Abstract:
A system and method for using a remote control to control an electrosurgical instrument, where the remote control includes at least one momentum sensor. As the surgeon rotates their hand mimicking movements of a handheld electrosurgical instrument, the movements are translated and sent to the remote controlled (RC) electrosurgical instrument. The surgeon uses an augmented reality (AR) vision system to assist the surgeon in viewing the surgical site. Additionally, the surgeon can teach other doctors how to perform the surgery by sending haptic feedback to slave controllers. Also, the surgeon can transfer control back and forth between the master and slave controller to allow a learning surgeon to perform the surgery, but still allow the surgeon to gain control of the surgery whenever needed. Also, the surgeon could be located at a remote location and perform the surgery with the assistance of the AR vision system.m.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This is a continuation and claims priority to U.S. patent application Ser. No. 13/205,889, filed Aug. 9, 2011, the entire contents of which are hereby incorporated by reference. 
     
    
     BACKGROUND 
       [0002]    Technical Field 
         [0003]    The present disclosure relates to a system and method for remotely controlling an electrosurgical instrument and, more particularly, to a remote control that uses momentum sensors to allow the surgeon to rotate and/or move the remote in a similar manner to handheld electrosurgical instrument. 
         [0004]    Background of Related Art 
         [0005]    Minimally invasive surgical procedures typically employ small incisions in body cavities for access of various surgical instruments, including forceps, laparoscopes, scalpels, scissors, and the like. It is often the case that several surgical hands, such as several laparoscopic instrument and camera holders, are necessary to hold these instruments for the operating surgeon during the particular surgical procedure. With the introduction of robotic-assisted minimally invasive surgery (MIS) in recent years, hospitals worldwide have made significant inves Intents in acquiring this latest technology for their respective facilities. 
         [0006]    Thus, it is known to use robotic-assisted MIS when carrying out surgical operations. When surgery of this kind is performed, access to a subcutaneous surgical site is provided via a number (typically 3 to 5) of small (typically 5-12 mm) incisions, through which a surgical arm is manually passed. The surgical arms are then coupled to the surgical robotic instrument, which is capable of manipulating the surgical arms for performing the surgical operations, such as suturing or thermally cutting through tissue and cauterizing blood vessels that have been severed. The surgical arms thus extend through the incisions during the surgery, one of which incisions is used for supplying a gas, in particular carbon dioxide, for inflating the subcutaneous area and thus create free space at that location for manipulating the surgical instruments. 
         [0007]    Therefore, open surgeries often require a surgeon to make sizable incisions to a patient&#39;s body in order to have adequate visual and physical access to the site requiring treatment. The application of laparoscopy for performing procedures is commonplace. Laparoscopic surgeries are performed using small incisions in the abdominal wall and inserting a small endoscope into the abdominal cavity and transmitting the images captured by the endoscope onto a visual display. The surgeon may thus see the abdominal cavity without making a sizable incision in the patient&#39;s body, reducing invasiveness and providing patients with the benefits of reduced trauma, shortened recovery times, and improved cosmetic results. In addition to the endoscope, laparoscopic surgeries are performed using long, rigid tools inserted through incisions in the abdominal wall. 
         [0008]    However, conventional techniques and tools for performing laparoscopic procedures may limit the dexterity and vision of the surgeon. Given the size of the incisions, the maneuverability of the tools is limited and additional incisions may be required if an auxiliary view of the surgical site is needed. Thus, robotic instruments may be used to perform laparoscopic procedures. 
         [0009]    One example of a robotic assisted MIS system is the da Vinci® System that includes an ergonomically designed surgeon&#39;s console, a patient cart with four interactive robotic arms, a high performance vision system, and instruments. The da Vinci it console allows the surgeon to sit while viewing a highly magnified 3D image of the patient&#39;s interior sent from the high performance vision system. The surgeon uses master controls on the console that work like forceps to perform the surgery. The da Vinci® system corresponds to the surgeon&#39;s hand, wrist, and finger movements into precise movements of the instruments within the patient&#39;s interior. 
