Patent Application
20240180580
A variety of surgical instruments include an end effector having a blade element that vibrates at ultrasonic frequencies to cut and/or seal tissue (e.g., by denaturing proteins in tissue cells). These instruments include piezoelectric elements that convert electrical power into ultrasonic vibrations, which are communicated along an acoustic waveguide to the blade element. The precision of cutting and coagulation may be controlled by the surgeon's technique and adjusting the power level, blade edge, tissue traction and blade pressure.
Examples of ultrasonic surgical instruments include the HARMONIC ACER Ultrasonic Shears, the HARMONIC WAVER Ultrasonic Shears, the HARMONIC FOCUS® Ultrasonic Shears, and the HARMONIC SYNERGY® Ultrasonic Blades, all by Ethicon Endo-Surgery, Inc. of Cincinnati, Ohio. Further examples of such devices and related concepts are disclosed in U.S. Pat. No. 5,322,055, entitled “Clamp Coagulator/Cutting System for Ultrasonic Surgical Instruments,” issued Jun. 21, 1994, the disclosure of which is incorporated by reference herein; U.S. Pat. No. 5,873,873, entitled “Ultrasonic Clamp Coagulator Apparatus Having Improved Clamp Mechanism,” issued Feb. 23, 1999, the disclosure of which is incorporated by reference herein; U.S. Pat. No. 5,980,510, entitled “Ultrasonic Clamp Coagulator Apparatus Having Improved Clamp Arm Pivot Mount,” filed Oct. 10, 1997, the disclosure of which is incorporated by reference herein; U.S. Pat. No. 6,325,811, entitled “Blades with Functional Balance Asymmetries for use with Ultrasonic Surgical Instruments,” issued Dec. 4, 2001, the disclosure of which is incorporated by reference herein; U.S. Pat. No. 6,773,444, entitled “Blades with Functional Balance Asymmetries for Use with Ultrasonic Surgical Instruments,” issued Aug. 10, 2004, the disclosure of which is incorporated by reference herein; and U.S. Pat. No. 6,783,524, entitled “Robotic Surgical Tool with Ultrasound Cauterizing and Cutting Instrument,” issued Aug. 31, 2004, the disclosure of which is incorporated by reference herein.
Still further examples of ultrasonic surgical instruments are disclosed in U.S. Pub. No. 2006/0079874, entitled “Tissue Pad for Use with an Ultrasonic Surgical Instrument,” published Apr. 13, 2006, now abandoned, the disclosure of which is incorporated by reference herein; U.S. Pub. No. 2007/0191713, entitled “Ultrasonic Device for Cutting and Coagulating,” published Aug. 16, 2007, now abandoned, the disclosure of which is incorporated by reference herein; U.S. Pub. No. 2007/0282333, entitled “Ultrasonic Waveguide and Blade,” published Dec. 6, 2007, now abandoned, the disclosure of which is incorporated by reference hercin; U.S. Pub. No. 2008/0200940, entitled “Ultrasonic Device for Cutting and Coagulating,” published Aug. 21, 2008, now abandoned, the disclosure of which is incorporated by reference herein; U.S. Pub. No. 2009/0105750, entitled “Ergonomic Surgical Instruments,” published Apr. 23, 2009, , issued as U.S. Pat. No. 8,623,027 on Jan. 7, 2014 the disclosure of which is incorporated by reference herein; U.S. Pub. No. 2010/0069940, entitled “Ultrasonic Device for Fingertip Control,” published Mar. 18, 2010, issued as U.S. Pat. No. 9,023,071 on May 5, 2015, the disclosure of which is incorporated by reference herein; and U.S. Pub. No. 2011/0015660, entitled “Rotating Transducer Mount for Ultrasonic Surgical Instruments,” published Jan. 20, 2011, issued as U.S. Pat. No. 8,461,744 on Jun. 11, 2013, the disclosure of which is incorporated by reference herein; and U.S. Pub. No. 2012/0029546, entitled “Ultrasonic Surgical Instrument Blades,” published Feb. 2, 2012, issued as U.S. Pat. No. 8,591,536 on Nov. 26, 2013, the disclosure of which is incorporated by reference herein.
Some ultrasonic surgical instruments may include an articulating shaft section. Examples of such ultrasonic surgical instruments are disclosed in U.S. Pub. No. 2014/0005701, entitled “Surgical Instruments with Articulating Shafts,” published Jan. 2, 2014, issued as U.S. Pat. No. 9,393,037 on Jul. 19, 2016, the disclosure of which is incorporated by reference herein; and U.S. Pub. No. 2014/0114334, entitled “Flexible Harmonic Waveguides/Blades for Surgical Instruments,” published Apr. 24, 2014, issued as U.S. Pat. No. 9,095,367 on Aug. 4, 2015, the disclosure of which is incorporated by reference herein.
As a result of the critical nature of procedures performed with surgical instruments, extremely tight tolerances may be required both for newly manufactured instruments as well as for reusable instruments that have previously been put into service. While a particular surgical instrument may meet or exceed a specification at the time of manufacture, its performance may degrade after several uses due to normal wear and tear, or due to expansion of parts as a result of heat sterilization between uses. While manufacturers of such a product may provide guidelines for a number of uses before an instrument should be disposed of, cost conscious end users may ignore such guidelines and create safety and usage issues for end users and patients.
While a variety of systems have been made and used for surgical device lifecycle management, it is believed that no one prior to the inventor(s) has made or used the technology as described herein.
It is believed the present invention will be better understood from the following description of certain examples taken in conjunction with the accompanying drawings, in which like reference numerals identify the same elements and in which:
The following description of certain examples of the technology should not be used to limit its scope. Other examples, features, aspects, embodiments, and advantages of the technology will become apparent to those skilled in the art from the following description, which is by way of illustration, one of the best modes contemplated for carrying out the technology. As will be realized, the technology described herein is capable of other different and obvious aspects, all without departing from the technology. Accordingly, the drawings and descriptions should be regarded as illustrative in nature and not restrictive.
It is further understood that any one or more of the teachings, expressions, embodiments, examples, etc. described herein may be combined with any one or more of the other teachings, expressions, embodiments, examples, etc. that are described herein. The following-described teachings, expressions, embodiments, examples, etc. should therefore not be viewed in isolation relative to each other. Various suitable ways in which the teachings herein may be combined will be readily apparent to those of ordinary skill in the art in view of the teachings herein. Such modifications and variations are intended to be included within the scope of the claims.
