CROSS-REFERENCE TO RELATED APPLICATION

[0001] This application claims priority to U.S. Provisional Application No. 61/925,597, filed on January 9, 2014, which is herein incorporated by reference in its entirety. Technical Field

[0002] Embodiments of the present invention are related to instrument control, and in particular the control of instruments used in minimally invasive teleoperated robotic surgery.

Discussion of Related Art

[0003] Surgical procedures can be performed in a minimally invasive manner using a teleoperated surgical system (a teleoperated robotic system). The benefits of a minimally invasive surgery are well known and include less patient trauma, less blood loss, and faster recovery times when compared to traditional, open incision surgery. In addition, the use of robot surgical systems (e.g., teleoperated robotic systems that provide telepresence), such as the da Vinci® Surgical System commercialized by Intuitive Surgical, Inc. of Sunnyvale, California, is known. Such robotic surgical systems may allow a surgeon to operate with intuitive control and increased precision compared to alternative minimally invasive surgical methods.

[0004] In one aspect of a minimally invasive surgical system, surgery is performed by a surgeon controlling a robot. The robot includes one or more instruments that are coupled to robot arms. The instruments access a surgical site through small incisions in the skin of a patient. A cannula is inserted into each incision and a shaft of the instrument can be inserted through the cannula to access the surgical site. In many cases, the instruments have functions beyond the standard kinematic motions of the end effectors. Historically, however, these functions were configured to be activated one at a time. For instance, in one aspect, the surgeon is seeks to use two instruments at the surgical site: an instrument with cautery function; and an instrument with suction function. When the surgeon is using the instrument with cautery function and the need for the instrument with suction function arises, historically the surgeon was required to discontinue activation of the cautery function in order to activate the suction function. Alternatively, the surgeon would require a second person at the patient side to operate the suction function.

[0005] There is a need to develop systems and methods for to improve efficiency of robotic minimum invasive surgery workflows.

SUMMARY

[0006] In accordance with aspects of the present invention, a surgical system is presented. In some embodiments, a surgical system includes one or more instruments collectively having a primary function and a secondary function, the primary function and the secondary function being complementary; a master supervisory controller coupled to control the one or more instruments; and surgeon side cart coupled to the master supervisory controller, wherein the master supervisory controller is configurable between a first state where the primary function and the secondary function are concurrently activated by a single action at the surgeon console and a second state where the primary function and the secondary function are activated separately by actions at the surgeon console.

[0007] In some embodiments, a method of concurrently activating two complementary functions includes receiving an instruction to switch from a first state to a second state. In the first state, a first control input is configured to activate a primary function and a second control input is configured to activate a secondary function complementary to the primary function. In the second state the first control input is configured to concurrently activate the primary function and the secondary function. An input is then received via the first contrl input, and the primary function and the secondary function are concurrently activated. [0008] These and other embodiments are further discussed below with respect to the following figures.

BRIEF DESCRIPTION OF THE DRAWINGS

[0009] Figures 1A, IB, and 1C illustrate components of an example teleoperated robotic surgical system.

[0010] Figure 2 illustrates components of an example teleoperated robotic surgical system at a surgical site.

[0011] Figure 3 is a schematic diagram of a teleoperated robotic surgical system.

[0012] Figure 4 is a flow chart illustrating a procedure for operation of a teleoperated robotic surgical system.

DETAILED DESCRIPTION

[0013] In the following description, specific details are set forth describing some

embodiments of the present invention. It will be apparent, however, to one skilled in the art that some embodiments may be practiced without some or all of these specific details. The specific embodiments disclosed herein are meant to be illustrative but not limiting. One skilled in the art may realize other elements that, although not specifically described here, are within the scope and the spirit of this disclosure.