         [0010]    However, the da Vinci® system only allows a single user to use the console and controllers at one time. Additionally, the 3D image shown in the da Vinci® system can only be viewed by the surgeon sitting at the console which prevents other surgeon&#39;s from assisting the surgeon in determining the best procedure to perform the surgery or from showing students how to perform the surgery. Additionally, the da Vinci® system is large and cumbersome and oversized relative to the electrosurgical instruments used in the procedure. 
       SUMMARY 
       [0011]    In accordance with the present disclosure, a system and method for using a remote control to control an electrosurgical instrument, where the remote control includes at least one momentum sensor. As the surgeon rotates their hand mimicking movements of a handheld electrosurgical instrument, the movements are translated and sent to the remote controlled (RC) electrosurgical instrument. The surgeon uses an augmented reality (AR) vision system to assist the surgeon in viewing the surgical site. Additionally, the surgeon can teach other doctors/students how to perform the surgery by sending haptic feedback to slave controllers. Also, the surgeon can transfer control back and forth between the master and slave controllers to teach another surgeon how to perform the surgery, but still allow the teaching surgeon to gain control of the surgery whenever needed. Also, the teaching surgeon could be located at a remote location and perform the surgery with the assistance of the AR vision system. 
         [0012]    According to an embodiment of the present disclosure, a method for performing an electrosurgical procedure includes the steps of generating a pre-operative image of an anatomical section of a patient and analyzing the pre-operative image to generate data about the anatomical section of the patient to assist a user during surgery. The method also includes the steps of receiving a real time video signal of a surgical site within the patient and displaying on a user interface the analyzed data with the video signal. Further, the method includes the step of inserting a remote controlled electrosurgical instrument within the patient. The remote controlled electrosurgical instrument is configured to communicate with a remote. Additionally, the method includes the steps of moving, rotating, and/or selecting a button on the remote in a similar manner to a hand-held electrosurgical instrument while the user uses the user interface to view the surgical site, and moving, rotating, and/or performing other actions by the remote controlled surgical instrument based on movements and or actions of the remote. 
         [0013]    According to another embodiment of the present disclosure, a method for performing an electrosurgical procedure includes the step of inserting a remote controlled electrosurgical instrument within a patient. The remote controlled electrosurgical instrument with at least one sensor and a base. The method further includes the step of moving a remote in a manner substantially similar to movement of a handheld electrosurgical instrument. The remote is configured with at least one momentum sensor. Also, the method includes the step of sending information from the momentum sensor to the base to move the remote controlled electrosurgical instrument within the patient based on movements of the remote. 
         [0014]    According to another embodiment of the present disclosure, a system for performing an electrosurgical procedure includes a remote controlled electrosurgical instrument configured to be inserted within a patient. The remote controlled electrosurgical instrument includes a base and the base connects to a remote. The remote is configured with at least one momentum sensor and at least one switch. The remote controlled electrosurgical instrument responds to twists, rotation, side to side, up and down, diagonal, and other motions of the remote as a user moves the remote in a similar manner to a handheld electrosurgical instrument. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0015]    Various embodiments of the present disclosure are described herein with reference to the drawings wherein: 
           [0016]      FIG. 1  is a schematic diagram of a remote controlled surgical system in accordance with an embodiment of the present disclosure; 
           [0017]      FIGS. 2A-C  are perspective views of different remotes used in accordance with an embodiment of the present disclosure; 
           [0018]      FIG. 3  is a perspective view of a remote controlled electrosurgical instrument in accordance with an embodiment of the present disclosure; 
           [0019]      FIG. 4  is a schematic diagram of an electrosurgical instrument control system in accordance with an embodiment of the present disclosure; 
           [0020]      FIG. 5  is a schematic diagram of an augmented controller system in accordance with an embodiment of the present disclosure; 
           [0021]      FIG. 6  is a schematic diagram of an augmented controller system in accordance with an embodiment of the present disclosure; 
           [0022]      FIG. 7  is a flow diagram of a process for controlling an electrosurgical instrument with a remote in accordance with an embodiment of the present disclosure; 
           [0023]      FIG. 8  is a flow diagram of a process for determining if the remote controlled electrosurgical instrument is within an augmented safety zone in accordance with an embodiment of the present disclosure; 
           [0024]      FIG. 9  is a schematic diagram of a master/slave remote system in accordance with an embodiment of the present disclosure; and 
           [0025]      FIG. 10  is a flow diagram of a process for sharing control of an electrosurgical instrument between master and slave remotes in accordance with an embodiment of the present disclosure. 
