CN111566749B - 机器人辅助外科平台的感测布置方式 - Google Patents
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Abstract
本发明公开了各种外科系统。一种外科系统包括机器人系统。所述机器人系统包括：控制单元；机械臂，所述机械臂包括附接部分；第一传感器系统，所述第一传感器系统与所述控制单元信号通信；以及第二传感器系统。所述第一传感器系统被配置为检测所述附接部分的位置。外科工具可移除地附接到所述附接部分。所述第二传感器系统独立于所述第一传感器系统，并且被配置为检测所述外科工具的位置。
Description
相关申请的交叉引用
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3月28日提交的标题为“机器人辅助外科平台的感测布置方式(SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS)”的美国临时专利申请序列号62/649,323的优先权的权益，该临时专利申请的公开内容全文以引用方式并入本文。
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-BASEDMEDICAL ANALYTICS)”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。
背景技术
本公开涉及机器人外科系统。机器人外科系统可包括中央控制单元、外科医生的命令控制台以及具有一个或多个机械臂的机器人。机器人外科工具可以可释放地安装到机械臂上。机器人外科工具的数量和类型可以取决于外科规程的类型。机器人外科系统可以在外科规程期间与一个或多个显示器和/或一个或多个手持式外科器械结合使用。
发明内容
在一个一般方面，提供了一种外科系统。所述外科系统包括机器人系统。所述机器人系统包括：控制单元；机械臂，所述机械臂包括附接部分；第一传感器系统，所述第一传感器系统与所述控制单元信号通信；以及第二传感器系统。所述第一传感器系统被配置为检测所述附接部分的位置。所述外科系统还包括可移除地附接到所述附接部分的外科工具。所述第二传感器系统独立于所述第一传感器系统，并且被配置为检测所述外科工具的位置。
在另一个一般方面，提供了另一种外科系统。所述外科系统包括机器人系统。所述机器人系统包括：控制单元；机械臂，所述机械臂包括第一部分、第二部分以及在所述第一部分和所述第二部分中间的接合部；第一传感器系统，所述第一传感器系统被配置为检测所述机械臂的所述第一部分和所述第二部分的位置；以及冗余传感器系统。所述冗余传感器系统被配置为检测所述机械臂的所述第一部分和所述第二部分的位置。
在又一个一般方面，提供了另一种外科系统。所述外科系统包括外科机器人，所述外科机器人包括：控制单元和机械臂。所述机械臂包括马达。所述外科系统还包括：外科工具，所述外科工具可移除地附接到所述机械臂；第一传感器系统，所述第一传感器系统与所述控制单元信号通信；以及第二传感器系统。所述第一传感器系统包括位于所述马达上的扭矩传感器，并且被配置为检测所述外科工具的位置。所述第二传感器系统被配置为独立地检测所述外科工具的位置。
附图说明
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。
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。
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规程的外科系统。
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。
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容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。
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。
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为容纳多个模块。
图7示出了根据本公开的至少一个方面的被配置为容纳多个模块的竖直模块化外壳。
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为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。
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。
图10示出了根据本公开的至少一个方面的包括耦接到模块化控制塔的多个模块的外科集线器。
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。
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。
图13示出了根据本公开的至少一个方面的被配置为控制外科器械或工具的各个方面的控制电路。
图14示出了根据本公开的至少一个方面的被配置为控制外科器械或工具的各个方面的组合逻辑电路。
图15示出了根据本公开的至少一个方面的被配置为控制外科器械或工具的各方面的时序逻辑电路。
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。
图17为根据本公开的至少一个方面的被配置为操作本文所述的外科工具的机器人外科器械的示意图。
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。
图19为根据本公开的至少一个方面的被配置为控制各个功能的外科器械的示意图。
图20为根据本公开的至少一个方面的发生器的简化框图，该发生器被配置为提供无电感器调谐等等益处。
图21示出了根据本公开的至少一个方面的发生器的示例，该发生器是图20的发生器的一种形式。
图22为根据本公开的一个方面的机器人外科系统的示意图。
图23为根据本公开的一个方面的机器人外科系统的机械臂的透视图，并且示意性地描绘了机器人外科系统的附加部件。
图24为根据本公开的一个方面的机器人外科系统的机械臂的透视图，并且进一步描绘了操作者手动地调节机械臂的位置。
图25为根据本公开的一个方面的在无源动力辅助模式下图24的机械臂随时间推移的力的图形显示。
图26为根据本公开的至少一个方面的无菌场内的机械臂和辅助交互式显示器的透视图。
图27为根据本公开的一个方面的图26的机械臂随时间推移的力的图形显示。
图28为根据本公开的至少一个方面的机器人外科系统的机械臂和机器人集线器的透视图。
图29为根据本公开的至少一个方面的附接到图28的机械臂的线性缝合器的端部执行器的细部图，描绘了在外科规程期间相对于靶向组织区域定位的端部执行器。
图30为根据本公开的一个方面的图29的线性缝合器随时间推移的距离和闭合力的图形显示。
图31为根据本公开的一个方面的描绘具有多个感测系统的机器人外科系统的示意图。
图31A为根据本公开的至少一个方面的图31的套管针的细部图。
图32为根据本公开的一个方面的描绘利用多个独立感测系统的机器人外科系统的流程图。
图33为根据本公开的一个方面的描绘外科集线器的态势感知的时间轴。
具体实施方式
本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以引用方式全文并入本文：
·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)；
·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)；
·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)；
·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)；
·美国专利申请序列号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)；
·美国临时专利申请序列号62/649,291，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)；
·美国专利申请序列号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)；
·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)；
·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)；
·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)；
·美国临时专利申请序列号62/649,313，其标题为用于耦接的外科装置的云接口(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)；
·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
·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)。
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全文以引用方式并入本文：
·美国专利申请序列号____________，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)；代理人案卷号END8499USNP/170766；
·美国专利申请序列号____________，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 OFDEVICES AND DATA CAPABILITIES)；代理人案卷号END8499USNP1/170766-1；
·美国专利申请序列号____________，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)；代理人案卷号END8499USNP2/170766-2；
·美国专利申请序列号____________，其标题为手术室中外科集线器的空间感知(Spatial awareness of surgical hubs in operating rooms)；代理人案卷号END8499USNP3/170766-3；
·美国专利申请序列号____________，其标题为通过智能外科集线器从次级源导出的数据的协同利用(Cooperative utilization of data derived from secondarysources by intelligent surgical hubs)；代理人案卷号END8499USNP4/170766-4；
·美国专利申请序列号____________，其标题为外科集线器控制布置方式(Surgical hub control arrangements)；代理人案卷号END8499USNP5/170766-5；
·美国专利申请序列号____________，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 AND CREATEANONYMIZED RECORD)；代理人案卷号END8500USNP/170767；
·美国专利申请序列号____________，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态的通信集线器和存储装置(COMMUNICATION HUB ANDSTORAGE DEVICE FOR STORING PARAMETERS AND STATUS OF A SURGICAL DEVICE TO BESHARED WITH CLOUD BASED ANALYTICS SYSTEMS)；代理人案卷号END8500USNP1/170767-1；
·美国专利申请序列号____________，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)；代理人案卷号END8500USNP2/170767-2；
·美国专利申请序列号____________，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)；代理人案卷号END8500USNP3/170767-3；
·美国专利申请序列号____________，其标题为外科集线器态势感知(SURGICALHUB SITUATIONAL AWARENESS)；代理人案卷号END8501USNP/170768；
·美国专利申请序列号____________，其标题为外科系统分布式处理(SURGICALSYSTEM DISTRIBUTED PROCESSING)；代理人案卷号END8501USNP1/170768-1；
·美国专利申请序列号____________，其标题为外科集线器数据的聚集和报告(AGGREGATION AND REPORTING OF SURGICAL HUB DATA)；代理人案卷号END8501USNP2/170768-2；
·美国专利申请序列号____________，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)；代理人案卷号END8502USNP/170769；
·美国专利申请序列号____________，其标题为钉仓与先前线性钉线的对准显示(DISPLAY OF ALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LINEAR STAPLE LINE)；代理人案卷号END8502USNP1/170769-1；
·美国专利申请序列号____________，其标题为无菌场交互控制显示器(STERILEFIELD INTERACTIVE CONTROL DISPLAYS)；代理人案卷号END8502USNP2/170769-2；
·美国专利申请序列号____________，其标题为计算机实现的交互式外科系统(COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS)；代理人案卷号END8503USNP/170770；
·美国专利申请序列号____________，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)；代理人案卷号END8504USNP/170771；
·美国专利申请序列号____________，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)；代理人案卷号END8504USNP1/170771-1；
以及
·美国专利申请序列号____________，其标题为双互补金属氧化物半导体(CMOS)阵列成像(DUAL CMOS ARRAY IMAGING)；代理人案卷号END8504USNP2/170771-2。
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全文以引用方式并入本文：
·美国专利申请序列号____________，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)；代理人案卷号END8506USNP/170773；
·美国专利申请序列号____________，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)；代理人案卷号END8506USNP1/170773-1；
·美国专利申请序列号____________，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)；代理人案卷号END8507USNP/170774；
·美国专利申请序列号____________，其标题为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)；代理人案卷号END8507USNP1/170774-1；
·美国专利申请序列号____________，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)；代理人案卷号END8507USNP2/170774-2；
·美国专利申请序列号____________，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)；代理人案卷号END8508USNP/170775；
·美国专利申请序列号____________，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)；代理人案卷号END8509USNP/170776；以及
·美国专利申请序列号____________，其标题为耦接外科装置的云接口(CLOUDINTERFACE FOR COUPLED SURGICAL DEVICES)；代理人案卷号END8510USNP/170777。
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全文以引用方式并入本文：
·美国专利申请序列号____________，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)；代理人案卷号END8511USNP/170778；
·美国专利申请序列号____________，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)；代理人案卷号END8511USNP1/170778-1；
·美国专利申请序列号____________，其标题为机器人辅助外科平台的控制(CONTROLS FOR ROBOT-ASSISTED SURGICAL PLATFORMS)；代理人案卷号END8511USNP2/170778-2；
·美国专利申请序列号____________，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)；代理人案卷号END8512USNP/170779；
·美国专利申请序列号____________，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)；代理人案卷号END8512USNP1/170779-1；
·美国专利申请序列号____________，其标题为用于机器人辅助外科平台的协同外科操作(COOPERATIVE SURGICAL ACTIONS FOR ROBOT-ASSISTED SURGICAL PLATFORMS)；代理人案卷号END8512USNP2/170779-2；以及
·美国专利申请序列号____________，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)；代理人案卷号END8512USNP3/170779-3。
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施，或与其它方面、变更形式和修改形式结合在一起实施，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。
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，可包括耦接到存储装置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，其被配置为彼此通信并且/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。
图2示出了用于对平躺在外科手术室116中的手术台114上的患者执行外科规程的外科系统102的示例。机器人系统110在外科规程中用作外科系统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耦接的外科工具。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。
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。
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。
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。
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。
一个或多个照明源可被配置为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。
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。
在各种方面，成像装置124被配置为用于微创规程中。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。
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。多光谱图像是捕获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获的附加信息。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。