For clarity of disclosure, the terms “proximal” and “distal” are defined herein relative to a human or robotic operator of the surgical instrument. The term “proximal” refers the position of an element closer to the human or robotic operator of the surgical instrument and further away from the surgical end effector of the surgical instrument. The term “distal” refers to the position of an element closer to the surgical end effector of the surgical instrument and further away from the human or robotic operator of the surgical instrument.
Instrument (100) is configured to be used as a shears. Instrument (100) of this example comprises a handle assembly (102), a shaft assembly (112), and an end effector (114). Handle assembly (102) comprises a body (104) including a pistol grip. Handle assembly (102) also includes a trigger (106) that is pivotable toward and away from pistol grip (108). It should be understood, however, that various other suitable configurations may be used, including but not limited to a pencil-grip configuration or a scissor-grip configuration. An ultrasonic transducer assembly (110) extends proximally from body (104) of handle assembly (102). Transducer assembly (110) is coupled with generator (122) via a cable (120) connected to receptacle assembly (124), such that instrument (100) and generator (122) cooperate to form an ultrasonic surgical system. Transducer assembly (110) receives electrical power from generator (122) and converts that power into ultrasonic vibrations through piezoelectric elements.
Various suitable forms that generator (122) may take will be apparent to those of ordinary skill in the art in view of the teachings herein, and may include, for example, a fixed battery, a removable battery, an inductive power supply, or the like. By way of example only, generator (122) may comprise a GEN 11 or GEN 300 sold by Ethicon Endo-Surgery, Inc. of Cincinnati, Ohio. In addition or in the alternative, generator (122) may be constructed in accordance with at least some of the teachings of U.S. Pat. No. 8,986,302, entitled “Surgical Generator for Ultrasonic and Electrosurgical Devices,” issued Mar. 24, 2015, the disclosure of which is incorporated by reference herein. Still other suitable forms that generator (122) may take, as well as various features and operabilities that generator (122) may provide, will be apparent to those of ordinary skill in the art in view of the teachings herein.
End effector (114) includes an ultrasonic blade (116) and a pivoting clamp arm (118). Clamp arm (118) is coupled with trigger (106) such that clamp arm (118) is pivotable toward ultrasonic blade (116) in response to pivoting of trigger (106) toward pistol grip (108); and such that clamp arm (118) is pivotable away from ultrasonic blade (116) in response to pivoting of trigger (106) away from pistol grip (108). Various suitable ways in which clamp arm (118) may be coupled with trigger (106) will be apparent to those of ordinary skill in the art in view of the teachings herein.
Blade (116) of the present example is operable to vibrate at ultrasonic frequencies in order to effectively cut through and seal tissue, particularly when the tissue is being compressed between clamp arm (118) and blade (116). Blade (116) is positioned at the distal end of an acoustic drivetrain. This acoustic drivetrain includes transducer assembly (110) and an acoustic waveguide (not shown) that extends through shaft assembly (112). Transducer assembly (110) includes a set of piezoelectric elements (not shown) that are located proximal to a horn (not shown) of the rigid acoustic waveguide. The piezoelectric discs are operable to convert electrical power into ultrasonic vibrations, which are then transmitted along the acoustic waveguide to blade (116) in accordance with known configurations and techniques. By way of example only, this portion of the acoustic drivetrain may be configured in accordance with the teachings of the various references that are cited herein. When ultrasonic blade (116) is in an activated state (i.e., vibrating ultrasonically), ultrasonic blade (116) is operable to effectively cut through and seal tissue, particularly when the tissue is being clamped between clamp arm (118) and ultrasonic blade (116).
While the following teachings are provided in the context of instrument (100), it should be understood that the following teachings may be readily applied in the contexts of various other kinds of instruments. By way of example only, the following teachings may be readily applied in the contexts of any of the instruments described in the various references cited herein. It should also be understood that the following teachings may be readily applied to instruments that are not ultrasonic surgical instruments, including but not limited to RF electrosurgical instruments, surgical staplers, and various other kinds of instruments. Other suitable contexts in which the following teachings may be applied will be apparent to those of ordinary skill in the art in view of the teachings herein.
Some surgical instruments, such instrument (100) described above, may implement usage tracking and control features to enable manufacturers to have some control over the instrument after an owner or end-user takes possession of the instrument. With complex and sensitive surgical instruments being used in life saving medical procedures, it can become a serious safety issue if surgical instruments are overused, abused, or otherwise used outside of their intended purpose or safe operating specification. To reduce dangers relating to overuse and abuse of surgical instruments, surgical instruments may be configured to become fully or partially disabled after the occurrence of certain events. As an example, a surgical instrument (100) may have fragile components that operate under high physical stress such as an end effector (114) or transducer (110). With unlimited use, failure of these components may be all but inevitable, and may have harmful consequences if a failure occurs during a surgical procedure.
To prevent dangerous over-use, a surgical instrument (100) may contain an EEPROM (150) or other memory feature that is configured to track various data such as the total amount of time instrument (100) is connected to a generator (122), the total number of activations of a blade (116) or clamp arm (118), the total number of times an advanced feature such as adaptive tissue technology (ATT) is activated, average power produced by instrument (100), average current drawn by instrument (100), activation types, activation durations, or other data stemming from the use of the instrument (100) during a surgical procedure. To further the example, when various conditions have been met, such as when information stored on EEPROM (150) indicates that instrument (100) has been activated more than 50 times, EEPROM (150) contents may be modified to completely disable instrument (100) until such a time that it can be inspected or reconditioned and returned to service. By way of example only, EEPROM (150) may be read and/or re-written by generator (122). By way of further example, EEPROM (150) may be located in handle assembly (102) or elsewhere. While an EEPROM (150) is used in the present example, various other suitable kinds of memory features that may be used will be apparent to those of ordinary skill in the art in view of the teachings herein.