[0014] This description and the accompanying drawings that illustrate inventive aspects and embodiments should not be taken as limiting— the claims define the protected invention. Various mechanical, compositional, structural, and operational changes may be made without departing from the spirit and scope of this description and the claims. In some instances, well-known structures and techniques have not been shown or described in detail to not obscure the invention. [0015] Additionally, the drawings are not to scale. Relative sizes of components are for illustrative purposes only and do not reflect the actual sizes that may occur in any actual embodiment of the invention. Like numbers in two or more figures represent the same or similar elements.

[0016] Further, this description's terminology is not intended to limit the invention. For example, spatially relative terms— such as "beneath", "below", "lower", "above", "upper", "proximal", "distal", and the like-may be used to describe one element's or feature's relationship to another element or feature as illustrated in the figures. These spatially relative terms are intended to encompass different positions (i.e., locations) and orientations (i.e., rotational placements) of a device in use or operation in addition to the position and orientation shown in the figures. For example, if a device in the figures is turned over, elements described as "below" or "beneath" other elements or features would then be "above" or "over" the other elements or features. Thus, the exemplary term "below" can encompass both positions and orientations of above and below. A device may be otherwise oriented (rotated 90 degrees or at other orientations) and the spatially relative descriptors used herein interpreted accordingly. Likewise, descriptions of movement along and around various axes includes various special device positions and orientations. In addition, the singular forms "a", "an", and "the" are intended to include the plural forms as well, unless the context indicates otherwise. And, the terms "comprises", "comprising", "includes", and the like specify the presence of stated features, steps, operations, elements, and/or components but do not preclude the presence or addition of one or more other features, steps, operations, elements, components, and/or groups. Components described as coupled may be electrically or mechanically directly coupled, or they may be indirectly coupled via one or more intermediate components.

[0017] Elements and their associated aspects that are described in detail with reference to one embodiment may, whenever practical, be included in other embodiments in which they are not specifically shown or described. For example, if an element is described in detail with reference to one embodiment and is not described with reference to a second embodiment, the element may nevertheless be claimed as included in the second embodiment.

[0018] Aspects of embodiments of the invention are described within the context of a particular implementation of a robotic surgical system. Knowledgeable persons will understand, however, that inventive aspects disclosed herein may be embodied and implemented in various ways, including teleoperated robotic and non-robotic embodiments and implementations. The implementations disclosed here are merely exemplary and are not to be considered as limiting the scope of the inventive aspects disclosed herein.

[0019] Figures 1A, IB, and 1C are front elevation views of three main components of a teleoperated robotic surgical system for minimally invasive surgery. These three components are interconnected so as to allow a surgeon, with the assistance of a surgical team, to perform diagnostic and corrective surgical procedures on a patient.

[0020] Figure 1A is a front elevation view of the patient side cart 100 component of, for example, the da Vinci™ Surgical System. The patient side cart includes a base 102 that rests on the floor, a support tower 104 that is mounted on the base 102, and several arms that support surgical tools. For the purposes of this specification, "surgical tool" may used interchangeably with "surgical instrument." As shown in Figure 1A, arms 106a, 106b, 106c are instrument arms that support and move surgical instruments used to manipulate tissue. Arm 108, for example, can be a camera arm that supports and moves an endoscope instrument 112. Instrument arm 106c can be an optional third instrument arm 106c that is supported on the back side of support tower 104 and that can be positioned to either the left or right side of the patient side cart as necessary to conduct a surgical procedure. FIG. 1 A further shows interchangeable surgical instruments 110a, 110b, 110c mounted on the instrument arms 106a, 106b, 106c, and it shows endoscope 112 mounted on the camera arm 108. Knowledgeable persons will appreciate that the arms that support the instruments and the camera may also be supported by a base platform (fixed or moveable) mounted to a ceiling or wall, or in some instances to another piece of equipment in the operating room (e.g., the operating table). Likewise, they will appreciate that two or more separate bases may be used (e.g., one base supporting each arm).

[0021] As is further illustrated in FIG. 1A, each of instruments 110a, 110b, 110c and endoscope 112 include an instrument interface 150a, 150b, 150c, and 150d, respectively, and an instrument shaft 152a, 152b, 152c, and 152d, respectively. In some embodiments, patient side cart 100 can include supports for cannulas for instruments 110a, 110b, 110c and endoscope 112.