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规程的患者周围的区域。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。
在各个方面，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。
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被配置为利用显示器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可使可视化系统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规程相关的诊断步骤。
在一个方面，集线器106还被配置为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，输入可以是显示在非无菌显示器107或109上的快照的修改形式，可通过集线器106路由到主显示器119。
参见图2，外科器械112作为外科系统102的一部分在外科规程中使用。集线器106还被配置为协调流向外科器械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。
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。
在外科规程期间，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规程期间缠结。在外科规程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。
本公开的各方面提供了用于外科规程的外科集线器，该外科规程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容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、被配置为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。
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容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。
某些外科规程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被配置为容纳不同的发生器，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。
本公开的方面提供了在涉及将能量施加到组织的外科规程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为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移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移动出与第一功率和数据触点的电接合。
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为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移动成与功率和数据触点电接合，并且其中第二能量发生器可滑动地移动出于第二功率和数据触点的电接合。
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，其被配置为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。
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可被配置为连接到单极装置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可被配置为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。
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。
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)，其被配置为可滑动地容纳模块140、126、128。图4示出了可滑动地容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被配置为当组合发生器模块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。
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。耦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容纳在集线器壳体136中的排烟模块126延伸的流体路径。
在各种方面，抽吸/冲洗模块128耦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为冲洗到外科部位的流体和从外科部位抽吸流体。
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为将超声能量和/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耦接到发生器模块140。
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。
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准特征件，该对准特征件被配置为将模块的对接端口对准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被配置为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。
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容纳在抽屉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。
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。
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耦接到另一个抽屉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。
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被配置为容纳外科集线器206的多个模块。横向模块化外壳160被配置为横向容纳和互连模块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。
图7示出了被配置为容纳外科集线器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容纳在主模块178中的多个子模块。
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耦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规程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，光源模块可被配置为递送白光或不同的光，这取决于外科规程。
在外科规程期间，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为允许在外科规程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。
在一个方面，成像装置包括包括多个通道的管状外壳。第一通道被配置为可滑动地容纳相机模块，该相机模块可被配置为与第一通道搭扣配合接合。第二通道被配置为可滑动地容纳光源模块，该光源模块可被配置为与第二通道搭扣配合接合。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搭扣配合接合。
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可被配置为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可被配置为集成来自不同成像装置的图像。
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日公布的标题为对固定件体内设备的可控制磁源(CONTROLLABLE MAGNETIC SOURCE TO FIXTUREINTRACORPOREAL APPARATUS)的美国专利申请公布2011/0306840和2014年8月28日公布的标题为用于执行微创外科规程的系统(SYSTEM FOR PERFORMING A MINIMALLY INVASIVESURGICAL PROCEDURE)的美国专利申请公布2014/0243597，以上专利中的每个全文以引用方式并入本文。
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被配置为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，可包括耦接到存储装置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还可耦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。
位于手术室中的模块化装置1a-1n可耦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可耦接到网络路由器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也可耦接到网络交换机209。网络交换机209可耦接到网络集线器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。
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为容纳多个装置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以显示例如在外科规程期间由装置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，诸如耦接到内窥镜的成像模块138、耦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。
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。耦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、移动、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。
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(诸如重叠由多个成像装置捕获的图像)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规程结果。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。
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/互联网协议(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。
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。
网络集线器207和/或网络交换机209耦接到网络路由器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。
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。
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)从固定装置和移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。
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。
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。
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包括耦接到计算机系统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耦接到耦接到内窥镜239的成像模块238、耦接到能量装置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、任选地耦接到显示器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耦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耦接到模块化控制塔236，如本文所述。模块化控制塔236可耦接到集线器显示器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。
图10示出了包括耦接到模块化控制塔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。
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，该临时专利申请的公开内容全文以引用方式并入本文，其中传感器模块被配置为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。
计算机系统210包括处理器244和网络接口245。处理器244经由系统总线耦接到通信模块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。
控制器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。
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为专门用于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结构，同时递送可定标的性能、连接性和存储器选项。
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)。
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。
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。
用户通过耦接到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。
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)。
在各个方面，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。
(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。
图11示出了根据本公开的一个方面的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(Texas Instruments)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。
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置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装置可被配置为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。
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并且耦接到暂停/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经由接口逻辑耦接到命令解码器326，以经由串行EEPROM接口330来控制来自串行EEPROM的命令。
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可被配置为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。
外科器械硬件
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可操作地耦接纵向可移动的位移构件以驱动I形梁刀元件。跟踪系统480被配置为确定纵向可移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为确定纵向可移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。
在一个方面，微处理器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，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电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，其细节可见于产品数据表。
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为专门用于IEC 61508和ISO26262安全关键应用等等，以提供先进的集成安全特征结构，同时递送可定标的性能、连接性和存储器选项。
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。
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可被配置为计算微控制器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。
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。在其它布置中，马达482可包括无刷马达、无绳马达、同步马达、步进马达或任何其它合适的电动马达。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，其可耦接到功率组件并且可与功率组件分离。
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，并且可被配置为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。
跟踪系统480包括根据本公开的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移动的驱动构件，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为包括驱动齿的齿条。在另一方面，位移构件表示I形梁的击发杆，它们中的每一者均可被适配和配置为包括驱动齿的齿条。因此，如本文所用，术语位移构件通常用于指外科器械的任何可移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，纵向可移动的驱动构件耦接到击发构件、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移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，位移构件可耦接到适于测量线性位移的任何位置传感器472。因此，纵向可移动驱动构件、击发构件、击发杆或I形梁或它们的组合可耦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、包括可移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移动的线性布置的霍尔效应传感器的磁感测系统、包括可移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移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。