       
    
    
     DETAILED DESCRIPTION 
       [0026]    Particular embodiments of the present disclosure are described hereinbelow with reference to the accompanying drawings. In the following description, well-known functions or constructions are not described in detail to avoid obscuring the present disclosure in unnecessary detail. 
         [0027]      FIG. 1  is a schematic diagram of a remote controlled surgical system  100  that allows a surgeon M to perform a surgical procedure on patient P using a remote  200 . Access to a subcutaneous surgical site within patient P is provided via a number (typically 3 to 5) of small (typically 5-12 mm) incisions  15 , through which at least one remote controlled (RC) electrosurgical instrument  10  is manually passed. Additionally, a camera  150  is inserted in at least one incision  15  to give the surgeon M a view of the surgical site. The video signal from the camera may be sent to an Augmented Reality (AR) controller  600  (See  FIGS. 5 and 6 ) to add additional data. The video signal and additional data are then displayed on a user interface  140 . The AR displayed image  142  may include labels on instruments, labels and/or margins of organs, tumors, or other anatomical bodies, and/or boundary zones around delicate anatomical bodies. The AR displayed image  142  may be in 2D or 3D. As the camera  150  is moved around the surgical site, the labels and data overlaid onto the video image move to the appropriate location. 
         [0028]    The surgeon M controls the RC electrosurgical instrument  10  by rotating and/or moving the remote  200  up, down, left, right, diagonally, and/or rotating. The movement of the remote  200  may be configured to move in a manner similar to a hand-held electrosurgical instrument. Additionally, the surgeon M can press a button on the remote  200  to activate an electrical signal to coagulate or cut tissue, staple tissue, or perform another function of the instrument. The surgeon M can be located in the same room as a patient or in a remote location such as another state or country. The remote  200  may be configured to send data to a base  300  attached to the RC electrosurgical instrument  10 . The data may be sent to the base  300  through a direct electrical connection or by Bluetooth®, ANT3®, KNX®, ZWave®, X10® Wireless USB®, IrDA®, Nanonet, Tiny OS®, ZigBee®, 802.11 IEEE, and other radio, infrared, UHF, VHF communications and the like. 
         [0029]      FIGS. 2A-C  show three possible embodiments of remote  200 , however, other embodiments may be possible.  FIG. 2A  discloses a first embodiment of a remote  220  that is generally circular in shape with a triangular front that may interconnect with the base  300  of the RC electrosurgical instrument  10 . The circular shape allows the remote  220  to fit into the palm of the surgeon&#39;s M hand, where the surgeon M can rotate his/her wrist to move the tool in a corresponding manner by easily pushing one or more buttons  225 ,  227 ,  229 ,  231 . The remote  220  includes at least one momentum sensor  224  and an infrared sensor  222 . The remote may be configured with one or more buttons  225 ,  227 ,  229 ,  231  that may be located on the top, side, and/or bottom of the remote. Button  225  may be used to activate an electrical signal to coagulate or cut tissue, staple tissue, or perform other surgical functions. For example, button  227  may be used to move the end effector assembly  100  in very small increments. Additionally, the remote  220  includes a haptic feedback mechanism  232  that provides feedback about position, force used, instruction, and other similar uses. In an alternative embodiment, visual communication may be used to identify which instrument the remote is operating, problems with where the RC instrument  10  is located, battery life of remote, which remote in a master/slave relationship is controlling the instrument, and other problems with the RC instrument  10  or system. Alternatively, the remote  220  can be configured with audio feedback (not shown) to inform the surgeon M of problems or pre-recorded specific instrument functions. The remote  220  further includes data ports  226   a  and  226   b  for communicating with the instrument base  300 . The data ports  226   a  and  226   b  may be connected directly to the instrument base  300  or wirelessly connected. 