[0022] Further, portions of each of the instrument arms 106a, 106b, and 106c are adjustable by personnel in the operating room to position instruments 110a, 110b, and 110c with respect to a patient. Other portions of instrument arms 106a, 106b, and 106c are actuated and controlled by the surgeon at a surgeon's console 120. Surgical instruments 110a, 110b, 110c, and endoscope 112, can also be controlled by the surgeon at surgeon's console 120.

[0023] FIG. IB is a front elevation view of a surgeon's console 120 component of an example surgical system. The surgeon's console 120 is equipped with left and right multiple degree of freedom (DOF) master tool manipulators (MTMs) 122a, 122b, which are kinematic chains that are used to control the surgical tools. The surgeon grasps a pincher assembly 124a, 124b on each of MTMs 122a, 122b typically with the thumb and fore or middle finger, and can move the pincher assembly to various positions and orientations. Opening and closing pincher assembly is typically used to operate a jawed surgical end effector (e.g., scissors, grasping retractor, needle driver, and the like) at the distal end of an instrument 110. When a tool control mode is selected, each of MTMs 122a, 122b is coupled to control a corresponding instrument arm 106 for the patient side cart 100. For example, left MTM 122a may be coupled to control instrument arm 106b and instrument 110a, and right MTM 122b may be coupled to control instrument arm 106b and instrument 110b. If the third instrument arm 106c is used during a surgical procedure and is positioned on the left side, then left MTM 122a can be switched between (1) controlling arm 106a and instrument 110a, and (2) controlling arm 106c and instrument 110c. Likewise, if the third instrument arm 106c is used during a surgical procedure and is positioned on the right side, then right MTM 122a can be switched between (1) controlling arm 106b and instrument 110b, to (2) controlling arm 106c and instrument 110c. In some instances, control assignments between MTMs 122a, 122b and arm 106a/instrument 110a combination and arm 106b/instrument 110b combination may also be exchanged. This may be done, for example, if the endoscope is rolled 180 degrees, so that the instrument moving in the endoscope's field of view appears to be on the same side as the MTM the surgeon is moving.

[0024] Additional controls are provided with foot pedals 128. Each of foot pedals 128 can activate certain functionality on the selected one of instruments 110. For example, foot pedals 128 can activate a drill or a cautery tool, or may operate irrigation, suction, or other functions. Multiple instrument functions can be activated by depressing multiple pedals 128.

Certain functionality of instruments 110 may be activated by other controls. For example, suction and/or irrigation may be continuously activated during certain procedures. In some embodiments of the present invention, concurrent activation of multiple functions on instruments 110 may be accomplished through a single input, for example depression of one of foot pedals 128.

[0025] Additionally, a user interface 130 can be utilized to set the operation of MTMs 122 and foot pedals 128. In some embodiments, a user interface 130 can be embedded within an armrest of surgeon console 120. Referring to Figure IB, user interface 130 can be any system that communicates with the surgeon. For example, user interface 130 can be a touchscreen, can be a display with a separate user input device, or can be a combination of touchscreen and separate user input. In Figure IB, user interface 130 is illustrated as a touch screen, but any form of user input/output device may be used. User interface 130 can also be used to set operation parameters that affect operation of the functions of instruments 110 when they are activated.

[0026] Surgeon's console 120 also includes a stereoscopic image display system 126. Left side and right side images captured by the stereoscopic endoscope 112 are output on corresponding left and right displays, which the surgeon perceives as a three-dimensional image on display system 126. In an advantageous configuration, the MTMs 122 are positioned below display system 126 so that the images of the surgical tools shown in the display appear to be co-located with the surgeon's hands below the display. This feature allows the surgeon to intuitively control the various surgical tools in the three-dimensional display as if watching the hands directly. Accordingly, the MTM servo control of the associated instrument arm and instrument is based on the endoscopic image reference frame.