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耦接到齿轮组件，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，或者经由直齿齿轮或其它连接连接至旋转致动器。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移动驱动构件，该纵向可移动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移动的击发构件、击发杆、I形梁或它们的组合。
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为在耦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”移动到点“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。
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。
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。
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，其可购自奥地利微电子公司(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可以是以小QFN 16引脚4×4×0.85mm封装提供的AS5055芯片。
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 TISSUE THICKNESS)的美国专利9,345,481中所述的那些，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 ADAPTIVE CONTROL OFMOTOR 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，绝对定位系统耦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。
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。
传感器474(诸如，例如应变仪或微应变仪)被配置为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将其提供给处理器462。另选地或除了传感器474之外，传感器476(诸如例如负荷传感器)可以测量由闭合驱动系统施加到砧座的闭合力。诸如例如负荷传感器的传感器476可以测量在外科系统器械或工具的击发行程中施加到I形梁的击发力。I形梁被配置成能够接合楔形滑动件，该楔形滑动件被配置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将其提供给处理器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被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握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，其被配置为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。负载传感器476可测量用于操作刀元件例如以切割被捕获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。
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。
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。
图13示出了控制电路500，该控制电路500被配置为控制根据本公开的一个方面的外科器械或工具的各方面。控制电路500可被配置为实现本文所述的各种过程。控制电路500可以包括微控制器，该微控制器包括耦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的机器可执行指令。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可包括易失性存储介质和非易失性存储介质。处理器502可包括指令处理单元506和运算单元508。指令处理单元可被配置为从本公开的存储器电路504接收指令。
图14示出了组合逻辑电路510，该组合逻辑电路510被配置为控制根据本公开的一个方面的外科器械或工具的各方面。组合逻辑电路510可被配置为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被配置为在输入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。
图15示出了根据本公开的一个方面的被配置为控制外科器械或工具的各个方面的时序逻辑电路520。时序逻辑电路520或组合逻辑522可被配置为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。所述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被配置为从输入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。在其它方面，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。
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发射到端部执行器。
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可以可操作地耦接到击发马达驱动组件604，该击发马达驱动组件可被配置为将由马达602生成的击发运动发射到端部执行器，具体地用于移置I形梁元件。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获的组织内并且/或者导致I形梁元件的切割刃被推进以切割所捕获组织。I形梁元件可通过反转马达602的方向而回缩。
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可以可操作地耦接到闭合马达驱动组件605，该闭合马达驱动组件605被配置为将由马达603生成的闭合运动发射到端部执行器，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配置转变成接近配置以捕获组织。端部执行器可通过反转马达603的方向而转变到打开位置。
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可以可操作地耦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为将由马达606a、606b生成的关节运动发射到端部执行器。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。
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为执行各种独立功能。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/或者推进切割边缘，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。
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可单独地耦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。
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/或状态之间移动或转变。在第一位置616中，开关614可以将公共控制模块610电耦接到击发马达602；在第二位置617中，开关614可以将公共控制模块610电耦接到闭合马达603；在第三位置618a中，开关614可以将公共控制模块610电耦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电耦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可同时电耦接到击发马达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。
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。
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发射到耦接到公共控制模块610的马达的电力。在某些情况下，当马达耦接到公共控制模块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。
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，这些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耦接到处理器622。
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，电池组可被配置为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。
在各种情况下，处理器622可控制马达驱动器626以控制耦接到公共控制器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/或停用耦接到公共控制器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。
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例如可以是可从德克萨斯器械公司(Texas Instruments)购得的LM 4F230H5QR。在至少一个示例中，Texas Instruments 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。
在某些情况下，存储器624可包括用于控制可耦接到公共控制器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。此类程序指令可使得处理器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。
在某些情况下，一个或多个机构和/或传感器(诸如例如传感器630)可用于警示处理器622应当在特定设置中使用的程序指令。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。
图17是根据本公开的一个方面的被配置为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，该控制电路被配置为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。
在一个方面，机器人外科器械700包括控制电路710，该控制电路被配置为经由多个马达704a-704e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可被配置为向控制电路710提供I形梁714的位置反馈。其它传感器738可被配置为向控制电路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。
在一个方面，控制电路710可包括用于执行使得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在相对于起始位置的特定时间(t)或I形梁714处于相对于起始位置的特定位置时的时间(t)处的位置。定时器/计数器731可被配置为测量所耗用的时间、计数外部事件或时间外部事件。
在一个方面，控制电路710可被编程为基于一个或多个组织条件来控制端部执行器702的功能。控制电路710可被编程为直接或间接地感测组织条件，诸如厚度，如本文所述。控制电路710可被编程为基于组织条件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。闭合控制程序可以控制由砧座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。
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，这些电路被配置为向马达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。
在一些示例中，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配置操作马达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可以选择处于闭环配置的击发控制程序。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。
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可经由相应的变速器706a-706e机械耦接到各个可移动机械元件，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耦接到可移动机械元件。位置传感器734可感测I形梁714的位置。位置传感器734可以是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，该编码器被配置为在I形梁714朝远侧和朝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。其它类型的位置传感器可提供指示I形梁714的运动的其它信号。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可通过聚合马达704已被指示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中或器械的任何其它部分处。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。
在一个方面，控制电路710被配置为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的输出轴耦接到扭矩传感器744a。扭矩传感器744a耦接到变速器706a，该变速器耦接到I形梁714。变速器706a包括可移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朝近侧的移动。在一个方面，马达704a可耦接到刀齿轮组件，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置I形梁714所需的力。位置传感器734可被配置为将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可包括被配置为向控制电路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。
在一个方面，控制电路710被配置为驱动闭合构件，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的输出轴耦接到扭矩传感器744b。扭矩传感器744b耦接到变速器706b，该变速器耦接到砧座716。变速器706b包括可移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移动。在一个方面，马达704b耦接到闭合齿轮组件，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可被配置为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与钉仓718相对地定位。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。
在一个方面，控制电路710被配置为使轴构件诸如轴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的输出轴耦接到扭矩传感器744c。扭矩传感器744c耦接到耦接到轴740的变速器706c。变速器706c包括可移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耦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上的旋转力。位置传感器734可被配置为将闭合构件的位置作为反馈信号提供给控制电路710。附加的传感器738诸如轴编码器可向控制电路710提供轴740的旋转位置。
在一个方面，控制电路710被配置为使端部执行器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的输出耦接到扭矩传感器744d。扭矩传感器744d耦接到耦接到关节运动构件742a的变速器706d。变速器706d包括可移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耦接到关节运动螺母，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。
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。这些铰接构件742a、742b由由两个马达708d、708e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。
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移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。
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购自奥地利微电子公司(Austria Microsystems,AG)的AS5055EQFT单片磁性旋转位置传感器。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耦接到CORDIC处理器的霍尔效应元件，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。
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它合适的传感器。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可被配置为感测力诸如击发力、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荷及其位置，(2)在齿条处的击发构件及其位置，(3)钉仓718在其上具有组织的部分，以及(4)两个关节运动杆上的负荷和位置。
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，其被配置为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为检测由砧座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可被配置为检测位于砧座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/或完整性。
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。
在一个方面，传感器738可被配置为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上的力可表示在砧座716和钉仓718之间捕集的组织区段所经受的组织压缩。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接收实时样本测量值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。
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。推进可移动的机械元件中的任一者诸如I形梁714所需的力对应于由马达704a-704e中的一个所消耗的电流。将力转换成数字信号并将其提供给控制电路710。控制电路710可被配置为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移动。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。
图18示出根据本公开的一个方面的被编程为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。