         [0030]      FIG. 2B  discloses a second embodiment of a remote  240  for use with the remote controlled surgical system  100 . Similar to the remote  220  in  FIG. 2A , the remote  240  includes data ports  226   a  and  226   b,  momentum sensor  224 , infrared sensor  222 , and/or haptic feedback mechanism  232 . Remote  240  is shaped with a handle  245  and a trigger  244 . The trigger  244  is similar to button  225  on remote  220 , and may be used to activate an electrical signal to coagulate or cut tissue, staple tissue, or perform another surgical function. Remote  240  further includes buttons  227 ,  229 , and  231  used to perform other functions of the RC instrument  10 . The size and shape of the handle  245  can be ergonomically shaped for a right-handed or left-handed surgeon and/or based on the size of the surgeon&#39;s hand. 
         [0031]      FIG. 2C  discloses a third embodiment of a remote  260 . Similar to the remote  240  in  FIG. 2B , the third remote  260  may include a housing  265 , a momentum sensor  224 , haptic feedback mechanism  232 , handle  245 , and/or trigger  244 . Trigger  244  is similar to button  225  on remote  220 , and may be used to activate an electrical signal to coagulate or cut tissue, staple tissue, or other procedure. Rotating wheel  262  is similar to button  227  on the first remote, and may be used to move the end effector assembly  100  in very small increments. Data port  230  wirelessly connects remote control  260  with the base  300  (see  FIG. 3 ) of the RC electrosurgical instrument  10 . Similar to the second remote  240 , the size and shape of the handle  245  can be ergonomically shaped for a right-handed or left-handed surgeon and/or based on the size of the surgeon&#39;s hand. In alternative embodiments, remote  260  may also include opening  270  defined therein, where a surgeon M can insert the same type end effector assembly  100  and shaft  12  as used within the patient P during surgery. This would allow the surgeon or others the ability see how the end effector is moving. 
         [0032]    Referring to  FIG. 3 , a RC surgical instrument  10 , such as forceps, includes a shaft  12  that has a distal end  14  configured to mechanically engage an end effector assembly  100  operably associated with the forceps  10  and a proximal end  16  that mechanically engages the base  300 . In the drawings and in the descriptions that follow, the term “proximal,” as is traditional, will refer to the end of the forceps  10  which is closer to a base  300 , while the term “distal” will refer to the end that is farther from the base. Alternatively, the system may be used with a remote controlled pencil or other electrosurgical instrument. 
         [0033]    Drive assembly  130  is in operative communication with the remote  200  through data port  340  for imparting movement of one or both of a pair of jaw members  110 ,  120  of end effector assembly  100 . The drive assembly  130  may include a compression spring (not shown) or a drive wire  133  to facilitate closing the jaw members  110  and  120  around pivot pin  111 . Drive wire  133  is configured such that proximal movement thereof causes one movable jaw member, e.g., jaw member  120 , and operative components associated therewith, e.g., a seal plate  128 , to move toward the other jaw member, e.g., jaw member  110 . With this purpose in mind, drive rod or wire  133  may be made from any suitable material and is proportioned to translate within the shaft  12 . In the illustrated embodiments, drive wire  133  extends through the shaft  12  past the distal end  14 . Both jaw members  110  and  120  may also be configured to move in a bilateral fashion. 
         [0034]    Base  300  receives an electrical signal from a generator (not shown). Generator may be connected to base  300  by a cable (not shown). By not including the generator within base  300 , the size of base  300  may be smaller. Additionally, base  300  may be used with an existing generator system. Alternatively, generator may be part of base  300 . 
         [0035]    Remote control  200  (See  FIG. 3A ) may be in operative communication with an ultrasonic transducer (not shown) via data port  340  when the RC surgical instrument  10  is an ultrasonic instrument (not shown). Alternatively, base  300  may be arranged with multiple RC surgical instruments  10  attached. Each RC surgical instrument  10  may be removable or permanently attached to base  300 . 
