CA2604563A1 - Surgical instruments with sensors for detecting tissue properties, and systems using such instruments - Google Patents
Surgical instruments with sensors for detecting tissue properties, and systems using such instruments Download PDFInfo
- Publication number
- CA2604563A1 CA2604563A1 CA002604563A CA2604563A CA2604563A1 CA 2604563 A1 CA2604563 A1 CA 2604563A1 CA 002604563 A CA002604563 A CA 002604563A CA 2604563 A CA2604563 A CA 2604563A CA 2604563 A1 CA2604563 A1 CA 2604563A1
- Authority
- CA
- Canada
- Prior art keywords
- sensor
- tissue
- patient
- processor
- procedure
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Granted
Links
- 238000000034 method Methods 0.000 claims abstract description 71
- 238000012544 monitoring process Methods 0.000 claims abstract description 31
- 230000003287 optical effect Effects 0.000 claims description 49
- 238000005259 measurement Methods 0.000 claims description 43
- 230000004044 response Effects 0.000 claims description 28
- 238000004891 communication Methods 0.000 claims description 27
- 239000013307 optical fiber Substances 0.000 claims description 18
- 238000006213 oxygenation reaction Methods 0.000 claims description 17
- 239000000758 substrate Substances 0.000 claims description 14
- 230000000694 effects Effects 0.000 claims description 13
- 230000036541 health Effects 0.000 claims description 12
- 230000010412 perfusion Effects 0.000 claims description 12
- 238000012545 processing Methods 0.000 claims description 11
- 239000012530 fluid Substances 0.000 claims description 10
- 230000003993 interaction Effects 0.000 claims description 10
- 239000000463 material Substances 0.000 claims description 10
- 230000007774 longterm Effects 0.000 claims description 8
- 239000000126 substance Substances 0.000 claims description 8
- 239000000523 sample Substances 0.000 claims description 7
- 238000002567 electromyography Methods 0.000 claims description 6
- 238000013507 mapping Methods 0.000 claims description 6
- 238000005253 cladding Methods 0.000 claims description 5
- 239000011248 coating agent Substances 0.000 claims description 5
- 238000000576 coating method Methods 0.000 claims description 5
- 230000001900 immune effect Effects 0.000 claims description 5
- 239000000090 biomarker Substances 0.000 claims description 4
- 230000000763 evoking effect Effects 0.000 claims description 4
- 230000008035 nerve activity Effects 0.000 claims description 4
- 238000004611 spectroscopical analysis Methods 0.000 claims description 4
- 206010002091 Anaesthesia Diseases 0.000 claims description 2
- 230000037005 anaesthesia Effects 0.000 claims description 2
- 238000005452 bending Methods 0.000 claims description 2
- 238000000701 chemical imaging Methods 0.000 claims description 2
- 230000009885 systemic effect Effects 0.000 claims description 2
- 238000001931 thermography Methods 0.000 claims description 2
- 239000011162 core material Substances 0.000 claims 2
- 239000003550 marker Substances 0.000 claims 1
- 210000001519 tissue Anatomy 0.000 description 138
- 230000008878 coupling Effects 0.000 description 35
- 238000010168 coupling process Methods 0.000 description 35
- 238000005859 coupling reaction Methods 0.000 description 35
- 239000000835 fiber Substances 0.000 description 23
- QVGXLLKOCUKJST-UHFFFAOYSA-N atomic oxygen Chemical compound [O] QVGXLLKOCUKJST-UHFFFAOYSA-N 0.000 description 15
- 239000001301 oxygen Substances 0.000 description 15
- 229910052760 oxygen Inorganic materials 0.000 description 15
- 238000001356 surgical procedure Methods 0.000 description 13
- 238000010586 diagram Methods 0.000 description 8
- 230000005284 excitation Effects 0.000 description 8
- 230000031700 light absorption Effects 0.000 description 8
- 230000008901 benefit Effects 0.000 description 7
- 238000010521 absorption reaction Methods 0.000 description 6
- 238000004422 calculation algorithm Methods 0.000 description 6
- 239000013598 vector Substances 0.000 description 6
- 238000004364 calculation method Methods 0.000 description 5
- 230000001154 acute effect Effects 0.000 description 4
- 238000004458 analytical method Methods 0.000 description 4
- 238000003491 array Methods 0.000 description 4
- 230000036770 blood supply Effects 0.000 description 4
- 238000001444 catalytic combustion detection Methods 0.000 description 4
- 230000007423 decrease Effects 0.000 description 4
- 230000006870 function Effects 0.000 description 4
- 230000000287 tissue oxygenation Effects 0.000 description 4
- 239000008280 blood Substances 0.000 description 3
- 210000004369 blood Anatomy 0.000 description 3
- 230000017531 blood circulation Effects 0.000 description 3
- 210000004204 blood vessel Anatomy 0.000 description 3
- 238000001914 filtration Methods 0.000 description 3
- 238000003384 imaging method Methods 0.000 description 3
- 230000004048 modification Effects 0.000 description 3
- 238000012986 modification Methods 0.000 description 3
- 210000000056 organ Anatomy 0.000 description 3
- 229920000642 polymer Polymers 0.000 description 3
- 230000000638 stimulation Effects 0.000 description 3
- 230000035899 viability Effects 0.000 description 3
- 102000001554 Hemoglobins Human genes 0.000 description 2
- 108010054147 Hemoglobins Proteins 0.000 description 2
- 230000003872 anastomosis Effects 0.000 description 2
- 239000000560 biocompatible material Substances 0.000 description 2
- 238000007796 conventional method Methods 0.000 description 2
- 238000013500 data storage Methods 0.000 description 2
- 238000013461 design Methods 0.000 description 2
- 239000000975 dye Substances 0.000 description 2
- 238000002474 experimental method Methods 0.000 description 2
- 239000007850 fluorescent dye Substances 0.000 description 2
- 239000000203 mixture Substances 0.000 description 2
- 210000003205 muscle Anatomy 0.000 description 2
- 210000005036 nerve Anatomy 0.000 description 2
- 230000008520 organization Effects 0.000 description 2
- 238000002496 oximetry Methods 0.000 description 2
- 230000000149 penetrating effect Effects 0.000 description 2
- 230000002980 postoperative effect Effects 0.000 description 2
- 230000000541 pulsatile effect Effects 0.000 description 2
- 238000002106 pulse oximetry Methods 0.000 description 2
- 230000001953 sensory effect Effects 0.000 description 2
- 238000013179 statistical model Methods 0.000 description 2
- 238000006467 substitution reaction Methods 0.000 description 2
- 238000002604 ultrasonography Methods 0.000 description 2
- 230000000007 visual effect Effects 0.000 description 2
- 239000004593 Epoxy Substances 0.000 description 1
- 206010021143 Hypoxia Diseases 0.000 description 1
- KHGNFPUMBJSZSM-UHFFFAOYSA-N Perforine Natural products COC1=C2CCC(O)C(CCC(C)(C)O)(OC)C2=NC2=C1C=CO2 KHGNFPUMBJSZSM-UHFFFAOYSA-N 0.000 description 1
- 208000004210 Pressure Ulcer Diseases 0.000 description 1
- 230000003044 adaptive effect Effects 0.000 description 1
- 230000004888 barrier function Effects 0.000 description 1
- 210000000013 bile duct Anatomy 0.000 description 1
- 229920002988 biodegradable polymer Polymers 0.000 description 1
- 239000004621 biodegradable polymer Substances 0.000 description 1
- 230000005540 biological transmission Effects 0.000 description 1
- 238000009530 blood pressure measurement Methods 0.000 description 1
- 229960001948 caffeine Drugs 0.000 description 1
- 230000015556 catabolic process Effects 0.000 description 1
- 238000002591 computed tomography Methods 0.000 description 1
- 230000001143 conditioned effect Effects 0.000 description 1
- 230000003247 decreasing effect Effects 0.000 description 1
- 238000006731 degradation reaction Methods 0.000 description 1
- 230000003111 delayed effect Effects 0.000 description 1
- 230000001419 dependent effect Effects 0.000 description 1
- 238000002059 diagnostic imaging Methods 0.000 description 1
- 201000010099 disease Diseases 0.000 description 1
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 description 1
- 239000003814 drug Substances 0.000 description 1
- 238000002565 electrocardiography Methods 0.000 description 1
- 239000003792 electrolyte Substances 0.000 description 1
- 238000005516 engineering process Methods 0.000 description 1
- MHMNJMPURVTYEJ-UHFFFAOYSA-N fluorescein-5-isothiocyanate Chemical group O1C(=O)C2=CC(N=C=S)=CC=C2C21C1=CC=C(O)C=C1OC1=CC(O)=CC=C21 MHMNJMPURVTYEJ-UHFFFAOYSA-N 0.000 description 1
- 238000004868 gas analysis Methods 0.000 description 1
- 229910000078 germane Inorganic materials 0.000 description 1
- 230000007954 hypoxia Effects 0.000 description 1
- 230000002757 inflammatory effect Effects 0.000 description 1
- 238000003331 infrared imaging Methods 0.000 description 1
- 238000001802 infusion Methods 0.000 description 1
- 238000002347 injection Methods 0.000 description 1
- 239000007924 injection Substances 0.000 description 1
- 230000010354 integration Effects 0.000 description 1
- 208000028867 ischemia Diseases 0.000 description 1
- 238000002357 laparoscopic surgery Methods 0.000 description 1
- 230000004298 light response Effects 0.000 description 1
- 239000007788 liquid Substances 0.000 description 1
- 230000033001 locomotion Effects 0.000 description 1
- 238000002595 magnetic resonance imaging Methods 0.000 description 1
- 206010025482 malaise Diseases 0.000 description 1
- 239000011159 matrix material Substances 0.000 description 1
- 239000004005 microsphere Substances 0.000 description 1
- 230000003387 muscular Effects 0.000 description 1
- 230000001537 neural effect Effects 0.000 description 1
- 238000010606 normalization Methods 0.000 description 1
- 230000036407 pain Effects 0.000 description 1
- 230000037361 pathway Effects 0.000 description 1
- 229930192851 perforin Natural products 0.000 description 1
- 230000002265 prevention Effects 0.000 description 1
- 230000008569 process Effects 0.000 description 1
- 239000002096 quantum dot Substances 0.000 description 1
- 238000002278 reconstructive surgery Methods 0.000 description 1
- 230000029058 respiratory gaseous exchange Effects 0.000 description 1
- 230000035807 sensation Effects 0.000 description 1
- 238000011524 similarity measure Methods 0.000 description 1
- 239000000243 solution Substances 0.000 description 1
- 230000003595 spectral effect Effects 0.000 description 1
- 238000001228 spectrum Methods 0.000 description 1
- 238000007619 statistical method Methods 0.000 description 1
- 238000003860 storage Methods 0.000 description 1
- -1 structures Substances 0.000 description 1
- 230000001360 synchronised effect Effects 0.000 description 1
- 210000000779 thoracic wall Anatomy 0.000 description 1
- 238000012549 training Methods 0.000 description 1
- RYYVLZVUVIJVGH-UHFFFAOYSA-N trimethylxanthine Natural products CN1C(=O)N(C)C(=O)C2=C1N=CN2C RYYVLZVUVIJVGH-UHFFFAOYSA-N 0.000 description 1
- 238000012800 visualization Methods 0.000 description 1
- 230000001755 vocal effect Effects 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/0059—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
- A61B5/0071—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence by measuring fluorescence emission
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B17/0644—Surgical staples, i.e. penetrating the tissue penetrating the tissue, deformable to closed position
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
- A61B17/1155—Circular staplers comprising a plurality of staples
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/30—Surgical robots
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/0059—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
- A61B5/0082—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes
- A61B5/0084—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes for introduction into the body, e.g. by catheters
- A61B5/0086—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes for introduction into the body, e.g. by catheters using infrared radiation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
- A61B5/026—Measuring blood flow
- A61B5/0261—Measuring blood flow using optical means, e.g. infrared light
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/145—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue
- A61B5/14542—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue for measuring blood gases
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/145—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue
- A61B5/1455—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue using optical sensors, e.g. spectral photometrical oximeters
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/145—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue
- A61B5/1455—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue using optical sensors, e.g. spectral photometrical oximeters
- A61B5/1459—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue using optical sensors, e.g. spectral photometrical oximeters invasive, e.g. introduced into the body by a catheter
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
- A61B5/6801—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be attached to or worn on the body surface
- A61B5/683—Means for maintaining contact with the body
- A61B5/6837—Sutures
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
- A61B5/7271—Specific aspects of physiological measurement analysis
- A61B5/7275—Determining trends in physiological measurement data; Predicting development of a medical condition based on physiological measurements, e.g. determining a risk factor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/74—Details of notification to user or communication with user or patient ; user input means
- A61B5/7405—Details of notification to user or communication with user or patient ; user input means using sound
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/74—Details of notification to user or communication with user or patient ; user input means
- A61B5/742—Details of notification to user or communication with user or patient ; user input means using visual displays
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/74—Details of notification to user or communication with user or patient ; user input means
- A61B5/7455—Details of notification to user or communication with user or patient ; user input means characterised by tactile indication, e.g. vibration or electrical stimulation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00022—Sensing or detecting at the treatment site
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00022—Sensing or detecting at the treatment site
- A61B2017/00026—Conductivity or impedance, e.g. of tissue
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00022—Sensing or detecting at the treatment site
- A61B2017/00039—Electric or electromagnetic phenomena other than conductivity, e.g. capacity, inductivity, Hall effect
- A61B2017/00044—Sensing electrocardiography, i.e. ECG
- A61B2017/00048—Spectral analysis
- A61B2017/00053—Mapping
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00022—Sensing or detecting at the treatment site
- A61B2017/00057—Light
- A61B2017/00066—Light intensity
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07228—Arrangement of the staples
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/30—Surgical robots
- A61B2034/301—Surgical robots for introducing or steering flexible instruments inserted into the body, e.g. catheters or endoscopes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/06—Measuring instruments not otherwise provided for
- A61B2090/064—Measuring instruments not otherwise provided for for measuring force, pressure or mechanical tension
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/0059—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
- A61B5/0075—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence by spectroscopy, i.e. measuring spectra, e.g. Raman spectroscopy, infrared absorption spectroscopy
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/0059—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
- A61B5/0082—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes
- A61B5/0084—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes for introduction into the body, e.g. by catheters
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/41—Detecting, measuring or recording for evaluating the immune or lymphatic systems
- A61B5/413—Monitoring transplanted tissue or organ, e.g. for possible rejection reactions after a transplant
-
- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10S901/00—Robots
- Y10S901/02—Arm motion controller
- Y10S901/09—Closed loop, sensor feedback controls arm movement
-
- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10S901/00—Robots
- Y10S901/30—End effector
- Y10S901/44—End effector inspection
Abstract
A system is provided that furnishes expert procedural guidance based upon patient-specific data gained from surgical instruments incorporating sensors on the instrument's working surface, one or more reference sensors placed about the patient, sensors implanted before, during or after the procedure, the patient's personal medical history, and patient status monitoring equipment. Embodiments include a system having a surgical instrument with a sensor for generating a signal indicative of a property of a subject tissue of the patient, which signal is converted into a current dataset and stored. A
processor compares the current dataset with other previously stored datasets, and uses the comparison to assess a physical condition of the subject tissue and/or to guide a procedure being performed on the tissue.
processor compares the current dataset with other previously stored datasets, and uses the comparison to assess a physical condition of the subject tissue and/or to guide a procedure being performed on the tissue.
Description
SURGICAL INSTRUMENTS WITH SENSORS
FOR DETECTING TISSUE PROPERTIES, AND
SYSTEMS USING SUCH INSTRUMENTS
FIELD OF THE INVENTION
[0001] The present invention relates to surgical instruments, specifically to surgical instruments with sensors used to detect properties of biological tissue, and a system for exploiting the information gathered by the sensors.
BACKGROUND ART
FOR DETECTING TISSUE PROPERTIES, AND
SYSTEMS USING SUCH INSTRUMENTS
FIELD OF THE INVENTION
[0001] The present invention relates to surgical instruments, specifically to surgical instruments with sensors used to detect properties of biological tissue, and a system for exploiting the information gathered by the sensors.
BACKGROUND ART
[0002] A living organism is made up of cells. Cells are the smallest structures capable of maintaining life and reproducing. Cells have differing structures to perform different tasks. A
tissue is an organization of a great many similar cells with vaiying amounts and kinds of nonliving, intercellular substances between thein. An organ is an organization of several different kinds of tissues so arranged that together they can perform a special function.
tissue is an organization of a great many similar cells with vaiying amounts and kinds of nonliving, intercellular substances between thein. An organ is an organization of several different kinds of tissues so arranged that together they can perform a special function.
[0003] Surgery is defined as a branch of medicine concerned with diseases requiring operative procedures.
[0004] Although many surgical procedures are successful, there is always a chance of failure. Depending on the type of procedure these failures can result in pain, need for re-operation, extreme sickness, or death. At present there is no reliable method of predicting when a failure will occur. Most often the failure occurs after the surgical procedure has been completed. Failures of surgical procedures can take many forms. The most difficult failures to predict and avoid are those that involve biological tissue. This difficulty arises for three distinct reasons. Firstly, the properties that favor the continued function of biological tissue are very coinplex. Secondly, these properties are necessarily disrupted by surgical manipulation. Finally, the properties of biological tissues vary between people.
[0005] During a surgical operation, a variety of surgical instruments are used to manipulate biological tissues. However, traditional surgical instruments do not have the ability to obtain information from biological tissues. Obtaining information from the biological tissues that surgical instruments manipulate can provide a valuable dataset that at present is not collected. For example, this dataset can quantitatively distinguish properties of tissues that will result in success or failure when adapted to specific patient characteristics.
[0006] Surgical instruments that incorporate sensors onto the instruments' worlcing surfaces are described, e.g., in U.S. Patent Application No. 10/510,940 and in U.S. Patent 5,769,791. The instruments described in the prior art have the ability to sense tissue properties; however, their utility is limited by an inability to account for the multitude of differences that exist between patients. This limitation of the prior art is clearly illustrated by the fact that the instruments generate feedback after sensor signals are compared to a fixed dataset within the device. Thus, the prior art instruments have no means of adapting to patient-specific characteristics that are of utmost importance in avoiding surgical procedure failure.
[0007] There exists a need for a system and methodology for using the information gathered by surgical instruments having sensors in an adaptive, patient-specific manner.
There also exists a need for instruments having sensors that are useful for monitoring a patient's condition during and after surgery.
SUMMARY OF THE INVENTION
There also exists a need for instruments having sensors that are useful for monitoring a patient's condition during and after surgery.
SUMMARY OF THE INVENTION
[0008]- An advantage of the present invention is a system which generates real time, patient specific procedural guidance for predicting success of a surgical procedure, and avoiding or detecting failure of the procedure. Another advantage of the present invention is a system which records data across the entire patient encounter including pre-operative, intra-operative and post-operative periods, as well as immediate, acute, short term, and long term outcomes both locally in hospital-based units as well as remotely in a data repository.
[0009] A fiu-ther advantage of the present invention is a system which provides expert procedural guidance based upon patient specific data gained from personal medical history, patient status monitoring equipment, surgical instruments incorporating sensors on the instrument's worlcing surface, reference sensors placed about the patient, and implanted sensors placed before, during or after the procedure.
[0010] A still further advantage of the present invention is a system which generates patient specific expert guidance in optimizing surgical procedures based upon statistically matched data from a central repository. Yet another advantage of the present invention is a system which adapts its guidance based on continuously updated, statistically significant data.
[0011] According to the present invention, the foregoing and other advantages are achieved in part by a system comprising a surgical instrument having a sensor for generating a signal indicative of a property of a subject tissue of a patient; a signal processor for receiving the signal and converting the signal into a current dataset; a memory for storing the current dataset; and a processor. The processor is configured to compare the current dataset with other datasets previously stored in the memory, and to assess a physical condition of the subject tissue or guide a current procedure being performed on the tissue, responsive to the comparison.
[0012] Another aspect of the present invention is a system comprising a surgical instrument coinprising an incident light source and a sensor for using incident light from the light source to generate a signal indicative of fluorescence of a subject tissue into which a fluorescent medium has been introduced; and a processor configured to receive the signal and to determine a tissue characteristic of the subject tissue responsive to the response of the fluorescence as indicated by the signal.
[0013] A further aspect of the present invention is a sensor consisting essentially of a rigid or flexible substrate and a plurality of sensing elements mounted to the substrate for monitoring a property of a living tissue.
[0014] A still further aspect of the present invention is a surgical fastening device comprising a sensor for measuring properties of and interaction with a living tissue on the fastening device.
[0015] A further aspect of the present invention is a system comprising a surgical instrument having a sensor for generating a signal indicative of a property of a subject tissue of a patient; a reference measurement instrument having a sensor for measuring a reference tissue and generating a reference measurement signal; a signal processor for receiving the signal and converting the signal into a current dataset, and for receiving the reference measurement signal and converting it into a current reference dataset; a memory for storing the current dataset and the current reference dataset; and a processor. The processor is configured to compare the current dataset with the current reference dataset, and to assess a physical condition of the subject tissue andJor guide a current procedure being performed on the tissue, responsive to the comparison.
[0016] Another aspect of the present iiivention is a system for monitoring a living tissue of a patient's body, coinprising a sensor implaiitable in the patient's body for generating a signal indicative of a property of the tissue; a controller for receiving the signal outside the patient's body; and a communications interface for communicating the signal from the sensor to the controller.
[0017] Additional advantages of the present invention will become readily apparent to those skilled in this art from the following detailed description, wherein only selected embodiments of the present invention are shown and described, simply by way of illustration of the best mode contemplated for carrying out the present invention. As will be realized, the present invention is capable of other and different embodiments, and its several details are capable of modifications in various obvious respects, all without departing from the invention. Accordingly, the drawings and description are to be regarded as illustrative in nature, and not as restrictive.
BRIEF DESCRIPTION OF THE DRAWINGS
BRIEF DESCRIPTION OF THE DRAWINGS
[0018] Refereiice is made to the attached drawings, wherein elements having the same reference numeral designations represent like elements throughout, and wherein:
[0019] FIG. 1 is a block diagrain of a sensing surgical instrument system according to an embodiment of the present invention.
'[0020] FIG. 2a shows a right angle surgical stapler according to an embodiment of the present invention.
[0021] FIG. 2b shows a linear surgical stapler according to an embodiment of the present invention.
[0022] FIG. 2c shows a circular surgical stapler according to an embodiment of the present invention.
[0023] FIG. 3 a shows sensing elements situated on a staple side outside of the staple lines of a surgical stapler according to an embodiment of the present invention.
[0024] FIG. 3b shows sensing elements situated in a sleeve fixed to a stapler head of a surgical stapler according to an embodiment of the present invention.
[0025] FIG. 3c shows sensing elements interleaved with staples in a surgical stapler according to an embodiment of the present invention.
[0026] FIGS. 4a-4e show fiber configurations of an optical sensor tip according to embodiments of the present invention.
[0027] FIG. 5a is a block diagram of a configuration for transmitting light for the optical sensor of Figs. 4a-4e.
[0028] FIG. 5b is a block diagram of a configuration for receiving light for the optical sensor of Figs. 4a-4e.
[0029] FIG. 6a is a graph showing the relationship between light absorption and incident wavelength for varying tissue oxygen saturation.
[0030] FIG. 6b is a graph showing an example of light absorption in tissue during de-oxygenation and re-oxygenation.
[0031] FIG. 6c is a timing diagram for an oximetry-type algorithm according to an embodiment of the present invention.
[0032] FIG. 7 is a flowchart for oximetry-type oxygenation sensing according to an embodiment of the present invention.
[0033] FIG. 8a is a graph showing a response to incident light and fluoresced light as fluorescent dye is introduced into a living tissue.
[0034] FIG. 8b shows a simulated representative fluorescent sensor response as the sensor traverses perfused and non-perfused tissue according to an embodiment of the present invention.
[0035] FIG. 9 is a flowchart for fluorescence sensing according to an embodiment of the present invention.
[0036] FIG. I Oa illustrates a system according to an embodiment of the present invention with light sources and receivers external to an instrument.
[0037] FIG. 10b illustrates a system according to an embodiment of the present invention with light sources, light receivers, and light guides internal to an instrument.
[0038] FIG. 10c illustrates a system according to an embodiment of the present invention with micro fabricated internal light sources, light receivers, and liglit guides.
[0039] FIG. 11a illustrates a sensor configuration according to an embodiment of the present invention where sensing elements are situated on a flexible substrate.
[0040] FIG. 1 lb illustrates a sensor configuration on a surgical retractor for open surgery according to an embodiment of the present invention.
[0041] FIG. 11 c illustrates a sensor configuration on a grasper for minimally invasive, laparoscopic surgery according to an embodiment of the present invention.
[0042] FIG. 11 d illustrates a sensor configuration where sensors are implanted into the body and transmit data wirelessly according to an einbodiment of the present invention.
[0043] FIG. 11 e illustrates a remotely powered integrated sensor and wireless transmitter according to an embodiment of the present invention.
[0044] FIG. 12a shows a surgical staple or clip with sensing capabilities according to an embodiinent of the present invention.
[0045] FIG. 12b is a cross-sectional view the sensing staple or clip of Fig.
12a.
[0046] FIG. 13a illustrates a system according to an embodiment of the present invention where the staples or clips measure electrical impedance.
[0047] FIG. 13b illustrates a system according to an embodiment of the present invention where staples or clips and a reference sensor perform electric electrical stiinulation and electrical activity sensing.
[0048] FIG. 14 is a block diagram of an intelligent expert system according to an einbodiment of the present invention with integrated sensing, monitoring, data storage, outcome prediction, and display capabilities.
[0049]
[0050]
[0051]
[0052]
[0053]
[0054] DESCRIPTION OF THE INVENTION
[0055] Conventional surgical instruments having sensors for measuring tissue properties have no means of adapting to patient-specific characteristics that are of utmost importance in avoiding surgical procedure failure. The present invention addresses and solves these problems stemming from conventional sensing surgical instruments.
[0056] According to the present invention, a system provides expert procedural guidance based upon patient specific data gained from surgical instruments incorporating sensors on the instrument's working surface, one or more reference sensors placed about the patient, sensors implanted before, during or after the procedure, the patient's persoiial medical history, and patient status monitoring equipment. In certain embodiments, the system records data across the entire patient encounter including pre-operative, intra-operative and post-operative periods, as well as immediate, acute, short term, and long term outcomes both locally in hospital-based units as well as remotely in a data repository.
[0057] In other embodiments, the inventive system generates patient-specific expert guidance in optimizing surgical procedures based upon statistically matched data from a central repository, and/or adapts its guidance based on continuously updated, statistically significant data.
[0058] The present invention will now be described in detail with reference to Figs. 1-14.
[0059] FIG. 1 schematically shows a representative sensing surgical instrument system with adaptively updating algorithms according to an embodiment of the present invention.
This embodiment specifically depicts a sensing surgical stapler 101 for measuring properties of tissue 102. One or more other similarly instrumented well-ktiown surgical instruments including, but not limited to, clip appliers, graspers, retractors, scalpels, forceps, electrocautery tools, scissors, clamps, needles, catheters, trochars, laparoscopic tools, open surgical tools and robotic instruments may be integrated into the system instead of or in addition to stapler 101. Sensing elements 104 reside on the stapling element side 105 and/or the anvil side 106. The stapler is coupled via a conventional optical, electrical, or wireless connection 108 to a processing and control unit 120.
[0060] The system of Fig. 1 includes one or more reference measurement points, internal or external, invasive, minimally invasive or noninvasive, intracorporeal or extracorporeal.
One example of such a reference measurement sensor, shown in the form of a clip 110, grasps reference tissue 112, typically healthy tissue in the same patient serving as a reference for use as a patient-specific baseline measurement. Sensing elements 111 are on one or both sides of the jaws 116 and 117. Reference sensor 110 need not be a clip, but can be a probe or any other sensing instrument or device. Reference sensor 110 is coupled via a conventional optical, electrical, or wireless connection 118 to processing and control unit 120.
[0061] In certain embodiments of the inventive system of Fig. 1, optical signals are generated by the sensor controller 123, light returning from the distal end of the sensors is received by sensing unit 121, and the associated signals are conditioned in signal processor 122 and converted into a dataset, which is stored in a memory, such as database 131. A
processor 124, is coupled to both the input and output datasets and compares the information to determine characteristics of the tissue, the patient, and the procedure.
The processor 124 comprises, for example, a conventional personal computer or an embedded microcontroller or microprocessor. Control and monitoring of the sensor outputs 123 and inputs respectively is performed with conventional commercially available or custom-made data acquisition hardware that is controlled by the processor 124. Signal processor 122 is integral with processor 124, or is a conventional digital or analog signal processor placed between the sensor input 121 and the processor 124. Depending on the sensing modality, the sensor data is translated into information that relates to tissue properties. In one exemplary optical sensing embodiment, oximetry-type techniques are used to convert the relative absorption of different wavelengths of light into an oxygen saturation percentage of hemoglobin in the blood. In another optical sensing modality, fluorescence response due to a fluorescent medium that has been introduced into the body is measured, and characteristics of the response including the intensity rise time and steady state value are indicative of the blood flow in the tissue in question. All raw data and processed results are recorded by a recorder 130. This dataset can include measurements made preoperatively, intra operatively, and/or post operatively, as well as pre procedurally (before actuation of the device), at the time of the procedure (as the device is actuated), and/or post procedurally (immediately and delayed after actuation of the device). In addition, outcomes are recorded; these outcomes include immediate outcomes (during procedure), acute outcomes (within 24 hours), sliort term outcomes (within 30 days), and long tenn outcomes. Post procedure outcomes can be either quantitative measureinents from implantable or other sensors, lab results, follow up imaging or other sources, or they can be qualitative assessments of the patient and the procedure by a medical professional.
[0062] A dynamically updated database of past patient encounters 131 is coupled with the processor 124 for creating a decision about tissue health based on previous knowledge.
Database 131 includes information about the current patient and also data from previous patients that is used to make an inforined decision about the tissue health and the likelihood of success of a procedure. The system offers solutions to the medical team to optimize the chance of procedural success. The collected dataset including sensor data and outcomes from the current procedure are added to database 131 to help make more informed future decisions. Outcomes can be added, after follow up visits with the patient at a later date, into either the system or a external database from an external source. The database 131 may be stored locally in base unit 120 or externally, but is updated by and sends updates to a central database that serves other base units 120 via a communications device 138, such as a conventional modem, an internet connection, or other network connection.
Further, recorder 130 can be linked to a central repository for patient inforination to include some or all recorded information with medical history in patient records.
[0063] Large amounts of data are collected for each patient. The database 131 contains all of the collected information and the corresponding outcomes, or a statistically significant subset of the collected data and patient outcomes. The database, or a subset thereof, acts as a statistical atlas of predicted outcomes for a given set of sensor inputs.
Conventional techniques are used for determining the relationship between the current sensor readings and those of the atlas, to interpolate or extrapolate a predicted outcome or likelihood of procedure success or failure. One technique well-known in the art represents the current patient's sensor and other inputs in a vector; the similar datasets from the atlas or database are represented in a similar form as a set of vectors. The "distance" between the current patient data and each set of previously stored data is determined; distance can be determined as the standard Euclidean distance between the vectors; i.e. the 2-norm of the difference between the vectors, or other distance measures as lcnown in the art including other norms and the Mahalanobis distance. The difference between the vectors, or the vectors themselves, can be multiplied by a weighting matrix to take into account the differences in the significance of certain variables and sensor readings in determining the outcome. The set of distances of the current dataset from the previously stored sets is used as a weighting factor for interpolating or extrapolating the outcome, likelihood of success or failure, or other characteristics of the previously stored datasets. In another well-known technique, methods typically used in image processing and statistical shape modeling for deforming a statistical atlas can be incorporated. A base dataset generated from the database of previously collected datasets and the most statistically significant modes of deformation are determined, where the previously collected datasets act as training datasets. The magnitudes of the deformation for each mode are deterinined to best match the atlas model to the current dataset. The magnitudes are then used to deform the set of previous outcomes in a similar fashion, or otherwise interpolate between the previous outcomes by determining how the each outcome is dependent on each mode of deformation, to determine the best fit for the current patient.
Other conventional techniques for predicting outcomes based on prior aiid current datasets are based on determining the similarity between the current dataset with those that were previously acquired from other patients, and using the similarity measure to determine a likelihood of a given outcome responsive to those corresponding to the prior datasets.
[0064] Attached to, or integrated directly into, the base control unit 120 is one or more output devices 134. Output device 134 is used to provide persons performing the procedure information about the physiologic condition of the tissue, and to help guide the procedure.