These configurations may be broadly referred to as instrument (100) life management configurations or features, with the particular conditional events and resulting instrument (100) configuration changes varying by particular embodiments. One such instrument (100) life management feature could be to exclusively pair a particular surgical instrument (100) with a particular generator (122) after the instrument (100) is powered by the generator for an amount of time that exceeds a certain threshold. For example, if a surgical instrument (100) is connected to a generator (122) for more than 10 hours, EEPROM (150) of the instrument (100), and, in some cases, a memory of the generator (122), may cach be modified to store a unique identifier associated with the other. Whenever instrument (100) is connected to a given generator (122), that generator (122) will check EEPROM (150) of instrument (100) to determine if there is a unique generator identifier stored. If there is no unique identifier, instrument (100) will function with any generator (122) that it is connected to. If there is a unique identifier, instrument (100) will only function with the generator (122) that is uniquely identified by the identifier. This feature, which may be referred to as generator pairing, is intended to prevent a single instrument (100) from being used with many different generators (122) in an attempt to prevent any single generator (122) from gathering enough usage data to determine that the instrument (100) has exceeded a safe usage threshold, while still allowing an instrument (100) to be used in the ordinary course of a medical procedure, which may require that the instrument (100) be swapped out for another instrument (100), removed and cleaned, removed for troubleshooting, and the like. Generator's (122) ability to store generator identifiers could vary based upon desired capabilities, and could include, for example, permanent storage of identifiers, storage of a configurable number of recently used devices, storage of a unique identifier for a certain period of time, and other storage procedures.
Another instrument (100) life management feature could be to completely or partially disable an instrument (100) after the total time that the instrument (100) is plugged into any combination of generators (122) exceeds 12 hours. This feature may be referred to as a total powered time limitation, and may be tracked by constantly updating a time value stored on EEPROM (150) of the instrument (100), a memory of the generator (122), or both. Once the total powered time exceeds a threshold, such as 12 hours, EEPROM (150) or a generator (122) memory or both will be updated to store a piece of data indicating that the total powered time for the instrument (100) has been exceeded. Each time the instrument (100) is connected to a generator (122), this data is searched for and, if present, the instrument (100) will not function. This feature is intended to prevent overuse of the instrument (100) by circumventing its normal operations or using instrument (100) in unpredictable ways that may extend its allowed life. Limiting the total powered time may prevent a user from achieving indefinite use by attempting to circumvent generator (122) pairing.
Another instrument (100) life management feature could be a limitation on the number of times an instrument (100) could be plugged into a generator (122). This feature may be referred to as a total connection limitation, and may be tracked by incrementing a counter stored on EEPROM (150) of an instrument (100), a memory of generator (122), or both, each time the instrument (100) is connected to a generator (122). When this counter exceeds a certain limit, EEPROM (150) data may be modified to disable instrument (100) for subsequent connections. This feature is intended to prevent circumvention of safety features by connecting the instrument (100) only for very brief periods when it is needed, and keeping it unconnected from a power supply at all other times in order to prevent any usage data from being gathered or incremented on EEPROM (150). One or more of the above features may be implemented on surgical instruments (100) and generators (122) in order to prevent various circumventions of instrument (100) safety features.
Despite the inclusion of instrument (100) life management features in an instrument (100), some surgical instruments, especially those lacking a passive disconnected power source, may have weaknesses in usage tracking that may be exploited to circumvent these usage-based safety features. Due to the lack of any persistent real time clock in some instruments (100) and generators (122), a user of instrument (100) may briefly plug instrument (100) into a generator (122), use instrument (100), and unplug instrument (100) from generator (122) multiple times during a medical procedure. In this way, the user may avoid total powered time and generator (122) pairing limitations, and may still extend the life of instrument (100) far beyond its intended use before total connection limitations may disable instrument (100). One way to address this unintended usage would be to add a persistent clock to a surgical instrument (100) or generator (122). However, a persistent clock would then require a constant power supply, and may require recharging of a battery, battery replacement, placement near electrical outlets, and other complications that may be costly and may impair usability.
One alternative to adding an integral real time clock is to add a single use battery placed in a circuit with a predictable rate of discharge. For example,
The net result of the above described circuit is a battery (206) with known charge that discharges at a predictable rate after the first time an instrument (100) is connected to a generator (122).
By varying the beginning charge of battery (206) and the resistance of resistor (204), battery (206) can be configured to discharge from an initial charge to a depleted charge within a desired time frame, which, as an example only, may be approximately 4-12 hours. This allows instrument (100) to have a strictly enforced lifespan, beginning from the first time a connection is made with generator (122). This lifespan may be long enough to allow a lengthy surgical procedure to be completed, but short enough to greatly reduce the likelihood of overuse or abuse of instrument (100). Implementing a battery (206) in this way to simulate a persistent clock avoids the need for replacing or recharging batteries, as the battery in the circuit described above is intended to be a one-time discharge.
While resistor (204) is used in the foregoing example, any other suitable component(s) may be used as a load to discharge battery (206) at a predetermined rate. Various suitable alternative discharge load features will be apparent to those of ordinary skill in the art in view of the teachings herein. For example, one alternative could be to include a light emitting diode (LED) or other simple light source in place of resistor (204). This LED could be placed within the body of instrument (100) so that light emitted by the LED is not visible, or could be placed on the exterior of instrument (100) and provide a visible indicator of whether battery (206) still has a charge sufficient to light the LED, which could also serve as an indicator that battery (206) still has sufficient charge to allow instrument (100) to function. As an additional alternative example, an electric micro motor or a vibration motor could be used instead of resistor (204), so that battery (206) could discharge at a predetermine rate as a result of the micro motor or vibration motor's operation. Yet another alternative example could be to include a simple timer clement configured to countdown until a time of expiration, which could serve a dual purpose of providing both a countdown until expiration as well as a predictable rate of battery discharge, which could provide a useful redundancy for determining instrument (100) expiration despite a user's attempt to recharge battery (206). Other simple components or circuits could be used in place of or in addition to resistor (204), including but not limited to constant current sinks, various types of transmitters and receivers, an audio device such as a speaker, or other devices that might consume and convert into a different form the energy stored in a battery.
Another version of surgical instrument (100) may use a capacitor instead of a battery (206) to simulate a persistent clock for instrument (100) life management purposes.