[0027] The endoscopic image reference frame is also used if the MTMs 122 are switched to a camera control mode. In some cases, if the camera control mode is selected, the surgeon may move the distal end of the endoscope by moving one or both of the MTMs 122 together (portions of the two MTMs 122 may be servo-mechanically coupled so that the two MTM portions appear to move together as a unit). The surgeon may then intuitively move (e.g., pan, tilt, zoom) the displayed stereoscopic image by moving the MTMs 122 as if holding the image in the hands.

[0028] The surgeon's console 120 is typically located in the same operating room as the patient side cart 100, although it is positioned so that the surgeon operating the console is outside the sterile field. One or more assistants typically assist the surgeon by working within the sterile surgical field (e.g., to change tools on the patient side cart, to perform manual retraction, etc.). Accordingly, the surgeon operates remote from the sterile field, and so the console may be located in a separate room or building from the operating room. In some implementations, two consoles 120 (either co-located or remote from one another) may be networked together so that two surgeons can simultaneously view and control tools at the surgical site.

[0029] FIG. 1C is a front elevation view of a vision cart 140 component of a surgical system. The vision cart 140 houses the surgical system's central electronic data processing unit 142 and vision equipment 144. The central electronic data processing unit includes much of the data processing used to operate the surgical system. In various other implementations, however, the electronic data processing may be distributed in the surgeon console 120 and/or patient side cart 100. The vision equipment includes camera control units for the left and right image capture functions of the stereoscopic endoscope 112. The vision equipment also includes illumination equipment (e.g., Xenon lamp or LEDs) that provides illumination for imaging the surgical site. As shown in FIG. 1C, the vision cart includes an optional touch screen monitor 146 (for example a 24-inch monitor), which may be mounted elsewhere, such as on the patient side cart 100. The vision cart 140 further includes space 148 for optional auxiliary surgical equipment, such as electrosurgical units, insufflators, suction irrigation equipment, or third-party cautery equipment. The patient side cart 100 and the surgeon's console 120 are coupled, for example via optical fiber communications links, to the vision cart 140 so that the three components together act as a single teleoperated minimally invasive surgical system that provides an intuitive telepresence for the surgeon. And, as mentioned above, a second surgeon's console may be included so that a second surgeon can, e.g., proctor the first surgeon's work.

[0030] Although the surgeon's console has been described in terms of specific embodiments, the surgeon's console may be in other forms, such as light-weight master inputs

(mechanically grounded or ungrounded) that are separate from a large cabinet, or even hand gesture recognition systems. So, the surgeon's console is the system component at which the surgeon's commands to move the instruments are received. And, the surgeon's console may or may not include the video output display that the surgeon views while moving the instruments.

[0031] During a typical surgical multi-port procedure with the teleoperated surgical system described with reference to FIGS. 1A-1C, at least two incisions are made into the patient's body (usually with the use of a trocar to place the associated cannula). One incision is for an endoscope camera instrument, and the other incisions are for the surgical instruments. In some surgical procedures, several instrument and/or camera incisions are utilized to provide access and imaging for a surgical site. Although the incisions are relatively small in comparison to larger incisions used for traditional open surgery, a minimum number of incisions is desired to further reduce patient trauma and for improved cosmesis. In some examples, a single incision is made and a special port that allows for the endoscope and up to 2 instruments is placed. This is referred to as single-port surgery. For the purposes of this disclosure, multi-port surgical applications will be described with the understanding that all instances describes can also be applied to single-port surgery.

[0032] FIG. 2 illustrates surgical instruments (e.g., those shown in FIGs. 1A) positioned at a surgical site. Cannulas 202a, 202b, and 202d extend through instrument incisions 204a, 204b, and 204d, respectively. As is shown in FIG. 2, shafts 152a, 152b, and 152d extend through cannulas 202a, 202b, and 202d, respectively. End effectors 206a, 206b, and 206d are attached to shafts 152a, 152b, and 152d, respectively. As discussed above, end effectors 206a, and 206b can be jawed surgical end effectors (e.g., scissors, grasping retractor, needle driver, and the like). Further, end effector 206c is illustrated as an endoscope tip. As shown in Figure 2, cannulas 202a, 202b, and 202d and shafts 152a, 152b, and 152d are positioned so that end effectors 206a, 206b, and 206d operate at a surgical site 210.