线性位移构件诸如I形梁764的位置、移动、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耦接到纵向可移动的驱动构件，因此I形梁764的位置可通过采用位置传感器784测量纵向可移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可包括一个或多个微控制器、微处理器或其它合适的处理器，以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。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)处相对于起始位置的位置。定时器/计数器781可被配置为测量耗用时间、计数外部事件或时间外部事件。
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可包括一个或多个电路，所述一个或多个电路被配置为向马达754提供马达驱动信号774，以驱动马达754，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。
马达754可从能量源762处接收电力。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可经由变速器756机械耦接到I形梁764。变速器756可包括一个或多个齿轮或其它连杆部件，以将马达754耦接到I形梁764。位置传感器784可感测I形梁764的位置。位置传感器784可以是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，该编码器被配置为在I形梁764朝远侧和朝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。其它类型的位置传感器可提供指示I形梁764的运动的其它信号。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中或器械的任何其它部分处。
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可包括例如磁性传感器、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它合适的传感器。传感器788可包括一个或多个传感器。
一个或多个传感器788可包括应变仪，诸如微应变仪，其被配置为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为检测由砧座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可被配置为检测位于砧座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/或完整性。
传感器788可被配置为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上的力可表示在砧座766和钉仓768之间捕集的组织区段所经受的组织压缩。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接收实时样本测量值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。
电流传感器786可用于测量由马达754所消耗的电流。推进I形梁764所需的力对应于例如由马达754消耗的电流。将力转换成数字信号并将其提供给控制电路760。
控制电路760可被配置为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752中的I形梁764以目标速度或接近目标速度移动。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。
外科器械750的实际驱动系统被配置为通过具有齿轮箱和与关节运动和/或刀系统的机械链路的有刷DC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曳力，它与电动马达754相对作用。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。
各种示例性方面涉及外科器械750，该外科器械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，并且当被配置用于使用时，钉仓768与砧座766相对定位。临床医生可将组织抓持在砧座766和钉仓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。响应于击发信号，马达754可沿着端部执行器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，具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和砧座766之间的组织。
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例如基于一个或多个组织状况来控制位移构件诸如I形梁764的远侧平移。控制电路760可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可被编程为以较高的速度和/或以较高的功率平移位移构件。
在一些示例中，控制电路760可以针对位移构件的行程的第一开环部分初始以开环配置来操作马达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760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 FORCONTROLLING A 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。
图19是根据本公开的一个方面的被配置为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。
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)。在其它具体实施中，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。
在一个方面，位置传感器784可被实现为绝对定位系统，包括被实现为购自奥地利微电子公司(Austria Microsystems,AG)的AS5055EQFT单片磁性旋转位置传感器的磁性旋转绝对定位系统。位置传感器784可与控制电路760交接，以提供绝对定位系统。位置可包括位于磁体上方并耦接到CORDIC处理器的霍尔效应元件，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。
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突片或特征部和通道接合特征部或基座。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。这些和其它传感器布置方式在2017年6月20日提交的共同拥有的标题为“TECHNIQUES FOR ADAPTIVE CONTROL OF MOTOR VELOCITY OF A SURGICAL STAPLING ANDCUTTING INSTRUMENT”的美国专利申请序列号15/628,175中有所描述，该专利全文以引用方式并入本文。
线性位移构件诸如I形梁764的位置、移动、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耦接到纵向可移动的驱动构件，因此I形梁764的位置可通过采用位置传感器784测量纵向可移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可包括一个或多个微控制器、微处理器或其它合适的处理器，以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。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)处相对于起始位置的位置。定时器/计数器781可被配置为测量耗用时间、计数外部事件或时间外部事件。
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可包括一个或多个电路，所述一个或多个电路被配置为向马达754提供马达驱动信号774，以驱动马达754，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。
马达754可从能量源762处接收电力。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可经由变速器756机械耦接到I形梁764。变速器756可包括一个或多个齿轮或其它连杆部件，以将马达754耦接到I形梁764。位置传感器784可感测I形梁764的位置。位置传感器784可以是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，该编码器被配置为在I形梁764朝远侧和朝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。其它类型的位置传感器可提供指示I形梁764的运动的其它信号。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中或器械的任何其它部分处。
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可包括例如磁性传感器、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它合适的传感器。传感器788可包括一个或多个传感器。
一个或多个传感器788可包括应变仪，诸如微应变仪，其被配置为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为检测由砧座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可被配置为检测位于砧座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/或完整性。
传感器788可被配置为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上的力可表示在砧座766和钉仓768之间捕集的组织区段所经受的组织压缩。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接收实时样本测量值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。
电流传感器786可用于测量由马达754所消耗的电流。推进I形梁764所需的力对应于例如由马达754消耗的电流。将力转换成数字信号并将其提供给控制电路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耦接到端部执行器792并且被施加到RF仓796。控制电路760控制RF能量向RF仓796的递送。
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耦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。
发生器硬件
图20是被配置为提供无电感器调谐等等益处的发生器800的简化框图。发生器800的其它细节在2015年6月23日公布的标题为用于超声和电外科装置的外科发生器(SURGICAL GENERATOR FOR ULTRASONIC AND ELECTROSURGICAL DEVICES,)的美国专利9,060,775中有所描述，该专利全文以引用方式并入本文。发生器800可包括患者隔离级802，该患者隔离级经由电力变压器806与非隔离级804通信。电力变压器806的次级绕组808包含在隔离级802中，并且可包括分接配置(例如，中心分接或非中心分接配置)以限定驱动信号输出810a、810b、810c，所述驱动信号输出用于将驱动信号递送至不同的外科器械，诸如例如超声外科器械、RF电外科器械和包括可单独或同时递送的超声能量模式和RF能量模式的多功能外科器械。具体而言，驱动信号输出810a、810c可将超声驱动信号(例如，420V均方根(RMS)驱动信号)输出至超声外科装置，并且驱动信号输出810b、810c可将RF电外科驱动信号(例如，100V RMS驱动信号)输出至RF电外科器械，其中驱动信号输出810b对应于电力变压器806的中心分接头。
在某些形式中，超声驱动信号和电外科驱动信号可同时提供至不同的外科器械和/或具有将超声能和电外科能两者传递至组织的能力的单个外科器械，诸如多功能外科器械。应当理解，提供给专用电外科器械和/或组合的多功能超声/电外科器械的电外科信号可以是治疗水平或亚治疗水平信号，其中亚治疗信号可用于例如监测组织或器械状况并向发生器提供反馈。例如，超声信号和RF信号可从具有单个输出端口的发生器单独或同时递送，以便向外科器械提供期望的输出信号，如将在下文更详细地讨论。因此，发生器可组合超声能量和电外科RF能量并且将组合的能量递送到多功能超声/电外科器械。双极电极可被放置在端部执行器的一个或两个钳口上。除了电外科RF能量之外，一个钳口可由超声能量同时驱动。超声能量可用于解剖组织，而电外科RF能量可用于脉管密封。
非隔离级804可包括功率放大器812，该功率放大器具有连接到电力变压器806的初级绕组814的输出。在某些形式中，功率放大器812可包括推挽放大器。例如，非隔离级804还可包括逻辑装置816，该逻辑装置用于向数模转换器(DAC)电路818供应数字输出，而该DAC电路继而将对应的模拟信号供应至功率放大器812的输入。在某些形式中，除其它逻辑电路之外，逻辑装置816可包括例如可编程门阵列(PGA)、FPGA、可编程逻辑装置(PLD)。因此，通过DAC电路818控制功率放大器812的输入，逻辑装置816可控制在驱动信号输出810a、810b、810c处出现的驱动信号的多个参数(例如，频率、波形形状、波形振幅)中的任一个。在某些形式中，如下所述，逻辑装置816结合处理器(例如，以下所述的DSP)可实现多个基于DSP的算法和/或其它控制算法，以控制发生器800所输出的驱动信号的参数。
可通过开关模式调整器820诸如功率转换器将功率供应至功率放大器812的功率轨。在某些形式中，开关模式调整器820可包括例如可调式降压调整器。例如，非隔离级804还可包括第一处理器822，在一种形式中，所述第一处理器可包括DSP处理器，诸如购自美国马萨诸塞州诺伍德的亚德诺半导体公司(Analog Devices,Norwood,MA)的Analog DevicesADSP-21469SHARC DSP，但可在各种形式中采用任何合适的处理器。在某些形式中，DSP处理器822可响应于由DSP处理器822经由ADC电路824从功率放大器812接收的电压反馈数据来控制对开关模式调整器820的操作。在一种形式中，例如，DSP处理器822可经由ADC电路824接收由功率放大器812放大的信号(例如，RF信号)的波形包络作为输入。随后，DSP处理器822可控制开关模式调整器820(例如，经由PWM输出)，使得被提供至功率放大器812的干线电压跟踪经放大信号的波形包络。通过基于波形包络以动态方式调制功率放大器812的干线电压，功率放大器812的效率可相对于固定干线电压放大器方案显著提高。
在某些形式中，逻辑装置816结合DSP处理器822可实现数字合成电路诸如直接数字合成器控制方案，以控制发生器800所输出驱动信号的波形形状、频率和/或振幅。在一种形式中，例如逻辑装置816可通过召回存储于动态更新的查找表(LUT)(诸如RAM LUT)中的波形样本来实现DDS控制算法，所述动态更新的查找表可被嵌入FPGA中。该控制算法尤其可用于如下超声应用，其中超声换能器诸如超声换能器可由其谐振频率下的纯正弦式电流驱动。因为其它频率可激发寄生谐振，因此最小化或降低动态支路电流的总失真可相应地最小化或降低不利的谐振效应。因为发生器800所输出的驱动信号的波形形状受输出驱动电路(例如，电力变压器806、功率放大器812)中所存在的各种畸变源的影响，所以基于驱动信号的电压和电流反馈数据可被输入至算法(诸如由DSP处理器822实现的误差控制算法)中，所述算法通过适当地以动态行进方式(例如，实时)使存储于LUT中的波形样本预先畸变或修改来补偿畸变。在一种形式中，对LUT样本所施加的预先畸变量或程度可根据所计算的动态支路电流与期望的电流波形形状之间的误差而定，其中所述误差可基于逐一样本确定。以该方式，预先失真的LUT样本在通过驱动电路进行处理时，可使动态支路驱动信号具有所期望的波形形状(例如，正弦形状)，以最佳地驱动超声换能器。因此，在此类形式中，当考虑到畸变效应时，LUT波形样本将不呈现驱动信号的期望波形形状，而是呈现要求最终产生动态支路驱动信号的期望波形形状的波形形状。
非隔离级804还可包括第一ADC电路826和第二ADC电路828，所述ADC电路经由相应的隔离变压器830、832耦接到电力变压器806的输出，以分别用于对由发生器800输出的驱动信号的电压和电流进行采样。在某些形式中，ADC电路826、828可被配置为以高速采样(例如，80兆次采样/秒(MSPS))，以使得能够对驱动信号进行过采样。在一种形式中，例如，ADC电路826、828的采样速度可实现驱动信号的约200x(根据频率而定)的过采样。在某些形式中，可通过令单个ADC电流经由二路式多路复用器接收输入电压和电流信号来执行ADC电路826、828的采样操作。通过在发生器800的形式中使用高速采样，可实现对流过动态支路的复杂电流的计算(这在某些形式中可用于实现上述基于DDS的波形形状控制)、对采样信号进行准确的数字滤波以及以高精度计算实际功耗等等。ADC电路826、828所输出的电压和电流反馈数据可由逻辑装置816接收及处理(例如，先入先出(FIFO)缓冲器、多路复用器)并被存储于数据存储器中，以供例如DSP处理器822后续取回。如上所述，电压和电流反馈数据可用作算法的输入用于以动态行进方式使LUT波形样本预先失真或修改。在某些形式中，当采集到电压和电流反馈数据对时，可能需要基于由逻辑装置816输出的对应LUT样本或换句话讲与所述对应LUT样本相关联，为每个所存储的电压和电流反馈数据对进行编索引。以此方式使LUT样本和电压和电流反馈数据同步有助于预失真算法的准确计时和稳定性。
在某些形式中，可使用电压和电流反馈数据来控制驱动信号的频率和/或振幅(例如，电流振幅)。在一种形式中，例如，可使用电压和电流反馈数据来确定阻抗相位。随后，可控制驱动信号的频率以最小化或减小所确定阻抗相位与阻抗相位设定点(例如，0°)之间的差值，从而最小化或减小谐波畸变的影响，并相应地提高阻抗相位测量精确度。相位阻抗和频率控制信号的确定可在DSP处理器822中实现，例如，其中频率控制信号作为输入被提供至逻辑装置816所实现的DDS控制算法。
在另一形式中，例如可监视电流反馈数据，以便将驱动信号的电流振幅保持在电流振幅设定点。电流振幅设定点可被直接指定或基于特定的电压振幅和功率设定点而间接地确定。在某些方面，可通过DSP处理器822中的控制算法(诸如例如比例积分微分(PID)控制算法)来实现对电流振幅的控制。控制算法为了适当控制驱动信号的电流振幅而控制的变量可包括例如：存储在逻辑装置816中的LUT波形样本的定标和/或经由DAC电路834的DAC电路818(其为功率放大器812提供输入)的满标度输出电压。
非隔离级804还可包括第二处理器836，以用于提供用户界面(UI)功能等等。在一种形式中，UI处理器836可包括例如购自美国加利福尼亚州圣何塞的阿特梅尔公司(AtmelCorporation,San Jose,California)的具有ARM926EJ-S核心的Atmel AT91SAM9263处理器。UI处理器836所支持的UI功能的示例可包括听觉和视觉用户反馈、与外围装置(例如，经由USB接口)的通信、与脚踏开关的通信、与输入装置(例如，触摸屏显示器)的通信以及与输出装置(例如，扬声器)的通信。UI处理器836可与DSP处理器822和逻辑装置816(例如，经由SPI总线)通信。尽管UI处理器836可主要支持UI功能，然而在某些形式中，其也可与DSP处理器822配合以减缓风险。例如，UI处理器836可被编程为监测用户输入和/或其它输入(例如，触摸屏输入、脚踏开关输入、温度传感器输入)的各个方面，并且当检测到错误状况时停用发生器800的驱动输出。
在某些形式中，DSP处理器822与UI处理器836两者例如可确定并监测发生器800的操作状态。对于DSP处理器822，发生器800的操作状态可指示例如DSP处理器822实现哪些控制和/或诊断过程。对于UI处理器836，发生器800的操作状态可指示例如UI的哪些元素(例如，显示屏、声音)可呈现给用户。相应的DSP处理器822和UI处理器836可独立地保持发生器800的当前操作状态并识别和评估当前操作状态的可能转变。DSP处理器822可用作此关系中的主体并确定何时会发生操作状态间的转变。UI处理器836可注意到操作状态间的有效转变并可证实特定的转变是否适当。例如，当DSP处理器822命令UI处理器836转变至特定状态时，UI处理器836可验证所要求的转变是有效的。如果UI处理器836确定所请求的状态间转变是无效的，则UI处理器836可使发生器800进入故障模式。
非隔离级804还可包括控制器838，以用于监测输入装置(例如，用于接通和断开发生器800的电容式触摸传感器、电容式触摸屏)。在某些形式中，控制器838可包括至少一个处理器和/或与UI处理器836通信的其它控制装置。在一种形式中，例如，控制器838可包括处理器(例如，购自阿特梅尔公司(Atmel)的Meg168 8位控制器)，该处理器被配置为监测经由一个或多个电容式触摸传感器提供的用户输入。在一种形式中，控制器838可包括触摸屏控制器(例如，购自阿特梅尔公司(Atmel)的QT5480触摸屏控制器)，以控制和管理从电容式触摸屏对触摸数据的采集。
