with the retrieval step in the process. In some cases, the surgical instrument may be a surgical tool mounted to a robotic arm of a robotic surgical system.

第十一步5222，执行规程的分段切除术部分。外科集线器106、206可推断外科医生正在基于来自外科缝合和切割器械的数据(包括来自其仓的数据)横切实质。仓数据可对应于例如由器械击发的钉的大小或类型。由于不同类型的钉用于不同类型的组织，因此仓数据可指示正被缝合和/或横切的组织的类型。在这种情况下，被击发的钉的类型用于实质(或其它类似的组织类型)，这允许外科集线器106、206推断规程的分段切除术部分正在进行。Eleventh step 5222, performing the segmental resection portion of the protocol. Thesurgical hubs 106, 206 can infer that the surgeon is transecting the substance based on data from the surgical stapling and cutting instruments, including data from their bins. The bin data may correspond, for example, to the size or type of staples fired by the instrument. Since different types of staples are used for different types of tissue, the bin data can indicate the type of tissue being stapled and/or transected. In this case, the type of staples fired is for parenchyma (or other similar tissue type), which allows thesurgical hub 106, 206 to infer that the segmental resection portion of the procedure is in progress.

第十二步5224中，执行节点解剖步骤。外科集线器106、206可基于从发生器接收的指示正在击发RF或超声器械的数据来推断外科团队正在解剖节点并且执行渗漏测试。对于该特定规程，在横切实质后使用的RF或超声器械对应于节点解剖步骤，该步骤允许外科集线器106、206进行此类推论。应当指出的是，外科医生根据规程中的具体步骤定期在外科缝合/切割器械和外科能量(即，RF或超声)器械之间来回切换，因为不同器械更好地适于特定任务。因此，其中使用缝合/切割器械和外科能量器械的特定序列可指示外科医生正在执行的规程的步骤。此外，在某些情况下，机器人工具可用于外科手术中的一个或多个步骤，并且/或者手持式外科器械可用于外科手术中的一个或多个步骤。(一个或多个)外科医生可例如在机器人工具与手持式外科器械之间交替和/或可同时使用装置。在第十二步5224完成时，切口被闭合并且规程的术后部分开始。In the twelfth step 5224, a node dissection step is performed. Thesurgical hub 106, 206 may infer that the surgical team is dissecting the node and performing leak testing based on data received from the generator indicating that the RF or ultrasonic instrument is firing. For this particular procedure, the RF or ultrasonic instruments used after the traversal material corresponds to the nodal dissection step that allows thesurgical hub 106, 206 to make such inferences. It should be noted that the surgeon periodically switches back and forth between surgical stapling/cutting instruments and surgical energy (ie, RF or ultrasonic) instruments according to specific steps in the protocol, as different instruments are better suited for specific tasks. Thus, the particular sequence in which the stapling/cutting instrument and the surgical energy instrument are used may indicate the steps of the procedure that the surgeon is performing. Additionally, in some cases, robotic tools may be used for one or more steps in a surgical procedure, and/or a hand-held surgical instrument may be used for one or more steps in a surgical procedure. The surgeon(s) may, for example, alternate between robotic tools and hand-held surgical instruments and/or may use the devices simultaneously. At the completion of the twelfth step 5224, the incision is closed and the postoperative portion of the procedure begins.

第十三步5226，逆转患者的麻醉。例如，外科集线器106、206可基于例如呼吸机数据(即，患者的呼吸率开始増加)推断出患者正在从麻醉中醒来。Thirteenth step 5226, reversing the patient's anesthesia. For example, thesurgical hub 106, 206 may infer that the patient is waking up from anesthesia based on, for example, ventilator data (ie, the patient's breathing rate begins to increase).

最后，第十四步5228是医疗人员从患者移除各种患者监测装置。因此，当集线器从患者监测装置丢失EKG、BP和其它数据时，外科集线器106、206可推断患者正在被转移到恢复室。如从该示例性规程的描述可以看出，外科集线器106、206可根据从可通信地联接到外科集线器106、206的各种数据源接收的数据来确定或推断给定外科手术的每个步骤何时发生。Finally, afourteenth step 5228 is for the medical personnel to remove the various patient monitoring devices from the patient. Thus, when the hub loses EKG, BP and other data from the patient monitoring device, thesurgical hub 106, 206 can infer that the patient is being transferred to the recovery room. As can be seen from the description of this exemplary procedure, thesurgical hubs 106 , 206 may determine or infer each step of a given surgical procedure based on data received from various data sources communicatively coupled to thesurgical hubs 106 , 206 when does it happen.

态势感知在2017年12月28日提交的标题为“INTERACTIVE SURGICAL PLATFORM”的美国临时专利申请序列号62/611,341中进一步描述，该专利申请全文以引用方式并入本文。在某些情况下，机器人外科系统(包括本文所公开的各种机器人外科系统)的操作可例如由集线器106、206基于其态势感知和/或来自其部件的反馈和/或基于来自云104的信息来控制。Situational awareness is further described in US Provisional Patent Application Serial No. 62/611,341, filed December 28, 2017, entitled "INTERACTIVE SURGICAL PLATFORM," which is incorporated herein by reference in its entirety. In some cases, operation of a robotic surgical system, including the various robotic surgical systems disclosed herein, may be performed, for example, by thehub 106 , 206 based on its situational awareness and/or feedback from its components and/or based on data from thecloud 104 . information to control.

用于智能电动外科缝合的安全系统Safety System for Smart Electric Surgical Sutures

本公开的各个方面涉及改进的安全系统，该改进的安全系统能够响应于经由外科器械的一个或多于一个传感器检测到的组织参数来调节、控制和/或调谐外科器械的内部驱动操作。根据至少一个方面，在端部执行器的钳口处经由一个或多于一个传感器检测到的力可为禁止端部执行器的一个或多于一个后续/另外的功能被执行的量值。根据另一方面，如在端部执行器的钳口内，可经由一个或多于一个传感器检测金属物体，该金属物体禁止端部执行器的一个或多于一个后续/另外的功能被执行。图88示出了包括外科器械23002、外科集线器23004和用户界面23006的外科系统23000。在此类方面，外科器械23002可包括一个或多于一个传感器23008，并且由外科器械23002的一个或多于一个传感器23008检测到的参数可传输/传送(例如，无线地)到外科集线器23004的控制电路23010。另外，在此类方面，外科集线器23004可被配置成能够确定与外科器械23002的部件(例如，端部执行器、轴等)相关联的外科功能(例如，解剖、夹持、凝结、缝合、切割、旋转、关节运动等)是否可基于由外科器械23002的一个或多于一个传感器23008检测到的参数安全地执行。值得注意的是，在此类方面，外科集线器23004可被配置成能够将与该确定相关联的一个或多个结果(即，与外科功能相关联的警告、防止外科功能的原因等)传输/传送到用户界面23006。此外，根据各个方面，本文所公开的各种用户界面可包括可选择的用户界面特征(例如，覆写元素23012)以继续外科功能，尽管存在支持防止的任何警告和/或原因。值得注意的是，在此类方面，可能不显示此类用户界面特征(例如，覆写元素23012)(例如，执行外科功能可能危及患者)。Various aspects of the present disclosure relate to improved safety systems capable of adjusting, controlling, and/or tuning the internal drive operation of a surgical instrument in response to tissue parameters detected via one or more sensors of the surgical instrument. According to at least one aspect, the force detected via the one or more sensors at the jaws of the end effector may be a magnitude that prohibits one or more subsequent/additional functions of the end effector from being performed. According to another aspect, such as within the jaws of the end effector, metallic objects may be detected via one or more sensors that inhibit one or more subsequent/additional functions of the end effector from being performed. 88 shows asurgical system 23000 including asurgical instrument 23002, asurgical hub 23004, and auser interface 23006. In such aspects, thesurgical instrument 23002 can include one or more than onesensor 23008, and parameters detected by the one ormore sensors 23008 of thesurgical instrument 23002 can be transmitted/transmitted (eg, wirelessly) to thesurgical hub 23004'sControl circuit 23010. Additionally, in such aspects, thesurgical hub 23004 can be configured to be capable of determining a surgical function (eg, dissection, clamping, coagulation, stapling, stapling, etc.) associated with a component (eg, end effector, shaft, etc.) of thesurgical instrument 23002 whether cutting, rotation, articulation, etc.) can be safely performed based on parameters detected by one or more of thesensors 23008 of thesurgical instrument 23002. Notably, in such aspects, thesurgical hub 23004 may be configured to be able to communicate/transmit one or more results associated with the determination (ie, warnings associated with the surgical function, reasons preventing the surgical function, etc.). Pass toUI 23006. Furthermore, according to various aspects, the various user interfaces disclosed herein may include selectable user interface features (eg, override element 23012) to continue surgical functions despite any caveats and/or reasons supporting prevention. Notably, in such aspects, such user interface features (eg, override element 23012) may not be displayed (eg, performing a surgical function may endanger the patient).

参见图89，根据本公开的各个方面，外科系统23100可包括控制电路(23112、23122、23132和/或23142，例如，以虚线显示一个或多个任选的位置)、用户界面(23118、23128、23138、23148和/或23158，例如，以虚线显示任选位置)，以及包括例如柄部组件23110、轴组件23120和端部执行器组件23130的外科器械23102。在此类方面，控制电路可集成到外科器械23102(例如，23112、23122和/或23132)的一个或多于一个部件(例如，柄部组件23110、轴组件23120和/或端部执行器组件23130等)中并且/或者集成到与外科器械23102配对(例如，无线地)的外科集线器23140(例如，23142)中。值得注意的是，根据各个方面，外科器械23102和/或外科集线器23140可以是态势感知的外科器械和/或态势感知的外科集线器。态势感知是指外科系统(例如，23100)根据从数据库接收的数据(例如，与外科手术(例如，23149和/或23150)相关联的历史数据)和/或从外科器械接收的数据(例如，外科手术期间的传感器数据)确定或推断与外科手术相关的信息的能力。例如，所确定或推断的信息可包括正在进行的规程的类型、正在接受手术的组织的类型、作为规程的对象的体腔等。基于与外科手术相关的此类背景信息，外科系统可例如在外科手术的整个过程中控制成对的外科器械23102或其部件(例如，23110、23120和/或23130)并且/或者向外科医生提供背景信息或建议(例如，经由用户界面23118、23128、23138、23148和/或23158)。关于态势感知的附加细节可例如在上文中标题“态势感知”下面找到。89, in accordance with various aspects of the present disclosure,surgical system 23100 may include control circuitry (23112, 23122, 23132, and/or 23142, eg, one or more optional locations are shown in dashed lines), user interfaces (23118, 23128 , 23138, 23148, and/or 23158, eg, optional locations shown in phantom), and asurgical instrument 23102 including, eg, ahandle assembly 23110, ashaft assembly 23120, and anend effector assembly 23130. In such aspects, control circuitry may be integrated into one or more components (eg, handleassembly 23110,shaft assembly 23120, and/or end effector assembly) of surgical instrument 23102 (eg, 23112, 23122, and/or 23132) 23130, etc.) and/or integrated into a surgical hub 23140 (eg, 23142) that mates (eg, wirelessly) with thesurgical instrument 23102. Notably, according to various aspects, thesurgical instrument 23102 and/or thesurgical hub 23140 may be a situationally aware surgical instrument and/or a situationally aware surgical hub. Situational awareness refers to the surgical system (eg, 23100) based on data received from databases (eg, historical data associated with surgical procedures (eg, 23149 and/or 23150)) and/or data received from surgical instruments (eg, sensor data during a surgical procedure) the ability to determine or infer information relevant to the surgical procedure. For example, the determined or inferred information may include the type of procedure being performed, the type of tissue being operated on, the body cavity that is the subject of the procedure, and the like. Based on such background information related to the surgical procedure, the surgical system may, for example, control the pair ofsurgical instruments 23102 or components thereof (eg, 23110, 23120, and/or 23130) throughout the surgical procedure and/or provide the surgeon with Background information or advice (eg, viauser interfaces 23118, 23128, 23138, 23148, and/or 23158). Additional details regarding situational awareness can be found, for example, above under the heading "Situational Awareness".

同样在图89中，根据一个方面，态势感知的外科集线器23140与用于执行外科手术的外科器械23102配对(例如，无线地)。在此类方面，外科器械23102可包括端部执行器组件23130，该端部执行器组件包括第一钳口、可枢转地联接到第一钳口的第二钳口，以及传感器23134，该传感器被配置成能够检测与端部执行器组件23130的功能(例如，解剖、夹持、凝结、切割、缝合等)相关联的参数并将该检测到的参数传输到外科集线器23140的控制电路23142。Also in Figure 89, according to one aspect, a situational awarenesssurgical hub 23140 is paired (eg, wirelessly) with asurgical instrument 23102 for performing a surgical procedure. In such aspects, thesurgical instrument 23102 can include anend effector assembly 23130 that includes a first jaw, a second jaw pivotally coupled to the first jaw, and asensor 23134 that The sensors are configured to detect parameters associated with the function of the end effector assembly 23130 (eg, dissection, clamping, coagulation, cutting, stapling, etc.) and transmit the detected parameters to thecontrol circuitry 23142 of thesurgical hub 23140 .

另外，在此类方面，外科器械23102还可包括轴组件23120，该轴组件包括传感器23124，该传感器被配置成能够检测与轴组件23120的功能(例如，旋转、关节运动等)相关联的参数并将该检测到的参数传输到外科集线器23140的控制电路23142。值得注意的是，应当理解，如本文和其他公开方面所引用的，传感器可包括多个传感器，该多个传感器被配置成能够检测与多个端部执行器组件和/或轴组件功能相关联的多个参数。因此，另外，在此类方面，外科集线器控制电路23142可被配置成能够在外科手术的整个过程中从此类传感器23134和/或23124接收检测到的参数(例如，传感器数据)。Additionally, in such aspects, thesurgical instrument 23102 may further include ashaft assembly 23120 that includes asensor 23124 configured to detect parameters associated with the function (eg, rotation, articulation, etc.) of theshaft assembly 23120 This detected parameter is transmitted to thecontrol circuit 23142 of thesurgical hub 23140. Notably, it should be understood that, as referenced herein and in other aspects of the disclosure, the sensors may include a plurality of sensors configured to detect functional associations with a plurality of end effector assemblies and/or shaft assemblies of multiple parameters. Thus, in addition, in such aspects, surgicalhub control circuitry 23142 may be configured to receive detected parameters (eg, sensor data) fromsuch sensors 23134 and/or 23124 throughout a surgical procedure.

每当执行相关联的端部执行器组件23130功能(例如，解剖、夹持、凝固、切割、缝合等)和/或相关联的轴组件23120功能(例如，旋转、关节运动等)时，可接收检测到的参数。外科集线器控制电路23142还可被配置成能够在外科手术的整个过程中从内部数据库(例如，外科集线器数据库23149)和/或外部数据库(例如，从云数据库23150)接收数据。根据各个方面，从内部数据库和/或外部数据库接收的数据可包括规程数据(例如，执行外科手术的步骤)和/或历史数据(例如，基于与外科手术相关联的历史数据指示预期参数的数据)。Whenever an associatedend effector assembly 23130 function (eg, dissection, clamping, coagulation, cutting, stapling, etc.) and/or an associatedshaft assembly 23120 function (eg, rotation, articulation, etc.) is performed, the Receive detected parameters. Surgicalhub control circuitry 23142 may also be configured to receive data from internal databases (eg, surgical hub database 23149 ) and/or external databases (eg, from cloud database 23150 ) throughout the surgical procedure. According to various aspects, data received from an internal database and/or an external database may include procedural data (eg, steps to perform a surgical procedure) and/or historical data (eg, data indicative of expected parameters based on historical data associated with a surgical procedure) ).

在各个方面，规程数据可包括用于外科手术的当前/公认的护理标准规程，并且历史数据可包括基于与外科手术相关联的历史数据的优选/理想参数和/或优选/理想参数范围(例如，系统限定的约束)。基于所接收的数据(例如，传感器数据、内部和/或外部数据等)，外科集线器控制电路23142可被配置成能够不断导出关于正在进行的外科手术的推论(例如，背景信息)。即，态势感知的外科集线器可被配置成能够例如记录与用于生成报告的外科手术有关的数据，验证外科医生正采取的执行外科手术的步骤，提供可能与特定规程步骤相关的数据或提示(例如，经由与外科集线器和/或外科器械(例如，23148、23158、23118、23128和/或23138)相关联的用户界面)，控制外科器械功能等。根据各个方面，态势感知的外科集线器23140可(例如，在执行端部执行器组件23130或轴组件23120的初始外科功能之后)基于从内部数据库23149和/或外部数据库23150接收的规程数据推断待执行的下一个外科功能。In various aspects, the procedure data can include current/accepted standard-of-care procedures for a surgical procedure, and the historical data can include preferred/ideal parameters and/or preferred/ideal parameter ranges based on historical data associated with the surgical procedure (eg, , system-defined constraints). Based on received data (eg, sensor data, internal and/or external data, etc.), the surgicalhub control circuit 23142 may be configured to continuously derive inferences (eg, contextual information) about the ongoing surgical procedure. That is, the situational awareness surgical hub may be configured to be able to, for example, record data related to surgical procedures used to generate reports, verify the steps a surgeon is taking to perform a surgical procedure, provide data or prompts that may be related to particular procedural steps ( For example, via user interfaces associated with surgical hubs and/or surgical instruments (eg, 23148, 23158, 23118, 23128, and/or 23138), surgical instrument functions, etc. are controlled. According to various aspects, the situationally awaresurgical hub 23140 may infer (eg, after performing an initial surgical function of theend effector assembly 23130 or shaft assembly 23120) to perform based on procedure data received from theinternal database 23149 and/or theexternal database 23150 the next surgical function.

另外，在此类方面，态势感知的外科集线器23140可基于从内部数据库23149和/或外部数据库23150接收的历史数据(例如，优选/理想参数)来评估检测到的参数(例如，响应于初始外科功能从传感器23134和/或23124接收到的参数)。此处，如果检测到的参数不超过优选/理想参数和/或在相应的优选/理想参数范围内，则态势感知的外科集线器23140可允许执行下一个外科功能和/或不防止/控制执行下一个外科功能。另选地，如果检测到的参数确实超过优选/理想参数和/或不在相应的优选/理想参数范围内，则态势感知的外科集线器23140可主动地防止下一个外科功能被执行。Additionally, in such aspects, the situational awarenesssurgical hub 23140 may evaluate detected parameters (eg, in response to initial surgical function received fromsensors 23134 and/or 23124). Here, the situational awarenesssurgical hub 23140 may allow execution of the next surgical function and/or not prevent/control execution of the next surgical function if the detected parameter does not exceed the preferred/desirable parameter and/or is within the corresponding preferred/desirable parameter range a surgical function. Alternatively, the situational awarenesssurgical hub 23140 may actively prevent the next surgical function from being performed if the detected parameter does exceed the preferred/ideal parameter and/or is not within the corresponding preferred/ideal parameter range.

根据本公开的另一个方面，态势感知的外科集线器23140可(例如，从外科器械23102的部件，例如，23130和/或23120)接收正在尝试/请求/致动特定外科功能的通信。在此类方面，态势感知的外科集线器23140可将该特定外科功能与推断的下一个外科功能进行比较，以确保当前/公认的护理标准规程被遵守。如果是这样，则态势感知的外科集线器23140然后可在允许特定外科功能继续之前(如所述)评估检测到的参数(例如，如所述)。如果不是这样，则态势感知的外科集线器23140可防止执行该特定外科功能，或防止执行该特定外科功能直到接收到覆写(例如，经由用户界面23、158、23148、23138、23128和/或23118，参见例如图88，可选择的用户界面元素23012)。在此类方面，如果接收到覆写，则态势感知的外科集线器23140然后可在允许特定外科功能继续之前评估检测到的参数(如上所述)。According to another aspect of the present disclosure, situational awarenesssurgical hub 23140 may receive communications (eg, from components ofsurgical instrument 23102, eg, 23130 and/or 23120) that are attempting/requesting/actuating a particular surgical function. In such aspects, the situationally awaresurgical hub 23140 can compare the particular surgical function to the inferred next surgical function to ensure that current/accepted standard of care protocols are being followed. If so, the situational awarenesssurgical hub 23140 may then evaluate the detected parameters (eg, as described) before allowing certain surgical functions to continue (as described). If not, the situational awarenesssurgical hub 23140 may prevent the particular surgical function from being performed, or prevent the particular surgical function from being performed until an override is received (eg, via theuser interface 23, 158, 23148, 23138, 23128, and/or 23118 , see eg Figure 88, Selectable User Interface Element 23012). In such aspects, if an override is received, the situationally awaresurgical hub 23140 may then evaluate the detected parameters (as described above) before allowing the particular surgical function to continue.

再次参见图89，根据另一个方面，态势感知的外科器械23102可用于执行外科手术。在此类方面，外科器械23102可包括柄部组件23110、轴组件23120和端部执行器组件23130。端部执行器组件23130可包括第一钳口、可枢转地联接到第一钳口的第二钳口，以及传感器23134，该传感器被配置成能够检测与端部执行器组件23130的功能(例如，解剖、夹持、凝结、切割、缝合等)相关联的参数并将该检测到的参数传输到控制电路(23112、23122、23132和/或23142，例如，以虚线显示一个或多个任选的位置)。Referring again to Figure 89, according to another aspect, the situational awarenesssurgical instrument 23102 may be used to perform a surgical procedure. In such aspects, thesurgical instrument 23102 can include ahandle assembly 23110, ashaft assembly 23120, and anend effector assembly 23130. Theend effector assembly 23130 can include a first jaw, a second jaw pivotally coupled to the first jaw, and asensor 23134 configured to detect a function of the end effector assembly 23130 ( For example, dissecting, clamping, coagulating, cutting, stapling, etc.) associated parameters and transmitting the detected parameters to the control circuit (23112, 23122, 23132 and/or 23142, for example, displaying one or more arbitrary selected location).

例如，在此类方面，检测到的参数可被传输到端部执行器组件23130的控制电路23132。此处，端部执行器组件控制电路23132可被配置成能够在外科手术的整个过程中从传感器23134接收检测到的参数(例如，传感器数据)。每当执行相关联的端部执行器组件23130功能(例如，解剖、夹持、凝固、切割、缝合等)时，可接收检测到的参数。For example, in such aspects, the detected parameters may be communicated to thecontrol circuitry 23132 of theend effector assembly 23130. Here, the end effectorassembly control circuit 23132 may be configured to receive detected parameters (eg, sensor data) from thesensors 23134 throughout the surgical procedure. Detected parameters may be received each time an associatedend effector assembly 23130 function is performed (eg, dissection, clamping, coagulation, cutting, stapling, etc.).

端部执行器组件23130还可被配置成能够在外科手术的整个过程中从内部数据库(例如，端部执行器存储器23136)和/或外部数据库(例如，经由外科集线器23140从云数据库23150，从外科集线器数据库23149等)接收数据。根据各个方面，从内部数据库和/或外部数据库接收的数据可包括钉仓数据(例如，与定位在端部执行器组件中的钉仓相关联的钉的尺寸和/或类型)和/或历史数据(例如，指示预期组织和/或待用基于历史数据的那些尺寸和/或类型的钉缝合的组织类型的数据)。在各个方面，接收的数据可包括基于历史数据(例如，系统限定的约束)与钉的那些尺寸和/或类型或那些预期组织和/或组织类型相关联的优选/理想参数和/或优选/理想参数范围。基于所接收的数据(例如，传感器数据、内部和/或外部数据等)，端部执行器控制电路23132可被配置成能够不断导出关于正在进行的外科手术的推论(例如，背景信息)。值得注意的是，根据另选的方面，端部执行器组件23130的传感器23134可将检测到的参数传输到与另一个外科器械23102部件(例如，柄部组件23110和/或轴组件23120)相关联的控制电路(例如，23112和/或23122)。在此类方面，其他外科器械部件控制电路(例如，23112和/或23122)可被类似地配置成能够执行如上所述的端部执行器控制电路23132的各个方面。此外，根据各个方面，外科器械23102的轴组件23120可包括传感器23124，该传感器被配置成能够检测与轴组件23120的功能(例如，旋转、关节运动等)相关联的参数并且将该检测到的参数传输到控制电路(例如，23112)，该控制电路类似地被配置成能够执行如上所述的端部执行器控制电路23132的各个方面。最后，态势感知的外科器械23102可被配置成能够例如向其用户警示差异(例如，经由端部执行器组件23130的用户界面23138，经由另一个外科器械23102部件(例如，轴组件23120和/或柄部组件23110)的用户界面(例如，23128和/或23118)，和/或经由与联接到外科器械23102的外科集线器23140相关联的用户界面23148和/或23158)。例如，该差异可包括检测到的参数超过与钉的那些尺寸和/或类型或那些预期组织和/或组织类型相关联的优选/理想参数和/或优选/理想参数范围。又如，态势感知的外科器械23102可被配置成能够基于该差异来控制外科器械23102功能。根据至少一个方面，态势感知的外科器械23102可基于差异来防止外科功能。Theend effector assembly 23130 can also be configured to be able to access data from an internal database (eg, end effector memory 23136) and/or an external database (eg, fromcloud database 23150 viasurgical hub 23140, fromcloud database 23150 via surgical hub 23140) throughout the surgical procedure.Surgical Hub Database 23149 etc.) to receive the data. According to various aspects, data received from an internal database and/or an external database may include staple cartridge data (eg, size and/or type of staples associated with a staple cartridge positioned in the end effector assembly) and/or history Data (eg, data indicating expected tissue and/or tissue type to be stapled with those sizes and/or types of staples based on historical data). In various aspects, the received data may include preferred/ideal parameters and/or preferred/ideal parameters associated with those sizes and/or types of staples or those expected tissues and/or tissue types based on historical data (eg, system-defined constraints) ideal parameter range. Based on received data (eg, sensor data, internal and/or external data, etc.), the endeffector control circuit 23132 may be configured to continuously derive inferences (eg, contextual information) about the ongoing surgical procedure. Notably, according to alternative aspects, thesensor 23134 of theend effector assembly 23130 can transmit the detected parameter to another component of the surgical instrument 23102 (eg, thehandle assembly 23110 and/or the shaft assembly 23120) connected control circuits (eg, 23112 and/or 23122). In such aspects, other surgical instrument component control circuits (eg, 23112 and/or 23122) may be similarly configured to perform various aspects of the endeffector control circuit 23132 as described above. Additionally, according to various aspects, theshaft assembly 23120 of thesurgical instrument 23102 can include asensor 23124 configured to detect parameters associated with the function of the shaft assembly 23120 (eg, rotation, articulation, etc.) The parameters are communicated to a control circuit (eg, 23112), which is similarly configured to perform various aspects of the endeffector control circuit 23132 as described above. Finally, the situationally awaresurgical instrument 23102 can be configured to alert its user of discrepancies, for example, via theuser interface 23138 of theend effector assembly 23130, via anothersurgical instrument 23102 component (eg, theshaft assembly 23120 and/or handle assembly 23110) (eg, 23128 and/or 23118), and/or viauser interfaces 23148 and/or 23158) associated withsurgical hub 23140 coupled tosurgical instrument 23102. For example, the difference may include detected parameters that exceed preferred/ideal parameters and/or preferred/ideal parameter ranges associated with those sizes and/or types of staples or those expected tissues and/or tissue types. As another example, the situationally awaresurgical instrument 23102 can be configured to be able to control thesurgical instrument 23102 function based on the difference. In accordance with at least one aspect, the situationally awaresurgical instrument 23102 can prevent surgical function based on differences.

态势感知的功能控制Functional Control of Situational Awareness

如本文所强调的，本公开的各个方面涉及外科器械，该外科器械执行功能(例如，夹持)，检测与该功能相关联的参数，使用态势感知方面经由控制电路评估该检测到的参数是低于还是超过预定义的参数(例如，被认为是理想/优选的)或者是低于还是超过该参数的预定义范围(例如，被认为是正常的)，并且响应于检测到的参数在预定义参数和/或预定义参数/范围之外而执行动作(即，停止一个或多个功能、警示用户、通知用户可能的原因等)。例如，图90示出了用于实现此类方面的算法23200，其中控制电路接收与由外科器械23202执行的外科功能相关联的一个或多个检测到的参数，并且从内部和/或外部数据库23204检索态势感知数据。然后，控制电路根据态势感知数据23206评估一个或多个检测到的参数并基于该评估23208执行动作。As emphasized herein, various aspects of the present disclosure relate to a surgical instrument that performs a function (eg, gripping), detects a parameter associated with the function, and evaluates the detected parameter via a control circuit using the situational awareness aspect is is below or exceeds a predefined parameter (eg, considered ideal/preferred) or falls below or exceeds a predefined range of that parameter (eg, considered normal), and in response to the detected parameter Actions are performed outside of defined parameters and/or predefined parameters/ranges (ie, stop one or more functions, alert the user, notify the user of a possible cause, etc.). For example, FIG. 90 shows analgorithm 23200 for implementing such an aspect, wherein the control circuit receives one or more detected parameters associated with the surgical function performed by thesurgical instrument 23202, and retrieves data from an internal and/orexternal database 23204 Retrieve situational awareness data. The control circuitry then evaluates one or more detected parameters based on thesituational awareness data 23206 and performs actions based on theevaluation 23208.

根据本公开的各个方面，在端部执行器组件的钳口处(例如，经由一个或多于一个传感器)检测到的力可为禁止端部执行器组件的一个或多于一个后续/另外的功能被执行的量值。例如，重新参见图12，可经由传感器474、476和/或478检测该力。在此类方面，传感器474可以是联接到端部执行器的应变仪，其中该应变仪被配置成能够测量端部执行器的一个或多个钳口上的应变的量值/振幅，其指示施加到该一个或多个钳口的闭合力。此外，在此类方面，传感器476可以是被配置成能够测量由闭合驱动系统施加到钳口的闭合力的负荷传感器。此外，在此类方面，传感器478可以是被配置成能够测量由马达消耗的电流的电流传感器，该电流与施加到钳口的闭合力相关。除此之外或又如，重新参见图17，可经由传感器744a和/或744b来检测该力。在此类方面，传感器744a和/或744b可以是扭矩传感器，该扭矩传感器被配置成能够提供表示由闭合驱动系统施加到钳口的闭合力的击发力反馈信号。According to various aspects of the present disclosure, the force detected at the jaws of the end effector assembly (eg, via one or more sensors) may inhibit one or more subsequent/additional ones of the end effector assembly The amount by which the function is performed. For example, referring back to FIG. 12 , the force may be detected viasensors 474 , 476 and/or 478 . In such aspects,sensor 474 may be a strain gauge coupled to the end effector, wherein the strain gauge is configured to measure the magnitude/amplitude of strain on one or more jaws of the end effector, which is indicative of the applied The closing force to the one or more jaws. Further, in such aspects,sensor 476 may be a load cell configured to measure the closing force applied to the jaws by the closing drive system. Further, in such aspects,sensor 478 may be a current sensor configured to measure the current drawn by the motor, which current is related to the closing force applied to the jaws. Additionally or alternatively, referring back to Figure 17, the force may be detected viasensors 744a and/or 744b. In such aspects,sensors 744a and/or 744b may be torque sensors configured to provide a firing force feedback signal indicative of the closing force applied to the jaws by the closing drive system.

在一个方面，重新参见图58，负荷传感器152082(例如，定位在轴组件或柄部组件中)可被配置成能够在轴组件附接到柄部组件之后检测负载。在此类方面，检测到的负载可超过预定义负载和/或预定义负载范围。在此类方面，参见图89，例如，与外科器械相关联的控制电路(例如，集成于外科器械的部件中23132、23122和/或23112，或集成于联接的外科集线器中23142)可以评估检测到的负载并使用态势感知(例如，基于历史数据)确定轴组件和/或端部执行器组件被损坏/必须被损坏。在此类方面，控制电路可被配置成能够记录与轴组件23120和/或端部执行器组件23130相关联的独特标识符，并且将该独特标识符指定为禁止进一步使用和/或附接到柄部组件23110。In one aspect, referring back to FIG. 58, a load sensor 152082 (eg, positioned in the shaft assembly or the handle assembly) can be configured to detect a load after the shaft assembly is attached to the handle assembly. In such aspects, the detected load may exceed a predefined load and/or a predefined load range. In such aspects, referring to FIG. 89, for example, control circuitry associated with a surgical instrument (eg, integrated in components of thesurgical instrument 23132, 23122, and/or 23112, or integrated in a coupled surgical hub 23142) may evaluate detection to the load and use situational awareness (eg, based on historical data) to determine that the shaft assembly and/or end effector assembly is/must be damaged. In such aspects, the control circuitry may be configured to be able to record a unique identifier associated with theshaft assembly 23120 and/or theend effector assembly 23130 and designate the unique identifier as prohibiting further use and/or attachment to Handleassembly 23110.

在另一方面，参见图89，例如，与外科器械相关联的控制电路(例如，集成于外科器械的部件中23132、23122和/或23112，或集成于联接的外科集线器中23142)可以被配置成能够评估在钳口处检测/感测到的力(例如，经由如所述一个或多于一个传感器)并且确定防止端部执行器组件的击发功能/周期。具体地讲，控制电路可使用态势感知(例如，基于历史数据)确定在钳口处检测/感测到的(例如，在击发功能/周期开始之前检测到的)力超过预定义力和/或预定义力范围。在此类方面，控制电路可被配置成能够防止击发功能/周期开始。此外，在此类方面，再次参见图89，控制电路可被配置成能够警示用户(例如，经由外科器械的部件的用户界面23138、23128和/或23118，和/或与外科集线器相关联的用户界面23148和/或用户界面23158)不能执行击发功能/周期，并且/或者通知用户可能的原因(例如，使得用户可以尝试减小在钳口处检测/感测到的力)。根据各个方面，如果在钳口处检测/感测到的力减小到预定义力和/或在预定义力范围内，则控制电路可被配置成能够允许击发功能/周期开始。In another aspect, referring to FIG. 89, for example, control circuitry associated with a surgical instrument (eg, integrated in components of thesurgical instrument 23132, 23122, and/or 23112, or integrated in a coupled surgical hub 23142) may be configured To be able to evaluate the force detected/sensed at the jaws (eg, via one or more sensors as described) and determine the function/cycle of preventing the firing of the end effector assembly. In particular, the control circuitry may use situational awareness (eg, based on historical data) to determine that the force detected/sensed at the jaw (eg, detected prior to the start of the firing function/cycle) exceeds a predefined force and/or Predefined force ranges. In such aspects, the control circuit may be configured to prevent initiation of the firing function/cycle. Further, in such aspects, referring again to FIG. 89, the control circuitry may be configured to alert a user (eg, viauser interfaces 23138, 23128, and/or 23118 of components of the surgical instrument, and/or a user associated with the surgical hub)Interface 23148 and/or user interface 23158) cannot perform the firing function/cycle and/or notify the user of the possible cause (eg, so that the user can attempt to reduce the force detected/sensed at the jaws). According to various aspects, the control circuit may be configured to allow the firing function/cycle to begin if the force detected/sensed at the jaws decreases to a predefined force and/or within a predefined force range.

在另一方面，参见图89，例如，与外科器械相关联的控制电路(例如，集成于外科器械的部件中23132、23122和/或23112，或集成于联接的外科集线器中23142)可以评估在钳口处检测/感测到的力(例如，经由一个或多于一个传感器，例如，如所述的负荷传感器、扭矩传感器等)并且初始确定允许端部执行器组件的击发功能/周期。然而，在开始击发功能/周期之后，控制电路可使用态势感知(例如，基于历史数据)确定击发力(例如，在击发功能/周期期间检测到的力)超过预定义击发力和/或预定义击发力范围。在此类方面，控制电路可被配置成能够停止击发功能/周期(例如，防止击发功能/周期继续)。此外，在此类方面，再次参见图89，控制电路可被配置成能够向外科医生提供关于超过的击发力或击发力范围的警示(例如，经由外科器械的部件的用户界面23138、23128和/或23118，和/或与外科集线器相关联的用户界面23148和/或用户界面23158)。根据各个方面，控制电路还可被配置成能够接收覆写命令(例如，经由一个或多个用户界面，参见例如图88，可选择的用户界面元素23012)以允许击发功能/周期继续。在此类方面，控制电路可使用态势感知(例如，基于历史数据)确定第二击发力(例如，在继续击发功能/周期期间检测到的力)超过第二预定义击发力和/或第二预定义击发力范围(例如，更高的阈值)。在此类方面，控制电路可被配置成能够再次停止击发功能/周期，警示外科医生并且/或者如所述接收覆写命令。89, for example, control circuitry associated with a surgical instrument (eg, integrated in components of thesurgical instrument 23132, 23122, and/or 23112, or integrated in a coupled surgical hub 23142) may be evaluated at The force detected/sensed at the jaws (eg, via one or more sensors, eg, load cells, torque sensors, etc., as described) and initial determination allows the firing function/cycle of the end effector assembly. However, after initiating a firing function/cycle, the control circuitry may use situational awareness (eg, based on historical data) to determine that firing force (eg, force detected during firing function/cycle) exceeds a predefined firing force and/or Predefined firing force range. In such aspects, the control circuit may be configured to stop the firing function/cycle (eg, prevent the firing function/cycle from continuing). Furthermore, in such aspects, referring again to FIG. 89, the control circuitry may be configured to provide an alert to the surgeon regarding an exceeding firing force or firing force range (eg, viauser interfaces 23138, 23128 of components of the surgical instrument). and/or 23118, and/oruser interface 23148 and/oruser interface 23158 associated with the surgical hub). According to various aspects, the control circuit may also be configured to be capable of receiving an override command (eg, via one or more user interfaces, see eg, FIG. 88, selectable user interface element 23012) to allow the firing function/cycle to continue. In such aspects, the control circuitry may use situational awareness (eg, based on historical data) to determine that a second firing force (eg, a force detected during a continued firing function/cycle) exceeds a second predefined firing force and/or A second predefined firing force range (eg, higher threshold). In such aspects, the control circuit may be configured to again stop the firing function/cycle, alert the surgeon and/or receive an override command as described.

在另一方面，参见图89，例如，与外科器械相关联的控制电路(例如，集成于外科器械的部件中23132、23122和/或23112，或集成于联接的外科集线器中23142)可评估在钳口处检测/感测到的力(例如，经由如所述一个或多于一个传感器)。此外，控制电路还可评估在轴组件内检测/感测到的力(即，经由如所述的一个或多于一个传感器)。此处，根据各个方面，控制电路可在执行外科手术的情况下交叉引用在钳口处检测/感测到的力和/或在轴组件内检测/感测到的力。根据此类方面，控制电路可使用态势感知(例如，基于规程数据和/或历史数据)确定在轴组件内检测/感测到的力超过预定义轴力和/或预定义轴力范围。在一个示例中，轴组件可包括被配置用于在特定外科手术中与特定组织类型一起使用的专门轴组件。在此类方面，控制电路可使用态势感知(例如，基于规程数据和/或历史数据)确定在专门轴组件内检测/感测到的力过高(例如，超过与专门轴组件相关联的预定义轴力和/或预定义轴力范围)和/或在钳口处检测/感测到的力不是预定义力和/或不在预定义范围内(例如，历史上与正在执行的外科手术相关联的预期力)。在此类方面，控制电路可被配置成能够停止击发功能/周期(例如，防止击发功能/周期开始和/或继续)。此外，在此类方面，再次参见图89，控制电路可被配置成能够向外科医生提供关于超过的轴力和/或轴力范围的警示(例如，经由外科器械的部件的用户界面23138、23128和/或23118，和/或与外科集线器相关联的用户界面23148和/或用户界面23158)。在各个方面，该警示可通知外科医生考虑将专门轴组件(例如，23120)与柄部组件23110分离，并且将另一个轴组件(例如，被配置用于检测/感测到的力和遇到的组织的常规重新加载)附接到柄部组件23110。在此类方面，控制电路可被配置成能够在适当的轴组件被附接时允许击发功能/周期开始和/或继续。89, for example, control circuitry associated with a surgical instrument (eg, integrated in components of thesurgical instrument 23132, 23122, and/or 23112, or integrated in a coupled surgical hub 23142) may be evaluated at Force detected/sensed at the jaw (eg, via one or more sensors as described). In addition, the control circuit may also evaluate the force detected/sensed within the shaft assembly (ie, via one or more sensors as described). Here, according to various aspects, the control circuit may cross-reference the force detected/sensed at the jaws and/or the force detected/sensed within the shaft assembly in the case of performing a surgical procedure. According to such aspects, the control circuitry may use situational awareness (eg, based on protocol data and/or historical data) to determine that a detected/sensed force within the shaft assembly exceeds a predefined shaft force and/or a predefined shaft force range. In one example, a shaft assembly may include a specialized shaft assembly configured for use with a particular tissue type in a particular surgical procedure. In such aspects, the control circuitry may use situational awareness (eg, based on protocol data and/or historical data) to determine that a detected/sensed force within a specialized shaft assembly is too high (eg, exceeds a predetermined threshold associated with the specialized shaft assembly). Defined axial force and/or predefined axial force range) and/or the force detected/sensed at the jaws is not a predefined force and/or is not within a predefined range (e.g. historically related to the surgical procedure being performed the expected force of the association). In such aspects, the control circuit may be configured to be able to stop the firing function/cycle (eg, prevent the firing function/cycle from starting and/or continuing). Further, in such aspects, referring again to FIG. 89, the control circuit may be configured to provide alerts to the surgeon regarding the axial force and/or axial force range exceeded (eg, via theuser interface 23138, 23128 of the component of the surgical instrument). and/or 23118, and/oruser interface 23148 and/oruser interface 23158 associated with the surgical hub). In various aspects, the alert may notify the surgeon to consider separating a specific shaft assembly (eg, 23120) from thehandle assembly 23110, and separate another shaft assembly (eg, configured for detection/sensing of forces and encounters (regular reloading of tissue) is attached to thehandle assembly 23110. In such aspects, the control circuit may be configured to allow the firing function/cycle to begin and/or continue when the appropriate shaft assembly is attached.

在另一方面，参见图89，例如，与外科器械相关联的控制电路(例如，集成于外科器械的部件中23132、23122和/或23112，或集成于联接的外科集线器中23142)可在外科手术期间评估在钳口处检测/感测到的力(例如，经由如所述一个或多于一个传感器)。根据此类方面，控制电路可使用态势感知(例如，基于规程数据和/或历史数据)确定组织蠕变等待时间低于与特定厚度和外科手术期间被夹持的特定组织相关联的预定义蠕变等待时间和/或预定义蠕变等待时间范围。换句话说，按照本文的图83和图84，初始的闭合力可已经衰减并且比预期更快以较低闭合力达到蠕变稳定性。在此类方面，控制电路可被配置成能够停止击发功能/周期(例如，防止击发功能/周期开始和/或继续)。另外，在此类方面，再次参见图89，控制电路可被配置成能够向外科医生提供关于缩短的蠕变等待时间的警示(例如，经由外科器械的部件的用户界面23138、23128和/或23118，和/或与外科集线器相关联的用户界面23148和/或用户界面23158)。在各个方面，该警示可通知外科医生考虑将端部执行器组件(例如，23130)与柄部组件分离，并且将另一个端部执行器组件(例如，被配置成能够处理具有检测到的蠕变等待时间的组织的端部执行器组件)附接到柄部组件23110。在此类方面，控制电路可被配置成能够在附接适当的端部执行器组件时允许击发功能/周期开始和/或继续。In another aspect, referring to FIG. 89, for example, control circuitry associated with a surgical instrument (eg, integrated in components of thesurgical instrument 23132, 23122, and/or 23112, or integrated in a coupled surgical hub 23142) may be The force detected/sensed at the jaws (eg, via one or more sensors as described) is assessed during surgery. According to such aspects, the control circuitry may use situational awareness (eg, based on protocol data and/or historical data) to determine that the tissue creep latency is below a predefined creep associated with a particular thickness and particular tissue clamped during surgery Variable waiting time and/or predefined creep waiting time range. In other words, according to Figures 83 and 84 herein, the initial closing force may have decayed and creep stability is achieved with lower closing forces faster than expected. In such aspects, the control circuit may be configured to be able to stop the firing function/cycle (eg, prevent the firing function/cycle from starting and/or continuing). Additionally, in such aspects, referring again to FIG. 89, the control circuit may be configured to provide an alert to the surgeon regarding the reduced creep latency (eg, via theuser interface 23138, 23128, and/or 23118 of the component of the surgical instrument). , and/oruser interface 23148 and/or user interface 23158) associated with the surgical hub. In various aspects, the alert may notify the surgeon to consider separating the end effector assembly (eg, 23130) from the handle assembly and disengaging another end effector assembly (eg, configured to A variable latency tissue end effector assembly) is attached to thehandle assembly 23110. In such aspects, the control circuit may be configured to allow the firing function/cycle to begin and/or continue when the appropriate end effector assembly is attached.

在另一方面，参见图89，例如，与外科器械相关联的控制电路(例如，集成于外科器械的部件中23132、23122和/或23112，或集成于联接的外科集线器中23142)可评估在钳口处检测/感测到的力(例如，经由如所述一个或多于一个传感器)。此外，控制电路还可评估针对关节运动构件(即，通过一个或多于一个传感器)检测/感测到的位置。例如，重新参见图12，可由联接到该关节运动构件的传感器472检测/感测该位置。在一个方面，传感器472可以是被配置成能够测量线性位移的位置传感器，其中传感器元件的单次旋转对应于关节运动构件的特定线性位移。在另一个示例中，重新参见图17，可由位于端部执行器中的位置传感器734检测/感测该位置。此处，位置传感器734可为接近传感器或被配置成能够提供可由控制电路跟踪以确定关节运动构件的位置的一系列脉冲的传感器。此处，根据各个方面，控制电路可在执行外科手术的情况下交叉引用在钳口处检测/感测到的力和/或针对关节运动构件检测/感测到的位置。根据此类方面，控制电路可使用态势感知(例如，基于规程数据和/或历史数据)确定针对关节运动构件检测/感测到的位置指示关节运动构件已推进(例如，在轴组件内)超过预先确定的推进位置和/或预先确定的推进位置范围。在各个方面，预先确定的推进位置和/或预先确定的推进位置范围可以与在钳口处检测/感测到的闭合力相关联。在此类方面，在超过指定的预先确定的推进位置的情况下，控制电路可被配置成能够停止击发功能/周期(例如，防止击发功能/周期开始和/或继续)。此外，在此类方面，再次参见图89，控制电路可被配置成能够向外科医生提供关于超过的推进位置和/或推进位置范围的警示(例如，经由外科器械的部件的用户界面23138、23128和/或23118，和/或与外科集线器相关联的用户界面23148和/或用户界面23158)。在各个方面，该警示可通知外科医生考虑将关节运动构件回缩到预先确定的推进位置和/或预先确定的推进位置范围内。此处，在一个示例中，预先确定的推进位置和/或预先确定的推进位置范围可在历史上实现对应的闭合力的期望和/或成功的击发功能/周期。在此类方面，控制电路可被配置成能够在适当的推进位置被实现时允许击发功能/周期开始和/或继续。89, for example, control circuitry associated with a surgical instrument (eg, integrated in components of thesurgical instrument 23132, 23122, and/or 23112, or integrated in a coupled surgical hub 23142) may be evaluated at Force detected/sensed at the jaw (eg, via one or more sensors as described). Additionally, the control circuit may also evaluate the detected/sensed position for the articulating member (ie, by one or more sensors). For example, referring back to Figure 12, the position may be detected/sensed by asensor 472 coupled to the articulation member. In one aspect,sensor 472 may be a position sensor configured to measure linear displacement, wherein a single rotation of the sensor element corresponds to a particular linear displacement of the articulation member. In another example, referring back to Figure 17, the position may be detected/sensed by aposition sensor 734 located in the end effector. Here, theposition sensor 734 may be a proximity sensor or a sensor configured to provide a series of pulses that can be tracked by the control circuitry to determine the position of the articulation member. Here, according to various aspects, the control circuit may cross-reference the force detected/sensed at the jaws and/or the position detected/sensed for the articulating member in the case of performing a surgical procedure. According to such aspects, the control circuitry may use situational awareness (eg, based on protocol data and/or historical data) to determine that the detected/sensed position for the articulation member indicates that the articulation member has advanced (eg, within the shaft assembly) beyond A predetermined advance position and/or a predetermined range of advance positions. In various aspects, a predetermined advance position and/or a predetermined range of advance positions may be associated with a detected/sensed closing force at the jaws. In such aspects, the control circuit may be configured to stop the firing function/cycle (eg, prevent the firing function/cycle from starting and/or continuing) in the event that a specified predetermined advance position is exceeded. In addition, in such aspects, referring again to FIG. 89, the control circuit may be configured to provide alerts to the surgeon regarding the exceeded advancement position and/or advancement position range (eg, via theuser interface 23138, 23128 of the component of the surgical instrument). and/or 23118, and/oruser interface 23148 and/oruser interface 23158 associated with the surgical hub). In various aspects, the alert may inform the surgeon to consider retracting the articulation member into a predetermined advanced position and/or within a predetermined range of advanced positions. Here, in one example, a predetermined advance position and/or a predetermined range of advance positions may historically achieve the desired and/or successful firing function/cycle of the corresponding closing force. In such aspects, the control circuit may be configured to allow the firing function/cycle to begin and/or continue when the appropriate advance position is achieved.

在另一方面，参见图89，例如，与外科器械相关联的控制电路(例如，集成于外科器械的部件中23132、23122和/或23112，或集成于联接的外科集线器中23142)可在外科手术期间评估在钳口处检测/感测到的力(例如，经由如所述一个或多于一个传感器)。根据此类方面，控制电路可使用态势感知(例如，基于规程数据和/或历史数据)确定闭合力高于与外科手术期间被夹持的特定组织相关联的预定义闭合力和/或预定义闭合力范围。换句话说，按照本文的图83和图84，检测/感测到的闭合力高于预期以允许击发功能/周期继续。在此类方面，控制电路可被配置成能够停止击发功能/周期(例如，防止击发功能/周期开始和/或继续)。另外，在此类方面，再次参见图89，控制电路可被配置成能够向外科医生提供关于升高的闭合力的警示(例如，经由外科器械的部件的用户界面23138、23128和/或23118，和/或与外科集线器相关联的用户界面23148和/或用户界面23158)。在各个方面，该警示可通知外科医生考虑调节击发马达速度。在一个示例中，如果特定组织是刚性组织，则该警示可建议外科医生将击发马达速度调低以避免撕裂刚性组织。在此类方面，可基于与正在执行的外科手术相关联的历史数据将速度调低。在另一个示例中，如果特定组织是弱剪切强度的粘性组织，则该警示可建议外科医生将击发马达速度调高以确保组织被适当地夹持。在此类方面，可基于与正在执行的外科手术相关联的历史数据将速度调高。在此类方面，控制电路可被配置成能够在设定适当的击发马达速度时允许击发功能/周期开始和/或继续。In another aspect, referring to FIG. 89, for example, control circuitry associated with a surgical instrument (eg, integrated in components of thesurgical instrument 23132, 23122, and/or 23112, or integrated in a coupled surgical hub 23142) may be The force detected/sensed at the jaws (eg, via one or more sensors as described) is assessed during surgery. According to such aspects, the control circuitry may use situational awareness (eg, based on protocol data and/or historical data) to determine that the closure force is higher than a predefined closure force and/or a predefined closure force associated with a particular tissue clamped during surgery Closing force range. In other words, according to Figures 83 and 84 herein, the detected/sensed closing force is higher than expected to allow the firing function/cycle to continue. In such aspects, the control circuit may be configured to be able to stop the firing function/cycle (eg, prevent the firing function/cycle from starting and/or continuing). In addition, in such aspects, referring again to FIG. 89, the control circuit may be configured to provide an alert to the surgeon regarding an elevated closing force (eg, viauser interfaces 23138, 23128, and/or 23118 of components of the surgical instrument, and/oruser interface 23148 and/or user interface 23158) associated with the surgical hub. In various aspects, the alert may inform the surgeon to consider adjusting firing motor speed. In one example, if the particular tissue is rigid tissue, the alert may advise the surgeon to turn down the firing motor speed to avoid tearing the rigid tissue. In such aspects, the speed may be adjusted down based on historical data associated with the surgical procedure being performed. In another example, if the particular tissue is a weak shear strength viscous tissue, the alert may suggest that the surgeon turn up the firing motor speed to ensure that the tissue is properly gripped. In such aspects, the speed may be adjusted up based on historical data associated with the surgical procedure being performed. In such aspects, the control circuit may be configured to allow the firing function/cycle to begin and/or continue when the appropriate firing motor speed is set.