[0033] As shown in Figure 2 cannulas 202a, 202b, and 202d include mounting fittings 208a, 208b, and 208d, respectively, that can be engaged by arms 106a, 106b, and endoscope arm 108, respectively. Cannulas 202a, 202b, and 202d further include cannula seal mounts 212a, 212b, and 212d, respectively.

[0034] During surgery, particularly if the surgery is abdominal surgery, pressurized C0 ₂ can be utilized to expand the abdomen, allowing for better access to the surgical site 210.

Cannula seals attached to cannula seal mounts 212a, 212b, and 212d prevent leakage of the pressurized C0 ₂ , fluids, and/or other materials from the patient.

[0035] During the operation, the surgeon sitting at surgeon's console 120 can manipulate end effectors 206a, 206b, and 206d as well as move shafts 152a, 152b, and 152d along their lengths. In the particular arrangement illustrated in Figure 2, instrument 206d is illustrated as an endoscope, instrument 206a can be, for example, a cautery tool, and instrument 206b can be, for example, a suction-irrigator tool. Suction is not only used to clear debris (blood, tissue, fluid, etc.) from the surgical field, but also used to clear plume (i.e. resulting from electro-cautery) from the surgical field to aid in visualization. Currently, surgeons frequently request a patient side assistant to suck smoke out with a laparoscopic suction-irrigator.

Alternatively, they frequently request that a patient side assistant open (e.g., by manually distending a cannula seal or removing the cannula seal altogether) to allow smoke resulting from cautery tool use to evacuate. In some cases, smoke evacuators can be attached to one or more of cannulas 202a, 202b, 202c to continuously filter the smoke plume. In either case, care is taken to balance the smoke removal while maintaining insufflation. Ideally, the smoke evacuation only occurs when the smoke is being generated, i.e., when the cautery tool is undergoing active use. [0036] In accordance with some embodiments of the present invention, end effector 206a can be actuated concurrently with end effector 206b. For example, a suction-irrigator tool as end effector 206b can be activated concurrently with cautery tool instrument as end effector 206a so that smoke at the surgical site 210 can be removed while it is being generated. In some cases, immediate removal of the smoke may help minimize condensation on the lens of endoscope instrument 206d because the smoke is immediately drawn away from the surgical site. In contrast, when smoke evacuation takes place through the opening of an unused cannula, the generally warm smoke generated by use of cautery has an opportunity to first fill the insufflation and cause the aforementioned condensation.

[0037] Systems according to some embodiments of the present invention can concurrently and automatically activate one or more secondary functions at the same time that a primary function is activated. No relative importance is implied by the terms primary and secondary. As illustrated in the example of Figure 2, for example, instrument 206a can be a cautery instrument or a drill instrument and instrument 206b can be a suction-irrigator. When cautery or drill instrument 206a is activated, suction-irrigator instrument 206b can be concurrently activated to remove the smoke or debris. In some embodiments, the primary function and the secondary function can be included on a single instrument. For example, a cautery instrument can include the cautery function, an irrigator function, and a suction function. In some embodiments, the primary function and one or more secondary functions can be performed by different instruments.

[0038] Figure 3 illustrates an example of a system 300 that can activate a secondary function when a primary function is activated, without further action by a surgeon. In the particular example illustrated in Figure 3, the secondary function is on a secondary instrument 304 while the primary function is performed by a primary instrument 302. In some embodiments, for example, the primary instrument 302 can be a cautery instrument (and the primary function a cautery function) and secondary instrument 304 can be a suction-irrigator (and the secondary function a suction-irrigator function). In some embodiments, for example, the primary instrument 302 can be a drill and secondary instrument 304 can be a suction-irrigator. As discussed above, in some embodiments the primary function and one or more secondary functions can be performed on a single instrument.