在某些形式中，当发生器800处于“功率关”状态时，控制器838可继续接收操作功率(例如，经由来自发生器800的功率源的线，诸如以下所述的功率源854)。以此方式，控制器838可继续监测输入装置(例如，位于发生器800的前面板上的电容式触摸传感器)，以接通和断开发生器800。当发生器800处于功率关状态时，如果检测到用户激活“接通/断开”输入装置，则控制器838可环形功率源(例如，启用功率源854的一个或多个DC/DC电压转换器856的操作)。控制器838可因此开始使发生器800转变至“功率开”状态的序列。相反，当发生器800处于功率开状态时，如果检测到“接通/断开”输入装置的激活，则控制器838可开始使发生器800转变至功率关状态的序列。在某些形式中，例如，控制器838可向UI处理器836报告“接通/断开”输入装置的激活，该处理器继而实现所需的过程序列以使发生器800转变至功率关状态。在此类形式中，控制器838可能不具有在建立起功率开状态之后从发生器800去除功率的独立能力。
在某些形式中，控制器838可使发生器800提供听觉或其它感观反馈，以警示用户功率开或功率关序列已开始。可在功率开或功率关序列开始时以及在与序列相关联的其它过程开始之前提供此类警示。
在某些形式中，隔离级802可包括器械接口电路840，例如以在外科器械的控制电路(例如，包括手持件开关的控制电路)与非隔离级804的部件(诸如例如，逻辑装置816、DSP处理器822和/或UI处理器836)之间提供通信接口。器械接口电路840可经由保持隔离级802和非隔离级804之间的合适的电隔离程度的通信链路(诸如例如，基于IR的通信链路)与非隔离级804的部件交换信息。可使用例如由隔离变压器供电的低压差电压调整器为器械接口电路840供应电力，该低压差电压调整器从非隔离级804被驱动。
在一种形式中，器械接口电路840可包括与信号调节电路844通信的逻辑电路842(例如，逻辑电路、可编程逻辑电路、PGA、FPGA、PLD)。信号调节电路844可被配置为从逻辑电路842接收周期性信号(例如，2kHz方波)，以生成具有相同频率的双极性询问信号。例如，可使用由差分放大器馈送的双极电流源生成询问信号。询问信号可传送至外科器械控制电路(例如，通过使用将发生器800连接到外科器械的缆线中的导电对)并被监测，以确定控制电路的状态或配置。控制电路可包括多个开关、电阻器和/或二极管，以修改询问信号的一个或多个特性(例如，振幅、整流)，使得可基于所述一个或多个特性唯一地辨别控制电路的状态或配置。在一种形式中，例如，信号调节电路844可包括ADC电路，以用于产生由于询问信号通过控制电路而出现在控制电路输入中的电压信号的样本。随后，逻辑电路842(或非隔离级804的部件)可基于ADC电路样本来确定控制电路的状态或配置。
在一种形式中，器械接口电路840可包括第一数据电路接口846，以实现逻辑电路842(或器械接口电路840的其它元件)与设置于外科器械中的或换句话讲与外科器械相关联的第一数据电路之间的信息交换。在某些形式中，例如，第一数据电路可设置于整体地附接到外科器械手持件的缆线中，或设置于用于使特定的外科器械类型或模型与发生器800交接的适配器中。第一数据电路可以任何合适的方式实现，并且可根据包括例如本文关于第一数据电路所述的任何合适的协议与发生器通信。在某些形式中，第一数据电路可包括非易失性存储装置，诸如EEPROM装置。在某些形式中，第一数据电路接口846可独立于逻辑电路842实现，并且包括合适的电路系统(例如，分立的逻辑装置、处理器)，以实现逻辑电路842和第一数据电路之间的通信。在其它形式中，第一数据电路接口846可与逻辑装置842成一体。
在某些形式中，第一数据电路可存储与相关联的特定外科器械相关的信息。此类信息可包括例如型号、序列号、其中已使用外科器械的多个操作、和/或任何其它类型的信息。这种信息可被器械接口电路840(例如，通过逻辑电路842)读取，被传输至非隔离级804的部件(例如，传输至逻辑装置816、DSP处理器822和/或UI处理器836)，以经由输出装置呈现给用户和/或控制发生器800的功能或操作。另外，任何类型的信息均可经由第一数据电路接口846(例如，使用逻辑电路842)传送至第一数据电路以存储于其中。此类信息可包括例如其中使用外科器械的操作的更新数目和/或其使用的日期和/或时间。
如先前所讨论，外科器械可从手持件拆卸(例如，多功能外科器械可从手持件拆卸)，以促进器械可互换性和/或可处置性。在此类情形中，常规发生器的识别所使用特定器械构型和相应地优化控制和诊断过程的能力可受限。然而，从兼容性角度来看，通过对外科器械添加可读数据电路来解决这一点是有问题的。例如，将外科器械设计为保持与缺少必备数据读取功能的发生器的向后兼容可能由于例如不同的信号方案、设计复杂性和成本而不切实际。本文所述器械的形式通过使用数据电路来解决这些问题，所述数据电路可经济地实现于现有外科器械中并具有最小的设计变化，以保持外科器械与电流发生器平台的兼容性。
另外，发生器800的形式可实现与基于器械的数据电路的通信。例如，发生器800可被配置为与包含在器械(例如，多功能外科器械)中的第二数据电路通信。在一些形式中，第二数据电路可以类似于本文所述的第一数据电路的方式实现。器械接口电路840可包括用于实现该通信的第二数据电路接口848。在一种形式中，第二数据电路接口848可包括三态数字接口，但也可以使用其它接口。在某些形式中，第二数据电路通常可为用于传输和/或接收数据的任何电路。在一种形式中，例如第二数据电路可存储与相关联的特定外科器械相关的信息。此类信息可包括例如型号、序列号、其中已使用外科器械的多个操作、和/或任何其它类型的信息。
在一些形式中，第二数据电路可存储关于相关联的超声换能器、端部执行器或超声驱动系统的电性能和/或超声性能的信息。例如，第一数据电路可指示老化频率斜率，如本文所述。除此之外或另选地，任何类型的信息均可经由第二数据电路接口848(例如，使用逻辑电路842)传送至第二数据电路以存储于其中。此类信息例如可包括其中使用外科器械的操作的更新数目和/或其使用的日期和/或时间。在某些形式中，第二数据电路可传输由一个或多个传感器(例如，基于器械的温度传感器)采集的数据。在某些形式中，第二数据电路可从发生器800接收数据并基于所接收的数据向用户提供指示(例如，发光二极管指示或其它可视指示)。
在某些形式中，第二数据电路和第二数据电路接口848可被配置为使得可实现逻辑电路842与第二数据电路之间的通信，而无需为此提供附加导体(例如，将手持件连接至发生器800的缆线的专用导体)。在一种形式中，例如，可使用实现于现有缆线上的单总线通信方案(诸如用于将询问信号从信号调节电路844发射至手持件中的控制电路的导体中的一者)将信息传送至第二数据电路并从第二数据电路传送信息。以此方式，可最小化或减少原本可能必要的外科器械的设计变化或修改。此外，因为在共用物理通道上实现的不同类型的通信可以是频带分离的，所以第二数据电路的存在对于不具有必备数据读取功能的发生器而言可为“隐形的”，因此能够实现外科器械的向后兼容性。
在某些形式中，隔离级802可包括至少一个阻挡电容器850-1，所述至少一个阻挡电容器连接到驱动信号输出件810b以阻止DC电流流向患者。例如，可要求信号阻挡电容器符合医疗规则或标准。尽管相对而言单电容器设计中很少出现错误，然而此类错误可造成不良后果。在一种形式中，可设置有与阻挡电容器850-1串联的第二阻挡电容器850-2，其中例如通过ADC电路852来监视从阻挡电容器850-1与850-2之间的点发生的电流泄漏，以对泄漏电流所感应的电压进行采样。这些样本可由例如逻辑电路842接收。基于泄漏电流的变化(如电压样本所示)，发生器800可以确定阻挡电容器850-1、850-2中的至少一个何时发生故障，从而比具有单个故障点的单电容器设计更具优势。
在某些形式中，非隔离级804可包括功率源854，以用于在合适的电压和电流下递送DC功率。功率源可包括例如400W的功率源，以用于递送48VDC的系统电压。功率源854还可包括一个或多个DC/DC电压转换器856，以用于接收功率源的输出，以在发生器800的各个部件所需的电压和电流下产生DC输出。如上文结合控制器838所述，当控制器838检测到用户激活“接通/断开”输入装置以启用DC/DC电压转换器856的操作或唤醒DC/DC电压转换器时，DC/DC电压转换器856中的一个或多个可从控制器838接收输入。
图21示出了发生器900的示例，该发生器是发生器800(图20)的一种形式。发生器900被配置为将多个能量模态递送至外科器械。发生器900提供用于独立地或同时将能量递送至外科器械的RF信号和超声信号。RF信号和超声信号可单独或组合提供，并且可同时提供。如上所述，至少一个发生器输出可通过单个端口递送多种能量模态(例如，超声、双极或单极RF、不可逆和/或可逆电穿孔和/或微波能量等等)，并且这些信号可分开或同时被递送到端部执行器以处理组织。
发生器900包括耦接到波形发生器904的处理器902。处理器902和波形发生器904被配置为基于存储在耦接到处理器902的存储器中的信息来生成各种信号波形，为了本公开清楚起见而未示出该存储器。与波形相关联的数字信息被提供给波形发生器904，该波形发生器904包括一个或多个DAC电路以将数字输入转换成模拟输出。模拟输出被馈送到放大器1106用于信号调节和放大。放大器906的经调节和放大的输出耦接到电力变压器908。信号通过电力变压器908耦接到患者隔离侧中的次级侧。第一能量模态的第一信号被提供给被标记为ENERGY1和RETURN的端子之间的外科器械。第二能量模态的第二信号耦接到电容器910两端并被提供给被标记为ENERGY2和RETURN的端子之间的外科器械。应当理解，可输出超过两种能量模态，并且因此下标“n”可被用来指定可提供多至n个ENERGYn端子，其中n是大于1的正整数。还应当理解，在不脱离本公开的范围的情况下，可提供多至“n”个返回路径RETURNn。
第一电压感测电路912耦接到被标记为ENERGY1和RETURN路径的端子的两端，以测量其间的输出电压。第二电压感测电路924耦接到被标记为ENERGY2和RETURN路径的端子的两端，以测量其间的输出电压。如图所示，电流感测电路914与电力变压器908的次级侧的RETURN支路串联设置，以测量任一能量模态的输出电流。如果为每种能量模态提供不同的返回路径，则应在每个返回支路中提供单独的电流感测电路。第一电压感测电路912和第二电压感测电路924的输出被提供给相应的隔离变压器916、922，并且电流感测电路914的输出被提供给另一隔离变压器918。电力变压器908(非患者隔离侧)的初级侧上的隔离变压器916、928、922的输出被提供给一个或多个ADC电路926。ADC电路926的数字化输出被提供给处理器902用于进一步处理和计算。可采用输出电压和输出电流反馈信息来调整提供给外科器械的输出电压和电流，并且计算输出阻抗等参数。处理器902和患者隔离电路之间的输入/输出通信通过接口电路920提供。传感器也可通过接口920与处理器902电气通信。
在一个方面，阻抗可由处理器902通过将耦接在被标记为ENERGY1/RETURN的端子两端的第一电压感测电路912或耦接在被标记为ENERGY2/RETURN的端子两端的第二电压感测电路924的输出除以与电力变压器908的次级侧的RETURN支路串联设置的电流感测电路914的输出来确定。第一电压感测电路912和第二电压感测电路924的输出被提供给单独的隔离变压器916、922，并且电流感测电路914的输出被提供给另一隔离变压器916。来自ADC电路926的数字化电压和电流感测测量值被提供给处理器902以用于计算阻抗。例如，第一能量模态ENERGY1可以是超声能量，并且第二能量模态ENERGY2可以是RF能量。然而，除了超声和双极或单极RF能量模态之外，其它能量模态还包括不可逆和/或可逆电穿孔和/或微波能量等。而且，虽然图21所示的示例示出了可为两种或更多种能量模态提供单个返回路径RETURN，但在其它方面，可为每种能量模态ENERGYn提供多个返回路径RETURNn。因此，如本文所述，超声换能器阻抗可通过将第一电压感测电路912的输出除以电流感测电路914的输出来测量，并且组织阻抗可通过将第二电压感测电路924的输出除以电流感测电路914的输出来测量。
如图21中所示，包括至少一个输出端口的发生器900可包括具有单个输出和多个分接头的电力变压器908，以例如根据正在执行的组织处理类型以一种或多种能量模态(诸如超声、双极或单极RF、不可逆和/或可逆电穿孔和/或微波能量等等)的形式向端部执行器提供功率。例如，发生器900可用较高电压和较低电流递送能量以驱动超声换能器，用较低电压和较高电流递送能量以驱动RF电极以用于密封组织，或者用凝固波形递送能量以用于使用单极或双极RF电外科电极。来自发生器900的输出波形可被操纵、切换或滤波，以向外科器械的端部执行器提供频率。超声换能器与发生器900输出端的连接将优选地位于被标记为ENERGY1和RETURN的输出端之间，如图21所示。在一个示例中，RF双极电极与发生器900输出端的连接将优选地位于被标记为ENERGY2和RETURN的输出端之间。在单极输出的情况下，优选的连接将是ENERGY2输出端的有源电极(例如，铅笔或其他探头)以及连接至RETURN输出端的合适的返回垫。
附加细节公开于2017年3月30日公布的标题为用于操作用于数字地生成电信号波形的发生器和外壳器械的技术(TECHNIQUES FOR OPERATING GENERATOR FOR DIGITALLYGENERATING ELECTRICAL SIGNAL WAVEFORMS AND SURGICAL INSTRUMENTS)的美国专利申请公布2017/0086914中，该专利申请全文以引用方式并入本文。
如本说明书通篇所用，术语“无线”及其衍生物可用于描述可通过使用经调制的电磁辐射通过非固体介质来传送数据的电路、装置、系统、方法、技术、通信信道等。该术语并不意味着相关联的组织不包含任何电线，尽管在一些方面它们可能不包含。通信模块可实现多种无线或有线通信标准或协议中的任一种，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)、Ev-DO、HSPA+、HSDPA+、HSUPA+、EDGE、GSM、GPRS、CDMA、TDMA、DECT、蓝牙、及其以太网衍生物、以及被指定为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。
如本文所用，处理器或处理单元是对一些外部数据源(通常为存储器或一些其它数据流)执行操作的电子电路。本文所用术语是指组合多个专门的“处理器”的一个或多个系统(尤其是片上系统(SoC))中的中央处理器(中央处理单元)。
如本文所用，片上系统或芯片上系统(SoC或SOC)为集成了计算机或其它电子系统的所有部件的集成电路(也被称为“IC”或“芯片”)。它可以包含数字、模拟、混合信号以及通常射频功能—全部在单个基板上。SoC将微控制器(或微处理器)与高级外围装置如图形处理单元(GPU)、Wi-Fi模块或协处理器集成。SoC可以包含或可不包含内置存储器。
如本文所用，微控制器或控制器为将微处理器与外围电路和存储器集成的系统。微控制器(或微控制器单元的MCU)可被实现为单个集成电路上的小型计算机。其可类似于SoC；SoC可包括作为其部件之一的微控制器。微控制器可包含一个或多个核心处理单元(CPU)以及存储器和可编程输入/输出外围装置。以铁电RAM、NOR闪存或OTP ROM形式的程序存储器以及少量RAM也经常包括在芯片上。与个人计算机或由各种分立芯片组成的其它通用应用中使用的微处理器相比，微控制器可用于嵌入式应用。
如本文所用，术语控制器或微控制器可为与外围装置交接的独立式IC或芯片装置。这可为计算机的两个部件或用于管理该装置的操作(以及与该装置的连接)的外部装置上的控制器之间的链路。
如本文所述的处理器或微控制器中的任一者可为任何单核或多核处理器，诸如由德克萨斯器械公司(Texas Instruments)提供的商品名为ARM Cortex的那些。在一个方面，处理器可为例如购自德克萨斯器械公司(Texas Instruments)的LM4F230H5QR ARMCortex-M4F处理器内核，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)、以及易得的其它特征。
在一个示例中，处理器可包括安全控制器，该安全控制器包括两个基于控制器的系列，诸如同样由德克萨斯器械公司(Texas Instruments)提供的商品名为Hercules ARMCortex R4的TMS570和RM4x。安全控制器可被配置为专门用于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结构，同时递送可定标的性能、连接性和存储器选项。
模块化装置包括可容纳在外科集线器内的模块(如结合图3和图9所述)和外科装置或器械，该外科装置或器械可连接到各种模块以便与对应的外科集线器连接或配对。模块化装置包括例如智能外科器械、医疗成像装置、抽吸/冲洗装置、排烟器、能量发生器、呼吸机、吹入器和显示器。本文所述的模块化装置可通过控制算法来控制。控制算法可在模块化装置自身上、在与特定模块化装置配对的外科集线器上或在模块化装置和外科集线器两者上执行(例如，经由分布式计算架构)。在一些示例中，模块化装置的控制算法基于由模块化装置自身感测到的数据来控制装置(即，通过模块化设备之中、之上或连接到模块化装置的传感器)。该数据可与正在手术的患者(例如，组织特性或吹入压力)或模块化装置本身相关(例如，刀被推进的速率、马达电流或能量水平)。例如，外科缝合和切割器械的控制算法可根据刀在其前进时遇到的阻力来控制器械的马达驱动其刀穿过组织的速率。
态势感知
态势感知是外科系统的一些方面通过从数据库和/或器械接收的数据确定或推断与外科规程有关的信息的能力。所述信息可包括所进行的规程的类型、进行手术的组织的类型或作为规程对象的体腔。利用与外科规程有关的背景信息，外科系统可以例如改善其控制与其连接的模块化装置(例如，机械臂和/或机器人外科工具)以及在外科规程期间向外科医生提供背景信息或建议的方式。
现在参见图33，该图示出了描绘集线器诸如外科集线器106或206的态势感知的时间轴5200。时间轴5200是说明性的外科规程以及外科集线器106、206可以从外科规程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。
态势感知外科集线器106、206在整个外科规程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可从配对的模块化装置和其它数据源接收该数据，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，提供可能与特定过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。
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电子病历(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。
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)。
第三步5206，医疗人员经由可通信地连接到外科毂集线器106、206的扫描器来扫描患者带。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。
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规程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规程的背景信息。在该具体示例中，外科集线器106、206确定外科规程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规程的什么步骤。
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。
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。
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手术步骤。
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可确定外科规程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耦接到外科集线器)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规程的具体类型和/或用于特定类型的外科规程的技术。
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规程的检索步骤交叉，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。
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械臂的外科工具。
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)横切软组织。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软组织(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。