在另一方面，参见图89，例如，与外科器械相关联的控制电路(例如，集成于外科器械的部件中23132、23122和/或23112，或集成于联接的外科集线器中23142)可在外科手术期间评估在钳口处检测/感测到的力(例如，经由如所述一个或多于一个传感器)。根据此类方面，控制电路可以使用态势感知(例如，基于规程数据和/或历史数据)确定在外科手术期间击发系统上的循环力高于预定义循环力和/或预定义循环力范围。换句话说，检测/感测到的循环力高于预期，并且可基于历史数据指示即将发生的马达故障。在此类方面，控制电路可被配置成能够停止击发功能/周期(例如，防止击发功能/周期开始和/或继续推进)。另外，在此类方面，再次参见图89，控制电路可被配置成能够向外科医生提供关于升高的循环力和可能的马达故障的警示(例如，经由外科器械的部件的用户界面23138、23128和/或23118，和/或与外科集线器相关联的用户界面23148和/或用户界面23158)。根据各个方面，控制电路还可被配置成能够接收覆写命令(例如，经由用户界面，参见例如图88，可选择的用户界面元素23012)以允许击发功能/周期继续。在此类方面，控制电路可在外科手术期间继续监测击发系统上的循环力是否高于预定义循环力和/或预定义循环力范围。在此类方面，控制电路可被配置成能够再次停止击发功能/周期，警示外科医生并且/或者如所述接收覆写命令。In another aspect, referring to FIG. 89, for example, control circuitry associated with a surgical instrument (eg, integrated in components of thesurgical instrument 23132, 23122, and/or 23112, or integrated in a coupled surgical hub 23142) may be The force detected/sensed at the jaws (eg, via one or more sensors as described) is assessed during surgery. According to such aspects, the control circuitry may use situational awareness (eg, based on protocol data and/or historical data) to determine that the circulatory force on the firing system during a surgical procedure is above a predefined circulatory force and/or a predefined circulatory force range. In other words, the detected/sensed cyclic force is higher than expected and may indicate an impending motor failure based on historical data. In such aspects, the control circuit may be configured to be able to stop the firing function/cycle (eg, prevent the firing function/cycle from starting and/or continuing to advance). In addition, in such aspects, referring again to FIG. 89, the control circuit may be configured to provide alerts to the surgeon regarding elevated circulatory forces and possible motor failure (eg, viauser interfaces 23138, 23128 of components of the surgical instrument). and/or 23118, and/oruser interface 23148 and/oruser interface 23158 associated with the surgical hub). According to various aspects, the control circuit may also be configured to be capable of receiving an override command (eg, via a user interface, see eg, FIG. 88, selectable user interface element 23012) to allow the firing function/cycle to continue. In such aspects, the control circuit may continue to monitor whether the circulatory force on the firing system is above a predefined circulatory force and/or a predefined circulatory force range during a surgical procedure. In such aspects, the control circuit may be configured to again stop the firing function/cycle, alert the surgeon, and/or receive an override command as described.

根据本公开的另一方面，参见图89，例如，与外科器械相关联的控制电路(例如，集成于外科器械的部件中23132、23122和/或23112，或集成于联接的外科集线器中23142)可评估在钳口处检测/感测到的力(例如，经由如所述一个或多于一个传感器)。此外，控制电路还可评估使端部执行器组件23130进行关节运动的力/扭矩。在此类方面，可经由一个或多于一个传感器(例如，与关节运动构件相关联的力传感器、与关节运动构件相关联的扭矩传感器、与被配置成能够驱动关节运动构件的马达相关联的电流传感器等)检测关节运动力/扭矩。例如，重新参见图17，可由联接到关节运动驱动系统的扭矩传感器744d和/或744e检测/感测关节运动力/扭矩。除此之外和/或另选地，再次参见图17，关节运动力/扭矩可与如传感器736测量的由马达704d和/或704e消耗的电流相关联。此处，根据各个方面，控制电路可在执行外科手术的情况下交叉引用在钳口处检测/感测到的力和/或针对关节运动构件检测到的关节运动力/扭矩。根据此类方面，控制电路可使用态势感知(例如，基于规程数据和/或历史数据)确定针对关节运动构件检测到的关节运动力/扭矩超过预定义关节运动力/扭矩和/或预定义关节运动力/扭矩范围。在各个方面，预定义关节运动力/扭矩和/或预定义关节运动力/扭矩范围可与在钳口处检测/感测到的力相关联。在此类方面，在超过指定的关节运动力/扭矩的情况下，控制电路可被配置成能够停止端部执行器组件的关节运动(例如，以防止关节运动继续)。此外，在此类方面，再次参见图89，控制电路可被配置成能够向外科医生提供关于超过的关节运动力/扭矩和/或关节运动力/扭矩范围的警示(例如，经由外科器械的部件的用户界面23138、23128和/或23118，和/或与外科集线器相关联的用户界面23148和/或用户界面23158)。根据各个方面，控制电路还可被配置成能够接收覆写命令(例如，经由用户界面，参见例如图88，可选择的用户界面元素23012)以允许关节运动继续。在此类方面，控制电路可在外科手术期间继续监测关节运动力/扭矩是否高于预定义关节运动力/扭矩和/或预定义关节运动力/扭矩范围。在此类方面，控制电路可被配置成能够再次停止关节运动，警示外科医生并且/或者如所述接收覆写命令。According to another aspect of the present disclosure, see FIG. 89, eg, control circuitry associated with a surgical instrument (eg, integrated in components of asurgical instrument 23132, 23122, and/or 23112, or integrated in a coupled surgical hub 23142) The force detected/sensed at the jaws can be assessed (eg, via one or more sensors as described). Additionally, the control circuitry can also evaluate the force/torque that articulates theend effector assembly 23130. In such aspects, the sensor may be connected via one or more sensors (eg, a force sensor associated with the articulation member, a torque sensor associated with the articulation member, a motor configured to drive the articulation member Current sensors, etc.) to detect joint motion force/torque. For example, referring back to Figure 17, the articulation force/torque may be detected/sensed by torque sensors 744d and/or 744e coupled to the articulation drive system. Additionally and/or alternatively, referring again to FIG. 17 , the articulation force/torque may be correlated to the current drawn by themotors 704d and/or 704e as measured by thesensor 736 . Here, according to various aspects, the control circuit may cross-reference the force detected/sensed at the jaws and/or the articulation force/torque detected for the articulation member in the case of performing a surgical procedure. According to such aspects, the control circuitry may use situational awareness (eg, based on protocol data and/or historical data) to determine that the detected articulation force/torque for the articulation member exceeds the predefined articulation force/torque and/or the predefined articulation force/torque Movement force/torque range. In various aspects, a predefined articulation force/torque and/or a predefined articulation force/torque range may be associated with the force detected/sensed at the jaws. In such aspects, the control circuit may be configured to stop articulation of the end effector assembly (eg, to prevent articulation from continuing) if a specified articulation force/torque is exceeded. Further, in such aspects, referring again to FIG. 89, the control circuit may be configured to provide alerts to the surgeon regarding the exceeded articulation force/torque and/or articulation force/torque range (eg, via a component of the surgical instrument)user interface 23138, 23128 and/or 23118, and/oruser interface 23148 and/oruser interface 23158 associated with the surgical hub). According to various aspects, the control circuit may also be configured to be capable of receiving an override command (eg, via a user interface, see eg, FIG. 88, selectable user interface element 23012) to allow articulation to continue. In such aspects, the control circuit may continue to monitor whether the articulation force/torque is above a predefined articulation force/torque and/or a predefined articulation force/torque range during the surgical procedure. In such aspects, the control circuit may be configured to stop articulation again, alert the surgeon, and/or receive an override command as described.

根据本公开的又一方面，参见图89，例如，与外科器械相关联的控制电路(例如，集成于外科器械的部件中23132、23122和/或23112，或集成于联接的外科集线器中23142)可评估在钳口处检测/感测到的力(例如，经由如所述一个或多于一个传感器)。此外，控制电路还可评估旋转轴组件23120(例如，轴构件)的力/扭矩。在此类方面，可经由一个或多于一个传感器(例如，与旋转/轴构件相关联的力传感器、与旋转/轴构件相关联的扭矩传感器、与被配置成能够旋转旋转/轴构件的马达相关联的电流传感器等)检测旋转力/扭矩。例如，重新参见图17，可由联接到旋转/轴构件驱动系统的扭矩传感器744c检测/感测旋转力/扭矩。除此之外和/或另选地，再次参见图17，旋转力/扭矩可与如传感器736测量的由马达704c消耗的电流相关联。此处，根据各个方面，控制电路可在执行外科手术的情况下交叉引用在钳口处检测/感测到的力和/或针对旋转/轴构件检测到的旋转力/扭矩。根据此类方面，控制电路可使用态势感知(例如，基于规程数据和/或历史数据)确定针对旋转/轴构件检测到的旋转力/扭矩超过预定义旋转力/扭矩和/或预定义旋转力/扭矩范围。在各个方面，预定义旋转力/扭矩和/或预定义旋转力/扭矩范围可与在钳口处检测/感测到的力相关联。在其他方面，预定义旋转力/扭矩和/或预定义旋转力/扭矩范围可对应于旋转/轴构件本身能够承受的力/扭力。在此类方面，在超过指定的旋转力/扭矩的情况下，控制电路可被配置成能够停止轴组件的旋转(例如，防止旋转/轴构件继续旋转)。此外，在此类方面，再次参见图89，控制电路可被配置成能够向外科医生提供关于超过的旋转力/扭矩和/或旋转力/扭矩范围的警示(例如，经由外科器械的部件的用户界面23138、23128和/或23118，和/或与外科集线器相关联的用户界面23148和/或用户界面23158)。根据各个方面，控制电路还可被配置成能够接收覆写命令(例如，经由用户界面，参见例如图88，可选择的用户界面元素23012)以允许旋转继续。在此类方面，控制电路可在外科手术期间继续监测旋转力/扭矩是否高于预定义旋转力/扭矩和/或预定义旋转力/扭矩范围。在此类方面，控制电路可被配置成能够再次停止旋转，警示外科医生并且/或者如所述接收覆写命令。According to yet another aspect of the present disclosure, see FIG. 89, eg, control circuitry associated with a surgical instrument (eg, integrated in components of asurgical instrument 23132, 23122, and/or 23112, or integrated in a coupled surgical hub 23142) The force detected/sensed at the jaws can be assessed (eg, via one or more sensors as described). Additionally, the control circuitry may also evaluate the force/torque of the rotating shaft assembly 23120 (eg, shaft member). In such aspects, one or more sensors may be provided via one or more sensors (eg, a force sensor associated with the rotation/shaft member, a torque sensor associated with the rotation/shaft member, and a motor configured to rotate the rotation/shaft member associated current sensors, etc.) to detect rotational force/torque. For example, referring back to Figure 17, the rotational force/torque may be detected/sensed by a torque sensor 744c coupled to the rotational/shaft member drive system. Additionally and/or alternatively, referring again to FIG. 17 , the rotational force/torque may be correlated to the current drawn by themotor 704c as measured by thesensor 736 . Here, according to various aspects, the control circuit may cross-reference the force detected/sensed at the jaws and/or the rotational force/torque detected for the rotational/shaft member in the case of performing a surgical procedure. According to such aspects, the control circuit may use situational awareness (eg, based on protocol data and/or historical data) to determine that the detected rotational force/torque for the rotational/shaft member exceeds a predefined rotational force/torque and/or a predefined rotational force /torque range. In various aspects, a predefined rotational force/torque and/or a predefined rotational force/torque range may be associated with a force detected/sensed at the jaws. In other aspects, the predefined rotational force/torque and/or the predefined rotational force/torque range may correspond to the force/torque that the rotational/shaft member itself can withstand. In such aspects, the control circuit may be configured to stop rotation of the shaft assembly (eg, prevent the rotation/shaft member from continuing to rotate) in the event that a specified rotational force/torque is exceeded. Further, in such aspects, referring again to FIG. 89, the control circuit may be configured to provide alerts to the surgeon regarding the exceeded rotational force/torque and/or rotational force/torque range (eg, via a user of a component of the surgical instrument)interface 23138, 23128 and/or 23118, and/oruser interface 23148 and/oruser interface 23158 associated with the surgical hub). According to various aspects, the control circuit may also be configured to be capable of receiving an overwrite command (eg, via a user interface, see eg, FIG. 88, selectable user interface element 23012) to allow rotation to continue. In such aspects, the control circuit may continue to monitor whether the rotational force/torque is above a predefined rotational force/torque and/or a predefined rotational force/torque range during the surgical procedure. In such aspects, the control circuit may be configured to stop rotation again, alert the surgeon, and/or receive an override command as described.

根据本公开的又一方面，参见图89，例如，与外科器械相关联的控制电路(例如，集成于外科器械的部件中23132、23122和/或23112，或集成于联接的外科集线器中23142)可被配置成能够评估在钳口处检测/感测到的打开力(例如，经由如所述一个或多于一个传感器)并且确定防止钳口打开。具体地讲，控制电路可使用态势感知(例如，基于历史数据)确定在钳口处检测/感测到的打开力超过预定义打开力和/或预定义打开力范围。在此类方面，控制电路可被配置成能够将钳口保持在夹持或部分夹持位置。此外，在此类方面，再次参见图89，控制电路可被配置成能够警示用户(例如，经由外科器械的部件的用户界面23138、23128和/或23118，和/或与外科集线器相关联的用户界面23148和/或用户界面23158)不能打开钳口，并且/或者通知用户可能的原因(例如，使得用户可以尝试减小在钳口处检测/感测到的打开力)。根据各个方面，如果在钳口处检测/感测到的打开力减小到预定义打开力和/或在预定义打开力范围内，则控制电路可被配置成能够允许钳口打开。According to yet another aspect of the present disclosure, see FIG. 89, eg, control circuitry associated with a surgical instrument (eg, integrated in components of asurgical instrument 23132, 23122, and/or 23112, or integrated in a coupled surgical hub 23142) It may be configured to be able to evaluate the detected/sensed opening force at the jaws (eg, via one or more sensors as described) and determine that the jaws are prevented from opening. Specifically, the control circuitry may use situational awareness (eg, based on historical data) to determine that the detected/sensed opening force at the jaw exceeds a predefined opening force and/or a predefined opening force range. In such aspects, the control circuit may be configured to maintain the jaws in the clamped or partially clamped position. Further, in such aspects, referring again to FIG. 89, the control circuitry may be configured to alert a user (eg, viauser interfaces 23138, 23128, and/or 23118 of components of the surgical instrument, and/or a user associated with the surgical hub)Interface 23148 and/or user interface 23158) fails to open the jaws and/or informs the user of the probable cause (eg, so that the user can attempt to reduce the detected/sensed opening force at the jaws). According to various aspects, the control circuit may be configured to allow the jaws to open if the detected/sensed opening force at the jaws decreases to a predefined opening force and/or is within a predefined opening force range.

短路检测和功能控制Short circuit detection and function control

根据本公开的各种其他方面，可基于被配置成能够检测短路的一个或多于一个传感器来控制外科器械的功能。即，如果在钳口内检测到金属物体，则可防止/禁止至少一个外科器械功能/致动(例如，切割、凝结等)。例如，图91示出了用于实现此类方面的算法23300，其中控制电路接收指示短路23302的一个或多个检测到的参数。控制电路还可检索内部和/或外部数据库数据23304。然后，控制电路评估一个或多个检测到的参数和/或数据库数据23306，并基于该评估23308执行动作。According to various other aspects of the present disclosure, the functionality of the surgical instrument may be controlled based on one or more sensors configured to detect short circuits. That is, if a metallic object is detected within the jaws, at least one surgical instrument function/actuation (eg, cutting, coagulation, etc.) may be prevented/inhibited. For example, FIG. 91 illustrates analgorithm 23300 for implementing such aspects, wherein a control circuit receives one or more detected parameters indicative of ashort circuit 23302. The control circuitry may also retrieve internal and/orexternal database data 23304. The control circuitry then evaluates one or more detected parameters and/ordatabase data 23306 and performs actions based on theevaluation 23308.

再次参见图89，根据本公开的各方面，外科系统23100可包括控制电路(23112、23122、23132和/或23142，例如，以虚线显示一个或多个任选的位置)、用户界面(23118、23128、23138、23148和/或23158，例如，以虚线显示任选位置)，以及包括例如柄部组件23110、轴组件23120和端部执行器组件23130的外科器械23100。在此类方面，控制电路可集成到外科器械23102(例如，23112、23122和/或23132)的一个或多于一个部件(例如，柄部组件23110、轴组件23120和/或端部执行器组件23130等)中并且/或者集成到与外科器械23102配对(例如，无线地)的外科集线器23140(例如，23142)中。在此类方面，端部执行器组件23130可包括第一钳口、可枢转地联接到第一钳口的第二钳口，以及传感器23134，该传感器被配置成能够检测与端部执行器组件23130的功能(例如，解剖、夹持、凝结、切割、缝合等)相关联的参数并将该检测到的参数传输到控制电路(例如，23112、23122、23132和/或23142)。在各个方面，第一钳口可包括砧座，并且第二钳口可包括被配置成能够接纳钉仓的细长通道。另外，在此类方面，外科器械23102还可包括轴组件23120，该轴组件包括传感器23124，该传感器被配置成能够检测与轴组件23120的功能(例如，旋转、关节运动等)相关联的参数并将该检测到的参数传输到控制电路(例如，23112、23122、23132和/或23142)。在此类方面，该控制电路可被配置成能够在外科手术的整个过程中从此类传感器(例如，23134和/或23124)接收检测到的参数(例如，传感器数据)。每当执行相关联的端部执行器组件23130功能(例如，解剖、夹持、凝固、切割、缝合等)和/或相关联的轴组件23120功能(例如，旋转、关节运动等)时，可接收检测到的参数。控制电路还可被配置成能够在外科手术的整个过程中从内部数据库(例如，外科器械的部件的存储器23136、23126和/或23116中或外科集线器数据库23149中)和/或外部数据库(例如，从外科集线器数据库23149、云数据库23150等)接收数据。根据各个方面，从内部数据库和/或外部数据库接收的数据可包括规程数据(例如，执行外科手术的步骤)和/或历史数据(例如，基于与外科手术相关联的历史数据指示预期参数的数据)。在各个方面，规程数据可包括用于外科手术的当前/公认的护理标准规程，并且历史数据可包括基于与外科手术相关联的历史数据的优选/理想参数和/或优选/理想参数范围(例如，系统限定的约束)。基于所接收的数据(例如，传感器数据、内部和/或外部数据等)，控制电路(例如，23112、23122、23132和/或23142)可被配置成能够不断导出关于正在进行的规程的推论(例如，背景信息)。即，外科器械可被配置成能够例如记录与用于生成报告的外科手术有关的数据，验证外科医生正采取的执行外科手术的步骤，提供可能与特定规程步骤相关的数据或提示(例如，经由与外科集线器23148相关联的用户界面和/或用户界面23158和/或与外科器械相关联的用户界面23138、23128和/或23118)，控制外科器械23102功能等。Referring again to FIG. 89, in accordance with aspects of the present disclosure,surgical system 23100 may include control circuitry (23112, 23122, 23132, and/or 23142, eg, showing one or more optional locations in dashed lines), user interface (23118, 23128, 23138, 23148, and/or 23158, eg, optional locations shown in phantom), andsurgical instrument 23100 including, eg, handleassembly 23110,shaft assembly 23120, and endeffector assembly 23130. In such aspects, control circuitry may be integrated into one or more components (eg, handleassembly 23110,shaft assembly 23120, and/or end effector assembly) of surgical instrument 23102 (eg, 23112, 23122, and/or 23132) 23130, etc.) and/or integrated into a surgical hub 23140 (eg, 23142) that mates (eg, wirelessly) with thesurgical instrument 23102. In such aspects, theend effector assembly 23130 can include a first jaw, a second jaw pivotally coupled to the first jaw, and asensor 23134 configured to detect contact with the end effector parameters associated with the function of the assembly 23130 (eg, dissection, clamping, coagulation, cutting, stapling, etc.) and communicate the detected parameters to the control circuitry (eg, 23112, 23122, 23132, and/or 23142). In various aspects, the first jaw can include an anvil, and the second jaw can include an elongated channel configured to receive a staple cartridge. Additionally, in such aspects, thesurgical instrument 23102 may further include ashaft assembly 23120 that includes asensor 23124 configured to detect parameters associated with the function (eg, rotation, articulation, etc.) of theshaft assembly 23120 This detected parameter is communicated to a control circuit (eg, 23112, 23122, 23132, and/or 23142). In such aspects, the control circuitry may be configured to receive detected parameters (eg, sensor data) from such sensors (eg, 23134 and/or 23124) throughout the surgical procedure. Whenever an associatedend effector assembly 23130 function (eg, dissection, clamping, coagulation, cutting, stapling, etc.) and/or an associatedshaft assembly 23120 function (eg, rotation, articulation, etc.) is performed, the Receive detected parameters. The control circuitry may also be configured to be able to retrieve data from an internal database (eg,memory 23136, 23126, and/or 23116 of components of a surgical instrument or surgical hub database 23149) and/or an external database (eg, Receive data fromsurgical hub database 23149,cloud database 23150, etc.). According to various aspects, data received from an internal database and/or an external database may include procedural data (eg, steps to perform a surgical procedure) and/or historical data (eg, data indicative of expected parameters based on historical data associated with a surgical procedure) ). In various aspects, the procedure data can include current/accepted standard-of-care procedures for the surgical procedure, and the historical data can include preferred/ideal parameters and/or preferred/ideal parameter ranges based on historical data associated with the surgical procedure (eg, , system-defined constraints). Based on received data (eg, sensor data, internal and/or external data, etc.), the control circuitry (eg, 23112, 23122, 23132, and/or 23142) may be configured to continuously derive inferences about the ongoing procedure ( For example, background information). That is, the surgical instrument may be configured to be able to, for example, record data related to the surgical procedure used to generate the report, verify the steps the surgeon is taking to perform the surgical procedure, provide data or prompts that may be related to particular procedural steps (eg, via User interface associated withsurgical hub 23148 and/oruser interface 23158 and/oruser interface 23138, 23128 and/or 23118 associated with surgical instruments), controlsurgical instrument 23102 functions, etc.

重新参见图89，在一个方面，在将靶组织夹持在端部执行器组件的钳口之间期间和/或之后，控制电路(23112、23122、23132和/或23142)可被配置成能够在允许后续功能(例如，击发、凝结等)之前检查钳口之间的导通。此处，根据各个方面，外科器械可包括电外科器械，该电外科器械包括钳口中的至少一者中的电极(例如，与砧座和/或钉仓集成)。在此类方面，如果电极之间存在短路，则可能难以用电外科能量(例如，RF能量)处理抓持在钳口之间的组织。在一个示例中，电极之间的导电物体(例如，夹具、钉、金属元件等)可使得钳口之间导通。在另一个示例中，如果钳口之间不存在足够的间隙(例如，在夹持靶组织之后)，则电极可接触，从而使得钳口之间导通。重新参见图53，例如，在本公开的一个方面，传感器152008a被配置成能够测量端部执行器钳口之间的间隙。在此类方面，第一钳口的传感器152008a可包括霍尔效应传感器，该霍尔效应传感器被配置成能够检测由第二钳口的磁体152012生成的磁场以测量第一钳口与第二钳口之间的间隙。值得注意的是，该间隙可表示夹持在第一钳口和第二钳口之间的组织的厚度。此处，如果钳口之间存在导通，则可能导致不期望的手术结果(例如，不完全的组织处理、导电物体的过度加热等)。89, in one aspect, during and/or after clamping the target tissue between the jaws of the end effector assembly, the control circuitry (23112, 23122, 23132 and/or 23142) may be configured to enable Check for continuity between jaws before allowing subsequent functions (eg, firing, coagulation, etc.). Here, according to various aspects, a surgical instrument can include an electrosurgical instrument that includes electrodes in at least one of the jaws (eg, integrated with an anvil and/or a staple cartridge). In such aspects, if there is a short between the electrodes, it may be difficult to treat tissue grasped between the jaws with electrosurgical energy (eg, RF energy). In one example, conductive objects (eg, clamps, staples, metal elements, etc.) between the electrodes may provide conduction between the jaws. In another example, if there is insufficient clearance between the jaws (eg, after clamping the target tissue), the electrodes may contact, thereby allowing conduction between the jaws. Referring back to Figure 53, for example, in one aspect of the present disclosure, thesensor 152008a is configured to measure the gap between the end effector jaws. In such aspects, thesensor 152008a of the first jaw can comprise a Hall effect sensor configured to detect the magnetic field generated by themagnet 152012 of the second jaw to measure the first jaw and the second jaw the gap between the mouths. Notably, the gap may represent the thickness of the tissue clamped between the first and second jaws. Here, if there is conduction between the jaws, undesired surgical outcomes (eg, incomplete tissue processing, excessive heating of conductive objects, etc.) may result.

根据一个方面(例如，双极模式)，第一钳口可包括砧座，并且第二钳口可包括被配置成能够接纳钉仓的细长通道，诸如图25所描绘的。在一个示例中，钉仓可包括有源电极以将电外科能量(例如，RF能量)递送到被抓持组织，并且砧座的至少一部分可充当返回电极。在一个示例中，砧座可包括有源电极以将电外科能量(例如，RF能量)递送到被抓持组织，并且细长通道的至少一部分可充当返回电极。根据另一方面(例如，单极模式)，第一钳口可包括砧座，并且第二钳口可包括被配置成能够接纳钉仓的细长通道。在一个示例中，钉仓可包括有源电极以将电外科能量(例如，RF能量)递送到被抓持组织，并且返回电极(例如，接地垫)可单独地定位在患者的身体上。在另一个示例中，砧座可包括有源电极以将电外科能量(例如，RF能量)递送到被抓持组织，并且返回电极(例如，接地垫)可单独地定位在患者的身体上。用于检测短路的各种配置在标题为“DETECTING SHORT CIRCUITS INELECTROSURGICAL MEDICAL DEVICES”的美国专利No.9,554,854中有所描述，该专利的全部公开内容以引用方式并入本文。According to one aspect (eg, bipolar mode), the first jaw can include an anvil, and the second jaw can include an elongated channel configured to receive a staple cartridge, such as depicted in FIG. 25 . In one example, the staple cartridge can include active electrodes to deliver electrosurgical energy (eg, RF energy) to grasped tissue, and at least a portion of the anvil can serve as a return electrode. In one example, the anvil can include active electrodes to deliver electrosurgical energy (eg, RF energy) to grasped tissue, and at least a portion of the elongated channel can serve as a return electrode. According to another aspect (eg, monopolar mode), the first jaw can include an anvil, and the second jaw can include an elongated channel configured to receive a staple cartridge. In one example, the staple cartridge may include active electrodes to deliver electrosurgical energy (eg, RF energy) to grasped tissue, and return electrodes (eg, ground pads) may be separately positioned on the patient's body. In another example, the anvil may include active electrodes to deliver electrosurgical energy (eg, RF energy) to grasped tissue, and return electrodes (eg, ground pads) may be separately positioned on the patient's body. Various configurations for detecting short circuits are described in US Patent No. 9,554,854, entitled "DETECTING SHORT CIRCUITS INELECTROSURGICAL MEDICAL DEVICES," the entire disclosure of which is incorporated herein by reference.

再次参见图89，根据各个方面，控制电路(23112、23122、23132和/或23142)可被配置成能够以多种方式检查导通。在一个方面，产生电外科能量的发生器和/或集成在外科器械中的传感器(例如，23134)可被配置成能够检测电极之间的阻抗何时下降到低于阈值达阈值时间段(即，指示短路的阻抗降)。此处，重新参见图48，传感器(例如，23134)可被配置成能够测量随时间变化的阻抗。在一个示例中，当电极遇到导电钉线时，电流可达到尖峰，而阻抗和电压降急剧下降。在另一个示例中，导通可呈现为具有最小电压变化的电流吸收器。用于检查导通/检测短路的各种另选方法，诸如在标题为“DETECTING SHORT CIRCUITSIN ELECTROSURGICAL MEDICAL DEVICES”的美国专利No.9,554,854中描述的那些，明确地以引用方式并入本文(例如，比较一系列脉冲的脉冲内的不同位置处的阻抗值)。Referring again to FIG. 89, in accordance with various aspects, the control circuits (23112, 23122, 23132, and/or 23142) may be configured to be able to check for continuity in a variety of ways. In one aspect, a generator that produces electrosurgical energy and/or a sensor integrated in a surgical instrument (eg, 23134) can be configured to detect when the impedance between electrodes drops below a threshold for a threshold period of time (ie, 23134). , indicating the impedance drop of the short circuit). Here, referring back to FIG. 48, a sensor (eg, 23134) can be configured to measure impedance over time. In one example, when an electrode encounters a wire of conductive spikes, the current can spike while the impedance and voltage drop drop dramatically. In another example, the conduction may appear as a current sink with minimal voltage change. Various alternative methods for checking continuity/detecting shorts, such as those described in U.S. Patent No. 9,554,854 entitled "DETECTING SHORT CIRCUITSIN ELECTROSURGICAL MEDICAL DEVICES", expressly incorporated herein by reference (e.g., compare impedance values at different locations within a pulse of a series of pulses).

在此类方面，如果检测到导通，则导电物体(例如，夹具、钉、钉线、金属元件等)可存在于/暴露于抓持在钳口之间的组织中。值得注意的是，此类导电物体可来自当前外科手术和/或先前外科手术。在此类方面，控制电路可被配置成能够向外科医生提供关于检测到导电物体的警示(例如，经由外科器械的部件的用户界面23138、23128和/或23118，和/或与外科集线器相关联的用户界面23148和/或用户界面23158)。例如，警示可表明外科医生重新定位端部执行器组件23130，使得电极不与任何导电物体接触并且/或者移除导致短路的导电物体。根据各个方面，控制电路还可被配置成能够接收覆写命令(例如，经由用户界面，参见例如图88，可选择的用户界面元素23012)以允许后续功能(例如，切割、凝结等)，尽管检测到导电物体(例如，夹具、钉、钉线、金属元件等)。In such aspects, if continuity is detected, conductive objects (eg, clips, staples, staple wires, metal elements, etc.) may be present/exposed in the tissue grasped between the jaws. Notably, such conductive objects may be from current surgery and/or previous surgery. In such aspects, the control circuit may be configured to be able to provide an alert to the surgeon regarding the detection of a conductive object (eg, viauser interfaces 23138, 23128, and/or 23118 of components of the surgical instrument, and/or associated with a surgical hub)User Interface 23148 and/or User Interface 23158). For example, the alert may indicate that the surgeon repositions theend effector assembly 23130 so that the electrodes are not in contact with any conductive objects and/or removes the conductive objects that caused the short circuit. According to various aspects, the control circuit may also be configured to be able to receive overwrite commands (eg, via a user interface, see eg, FIG. 88, selectable user interface element 23012) to allow subsequent functions (eg, cutting, coagulation, etc.), although Conductive objects (eg, clamps, nails, nail wires, metal elements, etc.) are detected.

根据一个方面，控制电路(23112、23122、23132和/或23142)可被配置成能够检查导通以避免截断夹具。在此类方面，在检测到短路之后，控制电路可被配置成能够向外科医生提供关于在钳口之间检测到导电物体的警示(例如，经由外科器械的部件的用户界面23138、23128和/或23118，和/或与外科集线器相关联的用户界面23148和/或用户界面23158)。在一个方面，外科医生可经由用户界面(例如，外科器械、外科集线器、发生器等上的交互式用户界面元件)调节控制电路的灵敏度。在此类方面，基于该调节，控制电路可被配置成能够在钳口之间检测到导电物体的情况下防止击发。According to one aspect, the control circuits (23112, 23122, 23132, and/or 23142) may be configured to be able to check for continuity to avoid clipping clips. In such aspects, upon detection of a short circuit, the control circuit may be configured to provide an alert to the surgeon regarding the detection of a conductive object between the jaws (eg, via theuser interface 23138, 23128 and/or the component of the surgical instrument). or 23118, and/oruser interface 23148 and/oruser interface 23158 associated with the surgical hub). In one aspect, the surgeon may adjust the sensitivity of the control circuitry via a user interface (eg, interactive user interface elements on surgical instruments, surgical hubs, generators, etc.). In such aspects, based on the adjustment, the control circuit may be configured to prevent firing if a conductive object is detected between the jaws.

再次参见图89，根据另一方面，控制电路23142可集成到与电外科器械23102配对(例如，无线地)的外科集线器23140中。在此类方面，外科集线器23140可预加载关于在钳口之间检测到导电物体的外科医生/用户设置。在一个示例中，如果在钳口之间检测到导电物体，则外科医生/用户设置包括防止击发。在另一个示例中，如果在钳口之间检测到导电物体，则外科医生/用户设置包括在允许击发之前发出警示。在又一方面，外科医生/用户设置包括允许外科医生/用户覆写警示。在又一方面，外科医生/用户设置包括临时复位，从而允许外科医生/用户在再次检查导通之前纠正这种情况(例如，运动钳口、移除导电物体)。Referring again to FIG. 89, according to another aspect, thecontrol circuit 23142 can be integrated into thesurgical hub 23140 that mates (eg, wirelessly) with theelectrosurgical instrument 23102. In such aspects, thesurgical hub 23140 may be preloaded with surgeon/user settings regarding the detection of conductive objects between the jaws. In one example, the surgeon/user settings include preventing firing if a conductive object is detected between the jaws. In another example, if a conductive object is detected between the jaws, the surgeon/user settings include an alert before firing is allowed. In yet another aspect, the surgeon/user settings include allowing the surgeon/user to override the alert. In yet another aspect, the surgeon/user setup includes a temporary reset, allowing the surgeon/user to correct the condition (eg, move the jaws, remove conductive objects) before rechecking for continuity.

再次参见图89，根据又一个方面，控制电路(23112、23122、23132和/或23142)可被配置成能够检查有意跨越钉线的导通。此处，在一些外科手术中，可能有益的是具有交叉钉线以确保连续横切(例如，肺切除术，尤其是来自多个角度的楔形件、套管规程等)。在此类方面，在检测到导通之后，控制电路可被配置成能够向外科医生提供关于在钳口之间检测到导电物体(例如，现有钉线)的警示(例如，听觉和/或视觉提示)(例如，经由外科器械的部件的用户界面23138、23128和/或23118，和/或与外科集线器相关联的用户界面23148和/或用户界面23158)。Referring again to FIG. 89, according to yet another aspect, the control circuits (23112, 23122, 23132, and/or 23142) can be configured to be able to check for intentional continuity across the staple line. Here, in some surgical procedures, it may be beneficial to have intersecting staple lines to ensure continuous transection (eg, pneumonectomy, especially wedges from multiple angles, cannula procedures, etc.). In such aspects, upon detection of continuity, the control circuit may be configured to provide an alert (eg, audibly and/or audibly and/or audibly) to the surgeon regarding detection of a conductive object (eg, existing staple wire) between the jaws visual cues) (eg, viauser interfaces 23138, 23128, and/or 23118 of components of the surgical instrument, and/oruser interface 23148 and/oruser interface 23158 associated with the surgical hub).

再次参见图89，根据其他方面，控制电路(23112、23122、23132和/或23142)可被配置成能够在外科手术的整个过程中从内部数据库(例如，外科器械的部件的存储器23136、23126和/或23116中或外科集线器数据库23149中)和/或外部数据库(例如，从外科集线器数据库23149、云数据库23150等)接收数据。根据各个方面，从内部数据库和/或外部数据库接收的数据可包括手术史数据(例如，关于对患者执行的先前外科手术的数据、关于当前外科手术的数据等)。在一个示例中，手术史数据可以指示钉在先前的外科手术中被使用和/或钉在何处被使用，并且当前的外科手术数据可以指示施夹器是否已经被用于施加夹具。基于所接收的数据(例如，手术史数据等)，控制电路(23112、23122、23132和/或23142)可被配置成能够不断导出关于正在进行的规程的推论(例如，上下文信息)。即，外科器械23120可为态势感知的并且可被配置成能够例如推断/确定检测到的导通可为来自先前外科手术的钉线或来自当前外科手术的夹具。又如，如果患者从未执行外科手术，施夹器尚未用于当前外科手术，并且钉仓已在当前外科手术中被击发，则控制电路可被配置成能够推断/确定在钳口之间检测到的导电物体是先前的钉线。再如，如果患者从未执行外科手术，施夹器已用于当前规程，并且尚无钉仓在当前外科手术中被击发，则控制电路可被配置成能够推断/确定在钳口之间检测到的导电物体为夹具。Referring again to FIG. 89, in accordance with other aspects, the control circuits (23112, 23122, 23132, and/or 23142) may be configured to be able to retrieve information from an internal database (eg, memory of components of thesurgical instrument 23136, 23126, and/or 23142) throughout the surgical procedure. Receive data fromsurgical hub database 23116 or surgical hub database 23149) and/or external databases (eg, fromsurgical hub database 23149,cloud database 23150, etc.). According to various aspects, the data received from the internal database and/or the external database may include surgical history data (eg, data regarding previous surgeries performed on the patient, data regarding current surgeries, etc.). In one example, surgical history data may indicate that the staples were used in a previous surgical procedure and/or where the staples were used, and current surgical procedure data may indicate whether a clip applier has been used to apply a clip. Based on the received data (eg, surgical history data, etc.), the control circuits (23112, 23122, 23132, and/or 23142) may be configured to continuously derive inferences (eg, contextual information) about the ongoing procedure. That is, thesurgical instrument 23120 may be situationally aware and may be configured to be able, for example, to infer/determine that the detected conduction may be a staple line from a previous surgery or a clip from a current surgery. As another example, if the patient has never had surgery, the clip applier has not been used in the current surgery, and the staple cartridge has been fired during the current surgery, the control circuit may be configured to be able to infer/determine that the detection between the jaws is The conductive object that arrives is the previously nailed wire. As another example, if the patient has never had surgery, the clip applier has been used in the current procedure, and no staple cartridge has been fired in the current surgery, the control circuit may be configured to be able to infer/determine detection between jaws. The resulting conductive object is a fixture.

实施例Example

在以下实施例中阐述了本文在标题“SAFETY SYSTEMS FOR SMART POWEREDSURGICAL STAPLING”下描述的主题的各个方面：Various aspects of the subject matter described herein under the heading "SAFETY SYSTEMS FOR SMART POWEREDSURGICAL STAPLING" are set forth in the following examples:

实施例1—一种外科系统，包括控制电路和外科器械。外科器械包括柄部组件、从柄部组件朝远侧延伸的轴组件以及联接到轴组件的远侧端部的端部执行器组件。端部执行器组件包括第一钳口、可枢转地联接到第一钳口的第二钳口、以及传感器。传感器被配置成能够检测与端部执行器的功能相关联的参数并将该检测到的参数传输到控制电路。控制电路被配置成能够基于系统限定的约束来分析检测到的参数，并且基于分析结果来防止外科器械的至少一个功能。外科系统还包括用户界面，该用户界面被配置成能够提供关于外科器械的至少一个被防止功能的当前状态。Embodiment 1—A surgical system including a control circuit and a surgical instrument. The surgical instrument includes a handle assembly, a shaft assembly extending distally from the handle assembly, and an end effector assembly coupled to a distal end of the shaft assembly. The end effector assembly includes a first jaw, a second jaw pivotally coupled to the first jaw, and a sensor. The sensor is configured to detect a parameter associated with the function of the end effector and transmit the detected parameter to the control circuit. The control circuit is configured to analyze the detected parameters based on system-defined constraints, and to prevent at least one function of the surgical instrument based on the results of the analysis. The surgical system also includes a user interface configured to provide a current status regarding at least one prevented function of the surgical instrument.

实施例2—根据实施例1所述的外科系统，其中系统限定的约束包括基于与由外科系统执行的外科手术相关联的历史数据的预定义参数或预定义参数范围中的至少一个。Embodiment 2—The surgical system ofembodiment 1, wherein the system-defined constraints include at least one of predefined parameters or predefined parameter ranges based on historical data associated with surgical procedures performed by the surgical system.

实施例3—根据实施例1或2所述的外科系统，其中当前状态包括外科器械的至少一个功能被防止的第一消息和指示该外科器械的至少一个功能被防止的原因的第二消息。Embodiment 3—The surgical system ofembodiment 1 or 2, wherein the current state includes a first message that at least one function of the surgical instrument is prevented and a second message that indicates why the at least one function of the surgical instrument is prevented.

实施例4—根据实施例1、2或3所述的外科系统，其中用户界面包括用户界面元素，该用户界面元素可选择以覆写控制电路，从而允许该外科器械的至少一个功能。Embodiment 4—The surgical system ofEmbodiments 1, 2, or 3, wherein the user interface includes a user interface element selectable to override the control circuitry to allow at least one function of the surgical instrument.

实施例5—根据实施例1、2、3或4所述的外科系统，其中传感器包括联接到端部执行器的力传感器，其中检测到的参数包括施加到端部执行器的第一钳口或第二钳口中的至少一者的力，并且其中经由控制电路防止的至少一个功能包括以下中的一者或多于一者：防止使用附接的轴、防止击发循环开始、防止端部执行器的关节运动、防止轴旋转或防止第一钳口或第二钳口中的一者或多于一者打开。Embodiment 5—The surgical system ofEmbodiments 1, 2, 3, or 4, wherein the sensor comprises a force sensor coupled to the end effector, wherein the detected parameter comprises a first jaw applied to the end effector or the force of at least one of the second jaws, and wherein the at least one function prevented via the control circuit includes one or more of the following: preventing use of an attached shaft, preventing initiation of a firing cycle, preventing end execution articulation of the device, preventing rotation of the shaft, or preventing one or more of the first or second jaws from opening.

实施例6—根据实施例1、2、3、4或5所述的外科系统，其中与检测到的参数相关联的端部执行器的功能包括夹持功能，并且其中经由控制电路防止的外科器械的至少一个功能包括以下中的一者或多于一者：解剖功能、凝结功能、缝合功能或切割功能。Embodiment 6—The surgical system ofEmbodiments 1, 2, 3, 4, or 5, wherein the function of the end effector associated with the detected parameter includes a gripping function, and wherein the surgery is prevented via the control circuit At least one function of the instrument includes one or more of the following: dissection function, coagulation function, suturing function, or cutting function.

实施例7—根据实施例1、2、3、4、5或6所述的外科系统，还包括通信地联接到外科器械的外科集线器，其中外科集线器包括控制电路。Embodiment 7—The surgical system ofEmbodiments 1, 2, 3, 4, 5, or 6, further comprising a surgical hub communicatively coupled to the surgical instrument, wherein the surgical hub includes a control circuit.

实施例8—根据实施例7所述的外科系统，其中柄部组件或外科集线器中的一者包括用户界面。Embodiment 8—The surgical system ofEmbodiment 7, wherein one of the handle assembly or the surgical hub includes a user interface.

实施例9—根据实施例1、2、3、4、5、6、7或8所述的外科系统，其中外科器械的柄部组件、轴组件或端部执行器组件中的一者包括控制电路。Embodiment 9—The surgical system ofEmbodiments 1, 2, 3, 4, 5, 6, 7, or 8, wherein one of the handle assembly, shaft assembly, or end effector assembly of the surgical instrument includes a control circuit.

实施例10—根据实施例1、2、3、4、5、6、7、8或9所述的外科系统，其中轴组件包括传感器，该传感器被配置成能够检测与轴的功能相关联的轴参数并且将该检测到的轴参数传输到控制电路。该控制电路还被配置成能够进一步基于检测到的轴参数来防止外科器械的至少一个功能。Embodiment 10—The surgical system ofEmbodiments 1, 2, 3, 4, 5, 6, 7, 8, or 9, wherein the shaft assembly includes a sensor configured to detect a axis parameters and transmit the detected axis parameters to the control circuit. The control circuit is also configured to prevent at least one function of the surgical instrument further based on the detected shaft parameter.

实施例11—一种外科系统，包括外科集线器和通信地联接到外科集线器的外科器械。外科器械包括柄部组件、从柄部组件朝远侧延伸的轴组件以及联接到轴组件的远侧端部的端部执行器组件。端部执行器组件包括第一钳口、可枢转地联接到第一钳口的第二钳口、以及传感器。传感器被配置成能够检测与端部执行器的功能相关联的参数并将该检测到的参数传输到外科集线器。外科集线器包括处理器和联接到处理器的存储器。存储器存储指令，所述指令可由处理器执行以基于系统限定的约束来分析检测到的参数，并且基于分析结果来防止外科器械的至少一个功能。外科系统还包括用户界面，该用户界面被配置成能够提供关于外科器械的至少一个被防止功能的当前状态。Embodiment 11—A surgical system including a surgical hub and surgical instruments communicatively coupled to the surgical hub. The surgical instrument includes a handle assembly, a shaft assembly extending distally from the handle assembly, and an end effector assembly coupled to a distal end of the shaft assembly. The end effector assembly includes a first jaw, a second jaw pivotally coupled to the first jaw, and a sensor. The sensor is configured to detect parameters associated with the function of the end effector and transmit the detected parameters to the surgical hub. The surgical hub includes a processor and a memory coupled to the processor. The memory stores instructions executable by the processor to analyze the detected parameters based on system-defined constraints, and to prevent at least one function of the surgical instrument based on the results of the analysis. The surgical system also includes a user interface configured to provide a current status regarding at least one prevented function of the surgical instrument.

实施例12—根据实施例11所述的外科系统，其中系统限定的约束包括基于与由外科系统执行的外科手术相关联的历史数据的预定义参数或预定义参数范围中的至少一个。Embodiment 12—The surgical system ofEmbodiment 11, wherein the system-defined constraints include at least one of predefined parameters or predefined parameter ranges based on historical data associated with surgical procedures performed by the surgical system.

实施例13—根据实施例11或12所述的外科系统，其中当前状态包括外科器械的至少一个功能被防止的第一消息和指示该外科器械的至少一个功能被防止的原因的第二消息。Embodiment 13—The surgical system ofEmbodiment 11 or 12, wherein the current state includes a first message that at least one function of the surgical instrument is prevented and a second message that indicates why the at least one function of the surgical instrument is prevented.

实施例14—根据实施例11、12或13所述的外科系统，其中用户界面包括用户界面元素，该用户界面元素可选择以覆写外科集线器，从而允许该外科器械的至少一个功能。Embodiment 14—The surgical system ofEmbodiments 11, 12, or 13, wherein the user interface includes a user interface element selectable to override the surgical hub to allow at least one function of the surgical instrument.

实施例15—根据实施例11、12、13或14的外科系统，其中传感器包括联接到端部执行器的力传感器，其中检测到的参数包括施加到端部执行器的第一钳口或第二钳口中的至少一者的力，并且其中经由外科集线器防止的至少一个功能包括以下中的一者或多于一者：防止使用附接的轴、防止击发循环开始、防止端部执行器的关节运动、防止轴旋转或防止第一钳口或第二钳口中的一者或多于一者打开。Embodiment 15—The surgical system ofEmbodiments 11, 12, 13, or 14, wherein the sensor comprises a force sensor coupled to the end effector, wherein the detected parameter comprises the first jaw or the first jaw applied to the end effector The force of at least one of the two jaws, and wherein the at least one function prevented via the surgical hub includes one or more of the following: preventing use of an attached shaft, preventing initiation of a firing cycle, preventing Articulate, prevent rotation of the shaft, or prevent one or more of the first jaw or the second jaw from opening.

实施例16—根据实施例11、12、13、14或15所述的外科系统，其中与检测到的参数相关联的端部执行器的功能包括夹持功能，并且其中经由外科集线器防止的外科器械的至少一个功能包括以下中的一者或多于一者：解剖功能、凝结功能、缝合功能或切割功能。Embodiment 16—The surgical system ofEmbodiments 11, 12, 13, 14, or 15, wherein the function of the end effector associated with the detected parameter includes a gripping function, and wherein the surgical hub prevents surgery via the surgical hub At least one function of the instrument includes one or more of the following: dissection function, coagulation function, suturing function, or cutting function.

实施例17—根据实施例11、12、13、14、15或16所述的外科系统，其中柄部组件或外科集线器中的至少一者包括用户界面。Embodiment 17—The surgical system ofEmbodiments 11, 12, 13, 14, 15, or 16, wherein at least one of the handle assembly or the surgical hub includes a user interface.

实施例18—根据实施例11、12、13、14、15、16或17所述的外科系统，其中轴组件包括传感器，该传感器被配置成能够检测与轴的功能相关联的轴参数并且将该检测到的轴参数传输到外科集线器。存储器还存储指令，所述指令可由处理器执行以进一步基于检测到的轴参数来防止外科器械的至少一个功能。Embodiment 18—The surgical system ofEmbodiments 11, 12, 13, 14, 15, 16, or 17, wherein the shaft assembly includes a sensor configured to detect a shaft parameter associated with the function of the shaft and to The detected shaft parameters are transmitted to the surgical hub. The memory also stores instructions executable by the processor to prevent at least one function of the surgical instrument further based on the detected shaft parameter.

实施例19—一种非暂态计算机可读介质，该非暂态计算机可读介质存储计算机可读指令，该计算机可读指令在被执行时致使器基于系统限定的约束分析与外科系统的端部执行器的功能相关联的检测到的参数，外科系统包括柄部组件、从柄部组件朝远侧延伸的轴组件以及联接到轴组件的远侧端部的端部执行器组件。端部执行器组件包括第一钳口、可枢转地联接到第一钳口的第二钳口，以及被配置成能够检测该检测到的参数并将该检测到的参数传输到机器的传感器。所述指令在被执行时还致使机器基于分析的结果来防止外科系统的至少一个功能，并且生成用户界面。用户界面提供关于外科系统的至少一个被防止功能的当前状态。Embodiment 19—A non-transitory computer-readable medium storing computer-readable instructions that, when executed, cause a device to analyze an endpoint with a surgical system based on system-defined constraints. A surgical system includes a handle assembly, a shaft assembly extending distally from the handle assembly, and an end effector assembly coupled to the distal end of the shaft assembly. The end effector assembly includes a first jaw, a second jaw pivotally coupled to the first jaw, and a sensor configured to detect the detected parameter and transmit the detected parameter to the machine . The instructions, when executed, also cause the machine to prevent at least one function of the surgical system based on the results of the analysis, and to generate a user interface. The user interface provides current status regarding at least one prevented function of the surgical system.

实施例20—根据实施例19所述的非暂态计算机可读介质，其还包括指令，所述指令在被执行时还致使机器在用户界面上生成覆写元素。覆写元素可选择以允许外科系统的至少一个功能。Embodiment 20—The non-transitory computer-readable medium of Embodiment 19, further comprising instructions that, when executed, further cause the machine to generate an overlay element on the user interface. The override element is selectable to allow at least one function of the surgical system.

用于智能电动外科缝合的安全系统Safety System for Smart Electric Surgical Sutures

用于评估操作参数的安全系统Safety system for evaluating operating parameters

本公开的各个方面涉及改进的安全系统，该改进的安全系统能够响应于经由外科器械的一个或多于一个传感器检测到的组织参数来调节、控制和/或调谐外科器械的内部驱动操作。更具体地讲，各个方面涉及感测并指示当前装置参数对感测到的组织参数的适当性。Various aspects of the present disclosure relate to improved safety systems capable of adjusting, controlling, and/or tuning the internal drive operation of a surgical instrument in response to tissue parameters detected via one or more sensors of the surgical instrument. More specifically, various aspects relate to sensing and indicating the appropriateness of current device parameters to sensed tissue parameters.

例如，感测到的组织参数可包括组织的类型、组织的厚度、组织的硬度、组织在患者解剖结构上的位置、组织的血管形成等，并且当前装置参数可包括仓颜色、仓类型、附属物、夹持负载、间隙、击发速率等。因此，根据本公开的各方面，生理感测可指示装置或其部件的不适当使用和/或装置的不适当定位。For example, sensed tissue parameters may include tissue type, tissue thickness, tissue stiffness, tissue location on patient anatomy, tissue vascularization, etc., and current device parameters may include cartridge color, cartridge type, attachment object, gripping load, clearance, firing rate, etc. Thus, according to aspects of the present disclosure, physiological sensing may indicate improper use of a device or components thereof and/or improper positioning of the device.