While resistor (404) is used in the foregoing example, any other suitable component(s) may be used as a load to discharge capacitor (402) at a predetermined rate. Various suitable alternative discharge load features will be apparent to those of ordinary skill in the art in view of the teachings herein. As with the resistor (204) of FIG.2, resistor (404) could be replaced with or used in conjunction with an LED, a micro motor or haptic motor, a current sink, transmitter, receiver, speaker, timer, or other device or component that can predictably consume charge from capacitor (402).
Other circuit designs that may support a chargeable capacitor with predictable discharge will be apparent to one of ordinary skill in the art in light of the disclosure herein. For example,
Upon a first connection of instrument (100) to a generator (122), the charge bit will not be present (block 500) in any EEPROM (150) or memory, and generator (122) will charge (block 502) capacitor (402) to a configured initial charge level and then write (block 504) the charge bit to EEPROM (150), a memory, or both to indicate that capacitor (402) received its initial charge. Thereafter, instrument (100) may operate normally (block 306) for a period of time, such as the time it remains connected to generator (122) or until capacitor (402) is fully discharged. If, after connection (block 300), the charge bit is determined to be present (block 500), generator (122) or instrument (100) or both will determine the charge remaining in capacitor (402), and if the charge remaining exceeds a threshold (block 506) indicating that instrument (100) is still within a usable life since its first connection and charging, instrument (100) will operate normally. If there is no charge remaining (block 506), or the charge falls below a certain threshold indicating that instrument (100) is outside of its usable life, instrument (100) may operate at a reduced function or may be disabled completely (block 308).
As with the example that incorporates a battery (206), the initial capacitor (402) charge and resistor (404) resistance may be varied to give instrument (100) a predictable lifespan after the first connection with a generator (122), such that capacitor (402) will quickly charge upon connection between instrument (100) and generator (122). Capacitor (402) will then completely degrade to the point where capacitor (402) will report no charge or no substantial charge (block 506) and result in instrument (100) becoming fully or partially inoperable (block 308) after a period of time that may range from about four to about fourteen hours. This example may have some advantages over the example shown in
One variation of using a capacitor (402) or battery (206) to simulate a persistent clock would be to include a time tracking circuit in addition to a battery (206) or capacitor (402). In this manner a pre-charged battery (206), or a battery (206) or capacitor (402) that is charged upon connection between instrument (100) and generator (122), could provide a one-time reservoir of current to operate a time tracking circuit for between about four to fourteen hours and, when a configured elapsed time has been reached, write data to an EEPROM (150) or memory, or both, to indicate that instrument (100) is outside of its usable life.
Another variation on the above may be to include a circuit or mechanical component that provides a predictable and detectable change in some physical property that begins upon a connection of instrument (100) with a generator (122) instead of relying on a predictable change in voltage and charge level of a battery (206) or capacitor (402). This could include, for example, a predictable chemical reaction that begins upon connection, such as the release by mechanical means of a corrosive agent that over a predictable period of time eventually destroys a current carrying circuit or fuse; a release of a chemical that predictably changes the optical, resistive, capacitive, or similar properties of a sensor over time; or some other feature that relies on mechanical and/or chemical component to alter a state of instrument (100) after passage of a certain period of time following the initial coupling of instrument (100) with generator (122).
Another variation on the use of a capacitor (402) that is predictably discharged by a resistor (404) would be to use a high quality film capacitor instead of a capacitor (402) and resistor (404). A high quality film capacitor could be chosen based on low or predictable self-discharge characteristics. The high quality film capacitor could be charged upon initial connection similarly to the above described capacitor (402). The high quality film capacitor could be embedded in instrument (100) where it not visible or easily reachable, but where the use of a cleaning solution would expose the film capacitor to a conductive solution and cause it to fully or partially discharge when the instrument (100) is cleaned or sanitized after use. Upon a subsequent connection to a generator (122), a capacitor charge level that indicates instrument (100) has been exposed to a conductive cleaning solution can be used to fully or partially disable instrument (100) (block 308).
Another variation on the use of a capacitor (402) would be configure a capacitor (402) initial charge and resistor resistance (404) so that capacitor (402) is fully discharged between about five minutes and about twenty-five minutes after instrument (100) being disconnected from a generator (122); but while instrument (100) is connected to generator (122), capacitor (402) would always charge back to its initial charge level. The period of five to twenty-five minutes would allow for a user to disconnect instrument (100) for troubleshooting, brief cleaning, or to use a different instrument (100) with generator (122), but after such a period elapsed instrument (100) could be fully or partially disabled (block 308). In effect, an instrument (100) would maintain a high charge in capacitor (402) during constant use or during use with brief periods of disconnection; but once instrument (100) was disconnected from generator (122) for an extended period of time, such as at the end of a surgical procedure, capacitor (402) would discharge and write data to EEPROM (150) partially or fully disabling instrument (100) (block 308).
Capacitor (402) and resistor (404) may be implemented in a variety of ways in order to provide a particular desired life span for instrument (100). Voltage decay in a resistor-capacitor circuit is modeled with an exponential curve. The response of the decay is related to the amount of charge in the capacitor and the dissipative load associated with the capacitor's construction as well as external circuitry that are intended to either discharge the capacitor measure its voltage.
For instance, according to the examples discussed above, discharge times for a capacitor (402) may vary from about five minutes, to more than ten hours. Ignoring variations in capacitor (402) that would affect the charge accumulated, such as manufacturing tolerances and variances, a capacitor (402) may be charged to about 5V from a current of about 5 mA, to keep maximum measured voltage within a reasonable range for sensitive circuitry and voltages and currents easily available to instrument (100) and generator (122). This example also assumes no substantial self-discharge of capacitor (402), which may be managed in real world versions by selection of materials, connections, insulations, and removal of contaminants to achieve the desired result. Voltage measurements may be taken only briefly, in order to minimize discharge of capacitor (402) as a result of measurement. With the assumptions above, Table 1 shows merely illustrative examples of voltage and current across several time constants for 5V on capacitor (402) and a 10 M Ohm dissipative resistance and 0.25V threshold, which represents a 95% discharge and 3 time constants, using the equation Vc=Voe (t/RC), or c=(In Vo/ln Vc)*(−t/R). Table 2 shows exemplary capacitance values that might be appropriate within this example to achieve specific discharge times.