The output device 134 takes information from the sensors, prior data, patient records, other equipment, calculations and assessments, and other information and presents it to the clinician and operating room staff in a useful manner. In one embodiment, the measured information is compared with prior datasets and prior patient outcomes, and the output device displays information to help assess the lilcelihood of success of a given procedure with the current configuration. The information displayed can simply be a message such as "go ahead as planned" or "choose another site." In another embodiment, the information is encoded in some form of sensory substitution where feedback is provided via forms including, but not limited to, visual, audible, or tactile sensation.
[0065] FIGS. 2a-2c depict specific stapler configurations according to embodiments of the present invention. FIG. 2a depicts a right angle surgical stapler 201. The stapling element side of the jaws 202 is instrumented with sensing elements 204 and 206 associated with each set of staple lines 208 and 210 which are on both sides of the cutter 212. In this embodiment, the anvil side of the jaws 214 is not instrunzented with sensors. Sensing elements 204 and 206 can be placed on either or both sides of the jaws 202 and 214. In one embodiment, the stapler is coupled via optical cable 220 to the previously described processing and control unit 120. This coupling 220 can also be electrical or wireless.
[0066] FIG. 2b depicts a linear surgical stapler 231 according to an embodiment of the present invention. The stapling element side of the jaws 232 is instrumented with sensing elements 234 and 236 associated with each set of staple lines 238 and 240 which are on both sides of the cutter 212. In this embodiment, the anvil side of the jaws 214 is not instrumented with sensors. Sensing elements 204 and 206 can be placed on either or both sides of the jaws 232 and 234. The stapler is coupled via optical cable 250 to the previously described processing and control unit 120. This coupling 250 is electrical or wireless.
[0067] FIG. 2c depicts a circular surgical stapler 261 according to an embodiment of the present invention. The stapling element side of the j aws 262 is instrumented with a ring of sensing elements 264 associated the ring of staples lines 270 and outside of the circular cutter 272. Since the anvil is detachable and connected by pin 278, in this embodiment, the anvil side of the stapler 276 is not instrumented with sensors. Sensing elements 264 are placed on either or both the stapling element side 264 and the anvil side 276. The stapler is coupled via optical cable 280 to the previously described processing and control unit 120.
Alternatively, this coupling 280 is electrical or wireless. Other stapler designs or clip appliers are instrumented similarly, with one or more sensors on one or both sides of the jaws.
[0068] FIGS. 3a-3c show configurations of sensing elements on the surface of a linear stapler according to embodiments of the present invention. These configurations are generalized to any shaped stapler or other surgical instrument. Sensing elements are shown in a.linear arrangement; they can be arranged in other patterns including staggered rows, randomized, single sensors and arrays of sensors. FIG. 3a shows a linear stapler head 301 with sensing elements 306 and 308 on the outside of staple or clips 303 and 304, which are outside the cutter 302. Cutter 302 is optional, and there may be a total of one or more staples, staple lines, or clips. The sensing elements 306 and 308 are situated such that they sense the tissue outside of the staple lines on one or both sides.
[0069] FIG 3b shows a linear stapler head 321 according to an embodiment of the present invention. Attached to the stapler or integrated into stapler head 321 is a strip or shell 327 and 329. This shell can be permanently integrated into the stapler or an addition to the stapler. Thus, it can be a modification to an existing stapler. Enclosed in the sensing shell 327, 329 are sensing eleinents 326 and 328. The stapler comprises one or more staples or clips 323 and 324 and cutters 322.
[0070] FIG 3c shows a linear stapler head 341 with the sensing elements 346 and 348 integrated into the stapler head, according to an embodiment of the present invention. The sensing elements are placed such that they are in line with or integrated between the staples or clips 343, 344. Medial to the staples and sensors is an optional cutter 342. The sensors are placed on one or both sides of the cutter.
[0071] FIGS. 4a-4e show configurations of optical sensing elements according to embodiments of the present invention wliere a surgical instrument is coupled to base unit 120 optically. This coupling can also be electrical or wireless with the actual electronic sensing elements placed in the instrument as opposed to an optical coupling from a remote source.
[0072] FIG. 4a shows an embodiment where the sensing element contains four optical fibers 405, 406, 408, and 409. These are embedded in a medium 402, typically optical epoxy, and enclosed in sheath or ferrule 401. In this embodiment, two optical fibers are used to transmit light into the tissue and two others are used to return light to the receiver in the base unit 120. The arrangement of the emitting and receiving elements is such that matching emitter/receiver pairs are adjacent or opposing. Further, the same optical fiber can be used to transmit light in both directions. One or more optical fibers are used to transmit light to and fiom the worlcing surface of the instrument.
[0073] FIG. 4b shows an optical fiber arrangement with fibers 425, 426, and embedded in a medium 422 which is enclosed in a sheath or ferrule 421. In this embodiment of the invention, two optical fibers are used for transmitting light into the tissue and a single fiber is used to return light to the receiver. FIG. 4c shows a similar einbodiment where there are two optical fibers 446 and 448 embedded in medium 442 inside of sheath or ferrule 441.
In this embodiment, a single optical fiber transmits all light to the tissue and a single fiber receives light from the tissue.
[0074] FIG. 4d shows an embodiment where there is a ring of optical fibers 466 that surround optical fiber 464 inside of medium 462 enclosed in sheath or ferrule 461. The outer ring of fibers 466 is used to transmit light while the inner fiber 464 receives light.
Alternatively, the outer ring of fibers 466 can be used to receive light transmitted from the inner fiber 464.
[0075] FIG. 4e shows another embodiment of the sensing element which contains a multitude of optical fibers 484 stabilized in a medium 482 enclosed in a sheath or ferrule 481. The fibers are arranged in an arbitrary or random pattern of light emitters and light receivers. Each fiber is attached to an individual light source or light sensor, and/or more than one fiber is coupled optically to share a light emitter or sensor.
[0076] FIG. 5a schematically displays a configuration of the light emitting coinponents for a single measurement point in one embodiment of the sensing stapler or other sensing i-nstrument of the invention. A processor 501, contained in the base unit 120 or onboard the instrument, commands the light controller 502, which also is located either in the base unit 120 or onboard the instrument. The light controller 502 is coupled to the light sources for one sensing modality by connections 504. The light sources 506, 508, and 510 provide the light that is incident on the tissue 102. In one embodiment, these light sources are lasers with wavelengths centered at red (near 660nm), near-infrared (near 790nm), and infrared (near 880nm), respectively. This configuration is used for oximetry-type sensing where one wavelength is situated at the isobestic point for light absorption in hemoglobin, one is situated at a greater wavelength, a.nd one is situated at a lesser wavelength.
Light sources 5p6, 508, and 510 are one, two, three, or more distinct light emitters and are laser, light emitting diode (LED), or other sources. Alternatively, these distinct light sources are a broadband light source such as a white light. If more than one light source is used, optical couplings 514 connect the sources to a light combiner 516. If more than one output is required (i.e. more than one measurement point using the same light source), optical coupling 518 takes the light into a light splitter 520. Optical couplings 524 take the light to the appropriate fiber assembly 530. Light is transmitted out of the fiber assembly at the fiber end 532 on the tip. This tip is as depicted in FIG. 4a.
[0077] The light controller 502 controls the light emitter for one or more sensing modalities. In this embodiment, there are two optical sensing modalities:
oximetry-type tissue oxygenation sensing and fluorescence sensing. Coupling 536 allows the light controller to control light source 538. Light source 538 is a high power blue LED with a center wavelength of 570nm. This light emitter is a laser, LED, or other light source. This source is composed of one or more sources that emit light at one or more wavelengths or a broadband light source emitting at a spectrum of wavelengths. Optical filtering can also be performed on a broadband ligllt source to produce the desired spectral output.
The light from light source 538 is coupled optically 540 to a light splitter 542 if more than one measurement point uses the same source. Optical coupling 544 connects the light to the optical cable assembly 530, and light is emitted at tip 548.
[0078] In another embodiment of the invention, the light from optical fibers 524 and 544 is, combined and the light is emitted from an optical fiber assembly as described in FIG. 4b, 4c, or 4d (emitter as fiber 464). In a further embodiment, the light from optical fibers 524 and 544 is split, or combined and split, into multiple fibers to be used with a cable assembly as shown in FIG. 4d (emitters as fibers 466) or FIG. 4e.
[0079] FIG. 5b schematically displays a configuration of light receiving components for a single measurement point in one embodiment of the sensing stapler or other sensing instrument 101. Light from the emitter described in FIG. 5a is incident upon the tissue being queried and the transmitted and/or reflected light passes into the tip 552 and returns through the optical cable assembly 530. Optical coupling 554 directs the light to light sensors 556.
In one embodiment, light sensor 556 is an avalanche photodiode. Sensor 556 is, but is not limited to, conventional photodiodes, avalanche photodiodes, CCDs, linear CCD
arrays, 2D
CCD arrays, CMOS sensors, photomultipliers tubes, cameras, or other light sensing devices.
In a further embodiment, light sensor 556 is a spectrometer or equivalent device that measures light intensity at one or more discrete wavelengths. In a still further embodiment, light sensor 556 is a set of selective photodiodes tuned to the wavelengths of emitted light from light sources 506, 508, and 510. Selective photodiodes are either naturally tuned to specific wavelengths or coupled with an appropriate optical filter. Light sensors 556 are coupled 558 with a signal processor 560. The signal processor 560 performs filtering, demodulating, frequency analysis, timing, and/or gain adjustment, and/or other signal processing tasks. The signal processor 560 is coupled with the processor 501 where further calculations, analysis, logging, statistical analysis, comparisons with reference, comparisons with database, visualization, notification, and/or other tasks are performed or directed.
[0080] Light from the emitter described in FIG. 5a is incident upon the tissue being queried and the transmitted and/or reflected light also passes into the tip 564 and returns through the optical cable assembly 530. Light is directed via optical coupling 568 to optical filters 572. In the fluorescence sensing modality, the optical filter 568 is a band pass or other filter that blocks the incident, excitation light while allowing the fluoresced light to pass.
Filter 572 is also useful to block the emitted light from other sensing modalities and/or other light including ambient light. The filter light is coupled optically via coupling 574 to light sensors 578. In one embodiment, light sensor 578 is an avalanche photodiode.
In other embodiments, light sensor 578 is the same form as light sensors 556. Light sensors 578 are coupled 580 with the signal processor 560 which is in tern coupled with the processor 501.
The processor 501 and signal processor 560 perforin the same functions as described previously with reference to FIG. 5a.
[0081] FIGS. 6a and 6b show plots that are used to describe oximetry sensing modality.
FIG. 6a shows the relationship between light absorption 601 and light wavelength 602 for a range of tissue oxygenation levels 603. The vertical lines 620, 624 and 628 correspond to the wavelengths of 660nm, 790nm and 880nm respectively. The light absorption 601 for the range of oxygen saturation levels 603 is different for each of the wavelengths. As oxygen saturation 603 decreases, the absorption increases for red light 620 and decreases for near-infrared light 628. At the isobestic wavelength near 624, light absorption is invariant to oxygen saturation. This wavelength can be used for calibration and for normalization of the signal to allow for consistent readings regardless of optical density of the tissue. One embodiment of the oxygen sensing modality emits light at the isobestic wavelength, one wavelength greater than the isobestic and one wavelength less than the isobestic, and senses the absorption responsive to the measured response. Other embodiments emit one or more wavelengths of light and measure the transmitted, reflected, or otherwise measurable light to determine the absorption, slope of the absorption function, or other characteristics of the response that can be related to the blood oxygen saturation and tissue health.
[0082] FIG. 6b shows a plot that represents an experiment used to verify the relationship between oxygen saturation and light absorption. Red light at 660mn represented by 652 and near infrared light at 880nm represented by 654 are used to illuminate a section of tissue, At the time marked by 658, blood supply to the tissue is occluded. At the time marked by 660, the blood supply is restored. As blood supply is restricted and tissue oxygen saturation drops, the transmitted light intensity (inverse of absorption) increase for near infrared light 620 and decreases for red light 654.
[0083] FIG. 6c shows a timing diagram and representative response for an algorithm according to the present invention used for oximetry-type oxygen saturation level sensing.
The algorithin provides for a robust method of sensing oxygenation that results in a response that is. minimally responsive to tissue type, color, thickness, or other properties. The timing diagram in FIG. 6c presents the method when two wavelengths of light (red and infrared) are used. It is extendable to other numbers of sources, and other types of sources and sensors.
[0084] The diagram of FIG. 6c shows the output light intensity 670 and the responsive light received 672 with respect to time 674 over a time period or cycle length 676. In one embodiment, the light emitter is a bi-color, bi-polar LED that emits red (660nm) and infrared (880nm) light; when a positive voltage 678 is applied, infrared light is emitted, and when a negative voltage 680 is applied, red light is emitted.
[0085] The light output intensities and corresponding response intensities are denoted with letters in the following description for use in the equations hereinbelow. In each cycle 676, red light is emitted with intensity 678 (A) and the corresponding sensed light intensity 678 (F) is recorded. Light is then shut off 682 (B) and the corresponding received light intensity 684 (G) is recorded as a baseline. Infrared ligllt is emitted with intensity magnitude 686 (C) and the corresponding sensed light intensity 688 (H) is recorded. To make the tissue response more invariant to tissue properties other than oxygenation (i.e.
tissue optical density and thickness), the maximum intensities where light can no longer sufficiently pass through (or other transmission method) the tissue and return to the sensor. Light intensity is ramped from 686 to 682. At time 690, the signal is lost and the output intensity 692 (D) is recorded.
Light intensity is ramped from 682 to 678. At time 694, the signal is regained and the output intensity 696 (E) is recorded. The times 690 and 694 and corresponding intensities 692 and 696 are determined by a simple threshold on received intensity 672.
[0086] In another embodiment, these levels are determined by placing a threshold on a moving average, integration, derivatives, curve fitting, or other methods.
Described is one embodiment of the timing for a robust oxygenation-type algorithm. Other functionally identical or similar embodiments exist.
[0087] A measure related to tissue oxygenation can be calculated responsive to the output and corresponding receiver light intensities. Initially, the "red ratio" is defined and is evaluated as (H-G)/(C-D), and the "infrared ratio" is defined and is evaluated as (F-G)/(A-E), where the letters correspond to the magnitudes of the light intensities as described. The numerator of the ratios determines the response after eliminating effects of ambient or other external light sources. The denominator of the ratios normalizes the response by the amount of light that was actually incident on the tissue that made it back to the sensor. The oxygenation is responsive to the two ratios. The "relative oxygen saturation"
is defined as the red ratio divided by the infrared ratio and is related, not necessarily linearly, to the oxygen saturation of the tissue being measured. The relative oxygen saturation is useful for determining trends in oxygenation and also as a comparison with respect to time and/or a separate reference sensor. One important difference between the technique described and that of standard pulse oximetry is that the employed algorithms are not based on pulsatile flow in the tissue. Therefore, it is possible to acquire the tissue oxygen saturation even if blood flow is non-pulsatile, or even not flowing. Further, the algorithms incorporated iinprove measurement robustness and stability by compensating for tissue thiclaless and type (or more specifically, the optical impedance of the tissue being measured).
[0088] FIG. 7 is a flowchart for one inventive embodiment of the oxygen sensing modality based on oximetry. This embodiment uses oximetry-type techniques for determining the light response from tissue responsive to three excitation wavelengths. These three wavelengths can include those described earlier: one red light source, one infrared light source, and one light source at the isobestic wavelength. The measured response in the absence of an excitation light is used as a baseline intensity and subtracted from the three measured responses. All raw data is logged, and a calculation is performed to convert the light absorption for the three wavelengths to a value related to tissue oxygenation. The calculated values are compared to a database or other previously acquired or determined dataset. Although exactly three wavelengths are shown, other embodiments use one or more wavelengtlis of excitation light. In fixrther embodiments, the intensities for each of the excitation lights may be ramped in intensity as detailed in FIG. 6c to create a more robust measurement that is invariant to tissue optical density.
[0089] FIGS. 8a-8b show typical results for experiments with the fluorescent sensing modality. Tissue perfusion can be assessed using fluorescence. Biofluorescence can be achieved using a variety of commercially available products. One example is fluorescein isothiocyanate which is an intravenously injected, biocompatible dye which fluoresces yellow-green (peak near 520nm) when illuminated with an blue/ultraviolet (peak near 488nm) source. This sensing modality can be incorporated into the configurations shown to allow for multi-modality sensing, or included as a stand-alone sensor. A dense array of sensors enables imaging of the perfusion along a line and a determination if there are patches of poorly perfused tissue in an otherwise healthy region. Stapler fluorography can also utilize fluorescent microspheres and quantum dots. These entities can be used as molecular tracers to characterize tissue substructure such as vessels, or bile ducts. In addition, inflammatory mediators and other biomolecules germane to anastomosis viability can be detected though fluorography at a staple line.
[0090] FIG. 8a represents the measured intensity of the transmitted and/or reflected incident light 808 and the measured intensity of the fluoresced response 804 to the incident light source. The plot shows the light intensity centered at the incident and fluoresced wavelengths as fluorescent dye is instilled into or perfused though the bloodstream at time 812. As the dye perfuses into the tissue being measured, the fluorescent response becomes evident and the sensed incident light decreases. The slope, rise time, magnitude, steady state value, shape, integral, or other characteristics and curve properties of the onset of fluorescence 816 can be used to determine characteristics of the tissue perfusion and health.
The steady state values of the fluoresced light 824 and incident light 828 can be used to determine tissue perfusion and overall health and/or the type of tissue. The measured response can be used alone, with a previously collected dataset from the same or other patients, or in conjunction with a reference signal. Infusion of the fluorescent medium can be introduced either in a single injection, or it can be ramped up in either continuously or in discrete increments. By varying the amount of fluorescent medium introduced into the patient, continuous or multiple measurements can be performed of the characteristics of the onset of fluorescent response.
[0091] FIG. 8b shows typical results for passing a fluorescence sensing probe 850 across a tissue sample 852. In one case, the fluoresced response 858 serves as a baseline for healthy tissue 856 and the decreased intensity 862 corresponds to a region of tissue that is depleted of blood supply 860. Alternately, the baseline intensity can be the lower level 862 and the fluorescence peaks to 858 as the probe passes over a blood vessel 860. This scanning technique can be used to determine sections of tissue with proper perfusion.
In one embodiment, multiple sensor probes 850 are integrated in a linear, grid like, or other arrangement on the surface of a surgical instrument such as a stapler, a retractor, a grasper, a clip applier, a probe, a scope, a needle, a catheter, a mesh substrate, or other device.
[0092] FIG. 9 is a flowchart for one embodiment of the inventive fluorescence sensing modality. Light containing or centered at a wavelength that excites the fluorescent medium is transmitted into the tissue. The light intensity of the fluorescent response is then measured; optical filters, wavelength selective light receivers, or a spectrometer are used to differentiate excitation light and fluorescent response. The measured response in the absence of an excitation light is used as a baseline intensity and subtracted from the fluorescent response. All raw data is logged, and a calculation is performed to determine one or more properties of the onset of the fluorescent response and the steady state value as described earlier. The calculated values are compared to a database or other previously acquired or determined dataset. This sensing modality can be coinbined with that described by the flowchart of FIG. 7. In one embodiment, both oximetry-type sensing as represented in FIG.
6 and FIG. 7 and fluorescence-type sensing as represented in FIG. 8 and FIG. 9 are combined into a single integrated device. The schematic diagram shown in FIG. 5 shows how light sources and detectors for both sensing modalities can be integrated into a single system.
Other sensing modalities, optical or other types, can be combined to perform inulti-modality sensing on the working surface of surgical instruments.
[0093] FIGS. IOa-lOc present techniques that can be used to perform said oximetry-type and/or fluorescence-type sensing. These techniques can be combined with other sensing modalities including optical sensors, electrical sensors, chemical sensors, mechanical sensors, MEMS sensors, nano sensors, biochemical sensors, acoustic sensors, immunologic sensors, fluidic sensors, or other types of sensors.
[0094] FIG. l0a shows a surgical stapler embodiment of the system configuration where all light sources and detectors are located external of the surgical instrument's body. In this embodiment, the light sources and detectors are located in control unit 1001 and sensing, control, calculations, and communications are performed in control electronics 1003. In one embodiment, control unit 1001 constitutes durable equipment and instrument 1028 is a potentially disposable device. For each measurement point, one or more light sources 1005 are coupled optically via 1007 to a light combiner 1009. The light sources can be narrowband emitters such as LEDs and lasers and/or broadband light sources such as white lights and can be use with or without additional optical filtering. For the same measurement point, one or more light receivers 1001 are coupled optically via 1013. The light receivers can be photodiodes, photodiode arrays, avalanche photodiodes, photomultiplier tubes, linear and two dimensional CCDs, CMOS sensors, spectrometers, or other sensor types.
The light traveling through couplers 1009 and receiver couplings 1013 are coupled to an optical connector 1020. In one embodiment, this connector is a standard high density fiber optic connection and coupling 1022 is a standard high density fiber optic cable.
Coupling 1022 connects to the sensing instrument 1028 at connector 1024 and passes through fiber 1030 to a breakout 1032. Sensor points 1034 can be either single fibers or multi-fiber sensor tips as represented in FIGS. 4a-e. The sensor tips transmit the incident light onto tissue 1036 and/or receive the reflected, transmitted, and/or fluoresced light from said tissue.
[0095] FIG. 10b depicts an embodiment where the light emitting and receiving components are located onboard a surgical instrument. In this embodiment, circuit board 1051 is mounted in or on the instrument and coupled via 1053 to a control unit. Coupling 1053 is electrical, optical or wireless. Attached to circuit board 1051 are light sources 1057 and light receivers 1060. In one embodiment, they are standard surface mount LEDs and photodiodes. Light guides, light combiners, and/or light splitters 1064 direct light to and from the sensing working surface 1066 of the instrument to and from the tissue being monitored 1068. In one embodiment, 1051 represents a flexible medium and light sources and receivers 1057 and 1060 represent alternative light sources and emitters such as organic LEDs and organic photo detectors.
[0096] FIG. 10c shows a further embodiment where the light emitting and receiving components are located onboard a surgical instrument. In this embodiment, the electronics are microfabricated into a compact sensing element that can fit onto the working surface of the instrument. As described hereinabove, coupling 1083 connects the circuit to an external controller. The circuit is built on base 1081. Light emitters 1087 and detectors 1090 are embedded in layer 1092. Coupled to the light sources and detectors are micro fabricated light guides, light combiners, and/or light splitters 1094 in layer 1096. The light guides direct light to and from the tissue being monitored 1098.
[0097] FIGS. 11 a-11 c depict further embodiments of sensing surgical instruments and devices according to the present invention. FIG 11 a shows a sensing flexible mesh 1104 that contains sensing elements 1106. Sensing elements 1106 can be electrical, optical, chemical, or other sensor types used to monitor the tissue 1102 or other operational parameters. The mesh 1104 can mold to the surface of tissue 1102. In one embodiment, sensors 1106 are oxygenation sensors as described previously and are used to monitor the tissue health and other tissue properties. In addition, when there is a plethora of sensors, mapping of the oxygenation levels of the surface of the tissue 1102 can be performed. If the location of the sensors is lcnown with respect to the tissue or imaging device, then this mapping can be overlaid on medical imaging information including x-ray, computed tomography, magnetic resonance imaging or ultrasound images and volumes, or it can be overlaid on a video signal from an endoscope or other camera. In another embodiment, sensors 1104 are electrical sensors that are used for EMG or other electrical activity or impedance mapping. The mesh is coupled via 1108. Coupling 1108 is electrical, optical, or wireless.
Sensors 1104, in optical sensing modalities, are either onboard electronics or the distal tips of optically coupled emitters and detectors.
[0098] The sensing surgical mesh can be generally described as a rigid or flexible surface that contains sensing elements. The sensing elements detect information about the tissue upon which they are placed. The mesh is flexible, or preshaped to conform to the tissue being monitored. In one embodiment wherein the mesh is bioabsorbable, the mesh is made of bioabsorbable polymers similar to those used in conventional absorbable sutures. In another enZbodiment wherein the mesh is durable, the mesh is made of polymers similar to those used in conventional non-absorbable sutures. In a further embodiment, the substrate is an adhesion barrier material, such as Seprafilm , available from Genzyme Corp.
of Cainbridge, MA. The tissue being monitored is either internal tissue, such as an organ being monitored after transplant or a bowel segment whose perfusion is to be verified, or is external tissue, such as a skin flap being monitored for reconstructive surgery, or skin being monitored for the prevention of bed sores. The mesh sensor array is either a temporary device used during a procedure (either single use or reusable), permanently implantable, or of a bio degradable, bio absorbable nature as is known in the art.
[0099] FIG. 11 b shows a surgical retractor 1122. The working surface of the retractor 1124 is instrumented with sensors as previously described (i.e., with sensing elements 1106) for measuring properties of a tissue 1128. In addition to monitoring tissue properties, interactions with tissue 1128 are measured using strain gages, piezoelectric sensors, load cells, multi-axis force/torque sensors, and/or other sensors 1130 and 1132. The retractor handle 1134 is held manually by a member of the operating room staff, mounted to a: frame or passive arm, or held by a robotic retraction system. Coupling 1136 couples sensors 1126, 1120, and/or 1132 to an onboard or external control interface (not shown) as described hereinabove. In one embodiment, sensors 1126 are oximetry-type sensors comprising of a plethora of multi-color LEDs and photodiodes and sensors 1130 and 1132 are either strain gages or multi-axis force/torque sensors respectively for measuring the force.s incident upon the tissue during retraction while simultaneously monitoring oxygenation levels. In the case of a robotic retraction system or other robotic-assisted surgery scenario, the sensed information including interaction forces and tissue status is used to close the control loop for the robot and/or provide warnings or augment the motions of the robot manipulator.
[00100] FIG. 11 c displays a surgical grasper that is instrumented with sensors 1144 mounted on grasper jaws 1146 and 1148. The grasper clamps or otherwise contacts tissue 1142 and senses oxygenation, tissue perfusion, electrical properties, chemical properties, temperature, interaction forces, grasping forces, and/or other parameters.
Coupling 1152 couples sensors 1144 to an onboard or external control interface (not shown) as described hereinabove. Sensors 1144 can be placed on one or both sides of the jaw and/or on the shaft 1150 of the instrument. In one embodiment, the grasper measures the oxygenation level of the tissue being grasped while simultaneously monitoring grasping force and other tissue interaction forces.
[00101] FIG. 11d shows a configuration for a sensor implanted in the body that relays information back to a controller. Sensor device 1160 contains one or more sensing elements 1162. The sensing elements can be any of the type described earlier including oxygenation, fluorescence, tissue perfusion, general health, tissue electrical impedance, tissue electrical activity, interaction forces, pH, electromyography, temperature, spectroscopy, fluid flow rate, fluid flow volume, pressure, biomarkers, radiotracers, immunologic, chemical, nerve activity, and evoked potential, and other sensor types capable of determining characteristics of tissue.
The sensor device 1160 is placed inside of, on the surface of, embedded into, or wrapped around tissue 1164. The tissue being monitored is, for example, an organ, a bowel segment, a blood vessel, a chest wall, or other biological tissue. The sensor can be temporary, permanently implantable, or bioabsorbable/biodegradable inside of body 1166.
In one embodiment, the sensor device is implanted onto the bowel and used for monitoring the tissue after a procedure and for obtaining data related to short and long term outcomes. In a.nother embodiment, the sensor is a ring that is placed around a blood vessel and is used to monitor blood flow in said vessel.
[00102] In some embodiments, one or more sensor devices on one or more tissues 1164 are communicatively coupled via 1170 to a communications interface 1172. In one embodiment, the coupling 1170 is a wireless lii-Ac where the power from a radio frequency signal generated by 1172 powers the sensor device 1160 which then takes a measurement and return data via wireless coupling 1170. The comununication interface is coupled via 1174 to a main control unit 1176. In anotlier embodiment, the communications interface 1172 is a portable battery powered device that can be carried by the patient, or a fixed device placed inside or outside of a hospital or a medical professional's office for powering and monitoring the internal sensors 1160. The communication interface 1172 can conveniently obtain acute, short, and long term follow-up data about a procedure after the surgery is complete. The communications interface 1172 and controller 1176 may be one in the same. In one embodiment, the controller 1176 is the main system's base control unit 120. In another embodiment, the communication interface 1172 is directly in communication with the main system's base unit 120 or the central database 131 directly.
[00103] In a further embodiment of the system shown in FIG. 11 d, the sensor device contains a MEMS sensing element and communications electronics, is placed in or on internal tissue, aild communicates wirelessly with and receives power from an external radio frequency source for the pui-pose of post procedure patent monitoring. In another embodiment, the sensing element is made of biocompatible materials known in the art, and an attached antenna is bioabsorbable in the patient's body. The associated electronics and/or antenna can be made either bioabsorbable or biodegradable, or such that their presence does not have any significant effect on the patient, or any combination thereof.
[00104] FIG. 11 e shows a detailed view of an embodiment of sensor unit 1160.
The sensor unit is built into substrate 1180 which, in one embodiment, is composed of a bioabsorbable polymer as is known in the art. The sensor unit contains a communications device 1182 which is coupled to an antenna 1184. In certain embodiments, the antenna body is made of a fully or partially bioabsorbable/biodegradable polymer, and contains connected tubes that are filled with conductive and biocompatible gel or liquid. The communications device is biocompatible, and can be bioabsorbable. Coupled via 1188 to the communications device 1182 are one or more sensing elements 1186. The sensing elements can be of any of the type described earlier. In one embodiment, the sensing elements are fully or partially bioabsorbable/biodegradable. In certain embodiments, the sensing elements and communications device obtain electrical power remotely from a radio frequency source, such as in RFID technology as known in the art, and use this power to perform sensing operations and to transmit data to communications interface 1172. The embodiinent shown in FIG. 11 e is a representative configuration of the sensor unit; other types, shapes, and configurations are understood to be included as well.
[00105] In further embodiments of the present invention, an absorbable optical fiber (such as shown in Figs. 4a-e) comprises at least a core and a.n outer cladding made out of bioabsorbable materials. Its layers can be made out of bioabsorbable materials with different time constants for degradation. For exainple, the cladding is thin but of a material composition that degrades very slowly, and the core is of a composition that degrades very fast since once the cladding is degraded, the fiber is useless. This bioabsorbable optical fiber is used for the light guides for optical sensors and/or for a communicative coupling between the sensors and a controller.
[00106] FIGS. 12a-c shows a surgical staple or clip with integrated sensing capabilities.
The staple, clip, suture, or other fastener itself can be used as an electrode, as a strain or force sensor, or as an optical pathway. Forces pulling on an anastomosis or other tissue joining can cause failure. By placing force measuring instrumentation on either a stapler or other instrument's working surface, or on staples, clips, sutures, or other fasteners themselves, it is possible to measure the strain induced on the tissue being joined.
[00107] FIG. 12a shows a staple with embedded sensors. The staple can include any of the sensing modalities discussed earlier. In one embodiment, strain sensing for measuring the pulling or pushing forces exerted by tissue on the staple legs 1206 may be incorporated into the fastener. In another einbodiment, strain gages 1204 are fabricated on the surface of the staple as 1204. In yet another embodiment, a coating or partial layer of a piezoelectric or resistive coating 1224 is fabricated around staple core 1222 as shown in cross-section A-A in FIG. 12b. In other embodiments, the staple is a hollow tube 1224 whose inner core 1222 is made of a piezoelectric, resistive, or other material or component that permits measurement or bending load on the staple legs 1206. This design is extendable to incorporating sensing capabilities into any surgical fastener including staples, clips, and sutures.
The staple, clip, or other fastener is made of in whole or in part of bioabsorbable/biodegradable, biocompatible materials as lcnown in the art.
[00108] FIGS. 13a-b depict embodiments where a staple, clip, or other electrode is used for electrical sensing on the surface of a surgical instrument. FIG. 13 a shows an embodiment where the instrument is used for tissue electrical impedance sensing. The electrical resistance/impedance of the tissue can be used to indicate tissue properties.
By ineasuring electrical impedance of internal tissue at the surface of a surgical instrument, it is possible to determine the tissue's status including indications of hypoxia and ischemia.
Electrodes or electrical contacts placed into the tissue are used as measurement points, the impedance measured between adjacent points and across any combination thereof. These electrodes are placed as small tips (invasive or surface contact only) on the working surface of a surgical instrument.
[00109] The instrument surface 1302 contains one or more staples, clips, or other electrodes 1304 that act as electrical contacts. The electrical contacts 1304 come in contact with tissue 1308 either on the surface or by penetrating into the tissue. The electrical impedance or resistance between the electrical contacts (either on the same staple or clip, or between adjacent or other pairs) is represented by 1310. Contacts are connected via coupling 1312 to a controller 1314 where the measurement electronics are housed.