在一个示例中，外科器械或其部件的不适当使用和/或外科器械的不正确定位可经由相关联的控制电路基于经由端部执行器的钳口处的一个或多于一个传感器检测到的生理感测来确定。在这样的示例中，在确定的不适当使用和/或确定的不正确定位之后，相关联的控制电路可防止执行端部执行器的一个或多于一个功能(例如，缝合)。此外，在此类示例中，如果相关联的控制电路确定外科器械或其部件和/或外科器械的定位已被整流(例如，不正确的钉仓被替换、外科器械重新定位等)或覆写已被接收(例如，经由外科器械上的用户界面、联接到外科器械的外科集线器上的用户界面、外科手术室中的用户界面等)，则该相关联的控制电路可允许端部执行器的一个或多于一个功能。In one example, inappropriate use of the surgical instrument or components thereof and/or incorrect positioning of the surgical instrument may be detected via associated control circuitry based on detection via one or more sensors at the jaws of the end effector Physiological sensing to determine. In such an example, the associated control circuitry may prevent one or more functions of the end effector (eg, stitching) from being performed following a determined inappropriate use and/or a determined incorrect positioning. Furthermore, in such examples, if the associated control circuitry determines that the surgical instrument or its components and/or the positioning of the surgical instrument has been rectified (eg, an incorrect staple cartridge was replaced, surgical instrument repositioned, etc.) or overridden has been received (eg, via a user interface on a surgical instrument, a user interface on a surgical hub coupled to a surgical instrument, a user interface in a surgical one or more functions.

参见图94，根据本公开的各个方面，外科系统24200可包括控制电路(24212、24222、24232和/或24242，例如，以虚线显示一个或多个任选的位置)、用户界面(24214、24224、22234、24244和/或24254，例如，以虚线显示一个或多个任选的位置)，以及外科器械24202。外科器械24202包括多个部件，诸如端部执行器组件24210的部件-A 24216至部件-N24218，并且类似地，出于说明的目的，以缩写形式分别包括轴组件24220和柄部组件24230的部件-A(C-A)至部件-N(C-N)。在各个方面，外科器械24202的每个部件可包括至少一个装置参数。例如，端部执行器组件24210的部件-A 24216可包括参数PAa-PAn 24217，端部执行器组件24210的部件-N 24218可包括参数PNa-PNn 24219等等。又如，轴组件24220的C-A至C-N中的每个和柄部组件24230的C-A至C-N中的每个可类似地包括至少一个装置参数。每个部件可被配置成能够将其一个或多个相应的装置参数传输到控制电路。外科器械24202还包括传感器(24213、24223和/或24233)，该传感器被配置成能够检测与外科器械的功能相关联的组织参数并将该检测到的组织参数传输到控制电路。控制电路可被配置成能够基于系统限定的约束与每个相应的装置参数协作来分析检测到的组织参数。94, in accordance with various aspects of the present disclosure, asurgical system 24200 may include control circuitry (24212, 24222, 24232, and/or 24242, eg, one or more optional positions are shown in dashed lines), user interfaces (24214, 24224 , 22234, 24244, and/or 24254, eg, with one or more optional locations shown in dashed lines), andsurgical instrument 24202.Surgical instrument 24202 includes a number of components, such as Part-A 24216 to Part-N24218 ofend effector assembly 24210, and similarly, for illustrative purposes, components ofshaft assembly 24220 and handleassembly 24230, respectively, are included in abbreviated form -A(C-A) to Part-N(C-N). In various aspects, each component of thesurgical instrument 24202 can include at least one device parameter. For example, Part-A 24216 ofend effector assembly 24210 may include parameters PAa-PAn 24217, Part-N 24218 ofend effector assembly 24210 may include parameters PNa-PNn 24219, and so on. As another example, each of C-A through C-N ofshaft assembly 24220 and each of C-A through C-N ofhandle assembly 24230 may similarly include at least one device parameter. Each component may be configured to transmit one or more of its corresponding device parameters to the control circuit.Surgical instrument 24202 also includes sensors (24213, 24223, and/or 24233) configured to detect tissue parameters associated with the function of the surgical instrument and transmit the detected tissue parameters to control circuitry. The control circuitry may be configured to be capable of analyzing the detected tissue parameters in cooperation with each respective device parameter based on system-defined constraints.

再次参见图94，在各个方面，控制电路24212、24222和/或24232(例如，分别示出为端部执行器组件24210、轴组件24220和柄部组件24230的元件)可集成到外科器械24202的多个部件(例如，柄部组件24230的柄部、轴组件24220的轴、端部执行器组件24210的端部执行器、端部执行器组件的钉仓等)中的一个或多于一个中或集成到与外科器械24202配对(例如，无线地)的外科集线器24240(例如，24242)中。类似地，一个或多个传感器24213、24223和/或24233；用户界面24214、24224和/或24234；并且在各个方面，存储器24215、24225和/或24235(例如，分别示出为端部执行器组件24210、轴组件24220和柄部组件24230的元件)可集成到多个部件中的一个或多于一个中。值得注意的是，根据各个方面，外科器械24202和/或外科集线器24240可以是态势感知的外科器械和/或态势感知的外科集线器。态势感知是指外科系统(例如，24200)根据从数据库接收的数据(例如，与外科手术相关联的历史数据)和/或从外科器械接收的数据(例如，外科手术期间的传感器数据)确定或推断与外科手术相关的信息的能力。例如，所确定或推断的信息可包括正在进行的规程的类型、正在接受手术的组织的类型、作为规程的对象的体腔等。基于与外科手术相关的此类背景信息，外科系统可例如在外科手术的整个过程中控制成对的外科器械或其部件，并且/或者向外科医生提供背景信息或建议。Referring again to FIG. 94, in various aspects,control circuits 24212, 24222, and/or 24232 (eg, elements shown asend effector assembly 24210,shaft assembly 24220, and handleassembly 24230, respectively) may be integrated into thesurgical instrument 24202 One or more of the components (eg, the handle of thehandle assembly 24230, the shaft of theshaft assembly 24220, the end effector of theend effector assembly 24210, the staple cartridge of the end effector assembly, etc.) Or integrated into a surgical hub 24240 (eg, 24242) that mates (eg, wirelessly) with asurgical instrument 24202. Similarly, one or more ofsensors 24213, 24223, and/or 24233;user interfaces 24214, 24224, and/or 24234; and, in various aspects,memories 24215, 24225, and/or 24235 (eg, shown as end effectors, respectively) Elements ofassembly 24210,shaft assembly 24220, and handle assembly 24230) may be integrated into one or more of a number of components. Notably, according to various aspects,surgical instrument 24202 and/orsurgical hub 24240 may be a situationally aware surgical instrument and/or a situationally aware surgical hub. Situational awareness is when a surgical system (eg, 24200) determines or is based on data received from a database (eg, historical data associated with a surgical procedure) and/or data received from a surgical instrument (eg, sensor data during a surgical procedure). The ability to infer information relevant to surgery. For example, the determined or inferred information may include the type of procedure being performed, the type of tissue being operated on, the body cavity that is the subject of the procedure, and the like. Based on such contextual information related to the surgical procedure, the surgical system may, for example, control pairs of surgical instruments or components thereof throughout the surgical procedure and/or provide contextual information or advice to the surgeon.

根据一个方面，态势感知的外科集线器(例如，24240)与用于执行外科手术的外科器械24202配对(例如，无线地)。在此类方面，外科器械24202可包括多个部件，包括端部执行器(例如，部件-A 24216)。端部执行器24216可包括第一钳口、可枢转地联接到第一钳口的第二钳口、切割刀片，以及集成的传感器24213，该集成的传感器被配置成能够检测与端部执行器24216的功能(例如，解剖、夹持、凝结、切割、缝合等)相关联的组织参数并将该检测到的组织参数传输到外科集线器24240的控制电路24242。包括端部执行器24216的外科器械24202的多个部件(例如，部件-N 24218，例如钉仓等)中的每个也被配置成能够将其一个或多个相应的装置参数(例如，分别为24219和24217)传输到外科集线器24240。值得注意的是，应当理解，如本文和其他公开方面所引用的，传感器(例如，24213)可包括多个传感器，该多个传感器被配置成能够检测与多个端部执行器24216功能相关联的多个组织参数。因此，另外，在此类方面，外科集线器控制电路24242可被配置成能够在外科手术的整个过程中接收此类参数数据(例如，一个或多个检测到的组织参数、包括端部执行器的每个部件的装置参数等)。每当要执行相关联的端部执行器功能(例如，解剖、夹持、凝固、切割、缝合等)时，可接收检测到的组织参数。外科集线器控制电路24242还可被配置成能够在外科手术的整个过程中从内部数据库(例如，外科集线器数据库24249)和/或外部数据库(例如，从云数据库24269)接收数据。根据各个方面，从内部数据库24249和/或外部数据库24269接收的数据可包括规程数据(例如，执行外科手术的步骤、指示与该外科手术相关联的相应的装置参数的数据)和/或历史数据(例如，基于与外科手术相关联的历史数据指示预期组织参数的数据、患者的手术史数据等)。在各个方面，规程数据可包括用于外科手术的当前/公认的护理标准规程，并且历史数据可包括基于与外科手术相关联的历史数据针对每个接收到的装置参数的优选/理想组织参数和/或优选/理想组织参数范围(例如，系统限定的约束)。基于所接收的数据(例如，参数数据、内部和/或外部数据等)，外科集线器控制电路24242可被配置成能够不断导出关于正在进行的外科手术的推论(例如，背景信息)。即，态势感知的外科集线器可被配置成能够例如记录与用于生成报告的外科手术有关的数据，验证外科医生正采取的执行外科手术的步骤，提供可能与特定规程步骤相关的数据或提示(例如，经由与外科集线器相关联的用户界面24244和/或用户界面24254和/或与外科器械相关联的用户界面24214、24224和/或24234)，控制外科器械功能等。According to one aspect, a situational awareness surgical hub (eg, 24240) is paired (eg, wirelessly) with asurgical instrument 24202 for performing a surgical procedure. In such aspects,surgical instrument 24202 can include multiple components, including an end effector (eg, Component-A 24216). Theend effector 24216 can include a first jaw, a second jaw pivotally coupled to the first jaw, a cutting blade, and anintegrated sensor 24213 configured to detect and the end effector and transmits the detected tissue parameters to thecontrol circuitry 24242 of thesurgical hub 24240. Each of the various components of thesurgical instrument 24202 including the end effector 24216 (eg, Component-N 24218, such as a staple cartridge, etc.) are also configured to enable one or more of their corresponding device parameters (eg, respectively, 24219 and 24217) to thesurgical hub 24240. Notably, it should be understood that, as referenced herein and in other aspects of the disclosure, a sensor (eg, 24213) may include a plurality of sensors configured to detect functions associated with a plurality ofend effectors 24216 of multiple organizational parameters. Thus, in addition, in such aspects, the surgicalhub control circuit 24242 may be configured to receive such parameter data (eg, one or more detected tissue parameters, including the end effector's device parameters for each component, etc.). Detected tissue parameters may be received whenever an associated end effector function (eg, dissection, clamping, coagulation, cutting, stapling, etc.) is to be performed. Surgicalhub control circuitry 24242 may also be configured to receive data from an internal database (eg, surgical hub database 24249 ) and/or an external database (eg, from cloud database 24269 ) throughout a surgical procedure. According to various aspects, data received frominternal database 24249 and/orexternal database 24269 may include protocol data (eg, steps to perform a surgical procedure, data indicating corresponding device parameters associated with the surgical procedure) and/or historical data (eg, data indicative of expected tissue parameters based on historical data associated with the surgical procedure, patient's surgical history data, etc.). In various aspects, the procedure data can include current/accepted standard of care procedures for the surgical procedure, and the historical data can include preferred/ideal tissue parameters for each received device parameter based on historical data associated with the surgical procedure and /or preferred/ideal tissue parameter ranges (eg, system-defined constraints). Based on the received data (eg, parametric data, internal and/or external data, etc.), the surgicalhub control circuit 24242 may be configured to continuously derive inferences (eg, contextual information) about the ongoing surgical procedure. That is, the situational awareness surgical hub may be configured to be able, for example, to record data related to surgical procedures used to generate reports, verify the steps a surgeon is taking to perform a surgical procedure, provide data or prompts that may be related to particular procedural steps ( For example, viauser interface 24244 and/oruser interface 24254 associated with the surgical hub and/oruser interfaces 24214, 24224 and/or 24234) associated with the surgical instrument, controlling surgical instrument functions, etc.

根据另一个方面，态势感知的外科器械(例如，24202)可用于执行外科手术。在此类方面，如本文所述，外科器械24202可包括多个部件，包括端部执行器24216。端部执行器可包括第一钳口、可枢转地联接到第一钳口的第二钳口、切割刀片，以及集成的传感器24213，该集成的传感器被配置成能够检测与端部执行器24216的功能(例如，解剖、夹持、凝结、切割、缝合等)相关联的组织参数并将该检测到的组织参数传输到控制电路。值得注意的是，在此类方面，检测到的组织参数可被传输到端部执行器24216的集成控制电路24212。包括端部执行器24216的外科器械的多个部件(例如，部件-N 24218，例如钉仓等)中的每个被配置成能够将其一个或多个相应的装置参数传输到集成端部执行器控制电路24212。在此类方面，集成端部执行器控制电路24212可被配置成能够在外科手术的整个过程中接收此类参数数据(例如，一个或多个检测到的组织参数、包括端部执行器的每个部件的一个或多个装置参数)。每当要执行相关联的端部执行器功能(例如，解剖、夹持、凝固、切割、缝合等)时，可接收检测到的组织参数。集成端部执行器控制电路24212还可被配置成能够在外科手术的整个过程中从内部数据库(例如，端部执行器存储器24215)和/或外部数据库(例如，经由外科集线器24240从云数据库24269，从外科集线器数据库24249等)接收数据。根据各个方面，从内部数据库和/或外部数据库接收的数据可包括钉仓数据(例如，与一个或多个装置参数已经由端部执行器控制电路24212接收的钉仓(例如，24218)相关联的钉的尺寸和/或类型)和/或历史数据(例如，指示预期组织和/或待用基于历史数据的那些尺寸和/或类型的钉缝合的组织类型的数据)。在各个方面，内部数据和/或外部数据可包括基于与外科手术相关联的历史数据针对每个接收到的装置参数的优选/理想组织参数和/或优选/理想组织参数范围(例如，系统限定的约束)。在一个示例中，基于历史数据(例如，系统限定的约束)，内部数据和/或外部数据可包括针对预期组织和/或组织类型或者针对与钉仓(例如，24218)的装置参数相关联的钉的尺寸和/或类型的优选/理想组织参数和/或优选/理想组织参数范围。基于所接收的数据(例如，参数数据、内部和/或外部数据等)，端部执行器控制电路24212可被配置成能够不断导出关于正在进行的规程的推论(例如，背景信息)。值得注意的是，根据另选的方面，端部执行器24216的集成传感器24213可将一个或多个检测到的组织参数传输到与另一个外科器械部件(例如，柄部组件24230的柄部)相关联的控制电路(例如，24222和/或24232)。在此类方面，其他外科器械部件控制电路(例如，24222和/或24232)可类似地被配置成能够执行如上所述的端部执行器控制电路24212的各个方面。最后，态势感知的外科器械(例如，24202)可被配置成能够例如向其用户警示差异(例如，经由端部执行器的用户界面24214，经由另一个外科器械部件的用户界面24224和/或24234(例如，柄部组件24230的柄部)，或经由与联接到外科器械24202的外科集线器24240相关联的用户界面24244)。例如，该差异可包括检测到的组织参数超过与钉的那些尺寸和/或类型或那些预期组织和/或组织类型相关联的优选/理想组织参数和/或优选/理想组织参数范围。又如，态势感知的外科器械(例如，24202)可被配置成能够基于该差异来控制外科器械功能。根据至少一个方面，态势感知的外科器械(例如，24202)可基于差异来防止外科功能。According to another aspect, a situational awareness surgical instrument (eg, 24202) may be used to perform a surgical procedure. In such aspects,surgical instrument 24202 can include a number of components, includingend effector 24216, as described herein. The end effector may include a first jaw, a second jaw pivotally coupled to the first jaw, a cutting blade, and an integratedsensor 24213 configured to detect contact with theend effector 24216 functions (eg, dissection, clamping, coagulation, cutting, stapling, etc.) associated with tissue parameters and transmits the detected tissue parameters to the control circuitry. Notably, in such aspects, the detected tissue parameters may be communicated to the integrated control circuit 24212 of theend effector 24216. Each of the various components of the surgical instrument including the end effector 24216 (eg, Component-N 24218, such as a staple cartridge, etc.) are each configured to transmit one or more of their corresponding device parameters to the integrated end effector Controller control circuit 24212. In such aspects, the integrated end effector control circuit 24212 may be configured to receive such parameter data (eg, one or more detected tissue parameters, including each one or more device parameters of the component). Detected tissue parameters may be received whenever an associated end effector function (eg, dissection, clamping, coagulation, cutting, stapling, etc.) is to be performed. The integrated end effector control circuit 24212 may also be configured to enable access to internal databases (eg, end effector memory 24215 ) and/or external databases (eg,cloud database 24269 via surgical hub 24240 ) throughout the surgical procedure , receive data from thesurgical hub database 24249, etc.). According to various aspects, data received from an internal database and/or an external database may include staple cartridge data (eg, associated with a staple cartridge (eg, 24218 ) for which one or more device parameters have been received by the end effector control circuit 24212 size and/or type of staples) and/or historical data (eg, data indicating expected tissue and/or tissue type to be stapled with those sizes and/or types of staples based on historical data). In various aspects, internal data and/or external data may include preferred/ideal tissue parameters and/or preferred/ideal tissue parameter ranges for each received device parameter based on historical data associated with the surgical procedure (eg, system-defined constraints). In one example, based on historical data (eg, system-defined constraints), internal data and/or external data may include data for the intended tissue and/or tissue type or for device parameters associated with the staple cartridge (eg, 24218 ). Preferred/ideal tissue parameters and/or preferred/ideal tissue parameter ranges for size and/or type of staples. Based on received data (eg, parametric data, internal and/or external data, etc.), the end effector control circuit 24212 may be configured to continuously derive inferences (eg, background information) about the ongoing procedure. Notably, according to alternative aspects, the integratedsensor 24213 of theend effector 24216 can transmit one or more detected tissue parameters to another surgical instrument component (eg, the handle of the handle assembly 24230) Associated control circuitry (eg, 24222 and/or 24232). In such aspects, other surgical instrument component control circuits (eg, 24222 and/or 24232) may similarly be configured to perform various aspects of the end effector control circuit 24212 as described above. Finally, a situationally aware surgical instrument (eg, 24202) can be configured to be able to alert its user of discrepancies, for example, via the end effector'suser interface 24214, via theuser interface 24224 and/or 24234 of another surgical instrument component (eg, the handle of handle assembly 24230), or viauser interface 24244 associated withsurgical hub 24240 coupled to surgical instrument 24202). For example, the difference may include detected tissue parameters that exceed preferred/ideal tissue parameters and/or preferred/ideal tissue parameter ranges associated with those sizes and/or types of staples or those expected tissues and/or tissue types. As another example, a situationally aware surgical instrument (eg, 24202) can be configured to be able to control the surgical instrument function based on the difference. In accordance with at least one aspect, a situationally aware surgical instrument (eg, 24202) can prevent surgical function based on differences.

不适当的装置放置Improper device placement

根据本公开的各个方面，生理感测(例如，经由一个或多于一个传感器检测)可指示装置放置问题。更具体地讲，根据此类方面，生理不相容性可存在于端部执行器的第一钳口和第二钳口内/之间(例如，在夹持之后)，并且可禁止/防止端部执行器的其他功能(例如，凝固、切割、缝合等)。According to various aspects of the present disclosure, physiological sensing (eg, detected via one or more sensors) may indicate a device placement problem. More specifically, according to such aspects, physiological incompatibilities may exist in/between the first and second jaws of the end effector (eg, after clamping), and the end effector may be inhibited/prevented. Other functions of the external actuator (eg, coagulation, cutting, suturing, etc.).

根据各个方面，外科手术可包括切除靶组织(例如，肿瘤)。参见图92，例如，患者组织24000的一部分可包括肿瘤24002。在此类方面，外科边缘24004可限定在肿瘤24002周围。值得注意的是，在外科手术期间，理想的是避免切除肿瘤周围的健康组织和/或使这种切除最小化。然而，为了确保完全移除肿瘤，与该外科手术相关联的当前/公认的护理标准规程可支持切除由围绕肿瘤的距离限定的预先确定的外科边缘和/或由围绕肿瘤的距离范围限定的预先确定的外科边缘范围。在一个方面，所支持的外科边缘可以是基于肿瘤的(例如，基于肿瘤的类型、肿瘤的尺寸等)。在另一方面，所支持的外科边缘可取决于肿瘤微侵入周围组织的程度。在其他方面，基于与该肿瘤和/或该外科手术相关联的历史数据，可将所支持的外科边缘与改善的长期存活相关联。在其他方面，相关联的控制电路(例如，根据图94，在外科器械中，在外科器械的部件中24212、24222、24232，在联接到外科器械的外科集线器中24242等)可以基于从内部数据库24215、24225和/或24235以及/或者外部数据库24249和/或24269接收的数据(例如，患者手术史数据、患者病史数据、复发肿瘤的护理标准规程等，来自云、来自外科集线器等)主动调节所支持的外科边缘。在此类方面，重新参见图92，通常支持的外科边缘(例如，24004)可以基于此类接收到的数据(例如，该患者的手术史数据和/或病史数据可表明肿瘤可能已进一步微侵入周围组织，患者可能已具有复发肿瘤的实例等)以确定的量/距离(例如，24010)对调节的外科边缘(例如，24012)做出改变。According to various aspects, the surgical procedure can include excision of the target tissue (eg, tumor). Referring to FIG. 92, for example, a portion ofpatient tissue 24000 may includetumor 24002. In such aspects, thesurgical margin 24004 can be defined around thetumor 24002. Notably, during surgery, it is ideal to avoid and/or minimize resection of healthy tissue surrounding the tumor. However, to ensure complete removal of the tumor, current/accepted standard of care protocols associated with this surgical procedure may support resection of a predetermined surgical margin defined by the distance around the tumor and/or a predetermined range of distances around the tumor Defined surgical margins. In one aspect, the supported surgical margins can be tumor-based (eg, based on tumor type, tumor size, etc.). On the other hand, the surgical margin supported may depend on the degree to which the tumor has minimally invaded surrounding tissue. In other aspects, supported surgical margins can be associated with improved long-term survival based on historical data associated with the tumor and/or the surgical procedure. In other aspects, associated control circuitry (eg, in a surgical instrument, in components of asurgical instrument 24212, 24222, 24232, in a surgical hub coupled to asurgical instrument 24242, etc., according to FIG. 94) may be based on data from an internal database Active conditioning of data received by 24215, 24225 and/or 24235 and/orexternal databases 24249 and/or 24269 (eg, patient surgical history data, patient medical history data, standard of care protocols for recurrent tumors, etc., from the cloud, from surgical hubs, etc.) Supported surgical margins. In such aspects, referring back to FIG. 92, generally supported surgical margins (eg, 24004) may be based on such received data (eg, the patient's surgical history data and/or medical history data may indicate that the tumor may have been further microinvasive Surrounding tissue, instances where the patient may have had a recurring tumor, etc.) make changes to the adjusted surgical margin (eg, 24012) by a determined amount/distance (eg, 24010).

此外，在各个方面，在为外科手术建立目标外科边缘(例如，24004和/或24012)之后，在外科手术期间有效和/或准确地识别并切除肿瘤和/或其目标外科边缘可能是困难的。再次参见图94，根据本公开的各个方面，外科器械24202的端部执行器(例如，24216)可包括第一传感器(例如，24213)，第一传感器被配置成能够测量第一信号并且将第一信号传输到相关联的控制电路(例如，在外科器械中、在外科器械的部件中24212、24222和/或24232、在联接到外科器械的外科集线器中24242等)。在此类方面，被配置成能够测量第二信号并将第二信号传输到相关联的控制电路的第二传感器可在使用外科器械切除肿瘤之前定位在肿瘤上/内(参见图92，例如，相对于肿瘤的中心位置24006)。此处，根据各个方面，第二传感器可与外科器械分离。除此之外和/或另选地，在此类方面，第二传感器可包括在使用外科器械切除肿瘤之前定位在肿瘤周边(参见图92，例如，24008)处的传感器。根据另一方面，多个第二传感器可定位在肿瘤的周边周围。此处，在此类方面，控制电路可被配置成能够基于第一信号和第二信号动态地计算第一传感器和第二传感器之间的距离。根据各个方面，第一传感器可定位在端部执行器的切割刀片处/附近。用于检测目标外科边缘的另外的示例性方法在标题为“SYSTEM AND METHOD FOR A TISSUE RESECTION MARGINMEASUREMENT DEVICE”的美国专利申请公布No.2016/0192960中有所描述，该专利申请的全部公开内容以引用方式并入本文。Furthermore, in various aspects, after a target surgical margin (eg, 24004 and/or 24012) is established for a surgical procedure, effectively and/or accurately identifying and resecting a tumor and/or its target surgical margin during surgery may be difficult . Referring again to FIG. 94, in accordance with various aspects of the present disclosure, the end effector (eg, 24216) of thesurgical instrument 24202 can include a first sensor (eg, 24213) configured to measure the first signal and convert the first A signal is transmitted to an associated control circuit (eg, in the surgical instrument, in components of thesurgical instrument 24212, 24222, and/or 24232, in a surgical hub coupled to thesurgical instrument 24242, etc.). In such aspects, a second sensor configured to measure and transmit the second signal to an associated control circuit may be positioned on/in the tumor prior to removal of the tumor using a surgical instrument (see FIG. 92, eg, relative to the center of the tumor 24006). Here, according to various aspects, the second sensor may be separate from the surgical instrument. Additionally and/or alternatively, in such aspects, the second sensor may include a sensor positioned at the periphery of the tumor (see FIG. 92, eg, 24008) prior to the use of surgical instruments to remove the tumor. According to another aspect, a plurality of second sensors may be positioned around the perimeter of the tumor. Here, in such aspects, the control circuit may be configured to be able to dynamically calculate the distance between the first sensor and the second sensor based on the first signal and the second signal. According to various aspects, the first sensor may be positioned at/near the cutting blade of the end effector. Additional exemplary methods for detecting target surgical margins are described in US Patent Application Publication No. 2016/0192960 entitled "SYSTEM AND METHOD FOR A TISSUE RESECTION MARGINMEASUREMENT DEVICE," the entire disclosure of which is incorporated by reference method is incorporated herein.

在一个示例中，如果第二传感器定位在肿瘤上/内(例如，在中心位置24006处)，则控制电路还可被配置成能够确定第二传感器与为外科手术建立的目标外科边缘之间的边缘距离。在此类示例中，控制电路可将动态计算的距离(例如，第一传感器和第二传感器之间的距离)与所确定的边缘距离进行比较，以有效且准确地将端部执行器(例如，切割刀片)定位在目标外科边缘处(例如，当动态计算的距离等于或基本上等于所确定的边缘距离时，端部执行器被正确地定位)。控制电路可被配置成能够利用此类技术来有效且准确地将端部执行器(例如，切割刀片)定位在目标外科边缘周围(例如，在切除期间)。In one example, if the second sensor is positioned on/in the tumor (eg, at central location 24006), the control circuit may also be configured to be able to determine the distance between the second sensor and the target surgical margin established for the surgical procedure edge distance. In such an example, the control circuit may compare the dynamically calculated distance (eg, the distance between the first sensor and the second sensor) to the determined edge distance to efficiently and accurately connect the end effector (eg, the distance between the first sensor and the second sensor). , cutting blade) is positioned at the target surgical edge (eg, the end effector is correctly positioned when the dynamically calculated distance is equal to or substantially equal to the determined edge distance). The control circuitry may be configured to utilize such techniques to efficiently and accurately position the end effector (eg, cutting blade) around the target surgical edge (eg, during resection).

在另一个示例中，如果第二传感器定位在肿瘤的周边处或者多个第二传感器定位在肿瘤的周边周围(例如，24008)，则控制电路还可被配置成能够确定一个或多个第二传感器与为外科手术建立的目标外科边缘之间的边缘距离。在此类示例中，控制电路可将动态计算的距离(例如，第一传感器和第二传感器之间的距离)与所确定的边缘距离进行比较，以有效且准确地将端部执行器(例如，切割刀片)定位在目标外科边缘处(例如，当动态计算的距离等于或基本上等于所确定的边缘距离时，端部执行器被正确地定位)。控制电路可被配置成能够利用此类技术来有效且准确地将端部执行器(例如，切割刀片)定位在目标外科边缘周围(例如，在切除期间)。当肿瘤异常成形时，此类方面可能是有益的。In another example, if the second sensor or the plurality of second sensors are positioned around the perimeter of the tumor (eg, 24008), the control circuit may also be configured to be able to determine one or more second sensors The edge distance between the sensor and the target surgical edge established for surgery. In such an example, the control circuit may compare the dynamically calculated distance (eg, the distance between the first sensor and the second sensor) to the determined edge distance to efficiently and accurately connect the end effector (eg, the distance between the first sensor and the second sensor). , cutting blade) is positioned at the target surgical edge (eg, the end effector is correctly positioned when the dynamically calculated distance is equal to or substantially equal to the determined edge distance). The control circuitry may be configured to utilize such techniques to efficiently and accurately position the end effector (eg, cutting blade) around the target surgical edge (eg, during resection). Such aspects may be beneficial when tumors are abnormally shaped.

再次参见图94，根据各个方面，控制电路可被配置成能够当端部执行器(例如，或其切割刀片)正确地相对于目标外科边缘(例如，24004和/或24012)定位时通知外科医生(例如，经由外科器械上的用户界面24214、24224和/或24234，联接到外科器械的外科集线器上的用户界面24244，和/或外科手术室中的用户界面24254等实时通知)。例如，用户界面可包括以下中的至少一者：i)手术部位的视频图像，其具有指示外科医生的目标外科边缘的数字叠加，以在视觉上确认端部执行器(例如，24216)定位在目标外科边缘处和/或相对于目标外科边缘导航端部执行器(例如，或其切割刀片)，ii)外科器械24202自身中的触觉反馈，以指示端部执行器的切割刀片定位在目标外科边缘处，以及/或者iii)听觉反馈，以指示端部执行器的切割刀片定位在目标外科边缘处。Referring again to FIG. 94, according to various aspects, the control circuit may be configured to notify the surgeon when the end effector (eg, or cutting blade thereof) is properly positioned relative to the target surgical edge (eg, 24004 and/or 24012) (eg, real-time notification viauser interfaces 24214, 24224, and/or 24234 on surgical instruments,user interface 24244 on a surgical hub coupled to the surgical instrument, and/oruser interface 24254 in a surgical operating room, etc.). For example, the user interface may include at least one of: i) a video image of the surgical site with a digital overlay indicating the surgeon's target surgical margin to visually confirm that the end effector (eg, 24216) is positioned at Navigating the end effector (eg, or its cutting blade) at and/or relative to the target surgical edge, ii) tactile feedback in thesurgical instrument 24202 itself to indicate that the end effector's cutting blade is positioned at the target surgical edge at the edge, and/or iii) audible feedback to indicate that the end effector's cutting blade is positioned at the target surgical edge.

再次参见图94，根据另外的方面，控制电路可被配置成能够在端部执行器(例如，切割刀片)太靠近癌边缘和/或在癌边缘内(例如，在目标外科边缘内、靠近被肿瘤微侵入的周围组织等)的情况下防止外科器械24202击发。根据此类方面，控制电路还可被配置成能够接收覆写命令(例如，经由外科器械上的用户界面24214、24224和/或24234，联接到外科器械的外科集线器上的用户界面24244，和/或外科手术室中的用户界面24254等)以允许击发继续。在一个示例中，此类用户界面可包括用户界面元素，该用户界面元素可选择以允许击发继续，例如24251。在此类方面，控制电路可继续相对于癌边缘监测端部执行器(例如，或其切割刀片)。另外，在此类方面，控制电路可被配置成能够再次停止击发，警示外科医生并且/或者如所述接收覆写命令。根据其他方面，控制电路可被配置成能够防止击发，直到发生复位事件(例如，打开端部执行器的钳口并相对于癌边缘重新定位端部执行器的钳口)。Referring again to FIG. 94, according to further aspects, the control circuit may be configured to enable the end effector (eg, cutting blade) to be too close to the cancer margin and/or within the cancer margin (eg, within the target surgical margin, close to theSurgical instrument 24202 is prevented from firing in the event of tumor microinvasion of surrounding tissue, etc.). According to such aspects, the control circuitry may also be configured to be capable of receiving override commands (eg, viauser interfaces 24214, 24224, and/or 24234 on the surgical instrument,user interface 24244 on a surgical hub coupled to the surgical instrument, and/or oruser interface 24254 in the surgical theatre, etc.) to allow firing to continue. In one example, such a user interface may include a user interface element selectable to allow firing to continue, eg, 24251. In such aspects, the control circuit may continue to monitor the end effector (eg, or its cutting blade) relative to the cancer margin. Additionally, in such aspects, the control circuit may be configured to stop firing again, alert the surgeon, and/or receive an override command as described. According to other aspects, the control circuit may be configured to prevent firing until a reset event occurs (eg, opening the jaws of the end effector and repositioning the jaws of the end effector relative to the cancer margin).

再次参见图94，根据本公开的其他方面，外科系统24200的一个或多于一个传感器可检测通过夹持在端部执行器(例如，24216)的第一钳口和第二钳口之间/内的组织的血流。例如，多普勒成像检测器(例如，集成在端部执行器24213上、联接到外科集线器，例如包括多普勒成像检测器的参数感测部件24253等)可被配置成能够定位和识别可原本在手术部位处(例如，经由红色、绿色和/或蓝色激光)看不到的血管，并且可执行散斑对比度分析以确定通过此类血管的血流量和/或血流速度。值得注意的是，在一个示例中，可能期望密封一些血管(例如，与肿瘤相关联的血管)，但不密封其他血管(例如，与健康组织/器官相关联的血管)。因此，相关联的控制电路(例如，在外科器械中，在外科器械的部件中24212、24222和/或24232，在联接到外科器械的外科集线器中24242等)可被配置成能够在血流超过预先确定的血流量和/或血流速度的情况下防止外科器械24202击发。根据此类方面，控制电路还可被配置成能够接收覆写命令(例如，经由外科器械上的用户界面24214、24224和/或24234，联接到外科器械的外科集线器上的用户界面24244，和/或外科手术室中的用户界面24254等)以允许击发继续(例如，如果血流与肿瘤相关联)。在一个示例中，此类用户界面可包括用户界面元素，该用户界面元素可选择以允许击发继续，例如24251。在此类方面，控制电路可继续监测被夹持组织的血流。另外，在此类方面，控制电路可被配置成能够再次停止击发，警示外科医生并且/或者如所述接收覆写命令。根据其他方面，控制电路可被配置成能够防止击发，直到发生复位事件(例如，打开钳口并且相对于血管重新定位端部执行器的钳口，该血管包括超过预定义血流量和/或血流速度的血流)。Referring again to FIG. 94, in accordance with other aspects of the present disclosure, one or more sensors of thesurgical system 24200 may detect/by clamping between the first and second jaws of the end effector (eg, 24216)/ blood flow within the tissue. For example, a Doppler imaging detector (eg, integrated on theend effector 24213, coupled to a surgical hub, such as aparametric sensing component 24253 including a Doppler imaging detector, etc.) can be configured to be able to locate and identify possible Blood vessels that are not otherwise visible at the surgical site (eg, via red, green, and/or blue lasers), and speckle contrast analysis may be performed to determine blood flow and/or blood velocity through such vessels. Notably, in one example, it may be desirable to seal some blood vessels (eg, blood vessels associated with tumors), but not others (eg, blood vessels associated with healthy tissues/organs). Accordingly, the associated control circuitry (eg, in a surgical instrument, in components of asurgical instrument 24212, 24222, and/or 24232, in a surgical hub coupled to asurgical instrument 24242, etc.) can be configured to enable flow overSurgical instrument 24202 is prevented from firing with predetermined blood flow and/or blood velocity. According to such aspects, the control circuitry may also be configured to be capable of receiving override commands (eg, viauser interfaces 24214, 24224, and/or 24234 on the surgical instrument,user interface 24244 on a surgical hub coupled to the surgical instrument, and/or oruser interface 24254 in the surgical theatre, etc.) to allow firing to continue (eg, if blood flow is associated with a tumor). In one example, such a user interface may include a user interface element selectable to allow firing to continue, eg, 24251. In such aspects, the control circuitry may continue to monitor blood flow to the clamped tissue. Additionally, in such aspects, the control circuit may be configured to stop firing again, alert the surgeon, and/or receive an override command as described. According to other aspects, the control circuit may be configured to prevent firing until a reset event occurs (eg, opening the jaws and repositioning the jaws of the end effector relative to a blood vessel that includes more than a predefined blood flow and/or blood flow) flow velocity of blood).

再次参见图94，根据本公开的其他方面，外科系统24200的一个或多于一个传感器可在将组织夹持在端部执行器(例如，24216)的第一钳口和第二钳口之间/内的同时和/或之后立即检测血压的升高。例如，血压监测器(例如，联接到外科集线器，例如，包括血压监测器的参数感测部件24253等)可检测与夹持同时发生的血压升高。根据各个方面，外科系统24200在是态势感知的，并且可推断检测到的血压升高是由将组织夹持在端部执行器的钳口之间/内引起的。例如，包括临界血流的血管可能已被捕集在钳口之间/内，从而导致血流收缩。因此，根据各个方面，相关联的控制电路(例如，在外科器械中，在外科器械的部件中24212、24222和/或24232，在联接到外科器械的外科集线器中24242等)可被配置成能够在血压升高超过预先确定的量和/或预先确定的范围的情况下防止外科器械24202击发。根据此类方面，控制电路还可被配置成能够接收覆写命令(例如，经由外科器械上的用户界面24214、24224和/或24234，联接到外科器械的外科集线器上的用户界面24244，和/或外科手术室中的用户界面24254等)以允许击发继续(例如，外科医生在组织仍被夹持的情况下观察到血压已下降、态势感知的外科系统将血压升高归因于另一原因等)。在一个示例中，此类用户界面可包括用户界面元素，该用户界面元素可选择以允许击发继续，例如24251。在此类方面，控制电路可继续监测患者的血压。另外，在此类方面，控制电路可被配置成能够再次停止击发，警示外科医生并且/或者如所述接收覆写命令。根据其他方面，控制电路可被配置成能够防止击发，直到发生复位事件(例如，打开钳口并相对于被夹持组织重新定位端部执行器的钳口)。Referring again to FIG. 94, in accordance with other aspects of the present disclosure, one or more sensors of thesurgical system 24200 may be between the first and second jaws of the end effector (eg, 24216) that clamp tissue Detect an increase in blood pressure during and/or immediately after. For example, a blood pressure monitor (eg, coupled to a surgical hub, eg,parameter sensing component 24253 including the blood pressure monitor, etc.) can detect an increase in blood pressure that occurs concurrently with clamping. According to various aspects, thesurgical system 24200 is situationally aware and can infer that the detected increase in blood pressure is caused by the clamping of tissue between/in the jaws of the end effector. For example, a vessel containing critical blood flow may have become trapped between/inside the jaws, causing blood flow to constrict. Thus, according to various aspects, associated control circuitry (eg, in a surgical instrument, in components of asurgical instrument 24212, 24222, and/or 24232, in a surgical hub coupled to asurgical instrument 24242, etc.) may be configured to enableSurgical instrument 24202 is prevented from firing if blood pressure rises beyond a predetermined amount and/or a predetermined range. In accordance with such aspects, the control circuitry may also be configured to be capable of receiving override commands (eg, viauser interfaces 24214, 24224, and/or 24234 on the surgical instrument,user interface 24244 on a surgical hub coupled to the surgical instrument, and/or oruser interface 24254 in the surgical operating room, etc.) to allow firing to continue (e.g., surgeon observes blood pressure has dropped while tissue is still clamped, situational awareness surgical system attributes blood pressure rise to another cause Wait). In one example, such a user interface may include a user interface element selectable to allow firing to continue, eg, 24251. In such aspects, the control circuit may continue to monitor the patient's blood pressure. Additionally, in such aspects, the control circuit may be configured to stop firing again, alert the surgeon, and/or receive an override command as described. According to other aspects, the control circuit may be configured to prevent firing until a reset event occurs (eg, opening the jaws and repositioning the jaws of the end effector relative to the clamped tissue).

再次参见图94，根据本公开的其他方面，外科系统的一个或多于一个传感器可检测夹持在端部执行器(例如，24216)的第一钳口和第二钳口之间/内的组织内的大量神经束。例如，心率监测器(例如，集成到端部执行器24213上，联接到外科集线器(例如，包括心率监测器的参数感测部件24253)等)可在将组织夹持在第一钳口和第二钳口之间/内的同时和/或之后立即检测心率的升高。根据各个方面，外科系统24200在是态势感知的，并且在从内部数据库24215、24225、24235、24249和/或外部数据库24249和/或24269(例如，与正在执行的外科手术的手术部位相关联的解剖信息)接收到的数据的情形下，可推断检测到的心率升高是由将组织夹持在端部执行器的钳口之间/内引起的。根据此类方面，相关联的控制电路(例如，在外科器械中，在外科器械的部件中24212、24222和/或24232，在联接到外科器械的外科集线器中24242等)可被配置成能够基于该推论防止外科器械24202击发。另外，根据此类方面，控制电路可被配置成能够接收覆写命令(例如，经由外科器械上的用户界面24214、24224和/或24234，联接到外科器械的外科集线器上的用户界面24244，和/或外科手术室中的用户界面24254等)以允许击发继续(例如，外科医生在组织仍被夹持的情况下观察到患者的心率已下降、态势感知的外科系统将心率升高归因于另一原因等)。在一个示例中，此类用户界面可包括用户界面元素，该用户界面元素可选择以允许击发继续，例如24251。在此类方面，控制电路可继续监测患者的心率。另外，在此类方面，控制电路可被配置成能够再次停止击发，警示外科医生并且/或者如所述接收覆写命令。根据其他方面，控制电路可被配置成能够防止击发，直到发生复位事件(例如，打开钳口并相对于被夹持组织重新定位端部执行器的钳口)。Referring again to FIG. 94, in accordance with other aspects of the present disclosure, one or more sensors of the surgical system may detect the presence of a force clamped between/inside the first and second jaws of the end effector (eg, 24216). Numerous nerve bundles within tissue. For example, a heart rate monitor (eg, integrated into theend effector 24213, coupled to a surgical hub (eg, aparameter sensing component 24253 including a heart rate monitor), etc.) can be used during clamping of tissue between the first jaw and the second jaw. An increase in heart rate was detected simultaneously and/or immediately after the two jaws. According to various aspects, thesurgical system 24200 is situationally aware, and accesses data frominternal databases 24215, 24225, 24235, 24249 and/orexternal databases 24249 and/or 24269 (eg, associated with the surgical site of the surgical procedure being performed). anatomical information), it can be concluded that the detected increase in heart rate is caused by the clamping of tissue between/inside the jaws of the end effector. According to such aspects, associated control circuitry (eg, in a surgical instrument, in components of asurgical instrument 24212, 24222, and/or 24232, in a surgical hub coupled to asurgical instrument 24242, etc.) may be configured to enable This inference preventsSurgical Instrument 24202 from firing. Additionally, according to such aspects, the control circuitry may be configured to receive override commands (eg, viauser interfaces 24214, 24224, and/or 24234 on the surgical instrument,user interface 24244 on a surgical hub coupled to the surgical instrument, andUser interface 24254 in the surgical theatre, etc.) to allow firing to continue (e.g., surgeon observes patient's heart rate has dropped while tissue is still clamped, situational awareness surgical system attributes elevated heart rate to another reason, etc.). In one example, such a user interface may include a user interface element selectable to allow firing to continue, eg, 24251. In such aspects, the control circuit may continue to monitor the patient's heart rate. Additionally, in such aspects, the control circuit may be configured to stop firing again, alert the surgeon, and/or receive an override command as described. According to other aspects, the control circuit may be configured to prevent firing until a reset event occurs (eg, opening the jaws and repositioning the jaws of the end effector relative to the clamped tissue).

再次参见图94，根据本公开的其他方面，外科系统24200的一个或多于一个传感器可检测外科器械24202与通电装置(例如，RF器械/装置)接触。在一个示例中，外科器械和通电装置可通信地联接到外科系统24200中的外科集线器24240。例如，重新参见图9，装置/器械235以及能量装置241可联接到外科集线器206的模块化控制塔236。在此类示例中，产生用于通电装置241的电外科能量的发生器240和/或集成到该通电装置中的传感器中的任一者可被配置成能够检测与该通电装置相关联的阻抗何时下降到低于阈值达阈值时间段(即，指示短路的阻抗降)。类似于图48，通电装置的集成传感器可被配置成能够测量随时间变化的阻抗。用于检测短路的各种另选方法，诸如在标题为“DETECTING SHORT CIRCUITSIN ELECTROSURGICAL MEDICAL DEVICES”的美国专利No.9,554,854中描述的那些，明确地以引用方式并入本文(例如，比较一系列脉冲的脉冲内的不同位置处的阻抗值等)。根据各个方面，外科系统24200是态势感知的，并且在从内部数据库24215、24225、24235、24249和/或外部数据库24249和/或24269(例如，指示外科手术的涉及使用单独的外科器械(例如，电外科器械/装置)的步骤和/或当前步骤的规程数据)接收到的数据的情形下，可推断检测到的短路是由单独的外科器械引起的(例如，外科器械的导电表面可能与通电装置接触，从而引起短路)。根据此类方面，相关联的控制电路(例如，在外科器械中，在外科器械的部件中24212、24222和/或24232，在联接到外科器械和通电装置的外科集线器中24242等)可被配置成能够基于该推论防止外科器械24202击发。如果存在短路，则可能难以用电外科能量(例如，RF能量)处理(例如，凝结)组织，并且可能导致不期望的手术结果(例如，不完全的组织处理、导电物体的过度加热等)。在这种情况下，控制电路可被配置成能够通知外科医生(例如，经由外科器械上的用户界面24214、24224和/或24234，联接到外科器械的外科集线器上的用户界面24244，和/或外科手术室中的用户界面24254等实时通知)存在短路并且外科器械24202的击发已暂停。另外，根据此类方面，控制电路还可被配置成能够接收覆写命令(例如，经由外科器械上的用户界面24214、24224和/或24234，联接到外科器械的外科集线器上的用户界面24244，和/或外科手术室中的用户界面24254等)以允许击发继续(例如，外科医生证实不存在短路、靶组织包括低阻抗等)。在一个示例中，此类用户界面可包括用户界面元素，该用户界面元素可选择以允许击发继续，例如24251。在此类方面，控制电路可继续监测短路。另外，在此类方面，控制电路可被配置成能够再次停止击发，警示外科医生并且/或者如所述接收覆写命令。根据其他方面，控制电路可被配置成能够防止击发，直到发生复位事件(例如，外科器械相对于通电装置重新定位，使得二者不再接触)。Referring again to FIG. 94, in accordance with other aspects of the present disclosure, one or more sensors of thesurgical system 24200 may detect that thesurgical instrument 24202 is in contact with an energized device (eg, an RF instrument/device). In one example, the surgical instruments and energization devices are communicatively coupled tosurgical hub 24240 insurgical system 24200. For example, referring back to FIG. 9 , device/instrument 235 andenergy device 241 may be coupled tomodular control tower 236 ofsurgical hub 206 . In such examples, eithergenerator 240 that generates electrosurgical energy forenergization device 241 and/or sensors integrated into the energization device may be configured to detect an impedance associated with the energization device When it falls below the threshold for a threshold period of time (ie, the drop in impedance indicating a short circuit). Similar to Figure 48, the integrated sensor of the energization device can be configured to measure impedance over time. Various alternative methods for detecting short circuits, such as those described in US Patent No. 9,554,854 entitled "DETECTING SHORT CIRCUITSIN ELECTROSURGICAL MEDICAL DEVICES", are expressly incorporated herein by reference (e.g., comparing the impedance values at different locations within the pulse, etc.). In accordance with various aspects, thesurgical system 24200 is situational aware, and instructs the use of separate surgical instruments (e.g., Electrosurgical instrument/device step and/or current step protocol data), it can be concluded that the detected short was caused by a separate surgical instrument (e.g., the conductive surface of the surgical instrument may be device contacts, causing a short circuit). According to such aspects, associated control circuitry (eg, in a surgical instrument, in components of asurgical instrument 24212, 24222, and/or 24232, in asurgical hub 24242 coupled to a surgical instrument and an energization device, etc.) may be configured The ability to preventsurgical instrument 24202 from firing based on this inference. If there is a short circuit, it may be difficult to treat (eg, coagulate) tissue with electrosurgical energy (eg, RF energy) and may lead to undesired surgical outcomes (eg, incomplete tissue processing, overheating of conductive objects, etc.). In this case, the control circuitry may be configured to be able to notify the surgeon (eg, viauser interfaces 24214, 24224, and/or 24234 on the surgical instrument,user interface 24244 on a surgical hub coupled to the surgical instrument, and/or Theuser interface 24254 in the surgical theatre is notified in real time that there is a short circuit and the firing of thesurgical instrument 24202 has been paused. Additionally, according to such aspects, the control circuitry may also be configured to be capable of receiving override commands (eg, viauser interfaces 24214, 24224, and/or 24234 on the surgical instrument,user interface 24244 on a surgical hub coupled to the surgical instrument, and/oruser interface 24254 in the surgical operating room, etc.) to allow firing to continue (eg, surgeon verifies no short circuit, target tissue includes low impedance, etc.). In one example, such a user interface may include a user interface element selectable to allow firing to continue, eg, 24251. In such aspects, the control circuit may continue to monitor for short circuits. Additionally, in such aspects, the control circuit may be configured to stop firing again, alert the surgeon, and/or receive an override command as described. According to other aspects, the control circuit may be configured to prevent firing until a reset event occurs (eg, the surgical instrument is repositioned relative to the energization device so that the two are no longer in contact).

不适当的装置选择/所提议的使用Inappropriate device selection/proposed use

根据本公开的各个方面，生理感测(例如，经由一个或多于一个传感器检测)可指示外科器械/装置选择问题。更具体地讲，根据此类方面，可存在外科装置-组织不相容性，并且可禁止/防止端部执行器的其他功能(例如，凝固、切割、缝合等)。According to various aspects of the present disclosure, physiological sensing (eg, detected via one or more sensors) may be indicative of surgical instrument/device selection issues. More specifically, according to such aspects, surgical device-tissue incompatibility may exist, and other functions of the end effector (eg, coagulation, cutting, stapling, etc.) may be inhibited/prevented.

再次参见图94，根据本公开的一个方面，控制电路(例如，在外科器械的部件中24212、24222和/或24232，在联接到外科器械的外科集线器中24242等)可被配置成能够在组织特定缝合器(例如，血管吻合器)和感测到的信息(例如，经由一个或多于一个传感器检测到的信息)的任何组合表明靶组织可能不合适(例如，反指示)该组织特定缝合器的情况下提供警告。Referring again to FIG. 94, according to one aspect of the present disclosure, control circuitry (eg, 24212, 24222, and/or 24232 in components of a surgical instrument, 24242 in a surgical hub coupled to a surgical instrument, etc.) may be configured to enable Any combination of a specific stapler (eg, a vascular stapler) and sensed information (eg, detected via one or more sensors) indicates that the target tissue may not be suitable (eg, counter-indicating) for that tissue-specific suture A warning is provided in the case of a device.

图93示出了根据本公开的各个方面的用于解决装置选择问题的示例性安全过程24100。根据至少一个方面，安全过程24100可由与外科系统(例如，图94的24200)的态势感知的外科集线器相关联的控制电路(例如，图94的24242)执行/实现(例如，在外科手术期间)。根据其他方面，安全过程24100可由与外科系统(例如，图94的24200)的态势感知的外科器械相关联的控制电路(例如，图94的24212、24222和/或24232)执行/实现(例如，在外科手术期间)。93 illustrates anexample security process 24100 for addressing device selection issues in accordance with various aspects of the present disclosure. In accordance with at least one aspect,security process 24100 may be performed/implemented (eg, during a surgical procedure) by a control circuit (eg, 24242 of FIG. 94 ) associated with a situationally aware surgical hub of a surgical system (eg, 24200 of FIG. 94 ) . According to other aspects, thesafety process 24100 may be performed/implemented (eg, during surgery).

参见图93，组织识别过程24108可接收包括装置选择24102(例如，缝合器选择，例如，适合于实质击发的缝合器、适合于血管击发的缝合器、适合于支气管击发的缝合器等)、由一个或多于一个传感器检测的各种装置测量24104(例如，端部执行器闭合角度、与端部执行器接触的组织的长度、闭合力/压缩曲线等)和态势感知信息24106(例如，规程信息、外科医生倾向等)的输入。93, thetissue identification process 24108 may receive adevice selection 24102 including a device selection 24102 (eg, stapler selection, eg, stapler suitable for parenchymal firing, stapler suitable for vascular firing, stapler suitable for bronchial firing, etc.), by Various device measurements 24104 (eg, end effector closure angle, length of tissue in contact with the end effector, closure force/compression curve, etc.) and situational awareness information 24106 (eg, protocol) detected by one or more sensors information, surgeon preference, etc.).