[0039] As shown in Figure 2, a cautery instrument may include shaft 152a and cautery end effector 206a. Further, a suction-irrigator may include shaft 152b and suction-irrigator end effector 206b as shown in Figure 2. Shaft 152d and end effector 206d shown in Figure 2 may be an endoscope which is not illustrated in Figure 3. As shown in Figure 3, both primary instrument 302 and secondary instrument 304 are attached to patient side cart (PSC) 100.

[0040] As is shown in Figure 3, and further as shown in Figure IB, the surgeon side cart 120 includes a user interface 130, MTMs 122, and pedals 128. Each of these controllable inputs is coupled to a processor 306. Although not shown in Figure 3, display system 126 can also be controlled by processor 306.

[0041] Processor 306 can communicate with master supervisory controller (MSC) 308. MSC 308 can be incorporated within vision cart 140 and can include applications operating on one or more processing systems. As such, MSC 308 may include one or more processors, volatile and non-volatile memory, user input devices, removable memory storage such as hard drives, and other components generally associated with a processor system. Applications may be stored in memory and operated by the one or more processors of MSC 308.

[0042] One such application can be a supervisor application 312. Supervisor application 312 communicates with a pedal routing map 310 and provides instructions to an original equipment manufacturer (OEM) device controller (ODC) 314. ODC 314 interfaces with a controller 316 that controls instrument 302 and may replace a manual controller such a foot pedal that can be interfaced with controller 316. Controller 316 may be a third-party controller that is coupled to instrument 302 during normally manual operations. As such, controller 316 is coupled directly to instrument 302. Additionally, controller 316 may be a third party controller that is coupled to another controller. For example, in one aspect, the primary instrument 302 is a suction-irrigator, the secondary instrument 304 is a cautery instrument, and controller 316 is coupled to a controller for a C0 ₂ insufflator. This enables system 300 to balance the suction flow rate of the suction irrigator with the insufflator flow rate, so that the pressure of an insufflation cavity may be kept substantially at equilibrium. This capability is be maintained when system 300 is configured to concurrently activate the suction-irrigator instrument when the cautery instrument is activated.

[0043] MSC 308 is also coupled to PSC 100, to which primary instrument 302 and secondary instrument 304 are attached. PSC 100 controls many of the directional and gripping features of primary instrument 302 and secondary instrument 304, as well as controlling an endoscope or other instruments that are attached to PSC 100.

[0044] MSC 308 is also coupled to a control transform processor (CTP) 318, which can control certain functions of PSC 100 for supervisor application 312. CTP 318 may be a processor system that performs some of the detail work of controlling primary instrument 302 and secondary instrument 304 for supervisor application 312. For example, CTP 318 may configure PSC 100 to perform various behaviors such as "suction-on", "suction-off ', or may perform following teleoperation functions.

[0045] Figure 4 illustrates a procedure 400 for operation of system 300 according to some embodiments of the present invention. As shown in Figure 4, procedure 400 begins with installation of primary instrument 302 and secondary instrument 304 on PSC 100. In step 404, supervisor application 312 can receive data from primary instrument 302 and secondary instrument 304. The data received from primary instrument 302 and secondary instrument 304 can include tool type, tool ID, and/or an indication of whether concurrent operation can be performed. In particular, if primary instrument 302 is a cautery instrument, it can indicate to supervisor application 312 that it is a cautery instrument, the pedal activation energy for operation, its tool ID, and that it can be operated concurrently with a suitable suction-irrigator instrument. If secondary instrument 304 is a suction-irrigator, it can indicate to supervisor application 312 that it is a suction-irrigator instrument, its tool ID, and that it can be operated concurrently with a suitable cautery instrument.