95%
Power to manage charging capacitor (402), and also to operate measurement and reporting circuitry, may be provided by generator (122). In order to rapidly charge capacitor (402) with current provided by generator (122), which may be about 5 mA, the smaller values of capacitance from Table 2 may be charged with a simple limiting resistor of 1 k ohms that keeps a 5V source limited to 5mA. The capacitor (402) for the 1, 2, and 5-minute discharge are charged with a half a second. The capacitor (402) for 10-hour discharge, with a 5 mA constant current, reaches a 5V charge in about 250 seconds. Suitable variations on the concepts above will be apparent to one of ordinary skill in the art in light of the disclosure herein.
User interface improvements for controls and displays available on generator (122) may be combined with other instrument (100) life management features to provide additional user feedback and inputs to better track instrument (100) usage and implement instrument (100) life management features.
If instrument (100) is unplugged from generator (122), generator (122) will display a prompt (block 806) to the user inquiring as to whether the case, or medical procedure, is complete. If the user indicates that the case is complete (block 808), the unique identifier associated with the used instrument (100) will be added to the listing of instruments (100) in generator (122), so that the same instrument (100), if connected again in the future (block 300), will be located on the listing of instruments (100) (block 800). If the user instead indicates that the case is not complete (block 808), the generator (122) will remain powered on and continue to track instrument (100) usage time (block 818). When instrument usage time tracked (block 818) by generator (122) exceeds (block 820) instrument (100) allowed use time, instrument (100) will be added to the listing of instruments in generator (122) and will be identified (block 800) as being listed in subsequent connections. In a different scenario, if generator (122) loses power (block 812), indicating that the user may be attempting to circumvent unplugging instrument (122) (block 804), generator (122) will immediately add instrument (122) to the list (block 810) before generator (122) completely powers down. In another scenario, if generator (122) reports any sort of error (block 816) that may indicate a legitimate need to power down generator (122), generator (122) will power down based upon a user input without adding instrument (100) to the generator list (block 816).
An external usage tracking device could also be used in conjunction with an instrument (100) and generator (122) to provide persistent time tracking of time intervals between a first connection of instrument (100) to a generator (122) and subsequent connections between instrument (100) and generator (122). An external usage tracking device could be in the form of a USB fob or stick that attaches to a USB port of generator (122), an adaptor that attaches inline between generator (122) and instrument (100), or the like; and may contain a processor, memory, and battery, and be configured to track the passage of time whether connected to a generator (122) or not. This could be achieved, for example, by tracking clock time, or by tracking the passage of seconds from an arbitrary time and relating each instrument (100) that the external usage tracking device communicates with to a point on the arbitrary timeline.
The external device could, in some versions, include wireless internet capabilities, Bluetooth capabilities, or other wireless or wired connections that could facilitate sharing of data between generator (122) and instrument (100) and one or more remote computers or servers, etc. This could allow valuable usage data to be pulled from sources that are typically not connected to a network and transmitted to a remote server for further use or study. This could additionally allow for software updates for generators (122) and instruments (100) to be disseminated through typical routine usage of generators (122) and instruments (100), rather than requiring special service by technicians or users.
When an instrument (100) is connected (block 300) to a generator (122), generator (122), or instrument (100), or both may examine EEPROM (150) or memory and retrieve instrument (100) usage information such as total connected time, total activation time, total activations, and similar instrument (100) usage so that one or more usage ratios may be determined (block 1000). A usage ratio might be total connected time relative to total activation time. Normal usage might indicate that during a ten-hour procedure instrument (100) is plugged in for 10 hours, and activated for 1 hour, so a usage ratio within the norm might be about 10:1. If the determined ratio exceeds this norm (block 1002) or falls below this norm (block 1004) by a substantial difference, instrument (100) may be placed into a state of reduced or disabled operation (block 308) by modifying EEPROM (150) of instrument (100). If the determined ratio (block 1000) is comparable to the expected ratio, instrument (100) may operate normally (block 306).
While
This instrument (100) life management feature may be useful where, for example, a user attempts to circumvent instrument (100) use limitations by keeping instrument (100) connected to generator (122) indefinitely in the hopes to avoid usage checks that only occur during connection and disconnection between instrument (100) and generator (122). As a result, instrument (100) may exhibit a ratio of 100 hours of connection time to 1 hour of use time, with the 100:1 ratio far exceeding the expected 10:1 ratio. This instrument (100) life management is also useful where, for example, a user attempts to circumvent instrument (100) use limitations on total use and generator (122) pairing by connecting an instrument (100), using instrument (100) briefly, and then disconnecting instrument (100), in order to prevent lockout or generator pairing (122) due to total connected time exceeding a threshold. An instrument (100) used in this way might exhibit a ratio of 10 hours of connected time to 9 hours of use time or activated time, a 10:9 ratio that falls short of the expected 10:1 ratio. Finer control could be achieved by storing a ratio matrix on the generator (122), where the acceptable ratio or range of ratios is also determined by the number of times an instrument (100) has been connected to a generator (122), with additional connections resulting in a narrow range of ratios that are considered normal use.
One way that users may attempt to circumvent instrument (100) life management features is to minimize the amount of time that an instrument (100) is connected to a generator (122), in order to prevent generator (122) pairing. By connecting an instrument (100) to generator (122), using instrument (100) briefly, and then disconnecting instrument (100), instrument (100) and generator (122) are limited in their ability to determine the passage of time between a recent connection and a subsequent connection unless they are able to persistently track time despite without an external power source. However, a user in some cases has a legitimate need to disconnect and reconnect an instrument (100), such as when an error occurs, a different instrument is needed, an instrument needs mid-procedure cleaning, or the like. This means that it is not feasible to disable or partially disable an instrument (100) in every situation where one or more connections occur. One way to allow the user to cycle an instrument (100) connection when legitimate reasons exist for such an action is to detect generator (122) and instrument (100) errors and prevent an instrument (100) disconnection that occurs immediately after a generator or instrument error from being considered by instrument (100) life management features for the purpose of limiting subsequent use of instrument (100). For example, if a particular instrument (100) and generator (122) are configured to disable instrument (100) after 10 connections, a disconnection and reconnection that occurs within five minutes of a generator (122) or instrument (100) error may not be counted against this total.