根据图93，在装置选择24102处，执行/实现安全过程24100的控制电路可被配置成能够从所选择的缝合器/装置接收装置参数和/或接收与所选择的缝合器/装置的每个部件(例如，钉仓)相关联的装置参数以指示装置选择。例如，与钉仓相关联的装置参数可包括仓的类型、仓的颜色、仓的附属物、仓的夹持负载极限、仓的间隙范围、仓的击发速率等。根据一个方面，一个或多个装置参数可在联接到外科系统时由缝合器/装置传输到控制电路。根据另选的方面，装置选择可经由用户界面(例如，与外科集线器相关联和/或在外科手术室中，例如图94的24244和/或24254)输入并且/或者从内部数据库和/或外部数据库接收(例如，关于正在执行的外科手术和/或可用的外科器械的数据，例如图94的24249和/或24269)。According to FIG. 93, atdevice selection 24102, the control circuit that performs/implements thesafety process 24100 may be configured to receive device parameters from the selected stapler/device and/or to receive each of the selected staplers/devices Device parameters associated with the component (eg, staple cartridge) to indicate device selection. For example, device parameters associated with a staple cartridge may include cartridge type, cartridge color, cartridge appendage, cartridge clamp load limit, cartridge clearance range, cartridge firing rate, and the like. According to one aspect, one or more device parameters may be communicated by the stapler/device to the control circuit when coupled to the surgical system. According to alternative aspects, device selection may be entered via a user interface (eg, associated with a surgical hub and/or in a surgical operating room, eg, 24244 and/or 24254 of FIG. 94 ) and/or from an internal database and/or externally The database receives (eg, data regarding the surgical procedure being performed and/or available surgical instruments, eg, 24249 and/or 24269 of FIG. 94).

另外，根据图93，可经由与端部执行器(例如，部件-A，图94的24216)和/或外科器械的其他部件(部件-N，图94的24218(例如，钉仓))相关联的一个或多于一个传感器(例如，如本文图17、图18、图53、图78等所述)来检测装置测量24104。例如，一个或多于一个组织传感器可被定位和配置成能够用于检查导通和/或沿端部执行器的长度测量组织阻抗，以评估与端部执行器接触的组织的长度(例如，图17的一个或多个传感器738使用分段电极确定组织位置和/或测量组织阻抗、图78的传感器153468确定沿端部执行器的长度存在组织等)。作为另一个示例，一个或多于一个传感器可被定位和配置成能够检测/评估钳口/端部执行器闭合角度(例如，位移传感器(例如，图17的位置传感器734)以检测夹持致动器/驱动构件的位移、间隙传感器(例如，图53的传感器152008a)以检测端部执行器的第一钳口和第二钳口之间的间隙等)。作为另一个示例，一个或多于一个传感器可被定位和配置成能够检测在第一钳口和第二钳口之间压缩/闭合组织的力(例如，在第一钳口和/或第二钳口的组织表面上的力传感器(例如，包括力传感器的图17的传感器738)以检测夹持组织时的力、传感器(例如，图17的电流传感器736)以检测与施加到组织的力相关的驱动构件的电流消耗、扭矩传感器(例如，图17的744b)以测量闭合力等)。本文其他地方已经讨论了用于检测端部执行器闭合角度、与端部执行器接触的组织的长度以及闭合力/压缩曲线的各种其他方面。In addition, according to FIG. 93, it may be via association with the end effector (eg, Component-A, 24216 of FIG. 94) and/or other components of the surgical instrument (component-N, 24218 of FIG. 94 (eg, cartridge)) Thedevice measurement 24104 is detected by coupling one or more sensors (eg, as described herein in FIGS. 17 , 18 , 53 , 78 , etc.). For example, one or more tissue sensors may be positioned and configured that can be used to check for continuity and/or measure tissue impedance along the length of the end effector to assess the length of tissue in contact with the end effector (eg, One ormore sensors 738 of Figure 17 use segmented electrodes to determine tissue location and/or measure tissue impedance,sensors 153468 of Figure 78 to determine the presence of tissue along the length of the end effector, etc.). As another example, one or more sensors may be positioned and configured to detect/evaluate the jaw/end effector closure angle (eg, a displacement sensor (eg,position sensor 734 of FIG. 17 ) to detect gripping displacement of the actuator/drive member, a gap sensor (eg,sensor 152008a of FIG. 53 to detect the gap between the first and second jaws of the end effector, etc.). As another example, one or more sensors may be positioned and configured to detect a force compressing/closing tissue between the first and second jaws (eg, between the first and/or second jaws) A force sensor (eg,sensor 738 of FIG. 17 including a force sensor) on the tissue surface of the jaws to detect the force while gripping the tissue, a sensor (eg,current sensor 736 of FIG. 17 ) to detect and apply the force to the tissue Current draw of the associated drive member, torque sensor (eg, 744b of Figure 17) to measure closing force, etc.). Various other aspects for detecting the angle of end effector closure, the length of tissue in contact with the end effector, and the closure force/compression curve have been discussed elsewhere herein.

接下来，根据图93，可按照图94经由与外科集线器24242相关联的内部数据库24249和/或外部数据库24269并且/或者经由与外科器械24202相关联的内部数据库24215、24225、24235和/或外部数据库24249、24269等接收手术感知信息24106。93, viainternal database 24249 and/orexternal database 24269 associated withsurgical hub 24242 and/or viainternal databases 24215, 24225, 24235 and/or external associated withsurgical instrument 24202 in accordance with FIG. 94Databases 24249, 24269, etc. receivesurgical awareness information 24106.

返回图93，组织识别过程24108被配置成能够确定外科器械遇到的组织类型(例如，实质、血管、支气管等)。在一个示例中，组织识别过程24108可以基于各种输入(例如，当钳口完全打开时沿着钳口的长度检测到的组织接触、闭合相对于孔曲线表明组织与实质一致等)来确定组织类型是实质。在另一个示例中，组织识别过程24108可基于各种输入(例如，在闭合期间几乎立即检测到的组织接触、被检测为仅在缝合器的小区域上并且被检测为限定在远侧上的组织接触、初始检测到的闭合力表明组织结构与血管一致等)来确定组织类型是血管(例如，PA/PV)。在另一个示例中，组织识别过程24108可基于各种输入(例如，在闭合期间几乎立即检测到的组织接触、被检测为在缝合器的小区域上并且被检测为限定在远侧和近侧两者上的组织接触、初始检测到的闭合力表明刚性组织结构与支气管一致等)来确定组织类型是支气管。根据各个方面，此类组织类型确定还可基于包括组织的厚度、组织的硬度、组织的位置(例如，相对于患者)以及由经由本文所述的一个或多于一个传感器进行的测量检测到的和/或从经由本文所述的一个或多于一个传感器进行的测量得出的组织中的血管形成的组织参数。值得注意的是，在得出组织识别输出/结果之前，组织识别过程24108可在另外的输入(例如，缝合器选择、外科手术信息、外科医生倾向等)的情形下进一步评估此类初始组织确定。这种态势感知最终产生组织识别输出/结果。这里，已经在本文其他地方(例如，胸外科手术示例等)进一步讨论了用于识别遇到的组织的各个方面。Returning to Figure 93, thetissue identification process 24108 is configured to be able to determine the type of tissue (eg, parenchyma, vessel, bronchus, etc.) encountered by the surgical instrument. In one example, thetissue identification process 24108 may determine tissue based on various inputs (eg, tissue contact detected along the length of the jaws when the jaws are fully open, closure versus hole curves indicating tissue conformance to parenchyma, etc.) Type is substance. In another example, thetissue identification process 24108 may be based on various inputs (eg, tissue contact detected almost immediately during closure, detected as only on a small area of the stapler, and detected as defined on the distal side Tissue contact, initially detected closing force indicating tissue structure conforms to blood vessels, etc.) to determine that the tissue type is a vessel (eg, PA/PV). In another example, thetissue identification process 24108 may be based on various inputs (eg, tissue contact detected almost immediately during closure, detected as being on a small area of the stapler, and detected as being defined distally and proximally Tissue contact on the two, initially detected closing force indicating rigid tissue structure consistent with the bronchi, etc.) to determine the tissue type is bronchi. According to various aspects, such tissue type determinations may also be based on factors including thickness of the tissue, stiffness of the tissue, location of the tissue (eg, relative to the patient), and measurements made via one or more of the sensors described herein. and/or tissue parameters of vascularization in tissue derived from measurements made via one or more of the sensors described herein. Notably, thetissue identification process 24108 may further evaluate such initial tissue determinations in the context of additional inputs (eg, stapler selection, surgical information, surgeon preference, etc.) before deriving tissue identification output/results . This situational awareness ultimately produces organizational identification outputs/results. Here, various aspects for identifying encountered tissue have been discussed further elsewhere herein (eg, thoracic surgery examples, etc.).

重新参见图93，组织识别输出/结果可用于确定所选择的缝合器/装置和/或所选择的缝合器/装置的每个部件(例如，钉仓、轴等)对于外科手术是否是最佳的24110。在此类方面，控制电路可从内部数据库和/或外部数据库(例如，参见图94，与外科集线器24242相关联的内部数据库24249和/或外部数据库24269，与外科器械24202相关联的内部数据库24215、24225、24235和/或外部数据库24249、24269等)接收另外的信息24112。更具体地，另外的信息24112可包括其他可用的缝合器、其他可用的能量装置、可用于与所选择的缝合器/装置一起使用的其他缝合器部件(例如，钉仓、轴等)等。根据至少一个方面，可用性可受制于手术位置处的当前库存。值得注意的是，另外的信息24112还可包括与每个其他可用的缝合器、每个其他可用的能量装置、可用于与所选择的缝合器/装置一起使用的每个其他缝合器部件等相关联的装置参数。Referring back to Figure 93, the tissue identification output/results can be used to determine whether the selected stapler/device and/or each component of the selected stapler/device (eg, cartridge, shaft, etc.) is optimal forsurgery 24110. In such aspects, the control circuitry may access data from an internal database and/or an external database (eg, see FIG. , 24225, 24235 and/orexternal databases 24249, 24269, etc.) receiveadditional information 24112. More specifically, theadditional information 24112 may include other available staplers, other available energy devices, other stapler components (eg, cartridges, shafts, etc.) available for use with the selected stapler/device, and the like. According to at least one aspect, availability may be subject to current inventory at the surgical site. Notably, theadditional information 24112 may also include information related to each other available stapler, each other available energy device, each other stapler component available for use with the selected stapler/device, etc. connected device parameters.

根据各个方面，当评估所选择的缝合器/装置是否为最佳24110时，执行/实现安全过程24100的控制电路可被配置成能够基于系统限定的约束与每个接收到的与所选择的缝合器/装置24102相关联的装置参数协作，来分析每个检测到的组织参数(例如，经由本文所述的一个或多于一个传感器检测)。此外，根据此类方面，控制电路可被配置成能够基于系统限定的约束，利用接收到的与每个其他可用缝合器、每个其他可用能量装置、可用于与所选择的缝合器/装置一起使用的每个其他缝合器部件等相关联的装置参数来分析每个检测到的组织参数(例如，经由本文所述的一个或多于一个传感器检测)。根据此类方面，控制电路可被配置成能够基于检测到的组织参数确定与所选择的缝合器/装置24102和/或所选择的缝合器/装置24102的部件相比，其他可用的缝合器中的一个或多于一个、其他可用的能量装置和/或可用于与所选择的缝合器/装置一起使用的其他缝合器部件是否更优化。According to various aspects, when evaluating whether the selected suture/device is optimal 24110, the control circuitry that performs/implements thesafety process 24100 may be configured to be able to associate each received and selected suture with each other based on system-defined constraints The device parameters associated with the device/device 24102 cooperate to analyze each detected tissue parameter (eg, detected via one or more of the sensors described herein). Further, according to such aspects, the control circuit may be configured to be able to utilize the received energy with each other available stapler, each other available energy device, available for use with the selected stapler/device, based on system-defined constraints Each detected tissue parameter (eg, detected via one or more of the sensors described herein) is analyzed using device parameters associated with each other stapler component, etc., used. According to such aspects, the control circuit may be configured to be able to determine, based on the detected tissue parameters, the number of other available staplers in comparison to the selected stapler/device 24102 and/or the selected stapler/device 24102 components whether one or more of the available energy devices and/or other stapler components available for use with the selected stapler/device are more optimized.

在各个方面，一个或多个检测到的组织参数可包括例如组织的类型、组织的厚度、组织的硬度、组织的位置、组织中的血管形成等，并且接收到的装置参数可包括例如，钉仓的类型、钉仓的颜色、钉仓的附属物、钉仓的夹持负载极限、钉仓的间隙范围、以及钉仓的击发速率等。根据各个方面，系统限定的约束(例如，基于在态势感知的外科系统中访问的历史数据和/或规程数据)对于每个接收到的装置参数可包括优选/理想组织参数和/或优选/理想组织参数范围。例如，优选/理想组织厚度和/或优选/理想组织厚度范围可与每个钉仓颜色相关联。在此类示例中，每个钉仓颜色可指示钉仓中的钉的类型和/或尺寸。此处，包括短钉的钉仓对于厚组织可能不是最佳的。根据另外的方面，系统限定的约束(例如，基于在态势感知的外科系统中访问的历史数据和/或规程数据)对于每个检测到的组织类型可以包括优选/理想夹持负载极限和/或优选/理想夹持负载极限范围。例如，与其相应的夹持负载极限相关联的每个钉仓可指示其可最佳地缝合的组织的类型。此处，本公开设想了接收到的装置参数(例如，钉仓的类型、钉仓的颜色、钉仓的附属物、钉仓的夹持负载极限、钉仓的间隙范围、钉仓的击发速率等)、和检测到的组织参数(例如，组织的类型、组织的厚度、组织的硬度、组织的位置、组织中的血管形成等)，以及所建立的系统限定的约束(例如，基于在态势感知的外科系统中访问的历史数据和/或规程数据与接收到的装置参数和/或检测到的组织参数相关联)的各种组合。In various aspects, the one or more detected tissue parameters may include, for example, type of tissue, thickness of tissue, stiffness of tissue, location of tissue, vascularization in tissue, etc., and received device parameters may include, for example, staples The type of cartridge, the color of the cartridge, the appendages of the cartridge, the clamping load limit of the cartridge, the clearance range of the cartridge, and the firing rate of the cartridge, etc. According to various aspects, system-defined constraints (eg, based on historical data and/or protocol data accessed in a situationally aware surgical system) may include preferred/ideal tissue parameters and/or preferred/ideal for each received device parameter Organization parameter range. For example, a preferred/desirable tissue thickness and/or a preferred/desirable tissue thickness range may be associated with each cartridge color. In such an example, each staple cartridge color may indicate the type and/or size of staples in the staple cartridge. Here, staple cartridges that include short staples may not be optimal for thick tissue. According to further aspects, system-defined constraints (eg, based on historical data and/or protocol data accessed in a situationally aware surgical system) may include preferred/ideal clamp load limits and/or for each detected tissue type Preferred/ideal clamping load limit range. For example, each staple cartridge associated with its respective clamping load limit can indicate the type of tissue it can best staple. Here, the present disclosure contemplates the received device parameters (eg, type of cartridge, color of the cartridge, appendage of the cartridge, clamp load limit of the cartridge, clearance range of the cartridge, firing rate of the cartridge etc.), and detected tissue parameters (eg, type of tissue, thickness of tissue, stiffness of tissue, location of tissue, vascularization in tissue, etc.), and established system-defined constraints (eg, based on Various combinations of historical data and/or protocol data accessed in the sensed surgical system are associated with received device parameters and/or detected tissue parameters).

再次参见图93，如果确定所选择的装置24102是最佳的，则执行/实现安全过程24100的控制电路可被配置成能够起初不执行任何操作(例如，稍后推荐)并且/或者记录分析已执行24114。相反，如果确定所选择的装置24102不是最佳的，则控制电路可被配置成能够确定是否存在安全问题24116。根据各个方面，当评估所选择的缝合器/装置24102是否存在安全问题时，控制电路可被配置成能够基于系统限定的约束与每个接收到的与所选择的缝合器/装置24102相关联的装置参数协作，来分析每个检测到的组织参数。Referring again to FIG. 93, if it is determined that the selecteddevice 24102 is optimal, the control circuitry that performs/implements thesecurity process 24100 may be configured to perform no action at first (eg, recommended later) and/or record that the analysis has been Execute 24114. Conversely, if it is determined that the selecteddevice 24102 is not optimal, the control circuitry may be configured to be able to determine if there is asafety issue 24116. According to various aspects, when evaluating the selected stapler/device 24102 for safety issues, the control circuitry may be configured to be able to associate with each received data associated with the selected stapler/device 24102 based on system-defined constraints The device parameters collaborate to analyze each detected tissue parameter.

与上文类似，检测到的组织参数可包括例如组织的类型、组织的厚度、组织的硬度、组织的位置、组织中的血管形成等，并且接收到的装置参数可包括例如，钉仓的类型、钉仓的颜色、钉仓的附属物、钉仓的夹持负载极限、钉仓的间隙范围、以及钉仓的击发速率等。根据各个方面，系统限定的约束(例如，基于在态势感知的外科系统中访问的历史数据和/或规程数据)对于每个接收到的装置参数可包括优选/理想组织参数和/或优选/理想组织参数范围。例如，优选/理想组织厚度和/或优选/理想组织厚度范围可与每个钉仓颜色相关联。在此类示例中，每个钉仓颜色可指示钉仓中的钉的类型和/或尺寸。此处，继续该示例，如果所选择的缝合器/装置24102的接收到的装置参数包括钉仓颜色(例如，指示短钉)，并且检测到的组织参数指示超过与所选择的缝合器/装置24102的钉仓颜色相关联的优选/理想组织厚度和/或优选/理想组织厚度范围的组织厚度，则所选择的缝合器/装置24102存在安全问题。利用不适当的钉仓可导致不太令人满意的结果和/或不期望的结果(例如，缝合失败、渗血、出血等)。在这种情况下，控制电路可被配置成能够警告外科医生24118(例如，参见图94，经由所选择的缝合器/装置上的用户界面24214、24224和/或24234，经由与外科集线器相关联的用户界面24244，经由外科手术室中的用户界面24254等)存在安全问题。在此类方面下，控制电路还可被配置成能够接收覆写命令24120(例如，经由所选择的缝合器/装置上的用户界面24214、24224和/或24234，经由与外科集线器相关联的用户界面24244，经由外科手术室中的用户界面等24254)以允许外科手术继续。在一个示例中，参见图94，此类用户界面可包括用户界面元素，该用户界面元素可选择以允许规程继续，例如24251。在另选的方面，响应于该警告，外科医生可校正所指出的安全问题(例如，用另一个钉仓替换不适当的钉仓)，此时可再次执行/实现装置选择安全过程24100。Similar to above, the detected tissue parameters may include, for example, the type of tissue, the thickness of the tissue, the stiffness of the tissue, the location of the tissue, vascularization in the tissue, etc., and the received device parameters may include, for example, the type of cartridge , the color of the cartridge, the appendages of the cartridge, the clamping load limit of the cartridge, the clearance range of the cartridge, and the firing rate of the cartridge, etc. According to various aspects, system-defined constraints (eg, based on historical data and/or protocol data accessed in a situationally aware surgical system) may include preferred/ideal tissue parameters and/or preferred/ideal for each received device parameter Organization parameter range. For example, a preferred/desirable tissue thickness and/or a preferred/desirable tissue thickness range may be associated with each cartridge color. In such an example, each staple cartridge color may indicate the type and/or size of staples in the staple cartridge. Here, continuing the example, if the received device parameter of the selected stapler/device 24102 includes a staple cartridge color (eg, indicating staples), and the detected tissue parameter indicates more than is consistent with the selected stapler/device The preferred/desirable tissue thickness and/or the preferred/desirable tissue thickness range of tissue thickness associated with the staple cartridge color of the 24102, then the selected stapler/device 24102 presents a safety concern. Utilizing an inappropriate staple cartridge can lead to less satisfactory and/or undesirable results (eg, suturing failure, oozing, bleeding, etc.). In this case, the control circuitry may be configured to alert the surgeon 24118 (eg, see FIG. 94 , viauser interfaces 24214, 24224, and/or 24234 on the selected stapler/device, via association with the surgical hub) Theuser interface 24244, via theuser interface 24254 in the surgical operating room, etc.) has security concerns. Under such aspects, the control circuit may also be configured to be capable of receiving an override command 24120 (eg, via auser interface 24214, 24224, and/or 24234 on the selected stapler/device, via a user associated with the surgical hub)interface 24244, via a user interface in the surgical operating room, etc. 24254) to allow surgery to continue. In one example, referring to FIG. 94, such a user interface may include a user interface element selectable to allow the procedure to continue, eg, 24251. In an alternative aspect, in response to the alert, the surgeon may correct the indicated safety issue (eg, replace the inappropriate staple cartridge with another), at which point the deviceselection safety process 24100 may be performed/implemented again.

与上文类似，根据另外的方面，系统限定的约束(例如，基于在态势感知的外科系统中访问的历史数据和/或规程数据)对于每个检测到的组织类型可以包括优选/理想夹持负载极限和/或优选/理想夹持负载极限范围。例如，与其相应的夹持负载极限相关联的每个钉仓可指示其可最佳地缝合的组织的类型。此处，继续该示例，如果所选择的缝合器/装置24102的接收到的装置参数包括其钉仓夹持负载极限，并且由组织识别过程24108识别的组织指示需要具有较高夹持负载极限的钉仓的组织类型，则所选择的缝合器/装置24102存在安全问题。利用不适当的钉仓可导致不太令人满意的结果和/或不期望的结果(例如，缝合失败、渗血、出血等)。在这种情况下，控制电路可被配置成能够警告外科医生24118(例如，参见图94，经由所选择的缝合器/装置上的用户界面24214、24224和/或24234，经由与外科集线器相关联的用户界面24244，经由外科手术室中的用户界面24254等)存在安全问题。在此类方面下，控制电路还可被配置成能够接收覆写命令24120(例如，经由所选择的缝合器/装置上的用户界面24214、24224和/或24234，经由与外科集线器相关联的用户界面24244，经由外科手术室中的用户界面24254等)以允许外科手术继续。在一个示例中，参见图94，此类用户界面可包括用户界面元素，该用户界面元素可选择以允许规程继续，例如24251。在另选的方面，响应于该警告，外科医生可校正所指出的安全问题(例如，用另一个钉仓替换不适当的钉仓)，此时可再次执行/实现装置选择安全过程24100。同样，本公开设想了接收到的装置参数(例如，钉仓的类型、钉仓的颜色、钉仓的附属物、钉仓的夹持负载极限、钉仓的间隙范围、钉仓的击发速率等)、和检测到的组织参数(例如，组织的类型、组织的厚度、组织的硬度、组织的位置、组织中的血管形成等)，以及所建立的系统限定的约束(例如，基于在态势感知的外科系统中访问的历史数据和/或规程数据与接收到的装置参数和/或检测到的组织参数相关联)的各种组合。Similar to above, according to further aspects, system-defined constraints (eg, based on historical data and/or protocol data accessed in a situationally aware surgical system) may include preferred/ideal grips for each detected tissue type Load limit and/or preferred/ideal clamp load limit range. For example, each staple cartridge associated with its respective clamping load limit can indicate the type of tissue it can best staple. Here, continuing the example, if the received device parameters of the selected stapler/device 24102 include its cartridge clamping load limit, and the tissue identified by thetissue identification process 24108 indicates that a device with a higher clamping load limit is required The tissue type of the staple cartridge, the selected stapler/device 24102 presents safety concerns. Utilizing an inappropriate staple cartridge can lead to less satisfactory and/or undesirable results (eg, suturing failure, oozing, bleeding, etc.). In this case, the control circuitry may be configured to alert the surgeon 24118 (eg, see FIG. 94 , viauser interfaces 24214, 24224, and/or 24234 on the selected stapler/device, via association with the surgical hub) Theuser interface 24244, via theuser interface 24254 in the surgical operating room, etc.) has security concerns. Under such aspects, the control circuit may also be configured to be capable of receiving an override command 24120 (eg, via auser interface 24214, 24224, and/or 24234 on the selected stapler/device, via a user associated with the surgical hub)interface 24244, viauser interface 24254 in the surgical theatre, etc.) to allow surgery to continue. In one example, referring to FIG. 94, such a user interface may include a user interface element selectable to allow the procedure to continue, eg, 24251. In an alternative aspect, in response to the alert, the surgeon may correct the indicated safety issue (eg, replace the inappropriate staple cartridge with another), at which point the deviceselection safety process 24100 may be performed/implemented again. Likewise, the present disclosure contemplates received device parameters (eg, type of cartridge, color of cartridge, appendage of the cartridge, clamp load limit of the cartridge, range of clearance of the cartridge, firing rate of the cartridge, etc. ), and detected tissue parameters (eg, type of tissue, thickness of tissue, stiffness of tissue, location of tissue, vascularization in tissue, etc.), and established system-defined constraints (eg, based on Various combinations of historical data and/or protocol data accessed in the surgical system associated with received device parameters and/or detected tissue parameters).

重新参见图93，如果确定所选择的缝合器/装置24116不存在安全问题，则执行/实现安全过程24100的控制电路可被配置成能够向外科医生提供建议24122。根据本公开的至少一个方面，如果另一个可用缝合器、另一个可用能量装置和/或另一个缝合器部件(例如，可用于与所选择的缝合器/装置一起使用的钉仓、轴等)24112更优化或更可选，则控制电路可被配置成能够警示外科医生(例如，参见图94，经由所选择的缝合器/装置上的用户界面24214、24224和/或24234，经由与外科集线器相关联的用户界面24244，经由外科手术室中的用户界面24254等)其可用性并推荐其在当前外科手术中的使用。在此类方面下，控制电路还可被配置成能够接收(例如，经由所选择的缝合器/装置上的用户界面24214、24224和/或24234，经由与外科集线器相关联的用户界面24244，经由外科手术室中的用户界面24254等)对该推荐的接受。在接受时，控制电路可被配置成能够呈现更优化的关于其他可用缝合器、其他可用能量装置和/或其他缝合器部件(例如，参见图94，部件A至部件N，例如，可用于与所选择的缝合器/装置一起使用的钉仓、轴等)24112的信息24124。在拒绝时，控制电路可被配置成能够结束24126装置选择安全算法和/或执行后续过程。Referring back to Figure 93, if it is determined that the selected stapler/device 24116 does not present a safety issue, the control circuitry that performs/implements thesafety process 24100 may be configured to provideadvice 24122 to the surgeon. In accordance with at least one aspect of the present disclosure, if another available stapler, another available energy device, and/or another stapler component (eg, a staple cartridge, shaft, etc., available for use with the selected stapler/device) 24112 More optimally or alternatively, the control circuit may be configured to alert the surgeon (eg, see FIG. The associateduser interface 24244, via theuser interface 24254 in the surgical operating room, etc.) its availability and recommends its use in current surgical procedures. Under such aspects, the control circuitry may also be configured to receive (eg, viauser interfaces 24214, 24224, and/or 24234 on the selected stapler/device, viauser interface 24244 associated with the surgical hub, viaUser interface 24254 in the surgical operating room, etc.) acceptance of the recommendation. Upon acceptance, the control circuit may be configured to be able to present a more optimized view of other available staplers, other available energy devices, and/or other stapler components (eg, see FIG. 94, components A through N, for example, may be used with Cartridge, shaft, etc.) 24112information 24124 for the stapler/device selected. Upon rejection, the control circuitry may be configured to end 24126 the device selection security algorithm and/or perform subsequent procedures.

根据各种其他方面，尽管相对于本文的缝合器/装置具体地讨论，但本公开不应限于此。更具体地讲，本发明所公开的方面类似地适用于其他外科器械，包括能量装置(例如，RF和/或超声外科器械)和/或其相应的部件和/或内窥镜式装置和/或其相应的部件。According to various other aspects, although discussed specifically with respect to staplers/devices herein, the present disclosure should not be so limited. More specifically, the disclosed aspects are similarly applicable to other surgical instruments, including energy devices (eg, RF and/or ultrasonic surgical instruments) and/or their corresponding components and/or endoscopic devices and/or or its corresponding parts.

实施例Example

在以下实施例中阐述了本文在标题“SAFETY SYSTEMS FOR SMART POWEREDSURGICAL STAPLING”下描述的主题的各个方面：Various aspects of the subject matter described herein under the heading "SAFETY SYSTEMS FOR SMART POWEREDSURGICAL STAPLING" are set forth in the following examples:

实施例1—一种外科系统，包括控制电路和外科器械。外科器械包括多个部件和传感器。外科器械的多个部件中的每个包括装置参数。每个部件被配置成能够将其相应的装置参数传输到控制电路。传感器被配置成能够检测与外科器械的所提议的功能相关联的组织参数并将该检测到的组织参数传输到控制电路。控制电路被配置成能够基于系统限定的约束与每个相应的装置参数协作来分析检测到的组织参数。外科系统还包括用户界面，该用户界面被配置成能够指示包括多个部件的外科器械是否适于执行所提议的功能。Embodiment 1—A surgical system including a control circuit and a surgical instrument. Surgical instruments include multiple components and sensors. Each of the plurality of components of the surgical instrument includes device parameters. Each component is configured to transmit its corresponding device parameter to the control circuit. The sensor is configured to detect tissue parameters associated with the proposed function of the surgical instrument and transmit the detected tissue parameters to the control circuit. The control circuitry is configured to be capable of analyzing the detected tissue parameters in cooperation with each respective device parameter based on system-defined constraints. The surgical system also includes a user interface configured to indicate whether the surgical instrument including the plurality of components is suitable for performing the proposed function.

实施例2—根据实施例1所述的外科系统，其中检测到的组织参数包括组织的类型、组织的厚度、组织的硬度、组织的位置或组织的血管形成中的至少一者。Embodiment 2—The surgical system ofEmbodiment 1, wherein the detected tissue parameter includes at least one of tissue type, tissue thickness, tissue stiffness, tissue location, or tissue vascularization.

实施例3—根据实施例1或2所述的外科系统，其中外科器械的部件包括钉仓，并且其中装置参数包括钉仓的类型，钉仓的颜色、钉仓的附属物、钉仓的夹持负载极限、钉仓的间隙范围以及钉仓的击发速率中的至少一者。Embodiment 3—The surgical system ofembodiment 1 or 2, wherein the component of the surgical instrument comprises a staple cartridge, and wherein the device parameter comprises the type of staple cartridge, the color of the staple cartridge, the appendages of the staple cartridge, the clips of the staple cartridge at least one of a holding load limit, a clearance range of the staple cartridge, and a firing rate of the staple cartridge.

实施例4—根据实施例1、2或3所述的外科系统，其中外科器械的部件包括端部执行器，并且其中检测到的组织参数包括以下中的至少一者：端部执行器在该组织上的闭合角度、与该端部执行器的组织接触表面接触的组织的长度以及将组织压缩在端部执行器内的力。Embodiment 4—The surgical system ofEmbodiment 1, 2, or 3, wherein the component of the surgical instrument includes an end effector, and wherein the detected tissue parameter includes at least one of the end effector in the The angle of closure on the tissue, the length of tissue in contact with the tissue-contacting surface of the end effector, and the force compressing the tissue within the end effector.

实施例5—根据实施例4所述的外科系统，其中控制电路还被配置成能够基于至少一个检测到的组织参数将组织识别为实质、血管或支气管。Embodiment 5—The surgical system ofEmbodiment 4, wherein the control circuit is further configured to identify the tissue as a parenchyma, a blood vessel, or a bronchi based on the at least one detected tissue parameter.

实施例6-根据实施例1、2、3、4或5所述的外科系统，其中控制电路还被配置成能够推荐与外科器械一起使用的至少一个另选部件以执行所提议的功能。Embodiment 6 - The surgical system ofEmbodiments 1, 2, 3, 4, or 5, wherein the control circuit is further configured to be able to recommend at least one alternative component for use with the surgical instrument to perform the proposed function.

实施例7—根据实施例1、2、3、4、5或6所述的外科系统，其中系统限定的约束包括与每个传输的装置参数相关联的预先确定的组织参数或预先确定的组织参数范围中的至少一者。Embodiment 7—The surgical system ofEmbodiments 1, 2, 3, 4, 5, or 6, wherein the system-defined constraints include predetermined tissue parameters or predetermined tissue associated with each transmitted device parameter At least one of the parameter ranges.

实施例8—根据实施例1、2、3、4、5、6或7所述的外科系统，其中控制电路还被配置成能够在超过系统限定的约束时防止所提议的功能。Embodiment 8—The surgical system ofEmbodiments 1, 2, 3, 4, 5, 6, or 7, wherein the control circuit is further configured to prevent the proposed function when system-defined constraints are exceeded.

实施例9—根据实施例8所述的外科系统，其中用户界面包括用户界面元素，该用户界面元素可选择以覆写控制电路，从而允许该外科器械的所提议的功能。Embodiment 9—The surgical system ofEmbodiment 8, wherein the user interface includes a user interface element selectable to override the control circuitry to allow the proposed functionality of the surgical instrument.

实施例10—根据实施例1、2、3、4、5、6、7、8或9所述的外科系统，其中外科器械的所提议的功能包括夹持组织、凝结组织、切割组织和缝合组织中的一者或多于一者。Embodiment 10—The surgical system ofEmbodiments 1, 2, 3, 4, 5, 6, 7, 8, or 9, wherein the proposed functions of the surgical instrument include gripping tissue, coagulating tissue, cutting tissue, and stapling one or more of the organizations.

实施例11—根据实施例1、2、3、4、5、6、7、8、9或10所述的外科系统，还包括通信地联接到外科器械的外科集线器，其中外科集线器包括控制电路。Embodiment 11—The surgical system ofEmbodiments 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10, further comprising a surgical hub communicatively coupled to the surgical instrument, wherein the surgical hub includes control circuitry .

实施例12—根据实施例11所述的外科系统，其中外科器械或外科集线器中的一者包括用户界面。Embodiment 12—The surgical system ofEmbodiment 11, wherein one of the surgical instrument or the surgical hub includes a user interface.

实施例13—一种外科系统，包括外科集线器和通信地联接到外科集线器的外科器械。外科器械包括多个部件和传感器。外科器械的多个部件中的每个包括装置参数。每个部件被配置成能够将其相应的装置参数传输到外科集线器。传感器被配置成能够检测与外科器械的所提议的功能相关联的组织参数并将该检测到的组织参数传输到外科集线器。外科集线器包括处理器和联接到处理器的存储器。存储器存储指令，所述指令可由处理器执行以基于系统限定的约束与每个相应的装置参数协作来分析检测到的组织参数。外科系统还包括用户界面，该用户界面被配置成能够指示包括多个部件的外科器械是否适于执行所提议的功能。Embodiment 13—A surgical system comprising a surgical hub and surgical instruments communicatively coupled to the surgical hub. Surgical instruments include multiple components and sensors. Each of the plurality of components of the surgical instrument includes device parameters. Each component is configured to transmit its corresponding device parameters to the surgical hub. The sensor is configured to detect tissue parameters associated with the proposed function of the surgical instrument and transmit the detected tissue parameters to the surgical hub. The surgical hub includes a processor and a memory coupled to the processor. The memory stores instructions executable by the processor to analyze the detected tissue parameters in cooperation with each respective device parameter based on system-defined constraints. The surgical system also includes a user interface configured to indicate whether the surgical instrument including the plurality of components is suitable for performing the proposed function.

实施例14—根据实施例13所述的外科系统，其中检测到的组织参数包括组织的类型、组织的厚度、组织的硬度、组织的位置或组织的血管形成中的至少一者。Embodiment 14—The surgical system ofEmbodiment 13, wherein the detected tissue parameter includes at least one of type of tissue, thickness of tissue, stiffness of tissue, location of tissue, or vascularization of tissue.

实施例15—根据实施例13或14所述的外科系统，其中外科器械的部件包括钉仓，并且其中装置参数包括钉仓的类型，钉仓的颜色、钉仓的附属物、钉仓的夹持负载极限、钉仓的间隙范围以及钉仓的击发速率中的至少一者。Embodiment 15—The surgical system ofembodiment 13 or 14, wherein the component of the surgical instrument comprises a staple cartridge, and wherein the device parameter comprises the type of staple cartridge, the color of the staple cartridge, the appendages of the staple cartridge, the clips of the staple cartridge at least one of a holding load limit, a clearance range of the staple cartridge, and a firing rate of the staple cartridge.

实施例16—根据实施例13、14或15所述的外科系统，其中外科器械的部件包括端部执行器，并且其中检测到的组织参数包括端部执行器在该组织上的闭合角度、与该端部执行器的组织接触表面接触的组织的长度以及将组织压缩在端部执行器内的力中的至少一者。Embodiment 16—The surgical system ofembodiment 13, 14, or 15, wherein the component of the surgical instrument includes an end effector, and wherein the detected tissue parameter includes an angle of closure of the end effector on the tissue, and At least one of a length of tissue that the tissue-contacting surface of the end effector contacts and a force compressing the tissue within the end effector.

实施例17—根据实施例13、14、15或16所述的外科系统，其中指令还可由外科集线器的处理器执行以推荐与外科器械一起使用的至少一个另选部件来执行所提议的功能。Embodiment 17—The surgical system ofEmbodiments 13, 14, 15, or 16, wherein the instructions are further executable by the processor of the surgical hub to recommend at least one alternative component for use with the surgical instrument to perform the proposed function.

实施例18—根据实施例13、14、15、16或17所述的外科系统，其中指令还可由外科集线器的处理器执行，以在超过系统限定的约束时防止所提议的功能。Embodiment 18—The surgical system ofEmbodiments 13, 14, 15, 16, or 17, wherein the instructions are further executable by the processor of the surgical hub to prevent the proposed function when system-defined constraints are exceeded.

实施例19—一种非暂态计算机可读介质，该非暂态计算机可读介质存储计算机可读指令，该计算机可读指令在被执行时致使机器基于系统限定的约束与外科系统的外科器械的多个部件中的每个的装置参数协作来分析检测到的组织参数，其中该检测到的组织参数与外科器械的所提议的功能相关联。外科系统包括外科器械，该外科器械包括多个部件。每个部件被配置成能够将其相应的装置参数传输到机器。该外科系统还包括传感器，该传感器被配置成能够检测该检测到的组织参数并将该检测到的组织参数传输到机器。指令在被执行时还致使机器生成用户界面，其中该用户界面提供包括多个部件的外科器械是否适于执行外科系统的所提议的功能的指示。Embodiment 19—A non-transitory computer-readable medium storing computer-readable instructions that, when executed, cause a machine to be based on system-defined constraints with a surgical instrument of a surgical system The device parameters of each of the plurality of components cooperate to analyze detected tissue parameters, wherein the detected tissue parameters are associated with the proposed function of the surgical instrument. A surgical system includes a surgical instrument that includes a plurality of components. Each component is configured to transmit its corresponding device parameters to the machine. The surgical system also includes a sensor configured to detect the detected tissue parameter and transmit the detected tissue parameter to the machine. The instructions, when executed, also cause the machine to generate a user interface, wherein the user interface provides an indication of whether the surgical instrument including the plurality of components is suitable for performing the proposed function of the surgical system.

实施例20—根据实施例19所述的非暂态计算机可读介质，这些指令在被执行时还致使机器在用户界面上生成覆写元素，其中该覆写元素可选择以允许外科器械的所提议的功能。Embodiment 20—The non-transitory computer-readable medium of Embodiment 19, the instructions, when executed, further cause the machine to generate an override element on the user interface, wherein the override element is selectable to allow all proposed feature.

根据感测到的闭合参数控制外科器械Control surgical instruments based on sensed closure parameters

测定组织完整性的压缩率Determining the compressibility of tissue integrity

在各个方面，外科器械可检测与外科器械的钳口的闭合相关联的多种不同变量或参数，这继而可用于调节或影响指示外科器械如何运行的各种操作参数。外科器械的钳口从打开位置转变到闭合位置以将组织夹持在其间的速率可被定义为夹持速率或闭合速率。在各个方面，闭合速率在钳口闭合实例的过程中可以是可变的或恒定的。与钳口的闭合相关联的特定参数比较的阈值可被定义为闭合阈值。In various aspects, the surgical instrument can detect a variety of different variables or parameters associated with the closure of the jaws of the surgical instrument, which in turn can be used to adjust or affect various operating parameters that dictate how the surgical instrument operates. The rate at which the jaws of a surgical instrument transition from an open position to a closed position to clamp tissue therebetween may be defined as the clamping rate or closing rate. In various aspects, the closing rate may be variable or constant over the course of the jaw closing instance. A threshold compared to a particular parameter associated with the closure of the jaws may be defined as a closure threshold.

以不适当的闭合速率或以不适当的闭合阈值夹持组织可导致对组织的损伤(例如，由于钳口向组织施加过大的力，组织可被撕裂)和/或外科器械的操作故障(例如，由于当钉被击发时组织未被钳口固定地保持，钉可变畸形)。因此，在一些方面，外科器械被配置成能够检测被外科器械夹持的组织的特性，并且对应地调节一个或多个闭合速率、一个或多个闭合阈值和其他操作参数。此外，每次外科手术可涉及多种不同的组织类型和/或具有不同特性的组织。因此，在一些方面，外科器械被配置成能够每当组织被夹持时动态地检测组织特性并且对应地调节一个或多个闭合速率、一个或多个闭合阈值和其他操作参数。Clamping tissue at an inappropriate closure rate or at an inappropriate closure threshold can result in damage to the tissue (eg, tissue can be torn due to excessive force applied to the tissue by the jaws) and/or malfunction of the surgical instrument (For example, staples can become deformed because tissue is not securely held by the jaws when the staples are fired). Accordingly, in some aspects, the surgical instrument is configured to detect properties of tissue gripped by the surgical instrument and adjust one or more closure rates, one or more closure thresholds, and other operating parameters accordingly. Furthermore, each surgical procedure may involve many different tissue types and/or tissues with different properties. Thus, in some aspects, the surgical instrument is configured to dynamically detect tissue properties and adjust one or more closure rates, one or more closure thresholds, and other operating parameters accordingly whenever tissue is gripped.

本公开提供了至少一种解决方案，其中外科器械被配置成能够检测与被端部执行器夹持的组织的压缩相关联的参数。外科器械还可被配置成能够根据检测到的组织压缩特性来区分表现出不同完整性的组织。然后可控制马达以影响钳口闭合速率和/或根据组织的完整性向用户提供反馈。例如，外科器械可被配置成能够在检测到的组织压缩特性指示组织为刚性的情况下降低钳口的闭合速率并且/或者在组织压缩特性指示组织具有低剪切强度的情况下向用户提供利用附属物增强的建议。The present disclosure provides at least one solution wherein the surgical instrument is configured to detect parameters associated with compression of tissue gripped by the end effector. The surgical instrument may also be configured to be able to differentiate between tissues exhibiting different integrity based on detected tissue compression properties. The motor can then be controlled to affect the jaw closure rate and/or provide feedback to the user based on the integrity of the tissue. For example, the surgical instrument may be configured to reduce the rate of closure of the jaws if the detected tissue compression characteristics indicate that the tissue is rigid and/or to provide a user with access if the tissue compression characteristics indicate that the tissue has low shear strength Suggestions for appendage enhancement.

图95示出了根据本公开的至少一个方面的外科器械21000的框图。在一个方面，外科器械21000包括联接到马达21006、用户界面21010和一个或多个传感器21004的控制电路21002。马达21006联接到端部执行器21008，使得马达21006使端部执行器21008的钳口(例如，图25所示的外科器械150010的砧座150306和/或通道150302)在第一或打开构型与第二或闭合构型之间转变，例如，如相对于图26所讨论的。一个或多个传感器21004能够可通信地联接到控制电路21002，使得控制电路21002从其接收数据和/或信号。控制电路21002能够可通信地联接到马达21006，使得控制电路21002根据例如从一个或多个传感器21004接收的数据和/或信号来控制马达21006的操作。用户界面21010包括被配置成能够向外科器械的用户提供反馈的设备，诸如显示器或扬声器。95 shows a block diagram of asurgical instrument 21000 in accordance with at least one aspect of the present disclosure. In one aspect,surgical instrument 21000 includescontrol circuitry 21002 coupled tomotor 21006 ,user interface 21010 , and one ormore sensors 21004 . Themotor 21006 is coupled to theend effector 21008 such that themotor 21006 causes the jaws of the end effector 21008 (eg, theanvil 150306 and/or thechannel 150302 of thesurgical instrument 150010 shown in FIG. 25 ) in the first or open configuration transitioning to and from the second or closed configuration, eg, as discussed with respect to FIG. 26 . One ormore sensors 21004 can be communicatively coupled to thecontrol circuit 21002 such that thecontrol circuit 21002 receives data and/or signals therefrom. Thecontrol circuit 21002 can be communicatively coupled to themotor 21006 such that thecontrol circuit 21002 controls the operation of themotor 21006 based on data and/or signals received from one ormore sensors 21004, for example.User interface 21010 includes a device, such as a display or speaker, that is configured to provide feedback to a user of the surgical instrument.

在各个方面，一个或多个传感器21004可被配置成能够检测夹持在端部执行器处的组织的压缩参数。在一个方面，一个或多个传感器21004可被配置成能够检测端部执行器21008的钳口的闭合力(FTC)，即，施加以使钳口从打开构型转变到闭合构型的力。例如，一个或多个传感器21004可包括被配置成能够检测由马达消耗的电流的马达电流传感器，诸如相对于图12、图18或图19所讨论的。对于DC马达，由马达消耗的电流对应于马达扭矩(例如，马达21006的输出轴的扭矩)，其表示端部执行器21008的FTC。端部执行器21008的FTC对应于被夹持组织的组织压缩，因为其表示当端部执行器21008在组织上闭合时从端部执行器21008传输到被夹持组织的力。施加到组织的力越大，组织被压缩的程度就越大。在另一方面，一个或多个传感器21004包括设置在端部执行器21008上的第一电极，该第一电极被配置成能够从对应的第二电极接收RF信号，诸如相对于图36至图38所讨论的。组织的电阻抗可对应于其组织厚度，这继而可对应于被夹持组织的组织压缩。在又一方面，一个或多个传感器21004包括力敏换能器，该力敏换能器被配置成能够确定施加到一个或多个传感器21004的力的大小，诸如参考图24所讨论的。与上面相对于FTC的讨论类似，换能器检测到的力表示当端部执行器21008在组织上闭合时从端部执行器21008传输到被夹持组织的力。施加到组织的力越大，组织被压缩的程度就越大。用户界面21010包括被配置成能够向外科器械的用户提供反馈的装置，诸如显示器或扬声器。在其他方面，一个或多个传感器21004可包括前述传感器和能够检测与夹持在端部执行器处的组织相关联的压缩参数的其他此类传感器的各种组合。例如，端部执行器(诸如图53所示的端部执行器15200)可包括第一传感器152008a(包括力敏换能器)和第二传感器152008b(包括阻抗传感器)。In various aspects, one ormore sensors 21004 can be configured to detect compression parameters of tissue clamped at the end effector. In one aspect, the one ormore sensors 21004 can be configured to detect the force to close (FTC) of the jaws of theend effector 21008, ie, the force applied to transition the jaws from an open configuration to a closed configuration. For example, the one ormore sensors 21004 may include a motor current sensor configured to detect current drawn by the motor, such as discussed with respect to FIG. 12 , FIG. 18 , or FIG. 19 . For a DC motor, the current drawn by the motor corresponds to the motor torque (eg, the torque of the output shaft of the motor 21006 ), which represents the FTC of theend effector 21008 . The FTC of theend effector 21008 corresponds to tissue compression of the clamped tissue because it represents the force transmitted from theend effector 21008 to the clamped tissue when theend effector 21008 is closed on the tissue. The greater the force applied to the tissue, the more the tissue is compressed. In another aspect, the one ormore sensors 21004 include a first electrode disposed on theend effector 21008 that is configured to receive RF signals from corresponding second electrodes, such as with respect to FIGS. 36-36 . 38 discussed. The electrical impedance of tissue may correspond to its tissue thickness, which in turn may correspond to tissue compression of the clamped tissue. In yet another aspect, the one ormore sensors 21004 includes a force-sensitive transducer configured to be able to determine the magnitude of a force applied to the one ormore sensors 21004, such as discussed with reference to FIG. 24 . Similar to the discussion above with respect to FTC, the force detected by the transducer represents the force transmitted from theend effector 21008 to the clamped tissue when theend effector 21008 is closed on the tissue. The greater the force applied to the tissue, the more the tissue is compressed.User interface 21010 includes a device configured to provide feedback to a user of the surgical instrument, such as a display or speaker. In other aspects, the one ormore sensors 21004 can include various combinations of the foregoing sensors and other such sensors capable of detecting compression parameters associated with tissue clamped at the end effector. For example, an end effector, such as end effector 15200 shown in Figure 53, can include afirst sensor 152008a (including a force sensitive transducer) and asecond sensor 152008b (including an impedance sensor).

控制电路21002可被配置成能够调节端部执行器21008的钳口的闭合速率以适应不同的组织类型。控制电路21002可被配置成能够监测在初始压缩时间段内施加在组织上的压缩力(例如，FTC)或与组织的压缩相关联的另一个参数(例如，组织阻抗)，并且基于组织压缩参数的变化率来相应地调节钳口闭合速率或时间。例如，针对更多粘弹性组织而言，降低闭合速率或增加闭合时间可能是有益的，而不是在短时间段内施加总压缩力，如上文相对于图22所讨论的。Thecontrol circuit 21002 can be configured to adjust the rate of closure of the jaws of theend effector 21008 to accommodate different tissue types. Thecontrol circuit 21002 can be configured to monitor the compressive force (eg, FTC) or another parameter associated with the compression of the tissue (eg, tissue impedance) exerted on the tissue during the initial compression period, and based on the tissue compression parameter rate of change to adjust the jaw closure rate or time accordingly. For example, for more viscoelastic tissue, it may be beneficial to decrease the closure rate or increase the closure time, rather than applying the total compressive force over a short period of time, as discussed above with respect to FIG. 22 .

图96示出了根据本公开的至少一个方面的用于根据被夹持组织的完整性来控制外科器械的过程21050的逻辑流程图。在过程21050的以下描述中，还应当参考图95。所示过程可由例如外科器械21000的控制电路21002执行。因此，执行该过程的控制电路21002从一个或多个传感器21004接收21052与由其感测的组织压缩参数有关的数据和/或信号(例如，数字或模拟)。在各个方面，组织压缩参数可包括与正在手术的组织的特性、类型、属性和/或状态相关联的参数；与外科器械21000的内部操作和/或属性相关联的参数；或者它们的组成部分。在一个方面，组织压缩参数可包括例如端部执行器21008的FTC。在另一方面，组织压缩参数可包括例如被夹持组织的厚度。控制电路21002可接收21052作为由一个或多个传感器21004传输的一个或多个离散值的与组织压缩参数有关的数据、由一个或多个传感器21004传输的然后可与一个或多个相关联的值相关的信号等。96 shows a logic flow diagram of aprocess 21050 for controlling a surgical instrument based on the integrity of the clamped tissue in accordance with at least one aspect of the present disclosure. In the following description ofprocess 21050, reference should also be made to FIG. 95 . The illustrated process may be performed bycontrol circuitry 21002 ofsurgical instrument 21000, for example. Thus, thecontrol circuit 21002 performing the process receives 21052 data and/or signals (eg, digital or analog) from one ormore sensors 21004 related to the tissue compression parameter sensed therefrom. In various aspects, tissue compression parameters may include parameters associated with properties, types, properties, and/or states of tissue being operated on; parameters associated with internal operations and/or properties ofsurgical instrument 21000; or components thereof . In one aspect, the tissue compression parameters can include, for example, the FTC of theend effector 21008. In another aspect, the tissue compression parameter may include, for example, the thickness of the clamped tissue. Thecontrol circuit 21002 may receive 21052 data related to tissue compression parameters as one or more discrete values transmitted by the one ormore sensors 21004, which may then be associated with one or more value-dependent signals, etc.