Coupling 1312 is either electrical, optical, or wireless. Additional surfaces, instruments, or opposing stapler or grasper jaws 1320 contain additional electrodes 1322. They are coupled via 1324 to an interface 1326 and further coupled via 1328 to the same or a different controller 1314, or coupled directly to the controller 1314.
[00110] FIG. 13b shows an embodiment where the instrument is used for tissue electrical activity sensing, including nerve and muscle stimulation and sensing.
Electrical activity in tissue can be used to assess the tissue's viability. The muscular and neuronal activity that occurs in the tissue of interest is measured using techniques similar to those in electromyography: either the naturally occurring activity, or the response to an excitation due to an electrical or other impulse. Implanting electrodes into the worlcing surface of a surgical instrument enables the viability of the local tissue to be quantified.
[00111] The instrument surface 1342 contains one or more staples, clips, or other electrodes 1344 that act as electrical contacts. The electrical contacts 1344 come in contact with tissue 1346 either on its surface or by penetrating into the tissue. The contacts are coupled via 1348 to a controller 1350 where the measurement electronics are housed.
Coupling 1350 is either electrical, optical, or wireless. Additional surfaces, instruments, or opposing stapler or grasper jaws 1352 contain additional electrodes 1354. They are coupled via coupler 1356 to an interface 1358 and further coupled by coupler 1360 to the same or a different controller 1350, or coupled directly to the controller 1314. The electrical contacts can be used for both sensing and/or stimulation of the tissue or components thereof. A
separate electrical contact 1362 is placed in tissue 1346. The separate contact can serve as a reference or as a source of nerve, muscle, or other stimulation that is sensed by the other electrical contacts 1344 and 1354. Reference contact 1362 is coupled via coupler 1364 to the controller 1350.
[00112] FIG. 14 shows a schematic layout of an integrated expert system according to the present invention. The base unit 1401 contains all processing, sensing, control, signal processing, communication, storage, and other required coinponents. Coupled via coupler 1403 is sensing surgical instrument(s) 1405. These instruments include, but are not limited to, all of the instruments and embodiments described hereinabove. Sensing modalities include, but are not limited to, any of those described herein, including oxygenation including oximetry-type sensing, fluorescence, tissue perfusion, general health, tissue electrical impedance, tissue electrical activity, interaction forces, pH, electromyography, temperature, spectroscopy, fluid flow rate including laser or ultrasound Doppler measurement, fluid flow volume, pressure, levels of biomolecules and electrolytes, biomarkers, radiotracers, immunologic, cheinical, nerve activity, evoked potential, and other sensor types capable of determining characteristics of tissue. Coupling 1403 is electrical, optical, and/or wireless. Instruments 1405 are tethered via electrical or optical cables, have builtin wireless functionality, or have a reusable battery powered wireless pack that powers the instrument's sensors and/or the instrument itself, and/or couples the signals to the base unit 1401. A reference measurement sensor 1415 of the same type as said surgical instruments and coupled via coupler 1413 to base unit 1401 is used to obtain patient-specific reference measurements used to help determine tissue health and predict procedural outcomes. In addition to the instruments, a robotic manipulator useable to control the instruments and or reference sensor is coupled to the base unit 1401. The manipulator can be controlled in a closed loop fashion to optiinize procedural outcomes responsive to real-time and prior patient specific information and prior statistical and other data.
[00113] Patient status sensing including cameras, infrared imaging, thermal imaging, spectroscopic imaging, and other sources 1425 and operating room monitors 1435 including anesthesia equipment monitors and vital signs monitors which include, but are not limited to, pulse rate and quality measurement, respiration rate and quality measurement, blood pressure measurement, blood gas analysis, pulse oximetry, and ECG, feed into base unit 1401 via couplings 1423 and 1433 respectively. This systemic data is recorded and synchronized with that of the sensing instruments, and also aids in determining tissue health and in predicting procedural outcomes. The system can also be coupled via coupling 1443 to the hospital's patient data storage system 1445 so that collected data is included in the database of patient medical history information. Further, patient medical history is incorporated iilto the system's analysis of sensor data to better predict and optimize outcomes.
[00114] All relevant data collected and post-procedural outcomes are stored in a central repository 1455 that is used to generate a statistical model that allows prediction of outcomes based on current sensor data. The coupling 1453 is bi-directional; prior data is used for analysis of the current procedure and current patient data and outcomes are added to the database 1455 for future use. Coupling 1453 need not be a permanent connection; data in a local copy of 1455 can be retrieved from and updated on each base unit 1401 at regular service intervals.
[00115] The collected data, statistical model, predicted outcomes, and other relevant information is presented in a comprehensible manner to the surgeon or other operating room staff using one or more output devices 1462 coupled to base unit 1401 via coupling 1460.
Coupling 1460 is wired or wireless, or output device 1462 can be integrated directly into the control unit 1401. Presentation of results can be performed in numerous ways including, but not limited to: visual feedback, audio feedback, force or other haptic feedback, or other forms of sensory substitution. The feedback can include plots, text-based messages, verbal messages, audible warnings, video overlays, and feedback on a robotic manipulator.
Communication with an external database or other source of data is achieved with a conununication device 1468 communicatively coupled to the base unit 1401 via 1466. The coupling can be wired, wireless, or the communications device may be embedded in the base unit. Communications device 1468 can be a conventional modem, or an internet or other network connection.
[00116] The present invention can be practiced by employing conventional materials, methodology and equipment. Accordingly, the details of such materials, equipment and methodology are not set forth herein in detail. In the previous descriptions, numerous specific details are set forth, such as specific materials, structures, chemicals, processes, etc., in order to provide a thorough understanding of the present invention.
However, it should be recognized that the present invention can be practiced without resorting to the details specifically set forth. In other instances, well known processing structures have not been described in detail, in order not to unnecessarily obscure the present invention.
[00117] Only an exemplary embodiment of the present invention and but a few examples of its versatility are shown and described in the present disclosure. It is to be understood that the present invention is capable of use in various other combinations and enviroiunents and is capable of changes or modifications within the scope of the inventive concept as expressed herein.
'[0020] FIG. 2a shows a right angle surgical stapler according to an embodiment of the present invention.
[0021] FIG. 2b shows a linear surgical stapler according to an embodiment of the present invention.
[0022] FIG. 2c shows a circular surgical stapler according to an embodiment of the present invention.
[0023] FIG. 3 a shows sensing elements situated on a staple side outside of the staple lines of a surgical stapler according to an embodiment of the present invention.
[0024] FIG. 3b shows sensing elements situated in a sleeve fixed to a stapler head of a surgical stapler according to an embodiment of the present invention.
[0025] FIG. 3c shows sensing elements interleaved with staples in a surgical stapler according to an embodiment of the present invention.
[0026] FIGS. 4a-4e show fiber configurations of an optical sensor tip according to embodiments of the present invention.
[0027] FIG. 5a is a block diagram of a configuration for transmitting light for the optical sensor of Figs. 4a-4e.
[0028] FIG. 5b is a block diagram of a configuration for receiving light for the optical sensor of Figs. 4a-4e.
[0029] FIG. 6a is a graph showing the relationship between light absorption and incident wavelength for varying tissue oxygen saturation.
[0030] FIG. 6b is a graph showing an example of light absorption in tissue during de-oxygenation and re-oxygenation.
[0031] FIG. 6c is a timing diagram for an oximetry-type algorithm according to an embodiment of the present invention.
[0032] FIG. 7 is a flowchart for oximetry-type oxygenation sensing according to an embodiment of the present invention.
[0033] FIG. 8a is a graph showing a response to incident light and fluoresced light as fluorescent dye is introduced into a living tissue.
[0034] FIG. 8b shows a simulated representative fluorescent sensor response as the sensor traverses perfused and non-perfused tissue according to an embodiment of the present invention.
[0035] FIG. 9 is a flowchart for fluorescence sensing according to an embodiment of the present invention.
[0036] FIG. I Oa illustrates a system according to an embodiment of the present invention with light sources and receivers external to an instrument.
[0037] FIG. 10b illustrates a system according to an embodiment of the present invention with light sources, light receivers, and light guides internal to an instrument.
[0038] FIG. 10c illustrates a system according to an embodiment of the present invention with micro fabricated internal light sources, light receivers, and liglit guides.
[0039] FIG. 11a illustrates a sensor configuration according to an embodiment of the present invention where sensing elements are situated on a flexible substrate.
[0040] FIG. 1 lb illustrates a sensor configuration on a surgical retractor for open surgery according to an embodiment of the present invention.
[0041] FIG. 11 c illustrates a sensor configuration on a grasper for minimally invasive, laparoscopic surgery according to an embodiment of the present invention.
[0042] FIG. 11 d illustrates a sensor configuration where sensors are implanted into the body and transmit data wirelessly according to an einbodiment of the present invention.
[0043] FIG. 11 e illustrates a remotely powered integrated sensor and wireless transmitter according to an embodiment of the present invention.
[0044] FIG. 12a shows a surgical staple or clip with sensing capabilities according to an embodiinent of the present invention.
[0045] FIG. 12b is a cross-sectional view the sensing staple or clip of Fig.
12a.
[0046] FIG. 13a illustrates a system according to an embodiment of the present invention where the staples or clips measure electrical impedance.
[0047] FIG. 13b illustrates a system according to an embodiment of the present invention where staples or clips and a reference sensor perform electric electrical stiinulation and electrical activity sensing.
[0048] FIG. 14 is a block diagram of an intelligent expert system according to an einbodiment of the present invention with integrated sensing, monitoring, data storage, outcome prediction, and display capabilities.
[0049]
[0050]
[0051]
[0052]
[0053]
[0054] DESCRIPTION OF THE INVENTION
[0055] Conventional surgical instruments having sensors for measuring tissue properties have no means of adapting to patient-specific characteristics that are of utmost importance in avoiding surgical procedure failure. The present invention addresses and solves these problems stemming from conventional sensing surgical instruments.
[0056] According to the present invention, a system provides expert procedural guidance based upon patient specific data gained from surgical instruments incorporating sensors on the instrument's working surface, one or more reference sensors placed about the patient, sensors implanted before, during or after the procedure, the patient's persoiial medical history, and patient status monitoring equipment. In certain embodiments, the system records data across the entire patient encounter including pre-operative, intra-operative and post-operative periods, as well as immediate, acute, short term, and long term outcomes both locally in hospital-based units as well as remotely in a data repository.
[0057] In other embodiments, the inventive system generates patient-specific expert guidance in optimizing surgical procedures based upon statistically matched data from a central repository, and/or adapts its guidance based on continuously updated, statistically significant data.
[0058] The present invention will now be described in detail with reference to Figs. 1-14.
[0059] FIG. 1 schematically shows a representative sensing surgical instrument system with adaptively updating algorithms according to an embodiment of the present invention.
This embodiment specifically depicts a sensing surgical stapler 101 for measuring properties of tissue 102. One or more other similarly instrumented well-ktiown surgical instruments including, but not limited to, clip appliers, graspers, retractors, scalpels, forceps, electrocautery tools, scissors, clamps, needles, catheters, trochars, laparoscopic tools, open surgical tools and robotic instruments may be integrated into the system instead of or in addition to stapler 101. Sensing elements 104 reside on the stapling element side 105 and/or the anvil side 106. The stapler is coupled via a conventional optical, electrical, or wireless connection 108 to a processing and control unit 120.
[0060] The system of Fig. 1 includes one or more reference measurement points, internal or external, invasive, minimally invasive or noninvasive, intracorporeal or extracorporeal.
One example of such a reference measurement sensor, shown in the form of a clip 110, grasps reference tissue 112, typically healthy tissue in the same patient serving as a reference for use as a patient-specific baseline measurement. Sensing elements 111 are on one or both sides of the jaws 116 and 117. Reference sensor 110 need not be a clip, but can be a probe or any other sensing instrument or device. Reference sensor 110 is coupled via a conventional optical, electrical, or wireless connection 118 to processing and control unit 120.
[0061] In certain embodiments of the inventive system of Fig. 1, optical signals are generated by the sensor controller 123, light returning from the distal end of the sensors is received by sensing unit 121, and the associated signals are conditioned in signal processor 122 and converted into a dataset, which is stored in a memory, such as database 131. A
processor 124, is coupled to both the input and output datasets and compares the information to determine characteristics of the tissue, the patient, and the procedure.
The processor 124 comprises, for example, a conventional personal computer or an embedded microcontroller or microprocessor. Control and monitoring of the sensor outputs 123 and inputs respectively is performed with conventional commercially available or custom-made data acquisition hardware that is controlled by the processor 124. Signal processor 122 is integral with processor 124, or is a conventional digital or analog signal processor placed between the sensor input 121 and the processor 124. Depending on the sensing modality, the sensor data is translated into information that relates to tissue properties. In one exemplary optical sensing embodiment, oximetry-type techniques are used to convert the relative absorption of different wavelengths of light into an oxygen saturation percentage of hemoglobin in the blood. In another optical sensing modality, fluorescence response due to a fluorescent medium that has been introduced into the body is measured, and characteristics of the response including the intensity rise time and steady state value are indicative of the blood flow in the tissue in question. All raw data and processed results are recorded by a recorder 130. This dataset can include measurements made preoperatively, intra operatively, and/or post operatively, as well as pre procedurally (before actuation of the device), at the time of the procedure (as the device is actuated), and/or post procedurally (immediately and delayed after actuation of the device). In addition, outcomes are recorded; these outcomes include immediate outcomes (during procedure), acute outcomes (within 24 hours), sliort term outcomes (within 30 days), and long tenn outcomes. Post procedure outcomes can be either quantitative measureinents from implantable or other sensors, lab results, follow up imaging or other sources, or they can be qualitative assessments of the patient and the procedure by a medical professional.
[0062] A dynamically updated database of past patient encounters 131 is coupled with the processor 124 for creating a decision about tissue health based on previous knowledge.
Database 131 includes information about the current patient and also data from previous patients that is used to make an inforined decision about the tissue health and the likelihood of success of a procedure. The system offers solutions to the medical team to optimize the chance of procedural success. The collected dataset including sensor data and outcomes from the current procedure are added to database 131 to help make more informed future decisions. Outcomes can be added, after follow up visits with the patient at a later date, into either the system or a external database from an external source. The database 131 may be stored locally in base unit 120 or externally, but is updated by and sends updates to a central database that serves other base units 120 via a communications device 138, such as a conventional modem, an internet connection, or other network connection.
Further, recorder 130 can be linked to a central repository for patient inforination to include some or all recorded information with medical history in patient records.
[0063] Large amounts of data are collected for each patient. The database 131 contains all of the collected information and the corresponding outcomes, or a statistically significant subset of the collected data and patient outcomes. The database, or a subset thereof, acts as a statistical atlas of predicted outcomes for a given set of sensor inputs.
Conventional techniques are used for determining the relationship between the current sensor readings and those of the atlas, to interpolate or extrapolate a predicted outcome or likelihood of procedure success or failure. One technique well-known in the art represents the current patient's sensor and other inputs in a vector; the similar datasets from the atlas or database are represented in a similar form as a set of vectors. The "distance" between the current patient data and each set of previously stored data is determined; distance can be determined as the standard Euclidean distance between the vectors; i.e. the 2-norm of the difference between the vectors, or other distance measures as lcnown in the art including other norms and the Mahalanobis distance. The difference between the vectors, or the vectors themselves, can be multiplied by a weighting matrix to take into account the differences in the significance of certain variables and sensor readings in determining the outcome. The set of distances of the current dataset from the previously stored sets is used as a weighting factor for interpolating or extrapolating the outcome, likelihood of success or failure, or other characteristics of the previously stored datasets. In another well-known technique, methods typically used in image processing and statistical shape modeling for deforming a statistical atlas can be incorporated. A base dataset generated from the database of previously collected datasets and the most statistically significant modes of deformation are determined, where the previously collected datasets act as training datasets. The magnitudes of the deformation for each mode are deterinined to best match the atlas model to the current dataset. The magnitudes are then used to deform the set of previous outcomes in a similar fashion, or otherwise interpolate between the previous outcomes by determining how the each outcome is dependent on each mode of deformation, to determine the best fit for the current patient.
Other conventional techniques for predicting outcomes based on prior aiid current datasets are based on determining the similarity between the current dataset with those that were previously acquired from other patients, and using the similarity measure to determine a likelihood of a given outcome responsive to those corresponding to the prior datasets.
[0064] Attached to, or integrated directly into, the base control unit 120 is one or more output devices 134. Output device 134 is used to provide persons performing the procedure information about the physiologic condition of the tissue, and to help guide the procedure.
The output device 134 takes information from the sensors, prior data, patient records, other equipment, calculations and assessments, and other information and presents it to the clinician and operating room staff in a useful manner. In one embodiment, the measured information is compared with prior datasets and prior patient outcomes, and the output device displays information to help assess the lilcelihood of success of a given procedure with the current configuration. The information displayed can simply be a message such as "go ahead as planned" or "choose another site." In another embodiment, the information is encoded in some form of sensory substitution where feedback is provided via forms including, but not limited to, visual, audible, or tactile sensation.
[0065] FIGS. 2a-2c depict specific stapler configurations according to embodiments of the present invention. FIG. 2a depicts a right angle surgical stapler 201. The stapling element side of the jaws 202 is instrumented with sensing elements 204 and 206 associated with each set of staple lines 208 and 210 which are on both sides of the cutter 212. In this embodiment, the anvil side of the jaws 214 is not instrunzented with sensors. Sensing elements 204 and 206 can be placed on either or both sides of the jaws 202 and 214. In one embodiment, the stapler is coupled via optical cable 220 to the previously described processing and control unit 120. This coupling 220 can also be electrical or wireless.
[0066] FIG. 2b depicts a linear surgical stapler 231 according to an embodiment of the present invention. The stapling element side of the jaws 232 is instrumented with sensing elements 234 and 236 associated with each set of staple lines 238 and 240 which are on both sides of the cutter 212. In this embodiment, the anvil side of the jaws 214 is not instrumented with sensors. Sensing elements 204 and 206 can be placed on either or both sides of the jaws 232 and 234. The stapler is coupled via optical cable 250 to the previously described processing and control unit 120. This coupling 250 is electrical or wireless.
[0067] FIG. 2c depicts a circular surgical stapler 261 according to an embodiment of the present invention. The stapling element side of the j aws 262 is instrumented with a ring of sensing elements 264 associated the ring of staples lines 270 and outside of the circular cutter 272. Since the anvil is detachable and connected by pin 278, in this embodiment, the anvil side of the stapler 276 is not instrumented with sensors. Sensing elements 264 are placed on either or both the stapling element side 264 and the anvil side 276. The stapler is coupled via optical cable 280 to the previously described processing and control unit 120.
Alternatively, this coupling 280 is electrical or wireless. Other stapler designs or clip appliers are instrumented similarly, with one or more sensors on one or both sides of the jaws.
[0068] FIGS. 3a-3c show configurations of sensing elements on the surface of a linear stapler according to embodiments of the present invention. These configurations are generalized to any shaped stapler or other surgical instrument. Sensing elements are shown in a.linear arrangement; they can be arranged in other patterns including staggered rows, randomized, single sensors and arrays of sensors. FIG. 3a shows a linear stapler head 301 with sensing elements 306 and 308 on the outside of staple or clips 303 and 304, which are outside the cutter 302. Cutter 302 is optional, and there may be a total of one or more staples, staple lines, or clips. The sensing elements 306 and 308 are situated such that they sense the tissue outside of the staple lines on one or both sides.
[0069] FIG 3b shows a linear stapler head 321 according to an embodiment of the present invention. Attached to the stapler or integrated into stapler head 321 is a strip or shell 327 and 329. This shell can be permanently integrated into the stapler or an addition to the stapler. Thus, it can be a modification to an existing stapler. Enclosed in the sensing shell 327, 329 are sensing eleinents 326 and 328. The stapler comprises one or more staples or clips 323 and 324 and cutters 322.
[0070] FIG 3c shows a linear stapler head 341 with the sensing elements 346 and 348 integrated into the stapler head, according to an embodiment of the present invention. The sensing elements are placed such that they are in line with or integrated between the staples or clips 343, 344. Medial to the staples and sensors is an optional cutter 342. The sensors are placed on one or both sides of the cutter.
[0071] FIGS. 4a-4e show configurations of optical sensing elements according to embodiments of the present invention wliere a surgical instrument is coupled to base unit 120 optically. This coupling can also be electrical or wireless with the actual electronic sensing elements placed in the instrument as opposed to an optical coupling from a remote source.
[0072] FIG. 4a shows an embodiment where the sensing element contains four optical fibers 405, 406, 408, and 409. These are embedded in a medium 402, typically optical epoxy, and enclosed in sheath or ferrule 401. In this embodiment, two optical fibers are used to transmit light into the tissue and two others are used to return light to the receiver in the base unit 120. The arrangement of the emitting and receiving elements is such that matching emitter/receiver pairs are adjacent or opposing. Further, the same optical fiber can be used to transmit light in both directions. One or more optical fibers are used to transmit light to and fiom the worlcing surface of the instrument.
[0073] FIG. 4b shows an optical fiber arrangement with fibers 425, 426, and embedded in a medium 422 which is enclosed in a sheath or ferrule 421. In this embodiment of the invention, two optical fibers are used for transmitting light into the tissue and a single fiber is used to return light to the receiver. FIG. 4c shows a similar einbodiment where there are two optical fibers 446 and 448 embedded in medium 442 inside of sheath or ferrule 441.
In this embodiment, a single optical fiber transmits all light to the tissue and a single fiber receives light from the tissue.
[0074] FIG. 4d shows an embodiment where there is a ring of optical fibers 466 that surround optical fiber 464 inside of medium 462 enclosed in sheath or ferrule 461. The outer ring of fibers 466 is used to transmit light while the inner fiber 464 receives light.
Alternatively, the outer ring of fibers 466 can be used to receive light transmitted from the inner fiber 464.
[0075] FIG. 4e shows another embodiment of the sensing element which contains a multitude of optical fibers 484 stabilized in a medium 482 enclosed in a sheath or ferrule 481. The fibers are arranged in an arbitrary or random pattern of light emitters and light receivers. Each fiber is attached to an individual light source or light sensor, and/or more than one fiber is coupled optically to share a light emitter or sensor.
[0076] FIG. 5a schematically displays a configuration of the light emitting coinponents for a single measurement point in one embodiment of the sensing stapler or other sensing i-nstrument of the invention. A processor 501, contained in the base unit 120 or onboard the instrument, commands the light controller 502, which also is located either in the base unit 120 or onboard the instrument. The light controller 502 is coupled to the light sources for one sensing modality by connections 504. The light sources 506, 508, and 510 provide the light that is incident on the tissue 102. In one embodiment, these light sources are lasers with wavelengths centered at red (near 660nm), near-infrared (near 790nm), and infrared (near 880nm), respectively. This configuration is used for oximetry-type sensing where one wavelength is situated at the isobestic point for light absorption in hemoglobin, one is situated at a greater wavelength, a.nd one is situated at a lesser wavelength.
Light sources 5p6, 508, and 510 are one, two, three, or more distinct light emitters and are laser, light emitting diode (LED), or other sources. Alternatively, these distinct light sources are a broadband light source such as a white light. If more than one light source is used, optical couplings 514 connect the sources to a light combiner 516. If more than one output is required (i.e. more than one measurement point using the same light source), optical coupling 518 takes the light into a light splitter 520. Optical couplings 524 take the light to the appropriate fiber assembly 530. Light is transmitted out of the fiber assembly at the fiber end 532 on the tip. This tip is as depicted in FIG. 4a.
[0077] The light controller 502 controls the light emitter for one or more sensing modalities. In this embodiment, there are two optical sensing modalities:
oximetry-type tissue oxygenation sensing and fluorescence sensing. Coupling 536 allows the light controller to control light source 538. Light source 538 is a high power blue LED with a center wavelength of 570nm. This light emitter is a laser, LED, or other light source. This source is composed of one or more sources that emit light at one or more wavelengths or a broadband light source emitting at a spectrum of wavelengths. Optical filtering can also be performed on a broadband ligllt source to produce the desired spectral output.
The light from light source 538 is coupled optically 540 to a light splitter 542 if more than one measurement point uses the same source. Optical coupling 544 connects the light to the optical cable assembly 530, and light is emitted at tip 548.
[0078] In another embodiment of the invention, the light from optical fibers 524 and 544 is, combined and the light is emitted from an optical fiber assembly as described in FIG. 4b, 4c, or 4d (emitter as fiber 464). In a further embodiment, the light from optical fibers 524 and 544 is split, or combined and split, into multiple fibers to be used with a cable assembly as shown in FIG. 4d (emitters as fibers 466) or FIG. 4e.
[0079] FIG. 5b schematically displays a configuration of light receiving components for a single measurement point in one embodiment of the sensing stapler or other sensing instrument 101. Light from the emitter described in FIG. 5a is incident upon the tissue being queried and the transmitted and/or reflected light passes into the tip 552 and returns through the optical cable assembly 530. Optical coupling 554 directs the light to light sensors 556.
In one embodiment, light sensor 556 is an avalanche photodiode. Sensor 556 is, but is not limited to, conventional photodiodes, avalanche photodiodes, CCDs, linear CCD
arrays, 2D
CCD arrays, CMOS sensors, photomultipliers tubes, cameras, or other light sensing devices.
In a further embodiment, light sensor 556 is a spectrometer or equivalent device that measures light intensity at one or more discrete wavelengths. In a still further embodiment, light sensor 556 is a set of selective photodiodes tuned to the wavelengths of emitted light from light sources 506, 508, and 510. Selective photodiodes are either naturally tuned to specific wavelengths or coupled with an appropriate optical filter. Light sensors 556 are coupled 558 with a signal processor 560. The signal processor 560 performs filtering, demodulating, frequency analysis, timing, and/or gain adjustment, and/or other signal processing tasks. The signal processor 560 is coupled with the processor 501 where further calculations, analysis, logging, statistical analysis, comparisons with reference, comparisons with database, visualization, notification, and/or other tasks are performed or directed.
[0080] Light from the emitter described in FIG. 5a is incident upon the tissue being queried and the transmitted and/or reflected light also passes into the tip 564 and returns through the optical cable assembly 530. Light is directed via optical coupling 568 to optical filters 572. In the fluorescence sensing modality, the optical filter 568 is a band pass or other filter that blocks the incident, excitation light while allowing the fluoresced light to pass.
Filter 572 is also useful to block the emitted light from other sensing modalities and/or other light including ambient light. The filter light is coupled optically via coupling 574 to light sensors 578. In one embodiment, light sensor 578 is an avalanche photodiode.
In other embodiments, light sensor 578 is the same form as light sensors 556. Light sensors 578 are coupled 580 with the signal processor 560 which is in tern coupled with the processor 501.
The processor 501 and signal processor 560 perforin the same functions as described previously with reference to FIG. 5a.
[0081] FIGS. 6a and 6b show plots that are used to describe oximetry sensing modality.
FIG. 6a shows the relationship between light absorption 601 and light wavelength 602 for a range of tissue oxygenation levels 603. The vertical lines 620, 624 and 628 correspond to the wavelengths of 660nm, 790nm and 880nm respectively. The light absorption 601 for the range of oxygen saturation levels 603 is different for each of the wavelengths. As oxygen saturation 603 decreases, the absorption increases for red light 620 and decreases for near-infrared light 628. At the isobestic wavelength near 624, light absorption is invariant to oxygen saturation. This wavelength can be used for calibration and for normalization of the signal to allow for consistent readings regardless of optical density of the tissue. One embodiment of the oxygen sensing modality emits light at the isobestic wavelength, one wavelength greater than the isobestic and one wavelength less than the isobestic, and senses the absorption responsive to the measured response. Other embodiments emit one or more wavelengths of light and measure the transmitted, reflected, or otherwise measurable light to determine the absorption, slope of the absorption function, or other characteristics of the response that can be related to the blood oxygen saturation and tissue health.
[0082] FIG. 6b shows a plot that represents an experiment used to verify the relationship between oxygen saturation and light absorption. Red light at 660mn represented by 652 and near infrared light at 880nm represented by 654 are used to illuminate a section of tissue, At the time marked by 658, blood supply to the tissue is occluded. At the time marked by 660, the blood supply is restored. As blood supply is restricted and tissue oxygen saturation drops, the transmitted light intensity (inverse of absorption) increase for near infrared light 620 and decreases for red light 654.
[0083] FIG. 6c shows a timing diagram and representative response for an algorithm according to the present invention used for oximetry-type oxygen saturation level sensing.
The algorithin provides for a robust method of sensing oxygenation that results in a response that is. minimally responsive to tissue type, color, thickness, or other properties. The timing diagram in FIG. 6c presents the method when two wavelengths of light (red and infrared) are used. It is extendable to other numbers of sources, and other types of sources and sensors.
[0084] The diagram of FIG. 6c shows the output light intensity 670 and the responsive light received 672 with respect to time 674 over a time period or cycle length 676. In one embodiment, the light emitter is a bi-color, bi-polar LED that emits red (660nm) and infrared (880nm) light; when a positive voltage 678 is applied, infrared light is emitted, and when a negative voltage 680 is applied, red light is emitted.
[0085] The light output intensities and corresponding response intensities are denoted with letters in the following description for use in the equations hereinbelow. In each cycle 676, red light is emitted with intensity 678 (A) and the corresponding sensed light intensity 678 (F) is recorded. Light is then shut off 682 (B) and the corresponding received light intensity 684 (G) is recorded as a baseline. Infrared ligllt is emitted with intensity magnitude 686 (C) and the corresponding sensed light intensity 688 (H) is recorded. To make the tissue response more invariant to tissue properties other than oxygenation (i.e.
tissue optical density and thickness), the maximum intensities where light can no longer sufficiently pass through (or other transmission method) the tissue and return to the sensor. Light intensity is ramped from 686 to 682. At time 690, the signal is lost and the output intensity 692 (D) is recorded.
Light intensity is ramped from 682 to 678. At time 694, the signal is regained and the output intensity 696 (E) is recorded. The times 690 and 694 and corresponding intensities 692 and 696 are determined by a simple threshold on received intensity 672.
[0086] In another embodiment, these levels are determined by placing a threshold on a moving average, integration, derivatives, curve fitting, or other methods.
Described is one embodiment of the timing for a robust oxygenation-type algorithm. Other functionally identical or similar embodiments exist.
[0087] A measure related to tissue oxygenation can be calculated responsive to the output and corresponding receiver light intensities. Initially, the "red ratio" is defined and is evaluated as (H-G)/(C-D), and the "infrared ratio" is defined and is evaluated as (F-G)/(A-E), where the letters correspond to the magnitudes of the light intensities as described. The numerator of the ratios determines the response after eliminating effects of ambient or other external light sources. The denominator of the ratios normalizes the response by the amount of light that was actually incident on the tissue that made it back to the sensor. The oxygenation is responsive to the two ratios. The "relative oxygen saturation"
is defined as the red ratio divided by the infrared ratio and is related, not necessarily linearly, to the oxygen saturation of the tissue being measured. The relative oxygen saturation is useful for determining trends in oxygenation and also as a comparison with respect to time and/or a separate reference sensor. One important difference between the technique described and that of standard pulse oximetry is that the employed algorithms are not based on pulsatile flow in the tissue. Therefore, it is possible to acquire the tissue oxygen saturation even if blood flow is non-pulsatile, or even not flowing. Further, the algorithms incorporated iinprove measurement robustness and stability by compensating for tissue thiclaless and type (or more specifically, the optical impedance of the tissue being measured).
[0088] FIG. 7 is a flowchart for one inventive embodiment of the oxygen sensing modality based on oximetry. This embodiment uses oximetry-type techniques for determining the light response from tissue responsive to three excitation wavelengths. These three wavelengths can include those described earlier: one red light source, one infrared light source, and one light source at the isobestic wavelength. The measured response in the absence of an excitation light is used as a baseline intensity and subtracted from the three measured responses. All raw data is logged, and a calculation is performed to convert the light absorption for the three wavelengths to a value related to tissue oxygenation. The calculated values are compared to a database or other previously acquired or determined dataset. Although exactly three wavelengths are shown, other embodiments use one or more wavelengtlis of excitation light. In fixrther embodiments, the intensities for each of the excitation lights may be ramped in intensity as detailed in FIG. 6c to create a more robust measurement that is invariant to tissue optical density.