[0046] Primary instrument 302 and secondary instrument 304 that may be capable of concurrent operations are typically such that primary instrument 302 and secondary instrument 304 are complementary. In other words, use of the primary instrument 302 is typically accompanied by use of the secondary instrument 304 during a surgical procedure. Some combinations of complementary instruments include a cautery instrument and a suction-irrigator as discussed above. Other complementary instruments can include a drill and a suction instrument, a drill and an irrigation instrument, a cautery instrument and suction instrument, a suction instrument and an irrigation instrument, a dispensing instrument that dispenses a material and a curing radiation instrument that emits energy that cures the dispensed material, a cutting instrument and a sealing instrument, a cautery instrument and an irrigation instrument (e.g., for cooling). In some embodiments, vision features may be concurrently adjusted with certain instrument functions. For example, the brightness of an endoscope may be adjusted while in fluorescence imaging mode during use of a cautery instrument. One skilled in the art will recognize that other complementary instrument pairs may be available.

[0047] In step 406, supervisor application 312 determines whether primary instrument 302 and secondary instrument 304 are capable of concurrent operation. If not, then procedure 400 proceeds to individual operation of instruments 416 where the surgeon operates primary instrument 302 and secondary instrument independently of each other. [0048] If primary instrument 302 and secondary instrument 304 are capable of concurrent operation, then in step 408 MSC 308 displays the option for the surgeon on user interface 130. In some embodiments, the surgeon may be provided with the option to link operation of primary instrument 302 with secondary instrument 304. Further, if the option is chosen by the surgeon, then parameters of operation for concurrent operation of secondary instrument 304 may also be input to user interface 130. For example, if secondary instrument 304 is a suction-irrigator instrument, the amount of suction to apply and/or the amount of irrigation to provide can be set by the surgeon. In some cases, irrigation or suction can be set to be intermittent where the surgeon can set the duty cycle and the strength of each function.

Furthermore, the concurrent function of secondary instrument 304 does not need to be on an actively controlled arm and could be operated on a third instrument arm or independently from a second console or the patient side assistant.

[0049] In step 410, procedure 400 determines whether or not the surgeon has activated concurrent operation of primary instrument 302 and secondary instrument 304. If the surgeon has not activated concurrent operation, the procedure 400 proceeds to individual operation 416 where primary instrument 302 and secondary instrument 304 are independently operated. During individual operation 416, if concurrent operation is possible, the option may be continuously displayed and the surgeon can toggle between concurrent operation and individual operation.

[0050] In some embodiments, procedure 400 may also determine whether the end effectors of primary instrument 302 and the end effector of secondary instrument 304 are positioned in close enough proximity and oriented with respect to one another for concurrent operation to be effective.

[0051] If concurrent operation is activated, then in step 412 supervisor application 312 in MSC 308 updates pedal routing map 310 to reflect activation of concurrent operation and the operating parameters. Pedal routing map 310 is updated so that one of pedals 128 that activates primary instrument 302 also concurrently activates secondary instrument 304.

[0052] In step 414, system 300 is operated in concurrent operation mode. As a result, when the surgeon presses the appropriate one of pedals 128 or other activating input that activates primary instrument 302, SSC 120 sends the pedal information to MSC 308 operating supervisor application 312. Supervisor application 312 reads pedal routing map 310 and routs the pedal press event to ODC 314 to activate primary instrument controller 316 and routs the pedal press event to CTP 318, which configures PSC 100 to activate secondary instrument 304. When the pedal 128 is deactivated, then SSC 120 communicates the deactivation with MSC 308 and supervisor application 312 communicates with ODC 314 and CTP 318 to deactivate primary instrument 302 and secondary instrument 304.