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泄漏测试。对于该特定规程，在横切软组织后使用的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规程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规程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。
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。
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可根据从可通信地耦接到外科集线器106、206的各种数据源接收的数据来确定或推断给定外科规程的每个步骤何时发生。
态势感知在2017年12月28日提交的标题为交互式外科平台(INTERACTIVESURGICAL PLATFORM)的美国临时专利申请序列号62/611,341中进一步描述，该临时专利申请的公开内容全文以引用方式并入本文。在某些情况下，包括本文所公开的各种机器人外科系统在内的机器人外科系统的操作可由集线器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的信息进行控制。
机器人系统
机器人外科系统可用于微创医学规程。在此类医学规程中，患者可置于与机器人外科系统相邻的平台上，并且外科医生可定位在远离平台和/或机器人的控制台上。例如，外科医生可定位在围绕外科部位的无菌场之外。外科医生经由控制台上的输入装置向用户界面提供输入，以操纵耦接到机器人系统的臂的外科工具。输入装置可以是机械输入装置，诸如控制柄或操纵杆，或非接触式输入装置，诸如光学手势传感器。
机器人外科系统可包括支撑一个或多个机械臂的机器人塔。至少一个外科工具(例如，端部执行器和/或内窥镜)可以安装到机械臂上。例如，外科工具可被配置为经由进行关节运动的腕部组件相对于相应的机械臂进行关节运动并且/或者经由线性滑动机构相对于机械臂平移。在外科规程期间，外科工具可例如经由插管或套管针插入患者的小切口中，或者插入患者的自然孔中，以将外科工具的远侧端部定位在患者体内的外科部位处。除此之外或另选地，在某些情况下，机器人外科系统可用于开放式外科规程中。
机器人外科系统15000的示意图描绘于图22中。机器人外科系统15000包括中央控制单元15002、外科医生的控制台15012、包括一个或多个机械臂15024的机器人15022，以及可操作地耦接到控制单元15002的主显示器15040。外科医生的控制台15012包括显示器15014和至少一个手动输入装置15016(例如，开关、按钮、触摸屏、操纵杆、万向节等)，所述手动输入装置允许外科医生远程操纵机器人15022的机械臂15024。读者应当理解，可以采用附加的和另选的输入装置。
中央控制单元15002包括可操作地耦接到存储器15006的处理器15004。处理器15004包括用于与机器人外科系统15000的部件交接的多个输入和输出。处理器15004可被配置为接收输入信号并且/或者生成输出信号以控制机器人外科系统15000的各种部件中的一个或多个(例如，一个或多个马达、传感器和/或显示器)。输出信号可包括并且/或者可基于可以由外科医生或另一临床医生预先编程和/或输入的算法指令。处理器15004可被配置为接受来自用户诸如控制台15012上的外科医生的多个输入，并且/或者可以与远程系统交接。存储器15006可以直接地和/或间接地耦接到处理器15004，以存储指令和/或数据库。
机器人15022包括一个或多个机械臂15024。每个机械臂15024包括一个或多个马达15026，并且每个马达15026耦接到一个或多个马达驱动器15028。例如，可以分配给不同的驱动器和/或机构的马达15026可座置在托架组件或外壳中。在某些情况下，在马达15026和一个或多个驱动器15028中间的变速器可允许马达15026与一个或多个驱动器15028的耦接和脱离。驱动器15028可被配置为实现一种或多种外科功能。例如，一个或多个驱动器15028可负责通过旋转机械臂15024和/或其连杆和/或接合部来移动机械臂15024。另外，一个或多个驱动器15028可耦接到外科工具15030，并且可以实现例如关节运动、旋转、夹持、密封、缝合、通电、击发、切割和/或打开。在某些情况下，外科工具15030可以是可互换的和/或可替换的。机器人外科系统和外科工具的示例在本文中进一步描述。
读者将会容易地认识到，计算机实现的交互式外科系统100(图1)和计算机实现的交互式外科系统200(图9)可以结合机器人外科系统15000。除此之外或另选地，机器人外科系统15000可包括计算机实现的交互式外科系统100和200的各种特征和/或部件。
在一个示例中，机器人外科系统15000可包括机器人系统110(图2)，该机器人系统包括外科医生的控制台118、外科机器人120和机器人集线器122。除此之外或另选地，机器人外科系统15000可以与另一个集线器诸如外科集线器106通信。在一个实例中，机器人外科系统15000可结合到外科系统中，诸如计算机实现的交互式外科系统100(图1)或计算机实现的交互式外科系统200(图9)。在这种情况下，机器人外科系统15000可以分别与云104或云204以及外科集线器106或外科集线器206相互作用。在某些情况下，机器人集线器或外科集线器可包括中央控制单元15002并且/或者中央控制单元15002可以与云通信。在其它情况下，外科集线器可以体现为与中央控制单元15002分开并且可以与中央控制单元15002通信的分立单元。
另一个机器人外科系统是英国剑桥的剑桥医疗机器人公司(Cambridge MedicalRobots Ltd.of Cambridge,England)的机器人外科系统。这种系统的示例描绘于图23中。参见图23，外科机器人包括从基座14401延伸的臂14400。臂14400包括通过旋转接合部14403耦接在一起的多个刚性分支14402。最近侧分支14402a通过接合部14403a耦接到基座14401。最近侧分支14402a和其它分支(例如，分支14402b和14402c)在接合部14403处串联耦接到另外的分支。腕部14404可由四个单独的旋转接合部构成。腕部14404将一个分支(例如，分支14402b)耦接到臂14400的最远侧分支(例如，图23中的分支14402c)。最远侧分支14402c携带有用于外科工具14406的附接件14405。臂14400的每个接合部14403具有一个或多个马达14407和一个或多个位置和/或扭矩传感器14408，所述马达可被操作以在相应的接合部处引起旋转运动，所述位置和/或扭矩传感器提供关于该接合部14403处的当前配置和/或负载的信息。马达14407可被布置在被马达驱动运动的接合部14403的近侧，以便例如改善重量分布。为了清楚起见，图23中仅示出一些马达和传感器。臂14400可以大体上如2014年8月18日提交的标题为带有一对相互啮合的螺旋转子的分配器装置(DISTRIBUTOR APPARATUS WITH A PAIR OF INTERMESHING SCREW ROTORS)的专利申请PCT/GB2014/053523和国际专利申请公布WO 2015/025140中所述，该专利申请于2015年2月26日公布并且全文以引用方式并入本文。扭矩感测在2016年5月13日提交的标题为外科机器人腕部中的扭矩感测(TORQUE SENSING IN A SURGICAL ROBOTIC WRIST)的美国专利申请公布2016/0331482中进一步描述，该专利申请于2016年11月17日公布并且全文以引用方式并入本文。
臂14400终止于附接件14405中，以与外科工具14406交接。附接件14405包括用于驱动外科工具14406的关节运动的驱动组件。驱动组件的可移动接口元件机械地交接以接合工具接口的对应可移动接口元件，以便将驱动运动从机械臂14400传递到外科工具14406。在典型的操作期间，一个外科工具可以一次或多次地被调换为另一外科工具。外科工具14406能够在操作期间与机械臂14400附接以及从机械臂拆下。驱动组件接口和工具接口的特征部可以在它们彼此接合时帮助它们对准，从而降低在需要由用户对准它们时的精确度。用于引导机械臂和外科工具的接合的杆在2016年12月9日提交的标题为机械臂和外科器械的引导接合(GUIDING ENGAGEMENT OF A ROBOT ARM AND SURGICAL INSTRUMENT)的美国专利申请公布2017/0165012中进一步描述，该专利申请于2017年6月15日公布并且全文以引用方式并入本文。
外科工具14406还包括用于执行操作的端部执行器。端部执行器可采用任何合适的形式。例如，端部执行器可包括平滑钳口、锯齿状钳口、夹具、一对剪切器、缝合针、相机、激光器、刀、缝合器、一个或多个电极、超声刀、烧灼器和/或吸盘。另选的端部执行器在本文中进一步描述。外科工具14406可包括在轴和端部执行器之间的关节运动结合，该关节运动结合可允许端部执行器相对于工具的轴移动。关节运动结合中的接合部可通过驱动元件诸如滑轮缆线来致动。用于使外科工具14406进行关节运动的滑轮布置在2016年12月9日提交的标题为用于使外科器械进行关节运动的滑轮布置(PULLEY ARRANGEMENT FORARTICULATING A SURGICAL INSTRUMENT)的美国专利申请公布2017/0172553中有所描述，该专利申请于2017年6月22日公布并且全文以引用方式并入本文。用于使外科工具14406进行关节运动的驱动元件被固定到工具接口的接口元件上。因此，机械臂14400可以如下将驱动运动传递到端部执行器：驱动组件接口元件的移动使工具接口元件移动，该工具接口元件使工具14406中的驱动元件移动，该驱动元件使关节运动结合的接合部移动，该接合部使端部执行器移动。对机械臂和工具诸如臂14400和工具14406的控制在2016年5月13日提交、2016年11月17日公布的标题为外科机器人腕部中的扭矩感测(TORQUE SENSING IN ASURGICAL ROBOTIC WRIST)的美国专利申请公布2016/0331482以及2016年1月21日提交、2016年7月28日公布的标题为机器人工具回缩(ROBOT TOOL RETRACTION)的国际专利申请公布WO2016/116753中进一步描述，所述专利申请中的每个全文以引用方式并入本文。
用于马达14407和传感器14408(例如扭矩传感器和编码器)的控制器分布在机械臂14400内。控制器经由通信总线连接到控制单元14409。在机械臂诸如臂14400中的通信路径的示例在标题为用于机械臂的驱动机构(DRIVE MECHANISMS FOR ROBOT ARMS)的美国专利申请公布2017/0021507以及标题为用于机械臂的齿轮封装(GEAR PACKAGING FORROBOTIC ARMS)的美国专利申请公布2017/0021508中进一步描述，所述专利申请中的每个于2016年7月22日提交并于2017年1月26日公布，并且所述专利申请中的每个全文以引用方式并入本文。控制单元14409包括处理器14410和存储器14411。存储器14411可以非瞬态方式存储软件，该软件能够由处理器14410执行以控制马达14407的操作，从而使臂14400以本文所述的方式进行操作。具体地，该软件可以控制处理器14410以根据来自传感器14408和来自外科医生命令接口14412的输入使马达14407(例如，经由分布式控制器)驱动。
控制单元14409耦接到马达14407，以根据通过软件执行所生成的输出来驱动马达。控制单元14409耦接到传感器14408以从传感器14408接收所感测到的输入，并且耦接到命令接口14412以从其接收输入。相应的耦接例如可以分别是电缆或光缆，并且/或者可通过无线连接来提供。命令接口14412包括一个或多个输入装置，由此用户可以期望的方式请求端部执行器的运动。输入装置可以是例如可手动操作的机械输入装置，诸如控制柄或操纵杆，或非接触式输入装置，诸如光学手势传感器。存储在存储器14411中的软件被配置为响应于这些输入，并且使得臂14400和工具14406的接合部根据预先确定的控制策略相应地移动。控制策略可包括安全特征部，该安全特征部响应于命令输入而缓和臂14400和工具14406的运动。概括地说，命令接口14412处的外科医生可以控制外科工具14406以执行期望的外科规程的方式移动。控制单元14409和/或命令接口14412可以远离臂14400。
外科机器人系统诸如图23所示的机器人外科系统的附加特征和操作在以下参考文献中进一步描述，这些参考文献中的每个均全文以引用方式并入本文：
·2016年1月21日提交的标题为机器人工具回缩(ROBOT TOOL RETRACTION)的国际专利申请公布WO 2016/116753，于2016年7月28日公布；
·2016年5月13日提交的标题为外科机器人腕部中的扭矩感测(TORQUE SENSINGIN A SURGICAL ROBOTIC WRIST)的美国专利申请公布2016/0331482，于2016年11月17日公布；
·2016年7月22日提交的标题为用于机械臂的驱动机构(DRIVE MECHANISMS FORROBOT ARMS)的美国专利申请公布2017/0021507，于2017年1月27日公布；
·2016年7月22日提交的标题为用于机械臂的齿轮封装(GEAR PACKAGING FORROBOTIC ARMS)的美国专利申请公布2017/0021508，于2017年1月27日公布；
·2016年12月9日提交的标题为机械臂和外科器械的引导接合(GUIDINGENGAGEMENT OF A ROBOT ARM AND SURGICAL INSTRUMENT)的美国专利申请公布2017/0165012，于2017年6月15日公布；以及
·2016年12月9日提交的标题为用于使外科器械进行关节运动的滑轮布置(PULLEY ARRANGEMENT FOR ARTICULATING A SURGICAL INSTRUMENT)的美国专利申请公布2017/0172553，于2017年6月22日公布。
在一个实例中，本文所公开的机器人外科系统和特征可以与机器人外科系统和/或图23的机器人外科系统一起使用。读者还应当认识到，本文所公开的各种系统和/或特征也可以与替代外科系统一起使用，所述替代外科系统包括例如计算机实现的交互式外科系统100、计算机实现的交互式外科系统200、机器人外科系统110、机器人集线器122、机器人集线器222和/或机器人外科系统15000。
在各种情况下，机器人外科系统可包括机器人控制塔，该机器人控制塔可容纳该系统的控制单元。例如，图23所示的机器人外科系统的控制单元14409可座置在机器人控制塔内。机器人控制塔可包括机器人集线器，诸如机器人集线器122(图2)或机器人集线器222(图9)。这样的机器人集线器可包括用于与一个或多个发生器(诸如超声发生器和/或射频发生器)和/或一个或多个模块(诸如成像模块、抽吸模块、冲洗模块、排烟模块和/或通信模块)耦接的模块化接口。
读者将会容易地认识到，本文所公开的计算机实现的交互式外科系统100(图1)和计算机实现的交互式外科系统200(图9)可以结合机械臂14400。除此之外或另选地，图23所示的机器人外科系统可包括计算机实现的交互式外科系统100和200的各种特征和/或部件。
机器人集线器可包括态势感知模块，该态势感知模块可被配置为合成来自多个源的数据以确定对外科事件的适当响应。例如，态势感知模块可以确定外科规程的类型、外科规程中的步骤、组织的类型和/或组织特征，如本文进一步所述。此外，这样的模块可以基于所合成的数据向机器人系统推荐特定的行动方案或可能的选择。在各种情况下，包括分布在整个机器人系统中的多个传感器的传感器系统可以向态势感知模块提供数据、图像和/或其它信息。这种态势感知模块可结合到控制单元中，诸如控制单元14409。在各种情况下，态势感知模块可以例如从非机器人外科集线器和/或云(诸如外科集线器106、外科集线器206、云104和/或云204)获得数据和/或信息。外科系统的态势感知在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和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中进一步公开，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。
再次参见图23，机械臂14400不包括用于使所附接的外科工具14406沿着工具14406的纵向轴线移动的线性滑动机构。相反，臂14400的分支14402被配置为围绕臂14400的各个接合部14403旋转以移动外科工具14406。换句话讲，外科工具14406沿着其纵向轴线AT的均匀移动需要各个分支14402的关节运动。例如，为了使外科工具14406沿着纵向轴线AT移动，机械臂14400将在其多个旋转接合部14403处移动。实际上，工具14406的用于使端部执行器延伸通过套管针、使端部执行器从套管针回缩和/或外科工具14406在诸如缝合过程中沿着纵轴AT局部位移的线性位移将需要多个旋转接合部14403的致动和臂14400的多个刚性分支部分14402的对应运动。
在其中机器人外科系统缺少线性滑动机构的情况下，如本文所述，智能感测系统、附加的通信路径和/或交互式显示器可实现对机械臂的更精确控制，包括实现涉及外科工具沿其轴线进行线性位移的控制运动。例如，为了确保工具14406的准确定位并避免在手术室内发生意外碰撞，希望在机器人系统中包括例如用于确定外科工具14406和/或机械臂14400各部分的位置、从无菌场内重新定位机械臂14400、传送外科工具14406相对于外科部位的位置、在外科部位处查看外科工具14406和/或在外科部位周围操纵外科工具14406的附加系统。
在一个方面，机器人外科系统可包括用于定位工具的初级控制机构和用于直接和/或独立地测量工具位置的次级装置。在一个方面，冗余或次级感测系统可被配置为确定和/或验证机械臂和/或附接到机械臂的外科工具的位置。次级感测系统可以独立于初级感测系统。
在一个实例中，初级控制机构可以依赖于闭环反馈来计算工具的位置。例如，机器人外科系统的控制单元可以发出用于机械臂的控制运动，包括各种马达和/或其驱动器，以在三维空间中移动机械臂的各部分，如本文进一步所述。例如，这样的控制单元可基于马达上的扭矩传感器和/或驱动器上的位移传感器来确定机械臂的各部分的位置和/或取向。在这种情况下，外科工具、端部执行器和/或其部件的位置可以由近侧定位的传感器确定。近侧定位的传感器可位于工具和/或机械臂的近侧外壳或安装部分中。在一个实例中，此类近侧定位的传感器可定位在例如无菌场之外。安装到机械臂上的外科工具的位置可通过例如测量臂的每个接合部的角度来确定。控制单元和与其通信的传感器(基于传递到其上的控制运动来确定臂的位置)可视为机器人外科系统的初级或第一感测系统。
除了初级感测系统之外，如本文所述，机器人外科系统可采用冗余或次级感测系统。该次级感测系统可包括一个或多个远侧定位的传感器。所述远侧定位的传感器可定位在例如无菌场内和/或端部执行器上。例如，远侧定位的传感器位于初级感测系统的近侧定位的传感器的远侧。在一个实例中，远侧定位的传感器可以是“本地”传感器，因为它们在无菌场和/或外科部位本地，而近侧定位的传感器可以是“远程”传感器，因为它们远离无菌场和/或外科部位。
现在参见图31，示意性地描绘了机器人外科系统14300的各部分。机器人外科系统14300在许多方面类似于图23的机器人外科系统。例如，机器人外科系统14300包括多个可移动部件14302。在一个方面，可移动部件14302是在旋转接合部处机械地串联耦接的刚性分支。例如，此类可移动部件14302可以形成类似于机械臂14400(图23)的机械臂。最远侧部件14302包括用于可释放地附接可互换外科工具诸如外科工具14306的附接件。机械臂的每个部件14302具有一个或多个马达14307和马达驱动器14314，所述马达和马达驱动器可被操作以影响相应接合部处的旋转运动。
每个部件14302包括一个或多个传感器14308，所述传感器可以是例如位置传感器和/或扭矩传感器。传感器14308可提供关于部件14402之间的各个接合部处的当前配置和/或负载的信息。马达14307可以由控制单元14309控制，该控制单元被配置为接收来自传感器14308和/或来自外科命令接口诸如外科命令接口14412(图23)的输入。
初级感测系统14310被结合到控制单元14309中。在一个方面，初级感测系统14310可被配置为检测一个或多个部件14302的位置。例如，初级感测系统14310可包括用于马达14307和/或驱动器14314的传感器14308。此类传感器14308远离患者P并且位于无菌场之外。尽管位于无菌场之外，但初级感测系统14310可被配置为检测无菌场内诸如在机械臂和/或其附接部分的远侧端部的位置处的部件14302和/或工具14306的位置。例如，基于机械臂及其部件14302的位置，控制单元14309可以外推外科工具14306的位置。
图31的机器人外科系统14300还包括次级感测系统14312，该次级感测系统用于直接跟踪机器人外科系统14300的各个部件和/或相关联的非机器人系统诸如手持式外科器械14350的部件的位置和/或取向。仍然参见图31，次级感测系统14312包括磁场发射器14320，该磁场发射器被配置为在一个或多个磁性传感器附近发射磁场以检测其位置。机械臂的部件14302包括磁性传感器14322，该磁性传感器可用于确定和/或验证各个部件14302的位置。例如，磁性传感器14322远离马达14307和驱动器14308。在任何情况下，通过马达的扭矩和/或驱动器的位移都不会影响磁性传感器的输出。因此，感测系统是独立的。