[0089] FIGS. 8a-8b show typical results for experiments with the fluorescent sensing modality. Tissue perfusion can be assessed using fluorescence. Biofluorescence can be achieved using a variety of commercially available products. One example is fluorescein isothiocyanate which is an intravenously injected, biocompatible dye which fluoresces yellow-green (peak near 520nm) when illuminated with an blue/ultraviolet (peak near 488nm) source. This sensing modality can be incorporated into the configurations shown to allow for multi-modality sensing, or included as a stand-alone sensor. A dense array of sensors enables imaging of the perfusion along a line and a determination if there are patches of poorly perfused tissue in an otherwise healthy region. Stapler fluorography can also utilize fluorescent microspheres and quantum dots. These entities can be used as molecular tracers to characterize tissue substructure such as vessels, or bile ducts. In addition, inflammatory mediators and other biomolecules germane to anastomosis viability can be detected though fluorography at a staple line.
[0090] FIG. 8a represents the measured intensity of the transmitted and/or reflected incident light 808 and the measured intensity of the fluoresced response 804 to the incident light source. The plot shows the light intensity centered at the incident and fluoresced wavelengths as fluorescent dye is instilled into or perfused though the bloodstream at time 812. As the dye perfuses into the tissue being measured, the fluorescent response becomes evident and the sensed incident light decreases. The slope, rise time, magnitude, steady state value, shape, integral, or other characteristics and curve properties of the onset of fluorescence 816 can be used to determine characteristics of the tissue perfusion and health.
The steady state values of the fluoresced light 824 and incident light 828 can be used to determine tissue perfusion and overall health and/or the type of tissue. The measured response can be used alone, with a previously collected dataset from the same or other patients, or in conjunction with a reference signal. Infusion of the fluorescent medium can be introduced either in a single injection, or it can be ramped up in either continuously or in discrete increments. By varying the amount of fluorescent medium introduced into the patient, continuous or multiple measurements can be performed of the characteristics of the onset of fluorescent response.
[0091] FIG. 8b shows typical results for passing a fluorescence sensing probe 850 across a tissue sample 852. In one case, the fluoresced response 858 serves as a baseline for healthy tissue 856 and the decreased intensity 862 corresponds to a region of tissue that is depleted of blood supply 860. Alternately, the baseline intensity can be the lower level 862 and the fluorescence peaks to 858 as the probe passes over a blood vessel 860. This scanning technique can be used to determine sections of tissue with proper perfusion.
In one embodiment, multiple sensor probes 850 are integrated in a linear, grid like, or other arrangement on the surface of a surgical instrument such as a stapler, a retractor, a grasper, a clip applier, a probe, a scope, a needle, a catheter, a mesh substrate, or other device.
[0092] FIG. 9 is a flowchart for one embodiment of the inventive fluorescence sensing modality. Light containing or centered at a wavelength that excites the fluorescent medium is transmitted into the tissue. The light intensity of the fluorescent response is then measured; optical filters, wavelength selective light receivers, or a spectrometer are used to differentiate excitation light and fluorescent response. The measured response in the absence of an excitation light is used as a baseline intensity and subtracted from the fluorescent response. All raw data is logged, and a calculation is performed to determine one or more properties of the onset of the fluorescent response and the steady state value as described earlier. The calculated values are compared to a database or other previously acquired or determined dataset. This sensing modality can be coinbined with that described by the flowchart of FIG. 7. In one embodiment, both oximetry-type sensing as represented in FIG.
6 and FIG. 7 and fluorescence-type sensing as represented in FIG. 8 and FIG. 9 are combined into a single integrated device. The schematic diagram shown in FIG. 5 shows how light sources and detectors for both sensing modalities can be integrated into a single system.
Other sensing modalities, optical or other types, can be combined to perform inulti-modality sensing on the working surface of surgical instruments.
[0093] FIGS. IOa-lOc present techniques that can be used to perform said oximetry-type and/or fluorescence-type sensing. These techniques can be combined with other sensing modalities including optical sensors, electrical sensors, chemical sensors, mechanical sensors, MEMS sensors, nano sensors, biochemical sensors, acoustic sensors, immunologic sensors, fluidic sensors, or other types of sensors.
[0094] FIG. l0a shows a surgical stapler embodiment of the system configuration where all light sources and detectors are located external of the surgical instrument's body. In this embodiment, the light sources and detectors are located in control unit 1001 and sensing, control, calculations, and communications are performed in control electronics 1003. In one embodiment, control unit 1001 constitutes durable equipment and instrument 1028 is a potentially disposable device. For each measurement point, one or more light sources 1005 are coupled optically via 1007 to a light combiner 1009. The light sources can be narrowband emitters such as LEDs and lasers and/or broadband light sources such as white lights and can be use with or without additional optical filtering. For the same measurement point, one or more light receivers 1001 are coupled optically via 1013. The light receivers can be photodiodes, photodiode arrays, avalanche photodiodes, photomultiplier tubes, linear and two dimensional CCDs, CMOS sensors, spectrometers, or other sensor types.
The light traveling through couplers 1009 and receiver couplings 1013 are coupled to an optical connector 1020. In one embodiment, this connector is a standard high density fiber optic connection and coupling 1022 is a standard high density fiber optic cable.
Coupling 1022 connects to the sensing instrument 1028 at connector 1024 and passes through fiber 1030 to a breakout 1032. Sensor points 1034 can be either single fibers or multi-fiber sensor tips as represented in FIGS. 4a-e. The sensor tips transmit the incident light onto tissue 1036 and/or receive the reflected, transmitted, and/or fluoresced light from said tissue.
[0095] FIG. 10b depicts an embodiment where the light emitting and receiving components are located onboard a surgical instrument. In this embodiment, circuit board 1051 is mounted in or on the instrument and coupled via 1053 to a control unit. Coupling 1053 is electrical, optical or wireless. Attached to circuit board 1051 are light sources 1057 and light receivers 1060. In one embodiment, they are standard surface mount LEDs and photodiodes. Light guides, light combiners, and/or light splitters 1064 direct light to and from the sensing working surface 1066 of the instrument to and from the tissue being monitored 1068. In one embodiment, 1051 represents a flexible medium and light sources and receivers 1057 and 1060 represent alternative light sources and emitters such as organic LEDs and organic photo detectors.
[0096] FIG. 10c shows a further embodiment where the light emitting and receiving components are located onboard a surgical instrument. In this embodiment, the electronics are microfabricated into a compact sensing element that can fit onto the working surface of the instrument. As described hereinabove, coupling 1083 connects the circuit to an external controller. The circuit is built on base 1081. Light emitters 1087 and detectors 1090 are embedded in layer 1092. Coupled to the light sources and detectors are micro fabricated light guides, light combiners, and/or light splitters 1094 in layer 1096. The light guides direct light to and from the tissue being monitored 1098.
[0097] FIGS. 11 a-11 c depict further embodiments of sensing surgical instruments and devices according to the present invention. FIG 11 a shows a sensing flexible mesh 1104 that contains sensing elements 1106. Sensing elements 1106 can be electrical, optical, chemical, or other sensor types used to monitor the tissue 1102 or other operational parameters. The mesh 1104 can mold to the surface of tissue 1102. In one embodiment, sensors 1106 are oxygenation sensors as described previously and are used to monitor the tissue health and other tissue properties. In addition, when there is a plethora of sensors, mapping of the oxygenation levels of the surface of the tissue 1102 can be performed. If the location of the sensors is lcnown with respect to the tissue or imaging device, then this mapping can be overlaid on medical imaging information including x-ray, computed tomography, magnetic resonance imaging or ultrasound images and volumes, or it can be overlaid on a video signal from an endoscope or other camera. In another embodiment, sensors 1104 are electrical sensors that are used for EMG or other electrical activity or impedance mapping. The mesh is coupled via 1108. Coupling 1108 is electrical, optical, or wireless.
Sensors 1104, in optical sensing modalities, are either onboard electronics or the distal tips of optically coupled emitters and detectors.
[0098] The sensing surgical mesh can be generally described as a rigid or flexible surface that contains sensing elements. The sensing elements detect information about the tissue upon which they are placed. The mesh is flexible, or preshaped to conform to the tissue being monitored. In one embodiment wherein the mesh is bioabsorbable, the mesh is made of bioabsorbable polymers similar to those used in conventional absorbable sutures. In another enZbodiment wherein the mesh is durable, the mesh is made of polymers similar to those used in conventional non-absorbable sutures. In a further embodiment, the substrate is an adhesion barrier material, such as Seprafilm , available from Genzyme Corp.
of Cainbridge, MA. The tissue being monitored is either internal tissue, such as an organ being monitored after transplant or a bowel segment whose perfusion is to be verified, or is external tissue, such as a skin flap being monitored for reconstructive surgery, or skin being monitored for the prevention of bed sores. The mesh sensor array is either a temporary device used during a procedure (either single use or reusable), permanently implantable, or of a bio degradable, bio absorbable nature as is known in the art.
[0099] FIG. 11 b shows a surgical retractor 1122. The working surface of the retractor 1124 is instrumented with sensors as previously described (i.e., with sensing elements 1106) for measuring properties of a tissue 1128. In addition to monitoring tissue properties, interactions with tissue 1128 are measured using strain gages, piezoelectric sensors, load cells, multi-axis force/torque sensors, and/or other sensors 1130 and 1132. The retractor handle 1134 is held manually by a member of the operating room staff, mounted to a: frame or passive arm, or held by a robotic retraction system. Coupling 1136 couples sensors 1126, 1120, and/or 1132 to an onboard or external control interface (not shown) as described hereinabove. In one embodiment, sensors 1126 are oximetry-type sensors comprising of a plethora of multi-color LEDs and photodiodes and sensors 1130 and 1132 are either strain gages or multi-axis force/torque sensors respectively for measuring the force.s incident upon the tissue during retraction while simultaneously monitoring oxygenation levels. In the case of a robotic retraction system or other robotic-assisted surgery scenario, the sensed information including interaction forces and tissue status is used to close the control loop for the robot and/or provide warnings or augment the motions of the robot manipulator.
[00100] FIG. 11 c displays a surgical grasper that is instrumented with sensors 1144 mounted on grasper jaws 1146 and 1148. The grasper clamps or otherwise contacts tissue 1142 and senses oxygenation, tissue perfusion, electrical properties, chemical properties, temperature, interaction forces, grasping forces, and/or other parameters.
Coupling 1152 couples sensors 1144 to an onboard or external control interface (not shown) as described hereinabove. Sensors 1144 can be placed on one or both sides of the jaw and/or on the shaft 1150 of the instrument. In one embodiment, the grasper measures the oxygenation level of the tissue being grasped while simultaneously monitoring grasping force and other tissue interaction forces.
[00101] FIG. 11d shows a configuration for a sensor implanted in the body that relays information back to a controller. Sensor device 1160 contains one or more sensing elements 1162. The sensing elements can be any of the type described earlier including oxygenation, fluorescence, tissue perfusion, general health, tissue electrical impedance, tissue electrical activity, interaction forces, pH, electromyography, temperature, spectroscopy, fluid flow rate, fluid flow volume, pressure, biomarkers, radiotracers, immunologic, chemical, nerve activity, and evoked potential, and other sensor types capable of determining characteristics of tissue.
The sensor device 1160 is placed inside of, on the surface of, embedded into, or wrapped around tissue 1164. The tissue being monitored is, for example, an organ, a bowel segment, a blood vessel, a chest wall, or other biological tissue. The sensor can be temporary, permanently implantable, or bioabsorbable/biodegradable inside of body 1166.
In one embodiment, the sensor device is implanted onto the bowel and used for monitoring the tissue after a procedure and for obtaining data related to short and long term outcomes. In a.nother embodiment, the sensor is a ring that is placed around a blood vessel and is used to monitor blood flow in said vessel.
[00102] In some embodiments, one or more sensor devices on one or more tissues 1164 are communicatively coupled via 1170 to a communications interface 1172. In one embodiment, the coupling 1170 is a wireless lii-Ac where the power from a radio frequency signal generated by 1172 powers the sensor device 1160 which then takes a measurement and return data via wireless coupling 1170. The comununication interface is coupled via 1174 to a main control unit 1176. In anotlier embodiment, the communications interface 1172 is a portable battery powered device that can be carried by the patient, or a fixed device placed inside or outside of a hospital or a medical professional's office for powering and monitoring the internal sensors 1160. The communication interface 1172 can conveniently obtain acute, short, and long term follow-up data about a procedure after the surgery is complete. The communications interface 1172 and controller 1176 may be one in the same. In one embodiment, the controller 1176 is the main system's base control unit 120. In another embodiment, the communication interface 1172 is directly in communication with the main system's base unit 120 or the central database 131 directly.
[00103] In a further embodiment of the system shown in FIG. 11 d, the sensor device contains a MEMS sensing element and communications electronics, is placed in or on internal tissue, aild communicates wirelessly with and receives power from an external radio frequency source for the pui-pose of post procedure patent monitoring. In another embodiment, the sensing element is made of biocompatible materials known in the art, and an attached antenna is bioabsorbable in the patient's body. The associated electronics and/or antenna can be made either bioabsorbable or biodegradable, or such that their presence does not have any significant effect on the patient, or any combination thereof.
[00104] FIG. 11 e shows a detailed view of an embodiment of sensor unit 1160.
The sensor unit is built into substrate 1180 which, in one embodiment, is composed of a bioabsorbable polymer as is known in the art. The sensor unit contains a communications device 1182 which is coupled to an antenna 1184. In certain embodiments, the antenna body is made of a fully or partially bioabsorbable/biodegradable polymer, and contains connected tubes that are filled with conductive and biocompatible gel or liquid. The communications device is biocompatible, and can be bioabsorbable. Coupled via 1188 to the communications device 1182 are one or more sensing elements 1186. The sensing elements can be of any of the type described earlier. In one embodiment, the sensing elements are fully or partially bioabsorbable/biodegradable. In certain embodiments, the sensing elements and communications device obtain electrical power remotely from a radio frequency source, such as in RFID technology as known in the art, and use this power to perform sensing operations and to transmit data to communications interface 1172. The embodiinent shown in FIG. 11 e is a representative configuration of the sensor unit; other types, shapes, and configurations are understood to be included as well.
[00105] In further embodiments of the present invention, an absorbable optical fiber (such as shown in Figs. 4a-e) comprises at least a core and a.n outer cladding made out of bioabsorbable materials. Its layers can be made out of bioabsorbable materials with different time constants for degradation. For exainple, the cladding is thin but of a material composition that degrades very slowly, and the core is of a composition that degrades very fast since once the cladding is degraded, the fiber is useless. This bioabsorbable optical fiber is used for the light guides for optical sensors and/or for a communicative coupling between the sensors and a controller.
[00106] FIGS. 12a-c shows a surgical staple or clip with integrated sensing capabilities.
The staple, clip, suture, or other fastener itself can be used as an electrode, as a strain or force sensor, or as an optical pathway. Forces pulling on an anastomosis or other tissue joining can cause failure. By placing force measuring instrumentation on either a stapler or other instrument's working surface, or on staples, clips, sutures, or other fasteners themselves, it is possible to measure the strain induced on the tissue being joined.
[00107] FIG. 12a shows a staple with embedded sensors. The staple can include any of the sensing modalities discussed earlier. In one embodiment, strain sensing for measuring the pulling or pushing forces exerted by tissue on the staple legs 1206 may be incorporated into the fastener. In another einbodiment, strain gages 1204 are fabricated on the surface of the staple as 1204. In yet another embodiment, a coating or partial layer of a piezoelectric or resistive coating 1224 is fabricated around staple core 1222 as shown in cross-section A-A in FIG. 12b. In other embodiments, the staple is a hollow tube 1224 whose inner core 1222 is made of a piezoelectric, resistive, or other material or component that permits measurement or bending load on the staple legs 1206. This design is extendable to incorporating sensing capabilities into any surgical fastener including staples, clips, and sutures.
The staple, clip, or other fastener is made of in whole or in part of bioabsorbable/biodegradable, biocompatible materials as lcnown in the art.
[00108] FIGS. 13a-b depict embodiments where a staple, clip, or other electrode is used for electrical sensing on the surface of a surgical instrument. FIG. 13 a shows an embodiment where the instrument is used for tissue electrical impedance sensing. The electrical resistance/impedance of the tissue can be used to indicate tissue properties.
By ineasuring electrical impedance of internal tissue at the surface of a surgical instrument, it is possible to determine the tissue's status including indications of hypoxia and ischemia.
Electrodes or electrical contacts placed into the tissue are used as measurement points, the impedance measured between adjacent points and across any combination thereof. These electrodes are placed as small tips (invasive or surface contact only) on the working surface of a surgical instrument.
[00109] The instrument surface 1302 contains one or more staples, clips, or other electrodes 1304 that act as electrical contacts. The electrical contacts 1304 come in contact with tissue 1308 either on the surface or by penetrating into the tissue. The electrical impedance or resistance between the electrical contacts (either on the same staple or clip, or between adjacent or other pairs) is represented by 1310. Contacts are connected via coupling 1312 to a controller 1314 where the measurement electronics are housed.
Coupling 1312 is either electrical, optical, or wireless. Additional surfaces, instruments, or opposing stapler or grasper jaws 1320 contain additional electrodes 1322. They are coupled via 1324 to an interface 1326 and further coupled via 1328 to the same or a different controller 1314, or coupled directly to the controller 1314.
[00110] FIG. 13b shows an embodiment where the instrument is used for tissue electrical activity sensing, including nerve and muscle stimulation and sensing.
Electrical activity in tissue can be used to assess the tissue's viability. The muscular and neuronal activity that occurs in the tissue of interest is measured using techniques similar to those in electromyography: either the naturally occurring activity, or the response to an excitation due to an electrical or other impulse. Implanting electrodes into the worlcing surface of a surgical instrument enables the viability of the local tissue to be quantified.
[00111] The instrument surface 1342 contains one or more staples, clips, or other electrodes 1344 that act as electrical contacts. The electrical contacts 1344 come in contact with tissue 1346 either on its surface or by penetrating into the tissue. The contacts are coupled via 1348 to a controller 1350 where the measurement electronics are housed.
Coupling 1350 is either electrical, optical, or wireless. Additional surfaces, instruments, or opposing stapler or grasper jaws 1352 contain additional electrodes 1354. They are coupled via coupler 1356 to an interface 1358 and further coupled by coupler 1360 to the same or a different controller 1350, or coupled directly to the controller 1314. The electrical contacts can be used for both sensing and/or stimulation of the tissue or components thereof. A
separate electrical contact 1362 is placed in tissue 1346. The separate contact can serve as a reference or as a source of nerve, muscle, or other stimulation that is sensed by the other electrical contacts 1344 and 1354. Reference contact 1362 is coupled via coupler 1364 to the controller 1350.
[00112] FIG. 14 shows a schematic layout of an integrated expert system according to the present invention. The base unit 1401 contains all processing, sensing, control, signal processing, communication, storage, and other required coinponents. Coupled via coupler 1403 is sensing surgical instrument(s) 1405. These instruments include, but are not limited to, all of the instruments and embodiments described hereinabove. Sensing modalities include, but are not limited to, any of those described herein, including oxygenation including oximetry-type sensing, fluorescence, tissue perfusion, general health, tissue electrical impedance, tissue electrical activity, interaction forces, pH, electromyography, temperature, spectroscopy, fluid flow rate including laser or ultrasound Doppler measurement, fluid flow volume, pressure, levels of biomolecules and electrolytes, biomarkers, radiotracers, immunologic, cheinical, nerve activity, evoked potential, and other sensor types capable of determining characteristics of tissue. Coupling 1403 is electrical, optical, and/or wireless. Instruments 1405 are tethered via electrical or optical cables, have builtin wireless functionality, or have a reusable battery powered wireless pack that powers the instrument's sensors and/or the instrument itself, and/or couples the signals to the base unit 1401. A reference measurement sensor 1415 of the same type as said surgical instruments and coupled via coupler 1413 to base unit 1401 is used to obtain patient-specific reference measurements used to help determine tissue health and predict procedural outcomes. In addition to the instruments, a robotic manipulator useable to control the instruments and or reference sensor is coupled to the base unit 1401. The manipulator can be controlled in a closed loop fashion to optiinize procedural outcomes responsive to real-time and prior patient specific information and prior statistical and other data.
[00113] Patient status sensing including cameras, infrared imaging, thermal imaging, spectroscopic imaging, and other sources 1425 and operating room monitors 1435 including anesthesia equipment monitors and vital signs monitors which include, but are not limited to, pulse rate and quality measurement, respiration rate and quality measurement, blood pressure measurement, blood gas analysis, pulse oximetry, and ECG, feed into base unit 1401 via couplings 1423 and 1433 respectively. This systemic data is recorded and synchronized with that of the sensing instruments, and also aids in determining tissue health and in predicting procedural outcomes. The system can also be coupled via coupling 1443 to the hospital's patient data storage system 1445 so that collected data is included in the database of patient medical history information. Further, patient medical history is incorporated iilto the system's analysis of sensor data to better predict and optimize outcomes.
[00114] All relevant data collected and post-procedural outcomes are stored in a central repository 1455 that is used to generate a statistical model that allows prediction of outcomes based on current sensor data. The coupling 1453 is bi-directional; prior data is used for analysis of the current procedure and current patient data and outcomes are added to the database 1455 for future use. Coupling 1453 need not be a permanent connection; data in a local copy of 1455 can be retrieved from and updated on each base unit 1401 at regular service intervals.
[00115] The collected data, statistical model, predicted outcomes, and other relevant information is presented in a comprehensible manner to the surgeon or other operating room staff using one or more output devices 1462 coupled to base unit 1401 via coupling 1460.
Coupling 1460 is wired or wireless, or output device 1462 can be integrated directly into the control unit 1401. Presentation of results can be performed in numerous ways including, but not limited to: visual feedback, audio feedback, force or other haptic feedback, or other forms of sensory substitution. The feedback can include plots, text-based messages, verbal messages, audible warnings, video overlays, and feedback on a robotic manipulator.
Communication with an external database or other source of data is achieved with a conununication device 1468 communicatively coupled to the base unit 1401 via 1466. The coupling can be wired, wireless, or the communications device may be embedded in the base unit. Communications device 1468 can be a conventional modem, or an internet or other network connection.
[00116] The present invention can be practiced by employing conventional materials, methodology and equipment. Accordingly, the details of such materials, equipment and methodology are not set forth herein in detail. In the previous descriptions, numerous specific details are set forth, such as specific materials, structures, chemicals, processes, etc., in order to provide a thorough understanding of the present invention.
However, it should be recognized that the present invention can be practiced without resorting to the details specifically set forth. In other instances, well known processing structures have not been described in detail, in order not to unnecessarily obscure the present invention.
[00117] Only an exemplary embodiment of the present invention and but a few examples of its versatility are shown and described in the present disclosure. It is to be understood that the present invention is capable of use in various other combinations and enviroiunents and is capable of changes or modifications within the scope of the inventive concept as expressed herein.
Claims (66)
1. A system comprising:
a surgical instrument having a sensor for generating a signal indicative of a property of a subject tissue of a patient;
a signal processor for receiving the signal and converting the signal into a current dataset;
a memory for storing the current dataset; and a processor configured to compare the current dataset with other datasets previously stored in the memory, and to assess a physical condition of the subject tissue or guide a current procedure being performed on the tissue, responsive to the comparison.
a surgical instrument having a sensor for generating a signal indicative of a property of a subject tissue of a patient;
a signal processor for receiving the signal and converting the signal into a current dataset;
a memory for storing the current dataset; and a processor configured to compare the current dataset with other datasets previously stored in the memory, and to assess a physical condition of the subject tissue or guide a current procedure being performed on the tissue, responsive to the comparison.
2. The system of claim 1, wherein the processor is further configured to predict the likelihood of success of the current procedure being performed on the subject tissue responsive to the comparison.
3. The system of claim 1, further comprising a recorder for recording the signal from the sensor and the current dataset.
4. The system of claim 2, wherein the memory includes data relating to at least one of pre-procedure data, during-procedure data, post-procedure data, immediate outcomes, short-term outcomes, and long-term outcomes of previous instances of the procedure, and the processor is configured to predict the likelihood of success of the current procedure responsive to the data relating to the outcomes.
5. The system of claim 4, wherein the processor is further configured to add at least one of pre-procedure data, during-procedure data, post-procedure data, and immediate outcomes of the current procedure to the memory.
6. The system of claim 4, wherein the processor is further configured to add short-term and long-term outcomes of the current procedure to the memory.
7. The system of claim 2, further comprising a communications device for communicating with a remote database comprising previously stored datasets and data relating to outcomes of previous instances of the procedure;
wherein the processor is configured to compare the current dataset with the datasets and data of the remote database.
wherein the processor is configured to compare the current dataset with the datasets and data of the remote database.
8. The system of claim 7, wherein the processor is further configured to update the remote database using the current dataset and at least one of pre-procedure data, during-procedure data, post-procedure data, immediate outcomes, short-term outcomes, and long-term outcomes of the current procedure.
9. The system of claim 2, further comprising a communications device for communicating with a patient data store comprising a medical history of the patient undergoing the current procedure;
wherein the processor is configured to predict the likelihood of success of the current procedure responsive to the medical history of the patient.
wherein the processor is configured to predict the likelihood of success of the current procedure responsive to the medical history of the patient.
10. The system of claim 9, wherein the processor is further configured to update the medical history of the patient using the current dataset and the outcome of the current procedure.
11. The system of claim 1, wherein the surgical instrument includes at least one of a surgical stapler, a clip applier, a grasper, a retractor, a scalpel, a forceps, a laparoscopic tool, an open surgical tool, a cauterizing tool, a robotic tool, a scissors, a clamp, a needle, a catheter and a trochar.
12. The system of claim 1, further comprising a reference measurement instrument having a sensor for measuring a reference tissue and generating a reference measurement signal.
13. The system of claim 12, wherein the reference tissue is a tissue of the patient.
14. The system of claim 12, wherein the signal processor is for converting the reference measurement signal to a reference baseline measurement dataset, and the processor is configured to assess the physical condition of the subject tissue responsive to the reference baseline measurement dataset.
15. The system of claim 12, wherein the reference measurement instrument comprises a sensor for grasping the reference tissue.
16. The system of claim 1, wherein the sensor comprises one of an optical sensor, a chemical sensor, mechanical sensor, a MEMS device, a nano sensor, an acoustic sensor, a fluid sensor and an electrical sensor.
17. The system of claim 13, wherein the sensor is for measuring at least one of oxygenation, fluorescence, tissue perfusion, general health, tissue electrical impedance, tissue electrical activity, interaction force, pH, electromyography, temperature, spectroscopy, fluid flow rate, fluid flow volume, pressure, biomarkers, radiotracers, immunologic characteristics, biochemical characteristics, nerve activity, and evoked potential.
18. The system of claim 1, further comprising a robotic manipulator for controlling the surgical instrument.
19. The system of claim 12, further comprising a robotic manipulator for controlling the reference measurement instrument.
20. The system of claim 4, further comprising patient monitoring equipment for generating patient condition data and transferring the patient condition data to the processor, wherein the processor is configured to assess the tissue condition and predict the likelihood of success of the current procedure responsive to the patient condition data.
21. The system of claim 20, wherein the patient monitoring equipment is for at least one of systemic monitoring, local monitoring, extracorporeal monitoring, intracorporeal monitoring, invasive monitoring and noninvasive monitoring.
22. The system of claim 20, wherein the patient monitoring equipment includes at least one of a vital sign monitor and anesthesia equipment.
23. The system of claim 4, further comprising patient status sensing equipment for generating patient status data and transferring the patient status data to the processor, wherein the processor is configured to assess the tissue condition, guide the current procedure, or predict the likelihood of success of the current procedure responsive to the patient status data.
24. The system of claim 23, wherein the patient status sensing equipment comprises at least one of thermal imaging equipment and spectroscopic imaging equipment.
25. The system of claim 1, wherein the sensor is for generating signals before, during and after actuation of the surgical instrument, and the signal processor is for processing such signals and including such signals in the dataset.
26. A system comprising:
a surgical instrument comprising an incident light source and a sensor for using incident light from the light source to generate a signal indicative of fluorescence of a subject tissue into which a fluorescent medium has been introduced; and a processor configured to receive the signal and to determine a tissue characteristic of the subject tissue responsive to the response of the fluorescence as indicated by the signal.
a surgical instrument comprising an incident light source and a sensor for using incident light from the light source to generate a signal indicative of fluorescence of a subject tissue into which a fluorescent medium has been introduced; and a processor configured to receive the signal and to determine a tissue characteristic of the subject tissue responsive to the response of the fluorescence as indicated by the signal.
27. The system of claim 26, wherein the processor is configured to determine the tissue characteristic responsive to a slope, rise time, magnitude, steady state value, shape, integral or other curve property of the response of the fluorescence.
28. The system of claim 26, wherein the processor is further configured to determine a characteristic of the subject tissue based on steady-state values of the incident light and the fluorescence.
29. The system of claim 28, wherein the characteristic of the subject tissue is a perfusion of the tissue.
30. The system of claim 26, comprising an array of the sensors disposed on a surface of the surgical instrument.
31. The system of claim 30, wherein the surgical instrument comprises one of a stapler, a retractor, a grasper, a clip applier, a probe, a scope, a needle, a catheter and a mesh substrate.
32. A sensor consisting essentially of a rigid or flexible substrate and a plurality of sensing elements mounted to the substrate for monitoring a property of a living tissue.
33. The sensor of claim 32, wherein the substrate is substantially conformable to the shape of the living tissue.
34. The sensor of claim 32, wherein the substrate is a flexible mesh.
35. The sensor of claim 32, wherein the sensing elements are for measuring oxygenation of the tissue.
36. The sensor of claim 32, wherein the sensing elements are arranged on the substrate for mapping the tissue property.
37. The sensor of claim 32, wlierein the sensing elements are for measuring electrical activity of the tissue, and are arranged for mapping the electrical activity of the surface of the tissue.
38. The sensor of claim 32, wherein the sensing elements are for measuring fluorescence, and are arranged for mapping the fluorescence of the surface of the tissue.
39. A surgical fastening device comprising a sensor for measuring properties of and interactions with a living tissue on the fastening device.
40. The surgical fastening device of claim 39, comprising one of a staple, a suture or a clip.
41. The surgical fastening device of claim 39, comprising a plurality of strain sensors located at corners or on the sides of a staple on an outer surface of the staple.
42. The fastening device of claim 39, wherein the sensor comprises a sensing coating around a circumference of a staple.
43. The surgical fastening device of claim 42, wherein the sensor comprises at least one of a piezoelectric coating and a resistive coating.
44. The surgical fastening device of claim 39 comprising a staple, wherein the staple is hollow and a strain sensor is disposed inside the staple for measuring a bending load on a leg of the staple.
45. The surgical fastening device of claim 39, wherein the sensor comprises at least one of an electrode, a MEMS sensor, and a remotely powered radio frequency transmitter unit.
46. The system of claim 20, wherein the patient monitoring equipment comprises a sensor consisting essentially of a rigid or flexible substrate and a plurality of sensing elements mounted to the substrate for monitoring a property of a living tissue.
47. The system of claim 20, wherein the patient monitoring equipment comprises at least one of an implantable sensor and a marker introduced to the subject tissue, the monitoring equipment remaining at the subject tissue after the current procedure for generating the patient condition data.
48. A system comprising:
a surgical instrument having a sensor for generating a signal indicative of a property of a subject tissue of a patient;
a reference measurement instrument having a sensor for measuring a reference tissue and generating a reference measurement signal;
a signal processor for receiving the signal and converting the signal into a current dataset, and for receiving the reference measurement signal and converting it into a current reference dataset;
a memory for storing the current dataset and the current reference dataset;
and a processor configured to compare the current dataset with the current reference dataset, and to assess a physical condition of the subject tissue or guide a current procedure being performed on the tissue, responsive to the comparison.
a surgical instrument having a sensor for generating a signal indicative of a property of a subject tissue of a patient;
a reference measurement instrument having a sensor for measuring a reference tissue and generating a reference measurement signal;
a signal processor for receiving the signal and converting the signal into a current dataset, and for receiving the reference measurement signal and converting it into a current reference dataset;
a memory for storing the current dataset and the current reference dataset;
and a processor configured to compare the current dataset with the current reference dataset, and to assess a physical condition of the subject tissue or guide a current procedure being performed on the tissue, responsive to the comparison.
49. The system of claim 48, wherein the reference tissue is a tissue of the patient.
50. The system of claim 48, wherein the signal processor is for converting the reference measurement signal to a reference baseline measurement dataset, and the processor is configured to assess the physical condition of the subject tissue responsive to the reference baseline measurement dataset.
51. The system of claim 48, wherein the reference measurement instrument comprises a sensor for grasping the reference tissue.