因此，控制电路21002确定感测到的组织压缩参数的值与一个或多个阈值相比如何，然后相应地生成响应。在一个方面，控制电路21002确定21054感测到的组织压缩参数的值与第一阈值的相对关系。例如，控制电路21002可确定21054感测到的组织压缩参数是否超过或大于第一或较高阈值。在一个方面，如果感测到的组织压缩参数超过第一阈值，则过程21050沿“是”分支继续，并且控制电路21002控制21056马达21006以增加闭合端部执行器21008的钳口所花费的时间长度。控制电路21002可通过例如以下方式来控制21056马达21006以增加钳口闭合时间：减小闭合钳口的速率，增加在初始夹持组织之后暂停钳口的运动的时间长度(即，组织蠕变等待时间)，或降低稳定阈值以结束夹持阶段。如果感测到的组织压缩参数未超过第一阈值，则过程21050沿“否”分支继续，并且在各个方面，过程21050可以结束或者过程21050可以继续，并且控制电路21002可将感测到的组织压缩的值与一个或多个附加阈值进行比较或者继续接收21052组织参数数据和/或信号。Accordingly, thecontrol circuit 21002 determines how the sensed value of the tissue compression parameter compares to one or more thresholds, and then generates a response accordingly. In one aspect, thecontrol circuit 21002 determines 21054 the value of the sensed tissue compression parameter relative to the first threshold. For example, thecontrol circuit 21002 can determine 21054 whether the tissue compression parameter sensed exceeds or is greater than a first or higher threshold. In one aspect, if the sensed tissue compression parameter exceeds the first threshold, theprocess 21050 continues along the "yes" branch and thecontrol circuit 21002controls 21056 themotor 21006 to increase the time it takes to close the jaws of theend effector 21008 length. Thecontrol circuit 21002 may control 21056 themotor 21006 to increase the jaw closure time by, for example, decreasing the rate at which the jaws are closed, increasing the length of time the jaw movement is paused after initially gripping the tissue (i.e., tissue creep waits) time), or lower the stabilization threshold to end the clamping phase. If the sensed tissue compression parameter does not exceed the first threshold,process 21050 continues along the "no" branch and, in various aspects,process 21050 can end orprocess 21050 can continue and controlcircuitry 21002 can convert the sensed tissue The compressed value is compared to one or more additional thresholds or continues to receive 21052 tissue parameter data and/or signals.

在另一方面，控制电路21002还确定21058感测到的组织压缩参数的值与第二阈值的相对关系。例如，控制电路21002可确定21058感测到的组织压缩参数是否低于或小于第二或较低阈值。在一个方面，如果感测到的组织参数低于第二阈值，则过程21050沿“是”分支继续，并且控制电路21002经由例如用户界面21010提供21060对应的反馈。所提供的21060反馈可包括例如经由显示器提供的视觉反馈或由扬声器提供的音频反馈。在一个方面，反馈可建议用户应采取一个或多个纠正措施来改善导致感测到的组织压缩参数出乎意料地低的情况。此类纠正措施包括例如利用附属物增强(即，组织厚度补偿件)，诸如在标题为“TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER”的美国专利申请No.8,657,176中所公开的，该专利申请据此以引用方式并入本文。在各个方面，附属物增强可包括可压缩材料的一层或一系列层，该层或一系列层被配置成能够适应捕集在砧座150306(图25)与钉仓150304(图25)之间的组织和/或向其施加附加的压缩力。In another aspect, thecontrol circuit 21002 also determines 21058 a relative relationship of the value of the sensed tissue compression parameter to a second threshold. For example,control circuitry 21002 may determine 21058 whether the sensed tissue compression parameter is below or below a second or lower threshold. In one aspect, if the sensed tissue parameter is below the second threshold, theprocess 21050 continues along the "yes" branch and thecontrol circuit 21002 provides 21060 corresponding feedback via, eg, theuser interface 21010. The feedback provided 21060 may include, for example, visual feedback provided via a display or audio feedback provided by a speaker. In one aspect, the feedback may suggest that the user should take one or more corrective actions to improve the situation that caused the sensed tissue compression parameter to be unexpectedly low. Such corrective measures include, for example, the use of appendage augmentation (ie, tissue thickness compensators) such as disclosed in US Patent Application No. 8,657,176, entitled "TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER," which is hereby referred to as Incorporated herein by reference. In various aspects, the appendage reinforcement can include a layer or series of layers of compressible material configured to accommodate entrapment between the anvil 150306 (FIG. 25) and the staple cartridge 150304 (FIG. 25) intervening tissue and/or apply additional compressive force thereto.

上面讨论的阈值可包括例如针对由一个或多个传感器21004感测的一个或多个参数的值和/或由一个或多个传感器21004感测的一个或多个参数的导数(例如，感测到的参数的时间速率变化)。在组织压缩参数包括端部执行器21008的FTC的方面，第一阈值可指示此类描绘：当高于第一阈值时，被夹持组织被认为是刚性的。由于钳口对组织的机械作用，或者对于肺组织，在再膨胀期间，刚性组织可相对容易撕裂。此外，第二阈值可指示此类描绘：当低于第二阈值时，被夹持组织被认为具有弱剪切强度(即，粘性的)。在切割构件(即，具有切割刃150182的I形梁150178)的缝合和/或击发期间，端部执行器21008可能相对难以牢固地抓持具有弱剪切强度的组织或以其他方式将其保持在适当的位置。The thresholds discussed above may include, for example, values for one or more parameters sensed by one ormore sensors 21004 and/or derivatives of one or more parameters sensed by one or more sensors 21004 (eg, sensed to the time rate of the parameter change). Where the tissue compression parameter includes the FTC of theend effector 21008, the first threshold may indicate such a delineation: above the first threshold, the clamped tissue is considered rigid. Rigid tissue may tear relatively easily during re-expansion due to the mechanical action of the jaws on the tissue, or for lung tissue. Furthermore, a second threshold may indicate such delineation: below the second threshold, the clamped tissue is considered to have weak shear strength (ie, viscous). During stapling and/or firing of the cutting member (ie, the I-beam 150178 with the cutting edge 150182), theend effector 21008 may be relatively difficult to firmly grasp or otherwise hold tissue with weak shear strength in the proper location.

应当指出的是，虽然图96中的过程21050的特定示例的步骤被描绘为以特定顺序或序列发生，但此类描绘仅用于说明目的并且过程21050的特定顺序并非是刻意的，除非从上文的描述中明确需要特定步骤的特定序列。例如，在过程21050的其他方面，控制电路21002可在确定21054感测到的组织压缩参数是否超过第一或较高阈值之前确定21058感测到的组织压缩参数是否低于第二或较低阈值。It should be noted that although the steps of the particular example ofprocess 21050 in FIG. 96 are depicted as occurring in a particular order or sequence, such depiction is for illustration purposes only and the particular order ofprocess 21050 is not intended, except from the above A specific sequence of specific steps is clearly required in the description herein. For example, in other aspects ofprocess 21050,control circuitry 21002 may determine 21058 whether the sensed tissue compression parameter is below a second or lower threshold before determining 21054 whether the sensed tissue compression parameter exceeds a first or higher threshold .

图97示出了根据本公开的至少一个方面的描绘了用于外科器械21000的示例性击发的端部执行器FTC 21104随时间21102变化的第一曲线图21100。在第一曲线图21100的以下描述中，还应当参考图95至图96。第一曲线图21100描绘了第一击发21110和第二击发21114，该第一击发和第二击发是由控制电路21002控制的外科器械21000进行的示例性击发，该控制电路执行上文相对于图96所述的过程21050。在该示例性示例中，第一阈值21106包括FTC的特定时间速率变化(即，ΔFTC)，并且第二阈值21108包括特定FTC。在各个方面，阈值21106、21108可以是固定的或预先确定的值，相对于一个或多个其他变量限定，或者由外科器械21000的用户编程或设定。97 shows afirst graph 21100 depicting an example firing of anend effector FTC 21104 for asurgical instrument 21000 overtime 21102 in accordance with at least one aspect of the present disclosure. In the following description of thefirst graph 21100, reference should also be made to FIGS. 95-96. Thefirst graph 21100 depicts afirst firing 21110 and asecond firing 21114, which are exemplary firings by thesurgical instrument 21000 controlled by acontrol circuit 21002 that performs the above with respect to Figs. 96.Procedure 21050. In this illustrative example,first threshold 21106 includes a specific time rate change in FTC (ie, ΔFTC), andsecond threshold 21108 includes a specific FTC. In various aspects,thresholds 21106 , 21108 may be fixed or predetermined values, defined relative to one or more other variables, or programmed or set by a user ofsurgical instrument 21000 .

对于第一击发21110，执行图96所示的过程的控制电路21002接收21052组织压缩参数数据和/或信号，并且确定21058在时间t₁处FTC降至第二阈值21108以下。因此，控制电路21002向用户提供21060反馈，包括建议用户采取某些措施和/或指示端部执行器21008正在抓持具有低剪切强度的组织。在一个方面，所提供的21060反馈可包括以下建议：建议用户松开端部执行器21008并利用施加到端部执行器21008以便增强和/或补偿低剪切强度组织的组织补偿件(例如，美国专利申请No.8,657,176中所述的组织补偿件)来重新击发外科器械21000。在一个方面，控制电路21002还可被配置成能够在FTC低于第二阈值的情况下使马达21006停止闭合端部执行器21008的钳口。在另一方面，控制电路21002可被配置成能够在FTC低于第二阈值的情况下提供让用户停止闭合端部执行器21008的钳口的建议。所提供的21060反馈可采取多种形式，包括例如在手术室显示器107、109、119(图2)和/或外科器械显示器上显示的提示、经由位于手术室中和/或外科器械上的扬声器发出的可听消息、经由外科器械的触觉反馈或它们的组合。For thefirst firing 21110, thecontrol circuit 21002 performing the process shown in FIG. 96 receives 21052 tissue compression parameter data and/or signals and determines 21058 that the FTC falls below thesecond threshold 21108 at time_t1 . Accordingly, thecontrol circuitry 21002 provides 21060 feedback to the user, including advising the user to take certain actions and/or indicating that theend effector 21008 is grasping tissue with low shear strength. In one aspect, the feedback provided 21060 can include a suggestion to recommend that the user loosen theend effector 21008 and utilize a tissue compensator applied to theend effector 21008 to enhance and/or compensate for low shear strength tissue (eg, The tissue compensator described in US Patent Application No. 8,657,176) to re-fire thesurgical instrument 21000. In one aspect, thecontrol circuit 21002 can also be configured to cause themotor 21006 to stop closing the jaws of theend effector 21008 if the FTC is below the second threshold. In another aspect, thecontrol circuit 21002 can be configured to provide a recommendation for the user to stop closing the jaws of theend effector 21008 if the FTC is below the second threshold. The provided 21060 feedback may take a variety of forms including, for example, prompts displayed on the operating room displays 107, 109, 119 (FIG. 2) and/or surgical instrument displays, via speakers located in the operating room and/or on the surgical instrument Audible messages issued, haptic feedback via surgical instruments, or a combination thereof.

对于第二击发21114(其可以是在第一击发21110之后利用组织补偿件进行的击发)，执行图96所示的过程21050的控制电路21002接收21052组织压缩参数数据和/或信号，并且在闭合端部执行器21008的过程中的任何点处不确定FTC降至第二阈值以下或超过第一阈值。因此，控制电路21002不影响钳口闭合速率、不向用户提供反馈并且不采取任何其他此类动作。For the second firing 21114 (which may be a firing with a tissue compensator after the first firing 21110), thecontrol circuit 21002 performing theprocess 21050 shown in FIG. 96 receives 21052 tissue compression parameter data and/or signals, and at closing At any point in the process of theend effector 21008 the indeterminate FTC falls below the second threshold or exceeds the first threshold. Thus, thecontrol circuit 21002 does not affect the jaw closure rate, provides no feedback to the user, and does not take any other such action.

图98示出了根据本公开的至少一个方面的描绘了用于外科器械21000的示例性击发的端部执行器FTC 21102随时间21104变化的第二曲线图21116。在第二曲线图21116的以下描述中，还应当参考图95至图96。第二曲线图21116描绘了第三击发21118，该第三击发是由控制电路21002控制的外科器械21000进行的示例性击发，该控制电路执行上文相对于图96所述的过程21050。在该示例性示例中，第一阈值21106包括FTC的特定时间速率变化(即，ΔFTC)。98 shows asecond graph 21116 depicting an example firing of theend effector FTC 21102 for asurgical instrument 21000 overtime 21104 in accordance with at least one aspect of the present disclosure. In the following description of thesecond graph 21116, reference should also be made to FIGS. 95-96. Thesecond graph 21116 depicts athird firing 21118, which is an exemplary firing by thesurgical instrument 21000 controlled by acontrol circuit 21002 that performs theprocess 21050 described above with respect to FIG. 96 . In this illustrative example,first threshold 21106 includes a specific time rate change in FTC (ie, ΔFTC).

对于第三击发21116，执行图96所示的过程的控制电路21002接收21052组织压缩参数数据和/或信号，并且确定21058在时间t₂处ΔFTC超过第一阈值21106。因此，控制电路21002控制21056马达21006以增加钳口闭合时间，诸如通过降低钳口闭合速率，这对应地降低了FTC 21102增加的速率。增加钳口闭合时间可有益于例如通过防止在短时间段内在组织上施加较大量的力来避免对刚性组织造成损伤。在一个方面，第一阈值21106可包括FTC的默认变化速率(ΔFTC_D)，即，外科器械21000的默认或基线FTC速率，而无需通过根据组织类型和其他此类参数的控制算法对FTC进行任何修改。在该方面，如果外科器械21000在外科手术期间经历的FTC超过FTC_D，则执行过程21050的控制电路21002可控制21056马达21006以增加钳口闭合时间。For thethird firing 21116, thecontrol circuit 21002 performing the process shown in FIG. 96 receives 21052 tissue compression parameter data and/or signals and determines 21058 that ΔFTC exceeds thefirst threshold 21106 at time_t2 . Accordingly, thecontrol circuit 21002controls 21056 themotor 21006 to increase the jaw closing time, such as by reducing the jaw closing rate, which correspondingly reduces the rate at which theFTC 21102 increases. Increasing the jaw closure time may be beneficial, for example, to avoid damage to rigid tissue by preventing large amounts of force on the tissue for a short period of time. In one aspect, thefirst threshold 21106 can include a default rate of change of FTC (ΔFTC_D ), ie, the default or baseline FTC rate of thesurgical instrument 21000 without any need for any modification of the FTC by a control algorithm based on tissue type and other such parameters Revise. In this regard, if the FTC experienced by thesurgical instrument 21000 during the surgical procedure exceeds the FTC_D , thecontrol circuit 21002 performing theprocess 21050 may control 21056 themotor 21006 to increase the jaw closure time.

执行前述算法或过程的控制电路21002确定将由一个或多个传感器21004感测的参数与一个或多个阈值进行比较的时间可包括外科器械21000的击发行程期间的离散实例、击发行程期间的一系列离散实例和/或击发行程期间的连续时间间隔。由控制电路21002监测并与阈值进行比较的组织压缩参数可包括例如FTC值(例如，图97所示的第二阈值21108)或ΔFTC值(例如，图97至图98所示的第一阈值21106)。The time at which thecontrol circuit 21002 executing the aforementioned algorithm or process determines to compare the parameter sensed by the one ormore sensors 21004 to one or more thresholds may include discrete instances during the firing stroke of thesurgical instrument 21000, a series during the firing stroke Discrete instances and/or continuous time intervals during a firing stroke. Tissue compression parameters monitored bycontrol circuitry 21002 and compared to thresholds may include, for example, FTC values (eg,second threshold 21108 shown in FIG. 97 ) or ΔFTC values (eg,first threshold 21106 shown in FIGS. 97-98 ) ).

在一个方面，控制电路21002还可被配置成能够存储与外科器械21000的击发相关的数据，然后任选地利用来自先前击发的数据来调节用于确定被夹持组织的组织完整性的算法。例如，来自先前击发的数据可用于调节图96所示的过程21050的第一阈值和/或第二阈值。在一个方面，外科器械21000可被配置成能够与执行态势感知系统的外科集线器106(图1至图3)配对，如上文在标题“态势感知”下所述并且如在2018年3月29日提交的标题为“SURGICAL HUB SITUATIONAL AWARENESS”的美国专利申请No.15/940,654中所述，该专利申请据此全文以引用方式并入本文。在该方面，态势感知系统可确定在外科手术期间正在手术的组织的类型，并且相应地调节用于确定被夹持组织的组织完整性的算法。在另一方面，外科器械21000可被配置成能够接收指示正在手术的组织的类型的用户输入，并且相应地调节用于确定组织完整性的算法。例如，外科器械21000可被配置成能够根据用户输入的组织类型而从默认值调节图96所示的过程21050的第一阈值和/或第二阈值。In one aspect, thecontrol circuit 21002 may also be configured to be capable of storing data related to firing of thesurgical instrument 21000, and then optionally using data from previous firings to adjust an algorithm for determining the tissue integrity of the clamped tissue. For example, data from previous firings may be used to adjust the first threshold and/or the second threshold ofprocess 21050 shown in FIG. 96 . In one aspect,surgical instrument 21000 can be configured to be paired with surgical hub 106 (FIGS. 1-3) implementing a situational awareness system, as described above under the heading "Situational Awareness" and as on March 29, 2018 Filed in US Patent Application No. 15/940,654 entitled "SURGICAL HUB SITUATIONAL AWARENESS," which is hereby incorporated by reference in its entirety. In this aspect, the situational awareness system can determine the type of tissue being operated on during the surgical procedure and adjust the algorithm used to determine the tissue integrity of the clamped tissue accordingly. In another aspect,surgical instrument 21000 can be configured to receive user input indicative of the type of tissue being operated on, and adjust algorithms for determining tissue integrity accordingly. For example, thesurgical instrument 21000 may be configured to be able to adjust the first threshold and/or the second threshold of theprocess 21050 shown in FIG. 96 from default values based on the tissue type entered by the user.

上文所述的技术允许外科器械21000避免损伤被夹持组织并且防止由钳口闭合速率引起的操作故障(例如，畸形钉)，所述操作故障对于正在手术的组织的特定特性是不适当的或不理想的。此外，上文所述的技术改善了外科器械对外科手术的过程期间遇到的组织的特性作出适当响应的能力。The techniques described above allow thesurgical instrument 21000 to avoid damage to the clamped tissue and prevent operational failures (eg, malformed pins) caused by the rate of jaw closure that are inappropriate for the specific characteristics of the tissue being operated on or not ideal. In addition, the techniques described above improve the ability of surgical instruments to respond appropriately to properties of tissue encountered during the course of a surgical procedure.

组织初始接触以确定组织类型Tissue initial contact to determine tissue type

以不适当的闭合速率或以不适当的闭合阈值夹持组织可导致对组织的损伤(例如，由于钳口向组织施加过大的力，组织可被撕裂)和/或外科器械的操作故障(例如，由于当钉被击发时组织未被钳口固定地保持，钉可变畸形)。因此，在一些方面，外科器械被配置成能够检测被外科器械夹持的组织的特性，并且对应地调节一个或多个闭合速率、一个或多个闭合阈值和其他操作参数。此外，每次外科手术可涉及多种不同的组织类型和/或具有不同特性的组织。因此，在一些方面，外科器械被配置成能够每当组织被夹持时动态地检测组织特性并且对应地调节一个或多个闭合速率、一个或多个闭合阈值和其他操作参数。Clamping tissue at an inappropriate closure rate or at an inappropriate closure threshold can result in damage to the tissue (eg, tissue can be torn due to excessive force applied to the tissue by the jaws) and/or malfunction of the surgical instrument (For example, staples can become deformed because tissue is not securely held by the jaws when the staples are fired). Accordingly, in some aspects, the surgical instrument is configured to detect properties of tissue gripped by the surgical instrument and adjust one or more closure rates, one or more closure thresholds, and other operating parameters accordingly. Furthermore, each surgical procedure may involve many different tissue types and/or tissues with different properties. Thus, in some aspects, the surgical instrument is configured to dynamically detect tissue properties and adjust one or more closure rates, one or more closure thresholds, and other operating parameters accordingly whenever tissue is gripped.

本公开提供了至少一种解决方案，其中外科器械被配置成能够根据抵靠钳口表面的组织接触程度和在与组织的初始接触点处钳口的相对位置来表征被夹持的组织的组织类型。然后，可将钳口的闭合速率和用于调节钳口闭合速率的阈值设定为由检测到的组织接触程度和检测到的钳口位置表征的组织类型的适当水平。例如，外科器械可被配置成能够区分实质和血管，因为与血管相比，在初始接触点处实质与钳口表面的接触程度更大并以更大的角度接触钳口。然后，外科器械可控制马达以影响钳口闭合速率，并相应地影响检测到的组织类型的调节阈值。The present disclosure provides at least one solution in which the surgical instrument is configured to characterize the tissue of the clamped tissue based on the degree of tissue contact against the jaw surface and the relative position of the jaws at the point of initial contact with the tissue type. The rate of jaw closure and the threshold for adjusting the rate of jaw closure can then be set to appropriate levels for the type of tissue characterized by the detected degree of tissue contact and the detected jaw position. For example, a surgical instrument may be configured to distinguish between parenchyma and blood vessels because the parenchyma is in greater contact with the jaw surface and at a greater angle than the vessel at the initial contact point. The surgical instrument can then control the motor to affect the jaw closure rate and, accordingly, the adjustment threshold for the detected tissue type.

重新参见图95，在一个方面，外科器械21000包括联接到马达21006、用户界面21010和一个或多个传感器21004的控制电路21002。马达21006联接到端部执行器21008，使得马达21006使端部执行器21008的钳口(例如，图25所示的外科器械150010的砧座150306和/或通道150302)在第一或打开构型与第二或闭合构型之间转变，如相对于图26所讨论的。一个或多个传感器21004能够可通信地联接到控制电路21002，使得控制电路21002从其接收数据和/或信号。控制电路21002能够可通信地联接到马达21006，使得控制电路21002根据例如从一个或多个传感器21004接收的数据和/或信号来控制马达21006的操作。Referring back to FIG. 95 , in one aspect, asurgical instrument 21000 includes acontrol circuit 21002 coupled to amotor 21006 , auser interface 21010 , and one ormore sensors 21004 . Themotor 21006 is coupled to theend effector 21008 such that themotor 21006 causes the jaws of the end effector 21008 (eg, theanvil 150306 and/or thechannel 150302 of thesurgical instrument 150010 shown in FIG. 25 ) in the first or open configuration and the second or closed configuration, as discussed with respect to FIG. 26 . One ormore sensors 21004 can be communicatively coupled to thecontrol circuit 21002 such that thecontrol circuit 21002 receives data and/or signals therefrom. Thecontrol circuit 21002 can be communicatively coupled to themotor 21006 such that thecontrol circuit 21002 controls the operation of themotor 21006 based on data and/or signals received from one ormore sensors 21004, for example.

在各个方面，一个或多个传感器21004可被配置成能够检测组织抵靠端部执行器21008的钳口表面的物理接触。在一个方面，一个或多个传感器21004可包括沿着端部执行器21008的组织接触表面(诸如砧座和仓或通道)设置的一个或多个组织接触传感器。组织接触传感器可包括例如沿着钳口的表面顺序地布置的分段电路的多个传感器或段，每个传感器或段被配置成能够确定组织是否抵靠钳口定位，如上文参考图75至图79所讨论的。在一个方面，一个或多个传感器21004包括多个电极，每个电极被配置成能够从设置在相对钳口上的对应电极接收RF信号，诸如参考图36至图38所讨论的。因此，控制电路21002可沿端部执行器21008的长度执行连续性测试，以确定组织存在于与每个电极对应的位置处，每个电极均能够从其对应的电极接收信号(因为信号传输介质(即，组织)必须位于两个电极之间，以使电极从其对应的电极接收信号)。在另一方面，一个或多个传感器21004包括多个力敏换能器，每个力敏换能器被配置成能够确定施加到一个或多个传感器21004的力的量，诸如参考图24所讨论的。因此，控制电路21002可确定组织存在于与检测抵靠其的非零力的每个力敏换能器对应的位置处。在其他方面，一个或多个传感器21004包括多个负荷传感器、压力传感器和/或被配置成能够检测抵靠其的物理接触的其他传感器。类似于上文相对于力敏换能器的讨论，控制电路21002可确定组织存在于与每个负荷传感器、压力传感器和/或检测抵靠其的非零力的其他传感器对应的位置处。在又一方面，一个或多个传感器21004包括电流传感器，该电流传感器被配置成能够检测由马达21006消耗的电流量，诸如参考图12、图18或图19所讨论的。因此，控制电路21002可根据由马达21006消耗的电流何时增加来确定端部执行器21008的钳口初始接触组织的点，以补偿当钳口接触组织并开始抵靠其施加夹持力时马达21006所经历的增加的夹持负载，诸如相对于图83所讨论的(即，FTC随着钳口夹持组织而增加153610、153616，并且FTC对应于马达电流)。上文所述的各个方面可单独使用或与其他方面结合使用，以用于确定端部执行器21008与正被夹持的组织之间的初始接触点和/或组织与端部执行器21008之间的接触程度。In various aspects, the one ormore sensors 21004 can be configured to detect physical contact of tissue against the jaw surfaces of theend effector 21008. In one aspect, the one ormore sensors 21004 can include one or more tissue-contacting sensors disposed along a tissue-contacting surface of theend effector 21008, such as the anvil and cartridge or channel. The tissue contact sensor may comprise, for example, a plurality of sensors or segments of segmented circuitry arranged sequentially along the surface of the jaws, each sensor or segment being configured to be able to determine whether tissue is positioned against the jaws, as described above with reference to FIGS. discussed in Figure 79. In one aspect, the one ormore sensors 21004 include a plurality of electrodes, each electrode configured to receive RF signals from corresponding electrodes disposed on opposing jaws, such as discussed with reference to FIGS. 36-38 . Accordingly, thecontrol circuit 21002 can perform a continuity test along the length of theend effector 21008 to determine that tissue is present at the location corresponding to each electrode, each of which is capable of receiving a signal from its corresponding electrode (due to the signal transmission medium (ie, tissue) must be located between the two electrodes for the electrodes to receive signals from their corresponding electrodes). In another aspect, the one ormore sensors 21004 includes a plurality of force-sensitive transducers, each force-sensitive transducer configured to be able to determine an amount of force applied to the one ormore sensors 21004, such as described with reference to FIG. 24 . discussed. Accordingly, thecontrol circuit 21002 can determine that tissue is present at a location corresponding to each force-sensitive transducer that detects a non-zero force against it. In other aspects, the one ormore sensors 21004 include a plurality of load sensors, pressure sensors, and/or other sensors configured to detect physical contact against it. Similar to the discussion above with respect to force-sensitive transducers, thecontrol circuit 21002 can determine that tissue is present at a location corresponding to each load sensor, pressure sensor, and/or other sensor that detects a non-zero force against it. In yet another aspect, the one ormore sensors 21004 include a current sensor configured to detect the amount of current drawn by themotor 21006 , such as discussed with reference to FIG. 12 , FIG. 18 , or FIG. 19 . Accordingly, thecontrol circuit 21002 can determine the point at which the jaws of theend effector 21008 initially contact tissue based on when the current drawn by themotor 21006 increases to compensate for when the jaws contact tissue and begin to apply a clamping force against themotor 21006 experienced an increased gripping load, such as discussed with respect to FIG. 83 (ie, FTC increases 153610, 153616 as the jaws grip tissue, and FTC corresponds to motor current). The various aspects described above may be used alone or in combination with other aspects for determining the initial point of contact between theend effector 21008 and the tissue being clamped and/or between the tissue and theend effector 21008. the degree of contact between them.

图99示出了根据本公开的至少一个方面的用于根据被夹持的组织的生理类型控制外科器械的过程21200的逻辑流程图。在过程21200的以下描述中，还应当参考图95。所示过程可由例如外科器械21000的控制电路21002执行。因此，执行所示过程21200的控制电路21002从一个或多个传感器21004(诸如上文所讨论和图100A至图101B所示的组织接触传感器)接收21202组织接触数据和/或信号。所接收21202的组织接触数据和/或信号指示组织是否正在接触传感器21004中的至少一个。因此，控制电路21002可确定21204端部执行器21008与正被夹持的组织之间的初始接触点。在一个方面，控制电路21002通过检测设置在钳口中的每个上的传感器21004中的至少一个何时检测到抵靠其的组织接触来确定21204何时发生初始组织接触。99 illustrates a logic flow diagram of aprocess 21200 for controlling a surgical instrument according to the physiological type of tissue being clamped, in accordance with at least one aspect of the present disclosure. In the following description ofprocess 21200, reference should also be made to FIG. 95 . The illustrated process may be performed bycontrol circuitry 21002 ofsurgical instrument 21000, for example. Accordingly,control circuitry 21002 performing the illustratedprocess 21200 receives 21202 tissue contact data and/or signals from one ormore sensors 21004, such as the tissue contact sensors discussed above and shown in Figures 100A-101B. The tissue contact data and/or signals received 21202 indicate whether tissue is contacting at least one of thesensors 21004. Accordingly, thecontrol circuit 21002 can determine 21204 the initial point of contact between theend effector 21008 and the tissue being clamped. In one aspect, thecontrol circuit 21002 determines 21204 when initial tissue contact occurs by detecting when at least one of thesensors 21004 disposed on each of the jaws detects tissue contact against it.

因此，控制电路21002确定21206钳口在初始组织接触点处的位置。在一个方面，控制电路21002可通信地联接到设置在端部执行器21008的钳口中的一个上的霍尔效应传感器，该霍尔效应传感器被配置成能够检测设置在相对钳口上的对应磁性元件的相对位置，诸如参考图77所讨论的。因此，控制电路21002可根据感测到的钳口之间的距离或间隙来确定21206钳口的位置。在另一方面，控制电路2100可通信地联接到位置传感器，该位置传感器被配置成能够检测闭合管的绝对或相对位置，该闭合管被配置成能够当闭合管被从第一或近侧位置被驱动到第二或远侧位置时闭合钳口，诸如参考图20至图21和图25所讨论的。因此，控制电路21002可根据感测到的闭合管的位置确定21206钳口的位置。在又一方面，控制电路21002可通信地联接到角度传感器，诸如来自Infineon Technologies的TLE5012B360°角度传感器，该角度传感器被配置成能够检测钳口中的至少一个被取向的角度。因此，控制电路21002可根据感测到的钳口被取向的角度确定21206钳口位置。Accordingly, thecontrol circuit 21002 determines 21206 the position of the jaws at the initial tissue contact point. In one aspect, thecontrol circuit 21002 is communicatively coupled to a Hall effect sensor disposed on one of the jaws of theend effector 21008, the Hall effect sensor configured to detect a corresponding magnetic element disposed on the opposite jaw , such as discussed with reference to FIG. 77 . Thus, thecontrol circuit 21002 can determine 21206 the position of the jaws based on the sensed distance or gap between the jaws. In another aspect, the control circuit 2100 is communicatively coupled to a position sensor configured to detect an absolute or relative position of the closure tube, the closure tube being configured to detect when the closure tube is moved from the first or proximal position The jaws are closed when driven to the second or distal position, such as discussed with reference to FIGS. 20-21 and 25 . Accordingly, thecontrol circuit 21002 can determine 21206 the position of the jaws based on the sensed position of the closed tube. In yet another aspect, thecontrol circuit 21002 is communicatively coupled to an angle sensor, such as a TLE5012B 360° angle sensor from Infineon Technologies, the angle sensor being configured to detect the angle at which at least one of the jaws is oriented. Accordingly, thecontrol circuit 21002 can determine 21206 the jaw position based on the sensed angle at which the jaws are oriented.

因此，控制电路21002确定21208所抓持的组织与钳口的一个或多个组织接触表面之间的接触程度。组织接触的程度可对应于已检测到组织的存在(或不存在)的传感器21004的数量或比率，诸如参考图79所讨论的。在一个方面，控制电路21002可根据已检测到组织的存在的一个或多个传感器21004与未检测到组织的存在的一个或多个传感器21004的比率来确定组织接触的程度。Accordingly, thecontrol circuit 21002 determines the degree of contact between the tissue grasped by 21208 and the one or more tissue-contacting surfaces of the jaws. The degree of tissue contact may correspond to the number or ratio ofsensors 21004 that have detected the presence (or absence) of tissue, such as discussed with reference to FIG. 79 . In one aspect,control circuitry 21002 can determine the degree of tissue contact based on a ratio of one ormore sensors 21004 that have detected the presence of tissue to one ormore sensors 21004 that have not detected the presence of tissue.

因此，控制电路21002根据确定21206的钳口位置和确定21208的组织接触的程度为马达21006设定21210控制参数。马达控制参数可包括例如闭合钳口的时间和/或一个或多个闭合阈值。在一个方面，控制电路21002可被配置成能够执行运行时计算和/或访问存储器(例如，查找表)以检索与钳口的特定位置和经由各种传感器感测的特定组织接触程度相关联的马达控制参数(例如，钳口闭合速率和闭合阈值)。在各个方面，控制电路21002可控制马达21006以通过例如调节钳口从打开位置转变到闭合位置的速率、调节钳口在组织的初始夹持之后暂停的时间长度(即，组织蠕变等待时间)和/或调节结束夹持阶段的稳定阈值来调节钳口闭合时间。在各个方面，一个或多个闭合阈值可包括例如端部执行器21008的最大允许FTC或控制电路21002停止驱动钳口闭合的马达21006或采取其他动作的FTC的变化率(即，ΔFTC)，如上面在标题“确定组织完整性的压缩率”下所讨论的。然后，控制电路21002可通过过程21200根据马达控制参数集21210控制马达21206。Accordingly, thecontrol circuit 21002sets 21210 control parameters for themotor 21006 based on determining 21206 the jaw position and determining 21208 the degree of tissue contact. Motor control parameters may include, for example, time to close the jaws and/or one or more closure thresholds. In one aspect, thecontrol circuit 21002 can be configured to be capable of performing runtime calculations and/or accessing memory (eg, a look-up table) to retrieve data associated with a particular position of the jaws and a particular degree of tissue contact sensed via various sensors Motor control parameters (eg, jaw closure rate and closure threshold). In various aspects, thecontrol circuit 21002 can control themotor 21006 to adjust the length of time that the jaws pause after initial gripping of tissue (ie, tissue creep latency) by, for example, adjusting the rate at which the jaws transition from the open position to the closed position And/or adjust the stability threshold for the end of the clamping phase to adjust the jaw closing time. In various aspects, the one or more closure thresholds may include, for example, the maximum allowable FTC of theend effector 21008 or the rate of change (ie, ΔFTC) of the FTC at which thecontrol circuit 21002 stops driving themotor 21006 for jaw closure or takes other action, such as Discussed above under the heading "Determining Compression Ratio for Tissue Integrity". Thecontrol circuit 21002 can then control themotor 21206 according to the motor control parameter set 21210 through theprocess 21200 .

钳口的位置以及在与组织的初始接触点处与组织的接触程度对应于被抓持的组织的厚度或几何形状，这继而对应于组织的生理类型。因此，控制电路21002可被配置成能够区分组织类型，然后相应地设定21210马达21006的控制参数。例如，控制电路21002可被配置成能够确定实质或血管组织是否已被端部执行器21008抓持，然后设定21210适于所检测的组织类型的马达控制参数。The position of the jaws and the degree of contact with the tissue at the point of initial contact with the tissue corresponds to the thickness or geometry of the grasped tissue, which in turn corresponds to the physiological type of tissue. Accordingly, thecontrol circuit 21002 can be configured to be able to differentiate tissue types and then set 21210 the control parameters of themotor 21006 accordingly. For example, thecontrol circuit 21002 can be configured to be able to determine whether parenchymal or vascular tissue has been grasped by theend effector 21008, and then set 21210 motor control parameters appropriate to the type of tissue detected.

在一些方面，可为每种组织类型选择钳口闭合速率以将最大FTC和/或ΔFTC保持在特定闭合阈值之下，同样可为每种组织类型选择该阈值。在一个方面，控制电路21002可被配置成能够设置最小夹持速率，使得钳口的闭合运动从不永久停止。在一个方面，控制电路21002可被配置成能够控制最大暂停时间以确保钳口闭合至少以默认速率进行。在一个方面，控制电路21002可被配置成能够在外科器械21000的使用期间超过闭合阈值或将其以其他方式搁置时，停止马达21006和/或向用户提供反馈。In some aspects, the jaw closure rate may be selected for each tissue type to maintain the maximum FTC and/or ΔFTC below a particular closure threshold, which may likewise be selected for each tissue type. In one aspect, thecontrol circuit 21002 can be configured to be able to set a minimum clamping rate such that the closing motion of the jaws never ceases permanently. In one aspect, thecontrol circuit 21002 can be configured to be able to control the maximum pause time to ensure that jaw closure occurs at least at a default rate. In one aspect, thecontrol circuit 21002 can be configured to stop themotor 21006 and/or provide feedback to the user when thesurgical instrument 21000 exceeds a closure threshold or is otherwise parked during use.

应当指出的是，虽然图99中的过程21200的特定示例的步骤被描绘为以特定顺序或序列发生，但此类描绘仅用于说明目的并且过程21200的特定顺序并非是刻意的，除非从上文的描述中明确需要特定步骤的特定序列。例如，在过程21200的其他方面，控制电路21002可在确定21206初始接触点处的钳口位置之前确定21208组织接触的程度。It should be noted that although the steps of the particular example ofprocess 21200 in FIG. 99 are depicted as occurring in a particular order or sequence, such depiction is for illustration purposes only and the particular order ofprocess 21200 is not intended, except from the above A specific sequence of specific steps is clearly required in the description herein. For example, in other aspects of theprocess 21200, thecontrol circuit 21002 may determine 21208 the degree of tissue contact prior to determining 21206 the jaw position at the initial contact point.

图100A至图101B示出了根据本公开的至少一个方面的在与组织的初始接触位置和闭合位置两者处抓持实质21030和血管21032的端部执行器21008的各种侧正视图。在所描绘的方面，端部执行器21008包括沿着钳口的组织接触表面设置的多个组织接触传感器21016，这些组织接触表面包括砧座21012和通道21014。在其他方面，除了沿着外科器械21000的通道21014设置之外或代替沿着该通道设置，组织接触传感器21016可沿着仓150304(图25)设置。为简明起见，在以下描述中，组织接触传感器21016将被讨论为沿着通道21014设置；然而，应当指出的是，本文所讨论的概念同样适用于组织接触传感器21016沿着仓150304设置的方面。如上所述，组织接触传感器21016可包括例如阻抗传感器、负荷传感器、力敏换能器以及它们的组合。在外科手术中使用外科器械21000期间，组织接触传感器21016可被描绘成激活的传感器21018(即，感测组织存在的传感器)和未激活的传感器21020(即，不感测组织存在的传感器)。100A-101B illustrate various side elevational views of anend effector 21008 grasping aparenchyma 21030 and ablood vessel 21032 at both an initial contact position with tissue and a closed position in accordance with at least one aspect of the present disclosure. In the depicted aspect, theend effector 21008 includes a plurality oftissue contact sensors 21016 disposed along the tissue contacting surfaces of the jaws, including theanvil 21012 and thechannel 21014. In other aspects,tissue contact sensors 21016 may be positioned along cartridge 150304 (FIG. 25) in addition to or instead of being positioned alongchannel 21014 ofsurgical instrument 21000. For simplicity, in the following description, thetissue contact sensor 21016 will be discussed as being positioned along thechannel 21014; however, it should be noted that the concepts discussed herein apply equally to aspects where thetissue contact sensor 21016 is positioned along thecartridge 150304. As noted above,tissue contact sensors 21016 may include, for example, impedance sensors, load cells, force-sensitive transducers, and combinations thereof. During use of thesurgical instrument 21000 in a surgical procedure, thetissue contact sensor 21016 may be depicted as an activated sensor 21018 (ie, a sensor that senses the presence of tissue) and an inactive sensor 21020 (ie, a sensor that does not sense the presence of tissue).

图100A和图101A分别示出了端部执行器21008与实质21030和血管21032的初始接触点。在一个方面，端部执行器21008和组织之间的初始接触点可被定义为在砧座21012和通道21014两者上存在至少一个激活传感器21018的点。如上所述，可根据钳口(即，砧座21012和/或通道21014)的位置以及在与组织的初始接触点处组织与钳口之间的接触程度来区分组织类型。例如，图100A和图101A示出了可如何基于在初始组织接触点处激活的传感器21018的比例来区分实质21030和血管21032。即，相对于夹持实质21030，夹持血管21032导致更少的激活传感器21018。还应当指出的是，砧座21012和通道21014上的激活的组织传感器21018的数量不需要在初始组织接触点处相等。作为另一个示例，图100A和图101A示出了可如何基于砧座21012在初始组织接触点处相对于通道21014被取向的角度来区分实质21030和血管21032。即，砧座21012在与实质21030的初始接触点处以第一角度θ₁取向，并且在与血管21032的初始接触点处以第二角度θ₂取向。激活的传感器21018的比例和砧座21012被取向的角度之间的差异可单独使用或组合使用(例如，通过图99所示的过程21200)，以表征正被夹持的组织的生理类型，然后为该组织类型设定适当的钳口闭合速率、闭合阈值和其他马达控制参数。Figures 100A and 101A illustrate the initial point of contact ofend effector 21008 withparenchyma 21030 andblood vessel 21032, respectively. In one aspect, the initial point of contact between theend effector 21008 and tissue can be defined as the point at which there is at least oneactivation sensor 21018 on both theanvil 21012 and thechannel 21014. As discussed above, tissue types can be differentiated based on the location of the jaws (ie,anvil 21012 and/or channel 21014) and the degree of contact between the tissue and the jaws at the point of initial contact with the tissue. For example, Figures 100A and 101A illustrate howparenchyma 21030 andblood vessels 21032 can be differentiated based on the proportion ofsensor 21018 activated at the initial tissue contact point. That is, clamping theblood vessel 21032 results in feweractive sensors 21018 relative to clamping theparenchyma 21030. It should also be noted that the number of activatedtissue sensors 21018 on theanvil 21012 andchannel 21014 need not be equal at the initial tissue contact point. As another example, Figures 100A and 101A show howparenchyma 21030 andblood vessels 21032 may be distinguished based on the angle at which theanvil 21012 is oriented relative to thechannel 21014 at the initial tissue contact point. That is, theanvil 21012 is oriented at a first angle θ₁ at the point of initial contact with theparenchyma 21030 and at a second angle θ₂ at the point of initial contact with theblood vessel 21032 . The difference between the ratio of activatedsensors 21018 and the angle at which theanvil 21012 is oriented can be used alone or in combination (eg, byprocess 21200 shown in FIG. 99 ) to characterize the physiological type of tissue being clamped, and then Set the appropriate jaw closure rate, closure threshold, and other motor control parameters for the tissue type.

图100B和图101B分别示出了端部执行器21008已完全夹持实质21030和血管21032的点。可以看出，当端部执行器21008夹持组织时，激活的传感器21018和未激活的传感器21020的数量或比例的变化同样可用于确定组织类型和/或组织的物理特性、组织被压缩的程度和/或砧座21012和通道21014之间的距离，以及各种其他参数。例如，血管21032在被完全夹持时变形远大于实质21030，这导致当端部执行器21008夹持血管21032时，激活的传感器21018的数量变化相对较大。在一些方面，控制电路可执行过程以根据在端部执行器21008被夹持时激活的传感器21018的数量的变化或变化率来确定组织类型(即，生理组织类型或具有某些物理特性的组织)。在一些方面，控制电路可执行过程以根据在端部执行器21008被夹持时激活的传感器21018的数量的变化或变化率来确定组织被压缩和/或变形的程度。Figures 100B and 101B show the point at which theend effector 21008 has fully gripped theparenchyma 21030 and thevessel 21032, respectively. It can be seen that when theend effector 21008 grips tissue, the change in the number or ratio of activatedsensors 21018 andinactivated sensors 21020 can also be used to determine tissue type and/or physical properties of the tissue, the degree to which the tissue is compressed and/or the distance between theanvil 21012 and thechannel 21014, and various other parameters. For example, thevessel 21032 deforms much more than theparenchyma 21030 when fully clamped, which results in a relatively large change in the number of activatedsensors 21018 when theend effector 21008 clamps thevessel 21032. In some aspects, the control circuitry may perform a process to determine tissue type (ie, a physiological tissue type or tissue having certain physical properties) based on a change or rate of change in the number ofsensors 21018 activated while theend effector 21008 is clamped ). In some aspects, the control circuitry may perform a process to determine the degree to which the tissue is compressed and/or deformed based on a change or rate of change in the number ofsensors 21018 activated while theend effector 21008 is clamped.

在其中外科器械21000包括执行上文在图99中所述的过程21200的控制电路21002的一些方面，当控制电路21002确定钳口21013已初始接触组织时，控制电路21002可被配置成能够检测或测量钳口之间的间距θ以及组织和钳口之间的组织接触的长度或程度L。闭合阈值(例如，FTC阈值或ΔFTC阈值)、初始闭合速度和一个或多个调节后的闭合速度(即，超过闭合阈值后钳口21013闭合的一个或多个闭合速度)可各自为θ和L的函数。如图100A至图100B所示，钳口间距可被定义为θ₁，并且组织接触的程度可被定义为在与第一组织(例如，实质21030)的初始接触点处的L₁。如图101A至图101B所示，钳口间距可被定义为θ₂，并且在与第二组织(例如，血管21032)的初始接触点处，组织接触的程度可被定义为L₂。因此，在θ₁>θ₂和L₁>L₂的一些方面，实质FTC阈值FTC_p>血管FTC阈值FTC_v；实质ΔFTC阈值ΔFTC_p>血管斜率阈值ΔFTC_v；并且血管初始闭合速度v_V1>实质初始闭合速度v_P1。下面参考图102至图103进一步详细讨论这些阈值之间的操作差异。In some aspects in which thesurgical instrument 21000 includes acontrol circuit 21002 that performs theprocess 21200 described above in FIG. 99, when thecontrol circuit 21002 determines that thejaws 21013 have initially contacted tissue, thecontrol circuit 21002 may be configured to detect or The spacing Θ between the jaws and the length or degree L of tissue contact between the tissue and the jaws are measured. The closure threshold (eg, FTC threshold or ΔFTC threshold), initial closure velocity, and one or more adjusted closure velocities (ie, one or more closure velocities at whichjaw 21013 closes after the closure threshold is exceeded) may be θ and L, respectively The function. As shown in FIGS. 100A-100B , the jaw spacing can be defined as θ₁ , and the degree of tissue contact can be defined as L₁ at the point of initial contact with the first tissue (eg, parenchyma 21030 ). As shown in FIGS. 101A-101B , the jaw spacing can be defined as θ₂ , and at the point of initial contact with the second tissue (eg, blood vessel 21032 ), the degree of tissue contact can be defined as L₂ . Thus, in some aspects where θ₁ >θ₂ and L₁ >L₂ , the parenchymal FTC threshold FTC_p > the vascular FTC threshold FTC_v ; the parenchymal ΔFTC threshold ΔFTC_p > the vessel slope threshold ΔFTC_v ; and the vessel initial closure velocity v_V1 > Substantial initial closing velocity v_P1 . The operational differences between these thresholds are discussed in further detail below with reference to FIGS. 102-103 .

图102示出了根据本公开的至少一个方面的第一曲线图21300和第二曲线图21302，其分别描绘了对于抓持实质21030的外科器械21000的例示性击发，端部执行器FTC21304和闭合速度21306随时间21308的变化。在以下对第一曲线图21300和第二曲线图21302的描述中，还应当参考图95以及图99至图100B。本文所述的例示性击发是为了展示上文参考图95和图99至图100B讨论的概念，并且不应解释为以任何方式进行限制。Figure 102 shows afirst graph 21300 and asecond graph 21302 depicting exemplary firing,end effector FTC 21304 and closure, respectively, for asurgical instrument 21000 grasping aparenchyma 21030 in accordance with at least one aspect of thepresent disclosure Velocity 21306 versustime 21308. In the following description of thefirst graph 21300 and thesecond graph 21302, reference should also be made to FIG. 95 and FIGS. 99-100B. The exemplary firings described herein are to demonstrate the concepts discussed above with reference to FIGS. 95 and 99-100B and should not be construed as limiting in any way.

外科器械21000的第一次击发可由第一FTC曲线21310和对应的第一速度曲线21310’表示，它们分别示出了在第一次击发过程中FTC和闭合速度随时间的变化。第一次击发可表示例如外科器械21000的默认击发或不包括控制电路21002执行图99所示的过程21200的外科器械21000的击发。当外科器械21000的击发开始时，控制电路21002控制马达21006以开始从其打开位置驱动砧座21014，从而使砧座21012的闭合速度急剧增加21318至初始或默认的闭合速度v_d1。当砧座21012从打开位置被驱动时，它与被夹持的组织接触，对于该特定的击发，该被夹持的组织是实质21030。当砧座21012在时间t₀接触被夹持的组织时，FTC就在时间t₁从初始FTC(例如，零)增加21312至峰值21314。在时间t₁，外科器械21000的控制电路21002确定FTC已经达到或超过FTC阈值(其可为例如独立于组织类型的默认阈值)，并且控制马达21006停止砧座21012的运动，从而使闭合速度下降21320至零。砧座21012的运动可暂停持续时间p₁，在此期间闭合速度保持21322为零。在暂停期间，FTC随着被夹持的组织松弛而逐渐减小21316。The first firing of thesurgical instrument 21000 can be represented by afirst FTC curve 21310 and a corresponding first velocity curve 21310', which show the changes in FTC and closure velocity over time, respectively, during the first firing. The first firing may represent, for example, the default firing of thesurgical instrument 21000 or the firing of thesurgical instrument 21000 that does not include thecontrol circuit 21002 performing theprocess 21200 shown in FIG. 99 . When firing of thesurgical instrument 21000 begins, thecontrol circuit 21002 controls themotor 21006 to begin driving theanvil 21014 from its open position, thereby sharply increasing 21318 the closing speed of the anvil₂₁₀₁₂ to the initial or default closing speed vd1. When theanvil 21012 is driven from the open position, it contacts the clamped tissue, which isparenchyma 21030 for this particular firing. When theanvil 21012 contacts the clamped tissue at time t₀ , the FTC increases 21312 from the initial FTC (eg, zero) to apeak value 21314 at time t₁ . At time t₁ , thecontrol circuitry 21002 of thesurgical instrument 21000 determines that the FTC has reached or exceeded an FTC threshold (which may be, for example, a default threshold independent of tissue type), and controls themotor 21006 to stop the movement of theanvil 21012 , thereby reducing the closure velocity 21320 to zero. Movement of theanvil 21012 may be paused for a duration p₁ during which the closing speed remains 21322 zero. During the pause, the FTC gradually decreases 21316 as the clamped tissue relaxes.

外科器械21000的第二次击发可由第二FTC曲线21324和对应的第一速度曲线21324’表示，它们分别示出了在第二次击发的过程期间FTC和闭合速度随时间的变化。与第一次击发相比，第二次击发可表示例如外科器械21000的击发，包括控制电路21002执行图99所示的过程。当外科器械21000的击发开始时，控制电路21002控制马达21006以开始从其打开位置驱动砧座21014，从而使砧座21014的闭合速度急剧增加21336。由于实质21030的相对厚度和/或几何形状，组织(即，实质21030)和钳口21013之间的初始接触点在砧座21012开始被马达21006驱动后不久出现；因此，执行图99所示的过程21200的控制电路21002能够几乎立即确定实质21030正被夹持并相应地设定闭合钳口的时间、一个或多个闭合阈值以及闭合过程中相对较早点的其他闭合参数。因此，控制电路21002控制马达21006以使砧座21014的闭合速度急剧增加21336至特定于实质21320组织的初始闭合速度v_p1。The second firing of thesurgical instrument 21000 can be represented by asecond FTC curve 21324 and a corresponding first velocity curve 21324', which respectively show the FTC and closure velocity versus time during the course of the second firing. Compared to the first firing, the second firing may represent, for example, the firing of thesurgical instrument 21000, including thecontrol circuit 21002 performing the process shown in FIG. 99 . When firing of thesurgical instrument 21000 begins, thecontrol circuit 21002 controls themotor 21006 to begin driving theanvil 21014 from its open position, thereby sharply increasing 21336 the closing speed of theanvil 21014. Due to the relative thickness and/or geometry of theparenchyma 21030, the initial point of contact between the tissue (ie, parenchyma 21030) and thejaws 21013 occurs shortly after theanvil 21012 begins to be driven by themotor 21006; thus, performing the Thecontrol circuit 21002 of theprocess 21200 is able to determine almost immediately that thesubstance 21030 is being clamped and set the time to close the jaws, one or more closure thresholds, and other closure parameters relatively early in the closure process accordingly. Accordingly, thecontrol circuit 21002 controls themotor 21006 to sharply increase 21336 the closing speed of the anvil₂₁₀₁₄ to an initial closing speed vp1 specific to the parenchymal 21320 tissue.