Another method of providing some flexibility between usability and enforcement of safety mechanisms would be to enforce an instrument (100) half-life that is triggered by disconnection of instrument (100) from generator (122); or by generator (122) being powered down. This recognizes a need to occasionally shut down a generator (122) or disconnect instrument (100) from generator (122) during a procedure, such as for cleaning, repositioning of equipment or personnel, a patient emergency, or the like, while also maintaining some enforcement of safety mechanisms and instrument (100) life management principles.
For example, if an instrument (100) is configured for ten hours of connected time for safety reasons, instrument (100) will be disabled after being connected to a generator (122) for a total of ten hours. If this instrument (100) loses power or generator (122) loses power before this ten-hour connection time is reached, the ten-hour threshold may be reduced (block 1104) in order to provide some flexibility to the user while preventing indefinite circumvention of the total time connected limitation. As an example, if the threshold for total time connected is ten hours before instrument (100) is deactivated, and instrument (100) is connected for 1 hour and then disconnected from generator (122), the threshold may be reduced to 7.5 hours or 5 hours upon reconnection between instrument (100) and generator (122). If instrument (100) is subsequently disconnected from generator (122) and reconnected with generator (122), the threshold may be reduced (block 1104) again to 5 hours, or 2.5 hours. In this manner, if a user attempts to overuse instrument (100) and circumvent limitations by constant disconnection and reconnection from/with generator (122), instrument (100) usage threshold will be reduced to a point where even the minimized usage causes instrument (100) to be disabled before extreme overuse can occur. This technique may be combined with other techniques, such as ignoring reconnections after an error, or ignoring a disconnection and reconnection if limited activation of instrument (100) suggests that instrument (100) was only briefly plugged in to test that instrument (100) will activate during a medical procedure, in order to reduce negative impact on legitimate uses of instrument (100).
The following examples relate to various non-exhaustive ways in which the teachings herein may be combined or applied. It should be understood that the following examples are not intended to restrict the coverage of any claims that may be presented at any time in this application or in subsequent filings of this application. No disclaimer is intended. The following examples are being provided for nothing more than merely illustrative purposes. It is contemplated that the various teachings herein may be arranged and applied in numerous other ways. It is also contemplated that some variations may omit certain features referred to in the below examples. Therefore, none of the aspects or features referred to below should be deemed critical unless otherwise explicitly indicated as such at a later date by the inventors or by a successor in interest to the inventors. If any claims are presented in this application or in subsequent filings related to this application that include additional features beyond those referred to below, those additional features shall not be presumed to have been added for any reason relating to patentability.
An apparatus comprising a surgical instrument, the surgical instrument comprising a generator connection, a user input, a processor, and a memory, wherein the memory is configured to store a set of device life management characteristics, wherein the processor is configured to enable or disable the surgical instrument based upon the set of device life management characteristics.
The apparatus of Example 1, wherein the surgical instrument further comprises a timing battery circuit, wherein the timing battery circuit is in communication with the processor such that the processor is configured to disable at least a portion of the surgical instrument based on a signal from the timing battery circuit.
The apparatus of Example 2, wherein the timing battery circuit comprises a battery, a discharge load feature, and an activation switch, wherein the generator connection is configured to close the activation switch when the surgical instrument is connected to a generator.
The apparatus of Example 3, wherein the discharge load feature is configured to discharge the battery at a predetermined discharge rate.
The apparatus of Example 4, wherein the processor is further configured to disable the surgical instrument when the battery charge falls below an activation threshold.
The apparatus of any one or more of Examples 4 through 5, wherein the predetermined discharge rate is selected to result in the battery charge falling below the activation threshold after the battery is coupled with the discharge load feature for between about 4 hours and about 24 hours.
The apparatus of any one or more of Examples 3 through 6, wherein the discharge load feature comprises a resistor.
The apparatus of any one or more of Examples 1 through 7, wherein the surgical instrument further comprises a timing circuit, wherein the timing circuit comprises a capacitor and a discharge load feature.
The apparatus of Example 8, wherein the generator connection is configured to supply power to the timing circuit and charge the capacitor to an initial charge when the surgical instrument is connected to a generator
The apparatus of Example 9, wherein the discharge load feature is configured to provide a predetermined discharge rate for the capacitor.
The apparatus of Example 10, wherein the processor is further configured to disable the surgical instrument when the capacitor charge falls below an activation threshold.
The apparatus of Example 11, the memory is configured to receive a charge bit is in response to the capacitor reaching the initial charge.
The apparatus of Example 12, wherein the processor is further configured to cease charging the capacitor when the charge bit is present on the memory.
The apparatus of any one or more of Examples 10 through 13, wherein the predetermined discharge rate for the capacitor is selected to result in the capacitor charge falling below the activation threshold after the capacitor is coupled with the discharge load feature for between about 4 hours and about 24 hours.
The apparatus of any one or more of Examples 1 through 14, further comprising a generator, the generator comprising a display and a user input, wherein the generator is configured to store a list of unique identifiers, wherein each unique identifier is associated with a used surgical instrument.
The apparatus of Example 15, wherein the generator is configured to operate the surgical instrument at a reduced functionality when the surgical instrument is represented on the list of unique identifiers.
The apparatus of any one or more of Examples 15 through 16, wherein the generator is configured to prevent the surgical instrument from being added to the list of unique identifiers when the surgical instrument is disconnected from the generator as a result of a generator error.
The apparatus of any one or more of Examples 15 through 17, wherein the generator is configured to add the surgical instrument to the list of unique identifiers when the surgical instrument is disconnected from the generator as a result of a generator power loss.
The apparatus of any one or more of Examples 15 through 18, wherein the generator is configured to add the surgical instrument to the list of unique identifiers in response to receiving an indication via the user input that a use of surgical instrument is complete.
The apparatus of any one or more of Examples 1 through 19, further comprising a generator and an external timer, wherein the external timer is configured to maintain a present time indicator.
The apparatus of Example 20, wherein the external timer comprises a timer processor, a timer memory, and a battery.
The apparatus of Example 21, wherein the generator is configured to charge the battery.
The apparatus of any one or more of Examples 20 through 22, wherein the generator is operable to retrieve the present time indicator from the external timer and write the present time indicator to a generator memory.
The apparatus of Example 23, wherein the generator is further configured to associate the surgical instrument with the present time indicator when the surgical instrument is connected to the generator.