52. The system of claim 48, wherein the reference measurement instrument sensor comprises one of an optical sensor, a chemical sensor, mechanical sensor, a MEMS device, a nano sensor, an acoustic sensor, a fluid sensor and an electrical sensor.
53. The system of claim 48, wherein the reference measurement instrument sensor is for measuring at least one of oxygenation, fluorescence, tissue perfusion, general health, tissue electrical impedance, tissue electrical activity, interaction force, pH, electromyography, temperature, spectroscopy, fluid flow rate, fluid flow volume, pressure, biomarkers, radiotracers, immunologic characteristics, biochemical characteristics, nerve activity, and evoked potential.
54. The system of claim 48, further comprising a robotic manipulator for controlling the reference measurement instrument.
55. A system for monitoring a living tissue of a patient's body, comprising:
a sensor implantable in the patient's body for generating a signal indicative of a property of the tissue;
a controller for receiving the signal outside the patient's body; and a communications interface for communicating the signal from the sensor to the controller.
a sensor implantable in the patient's body for generating a signal indicative of a property of the tissue;
a controller for receiving the signal outside the patient's body; and a communications interface for communicating the signal from the sensor to the controller.
56. The system of claim 55, wherein the sensor is for placing in, on, in contact with, embedded into, or surrounding the tissue.
57. The system of claim 56, wherein the sensor is fully or partially bioabsorbable or biodegradable in the patient's body.
58. The system of claim 56, wherein the communications interface is a wireless receiver, and the sensor is for wirelessly communicating the signal to the communications interface.
59. The system of claim 58, wherein the sensor is powered externally from a radio frequency source.
60. The system of claim 56, wherein the sensor is for monitoring the tissue property before, during or after a procedure performed on the patient.
61. The system of claim 60, wherein the sensor is for monitoring short and long-term outcomes of the procedure.
62. The system of claim 58, wherein the communications interface is portable.
63. The system of claim 62, wherein the communications interface comprises a radio frequency source for powering the sensor.
64. The system of claim 58, wherein the sensor comprises an antenna, and at least one of the sensor, the communications interface and the antenna is fully or partially bioabsorbable or biodegradable in the patient's body.
65. The system of claim 57, wherein the sensor comprises a bioabsorbable or biodegradable optical fiber.
66. The system of claim 65, wherein the optical fiber has a core and an outer cladding comprising bioabsorbable or biodegradable materials, and the cladding material degrades substantially more slowly relative to the core material.
Applications Claiming Priority (5)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US67187205P | 2005-04-15 | 2005-04-15 | |
US60/671,872 | 2005-04-15 | ||
US76635906P | 2006-01-12 | 2006-01-12 | |
US60/766,359 | 2006-01-12 | ||
PCT/US2006/013985 WO2006113394A2 (en) | 2005-04-15 | 2006-04-14 | Surgical instruments with sensors for detecting tissue properties, and systems using such instruments |
Publications (2)
Publication Number | Publication Date |
---|---|
CA2604563A1 true CA2604563A1 (en) | 2006-10-26 |
CA2604563C CA2604563C (en) | 2020-07-28 |
Family
ID=37115711
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
CA2604563A Active CA2604563C (en) | 2005-04-15 | 2006-04-14 | Surgical instruments with sensors for detecting tissue properties, and systems using such instruments |
Country Status (5)
Country | Link |
---|---|
US (5) | US9204830B2 (en) |
EP (2) | EP3095379A1 (en) |
CN (2) | CN101495025B (en) |
CA (1) | CA2604563C (en) |
WO (1) | WO2006113394A2 (en) |
Families Citing this family (779)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20070084897A1 (en) | 2003-05-20 | 2007-04-19 | Shelton Frederick E Iv | Articulating surgical stapling instrument incorporating a two-piece e-beam firing mechanism |
US9060770B2 (en) | 2003-05-20 | 2015-06-23 | Ethicon Endo-Surgery, Inc. | Robotically-driven surgical instrument with E-beam driver |
US8215531B2 (en) | 2004-07-28 | 2012-07-10 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument having a medical substance dispenser |
US11896225B2 (en) | 2004-07-28 | 2024-02-13 | Cilag Gmbh International | Staple cartridge comprising a pan |
US7545272B2 (en) | 2005-02-08 | 2009-06-09 | Therasense, Inc. | RF tag on test strips, test strip vials and boxes |
US9204830B2 (en) | 2005-04-15 | 2015-12-08 | Surgisense Corporation | Surgical instruments with sensors for detecting tissue properties, and system using such instruments |
US11484312B2 (en) | 2005-08-31 | 2022-11-01 | Cilag Gmbh International | Staple cartridge comprising a staple driver arrangement |
US7673781B2 (en) * | 2005-08-31 | 2010-03-09 | Ethicon Endo-Surgery, Inc. | Surgical stapling device with staple driver that supports multiple wire diameter staples |
US10159482B2 (en) | 2005-08-31 | 2018-12-25 | Ethicon Llc | Fastener cartridge assembly comprising a fixed anvil and different staple heights |
US8800838B2 (en) | 2005-08-31 | 2014-08-12 | Ethicon Endo-Surgery, Inc. | Robotically-controlled cable-based surgical end effectors |
US9237891B2 (en) | 2005-08-31 | 2016-01-19 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical stapling devices that produce formed staples having different lengths |
US11246590B2 (en) | 2005-08-31 | 2022-02-15 | Cilag Gmbh International | Staple cartridge including staple drivers having different unfired heights |
US7669746B2 (en) | 2005-08-31 | 2010-03-02 | Ethicon Endo-Surgery, Inc. | Staple cartridges for forming staples having differing formed staple heights |
US7934630B2 (en) | 2005-08-31 | 2011-05-03 | Ethicon Endo-Surgery, Inc. | Staple cartridges for forming staples having differing formed staple heights |
US20070066881A1 (en) | 2005-09-13 | 2007-03-22 | Edwards Jerome R | Apparatus and method for image guided accuracy verification |
EP1924198B1 (en) | 2005-09-13 | 2019-04-03 | Veran Medical Technologies, Inc. | Apparatus for image guided accuracy verification |
US20070106317A1 (en) | 2005-11-09 | 2007-05-10 | Shelton Frederick E Iv | Hydraulically and electrically actuated articulation joints for surgical instruments |
US20110024477A1 (en) | 2009-02-06 | 2011-02-03 | Hall Steven G | Driven Surgical Stapler Improvements |
US8708213B2 (en) | 2006-01-31 | 2014-04-29 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a feedback system |
US8186555B2 (en) | 2006-01-31 | 2012-05-29 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting and fastening instrument with mechanical closure system |
US11224427B2 (en) | 2006-01-31 | 2022-01-18 | Cilag Gmbh International | Surgical stapling system including a console and retraction assembly |
US20110006101A1 (en) | 2009-02-06 | 2011-01-13 | EthiconEndo-Surgery, Inc. | Motor driven surgical fastener device with cutting member lockout arrangements |
US8820603B2 (en) | 2006-01-31 | 2014-09-02 | Ethicon Endo-Surgery, Inc. | Accessing data stored in a memory of a surgical instrument |
US11278279B2 (en) | 2006-01-31 | 2022-03-22 | Cilag Gmbh International | Surgical instrument assembly |
US9861359B2 (en) | 2006-01-31 | 2018-01-09 | Ethicon Llc | Powered surgical instruments with firing system lockout arrangements |
US7845537B2 (en) | 2006-01-31 | 2010-12-07 | Ethicon Endo-Surgery, Inc. | Surgical instrument having recording capabilities |
US8161977B2 (en) | 2006-01-31 | 2012-04-24 | Ethicon Endo-Surgery, Inc. | Accessing data stored in a memory of a surgical instrument |
US11793518B2 (en) | 2006-01-31 | 2023-10-24 | Cilag Gmbh International | Powered surgical instruments with firing system lockout arrangements |
US7753904B2 (en) | 2006-01-31 | 2010-07-13 | Ethicon Endo-Surgery, Inc. | Endoscopic surgical instrument with a handle that can articulate with respect to the shaft |
US20110290856A1 (en) | 2006-01-31 | 2011-12-01 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical instrument with force-feedback capabilities |
US8763879B2 (en) | 2006-01-31 | 2014-07-01 | Ethicon Endo-Surgery, Inc. | Accessing data stored in a memory of surgical instrument |
US20120292367A1 (en) | 2006-01-31 | 2012-11-22 | Ethicon Endo-Surgery, Inc. | Robotically-controlled end effector |
US7535228B2 (en) * | 2006-03-21 | 2009-05-19 | Radiation Monitoring Devices, Inc. | Sensor array for nuclear magnetic resonance imaging systems and method |
US8992422B2 (en) | 2006-03-23 | 2015-03-31 | Ethicon Endo-Surgery, Inc. | Robotically-controlled endoscopic accessory channel |
US20070225562A1 (en) | 2006-03-23 | 2007-09-27 | Ethicon Endo-Surgery, Inc. | Articulating endoscopic accessory channel |
US20070244724A1 (en) * | 2006-04-13 | 2007-10-18 | Pendergast John W | Case based outcome prediction in a real-time monitoring system |
ATE499040T1 (en) * | 2006-05-11 | 2011-03-15 | Koninkl Philips Electronics Nv | DEVICE FOR ADMINISTRATION OF DRUGS AND/OR MONITORING THE CONDITION OF A PATIENT |
US8322455B2 (en) | 2006-06-27 | 2012-12-04 | Ethicon Endo-Surgery, Inc. | Manually driven surgical cutting and fastening instrument |
US10568652B2 (en) | 2006-09-29 | 2020-02-25 | Ethicon Llc | Surgical staples having attached drivers of different heights and stapling instruments for deploying the same |
US8348131B2 (en) | 2006-09-29 | 2013-01-08 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with mechanical indicator to show levels of tissue compression |
US10130359B2 (en) | 2006-09-29 | 2018-11-20 | Ethicon Llc | Method for forming a staple |
US20080094228A1 (en) * | 2006-10-12 | 2008-04-24 | Welch James P | Patient monitor using radio frequency identification tags |
US8652120B2 (en) | 2007-01-10 | 2014-02-18 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between control unit and sensor transponders |
US8684253B2 (en) * | 2007-01-10 | 2014-04-01 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between a control unit of a robotic system and remote sensor |
US8459520B2 (en) * | 2007-01-10 | 2013-06-11 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between control unit and remote sensor |
US11291441B2 (en) * | 2007-01-10 | 2022-04-05 | Cilag Gmbh International | Surgical instrument with wireless communication between control unit and remote sensor |
US8540128B2 (en) | 2007-01-11 | 2013-09-24 | Ethicon Endo-Surgery, Inc. | Surgical stapling device with a curved end effector |
US11039836B2 (en) | 2007-01-11 | 2021-06-22 | Cilag Gmbh International | Staple cartridge for use with a surgical stapling instrument |
US8727197B2 (en) | 2007-03-15 | 2014-05-20 | Ethicon Endo-Surgery, Inc. | Staple cartridge cavity configuration with cooperative surgical staple |
US8893946B2 (en) * | 2007-03-28 | 2014-11-25 | Ethicon Endo-Surgery, Inc. | Laparoscopic tissue thickness and clamp load measuring devices |
US8083685B2 (en) * | 2007-05-08 | 2011-12-27 | Propep, Llc | System and method for laparoscopic nerve detection |
US7905380B2 (en) | 2007-06-04 | 2011-03-15 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a multiple rate directional switching mechanism |
US8931682B2 (en) | 2007-06-04 | 2015-01-13 | Ethicon Endo-Surgery, Inc. | Robotically-controlled shaft based rotary drive systems for surgical instruments |
US7832408B2 (en) | 2007-06-04 | 2010-11-16 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a directional switching mechanism |
US8534528B2 (en) | 2007-06-04 | 2013-09-17 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a multiple rate directional switching mechanism |
US11564682B2 (en) | 2007-06-04 | 2023-01-31 | Cilag Gmbh International | Surgical stapler device |
US8308040B2 (en) | 2007-06-22 | 2012-11-13 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with an articulatable end effector |
US7753245B2 (en) | 2007-06-22 | 2010-07-13 | Ethicon Endo-Surgery, Inc. | Surgical stapling instruments |
US11849941B2 (en) | 2007-06-29 | 2023-12-26 | Cilag Gmbh International | Staple cartridge having staple cavities extending at a transverse angle relative to a longitudinal cartridge axis |
US8165663B2 (en) * | 2007-10-03 | 2012-04-24 | The Invention Science Fund I, Llc | Vasculature and lymphatic system imaging and ablation |
US8285366B2 (en) | 2007-10-04 | 2012-10-09 | The Invention Science Fund I, Llc | Vasculature and lymphatic system imaging and ablation associated with a local bypass |
US8285367B2 (en) | 2007-10-05 | 2012-10-09 | The Invention Science Fund I, Llc | Vasculature and lymphatic system imaging and ablation associated with a reservoir |
US8260415B2 (en) | 2007-12-21 | 2012-09-04 | Medtronic, Inc. | Optical sensor and method for detecting a patient condition |
US8165676B2 (en) * | 2007-12-21 | 2012-04-24 | Medtronic, Inc. | Optical sensor and method for detecting a patient condition |
US8961448B2 (en) * | 2008-01-28 | 2015-02-24 | Peter Forsell | Implantable drainage device |
US8561870B2 (en) | 2008-02-13 | 2013-10-22 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument |
US8459525B2 (en) | 2008-02-14 | 2013-06-11 | Ethicon Endo-Sugery, Inc. | Motorized surgical cutting and fastening instrument having a magnetic drive train torque limiting device |
US8584919B2 (en) | 2008-02-14 | 2013-11-19 | Ethicon Endo-Sugery, Inc. | Surgical stapling apparatus with load-sensitive firing mechanism |
US8622274B2 (en) * | 2008-02-14 | 2014-01-07 | Ethicon Endo-Surgery, Inc. | Motorized cutting and fastening instrument having control circuit for optimizing battery usage |
US7793812B2 (en) | 2008-02-14 | 2010-09-14 | Ethicon Endo-Surgery, Inc. | Disposable motor-driven loading unit for use with a surgical cutting and stapling apparatus |
US9179912B2 (en) | 2008-02-14 | 2015-11-10 | Ethicon Endo-Surgery, Inc. | Robotically-controlled motorized surgical cutting and fastening instrument |
US8573465B2 (en) | 2008-02-14 | 2013-11-05 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical end effector system with rotary actuated closure systems |
US8657174B2 (en) | 2008-02-14 | 2014-02-25 | Ethicon Endo-Surgery, Inc. | Motorized surgical cutting and fastening instrument having handle based power source |
US8636736B2 (en) | 2008-02-14 | 2014-01-28 | Ethicon Endo-Surgery, Inc. | Motorized surgical cutting and fastening instrument |
RU2493788C2 (en) | 2008-02-14 | 2013-09-27 | Этикон Эндо-Серджери, Инк. | Surgical cutting and fixing instrument, which has radio-frequency electrodes |
US8752749B2 (en) | 2008-02-14 | 2014-06-17 | Ethicon Endo-Surgery, Inc. | Robotically-controlled disposable motor-driven loading unit |
US7866527B2 (en) | 2008-02-14 | 2011-01-11 | Ethicon Endo-Surgery, Inc. | Surgical stapling apparatus with interlockable firing system |
US7819298B2 (en) | 2008-02-14 | 2010-10-26 | Ethicon Endo-Surgery, Inc. | Surgical stapling apparatus with control features operable with one hand |
US8758391B2 (en) | 2008-02-14 | 2014-06-24 | Ethicon Endo-Surgery, Inc. | Interchangeable tools for surgical instruments |
US20130153641A1 (en) | 2008-02-15 | 2013-06-20 | Ethicon Endo-Surgery, Inc. | Releasable layer of material and surgical end effector having the same |
US11272927B2 (en) | 2008-02-15 | 2022-03-15 | Cilag Gmbh International | Layer arrangements for surgical staple cartridges |
US8118206B2 (en) * | 2008-03-15 | 2012-02-21 | Surgisense Corporation | Sensing adjunct for surgical staplers |
WO2009116029A2 (en) * | 2008-03-17 | 2009-09-24 | Or-Nim Medical Ltd. | Apparatus for non invasive optical monitoring |
CN103542935B (en) * | 2008-03-19 | 2016-02-03 | 超级医药成像有限公司 | For the Miniaturized multi-spectral that real-time tissue oxygenation is measured |
US7954686B2 (en) | 2008-09-19 | 2011-06-07 | Ethicon Endo-Surgery, Inc. | Surgical stapler with apparatus for adjusting staple height |
PL3476312T3 (en) | 2008-09-19 | 2024-03-11 | Ethicon Llc | Surgical stapler with apparatus for adjusting staple height |
US9050083B2 (en) | 2008-09-23 | 2015-06-09 | Ethicon Endo-Surgery, Inc. | Motorized surgical instrument |
US9005230B2 (en) | 2008-09-23 | 2015-04-14 | Ethicon Endo-Surgery, Inc. | Motorized surgical instrument |
US9386983B2 (en) | 2008-09-23 | 2016-07-12 | Ethicon Endo-Surgery, Llc | Robotically-controlled motorized surgical instrument |
US11648005B2 (en) | 2008-09-23 | 2023-05-16 | Cilag Gmbh International | Robotically-controlled motorized surgical instrument with an end effector |
US8210411B2 (en) | 2008-09-23 | 2012-07-03 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting instrument |
US8608045B2 (en) | 2008-10-10 | 2013-12-17 | Ethicon Endo-Sugery, Inc. | Powered surgical cutting and stapling apparatus with manually retractable firing system |
US8653830B2 (en) * | 2008-12-02 | 2014-02-18 | Ut-Battelle, Llc | Optically stimulated differential impedance spectroscopy |
US8938279B1 (en) | 2009-01-26 | 2015-01-20 | VioOptix, Inc. | Multidepth tissue oximeter |
US8517239B2 (en) | 2009-02-05 | 2013-08-27 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument comprising a magnetic element driver |
US8397971B2 (en) | 2009-02-05 | 2013-03-19 | Ethicon Endo-Surgery, Inc. | Sterilizable surgical instrument |
US8414577B2 (en) | 2009-02-05 | 2013-04-09 | Ethicon Endo-Surgery, Inc. | Surgical instruments and components for use in sterile environments |
US8444036B2 (en) | 2009-02-06 | 2013-05-21 | Ethicon Endo-Surgery, Inc. | Motor driven surgical fastener device with mechanisms for adjusting a tissue gap within the end effector |
CA2751664A1 (en) | 2009-02-06 | 2010-08-12 | Ethicon Endo-Surgery, Inc. | Driven surgical stapler improvements |
US8454547B2 (en) | 2009-02-25 | 2013-06-04 | The Invention Science Fund I, Llc | Device, system, and method for controllably reducing inflammatory mediators in a subject |
US8758330B2 (en) | 2010-03-05 | 2014-06-24 | The Invention Science Fund I, Llc | Device for actively removing a target cell from blood or lymph of a vertebrate subject |
US8246565B2 (en) * | 2009-02-25 | 2012-08-21 | The Invention Science Fund I, Llc | Device for passively removing a target component from blood or lymph of a vertebrate subject |
US8317737B2 (en) * | 2009-02-25 | 2012-11-27 | The Invention Science Fund I, Llc | Device for actively removing a target component from blood or lymph of a vertebrate subject |
EP2432400B1 (en) * | 2009-03-13 | 2019-08-28 | Surgisense Corporation | Sensing adjunct for surgical staplers |
US9339221B1 (en) * | 2009-03-24 | 2016-05-17 | Vioptix, Inc. | Diagnosing intestinal ischemia based on oxygen saturation measurements |
US9737213B1 (en) * | 2009-03-24 | 2017-08-22 | Vioptix, Inc. | Using an oximeter probe to detect intestinal ischemia |
WO2010118150A1 (en) * | 2009-04-07 | 2010-10-14 | Carnegie Mellon University | Real-time microdialysis system |
US8955732B2 (en) * | 2009-08-11 | 2015-02-17 | Covidien Lp | Surgical stapling apparatus |
US8360299B2 (en) * | 2009-08-11 | 2013-01-29 | Covidien Lp | Surgical stapling apparatus |
US8276801B2 (en) | 2011-02-01 | 2012-10-02 | Tyco Healthcare Group Lp | Surgical stapling apparatus |
US8648932B2 (en) | 2009-08-13 | 2014-02-11 | Olive Medical Corporation | System, apparatus and methods for providing a single use imaging device for sterile environments |
KR100944409B1 (en) | 2009-08-24 | 2010-02-25 | (주)미래컴퍼니 | Surgical robot system and force-feedback measuring method thereof |
KR100944410B1 (en) | 2009-08-26 | 2010-02-25 | (주)미래컴퍼니 | Surgical robot system and operating force measuring method thereof |
US8582421B2 (en) * | 2009-09-09 | 2013-11-12 | Abbott Diabetes Care Inc. | Analyzing wireless communication degradation through comparison of communication links |
JP2013526888A (en) * | 2009-09-30 | 2013-06-27 | ヘルスウォッチ エルティーディー. | Non-interference continuous health monitoring and warning system |
WO2011060220A1 (en) * | 2009-11-12 | 2011-05-19 | Nellcor Puritan Bennett Llc | Systems and methods for combined physiological sensors |
US8851354B2 (en) | 2009-12-24 | 2014-10-07 | Ethicon Endo-Surgery, Inc. | Surgical cutting instrument that analyzes tissue thickness |
US8220688B2 (en) | 2009-12-24 | 2012-07-17 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting instrument with electric actuator directional control assembly |
CN102858236B (en) * | 2010-01-08 | 2015-02-11 | 达腾科技有限公司 | Physiological signal acquisition device and capability monitoring device incorporating the same |
US20110231336A1 (en) * | 2010-03-18 | 2011-09-22 | International Business Machines Corporation | Forecasting product/service realization profiles |
CA2793147A1 (en) | 2010-03-25 | 2011-09-29 | Olive Medical Corporation | System and method for providing a single use imaging device for medical applications |
MX2012012756A (en) * | 2010-05-04 | 2013-05-09 | Ethicon Llc | Self-retaining systems having laser-cut retainers. |
MY174431A (en) * | 2010-05-14 | 2020-04-17 | Univ Sabanci | An apparatus for using hydrodynamic cavitation in medical treatment |
US10314650B2 (en) | 2010-06-16 | 2019-06-11 | Biosense Webster (Israel) Ltd. | Spectral sensing of ablation |
US11490957B2 (en) | 2010-06-16 | 2022-11-08 | Biosense Webster (Israel) Ltd. | Spectral sensing of ablation |
US8783543B2 (en) | 2010-07-30 | 2014-07-22 | Ethicon Endo-Surgery, Inc. | Tissue acquisition arrangements and methods for surgical stapling devices |
US8360296B2 (en) | 2010-09-09 | 2013-01-29 | Ethicon Endo-Surgery, Inc. | Surgical stapling head assembly with firing lockout for a surgical stapler |
US20120078244A1 (en) | 2010-09-24 | 2012-03-29 | Worrell Barry C | Control features for articulating surgical device |
US9220501B2 (en) | 2010-09-30 | 2015-12-29 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensators |
US9295464B2 (en) | 2010-09-30 | 2016-03-29 | Ethicon Endo-Surgery, Inc. | Surgical stapler anvil comprising a plurality of forming pockets |
US11298125B2 (en) | 2010-09-30 | 2022-04-12 | Cilag Gmbh International | Tissue stapler having a thickness compensator |
US9277919B2 (en) | 2010-09-30 | 2016-03-08 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator comprising fibers to produce a resilient load |
US20120080498A1 (en) | 2010-09-30 | 2012-04-05 | Ethicon Endo-Surgery, Inc. | Curved end effector for a stapling instrument |
US9861361B2 (en) | 2010-09-30 | 2018-01-09 | Ethicon Llc | Releasable tissue thickness compensator and fastener cartridge having the same |
US11812965B2 (en) | 2010-09-30 | 2023-11-14 | Cilag Gmbh International | Layer of material for a surgical end effector |
US9414838B2 (en) | 2012-03-28 | 2016-08-16 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator comprised of a plurality of materials |
US10945731B2 (en) | 2010-09-30 | 2021-03-16 | Ethicon Llc | Tissue thickness compensator comprising controlled release and expansion |
US9332974B2 (en) | 2010-09-30 | 2016-05-10 | Ethicon Endo-Surgery, Llc | Layered tissue thickness compensator |
US11925354B2 (en) | 2010-09-30 | 2024-03-12 | Cilag Gmbh International | Staple cartridge comprising staples positioned within a compressible portion thereof |
US8893949B2 (en) | 2010-09-30 | 2014-11-25 | Ethicon Endo-Surgery, Inc. | Surgical stapler with floating anvil |
CN103140178B (en) | 2010-09-30 | 2015-09-23 | 伊西康内外科公司 | Comprise the closure system keeping matrix and alignment matrix |
US9629814B2 (en) | 2010-09-30 | 2017-04-25 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator configured to redistribute compressive forces |
US9364233B2 (en) | 2010-09-30 | 2016-06-14 | Ethicon Endo-Surgery, Llc | Tissue thickness compensators for circular surgical staplers |
US9301753B2 (en) | 2010-09-30 | 2016-04-05 | Ethicon Endo-Surgery, Llc | Expandable tissue thickness compensator |
US9314246B2 (en) | 2010-09-30 | 2016-04-19 | Ethicon Endo-Surgery, Llc | Tissue stapler having a thickness compensator incorporating an anti-inflammatory agent |
US9307989B2 (en) | 2012-03-28 | 2016-04-12 | Ethicon Endo-Surgery, Llc | Tissue stapler having a thickness compensator incorportating a hydrophobic agent |
US9839420B2 (en) | 2010-09-30 | 2017-12-12 | Ethicon Llc | Tissue thickness compensator comprising at least one medicament |
US9320523B2 (en) | 2012-03-28 | 2016-04-26 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator comprising tissue ingrowth features |
US9517063B2 (en) | 2012-03-28 | 2016-12-13 | Ethicon Endo-Surgery, Llc | Movable member for use with a tissue thickness compensator |
US8695866B2 (en) | 2010-10-01 | 2014-04-15 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a power control circuit |
US8602983B2 (en) | 2010-12-20 | 2013-12-10 | Covidien Lp | Access assembly having undercut structure |
WO2012088179A1 (en) * | 2010-12-20 | 2012-06-28 | Opsys, Ltd. | Control circuit and surgical tool |
US8641610B2 (en) | 2010-12-20 | 2014-02-04 | Covidien Lp | Access assembly with translating lumens |
US8696557B2 (en) | 2010-12-21 | 2014-04-15 | Covidien Lp | Access assembly including inflatable seal member |
US9393017B2 (en) | 2011-02-15 | 2016-07-19 | Intuitive Surgical Operations, Inc. | Methods and systems for detecting staple cartridge misfire or failure |
KR102081754B1 (en) | 2011-02-15 | 2020-02-26 | 인튜어티브 서지컬 오퍼레이션즈 인코포레이티드 | Systems for detecting clamping or firing failure |
US10413349B2 (en) | 2011-03-04 | 2019-09-17 | Covidien Lp | System and methods for identifying tissue and vessels |
US8827903B2 (en) | 2011-03-14 | 2014-09-09 | Ethicon Endo-Surgery, Inc. | Modular tool heads for use with circular surgical instruments |
US9649113B2 (en) | 2011-04-27 | 2017-05-16 | Covidien Lp | Device for monitoring physiological parameters in vivo |
RU2606493C2 (en) | 2011-04-29 | 2017-01-10 | Этикон Эндо-Серджери, Инк. | Staple cartridge, containing staples, located inside its compressible part |
US9622650B2 (en) | 2011-05-12 | 2017-04-18 | DePuy Synthes Products, Inc. | System and method for sub-column parallel digitizers for hybrid stacked image sensor using vertical interconnects |
US11207064B2 (en) | 2011-05-27 | 2021-12-28 | Cilag Gmbh International | Automated end effector component reloading system for use with a robotic system |
US9072535B2 (en) | 2011-05-27 | 2015-07-07 | Ethicon Endo-Surgery, Inc. | Surgical stapling instruments with rotatable staple deployment arrangements |
JP5865606B2 (en) * | 2011-05-27 | 2016-02-17 | オリンパス株式会社 | Endoscope apparatus and method for operating endoscope apparatus |
NL2007038C2 (en) | 2011-07-04 | 2013-01-07 | Vereniging Voor Christelijk Hoger Onderwijs | System and method for predicting the viability of a body tissue in a patient, and measuring device used therein. |
US9844384B2 (en) * | 2011-07-11 | 2017-12-19 | Covidien Lp | Stand alone energy-based tissue clips |
US9092559B2 (en) * | 2011-08-16 | 2015-07-28 | Ethicon Endo-Surgery, Inc. | Drug delivery system with open architectural framework |
US11197797B2 (en) * | 2011-09-15 | 2021-12-14 | Sigma Instruments Holdings, Llc | System and method for treating soft tissue with force impulse and electrical stimulation |
DE102011053755A1 (en) * | 2011-09-19 | 2013-03-21 | Aesculap Ag | Temperature sensor, temperature measuring device and medical systems with a temperature sensor or a temperature measuring device |
US8753344B2 (en) | 2011-09-23 | 2014-06-17 | Smith & Nephew, Inc. | Dynamic orthoscopic sensing |
US9050084B2 (en) | 2011-09-23 | 2015-06-09 | Ethicon Endo-Surgery, Inc. | Staple cartridge including collapsible deck arrangement |
WO2013063377A1 (en) * | 2011-10-28 | 2013-05-02 | The Feinstein Institute For Medical Research | Microchip sensor for continuous monitoring of regional blood flow |
US9220502B2 (en) * | 2011-12-28 | 2015-12-29 | Covidien Lp | Staple formation recognition for a surgical device |
CN104136072B (en) * | 2012-01-31 | 2016-08-24 | 心脏起搏器公司 | Use implantable device and the method for biomarker group data diagnosis heart failure |
US9044230B2 (en) | 2012-02-13 | 2015-06-02 | Ethicon Endo-Surgery, Inc. | Surgical cutting and fastening instrument with apparatus for determining cartridge and firing motion status |
JP6094987B2 (en) * | 2012-02-20 | 2017-03-15 | 国立大学法人浜松医科大学 | Fluorescence detection device |
US10249036B2 (en) * | 2012-02-22 | 2019-04-02 | Veran Medical Technologies, Inc. | Surgical catheter having side exiting medical instrument and related systems and methods for four dimensional soft tissue navigation |
US11399898B2 (en) | 2012-03-06 | 2022-08-02 | Briteseed, Llc | User interface for a system used to determine tissue or artifact characteristics |
US20150066000A1 (en) * | 2012-03-06 | 2015-03-05 | Briteseed Llc | Surgical Tool With Integrated Sensor |
JP6734052B2 (en) | 2012-03-27 | 2020-08-05 | コーニンクレッカ フィリップス エヌ ヴェKoninklijke Philips N.V. | Integrated delayed optical feedback in image guidance |
MX353040B (en) | 2012-03-28 | 2017-12-18 | Ethicon Endo Surgery Inc | Retainer assembly including a tissue thickness compensator. |
US9198662B2 (en) | 2012-03-28 | 2015-12-01 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensator having improved visibility |
CN104321024B (en) | 2012-03-28 | 2017-05-24 | 伊西康内外科公司 | Tissue thickness compensator comprising a plurality of layers |
CN104334098B (en) | 2012-03-28 | 2017-03-22 | 伊西康内外科公司 | Tissue thickness compensator comprising capsules defining a low pressure environment |
US11871901B2 (en) | 2012-05-20 | 2024-01-16 | Cilag Gmbh International | Method for situational awareness for surgical network or surgical network connected device capable of adjusting function based on a sensed situation or usage |
US9101358B2 (en) | 2012-06-15 | 2015-08-11 | Ethicon Endo-Surgery, Inc. | Articulatable surgical instrument comprising a firing drive |