当砧座21012从打开位置被驱动时，它与被夹持的组织接触，对于该特定的击发，该被夹持的组织是实质21030。当砧座21012在时间t₀接触被夹持的组织时，FTC就在时间t₂从初始FTC(例如，零)增加21326至第一峰值21328。应当指出的是，与第一次击发相比，FTC在第二次击发期间更缓慢地增加21326，因为执行过程21200的控制电路21002在第二次击发中选择适合于被夹持的组织的类型的第一或初始闭合速度v_p1，从而与外科器械21000的未修改击发相比减少了施加在组织上的力的量。在时间t₂，外科器械21000的控制电路21002确定FTC已经达到或超过FTC阈值FTC_p(当控制电路21002确定实质21030组织被夹持时，该阈值已在t₀时或之后由控制电路21002设定)。实质FTC阈值FTC_p可表示例如可安全地或有利地施加在实质21030组织上的最大力。因此，控制电路21002控制马达21006停止砧座21012的运动，使闭合速度下降21338至零。砧座21012的运动可暂停持续时间p₂，在此期间闭合速度保持21340为零。在暂停期间，FTC随着被夹持的组织松弛而逐渐减小21330。暂停持续时间p₂可等于默认暂停持续时间(例如，p₁)或由控制电路21002为实质21030组织选择的闭合参数。When theanvil 21012 is driven from the open position, it contacts the clamped tissue, which isparenchyma 21030 for this particular firing. When theanvil 21012 contacts the clamped tissue at time t₀ , the FTC increases 21326 from the initial FTC (eg, zero) to afirst peak value 21328 at time t₂ . It should be noted that the FTC increases 21326 more slowly during the second firing compared to the first firing because thecontrol circuit 21002 performing theprocess 21200 selects the appropriate type of tissue to be clamped in the second firing The first or initial closure velocity v_p1 , thereby reducing the amount of force exerted on the tissue compared to unmodified firing of thesurgical instrument 21000 . At time t₂ , thecontrol circuit 21002 of thesurgical instrument 21000 determines that the FTC has reached or exceeded the FTC threshold FTC_p (the threshold has been set by thecontrol circuit 21002 at or after t₀ when thecontrol circuit 21002 determines that substantial 21030 tissue is gripped Certainly). The substantial FTC threshold FTC_p may represent, for example, the maximum force that can be safely or advantageously exerted on the substantial 21030 tissue. Therefore, thecontrol circuit 21002 controls themotor 21006 to stop the movement of theanvil 21012, causing the closing speed to drop 21338 to zero. Movement of theanvil 21012 may be paused for a duration_p2 during which the closing speed remains 21340 zero. During the pause, the FTC gradually decreases 21330 as the clamped tissue relaxes. The pause duration p₂ may be equal to the default pause duration (eg, p₁ ) or a closure parameter selected by thecontrol circuit 21002 for thesubstance 21030 tissue.

在时间t₃处暂停持续时间p₂已经过去之后，控制电路21002重新接合马达21006，并恢复闭合砧座21012。因此，闭合速度增加21342至第二闭合速度v_p2。在一些方面，在首先超过实质FTC阈值FTC_p之后，控制电路21002将砧座21012闭合的闭合速度减小到特定于实质21030组织的第二闭合速度v_p2，其中v_p2<v_p1。控制电路21002可被配置成能够在超过实质FTC阈值FTC_p之后以较低的速度闭合砧座21012，因为这可指示组织比检测到的组织类型预期的更厚、更具刚性或以其他方式更耐受来自砧座21012的闭合力。因此，可能期望减小闭合速度以试图减小随后施加在被夹持的组织上的闭合力的量。After the pause duration_p2 has elapsed at time_t3 , thecontrol circuit 21002 re-engages themotor 21006 and resumes closing theanvil 21012. Therefore, the closing speed is increased by 21342 to the second closing speed v_p2 . In some aspects, after first exceeding the parenchymal FTC threshold_FTCp , thecontrol circuit 21002 reduces the closing velocity of the anvil₂₁₀₁₂ closure to a second closing velocity vp2 specific to the parenchymal 21030 tissue, where_vp2 <_vp1 . Thecontrol circuit 21002 can be configured to be able to close theanvil 21012 at a slower rate after the substantial FTC threshold FTC_p is exceeded, as this can indicate that the tissue is thicker, more rigid, or otherwise more rigid than expected for the detected tissue type. Withstands closing force fromanvil 21012. Therefore, it may be desirable to reduce the closing speed in an attempt to reduce the amount of closing force subsequently exerted on the clamped tissue.

当砧座21012在时间t₃恢复闭合时，FTC再次开始增加，直到其在时间t₄达到峰值21332，并且再次达到或超过实质力阈值FTC_p。在时间_t4处，外科器械21000的控制电路21002确定FTC已经达到或超过FTC阈值FTC_p。因此，控制电路21002控制马达21006停止砧座21012的运动，使闭合速度下降21346至零。砧座21012的运动可暂停持续时间p₃，在此期间闭合速度保持21348为零。在暂停期间，FTC随着被夹持的组织松弛而逐渐减小21334。When theanvil 21012 returns to closure at time_t3 , the FTC begins to increase again until it peaks₂₁₃₃₂ at time t4 and again reaches or exceeds the substantial force threshold_FTCp . At time_t4 , thecontrol circuitry 21002 of thesurgical instrument 21000 determines that the FTC has reached or exceeded the FTC threshold_FTCp . Therefore, thecontrol circuit 21002 controls themotor 21006 to stop the movement of theanvil 21012, causing the closing speed to drop 21346 to zero. Movement of the anvil₂₁₀₁₂ may be paused for a duration p3 during which the closing speed remains 21348 zero. During the pause, the FTC gradually decreases 21334 as the clamped tissue relaxes.

图103示出了根据本公开的至少一个方面的第三曲线图21350和第四曲线图21352，其分别描绘了对于抓持血管21032的外科器械21000的例示性击发，端部执行器FTC21354和闭合速度21356随时间21358的变化。在以下对第三曲线图21350和第二曲线图21352的描述中，还应该参考图95、图99、图101A至图101B。本文所述的例示性击发是为了展示上文参考图95、图99、图101A至图101B讨论的概念，并且不应解释为以任何方式进行限制。103 shows athird graph 21350 and afourth graph 21352 depicting exemplary firing,end effector FTC 21354 and closure, respectively, forsurgical instrument 21000 graspingblood vessel 21032 in accordance with at least one aspect of thepresent disclosure Velocity 21356 versustime 21358. In the following description of thethird graph 21350 and thesecond graph 21352, reference should also be made to FIGS. 95, 99, 101A-101B. The exemplary firings described herein are to demonstrate the concepts discussed above with reference to Figures 95, 99, 101A-101B and should not be construed as limiting in any way.

外科器械21000的第三次击发可由第三FTC曲线21360和对应的第一速度曲线21360’表示，它们分别示出了在第三次击发的过程期间FTC和闭合速度随时间的变化。第三次击发可表示例如外科器械21000的默认击发或不包括控制电路21002执行图99所示的过程的外科器械21000的击发。当外科器械21000的击发开始时，控制电路21002控制马达21006以开始从其打开位置驱动砧座21014，从而使砧座21012的闭合速度急剧增加21370至初始或默认的闭合速度v_d2。初始闭合速度v_d2可以等于或可以不等于图102中的初始闭合速度v_d1。当砧座21012从打开位置被驱动时，它在与被夹持的组织接触之前行进一段时间，对于该特定的击发，该被夹持的组织是血管21032。应当指出的是，这与外科器械21000夹持实质21030的击发形成对比，如图102所示。当血管21032相对较薄时，砧座21012通常必须在与血管21032初始接触之前行进一段距离，而实质21032通常比血管21032厚，因此砧座21012通常几乎立即与血管21032初始接触。因此，FTC最初是平坦的21362，因为砧座21012行进一段时间而不接触组织。一旦砧座21012在时间t₀接触组织，FTC就在时间t₂从初始或平坦的21376FTC(例如，零)增加21364至峰值21366。在时间t₂，外科器械21000的控制电路21002确定FTC已经达到或超过FTC阈值(其可为例如独立于组织类型的默认阈值)，并且控制马达21006停止砧座21012的运动，从而使闭合速度下降21372至零。砧座21012的运动可暂停持续时间p₄，在此期间闭合速度保持21374为零。在暂停期间，FTC随着被夹持的组织松弛而逐渐减小21368。The third firing of thesurgical instrument 21000 can be represented by athird FTC curve 21360 and a corresponding first velocity curve 21360', which show the FTC and closure velocity versus time, respectively, during the course of the third firing. The third firing may represent, for example, the default firing ofsurgical instrument 21000 or the firing ofsurgical instrument 21000 that does not includecontrol circuitry 21002 to perform the process shown in FIG. 99 . When firing of thesurgical instrument 21000 begins, thecontrol circuit 21002 controls themotor 21006 to begin driving theanvil 21014 from its open position, thereby sharply increasing 21370 the closing speed of the anvil₂₁₀₁₂ to the initial or default closing speed vd2. The initial closing velocity v_d2 may or may not be equal to the initial closing velocity v_d1 ingraph 102 . When theanvil 21012 is driven from the open position, it travels for a period of time before coming into contact with the clamped tissue, which for this particular firing is theblood vessel 21032. It should be noted that this is in contrast to the firing ofsurgical instrument 21000 grippingsubstance 21030 as shown in FIG. 102 . When thevessel 21032 is relatively thin, theanvil 21012 typically must travel some distance before initial contact with thevessel 21032, and theparenchyma 21032 is typically thicker than thevessel 21032, so theanvil 21012 typically makes initial contact with thevessel 21032 almost immediately. Thus, the FTC is initially flat 21362 as theanvil 21012 travels for a period of time without contacting the tissue. Once theanvil 21012 contacts the tissue at time_t0 , the FTC increases 21364 from an initial or flat 21376 FTC (eg, zero) to apeak 21366 at time_t2 . At time t₂ , thecontrol circuitry 21002 of thesurgical instrument 21000 determines that the FTC has reached or exceeded the FTC threshold (which may be, for example, a default threshold independent of tissue type), and controls themotor 21006 to stop the movement of theanvil 21012 , thereby reducing theclosure velocity 21372 to zero. Movement of the anvil₂₁₀₁₂ may be paused for a duration p4 during which the closing speed remains 21374 zero. During the pause, the FTC gradually decreases 21368 as the clamped tissue relaxes.

外科器械21000的第四次击发可由第二FTC曲线21375和对应的第一速度曲线21375’表示，它们分别示出了在第二次击发的过程期间FTC和闭合速度随时间的变化。与第一次击发相比，第四次击发可表示例如外科器械21000的击发，包括控制电路21002执行图99所示的过程21200。当外科器械21000的击发开始时，控制电路21002控制马达21006以开始从其打开位置驱动砧座21014，从而使砧座21014的闭合速度急剧增加21386。由于血管21032的相对薄度和/或几何形状(与例如实质21030相比)，组织(即，血管21032)和钳口21013之间的初始接触点直到砧座21012已被马达21006驱动一段时间之后才出现；因此，执行图99所示的过程21200的控制电路21002不能够确定血管21032正被夹持并相应地设定闭合钳口的时间、一个或多个闭合阈值和其他适当的闭合参数，直到闭合过程已被执行一段时间。因为砧座21012不接触血管21032的较薄组织达一段时间，因此控制电路21002相应地不能够检测正被夹持的组织的类型，所以控制电路21002控制马达21006以使砧座21014的闭合速度急剧增加21386至默认速度v_d。The fourth firing of thesurgical instrument 21000 may be represented by asecond FTC curve 21375 and a corresponding first velocity curve 21375', which show the FTC and closure velocity versus time, respectively, during the course of the second firing. Compared to the first firing, the fourth firing may represent, for example, the firing of thesurgical instrument 21000, including thecontrol circuit 21002 performing theprocess 21200 shown in FIG. 99 . When firing of thesurgical instrument 21000 begins, thecontrol circuit 21002 controls themotor 21006 to begin driving theanvil 21014 from its open position, causing a sharp increase 21386 in the closing speed of theanvil 21014. Due to the relative thinness and/or geometry of the vessel 21032 (compared to, eg, the parenchyma 21030), the initial point of contact between the tissue (ie, the vessel 21032) and thejaws 21013 is not until after theanvil 21012 has been driven by themotor 21006 for a period of time occurs; therefore, thecontrol circuit 21002 executing theprocess 21200 shown in FIG. 99 is unable to determine that thevessel 21032 is being clamped and set the time to close the jaws, one or more closure thresholds, and other appropriate closure parameters accordingly, until the closing process has been executed for some time. Because theanvil 21012 does not contact the thinner tissue of theblood vessel 21032 for a period of time, thecontrol circuit 21002 is correspondingly unable to detect the type of tissue being clamped, so thecontrol circuit 21002 controls themotor 21006 to sharpen the closing speed of theanvil 21014 Added 21386 to default speed v_d .

当砧座21012从打开位置被驱动时，FTC最初是平坦的21376，因为砧座21012行进一段时间而不接触组织。一旦砧座21012在时间t₀接触组织，FTC就从初始FTC(例如，零)增加21378。在接触血管21032之后，执行图99所示的过程21200的控制电路21002能够确定血管21032正被夹持并相应地设定闭合钳口的时间、一个或多个闭合阈值以及闭合过程中该点的其他闭合参数。在时间t₁，控制电路21002确定ΔFTC已经达到或超过ΔFTC阈值ΔFTC_v(当控制电路21002确定血管21032被夹持时，该阈值已在t₀时或之后由控制电路21002设定)。血管ΔFTC阈值ΔFTC_v可表示例如可安全地或有利地施加在血管21032组织上的力的最大变化率。因此，控制电路21002控制马达21006以将闭合速度下降21388至特定于血管2032组织的血管闭合速度v_v1，其中v_v1<v_d。When theanvil 21012 is driven from the open position, the FTC is initially flat 21376 because theanvil 21012 travels for a period of time without contacting the tissue. Once theanvil 21012 contacts the tissue at time t₀ , the FTC is increased 21378 from the initial FTC (eg, zero). After contacting thevessel 21032, thecontrol circuit 21002 performing theprocess 21200 shown in FIG. 99 can determine that thevessel 21032 is being clamped and set the time to close the jaws, one or more closing thresholds, and the amount of time during the closing process accordingly. Other closure parameters. At time t₁ , thecontrol circuit 21002 determines that ΔFTC has reached or exceeded the ΔFTC threshold ΔFTC_v (this threshold has been set by thecontrol circuit 21002 at or after t₀ when thecontrol circuit 21002 determines that thevessel 21032 is clamped). The vessel ΔFTC threshold ΔFTC_v may represent, for example, the maximum rate of change of force that can be safely or advantageously applied to the tissue of thevessel 21032 . Accordingly, thecontrol circuit 21002 controls themotor 21006 to decrease 21388 the closure velocity to the vessel 2032 tissue-specific vessel closure velocity v_v1 , where v_v1 < v_d .

当砧座21012以较低血管闭合速度v_v1推进时，FTC比先前更缓慢地增加21380，直到其在时间t₃达到峰值21382。在时间t₃，控制电路21002确定FTC已经达到或超过FTC阈值FTC_v(当控制电路21002确定血管21032被夹持时，该阈值已在t₀时或之后由控制电路21002设定)。血管FTC阈值FTC_v可表示例如可安全地或有利地施加在血管21032组织上的最大力。因此，控制电路21002控制马达21006停止砧座21012的运动，使闭合速度下降21932至零。砧座21012的运动可暂停持续时间p₅，在此期间闭合速度保持21394为零。在暂停期间，FTC随着被夹持的组织松弛而逐渐减小21384。暂停持续时间p₅可等于默认暂停持续时间(例如，p₁)或由控制电路21002为血管21032组织选择的闭合参数。As theanvil 21012 is advanced at the lower vessel closure velocity v_v1 , the FTC increases 21380 more slowly than before until it peaks 21382 at time_t3 . At time_t3 , thecontrol circuit 21002 determines that the FTC has reached or exceeded the FTC threshold_FTCv (the threshold has been set by thecontrol circuit 21002 at or after_t0 when thecontrol circuit 21002 determines that thevessel 21032 is clamped). The vessel FTC threshold FTC_v may represent, for example, the maximum force that can be safely or advantageously applied to the tissue of thevessel 21032. Therefore, thecontrol circuit 21002 controls themotor 21006 to stop the movement of theanvil 21012, causing the closing speed to drop 21932 to zero. Movement of the anvil₂₁₀₁₂ may be paused for a duration p5 during which the closing speed remains 21394 zero. During the pause, the FTC gradually decreases 21384 as the clamped tissue relaxes. The pause duration p₅ may be equal to the default pause duration (eg, p₁ ) or a closure parameter selected by thecontrol circuit 21002 for the tissue of thevessel 21032 .

总之，图102至图103突出显示了外科器械21000在有和没有控制电路21002执行图99所示的过程21200的情况下起作用的不同方式。In summary, FIGS. 102-103 highlight the different ways in which thesurgical instrument 21000 functions with and without thecontrol circuit 21002 performing theprocess 21200 shown in FIG. 99 .

图104示出了根据本公开的至少一个方面的第五曲线图21400，其描绘了对于外科器械的例示性击发，端部执行器FTC 21402和闭合速度21404随时间21406的变化。在以下对第五曲线图21400的描述中，还应当参考图95以及图99至图101B。本文所述的例示性击发是为了展示上文参考图95和图99至图101B讨论的概念，并且不应解释为以任何方式进行限制。104 shows afifth graph 21400 depicting changes inend effector FTC 21402 andclosure velocity 21404 overtime 21406 for an exemplary firing of a surgical instrument in accordance with at least one aspect of the present disclosure. In the following description of thefifth graph 21400, reference should also be made to Figure 95 and Figures 99-101B. The exemplary firings described herein are to demonstrate the concepts discussed above with reference to FIGS. 95 and 99-101B and should not be construed as limiting in any way.

外科器械21000的第五次击发可由第五FTC曲线21408和对应的第五速度曲线21408’表示，它们分别示出了在第五次击发的过程期间FTC和闭合速度随时间的变化。第五次击发可表示例如外科器械21000的击发，包括控制电路21002执行图99所示的过程。当外科器械21000的击发开始时，控制电路21002控制马达21006以开始从其打开位置驱动砧座21014，从而使砧座21014的闭合速度急剧增加21416，直到其稳定在21418特定闭合速度。随着砧座21012闭合，FTC增加21410，直到在特定时间达到峰值21412。FTC从峰值21412减小21414，直到组织被完全夹持，此时控制电路21002控制马达21006停止砧座21012的闭合，并且闭合速度下降21420至零。The fifth firing of thesurgical instrument 21000 may be represented by afifth FTC curve 21408 and a corresponding fifth velocity curve 21408&apos;, which show the changes in FTC and closure velocity over time, respectively, during the course of the fifth firing. The fifth firing may represent, for example, the firing of thesurgical instrument 21000, including thecontrol circuit 21002 performing the process shown in FIG. 99 . When firing of thesurgical instrument 21000 begins, thecontrol circuit 21002 controls themotor 21006 to begin driving theanvil 21014 from its open position, resulting in asharp increase 21416 in the closing speed of theanvil 21014 until it stabilizes at 21418 the specified closing speed. As theanvil 21012 closes, the FTC increases 21410 until it reaches apeak 21412 at a particular time. The FTC decreases 21414 from thepeak 21412 until the tissue is fully clamped, at which point thecontrol circuit 21002 controls themotor 21006 to stop the closing of theanvil 21012 and the closing speed drops 21420 to zero.

因此，第五次击发表示外科器械21000的击发，其中在钳口21013的闭合期间没有达到或超过FTC阈值、ΔFTC阈值或任何其他闭合阈值。换句话讲，在钳口21013闭合的过程期间，第五次击发保持在所有控制参数内。因此，控制电路21002不在钳口21013闭合的过程期间暂停砧座21012、调节砧座21012的闭合速度或采取任何其他校正动作。Thus, the fifth firing represents a firing of thesurgical instrument 21000 in which the FTC threshold, the ΔFTC threshold, or any other closure threshold was not reached or exceeded during the closure of thejaws 21013 . In other words, during the process ofjaw 21013 closing, the fifth shot remains within all control parameters. Thus, thecontrol circuit 21002 does not pause theanvil 21012, adjust the closing speed of theanvil 21012, or take any other corrective action during the process of closing thejaws 21013.

图105示出了根据本公开的至少一个方面的第六曲线图21422，其描绘了对于外科器械的例示性击发，端部执行器FTC 21402和闭合速度21404随时间21406的变化。在以下对第六曲线图21422的描述中，还应当参考图95以及图99至图101B。本文所述的例示性击发是为了展示上文参考图95和图99至图101B讨论的概念，并且不应解释为以任何方式进行限制。105 shows asixth graph 21422 depicting changes inend effector FTC 21402 andclosure velocity 21404 overtime 21406 for an exemplary firing of a surgical instrument, in accordance with at least one aspect of the present disclosure. In the following description of thesixth graph 21422, reference should also be made to FIG. 95 and FIGS. 99-101B. The exemplary firings described herein are to demonstrate the concepts discussed above with reference to FIGS. 95 and 99-101B and should not be construed as limiting in any way.

外科器械21000的第六次击发可由第六FTC曲线21424和对应的第六速度曲线21424’表示，它们分别示出了在第六次击发的过程期间FTC和闭合速度随时间的变化。第六次击发可表示例如外科器械21000的击发，包括控制电路21002执行图99所示的过程21200。当外科器械21000的击发开始时，控制电路21002控制马达21006以开始从其打开位置驱动砧座21014，从而使砧座21014的闭合速度急剧增加21432，直到其达到特定闭合速度。随着砧座21012闭合，FTC增加21426，直到在特定时间达到峰值21428。在该特定实例中，外科器械21000的操作者选择打开外科器械21000的钳口21013，以便重新调节其中的组织。因此，闭合速度下降21434，直到其达到负闭合速度，这表明钳口21013正在被打开，以便例如容易地允许组织在钳口21013内被重新调节。闭合速度然后返回21436到零，钳口21013停止。相应地，FTC随着钳口21013从组织释放而减小21430到零。The sixth firing of thesurgical instrument 21000 may be represented by asixth FTC curve 21424 and a corresponding sixth velocity curve 21424&apos;, which show the FTC and closure velocity versus time, respectively, during the course of the sixth firing. The sixth firing may represent, for example, firing of thesurgical instrument 21000, including thecontrol circuit 21002 performing theprocess 21200 shown in FIG. 99 . When firing ofsurgical instrument 21000 begins,control circuit 21002 controls motor 21006 to begin drivinganvil 21014 from its open position, thereby sharply increasing 21432 the closing speed ofanvil 21014 until it reaches a particular closing speed. As theanvil 21012 closes, the FTC increases 21426 until it reaches apeak 21428 at a particular time. In this particular example, the operator ofsurgical instrument 21000 chooses to openjaws 21013 ofsurgical instrument 21000 in order to readjust tissue therein. Thus, the closing speed drops 21434 until it reaches a negative closing speed, which indicates that thejaws 21013 are being opened, for example to easily allow tissue to be reconditioned within thejaws 21013. The closing speed then returns 21436 to zero and thejaws 21013 stop. Accordingly, the FTC decreases 21430 to zero as thejaws 21013 are released from the tissue.

图106示出了根据本公开的至少一个方面的第七曲线图21438，其描绘了对于外科器械的例示性击发，端部执行器FTC 21402和闭合速度21404随时间21406的变化。在以下对第七曲线图21438的描述中，还应当参考图95以及图99至图101B。本文所述的例示性击发是为了展示上文参考图95和图99至图101B讨论的概念，并且不应解释为以任何方式进行限制。106 shows aseventh graph 21438 depicting changes inend effector FTC 21402 andclosure velocity 21404 overtime 21406 for an exemplary firing of a surgical instrument, in accordance with at least one aspect of the present disclosure. In the following description of theseventh graph 21438, reference should also be made to FIG. 95 and FIGS. 99-101B. The exemplary firings described herein are to demonstrate the concepts discussed above with reference to FIGS. 95 and 99-101B and should not be construed as limiting in any way.

外科器械21000的第七次击发可由第七FTC曲线21440和对应的第七速度曲线21440’表示，它们分别示出了在第七次击发的过程期间FTC和闭合速度随时间的变化。第七次击发可表示例如外科器械21000的击发，包括控制电路21002执行图99所示的过程21200。当外科器械21000的击发开始时，控制电路21002控制马达21006以开始从其打开位置驱动砧座21014，从而使砧座21014的闭合速度急剧增加21450至第一闭合速度v₁。随着砧座21012闭合，FTC增加21442，直到时间t₁。在时间t₁，控制电路21002确定ΔFTC已经达到或超过ΔFTC阈值ΔFTC_T，其可以是默认的ΔFTC阈值或者是由控制电路21002根据图99所示的过程21200检测到的特定生理组织类型的ΔFTC阈值。又如，ΔFTC_T可通过由外科器械2100的控制电路21002和/或另一个控制电路响应于其他感测参数或根据另一种算法执行的另一个过程来设定。例如，如果钳口闭合在图99所示的过程21200的操作参数内进行，但是外科器械21000的另一个传感器和/或过程确定被夹持的组织仍然以某种方式偏离预期参数(例如，组织比给定组织类型的预期更厚或更薄)，则相应地设定闭合钳口21013的时间、一个或多个闭合阈值和其他控制参数。在一个示例中，第二传感器在时间t₁处检测到组织比预期更薄。因此，控制电路21002设定新的ΔFTC_T(在该示例中，其低于先前的ΔFTC_T)，控制电路21002然后确定在该时间t₁处达到或超过该新值。The seventh firing of thesurgical instrument 21000 may be represented by aseventh FTC curve 21440 and a corresponding seventh velocity curve 21440', which show the FTC and closure velocity versus time, respectively, during the course of the seventh firing. The seventh firing may represent, for example, firing of thesurgical instrument 21000, including thecontrol circuit 21002 performing theprocess 21200 shown in FIG. 99 . When firing of thesurgical instrument 21000 begins, thecontrol circuit 21002 controls themotor 21006 to begin driving theanvil 21014 from its open position, thereby sharply increasing 21450 the closing speed of theanvil 21014 to the first closing speed v₁ . As theanvil 21012 closes, the FTC increases 21442 until time t₁ . At time t₁ , thecontrol circuit 21002 determines that the ΔFTC has reached or exceeded the ΔFTC threshold ΔFTC_T , which may be the default ΔFTC threshold or the ΔFTC threshold for a particular physiological tissue type detected by thecontrol circuit 21002 according to theprocess 21200 shown in FIG. 99 . . As another example, the ΔFTC_T may be set by another process performed by thecontrol circuit 21002 of the surgical instrument 2100 and/or another control circuit in response to other sensed parameters or according to another algorithm. For example, if jaw closure is performed within the operating parameters of theprocedure 21200 shown in FIG. 99, but another sensor and/or procedure of thesurgical instrument 21000 determines that the clamped tissue still deviates in some way from the expected parameters (eg, tissue thicker or thinner than expected for a given tissue type), the time to close thejaws 21013, one or more closure thresholds, and other control parameters are set accordingly. In one example, the second sensor detects that the tissue is thinner than expected at time_t1 . Accordingly, thecontrol circuit 21002 sets a new ΔFTC_T (in this example, which is lower than the previous ΔFTC_T ), and thecontrol circuit 21002 then determines that the new value is reached or exceeded at this time t₁ .

因此，控制电路21002控制马达21006以使砧座21012的闭合速度下降21452至第二闭合速度v₂，其中v₁>v₂。从t₁开始，闭合速度的下降导致FTC以较慢的速率增加21444。FTC增加21444，直到它在FTC阈值FTC_T以下达到峰值21446，然后下降。由于在t₁之后第七次击发保持在所有闭合参数内，所以闭合速度保持21454在第二闭合速度v₂，直到组织被完全夹持，此时控制电路21002控制马达21006停止砧座21012的闭合，并且闭合速度下降21456至零。Accordingly, thecontrol circuit 21002 controls themotor 21006 to decrease the closing speed of theanvil 21012 by 21452 to a second closing speed v₂ , where v₁ >v₂ . From t₁ , the decrease in closing speed causes the FTC to increase by 21444 at a slower rate. FTC increases by 21444 until it peaks 21446 below the FTC threshold FTC_T , and then decreases. Since the seventh firing after_t1 remains within all closure parameters, the closure speed remains 21454 at the_second closure speed v2 until the tissue is fully clamped, at which point thecontrol circuit 21002 controls themotor 21006 to stop the closure of theanvil 21012 , and the closing speed drops 21456 to zero.

图107示出了根据本公开的至少一个方面的描绘了阻抗21502随着时间21504变化的曲线图21500，以确定外科器械的钳口何时接触组织和/或钉。在第七曲线图21438的以下描述中，还应当参考图95。如上所述，被配置成能够检测由端部执行器21008夹持的组织的压缩程度和/或被配置成能够检测与组织的初始接触的一个或多个传感器21004可包括例如阻抗传感器。如由一个或多个阻抗传感器检测的组织的阻抗和/或阻抗变化率可用于确定被夹持的组织的状态。例如，如果检测到的阻抗已稳定在21506表示开路状态的阻抗Z_OC处，则联接到阻抗传感器的控制电路21002可确定钳口是打开的和/或未接触组织。又如，当检测到的阻抗初始从开路阻抗Z_OC减小21508时，则联接到阻抗传感器的控制电路21002可确定已与组织进行初始接触。又如，当检测到的阻抗从开路阻抗Z_OC减小21510时，联接到阻抗传感器的控制电路21002可利用阻抗曲线随时间的形状和/或检测到的阻抗变化率来确定组织压缩速率和/或组织被压缩的程度。再如，如果检测到的阻抗下降21512至零，则联接到阻抗传感器的控制电路21002可确定端部执行器21008的钳口已接触钉，这使阻抗检测系统短路。107 shows agraph 21500 depictingimpedance 21502 as a function oftime 21504 to determine when the jaws of a surgical instrument contact tissue and/or staples in accordance with at least one aspect of the present disclosure. In the following description of theseventh graph 21438, reference should also be made to FIG. 95 . As described above, the one ormore sensors 21004 configured to detect the degree of compression of the tissue gripped by theend effector 21008 and/or to detect initial contact with the tissue may include, for example, impedance sensors. The impedance and/or rate of change of impedance of the tissue, as detected by one or more impedance sensors, can be used to determine the state of the clamped tissue. For example, if the detected impedance has stabilized at 21506 the impedance Z_OC representing an open circuit state, thecontrol circuit 21002 coupled to the impedance sensor can determine that the jaws are open and/or not contacting tissue. As another example, when the detected impedance initially decreases 21508 from the open circuit impedance Z_OC , then thecontrol circuit 21002 coupled to the impedance sensor can determine that initial contact has been made with tissue. As another example, when the detected impedance decreases 21510 from the open circuit impedance Z_OC , thecontrol circuit 21002 coupled to the impedance sensor can utilize the shape of the impedance curve over time and/or the rate of change of the detected impedance to determine the rate of tissue compression and/or or the extent to which the tissue is compressed. As another example, if the detected impedance drops 21512 to zero, thecontrol circuit 21002 coupled to the impedance sensor can determine that the jaws of theend effector 21008 have contacted the nail, which short-circuits the impedance detection system.

实施例Example

在以下实施例中阐述了本文在标题“根据感测到的闭合参数控制外科器械”下描述的主题的各个方面：Various aspects of the subject matter described herein under the heading "Controlling a Surgical Instrument Based on Sensed Closure Parameters" are set forth in the following examples:

实施例1—一种外科器械，该外科器械包括端部执行器，该端部执行器包括能够在打开构型和闭合构型之间转变的钳口。外科器械还包括可操作地联接到钳口的马达。该马达被构造成能够使钳口在打开构型和闭合构型之间转变。外科器械还包括传感器，该传感器被配置成能够传输指示与钳口之间的组织相关联的组织压缩参数的至少一个信号。外科器械还包括联接到传感器和马达的控制电路。该控制电路被配置成能够接受该至少一个信号，当钳口从打开构型转变到闭合构型时基于该至少一个信号确定组织压缩参数的值，致使马达根据该组织压缩参数的值是否高于第一阈值来增加使钳口转变到闭合构型的时间，并且根据组织压缩参数的值是否低于第二阈值来提供反馈。Embodiment 1—A surgical instrument including an end effector including jaws that are transitionable between an open configuration and a closed configuration. The surgical instrument also includes a motor operably coupled to the jaws. The motor is configured to transition the jaws between an open configuration and a closed configuration. The surgical instrument also includes a sensor configured to transmit at least one signal indicative of a tissue compression parameter associated with tissue between the jaws. The surgical instrument also includes a control circuit coupled to the sensor and the motor. The control circuit is configured to accept the at least one signal and determine a value of the tissue compression parameter based on the at least one signal when the jaws transition from the open configuration to the closed configuration, causing the motor to depend on whether the value of the tissue compression parameter is higher than A first threshold is used to increase the time to transition the jaws to the closed configuration, and feedback is provided based on whether the value of the tissue compression parameter is below a second threshold.

实施例2—根据实施例1所述的外科器械，其中组织压缩参数包括由马达施加的使钳口转变到闭合构型的力。Embodiment 2—The surgical instrument ofEmbodiment 1, wherein the tissue compression parameter includes a force applied by the motor to transition the jaws to the closed configuration.

实施例3—根据实施例1所述的外科器械，其中组织压缩参数包括由马达施加的使钳口转变到闭合构型的力的时间变化率。Embodiment 3—The surgical instrument ofEmbodiment 1, wherein the tissue compression parameter includes a time rate of change of force applied by the motor to transition the jaws to the closed configuration.

实施例4—根据实施例1、2或3所述的外科器械，其中反馈包括对于附属物增强的建议。Embodiment 4—The surgical instrument ofEmbodiment 1, 2, or 3, wherein the feedback includes a recommendation for appendage enhancement.

实施例5—根据实施例1、2、3或4所述的外科器械，其中控制电路被配置成能够通过减小马达使钳口转变到闭合构型的速率来增加使钳口转变到闭合构型的时间。Embodiment 5—The surgical instrument ofEmbodiment 1, 2, 3, or 4, wherein the control circuit is configured to increase the transition of the jaws to the closed configuration by reducing the rate at which the motor transitions the jaws to the closed configuration type of time.

实施例6—根据实施例1、2、3或4所述的外科器械，其中控制电路被配置成能够通过在使钳口转变到闭合构型时增加马达暂停的时间长度来增加使钳口转变到闭合构型的时间。Embodiment 6—The surgical instrument ofEmbodiment 1, 2, 3, or 4, wherein the control circuit is configured to increase the transition of the jaws by increasing the length of time the motor pauses when transitioning the jaws to the closed configuration time to closed configuration.

实施例7—根据实施例1、2、3或4所述的外科器械，其中控制电路被配置成能够通过降低稳定阈值以在使钳口转变到闭合构型时使马达停止来增加使钳口转变到闭合构型的时间。Embodiment 7—The surgical instrument ofEmbodiments 1, 2, 3, or 4, wherein the control circuit is configured to increase the rate of movement of the jaws by lowering the stability threshold to stop the motor when transitioning the jaws to the closed configuration Time to transition to closed configuration.

实施例8—一种外科器械，该外科器械包括端部执行器。该端部执行器包括能够在打开构型和闭合构型之间转变的钳口，以及沿钳口中的每个的组织接触表面设置的一个或多个传感器。该一个或多个传感器被配置成能够检测与组织的接触。外科器械还包括可操作地联接到钳口的马达。该马达被构造成能够使钳口在打开构型和闭合构型之间转变。外科器械还包括联接到该一个或多个传感器和马达的控制电路。该控制电路被配置成能够确定组织接触钳口的组织接触表面的初始接触点，确定在该初始接触点处钳口之间的间距，确定组织接触表面与组织之间的接触程度，致使马达以对应于在初始接触点处钳口之间的间距以及组织接触表面与组织之间的接触程度的速率使钳口转变到闭合构型，并且致使马达根据由马达施加的使钳口转变到闭合构型的力是否超过阈值来调节使钳口转变到闭合构型的速率。阈值对应于在初始接触点处钳口之间的间距以及组织接触表面与组织之间的接触程度。Embodiment 8—A surgical instrument including an end effector. The end effector includes jaws that are transitionable between an open configuration and a closed configuration, and one or more sensors disposed along the tissue-contacting surface of each of the jaws. The one or more sensors are configured to detect contact with tissue. The surgical instrument also includes a motor operably coupled to the jaws. The motor is configured to transition the jaws between an open configuration and a closed configuration. The surgical instrument also includes a control circuit coupled to the one or more sensors and the motor. The control circuit is configured to determine an initial contact point of the tissue-contacting surface of the tissue-contacting jaws, determine the spacing between the jaws at the initial contact point, determine the degree of contact between the tissue-contacting surface and the tissue, and cause the motor to A rate corresponding to the spacing between the jaws and the degree of contact between the tissue-contacting surface and the tissue at the initial contact point transitions the jaws to the closed configuration and causes the motor to transition the jaws to the closed configuration in accordance with the applied force by the motor. The rate at which the jaws transition to the closed configuration is regulated by whether the force of the type exceeds a threshold. The threshold corresponds to the spacing between the jaws and the degree of contact between the tissue contacting surface and the tissue at the initial contact point.

实施例9—根据实施例8所述的外科器械，其中该一个或多个传感器包括压力传感器。Embodiment 9—The surgical instrument ofEmbodiment 8, wherein the one or more sensors comprise pressure sensors.

实施例10—根据实施例8所述的外科器械，其中该一个或多个传感器包括阻抗传感器。Embodiment 10—The surgical instrument ofEmbodiment 8, wherein the one or more sensors comprise impedance sensors.

实施例11—根据实施例8、9或10所述的外科器械，其中钳口之间的间距包括钳口之间的角度。Embodiment 11—The surgical instrument ofEmbodiment 8, 9, or 10, wherein the spacing between the jaws includes an angle between the jaws.

实施例12—根据实施例8、9或10所述的外科器械，其中钳口之间的间距包括钳口之间的间隙。Embodiment 12—The surgical instrument ofEmbodiment 8, 9, or 10, wherein the spacing between the jaws includes a gap between the jaws.

实施例13—一种外科器械，该外科器械包括端部执行器。该端部执行器包括钳口和接触传感器组件，该钳口被构造成能够在打开构型和闭合构型之间转变以抓持组织，该接触传感器组件被配置成能够感测抵靠该接触传感器组件的组织。外科器械还包括被配置成能够感测钳口的构型的位置传感器和联接到钳口的马达。该马达被构造成能够使钳口在打开构型和闭合构型之间转变。外科器械还包括联接到接触传感器组件、位置传感器和马达的控制电路。该控制电路被配置成能够确定组织接触钳口的初始接触点，经由位置传感器确定在初始接触点处钳口的构型，经由接触传感器组件确定在初始接触点处组织与钳口之间的组织接触量，根据在初始接触点处钳口的构型和组织接触量来设定马达使钳口转变到闭合构型的闭合速率，根据在初始接触点处钳口的构型和组织接触量来设定闭合阈值，并且根据由马达施加的力来控制马达，以使钳口相对于阈值转变到闭合构型。Embodiment 13—A surgical instrument including an end effector. The end effector includes a jaw configured to transition between an open configuration and a closed configuration to grasp tissue, and a contact sensor assembly configured to sense against the contact Organization of sensor components. The surgical instrument also includes a position sensor configured to sense the configuration of the jaws and a motor coupled to the jaws. The motor is configured to transition the jaws between an open configuration and a closed configuration. The surgical instrument also includes a control circuit coupled to the contact sensor assembly, the position sensor, and the motor. The control circuit is configured to be able to determine an initial contact point of the tissue contacting jaws, determine the configuration of the jaws at the initial contact point via the position sensor, determine the tissue between the jaws at the initial contact point via the contact sensor assembly The amount of contact, based on the configuration of the jaws and the amount of tissue contact at the initial point of contact, sets the rate at which the motor transitions the jaws to the closed configuration, based on the configuration of the jaws and the amount of tissue contact at the point of initial contact A closing threshold is set, and the motor is controlled according to the force applied by the motor to transition the jaws to a closed configuration relative to the threshold.

实施例14—根据实施例13所述的外科器械，其中传感器组件包括压力传感器。Embodiment 14—The surgical instrument ofEmbodiment 13, wherein the sensor assembly includes a pressure sensor.

实施例15—根据实施例13所述的外科器械，其中传感器组件包括阻抗传感器。Embodiment 15—The surgical instrument ofEmbodiment 13, wherein the sensor assembly comprises an impedance sensor.

实施例16—根据实施例13、14或15所述的外科器械，其中钳口的构型对应于钳口之间的角度。Embodiment 16—The surgical instrument ofEmbodiment 13, 14, or 15, wherein the configuration of the jaws corresponds to the angle between the jaws.

实施例17—根据实施例13、14或15所述的外科器械，其中钳口的构型对应于钳口之间的间隙。Embodiment 17—The surgical instrument ofEmbodiment 13, 14, or 15, wherein the configuration of the jaws corresponds to the gap between the jaws.

用于基于术前信息调节端部执行器参数的系统System for adjusting end effector parameters based on preoperative information

本公开的各方面被呈现为用于调节由外科器械的控制电路所执行的闭合控制程序实现的闭合阈值和闭合速率，其中基于术前信息进行调节。调节闭合阈值可以是由计算机实现的交互式外科系统(包括一个或多个外科系统102和基于云的分析医疗系统诸如云104、204，为清楚起见，其被称为云104)执行态势感知的一个示例。例如，可基于从云104接收的或由外科集线器或外科器械确定的围术期信息将闭合阈值调节到患者特定的闭合阈值。如本文所用，围术期信息包括术前信息、术中信息和术后信息。Aspects of the present disclosure are presented for adjusting closure thresholds and closure rates achieved by a closure control program executed by a control circuit of a surgical instrument, wherein the adjustment is based on preoperative information. Adjusting the closure threshold may be performed by computer-implemented interactive surgical systems (including one or moresurgical systems 102 and cloud-based analytical medical systems such asclouds 104, 204, which are referred to ascloud 104 for clarity) to perform situational awareness an example. For example, the closure threshold may be adjusted to a patient-specific closure threshold based on perioperative information received from thecloud 104 or determined by the surgical hub or surgical instrument. As used herein, perioperative information includes preoperative information, intraoperative information, and postoperative information.

术前信息是指在利用外科器械执行外科操作之前接收的信息，而术中信息是指在外科操作期间(例如，在执行外科操作的步骤时)接收的信息。具体地讲，计算机实现的交互式外科系统可确定或推断用于特定手持式智能外科器械的端部执行器闭合参数，诸如适当的端部执行器闭合阈值和闭合速率算法。这种推断可基于与要执行的外科手术相关的以及与对应患者相关的上下文信息。上下文信息可包括或基于围术期信息来确定。外科器械可以是本公开中描述的任何合适的外科器械，诸如外科器械112、600、700、750、790、150010。为清楚起见，参考外科器械112。Preoperative information refers to information received prior to performing a surgical procedure with a surgical instrument, while intraoperative information refers to information received during a surgical procedure (eg, while performing steps of a surgical procedure). In particular, the computer-implemented interactive surgical system may determine or infer end effector closure parameters for a particular handheld smart surgical instrument, such as appropriate end effector closure thresholds and closure rate algorithms. This inference may be based on contextual information related to the surgical procedure to be performed and related to the corresponding patient. Contextual information may include or be determined based on perioperative information. The surgical instrument may be any suitable surgical instrument described in this disclosure, such assurgical instruments 112 , 600 , 700 , 750 , 790 , 150010 . For clarity, reference is made tosurgical instrument 112 .

围术期信息，诸如围术期诊断的疾病和治疗，可影响正由外科器械112处理的组织的性质或特性。例如，患者可能先前已被诊断出患有癌症并且已接受放射治疗以治疗该癌症。因此，该术前信息将表明患者的组织可具有增加的硬度特性。然而，当前应用的闭合控制程序可能无法解决这种增加的硬度。因此，使用闭合控制程序根据一般闭合速率算法来执行外科手术可由于患者组织的过度压缩而导致对组织的不必要创伤或损伤。另外，在外科操作期间，可诸如通过识别正在处理多种潜在类型的组织中的哪种组织类型来分析术中信息。不同类型的组织也可具有不同的组织特性，诸如组织硬度。因此，术中信息的变化可用于执行术中调节，作为围术期调节的替代或补充。总之，闭合控制程序可能不考虑应根据围术期信息(诸如组织类型、正在执行的外科手术和已经执行的外科步骤)来应用不同的闭合速率阈值。Perioperative information, such as perioperatively diagnosed diseases and treatments, may affect the properties or characteristics of the tissue being processed bysurgical instrument 112 . For example, a patient may have been previously diagnosed with cancer and received radiation therapy to treat the cancer. Thus, this preoperative information will indicate that the patient's tissue may have increased stiffness properties. However, currently applied closure control procedures may not address this increased stiffness. Thus, using a closure control program to perform a surgical procedure according to a general closure rate algorithm may result in unnecessary trauma or damage to the tissue due to excessive compression of the patient's tissue. Additionally, during a surgical procedure, intraoperative information can be analyzed, such as by identifying which of a number of potential types of tissue is being processed. Different types of tissue may also have different tissue properties, such as tissue stiffness. Therefore, changes in intraoperative information can be used to perform intraoperative adjustments as an alternative to or in addition to perioperative adjustments. In summary, closure control procedures may not take into account that different closure rate thresholds should be applied depending on perioperative information such as tissue type, surgical procedure being performed, and surgical steps performed.

当用外科器械112执行外科操作时，可能期望外科器械考虑不同的组织类型以及这些不同组织类型的各种特性。具体地讲，可能期望外科器械112在临床医生用外科器械执行外科操作之前以及在执行外科操作期间有效地确定组织类型和该组织类型的特性。When performing surgical procedures withsurgical instrument 112, it may be desirable for the surgical instrument to take into account different tissue types and various properties of these different tissue types. In particular, it may be desirable for thesurgical instrument 112 to effectively determine the tissue type and properties of the tissue type prior to and during the performance of a surgical procedure by a clinician with the surgical instrument.

因此，在一些方面，提供了基于云的分析医疗系统(例如，计算机实现的交互式外科系统100)，其中可考虑围术期信息以确定待处理组织的类型和处理前被处理组织的特性。例如，待执行的外科手术和其他患者信息可以是在执行外科手术之前检索的术前信息的实例。先前执行的外科操作步骤、其他手术史以及组织类型的变化是可考虑的术中信息的示例。一般来讲，该围术期信息可与指示闭合参数的传感器信号结合使用，以确定、推断或调节外科器械112的端部执行器的参数(例如，闭合变化率和闭合阈值)。端部执行器可以是本公开中描述的任何端部执行器，诸如端部执行器702、151600、150300、151340、152000、152100、152150、152200、152300、152350、152400、153460、153470、153502。为清楚起见，参考端部执行器702。Accordingly, in some aspects, a cloud-based analytical medical system (eg, computer-implemented interactive surgical system 100) is provided in which perioperative information can be considered to determine the type of tissue to be treated and the characteristics of the tissue being treated prior to treatment. For example, the surgical procedure to be performed and other patient information may be an example of preoperative information retrieved prior to performing the surgical procedure. Previously performed surgical procedures, other surgical histories, and changes in tissue type are examples of intraoperative information that may be considered. In general, this perioperative information may be used in conjunction with sensor signals indicative of closure parameters to determine, infer, or adjust parameters of the end effector of surgical instrument 112 (eg, closure rate of change and closure threshold). The end effector may be any end effector described in this disclosure, such asend effector 702, 151600, 150300, 151340, 152000, 152100, 152150, 152200, 152300, 152350, 152400, 153460, 153470, 153502. Reference is made to endeffector 702 for clarity.

分析围术期信息以获得闭合速率相关的态势感知可以多种方式实现。基于围术期信息，外科器械的控制电路诸如控制电路500、710、760、150700(上文参考图12、图15、图17，以及图29A至图29B所讨论的)可调节在所选择的闭合控制程序中使用的闭合变化率和闭合阈值输入。为清楚起见，参考控制电路500。控制电路500还可基于围术期信息来选择不同的控制程序。附加地或另选地，外科集线器诸如外科集线器106、206(为清楚起见称为外科集线器106)可从云104或外科器械112接收围术期信息。例如，外科集线器106可从云104接收患者的电子医疗记录(EMR)或基于外科器械112的组织接触或压力传感器(例如，如图24所示)确定的初始组织厚度测量结果。Analysis of perioperative information for situational awareness related to closure rates can be achieved in a number of ways. Based on the perioperative information, the control circuitry of the surgical instrument, such as thecontrol circuitry 500, 710, 760, 150,700 (discussed above with reference to Figures 12, 15, 17, and 29A-29B) may adjust at the selected The closure rate of change and closure threshold inputs used in the closure control program. Reference is made to controlcircuit 500 for clarity. Thecontrol circuit 500 may also select different control programs based on perioperative information. Additionally or alternatively, surgical hubs such assurgical hubs 106 , 206 (referred to assurgical hub 106 for clarity) may receive perioperative information fromcloud 104 orsurgical instrument 112 . For example,surgical hub 106 may receive from cloud 104 a patient's electronic medical record (EMR) or initial tissue thickness measurements determined based on tissue contact or pressure sensors of surgical instrument 112 (eg, as shown in FIG. 24 ).

然后，外科集线器106可分析所接收的围术期信息。基于该分析，外科集线器106然后可将信号发射到外科器械112以调节在所选择的闭合控制程序中使用的闭合变化率和闭合阈值输入。外科集线器106还可指示外科器械112选择不同的闭合控制程序，诸如通过控制电路选择不同的控制程序。不同控制程序的选择可基于从集线器106接收的信号或由外科器械112从集线器106接收更新的控制程序。云104还可执行用于调节闭合速率和所使用的最大阈值的分析。具体地讲，云104的处理器可分析围术期信息以确定例如用于改变对闭合控制程序的输入或选择由外科器械执行的不同的合适闭合控制程序的组织类型和特性。Thesurgical hub 106 can then analyze the received perioperative information. Based on this analysis, thesurgical hub 106 may then transmit signals to thesurgical instrument 112 to adjust the closure rate of change and closure threshold inputs used in the selected closure control procedure. Thesurgical hub 106 may also instruct thesurgical instrument 112 to select a different closure control program, such as through a control circuit to select a different control program. The selection of the different control programs may be based on signals received from thehub 106 or an updated control program received from thehub 106 by thesurgical instrument 112 .Cloud 104 may also perform analysis to adjust closure rates and maximum thresholds used. In particular, the processor ofcloud 104 may analyze perioperative information to determine tissue types and characteristics, eg, for changing inputs to closure control procedures or selecting a different suitable closure control procedure to be performed by a surgical instrument.

这样，云104可(例如，经由集线器106)指示外科器械112应用合适的闭合速率算法和闭合最大阈值。组织类型和特性还可基于指示闭合参数的传感器信号来确定。传感器可以是组织接触或压力传感器、力传感器、马达电流传感器、位置传感器、负荷传感器或其他合适的传感器，诸如上述传感器472、474、476、630、734、736、738、744a–744e、784、788、152408、153102、153112、153118、153126、153200、153438、153448、153450a、153450b、153474。为清楚起见，参考传感器474。传感器474被配置成能够传输指示外科器械112的参数的传感器信号。一些类型的围术期信息可在确定组织类型和特性之前存储在云104中。例如，患者EMR可存储在云104的存储器(例如，云数据库)中。一般来讲，外科器械112、集线器106或云104可分析围术期信息以确定用于态势感知的组织类型和特性。In this way,cloud 104 may instruct surgical instrument 112 (eg, via hub 106) to apply an appropriate closure rate algorithm and closure maximum threshold. Tissue types and properties may also be determined based on sensor signals indicative of closure parameters. The sensors may be tissue contact or pressure sensors, force sensors, motor current sensors, position sensors, load sensors, or other suitable sensors, such assensors 472, 474, 476, 630, 734, 736, 738, 744a-744e, 784, 788, 152408, 153102, 153112, 153118, 153126, 153200, 153438, 153448, 153450a, 153450b, 153474. Reference is made tosensor 474 for clarity.Sensors 474 are configured to transmit sensor signals indicative of parameters ofsurgical instrument 112 . Some types of perioperative information may be stored in thecloud 104 prior to the determination of tissue type and characteristics. For example, patient EMRs may be stored incloud 104 storage (eg, a cloud database). Generally, thesurgical instrument 112, thehub 106, or thecloud 104 may analyze perioperative information to determine tissue types and properties for situational awareness.