         [0036]      FIG. 4  illustrates a control system  305  for the RC surgical instrument  10  including the microcontroller  350  which is coupled to the position and speed calculators  310  and  360 , the loading unit identification system  370 , the drive assembly  130 , and a data storage module  340 . In addition, the microcontroller  350  may be directly coupled to a sensor  315 , such as a motion sensor, torque meter, ohm meter, load cell, current sensor, etc. The microcontroller  350  includes internal memory which stores one or more software applications (e.g., firmware) for controlling the operation and functionality of the RC surgical instrument  10 . 
         [0037]    The loading unit identification system  370  identifies to the microcontroller  350  which end effector assembly  100  is attached to the distal end  14  of the RC instrument  10 . In an embodiment, the control system  300  is capable of storing information relating to the force applied by the end effector assembly  100 , such that when a specific end effector assembly  100  is identified the microcontroller  350  automatically selects the operating parameters for the RC surgical instrument  10 . For example, torque parameters could be stored in data storage module  320  for a laparoscopic grasper. 
         [0038]    The microcontroller  350  also analyzes the calculations from the position and speed calculators  310  and  360  and other sensors  315  to determine the actual position, direction of motion, and/or operating status of components of the RC surgical instrument  10 . The analysis may include interpretation of the sensed feedback signal from the calculators  310  and  360  to control the movement of the drive assembly  130  and other components of the RC surgical instrument  10  in response to the sensed signal. Alternatively, the location of the RC surgical instrument  10  may be calculated using the method disclosed in U.S. Ser. No. 12/720,881, entitled “System and Method for Determining Proximity Relative to a Critical Structure” filed on Mar. 10, 2010, which is hereby incorporated by reference. The microcontroller  350  is configured to limit the travel of the end effector assembly  100  once the end effector assembly  100  has moved beyond a predetermined point as reported by the position calculator  310 . Specifically, if the microcontroller determines that the position of the end effector assembly  100  is within a safety zone determined by the AR controller  200 , the microcontroller is configured to stop the drive assembly  130 . 
         [0039]    In one embodiment, the RC surgical instrument  10  includes various sensors  315  configured to measure current (e.g., an ampmeter), resistance (e.g., an ohm meter), and force (e.g., torque meters and load cells) to determine loading conditions on the end effector assembly  100 . During operation of the RC surgical instrument  10  it is desirable to know the amount of force exerted on the tissue for a given end effector assembly  100 . Detection of abnormal loads (e.g., outside a predetermined load range) indicates a problem with the RC surgical instrument  10  and/or clamped tissue which is communicated to the user. 
         [0040]    The data storage module  320  records the data from the sensors  315  coupled to the microcontroller  350 . In addition, the data storage module  320  may record the identifying code of the end effector assembly  100 , user of surgical tool, and other information relating to the status of components of the RC surgical instrument  10 . The data storage module  320  is also configured to connect to an external device such as a personal computer, a PDA, a smartphone, or a storage device (e.g., a Secure Digital™ card, a CompactFlash card, or a Memory Stick™) through a wireless or wired data port  340 . This allows the data storage module  320  to transmit performance data to the external device for subsequent analysis and/or storage. The data port  340  also allows for “in the field” upgrades of the firmware of the microcontroller  350 . 
         [0041]    Embodiments of the present disclosure may include an augmented reality (AR) control system  610  as shown in  FIGS. 5-6 . The RC surgical instrument  10  is connected to an AR controller  600  via the data port  660  which may be either wired (e.g., FireWire , USB, Serial RS232, Serial RS485, USART, Ethernet, etc.) or wireless (e.g., Bluetooth®, ANT3®, KNX®, Z-Wave X10®, Wireless USB®, Wi-Fi , IrDA®, nanoNET®, TinyOS®, ZigBee®, 802.11 IEEE, and other radio, infrared, UHF, VHF communications and the like). Additionally, remote  200  ( 220 ,  240 ,  260 ) is connected to the AR controller  600  via data port  660  which may be either wired (e.g., FireWire®, USB, Serial RS232, Serial RS485, USART, Ethernet, etc.) or wireless (e.g., Bluetooth®, ANT3®, KNX®, Z-Wave , X10®, Wireless USB®, Wi-Fi®, IrDA®, nanoNET®, TinyOS®, ZigBee®, 802.11 IEEE, and other radio, infrared, UHF, VHF communications and the like). 