US9561038B2 (en) | 2012-06-28 | 2017-02-07 | Ethicon Endo-Surgery, Llc | Interchangeable clip applier |
US9119657B2 (en) | 2012-06-28 | 2015-09-01 | Ethicon Endo-Surgery, Inc. | Rotary actuatable closure arrangement for surgical end effector |
BR112014032776B1 (en) | 2012-06-28 | 2021-09-08 | Ethicon Endo-Surgery, Inc | SURGICAL INSTRUMENT SYSTEM AND SURGICAL KIT FOR USE WITH A SURGICAL INSTRUMENT SYSTEM |
US8747238B2 (en) | 2012-06-28 | 2014-06-10 | Ethicon Endo-Surgery, Inc. | Rotary drive shaft assemblies for surgical instruments with articulatable end effectors |
US9028494B2 (en) | 2012-06-28 | 2015-05-12 | Ethicon Endo-Surgery, Inc. | Interchangeable end effector coupling arrangement |
US20140005718A1 (en) | 2012-06-28 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Multi-functional powered surgical device with external dissection features |
US9072536B2 (en) | 2012-06-28 | 2015-07-07 | Ethicon Endo-Surgery, Inc. | Differential locking arrangements for rotary powered surgical instruments |
US9101385B2 (en) | 2012-06-28 | 2015-08-11 | Ethicon Endo-Surgery, Inc. | Electrode connections for rotary driven surgical tools |
US9289256B2 (en) | 2012-06-28 | 2016-03-22 | Ethicon Endo-Surgery, Llc | Surgical end effectors having angled tissue-contacting surfaces |
US20140001231A1 (en) | 2012-06-28 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Firing system lockout arrangements for surgical instruments |
RU2636861C2 (en) | 2012-06-28 | 2017-11-28 | Этикон Эндо-Серджери, Инк. | Blocking of empty cassette with clips |
US11202631B2 (en) | 2012-06-28 | 2021-12-21 | Cilag Gmbh International | Stapling assembly comprising a firing lockout |
US9649111B2 (en) | 2012-06-28 | 2017-05-16 | Ethicon Endo-Surgery, Llc | Replaceable clip cartridge for a clip applier |
US9408606B2 (en) | 2012-06-28 | 2016-08-09 | Ethicon Endo-Surgery, Llc | Robotically powered surgical device with manually-actuatable reversing system |
US9125662B2 (en) | 2012-06-28 | 2015-09-08 | Ethicon Endo-Surgery, Inc. | Multi-axis articulating and rotating surgical tools |
MX344146B (en) | 2012-07-26 | 2016-12-07 | Depuy Synthes Products Inc | Camera system with minimal area monolithic cmos image sensor. |
US9480855B2 (en) | 2012-09-26 | 2016-11-01 | DePuy Synthes Products, Inc. | NIR/red light for lateral neuroprotection |
JP6034668B2 (en) | 2012-11-08 | 2016-11-30 | 富士フイルム株式会社 | Endoscope system |
JP6008700B2 (en) * | 2012-11-08 | 2016-10-19 | 富士フイルム株式会社 | Endoscope system |
EP2928399A4 (en) * | 2012-12-09 | 2016-08-24 | Autonomix Medical Inc | Regulating organ and tumor growth rates, function, and development |
US9386984B2 (en) | 2013-02-08 | 2016-07-12 | Ethicon Endo-Surgery, Llc | Staple cartridge comprising a releasable cover |
EP2956066A4 (en) * | 2013-02-14 | 2016-10-19 | Paul Weber | Systems, apparatus and methods for tissue dissection |
US10092292B2 (en) | 2013-02-28 | 2018-10-09 | Ethicon Llc | Staple forming features for surgical stapling instrument |
MX364729B (en) | 2013-03-01 | 2019-05-06 | Ethicon Endo Surgery Inc | Surgical instrument with a soft stop. |
US9554794B2 (en) | 2013-03-01 | 2017-01-31 | Ethicon Endo-Surgery, Llc | Multiple processor motor control for modular surgical instruments |
RU2672520C2 (en) | 2013-03-01 | 2018-11-15 | Этикон Эндо-Серджери, Инк. | Hingedly turnable surgical instruments with conducting ways for signal transfer |
US9936951B2 (en) * | 2013-03-12 | 2018-04-10 | Covidien Lp | Interchangeable tip reload |
US20140263552A1 (en) | 2013-03-13 | 2014-09-18 | Ethicon Endo-Surgery, Inc. | Staple cartridge tissue thickness sensor system |
US9629629B2 (en) | 2013-03-14 | 2017-04-25 | Ethicon Endo-Surgey, LLC | Control systems for surgical instruments |
US9883860B2 (en) | 2013-03-14 | 2018-02-06 | Ethicon Llc | Interchangeable shaft assemblies for use with a surgical instrument |
AU2014233190B2 (en) | 2013-03-15 | 2018-11-01 | DePuy Synthes Products, Inc. | Image sensor synchronization without input clock and data transmission clock |
US10750933B2 (en) | 2013-03-15 | 2020-08-25 | DePuy Synthes Products, Inc. | Minimize image sensor I/O and conductor counts in endoscope applications |
WO2014150509A1 (en) * | 2013-03-15 | 2014-09-25 | Intuitive Surgical Operations, Inc. | Shape sensor systems for tracking interventional instruments and methods of use |
US10098585B2 (en) | 2013-03-15 | 2018-10-16 | Cadwell Laboratories, Inc. | Neuromonitoring systems and methods |
EP4079242A1 (en) * | 2013-03-19 | 2022-10-26 | Surgisense Corporation | Apparatus, systems and methods for determining tissue oxygenation |
US9795384B2 (en) | 2013-03-27 | 2017-10-24 | Ethicon Llc | Fastener cartridge comprising a tissue thickness compensator and a gap setting element |
US9332984B2 (en) | 2013-03-27 | 2016-05-10 | Ethicon Endo-Surgery, Llc | Fastener cartridge assemblies |
US9572577B2 (en) | 2013-03-27 | 2017-02-21 | Ethicon Endo-Surgery, Llc | Fastener cartridge comprising a tissue thickness compensator including openings therein |
BR112015026109B1 (en) | 2013-04-16 | 2022-02-22 | Ethicon Endo-Surgery, Inc | surgical instrument |
US9867612B2 (en) | 2013-04-16 | 2018-01-16 | Ethicon Llc | Powered surgical stapler |
US10690684B2 (en) | 2013-05-10 | 2020-06-23 | Majelco Medical, Inc. | Apparatus and system for measuring volume of blood loss |
US10285596B2 (en) | 2016-04-11 | 2019-05-14 | Majelco Medical, Inc. | Apparatus and system for measuring volume of blood loss |
US10041960B2 (en) * | 2013-05-10 | 2018-08-07 | University Of Utah Research Foundation | Devices, systems, and methods for measuring blood loss |
US10420583B2 (en) | 2013-05-22 | 2019-09-24 | Covidien Lp | Methods and apparatus for controlling surgical instruments using a port assembly |
US9574644B2 (en) | 2013-05-30 | 2017-02-21 | Ethicon Endo-Surgery, Llc | Power module for use with a surgical instrument |
WO2014194317A1 (en) | 2013-05-31 | 2014-12-04 | Covidien Lp | Surgical device with an end-effector assembly and system for monitoring of tissue during a surgical procedure |
US9289265B2 (en) * | 2013-07-10 | 2016-03-22 | The Johns Hopkins University | MRI-compatible, integrated force and torque sensors and systems that incorporate the sensors |
US9510828B2 (en) | 2013-08-23 | 2016-12-06 | Ethicon Endo-Surgery, Llc | Conductor arrangements for electrically powered surgical instruments with rotatable end effectors |
RU2678363C2 (en) | 2013-08-23 | 2019-01-28 | ЭТИКОН ЭНДО-СЕРДЖЕРИ, ЭлЭлСи | Firing member retraction devices for powered surgical instruments |
US11166672B2 (en) | 2013-10-18 | 2021-11-09 | Atlantic Health System, Inc. | Nerve protecting dissection device |
US10022090B2 (en) | 2013-10-18 | 2018-07-17 | Atlantic Health System, Inc. | Nerve protecting dissection device |
US9839428B2 (en) | 2013-12-23 | 2017-12-12 | Ethicon Llc | Surgical cutting and stapling instruments with independent jaw control features |
US9724092B2 (en) | 2013-12-23 | 2017-08-08 | Ethicon Llc | Modular surgical instruments |
US9763662B2 (en) | 2013-12-23 | 2017-09-19 | Ethicon Llc | Fastener cartridge comprising a firing member configured to directly engage and eject fasteners from the fastener cartridge |
US20150173756A1 (en) | 2013-12-23 | 2015-06-25 | Ethicon Endo-Surgery, Inc. | Surgical cutting and stapling methods |
US9962161B2 (en) | 2014-02-12 | 2018-05-08 | Ethicon Llc | Deliverable surgical instrument |
US9301691B2 (en) | 2014-02-21 | 2016-04-05 | Covidien Lp | Instrument for optically detecting tissue attributes |
US9884456B2 (en) | 2014-02-24 | 2018-02-06 | Ethicon Llc | Implantable layers and methods for altering one or more properties of implantable layers for use with fastening instruments |
JP6462004B2 (en) | 2014-02-24 | 2019-01-30 | エシコン エルエルシー | Fastening system with launcher lockout |
US20150238260A1 (en) * | 2014-02-26 | 2015-08-27 | Covidien Lp | Surgical instruments including nerve stimulator apparatus for use in the detection of nerves in tissue and methods of directing energy to tissue using same |
US10251600B2 (en) | 2014-03-25 | 2019-04-09 | Briteseed, Llc | Vessel detector and method of detection |
US20150272582A1 (en) | 2014-03-26 | 2015-10-01 | Ethicon Endo-Surgery, Inc. | Power management control systems for surgical instruments |
US9820738B2 (en) | 2014-03-26 | 2017-11-21 | Ethicon Llc | Surgical instrument comprising interactive systems |
US9913642B2 (en) | 2014-03-26 | 2018-03-13 | Ethicon Llc | Surgical instrument comprising a sensor system |
US10013049B2 (en) | 2014-03-26 | 2018-07-03 | Ethicon Llc | Power management through sleep options of segmented circuit and wake up control |
BR112016021943B1 (en) | 2014-03-26 | 2022-06-14 | Ethicon Endo-Surgery, Llc | SURGICAL INSTRUMENT FOR USE BY AN OPERATOR IN A SURGICAL PROCEDURE |
BR112016023807B1 (en) | 2014-04-16 | 2022-07-12 | Ethicon Endo-Surgery, Llc | CARTRIDGE SET OF FASTENERS FOR USE WITH A SURGICAL INSTRUMENT |
US10426476B2 (en) | 2014-09-26 | 2019-10-01 | Ethicon Llc | Circular fastener cartridges for applying radially expandable fastener lines |
US20150297223A1 (en) | 2014-04-16 | 2015-10-22 | Ethicon Endo-Surgery, Inc. | Fastener cartridges including extensions having different configurations |
CN106456176B (en) | 2014-04-16 | 2019-06-28 | 伊西康内外科有限责任公司 | Fastener cartridge including the extension with various configuration |
BR112016023825B1 (en) | 2014-04-16 | 2022-08-02 | Ethicon Endo-Surgery, Llc | STAPLE CARTRIDGE FOR USE WITH A SURGICAL STAPLER AND STAPLE CARTRIDGE FOR USE WITH A SURGICAL INSTRUMENT |
US10561422B2 (en) | 2014-04-16 | 2020-02-18 | Ethicon Llc | Fastener cartridge comprising deployable tissue engaging members |
US20150305650A1 (en) | 2014-04-23 | 2015-10-29 | Mark Hunter | Apparatuses and methods for endobronchial navigation to and confirmation of the location of a target tissue and percutaneous interception of the target tissue |
US20150305612A1 (en) | 2014-04-23 | 2015-10-29 | Mark Hunter | Apparatuses and methods for registering a real-time image feed from an imaging device to a steerable catheter |
US10251725B2 (en) | 2014-06-09 | 2019-04-09 | Covidien Lp | Authentication and information system for reusable surgical instruments |
US10045781B2 (en) | 2014-06-13 | 2018-08-14 | Ethicon Llc | Closure lockout systems for surgical instruments |
JP2016002353A (en) * | 2014-06-18 | 2016-01-12 | ソニー株式会社 | Detection device and method, and program |
US10524694B2 (en) | 2014-06-25 | 2020-01-07 | Canaray Medical Inc. | Devices, systems and methods for using and monitoring tubes in body passageways |
US10123731B2 (en) | 2014-08-08 | 2018-11-13 | Medtronic Xomed, Inc. | Wireless sensors for nerve integrity monitoring systems |
US20160051221A1 (en) * | 2014-08-25 | 2016-02-25 | Covidien Lp | System and Method for Planning, Monitoring, and Confirming Treatment |
BR112017004361B1 (en) | 2014-09-05 | 2023-04-11 | Ethicon Llc | ELECTRONIC SYSTEM FOR A SURGICAL INSTRUMENT |
US11311294B2 (en) | 2014-09-05 | 2022-04-26 | Cilag Gmbh International | Powered medical device including measurement of closure state of jaws |
US9788836B2 (en) | 2014-09-05 | 2017-10-17 | Ethicon Llc | Multiple motor control for powered medical device |
CN107003984A (en) | 2014-09-17 | 2017-08-01 | 卡纳里医疗公司 | Equipment, system and method for using and monitoring Medical Devices |
US10105142B2 (en) | 2014-09-18 | 2018-10-23 | Ethicon Llc | Surgical stapler with plurality of cutting elements |
BR112017005981B1 (en) | 2014-09-26 | 2022-09-06 | Ethicon, Llc | ANCHOR MATERIAL FOR USE WITH A SURGICAL STAPLE CARTRIDGE AND SURGICAL STAPLE CARTRIDGE FOR USE WITH A SURGICAL INSTRUMENT |
US11523821B2 (en) | 2014-09-26 | 2022-12-13 | Cilag Gmbh International | Method for creating a flexible staple line |
US10543041B2 (en) | 2014-10-03 | 2020-01-28 | Covidien Lp | Energy-based surgical instrument including integrated nerve detection system |
US10231783B2 (en) | 2014-10-03 | 2019-03-19 | Covidien Lp | Energy-based surgical instrument including integrated nerve detection system |
US10076325B2 (en) | 2014-10-13 | 2018-09-18 | Ethicon Llc | Surgical stapling apparatus comprising a tissue stop |
CA2963861C (en) | 2014-10-14 | 2023-10-03 | East Carolina University | Methods, systems and computer program products for visualizing anatomical structures and blood flow and perfusion physiology using imaging techniques |
US11553844B2 (en) * | 2014-10-14 | 2023-01-17 | East Carolina University | Methods, systems and computer program products for calculating MetaKG signals for regions having multiple sets of optical characteristics |
EP3188652A4 (en) * | 2014-10-14 | 2018-05-23 | East Carolina University | Methods, systems and computer program products for determining hemodynamic status parameters using signals derived from multispectral blood flow and perfusion imaging |
US9924944B2 (en) | 2014-10-16 | 2018-03-27 | Ethicon Llc | Staple cartridge comprising an adjunct material |
US10517594B2 (en) | 2014-10-29 | 2019-12-31 | Ethicon Llc | Cartridge assemblies for surgical staplers |
US11141153B2 (en) | 2014-10-29 | 2021-10-12 | Cilag Gmbh International | Staple cartridges comprising driver arrangements |
US11504192B2 (en) | 2014-10-30 | 2022-11-22 | Cilag Gmbh International | Method of hub communication with surgical instrument systems |
US9844376B2 (en) | 2014-11-06 | 2017-12-19 | Ethicon Llc | Staple cartridge comprising a releasable adjunct material |
US10736636B2 (en) | 2014-12-10 | 2020-08-11 | Ethicon Llc | Articulatable surgical instrument system |
US10085748B2 (en) | 2014-12-18 | 2018-10-02 | Ethicon Llc | Locking arrangements for detachable shaft assemblies with articulatable surgical end effectors |
US9844375B2 (en) | 2014-12-18 | 2017-12-19 | Ethicon Llc | Drive arrangements for articulatable surgical instruments |
US10188385B2 (en) | 2014-12-18 | 2019-01-29 | Ethicon Llc | Surgical instrument system comprising lockable systems |
US10004501B2 (en) | 2014-12-18 | 2018-06-26 | Ethicon Llc | Surgical instruments with improved closure arrangements |
US9987000B2 (en) | 2014-12-18 | 2018-06-05 | Ethicon Llc | Surgical instrument assembly comprising a flexible articulation system |
US9844374B2 (en) | 2014-12-18 | 2017-12-19 | Ethicon Llc | Surgical instrument systems comprising an articulatable end effector and means for adjusting the firing stroke of a firing member |
US10117649B2 (en) | 2014-12-18 | 2018-11-06 | Ethicon Llc | Surgical instrument assembly comprising a lockable articulation system |
BR112017012996B1 (en) | 2014-12-18 | 2022-11-08 | Ethicon Llc | SURGICAL INSTRUMENT WITH AN ANvil WHICH IS SELECTIVELY MOVABLE ABOUT AN IMMOVABLE GEOMETRIC AXIS DIFFERENT FROM A STAPLE CARTRIDGE |
AU2015268674A1 (en) * | 2014-12-29 | 2016-07-14 | Biosense Webster (Israel) Ltd. | Spectral sensing of ablation |
EP4000509B1 (en) * | 2015-02-19 | 2023-08-30 | Briteseed, LLC | Surgical system for determining vessel size |
ES2892526T3 (en) * | 2015-02-19 | 2022-02-04 | Briteseed Llc | System for determining the size of a vessel by light absorption |
US10180463B2 (en) | 2015-02-27 | 2019-01-15 | Ethicon Llc | Surgical apparatus configured to assess whether a performance parameter of the surgical apparatus is within an acceptable performance band |
US10182816B2 (en) | 2015-02-27 | 2019-01-22 | Ethicon Llc | Charging system that enables emergency resolutions for charging a battery |
US9993258B2 (en) | 2015-02-27 | 2018-06-12 | Ethicon Llc | Adaptable surgical instrument handle |
US11154301B2 (en) | 2015-02-27 | 2021-10-26 | Cilag Gmbh International | Modular stapling assembly |
US10045776B2 (en) | 2015-03-06 | 2018-08-14 | Ethicon Llc | Control techniques and sub-processor contained within modular shaft with select control processing from handle |
JP2020121162A (en) | 2015-03-06 | 2020-08-13 | エシコン エルエルシーEthicon LLC | Time dependent evaluation of sensor data to determine stability element, creep element and viscoelastic element of measurement |
US10548504B2 (en) | 2015-03-06 | 2020-02-04 | Ethicon Llc | Overlaid multi sensor radio frequency (RF) electrode system to measure tissue compression |
US9901342B2 (en) | 2015-03-06 | 2018-02-27 | Ethicon Endo-Surgery, Llc | Signal and power communication system positioned on a rotatable shaft |
US10441279B2 (en) | 2015-03-06 | 2019-10-15 | Ethicon Llc | Multiple level thresholds to modify operation of powered surgical instruments |
US9895148B2 (en) | 2015-03-06 | 2018-02-20 | Ethicon Endo-Surgery, Llc | Monitoring speed control and precision incrementing of motor for powered surgical instruments |
US9808246B2 (en) | 2015-03-06 | 2017-11-07 | Ethicon Endo-Surgery, Llc | Method of operating a powered surgical instrument |
US10617412B2 (en) | 2015-03-06 | 2020-04-14 | Ethicon Llc | System for detecting the mis-insertion of a staple cartridge into a surgical stapler |
US9924961B2 (en) | 2015-03-06 | 2018-03-27 | Ethicon Endo-Surgery, Llc | Interactive feedback system for powered surgical instruments |
US10245033B2 (en) | 2015-03-06 | 2019-04-02 | Ethicon Llc | Surgical instrument comprising a lockable battery housing |
US9993248B2 (en) * | 2015-03-06 | 2018-06-12 | Ethicon Endo-Surgery, Llc | Smart sensors with local signal processing |
US10687806B2 (en) | 2015-03-06 | 2020-06-23 | Ethicon Llc | Adaptive tissue compression techniques to adjust closure rates for multiple tissue types |
US10390718B2 (en) * | 2015-03-20 | 2019-08-27 | East Carolina University | Multi-spectral physiologic visualization (MSPV) using laser imaging methods and systems for blood flow and perfusion imaging and quantification in an endoscopic design |
US11322248B2 (en) | 2015-03-26 | 2022-05-03 | Surgical Safety Technologies Inc. | Operating room black-box device, system, method and computer readable medium for event and error prediction |
US10213201B2 (en) | 2015-03-31 | 2019-02-26 | Ethicon Llc | Stapling end effector configured to compensate for an uneven gap between a first jaw and a second jaw |
US10039915B2 (en) | 2015-04-03 | 2018-08-07 | Medtronic Xomed, Inc. | System and method for omni-directional bipolar stimulation of nerve tissue of a patient via a surgical tool |
CN112842527A (en) * | 2015-05-15 | 2021-05-28 | 马科外科公司 | System and method for providing guidance for robotic medical procedures |
WO2016191307A1 (en) * | 2015-05-22 | 2016-12-01 | Cercacor Laboratories, Inc. | Non-invasive optical physiological differential pathlength sensor |
US10092741B2 (en) * | 2015-06-08 | 2018-10-09 | Misonix, Inc. | Ultrasonic surgical apparatus and associated method |
US10182818B2 (en) | 2015-06-18 | 2019-01-22 | Ethicon Llc | Surgical end effectors with positive jaw opening arrangements |
CN107771059B (en) * | 2015-06-19 | 2023-08-18 | 皇家飞利浦有限公司 | Catheter apparatus |
US11058425B2 (en) | 2015-08-17 | 2021-07-13 | Ethicon Llc | Implantable layers for a surgical instrument |
US10213203B2 (en) | 2015-08-26 | 2019-02-26 | Ethicon Llc | Staple cartridge assembly without a bottom cover |
CN108348233B (en) | 2015-08-26 | 2021-05-07 | 伊西康有限责任公司 | Surgical staple strip for allowing changing staple characteristics and achieving easy cartridge loading |
US10172619B2 (en) | 2015-09-02 | 2019-01-08 | Ethicon Llc | Surgical staple driver arrays |
MX2022006191A (en) | 2015-09-02 | 2022-06-16 | Ethicon Llc | Surgical staple configurations with camming surfaces located between portions supporting surgical staples. |
US10363036B2 (en) | 2015-09-23 | 2019-07-30 | Ethicon Llc | Surgical stapler having force-based motor control |
US10076326B2 (en) | 2015-09-23 | 2018-09-18 | Ethicon Llc | Surgical stapler having current mirror-based motor control |
US10238386B2 (en) | 2015-09-23 | 2019-03-26 | Ethicon Llc | Surgical stapler having motor control based on an electrical parameter related to a motor current |
US10085751B2 (en) | 2015-09-23 | 2018-10-02 | Ethicon Llc | Surgical stapler having temperature-based motor control |
US10327769B2 (en) | 2015-09-23 | 2019-06-25 | Ethicon Llc | Surgical stapler having motor control based on a drive system component |
US10105139B2 (en) | 2015-09-23 | 2018-10-23 | Ethicon Llc | Surgical stapler having downstream current-based motor control |
US10299878B2 (en) | 2015-09-25 | 2019-05-28 | Ethicon Llc | Implantable adjunct systems for determining adjunct skew |
US10603039B2 (en) | 2015-09-30 | 2020-03-31 | Ethicon Llc | Progressively releasable implantable adjunct for use with a surgical stapling instrument |
US11890015B2 (en) | 2015-09-30 | 2024-02-06 | Cilag Gmbh International | Compressible adjunct with crossing spacer fibers |
US20170086829A1 (en) | 2015-09-30 | 2017-03-30 | Ethicon Endo-Surgery, Llc | Compressible adjunct with intermediate supporting structures |
US10980539B2 (en) | 2015-09-30 | 2021-04-20 | Ethicon Llc | Implantable adjunct comprising bonded layers |
US10716508B2 (en) | 2015-10-08 | 2020-07-21 | Briteseed, Llc | System and method for determining vessel size |
US10445466B2 (en) | 2015-11-18 | 2019-10-15 | Warsaw Orthopedic, Inc. | Systems and methods for post-operative outcome monitoring |
US10339273B2 (en) | 2015-11-18 | 2019-07-02 | Warsaw Orthopedic, Inc. | Systems and methods for pre-operative procedure determination and outcome predicting |
EP3376988B1 (en) * | 2015-11-19 | 2023-08-23 | Covidien LP | Optical force sensor for robotic surgical system |
WO2017098503A1 (en) * | 2015-12-07 | 2017-06-15 | M.S.T. Medical Surgery Technologies Ltd. | Database management for laparoscopic surgery |
US10624616B2 (en) * | 2015-12-18 | 2020-04-21 | Covidien Lp | Surgical instruments including sensors |
US10292704B2 (en) | 2015-12-30 | 2019-05-21 | Ethicon Llc | Mechanisms for compensating for battery pack failure in powered surgical instruments |
US10265068B2 (en) | 2015-12-30 | 2019-04-23 | Ethicon Llc | Surgical instruments with separable motors and motor control circuits |
US10368865B2 (en) | 2015-12-30 | 2019-08-06 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
CN108697344A (en) * | 2016-01-14 | 2018-10-23 | 乔治·P·泰特尔鲍姆 | Early stage apoplexy detection device |
CN108882932B (en) | 2016-02-09 | 2021-07-23 | 伊西康有限责任公司 | Surgical instrument with asymmetric articulation configuration |
US11213293B2 (en) | 2016-02-09 | 2022-01-04 | Cilag Gmbh International | Articulatable surgical instruments with single articulation link arrangements |
US10245029B2 (en) | 2016-02-09 | 2019-04-02 | Ethicon Llc | Surgical instrument with articulating and axially translatable end effector |
US10448948B2 (en) | 2016-02-12 | 2019-10-22 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10258331B2 (en) | 2016-02-12 | 2019-04-16 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US11224426B2 (en) | 2016-02-12 | 2022-01-18 | Cilag Gmbh International | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US11191479B2 (en) | 2016-03-23 | 2021-12-07 | Canary Medical Inc. | Implantable reporting processor for an alert implant |
KR102455911B1 (en) | 2016-03-23 | 2022-10-19 | 카나리 메디칼 아이엔씨. | Portable Reporting Processor for Alert Implants |
US10675021B2 (en) | 2016-04-01 | 2020-06-09 | Ethicon Llc | Circular stapling system comprising rotary firing system |
US10376263B2 (en) | 2016-04-01 | 2019-08-13 | Ethicon Llc | Anvil modification members for surgical staplers |
US11284890B2 (en) | 2016-04-01 | 2022-03-29 | Cilag Gmbh International | Circular stapling system comprising an incisable tissue support |
US10617413B2 (en) | 2016-04-01 | 2020-04-14 | Ethicon Llc | Closure system arrangements for surgical cutting and stapling devices with separate and distinct firing shafts |
US10307159B2 (en) | 2016-04-01 | 2019-06-04 | Ethicon Llc | Surgical instrument handle assembly with reconfigurable grip portion |
US10828028B2 (en) | 2016-04-15 | 2020-11-10 | Ethicon Llc | Surgical instrument with multiple program responses during a firing motion |
US10405859B2 (en) | 2016-04-15 | 2019-09-10 | Ethicon Llc | Surgical instrument with adjustable stop/start control during a firing motion |
US10335145B2 (en) | 2016-04-15 | 2019-07-02 | Ethicon Llc | Modular surgical instrument with configurable operating mode |
US10456137B2 (en) | 2016-04-15 | 2019-10-29 | Ethicon Llc | Staple formation detection mechanisms |
US11607239B2 (en) | 2016-04-15 | 2023-03-21 | Cilag Gmbh International | Systems and methods for controlling a surgical stapling and cutting instrument |
US10426467B2 (en) * | 2016-04-15 | 2019-10-01 | Ethicon Llc | Surgical instrument with detection sensors |
US11179150B2 (en) | 2016-04-15 | 2021-11-23 | Cilag Gmbh International | Systems and methods for controlling a surgical stapling and cutting instrument |
US10492783B2 (en) | 2016-04-15 | 2019-12-03 | Ethicon, Llc | Surgical instrument with improved stop/start control during a firing motion |
US10357247B2 (en) | 2016-04-15 | 2019-07-23 | Ethicon Llc | Surgical instrument with multiple program responses during a firing motion |
US11317917B2 (en) | 2016-04-18 | 2022-05-03 | Cilag Gmbh International | Surgical stapling system comprising a lockable firing assembly |
US10368867B2 (en) | 2016-04-18 | 2019-08-06 | Ethicon Llc | Surgical instrument comprising a lockout |
US20170296173A1 (en) | 2016-04-18 | 2017-10-19 | Ethicon Endo-Surgery, Llc | Method for operating a surgical instrument |
TWI633302B (en) * | 2016-05-20 | 2018-08-21 | 奇美醫療財團法人奇美醫院 | Non-invasive free tissue transfer evaluation method and system |
EP3463162A4 (en) * | 2016-06-03 | 2020-06-24 | Covidien LP | Systems, methods, and computer-readable program products for controlling a robotically delivered manipulator |
US10842531B2 (en) | 2016-06-22 | 2020-11-24 | Cochlear Limited | Electrode insertion tool with additional functionality |
USD847989S1 (en) | 2016-06-24 | 2019-05-07 | Ethicon Llc | Surgical fastener cartridge |
USD850617S1 (en) | 2016-06-24 | 2019-06-04 | Ethicon Llc | Surgical fastener cartridge |
US10893863B2 (en) | 2016-06-24 | 2021-01-19 | Ethicon Llc | Staple cartridge comprising offset longitudinal staple rows |
JP6957532B2 (en) | 2016-06-24 | 2021-11-02 | エシコン エルエルシーEthicon LLC | Staple cartridges including wire staples and punched staples |
USD826405S1 (en) | 2016-06-24 | 2018-08-21 | Ethicon Llc | Surgical fastener |
CN105933459A (en) * | 2016-07-05 | 2016-09-07 | 四川长虹通信科技有限公司 | Molecular recognition terminal, molecular recognition mobile phone and molecular recognition method |
US10460457B2 (en) * | 2016-07-12 | 2019-10-29 | Novartis Ag | Adaptive adjustment of overlay image parameters |
US11285314B2 (en) * | 2016-08-19 | 2022-03-29 | Cochlear Limited | Advanced electrode array insertion |
JP7058642B2 (en) | 2016-08-30 | 2022-04-22 | ブライトシード・エルエルシー | A system for compensating for angular displacement in the irradiation pattern |
US10849517B2 (en) | 2016-09-19 | 2020-12-01 | Medtronic Xomed, Inc. | Remote control module for instruments |
KR101838188B1 (en) * | 2016-10-31 | 2018-03-13 | 비앤알(주) | Circular Stapler |
US9999899B2 (en) | 2016-11-01 | 2018-06-19 | International Business Machines Corporation | Controlled exposure of in-vivo sensors |
US20180168633A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Surgical stapling instruments and staple-forming anvils |
US10835245B2 (en) | 2016-12-21 | 2020-11-17 | Ethicon Llc | Method for attaching a shaft assembly to a surgical instrument and, alternatively, to a surgical robot |
US10695055B2 (en) | 2016-12-21 | 2020-06-30 | Ethicon Llc | Firing assembly comprising a lockout |
US11684367B2 (en) | 2016-12-21 | 2023-06-27 | Cilag Gmbh International | Stepped assembly having and end-of-life indicator |
US20180168650A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Connection portions for disposable loading units for surgical stapling instruments |
US10856868B2 (en) | 2016-12-21 | 2020-12-08 | Ethicon Llc | Firing member pin configurations |
US10898186B2 (en) | 2016-12-21 | 2021-01-26 | Ethicon Llc | Staple forming pocket arrangements comprising primary sidewalls and pocket sidewalls |
US10687810B2 (en) | 2016-12-21 | 2020-06-23 | Ethicon Llc | Stepped staple cartridge with tissue retention and gap setting features |
US10888322B2 (en) | 2016-12-21 | 2021-01-12 | Ethicon Llc | Surgical instrument comprising a cutting member |
CN110099619B (en) | 2016-12-21 | 2022-07-15 | 爱惜康有限责任公司 | Lockout device for surgical end effector and replaceable tool assembly |
US10758230B2 (en) | 2016-12-21 | 2020-09-01 | Ethicon Llc | Surgical instrument with primary and safety processors |
JP7010956B2 (en) | 2016-12-21 | 2022-01-26 | エシコン エルエルシー | How to staple tissue |
BR112019011947A2 (en) | 2016-12-21 | 2019-10-29 | Ethicon Llc | surgical stapling systems |
US11134942B2 (en) | 2016-12-21 | 2021-10-05 | Cilag Gmbh International | Surgical stapling instruments and staple-forming anvils |
US10835247B2 (en) | 2016-12-21 | 2020-11-17 | Ethicon Llc | Lockout arrangements for surgical end effectors |
US10993715B2 (en) | 2016-12-21 | 2021-05-04 | Ethicon Llc | Staple cartridge comprising staples with different clamping breadths |
US10426471B2 (en) | 2016-12-21 | 2019-10-01 | Ethicon Llc | Surgical instrument with multiple failure response modes |
US11179155B2 (en) | 2016-12-21 | 2021-11-23 | Cilag Gmbh International | Anvil arrangements for surgical staplers |
US20180168615A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Method of deforming staples from two different types of staple cartridges with the same surgical stapling instrument |
US10537325B2 (en) | 2016-12-21 | 2020-01-21 | Ethicon Llc | Staple forming pocket arrangement to accommodate different types of staples |
US11419606B2 (en) | 2016-12-21 | 2022-08-23 | Cilag Gmbh International | Shaft assembly comprising a clutch configured to adapt the output of a rotary firing member to two different systems |
US10736629B2 (en) | 2016-12-21 | 2020-08-11 | Ethicon Llc | Surgical tool assemblies with clutching arrangements for shifting between closure systems with closure stroke reduction features and articulation and firing systems |