在某些情况下，磁性传感器14322可定位在无菌场内。例如，外科工具14306可包括磁性传感器14324，该磁性传感器可用于确定和/或验证附接到机械臂上的外科工具14306的位置并且/或者确定和/或验证外科工具14306的部件诸如击发元件的位置。除此之外或另选地，一个或多个患者传感器14326可定位在患者P内以测量患者的位置和/或解剖学取向。除此之外或另选地，例如，一个或多个套管针传感器14328可定位在套管针14330上以测量套管针的位置和/或取向。
再次参见图23所示的机械臂14400，外科工具14406在机械臂14400的远侧端部处附接到附接部分14405。当外科工具14406定位在套管针内时，机器人外科系统可以建立可以由机器人外科系统固定的虚拟枢轴，使得可以在其周围操纵臂14400和/或外科工具14406以避免和/或最小化对套管针的侧向力施加。例如，在某些情况下，对套管针施加力可能会损伤周围的组织。因此，为了避免对组织的意外损伤，机械臂14400和/或外科工具14406可被配置为围绕套管针的虚拟枢轴移动而不会改变其位置，从而不会改变套管针的对应位置。即使当施加外科工具14406的线性位移以进入或离开套管针时，虚拟枢轴也可以保持不受干扰。
在一个方面，图31A中的套管针传感器14328可定位在套管针14330上的虚拟枢轴14332处。在其它情况下，套管针传感器14328可以与虚拟枢轴14332相邻。将套管针传感器14328置于其虚拟枢轴14332处和/或附近可以跟踪套管针14330和虚拟枢轴14332的位置，并且有助于确保例如在外科工具14306的位移期间套管针14330不移动。在这种情况下，在无需物理接合或保持套管针14330的情况下，机器人外科系统14300可以确认和/或保持套管针14330的位置。例如，次级感测系统14312可以确认套管针14330的虚拟枢轴14332和外科工具14306相对于其的位置。
除此之外或另选地，一个或多个传感器14352可以定位在一个或多个手持式外科器械14350上，所述手持式外科器械可以在外科规程期间与机器人外科系统14300所利用的外科工具14306结合使用。
次级感测系统14312被配置为在外科场地内例如在手术室和/或无菌场内检测一个或多个手持式外科器械14350的位置和/或取向。此类手持式外科器械14350可包括自主控制单元，该自主控制单元可以例如不由机器人控制。如图31所示，手持式外科器械14350可包括传感器14352，该传感器可以被例如磁场发射器14320检测到，使得手持式外科器械14350的定位和/或位置可以由机器人外科系统14300确定。在其它情况下，手持式外科器械14350的部件可以提供可检测的输出。例如，马达和/或电池组能由手术室中的传感器检测到。
在一个方面，磁场发射器14320可结合到主机器人塔中。无菌场内的传感器14322、14324、14326、14328和/或14352可以将磁场反射回主机器人塔，以识别其位置。在各种情况下，来自磁场发射器14320的数据可被传送至显示器14340，使得外科机器人、外科工具14302、套管针14330、患者P和/或手持式外科器械14350的各个部件的位置可以叠加在外科部位的实时视图上，诸如由内窥镜在外科部位处获得的视图。例如，显示器14340可以与机器人外科系统的控制单元和/或与机器人集线器诸如集线器106、机器人集线器122、集线器206和/或机器人集线器222(图9)进行信号通信。
在其它情况下，磁场发射器14320可以在机器人控制塔的外部。例如，磁场发射器14320可结合到集线器中。
与包括磁场发射器14320的次级感测系统14312相似，在某些情况下，飞行时间传感器可以定位在机器人部件14302、外科工具14306、患者P、套管针14328和/或手持式外科器械14350中的一者或多者上，以在发射点和反射点之间提供一系列距离。例如，此类飞行时间传感器可以提供对机器人部件14302、外科工具14306、患者P、套管针14328和/或手持式外科器械14350的位置的初级或次级(例如冗余)感测。在一个实例中，飞行时间传感器可采用红外光脉冲以提供距离标测并且/或者促进无菌场内的3D成像。
在一个实例中，次级感测系统14312可包括冗余感测系统，该冗余感测系统被配置为确认机器人部件和/或工具的位置。除此之外或另选地，次级感测系统14312可用于校准初级感测系统14310。除此之外或另选地，次级感测系统14312可被配置为防止机械臂和/或机器人外科系统的部件之间的意外缠结和/或碰撞。
再次参见图31，在一个实例中，机器人外科系统14300的部件14302可以对应于分立的机械臂，诸如机器人外科系统15000(图22)中的机械臂15024和/或图2所示的机械臂。次级感测系统14312可被配置为当在外科室周围操纵多个臂时检测机械臂和/或其部分的位置。在某些情况下，当命令一个或多个臂朝向潜在的碰撞方向移动时，次级感测系统14312可通过在外科医生控制台上的警报和/或指示来警示外科医生，以防止臂意外碰撞。
现在参见图32，该图描绘了机器人外科系统的流程图。该流程图可以被例如机器人外科系统14300(图31)利用。在各种情况下，两个独立的感测系统可被配置为检测外科部件诸如机械臂和/或外科工具的一部分的位置和/或取向。第一感测系统或初级感测系统可以依赖于机械臂的马达和/或马达驱动器上的扭矩和/或负载传感器。第二感测系统或次级感测系统可以依赖于机械臂和/或外科工具上的磁性和/或飞行时间传感器。第一感测系统和第二感测系统被配置为独立且并行地操作。例如，在步骤14502处，第一感测系统确定机器人部件的位置和取向，并且在步骤14504处，将所检测到的位置和取向传送至控制单元。同时，在步骤14506处，第二感测系统确定机器人部件的位置和取向，并且在步骤14508处，将所检测到的位置和取向传送至控制单元。
在步骤14510处，将机器人部件的独立确定的位置和取向传送至中央控制单元，诸如传送至机器人控制单元14309和/或外科集线器。在比较位置和/或取向时，可以在步骤14512处优化机器人部件的控制运动。例如，独立确定的位置之间的差异可用于提高控制运动的准确度和精度。在某些情况下，控制单元可以基于来自次级感测系统的反馈来校准控制运动。来自初级和次级感测系统的数据可以由集线器诸如集线器106或集线器206和/或存储在云诸如云104或云204中的数据聚合，以进一步优化机器人外科系统的控制运动。
在某些情况下，机器人系统14300可以与集线器诸如集线器106或集线器206进行信号通信。集线器106、206可包括态势感知模块，如本文进一步所述。在一个方面，第一传感器系统14310和第二传感器系统14312中的至少一者是用于态势感知模块的数据源。例如，传感器系统14310和14312可以将位置数据提供给态势感知模块。另外，例如，集线器106、206可被配置为基于来自传感器系统的数据并结合态势感知来优化和/或校准机械臂14300和/或外科工具14306的控制运动。在一个方面，例如，当手持式外科器械14350已进入手术室或外科室和/或当端部执行器已被击发时，感测系统诸如次级感测系统14312可告知集线器106、206及其态势感知模块。基于此类信息，集线器106、206可以确定和/或确认具体外科规程和/或其步骤。
读者应当理解，本文所公开的各种独立的和冗余的感测系统可以被机器人外科系统用于提高控制运动的准确度，尤其是例如当沿着纵向轴线移动外科工具而不依赖于线性滑动机构时。
在一个方面，外科集线器包括处理器和通信地耦接到该处理器的存储器，如本文所述。存储器存储指令，该指令能够由处理器执行以独立于初级感测系统检测机器人控制的部件的位置，如上所述。
在各个方面，本公开提供了一种控制电路，该控制电路被配置为独立于初级感测系统检测机器人控制的部件的位置，如上所述。在各个方面，本公开提供了一种存储计算机可读指令的非暂态计算机可读介质，该计算机可读指令在被执行时使机器独立于初级感测系统检测机器人控制的部件的位置，如上所述。
在一个方面，机器人外科系统可被配置为与安装在其机械臂上的一个或多个智能外科工具进行无线通信。机器人系统的控制单元可以例如经由无线连接与一个或多个智能外科工具通信。除此之外或另选地，机器人外科系统可包括机器人集线器，该机器人集线器可以与安装在机械臂上的智能外科工具进行无线通信。在其它情况下，非机器人外科集线器可以与安装在机械臂上的智能外科工具进行无线通信。在某些情况下，信息和/或命令可经由无线连接从控制单元提供给智能外科工具。例如，可经由通过外科工具上的无线通信链路接收的数据来控制外科工具的某些功能。类似地，在一个方面，可经由通过与外科工具的无线通信链路接收的数据，将闭环反馈提供给机器人外科系统。
主要参见图28至图30，外科工具14206被安装到外科机器人的机械臂14000上。机械臂14000在许多方面类似于图23中的机械臂14400。例如，臂14000包括多个可移动部件14002。在一个方面，可移动部件14002是在旋转接合部14003处机械地串联耦接的刚性分支。例如，此类可移动部件14002形成类似于臂14400(图23)的机械臂14400。机械臂14400的最远侧部件14002c包括用于可释放地附接可互换外科工具诸如外科工具14206的附接件14005。臂14000的每个部件14002具有一个或多个马达和马达驱动器，所述马达和马达驱动器可被操作以影响相应接合部14003处的旋转运动。
每个部件14002包括一个或多个传感器，所述传感器可以是例如位置传感器和/或扭矩传感器，并且可提供关于部件14002之间的各个接合部处的当前配置和/或负载的信息。马达可以由控制单元诸如控制单元14409(图23)控制，该控制单元被配置为接收来自传感器14008和/或来自命令接口诸如外科医生的命令控制台14412(图23)的输入。
外科工具14206是包括无线通信模块14208(图29)的线性缝合器。该线性缝合器可以是智能线性缝合器，并且可包括例如智能紧固件仓、智能端部执行器和/或智能轴。智能外科部件可被配置为例如确定各种组织特性。在一个实例中，可基于所检测到的组织特性来实现一种或多种高级端部执行器功能。外科端部执行器可包括例如用于确定组织厚度、压缩和/或阻抗的一个或多个传感器。此外，某些感测到的参数可以指示组织变化，诸如肿瘤的位置。用于感测各种组织特性的智能外科装置在以下参考文献中进一步公开：
·2014年9月5日提交的美国专利9,757,128，其标题为具有影响第二传感器的输出或判读的传感器的多传感器(MULTIPLE SENSORS WITH ONE SENSOR AFFECTING ASECOND SENSOR’S OUTPUT OR INTERPRETATION)，于2017年9月12日公布；
·2015年3月6日提交的美国专利申请14/640,935，其标题为用于测量组织压缩的叠加式多传感器射频(RF)电极系统(OVERLAID MULTI SENSOR RADIO FREQUENCY(RF)ELECTRODE SYSTEM TO MEASURE TISSUE COMPRESSION)，现为美国专利申请公布2016/0256071，于2016年9月8日公布；
·2016年12月16日提交的美国专利申请15/382,238，其标题为基于组织表征进行能量选择性应用的模块化电池供电的手持式外科器械(MODULAR BATTERY POWEREDHANDHELD SURGICAL INSTRUMENT WITH SELECTIVE APPLICATION OF ENERGY BASED ONTISSUE CHARACTERIZATION)，现为美国专利申请公布2017/0202591，于2017年7月20日公布；以及
·2016年8月16日提交的美国专利申请15/237,753，其标题为基于测量力的推进速率和应用力的控制(CONTROL OF ADVANCEMENT RATE AND APPLICATION FORCE BASED ONMEASURED FORCES)，现为美国专利申请公布2018/0049822，于2018年2月22日公布；
这些参考文献中的每个均全文以引用方式并入本文。
如图28所示，无线通信链路14210设置在外科工具14206和集线器14212之间。集线器14212是外科集线器，如集线器106或集线器206。在其它情况下，集线器14212可以是机器人集线器，如机器人集线器122或机器人集线器222。在图28中，无线通信模块14208包括无线信号发射器，该无线信号发射器位于外科工具14206的端部执行器的远侧端部附近。在其它情况下，无线发射器可以定位在端部执行器的近侧部分上或外科工具14206的轴上。
外科工具14206和外科集线器14212之间的无线通信链路14212通过无菌阻隔14230提供实时数据传输。除此之外或另选地，无线通信模块14208可被配置为与机器人控制塔和/或控制单元通信，该机器人控制塔和/或控制单元基于外科医生的命令控制台处的输入向机械臂14000发出控制运动并且向外科工具14206发出致动。在某些情况下，用于机械臂14000的控制单元可结合到外科集线器14212和/或机器人集线器诸如机器人集线器122(图2)或机器人集线器222(图9)中。
在某些情况下，可能难以确认外科工具14206在外科室内、外科部位周围和/或相对于靶向组织的位置。例如，外科工具14206的侧向位移可以由物理边界诸如纵向延伸的套管针约束。在这种情况下，外科工具14206的侧向位移可以由来自套管针和/或在套管针上的阻力确定。相反，外科工具14206的线性位移可以不受外科系统的物理边界的约束。在这种情况下，当控制单元引导外科工具14206或其一部分的线性位移，并且各种可移动连杆14002和接合部14003进行关节运动以影响线性位移时，可能难以确定和/或确认外科工具14206及其相应部分的位置。
当外科工具14206沿着与外科工具14206的轴共线的工具AT(图29)的纵向轴线移动时，可能难以确定和/或确认外科工具14206的确切位置。在某些情况下，如本文所提供，机器人外科系统可包括次级感测系统，该次级感测系统被配置为检测外科工具14206的位置。例如，无线通信模块14208可以与次级感测系统诸如次级感测系统14312(图31)和/或其传感器进行信号通信。此外，无线通信模块14208可以将通过次级感测系统14312检测到的外科工具14206的位置经由无线通信链路14210传送至外科集线器14212。除此之外或另选地，无线通信模块14208可以将信息从智能外科工具14206的各个传感器和/或系统传送至外科集线器14212。外科集线器14212可将信息传播到手术室内的显示器或外部显示器、云和/或与外科规程结合使用的一个或多个集线器和/或控制单元。
主要参见图29，在一个实例中，外科工具14206可用于从患者组织T中移除癌性肿瘤14242。为了确保完全移除肿瘤14242，同时最小化健康组织的移除，可以在肿瘤14242周围限定预定义的边缘区14240。例如，边缘区可以由外科医生基于患者数据、来自集线器和/或云的聚合数据和/或由外科系统的一个或多个智能部件感测到的数据来确定。在操作期间，外科工具14206可以沿着边缘区14240横切组织T，使得边缘区14240与肿瘤14242一起被移除。例如，初级感测系统14310和次级感测系统14312(图31)可以确定外科工具14206相对于边缘区的位置。此外，无线通信模块14208可以将所检测到的位置传送至控制单元。
在某些情况下，图28至图30的机器人系统可被配置为当外科工具14206在边缘区14240内移动时致动(例如，击发)外科工具14206。例如，主要参见图30，该图描绘了在图28的外科规程期间线性缝合器14206随时间推移的距离和闭合力的图形显示14250。随着外科工具14206在时间t1处接近边缘区14240，闭合力(FTC)增大，表明外科工具14206在时间t1和时间t2之间被夹持在肿瘤14242周围的组织T上。更具体地，外科工具14206在移动至距离D1和D2之间某一距离的位置时被夹持。距离D1可以指例如肿瘤14242周围的边缘区14240的外边界，并且距离D2可以指例如边缘区14240的内边界，该内边界可被认为是肿瘤14242的边界。
在各种情况下，当外科工具14206基于来自初级感测系统和/或次级感测系统的输入而定位在适当的距离处时，控制单元及其处理器可以自动影响夹持运动。在其它情况下，控制单元及其处理器可以自动警示外科医生外科工具14206定位在适当的距离处。类似地，在某些情况下，处理器可基于所检测到的外科工具14206的位置来自动击发外科工具14206并且/或者向外科医生建议击发外科工具14206。读者将会容易地认识到，可以设想其它致动运动，诸如使能量工具和/或进行关节运动和可进行关节运动的端部执行器通电。
在某些情况下，集线器14212可包括态势感知系统，如本文进一步所述。在一个方面，肿瘤14242和/或其周围的边缘区14240的位置可以由态势感知系统或集线器14212的模块确定。在某些情况下，无线通信模块14208可以与集线器14212的态势感知模块进行信号通信。例如，再次参见图33，在步骤5220和5222处提供的缝合器数据和/或仓数据可经由例如缝合工具14206的无线通信模块14208提供。
在一个方面，定位在外科工具14206上的传感器可用于确定和/或确认外科工具14206(即，次级感测系统)的位置。此外，所检测到的线性缝合器的位置可通过无线通信链路14210传送至外科集线器14212，如本文进一步所述。在这种情况下，外科集线器14212可基于经由无线通信链路14230传送的数据来获得关于外科工具14206相对于肿瘤14242和边缘区14240的位置的实时或近实时的信息。在各种情况下，机器人外科系统还可基于用于将机械臂14000定位在外科室(即，初级感测系统)周围的马达控制算法来确定外科工具14206的位置。
在一个方面，机器人外科系统可以与成像系统集成。由成像系统获得的来自外科部位的实时馈送可被传送至机器人外科系统。例如，再次参见图2和图3，来自集线器106中的成像模块138的实时馈送可被传送至机器人外科系统110。例如，实时馈送可被传送至机器人集线器122。在各种情况下，实时馈送可叠加到一个或多个有源机器人显示器上，诸如外科医生的命令控制台118处的馈送。叠加的图像可被提供给外科室内的一个或多个显示器，诸如显示器107、109和119。
在某些情况下，实时馈送在机器人显示器上的叠加可以使外科工具能够在由实时成像系统所示的外科工具和/或其端部执行器限定的轴体系内被精确控制。在各种情况下，机器人外科系统110和成像系统138之间的配合可提供可视化场内的外科工具的三角测量和器械标测，这可以实现对工具角度和/或其推进的精确控制。此外，从标准的多轴固定笛卡尔坐标系到由当前安装的工具和/或其端部执行器限定的轴的移位控制可以使外科医生能够沿着清晰的平面和/或轴发出命令。例如，机器人外科系统的处理器可引导外科工具沿着外科工具的细长轴的轴线位移或者引导外科工具基于所选的绕其旋转的点从当前位置以特定角度旋转。在一个示例中，外科工具的叠加馈送可以结合次级或冗余感测系统，如本文进一步所述，以确定外科工具的位置和/或取向。
在某些情况下，机械臂诸如机械臂14400(图23)可能会非常重。例如，机械臂的重量可使得大多数强壮的临床医生难以手动抬起或重新定位机械臂。此外，机械臂的马达和驱动机构只可基于来自外科医生命令控制台的输入由位于控制单元处的初级控制系统控制。换句话讲，机器人外科系统诸如图23所示的系统可以不包括用于机械臂14400的次级控制系统，该次级控制系统在机械臂14400本地并且在无菌场内。
机器人外科系统中的机械臂可能易于与无菌场内的设备和/或人员发生意外碰撞。例如，在外科规程期间，位于无菌场内的外科医生、护士和/或医疗助手可以绕无菌场和/或绕机械臂移动。在某些情况下，外科医生、护士和/或医疗助手例如可以将设备重新定位在无菌场诸如操作台和/或推车内。当位于无菌场之外的外科医生控制机械臂时，位于无菌场内的另一位外科医生、护士和/或医疗助手可能还希望手动移动和/或调整一个或多个机械臂的位置，以避免与臂的潜在碰撞、臂与其它设备和/或其它臂的缠结并且/或者以更换、重新装载和/或重新配置安装在臂上的外科工具。然而，为了重新定位机械臂，外科医生可能需要关闭机器人外科系统的电源，以使无菌场内的临床医生能够手动地重新定位机械臂。在这种情况下，可能需要临床医生携带相当重的无动力或掉电的机械臂。
在一个实例中，机器人外科系统可包括交互式显示器，该交互式显示器在无菌场本地并且/或者在机械臂本地。这样的本地显示器可有利于临床医生在无菌场内对臂的操纵和/或定位。换句话讲，除命令控制台处的外科医生之外的操作者可以控制机械臂的位置。
现在参见图24，临床医生正在向机械臂14000施加力以手动调整机械臂14000的位置。在某些情况下，采用机械臂14000的机器人外科系统可采用无源动力辅助模式，在该模式下，临床医生可以容易地将机械臂14400重新定位在无菌场内。例如，尽管机械臂14000被供电并且由远程控制单元控制，但临床医生可以手动调整机械臂14000的位置，而不需要临床医生承担机械臂14000的全部重量。临床医生可以拉动和/或推动机械臂14000以调整其位置。在无源动力辅助模式中，可以约束和/或限制提供给机械臂14000的电力以允许临床医生无源地重新定位。
现在参见图25，该图描绘了在无源动力辅助模式下机械臂14000(图24)随时间推移的力的图形显示14050。在无源动力辅助模式下，临床医生可以向机械臂14000施加手动力以启动机械臂14000的重新定位。临床医生可位于无菌场内。在某些情况下，当机械臂14000感测到手动操纵时，可激活无源动力辅助模式。
如图25所示，临床医生施加的手动力可增大至超过预定义阈值，诸如图25所示的15磅极限，以影响机械臂14000的重新定位。在某些情况下，预定义阈值可对应于强壮的助手可以容易地施加在机械臂14000上而没有不当的应力或应变的最大力。在其它情况下，预定义阈值可对应于机械臂14000上的最小阈值力，以避免为与机械臂14000的无意或意外接触提供动力辅助。