         [0042]      FIG. 5  illustrates a schematic diagram of an AR control system  610  in accordance with an embodiment of the present disclosure. With reference to  FIG. 5 , the augmented reality (AR) controller  600  is configured to store data transmitted to the controller  600  by a RC surgical instrument  10  and a remote  200  ( 220 ,  240 ,  260 ) as well as process and analyze the data. The RC surgical instrument  10  is a robotic instrument. The AR controller  600  is also connected to other devices, such as a video display  140 , a video processor  120  and a computing device  180  (e.g., a personal computer, a PDA, a smartphone, a storage device, etc.). The video processor  120  may be used for processing output data generated by the AR controller  600  for output on the video display  140 . Additionally, the video processor  120  may receive a real time video signal from a camera  150  inserted into the patient during the surgical procedure. The computing device  180  may be used for additional processing of the pre-operative imaged data. In one embodiment, the results of pre-operative imaging such as an ultrasound, MM, x-ray, or other diagnosing image may be stored internally for later retrieval by the computing device  180 . 
         [0043]    The AR controller  600  includes a data port  660  ( FIG. 6 ) coupled to the microcontroller  650  which allows the AR controller  600  to be connected to the computing device  180 . The data port  660  may provide for wired and/or wireless communication with the computing device  180  providing for an interface between the computing device  180  and the AR controller  600  for retrieval of stored pre-operative imaging data, configuration of operating parameters of the AR controller  600  and upgrade of firmware and/or other software of the AR controller  600 . 
         [0044]    Components of the AR controller  600  are shown in  FIG. 6 . The AR controller  600  includes a microcontroller  650 , a data storage module  655  a user feedback module  665 , an OSD module  640 , a HUD module  630 , and a data port  660 . 
         [0045]    The data storage module  655  may include one or more internal and/or external storage devices, such as magnetic hard drives, or flash memory (e.g., Secure Digital® card, Compact Flash® card, or MemoryStick®). The data storage module  655  is used by the AR controller  600  to store data from the RC surgical instrument  10  and remote  200  ( 220 ,  240 ,  260 ) for later analysis of the data by the computing device  180 . The data may include information supplied by a sensor  315  ( FIG. 4 ), such as a motion sensor, torque sensor, and other sensors disposed within the RC surgical instrument  10 . 
         [0046]    The microcontroller  650  may supplant, complement, or supplement the control circuitry  305  of the RC surgical instrument  10  shown in  FIG. 4 . The microcontroller  650  includes internal memory which stores one or more software applications (e.g., firmware) for controlling the operation and functionality of the RC surgical instrument  10 . The microcontroller  650  processes input data from the computing device  180  and adjusts the operation of the RC surgical instrument  10  in response to the inputs. The RC surgical instrument  10  is configured to connect to the AR controller  600  wirelessly or through a wired connection via a data port  340 . The microcontroller  650  is coupled to the user feedback module  665  which is configured to inform the user of operational parameters of the RC surgical instrument  10 . The user feedback module  665  may be connected to a user interface. The user feedback module  665  may be coupled to the haptic mechanism  232  within the remote  200  ( 220 ,  240 ,  260 ) to provide for haptic or vibratory feedback. The haptic feedback may be used in conjunction with the auditory and visual feedback or in lieu of the same to avoid confusion with the operating room equipment which relies on audio and visual feedback. The haptic mechanism  232  may be an asynchronous motor that vibrates in a pulsating manner. In one embodiment, the vibrations are at a frequency of about 30 Hz or above. The haptic feedback can be increased or decreased in intensity. For example, the intensity of the feedback may be used to indicate that the forces on the instrument are becoming excessive. In alternative embodiments, the user feedback module  265  may also include visual and/or audible outputs. 