US10945727B2 (en) | 2016-12-21 | 2021-03-16 | Ethicon Llc | Staple cartridge with deformable driver retention features |
US20180168577A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Axially movable closure system arrangements for applying closure motions to jaws of surgical instruments |
US10709901B2 (en) | 2017-01-05 | 2020-07-14 | Covidien Lp | Implantable fasteners, applicators, and methods for brachytherapy |
US9935395B1 (en) | 2017-01-23 | 2018-04-03 | Cadwell Laboratories, Inc. | Mass connection plate for electrical connectors |
CN110381875B (en) * | 2017-02-09 | 2023-03-21 | 皇家飞利浦有限公司 | Location detection based on tissue discrimination |
US10638944B2 (en) * | 2017-02-22 | 2020-05-05 | Covidien Lp | Methods of determining tissue viability |
US10687811B2 (en) | 2017-03-08 | 2020-06-23 | Covidien Lp | Surgical instruments including sensors |
US11259892B2 (en) | 2017-03-10 | 2022-03-01 | Asensus Surgical Us, Inc. | Instrument for optical tissue interrogation |
US10945616B2 (en) | 2017-05-12 | 2021-03-16 | Covidien Lp | Blood pressure measuring surgical instrument |
CN107242855A (en) * | 2017-06-05 | 2017-10-13 | 天津大学 | A kind of biological tissue's dynamic modulation spectral measurement device and method |
USD890784S1 (en) | 2017-06-20 | 2020-07-21 | Ethicon Llc | Display panel with changeable graphical user interface |
US11517325B2 (en) | 2017-06-20 | 2022-12-06 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured displacement distance traveled over a specified time interval |
US10881396B2 (en) | 2017-06-20 | 2021-01-05 | Ethicon Llc | Surgical instrument with variable duration trigger arrangement |
US11071554B2 (en) | 2017-06-20 | 2021-07-27 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on magnitude of velocity error measurements |
US11090046B2 (en) | 2017-06-20 | 2021-08-17 | Cilag Gmbh International | Systems and methods for controlling displacement member motion of a surgical stapling and cutting instrument |
US10390841B2 (en) | 2017-06-20 | 2019-08-27 | Ethicon Llc | Control of motor velocity of a surgical stapling and cutting instrument based on angle of articulation |
USD879809S1 (en) | 2017-06-20 | 2020-03-31 | Ethicon Llc | Display panel with changeable graphical user interface |
US10813639B2 (en) | 2017-06-20 | 2020-10-27 | Ethicon Llc | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on system conditions |
US10646220B2 (en) | 2017-06-20 | 2020-05-12 | Ethicon Llc | Systems and methods for controlling displacement member velocity for a surgical instrument |
US10307170B2 (en) | 2017-06-20 | 2019-06-04 | Ethicon Llc | Method for closed loop control of motor velocity of a surgical stapling and cutting instrument |
US10368864B2 (en) | 2017-06-20 | 2019-08-06 | Ethicon Llc | Systems and methods for controlling displaying motor velocity for a surgical instrument |
US10881399B2 (en) | 2017-06-20 | 2021-01-05 | Ethicon Llc | Techniques for adaptive control of motor velocity of a surgical stapling and cutting instrument |
US10888321B2 (en) | 2017-06-20 | 2021-01-12 | Ethicon Llc | Systems and methods for controlling velocity of a displacement member of a surgical stapling and cutting instrument |
US11653914B2 (en) | 2017-06-20 | 2023-05-23 | Cilag Gmbh International | Systems and methods for controlling motor velocity of a surgical stapling and cutting instrument according to articulation angle of end effector |
US10327767B2 (en) | 2017-06-20 | 2019-06-25 | Ethicon Llc | Control of motor velocity of a surgical stapling and cutting instrument based on angle of articulation |
US10779820B2 (en) | 2017-06-20 | 2020-09-22 | Ethicon Llc | Systems and methods for controlling motor speed according to user input for a surgical instrument |
US10624633B2 (en) | 2017-06-20 | 2020-04-21 | Ethicon Llc | Systems and methods for controlling motor velocity of a surgical stapling and cutting instrument |
US11382638B2 (en) | 2017-06-20 | 2022-07-12 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured time over a specified displacement distance |
USD879808S1 (en) | 2017-06-20 | 2020-03-31 | Ethicon Llc | Display panel with graphical user interface |
US10980537B2 (en) | 2017-06-20 | 2021-04-20 | Ethicon Llc | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured time over a specified number of shaft rotations |
EP4218552A1 (en) * | 2017-06-20 | 2023-08-02 | Boston Scientific Scimed, Inc. | Devices and methods for determining blood flow around a body lumen |
US10993716B2 (en) | 2017-06-27 | 2021-05-04 | Ethicon Llc | Surgical anvil arrangements |
US10631859B2 (en) | 2017-06-27 | 2020-04-28 | Ethicon Llc | Articulation systems for surgical instruments |
US11324503B2 (en) | 2017-06-27 | 2022-05-10 | Cilag Gmbh International | Surgical firing member arrangements |
US11266405B2 (en) | 2017-06-27 | 2022-03-08 | Cilag Gmbh International | Surgical anvil manufacturing methods |
US10772629B2 (en) | 2017-06-27 | 2020-09-15 | Ethicon Llc | Surgical anvil arrangements |
US10856869B2 (en) | 2017-06-27 | 2020-12-08 | Ethicon Llc | Surgical anvil arrangements |
EP4070740A1 (en) | 2017-06-28 | 2022-10-12 | Cilag GmbH International | Surgical instrument comprising selectively actuatable rotatable couplers |
US11564686B2 (en) | 2017-06-28 | 2023-01-31 | Cilag Gmbh International | Surgical shaft assemblies with flexible interfaces |
USD851762S1 (en) | 2017-06-28 | 2019-06-18 | Ethicon Llc | Anvil |
US10211586B2 (en) | 2017-06-28 | 2019-02-19 | Ethicon Llc | Surgical shaft assemblies with watertight housings |
US10716614B2 (en) | 2017-06-28 | 2020-07-21 | Ethicon Llc | Surgical shaft assemblies with slip ring assemblies with increased contact pressure |
US11246592B2 (en) | 2017-06-28 | 2022-02-15 | Cilag Gmbh International | Surgical instrument comprising an articulation system lockable to a frame |
US10765427B2 (en) | 2017-06-28 | 2020-09-08 | Ethicon Llc | Method for articulating a surgical instrument |
USD906355S1 (en) | 2017-06-28 | 2020-12-29 | Ethicon Llc | Display screen or portion thereof with a graphical user interface for a surgical instrument |
US11259805B2 (en) | 2017-06-28 | 2022-03-01 | Cilag Gmbh International | Surgical instrument comprising firing member supports |
US10758232B2 (en) | 2017-06-28 | 2020-09-01 | Ethicon Llc | Surgical instrument with positive jaw opening features |
USD854151S1 (en) | 2017-06-28 | 2019-07-16 | Ethicon Llc | Surgical instrument shaft |
US11389161B2 (en) | 2017-06-28 | 2022-07-19 | Cilag Gmbh International | Surgical instrument comprising selectively actuatable rotatable couplers |
US10903685B2 (en) | 2017-06-28 | 2021-01-26 | Ethicon Llc | Surgical shaft assemblies with slip ring assemblies forming capacitive channels |
USD869655S1 (en) | 2017-06-28 | 2019-12-10 | Ethicon Llc | Surgical fastener cartridge |
US10398434B2 (en) | 2017-06-29 | 2019-09-03 | Ethicon Llc | Closed loop velocity control of closure member for robotic surgical instrument |
US10258418B2 (en) | 2017-06-29 | 2019-04-16 | Ethicon Llc | System for controlling articulation forces |
US10932772B2 (en) | 2017-06-29 | 2021-03-02 | Ethicon Llc | Methods for closed loop velocity control for robotic surgical instrument |
US10898183B2 (en) | 2017-06-29 | 2021-01-26 | Ethicon Llc | Robotic surgical instrument with closed loop feedback techniques for advancement of closure member during firing |
CA3004066A1 (en) * | 2017-06-29 | 2018-12-29 | Covidien Lp | Surgical instruments including sensors |
US11007022B2 (en) | 2017-06-29 | 2021-05-18 | Ethicon Llc | Closed loop velocity control techniques based on sensed tissue parameters for robotic surgical instrument |
US11471155B2 (en) | 2017-08-03 | 2022-10-18 | Cilag Gmbh International | Surgical system bailout |
US11304695B2 (en) | 2017-08-03 | 2022-04-19 | Cilag Gmbh International | Surgical system shaft interconnection |
US11944300B2 (en) | 2017-08-03 | 2024-04-02 | Cilag Gmbh International | Method for operating a surgical system bailout |
US11759184B2 (en) | 2017-08-07 | 2023-09-19 | Utah Valley University | Apparatus, system and method for diagnostic imaging forceps |
JP7427251B2 (en) * | 2017-08-28 | 2024-02-05 | イースト カロライナ ユニバーシティ | Multispectral physiology visualization (MSPV) using laser imaging methods and systems for blood flow and perfusion imaging and quantification in endoscope design |
US11723600B2 (en) | 2017-09-05 | 2023-08-15 | Briteseed, Llc | System and method used to determine tissue and/or artifact characteristics |
US20200261170A1 (en) * | 2017-09-06 | 2020-08-20 | Technion Research & Development Foundation Limited | Robotic system for minimally invasive surgery |
US10796471B2 (en) | 2017-09-29 | 2020-10-06 | Ethicon Llc | Systems and methods of displaying a knife position for a surgical instrument |
US10743872B2 (en) | 2017-09-29 | 2020-08-18 | Ethicon Llc | System and methods for controlling a display of a surgical instrument |
US11399829B2 (en) | 2017-09-29 | 2022-08-02 | Cilag Gmbh International | Systems and methods of initiating a power shutdown mode for a surgical instrument |
USD907647S1 (en) | 2017-09-29 | 2021-01-12 | Ethicon Llc | Display screen or portion thereof with animated graphical user interface |
US10765429B2 (en) | 2017-09-29 | 2020-09-08 | Ethicon Llc | Systems and methods for providing alerts according to the operational state of a surgical instrument |
USD917500S1 (en) | 2017-09-29 | 2021-04-27 | Ethicon Llc | Display screen or portion thereof with graphical user interface |
US10729501B2 (en) | 2017-09-29 | 2020-08-04 | Ethicon Llc | Systems and methods for language selection of a surgical instrument |
USD907648S1 (en) | 2017-09-29 | 2021-01-12 | Ethicon Llc | Display screen or portion thereof with animated graphical user interface |
US11564756B2 (en) | 2017-10-30 | 2023-01-31 | Cilag Gmbh International | Method of hub communication with surgical instrument systems |
US11911045B2 (en) | 2017-10-30 | 2024-02-27 | Cllag GmbH International | Method for operating a powered articulating multi-clip applier |
US11134944B2 (en) | 2017-10-30 | 2021-10-05 | Cilag Gmbh International | Surgical stapler knife motion controls |
US11317919B2 (en) | 2017-10-30 | 2022-05-03 | Cilag Gmbh International | Clip applier comprising a clip crimping system |
US11406390B2 (en) | 2017-10-30 | 2022-08-09 | Cilag Gmbh International | Clip applier comprising interchangeable clip reloads |
US11090075B2 (en) | 2017-10-30 | 2021-08-17 | Cilag Gmbh International | Articulation features for surgical end effector |
US11291510B2 (en) | 2017-10-30 | 2022-04-05 | Cilag Gmbh International | Method of hub communication with surgical instrument systems |
US11311342B2 (en) | 2017-10-30 | 2022-04-26 | Cilag Gmbh International | Method for communicating with surgical instrument systems |
US20190125320A1 (en) | 2017-10-30 | 2019-05-02 | Ethicon Llc | Control system arrangements for a modular surgical instrument |
US11510741B2 (en) | 2017-10-30 | 2022-11-29 | Cilag Gmbh International | Method for producing a surgical instrument comprising a smart electrical system |
US11229436B2 (en) | 2017-10-30 | 2022-01-25 | Cilag Gmbh International | Surgical system comprising a surgical tool and a surgical hub |
US11801098B2 (en) | 2017-10-30 | 2023-10-31 | Cilag Gmbh International | Method of hub communication with surgical instrument systems |
US10779903B2 (en) | 2017-10-31 | 2020-09-22 | Ethicon Llc | Positive shaft rotation lock activated by jaw closure |
US10842490B2 (en) | 2017-10-31 | 2020-11-24 | Ethicon Llc | Cartridge body design with force reduction based on firing completion |
US11197670B2 (en) | 2017-12-15 | 2021-12-14 | Cilag Gmbh International | Surgical end effectors with pivotal jaws configured to touch at their respective distal ends when fully closed |
US10743875B2 (en) | 2017-12-15 | 2020-08-18 | Ethicon Llc | Surgical end effectors with jaw stiffener arrangements configured to permit monitoring of firing member |
US10687813B2 (en) | 2017-12-15 | 2020-06-23 | Ethicon Llc | Adapters with firing stroke sensing arrangements for use in connection with electromechanical surgical instruments |
US10966718B2 (en) | 2017-12-15 | 2021-04-06 | Ethicon Llc | Dynamic clamping assemblies with improved wear characteristics for use in connection with electromechanical surgical instruments |
US10828033B2 (en) | 2017-12-15 | 2020-11-10 | Ethicon Llc | Handheld electromechanical surgical instruments with improved motor control arrangements for positioning components of an adapter coupled thereto |
US11006955B2 (en) | 2017-12-15 | 2021-05-18 | Ethicon Llc | End effectors with positive jaw opening features for use with adapters for electromechanical surgical instruments |
US10779826B2 (en) | 2017-12-15 | 2020-09-22 | Ethicon Llc | Methods of operating surgical end effectors |
US10869666B2 (en) | 2017-12-15 | 2020-12-22 | Ethicon Llc | Adapters with control systems for controlling multiple motors of an electromechanical surgical instrument |
US10779825B2 (en) | 2017-12-15 | 2020-09-22 | Ethicon Llc | Adapters with end effector position sensing and control arrangements for use in connection with electromechanical surgical instruments |
US10743874B2 (en) | 2017-12-15 | 2020-08-18 | Ethicon Llc | Sealed adapters for use with electromechanical surgical instruments |
US11071543B2 (en) | 2017-12-15 | 2021-07-27 | Cilag Gmbh International | Surgical end effectors with clamping assemblies configured to increase jaw aperture ranges |
US11033267B2 (en) | 2017-12-15 | 2021-06-15 | Ethicon Llc | Systems and methods of controlling a clamping member firing rate of a surgical instrument |
US10716565B2 (en) | 2017-12-19 | 2020-07-21 | Ethicon Llc | Surgical instruments with dual articulation drivers |
USD910847S1 (en) | 2017-12-19 | 2021-02-16 | Ethicon Llc | Surgical instrument assembly |
US11045270B2 (en) | 2017-12-19 | 2021-06-29 | Cilag Gmbh International | Robotic attachment comprising exterior drive actuator |
US11020112B2 (en) | 2017-12-19 | 2021-06-01 | Ethicon Llc | Surgical tools configured for interchangeable use with different controller interfaces |
US10835330B2 (en) | 2017-12-19 | 2020-11-17 | Ethicon Llc | Method for determining the position of a rotatable jaw of a surgical instrument attachment assembly |
US10729509B2 (en) | 2017-12-19 | 2020-08-04 | Ethicon Llc | Surgical instrument comprising closure and firing locking mechanism |
US11311290B2 (en) | 2017-12-21 | 2022-04-26 | Cilag Gmbh International | Surgical instrument comprising an end effector dampener |
GB201721581D0 (en) * | 2017-12-21 | 2018-02-07 | Thalamus Al Ltd | A medical management system |
US11076853B2 (en) | 2017-12-21 | 2021-08-03 | Cilag Gmbh International | Systems and methods of displaying a knife position during transection for a surgical instrument |
US20190192147A1 (en) | 2017-12-21 | 2019-06-27 | Ethicon Llc | Surgical instrument comprising an articulatable distal head |
US11129680B2 (en) | 2017-12-21 | 2021-09-28 | Cilag Gmbh International | Surgical instrument comprising a projector |
JP7313353B2 (en) | 2017-12-22 | 2023-07-24 | ブライトシード・エルエルシー | Miniature system used to determine tissue or artifact properties |
US11096693B2 (en) | 2017-12-28 | 2021-08-24 | Cilag Gmbh International | Adjustment of staple height of at least one row of staples based on the sensed tissue thickness or force in closing |
US11376002B2 (en) | 2017-12-28 | 2022-07-05 | Cilag Gmbh International | Surgical instrument cartridge sensor assemblies |
US11864728B2 (en) | 2017-12-28 | 2024-01-09 | Cilag Gmbh International | Characterization of tissue irregularities through the use of mono-chromatic light refractivity |
US11832840B2 (en) | 2017-12-28 | 2023-12-05 | Cilag Gmbh International | Surgical instrument having a flexible circuit |
CN111512390A (en) * | 2017-12-28 | 2020-08-07 | 爱惜康有限责任公司 | System for detecting proximity of a surgical end effector to cancerous tissue |
US11446052B2 (en) | 2017-12-28 | 2022-09-20 | Cilag Gmbh International | Variation of radio frequency and ultrasonic power level in cooperation with varying clamp arm pressure to achieve predefined heat flux or power applied to tissue |
US11076921B2 (en) | 2017-12-28 | 2021-08-03 | Cilag Gmbh International | Adaptive control program updates for surgical hubs |
US11896322B2 (en) | 2017-12-28 | 2024-02-13 | Cilag Gmbh International | Sensing the patient position and contact utilizing the mono-polar return pad electrode to provide situational awareness to the hub |
US11147607B2 (en) | 2017-12-28 | 2021-10-19 | Cilag Gmbh International | Bipolar combination device that automatically adjusts pressure based on energy modality |
US11308075B2 (en) | 2017-12-28 | 2022-04-19 | Cilag Gmbh International | Surgical network, instrument, and cloud responses based on validation of received dataset and authentication of its source and integrity |
US11571234B2 (en) | 2017-12-28 | 2023-02-07 | Cilag Gmbh International | Temperature control of ultrasonic end effector and control system therefor |
US11419667B2 (en) | 2017-12-28 | 2022-08-23 | Cilag Gmbh International | Ultrasonic energy device which varies pressure applied by clamp arm to provide threshold control pressure at a cut progression location |
US11559307B2 (en) | 2017-12-28 | 2023-01-24 | Cilag Gmbh International | Method of robotic hub communication, detection, and control |
US11559308B2 (en) | 2017-12-28 | 2023-01-24 | Cilag Gmbh International | Method for smart energy device infrastructure |
US11659023B2 (en) | 2017-12-28 | 2023-05-23 | Cilag Gmbh International | Method of hub communication |
US11202570B2 (en) | 2017-12-28 | 2021-12-21 | Cilag Gmbh International | Communication hub and storage device for storing parameters and status of a surgical device to be shared with cloud based analytics systems |
US11045591B2 (en) | 2017-12-28 | 2021-06-29 | Cilag Gmbh International | Dual in-series large and small droplet filters |
US11786251B2 (en) | 2017-12-28 | 2023-10-17 | Cilag Gmbh International | Method for adaptive control schemes for surgical network control and interaction |
US11540855B2 (en) | 2017-12-28 | 2023-01-03 | Cilag Gmbh International | Controlling activation of an ultrasonic surgical instrument according to the presence of tissue |
US11304763B2 (en) | 2017-12-28 | 2022-04-19 | Cilag Gmbh International | Image capturing of the areas outside the abdomen to improve placement and control of a surgical device in use |
US11612444B2 (en) | 2017-12-28 | 2023-03-28 | Cilag Gmbh International | Adjustment of a surgical device function based on situational awareness |
US11389164B2 (en) | 2017-12-28 | 2022-07-19 | Cilag Gmbh International | Method of using reinforced flexible circuits with multiple sensors to optimize performance of radio frequency devices |
US20190201113A1 (en) | 2017-12-28 | 2019-07-04 | Ethicon Llc | Controls for robot-assisted surgical platforms |
US10944728B2 (en) | 2017-12-28 | 2021-03-09 | Ethicon Llc | Interactive surgical systems with encrypted communication capabilities |
US11253315B2 (en) | 2017-12-28 | 2022-02-22 | Cilag Gmbh International | Increasing radio frequency to create pad-less monopolar loop |
US11179208B2 (en) | 2017-12-28 | 2021-11-23 | Cilag Gmbh International | Cloud-based medical analytics for security and authentication trends and reactive measures |
US11419630B2 (en) | 2017-12-28 | 2022-08-23 | Cilag Gmbh International | Surgical system distributed processing |
US11364075B2 (en) | 2017-12-28 | 2022-06-21 | Cilag Gmbh International | Radio frequency energy device for delivering combined electrical signals |
US11278281B2 (en) | 2017-12-28 | 2022-03-22 | Cilag Gmbh International | Interactive surgical system |
US11596291B2 (en) | 2017-12-28 | 2023-03-07 | Cilag Gmbh International | Method of compressing tissue within a stapling device and simultaneously displaying of the location of the tissue within the jaws |
US11576677B2 (en) | 2017-12-28 | 2023-02-14 | Cilag Gmbh International | Method of hub communication, processing, display, and cloud analytics |
US11109866B2 (en) | 2017-12-28 | 2021-09-07 | Cilag Gmbh International | Method for circular stapler control algorithm adjustment based on situational awareness |
US11056244B2 (en) | 2017-12-28 | 2021-07-06 | Cilag Gmbh International | Automated data scaling, alignment, and organizing based on predefined parameters within surgical networks |
US11160605B2 (en) | 2017-12-28 | 2021-11-02 | Cilag Gmbh International | Surgical evacuation sensing and motor control |
US11026751B2 (en) | 2017-12-28 | 2021-06-08 | Cilag Gmbh International | Display of alignment of staple cartridge to prior linear staple line |
US11896443B2 (en) | 2017-12-28 | 2024-02-13 | Cilag Gmbh International | Control of a surgical system through a surgical barrier |
US11678881B2 (en) | 2017-12-28 | 2023-06-20 | Cilag Gmbh International | Spatial awareness of surgical hubs in operating rooms |
US11234756B2 (en) | 2017-12-28 | 2022-02-01 | Cilag Gmbh International | Powered surgical tool with predefined adjustable control algorithm for controlling end effector parameter |
US11069012B2 (en) | 2017-12-28 | 2021-07-20 | Cilag Gmbh International | Interactive surgical systems with condition handling of devices and data capabilities |
US11266468B2 (en) | 2017-12-28 | 2022-03-08 | Cilag Gmbh International | Cooperative utilization of data derived from secondary sources by intelligent surgical hubs |
US11464535B2 (en) | 2017-12-28 | 2022-10-11 | Cilag Gmbh International | Detection of end effector emersion in liquid |
US10987178B2 (en) | 2017-12-28 | 2021-04-27 | Ethicon Llc | Surgical hub control arrangements |
US11410259B2 (en) | 2017-12-28 | 2022-08-09 | Cilag Gmbh International | Adaptive control program updates for surgical devices |
US11317937B2 (en) | 2018-03-08 | 2022-05-03 | Cilag Gmbh International | Determining the state of an ultrasonic end effector |
US11832899B2 (en) | 2017-12-28 | 2023-12-05 | Cilag Gmbh International | Surgical systems with autonomously adjustable control programs |
US11051876B2 (en) | 2017-12-28 | 2021-07-06 | Cilag Gmbh International | Surgical evacuation flow paths |
CN111601542A (en) * | 2017-12-28 | 2020-08-28 | 爱惜康有限责任公司 | Capacitively coupled return path pad with separable array elements |
US10966791B2 (en) | 2017-12-28 | 2021-04-06 | Ethicon Llc | Cloud-based medical analytics for medical facility segmented individualization of instrument function |
US11424027B2 (en) | 2017-12-28 | 2022-08-23 | Cilag Gmbh International | Method for operating surgical instrument systems |
US11744604B2 (en) | 2017-12-28 | 2023-09-05 | Cilag Gmbh International | Surgical instrument with a hardware-only control circuit |
US11696760B2 (en) | 2017-12-28 | 2023-07-11 | Cilag Gmbh International | Safety systems for smart powered surgical stapling |
US10892995B2 (en) | 2017-12-28 | 2021-01-12 | Ethicon Llc | Surgical network determination of prioritization of communication, interaction, or processing based on system or device needs |
US11589888B2 (en) | 2017-12-28 | 2023-02-28 | Cilag Gmbh International | Method for controlling smart energy devices |
US11257589B2 (en) | 2017-12-28 | 2022-02-22 | Cilag Gmbh International | Real-time analysis of comprehensive cost of all instrumentation used in surgery utilizing data fluidity to track instruments through stocking and in-house processes |
US11304720B2 (en) | 2017-12-28 | 2022-04-19 | Cilag Gmbh International | Activation of energy devices |
US11166772B2 (en) | 2017-12-28 | 2021-11-09 | Cilag Gmbh International | Surgical hub coordination of control and communication of operating room devices |
US11818052B2 (en) | 2017-12-28 | 2023-11-14 | Cilag Gmbh International | Surgical network determination of prioritization of communication, interaction, or processing based on system or device needs |
US10932872B2 (en) | 2017-12-28 | 2021-03-02 | Ethicon Llc | Cloud-based medical analytics for linking of local usage trends with the resource acquisition behaviors of larger data set |
US11529187B2 (en) | 2017-12-28 | 2022-12-20 | Cilag Gmbh International | Surgical evacuation sensor arrangements |
BR112020013066A2 (en) * | 2017-12-28 | 2020-12-01 | Ethicon Llc | surgical systems to detect irregularities in tissue distribution on the end actuator |
US20190201142A1 (en) | 2017-12-28 | 2019-07-04 | Ethicon Llc | Automatic tool adjustments for robot-assisted surgical platforms |
US11786245B2 (en) | 2017-12-28 | 2023-10-17 | Cilag Gmbh International | Surgical systems with prioritized data transmission capabilities |
US11132462B2 (en) | 2017-12-28 | 2021-09-28 | Cilag Gmbh International | Data stripping method to interrogate patient records and create anonymized record |
US11311306B2 (en) | 2017-12-28 | 2022-04-26 | Cilag Gmbh International | Surgical systems for detecting end effector tissue distribution irregularities |
US10758310B2 (en) | 2017-12-28 | 2020-09-01 | Ethicon Llc | Wireless pairing of a surgical device with another device within a sterile surgical field based on the usage and situational awareness of devices |
US10943454B2 (en) | 2017-12-28 | 2021-03-09 | Ethicon Llc | Detection and escalation of security responses of surgical instruments to increasing severity threats |
US11304745B2 (en) | 2017-12-28 | 2022-04-19 | Cilag Gmbh International | Surgical evacuation sensing and display |
US10849697B2 (en) | 2017-12-28 | 2020-12-01 | Ethicon Llc | Cloud interface for coupled surgical devices |
US11423007B2 (en) | 2017-12-28 | 2022-08-23 | Cilag Gmbh International | Adjustment of device control programs based on stratified contextual data in addition to the data |
US20190201042A1 (en) | 2017-12-28 | 2019-07-04 | Ethicon Llc | Determining the state of an ultrasonic electromechanical system according to frequency shift |
US11903601B2 (en) | 2017-12-28 | 2024-02-20 | Cilag Gmbh International | Surgical instrument comprising a plurality of drive systems |
US10755813B2 (en) | 2017-12-28 | 2020-08-25 | Ethicon Llc | Communication of smoke evacuation system parameters to hub or cloud in smoke evacuation module for interactive surgical platform |
US11857152B2 (en) | 2017-12-28 | 2024-01-02 | Cilag Gmbh International | Surgical hub spatial awareness to determine devices in operating theater |
US11324557B2 (en) | 2017-12-28 | 2022-05-10 | Cilag Gmbh International | Surgical instrument with a sensing array |
US11432885B2 (en) | 2017-12-28 | 2022-09-06 | Cilag Gmbh International | Sensing arrangements for robot-assisted surgical platforms |
US10695081B2 (en) | 2017-12-28 | 2020-06-30 | Ethicon Llc | Controlling a surgical instrument according to sensed closure parameters |
US11464559B2 (en) | 2017-12-28 | 2022-10-11 | Cilag Gmbh International | Estimating state of ultrasonic end effector and control system therefor |
US11633237B2 (en) | 2017-12-28 | 2023-04-25 | Cilag Gmbh International | Usage and technique analysis of surgeon / staff performance against a baseline to optimize device utilization and performance for both current and future procedures |
US11666331B2 (en) * | 2017-12-28 | 2023-06-06 | Cilag Gmbh International | Systems for detecting proximity of surgical end effector to cancerous tissue |
US11273001B2 (en) * | 2017-12-28 | 2022-03-15 | Cilag Gmbh International | Surgical hub and modular device response adjustment based on situational awareness |
US10892899B2 (en) | 2017-12-28 | 2021-01-12 | Ethicon Llc | Self describing data packets generated at an issuing instrument |
US11284936B2 (en) | 2017-12-28 | 2022-03-29 | Cilag Gmbh International | Surgical instrument having a flexible electrode |
US11937769B2 (en) | 2017-12-28 | 2024-03-26 | Cilag Gmbh International | Method of hub communication, processing, storage and display |
US11100631B2 (en) | 2017-12-28 | 2021-08-24 | Cilag Gmbh International | Use of laser light and red-green-blue coloration to determine properties of back scattered light |
US11771487B2 (en) | 2017-12-28 | 2023-10-03 | Cilag Gmbh International | Mechanisms for controlling different electromechanical systems of an electrosurgical instrument |
US11304699B2 (en) | 2017-12-28 | 2022-04-19 | Cilag Gmbh International | Method for adaptive control schemes for surgical network control and interaction |
US11291495B2 (en) | 2017-12-28 | 2022-04-05 | Cilag Gmbh International | Interruption of energy due to inadvertent capacitive coupling |
US11602393B2 (en) | 2017-12-28 | 2023-03-14 | Cilag Gmbh International | Surgical evacuation sensing and generator control |
NL2020240B1 (en) * | 2018-01-05 | 2019-07-12 | Veenhof Medical Devices B V | Testing tissue viability for an anastomosis |
US11589915B2 (en) | 2018-03-08 | 2023-02-28 | Cilag Gmbh International | In-the-jaw classifier based on a model |
US11259830B2 (en) | 2018-03-08 | 2022-03-01 | Cilag Gmbh International | Methods for controlling temperature in ultrasonic device |
US11534196B2 (en) | 2018-03-08 | 2022-12-27 | Cilag Gmbh International | Using spectroscopy to determine device use state in combo instrument |
US11589865B2 (en) | 2018-03-28 | 2023-02-28 | Cilag Gmbh International | Methods for controlling a powered surgical stapler that has separate rotary closure and firing systems |
US10973520B2 (en) | 2018-03-28 | 2021-04-13 | Ethicon Llc | Surgical staple cartridge with firing member driven camming assembly that has an onboard tissue cutting feature |
US11129611B2 (en) | 2018-03-28 | 2021-09-28 | Cilag Gmbh International | Surgical staplers with arrangements for maintaining a firing member thereof in a locked configuration unless a compatible cartridge has been installed therein |
US11207067B2 (en) | 2018-03-28 | 2021-12-28 | Cilag Gmbh International | Surgical stapling device with separate rotary driven closure and firing systems and firing member that engages both jaws while firing |
US11471156B2 (en) | 2018-03-28 | 2022-10-18 | Cilag Gmbh International | Surgical stapling devices with improved rotary driven closure systems |