因此，基于围术期信息确定的组织类型和特性可用于主动调节闭合速率和所使用的最大阈值。即，可使用围术期信息来预测更有效的闭合参数(例如，端部执行器702参数)，使得由外科器械112应用的闭合控制程序使用考虑患者特定组织特性和正被处理的组织的类型的闭合速率和阈值。因此，使用如本文所述的闭合速率和阈值态势感知可有利地使外科器械112能够应用调节的闭合速率和阈值而不过度压缩待处理的组织。过度压缩可基于端部执行器702的第一钳口构件和第二钳口构件。第一钳口构件和第二钳口构件可分别为例如第一钳口构件152002、152152、152154和第二钳口构件152204、152254、152304。第一钳口构件和第二钳口构件也可指砧座716、766和钉仓718、768。为清楚起见，第一钳口构件被称为152002，而第二钳口构件被称为152204。第一钳口构件152002和第二钳口构件152004可限定端部执行器702的孔，该孔被限定为第一钳口构件152002和第二钳口构件152004之间的距离。Thus, tissue types and properties determined based on perioperative information can be used to actively adjust closure rates and maximum thresholds used. That is, perioperative information can be used to predict more effective closure parameters (eg,end effector 702 parameters), such that the closure control program applied bysurgical instrument 112 uses a method that takes into account patient-specific tissue characteristics and the type of tissue being treated Closure rate and threshold. Thus, use of closure rates and threshold situational awareness as described herein may advantageously enablesurgical instrument 112 to apply adjusted closure rates and thresholds without unduly compressing the tissue to be treated. The overcompression may be based on the first and second jaw members of theend effector 702 . The first and second jaw members may be, for example,first jaw members 152002, 152152, 152154 andsecond jaw members 152204, 152254, 152304, respectively. The first and second jaw members may also be referred to as theanvils 716 , 766 and thestaple cartridges 718 , 768 . For clarity, the first jaw member is referred to as 152002 and the second jaw member is referred to as 152204. Thefirst jaw member 152002 and thesecond jaw member 152004 can define a bore of theend effector 702 that is defined as the distance between thefirst jaw member 152002 and thesecond jaw member 152004.

例如，当端部执行器702的孔不必要地小时，可能会由于过度压缩而发生不必要的组织损伤或创伤。减小或防止这种过度压缩可通过使用围术期信息和/或来自传感器474的传感器信号进行调节来实现。另外，可最小化在初始闭合参数测量期间施加的压缩，诸如基于负荷传感器474(测量闭合力)和定位传感器474(测量第一钳口构件152002和第二钳口构件152004的位置)。一般来讲，传感器474可被配置成能够测量由外科器械112的端部执行器702施加的闭合力。除了根据围术期信息主动推断组织特性和类型之外，外科器械112、集线器106和云104中的一者或多者可使用来自传感器474(如图12所示)的感测测量结果来验证或在必要时对施加的闭合力、闭合速率和闭合阈值进行进一步调节。具体地，接触传感器可用于确定未变形的组织厚度。另外，负荷传感器474与位置传感器474组合可用于基于所施加的分别相对于第一钳口构件152002和第二钳口构件152004的位置的闭合力来确定组织厚度。这些验证或进一步的调节可在术前或术中执行。For example, when the bore of theend effector 702 is unnecessarily small, unnecessary tissue damage or trauma may occur due to excessive compression. Reducing or preventing such over-compression may be accomplished by adjusting using perioperative information and/or sensor signals fromsensor 474 . Additionally, compression applied during initial closure parameter measurements may be minimized, such as based on load sensor 474 (measuring closure force) and position sensor 474 (measuring the position offirst jaw member 152002 and second jaw member 152004). Generally speaking, thesensor 474 may be configured to measure the closing force applied by theend effector 702 of thesurgical instrument 112 . In addition to actively inferring tissue properties and types from perioperative information, one or more ofsurgical instrument 112,hub 106, andcloud 104 may use sensed measurements from sensors 474 (shown in FIG. 12) to verify Or make further adjustments to the applied closing force, closing rate and closing threshold if necessary. Specifically, contact sensors can be used to determine undeformed tissue thickness. Additionally, theload sensor 474 in combination with theposition sensor 474 can be used to determine tissue thickness based on the applied closing force relative to the position of thefirst jaw member 152002 and thesecond jaw member 152004, respectively. These verifications or further adjustments can be performed preoperatively or intraoperatively.

可连续地执行闭合参数态势感知。因此，临床医生或外科医生可持续使用围术期信息以视情况(例如，当执行外科手术的步骤时)调节端部执行器702的闭合参数(例如，闭合控制程序的闭合参数)。例如，当基于临床病史(例如，外科医生的常规做法)确定正在执行的外科手术的下一个步骤涉及血管组织时，可使用围术期信息来调节端部执行器702的闭合参数。在这种情况下，态势感知的外科器械112可以恒定的闭合变化率施加闭合力。此类围术期信息可与指示外科器械112的闭合参数的传感器信号结合使用，以调节端部执行器702的闭合参数(例如，闭合变化率和控制程序的闭合阈值)。围术期信息(诸如术中信息)可指示患者先前已通过放射治疗进行过治疗。Closed parameter situational awareness may be performed continuously. Accordingly, a clinician or surgeon may continue to use perioperative information to adjust closure parameters of the end effector 702 (eg, closure parameters of a closure control procedure) as appropriate (eg, when performing steps of a surgical procedure). For example, perioperative information may be used to adjust closure parameters ofend effector 702 when it is determined based on clinical history (eg, the surgeon's routine practice) that the next step in a surgical procedure being performed involves vascular tissue. In this case, the situationally awaresurgical instrument 112 may apply the closure force at a constant rate of closure change. Such perioperative information may be used in conjunction with sensor signals indicative of closure parameters ofsurgical instrument 112 to adjust closure parameters of end effector 702 (eg, closure rate of change and closure thresholds for control procedures). Perioperative information, such as intraoperative information, may indicate that the patient has been previously treated with radiation therapy.

基于该信息，控制电路500可推断增加的组织硬度，这是可在外科手术的整个步骤中考虑的组织特性。在一个示例中，这种增加的组织硬度可以是用于补充指示组织厚度的传感器信号的围术期信息，使得可实现对更适当的端部执行器702闭合参数值的调节。围术期信息还可指示所应用的外科手术为可由存储在云104中的数据确定的叶切除术。基于对叶切除术的了解，可确定待处理(例如，缝合)的可能组织类型包括血管、支气管组织和实质组织。Based on this information, thecontrol circuit 500 can infer increased tissue stiffness, which is a tissue property that can be considered throughout the steps of the surgical procedure. In one example, this increased tissue stiffness may be perioperative information used to supplement sensor signals indicative of tissue thickness so that adjustments to moreappropriate end effector 702 closure parameter values may be achieved. The perioperative information may also indicate that the surgical procedure applied was a lobectomy as may be determined by data stored in thecloud 104 . Based on knowledge of the lobectomy, possible tissue types to be treated (eg, sutured) can be determined to include blood vessels, bronchial tissue, and parenchymal tissue.

因此，基于围术期信息，可在开始组织的治疗处理之前预测或推断当前正由外科器械112处理的特定组织类型和组织的特性。例如，结合治疗、诊断和患者信息考虑初始组织厚度(当前正被处理的组织首次接触端部执行器702时测量的)可使得能够推断先前被照射的实质组织正被处理。因为正被处理的组织的类型和特性可在开始外科手术之前根据上下文确定，所以在治疗处理开始之前，由外科器械112的控制电路500实施的闭合控制程序可被有利地调节(例如，通过根据推断的组织类型或特性改变输入参数)或改变(例如，通过选择不同的控制程序)。具体地，可减小最大组织闭合阈值以解决正被处理的经照射的实质的硬度和脆性。最大阈值可指可施加的最大闭合力或最大闭合变化率。此外，还可调节闭合控制程序的闭合算法，以基于识别被照射的实质应用较慢、较保守的闭合速率。Thus, based on perioperative information, the particular tissue type and tissue properties currently being treated bysurgical instrument 112 can be predicted or inferred prior to initiating therapeutic treatment of the tissue. For example, considering the initial tissue thickness (measured when the tissue currently being treated first contacts the end effector 702) in conjunction with treatment, diagnostic and patient information may enable the inference that previously irradiated parenchymal tissue is being treated. Because the type and characteristics of the tissue being treated can be determined contextually prior to commencing a surgical procedure, the closure control program implemented by thecontrol circuitry 500 of thesurgical instrument 112 can advantageously be adjusted prior to initiation of the therapeutic procedure (eg, by The inferred tissue type or property changes input parameters) or changes (eg, by selecting a different control program). Specifically, the maximum tissue closure threshold may be reduced to account for the hardness and brittleness of the irradiated substance being processed. The maximum threshold may refer to the maximum closing force or the maximum closing change rate that can be applied. In addition, the closure algorithm of the closure control program can also be adjusted to apply a slower, more conservative closure rate based on identifying the substance being irradiated.

另外，可确定外科器械112是否为例如用于经照射实质的适当缝合外科器械112。如果围术期信息指示所选择的外科器械112不适用于其预期用途，则可生成警告。例如，如果可基于围术期信息推断当前正被处理的组织是支气管组织并且选择不合适的血管吻合外科器械112，则将向临床医生生成警告。一般来讲，外科器械112可基于外科器械类型、围术期信息和传感器信号之间的确定的、预测的或推断的不一致性来生成警示。此外，如上所述，术中信息也可用于在整个外科手术期间进行调节。例如，整个规程操作中的当前步骤可为处理刚性支气管组织，这通常将导致较慢的闭合速率。在初始调节之后也可进行进一步的调节。具体地，在操作期间可进行进一步的调节，例如当分析附加的术中信息(例如，感测到的信息)并且推断应修改或调节当前应用的闭合算法中施加的闭合力时，将较慢的闭合速率调节为较快的闭合速率。在某些情况下，这种调节也可在术后进行。Additionally, it may be determined whether thesurgical instrument 112 is a suitable staplingsurgical instrument 112 for use with irradiated parenchyma, for example. A warning may be generated if the perioperative information indicates that the selectedsurgical instrument 112 is not suitable for its intended use. For example, if it can be inferred based on perioperative information that the tissue currently being processed is bronchial tissue and an inappropriate vascular anastomoticsurgical instrument 112 is selected, a warning will be generated to the clinician. In general,surgical instrument 112 may generate alerts based on determined, predicted or inferred inconsistencies between surgical instrument type, perioperative information, and sensor signals. In addition, as discussed above, intraoperative information can also be used to make adjustments throughout the surgical procedure. For example, the current step in the overall procedure operation may be the treatment of rigid bronchial tissue, which will generally result in slower closure rates. Further adjustments can also be made after the initial adjustment. In particular, further adjustments may be made during operation, such as will be slower when analyzing additional intraoperative information (eg, sensed information) and inferring that the closure force applied in the currently applied closure algorithm should be modified or adjusted The closing rate is adjusted to a faster closing rate. In some cases, this adjustment can also be done postoperatively.

因此，在治疗处理开始之前或期间，可基于所确定的组织类型、组织特性和围术期信息来有利地调节闭合速率和阈值。因此，这种调节可有利地避免或最小化由过度应变导致的组织损伤，并且有利于来自缝合外科器械112的钉的适当成形。Thus, closure rates and thresholds can be advantageously adjusted based on the determined tissue type, tissue properties, and perioperative information before or during the initiation of a therapeutic treatment. Thus, such adjustment may advantageously avoid or minimize tissue damage caused by excessive strain and facilitate proper formation of staples from staplingsurgical instrument 112 .

图108和图109是根据本公开的各个方面的曲线图22000、22100，其示出了可基于围术期信息使用的各种端部执行器闭合阈值函数并且示出了经调节的端部执行器闭合控制算法。曲线图22100是曲线图22000的放大视图。在图108和图109中，在曲线图22000、22100的y轴22002、22102上指示了夹持或闭合力(FTC)，该力可被理解为施加到端部执行器702的夹持力。在x轴22004、22104上指示经过或跨越一个手术周期的时间。例如，图108的x轴22004指示周期跨度13秒。相比之下，图109的x轴22104跨度略少于2秒。如图108所示，默认的通用组织闭合阈值函数(表示为FTC_d 22006)通常可应用于控制在通用外科手术中使用的外科器械112的端部执行器702闭合。108 and 109 aregraphs 22000, 22100 illustrating various end effector closure threshold functions that may be used based on perioperative information and illustrating adjusted end effectors in accordance with various aspects of the present disclosure controller closure control algorithm.Graph 22100 is an enlarged view ofgraph 22000. In FIGS. 108 and 109 , the clamping or closing force (FTC), which can be understood as the clamping force applied to theend effector 702, is indicated on the y-axis 22002, 22102 of thegraphs 22000, 22100. Time over or across a surgical cycle is indicated on thex-axis 22004, 22104. For example, thex-axis 22004 of Figure 108 indicates that the period spans 13 seconds. In contrast, thex-axis 22104 of Figure 109 spans slightly less than 2 seconds. As shown in FIG. 108, a default generic tissue closure threshold function (denoted as FTC_d 22006) is generally applicable to controlend effector 702 closure ofsurgical instruments 112 used in generic surgical procedures.

在曲线图22000、22100上还显示了比默认FTC_d 22006更保守的其他阈值。然而，也可使用不太保守的阈值。如FTC_L1 22008和FTC_L2 22010所示，相对于默认的闭合力函数，可采用更保守的闭合阈值来减小外科器械的闭合力。FTC_L1 22008和FTC_L2 22010可以是存储在外科器械112、集线器106或云104的存储器中的阈值。附加地或另选地，FTC_d 22006可在手术周期期间的合适点处动态调节。动态调节可由控制电路500、对应的集线器106或云104执行。另外，曲线图22000、22100指示不同闭合阈值函数FTC_d、FTC_L1和FTC_L2 22006、22008、22010的对应斜率。由于闭合阈值可在对应的手术周期中作为时间的函数而改变，因此闭合阈值的斜率可在整个手术周期中是恒定的，或者在手术周期中视情况改变。Other thresholds that are more conservative than thedefault FTC_d 22006 are also shown ongraphs 22000, 22100. However, less conservative thresholds can also be used. As shown inFTC_L1 22008 andFTC_L2 22010, a more conservative closure threshold may be employed to reduce the closure force of the surgical instrument relative to the default closure force function.FTC_L1 22008 andFTC_L2 22010 may be thresholds stored in memory ofsurgical instrument 112 ,hub 106 , orcloud 104 . Additionally or alternatively, theFTC_d 22006 may be dynamically adjusted at appropriate points during the surgical cycle. Dynamic adjustment may be performed by thecontrol circuit 500 , the correspondinghub 106 or thecloud 104 . Additionally, thegraphs 22000, 22100 indicate the corresponding slopes of the different closure threshold functions FTC_d , FTC_L1 andFTC_L2 22006 , 22008 , 22010 . Since the closure threshold may vary as a function of time during the corresponding surgical cycle, the slope of the closure threshold may be constant throughout the surgical cycle, or may vary as appropriate during the surgical cycle.

换句话讲，由特定闭合阈值函数定义的瞬时变化率在手术周期的不同时间范围之间可能不同。例如，特定闭合阈值函数可定义在手术周期的开始附近相对较慢的增加速率和在手术周期的中间附近相对较快的增加速率。闭合阈值函数ΔFTC_d、ΔFTC_L1和ΔFTC_L222106、22108、22110为函数FTC_d、FTC_L1和FTC_L2 22006、22008、22010的放大视图，并且示出了闭合阈值函数的对应斜率。在图109的方面，可以看出斜率是恒定的，尽管斜率可视情况改变。可根据所选择的闭合阈值函数来调节闭合变化率。调节的一个示例由图108和图109中的“x”示出，并且在曲线图22100的放大视图中以更大的尺寸示出。在该示例中，调节如线22012、22112所示的闭合变化率，使得它们不超过ΔFTC_L2 22110。In other words, the instantaneous rate of change defined by a particular closure threshold function may differ between different time frames of the surgical cycle. For example, a particular closure threshold function may define a relatively slow rate of increase near the beginning of the surgical cycle and a relatively fast rate of increase near the middle of the surgical cycle. The closing threshold functions ΔFTC_d , ΔFTC_L1 andΔFTC_L2 22106, 22108, 22110 are enlarged views of the functions FTC_d , FTC_L1 andFTC_L2 22006, 22008, 22010 and the corresponding slopes of the closing threshold functions are shown. In the aspect of Figure 109, it can be seen that the slope is constant, although the slope may vary as appropriate. The rate of change of closure can be adjusted according to the selected closure threshold function. An example of an adjustment is shown by the "x" in Figures 108 and 109, and is shown at a larger size in the enlarged view of thegraph 22100. In this example, the closing rates of change as shown bylines 22012, 22112 are adjusted so that they do not exceedΔFTC_L2 22110.

在一个方面，外科器械112的马达诸如马达482、704a–704e、754、150082、150714可使第一钳口构件152002相对于端部执行器702的第二钳口构件152004运动。为清楚起见，参考马达482。马达482可根据由线22012、22112表示的闭合变化率和所选择的闭合阈值来运动或闭合端部执行器702。为此，控制电路500可调节由马达482消耗的电流，以基于所选择的阈值改变马达482的速度或扭矩。例如，曲线图22000、22100示出了控制电路500可如何在点“x”(如曲线图上所示)处调节马达482，使得外科器械112的闭合变化率参数改变以保持在所选择的阈值FTC_L2 22010内。可基于围术期信息来选择和确定可为患者特定阈值的FTC_L2 22010。In one aspect, a motor of thesurgical instrument 112 , such as themotors 482 , 704a - 704e , 754 , 150082 , 150714 , can move thefirst jaw member 152002 relative to thesecond jaw member 152004 of theend effector 702 .Motor 482 is referenced for clarity. Themotor 482 can move or close theend effector 702 according to the closure rate of change represented bylines 22012, 22112 and the selected closure threshold. To this end, thecontrol circuit 500 may adjust the current drawn by themotor 482 to vary the speed or torque of themotor 482 based on the selected threshold. For example,graphs 22000, 22100 illustrate how thecontrol circuit 500 may adjust themotor 482 at point "x" (as shown on the graph) such that the rate-of-closure parameter of thesurgical instrument 112 changes to remain at the selected threshold WithinFTC_L2 22010. TheFTC_L2 22010, which may be a patient-specific threshold, may be selected and determined based on perioperative information.

曲线图22000、22100中描绘的FTC阈值22006、22008、22010可以是由控制电路500执行的不同或相同闭合控制程序的参数。这些闭合控制程序可本地存储在外科器械112的存储器上或远程存储在集线器106或云104上。一般来讲，闭合阈值函数定义闭合阈值如何在周期中作为时间的函数而改变，从而在周期期间的任何时间点指示瞬时适用的闭合阈值。例如，闭合阈值可定义可施加以闭合端部执行器钳口的最大闭合力或所用闭合力的最大变化率。图108示出了使用阈值作为所用闭合力的最大变化率。在曲线图22000、22100上的所选择的时间点，相对于x轴22004、22104上的时间和y轴22002、22102上的FTC绘制的线22012、22112，指示在该时间点施加以闭合钳口152002、152004的瞬时力。TheFTC thresholds 22006 , 22008 , 22010 depicted in thegraphs 22000 , 22100 may be parameters of different or the same closed control procedure performed by thecontrol circuit 500 . These closure control programs may be stored locally on the memory of thesurgical instrument 112 or remotely on thehub 106 orcloud 104 . In general, the closure threshold function defines how the closure threshold varies over a cycle as a function of time, thereby indicating an instantaneously applicable closure threshold at any point in time during the cycle. For example, the closing threshold may define the maximum closing force that can be applied to close the end effector jaws or the maximum rate of change of closing force used. Figure 108 shows the use of a threshold as the maximum rate of change of closure force used.Lines 22012, 22112 plotted against time on thex-axis 22004, 22104 and FTC on the y-axis 22002, 22102 at the selected time point on thegraphs 22000, 22100, indicating that the closing jaw was applied at that time point Instantaneous forces of 152002, 152004.

如线22012所示，所施加的力随时间从时间零推移到时间t₁而增加，之后增加速率减慢到零，然后减慢到减小力的速率。在时间t₂之前不久，下降速率要快得多。在时间t₂之后，所施加的用于闭合钳口的力开始转变到零速率，然后以非零速率再次减小。如曲线图22100的线22112所示，所施加的用于闭合钳口152002、152004的闭合力在时间零到略早于0.5秒的时间(在x轴22104上示出)之间增加。在对应于曲线图22100上的“x”的时间，控制电路500可调节马达482以调节所选择的闭合算法，使得闭合的增加速率减小。这样，马达482可由控制电路500控制以保持在所选择的患者特定阈值ΔFTC_L2 22110内。此外，如曲线图22100所示，在对应于“x”的时间之后，施加的闭合力的较慢增加速率变为恒定速率。As shown byline 22012, the applied force increases over time from time zero to time_t1 , after which the rate of increase slows to zero, and then to the rate of decrease in force. Shortly before time_t2 , the rate of decline is much faster. After time_t2 , the force applied to close the jaws begins to transition to a zero rate and then decreases again at a non-zero rate. As shown byline 22112 ofgraph 22100, the closing force applied to closejaws 152002, 152004 increases between time zero and a time slightly earlier than 0.5 seconds (shown on x-axis 22104). At times corresponding to "x" ongraph 22100,control circuit 500 may adjustmotor 482 to adjust the selected closure algorithm such that the rate of increase in closure decreases. In this way, themotor 482 may be controlled by thecontrol circuit 500 to remain within the selected patient-specific threshold ΔFTC_L2 22110. Furthermore, as shown ingraph 22100, after a time corresponding to "x", the slower rate of increase in the applied closing force becomes a constant rate.

在一个方面，可在手术周期期间施加相同总量的所施加FTC。然而，闭合端部执行器所施加的力可视情况更逐渐地或立即地施加。这由变化率示出，变化率由线诸如线22012、22112的闭合变化率表示。尽管图109将三个所描绘的阈值ΔFTC_d、ΔFTC_L1和ΔFTC_L222106、22108、22110中的每一个示出为FTC_d、FTC_L1和FTC_L2 22006、22008、22010的放大视图，但是在一些方面，ΔFTC_d、ΔFTC_L1和ΔFTC_L2 22106、22108、22110表示不同的闭合阈值函数。换句话讲，控制电路500可从阈值FTC_d、FTC_L1和FTC_L2 22006、22008、22010中的任一个调节到阈值ΔFTC_d、ΔFTC_L1和ΔFTC_L2 22106、22108、22110，这些阈值在这种情况下将是完全不同的阈值。In one aspect, the same total amount of FTC applied may be applied during the surgical cycle. However, the force applied to close the end effector may be applied more gradually or immediately as appropriate. This is shown by the rate of change, which is represented by the closed rate of change of lines such aslines 22012, 22112. Although FIG. 109 shows each of the three depicted thresholds ΔFTC_d , ΔFTC_L1 andΔFTC_L2 22106, 22108, 22110 as enlarged views of FTC_d , FTC_L1 andFTC_L2 22006, 22008, 22010, in some Aspects, ΔFTC_d , ΔFTC_L1 andΔFTC_L2 22106, 22108, 22110 represent different closure threshold functions. In other words, thecontrol circuit 500 can adjust from any of the thresholds FTC_d , FTC_L1 andFTC_L2 22006, 22008, 22010 to the thresholds ΔFTC_d , ΔFTC_L1 andΔFTC_L2 22106, 22108, 22110, which are case would be a completely different threshold.

如上所述，闭合阈值函数的斜率有可能在一个手术周期期间改变。在这种情况下，可在整个手术周期内一致地或单独地调节动态斜率。一般来讲，闭合阈值参数调节可通过改变当前闭合控制程序的参数(例如，通过控制电路500直接改变由控制电路500实现的闭合阈值函数)或完全切换到新的闭合控制程序来实现。切换或调节可由控制电路500、集线器106或云104基于围术期信息来执行。例如，控制电路500可从当前控制程序切换到从云104接收的第二闭合控制程序。第二闭合控制程序也可从云104传输到集线器106。As mentioned above, the slope of the closure threshold function is likely to change during a surgical cycle. In this case, the dynamic slope can be adjusted consistently or individually throughout the surgical cycle. In general, closure threshold parameter adjustments can be accomplished by changing parameters of the current closure control program (eg, by directly changing the closure threshold function implemented bycontrol circuit 500 by control circuit 500) or by switching to a new closure control program entirely. The switching or adjustment may be performed by thecontrol circuit 500, thehub 106, or thecloud 104 based on perioperative information. For example, thecontrol circuit 500 may switch from the current control program to a second closed control program received from thecloud 104 . A second closure control program may also be transmitted from thecloud 104 to thehub 106 .

如上所述，用于处理组织的外科器械112、对应的集线器106和云104中的一者或多者可用于接收、推断或确定围术期信息，以便确定、推断或预测当前正被治疗处理的组织的类型和特性。这些闭合态势感知推断和预测可用于调节闭合变化率阈值。因此，除了FTC_d、ΔFTC_d 22006、22106之外，曲线图22000、21000还示出了例如第二组织闭合变化率阈值函数FTC_L1、ΔFTC_L1 22008、22108，外科器械112所使用的闭合算法可自动结合该函数。即，外科器械112可调节对当前闭合控制程序的输入或调节至将由控制电路500执行的不同控制程序。例如，态势感知的外科集线器106可基于位于胸腔中的目标区域来确定当前应用的外科手术是肺外科手术。继而，例如，可基于来自手术室中使用的另一装置的通气输出，将胸腔推断为目标区域。因此，确定处理的组织类型是肺组织。因此，外科器械112可从先前使用的阈值FTC_d 22006、22106调节为使用针对肺组织的默认闭合阈值函数FTC_L1 22008、22108。此类调节可在跨越y轴22004、22104的手术周期期间进行。As described above, one or more of thesurgical instrument 112, the correspondinghub 106, and thecloud 104 for treating tissue may be used to receive, infer, or determine perioperative information in order to determine, infer, or predict what is currently being treated. the type and characteristics of the organization. These closure situational awareness inferences and predictions can be used to adjust closure rate-of-change thresholds. Thus, in addition to FTC_d ,ΔFTC_d 22006, 22106,graphs 22000, 21000 show, for example, a second tissue closure rate-of-change threshold function FTC_L1 ,ΔFTC_L1 22008, 22108, the closure algorithm used bysurgical instrument 112 may This function is automatically combined. That is, thesurgical instrument 112 may adjust the input to the current closure control program or adjust to a different control program to be executed by thecontrol circuit 500 . For example, the situational awarenesssurgical hub 106 may determine that the currently applied surgical procedure is lung surgery based on the target area located in the chest cavity. Then, for example, the thorax may be inferred as the target area based on ventilation output from another device used in the operating room. Therefore, the type of tissue to be treated was determined to be lung tissue. Accordingly, thesurgical instrument 112 may be adjusted from the previously usedthreshold FTC_d 22006, 22106 to use the default closurethreshold function FTC_L1 22008, 22108 for lung tissue. Such adjustments can be made during a surgical cycle spanning the y-axis 22004, 22104.

例如，态势感知的外科集线器106可预测患者的肺将包括相对脆弱的组织。因此，如图108和图109所示，可将闭合阈值函数调节到较低的FTC阈值函数。闭合阈值可以是例如由端部执行器应用的最大允许FTC值或最大允许FTC变化率。肺组织的相对高硬度的推断可通过其他围术期信息来确认。例如，可分析存储在云104中的患者的EMR，以确定该患者先前已被诊断患有癌症并且已经受放射治疗。这种类型的术前信息可用于推断肺组织的组织特性，包括相对高的硬度和显著的液体含量(例如，组织中水的百分比)。For example, the situational awarenesssurgical hub 106 may predict that a patient's lungs will include relatively fragile tissue. Therefore, as shown in Figures 108 and 109, the closing threshold function can be adjusted to a lower FTC threshold function. The closure threshold may be, for example, the maximum allowable FTC value or the maximum allowable FTC rate of change applied by the end effector. The inference of relatively high stiffness of lung tissue can be confirmed by other perioperative information. For example, a patient's EMR stored incloud 104 may be analyzed to determine that the patient has been previously diagnosed with cancer and has been treated with radiation. This type of preoperative information can be used to infer tissue properties of lung tissue, including relatively high stiffness and significant fluid content (eg, percentage of water in the tissue).

除了确认初始预测之外，围术期信息还可用于根据不准确的初始预测进行调节。例如，外科器械112可基于组织具有比其实际具有的柔韧性更大的柔韧性的错误假设来应用次优闭合算法。在这种情况下，患者病史术前信息可用作错误假设校正的一部分。一般来讲，围术期信息可与指示闭合参数的传感器信号结合使用。有利的是，围术期信息可确认基于传感器信号确定的初始闭合算法，或者可用于将初始闭合算法调节为不同的、更合适的闭合算法。例如，传感器信号可指示感测到的施加的闭合力与端部执行器702孔位置(例如，第一钳口152002相对于第二钳口152004的位置)之间的关系。这种信号可用于确定组织硬度，并可与其他围术期信息结合使用，以在外科操作之前或期间调节闭合算法。In addition to confirming initial predictions, perioperative information can be used to adjust based on inaccurate initial predictions. For example, thesurgical instrument 112 may apply a suboptimal closure algorithm based on the false assumption that tissue has more flexibility than it actually has. In this case, preoperative information on the patient's medical history can be used as part of correction of false assumptions. In general, perioperative information can be used in conjunction with sensor signals indicative of closure parameters. Advantageously, the perioperative information can confirm the initial closure algorithm determined based on the sensor signals, or can be used to adjust the initial closure algorithm to a different, more appropriate closure algorithm. For example, the sensor signal may indicate a relationship between the sensed applied closing force and theend effector 702 bore position (eg, the position of thefirst jaw 152002 relative to the second jaw 152004). This signal can be used to determine tissue stiffness and can be used in conjunction with other perioperative information to adjust closure algorithms before or during surgical procedures.

因此，图108和图109的曲线图22000、22100示出了可基于患者特定的组织特性进一步调节默认肺组织阈值函数FTC_L1。如图108和图109所示，外科器械可例如基于患者特定的围术期信息从阈值函数FTC_L1 22008进一步调节为FTC_L2 22010或FTC_d 22006。因此，调节可发生在外科手术开始之前或外科手术期间。此外，可从FTC_d 22006调节为FTC_L2 22010，或者可简单地直接实现阈值函数FTC_L2 22010。基于围术期信息在任何可用的闭合阈值函数之间进行调节是可能的。Thus,graphs 22000, 22100 of Figures 108 and 109 show that the default lung tissue threshold function FTC_L1 can be further adjusted based on patient-specific tissue characteristics. As shown in Figures 108 and 109, the surgical instrument may be further adjusted from athreshold function FTC_L1 22008 toFTC_L2 22010 orFTC_d 22006, eg, based on patient-specific perioperative information. Thus, the adjustment may occur prior to the initiation of the surgical procedure or during the surgical procedure. Furthermore, it can be adjusted fromFTC_d 22006 toFTC_L2 22010, or thethreshold function FTC_L2 22010 can simply be implemented directly. It is possible to adjust between any of the available closure threshold functions based on perioperative information.

虽然图108和图109示出了对较低阈值的调节，但是对较高阈值的调节也是可能的。图108和图109中所示的阈值函数可对应于可由特定闭合控制程序实现的特定控制过程。另选地，控制过程可对应于不同的闭合控制程序。例如，控制电路500可直接修改所选择的闭合控制算法本身，或者切换到不同的闭合控制算法。也就是说，可修改例如由线22012、22112表示的特定闭合控制算法或特定的所应用的闭合变化率的闭合阈值函数。基于围术期信息，可在外科手术期间执行闭合阈值函数修改。另外，除了时间之外，阈值函数也可为一些其他参数的函数，诸如所使用的钉尺寸。Although Figures 108 and 109 show adjustments to lower thresholds, adjustments to higher thresholds are also possible. The threshold functions shown in Figures 108 and 109 may correspond to specific control procedures that may be implemented by specific closure control programs. Alternatively, the control process may correspond to a different closure control program. For example, thecontrol circuit 500 may directly modify the selected closure control algorithm itself, or switch to a different closure control algorithm. That is, a particular closure control algorithm, such as represented bylines 22012, 22112, or a particular closure threshold function for the rate of change of closure applied may be modified. Based on perioperative information, closure threshold function modifications can be performed during surgery. Additionally, in addition to time, the threshold function may also be a function of some other parameter, such as the pin size used.

附加地或另选地，闭合调节可包括仅将输入调节为闭合阈值函数。例如，如果组织特性诸如组织厚度是闭合阈值函数的输入，则围术期信息可用于预测性或推断性地修改输入，以便根据预测的或推断的组织厚度输入来修改输出闭合阈值。因此，可基于围术期信息修改所应用的闭合阈值函数。如上所述，所应用的闭合阈值函数由所应用的闭合控制算法定义。另外，可基于围术期信息来调节所施加的FTC或闭合力线22012、22112。Additionally or alternatively, the closing adjustment may include adjusting the input only to a closing threshold function. For example, if tissue properties such as tissue thickness are the input to the closure threshold function, perioperative information can be used to predictively or inferentially modify the input to modify the output closure threshold based on the predicted or inferred tissue thickness input. Therefore, the applied closure threshold function can be modified based on perioperative information. As mentioned above, the applied closure threshold function is defined by the applied closure control algorithm. Additionally, the applied FTC orclosure force 22012, 22112 can be adjusted based on perioperative information.

在一个方面，FTC或闭合力线22012、22112表示由控制电路500执行的对应闭合控制程序的闭合变化率参数。FTC线22012、22112也由所应用的闭合控制算法定义。在一个方面，如图108和图109中的“x”所示，所施加的闭合力可以在正在执行的外科手术的周期期间动态调节。这种动态调节也可以是态势感知的应用。换句话讲，可结合围术期信息以推断或预测在外科手术期间对阈值或阈值函数的调节。这样，如图108和图109所示，在对应于图108和图109中表示的“x”的一个或多个时间，所施加的FTC被调节或修改以保持在对应的瞬时闭合阈值内。总之，所应用的闭合控制算法可包括闭合阈值函数和闭合变化率，这两者均可基于围术期信息进行调节。In one aspect, the FTC or closingforce lines 22012 , 22112 represent the closing rate-of-change parameters of the corresponding closing control routine executed by thecontrol circuit 500 . The FTC lines 22012, 22112 are also defined by the applied closure control algorithm. In one aspect, as shown by "x" in Figures 108 and 109, the applied closure force can be dynamically adjusted during the cycle of the surgical procedure being performed. This dynamic adjustment can also be an application of situational awareness. In other words, perioperative information can be combined to infer or predict adjustments to thresholds or threshold functions during surgery. Thus, as shown in Figures 108 and 109, at one or more times corresponding to "x" represented in Figures 108 and 109, the applied FTC is adjusted or modified to remain within the corresponding instantaneous closure threshold. In summary, the applied closure control algorithm may include a closure threshold function and a closure rate of change, both of which can be adjusted based on perioperative information.

一般来讲，可基于正被处理组织的确定的、推断的或预测的特性或类型来执行对不同闭合阈值或不同闭合阈值函数的调节。如上所述，可基于围术期信息来确定、推断或预测组织特性或类型。对另一闭合阈值的调节可被理解为参考由外科器械112的马达482生成的最大扭矩或马达速度的变化率来调节最大阈值。围术期信息的各种实例可用于确定、推断或预测组织类型或组织特性。例如，水的量、肌肉性质和组织的脉管系统可影响将应用的闭合速率算法(包括闭合阈值)。在一个方面，这些性质以及其他组织类型和组织特性性质用于确定默认闭合阈值FTC_D 22006或任何其他初始闭合控制程序参数。In general, adjustments to different closure thresholds or functions of different closure thresholds may be performed based on determined, inferred, or predicted characteristics or types of tissue being treated. As discussed above, tissue properties or types can be determined, inferred, or predicted based on perioperative information. Adjustment of the other closure threshold may be understood as adjusting the maximum threshold with reference to the maximum torque generated by themotor 482 of thesurgical instrument 112 or the rate of change of the motor speed. Various instances of perioperative information can be used to determine, infer, or predict tissue types or tissue properties. For example, the amount of water, muscle properties, and tissue vasculature can affect the closure rate algorithm (including closure thresholds) that will be applied. In one aspect, these properties, along with other tissue type and tissue characteristic properties, are used to determine the defaultclosure threshold FTC_D 22006 or any other initial closure control program parameter.

因此，高脉管系统可能是用于推断具有相对低斜率的默认闭合阈值函数的组织特性。除了确定初始控制程序参数之外，如果术前信息诸如所应用的外科手术和手术史(例如，临床医生参考规程的外科步骤执行规程的典型例程)可用于推断具有高血红蛋白含量的血管组织正被靶向，则外科器械所应用的闭合变化率可被调节为较慢。因此，这些性质可用于在术前和术中确定控制程序参数。另外，围术期信息可用于确认血管组织规程中使用了合适的血管吻合器。Thus, high vasculature may be a tissue property for inferring a default closure threshold function with a relatively low slope. In addition to determining initial control procedure parameters, if preoperative information such as the surgical procedure applied and surgical history (eg, a typical routine for a clinician to perform the procedure with reference to the surgical steps of the procedure) can be used to infer that vascular tissue with high hemoglobin content is being targeted, the rate of change of closure applied by the surgical instrument can be adjusted to be slower. Therefore, these properties can be used to determine control procedure parameters preoperatively and intraoperatively. Additionally, perioperative information can be used to confirm the use of an appropriate vascular stapler in the vascular tissue procedure.

图110是根据本公开的一个方面的由计算机实现的交互式外科系统100调节闭合速率算法的方面的流程图22200。在步骤22202，确定当前闭合算法。这可指确定当前由外科器械112的控制电路500执行的闭合控制程序。如上文结合图108和图109所述，当前闭合算法或控制程序可包括闭合阈值函数(例如，闭合阈值参数)和所施加的闭合力(FTC)函数(例如，闭合变化率参数)。流程图22200接下来进行到步骤22204，在该步骤中接收并分析术前信息。如上所述，术前信息可包括基于组织接触传感器474的初始组织厚度、包括先前诊断和治疗的患者病史(例如，在存储在集线器或云中的患者信息EMR记录上列出)、临床病史诸如外科医生的典型外科例程、识别的外科器械和相关材料，以及识别的当前外科手术。在步骤22206，该术前信息可用于确定、推断或预测组织类型或组织特性。110 is aflowchart 22200 of an aspect of the computer-implemented interactivesurgical system 100 adjusting the closure rate algorithm in accordance with one aspect of the present disclosure. Atstep 22202, the current closure algorithm is determined. This may refer to determining the closure control procedure currently being performed by thecontrol circuitry 500 of thesurgical instrument 112 . As described above in connection with Figures 108 and 109, the current closure algorithm or control program may include a closure threshold function (eg, a closure threshold parameter) and an applied closure force (FTC) function (eg, a closure rate of change parameter).Flowchart 22200 then proceeds to step 22204 where preoperative information is received and analyzed. As noted above, preoperative information may include initial tissue thickness based ontissue contact sensor 474, patient medical history including previous diagnoses and treatments (eg, listed on patient information EMR records stored in a hub or cloud), clinical history such as The surgeon's typical surgical routine, identified surgical instruments and related materials, and identified current surgical procedures. Atstep 22206, this preoperative information may be used to determine, infer, or predict tissue type or tissue properties.

例如，如由组织接触传感器474测量的未变形的初始组织厚度可用于确定初始闭合算法。术前信息诸如患者肺部病史可用于确定当前正在执行的外科手术是胸腔规程，组织类型是肺组织。该术前信息还可用于确定对初始闭合算法的调节。附加地或另选地，通过比较非治疗性(或准非治疗性)初始组织压缩测量结果和闭合构件位置测量结果(例如，端部执行器的第一钳口和第二钳口的位置)所测得的初始组织硬度也可与术前信息结合使用。从外科手术室的通气装置接收的通气术前信息还可用于推断当前规程是胸腔手术。其他术前信息也可用于进一步预测所执行的特定胸腔规程。例如，基于云中指示患者患有癌症的患者EMR记录，可在步骤22206推断胸腔规程是肺叶切除术，以切除肺叶中的癌组织。For example, the undeformed initial tissue thickness as measured by thetissue contact sensor 474 can be used to determine the initial closure algorithm. Preoperative information such as the patient's lung history can be used to determine that the surgical procedure currently being performed is a thoracic procedure and the tissue type is lung tissue. This preoperative information can also be used to determine adjustments to the initial closure algorithm. Additionally or alternatively, by comparing non-therapeutic (or quasi-non-therapeutic) initial tissue compression measurements to closure member position measurements (eg, the position of the first and second jaws of the end effector) The measured initial tissue stiffness can also be used in conjunction with preoperative information. The ventilation preoperative information received from the ventilation device in the surgical theatre can also be used to infer that the current procedure is a thoracic surgery. Additional preoperative information can also be used to further predict specific thoracic procedures performed. For example, based on patient EMR records in the cloud indicating that the patient has cancer, it may be inferred atstep 22206 that the thoracic procedure is a lobectomy to remove cancerous tissue in a lung lobe.

此外，患者EMR记录还可指示，患者病史指示患者先前已接受针对癌症的放射治疗。在这种情况下，例如，可推断或预测被照射的肺组织将是刚性的，但也容易受到外科器械112施加单极RF能量的影响。这将是推断的组织特性的一个示例。另外，执行肺叶切除术的推断也可用于确定用于由外科器械112缝合的可能组织包括血管(PA/PV)、支气管和实质。在步骤22208，基于术前信息确定对当前闭合算法的调节并应用该调节。如上所述，可基于组织类型和组织特性来调节闭合阈值和所施加的FTC。例如，高组织硬度可能需要所施加的FTC的较慢且更保守的变化率(例如，如由FTC线22012、22112表示)，以及通常输出较低最大阈值的闭合阈值(例如，如由FTC_L2 22010和ΔFTC_L2 22110表示)。In addition, the patient EMR record may also indicate that the patient's medical history indicates that the patient has previously received radiation therapy for cancer. In this case, for example, it may be inferred or predicted that the irradiated lung tissue will be rigid, but also susceptible to the application of monopolar RF energy by thesurgical instrument 112 . This would be an example of an inferred tissue property. Additionally, the extrapolation of performing a lobectomy may also be used to determine possible tissues for suturing bysurgical instrument 112 including blood vessels (PA/PV), bronchi, and parenchyma. Atstep 22208, adjustments to the current closure algorithm are determined based on the preoperative information and applied. As discussed above, the closure threshold and applied FTC can be adjusted based on tissue type and tissue properties. For example, high tissue stiffness may require a slower and more conservative rate of change of the applied FTC (eg, as represented byFTC lines 22012, 22112), and a closure threshold that typically outputs a lower maximum threshold (eg, as represented byFTC_L2 22010 and ΔFTC_L2 22110).

最大阈值可指示第一钳口构件152002和第二钳口构件152004处于足以使外科器械112击发钉的位置的阈值。例如，相对较厚的组织可对应于较慢的闭合力变化率以及通常较高的最大闭合阈值。另外，可基于所确定的外科手术和临床病史来推断组织类型或结构，以用于在步骤22208处识别其他闭合算法调节。例如，主治外科医生记录的临床病史可指示首先处理血管的做法。可以推断，组织类型和结构是具有高血液含量(即，高脉管系统)的血管肺组织。基于该推断的组织类型和特性信息，可以确定对较慢的所施加FTC的变化率的调节将是有益的。总之，在步骤22208，基于推断的信息确定对当前闭合算法的调节，并且应用该调节。因此，可使用调节后的当前闭合算法并利用外科器械112来执行当前外科操作。The maximum threshold may indicate a threshold at which thefirst jaw member 152002 and thesecond jaw member 152004 are in a position sufficient for thesurgical instrument 112 to fire the staples. For example, relatively thicker tissue may correspond to a slower rate of change of closure force and generally a higher maximum closure threshold. Additionally, tissue type or structure may be inferred based on the determined surgical and clinical history for use atstep 22208 to identify other closure algorithm adjustments. For example, the clinical history recorded by the attending surgeon may indicate that the vessel is treated first. It can be inferred that the tissue type and structure is vascular lung tissue with high blood content (ie, high vasculature). Based on this inferred tissue type and characteristic information, it can be determined that adjustments to the slower rate of change of applied FTC would be beneficial. In summary, atstep 22208, an adjustment to the current closure algorithm is determined based on the inferred information, and the adjustment is applied. Accordingly, the current surgical operation may be performed using the adjusted current closure algorithm and utilizing thesurgical instrument 112 .

流程图22200然后进行到判定操作22210，在该操作处确定所识别的外科手术的任何步骤是否剩余。如果没有剩余步骤(即，对判定操作22210的回答为否)，则流程图22200在一些方面终止。然而，如果对判定操作22210的回答为是，则还存在剩余外科手术的另外步骤。因此，流程图22200的当前状态是操作中。在这种情况下，流程图进行到步骤22212，在该步骤中可接收并分析术中信息。例如，术中信息可指示在外科手术的该步骤期间处理的组织类型是实质。具体地，例如可基于临床病史推断组织是实质。该推断可结合组织接触传感器474的测量结果和负荷传感器474对闭合构件位置的测量结果进行。此外，临床病史可能表明，在用单极RF能量外科器械解剖后，主治外科医生常规地完成肺裂(肺胸膜的两倍折叠，即向内折叠至鞘肺实质)。在这种情况下，可基于先前完成的单极RF解剖推断出外科手术的当前步骤是肺实质组织。Flowchart 22200 then proceeds todecision operation 22210, where it is determined whether any steps of the identified surgical procedure remain. If there are no remaining steps (ie, the answer todecision operation 22210 is no), theflowchart 22200 terminates in some aspects. However, if the answer todecision operation 22210 is yes, then there are additional steps for the remaining surgical procedure. Therefore, the current state offlowchart 22200 is in operation. In this case, the flow diagram proceeds to step 22212 where intraoperative information may be received and analyzed. For example, intraoperative information may indicate that the type of tissue processed during this step of the surgical procedure is parenchymal. In particular, tissue can be inferred to be parenchymal, eg, based on clinical history. This inference may be made in conjunction with the measurement of thetissue contact sensor 474 and the measurement of the position of the closure member by theload sensor 474 . In addition, the clinical history may indicate that the attending surgeon routinely completes the fissure (double fold of the lung pleura, ie, inward to the sheath lung parenchyma) after dissection with a monopolar RF energy surgical instrument. In this case, it can be deduced that the current step of the surgical procedure is lung parenchyma based on previously completed monopolar RF anatomy.

另外，例如，外科集线器106可确定正在使用的外科器械112是否是用于实质击发的适当缝合器。初始组织接触传感器474的测量结果可指示组织相对较厚，诸如基于当端部执行器702完全打开(在最大钳口孔处)时接触第一钳口构件152002和第二钳口构件152004的长度的组织，这可与实质一致。此外，负荷传感器474对闭合构件位置的测量结果(如由闭合件与钳口孔曲线的比较来表示)可指示相对较高的组织硬度。该硬度特性可与被照射的实质一致，这是可通过参考云中的患者EMR数据来确认的预测。这样，例如在步骤22212处，传感器信号和围术期信息可结合使用。Additionally, for example, thesurgical hub 106 may determine whether thesurgical instrument 112 being used is an appropriate stapler for substantial firing. Measurements from the initialtissue contact sensor 474 may indicate that the tissue is relatively thick, such as based on the length of contact with thefirst jaw member 152002 and thesecond jaw member 152004 when theend effector 702 is fully open (at the largest jaw hole) organization, which may be consistent with the substance. Additionally, a measurement of the position of the closure member by the load cell 474 (as represented by a comparison of the closure to the jaw hole curve) may indicate relatively high tissue stiffness. This stiffness characteristic may be consistent with the irradiated substance, a prediction that may be confirmed by reference to patient EMR data in the cloud. Thus, for example atstep 22212, sensor signals and perioperative information may be used in combination.

基于该接收和分析的术中信息，可在判定操作22214处确定需要进一步调节。另一方面，如果判定操作22214处的回答为否，则流程图将返回至判定操作22210。当判定操作22214处的回答为是时，推断组织类型和组织特性，诸如确定实质组织结构和硬度特性，类似于上文在步骤22206处所述。随后，可在步骤22208处确定对当前应用的闭合算法的调节，并且应用该调节。具体地，关于正在处理刚性和脆弱的实质组织的推断可导致对所施加闭合力的更慢、更保守的变化率的调节。Based on this received and analyzed intraoperative information, it may be determined atdecision operation 22214 that further adjustments are required. On the other hand, if the answer atdecision operation 22214 is no, the flowchart will return todecision operation 22210. When the answer atdecision operation 22214 is yes, tissue type and tissue properties are inferred, such as determination of parenchymal tissue structure and stiffness properties, similar to that described above atstep 22206. Subsequently, adjustments to the currently applied closure algorithm may be determined atstep 22208 and applied. In particular, inferences that rigid and fragile parenchymal tissue is being processed can lead to slower, more conservative rate-of-change adjustments to the applied closure force.

因此，当前闭合算法可被调节为使闭合阈值和变化率最小化的算法。即，调节后的阈值可具有减小的最大闭合力阈值、闭合力的更渐进的变化率、闭合力阈值的减小的变化率或上述的某种组合或子组合。例如，在临床医生无意中超过闭合阈值的情况下，可设置等待时间。例如，超过闭合阈值可指示被压缩的组织或材料对于击发钉而言太厚，因此该等待时间可能是必要的。因此，等待时间可使得端部执行器702中的一些组织材料或流体能够排出或流出。在合适的等待时间后，确定组织可被适当地压缩以实现适当的端部执行器702构型，使得缝合外科器械112可击发钉。由于调节后的闭合算法更保守，因此可使用长等待时间。然而，临床医生可能能够通过手动选择外科器械112上的更快夹持协议使用来覆写该长等待时间或保守调节的闭合算法。Therefore, the current closure algorithm can be adjusted to one that minimizes the closure threshold and rate of change. That is, the adjusted threshold may have a reduced maximum closing force threshold, a more gradual rate of change in closing force, a reduced rate of change in closing force threshold, or some combination or subcombination of the foregoing. For example, a wait time can be set in the event that the clinician inadvertently exceeds the closure threshold. For example, exceeding the closure threshold may indicate that the compressed tissue or material is too thick to fire the staples, so this wait time may be necessary. Thus, the waiting time may allow some tissue material or fluid in theend effector 702 to drain or flow out. After a suitable waiting time, it is determined that the tissue can be properly compressed to achieve theappropriate end effector 702 configuration so that the staplingsurgical instrument 112 can fire the staples. Since the adjusted closure algorithm is more conservative, long wait times can be used. However, the clinician may be able to override this long-latency or conservatively adjusted closure algorithm by manually selecting faster gripping protocol usage on thesurgical instrument 112 .

在步骤22208处将该修改的闭合算法应用于实质组织时，流程图再次进行到判定操作22210。在此，回答可同样为“是”，因为存在外科手术的剩余步骤。例如，叶切除术随后可进行到血管吻合步骤。同样，在步骤22212处，接收并分析术中信息。例如，外科集线器可确定临床医生已选择了血管吻合器外科器械。另外，来自组织接触传感器474的初始测量结果可指示在闭合期间几乎立即发生组织接触。此外，组织接触可被确定为包围血管吻合器112的小区域，并且被限制在吻合器112的远侧上。负荷传感器474测量结果还可指示柔顺组织结构。另外，可推断组织可具有相对低的硬度，这可与肺部肺血管一致。此外，临床病史可能表明，主治外科医生通常将血管吻合器112用于血管，作为完成肺裂之后的步骤。因此，术中信息结合例如闭合参数传感器信号可用于推断组织类型和组织特性。具体地，可基于所选血管吻合器112的特定特性来预测血管组织正在被处理。例如，初始组织接触和负荷传感器474的测量结果可确认该初始预测。When the modified closure algorithm is applied to parenchymal tissue atstep 22208, the flowchart again proceeds todecision operation 22210. Here, the answer may also be "yes", since there are remaining steps of the surgical procedure. For example, a lobectomy can then proceed to a vascular anastomosis step. Likewise, atstep 22212, intraoperative information is received and analyzed. For example, the surgical hub may determine that the clinician has selected a vascular stapler surgical instrument. Additionally, initial measurements fromtissue contact sensor 474 may indicate that tissue contact occurs almost immediately during closure. In addition, tissue contact can be determined as a small area surrounding thevascular stapler 112 and limited to the distal side of thestapler 112 .Load cell 474 measurements may also be indicative of compliant tissue structure. Additionally, it can be inferred that the tissue may have a relatively low stiffness, which may be consistent with the pulmonary vasculature. Additionally, the clinical history may indicate that the attending surgeon typically applies thevascular stapler 112 to the vessel as a step after completion of the fissure. Thus, intraoperative information in combination with eg closure parameter sensor signals can be used to infer tissue type and tissue properties. In particular, vascular tissue may be predicted to be being processed based on specific characteristics of the selectedvascular stapler 112 . For example, measurements of initial tissue contact andload sensor 474 may confirm the initial prediction.