         [0047]    The microcontroller  650  outputs data on video display  140  and/or the heads-up display (HUD)  635 . The video display  140  may be any type of display such as an LCD screen, a plasma screen, electroluminescent screen and the like. In one embodiment, the video display  140  may include a touch screen and may incorporate resistive, surface wave, capacitive, infrared, strain gauge, optical, dispersive signal or acoustic pulse recognition touch screen technologies. The touch screen may be used to allow the user to provide input data while viewing AR video. For example, a user may add a label identifying the surgeon for each tool on the screen. The HUD display  635  may be projected onto any surface visible to the user during surgical procedures, such as lenses of a pair of glasses and/or goggles, a face shield, and the like. This allows the user to visualize vital AR information from the AR controller  600  without loosing focus on the procedure. 
         [0048]    The AR controller  600  includes an on-screen display (OSD) module  640  and a HUD module  630 . The modules  640 ,  630  process the output of the microcontroller  650  for display on the respective displays  140  and  635 . More specifically, the OSD module  640  overlays text and/or graphical information from the AR controller  600  over video images received from the surgical site via camera  150  ( FIG. 1 ) disposed therein. Specifically, the overlaid text and/or graphical information from the AR controller  600  includes computed data from pre-operative images, such as x-rays, ultrasounds, MRIs, and/or other diagnosing images. The computing devices  180  stores the one or more pre-operative images. In an alternative embodiment, the data storage module  655  can store the pre-operative image. The AR controller  600  processes the one or more pre-operative images to determine margins and location of an anatomical body in a patient, such as an organ or a tumor. Alternatively, the computing device  180  can process and analyze the pre-operative image. Additionally, the AR controller can create safety boundaries around delicate structures, such as an artery or organ. Further, the AR controller  600  can decipher the one or more pre-operative images to define structures, organs, anatomical geometries, vessels, tissue planes, orientation, and other similar information. The AR controller  600  overlays the information processed from the one or more pre-operative images onto a real time video signal from the camera  150  within the patient. The augmented video signal including the overlaid information is transmitted to the video display  140  allowing the user to visualize more information about the surgical site including area outside the vision of the camera  150 . Additionally, as the camera moves around the surgical site, the labels and/or data overlaid is moved to the appropriate location on the real time video signal. 
         [0049]      FIG. 7  is a flow diagram of a process  700  for controlling an electrosurgical instrument with a remote  200  ( 220 ,  240 ,  260 ) according to an embodiment of the invention. After the process  700  starts at step  705 , a pre-operative image is generated from a diagnosing imaging source, such as from an MRI, ultrasound, x-ray, CAT scan, etc. at step  710 . The pre-operative image is taken of an anatomical section of the patient, which may include organs, tissue, vessels, bones, tumors, muscles, etc. Multiple images can be generated from one or more sources based on the information required by the surgeon M. Next, the pre-operative image is analyzed to generate data to assist the surgeon M during surgery at step  715 . The analyzing may be done by the computing device  180  or the microprocessor  650 . The data may include margins and location of the anatomical section. Prior to starting the surgery, a camera  150  is inserted within the patient. A real time video signal of the patient during the surgical procedure is received at AR controller  600  during the surgical procedure at step  720 . The analyzed data is displayed with the real time video signal at step  725 . For example, if the anatomical section is a tumor then the location and margins of the tumor are calculated and then the name and margins are augmented onto the video signal to assist the surgeon M in locating the tumor. A RC electrosurgical instrument  10  is inserted into a body cavity or incision at step  730 . A user M moves, twists, and/or selects buttons on the remote control  200  at step  735 . The surgeon M may move the remote  200  in a manner similar to actions done with a handheld electrosurgical instrument. Before the process  700  ends at step  745 , the RC surgical instrument  10  moves, twist, and/or performs other action based on the movements performed by the remote  200  at step  740 . The movements of the remote  200  are sent wirelessly or the remote is directly connected to the RC surgical instrument  10 . 