[0053] As discussed above, in some embodiments secondary instrument 304 is a suction- irrigator instrument and primary instrument 304 is a cautery instrument. The cautery instrument can be a bipolar instrument, a monopolar instrument, a harmonic (i.e. ultrasonic) instrument, or any other high frequency (HF) energy instrument. The surgeon can activate a "smoke evacuation" feature on user interface 130 such that when both a suction- irrigator and a HF energy instrument are inserted into the patient, the smoke evacuator mode will allow system 300 to open a suction valve on the suction-irrigator during active use of the HF instrument. The smoke evacuation may be continuous or intermittent, depending on how the surgeon has configured secondary instrument 304 through user interface 130 or from the third party monitoring device (i.e. insufflator). The suction rate can be less than the insufflation rate so that there is no loss of pneumoperitoneum when the smoke evacuator mode is active. Further, the suction may be pulsed with a duty cycle and strength such that the suction rate is less than the insufflation rate.

[0054] In some embodiments, primary instrument 302 may be a drill and secondary instrument 304 can be a suction-irrigator. In this case, a "drill irrigation" mode can be activated by the surgeon through user interface 130. In the "drill irrigation" mode, system 300 will automatically open an irrigation valve during active use of the drill. This activation will provide irrigation to cool down the burr and tissue and minimize the generation of bone dust.

[0055] By asking the surgeon to activate the "smoke evacuator" or "drill irrigation" modes whenever these features are needed, the risk of inadvertent suction or irrigation activation is minimized because the surgeon is aware the suction or irrigation will be delivered simultaneously with the energy instrument or drill respectively. The suction-irrigator may not always be activated (in active following/control from the SSC), so it is even more important that the surgeon activate these modes purposely through user interface 130 to prevent inadvertent actions.

[0056] In some embodiments, a control such as a slider can be added to user interface 130 that allows the surgeon to control the amount of suction or irrigation when using the smoke evacuator or drill irrigation functions respectively. These settings can be defaulted to the minimal setting to minimize impact if the mode is activated inadvertently.

[0057] In some embodiments of the invention, a primary function and a secondary function are performed by a primary tool and a secondary tool, respectively. Tool tracking can be used so that a secondary instrument, e.g., a suction-irrigator instrument 206b, can automatically track a primary instrument, e.g., a drill instrument 206a. As a result, as drill instrument 206a is moved, the irrigation flow from suction-irrigator instrument 206b can follow automatically without the surgeon actively controlling the suction-irrigator. In some embodiments, tool tracking can be used to turn on or off the secondary instrument activation feature if the secondary instrument is not within a specified distance from the tip of the primary instrument for effective complementary operation. [0058] In some embodiments, activation of concurrent mode depends on the proximity of the end effectors of primary instrument 302 and secondary instrument 304. It may be important that the end effector of secondary instrument 304 be in close proximity to the end effector of primary instrument 302 to be effective for complementary operation.

[0059] In some embodiment, concurrent activation of a secondary function on the secondary instrument 304 with activation of a primary function on the primary instrument 302 in concurrent operation mode may be triggered by a separate sensor. For example, if primary instrument 302 is a cautery instrument and secondary instrument 304 is a suction-irrigator instrument, concurrent activation of the suction-irrigator function with activation of the cautery function may be triggered by a smoke sensor that uses image processing of real-time images from a surgical site captured by an endoscope to detect the presence of smoke at the surgical site.

[0060] In some embodiments, system 300 may, for example, irrigate primary instrument 302 by concurrent operation of an irrigator in secondary instrument 302 during operation of primary instrument 302 or shortly after operation of primary instrument 302 to cool primary instrument 302. Such an irrigation can be particular useful for cooling cutting or cautery instruments to minimize damage to surrounding tissue.

[0061] In some embodiments, secondary instrument 304 is a suction-irrigator insrument and system 300 concurrently activates suction and irrigation in response to activation of a primary instrument 302. For example, if primary instrument is a drill or a stabilizer, then both irrigation and suction can be concurrently activated. On focus based tasks, providing suction concurrently with functions like cold cutting may be very helpful.

[0062] The above detailed description is provided to illustrate specific embodiments of the present invention and is not intended to be limiting. Numerous variations and modifications within the scope of the present invention are possible. The present invention is set forth in the following claims.