The apparatus of Example 24, wherein the generator is configured to operate the surgical instrument at a reduced functionality when two or more present time indicators associated with the surgical instrument indicate that the surgical instrument has exceeded a usable life.
The apparatus of Example 25, wherein the usable life is between about 4 and about 24 hours.
The apparatus of any one or more of Examples 1 through 26, wherein the processor is configured to determine a total generator connection time from the set of device life management characteristics, wherein the total generator connection time indicates a total duration of time that the surgical instrument has been connected to a generator.
The apparatus of Example 27, wherein the processor is configured to determine a total activation time from the set of device life management characteristics, wherein the total activation time indicates the total duration of time that the surgical instrument has been activated.
The apparatus of Example 28, wherein the processor is configured to determine a ratio of the total generator connection time to the total activation time.
The apparatus of Example 29, wherein the processor is configured to operate the surgical instrument at a reduced functionality when the ratio exceeds an upper abnormal use threshold or when the ratio falls short of a lower abnormal use threshold.
The apparatus of any one or more of Examples 1 through 30, wherein the processor is configured to determine a total generator connection time from the device life management characteristics, wherein the total generator connection time indicates the duration of time that the surgical instrument has been connected to a generator.
The apparatus of Example 31, wherein the processor is configured to operate the surgical instrument at a reduced functionality when the total generator connection time exceeds a connection threshold.
The apparatus of any one or more of Examples 31 through 32, wherein the processor is configured to reduce the connection threshold each time the surgical instrument is disconnected from the generator.
The apparatus of Example 33, wherein the connection threshold is about 12 hours, and wherein the processor is configured to reduce the connection threshold to about 6 hours after a first disconnection, to about 3 hours after a second disconnection, and to about 1.5 hours after a third disconnection.
An apparatus comprising a surgical instrument, the surgical instrument comprising: an end effector, wherein the end effector comprises a surgical feature, a generator connection, a user input, wherein the user input is operable to activate the surgical feature of the end effector, a processor, and a memory, wherein the memory is configured to store a set of device life management characteristics, and wherein the processor is configured to enable or disable the surgical feature based upon the set of device life management characteristics.
The apparatus of Example 35, wherein the surgical instrument further comprises a timing battery circuit, and wherein the processor is configured to disable the surgical feature based on a signal from the timing battery circuit.
The apparatus of Example 36, wherein the timing battery circuit comprises a battery, a discharge load feature, and an activation switch, wherein the generator connection is configured to close the activation switch when the surgical instrument is connected to a generator.
The apparatus of Example 37, wherein the discharge load feature comprises a resistor configured to discharge the battery at a predetermined discharge rate.
The apparatus of Example 38, wherein the processor is further configured to disable the surgical feature when the battery charge falls below a disable threshold, wherein the predetermined discharge rate is selected to result in the battery charge falling below the disable threshold between about 4 hours and about 24 hours after the activation switch is closed.
The apparatus of any one or more of Examples 37 through 39, wherein the discharge load feature comprises a light emitting diode configured to discharge the battery at a predetermined discharge rate.
The apparatus of any one or more of Examples 36 through 40, further comprising a timing circuit, wherein the timing circuit comprises a capacitor and a discharge load feature.
The apparatus of Example 41, wherein the generator connection is configured to supply power to the timing circuit and charge the capacitor to an initial charge when the surgical instrumented is connected to a generator.
The apparatus of Example 42, wherein the discharge load feature is configured to provide a predetermined discharge rate for the capacitor, and wherein the surgical feature is disabled when the capacitor charge falls below a disable threshold.
The apparatus of Example 43, wherein the memory is configured to receive a charge bit in response to the capacitor reaching the initial charge, and wherein the processor is further configured to cease charging the capacitor when the charge bit is present on the memory.
The apparatus of any one or more of Examples 35 through 44, further comprising a generator, the generator comprising: a display, and a generator user input, wherein the generator is configured to store a list of unique identifiers, wherein each unique identifier is associated with a used surgical instrument, and wherein the generator is configured to disable the surgical feature when the surgical instrument is represented in the list of unique identifiers.
The apparatus of Example 45, wherein the generator is configured to prevent the surgical instrument from being added to the list of unique identifiers when the surgical instrument is disconnected from the generator as a result of a generator error.
The apparatus of any one or more of Examples 45 through 46, wherein the generator is configured to add the surgical instrument to the list of unique identifiers when the surgical instrument disconnected from the generator as a result of a generator power loss.
The apparatus of any one or more of Examples 45 through 47, wherein the generator is configured to add the surgical instrument to the list of unique identifiers in response to receiving an indication via the generator user input that a use of the surgical instrument is complete.
The apparatus of any one or more of Examples 35 through 48, further comprising a generator, comprising a generator memory; and an external timer, comprising a timer processor, a timer memory, and a battery, wherein the external timer is configured to maintain a present time indicator, and wherein the generator is configured to charge the battery, retrieve the present time indicator from the external timer and write the present time indicator to the generator memory, associate the surgical instrument with the present time indicator when the surgical instrument is connected to the generator, and the surgical feature when two or more present time indicators associated with the surgical instrument indicate that the surgical instrument has exceeded a usable life.
The apparatus of any one or more of Examples 35 through 49, wherein the processor is configured to determine a total generator connection time based upon the set of device life management characteristics, wherein the total generator connection time indicates a total duration of time that the surgical instrument has been connected to a generator, determine a total activation time based upon the set of device life management characteristics, wherein the total activation time indicates the total duration of time that the end effector has been in use, determine a usage ratio of the total generator connection time to the total activation time, and disable the surgical feature when the usage ratio exceeds an upper abnormal use threshold or when the ratio falls short of a lower abnormal use threshold.
The apparatus of any one or more of Examples 35 through 50, wherein the processor is configured to determine a total generator connection time based upon the device life management characteristics, wherein the total generator connection time indicates the duration of time that the surgical instrument has been connected to a generator, disable the surgical feature when the total generator connection time exceeds a connection time threshold, and reduce the connection time threshold each time the surgical instrument is disconnected from the generator.
The apparatus of Example 51, wherein the connection threshold is about 12 hours, and wherein the processor is configured to reduce the connection threshold to about 6 hours after a first disconnection from the generator, to about 3 hours after a second disconnection from the generator, and to about 1.5 hours after a third disconnection from the generator.