US11090047B2 (en) | 2018-03-28 | 2021-08-17 | Cilag Gmbh International | Surgical instrument comprising an adaptive control system |
US11278280B2 (en) | 2018-03-28 | 2022-03-22 | Cilag Gmbh International | Surgical instrument comprising a jaw closure lockout |
US11219453B2 (en) | 2018-03-28 | 2022-01-11 | Cilag Gmbh International | Surgical stapling devices with cartridge compatible closure and firing lockout arrangements |
US11096688B2 (en) | 2018-03-28 | 2021-08-24 | Cilag Gmbh International | Rotary driven firing members with different anvil and channel engagement features |
US11253182B2 (en) | 2018-05-04 | 2022-02-22 | Cadwell Laboratories, Inc. | Apparatus and method for polyphasic multi-output constant-current and constant-voltage neurophysiological stimulation |
KR102143104B1 (en) * | 2018-05-18 | 2020-08-10 | 비앤알(주) | Device for detection of blood vessel and surgical instrument for laparoscopy comprising the same |
US11109787B2 (en) * | 2018-05-21 | 2021-09-07 | Vine Medical LLC | Multi-tip probe for obtaining bioelectrical measurements |
WO2019226119A1 (en) | 2018-05-22 | 2019-11-28 | Nanyang Technological University | Force sensor for tendon-actuated mechanisms |
US11443649B2 (en) | 2018-06-29 | 2022-09-13 | Cadwell Laboratories, Inc. | Neurophysiological monitoring training simulator |
US11039834B2 (en) | 2018-08-20 | 2021-06-22 | Cilag Gmbh International | Surgical stapler anvils with staple directing protrusions and tissue stability features |
USD914878S1 (en) | 2018-08-20 | 2021-03-30 | Ethicon Llc | Surgical instrument anvil |
US10912559B2 (en) | 2018-08-20 | 2021-02-09 | Ethicon Llc | Reinforced deformable anvil tip for surgical stapler anvil |
US11324501B2 (en) | 2018-08-20 | 2022-05-10 | Cilag Gmbh International | Surgical stapling devices with improved closure members |
US11253256B2 (en) | 2018-08-20 | 2022-02-22 | Cilag Gmbh International | Articulatable motor powered surgical instruments with dedicated articulation motor arrangements |
US10842492B2 (en) | 2018-08-20 | 2020-11-24 | Ethicon Llc | Powered articulatable surgical instruments with clutching and locking arrangements for linking an articulation drive system to a firing drive system |
US11291440B2 (en) | 2018-08-20 | 2022-04-05 | Cilag Gmbh International | Method for operating a powered articulatable surgical instrument |
US10779821B2 (en) | 2018-08-20 | 2020-09-22 | Ethicon Llc | Surgical stapler anvils with tissue stop features configured to avoid tissue pinch |
US10856870B2 (en) | 2018-08-20 | 2020-12-08 | Ethicon Llc | Switching arrangements for motor powered articulatable surgical instruments |
US11083458B2 (en) | 2018-08-20 | 2021-08-10 | Cilag Gmbh International | Powered surgical instruments with clutching arrangements to convert linear drive motions to rotary drive motions |
US11045192B2 (en) | 2018-08-20 | 2021-06-29 | Cilag Gmbh International | Fabricating techniques for surgical stapler anvils |
US11207065B2 (en) | 2018-08-20 | 2021-12-28 | Cilag Gmbh International | Method for fabricating surgical stapler anvils |
US11350978B2 (en) | 2018-09-07 | 2022-06-07 | Cilag Gmbh International | Flexible neutral electrode |
EP3850338B1 (en) * | 2018-09-11 | 2023-06-07 | Koninklijke Philips N.V. | Optical method for gingivitis detection |
US11376006B2 (en) | 2019-02-06 | 2022-07-05 | Covidien Lp | End effector force measurement with digital drive circuit |
US11369377B2 (en) | 2019-02-19 | 2022-06-28 | Cilag Gmbh International | Surgical stapling assembly with cartridge based retainer configured to unlock a firing lockout |
US11464511B2 (en) | 2019-02-19 | 2022-10-11 | Cilag Gmbh International | Surgical staple cartridges with movable authentication key arrangements |
US11317915B2 (en) | 2019-02-19 | 2022-05-03 | Cilag Gmbh International | Universal cartridge based key feature that unlocks multiple lockout arrangements in different surgical staplers |
US11357503B2 (en) | 2019-02-19 | 2022-06-14 | Cilag Gmbh International | Staple cartridge retainers with frangible retention features and methods of using same |
US11272931B2 (en) | 2019-02-19 | 2022-03-15 | Cilag Gmbh International | Dual cam cartridge based feature for unlocking a surgical stapler lockout |
US11147553B2 (en) | 2019-03-25 | 2021-10-19 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11172929B2 (en) | 2019-03-25 | 2021-11-16 | Cilag Gmbh International | Articulation drive arrangements for surgical systems |
US11696761B2 (en) | 2019-03-25 | 2023-07-11 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11147551B2 (en) | 2019-03-25 | 2021-10-19 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11452528B2 (en) | 2019-04-30 | 2022-09-27 | Cilag Gmbh International | Articulation actuators for a surgical instrument |
US11471157B2 (en) | 2019-04-30 | 2022-10-18 | Cilag Gmbh International | Articulation control mapping for a surgical instrument |
US11648009B2 (en) | 2019-04-30 | 2023-05-16 | Cilag Gmbh International | Rotatable jaw tip for a surgical instrument |
US11432816B2 (en) | 2019-04-30 | 2022-09-06 | Cilag Gmbh International | Articulation pin for a surgical instrument |
US11253254B2 (en) | 2019-04-30 | 2022-02-22 | Cilag Gmbh International | Shaft rotation actuator on a surgical instrument |
US11903581B2 (en) | 2019-04-30 | 2024-02-20 | Cilag Gmbh International | Methods for stapling tissue using a surgical instrument |
US11426251B2 (en) | 2019-04-30 | 2022-08-30 | Cilag Gmbh International | Articulation directional lights on a surgical instrument |
US11728033B2 (en) * | 2019-05-29 | 2023-08-15 | Medos International Sarl | Dynamic adaptation of clinical procedures and device assessment generation based on determined emotional state |
US11690624B2 (en) * | 2019-06-21 | 2023-07-04 | Covidien Lp | Reload assembly injection molded strain gauge |
USD964564S1 (en) | 2019-06-25 | 2022-09-20 | Cilag Gmbh International | Surgical staple cartridge retainer with a closure system authentication key |
USD952144S1 (en) | 2019-06-25 | 2022-05-17 | Cilag Gmbh International | Surgical staple cartridge retainer with firing system authentication key |
USD950728S1 (en) | 2019-06-25 | 2022-05-03 | Cilag Gmbh International | Surgical staple cartridge |
US11224497B2 (en) | 2019-06-28 | 2022-01-18 | Cilag Gmbh International | Surgical systems with multiple RFID tags |
US11497492B2 (en) | 2019-06-28 | 2022-11-15 | Cilag Gmbh International | Surgical instrument including an articulation lock |
US11771419B2 (en) | 2019-06-28 | 2023-10-03 | Cilag Gmbh International | Packaging for a replaceable component of a surgical stapling system |
US11259803B2 (en) | 2019-06-28 | 2022-03-01 | Cilag Gmbh International | Surgical stapling system having an information encryption protocol |
US11051807B2 (en) | 2019-06-28 | 2021-07-06 | Cilag Gmbh International | Packaging assembly including a particulate trap |
US11478241B2 (en) | 2019-06-28 | 2022-10-25 | Cilag Gmbh International | Staple cartridge including projections |
US11553971B2 (en) | 2019-06-28 | 2023-01-17 | Cilag Gmbh International | Surgical RFID assemblies for display and communication |
US11246678B2 (en) | 2019-06-28 | 2022-02-15 | Cilag Gmbh International | Surgical stapling system having a frangible RFID tag |
US11660163B2 (en) | 2019-06-28 | 2023-05-30 | Cilag Gmbh International | Surgical system with RFID tags for updating motor assembly parameters |
US11376098B2 (en) | 2019-06-28 | 2022-07-05 | Cilag Gmbh International | Surgical instrument system comprising an RFID system |
US11219455B2 (en) | 2019-06-28 | 2022-01-11 | Cilag Gmbh International | Surgical instrument including a lockout key |
US11523822B2 (en) | 2019-06-28 | 2022-12-13 | Cilag Gmbh International | Battery pack including a circuit interrupter |
US11684434B2 (en) | 2019-06-28 | 2023-06-27 | Cilag Gmbh International | Surgical RFID assemblies for instrument operational setting control |
US11298127B2 (en) | 2019-06-28 | 2022-04-12 | Cilag GmbH Interational | Surgical stapling system having a lockout mechanism for an incompatible cartridge |
US11241235B2 (en) | 2019-06-28 | 2022-02-08 | Cilag Gmbh International | Method of using multiple RFID chips with a surgical assembly |
US11291451B2 (en) | 2019-06-28 | 2022-04-05 | Cilag Gmbh International | Surgical instrument with battery compatibility verification functionality |
US11399837B2 (en) | 2019-06-28 | 2022-08-02 | Cilag Gmbh International | Mechanisms for motor control adjustments of a motorized surgical instrument |
US11627959B2 (en) | 2019-06-28 | 2023-04-18 | Cilag Gmbh International | Surgical instruments including manual and powered system lockouts |
US11638587B2 (en) | 2019-06-28 | 2023-05-02 | Cilag Gmbh International | RFID identification systems for surgical instruments |
US11464601B2 (en) | 2019-06-28 | 2022-10-11 | Cilag Gmbh International | Surgical instrument comprising an RFID system for tracking a movable component |
US11426167B2 (en) | 2019-06-28 | 2022-08-30 | Cilag Gmbh International | Mechanisms for proper anvil attachment surgical stapling head assembly |
US11298132B2 (en) | 2019-06-28 | 2022-04-12 | Cilag GmbH Inlernational | Staple cartridge including a honeycomb extension |
US11877833B2 (en) | 2019-07-26 | 2024-01-23 | Covidien Lp | Systems and methods for monitoring blood pressure with a powered linear drive |
KR102159207B1 (en) * | 2019-08-07 | 2020-09-23 | 비앤알(주) | Device for detection of blood vessel and surgical instrument for laparoscopy comprising the same |
CN112386335A (en) | 2019-08-12 | 2021-02-23 | 巴德阿克塞斯系统股份有限公司 | Shape sensing systems and methods for medical devices |
US11123068B2 (en) * | 2019-11-08 | 2021-09-21 | Covidien Lp | Surgical staple cartridge |
US11395653B2 (en) * | 2019-11-26 | 2022-07-26 | Covidien Lp | Surgical stapling device with impedance sensor |
US11925347B2 (en) | 2019-12-13 | 2024-03-12 | Dinesh Vyas | Stapler apparatus and methods for use |
US20230056943A1 (en) * | 2019-12-13 | 2023-02-23 | Dinesh Vyas | Stapler apparatus and methods for use |
US11931033B2 (en) | 2019-12-19 | 2024-03-19 | Cilag Gmbh International | Staple cartridge comprising a latch lockout |
US11607219B2 (en) | 2019-12-19 | 2023-03-21 | Cilag Gmbh International | Staple cartridge comprising a detachable tissue cutting knife |
US11701111B2 (en) | 2019-12-19 | 2023-07-18 | Cilag Gmbh International | Method for operating a surgical stapling instrument |
US11529139B2 (en) | 2019-12-19 | 2022-12-20 | Cilag Gmbh International | Motor driven surgical instrument |
US11304696B2 (en) | 2019-12-19 | 2022-04-19 | Cilag Gmbh International | Surgical instrument comprising a powered articulation system |
US11559304B2 (en) | 2019-12-19 | 2023-01-24 | Cilag Gmbh International | Surgical instrument comprising a rapid closure mechanism |
US11291447B2 (en) | 2019-12-19 | 2022-04-05 | Cilag Gmbh International | Stapling instrument comprising independent jaw closing and staple firing systems |
US11576672B2 (en) | 2019-12-19 | 2023-02-14 | Cilag Gmbh International | Surgical instrument comprising a closure system including a closure member and an opening member driven by a drive screw |
US11844520B2 (en) | 2019-12-19 | 2023-12-19 | Cilag Gmbh International | Staple cartridge comprising driver retention members |
US11234698B2 (en) | 2019-12-19 | 2022-02-01 | Cilag Gmbh International | Stapling system comprising a clamp lockout and a firing lockout |
US11529137B2 (en) | 2019-12-19 | 2022-12-20 | Cilag Gmbh International | Staple cartridge comprising driver retention members |
US11911032B2 (en) | 2019-12-19 | 2024-02-27 | Cilag Gmbh International | Staple cartridge comprising a seating cam |
US11464512B2 (en) | 2019-12-19 | 2022-10-11 | Cilag Gmbh International | Staple cartridge comprising a curved deck surface |
US11446029B2 (en) | 2019-12-19 | 2022-09-20 | Cilag Gmbh International | Staple cartridge comprising projections extending from a curved deck surface |
US11504122B2 (en) | 2019-12-19 | 2022-11-22 | Cilag Gmbh International | Surgical instrument comprising a nested firing member |
US20210196302A1 (en) * | 2019-12-30 | 2021-07-01 | Ethicon Llc | Method for operating a surgical instrument |
USD966512S1 (en) | 2020-06-02 | 2022-10-11 | Cilag Gmbh International | Staple cartridge |
USD975278S1 (en) | 2020-06-02 | 2023-01-10 | Cilag Gmbh International | Staple cartridge |
USD976401S1 (en) | 2020-06-02 | 2023-01-24 | Cilag Gmbh International | Staple cartridge |
USD975850S1 (en) | 2020-06-02 | 2023-01-17 | Cilag Gmbh International | Staple cartridge |
USD974560S1 (en) | 2020-06-02 | 2023-01-03 | Cilag Gmbh International | Staple cartridge |
USD975851S1 (en) | 2020-06-02 | 2023-01-17 | Cilag Gmbh International | Staple cartridge |
USD967421S1 (en) | 2020-06-02 | 2022-10-18 | Cilag Gmbh International | Staple cartridge |
US20210393310A1 (en) * | 2020-06-23 | 2021-12-23 | Olympus Corporation | Method for controlling a medical device and a medical device implementing the same |
US11737748B2 (en) | 2020-07-28 | 2023-08-29 | Cilag Gmbh International | Surgical instruments with double spherical articulation joints with pivotable links |
US11872355B2 (en) * | 2020-09-04 | 2024-01-16 | Covidien Lp | Medical device for detecting fluid parameters using fluorescent probes |
CN217525118U (en) * | 2020-09-25 | 2022-10-04 | 巴德阿克塞斯系统股份有限公司 | Medical instrument system for inserting a medical instrument into a patient |
US11717289B2 (en) | 2020-10-29 | 2023-08-08 | Cilag Gmbh International | Surgical instrument comprising an indicator which indicates that an articulation drive is actuatable |
US11779330B2 (en) | 2020-10-29 | 2023-10-10 | Cilag Gmbh International | Surgical instrument comprising a jaw alignment system |
US11517390B2 (en) | 2020-10-29 | 2022-12-06 | Cilag Gmbh International | Surgical instrument comprising a limited travel switch |
US11452526B2 (en) | 2020-10-29 | 2022-09-27 | Cilag Gmbh International | Surgical instrument comprising a staged voltage regulation start-up system |
USD1013170S1 (en) | 2020-10-29 | 2024-01-30 | Cilag Gmbh International | Surgical instrument assembly |
US11896217B2 (en) | 2020-10-29 | 2024-02-13 | Cilag Gmbh International | Surgical instrument comprising an articulation lock |
US11931025B2 (en) | 2020-10-29 | 2024-03-19 | Cilag Gmbh International | Surgical instrument comprising a releasable closure drive lock |
US11844518B2 (en) | 2020-10-29 | 2023-12-19 | Cilag Gmbh International | Method for operating a surgical instrument |
USD980425S1 (en) | 2020-10-29 | 2023-03-07 | Cilag Gmbh International | Surgical instrument assembly |
US11617577B2 (en) | 2020-10-29 | 2023-04-04 | Cilag Gmbh International | Surgical instrument comprising a sensor configured to sense whether an articulation drive of the surgical instrument is actuatable |
US11534259B2 (en) | 2020-10-29 | 2022-12-27 | Cilag Gmbh International | Surgical instrument comprising an articulation indicator |
US11737751B2 (en) | 2020-12-02 | 2023-08-29 | Cilag Gmbh International | Devices and methods of managing energy dissipated within sterile barriers of surgical instrument housings |
US11744581B2 (en) | 2020-12-02 | 2023-09-05 | Cilag Gmbh International | Powered surgical instruments with multi-phase tissue treatment |
US11944296B2 (en) | 2020-12-02 | 2024-04-02 | Cilag Gmbh International | Powered surgical instruments with external connectors |
US11653920B2 (en) | 2020-12-02 | 2023-05-23 | Cilag Gmbh International | Powered surgical instruments with communication interfaces through sterile barrier |
US11849943B2 (en) | 2020-12-02 | 2023-12-26 | Cilag Gmbh International | Surgical instrument with cartridge release mechanisms |
US11890010B2 (en) | 2020-12-02 | 2024-02-06 | Cllag GmbH International | Dual-sided reinforced reload for surgical instruments |
US11653915B2 (en) | 2020-12-02 | 2023-05-23 | Cilag Gmbh International | Surgical instruments with sled location detection and adjustment features |
US11678882B2 (en) | 2020-12-02 | 2023-06-20 | Cilag Gmbh International | Surgical instruments with interactive features to remedy incidental sled movements |
US11627960B2 (en) | 2020-12-02 | 2023-04-18 | Cilag Gmbh International | Powered surgical instruments with smart reload with separately attachable exteriorly mounted wiring connections |
US11749877B2 (en) | 2021-02-26 | 2023-09-05 | Cilag Gmbh International | Stapling instrument comprising a signal antenna |
US11701113B2 (en) | 2021-02-26 | 2023-07-18 | Cilag Gmbh International | Stapling instrument comprising a separate power antenna and a data transfer antenna |
US11793514B2 (en) | 2021-02-26 | 2023-10-24 | Cilag Gmbh International | Staple cartridge comprising sensor array which may be embedded in cartridge body |
US11696757B2 (en) | 2021-02-26 | 2023-07-11 | Cilag Gmbh International | Monitoring of internal systems to detect and track cartridge motion status |
US11744583B2 (en) | 2021-02-26 | 2023-09-05 | Cilag Gmbh International | Distal communication array to tune frequency of RF systems |
US11925349B2 (en) | 2021-02-26 | 2024-03-12 | Cilag Gmbh International | Adjustment to transfer parameters to improve available power |
US11751869B2 (en) * | 2021-02-26 | 2023-09-12 | Cilag Gmbh International | Monitoring of multiple sensors over time to detect moving characteristics of tissue |
US11723657B2 (en) | 2021-02-26 | 2023-08-15 | Cilag Gmbh International | Adjustable communication based on available bandwidth and power capacity |
US11730473B2 (en) | 2021-02-26 | 2023-08-22 | Cilag Gmbh International | Monitoring of manufacturing life-cycle |
US20220273294A1 (en) * | 2021-02-26 | 2022-09-01 | Cilag Gmbh International | Surgical instrument system comprising a power transfer coil |
US11812964B2 (en) | 2021-02-26 | 2023-11-14 | Cilag Gmbh International | Staple cartridge comprising a power management circuit |
US11950779B2 (en) | 2021-02-26 | 2024-04-09 | Cilag Gmbh International | Method of powering and communicating with a staple cartridge |
US11950777B2 (en) | 2021-02-26 | 2024-04-09 | Cilag Gmbh International | Staple cartridge comprising an information access control system |
US11826012B2 (en) | 2021-03-22 | 2023-11-28 | Cilag Gmbh International | Stapling instrument comprising a pulsed motor-driven firing rack |
US11723658B2 (en) | 2021-03-22 | 2023-08-15 | Cilag Gmbh International | Staple cartridge comprising a firing lockout |
US11806011B2 (en) | 2021-03-22 | 2023-11-07 | Cilag Gmbh International | Stapling instrument comprising tissue compression systems |
US11717291B2 (en) | 2021-03-22 | 2023-08-08 | Cilag Gmbh International | Staple cartridge comprising staples configured to apply different tissue compression |
US11737749B2 (en) | 2021-03-22 | 2023-08-29 | Cilag Gmbh International | Surgical stapling instrument comprising a retraction system |
US11759202B2 (en) | 2021-03-22 | 2023-09-19 | Cilag Gmbh International | Staple cartridge comprising an implantable layer |
US11826042B2 (en) | 2021-03-22 | 2023-11-28 | Cilag Gmbh International | Surgical instrument comprising a firing drive including a selectable leverage mechanism |
US11849944B2 (en) | 2021-03-24 | 2023-12-26 | Cilag Gmbh International | Drivers for fastener cartridge assemblies having rotary drive screws |
US11849945B2 (en) | 2021-03-24 | 2023-12-26 | Cilag Gmbh International | Rotary-driven surgical stapling assembly comprising eccentrically driven firing member |
US11786243B2 (en) | 2021-03-24 | 2023-10-17 | Cilag Gmbh International | Firing members having flexible portions for adapting to a load during a surgical firing stroke |
US11896218B2 (en) | 2021-03-24 | 2024-02-13 | Cilag Gmbh International | Method of using a powered stapling device |
US11896219B2 (en) | 2021-03-24 | 2024-02-13 | Cilag Gmbh International | Mating features between drivers and underside of a cartridge deck |
US11793516B2 (en) | 2021-03-24 | 2023-10-24 | Cilag Gmbh International | Surgical staple cartridge comprising longitudinal support beam |
US11832816B2 (en) | 2021-03-24 | 2023-12-05 | Cilag Gmbh International | Surgical stapling assembly comprising nonplanar staples and planar staples |
US11857183B2 (en) | 2021-03-24 | 2024-01-02 | Cilag Gmbh International | Stapling assembly components having metal substrates and plastic bodies |
US11903582B2 (en) | 2021-03-24 | 2024-02-20 | Cilag Gmbh International | Leveraging surfaces for cartridge installation |
US11786239B2 (en) | 2021-03-24 | 2023-10-17 | Cilag Gmbh International | Surgical instrument articulation joint arrangements comprising multiple moving linkage features |
US11944336B2 (en) | 2021-03-24 | 2024-04-02 | Cilag Gmbh International | Joint arrangements for multi-planar alignment and support of operational drive shafts in articulatable surgical instruments |
US11744603B2 (en) | 2021-03-24 | 2023-09-05 | Cilag Gmbh International | Multi-axis pivot joints for surgical instruments and methods for manufacturing same |
US11950860B2 (en) | 2021-03-30 | 2024-04-09 | Cilag Gmbh International | User interface mitigation techniques for modular energy systems |
US11826047B2 (en) | 2021-05-28 | 2023-11-28 | Cilag Gmbh International | Stapling instrument comprising jaw mounts |
EP4356398A1 (en) | 2021-06-14 | 2024-04-24 | Preh Holding, LLC | Connected body surface care module |
US11883028B2 (en) | 2021-09-08 | 2024-01-30 | Covidien Lp | Systems and methods for post-operative anastomotic leak detection |
US11957337B2 (en) | 2021-10-18 | 2024-04-16 | Cilag Gmbh International | Surgical stapling assembly with offset ramped drive surfaces |
US11877745B2 (en) | 2021-10-18 | 2024-01-23 | Cilag Gmbh International | Surgical stapling assembly having longitudinally-repeating staple leg clusters |
US11937816B2 (en) | 2021-10-28 | 2024-03-26 | Cilag Gmbh International | Electrical lead arrangements for surgical instruments |
US20230290497A1 (en) * | 2022-03-10 | 2023-09-14 | Ix Innovation Llc | Implantable sensor device |
JP7408869B1 (en) | 2023-04-12 | 2024-01-05 | 日機装株式会社 | blood purification device |
JP7408868B1 (en) | 2023-04-12 | 2024-01-05 | 日機装株式会社 | blood purification device |
Family Cites Families (38)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4515165A (en) * | 1980-02-04 | 1985-05-07 | Energy Conversion Devices, Inc. | Apparatus and method for detecting tumors |
US5318023A (en) * | 1991-04-03 | 1994-06-07 | Cedars-Sinai Medical Center | Apparatus and method of use for a photosensitizer enhanced fluorescence based biopsy needle |
US5772597A (en) | 1992-09-14 | 1998-06-30 | Sextant Medical Corporation | Surgical tool end effector |
US5987346A (en) * | 1993-02-26 | 1999-11-16 | Benaron; David A. | Device and method for classification of tissue |
US5833603A (en) * | 1996-03-13 | 1998-11-10 | Lipomatrix, Inc. | Implantable biosensing transponder |
GB9623363D0 (en) * | 1996-11-09 | 1997-01-08 | Moor Instr Ltd | Apparatus for measuring microvascular blood flow |
US5860917A (en) * | 1997-01-15 | 1999-01-19 | Chiron Corporation | Method and apparatus for predicting therapeutic outcomes |
US6317624B1 (en) * | 1997-05-05 | 2001-11-13 | The General Hospital Corporation | Apparatus and method for demarcating tumors |
AU743966B2 (en) * | 1998-01-22 | 2002-02-14 | Biosense, Inc. | Intrabody measurement |
US6174291B1 (en) | 1998-03-09 | 2001-01-16 | Spectrascience, Inc. | Optical biopsy system and methods for tissue diagnosis |
US6391023B1 (en) | 1998-05-28 | 2002-05-21 | Pearl Technology Holdings, Llc | Thermal radiation facelift device |
GB9814506D0 (en) * | 1998-07-03 | 1998-09-02 | Stanley Christopher J | Optical sensor for insitu measurement of analytes |
CA2341724C (en) | 1998-09-30 | 2010-12-21 | Sicel Technologies, Inc. | Methods, systems, and associated implantable devices for dynamic monitoring of tumors |
JP3796086B2 (en) * | 1999-12-27 | 2006-07-12 | 株式会社日立製作所 | Biological light measurement device |
CN100594848C (en) | 1999-12-30 | 2010-03-24 | 珍品技术控股有限公司 | Device for performing face-lifting surgery |
WO2002007587A2 (en) | 2000-07-14 | 2002-01-31 | Xillix Technologies Corporation | Compact fluorescent endoscopy video system |
US6494882B1 (en) * | 2000-07-25 | 2002-12-17 | Verimetra, Inc. | Cutting instrument having integrated sensors |
DE10059070C1 (en) * | 2000-11-28 | 2002-02-14 | Pulsion Medical Sys Ag | Device for determining tissue perfusion has source and expansion optics arranged in safety housing so only expanded beam of intensity within safety limits for persons near device emanates |
JP4090699B2 (en) * | 2001-04-02 | 2008-05-28 | 株式会社日立製作所 | Biological light measurement device |
US7769432B2 (en) * | 2001-12-10 | 2010-08-03 | Board Of Trustees Of The University Of Arkansas | Minimally invasive diagnosis and treatment for breast cancer |
US7720532B2 (en) * | 2004-03-23 | 2010-05-18 | Dune Medical Ltd. | Clean margin assessment tool |
US20060241496A1 (en) | 2002-01-15 | 2006-10-26 | Xillix Technologies Corp. | Filter for use with imaging endoscopes |
ES2377483T3 (en) * | 2002-04-25 | 2012-03-28 | Tyco Healthcare Group Lp | Surgical instruments that include microelectromechanical systems (MEMS) |
WO2003094754A1 (en) * | 2002-05-09 | 2003-11-20 | Tyco Healthcare Group Lp | Organ retractor and method of using the same |
CA2499469C (en) | 2002-07-17 | 2013-06-04 | Novadaq Technologies Inc. | Combined photocoagulation and photodynamic therapy |
CA2515439A1 (en) * | 2003-02-07 | 2004-08-26 | Ramez Emile Necola Shehada | Surgical drain with sensors for monitoring internal tissue condition and for monitoring fluid in lumen |
WO2005032342A2 (en) * | 2003-09-30 | 2005-04-14 | Vanderbilt University | Methods and apparatus for optical spectroscopic detection of cell and tissue death |
US7720521B2 (en) * | 2004-04-21 | 2010-05-18 | Acclarent, Inc. | Methods and devices for performing procedures within the ear, nose, throat and paranasal sinuses |
US20070208252A1 (en) * | 2004-04-21 | 2007-09-06 | Acclarent, Inc. | Systems and methods for performing image guided procedures within the ear, nose, throat and paranasal sinuses |
US7640046B2 (en) * | 2004-06-18 | 2009-12-29 | Cardiac Pacemakers, Inc. | Methods and apparatuses for localizing myocardial infarction during catheterization |
US9204830B2 (en) | 2005-04-15 | 2015-12-08 | Surgisense Corporation | Surgical instruments with sensors for detecting tissue properties, and system using such instruments |
US20060239921A1 (en) | 2005-04-26 | 2006-10-26 | Novadaq Technologies Inc. | Real time vascular imaging during solid organ transplant |
WO2006116634A2 (en) | 2005-04-26 | 2006-11-02 | Novadaq Technologies, Inc. | Method and apparatus for vasculature visualization with applications in neurosurgery and neurology |
JP5058977B2 (en) | 2005-04-29 | 2012-10-24 | ノバダック テクノロジーズ インコーポレイテッド | System for imaging and treating the choroid and retina |
US10231624B2 (en) | 2005-08-10 | 2019-03-19 | Nov Adaq Technologies Ulc | Intra-operative head and neck nerve mapping |
US7420151B2 (en) | 2005-10-17 | 2008-09-02 | Novadaq Technologies Inc. | Device for short wavelength visible reflectance endoscopy using broadband illumination |
US20090303317A1 (en) | 2006-02-07 | 2009-12-10 | Novadaq Technologies Inc. | Near infrared imaging |
CA2721075C (en) * | 2008-04-11 | 2016-12-13 | Physcient, Inc. | Methods and devices to decrease tissue trauma during surgery |
-
2006
- 2006-04-14 US US11/918,456 patent/US9204830B2/en active Active
- 2006-04-14 EP EP16001279.5A patent/EP3095379A1/en not_active Withdrawn
- 2006-04-14 CA CA2604563A patent/CA2604563C/en active Active
- 2006-04-14 CN CN200680021505XA patent/CN101495025B/en active Active
- 2006-04-14 WO PCT/US2006/013985 patent/WO2006113394A2/en active Application Filing
- 2006-04-14 EP EP06758332.8A patent/EP1868485B1/en active Active
- 2006-04-14 CN CN201310328574.7A patent/CN103622725B/en active Active
-
2015
- 2015-11-23 US US14/949,846 patent/US10231634B2/en active Active
-
2019
- 2019-03-12 US US16/299,808 patent/US11324412B2/en active Active
-
2022
- 2022-05-09 US US17/739,982 patent/US11517213B2/en active Active
- 2022-12-06 US US18/076,131 patent/US20230363658A1/en active Pending
Also Published As
Publication number | Publication date |
---|---|
US20230363658A1 (en) | 2023-11-16 |
US20160073909A1 (en) | 2016-03-17 |
US9204830B2 (en) | 2015-12-08 |
EP1868485B1 (en) | 2016-06-08 |
CN101495025B (en) | 2013-09-04 |
EP1868485A4 (en) | 2010-10-20 |
CA2604563C (en) | 2020-07-28 |
CN101495025A (en) | 2009-07-29 |
US20090054908A1 (en) | 2009-02-26 |
EP1868485A2 (en) | 2007-12-26 |
US11324412B2 (en) | 2022-05-10 |
US20220257125A1 (en) | 2022-08-18 |
CN103622725B (en) | 2018-02-02 |
US10231634B2 (en) | 2019-03-19 |
WO2006113394A2 (en) | 2006-10-26 |
US11517213B2 (en) | 2022-12-06 |
CN103622725A (en) | 2014-03-12 |
EP3095379A1 (en) | 2016-11-23 |
US20190209024A1 (en) | 2019-07-11 |
WO2006113394A3 (en) | 2009-04-16 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
US11517213B2 (en) | Surgical instruments with sensors for detecting tissue properties, and system using such instruments | |
US11903703B2 (en) | Wireless laparoscopic probe | |
US20210338121A1 (en) | Apparatus, systems and methods for determining tissue oxygenation | |
CA2763087C (en) | Handheld apparatus to determine the viability of a biological tissue | |
JP6457806B2 (en) | Instrument for optical detection of tissue attributes | |
US5772597A (en) | Surgical tool end effector | |
Fischer et al. | Ischemia and force sensing surgical instruments for augmenting available surgeon information | |
WO2016134327A1 (en) | System for determining vessel size using light absorption | |
CN117042704A (en) | Predicting adhesions based on biomarker monitoring | |
Méndez | Biomedical fiber optic sensor applications | |
WO2009090293A1 (en) | Endoscopic probe with opto-electronic sensor for use in diagnostics and surgery |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
EEER | Examination request |