当用户在机械臂14000上施加的力超过预定义阈值时，机器人外科系统的一个或多个马达(例如，图23中的马达14407)可以向机械臂14000施加辅助力，以帮助沿操作者在机械臂14000上的力所指示的方向重新定位机械臂14000。在这种情况下，操作者可以轻松地操纵臂的位置，以避免意外的碰撞和/或缠绕，并且当操作者的力超过舒适的阈值力时，马达可以辅助或配合臂的重新定位。由机器人外科系统的马达提供的无源动力辅助可以补偿机械臂14000的重量。在其它情况下，辅助力可以小于机械臂14000的重量。在某些情况下，可将辅助力限制为最大力，诸如图25所示的5磅极限。限制辅助力可确保机械臂14000不会在外科室中与人员、外科设备和/或另一机械臂强力碰撞。
在一个方面，无源动力辅助模式可以在外科规程的一部分期间停用或锁定。例如，当外科工具定位在外科部位处或外科部位和/或靶向组织的预定义半径内时，无源动力辅助模式可被锁定。除此之外或另选地，在外科规程的某些步骤期间，无源动力辅助模式可被锁定。态势感知可被配置为确定是否应锁定无源动力辅助模式。例如，基于集线器知道的关于外科规程步骤的信息(参见例如图33)，态势感知模块可能不建议使用无源动力辅助模式。类似地，无源动力辅助模式可以在图33所示的外科时间轴的某些部分期间激活。
在一个方面，用于操作机械臂的控制单元包括处理器和通信地耦接到该处理器的存储器，如本文所述。存储器存储指令，该指令能够由处理器执行以在无源功率辅助模式下操作，在该模式下，处理器被配置为处理施加到机械臂的手动力，并且如果该手动力超过预定义阈值，则引导机械臂的一个或多个马达以提供辅助力，从而沿手动力所指示的方向重新定位机械臂。
在各个方面，本公开提供了一种控制电路，该控制电路被配置为运行无源功率辅助模式，如上所述。在各个方面，本公开提供了一种存储计算机可读指令的非暂态计算机可读介质，该计算机可读指令在被执行时使机器运行无源动力辅助模式，如上所述。
现在参见图26和图27，无菌场内的临床医生正在利用无菌场内的本地控制模块14160影响机械臂14100的重新定位。机械臂14100在许多方面类似于图23中的机械臂14400。例如，机械臂14100包括多个可移动部件14102。可移动部件14102是在旋转接合部14103处机械地串联耦接的刚性分支。例如，可移动部件14102形成类似于机械臂14400(图23)的机械臂14100。最远侧部件14102c包括用于可释放地附接可互换外科工具诸如外科工具14106的附接件14105。机械臂14100的每个部件14102具有一个或多个马达和马达驱动器，所述马达和马达驱动器可被操作以影响相应接合部14103处的旋转运动。
每个部件14102包括一个或多个传感器，所述传感器可以是例如位置传感器和/或扭矩传感器，并且可提供关于部件14102之间的各个接合部处的当前配置和/或负载的信息。马达可以由控制单元诸如控制单元14409(图23)控制，该控制单元被配置为接收来自传感器和/或来自外科命令接口诸如外科命令接口14412(图23)的输入。
本地控制模块14160包括交互式显示器14164和触摸屏14166，该触摸屏被配置为接受输入，诸如来自手指和/或触笔14168的输入。本地控制模块14160是手持式移动数字电子装置。例如，本地控制模块14160可以是例如平板电脑或其它移动平板电脑或智能电话。在使用中，临床医生经由本地控制模块14160的显示器14164和/或触摸屏14166向机械臂14100提供重新定位指令。本地控制模块14160是无线通信模块14162，使得来自临床医生的输入可被传送至机械臂14100以影响臂控制运动。本地控制模块14160可例如经由Wi-Fi连接与机械臂14100和/或机器人系统的控制单元(例如，图23中的控制单元14409)进行无线通信。
机械臂14100包括由图26中的六个箭头指示的六个自由度。近侧自由度可以由本地控制模块14160控制，并且远侧自由度可以由远程控制模块控制。在一个实例中，三个最近侧自由度(关于两个最近侧接合部14103的关节运动和中间分支14102绕其轴线的旋转)可以由本地控制模块控制，并且三个最远侧自由度(关于最远侧接合部14103的关节运动、最远侧分支14102c绕其轴线的旋转以及外科工具14106沿其轴线的位移)可以由远程控制模块控制。在这种情况下，无菌场内的临床医生会影响机械臂的总体控制运动，诸如近侧臂和/或接合部的控制运动。例如，无菌场内的临床医生可经由本地控制模块14160将机械臂快速轻松地移动到大致位置，诸如术前位置、工具调换位置和/或重新加载位置。在这种情况下，本地控制模块14160是机械臂14100的次级控制系统。无菌场外的外科医生可经由外科医生的命令接口14412(图23)处的输入来影响更加局部化或精细的机械臂控制运动。在这种情况下，无菌场外的外科医生的命令接口14412是初级控制系统。
读者将容易地认识到，可以设想少于或多于六个的自由度。还可以设想另选的自由度。此外，可将不同的自由度分配给本地控制模块14160和/或远程控制模块。在某些情况下，可将一个或多个自由度分配给本地控制模块14160和远程控制模块。
现在主要参见图27，该图描绘了机械臂14100随时间推移的力的图形显示14150。从时间0到时间t1，临床医生在无菌场内向机械臂14100施加本地致动的场内力，以调整机械臂14100的大致位置。在某些情况下，可归因于来自本地控制模块14160的输入的力可被限制为第一最大力(例如，图27所示的50磅极限)。通过利用本地控制模块14160，例如，无菌场内的临床医生可以快速地重新定位机械臂14100以调换和/或重新加载外科工具14106。时间0至时间t1可对应于本地致动模式。外科规程中的有源设置或重新加载时间可在本地致动模式期间发生。例如，在本地致动模式期间，例如，机械臂14100可以不与患者组织接触和/或在外科部位周围的预定义边界之外。
此后，外科医生的命令控制台处的外科医生可以进一步致动机械臂14100。例如，从时间t2至时间t3，远程致动的力可归因于来自外科医生命令控制台的输入。远程致动的力可被限制为第二最大力(例如，图27所示的5磅极限)，该第二最大力小于第一最大力。通过限制第二最大力，在某些情况下，外科医生不太可能在无菌场内引起高力或高速碰撞，而较大的第一最大力允许机械臂14100快速地重新定位。时间t2至时间t3可对应于外科规程期间的远程致动模式，所述外科规程期间可包括当机器人工具14106正在有源地操纵组织(抓握、拉动、保持、横切、密封等)时和/或当机械臂14100和/或其外科工具14106位于外科部位周围的预定义边界内时。
在一个方面，本地致动模式和/或远程致动模式可以在外科规程的一部分期间停用或锁定。例如，当外科工具与组织接合或以其它方式定位在外科部位处时，可以锁定本地致动模式。态势感知可被配置为确定是否应锁定本地致动模式。例如，基于集线器知道的关于外科规程步骤的信息(参见例如图33)，态势感知模块可能不建议使用本地致动模式。类似地，在外科规程的其它部分期间，可能不建议使用远程致动模式。
在一个方面，用于操作机械臂的控制单元包括处理器和通信地耦接到该处理器的存储器，如本文所述。存储器存储指令，该指令能够由处理器执行以在外科规程的部分期间基于来自本地控制模块的输入向机械臂提供控制运动，并且在外科规程的部分期间基于来自远程控制模块的输入向机械臂提供控制运动。第一最大力可以限制来自本地控制模块的控制运动，并且第二最大力可以限制来自远程控制模块的控制运动。
在各个方面，本公开提供了一种控制电路，该控制电路被配置为经由本地控制模块和远程控制模块操作机械臂，如上所述。在各个方面，本公开提供了一种存储计算机可读指令的非暂态计算机可读介质，该计算机可读指令在被执行时使机器经由本地控制模块和远程控制模块操作机械臂。
下述专利的全部公开内容据此以引用方式并入本文：
·2011年5月27日提交的美国专利9,072,535，其标题为具有可旋转钉部署布置的外科缝合器械(SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENTARRANGEMENTS)，于2015年7月7日公布；
·2012年6月28日提交的美国专利9,072,536，其标题为旋转电动外科器械的差分锁定布置(DIFFERENTIAL LOCKING ARRANGEMENTS FOR ROTARY POWERED SURGICALINSTRUMENTS)，于2015年7月7日公布；
·2012年6月28日提交的美国专利9,204,879，其标题为柔性驱动构件(FLEXIBLEDRIVE MEMBER)，于2015年12月8日公布；
·2012年6月28日提交的美国专利9,561,038，其标题为可互换的施夹器(INTERCHANGEABLE CLIP APPLIER)，于2017年2月7日公布；
·2014年9月5日提交的美国专利9,757,128，其标题为具有影响第二传感器的输出或判读的传感器的多传感器(MULTIPLE SENSORS WITH ONE SENSOR AFFECTING ASECOND SENSOR’S OUTPUT OR INTERPRETATION)，于2017年9月12日公布；
·2015年3月6日提交的美国专利申请14/640,935，其标题为用于测量组织压缩的叠加式多传感器射频(RF)电极系统(OVERLAID MULTI SENSOR RADIO FREQUENCY(RF)ELECTRODE SYSTEM TO MEASURE TISSUE COMPRESSION)，现为美国专利申请公布2016/0256071，于2016年9月8日公布；
·2016年12月16日提交的美国专利申请15/382,238，其标题为基于组织表征进行能量选择性应用的模块化电池供电的手持式外科器械(MODULAR BATTERY POWEREDHANDHELD SURGICAL INSTRUMENT WITH SELECTIVE APPLICATION OF ENERGY BASED ONTISSUE CHARACTERIZATION)，现为美国专利申请公布2017/0202591，于2017年7月20日公布；以及
·2016年8月16日提交的美国专利申请15/237,753，其标题为基于测量力的推进速率和应用力的控制(CONTROL OF ADVANCEMENT RATE AND APPLICATION FORCE BASED ONMEASURED FORCES)，现为美国专利申请公布2018/0049822，于2018年2月22日公布；
它们各自的全文以引用方式并入本文。
实施例
本文所述主题的各个方面在以下编号的实施例中陈述：
实施例1.一种外科系统，包括：机器人系统，所述机器人系统包括：控制单元；机械臂，所述机械臂包括附接部分；以及与所述控制单元信号通信的第一传感器系统，其中所述第一传感器系统被配置为检测所述附接部分的位置。所述外科系统还包括可移除地附接到所述附接部分的外科工具。所述外科系统还包括第二传感器系统，所述第二传感器系统被配置为检测所述外科工具的位置，其中所述第二传感器系统独立于所述第一传感器系统。
实施例2.根据实施例1所述的外科系统，其中，所述第二传感器系统包括：磁场发射器和结合到所述外科工具中的磁场传感器。
实施例3.根据实施例1和2中任一项所述的外科系统，还包括手持式电池驱动外科器械，所述手持式电池驱动外科器械包括器械传感器，其中所述第二传感器系统被配置为检测所述器械传感器的位置。
实施例4.根据实施例3所述的外科系统，还包括实时显示器，所述实时显示器被配置为基于来自所述第二传感器系统的数据显示所述外科工具的位置和所述器械传感器的位置。
实施例5.根据实施例3和4中任一项所述的外科系统，其中，所述手持式电池驱动外科器械包括自主控制单元。
实施例6.根据实施例1至5中任一项所述的外科系统，还包括具有套管针传感器的套管针，其中所述第二传感器系统被配置为检测所述套管针传感器的位置。
实施例7.根据实施例6所述的外科系统，还包括实时显示器，所述实时显示器被配置为基于来自所述第二传感器系统的数据显示所述外科工具的位置和所述套管针的位置。
实施例8.根据实施例1至7中任一项所述的外科系统，还包括应用于患者的多个患者传感器，其中所述第二传感器系统被配置为检测所述患者传感器的位置。
实施例9.根据实施例8所述的外科系统，还包括实时显示器，所述实时显示器被配置为基于来自所述第二传感器系统的数据显示所述外科工具的位置和所述患者传感器的位置。
实施例10.一种外科系统，包括：机器人系统，所述机器人系统包括：控制单元；机械臂，所述机械臂包括第一部分、第二部分以及在所述第一部分和所述第二部分中间的接合部；第一传感器系统，所述第一传感器系统被配置为检测所述机械臂的所述第一部分和所述第二部分的位置；以及冗余传感器系统，所述冗余传感器系统被配置为检测所述机械臂的所述第一部分和所述第二部分的位置。
实施例11.根据实施例10所述的外科系统，其中，所述机械臂包括马达，并且其中所述第一传感器系统包括位于所述马达上的扭矩传感器。
实施例12.根据实施例10和11所述的外科系统，其中，所述冗余传感器系统包括磁场发射器和定位在所述机械臂上的多个磁性传感器。
实施例13.根据实施例10至12中任一项所述的外科系统，其中，所述控制单元包括处理器和通信地耦接到所述处理器的存储器，其中所述存储器存储指令，所述指令能够由所述处理器执行以将由所述第一传感器系统检测到的位置与由所述冗余传感器系统检测到的位置进行比较，从而优化所述机械臂的控制运动。
实施例14.根据实施例10至13中任一项所述的外科系统，还包括控制电路，所述控制电路被配置为将由所述第一传感器系统检测到的位置与由所述冗余传感器系统检测到的位置进行比较，以优化所述机械臂的控制运动。
实施例15.一种外科系统，包括：外科机器人，所述外科机器人包括：控制单元；以及机械臂，所述机械臂包括马达。所述外科系统还包括可移除地附接到所述机械臂的外科工具。所述外科系统还包括与所述控制单元信号通信的第一传感器系统，其中所述第一传感器系统包括位于所述马达上的扭矩传感器，并且其中所述第一传感器系统被配置为检测所述外科工具的位置。所述外科系统还包括第二传感器系统，所述第二传感器系统被配置为独立地检测所述外科工具的位置。
实施例16.根据实施例15所述的外科系统，其中，所述第二传感器系统包括：磁场发射器和结合到所述外科工具中的磁场传感器。
实施例17.根据实施例15和16中任一项所述的外科系统，还包括手持式电池驱动外科器械，所述手持式电池驱动外科器械包括器械传感器，其中所述第二传感器系统被配置为检测所述器械传感器的位置。
实施例18.根据实施例15至17中任一项所述的外科系统，还包括具有套管针传感器的套管针，其中所述第二传感器系统被配置为检测所述套管针传感器的位置。
实施例19.根据实施例15至18中任一项所述的外科系统，还包括应用于患者组织的多个患者传感器，其中所述第二传感器系统被配置为检测所述患者传感器的位置。
实施例20.根据实施例15至19中任一项所述的外科系统，还包括实时显示器，所述实时显示器被配置为基于来自所述第一传感器系统和所述第二传感器系统的数据显示所述外科工具的一个或多个位置。
实施例21.根据实施例15至20中任一项所述的外科系统，还包括集线器，所述集线器包括态势感知系统，其中所述第一传感器系统和所述第二传感器系统包括用于所述态势感知系统的数据源。
尽管已举例说明和描述了多个形式，但是申请人的意图并非将所附权利要求的范围约束或限制在此类细节中。在不脱离本公开的范围的情况下，可实现对这些形式的许多修改、变化、改变、替换、组合和等同物，并且本领域技术人员将想到这些形式的许多修改、变化、改变、替换、组合和等同物。此外，另选地，可将与所描述的形式相关联的每个元件的结构描述为用于提供由所述元件执行的功能的器件。另外，在公开了用于某些部件的材料的情况下，也可使用其他材料。因此，应当理解，上述具体实施方式和所附权利要求旨在涵盖属于本发明所公开的形式范围内的所有此类修改形式、组合和变型形式。所附权利要求旨在涵盖所有此类修改、变化、改变、替换、修改和等同物。
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。
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。
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。
如本文的任何方面所用，术语“逻辑”可指被配置为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。
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。
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。
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。另选地或除此之外，通信装置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。另选地或除此之外，收发器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。
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，使用术语诸如“处理”、“估算”、“计算”、“确定”、“显示”等的讨论是指计算机系统或类似电子计算装置的动作和进程，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它此类信息存储、传输或显示装置内的物理量的其它数据。
一个或多个部件在本文中可被称为“被配置为”、“可被配置为”、“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“被配置为”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。
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。
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。
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。
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重叠、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。
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。
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。
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。
Claims (13)
1.一种外科系统，包括：
手持式外科器械；
机器人系统，所述机器人系统包括：
控制单元；
机械臂，所述机械臂包括第一部分、第二部分以及在所述第一部分和所述第二部分中间的接合部；
可移除地附接至所述机械臂的外科工具；
第一传感器系统，所述第一传感器系统被配置为检测所述机械臂的所述第一部分和所述第二部分的位置，和/或所述外科工具的位置；和
冗余传感器系统，所述冗余传感器系统被配置为检测所述机械臂的所述第一部分和所述第二部分的位置、所述外科工具的位置、所述手持式外科器械的位置、和/或患者的位置，其中，所述冗余传感器系统独立于所述第一传感器系统，
其中，所述第一传感器系统依赖于所述机械臂的马达和/或马达驱动器上的扭矩和/或负载传感器，并且所述冗余传感器系统依赖于无菌场内的磁性传感器，并且
其中，所述控制单元被配置成通过利用来自所述冗余传感器系统的反馈来校准所述第一传感器系统，以优化所述机器人系统的控制运动，从而避免意外的缠绕和/或碰撞。
2.根据权利要求1所述的外科系统，其中，所述第一传感器系统包括位于所述马达上的扭矩传感器。
3.根据权利要求1所述的外科系统，其中，所述冗余传感器系统包括磁场发射器、定位在所述机械臂上的多个磁性传感器，以及结合到所述外科工具中的磁场传感器。
4.根据权利要求1所述的外科系统，其中，所述控制单元包括处理器和通信地耦接到所述处理器的存储器，其中所述存储器存储指令，所述指令能够由所述处理器执行以将由所述第一传感器系统检测到的位置与由所述冗余传感器系统检测到的位置进行比较，从而优化所述机械臂的控制运动。
5.根据权利要求1所述的外科系统，还包括控制电路，所述控制电路被配置为将由所述第一传感器系统检测到的位置与由所述冗余传感器系统检测到的位置进行比较，以优化所述机械臂的控制运动。
6.根据权利要求1所述的外科系统，其中，所述手持式外科器械是手持式电池驱动外科器械，其包括器械传感器，其中所述冗余传感器系统被配置为检测所述器械传感器的位置。
7.根据权利要求6所述的外科系统，还包括实时显示器，所述实时显示器被配置为基于来自所述冗余传感器系统的数据显示所述外科工具的位置和所述器械传感器的位置。
8.根据权利要求7所述的外科系统，其中，所述手持式电池驱动外科器械包括自主控制单元。
9.根据权利要求1所述的外科系统，还包括具有套管针传感器的套管针，其中所述冗余传感器系统被配置为检测所述套管针传感器的位置。
10.根据权利要求9所述的外科系统，还包括实时显示器，所述实时显示器被配置为基于来自所述冗余传感器系统的数据显示所述外科工具的位置和所述套管针的位置。
11.根据权利要求1所述的外科系统，还包括应用于患者的多个患者传感器，其中所述冗余传感器系统被配置为检测所述患者传感器的位置。
12.根据权利要求11所述的外科系统，还包括实时显示器，所述实时显示器被配置为基于来自所述冗余传感器系统的数据显示所述外科工具的位置和所述患者传感器的位置。
13.根据权利要求1所述的外科系统，还包括集线器，所述集线器包括态势感知系统，其中所述第一传感器系统和所述冗余传感器系统包括用于所述态势感知系统的数据源。
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