因此，在判定操作22214处可确定需要进一步调节，这致使流程图22200进行到步骤22206。在步骤22206处，可推断组织为具有相对低的组织厚度和硬度的血管组织。因此，流程图22200进行到步骤22208，在该步骤中，将先前应用的保守闭合算法调节为正常闭合算法。正常闭合算法可包括恒定的闭合变化率。另外，闭合阈值可高于用于实质组织的控制算法中使用的阈值。换句话讲，正常闭合算法可达到更高的最大施加闭合力，并且闭合变化率可比实质组织更快。外科器械还可经由合适的指示器(诸如显示特定颜色的发光二极管(LED)指示器)通知临床医生对正常闭合算法的调节。在另一个示例中，可在步骤22206处确定患者具有完成的肺裂。因此，在外科手术中还未执行实质组织的任何钉击发。响应于该确定，外科器械可提示临床医生诸如经由外科器械的显示器来确认该推断正确。然后，临床医生可手动选择用于外科手术的该步骤或阶段的适当闭合控制算法。附加地或另选地，外科器械112可默认为保守闭合算法，因为在步骤22206处执行的推断可能不是决定性的。在任何情况下，在步骤22208处应用调节后的闭合算法。Accordingly, atdecision operation 22214 it may be determined that further adjustment is required, which causesflowchart 22200 to proceed to step 22206. Atstep 22206, the tissue can be inferred to be vascular tissue with relatively low tissue thickness and stiffness. Accordingly,flowchart 22200 proceeds to step 22208, in which the previously applied conservative closing algorithm is adjusted to a normal closing algorithm. The normal closure algorithm may include a constant closure rate of change. Additionally, the closure threshold may be higher than the threshold used in control algorithms for parenchymal tissue. In other words, the normal closure algorithm can achieve a higher maximum applied closure force, and the rate of change of closure can be faster than parenchymal tissue. The surgical instrument may also notify the clinician of adjustments to the normal closure algorithm via a suitable indicator, such as a light emitting diode (LED) indicator displaying a particular color. In another example, it may be determined atstep 22206 that the patient has a completed fissure. Thus, no staple firing of parenchymal tissue has been performed during the surgical procedure. In response to the determination, the surgical instrument may prompt the clinician to confirm that the inference is correct, such as via the surgical instrument's display. The clinician can then manually select the appropriate closure control algorithm for that step or phase of the surgical procedure. Additionally or alternatively, thesurgical instrument 112 may default to a conservative closure algorithm, as the inference performed atstep 22206 may not be conclusive. In any event, the adjusted closure algorithm is applied atstep 22208.

继续描述肺叶切除术示例，流程图进行到判定操作22210。在判定操作22210处，可确定存在外科手术的剩余步骤。因此，在步骤22212处，接收并分析术中信息。基于术中信息，可推断正被处理的组织类型为支气管组织。此外，初始组织接触传感器474的测量结果可指示在端部执行器702的初始闭合期间，抓持在端部执行器702之间的组织几乎立即接触第一钳口构件152002和第二钳口构件152004，并且这种接触对应于缝合外科器械112的小区域。另外，这种接触被限制在钳口构件152002、152004的两侧上。Continuing with the description of the lobectomy example, the flowchart proceeds todecision operation 22210. Atdecision operation 22210, it may be determined that there are remaining steps of the surgical procedure. Thus, atstep 22212, intraoperative information is received and analyzed. Based on the intraoperative information, it can be inferred that the type of tissue being processed is bronchial tissue. Additionally, the measurements of the initialtissue contact sensor 474 may indicate that during initial closure of theend effector 702, tissue grasped between theend effectors 702 contacts thefirst jaw member 152002 and the second jaw member almost immediately 152004, and this contact corresponds to a small area of suturing thesurgical instrument 112. Additionally, this contact is limited to both sides of thejaw members 152002, 152004.

因此，可预测这种组织接触情况对应于支气管组织。如上所述，这些初始组织接触传感器474的测量结果可以是非治疗性的或准非治疗性的。此外，闭合负荷传感器474的测量结果(如由闭合件与钳口孔曲线的比较来表示)可指示与支气管组织一致的刚性组织结构。外科手术历史表明已在外科手术中使用了血管吻合器112，这也可意味着很可能已经进行了实质钉击发并且已经发生了显著的单极RF能量使用。例如，结合临床病史考虑的该外科手术历史可用于预测外科医生正在处理支气管组织。这一预测将与外科医生将支气管缝合作为叶切除术中的最后一步的常规做法是一致的。基于在步骤22212处分析这种类型的信息和其他合适的术中信息，可在判定操作22214处确定需要进一步调节。由于对判定操作22214的回答为是，因此流程图进行到步骤22206，在该步骤中推断出被处理的组织是具有正常组织硬度和厚度的支气管组织。Therefore, this tissue contact situation can be predicted to correspond to bronchial tissue. As noted above, these initialtissue contact sensor 474 measurements may be non-therapeutic or quasi-non-therapeutic. In addition, measurements of the closure load cell 474 (as represented by a comparison of the closure and jaw hole curves) may indicate rigid tissue structures consistent with bronchial tissue. The surgical history indicates that thevascular stapler 112 has been used in the surgical procedure, which may also mean that substantial staple firing has likely occurred and significant monopolar RF energy use has occurred. For example, this surgical history, considered in conjunction with the clinical history, can be used to predict that a surgeon is dealing with bronchial tissue. This prediction would be consistent with surgeons' routine practice of bronchial suturing as the last step in lobectomy. Based on analyzing this type of information and other suitable intraoperative information atstep 22212, it may be determined atdecision operation 22214 that further adjustments are required. Since the answer todecision operation 22214 is yes, the flowchart proceeds to step 22206 where it is concluded that the tissue being processed is bronchial tissue of normal tissue stiffness and thickness.

在一个方面，可容易地断定被处理的组织是支气管组织，因为外科器械112仅被配置用于特定组织类型。例如，外科器械112可仅适于击发用于支气管的钉。相反地，外科器械112可仅适于击发用于实质组织的钉。在这种情况下，可由外科器械112生成警告，因为外科医生试图用专用于实质组织的钉来处理支气管组织。该警告可以是听觉警告、视觉警告或一些其他适当的警告。在另一个示例中，如果血管吻合器112被选择用于与支气管组织一起使用，则可由血管吻合器112提供警告。如上所述，可基于围术期信息来确定正被处理的组织是血管吻合器被禁用的支气管组织。类似地，当外科器械112用于与它们不兼容的组织类型或特性时，可使用其他围术期信息(诸如闭合负载和钉仓选择)来提供警告。如上所述，使用围术期信息进行的推断可结合闭合参数传感器信号进行。在所有情况下，可实施安全检查以确保正在使用的外科器械112对于正在处理的组织是安全的。In one aspect, the tissue being processed can be readily concluded to be bronchial tissue because thesurgical instrument 112 is only configured for a particular tissue type. For example, thesurgical instrument 112 may only be adapted to fire staples for the bronchi. Conversely,surgical instrument 112 may only be adapted to fire staples for parenchymal tissue. In this case, an alert may be generated bysurgical instrument 112 because the surgeon is attempting to treat bronchial tissue with staples dedicated to parenchymal tissue. The warning may be an audible warning, a visual warning or some other suitable warning. In another example, a warning may be provided by thevascular stapler 112 if thevascular stapler 112 is selected for use with bronchial tissue. As described above, the tissue being processed may be determined to be bronchial tissue for which the vascular stapler is disabled based on perioperative information. Similarly, other perioperative information, such as closure load and cartridge selection, may be used to provide warnings whensurgical instruments 112 are used with tissue types or properties that are incompatible with them. As mentioned above, inferences using perioperative information can be made in conjunction with closure parameter sensor signals. In all cases, safety checks can be performed to ensure that thesurgical instrument 112 being used is safe for the tissue being processed.

根据推断的组织类型和特性，在步骤22208处，对当前闭合算法进行调节。尽管可确定恒定的闭合速率是合适的，但闭合速率可被调节为更快或更慢，具体取决于例如所推断的支气管组织特性。可以相同或类似的方式修改闭合阈值。此外，还可调节当前闭合算法，使得如果并且当外科器械112超过瞬时适用的闭合阈值时，自动启用或建议更长的等待时间。例如，支气管组织的该等待时间可长于用于实质组织的等待时间。如上所述，例如，经由LED指示器通知外科医生对闭合算法的选定调节。临床医生也可以覆写为更长的等待时间，使得在适当的情况下可允许外科医生击发缝合器外科器械112。流程图22200然后进行到步骤22212，在该步骤中可确定不存在剩余外科手术的另外步骤。Based on the inferred tissue type and properties, atstep 22208, the current closure algorithm is adjusted. Although a constant closure rate may be determined to be appropriate, the closure rate may be adjusted to be faster or slower, depending, for example, on inferred bronchial tissue properties. The closure threshold can be modified in the same or similar manner. Additionally, the current closure algorithm may also be adjusted such that a longer wait time is automatically enabled or recommended if and when thesurgical instrument 112 exceeds the instantaneously applicable closure threshold. For example, this waiting time for bronchial tissue may be longer than that for parenchymal tissue. As described above, the surgeon is notified of selected adjustments to the closure algorithm, eg, via LED indicators. The clinician may also override a longer wait time so that the surgeon may be allowed to fire the staplersurgical instrument 112 under appropriate circumstances.Flowchart 22200 then proceeds to step 22212, where it may be determined that there are no additional steps for surgery remaining.

在一个方面，流程图22200可由控制电路实现。然而，在其他方面，流程图22200可由外科集线器106或云104实现。另外，虽然步骤22204和22212分别根据术前信息和术中信息进行描述，但它们并不限于这种方式。具体地，通常可接收和分析围术期信息，而不是特定的术前或术中信息。如上所述，围术期信息涵盖术前、术中和术后信息。此外，传感器信号可与围术期信息结合用于上下文和推断性闭合算法调节。In one aspect,flowchart 22200 may be implemented by a control circuit. However, in other aspects,flowchart 22200 may be implemented bysurgical hub 106 orcloud 104 . Additionally, althoughsteps 22204 and 22212 are described in terms of preoperative and intraoperative information, respectively, they are not limited in this manner. Specifically, perioperative information is often received and analyzed, rather than specific preoperative or intraoperative information. As mentioned above, perioperative information covers preoperative, intraoperative and postoperative information. Additionally, sensor signals can be combined with perioperative information for contextual and inferential closure algorithm adjustments.

实施例Example

在以下实施例中阐述了本文在标题“用于基于术前信息调节端部执行器参数的系统”下描述的主题的各个方面：Various aspects of the subject matter described herein under the heading "System for Adjusting End Effector Parameters Based on Preoperative Information" are set forth in the following examples:

实施例1—一种外科系统，该外科系统包括外科器械。该外科器械包括端部执行器，该端部执行器包括第一钳口和第二钳口。第一钳口被构造成能够相对于第二钳口运动。外科器械还包括马达，该马达被构造成能够根据闭合变化率参数和闭合阈值参数使第一钳口相对于第二钳口运动。外科器械还包括传感器，该传感器被配置成能够传输指示端部执行器的闭合参数的传感器信号。外科系统还包括通信地联接到传感器的控制电路。控制电路被配置成能够接收围术期信息，其中围术期信息包括围术期疾病、围术期治疗和外科手术的类型中的一者或多者。控制电路还被配置成能够从传感器接收传感器信号，并且基于围术期信息和传感器信号来确定对闭合变化率参数和闭合阈值参数的调节。Embodiment 1—A surgical system including a surgical instrument. The surgical instrument includes an end effector including a first jaw and a second jaw. The first jaw is configured to be movable relative to the second jaw. The surgical instrument also includes a motor configured to move the first jaw relative to the second jaw according to the closure rate of change parameter and the closure threshold parameter. The surgical instrument also includes a sensor configured to transmit a sensor signal indicative of a closure parameter of the end effector. The surgical system also includes a control circuit communicatively coupled to the sensor. The control circuit is configured to receive perioperative information, wherein the perioperative information includes one or more of perioperative disease, perioperative treatment, and type of surgery. The control circuit is also configured to receive the sensor signal from the sensor and determine adjustments to the closure rate of change parameter and the closure threshold parameter based on the perioperative information and the sensor signal.

实施例2—根据实施例1所述的外科系统，其中控制电路还被配置成能够基于围术期信息和传感器信号中的一者或多者来确定待由外科器械处理的组织的特性。Embodiment 2—The surgical system ofEmbodiment 1, wherein the control circuit is further configured to determine characteristics of tissue to be treated by the surgical instrument based on one or more of perioperative information and sensor signals.

实施例3—根据实施例2所述的外科系统，其中组织特性包括组织类型特性、肌肉特性、脉管特性、水含量特性、硬度特性和厚度特性中的一者或多者。Embodiment 3—The surgical system ofEmbodiment 2, wherein the tissue properties include one or more of tissue type properties, muscle properties, vascular properties, water content properties, stiffness properties, and thickness properties.

实施例4—根据实施例1、2或3所述的外科系统，其中控制电路还被配置成能够基于对闭合变化率参数和闭合阈值参数的所确定的调节来改变马达的速度。Embodiment 4—The surgical system ofEmbodiment 1, 2, or 3, wherein the control circuit is further configured to vary the speed of the motor based on the determined adjustments to the closure rate of change parameter and the closure threshold parameter.

实施例5—根据实施例1、2、3或4所述的外科系统，其中控制电路还被配置成能够基于外科器械的类型与围术期信息和传感器信号中的一者或多者之间的不一致性来生成警示。Embodiment 5—The surgical system ofEmbodiments 1, 2, 3, or 4, wherein the control circuit is further configured to be able to communicate based on the type of surgical instrument and one or more of perioperative information and sensor signals inconsistencies to generate alerts.

实施例6—根据实施例1、2、3、4或5所述的外科系统，其中围术期信息还包括待由外科器械处理的组织的类型、组织特性、临床病史以及与外科器械一起使用的钉仓的类型中的一者或多者。Embodiment 6—The surgical system ofembodiment 1, 2, 3, 4, or 5, wherein the perioperative information further includes the type of tissue to be treated by the surgical instrument, tissue characteristics, clinical history, and use with the surgical instrument One or more of the types of staple cartridges.

实施例7—根据实施例1、2、3、4、5或6所述的外科系统，其中闭合阈值参数是最大闭合力阈值，并且控制电路还被配置成能够基于达到最大闭合力阈值而禁用马达达预先确定的时间段。Embodiment 7—The surgical system ofEmbodiments 1, 2, 3, 4, 5, or 6, wherein the closure threshold parameter is a maximum closure force threshold and the control circuit is further configured to disable upon reaching the maximum closure force threshold The motor reaches a predetermined period of time.

实施例8—一种外科系统，该外科系统包括外科集线器，该外科集线器被配置成能够接收从云计算系统的远程数据库传输的围术期信息。外科集线器通信地联接到云计算系统。外科系统还包括通信地联接到外科集线器的外科器械。该外科器械包括端部执行器，该端部执行器包括第一钳口和第二钳口。第一钳口被构造成能够相对于第二钳口运动。端部执行器还包括马达，该马达被构造成能够根据从外科集线器接收的闭合控制程序的闭合变化率参数和闭合阈值参数使第一钳口相对于第二钳口运动。端部执行器还包括传感器，该传感器被配置成能够传输指示端部执行器的闭合参数的传感器信号。外科集线器还被配置成能够从传感器接收传感器信号，并且基于围术期信息和传感器信号来确定对闭合变化率参数和闭合阈值参数的调节。Embodiment 8 - A surgical system comprising a surgical hub configured to receive perioperative information transmitted from a remote database of a cloud computing system. The surgical hub is communicatively coupled to the cloud computing system. The surgical system also includes a surgical instrument communicatively coupled to the surgical hub. The surgical instrument includes an end effector including a first jaw and a second jaw. The first jaw is configured to be movable relative to the second jaw. The end effector also includes a motor configured to move the first jaw relative to the second jaw according to the closure rate of change parameter and the closure threshold parameter of the closure control program received from the surgical hub. The end effector also includes a sensor configured to transmit a sensor signal indicative of a closure parameter of the end effector. The surgical hub is also configured to receive sensor signals from the sensors and determine adjustments to the closure rate of change parameter and the closure threshold parameter based on the perioperative information and the sensor signals.

实施例9—根据实施例8所述的外科系统，其中闭合控制程序是第一闭合控制程序，外科集线器还被配置成能够将第二闭合控制程序传输到外科器械，并且第二闭合控制程序限定对闭合变化率参数的调节和对闭合阈值参数的调节。Embodiment 9—The surgical system ofEmbodiment 8, wherein the closure control program is a first closure control program, the surgical hub is further configured to transmit a second closure control program to the surgical instrument, and the second closure control program defines Adjustment of the closing rate of change parameter and adjustment of the closing threshold parameter.

实施例10—根据实施例9所述的外科系统，其中云计算系统被配置成能够将第二闭合控制程序传输到外科集线器，并且对闭合变化率参数的调节以及对第二闭合控制程序的闭合阈值参数的调节基于围术期信息来调节。Embodiment 10—The surgical system ofEmbodiment 9, wherein the cloud computing system is configured to enable the transmission of the second closure control program to the surgical hub, and the adjustment of the closure rate of change parameter and the closure of the second closure control program Adjustment of threshold parameters is adjusted based on perioperative information.

实施例11—根据实施例8、9或10所述的外科系统，其中外科器械被配置成能够基于外科器械的类型与围术期信息和传感器信号中的一者或多者之间的不一致性来生成警示。Embodiment 11—The surgical system ofEmbodiments 8, 9, or 10, wherein the surgical instrument is configured to be capable of inconsistencies based on the type of surgical instrument and one or more of perioperative information and sensor signals to generate an alert.

实施例12—根据实施例8、9、10或11所述的外科系统，其中闭合阈值参数是最大闭合力阈值，并且外科集线器还被配置成能够基于达到最大闭合力阈值而禁用马达达预先确定的时间段。Embodiment 12—The surgical system ofEmbodiments 8, 9, 10, or 11, wherein the closure threshold parameter is a maximum closure force threshold, and the surgical hub is further configured to disable the motor for a predetermined amount based on reaching the maximum closure force threshold time period.

实施例13—根据实施例8、9、10、11或12所述的外科系统，其中围术期信息包括围术期疾病、围术期治疗、外科手术的类型、临床病史、外科器械的类型、正由外科器械处理的组织的类型以及组织的特性中的一者或多者。Embodiment 13—The surgical system ofembodiment 8, 9, 10, 11, or 12, wherein the perioperative information includes perioperative disease, perioperative treatment, type of surgery, clinical history, type of surgical instrument , one or more of the type of tissue being treated by the surgical instrument, and the properties of the tissue.

实施例14—根据实施例9所述的外科系统，其中外科集线器还被配置成能够基于对闭合变化率参数和闭合阈值参数的所确定的调节来改变马达的速度。Embodiment 14—The surgical system ofEmbodiment 9, wherein the surgical hub is further configured to be able to vary the speed of the motor based on the determined adjustments to the closure rate of change parameter and the closure threshold parameter.

实施例15—一种外科器械，该外科器械包括端部执行器，该端部执行器包括第一钳口和第二钳口。第一钳口被构造成能够相对于第二钳口运动。外科器械还包括马达，该马达被构造成能够根据从外科集线器接收的第一闭合控制程序的闭合变化率参数和闭合阈值参数使第一钳口相对于第二钳口运动。外科器械还包括传感器，该传感器被配置成能够传输指示端部执行器的闭合参数的传感器信号，以及通信地联接到传感器和马达的控制电路。控制电路被配置成能够从传感器接收传感器信号，并且基于围术期信息和传感器信号来确定对闭合变化率参数和闭合阈值参数的调节。Embodiment 15 - A surgical instrument including an end effector including a first jaw and a second jaw. The first jaw is configured to be movable relative to the second jaw. The surgical instrument also includes a motor configured to move the first jaw relative to the second jaw in accordance with the closure rate of change parameter and the closure threshold parameter of the first closure control program received from the surgical hub. The surgical instrument also includes a sensor configured to transmit a sensor signal indicative of a closure parameter of the end effector, and a control circuit communicatively coupled to the sensor and the motor. The control circuit is configured to receive the sensor signal from the sensor and to determine adjustments to the closure rate of change parameter and the closure threshold parameter based on the perioperative information and the sensor signal.

实施例16—根据实施例15所述的外科系统，其中外科器械被配置成能够基于外科器械的类型与围术期信息和传感器信号中的一者或多者之间的不一致性来生成警示。Embodiment 16—The surgical system ofEmbodiment 15, wherein the surgical instrument is configured to generate an alert based on an inconsistency between the type of surgical instrument and one or more of perioperative information and sensor signals.

实施例17—根据实施例15或16所述的外科系统，其中控制电路还被配置成能够从第一闭合控制程序切换到从云计算系统接收的第二闭合控制程序，并且基于第二闭合控制程序改变马达的速度。Embodiment 17—The surgical system ofembodiment 15 or 16, wherein the control circuit is further configured to switch from a first closure control program to a second closure control program received from the cloud computing system, and based on the second closure control The program changes the speed of the motor.

实施例18—根据实施例15、16或17所述的外科系统，其中控制电路还被配置成能够基于围术期信息和传感器信号中的一者或多者来确定待由外科器械处理的组织的特性和类型。Embodiment 18—The surgical system ofEmbodiments 15, 16, or 17, wherein the control circuit is further configured to be able to determine tissue to be treated by the surgical instrument based on one or more of perioperative information and sensor signals characteristics and types.

实施例19—根据实施例15、16、17或18所述的外科系统，其中闭合阈值参数是最大闭合力阈值。Embodiment 19—The surgical system ofEmbodiments 15, 16, 17, or 18, wherein the closure threshold parameter is a maximum closure force threshold.

实施例20—根据实施例19所述的外科系统，其中闭合阈值参数是最大闭合力阈值。Embodiment 20—The surgical system of Embodiment 19, wherein the closure threshold parameter is a maximum closure force threshold.

在各个方面，根据本公开的传感器阵列的传感器可被放置于钉仓上。粘合剂掩模可在预先确定的位置处嵌入有传感器。在各个方面，传感器附接到钉仓上的凸耳，使得传感器被定位成高于钉仓的仓平台，以确保与组织接触。例如，可使用丝网印刷技术在聚酯基底上大量形成粘合剂掩模。导电垫可印刷到共同位置。In various aspects, sensors of a sensor array according to the present disclosure may be placed on a staple cartridge. The adhesive mask may be embedded with sensors at predetermined locations. In various aspects, the sensor is attached to a lug on the staple cartridge such that the sensor is positioned higher than the cartridge platform of the staple cartridge to ensure tissue contact. For example, an adhesive mask can be mass formed on a polyester substrate using screen printing techniques. Conductive pads can be printed in common locations.

在各种示例中，除了检测到与癌组织的接近度之外，本公开的端部执行器还可被配置成能够靶向特定组织中的特定癌症类型。如在Altenberg B和Greulich KO，Genomics，第84卷，第2004期，第1014-1020页的杂志出版物(其全文以引用方式并入本文)中所指出的，某些癌症通过糖酵解基因的过表达来表征，而其他癌症不通过糖酵解基因的过表达来表征。因此，本公开的端部执行器可配备有对某些癌组织具有高特异性的传感器阵列，这些癌组织通过糖酵解基因的过表达来表征，诸如肺癌或肝癌。In various examples, in addition to detecting proximity to cancerous tissue, end effectors of the present disclosure may also be configured to target specific cancer types in specific tissues. As noted in the journal publication of Altenberg B and Greulich KO, Genomics, Vol. 84, No. 2004, pp. 1014-1020, which is hereby incorporated by reference in its entirety, certain cancers are are characterized by overexpression of glycolytic genes, while other cancers are not characterized by overexpression of glycolytic genes. Thus, the end effectors of the present disclosure can be equipped with sensor arrays with high specificity for certain cancerous tissues characterized by overexpression of glycolytic genes, such as lung or liver cancer.

在各个方面，根据本公开的传感器阵列的传感器读数由外科器械传送到外科集线器(例如，外科集线器106、206)，以用于附加分析和/或用于态势感知。In various aspects, sensor readings of sensor arrays in accordance with the present disclosure are communicated by surgical instruments to surgical hubs (eg,surgical hubs 106, 206) for additional analysis and/or for situational awareness.

上述具体实施方式已通过使用框图、流程图和/或示例阐述了装置和/或方法的各种形式。只要此类框图、流程图和/或示例包含一个或多个功能和/或操作，本领域的技术人员就要将其理解为此类框图、流程图和/或示例中的每个功能和/或操作都可以单独和/或共同地通过多种硬件、软件、固件或实际上它们的任何组合来实施。本领域的技术人员将会认识到，本文公开的形式中的一些方面可作为在一台或多台计算机上运行的一个或多个计算机程序(如，作为在一个或多个计算机系统上运行的一个或多个程序)，作为在一个或多个处理器上运行的一个或多个程序(如，作为在一个或多个微处理器上运行的一个或多个程序)，作为固件，或作为实际上它们的任何组合全部或部分地在集成电路中等效地实现，并且根据本发明，设计电子电路和/或编写软件和/或硬件的代码将在本领域技术人员的技术范围内。另外，本领域的技术人员将会认识到，本文所述主题的机制能够作为多种形式的一个或多个程序产品进行分布，并且本文所述主题的示例性形式适用，而不管用于实际进行分布的信号承载介质的具体类型是什么。The foregoing detailed description has set forth various forms of apparatuses and/or methods through the use of block diagrams, flowcharts, and/or examples. So long as such block diagrams, flowcharts and/or examples include one or more functions and/or operations, those skilled in the art will understand each function and/or operation in such block diagrams, flowcharts and/or examples or operations may be implemented individually and/or collectively by a variety of hardware, software, firmware, or virtually any combination thereof. Those skilled in the art will recognize that some aspects of the forms disclosed herein may be implemented as one or more computer programs (eg, as one or more computer programs) running on one or more computers one or more programs), as one or more programs running on one or more processors (eg, as one or more programs running on one or more microprocessors), as firmware, or as Indeed any combination of them is equivalently implemented in whole or in part in an integrated circuit, and it would be within the skill of those skilled in the art to design electronic circuits and/or code software and/or hardware in accordance with the present invention. In addition, those skilled in the art will recognize that the mechanisms of the subject matter described herein can be distributed as one or more program products in a variety of forms, and that exemplary forms of the subject matter described herein are applicable regardless of use in actual implementation. What is the specific type of signal bearing medium distributed.

用于编程逻辑以执行各种所公开的方面的指令可存储在系统内的存储器内，诸如动态随机存取存储器(DRAM)、高速缓存、闪存存储器或其它存储器。此外，指令可经由网络或通过其它计算机可读介质来分发。因此，机器可读介质可包括用于存储或发射以机器(例如，计算机)读形式的信息的机构，但不限于软盘、光学盘、光盘、只读存储器(CD-ROM)、磁光盘、只读存储器(ROM)、随机存取存储器(RAM)、可擦除可编程只读存储器(EPROM)、电可擦除可编程只读存储器(EEPROM)、磁卡或光卡、闪存存储器、或经由电信号、光学信号、声学信号或其它形式的传播信号(例如，载波、红外信号、数字信号等)在因特网上发射信息时使用的有形的、机器可读存储装置。因此，非暂态计算机可读介质包括适于以机器(例如，计算机)可读的形式存储或发射电子指令或信息的任何类型的有形机器可读介质。Instructions for programming logic to perform the various disclosed aspects may be stored in memory within the system, such as dynamic random access memory (DRAM), cache, flash memory, or other memory. Furthermore, the instructions may be distributed over a network or through other computer-readable media. Thus, a machine-readable medium may include a mechanism for storing or transmitting information in a form readable by a machine (eg, a computer), but is not limited to a floppy disk, optical disk, optical disk, read only memory (CD-ROM), magneto-optical disk, only Read Memory (ROM), Random Access Memory (RAM), Erasable Programmable Read Only Memory (EPROM), Electrically Erasable Programmable Read Only Memory (EEPROM), magnetic or optical cards, flash memory, or via electrical A tangible, machine-readable storage device used when a signal, optical signal, acoustic signal, or other form of propagated signal (eg, carrier wave, infrared signal, digital signal, etc.) transmits information over the Internet. Accordingly, non-transitory computer-readable media includes any type of tangible machine-readable media suitable for storing or transmitting electronic instructions or information in a form readable by a machine (eg, a computer).

如本文任一方面所用，术语“控制电路”可指例如硬连线电路系统、可编程电路系统(例如，计算机处理器，该计算机处理器包括一个或多个单独指令处理内核、处理单元，处理器、微控制器、微控制器单元、控制器、数字信号处理器(DSP)、可编程逻辑装置(PLD)、可编程逻辑阵列(PLA)、场可编程门阵列(FPGA))、状态机电路系统、存储由可编程电路系统执行的指令的固件、以及它们的任何组合。控制电路可以集体地或单独地实现为形成更大系统的一部分的电路系统，例如集成电路(IC)、专用集成电路(ASIC)、片上系统(SoC)、台式计算机、膝上型计算机、平板计算机、服务器、智能电话等。因此，如本文所用，“控制电路”包括但不限于具有至少一个离散电路的电子电路、具有至少一个集成电路的电子电路、具有至少一个专用集成电路的电子电路、形成由计算机程序配置的通用计算设备的电子电路(如，至少部分地实施本文所述的方法和/或设备的由计算机程序配置的通用计算机，或至少部分地实施本文所述的方法和/或设备的由计算机程序配置的微处理器)、形成存储器设备(如，形成随机存取存储器)的电子电路，和/或形成通信设备(如，调节解调器、通信开关或光电设备)的电子电路。本领域的技术人员将会认识到，可以模拟或数字方式或它们的一些组合实施本文所述的主题。As used in any aspect herein, the term "control circuitry" may refer to, for example, hardwired circuitry, programmable circuitry (eg, a computer processor that includes one or more individual instruction processing cores, processing units, processing devices, microcontrollers, microcontroller units, controllers, digital signal processors (DSPs), programmable logic devices (PLDs), programmable logic arrays (PLAs), field programmable gate arrays (FPGAs), state machines Circuitry, firmware that stores instructions for execution by programmable circuitry, and any combination thereof. The control circuits may be implemented collectively or individually as circuitry forming part of a larger system, such as an integrated circuit (IC), an application specific integrated circuit (ASIC), a system on a chip (SoC), a desktop computer, a laptop computer, a tablet computer , servers, smartphones, etc. Thus, as used herein, "control circuit" includes, but is not limited to, an electronic circuit having at least one discrete circuit, an electronic circuit having at least one integrated circuit, an electronic circuit having at least one application specific integrated circuit, forming a general-purpose computer configured by a computer program Electronic circuitry of an apparatus (eg, a general-purpose computer configured by a computer program at least partially implementing the methods and/or apparatus described herein, or a microcomputer configured by a computer program at least partially implementing the methods and/or apparatus described herein) processors), electronic circuits that form memory devices (eg, random access memory), and/or electronic circuits that form communication devices (eg, modems, communication switches, or optoelectronic devices). Those skilled in the art will recognize that the subject matter described herein may be implemented in analog or digital fashion, or some combination thereof.

如本文的任何方面所用，术语“逻辑”可指被配置成能够执行前述操作中的任一者的应用程序、软件、固件和/或电路系统。软件可体现为记录在非暂态计算机可读存储介质上的软件包、代码、指令、指令集和/或数据。固件可以体现为在存储器设备中硬编码(例如，非易失性)的代码、指令或指令集和/或数据。As used in any aspect herein, the term "logic" may refer to applications, software, firmware and/or circuitry configured to perform any of the foregoing operations. Software may be embodied as a software package, code, instructions, sets of instructions, and/or data recorded on a non-transitory computer-readable storage medium. Firmware may be embodied as code, instructions or a set of instructions and/or data hardcoded (eg, non-volatile) in a memory device.

如本文任一方面所用，术语“部件”、“系统”、“模块”等可指计算机相关实体、硬件、硬件和软件的组合、软件或执行中的软件。As used in any aspect herein, the terms "component," "system," "module," etc. may refer to a computer-related entity, hardware, a combination of hardware and software, software, or software in execution.

如本文任一方面中所用，“算法”是指导致所需结果的有条理的步骤序列，其中“步骤”是指物理量和/或逻辑状态的操纵，物理量和/或逻辑状态可以(但不一定)采用能被存储、转移、组合、比较和以其它方式操纵的电或磁信号的形式。常用于指这些信号，如位、值、元素、符号、字符、术语、数字等。这些和类似的术语可与适当的物理量相关联并且仅仅是应用于这些量和/或状态的方便的标签。As used in any aspect herein, "algorithm" refers to an organized sequence of steps leading to a desired result, wherein "step" refers to the manipulation of physical quantities and/or logical states, which may (but need not be) ) take the form of electrical or magnetic signals capable of being stored, transferred, combined, compared and otherwise manipulated. Often used to refer to these signals as bits, values, elements, symbols, characters, terms, numbers, etc. These and similar terms may be associated with the appropriate physical quantities and are merely convenient labels applied to these quantities and/or states.

网络可包括分组交换网络。通信装置可能够使用所选择的分组交换网络通信协议来彼此通信。一个示例性通信协议可包括可允许使用传输控制协议/因特网协议(TCP/IP)进行通信的以太网通信协议。以太网协议可符合或兼容电气和电子工程师学会(IEEE)于2008年12月发布的名为“IEEE 802.3标准”的以太网标准和/或本标准的更高版本。另选地或附加地，通信装置可以能够使用X.25通信协议彼此通信。X.25通信协议可符合或符合国际电信联盟电信标准化部门(ITU-T)颁布的标准。另选地或附加地，通信装置可以能够使用帧中继通信协议彼此通信。帧中继通信协议可符合或符合国际电话和电话协商委员会(CCITT)和/或美国国家标准学会(ANSI)发布的标准。另选地或附加地，收发器可以能够使用异步传输模式(ATM)通信协议彼此通信。ATM通信协议可符合或兼容ATM论坛于2001年8月发布的名为“ATM-MPLS网络互通2.0”的ATM标准和/或该标准的更高版本。当然，本文同样设想了不同的和/或之后开发的连接取向的网络通信协议。The network may include a packet-switched network. The communication devices may be capable of communicating with each other using the selected packet-switched network communication protocol. An exemplary communication protocol may include an Ethernet communication protocol that may allow communication using Transmission Control Protocol/Internet Protocol (TCP/IP). The Ethernet protocol may conform to or be compatible with the Ethernet standard titled "IEEE 802.3 Standard" published by the Institute of Electrical and Electronics Engineers (IEEE) in December 2008 and/or later versions of this standard. Alternatively or additionally, the communication devices may be able to communicate with each other using the X.25 communication protocol. The X.25 communication protocol may conform or conform to standards promulgated by the International Telecommunication Union Telecommunication Standardization Sector (ITU-T). Alternatively or additionally, the communication devices may be able to communicate with each other using a frame relay communication protocol. The Frame Relay communication protocol may conform or conform to standards published by the Consultative Committee for International Telephone and Telephony (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) communication protocol. The ATM communication protocol may conform to or be compatible with the ATM standard named "ATM-MPLS Network Interworking 2.0" published by the ATM Forum in August 2001 and/or a higher version of the standard. Of course, different and/or later developed connection-oriented network communication protocols are also contemplated herein.

除非上述公开中另外明确指明，否则可以理解的是，在上述公开中，使用术语如“处理”、“估算”、“计算”、“确定”、“显示”等的讨论是指计算机系统或类似的电子计算设备的动作和进程，其操纵表示为计算机系统的寄存器和存储器内的物理(电子)量的数据并将其转换成相似地表示为计算机系统存储器或寄存器或其他此类信息存储、传输或显示设备内的物理量的其他数据。Unless explicitly stated otherwise in the above disclosure, it is understood that in the above disclosure, discussions using terms such as "processing," "estimating," "calculating," "determining," "displaying," etc. refer to computer systems or similar Actions and processes of electronic computing devices that manipulate data represented as physical (electronic) quantities within the registers and memory of a computer system and convert it into similarly represented computer system memory or registers or other such information storage, transmission or other data showing physical quantities within the device.

一个或多个部件在本文中可被称为“被配置成能够”、“可被配置成能够”、“可操作/可操作地”、“适于/可适于”、“能够”、“可适形/适形于”等。本领域的技术人员将会认识到，除非上下文另有所指，否则“被配置成能够”通常可涵盖活动状态的部件和/或未活动状态的部件和/或待机状态的部件。One or more components may be referred to herein as "configured to be able", "configurable to be able", "operable/operable", "adapted/adaptable", "capable", " Conformable/Conformable to" etc. Those skilled in the art will recognize that unless the context dictates otherwise, "configured to be able" may generally encompass active state components and/or inactive state components and/or standby state components.

术语“近侧”和“远侧”在本文中是相对于操纵外科器械的柄部部分的临床医生来使用的。术语“近侧”是指最靠近临床医生的部分，术语“远侧”是指远离临床医生定位的部分。还应当理解，为简洁和清楚起见，本文可结合附图使用诸如“竖直”、“水平”、“上”和“下”等空间术语。然而，外科器械在许多方向和位置中使用，并且这些术语并非限制性的和/或绝对的。The terms "proximal" and "distal" are used herein with respect to a clinician manipulating the handle portion of a 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 should also be understood that, for brevity and clarity, spatial terms such as "vertical," "horizontal," "upper," and "lower" may be used herein in connection with the drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and/or absolute.

本领域的技术人员将认识到，一般而言，本文、以及特别是所附权利要求(例如，所附权利要求的正文)中所使用的术语通常旨在为“开放”术语(例如，术语“包括”应解释为“包括但不限于”，术语“具有”应解释为“至少具有”，术语“包含”应解释为“包含但不限于”等)。本领域的技术人员还应当理解，如果所引入权利要求叙述的具体数目为预期的，则这样的意图将在权利要求中明确叙述，并且在不存在这样的叙述的情况下，不存在这样的意图。例如，为有助于理解，下述所附权利要求可含有对介绍性短语“至少一个”和“一个或多个”的使用以引入权利要求。然而，对此类短语的使用不应视为暗示通过不定冠词“一个”或“一种”引入权利要求表述将含有此类引入权利要求表述的任何特定权利要求限制在含有仅一个这样的表述的权利要求中，甚至当同一权利要求包括介绍性短语“一个或多个”或“至少一个”和诸如“一个”或“一种”(例如，“一个”和/或“一种”通常应解释为意指“至少一个”或“一个或多个”)的不定冠词时；这也适用于对用于引入权利要求表述的定冠词的使用。Those of skill in the art will recognize that the terms used herein, in general, and in the appended claims in particular (eg, the body of the appended claims) are generally intended to be "open" terms (eg, the term "" Including" should be interpreted as "including but not limited to", the term "having" should be interpreted as "having at least", the term "including" should be interpreted as "including but not limited to", etc.). It will also be 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 claims. However, use of such phrases should not be taken to imply that introduction of a claim expression by the indefinite articles "a" or "an" limits any particular claim containing such introduced claim expression to containing only one such expression even when the same claim includes the introductory phrases "one or more" or "at least one" and phrases such as "a" or "an" (eg, "an" and/or "an" should generally be When interpreted as an indefinite article meaning "at least one" or "one or more"); this also applies to the use of the definite article for introducing claim expressions.

术语“包括(comprise)”(以及“包括(comprise)”的任何形式，诸如“包括(comprises)”和“包括(comprising)”)、“具有(have)”(以及“具有(have)”的任何形式，诸如“具有(has)”和“具有(having)”)、“包含(include)”(以及“包含(include)”的任何形式，诸如“包含(includes)”和“包含(including)”)、以及“含有(contain)”(以及“含有(contain)”的任何形式，诸如“含有(contains)”和“含有(containing)”)为开放式系动词。因此，“包括”、“具有”、“包含”或“含有”一个或多个元件的外科系统、装置、或设备具有这些一个或多个元件，但不限于仅具有这些一个或多个元件。同样，“包括”、“具有”、“包含”或“含有”一个或多个特征部的系统、装置、或设备的元件具有那些一个或多个特征部，但不限于仅具有那些一个或多个特征部。The term "comprise" (and any form of "comprise" such as "comprises" and "comprising"), "have" (and "have" any form, such as "has" and "having"), "include" (and any form of "include", such as "includes" and "including" "), and "contain" (and any form of "contain" such as "contains" and "containing") are open-ended copulas. Thus, a surgical system, device, or device that "comprises," "has," "comprises," or "contains" one or more elements has those one or more elements, but is not limited to having only those one or more elements. Likewise, an element of a system, apparatus, or device that "comprises," "has," "includes," or "contains" one or more features has those one or more features, but is not limited to having only those one or more features feature part.

另外，即使明确叙述引入权利要求叙述的特定数目，本领域的技术人员应当认识到，此种叙述通常应解释为意指至少所叙述的数目(例如，在没有其它修饰语的情况下，对“两个叙述”的裸叙述通常意指至少两个叙述、或两个或更多个叙述)。此外，在其中使用类似于“A、B和C中的至少一者等”的惯例的那些情况下，一般而言，这种结构意在具有本领域的技术人员将理解所述惯例的意义(例如，“具有A、B和C中的至少一者的系统”将包括但不限于具有仅A、仅B、仅C、A和B一起、A和C一起、B和C一起和/或A、B和C一起等的系统)。在其中使用类似于“A、B或C中的至少一者等”的惯例的那些情况下，一般而言，这种结构意在具有本领域的技术人员将理解所述惯例的意义(例如，“具有A、B或C中的至少一者的系统”应当包括但不限于具有仅A、仅B、仅C、A和B一起、A和C一起、B和C一起和/或A、B和C一起等的系统)。本领域的技术人员还应当理解，通常，除非上下文另有指示，否则无论在具体实施方式、权利要求或附图中呈现两个或更多个替代术语的转折性词语和/或短语应理解为涵盖包括所述术语中的一者、所述术语中的任一个或这两个术语的可能性。例如，短语“A或B”通常将被理解为包括“A”或“B”或“A和B”的可能性。Additionally, even if a specific number of an introduced claim recitation is explicitly recited, one skilled in the art will recognize that such recitation should generally be construed to mean at least the recited number (eg, in the absence of other modifiers, to "" The "naked narration of two narrations" generally means at least two narrations, or two or more narrations). Furthermore, in those cases where a convention similar to "at least one of A, B, and C, etc." is used, in general, this structure is intended to have the meaning that those skilled in the art would understand the convention ( For example, "a system having at least one of A, B, and C" would include, but not be limited to, having A only, B only, C only, A and B together, A and C together, B and C together, and/or A , B and C together etc.). In those cases where a convention similar to "at least one of A, B, or C, etc." is used, in general, such constructions are intended to have the meaning that those skilled in the art would understand the convention (eg, "A system having at least one of A, B, or C" shall include, but is not limited to, having A only, B only, C only, A and B together, A and C together, B and C together, and/or A, B systems such as with C). It will also be understood by those skilled in the art that, generally, unless the context dictates otherwise, the presentation of two or more alternative terms in the detailed description, claims, or drawings, inflectional words and/or phrases should be construed as The possibility of including one of the terms, either of the terms, or both of the terms is encompassed. For example, the phrase "A or B" will generally be understood to include the possibilities of "A" or "B" or "A and B".

对于所附的权利要求，本领域的技术人员将会理解，其中表述的操作通常可以任何顺序进行。另外，尽管以(一个或多个)序列出了多个操作流程图，但应当理解，可以不同于所示顺序的其它顺序进行所述多个操作，或者可以同时进行所述多个操作。除非上下文另有规定，否则此类替代排序的示例可包括叠加、交错、中断、重新排序、增量、预备、补充、同时、反向，或其他改变的排序。此外，除非上下文另有规定，否则像“响应于”、“相关”这样的术语或其它过去式的形容词通常不旨在排除此类变体。With regard to the appended claims, those skilled in the art will understand that the operations recited therein can generally be performed in any order. Additionally, although the various operations are presented in a flowchart of sequence(s), it should be understood that the various operations may be performed in other orders than shown, or may be performed concurrently. Unless the context dictates otherwise, examples of such alternative orderings may include overlapping, interleaved, interrupted, reordered, incremental, preparatory, supplemental, simultaneous, reversed, or other altered orderings. Furthermore, terms like "responsive to," "related to," or other past-tense adjectives are generally not intended to exclude such variations unless the context dictates otherwise.

值得一提的是，任何对“一个方面”、“一方面”、“一范例”、“一个范例”的提及均意指结合所述方面所述的具体特征、结构或特性包括在至少一个方面中。因此，在整个说明书的不同位置出现的短语“在一个方面”、“在一方面”、“在一范例”、“在一个范例”不一定都指同一方面。此外，具体特征、结构或特性可在一个或多个方面中以任何合适的方式组合。It is worth mentioning that any reference to "an aspect", "an aspect", "an example", "an example" means that the 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 example," "in an example" 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.

本说明书提及和/或在任何申请数据表中列出的任何专利申请，专利，非专利公布或其它公开材料均以引用方式并入本文，只要所并入的材料在此不一致。因此，并且在必要的程度下，本文明确列出的公开内容代替以引用方式并入本文的任何冲突材料。据称以引用方式并入本文但与本文列出的现有定义、陈述或其他公开材料相冲突的任何材料或其部分，将仅在所并入的材料与现有的公开材料之间不产生冲突的程度下并入。Any patent applications, patents, non-patent publications or other publications mentioned in this specification and/or listed in any Application Data Sheet are incorporated herein by reference to the extent that the incorporated material is inconsistent herein. Accordingly, and to the extent necessary, the disclosure expressly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, purportedly incorporated herein by reference, but which conflicts with existing definitions, statements, or other disclosed material set forth herein, will not arise only between the incorporated material and the existing disclosed material merged to the extent of conflict.

概括地说，已经描述了由采用本文所述的概念产生的许多有益效果。为了举例说明和描述的目的，已经提供了一个或多个形式的上述具体实施方式。这些具体实施方式并非意图为详尽的或限定到本发明所公开的精确形式。可以按照上述教导内容对本发明进行修改或变型。选择和描述的一个或多个形式是为了说明原理和实际应用，从而使本领域的普通技术人员能够利用适用于预期的特定用途的所述多个形式和多种修改形式。与此一同提交的权利要求书旨在限定完整范围。In general terms, a number of benefits have been described that result from employing the concepts described herein. The foregoing detailed description has been presented in one or more forms for the purposes of illustration and description. These detailed descriptions are not intended to be exhaustive or to be limited to the precise forms disclosed. Modifications and variations of the present invention are possible in light of the above teachings. The form or forms was 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 modifications as are suited to the particular use contemplated. The claims filed herewith are intended to define the full scope.

Claims (20)

1. A surgical system, comprising:

a surgical instrument, wherein the surgical instrument comprises:

an end effector, the end effector comprising:

a first jaw; and

a second jaw, wherein the first jaw is configured to move relative to the second jaw;

a motor configured to move the first jaw relative to the second jaw as a function of a closure rate of change parameter and a closure threshold parameter; and

a sensor configured to transmit a sensor signal indicative of a closure parameter of the end effector; and

a control circuit communicatively coupled to the sensor, wherein the control circuit is configured to:

receiving perioperative information, wherein the perioperative information includes one or more of perioperative disease, perioperative treatment, and type of surgical procedure;

receiving the sensor signal from the sensor; and

determining adjustments to the closure rate parameter and the closure threshold parameter based on the perioperative information and the sensor signal.

2. The surgical system of claim 1, wherein the control circuit is further configured to determine a characteristic of tissue to be treated by the surgical instrument based on one or more of the perioperative information and the sensor signal.

3. The surgical system of claim 2, wherein the tissue characteristic comprises one or more of a tissue type characteristic, a muscle characteristic, a vasculature characteristic, a water content characteristic, a stiffness characteristic, and a thickness characteristic.

4. The surgical system of claim 1, wherein the control circuit is further configured to vary a speed of the motor based on the determined adjustments to the closure rate of change parameter and closure threshold parameter.

5. The surgical system of claim 1, wherein the control circuit is further configured to generate an alert based on an inconsistency between the type of the surgical instrument and one or more of the perioperative information and the sensor signal.

6. The surgical system of claim 1, wherein the perioperative information further comprises one or more of a type of tissue to be treated by the surgical instrument, a tissue characteristic, a clinical history, and a type of staple cartridge used with the surgical instrument.

7. The surgical system of claim 1, wherein:

the closure threshold parameter is a maximum closure force threshold; and is

The control circuit is further configured to disable the motor for a predetermined period of time based on reaching the maximum closing force threshold.

8. A surgical system, comprising:

a surgical hub configured to receive perioperative information transmitted from a remote database of a cloud computing system, wherein the surgical hub is communicatively coupled to the cloud computing system; and

a surgical instrument communicatively coupled to the surgical hub, wherein the surgical instrument comprises:

an end effector, the end effector comprising:

a first jaw; and

a second jaw, wherein the first jaw is configured to move relative to the second jaw;

a motor configured to move the first jaw relative to the second jaw according to a closure rate of change parameter and a closure threshold parameter of a closure control program received from the surgical hub; and

a sensor configured to transmit a sensor signal indicative of a closure parameter of the end effector; and is

Wherein the surgical hub is further configured to:

receiving the sensor signal from the sensor; and

determining adjustments to the closure rate parameter and the closure threshold parameter based on the perioperative information and the sensor signal.

9. The surgical system of claim 8, wherein:

the close control program is a first close control program;

the surgical hub is further configured to transmit a second closure control procedure to the surgical instrument; and is

The second closure control procedure defines an adjustment to the closure rate of change parameter and an adjustment to the closure threshold parameter.

10. The surgical system of claim 9, wherein:

the cloud computing system is configured to transmit the second closure control program to the surgical hub; and is

Adjusting the closure rate parameter adjustment and the closure threshold parameter adjustment of the second closure control procedure based on perioperative information.

11. The surgical system of claim 8, wherein the surgical instrument is configured to generate an alert based on an inconsistency between a type of the surgical instrument and one or more of the perioperative information and the sensor signal.

12. The surgical system of claim 8, wherein:

the closure threshold parameter is a maximum closure force threshold; and is

The surgical hub is further configured to disable the motor for a predetermined period of time based on reaching the maximum closure force threshold.

13. The surgical system of claim 12, wherein the perioperative information includes one or more of perioperative disease, perioperative treatment, type of surgical procedure, clinical history, type of the surgical instrument, type of tissue being treated by the surgical instrument, and characteristics of the tissue.

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

15. A surgical instrument, comprising:

an end effector, the end effector comprising:

a first jaw; and

a second jaw, wherein the first jaw is configured to move relative to the second jaw;

a motor configured to move the first jaw relative to the second jaw according to a closure rate of change parameter and a closure threshold parameter of a first closure control procedure received from a surgical hub; and

a sensor configured to transmit a sensor signal indicative of a closure parameter of the end effector; and

a control circuit communicatively coupled to the sensor and the motor, wherein the control circuit is configured to:

receiving the sensor signal from the sensor; and

determining adjustments to the closure rate parameter and the closure threshold parameter based on perioperative information and the sensor signal.

16. The surgical instrument of claim 15, wherein the surgical instrument is configured to generate an alert based on an inconsistency between a type of the surgical instrument and one or more of the perioperative information and the sensor signal.

17. The surgical instrument of claim 15, wherein the control circuit is further configured to:

Switching from the first closed control program to a second closed control program received from a cloud computing system; and

varying a speed of the motor based on the second closing control procedure.

18. The surgical instrument of claim 15, wherein the control circuit is further configured to determine a characteristic and a type of tissue to be treated by the surgical instrument based on one or more of the perioperative information and the sensor signal.

19. The surgical instrument of claim 15, wherein the closure threshold parameter is a maximum closure force threshold.

20. The surgical instrument of claim 19, wherein the control circuit is further configured to disable the motor for a predetermined period of time based on reaching the maximum closure force threshold.

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