An apparatus comprising: a surgical instrument, the surgical instrument comprising: an end effector, wherein the end effector comprises a surgical feature, a generator connection, a user input, wherein the user input is operable to activate the surgical feature of the end effector, a processor, and a memory, wherein the memory is configured to store a set of device life management characteristics, wherein the processor is configured to enable or disable at the surgical feature based upon the set of device life management characteristics; and a generator, the generator comprising: a display, and a generator user input, wherein the generator is configured to store a list of unique identifiers, wherein each unique identifier is associated with a used surgical instrument, and wherein the generator is configured to disable the surgical feature when the surgical instrument is represented in the list of unique identifiers, wherein the generator is configured to: prevent the surgical instrument from being added to the list of unique identifiers when the surgical instrument is disconnected from the generator as a result of a generator error, add the surgical instrument to the list of unique identifiers when the surgical instrument disconnected from the generator as a result of a generator power loss, and add the surgical instrument to the list of unique identifiers in response to receiving an indication via the generator user input that a use of the surgical instrument is complete.
An apparatus comprising a surgical instrument, the surgical instrument comprising: an end effector, wherein the end effector comprises a surgical feature, a generator connection, a user input, wherein the user input is operable to activate the surgical feature of the end effector, a processor, and a memory, wherein the memory is configured to store a set of device life management characteristics, and wherein the processor is configured to enable or disable the surgical feature based upon the set of device life management characteristics, wherein the processor is further configured to: determine a total generator connection time based upon the set of device life management characteristics, wherein the total generator connection time indicates a total duration of time that the surgical instrument has been connected to a generator, determine a total activation time based upon the set of device life management characteristics, wherein the total activation time indicates the total duration of time that the end effector has been in use, determine a usage ratio of the total generator connection time to the total activation time, disable the surgical feature when the usage ratio exceeds an upper abnormal use threshold or when the ratio falls short of a lower abnormal use threshold, disable the surgical when the total generator connection time exceeds a connection time threshold, and reduce the connection time threshold each time the surgical instrument is disconnected from the generator.
It should be understood that any of the versions of instruments described herein may include various other features in addition to or in lieu of those described above. By way of example only, any of the instruments described herein may also include one or more of the various features disclosed in any of the various references that are incorporated by reference herein. It should also be understood that the teachings herein may be readily applied to any of the instruments described in any of the other references cited herein, such that the teachings herein may be readily combined with the teachings of any of the references cited herein in numerous ways. Other types of instruments into which the teachings herein may be incorporated will be apparent to those of ordinary skill in the art.
It should also be understood that any ranges of values referred to herein should be read to include the upper and lower boundaries of such ranges. For instance, a range expressed as ranging “between approximately 1.0 inches and approximately 1.5 inches” should be read to include approximately 1.0 inches and approximately 1.5 inches, in addition to including the values between those upper and lower boundaries.
It should be appreciated that any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated material does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.
Versions of the devices described above may have application in conventional medical treatments and procedures conducted by a medical professional, as well as application in robotic-assisted medical treatments and procedures. By way of example only, various teachings herein may be readily incorporated into a robotic surgical system such as the DAVINCI™ system by Intuitive Surgical, Inc., of Sunnyvale, California. Similarly, those of ordinary skill in the art will recognize that various teachings herein may be readily combined with various teachings of U.S. Pat. No. 6,783,524, entitled “Robotic Surgical Tool with Ultrasound Cauterizing and Cutting Instrument,” published Aug. 31, 2004, the disclosure of which is incorporated by reference herein.
Versions described above may be designed to be disposed of after a single use, or they can be designed to be used multiple times. Versions may, in either or both cases, be reconditioned for reuse after at least one use. Reconditioning may include any combination of the steps of disassembly of the device, followed by cleaning or replacement of particular pieces, and subsequent reassembly. In particular, some versions of the device may be disassembled, and any number of the particular pieces or parts of the device may be selectively replaced or removed in any combination. Upon cleaning and/or replacement of particular parts, some versions of the device may be reassembled for subsequent use either at a reconditioning facility, or by an operator immediately prior to a procedure. Those skilled in the art will appreciate that reconditioning of a device may utilize a variety of techniques for disassembly, cleaning/replacement, and reassembly. Use of such techniques, and the resulting reconditioned device, are all within the scope of the present application.
By way of example only, versions described herein may be sterilized before and/or after a procedure. In one sterilization technique, the device is placed in a closed and sealed container, such as a plastic or TYVEK bag. The container and device may then be placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, or high-energy electrons. The radiation may kill bacteria on the device and in the container. The sterilized device may then be stored in the sterile container for later use. A device may also be sterilized using any other technique known in the art, including but not limited to beta or gamma radiation, ethylene oxide, or steam.
Having shown and described various embodiments of the present invention, further adaptations of the methods and systems described herein may be accomplished by appropriate modifications by one of ordinary skill in the art without departing from the scope of the present invention. Several of such potential modifications have been mentioned, and others will be apparent to those skilled in the art. For instance, the examples, embodiments, geometrics, materials, dimensions, ratios, steps, and the like discussed above are illustrative and are not required. Accordingly, the scope of the present invention should be considered in terms of the following claims and is understood not to be limited to the details of structure and operation shown and described in the specification and drawings.
This application is a continuation of U.S. patent application Ser. No. 16/801,400, entitled “System and Method to Track Usage of Surgical Instrument,” filed Feb. 26, 2020, and published as U.S. Pat. Pub. No. 2020/0268408 on Aug. 27, 2020, which is a divisional of U.S. patent application Ser. No. 15/491,139, entitled, “System and Method to Track Usage of Surgical Instrument,” filed Apr. 19, 2017, and issued as U.S. Pat. No. 10,624,667 on Apr. 21, 2020, which claims the benefit of U.S. Pat. App. No. 62/339,151, filed May 20, 2016, the disclosure of which is hereby incorporated by reference in its entirety.
| Number | Date | Country | |
|---|---|---|---|
| 62339151 | May 2016 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 15491139 | Apr 2017 | US |
| Child | 16801400 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 16801400 | Feb 2020 | US |
| Child | 18402229 | US |