         [0050]      FIG. 8  is a flow diagram of process  800  for determining if the remote controlled electrosurgical instrument is within an augmented safety zone according to an embodiment of the invention. After the process  800  starts at step  805 , a pre-operative image of an anatomical section of a patient is generated at step  810 . The pre-operative image can be generated from any type of diagnosing image, such as an x-ray, MRI, CAT scan, ultrasound, etc. The pre-operative image analyzed to determine a safety zone around organs, tissue, and/or other delicate anatomical structures at step  815 . Prior to starting the surgical procedure, a camera  150  is inserted within the patient. During the surgical procedure, a real time video signal is received by the AR controller  600  via video processor  120  at step  825 . The AR controller  600  augments the safety zone onto the video signal at step  830 . For example, the safety zone may be represented as a cross hatched area or in a different color, such as a yellow area around an organ. A RC electrosurgical instrument  10  is inserted into a cavity or incision  15  within the patient P at step  830 . The location of the surgical instrument  10  within the patient is measured at step  835  using the position calculator  310 , speed calculator  360 , and other sensors  315 . Alternatively, the location of the RC instrument  10  and/or end effector assembly  100  may be calculated using the method disclosed in U.S. Ser. No. 12/720,881, entitled “System and Method for Determining Proximity Relative to a Critical Structure” filed on Mar. 10, 2010, which is hereby incorporated by reference. The AR controller  200  determines if the RC surgical instrument  10  is within the safety zone at step  840 . If the RC surgical instrument  10  is not within the safety zone, then allow the surgeon M to move, twist, and/or select buttons on remote  200  at step  845 . The movement of the remote may be similar to movement of a handheld electrosurgical instrument. The RC electrosurgical instrument  10  then moves, twists, and/or performs action based on the movement or actions from the remote at step  850 . Then, the system measures the new location of the RC electrosurgical instrument  10  at step  835 . If the RC electrosurgical instrument  10  is within the safety zone, then the AR controller  600  notifies the surgeon at step  855 . This notification can be visual, audible, or haptic feedback. Additionally, before process  800  ends at step  865 , the AR controller  600 , if necessary, can stop the drive assembly  130  at step  860 . 
         [0051]      FIG. 9  illustrates a schematic diagram of a master/slave remote control system  900  according to an embodiment of the invention. Similar to the remote controlled surgical system  100  shown in  FIG. 1 , the master/slave remote control system  900  includes a patient P with at least one incision  15 , a RC electrosurgical instrument  10 , a base  300 , a camera  150 , and a display  140  with an augmented displayed image  142 . Additionally, the master/slave remote control system  900  includes a first user that is the master M (surgeon) that uses a master remote  960  and at least one slave user  950   a,    950   b  that uses a slave remote  970   a, b . As the master M moves, tilts, selects buttons on the master remote  960 , the slave remote may receive haptic feedback to teach the slave user how to move the slave remote  970   a.  Additionally, the master remote  960  may allow the master M to transfer control to slave remote  970   a  and then to  970   b  or back to the master remote  960 . The master M can be located in the same room with slave  950   a  and/or  950   b  or the master M can be located in a remote location, such as another state or country. 
         [0052]      FIG. 10  is a flow diagram of a process  1000  for sharing control of an electrosurgical instrument between a master and a slave according to an embodiment of the invention. The process  1000  starts at step  1010 , displaying a real time video signal with data from a pre-operative image at step  1020 . The master remote  960  selects a slave remote  970   a  to control the RC electrosurgical instrument at step  1030 . The slave user  950   a  moves, twists, or selects buttons on the slave remote  970   a  to control the RC electrosurgical instrument  10 . The master M may override the slave remote  970   a  to regain control of the RC electrosurgical instrument at step  1040 . Before the process  1000  ends at step  1060 , the master M moves, tilts, and/or selects buttons on the master remote  960 , haptic feedback is sent to the slave remote  970   a, b  at step  1050  to train the slave user  950   a, b  how to use the remote. 
         [0053]    While several embodiments of the disclosure have been shown in the drawings and/or discussed herein, it is not intended that the disclosure be limited thereto, as it is intended that the disclosure be as broad in scope as the art will allow and that the specification be read likewise. Therefore, the above description should not be construed as limiting, but merely as exemplifications of particular embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.